Chauliac was particularly interested in the radical cure of hernia, and he
discusses six different operations for this purpose. Gurlt points out that
Chauliac's criticism of these operations is quite modern in its viewpoint.
He declared that practically the object of radical operations for hernia
is to produce a strong, firm tissue support over the ring through which
the cord passes, so that the intestines cannot descend through it. It is
rather interesting to find that the surgeons of this time tried to
obliterate the canal by means of the cautery, or inflammation-producing
agents--arsenic and the like--a practice that recalls some methods still
used more or less irregularly. They also used gold wire as a support; it
was to be left in the tissues, and was supposed to protect and strengthen
the closure of the ring. At this time all these operations for the radical
cure of hernia involved the sacrifice of the testicle, because the old
surgeons wanted to obliterate the ring completely, and thought this the
easiest way. Chauliac criticizes the operation in this respect, but says
that he has "seen many cases in which men possessed of but one testicle
have procreated, and this is a problem where the lesser of two evils is
to be chosen."
While he discussed hernia operations so freely, the great French surgeon
did not believe that everyone who suffered from a hernia ought to be
submitted to an operation. He quite agreed with Mondeville who, in the
preceding generation, declared that many operations for hernia were done
not for the benefit of the patient but for the benefit of the surgeon--a
mode of expression that is likely to strike a sympathetic chord in some
physicians' minds even at the present time. Chauliac's rule was that no
operation should be attempted unless the patient's life was put in danger
by the hernia, but that a truss should be worn to retain it. He emphasized
that trusses should not be made according to rule, but must be adapted to
each individual, and he invented several forms of trusses himself. He
developed the method of taxis by which hernias might be reduced, suggested
an exaggerated Trendelenburg position for operations for hernia and for
the manipulations necessary for the reduction of hernia.
Public-domain text, read in full here on John Shaqi.
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