Hernias

‘A Hernia is a preternatural Tumor, which happens in the Circumference of the Belly, and is occasion’d by some solid Parts, or the settling of some Humours’.

René-Jacques Croissant de Garengeot, A treatise of chirurgical operations, according to the mechanism of the parts of the humane body, and the theory and practice of the most Learned
(London, 1723), p. 84.

Pierre Dionis, Cours d’operations de chirurgie, demonstrées au Jardin Royal … (Paris, 1714), fig. XXI facing p. 267.

Today hernias are usually divided into the following common types: inguinal (inner groin), femoral (outer groin), umbilical (belly button), incisional (resulting from an incision), and hiatal (upper stomach). They are caused by an organ or fatty tissue pushing through surrounding muscle. Worth was clearly interested in hernias as he bought a number of texts specifically on their treatment: Nicolas Lequin’s Traité des Hernies (Paris, 1690); Jean Piochon de Launay’s Instructions necessaires pour ceux qui sont incommodés des décentes (Paris, 1690) and Antoine Lequin’s Le chirurgien herniare (Paris, 1697).

Besides these treatises specifically devoted to treatment of hernias many of Worth’s surgical books incorporated discussions of different types of hernia and their treatment for, as De Moulin notes, ‘ruptures’ was a particularly frequent topic in surgical textbooks of the period.[1] Surgical intervention was not always preferred. The seventeenth-century Dutch surgeon, Paul Barbette (1620-65), advocated the use of ointment and bandaging (trusses) for inguinal hernias and, as we see in this illustration from the later French surgeon Pierre Dionis (1643-1718), the use of bandaging in the treatment of hernias was a common practice. This didn’t treat the cause of the hernia but it helped keep it in place.

Portrait of René Jacques Croissant de Garengeot by Ambroise Tardieu, courtesy of the National Library of Medicine.

The rare ‘De Garengeot hernia’ (where the vermiform appendix is included within the femoral hernia) was named after René Jacques Croissant de Garengeot (1688-1759), another author whose work was collected by Worth. In the preface to his Traité des operations de chirurgie (Paris, 1720), De Garengeot mentions three contemporary famous French surgeons in the preface to his work: Jean Baptiste Verduc, Joseph de La Charrière and M. de La Vaugion (texts by all three were collected by Worth). To these names one might add Pierre Dionis and Henry-François Le Dran (1685-1770), whose works were also bought by Worth. Together they represent the early eighteenth-century French school of surgery which drew surgeons from far and wide. Works by all of these French surgeons were quickly translated and reprinted – for example De Garengeot’s Traité des operations de chirurgie (Paris, 1720) was translated into English in 1723 and Worth’s other book by him, his 1723 text on surgical instruments, was translated into Dutch in 1728.

René Jacques Croissant de Garengeot, Nouveau traité des instrumens de chirurgie les plus utiles; et de plusieurs nouvelles machines propres pour les maladies des os. … Par René Jacques Croissant de Garengeot … (Paris, 1723), vol. I, plate facing p. 243.

In this image, from Worth’s copy of De Garengeot’s text on surgical instruments, we see the ‘bistouri herniare’, an instrument used by the French School of Surgery when surgical intervention was deemed necessary. But what actually caused hernias? La Vauguion, writing in 1698, offered his readers the following explanation:

The Causes are External or Internal.

‘The External Causes are Violent Blows, Rude Shaking, Long Races, Dancing, Leaping, continual Bawling, Frequent Debauches with Women, and generally all violent Exercises. The Internal Causes are first the copious Defluxion of Serosities separated from the Glands of the Guts, Groin and Peritoneum, which plentifully watering these parts, dispose them to yield to all Impulsions. The second cause is the great quantity of Fat and Oleous parts in the Omentum and Mesentery, which smear and grease the Fibres of the Peritoneum and by this means soften, relax, and dispose them to dilate and yield to the Motion, and pushing forwards of those parts which form Hernias. For this reason all Persons who eat much Oyle in their Diet, are more subject to inconveniences of this kind than others. Windy Dyet contributes very much to the rise of Hernias ; for the included Air by its Rarefaction distends the Guts, which push forward on the Peritoneum, and enter its Productions’.[2]

Sources

De Garengeot, René-Jacques Croissant, A treatise of chirurgical operations, according to the mechanism of the parts of the humane body, and the theory and practice of the most Learned (London, 1723). This is an English translation of Worth’s copy of De Garengeot’s Traité des operations de chirurgie (Paris, 1720).

De Moulin, Daniel, A History of Surgery (Dordrecht, 1988).

De Vauguion, M., A compleat body of chirurgical operations, containing the whole practice of surgery. With observations and remarks on each case … (London, 1707). This is an English translation of Worth’s copy of Vauguion’s Traité complet des operations de chirurgie (Paris, 1698).

Talini, Carolina et al. ‘De Garengeot hernia: Case report and review’, Int J Surg Case Rep., vol. 8 (2015), 35-37.

Text : Dr Elizabethanne Boran, Librarian of the Edward Worth Library, Dublin.

[1] De Moulin, Daniel, A History of Surgery (Dordrecht, 1988), p. 230.

[2] De Vauguion, M., A compleat body of chirurgical operations, containing the whole practice of surgery. With observations and remarks on each case … (London, 1707), pp 36-7.