Cases in surgery / by James Spence.

  • Spence, James, 1812-1882.
Date:
[1848]
Catalogue details

Licence: Public Domain Mark

Credit: Cases in surgery / by James Spence. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    3 for should her symptoms become more violent. I saw her early next mornmg, when I foimd that, although the vomiting and pain had been relieved by the opiate during the night, her pulse had increased much in frequency, and the hernia and abdomen were more tense and painful, and her countenance more anxious. Under these circumstances I recommended her to submit to the opera- tion without further delay; it was only with great difficulty she gave her consent, so that it was nearly one p.m. before the operation was performed, being about twenty-foiu- hours from the commencement of the attack. On performing the operation, the parts over the sac were found matted to- gether and adherent. On opening the sac, a portion of intestme of very dark port-wine colour was exposed, tightly constricted; I divided the stricture, and after separating some slight adhesions between the intestine and sac about its neck, returned the bowel, dressed the wound, and bandaged her in the usual manner. An opiate was then given; in the evening I found the vomiting had ceased, but the abdominal tenderness still continued, and the bowels had not been moved. She was ordered an ounce of castor oil and a cathartic enema. As the pain in the abdomen increased during the night, Dr Menzies was sent for and bled her freely from the arm, and at my morning visit I found her somewhat easier, and her bowels had been freely opened, but still there was great tender- ness of the abdomen, thirst, quick pulse, and hot skin, and occasional retching ; leeches were apphed to the epigastrium, and she was directed to have two grains of calomel and half a grain of opium every two hours. Next day she seemed much worse; there was great distension of the abdomen, and the feeling as if effusion had taken place; her face was of a deep yellow colour, and flushed on the cheeks; pialse 120, and sharp ; tongue furred. A large blister was applied over the belly, and the calomel and opium continued ; the blister rose well, and on the fourth day after the operation the mercury began to affect the mouth, and shortly afterwards she had a copious dark evacuation from the bowels. Next morning I found her much relieved, and her bowels had been opened freely several times with great reUef; the tenderness of the abdomen was almost quite gone. From this time she continued to go on progressively to recovery, although it was a considerable time before the abdominal effusion disappeared, and she re- quired the cautious use of stimuli and nourishing diet to complete her cure, which was effected in about five weeks. Case III.—Strangulated Femoral Hernia. On the 18th June 1847,1 was sent for by Mr Falconer of Loanhead to visit Mrs F., aged sixty-four, who had been seized that morning with the usual symptoms of strangulated hernia. This patient had been the subject of a femoral hernia for several years, for Avhich she had constantly wora a truss, and ^v\uch. she coiild always readily reduce when it came down ; on the present occasion she had left off the truss, and the hernia came down whilst she was making some exertion, and she failed in her attempts to reduce it. Sicloiess, pain in the part and at the um- bilicus, accompanied by vomiting, soon came on, and she sent for Mr Falconer, who tried to reduce it, but without success. I saw her about five p.m., when I found her with a quick pulse, anxious expression of countenance, and occasional vomit- ing ; the tumour was ^^mall and very tense, but the abdomen was not much dis- tended, nor very painful except just before the attacks of vomiting. I attempted the taxis again steadily but very gently, as the peculiar tense feel- ing of the swelling showed that it was tightly constricted at the neck ; the attempt to reduce it failed, and I then recommended her to submit to the operation at once. This she was very imwilling to do, as she thought the bad symjitoms were not mcreasing ; but on explaining to her and her family her great dnn-er, she consented, and I accordingly proceeded to operate, assisted by Mr Falconer' and Dr KeiUer. The incision was made in the usual form, and nothing peculiar ap pearcd untd the cnbriform fascia was divided, when a structiu-e came into ne\v which appeared like the hernial sac ; on divicUng the superimposed fascia more