.TRUSS. 



prefs ; and, in general, do not requii-e the ufe of a tliigh- 

 ftrap, which is ufually a very difagreeable part of the trufs 

 to a patient. 



" The valuable properties of this inftrument ( fays Mr. 

 Lawrence ) depend entirely on its fpring, which keeps the 

 pad conftantly prefled againft the herniary opening ; and 

 gives it a power of reaction, by which an uniform prelTure 

 is maintained under varying attitudes. This elafticity can 

 be attained only by the employment of fteel. In the firft 

 attempts at procuring fomething better than the non-elaftic 

 bandages, iron was ufed ; and the inilruments fabricated by 

 Blegny at Paris were conftrufted of this metal. It is ob- 

 vioufly inadequate to accomplifh the ends which we have in 

 view, in treating hernis ; yet it is only at a comparatively 

 recent period that its defefts have been difcovered. 

 Arnaud, whofc writings contain much valuable information 

 on this fubjeft, recommends for the fpring of a trufs a mix- 

 tare of malleable iron and fteel, fo that the inftrument may 

 be moulded by the hand to any particular fiiape which the 

 patient may require ; and he is followed on this point even 

 by Richter. A trufs which admits of fuch management, 

 muft in effeft be expofed m.ore or lefs to the objeftions 

 which apply to the non-elaftic bandarge ; and the only ma- 

 terial which pofTefTes the requifite qualities of firmnefs and 

 elafticity, is well-tempered fteel. 



" The moft important part, then, of an elaftic trufs, con- 

 fifts of a flat and naiTow piece of fteel, adapted to the form 

 of the body, and called the fpring. This paftes round the 

 afFefted fide of the trunk, terminates anteriorly on an ex- 

 panded plate of iron, to which it is rivetted, placed over the 

 mouth of the fac, and extends behind to various diftances 

 beyond the fpine. The pofterior furface of the plate is 

 furniftied with a convex culhion, termed the pad, and adapted 

 in form and fize to the opening which it is defigned to clofe. 

 The fpring is covered externally with leather, and that it 

 may fit eafily on the body, its inner furface is lined with 

 fome foft fubftance ; a ftrong ftrap, extending from its pof- 

 terior end, pafles round the found fide of the trunk, and is 

 fafter.ed to a hook on the front of the plate. This ftrap, 

 being perforated by feveral holes, enables the patient to 

 tighten or loofen the trufs at pleafure." Lawrence on 

 Ruptures, p. 71, 72. edit. 3d. 



In a note, this gentleman obferves, that the fpring of the 

 trufs has commonly been a femicircle, with the pofterior end 

 refting on the fpine. Camper propofed to carry it round to 

 the anterior fuperior fpine of the ilium on the found fide : 

 and Scarpa vei-y much approves the plan. Trufles of this 

 form fit with a firmnefs which cannot be given to the others 

 by tightening the ilrap. They keep up the rupture much 

 better than even a Itronger fpring of the other kind. 

 Hare-llcin, with the hair outwai'ds, is confidered the beft 

 article for covering the fpring, with a view of keeping it 

 from the ill effects of the perfpiration. 



When it is necefTary to make ftrong compreffion, as in 

 larire old ruptures, and in perfons who cannot avoid labour 

 and exercife, the elaftic fpring fhould be made accordingly 

 thicker and broader. But an objeft of the firft-rate im- 

 poitance is to make the fpring prefs equally upon every 

 point of the body which it touches. This is what demands 

 the eai-neft attention both of the furgeon and the inftru- 

 ment-maker, efpecially as the hips of fome individuals are 

 flat and narrow, while thofe of other perfons are broad and 

 prominent. A thick, flexible, metalUc wire, accurately ap- 

 plied round the peKns, will fervc to take the mcafure and 

 proper fhape of the fpring, which may after-wards be altered 

 a little, if found neceffary. The wire, however, fhould be 



6 



fomewhat longer, on account of the length of the fpnii^ 

 being diminilhed in the conftruClion of it. Callifen difsp- 

 proves of fprings which extend quite round to the oppofite 

 hip ; but he thinks a certain bend of the fpring downward, 

 near the pad, is ufeful in trufles for inguinal ruptures, as, 

 by this means, the part of the inftrument which goes round 

 the pelvis can be made to fit more clofely, and is placed at 

 a convenient diftance from the trochanter, fo as to be lefs 

 liable to derangement. The neck of a trufs for a femoral 

 hernia (hould be ftiorter, and, in general, the inftrument re- 

 quires in this cafe the employment of a thigh-ftrap to keep 

 the pad from flipping into the bend of the groin. 



The pad of a trufs is frequently compofed of a piece of 

 cork covered with leather, with the intervention of fome 

 wool or horfe-hair. Propofals have been made to ufe pads 

 which are formed of bladder or elaftic gum, filled with air, 

 but we know nothing of the real merits of fuch con- 

 trivances, nor ftiould we expecl them to anfwer. Callifen 

 gives a general preference to pads which have a flat and 

 not a conical furface, which laft form not only produces 

 lefs equal prefigure, but is more liable to flip. The ftiape 

 and fize of the pad ftiould of courfe correfpond to the figure 

 and dimenfions of the ring, or opening, at which the rupture 

 protrudes. In the inguinal hernia, the pad fhould be long 

 and oblique ; in the crural, fhorter ; in the umbilical, 

 round ; and in the ventral, for the moft part, oval. In 

 large old ruptures, the pad ihould be large accordingly ; 

 and in fmall recent cafes, it fliould be fmall in proportion. 

 For fat fubjefts, the pad fliould be firm and prominent ; 

 but for thm perfons, it fliould be flatter and fofter. Nay, 

 it has even been found fometimes neceflary to accommodate 

 the ftiape of the pad to the various degrees of convexity or 

 flatnefs of the os pubis. 



Trufles are fometimes fabricated with a. pad moveable 

 on the fpring, inftead of being rivetted to it. This may be 

 inclined upwards or downwards, according to the form of 

 the abdomen ; and it is retained at the defired point by a 

 fpring fitting into the teeth of a rack. In others, the plate 

 contains a fcrew, by which the cufhion is puftied farther in- 

 ward, or allowed to recede, at pleafure. Although there 

 cannot be a doubt that fome of thefe inventions poflefs 

 confiderable merit, and arc, in certain inftances, fuperiorly 

 ufeful, it muft be confefled that, in general, their utihty is 

 not fo much greater than that of common pads, as to make 

 amends for the want of fimplicity and the increafe of ex- 

 pence. We fliould be forry, however, to fay any thing 

 that would unfairly difcourage all fuch ingenious endeavours 

 to improve fo difiicult an inftrument to make perfeft as 

 a trufs ; and we therefore repeat our belief, that there are 

 particular cafes, in which pads, with racks, fcrews, fprings. 

 Sec. may be employed with great advantage. 



Notwithftanding every care, fometimes even elaftic trufli?s 

 cannot be hindered from flipping away from the part which 

 they are defigned to comprefs. Sometimes they flip down- 

 wards, which in fat fubjefts is generally caufed by the 

 projeftion of the abdomen. Occafionally, the fault con- 

 fifts in the inftrument becoming difplaced in the direftion 

 upwards, which moftly happens in thin perfons, and is pro- 

 duced by the flatnefs of the abdomen. In the firft cafe, 

 the difplacenient is to be prevented by the ufe of an elaftic 

 fcapulary ; in the fecond, the flipping of the pad upwards 

 is to be prevented by the employment of a thigh-ftrap. 



When a patient is afllifted with a rupture on each fide, 

 the two protrufions may be very well kept up by means of 

 a fingle trufs, made with two pads, which are joined to- 

 gether, at the e.\aft diftance of the rings from each other, 



by 



