1000000031

r aru,

though

lhey

nol

re-unitc

in fo

ilion

a time.

Wheo

.. lcnrlon is

Fat tly

diviJ td,

it is

gener;,¡lIy attcndtu with

éln

t:X.:clh\'C

paio,

fltmmatiún,

ce.

in conJeqncnce or

the re ·

maining fiores

bt.ip

Hrc\chcd and [oreed by

lhe aaioo

(lf

murcie,

,~bich

nl!cdl-"rily will eontraét mOl e when ("me ol'

iu r(fin.lOee is taken

aw~y .

To cb,i.1C this

marchief,

has

beco hi,hcrto

indifput olblc

nllx:m

fu' gcry, tO

cut the

tendon quite through, ami immc:dialcly

arterwards

pcrform

lhe rUture. BUI

this

prd8ic::: i9 oH

advirc~LJe;

for though

the

dl,¡fion

of lhe l(ndoll

.tfford

prd~nt

cafe , )'Cl

the

mer~

Bexion of the

juiOl

will

hHe

,he fam.:

({feét,

iC,

fUf

ex–

a:nplc,

be a wound of a flexo r (codon: bcfides, in arder

to few up lhe extremities of rhe tcnJo,!l whcn dividcd, we

are obliged tO put the limb iD fueh

fillw;u ion, th.t lhey

may be brouf'ht into- conuét, ami even to Cufh in it in that

poClure to the 6niOling

the cure: if then, the poHure

,,'iJl

laJ

(he tendon in this poútion. we can likt:wife keep it

fa wilhout utiog the ruture, and are more rure of its Dot

llipping away, which Cometimes happens (rom any cardefs

motion

al' the j nint ,

when lhe ll.itch cs have almoH \l'orn

Ihrough the lips o( (he wound ; on which aceounr, it is

211

mcilOS

advifeablc, in this cafe, to forbta r che future, and

only to favour the lituation of rhe exu emities of lhe tendon,

by plaeing ,he limb properiy.

BUl

wheo the tendon

quite feparated, and tbe cnds are

Withdrawo fro m one another, haviog brought them

10gC

ther

with yaur.fingers, you ma few lhem"'Wlth a nraight

trian~

g\ilar pointcd oeed le, paffiog it from without i"wards, and'

from wíthin outwards in fmali tendoos; aboul three tenths

¡nch from theiT extremitics, and

the

(tildo

A ch'¡liJ

haJf an ineh.

tlie woond of ,he n,in will be nearly "an"e,fe, i,lh oul d

Ilot

be raifed

tó

expofe more

the tendon ,

bu,

rinher

fcw~

.d up wi,h it, whieh will conduce to the Ilreng'h of ,he

fDture. The knot of the Jigature is tO be made as in other

lVol.lnds, and the drcffiHgS "re to be (he rame: (here is a

{on

of Ihin

crooked

aeedle th.u CUtS 00 ilS concafe and con–

YCX

jides, which is ver

hándy

the (ulure of large

tcn~

don., aAd 'o be preferred 'o ,he Clraigh, one. Du ring ,he

cure, (he dreffings mufl be faperficial. and lhe pans kept

Ile~d~

wi,h paneboard and bandage: lI,e

f01.JI

tendon, re·

UnUe

three wceks, blilt the

Itndo AchilliJ

requires (ix

leaCl,

O(lh.

GAsTR O RAPHT.

T"J

word figniGes no mOfe thao

f~\,

ing up any wound

of the belly; yct in

common acceptation,

,mplíes chal the

wo~nd

of (he

belly

is complicated Wilh another of che

in~

teCllOe. Now ,he fymplOln. h id down for úilllngu;(l,ing

\IIhen

t.he

~nlcll.ine

woundcd.

nOl

with any cenalOty

dct,ermll:lc

be wOllnded oply in one pl.\ce ; which wan(

of InfOrmatlOD makes

abfurd to open the abnomen in or.

der to come at il :

fo, the operation of llitchinJ! the bow–

tls can only lake place where ,hey

r.JI

ou, o( ,he abdomen,

and

we can fee

whcrc

lhe \..'ound is, or ho\V m;m)' wounds

there

H e :

11;t ppcns thaLthe intel1inc!. fal l out

un~\ ol1nd·

cd,

t~e

ba(¡neCs of lhe furgeon is

reluro lhenl immediate .

11,

~uhout

wailing for [plrituous or emolJie-nt fOl1ltn t:uions ;

.nd

caCe: (.hey pufT

fa as to prc:vtot lht:ir rt¿uélíon

the

~ame

on.fice. you may with a knife or prCJ!.':

[cimo

fuffic,ently dd.ate

for

th.a

purpcf!.! ,

(Ve o

prir..k

thcm

Jet tJut lhe wlOd.

Upon Ihe

tuppo~tion

the

intdline

bcin:; wounf.!-:J i.l

VOL.

1I1. N°. 96.

manner as to require lhe

o?~r:\t:~n,

(ror

fm.tl

punétul es it is not

neccfr.HY

,) the nlc!thod of doing il Illay

this : 'T aking

flraight

n(!edl~

wlth

fmall

thrc:IJ , ) (JU

lay

hoiJ of the bowel with )lOU' Icft h1nd , anJ

(t w

up dIe

wCJund by the gI0\'er'5 Ilitch, that is, by paliing lhe Ill!/!d/<:

lhrough the Iips of the w(\und, from wil hin

OUI

\'/JrJs aH

the way, fo as to leave" lenglh of th read al both endz,

which are tO hang OUt of lhe Illcl ri on of toe abdllm:n¡ lhen

carcfull y O1ak!og the inlerrupted

rUIUre

of lh'! external

wou nd, you pull the bowel by ,he fm.1I ,hrc'Gs in

eoo–

tatl with lhe peritonzum, in order 10 proculc an adhcúcn,

.nd ,ie ,hem upon a rmAII bolfler of linen. In .boo,

r. K

days, it

fa id

lhe

ligature of che intdlioe

will be loor!.! e–

nough to be cut and drawn away . which muft be done Wilh–

out gre.1t force ; in Ihe interim, lhe wound is tO be trt'ared

with (uperhcial dreffi ogs, and the patient to be kcpt

vel

Ilill and Jow.

O[ ¡he

Bu,oN OCEeE.

W HEN the intdline or omcntum ralls out

of the

abdomell

into a"y pan, (he lumour in gener:!:1 is known by (he

n :U\1t:

her"i:J;

which ls fanh cr fpecified cithcrfromlhe dlfference

of fitUalion, or lhe nature of.

i1$

Conlent5. \\fhen ¡he in–

td tioe or omentum falls through the navel,

is calleJ a

h(rl1ia ·umbilicaliJ,

o:omphn/o/

when through lhe ring'

of the abdominal

murcies

ioto the groio,

hu n;o

ingulnaliI;

or iE iota the fc:rolum,

[cro/tI/il :

the(t: two lan, though the

firCl only i. properly fo ealled, are known by ,he name of

bubonoccJe.

When they

f.dl

uoder

lhe

lig(JlII~nlum

F.J/lf/pii,

th rough the Carne paffage that tbe ¡bac vefTds creep lOtOIhe

Ihigh.

is nlled

hirn;o ftlnlJraliJ.

The buIJonocde is airo

fometimes accompanied with a defeeot of lhe bladder : how–

ever, (he caCe is very rare

but when it oceurs, il is knowQ

by lhe p:uieot's inability lO urin!", tiJl the

hu nia

the

bl..dder is redueed wilhio lhe pelVIS, \ Vlth regard

Ihe

eonlenu charaéterifing

(he

fwcl ling, il is thus diílingu O\ed:

lhe inteUine ooly is fallen, it becomes :ln

41IIO'oede ;

the

ornentum,

(,pipI1)171)

t'pip/ou/t;

and

both.

oJl~'ro~

(}iploce/e.

Th(re is, bdides Ihere, ar.olher klrtd of hernia

rncotiooed and derertbed

tite

mod<:los,

wh(n

d l(

ínler·

tioe or omentum is infiouated betwceo

tIJe

inter/tlces of

¡he

murcies, in dlffereot pans of the

bdly:

this hl.'rni ..

ha.s

den"cd

íts

name from Ih e pl ace :.fTctlc::d, anJ

ealled ,he

hernia

venlroli,;

and laHly, there havc becn a (c\V in–

naoees, whtre the ¡olcaines or omentum havc fallen

¡hro'

the great furameo of lbe irchium ioto Ihe I1Hcrn.d p"rt uf

the thigh . betwcco and uoder ,he

t~ Ó

hc;~ds

t h~

triceps murcie.

AII

Ihe kinds of hernias of the

intcr!in~s

anJ ""' ('OIUllI ,

are owing to ... prctcrnatural dilatatic)O of lhe palliculH o–

rífices rhrough which Ihey pals, aod r¡ot tO a

!,tCel 041iot)

them .

The

ruplure

of lhe groin, or

fcrolum ,

is tlle

m.,(l COO1 '

mon (pecic::s of

h~rnia,

and in young childl ClllS H rc::

rreCJ

I.:ot;

bUl

rardy happcns io ¡of¡ oey, t!lat any

mlíc:hi~ f~ ~rik

fro01

i1.

F or lhe mon pHt, lhe

iotd lllle

rctl1ros of Id'rif

ioto

,he cavily of th!:'

abdomen,

whcr:cvt:r ,h<: pel fnn 11\ 5

¿own, at lean a fmaJl degree of eomprl.. ff!:;n wdl

nlAk~

it.

T o ftcure tlJe inteí!ioe when returncd ¡uro its proper "I"::t,,

lhere are (lecl truO'ls

now

1'0 artrull y nude,- that hy

b~·illg

aeeo01 OJodaled exaé'dy

lhe

p.II

't,

t11' y

p~l jornt

lile

('dj~ cc:

a 1,)01(l .:r, wi thout gallillg, or e\'en

li\tlil~

unc ..

l~O

ti,!!

pati.ot.

T~le(e

il1f1! u;l1':nls

art:: cf fo !;n.: .•

L:rvin ,. Ih..

8 U

·r

. Co