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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    cord, reduced to such a diminutive size by the excision of the [313] veins, will be as little likely to be the cause of a recurrence in the lower angle of the wound as in the upper angle when it is transplanted/' Cases in which the Veins should not he Excised. When during the dissection of the sac the cord is torn from its bed in the inguinal canal and subjected to trauma- tism, and the testicle withdrawn from the scrotum, the veins should not be excised, because the probabilities of epididymitis and atrophy are too great. In such cases I would advise the transplantation of the veins alone, so that the larger cord is divided, and the wound is weakened less by the presence of a very small cord in two places than by the presence of a larger cord in one place, which from our results we know to have been the cause of a recurrence in 6.4 per cent of the cases.'' Xote, June, 1899. In October, 1898, I performed for the first time the splitting of the cord, transplanting the veins only. Since this date the modification has been followed in 26 operations for inguinal hernia. In 12 the rectus muscle was transplanted. The wounds in 25 cases healed per primam. In 19 cases no swelling of the testicle followed op- eration. In 7 cases there was slight but temporary swelling. Thrombosis of the veins was not observed in any of the 26 cases. It is seven months since the first two operations. Both are perfect results. The others are recent operations. When the bundle of veins is unusually large, and complete excision is contra-indicated for reasons already given, I have suggested that a portion should be ligated and excised and the remainder transplanted. This has been done in a recent case by Doctor Gushing. In children the veins should not be excised; the proba- bility of atrophy is greater than in adults. As we have had no recurrences whether veins have been excised or not, it does not seem to make much difference what is done with the very small cord. The splitting of the cord has been discontinued by its author.