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).
Thank you for submitting a comment on this article. It will be reviewed by JAMA Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.