1000000031

750 / 868

s u R G E n Y. 6-,)
\Vhen lhr lunico vaginalÍJ is bid hace. you mufi cut
car~rully through il and the per;ton.eull'. in arder tO avold
prickinc the intd bnes,
T he p!rilon~llm being Clll through, Wc: arrivc: tO iu can–
tents. the n ..ture oC whlt:h witl dl!lerminc Iht! neX! proce:fs:
for ir it is ioten:ne only , it mufi dircfll~ be reriuccd I hUl
ir t.hereis any 0101 ~fit'd Ollu nlum, it mull be cm cff ; in or
dcr 10 which it ~i5 ..dvtled (O rnake a ligature above lhe pan
woundcd, to prcvent 10 h:emorrh:tge; bUl It 1$ 'lUItC nt:ed–
lefs, and in (ome mC:,ifult! pernicious, as tt puckcrs up lhe
lotdhne. and difordcrs \ts litu.Hian, Ir made elote. ID it.
\Vhen lhe DI/un/u", is remuv.;;d, we neXl ddate lhe
wound; to do whlch WHh (.de ty. 'ol" ¡nlioite numbcr of in
{humenr$ have beco ¡nycoled: bUl (here is none: we eao u(e
in lhis c.. Ce Wilh fo gllOd man"geme,n as • kOlfe; aud the
6nger in lhls operanon 1S" oflen ;¿ . much bt:ller oefeoce a–
gaioll prickin: ,he bowels. ,hOln a dirt'étor. T he knlfe
muU be a liul: crookl.:'d and blunt at iu ex,rcmity, hke the
end of a probe, Sorne rurgeons pcrhaps m..y not bl! Ilt!.l_
dy cnr ugh '9 CUI dex(crouOy wlth • kOlfe. and m:\y ,ht!re_
(ore perlorm the: incdion wlth probe-Cc:IT.H! cJ.refully intro–
o ucing one bl ...de bt!t"'cco ,he ¡meHloe and clfcumfe:rcnce
of lhe: rin¡ s, and dllltinc upwdrds, and a Itnle obllqudy
outw,¡rdl , When lhe 6nga anJ knife only are cm!>loycd,
the manner of doing lhe oper"lion wllI be 6y prd rll1'; Ihe
gUl down wilh ,he ture_fi nger, and 'carrying Ihe kOtre be–
tween it and the: mufcle..s fo""s tO dilAte upw..,ds . bout Jn
in"h ,.hieh wdl be a ",,,und g<nerJlly I"Ce <D"UCn: bu,
jf. upon examtoiltion, jt !h..tll appear Ih -t l lhe intefbne iJ
n rangulated wilhin the obd'Jllun, which moly poffioly happen
from " eontrd.d:ion o( the pui/on6 t111J oear lhe t'o(nance In_
co Ih(' fae; io lhat cale, the ¡ncilioo muU be coottnueJ
.h.-otlgh the lengch of th'e conlrotfled channel, or che con–
{~q llence wtll be (,,,041. :ng lhe .nteHine be re _
fl oreo lOtO the!crlJ/UIII : OQ lh., ¡ CCUU1 ' the oper..lOr Ihould
paC, his finger up che loe ¡.HO lhe ohJo",~n, ¡ fter lhe rell UC–
lioo of .he gUl, in orrlcr to dif~over whc!ther it be {¡fely re:_
turned lOto in proper J'l1 ..cc,
T he opt'ning b('lng molde, lhe inteOine is graJu211 y tO be
pu!he I int!l the' t:bJtun,n. and (he .....ouoJ to he Ilttched up;
ff)r ch', purpofe fom e ¡he quilled, ano olhcrs rhe in_
terrupled rUtUre, to be p..t(fc:d Ihrough the Don ArtJ mufcles;
bUI as there is nl'l ro much danger. of Ihe bowcls (¡II,ng OUt
",hen a drelling and h,nd 'Ce are applied, and .he palitO! all
the while kept upon hi! hack, bUI tlllt it ,"ay bt: prevent–
!d by one or twO C1.~ht ft llches through th~ (k n only. i[
u by all means advi le. ble tO foJlo\V IhlS mClhuJ, (jnce the
flriaurc of a ligalure. in thefe tcndlnous p.ins m..ty b: o"n–
j~rnuc,. .
H therto, in the dcferi ption of the hf,b'",,,uh, lile have
{uplUJfed the conl~nu t O be loofe, or fep,Hale in the lúe:
bUI it happ'cns fOIOe:times in an oper.uon, tlt at \Ve finl! out
only .n.. adltdiofl of the out(ide o( the poillJlI ~!i1ll 10 tbe
Iuni"',, tJn.~inolil, aod fpe roldtlC vcfl'd, bUllikc ·J.'ICe of fome:
part of lhe inteO io!.:! tu ItS IOler., ,1 flJdace; "nJ 1:1 ttllS cdCe
there ¡"ro mllch cuorufion, Ihat Ihe 0P' r lIor is ofl!!n \)t'lIt,::' d
lo extirpare lhe I~fliclc. in order ro ddr.l1 itw,jY dttin ,
tan¡;le the gur: thuu~h ir It e n b d ,oe wit h out ¡;.tll r.t·f(IO, it
oughl : hClwcver. this ,.¡;ddc:uI h,H)D~'ns r,mdy excC'pl 'in
lh,oCe luplurCs th.u h"W'c Ilccn .t IJo!: ll'l:= :n .be: Jrroltl.lll ·
wlth-;m r~lurninn: in v:hlch C"CI.' th· dlffi c',ll!y :lnd h .z."o,
of Ih~ oper;¡li"n arl' fu 'Ir~3t th ;¡1 u"l .. r~ by ,he rv· ' j}
lOros of an inflJllIcd iOl~í~in(:J it C11uuld DOI~bc uO(!crt~k~n ,
The drellirg of ,he wound fi ,n of.• IlIn1y b, wi.h dry
lint, and afler\Varos as dirt éto.:d under the he:,,1 oí wounds.
1~he Dper.uion of the hubDI10U/t' in womco fo neady re–
fe",bles thal performed on meJl, tha! it requi res no p:u ticu–
lar deofc.ription : ooly in lhem Ih e rupture IS Coo'meJ uy lite
intcflioe or om;lIlum (alliog clown throuóh tite parfolge of
Ihe: /ig31110//UIH roltwdfl1l1 ioto Ihe groío, or one of lhe la–
bia p1td~"di ; where c"uCing lhe f"Ole fyll1ptOOlS. as whcn
obflruéted io theftrol ulII, It is tObe returned by lhe ".ltlata–
<ion of .ha. paO'.ce.
0j'11:. EPIPLOCHE.
T tl E RE have beco a few ¡nflances where fo nrea: a quan_
tity of the OUUf1Jum has f<tllt-n ioto lhc p :rolulII, that, hy
dr"w,ng the nomach and bowels downw;u ds. it h~s exctl~d
vomiting!, IOflJmm.ttion, anJ Ihe l.. me lrain o( rymptoms
as happeo in a bubonoed~; in whtch lhe OpclotllOn of
opelllng of the ¡erQIIJIIl 15 nc:cerra!'y : the ¡neífion mult be
m-tde io lhe mdnoer o( thal for the ruplu re of the: in(elline,
¡ mI lhe [..me rules obrel ve!! wilh regard to lhe ol/JenlulIl
lhJt are laid down in lhe lall fetilon, lt IS neceff..·y alfo,
(he rangs of the muld es Chou lJ be d¡lalec.! ; or otht'r\Vife,
Ihoogh you have taken fOlne of Ihe monifie-d pU l of
Ihe DJlUIl/um, lhe rd l th;H is out of in place, . mi It rAo~led
in lhe: pt rfor.tion, wil! gangrene al'o " oe wound is 10
be treated io lhe ("lile Olanoer as lh.u ¡(u:r lhe operation
of lhe bub(¡l/oC(/~,
Oj' Ihe H ER tllA F ."ORA L<S ,
TWls rpec:es of rupt~re is {he Cune in bOlh fexcs, anel
fornled by the f"lI lng of Ihe OllUnlU1II or intc.Ütne, or bOlh
uf Ihem , ¡nto che 1OIioe o(lhe (hlgh, lhrou~h lheMeh fll ..de
by the 01 puhiJ and 1~~o"Je,,/ulII Fol/f.ipii. where lhe di ..<:
vefl'::Is and cendons of Ihe fJÍllJJ ..nd '/,oeul illlufltulllufcles
p.r, from Ihe obd?l1U", [ 1 i:; Vt ry nc:celT04ry furgeon$
Ih\lUld oe: ol oHe of th~ frequency of Ihis d.lorder/ which
c'e.Hes Ihe: t'dme fy mploms as uther ruptures, ,..tod muft lirf~
of :0.11 ~e Ife..t· d by the lolme methods : Ihe nu oncr uf ()pe~
r:Utng In the redlltlion is h~ re tOO fo exaflly dlt! (,lInr-, Wllh
Ihc rldfc:rencc: uf lhe liga01c:nl 1OIh: ...d of lhe n ngs of
, he muCcles, lh.H il v.:ould be a mere repetllion of ,he ope–
ralloo (or Ihe bfl~olJoeele tO glv~ :wy ct.:fcnpliol1 o( il: ool y
il m .y be obf:. rvc:J , dIal ,he fpermíltte curd , 2S il entefs io_
10 lhe ohJ'JIIt:'n, lies ne:ilrly tr ol ofverft: 10 the in cdi In, ;'tnd
cloCe in CfJOI .l.[t wil h Ihe lig..tmcnt ; fo th il.t unlcrs yOIl tn"ke:
lhe dllJI04ttoll obliqucly oUlwards , inOeaJ 01 p: rpcndlcul"r1y
upwards, you wtl l prob,luly di vide tllofe: n n~Js .
(Jj' Ir, EXO:,tr HAL O S,
T HI S ruptu re is o\\.'ing tO a protrufion oC lhe iorefli ne, or
CIII0 1/U JII, or hoth of Ihem , a l lhe n¡\'eI , ~ntl r"rdy happen!
tu be the fuhj -:tl of ao operalton: (ur Iho\\¡~h Ihe c ... re is
e mnnJO, ye, moll of them alC grAduAlly rormeJ from very
fm,dl heglnning5 ; ~nd if thl'y do out retllrn i/tto lhc ah.Jollun
upon Iying down , in all rrobdl'llltj th('y adherc wilhont aoy
greal incllnvenlén,.:e 10 lhe p:l tte:1t , till fome: time or other
an lr.l1,lll rf\ott;on (,!lIs upon Ihe: iOlefl .nrs. which Coon brin;;s
on ~ "londi ca'ion , ami dt!;lth ~ unlc(c:; , b)' gle,tt ehance, the::
O1:Jrtllicd plft reparottc:s froOl lhc foundone, leilv'ng il! ex–
trc:m·ty to perform lhe office of an 011111: in lhis en~ergeli­
ey. Iww· \I n, it is ;:¡d\'lfcablc to attcmpt lhe re,h~t,t.n . ir
c..tl le.! in ;U lheo: bcginnin}~, though Ihe I1n;,'nf:d ln of
lhe }tIC and it5 Cont(.'nlS are a gl'c:n ol;!l.lclc tOlh~ fu::crfs :
lh::.