The technic of modern operations for hernia / by Alexander Hugh Ferguson ... Illustrated by reproductions of original drawings from the author's collection.

Ferguson, Alexander Hugh.

Date:: 1907

Credit: The technic of modern operations for hernia / by Alexander Hugh Ferguson ... Illustrated by reproductions of original drawings from the author's collection. 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.

30/376 page 26

$In 1871 English reported 38 cases, of which 27 were inguinal, 9 crural, I ischiatic and i obturator. In 1892 Bitzako compiled the literature of 113 cases, 91 of which were inguinal, 17 crural. Puech in a series of 88 cases gives 54 congenital, 17 doubtful and 17 acquired cases. English be- lieves that 17 of his cases were congenital. Bitzako states that 66 of his series were congenital. Thus far the ovary has been found to constitute the contents of the sac in 4 cases of ischiatic hernia. Lockwood {Brit. Med. Jour., June 13, 1896) reports an unusual case of hernia of the ovary that occurred in an infant only six months of age. The child became ill suddenly, and two days later there appeared a swell- ing which was tender to touch but was easily reducible. It was about three inches long and one and a half inches broad. The skin over it was inflamed. There was no impulse on crying, but the child vomited occa- sionally. There w^as no obstruction of the bowels. A diagnosis was made of strangulated hernia and at the operation the sac was found to contain the ovary, the fimbriated end of the Fallopian tube, and a grumous fluid. There were no adhesions at the internal ring. The tube and ovary were replaced, the sac was ablated, and the wound closed. Mr. Owen reported a similar case. P. F. Morf {Annals of Surgery, ]\Iarch, 1901) reports one case of hernia of the Fallopian tube, without hernia of the ovary, occurring in a woman who had suffered from a congenital hernia in the left inguinal re- gion. The case illustrates the extension of the inflammation from the vagina through the uterus and then through the tube into the sac of the hernia where it caused suppuration. A portion of omentum was also found in the sac. Of 24 cases recorded in the literature, 13 were inguinal, 10 crural and one obturator. Strangulation was present in 14 cases. Of these six were inguinal, seven femoral and one obturator. J. H. Jopson (Annals of Surgery, July, 1904) reports the case of a woman, aged 27, multipara, who had had a sm.all right inguinal hernia as long as she could remember. It was of about the size of a walnut, a small^ hard, painless protrusion, which always descended when she was on her feet and disappeared on lying down. It always was reducible; it gave her no trouble, and she never wore a truss. Suddenly, while washing, a large protrusion appeared in the right groin, accompanied by severe pain. There was neither vomiting, constipation, fever or chill. The swelling then was of about the size of a fist, situated in the right inguino-labial region, coming from the external abdominal ring; hard, irreducible and somewhat tender. A probable diagnosis was made of omental hernia. The tumor was pear- shaped, the wide end presenting. The sac was adherent, except at the con- stricted base. While endeavoring to unfold the sac, it suddenly split longi- tudinally and about three-quarters of an ounce of a yellow, odorless pus escaped. An ovary was seen to protrude from the canal to the right of the neck of the mass, also the broad ligament and tube. It was then discovered that the herniated mass was the uterus turned over forward, the supravaginal portion running backward, downward and inward toward the cervix. The necrotic and infected condition of the body of the uterus forbade its reduction and it, with the ovar}^ and sac, were removed. To se-$