Hernia of the abdominal cicatrix and operations for its cure / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927
Date:
[1897]
Catalogue details

Licence: Public Domain Mark

Credit: Hernia of the abdominal cicatrix and operations for its cure / by Alban Doran. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    day. A month later she was reported as quite free from any of the trouble due to the hernia; she was under treatment for her nerve symptoms in the Marylebone Infirmary. It is clear that the above cases were forms of ventral hernia which could not have been treated after the fashion recommended by Mr. Greig Smith, and they displayed con- ditions which he seemed to consider as rare or non-existent in this kind of rupture. Operations of the kind just described are not without risk. I know of two fatal cases, in one of which inflammation of the parotid occurred. In analysing these four cases the first thing to note is the apparent cause of the hernia in each. In none could either the operator or his method be blamed. Thus the patient in Case 4 was half insane and considering her behaviour directly after the first operation it is remarkable that she did not sufEer from worse complications than hernia. In Case 1 the patient chose to wear an ill-fitting belt from the first without acquainting Mr. Hulke of the fact. How far her cerebral disease was the cause of carelessness on her part I cannot say. Case 3 is easily understood the incision was made through inflamed tissues for the relief of suppuration and drainage was necessary. There remains Case 2. Here the operator had to cut through an old cicatrix made for explora- tory purposes and he found it best to use the serre-nceud. Under such conditions hernia may develop notwithstanding the greatest care. As with these four cases so it is as a rule with most other instances of hernia of abdominal cica- trices, save where there has been manifestly undue hurry in removing the sutures or where the peritoneum has been taken up too far from its cut edge or where the operator has evidently been careless in regard to the bandaging or strapping of the wound. In all four cases the patient eagerly solicited an operation for the relief of her condition. In Case 3 an operation was urgent, the discomfort was extreme, and the hernia very large. The patient in Case 2 also , suffered badly, the neck of the sac was very sharp, and, as in Case- 3, the patient was perfectly competent to decide for herself. In the latter respect the matter was somewhat different in the first and last cases. In Case 1 the patient concealed from us the fact that she had suffered from disease. Her friends admitted that she dreaded to let the truth be known lest she might lose a situation. I fancy that I should not have operated had I known about the fit; hemiplegia is a much more serious matter than ventral hernia, and the
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