Essays in surgical anatomy and surgery / By John A. Wyeth.

  • Wyeth, John A. (John Allan), 1845-1922.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Essays in surgical anatomy and surgery / By John A. Wyeth. 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.

    293/304 (page 259)
    It will be seen that ]n females, of 26 cases, the ohturalor was from the deep cpiyantric in V6}^ instances; from the posterior trunk of the internal iliac in 1^-; from tiic anterior trunk in 11 i)i,sl,aii(;(;s. In males, of 27 cases, it was from the epigastric in only 5; from \\\Q posterior trunk in 1; while from the anterior trunk of the internal iliac it was derived in 22 instances. In these cases it is seen that, in females we may expect to find the obturator to be derived from the deep epigastric in 1 of 2 cases; in males, in I of 4| cases. And, in a total of 61 cases, regardless of sex, the proportion is 20, or 1 in 8. Tiedemann is the only one of these anatomists who notices the difference between the origin of this vessel in males and females. In 160 cases in which Cloquet noted the obturator as coming from the internal iliac, 87 were in males, 73 in females, showing, as in my cases, the greater tendency of this vessel to come from the internal iliac in men. In 56 cases this same author noted from the epigastric, 21 were in males, 35 in females; agreeing, also, with the dissections embodied in this article, that the tendency of the obturator to come from the deep epigastric was much greater in women than in men. So great is this difference, that the estimates made from both sexes should not be considered, in view of the probable contact with this vessel in femoral hernia. An examination of the foregoing tables will show that, in 19 of 26 subjects, this artery was derived from the same point on the two sides, showing, in this respect, a symmetry of arrangement I have not noticed in any other artery of the body. Femoral hernia being comparatively a rare accident in the male, and the obturator artery having a dangerous relation to the femoral ring in the male sex in only a small proportion of cases, the surgi- cal interest of this vessel belongs to the opposite sex. When derived from the epigastric, it usually comes off from this artery from | to f of an inch from the origin of the epigastric from the external iliac. It then turns abruptly down on the outer side of the femoral ring, being in intimate relation with the sheath of the external iliac vein, and thus makes its way to the obturator foramen in such a manner that it would be exceedingly difficult for the in- testine, descending to form a femoral hernia, to insinuate itself between the iliac vein and the obturator artery, so as to loop this latter vessel around the hernia. This danger will be greater as the