. Un nouveau manuel de chirurgie, civile et militaire. Incision de McBurneys. L'incision d'EePresents McBurney, qui s'étend parallèlement aux fibres du muscle abdominal externe oblique, a) séparant ses fibres sans les couper, puis séparant les fibres du muscle interne oblique, b) de nouveau sans couper ses fibres et s'étendant à travers le fascia transverse et le péritoine (c) dans la même direction. Indications de fonctionnement. Dans la plupart des cas de hernie ventrale, la section abdominale de la suite n'a pas d'anneau défini, l'ouverture étant large; il n'y a donc aucun danger de strangulation. Le

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. A new manual of surgery, civil and military. McBurneys Incision. Eepresents McBurneys incision, which extends parallel with the fibres of the externaloblique abdominal muscle, (a) separating its fibres without cutting them, then separating thefibres of the internal oblique muscle, (b) again without cutting its fibres and extending throughthe transversalis fascia and peritoneum (c) in the same direction. Indications for operation. In most cases of ventral hernia followingabdominal section there is no definite ring, the opening being wide; there isconsequently no danger from strangulation. There is, however, the constantfeeling of insecurity and weakness in the abdominal wall which prevents the GENERAL SURGERY OF THE ABDOMEN 355 patient from performing the duties, or indulging in the pastimes, of persons inhealth, and as the tissues become thinner and thinner, there is really somerisk of having them give way entirely.. Closure of Abdominal Wound. Eepresents the manner of applying sutures in closing an abdominal incision in the medianline; (a) representing the deep strong fascia composed of the aponeurosis of the externaloblique abdominal muscles; (b) the rectus abdominis muscle, and (c) the transversalis fasciaand peritoneum. Moreover, the digestive disturbances of which such patients complain aredue partly to the fact that there are usually adhesions between the intestinesand omentum and the scar which interfere with the passage of food and gasesthrough the portion of the alimentary canal thus impaired. When the protrusion is so great as above described, and cannot be com- 356 GENERAL SURGERY OF THE ABDOMEN fortably retained by means of a bandage, there is a sufficient amount ofmechanical obstruction to the intestines from their crowding into this pouchto account for the digestive disturbances. For these reasons it seems wiseto advise operative treatment, especially in young patients. Operative tec

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