Proceedings of the Westminster Medical Society. Nos. 1-3 (session 1848-1849).

  • Westminster Medical Society (London, England)
Date:
[1848-1849]
Catalogue details

Licence: Public Domain Mark

Credit: Proceedings of the Westminster Medical Society. Nos. 1-3 (session 1848-1849). 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.

    74/76 (page 74)
    Mr. Nunn exhibited a Perinaeal Bandage, which he had found useful in Prolapsus Uteri, and where the abdomen required support. A band passes round the abdomen, and from each side there descends a strap, which passes between the thighs, and is fastened on the opposite side to the abdominal band. He had found it supersede the necessity for a pessary. Mr. Hancock read a paper on the Operation for Strangulated Hernia. The recommendation of not opening the sac, he stated, has recently been brought prominently under the notice of the profes- sion, and has at various times been ably advocated by Petit, Le Dran, Monro, Sir C. Bell, Bransby Cooper, Aston Key, Luke, and Gay, in whose hands it has been successful, particularly in those of Mr. Luke; whilst the statistics advanced by the latter gentleman certainly appear, at first sight, greatly to favour this mode of pro- ceeding. On the other hand, it has also been as ably opposed by men of eminence—viz., Dupuytren, Richter, Hey, Heister, Sir A. Cooper, (excepting in old and large incarcerated hernia,) Law- rence, Listen, and Lizars, and more recently by South. A closer inquiry, however, into the statistics and arguments adduced in favour of this operation, tends greatly to diminish its claims to superiority, and proves that the mortality after operations for strangulated hernia depends, in most instances, upon causes entirely independent of the operation; that opening the sac does not, in reality, increase the danger, but that, on the contrary, the advan- tages of this method are so great, that, as a general rule, it ought to be adopted as the safer mode, and as presenting the greater cer- tainty of success. It having been urged by the advocates of Petit's operation, that by its adoption we avoid the following dangers—viz. Peritoneal inflammation consequent upon the exposure of an inflamed or strangulated portion of the bowel, which, accord- ing to Key, is the cause of death in the majority of cases; Haemorrhage into the cavity of the abdomen, should a vessel be wounded; Risk of wounding the intestine; Opening the sac, and thereby laying bare the peritoneal cavity of the abdomen; Immediate manipulation of parts so important to life; and, according to Gay, inducing unhealthy processes in the ex- ternal wound;— the author asks, in the first place, are these objections valid or tenable? Have not the surgeons in question, in their anxiety to support their own particular views, overlooked the real causes of failure, and grasped at the shadow whilst they neglected the sub- stance? The published records of strangulated hernia cause a feeling of surprise in the minds of the readers; not that the mor- tality has been so great, l)ut that it has not been grcatLa-, as every