Surgical emergencies; 12 lectures delivered at the University of Leipsic / by Dr. L. von Lesser. Tr. and rev. by Frederick A. Lyons.

  • Lesser, L. von (Ladislaus von), 1846-1925.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Surgical emergencies; 12 lectures delivered at the University of Leipsic / by Dr. L. von Lesser. Tr. and rev. by Frederick A. Lyons. 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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    straightening the axes of both the efferent and the afferent intestines. Besides narcosis, certain positions of the lower extremi- ties facilitate taxis; flexion and adduction of the thighs relax the abdominal walls and reduce the tension of the inguinal canal. In crural hernias coincident rotation of the thighs inwards favors a relaxation of the fascia lata. Elevation of the coccyx acts by allowing the intestines to fall back against the diaphragm and by the traction which the mesentery is thus caused to make upon the hernial loop. In like man- ner deep inspirations, lying on the healthy side and perhaps also a knee-elbow position, exert their influence. Those adju- vants to taxis which were formerly recommended, as, bleed- ing, leeches, the warm bath, extensive cupping of the abdo- men, warm fomentations, narcotics, (opium, belladonna) etc., have been entirely substituted by chloroform (or ether) nar- cosis. The administration of purges, clysters, tobacco (inf. fol. nicot. [5.0] 200,0; gummi mimos, 10,0 ol. ricini 15, o; M. D. S. for two injections) the ice bag, direct compression of the hernial tumor (elastic compress), have yielded favora- ble results only in isolated cases, and then owing to particu- larly favorable circumstances. Results should sooner be expected from forcible injection or pouring of water into the rectum, as in ileus. When taxis is properly made under the influence of an an- aesthetic we will not hesitate to proceed immediately to herni- otomy, utilizing the existing narcosis and having made all preparations before. We will now occupy our attention with the details of this operation. 1. We must consider the cases wherein apparently suc- cessful taxis makes herniotomy become necessary. Spuri- ous reduction, apparent reduction, false reduction (Streu- bel*) occurs upon returning the hernial loop en bloc with its sack in strangulation, above the hernial orifice between the abdominal parietes and the peritoneum parietale. A simi- lar occurrence can take place after opening the hernial sack in herniotomy when the hernial walls are not fixed during reposition of the loop. Then the gut may be forced through the dilated hernial neck into the abdominal cavity beside the neck, and between the peritoneum and abdominal wall. 2. By annular tearing of the constringent hernial neck,