Toy
Scarce

860


ORISE
1. Oblique Line of Action.
a
开业
​2. Place for Frufs behind
London. Published 1802
دن
3. Place for Truss before


NEW
WhoW
INVENTIONS AND DIRECTIONS,
&c. &c.

As the Profits arising from the Sale of, this
Work will be appropriated to charitable Purposes,
it has been entered at Stationers' Hall, to prevent
surreptitious Editions.
98

NEW
INVENTIONS AND DIRECTIONS
FOR
Ruptured Persons,
TEACHING THEM THE ART OF EFFECTUALLY KEEPING UP
INGUINAL AND SCROTAL RUPTURES.
BY W. H. T. Esq.
TO WHICH IS PREFIXED,
A RECOMMENDATORY LETTER
BY WILLIAM BLAIR, A.M. F.M.S.
MEMBER OF THE ROYAL COLLEGE OF SURGEONS IN LONDON, SURGEON OF THE
LOCK HOSPITAL AND ASYLUM, OF THE FINSBURY DISPENSARY, OF
THE BLOOMSBURY DISPENSARY, AND LECTURER ON THE
DISEASES AND OPERATIONS OF SURGERY.
Second Edition, with Additions.
"Non ignara mali miseris succurrere disco."
London:
PRINTED BY
VIRGIL
THOMAS COLLINS, HARVEY'S BUILDINGS, STRAND:
SOLD BY
T.HURST, PATERNOSTER-ROW; J. CALLOW, CROWN COURT,
SOHO; AND HATCHARD, No. 190, PICCADILLY.
Price Two Shillings.
1802.
[Entered at Stationers' hall.]
lavoman/Kare
Book Room
RD
73

T75
15 скоттаята аял континуи
TY
enocak damianiE
1114TOURED TO TRA AT KE DAL
CHUTANT SURO452 079 TATUAG
Ti X OPMO LAKOJA
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100 OST
0179.
in cef.og caRNETĀM UZA
grillin port in I
Ba

10
00140
PREFACE.
sidua ed
WITH painful reluctance I disturb a re-
pose necessary to an enervated constitution,
by presuming to address the world, without
even the inducement of professional fame or
emolument*: nothing could have influenced
me to appear at the bar of a public tribunal
but the magnitude of the subject, the Life of
Man, and an experimental conviction in my
own case, as well as in a great variety of
others, that the ruptured man is unneces-
sarily living miserably or dying prematurely,
from the usual construction and application
of trusses.
* I communicated my information to a truss-maker,
a man of education and understanding, lately deceased;
but, though I suffered twenty-four years
under his care,
his pride prevented him listening to me: his trusses, from
my alterations and additions, are now become perfectly
useful. I never could get him really to execute the
meaning of the word fix: my idea of it was, to sew
firmly, so as not to move.
I think

vi
PREFACE.
I think with M. LE DRAN, as quoted by
ARNAUD, “whatever tends to the preserva-
tion of the Life of Man, cannot be put in too
clear a light; and, to conceal from the world
any learning which may be useful to society, is
the same treason against the public, as to bury
a treasure. Let us avoid imitating such as are
avaricious of their knowledge, and whose
despicable jealousy would rejoice to see the
world in the darkest ignorance, for the sake
of engrossing to themselves the public con-
fidence." Le Dran, Præfat, 2. Observ. ome
I do not arrogate to myself superior intel-
ligence or powers, and candidly own my im-
provements are the result of accident and
necessity (the mother of invention), as well
as of experiment. A wearer of trusses must
have ideas that can only be obtained by wear-
ing such an instrument: a horse, could he
speak, would pronounce which was the best
saddle.
Long after my methods were executed, I
was much pleased, accidentally to find that
I had adopted the old system of firmness, and
the mode of wearing a truss, of an eminent
French

PREFACE.
vii
French Surgeon, who practised about the
year 1726; and whose work, translated from
the French, was published by MILLAR, in
the Strand, 1748, entitled A Dissertation
on Hernias or Ruptures, in two parts, by
GEORGE ARNAUD, Master of Arts and
Surgery; Member of the Royal Academy of
Surgery, at Paris; Demonstrator in the
School of St. Côme; Surgeon for Ruptures
of the Hospitals of Hôtel-Dieu; the Invalids
and Incurables of the City of Paris; and of
all the Military Hospitals in France." I was
charmed with the discovery, as I can speak in
stronger terms of the system of another; and,
being the system of a professional man, I
hoped it would attract the notice of profes-
sional men: yet, I must do myself the justice
to say, that Mons. ARNAUD'S system is com-
pletely executed by means of the calico
cushion, and which, perhaps, it could not
have been without it.
At page 194 of ARNAUD's Dissertation,
he says, "these measures ought to be divided
between the surgeon and patient, till the
truss has acquired a firm invariable situa-
tion:" my expression was, immoveable.
Page

viii
PREFACE.
Page 203, he says, "we are to observe,
whether the edge of the girdle is immediately
above the fissure of the buttocks; if it is not
so, we must carefully place it there, and the
cushion will be in the just and proper posi-
tion for stopping up the aperture of the
hernia."
Page 206, he says, "as the truss is made
to stop up the hole which gives a passage to
the parts, so it is necessary that the cushion,
(i. e. pad of the truss), should be placed di-
rectly on the hole, not under it."
I do not exactly understand Mr. ARNAUD,
when he talks about "bending the iron 'till it
fits"; but the elasticity of our modern trusses,
renders such an inquiry unnecessary.
From the number of impositions that have
appeared in the world, on the subject of
Rupture, one's mind is almost paralysed. I
owe too much respect to the world and myself
to trifle; I will assert, therefore, from my
own experience and that of others, of all
ranks, that during the most laborious exer-
tions,

PREFACE.
ix
tions, my instructions being observed, a re-
ducibly ruptured patient, (the vertebræ and
pelvis being naturally formed), may be as free
from pain or danger, either from the disease*
or the instrument, as if he had no complaint
at all.
Where the back is quite straight, and no
projection of the posteriors, or of the lower
hip-bones, (the great trochanters), I will not
say but the truss may slip; yet, even in such
a case, it has succeeded. Where men are
formed in the usual manner, I aver that it can-
not move.
I have the honour to inform the public,
my methods have been adopted, after an in-
vestigation as to fact, with that liberality of
sentiment that ever accompanies great minds,
by some of the first medical characters in the
metropolis.
I fear my wish to be completely under-
stood has produced some tautology.
Agreeably to the suggestion of the Editor
of the British Critic-indeed the liberal and
b
handsome

PREFACE.
handsome observations of our public Journa-
lists encouraged me to proceeda truss and
the calico cushion are left at Mr. HURST'S
and Mr. HATCHARD's, for public inspection,
who have had the goodness to take that trou-
ble; also, a truss which has been in use near
twenty years, and which once was useless.
Let the effect of the buckle on the pad be
observed; it is marked and worn by the
thigh strap pulling against it, when the abdo-
men pressed forward or downward.
The profits, if any accrue, of all the edi-
tions of this publication, will be expended
in trusses for the benefit of a public charity.
Obvious circumstances of delicacy prevent
me from putting more than the initials of my
name to this publication; but, that the pub-
lic may know something of the man who ad
dresses them, let the egotism be excused, as
credibility is properly attached to situations
in life. He begs leave, therefore, to observe,
that he is a private gentleman, of easy fortune,"
and of landed property, having many years
had the honor of holding a captain's com-
mission in the militia of this country.
To conclude,

PREFACE.
xi
18.10
To conclude, in the words of ARNAUD,
"I have, with great diligence, communicated
to the public whatever my particular appli
cation has enabled me to discover".
W. H. T.
子 ​duroy blow talt bosouro ored ney d
-
quoy to total rammed 1:33aman ymsen ei no
viving silheol dreninge a toy endlecys
Opole
Jeshold those in ja.
COPY OF

ferences
xii 28
COPY OF A
RECOMMENDATORY
LETTER TO THE AUTHOR,
DEAR SIR,
FROM
WILLIAM BLAIR, Esq.
SURGEON OF THE LOCK HOSPITAL AND ASYLUM,
&c. &c. &c.
OCT. 31, 1801.
Great Russel Street,
Bloomsbury Square.
I THINK myself honoured by
the wish you have expressed, that I would permit
you to use my name as a recommendation of your
pamphlet; but I am not quite reconciled to the
idea of appearing very prominent, lest the purity
of my motives should be questioned,
I have several times employed the trusses as
recommended by you, which admirably, well
answered my wishes; and I have even found your
calico pads alone, when applied to an old worn-
out truss, produce the most decided advantages,
in keeping up a Rupture of long standing.
The

XIII
The principal benefit I have derived from your
instructions and friendly intercourse, has been in
the mode of applying the truss, not obliquely as
is usual, but after the manner described by
MONS. ARNAUD; so that the line formed by the
hoop or spring is exactly in a circular direction.
The trouble you have taken, in order to the
revival of this method, does you great credit; and
the publication of it must prove useful to un-
prejudiced persons, who will fairly make the
experiment,
I know your intention to be honourable and
disinterested, in thus stepping forward to serve
your afflicted fellow-creatures. If you cannot
persuade yourself to put your own name to the
next edition of your pamphlet, I do not decline
to afford it my feeble sanction, by permitting the
insertion of this letter; but I hope you will see
the propriety of informing the public to whose
benevolent exertions they are indebted for so
useful a treatise.
With due respect
To W. H. T. Esq.
I remain, DEAR SIR,
Your obliged Friend,
WILLIAM BLAIR.

CONTENTS.
PREFACE
Copy of a Recommendatory Letter from
WILLIAM BLAIR, ESQ. to the Author
CHAPTER I.
A Letter of Preliminary Instructions to a
Ruptured Patient
CHAPTER II.
The Author's Case
CHAPTER III.
The Modes of Reducing a Rupture
CHAPTER IV.
4
On the Construction of a Truss
CHAPTER V.
The Description and Uses of a Cushion of
Coarse Calico
Page
V
xii
17
22
26
29
33
CHAP.

CONTENTS.
V
On the Mode of Wearing the Truss, for an
Inguinal or Scrotal Rupture
CHAPTER VI.
ments
Cautions against Dumb Bells
9
CHAPTER VII.
CHAPTER VIII.
A Recapitulation of the Author's Improve-
CHAPTER IX.
On the Permanent Cure of Ruptures.
CHAPTER X.
On the Phenomena of Ruptures
CHAPTER XI.
Military, Parochial, and Hospital Consider-
ations, on Ruptures
Postscript
Page
37
40
41
43
47
49
51
NEW

SUPTATIO
Ou iye Lesponent Que
fle
う
​brogea

NEW INVENTIONS,
&c. &c.
CHAPTER I.
A LETTER OF PRELIMINARY INSTRUC-
TIONS TO A RUPTURED PATIENT.
FROM
ROM its great ease and convenience both
to the writer and reader, I adopt the epis-
tolary form. I therefore, Sir, hope to give
you such clear instructions, as will enable
you to be comfortable, if the Rupture is re-
ducible. Your wonder will cease at my suc-
cess, in keeping up Ruptures, when I tell
you the reason; which is, that my method
really inflicts that firm pressure, which the
usual mode could not do in a sufficient
degree. Above the groin of every human
being is a small aperture through which the
B
intestine

18
intestine may descend, and which you must
learn to reduce; that is, return to its place
whatever comes down, agreeably to these
instructions. (See chap. 3.)
2dly. Then, under the pad of the truss is
to be worn a calico roller or cushion, (See
chap. 5). The rough edges of this cushion are
to be worn upwards and downwards; and it is
to be about a quarter of an inch broader than
the pad of the truss, except the side next the
thigh.
3dly. As to the method of wearing the
truss, (See chap. 6). Place the lower edge of
the hoop part of the truss as low down behind
as the division of the posteriors, but no
lower, (See fig. 2). Put it straight round
the body, pull it as tight as possible: it will
lodge on and above the lower hip bone, and
remain in its place on the aperture. If you
be already in possession of a truss, wear it
as above; for it must be a bad truss indeed,
that will not then, with the calico cushion,
keep up a Rupture: but with a thigh strap
fixed to the hoop, and a buckle at the bot-
tom of the pad, the Rupture cannot descend.
The
18023

19
The thigh strap should be sewn to the hoop
part after being fitted on, about one inch
behind the lower hip bone, (the great tro-
chanter). I wish you to understand how
necessary this is to be done, and why the thigh
strap sewn fast to the hoop at (a) should
keep up the Rupture. It is, because when
the belly pushes against the pad under (b),
the sewing at (a) draws (b) close to the
body.
Patients generally think-
First, That the truss will drop off.
Secondly, That they are bound so tight
they cannot walk. But,
Thirdly, In a short time they exclaim-I
feel well! I feel no Rupture!
Be assured, in a reducible case, if success
does not attend you, the only cause that a
failure can be attributed to is, the want of a
literal, full, and accurate attention to my in-
structions. I also subjoin some general di-
rections for the ruptured:
The patient should have two trusses in his
B 2
possession

20
possession fit for use.
He should never,
night or day, be without his truss on: for a
cough in the night might produce a fatal
descent and stricture; and by permitting the
Rupture to descend, Nature has no chance
of recovering the power of retaining the parts
in their position.
He should, as soon as the complaint comes
on, obtain medical advice; and lose no time,
as by delay adhesions may be formed, which
might have been prevented. The patient him-
self should learn to sew the thigh strap to the
hoop part, and have by him more straps and
calico cushions than trusses.
All persons, even those who are not rup-
tured, should, when riding on horseback,
wear leathern breeches; as they keep the in-
testines in a state of quietude, therefore are
less likely to become ruptured from violent
exertions.
The utmost caution is necessary, to observe
that the Rupture is reduced before the truss
be put on, or much harm, even death itself,
emight

21
might ensue; and, in young males, the situa-
tion of the testes must also be attended to.
A double truss, even for a single Rupture,
is preferable; it sits as easy as a single one,
and perhaps, might prevent a Rupture on the
sound side.
In all cases where trusses are provided, a
skilful surgeon ought to examine the patients
and apply the trusses; for many instances
have occurred of people wearing them, who
never had a Rupture, and of others who,
though ruptured, received no benefit for
want of careful management in the application
of the trusses they employed.
Females afflicted with reducible Ruptures
in the groin, have adopted the methods here
described, and with the usual success, though
engaged in the most laborious work.
CHAP.

22
CHAPTER II.
THE AUTHOR'S CASE.
co
my case
In
I CONC
CONCEIVE that a plain recital of
and habits will elucidate my methods.
every part of this publication the reader will
recollect, that all the observations are founded
on facts within my own case, or the cases of
others; and I believe it will appear, that
these instructions are necessary to be known
by the ruptured.
My Rupture is of that species called hernia
congenita. At the age of twenty-two, (twenty-
eight years ago), while riding on horseback,
both the omentum and intestine descended
into the tunica vaginalis testis, and was there
incarcerated many hours with dreadful
agony.
My surgeon in the country, who reduced it,
sent me to a truss-maker in London, and
who

23-
who was one of the best: he made an excel-
lent formed truss. The late eminent Mr.
PERCIVAL POTT, Surgeon, to whom the
world will ever be indebted, inspected the
Rupture.
I found the truss of little use; the thigh
strap, which was of cotton, was not fixed to
the hoop, but it hitched on a brass knob and
constantly slipped off. On the most trifling
exercise the Rupture descended; half my
time was consumed in reducing it, and often
in great pain. Above twenty times I have
felt all the agonies of a strangulated gut, par-
ticularly about four years ago in Dublin, ex-
pecting my death for two days, and preferring
that to the surgical operation,
Nausea, sweats, shiverings, cramps in the
legs ensued; death was my only prospect-
when suddenly and unexpectedly, from the
applications used by my surgeon, the Rup-
ture became reducible; and, as far as I am
able to form an opinion, a novel case happily
for me occurred: and the irritation has, as
far as I can judge, detached the omentum
from the testis.
The

24
The omentum is now reducible; and since
my improvements were made the Rupture
never descends, except when the truss is re-
moved, and then it comes down to a great
size. So powerful are the combined effects
of these improvements, that with safety I have
performed the most violent exertions on foot
and horseback; ascending and descending
the steps of the monument with designed ra-
pidity; leaping over hedges, &c. for expe-
riment, before I addressed the public.
From the same cause, the same happy con-
sequences have attended even a printer, wea-
ver, porter, and other labouring men, of all
ages. I wear this double truss with a steel
spring night and day, without inconvenience;
and from its immoveable position and use,
happily forget both the complaint and the
truss. For years, I laboured under, at times,
the most excruciating pains from swelled
testes; the cause then did not occur to me:
these pains were produced by the hard part
of the truss injuring the spermatic vessels.
A repetition of these dreadful pains from a
rough journey in a mail coach opened my
eyes,

25
eyes, about three years since; and, from an
idea accidentally communicated to me, I
adopted the use of, and by various experi-
ments brought to perfection, the calico cu-
shion, since which time the pains in the testes
have ceased. Twenty years ago I attempted
my plan of immoveability; but did not suc-
ceed, the spermatic chords being unpro-
tected.
I should observe, that some of the same
trusses which were useless to me before the
improvements were used, are now quite ef
fectual.
puodyb
domaso Agio 16 dar
dog noon ries
dil
ad or dead tamplis
tom odi fo baad of brolley
419.61
CHAP.

26
oil baconic stay di spedis
CHAPTER III.
edgword anom
mudbals pre noul
என்
THE MODES OF REDUCING A RUPTURE..
Que son in the
orpen grad
bosons
IN
N cases of strangulated intestine, or of
stricture, the patient should lay on the side
of his body contrary to that on which the
Rupture is; by which position, there must
be a lateral recession of pressure from the
aperture, which will give ease when the in-
testine or omentum cannot from inflamma-
tion return through the aperture *.
Another position, in cases of difficulty is,
to lay upon a chair with its back on the floor,
the patients' heels to be placed against the
wall, and his head on the ground.
* I am indebted to Mr. MORFIE, Surgeon, of Dublin,
for this idea.
Let

27-
Let the breath be held in before an at-
tempt is made to reduce the bowel; the
acts of breathing and speaking contribute to
force down a Rupture.
Cover the fingers with the shirt or hand-
kerchief, by which means the Rupture is
gathered up with more certainty and dispatch.
mide ad div pul adi svol
To render the practice easy to every one,
I use the expression knead the bowel up-
wards through the aperture, as dough is
kneaded*; but during a state of inflamma-
tion, press upon the intestines very gently,
if at all.
dgids edi ebau, qenia digids te weza
By comparing the ruptured side of the
body with the sound side, it may be seen
and felt when the Rupture is reduced.
Method makes every thing easy, therefore
observe the following directions in the order
in which they are placed:
*In the act of kneading, the fingers are to be ex-
tended and drawn forwards, gently and shortly.
TARO
C2
1. Lay

28
56
Motion
And
1. Lay down. The head is to be low-
ered, and the heels to be drawn up, or the
knees to be raised.
8 ob 9910)
DANS
2. Hold in the breath.
ww vd Jabbas
io di qe bardise
4. Cover the fingers with the shirt or
handkerchief.
3. Be perfectly silent.
bregal
arb
5. Knead up the Rupture.
erli sas I
GI NHÀ T
aud
6. Put on the cushion and truss.
7. Draw the thigh strap under the thigh
very tight, and buckle it to the pad.
spoodle en vari doide m
CHAP.

29
of gach dal
od in CHAPTER IV. affig
dgint of
ON THE CONSTRUCTION OF A. TRUSS.
tove togool bus
26
moned si no f
grila
medies beg oth to the
THE
HE pad should be broad and flattened,
though not entirely flat. A pad of this kind
causes more pressure than those which have
a round elevation in the centre, from a false
idea of producing pressure into the aperture;
and the neck of the pad should be short, for
if it be so long as to lay on the thigh, the truss
would move, and the Rupture descend. A
short necked truss will lay in the hollow of
the groin.
825012
The hoop or spring part of the truss must
be formed in an exact circular line with the
pad.
Not much edging of leather should project
from the hoop of the truss, nor any quilting
or stuffing.
The

30
The thigh strap to be made of wash-lea
ther, lined with moderately thick tape, to
prevent its stretching; the end adjoining the
buckle to be of neat's leather. The thigh
strap to be sewn with strong double thread.
well waxed, to the hoop part of the truss,
and looped over it: by this fixture of the
thigh strap*, pressure will act on the bottom
part of the pad of the truss. (See plate, fig.
2. a. b.) borded Livone beq qu
dovods
The bottom part of the pad of the truss is
one part that stops the aperture: I have in-
vented a double-tongued buckle, instead of
the lower brass knob; this buckle draws and
fixes the bottom of the truss close to the
abdomen---there should be a groove in the
buckle for the tonguest bloom node
su
* I must repeat, that the thigh strap, from its importance,
cannot be sewn to the hoop part of the truss 'till after the
truss has been fitted on; then sew it nearly one inch be-
hind the lower hip bone, or the great trochanter, which
projects below the thigh joint.
beq
+ It is material that the tongues should be out of the way:
nothing would be better than buckles with inverted
tongues, i. e. on the inside, agreeably to the plan of
JACKSON'S patent knee-buckle.
Any

31
Any truss, (constructed contrary to the
above directions), will fail of keeping up a
Rupture with certainty. bad to lub
org of antolon gniston gates lead bird
The double-tongued buckle is to be placed.
on the pad, in such a manner, as to have
effect; the cross front strap should be lined
and edged, which adds to its power.
In all and every part of the truss, in its
sewing, its straps, its appendages, observe
only one idea, and execute it: let there be
ACTION, and materials of the best quality.
The dangers of a circular steel spring
have been mentioned: a truss cannot have
proper effect without a steel spring; it is not
the spring, but the hard part of the pad of
the truss that is dangerous, and has ruined
many a man*.
The
* There are cases, in which, I think, a steel spring
cannot be used without danger; but those cases, I be-
lieve, exist only in infants or very young persons, whose
bones are soft, and the body in a rapid state of increasing
bulk from growth. In these cases it is highly desirable
to try the effect of a leathern girdle with the pad, as
usual;

32
The double truss should be united behind
by a double-tongued buckle and strap, to let
out or take in; and not formed in one horrid
hard steel spring, cutting the loins to pieces.
Joob sty
usual; this being applied straight round the body as di-
rected, and with the calico cushion, perhaps, might keep
up a Rupture.
In adults, the steel spring seems to me highly neces-
sary, and it can do no harm. I do not think that, to per-
form the usual exercises of life, there can be compression
and power enough without a steel spring; but, I cannot
positively decide without a trial.
Paleis
CHAP.

33
tellit vis CHAPTER V.ral wolle
THE DESCRIPTION AND USES OF A CU-
SHION OF COARSE CALICO, WITH IN-
STRUCTIONS HOW TO FORM IT.
CUT
UT or tear a slip of coarse calico*, about
twelve inches in length. Form it into a square,
of a size that it will project a quarter of an
inch round the edges of the pad of the truss,
except that end next the thigh; but, having
no projection beyond the neck of the pad:
the rough edges are to be upwards and
downwards; then tightly fold over, the first
slip many others. For a grown person,
the thickness should be about three-quar-
ters of an inch: there is more danger of
forming this cushion too thin than too
* About 1s. or 14d. per yard.
D
thick:

34
thick; its thickness or thinness must de-
pend on the size of the patient. When the
hollow in the groin is completely filled up
by it, and it remains immoveable under the
pad of the truss, it is then of a proper size.
This calico cushion is to be worn under
the pads of the truss; the outer slip or two of
which may be changed at pleasure, for the
purpose of cleanliness, or restoring the cu-
shion to a proper degree of thickness. This
cushion, judiciously made, will, even with a
bad truss, most materially assist in keeping
up a reducible Rupture; and, with a truss
made and used according to the directions of
the Author, aided by his other improvements,
will render the descent of a reducible Rup-
ture, impossible. Where the omentum is
not reducible, the application of this cushion
is much preferable to the usual mode, by af-
fording it protection from the injuries of
pressure.
Its various and beneficial properties are
immense; and would appear wonderful, if
not explained:
First,

€35
First, It protects the spermatic vessels from
being injured by the hard pad of the truss,
which injury often produces hydrocele, in-
flammation of the spermatic vessels, hernia
humoralis, &c.
Secondly, By protecting the spermatic
vessels from the injuries of pressure, it pro-
duces a desideratum never before obtained.
It enables the patient to girt the truss round
the body with such an effective degree of
tightness, that the Rupture cannot descend.
Thirdly, By uniting the properties of soft-
ness and solidity, it yields to the form of the ab-
domen; and thus completely fills up the
aperture or ring in the abdominal muscles,
through which the Rupture descends.
Fourthly, It is an additional column of
pressure; and the truss being tightly fastened,
keeps the omentum and intestines all round
and above the aperture, in such a state of
quietude, that it lessens their power in de-
scent and they are therefore less likely to
protrude; on the plain mechanical position,
that the smaller degree of force with which a
D 2
body

36
body moves, the smaller force it possesses at
the end of its action.
Fifthly, It elevates the pad part of the truss
to the line of elastic action with the hoop part,
and thereby preserves and enforces its elas-
ticity, retaining the truss in a state of perma-
nent effect.
Lastly, On the tight application of this
cushion, the patient is also relieved from all
rumbling pains arising from the internal and
partial descent of the Rupture, and from its
combined qualities we accomplish the most
difficult attainments; being enabled to inflict
pressure on substances naturally too tender
to bear pressure, and thereby enforce a sys-
tem of immoveability; without the adoption
of which, the use of all trusses are inefficacious.
It is necessary to add, that neither fine,
old, nor washed linen, will have the desired
effect; and a cushion after use, having ac-
quired its form, is better than a new one.
Its edges should be occasionally clipped; and
the cushion should be formed of separate
slips, as before directed, to be folded over
each other.
CHAP.

37
CHAPTER VI.
ON THE MODE OF WEARING THE TRUSS,
FOR AN INGUINAL OR SCROTAL
RUPTURE.
TH
HE art of putting a truss on the human
body has appeared so easy, as not to be con-
sidered as an art.
The immutable laws of motion were not
adopted in the usual mode of wearing the
truss: it was the custom to raise the spiral hoop
part on the hips, (See plate, fig. 1.), several
inches higher than the pad part; by which
method, a false and oblique line of action was
adopted, and of course, a small pressure on
the aperture*. The hinder part of the truss
* In like manner, if the bandage put round the arm after
bleeding, was to be placed one part of it disproporti-
onately higher than the other, there would not be suffi-
cient pressure to keep the compress on the orifice of
the vein, and the patient might bleed to death..
was

38
was always put very many inches too high.
The following mode is adapted for Ruptures
in the groin: (See plate, fig. 2. 3.)
Place the hind part of the hoop of the truss
as low down*, as the fissure or division of
the posteriors, but not lower; continue the
hoop part or parts in an exact circular line
round the body, (the spring of the truss be-
ing made in a circular line). This mode, the
edge of the hoop lodging on, over, and above
the great trochanter, and below the margin of
the hip-bone, will keep the pad or pads of the
truss on the apertures; producing to the
wearer the most effective action, and re-
moving the truss from a painful, galling,
moveable situation to an easy, comfortable,
and immoveable one.
But it is necessary to unite all the improve-
ments here suggested, to produce entire safety
and effect, most particularly by strong sewing
the thigh stap to the hoop part of the truss;
then draw this strap as tight and close as pos-
sible round the thigh to the buckle on the pad
* Agreeably to Mr. ARNAUD's own directions and
words.
of

39
ال
of the truss tightness of girting decreases,
rather than causes the galling, by lessening
friction.
Another advantage which arises from this
mode of wearing the truss is, that it will
not be seen.
When the double truss is put on as it ought,
it should be pulled so very tight* as to make
the flesh, between the two pads, rise to the
thickness of the fore-finger. There will
be no pain; for the pressure is only where it
ought to be, on the pad or pads of the truss.
The single truss should be pulled as tight
as possible; the cushion enables it so to be
done, and two brass knobs should be inva-
riably on the upper part of every truss.
Patients, whose Ruptures could not be
kept up, and who had, for above twenty
years, tried all kinds of trusses, are now by
this plan completely comfortable, and per-
form all exercises.
Co
gahib
Howe
* The hinder strap also, that unites the two parts of
the truss, should be properly tightened, and kept so.
CHAP.

40
CHAPTER VII.
gdi lo
rober
001
Jon
CAUTIONS AGAINST DUMB BELLS.
Steg
I
MUST point out one possible cause of
Rupture, both inguinal and umbilical; I
mean dumb bells, which are also used both in
our armies and our boarding schools, for the
purposes of expanding the chest, or obtaining
exercise within doors. One case of a gentle-
man came to my knowledge, who became
ruptured in the act of using dumb bells, which
caused these observations. Let their violent
action on the body be observed, and their
possible effect is obvious. I hope this cau-
tion will either banish the use of them from
our armies and schools; or, at least, put per-
sons on their guard, in having recourse to
such dangerous bodily exertions.
CHAP.

41
CHAPTER VIII.
A RECAPITULATION OF THE AUTHOR'S
IMPROVEMENTS.
No.
1. THE fixture of the thigh strap to the
hoop* part of the truss, invented by the Au-
thor twenty years ago.
oing
2. A buckle and its double tongue on the
pad +, with a groove for the tongues, instead
of a brass knob.
3. The mode of applying the thigh
strap.
4. The calico cushion.
5. The mode of wearing the truss.
6. The application of the laws of motion.
* See plate, fig. 2, (a).
E
+ See plate, fig. 3, (b).
CHAP.

42
EXPLANATION OF THEIR USES.
No.
1. THE strap draws and fixes the lower
part of the pad of the truss to the body, and
which lower part keeps up the Rupture.
2. It fixes the pad against the body.
3. It draws the thigh strap close to the
flesh, thereby enforces actions of No. 1 and 2.
4. See Chapter V.
5. Exchanges pain, inutility, and movea-
bility, for ease, utility, and immoveability.
6. Produces mechanical effect.
edures stars to show of
nomom to mid sa te roussigasof d
CHAP.

43
lostboy a zhpowrot z
400's our badzin
and condo CHAPTER IX.
313552
48802
ar vienu? vlich aneque
ON THE PERMANENT CURE OF RUP-
dogshred ba TURES.
o bellug one anolobore bus toog and
$2990 na mor
nespoil de bashar jo
I SH
SHALL not presume to give my own opi-
nion on this subject, but most seriously re-
commend to the perusal of the ruptured some
few quotations; and request they will recol-
lect, that they were the opinions of one of the
first surgeons in Europe, the late PERCI-
VAL POTT, Esq. of St. Bartholomew's Hos-
pital. I must remind the ruptured man,
that, as if his complaint did not make him
sufficiently miserable, he has been in all ages,
and yet is, a marked character for depreda-
tion, by all sorts of unprincipled personages.
o grillist den svar
The doctrine of the cure of Ruptures is a
mine of wealth to the Rupture-monger, and
of plunder and misery to the patient.-Mr.
POTT says, in his Treatise on Ruptures,
E 2
Sect.

44
Sect. 13, Attempts towards a radical Cure-
"No disease has ever furnished such a con-
stant succession of quacks as Ruptures have.
"Our present newspapers daily supply us
with a number of the lesser dealers in specific
medicines and new-invented bandages, by
which the poor and credulous are gulled out
of what little money they can spare. Opera-
tive quackery is not indeed so frequent, or
so readily submitted to; but I wish I could
say, that more than one life has not been de-
stroyed in our time, by attempts to form and
support the character of an operator in this
disease. To this kind of hazard the poor are
luckily not so liable, as it can only be worth
the while of these Rupture doctors to MUR-
DER those who have before hand been sim-
ple enough to pay them well for it.
Sang vhnoroillus
"I have already said, that to replace the
prolapsed body or bodies within the cavity
of the belly, and to prevent their falling out
again, by means of a proper bandage, is all
that the art of surgery is capable of doing in
this disease. Whether Nature will be capa-
ble of so contracting the part as to prohibit
a future

45
a future descent or not, is a matter of great
uncertainty, and which can be known only
from the event.ad zhomsi ber
anded asholdetnams to email
to
"This is a subject in which mankind are
much interested, and on which a good deal
might be said; but, as an honest attempt to
save the afflicted from the hands of those who
have no character to lose, and whose only
point is money, might, from one of the pro-
fession, be construed into malevolence and
craft, I will not enter into it; but shall con-
clude, by wishing that they who have capa-
city to judge of these matters, (which are as
much the objects of common sense as any
other kind of knowledge), would not suffer
themselves to be deluded by the impudent as-
sertions of any charlatans whatever; but de-
termine in this, as they do in many other
things, that is, by the event.
diy bozos qu bol
"In short, if they who have so much cre-
dulity as to be inclined to believe and trust
these lying impostors, would only defer the
payment of them till they had completed
their promises, the fallacy would soon be at
an end."
The

46
sato Srd ar-
The ruptured patient goes unrelieved from
patentee to patentee, from truss-maker to
truss-maker, and laments his wretched Rup-
ture; when the only lamentable fact is, he has
a wretched truss, more wretchedly put on.
Lash
s doute co bus bstgemi Soun
In the reign of King George the First or
Second, the parliament granted five thou-
sand pounds to a pretended curer of Rup-
tures; yet Queen Caroline, (see Lord Or-
ford's letters) lived wretched, and died of a
Rupture, d
one con dhe I find
der vd shelb
I must quote from the ingenious Mr.
White's Antiquities of Selborne, in Hamp-
shire, an anecdote he there relates, of a rustic
mode of curing Ruptures in children!" At
Tring, in Hertfordshire, a young ash tree is
sawn partly in two, the ruptured child is
drawn nine times through the middle of the
tree, which is then closed up, covered with
clay, and tied together; if the tree lives,
the child is to be cured of its malady."vlb
aryl cas
I have heard of the same judicious method
in other places. dallal on
eximiorgiods
babe
CHAP:
4

47
moto de bailschend to
Supaon
won
STOR
CHAPTER X.
ON THE PHENOMENA OF RUPTURES.
I
CALL the phenomena of Ruptures those
events that are not to be easily accounted for.
A Rupture will sometimes cure itself; that
is, the intestine will resume its position and
health, even in adults, without any apparent
cause; as happened to myself, on the right
side, twenty-four years ago, and also to a
friend of mine. I have heard of other similar
cases; but no man can reasonably expect
such an event, and remain indifferent with
his disorder.
A Rupture may have a proneness of de-
scent for weeks together, the patient in equal
health, and using no exertion but walking
across a room; and yet, at other times; it
will keep up, though exertion is used, and
the same trusses on.
A Rup-

48
A Rupture unattached, either of the intes-
tines or omentum, will, sometimes, most sud-
denly recede into its place, without any
assistance from the patient. This is more
especially apt to occur, immediately after a
violent looseness of the bowels.
CHAP.

49
omu.om smo ni xohing, I di corldzes ba
Inst 1 and
zpoffle terre CHAPTER XI.
shq
12eings arlyd
MILITARY, PAROCHIAL, AND HOSPITAL
CONSIDERATIONS, ON RUPTURES.
Cou
ons
nsas tragibnjing dede bus ans
norbins here
aid mod heal
T
Ir is to be wished, that ruptured soldiers,
when discharged from the army, should be
furnished with trusses, even at their own ex-
pence. The stoppages of a few shillings for
that purpose, might save them much future
pain and misery.
It is to be lamented, in a country peculiar
for its humanity and wisdom, that the indi-
gent, who are ruptured, should suffer merely
from want of due exertion in their behalf.
That a fellow-creature should languish for
years and become burthensome to his parish,
because a few shillings are not expended in
a truss, is most absurd, as well as cruel.
F
The

50
The parishes in London, in some measure,
provide trusses for their poor; but I fear,
that in the country, many parochial officers
know not what a Rupture is, and the rup-
tured wretch only knows by his agonies. I
wish in every parish in England there was a
charitable subscription to furnish trusses,
and to have them ready for their own poor or
their children; and, that an indigent man
could as easily get a truss, as a loaf, from his
parish officers.
It would be highly useful, if the well-dis-
posed would leave legacies to those of our
hospitals-St. Bartholomew, St. Thomas,
Middlesex, &c. &c.--that receive ruptured
patients in cases of strangulated hernia, for
the specific purpose of buying trusses: one
hundred pounds only, would do much good.
The hospitals can maintain the patients, but
not provide them with trusses, from the na-
ture of their establishment.
moit
I knew a woman who had endured the
operation, and other instances of patients, who
were obliged to be discharged without trusses;
for

51
for want of which, after a single day's la-
bour, they might have been in the same mi-
serable situation again.
POSTSCRIPT.
454
THE author accidentally omitted
to mention that a specimen of his trusses may be
seen by any medical gentleman, at Mr. J. CALLOW's,
BOOKSELLER, CROWN COURT, SOно; who will also
take the trouble of referring persons that desire
it, to a truss-maker of ability, who is acquainted
with the author's inventions and directions.
THE END.
LONDON,
December, 1801.
PRINTED BY
THOMAS COLLINS, No. 1, HARVEY'S BUILDINGS, STRAND.

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