Volume 1
A manual for the practice of surgery / by Thomas Bryant.
- Thomas Bryant
- Date:
- 1879
Licence: Public Domain Mark
Credit: A manual for the practice of surgery / by Thomas Bryant. Source: Wellcome Collection.
Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.
682/766 (page 650)
![Bag-truBS. A reducible hernia may become irreducible. Use of ice. I Example. !■ i Obstructed ii lieruia. ]!; ^ Symptoms. Constitu- j' tional. ' Local. Wlien cUrouic. Treatment. Rest. Warmth. Use of purgatives. Avoid manipula- tion. may be treated by a truss, the pad being made of such n shape as to adapt itself to the neck of the tumour, and of such a substance as to seal the orifice of the sac without causing pain; air, sand, or india rubber being probably the best material for pads. Every patient with such a hernia should be warned against taking violent exercise, or over-distending the abdominal viscera. The bowels should never be allowed to become constipated, and, above all, the slightest symptom of pain or increase of size in the tumour should be brought at once under medical advice, since these irreducible herniae are treacherous things, and become obstructed and strangulated very insidiously. In some cases of irreducible hernia, reduction may be effected by rest in the horizontal posture, a brisk purge or enema, and the administra- tion of small doses of saline purgatives, such as the sulphate of magnesia, so as to keep up a gentle action of the bowels, with the local applica- tion of ice, the diet being at the same time nutritious, though not of a bulky nature. The late Mr. Bransby Cooper gave small doses of blue pill and tartar emetic, but I have not found such remedies necessary. In this way, in a boy, set. 16, after a month’s treatment, I have procured the reduction of a scrotal hernia that had been down three months; and an equally good result in the case of a gentleman, set. 36, after three weeks’ treatment, where both locally and generally, much disturbance existed. Old irreducible herniae are rarely made reducible by treatment, but the recent can generally be reduced by the means already indicated. Obstructed Hernia. The symptoms of an obstructed hernia as of obstructed intestine are not very definite, but the chief are, obscure abdominal pains with a dragging sensation about the umbilicus after food, nausea, and, at times vomiting. Constipation, when present, aggravates the symptoms, and renders the local signs of obstructed hernia more marked, the tumour becoming distended, tympanitic, and painful. Ou manipulation, the intestine in the hernia may be partially or wholly emptied of its gaseous if not of its solid contents, and the compression of the tumour be accompanied by the peculiar gurgling sound of gas and fluid as these traverse the canal towards the abdominal cavity. When suen symptoms are chronic, they are generally known as indicating an incarcerated hernia, but such a term is not satisfactory, it being applied to the obstructed as well as to the irreducible hernia, and should be discontinued. Treatment.—These cases require great care in their treatment, because if neglected, they pass on rapidly to inflammation or strangula- tion. B,est in the horizontal position is of primary importance, and the tumour if scrotal should be slightly elevated. Warmth to the hernia, also, often gives comfort, relaxing the parts, and thus favouring reduction. When constipation unaccompanied by vomiting exists, a brisk purge may be given, but with this symptom a purgative enema is to be preferred, the natural action of the bowels being stimulated by these means, and the contents of the hernial sac moved ou. The tumour itself should not be manipulated at this stage of the case, such a step doing harm by bruising or setting up inflammatory action. When](https://iiif.wellcomecollection.org/image/b21303010_0001_0682.jp2/full/800%2C/0/default.jpg)
