On some points connected with the anatomy and surgery of inguinal and femoral herniae : being the substance of the lectures delivered in the theatre of the Royal College of Surgeons in February 1831 / by G. J. Guthrie.

  • George James Guthrie
Date:
1833
Catalogue details

Licence: Public Domain Mark

Credit: On some points connected with the anatomy and surgery of inguinal and femoral herniae : being the substance of the lectures delivered in the theatre of the Royal College of Surgeons in February 1831 / by G. J. Guthrie. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    the abdomen. In by far the greater number of cases this mode of proceeding will be found as effectual as it is safe ; but if it should not be sufficient, and a further division of deeper-seated parts is necessary, in what manner should it be done ? By continuing the incision upwards, or by making a new one in connexion with it, but horizontally? There are objections to both. It is urged against the operation upwards, that the spermatic cord may be divided by it; but as the operation is usually performed on women, this objection has not so much weight, for this part may be easily avoided, and if necessary even drawn out of the way, but which I do not however think will be necessary. The division of the edge of Gimbernat’s ligament by a horizontal incision is dangerous for two reasons: first the depth of the parts and the greater chance of cutting the intestine, which if protruded in any quantity can only with great difficulty be kept out of the way of the knife ; and secondly the danger of wounding the obturatrix artery when it happens to surround the neck of the sac. I know that if the end of the bistoury be just carried beyond the edge of Gimbernat’s ligament and no further, it may be cut without injuring this vessel, which in these cases runs close to it; but I have been made aware of more than one accident of this nature having occurred in operations performed by some of the best anatomists and surgeons in London, and the patients subsequently bled at intervals until they died from hemorrhage. It does not appear, then, that the ablest and best informed men can avoid such a misfortune, and I am therefore disposed to recommend that the operation should never be done in this way until the one directly Upwards has been tried in vain ; and if attention is paid to the division of that portion of the fascia lata which is attached to Gimbernat’s ligament and to the pubes as well as of the fascia propria, I suspect sufficient room will be obtained without cutting hori- zontally inwards. If this should be insufficient, of which I have great doubts, the horizontal incision may then be made with more ease and advantage, but to a far less extent. The obturatrix artery is something of an anatomical bugbear in this operation also ; it has very rarely been injured, although the case I have adduced shows that it may be cut, but then it may be tied, and ought to be tied in every case in which it has been divided. The operation is very simple. In the male a transverse incision should be made in the line of Poupart’s ligament, the aponeurosis or tendon of the external oblique muscle is then to be divided and the spermatic cord exposed ; this is to be drawn upwards and kept in that
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