. Abdominal hernia : its diagnosis and treatment. in putting sutures in place. it. This constitutes the first stitch, but should not be tieduntil the others are in place. Sutures should then be placed in Fin. 188. iVl ^rj -rw s \uA ? v A HL 1 W ^m^ 1 \\ \ iP A ?? -f ^^1 1 ^^^ ^ Double reducible femoral hernia in a woman of 60 years. Left side does not show, but wasnearly the size of a hens egg. Swelling above pubes is due to subcutaneous fat. the same manner every quarter of an inch apart until near thespine of the pubes (fig. i86). Usually three or four will com-pletely close the femoral open
. Abdominal hernia : its diagnosis and treatment. in putting sutures in place. it. This constitutes the first stitch, but should not be tieduntil the others are in place. Sutures should then be placed in Fin. 188. iVl ^rj -rw s \uA ? v A HL 1 W ^m^ 1 \\ \ iP A ?? -f ^^1 1 ^^^ ^ Double reducible femoral hernia in a woman of 60 years. Left side does not show, but wasnearly the size of a hens egg. Swelling above pubes is due to subcutaneous fat. the same manner every quarter of an inch apart until near thespine of the pubes (fig. i86). Usually three or four will com-pletely close the femoral opening. 340 ABDOMINAL HERNIA. When tied clown and the ends cut moderately closethe fascia should be closed in by plain catgut, to avoid apocket in the tissues that otlierwise may result, and the sl<inmay then be closed by buried sutures of the same. I haveusually covered the wound by collodion and a compress ofsterilized gauze held in place by a figure-of-eight bandage. Inten days tlie dressings are changed and a bandage for tem- FiG. Same case as bhown in fig. 188; side view. poran support is applied. If liealing has been complete, thepatient is allowed to sit up on the tentli and leave the house onthe fourteentli day after tlie operation. The bandage used after the first dressing consists of apelvic belt, of three thicknesses of canton flannel, with a com-press of gauze over the former site of the hernia, and a perinealstrap to prevent its slipping up. This is to be worn for fourweeks. Neitlier truss or otlier permanent support should beworn. SURGICAL CURE: FEMORAL 341 As it is not an uncommon occurrence to have Ijoth inguinaland femoral hernia on the same side, it is deemed best to saya few words regarding the combined operations: A singleincision will answer every purpose, but it should be a littlelonger, beginning over the centre of the inguinal canal andcurving downward, passing to the inner side and parallel withthe femoral vessels to the saphenous opening; this gi
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