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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![two instances, should always be adopt- ed, whenever the tumour is at all large; I might', perhaps, safely add, that when the parts admit of being reduced, with- out laying open the sac, this method should always be preferred. It consists in only making an incision sufficient to divide the stricture, without opening the sac at all, or, at all events ao more of it, than is inevitable. In umbilical herniac, of not a large size, Mr. C. recommends the following plan of operating: As the opening in- to the abdomen is placed towards the upper part of the tumour, I began the incision a little below it, that is, at the middle of the swi Uing, and extended it to its lowest part. I then made a second incision at the upper part of the first, and at right angles with it, so that the double incision was in the form of the lettt r T, the top of which crossed the middle of the tumour. The integuments being thus divided, the angles of the in- cision were turned down, which expos- ed a considerable portion of the hernial sac. This being then carefully opened, the finger was passed below the intes- tines to the orifice of the sac at the um- bilicus, and the probe-pointed bistoury being introduced upon it, I directed it into the opening at the navel, and divid- ed the line;i alba downwards, to the re- quisite degree, instead of upwards, as in the former operation. When the omentum and intestine arc returned, the portion of integument and sac, which is leit, falls over the opening at the umbilicus, covers it, and unites to its edge, and thus lessens the risk of peritoneal inflammation, by more readi- ly closing the wound. (On Crural and Umbilical Hernia.} [Mr. Lawrence remarks that in old umbilical hernia: there is generally found a considerable portion of omen- tum adhering to the sac. About two years ago I operated on a case of umbi- lical hernia, in which the sac differed from any I have seen described. Upon cutting into it I found a portion of ili- um, ten inches in length, strangulated II) several places, by bands passing in all directions from the sac to the omen- tum forming a cavity much resembling the ventricles of tht heart. The omen- tum, and sac had been blended together in this way, probably for years. The in- testine was not a part of the usual con- tents of the sac, but had been forced in- to this singular cavity and become Btric- tured in four distinct placts by these productions. It was necessary by very il dissection to divide these baads and liberate the stricturtd intestine, which was accomplished, and the intes- tine evidently not being gangrenous was returned into the abdomen.] LESS FREQ.UENT KINDS OF HEIIXIA. The ventral hernia, described by Cel- sus, is not common; it may appear at almost any point of the anterior part of the belly, but, is most frequently found between the recti muscles. The portion of intestine, &c. is always contained in a sac, made ! y the protrusion of the pe- ritonaeum. Mr. A. Cooper imputes its causes to the dilatation of the natural foramina for the transmission of vessels, to congenital deficiencies, lacerations, and wounds, of the abdominal muscles, or their tendons. In small ventral her- nia:, a second fascia is found beneath the superficial one; but, in large ones, the latter is the only one covering the sac. When the ventral hernia is reduced, it should be kept in its place by a band- age, or truss. When strangulated, it admits, more frequently than most other cases, of being relieved by medi- cal treatment If attended with stric- ture, which cannot otherwise be reliev- ed, that stricture must be carefully di- vided. Mr. A. Cooper recommends the valvular incision, and the dilatation to be made, either upward, ordownward, according to the relative situation of the tumour and epigastric artery, which crosses the lower part of the linea semi- lunaris. Pudendal Hernia.—This is the name, assigned by Mr. A. Cooper, to that which descends between the vagina and ramus ischii, and forms an oblong tumour in the labium, traceable within the pelvis, as far as the os uteri. Mr. C. thinks this case has sometimes been mistaken for a hernia of the foramen ovale. When reducible, a common fe- male bandage, or the truss used for a prolapsus ani, should be worn. A pes- sary, unless very large, could not very well keep the parts from descending, as the protrusion happens so far from the vagina. Mr. C. is of opinion, that, when strangulated, this hernia, incon- sequence of the yielding nature of the. parts, ma)- generally be reduced, by pressing them with gentle and regular force, against the inner side of the branch of tbeiscluum. If not, the warm](https://iiif.wellcomecollection.org/image/b21110657_0043.jp2/full/800%2C/0/default.jpg)
