The cure of the more difficult as well as the simpler inguinal ruptures.

  • Halsted, William, 1852-1922.
Date:
1903
Catalogue details

Licence: Public Domain Mark

Credit: The cure of the more difficult as well as the simpler inguinal ruptures. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    good, the value of the excision of the veins of the cord and the [209] necessity for paying more attention to the neglected lower angle of the wound. Naturally, it was primarily to the upper angle that we had devoted our thoughts, for, as emphasized in one of the author's articles on the subject, the cord is the first cause of the hernia and the ultimate obstacle to its cure.' And this is true, notwithstanding the fact that recurrences at the lower angle were at first not very rare; for, our attention having been called to these lower angle recurrences, methods to cure them were soon found. The success attending excision of the veins (one hundred and eighteen cases without recurrence at the site of the trans- planted vas deferens) seemed to justify a continuance of this practice, provided it occasioned no undesirable results; but excision of the veins with transplantation of the vas deferens taught us that, not infrequently, a hydrocele, usually insig- nificant in size, was to be expected, and that in about 10 per cent of the cases atrophy of the testicle had occurred. x\tro- phy of this organ, however, was observed only in cases com- plicated by a very considerable swelling of the epididymis, and this observation of Bloodgood's, made so many years ago, has been verified by our study of more than one thousand operations. Great care was exercised, therefore, in excising the veins and, for a short time, a few months perhaps, this procedure was not so invariably practiced by all of us, being reserved for cases which seemed imperatively to demand it. We formerly handled the cord as, I presume, almost everyone still does; separated it, more or less roughly, by tearing, from the sac and its enveloping membranes, and raised it on a hook or strip of gauze preparatory to transplan- tation and while the stitches were being applied. We now treat the vas deferens with great deference, thanks again to Bloodgood. (Vide description of operation below.) It occurred to Bloodgood before the publication of his report on hernia that it might be well to split the cord, transplanting only the veins to the outer angle of the wound and permitting the vas deferens to lie undisturbed. This method was finally abandoned by Bloodgood and other members of the staff who had practiced it, because the subtraction of the vas deferens