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.

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    with flakes of recent lymph, and retained the indented appearance even after the constriction was divided and though from the appearance of the intestine and the feeble state of the patient, I formed a very bad opinion of the case, I was agreeably disappointed to find my prognosis was not fulfilled, for he made an excellent recovery. The cases of R—y and Mrs M‘G. afford examples of the symptoms existing for some days, gradually increasing in intensity, and inducing great alteration in the constricted portion of the intestine, yet contrary to what might have been expected and what is generally found under such unfavourable circumstances, both recovered without the supervention of peritonitis or other bad symptoms. Mrs M‘G.’s case possesses some interest also, as um¬ bilical hernia? are not very frequently the subjects of operation, and the obliteration of the peritoneal sac at one part, and the adhesion of the omentum there to the deep surface of the superficial fascia, is also a point of practical importance worthy of notice. Case IX.—Scrotal Hernia, apparently reduced by Taxis. Small Hernial Tumour felt at upper part of Canal; Operation; Death. Mr C., set. 85, was seized with the symptoms of strangulated hernia on the 23d December 1853. He was seen by Dr Cruickshank of North Berwick, who found a large scrotal hernia which the patient stated he had had for upwards of twenty years, but that it had never troubled him as he could always reduce it. Dr C. returned the tumour apparently by the taxis, but the symptoms still continuing, Dr C. asked me to meet him to examine the case. I visited him on the afternoon of the 27th, and found him restless and suffering from hiccough. I was informed that the vomiting had not been so bad for some hours, and that he had had a slight motion of the bowels after an enema. The abdomen was tense and painful to the touch; there was, however, no distinct appearance of hernial swelling but merely a general fulness from great development of fat on both inguinal regions. On examining the left side where the large scrotal hernia had existed, by passing my finger from below upwards along the cord, I thought I could detect a small swelling at the upper part of the canal. After again examining him, and feeling more satisfied as to the existence of the small swelling, I explained to his friends the necessity of an operation to afford him the only chance of relief, although from his exhausted state and advanced age the case was very un¬ favourable. He had previously suffered from acute rheumatism and asthma, and on trying to administer chloroform it so depressed his pulse that its use could not be continued. An incision was made beginning well over the position of the deep ring and carried down for about 2\ or 3 inches. A very great depth of fat required to be divided in order to reach the tendon of the external oblique. I then slit up the tendon from the external ring so as to expose the canal, and when this was done I brought into view a small hernial tumour, about the size of a walnut, constricted at the deep ring. The sac was cautiously opened as there was no fluid in it. The bowel was found very red and granular, but not very dark, and it presented no appearance of gangrene. The constriction was then divided directly upwards. I next gently drew down the gut to examine it immediately above the stricture, when I found a small firm band of lymph constricting it within the sac. This I also divided, then readily returned the bowel, and dressed and bandaged the wound in the usual manner. I did not see the patient again, but I learned from Dr Cruickshank that after a temporary relief, the symptoms of vomiting and hiccough returned c