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.

    9/40 (page 3)
    concerned, was even more radical than Bassini's (the cord was [308] transplanted into the substance of the divided internal oblique muscle), we were tempted, at the very outset, to test the rela- tive value of cord transplantation in some of the cases, and permitted the entire cord to lie undislocated and altogether undisturbed in its bed and to trust to the suture of the inter- nal oblique muscle to Poupart's ligament, to the lining of the wound with muscle to efEect a cure. It was well wor- thy of note, as Bloodgood emphasizes in his article, that all of the cases treated in this manner (cord undisturbed) remained cured. Another fact which Bloodgood's painstaking study established was that of one hundred and nine cases in which the larger bundle of veins of the cord was excised and the heal- ing was per primam, not one showed a recurrence or any weak- ness at the site of the transplanted vas deferens, whereas in 6.4 per cent of the cases which healed by first intention and in which the veins had not been excised, there was a recurrence at the upper angle of the wound, at the site of the trans- planted cord. And even in the wounds which suppurated, there was not a recurrence in the nine cases of vein excision, whereas, of eleven suppurating cases in which the cord-veins were not excised, four (36.3 per cent) recurred. In 118 cases, therefore, in which the larger bundle of veins was ex- cised there was no recurrence at the site of the transplanted cord whether suppuration' occurred or not. And, certainly. 3 Nine suppurations in 118 cases, and for most of wliich the author was personally responsible, seems a large percentage (7.6^) even for hernia cases ten years ago, but it was considered a good showing in those days. Since every one, including the operator, has invariably worn rubber gloves, suppurations even in the operations for hernia, has occurred in probably less than 1^ of the cases. In 1890, all the assis- tants at an operation, the nurses and physicians, systematically wore gloves, bat the operator wore them only for special operations, such as exploratory laparotomies, explorations for foreign bodies, loose carti- lages, etc., in the joints, suture of the fractured patella, etc.—in other words, when there was a possibility of doing serious harm and no cer- tainty of doing great good. By degrees the operator wore gloves more frequently, until Dr. Bloodgood as Resident Surgeon, and who had become thoroughly accustomed to them as assistant, wore them invariably as operator and demonstrated from our statistics the necessity of doing so. It seems to be a fact that one who has been trained to operate always