A REVIEW
OF A
REPORT OF A COMMITTEE
OF THE
AMERICAN MEDICAL ASSOCIATION,
ON THE
PERMANENT CURE
OF
REDUCIBLE HERNIA OR RUPTURE.
BY GEORGE HEATON, M.D.
Member of the Mass. Med. Soc.; Fellow of the Royal Society of Physicians and Surgeons, London; of
the Westminster and London Medical Societies; of the Parisian Medical Society of France, &c.
FIAT JUSTITIA, RUANT PRINCIPES ATHENARUM.-Antiq. Fab.
BOSTON:
PRINTED BY WILLIAM CHADWICK,
EXCHANGE STREET.
1853.


A
REVIEW
OF A
REPORT OF A COMMITTEE
OF THE
AMERICAN MEDICAL ASSOCIATION
ON THE
PERMANENT CURE
OF
REDUCIBLE HERNIA OR RUPTURE.
BY GEORGE HEATON, M.D.
Member of Mass. Med. Soc; Fellow of the Royal Society of Physicians and Surgeons, London; of the West-
minster and London Medical Societies; of the Parisian Medical Society of France, &c.
FIAT JUSTITIA, RUANT PRINCIPES ATHENARUM.-Antiq. Fab.
BOSTON:
PRINTED BY WILLIAM CHADWICK,
EXCHANGE STREET.
1853.

BEBOEL OL 7 COMUULLEE
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REVIEW.
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A Committee appointed by the American Medical Association, to
investigate the subject of the permanent cure of Reducible Hernia,
having made a report on the same, wherein they come to certain
conclusions, which a long and extensive experience in the treatment
of Hernia has convinced me to be unsustained by facts, and make
a certain statement in regard to me which is not true, basing
thereon some reflections alike unwarrantable and unworthy of hon-
orable men, I am induced to submit the following review of the
Report to the consideration of the profession.
Before considering the subject matter of the report, I will notice
briefly the particular portion which the Committee have seen fit to
devote to me. o
In speaking of certain communications received by them from
various sources, they say:
ht
"The writer of the fourth letter, George Heaton, M. D., of Bos-
ton, has devoted himself pretty extensively to the treatment of
Reducible Hernia, and had given notice to that effect, from time to
time, for some years, in medical and other publications. *
The Committee, therefore, sent him not only a copy of the ques-
tions which they had addressed to the profession at large, but they
also wrote him a private note, couched in the most respectful
terms. To this he made a courteous reply, but, at the same time,
declined giving the information sought for. Not content with this,
he caused the note addressed to him, and his answer, to be printed
in several newspapers, which has, in our opinion, given him a
notoriety, wherever the transaction is known, of a very unenviable
character.

It is certainly an unusual course for a member of our profession
to conceal from his brethren any method of treatment which he
may regard as more valuable than those in common use; and it is
clearly one which cannot be too strongly reprobated by all honor-
able and high-minded men."
In this, there are two sources of complaint-the publication of
their letter to me, with my reply, and my refusal to make them the
medium of communicating my discovery to the world. The latter
point I will discuss anon. I will only say of it now, that I feel
myself fully competent, and imagine I have the right, to make
known any discoveries that I may make, without the aid of any
other man or committee of men, at such time, and in such way, as
may be convenient to me.
The statement of the Committee, in regard to the publication of
our correspondence, grossly misrepresents the whole matter, and
conveys a totally wrong impression.
I will state the case briefly, and let the profession draw their own
inferences.
The Committee assert that they sent me, in the first place, a copy
of the questions which they addressed to the profession at large.
Whether such a copy was sent to any or every other member of
the profession, and if so, at what time, I know not. Nothing of
the kind was ever sent to me; and it was not until after I had
rendered doubtful, by my reply to their note, whether I should
communicate my discovery through them, or not, that these ques-
tions were published in the Boston daily journals, addressed to the
profession and public at large. The only communication I ever
received from the Committee, was the following:
BOSTON, Oct. 30th, 1851.
DEAR SIR:-The undersigned are a Committee of the Am. Med.
Association, to prepare a report on the "Radical Cure of Hernia."
Being aware that you have given much attention to this interesting
branch of surgery, and learning that your method of treatment
has been attended with a great degree of success, they are
desirous of ascertaining from you what is the precise mode you
adopt, and what has been the general result.

5
They trust that you will readily communicate such information
as may aid them in the performance of the duty assigned them by
the Association, and a compliance with their wishes at your earliest
convenience, will be gratefully felt and acknowledged by your
friends and humble servants,
GEO. HEATON, M. D.
GEO. HAYWARD,
}
J. MASON WARREN, Committee.
S. PARKMAN.
Although I was unable to see the propriety of a request on the
part of those who did not profess to know anything of any prac-
tical value of a subject, to obtain from one the results which
patience, perseverance, and years of hard study had afforded him
on the same subject, merely that they might be the medium of
heralding his discoveries to the profession, and considered their
supposition, that I would readily accede to their request, as an
hypothesis which neither they nor any other reasonable man ought
to entertain, I still concluded, considering the very courteous man-
ner of the Committee, to give their request due consideration.
After having done so, I submitted to them the following reply, some
two weeks or more after I received their note.
BOSTON, Nov. 17th, 1851.
No. 2, EXETER PLACE.
GENTLEMEN:-Your note of the 30th ult., requesting me to
communicate to you the precise mode I adopt for the radical cure of
Reducible Hernia, in order to assist you in making out a report, in
compliance with the wishes of the Am. Med. Association, was duly
received.
I at once took the matter into consideration, and determined to
comply with your polite request. Upon more mature reflection,
however, I found that it would be very difficult, if not impossible,
for me to do so, and at the same time do justice to myself and the
subject, in the limited time allowed me.
I have devoted, as you are aware, many years to the careful in-
vestigation of this important branch of surgery, and have, I am

6
happy to say, discovered a safe and certain method of curing a
complaint which has so long baffled the skill of our profession.
But, knowing that so many surgeons of eminence have so far
convinced themselves of their ability to cure the disease, that they
have actually published to the world their particular modes of oper-
ation-no one of which, however, has outlived its author- and, on
the contrary, knowing that many, by prematurely thrusting their
supposed discoveries upon the profession, have not only brought
upon themselves censure, but even ridicule,-I determined, even
long after I had satisfied myself, and verified my theory, by hun-
dreds of successful cases, that it should be subjected to the more
convincing test of time, and consequently delayed publishing it to
the profession.
After long deliberation, I decided that I would either publish the
matter through a paper, or more at length in a volume, and
finally had determined to follow the latter course.
If I shall determine to publish, as preliminary to my work, a
paper on the subject, I shall be most happy, gentlemen, to make
you the medium of communication. In the meantime, hoping that
you will excuse the delay I have shown in replying to your note,
and thanking you for your kind recognition of my claims, I am
your friend and humble servant,
GEO. HAYWARD, M. D.,
GEORGE HEATON.
J. MASON WARREN, M. D., Committee Am. Med. Association.
S. PARKMAN, M. D.
It was after I sent them this reply, that certain questions ap-
peared in the daily journals, addressed, seemingly, to the medical
profession, but virtually, like every thing else in a public journal, to
the public at large.
The Committee, all Boston men, knew well, and the public knew
well, that I had been attending for some ten or twelve years, to the
radical cure of Hernia, and also, as the Committee admit, that my
method had been attended with a great degree of success.
After having requested me, then, to make to them an exposé of
my peculiar mode of treatment, and having obtained what they

7
deemed to be my refusal to do so, with my reasons assigned, (which
they have, however, carefully, and most inexcusably, kept out of
their report,) they appealed through the daily press to the public.
Now what, I ask, would be the inference which any man unac-
quainted with the whole truth of the matter, would draw from
reading an appeal from eminent physicians, through the columns
of a newspaper, desiring to be furnished with data,-if any such
there were,-bearing on the radical cure of Hernia? Manifestly,
that there was no cure for Hernia known.
Should I, then, suffer so false an impression to be spread abroad,
when I had professed, for years, to cure Hernia? When the public,
or a large portion of it, at least, had understood that I did? When
the medical profession throughout the country, and some of its
leading members in Europe, understood it? When the very mem-
bers of this Committee not only knew it, but knew of its great
success?
Did the Committee suppose, when they published those questions,
calculated to brand me, in the eyes of those who read them, as an
impostor, and all my pretensions, for ten years, as quackery, that I
would neglect to notice them, merely to gratify an unwillingness
on their part, to have what they pretended to be their honest senti-
ments made known? That I would disregard my own welfare, and
that of those dependent on me, merely for fear of some imaginary
breach of the laws of etiquette? If they did, they must have sup-
posed me to be destitute of the very common and necessary instinct
of self-defence, or, at all events, to be a very different person from
what I am. I can assure them, that had their note been of a pri-
vate nature, as it in reality was not, it would have been given to
the public under like circumstances.
The note contained, as I supposed, their honest sentiments; and,
although containing nothing of a private nature, as any one may
see by referring to it, would still have been cheerfully kept private,
had not their course afterwards obliged me to publish it as a
matter of self-defence. It was the only means I could adopt to
destroy effectually the false, and to me fatal impression, which
their appeal was calculated to produce. If they did not mean what
they said in their note,-if it was only an ingenious trap to catch

8
an unsuspecting victim, they may have reason to regret its publi-
cation; but not to charge me with any breach of professional or
other etiquette. I repel any such imputation as an ill-disguised
sophism to conceal a more ill-disguised feeling.
As to the opinion of the Committee, that the transaction, wherever
known, has given me a notoriety of a most unenviable character,
I must beg leave to differ from them entirely.
As far as I can judge, from conversation with distinguished mem-
bers of the profession, and from communications received from all
parts of the country, immediately after the publication of those
letters, the notoriety which accrued to me was eminently of an
enviable character; if, by envy, we are to understand (as the Com-
mittee seems to) the desire on the part of one person to come into
the condition of another.
The majority of the profession, and the public generally, probably
neither cared nor thought any thing of the letters themselves, or
of the circumstances of their publication, any further than as they
were the vehicle of conveying the announcement, that a new and
valuable discovery had been made in surgery. The notoriety in
question, seemed to me to be precisely that which would attach to
any author of a discovery which had been confirmed by scientific
men.
It was such, for example, as accrued to the discoverer of the
anæsthetic power of sulphuric ether, after its value had been at-
tested by this Committee and others, at the Mass. Gen. Hospital.
And the opinion of the Committee on the particular mode in which
this discovery was made known to the world, is of as little interest
or consequence to the profession and the public, as the almost end-
less discussion known as the "Ether controversy."
The welfare of mankind being of so much more consequence than
the laws of etiquette, men do not stop to enquire whether these
latter have been fully observed in making a valuable discovery
known.
An engineer announces that he has discovered a mode of substi-
tuting heated air for steam, in the propulsion of machinery. It is
immaterial to the public whether the gentleman consulted his fel-
low engineers and mechanics, or not, so long as it has faith in the
genuineness of his discovery.

91
The opinion of the Committee, on this point, I deem to be false;
and, whether false or true, of no value whatever, and totally out of
place in a report purporting to treat of the radical cure of Hernia.
The relevancy of the laws of etiquette to the approximation of the
pillars of the abdominal ring, the true point to be discussed in such
a report, I have yet to learn.
The Committee assert that "it is an unusual course for a member
of our profession to conceal from his brethren any method of treat-
ment which he may regard as more valuable than those in common
use."
Without being the apologist or defender of selfishness, as ex-
hibited by the medical or any other profession, I doubt the truth
of the assertion as a general one. It is an adage, almost an axiom,
that every physician makes his own theory and practice.
The evident and immediate consequence of this is, that there are
as many different modes of treating diseases in general (there are
exceptions of course) as there are physicians. Another fact, with
which we are all acquainted, and which has always been the stand-
ing reproach of the profession, is the jealousy, almost proverbial,
which exists among its members. The origin of this feeling is not,
it is true, to be charged upon physicians themselves, but probably
to that disposition or desire on the part of patients or their friends,
in critical or difficult cases, to change their medical attendants.
The effect of it is, to induce them to study out more carefully than
they otherwise might, successful modes of treating disease; and
while they would not withhold from the profession or public the
matured results of their careful experience, they do not feel called
upon to pause from their labors at the command of every tyro,
until he shall be instructed equally with themselves. Physicians,
generally, do not fling this as a reproach at each other, but consider
it a merit rather. Complaints, if they ever do come, emanate from
those who, having become independent of their profession, have time
to instruct, in their peculiar ethics, their less fortunate brethren,
since they are not likely to be called upon to act up to them. The
"high-minded and honorable men" of whom the Committee make
mention, I have too often found to be those, who, by an illustrious
name handed down through a long line of ancestry, or by a compe-
2

10
tency of the means of subsistence, which has come to them over the
same royal road, are independent of the labors to which other men
are subject, and can, from their position of leisure, launch their
darts at their more laborious brethren with impunity. So far from
fearing to lose the esteem of such men, I am quite willing to be the
object of their reprobation.
I do not wish to be understood as basing the defence of my
position on any ground of expediency, but, as the Committee have
taken the liberty to decide summarily certain points which are, at
least, open for discussion, I have presumed to differ from them.
In my course, I profess to have followed no authority or precedent
whatever, but to have been governed by my own idea of right, and [
the course I have taken is so in accordance with my own convictions
of duty, that nothing would have induced me to swerve from it. Ja
There is another fact, of which, however insignificant in itself, as
it involves a point of etiquette, the profession may as well be in-
formed.
The Association, as I am told by one who was present, appointed
the Chairman of this Committee alone, giving him the privilege of
selecting two others as associates. Now one would suppose, a priori,
that in such a case, if there was one particular member of the pro-
fession whom the Chairman knew to have devoted more time than
any one else to Hernia-whose mode of treatment, practised daily
for years, he knew had been attended with great success,-he
would, out of mere regard for professional courtesy, have selected
this individual as an associate, instead of choosing one who, however
otherwise distinguished as a surgeon, knew nothing more of the
matter in question than he himself knew, and then, having com-
pleted his body corporate, turn deliberately to the individual whom
he acknowledged to be the depositary of all the facts of any value
not already known, and request him (very politely indeed) to make
an exposé of his "precise mode" of treatment, and a general his-
tory thereof, in order, forsooth, that these three individuals might
have the privilege of communicating it to mankind.
Verily, the Committee must either have regarded me as totally
incapacitated for communicating my discoveries to the world, or as
too modest to make them known without the aid of an interpreter,
to neither of which hypotheses, I must say, do I plead guilty.

$11
The charge of a want of philanthrophy on my part, (which I con-
ceive to be the essence of what the Committee recommend to the
reprobation of honorable and high-minded men,) from their own
admission, is reflected directly back on themselves.
They admit, without any qualification, that they have learned of
the great success of my operation in the treatment of Hernia, and
yet not one of the Committee, that I am aware of, ever sent or even
recommended a patient to me.
Whenever patients of theirs have consulted me, it has been of
their own accord, or at the suggestion of some friend; never by the
advice of the physicians themselves in the outset.
In cases where they have informed their physicians beforehand,
that they were about to place themselves under my care, the former
have, indeed, condescended to assure them (as the patients them-
selves have informed me) that "Dr. Heaton has had much expe-
rience in the treatment of Hernia, and they would undoubtedly be
safe in his hands."
ibar ada sot
Most of my patients from out of town have been sent to me by their
physicians. In a majority of cases, these physicians have had no
more to rely on than the mere announcement through a medical
journal, that I treated Hernia; yet, on the bare peradventure that
I might cure it, hundreds have been thus recommended to my care.
If the Committee were aware, as they assert they were, of my
great success in treating Hernia, it certainly would have been the
truest philanthropy on their part (according to any plausible defi-
nition of the word philanthropy) to recommend the afflicted to
one "in whose hands, from his long experience in the treatment
of Hernia, they would undoubtedly be safe."
I will give a brief history of my experience in the treatment of
Hernia, of the encouragement and discouragement with which I
have been favored by sundry of my professional brethren, and let
those who are ignorant of the matter draw their own conclusions
as to who is in the right and who in the wrong.
As the Committee have much to say of the operation by injection,
the value of which, in my opinion, they exaggerate entirely, and
the origin of which, whether accidentally or intentionally, they at-

12
tribute to the wrong source, I will give the true account of the
origin and value of this operation; from which, I will premise, two
conclusions will be obvious, at variance with those to which the Com-
mittee seem to have come. First, that Dr. Pancoast is not the origin-
ator of the operation by injection; that I performed it, and des-
cribed it to my friend Dr. Mott, of New York; and, moreover, that
Dr. Jayne, of Illinois, had invented an instrument for performing
said operation, and secured letters patent on the same some two
years before Dr. Pancoast, according to his own account, made any
experiments with it. Secondly, that the subcutaneous operation by
injection of the hernial sac, is neither a simple nor advisable opera-
tion; that, although successful in many cases, if rightly performed,
the difficulty of performing it without bad consequences ought to
condemn it entirely.
My attention, with that of Dr. Hart, of Alton, Illinois, was first
directed more particularly to the operation by injection of the sac,
for the radical cure of Hernia, by Dr. Jayne, who had invented an
instrument for performing such an operation, and before coming to
us, had, in the year 1840, secured a patent on the same.
Having at that time under our care several cases of Reducible
Hernia among the convicts in the Penitentiary at Alton, we imme-
diately set about testing the value of the operation on the persons
of these, and also on that of some of the blacks at St. Louis. The
operation consisted in injection of the sac subcutaneously with an
irritating fluid, by means of the instrument before mentioned. In
the selection of a fluid for the purpose, Dr. Jayne gave the prefer-
ence to some one of the essential oils, using now and then tincture
of cantharides. In my first operations I used also the essential
oils, but soon abandoned them for the tincture of iodine. I believe,
therefore, that I performed the operation of injection with iodine,
of which so much has been said, before any other man.
Before our experiments, the operation of injection by the subcu-
taneous method had never been performed either in this country or
in Europe. At least no report had been made of any such opera-
tion, and there is no reason to suppose that it had ever been
undertaken.
With the success of these experiments we were much elated, and

13
felt that the desideratum for the radical cure of Hernia had at
length been discovered. Subsequently, in November, 1841, I com-
municated the result of the operation to Dr. Valentine Mott, of
New York. He expressed himself highly pleased with it, and made
a complimentary allusion to it in his lectures before the University.
In the Spring of 1842 I came to Boston, where I had concluded
to remain, and make the treatment of Hernia a speciality. Having
obtained an introduction to the leading members of the profession in
Boston, and particularly to the Surgeons of the Mass. Gen. Hospital,
I informed these latter of my intention, and offered to operate in
their presence, on any case or cases which they would furnish me,
and let them see the result, knowing well that such cases were con-
tinually coming under the notice of physicians, and were probably
always to be found in the hospital. No notice was taken of this
offer, no cases were furnished me.
Although I considered that I was under no obligation to those
who had shown such entire want of what I believed to be common
courtesy, I still, some six months after this, when I had, through
the kindness of a medical friend, obtained several cases of Reduci-
ble Hernia, addressed the surgeons to whom I had made my origi-
nal proposal, and other members of the profession, a polite note,
inviting them to be present and witness me operate for the radical
cure of Hernia. Most of those invited were present, and witnessed
the operation. I felt then that I had done my part, that I had
cleared myself, at all events, of the liability to a charge of a want
of professional courtesy; and from that day to the present I have
taken an entirely independent course.
Feeling that these men, not only by the total want of encourage-
ment, but the complete discouragement which I had received from
them, had forfeited all right to expect any further advances from
me, I resolved to rely entirely on my own individual effort for
success, and in spite of the frowning, discountenancing, nay, the
very direct opposition which the would-be leaders of the profession
here have shown me, I have so relied to this day, and thank fortune
that I have leaned on no broken reed.
So much for my course, on which the Committee have seen fit to
reflect so severely. I will only say in addition, that such reflections

14
ill come from the very ones from whose want of courtesy and good
feeling the course which they reprobate was entered upon.
The operation by injection, in many cases so satisfactory and
apparently so permanent, in others was not so. Frequently it
required to be repeated several times on the same individual, and
in all cases the utmost care was required in its performance to avoid
troublesome consequences, as, I understood, those of the Committee
who undertook it found out.led ads of
Becoming dissatisfied with this operation, and having already, in
the course of my investigations, tested every principle of any degree
of plausibility which had been suggested or relied upon by operators
in times past, for the cure of Hernia, with no satisfactory results, I
felt that the only hope of a permanent cure in all or in a majority
of cases of Hernia, lay in some modus operandi, the effect of which
should be an approximation of the pillars of the abdominal ring, or
a closure of the tendinous openings. For a long time, therefore, I
conducted all my researches with a view of getting at some principle
which would enable me to accomplish this.
These researches, in which of necessity I was obliged to rely
almost entirely on theory alone, did conduct me, I am happy to say,
to precisely such a principle; a principle on which I have based a
mode of treatment and operation which closes effectually and per-
manently the various openings through which hernial protusions
take place. Not only, indeed, does it do this, but in those cases
where, from a general weakness resulting from the extreme delicacy
of the textures connected with Hernia, or a thinness, as it were, of
the parietes abdominales, there is a positive predisposition to the
complaint, I have found that it rendered the part firmer and better
able to resist pressure than in its original condition.
In such cases, where there has been a recurrence of Hernia, I have
almost invariably found it occurring at some other opening. Thus,
when I have cured a person of oblique Inguinal Hernia, and he has
afterwards, from a fall or violent strain, brought it on anew, it has
proved, almost without exception, to be direct Inguinal Hernia.s
The Committee are aware, and every physician who knows the
anatomy of the parts thoroughly must be aware, that any opera-
tion for the radical cure of Hernia must be, at the best, a delicate

15
operation, and an operation which an unskilful or unpractised
hand would undertake with no little hazard. And yet it might be
an operation, the apparent simplicity of which would strike any
one ignorant of the complicated anatomy of Hernia, the vital
organs and vessels involved therein. The history of the attempts
at the cure of Hernia furnishes, we all know, a series of catastrophes
perhaps unequalled in the annals of any other branch of surgery.
Such is the frequency of the complaint, the alarming condition
which it so often assumes, and to which it is always liable, and the
readiness with which men submit to any operation likely to cure it,
that it has always furnished a broad and fruitful field for the
labors of quackery and imposition.
Suppose, then, an operation against which skepticism, from a
high quarter, has already directed its attacks, should be announced
to the world, the apparent simplicity of which were its obvious
characteristic. What, according to the reason and experience of
every physician, would be its probable destiny? It would be under-
taken by surgeons of every grade of capacity, by quacks of
every grade of villainy. With the more skilful and more expe-
rienced of the former, it would probably be attended with success.
With those of less experience and manual skill, it would undoubt-
edly be condemned, not from its own deficiency, but simply from
their inability to perform it.
The attempts of the latter class would, in a majority of cases,
prove most unfortunate, if not fatal to those who might fall into
their hands. All the evil results would be attributed not to their
true cause, the fact of a man's undertaking what he is not com-
petent to perform, but unquestionably to the operation itself.
That this is not all theory, I think I have letters in my possession
to prove.
I have been applied to from various parts of the country,
through letters, by non-professional men, desiring to obtain from
me, by payment or otherwise, my mode of operation; and by
persons whose very letters show their entire ignorance of Hernia,
and their utter incompetency to undertake so difficult a branch of
surgery as a profession.
It is this class of reckless experimenters who would eagerly seize
an operation apparently simple, which promised to cure a complaint

16
so universally prevalent as Hernia, and whose efforts would, in a
very short time, condemn both the operation and its author to
inglorious oblivion.
I am not so destitute of foresight as to run any such risk in
making haste to publish a discovery of mine. Although satisfied
early of the value of my operation, I determined not to give it to
the world until its success should have placed it beyond the reach
of cavil or skepticism. Such was the ground I took in my letter
to the Committee, and such is the ground on which I defend myself
from the unjust and dishonorable reflections in their report.
But, setting aside all apologies and extenuations, how the Com-
mittee can so ignore the indisputable right which every man has
to make known a discovery he may have made in science, at such a
time and in such way as he may see fit, is beyond my comprehension.
It is a right which, if we have any rights as individuals, is so
evident, that any man or any society that shall attempt or pretend
to override it, certainly lays itself open to the charge of an unwar-
rantable assumption of authority.
-
The Committee have presumed not to form an opinion only-
which of itself would be of no consequence, but, on the ground of
that opinion, to base certain reflections for the public ear, when the
very premises on which alone a correct opinion may be formed are
entirely unknown to them.
A man may, for the very best of reasons, keep a certain discovery
for a time to himself. It may be necessary both for his own safety
and that of the discovery itself. Nay, the case is supposable, and
even probable, where it may be the part of the highest philanthropy
for him to do so.
A surgeon, for example, from long experience in performing a
very delicate operation, for an ever-varying and always complicated
complaint, may have so disciplined his sense of touch, and have
acquired such delicacy of manipulation, that he can detect those
peculiarities, whether anatomical or abnormal, a knowledge of which
is absolutely essential to the successful treatment of the complaint,
and adapt his mode of treatment to the Protean phases it may
This faculty, acquired only by long experience, he knows
he cannot communicate to another; yet on it the success of his
assume.

17
operation mainly depends. The mere description of the operation
he may give to any one; but in the hands of other men it is very
sure to prove unsuccessful. In this want of success he of course
must share, until finally the operation is condemned, merely
because other men lack the ability to perform it. badan't
Yet, according to the Committee's theory of condemnation, the
very course on the part of the surgeon which would secure to
humanity the benefit of such an operation, is not merely to be found
fault with, but actually held up to the reproach of all honorable
and high-minded men.
The absurdity of such a judgment, on the part of sensible men,
is to me so manifest, that I deem it almost an insult to common
sense to expose it; and had they seen fit, in their report, to have
stated their own private opinion in regard to my course, although
it must have been entirely without foundation, it might have
remained on record undisturbed; but as they have gone still
further, and founded on this baseless opinion certain reflections
derogatory to my character, I cannot refrain from holding up so
dishonorable, if not libellous an attack, as eminently worthy the
reprobation of every true gentleman in the profession and com-
munity. I find nothing generous, nothing manly in such an attack.
Indeed, what I have done to merit it I cannot divine. I am not
aware that I ever intentionally insulted any one of the Committee.
If my course has not been such as comes up to their idea of philan-
thropy, they may in their hearts pity my want
of humanity, but
never, while I am not doing evil to my fellow men, upbraid me
publicly, I flatter myself, however, that I feel quite as tenderly
for those suffering in mind or body, as they do. I think I might
descend to the same acts of charity and self-sacrifice. In the
faculty of deliberately attacking a fellow physician who is pursuing
the even tenor of his course, and perchance doing good in an humble
way, without interfering in the least with others- of attempting to
undermine the reputation which years of steady industry may have
afforded him-I yield the palm most willingly to the Committee, and
trust they may find quiet repose on such laurels. I must inform
them, however, that denunciation founded on mere surmise, from
however lofty a source it may emanate, and however well it may
3

18
answer as an apology for the meagreness of a report, is not likely
to be digested as truth by the generality of men of sense and
honor.
After expressing their acknowledgment to the few physicians
who have furnished them with the results of their experience in the
treatment of Hernia, they assert that they have not obtained all,
in this way, which the Association had a right to expect. Just how
extensive may have been the expectations of the Association, in
fact, just whom the Committee mean by the Association, it is not
easy to tell.
I understand the American Medical Association to include all
regular physicians in the country. A majority of these, probably,
had no expectation whatever in regard to any of the reports of the
various committees.
Those who might have had any in regard to that of the Com-
mittee on Hernia, imagined, I presume, that this Committee
themselves had something extraordinary which they were anxious
to divulge, and were not to furnish a report of various unsuccessful
attempts to cure Hernia, already made known to the profession over
and over again, by their authors and others treating on Hernia,
and without exception abandoned as failures. That surgeons of
high standing should presume to fill out the pages of a report with
an exposition of operations of such notorious worthlessness and
barbarity as those of cauterization, ligature, suture, invagination,
&c., was more than the Association had reason to expect or desire.
It certainly was to be hoped, for the honor and welfare of the
medical profession, that such operations, already expounded and
exploded ad satietatem one would suppose, might never again be
dragged out from their obscurity, and paraded before the profession
and public to increase a prejudice, already sufficiently strong,
against physicians, but might be permitted to rest in peace, as sad
monuments of the rashness and complete disregard of life of which
scientific men may be guilty. Had any troubled themselves to
think of the matter beforehand, they would, of course, have seen
that had a particular individual anything really new and valuable
in regard to the treatment of Hernia, he would be far more likely
to make it known per se when he saw fit, than to take advantage of

19
even so distinguished a medium of communication as this Com-
mittee furnished.
The interest created among physicians in general by their
appeal, seems to have been by no means commensurate with the
Committee's expectations. From the entire medical profession
throughout the country, (exclusive, I suppose, of the Canadas and
Mexico,) seven only have thought it worth while to furnish them
with communications, the value of which may be inferred from
the fact, that the sweeping conclusions at the close of their report
condemn them without mercy or apology.
Their language seems to imply that, in their opinion, many
physicians have kept back valuable information which they had a
right to expect; and I only wonder, considering the particular
notice they have taken of one individual for his inexcusable reserve,
that they did not condense their indignation against all these other
imaginary delinquents into, at least, one general sentence of
condemnation.
At the close of their report are three conclusions, which seem to
contain the sum and substance of their efforts to perform the duty
assigned them by the Association.
As I presume I have had more experience in the treatment of
Hernia than the Committee and all those whose communications
they give in their report together - having, as far as I can learn
from the published accounts of their experience, treated and cured
a hundred cases where they have attempted one-I shall take the
liberty to examine these conclusions critically.
They are as follows:
1. "There is no surgical operation at present known which can
be relied on, with confidence, to produce in all instances, or even in
a large proportion of cases, a radical cure of Reducible Hernia."
This conclusion I, of course, affirm to be false in toto. I assert
that there is a surgical operation which can be relied on with
confidence, to produce a radical cure of Hernia, not only in a large
proportion of cases, but in all cases which one could reasonably
expect to be cured; and I am ready to prove the assertion by
referring the skeptical to five hundred cases, or more, if they
I have given a few examples of these as an appendix to this Review.

20
choose, including those of almost every degree of severity,
exhibiting the complaint in nearly every form which, it seems to
me,
it is possible for it to assume, and as it occurs in those of every
age, from the infant of nine months to the adult of seventy
years,-treated and radically cured by this operation.
2. "That they regard the operation of injection by the subcu-
taneous method, as the safest and best. This will, probably, in
some cases produce a permanent cure, and in many others will
afford great relief."
As this conclusion is entirely empirical, I suppose the one who
has had the most extensive experience with the operation, may be
permitted to decide upon its merits. As to its being the safest and
best, I will only say, that I think it neither safe nor well for the
Committee to recommend it in any such terms. Certain it is, that
in the hands of inexpert operators it is very far from being a safe
operation; in the hands of none, whether expert or not, is it the
best. The second portion of this conclusion is of no consequence.
The same might be said, with equal truth, of the obsolete operations
of cauterization, invagination, the royal stitch, and various other
barbarities which the humanity of modern surgeons has condemned.
No one doubts that in some cases they did produce permanent cures,
while in many other cases, the relief afforded by them was certainly
permanent and final as to all troubles of the body.
3. "That compression, when properly employed, is, in the present
state of our knowledge, the most likely means of effecting a radical
cure in the greatest number of cases."
As to compression as a curative agent, twelve years' experience
in the treatment of Hernia has led me to a different conclusion
entirely. As a remedial agent, as an agent essential to the safety
of those afflicted with Hernia, before they are radically cured, I do
not wish to detract from its value. That now and then persons are
cured by means of compression, is not to be denied.
But as a
curative agent in general, it is not to be relied on at all.
I have known, and so have the Committee, in all probability, the
most favorable cases to have received almost perfect compression,
from well-constructed trusses, and that, too, for a period sometimes
of twenty years, without having their aspect changed, unless for
the worse, in the slightest degree.

21
There are some other points in the report deserving criticism,
and some not connected with it, which I may have occasion to notice
at a future time. In what I have said, I may have shown feeling,
perhaps too much. My apology is, that I have had to defend what
I know in my heart to be an honorable course, against an uncalled-
for and unjust attack, which would represent it not only as dis-
honorable, but as worthy the reproach of honorable men. Engaged
in defence of character, I have spoken decidedly. I have no dispo-
sition to offer insult, and cannot brook it, come whence it may. For
condemning misstatements, misrepresentation, and pernicious
opinions, by whomsoever made or entertained, I offer no apology.
Taking the report as a whole, as it has failed to add to our
knowledge a single new fact or principle from which future good
is likely to be derived, while, as a review of various obsolete
operations, its place was more than supplied by a similar review by
Dr. Bryant, of which it seems to be little more than a mere tran-
script; and, moreover, as they have seen fit to make it the vehicle
of an ungentlemanly attack upon a private individual, for not
complying with an arbitrary request-an individual, too, towards
whom one of the Committee, at least, had not shown even common
courtesy-it is certainly unworthy the character of the Association
for which it was prepared.


APPENDIX.
I have here subjoined skeleton reports of a few cases, taken
at random from my journal. It will be readily seen by those
conversant with Hernia, that these exhibit the complaint in its
most aggravated form, and are those which serve as tests of the
value of any operation for its radical cure. In all or nearly all of
them, the Hernia could not be retained with any truss; the patient
suffered great pain at times, and constant inconvenience; in many,
a bad varicocele or enlargement of the spermatic veins accompanied
the Hernia; while in others, these two complaints were combined
with hydrocele. The time I have required patients, in such cases,
to remain under my care, has been ordinarily from two to three
weeks.
The impression, which I find to be quite general, that my mode
of treating Hernia requires a formidable surgical operation,
I would here state to be entirely wrong. The operation which I
perform is wholly subcutaneous, and is done with a delicate instru-
ment adapted to the purpose, the wound from which cannot be
discerned six hours after the operation.
Mr. K. D. C., of Marlboro', Vt., aged 22 years, consulted me
February 28th, 1847, for a direct Inguinal Hernia, of about one
years' standing. The Hernia had got to be of great size, had
descended into the scrotum, which it filled up. He was unable to
retain it with any truss, and had in consequence been obliged to
give up business in a great measure. I operated for its radical
cure, February 28th. He remained under my care one week. It
has never made its appearance since the operation.

24
Mr. J. C., of Fall River, Mass., aged 35 years, very fleshy, had a
very large oblique Inguinal Hernia, which he had found it impos-
sible to keep up with a truss. May 15th, 1847, I operated for the
cure of the same. Cure complete.
Mr. J. B., Boston, aged about 24 years, had had for six years an
oblique Inguinal Hernia of the right side. The opening through
which the protusion took place, I found so large as to admit three
fingers readily. I performed my operation for its radical cure,
May 20th, 1847. There has been no appearance of the Hernia
since.
Mr. A. M., Gloucester, Mass., aged 27 years, consulted me for a
Hernia and Varicocele, both of over ten years' standing, and very
troublesome, rendering it difficult and sometimes impossible for
him to attend to his business. May 21st, I operated on the Hernia;
May 24th, on the Varicocele. He remained under my care two
weeks. Both complaints were radically cured.
Mr. D. G. A., of Prospect, Me., seafaring man, placed himself
under my care for the cure of an oblique Inguinal Hernia, of six
years' standing, June, 1847. The Hernia had attained the size of
a large hen's egg, and was partially irreducible. I operated for the
radical cure of the same, June 1st. The last time I heard from
him, two years afterwards, he was entirely well.
Mr. P., of Providence, aged about 54 years, consulted me in
July, 1847, for an Inguinal Hernia of the right side, of sixteen
years' standing. It was very large, and he had been unable to find
any truss to retain it. For several years he had allowed it to
remain down constantly. After a few days' preparatory treatment,
I operated for its radical cure, July 10th. He left me cured, and
has remained so.
Mr. D., of Boston, aged 26 years, had suffered much for several
years, from a double Inguinal Hernia. Although he had worn a
strong double truss, he had, at times, found it ineffectual for
retaining the Hernia. It had several times become partially stran-
gulated, causing excessive pain, and threatening his life. I
operated for its radical cure, July 28th, 1847. He remained under
my care two weeks, and left cured.
Mr. H., of Bridgewater, Mass., aged about 35 years, had been

25
troubled for seventeen years with an oblique Inguinal Hernia of
the right side. When it descended it became very painful. It was
accompanied with a hydrocele of the spermatic cord. He came
under my care in November, 1847. Left cured, and there has been
no appearance of the Hernia since.
Mr. J. S., Gloucester, Mass., aged about 40 years, consulted me
for a direct Inguinal Hernia of the right side, of long standing.
The protruded mass was very large, consisting, I found on exami-
nation, of both bowel and omentum, the latter being about equal
in size to a hen's egg, and irreducible. I found the adhesions so
strong, that it was impossible to reduce it by taxis. I therefore cut
down and removed the irreducible mass of omentum. Afterwards
I operated for a radical cure, January 10th, 1848. He has had no
trouble since.com
Mr. H., of Boston, age about 28 years, had been troubled from
boyhood with oblique Inguinal Hernia of the right side. I operated
for a radical cure of the same, March 31st, 1848. Hernia has
never appeared since.
Mr. F. B., of Concord, Mass., consulted me, January, 1848, for an
oblique Inguinal Hernia of the right side, and a Femoral Hernia
on the same side, the latter being of unusual size. They were of
four years' standing, had descended freely, and he was unable to
prevent the descent with a truss. Much of the time he had been
unable to work with any comfort. January 20th, I operated on
both. A radical cure was effected.
Mr. J. S., Valley Falls, R. I., came to me with an Inguinal Hernia
on the right side, of fourteen years' standing. It had for a long
time caused him great pain in the back and loins. Accompanying
the Hernia was a small Hydrocele, and a Varicocele of the left
side. He was a good deal broken down. October 5th, 1847, I
operated for the cure of the Hernia; a day or two afterwards for
the radical cure of the Varicocele and Hydrocele. Patient
remained at my Infirmary three weeks. A permanent cure was
effected of the three complaints, followed by a great improvement
in the general health.
Mr. D. H., of Essex, Mass., aged 18 years, was ruptured and
otherwise badly injured by a fall from the cars. Admitted to
4
my

26
Infirmary, March 10th, 1848, previous to which he had been con-
fined to his bed six months. Simultaneously with the Hernia,
Varicocele appeared on the left side. March 10th, I operated on the
Hernia; shortly afterwards on the Varicocele. April 5th, he left
cured, and has had no trouble from either complaint since. He is
now in California.
Mr. H. B. G., of Boston, consulted me for an oblique Inguinal
Hernia of the right side, of large size. The hernial opening was
very large, so that a truss would not retain the protrusion. It
descended readily beneath the truss, causing great inconvenience.
I operated for its radical cure, March 6th, 1848. It has never
appeared since.
Mr. J. J., of South Boston, aged 40 years, had had an Inguinal
Hernia on the left side for two years. The opening was very
large, and the Hernia could not be kept up with a truss, but
descended freely into the scrotum. I operated on it, March 18,
1848. Cure was permanent.
Mr. A. J. W., of Boston, aged 27, placed himself under my care
for the treatment of an Inguinal Hernia of the right side, March
24th, 1848. The hernial opening was large, and the protrusion not
retainable by a truss, Operated, March 24th, and effected a
radical cure.
Mr. W., of New Orleans, 35 years of age, had had an Inguinal
Hernia of many years' standing, accompanied with Varicocele. He
came to my Infirmary, 26th July, 1848. Left, August 7th, cured
of both complaints.
H. E., of Charlestown, 9 years old, had a direct Inguinal Hernia
of five years' standing. Trusses had been tried, and, as usual, to
no purpose. Difficulty grew worse. Truss had caused much sore-
ness of the parts. I operated on him, January 4th, 1849, and
effected a radical cure of the Hernia.
Mr. M. A., of Essex, Mass., aged 61 years, accustomed to hard
work, had an oblique Inguinal Hernia of the right side, of five or
six years' standing. Admitted to Infirmary, February 26th, 1849.
Left cured, and has had no trouble since.
Mr. W., of Brookline, Mass., age 68 years, consulted me for an
oblique Inguinal Hernia of the right side, of five years' standing.

27
He had found it impossible to retain it with a truss. May 17,
1849, I operated for its radical cure. Hernia never appeared
afterwards.
Mr. J. A., of Fall River, aged about 27 years. Admitted to my
Infirmary, May 14, 1850. Had an oblique Inguinal Hernia of the
right side, of several years' standing; also a Varicocele of the
left side. May 14th, I operated on the Hernia; May 31st, on the
Varicocele. A complete cure of both was effected. This patient
had tried the best trusses without any relief, but rather an
aggravation of his difficulties.
Mr. F., of Boston, about 30 years of age, came to me in June,
1849, with a very large direct Hernia, which he had never been
able to keep up with a truss. June 6th, admitted to my Infirmary,
and operated on. Left in a short time, radically cured.
Mr. M. F., of Portsmouth, N. H., aged about 23 years. Ad-
mitted to Infirmary, June, 1850. Had a very large direct Hernia
of the right side, accompanied with Varicocele of the left side.
June 14th, I operated on the Hernia; within a week, on the Vari-
cocele -effecting a complete cure of both.
Mr. G. B., of Jamaica Plains, Mass., about 22 years of age.
Admitted to Infirmary, Sept. 9th, 1850. Had a large Inguinal
Rupture of the left side, which he had tried in vain to retain with
a truss. Operated for its radical cure, Sept. 9th. Hernia never
reappeared.
Mr. K., of Kennebunk, Me., aged about 27 years, very fleshy.
Admitted to Infirmary, Oct. 22d, 1850. Had a very large direct
Inguinal Rupture of long standing, which he had been unable to
keep up with a truss. Patient called on me a few days since to
show that he was completely cured.
Admitted to
Mr. M., of Fall River, Mass., aged about 46.
Infirmary, November, 1850. Had an oblique Inguinal Rupture
of the size of a hen's egg. It was of several years' standing, and
could not be kept up by a truss. Radical cure readily effected.
Mr. S., of Salem, aged 55, very fleshy. Admitted to Infirmary,
December 9th, 1850. Had two very large Inguinal Ruptures which
would descend in spite of the strongest truss. Operated, December
9th, for a radical cure, which was effected.

28
Mr. G. P., of Salem, aged about 37 years. Came to Infirmary,
December, 1850. Had had for many years a direct Inguinal Her-
nia, accompanied with a Hydrocele. A radical cure of both com-
plaints was effected.
CASES OF IRREDUCIBLE HERNIA.
During the month of June, 1844, Mr. D., aged 41 years, of thin
habit of body, consulted me for a Femoral Hernia on both sides.
That on the right was about the size of a butternut, and had been
irreducible twenty years. He had worn a scoop truss a part of the
time, and had been a great sufferer. This, to my surprise, I was
able no reduce by taxis, continued for about half an hour. I
immediately operated on it for a radical cure. The Hernia on the
left side had not been irreducible so long as the other, but I found
it impossible to reduce it by taxis, and therefore cut down and
removed a portion of the contents of the tumor, which proved to be
omentum, and which had increased to such an extent that it was
impossible to return it. The patient was radically cured of both
Herniae.
Mr. M., aged 55, very fleshy, weighing over three hundred
pounds. Came to me in December, 1845, with an Umbilical Hernia
of twenty years' standing, which had not been returned to its
proper place during the whole time, and was considered irreducible.
On the 22d of December I made my first attempt to reduce it by
taxis. The next day I made another trial, and so on for the
several succeeding days, working on it for some half an hour or
more once or twice in twenty-four hours, until, on the 27th, I
succeeded in reducing it completely. A radical cure was then
easily effected.
September, 1846, Miss H., aged 35, of spare habit, came under
my care with an Omental Femoral Hernia, of two years' standing.
The omentum had been irreducible from six to eight months.
During this time she had been able to do but little work,- had
suffered much from attacks of colic, which could with difficulty be
relieved. Finding it impossible to effect the reduction by external
pressure, I performed the operation usually done in strangulated

29
Hernia. I found strong adhesions existing between the sac and
omentum. These I found it difficult to break up, as is almost
always the case in Femoral Hernia. This being done, and a slight
enlargement of the ring having been made, the reduction was
readily effected. A radical cure followed this operation.
July, 1847, Mrs. K., aged about 43, of spare habit, came to con-
sult me for two Inguinal Herniae. The one on the right side had
been irreducible from three to four years. The protrusion was about
the size of an English walnut. I found it impossible to reduce it
by taxis, and therefore operated with the knife. The operation was
successful, and was followed by a radical cure.
Mrs. K., about 45 years of age, of robust person, consulted me,
May, 1847, for an omental Inguinal Hernia of the left side, of six-
teen years' standing. For nine years it had been irreducible. She
had been under the care of eminent surgeons, without, however,
obtaining relief. At their suggestion she had worn a scoop truss,
which seemed to afford little or on relief. During a part of the
time she had been unable to walk, and finally had become much
broken down in health by her sufferings. I found, on examination,
that there was much water in the sac, and probably for that reason
no adhesions of any consequence. I therefore concluded to perform
a subcutaneous operation. This I did, and upon enlarging the ring,
the protruded mass readily slipped back into the abdomen. I after-
wards operated on this, and on a reducible Femoral Hernia of the
other side, for a radical cure.
Capt. S., aged 40 years, came under my care in January, 1848.
He had an omental Intestinal Hernia, which had descended into the
scrotum. The omental portion had been irreducible for five years.
This I removed. Patient suffered little inconvenience from the
operation, and I soon after operated successfully for the radical cure
of the Intestinal Hernia.
Mrs. H., aged 38, somewhat corpulent, came to me in May, 1848,
with a very large Inguinal Rupture on the right side, and an irre-
ducible Femoral Rupture on the left side. Her sufferings, she
informed me, had been very great, sometimes almost intolerable.
Finding it impossible to reduce the tumor on the left side, I cut
down upon it. Finding the contents to be omentum entirely, I

30
removed that portion which could not be returned, and restored the
remainder to the abdominal cavity. The patient soon recovered
from this operation, so that I was enabled to operate on this side as
well as on the Hernia of the right side, for a radical cure, which
proved entirely successful, restoring the patient to health, and free-
dom from the severe pain with which she had so long been afflicted.
Mr. K., of Acton, Mass., aged 54. Admitted to Infirmary, Nov.,
1848. Had an irreducible omental Femoral Hernia of several
years' standing. It was very painful, and obliged him to give up
work. Being unable to reduce it by taxis, I removed the protruded
mass, and afterwards operated with success for a radical cure.
Capt. R., aged about 55, of spare habit, came to me in the month
of November, 1850, with an irreducible Femoral Hernia on the left
side, of seven years' standing. I found, on cutting down, that it
contained omentum only. Having been out for a long time, it had
become considerably enlarged, and was not fit to be returned; I
therefore removed it. The patient very soon recovered from the
operation, and was radically cured.
Mrs. B., aged about 25, consulted me in June, 1841, for an
irreducible Femoral Hernia, of thirteen years' standing. She had
suffered much at different times from attacks of colic. I tried in
vain to effect the reduction by taxis, and therefore resorted to the
operation. I found very strong adhesions existing, and was obliged
to enlarge the ring considerably, in order to effect the reduction.
No inconvenience was experienced from the operation, and the
patient soon recovered.
Mr. C., aged about 24 years, came to me with an irreducible
Omental Hernia of recent occurrence. It was very painful, so
much so that he had been unable to wear a truss, or any kind of
support, and most of the time had not been able to walk. The
soreness was so great that I could not try the taxis to any extent;
I therefore cut down upon it, and returned it, the patient suffering
little inconvenience from the operation. A cure was effected in this
case, and the patient restored to health.
Miss V., aged about 35, consulted me, December, 1851, for an
irreducible Femoral Hernia, of ten years' standing. She had
suffered much, at times, from partial strangulation, to which she

31
was almost constantly subject. Protracted vomiting or retching
occurring at frequent intervals, and sometimes continuing for two
or three days, had rendered existence oftentimes a burden to her.
I endeavored to reduce the protrusion by taxis, but without success,
and finally was obliged to resort to the operation that I usually
perform in such cases. I found the Hernia to consist of omen-
tum, a portion of which I had to remove. I afterwards operated
successfully for its radical cure.

12
Dr. Heaton, hearing from various sources that he is supposed to
be, according to his previous intention, at the present time in
Europe, desires to correct such an impression.
He will for the present remain in Boston, and may be found at
his residence, No. 2, Exeter Place, or at No. 40, Lincoln Street.
He continues to receive patients as heretofore, and to attend to
the radical cure of Hernia or Rupture, in all its forms, including
both Reducible Hernia and those cases usually called Irreducible;
also to the treatment and cure of Varicocele, Hydrocele, &c., and
to Uterine diseases.