102 



SURGERY. 



INGUINAL ANEURISM. 



This is a pulsating tumour in the groin, not to be mistaken for a 

 bubo, hernia, &c. The external iliac is tied by making an incision (a, 

 Fig. 31), about 3 J inches in length, commencing on a level with the 

 anterior superior spinous process, and about an inch distant from it ; 

 and continued nearly parallel with Pou part's ligament, to a point 1 

 inch above, and 1^ inches to the outside of the pubes. Carefully cut- 

 ting through the skin, superficial fascia, tendon of the external oblique, 

 internal oblique, and transversalis muscles, the fascia transversalis 

 will be exposed, with some danger of wounding the epigastric artery. 

 This fascia should be scratched through, and the peritoneum pushed 

 aside, and held out of the way by an assistant with a spatula : the 

 artery will be detected by its pulsation on the inner border of the 

 psoas muscle : the vein being on its inner side. The operation for 

 tying the internal iliac or the common iliac is made by making an 

 incision b. The letter c shows the incision of Sir Astley Cooper 

 when he tied the aorta. 



Fig. 32. 



POPLITEAL ANEURISM. 



This is of frequent occurrence, and 

 occupies the space between the hamstrings 

 behind the knee, causing pain, numbness 

 and swelling of the leg, disease of the 

 joint, &c. 



The operation is to tie the femoral artery. 

 The patient being properly placed, the sar- 

 torius muscle is rendered prominent by 

 raising and adducting the thigh. An in- 

 cision of two or three inches in length is 

 made upon the inner side of the sarto- 

 rius muscle, in the upper part of the thigh, 

 according to Scarpa, where the artery is 

 superficial. The saphena vein is to be re- 

 garded in the dissection of the superficial 

 fascia. After opening the sheath, care 

 must be taken not to injure the vein, nor 

 to include the saphenus nerve. Hunter's 

 operation is somewhat below, and in its 

 performance the sartorius must be divided 

 or pushed aside. — The anteriar tibial artery 

 may be tied in several places : at the 

 upper part of the leg, by a free incision, so 



