The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . .The patient having been brought to the edge of the bed, or placed on atable of convenient height, the bladder is emptied, and the parts tluitare the seat of operation are shaved. The dissection of the hernialcoverings in layers anatomically arranged, is never done at an Surgeon dissects, or rather cuts, down to the sac, then tui-us asidethe coverings as a whole, and divides the stricture. He proceeds as fol-lows: An incision of sufficient length is made over the neck of the sac ;th
The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . .The patient having been brought to the edge of the bed, or placed on atable of convenient height, the bladder is emptied, and the parts tluitare the seat of operation are shaved. The dissection of the hernialcoverings in layers anatomically arranged, is never done at an Surgeon dissects, or rather cuts, down to the sac, then tui-us asidethe coverings as a whole, and divides the stricture. He proceeds as fol-lows: An incision of sufficient length is made over the neck of the sac ;this may be best done by pinching up a fold of skin, pushing tlie scalpelthrough its base with the back of the instrument turned towards thehernia, and then cutting upwards (Fig. 674). A linear incision is thusmade, which may be extended at either end if necessary; the dissectionis then carried through the superficial fascia and fat with the scalpel andforceps. If any small artery spout freely, it had better be tied at once,lest the bleeding obstruct the view of tlie part in the subsequent steps. Fig. 67-1.—Operatioa for Hernia- Division of th-^ Skin. Fig. —Operation for Hernia: In-cision of Subserous Areolar Tissue. of the operation. As the Surgeon approaches the sac, more caution isrequired, particularly if the subserous areolar tissue be dense, opaque,and laminated. The Surgeon must pinch this up with the forceps, makea small incision into it, introduce a director, and lay it open upon this,or on the finger (Fig. 675). If it be thin and not opaque, so as to admita view of the subjacent parts, he raiy dissect it through with the unsup-ported hand. In this way he proceeds until the sac is reachel, which is 614 HERNIA. usually known by its rouiifled and tense appearance, its filamentouscharacter, and by the arborescent arrangement of vessels ui)on its sur-face. In some cases the Surgeon thinks that he has reached the sac,when in reality he has onl}^ come upon a deep laye
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