The surgical assistant, a manual for students, practitioners, hospital internes and nurses . Fig. 78. Retraction of divided external oblique, exposing the sac, which isbeing opened between two mouse-tooth forceps. explores its interior. If the hernia is of the congenitalvariety clamps are also affixed temporarily to the edge ofthe lower end of the sac, after it is divided. The contents of the hernia determine the next step. Thus,if omentum presents, catgut ligatures are needed to secureits bloodvessels preparatory to its amputation; if strangu- Herniotomv. 229 latecl intestine is found, hot to
The surgical assistant, a manual for students, practitioners, hospital internes and nurses . Fig. 78. Retraction of divided external oblique, exposing the sac, which isbeing opened between two mouse-tooth forceps. explores its interior. If the hernia is of the congenitalvariety clamps are also affixed temporarily to the edge ofthe lower end of the sac, after it is divided. The contents of the hernia determine the next step. Thus,if omentum presents, catgut ligatures are needed to secureits bloodvessels preparatory to its amputation; if strangu- Herniotomv. 229 latecl intestine is found, hot towels may be called for in orderto test its viability; etc. When the hernial contents have been dealt with a stripof gauze may be needed to insert into the neck of the sac toprevent protrusion of viscera, while the sac and cord are be-ing separated. In aiding in this latter manipulation the as-sistant must use his anatomical forceps gently, for the pamp-. <^^- Fig. 79. Separation of sac from cord. Note bandage around penis, arteryclamp attached to cut edge of sac, blunt hook lifting up cord. inniform plexus is easily bruised and made to bleed. Heshould also guard the vas deferens against any injury bythe surgeons knife or scissors. The sac having been sepa-rated the assistant holds aside the cord structures by meansof a blunt hook or fillet of gauze—again exercising gentle-ness in order to avoid pulling the testicle out of the scrotumor producing a hematoma in the cord. 230 The Surgical Assistant. The gauze strip now removed from the canal, the purse-string catgut suture is handed for insertion into the neck ofthe sac. While this is being introduced the assistant liftsup on the forceps attached to the sac, and as the purse-stringis being drawn together he inserts a slender instrument,e. g., a sponge handle, into the canal to prevent any protrud-ing intestine from being caught in the ligature. After thefirst knot the sac is still h
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1905
