scrotum.”^32 Stated simply, a weakness in the lower abdominal wall allows
your “guts” to billow through. Every medical student remembers the photo
of a man with a hernia so massive it spilled dozens of pounds of intestines
into his scrotum, necessitating ambulation with a wheelbarrow in front of
him. I shudder just thinking about it.
The loop of bowel that pokes through the abdominal wall can become
strangulated, hastening death, but typically, the hernia patient presents
with non-life-threatening complaints of pain and unsightly swelling. With
no effective treatment, and a tacit “you’re not dying,” physicians were
accustomed to brushing away patients. That all changed on June 13, 1889.
Halsted was not the first to attempt hernia repair, just the first to report
(in English) a dramatically effective technique. Of course, it was based on
scientific analysis of the anatomical structures. He had performed
numerous fastidious dissections, comprehending that deep repair of the
tough fascia and muscles to the stout inguinal ligament, and reinforcing
the internal abdominal ring, were the keys to a successful repair. Making
an incision in the groin area, Halsted would discerningly tease the tissue
layers apart, protect the spermatic cord, excise the hernia sack, and suture
the appropriate layers together. The Halsted repair was born.
Halsted presented his technique in late 1889 at the Johns Hopkins
Hospital Medical Society, and published his report in January 1890. In
retrospect, Edoardo Bassini, an Italian surgeon in Padua, had
independently published a similar procedure (in Italian) a couple months
before, leading some academics to give dual credit to Bassini and Halsted.
Rapidly, patients came streaming from all over the country to have Halsted
repair their hernias.
Further refinement by Halsted, and his star residents, drove the success
rate even higher. One of Halsted’s great legacies was Henry Cushing,
another Yale graduate, who would refine the hernia repair of Halsted to
include the use of cocaine anesthesia. (Cushing would become the father
of neurosurgery, and his face can be seen on the logo of the American
Association of Neurological Surgeons.) Today’s technique of hernia repair
is technologically different than the Halsted/Bassini approach, but the
significance of Halsted’s intervention for a serious condition, under
elective scheduling, shocked the trajectory of hospital care. Just a few
decades before, hospitals were only death houses, and no one (in their
right mind) would consult with a surgeon when relatively well.
marcin
(Marcin)
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