New elastic apparatus for hernia : on the advantages of the new elastic belt and air pad, for inguinal, crural, and umbilical hernia : invented by Mr. Philip Bourjeaurd.

  • Bourjeaurd, Philippe.
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: New elastic apparatus for hernia : on the advantages of the new elastic belt and air pad, for inguinal, crural, and umbilical hernia : invented by Mr. Philip Bourjeaurd. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    >1 saving hundreds qf patients from pain, and the fearful casualties con- séquent upon strangulation. Although Surgeons could by no means hâve been satisfied with the steel trusses, the force of habit lias nevertheless prevailed for a long time ; and these metallic contrivances hâve continued to be worn, although it was in many instances apparent, tliat the cases of strangulation requiring opera- tion, were to be traced to this inefficiency. These untoward consec|uences will now but seldoiu arise, and I am not a little proud oftlïûs contributing to the welfare and security of patients, and so elficaciously assisting Sur- geons in the arduous duties they liave to perforai. Tliat steel springs should bave been so long in use is really astonishing ; for in looking at the nature of kernia, and at the structure of the abdominal walls, it will at once become clear tliat the steel trusses must, tliough ever so much improved, do more or less liarm. This will become palpable wlien we put in juxta position the yielding nature of the parietes of the abdomen ; the delicaey and proneness to inflammation of the peritonæum ; the liability of the bowels to be distended with flatus ; with the ruthless pressure exerted by the steel spring. This view of the evil elfects of the steel truss is coulined to the side on which the instrument1 is applied; but it should not be forgotten, tliat the grealest mischief may be doue in the opposite groin, by the partial pres- sure ellected on one side only ; but to this circumstance I shall presently allude. Tliat the steel trusses must really be hurtful, and very imperfectly keep up hernia, are facts which naturally spring from the nature ol these pro- trusions, and from the aim held in view, when a truss is applied. We may suppose, tkat in ordinary cases tliere is a constant tendency in the bowel or omentum, (when hernia lias once taken place) of finding their wajr into the inguinal or crural canal or to the umbilical cicatrix. Tliere is in fact, in cases of reducible hernia, a constant pressure against the ring, which latter, by the presence of the peritonæal sac in the canal, is ever ready to yield to intestine or omentum. Now the means ot prevent- incr protrusion should certainly not consist of strong pressure, with a °globular body, over a small area, but of a diftused compression which should support the wliole contents of the abdomen, so as to climi- nisli the weight, and consequently the pressure of the intestinal mass against the abdominal walls. Tliere can hardly be any doubt, but tliat this is the right view ot the nse and I must be allowed to say tliat the trusses which are couimoidy worn are far from accomplishing the désirable objeet to which 1 liave just ■dluded. Wliat is in general the plan upon which these trusses are cou- struct'ed9 A semi-circle made of more or less unyielding steel spring, with a pad at one extremitv, which resta against the spinc, and another in front, which by displacing the intestines and pressing backwards •îlinost meets the posterior one against the spme. 1 liave seen cases of chüdren with whoin the posterior pad pressed so liard upon the spine tliatthe littlc patient coukl hanlly walk, and side in a very awkward manner during progression. Such patients