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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under theskin. Xo injurious results seem to follow from this exposed position, butwhat becomes of the valvular arrangement of the two layers? This is ob-viously lost and a direct opening made through both. It seems to me this is wrong in principle. Instead of restoring the obliquity of the inguinalcanal we have destroyed it. I will now call attention to certain difficulties in the Bassini methodwhich a large experience with it has impressed upon me. No other oper-ation, in my opinion, can compare with it in elegance and efficiency, yetevery one who has used it in fifty or a hundred cases will corroborate mein stating that in very large openings quite an undesirable degree of tensionis put upon the deep row of stitches. I never met a case in which thesecould not be placed and the parts coapted, but in very large internal ringsthere is now and then an utter absence of conjoined tendon on the innerside of the opening. Instead of finding, as in Fig. 1, a fair amount of conjoined tendon to
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FIG 3 Fig. i. 468 Original Articles. sew to, we find, as in Fig. 3, that we must depend mainly upon the rectusmuscle or its sheath. This draws the parts so much out of normal relationthat the observer must be sceptical as to their permanent union, (see Fig.4.) Quite a similar trouble is met in large direct hernias—it being quitedifficult to get tendinous tissue enough properly to fill the gap by a trueplastic operation. As you are aware Waelfler has recently used the sheathof the rectus for closing this gap, but, as his operation is an out and outlaparotomy, and involves no less than eight distinct rows of buried sutures,I think it is more ingenious than practical. This brings me to my own modification, the imbricating or overlap-ping method which I used at first tentatively, but now employ in nearlyevery case. Briefly, this consists in sliding a flap or layer of externalaponeurosis into a position behind the canal so as to reinforce the posterior

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