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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    This case is interesting from the length of time which elapsed between the performance of the operation and the evacuation of the bowels, and likewise from the subsequent formation of an artificial anus. In its progress, and likewise in some of the morbid changes, it appears to me to bear a very striking resemblance to those cases of ileus so well described by Dr Abercrombie. The bowels, after the division of the stricture, were long of regaining their tone, became over-distended, and the usual termination followed—intense inflammation of the affected parts, as indicated by the extremely softened and lacerable state of the whole canal above the point which had been constricted. A strangulated bowel may, subsequently to its reduction, give way at two points; it may give way, as a consequence of gan¬ grene, in the part contained in the sac beyond the stricture; and, again, it may give way by the process of ulceration at the part which was embraced by the constriction, as followed in a case which I shall immediately relate. In the case I have stated that the bowel at the time of the operation appeared to be in pretty good condition : such a degree of inflammatory action, however, had been established as to terminate in gangrene, and the sub¬ sequent formation of an artificial anus. Such an occurrence is by no means rare ; and we find, in the different works on hernia, cases in which the bowel has given way at a much more distant period than in the present. Some are related in which this had occurred after the lapse of several, even five or six, weeks. Strangulated Crural Hernia—Reduction by the Taxis—Perfor¬ ation by Ulceration after six Hays—Death. Mrs W., set. forty-five. On the 5th October I visited this patient with my friend Mr Knox. She was then labouring under symptoms of strangulated hernia. The account given of the case was as follows:—On the 3d, she observed a small tumour in the left groin, but as it gave no uneasiness, no attention was paid to it. It continued in the same state during all that day and the next, the bowels having during that time been freely moved. Between the night of the 4th and the morning of the 5th it became painful, and shortly afterwards she began to com¬ plain of general pain of the abdomen, which during the night was accompanied with frequent vomiting. She was seen by Mr Knox about 1 p. m. on the 5th, about nine hours after the symptoms of strangulation had commenced. The symptoms were then urgent. The hernial tumour was about the size of a walnut. It was tense and painful, and there was considerable general pain of abdomen, but no great disten¬ tion. There had been frequent vomiting, and latterly this had become feculent. There was much anxiety ; the face was pale, and the skin rather cool. The pulse was small, about 120, and easily compressed. Mr K. immediately employed the taxis,