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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    fails, herniotomy can not be too soon performed. 'KELOTOMY. An operation for strangulation is per se, not dan- gerous. The measure of its gravity is formulated by the condition of the parts and of the patient at the time of operation. I have had thirty-seven opera- tions for strangulated hernia. Of these, six ended in death, two from gangrene and peritonitis, one from pneumonia in a man of 70, one from heart failure in a woman with aortic regurgitation, and one through an error in judgment in adding the radical to the relief operation in a large scrotal hernia. In the sixth case, laparotomy was performed for reduction en masse. The intestine, which seemed viable at the time of the operation by lamplight, gave way on the fifth day. With my present kuowledge the deaths from heart failure and pneumonia might have been averted, by substituting cocain for general auesthesia, since in neither patient could it have been a question of radical operation. In a case recently seen with Dr. Topmiller, I made the relief operation, removing a mass of omentum the size of a walnut, and returned the intestine without inflicting enough suffering to elicit a moan. The patient was 68 years of age and the subject of cardiac asthma. From the foregoing limited experience, the conclu- sion is justified that in an otherwise healthy individ- ual, death does not follow herniotomy, except as a consequence of grave changes in the hernial contents or within the abdominal cavity. The full statistics of Hagedorn of 170 operations fully bears out this view, it includes cases treated between 1883 and 1890. The general mortality was 14 per cent. The death rate was nil in cases in which the large intestine was involved; 48 per cent, in cases where the small in- testine and omentum were unchanged; from 22 to 38 per cent, in cases where it was ecchymotic or sus- pected of gangrene. These results are a vast im- provement on those given by Benno Schmidt, Rose