Reprinted from the Columbus Medical Journal" of November, 1887. 
THE RADICAL CURE OF HERNIA. 
BY H. J. HERRICK, CLEVELAND, 
Professor State Medicine and Hygiene, Western Reserve University, MedT&Jtf. 
Department. 
Read before the Ohio State Medical Society, June, 1887. 
Surgical treatment for the radical cure of hernia, when there is no 
strangulation or immediate demand for surgical interference, has not be- 
come an established custom among physicians. Temporizing means with 
the truss, in some one of the varied ingenious forms, is the usage, and this 
even when the opening is so large that the protruding part can not be 
retained by truss of any device during labor and changing positions. 
It is the purpose of this paper to raise the question whether with the 
improved methods in surgery at the present day we should not advise, in 
certain cases, surgical treatment for radical cure. If so, in what cases 
and by what methods ? 
It is to be borne in mind that no method can be regarded as devoid 
of all danger, and that the patient will be willing to take certain chances 
in order to be free from the annoyance of truss and the possible danger 
from inflammation and strangulation at some unexpected time, and be- 
cause unexpected accompanied with greater danger. 
It is my conviction that more frequent resort to surgical means for 
radical cure is the duty of the surgeon to-day. It is my purpose, in 
attempting to sustain this conviction and also to point out the operation 
which I would advise, to report a case in detail. 
A. B„ aged 28, a German of regularity and good constitution, came 
to me July, 1885. He had scrotal hernia of both sides, the size of my 
fist, which he was unable to keep up with a truss; the openings were 
large, and any lifting or attempt at labor increased the size of the rupture 
very greatly. He was a single man, though he desired to marry, but in 
his present condition felt that he could not. He could not work with 
any comfort or safety, and under those conditions felt that life was with- 
out value to him. After a careful examination of the case and consulta- 2 
Communications. 
tion, I proposed the operation for the radical cure. I further concluded 
to operate upon both sides at the same operation. I was assisted by Dr. 
Dudley Allen, who also gave valuable counsel, and Dr. B. L. Millikin. 
The operation consisted in shaving off the hair and bathing the 
surface cleanly and applying towels wet in a solution of bichloride of mer- 
cury, i per thousand, around the parts to be incised. An incision was 
made from the scrotum along the course of the cord up to the external 
ring. Dissections were made down to the sac, and its contents forced 
back into the abdomen; the sac was then drawn out of its position in the 
scrotum and clamped between the handles of dressing forceps, when the 
sac was cut off, leaving space between the stumo of the sac and the for- 
ceps to stitch the edges together with a continued suture of fine silk, 
rendered aseptic by carbolic acid solution (i to 20). Having thus 
effectually closed the stump, it was pushed back into the abdomen. The 
edges of the ring were made bare and five sutures, half an inch apart, 
were used for bringing them with adjacent areolar tissue together. The 
sutures were of silk, larger in size than that used for the neck with the 
same aseptic precautions. In the same manner the deep fascia was 
brought together, and finally the integument and superficial fascia. The 
antiseptic care of cleanliness and mercuric bichloride (1 per 1000), was 
used, without the spray. Great care was taken to remove all lacerated 
tissue and coagula, and no drainage tube was used. The left side having 
thus been operated upon first, the right side was treated in the same 
manner. After the completion of the operation, the parts were thoroughly 
dusted with iodoform, antiseptic gauze was applied and absorbent cotton. 
The spica bandage was firmly applied, so as to offer support to the parts 
and keep the dressing firm. 
The operation was made July 2, and the dressing left until the 14th. 
The first day after the operation, owing, it was thought, to accumulation 
of water in bladder and flatus in rectum, fever rose to ioo°, but these 
conditions being relieved, the fever subsided and did not return during 
the course of recovery. Indeed, no unfavorable symptoms occurred, 
and when the dressing was removed, twelve days after operation, the 
wounds were effectually closed without suppuration. The superficial 
stitches were removed. No unfavorable results occurred from the deep 
ones. 
He left the hospital after about three weeks, perfectly cured. The 
operation was performed in July, 1885. I have heard from him since, 
and learn that he has no trouble whatever and no show of a return. Herrick.-Cure of Hernia. 
3 
In this operation I claim nothing in the procedure as new, unless it 
is the clamping of the neck and removing the sac, and finally the use of 
the continued suture for the closure of the stump. By this method the 
peritoneal cavity is not opened at all so as to allow entrance of any septic 
material; thus, perhaps, the greatest danger in the operation is averted. 
Indeed, from the facility of the operation, the ability to fully prepare 
the patient for the operation, and the absence of any unfavorable results, 
I feel impelled to urge the advisability of the operation, when before I 
had been very timid about such a procedure. I am satisfied that many 
men are enduring almost constant discomfort and danger where this 
operation, with the minimum risk, would offer complete recovery. I 
venture that most physicians in active practice have one or more victims 
with such hernias as render life hazardous and cause great suffering and 
care. 
The various means resorted to in former years, as the use of the sub- 
cutaneous ligature, or needle, or injections, have been presented with 
earnest advocates and skillful efforts, but all have been found wanting, 
according to the verdict of the profession. In later years, what has been 
termed the open or direct method has been used, with more flattering 
promise, for the relief of a large class of sufferers. 
Dr. Henry O. Marcy, of Boston, in a valuable paper before the 
American Medical Association, sets forth this method and its success in a 
very forcible way. His method differs from the one used by me in that 
he does not clamp the neck of the sac, thus effectually guarding against 
entrance of septic material into the peritoneal cavity; also in the use of 
animal fibre in each set of deep sutures. I regard the silk as an animal 
production, and when rendered aseptic it is preferable to any animal 
fibre, being more reliable for strength and less liable to loosen or slip. 
Other operators in late years have advised the "open method." 
Dr. John Woods' method, if fully understood by me, consists in an 
incision in the scrotum, by which operation the fundus of the sac is 
carried up into the ring and attached to its margin. The results, as given 
by him, are quite favorable, though the liability to recurrence, the cause 
of which is obvious, is a plea against its advisability. It seems to me to 
incur as much, or more, danger than the operation of Wutzer with the 
view of accomplishing very nearly the same results. In place of the 
scrotal incision he would use a staff for invaginating the sac, and that is 
armed with a needle and clamp, for fixing the fundus in the ring until 
adhesions are formed. 4 
Communications. 
The operation by injection, as advocated by Heaton and Warren, of 
Boston, and revived by W. B. DeGarmo, is also doomed to failure. 
Though quite favorable statistics are given as to the results, and large ex- 
pectations are raised, yet I am of the opinion that its adoption by the 
profession is not to be anticipated. It must be obvious, on a momentary 
reflection, that so long as the sac remains, or portions of it, there is a 
funnel like gathering of peritoneum which favors the descent of the organ 
which acts upon it constantly like a wedge to reopen what many have 
been completely or partially closed. The subcutaneous methods gener- 
ally may be regarded as failures, while they involve as much or more risk 
to the life of the patient. 
I have operated by Heaton's method-injecting the fluid extract of 
quercus alba-several times, at first getting such indurations and adhesions 
as to give promise of cure, but after a time the induration disappeared and 
the protrusion returned as before. It is claimed by DeGarmo that the 
operation is absolutely without danger, but judging from my own experi- 
ence and what I have observed from similar treatment by others, I am 
satisfied that this is an overstatement. 
I have certainly seen one case which one or two years after the 
treatment, suffered from disease of the omentum with peritonitis and 
death, results almost beyond question of the treatment of femoral hernia 
by injection. In cases operated on by me symptoms supervened which 
put from my mind the idea of perfect safety after such treatment. 
I am driven to the conclusion, that the direct open method is the only 
one that promises almost obsolute guarantee of cure with the least possi- 
ble danger. Besides, the whole procedure is rational and so perfectly 
under the supervision of the surgeon as to command considerate approval.