Mr. John Valentine, 1834
This month, in honor of Valentine’s Day, my social media is focusing on hernia red flags. Over 8 videos, I’m highlighting warning signs that can signal a hernia has become dangerous and needs urgent care.
This series was inspired by a historical case from surgeon Mr. Valentine and one of his youngest patients. It’s a sad case, but illustrates how far we have come since the advent of anesthesia in 1842, by Dr. Crawford Long.
The story takes place on May 17, 1832. A 10-month-old, Charles, was diagnosed with three hernias. During his exam, Mr. Valentine noted that Charles’ left inguinal hernia, roughly the size of an egg, was strangulated (it could not be pushed back in). In addition to the large bulge, Charles had stopped having bowel movements and had begun vomiting earlier that day.
Today, these symptoms would immediately be red flags. In modern medicine, a painful, non-reducible hernia with GI changes is a surgical emergency at any age.
But, in 1832, that was not the case.
Instead of emergency surgery, doctors attempted treatments available at the time, including warm baths, manual pressure on the bulge, and ice. These treatments continued overnight without improvement.
The following day, Mr. Valentine wrote that he decided to operate, believing it was the only chance to save Charles’ life.
Four days later, Charles died from an infection caused by a hole in his bowel, a complication of the strangulated hernia.
While incredibly tragic, cases like Charles’ helped shape modern surgical understanding and guidelines. We now recognize strangulated hernias as time-sensitive emergencies that require immediate surgery.
The good news is that today, with early recognition and prompt treatment, outcomes are dramatically better.
Takeaways
Most hernias are not immediately dangerous. However, knowing the warning signs can make a lifesaving difference. Modern hernia surgery by a specialist is safe, effective, and has a fast recovery.
Mr. Valentine and Charles’ story reminds us how far medicine has come, and why recognizing symptoms and seeking care quickly matters. It also inspires how I treat my patients. A few years ago, if patients had asymptomatic hernias, I often recommended watchful waiting. When patients started experiencing symptoms, I told them to come back and see me for a follow up appointment.
And then Covid-19 struck. Elective surgeries stopped. Emergency rooms were full of patients. It was dangerous to leave your home. I saw too many patients delaying their hernia surgery. The advice I gave to “wait it out and only come back as needed” may not have been the best advice.
That is when I changed how I treat hernias. Rather than encourage watchful waiting for everyone, I started encouraging patients to schedule their surgery for a time convenient for them in the next few months. If they want to wait, I tell them I’ll see them in a year, rather than just waiting for them to show up in pain. The risks of ongoing discomfort, strangulation, infections, and emergency surgery just aren’t worth it.
With all of that said, if you have a hernia, seek urgent medical evaluation if you notice:
- A bulge that suddenly becomes painful
- A hernia that cannot be pushed back in
- Nausea or vomiting
- Abdominal bloating
- Constipation or inability to pass gas
- Skin changes over the hernia such as redness or darkening
Suggested References
Valentine J. Mr. Valentine’s Case of Hernia in a Child. Prov Med Surg J (1840). 1840 Nov 28;1(9):149-50. doi: 10.1136/bmj.s1-1.9.149-a. PMID: 21372935; PMCID: PMC2488440.
N C Gallegos, J Dawson, M Jarvis, M Hobsley, Risk of strangulation in groin hernias, British Journal of Surgery, Volume 78, Issue 10, October 1991, Pages 1171–1173, https://doi.org/10.1002/bjs.1800781007
Helgstrand, F., Rosenberg, J., Kehlet, H., & Bisgaard, T. (2013). Outcomes after emergency versus elective ventral hernia repair: A prospective nationwide study. World Journal of Surgery, 37(10), 2273–2279. https://doi.org/10.1007/s00268-013-2123-5