A DETAILED UNDERSTANDING of the anatomy of hernias and their attendant classification was common knowledge by the beginning of the 19th century. However, despite their structural familiarity with this condition, surgeons knew that the incising and dissection of virginal fascial planes and the closing of a hernial defect with sutures would usually bring about severe postoperative complications while proving futile to curing the hernia and possibly leading to death. Although anesthesia was available, the concepts of antisepsis and asepsis were unknown; abscesses, putrefaction, and tissue sloughs represented the end result of open hernia surgery. For these reasons the inguinal canal was rarely dissected, and hernias were unable to be adequately repaired. Instead, absurd methods were used including the invagination of the skin and hernial sac with abrasive external sutures to block the defect, or even wilder attempts to slough the inguinal canal with injections of ammonia to promote the formation of mass scarring. It was not until the 1890s and the pioneering work of Edoardo Bassini (1844-1924) and William Halsted (1852-1922) that the modern hernioplasty would finally be developed.
From A Treatise on Hernia (1876) by Greensville Dowell, this plate demonstrates positions of hernia in the abdominal region (author's collection).
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