Advice to the people in general, with regard to their health

by S. A. D. Tissot

§ 476. In a more advanced Age, a Bandage only of Fustian is not sufficient; one must be procured with a Plate of Steel, even so as to constrain and incommode the Wearer a little at first: nevertheless it soon becomes habitual, and is then no longer inconvenient to them.

§ 477. Ruptures sometimes attain a monstrous Size; and a great Part of the Guts fall down in to the Scrotum or Bag, without any Symptom of an actual Disease. This Circumstance, nevertheless, is accompanied with very great Inconvenience, which disables Persons affected with it to work; and whenever the Malady is so considerable, and of a long Standing too, there are commonly some Obstacles that prevent a compleat Return of the Guts into the Belly. In this State indeed, the Application of the Bandage or Truss is impracticable, and the miserable Patients are condemned to carry their grievous Burthen for the Remainder of their Lives; which may however, be palliated a little by the Use of a Suspensory and Bag, adapted to the Size of the Rupture. This Dread of its increasing Magnitude is a strong Motive for checking the Progress of it, when it first appears. But there is another still stronger, which is, that Ruptures expose the Patient to a Symptom frequently mortal. This occurs when that Part of the Intestines fallen into the Scrotum inflames; when still increasing in its Bulk, and being extremely compressed, acute Pains come on: for now from the Increase of the Rupture's Extent, the Passage which gave Way to its Descent, cannot admit of its Return or Ascent; the Blood-vessels themselves being oppressed, the Inflammation increases every Moment; the Communication between the Stomach and the Fundament is often entirely cut off; so that nothing passes through, but incessant Vomitings come on [this being the Kind of Miserere, or Iliac Passion I have mentioned, [§ 320]] which are succeeded by the Hickup, Raving, Swooning, cold Sweats, and Death.

§ 478. This Symptom supervenes in Ruptures, when the Excrements become hard in that Part of the Guts fallen into the Scrotum; when the Patient is overheated with Wine, Drams, an inflammatory Diet, &c. or when he has received a Stroke on the ailing Part, or had a Fall.

§ 479. The best Means and Remedies are, 1, as soon as ever this Symptom or Accident is manifest, to bleed the Patient very plentifully, as he lies down in his Bed and upon his Back, with his Head a little raised, and his Legs somewhat bent, so that his Knees may be erect. This is the Attitude or Posture they should always preserve as much as possible. When the Malady is not too far advanced, the first Bleeding often makes a compleat Cure; and the Guts return up as soon as it is over. At other Times this Bleeding is less successful, and leaves a Necessity for its Repetition.

2, A Glyster must be thrown up consisting of a strong Decoction of the large white Beet Leaves, with a small Spoonful or Pinch of common Salt, and a Bit of fresh Butter of the Size of an Egg.

3, Folds of Linen dipt in Ice-water must be applied all over the Tumour, and constantly renewed every Quarter of an Hour. This Remedy, when immediately applied, has produced the most happy Effects; but if the Symptom has endured violently more than ten or twelve Hours, it is often too late to apply it; and then it is better to make Use of Flanels dipt in a warm Decoction of Mallow and Elder Flowers, shifting them frequently. It has been known however, that Ice-water, or Ice itself has succeeded as late as the third Day. [¹⁰²]

4, When these Endeavours are insufficient, Glysters of Tobacco Smoke must be tried, which has often redressed and returned Ruptures, when every Thing else had failed.

5, And lastly, if all these Attempts are fruitless, the Operation must be resolved on, without losing a Moment's Time; as this local Disease proves sometimes mortal in the Space of two Days; but for this Operation an excellent Surgeon is indispensably necessary. The happy Consequence with which I have ordered it, in a most desperate Case since the first Edition of this Work, on the sixth Day after a Labour, has convinced me, still more than any former Observation I had made, that the Trial of it ought never to be omitted, when other Attempts have been unavailing. It cannot even hasten the Patient's Death, which must be inevitable without it, but it rather renders that more gentle, where it might fail to prevent it. When it is performed as Mr. Levade effected it, in the Case I have just referred to, the Pain attending it is very tolerable and soon over.

I shall not attempt to describe the Operation, as I could not explain myself sufficiently to instruct an ignorant Surgeon in it; and an excellent and experienced one must be sufficiently apprized of all I could say concerning it.

A certain Woman in this Place, but now dead, had the great and impudent Temerity to attempt this Operation, and killed her Patients after the most excruciating Torments, and an Extirpation, or cutting away of the Testicle; which Quacks and ignorant Surgeons always do, but which a good Surgeon never does in this Operation. This is often the Custom too (in Country Places) of those Caitiffs, who perform this Operation without the least Necessity; and mercilessly emasculate a Multitude of Infants; whom Nature, if left to her own Conduct, or assisted only by a simple Bandage, would have perfectly cured; instead of which, they absolutely kill a great many, and deprive those of their Virility, who survive their Robbery and Violence. It were religiously to be wished such Caitiffs were to be duly, that is, severely punished; and it cannot be too much inculcated into the People, that this Operation (termed the Bubonocele) in the Manner it is performed by the best Surgeons, is not necessary; except in the Symptoms and Circumstances I have mentioned, and that the cutting off the Testicle never is so.