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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    is drawn up tight, pulling the plug formed of the sac into place at the internal ring; its two ends are tied on the outer surface of the tendon of the external oblique, and cut off short. The skin-flap is laid over in place again, the wound closed by sutures, and the ordinary antiseptic dressings applied. Until the wound is completely healed the patient is kept in bed. I have not put a truss on any of the patients recently sub- jected to this operation, but have cautioned them-Sgainst rnaking any muscular effort likely to bring undue stress upon the parts until time enough has elapsed for their consolidation. As to the ultimate results of this operation I have no cases of sufficient duration to enable me-to speak positively. A man, aged twenty-two years, operated on October 24th, is present for your examination this evening; he does full work as an orderly at the Pennsylvania Hospital without either truss or discomfort. To my disappointment, a boy, aged twelve years, operated on December 12th, has failed to be here; there is no sign of yield- ing of the plug, though he is running about as heedlessly as any boy of his age. A man, aged forty-nine years, operated on at the same time, seems also to be completely relieved. On January loth I operated on a man aged fifty-four years, at St. Joseph’s Hospital; he has since had a severe bronchitis, but his hernia seems entirely controlled, and he is now going about freely. Another man, aged thirty-two years, in the Pennsyl- vania Hospital, operated on January 7th, is still under treatment. Of four other cases, including the first one, operated on in September, 1890, I will not speak, as they passed completely out of my knowledge too early for the results to be determined. I am well aware that my array of cases is very small, but the first two above mentioned and the fourth afforded pretty severe tests of the efficiency of the closure of the canal. I offer the method as one which seems to me sound in principle and prom- ising well; moreover, in case of its failure, the parts are in condition for the repetition of this procedure or for the adop- tion of any other that may commend itself. Of course, there must be an exercise of judgment as to the suitableness of any mode of operation in any given case. I think there would be difficulty in adopting the one now described in cases of congenital hernia; and whenever for any reason the sac must be extensively opened it would have to be carefully sutured before invaginating it. And I believe that it might not answer well if the canal and internal ring were very wide