Case of Strangulated Congenital Hernia Reduced En Masse

J. Luke
1843 Boston Medical and Surgical Journal  
The subject of the case was by profession an engraver, xl. 39 years, married ; father of eight children, and generally a healthy man. About 9 o'clock in the evening of the 6th of October, 1843, he called in his way home at Mr. Dawson's surgery, Islington, complaining of severe pain in the abdomen and sickness. He stated that he had suffered a similar pain on the 4th, which had disturbed his rest during the night, but that it had passed off* in the morning, leaving him easy throughout the 5lh,
more » ... roughout the 5lh, on which day there had been a motion from the bowels. LTpon the present occasion the pain had returned with increased violence, and had existed for about two hours. The pulse was not more than 70 in a minute, and there were not any febrile symptoms present. Pressure could be borne over the whole abdomen without any increase of pain. Mr. Dawson being aware of the existence of a hernia, instituted inquiries concerning it, but learnt that it was not down, and had not been down for a long time previous. An active aperient was administered, and the abdomen ordered to be fomented. About half past 11 Mr. Dawson was called to the patient's house, the pain of the abdomen having much increased. He learnt that since his previous interview the hernia had descended, and now formed a tumor about the size of an egg, hard, but not very painful. The reduction of this by the taxis was accomplished in three or four minutes, by the use of moderate pressure and with little pain, after which ihe patient expressed himself relieved. An ounce of castor oil combined with ten drops of tincture of opium was administered, and retained on the stomach without sickness. When seen on the morning of the 7th, it was found that he had passed a restless night, and suffered much pain and tenderness over the whole abdomen, but not more at one part than another, nor more on the right side than on the left. There had not been any action of the bowels, and the sickness had returned. The. countenance was much depressed. Sixteen ounces of blood were taken from the arm, followed by faintness, and calomel combined with opium was given.
doi:10.1056/nejm184312060291801 fatcat:vysxnew55fbqfk32u64votxpsq