COMPLICATIONS. — Orchitis occasion ally follows operation, especially if the hernim have been of the congenital type and of large size. The application of an ice-bag for a few days always relieves this condition. In adult cases it is of great advantage, immediately after oper ation, to apply a strip of rubber plaster, about two inches wide, across the thighs in such a way as to form a support for the testes. It prevents any dragging on the cord and adds much to the comfort of the patient.
Injury to the Cord.—If the operation is performed with due care, there is no danger of injuring the cord, even in chil dren. If the bleeding vessels are at once caught and tied, the wound kept clean, the different layers of tissue can be recog nized as easily as in a dissection on the cadaver. Bassini's operation cannot be properly performed unless this be done.
Atrophy of the Testis.—When Bassini's operation was first introduced, atrophy of the testis was regarded as a possible danger, and this deterred some surgeons from employing the method. Not a single case of atrophy of the testis has been observed by Dr. Bull and me in over 650 of Bassini operations. Cases of atrophy have been occasionally ob served after Halsted's operation, by Dr. Halsted himself, as well as by other sur geons. O'Connor very recently reported 20 per cent. of atrophy of the testis in 129 cases operated upon by Halsted's method.
Study of 459 cases of hernia operated on in the Johns Hopkins Hospital from June, 1SS9, to January, 1S99, with spe cial consideration of 26S cases operated on by the Halsted method, and the trans plantation of the reetus muscle in certain eases of inguinal hernia in which the con joined tendon is obliterated.
For a non-strangulated hernia: The probabilities of failure are less than V2 of 1 per cent.; of pneumonia, if a gen eral anaesthetic is given, 1/2 per cent.; of phlebitis of the leg, 0.7 per cent.; of suppuration from the wound, 4 per cent., and, since the introduction of gloves, less than 1 per cent.; of a recurrence of the hernia, if femoral, none; if umbilical or ventral, in which the recti muscle can be included by the suture, none; if the muscles are too widely separated to be included by the suture, 20 per cent.; if an inguinal hernia, less than 4 per cent. Now that the rectus muscle is transplanted when the conjoined tendon is obliterated, that the size of the cord is diminished by the excision of the veins or the splitting of the cord, transplanting the veins only, the percentage of recur rence will be reduced much below 4 per cent. Thus far in cases in which these
modifications have been introduced there has been no recurrence.
Pneumonia following the general anws thetic is the chief danger in operations for hernia; there were 5 cases (1.2 per cent.) in non-strangulated hernia, 2 of which died later of tuberculosis of the lungs. In 15 cases of strangulated her nia in which the gut was gangrenous, or in which peritonitis was present before operation, 14 died. Twenty-five per cent. of these showed evidences of a broncho pneumonia at the autopsy; in 1 case it was the cause of death (the suture for the gangrenous cut was successful) ; in 13 cases peritonitis was also present. Bloodgood (Johns Hopkins Hosp. Re ports, Nos. 5, 6, 7, 8, and 9, vol. vii, '99).
Many relapses follow the operations of Bassini and Halsted because so much destruction of the normal muscular tis sue has taken place from the long con tinuance of the condition that it is im possible, by these methods, to sustain the pressure from within. It is also due to the fact that there is no effort made on the part of the surgeon to reproduce the tissue which has been destroyed by pressure, and to prevent the stretching of the connective tissue which always re sults from wound-healing. McBurney's operation has also been followed by the most lamentable relapses. The follow ing procedure proposed to insure the re production of large masses of inflamma tory material to restore the abdominal parietes: 1. The introduction of a fine silver wire-filigree throughout the entire inguinal canal, over the transversalis fascia, which adds to the strength of the weakened abdominal parietes and pre vents the new material from stretching. 2. Cutting off the hernial sac, and re treating from the operation exactly as from any abdominal operation, stitching up the peritoneum and transversalis fascia with a continued suture of fine silver wire. 3. The use of fine silver wire with a continued suture. Steriliza tion of the wire, after it has been thor oughly boiled or steamed, is obtained by immersing it into pure carbolic acid a few minutes before the operation, dip ping in alcohol, then holding it over an alcohol-lamp until the alcohol is burned off. Drainage should be avoided if pos sible; but if necessary in thick, abdom inal walls with much fat, a glass drain may be used. Phelps (Med. Record, Feb. 2, 1901).