Rupture, or a partial protrusion of an intestine, is one of those complaints which has lately become so general, especially among the labouring classes, as to induce benevolent persons in the British metropolis to institute a society for the relief of the unfortunate poor affliet-ed with this malady, under the direction of Mr. Turnbull.
The places in which ruptures generally appear, are the groin, scrotum, upper and anterior part of the thigh, the navel, and between the abdominal muscles. The tumor most frequently consists of a portion either of the intestinal canal, or of the omentum (known by the name of caul) or sometimes even of both : though instances have occurred of the liver, stomach, spleen, bladder, etc. having formed the contents. - From the nature and situation of parts, the different species are distinguished and named : thus, a rupture is called inguinal, when situated in the groin ; but, when proceeding down to the scrotum, which is often the case, it receives the appellation of scrotal ; when occurring on the thigh, it is termed femoral; and, when the navel is the part affected, umbilical. The size of the sac varies according to the stage of the disorder : at the beginning it appears small, but by degrees increases.
Symptoms: An elastic white swelling, attended with pain, which becomes more violent on every rtion ; nausea ; vomiting; and obstruction of the bowels. When the tumor is produced by a portion of the gut, without containing any frees, the surface will be found smooth or equal; and, if comp; ed, quickly resumes its former size on removing the finger. On the contrary, when hard feces are contained in an intestinal rupture of long standing, they will be obvious from considerable inequalities. - Should a portion, both of intestine caul, be included in the sac, it will then he unequal and soft; but, if ari alone, there will be no obstruction of the bowels. The inguinal rupture begins in the groin, and gradually descends into the scrotum, or into the labia vaginae. the femoral hernia occurs more frequently in women ; and is often mistaken for the former: hence it is necessary to observe, that the tumor in the latter is, deeper; and that the ring of the abdominal muscles, which in this case lies above the swelling, in that of the inguinal kind, entirely surrounds the diseased part.
The event of this malady depends on the nature of the substance included. If the protruded parts not timely reduced, the most fatal consequences, such as stricture, inflammation, and mortification, may be apprehended; though the portion of intestine, thus strangulated, be inconsiderable; but, if the caul alone be propelled, it is seldom attended with danger; because this membrane is not of such importance in the animal economy as the viscera and intestine
Causes : As ruptures uniformly take place in consequence of local debility, it follows, that whatever may have such effect, will also occasion a protrusion of parts from their natural situation ; for instance, all violent bodily exercise, singing, crying, lifting heavy burthens, quick and sudden motions, leaping, falling, etc. every forcible compression of the abdominal viscera by too narrow garments, such as stays, or waistbands. Hence soldiers, singers, dancers, porters, and women of difficult parturition, are very subject to this malady. - In children, it often proceeds from crying, obstruction of the bowels, flatulence, and the neglect of nurses. It has also been remarked, that the inhabitants of those countries where oil forms a considerable article of diet, are exceedingly liable to ruptures.
Cure : The first object should be to reduce the protruded parts, before a strangulation takes place. For this purpose, the patient must be laid on his back ; the head being low, and the breech elevated by pillows. Warm fomentations of mild aromatic and emollient substances, such as chamomile-flowers, mallows, etc. are next to be employed ; the effects of which will be greatly promoted by injecting a decoction of similar herbs with a table spoonful or two of sweet oil. After having persevered in these applications for some time, attempts should be made to reduce the tumor by gentle pressure; and, if this prove ineffectual, greater force must be used, yet so that the operator, while he presses with the palm of his hand, may re-conduct the projecting part with his fingers, through the same aperture through which it had been protruued, closely following its. natural direction. Thus, if the hernia be in the groin or scrotum, the pressure must be made obliquely upwards and outwards ; in femoral cases, it should be performed directly upwards; and umbilical ruptures are reposed by compressing them backwards.
The greatest benefit has been derived from the application of vitriolic aether to the swelling, so as to evaporate this volatile liquor by gradually dropping it on the part affected. If the patient be of a plethoric habit, copious bleeding becomes necessary ; as it occasions relaxation, and prevents inflammation. In order to preserve the part in its natural situation, and to prevent a relapse, after it has been reduced, a sufficient degree of pressure must be applied to the ruptured spot; an object which will be most effectually attained by a spring truss. This instrument is manufactured in a superior manner by Mr. Savigny, of King-street, Co-vent-garden.
The reduction of umbilical ruptures, if timely undertaken, is mostly effected by the application of a bandage. - If, however, the treatment before stated, should not be attended with success, but the pain and other symptoms increase, recourse ought immediately to be had to a skilful surgeon ; as procrastination may render the malady incurable.