_THE THERAPEUTICS OF STRANGULATED HERNIA._
By W. C. ABBOTT, M. D.
No doubt some will smile at the above caption, and say: “The idea! Who
ever heard of such a thing?” Others will read what follows and, perhaps,
profit thereby.
Strangulated hernia is looked upon as, strictly, a surgical affair, only
two ways of treatment being thought of, _i. e._, reduction by taxis or,
in case of failure—and if the patient and family will consent, the
knife. The former usually fails, and consent to the latter is frequently
so long deferred that the result is anything but satisfactory; hence,
any measure which is at the same time simple and helpful should be
looked upon as a valuable acquisition.
The plan of treatment which I wish to present will best be understood if
illustrated by the record of a case in hand. One morning, recently, I
was summoned hurriedly to see an elderly German laborer, whose “breach
was down,” so the messenger said, and it surely was. Such a scrotal
display I never saw before; a mass larger than a child’s head, and as
hard and tense as a foot-ball. I thought, at first, that part of it must
be an old hydrocele, but was assured by the sufferer that “him all goes
back.” This rupture was of some ten years standing. Formerly the hernia
was retained with a truss, but of late years it had been allowed to go
up and down according to circumstances, never having become strangulated
before. Now, my experience has been that when an old man who has had
years of practice reducing his hernia fails to put it back, the surgeon
has a job on his hands.
In this particular case most of the mass was resonant, but there was a
lump the size of a goose-egg, close to the ring, that was hard and gave
a perfectly flat precussion note—the omentum—congested by strangulation,
the very irritation from which caused a tighter spasm of the
muscle-fibres between which the mass protruded. I tried taxis
faithfully; so had the old man, and we both failed. I used hot
fomentations to no avail; I placed him at an incline of 45° and sprayed
the mass with cold water to stimulate contraction of the muscles of the
cord. They contracted sharply, but had no effect except to increase his
pain. I lowered him to the horizontal position, covered him up with a
hot blanket, and sat down to rest.
Here was an old man, hernia strangulated for some two or three hours, a
serious case. It was growing worse every moment, and nothing seemed
likely to avail but the knife. The spasm was intense. How could I relax
it?
I hesitated to try an anesthetic for various reasons, one of which was
that _I found a piece of candle burning in a beer mug at the feet of my
patient_. Knowing the great value of hyosciamine in spasm of the
viscera, I took from my ever-present alkaloidal granule-case hyosciamine
amorphous, gr. 1–134, and gave it hypodermatically with morphine
sulphate, gr. ¼, and atropine, gr. 1–250. In a few moments my patient
said, “that’s better”; and in less than ten minutes a gurgling of gas
was heard through the mass indicating relaxation of spasm. Thus
encouraged I gave a second dose, adding to hyosciamine, gr. 1–250,
strychnine arseniate, gr. 1–48, the latter to induce forced peristalsis.
In less than ten minutes more, I heard a loud gurgling sound, and my
patient cried, “him’s gone,” and, sure enough, it had. The entire mass
had disappeared through a hole the size of a nickel.
A retentive bandage for the time, and a well fitted truss a few days
after, completed the treatment of, to me, an interesting case, which
leads me to suggest a “therapeutics for strangulated hernia” for your
consideration.
2666 Commercial St., Chicago.
_PERISCOPE OF THERAPEUTICS._
By J. LINDSAY PORTEOUS, M.D., F.R.C.S., Ed.