In my experience, the sudden development of a large inguinal hernia is more likely to follow an episode where the legs are suddenly stretched apart when the person slips rather than following an episode of lifting.

Inguinal hernias are much more common in men and this is to be expected when we consider the developmental anatomy.

The only proper treatment is operation. Trusses are mentioned only to be condemned. It has been found that long-term results are better if hernias are operated on even in bedridden elderly men.

A common complication of a hernia is that a portion of the bowel in the hernial sac may become trapped, twisted and its blood supply cut off.

If the bowel is just trapped, it is called an incarcerated hernia. If the bowel is kinked and obstructed, it is a strangulated hernia and, when the blood supply is cut off, the bowel becomes gangrenous. These complications usually require urgent operation.

A small hernia with a wide neck which is unlikely to become strangulated may be left if it causes no symptoms. But the tendency is for it to get worse, so operation should not be long delayed.

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The Rhesus or Rh factor is present in all red blood cells and was detected in 1940.

It was named from the Rhesus monkey on which the experiments were conducted.

There are three pairs of Rh factors, or antigens, and these are determined by six genes — Ñ, c; D, d; E, e — carried on a pair of chromosomes. One chromosome comes from the mother and one from father.

However, it is the D antigen which alone determines whether a person is Rh positive or Rh negative. Eighty-five per cent of us are Rh positive, that is we have the D gene.

When an Rh negative woman is pregnant with an Rh positive foetus, the red cells containing this Rh factor can leak into the mother’s circulation. And stimulate the production of antibodies.

This leakage may occur at any time during pregnancy but is more likely at the time of delivery or during a spontaneous miscarriage or induced abortion.

This sensitisation is more likely if the mother’s blood and that of the baby are ABO compatible. The ABO is the main blood grouping of which there are four — À, Â, AB and O.

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