Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner.
- Date:
- MDCCCXLIX [1849]
Licence: Public Domain Mark
Credit: Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner. Source: Wellcome Collection.
37/262 page 35
![cases of intus-su sceptic, we would merely point out, that cases like that of Dr Homolle’s patient differ materially in some respects from such internal stran¬ gulations or obstructions ; and that the points of difference are of such a nature as to show the propriety of operating on the same general principles which warrant us in doing so in ordinary cases of strangulated hernia. The principal objection to operations in cases of in¬ ternal strangulations, is the uncertain¬ ty—both as to the situation and nature of the obstruction—so that the surgeon may find, after opening the abdomen, that he either cannot ascertain or reach the seat of constricted or obsti ucted portion of bowel, or that, having found it, he cannot, from its very nature, relieve it by operation. But in cases where strangulated hernia is reduced en masse by taxis, there are two points which appear to us as obviously in¬ dicating the line of practice. The first is, that in such cases the stran¬ gulation can scarcely arise from any but one cause, viz., constriction by the neck of the sac ; and the second, which follows from the first, is the compara¬ tive fixity of position of the hernial mass, owing to the connexions of the peritoneal sac ; for when we reflect that the sac is formed by the parietal peritoneum, we at once see, that though the tumour be pushed back through the canal, it can¬ not be very far removed from its origi¬ nal position with regard to the internal opening, and that it will thus be I’e- tained within the reach of surgical in- terfei’ence ; so that, whilst an operation aflbrds the patient the only chance of re¬ lief, we have the advantage of a degree of certainty, both as to the position of the strangulated intestine and as to its cause; and for these reasons we consi¬ der operation in such cases not only warrantable but imperatively demand¬ ed ; and the successful results of M. Robert’s operation will, we trust, lead to its general adoption.]—J. S. 51.—On the Employment of Sugar of Lead in Strangulated Hernia. By Drs Nedhold and Hasserbronc.—The use of sugar of lead enemata for reduction of strangulated hernia, was first recom¬ mended by Neuber and Seitl; it has recently been tried by Drs Neuhold and Hasserbronc. Dr N. atfirms that opera¬ tions would become very rare were this agent more extensively used :—he states that in his experience of its efrects,he has always met with success, and that he has given four to six enemata, each con¬ taining ten grains, of the acetate of lead, without bad results. In a case of a very large scrotal hernia, which had resisted the taxis and all other means for twenty- eight hours, and the patient refusing to consent to an operation, ten grains of the acetateof lead dissolved in six ounces of tepid water were given as an enema, and this was to be repeated every two hours. The pulse, which was small and contracted, gradually became more de¬ veloped, the general condition hourly improved, and the hernia spontaneously returned while the man was asleep. In another case of inguinal hernia. Dr N. was not called till strangulation had lasted three days, and had given rise to the worst symptoms. The patient’s con¬ dition improved much after the use of the enema, and the hernia readily yielded to the taxis. Dr Hasserbronc has tried it, and with complete success ; the following are the circumstances of the case:—In the month of September 1848, Dr H. was called to visit Michael Th-, a basket-maker, about sixty years old, to reduce a large inguinal hernia of the right side. The patient had already made several ineflfec- tual attempts to reduce it, but he only rendered the tumour more painful. Con¬ stipation was present, hiccough, and strong agitation. Dr H. tried the taxis, emollient enemata, cold applications to the tumour, and other usual means, without success : the strangulation had already lasted thirty-six hours. He was going to request a consultation for the purpose of advising an operation ; before doing so, however, he determined to try sugar of lead enemata, forty grains to twenty-four oz. of warm water for four enemata ; two every two hours; at the same time he ordered cold applications of strong sugar of lead to the tumour : after the third ene¬ ma Dr H. again tried the taxis, and was able to reduce the hernia. He or¬ dered immediately an ounce and a half of castor oil; the patient had several stools during the night without suffering any bad effects : two days after he re¬ sumed his usual business. Though not altogether sharing in M. Neuhold’s hopes. Dr H. believes this remedy will play an important part in the treatment of strangulated hernia, and that it will ad¬ vantageously supplant tobacco enemata, which are not free from danger.— L’Union Mtdicale, Nov. 30, 1848.](https://iiif.wellcomecollection.org/image/b29348390_0037.jp2/full/800%2C/0/default.jpg)
