Avicenna recommends the cautery, but does not describe the other operation. Haly’s description is evidently taken from our author. (Pract. ix, 50.)
Rhases states correctly that hernia generally arises from dilatation of the passage which leads from the cavity of the abdomen to the testicle. In ordinary cases, he says, there is no rupture of the peritoneum. He states that the contents of the hernial tumour are either intestines or omentum. The omentum, he adds, is the intestine most commonly found in ruptures. He says the peritoneum (sifac) lines the whole intestines and surrounds the testicles. Antyllus, from whom he gives a subsequent extract, states in like manner that the peritoneum descends to the testicles and forms the tunica elytroides, i. e. vaginalis. Antyllus also affirms that hernia arises from relaxation of the passage between the cavity of the abdomen and the testicles. This opinion regarding ruptures is maintained by several of the authorities quoted by Rhases. (Contin. xxiv.)
Sprengel says of Rhases: “Sa théorie des hernies proprement dites est infiniment préférable à celle des Grecs.” (Hist. de la Méd.) The account which Rhases gives of ruptures is, no doubt, very correct; but there is every reason to suppose that it was entirely taken from the works of the Greek surgeons.
The operations practised by the ancients for the radical cure of hernia cannot but appear to us extremely cruel and hazardous; and yet the danger attending them must have been less than is generally supposed, otherwise they could not have been so frequently performed as they were about two centuries ago. Fabricius ab Aquapendente mentions that a celebrated rupture doctor of his time informed him that he used to operate upon 200 patients at an average every year. Fabricius, however, prudently recommends us not to perform the operation except in extreme cases, and to be content in general with supporting the parts by means of a truss.
The ancients never operated to relieve strangulated hernia.
SECT. LXVI.—ON BUBONOCELE, OR INGUINAL HERNIA.
Enterocele arising from distension commences as bubonocele; for at first the peritoneum being stretched the relaxed intestine is protruded as far as the groin, and forms this disease, which the ancients operated upon in this manner. After making the incision to the extent of three fingers’ breadth transversely across the tumour in the groin, and removing the membranes and fat, and the peritoneum being exposed in the middle where it is raised up to a point, let the knob of a probe be applied, by which the intestines will be pressed deep down. The prominences, then, of the peritoneum formed on each side of the knob of the probe are to be united to one another by sutures, and then we extract the probe, neither cutting the peritoneum nor removing the testicle, nor anything else, but curing it with the applications for fresh wounds. But since burning in cases of bubonocele is preferred by most of the moderns it will be right for us to give an account of this operation. After the man has undergone moderate exercise, let him cough violently and strain to keep in his breath; and when the swelling appears at the groin we mark with black ink or collyrium the place that is to be burned in a triangular figure, making its transverse line above in the situation of the groin, and we also make a mark in the middle of the triangle. Having laid the patient in a recumbent posture we first apply to the mark in the middle nail-shaped cauteries heated in the fire, afterwards burn the sides of the triangle with gamma-shaped (Γ) cauteries, and afterward level the triangle with cauteries shaped like tiles or lentils, an assistant during the whole process of burning wiping away the ichorous discharges with a rag; and in those who are of a moderate habit of body the burning should be carried to such a depth as to touch the fat. But in those who are lean we must not attend to this mark lest by mistake we should burn the peritoneum; nor again in those who are grosser and fatter, for in them the fat appears before a sufficient burning has taken place. We must, therefore, be rather guided as to its extent by a skilful conjecture. After the burning, having triturated salts with leeks we apply them to the eschar, and use the inguinal bandage shaped like the Greek letter Χ. On the following days we complete the cure with the dressings fitting for eschars, such as lentils with honey, and the like.
Commentary. Celsus directs us, when the inguinal tumour is moderate in size, to make one incision; but if larger, he recommends two lines to be made, so that the middle may be cut out; then, without extracting the testicle, as advised in certain cases of prolapsed intestines, the veins are to be bound together and tied where they adhere to the tunics, and afterwards cut below the knots. (vii, 24.)
Avicenna speaks of astringent applications and the actual cautery, but disapproves of the incision and suture. (iii, 22, 1.)