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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    canal, but which we now make use of as often as feasible, [210] probably in over 75 per cent of the cases, is the utilization of at least a part of the cremaster muscle, which we formerly cut away. This is a step of the operation to which one is irresist- ibly drawn in some cases by the great strength of the cremas- ter and the firmness and extent of its attachments to Poupart's ligament. A natural insertion, such as this, of the cremaster and its fascia into Poupart's ligament, has in each case a value which can be demonstrated on the operating table and can be counted upon definitely to contribute something, and occa- sionally perhaps a great deal, to the strength of the abdominal wall; whereas the artificial insertion of the internal oblique into Poupart's ligament, although undoubtedly of the utmost importance and always to be tried for, may occasionally and perhaps often fail, from insufficient muscle, too great tension, or gradual redressment, to close securely even the upper part of the canal. The lower part of the canal, ordinarily pro- tected by the conjoined tendon, can rarely be entirely safe- guarded by the muscle fibres of the internal oblique when its conjoined tendon is deficient. The cremaster, on the other hand, seems in just these cases to serve a particularly good purpose. The cremaster, unaided, has repeatedly made such a complete and strong looking closure that we have felt the hernia would be well cured if the operation were abandoned at this stage. I have today, June 10, 1903, examined a patient whose very wide inguinal canals (the gap would have admitted the hand) were closed eighteen months ago solely by the cremasters stitched over instead of under the internal oblique muscle; the result, in the opinion of those who examined the case, is absolutely perfect, on both sides. My house surgeon. Dr. Fol- lis, and one or two others examined the man'' with me. Even [sii] ^The history is briefly this. Male, fet. 59 years; Surgical No. 12,905 ; was operated upon January 15, 1902, for two very large scrotal ruptures, eighteen and twenty-four inches long (from external ring to bottom of scrotum). The conjoined tendons on both sides were almost obliterated. The circumcentral rings easily admitted four fingers. The cremaster muscles, very well developed, were used to close the entire dehiscence because the internal oblique muscles could, only with great tension, be