BMJ

Strangulated Hernia, Operated on by the Patient with a Razor, Terminating in Radical CureAuthor(s): John ParsonsSource: Provincial Medical Journal and Retrospect of the Medical Sciences, Vol. 6, No. 138(May 20, 1843), pp. 151-152Published by: BMJStable URL: http://www.jstor.org/stable/25492057 .

Accessed: 18/06/2014 14:00

Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .http://www.jstor.org/page/info/about/policies/terms.jsp

.JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range ofcontent in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new formsof scholarship. For more information about JSTOR, please contact support@jstor.org.

.

BMJ is collaborating with JSTOR to digitize, preserve and extend access to Provincial Medical Journal andRetrospect of the Medical Sciences.

http://www.jstor.org

This content downloaded from 185.44.78.76 on Wed, 18 Jun 2014 14:00:59 PMAll use subject to JSTOR Terms and Conditions

STRANGULATED HERNIA. 151 been advised in large doses, two minims once or

twice a-day, and this dose to be repeated several

successive days, so as to keep up fresh purging. We

have not met any cases requiring such heroic treat

ment. Dr. Bennett (" Lancet," December 21, 1839) lhas

found the iodide of potass of great use in cases of

nervous headache, when the circulation was not

affected. Dr. Martinet (" Edinburgh Journal," February,

1842), particularly in cases of crural and sciatic

neuralgia, advises the use of turpeiitine as follows:

White of egg, No. 1 turpentine, three drachms; Syrup of pepperminlt, two ounces; Syrup of orange, two ounces. Mlix. A tablespoonful

three times a-day, adding laudanum if sickness is present.

In most instances the pain has ceased in a week.

A drachm of creosote to the ounce of lard has been

strongly recommended as a local application. Magendie has found great benefit from inserting

two platinum needles in the nerve, anld passinig the

current from Clark's electro-magnetic machine, coni

iecting the positive pole with the needle nearest the

origin of the nerve. If the pain shifts, we must follow

it in the affected branch.

The mode of using electro-magnetism is not with

out importance. We found, by experiments on a

recently amputated limb, that the wires applied to

the dry skin produced very little effect. If the sur

face was moistened the contractions increased, but

less so than when the wires were inserted beneath the

skin. If the currenit was gentle, the effects were

limited to particular muscles; but if active, the

whole limb was affected, the flexors predominating,

without reference as to where the wires were in

contact. It is evident, therefore, that connecting the

wires with needles, and regulating the force of the

current as we wish to act, locally or generally, are

essential to tlle fuill trial of electro-magnetism. 'The following is Dr. Graves' nieuralgic plaster:

Powder of opium, two scruples; Camphor, half a drachlm; Burgundy pitch, and plaster of lead, of each as

much as may be necessary. Mix.

This is enough for the largest plaster. Steep the part

with warm water before applying it.

The rcader may perhaps glean some useful hiints

in these scattered references to tIme experienlce of

others. They are not intended to obviate the nleces

sity of reference to standdrd treatises on thme subject.

Some of the more important but better known reme

dies have not even been mentioned, such as iron and

arsenic, their uses and value being necessarily familiar

to every practitioner.

Diagnosis.-In all painful affectionis of the face we

lhave assumed one or more braimclmes of the fiftlh pair

to be affected, and have never regarded the seventh

nerve as implicated vhere the motor powers were not

involved. A much larger number of cases than those we have

selected should properly be iilcluded under the head " Neuralgia." In fact, all painful affections of the

viscera, apart from inflammatory misclhief amld organic

change, belong to the same class, and are cured by

the same remedies. To limit the term to painfnl

conditions of particuilar nerves is a wholly arbitrary

arrangement, and though the distinction between nervous and vascular disturbance is practically recog nised in every organ of the body, it has but very par

tially influenced nosological classification. The more we reflect upon the subject the more we are impressed witlh the difficulties attending a really scientific diag nostic arrangement of disease, and we think that we

possess in the effects of remedies a surer index of the

essential condition than wlhat we are sometimes

enabled to inlfer from the analysis of symptoms. There

must be somethiing radically faulty in our scienice when it so frequently clashes with the practice of our

art. The mind feels that muchl greater simplicity and

precisioni might be attained, but the genius destined

to make the vision a reality is probably yet unborn.

[ To be continued.]

STRANGULATED HERNIA,

OrERATED ON BY TIIE PATIENT WITH A RAZOP.i TERMlIINATING IN RtADICAL CURE.

By JOHN PARSONS, Esq.,

Surgeon to the Bridgwater Eye Dispensary.

On the 3rd April, 1841, I was summoned in a great

hurry to a parish six miles distant, to see James Bown,

aged forty-five, who, the messenger informed me, had

woulided himself in the abdomen with a razor. On

my arrival, about an hour after the accident, I ascer

tained that he had been the subject of a reducible

conigenital hernia of the right side, but for which he

had never worn a truss, and which had never given

him any uneasiness until the morniing of this day,

when, on returning home at one o'clock from being

actively engaged in putting up a mud wall, and ex

erting himself in lifting heavy batches of miid to the

top of its surface, hie felt very uneasy, anid was unable,

as usual, to return the protrusion; it soon became

much more painful and very tender, and, repeated

attempts on his part failing to reduce it, he made a

sudden gaslh across the nleck of the swellinlg with a

razor; a dark-colored fluid immediately escaped with

considerable hiemorrllage, so much so as to induce

faintinig, o0i partial recovery from which he succeeded

in reduciing the hernia. On examination, an incision

of about three inches in lengtlh extended across the

upper portion of the ingliinal canal; all hnmorrhage

had ccased, butt there still exuded a small quantity of

the samne dark-colored fluid; the hernia was reduced,

and the finger could be readily passed downwards

into the sac, but not so readily upwards into the

abdominal cavity. He was in a state of great col

lapse, with a very small and feeble pulse; warmth

and restoratives, soon, however, succeeded in bringing

on reaction, and ino iore hbemorrllage occurring, the

wound was brought together by suture alld adhesive

plaster. In the evening, some pain and restlessness

coming on, he was ordered five grains of calomel anid

two of opium.

April 4. [lad passed the former part of tlle niglht

quietly, and obtainied some sleep, but this morlliiig

complained of great pain and tenderniess over the

lower part of the abdomen. Pulse 120, small, and

feeble; tonigue much furred, aind great thirst ; lias

hlad 110 evacuatioii fioni tha bowels since the 2ild.

This content downloaded from 185.44.78.76 on Wed, 18 Jun 2014 14:00:59 PMAll use subject to JSTOR Terms and Conditions

152 MEDICAL LITERATURE IN THE NIN ETEETH CENTURY.

Ordered one ounce of castor oil directly; twelve

leeches to the abdomen and warm fomentations; also

every four hours

Mercury with chalk, five grains; Powdered compound ipecacuanha, three grains

with the following draught:

Liquor of acetate of ammonia, two drachms; Spirit of nitric wther, fifteen minims; Saline mixture, ten drachms.

Under this treatment, the mercury being carried

to the extent of slightly affecting the gums, he rapidly

became convalescent, the wound healed, and he did

not find the slightest inconvenience until the 20th, when, afterwalking about nearly thewhole morning, he

felt great pain of a sharp throbbing character about

the scrotum and hernial sac, extending into the in

guinal canal, these parts becoming very much swollen

and tender. In spite of active antiphlogistic treat

ment these symptoms gradually increased until May

9th, when fluctuationbeingvery evident throughout the whole extent of the swelling, an incision was made

at the most depending part, and extended upwards

into the inguinal canal, laying open the whole extent

of the sac, and giving exit to about four ounces of

fcetid pus; granulations quickly sprung up, fillinig the

whole cavity of the sac and inguinal canal with solid

matter. No descent of the hernia has ever since

occurred; he wears no kind of support, says he is

stronger and better than ever he was, and does not

regret the operation he performed for himself, to

which I can bear my willing testimony, having seen

him only a few days ago engaged at his old occupation

puttinlg up a mud house, to supply the loss of his own,

recently destroyed by fire.

Bridgwater, May 14, 1843.

PROVINCIAL MEDICAL JOURNAL

SATURDAY, MAY 20, 1843.

If it be true that the advancement of a science is

to be estimated by the character of the literary pro

ductions of its disciples, the medical science of this

country in the nineteenth century no longer deserves

credit for progressive improvement-nay, worse, it

has retrograded. No longer do authors strive to

attain that amount of excellence acquired by a Hip

pocrates, a Sydenham, and a Cullen; the " Rosa

Anglica" of John o' Gadsden now affords a preferable

standard of medical science, and ministering to their

anxiety to acquire temporary advantages, they have

drawn down upon themselves permanent discredit. To illustrate the truth of the position we have here

ventured to assume, and to perform the.necessary aud

most unpleasing task of exemplification, it is by no

means requisite to appeal to the subject-matter of our

recent medical writings, and as our present observa

tions are obliged to be somewhat limited, we shall be

content with a small field of evidence.

We will not, then, even allude to the matter con

tained in these published writings; we will speak only

of their titles. The list before us is a motley group,

presenting every form of attraction for the hypochon

driac dyspeptic, or hysterical female; but, alas ! none

for the scientific inquirer. Their title-pages carefully analysed afford the best possible evidence of the

purposes for which their contents have been compiled.

Miraculous cases and equally wondrous cures form

the bulk of such works, a well-directed reference to

which constitutes one of the chief points of the title

page, to which is added a delicate allusion to a pre

face havinig tacked to its end the residence of its

disinterested author. These literary productions these " rivulets of type in worlds of margin"-often

illustrated by vividly-colored drawings, and bound up in a kind of elegant undress, are extensively

circulated through all classes of persons, in the hope

that they may speedily find their way to the

houses of rich hypochondriacs, or minigle with the

bijouterie in the boudoir of a nervous lady. Writings

on " Habitual Constipation," " Enlarged Abdomen,"

" Indigestion, and the Causes of Low Spirits," " On

Spasm and Languor," and lastly, nzirabile dictu,

" Consumption Curable." These are they which prove

the most common, because to the public the most

attractive, titles, and better caleculated to fulfil the

objects for which they were written; nor are works

of the character we have described alone the pro

duction of inferior and uneducated practitioners, but

in the ranks of the Royal College of Physicians in

London we recognise the authors of many such. The

best and the worst of those essays to which we have

referred, have for their writers those on whom the

honors of the fellowship have already descended. The

publication of works of this class may offer temporary

advantages to their authors, but do much of evil to

medical science. When men possessing acknowledged

rank in the profession descend to the authorship of

such literary productions, they become the examplars

for others who are as yet but candidates for medical

honors, and induicing them to pursue similar courses

eventually, lessen the desire for scientific research,

and thus retard, if not altogether arrest, the advance

ment of medical knowledge. It is the duty of those

who have been placed in public medical appointments,

who have the advantages of large fields for inquiry

and for accumulating experience, to avail themselves

of the opportunities thus within their reach for the

cultivation of that science upon the pursuit of which

so great an amount of human happiness depends.; but

if, instead of adopting this course, they seek but to

become the authors of popular pamphlets, they no

longer can lay claim to the respect of their juniors,

but most deservedly merit their contempt. It is, in

truth, with much regret that we have from time to

time seen advertisements announcing the approaching

This content downloaded from 185.44.78.76 on Wed, 18 Jun 2014 14:00:59 PMAll use subject to JSTOR Terms and Conditions