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
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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![long- while after they had been operat- ed upon, and the great number of* stu- dents, who examined them, all acknow- ledged, that the ring- was completely obliterated, and there was no impulse of the viscera in coughing', sneezing, &c. Other children, in the knowledge of the surgeons of the Hotel-Dieu, have remained perfectly cured of their umbilical hernia;, by the operation, which Desault has revived. Bichat is acquainted with two young subjects, who were operated on four years ago, and have since had no relapse. The operation is almost certainly successful in young infants; but, it be- comes less so, in proportion as their age increases. Bichat relates three ca- ses, which tend to show, that success may be completely obtained at the age of a year and a half; that the cure is difficult, when the child is four years old; and impossible, when it is nine. Several other operations, done too late, have had the same result. (See (Envres Chir. dc Desault par Bichat, torn. 2. p. 315, &c.) Mr. Pott notices the plan of curing the exomphalos with the ligature, and expresses himself strongly against the practice in general. This treatment, however, on children, is now satisfacto- rily proved to be an eligible one. To adults the plan is not applicable, parti- cularly, when the tumour is large. Mr. Pott was decidedly in favour of com- pression, and he observes, that, in young subjects, and small hernia:, a bandage, worn a proper time, generally proves a perfect cure. (vol. 2) t'MBILICAL HERNIA IN ADULT SUB- JECTS. This case is to be treated on the prin- ciples common to all ruptures. When reducible, the parts should be kept up with a bandage, or truss; which plan, however, at this period of life, affords no hope of a radical cure. Mr. Hey lias described one of the best trusses for the exomphalos, which is applicable to children, when compression is prefer- red, as well as to adult subjects It was invented by Mr. Marrison, an ingenious mechanic at Leeds. It consists of two pieces of thin elastic steel, which surround the sides of the abdomen, and nearly meet be- hind. At their anterior extremity they form conjointly an oval ring, to one side of which is fastened a spring of steel of the form represented. At the end of this spring is placed the pad or bolster that presses upon the hernia. By the elasticity of this spring the hernials re- pressed in every position of the body, and is thereby retained constantly with- in the abdomen. A piece of callico or jean is fastened to each side of the oval ring, having a continued loop at its edge, through which a piece of tape is put, that may be tied behind the body. This contrivance helps to preserve the instrument steady in its proper situa- tion. (Pract. Ob». in Surg. p. 231.) When the exomphalos is irreducible, and large, the tumour must be support- ed with bandages. As Mr. Pott remarks: The umbili- cal, like the inguinal hernia, becomes the subject of chirurgic operation, when the parts are irreducible by the hand only, and are so bound as to pro- duce bad symptoms. But though I have in the inguinal and scrotal hernia advis- ed the early use of the knife, I cannot press it so much in this; the success of it is very rare, and I should make it the last remedy. Indeed I am much inclined to believe, that the bad symptoms which attend these cases are most fre- quently owing to disorders in the intes- tinal canal, and not so often to a stric- ture made on it at the navel, as is sup- posed. I do not say that the latter does not sometimes happen, it certainly does; but it is often believed to be the case when it is not. [On this opinion of Mr. Pott's I take the liberty to remark, that no surgeon ought to undertake an operation for the cure of hernia, unless certain that the hernia exists. If an umbilical hernia be strangulated, it calls us loudly for the operation as any other, and I see no rea- son why it should be longer delayed.] When the operation becomes ne- cessary, it consists in dividing the skin and hernial sac, in such manner as shall set the intestine free from stricture, and enable the surgeon to return it into the abdomen. (Pott on Ruptures.) The rest of the conduct of the sur- geon is to be regulated by the usual principles. The division of the stricture is pro- perly recommended to be made direct- ly upward, in the course of the linea alba. In consequence of the great fatality of the usual operation for the exompha- los, I think the plan suggested, and suc- cessfully practised by Mr. A. Cooper in](https://iiif.wellcomecollection.org/image/b21110657_0042.jp2/full/800%2C/0/default.jpg)
