A dictionary of practical surgery: containing a complete exhibition of the present state of the principles and practice of surgery, collected from the best and most original sources of information, and illustrated by critical remarks (Volume 2).

  • Samuel Cooper
Date:
1810
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Licence: Public Domain Mark

Credit: A dictionary of practical surgery: containing a complete exhibition of the present state of the principles and practice of surgery, collected from the best and most original sources of information, and illustrated by critical remarks (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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    discharge per amim, attended with a frequent, hard pulse, and some degree of fever. A patient, thus circumstanced, is in some danger, and demands immediate assistance. A stricture made on the prolapsed part of the gut, by the aper- ture, through which it passes, is the immediate cause of all the bad symp- toms, and of course, the removal of such stricture is the only thing, which can bring relief. This object can only be accomplished by returning the bow- el back into the abdomen, or dividing the parts, which form the stricture. The former plan is always the most de- sirable, when practicable. We next proceed to notice the vari- ous measures to be adopted for the re- lief of a strangulated hernia, so as to obtain the best chance of doing away the necessity of an operation. After treating of the merits of each plan, a few remarks will be offered on the or- der in which the means should be put in practice, a subject that has been most lamentably neglected, even by the latest writers on this interesting dis- ease. Taxis.—This is the term applied to the operation of reducing a hernia with the hand. It is much promoted by the position of the patient's body; Winslow thought it advantageous to have it pla- ced in an inclined plane, and the thighs bent towards the trunk. Mr. A. Cooper advises the same practice, observing, that this posture, by relaxing the fascia of the thigh, relaxes also the aperture, through whi< h the hernia passes. Eve- ry degree of tension, and relaxation of the femoral fascia must undoubted]} be attended with a corresponding chang-e in the abdominal ring. But flexion of the thigh, besides relaxing this fascia, also relaxes the abdominal, internal ili- ac, and psoas muscles. The pressure, which is m -de on the tumour by the hands of the surgeon, should always be directed upwards pnd outwards, in ca- ses of inguinal hernia, along the course of the spermatic cord, and Mr. A. Coo- per advises it to be continued from a quarter to half an hour. {On Inguinal and Congenital Hernia.) As the femoral hernia passes down- wards, and then forwards, the pressure must be directed first backwards and then upwards. No violence should ever be used, for, besides being unavailing, it must greatly aggravate the inflamed state of the contents of the hernial sac, and, it has even made the intestine burst. (See Cooper on Inguinal Hernia, &c. p. 23.) Besides bending the thigh, care should also be taken to rotate it in- wards, which will have great effect in relaxing the femoral fascia, and tendon of the external oblique muscle. Sus- pension of the patient over the shoul- ders of an assistant has been thought to facilitate reduction: I have tried it of- ten, (says Mr. Hey;) but have not found it to be of such superior efficacy, as some authors have represented. P. 144. The return of a piece of intestine is generally preceded by a peculiar noise, caused by the passage of air through the stricture. It recedes at first gradu- ally, and then slips up suddenly. The omentum goes up slowly to the very last portion, which must be actually pushed through the opening. If the tax- is should not succeed at first, it will of- ten do so after the warm bath, bleed- ing, or cold applications. Small herniae, being attended with the closest stric- ture, are the most difficult to reduce, and, for the same reason, crural ones do not so often yield to the taxis, as in- guinal ones in the male subject. The taxis becomes less likely to succeed, the longer the inflamed viscera have been down, because adhesions are like- ly to have formed. Mr. Lawrence ob- serves, (p. 63.) When the rupture becomes painful, we are no longer jus- tified in persevering in attempts at re- duction by the hand. A sufficient pres- sure cannot now be endured; and the force which is employed only tends to increase the inflammation, and accele- rate the approach of gangrene. At this period, the operation is required, and should be performed without delay De- sault even proscribed the taxis alto- gether in the inflammatory strangula- tion, until the previous use of other means had produced a change in the state of the swelling. However, I should never advise the reader to fancy he can diminish the inflammation of a strangulated hernia in any other way, than by delivering the bowels from the pressure of the stricture. Bleeding may check, but cannot stop, much less di- minish, the inflammation, that prevails: Bleeding.—The inflammation, which attacks the protruded viscera, and spreads thence over the whole abdo- men, and the temporary weakness and often fainting, which the sudden Lots