Notes on the radical cure of hernia / by W. Mitchell Banks.

  • Banks, W. Mitchell (William Mitchell), 1842-1904.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: Notes on the radical cure of hernia / by W. Mitchell Banks. 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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    cures has been done, I believe that the opinion is that for really bad cases of congenital hernia Spanton’s operation is not sufficiently curative, and that the only thing is removal of the sac and closure of the pillars of the ring. If it be admitted that in adults the only ruptures which need be tackled are those which cannot be satisfactorily kept up by a well made truss, we must next note the reasons why the said ruptures are not amenable to the operation of a supporting instrument. The first consists simply in the enormous size of the rupture itself, combined with great patency of the hernial aperture. Many ruptures by reason of neglect become so huge that no instrument can possibly hold them up, except by the exercise of a pressure which soon becomes unbearable. There is no doubt that these great herniae most emphatically stand in need of radical cure, but there has been a natural tendency to fight shy of them on account of the magnitude and danger of the operations which have to be performed. I have lately been attacking specimens of very great size, and am beginning to get over my dread of them, but there is no doubt that some of the operations have been very extensive, and have given rise to no little auxiety. Like ovariotomy, they were certainly of a kind that forty years ago would have subjected anyone who did them and failed to a criminal prosecution. In the case of very large ruptures, it is, therefore, only right fully to explain to the patients that they run a not inconsiderable amount of risk, and to leave pretty much with themselves the decision of what is to be done. For, after all, one must remember that a person with a very big and very troublesome rupture may live long enough, and do plenty of good work; consequently, a death from an “operation of convenience,” which, perhaps, has been urged upon the patient by the surgeon, is a source of great regret and mortification to him, as I myself experienced in the only fatal case which I have yet had. Of course, in this, as in every other surgical operation, one must take into account the age and strength of the patient. To operate upon a broken down used up old man of three score and ten, with a rupture as big as his head, is only to court destruction. The operation is one which