Umbilical hernia, operation, cure : ligation of femoral artery for popliteal aneurism, cure : fecal fistula caused by appendicitis, operation, cure : a clinical lecture delivered at the Jefferson Medical College Hospital, April 6, 1892 / by W.W. Keen.

  • William Williams Keen
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Umbilical hernia, operation, cure : ligation of femoral artery for popliteal aneurism, cure : fecal fistula caused by appendicitis, operation, cure : a clinical lecture delivered at the Jefferson Medical College Hospital, April 6, 1892 / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    as little to do as possible. I use the water quite warm, and this is an advantage, as the shock is thus lessened. A large flat pad of gauze being placed under the opening, I am now ready to introduce the stitches. In doing so great care must be exercised that the intestine is not injured; the gauze pad is here a great help, while at the same time it absorbs the blood caused by the punctures. I have now closed the peritoneal cavity and shall next dissect out and remove most of the sac. You see how corded its internal surface is from the presence of connective-tissue fibers. I also remove a large piece of redundant skin and am now ready to close the wound. In doing so, I include in the sutures the bor- ders of what is left of the sac, which will tend to hx it more firmly and so prevent any recurrence of the hernia. As you will note, the patient has a flabby belly. When I remove the sutures, and possibly before, I shall support the abdomen by adhesive straps, and cer- tainly by a firm binder, and when she gets up at the end of three weeks or a longer period, I shall make her wear an elastic belt for months or a year or two, so as to support the abdominal wall. [Note.—Her highest subsequent temperature was 990, and she made a speedy recovery. Since leaving the hospital she has returned on account of the dis- charge of three of the silk ligatures. The hernia re- mains cured.] Case II. Ligation of the superficial femoral artery for popliteal aneurism.—The next patient is one that you have already seen. It is the case of popliteal aneurism which I have already twice attempted to cure, but failed each time. I brought the patient before you four weeks ago and tried forced flexion, flexing the heel to the buttock,, securing it there by a bandage around the bent leg and thigh, and also by attaching the heel of a slipper on the foot to a bandage around the waist. In this way I