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The patient fell 40 feet, landing on some rubbish and old iron, and received a wound measuring six inches over the right iliac crest, through which the lower end of the right kidney protruded; a piece of the kidney was lost. The case was remarkable because of the slight amount of hemorrhage.
The valve of the colon is well adapted to prevent the retrograde motion of the excrements; yet, as this valve is possessed of a living power, in the iliac passion, either from spasm, or other unnatural exertions, it keeps itself open, and either suffers or promotes the retrograde movements of the contents of the intestines below; as in ruminating animals the mouth of the first stomach seems to be so constructed, as to facilitate or assist the regurgitation of the food; the rings of the oesophagus afterwards contracting themselves in inverted order.
The essential lesion is the absence or deficiency of valves, so that they are incompetent and fail to support the column of blood which bears back upon them. Normally the valves in the femoral and iliac veins and in the inferior vena cava are imperfectly developed, so that in the erect posture the great saphena receives a large share of the backward pressure of the column of venous blood.
Twenty days after no evidence of pulsation remained in the sac, and three months later the sailor was well and able to resume his duties. Ligation of the common iliac artery, which, in a case of gunshot injury, was first practiced by Gibson of Philadelphia in 1812, is, happily, not always fatal. Of 82 cases collected by Ashhurst, 23 terminated successfully.
They receive lymph from the deep lymphatics of the lower limb, and some of the efferent vessels from the femoral and superficial inguinal glands. The lymph then passes on through the femoral canal to the external iliac glands.
It is the longest part of the small intestine, and terminates in the right iliac region, opening into the large intestine. This opening is guarded by the folds of the membrane forming the ileo-cæcal valve, which permits the passage of material from the small to the large intestine, but prevents its backward movement. The Coats of the Small Intestine.
It has since, however, been found in New Zealand and in India; while the discoverers of South America obtained specimens of it in its natural state from the natives of Peru, who used it for making axes and arrow-heads, and gave it the name of piedra de yjada, from which comes our common word jade, on account of its use as a supposed cure for the iliac passion.
The assistant seizes with his right hand the right side of this wrinkle; the operator takes the bistoury and cuts the wrinkle, at one stroke, through the middle; the wrinkle having been suffered to go down, a separation of the hide is presented, of sufficient length to admit the introduction of the hand; the edges of the hide are separated with the thumb and fore-finger of the left hand, and in like manner the abdominal muscles are cut through, for the distance of a centimetre from the lower extremity of the incision made in the hide, the iliac slightly obliquely, and the lumbar across; a puncture of the peritoneum, at the upper extremity of the wound, is then made with the straight bistoury; the buttoned bistoury is then introduced, and moved obliquely from above to the lower part, up to the termination of the incision made in the abdominal muscles.
The rectal explorations may reveal a pulseless state of one or more of the iliac arteries and a hardness and enlargement of the aortic quadrifurcation, but sometimes this palpation fails to disclose any perceptible diminution of the blood current of these vessels. The obturation being incomplete, it may be impossible by palpation to decide that thrombosis really exists.
Any of the methods already described is available for their treatment the choice lying between Matas' operation and ligation of the external iliac. Aneurysm of the profunda femoris is distinguished from that of the main trunk by the fact that the pulses beyond are, in the former, unaffected, and by the normal artery being felt pulsating over or alongside the sac.
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