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

  • William Stewart Halsted
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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    1211] had I known what the result in this case was to be, I would have used, if possible, the internal oblique muscles in the old way, and hence have stitched the cremaster under rather than over the former. But the muscles were attenuated and not close at hand. Stitching the cremaster over the internal ob- lique muscle necessarily precludes the sewing of the latter to Poupart's ligament. The closure with the cremaster seems almost ideal in some cases; it is a method so inviting during the operation, and so true, when finished, to one of the great principles of surgery; there is no tension. It is, in this respect, as a plastic operation should be. What the ultimate verdict will be it is too soon to predict. The cremaster fibres, particularly the hypertrophied ones, will, in time, atrophy; but when this occurs, the cremasteric fascia, perhaps stronger than before, would probably remain, holding together the atro- phied muscle bundles. There can, at least, no harm result from this attempt to strengthen the wall, for the internal oblique muscle has been used in the usual manner. The worst that could happen would be a recurrence, in a certain class of cases, at the lower angle, one that might, possibly, have been avoided if the aponeurosis over the rectus muscle had been employed instead of the cremaster as described by the author. The future will decide these nicer points, and it would seem that only the nicer points remain now to interest the operator. Another feature of the present operation is to transplant the neck of the sac as described below. It is merely an addi- tional precaution warranted by the good results obtained by Kocher and others with his operation. And, finally, we overlap the aponeurosis of the external ob- lique muscle to insure the union which a mere approximation of the edges of the aponeurosis cannot do, and to close more snugly the external ring. We still examine with the same care, but no longer with concern, the epididymis, testicle, stump of veins, etc., chiefly to ascertain if there is congestion (induration) of drawn down to Poupart'a ligament; the former was stitched in front of instead of behind the latter muscles. We had never before and have never since had occasion to use the cremasters in this way. Dr. Mitchell, my house surgeon, operated upon one side, and the author upon the other.
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