Atlas and epitome of abdominal hernias / by Dr. Georg Sultan.

  • Sultan, Georg.
Date:
1902
Catalogue details

Licence: Public Domain Mark

Credit: Atlas and epitome of abdominal hernias / by Dr. Georg Sultan. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    Fig. 106.—Multiple lateral ventral hernias. This patient was thirty-nine years of age and had borne five children without exhibiting any abnormality of the abdominal wall. At about the fourth or fifth month of the sixth pregnancy she fell and struck her abdomen against a pile of rubbish. Soon after this accident she noticed the appearance of an umbilical hernia. After the birth of the sixth child the um- bilical hernia gradually enlarged ; it was no longer reducible and was finally operated upon. About eight weeks later she caught cold, and the coughing caused a new hernial protrusion above the scar resulting from the operation. She was then operated upon a second time. She again became pregnant, and during and after this pregnancy other hernias developed at several locations in the abdominal wall. When the patient was examined at the surgical clinic at Gottingen, she had a most marked pendulous abdomen and a linear operative scar which commenced above the umbilicus and extended downward in the median line for a distance of 12 centimeters (4| inches). In addition to a diffuse protrusion of the u]3per portion of the operative scar and of the region immediately above it, three sharply circumscribed lateral ventral hernias were observed. The first of these was as large as a child's head and situated upon the right side ; its contents could be reduced, a gurgling murmur being heard at the time of reduction, and three or four fingers could be comfortably introduced into the hernial orifice. The second hernia was below, and the third to the left of the operative scar. The latter two hernias were only half as large as the first ; they were readily reducible and their hernial orifices were large enough to admit one or two fingers. come enlarged and filled with viscera by an injury which produces an excessive tension of the anterior abdominal wall and, at the same time, a violent augmentation of the intra-abdominal tension. It is worthy of note that the epigastric hernias developing without preceding injury are usually observed in strong healthy men in the prime of life who do the heaviest kind of work. Volckers has re- cently laid particular stress upon this fact, and regards the strenuous occupation as the chief cause of development of such hernias. The continuous heavy work is supposed to