INTESTINAL HÆMORRHAGE. 505 Contine Linding Book IX, Chap. X.] or two, by exception, if the first has not produced a lessening of the ide congestion—for at this age two leeches which draw much blood may tem str Cord & produce irreparable mischief. When the child has no external sign of plethora, and has no symptom of the state called apoplectic, we must be careful of the abstraction of blood, which is no longer indicated, and which can have no other result than to add to the weakness produced dented by the intestinal hemorrhage, that which they habitually occasion themselves. ΟΥ In the hæmorrhage caused by acute or chronic inflammation of the intestine, we must not think of the use of leeches. These inflammations almost always constitute adynamic diseases; and if the hæmorrhage presents itself in their progress, it is at an advanced period, at the period u of ulceration, when the feebleness is extreme, and when, consequently, Jonies'+ Astring antiphlogistics are rarely indicated. It is by means of acid astringents Euts an Under this title may then be employed in the various kinds of ulicated intestinal hæmorrhage of little children, cold water externally to the abdomen, internally by the mouth, or by enemata frequently repeated. by This .These enemata should be composed of two or three large spoonfuls only. They may be rendered more active with three grains of tannin, or with seven grains of the extract of rhatany, or seven grains of catechu, or lastly, with one grain of nitrate of silver. In this latter case a small glass syringe and distilled water must be used in order to avoid the premature decomposition of the medicine. The extract of rhatany, catechu, tannin, acetate of lead, may be given internally, but with great caution, regard being paid to the tender age of the children, and also without losing sight of the cause of the hæmorrhage, which should, in some cases, prevent their employment. Their use should be abstained from in passive intestinal hæmorrhage with the apoplectic state. On the contrary, they may be employed on nearly every other occcasion in the dose of one grain for every 3 iss. of the vehicle for the rhatany, the catechu, and the tannin, and the acetate of lead in the dose of one-sixth of a grain. As to polypi in the rectum, they should be made to extrude by means of an enema or a purgative; a ligature should then be applied round the pedicle, and excision performed according to the rules pointed' out in surgical treatises. [Dr. West relates three examples of intestinal hæmorrhage: one occurring soon after birth, another between the second and third month, and the third at the tenth month. Dr. Willshire (British and Foreign Med. Chir. Rev.; July, 1853) has seen two cases in which, during the first month, some amount of blood has been ejected, both by the stomach and bowels, both patients recovering, but reduced to a severe нашия Condition of the pas was repeated to him by Mr. Lovek, d the Sch of April; labour quite de crime or tied prematurely; natural lividity of any us and Frely, and rather beyond the Bertl är apneste filed, child became drowsy FORA DE-DE Nated to prevail, when of the stant, the surface being old and clamay wa dienace need for the stomach a deTe mes va aberanis releved, the motion vin de Lesmass octaned to occur s van de mark ári. Put mortem : “Stornach weist man dus find; as ghazus full of the * 5 WAL 7 de ma: mos membrane of the enres vil a thick layer of blood and viscid Zest Wing Barved by portions of coagua 2. mari of a log mahogany colour, and LEHV Žena · Joe, 1834 · in a chid nei bung zei sñer is prisation had ceased: AR IN BANT ANi mill vare jocessing favourably; the betes when the maat was best mver a chamber vessel. From 11. The mat kai mire i ess hemorrhage, and once the * De Mes via she ascribed as poing Exe a “long red h. Bair ant vas irure but the little patient was too mare a coci quam tee boars after the first A IN teneto Jetistes vas the only antecedent symptom to In the pot muren cuminton made thirty-six hours stur baik, ki ne erst served as be benaży, but completely blanched by the ge sure if in her ; the mescives, boch small and great, were tum vid ofæen, was laces ful my coagulated, and moulded to the MRSLPS VIVE VIN IZLY MICarei mua the coala The latter in one case eurojet de son in a pos cul The full portions of the blood were dark. madeus, an era o four, visdel of the macces membrane, owing to the thick 2030UES TICIS sreng de koer, vixò va à is whole extent uniformly stained vii a ich nha đưP; DE DE Stritest trace of any organic lesion could be ŽKO TYROL, Khugh the almentary and vis most carefully examined in its The dive may sccum Lace and be resized so that none appears externally, and yet the patient be of hætverhare. M. Bodnar Krzuckerzen der Neugebornen, §e.› reiates a case highly illustrative of the latter stament, or the eleventh day after birth, the boy's skin (then of a pale yellow eviscri dimbribed in warmth, the impulse of the heart became dull and prolonged, and the respiratory marmar scarcely perceptible. The child lay almost motionless, and simmdering. The day following, the surface could scarcely be kept warm, and the ättle patient had to be aroused to suck. On the twentieth day after birth it died. The brain was found to be anemic, the lungs plethoric, whilst blood was effused into the duodenum and stomach. - P.H.B.] CHAPTER XI. ON ABDOMINAL HERNIA. Instances of abdominal hernia amongst the newly-born and children at the breast are common enough; they are congenital or accidental, and are situated at the umbilicus or inguinal canal. ON UMBILICAL HERNIA. Congenital umbilical hernia, described under the name of exomphalos, or omphalocele, is characterized by the presence of a sac of greater or less size situated at the umbilicus and filled by one or several folds of intestine. Sometimes the dilated base of the cord forms the ia sac; in this case great care must be taken not to include in the ligature the fold of intestine which constitutes the hernia. Sometimes the tumour is of so great a size that the ligature of the cord near its base is out of the question, and the children appear consigned to a certain death. But this, however, is not always the case; for M. Requin has seen a child recover who was born with an exomphalos as large as the fist. The tumour was reducible, and was formed of the transparent coverings at the base of the cord. After the reduction of the intestine, the opposite margin of the umbilical opening could be approximated, and the child ceased to suffer and to cry out. He took but slight nourishment in the first days which followed birth, then he had several evacuations of the meconium. The tumour, which had been covered by a waxed cloth moistened with oil of sweet almonds, increased in volume, became irreducible, and its walls presented all the phenomena of a peritonitis, but of a local one. This inflammation made progress, the child got worse, and was seized with an abundant diarrhoea, which gradually increased. On the eleventh day, the diarrhoea was arrested, the child was more calm, the tumour of less size, one portion was gangrenous, the other suppurating; lastly, on the twenty-first day, there was no tumour projecting from the umbilicus; the child had recovered its strength and plumpness; and, after fifty days, the umbilical wound from circular had become oblong, was only one inch long and six lines broad, and all the functions of the child were accomplished in a satisfactory manner. Maylee Решалка ble Case, of 4, Accidental umbilical hernia is observed at a more or less distant cedenta interval after birth in children who cry much. The cutaneousien umbilical cicatrix separates itself from the deep cicatrix, and forms a small opening or eventration by which the intestines protrude at ou the time of the cry and efforts of the child. This hernia, entirely reducible, covered by the skin, presents the size of a small nut, and in sometimes increases to nearly one inch in length. The finger which depresses it easily penetrates into the umbilical opening. Accidental umbilical hernia is attended with little inconvenience and causes no suffering to the children. It is a lesion which creates fer for the future, because it may remain, increase in size, and give origin at a more distant period to symptoms of strangulation-a very rar circumstance, however, in this variety of hernia. We should then endeavour to cure children of umbilical hernia, especially as this is generally a very easy affair. When the bernis His is congenital and of small size, in placing the ligature on the ord the folds of intestines contained in the cord are to be pushed back. and after the fall of the cord, compression should be maintained on Fresh the umbilicus by a small pad, properly fastened with sticking-plaister. Accidental umbilical hernia is always cured by compression, by means all of graduated compresses applied by a bandage round the body; by a pad of sponge covered with linen, or by a conical pad filled with bran, as large as a nut, and kept in position by a band of diachylon; or lastly, an elastic band of ordinary caoutchouc or cloth, having a pad at the position of the hernia. Bandages with metal springs are {{ painful, and do not always so perfectly fulfil the necessary indications as the apparatus just mentioned; they should be completely banished in the treatment of children. When this compression is well applied and is continued for some time under the influence of growth and of the plumpness which the children assume, the cellular tissue of the abdominal walls becomes fixed to the umbilicus, and adhesions take place; the hernial sac disappears, and a cutaneous depression succeeds the umbilical tumour. [Instances of inclusion in the ligature of a portion of intestine on tying the umbilical cord, against which Bouchut cautions us, are mentioned by Mauricean (Traité des Accouchements; vol. i, p. 497), Sabatier (De la Medicine Opératoire; vol. i, p. 152), and others. The practice recommended by Bouchut, of returning the protrusion, and preventing the reprotrusion by graduated compresses, is preferable to that of Hamilton (Cooper, on The Anatomy and Surgical Treatment of Abdominal Hernia; p. 32\ who, after returning the intestine, applied a stout bandage around the base of the swelling, and brought the edges of the abdominal coverings together, with two silver needles and sticking-plaister, and the cure was effected in a few days. If the congenital rupture be considerable, and its return in a gentle manner not possible, the child usually dies soon after birth, in which case, the external covering is thrown off, and the intestines are laid bare. Experience, however, proves, that if the swelling be properly protected from all external pressure, granulations may be produced after separation of the external covering, and thus the whole part be gradually covered with firm skin and a tendinous expansion 2 (Ribke, in Rusts Magazin; vol. viii, part i, p. 130.-P.H.B.] " INGUINAL HERNIA. Inguinal hernia is infinitely more rare than umbilical hernia; it is nearly always congenital, very seldom accidental, and is usually observed in boys. Billard, however, has reported a case of it in a girl, but it was a congenital hernia of the ovary. The following is the case: Josephine Romer, twenty-seven days old, was admitted into the infirmary on the 12th of September. She is strong and appears to be endowed with a good constitution; the belly is slightly tender; there exists at the left inguinal region a roundish tumour, as large as a filbert, rather hard to the touch, cannot be reduced into the abdomen by taxis, does not diminish by pressure, nor does it increase on the cry of the child. It is directed obliquely towards the external Case of labium of the same side, but does not yet quite reach it. The consideration of the situation of the tumour might lead to the belief that it was formed by arra a congenital inguinal hernia, but the sex of the child did not allow Billard to admit this supposition. He suspended his judgment, and twenty-six days afterwards the child having died of pneumonia, he was enabled to make an anatomical examination of the nature and of the cause of this tumour. The body was very much emaciated; there was a very decided injection of the intestinal tube, inflammation of the follicles of the large intestine and very well marked hepatization of the right lung at its inferior lobe and posterior border. The hernial tumour was formed by the left ovary descending through inguinal canal and ring, which were much larger than usual in young girls. The uterus, drawn by its round ligament and by the ovary which caused the hernia, had deviated from its natural position and inclined towards the left side of the bladder. The left kidney, instead of being on the same level with that of the opposite side, was drawn downwards by the cellular tissue which envelops it, and by a fold of peritoneum, which was connected with the orifice of the sac; the renal artery narrowed. Lastly, the ovary and the fimbriated extremity of the Fallopian tube, and vein had yielded to this traction, and were elongated and at the same time slightly reddened and swollen, were placed free at the bottom of the sac formed by a prolongation of the peritoneum with the cavity of which it communicated. There were no folds of intestine adhering to the neighbouring parts, and the ovary of the opposite side was in its natural situation. On a careful examination of the round ligament of the uterus, of the side on which the hernia existed, I observed that it was much shorter than that of the opposite side, and that it terminated in the thickness of the external labium by an aponeurotic expansion, instead of being lost in delicate filaments as is most usually remarked; so that it would appear that this ligament, of less extent and more solidly fixed to the external lip than is commonly observed, had in the first instance caused deviation of the womb, and, in consequence, the traction of the ovary across the inguinal ring. From this abnormal adhesion it thence resulted that all the extensible and mobile parts of the left side of the abdomen, which had connections of continuity or contiguity with the hernial parts, had themselves been drawn down towards the side of the hernia, because they could not separate from each other, nor follow the movement of ampliation of the abdomen during the development of the child in the uterus. With the exception of the case of inguinal hernia formed by the ovary, there is no congenital and inguinal hernia formed by the intestine amongst newly-born girls. of the left &. chuld |