A brief essay on the nature and treatment of herniae or ruptures : illustrated with engravings / by David Tod.

  • Tod, David
Date:
1851
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Licence: Public Domain Mark

Credit: A brief essay on the nature and treatment of herniae or ruptures : illustrated with engravings / by David Tod. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    by coughing or sneezing prompts them to place their hands to the weak parts, whe they perceive that they are either actually ruptured or about to be so. Symptoms nf Hernia.'—The symptons of hernia; are—a swelling in the groin, or: the uavel, vyhich disappears when the person lies on the back, and l eappears on risin up : coughing will cause it to press against the hand when placed on it. If the hei nia is an enterocele, and the protruding portion of intestine small, the tumour small in jn-oportion, and it can generally be easily reduced; in its ascent into tl; abdomen it is often accompanied with a gurgling noise. If the hernia is an epiplocel the tumour is rather flabby and has an unequal feel; on reducing it no gurgling noit is heard. If the hernia is an entero-epiplocele, the tumour is not flabby, but it hi likcAvise an unequal feel; on returning it, the gut ascends first, with a gurgling noist and the omentum follows, without producing that noise. Treatment of Hernia.—From the preceding remarks, ever^- person afllicted wii hernia may easily infer that no permanent cure can he effected without the immediaft cause of the disease being removed, that is to say, unless the weak parts of the abdd minal walls become strong enough to resist the pressure of the viscera, and keep ther within the abdomen. This can be accomplished only by the combination of natuji and art: Nature, if assisted by Art, will gi-adually heal up the breach made in tl abdominal walls. The treatment of herniae, therefore, embraces three operations :- The first is to restore the whole of the protruding viscera with their elongated per toneal sac into the abdomen ; the second, to bring and permanently keep together tl surfaces of the internal abdominal ring. This being satisfactorih' accomplished, the» remains to administer those medicines which experience has ])roved eifective to arour ( the inert restorative powers in the system, particularly at the seat of the disease. This treatment, howevei', is only applicable to reducible hernia. As to irreducible hernias, the treatment must depend on the condition of each ind i vidual case. There are two different stages of irreducible heraiaj, the totally irreducil) i and the partly irreducible, the nature of which must be ascertained before am* atteiu i. at effectually relieving the patient is made. If the hernia is found to be totally inii ducible from the contents of the tumour having become thickened and hardened,i connected by adhesions with each other or with their containing sac, an attempt a reduction ought never to be made. If however the contents of a hernial tumour ai l i found to be but partly irreducible, in which case the irreducible part always consia ri of the omental portion, and the reducible of the intestinal portion, the latter shoift ] cautiously be returned to the abdomen, and there retained by a properly constructB 3a truss, to which a suspensory bag may be fixed to support the irreducible omenli ii portion, in order to lessen the inconvenience arising from the v. eight of the protrusioi s i In trying to reduce a hernial tumour, only moderate pressure must be used, ail ^ the patient should be ]ve])t constantly talking to prevent the retention of the breaai 9 for in this state a reduction cannot be effected, as the simultaneous pressure of m ii« diaphragm and of the abdominal muscles on the viscera opposes it. n If the case be an inguinal hernia situated in the canal between the internal a external rings, the protruding viscera will slip back into the abdomen, by the pati^ merely lying down on his back, or standing in an erect posture, a gentle presi being made with the fingers upon the tumour. In the case of a scrotal herniaj^Bi, patient shf)uld lie down on his back, have the pelvis raised about four inches hi than his shoulders, to lessen the superincumbent weight of the viscera in the regions of the abdomen; the legs extended, separated and quiescent to exteni iliacus internus and psoas magnus nuisclesf behind the internal rng and ing canal; then softly squeeze the lower portion of the tumour to force the fluid contei * I purposely omit to include the nature, symptoms and treatment of strangulated hq^^^ in this essay, which is more immediately intended for the guidance of ruptured i)crsoiiMi?t wliom tiie disease has not reached tliat dangerous state. iMo^t earnestly would 1 warn against delay, particularly those recently ruptured, in applying for remedy and prcvelil means to duly qualilied men, and not to seek relief, as is too frequently the case, at hands of individuals iinac(niaintc(l with the pathological anaiomy of hernia, which may consequences still worse than procrastination. In far the most cases (hat conuMinder s cognizance, incarceration of hernia has been hrought on by the ruptured person having an ill-constructed truss. j^Hft'' t Wlien the thigh is flexed, the contraction of these nmscles behind the inner ring an^MjUK guinal canal obstruct the return of the protruding viscera. The same reuiark is applical j to the pectinalis muscle in femoral hernia.