Nothing more clearly demonstrates the evolution of surgical thought and practice than a comparison of the questions deemed of prime importance in relation to strangulated hernia at the extremes of two decades.
Prior to 1870, the question to be answered in every case was "Is the sac to be opened, or not." At the present, a condition is hardly to be conceived in which the operator would refrain from opening the peritoneal tunic, thoroughly inspecting the hernial contents and wherever feasible supplementing the relief with the radical operation.
Taxis, which then played so prominent a rôle in all cases has been accorded a more and more subordinate position, as its dangers ever increasing with the age of the strangulation were more fully appreciated, and in proportion as surgery sought the light for its manipulations in large and open wounds. Then, the teachings of the German and English schools regarding gangrenous
RANSOHOFF J. THE MANAGEMENT OF GANGRENOUS HERNIA, WITH REPORT OF A CASE. Read in the Section of Surgery and Anatomy, at the Forty-third Annual Meeting of the American Medical Association, held at Detroit, Mich., June, 1892. JAMA. 1892;XIX(7):198–200. doi:10.1001/jama.1892.02420070022001e
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