The do-it-yourself hernia operation

Case of strangulated herniaIn the nineteenth century medical attention was a luxury which had to be paid for, and which not all could afford.  What, then, would you do if you were living in abject poverty and developed a serious illness?  Many people put their faith in traditional remedies or prayer; a few took matters into their own hands.

Here’s a tale from the Provincial Medical Journal, published in 1843, which describes a scene with which many doctors must have been familiar.  The report is written by James Parsons, a surgeon from Bridgwater:

On the 3rd April, 1841, I was summoned in a great hurry to a parish six miles distant, to see James Brown, aged forty-five, who, the messenger informed me, had wounded himself in the abdomen with a razor. On my arrival, about an hour after the accident, I ascertained that he had been the subject of a reducible congenital hernia of the right side, but for which he had never worn a truss, and which had never given him any uneasiness until the morning of this day, when, on returning home at one o’clock from being actively engaged in putting up a mud wall, and exerting himself in lifting heavy batches of mud to the top of its surface, he felt very uneasy, and was unable, as usual, to return the protrusion; it soon became much more painful and very tender, and, repeated attempts on his part failing to reduce it, he made a sudden gash across the neck of the swelling with a razor; a dark-colored fluid immediately escaped with considerable haemorrhage, so much so as to induce fainting, on partial recovery from which he succeeded in reducing the hernia.

Mr Parsons found an incision of about three inches in length. The bleeding had stopped, but the patient was not well:

He was in a state of great collapse, with a very small and feeble pulse; warmth and restoratives, soon, however, succeeded in bringing on reaction, and no more haemorrhage occurring, the wound was brought together by suture and adhesive plaster. In the evening, some pain and restlessness coming on, he was ordered five grains of calomel and two of opium.

The following day Mr Parsons returned, and found that his patient had managed to get some sleep, but was still in great pain. The surgeon prescribed some medicines.

Ordered one ounce of castor oil directly; twelve leeches to the abdomen and warm fomentations; also every four hours:

Mercury with chalk, five grains; Powdered compound ipecacuanha, three grains with the following draught:-

Liquor of acetate of ammonia, two drachms; Spirit of nitric ether, fifteen minims; Saline mixture, ten drachms.

Under this treatment the patient’s condition rapidly improved, and a few days later he was able to get out of bed and resume his normal work.  But a few weeks later, after a long walk, he began to experience renewed pain.

In spite of active antiphlogistic treatment these symptoms gradually increased until May 9th, when fluctuation being very evident throughout the whole extent of the swelling, an incision was made at the most depending part, and extended upwards into the inguinal canal, laying open the whole extent of the sac, and giving exit to about four ounces of foetid pus; granulations quickly sprung up, filling the whole cavity of the sac and inguinal canal with solid matter.

Despite his unwise attempt at do-it-yourself surgery, the patient made a complete recovery.

No descent of the hernia has ever since occurred; he wears no kind of support, says he is stronger and better than ever he was, and does not regret the operation he performed for himself, to which I can bear my willing testimony, having seen him only a few days ago engaged at his old occupation putting up a mud house, to supply the loss of his own, recently destroyed by fire.

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