On a modification of the 'invagination' method of operating for the radical cure of hernia / by John H. Packard.

  • Packard, John H. (John Hooker), 1832-1907.
Date:
[1895]
Catalogue details

Licence: Public Domain Mark

Credit: On a modification of the 'invagination' method of operating for the radical cure of hernia / by John H. Packard. 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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    [Reftd before the Philadelphia Academy of Surgery. February 4, 1895.] ; IC~1 . Jl-' ' r / p T V ON A MODIFICATl6'}KQF.iTiJ^‘invagination METHOD OF 0PERATII?STOR THE RADICAL CURE OF HERNIA. By JOHN H. PACKARD, M.D. Surgeon to the Pennsylvcuiia Hospital and to the St. Joseph's Hospital. I THINK it can hardly be necessary to enter into any argument as to the desirableness of effecting the radical cure of hernia in every case where it is possible. My own experience is that there is great difficulty in getting trusses properly fitted, as well as in having them properly applied by the patients. Yet a truss badly made or wrongly put on may be worse than useless; it may cause suffering, and even danger to life. A radical cure can be accomplished in only one way: by doing away with the sac as such ; by obliterating the tube of peritoneum, like a glove-finger, through which the descent of bowel or of omentum takes place. This is the object aimed at in all the proposed procedures, which are very many. Sedillot, in the edition of his Medecine Operatoire published in 1855, enu- merated twenty-five, and his list was not then complete. The number has been very largely increased since that time, and especially, of course, since by the introduction and general adoption of antiseptic methods, the dangers of such interference have been in great measure set aside. Modern surgeons have suggested and put in practice much bolder modes of dealing with the problem than could formerly have been employed. By some, as Banks and McBurney, the sac is ligated and cut off as high up as possible. Barker cuts it off at the external ring and carries the stump up to be sutured into the internal ring. Ball twists it up and applies an intercolumnar suture. McEwen and Bishop crumple it up by means of “ drawing- string’’ sutures. Bassini’s and Halsted’s plans are to make a new canal and a new ring ; Landerer makes a plastic operation, trans- planting one of the columns of the external ring. Kocher car- ries the sac away from its position, angulating it twice, bringing it out through an artificial opening in the tendon of the external oblique muscle, and then twisting it. I do not propose to discuss these various methods, but venture to suggest another plan by which the hernial canal can be closed, I believe securely and permanently, and the object ac- complished in a simple way. I think it may be laid down as a sound rule of surgery, that in all operations there should be as little sacrifice and as little