A correct definition for abdominal hernia illustrated by two cases : 1, strangulated hernia through linea semilunaris, and 2, intraabdominal incarcerated hernia / by George I. Miller.

  • Miller, George I.
Date:
1909
Catalogue details

Licence: In copyright

Credit: A correct definition for abdominal hernia illustrated by two cases : 1, strangulated hernia through linea semilunaris, and 2, intraabdominal incarcerated hernia / by George I. Miller. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    VV'^hen, as in my case, no definite cause for its ex- istence can be found, such as injury or suppuration, we must conclude that it is the result of some con- genital defect or acquired paralysis of that region. Case II.—On August i, 1908, I was called by a physician to see his father in law, whom I was told was suffering from an attack of appendicitis. The patient, J. W., was fifty-five years old, well preserved and weighed 220 pounds. While attending his business as wool merchant four days prior to the date of my visit, he experienced a severe pain in the right iliac region, particu- larly in the region of the appendix. The pain was very severe so that he was obliged to be in bed and keep the right leg drawn up. He vomited several times and was con- stipated. Previous History.—For the last ten years, he had suf- fered from some discomfort in the abdomen. Three years ago the discomfort increased with occasional attacks of pain in the lower right quadrant of the abdomen. He fol- lowed advice given to him at the time and put on a truss which he wore ever since. During one of his uncomfortable attacks about six months ago he called at my office, and requested me to ex- amine him and tell him whether or not he had a rupture. After a most careful examination I failed to find evidences of an existing hernia. There was no bulging of any part of the abdomen. The external ring was not abnormally enlarged. His statement of an impulse in the right in- guinal region during coughing and sneezing was considered a weakened abdominal resistance. He had no other sensa- tions, no digestive disturbances. Regular movements of the bowels. When I saw him this time he was in bed, complained of pain in the right iliac region and a feling of fulness in the ab- domen. On inspection I found the abdomen very much distended, innumerable small dilated veins beneath the skin gave the whole surface a bluish tinge. There were marked tenderness and more or less rigidity of the muscles in the region of the appendix and downwards to the pubic bone. By the rectum I felt a resisting mass. The liver dullness extended about an inch and a half below the ribs. He had a chronic bronchitis. I advised the patient to go to the hospital, but he positively refused. Two days after this I was again called and found that the pain and tender- ness in the right iliac region had increased. By this time I