Hernia, hydrocele and undescended testicle

Abstract

NY discussion of the subject of inguina1 A hernia in infants and chiIdren centers around statistics. These compiIed figures aIways tend to confirm the poIicies or concIusions of the author, or both. I aIso am guiIty, having reviewed 1,000 consecutive cases on my own service and presented the findings before the CentraI SurgicaI Association in 1961. This painstaking effort convinced me, at Ieast, that no one beyond the status of junior house officer is ever reaIIy influenced by the statistics and experiences of others. In 1922 HaIsted [I] commented on the subject of hernia as foIIows: “Indeed I have not seen a singIe paper since Bassini’s which contributed anything new.” Bassini’s Iast paper on the subject was probabIy the 1890 paper. My paper wiI1 certainIy do nothing to refute HaIsted’s views. With this in mind, I propose mereIy to state the present poIicies of the pediatric surgica1 section of the Mayo CIinic. Our present regimen for handIing patients with hernia is naturaIIy infIuenced by many factors, some of which are rather pecuIiar to the circumstances under which we practice surgery. I doubt that anything I say wiI1 aIter your present procedures and it is equaIIy probabIe that you wiI1 not change mine. The detection of a smaI1 inguina1 hernia in a pIump infant is usuaIIy based primariIy on the history and description by the parents. The percentage of unsuspected hernias detected at routine physica examination is reIativeIy smaI1 unIess some fuIIness or buIge has been noted by the famiIy, aIthough not recognized as a hernia. Attentive history taking, demonstration by the parents and carefu1 examination of the infant in a reIaxed position in a warm room are most IikeIy to revea1 a hernia. OccasionaIIy a11 methods fai1 and it may then be necessary to instruct the