Cases of strangulated hernia / [James Spence].

  • Spence, James, 1812-1882.
Date:
[between 1850 and 1859?]
Catalogue details

Licence: Public Domain Mark

Credit: Cases of strangulated hernia / [James Spence]. Source: Wellcome Collection.

    10/12 (page 26)
    with abdominal tenderness, and the patient gradually sank and died on the 30th of December. Case X.—Strangulated Femoral Hernia; Operation; Recovery. I visited this patient at the request of Dr Maine of Gorebridge, and as I only saw her on the occasion of my performing the operation, I am indebted to Dr Maine for the rest of the report of the case. Mrs W., let. 62, previously stout and healthy, was rather suddenly seized with pain in the right hypochondrium, at twelve o’clock noon on the 10th March, followed by sickness and vomiting. Was first seen at twelve p.m. Pain severe but intermittent, and shooting along the course of transverse colon. Pulse, skin, and tongue natural. Bowels have been confined for two days. A calomel and Colocynth pill, with one grain of opium was given, and warm fomentations directed to be applied to abdomen. 11. —No Better. Pain and vomiting at intervals; rather anxious expression of countenance. Bowels not moved. On examining the lower part of left side of abdomen a tumour, the size of a large walnut, was found in the inguino¬ femoral region rather hard and somewhat nodulated. She complained of no pain in the part, even on pressure, but some uneasiness in the bowels above it. Dr Maine tried to reduce it, but could not; he directed a simple enema to be given, and warm fomentations to the abdomen on the return of pain. Dr Thomson, Dalkeith, saw her with Dr Maine in the evening, when they found her much easier. Had one or two attacks of pain during the day, but not of long continuance. Pulse good ; enema had brought away a hard stool. Ap¬ plied taxis again, but without success. An opiate to be given at bed-time. 12. —Twelve p.m. Has remained nearly free from pain and vomiting all day. Repeat the opiate. 13. —I saw this patient about half-past five p.m. of the 13th March, along with Drs Maine and Thomson. The abdomen was tense and generally tender to the touch, her features were sharp and anxious, and bedewed with cold per¬ spiration. The pulse was 96 and jerking ; tongue rather dry and white in centre. She stated that the vomiting had not been so frequent as yesterday, but that whenever she takes food or liquid the vomiting returns. The bowels were obstinately constipated. On examination of the left inguino-femoral region I found a hard firm swell¬ ing about the size of a walnut, somewhat flattened and movable. It lay out¬ ward over the vessels, and no distinct neck could be traced from it towards the direction of the femoral ring, and there was not the slightest impulse on cough¬ ing. Still the symptoms and history of the case, combined with the presence of a tumour in this region, seemed to me sufficient warrant to operate. I ac¬ cordingly, after obtaining the patient’s consent, did so. I made a T incision over the swelling, but from the very great amount of fat, I had to convert it into a crucial incision to gain room. After dissecting through a great depth of fat, I exposed a small hernia. The sac was found vascular with masses of fat developed in it, so as very closely to resemble omentum, but by tracing it up¬ wards to the narrow neck of the tumour, its true nature was easily recognised. I next opened the sac, which required great care, as it contained no fluid. The bowel was dark and granular, but not adherent. On dividing the constriction, which was very tight, a large quantity of red¬ dish serum escaped from the abdomen. The bowel was then gently reduced, and the wound dressed and bandaged. 14. —Passed a comfortable night, but complains of considerable pain over abdomen generally—has vomited this morning—considerable thirst present. Pulse 110, good. Ordered a grain of opium and two of calomel every three hours. Twelve p.m., greatly relieved. Pulse 100. Pills to be given every four hours. 15. —Much in the same state as last night. 3vj- of castor oil to be given at once, and a grain of opium every six or eight hours.