Remarks on the modes of proceeding in regard to the hernial sac in the operation for strangulated hernia / by William Pirrie.

  • William Pirrie
Date:
1848
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Licence: Public Domain Mark

Credit: Remarks on the modes of proceeding in regard to the hernial sac in the operation for strangulated hernia / by William Pirrie. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    of large and old hemiEe, where the more judicious proceeding is to divide the stricture, and not to attempt reduction. The plan of not opening the sac, although practifeed in certain cases by Franco and Par^, was first strongly recommended by Petit, and consequently has been designated the method of Petit, to dis- tinguish it from the mode in common use. Petit practised this method as early as 1718. It was subsequently advocated by Ga- rengeot; and, at a still later period, adopted and strongly recom- mended by Bonnet of Lyons. In this country it was introduced by the second Monro, who advocated its adoption in cases of small and recent hernia, and men- tioned four cases in which he resorted to that mode of proceeding. In one of them, however, adhesions prevented the return of the hernia, and in two of them he was obliged to cut the neck of the sac. Li later times, the same proceeding was adopted by Sir Astley Cooper in cases of large and old hernise, and strongly re- commended by him as the decidedly preferable mode in cases of that class. Mr Lawrence, in his valuable Treatise on Ruptures, remarks, The plan of removing the stricture, and returning the prolapsed parts AAathout opening the sac at all, ought, I think, to be more frequently adopted than it has hitherto been, although it ap- pears objectionable as a measure of general use, in the operation for strangulated hernia. To Mr Key, however, the merit midoubtedly belongs of having recommended a more general adoption of Petit's mode than had previously prevailed in this country. In his admi- rable Memoir on the Advantages and Practicability of dividing the Stricture in Strangulated Hernia on the Outside of the Sac, published in 1833, will be found much valuable information on this interesting subject. Mr Luke of the London hospital strongly recommends this mode, and his success is a decided testimony in its favour. Out of nearly forty patients he has not lost more than two. In October 1845, when I had occasion to be in London, 'Mr Listen showed me a patient in the North London hospital, in whose case he had adopted this mode; and, in a communication I afterwai'ds received from him, he informed me that he had practised it in a few other instances, and felt convinced of its being the preferable mode when the hernia is small and recent, and when there is no reason to apprehend an unsound state of the intestine. And, judging from the recorded statements of some other distinguished surgeons, this mode seems to be meeting with deservedly increased favour; and I have no doubt will continue to do so, if practised under the limitations already mentioned. There can be no doubt that intestinal inflannnation is the most frequent cause of death after the operation for strangulated hernia. Some of the advocates of Petit's method have assigned as the causes of that inflammation, when the ordinary proceeding is adopted, the exposure of tlie intestine to light and air, change of temperature, and handling. I agree with Mr Lawrence in ascribing it not to
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