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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    garded the development of the testis, I gave him a note to a medical friend in Glasgow, hut he did not apply to him ; during the short time, however, that he was under my own observation, there was no apparent increase in the size of the testicle. Remarks.—This case is interesting, in as much as operations in cases of congenital hernia are not very common, hut more especially as calling attention to some points in the diagnosis of such cases. It will he noticed that the local appearances were different from those usually met with in hernial tumours; the scrotum was not only tense and elastic, but evidently contained fluid like a hydrocele; whilst the testicle (which can always be felt, in ordinary hernise, be¬ hind and below the hernial tumour) could not be found, and the impulse on coughing was by no means the direct, distinct impulse which we generally feel in hernia. In this instance, the history of the case, and the urgent symptoms of strangulation, left no doubt as to the presence of hernia, and conse¬ quently of the proper course to be pursued; but suppose that, instead of this, the protrusion at the upper part had occurred more gradually and without strangulation, and the patient had applied on account of the swelling in the scrotum, the surgeon, finding a smooth, elastic tumour, transparent to light, like a hydrocele (which in one sense it really was), the testicle not to be felt as in ordinary scrotal hernia, and no distinct impulse on coughing, might mistake it for an ordi¬ nary hydrocele; and this shows the necessity of careful examination in every case, first, to ascertain distinctly the position of the testicle, and also to inquire carefully into the previous history of the case; for if, content with the evident transparency of the scrotal swelling, the surgeon were to draw off the fluid and inject as for hydrocele, in such a case as I have supposed, I need scarcely remark how disastrous the consequences would, in all probability, be. Case II.—Strangulated Femoral Hernia. On the 1st December 1846, I was requested by Dr Menzies to visit Mrs C., who had been suffering under symptoms of strangulated hernia since two p.m. on the afternoon of that day. I found on my arrival, that the vomiting had somewhat abated, although still continuing occasionally, and that her bowels had not been opened since the symptoms commenced. Her pulse was eighty-six, and soft; the belly not much distended, but the hernial tumour felt tense, and there was twist¬ ing pain at the umbilicus before the attacks of vomiting. She stated that she had noticed the swelling for several years ; but as it gave her no uneasiness she took no notice of it until about two years ago, when a medical gentleman who was attending her for another complaint, told her its nature, and advised her to wear a truss; but it resisted all attempts to reduce it then, and, as it gave no trouble, she thought no more of it until the present attack. I again attempted the taxis, but ineffectually. As the symptoms did not seem urgent, whilst the history of the case showed that the hernia had been irreducible for some years, I considered a short delay admissible in case the symptoms might be dependent upon some abdominal irritation unconnected with the hernia, as had occurred to me in a case of which I have given an account in a former collection of hernial cases. I accordingly ordered an opiate draught to be taken, and a sinapism to be applied over the epigastrium, and left her, desiring to be sent