Surgical cases / [James Duncan].

  • Duncan, James, 1810-1849
Date:
[1845]
Catalogue details

Licence: Public Domain Mark

Credit: Surgical cases / [James Duncan]. Source: Wellcome Collection.

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    that, even in those instances in which the rupture is irreducible, we are sometimes, by careful attention to the symptoms as well as the history of the case, enabled to ascertain whether or not the strangulation of the bowel is to be regarded as their cause. We are told that the surgeon, by attention to the following circumstances, may be enabled to decide this point:—“ The pain in ileus is felt in the abdomen and not in the swelling, which continues soft, while the belly is inflated, hard, and tense. The attack is sudden, and not preceded by any of the occasional causes which could affect the rupture ; and the ring is free. The affection extends in the sequel to the swelling, which then becomes painful and tense ; but it appears later here than in the belly, and does not proceed to so great a degree. All these circumstances will of course aid materially in enabling us to form an opinion as to the nature of the case; and two are related by Mr Pott, in which by attention to them he was led in both to form a correct diagnosis, and in one of them to refuse to perform the operation, which he was urged to have recourse to by the other surgeons in attendance. The operation in one, and the dissection in both, verified the accuracy of his opinion. It would, however, we believe, in many cases be dangerous to act upon an opinion thus formed, and we are the more convinced of this, inasmuch as we have seen more than one case in which all the indications thus laid down existed, and neverthe¬ less the symptoms were clearly to be referred to the hernia, from the complete success which attended the performance of the operation. What the cause of the gangrene of the gall-bladder was it is difficult to say. There was no obstruction in the ducts ; but it is possible that some biliary calculus might have been temporarily impacted in them, but for a sufficient length of time to induce the inflammatory action which terminated in the formation of the slough. Femoral Hernia—Difficulty in Diagnosis—Operation—Cure. The following case illustrates the danger which might accrue were we to act upon the diagnostic marks as quoted above, as well as the propriety of the practice now generally recommended in doubtful cases. I was asked by Dr Simpson to see a poor woman in the Old Town who had been labouring for nearly two days under symptoms of obstruction of the bowels. In this patient the general symptoms had been urgent from the day before that on which I saw her. A small tumour existed in the region of femoral hernia of the left side, but was so perfectly free from pain that not only were the symptoms not believed to depend upon it, but by several the very existence of a hernia was doubted. When I first saw her the general symptoms continued urgent, and the patient had an expression of considerable anxiety. The