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20 After this introduction, we come to particular conditions. And if in a young child intestine prolapses, bandaging should be tried before the knife. For this a strip of linen is taken, to one end of which is stitched a ball of rags which is placed on the prolapse itself so as to push back the intestines: then the rest of the strip of bandage is firmly tied all round; under this the intestines are often forced inside and the tunics become agglutinated together. Again, if the patient is older, and the large size of the swelling shows that much of the intestines has come down, and if in addition there is pain and vomiting, which generally happens because faeces from undigested food have slipped down, then it is clearly impossible to employ the knife except harmfully; the trouble can only be mitigated, and must be drawn out by other measures. Blood should be let from the arm, then if the patient's strength permits, fasting for three days should be prescribed, or else at least for as long as the strength allows. Meanwhile a plaster of linseed first boiled in honey wine is to be kept on over the hernia. Later one of barley meal with resin is to be applied, and the patient immersed in a bath of hot water to which olive oil also has been added; after which some light warm food is to be given. Some also employ a clyster; but that can only bring down something[p. 411] into the scrotum, and cannot evacuate anything from it. When by the measures just described, the disease has been mitigated, if at any time pain recurs, the same measures will have to be repeated which we have just found to be beneficial. If without causing any pain, a large amount of intestine has prolapsed, it is useless to operate; not that it is impossible to push back the intestines out of the scrotum, unless inflammation prevents it, but because as they are forced back they may become impacted in the groins and give rise to a swelling, so that the trouble is not ended but only changed in position. But in a case which is suitable for treatment by the knife, as soon as the incision made in the groin reaches the middle tunic, this must be seized near the margins by a couple of hooks, when, after drawing down all the fine membranes the surgeon sets it free. Nor is there any danger in wounding what has to be cut out, since the intestine must lie underneath it. When the middle tunic has been thus drawn down, it is slit open from the groin to the testicle, but so as not to injure the latter; then it is cut away. Generally, however, this treatment is only admissible in boyhood and when the trouble is limited. For a robust man with a more extensive disorder the testicle should not be turned out, but kept in position. The procedure is as follows. The groin is laid open as before down to the middle tunic, and this tunic is seized as described above with two hooks, whilst the assistant keeps the testicle in its place, so that it does not come out of the wound; then the middle tunic is cut into with a scalpel towards its lower part, and through the opening the index finger of the left hand is passed beneath the testicle which[p. 413] is forced up into the wound; then the thumb and forefinger of the right hand separate the vein, the artery and the cord, and their tunic from the one above them. Any little membranes in the way are divided with a scalpel until now the entire tunic comes into view. After cutting away what has to be excised, and replacing the testicle, a rather broad strip is to be pared off from the edges of the wound in the groin, so that by making the wound broader it may form more flesh.
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