A third and fourth series of fifty cases of ovariotomy : with remarks on the situation and length of the incision required in the operation / by T. Spencer Wells.

  • Wells, Spencer, 1818-1897.
Date:
[1867]
Catalogue details

Licence: Public Domain Mark

Credit: A third and fourth series of fifty cases of ovariotomy : with remarks on the situation and length of the incision required in the operation / by T. Spencer Wells. Source: Wellcome Collection.

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    wall, and filled by small urinary concretions. Usually it is obliterated, and forms the vesico-umbilical ligament running up along the linea alba from the bladder to the umbilicus. 7. The deep fascia, or the layers of areolar tissue between the inner surface of the transversalis muscle and the perito¬ neum, or rather between the fascia transversalis and the peritoneum, is very elastic, and only loosely adherent, so that it is easy to separate the peritoneum to a considerable extent without opening it. Indeed, if fluid be free in the peritoneal cavity, the membrane bulges up, like a bluish thin-walled cyst, as soon as the deep fascia is divided. 8. The peritoneum. It must be remembered that the obliterated umbilical vessels and urachus, passing from the fundus of the bladder to the umbilicus, are inclosed in a fold of the parietal peritoneum. The inferior epigastric artery, ascending obliquely from Pouparf’s ligament to the posterior surface of the rectus muscle, is inclosed in a similar but less prominent fold. The fold from the umbilicus forming the suspensory ligament of the liver has been already alluded to. It is with later steps of the operation of ovario¬ tomy that the peritoneum and its reflections have the most important relations. In connection with the first incision it is only necessary to add that it must be useless to carry this incision nearer to the symphysis pubis than the reflection of the peritoneum from the anterior abdominal wall to the bladder; and it is a safe rule to stop short of this point, and not carry the lowest point of the incision nearer than two inches to the symphysis pubis.