Tri-State medical journal (1895) (14582782048)

Identifier: tristatemedicalj2189ball (find matches)

Title: Tri-State medical journal

Year: 1895 (1890s)

Authors: Ball, James Moores, 1863-1929

Subjects: Tri-State Medical Society Medicine

Publisher: St. Louis : (s.n.)

Contributing Library: The College of Physicians of Philadelphia Historical Medical Library

Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities

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is gently lifted from its bed and held aside by retractors. The sizeand form of the internal ring now become apparent. Its abnormal enlarge-ment is always in a direction downward and inward. The outer margin 466 Original Articles. shows a firm crescentic border, and the inner a yielding aperture followingPouparts ligament toward the pubic bone. Sometimes it is so large as toreach the border of the rectus muscle. We now come to that step of the Bassini operation which is most orig-inal and important, which is the operation, the other step being common toseveral others. The posterior wall of the inguinal canal, up to, and includ-ing the deep ring, is narrowed by sewing the conjoined tendon and trans-versalis fascia to the free or shelving edge of Pouparts ligament. Of course,the lower flap of external oblique tendon must be drawn downward to ex-pose Pouparts ligament, and it will be unnecessary to explain that thisbrings into view the inner aspect of this ligament. Absolute immunity for

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down to Pouparts ligament. The lowerflap shown retracted will be replaced overcord to the dotted line. the femoral vessels can be obtained by interposing the left forefinger bet-ween them and the ligament, while suturing over the femoral canal. Bas-sini, himself, uses silk for the buried sutures. I have been unable to getas uniform results with silk as with kangaroo tendon, and use nothing elseat present. Catgut is entirely to be distrusted as to permanency. Thesedeep sutures should begin below, the first one or two often entering theouter border of the rectus muscle. They should include plenty of tissue on The Imbrocation Method-Andrews. 467 the upper side, and should not be too near together, lest they strangulatesegments of intervening tissue and produce necrosis. The line of stitchesshould be carried far enough toward the internal ring to narrow it to thesize of a lead pencil, or smaller, so as just to transmit the cord, exceptwhere there are abnormal enlargements or varix is pres

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1895

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