Cases in surgery. Cases of strangulated hernia / by James Spence.

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

Licence: Public Domain Mark

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

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    CASES IN SURGERY. By JAMES SPENCE, Surgeon. FROM THE MONTHLY JOURNAL OF MEDICAL SCIENCE, FOR APRIL 1818. Cases of Strangulated Hernia. Case I.—Congenital Hernia. J-M-, aged eighteen, a coachmaker by trade, whilst engaged at his usual occupation overstretched himself, and immediately felt severe pain at the lower part of the belly. On putting his hand to the part he felt a hard swelling, and became sick and vomited. He managed to walk home with great difficulty, and sent for Dr Cowan, Rankeillar Street, at whose request I visited him about four hours after the accident, Dr Cowan having already tried the taxis and other measures to relieve him without success. On examination, I found a tense elastic swelling extending from the inguinal region into the scrotum on the left side; there was evidently a considerable quantity of fluid in the scrotal portion of the swell¬ ing, the testicle of that side could not be felt, and there was only very slight im¬ pulse communicated to the tumour on coughing. The patient said, 44 That when a child there used to be something the matter at that part, but he did not recol¬ lect much about it, as he had not been troubled with it since he grew up, only the testicle had never been down on that side.” As my attempts to reduce the hernia by the taxis failed, I proceeded to operate. On opening the sac, a large quantity of serous fluid escaped, and then I found a small knuckle of intestine tightly constricted, situated at the upper part. On dividing the resisting edge of the external abdominal ring, and passing my finger upwards, I felt another very tight stricture at the neck of the sac, which I divided, and returned the bowel into the abdomen. On this being done, the testicle came into view, lying within the inguinal canal, in such a position that its serous surface must have been in contact with that of the intestine, the posterior layer of the hernial sac investing the gland forming the tunica vaginalis testis; in other words, the intestine lay within the tunica vaginalis, which was still open towards the abdomen, and continuous with the general sac of the peritoneum. I drew the testicle and chord gently downwards into the scrotum, and, after bringing the edges of the incision together by sutures, I bandaged the patient in the usual manner, and directed him to have an opiate draught immediately, and a dose of castor-oil in the morning, if the bowels were not opened previously. Next day I found he was going on favour¬ ably, the bowels having been freely opened, and no rapidity of pulse or tenderness of abdomen being present; I removed the stitches on the third day after the operation, when I found the wound had nearly healed by the first intention; the testicle could be felt at the upper part of the scrotum, but sufficiently far down to be removed from the pressure of the pad and bandages. From his parents, who had now come to toAvn, I learned, that the absence of the left testicle had been noticed at his birth, that it had never since come doAvn, and that, when a child, he had occasionally a swelling at the part, which they then attributed to 44 Avind.” Every thing went on well till the twelfth day after the operation, Avhen, on visiting him to get a truss fitted for him, I found him complaining of an acute throbbing pain in the scrotum, Avhichhe said had commenced about two days previously; the lower part of the scrotum Avas inflamed and tense, Avith evident fluctuation. Accordingly I made an incision into it, and gave vent to a quantity of pus; this afforded him immediate relief, the part soon healed, and he left Edinburgh completely cured at the end of four Aveeks. As I Avas anxious to watch the future progress of the case as re- EDINBURGH ; SUTHERLAND AND KNOX, 58, PRINCES STREET,