Remarks on strangulation and radical cure of hernia : based on over 120 operations / by Rushton Parker.

  • Parker, Rushton, 1847-1932.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on strangulation and radical cure of hernia : based on over 120 operations / by Rushton Parker. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The tendency to hernia thus presented is therefore much greater in male than in female infants, Avhile in both sexes the right side is found more often open than the left. With regard to strangulation, of which the typical symptoms, pain, constipation, and vomiting, are not difficult to appreciate when typically present with a hernial tumour, I think the part played by this last in determining the diagnosis is apt to be undervalued, though it is the only point distinguishing strangulated hernia from other kinds of intestinal obstruction. Of the symptoms themselves there are great varieties in suddenness and severity, and if it were not for the accompany- ing tumour surgeons would often be in great doubt as to the necessity of operating. First, as to the possible cause of the diversity of sjmaptoms, it will be thought that intensity and suddenness of symptoms should be a natural measure of the tightness of strangulation. Sometimes it truly is, especially when bowel descends for the first time. This, by the way, may occur under two circum- stances, either at the first descent of the hernia, in w^hich case it is very noticeable ; or at the first entrance of intestine into an old hernia, containing only omentum, but with a very narrow neck. This may be striking enough if thought of, but is liable to be overlooked. This discovery of tight strangulation with slight S}Tiiptoms has sometimes been due to operation when in doubt, and because of doubt, a golden rule that has saved many lives. To those who have seen but little it is an admirable substitute for experience, to which it however leads ; while no man has seen so much as to be able to dispense with it. The oftener any one has acted up to it, the more he prizes it. I remember a young man sent in with his doctor's request that the surgeon on duty should be summoned at once. There was a history of hernia, strangulation, and taxis, and a soft inguinal tumour with a liquid feel, and a slight impulse on coughing, but no abdominal distension, vomiting, or any symptom. I was guided entirely by the urgent message that he should be seen at once, and was in a state of extreme doubt