In this particular case most of the mass was resonant, but there was a lump the size of a goose-egg, close to the ring, that was hard and gave a perfectly flat precussion note—the omentum—congested by strangulation, the very irritation from which caused a tighter spasm of the muscle-fibres between which the mass protruded. I tried taxis faithfully; so had the old man, and we both failed. I used hot fomentations to no avail; I placed him at an incline of 45° and sprayed the mass with cold water to stimulate contraction of the muscles of the cord. They contracted sharply, but had no effect except to increase his pain. I lowered him to the horizontal position, covered him up with a hot blanket, and sat down to rest.
Here was an old man, hernia strangulated for some two or three hours, a serious case. It was growing worse every moment, and nothing seemed likely to avail but the knife. The spasm was intense. How could I relax it?
I hesitated to try an anesthetic for various reasons, one of which was that I found a piece of candle burning in a beer mug at the feet of my patient. Knowing the great value of hyosciamine in spasm of the viscera, I took from my ever-present alkaloidal granule-case hyosciamine amorphous, gr. 1–134, and gave it hypodermatically with morphine sulphate, gr. ¼, and atropine, gr. 1–250. In a few moments my patient said, “that’s better”; and in less than ten minutes a gurgling of gas was heard through the mass indicating relaxation of spasm. Thus encouraged I gave a second dose, adding to hyosciamine, gr. 1–250, strychnine arseniate, gr. 1–48, the latter to induce forced peristalsis. In less than ten minutes more, I heard a loud gurgling sound, and my patient cried, “him’s gone,” and, sure enough, it had. The entire mass had disappeared through a hole the size of a nickel.
A retentive bandage for the time, and a well fitted truss a few days after, completed the treatment of, to me, an interesting case, which leads me to suggest a “therapeutics for strangulated hernia” for your consideration.
2666 Commercial St., Chicago.
PERISCOPE OF THERAPEUTICS.
By J. Lindsay Porteous, M.D., F.R.C.S., Ed.
Methylene Blue.
Recently I have had an opportunity of proving the efficacy of this new solvent, and am much pleased with the result obtained.
During the months of August and September I had five children under my care, suffering from diphtheria. As all the children belonged to one Institution, had the same nurse, and in every way the same surroundings, I had a good opportunity of testing the solvent powers of this drug, as compared with others. In the first child, age 4 years, I used acetic acid spray as a solvent, giving iron and potassium chlorate internally. Although the membranes in fauces visibly shrank, the disease extended downwards rapidly, almost choking the patient. Intubation was resorted to, which for a time relieved the choking symptoms, but the child gradually, sank.