On Irreducible Hernia
Boston Medical and Surgical Journal
A case occurring in my wards at the City Hospital, exemplifying the difference between irreducible ami strangulated hernia, and the, advantages which result from a little patient waiting before proceeding to a cutting operation, furnished the text for this little essay. It also exhibited the phenomena of inflamed hernia and its proper treatment. Abernethy held an amputation, and by consequence any cutting operation, to be the opprobrium of surgery. Velpeau taught that a scratch was a gate open
... ch was a gate open to death. Hence, ho who by excellence in diagnosis has been able to avoid a recourse to the knife is entitled to a far greater meed of glory than be who has expertly performed a needless operation. Perhaps in no department of surgery is this idea to be more constantly kept in remembrance than in that which relates to hernia. The common error is to confound irreducibility with strangulation ; inflammation of a hernia, as contradistinguished from strangulation, is often totally ignored. So much lias been said and so well said about " delay in operating," that I fear the. too prevalent idea regarding hernia is, that if taxis together with ether does not succeed, an operation must follow, without waiting to see if the hernia bo really strangulated or not, or if opium, ice, poultices, leeches, a raised position of the pelvis, persistently followed, would not do a great deal better ; or whether, if some operation must be done, the pneumatic aspirator, or even the finger in some cases, so as to forcibly dilate the constriction, would not. answer as well as the knife. A surgeon who is skilled in diagnosis will rarely find a case of hernia to operate on. Such a surgeon may be called timid or over-cautious, but he has often the satisfaction of knowing that surgery has Buffered no .injury at his bands. Nothing should or can cause a true surgeon moro self-condemnation than to feel that he has by a needless or ill-timed operation increased the chances of death. Dr. Gross has recently uttered some excellent words regarding baste to operate for hernia. Carsten Holthousc, whose excellent work on hernia should be in every surgeon's library, is full of instruction on this point. I like Mr. HolthouseV division of hernia into "irreducible,"