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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    freely, I found that this was. not the sac, hut 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 colour. 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. An opiate draught was given, containing forty drops of the solution of muriate of morphia. On the third 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 in the belly since then. She ultimately recovered in about three weeks, without 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 urgent. This danger arises from peri¬ toneal inflammation being lighted up before the operation is per¬ formed ; and then, as in the case of Mrs 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 will be noticed a feature of not un¬ common occurrence, but one which may throw the surgeon off his guard; viz., the remission of the vomiting and urgent symptoms, whilst there is a very tight constriction, and the morbid action is really progressing. X have in my possession a preparation of a strangulated femoral hernia, where ulceration of the intestine had occurred above the stricture; and yet so slight apparently 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 overlooking 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 urgent form. In cases like that of Mrs C- where the hernia 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 intestinal irritation and in¬ flammation ; and the case of this kind which I have already referred to as published in this Journal for August 1845, is a good example of this. But whilst this warrants some deliberation, and cautious watching of the symptoms, and a little longer delay than in ordinary cases, lest we should find an operation had not been required, we must also recollect the great danger to which we expose the patient by undue delay; and for this reason I still adhere to the opinion I expressed in