Surgical cases / [James Duncan].

  • James Duncan
Date:
[1844]
Catalogue details

Licence: Public Domain Mark

Credit: Surgical cases / [James Duncan]. Source: Wellcome Collection.

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    duce it gave considerable pain. There was but little distention of the abdomen, and very slight tenderness, but much complaint of twisting pain at the umbilicus. Vomiting had only commenced about two hours before I visited him, and was not yet feculent. Pulse 108. Skin moderately warm. Countenance expressive of much anxiety. After the attempts at reduction which Sir G. B. and myself made, had, after what we considered a fair trial, failed, the cir¬ cumstances of the case were explained to the man, and he readily submitted to the operation. An incision of about three inches in length was made over the neck of the tumour, and the tendon of the external oblique ex¬ posed. It was at once seen that the external ring was the seat of the stricture. The constriction was exceedingly tight, and the edges of the ring were completely concealed by the projection which the tumour formed around them. I determined upon dividing it if possible without interfering with the sac. This was accomplished with facility by dividing the constricting parts with the point of the bistoury, these, from their state of tension, giving way at the slightest touch. The only difficulty met with arose from the edge of the ring being concealed by the bulging which the tumour made around it. This, however, was easily overcome by drawing down the tumour and compressing it with the point of the linger immediately below the point where it was wished to divide the stricture. After about four or five lines of the tendon were divided in this manner, it was at once seen that the constriction was re¬ lieved, and the intestine was returned without the slightest difficulty. The edges of the wound were brought together by a few points of interrupted suture, and a compress and bandage applied. Within an hour after the operation the bowrnls w ere moved, and all the distressing symptoms entirely disappeared. From this time every thing went on well, and the greater part of the wound healed by the first intention. In this case I followed the practice of dividing the stricture external to the sac,—a practice which, although ably advocated by Mr Key and others, and unquestionably in very many cases an exceedingly safe one, has been but too generally opposed. It appears to me to illustrate very well the facility with which in many cases this operation can be performed, and its comparative safety to that generally followed. The danger of wounds in¬ volving the peritoneum, more particularly if the parts are in a state of inflammation, is wrell known, and I have no doubt that had I in this case operated in the usual manner, the chances of recovery would have been much diminished. Every surgeon must have seen cases of hernia, operated upon under the most favourable circumstances, terminate fatally in consequence of the