DOI: 10.7925/drs1.ucdlib_280396
title: Strangulated congenital hernia

description: Watercolour medical illustration depicting strangulated congenital hernia. It has the alternative reference number 1162, 246 and P4A on the front. The Richmond Hospital Museum reference is B.c.66. The entry for this in P263/1 pg. 14 reads 'Strangulated congenital hernia. Pat.k Tennyson aet 21. Mr Smith'. The artist's name is in the bottom right corner 'J. Connolly fec.t'. The handwritten and typescript notes on the back begins 'Strangulated Hernia (congenital)'.
description: Scope and content: The full handwritten and typescript notes on the back read 'Strangulated Hernia (congenital) – Professor R.W. Smith detailed the following case, and exhibited the recent specimen. Peter Tennyson, aged 21, was admitted into the Richmond Hospital, February 1, 1851, with a tumour (constricted near its centre) extending from the internal abdominal ring, on the left side, to the bottom of the scrotum; all parts of it were opaque, but the lower division obviously contained a fluid in considerable quantity; the testis was plainly felt at the lower and back part of this portion of the tumour, and in the constricted portion the cord could be felt greatly thickened. The lower tumour was of a globular or pyriform shape, the upper being of an oblong form, extending upwards and outwards. The scrotum was thickened, and the entire tumour dull on percussion. The man stated that last summer he received a blow on the testis, which was followed by a slight and temporary enlargement of the gland; and that about the same period he was attacked with vomiting and colic, which continued to occur from time to time until the period of his admission into the hospital. He had never noticed any tumour in the groin until January 30, 1851, when he felt something suddenly yield in the left groin, while he was threshing. In the course of the same day the usual symptoms of strangulated hernia came on, as vomiting, &c.When admitted at 9 o'clock, P.M. February 1, his face was pale and expressive of great anxiety; the surface cold; the bowels constipated for three days; the tongue slightly furred; the pulse feeble; occasional hiccough; abdomen tympanitic; he had not vomited since morning. The lower portion of the tumour, in shape, in its containing a fluid, and in position of the testicle, resembled a hydrocele, so much as to lead to its being examined with a candle more than once; but it was everywhere opaque. It further resembled hydrocele in the facility with which the spermatic cord could be felt above it. No positive opinion was arrived at as to the nature of this scrotal tumour. The upper or inguinal tumour was manifestly a hernia in a state of strangulation; it was an oblique hernia. The strangulation having now existed for three days, and the taxis having been ineffectually tried, the operation for strangulated inguinal hernia was performed at half-past 11, P.M. When the sac was opened, a large quantity of black-coloured serum escaped, and a mass of omentum was exposed, upon raising which a portion of dark-coloured intestine was seen. The finger could be passed through the sac to the bottom of the lower division of the tumour, and the naked testicle distinctly felt; the sac thus proved to be the tunica vaginalis, and the case one of congenital hernia, so called. The violent struggles of the man, who was very muscular, rendered the operation difficult; the stricture, however (which was at the internal ring), was safely divided, and the intestine returned: the omentum, being everywhere adherent, was left in the sac. During the 2nd and 3rd, the case proceeded favourably, the bowels acted several times, and the pulse was 70. Upon the fourth he had a profuse perspiration; his tongue was furred, and there was some tympany. The scrotum was swollen, red, and painful. Upon the following day, a quantity of sanious matter and fetid air issued from the scrotum through the wound, during a fit of coughing. The sutures were now removed, and a considerable quantity of pus given exit to. His face was flushed, and the expression of his countenance anxious and depressed; erysipelas also had appeared around the wound. Upon the 7th, the erysipelas had extended considerably, and the omentum was in a state of slough: in the evening vomiting came on, and the abdomen was tender to the touch. The vomiting continued incessant throughout the night, and upon the 8th the patient died. Post Mortem Examination – Upon laying open the sac throughout its entire length, the testis was exposed at its lower part; it was covered with a layer of coagulable lymph, which was evidently not of recent formation. A similar layer adhered the inner surface of the tunica vaginalis, the cavity of which communicated freely with that of the peritoneum. The omentum still adherent to the upper part of the sac & to the margin of the ring was in a gangrenous state. Strangulated entro-epiplocele (congenital). Operation. Death'. Includes stamp of Bristol Boards papermakers in bottom right corner.
description: Numbering/sequence: Original reference number: 1162.