464 



SURGERY. 



tion, as that would produce the mortification or 

 death of the limb. 



Hernia or Rupture, \% another disease that often 

 affords the patient who is ignorant of its nature 

 great uneasiness, especially on its first appearance. 

 As the nature of our work docs not require us to 

 enter at length on a consideration of the various 

 species of hernia, we shall confine our attention to 

 those varieties most common, and where domestic 

 management may prove most useful. 



Hernia or Rupture may be defined the descent 

 or protrusion of some of the abdominal viscera out 

 of their place, so as to produce an evident and pre- 

 ternatural swelling in the abdomen itself, or in 

 some of the adjacent parts, greater or smaller, 

 according to the quantity of the viscera, which 

 have been forced out of their natural cavity. The 

 parts which most commonly descend or are pro- 

 truded are the intestines and the omentum, and 

 when the former, the hernial sac, or tumour, is 

 called an enterocele; when the latter, an epiploccle, 

 or when both do so it is denominated an entero- 

 epiplocele. 



The most intelligible description for a general 

 reader is the name which the hernia takes from the 

 place in which it makes its external appearance. 

 When in the groin it is called an inyuenal hernia, 

 or bubonocele; in the hollow of the thigh, crural or 

 femoral hernia; at the navel, umbilical hernia, and 

 ventral when it occurs at any promiscuous part 

 of the abdomen ; in the scrotum it is called scrotal 

 hernia, and in females the tumour frequently 

 appears in the labia pudendi ; and there assumes 

 the name of its site, pudendal hernia. 



There are many cases in which the hernial con- 

 tents lie quietly in the sac, and admit of being 

 readily put back into the abdomen, and in this 

 case it is called reducible hernia ; or when the 

 parts that have descended suffer no constriction, 

 yet cannot be put back, owing to adhesions, or 

 their large size, in relation to the aperture through 

 which they have to repass, the name of irreducible 

 is applied to the hernial tumour. The kind of 

 hernia which is, however, most distressing, pain- 

 ful, and frequently fatal, is what is denominated 

 incarcerated or strangulated hernia; it means a 

 hernia which not only cannot be reduced, but ac- 

 tually suffers constriction, so that if a piece of 

 intestine be protruded, the pressure to which it is 

 subjected stops the pressage of its contents onwards 

 towards the anus, inflames the bowels, and brings 

 on a train of the most painful and alarming conse- 

 quences. 



As a warning to those who from either careless- 

 ness have omitted the necessary precautions, or 

 through ignorance, did not employ them, and who 

 having a rupture or hernia that becomes strangu- 

 lated, we shall detail the symptoms which most 

 usually appear when strangulation takes place. 

 These symptoms are swelling of the groin or scro- 

 tum, resisting the impression of the fingers. If 

 the hernia be of the intestinal kind, it is generally 

 painful to the touch, and the pain is increased by 

 cougaing, sneezing, or standing upright. These 

 are the very first symptoms, and if they are not 

 relieved, are soon followed by others, such as sick- 

 ness at stomach, a frequent retching or inclination 

 to vomit, a stoppage of all discharge per anum, 

 attended with frequent hard pulse, and some 

 degree of fever. If these symptoms are not re- 

 moved, by the return or reduction of the rupture 

 (or intestine), that is, if the attempts made for this 



purpose do not succeed, the sirkiu*.-.- brroiui s more 

 troublesome, the vomiting more frequent, the pain 

 more intense, the tension of the belly greater, 

 the fever higher, and a general restlessness comes 

 on which it is difficult to bear, and even painful In 

 witness; and now only one remedy remains, which 

 is to set the rupture free by an operation performed 

 by a skilful surgeon and dexterous operator. 



When these symptoms make their appearance, 

 blood-letting, so as even to occasion syncope or 

 fainting, the warm bath, tobacco enemas, and oilier 

 such modes are employed; but when notwith- 

 standing all these symptoms arc unabated, the 

 rupture should be relieved, else mortification and 

 death will speedily ensue. 



We now recur to the more pleasing subject of 

 a reducible hernia, free from strangulation. This 

 appears an indolent tumour at some point of the 

 parieties of the abdomen, most frequently descend- 

 ing out of the abdominal ring, or top of the thigh, 

 or else out of the navel, but occasionally out of 

 various other situations, as already described. The 

 swelling most commonly originates suddenly, ex- 

 cept in the circumstances above detailed, and it is 

 subject to a change of size, being smaller when the 

 patient lies on the back and larger when standing. 

 The tumour frequently diminishes when pressed, 

 and grows large again when the pressure is removed, 

 and its tension and size often incretise after a meal, 

 or when the patient is flatulent. Those who 

 labour under hernia are very apt to be troubled 

 with cholic constipation and vomiting, in conse- 

 quence of the unnatural situation of the bowels ; 

 frequently, however, the functions of the viscern 

 seem to suffer little or no interruption. To guard 

 against irregularities and those unpleasant feelings, 

 the patient should keep the bowels in an easy state, 

 by taking a tea spoon full of the following powder 

 in a wine glass of pepperment tea, or even plain 

 water, every other day. Take of magnesia two 

 drachms, powder of rhubarb and powder of calumbu 

 each half a drachm, powder of ginger one scruple, 

 mixed intimately by rubbing the ingredients 

 together in a wed'gewood mortar. Patients should 

 likewise wear a truss (see Plate LXXXVII. figs. 

 13 and 14), an instrument which has been greatly 

 improved of late. Those made on the principle of 

 Salmon and Ody's patent (now expired), will be 

 found most convenient and comfortable for those 

 who require to use little exertion ; but, perhaps, 

 the best truss for those who labour is the common 

 spring truss, as figured in the plate. As hernia fre. 

 quently appears on both sides of the abdomen, a 

 double truss is required. For the figures of hernial 

 trusses, single and double, and modes of application, 

 see figs. 11, 12, 13, 14. 



SPRAINS, CONTUSIONS, AND BRUISES. 



Cruises are often followed by very serious con- 

 sequences when they are inflicted in the neighbour- 

 hood of joints or over bones, which have only 

 thin cutaneous or muscular covering. In accidents 

 of this description we generally have, first, an im- 

 paired state of the vitality of the part, the conse- 

 quence of the injury received by its nerves and 

 blood vessels; and, second, an inflammatory action, 

 being the consequence of the previous state ; and 

 in the third stage a state of debility, the result of 

 the preceding increesed action. There is, likewise, 

 more or less extravasation of blood from the run- 



