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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    1.209] the eases in which the veins were excised, were not the simpler ones. One of xhe most important of the facts ascertained by Bloodgood was the great variation in the width of the con- joined tendon and the responsibility of the insufficient tendon for the recurrences at the lower angle of the wound, through the external ring, direct. The transplantation of the rectus muscle recommended by Bloodgood * to close this defect seems to accomplish Avhat its originator hoped it might, although, a priori, one would fear that this powerful straight muscle must eventuaJlly djraw away from Poupart's ligament to which it had been sewed. Is it not conceivable, however, that a, new encompassing fascia may develop about a transplanted muscle and that this fascia may remain even after the muscle has been pulled away? Experiments upon animals to deter- mine this point would be interesting. M. Holl, now Professor of Anatomy in Gratz, directed attention many years ago to the part muscles probably play in the determination and develop- ment of the fasciae. Hence, so long ago as 1896 we recognized, thanks to Blood- in rubber gloves finds it awkward to operate without them. I have more than once heard my assistants, while performing some insignificant operation without them, call for gloves because, as they said, they were conscious of unnatural finger movements, of a certain clumsiness with- out them. With gloves one probably acquires special methods of tying knots, holding instruments, etc. In our clinic the heavier gloves are exclusively used, although probably every member of the Staff has by predisposition been in favor of the thinner gloves and had to convince himself by trial of the thinner varieties that the thick ones, even with seams on the fingers, were preferable. The thin gloves were too slip- pery ; also too unsafe, chiefly because of the danger of minute unde- tected holes. Cotton gloves, if changed very frequently, are undoubt- edly better than no gloves at all. If the operator desires the physical property of the cotton which enables him to hold more securely and handle with more precision the intestines and viscera he might wear a very delicate gauze-mesh glove over the rubber or over two or three fingers of the rubber glove. Possibly a rubber glove might be manu- factured with a wide gauze mesh permanently imbedded in its palmar surface. ■•Anton Wofler, Beitrage zur klinischen Chirurgie (Festschrift f. Billroth), 1893.