Short version • In the 1930-50s a number of American military and Veterans-Administration hospitals, university radiology departments and a few private “hernia clinics” ran special outpatient units that dealt almost exclusively with symptomatic hiatal hernia.
• Their main activity was non-operative reduction of the hernia under fluoroscopy (sometimes called “pneumatic,” “syringe,” or “inflation” reduction) followed by corsets, diet, posture and physiotherapy.
• Results were modest and relapse was common (30-70 % within a year).
• Once reliable operations (Nissen 1956, Belsey 1961, Collis 1957) and, later, powerful drugs for reflux (cimetidine 1976, omeprazole 1988) became available, the conservative technique was abandoned and the small single-disease units were absorbed into general gastro-intestinal or surgical services.
• Therefore the “centres for hiatus hernia” of the 1950s disappeared rather than failed; their task was taken over by modern GI, radiology and general-surgery departments.

Longer historical answer

1. Why did such centres appear? • Hiatal (sliding) hernia was recognised radiologically only in the 1920s (Akerlund 1926).
   • In the 1930s-40s it became clear that many patients who complained of “indigestion,” “cardiospasm,” or “chronic heart-burn” actually had a hernia visible on a barium study.
   • Surgery before the Second World War was hazardous; therefore radiologists, internists and physiotherapists tried to treat the condition non-operatively.
   • Because the technique required fluoroscopic equipment, a radiologist and sometimes several sessions, it was convenient to group cases in special clinics. Walter-Reed Army Hospital, Brooke Army Medical Center, St-Mary’s Hospital (San Francisco), the Cleveland Clinic, the Mayo Clinic, and several VA hospitals ran such services, and papers in AJR, JAMA, Annals of Surgery and Radiology between 1936 and 1955 refer to them as “hiatus-hernia clinics” or “centres.”

2. What was actually done there? a. Pneumatic / syringe / inflation reduction
   – A lubricated stomach tube was introduced.
   – 800-1500 ml of air were injected from a large glass syringe while the patient stood in front of the fluoroscope.
   – Air distended the stomach; with the patient performing Valsalva manoeuvres and deep knee bends the herniated fundus often slipped back below the diaphragm.
   – The moment reduction was seen, an abdominal binder or a specially fitted corset was applied to keep the stomach in place.
   b. Postural and physiotherapy measures
   – Bed head raised 6-8 in (15-20 cm).
   – Sleeping in the left-lateral position.
   – Specific diaphragmatic-breathing and abdominal-strengthening exercises.
   c. Diet and weight measures
   – Small, low-fat meals, no food for 3 h before lying down, weight reduction in the overweight.
   d. Medication
   – Antacids (magnesium trisilicate, aluminium hydroxide), belladonna alkaloids.

   A typical programme lasted 2-4 outpatient visits over six weeks; a few places kept patients on the ward for 2-3 days.

3. How well did it work? • Immediate reduction was achieved in 70-90 % of patients in most series (Skinner 1938, Chernin 1947, Allison 1951).
   • Symptoms improved initially in 60-80 % but 6-12-month follow-up showed relapse of herniation or reflux in 30-70 %; many patients required repeat reductions three or more times.
   • Complicated (para-oesophageal or large mixed) hernias failed reduction more often and sometimes strangulated, prompting emergency surgery.

4. Why did the centres decline? 1950s-60s – arrival of effective operations
   • 1955/56 Nissen published the fundoplication (initially via thoracotomy).
   • 1957 Collis devised the diaphragmatic hernia repair with intra-thoracic gastroplasty.
   • 1961 Belsey Mark IV repair became popular in the U.S.
   Open surgery offered cure rates >90 % with acceptable mortality (<2 % in specialised units).

   1970s-80s – effective pharmacological therapy
   • 1976 cimetidine (first H₂-blocker) dramatically reduced acid reflux symptoms.
   • 1988 omeprazole (first proton-pump inhibitor) was even more effective.
   Non-surgical patients could now be managed by pills rather than repeated fluoroscopic sessions and corsets.

   1990s – minimally invasive surgery
   • Laparoscopic Nissen fundoplication (Dallemagne 1991) and later Toupet or Dor procedures provided elective repair with short hospital stay.
   In that climate, separate “hiatus-hernia centres” offered no advantage. Their staff, space and fluoroscopy suites were re-tasked to general radiology/GI departments, while surgical patients went to increasingly specialised foregut surgery programs.

5. What happened to them? • No particular official order closed them; they were simply reorganised or renamed as hospital departments evolved.
   • Records of such clinics survive mostly as journal articles, theses and hospital annual reports; they are not obvious in modern databases, which is why very few digital traces remain.

Key historical references (all available in large medical libraries) – Skinner, “Pneumatic reduction of hiatus hernia,” JAMA 1938.
– Chernin, “Conservative treatment of hiatal hernia,” Radiology 1947.
– Allison & Spencer, “The anatomy and treatment of hiatus hernia,” Ann Surg 1951.
– Belsey, “Hiatus hernia with short oesophagus,” Thorax 1950.
– Nissen, “Eine einfache Operation zur Beeinflussung der Refluxoesophagitis,” Schweiz Med Wochenschr 1956.
– Javid et al., “Evaluation of conservative management of hiatus hernia,” Ann Surg 1959.

In summary, the 1950s “centres for hiatus hernia” were real, but their main therapy—fluoroscopic pneumatic reduction plus corset and lifestyle advice—proved inferior to later operations and drugs. As medical practice consolidated into multidisciplinary departments after 1960, the once-separate clinics quietly disappeared.