A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments, remedies and applications employed in surgery : the etymology and signification of the principal terms : ... forming together a "catalogue raisonné" of surgical literature (Volume 2).

  • Cooper, Samuel, 1780-1848.
Date:
1823
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments, remedies and applications employed in surgery : the etymology and signification of the principal terms : ... forming together a "catalogue raisonné" of surgical literature (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    11ER.MA. .ous by the neglect ol »hi* '• [f ihe hernia l)c ot the intestinal kind merely, and the portion mgulotion liLelv to happen in this case, and i productive of mi ichief, when it has hap- pened : for tht- smaller the portion ol wbii Mtlon ohi.Is, and the more haz.n te con- duce. I have seen a fatal gangrene, in a bubonocele, which had not been formed forty-eight hours, and in which the piece e was little more than half an inch. Another observation made by Pott is, that if the hernia be caused bj a portion »f the intestine, ileum only, it is in general more easily reducible, thun if B part of the colon has descended with it, which will also require mo and more patience in the attempt. The redaction of a mere in- testinal hernia too (trrt(ris paribus) will al- - remain more practicable, than that of a mere omental one, alter it has attained to a certain size and state, ai the part con- tained within the former is liable to less al- teration ol form than that within the latter; which alteration has already been mention- - no unfrequeot hinderance of the re- turn of an old caul rupture. Not that the porta within a mere intes- tinal hernia arc absolutely exempt from such an alteration as may render their re- turn into the belly impracticable, even where then' is no stricture . 'ott, I have seen that part of the mesentery, which has lain lent; in the neck of the sac of an old rupture, so considerably hardened and thick- ened, as to prove an insuperable obstacle to its reduction. Upon the whole, this author infers, that an intestinal rupture is subject to worse symptoms, and a greater degree of hazard, than an omental one, though the laid : by no means, so void of either hs it was formerly supposed to be ; that bad symp- tom! are more likely to attend a recent rupture, than one of ancient date ; that the descent of a very imall piece of intestine is more hazardous than that of a larger ; and that the hernia, which consists of gut only, is in general attended with worse circumstan- ces, than that which is made up of both gut and caul. Mr. Hey coincides with Pott, in thinking the prognosis more unfavourable when the tumour is sm»ll. I think it is not a bad general rule, that the smaller the hernia, the less hope then? is of reducing it by the taiis Long-continued efforts to reduce a prolapse.) intestine, are most likely to suc- ceed in old and large hernias, when no ad- hesions have taken place. {Pracl. Ubscrv. in Surgery, p. 2( 3.) The opening (say? Mr. Lawrence) through which tlje parts protude, is narrow- er in some situations than in others; the progress of the case will therefore be more rapid ol ll' I' I in- apertui I hi femoral hernia ; this kind ol rup- ture in men, and the bubonocele in women, rticularly narrow entrance. On line grounds, femoral, inguinal, and umbilical ruptures are more dangerous Ihau rentral, perineal, or vaginal kinds. on Ruptures, ■'*•) HID IMMKDl 1 i E HI Dl ' 1 ION, 1I»D ATTINhl.n WITH ANY TROl' KLESOMK OK MAP si Ml | '< 'i i .ir. Pott, is verj quently met with in infants and sunn i in adults, and is too often neglected in both. In the former, as the descent seldom hap- pens but when the infant strains to cry, and the gut is either easily put up, or returns tuA spontc, ;is scion as the child becomes quiet, it often is either totally unattended to, or an attempt made to restrain it only by a ban- made of cloth, or dimity, and which being ineffectual for such purpose, lays the foundation for future trouble and mischief. <; This is, in great measure, owing to a. common opinion, that a young infant can- not wear a steel truss ; b generally prevail- ing error, and which ought to be corrected. There is no age at which such truss may not be worn, or ought not be applied ; it is, when well made, and properly put on, not only perfectly safe and easy, but the only kind of bandage that can be depended upon .; and as a radical cure depends greatly on illness of the hernial sac, and its being capable of being so compressed as possibly to unite, and thereby entirely close the pas- from the belly, it must therefore appear to every one who will give himself the trouble of thinking on the subject, that the fewer times the parts have made a descent, and the smaller and finer the elongation of the peritoneum is, the greater the probabili- ty of such cure must be. The same method of acting must, for the same reasons, be good in every age in which a radical cure may reasonably be expected ; that is, the prolapsed parts cannot be too soon returned, nor too carefully prevented from falling down again, every new descent rendering a cure both more distant and more uncertain. As soon as the parts are returned, the truss should be immediately put on, and worn without remission, care being taken, especially if the patient be un infant, to keep the parts on which it presses constantly washed, to prevent galling. It can hardly be necessary to say, that the surgeon should be carelul to see that the truss fits, as his success and reputation de- pend on such care. A truss which does not press enough, is worse than none at all, a- it occasions loss of time and deceives the patient, or his friends ; and one which press- es too much, or on an improper part, gives pain and trouble, by producing an inflam-