Children and old people are most liable to this disease. In the former it is generally occasioned by excessive crying, coughing, vomiting, or the like. In the latter, it is commonly the effect of blows or violent exertions of the strength, as leaping, carrying great weights, &c. In both, a relaxed habit, indolence, and an oily or very moist diet, dispose the body to this disease.
A rupture sometimes proves fatal before it is discovered. Whenever sickness, vomiting, and obstinate costiveness give reason to suspect an obstruction of the bowels, all those places where ruptures usually happen ought carefully to be examined. The protrusion of a very small part of the gut will occasion all these symptoms; and, if not returned in due time, will prove mortal.
On the first appearance of a rupture in an infant, it ought to be laid upon its back, with its head very low. While in this posture, if the gut does not return of itself, it may easily be put up by gentle pressure. After it is returned, a piece of sticking-plaster may be applied over the part, and a proper truss or bandage must be constantly worn for a considerable time. The method of making and applying these rupture-bandages for children is pretty well known. The child must, as far as possible, be kept from crying, and from all violent exertions, till the rupture is quite healed.
In adults, when the gut has been forced down with great violence, or happens from any cause to be inflamed, there is often great difficulty in returning it, and sometimes the thing is quite impracticable without an operation; a description of which is foreign to our purpose. As I have been fortunate enough, however, always to succeed in my attempts to return the gut, without having recourse to any other means than what are in the power of every man, I shall briefly mention the method which I generally pursue.
After the patient has been bled, he must be laid upon his back, with his head very low, and his breech raised high with pillows. In this situation flannel cloths wrung out of a decoction of mallows and camomile-flowers, or, if these are not at hand, of warm water, must be applied for a considerable time. A clyster made of this decoction, with a large spoonful of butter and an ounce or two of salt, may be afterwards thrown up. If these should not prove successful, recourse must be had to pressure. If the tumour be very hard, considerable force will be necessary; but it is not force alone which succeeds here. The operator, at the same time that he makes a pressure with the palms of his hand, must with his fingers artfully conduct the gut in by the same aperture through which it came out. The manner of doing this can be much easier conceived than described. Should these endeavours prove ineffectual, clysters of the smoke of tobacco may be tried. These have been often known to succeed where every other method failed.
There is reason to believe that, by persisting in the use of these, and such other means as the circumstances of the case may suggest, most hernias might be reduced without an operation. Cutting for the hernia is a nice and difficult matter. I would therefore advise surgeons to try every method of returning the gut before they have recourse to the knife. I have once and again succeeded by persevering in my endeavours, after eminent surgeons had declared the reduction of the gut impracticable without an operation[[201]].
An adult, after the gut has been returned, must wear a steel bandage. It is needless to describe this, as it may always be had ready made from the artists. Such bandages are generally uneasy to the wearer for some time, but by custom they become quite easy. No person who has had a rupture after he arrived at man’s estate should ever be without one of these bandages.
Persons who have a rupture ought carefully to avoid all violent exercise, carrying great weights, leaping, running, and the like. They should likewise avoid windy aliment and strong liquors; and should carefully guard against catching cold.
CHAP. LIII.
OF CASUALTIES.
It is certain that life, when to all appearance lost, may often, by due care, be restored. Accidents frequently prove fatal, merely because proper means are not used to counteract their effects, No person ought to be looked upon as killed by any accident, unless where the structure of the heart, brain, or some organ necessary to life, is evidently destroyed. The action of these organs may be so far impaired as even to be for some time imperceptible, when life is by no means gone. In this case, however, if the fluids be suffered to grow cold, it will be impossible to put them again in motion, even though the solids should recover their power of acting. Thus, when the motion of the lungs has been stopt by unwholesome vapour, the action of the heart by a stroke on the breast, or the functions of the brain by a blow on the head, if the person be suffered to grow cold, he will in all probability continue so; but, if the body be kept warm, as soon as the injured part has recovered its power of acting, the fluids will again begin to move, and all the vital functions will be restored.