FIBRINE. 



257 



the latter, it does not promise more successful 

 results : should secondary hemorrhage succeed 

 to it, there is little prospect that the ligature of 

 the iliac would afterward succeed, and the 

 uncertainty existing with regard to the point of 

 origin of the profunda raises a very strong ob- 

 jection against it, inasmuch as we cannot know 

 whether the origin of that vessel be above, 

 below, or at the point at which the ligature is 

 to be applied : it is further exposed to the 

 difficulty, before adverted to, which is likely 

 to arise in cases of high origin of the profunda, 

 in which that vessel may be taken for the 

 femoral, and thus another source of embar- 

 rassment be encountered. 



In the performance of it the following struc- 

 tures will present : 1. the skin ; 2. the subcu- 

 taneous cellular stratum along with the inguinal 

 glands and the superficial inguinal vessels of 

 the latter : those which are most exposed to be 

 divided are the superficial epigastric and its 

 branches ; the superficial anterior iliac and the 

 superficial pudics may be encountered, but 

 they are less likely; 3. the superficial lamina 

 of the iliac portion of the fascia lata; and 4. 

 the prolongation of the fascia transversalis, 

 which forms the front of the femoral sheath. 



An incision three inches long will suffice ; it 

 should commence above Poupart's ligament, 

 and be continued in the line of the vessel for 

 two inches below it. 



If the superficial vessels bleed, on division, 

 so much as to interfere with the course of the 

 operation, they should be at once secured; 

 otherwise they will probably cease themselves, 

 and give no further trouble. 



The lymphatic glands, if in the way of the 

 incisions, may be either held aside or removed. 

 The fascia lata and sheath may be treated in 

 the same manner as in the other operations 

 described ; they can be easily distinguished in 

 consequence of the thin stratum of fat which is 

 usually interposed. 



The insulation of the artery and the passage 

 of the needle require the same precautions as 

 in the operations at other parts of the vessel's 

 course. The vein being placed along the inside 

 of the artery the needle should be passed from 

 that side. 



The crural nerve and its branches are here 

 altogether safe, as they lie without the femoral 

 canal, but, as has been before pointed out, the 

 crural branch of the genito-crural nerve may 

 be included in the ligature ; it will be most 

 certainly avoided by the careful insulation of 

 the artery: the operator should also assure 

 himself, before tying the ligature, that no fila- 

 ment is enclosed. 



Should two arteries present, as described in 

 the anatomy of the profunda, and a question 

 arise as to which is the femoral, the criteria 

 pointed out will enable the operator to decide 

 (see profunda artery ) ; and the difficulty will, 

 almost certainly, be altogether avoided by cut- 

 ting directly upon the centre line of the femoral 

 as ascertained by its pulsations. 



Operation on the profunda artery. From 

 the anatomical details it follows that in the ma- 

 jority of cases the profunda is situate, in the 



VOL. II. 



first stage of its course at least, at the outer or 

 iliac side of the femoral artery, though upon 

 a plane posterior to that vessel : it has also, at 

 the same time, the same coverings, differing 

 only in being contained in a sheath proper to 

 itself; and hence, if necessary, the profunda 

 might be reached in that situation by an opera- 

 tion similar to that for exposing the femoral 

 itself at the same place, in which much advan- 

 tage would be obtained by first exposing the 

 latter vessel, and following it as a guide to 

 the origin of the former ; which, if in its usual 

 situation, will be exposed by displacing the 

 femoral inward, and then the proper sheath of 

 the profunda should be opened to a certain ex- 

 tent, in order to allow the application of the 

 ligature at a sufficient distance from the origin 

 of the vessel. But in the inferior stages of its 

 course it may be laid down, as a general rule, 

 that it cannot be reached from the front of the 

 thigh, inasmuch as, with the exception of those 

 cases in which it is throughout external to the 

 femoral, and in which, from its deep position 

 and the want of a guide to its exact situation, 

 the rule will yet equally apply, it is not only 

 more deeply seated, but it is separated from 

 the anterior surface of the limb by the super- 

 ficial femoral artery, and by the femoral, pro- 

 funda, and circumflex veins, as well as by the 

 coverings of the femoral vessels, and lastly by 

 the adductor longus muscle. In any case, did 

 circumstances render necessary the attempt to 

 tie the profunda, it would be an operation in 

 which much uncertainty and difficulty must be 

 anticipated, in consequence of the varieties 

 presented by that artery in its origin and 

 course. 



For Bibliography see ANATOMY (INTRODUC- 

 TION), and ARTERY. 



(B. Alcock.) 



FIBRINE, (Yr.fibrine; Germ. Faserstoff.) 

 Under this name physiologists and chemists 

 have generally described the animal proximate 

 principle constituting that part of muscular 

 fibre which is insoluble in cold water, and that 

 portion of the coagulum of blood which re- 

 mains after the removal of its colouring matter. 



The fibrine of blood is best obtained by 

 stirring a quantity of fresh-drawn blood with a 

 piece of wood, to which the coagulum adheres, 

 and may afterwards be washed in large and 

 repeated portions of water till it loses its co- 

 louring particles, and remains in the form of 

 a buff-coloured, fibrous, and somewhat elastic 

 substance ; this may then be partially dried by 

 pressure between folds of blotting-paper, di- 

 gested in alcohol to remove fat, and then care- 

 fully dried, during which process it loses about 

 three-fourths of its weight, and becomes brittle 

 and of a yellowish colour: it is insipid and in- 

 odorous. In cold water it slowly resumes its 

 original appearance but does not dissolve: 

 when, however, it is subjected to the long- 

 continued action of boiling water it shrinks 

 and becomes friable, and a portion of a newly- 

 formed substance is at the same time taken up 

 by the water, which gives it a yellowish colour 

 and the smell and taste of boiled meat, and 



s 



