The internal iliac artery may require to be tied in consequence of a wound, or for aneurism of the glutaeal or other of its branches. The operations of tying it has been performed in seven instances, in four of which it succeeded. It was first tried by Dr. Stevens, of Santa Cruz, in the West Indies : this patient recovered.* It was afterwards performed unsuccessfully, at the York Hospital, by Mr. Atkinson. It was also performed by a Russian army surgeon, upon whom the Emperor Alexander settled a pension as a reward for his dexterity and skill. Dr. White, of Hudson, tied the artery on a tailor aged sixty years : in both these latter cases the operation succeeded. It was also tied by Mr. Mott; and by Thomas, of Barbadoes: these two patients died. It was since tied by Mr. Guthrie.

In Dr. Stevens's and Mr. Atkinson's cases the operations in each case was commenced by an incision, five inches long, through the integuments, fascia, and muscles, parallel and a little external to the epigastric artery.

Mr. White made a similar incision on the side of the abdomen, about seven inches long, with its convexity to the ilium, commencing near the umbilicus, and terminating near the inguinal ring.

The remaining steps, in these cases, consisted in pushing inwards the sac of the peritoneum and carrying the finger along the external iliac artery, until it reached the origin of the internal iliac.

* Med. Ch. Trans., vol. v. p. 422. Averill's Operative Surgery, p. 55.

It is a fact worthy of attention that the ureter is closely connected to the peritoneum, and invariably accompanies this membrane when it is removed out of the way during the operations, so that there will be no fear whatever of including this duct within the ligature.

In order to arrive at the internal iliac artery, an incision should be made in the direction of a line extending from the umbilicus to midway between the spine of the pubis and the anterior superior spine of the ilium; this incision should commence at the outer edge of the rectus muscle, and terminate about an inch above Poupart's ligament, in order to avoid the spermatic cord. The different muscular layers composing the anterior wall of the abdomen being successively divided, the transversalis fascia should be cautiously scraped through, and the peritoneum exposed and pushed inwards. The fascia covering the vessels should also be torn with the nail, and then, by following the external iliac artery backwards, we arrive at the internal. In the angle between them lies the external iliac vein, which should be carefully avoided, and the needle introduced from within outwards.

The branches of the internal iliac artery are classed into those which remain within the pelvis, and those which leave it to be distributed externally. The latter are four in number, viz., the glutaeal, sciatic, pudic, and obturator; and the former, which in the male are five in number, are the iliolumbar, lateral sacral, middle haemorrhoidal, vesical, and umbilical ; to which may be added in the female, the uterine and vaginal. We shall proceed, first, with the description of the external branches.

The branches of the internal iliac artery are the following:

Branches Supplying The Parts Outside The Pelvis

Glutaeal. Sciatic. Pudic. Obturator.

Branches Supplying The Parts Within The Pelvis

Ilio-lumbar. Umbilical: and, in addition, Lateral Sacral. in the female, the Middle Hgemorrhoidal. Uterine and the Vesical. Vaginal.