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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![freely, I found that tliis was not the sac, but consisted of two or three small cysts, in appearance not unlike very small grapes. On opening one of them, a small quantity of fluid escaped, and the interior was seen to be smooth, as if lined with serous membrane. I then punctured the others, and, on dividing another layer of condensed cellular tissue, exposed the sac; on opening it a knuckle of small intes- tine was exposed, tightly constricted, and of a dark coloiu:. I then divided the stricture, reduced the intestine, and dressed the wound in the usual manner. She felt immediate relief from the pain and vomiting, and expressed herself thankful that she had submitted to the operation. A.n opiate draught was given, containing forty drops of the solution of muriate of morpliia. On the tliird day after the operation I again visited her, and dressed the wound, and removed the sutures. Her bowels had been freely opened within twelve hours after the operation, and she had suffered no pain m the belly since then. She ultimately recovered in about three weeks, ^vithout any bad symptoms supervening. Remarks.—I have placed these two cases together, as contrasting the advantage of early operation with the dangers to which even a comparatively short delay exposes the patient, although the symp- toms may not appear to be m-gent. This danger arises from peri- toneal inflammation being Hghted up before the operation is per- formed ; and then, as in the case of ^Ii's C , we have to combat the most violent form of that disease. Few patients have _ made a more narrow escape, and I consider that much of the credit is due to the unremitting attention and active medical treatment employed by Dr Menzies. In both of these cases there mil be noticed a feature of not mi- common occm-rence, but one which may throw the sm-geon off liis guard; viz., the remission of the vomiting and lU'gent symptoms, whilst there is a very tight constriction, and the morbid action is really progressing. I have in my possession a preparation of a strangulated femoral hernia, where iilceration of the intestine had occm-red above the stricture; and yet so slight appai-ently had the symptoms been, that the death was reported to be the result of general debility! And this could scarcely have arisen from the medical man overiooldng the symptoms; for the woman had a large femoral hernia on the opposite side, for which she had formerly undergone an operation; so that she herself would have drawn attention to the symptoms had they been present in an m'gent form. In cases like that of Mi's C , where the heniia has never been reducible, it becomes of course more difficult to judge whether the symptoms depend on strangulation or not; for such patients are as liable as other people, if not more so, to intestmal ni'itation and m- flammation; and the case of this kmd which I have already refeired to as published in this Joui'ual for August 1845, is a good example of this. . + 1 nn- But whilst this warrants some deliberation, and cautioiis watciun^ of the symptoms, and a little longer delay than m ordmaiy cases, lest we should find an operation had not been requu'ed, we must also recollect the great danger to which we cx]iosc the patient by uiimie delay; and fo? this reason I still adhere to the opinion I expressed m](https://iiif.wellcomecollection.org/image/b21475155_0006.jp2/full/800%2C/0/default.jpg)
