The New York Polyclinic Volume 3-4 (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1894 Excerpt: ...this being the first time in 20 years that the hernia could not be reduced, the patient was anaesthetized. Under careful antiseptis, incision was made, and the sac readily opened, which was found to contain both omentum and intestine, both very much congested. The protruding omentum was cut off, and the stump returned to abdominal cavity without difficulty. Beneath the peritoneal layer of the intestine there were a number of spots of extrasavated blood. The gut was not in a sphacelous condition, but nearly so. As the intestine could not be replaced, the internal ring in the left upper quadrant was incised with a blunt pointed bistoury without obtaining the desired result. Then the index and middle fingers of left hand were put in the internal ring, in the hope of dilating the ring sufficiently so that reduction could be made. The patient was then put in a sort of Trendelenburg's position, and while an assistant was manipulating the gut above the hand in the ring, it burst, and the feces within the strangulated part of gut escaped upon the wound, but not in the peritoneal cavity. This ruptured gut was closed with three Lembert sutures. A small lobe of mesentery was turned over and stitched over the already closed wound with a continuous suture of small catgut through the peritoneal layer of the gut. As the patient was in a collapsed state, the wound was closed and a radical cure by Macewen's operation obtained. The sac was left in situ and stitched with heavy catgut to Poupart's ligament. The external wound was closed with two deep, heavy catgut sutures, and then superficial stitches with silk, no attempt at drainage being made. Twenty days after operation patient was able to attend his usual avocation, that of a brick mason. Four months after the operation, ..