Permanent cure of reducible hernia / by George Hayward ; presented to the American Medical Association, at its session of May, 1852.

  • Hayward, George, 1791-1863.
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: Permanent cure of reducible hernia / by George Hayward ; presented to the American Medical Association, at its session of May, 1852. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    the neck of the sac, its contents having been previously returned into the abdomen, and tying it so tightly as to cause all the parts below to slough. In inguinal hernia in the male, this, of course, destroyed the testicle. Another mode was to pass a needle with a ligature through the skin and around the neck of the sac, and then tie the ends of the ligature over a piece of wood placed on the integuments. The pres- sure could in this way be increased till sloughing was produced; and it was pretended by some who practised this operation that, if proper care was used, the sac only might be included in the ligature, and thus the testicle be saved. This, however, did not prove to be true; it was found that notwithstanding the utmost precaution, the sperm- atic cord was so much compressed that the functions of the testicle were lost, even if the organ itself was not destroyed. In order to obviate this difficulty, the operation by the punctum aureum, as it was called, a ligature of golden wire, was suggested and practised. An incision was made in the integuments, the sac laid bare, and a needle, armed with a wire of gold, was carried under the neck of the sac near the external ring. The ligature was tightened from time to time, and it was thought that the neck of the sac might in this way be sufficiently closed to prevent the return of the hernia, without destroying the spermatic cord. But such was not the fact. The same operation was performed with a common ligature, and sometimes with one of lead. But in all these methods, so much pressure was made on the spermatic vessels as to produce an atrophy if not an entire destruction of the testicle; and this circumstance, probably, more than anything else, led to the operation by Suture.—This method, because it did not destroy the virility of the patient, and would not consequently deprive him of the power of increasing the king's subjects, was called the royal stitch. There were two modes in which this operation was performed. The first step in both was to return the contents of the hernial sac. This being done, in one method a needle armed with a ligature was passed through the neck of the sac, which was sowed up by the continued suture, as is done in wounds of the intestines. No incision was made, but the needle was carried through the integuments. In the other method, the hernial sac was first laid bare, the con- tinued suture was used in the same way, and then a part or the whole of the sac below the suture was removed. In both cases the thread