File:Tri-State medical journal and practitioner (1897) (14591778307).jpg

Identifier: tristatemedicalj4189unse (find matches)
Title: Tri-State medical journal and practitioner
Year: 1897 (1890s)
Authors:
Subjects: 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

View Book Page: Book Viewer
About This Book: Catalog Entry
View All Images: All Images From Book
Click here to view book online to see this illustration in context in a browseable online version of this book.

Text Appearing Before Image:
ora double knot is made, though this is less satisfactory from the point ofview of firmness; then the entire remainder of the sac is split in two, andthe strips thus obtained are tied together once or twice (Fig. 2). Lastly,in order to insure absolute firmness, a hole may be made in one of thesestrips and the other passed through it (Fig. 3),so as to prevent all possi- Medical Progress 45 bility of the knot slipping; this manoeuvre, moreover, may be repeated twoor three times (Fig. 4 ), if the strips are sufficiently long. When the sac isshort, it is frequently impossible to tie more than one knot with the entiresac; in this case the knot is secured, as stated, by splitting the remainderof the sac in two strips, which are then tied together once or twice (Figs.2 and 3). All these manoeuvres, which are executed in less time than it takes todescribe them, are carried out not with the fingers, which frequently wouldnot be possible, but with the aid of forceps, when they are executed with
Text Appearing After Image:
Fie. 2. Fig. 4. ease, as will be seen from the accompanying drawings, for which we areindebted to Mr. Ombredanne, our house-surgeon. The last knot having been tied, the sack is released, when it disappearsat once in the abdominal cavity, exactly as when the sac has been resectedin the usual operation. In all the patients operated upon we found thatthe highest point of the knot farthest away was invariably situated at least3 or 4 centimetres above the internal inguinal ring. 4kIt then only remains to finish the operation in the usual way, exceptthat silver-wire sutures are employed, as stated above. 46 Medical Progress. In cases of old=standing hernise, the sac may be so thick as to pre-clude its being tied in its entirety. In two cases of this kind we wereobliged to give this up and split the entire sac in two at once, tying the twoends together several times in the manner indicated in Figs. 2 and 3; inone case, we even split the sac into four equal parts, and tied them togethertwo an

Note About Images