INDIANAPOLIS MEDICAL JOURNAL (Central States Medical Monitor and Indiana Medical Journal) CURRAN POPE, M. D., Louisville, Ky. F. F. HUTCHINS, M. D., Indianpolis. E. S. MCKEE, M. D., Cincinnati. E. D. CLARK, M. D., Indianpolis. J. N. HURTY, M. D., Indianapolis. W. H. FOREMAN, M. D., Indianapolis. J. O. STILLSON, M. D., Indianpolis. WALTER SCHELL, M. D., Terre Haute, Ind. * LIBRARY * INDIANAPOLIS MEDICAL JOURNAL (Central States Medical Monitor and Indiana Medical Journal) SAMUEL E. EARP, M. S., M. D., Editor-in-Chief. ALEMBERT W. BRAYTON, M. S., M. D., Editor. SIMON P. SCHERER, M. D., SAMUEL C. NORRIS, M. D., Associate Editors. COLLABORATORS Curran Pope, M. D., Louisville, Ky. George L. Chapman, M. D., Colo. Springs. J. N. Hurty, M. D., Indianapolis. This is an Independent Medical Journal whose columns are open for anything that will interest or instruct the profession. The Editor assumes no responsibility for the views of contributors. Vol. XVII. INDIANAPOLIS, IND., JANUARY 15, 1914. ORIGINAL COMMUNICATIONS. ADHESIONS AND HERNIA. By D. F. Lee, M. D., Indianapolis. Having discussed in a previous paper the dangers of the truss and the unsurgical procedure of trying to cure hernia by injecting the sack, I have purposely omitted reference to either of these in this paper. A slight reflection will show that a very large per cent. of cases of strangulation are the result of adhesions of some kind. It is equally true that nearly all cases of incarcerated hernia are so imprisoned by adhesions, and this is very important since in nearly every case, especially if the imprisoned part be intestine, it will sooner or later become obstructed or strangulated. The probability of existing adhesions shou'd be carefully considered before attempting reduction of a hernia by taxis. The extent of injury in strangulation often depends upon the character of adhesions in the case. A very extensive adhesion may exist No. 1 and not do serious harm, while a very narrow band may give rise to most serious obstruction of the bowel content, and at the same time produce rapid death of the intestine by obstructing its circulation. And, again, a broad adherent surface may so disorganize the gut wall by hypertrophy or softening, that resection will be necessary to prevent the dangers resulting from raw surfaces, or oozing, or, possibly to avoid the danger of contraction of cicatricial tissue; or, still again, to protect the peritoneum against the ravages of escaping pathogenic microbes. The various types of adhesions may be studied under three classifications. First, those taking place in the hernial canal; second, pre-existing intra-abdominal; third, post-operative intra-abdominal. Of the adhesions taking place within the hernial canal, the types are so varied |