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:
1816
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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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    parts of nitre and sal-ammoniac. To one pint of water, in a bladder, ten ounces of the mixed salts are to be added. If, after four hours, (says this distinguished surgeon) the symptoms become mitigated, and the tumour lessens, this remedy may- be persevered in, for some time longer; but, if they continue with unabated vio- lence, and the tumour resist every attempt at reduction, no farther trial should be ■made of the application. (On Inguinal and Congenital Hernia.) When ice lias not been at hand, aether has occasionally been found a good substitute, when al- lowed to evaporate from the surface of the swelling. Care must be taken, that the cold be not so applied as to freeze the scrotum, and bring on sloughing. {A. Cooper, p. 15.) Gpiutes.—Mr. Hey has seen several cases, in which opiates, given freely, (in athletic persons after bleeding) have pro- cured a reduction of strangulated hernia. He cannot say, however, that this re- medy is generally successful; but, it has th;- advantage of removing, for a time, the pain and vomiting usually attendant on strangulation, even though it prove ultimately inefficacious. Opiates should be given in large doses, when it is wished to try their effect in procuring reduction ; and whenever the symptoms of strangula- tion return, after having been removed by opiates, the operation should be per- formed Without delay. {P. 134, 135.) Tobacco Gljsters.—For this purpose, some surgeons prefer a decoction of to- bacco, made by infusing, or boding, one dram of the plant, for ten minutes, in a pint of water ; others employ the smoke, which is prepared, and introduced into the rectum, by means of a well-known apparatus for the purpose. Perhaps, both methods are equally efficacious ; but, as one requires an apparatus, while the otlier does not, and is equally proper, the decoction may be entitled to most recom- mendation. The machine for the smoke is also frequently found out of order. Tobacco glysters are, next to the opera- tion, the most certain means of bringing about the reduction of the strangulated parts. They not only excite the action of the intestines, they also exert a pecu- liar depressing influence on the whole system, reducing the pulse, and causing nausea and sickness, cold sweats and fainting, under which circumstances the parts recede spontaneously, or may be easily reduced. Mr. A. Cooper pru- dently advises injecting half the above quantity at first; for he has seen two drams, and even one, when used as an infusion, and introduced at once, prove fatal. (P- 24.) The rest should pre- sently be injected when it appears, that the tobacco does not operate wilhjthc ex- traordinary v.olence, with which it does in a few particular constitutions. Poultices and Fomentations. We only mi ke mention of these, to say, they have not the least confidence of any experienc- ed, or intelligent surgeon. Whoever wastes time, in these urgent cases, in try- ing- the effects of such applications, merits censure for his credulity, ignorance, and unfitness to undertake the treatment of a rapid disease, in which, as Pott remarks, if we do not get forward, we generally go backward; and whatever does no good, if it be at all depended upon, certainly does harm, by occasioning an irretrievable loss of time. {Placing the patient on an inclined plane, with his feet highest.—Wmslow and Cooper recommended this position of the body during the efli^to to reduce the hernia by taxis. I woW recommend it however, to be continued longer; from having seen two cases in which this simple measure succeeded after seve- ral of those, already recited, had been tried in vain. The patient should lie upon his back, and the foot of the bed be elevated about twenty inches higher than the head. This posture need not interrupt the administration of other remedies, and in some cases will be found powerfully to aid them.] OF THE ORDER, I* WHICH THE PRECED- ING METHODS AND REMEDIES SHOULD BE TRIED, AND OF THE TIME, WHEN THE OPERATION SHOULD NOT BE DE- BATED. In the treatment of a strangulated her- nia, a surgeon cannot be too deeply im- pressed with the danger of spending time in the trial of methods of inferior efficacy, or of such as are evinced to be ineffectual in the cases before them. The rapidity, with which gangrenous mischief sometimes arises, and the patient loses his life, has been proved in a mul- titude of unfortunate examples, and should operate as a warning to all practitioners against the danger of deferring the ope- ration too long. In the course of my reading, however, I have not met with so remarkable an instance of the sudden mortification, and rapidly fatal termina- tion of an hernia, as the following case re- corded by Mr. Larrey, in speaking of the fatiguing and forced marches performed by the French soldiers in Egypt. These marches, he says, brought on in one of the military a hernia which formed sud- denly, and became at the same time str i-