3/3
m/?
soweto
Family references 1/X X, XI, X, X, XI
361
XXI XXV
ChIP
33

$300
Raymond Russell.
3-100-29
Rave



DIEU
HON
MON DRO
MA
--
PENS
EMINE LKINGS PATENT
T SHELDRAKE!
N°50
Carter Del!
Medland Se
Truss Maker to the Westminster Hospital, & Marylebone Infirmary.
No 50, STRAND, LONDON.

USEFUL HINTS
TO THOSE WHO ARE
AFFLICTED
WITH
RUPTURES;
ON THE
NATURE, CURE, AND CONSEQUENCES OF
THE DISEASE;
AND ON THE
EMPIRICAL PRACTICES
OF THE
PRESENT DAY.
By T. SHELDRAKE,
TRUSS-MAKER TO THE WESTMINSTER HOSPITAL
LONDON:
Printed for the Author, and sold at his House, No. 50, in the Strand; and by
his Agent, W. HALLIDAY, Arran Quay, Dublin.
1803.
Book Room
RD
23

18
554
50
27
JUN 130
ONE QEW FROUS 2
CECOCIETA
Printed by Cox, Son, and Baylis,
Great Queen-Street.

TO
JOHN HEAVISIDE, Esa.
SURGEON EXTRAORDINARY TO THE KING,
F. R. S. F. S. A. &c. &c.
To whom any attempt to establish rational Princi-
ciples of treating a Disease, that has been too
much abandoned to the Practices of Quackery,
will prove acceptable,
THIS WORK IS,
(BY HIS PERMISSION)
Dedicated by
His most obliged, and most obedient Servant,
No. 50, Strand,
May 1st, 1803.
THE AUTHOR.

SOIRIVARE MHOM
CAPCFOX EXURYOFDIA EN LO AND KING'
33
Joan fanciter delidadeo & exements pus code of
our need and in
ceseda s gatser to alab
Ied of Denchards
Descburda dönen
erong hiw
posu
Dros par
Bispose of Ordere
2Z0w UT
C

2843284
200 20
PREFACE.
THE following observations were composed for the infor-
mation of those whose knowledge of ruptures was limited to
the fact that they themselves were afflicted with the dis-
ease. Such may generally be divided into two classes,
viz. those to whom the disease is an object of terror, and
those who think it is of no consequence: the former tor-
ment themselves with needless apprehensions, and embitter
their lives with perpetual anxiety to avoid evils that are
created by their own imaginations; while the latter fre-
quently betray themselves into imminent danger by their
imprudent negligence.
To re-assure the one, to caution the other, and to
point out to both the only course that will place them in
safety from the effects of this disease, are the objects
which, it is hoped, may, possibly, be effected by this publi-
cation. It contains what may be called a popular account
of the disease, i. e. such an account as professional men
will allow to be true, and patients may understand, without
possessing that information which professional men have on
the subject.
On the radical cure of the disease it was not necessary
to enlarge much, because that subject is so well under-
stood, the opinions of intelligent professional men are so
firmly established, and the attempts to perform the radical
cure are so generally avoided, even by empirics, that it
scarcely seemed necessary to enter into that part of the
subject; but, as a disposition has been manifested to revive
some exploded doctrines on the radical cure, it was thought
right, in a work of this nature, to lay some of the well-
known opinions upon that subject before the reader. Those
which have been selected are either from Mr. Pott, whose
authority on the subject is now become classical, or are
similar

vi
similar to his, where it has not been thought necessary to
adopt his own words.
PREFACE.
On the palliative cure, a different system has been,
necessarily, pursued. As the palliative cure of a rupture is
effected by the application of a truss, a very wide field is
at once opened for investigation. The pretenders to new
invented trusses are the principal empirics who lay siege to
the credulity of ruptured patients in the present day: all
of them pretend to unrivalled excellence, and infallible
success; most of them have their vouchers, and some have
their patrons, who use not the most justifiable means to
puff their favourite nostrum into notice; and, where such
artifices are practised, it would be singular indeed if the
unwary were not sometimes deceived. From a knowledge
of these truths, it has been thought right to discuss the
general principles on which trusses should be constructed,
and to investigate the actual merits of those which are most
obtrusively forced upon the public notice. The conse-
quences of this investigation cannot be equally honourable
to all; yet, if it is fairly conducted, it may ultimately pro-
cure to each that portion of approbation which it will be
found to deserve.
In thus destroying the absurd pretensions of many to
infallible success upon this subject, I have no contre-projet
to set up in their stead. I am convinced that almost every
rupture requires a truss to be adapted to its own peculiar
circumstances, and which, of course, would be improper if
applied to another rupture, under different circumstances.
The existence of this axiom, when it is understood, will at
once prove that the construction, adaptation, and applica-
tion of a truss, is as much an effort of professional skill as
the application of any effectual remedy to any other disease:
there is the same room for exerting superior skill on one side,
and the same opportunity of doing mischief through the
rashness of ignorance on the other, as in the treatment of
any other disease. Whenever this axiom shall be generally
acknowledged, a field will be opened for men of talents and
education to engage in the practice of this employment, which
is now too frequently abandoned to workmen of the lowest
description. If I should succeed in doing this, the satisfac-
tion of contributing to establish a rational practice, on the
destruction of one species of injurious quackery, will amply
compensate for the trouble it may cost me.
Besides

PREFACE.
Vii
Besides investigating, in a general way, the princi-
ples on which trusses are applied to produce their effect, I
have attempted to ascertain, to what kind of ruptures pe-
culiar species of trusses may be best applied. This at-
tempt must, from the nature of the subject, be imperfect;
but, I trust, so much has been said as will demonstrate that
no one kind of truss can be applicable to all ruptures indis-
criminately; and this demonstration will prove the absurd
pretensions, and mischievous tendency of trusting on this
subject to that description of persons, who, having acquired
the knack of making trusses in some particular manner,
apply those trusses indiscriminately to every patient who
comes in their way.
Works like this generally fall into the hands of those
who do not apply regularly for professional advice. To
make it useful to this description of readers, I have inserted
such information as can, without impropriety, be given in
writing with respect to the patient's management of him-
self, and the application of the truss. Much advice of this
kind must be varied according to circumstances, and adapt-
ed to individual cases; yet, as a kind of general system,
if such a term may be used, I hope that what is contained
on that head in the following pages will not be found en-
tirely useless. In short, though it is possible, that, from the
various objects it embraces, few will take the trouble to
read the whole, yet I am not without hopes, that, whether
the patient's object is to obtain a just account of the various
trusses that may be offered to his notice, or a rational idea
of the principles on which trusses should be applied to
afford the best chance of being useful, he may find the fol-
lowing little work not entirely beneath his notice; and, on
this account, though not without knowing it has many de-
fects, and believing it may have many more than I actually
know of, I chearfully leave it to its fate.
Though it is an unpleasant task, as it cannot be exe-
cuted without the appearance of egotism, I trust that I shall
be excused for taking this opportunity to say something of
myself, when I shall have given the reasons which induce
me to do so.
Aperson who foolishly supposes, that by using every
means in his power to vilify my character, he shall serve
his own interest, tells those who will listen to him, that I
ASSUME

VIIL
PREFACE.
ASSUME THE CHARACTER AND PRACTICE OF A SURGEON:
this is (within the knowledge of the person who makes
the assertion) entirely false; and the assertor is so far
beneath notice, that, if a mistake of a different nature
had not been made in a more respectable quarter, I should
not have thought it necessary to say any thing now upon the
subject.
The Editor of a Review*, who gave a very fair, liberal,
and, I trust it will be found, a very just account of my last
publication, has begun his account with the following ob-
servation, "Distortions of the feet are so frequent and so
"distressing, that every rational attempt to remove them
66
deserves to be examined with proper attention. The
"The author of this Essay, though not a professional man,
"offers a mode of treatment in these cases, that has many
"circumstances to recommend it, and which is supported
"by the result of different practical trials. Why surgeons,
"who are acquainted with the anatomical structure of the
"parts, have not, by availing themselves of mechanical
"science, treated deformations of this, and other kinds,
"on philosophical principles, we are not enabled to say;
"but certain it is, that they are rarely undertaken by per-
sons thus educated."
46
The account which this Reviewer gave of my Work is
so very candid and fair, that it is impossible to suppose he
meant to act in an hostile or illiberal manner; yet the con-
clusion, which any unprejudiced person may draw from his
exordium, is, that I am not a professional man; that I do
not understand the anatomical structure of the parts which
are concerned in the diseases I am undertaking to cure, and
of course, though what I offered to public notice has many
circumstances to recommend it, it has come into my posses-
sion by other means than by the study of causes, and con-
sequent adaptation of means to produce effects; and, of
course, that my discovery, whatever it might be, or by
whatever accident it was made, would be less valuable
than if it had been made by one who was prepared, by
previous education and practice, for the undertaking.
Such
* Analytical Review for October 1798, page 387. The whole ex-
tract is inserted at the end of this work.

PREFACE.
ix
Such an opinion given by one whose intentions were evi-
dently favourable, and an insinuation like that which I be-
fore noticed, that has been made with no good intention, prove
that the real nature of my situation and pursuits are not ge-
nerally known by those with whom I am not personnally ac-
quainted; and, with some other reasons which soon will
appear, will, I hope, justify me in now writing, thus par-
ticularly, to give an account of myself.
My father was what is usually called a truss-maker; he
had the most extensive business of that kind, and had the
highest reputation in his time for the usual routine of his
business; but he never pretended to what he did not pos-
sess, a professional knowledge of those diseases which may
be alleviated or cured by the judicious application of me-
chanical means. He gave me a liberal education, bred
me to his own employment, and twenty-three years ago
determined that I should enter the world in an independent
situation.
In the situation to which I was bred, I continually saw
professional men recommending patients to apply for mecha-
nical instruments to assist, alleviate, or cure various diseases,
which could not be assisted by any other means, and seldom
were these applications attended with success, from the
total want of professional knowledge in the person applied
to: and I was thus early impressed with a conviction, that
a certain class of diseases might be materially assisted, and
many of them radically cured, by mechanical applications;
provided that the knowledge of the diseases, and the power
of supplying the necessary remedies, could exist in the same
person.
My actual knowledge was, in the beginning, no more
than I could gain from the experience of my father in his
particular department: but I was no sooner at liberty, than
I determined to make every exertion to qualify myself for
that undertaking I resolved to engage in: I became a pupil
in the anatomical and surgical schools of the Hunters, with
a design to learn every thing from them which could
pro-
mote my success; and at the same time, and from that
time to the present moment, have devoted all my time,
made every exertion, and spared no expence, to obtain
knowledge of every kind, that could contribute to the suc-
cess of my favourite plan. How far it has been successful
b
it

PREFACE.
it is not for me to say; but as I see professional men, rising
into eminence, to whom I was known when we were pupils,
and by whom I have been known from that time to the pre-
sent, I shall leave that part of my character to be deter-
mined by their report of me.
If these facts had been known to the Reviewer, he
would, perhaps, instead of saying I was not a professional
man, have said, that I was neither physician, surgeon, or
apothecary, but that, having endeavoured to acquire a compe-
tent knowledge of every department of science, that was
connected with the subject of my pursuit, I solicited atten-
tion, upon that ground, to the subject I was then laying
before it.
The subjects to which my attention has been directed,
are those diseases to which bandages, or mechanical appli-
cations of any kind may be applied, to assist, to alleviate,
or to cure. A very extensive list! one essential part of
which is the construction and application of bandages to
various kinds of herniæ; this is the subject of the papers
which are now laid before the Public; another is the treat-
ment of curvature in the spine and deformities that are
connected with it: upon this subject I published, more than
twenty years ago, an essay, in which I described an instru-
ment for such purposes, that was constructed upon prin-
ciples which then were new, but now are to be considered
as firmly established *; and a third is the cure of distor-
tions in the legs and feet of children and others, which had
always been considered as absolutely incurable till I disco-
vered a system of treating them with uniform success.
The opinions of professional men were various upon
this subject: the most sanguine limitted themselves to de-
cide, that such diseases might be cured at a very early
period
* It may not be improper to observe here, that although the princi-
ples on which I began to treat this complaint were just, so far as they
went, and superior to what had been previously known, I am now au-
thorised to say, they were extremely imperfect. Continual experience,
since the date of that publication, has enabled me to improve every part
of my system, and bring it nearer to perfection: the result of that expe
rience will be published in a Treatise upon that subject which I am now
preparing for the press.

PREFACE.
Xi
period of life; but, it was universally agreed, that at a
inore advanced stage it was physically impossible to cure
them, and no man of character would make the attempt.
Attempts were made, however, but by men who were
either unqualified by nature or education, or by such as
with a moderate share of cunning, and very little know-
ledge, undertook such things, with no better design than
to obtain money from the credulous; and, in consequence
of the uniform termination of such undertakings, the
whole were, perhaps with too much justice, considered as
the practices of unprincipled quacks.
With a knowledge of these facts, after fully investi-
gating the subject, I commenced my undertaking: I knew
that, by promising too much or failing in any thing I un-
dertook, I should inevitably be placed upon the list of those
unprincipled or ignorant men, who had ventured on the
same subject before me. Knowing the importance of re-
putation, and that I staked that, as well as every thing
valuable in life, upon my undertaking, it cannot be sur-
prizing that I should proceed with extreme caution. I
ascertained every fact that came under my observation; I
published no fact but what I had evidence to prove, and
while I stated, from positive experience, what might be
done to cure these diseases, I argued by fair induction from
those facts, to shew the probability of success in other
cases which appeared to be more hopeless: by this pro-
ceeding I obtained the confidence of other patients, who,
at more advanced periods of life, were entrusted to my
care. Fresh experiments led to fresh success, and though
it is now known, that these diseases may be cured at pe-
riods of life when it was thought it would be impossible to
effect any thing, we have no data from which to conclude
at what period of life such distortions are certainly incu-
rable:* I have the satisfaction to know, that in no case that
has
* In 1798, I published a Practical Treatise on the Club Foot, &c.
in which was inserted an explanation of the principles upon which I
conducted the cure of those deformities, with thirty one cases of patients
not exceeding the age of two years, and had been cured. From the
structure of the parts, and the facts of those cases, I argued the pro-
bability there was, that persons much farther advanced in life might be
cured of the same diseases. Subsequent experience has justified the con-
clusion; and, in the course of next winter, I shall publish a collection
b 2
of

xii
PREFACE.
has been entrusted to my care has less been afflicted than
I had foretold; that, in many, much more has been done,
and that my veracity has never been questioned in the ac-
counts I have published of those cases, which have been
entrusted to my care: yet with all this caution, and so much
success, it is a little hard that my character should have been
injured, upon this very subject, by the base conduct of
one, by whom, in the ordinary course of human transac-
tions, a man would least expect to be injured in this manner.
As I know the conduct to which I allude is adopted sys-
tematically, and practised steadily, with a design to carry
it to the utmost extent, I think it my duty, and believe it
will be possible, to put an end to it, by making the tran-
sacti on public.
I have a younger brother, with whom I have chosen to
avoid all connexion or communication: this person, like
myself, received from his father the instructions that
were necessary to make him a decent common truss-maker;
and, so long as I had any knowledge of him, he had no
other qualification, nor did he seem to have talent or in-
clination to qualify himself for any thing better: he may
since have improved himself much in that respect; of this
fact I have no knowledge, but if I am to judge of the pro-
gress of his knowledge, by the increase of his candour,
liberality, or integrity towards myself, I shall have but
very little to say in his favour on that subject. So soon as I
had reduced my system of curing the club foot to a state
that I could ensure its success, I took out a patent for the
discovery. At first many professional men very naturally
supposed that I was too sanguine in my expectations,
and suspended their opinions till more facts were known.
But while these gentlemen very properly acted in this man-
ner, some of my own relations were active, upon every
opportunity, in representing me as an impostor, who was
intentionally practising deception for the purposes of fraud.
This was not very decent, and had very little effect; and
William Sheldrake soon adopted a practice which he pro-
bably thought would be advantageous to himself, whatever
degree of reputation might attend it.
Soon
of facts, to prove that every case of the same disease which has come
under my care, even at so late a period as the age of fifteen years, has
been completely cured.

PREFACE.
xiii
Soon after the publication of my Treatise on the Club-
foot, I was informed that he had, in one case, attempted
to practise my method of curing that disease. I obtained
permission to examine the patient, and found it was the
slightest degree of the disease, in a very young child, and
that he was applying, as well as HE could, instruments that
resembled those which I should have used in a similar case.
I requested my attorney would write to inform him that I
had discovered he was infringing on my patent, and that, if
he did not immediately desist, or if, in any other instance, he
acted in the same manner, I would support my right, and
prosecute him to the utmost rigour of the law. To this no
answer was returned; but I soon found a report was in
circulation (I know not by whom propagated) that I had
brought an action upon this subject against this innocent,
good brother. The truth is, that I did not, nor even in-
tended to do so; but well knowing both his principles and
practice, I directed my attorney to write, that he might not
afterwards say he had unintentionally attempted to pirate
my invention; and, I presume, the publication of this fact
will as effectually do him justice, as if he had been prose-
cuted legally for this daring and very honest attempt to
injure my property.
Some time after this I cured the son of a gentleman,
who lives near Queen-square, of two distorted feet. The
nurse who had the care of this child became acquainted
with a poor woman, who had a child in the same situation,
and, knowing of my success with her charge, advised her
friend
*Stating, as I do most decidedly, that the instruments used by
W. S. in this case were like those which I should have used, which are
my own invention, for which, as well as for the use of which, I have
obtained the King's Patent, and for the pirating of which 1 might have
prosecuted this GOOD YOUNG MAN, if I had been so minded, I shall
shew how the honest lad might have obtained what little knowledge he
had on the subject. An old woman servant, who had been in my family
many years, and was at last discharged for misconduct, offered her ser-
vices to him, and, as she was no doubt thought to be a most valuable
acquisition, was accepted. Having been several years in my house, she
had seen many things laying about, and had occasionally been admitted
into the room while I was dressing a poor patient. Having thus ac-
quired an immense stock of knowledge, I have no doubt that she faith-
fully communicated the whole to her new master. Whether he had
any better ground to establish his project upon, I shall leave him to
prove whenever he is disposed to do so.

XIV
PREFACE.
friend to apply to me. On hearing my name, this poor
woman loaded me with execrations; said her child had
been under my care a long while, without receiving any
benefit; that I had drawn money from her till she could afford
to pay no more; and she was obliged to desist, with the
loss of her money, the loss of her time, and the additional
mortification of having her child as much a cripple, as if no
attempt had been made to relieve it. This information was
conveyed to me. I had never seen the woman or her
child; and, as my character was thus violently attacked,
by a person, and for a cause of which I had not the least
knowledge, I resolved to investigate the matter fully. I
found the woman had been advised to apply to THE Mr.
Sheldrake who had discovered a method of curing the club-
foot, &c.: she applied to W. S. and understood that he
was the person she was advised to employ; she therefore
continued her child under his care, till she found it neces-
sary to withdraw in the manner I have related,
Dr. C. to whom I have been well known for many
years, and to whom I am indebted for many recommen-
dations, gave me the address of a lady who wished to con-
sult me; he desired that I would go immediately, as she
was impatient, and he had promised to send me the day
before, but unavoidable engagements had prevented him
from calling on me. I went, and, to my astonishment,
learned that W. S. had been there before me. The lady
was impatient; finding I did not come so soon as she ex-
pected, sent her servant to fetch me. This servant had
been told there were two persons of the same name; for
this reason she was particular in her enquiries, and was
told she was certainly right in her application, as Dr. C.
frequently sent patients to him, W. S. and was at that time
employed in attending his wife. This explanation appeared
so satisfactory, that he was ordered to wait on the lady,
received his orders, and no doubt was exulting in his suc-
cess, when my appearance spoiled his sport. I do not be-
lieve that Dr. C. ever recommended a patient to W. S.;
he certainly did not recommend this one, or he would not
have given me the directions to wait on her himself. Upon
full explanation, W. S. was discharged, with no other
recompense than he could derive from the detection of his
very honourable practice.
I re-

PREFACE.
XV
I received a letter from a lady I had known many
years, in which she reproved me, in very strong terms,
for neglecting some business which, she said, I had to do
for her. I was surprised at this, as I had not heard from
her for some time. I called upon her in consequence, and
she was as much surprised at seeing me. She said, that
some time before she had directed a letter to my house, as
usual (which letter got into the hands of W. S.); but find-
ing a stranger wait upon her, she enquired for me: the
answer she got was ambiguous, but she understood from it
that I was either dead, or had retired from business, and
that the person she saw was my successor; of course she
gave him her orders, but had not seen him since. This
induced her to write the second letter, which got into my
hands, and led to an explanation. She was much pro-
voked at his baseness, and wrote a letter, in which she re-
quired him to deliver the articles he had taken to alter for
her into the hands of my servant, who was the bearer. I ac-
companied this with a line from myself, in which I cautioned
him seriously against a repetition of such conduct. He re-
fused to restore the article claimed, and applied very coarse
terms to the lady who had discovered her mistake. My
letter contained a strong reproof, but it was under cover to
himself; it was intended for his use, and he made his own
use of it, by detaining my servant, calling his own together,
and reading the letter aloud in midst of the whole assembly,
reviling me at the same time with every foul epithet his
vile imagination could suggest.
A lady, whose child had been under my care for some
time with an umbilical hernia, wrote me, by her servant, to
send her some new bandages like those which she had had
before, and, that no mistake might happen, sent one of the
old bandages for a pattern. The servant, by mistake, de-
livered the order to W. S. who took it, and sent a boy
with a bandage totally different from the pattern, accompa-
nied by a bill and receipt, and with positive orders not to
leave it without the money. Such a message from me
justly surprised the lady, and induced her to examine the
bandage: she then discovered the difference, and, by exa-
mining the messenger, her servant's mistake. The boy,
however, was true to his master's interest, and was equally
unwilling to take back the bandage, and return without the
money; though he was, at last, compelled to do both. The
lady then sent for me. It was evident there was no mistake, as
W. S.

xvi
PREFACE.
W. S. must have known, from the lady's letter, that he had
never been employed by her; from the bandage which was
sent as a pattern, that he had not supplied her with it; and
he did not even attempt to execute the order literally, by
making bandages like the pattern sent, though he dared to
send a bandage different from those that were ordered, and
forbid his boy to return without the money for it. I therefore
advised the lady to write and desire that the pattern ban-
dage might be returned by the bearer; she did so, and the
letter was delivered by my assistant. W. S. reviled the
lady in
very gross terms, and refused to return the ban-
dage; it was indeed of no value, any farther than as it
served to mark the decency, the integrity, and the honesty
of his conduct in the whole transaction.
A gentleman at Beverley, in Yorkshire, had a daugh-
ter who laboured under a distorted spine: he was advised
to bring her to London, and put her under my care. He
came to London, and knowing that I lived in the Strand,
he came to seek me, and by accident he applied to William
Sheldrake. It cannot be supposed that I should know what
conversation past; but the result was, that W. S. was en-
gaged to the patient. He fixed a time to wait on her, but
did not attend: messages were sent, but still no notice was
taken. In this manner almost a fortnight elapsed, when
this gentleman, being here with his family for no other
reason than to get this assistance for his child, anxious for
her welfare, and stung with resentment at the negligent
manner in which he had been treated, wrote a letter
expressive of his feelings, which he directed, Mr. Shel-
drake, Strand. This was sent by his servant, who brought
it to my house, and supposing by the address it was in-
tended for me, I opened it. As the subject of this letter
was like many similar accidents which I had known, I wrote
to explain the relative situation of W. S. and myself, and
suggested the propriety of ascertaining whether he had not,
in his first application, addressed himself to a person he did
not mean to employ. Mr. B. called on me in consequence,
and, on mutually explaining some circumstances, he was
convinced that he had been mistaken; he therefore dis-
carded W. S. and the patient was put under my care.
These anecdotes are selected from a large number of
similar ones that have come to my knowledge, but these
are sufficient to prove the facts I mean to establish. There
19

PREFACE.
xvii
is but one conclusion can be fairly drawn from them, and
that I shall not take the liberty to point out; but there are
three inferences may be drawn from them by persons who
have different ways of thinking, upon each of which I shall
say a few words hypothetically, without attempting to as-
certain which is the truth.
First, it may be said, that although W. S. had not the
least qualification for any thing but the trade of a common
truss-maker, so long as I had any knowledge of him, he
MAY, since that period, have qualified himself for very su-
perior pursuits. It is possible that he MAY have done so,
but, as I have no knowledge of the fact, I cannot speak on
the subject. Still, however, I am entitled to observe, that,
if he has so qualified himself, if he has acquired any skill, on
any particular subject, that may distinguish him from the
common herd of workmen who attempt to make trusses,
he has manifested a strange obliquity of understanding, in
not making public the fruits of his knowledge upon those
subjects which have been the objects of his study, and thus
fairly stating his claim to the reputation that would follow
his success. Such would be the practice of most men of
talents; but I have never learnt that he has done this,
though the preceding anecdotes will prove that he has done
things which very few men of inferior talents or character
would think of practising.
Secondly, it may be said, that W. S. may have
projected some method of curing distorted limbs, which
is different from mine. This is possible, but there are
some obstacles to be got over before this doctrine can
be admitted, viz. why did he use a practice similar to
that which he might have learned from my discarded servant,
in the first case I have related? and why did he not cure the
second case that I have shewn was entrusted to his care?
When the nature of his practice and the extent of his suc-
cess upon this subject is publicly known, his reputation, so
far as relates to it, will be fully established. Till that
period, the facts I have related will stand for judgment,
without the least reflection from me to accompany them.
Thirdly, it may be suggested by some sceptical peo-
ple, that it is possible W. S. may remain, so far as relates
to knowledge, talent, and integrity, just as he was at the
time I ceased to have any knowledge of him; that, feeling
C
his

XVIII
PREFACE.
his own inferiority, he may have fixed himself in the same
street with myself, and cunningly lain in wait, in hopes
that many who did not know there were two persons of the
same name, and, nominally, in the same employment, would
by this means fall into his hands; and, if they do not take
the trouble to ascertain whether he is the person they meant
to employ, the maxims of the world will excuse him for
making his own advantage of them. That such doctrines
are held by some people, I know perfectly well; but not
being skilled in casuistry, I shall not dilate on the propriety
of such conduct, though I may form my own opinion, and
leave every one else at liberty to say what they please on
the subject,
I have been compelled, much against my inclina-
tion to explain these particulars, in order to preserve
myself from the injury that I must continually suffer in
consequence of such practices as I have related; injury that
originates in the baseness of others, and, however it may be
intended, must affect my reputation more than my property,
It is evident, that if Mr. B. of Beverley had not discovered
his mistake, he must have returned home, and made, to my
friends in that part, a very unfavourable report of the con-
duct of that person whom they had recommended to his
notice. This must have degraded my character in their
estimation, and, in all probability, prevented them from
favouring me with any recommendation in future. It is
equally evident that the woman, whose child had not been
cured, was applying all her censures upon that occasion to
me, though I had no knowledge of the subject; and, if the
mistake had not fortunately been discovered, might, in
time, have materially injured my reputation in her small
circle; and any other person, having made the same mis-
take, and met with the same disappointment, might very
unjustly, though without any malevolent intention, do me
inconceivable mischief, by propagating false reports of
me, supposing me to be the person by whom they have been
improperly treated, although I, in fact, should be innocent
of such transactions. I trust, therefore, I shall be ex-
cused for having related these anecdotes, to caution those
who may be induced to seek for the author of this work not
to be misled to apply to W. S. who, I believe, will not be
very forward to inform them of their mistake,
The

PREFACE,
XIX
The same motive will likewise justify me for men-
tioning another subject, which otherwise it would be need-
less to introduce. The nature of my professional engage-
ments will oblige me soon to change my residence to a
different situation; my manufactory and warehouse will
always remain where I now reside, but I shall shortly re-
move my private residence to a different part of the town.
On the premises here I shall attend as much as possible,
and, in my absence, an able assistant will always be found;
but, as the ablest assistants will always be inferior to their
principal, many may chuse to see me in preference to my
assistant, and it may be more convenient and agreeable for
them to send to my private house, to which a reference
will always be had from my people at the manufactory.
If this circumstance had not been explained at this time, it
is possible that those whose manoeuvres have been so ho-
nourably exerted to injure me, might contrive some means,
in consequence of my partial removal, to mis-direct those
who might intend to consult me in my profession.
May 6th, 1803.
T. SHELDRAKE, No. 50, STRAND,
BETWEEN THE ADELPHI AND YORK-BUILDINGS,
*It is with reluctance I have been induced to mention myself in
any manner; hut circumstances of this nature I never would have men-
tioned except from motives of strong necessity, which it will become
me to explain.
By alterations which have been made in houses in the neighbour-
hood, the numbers of the houses in this part of the Strand are become
irregular: my house is numbered 50, the next house but one has the
same number upon it. Many having the name of the person they are
in search of, and the number of his house equally in their minds, will
often catch at the number, and thus enquire for the person they want
at the wrong house. When any one enquires thus at my house for the
owner of the other No. 50, they are immediately informed of their mis-
take, and properly directed; but if any one, by mistake, enquires for
me at that house, the persons who are in it, knowing the fact well,
and living within sight of my door, immediately tell them, Mr. Shel-
drake does not live in that house, nor in that neighbourhood; that William
Sheldrake is the only person of that name that they know of, and imme-
diately direct them to his house.
Mr. Heaviside and Mr. Doratt advised a Gentleman, whose son
had a distorted spine, to place him under my care. The mother, by
mistake, carried her child to W. S.; she mentioned by whom she was
recommended,

PREFACE.
recommended, and explained what those Gentlemen had ordered to be
done for the child. W. S. told her that it was impossible to execute
what had been advised, and suggested something that, in his wisdom,
appeared to be better, or, at least, more within the reach of his capacity
to execute; the Lady, however, resolved to adhere to the advice she had
previously received, and W. S. finding he could not induce her to alter
her resolution, behaved with the grossest insolence, and, without in-
forming her of the mistake she had made, suffered her to leave his
house. She returned to Mr. D. who informed her of her mistake, and
the child is now in my hands. Now, W. S. must have known that he
was totally unconnected with the Gentlemen whose names had been
mentioned; he asserted that it was impossible to execure the idea
which those Gentlemen had suggested, (a pretty strong acknowledge-
ment that he was unable to execute it.) The health, perhaps the life
of the patient depended on the efficacy of what should be done for him ;
yet, with the knowledge of all these facts, W. S. first attempted to
substitute some absurdity of his own, for what men of professional
eminence had recommended to the patient; and, failing of success in
this attempt, suffered the Lady to leave him, without informing her of
the mistake, which he must have been convinced she had made when she
applied to him.
If, then, one person who lives within sight of my house, and knows
he is telling a falsehood, dares to tell those who apply at his house by
mistake, that I do not live even in the neighbourhood, and thus drive
those who are in search of me into the hands of William S. and if W. S.
when persons apply to him by mistake, will not set them right, even
when he dare not undertake to do that which they want, I shall certainly
not be accused of ill nature or affectation, for mentioning such facts as
will, if properly attended to, prevent any one from being imposed on by
any
kind of deception,

XXI
Lately was published,
A practical Essay on the Club-Foot, and other Distortions of
the Legs and Feet of Children, intended to show under
what Circumstances they are curable or otherwise; with
Thirty-One Cases that have been successfully treated, by
the Method for which the Author has obtained the King's
Patent, and the Specification of the Patent for that Pur-
pose, as well as for curing Distortions of the Spine, and
every other Deformity that can be remedied by mechanical
Applications. By T. Sheldrake, Truss-Maker to the
Westminster Hospital.
The following account was given of the above work
in the British Critic for October 1798:
"In the 8th vol. of our Review (p. 199) we gave an
account of this author's treatise of distortions of the feet,
in which the superiority of his method over all that had
been before known and practised, seemed to be clearly as-
certained. Further experience has shown the justness of
the principles on which he proceeded. In the present
volume he has given the history of thirty-one cases, in
which his method has proved successful, many of them
attested by persons of so much respectability, as leaves no
room to doubt they are fairly stated. As various impo-
sitions have been practised to deprive the author of the
credit and emolument to which he is justly entitled, he has
taken out a patent for his invention; the specification for
which is here published, accompanied with engravings re-
specting the machines he employs, as well as different
kinds of clubbed feet, and of other distortions of the trunk
of the body and of the limbs, to the cure of which his in-
struments are adapted."
From the Analytical Review of the same month.
Sheldrake on the Club-Foot.
"Distortions of the feet are so frequent and so dis-
tressing, that every rational attempt to remove them de-
serves to be examined with proper attention. The author
of this essay, though not a professional man, offers a mode
D
of

XXI
of treatment in these cases, that has many circumstances to
recommend it, and which is supported by the successful
results of different practical trials. Why surgeons, who
are acquainted with the anatomical structure of the parts,
have not, by availing themselves of mechanical science,
treated deformations of this and other kinds on philosophi-
cal principles, we are not enabled to say; but certain it is,
that they are rarely undertaken by persons thus educated.
"The author of this essay presents his plan of treat-
ment fairly to the notice of the professional inquirer, and
claims his regard on these grounds.
Pref. P. ii." The situation," says he," in which
I was bred, having given me numerous opportunities of
seeing these diseases, in all their varieties, and of seeing
they were always treated in a way from which little be-
"nefit was derived, naturally directed my mind to the
66
subject; and the nature of my professional education
and pursuits, during the last twenty years, having ena-
"bled me to consider them in a way that had escaped
"the observation of others, and to make numerous expe-
"riments, in hopes of being able to cure them, I at last
"succeeded in some cases, in an eminent degree. An ac-
"count of these cases was published several years ago; and
"the attention that publication excited, procured me
numerous opportunities for pursuing my enquiries on
"this subject, the result of which will be found in the fol-
lowing pages.
66
22
In a former work*, of which the present would seem
to be a continuation, Mr. S. showed what had been done
by other practitioners with a view to remedy these defor-
mities.
Pref. P. iii.-The present essay" contains the his-
< tory of some cases, which were placed, with unlimited
"confidence, under my care, and in which I was, there-
"fore, perfectly successful. And, as I knew I must en-
"counter the scoffs of incredulity, the doubts of scepti-
"cism, and the insinuations of those who might be en-
"vious of my success, I had the precaution to request,
"that they might be shewn to gentlemen in the profession
of
See our Rev. Vol. xxv. p. 31.

XXIII
"of surgery, whose knowledge, judgment and integrity,
"were unquestionable, and who would, therefore, always
"ascertain whether what I attempted was rational, and
"what degree of success attended my efforts. The un-
"biassed opinions of these gentlemen are added to the
"history of each case, and will form a mass of incontro-
"vertible evidence to the truth of the facts."
"After describing fifteen cases, in many of which his
method of management completely succeeded, he comes to
the circumstances that render the club-foot curable, or
otherwise. In considering this part of the subject, he finds
it necessary to inquire into the anatomical structure of the
parts concerned, and from the examination of the bones in
these cases of disease, he attempts to prove,
P. 87,-" That before the age of two years, the indi-
"vidual bones of a club-foot are not distorted in any man-
ner;
that as far as the bones are concerned in the dis-
ease, it is only by improper combination; that after the
age of two years, individual bones become deformed,
"according to circumstances, which vary in different
cases; but which do not, in all, render the disease in-
"curable. I shall now proceed to examine the condition
"of the ligaments, in various stages of the disease, in order
to discover what alterations must be produced in them,
❝ in order to effect a cure."
66
66
66
(C
66
"The ligaments and muscles are examined in the
same way, and several practical deductions laid down.
From the whole these conclusions are formed,
P. 135.-" That three distinct operations are requi-
"site to cure this deformity; first, to reduce the bones
"to their natural position, and natural form, if the
"patient's age has occasioned any malformation to take
"place; secondly, to produce extension of any muscle
"that has actually been contracted, or seems to be so
"from the position and consequent inactivity of the foot;
"and thirdly, to keep the foot bound in its natural posi-
"tion, till those muscles which have, from the circum-
"stances of the disease, been weak and inactive, perfectly
recover their tone and power, when, and when only,
"the cure will be complete."
CC
"I may likewise be permitted to conclude, from
what has been said, that every case of this disease may
be perfectly cured, before the patient is three years
old; that after that age, some may soon become in-
curable;

xxiv
"curable; but that others may remain in a condition to be
"cured, till the age of ten, eleven, or twelve years old,
" and even to much later periods of life."
"These observations being made on that species of
club-foot that occurs before birth, the author comes
next to those which happen afterwards. Here he also
offers many remarks, and gives different practical direc-
tions. We have likewise some cases in illustration of the
positions. In recent distortions of the knee-joints, Mr. S.
tells us,
P. 174,-That "two operations are requisite to
"effect a cure, viz. to replace the bones in their natural
"relative position; and to retain them there, till the liga-
❝ments and tendons connected with the knee-joint, have
"recovered their natural power of supporting the weight
"of the body properly on the legs.
"In recent cases, where the distortion has been
"brought on suddenly, or at least quickly, by debility,
"the reduction will be easily effected; for the same debi-
"litated state of the parts that has occasioned them to
"give way, will not oppose any obstacle to any rational
attempts to return the legs to their natural form, and
" and then time, with the assistance of cold baths, &c.
"will enable them to recover, perfectly, their natural
"functions. But when, from length of time the disease
" has existed, age of the patient, or any other circumstance,
"the parts have become rigid or contracted, it will require
"considerable caution to reduce them to their natural
"position; but still it is possible to do so.
"As the degree of relaxation requisite to produce
this distortion is not great, so the degree of rigidity or
contraction necessary to retain it in its worst form, is
"not greater than the relaxation which occasioned it,
From this view of the subject, and from what we know
"of the effects of mechanical action upon tendinous con-
"tractions, it is not too much to conclude, there are
few, if any cases, even in adults, that are absolutely
incurable; and from a knowledge that the mode of
"treatment I have invented may be adopted to every pos-
"sible case, it would, perhaps, not be unwarrantable to
"conclude, that every case, which in its nature is not
incurable, may be cured by it."
CC
"As the real value of every discovery or improvement
is shown by the practical result, we have little hesitation in
saying

XXV
saying, that if Mr. S.'s method of managing the distortions
he has here described be so completely successful as he
assures us it is, it must be of much utility."
A. R.
A few remaining copies of this Work may be had at
the Author's house, No, 50, Strand.
He is preparing a Second Edition for the Press, which
will be published during the ensuing winter, with an Ap-
pendix, containing the history of cases which have been
successfully treated, in patients at various periods of life
between the ages of three and fifteen years.
The Appendix will be sold separate, to accommodate
the purchasers of the former edition,


CONTENTS.
Of Ruptures; their Situation, Contents, Con-
sequences, &c.
Of the Cure of Ruptures
Of the palliative Cure
Of Timbrell's new Inventions
Of Bowman's patent Truss
On what are called, patent Trusses, without
Straps
Of Turnbull's few Rules, &c.
On the various Principles of constructing
Trusses, and their Advantages and De-
fects
On the Application of a Truss, and the Pa-
tient's Management of himself
On the radical Cure of Ruptures
On curing Ruptures by the patent Plaster
On the empirical Practices of the present
Day
LIST OF PLATES.
Plate I. to face p. 92.
Plate II.
p. 183.
Plate III.
Plate IV.
p. 111.
p. 120.
Page
1.
12
15
22
55
59
75
91
115
130
148
153


USEFUL HINTS
FOR
THOSE WHO ARE AFFLICTED WITH
RUPTURES. &c.
Of Ruptures; their Situation, Contents,
Consequences, &c.
THE disease called hernia, descent, or rupture, is a tu-
mour, formed by a portion of the abdominal viscera, which
is protruded through an aperture made in some of the con-
taining parts of the abdomen: it varies both in size and
contents, in different patients; some labour under this
disease for a long time, without being sensible of their si-
tuation; others have it for many years without feeling any
inconvenience, except what is occasioned by its bulk;
though, in many instances, it has been known to prove fa-
tal in a short time after its first appearance.
Ruptures are variously named, on account of their
situation in different parts of the body, or from their con-
tents; sometimes their names are descriptive of both these
circumstances. The inguinal and scrotal hernias are the
most common; cases of the femoral hernia seldom
occur; but, except the inguinal and scrotal, the umbilical
rupture is most frequently met with; the ventral hernia,
too, is not uncommon: ruptures generally contain a por-
tion of the omentum, of the intestine, or of both; and
other viscera have sometimes been found in them.
B
Other
*The femoral hernia occurs more frequently in women than in
men; and the number of those women who have femoral hernias is, to
those who have inguinal ruptures, at least in tenfold
proportion. Wo-
men are, for obvious reasons, much more liable to umbilical hernias
than men.

2
Other diseases may be mistaken for ruptures, though
the resemblance is not so perfect but that they may, by the
experienced surgeon, be distinguished from each other:
it is of the utmost importance to patients that this should
be done; because diseases, that are different in their na-
ture require very different treatment, and if the mode of
treatment that is proper for one, should, through mistake,
or from worse motives, be adopted in treating another dis-
ease, it will frequently be productive of fatal consequences.
It is known that empirics and pretended rupture-curers
have mistaken ruptures for other diseases, and other dis-
eases for ruptures, and have actually destroyed their pa-
tients by the mode of treatment they adopted in conse-
quence of such mistakes.
The parts which form the inguinal rupture come out
of the abdomen through the aperture in the tendon of the
obliquus externus muscle, in the same direction with,
and upon the spermatic vessels in men, and upon the liga-
menti uteri in women: it commonly forms a small tumour
in the groin at first; but, if neglected, it descends gra-
dually into the scrotum, in the one, and the labia in the
other sex: sometimes violent exertion will produce a large
rupture, and instantaneously force it down into the scro-
tum. At its first appearance in the groin, this rupture is
frequently mistaken for a bubo, but, as it increases in size,
it assumes a different appearance, and may be confounded
with other diseases.
If the inguinal rupture is composed of omentum only,
it will feel flabby, unequal, be easily compressible, and, at
first, is generally free from pain; but, as a greater portion
of the omentum descends, it will, by its connexion with
the stomach, sometimes create nausea, and a desire to vo-
mit, even when there is no stricture. The varicocele is
sometimes mistaken for an omental hernia; but the atten-
tive observer will easily discover the difference: the vari-
cocele being a relaxation of the spermatic vessels, is inse-
parably connected with the testicles, but the testicle is ge-
nerally to be felt distinct, and is easily to be separated from
an omental hernia, even when that hernia is not return-
able; the swelling formed by a rupture may always be
traced up to the aperture through which it descends from
the abdomen, but, the varicocele is seldom, if ever, ex-
tended so high; if a rupture is returned into the abdomen,
and the hand carefully applied upon the part, it will not
descend again while that application is continued; but if a
varicocele is treated in the same manner, it will return the

3
moment the patient is in an erect posture, notwithstand-
ing the hand is applied so carefully that nothing can have
descended through the ring; which must have been the
case if it had been a true rupture; so that, on accouut of
these various circumstances of the two diseases, none but
ignorant or inattentive persons can mistake them for each
other. If a truss is applied upon a patient who has the
varicocele, the application will increase the disorder.
The inguinal hernia is, when in its incipient state, some-
times mistaken for a bubo; in its more advanced stages it
has often been confounded with the hydrocele, or watry
rupture; but the hydrocele has more frequently been mis-
taken for the true rupture, notwithstanding the difference
is so manifest that it is difficult even for a novice in the
profession to mistake one of these diseases for the other;
indeed, there is reason to believe this mistake is frequently
made through craft, rather than ignorance, because the
operation for the palliative cure of the hydrocele is simple,
and the empiric, who imagines he can perform it, may, by
so doing, gain an opportunity to boast that he has per-
formed the radical cure of a true rupture where no such
disease existed. Enlarged glands are sometimes treated
as ruptures, and from the same laudable motives*.
B 2
Ruptures
* In October, 1783, a gentleman applied to me, and gave the fol-
lowing account of himself: He had, for many years, had a swelling in
his left groin, but, as it had never given him pain or uneasiness of any
kind, he neglected it till, accidentally reading some essays on the treat-
ment of ruptures, he was so effectually frightened by that performance,
that he immediately came to London and applied to the author for ad-
vice. This celebrated personage told him it was a rupture; that it
would be necessary to apply bandages, and he likewise offered to per-
form the radical cure: a truss was applied, and the patient directed to
call frequently. It was about a fortnight after this time when I saw
him; he told me the swelling had continued invariably the same; it
was down at the time, and had been down ever since the truss was put
on; he was uneasy in his mind, but as, from the operator's behaviour,
he entertained a bad opinion of his abilities and a worse of his honesty,
he did not go to him again.
Upon examination, I found a tumour not so large as half a pigeon's
egg, firm to the touch, and quite immoveable from its present situa-
tion: the patient said it was very small when he first perceived it, it
had increased gradually from the time of its first appearance without
being once painful, nor had it ever returned into the abdomen: he
likewise assured me it could not be the effect of a venereal complaint,
as he had never had that disease, there was every reason to believe it
was an enlarged gland; I told him so, gave him the reasons upon which
my opinion was founded, and at the same time recommended it to him
if

Ruptures are sometimes connected with, as well as
mistaken for, other diseases: an intestinal hernia and a hy-
drocele may exist in the same patient, and on the same
side; an omental hernia and a varicocele have been found
under the same circumstances: this case requires very de-
licate treatment, because it is well known that pressure
will increase the varicocele, and pressure is absolutely ne-
cessary to keep up the rupture.
The femoral rupture passes out of the abdomen under
Pouparts ligament, and nearly in the same direction with
the crural artery: it forms a tumour in the upper and fore-
part of the thigh; it is, on account of its situation, more
difficult to reduce, and more troublesome to retain, than
it is to perform the same operations on any other kind of
rupture: it is, for the same reasons, less frequently cured
in a radical sense, and therefore it is fortunate for patients
that it occurs but seldom in practice.
The exomphalus, umbilical, or navel rupture derives
its name from its situation; and, like other ruptures, gene-
rally contains a portion of the omentum, of the intestine,
or of both; though other viscera have sometimes been
found in them: it is not so frequently strangulated, when
in its incipient state, as other ruptures are; though to pa-
tients, who labour under it, it often proves fatal if not
treated with propriety.
Infants are frequently troubled with navel ruptures,
but, by the skilful application of a proper bandage, are
generally cured in a short time. Women, particularly
those
if he had any doubts remaining, to apply to Mr. Hunter, or any other
eminent surgeon, who, I did not doubt, would confirm what I had
said: he declared himself perfectly satisfied, and said he should submit
the treatment of it to the surgeon he usually employed; I saw him no
more.
As this empiric exulted over one of his brethren who was justly
punished for defrauding and maltreating a patient, it will be fair to
apply his own mode of reasoning upon that, to his own behaviour upon
this occasion. Either he believed it was, or he knew it was not a
rupture:
As he has repeatedly assured the public that he alone understands
the nature, und proper methods of treating ruptures, he cannot be ad-
mitted to plead ignorance on this occasion, however justly he may be
entitled to that qualification; ergo,
He knew it was not a rupture: and,
Knowing the disease was not what he described it to be, why did
he apply a truss, and undertake the radical cure of a rupture?
It could only be to defraud the patient of a sum of money under the
pretence of curing him of a disease which he knew did not exist!

those who have had children, are most subject to them:
it is sometimes found in men who are advanced in years,
though but seldom, if ever, in those who are not past the
prime of life. The greatest number of those who are
troubled with this kind of rupture are of the female sex;
but there are at least thirty men who have the inguinal
and femoral ruptures, to one woman that has the same
diseases.
The ventral rupture may appear in almost any point
of the fore-part of the belly, but as Mr. Pott observes, it
is most frequently found in, or, between the recti-muscles:
it is commonly occasioned by violent blows, it is a disease
that seldom occurs, and it is, of all the various kinds of
ruptures, that which is least liable to prove fatal in its in-
cipient state: because the aperture through which it
passes has but little power to contract itself and occasion a
strangulation while the rupture is small; but, if neglected,
the rupture will become large, and irreducible, and, at
that period, frequently proves fatal. Many, who are said
to die of mortification in their bowels, have that morti-
fication brought on by old, neglected, ventral and umbili-
cal ruptures.
The hernia congenita* is always produced in infants,
and requires particular attention on account of its impor-
tance as a rupture, but more on account of its connexion
with the testicle, which may be, and very frequently is,
injured by improper treatment; several patients are known
whose testicles have been, and now necessarily must be,
confined within the abdomen, or at least prevented from
descending into the scrotum by trusses applied, either
through ignorance or want of principle, by that empiric +
who has presumed to insinuate that all medical men are
ignorant of the proper methods of treating ruptured
patients.
Tors
Many
*This rupture is peculiarly circumstanced, because it comes in
immediate contact with the testicle. For a particular description see
Mr. Pott's Treatise.
+ This worthy personage was recommended to a nobleman whose
son was supposed to have a rupture, and, according to his usual cus-
tom, he applied some trusses: an eminent surgeon was afterwards
called in, and, to the astonishment of the family, proved the child had
not a rupture, but that the empiric had, by applying his trusses impro-
perly, confined the testicles in the groin. Many other cures are known
in which this immaculate rupture curer has performed the same ope-
ration,

Many diseases are the consequences of particular
modes of living, and, therefore, are confined to particular
classes of men; but this is by no means the case with
ruptures, for, no person, whatever may be his situation in,
or time of life, can be said to be free from the danger of
getting a rupture: but, though every man is liable to
have ruptures, all men are not equally subject to them;
those whose situations oblige them frequently to make
sudden and violent exertions, and those whose constitu-
tions are weak, or bodies debilitated, are known to be
more frequently troubled with ruptures than the rest of
mankind.
It has been asserted, by various writers, that the labo+
rious part of mankind are most liable to ruptures; the
truth of this is doubtful: for in very extensive practice for
many years I have observed, that the number of those in
the middling and upper walks of life greatly exceeds the
proportion of those in the more laborious stations; and a
small degree of attention to the causes of the disease will
prove, in theory, that the contrary should be, as well as
experience proves, in practice, that it is the fact.
The various causes of ruptures may be reduced un-
der two distinct heads; they are occasioned by sudden
exertions; or they are produced without any exertion of
the patient, and, therefore, they so frequently take place
in people who are generally or partially relaxed.
This being the case, it is by no means surprizing that
we find ruptured patients are, most frequently people
whose situations in life place them above the necessity of
submitting to bodily labour: such people, by violent, or
by sudden and unexpected, though trifling exertions,
frequently get ruptures; jumping, an unexpected stumble,
the starting of a horse, drawing a cork from a bottle, and
many, equally trifling accidents, will produce them: or,
by being in a relaxed or debilitated state, they have them
come on so gradually that even the patients cannot tell
the time at which their ruptures first appeared; and they
will afterwards increase to a considerable size, sometimes
without being attended with any apparent danger.
Ruptures of this kind, however, generally prove
more pernicious in the end, because they are frequently
neglected till they become incapable even of the palliative.
cure, and they continue to increase till they frequently
destroy the patient. It is, perhaps, on account of the re-
laxation produced by the climate that the gentlemen in
the West-Indies are peculiarly subject to ruptures; in the
southern

7
southern parts of Europe, too, ruptures are, perhaps for
the same reasons, more common than they are in England:
I am informed that, in Italy, ruptures are so common, and
the trusses made for the palliative cure so imperfect, that
numbers of the people who are far advanced in life have
them to an amazing size, and, not unfrequently, retire
into monasteries to end their days, because their ruptures
render them almost incapable of labour, and ever of tak-
ing moderate exercise.
But notwithstanding the lower classes of people, in
this country, lead very laborious lives, they undergo a de-
gree
of labour, with little inconvenience, that men, who
are not accustomed to the same kind of life, could not
support themselves under without making the greatest
exertions: the former are used to it from their infancy,
their constitutions acquire strength proportioned to their
labour, and they are not affected by many of those acci-
dents that occasion ruptures in more effeminate men:
their laborious lives form a kind of routine which they
constantly go through with very little exertion, or, when
obliged to exert themselves, their natural strength enables
them to do so with very little danger; for this reason it
is that we find the laborious part of mankind are not
troubled with ruptures in so great a proportion as those
of superior rank.
Still the number of labouring people who are afflicted
with ruptures is very great. When laborious people
have ruptures, they generally prove the worst cases that
occur in practice; because, if they do not feel immedi-
ately the symptoms of strangulation, they, in general,
either neglect them entirely, or do not procure effectual
relief; and, in consequence of this neglect, their ruptures
frequently increase to an amazing size, become incapable
of the palliative as well as the radical cure, and very
often destroy the patients. When a rupture is once
formed, every, even the most trifling exertion, and
almost every motion has a tendency to increase it; and, if
it is not properly treated at first, will render it trouble-
some and irreducible; and the patient will from that mo-
ment be constantly in danger, without a possibility of
being relieved, except by one of the most important ope-
rations of surgery.
It is well known that many of the worst ruptures are
found among sea-faring people: because, the life of a
sailor is not uniformly laborious; it is a life of alternate
ease and violent exertion: as they are so often obliged to
exert

exert themselves much beyond their natural strength, it is
by no means surprizing that they should sometimes get
ruptures; this generally happens when they are at sea and
can get no assistance; as they are, besides, obliged to per-
severe in their labour, a repetition of the action that pro-
duced will continually increase the disorder: this is the
natural consequence of neglect in every case, and therefore
cannot be considered as a circumstance peculiar to them.
For these reasons their ruptures are generally worse; but
if an exact calculation could be made, it would, perhaps,
appear that they are less frequent among sailors, in pro-
portion to their numbers, than they are among any other
set of men, unless it should be supposed, that a very great
number of them have the disease without being conscious
of their situation.
*
A rupture may enlarge itself gradually, from the time
of its first appearance, until it has attained to a consider-
able size, or, it may be produced instantaneously to a
very great extent. If its progress is gradual, and it be
an inguinal hernia, it will, at first, form a small tumour in
the groin; this will gradually increase and extend itself
into the scrotum; and will, if still neglected, grow to an
enormous size. I have seen a patient with a double rup-
ture; which extended the scrotum and skin of the penis
so as to form one large sac, and obliterate all appearance
of the particular parts.
This case could only have been produced in conse-
quence of continual neglect, for, if it had been attended to
at its first appearance, if the palliative cure had been judi-
ciously performed, it would never have grown larger than
it was the first day, and by persevering in the palliative
a radical cure might have been effected; every patient
who neglects even the smallest rupture is liable to have it
increase to the same size with the above-mentioned, and
he will be in danger of falling a sacrifice to his neglect,
in consequence of the strangulation that may at any time
come
* In Sir John Sinclair's Essay on Longevity it is observed, "the
"number of ruptured men among the in-pensioners of Greenwich
"Hospital, on the 3d of May, was 161, or 1-15th, the number being
2,410: among the out-pensioners, amounting to 2,500, the number
"was only about 50, or nearly 1-40th." As there can be no doubt
respecting the accuracy of the above statement, and it is said that one
person in ten throughout this country has a rupture, (by some the num-
ber is rated still higher) if there is no exaggeration in this statement,
it is evident, that ruptures are less frequent among sailors than among
the bulk of the people.

come on, or in consequence of various evils that may be
occasioned by the viscera being removed from their natu-
ral situation.
A rup-
Perhaps every surgeon is convinced that the empirical author of
some essays on ruptures has invented cases to shew the fatal conse-
quences that are produced by neglecting ruptures: certain it is that he
has related such cases as never did exist as he has described them; the
cause that is once supported by falsehood will fall into discredit, and
therefore we may conclude that he has wilfully done more towards pre-
vailing upon patients to neglect their ruptures than all the ignorant
rupture curers in London; to counteract the numerous falsehoods of
this scribbler, and prove the importance of attending to ruptures that
are to appearance not dangerous, I shall not advance any thing more.
merely upon my own authority, but I will produce a case from a pub-
lication of unquestionable authority, the Edinburgh Medical Essays,
vol. 1. page 290:
"A gentleman about 63 years of age, of a gross habit, healthy
constitution, and regular course of living, had from his youth been sub-
ject to an epiplocele: about the year 1722, his appetite for meat began
to fail, and his body to waste; during his indisposition he had not muck
thirst, and was generally costive, till some weeks before his death that
a looseness came, not excessive nor accompanied with gripes, towards
the end of which, his stools had a mixture of some purulent matter and
a very noisome smell: his urine for most part was reddish, in smal
quantity, and let fall a gross red ground; he never complained of any
pain but what was occasioned by the piles, which went off in a week or
two without blooding. About two months before his death he was sen-
sible of a weight of his stomach, in which time also he observed the
hernia to increase much, and wis troubled with frequent belchings; the
three last months of his iliness he had great watchings: his pulse was
full, strong, slow, and hard, and his breathing easy and free till a few
days before his death.
"At the beginning of his indisposition he used no other medicine
but some gently purging and stomatic bitters, fearing that vomits might
increase the hernia; but his disease still going on, about the month of
July he was prevailed on to take a vomit of emetic tartar, and after
that several others, at due distance, and pretty strong, which brought
up with much difficulty a quantity of tough, heavy, thick phlegm, by
which he had some short relief; he used likewise bitter stomatic infu-
sions with and without purgatives, and also such medicines as were pro-
per to mitigate the most pressing symptoms. He used moderate exer-
cise in the country, a regular diet, and asses milk; but his body still
wasting, and his strength gradually failing, he died the 25th of Octo-
ber, 1723. Upon the 27th his body was opened.
"The first thing observable was, that upon cutting the teguments
of the lower belly there appeared little fat, and the fleshy fibres of the
muscles were almost entirely consumed.
"2dly. The abdomen being fully laid open there appeared very
little of the caul, and that reached scarce so far down as the navel, ex-
cept upon the left side, where more than the half of it had fallen down
to the scrotum, and was attached to the lower part of the left testicle,
the

10
A rupture may increase to a very enormous size, in a
very few years; in some cases its progress will be slower,
and, in others, it will never attain to a very large size;
but, except the inconvenience arising from the bulk of a
large rupture, the dangerous consequences, if neglected,
are equal in every case, as a very small rupture has been
known to prove fatal in less than a day. Sometimes, in
consequence of a blow, or of very violent exertions, a
large rupture will be instantaneously produced; such rup-
tures are, perhaps, more frequently cured than any others,
because the sudden production of the disease, and the
painful symptoms that often accompany it under these
circumstances, will impress patients with a just idea of
their
the annulus on that side being dilated so as to admit likewise two or
three fingers.
"3dly. By this falling down of the caul, the stomach, which was
very much inflated, and extremely thin and smooth, had been pulled
out of its situation, so that the pylorous tended obliquely downwards al-
most as far down as the right side of the navel, and the gullet entered
the stomach at an acute angle.
4thly. The liver was large, weighing about six pounds, and
reached under the left hypochonder, taking up that part of space the
stomach should naturally have possessed; upon its surface, and through
its whole substance, were white steatomous swellings, as also several
ulcers, especially upon the concave side.
5thly. The gall bladder contained a blackish bile, and the
ductus choledochus was so large as to admit two fingers where it en-
tered the duodenum.
"6thly. The pancreas was schirrous, but the mesenteric glands
were no ways indurated; these and every thing else in the lower belly
appeared to be sound.
"7thly. In the thorax the lungs were of a blackish colour, and
the first division of the bronchi in the left lobe of the lungs, there was
found a round hard body about the bigness of a filbert, outwardly as
black as ink; but when the membranous cover was removed, appeared
brownish, and was of a strong brittle substance, like to something he
had once spit up in the time of his sickness.
"8thly. The heart was extremely flaccid."
This case affords a striking proof of the necessity of attending to
ruptures that are, to appearance, not attended with dangerous symp-
toms. The patient had had it from his youth, it had never been pain-
ful, and therefore had been neglected, till it adhered to the testicle, and
consequently became irreducible; it increased in size till its action
upon the stomach ruined the patient's health, and, in the end, was the
cause of his death: these effects would not have been produced if the
rupture had been attended to when in its incipient state; few argu-
ments can be necessary to prevail on patients in similar circumstances
to avoid the same fate by proper attention to, even the smallest rupe
tures.

11
their situation, and induce them to pay that degree of at-
tention to it which can only secure them from the fatal
consequences of the disease: a precaution that is too
often neglected when it approaches in a more insidious
manner.*
Stricture upon, or strangulation, of a rupture may be
occasioned by the descent of a greater portion of the ab-
domenal viscera than had been down before, or, in other
words, by an increase of the size of the rupture; it may
be occasioned by contraction of the parts through which
the rupture descends, or, it may be occasioned by the pres-
sure of a truss which suffers the viscera to escape under it;
as this is, perhaps, not unfrequently the case, it is of the ut
most importance that every case should have a truss adapt-
ed to its particular circumstances, because, the patient's
safety, and often his life, as well as all the hopes of a radi-
cal cure, depend upon the efficiency of that application.
When a rupture is strangulated, the parts become in-
flamed, the patient is attacked by sickness and vomiting,
the intestinal canal, by its connexion with the hernia, is
prevented from discharging its contents; the inflammation
increases, and, if these symptoms are not removed in
time, a mortification takes place, and death is the inevita-
ble consequence.
The time in which this event takes
place is not the same in every case; a strangulation will
sometimes prove fatal in a few hours, and patients will
sometimes labour under it several days before its ultimate
consequence is produced.
A rupture may become strangulated † at any period
from the time of its first appearance; or, it may give the
patient
C 2
* Besides the dangers to which those patients are liable who have a
rupture come on in an almost imperceptible manner, it is necessary to
observe, that they are particularly liable to have a second rupture come
on the other side, opposite to that which has been reduced and retained
by a proper truss. I have seen this happen so often, that when a pa-
tient has got one rupture under the abovementioned circumstances, and
has an apparent fulness on the other side, I always recommend the ap-
plication of a double truss: and think myself justified in so doing, be-
cause when the approach of a disease is certain, it is more prudent to ap-
ply a prevention than to let it take place in order to render a cure ne-
cessary..
+ The larger a rupture is, the greater will be the danger from
strangulation; as the difficulties to be overcome will be in proportion to
its size; but a rupture of the smallest size has sometimes been known to
rove fatal within a short time after its first appearance.

12
patient no uneasiness for many years; the symptoms of
strangulation may afterwards come on, and the disease
prove fatal in a few hours. As, in such cases, adhesions
will generally be formed, no relief can be expected except
from the operation, which will be rendered more difficult,
and its beneficial effects more precarious, by those adhe-
sions; it is therefore evident, and cannot be too forcibly
impressed upon every patient's mind, that no rupture,
however trifling, or however destitute of painful or dan-
gerous symptoms, it may appear to be, should be neglect-
ed: because it is liable to become strangulated at any mo-
ment after its first appearance; and the danger of stran-
gulation producing fatal effects, will be increased in pro-
portion to the length of time the disease had been pre-
viously neglected; or, if strangulation is brought on by
improper treatment, the danger will be increased in pro-
portion to the time that such treatment is submitted to..
From what has been said, it is fair to conclude, that no pa-
tient who has a rupture, even of the smallest size, is free
from danger while that rupture is suffered to come down;
that continual neglect will render even the palliative cure
impracticable, and, in that case, the patient must be almost
entirely abandoned to the fatal effects of his disease; but,
that if the palliative cure is judiciously performed while the
disease is in its incipient state, the patient will be effectually
secured from future danger, so long as that cure is
applied.
Of the Cure of Ruptures.
Ilaving thus attempted to give a general idea of the
disease, its nature, &c. it will be proper to shew what may
be done to cure it, or at least to obviate its most dangerous.
symptoms, and place those who labour under it in as much
safety as the nature of their situation will admit.
Many opinions have been entertained with respect to
the number of persons who are afflicted with ruptures &
these opinions have, necessarily, been influenced by the
experience of those who have advanced them; and, in
some, perhaps, exaggeration has been occasioned by no
very laudable motives; it is probable that the fact cannot
be very accurately investigated, but, if the extent of my
practice, for many years, can enable me to form a just opi-
nion on the subject, I would say, as nearest the truth, that
one person in twelve, throughout this country, is afflicted
with

135
with a rupture: a very large proportion! Of these many
never seek for professional advice, till accident unexpect-
edly makes them acquainted with their dangerous situation,
but, many more, knowing they have the disease, and,
supposing they are competent to judge for themselves of
the remedy that should be applied, never seek professional
advice at all; but commonly fall a prey to empirics of
every description. It is to shew these the dangers they
expose themselves to, to caution them against the artifices
that are daily practised to deceive them, and to give them
that information which they will not obtain from those to
whom they habitually entrust themselves, that these sheets
have been written, and, if their future effect should be
equal to that which has already been experienced, I trust
they will not have been written in vain.
To be told that he has a dangerous disease, for which
no certain cure can be obtained, must powerfully affect the
feelings of every man, yet such is the unpleasant informa-
tion that every well-informed man must give to the pa-
tient who consults him about a rupture: he may add, that,
by using proper means, he may certainly secure himself
from the dangers that would be the consequence of ne-
glect; prevent the increase of the disease, preserve his
health, and continue as active, and for as long a period of
time as if he never had had the disease; he may go far-
ther and say, that out of a given number of patients who
have ruptures, a certain proportion, perhaps one in ten,
gets absolutely radically cured, they lay aside their trusses
and never feel the least return of their ruptures; but no
man in his senses will tell this or that particular patient that
he is the fortunate one who will be radically cured, at least
whatever may be his opinion as to the probability of such
an event, he will not mention it with the same certainty as
he would foretel the cure of almost any other disease.
Such information must leave the mind of a patient in a
very disagreeable state of suspense; and, it is not sur-
prising that, before he will submit to the sentence so pass-
ed upon his case, he should imagine that he has not yet ob-
tained the best advice, and resort to those whose promises
afford him stronger hopes of success.
It is not discreditable to the older practitioners in sur-
gery that they attempted the cure of hernia, it was their
profession to cure diseases, of course this, as well as every
other disease, was a legitimate object of attention. One
method was tried, and failed; another was adopted, and
with

14
some
with no better success; and thus every thing that could be
suggested by conjecture, false theory, foolish speculation
or mere guess, was alternately recommended, tried, and
uniformly failed: as anatomy was more generally studied
and better understood, a spirit of investigation led *
eminent surgeons to examine the state of the parts, and to
demonstrate, in consequence of this examination, that a rup-
ture could not be radically cured by any exertion of the
surgical art. From this period, it became the general, in-
controvertible doctrine of the profession, that those who
have ruptures can only depend, with certainty, upon a
palliative cure, and that a radical cure, when it does take
place, is always the consequence of those means which are
used to effect a palliative cure being regularly, uniformly,
and perseveringly applied.
Such being the uniform and well-founded opinions of
well-informed professional men upon this subject, those
empirics, whose object is to prey upon the credulity of
those to whom professional men cannot, from the nature
of the diseases they labour under, render all the assist-
ance they require, found that patients who are afflicted
with ruptures were peculiarly adapted for their purpose;
hence the public was annoyed by impostors, who pretend-
ed that a rupture was, by methods known to them only, as
curable as any other disorder, &c. &c. but as the gradual
extension of truth, by the exertions and perseverance of
professional men has exterminated these, † there will be no
occasion
*No man was more eminent on this account than the late celebrated
Mr. Pott, and of all the labours of his very useful life, none was, per-
haps, more conducive to his reputation, or more serviceable to society
than the publication of his treatise on ruptures; it threw a light on the
subject which put an end to the confusion in which it was till then in-
volved, and laid a foundation for the extermination of that host of im-
postors, who, under the pretence of curing ruptures defrauded, in-
jured, and sometimes murdered those who placed themselves in their
hands.
† An account of the practices of some of these men may not be
without its use, as it may caution the unwary not to trust the promises
of similar impostors should such ever again make this appearance.
One of the last was a Mr. Lee, he had been bred to surgery, and
applied himself particularly to the treatment of ruptures, his first doc-
trine was that every rupture might be radically cured by an operation
in some respects like the operation for bubonocele, or, as the common
people express it, cutting for it; his practice was to perform that ope-
ration, not to relieve strangulated hernia, but to cure the rupture of
every

15
occasion to enter into the detail of such facts as would
prove the fallacy of those pretences that were used to de-
fraud, under the pretence of curing the credulous and un-
wary, as it is now well known that the radical cure, when
it does take place, is effected by the same means that are
used to perform the palliative cure, it is time to proceed to
that part of the subject.
Of the Palliative Cure.
When the parts, which have descended to form a rup-
ture, are returned into the abdomen, and are there secured by
a proper truss, that rupture is said to be palliatively cured,
because the rupture does not descend so long as the truss is
kept in its proper place: when the parts are restored to
their natural state, so as to remain there, without the
assistance of a bandage, the cure is said to be radical,
or compleat.
As the cure of a rupture, in either sense, depends en-
tirely upon the truss or bandage, that instrument becomes
an object of considerable importance; much ingenuity has
been exerted in constructing trusses in various manners;
much imposition has been practised, under the pretence of
selling new inventions of this kind; so much indeed, that
since the cxtermination of the rupture-curing quacks, ig-
gorant, unprincipled venders of trusses are the only em-
pirics,
every patient who would place himself under his care; and his prac-
tice proved the truth of his doctrine, for very many of his patients
were radically cured of all their complaints. I know one gentleman
who had been his patient: he had a large omental hernia, there was
neither stricture nor adhesion; but as he was in the prime of life he
disliked the thoughts of passing through life with a troublesome com-
plaint, and therefore placed himself under the care of Mr. Lee, who
divided the integuments, and hernial sac, cut off almost all the omentum
that had protruded as well as the hernial sac, and only returned that
portion which had protruded, and sewed up the orifice to close the sac.
Fortunately he survived this operation; he is still alive, and from the
time he got well of the wound to the present moment he has been
obliged to wear trusses, so that he gained nothing by all the pain
he suffered and danger he went through, but a thorough conviction
that his rupture was incurable, and that he had run the most eminent
risk of his life, by relying on the promises of an unprincipled villain.
The death of several patients, who were less fortunate than this
gentleman, excited so much attention, that Mr. L. changed his plan,
and instead of committing murder, was contented to be guilty of fraud,
for the rest of his life he pretended to cure ruptures by the application
of astringent washes, bandages, &c.

16
pirics, are the only persons who now prey upon the rup-
tured patient, who seems, by a singular fatality, to have
been marked from the beginning as a perpetual victim to
imposition and fraud. As this is the case, it seems to be
desirable that so much should be said on the subject as will
enable those who are interested to form a just opinion of
it, I shall, therefore, enter so far into the history of these
bandages, as will enable those to whom the subject is of
importance to form a just opinion upon it. What is a pro-
per truss? That is a proper truss for any patient which
enables him to keep up his rupture perfectly, without suf-
fering any injury, and with as little inconvenience as the
circumstances of his particular case will admit of: accord-
ing to this definition, any truss, however imperfect it is,
or however defective the principles on which it is con-
structed may be, if it answers the purpose for which it is
used by any patient, is to be called a proper truss; this
definition, so far as it relates to any particular case is cer-
tainly just; for if a patient obtains that which is his prin-
cipal object, if he keeps up his rupture, and if in so do-
ing he accommodates himself to bear, and to feel himself
comfortable under the pressure of circumstances which a
professional man, reasoning generally on the subject,
would call inconveniences or defects, it is certain that he
could obtain, no advantage by leaving the kind of truss he
had been accustomed to, and adopting those which he may
be told is different from, or better than his own : on the
contrary, it is probable that the difference between that
which he has been accustomed to, and that which he is
prevailed on to substitute in its stead, would be unpleasant
to him, and he must go through the disagreeable task of
reconciling himself to the change before he can be as easy
as he was before: as this would be so much pain and trou-
ble incurred for no adequate end, it would be needless to
persuade any one who feels perfectly satisfied with the
truss he is accustomed to, to lay it aside for one that might
justly even be called better.
On the other hand, if any person who has worn a
truss of any particular kind should advance, that because
HE is perfectly satisfied with it, it is the best and most
perfect that can be used, notwithstanding substantial reasons
may be given to prove it is defective in many particulars,
his assertion would be too ridiculous to deserve a serious
answer; but those who feel inconveniences from the use
of trusses which they wish to avoid, or those who are be-
9
ginning

17
ginning to use them will be glad to learn which is
the best and most likely to answer their purpose; for
their information a sketch of the history of these bandages,
their progress towards perfection, and the variations that
have been made in them will be attempted.
On reducing a rupture, and keeping the hand upon
the aperture through which it had extruded, it would be
found that the rupture did not return, so long as the
hand was kept in that situation; but the hand cannot be
always so employed, and this, perhaps, first suggested the
idea of employing a bandage for the same purpose, the
simplest bandage, and that which would obviously be first
suggested on such an occasion, is formed by passing a belt
round the body, and fixing a pad or cushion of some firm,
perhaps incompressible substance between it and the aper-
ture through which the rupture had protruded: it was ex-
pected that this contrivance would keep the aperture
closed and prevent the extrusion of the parts; but a little.
examination will discover sufficient reasons to shew why
it could not do so in the greatest number of cases in which
it was adopted.
If a belt is firmly fastened round a body of regular
figure and uniform substance it will press equally in its
whole circumference; but this is not the case with that
part of the body on which a truss is worn: even in the
cae of a fat man whose body appears to be round, the
bones of the pelvis form various projecting points in the
direction of the truss, which, when it is fastened, galls
those parts so as to excoriate the skin and give insufferable
pain; this objection relates only to the uneasiness of such a
bandage, but more forcible ones are made to its inefficacy.
The injury produced by a rupture is local, confined
almost to a point, but the pressure made by a belt is uni-
form in the whole circumference of the body; to remedy
this defect the pad is introduced to produce the pressure
immediately. on the part, but it does not do so to the ex-
tent that is necessary, and in many cases not at all. For
example; if the body was hard, and the pad incompressible,
it would keep the belt at a distance from the body where
it lay between them; if the belt was hard and incompressi-
ble, as well as the pad and the body soft, then would the
pad be forced into the aperture by the resistance of the
belt, and answer the intended purpose so far as the pati-
ent could bear that kind of pressure: but in the case we
are considering, the belt and that part of the body upon
which
D

18
which pressure is to be made are equally soft, and the pad
being interposed, is merely kept in equilibrio between
them in very slight cases, or where the patient is in bed,
or otherwise at rest, this may be sufficient; but it never
was in any bad case, or where the patient required to
use much exertion: the moment such a patient begins to
walk, or make any effort, the rupture descends; if, in hopes
of preventing, he fastens the bandage tighter, he produces
pain upon the hips, &c. without obtaining the effect he
desires. Some persons imagined they could obviate this
defect by introducing spiral and other springs into the
pad, which they said would produce more pressure imme-
diately on the part: they only forgot to add, they would
do so when a point of resistance was found from which that
pressure would be brought to act; but so long as the belt
continues of soft, unresisting materials, the spring is
merely suspended between it and the body, and is liable to
all the inconveniencies of the common pad; it has been
tried, and exploded as totally inadequate to the purposes
for which it is intended.
This being the case, it may be thought useless to en-
ter into this disquisition on its defects: but it is necessary
to observe, that though numerous variations of this kind of
bandage were tried and exploded more than half a cen-
tury ago, some persons at the present time, either not
knowing, or not caring about this fact, having busied
themselves in obtruding such things on the world as new
inventions; it is not necessary to draw them from obscu-
rity by more particular notice, but it is hoped, that this
investigation of the general principle, which applies to
them all, will enable those who are interested in knowing
the fact to see why these pretended new inventions are not
found to answer the expectations of those who are induced
to try them.
The universal failure of those attempts that were
made to support ruptures by bandage, either simple or
with springs of various kinds in the pads, at last led to a
farther improvement in the construction of instruments for
this purpose, viz. to make that part which went round the
body of some firm, unyielding substance, that might op-
pose an invincible point of resistance to the extrusion of
the rupture, and thus effect the desired purpose: the con-
trivance hit upon, was to make that part, which goes round
the body, of iron or steel so strong, that when fitted round
the patient it made the pad squeeze so close upon the
aperture

19
that
aperture, that, it was said, it would be impossible for any
part of the rupture to extrude: it is true that it would
have been impossible, that a rupture should come down
when supported by such a bandage, but it is equally true,
the pressure from these trusses is from its very nature so
tormenting that few patients could bear them at all, and no
one could wear them with any satisfaction: this induced
attempts to diminish the pressure, and the consequence
was, in such cases, a descent of the hernia which then was
compressed under a strong iron bandage, and inflammation
and all its terrible consequences produced. Contrivances
were attempted to vary and modify the pressure, but with
no better success; in short, between the insufficiency of
bandages of various kinds + and the torment of iron, (vul-
garly at that time called) steel trusses, the situation of
per-
sons who were under the necessity of using them, was more
generally deplorable than can now be imagined.
About the year 1733, some person in France invented
a method of making trusses with a circular steel spring
round the body, instead of the iron hoops which till then
had been used; the improvement was important, and was
soon so generally adopted, that, it is known from in-
controvertible facts, trusses were made upon this plan by
those
D 2
* Agreeable to my plan I now merely discuss the general principle;
which was not altered by any of these contrivances; they consisted of
screws of various kinds, and other methods of turning the pads in various
directions, but still, when varied, the pressure was always produced in
the same way. It is needless to enter into a particular description of all
these methods, but it may be proper to observe that many of them have
been revived in the present time with all the pomp and parade of new
discoveries. Compare them together, and let the experience of the an-
cients demonstrate the merits of the moderns in this respect.
+ The curious reader will find in the Adventurer, a paper upon
this
subject; it relates to one Woodward, the last of the bandage making
impostors, if we except old Lee who adopted the use and abuse of them
after general clamour had driven him from his peculiar practice.
+ In the Edinburgh Medical Essays, published, I think, in 1737,
it is observed, that a paper is inserted in the Memoirs of the French
Academy for the preceding year, which contains the description of a
spring truss, which the author considers as a new invention, not know-
ing, says the Edinburgh writer, that spring trusses are commonly used in
this country. This assertion seems to invalidate Blakie's claim; bur,
when it is considered that iron trusses were, at that time, commonly call-
ed steel, or spring trusses, it is evident that the Edinburgh writer did not
understand the difference between them and the elastic truss, at that time
newly invented.
I have

20
those artists in London who were best informed on the sub-
ject: in the year 1764, however, a Mr. Blakie, who had
lived long in France arrived in London, and offered this his
invention, as he called it, to the public notice and published
a small pamphlet, in which he describes the principles on
which these trusses were constructed: the public, however,
was in possession of this invention before his arrival, and,
as he was a man of much ingenuity, and more modesty than
many who have since obtruded themselves upon the world,
he shortly returned to the Continent.
From the first introduction of the elastic truss, till the
year 1780 and 1781, no alteration whatever was made in
the principle upon which trusses were constructed; new
inventions, as they were called, were brought forwards, but,
upon a candid examination it will appear, that these were
either different modifications of form (this subject will be
noticed hereafter) adopted by different people, or they
were only the impudent attempts of ignorant unprincipled
men to draw the eyes of the public on themselves: indeed
the empiricism of which ruptured patients have always been
the dupes, seems, from this period, to have taken a different
direction: the labours of Pott, the Hunters and their
cotemporaries had fully demonstrated the nature of the
disease: this had, in fact laid a sure foundation for the
destruction of quackery upon that subject; but, as empi-
rics do not easily part with profitable subjects, those who
wished to play upon the unfortunate of this description,
found the application of trusses was the engine by which
their operations must be carried on; we are, on this ac-
count, to find quackery with respect to ruptured patients is
now
I have not seen that paper in the French Memoirs which is alluded
to by the Edinburgh writer, but I have seen, in a translation of select
cases published by Cave, in 1750, a paper by Mr. de l'Aunay, with a
plate, in which is described and represented an elastic truss, constructed
upon the same principles as those made by Blakie, by others in England
before him, and by every one since that time who has any just claim to
skill or knowledge on this subject.
Whether Blakie or de l'Aunay was the real inventor, or whether
the former only claimed the title upon his arrival in London, is a point
that cannot now be determined: but it is certain that, however the fact
may be, the invention was known in London before his arrival: it was,
perhaps, generally adopted soon after the date of Cave's publication; as
it was proved, on the trial between Brand and Reid, that elastic trusses
were made in London so early as 1756. Blakie's pamphlet is dated
London, 1764. Brand's pretended invention is dated Aberdeen, 1764.

21
now chiefly carried on under the pretence of applying new
invented trusses, it is therefore proper to collect such infor-
mation on the subject as may put the inexperienced patient
on his guard with respect to it.
The elastic truss, instead of the simple belt of the
common bandage, or the stiff iron circular of the old fash-
ioned truss, has a circular spring which goes round the
body; this spring is so formed as, by its re-action when it
is properly adapted and applied to the part, to press the
pad upon the opening through which the hernia has de-
scended, and thus prevent its farther extrusion so long as
the truss is in use: and it should be so modified at the
same time that it does not cause any uneasy sensation in
consequence of the variation of size in the abdomen which
is continually taking place in respiration. It is this pecu-
liar action of the elastic truss which Mr. Blakie had in view
when he wrote the following passage.
"It has been said, that the most natural remedy for
ruptures is that of applying the hand to the part where
"the pain is felt: but as that remedy cannot be perma-
66
(C
nent, a bandage must be put on, not only to supply the
"functions of the hand, but to exert a continual pressure
"against the rupture, and thereby compel the parts which
"form it to remain constantly in their natural place.
"Such a bandage will adjust itself to every motion of the
"body, without giving pain, and neither gall the loins,
nor hips, or any other part it is in contact with. "Tis, in
short, a bandage that imitates the kind pressure of the
"hand in all its degrees." (Blakie on Ruptures.)
46
This was the description of the original inventor, after
he had had more than thirty years experience of the effica-
cy of his invention; after that invention had been gene-
rally adopted by others in this country; and, as the uni-
versal experience of all professional men of eminence for
half a century since has proved the superiority of that prin-
ciple over every one that preceded it, it may seem like
waste of time to enter more minutely into this part of the
subject: but when it is known that some attempts are
made, to revive the use of those bandages which were ex-
ploded by the introduction of this; that these exploded
bandages are most ignorantly or more impudently intro-
duced as NOVELTIES by persons who attribute to the clas-
tie truss those defects which it never can possess imless
made by very ignorant men; but which are the insepara-
ble companions of those bandages which they endeavour to
revive,

22
revive, it becomes very necessary to investigate the prin-
ciple of the elastic truss, the defects it really has, and those
that are falsely attributed to it by those who may be inte-
rested in its depreciation, and incompetent to judge of its
merits.
The elastic truss, then, consists of a circular spring
which goes, in some cases, entirely round the body, but in
others only in part; but, in every case it must go so far
round as to form a solid rest or basis from which the pad
is to act by pressing on the proper part: this pressure is
made by the spring which is set in a form as nearly circular
as the form of the part it is applied to will admit, and pro-
duces its pressure by contracting in a horizontal direction
round the body, and by this means producing its full effect
by pressing the pad directly on the part upon which it lies.
If the truss be properly adapted, and skilfully applied, it
will, in many cases effectually answer its purpose; but, if it
is imperfectly constructed, or injudiciously applied, it will
fail, and then the patient will be in a worse situation than if
he had no truss. There are various modes of constructing
elastic trusses, but by those who are conversant in the sub-
ject, the general principles on which they should be con-
structed are reduced to two. viz. 1st. They should be so
constructed as to keep up the rupture of every patient ef-
fectually, and to be in every case as easy as is consistant
with the circumstances of that case: and, 2dly, they should
not only keep up the rupture effectually, but should pro-
duce so much compression of the parts as may, if it be pos-
sible, cause a permanent union and thus constitute a radical
cure.
Of Timbrell's New Inventions.
Various objections have been made to the elastic truss;
some fairly arise from defects in the principle upon which
that instrument is constructed, and must act; others are the
consequence of misapplication of trusses by ignorant men,
and others originate with men who have a plentiful stock
of ignorance of the subject, and are determined, if possible,
to substitute some other article that will be more advan-
tageous to themselves, however it may be to their patients.
The former objections will be considered in a different part
of this work, at present those which may be supposed to
come

23
come under the latter head will be examined, and as these
persons boldly proclaim the superiority of their peculiar
bandages over that which they endeavour to decry, it
will be perfectly fair to pursue the comparison which they
have been forward to make, and by an accurate examina-
tion of their pretended discoveries, shew how far they are
entitled to that notice they are so clamorous to obtain.
The first, on account of its actual insignificance, and
the artifice and perseverance with which it is obtruded on
public notice, is what is called New Inventions, and Direc-
tions for ruptured Persons, said to be written by a gentle-
man of fortune without any view to private emolument,
and who merely publishes his discoveries to serve the un-
fortunate, and dedicates the profits of his pamphlets (which
are charged enormously high even according to the
sent price of printing), to charitable purposes.
pre-
It is a fact more creditable to the feelings than to the
penetration of Englishmen, that when any claim is made
upon their purses for the purposes, or under the pretence of
charity, their hearts expand, and they willingly pour their
wealth into the hands of those who shew them objects on
which their benevolence may be exerted, without suppo-
sing that a knave may embezzle the money which they
give for the most laudable purposes, or that an impostor
may ask it for purposes to which they never mean to em-
ploy it. It is to this peculiarity of disposition that we owe
the numerous establishments which are dedicated to the
service of the poor, and would do honour to human nature
wherever they existed, and it is from the same peculiarity
that we see frauds sometimes successful which would not
impose on the most credulous for a moment, if they had
taken the trouble to examine the proposals that had been
made to them by the plain standard of common sense:
whether the work now under consideration is to be fairly
included under either of those heads, may perhaps be de-
termined by the following circumstances.
The author describes himself as an independent gen-
tleman,
*Fifty-two pages, very loosely printed, price 2s. Appendix, 37
pages, ditto, price 1s. 6d. but who would scruple to pay so much for the
work of a gentleman of easy fortune when the profits are to be bestowed
for charitable burposes, and he may save his own life into the bargain, by
learning so much about ruptures and calico cushions, &c. &c. &c.!!!

24
tleman, who has suffered from a rupture, and having found
the insufficiency of the methods usually employed, has in-
vented, discovered, or adopted such as he has found effec-
tual, and therefore, now gives the fruits of his experience
to the world merely for the benefit of unfortunate fellow suf-
ferers, without the most distant expectation of deriving any
advantage to himself from the communication.
It is an axiom in sound criticism that no man is to be
blamed because he has not done that which he did not un-
dertake to do; or because he does not understand that
which he does not pretend to be acquainted with: the au-
thor before us is to receive the benefit of that axiom to its
fullest extent; he does not pretend to be a professional
man, therefore it is not to be supposed that he understands
all that a professional should know on the subject; but he
does pretend to communicate important information which
has eluded the grasp of all professional men, and which he
has acquired by studying his own case; that case he has
described; if truly, a professional man must understand
the description and admit it is true, or prove its fallacy;
and if an examination of the history of that case proves
that its author has any knowledge of that which he pretends
to describe, it may be necessary to enquire how far the con-
clusions he attempts to draw from it are entitled to farther
notice.
He says (p. 2, 1st. edit.) "From my earliest remem-
brance, I recollect a particular formation in my left testes,
which was in an artificial sac: at the age of twenty two,
"riding on horseback, both the omentum and intestine de-
"scended into this sac, and was there incarcerated many
hours with dreadful agony. I DID NOT THEN KNOW
"WHAT A RUPTURE WAS, my surgeon, in the country,
"who reduced it, sent me to a truss-maker in London,
"who was one of the best; he made an excellent formed
" truss. The late eminent Mr. Pott, surgeon, to whom
"the world will ever be indebted, inspected and approved
"the old mode of putting on this truss.
"I found this truss of little use; the thigh strap,
" which was of cotton, was not fixed to the hoop, it hitch-
❝ed on a brass nob, 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 stricture, particularly about three years ago in Dub-
‹‹ lin,

25
66
"lin, and expected my death for two days, preferring,
"that, to the operation of cutting.
"Nausea, sweats, shiverings, cramps in the legs, en-
sued, death was my only prospect when suddenly and
unexpectedly, possibly from the fomentations used by my
"surgeon, the rupture became reducible, and as far as I
able to form an opinion, a novel case, happily for me,
"occurred. The rupture was of that species, called HER-
NIA CONGENITA; and the INFLAMMATION has, as far
" as I can judge, DETACHED the omentum from the
am
66
66
"testis.
66
"The omentum is now reducible; and since the im-
provements, the rupture never descends into the sac,
"except when the truss is removed, and then it comes
"down to a great size. So powerful are the combined
"effects of my improvements that, with safety, I perform
"the most violent exertions on foot and horseback, both on
"the road and hunting."
66
This is the author's case, and a most singular one it is:
he has truly said, (IF the case is true,) it is a NOVEL one,
but whether it be happily so for him, may at present admit
of some doubt. 20
I would ask, with all becoming gravity, How he
came to recollect that there was a particular formation in
his left testis which was in an ARTIFICIAL SAC, FROM
HIS EARLIEST REMEMBRANCE, that is from the time
he was a little tiny boy? Did he ascertain the fact
by accurate comparison with every other little boy who was
equally curious on the subject? Or did his mamma, who
might have some natural, though no professional knowledge
of these things, compare his left testis with such others as
she was acquainted with, and fix an idea of the difference
indelibly upon his sensorium at the time she nourished him
with her milk, and thus give him all the benefit of intuitive
knowledge without having recourse to any experimental
enquiry? Leaving this knotty point to unravel itself, it may
be sufficient to state the following few facts respecting Her-
nia Congenita.
The testicle is originally formed within the cavity of.
the abdomen; about the time of birth it descends into the
scrotum carrying before it a portion of the peritoneum
which soon closes round the spermatic cord, and thus forms
the tunica vaginalis propria testis: if a child gets a rupture
before that portion of the peritoneum has closed found
the
E

26
the cord it descends into the same sac, that is, the parts
which form the rupture are in immediate contact with the
testicle, and the tunica vaginalis propria testis constitutes
the hernial sac. But, if at any after period, the rupture
takes place, that rupture carries before it a distinct por-
tion of the peritoneum which forms the hernial sac, and
the testicle remains within its own proper tunica vaginalis:
in other words, it is absolutely impossible that any person
should have a hernia congenita, unless he got it at the time
of birth or within a very short time afterwards. What then
are the facts of this novel and undoubtedly wonderful case
supposing it to have actually existed?
The writer at the age of twenty two, got a rupture by
riding on horseback, at which time he did not know what a
rupture was: all this may be true, and, if it is, proves in-
contestibly that it could not be the hernia congenita: whe-
ther he is a weak minded patient who has pored over books
which he does not understand, till he has frightened himself
into a belief that what he relates is true, or whether he is a
person who writes with the less laudable design of alarming
others it may not be easy to determine, but it is evident
that the whole narrative is a collection of circumstances
awkwardly put together in a way that might justly create
surprize; and considered in this point of view, he certainly
has gained his end: whatever the writer may be, the idea
of forcing or detaching the omentum from the testis, was so
conveniently horrid that he naturally endeavoured to make
the most of it, though, except in one particular, he has not
been very fortunate in the attempt.
ONE NOVELTY at least this gentleman has brought
into notice: the Potts, the Hunters, and SUCH FOOLISH
people as have undertaken to instruct young men in the pro-
fession of surgery, informed us that inflammation in parts
which were in contact with each other frequently produced
adhesions between them, and every well informed surgeon
has uniformly believed this to be true; but W. H. T. Esq.
has discovered that inflammation separates parts that have
adhered, or, to use his own words, DETACHED the omen-
tum from his wonderful left testis that was from his earliest
remembrance placed in an artificial sact. And this won-
derful
If we were disposed to be jocular on so serious a subject,
we might ask who made the artificial sac, and who put the testicle
into it a

27
derful discovery must work a great revolution in every
part of surgery, for as every point of practice that is con-
nected with inflammation is adapted to that principle which
has been thought to be true, and W. H. T. Esq. has dis-
covered that the reverse of that principle is the truth, it
follows of course, that all the practice must be reversed, in
order to accommodate it to the principle he has dis-
covered.
As every writer is entitled to the benefit of his own
corrections or repentance, it will be proper to mention that
the preceding observations were made on the history of his
case as it appeared in the first edition; in the second some
alterations have been made, viz. he says nothing of his ear-
liest REMEMBRANCE, and it is very singular that he should
have forgot in two years, what had made so strong an im-
pression on him all the former part of his life. Are we to
believe, from this circumstance, that his imagination was
stronger than his memory, and induced him to believe that
he remembered what had never existed in reality? And that
some better information that he may have collected since
he has volunteered as a doctor for ruptures, has convinced
him of the prudence of preventing others from recollecting
this powerful act of his juvenile remembrance?
Instead of saying the inflammation has detached the
omentum, &c. he says, in the second edition, the irritation
has detached the omentum from the testis: as an admirer
of new discoveries, I most fervently wish this is not to be
construed into an acknowledgment that the forementioned
discovery of the effects of inflammation is a mistake; yet
what other interpretation will the passage bear? Does he
mean to insinuate that as the omentum and testicle were
most unnaturally joined together, their union was like that
of an ill assorted man and his wife whose connexion could
not be dissolved by gentle methods, who would not live
happily together but were continually bickering, till at last,
in a fit of irritation or violent passion they burst from each
other with a resolution never to meet again.
If the reader should imagine that more attention has
been bestowed on the history of this case than its impor-
tance merits, he must be requested to remember that the
author PRETENDS to no more knowledge than his expe-
rience in this case will afford, therefore if there is a neces-
sary connexion between the foundation and the super-
structure it is necessary to probe this case to the bottom,
to see if the facts of the case are of a nature to afford so
E 2
much

23
much knowledge as will enable the author, by virtue of
it only to commence infallible doctor of ruptures, and cor-
rector general of all professional men and others who may
be any way concerned in the treatment of the disease, or
whether the whole is a quicksand that will soon let the
building, he endeavours to raise on it, sink into everlasting
oblivion.
Of the case there will be, perhaps, but one opinion;
it will therefore now be proper to examine what this Gen-
tleman calls his NEW INVENTIONS, which he so strenuously
claims for himself the merit of introducing to notice: these,
he says are,
1st. That the circular spring, or "hoop part of the
truss, as he calls it, should be in a true circular line with
"the pad," (p. 9) and not in any kind of oblique di-
rection.
2dly. The thigh strap should be made of wash leather,
lined with thin tapes to prevent its stretching; the end, ad-
joining the buckle to be of neat's leather, the thigh strap to
be sewn with strong thread well waxed, to the hoop part of
the truss; and buckled by a double tongued buckle which he
has invented to the bottom part of the pad, and
3dly. A calico cushion, invented by him, and which
he considers as an universal remedy for all ruptures.
He begins the first part of his subject by quoting the
elegant adage between two stools, &c." which he ex-
plains, by saying, "such is the unfortunate situation of the
"wearer of trusses; the art of putting a truss on the hu-
man body appears so easy and simple as not to be con-
"sidered as any art. Few truss-makers are men of science,
and SURGEONS HAVE NEVER SCIENTIFICALLY CONSI
DERED THE SUBJECT *."
米​”
Those
66
*The conclusion of his sentence, which is here added, that he may
not complain of misrepresentation is "rules of science, of common rea-
66
son, and the immutable laws of motion have not been thought of.
Ruptures descend, and patients die." On this, as on the former oc-
casion, I quote the first edition of the work, because, when a man deli-
berately writes for publication, he probably writes seriously that which
is consistent with his real intention; but, when he corrects that which he
has already published, he may be actuated by other motives, a desire to
conceal that which he did not intend should meet the general eye, a fear
to offend, or a hope to conceal his own ignorance, may tempt him to give
a different
66

29
Those who have the means of knowing the secret his-
tory of many of those people, and of the mischiefs frequently
occasioned by their ignorance and presumption, will readily
allow that the first part of his assertion is true; but is it not
singular, that in the present state of their profession, sur-
geons (i. e. no one surgeon) have never scientifically con-
sidered this subject? This is a charge laid against the whole
profession, that they are ignorant of the proper method of
treating a dangerous disease, that is as common as any that
afflicts the inhabitants of this country; and who, it may be
asked, has scientifically considered the subject, if gentlemen
in the profession of surgery have not? the only answer to
be drawn by fair induction from the insinuations of this
person is, that no one but himself has so considered it; an
answer that is equally sensible, modest, and TRUE.
Such is his introduction; he then proceeds in the fol-
lowing words: "The usual mode of wearing the truss is,
"for no one reason in the world, but from an old custom-
"to raise the hoop parts on the hips several inches higher
"than the pad part, by which method a false line of action
"is adopted, and of course a small pressure on the aper-
"ture. The hinder part of the truss is always put many
"inches too high." It is not meant to insinuate that no
individual has ever made or applied a truss in the manner
that W. H. T. Esq. here reprobates, because it will shortly
be proved that one person has done so, but it will be proved,
that when he said that this was the usual mode of wearing a
truss from an old custom, he said, what was not true. About
the year 1764, one Brand procured a patent for a truss,
which he pretended was his invention, and his trusses were
always made to lay in a direct line with the pad round the
body; Brand's son, afterwards, made trusses, always in the
same manner: the old man prosecuted several persons for
infringing his patent, but on the trial of these causes it came
out that there was no one point either of general principle,
or
a different turn to what he had previously written. Thus W. H. T.
Esq. in his second edition omits his elegant proverb, and his false and
scurrilous reflection on surgeons, by which he puts himself in a dilemma
of which he is entitled to receive the full benefit; if, when he wrote his.
first edition, he did not know that the insinuation contained in that reflec-
tion was false, he was too ignorant to write with propriety on the subject:
if he did know it was false, he must have emitted it for purposes that
render him too contemptible for notice.

30
or modification of principle, that was new in Brand's trusses;
they were in every respect like those that were made by
every person who made trusses at that time, and therefore
Brand was non suited.
Here then is evidence that what W. H. T. Esq. says,
is the usual mode of wearing a truss from an old custom, was
unknown, and what he modestly brings forward as a new
and effectual discovery of his own, which he intends shall
root out the old custom, was the general, the invariable
practice forty years ago, and an application to any person
who is acquainted with the profession since that time, will
convince any enquirer that it has been the general practice
ever since; and a singular confirmation of this fact will be
obtained from a quarter where it could be least expected.
Mr. Turnbull, who has attempted to establish a charity
for the joint benefit of the ruptured poor, and himself
sayst, "I think it necessary to mention one improvement,
which, in the course of my practice, I have been induced
6 to prefer.
"Those employed, in general, often produce consider-
"able
*Lest, in this age of disinterestedness, it should be thought I bear
hard on Mr. Turnbull, by insinuating that he had any regard to his own
interest in this undertaking, I beg leave to produce the following proof,
To Mr. T. Sheldrake,
Sir,
As several of my friends have some intention to establish an insti-
tution for furnishing the ruptured poor of both sexes with trusses, we
wish to know from the best calculation, what are the proportionate num-
ber of individuals ruptured in this kingdom-is it one person in 10, 15,
or 20?
Knowing that you have paid some attention to this subject, and
which I have read with pleasure, to whom then could I better apply for
such information?
I am Sir,
Yours, &c.
Fen Court.
P. S. Your early answer will much oblige me.
Here then is positive proof of certain facts, viz. that certain friends
of this Mr. Turnbull, without knowledge or information on the subject,
had some intention of establishing such an institution; and, that he
employed himself in begging what information he could get to enable them
to draw up a plan with truth or plausibility enough to set the scheme a
going: and it is no unfair inference to suppose, that by such conduct,
they meant to serve him, and he meant to serve HIMSELF.
68
In due time a society was established, and to a publication called
a few General Rules, &c." was prefixed a dedication, of which the
following is a part.
+ A few general Rules, &c. 2d edit. p. 19.
W. Turnbull.
Society

31
66
by
able uneasiness, by a too great pressure on the lower
part of the hips. This, I conceive, I have remedied,
"Society for the Relief of the Ruptured Poor.
To the Right Hon. Henry Dundas, one of his Majesties principal
Secretaries of State, President.
Sir Francis Blake, Bart.
Sir Walter Farqhuar, Bart. M.D.
Maxwell Garthshore, M.D. and F.R.S. and
John Heaviside, Esq. surgeon extraordinary to his Majesty,
Vice Presidents.
Gentlemen,
I dedicate this manual to you, as the liberal and active guardians
of a charity, which, from its general importance, now ranks in the first
class of useful establishments, and, under your influence, in proceeding to
a happy maturity. If, in the course of my official situation, as surgeon
to the institution, I have contributed to its advancement, my labours will
be amply rewarded: I shall receive the blessings of the afflicted, and
secure the flattering distinction of your esteem and approbation."
And, in the Appendix to the same publication, he says, "to alle-
viate the miseries of the poor, who, from their laborious avocations, are
more subject to rupture complaints, and less able to seek relief, than the
affluent; several gentlemen, not less distinguished for their rank and
opulence than for their benevolence, stood nobly forward in 1796 and
founded this charity. The Right Hon. Henry Dundas became presi-
dent, and when party contentions and political differences are exploded
and forgotten, his name will live in the bosom of posterity, as the disin-
terested and liberal benefactor of suffering humanity. The offices of
vice presidents were accepted by four gentlemen, whose names are re-
cited in the first sheet of this manual, and, who also came forward with
a chearfulness that unequivocally demonstrated the beneficence of their
nature. My appointment of surgeon to the institution, I consider as one
of the most flattering distinctions of my life. In the discharge of my
duty, I claim no other merit than what may arise from a persevering and
DISINTERESTED attention."
The whole of this is most artfully constructed to impress the reader's
mind with an idea that this institution was founded by or with the con-
currence of those gentlemen whose names were so ostentatiously pushed
forward; that this Mr. Turnbull was selected and elected by them to be
its surgeon; and that he, good man, had no merit or expectation but the
PURE designs that he should derive from the persevering and DISINTE
RESTED discharge of his duty. This is not, really, true; the project was
his own, every gentleman that, it was thought, would contribute a gui-
nea, or become otherwise useful, was hunted till he did so: a society
was thus formed, and those gentlemen whose names have been so osten-
tatiously published, did suffer their names to be placed in those situa-
tions, because they knew that such an institution, if properly conducted,
would be highly beneficial, and were desirous that every advantage
which it could derive from their names, and their support, should be
given to it, funds were raised, for the relief of the objects whose diseases
might

32
66
by making the pad droop more, and rendering the neck
longer and more curved; the circular steel spring, by
"these
might induce them to apply for assistance, as the subscribers believed,
though the fact may be more correctly stated, by saying, the funds were
devoted to the purposes of the institution.
The Vice Presidents, &c. were frequently told, the affairs of the in-
stitution were proceeding in the most prosperous way, but as their
names were conspicuously held out to the public as sanctioning this un-
dertaking, they thought it incumbent on them to ascertain the facts;
they did institute an inquiry, and, in consequence, did discover such
facts as induced them to withdraw from all connexion with the under-.
taking, and the respectable Society for relieving the ruptured Poor, is
now, to use a lawyer's phrase, non est inventus.
It is true, that something like a resurrection of this institution has
been attempted, but it is worthy of remark, that the name of Mr.
Turnbull is the only one thought to be of importance enough to deserve
public mention; for example, in the Monthly Magazine, for October,
1802, is the following paragraph, which was undoubtedly inserted by
authority." Since the commencement of that truly useful institution,
*The Society for the Relief of the Ruptured Poor, 1800 patients and
upwards, have been admitted under the care of Mr. Turnbull, and
"received essential benefit, in a great number of instances a radical
20
cure has been effected." Here we see the modest Mr. Turnbull, who,
when it suited his purpose, on a former occasion, affected to have
BEEN CHOSEN by the gentlemen whom he pubiickly thanked for hav-
ing elected him, and affected too, to have no ambition but to discharge
the duties of his station under their auspices, is here held up to view
as the only person who dees ANY THING IN THIS BUSINESS.
The fact is, that having, by means best known to himself, got rid of
those gentlemen who would have added credit to the undertaking, be-
cause it is well known they would not connect themselves with any
thing that they thought disreputable, he is willing to do that by himself,
if possible, which he would have been more willing to do under the
sanction of their names if he could have kept it, because he might have
done it more effectually.
I have entered at length into this subject, because it is necessary to
convince those who are willing to give their money for benevolent pur-
poses, that, when they do so they should likewise take the trouble to
see it is expended for the purposes they intended it for. Without al-
luding in the least to Mr. Turnbull, I shall add two anecdotes to prove,
that money has been given for most laudable charities, and converted by
unprincipled projectors to their own use. The first happened in this
country within the recollection of many hundreds still living, the se-
cond, if it ever happened at all, happened in a very distant land.
Some years ago, an ingenious projector discovered that a certain
class of persons in this country were peculiarly exposed to a state of
misery that too commonly terminated in an untimely, end, and most
philanthropically devised a plan to rescue them from that state, and
make them useful members of society; the advantages of that plan
were so obvious, that many benevolent persons subscribed the money
necessary

33
"these means, rests higher upon the loins, anl conse-
"quently must produce a less pressure on the hip joints,
66
an
necessary to carry it into execution, and the projector, though known
to be without property, and not in a way to acquire any, undertook to
conduct the whole, and formally refused even to accept of a salary for
his trouble.
The leading subscribers, after some time, thought it necessary to
examine the state of the concern, and found, besides what was known to
have been expended for the uses of the charity, there was a deficiency
of twelve hundred pounds, of which no account could be obtained, and
therefore they discharged the manager. This person, having thus lost
his profitable situation, complained of ill usage, set up a counter plan,
to be conducted under his auspices, got a number of associates who
were called his collectors, divided the town into districts, and sent his
collectors from door to door, to demand money for the use of his insti-
tution with more effrontery than would be exerted by an impudent
dun in demanding the payment of money that was due to him. Much
money was obtained by this means, but at last the projector vanished
out of sight, no one knew what became of the money he received, and
the original institution, having fallen into respectable hands, still exists,
a thriving proof of the benevolence of the inhabitants of this
country.
A's the second anecdote is said to have happened in past times, it
cannot be supposed that I should vouch for the correctness of it; and
therefore shall merely relate it as it is conveyed to me, with the an-
thority on which it stands; I leave every one to give it what credit they
may think it deserves.
Having some connexion with a gentleman who is descended from
the historian of Lilliput, I learn from him, that many papers relative to
that wonderful people remain unpublished, and which, if ever they are
published will prove, that although they were but six inches high they
possessed all the virtues and some of the vices incident to men of larger
growth, and as a proof of this position the following anecdote has been
selected:
The people were much afflicted with a disease which was always
dangerous, and not unfrequently fatal: the rich were generally able to se-
cure themselves from its ravages, but the poor, for want of ability to obtain
proper assistance very frequently became its victims. One of the medi-
cal tribe who had little employment, reputation, or property, took ad-
vantage of this circumstance to make a good thing for himself. He
persuaded the rich to raise a fund, by means of which the poor might,
without any expense to themselves be supplied with the assistance they
wanted. The plan was so visibly calculated to do good, that it was
immediately encouraged, and would have proved one of the most bene-
ficial establishments in the country, if the management of the whole, as
well as the money raised to support it, had not been entrusted to the ori-
ginal projector, and a junto of his friends, who were resolved to turn it
every way to his advantage. He got an assistant whose fortune he pro-
mised to make by this establishment; but, as they were equally needy,
and some time was necessary to bring the establishment to the point they
wished, they agreed to support themselves in the interim by a mode
which

34
66
an inconvenience which has been much complained of
"by those who have been under a necessity of wearing
"these bandages."
Here then, we have Mr. Turnbull particularly de-
scribing, and taking credit to himself for bringing into
practice that particular method of constructing trusses,
which W. H. T. Esq. says, was the usual method, for no one
reason in the world, but from an old custom, and W. H. T.
Esq. in return demonstrates, in the most satisfactory man-
ner, that Mr. Turnbull's boasted improvement is the most
absurd, most dangerous, and most ineffectual method that
can be adopted, and what is not a little paradoxical, they
both are in the right, and each of them is wrong.
It is singular that Mr. Turnbull should demonstrate
any fact, particularly one that will so little increase his re-
putation as a director of mechanics, for it is not supposed
that
which our historian does not seem to have understood, as he employs
several pages in explaining the terms drawing and accepting bills, cross
acceptances, &c. but the whole seems to amount to what has since, in
England, been called, bills of accommodation; many of these were ma-
nufactured, and becoming due before the money was forth coming, the
doctor threw them all upon his deputy, and left him to settle them as
he could.
This one, being unable to pay, thought to get indemnified by
complaining of his associate, and exposing him to the society, which he
attempted to do in a full assembly, but the doctor had many friends
there who got a majority to determine, that the society would not inter-
fere in the private transactions of its officers; they expelled the deputy
for improper behaviour in prefering his complaint, and voted that a
large sum of money should be given to the doctor out of the funds of
the charity, as a grateful return for the manifold services he had ren-
dered it. This disgusted the honourable part of the members, who im-
mediately renounced the society, and as no persons of respectability
would afterwards be connected with those who remained, it sunk, after
some struggles, into oblivion; and thus, by the conduct of a few unprin-
cipled men, was an establishment, which at its outset promised to be
as useful as any in Lilliput, totally destroyed, and the suffering poor
deprived of that assistance which the benevolence of their richer neigh-
bours would willingly have afforded them.
To return from this long digression to Mr. Turnbull; when the
secrets of his conscience shall be laid open, it will be known why those
gentlemen whom he beplaistered with so much praise withdrew them-
selves from the society for relieving the ruptured poor, which they had
been so willing to support, and which they had the power to serve; and
why, since those gentlemen did leave it, no name of more consequence
than that of Mr. Turnbull has been found to put at the head of the
concern.
Till he does explain all this, the transaction, in all its parts, may
form one of the most flattering distinctions of his life, and yet not be
that kind of distinction which every man will envy him,

35
that he will pretend to be a mechanic himself; and it is
unfortunate that he should introduce his pretended improve-
ment and real invention, by contrasting it with an account
of the uneasiness produced by those trusses which go di
rectly round the body, for it is certain that no uneasiness is
produced by trusses made in this way, when they are pre-
perly adapted to the patients they are intended for: W. H.
T. Esq. is right in his critique on Mr. Turnbull's invention,
but has made two trifling mistakes, first, in saying it was
the usual mode, from an old custom, and secondly, for
saying that that deviation from Mr. T's invention, which he
recommends, is his own discovery when ten thousand proofs
may be produced to prove it has been the universal prac-
tice for almost half a century.
The next part of W. H. T. Esqr's. invention that claims
our attention is, what relates to the understrap, and mat-
ters connected with it; what he says on this part of the
subject is comprised in the following words, the thigh-
66
strap to be made of wash-leather, lined with thin tape,
"the end adjoining the buckle to be of neat's leather.
"The thigh-strap to be sown with strong thread well
"waxed, to the hoop part of the truss; by this fixture
"of the thigh-strap, the pressure will act on the bottom
part of the pad of the truss.
66
"The bottom part of the pad of the truss is the part
"that stops the aperture: a double-tongued buckle I have
"invented, instead of the lower brass knob. This buckle
draws and fixes the bottom of the truss close to the ab-
"domen.'
92
66
Thus far he goes in his first edition, which Is DATED
AND PUBLISHED IN 1800. In the second edition, dated
and published in 1802, he has added the following note:
"I communicated my information to a truss-maker, a
"man of education and understanding, LATELY DECEAS-
"ED: but, though I suffered twenty-four years under his
CC care, his pride, prevented him listening to me: his
"trusses, from my alterations and additions, are now be-
come perfectly useful. I never could get him really to
"EXECUTE the meaning of the word FIX: my idea of it
was, to sow FIRMLY So as not to move!"
I know not wнO W. H. T. Esq. is, nor do I know *
what
66
66
*He says, 1st edit. p. 31. "During a seclusion from the world.
"from bad health, ruptures and trusses were my hobby horses, and I
** have
F 2

36
what may be his motives for writing as he has done; but,
before we part, I shall prove that he has collected many par-
ticulars, which, if they were not general, were at least
long known in the best practice, and assumes the merit
that may be due to them as inventions of his own; and is
not very unwilling to make dastardly insinuations, to the
prejudice of those from whom he might have received
them if he actually did not; an honourable peculiarity of
conduct, of which the present is a very convincing proof.
My father died in January 1800, at which time
W. H. T.'s work was either published, or on the eve of
publication, and it does not contain the note I have quoted
from the second edition, which was published in 1802. Why
was NOT that note inserted in the first edition. ? because he
dared not make an allusion which is scandalously false, to a
man who was able to justify himself. Why was it in-
serted in the second? because dead men cannot defend
themselves; my father was then recently deceased, and
no other person is since dead to whom such an allusion
could apply; and this benevolent liberal-minded man, claim-
ing to himself sOLE AND UNIVERSAL knowledge on the
subject he was writing upon, thought it would be an ad-
dition
"have made great improvement in the umbilical truss."
No man can
be a more strenuous advocate for the freedom of hobby horses than my-
self; but, I mean general freedom, not upon the French principle of
freedom to one, and annoyance to all the rest of mankind: but when a
little poney that might be drowned in the water that lodges in a cart rut,
will not keep the road, nor let a broad wheeled waggon, or a stage coach,
or a foot passenger pass without kicking, and plunging, and striking at
the pannels, and dashing the mud about in every direction, to the extent
of its little abilities, I think it an act of charity in any passenger to give
him a few smart lashes, to make him keep in his own track, and leave
the rest of the road free for those who chuse to travel the same way.
W. H. T. Esq. seems to have acted in a way that is common with those
who engage in hobby-horsical pursuits. They begin with what they
think they understand, go on to what they know they are ignorant of,
and then, if the tits have any spirit they set off full speed, the riders lose
the stirrups and reins, hold fast by the mane, and dash away without
stopping till they get thrown into a slough, from which they find it dif-
ficult to extricate themselves. Thus it has literally been with him; he
began with his own case, acknowledged he had no professional knowledge
of the subject, yet gave advice to those who want professional assist-
ance, and has ended in assuming the dictatorship of all the surgeons, truss
makers, and patients in the world-and how he will extricate himself
from his perilous situation time only will shew.

37
dition to his fame to say he had offered to give the fruits
of his knowledge to a man of eminence, who proudly
rejected the mighty boon; but there is something in hy-
pocrisy and falsehood that always leads to its own de-
tection; this truth has long been known, and is again con-
firmed by W. H. T. Esq. in the present instance.
If he suffered twenty-four years under the pride and
obstinacy of the person he alludes to, when did he acquire
the knowledge that would enable him to put an end to his
sufferings? as all the knowledge he has on this subject has
been obtained by experiments on his own person, and as
during this twenty-four years he so frequently offered his
information to this obstinate* man, at what time + did
he make those experiments on himself, which led to these
important discoveries? Again, if he had made these dis-
coveries which were slighted by the obstinate man, why did
he continue suffering when it was in his own power to put
an
*As this allusion of W. H. T. has obliged me to mention my fa-
ther, I trust I shall be excused for adding a few words on that subject:
his manners were rough, but he had a sturdiness of principle that al-
ways prevented him from doing what he thought was wrong in the ex-
ercise of his professional duty. The principle was good, that modi-
fication of it was wrong which sometimes made him refuse to conform
to the wishes of his patients in matters of indifference; but he was
right when he refused to accommodate himself to the folly or absurdity
of those who would sometimes apply to him: in this particular he re-
sembled the late Mr. Pott, of whom I shall relate an anecdote for the
edification of W. H. T. Esq. and such malades imaginaires, if there
are any more such in existence.
A gentleman who had a rupture consulted Mr. Pott, who gave
him all the necessary advice and information, and supposed the inter-
view was then at an end; but the patient, who had read some surgical
books, and imagined many things in his own case, which never had
existence, was determined to enter into a full discussion of them with
Mr. P. who no sooner perceived his drift than he exclaimed, "Pshaw,
Sir! your rupture is in your head," and turned from him abruptly. The
reproof was not of the most elegant kind, but it was most certainly
just.
+ This gentleman's manner of writing is so desultory, that it is
not always easy to follow him. Since writing the above, I find he says,
if his (1st edit. p. 22.) first improvement, the fixture of the thigh strap
to the hoop part of the truss invented by the author twenty years ago.
Taking all his assertions for gospel, it appears then that he must have
suffered continually by the pride and obstinacy of his truss-maker, for
twenty years after he had invented something that would certainly put
an end to all his sufferings. A most singular proof of fortitude under
pain, voluntarily submitted to, and as most people would think, for no
useful purpose.

38
an end to his own sufferings? When W. H. T. Esq. shall
have given answers to these questions that shall be con-
sistent with each other, and with the note which gave rise
to them, he will add more to his own reputation than by
all the new inventions he has yet made public. He may say
his allusion does not point to the person I direct it to, and
if he can prove this he certainly is at liberty to do so; but
as I believe it will be impossible for him to do this, I shall
proceed to prove, that his insinuation is false in every par-
ticular; which I think I can do to the satisfaction of every
impartial person.
It is thirty years since my father began to teach me
his business, as he then practised it; one of his first lessons
was, always to sew the understrap fast to the truss on the par-
ticular part it ought to lie upon, and so as not to let it slide or
slip backwards or forwards in any manner: because the sta-
bility of the truss depends on the understrap having hold of
it by two fixed points, one on the pad, and the other on the
proper part of the hip. This is the rule which he inva-
riably adhered to during his life; which I invariably fol-
lowed, in consequence of instruction before I had reflect-
ed on the subject, and afterwards from a conviction of its
propriety, when I had examined it in every way that it
could be examined. I know this is not the general prac-
tice, but I do not think it confined to myself, and claim
no merit on the occasion but that of proving, that
W. H. T.'s pretension to it, as a discovery of his own, is
totally void of foundation.
With respect to the rest of what he says on this sub-
ject it is only necessary to observe, that understraps are most
commonly made of linen, but many make them of leather
as he advises, and though they are usually fastened at the
knobs of the truss, buckles are frequently used; the varia-
tions on these subjects are almost and have long been infi-
nite, and W. H. T.'s pretensions to the invention of what
he mentions is quite uniform with the rest of his dis-
coveries.
That invention of W. H. T.'s which he thinks of most
importance, and which has evidently made a more perma-
nent impression upon his head than could be expected
from so soft a material, is his calico cushion, which, ac-
cording to him, is not only good in itself, but actually
transforms bad trusses into good ones; a qualification, which
if it is not exaggerated, will certainly render it an acqui-
sition of much consequence to many poor truss makers, as
well

39
well as many unfortunate suffering patients: the utility
of any thing of this kind will be discussed in another part,
our present intention is to ascertain the truth of W. H.
T.'s claim to the invention, and the merit of introducing it
into practice. Of this calico cushion, he says, 1st edit.
p. 14, a description of a cushion of coarse calico, invented
by the author, from a very slender idea communicated to
him.
<C
66
In the preface to his 2d edit.
p. 6, he says, "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 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, &c. (enumerating all
"his titles). 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 professional men." Thus, it
seems, this gentleman claims to himself the merit of an
invention the idea of which he acknowledges was commu-
nicated to him; and which, after his methods were exe-
cuted, he found was the old system of firmness, promul-
gated by Arnaud, who practised in Paris in 1726, and
whose work was translated and published in London in
(6
1748.
It is remarkable, that all those who engage in the
practice of quackery, whether their object is to get mo-
ney, to get reputation, or only to get a little hobby-horsi-
cal amusement, act precisely in the same manner, that is,
they lay claim to merit which they know they do not
deserve, and garble what evidence they find, to produce
such as may be in their favour, and keep hack what they
know must make against them. This has been the conduct
of
*The particular description of this cushion is to be found in his
book, it consists of a number of folds of calico made into a cushion of
some thickness, and laid under the pad of the truss. As he has not
mentioned the exact number of magical folds required, or said that
calico has any specific virtue above all other stuffs, I presume that an
equal quantity of any other soft material disposed in the same manner,
will produce just the same effect.

40
of W. H. T. Esq. on this occasion, for, with Arnaud's
book before him to transcribe the title as he has done, he
must have known that Arnaud practised in London in the
year 1748, and that the translation was published here for
and by himself; why has he not mentioned this? For a very
evident reason; to induce his readers to form an opinion,
that would not be improbable if the facts were as he has
stated them, viz. that he at the present day might form
a system from his own reflection, which had been practised
by a French surgeon in the beginning of the last century,
without HTS being acquainted with the circumstance: but,
had he stated the fact which he did know, viz. that Ar-
naud was practising in London in 1718, had he told that
which he might have known, viz. that he continued to
practice in London for the rest of his life, and he died at a
very advanced age, something more than twenty years
ago, a very different inference would be drawn, and which,
as he seems desirous to keep out of sight, shall now be
brought forward for his benefit.
Whatever was useful in Arnaud's book, would in all
probability be used in his practice, and as he practiced in
London till the end of his life, (say 25 or even 30 years ago)
whatever was useful in his practice, would be gradually
disseminated and adopted by various persons who were
interested in getting the best information on this subject,
and from some of these W. H. T. might have got the
idea upon which his pretended invention is founded: but
though this is conceded for argument sake, it is too much
to be granted in point of fact: the idea of interposing
some soft material between the body and any thing that
pressed upon it so as to give pain, is so very natural that
it would occur to most people immediately; certainly it
did not originate with W. H. T. or Arnaud; I have
known, perhaps, hundreds of patients who have done the
same thing from their own feelings; I have known many
others who have done the same thing by the advice of
their surgeons, &c. I, for reasons that will be hereafter
explained, have made it a part of my regular practice ever
since I was able to form any opinion upon such points as
I thought it incumbent on me to recommend to my pa-
tients: of course I shall not deny the utility of such things
as he recommends on this occasion, though it is certain
that his pretending TO HAVE INVENTED this is nearly as
absurd as if he should pretend to have invented the art of
cating his dinner.
As

41
As there is nothing new in any thing that is useful
in his publication, and as much pains have been taken to
puff it into notice by every kind of manoeuvre, it may be
curious to ascertain what motive could be the occasion of
so much pains being taken: it is printed in much form,
that "the profits arising from the sale of this work will be
66
appropriated to charitable purposes." This may have
been intended by the author as a consequence of, but
could not be a motive for the publication; because, who-
ever proposes to effect any purpose by an act, generally
proportions the means to the end according to-the best of
his judgment, but any one who is acquainted with the
subject, and followed the advertisements through news-
papers, magazines, the covers of reviews, &c. must be
convinced that more money has been expended in that
way than the sale of the work can have produced, there-
fore no profits have been, or are likely to be appropriated to
charitable uses: the real motive, however, seems to peep
out like the cloven foot at the end of the publication. At
p. 51, 2d edit. appears the following postscript:
The author accidentally omitted to mention that a
specimen of his trusses may be seen by any medical gen-
tleman, at Mr. J. Callows, Bookseller, Crown Court,
Soho; 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.
There lies the fact. The first edition was nominally
published at a bookseller's, but was in reality sold princi-
pally at the shop of an obscure truss maker in an obscure
part of the town, who exhibited about two dozen copies
of it in his window, and in answer to inquiries said, he
piqued himself on executing the plans suggested by the
author of those new inventions. It is possible that the
author may have benevolently fancied, that what he calls
his new inventions may be useful to the parties interested;
that he has no interest of his own to serve by it; that hav-
ing found some working man, or perhaps, some man who
is not even a workman, though able to please him, he re-
warded him by giving him the publication of this treatise
for the joint benefit of himself and the public: hence the
peculiar manner in which it was first published: it has,
perhaps been suggested by some discerning friend, that
this mode is not very consistent with the pretensions to dis-
interestedness which it contains, and therefore, on publish-
ing a second edition, it is left entirely to the booksellers,
C
only

42
only referring to the truss-maker of ability, as a circum-
stance almost too trifling to be remembered, though in
fact, he had a principal share in the concern: in all this
there is no more harm than what arises from the duplicity
of assigning one motive for an action, which, in reality is
the effect of another.
In taking leave of this subject it will be right to attempt
at least, to reduce all the glaring inconsistencies it contains
into some regular order; it will be candid and liberal to
suppose that a man speaks the truth of himself, when there
is no proof that what he says is false; it is, therefore, to
be presumed from the evidence of his own works, that
W. H. T. Esq. is a gentleman of easy fortune, who has no
view to increase that, or his professional reputation, by pub-
lishing his new inventions: but, having at a former period
got two ruptures, one in his groin, the other in his head*
and not finding them equally manageable, has wandered
from surgeon to surgeon, and truss-maker to truss-maker,
till he has circulated himself through the whole profession
and all the trade: having thus collected an idea from one,
and a hint from another, till he has made up a system which
answers his purpose; and, as he has really forgot from
whom he received any of the parts, calls the whole his
own.
Having thus passed his life in quacking himself, he is
now willing to pass his dotage in dispensing the fruits of
his experience for the benefit of others, and as this is his
hobby horse, from which he expects no advantage, he has
given his treatise to some person to publish, who has a
secret motive to answer, which he thinks will best be served
by
That
**
*Outré as this statement may appear it is literally true.
rupture which got into close contact with his left testicle was, of course,
on his left side. In p. 27, 1st edit. he says, "a rupture will cure
itself; that is, the peritoneum 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." Now, unless a rupture on
the right side, and a rupture on the left side constitute but one rupture,
it is certain that this unfortunate gentleman had two ruptures; but,
whether that which was so easily cured, or that which has been so con-
stant in its attachment to him is the rupture in his head, I shall not
take upon me to determine. The above is certainly a true statement of
his case, unless we should suppose W. H. T. Esq. has written a false-
hood which is not to be believed, as he says, with all the confidence of
innocence in his appendix, p. 8, "could I, who am well known in the
world, dare to make these assertions, if untrue?"
40

43
by pretending to publish this gentleman's book under the
stale device of giving the profits for charitable purposes,
though his own benefit is all that he has in view, and by
the steps taken to secure that, it is rendered morally cer-
tain, that no profit will ever accrue to any charity what-
ever.
The only circumstance in this work, that merits
more serious consideration, is the commendatory letter of
Mr. Blair: when a gentleman of his rank in his profession
gives his name to a man who places it conspicuously in
advertisements that are spread in every direction with no
more respectability than the puffs of a common quack
medicine, it is natural to believe he has some strong mo-
tive for so doing: the person to whom Mr Blair's name is
given, undoubtedly means to obtain that credit by the use
of it, which he would not derive from his own, if it were
known; it will, therefore, be necessary to examine Mr.
Blair's letter, to see if he means to support all the asser-
tions of W. H. T. Esq. or, whether his meaning has been
distorted, so as to give it the appearance of doing so, al-
though in fact it was not his intention. That it may not
be supposed any unfair quotation has been made for this
purpose, his letter is printed entire at the foot of the
page, † and those parts that are commented upon are printed
in italics.
No
* Not knowing these persons, or being in their confidence, it can-
not be expected that I should be able to explain their motives here. I
shall, however, state a case hypothetically which may happen at some
future period, though it has not yet taken place.
Suppose then, that when Mr. Turnbull shall establish a new cha-
ritable institution, he may not find any man of established reputation,
who will be connected with him, he must have a truss-maker, and he
may find it easier to make one such as he wants than to get one ready
made; he may promise such a one mountains of gold, and in the end
only tease him with bits of paper and disappointments, and having thus
disgusted, may turn him off to seek his fortune.
If all this should happen, and W. H. T. Esq. should want an ope-
rator, and meet with this man, he may think the golden mountain is
now found, and set himself seriously to work, and knowing all the be-
nefits Mr. Turnbull has derived from his charity, he may think, that to
publish with the view of giving the profits to charitable purposes may
be the best plan to bring it into general notice.
+ Dear Sir,
I think myself honoured by the wish you have
expressed, that I would permit you to use my name as a recommenda-
G 2
tion

44
No man, who is acquainted with the reputation of
Mr. Blair, either professional or private, will doubt the
purity of his motives for stepping forward on this occa-
sion; though it is to be regretted that he did not exclude
all ambiguity from his opinion, particularly as that ambi-
guity is most conspicuous where the clearest decision was
wanted: he says, "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 Monsieur Ar-
"naud, so that the hoop or spring is exactly in a circular
"direction."
What does Mr. Blair mean by the word usual in this
place? Does he mean to say that in his practice it has been
usual to apply trusses in an oblique, and not in an horizon-
tal direction? and that W. H. T. Esq. first induced him
to adopt the right method? Of this Mr. Blair's word is
sufficient proof, for he must know the fact, and, indeed,
acknowledges it, by confessing that W. H. T. Esq. in-
structed him in that mode of applying the truss; or does
Mr. B. mean, by the word usual, to say, that all persons,
of every description usually applied trusses in this oblique
way, till this apostle, W. H. T. Esq. came to convert them
to his truth? That is the construction which this gentle-
man
tion of your pamphlet; but I am not quite reconciled to the idea of ap
pearing 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, produced the
most decided advantages, in keeping up a rupture of long standing.
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 Monsieur Ar-
naud; so that the line formed by the hoop or spring is exactly in a cir-
cular 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
unprejudiced 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 per-
mitting the insertion of this letter, but I hope you will see the pro-
priety of informing the public, to whose benevolent exertions they are
indebted for so useful a treatise. I am, &c. &c. WM. BLAIR.
To W. H. T. Esq.

45
any
man wishes to have put on Mr. Blair's words, though in
fair construction they will scarcely bear that meaning:
W. H. T. Esq. asserts, indeed, that he has done this, and
there is little reason to doubt that he wishes Mr. Blair's
letter should be understood as confirming that assertion:
but if Mr. Blair does mean to confirm this assertion, he
must not only state what has been done in his practice, but
that he has enquired through all the profession, and dis-
covered that no other person knew how to apply a truss
properly; now as he certainly has not made that enquiry,
and as that practice, which seems to have been new to him,
though in general (not universal) practice for half a cen-
tury, W. H. T. Esq. can derive no advantage from Mr.
B.'s testimony as to the novelty of what he is pleased to call
his invention.
This claim of W. H. T. Esq. is, in fact, destroyed by
Mr. B. immediately afterwards, where he says, "The
"trouble you have taken in order to the revival of this
method does you great credit." Mr. B. will admit that
his compliment on the revival of this method necessarily
amounts to a declaration that he did not INVENT it, which
W. H. T. Esq, says he did. Here the evidence of
Mr. Blair is at variance with the assertion of W. H. T.
Esq. and both of them are at variance with the truth; for
I trust it has been proved, to the satisfaction of those
who are impartially disposed, that this practice has nei-
ther been invented nor revived, but has been in common,
though not universal use, for at least half a century.
On the important affair of the calico cushion too, Mr.
Blair is profuse in his compliments: after what has been
said on that subject, it will only be necessary to add, that,
within my own knowledge, many patients, without in-
formation, and from the plain suggestions of common
sense, in attempting to obviate the unpleasant effects of
pressure, have applied similar substances in the same man-
ner: and I have, for reasons that will be explained here-
after, constantly recommended the same practice; but, if
it should be contended, that the plain sense of any man
might not lead him to adopt the same practice, it may
evidently be deduced from Arnaud's publication; this is,
indeed, acknowledged by W. H. T. Esq. with circum-
stances that prove to whom he was indebted for it: in this
statement of facts, it will plainly appear, there is no incli-
ration to deny the utility of the thing, though it certainly
1s

46
is intended to prevent those from claiming the merit of the
INVENTION to which they certainly can have no claim.
I am really sorry to see Mr. Blair mention Arnaud
with terms of unqualified approbation, because he was, in
every respect, a disgrace to the profession of surgery:
because W. H. T. Esq. admires him, and avows "his in-
"tention to make many quotations from him," because
the consequence of this project, if duly executed, must be,
to introduce into notice, and perhaps into practice, the
system of this quack, who was driven, by the contempt of
mankind, to pass his life in the obscurest walks of society,
as a just reward for his impudent attempt to cheat the pub-
lic under the pretence of curing ruptures: since it is be-
come fashionable to quote Arnaud, I, too, will quote him
at the foot of the page, to shew what he was capable of,
and how justly they act who endeavour to render him an
object of praise, admiration and imitation.
If an attempt was made to bring all his absurdities
into view, nearly the whole of his book must be tran-
scribed, but it will be sufficient to produce two passages,
one
* In hernias of the inferior part of the abdomen, the situation ought
to be such, that, the patient being laid upon his back, his buttocks and
thighs may be considerably elevated, as well to determine the parts more
easily into the cavity of the abdomen, as to keep the muscles in a kind
of general relaxation. If the hernia is in the scrotum it ought to be sup-
ported below, and raised by something of a soft nature, such as a pillow.
This situation ought to be the same during the strangulation; but this
posture is of so great importance in the first moments of this symptom,
that a great many persons have preserved their lives by lying down even
in the fields and applying to their hernias, the pomatum I generally give
my patients. This pomatum is a remedy, which though peculiar to myself,
I shall not be so mercenary to keep a secret. The effects of it are so speedy,
that the most considerable strangulations are either reduced spontaneously,
or may be very easily reduced, when it has been applied an hour to the
hernia, unless it is accompanied with adhesions to the parts. The effi-
cacy of this remedy, which on account of its speedy effects, surpasses all
others the best adapted to this symptom, cannot be better evinced, than
by the relief it affords, the very moment it is applied to the most painful
hemorrhoids.
It is prepared in the following manner.
Dissolve an ounce of the gold of African ducats, or of the purest
gold in aqua regia; precipitate the dissolution, and let it subside, and
then pour off the menstruum by inclination, wash the precipitated sub-
stance several times in fountain water, in order to dissolve the salts of
nitre, which will be entangled in the divided parts of the gold. Put the
precipitated

47
one an infallible receipt to cure ruptures;* the other a
case to illustrate the success of his practice.
With
precipitated substance into a glass mortar, and triturate it for two or
three hours. Then pour upon it by little and little, four pints of highly
rectified spirit of wine, and stir the powder with a glass pestle, in order
to make its parts rise; pour off the liquor by inclination, into a china
vessel,taking great care not to mix with it, what of the powder remains
at the bottom of the mortar. Put some of the spirit into the mortar
again, and continue to move and pour the mixture into the china bason.
Repeat this operation till the whole of the powder is entirely carried off.
Set fire to the spirit of wine, and allow it to consume till there only re-
mains a small degree of moisture in the powder. Then quench the
same, in order to avoid the fulmination of the gold. The remaining hu-
midity is to be dried by the sun.
Take this powder and put it again into the glass mortar. Add to
it two ounces of the seeds of oriental pearl reduced to an impalpable
powder on a marble. Pour upon it four ounces of white and very clear
vinegar: stir these powders together with the vinegar, for three hours
at least, let the whole subside for twenty four hours; filter the vinegar,
and put the powders, into a glazed earthen vessel. Pour upon that a pint
of the oil of pistachie's, and two ounces of orange flower water, then
add four ounces of virgin wax. Boil the whole, to make a pomatum ac-
cording to the art. When it is cold wash it by little and little, for twelve
or fifteen hours, with water of butter-milk distilled in balneo maria in
which is macerated a sufficient quantity of the leaves of burdock and
nightshade. After it is washed, mix exactly with the pomatum an
ounce of sedative salt and half an ounce of saffron reduced to powder.
N B. It is of importance to boil it to a proper consistence, and to
wash it carefully, in order to preserve it from corruption. Arnaud on
Ruptures, p. 137.
* In 1732, I was called to Ibouville, a town about forty miles from
Paris, to see Mr. Doudeuill, a man of sixty years of age, who had a com-
plete hernia twenty-six inches in circumference. It descended to the
middle part of the thigh. The tumour was very soft, and seemed as if
it would re-enter easily. The patient told me, that it was near six years
since it had arrived at the same bulk; that it was almost twenty in as-
suming that largeness; that for four or five years past he was afflicted
with colics and faintings, which often obliged him to sit down for relief,
and support the tumour with his hand; but that for eight or nine days
past he felt a great deal of more pain than usual. For five days he had
vomited his faeces, and went but very little to stool, though the wind was
freely discharged through the anus. The tumour was soft and very sen-
sible. From these signs I concluded, that adhesions were the cause of
these symptoms, and therefore thought the only method to be taken, was
to perform the operation. Nothing could be added to the general reme-
dies, which had been used with all possible care. I took the advice of
Mr. Coste, surgeon of Miru, who agreed with me, on the pressing ne-
cessity for the operation. I apprised the patient's friends and himself of
the danger there was in undertaking an operation of this kind; but said,
at the same time, that there was no other method of preserving his life.
The courage of the patient, who was a man of a robust constitution, was
animated

48
With respect to the first, it is to be observed, that in
the old practice of physic and surgery many remedies were
used
animated by the hope of a cure, though uncertain, so that he prevailed on
his friends to consent that I should perform the operation, which I did
in this manner. I laid bare the whole tumour, by dissecting all the in-
testines, which made only one body with the herniary sac, which was of
a considerable thickness. I used all the necessary precautions not to open
the intestine, in which attempt I succeeded. However, it was gan-
grened in a great many places, which were of different bulks and figures.
Some of them were round, others long, others triangular, and others of
irregular figures. Some of them were half an inch broad and long,
whilst others were two, and others three inches. But there were dis-
tances between them, consisting of five or six inches of the sound parts.
1 at last laid all the parts bare, after an hour and a quarter's hard la-
bour. Then being fatigued to such a degree, as almost to have lost the
use of my limbs, I was obliged to rest myself, and in the mean time
covered the tumour with a fine linen cloth soaked in tepid water. I
deliberated with Mr. Coste on the method to be taken, in order to finish
the operation. The confusion of the parts, by means of the thick and
fleshy adherences which kept them together, and the mortification which
had seized most of them, made me propose cutting off all that was with-
out the abdomen. I told the patient this ungrateful piece of news,
which, instead of terrifying him, AUGMENTED HIS COURAGE. The
large portion of the mesentery, which sustained the ileum, which was
less altered than the colon, was the principal object of my attention. I
could not remove this intestine, without dreading an hemorrhage from
the mesenteric vessels. In proportion as I made the ligatures, I cut the
intestines where the tied vessels terminated. I then tied the vessels of
the coecum with a single thread, and cut that intestine. I made three
or four ligatures on the mesocolon, and cut the intestine which it sus-
tained, and which was very gangrenous in all its length, which con-
sisted of about eight or ten inches. All this parcel of the intestine thus
cut successively, according to its length, being totally removed, there no
longer remained any thing in the scrotum, except the testicle, which
was sound, and included in its membranes, and the mesentery with the
ends of the colon and the ileum, each of which came about two inches
without the ring. There was no portion of the epiploon in the tumor.
My design at first was to stitch the two ends of the intestine together,
but the determination they had taken to come out of the abdomen, was
such an obstacle, that I could not have succeeded in this attempt. They
came out in such a manner, that the colon passed above the ileum, and
was situated towards the penis, whilst the ileum lay towards the thigh.
Besides this circumstance, they were intimately adherent not only to
each other, but also to the ring itself. In order to have joined their ex-
tremities, it would have been necessary to detach these adherences,
which was not possible; it was therefore necessary to leave them in this
situation. As the ring greatly compressed the two ends of the intes-
tine, and as the foeces had not a sufficient free discharge, I made a dila-
tation in the ileum and ring, by introducing my buttoned bistory into the
remaining part of the ileum, which I boldly divided. But I acted
otherwise

49
used that were expensive, troublesome, and absurd in the
extreme; but they were the productions of well-meaning
though
otherwise with respect to the ring, which I was obliged to disengage on
the side of its inferior pillar. I only made a small dilatation in it, on
account of the epigastric artery, which, in such cases, is very near this
pillar. The feces were forthwith discharged in a very large quantity,
and the excrements were involuntarily voided, for ten or twelve hours
without intermission. Notwithstanding the many ligatures 1 had made,
a great number of small vessels, which had escaped, discharged a good
deal of blood during the operation. I permitted this discharge so long
as it did not incommode me, both to facilitate the evacuation of the
vessels, and because I HAD NOBODY TO ASSIST ME, EXCEPT A WO-
MAN, who secured the parts WHILST THE PATIENT HIMSELF HELD
THE CANDLE; for Mr. Coste was obliged to leave me, on account of
some pressing business. I dressed the wound with dry lint, with which
I covered the mass of the mesentery. I left the extremities of the in-
testines free, only covering them with a simple pledget dipt in the yolk
of an egg. I compressed the mesentery as regularly as I could, by means
of compresses and a bandage. The hemorrhage ceased, but it was only
for twelve or fifteen hours; for I was obliged to dress the patient twice
in the night, and to use the strongest styptics, in order to brace up the
extremities of the small vessels, which either could not be comprehended
in the ligatures, or which had escaped from them, and whose orifices
were become much larger, and permitted so great a quantity of blood to
be extravasated, that the patient must have died, if I had not continued
with him; for Mr. Coste was obliged to go to his own home, which was
about three miles distant. Next day there survened a hiccup so violent,
that I thought the patient could not surmount it; for he was several
times like to die for want of intervals sufficient for inspiration. The
great quantity of blood he had lost by the hemorrhage, and by the two
copious venesections, did not permit me to seek for relief in the aper-
ture of a vein; I was therefore obliged to use laudanum in substance,
the dose of which I augmented by half grains every half hour; so that
in two hours be took four grains and a half of it, which at last alleviated
the hiccup. He remained about five or six hours as it were intoxicated
and without sleep, but during that time he enjoyed an agreeable tran-
quillity, and the hiccup was so diminished, that nothing dangerous was
to be dreaded from it. It continued, however, three or four days, but
always became less and less. By the examination we made of the quan
tity of the intestines I had taken away, we found that there were more
than SEVEN FEET OF THEM. The patient, by the care of Mr. Coste,
was cured in six weeks. Three months after the cure I advised him to
come to Paris, that I might try to reunite the extremities of the intes-
tine. Messieurs Petit, Le Dran, Morand and Verdier, whom I called
to consult on the means which might be employed to remedy this in-
convenience, found that the reunion was so much the less impracticable,
because the direction which the ends of the intestine had taken, could
not have permitted it during the operation; besides, the portion of the
ileum was so retracted, that it was hardly possible to receive it. It
formed a kind of body like a hen's arse, whose margins re-entered in-
H
ternally.

50
though mistaken men; far different from this was Arnaud,
for no one will now believe that he ever attempted to make
that composition which he has described with so much
pomp, much less that he ever attempted to use it, and
least of all, that if he did make and use it, it had ever
cured a single patient: the whole is the most impudent
piece of quackery that ever was brought forward in face
of the world, and renders it unnecessary to say more on
the character of this man, who is mentioned in terms of the
highest praise by W. H. T. Esq. and without a word of
censure by Mr. Blair.
The second extract is a case that must reflect eternal
disgrace on English surgeons and English patients; the
first very unwisely bind their patients before they begin
an operation, and the latter submit to be bound for fear
they should not have fortitude to bear the pain they must
undergo: while the great Arnaud disdained such pre-
cautions, and this poor old Frenchman, with no other sup-
port than an old woman and his own good spirits, held
the
ternally: The colon had totally disappeared. All the part of the me-
sentery, which had remained out of the abdomen after the operation,
was so dissolved, that no mark of it was to be felt, either in the scrotum,
or about the ring. It afterwards created no trouble in the dressings.
This remark is of great importance, because it lays a foundation for some
reflections on the cause of that perplexity, which a part of the mesen-
tery remaining without the abdomen created to Mr. Le Dran, in the
operation described in the sixtieth observation. Our patient was there-
fore obliged, during the remainder of his life, to use an artificial anus.
But his industry rendered this inconvenience more supportable to him,
than it would have been to any other person. He was very careful not
to offend others by the bad smell, which they must necessarily feel, if he
had not subjected himself to some little pieces of art and contrivance,
which freed him from that disagreeableness which his misfortune must
have otherwise produced. He had made several pessaries of cork covered
with wax, in the form of a bottle cork, proportioned to the bulk and
largeness of the intestine, and about an inch and an half long. This pes-
sary was tied with a small cord to the principal compress. He intro-
duced it into the intestine, and laid three or four other compresses on the
former. He secured the whole by a bandage composed of a single cir-
cular, and a slip, which passed under the thigh, from behind forwards,
in order to be fixed to the circular by a pin. He undid this apparatus
every morning and evening, in order to empty it as occasion required.
He was sometimes obliged to facilitate the discharge of the excrements,
though always of a very liquid consistence, by means of a clyster. At
other times the smallest portion of the fæces was not discharged into his
apparatus. By this means he enjoyed six years of perfect health, and at
jast died of an indigestion. Arnaud on Ruptures, p. 341.

51
the candle himself while more than seven feet of his in-
testines were cut away from him, and there is no doubt,
had the tune been in existence, would have sung Ca Ira all
the time of the operation, with as much glee as if he had
been dancing the Carmagnol before the Princess de Lam-
balle's head. The case requires no farther comment.
the
The fate of this Arnaud has been a little singular:
he had met with the only recompense that his best friends
would wish for him, that of being entirely forgotten: he
was then first brought forward as a great man, by
great Mr. Turnbull:* then mentioned with admiration
by W. H. T. Esq. and received a smile of approbation
from Mr. Blair; still there was something wanting to com-
plete his fame, but I may venture to hope, that my coming
forward to make a quartetto on the occasion will leave no-
thing to desire on that head.
It is now time to have done with W. H. T. Esq. and his
new inventions; he seems to have expected criticism, to
have
H 2
*This elegant, accurate and correct writer says, in the dedication
to his few Rules, &c. p. 8. "I have stated, in a former edition of this tract,
"that a CELEBRATED WRITER, ARNAUD, who published a LEARN-
"ED and ACCURATE dissertation on hernia, had delivered it as his
" opinion, that one in ten of the people, male and female, are ruptured.
The character of this writer, having acquirrd a deserved celebrity
"throughout Europe, entitles him NOT ONLY TO OUR ESTEEM, but
"our CONFIDENCE, &c. &c." Again p. 10.-"It becomes me, on
"this occasion, to observe, that by opposing so GREAT AN AUTHORITY,
"I subject myself to the censure of professional men, and I confess,
"this idea has, for some time past, MADE ME UNEASY; but, with
"the utmost deference to the abilities and character of Arnaud, I can-
"not but imagine he is misraken as to the number of people labouring
"under this calamity."
Those who have read the two extracts I have made from Arnaud's
book, and think it possible that Mr. Turnbull may be fond of FUN,
will suspect that, in writing the above, he intended to HOAX his
readers; whether this was the case, or whether his own knowledge of
the subject REALLY induced him to think the learned and accurate
Arnaud was entitled to so much esteem and confidence that ALL PRO-
FESSIONAL MEN would blame HIM for differing from Arnaud's opi-
nion, I shall not take upon me to determine, but it is likely he ex-
pected to gain some tribute to his own great erudition by quoting, in
This awful manner, an author, who certainly was unknown to the
greatest part of, if not all his readers. W. H. T. Esq. seems to have
caught the Arnaud mania from Mr. Turnbull, which is not uncha-
racteristic, but it is really surprising, that Mr. Blair should add his
name to those of two men so different from himself in praising Arnand,
whose works, it is presumed, will now be valued as they ought to be.

52
have courted opposition, and to have been disappointed at
not meeting with it; for, in his first edition, he modestly
enough offers his inventions, in his second, supposes a host
of patentee truss-makers are rising in battle array against
him, and, in the Appendix, he dashes down the gauntlet
of defiance with a most Quixotte like fury, by saying,
his mode alone is right *." As he has ridden his little
hobby horse over the common for two years unaccom-
panied and unmolested, he may not be displeased with the
company of a fellow traveller in the same way. My hobby
horse is telling stories, I have reserved a choice one for his
use, and shall leave the application of it to himself. In the
year 1745, when the rebel army was approaching to Derby
the country people flocked into the town before them, and
spread dreadful accounts of the devastation they com-
mitted; among other things, it was said, they ravished all
the women: the ladies gave a general shriek and ran to
their hiding places for safety: one good old soul who had
lived in peace for many years, and never thought such
thing's would come to pass in her time, barricadoed her cot-
tage door, and waited in awful expectation, the horrors of
the night: as all was silent she ventured to peep out at the
door, but, as a group of highlanders was close by, she in-
stantly shut it again. Again she peeped, and seeing them
remain in the same place, ventured to gaze stedfastly at
them, till she had caught the eye of one of the Scots, when
she became fascinated, as a poor bird is said to be by the
rattle snake, and stood with the door and her mouth wide
open in expectation of the fate she had no power to avoid :
finding he did not stir, she made faces by way of provocation;
but, as he was still unmoved, she began to lose her temper,
and, thinking a little gentle raillery might bring them
Sooner
*As his doctrine on this subject comes in a syllogistic form, it
would be unjust not to state it in his own way.
In mechanical action there is only a right and a wrong; W. H. T.
Esq. is in the right,
Ergo, all those who differ from him must be in the wrong.
The argument is a good one, and may be stated various ways, for
example:
In mechanical action there is only a right and a wrong;
Some one who differs from W. H. T. Esq. is in the right;
Ergo, W. H. T. Esq. must be in the wrong.
And, as the evidence of facts is three to one against him, he is entitled to
the full benefit of his own syllogism.

53
sooner into action, she screamed as loud as she could, ye
nasty bare ad rascals when do you begin to ravish, or
do you mean to keep poor people up all night for nothing
at all?
pre-
Should W. H. T. Esq. meet with any thing in the
ceding pages, to provoke his risible faculties, or excite his
irratibility, of which he seems to have, at least an equal
share, he will have the goodness to believe that nothing
has been written to impede the progress of any real im-
provement he may have made; on the contrary, it has been
seriously intended to shew the full value of every thing of
that kind, and attribute to every person that portion of merit
which he actually possesses, or, to use a phrase that is a lit-
tle homely, indeed, to put the saddle upon the right horse.
I had written thus far, without any more knowledge
of the author of these new inventions, &c. than could be
gathered from his title page and pamphlet, and now that
he has manifested himself in propria persona, have not the
least desire to alter a tittle that has been written; but since
he has overcome the "obvious scruples of delicacy which
prevented him from giving more than the initials of his
name to the public," and is now publicly blazoned with
all his titles, I shall address a few words to him in his own
character: for, though the man who goes in masquerade
is bound to take in good part whatever is addressed to the
character he assumes, if the flap of a Harlequin's sword, or
the whack of an oaken cudgel, should apply too close to
be agreeable to his feelings, he is, on taking off the mask
entitled to a serious explanation: that explanation I shall
now give to save him the trouble of asking it, and me the
trouble of writing again on the subject.
66
Such hypocondriacs as Mr. Timbrel, may think it
hard not to be allowed to understand their own cases, yet
that fact has been incontestibly proved by him; for he has pub-
lished such a statement of his case as it is impossible it should
exist, and therefore, must be untrue: this might, at first,
be the effect of ignorance, but, in his second edition the
whole is so far altered as to put those circumstances, the
impossibility of which has been shewn, compleatly out of
sight; and, after having done this, in a subsequent pub-
lication, he boldly claims the character of unimpeachable
veracity, by saying, " dare I, who am well known in the
"world, say these things if they were not true?" Without
any breach of good manners, I feel myself entitled to say,
this is the most consummate piece of assurance I have ever
met

54
met with any man, who is not professionally acquainted
with a subject he undertakes to write upon, may make
mistakes; but, having made and discovered such mistakes,
any man of common understanding, who meant honour-
ably to give what he thought useful information, would
correct his own mistakes as publicly as he had committed
them, for he must be sensible, that in proportion to the
benefit any person might derive from his communication,
if it was true, may be the mischief that might be done by
it if it was false; how far Mr. Timbrel's conduct coin-
cides with this rule I shall leave for others to determine.
Having already examined Mr. Timbrel's work, I
shall only notice one circumstance that has happened since :
he has applied to the Society for Encouragement of Arts,
&c. and obtained their gold medal for his communication;
this is the greatest honorary reward that society can
bestow.
It is not to be supposed that the few guineas which
are the intrinsic value of that medal, could be the temp-
tation to induce him to take so much trouble; but, when
it is considered that for twelve long months the commenda-
tory letter of Mr. Blair has been advertised in newspapers,
magazines, &c. &c. as puffing Mr. Timbrel's new inventions,
it is not unreasonable to suppose that, whatever may be his
motives for thus keeping them in view, having worn out
one voucher, he is willing to have another ready in succes-
sion: and, in this point of view, there is no doubt that
"the Society for the Encouragement of Arts, &c. having
"bestowed their gold medal on Mr. Timbrel for his valuable
"NEW INVENTIONS, &c." would make a most conspi-
cuous figure: but, as it would place the society in a situa-
tion very little respectable, it may be proper to observe,
that the society was induced to give that testimony of its
approbation, by its belief in Mr. Timbrel's own repre-
sentation
It is said that Mr. Timbrel produced to the society, or its com-
mittee, Mr. Blair's letter, his own printed pamphlet, a truss, and a
wooden figure made to fit the truss; and proved the efficacy of his in-
vention by exhibiting himself and an old washerwoman, who was
said to have a rupture; these two amused themselves with jumping off
chairs, &c. to shew how well their ruptures kept up. All this was no
doubt managed with becoming gravity and decency, and as it is con-
fessedly a hobby-horsical pursuit of Mr. Timbrel's, it will be granted
that

55
sentation of his own invention, and the perusal of that letter of
Mr. Blair's which has been printed: it follows of course, that
the society did, at the time believe in the truth of those re-
presentations, but does not really afford any additional con-
firmation of the facts pretended to be invented by Mr. T.
on the contrary, as every part of the subject has now been
fully investigated, if it should appear that there is no no-
velty in any part of his new inventions, it will only amount
to a proof that the society has been deceived as well as
others, into a belief of what is not true.
It would be imprudent to hazard a conjecture as to
Mr. Timbrel's real motives for acting as he had done in com-
municating his discoveries, inventions or whatever else he
may call them to the public; if he had no other design
than that of communicating to others, that which he had
found useful in his own case; it is to be regretted, that in
so doing, he should have practised artifices that have often
been practised by contemptible empirics for the purposes
of deception, and to be hoped that he will take in good part
this humble attempt to teach him the prudence, as well as
the propriety of not attempting to accomplish an useful
end by very improper means.
Of Bowman's Patent Truss.
As what are called Bowman's patent trusses, have been
obtruded, upon public notice, with much pertinacity for
some years past, their merits, if they have any, are entitled
to investigation in this place: it is said, that the author, pa-
tentee, or proprietor of this article, is engaged in some de-
partment of the medical profession; a fact, of which I have
no knowledge, but really know not how to believe; because
he has not acted on this occasion as it is reasonable to sup-
pose a man who had but common sense would do, either
with reference to the respectability of his professional si-
tuation, or even his own personal advantage.
Mr. Pott first emerged into general notice by the at-
tention he paid to ruptures; the Hunters too paid so much
attention to them, and seemed to think the reputation that
would attach to those who best understood this subject of
so much consequence that they engaged in a dispute with
Mr. Pott, which was conducted with much acrimony, re-
specting
that he and his washerwoman made as respectable an appearance as
Corporal Trim did, when Uncle Toby discovered him shewing Susan-
nah how to batter in breach.

56
specting the discovery of some facts relative to ruptures,
which each party claimed as his own : other celebrated
men have arrived at eminence in the same way, and so
much has public attention been directed to the disease for
some years past, that any man who had acquired any
decided superiority in the treatment of this disease must,
by making it known in a manner suited to the respecta-
bility of his professional rank, have acquired wealth and
reputation with as much ease and certainty as by exerting
himself in any department of the profession. These facts
Mr. Bowman must have known if he is in the profession,
yet these advantages he has relinquished by withdrawing
himself as much as possible from all visible connexion with
a concern of so much importance, and advertising it to be
sold in a cutler's shop with a printed bill of directions for
applying it, as the elixir of life or any other nostrum is
sold by the dealers in quack medicines in this town. As
Mr. B. has done this, we are bound to follow his track,
and make the best use we can of the posting bill and bill
of directious, as we have no other clue to guide us in our
inquiries.
The posting bill, which is still to be seen stuck up in
the window of a cutler, who is, or was employed as a
vender of this universal remedy for ruptures, is as
follows:
"Ruptures.
"By the King's Patent.
"Trusses, on an entire new principle, for the preven
❝tion and cure of ruptures, in both sexes, having no cir-
"cular steel spring, which is generally found so very uneasy
"to the wearer, and so liable to corrode and break.
"The same truss will fit almost any sized person,
"thereby rendering a measure unnecessary.
"The same truss will do equally well for a rupture
"of either side, and admits of the pressure being varied,
"according to the necessity of the case.
"These peculiar advantages render them highly
"essential to those going to or residing in foreign coun-
"tries, where the difficulty experienced in procuring a
truss to fit accurately is of serious consequence.
66
"With each truss is given a plate, and full directions
for applying it, but should further instructions be requir
ed, A MEDICAL GENTLEMAN IS APPOINTED FOR
66
" THAT PURPOSE.
66
29
As a full investigation of the use and advantage of the
circular

$7
circular spring, and a comparison between that and the
means which have been tried to effect the same purpose,
before the elastic truss was invented, which were justly
exploded by the introduction of that important invention,
and which Mr. B. and others have attempted to revive un-
der the pretence of its being a new invention, will be at
tempted in another part of this work; it will be needless
to notice his introductory observation here: but the two
next assertions, that the same truss will fit almost any sized
person, and the same truss will do equally well for a rupture
of either side, are so much at variance with all received
opinions, and so evidently enigmatical as to excite a great
portion of our curiosity; this we can only gratify by re-
ference to the bandage itself, or, for want of that to the
plate and bill of directions which are generously given
with each truss: the latter is printed verbatim at the foot
of the page, and authentically proves the following
facts, viz.
That
Patent Trusses without a circular Steel Spring.
The difficulty experienced in procuring a truss to fit accurately
(more especially felt abroad) together with the many inconveniences
attending the steel spring, its liability to corrode, break, &c. &c. in-
duces the patentee to offer to the public a truss, which he flatters him-
self will be more generally useful, and to obviate many of the disadvan-
tages attending those at present in use.
These trusses are so constructed, that the same truss will fit dif-
ferent sized persons, will do for a rupture on either side, and admits
of the pressure being varied, according to the necessity of the case.
Each truss is put up as for the left side; but should the rupture be
on the right side, it is only necessary to slip the circular band and
buckle from the brass studs, by which they are attached to the pad, and
change sides.
Fig. 1st. Represents a truss, extended, and fitted up for a rupture
of the left side.
A. The circular band, to be buckled firmly round the hips, with
the buckle C, and the strap D.
B. The spring pad, to be placed immediately on the part where
the rupture has protruded, taking care the rupture is first perfectly
reduced.
E. The under strap, to come under the thigh, and in the groin of
the rupture side, and fastened on the single brass stud in the pad.
F. The sliding cushion to rest in the groin.
gggg. Slides for shortening the truss, according to the size of
the wearer.
H. Brass eyes for receiving the hooks of the under strap.
I
Fig.

58
That this new patent invention consists of the fol
lowing parts, viz. 1st. A belt, or circular band, as it is
elegantly called, made of leather * or other soft materials,
long enough to go round the body of a large fat man;
consequently, by the help of a pair of scissars, may be
made to fit the size of any other man, however little or
thin he may be all this is evidently simple and true.
2dly. A spring pad, to be placed immediately on the
part where the rupture has protruded.
3dly. The understrap to go under the thigh, &c. &c.
and,
4thly. A sliding cushion to rest in the groin +.
All this only amounts to a simple truss, consisting
of a spring pad to be fixed on the part by a belt
round the waist; there is, perhaps, scarcely a common
truss-maker in town who has not, occasionally made
trusses of this kind, and Mr. Blakie, the real inventor
of the elastic truss, published a small treatise in the year
Fig. 2d and 3d. Represents the truss on for a rupture of the left
side, and it is requested to observe accurately the situation of the cir-
cular band, with respect to the hips, otherways the truss will not be
near so easy; and the under strap must be drawn sufficiently tight to
keep up the rupture; the degree of pressure necessary will soon be dis-
covered by the wearer.
They are particularly adapted for the East and West-Indies.
It is sometimes recommended at first wearing, to apply three or
four folds of flannel, or other soft substance, between the under strap
and skin.
Upper Titchfield-Street, Fitzroy-Square, No. 51.
*This is not said in words, but may fairly be taken for granted,
because the posting bill declaims formally against the circular spring,
and the sole object of this pretended new invention is to provide a sub-
stitute for the circular spring.
+ This sliding cushion is a most impertinently intrusive fellow.
Mr. Bowman has been sporting his new invented patent trusses upon
the town for several years; the printed paper I transcribe from has
been in my possession more than six years: yet W. H. T. Esq. who dares
not assert what is not true, has within two years published a treatise to
prove, that HE has invented his infallible calico cushion, which is, in
fact, a sliding cushion to rest in the groin, and I have proved, that it
may fairly be deduced from Arnaud, who published his valuable book
more than half a century ago. Now, as all these worthies are equally
entitled to credit, if they have any spirit, we shall be entertained with
a battle royal to ascertain who really is the inventor of the important
article in question,
1764,

59
1764, to explain the nature of his invention, and in
this he mentions the belt-truss and spring-pad as one
of those inventions that had been found ineffectual, and
was therefore nearly exploded with these facts in exist-
ence Mr. B. must be extremely ignorant of what it became
him to know, or he must have some qualification much
worse than ignorance, if he will venture to say, that this
which he calls his invention is upon an entire new princi-
ple. Thus driven from his new principle, he may seek for
refuge in asserting, that he has adopted some particular
modification of that kind of bandage, which renders it
more effectual than those which were previously used:
weak as this subterfuge must be, it is still, if true, capa-
ble of being proved; yet it will be difficult to prove this,
for, if I am not misinformed, he has, himself, tried springs
of different constructions, certainly not because he found
that particular one he may pretend to have invented an-
swer his purpose.
Every circumstance respecting this undertaking seems
it is the work of a man who artfully adopts every
prove
precaution that may preserve him from the shame that
must attend the exposition of his pretended invention, at
the same time that every artifice is adopted to make the
credulous become dupes to his project: perhaps, the most
impudent of these is the insinuation very generally circu-
lated, though no one knows who is the author of it, that
the inventor of this truss is a respectable surgeon: to say
nothing of the improbability, that any surgeon of but com-
mon information, should be so ignorant as not to know
that this pretended new invention is, in fact, an old one,
that has been exploded for its inutility, or that a sur-
geon, who valued his own reputation, would sedulously,
and with great perseverance, obtrude upon the public, as
new and effectual, an invention which he well knew was
obsolete and exploded, because experience had proved it
to be ineffectual. There is a circumstance in the posting
bill itself, which puts it beyond all doubt, that the author
cannot be a medical man.
to
Having previously asserted, that the same truss will
fit almost any sized person, and do equally well for a
rupture on either side, he adds, "with each truss is
given a plate, and full directions for applying it, but,
should further instructions be required, a medical gentleman
is appointed for that purpose," by WHO is this medical gen-
tleman appointed? Undoubtedly by the inventor, patentee,
or proprietor of this extraordinary truss, who, therefore,
12
cannot

60
cannot be himself a medical man, for, if he was, and act-
ing fairly, honestly, and uprightly, in the scheme he is
engaged in, however contemptible his invention, or mis-
taken his opinions might be, he could not hesitate to say
positively, should any further instructions be necessary, I
will attend to give the necessary instructions to the pur-
chaser, that he may be enabled to do justice to my valua-
ble invention as well as to himself; that he has not said
this, is a strong corroborating proof, that he is not a medi-
cal man, and the other circumstances which have already
been explained will enable the reader to form a just opi-
nion of the whole project as it has been long obtruded
upon public notice.
On what are called Patent Trusses without Straps.
The most extraordinary deception that has been prac
tised upon the credulity of those who are afflicted with
ruptures in the present times, is what is called New invented
Trusses without Straps, by the King's Patent. Extraordinary,
whether we consider its absolute want of novelty, or any
kind of merit, or the artifices by which some gentlemen in
the profession of surgery have been misled to give it their
sanction, and by this means are, unintentionally, become
associates in obtruding, perhaps, the most impudent decep-
tion that ever was practised upon the public: this being the
case, it becomes meritorious to unravel the whole pretended
invention, and shew those, who it is intended to deceive,
what it actually is.
It is necessary to premise, that about thirty years ago,
a Mr. Squire procured a patent for a method of making
trusses, which were to be used without straps: he was pa-
tronized by Mr. Hunter and other eminent men of that day;
and his trusses were very generally used, but with very un-
equal success. Had Mr. Squire been educated or properly
instructed for the employment he embarked in, he must
have known that no one mode of making trusses could be
properly adopted, to all the varieties of the complaint; and
had he had the least scientific knowledge, he must easily
have learnt how to obviate the real inconveniencies that
many laboured under from the use of his trusses; but this
was not the case: he had invented one mode of making trus-
he very honestly made all his trusses by one pattern,
varying only in size, and applied them indiscriminately to
ses,
every

61
every one who required his assistance; the consequence
was, that one was benefited, another, perhaps, injured by
them; staunch friends praised, and bitter enemies reviled
them beyond measure; and, in the midst of this contrariety
of opinions, his patent expired, his invention became free
for every one to use, and has been very much used ever
since, with success proportioned to the various capacities of
those who attempt to adopt it.
His invention consisted in making the circular string
go all round the body, instead of little more than half round;
as was the general practice before: by this improvement of
his, it is found that a truss will keep firmer in its place, and
therefore, where it can with propriety be used, a rupture
will be kept up with more certainty than by a truss of the
common form: its inconvenience was, that he did not know
how to accommodate the curve of the spring, so that when
applied to the body, its action should be exerted on the part
where pressure should be applied, with as little pressure as
possible on any other part of the body; the consequence
of this defect was, that very few of his trusses were worn
without producing intolerable pains by galling the hips, but
more especially the back, on which account many were
obliged to discontinue the use of these trusses who might
have been served by them. But a more serious inconve-
nience was produced, not by a necessary defect in the con-
struction of the truss, but by the false doctrine broached by
those professional men, who chiefly recommended it: by
these it was said, that the more pressure was made by the
truss, the more probability there was of effecting a radical
cure: this, as an abstract principle, might be true, but could
not be generally reduced to practice, without doing much
mischief; those who advised this practice, forgot that the
spermatic vessels lay immediately under the parts pressed
upon by the truss, and that hard pressure on those parts
would produce inflammation in the spermatic vessels, con-
sequently in the testicles, and very serious consequences
might ensue: yet, as those who once advance a doctrine
publicly are not very ready to change it, the patients con-
tinued to be squeezed hard in spite of inflamed testicles,
&c. until their feelings got the better of bad advice, and
they adopted a system that was less mischievous. Yet,
notwithstanding all its defects, Mr. Squire's improvement
was a very valuable addition to the general stock of know-
ledge we had before on the subject; and, in good hands,
will always be found useful.
About

62
About two years ago, a man introduced himself to se-
veral gentlemen in the profession of surgery, on pretence
of soliciting their patronage for a method, he said he had
invented, of making trusses, and for which he intended to
obtain a patent. One gentleman, from whom I have this
information, questioned him minutely respecting his sup-
posed invention, but could obtain no other information than
that the peculiar advantage of this, his supposed invention
was, that the springs were very strong, and being made to
go all round the body, and fasten without any straps: the
surgeon gave his opinion of this invention as far as the de-
scription was intelligible, and added, that the particular
point, on which he seemed to lay the most stress, was not
new; it was well known to have been executed by Mr. Squire
many years before, and its success had not proved equal to
the sanguine expectations that had been formed of it. To this
the projector answered, as all people do, who have formed
schemes which they do not wish to have contradicted, that,
although Mr. Squire's invention had not succeeded, he
knew his would; and, as he found this gentleman was not
likely to become either a tool or a dupe to his project, he
retired much disappointed, and never returned again.
As this person left no mark by which he could be
traced, it cannot certainly be known who he was, but, from
such an invention being soon afterwards advertised, and forced
înto notice with much confidence, it is presumed, he might
be the soi-disant inventor of New invented Trusses without
Straps, said to be made by the King's Patent. However
that may be, our business at present is with that INVEN-
TION, as it is most absurdly called, to investigate its merits
most accurately, in order to enable those who may be inte-
rested to know the truth, to determine whether it is a real
invention of any utility, or only an artful deception, fa-
bricated for the purposes of imposition and fraud.
In pursuance of this plan, application has been made
at the patent office, where it appears, that the only patent
which can be supposed to be connected with such an in-
vention, is one with the following title, viz.
For a Method of bending Steel, without the assistance
of heat; which may be applied to the manufacturing of sur-
gical Instruments, and to a variety of other useful purposes.
A correct copy of the specification of this patent has
been obtained from the proper office, and is printed verba-
tim, as follows, viz.
To all whom these presents shall come, I, Joseph Egg,
of

63
of Great Windmill-street, in the parish of St. James's, in
the city of Westminster, gun-maker, send greeting.
Whereas, his most excellent Majesty, King George the
Third, did, by his letters patent, under the great seal of
Great Britain, bearing date at Westminster, the twenty-
first day of August, in the fortieth year of his reign, give
and grant unto me, the said Joseph Egg, his especial
licence, that I the said Egg, during the term of years
therein mentioned, should, and lawfully might use, ex-
ercise and vend within England, Wales, and the town of
Berwick-upon-Tweed, MY DISCOVERY of an entire new
method of bending steel without the assistance of heat, which
may be applied to the manufacturing of surgical instru-
ments, and to a variety of other useful purposes, where
In
BENT STEEL AND STEEL SPRINGS ARE NECESSARY.
which said letters patent there is contained a proviso, oblig-
ing me, the said Joseph Egg, by an instrument under my
hand and seal, to cause a particular description of the nature
of my said discovery, and in what manner the same is to be
performed, to be enrolled in his Majesty's High Court of
Chancery, within one calendar month of the date of the said
recited letters patent, as in and by the same (relation being
thereunto had) may more fully and at large appear.
Now know ye, that in compliance with the said proviso,
I, the said Joseph Egg do hereby declare, that my said
discovery of an ENTIRE NEW METHOD OF BENDING
STEEL WITHOUT THE ASSISTANCE OF HEAT, which may
be applied to the manufacturing of surgical instruments, and
to a variety of other useful purposes, where bent steel and
steel springs are necessary, is described in manner following,
that is to say;
Take a piece of straight steel, tempered similar to a
spring sword blade, and place one end against the body,
and take the other end in the hand, bending it at the same
time over a circular piece of steel or iron (such as is com-
monly known by the name of a big iron) moving it back-
wards and forwards as may be necessary to vary the blow,
which should be struck in a parallel direction with the cen-
tre of the circular steel or iron (over which the spring wheel
is bent) by an instrument similar to a hammer, but instead
of a round face, or blunt edge, it must be like a chissel, so
as to make a cut or impression at every blow, which by
continuing to bend the steel spring and cutting it at every
blow with the said instrument, the spring may be made to
a form proper for a rupture or a truss, or any other similar
shape

shape that may be required. In witness whereof, I, the said
Joseph Egg, have hereunto set my hand and seal, this nine-
teenth day of September, in the year of our Lord, one
thousand eight hundred.
(Signed)
JOSEPH EGG,
Sealed and delivered (being first duly stamped) in the
presence of
JOHN OSTLER,
CHAS. E, JONES.
And be it remembered, that on the same nineteenth day
of September, in the year above-mentioned, that aforesaid
Joseph Egg came before our lord the King in his Chancery,
and acknowledged the specification aforesaid, and all and
every thing therein contained, in form above written. And
also the specification aforesaid, was stamped according to
the tenor of the statute, in that case made and provided.
Inrolled the same nineteenth day of September, in the year
above written.
Examined with the record in the Petty Bag-office,
in the Court of Chancery, this 15th day of No-
vember, 1802,
(Signed)
P. PARRY,
Much has been said of the abuses that have been com-
mitted on public credulity, under the sanction of patents,
and it would be extremely difficult to produce a stronger
proof of the extent to which those abuses may be carried,
than the patent, of which the specification has just been re-
cited; yet the laws which regulate patents are very clear,
and the principles upon which they are founded are un-
doubtedly just: they are simply these: That a man, who
by any exertion of talents and industry, produces any in-
vention that will be useful to society, is entitled to a recom-
pence proportioned to the utility of his invention, and
ought to receive it from those who will be most benefited
by it; therefore a patent is granted to secure him the ex-
clusive privilege of selling his invention for the term of
fourteen years, for his own benefit; after that period it is
free for every one to make what use he pleases of it.
The proceedings to obtain a patent, are as follows:
The suppliant makes affidavit before a Master in Chan-
cery, that the invention for which he requires the patent, is
bona fide, entirely his own invention; that it is unknown;
that he has never sold or made it public in any manner, and
that he believes it will be a benefit to the public, when it
shall be promulgated.
In

65
In consequence of making this affidavit he receives his
patent, upon condition that he declares truly what his inven-
tion is, and so exactly, that no other person may inad-
vertently infringe his privilege; and that within a month
he shall cause to be registered in the proper office, an exact
and true specification of all the particulars of his invention,
that it may remain a public record of the transaction. If
he fails in any of these conditions his patent becomes void,
and his invention, whatever it may be, becomes public, and
every person is at liberty to make his own use of it: no
punishment is provided for those who take out patents for
old, obsolete, or well known inventions; that must be in-
flicted by general contempt on those who, by means little
different from wilful perjury, endeavour to convert an use-
ful privilege into an instrument of fraud.
It will be proper to ask, if the gunsmiths, who pretend
to make "new invented trusses without straps BY THE
KING'S PATENT," have any other patent besides that of
which the specification has been transcribed? If they have,
no reflection that can be made upon it can attach itself to
them; if they have not, though no personal allusion will
be made to them, they will be entitled to the benefit of
any reflection the reader will make when he is acquainted
with the merits of the patent in question.
If a man should really believe (however mistaken he
might be as to the fact) that he had invented any article,
and procured a patent for it, he would not hesitate to say
he had invented that particular article, and would describe
it most plainly; it would be his interest to do so, because
by that means only, he would secure his exclusive privi-
lege; if he knew he had not invented any particular arti-
cle, and should choose to take out such a patent as would
induce the public to believe he had, what would be his con-
duct? would he, or would he not, adopt such a system of pre-
varication as would prevent, as much as possible, those who
should enquire into it to ascertain the real state of the fact?
It is very remarkable that the person who was the original
proprietor of the patent, of which the specification has been
transcribed, would have the public believe that he has ob-
tained the King's patent for a truss that may be worn with-
out straps, and which truss is of his own invention, and yet
should take out a patent in which the word truss is not men-
tioned; in the specification of which no kind of truss is de-
scribed or distinguished from other trusses that are generally
known; and in which it is merely said in so vague a manner,
K
that

66
that the words might escape the notice of even an attentive
observer, "The SPRING may be made to a form proper
for a RUPTURE or a TRUSS."
If those who are accustomed to trace the arts of pre-
varication will examine the structure of that sentence by
which the scheme is announced to the public, or the
patent and specification, they will perceive there is nothing
that amounts to an assertion that the patentee invented any
kind of truss; there is only that kind of circumlocution,
(which those who admit the rectitude of jesuitical princi-
ples will approve) that may induce the incautious to be-
lieve he actually has; and, if those who have a very
strong interest to avoid deception will not take the trouble
to do so, the Jesuits, at least, will say they deserve to be
deceived.
66
The INVENTION for which this patent has been obtained,
and which the patentee has sworn to be a new discovery, and
bona fide, his own invention, is, as declared in the specification,
"My discovery of an entire new method of bending steel with-
out the assistance of heat." The only question to be tried
then, in order to ascertain the validity of this patent is,
whether the allegation sworn to in order to obtain it is true;
whether there is any invention at all, or whether that invention
be bona fide the invention of the patentee. If it is, it might
afterwards be debated whether, by virtue of a specification
so loosely worded, he might create a monopoly of surgeons'
instruments, or cutlery wares, or any other articles, by
virtue of it: but, if it is not, though he has sworn to the
reality and truth of his inventions, though he has paid the
fees of office, and got a parchment with certain stamps
and seals upon it, that parchment is no patent that can
authorise him to claim an exclusive privilege to manufac-
ture any one article of any kind.
Those who are acquainted with the manufacture of
steel in any branch know, that articles of steel are first forged
or otherwise wrought to a proper shape, then heated to a
certain degree, and quenched in cold water or other fluid:
in this state they are quite hard, and, in order to bring them
to a proper temper, they are again exposed to so much
heat as will lower them to the point desired; they are then
in a state fit for finishing.
In the act of hardening in cold water, the steel fre-
quently takes a shape different from what the workman
desires: a knife-blade or a razor becomes crooked; or
a spring takes a different curve from that which it ought to
have: if the workmen were to soften these things again to
make

67
make them straight, theywould, in allprobability, lose their
labour, as on the next hardening they would, perhaps, cast
out of shape again; besides, the quality of the metal would
be injured by repeated hardening. To avoid these incon-
veniences, all workmen who make articles of any kind in
tempered steel, have, from time immemorial, had A ME-
THOD OF BENDING STEEL WITHOUT THE ASSISTANCE OF
HEAT, by means of which they alter the improper shape or
THEIR WORK, and give it that shape which they wish it to
have. This operation is performed in the following
manner:
The workman has a hammer formed like a blunt chis-
sel, he lays the work (already tempered) upon the anvil,
stake, bick iron, or any other convenient place, and strikes
the steel many times with the sharp edge in a proper
direction, so that by cutting it in that direction full of
small notches, the defective form of the work is altered,
and it is reduced to that which it ought to have; in other
words, the steel is bent without heat into the form it is
proper to give it. This operation is, by the workmen, called
hacking; the cutlers call the tool they use to perform it a
hack hammer; and perhaps there is no journeyman in that
trade, whether he makes amputating-knives, case-knives,
razors, springs, or any other articles, who does not daily
perform this operation of bending steel without heat. Let
the most accurate investigator compare it with Egg's spe-
cification, and determine what is the difference between his
specified new invention and their old practice.
But, it may be said, if this invention be not new, the
application of it to the making of trusses may be new, and,
if trusses made in this manner possess any advantages over
those made in other ways, they are entitled to a prefe-
rence, which, in that case, they will obtain, though the
soi-disant inventor cannot by patent secure the advantages
that may arise to himself: that is indeed the only impor-
tant and real question which we shall now proceed to in-
vestigate.
The good qualities of a tempered steel spring, for
whatever use it may be intended, depend upon the fol-
lowing particulars, viz. that the metal of which it is made
shall be of a proper quality, uniform in its texture, free
from flaws or inequalities of any kind; and so much de-
pends on this, that a few strokes unequally applied in
forging, will make the steel closer in its texture, and there-
fore harder in some parts than others. To prevent this,
K 2
the

68
the workman, after he has forged his spring, places it for
a long time in a low heat, by which the whole spring is
reduced, as nearly as possible, to one uniform texture.
Yet, with all the care that can be taken, springs that are
forged are never so uniform in their texture, and, there-
fore, can never be so good as those which are never
touched by a hammer, which is the case with those that
are made of steel that is reduced to a proper size by a
flatting machine. Supposing the metal to be uniform in
its texture before it is tempered, it is obvious that the ap-
plication of a regular heat in tempering, will give an uni-
form degree of elasticity to the whole spring; and, on the
contrary, if an uniform degree of heat be applied to a
spring whose parts are previously of an unequal texture,
it is certain that such a spring must be unequal in its tem-
per, therefore it will be incapable of sustaining any regular
action: when subjected to such action, some of its parts
must either bend or break; because, when the substance,
texture and temper of a spring are equal in all its parts,
the power of the whole is equally divided between them;
but when any part is more brittle, harder, or softer than
the rest, it is therefore weaker, and, when subjected to the
same action, must demonstrate its own weakness and either
bend or break.
A workman, who understands his business, may al-
ways make his springs, and temper them properly; but
there is one circumstance of which he is by no means
master. From some peculiar circumstances in the tem-
pering of steel, a great portion of the articles tempered
are distorted from their proper shapes: curved instruments
become straight, and straight ones curved, and therefore are
improper for the use they are intended for: if they were
to be softened, rectified and tempered, the quality of the
metal would be debased, and still they might bend again
in the tempering, however frequently it might be repeated;
therefore, the only alternative is to lay them aside as use-
less, or to endeavour to rectify them after they have been
tempered, and for this purpose the operation of hacking has
been used among all descriptions of workmen, in steel, for
time immemorial. The effect is produced in this manner:
if the instrument, whatever it may be, is straight, and should
be bent in the hardening, the workman lays it on a proper
tool, and with his hack-hammer strikes it very carefully
upon the concave side, varying the stroke continually,
and by this means cuts that side full of indentations or
notches,

69
notches, by which means that side is lengthened till it be
comes equal to the other, and of course the instrument
straight: if the intention of hacking is to make the instrument
more curved, he lays the hollow side upon a mandril, bick
iron, &c. and strikes with his hammer on the curved side,
and the instrument becomes more curved, till it is brought
to its proper shape.
But it must be remarked, that, although the workman
by this means makes his article saleable, instead of laying it
aside as useless, it is always worse than if it had not under-
gone that operation, for the following reasons: every in-
dentation made by the hack-hammer renders the part
struck more compact, and consequently harder than the
general temper of the instrument; therefore, instead of
being uniform in its texture and temper, every instrument
that has bsen subjected to this operation is full of inequa
lities in both respects; and as every mark of the hack-
hammer is obliterated from knives and such articles in the
finishing, it is probable that so many of them break when
subjected to any exertion, in consequence of the unequal
texture that is produced by the operation I have described;
but as the very essence of a spring consists in the uniformity
of texture and temper, which alone can enable it to bear
the continual action and reaction to which it is to be sub-
jected, no spring can be depended on upon which this
hucking or bending has been performed.
From what has been said, it is evident, that a perfect
spring should be uniform in its texture and equal in its
temper; that, from difficulties in the manufacturing them,
many have qualities the reverse of these; it is therefore
evident, that if Egg's method of making springs by bending
steel without heat (whether it is his own invention or not)
is superior to that commonly used, it must be calculated to
give them more uniformity in their texture, and more re-
gularity in their temper, than can be obtained by the com-
mon methods; whether it can do this is the only point to
be investigated, and will very easily decide the question.
He takes a piece of straight steel, tempered SIMILAR to
a spring sword blade, bends it as near to the form it is in-
tended to give it as he can, and strikes it full of notches
with his chissel-like hammer, which operation hacks it in
the form in which it is bent. As it has already been shewn
that this operation has been used, time immemorial, by
most workmen, and that it must debase the valuable pro-
perties of any spring it is applied to, there can be few ar-
guments

70
guments required to prove that the ORIGINALITY and the
MERIT of his invention are in strict unison with each
other.
But there is a gross fallacy in that part where he says,
take a piece of straight steel tempered SIMILAR to a spring
sword blade, which should be explained, and which shall
be particularly pointed out in this investigation. It is well
known, that every man who uses a sword stakes his life
upon the goodness of his weapon; and as the makers of
swords are aware of this, they are as careful as possible in
tempering them; so that there is no doubt, that, after every
allowance is made for carelessness of workmen in extensive
manufactories, sword blades are among the best tempered
articles of steel that come into general use. This being
the case, this man has displayed no small artifice in saying,
take a piece of steel tempered SIMILAR to a spring sword
blade, &c. But has he said, or will he dare to say in plain
terms, that, by the method described in his specification, he
can turn, or EVER HAS turned, a sword blade, or a straight
spring tempered like a sword blade, into the form of a truss?
I put this pointedly, because a foolish story has been pro-
pagated, that this method of making springs for trusses is
so peculiar, that they can only be made of sword blades,
and that the patentee actually imports German sword
blades for the purpose of making them. I hope that he
does not tell this tale, and that it is only the foolish mis-
take of some person who has misconstrued the ambiguous
sentence in the specification, in which it is said: "Take
66
a straight piece of steel tempered SIMILAR to a spring
"sword blade, &c." Till this is cleared up by positive
proof from the patentee, I have no hesitation in saying,
that, by accurate examination of some of these trusses that
are still in my possession, I am convinced they are made
of steel that never has been tempered like a sword blade,
as they are still soft, and only owe the little elasticity they
possess to being partially hammer-hardened by the strokes
of the hammer on the outside of the curve.
The subject might with safety be left to its own me-
rits here; but as an investigation has been undertaken, it
will be right to mention some additional facts that will put
the matter beyond the possibility of future dispute.
A gentleman who had a rupture, and was so irritable
that he would not bear the pressure requisite to keep up
his rupture, was induced to get one of these trusses: it
did keep up his rupture, but it gave him more uneasiness
than

771
than the truss he had previously objected to the use of.
On seeing him some time afterwards, he told me his truss
was now become easy, for he found, that though it seemed
to be strong, he could bend it in any way he pleased, and
by this means he had altered it, and made it quite easy..
He wrote me the following note:
DEAR SIR,
I have repeatedly tried to wear the truss I had from
you last, but the spring is so powerful at the pad, that
the pressure is more than I can bear, except in a sitting
position; in every other respect it fits perfectly, and the
pad presses exactly in the proper place.
I am just returned from Ireland, and left the spring
as much extended as I safely could, but even five weeks has
MADE NO ALTERATION IN THIS RESPECT. I will thank
you for a line to say when the bearer may call for one of
exactly the same dimensions. I am your's, &c.
If I had not known that this gentleman was perfectly
serious, I should have suspected both his communications
to be ironical. To object as a fault that five weeks con-
tinued extension made no alteration in the form or power
of one spring, and to mention as a subject for praise that
the other might be bent with the hand into any shape he
pleased, certainly had that appearance; but as he un-
doubtedly was serious, and as both his communications.
were correct, they prove every thing that is necessary on
this subject.
I directed a person to purchase one of these trusses for
the purpose of investigating all the facts of its construction.
On taking off the covering, the spring appeared to be
nicely burnished SIMILAR TO a sword blade; on the out-
side it was struck full of indentations, but on the inside it
is perfectly smooth, and had not the mark of a single
counter-stroke*: a part of it was almost blue, evidently
* In explanation of this it is necessary to mention, that when a
piece of metal is laid upon the anvil or similar implement, and struck
with a hammer, an impression is made upon the surface struck in pro-
portion to the violence of the blow and the softness of the metal, and
another impression is made on the underside of the metal that is pressed
against the anvil by the stroke of the hammer; this 1 call the counter-
stroke: it will not be so violent at to be indented like that which is
struck by the hammer, but it certainly would be perfectly visible on
the burnished metal. If, therefore, this spring had been burnished
before it was bent, there would have been a counter-stroke visible di-
4
rectly

72
from the action of fire applied after it had been polished;
I found several parts of the spring might easily be bent by
the hand, but as I wished to keep this truss as a specimen,
I did not entirely destroy its form; and, with an old file,
I found that every part of it might be filed as easily as any
soft steel. Now, though we know that a well tempered
spring is not quite insensible to the file, it cannot be filed
in the manner this one was; and as the very essence of a
spring is to yield to pressure, and to resume its form on the
removal of that pressure, it is evident that this never was
properly tempered, and cannot with propriety be called a
spring; whether it was finished in the manner I have de-
scribed for the purposes of deception*, it is impossible
now to determine.
A gentleman was induced by strong recommendation
to purchase one of these trusses: finding it was impossible
for him to wear it, he gave it to me, and on taking it to
pieces, I found the steel part of it exactly like the former
in every respect. I bent it with my hands into a shape
totally different from that it originally had, and in this
state they both remain in my possession for the inspection
of those who wish to ascertain the facts I have related. It
is to be remarked, that both these trusses have straps and
fastenings to fix them round the body in the usual way; than
which nothing can more strongly prove the seller's own
opinion of the fallacy of the pretence that these trusses may
be used WITHOUT STRAPS, to say nothing of the falsehood
of pretending that they have invented the method of
making trusses to be worn without straps, which really was
the invention of the late Mr. Squire. From all that has
been said, there is but one conclusion to be fairly drawn,
but, for the accommodation of those who are unwilling to
form a decided opinion, I shall state two that may be
drawn,
rectly opposite to every indentation that appears on the outside; but, as
there is not one, and as every stroke is ostentatiously left on the outside,
it is evident that the spring was burnished after is was turned, and after
the indentations were made on the outside: Whether this burnishing
was so applied from a foolish affectation of finishing the work, or to give
it the appearance of a sword blade for the purpose of deception, I shall
not take upon me to determine.
* Lawyers, who understand definitions, are aware that there is an
essential difference in the meanings of the words deception, imposition,
and fraud; but as every plain man may not comprehend the distinction,
it would be wasting time to engage in any disquisition on that subject.

73
in any
drawn, and leave them to chuse that which they may
prefer. The first is, that there is no one circumstance
respecting this soi-disant invention that is new, superior to
every common method of making trusses, or,
respect worth notice; or, secondly, if it should be thought
useful, and fit to be adopted in general practice, the spe-
cification is so constructed, that the patentee cannot sup-
port his monopoly, therefore every person is at liberty to
make them who shall think proper to do so.
As these gun-makers have not made any claim or pre-
tence to knowledge of ruptures, or those circumstances
which are requisite to enable any one to apply trusses with
propriety, and without danger of doing mischief, it must
be improper to say any thing on that subject; it is possible.
they may not be so far masters of the subject as to refute
the observations that have been made, and, in that case,
they may endeavour to oppose them by the opinions of
some professional men: when such opinions are brought
forward, they shall be examined; in the meanwhile, some
general observations on that subject may not be useless,
as they may induce professional men to be cautious, how
they suffer their uames to be used on such occasions, and
may likewise teach unwary patients to be cautious, lest
they be imposed on by uuwarrantable abuse of the names
of respectable professional men; for it is certain that the
greatest and the worst part of the quackery that is practised
on this subject, is supported by abuse of the names of men
who would start at the imputation of supporting the most
contemptible quackery, though they are not conscious of
the fact. The progress of such undertakings is nearly in
the following way.
Some workman who has no actual knowledge of the
subject he engages in, imagines he has invented a truss
that is different from those he has seen; full of this fan-
cied discovery, he frames a plausible account of it, in-
troduces himself to such surgeons as he can gain admit-
tance to, tells his tale, and, perhaps, is promised a re-
commendation: an opportunity offers, his truss is tried,
and gives satisfaction; he modestly asks for a written cer-
tificate of the fact, which is thought too reasonable to be
denied; indeed any gentleman may, without impropriety,
do this, as he only certifies to a fact that he has seen; but
let the consequence be observed. The adventurer, having
obtained a few such certificates, acquires both confidence
and impudence, obtrudes himself upon the world as having
made a great and important discovery; provokes inquiry,
and
L

74
and it appears, that what he, ignorant of the subject, be-
lieved to be his discovery, was well known before: en-
raged at meeting with this check, he produces his certi-
ficates; and though the writers only meant each to certify
that particular fact which he had seen, they are collec-
tively obtruded on the public as vouching for all the pre-
tensions to originality and superior excellence which he
who has received them chuses to lay claim to.
Such has been the origin and progress of most of the
pretended improvers of trusses during the last thirty years.
The importance of the disease is acknowledged, the diffi-
culty of treating it properly is likewise admitted; can it
then be doubted that infinite mischief has been done by the
tribe of blacksmiths, sadlers, and such like workmen, who,
without knowledge, or the consciousness that knowledge is
necessary, have erected themselves into makers of new in-
vented trusses? Most gentlemen in the medical profession
are aware of the mischiefs that are daily perpetratedby the arts
of quackery in every department; it therefore can only be
necessary to mention the fact, to induce THEM to be cau-
tious how they suffer their names to be used, and to induce
the unwary patient to be more cautious how they rely on
such certificates as may have been obtained by artifice,
and used for the purposes of deception.
But there are some men, though the number is very
small, who are more forward to recommend these new
adventurers from motives that are base, corrupt, and every
way unjustifiable; they sell their recommendation to those
who will pay the most for it. Whoever considers what
the character of a surgeon ought to be, and what the
character of a great majority of the gentleman in that pro-
fession actually is, will think nothing can be more base
and contemptible than such a person as I have described:
on the one hand hunting for patients, telling them of the
danger of the disease, of the importance of a good truss,
and offering his services to procure one; on the other*,
* A person of this description brought a patient to my house, and,
under the pretence of explaining the case, drew me into another room.
The explanation he gave was, that he expected I should give him half
the price of the truss for his recommendation: his proposal was re-
jected; he returned to his patient, and modestly told him, in my hear-
ing, that I had not a truss that was fit for him; and they both went
away.
In less than a month the patient returned by himself. I then learnt
his honest surgeon had got him a truss from a workman of the lowest
description,

75
traversing the town to find out that workman who will
give him the most profit, and thus endangering the safety
of his patient, for the honest purpose of getting a few
shillings for himself. The number of persons who act in
this manner is undoubtedly small; but as they will always
be spurned by men of character, they naturally fall into
connexion with those who have none, and are most likely
to rally round that one of the honourable number who may
be, in fact, least entitled to notice for his merit. With
the cautions he should derive from the knowledge of these
facts, the reader may safely be trusted to examine the
opinions of those who volunteer themselves in supporting
many of the new invented trusses of the present day.
Of Turnbull's few Rules, &c.
As the most prominent of these schemes that are ob-
truded, with a view to lead or mislead the unwary who are
afflicted with ruptures, exists in a pamphlet, called "A
"few General Rules and Instructions, very necessary to be
"attended to by those of both Sexes who are afflicted with
Ruptures;" it is proper, in a work like the present, to
enter into a critique of that tract, in order to ascertain the
REAL as well as the ostensible motives of the author, and
to ensure him all the praise which the merit of his
formance may fairly entitle him to.
per-
As it is a maxim in sound criticism not to censure a
man because he has not done what he did not undertake
to perform, I shall, in conformity with this maxim, not
censure the author, because he has not treated his subject
with that clearness and precision that would bring con-
viction to the minds of well-educated professional men, as
he has declared his "intention to avoid the technical lan-
guage of his profession;" but as he has said, page 7,
he intended these few sheets for the consideration and
"observance of the indigent and middling classes of so-
ciety,
56
L 2
66
66
description, whom he extolled as being a wonderful clever man; but
he not having found him so, returned to me, and has been my patient
ever since. [

76
"ciety, and hopes they will not only be found useful to
"the peasant or indigent mechanic, but to those more ele-
"vated in life, who are not acquainted with the phraseo-
"logy adopted in the science of surgery," I shall proceed
to inquire what use or benefit they, for whose use they
were intended, are likely to derive from these few rules,
&c. &c.
In order to ascertain this it must be presupposed that
the reader has a rupture, that he is so situate as not to be
able to procure professional assistance, but has fortunately
obtained possession of these rules, &c. which are to serve
as a manual to direct him to take care of himself in various
situations, and first to reduce the rupture even in case of
strangulation.
He says, p. 29. "If the assistance of a surgeon can-
not be had on the first appearance of the disease, the
"patient must give up all kind of exercise or labour.
Every exertion, however trifling, only tends to force the
"intestines from their natural position, and increase the
"malady. Immediate rest becomes essential, and the
"position of the patient should be always with the head
"lower than the body. To favour a return of the intes-
"tines, it will be also necessary to place the feet of the
"patient over the shoulders of another person, and to
"permit his body to hang downwards. When in that
"situation he should be JOLTED A GOOD DEAL! Which
"in many cases, has been attended with the best con-
66 sequences.
(C
Again, p. 30. "At this moment a gentle pressure of
"the hands and fingers should be made. The person
"operating in this way should grasp the swelling with one
"hand at the bottom, while with the fingers of the other,
4.
an attempt be made to push gently the contents of the
"tumour into their place: always observing, that the
66 parts last swelled be first reduced."
Again, p. 31. "When the return of the gut cannot
"be obtained by the means before-mentioned, the best
"consequences may be expected by an immediate appli-
cation of cold water, or ice, if it can be procured. To
"increase the coldness of the water, and thereby facilitate
"the return of the intestines, two ounces and a half of
"crude sal armoniac should be dissolved in a quart of
spring water, and frequently applied to the part. When
"this mixture, by standing, acquires the temperature of the
atmosphere,
66

77
"atmosphere, it loses its cooling properties, and, there-
"fore, a fresh solution should be made."
Again, p. 32. "An injection of cold water may
"likewise be administered with great effect; but, for this
operation, a pewter syringe, † containing a pint or a
"pint and a half (of cold water) must be provided, and
"which may be had of most of the pewterers in London.
"These syringes, admitting of greater force in the act
"of administering the contents and lodging them in
"the intestines, than those formed of elastic gum or a
"bladder very often effect the reduction of the gut when
"other means have failed."
66
66
Dashing of cold water on the legs and thighs, in
cases of difficult reduction, has been also recom-
"mended."
"In addition to the cold applications recommended as
"above, I would advise warm ones to be applied to the
belly at the same time, and in the following manner.
"Take the bladder of an ox, two-thirds full of warm
"water, cover it with flannel, to prevent any moisture
from touching the body of the patient. Apply the blad-
"der, thus prepared, so as to cover the whole of the belly
"above the tumour, and, at the same moment, let the cold
bathings before mentioned, be made directly to the rup-
"tured
66
66
66
*Sapient artes magister! who hast, in the abundance of thy know-
ledge and philanthrophy, published a two shilling-pamphlet to inform
the indigent and ignorant that when cold water becomes warm it
loses its cooling properties, and those who wish to have it cold must cool
it over again!
+ If the text is literally understood, it must be the author's meaning,
that the pewterers keep these syringes ready filled with cold water; but
it will be charitable to suppose, that in the fervor of composition he did
not clearly see his own meaning, and that this is an unintentional
mistake.
When reading this and the following passage separately their absur-
dity may not be apparent, but, on comparing them, it will be evident, for
example, he first says, the bladder of warm water must be laid upon the ab-
domen, but carefully wrapped up in flannel to prevent any moisture from
touching the body of the patient, then the cold water must be dashed di-
rectly upon the ruptured part! Now, as that is generally in some part of
the abdomen which was previously covered with flannel to prevent any
moisture from touching the body, the solution of these difficulties is not
very easy; if the flannel is placed on the body to keep the hot water
from it, how is the cold water to get to it. Has the cold water any salu-
tary

78
"tured part. These contrary applications of heat and
" cold have been attended with the best consequences
66
66
because, at the same time that it becomes necessary to
"relax and enlarge the ring or opening through which
"the intestines pass, and which is formed by the tendons
"of the muscles of the belly, it is at the same time ne-
cessary to contract and diminish the size of the
gut,
"that the reduction may be effected with less difficulty."
For the surgical reader, enough has been quoted! but
the danger is, lest the air of gravity with which all this is
delivered, should prevent the indigent ignorant reader
from seeing that Mr. Turnbull's object seems to be to ban-
ter, or, as the school-boys call it, make game of him: for
it is impossible for even him to believe, that all this would
be attempted by an ignorant patient and his friends; and
a professional man would scarcely trifle with his patient
in obedience to the dictates of this author; as it is impro-
bable that this scheme will ever be practised according to
the plan laid down by Mr. T. it may afford some enter-
tainment to a person of lively imagination to suppose he
sees a patient, with strangulated hernia, treated according
to these rules: let the reader imagine, then, he sees a pa-
tient suspended by the heels, and JOLTED A GOOD DEAL,
alias WELL SHAKEN,* by one clumsy operator; pressed
on the inflamed and painful tumour by the hard hands of a
second;
tary effect upon the custicle, and is the hot water deleterious? In his
next edition this master of arts will probably explain these phenomena,
and make the learned acquainted with those laws of physics on which they
depend.
*I do not mean to call Mr. Turnbull plagiary, though the above
idea is not original. When Dicky Gossip, of facetious memory, en-
gaged in the practice of physic, he, like Mr. Turnbull, endeavoured to
distinguish himself by doing something in the literary way. Upon the
first draught he sent to his first patient he inscribed the following
label:
When taken,
Well shaken.
The distich was certainly ambiguous; the nurse interpreted it in her
own way, and having duly administered the draught, took the patient
by the heels, and literally shook him to death.
It would be libelling the character of poor Dicky to compare his
practice to Mr. Turnbull's; for though the patient was actually shaken
to death in consequence of the orders he gave, there was a mistake; he
did not order his patient to be shaken at all. But Mr. Turnbull adopts
the nurses practice literally, by ordering the patient to be well shaken
or jolted: and it is not difficult to foresee, that if the business was un-
dertaken by an operator as well inclined as she was, the event would be
the same in both cases,

79
second; injected per anum with cold water by a third,
and alternately splashed with cold, and dashed with hot
water on the abdomen by a fourth: if he' considers that
when ignorant people do act by the direction of a learned
doctor, they are under the strong impressions of implicit
faith, and, to all the preceding circumstances, adds, the
screams of the unfortunate sufferer, he may form a toler-
able idea of the inhabitants of Pandemonium, tormenting
one who was newly arrived among them.
If to what has been said, I may add one more serious
observation it shall be this; there is no folly greater, than,
if so great, as the attempt to direct unpracticed men to
perform even trining surgical operations; there is no si-
tuation more dangerous than that of a patient labouring
under strangulated hernia; few situations indeed where
more fatal consequences will ensue from apparently trifling
circumstances of misconduct. If, therefore, Mr. T. sup-
poses these rules, as he calls them, should ever be practised
by those for whose use he says they are intended-I
shall not say a word more on the subject.
66
Though it is not to be doubted that he composed these
rules, &c. for those whose benefit he says they were in-
tended, it is equally certain, that he hopes to extend his
own practice in this particular branch of business: acting
upon these principles, it is not surprising he should cast a
hawk's eye upon a class of patients who have kept clear
from the hands of professional men, as well as the hands of
all mankind. He says, p. 23," females, who have been
virtuously educated, too frequently conceal this malady
"until it becomes incurable: THIS IS A FALSE DELI-
CACY, and should never be indulged. Women very
" often complain of cholic, which they treat with indif-
"ference, but which, upon examination, has been found
"to proceed from a rupture in the navel. On the least ap-
pearance of a SWELLING, those means recommended
"under the head of TREATMENT, for reducing ruptures,
"should be immediately adopted, and a compressive ban-
"dage applied."
$6
66
The first part of this passage reminds one of Uncle
Toby's attempt to account for Mrs. Shandy's resolution to
employ the female midwife in preference to Doctor Slop:
"Perhaps, Brother," said Uncle Toby," Mrs. Shandy
"will not like a strange man to come so near her-
The remainder has a serious connexion with Mr. Turn-
bull's improved practice, which he either hopes, in-
terestedly,

80
terestedly, will center in himself, or, with more liberality,
will be divided among the gentlemen who practise sur-
gery; in either case it deserves mature consideration.
How females, virtuously, or even otherwise, educated,
may like Mr. Turnbull's new invented system of jolting,
squirting, splashing and dashing, I know not; though it
is possible even his learning and abilities may not have in-
fluence enough to induce them to submit to it cheerfully;
but this is of little consequence; for, as he directs this to
be done by any by-stander, ere a surgeon can be called, it
is like to be over before he arrives; there is another point
of practice, however, which he wishes to reserve exclusively
for the surgeon.
He says, p. 28, "The patient should, on no account,
apply the truss himself (or herself) on the first appear-
❝ance of the rupture; but, in this particular instance,
"submit entirely to the conduct of the surgeon. It is his
"province to determine whether the whole of the in-
"testines are returned, or a part remains in the opening
"through which they descended."
64
Again, p. 20, "There are many people, however,
"who cannot bear the slightest compression produced by
"the truss on its first application, This inconvenience
inay be remedied in the following manner :-let those,
"who are thus circumstanced, apply a truss, containing
a slight steel spring band, for half an hour, the first,
"second, and third day: at the expiration of this time,
"the patient may wear it for an hour the three succeed-
46
ing days, and so increase half an hour every third day for
"about six weeks. It may then be changed for one of a
stronger spring, and, at the end of three or four
months, the patient will be able to bear a truss produc-
"ing, if necessary, the greatest compression.
22
99
As the superior irritability of the female constitution
may frequently disincline, or perhaps render them unable
to bear the pressure of a truss; as "they MUST on this
" occasion submit entirely to the conduct of the surgeon,'
and as they MAY by his daily attendance for three or four
months be enabled to bear the pressure of the truss, every
man of feeling who possesses Mr. Turnbull's very natural
regard for the sex, and whose situation will justify his
hopes of partaking in this new branch of practice will
sincerely pray that it may be universally adopted.
Such are the striking parts of these "few general
rules, &c." relative to the reduction of strangulated her-
nia; though the author directs, with equal solemnity, how
to

81
to apply the tobacco glyster, purging medicines, &c. &c.
On these I shall not employ the readers time or my own,
though I may be permitted, in addition to what is already
written, to observe, that if any absurdity exceeds all the
follies of which a professional man can possibly be guilty,
it is that of pretending to teach persons, without previous
knowledge or means of observation to perform any thing
like a surgical operation: and if this is the case in general,
how much more so must it be if persons so instructed pre-
tend to reduce a strangulated hernia, an operation in
which the most experienced surgeons sometimes fail, and
where a very trifling mistake from ignorance will cer-
tainly be fatal? This question I shall leave others to an-
swer, and proceed to examine what may be termed the
lighter parts of this valuable production.
66
Page 27, he says, "It is a fact, which should be gene-
rally promulgated and attended to, that much depends
"on the means used at the commencement of the malady.
"The truss is ONE of the most effectual remedies at pre-
"sent discovered for the treatment of this disorder; and,
to whatever part it is to be applied, the greatest care
"must be taken to fit it with every possible exactness.
"If this be not particularly attended to, the truss, instead
"of being useful, will be extremely injurious; for the
"sole intent of these bandages is to press directly on the
opening through which the gut descended, or was forced
" from its natural position: the strictest attention should
"therefore be paid not only to the formation of the truss,
"but to its application. It too often happens, that the
person who makes the truss applies it; and this presump-
"tion on his part, and want of CAUTION IN THE PATI-
"ENT, seldom fail to do mischief. A MAN MAY BE A
"GOOD MECHANIC, and perform his work with ability;
"but he alone can apply the bandage with effect, who is
acquainted with the anatomy of the human frame."
36
66
66
The meaning of the above passage is sufficiently ob-
vious; but though he censures those who make and ap-
* There is no fact in surgery better established than that a rup-
ture can only be, palliatively or radically, cured by the application of a
truss; what, then, does the author mean by saying the truss is ONE of
the most effectual remedies, and does he mean to say in the face of the
world that there is ANY other? Or does he only communicate this doc-
trine to his patients in private ?
ply
M

82.
ply trusses, he cannot mean the censure to be general not-
withstanding it is conveyed in general terms. To the MAY
BE marked in italics, I shall add another equally true,
viz. that a man may be a good surgeon without knowing
much of mechanical science, or any thing of the practice
of any mechanical trade: if such an one should undertake
to direct ignorant workmen to make trusses, he would
always produce something worse than would be made by
a mechanic who happened to understand the structure of
the human body so far as is connected with his own occu-
pation: but, a man MAY BE contemptible as a surgeon,
he may feel that the small quantity of his employment
exceeds his desert: such an one MAY resort to the prac-
tice of a mechanical employment for which he is totally
unfit; he may be conscious of this, and to further his pro-
ject he may artfully combine a number of circumstances
together so as to induce the unwary to believe he is a
very great man, till they find their mistake by woeful ex-
perience, all these may be's combined should induce those
who require professional assistance to examine CAUTI-
OUSLY the pretensions of those who obtrude themselves
ostentatiously on their notice.
On trusses he says, p. 19, "The formation of these
bandages is now so generally known, that an elaborate
"explanation or description of them might be justly
"deemed superfluous: but, as many improvements have
❝ been lately made in their construction, I think it neces-
sary to mention one, which, in the course of My prac-
"tice I have been induced to prefer.
66
66
"Those employed in general often produce consi-
derable uneasiness by a too great pressure on the lower
part of the hips. This, I conceive, I have remedied by
making the pad droop more, and rendering the neck
"longer and more curved. The circular steel spring, by
"these means, rests higher upon the loins, and, conse-
"quently, must produce a less pressure on the hip joints,
"an inconvenience which has been much complained of
"by those who have been under a necessity of wearing
"those bandages.
"The pad, or cushion, of this truss is likewise
broader than those in general use, with a prominence,
"or slight elevation in the middle; while its sides, al-
64
though not perfectly flat, are considerably more so
"than those commonly employed. Of this construction,
they apply with much more exactness, and sit more
" firmly
46
$6

833
firmly on the parts, than when altogether round, as
"they are commonly made, without any flatness on their
"sides."
66
Whether Mr. Turnbull was unable to describe the
structure of a truss, and thus evaded the difficulty by
saying it was too well known to need description, or whe-
ther he thought the ignorant and indigent for whom he
professes to write would not attend to all that his immense
knowledge might have imparted on this subject, had he
been so disposed, I will not undertake to determine: cer-
tain it is that there is nothing in the above passages but
his ipse dixit respecting the inconveniences of the trusses
generally used, and that which he has been induced to pre-
fer, and which, from the egotistical manner in which it is
mentioned, I presume, originated with himself: but, as the
subject will admit of something like demonstration, and
some few readers may wish to know more than he has
communicated, I shall, perhaps, be excused for presuming
to endeavour, at least, to supply the deficiency.
The maximum of pressure that can be made by a
truss which acts by means of a circular spring will be made
when the pad is in a direct line with the spring; but the
form of the body and the direction in which the pad must
be applied to the aperture does not admit of this, still,
however, it is desirable to keep it as near the horizontal
direction as possible, in order to obtain as much force as is
necessary from the action of the spring to enable the truss
to perform its functions: the spring must be circular to act
with effect, and that part of the body on which the truss must
lie is not of a circular form; this difference between the truss
and the parts on which it is to act occasions most of the
difficulties that occur in adapting trusses properly to the
patients who wear them; and it is the power of overcom-
ing these difficulties which constitutes an essential part of
the art of making trusses; a power which I have no doubt
many possess, and which, whoever does not possess, he
can only be called an ignorant pretender to an art he does
not understand: this being the fact, where are the incon-
veniencies which Turnbull has specified as often found in
those generally used?
There are many ignorant workmen who pretend to
make trusses, and as this description of persons sometimes
offer to work cheaper than men of respectable character,
they sometimes find employers, who at last discover that
such
M 2

84
such workmen are totally incompetent to perform what
they have undertaken: if they are honest, in spite of their
ignorance they will attempt to alter their work, in hopes
of obviating the inconveniencies complained of by their
employers: the consequences are obvious; not understand
ing the nature of the instrument they pretend to make, or
the principles upon which its ease and utility depend,
they blunder on from one mistaken notion to another
without considering that all the inconveniencies complain-
ed of originated in their own ignorance.
There are a very few surgeons who from want of
talents do not find employment in their own profession;
and some of them have occasionally cast a longing eye upon
ruptured patients, who are too often prone to become dupes
to the impudence of ignorant pretenders: while the sub-
ject was imperfectly understood such people commonly
degenerated into quacking rupture curers; but the pre-
sent state of surgery has enabled its professors to render
the stale pretence of curing ruptures too contemptible to
be openly advanced by those who are not prevented by
their honesty from defrauding the credulous and unwary
who fall into their power: some plausible pretence is to
be used as a lure, and more than one person within my
recollection has used the following; that all truss-makers
are ignorant; that they, the truss providing surgeons can
direct them to be made in a superior manner, and there-
fore it is the interest of patients to apply to these sur-
geons in preference to any other gentleman of that pro-
fession, and in preference to any truss-maker whatever;
the consequence is, that patients who are so ensnared pay
the same for their trusses as if they employed men of the
first character; they pay the undertaking surgeon for his
superintendance, and they are worse served than any
other description of patients for the following plain
reasons.
1st. No man of character, who understands his own
business, will degrade himself by doing business for such
men, whose object is to purchase what they use at the
lowest price, and charge their employers the highest.
2dly. Being thus excluded from dealing with men of
character, they are necessarily driven to employ such ig-
norant workmen as they can find.
3dly. Finding such men are incapable of executing
properly what they undertake, they themselves un
dertake

85
dertake to direct them in the execution of their work,
thus the ignorance of the director acting upon the igno-
rance of the workmen produces additional inconveni-
ences to all parties concerned, and this is the origin of
most of the objections that are made to the principles on
which the elastic truss, which acts by a circular spring,
ought to be constructed. It may be said, that all this is
irrelevant to the present question. This must be granted;
for Mr. Turnbull has said so much of his own knowledge
and experience, all which, I know to be true, that I
firmly believe there is no person engaged in the same pur-
suits with himself, who is able to compete with him, how
thankful, then, ought I to be that he has not exerted
all his powers upon this subject! that he has only mention-
ed the frivolous, foolish objections that have been made to
the principle upon which the best elastic truss is construct-
ed, because some ignorant workmen have made bad
trusses.
If what I have said on the action of a truss, properly
adapted to the person who wears it, be compared with
"that improvement, which, in the course of his practice,
"Mr. Turnbull has been induced to prefix," it will be
evident, that, by making the pad more drooping as he
calls it, the point of pressure is removed from the center
of action by which the pressure is to be produced: conse-
quently, the power of the truss is diminished in exact pro-
portion as the pad is so made to droop: another conse-
quence arises from this; as the strap which fastens the
truss is connected with the circle which, according to the
improvement Mr. T. has preferred, goes round the body
above the hips, it must draw the pad of the truss upwards
out of its place, unless kept down by the powerful action
of an understrap fastened very tight; and this produces
serious inconveniencies from its pressure on that part it
lies upon; but, if the spring goes as directly round
the body as circumstances will admit, the pressure of the
pad, and fastening of the truss will be nearly in the line
of its action; it will keep firm to its place, in many cases
without understrap, and in those cases where the under-
strap is necessary it will require less force, and produce
less inconvenience than it must do when applied to keep down
that drooping pad which Mr. Turnbull has been induced to
prefer. Wheever has a truss that produces uneasiness, by
galling the hips, may be assured, it is either made by an
ignorant man, who knows not how to construct a truss
5
properly,

86
properly, or, that it does not fit him, or that it is misap-
plied.
When Mr. Turnbull said, "the pad or cushion
" of the truss he has been induced to prefer is
"broader, &c. than that in general use," if he intended to
convey any determinate idea he ought to have shewn what
the form or size of that in general use is, if there is any
form or size generally adopted: the fact is, that this part
of the truss is made of every form and every size that can
be adapted to the need or convenience of particular pa-
tients, and according to the degree of knowledge, to the
caprice or the ignorance of those who make trusses. If
Mr. Turnbull does not know this, I shall say nothing about
his knowledge; if he does know it he must be sensible that
he has used so many words to convey no information;
though it will leave him at liberty to say, if he pleases,
when any truss whatever is shewn to him he thinks it is not
broad enough, but that he will advise one to be used that is
broader, &c. &c.
Mr. Turnbull says, p. 54. "As trusses are considered
"the most important and effectual contrivance for alle-
"viating, and frequently preventing the disease from in-
"creasing, I am induced to recommend to all surgeons who
"reside in the country, to provide themselves with an as-
"sortment of these bandages, suited to the different species
"of the malady, and the age, size, and sex, of the people in
"general. I have experienced, in a variety of cases, the
happiest consequences by adopting this method even in the
"metropolis, where trusses can soon be provided. In many
"instances, an immediate application of the truss is of the
"utmost importance, and therefore, I keep a quantity by
"me, that a moment may not be lost in fitting them to the
66
part affected. In many remote parts of the country, se-
"veral days may elapse before the surgeon can be supplied
"with a truss; and, when delivered, it is extremely pro-
"bable, that some part of the bandage may be found de-
"fective. The necessity, therefore, of providing against
"delays which may be fatal to the patient must be ob-
"vious, and therefore, I earnestly recommend to those
"professional men, who reside in the country, to provide
66
a competent assortment of trusses, and to have them made
"in London by THE MOST SKILFUL HANDS.
I have, till now, only considered Mr. Turnbull's per-
formance as likely to be serviceable to the patient, but as
it is now likely to be serviceable to the truss-maker, a mo-
derate
66

87
derate portion of self interest induces me to wish particular
attention may be paid to the passage above quoted.
I have found by an estimate which my professional
situation has obliged me to make for many years past, that
including every variation of the different species, &c. of the
disease, age, size, sex, &c. of patients, it requires that I
should have an assortment of at least one thousand trusses,
before I have a tolerable chance to supply every patient on
demand with the truss that will be properly adapted to his
complaint: to reduce this matter to an absolute certainty
it will require double that number. If then, every surgeon
in the country, who may have occasion to send to London
for one or two trusses in a year, can be prevailed on to
keep such an assortment as Mr. T. recommends, by him,
my business would increase a thousand fold, and as I do
not pretend to be the only good truss maker in London, the
same benefit will be extended to others; I expect to be im-
plicitly believed, when I say most sincerely do I hope that
every surgeon in the United Kingdom may adopt the plan
recommended to them by Mr. Turnbull.
He, like a good advocate, has confined himself to such
arguments as are likely to influence those he wishes to pre-
vail upon to adopt his system; for this reason he has not
said how this scheme may affect the patients; as gentlemen
in secluded situations in the country may not understand
what advantages are to be derived from the speculation, he
tells them that he has experienced, in a variety of cases,
"the happiest consequences by adopting this method even in
"the metropolis, where trusses can soon be provided."
As Mr. Turnbull has not told what those "happiest
"consequences were that he has experienced by adopting this
"method in the metropolis," I trust that I shall be excused
for attempting in some degree to supply the deficiency in
his information.
Mr. Turnbull, then, has, by getting himself adver-
tised in the newspapers as surgeon to a society for sup
plying the poor with trusses, &c. induced many, who had
no better means of information than those advertisements
afforded, to believe that he has been selected from the sur-
geons of the metropolis to manage that institution, on ac-
count of his superior and more extensive knowledge of the
subject; this belief, has induced such persons as have rup-
tures to apply to him for advice; the advice to a ruptured
patient is to get a proper truss, and-Pat, Mr. Turnbull has
it by him to apply instantaneously; the patient has no
time

88
time for a reflection, or to seek farther advice; but, I pre-
sume, pays Mr. T. for his advice, pays for his truss and de-
parts in peace.
I do not mean to suppose the advice given was im-
proper, or the trusses sold were bad; but, as the infirmi-
ties of human nature lead all men to connect themselves
with some gentlemen of the surgical profession, I do mean
to express my belief, that, if they had not been diverted
by this manoeuvre of Mr. Turnbull's, they would have
consulted those gentlemen with whom they were previously
connected, instead of applying to him; these gentlemen
might have directed them to apply elsewhere for their
trusses, and thus he would not have experienced any of
those happiest consequences he so feelingly describes.
But Mr. T. seems to fear, that surgeons in the coun-
try will not take his advice, he seems to think it possible
that all patients will not consult a surgeon; for he "lays
"down certain rules by which the patient will be com-
petent, by observing these rules, to give directions to
"the truss-maker, who may send him a truss, however
"distant the afflicted person and the artist may reside
"" from each other."
46
It certainly is whimsical, that Mr. Turnbull, after
arguing to prove, that a patient should, on no account,
apply a truss upon himself, without the assistance of a
surgeon, should pretend to enable a patient to commit that
very imprudent act, but such is the imperfection of our na-
ture! As we have the rules, I shall mention those briefly
which do not merit particular attention, and only make ob-
servations on such as do.
1st. Describe the cause of the rupture, &c.
2dly. Whether recent or of long standing.
3dly. Where situate, and on what side.
4thly. Its figure, size, &c.
5thly. Whether reducible or otherwise.
6thly. When the rupture is at the folding of the groin,
describe whether it descends into the hernia, or, if the pa-
tient be a woman into the labia pudenda.
7thly. If the patient hath two ruptures, &c.
8thly. Whether the patient is lean or corpulent.
9thly. If he hath any deformities.
10thly. Of just measure round the body, &c.
The substance of these ten rules might be easily com-
prised in one short sentence; but they are thus subdivided
and extended, to give an affected appearance of particu-
larity

89
larity to a subject that must be obscured in proportion as it
it is treated in a manner that deviates from brevity. The
sixth in particular is a singular specimen of what may be
effected by treating a simple subject in an affected manner.
As Mr. T. has disclaimed all pretensions to the merit of
treating his subject in the appropriate language of a pro-
fessional man, he is only blameable in using the language
of colloquial vulgarity, in a way that must lead those for
whose use, it is pretended he wrote it, into mistakes that
may be of serious consequence. A professional man knows
exactly the different situations of the bubonocele and
crural hernia; but if the unprofessional reader could annex
any idea to the words folding of the groin, he would
naturally use them in describing the crural hernia, which
never descends into the scrotum, TURNBULIZED, the
purse; and if he described a bubonocele which descended into
the scrotum, he would never say it descended from the
folding of the groin. Though professional men may smile
at the absurdity of this mode of description, the use of it
ought to be seriously deprecated, as tending to do mis-
chief by giving false ideas of the disease to those who are
sufficiently prone to misunderstand it.
Mr. Turnbull says, p. 50, "It would be a criminal
"departure from my original intention, were I to conceal
"the melancholy consequences that generally ensue from
"totally neglecting or treating this malady with inatten-
tion. To elucidate this, I will state, however painful
"to my feelings, the common effects of a strangulated
"hernia, which, in many cases, might have been pre-
"vented, had the disease been properly treated on its
"original appearance.
Fave
This is a state of the disorder which is created by a
"strong compression of the parts through which the in-
"testines pass, which will not permit them to descend or
return. The symptoms are, violent pains in the part
"where the intestines become strangulated; and, as the
"patient cannot void, he soon feels a nausea, which is
succeeded by vomitings of thick saliva. In a short
"time, the excrements are discharged only through the
(7
mouth; and, in this miserable state, the afflicted person
" is in constant dread of suffocation. Profuse perspiration
66
or fever succeeds; the extremities turn cold; the eyes
" become fixed, and assume a frightful stare; mortifi-
"cation comes on; but, at intervals, when the senses
44
return, the patient generally shrieks, or implores relief
"in tones expressive of lamentation and despair. At
"length
66
N

90
"length he expires, and in such a state of torture and
"convulsion, as to delineate a scene of the most tran-
"scendent and complicated wretchedness."
There are some circumstances in the above melan-
choly description, the truth and accuracy of which I am
strongly inclined to dispute; but as they are intended to
caution the unwary patients, and induce them to pay proper
attention to themselves, I shall let them pass. I cannot,
however, resist the inclination I have to observe, that
Hudibras has justly said, "No argument like matter of
"fact is;" an axiom that is peculiarly applicable to this
subject, had it occurred to Mr. Turnbull when he was
writing upon it. In the new practice he has lately en-
gaged in, he must have come to the knowledge of many
facts which would prove, that the ignorance, the impu-
dence and knavery of many pretenders to knowledge in
the treatment of ruptures, has occasioned much injury to
those who have been dupes to their pretensions; and the
exposition of these facts would have rendered more service
to the cause of humanity than all the declamation he has
written. As he has not done this, I can only lament the
omission. I shall now take leave of the subject by relating
a little anecdote, that will not be without its use.
Doctor Turnbull, ci-devant physician to the Eastern
Dispensary, and provisional president of the society for
supplying the ruptured poor with trusses, was taken ill
one day after dinner: his disease was supposed to be in-
flammation in the bowels; every thing that the skill and
tenderness of his friends could suggest for his relief was
attempted, but, notwithstanding all the exertions of their
skill, in twenty-four hours he was dead! When the pro-
per persons came to pay the last sad duties to his remains,
they found a small umbilical hernia, strangulated and mor-
tified, and which, without the assistance of a Coroner's
Jury, may be pronounced to have been the cause of his
death.
Reader! if thou hast a rupture, remember the fate of
Doctor Turnbull, and take care of thyself while thou hast
yet power to avoid the same. Be not the dupe of those
wretches who, equally destitute of principle and know-
ledge, only intend to defraud thee of thy money, though
they frequently may endanger thy life; consult the most
eminent professors of surgery on such occasions, and thou
wilt be safe.
On

91
On the various Principles of constructing Trusses, and their
Advantages and Defects.
Having examined, at some length, the works of four
persons who have made themselves most prominent as in-
ventors, or as promulgators of trusses which they are
pleased to call new invented trusses, though there is some
reason to think they are no inventions at all, it would be
needless to proceed in the examination of others who may
have even less merit or less notoriety; they all possess one
property in perfect equality; each of them asserts that his
own nostrum or invention is the only truly useful one,
that is, equally applicable to all cases, and that every thing
which differs from his must be pernicious, and therefore,
it is presumed he means to insinuate, should be avoided.
Now as each of those four worthies asserts or insinuates
this in the most positive terms, and as each of them differs
in the most positive manner from all the others in every
essential point, it must follow that, whoever gives his
faith to any one of them, must necessarily suppose all the
others are in the wrong: but, there is a certain doctrine
very generally credited among those who really understand
the subject, that will lead to a different conclusion, viz.
that each of them is right in the conclusion he draws with
respect to the others, and each of them is wrong in the
assertion he makes with respect to himself. The doctrine
I allude to is this: that, as ruptures in different people
continually vary in their principal circumstances, so much
that two ruptures are very seldom found alike, every
rupture requires a truss constructed, adapted and applied
to its own peculiar circumstances. From this doctrine it
follows as a necessary consequence, that every kind of
truss may be useful in some cases and pernicious in
others, but that no kind of truss can be useful in all. If
this doctrine should be either admitted or proved, it will
follow inevitably, that any man who declares he has in-
vented or discovered any particular kind of truss which is
applicable to all cases, declares that which is, in the na-
ture of things, impossible, and, therefore, cannot be true.
As it is of general importance that this doctrine should
be established, in opposition to the wretched and contra-
dictory systems of quackery that are daily obtruded on the
notice of the public, I shall endeavour to demonstrate the
truth of it, as far as it is capable of demonstration, at least,
N 2
as

92
as far as my opportunities of investigating the subject will
enable me to do so.
The simplest truss, whether we consider the con-
struction, or the mode of applying it, is the belt-truss,
consisting of a belt, or band to go round the body, a pad to
press upon the aperture through which the rupture de-
scends, and an understrap to keep the pad to its place:
the mode of action, the conveniencies and the defects of
this truss may, perhaps, be understood from the following
explanation:
be-
Any simple belt that is drawn close round the body
will pass in a circular line so as to represent a horizontal
section of that body: if it was of a substance uniformly
hard, the bandage would adapt itself perfectly to the form
of the body, if its form was circular, or of any form ap-
proaching to a circle; but if any part of the body was
Lollow, the bandage will not adapt itself to that part;
cause, the projecting parts on each side the hollow will
form points between which the bandage will draw in a
straight line, and leave the hollow untouched: if the body
was uniformly soft, a belt drawn tight round it would
press uniformly on every part, till the whole was drawn
into a circular form, and could be made no tighter; but
as the human body is composed of some materials that are
soft and others that are hard, the effect of a belt drawn
tight round it is of a mixed nature: it will compress the
soft parts uniformly, till resistance is made by the bones
underneath; then it will squeeze the soft parts between
the bandage and the bones, and, if any of those bones
form acute projections, the soft parts will be most squeezed
there: of course, if a belt is applied and tightly fastened
round the body for any long time, it must produce un-
easiness from partial pressure; and, if continued for any
long time, it must produce excoriations and acute pain. Per-
haps this will be better understood by reference to the annexed
figures. Figure 1. in plate 1. represents a horizontal section
of the human body, at the part on which a truss is applied
for the inguinal hernia: it is of a thin person, and repre-
sents the general form of the bones of the pelvis, when
viewed in that situation, and thinly covered with flesh,
preserving much of the irregular form of the bones in that
part:* the dotted line on the outside is a belt drawn tight
round
*These are not to be understood as correct anatomical represen-
tations of the parts, but as diagrams intended to illustrate the doctrine it
is intended to explain.

Plate. 1
Frigilom
Fig: 4.
Fig. 2.
Fig. 5.
Fig: 3
Fig: 6.


933
round such a body, and pressing closely on the hips and
os sacrum, while it scarcely, if at all, touches the other
parts. Figure 2. represents a similar section of a body well
covered with flesh, and therefore of a more regular form;
the dotted line within this indicates the form and position
of the bones of the pelvis. It is easy to see, that if a belt
was drawn tight round this body in the manner repre-
sented by the dotted line in fig. 1, it would seem to set
equally close all round, but, in fact, the projecting part
of the os sacrum and other bones of the pelvis would form
points of resistance, between which and the bandage the
soft parts would be compressed, bruised and excoriated ;
so that any bandage that should be constructed on this
principle, and applied to keep up a rupture of any size,
or in a patient subject to much violent exertion, must al-
ways render him liable to excoriation, and all the un-
easiness and pain attendant on it; while, for other reasons
that are to be explained, such a truss can never keep up
his rupture with any certainty.
Those parts in which the inguinal and crural ruptures
lie, are situate in a hollow out of the circular line of the
bandage, and therefore less liable to the action of the
bandage than any other: to obviate this the pad is pro-
vided, being a hard, or at least, very little compressible
substance applied on the aperture, and kept there by
the bandage round the body. It is supposed, on a super-
ficial view, that this pad is, by fastening the belt, pressed
so close upon the aperture, as to keep it perfectly closed,
and thus effectually prevent the rupture from extruding.
This undoubtedly may happen sometimes, but it certainly
cannot take place in general to such an extent as to war-
rant the adoption of this kind of truss for the greater part
of ruptures, for reasons that are sufficiently evident: 1st,
when a pad is so introduced between the belt and the body,
it acts equally upon each, as may be seen by reference to
fig. 3, the elliptical line of which represents a section of
the body; the dotted line, the belt going round the body,
and the pad lying between the two. Now, if the body
was perfectly hard, the pad would not depress it in the
least, but would cause the girdle to remove from the body
for a space equal to the thickness of the pad, as at fig.
4; if, on the contrary, the body was soft, and the belt
was of steel or any incompressible substance, instead of
being of soft materials, the pad would be completely de-
pressed into the body, as at fig. 5; but both the girdle and
the body being soft, and the pad of this kind of truss bard,
it

94
follows of course, that it acts equally upon them both; in
other words, if fastened moderately tight, it partly de-
presses the body, and partly forces the belt out of the
circular direction, keeping itself equally suspended be-
tween the two. If a rupture could, under all the circum-
stances in which a patient must be placed, be kept up by
mere juxtaposition of the bandage, this kind of truss
might be sufficient for the purpose; but, as there are very
few cases in which this can happen, something more must
be done. If the belt is only fastened so tight as to lie close
on the body, and keep the pad firm to the part, any exer-
tion the patient may make forces the rupture downwards,
and, not meeting with adequate resistance from the truss,
it is immediately protruded: if, to prevent this, the belt is
drawn tighter round the body, it must inevitably follow,
that it will produce more additional pressure upon the hips
than it does upon the rupture; and, if increased and kept
up for any considerable time, intolerable pain and per-
petual excoriation must be produced without adequate
advantage. Another defect in this truss arises from the
inevitable action of the under-strap.
The aperture through which the inguinal hernia
descends, is situate in the fore part of the abdomen, not
directly over the perineum, but obliquely and much nearer
the side of the body, as it is represented at fig. 6, which
shews a front view of the body, and represents the situa-
tion of the truss and understrap. There are two reasons
for using the under-strap with this truss: 1st, to prevent
the truss from sliding upwards out of its place, which is
the general reason for using understraps with all tausses;
and, 2dly, it is very common for those who apply these
trusses to make the pad of an oblong form, and situate
below the line of the girdle; therefore they depend on
fastening the under-strap very tight, to produce any pres-
sure by the pad upon the part: the consequence is, that
by fastening the under-strap very tight in an oblique direc-
tion, the pad is necessarily drawn forwards out of its
place, till it comes into a perpendicular situation directly
over the perineum, as it is indicated by the dotted lines on
the plate, and the rupture of course permitted to descend.
From what has been said, the inconveniencies and imper-
fections of this kind of truss are so great and evident, that
it is not surprising it has long been laid aside by every
well-informed practitioner; but it is very surprizing that
any person should attempt to revive it, and introduce it as
a new invention, as such an attempt is a proof of more
ignorance,

95
ignorance, as well as assurance, than one would willingly
attribute to any person who would pretend to be considered
as a professional man.
In discussing the merits of the above species of ban-
dage, I have adhered to the general principle, as consisting
of a belt, a pad, and an under-strap; but it must be ob-
served, that all these parts have been made by different
workmen in various manners; particularly the pads have
been made with springs, under the idea that these will
produce more pressure than those pads which have no
springs. This is certainly true, and therefore they are
something better; but still, as they possess all the radical
defects of this species of bandage, they are justly con-
sidered as equally imperfect in point of principle, and
therefore have been equally and justly exploded.
The only cases in which it is adviseable to use trusses of
the above description, are in persons who have ruptures
that are extremely slight, and who are not called
upon to
make any kind of exertion, or when it is thought adviseable
to wear a bandage in bed, and the bandage generally used
is found to be irksome: in such cases the belt-truss, of any
description, may be used without impropriety; but when-
ever it is applied to persons in situations different from
the above, it will always prove to be either the most irk-
some or the most ineffectual bandage that can be used.
The next species of truss that has been adopted, was
that which was formerly called, in contradistinction to
the above, the Steel Truss. It was made of a strong bar
of iron or steel, fitted as near as might be to the shape of
the body: to this a pad was applied and fastened round
the body by straps in the usual way. This was found to
be so inconvenient, so inadequate, and so extremely dan-
gerous, that it was very soon universally exploded: it
would therefore be needless to enter into any description of
its principle, if attempts had not lately been made to
introduce, as a novelty, a bandage made upon this very
principle, which, for that reason, it may not be improper
to explain, in order to shew its inefficacy.
It is certain that, in respiration, the expansion of that
part of the abdomen on which a truss is to be applied,
varies at least an inch in a middle sized man, and in larger
persons the variation is still greater every time they
breathe. In consequence of this peculiarity, a truss of
this description, having no motion or elasticity, must
either fit the body in its enlarged or in its contracted
state: if it fits in the former, it must be too large and
too

96
too loose in the latter state, of course it must allow the
rupture to descend, and then the patient will be liable to
all the consequences of stricture from the pressure of the
truss; if, to obviate this defect, the truss is made to sit
close enough to keep the rupture up effectually, while the
body is in its most contracted state, it must press with
increased violence every time the abdomen is enlarged
by the act of inspiration, besides, the pressure of such a
bandage, acting perpetually on the spermatic vessels, as
well as on all the soft parts which lie between the truss and
the pelvis, must always produce inflammation and ex-
coriations of those parts: this actually did take place in
most of those who used these trusses, and occasioned them
to be disused: and this has already happened to many
who have used those which have been made by the man
who has taken a patent for trusses made upon this principle,
which he calls new, and will, undoubtedly, soon occasion
them to sink into oblivion.
As the elastic truss has long been in general use, its
merits are very well known; as it is well known too, that,
in some cases it is defective, but as it may be said with
confidence, that no other invention (taking the word in
its general sense) is likely to supercede this, it is certainly
worth while to ascertain and remedy its defects, and thus
give it all the perfection that it may require or be suscep-
tible of. As a rupture is formed by a portion (greater
or less) of the contents of the abdomen, extruded through
the containing parts, by various efforts made by the patient,
in different situations of life, it is obvious, that the force it
exerts in extruding, must be proportioned to its own bulk,
and the violence of the effort that produces it: the remedy is,
first, to reduce it, and afterwards retain it in its natural
situation, by some extraneous substance, that shall be
applied so as to cover and keep itself, on the aperture
through which the parts have descended: this is the use of
the truss.
It has already been shewn, that simple bandage con-
nected with pads, and that either have or are without
springs, cannot effect this purpose; nor can it be effected
by solid pressure; it remains then to shew how it is effected
by elastic pressure, before we can explain the real defects
of
*I use this for want of a better term, as a contradistinction to
elastic pressure.

97
of the instrument to be employed, and the improvements
of which it is susceptible.
The elastic truss consists of a spring that
goes either
wholly or in part round the body, and a pad to lie upon
the aperture through which the rupture descends; besides
proper straps for fastenings, &c. the spring, which is the
acting power, is formed into a circle, or part of a circle, or
rather parts of different circles, it is extended to be placed
round the body, and, by its efforts to contract itself till it
reaches a state of rest in its original form, makes that
pressure which is to keep up the rupture.
It is evident that this pressure is essentially different
from that which can be produced by a pad, when secured
on its place, by a belt drawn tight round the body, or by
the dead pressure of a solid iron or steel hoop; it may be
exerted to any degree that it can possibly be required, but,
it may be so exerted as to be productive of serious mischief
in many cases; it may, therefore, not be improper to
explain some of the principles upon which the proper
application of this pressure depends. The strength of the
truss should be rather more than, or at least equal to the
force with which the parts, which form the rupture, are
propelled downwards by their own weight, and acted upon
by any exertion the patient may use this pressure must
be absolute, or the rupture cannot be kept up: what,
then, it may be asked, is the use of the elastic or flexible
power of the truss? why is it superior to the dead
pressure
of the old iron or steel truss? the following are some of
the reasons which seem to prove its superiority:
A certain force is requisite to keep up a rupture of a
given size, and this force must be constantly and invariably
applied, or the rupture will, in many situations, descend:
but the parts in which the apertures through which ruptures
descend are situate, are subject to many and great varia-
tions in respiration, in difference of position from many ac-
tions, as stooping, sitting, riding, &c. &c. the elastic power
of the spring is intended to follow the parts through all these
variations, in many cases it does this effectually; in others
less perfectly, but in all, it certainly does, when properly
adapted and applied, do this more effectually than any
other method that has been, or perhaps that can be
devised.
Besides possessing the actual strength that will be
required to keep up the rupture to which it is to be applied,
the spring of a truss should have as much flexibility as it
possibily can have, consistently with the requisite strength,
0
as

98
as it is that flexibility which secures to the patient all the
ease it is possible to derive from the use of the truss, and
it is from the rigidity of the spring, supposing the truss
to be, in every other respect proper, that the patient will
derive perpetual and unnecessary uneasiness.
As the apertures, through which the different kinds of
ruptures pass, are differently situate in the containing parts
of the abdomen, they are liable to vary continually by its
contraction and extension, in respiration as well as by
the positions it is thrown into by the numerous actions
which every person is sometimes called upon to perform :
as these variations of position are very considerable, the
flexibility of the spring only can enable it to follow them,
so as to keep up the rupture with ease: it is true, that a rigid
spring may, in some situations, keep up a rupture as well
as a more flexible one, if that was the only consideration;
but some attention is due to the comfort of ease, and
more is necessary to avoid the danger that may arise from
the contrary effect: for, it is certain that pain can never be
long inflicted on those parts that are connected with rup-
ture, without producing mischief. *
One
There is no doubt, but very serious injuries are often the conse-
quence of violent pressure from trusses that are improperly applied:
those who sustain such injuries are not willing that they should be
known; and, therefore, but few instances occur that can be authen-
ticated publicly. The following happened within my own knowledge:
"SIR,
"Having lately, by accident, discovered your publication on
rupture cases, I have been induced to purchase it, and being so
unfortunate as to be afflicted with one, I have taken the liberty to
write to you on the subject, and when I have submitted the real state
of my case to your consideration, shall think myself particularly obliged
if you will favour me with a line what steps you think most proper for
me to take on the occasion.
"I am now about thirty-three years of age, and when I was not
more than fourteen years old, I discovered a small swelling on the
right side, but did not then know the cause, nor did I feel any great
inconvenience till about the age of twenty-one years, when the
prolapsion was so painful I applied to a country apothecary, who sup-
plied me with a truss very incompetent for the purpose. 1 afterwards
made use of an elastic truss for some years, but did not make any
application to the proprietor of them till within these four years, at
which time, and ever since, when I have applied to him he led me to
expect a radical care.
"Now my own observations on my case, prove what you say to be
strictly just, and believe I never must expect any thing beyond the
partial cure of a well adapted truss. The rupture keeps up tolerably
well, but I am afraid the spermatic vessels have been much injured,
as

99
One of these empirics who has cbtained or purchased
2 patent for a truss as a new invention, which has long
been exploded as the most pernicious and mischieveous
of all the older trusses, and had no previous knowledge
of the subject he was engaging in, founded his principal
claim to notice on his being able to make the springs of
trusses stronger than can be made by any other method;
it requires less knowledge and more assurance to make
such an assertion as this, than it would seem liberal to
attribute to any person whatever; yet, as it has been
made, he is to take all the consequences: the truth is,
that it is easier to make a strong spring, i. e. a spring
that shall press very hard upon the part, than it is to
make a slight one; but the real difficulty in constructing
the springs of trusses is to make a strong spring that
shall be easy to the wearer: this is so much the case that
02
it
as the testicles are very much reduced, and have for many years
experienced a want of that vigour which I am certain a perfect state
of good health would have furnished me with, had not this unfortunate
circumstance prevented it.
"The distance I live from London is 100 miles, yet I would most
willingly embrace the first opportunity of waiting upon you in town,
and believe I can make it convenient to my business to be there for a
week or ten days, in about a month's time, and could I but have any
hopes of success in the recovery of that manhood I am at present so
unhappy to feel the want of, or could I be a sured that any truss
could be so adapted to keep up the rupture, and at the same time to
recover the circulation, it would relieve me from the most heart-felt
anxiety and disquietude."
Mr. Sheldrake.
"I am, Sir,
"Yours, &c,"
*
I had soon an opprtunity of seeing this patient, who appeared to
be a stout man, and in perfect health: his ruptures (for he now had
one on each side) were not remarkably large, but the testicles were
reduced to less than haif their natural, or the common size; he assured
me the decrease began within a few years, that his trusses constantly
gave him pain in the parts they pressed upon, which pain likewise
extended to the testicles, and made them constantly feel uneasy and
tender that he observed them to continue decreasing: and his virile
powers were nearly gone. As I saw no reason to suppose they could
be recovered, or the testes regain their natural size, I gave him my
opinion to that effect; advising him, however, to consult Mr. Hunter,
or any other experienced surgeon, who would give him better advice
than I could: there was little encouragement to hope that his rupture
could be cured, but I thought I could engage to adapt a truss that
should effect a palliative cure without farther injury to the testicles;
this however, was a matter of no small difficulty, but with some
trouble, I adapted a truss which he could wear without feeling the
least uneasiness, and he left me perfectly satisfied.

100
it will be found universally, that where the common
workmen who venture upon business of this kind, under-
take to apply trusses to ruptures of any size, they substi-
tute strength for skill: finding (though they do not know it
is because they know not how to adapt a truss properly)
that one truss does not keep up a rupture, they substitute
a stronger; and thus go on progressively, till they apply
more strength than it is possible for any human being to bear
with safety; if by this means they do succeed in keeping up
any rupture it is at the expence of producing inflamed sper-
matic vessels, testes, &c. and perpetual excoriation
wherever the truss is in contact with the body; but they
more frequently do not succeed, their patients' ruptures
descend, and then being acted upon by such violent pres-
sure, the most pernicious, often the most fatal conse-
quences are produced: the improvement of this person
then, if it answers his description of it, is an aggravation
of the common defect of those trusses which are made by
the most ignorant workmen; experience has proved it to
be so, and it will soon return to that oblivion from which
he has attempted to redeem it.
Though nothing but much practice combined with
accurate and experimental knowledge of theory, can
enable any one to construct, adapt, and apply, trusses
with all the care and safety with which they may be
applied; yet, as it is of consequence that the mischieveous
tendency of the above-mentioned doctrine should be made
evident, it is hoped, that the following attempt to explain
the theory on which trusses should be constructed, will
enable those, to whom it is of importance, to form a
correct opinion on the subject: The whole force with
which any spring can act is equally divided between the
point of its extreme contraction and that of its full
extension; thus, if the whole force with which the spring
of a truss can act, when on the body, is equal to ten
pounds, and its form is such, that, when taken off the
body and suffered to fall into a state of rest, the pad shall
pass over a space of ten inches, * every inch of that
space is equal to one pound, or one tenth of the whole
force. The resistance that is made to the truss is, first,
by the rupture attempting to protrude; and, secondly,
by expansion of the abdomen in respiration. The va-
riation in size of the abdomen is nearly one inch in
res-
See plate 2, fig. 2.

101
respiration; if then, the force of the rupture is equal
to nine pounds, and a truss, whose spring is such as
has been described, be applied, the rupture will be most
effectually kept up, and with as much ease as the nature of
the case will admit, because all the force that is necessary
will be applied to the rupture, and no more than is indis-
pensably necessary will impede the freedom of respiration:
but, if a truss the whole power of whose spring is equal to
ten pounds, and whose range of extension and contraction
is but three inches, should be applied to the same rupture,
it would be equally well kept up, it is true, but the patient
would be in a state of perpetual uneasiness, because more
than one-third of the force of the whole would be employed
in counteracting the freedom of respiration; and, in conse-
quence of the peculiar manner in which the spring of a
truss acts on the body in its whole circumference, it will
perpetually produce galling pain in every part it touches.
It is more difficult to make trusses of the lighter con-
struction, than of that which has been last described; in-
deed that part of the subject is so far beyond the compre-
hension of the common people, who pretend to make trusses,
that they almost always fail; in attempting to get strength,
they get clumsiness and rigidity, and thus lose all the be-
nefit that should be derived from the principle of elasticity
so adapted and applied, as to produce uniform compression
on the rupture in every situation the patient may be placed
in: such workmen may dispute with each other who can
make the strongest trusses, and when that point is settled,
it will be found that the strongest truss is the WORST, be-
cause it will be the most uneasy, and because that kind of
truss will always produce excoriation of the integuments,
and frequently inflammation of the spermatic vessels, and
every viritable part connected with them.
From what has been said, it appears there are three
species of bandages; 1st, that whose pressure is produced
by the action of a belt bound tight round the body; 2dly,
that whose pressure is from an iron or steel hoop, (or a very
strong spring possessing similar properties) whose circum-
ference is less than that of the body, and produces its pres-
sure by squeezing the body within it; and 3dly, the elastic
truss, whose effect is produced by the action of a spring con-
stantly exerted upon the part: the superiority of the last,
both in theory and practice, is so evident, that from the
time of its being first made public, it has gradually and
ead odious sham and now noi
herong
almost

102
almost universally superseded every other; and, it is ex-
tremely probable, will always maintain its superiority: yet,
though the principle is the most perfect, the application of
it is in many cases imperfect and improper; and must al-
ways be so, so long as any one modification of it, or, to
use other words, so long as any person will apply trusses of
one form or construction to all sorts of ruptures, or to the
ruptures of all persons, however different they may be from
each other: this is, unfortunately, a very general practice,
and in hopes of putting an end to it, I shall endeavour to
explain how far trusses of different constructions are appli-
cable to patients who have ruptures that are in essential
points, different from each other.
The grand principle to be acted upon is, that the truss
should produce its full pressure directly upon the part, so
as to keep up the rupture effectually, and impede the free-
dom of action, in any respect, as little as possible; and that
it should keep firmly to its position, in every situation the
patient should place himself in, with as little assistance as
possible from straps or any other extraneous mode of fast-
ening.
The most general method of making the truss for in-
guinal or crural hernia, is to make the circular spring be-
tween one-half and two thirds of the circumference of the
body, the pad is at one end of the spring, and the belt,
which goes round the whole body, has a strap at the end
which fixes on proper fastenings that are on the pad: the
spring of this truss should be of such a form that when
opened to be placed on the body, it should set as close as
the form of the body will allow; if it is too large, it will
be uncomfortable and unsteady, of course it will not keep
up the wearer's rupture with safety; if it is too small, it
must be squeezed on to the body to get it into its place:
the circle of the spring being smaller than the body, must
compress some of the soft parts; its own action, as a spring,
must be impeded, and then it must be both ineffectual and
continually painful: this objection, though frequently made
to trusses in general, is, in fact, only an objection to the
improper construction and application of them, by those
pretenders who are too ignorant of the subject to know
what ought to be done, and, perhaps not capable of doing
it if they had the requisite information: but the uniform
experience of many thousand patients, who have worn
trusses of this description during the seventy years that
have elapsed since the invention was first made public, has
proved,


Plate. 2.
F.1.
F.4.
F.3
F2.
Fig. 5.
13
Fig: 6.
13

103
proved, that, in much the greatest number of cases that
occur, this is the most proper; because the most simple
and easy kind of truss that can be employed; and it is to
be regretted that the attention of patients is not effectually
directed to their own situation at that early period of the
disease, when this species of truss would be sufficient: for,
though it may gratify the feelings of a professional man to
know that he has rescued his patient from the effects of a
dangerous disease, or those of a patient to know that he
has escaped from imminent danger, yet it surely would be
better, if, on the first approaches of the disease, such a
remedy was to be applied as would prevent it from becom-
ing dangerous, and at the same time so easy in itself as to
be used without inconvenience.
Plate 2. fig. 1. represents a truss, of this description, in
a state of rest; the dotted line describes the form of the body
it is to be applied to when open; from these figures it is
presumed the nature of its action may be understood: in
ruptures that are not remarkably large, or in patients who
do not subject themselves to violent exertions, this truss will
answer every useful purpose; but for those who have bad
ruptures, or do make violent exertions, or are in situations
that will be hereafter described, this kind of truss will be
imperfect and insufficient; the particular defects will now
be explained, and the means of obviating them pointed
out.
The spring of this truss produces its effect by contrac-
ting, in an horizontal direction, round the body: it is opened
when put on, the pad is placed on the aperture through
which the rupture would protrude, and the spring, by en-
deavouring to contract itself, presses the pad upon the
opening and prevents the extrusion of the rupture; the
straps, &c. are only intended to keep the truss in its place;
in ruptures, such as have been described, this is abundantly
sufficient; but, for larger ruptures, or for the ruptures of
persons who are called upon to make violent exertions, if
a truss of this construction is employed, as it acts by con-
traction round the body, and the spring must be very
strong, that contraction will produce uneasiness so far as
the spring lies upon the body; if the straps are fastened
tighter with a view of producing more pressure, by so doing
the pad of the truss may be drawn forward out of its place;
if it does not do so, such fastening of the straps must inevi-
tably produce uneasiness upon both hips, and in the whole
direction of the thigh-strap; and thus perpetual uneasiness
be

104
be kept up, and a very imperfect remedy be obtained; the
most effectual and the easiest will be to resort to a truss of
a different construction.
When Mr. Squire invented his method of making
trusses with the springs to go all round the body, it was
strongly recommended by Mr. Hunter and his school; it
was very extensively adopted in practice, but many patients
have been obliged to discontine the use of them, and Mr.
Timbrel the Dictator, who censures in the strongest
terms whatever does not coincide with his omniscience on
this subject, writes in terms calculated to excite horror at
the bare mention of this truss: amidst such contradictory
opinions, but particularly in opposition to such weighty
authority as that of the Dictator, it may seem unpardonable
rashness to say, that trusses of the above-mentioned des-
cription should ever be used, yet even that rashness must
be exceeded on this occasion by a declaration that, in ma-
ny cases where much pressure is to be applied, and where
it is particularly important that that pressure should be
most steadily directed to keep up a difficult rupture, with
little assistance from straps or other extraneous fasten-
ings, this description of truss is the most effectual and most
easy, and therefore ought to be adopted: but as no assertion
should be valued on a subject that is capable of being prov-
ed, it may not be amiss to attempt, at last, a demonstration
of the truth of this assertion.
very
Fig. 3. plate 2. represents a double truss made of one
spring to go all round the body, this truss is in a state of
rest: fig. 4. represents the same truss, opened as it will
be when placed on the body of the wearer; the dotted line
marks the direction in which the pads would move, if the
truss was taken off the body and suffered to collapse into its
natural form: it is evident upon inspecting the truss des-
cribed, fig. 1 and 2. that when that truss collapses, it
must contract its whole circle at the same time that it pro-
duces any pressure, and, if the spring is strong, it must
contract its own circle greatly before it can much increase
the
As this great personage has discovered that no one who thinks
differently from himself on these subjects, can possibly be in the right,
and as I wish to avoid the imputation of misrepresenting his opinions or
assertions, I shall quote the following passage verbatim from the 1st and
2d editions of his new inventions. "The double truss should be UNITED
"behind by a double tongued buckle and straps, to let out or take in;
not by one horrid hard steel spring, cutting the loins to pieces."
44

105
the pressure of the pad, therefore, its force must he felt at
least as much in the whole circumference of the spring, as
it can be under the pad, when only the pressure is wanted:
but it is evident that when this truss collapses, by which
means its action on the ruptures is produced, the pads at
the two extremities of the spring have the greatest quantity
of motion, and therefore make all the pressure they are
capable of upon the apertures through which the ruptures
descend before any material alteration has taken place in
the form or diameter of the spring, and for the same rea-
sons it must be easier than that which cannot press at all,
without contracting itself at the same time all round the
body, and of course, producing uneasiness from pressure
on every part it lies upon.
Why then, it may be asked, is it acknowledged that
so many have laid these trusses aside because they were
found to be uneasy? First, because it was a false doctrine
advanced by many professional men who at that time
recommended them that too much pressure could not be
applied to a rupture; that great pressure was useful by pro-
ducing adhesion and of course a radical cure; but they did
not consider that the good effects of such practice, were at
best but precarious, while the injury that must be done by
inflammation, produced by violent pressure on parts con-
nected with the rupture would be great and certain; but
Mr. Squire being a mere workman without pretensions to
professional knowledge, acted honestly by the advice of
those who took him under their patronage, and made the
springs of his trusses as strong as he could; when patients
complained of pain from pressure, they were told it was for
their good, the greater the pain the greater the irritation,
and consequently the sooner adhesion, and of course a
radical cure would be effected: so many as had not the re-
quisite degree of faith to try this practice, abandoned it
at once; whilst those who had, did make the trial for the
requisite time, and finding it did not succeed, abandoned
the scheme, and joined the former party in decrying the
poor truss, instead of the false principle upon which it
was endeavoured to adapt it to their use.
Another objection to this truss arose from some diffi-
culties in the construction, which the common workmen
who are employed on this subject neither understand, nor,
if they did, would be able to remedy, viz. that of so pro-
portioning the curve of the spring to the shape of the body,
that it shall press on the part without pressing unequally on
P
the

106
the body: if it does not do so, it must be evident that
wherever unequal pressure is applied, either upon the hips
or os sacrum, pain and excoriation must be the consequence:
but this defect is to be attributed to the ignorance of the
workman, not to the principle of the instrument, which
when skilfully adapted, certainly, in many cases, possesses
many advantages over those which had been previously used.
It has been said already that when those trusses which
are made without any springs are fastened very tight, they
are liable to be drawn out of their places; and it has been
said, that when the truss, whose spring only goes in part
round the body, is fastened tight, it is sometimes liable to
the same inconvenience, but this can never happen with the
truss whose spring goes entirely round the body for this
reason: the body, in that part where the truss lies, is
nearly elliptical: the bones of the pelvis from the ilium on
one side round the os sacrum to the ilium on the other,
form one mass which gives it invariable solidity; the abdo-
men in which the apertures through which the ruptures
extrude are situate, forms the front, which varies in size
during respiration and on other occasions; it is evident
then, from this state of the case, that, if the truss, fig. 4.
be so adapted to the form of the body that it sits uniformly
and close all round, and the pads lie directly upon the
apertures which are indicated by lines AA, and it shall be
found necessary to fasten the truss as tight as possible, the
spring will be drawn uniformly closer to the body without
partial pressure on the hips or back*, the pads will be kept
closer on the apertures, and the expansive power of the
abdomen will be diminished, so as to give a sensation of
uniform tightness in the whole circle occupied by the truss.
As the idea of using trusses that shall keep in their pro-
per situation without being fastened with straps originated
with the truss we are now considering, and as its advantages,
real or supposed, seem to have been misunderstood, this
will be the proper place for considering that part of the
subject:
*The effect of this is peculiarly striking, when contrasted with
that of the belt truss under similar circumstances: it has been already
demonstrated, that when the latter is fastened tight, the soft parts
yield wherever they can, and pressure is made partially on the bones,
and thus pain and exorication is produced; but this cannot possibly hap-
pen with the circular spring however tight it may be fastened, the spring
forms a circle corresponding to the form of the body, and the bandage
however tight it may be acts upon the spring only, and contracts its cir-
cle only, without the possibility of producing partial pressure.

107
subject: as none of the trusses that had been previously
used were found to keep well in their places in cases of much
difficulty, recourse was had in such cases to various modes
of fastening by buckles, straps, &c. the inventors of which
were willing to pique themselves on their ingenuity, though
it only ended in galling their patients with troublesome and
painful ligatures of various kinds: no sooner was it discov-
ered that this truss kept its place better than any other, and
with less fastening, than it was supposed that it might keep
its place without any fastening at all; it was tried in some
cases with success, and the spirit of exaggeration, which
so frequently exerts itself on such occasions, immediately
declared that no strap or fastening of any kind was neces-
sary to be used with that kind of truss: the experiment was
universally tried and most commonly failed; yet, the truth
is that some ruptures may be kept up by a truss of this
kind without any strap, but no rupture can be so kept up
without a truss is used which is much stronger, and of
course more uneasy than it would be necessary to use, if
the ordinary mode of fastening was employed, and, in
much the greater number of cases no degree of strength in
the truss will enable it to keep up the rupture without the
usual mode of fastening it be employed: as it is of conse-
quence that this should be well understood, it may not be
unacceptable if an attempt is made to explain it here.
It will not be difficult to ascertain what degree of force
will keep up a rupture during the exertions the patient
usually makes, and by applying a truss whose power shall
be greater than the force usually exerted by the patient,
his rupture will certainly be kept up so long as he does not
exceed his usual exertions, because the spring passing all
round the body in the manner that has been already des-
cribed, will certainly keep the pads in their places; but it
is impossible to calculate what force may be exerted by a
rupture when propelled by a violent and unexpected exer-
tion; the attempt to counteract it can only be made by ap-
plying a truss whose power shall be extremely great, and
therefore perpetually uneasy, at the same time that it may
be incapable of resisting the effect of a sudden action; and
if a rupture is by violence forced down under such a truss,
the pain, the danger and the actual mischief will always be
very great: perhaps the most proper method will be to let
all the pressure that is necessary to keep up the rupture be
made by the truss alone; but to apply a strap to fasten it in
such a way that no exertion of the patient can possibly force
P2
the

108
spring outwards, so far as to allow the rupture to extrude:
this method will combine the advantages of super-pressure
(if I may use such an expression) from the spring, and a
positive check from the fastening whenever each shall be
necessary.
Another subject connected with that under considera-
tion, is the use or the abuse of understraps: but few years
have elapsed since the quacks of that day who endeavoured
to recommend themselves to notice without knowing what
was really deserving of approbation, pretended to have in-
fallible methods of making trusses that should be worn
without any understraps: the tables are now turned, and
the heroes of the present day are exerting their ingenuity
in inventing understraps, and compresses, and buckles and
fastenings, without end. Mr. Timbrell, the dictator, who
stands at the head of this class, and expects that his ipse
dixit should, on this, as on every occasion, be received with
all the veneration formerly bestowed on the oracles deliver-
ed by the priestess of Delphos, says, he has invented a new
understrap, a new buckle, and a new mode of fastening;
without which, he says, no truss can be worn with safety:
venerating his knowledge and wisdom, as we must do, we
must with great diffidence suppose it has been proved that
every truss whose power depends upon the tightness of its
fastenings must be bad, because it is uncertain and unne-
cessarily painful; but, if we do believe this, we shall be
tempted to ask, what is the real use of the understrap?
If that doctrine which it has been the intention of these
pages to maintain, should be admitted, viz. that the truss
should keep up the rupture by its own elastic power, and
that the fastening round the body should prevent any vio-
lent exertion from overcoming the power of the truss, it
will follow, as a collateral fact, that the under strap can
only act as a check to prevent the truss from getting out of
its place in another direction: the disease is dangerous, the
truss is a necessary inconvenience, and the under strap is
another inconvenience, often, but not always, equally
necessary. The truth is, that some persons are so formed
that no truss will keep in its proper situation upon them
without an under strap, to hinder it from rising up out of
its place on the most trivial motions in walking, riding, &c.
But much the greater number of patients may wear
their trusses without any understraps, and perform all the
ordinary functions of life in safety: yet as no man can be
certain that he shall not be called on to make violent ex-
ertions

109
ertions when he may not be prepared for them, every
patient will do well to keep an understrap on his truss as a
safe guard in time of exertion, though not as a matter of
prime necessity; the understrap should be so fixed and
fastened as to keep the truss to its place; but never so as to act
in compressing the pad upon the aperture: it is true, that
with bad trusses this is frequently done to supply the defi-
ciency of power in the truss, but it is a bad succedaneum,
and with good trusses never can be necessary.
Having several times used the term circular spring, it
is necessary to explain the sense in which it is to be under-
stood: by the circular spring of the truss, then, is to be
understood that spring which goes round the body, what-
ever the form of the body, or the precise form of the
spring may be. It is the more necessary to give this ex-
planation because Mr. Timbrell, by whose side I have
moved longer than can be agreeable to either of us, has
used the same term in a very different sense.
He says
(p. 17, 1st edit.), " continue the hoop part or parts in a
TRUE circular line round the body, the spring of the
truss being made in a TRUE circular line." As this de-
scription cannot possibly be true in any sense that the
words can be understood, and as those who may favour
Mr. Timbrell with implicit confidence on this subject,
will probably form very false opinions on this subject, it
cannot be improper to explain the real state of the facts.
First, as the body is not circular, and the truss should
be made to fit the body, it cannot be circular in any other
sense than that in which I have used it, and therefore can
never be made in a TRUE circular line: and, secondly, in
fig. 5. pl. 2, I have drawn the profile of the body of a well
formed man of moderate size: and most people may prove
the truth of the facts it is meant to explain, by comparing
it with any subject that is within their reach; when standing
erect, the back of the pelvis from the upper line marked on
the sketch, to the most prominent part of the nates indicated
by the lowest line, deviates from the perpendicular in different
subjects from five to twelve to fifteen degrees (it will do
for the present argument to take the lowest number,) and
the front of the abdomen from the height of the navel down
to the lowest part of the pubis, inclines inwards from the
perpendicular as much as the opposite side does outwards,
in well made subjects, but in fat unwieldy people much
more; the following consequences inevitably result from
the facts above stated:
The

110
The spring of a truss is made of a flat piece of steel
bent into a form partaking more or less of a circle, and
being laid upon a plane surface, would act, by contraction
and extension, in a horizontal direction upon the plane it is
laid on; but, being applied to the body, the flat surface of
the spring would adapt itself to the flat surface of the body,
and clasp itself directly round it, and, of course, if the two
sides of the body shewn in the sketch were perpendicular to
the horizon, the spring going directly round the body, its
edge when viewed in profile, would really lie parallel to the
horizon; but, as the body inclines five degrees out of the
perpendicular, and the spring naturally preserves its hori-
zontal situation with respect to the body, must necessarily
deviate five degrees from its parallel situation with respect
to the plane of the horizon: this is what Mr. Timbrel, in
the plenitude of his knowledge, would call from its appear-
ance on the body, acting in an oblique direction, yet it is
evidently the natural, true and perfect action of the spring
when placed upon the body, and in which it would main-
tain itself with the greatest ease to the wearer, and the
most effectual for exerting its full power on the rupture
without the least assistance from understraps, except for
the reasons that have been already mentioned; yet this is,
undoubtedly what Mr. Timbrel, looking at the sketch,
would call an oblique line of action, and pretend to remedy
by drawing down the back of the truss, and keeping it
down by tight straps, and new invented double tongued
buckles, and heaven knows how many other infallible dis-
coveries.
Fig. C. demonstrates the body thrown forwards out of
the perpendicular as it is in nature, consequently, the ho-
rizontal line is raised obliquely with respect to the plane of
the horizon, notwithstanding it preserves its horizontal
position with respect to its own perpendicular: the dotted
lines shew what would be its proper position, if its own
sides were perpendicular to the horizon of the plane it
stands on.
Thirdly, If we may judge from the model that has
been sent by Mr. Timbrel to the Society for Encouragement
of Arts, &c. which was evidently made to fit the truss that
accompanies it, as it does not resemble any human being
that ever existed, it is his opinion that the front and back of
the body are perpendicular to the plane on which a person
stands, of course when he says the spring is to continue in
a


PL.3.
Fig:1.
Fig: 5.
Fig: 2.
Fig.6.
Fig. 3.
Fig: 7.
Fig. 4
Fig. 8.

111
a true circular line round the body, he means the spring is
to lie in a direction parallel to the plane on which the per-
son stands, and then it will act in a circular line round the
body; the falsehood of this doctrine has, in fact been proved
already, but the dogmatical manner in which this
person
makes his assertions, renders it proper to shew by direct
examination, how little he understands the subject on which
he presumes to dictate so imperiously.
The perpendicular lines AA, fig. 7. represent the
body standing upright upon the plane B, and the line C,
on a parallel with the plane, represents the truss passing in
a true circular line round the body, according to Mr. T's
notion: if the body was so perpendicular, then the truss
would be in a true circular line round it; but as the body
inclines out of the perpendicular, as marked by the dotted
lines, and the truss is kept parallel to the plane on which
the person stands, by means of understraps drawn tight
and fastened down by new invented double tongued
buckles, and such sort of things, it is evident that the back
of the truss is DRAWN DOWN BELOW the true circular line
of the springs' action, and forcibly kept down by pressure
of the understrap between the thighs; and by this means
the edge of the spring bears upon the back and must keep
the parts in a state of constant uneasiness: the real circular
line into which the spring of the truss will naturally throw
itself, and remain permanently, with ease, and in many cases
without the assistance of any understrap, as has been al-
ready mentioned, is indicated by the dotted line E. and
every thing advanced by Mr. T. on this subject is abso-
lutely fallacious.
It is to be observed, there are many patients who cannot
effectually keep up their ruptures by any of the trusses that
have been described; the cause of this may be explained by a
very fat person who has a large rupture, and is besides,
occasionally called upon to make very violent exertions:
the consideration of such a case, too, will enable us to ex-
plain the improvement in the general principle of construc-
ting trusses, which will always enable us to treat this
case with success, and which may frequently be adopted in
other cases of difficulty with great advantage.
Plate 3. fig. 1. represents a horizontal section of the
bones of the pelvis, so far as to shew their general form
when viewed in that direction. Fig. 2. represents the
same bones moderately covered with the muscles, integu-
ments, &c. in a person of moderate size. Fig. 3. repre-
sents

112
sents the same, carrying a large portion of fat, &c. and
fig. 4. the same when become extremely corpulent: In all
these the pelvis is marked with a firm line, and the circum-
ference of the body is indicated by a dotted line: and on
these figures is a dotted line on each side to indicate that
part of the pubis over which the rupture passes when it
begins to descend out of the abdomen.
I have seldom found a patient who complained of pain
occasioned by the pressure that was necessary to keep up
his rupture, when that pressure was applied in the best
manner, viz. by applying his hand to the part: many
patients, indeed, when desired to do this, will find it ex-
tremely difficult to perform it; they will often find it re-
quires great force to keep a rupture in this manner while
they are in an erect position, but when they are able to
effect it, it is done without pain: the reason for this is ob-
vious; the pressure is produced by means which does not
injure the parts, and is made upon the aperture only
through which the rupture protrudes, without confining, or
otherwise affecting any other part of the body: we are au-
thorised to conclude, from this fact, that the perfect theory
upon which we should in keeping up ruptures would be by
direct pressure upon the aperture, after the rupture has been
returned, and without compressing or confining any other
part of the body; but as this is evidently impossible by any
means but keeping the hand to the part, the most perfect
practice will be that which enables us to gain the object in
view by direct pressure on the part, with the least possible
inconvenience to the surrounding parts.
It has been already shewn that this pressure may be
made in a sufficient degree, in many cases, by the simplest
kind of spring truss when properly adapted, and in more by
that truss where a spring is made to pass all round the
body; but in such cases as that described by Fig. 4. even
that truss cannot succeed for this reason; Fig. 5 represents
the same body with a double truss placed on it, and the
pads directly over the apertures through which the ruptures
descend: it is clear that the ruptures of such a person can-
not be kept up unless the pads of the truss depress the skin,
fat, cellular substance, &c. which lies under them so much
as to keep the apertures perfectly close, by which means
the pads must be brought very near to the pubes: now as
this must be effected by contraction of the circular spring
round the body, it will be evident on referring to the figure
in which the pads of the truss, when near the pubes are
marked

113
marked with dotted lines, and the spring when correspond-
ingly contracted is marked in the same manner, that the
pads cannot be brought so near the pubes as is necessary
without depressing the skin, &c. &c. as much in proportion,
for almost two-thirds of the circumference of the body: this
is a degree of compression that few people can bear at all,
that none can bear without great excoriation and perpetual
pain in consequence; and even those who have fortitude to
bear it, very rarely find their ruptures can be effectually
supported. It is for this very strong reason that many per-
sons inclined to corpulence, and advancing in life, get rup-
tures, small perhaps at first, apply trusses to support them
without success, wander from one truss-maker to another,
and one quack to a succeeding one, each of whom, perhaps,
blames his predecessor, and vaunts his own superiority,
though with no better success, till the patient wearied with
fruitless trials, sinks into despair and abandons himself to
the effects of an increasing disease, which renders him in
the close of life a burthen to himself, and perhaps, in some
unexpected moment brings him to an untimely end. This
cannot be justly charged to the ignorance or misconduct of
any particular person, it is because the principle of the in-
strument is defective, and for that defect the following re-
medy is offered:
Fig. 6. represents a truss whose circular spring is like
the former, but the pads of which are supported by a
spring * within itself, whose form and power are such, that
when not fastened on the body, its apparent thickness or
that which is caused by expansion of the spring, shall be, at
least, equal to the depth through which the pressure must
be made to reach the pubes: Fig. 7. the same truss placed
on the body, but not fastened, in this state the pads only
touch the body, and the circular spring remains at a dis-
tance equal to the height of the pad; but, when the patient
is laid on his back, the rupture reduced, the two ends
of the circular spring drawn gradually together, and
fastened by the straps and buckles or pins provided for that
purpose, it will be found, that in proportion as the circular
Q
spring
* It is needless to enter into a minuter description of this part, as
several kinds of springs may be used in different cases, with equal suc
cess. I have used spiral springs, and springs compounded of different
parts, the peculiar kind of spring should be adapted to the peculiar cir-
umstances of each case.

114
spring is drawn close, the pads will be pressed upon the
apertures so as to secure them most effectually, and prevent
the descent of the rupture, and when this is effectually done
the circular spring will be merely brought into contact with
the body as represented by fig. 8; in this state it will remain.
easy in its situation, without producing any of those incon-
veniencies that are unavoidable from contraction of the
circular spring, in trusses of any other construction.
In mentioning this truss I am not recommending an
untried novelty to notice: it is now twenty-two years since
I first published an account of it; it was then a novelty, and
I have used it since with general success: not with a view,
however, of proposing it as an universal remedy to super-
sede every other kind of truss, but as possessing superior
power that may be very advantageously adopted in a va
riety of cases with success.
One of these has been particularly described, and it
may be proper to add another, the explanation of which,
will perhaps, elucidate the principle on which it may be ap-
plied to many others with success.
Taking for our guide that principle which teaches,
that as much pressure as possible should be made directly
upon the part affected, and as little as possible upon any
other part of the body, we shall see that by adopting this
method of constructing trusses in those cases where much
strength is required, the necessary degree of pressure may
be produced with more ease than by the action of a single
spring; to explain this, in the most satisfactory way, it may
be right to adopt specific terms, it may be proper to state
the case in the following way: if a certain degree of power
is required to keep up a rupture of a certain size, and that
power is applied by the action of a circular spring only, the
effect will be produced, but a certain degree of incon-
venience will be felt from the action of the spring upon
body; but if the same degree of power is required from a
truss which consists of a circular spring, and a spring in the
pad, one half at least of that power may be produced by
the action of the spring in the pad, therefore the circular
spring need be but half as strong as the former, of course its
inconveniencies, whatever they may be, will be, in the last
case, but half as much as in the former: and this is an object
of great consequence in many cases; the only incon-
venience, if it should be thought one, is that the pads of
the double springed truss must be larger than in the former;
this is an objection, however, which I apprehend will have
the
but

115
but little weight when set in opposition to any solid ad-
vantage, at least it gives the patient who has the only
right to judge for himself which of the two he would
prefer.
As it is presumed enough has been said to demon-
strate the truth of that position which it is the intention of
these papers to prove, viz. that no one kind of truss can
be equally applicable to all sorts of ruptures, and that
different kinds of trusses have various advantages, when
properly applied to those cases which are adapted for them,
it may be proper to proceed to those observations with
which it is intended to conclude the whole.
On the Application of a Truss and the Patient's Manage-
ment of himself.
Those who get ruptures, without knowing what their
complaint is, commonly apply to their surgeons for re-
lief, and, in doing this, if they are connected with men
of reputation and talents, they will generally gain all the
information that will be necessary to guard them against
all the dangerous consequences of the disease: and if they
have prudence to be satisfied with this information and act
uniformly and steadily, according to the advice they have.
received, they will seldom find any serious inconvenience
from the disease, or from the plan it is necessary for them
to follow, in order to preserve themselves from it: but,
unfortunately, this is not the case with the majority of pa-
tients: many, having received proper advice, neglect it,
or are seduced by the pretences of empirics to try their
nostrums as superior in efficacy to the system adopted in
regular practice; many never apply to professional men,
but apply, from their own judgment, to any truss-maker
they chuse to employ; if they fall thus into the hands of
ignorant men, they are not only injured, in the first in-
stance, but by getting false information respecting the dis-
ease in general, or their own particular cases, often adopt
opinions that prejudice them against the advice of more
able men and many, being filled with apprehensions and
prejudices with respect to their own situations, become mi
serable from the fear of imaginary dangers, form opinion
of their own situations and cases, imagine circumstance
Q2
which

116
which can never exist, and in hopes of obtaining relief,
pass their lives in anxiously wandering from one pretender
to another, to obtain that assistance which it will be im-
possible to gain: to such at least, as well as to those
who wish to obtain some knowledge of those facts which
it becomes every patient to know, that he may be en-
abled to take proper care of himself, the following observa-
tions may not prove unacceptable:
Every rupture, however trifling it may seem to be,
is liable to become fatal in a very few hours, if it is neg-
lected, or if effectual means are not employed to reduce
it, and keep the parts effectually in their natural situation;
those whose ruptures become painful immediately on their
first appearance, or in whom symptoms of strangulation
supervene, having been admonished by their own feelings
of the danger of their situation, when it is past, are in ge-
neral, very willing to take so much care of themselves as to
prevent a return; but those in whom ruptures come on by
imperceptible degrees, and who feel no inconvenience for
months, perhaps, sometimes for years, are very willing
to trust their own experience, and believe that what they
may be told of the dangerous consequences of the disease
is greatly exaggerated, or perhaps totally destitute of
foundation; such persons will not submit to the restraint
that is necessary to prevent the increase of the disease,
and preserve them from impending danger; their ruptures
silently increase, and become irreducible; no caution in avoid-
ing improper exertion is used, till at length symptoms of
strangulation come on, and an important operation be-
comes ncessary to preserve them from their fatal conse-
quences: most of the bad ruptures that I have seen have
been in patients of this description; the account they have
given of themselves has generally been to this effect:
"I know not when or how I got my rupture, it was very
"small at first and increased by degrees, but as it gave
"me no pain I thought it of no consequence; in this way
"I went on for a long time till its size became trouble-
"some, or till other symptoms occurred that induced me
"to seek for advice, and I now find that by neglect I
"have fallen into a situation of danger, great part of which
"I might have avoided had I sooner taken good advice."
The task is undoubtedly difficult, but no time can be better
employed than that which is spent in convincing such pa-
tients that the slightest rupture should not be neglected;
that by early attention every rupture may be kept in a
state

117
state that will prevent every danger, and with very little
inconvenience; but, that by not attending to these admo-
nitions, they must, in the end, fall into situations that
will become permanently troublesome, and at some period,
probably fatal.
It may be said with truth, that every rupture which
is reducible may certainly be kept up, by the application
of a proper truss: but, as this simple proposition has been
frequently misrepresented, and is often misunderstood, it
will be very proper to explain it in this place.
Every rupture descends with a force proportioned to
its own bulk, and the exertion made by the patient in va-
rious situations; after it is reduced it is to be kept in its
place by the pressure of a bandage whose power is greater
than the whole power exerted by the rupture in descend-
ing: when this pressure is applied in the most favourable.
manner, it is made on the outside of that opening through
which the rupture descends; and as no part that is endued
with sensibility or irritability can be pressed upon without
feeling the pressure, the pressure that is made to keep up
every rupture must be felt very sensibly; that feeling must
be great in proportion to the size of the rupture and con-
sequent force of the pressure applied; in small ruptures
it will be trifling and of course not inconvenient; in larger
it must be great, and proportionably inconvenient; in
such cases it is necessary to appeal to the patient's judg-
ment to determine him to submit to the requisite pressure,
till he is reconciled to the inconvenience, in order to keep
up his rupture, as that cannot be done without it: there
are few men, whose minds have not been poisoned by
quackery, who will not feel the force of this appeal, which
is made to their judgement :some, indeed, will not, while
others, though very few, may be so circumstanced that
they cannot bear any pressure whatever: the first, after
every proper attempt has been made to induce them to sub-
mit to whatever is necessary, may be abandoned to them-
selves, the latter are cases that are extremely rare, and
when they do occur are just subject o commiseration.
But, besides the pressure which is absolutely necessary
in every case, much pressure may be improperly applied,
by trusses constructed upon bad principles, by the impro-
per application of trusses made upon good principles, or
by the injudicious application of any trusses whatever. All
this should be guarded against with the most scrupulous
attention, or very unpleasant consequences will frequently
ensue.
All

118
All this may at first appear to be so evident, as to
render this exposition unnecessary; but whoever should take
the trouble to go round among those people who, having
no education or knowledge to qualify them for what they
pretend to do, would soon perceive the necessity of this
explanation, as such people commonly proceed in this
way: having got the knack of making some kind of truss,
they say, that all trusses, except those which are made by
themselves, are good for nothing; that their trusses are
applicable to all cases, will keep all ruptures with certainty,
and are so easy, that they may be worn in all cases without
the least inconvenience. The absurdity of such pretences
may be diverting, but the mischief they occasion is by
inducing patients to form false opinions on the subject,
which it will afterwards be very difficult to eradicate from
their minds.
Every patient should be apprised, that no truss can
be properly constructed, adapted, and applied to any case,
except by those who are acquainted with the structure of
the parts, the nature of the disease, and the mecha-
nical principles and action, as well as power of the in-
strument to be applied; mere workmen, though useful
as labourers in the hands of such men, are, of themselves,
incapable of any thing but labouring as workmen; if they
attempt more, they generally do mischief; and, indeed,
there is much mischief done by persons of this description,
who venture to apply trusses to such patients as are willing
to put themselves in their hands.
It behoves every patient to ascertain, by the best means
in his power, the capacity of the person he means to em-
ploy, and, when he does employ, to place implicit con-
fidence in him: he may be assured, that practical men
always acquire, by experience, some information which
cannot be obtained in any other way; and no one can ob-
tain the full benefit of that information, unless he disposes
himself to follow implicitly the advice that may be given
him, at least, till he finds it is less beneficial than he is led to
expect. The patient who should argue with his physician
upon the properties and effect of every medicine he is ad-
vised to take, would seldom do justice either to his doctor
or himself; and the patient who has a rupture, and will
follow no advice but that which is exactly fitted to his own
inclination, will commonly find himself in the same situa-
tion. Much may be said upon the manner of fitting a
truss to a patient, much has been said by some late writers
oll

119
on this subject; but certainly with no good effect, if with
any good intention. The fact is, that every rupture should
have a truss constructed, adapted and applied to its own
particular circumstances: to do this is an act of personal
skill, the effects of which will be felt, but cannot be under-
stood or imitated by any kind of description; every at-
tempt to do this, is, therefore, at best, but the affectation of
doing something, when, in fact, nothing useful is done.
Every patient should, when it is possible, have per-
sonal interviews with those who are to construct and apply
his truss, as many circumstances that are of importance to
the well fitting of a truss, may be seen, in a moment, that
cannot be understood from any information or description;
the want of such interviews will, therefore, be productive of
serious inconvenience to the patient, as well as to the
person he employs. It would be needless to make this
observation, if many patients did not, from motives of false
delicacy, obtain trusses by pretending to purchase them
for distant friends. With such imperfect information as
they can gain with trusses obtained in this manner, they
think they are competent to apply them to themselves;
they fail in the attempt, and, after suffering many incon-
veniencies, at last are obliged to seek that information,
which, if obtained at first, would have saved them much
unnecessary pain and trouble.
When a patient first begins to wear trusses, he should
obtain the best information in his power as to the mode of
reducing his rupture and applying the truss; in this he
should make himself perfect, as it is an operation he will
frequently have to perform for himself. It is, indeed,
understood that the truss should continually keep up
the rupture, but if the patient takes off his truss on going
to bed, he should be able to put it on properly on rising in
the morning: his rupture may descend while his truss is
off, and he should, therefore, be able to reduce his rupture
perfectly, and apply his truss properly whenever this hap-
pens. This information, like every other that is connected
with the subject, will be best obtained on a personal ex-
planation; every other will be imperfect, but as there are
situations where personal information cannot be obtained,
the following imperfect attempts to supply the deficiency
may not prove unacceptable.
A patient will, most easily, reduce his rupture while
lying on his back, with his knees raised so as to relax the
muscles which are connected with the abdomen as much as
possible,

120
possible; then raising the rupture, and separating it from
the testicle, if it is a scrotal hernia, and pressing it gently
upwards in the direction the spermatic vessels descend
from the abdomen, he will gradually return the whole into
the cavity, and keep one hand on the aperture till the
truss is applied, which will be done best while he is lying
down: if his truss be constructed on good principles,
and properly adapted to his case, It should be so applied,
that the lower edge of the pad be parallel to the upper edge
of the os pubis, by which means the rupture will be effec-
tually kept up, and no improper pressure made on the
spermatic vessels; any other method of applying the truss
must be improper. If it is placed higher than the situa-
tion I have described, the rupture will descend under the
truss, and the patient be injured by the pad pressing on
it; if it is placed lower, the spermatic vessels will be
injured by the pressure, and, even with this additional
inconvenience, the rupture will seldom be properly kept
up.
It is peculiarly necessary to impress this on the pa-
tient's mind, as some of the quacks of the present day
recommend a very different system: according to them,
the action of the truss is to be nothing, and the patient is
to depend upon girding it on tight, and buckling it down
fast with double-tongued buckles and never-failing straps,
and various projects that are equally rational. On the
principles on which trusses should be constructed, enough
has been said in a different part of this work; and it is
presumed, that a little reflection will convince those who
are unprejudiced on the subject, that the mode here re-
commended is best adapted to be made a general rule.
assist them in forming a judgment, we give a brief expla-
nation of the figures in the following plate.
To
Plate 4. figure 1. is intended to convey an idea of the
os pubis and bones connected with it, when viewed in front:
on one side a dotted line describes the course in which the
rupture descends, in its progress from the cavity of the
abdomen into the scrotum; on the other, the pad of the
truss is put upon the pubis, to shew the manner in which
it should be fixed. Figure 2. shews the pad placed upon a
body of corresponding form, and the os pubis is marked
with dotted lines. It is hoped that these sketches will
enable those who are not acquainted with the anatomy of
the parts, to comprehend how the pad of the truss should
be placed. If it is put so far above the pubis as to allow
any

LLA.
Fig:1.
you
Fig:2.


121
any thing to pass between that bone and itself, the rupture
will descend; if so low as to press directly upon the os
pubis, the spermatic vessels must be forcibly compressed,
which is always painful, and will sometimes occasion the
testicle to swell; but if it is put so that the lower edge of
the pad is quite even with the upper edge of the pubis,
the aperture will be completely closed; and if the truss is,
in other respects, properly adapted to the wearer, the rup-
ture will not descend.
It is not uncommon for those who apply trusses, to
make patients, immediately on putting on a truss, strain,
cough, jump, and play many other antick tricks, to see
if they can force their ruptures down. This practice,
surely, cannot be too severely reprobated. It is true, that
every patient should have a truss that will enable him to
go through his accustomed exercise, whatever that may
be, and even make any exertion he may be called upon for,
without suffering his rupture to get down; but as every man
is not to be a merry Andrew, it is surely absurd to make
every patient play merry Andrew's tricks. Mr. Timbrell
and his washer-woman may cast their somersets as they
please: his object was to get a gold medal, her's to serve
her master; and, on such occasions, a little absurdity may
surely be allowed; but, to those who soberly wish to guard
themselves from the consequences of this insidious and dan-
gerous disease, a different practice should most undoubtedly
be recommended.
It is known that a rupture, which has frequently de-
scended without producing any bad effects, and been easily
reduced, has suddenly descended and could not be returned
without the operation; when this happens accidentally, it
is a misfortune that could not be avoided; but who, that
is in his senses, would bring it on himself by endeavouring
to force his rupture down? yet this is a consequence that
may frequently be expected to follow from the common
practice of trying if a rupture can be forced down after
the truss is put on; if the pressure from the truss is not suf-
ficient, or if it is not directed to the proper part, the 'rup-
ture will certainly be forced down, and the consequences
that have been pointed out may, very probably take place:
If so much pressure be applied as will at once keep up a
rupture which had not previously been supported, in most
a truss much stronger than is necessary will
frequently be applied, and then the patient's permanent
cases
R
ease

122
ease and comfort will be diminished, if those mischiefs, which
are the consequence of improper pressure be not produced;
it is a fact, that when a rupture has been neglected, it will
at first be difficult to keep it in its place:* but by atten
tion, perseverance and due care, the tendency to descend
will diminish in a few days so much, that a truss, which at
first seems not to be sufficient to keep up the rupture, will
afterwards do so under every circumstance in which the
exertion of the patient's labour or exercise may place him.
After examining all these circumstances, the most rational
plan seems to be to construct, adapt and apply to every case,
such a truss as appears likely to answer every purpose,
then to direct the patient to avoid much exercise and vio-
lent exertions for several days, till he has accustomed him-
self to bear the full pressure of the bandage without incon-
venience, and is able to manage it perfectly by himself:
may then
then engage
in his usual excrtions, and even make
any exertion he may think proper in perfect safety.
he
Having obtained trusses that are perfectly adapted to
his case, and learned how to apply them with propriety,
the patient is likewise to be informed how to guard himself
against some inconveniencies, which, at times, may fall upon
every person who wears a truss, but are peculiarly apt to
attack those who have bad ruptures at the time they first
begin to apply trusses, or such as are peculiarly liable to
be
A case which strongly exemplifies this fact came under my ob-
servation some time ago. A gentleman had a troublesome scrotal
hernia, and incipient ascites besides: this rendered it very difficult to
keep up his rupture, and indeed he had quite neglected it, but his
surgeon having convinced him of the danger he incurred, induced him
to apply to me. I found it extremely difficult to adapt trusses to his pe-
culiar situation, and when this was done, the patient was not able to
take proper care of himself; when his rupture got down he knew not
how to reduce it, so that he was continually sending for his surgeon or
me; at length he was ordered into the country for the benefit of his
health, here he could have no assistance with respect to his rupture, and
was forced to depend upon his own exertions, the consequence was,
that on his return to town he had regained his health, his rupture gave
him no trouble, and he wore with ease those trusses, which, before he
went into the country, seldom kept it upon him more than half a day
at a time.
This patient's trusses were certainly not altered; the change in
their effect may be justly attributed in part to the change in the pa-
tient's health, partly to the power he acquired of applying them pro-
perly, and in part to the diminution of that tendency the rupture had
to descend in consequence of its being so long neglected.

123
be affected by friction on the skin, or by the effects of
even slight pressure. It is presumed that the effects of
improper pressure are guarded against in the construction
of the truss, both with respect to its form, the action of
the spring, and the manner of constructing the pad; but
as various opinions are afloat upon this subject, it may not
be improper to attempt, at least, to reduce them to a ra-
tional system.
As the common venders of trusses act upon a manu-
facturing principle, or rather as mere workmen, who fol-
low a pattern they chance to get, without understanding
the meaning or use of what they do, most of them have
some regular plan which they apply to all cases, and
are ready enough to say, that their plan is the best;
but the truth is, that in this, as well as in every
other particular, each case will require that its ban-
dages shall be adapted to its own peculiar circum-
stances, and a number of cases may each have bandages
that differ materially from each other, though every one
may be properly adapted to that for which it is intended.
If any thing like a general system can be adopted it will
be regulated, in part, at least, by something like the fol-
lowing considerations, viz. That as the rupture, in every
case, descends through an aperture of a given size, the
pad should be larger than is necessary to cover that aper-
ture, and its basis so firm, that the rupture acting con-
tinually upon it shall not materially alter its form: and
that this firm part should be so soft as not to injure the soft
and irritable parts it must necessarily act upon: referring
all this to the construction of trusses, it must be observed,
that if a person who has not been accustomed to wear a
truss should get one ever so well adapted to his case, if his
skin is tender, particularly in hot weather, or on taking
violent exercise, the friction of the truss will irritate the
skin, and produce excoriation: the reason for this, as well
as the proper remedy may be thus explained: when the
skin gets moist by perspiration the pad of the truss be-
comes damp and sticks to it, the motion of the body makes
the truss move about, and of course the skin is fretted: if
any thing, such as a piece of fine linen several times dou-
bled, be interposed between the truss and the body, it
absorbs the moisture on one side, and receives the friction
of the truss on the other, and by this means the parts
which lie under the truss are kept cool and easy instead of
being irritated and painful.
If
R 2

124
If the pad of the truss has been originally too hard,
or if it is grown by age so hard as to be painful, instead of
a few folds of linen, a cushion, consisting of many folds
of linen, cotton, fine flannel, or any other soft material
may be introduced under it, so as to give that degree of
softness which may be desired: this is so obvious, that it has
suggested itself to thousands who have felt the abovemen-
tioned inconveniencies, without any other information:
yet one person has been so foolish as to assert, in the most
public manner, that he has invented this practice, and to
complete the measure of his absurdity, he confesses, that
he received the hint, or idea as he calls it, from another.
Sea bathing, or the cold bath, may often be found
useful, but when either is improper, the use of cold
water, applied to the part with a sponge, should not be
dispensed with: this is not only pleasant, as conducing to
cleanliness, but it will have a good effect, as tending to
brace the parts affected, and so far increase the probability
of effecting a radical cure.
It is now proper to recapitulate that a rupture is not
necessarily a dangerous disease; at whatever period a pa-
tient gets a rupture, it is in his own power to prevent it from
getting worse or affecting his health; but if he neglects it,
it may always prove fatal in a very few hours, or, if it
does not, it will certainly increase as he advances in life,
and at last get into a state that will effectually render him
unfit for bodily exertion, and thus leave him a prey to
anxiety, and the dread of danger, which will be per-
petually impending, and beyond the power of human art
to avert.
It is particularly necessary to impress the conviction of
these truths on the minds of females, and others who are ad-
vancing in life; and who, first from unwillingness to obtain
proper advice, and afterwards from unwillingness to adopt
what must occasion them some trouble to reconcile them-
selves to, are prone to neglect themselves till they are past
that state in which they can be essentially relieved; as the
worst, and from those causes the most unmanageable rup-
tures are to be found among persons of that class, it may
not be useless to subjoin the following cases for their in-
formation:
A lady, in the early part of her life got a small crural
hernia, she procured a proper bandage, which she wore
without any inconvenience for some years: at last she be-
came weary of her bandage, and laid it aside; her rupture
gave

125
gave her no trouble, she, therefore, took no notice of it,
though it went on gradually increasing; and, as she declined
in life, it attained to a very great size.
When an event happened which alarmed many rup-
tured patients, this lady likewise took the alarm, applied
the old bandage which she had kept by her, but finding it
was useless, by the advice of her surgeon she sent for me;
she produced the old truss, informed me how easy, how
pleasant, it had been, and expected that I should make her
one as easy and as pleasant to suit the present state of her
case. It was in vain to represent that her rupture was now
more than twenty times as large as at first, and that of
course the truss to be applied must be proportionably
strong, which would occasion more restraint, though it
would produce no unpleasant consequences; her commands
were absolute, and the gentleman who introduced me wish-
ed that I should try, at least, to please her: I did so, pro-
duced trusses that were as easy as she could wish, but they
did not keep up her rupture. I then applied a truss that
did keep it up compleatly, without any untoward circum-
stance, except the restraint that was indispensably neces-
sary: this she would not bear, said she had rather abide by
all the consequences of the disease rather than wear any
truss, and has determined to avoid every exertion that it is
in her power to avoid, that she may not increase her rup-
ture, and leave the rest to chance.
Had this lady paid due attention to the advice that
was given her at the commencement of the disease, she
might, by wearing such bandages as were no inconvenience
to her, have preserved herself from every ill consequence of
the disease during her life: but she felt nothing, therefore
believed nothing was to be felt, and would not even use a
precaution that could be but little trouble, to reserve
herself from possible inconveniencies in future: those in-
conveniencies did fall on her; she felt, and wished to avoid
them; but want of resolution, or at least false reasoning
upon the subject still pursued her, and she resolves to suffer
all the consequences of the disease, rather than a trifling
inconvenience which a different mode of reasoning might
have convinced her would soon be no inconvenience at all.
Her rupture may not prove fatal, but it requires little pene-
tration to foresee, that in order to prevent it from becoming
so she relinquishes all the advantages that she might have de-
rived from exercise in prolonging the term of health, and, by
this means is accelerating the period of decripid old age.
A gen-

126
A gentleman got a double rupture at an early period
in life; by the advice of his surgeon he obtained trusses from
the most eminent persons at that time in town; they answer-
ed his purpose extremely well, and he felt no inconvenience
from them or from his rupture.
As he advanced in life he grew corpulent; and the
trusses made for him by the same person he had always em-
ployed were uneasy and ineffectual; he applied to others
with no better success. He resided several years in Ireland,
but could get no relief, and continued to increase in size,
his ruptures likewise enlarged so much that he was incapa-
ble of taking any active exercise, and thus sunk into
a bad state of health, bodily as well as mental, by reflecting
on the principal cause of his decline. In this case there was
no neglect to be attributed to the patient, or to those under
whose care he placed himself: although the trusses he used
were constructed in the best manner that was known at that
time, and answered every useful purpose that could be
descried for many years, the defective principles on which
they were constructed, rendered it impossible that by any
exertion of his own or of others, they should keep up his
ruptures after the very great alteration in his size: (the
reason for this has been explained in another place,) by
this circumstance only was he obliged to relinquish the use
of trusses, and sink, as he thought, immediately into a state
of ill health, and increasing disease; the loss of a relation
by the same complaint roused him from his lethargy, he
came to London with a determination to get assistance if it
was possible; he applied to the late Mr. Rush, and by him
was recommended to me.
He was at this time so fat that his belly projected for-
wards so that the apperture in the abdominal muscles was
perpendicular when he was standing, instead of being in au
oblique direction, and this was one reason why any truss
that acted by contraction in a circular direction could not
keep up his rupture; another was, that the great quantity
of fat, &c. lying between the abdominal muscles and the
integuments, rendered it impossible for any truss made upon
the common principles to keep up his ruptures, which, to-
gether were equal in bulk to the size of a man's head: many
attempts were made without success; but the steady per-
severance of the patient, and the attention of Mr. Rush
stimulated my exertions, till at last I succeeded in adapting
trusses that effectually keep up his ruptures. At first he
was teized with excoriations from the pressure of the pads
of

127
of the truss, but these were overcome by proper applica
tions, and the parts soon becoming accustomed to the ac-
tion, have never since been liable to the same accident: he
never takes off his truss except for the purposes of cleanli-
ness, and as his age and unwieldiness incapacitate him from
doing this himself, it is done by me when he is in town, and
by some medical gentleman when he is in a different situa
tion: his ruptures never come down, he feels nothing that
he thinks inconvenient, he takes every exercise that is
consistent with his age and situation, and enjoys the best
state of health that can be expected at his time of life; in
this state he has now continued more than two years.
This is undoubtedly the worst case I have had, in
which I could boast of complete success; every circum-
stance of the disease was unfavourable, but there was no
caprice or frowardness on the part of the patient, he was
willing to submit to every thing that could possibly be tried
for his relief, and therefore, we at length succeeded in re-
lieving him effectually. In the following case, where the
leading circumstances were very similar, but the conduct
of the patient extremely different, the consequences have
been such as might be expected from that conduct:
Soon after the gentleman, whose case I have just re-
lated, came under my care, I was applied to by a butcher,
who was equal in height and bulk, whose ruptures were as
bad, but who was not so far advanced in life: this man had
had his ruptures for several years, had wandered from one
empirical truss-maker to another, each of them had told
him that his ruptures might certainly be kept up by their
trusses which were so easy that he would scarcely be sen-
sible of any restraint or uneasiness; as each of them had
failed of performing his promise, the patient was convinced
that they were unable to perform it, but was convinced
that some other might do that which they were unable to
perform.
As a previous step, I thought it necessary to convince
him that ruptures so large, existing in a man so corpulent,
and who was perpetually called upon to make violent exer-
tions, could not be kept up without the application of
considerable force, and this could not be applied without
being felt. I ventured to promise, however, that his rup-
tures might be properly kept up, and when he had gra-
dually accustomed himself to the pressure of his truss, any
inconvenience he might feel, on that score, would be over-
balanced

128
balanced by the comfort of retaining his ruptures within
the abdomen, and the consciousness of being free from
any danger from the disease: with this he expressed him-
self satisfied, and promised to conform to the plan recom-
mended. With the experience of the former case, fresh in
my memory, I felt the propriety of applying the same kind
of truss to this patient; it was done, and promised to be
equally successful: but the patient would not give it a full
trial, he found the pressure was uneasy, he was told by his
friends that trusses might be worn without inconvenience,
and since he had, unfortunately, not been able to find such
a truss, he resolved to go without any, and abide by the
consequences. At no very distant period his ruptures
came down with the most serious symptoms of strangula-
tion. He applied to an eminent surgeon who luckily re-
duced it and obviated all the unpleasant symptoms that had
occurred; he then advised the application of a truss, and
the truss I had recommended was produced; this gentle-
man had never seen such a bandage before, certainly did
not comprehend the principles upon which it was con-
structed, and, instead of attempting to investigate them,
pronounced, most dogmatically, that it was not proper to be
used, and directed a message, most peremptorily to me, to
desire that I would make a truss in the common manner,
which in HIS opinion would answer every useful purpose:
this message was conveyed by the patient's wife, and pro-
bably not much refined in the carriage; but as I was unwil-
ling to seem captious, I complied with the request, pre-
pared such a truss as he desired, which, as I foresaw, prov-
ed ineffectual: I was not willing to have any farther trou-
ble, declined to make any more fruitless attempts, and the
patient remains to this time without any truss, willingly ex-
posed to strangulation and all its consequences.
The resemblance of the leading circumstances of the
disease in these two cases, and the difference of the event
in consequence of the different conduct of the patients,
afford the strongest proof that can be given of the effect
of rational attention and irrational neglect: the gentleman,
from the first paid proper attention to his complaint, and
when circumstances, which he could not command, occa-
sioned such alterations as rendered the best assistance he
could obtained ineffectual, he very unwillingly submitted
to his fate: when a fresh prospect of relief appeared, he
again attempted to obtain it, chearfully submitted to every
attempt

129
attempt, till in the end he obtained permanent relief that
has placed him in a state of security and comfort. While
the butcher, instead of adopting the same line of conduct,
indulged expectations that could not be realized, refused
the relief that was within his reach, because it could not be
had without a little trouble to himself, and therefore sat
down in a state that keeps him in continual danger of sa-
crificing his life to his imprudence.
It has, perhaps, been satisfactorily proved, that relief
will always be most effectually obtained in these cases by
personal application; but as many are so situate that they
cannot do this, they can only obtain trusses by having
them sent to a distance: in order to insure success, as
much as it can be insured under these circumstances, they
should send the proper measure of the patient, and the best
information that can be obtained of particulars of the case,
to the following effect:
The measure should be taken directly round the body
upon the part where the rupture lies; i. e. if it is in the
groin, the measure should be taken directly round the
body where the thighs join to the pelvis; and not round
the smallest part of the body, which is commonly called
the waist; if the rupture is in the navel the measure should
be taken directly round at that part it should be men-
tioned whether the patient is tall and thin, or short and fat,
for a tall thin man may measure the same number of
inches as a short fat one, and the form of their bodies be
essentially different from each other, so that a truss
which is proper for one would be highly improper for the
other.
It should be told whether he is subjected to great bo-
dily exertions, whether from exercise or labour; whether
his ruptures are large, and what are their contents, when
that can be ascertained; and likewise whether he has a
double rupture, or only on one side, and on which side
that is.
In consequence of such information trusses are very
frequently sent to patients at a distance, and often with
success, but when they do not succeed the patient's last and
only resource is in personal application.
S
On

130
On the radical Cure of Ruptures.
When this work was planned, it was not thought neces-
sary to say much on the radical cure of ruptures; because,
almost half a century has elapsed since so much light was
thrown on the subject by the writings of Mr. Pott, that all
professional men, who have either intelligence or integrity,
have relinquished the attempt, knowing it to be absolutely
impracticable. The quacks, as it was always a favourite
system of fraud with them, pretended to perform this cure for
some time longer; but even they have abandoned it, and
many years have elapsed since any one was known to be
hardy enough to say he would undertake to cure this dis-
case. Under these circumstances, in writing such a trea-
tise as this, it was sufficient to say, that the radical cure of
ruptures was attempted in the infancy of surgery; but
that, on more correct investigation, it had been universally
abandoned as impracticable. Since the greatest part of
these papers were printed, however, something has hap-
pened, which shews that this subject is still entitled to
mature consideration.
In the London Medical Journal for February, 1803,
appeared a paper, called, "Some Considerations to shew
"that the Idea of effecting a Cure of the Bubonocele
ought not to be entirely abandoned." This paper is
signed with the initials S. C.
66
In the notice to correspondents, in the next number,
"The editors request the author of the proposal for a
"radical eure of bubonocele, signed S. C., and printed in
"our last number, p. 161, to transmit his name; other-
"wise, they shall be under the necessity of giving the
priority of that proposal to Mr. Carlisle, who publicly
"signified his intention to perform such an operation, at
"the weekly consultation of the Westminster Hospital,
seven weeks before the receipt of S. C.'s letter.'
6
Should it eventually prove that S. C. and Mr. Carlisle are
the same person, there is at least
there is at least one, but should it
prove that
they are two distinct persons, then there will be two gentle-
men whose opinions are entitled to some notice, and who
think that all the eminent men, who have practised surgery
for the last fifty years, during which period this art has
arrived much nearer perfection than it had ever done be-
fore, were mistaken in their opinions, and wrong in their
practice in the treatment of a very common disease, that
was
CC

131
was very important to the patient, and had obtained a
great portion of professional attention. We certainly
ought to pause before such an opinion should be enter-
tained, and very seriously examine any arguments that
may be brought forward in support of it; and such an exa-
mination will be attempted on the present occasion.
Having thought it necessary to quote the notice in the
Medical Journal, in which Mr. Carlisle's name is men-
tioned, it is likewise necessary to add, that I have not the
least knowledge of HIS operation. It does not seem to
have been as yet performed, possibly it never may be;
at all events, when it is, its merits will be known, and it
must not be understood that there is any intention to ques-
tion the merits of Mr. Carlisle's project in this discussion,
which is strictly an examination of the proposition made
public by the writer who calls himself S. C.
That writer's assertions are: that, 1st," Mr. Pott, or
66 any other writer, has not adduced objections sufficiently
"forcible to shew, that what is termed the royal stitch
ought to be for ever abandoned." 2dly, That the
profession has, "perhaps without good reason, suffered
"that operation to fall into entire disrepute;" and
3dly, that it is deserving much more consideration than
"modern practitioners seem to have bestowed upon it, and
"is by no means so incapable of being improved, but
"that it may thereby be rendered likely, under certain
circumstances, to prove both safe and efficacious."
CC
It would be absurd in me to attempt a vindication of
Mr. Pott; but as this question is to be again agitated, and
his opinions certainly have had much weight, it will be
proper to introduce them here, as well to let them have
what attention they really deserve, as to introduce them
to the notice of those who may not be inclined to search
for them in the body of his work.
66
Attempts towards a radical Cure.*
"In the first section of this treatise I have said, that the
means used to obtain both a palliative and a radical cure
were exactly the same, and the event was dependent on
many circumstances which a surgeon could neither direct
S 2
nor
Pott's Treatise on Ruptures, p. 156.

132
nor alter; such as the age of the patient, the date of the
rupture, the thickness of the hernial sac, the size of the
abdominal opening, &c.
They who are unacquainted with the true nature of
this disease, may possibly be surprised at this assertion,
and be thereby induced to believe, what has in all times
been so confidently asserted, viz. that there are methods
and medicines whereby the disease may always be per-
fectly cured; and that the surgeons, either through indo-
lence will not get information of them, or through ob-
stinacy will not practise them. If either of these charges
was true, it must be the latter, for we certainly do know
what attempts of this kind have been made; and if any of
these means had really deserved the character which has
been given of them, had been safely practicable, or had
proved generally successful, I should certainly have spoken
of them in their proper place: but this is so far from being
the case, that, on the contrary, however they may have
been applauded by a few individuals, they have, upon re-
peated experiment, been found unfit for general practice,
being either totally inefficacious or painfully mischievous.
The majority, nay, almost all they who have submitted to,
or tried them, have remained uncured of their disease, or
have been mutilated or murdered in the attempt.
"Several of these methods have indeed the sanction of
antiquity, and have been described, and even practised,
by many of the old surgeons. The principal of these, or
they which are most worthy of notice, are, the cure by
cautery; the cure by caustic; that by castration; the
punctum aureum; the royal stitch; and the cure by incision.
"In Avicenna, Albucasis, Paulus Egineta, Fab. ab Aqua-
pendente, Guido de Cauliaco, Severinus, Theodoric, Ro-
landus, Sergeant Wiseman, and others, will be found the
cure by cautery, which is performed as follows:
"After a proper time spent in fasting and purging, the
patient must be put into an erect posture, and by coughing,
or sneezing, is to make the intestine project in the groin
as much as possible, when the place and circumference of
such projection is to be marked out with ink: then the
patient being laid on his back, the intestine is to be re-
turned fairly into the belly, and a red hot caustic is to be
applied according to the extent of the marked line. For
this purpose, cauteries of different sizes, shapes, and figures,
have been devised; anular, elliptical, circular, like the
Greek letter, gamma, &c. The writers who have given an
account

133
account of this operation, have differed a good deal from
each other, not only in the size and figure of the cautery,
but in the depth of its effects. Some have directed it to be
repeated, so as to denude the os pubis; others direct that
the skin only be destroyed by the iron; the cellular mem-
brane, sac, periosteum, &c. with repeated escharotic ap-
plications; but in all of them the exfoliation* of the bone
is made a necessary part of the process. The eschar and
sloughs being separated, and the exfoliation cast off, the
patient is ordered to observe an extremely strict regimen,
to lie on his back during the cure, and to wear a bandage
for some time after, in order to prevent a new descent of
the parts, which, notwithstanding all the pain and all the
hazard the patient had undergone, he was still liable to.
"The cure by caustic seems to have succeeded to that
by cautery, and is described by most of the same writers;
by Guido, Severinus, Lanfranc, Pary, Theodoric, Scul-
tetus, &c.
"The patient being laid on his back, and the parts
returned into the belly, a piece of caustic is to be applied
on the skin, covering the opening in the abdominal tendon,
so large as to produce an eschar, about the size of half a
crown. Some suffer this eschar to separate, others divide
it, and then by the repeated applications of escharotics,
destroy the membrana cellularis, with as much of the
hernial sac as can be done without injuring the spermatic
vessels. For this purpose, different kinds of corrosive ap-
plications have been made use of: pastes loaded with
sublimate or arsenic; the stirpes brassica, burnt; the tithy-
malus; lapis infernalis alone, or with suet and opium; oil
of vitriol; with many others, according to the humour of
the operator. But though the means are somewhat diffe-
rent from each other, the end or intention in the use of
them all is the same, viz. to remove or destroy the skin
and cellular membrane covering the tumour, together with
a part of the hernial sac, and by that means to procure
such an incarnation, as by its firmness, and its attachment
46
to
* Albuçasis says,
"Et scias quod quando tu non consequeris os
cum cauterio, non confert operatio tua.
Rolandus orders the cautery to be used in the same manner; so do
Guido, Theodoric, &c. Brunus says, "Si non fuerit os consecutum, in
primâ vice, tunc itera cauterium vice aliâ donec consequeris; quia si
non consecutum fuerit os cum cauterio, parum confert operatio tua."

134
to the bones and parts adjacent, shall prevent a new
descent of either gut or caul.
"The mere relation of one of these methods is sufficient
to shock any humane or
humane or ingenuous man. The horror
attending the use of the cautery must be great, to say
nothing of the extreme uncertainty of the size or depth of
the eschar; the apprehension from the caustic will be
less, indeed, but the pain must be nearly as great, and of
much longer duration.
"The parts to be destroyed are, as I have just said, the
skin, the membrana adiposa, part of the hernial sac, and
the periosteum covering the os pubis; and this is to be
accomplished without injuring the spermatic vessels, or the
tendon of the abdominal muscle.
"If the spermatic vessels are hurt, an inflamed or dis-
eased testicle will be the consequence; if they are de-
stroyed, the testicle will become useless. If the tendon of
the oblique muscle be injured, either by the iron or by the
caustic, terrible sloughs, a large ill-conditioned
sore, and
a brisk symptomatic fever must be expected, which in
some habits must be productive of considerable mischief:
and that considerable mischief was often done by these
processes, may be learned from the very writers who de-
scribe them*.
If
Guido, speaking of the cure by caustic, says, "In quo summe
"cavendum est, quod dominus sit de corrosivo; si enim indocte appli-
"cator, febrim commovet, & accidentia mala." That great pain, de-
fluxion on the hæmorrhoidal vessels, and inflammation and swelling of
the scrotum, were often the consequence of these attempts, may be
learned from the same author, who, speaking of the method of applying
the caustic, says, "Et ita continue fiat quousque caro miracis tota st
corrupta, usque ad Didimum, quod cognoscitur per inflationem bursæ,
"testiculorum;" and that the caustic has gone deep enough, he gives the
following proof: "Quod cognoscetur per majorem tumorem testiculi &
66
per majorem dolorem dorsi & partium posteriorum." Brunus says,
"Et cave summâ diligentiâ, ne in horâ cauterizationis exeat intestinum,
" & comburatur." Lanfranc, speaking of the ill effect of the caustic
in some habits, says, "Et sic multi spasmantur, & spasmati subito
"moriuntar." Fab. ab Aquapendente says, "Quæ tamen chirurgia
"uti videtis, difficilis admodum sunt, & inter subtilissimas haberi
possunt; quo sit ut plerique patientes affectus perpetuo gestare
"quam his chirurgis submittere se vellent;" and, in another place,
66
46
Quæ porro chirurgiæ vehementem dolorem afferunt & satis difficilis
sunt." In short, whoever will take the trouble of reading the old
writers on this subject, will, even from their own account, be satisfied,
both of the pain, hazard, and inefficacy of all these methods.
64
65

135
"If the os pubis be laid bare, whether by cautery or by
caustic, some of the before-mentioned hazard must be in-
curred; if it be not, the intention will in general be frus-
trated; that is, the intestine will slip down behind the
scar, and put the patient under the same necessity of
wearing a bandage, as he lay under before he submitted to
so painful and so hazardous an experiment.
"If the preservation of life was the object of these means,
something might be said in their vindication; the ancepts
remedium must for ever be preferable to desperation. But
that is not the case; they are recommended to be put in
practice when the patient's life is in no kind of danger, and
are designed merely to save him the trouble of wearing a
truss, which purpose they can seldom answer; for it is
well known, that after the use of the cautery, caustic, and
every method, either proposed for a radical cure, or used
to rescue a ruptured patient from death, that the intestine
will slip down behind the cicatrix, and form a new bubo-
nocele, which can only be kept up by a proper bandage.
"The three other means made use of by the ancients
towards obtaining a radical cure, were the punctum au-
reum, the royal stitch, and castration.
"The punctum aureum was performed as follows: The
intestines being emptied by purging, and the hernia re-
duced, an incision was made through the skin and mem-
brana adiposa, down to the spermatic process. This in-
cision was to be of such length, as to permit the operator,
either with his finger or with a hook, to take up the said
process, and to pass a golden wire under it, which wire
was to be twisted in such a manner as to prevent the in-
testine from slipping down again into the hernial sac, but
not so tight as to intercept or obstruct the circulation, of the
bloood to the testicle. Some operators preferred a leaden
wire to a golden one, and others a silken ligature.
"It may possibly seem rather uncivil to say, that both
this and the succeeding operation were directed and prac-
tised by people who were very little acquainted with the
true nature and structure of the parts they operated upon,
or indeed of the disease for which they prescribed such
operation; but had not that been the case, they never
could have proposed so fallacious and uncertain a method
of treating it; for if the wire, or whatever was passed
round the proces, did not bind pretty tight, it would not
prevent a descent of the gut, and the whole, though pain-
ful and irksome, must become absolutely useless; if it
bind

136
bind tight, it must necessarily retard and obstruct the cir-
culation of the blood through the spermatic vessels, and
produce a disease of them and of the testicle*.
"The royal stitch was performed in this manner: The
intestines being emptied, and the portion which had de-
scended being replaced, an incision was made in such
manner as to lay bare the spermatic chord, about two
inches in length from the abdominal opening downward.
When the process was freed from the cellular membrane, it
was to be held up by an assistant, while the surgeon, with
a needle and ligature, made a continued suture from the
lower part of the incision to the upper, in such a manner
as to unite the divided lips of the wound again, compre-
hending the cellular membrane, and thereby endeavouring
to straighten the passage, as they called it, from the belly
into the scrotum, without injuring the spermatic vessels.
"The operation is described by many of the old wri-
terst, with some small variation from each other, both in the
manner and the instruments; but all tending to the same
end, and all proving, that their idea of the disease, and of
the parts affected by it, were erroneous and imperfect.
The fatigue to the patient must be greater in this than in
the preceding operation, both on account of the large in-
cision, and of the suture. In some habits either of them
must be very hazardous, and, in the majority of cases,
painful, troublesome, and tedious; which circumstances
might nevertheless be submitted to, if the cure was cer
tain, the contrary to which did most frequently happen,
even by the confession of the very writers who propose and
describe these methods, and who universally order the long
wearing a truss after such operations have been submit-
ted to.
"Some who thought the stitch added unnecessarily to
the pain, have directed the incision to be made in the
same manner as for the suture; but instead of sewing the
lips together, have advised that the common membrane be
dissected out pretty clean, and the sore digested and in-
carned. This is so like to the operation for the incarce-
rated
* Whoever would know the particular methods of executing this
operation, may find them in Guido, Parey, Franco, Scultetus, Smaltzius,
Permannus, Nuck, &c.
+ Paulus, Albucasis, Fab. ab Aquapendente, Guido, Rolandus,
Parey, Serjeant Wiseman, &c. &c. &c.

137
rated bubonocele, both in the manner of making the inci-
sion, and in its consequence, as tending toward a radical
cure, that it may be looked upon as really the same thing;
and how very fallacious and uncertain that operation
proves towards answering this end is too well known.
"Both these, the royal stitch and the punctum aureum,
proved often destructive to the testicle, even in the most
judicious hands, and when it got into those of ignorant
pretenders it proved most frequently so; for not knowing
how to perform properly what they had undertaken, and
finding it much more easy, after the incision was made, to
slip out the testicle, they most commonly did so.
"These are the principal methods proposed or prac-
tised by our forefathers for a radical cure of a rupture;
among the writers indeed will be found some trifling varia-
tions from each other in the execution of them, but the
intention and aim is the same in all, viz. to prevent a new
descent of either gut or caul, by producing a union of the
parts, through which they either did or were supposed to
pass. According to the degree of anatomical knowledge,
and humanity of the proposer, they will be found to be
more or less rational and gentle; but are all of them pain-
ful, hazardous, and most frequently fallacious, and have
therefore been totally disused by all modern practitioners,
who have either knowledge, compassion, or honesty.
"No disease has ever furnished such a constant succes-
sion of quacks as ruptures have; they who have had some
smattering of anatomy or surgery, and whose humanity
has not been their prevailing quality, have adopted one
of the preceding operations, or something like them; while
they who have had less knowledge and more timidity, have
had recourse to the more sneaking knavery of specific ap-
plications.
"The histories of Prior Cabriere, Bowles, Sir Thomas
Renton, Dr. Little John, &c. &c. &c. to be found in Dio-
nis, Houston, and other writers, will furnish, to the reader,
an idea of the practice and performances of some of those
who stood at the head of those bold promisers: and our
present newspapers daily supply us with a number of the
lesser dealers in specific medicines and new invented ban-
dages, by which the poor and credulous are gulled out
of what little money they can spare. Operative quackery
is not indeed so frequent, or so readily submitted to; but I
wish I could not say, that more than one life has not been
destroyed in our own time, by attempts to form and sup-
T
port

198
port the character of an operator in this disease: to this
kind of hazard indeed, the poor are luckily not so liable,
as it can only be worth the while of these rupture-doctors
to murder those who have before hand been simple enough
to pay them well for it.
"This is a subject in which mankind are much interest-
ed, and on which a good deal might be said; but as an
honest a tempt 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 profession, be misconstrued
into malevolence and craft; I will not enter into it, but
shall conclude by wishing, that they who have capacity 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 assertions
of any charlatan whatever, but determine in this as they
do in many other things, that is, by the event. In short
if they who have so much credulity as to believe these
lying impostors, would only defer the payment of them
till they had compleated their promises, the fallacy would
soon be at an end."
Such were the opinions of Mr. Pott; on which I shall
only remark, that he did not produce them as a set of
dogmas to which he demanded implicit obedience; but,
he had investigated the subject fully, and published the
treatise as the result of his investigation, virtually expect-
ing that every intelligent and honourable member of his
profession would likewise investigate it, and having done
so would refute his opinions if they were not founded in
truth; or, if they were true, join with him in impressing the
world at large with that truth, as the best means of exter-
minating a set of impostors, who, under the pretence of curing
ruptures, which they knew they could not cure, were conti-
nually practising the grossest frauds, and sometimes were
guilty of absolute murder. His success was equal to his wishes;
no man will accuse the surgeons who have flourished dur-
ing the last fifty years of want of care or inclination to in-
vestigate the objects of their pursuit; this subject was
continually before them, and they did fully investigate it,
the consequence has been a full and universal confirmation
of the doctrines of Mr. Pott, so that, if any point in the
practice of surgery can be said to be absolutely fixed, it is
that of the treatment of ruptures upon the principles re-
commended by Mr. Pott. S. C. is the first who has pub
licly arraigned the propriety of that treatment; if, in so
doing,

139
doing, he was merely creating a difference of opinion upon
a speculative subject, the consequence would be, compara-
tively, small; but if any surgeon, whose name is entitled
to consideration, should seriously give his sanction to the
world, that ruptures may be cured by this operation, the
empirics, who very unwillingly relinquished it, would re-
vive the practice, quote their authority, and, under the
sanction of this name, revive the practice of those frauds,
which no good man would ever wish to see practised at all.
For this reason only, it is necessary to examine the argu-
ments of S. C., to shew how little reason there is to believe
that any benefit can be expected from that operation, with
any improvement that can be made upon it. In doing this,
as his opinions should certainly be examined with candour,
his own words will be used wherever it may be necessary
to quote him.
"He says,
"Indisputably it seems to be a very na-
"tural idea, that the descent of a hernia must be hindered by
"closing the aperture through which they protrude." This
must undoubtedly be granted*, and will be confirmed by a
stronger assertion, that it is the ONLY way in which a
rupture can be cured; yet, there is good reason to believe,
that the aperture through which the parts forming a rupture
protrude, never can be closed by the operation S. C. proposes;
and if this should be made out, it must inevitably follow,
that no benefit can be derived from that operation.
66
66
He says, p. 163, "Ist, The hernial sac of a bubono-
cele, as it is hardly necessary to premise, is formed by
an elongated production of the peritoneum, which is
"pushed down before the protruded viscera either into the
groin or scrotum; at its exit through the abdominal
ring, it is situated over the spermatic chord, upon the
"anterior part of which, and tunica vaginalis, it also lies
"in its course downwards, and is only covered by the
common integuments of the groin and scrotum. As it
"soon becomes adherent to the circumjacent parts after its
first protrusion, surgeons are seldom or never able to
"procure its return.
66
"2dly,
66
66
66
T 2
*Though we are treating this subject seriously, I cannot refrain
from putting S. C.'s position in other words, to shew it is so complete
a truism, that it is surprising how any person, writing seriously, could
make use of it. If by accident a hole should be opened, through which
certain matters come out, the only way to make them keep in, is to
close the hole up again. This is almost equal to Mr. Timbrell.

140
66
"2dly, Probably it will generally be concluded, that
a hernial sac is capable of uniting by the adhesive in-
"flammation, just as most other parts of the body do. If
any one doubts it, he has only to call to his remembrance,
cases where a radical cure has occasionally followed the
"concretion of the neck of the sac, after inflammation ex-
"cited by the pressure of the pad of a truss; also others,
" where its internal surface adheres to the contained
"viscera.
66
66
66
3dly, The generality of surgeons will, perhaps,
"allow, that it may be united, but not firmly enough to
prevent the recurrence of the hernia; and may appre-
"hend, that, in case it should recur, on account of
"the altered state of the parts, strangulation will take
66
66
place. To such objections I reply, that reasoning
on those radical cures that have occasionally been produced
"by the pressure of a truss, and commonly endured through
86
life; and considering the analogy of cases where the sac
" and contained parts adhere so firmly together, as abso-
lutely to be inseparable without the knife, it seems im-
probable that the adhesion of the neck of the sac should not
"be firm enough to prevent a recurrence of the disease; and
"that the danger apprehended from the altered state of
"the parts, is at least counterbalanced by that peril, to
"which every person, subject to the occasional descent of
a hernia, is exposed."
46
Every point begged for in the preceding quotation will
be conceded, and yet it is meant to contend, that, in no
case, can this operation cure a rupture, without the appli-
cation of a truss; and, by way of supplement, it will be
contended, that if, as S. C. expects, it should succeed in
very bad cases, it is impossible that it should succeed in
very slight ones. The consequence of this argument, if the
truth of it should be proved, would be, that those who
have slight ruptures must suffer them to become bad, be-
fore they could have a chance of being cured by this ope-
ration; and as this is to be done only to avoid the trouble
of wearing a truss to keep up a slight rupture, it is pro-
bable that many patients will not be induced to make the
experiment.
The hernial sac has this peculiarity, that it grows
thicker in proportion as it is extended, and may be so ex-
tended and protruded, as to cover and form a hernial sac for
any portion of viscera that can constitute the largest rupture.
It
66

141
It is admitted, that the operation recommended by S. C.
is very neat, and may be performed without danger to the
patient; it may be granted, too, that this operation will
obliterate most of the hernial sac, and yet the patient will
gain nothing but the pain by the operation; for the hernial
sac is a part of the rupture, the opening through which it
descended not being kept close by pressure from a truss,
will remain open; the viscera will, on the patient's be-
coming active, again protrude, carrying a fresh portion of
peritoneum before it to constitute a new sac, and thus the
rupture will be as compleat as at first. If this is foreseen,
and the patient is advised to wear a truss for a time, to
prevent a recurrence of the rupture, the operation is per-
fectly useless, since it is only recommended to render the
application of a truss unnecessary.
Taking this view of the case, it is needless to enquire
whether S. C.'s operation is an improvement upon other
operations that have been performed with the same view;
the argument here is, that it is impossible to cure any rup-
ture by any operation that shall obliterate the hernial sac,
(it is admitted, that the hernial sac may, in many cases,
be obliterated by S. C.'s operation) since the radical cure
depends upon a different circumstance; but this much may
be said with safety: if S. C. believes and understands
what he has written, he must know that his whole ar-
gument is a fallacy; for all his argument is by analogy
from what does happen in the radical cure of a rupture
by pressure of a truss, to what he thinks will happen if
the operation he recommends is performed, though, in
point of fact, the two cases are totally unlike.
Before the publication of Mr. Pott's treatise, the
real state of the aperture through which the rupture
descends was not well understood; since that period it
has been well understood by professional men, though
most of those who are not of the profession still entertain a
very false notion of it: from its being commonly called the
abdominal ring, they suppose it is an opening directly into
the cavity of the abdomen, and only covered by the in-
teguments, &c. But this is by no means the case; and as
a right understanding on this point is necessary to enable
us to see the fallacy of S. C.'s arguments, it will be ex-
cusable to extract Mr. Pott's account of it, in preference to
producing any other authority.
"The

142
**The pair of muscles called obliqui externi ascen-
"dentes, cover all that part of the belly which is without
bone, and the lower and anterior parts of the thorax. They
are fleshy on the sides, and tendinous on the middle
"and lower parts; they spring from the seventh and
"eighth ribs, and from all below them, by fleshy por-
tions, which indigitate with corresponding parts of other
"muscles, called the serratus major anticus, and the
latissimus dorsi, and becoming tendinous, are inserted
into what is called the linea alba, the spine of the os
"ilium, and into the os pubis.
4C
46
"At the lower part of the belly, on each side, a little
"above the last mentioned bone, the fibres of the tendon
"of this muscle separate from each other, and form
"thereby two apertures, through which pass the sper-
*matic vessels in men, and the ligamenta uteri in women.
"These openings are of an oval figure, and have an oblique
direction from above downward; the upper part of them
" is rather wider than the lower, and they are of larger
"size in men than in woment.
"The tendinous fibres of this muscle, as they pro-
ceed from its fleshy part obliquely downward, have
"several small apertures for the passage of vessels and
nerves; and, at their insertion into the os pubis, they
"cross one another, and are, as it were, interwoven, by
"which means their insertion is strengthened, and their
"attachment made firmer.
C6
"What is called by the particular name of pouparts
"ligament, is really nothing more than the lower border
" of tendon, stretched from the fore part of the os ilium,
"or haunch-bone, to the os pubis, and turned or folded
"inward at its interior edge. The other muscles of the
"belly are the obliquus internus, the transversalis, the
"rectus, and the pyramidalis, none of which have any
"concern with our present subject. The spermatic chord
"does indeed pass under the lower edge or border of the two
"first
* Pott on Ruptures, p. 11.
+ A detachment of fibres from the fascia lata of the thigh, is gene-
rally united with the tendon composing the aperture on the obliquus
externus, which mixture or connection of fibres will, in some measure,
account for the pain which they who labour under strangulated ruptures
feel upon standing upright, and the relief which bending the thigh up-
ward towards the belly always gives them.

143
<C
first of these, but at such a distance, and in such a
"manner, that no action of these muscles can any way
"affect, or even make any stricture either on it, or on a
❝ hernia accompanying it; they have no perforations or
"apertures, though so many writers of credit (even late
ones) have both described and delineated them*; con-
sequently they can have no share in the embarrassment
"of the parts contained in a hernial sac, nor require any
"division, in that operation, which becomes sometimes
necessary towards setting them free, which is a fact of
no small consequence to an operator.
LC
66
"The inside of these muscles, and indeed the whole
cavity of the belly, is lined with a smooth, firm, but
"easily dilatable membrane, called the peritoneum, a
"minute account of which would lead me beside my pre-
"sent purpose, and therefore I shall only observe, that it
"lines the whole abdomen, and gives an external coat to
66 every viscus contained in it.
6C
"Behind the peritoneum lies a loose cellular mem-
"brane, by some called its appendix, which is found in
"different quantity in different places. In some the cells
are empty, and are immediately visible upon being
"blown into; in other parts it is plentifully stocked with
"fat; and, though somewhat varied in its appearance in
"different places, is found in most parts of the body.
"This
46
*However incredible and strange it may seem, yet I am con-
vinced, that operations have been performed by informations obtained
from books only, without any previous anatomical knowledge, any
practice on dead bodies, and barely any, if any, opportunities of seeing
such operations performed by others on the living. How grossly must
such an operator be deceived by the accounts of the rings, as they are
usually, though absurdly, called, of the abdominal muscles. After he
has divided the first, or that of the external oblique, he will expect to
find a second in the internal, and a third in the transversalis, and will
never suppose that he is got into the cavity of the belly, till he has
divided all the three. It is, therefore, of the utmost consequence that
this matter be set right, and that, notwithstanding what has been said
on this subject by writers of great eminence, every surgeon be in-
formed, that the external oblique muscle is the only one which has any
opening in it; that the description given by Mr. Cheselden of these
muscles, in the last edition of his anatomy, is erroneous; and all de-
scriptions, and all delineations (some of which are to be found even in
later writers) of more openings than that single one on each side are
not representations of nature, but are the images of a luxuriant fancy,
and have no foundation in truth,

144
"This cellular membrane, void of fat, surrounding
the spermatic vessels, as they pass forth from the cavity
"of the abdomen into the groin, is called the tunical va-
"ginalis of the chord, or tunica communis vasorum sper-
"maticorum; which chord, thus envelopped, passing
"under the inferior edge or border of the transversalis,
" and internal oblique muscles, and through the perfora-
<tions or natural apertures of the external oblique, de-
"scends through the groin to the testicle in such manner,
that the spermatic vessels, in their passage from the
cavity, are really and truly behind the peritoneum.
"The tunica vaginalis testis is a membrane perfectly
"distinct from this, forming a particular cavity which
"includes the glandular substance of the testicles, and has
"nothing to do with a common rupture. In every fœtus,
66
until, or very near until the time of birth, there is an
open and free communication between the cavity of this
"last tunic and that of the belly, for the passage of the
"testicle from the abdomen into the scrotum: soon after
"the birth, this passage closes and becomes impervious;
"nor is there ever after the time of such closing, any
"communication between the cavity of the belly, and that
"of the tunica vaginalis testis. But though the passage
"remains in general for ever shut, yet the place where
"its orifice or mouth was, may always be known by a
"kind of cicatricula, much like to what appears within
"the abdomen, opposite to the navel, or place where the
"umbilical vessels of the foetus passed to and from the
"placenta; at the place of which cicatricula the perito-
"neum is generally weaker than elsewhere. Now, if it
❝ be remembered, that this weak part is necessarily op-
"posite to the natural opening in the tendon of the external
"oblique muscle, that neither the internal oblique muscle,
nor the transversalis, come low enough to make any
"resistence to whatever shall press against this part; and
"that the acknowledged use of the muscles of the abdomen
" is by pressing on all its contained viscera, to assist di-
gestion, the expulsion of the faces, urine, and foetus;
" and that in many natural actions, such as sneezing and
"coughing, &c. and in all great exertions of strength and
"force, our erect posture must necessarily occasion a
66
66
pressure to be made against the lower part of the inside
"of the belly, by some of its contents; a very probable
"and satisfactory account of the common inguinal and
"scrotal hernia may be collected."
To
66

145
To the professional reader, the above quotation from
Mr. Pott must be perfectly intelligible; to others it may
be necessary to say in different words, that a rupture does
not pass out of the abdomen by an aperture directly out-
wards, but obliquely between the muscles, the spermatic chord,
and the integuments; and whena radical cure does take place,
from the pressure of a truss, in a rupture that has descended
completely out of the abdomen, it is effected in the fol-
lowing way: The viscera, or omentum, are returned into
the cavity of the belly; that part of the peritoneum, which
now constitutes the hernial sac, remains at whatever point
it has been pushed to by the extrusion of the rupture: the
truss is applied, not only to cover the opening through
which the rupture has descended, but a considerable por
tion of the surrounding parts; and this pressure produces
three distinct adhesions; 1st, between the integuments and
the outside of the hernial sac, which lies in contact with
them; 2dly, between the two sides of the sac which are
brought into contact with each other; and 3dly, between the
outside of the sac on the posterior part, and those parts
which it lies immediately upon. These adhesions are pro-
duced by the pressure of the truss, so far as the size of the
pad will allow it to extend, and thus render the aperture as
impervious as it was before the rupture appeared. It is
easy to see there is no analogy between these facts and
those which must occur in consequence of the operation
proposed by S. C.; of course, every argument which he is
disposed to adduce by way of analogy from them, is with-
out foundation.
But, evident as this must be to every well in-
formed man, it is probable that S. C. will not accede to
the above conclusion until it is proved; it will, therefore,
be necessary briefly to explain the difference.
It is admitted, "That the hernial sac is capable of
"uniting by the adhesive inflammation, just as much as
"other parts of the body do;" it is admitted, that sepa-
rating the hernial sac, by S. C.'s operation, from the pe-
ritoneum which has not yet extruded, will effectually pre-
vent the viscera from descending into that sac which has
been cut away, and that the divided parts of the peritoneum
will unite perfectly; but what is to be the consequence of
this union? Will it obliterate or cure the rupture? Most
certainly not. The passage through which the rupture de-
scended remaining open, and the peritoneum being in a con
11
dition

146
dition to supply as much more of its substance as may be
necessary to form a new hernial sac of any size, the moment
the patient begins to take the accustomed exercise, the rup-
ture will begin to descend, and soon arrive at the size it was
before, UNLESS IT IS PREVENTED BY THE APPLICATION
OF A PROPER TRUSS. The patient will then find he has
undergone a painful operation, that is not quite without
danger, for sake of avoiding the truss, which at last he will
find his only safeguard.
But there is another point of view in which this pro-
posal of S. C's ought to be considered. Those who, un-
fortunately, are afflicted with any disease, wish to get rid
of it as soon as they can, and feel as little of its effects as
possible; and professional men, whose interest will be
most effectually served, and reputation most increased, by
pleasing their patients in this particular, will find all their
purposes will be best answered by taking the diseases they
mean to cure at the earliest period; as the patient will
suffer less from the disease, and be cured with more ease,
while his own practice will be more successful, and he will
succeed with less trouble than if he acted upon a different
plan. Yet, S. C. writes upon a plan very different: he consi-
ders the worst cases of rupture as most certain of being cured;
when these prove successful, those not so bad are to be
undertaken; and when these likewise are cured, others, not
so bad, may be undertaken, proceeding gradually as we
succeed, till in the end not the most trifling rupture may
escape being cured, if this operation is performed in due
time. This proposition is so irresistably ludicrous, that it
is difficult to conceive it can be seriously made by any pro-
fessional man; yet S. C. seems to be serious, and his ar-
gument, when correctly addressed to a patient, would be
this: Sir, you wish to be cured of the rupture you have;
a radical cure is desirable, but you are not yet bad enough to
be cured. Your rupture may now be effectually kept up by
a truss; BUT" a truss is a very cumbersome thing," and
therefore you ought not to wear a truss at all. There is
an operation by which you may be cured, when your rupture
is bad enough, and to take the benefit of this operation,
you have only to go without your truss for a few months.
It is true, that a man who has a rupture, and wears no truss,
is liable to strangulation, and death in consequence; but it is
likewise possible, by great accident, that strangulation may
come on while he wears a truss; therefore it is better not to
wear

147
wear a truss, but increase your rupture as fast as you can, and
when it is arrived at the desired point, the operation I re-
commend may be performed, and you may be effectually
cured.
Thus far I have considered this as a question of theory
only; but it is proper to mention a fact that will place it in
a different point of view. In the note, p. 14, of this work,
some notice is taken of a Mr. Lee, who pretended to cure
ruptures by an operation; that operation was the same as
the one recommended by S. C., viz. by dividing the sac
from the peritoneum, at the part where the rupture left
the abdomen, and closing up the orifice, thus to prevent
the return of the rupture. This was the daily practice of
Mr. Lee, so long as he could find patients who would con-
fide in him; a practice undertaken upon system, boasted
of as successful, and not abandoned by him, till the death
of some patients, with very untoward circumstances, in-
duced him to relinquish the practice.
It is not intended to draw any comparison between
S. C. and Mr. Lee; but it is proper to say, that as the
latter was bred to surgery, and had fixed his hopes of re-
putation and fortune on the success of that practice he had
engaged in, it is but candid to suppose he performed his
operation as well as he could, and took every care of his
patients. The opposition he met with rendered the authenti-
cation of his success an object of consequence to him; yet,
though he always boasted of it, he never could produce an
authentic case in which he had succeeded; and it is pro-
bable, that a long period will elapse before one patient will
submit to, or one surgeon perform, the operation recom-
mended by S. C.; for, at the present moment, it is doubt-
ful if even he is serious in making the proposition, or if
his paper in the Medical Journal is not rather thrown out
as a subject for disputation, than as a serious proposal
to be reduced to practice. Yet, as much mischief may
be done by even a playful attempt to disturb a prac-
tice that seems to be fixed upon a rock of adamant, it is
hoped, that this attempt to discuss the subject seriously
will not be without its use.
U 2
On

148
On curing Ruptures by the patent plaster.
Within a short time a patent has been obtained for a
method of treating and curing ruptures, by means of a
plaster which is or should be described in the specification
of the said patent. As this is a subject of much conse-
quence to those who are afflicted with ruptures, it is natu-
rally entitled to notice in a work like this; and, accordingly
it will now be investigated.
In the beginning of the last century, emplast. ad her-
niam was an article regularly kept in the shops, and as re-
gularly prescribed by one set of practitioners, and pro-
scribed by another, according to their dillerent opinions of
its efficacy in curing the disease; the dealers in secrets,
who always have something MORE effectual than what is
known in general practice, .had their particular plasters,
and the quacks, who improved upon those, had THEIR IN-
FALLIBLE PLASTERS for the cure of all kinds of ruptures,
though ever so large and of ever so long standing; but, even
in that age of credulity, these pretensions were disputed,
and since the modern discoveries with respect to this disease
have demonstrated that from the nature and situation of the
parts concerned in the disease, it is impossible that any ex-
ternal application should cure it, the quacks and the plas-
ters have gone to the vault of all the capulets, from whence
it was supposed they never would return.
This being the case, the patent mentioned above, must
be obtained, either for the discovery of some ingredients of
power superior to any before known to the medical world,
for the discovery of some principle in the animal economy,
which till now has been unknown, and the knowledge of
which has enabled the discoverer to cure ruptures; to dis-
cover which of these is the truth, it will be necessary to
examine the specification of that patent, which is extracted
from the repertory of arts, &c. and the compilers of which
will, no doubt, be able to prove whether it is, or is not, a
correct transcript from the original in the Petty Bag
office.
"To all whom these presents shall come, &c. Now,
know yo, that I the said J- O O B- in com-
"pliance with the said proviso, do hereby describe the
nature of our said discovery, and the method of the
treating and curing ruptures to be as follows; that is to
6. Suv
46

149
(6
say, that our said invention and discovery, doth consist of
"an ointment or salve, composed of the several drugs, and
"mixed and compounded in the proportion following;
"namely, one pound of incense pulverised, one pound of
"almecago, one pound of turpentine, one pound of bal-
"sam of capivi, and one pound and a quarter of white
or virgins wax, and in the same proportion for a greater
"or less quantity, always adding one fourth more of white
"or virgins wax. I likewise, further declare, that the
"best method of making this ointment is, by first pound-
<6
ing the incense and almecago till it is reduced to a fine
"powder; then mix it with the turpentine and capivi,
"repeatedly stirring it, for the space of three days, in a
"strong basin or bowl of earthenware; then melt the
wax to an oily substance, and when so melted all the
"other ingredients are then to be thrown in, when the
"whole is to be put on the fire, and stirred for a quarter
" of an hour. Then leave it for eight days; and, after the
"expiration of those eight days it must be put on the fire
"again, and be well stirred for a quarter of an hour, and
" and when cold will be fit for use. And lastly, I declare
"that the best method of using and applying the same,
"and the rules and regimen to be observed and attended
to by the patients, are as follows: Cut a piece of leather
"the size of the rupture, or rather larger, and spread the
"ointment over it: then warm it a little, and apply it
66
66
66
exactly upon the rupture. The patient, however, must
"first lay on his back, and if the intestines are down they
"must be returned; and when they are restored to their
66
proper place and position, then the plaster must be im-
mediately applied to the part, and then secured or fas-
tened, by means of a truss, as tight as possible, and re-
"main so for fifteen days, after which time the plaster is
"taken off, and a fresh one put on for the space of fifteen
"days more, making altogether thirty days; but it must
"be perfectly understood, that after the application,
namely, on the first day, the patient must go to bed,
" and remain there for twenty-four hours; and during the
"whole thirty-days he must be extremely cautious not to
"ride on horseback, nor walk fast or any distance; that
"he should avoid going up and down stairs as much as
"possible, and should not lift any weight, or use any exer-
"tion, so as to extend the muscles: that he must also be
very particular in his diet during the thirty days, and
"avoid
66
66

150
"avoid eating butter, oil, and all simular substances; and
"also, be extremely moderate in drinking, as well as in
every other respect, during all the before mentioned
"period, limited for the cure of the complaint in
" question."
44
Such is the specification, which should, and in all pro-
bability, does contain a true account of every particular of
the patentees discovery. All the ingredients that enter
into the composition of the plaster, except one, are well
known to professional men, and nothing will be hazarded
in saying, that none of them, either jointly or separately,
can have the least effect, when used with the intention of
curing ruptures; all the efficacy of this patent plaster,
then, if it has any efficacy, must reside in that ingredient,
which is called (in the specification) almacago. Enquiries
have been made of many professional men, of druggists and
other dealers in articles of the Materia Medica, without
discovering what almecago is; the patentee has not, then,
fulfilled the conditions on which his patent has been grant-
ed, for unless he had described what this valuable unknown
drug is, and where it is to be found, it will be impossible for
any one, after the patent is expired, to prepare this valuable
plaster. In the old practice, oxycroceum, and album
græcum, were used in the emplast. ad herniam; and, if it
should eventually prove that this patent is for reviving the
old practice, and calling it a new discovery, it is possible,
that almecago is a new name for some such valuable, but
now forgotten remedy.
Leaving the almecago out of the question, we are en-
titled to say, that this plaster has no specific power for
curing ruptures; and if we included that valuable article,
we might not injure the patentee by making the same as-
sertion, because his patent is not for a specific plaster, but
for a method of treating and curing ruptures; as he does
not pretend to have discovered any new principle in the
animal economy to account for the success of his method,
we are to understand, that the principles which are gene-
rally received among professional men are incontrovertible,
and, directing our enquiries by these principles, we are to
ascertain, 1st, how far the method of treating, &c. is new,
and, 2lly, how far it is, if it is at all effectual,
The method of treatment directed, is, to reduce the
rupture, and apply the plaster on the part; and secure it
by

151
by means of a truss fastened as tight as possible for fifteen
days; then to apply a second plaster and the truss again
for fifteen days, by which we are to understand, from the
term of the specification, that the cure is to be compleat in
that time: no definition is given of what the writer means
by curing a rupture; but, in candour, it must be under-
stood, that he means to place the patient in such state of
health that his rupture shall not return upon taking his
customary exercises; and, that he shall be, in every respect,
in the same situation he was in before his rupture made its
first
appearance; it is not specified that the writer has dis-
covered any new principle in the animal economy, which
should induce us, contrary to uniform experience deduced
from our knowledge of existing facts, to believe that any rup-
ture can be cured by the application of this plaster, or any
the r external application; the patent, therefore, must
rest its validity on its being an attempt to cure ruptures by
a method unknown, and, consequently unpractised before;
to determine this claim by comparison with what was for-
merly done, I shall briefly describe the old practice, and
refer those who wish for farther information, to the History
of Ruptures, published by Houston, who seems, with
much labour, to have extracted all the facts that were known
to different authors on the subject.
Two descriptions of men practised the cure of rup-
tures by the application of plasters; the first, actually be-
lieved the patients would be cured by what they did for
them, and proceeded, bond fide, in their work; they
emptied the bowels, applied their plaster with a truss to
keep it on tight, kept the bowels open, and confined their
patient strictly to bed for one, two, or three months, when
they said they were well. As men who act from prin-
ciple, though their practice should be inefficient, are sel-
dom willing to admit this, and as many patients who have
ruptures, have insurmountable objections to acknowledge
that fact, it is not surprising that many persons who prac-
tised this method should get the reputation of curing rup-
tures, which they never did cure; but the second class
acted in a different manner; their practice was fraud, they
knew they could not cure the cases they undertook, their object
was to get the reputation of having cured each patient who
applied to them; and, in consequence, additional employ-
ment, while they artfully endeavoured to conceal their want
of success: to answer these purposes, they proceeded in
treating their patients by plaster, purging, and rest;
but,

152
but, they added this advice; that they were well, but the
parts continued weak, it would therefore, be necessary to
wear a truss for some time to prevent a relapse; in this
manner they parted with their patients; and, if these lite-
rally followed the last piece of advice, they imagined they
were well, and the expectations of both parties were ful-
filled: if the patient thought the parts had got strength
enough to do without the truss, and found his rupture re-
turn, he was told it was a fresh rupture; and, if he had
sufficient faith, the operation of performing the cure by
plasters, &c. was to be repeated.
Thus much having been said of the efficacy of the pa-
tent plaster, and the novelty of the mode of curing rup-
tures by such applications, it only remains to ascertain
what benefit may really be obtained, by a patient who sub-
mits to that mode of treatment. The inconvenience a pa-
tient suffers when he first puts on a truss, is from pressure
of the truss upon parts that are not accustomed to bear
pressure; from friction upon those parts from the neces-
sary actions of the body combined with the effects of pres-
sure, and from the efforts made by the parts to descend,
notwithstanding the resistance of the truss: all this incon-
venience will disappear in no great portion of time; the
parts will then bear pressure without creating pain, the
effects of friction may be guarded against, and it is con-
tinually found that a rupture which could scarcely be kept
up an hour at a time by a truss on first application, will,
after some time, be perfectly and continually kept up by
the same truss that seemed at first to be insufficient to pro
duce that effect: but, a man, otherwise in good health,
if he is a little irritable, will find it easier to complain of
such inconveniencies than to bear with them till they
disappear; if such a man was laid in his bed, and told he
must remain there for some time, and then that he must
take no exercise for a month, and, if any trifling appli-
cation was made to amuse his mind, and persuade him
it was really an important remedy that would work his
cure, he would, in all probability submit, and at the end
of the month, not feeling the inconveniencies he did feel
in the beginning of it, might imagine he was cured, and
then would not find it very troublesome to wear his easy
truss so long as the parts continue weak, in order to prevent a
return of the disease; this is all the good that, in my opi-
nion, has ever been done by plasters when applied to
cure ruptures; nor, till there is much stronger evidence
to

153
to prove the fact than has yet come to my knowledge, shall
I believe that the patent plaster, or the patent method of
treatment and cure, is more effectual than any other plaster,
or method of applying a plaster, that has ever been used.
On the empirical Practices of the present Day.
There may be some men living, who remember the
confused state of professional opinions respecting ruptures,
and the method of treating them, before the appearance of
Mr. Pott's treatise on that subject. There are many who
remember, that after the general attention which profes-
sional men had given to it, had settled their opinions re-
specting it, the quacks of the day adhered to the old prac-
tice, and made it a vehicle of deception and fraud; but
these at last disappeared, and the rational practice was
permanently established. Under these circumstances, it
must excite great surprize to see that one man, if not two,
whose name in the profession of surgery is entitled to re-
spect, endeavour to revive an operation which long expe-
rience has proved to be ineffectual; and another person
obtain a patent for a pretended new method of curing rup-
tures, which, in fact, strikingly resembles the practice of
the old system of quackery. These things seem to prove,
that something like fatality keeps the spirit of quackery for
ever active in its attempts to prey upon the credulity of
ruptured patients; and, as the antidote should at least be
equal to the poison, it is hoped that the following hints on
the empirical practices of the present day, may not be
without their use, in guarding the unwary from the snares
that are laid for them with no sparing hand.
In the profession of surgery, and in every department
of the healing art, much must be done, in doubtful cases,
by the judgment of professional men, reasoning by induc-
tion from known facts, to others that are not so well un-
derstood. Their success will be various, in proportion to
their knowledge, their penetration and their judgment:
those who have most talent will be most successful; but the
inferiors, though they will acquire less reputation, will
incur no censure while they act honestly according to the
best of their judgment; since their want of success is the
consequence of want of talent, and not want of industry or
integrity.
Whether
X

154
Whether the art of adapting mechanical instruments
to such diseases as can only be remedied or alleviated by
such assistance, is to be considered as a branch of surgery,
when properly exercised by those who are qualified by edu-
cation and experience for the undertaking, or whether it is
only an humble attendant upon surgery, is of no conse-
quence; since those who engage in it are to be judged for
their conduct upon exactly the same principles. That this
profession, art, or occupation, has not been commonly fol-
lowed by men who have been properly educated for the
task, is perfectly notorious; though there are some excep-
tions to a practice that is but too common, there are ex-
ceptions, too, of another kind, which have been very com-
mon, and the source of much mischief to the unfortunate.
It will be proper to point these out in concluding this work.
When a surgeon tells his patient in private, or writes
to tell the public, that trusses which do not properly keep
up the ruptures they are applied to, are mischieveous
things, and ought to be avoided as likely to prove fatal;
that many ignorant men, totally unqualified for the em-
ployment, do undertake to make trusses; and that, there-
fore, every patient should be careful to apply to a man
who is properly qualified for his employment, and even
apply to his surgeon to see that the truss is properly con-
structed, adapted and applied; that surgeon is entitled to
praise, for he does his duty by his patient. But if it
should ever happen that a surgeon, unfortunately for him-
self, without practice, and, as unfortunately for those who
trust him, without principle, should invent a system of
quackery, pretend to be employed by a respectable esta-
blishment which does not exist, and arrogate to himself
superior reputation for skill in the treatment of the disease
which it is pretended is the object of that establishment
to provide a remedy for, though the establishment was a
creature of his own creation, and intended as a tool for his
nefarious practices; if, instead of providing, or being able
to provide, the best remedies for those who may be induced
to apply to him, he procures the worst, because they afford
a good profit to himself, he would be entitled to the con-
tempt and execration of mankind; because, he fraudu-
lently trifles with the diseases of the unfortunate, for the
sake of making a good thing for himself. That such a man
has existed is well known; and those who are interested in
knowing the fact, will do well to ascertain that such a
person

155
person does not exist, before they trust to many of those
who will be willing enough to recommend themselves to
their notice.
It has been said, with truth, that much mischief has
been, and is continually done, by trusses badly made, or
applied by ignorant people; and that most of the quackery
of the present day is carried on by ignorant, unprincipled
men, who pretend to make trusses. That this observation
may not be converted into a general reflection, it seems
necessary to explain how far, and under what circumstances,
it is true.
Many persons are employed in making trusses, who
follow it as a mechanical trade: some of them are men of
property and unspotted integrity; but, not having all the
knowledge that is requisite to qualify them for their em-
ployment, their practice is necessarily defective in propor-
tion to the deficiency of their information; yet, as they act
with the best intentions, and to the best of their ability,
they cannot be censured for want of probity: they are to
be considered as men of inferior talents, who follow the
employment they were bred to, and very honestly do their
duty as well as they can.
But the greatest and most frequent injuries are sus-
tained by those patients who are induced to employ work-
men of the lowest order, who are totally unqualified in every
respect to construct, adapt, or apply a truss with propriety;
yet, in consequence of having been employed as labourers
by some person of reputation, set up for themselves, and,
being equally destitute of knowledge, modesty or shame,
boldly undertake to do what they are unable to perform,
and too frequently injure those who employ them. As this
is a subject of much importance, I trust I shall be ex-
cused for endeavouring to prove it in the most satisfactory
manner.
Those who reason upon this subject by analogy from
what may happen in common mechanical trades, will judge
very falsely in supposing that a workman of any descrip-
tion, who is employed in making parts of trusses, can ever
acquire that kind of knowledge that will enable them to
adapt and apply them with propriety; yet the arrogance
of such people frequently induces them to make the at-
tempt; and patients, who trust themselves in their hands,
have frequently occasion to repent of their imprudence;
but, as a declaration of this kind should not remain in the
form of a mere assertion, it will be necessary to produce
X 2
the

156
the proofs, which I shall do by explaining the nature of
the manufactory, as conducted by myself.
During the time I have been engaged in it, I have
employed not less than an hundred hands, at different
times; none of them bred to the employment I put them
to; all of them put to different kinds of work proportioned
to their talents; many of them desirous to gain all the in-
formation they could for their own advantage, and not a
few very willing to pilfer any thing that would be advan-
tageous to themselves. Every article that goes from my
house is different, no matter whether better or worse, from
the articles intended for the same purposes that can be got
elsewhere. It has been an object with several to imitate
them, and get the best information they could for that
purpose; and I can point out one person who has sent men
to offer themselves for employment to me, that they might
enable him to make imitations of those things which have
acquired reputation in my hands. Against villainy so de-
termined, and so constantly exercised, no man could stand
a single year, unless he was able to keep his people in
check so far as to make them do what he wanted, without
gaining a knowledge of those circumstances to which he
owes his superiority; and as some of those persons I have
discharged may, at a future time, without any actual qua-
lification, pretend to knowledge on these subjects, in con-
sequence of having been employed as labourers by me, it
concerns my own character to shew that such pretensions
are without foundation, and circumstances artfully adopted
as colourable pretences to impose upon the unwary.
The articles which are connected with the business of
my house may be reduced to three distinct classes, of which
I shall treat separately. 1st. Trusses and bandages for
similar purposes; 2dly, such various instruments as are
used in correcting the deformities of children; and 3dly,
such instruments as are used in my particular practice of
curing various distortions of the limbs and body; each of
these classes shall be considered separately.
Having found a workman who is able to make springs,
he is employed to make a large number of one size and
strength, these when done are taken away; he is then
employed upon another size, and so on progressively, till
an assortment is obtained of every size and every degree
of strength that can possibly be wanted. Each size is then
put into the hands of another workman, with a pattern
formed by myself, to which he is to turn that size exactly;
each

157
each size passes through his hands in the same manner, and
are removed from him: they are then given to another,
whose business it is to temper them, and in this state they
are finally removed to the warehouse till wanted for use.
The leather for coverings is cut out and prepared by
journeymen sadlers and workmen of that description, and
finally made by women kept at a distance from the house,
and who are totally unknown to every other person in my
service; complete assortments of the pads and springs for
them are made and stored up in the same manner, so that
I have constantly by me an assortment of all the parts of
many hundred complete trusses, including every variation
of size, strength, &c. that can possibly be required, and
yet, not one of them can be completed without specific in-
structions from myself.
An assortment is finished by putting all the parts toge-
ther, by specific instructions from myself: these are kept
ready for use; but when any one is wanted different from
those which are ready, reference must be made to me;
upon learning those circumstances which are necessary
respecting the patient and his disease, the parts that are
requisite to form a proper truss are selected, put together and
finished by the proper workinen; from this account it must
be evident, that a set of workmen may be employed in
making parts of trusses for many years without having
made one complete, of course they cannot have learned,
by experience, how to make one.
With respect to the collars, and other instruments in
general use, the same system is pursued; different parts
are made to patterns by different workmen, some in the
home manufactory, and others in distant situations totally
unknown to the rest; a large assortment of these parts is
kept ready, are adapted to such other, and the essential
forms given by myself, and they are finished for use by a
different set of workmen from those who did the former
parts.
The third assortment is in a situation still different;
it consists of the instruments which are used in my peculiar
practice of curing distortions of the spine, and legs, and
feet of children: these instruments are formed from cor-
rect designs made by myself, from the patients to whose
cases they are peculiarly adapted; these patients and their
particular defects are never known to any person in my ser-
vice; the workmen who are employed never knew for what,
or for whom any instrument is intended, of course, they can
gain

158
gain neither knowledge or experience on this head, beyond
that of a labourer who has been employed upon, and can
execute work which he does not understand. *
It is now, perhaps, evident, that no workmen, who are
employed in this manufactory, can ever gain knowledge
or experience, as to the use and application of the articles
they work upon; even if they were qualified by education
to understand it; yet it is notorious, that many workmen
of the lowest description do attempt to engage in under-
takings of this kind; and, by assuming the name of truss-
makers, do infinite mischief to those who employ them;
and being confounded with respectable men under the same
title, give opportunity to such sapient critics as Mr. Tim-
brell, to say, truss-makers are not men of science, and to
believe that such stuff as he has written may be a vast ad-
dition to the existing stock of knowledge upon this subject:
general reflections are always false, but it is likewise true,
that inconceivable mischief is done by many ignorant work-
men, who undertake to make and apply trusses; yet it
would undoubtedly not be true to say, that all who follow
the same occupation are liable to the same censure: the
mischief that is done by this species of quackery is to be
attributed principally to the patients who employ them;
for so long as every labourer, who has been employed in
the lowest offices of a manufactory of this kind, can be
supposed to have learnt as much as will enable him to con-
struct, adopt and apply bandages and other instruments,
to such cases as require mechanical assistance; and so long a
a liberal, at least an appropriate education is not considered
an essential requisite to qualify a man for this employment,
so long will the quackery of ignorant workmen, improperly
called truss-makers, exist; at once a disgrace to the com-
mon sense of mankind, and a pest to society.
There is another practice that may, without impro-
priety, be called quackery, which is nearly as pernicious as
the last mentioned; this is by obtruding upon the Public,
*What has been said on this subject is only illustrated by what
actually passes in my own manufactory, because I am only to speak of
that which I do know: and I am not acquainted with the interior of
any other person's manufactory, yet there is little doubt, that if the in-
terior management of other houses was made known, it would afford
additional information to prove, that no common workman, who is em-
ployed in such a manufactory, can ever obtain so much knowledge as
will enable him to construct and apply a truss with propriety.
under.

159
under the sanction of patents for new inventions, modes of
making trusses which are either obsolete or ineffectual: a
man who has no actual knowledge on the subject, imagines
something different from what he has read, concludes he
has invented what was not known before, and obtains a pa-
tent for his invention: candour induces one to suppose
that so far he has proceeded without corrupt or unjustifia-
ble motives; had he made previous enquiries, he might
have learned that what was new to him had been well
known to others, but having, when too late to retract,
staked his money, he enters the lists, puffs his article to make
it sell, without any regard to his present knowledge of his
own imposture, till he is driven by neglect to abandon it,
or encouraged by success to become a determined daring
impostor, totally regardless of whose health he may injure,
or whose life he may destroy, provided he does but sell his
patent invention. I shall not, however, enlarge more upon
this subject here, but only observe, that there are one or
two pretended patent inventions at this moment obtruded
upon public notice, upon the detestable principle I have
just mentioned.
This tract has grown to a size far beyond what I ex-
pected at the time I sat down to write : it seemed, in spe-
culation, very easy to explain the rational method of treat-
ing ruptures, and examine some of those inventions which
were connected with it; but, upon closer inspection it ap-
peared, that many parts of the subject had been so studi-
ously confused, and falsehood so artfully substituted for
truth, that it required both industry and exertion to place
the various parts in their proper point of view. It would
have been easy, indeed, to say that one thing was good, or
another was bad, that this opinion was right or that was wrong;
but this would have been adopting that kind of conduct which
ought always to be reprobated, viz. of relying upon asser-
tions instead of producing proofs: instead of acting in this
manner, I determined to collect from the works of
those whose pretensions were examined, facts that were in-
controvertible; and which, when rightly understood, would
enable every reader to form a just conclusion on the sub-
ject, but have not pretended to draw any conclusion my-
self: this has been attempted, with what success must be
determined by the event; if I shall have succeeded in de-
monstrating that, although the construction, adoption, and
application of trusses to ruptures, has been too frequently
followed as a mechanical trade by workmen of the lowest
description,

160
description, that although others with equal ignorance and
less principle have pretended to make trusses that are
specific applications to all ruptures under all circumstances,
this trade, art, or profession, which ever it may be called,
can never be followed with propriety and effect, except by
men who unite in their own persons the scientific know-
ledge of the diseases which come under their observation,
and the skill of the scientific mechanic to direct the con-
struction of those remedies which it may be necessary to
apply, I shall have rendered an essential service to so-
ciety by indicating the only rational practice, and laying a
foundation for exterminating a species of empiricism that
is, at once, an insult to common sense and an injury to
society.
FINIS
Printed by Cox, SON, and BAYLIS, No. 75, Great Queen-Street,
Lincon's Inn Fields,



∙
KSEY
ARTES
SCIENTIA
LIBRARY VERITAS OF THE
UNIVERSITY OF MICHIGAN
STATURETTERS
TCEBOR
QUERIS-PENINSULAM AMCENAM
CIRCUMSPICE
The
George E. Wantz
(UM Medicine 1946)
Collection
234