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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    CASES OF STRANGULATED HERNIA. 1 Case I.—Strangulated Femoral Hernia ; Division of Constriction External to the Sac; Recoverp. Mrs R., set. 70. I saw this patient with Dr Gordon on the 19th March 1849. Dr G. had been sent for in the morning, and found that the hernia had come down, or at least that it had been first noticed about twentv-four hours previously. He had tried to reduce it by the taxis, but without success. On examination, I found a small femoral hernia, tense, unyielding, and very painful; there had been no motion from the bowels since the first appearance of the rupture, although enemata and purgatives had been given ; there was constant vomiting and great general prostration ; the belly was tympanitic and tender to the touch. Under these circumstances, I put the patient under the influence of chloro¬ form, having first obtained her consent to an operation if the taxis should fail. I then attempted the taxis when she was completely under the in¬ fluence of the chloroform, and the parts were fairly relaxed by attention to position, but could not succeed. I accordingly proceeded to operate. I made an incision parallel to Poupart’s ligament, and another perpendicularly down¬ wards from it, over the tumour, so as to enable me to see the deep-seated parts at the neck of the swelling distinctly. After dividing the superficial fascia and some cellular tissue, the falciform process was exposed, the resisting fibres divided carefully ; the probe-pointed bistoury guided on the finger was then insinuated gently between it and the hernial sac, and by turning the edge obliquely upwards and inwards a deeper constriction was divided. The sac and its contents were then drawn gently downwards, and a few fibres, appa¬ rently closely attached to the sac, and which seemed to constrict it, were scratched through with the bistoury. Holding the sac with one hand, I easily returned its contents into the abdomen, and feeling that it was empty and small, I invaginated it by pushing it upwards with my finger. I retained it within the ring till one of the gentlemen who assisted me in the operation closed the wound by sutures, the finger being withdrawn just before the last stitch was closed. A pad of sponge enveloped in lint was then placed over the opening, supported by a larger pad, and the whole secured by a spica bandage. An opiate was given after the effects of the chloroform had passed off. During the operation a little delay was caused by vomiting occurring while the patient was under chloroform, requiring her to be raised so as to prevent the fluid from passing down the air-jiassages. I saw her again in the evening; she seemed quite relieved ; the vomiting and hiccup had ceased, and there was no tender¬ ness of the abdomen. Next, day she had a dose of castor-oil, which, however, did not act; two Colocynth pills were then given, and next morning I found the bowels had acted freely three times. The wound healed well; she reco¬ vered rapidly, and she was able to be up in about a fortnight after the opera¬ tion. Case IT.—Strangulated Femoral Hernia; Sac Opened; Recovery. Margaret M., set. 80, had been subject to femoral hernia for about eighteen months previous to my seeing her. The hernia used to come down occasion-, ally, but was always easily returned, and she had never worn a truss regularly. B