DOI: 10.7925/drs1.ucdlib_280384
title: Umbilical hernia

description: Watercolour medical illustration depicting umbilical hernia in a woman. It has the alternative reference number 1729, 329 and P4A on the front. The Richmond Hospital Museum reference is B.c.69. The entry for this in P263/1 pg. 14 reads 'Umbilical hernia. Mary London[?] aet 60. Mr Adams'. In the top left corner is written the date 'Aug.t 28 1840'. The typed note on the back begins 'Enormous Umbilical Hernia'.
description: Users are advised that this item contains graphic images which may cause upset or distress.
description: Scope and content: The full typed note on the back reads 'Enormous Umbilical Hernia – Mr Adams said the case he was about to bring before the Society was one of hernia. About nine years ago it had been strangulated, so as to require and operation, which proved successful, the stricture being divided and the intestine reduced. The woman recovered rapidly, and was able to follow her occupation as a nursetender. The hernia, however, was merely relieved, but not cured; it returned again, increased gradually in size, as was shown by the case exhibited by Mr Adams. At this period its vertical measurement was nineteen inches; its circumference at its narrowest part twenty-eight inches, and at the widest part thirty-four inches. This was nearly its condition, when Mr Adams was called to see her in August last. Her symptoms at the time were those of strangulated hernia; the tumour was tense and painful on pressure; she had constant vomiting, thirst, fever, and obstinate constipation. She stated, that she had been frequently attended by Mr Atkinson, of Gardiner-street, for the same symptoms; in a word she had repeated attacks of inflammation of the hernia sac and its contents. These were usually brought on by excess of labour, night-watching, irregularity of diet, or intemperance. She got over these attacks, sometimes by her own efforts, sometimes by medical advice and assistance. On some occasions, when sent for to visit her, Mr Adams found that she had got better, had gone out, and was engaged in her usual occupation. On the last occasion he found her very ill, and advised her to go into the Richmond Hospital. She complied with his advice, and a consultation was held; but her case was so unfavourable that nothing was done, and she died about fourteen hours after admission. The appearance of the tumour at the time of her death was well represented by the cast; some parts of it felt solid, others fluid or elastic, and altogether it conveyed very much the idea of a malignant tumour. Mr Adams also exhibited a drawing to show the state of the skin covering the tumour, as it appeared immediately after death. It was quite livid and black, as if in the first stage of mortification. Having detailed so much of the history of the case, he said he would beg leave to shew [sic] the sac and its contents. The sac itself, contrary to the descriptions usually given of umbilical hernia, was remarkably thick. In most cases it is stated, that the sac of an umbilical hernia is very thin, and Billard makes mention of some instances in which there was no peritoneal covering. In Mr Adams' case the sac was not only entire, but also of considerable density. Externally the hernia presented a thick, firm covering; internally it presented the appearance of a multilocular sac traversed by membranous bands or septa, between which numerous coils of intestine were firmly impacted. The sac shewed [sic] evident marks of repeated attacks of inflammation, but with this exception, the intestines were sound, the gangrene being limited to the integuments over the tumour. About twelve feet of intestine, with a portion of omentum, were found to be protruded, the intestines being greatly distended and confined at different points by the membranous bands which traversed the interior of the sac. On making a careful examination of the tumour on the following morning, Mr Adams discovered towards the upper part a kind of pouch, in which a considerable coil of intestine lay, and this he found to be the really strangulated portion. This discovery, however, proved to be one of very considerable difficulty, for it took him and Mr Smith nearly an hour and a half to uncoil the large mass of intestine, and reach the seat of stricture. This fact was in itself quite sufficient to contra-indicate the performance of an operation, even if the patient had not been in the low state she was at the time of admission. (Museum, Richmond Hospital.) Mary London[?] 60'.
description: Numbering/sequence: Original reference number: 1729.