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Accordingly hernia, with Gilbert, includes not only scrotal hernia, but also hydrocele, orchitis, tumors of the testicles, etc. This is apparent, too, in his treatment of hernia, which consists usually in the employment of various poultices and ointments, bleeding from the saphena, cups over the kidneys, etc., though hydrocele is tapped and a seton inserted.

If the patient is placed on a couch and the limb elevated, the veins are emptied, and if pressure is then made over the region of the saphenous opening and the patient allowed to stand up, so long as the great saphena system alone is involved, the veins fill again very slowly from below.

The most typical example of this form of phlebitis is that so frequently met with in the great saphena vein, especially when it is varicose. The onset of the attack is indicated by a sudden pain in the lower limb sometimes below, sometimes above the knee. This initial pain may be associated with shivering or even with a rigor, and the temperature usually rises one or two degrees.

In order, therefore, that this faulty conception may be deprived of that nourishing sap by which it lives, open the liver vein and saphena in both feet, apply cupping glasses to the loins and sides of the stomach, and when that has been done, let the uterine parts be first softened, and then the expulsive powers be stimulated to get rid of the burden.

In the middle of the menstrual period, open the liver vein, and two days before, open the saphena in both feet; if the repletion is not very great apply cupping glasses to the legs and thighs, although there may be no hope of removing the suppression.

When the whole length of the main trunk of the great saphena is implicated, the pressure in the vein is high and the patient suffers a good deal of pain and discomfort. When, on the contrary, the upper part of the saphena and its valves are intact, and only the more distal veins are involved, the pressure is not so high and there is comparatively little suffering.

In the lower extremity the varicosity most commonly affects the vessels of the great saphena system; less frequently those of the small saphena system. Sometimes both systems are involved, and large communicating branches may develop between the two.

The essential lesion is the absence or deficiency of valves, so that they are incompetent and fail to support the column of blood which bears back upon them. Normally the valves in the femoral and iliac veins and in the inferior vena cava are imperfectly developed, so that in the erect posture the great saphena receives a large share of the backward pressure of the column of venous blood.

I may say that after the third venesection, with an interval of two hours, I withdrew a half-pound of blood from the saphena vein, and that night she slept, although she had not slept for many nights. And I did nothing more, except to prescribe a light and cool diet. The third day after the bleeding she was entirely free from any trouble in her hand.

She was fat, full-blooded, and before the attack had lived freely on milk and flesh. Accordingly she was robust, and I bled her from the basilic vein of the left hand and the saphena of the right foot, both within an hour. Each hour I withdrew a half-pound of blood, then I fed her and for three hours I drew half a pound of blood from the saphena.