A manual of the operations of surgery : for the use of senior students, house surgeons, and junior practitioners / by Joseph Bell.

  • Joseph Bell
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: A manual of the operations of surgery : for the use of senior students, house surgeons, and junior practitioners / by Joseph Bell. Source: Wellcome Collection.

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    side of the body of the fourth lumbar vertebra, the common iliac of the right side would have a longer course to pur- sue than that on the left, if both ended at corresponding points. However, this is not always the case, as has been pointed out by Mr Adams of Dublin, as the right common iliac often bifurcates sooner than the left does. With this slight difference, the position of the two vessels is precisely similar, each extending along the brim of the pelvis from the bifurcation of the aorta towards the sacra-iliac synchon- drosis for about two inches. Sometimes the division takes place a little higher, even at the junction of the last lumbar vertebra and the sacrum. This variation depends chiefly on the length of the artery, which, as Quain has shown, varies from one inch and a half to more than three inches. The anterior surface of both arteries is covered by the peritoneum, and each is crossed by the ureter just as it bifurcates into its branches. The artery of the right side is in close contact behind with its corresponding vein, which at its upper part pro- jects to the outside, and below to the inner side. The artery of the left side is less involved with its vein, which lies below it, and to the inside. The right is in contact with a coil of ileum, the left with the colon. The inferior mesenteric artery crosses the left one, while to the outside of both, and behind them, lie the sympathetic and obturator nerves. There are no named branches from the common iliac. Operation.—The chief difficulties to be encountered are— ]. The close proximity of the peritoneum, and specially the risk there is that it has become adherent to the sac of the aneurism; 2. The depth of the parts, and tendency of the intestines to roll into the wound; 3. Specially on the right side, the proximity of the great veins. With these excep- tions the passing of the ligature is not so difficult as in some
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