Chapter 17 - Surgical Diseases
Modern Surgery
Suppuration and Abscess
Ulceration and Ulcers
Malignant Pustule
Burns and Scalds
Frost Bite
Septic Wounds
Incised Wounds
Rules for Examining and Dressing Wounds
Antiseptic Dressings
Way Wounds Unite
Punctured Wounds
Lacerated Wounds
Granulation and Scarification
Gunshot Wounds
Poisoned Wounds
Way Broken Bones Unite
Different Diseases of Bones
White Swelling
Stiff Joint
Water in the Scrotum
Blood in the Scrotum
Varicose Veins
Deformities and Irritations of the Spine
Wry Neck
Foreign Bodies in the Eye
Inflammation of the Edge of the Eyelids
Disorder of the Lashes
Chronic Inflammation of the Lachrymal Sac
Inflammation of the Cornea
Inflammation of the Iris
Weakness of Sight
Imperfect Vision
Short and Long Sight
Affections of the Ear
Inflammation of the Meatus
Wax in the Ear
Inflammation of the Tympanum, Deafness
Bleeding from the Nose
Ingrowing Toe Nail
Chafing and Excoriation
Foreign Substances
Bleeding from Wounds
Proud Flesh
Compression of Arteries to Stop the Flow of Blood
Care of the Teeth
Rotting of the Teeth
Filling Teeth
The First Teeth
Cleaning the Teeth
Ulcer of the Stomach
Riggs' Disease

17.46 Hernia

Rupture. Hernia.

HERNIA signifies a protrusion of any internal organ from the cavity where it belongs; but the term is generally restricted so as to mean no more than a protrusion of the bowel through the walls of the belly.
When the abdominal walls are weak, from any cause, no matter what, lifting, straining, or making violent muscular exertion of any kind, will then often cause the bowel to force itself through at the most debilitated spot; and pushing the lining of the belly, the peritoneum, along before it, a bag or sac is formed, in which the projecting bowel is enclosed, forming an external tumor.

Divisions of Hernia. Rupture may occur in several different places, and has accordingly received different names.

Umbilical Hernia is a protrusion of the bowel at the umbilicus or navel. This is most common in children soon after birth; and women who are often pregnant are liable to it.

Ventral Hernia is that which occurs at any part of the belly where other forms of rupture do not appear.

Inguinal Hernia is that in which the bowel protrudes at the groins, or through the abdominal rings.

Scrotal Hernia is that in which the bowel descends into the bag or scrotum.

Femoral Hernia is the dropping down of the bowel behind what is called Poupart's ligament, and appearing as a tumor at the upper part of the thigh.

Reducible Hernia. Rupture is said to be reducible, when the bowel may be put back into the cavity from which it came.

Irreducible Hernia. Hernia is called irreducible when the protruding bowel cannot be returned into the belly.

Strangulated Hernia is that form of the complaint in which the bowel is so pressed upon at the point where it passes through the walls of the belly that it is strangled or constricted so that its contents cannot pass through.

Symptoms of Hernia. A soft tumor, which may be compressed, appears somewhere about the belly; and is increased in size when the patient stands up. It also swells when he coughs, or makes any exertion; and grows smaller, or entirely disappears, when he lies down.

Treatment. In a case of reducible hernia, the first thing to be done is to put the bowel back in its place, which is accomplished by gently pressing and kneading the tumor, and swaying it back and forth, being careful to use no violence, until it can be pushed within the abdominal walls. It is then to be kept in its place by the use of a truss, made expressly to fit the case. This instrument should be constantly worn by day, and by night, too, if not too irksome; but if worn by day only, it should always be applied before rising in the morning.

Irreducible Hernia may be palliated by wearing a truss with a hollow pad, which will so evenly and firmly embrace the tumor as neither to irritate it, nor permit any further protrusion or enlargement.

Strangulated Hernia. If a person has worn a truss for some time, and suddenly leaving it off, makes some violent exertion, either the bowel or omentum is liable to be suddenly forced through a narrow aperture, and to become strangled. In such case, the patient has flatulence, colicky pains, a sense of tightness across the belly, and a desire to go to stool, but no ability to pass anything. Then follows vomiting, first the contents of the stomach, then mucus and bile, and, lastly, the fecal matters from the bowels, which are not permitted to pass on to their natural outlet. The neck of the hernial sac now becomes swelled, tender and painful, the countenance is anxious, and the pulse small, hard and wiry; and, after a time, the tumor begins to mortify, the patient expresses himself free from all pain, and soon after dies.
In the treatment, the bowel is to be returned if possible. To do this, the bladder should first be emptied with a catheter, and the patient should lie down with his shoulders raised, and both his thighs bent towards the belly, and placed close to each other, so as to relax all the ligaments and muscles of the belly. The surgeon may now work gently for half an hour, if necessary, trying to put the bowel back, but must be very careful not to excite inflammation by any violence.
If he does not succeed, efforts are next to be made still further to relax the muscles, as well as to reduce the force of the heart's action. and to diminish the size of the tumor. With the tincture or fluid extract of veratrum viride, the heart's action and force of the circulation may be reduced to any desirable extent.
To reduce the tumor, apply pounded ice in a bag, or a freezing mixture (354.) If the pain be acute give large doses of opium or morphia. Ether is generally required to reduce a hernia.
If all these remedies fail, there is then no hope but in relieving the stricture by a surgical operation, which must not be deferred too long.

General Directions. Rupture is an exceedingly common affection. Perhaps every third or fourth person suffers from it more or less. Females, from motives of delicacy, are apt to conceal the misfortune, and not seek advice. This exposes them to danger. Queen Caroline, wife of George 11, lost her life by such concealment.
A swelling coming on suddenly in the groin or at the navel, after considerable exertion, may be taken to be a rupture without much fear of mistake.
The complaint being discovered, the bowel should be put back in its place, and a truss be put on at once. In the case of young persons, a truss may frequently effect a cure; but, that it may do this, it should not be taken off, night or clay, except to cleanse it, and then only when the wearer is in bed.
Those who can afford it should have two trusses of the same size and strength, so that if one get out of order, the other may take its place while it is being repaired; for an hour's absence of the truss might occasion a mischief which it would require months to repair.
Persons having a rupture must be very careful to keep costiveness at a distance; for straining at stool is highly injurious.

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