Treatment of strangulated hernia : read in the Section on Surgery and Anatomy at the Forty-fifth Annual Meeting of the American Medical Association, held at San Francisco, June 5-8, 1894 / by Joseph Ransohoff.

  • Ransohoff, Joseph, 1853-1921.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Treatment of strangulated hernia : read in the Section on Surgery and Anatomy at the Forty-fifth Annual Meeting of the American Medical Association, held at San Francisco, June 5-8, 1894 / by Joseph Ransohoff. 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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    of the peritoneum, must be established by the finger within the belly cavity before the reduction of the hernia can be said to be assured. With a free sever- ance of adhesions about the neck of the sac, a mass reduction is not possible after herniotomy. When complications such as these follow herniotomy or taxis, the opening of the abdomen is justifiable. In no ordinary strangulated hernia, however, is hernio- celiotomy a proper procedure. Introduced as early as 1590 by Rosset and in 1723 by Cheselden, this chimera was almost forgotten until Mr. Tait made an effort to revive it in a paper before the British Medical Association, in 1891. Possibly of service for the radical relief, for reasons almost obvious it can have no place among procedures for strangulated hernia. The most important question entering into the treatment of this subject is what to do with gan- grenous hernia. Shall the constricting ring be divided? The theory was long advocated, and recently again promoted by Banks, that the constriction ring should ordinarily not be divided in gangrenous her- nia, on the ground that it bars the development of general peritonitis. By the constriction the septic products of a hernia may be isolated for a time. But the peritonitis develops from within, and that without the direct implication of the intestine. In a case of gangrenous hernia which contained only omentum, seen with Dr. Tilton, of Kentucky, death resulted from general peritonitis. Just beyond the neck of the sac was the colon fixed by the adherent omentum, and its wall rendered paretic through traction, was unable to resist the passage through it of organisms fatal to the peritoneum. Gangrene of the omentum is rare. Its safety is found in the ease with which it forms adhesions to the sac wall, through which it then receives its nutri- tion. The case alluded to is the only one I have seen. Benno Schmidt questions altogether the ex- istence of primary strangulation of the omentum.