Emergency surgery, for the general practitioner.

  • Sluss, John W. (John William), 1867-
Date:
1910
Catalogue details

Licence: Public Domain Mark

Credit: Emergency surgery, for the general practitioner. 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.

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    If more time is available, after the sac is trimmed its edges are sutured as after a laparotomy. The sheaths of the recti muscles are opened up and the inner border of each muscle exposed. The two sides are then brought in contact and three tiers of sutures applied; one uniting the deep layer to its fellow of the opposite side; the second uniting the two muscles; the third uniting the two superficial layers of the sheath. Finally the excess of subcutaneous fat is trimmed away and the skin sutured. The usual dressing is used, held in place by a wide binder, and the after-treatment, already indicated, is instituted. Figs. 396 and 397 show the manner in which Mayo perfects the radical cure. Obturator Hernia.—A strangulated obturator hernia is rare, yet it is to be thought of and ruled out before opening the abdomen for in- testinal obstruction. Several points help to locate the trouble even when no marked tumor is present. The presence of pain over the region of the obturator foramen directs the attention to that point, and pressure made there projects a pain down the inner side of the thigh to the knee, along the course of the obturator nerve. In the female vaginal examination will reveal the tumor. In this form of strangulated hernia, taxis is useless and likely to be very harmful, and therefore must never be employed. A herniotomy must be done without delay, though in these cases it is a procedure by no means simple. Several anatomical points must be borne in mind. The hernia usually comes out through the upper part of the obturator membrane and is covered over by the pectineus muscle. It may work into the pectineus or it may lie on a lower level, working into the obturator externus. The pectineus is usually the chief guide to the hernia. The obturator vessels and nerve are usually found behind and to the outer side of the neck of the hernia, though one cannot count on that. The femoral vessels lie to the outer side. It is the obturator membrane which constitutes the constricting ring. The operation, chiefly as described by Treves, is as follows: The pelvis is elevated, the thigh flexed and adducted, the femoral artery located, and about a finger's breadth internal an incision is made from