Hernia : its etiology, symptoms and treatment / by W. McAdam Eccles.

  • Eccles, W. McAdam (William McAdam)
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: Hernia : its etiology, symptoms and treatment / by W. McAdam Eccles. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    well to resect the portion of the bladder that has been affected. Sometimes a fistula may result, but usually this will close of itself, provided that sepsis is rigidly excluded. After the bladder wall has been sutured in either of the two supposed cases alluded to above, there still remains the necessity of dealing with the portion of the bladder that is found adherent to the sac-wall. This will need attention both when found thus accidentally, and in those cases in which the presence of the bladder has been surmised before an operation has been undertaken. The peritoneum covering the wall of the bladder should be carefully incised so as to free it from that forming the rest of the sac-wall. In this manner the organ itself will be completely separated from the actual sac. The circular or oval aperture in the latter, that is in reality in the parietal peritoneum, can be dealt with as in a laparotomy aperture by a continuous suture or by a series of interrupted ones. The bladder itself may then be carefully loosened from the tissues in which it had come to lie, and pushed gently back within the abdominal wall. The remainder of the radical operation is conducted as for an ordinary form of inguinal hernia. A truss should always be adjusted when the patient convalesces. HERNIA OF THE VERMIFORM APPENDIX. Varieties.—The vermiform appendix may be found in the sac of a hernia either accompanied by other viscera, par- ticularly the caecum, or it may be the sole contents of the sac. The former condition is by no means an uncommon one, and constitutes an ordinary example of hernia, save for the fact that the appendix may be the site of inflammation whilst it lies among other viscera within the sac. When the latter condition is present, the appendix being the only occupant of the hernia, an interesting question arises as to how the appendix has come to enter the sac of a hernia. Causation.—The normal appendix, some 4 to 5 inches long, with a complete meso-appendix, is free to move about in the abdominal cavity within a certain range around its attach- ment to the caecum, but it cannot be brought down to, and