On the Radical Cure of Hernia

A. Rabagliati
1887 BMJ (Clinical Research Edition)  
Senior Surgeon to the Bradford Infirmary. I HAVE not had the large personal experience which some surgeons can boast of in the treatment of hernia ; but I have had the opportunity of watching a large number of cases treated in the Bradford Infirmary during some years past, and of comparing the general results in my own practice and those of other surgeons. Of cases in which I have performed the operation solely with the view of effecting a radical cure, without the presence of urgent symptoms
more » ... dicating the necessity of operation, I have notes of three cases. In all of them the operation was perfectly successful. I will make a few remarks on these cases immediately. In seven other cases I have operated on account of urgent symptoms of strangulation, at the same time removing the sac, in the way to be described below; and have been fortunate enough to save all my cases at the time and to effect, in addition, in all of them to which my information extends, a radical 3ure of the condition. In five other cases I have operated for relief of strangulation, but without making any attempt to effect a radical cure by removing the sac. Of these, three have died and only two recovered. These five cases were all operated on previous to the time when I ventured to remove the sac, and when the old operation of nutting down and relieving the stricture and returning the bowel was the ordinary practice in Bradford. That operation I had seen to be followed by a shocking mortality. Looking back over a series of years ending with 1881, I find that actually about 60 per cent. of the cases operated upon in the Bradford Infirmary sank after the operation. This being so, it was quite evident that something had to be done and in casting about for remedies it seemed that perhaps the introduction of antiseptics might improve the position of affairs, especially as I had experienced considerable success in ovariotomy at that time. Accordingly, in 1882, having to deal with a strangulated femoral hernia in a female, I performed the ordinary operation antiseptically; but my patient, a woman aged 72, died on the eighth day of peritonitis. My next case was a man suffering from strangulated scrotal hernia, and in him I operated, again antiseptically, but thinking that the cause cf the fatal peritonitis in my previous case might have been want of free drainage (though there was no proof of this), I stitched up the wound except at the bottom, where I left a drainage tube in. I remember one of the infirmary residents said at the time, he thought the drainage tube calculated to prevent the proper influence of the antiseptic operation; but not knowing what better to do, I left
doi:10.1136/bmj.2.1405.1206 fatcat:kxbz6qpblja3jgjbnaiylg673a