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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    advised the early use of the knife, I can- not press it so much in this : tlie success of it is very cure, and I should make it die last remedy. Indeed I am much inclined to believe, that the bad symptoms which attend these cases are most fre- quently owing to disorders to the intes- tinal canal, and not so often to a stricture made on it at the navel, as is supposed. 1 do not say that the latter does not some- times 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 as loudly for the operation as any other, and I see no rea- son why it shomd be longer delayed.] When the operation becomes neces- sary, it consists in dividing the skin and hernial sac, in such manner as shall set the intestine free from stricture, and en- able the surgeon to return it into the ab- domen. (JJrjti on Ruptures.) The rest of the conduct of the surgeon is to be regulated by the usual principles. The division of the stricture is proper- ly recommended to be made directly up- ward, in the course of the linea alba. In consequence of the great fatality of the usual operation for the exomphalos, I think the plan suggested, and successfully practised by Mr. A. Cooper in two in- stances, should always be adopted, when- ever the tumour is at all large, and free from gangrene; a plan, that has also re- ceived the high sanction of that distin- guished anatomist and surgeon. Professor Scarpa. {Traite des Hermes, p. 362.) I might, perhaps, safely add, that when the parts admit of being reduced, without lay- ing open the sac, this method should al- ways be preferred. It consists in only making an incision sufficient to divide the stricture, without opening the sac at ali, »r, at all events no more of it, than is in- evitable. In umbilical hernia, of not a large size, Mr C. recommends the following plan of operating : As the opening into the ab- domen is placed towards the upper part of the tumour, I began the incision a lit- tle below it, that is, at the middle of the swelling, and extended it to its lowest part. I then made a second incision at the upper part of the first, and at right ARgles with it, so that the double incision was in the form of the letter T, the top of Which crossed the middle of the tumour. The integuments being thus divided, the angles of the incision were tinned down, which exposed a considerable portion of the hernial sac. This being then care, fully opened, the finger was passed below the intestines to the orifice of the sac at the umbilicus, and the probe-pointed bis- toury being introduced upon it, I directed it into the opening at the navel, and di- vided the linea alba downwards, to the requisite degree, instead of upwards, as in the former operation. When t!ie omen- tum and intestine arc. returned, the por- tion of'integument and sac, which is left, falls over the opening at the umbilicus, covers it, and unites to its edge, and thus lessens the risk of peritoneal inflamma- tion, by more readily closing the wound. {On Crural and Umbilical If, rnia.) [Mr. Lawrence remarks that in old umbilical hernia: (here is generally found a considerable portion of omentum ad- hering to the sac. About two years ago I operated on a case of umbilical hernia, in which the sac differed from any 1 have seen described. Upon cutting into it I found a portion of ilium, ten inches in length, strangulated in several places, by bands passing in all directions from the sac to the omentum, forming a cavity much resembling the ventricles of the heart. The omentum, and the sac had been blended together in this way proba- bly for years. The intestine was not a part of the usual contents of the sac, but had been forced into this singular cavity and become strictored in four distinct places by these productions. It was ne- cessary by very careful dissection to di- vide these bands and liberate the stric- tured intestine, which was accomplished, and the intestine evidently not being gan- grenous was returned into the abdomen.] LESS FUEO.UENT KINDS OF HKRNIA. The ventral hernia, described by Celsus, is not common ; it may appear at almost any point of the anterior part of the belly, but, is most frequently found between tlie recti muscles. The portion of intestine, &c. is always contained in a sac, made by the protrusion of the peritonaeum. Mr. A Cooper imputes its causes to the dilata- tion of the natural foramina for the trans- mission of vessels, to congenital deficien- cies, lacerations, and wounds, of the ab- dominal muscles, or their tendons. In small ventral hernia, a second fascia is found beneath the superficial one; but, in large ones, the latter is the only one cov- ering the sac. Herniae in the course of the linea alba sometimes occur so near the umbilicus, that they are liable to be mistaken for true umbilical ruptuies. They may take place either above, or below the navel. TLe first case, however, is more frt