TRUSS. 



by a piece of llecl, applied over the convexity ol the fym- 

 phylis of the pubes, and proportioned in length to the fpace 

 between the two openings through which the vifccra de- 

 scend. In fuch cafes, however, it is abfolutely necelFary to 

 have the fpring ttronger, than if there were only one rupture. 

 The trufs (liould alfo be made to put on that fide of the 

 body, upon which the hernia, moft difficult to retain, is 

 fituated. There are fome praftitioners, who give the pre- 

 ference to the ufe of two fingle truffes, joined together in 

 front and behind with fuitable ftraps. 



With refpeCt to the application and ufe of truffes, the 

 following inftruftions feem to merit attention. 



1. A trufs fliould never be firft applied, or changed, ex- 

 cept when the patient is in the horizontal pofture, and it is 

 known with certainty that all the contents of the rupture 

 are completely reduced. 



2. The firft applications of a trufs fhould always be 

 made under the fupcrintendance of the furgeon himfelf ; 

 and care fhould be taken to put on the inftrument in fuch a 

 manner, that the lower third of the pad will comprefs the 

 neck of the hernial fac againft the os pubis, while the upper 

 portion will comprefs the abdominal ring. The furgeon 

 ihould alfo make the patient acquainted with the right man- 

 ner of applying the trufs ; the principles on which it keeps 

 up the bowels, and affords a chance of a radical cure ; the 

 roquifite cautions to be obferved, &c. When a patient 

 firfl begins to wear a trufs, he fhould be particularly care- 

 ful not to be guilty of any imprudent exertions, and it be- 

 hoves him to obferve moil attentively, that the inftniment 

 does not flip from its proper fituation. It will alfo be 

 neceffary for him to pay attention to the inllrument being 

 neither too tight, nor too loofe. 



3. The patient ought to be provided with at leafl two 

 t ruffes, which fhould be changed every morning in bed. 

 Tn -order to fave the trufs, efpecially in fat perfons, who 

 perfpire a great deal, it is a good plan to lay a foft piece of 

 linen under the pad. 



4. An uneafmefs about the ring, which always gives rife 

 to a fufpicion that a portion of inteftine, or omentum, is 

 protruded, makes it proper to take off the trufs, carefully 

 examine the parts, and reduce them if they have defcended. 



5. When the fkin is excoriated by the trufs, the part may 

 be cured by fprinkling upon it the powder of acetite of 

 lead, fuller's-earth, lapis calaminaris, &c. or bathing the 

 part with the faturnine lotion. It will alfo be right to pro- 

 teft the excoriated place with a piece of linen put under the 

 trufs. 



6. When the preffure of the trufs excites affeftions and 

 fwelhngs of the fpermatic cord and tefticle, either the thigh- 

 ftrap muft be relaxed, or the lower part of the pad made 

 lefs prominent. 



7. In children a very tight trufs is altogether hurtful, 

 and may be the caufe of various curvatures and deformities ; 

 but the crroneons opinion, that they ought not to wear 

 a firing trufs, we have noticed in another place. See 

 Hernia. 



8. Sometimes very old large ruptures cannot be fccurcly 

 kept up by means of a trufs, and even when the pad is 

 extremely large, not more fuccefs is often experienced. 

 Should they be retained, it may happen that the ill eflefts 

 of the comprefTion will be felt in the flraightened ftate of the 

 cavity of the abdomen, or in the fpcedy appearance of 

 another hernial tumour on the oppofite fide. Ruptures to- 

 tally irreducible, and various diforders of the tefticle and 

 cord, do not admit of the ufe of a ftecl trufs. 



Whoever wears a trufs, fhould be careful to employ 

 it day afld night, without interruption, fo that there may be 



no opportunity for the heriiia to protrude again. If, under 

 the employment of a trufs, the rupture once defcends again, 

 either a ftrangulation happens from the narrow nefs of the 

 neck of the fac ; or, at all events, the liope of a radical 

 cure, which may have been entertained for months and years, 

 vanilhes in a moment. For experience has put it beyond 

 all doubt, that, by the continual unremitted ufe of a trufs, 

 and the fteady retention of the contents of the hernia, the 

 neck of the liernial fac, and the ring, may be gradually 

 leffened in diameter, until they are entirely clofed, and a 

 radical cure of the rupture effefted. This is more fre- 

 quently obferved in young fubjefts ; feldom in adults ; and 

 hardly ever in perfons of advanced years. But truffes muft 

 be worn a long while, nor fhould the patient venture to lay 

 afide their ufe till after many cautious attempts ; beginning 

 the experiment at firfl only in the night-time, and not mak- 

 ing it in the day, till after a confiderable period from tlic 

 time when he firll thinks himfelf fafe. The longer and 

 more attentively a trufs is worn, the greater is the hope of 

 a radical cure. Callifen, Syft. Chir. Hod. tom. ii. 



Reprefentalions of various kinds of truffes may be feen 

 in Plate IX. Surgical Plates. Fig. i. exhibits a common 

 trufs. Fig. 2. the fpring terminating in front in the ex- 

 panded plate of metal, often termed the head of the trufs. 

 Fig. 3. rcprefents a trufs for a double rupture, with two 

 pads affixed to one fpring, and furnifhed with two thigh- 

 ftraps, which, in fuch a cafe, would be almofl indifpenfable. 

 Fig. 4. exhibits Dr. Hulme's palm trufs, fo named by its 

 inventor, from its afting continually hkc the preffure of a 

 hand. Its particidarity confifts in its fprings not being 

 placed in that part of the trufs which goes round the 

 body, but in the pad itfelf ; where there are three fpiral 

 fprings. A full defcription of this trufs may be found in 

 the Tranfaftions of the Medical Society of London ; 

 but as the conftruftion of this inftrument docs not make 

 much provifion againft the flipping and difplacement 

 of the pad, it can afford very little fecurity to the patient, 

 and does not therefore appear to us to be deferving cf 

 recommendation. Fig. 5. reprefents a very good ordinary 

 trufs, made by Mr. Whitford, a furgeon's inftrument- 

 maker in Smithfield. Fig. 7. exhibits Mr. Salmon's pa- 

 tent trufs, with the additional fprings, all three of which 

 together are capable of exerting a force equal to nine 

 pounds weight. A is the fpring, made fo as to exert a 

 pofitive force on the cufhion at each end. At the front 

 and back ends are different holes, to which the plates and 

 cufhions may be inftantly fhifted by the wearer, fo as to 

 admit of being correftly accommodated to the parts. B, C, 

 the additional fprings detached, either, or both, of which 

 may be added, fo as to incrcafe the power of the trufs, if 

 requifite. Thefe fprings are fimply flipped into a loofe 

 leather or other cafe. D, the front plate with its cufhion. 

 This plate will apply to either of the holes in the fpring, 

 and is kept on the ruptured part by the pin, on which it 

 turns in all direftions ; fo that whatever be the fhape or 

 irchnation of the body, the plate adapts itfelf to fuch 

 changes, not being confined in its diroftion by any pow-er 

 of the fpring. The cufliions are fimple cafes ftuffcd witli 

 the fofteft materials. E, tlie back plate and cufliion. F F 

 a ftrap to be ufcd, if occafion require, to prevent a forcible 

 removal of the cuftiions. 



Fig. 7. reprefents a fcAion of the pelvis, round which 

 the trufs is to be applied. Mr. Salmon contends, th.it if 

 the fpring only paffed round to the point diametrically op- 

 pofite that from which it commenced, it would not remain 

 ttationary, as both extremities would reft on planes inclined 

 to their adlion. For a full explanation of this figure, how- 

 ever, 



