Report of the surgical cases and operations that occurred in the Massachusetts General Hospital from May 12, 1837 to May 12, 1838 / by George Hayward.

  • Hayward, George, 1791-1863.
Date:
1838
Catalogue details

Licence: Public Domain Mark

Credit: Report of the surgical cases and operations that occurred in the Massachusetts General Hospital from May 12, 1837 to May 12, 1838 / by George Hayward. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    17/40 (page 13)
    Case 1st.—Micliael Murphy, set. 40. Married. Laborer. Irish. July 20.—Slates that since childhood he has always had an inguinal hernia of the left side, easily and entirely reducible at all times—never any incarceration that he is aware of. Six days since was attacked with pain in the abdoiDcn about unibjlicus, described as colic—got some ca- thartic medicine, which operated. Three days ago hernia came down, and lias not been able to reduce it since. Has been bled twice, and the taxis attempted by several without success. Has not had much pain in the tumor. No vomiting. Took salts yesterday, which operated. Now, pulse 88, of moderate strength. Tongue, white coat on lobes, moist. Strength good. No sickness. No pain, nor tenderness of epi- gastrium. Some tenderness in left iliac region, less in right. On exarni- nation, on the left side there is an inguinal hernia—the size of two clenched hands—to the touch hard, without resonance. Integuments slightly reddened. External ring tightly girt around the neck of the tumor, which is remarkably large and firm. Some pain upon pressure. Hernia probably omental. A purgative enema was first given, which came away without opera- lion. The taxis was then attempted in the warm bath, but without suc- cess, although the size of the tumor was somewhat diminished. The patient was then ordered the following—R. 01. crot. tig., gtt. i.; jalapas, q. s. Ft. pil. no. i. Every four hours till free operation. Ice to be assiduously applied two hours. A consultation to be called for to- morrow at 11, A. M., to decide on the propriety of operating under the present circumstances. 6, P. M.—Four full dejections after one pill. No reduction of tumor. Pulse as before. Apply bitter fomentations through night. 21.—Scrotum oedematous at bottom. Tumor still the same. Pulse 88. Very little pain. Slept part of night. A consultation being held, it was decided to perform the operation. 11, A. M.—Operation by Dr. Hayward. Patient being placed upon the table, an incision was then made from the edge of the ring two thirds down the tumor, dividing the integuments. The different fascice, which were much thickened, were then divided on a director in the usual man- ner. The sac being thus exposed, was opened ; it was one quarter of an inch in thickness. On opening the sac a gangrenous odor was emit- ted, and on further examination nothing was found in it. But the sac itself was in a gangrenous stale. It was then decided to remove the sac, which was accordingly done, though with much difficulty, on account of the nu- merous and strong adhesions. In the removal of the sac, the tunica vaginalis testis was punctured, and about g ij. of the water of a hydro-