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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    [309] did not appreciably reduce the size of the cord; furthermore, there were one or two recurrences at the site of the trans- planted veins. This is a particularly good confirmation of the author's belief that the veins are largely responsible for the development of oblique inguinal hernia. The vas deferens contributes, relatively, very little to the size of most adult cords, but the veins, which at one moment make a bundle as large as one's linger, may the next and when empty be reduced to the size of a small quill. Is not this variation in the size of the cord possibly a factor in the production of hernia? When the hernia is first developing and the sac is, at opera- tion, inside the internal abdominal ring, it can readily be demonstrated by a little pull on the veins. The fat, too, which is recognized as sometimes a probable factor in the pro- duction of hernia, accompanies for a short distance the veins rather than the vas deferens. This fat when present should be excised with the veins. For several years, then, we have been excising the veins in this careful manner, leaving the vas deferens untransplanted, undisturbed, and the internal oblique muscle undivided. In a few cases, however, without, that I am aware of, ultimate damage to the testicle, we transplanted the vas deferens to the outer angle of the wound. But we are quite certain that, as a rule, the less the vas deferens is mani- pulated and the more carefully the veins are excised, the less is the subsequent congestion of the epididymis. It is instruc- tive from day to day to study the stump of the veins, the epididymis, the testicles, etc., after operations for hernia. It is not the purpose of this communication to give the re- sults in detail of these observations. In a recent private case, urethritis Neisseri made its appear- ance a few hours after the operation. We naturally watched the epididymis on the operated side with some concern, fear- ing that excision of the veins might lower the resistance of this organ. On the twelfth day, without warning, a very slight induration of the epididymis became evident. T attributed [310] tliis to the fact that the patient carried out his irrigation- treatment badly, for the proper^ method of irrigation being 6 When the author's method of treating gonorrhoea can fail in his own wards, because improperly understood, it is not strange that so admir-