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Foremost among the obstacles which formerly stood in the way of success with radical cure of hernia was sepsis. This was no more true of hernia than of other abdominal work, but in the days now past when all wounds suppurated in the course of healing and when it was rightly thought that opening into the peritoneum was almost a sin, hernia work could not and did not prosper.
Directly dependant upon this obstacle of sepsis (including septic peritonitis) was that of timidity or conservatism, which acted as a blight upon the best surgeons up to about the time of Macewen's method. This tended in two ways to prevent progress: 1, by limiting the extent of the work, thus promoting half measures; 2, by leading many authorities to condemn radical-cure work altogether.
A third obstacle to success by operators of the past has been the extreme multiplicity of operations proposed
ANDREWS EW. PAST AND PRESENT OBSTACLES TO THE RADICAL CURE OF HERNIA, WITH DEMONSTRATIONS. JAMA. 1897;XXVIII(19):868–871. doi:10.1001/jama.1897.02440190006002
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