PLAIN and FAMILIAR
INSRUCTIONS
O N
RUPTURES,
Defigned for the USE of the
FEMALE SEX:
In which are given
DISTINCT NOTIONS
OF THESE
MALADIES,
AND
The moft proper MEANS of curing them:
Together with
Accurate RULES and DIRECTIONS on the USE
and APPLICATION
OF
TRUSSE S.
By Mademoiſelle GUITON,
SURGEON of Paris.
LONDON:
Sold at the AUTHOR's, at No. II. in Martlet-Court, Bow-Street,
Covent-Garden; by H. WHITRIDGE, at the Royal-Exchange; R.
SPAVAN, in Ivy-Lane; W.OWEN, at Temple-Bar; G. WOODFALL,
at Charing-Crofs; H. CHAPELLE, in Grosvenor-Street; and at the
Court of Requests. 1750.
(Price one Shilling.)

Taubman/Rare
Book Room
RD
621
G84

[iii]
PREFACE.
A
S Ruptures are diforders, on which,
very prepofterously, a character of dif
grace has been faftened, fo almost all
thofe of our fex, who labour under
them, imagine thefe infirmities to be
a ftain to their honour; they fix upon them a kind
of ignominy, which is the reafon, that inftead of
having recourfe to the remedies proper for them,
they would, by a mifplaced fhame, diffemble them to
others, and even conceal from themfelves the know-
ledge of the danger they are in.
We fhall find this delicacy to be quite out of place,
if we confider, that thefe diforders are the most com-
mon of all thofe afflicting human bodies; that they are
the growth of every country, the fate of every age,
and

[iv]
and of every condition in life, and that they hap-
pen through caufes much more fimple and innocent,
than most of thofe producing the other diftempers.
Tis through the conviction of this truth, that
perfons of diftinguished rank, who have deigned to
own their mistake on this head, have prevailed upon
me to publish the following inftructions. Their pur-
pofe was, that all perfons afflicted, as they were,
might learn to lay afide their prejudices, and fet
about to procure for themfelves the means of aid
thefe diforders call for.
The circumftances of my life put me in a capacity
of acquitting myfelf of this duty, with all the
precision neceffary to a work of this nature: Born
in the bofom of furgery, and brought up under the
infractions of Mr. Arnaud, author of the treatife
on thefe diftempers, published not long fince, I have
been enabled (tho' the only one of my fex) to merit
the honour of being admitted into the number of the
furgeons of Paris, for the treatment of Ruptures
in women. Some perfons, jealous of my talents,
do indeed difpute me this privilege, and attempt to
mifguide the public on my fcore; but the patent,
or letters of my Reception, fubjoined to this preface,
muft defeat all fuch furmifes, in justifying my title
to that honour.
To come up fully to my engagements, I propofe, in
thefe inftructions, to put perfons of my fex on their
guard against the untoward fymptoms attending
ruptures. Thefe diforders, which are fo many con-
cealed

[v]
cealed enemies, becaufe unknown, will no fooner be
difcovered than be deftroyed. Each patient will be
in condition, upon reading this differtation with a
Small degree of attention, to become acquainted with
thefe maladies, and their cure: No longer fhall
any one be able to alledge her want of knowledge
for excufe; nor any longer be reftrained, by reafons
of decency or modefty, on a conviction of our under-
ftanding in thefe kinds of diforders.
All the views of the perfons, for whom I write,
are bere fully anfwered, in the order I obferve for
their inftruction. Ifet out with the notion of Rup-
tures in general; then I enter upon a particular
detail of each of thefe diforders: I defcribe the parts
where they are formed, in proportion as I come to
Speak to the differences of thefe diflempers: I ex-
plain their caufes, their fymptoms and figns; fo that,
with a glance of the eye, the female reader may be-
come acquainted with each particular cafe. Finally,
I come to speak to the means of effecting a radical
cure upon them. And, among all the means, ban-
dages or truffes being the most common and moft ne-
ceffary, I enlarge, as much as poffible, on the man-
ner of making and adjusting them to the body of the
patient. I lay down the neceffary rules for taking
the proper measures of the body, in order to execute
them well, and I point at the inconveniencies which
fome have oppofed to the ufe of thefe machines: And
every one not being in cafe of having the neceffary
relief against the ftrangulation of the gut, each
female

[vi]
female patient will here find the most efficacious
remedies, and eafy of execution, that can poffibly be
employed against that fymptom, and by their means
may remove it themselves.
I have avoided, as much as poffible, the use of the
terms of art, which are always uncouth to perfons not
of the profeffion, and fubftituted in their ftead thofe
of a more familiar and common ufe.
The Extract of the PATENT mentioned
above.
FRancis de la Peyronnie, Efq; counfellor, firft
furgeon to the king, head of the furgery of
the kingdom, &c. To all to whom thefe pre-
fents fhall come, greeting, &c. Taking into our
confideration the confent of the firft phyfician to
the king, we have ordered the matriculation of
Demoiſelle Mary Guiton, and that the fhall ap-
pear in our chamber of jurifdiction of St. Come
at Paris, to pafs examination; where having ap-
peared, being conducted and prefented by Mr.
George Arnaud, mafter in furgery at Paris, we
have interrogated and examined her, and caufed
her to be interrogated and examined, on all the
branches of the herniary furgery, and on the con-
ftruction, compofition, and application of the truffes
proper for the Ruptures of women, in prefence
of the dean of the faculty of phyfic of Paris, the
re-

[vii]
receiver in office, and the dean of the company
of furgeons of Paris, of all the mafters which
conftitute the council of the faid company, of the
two maſters of each of the four claffes, and of the
two Experts, by the four wardens in office. Af-
ter feveral examinations, the faid Mary Guiton
having withdrawn, with the advice of the meet-
ing, which had found her qualified, we have
received and admitted, and do hereby receive and
admit, the faid Mary Guiton to the quality of an
Expert, for the cure of Ruptures, and for the
conftruction, compofition, and application of the
truffes and other inftruments neceffary for the
Ruptures happening in women, &c. In confe-
quence of which, we have allowed, and do here-
by allow you the faid Demoiſelle Mary Guiton,
to fettle in quality of Expert for the Ruptures of
women in any part of the city and fuburbs of Paris
you fhall judge proper; but provided always, that
you the faid Mary Guiton fhall, on every firft
Monday of the month be prefent at St. Come, at
the vifitation of the poor women labouring under
thefe maladies, and pay yearly the dues to the
company; and we have taken of the faid Demoi-
felle Guiton the oath required and cuftomary. In
witnefs of which Mr. Nicolas Bourgeois, our
Lieutenant, has figned thefe prefents, caufed to
affix the feal of our arms to them, and to be coun-
terfign'd by Mr. Charles Jaques Collins, procurator
to the chatelet of Paris, our ordinary regifter, and
of

[viii]
of our chamber of jurifdiction of St.Come at Paris,
Given in our faid chamber of jurifdiction of St.
Come at Paris, Tuesday the 24th of January,
one thouſand ſeven hundred and forty-one.
Signed
Bourgeois,
COLLIN
THE

[ ix ]
THE
CONTENTS.
CHAP. I.
F Ruptures in general.
OF
P. I.
CHAP. II.
Of the general caufes of Ruptures.
3
CHAP. III.
Of the figns of true hernias.
6
CHAP. IV.
8
Of the fymptoms of Ruptures.
CHAP. V.
Of the Ruptures of the navel.
Of the Rupture of the groin.
II
CHAP. VI.
13
CHAP. VII.
Of the crural hernia. AHO
16
en
CHA P. VIII
Of the ventral hernia.
18
CHAP.

[x]
CHAP.
IX.
Of the means of remedying the ftrangulation. p. 20
CHAP. X.
Of the truffes proper for the different fpecies of
Ruptures
CHAP. XI.
23
Of the inconveniencies which may happen during
the use of truffes.
CHAP. XII.
26
A method for taking the measures of the truffes
neceffary for perfons afflicted with Ruptures. 32
CHAP. XIII.
On the manner of putting on the truffes; neceffary
precautions to be obferved previous to the laying
or adjusting them.
CHAP. XIV.
Of the radical cure of Ruptures.
CHAP. XV.
35
38
Of the Ruptures of the womb, otherwife called the
inverfion of the womb, relaxation of the womb,
falling of the womb; the relaxation and inver-
fion of the vagina.
CHA P. XVI.
Of the relaxation of the fundament.
CHA P. XVII.
39
44
Of falfe hernias. Y SAND
MANO

PLAIN and FAMILIAR
INSTRUCTIONS
ON
RUPTURES,
DESIGNED
For the USE of the FEMALE SEX.
CHAP. I.
Of Ruptures in general.
THE DESIGN OF
HE intention, which I
THE WORK.
T
have of giving inftruc
tions to perfons of my
own fex afflicted with
Ruptures, neceffarily obliges me to engage in fome de-
tail upon the character of thefe diforders, their differ-
ences, their caufes, their figns, and their ſymptoms,
in order to arrive at the knowlege of the means
proper to guard againft, or cure them.
B
WHAT

[2]
WHAT A RUPTURE IS. Ruptures are tumours
or fwellings formed by the iffuing forth of certain
parts contained in the belly.
They are fo called, becauſe there is produced a kind
of divifion or feparation of fome of the parts of the
belly, which ferve to contain the caul, the guts, the
liver, the spleen, the ftomach, &c. Thefe parts, which
ſeparate or divide, are called the mufcles, and thefe
have five natural apertures or openings, which ferve
to give exit or iffue from the belly to certain neceffary
parts. Of thefe openings I fhall fpeak in the follow-
ing chapter.
DIVISION OF RUPTURES. Ruptures are divid-
ed into true and falfe.
TRUE. The true Ruptures are thofe formed bythe
coming forth of thoſe parts contained in the lower belly.
FALSE. The falfe Ruptures are tumours or fwell-
ings formed by the collection of the blood, the lym-
pha, or other humours, in the parts where the true
Ruptures happen.
DISTINCTION OF RUPTURES. Ruptures are di-
ftinguiſhed according to the parts of which they con-
fift, and the places they poffefs.
DIFFERENCES. They differ among themfelves
on the fcore of the parts of which they confift; in that
fome are formed by the guts; others by the caul;
and others, again, by the guts and the caul together.
UNCOMMON RUPTURES. There are alſo fome
Ruptures formed by the ftomach, the bladder (which
happens rarely); others by the ovaries, and the womb
paffing thro' the openings, in the bending of the groin;
but thefe forts of Ruptures happen ftill more rarely:
and fo, without infifting on a particular detail of them,
which would throw confufion into the difcourfe, I fhall
MIU
only

[3]
only mention thofe produced by the gut and the caul
to which I fhall add thofe of the womb, and the fall-
ing of the fundament.
DIFFERENCES OF TRUE RUPTURES. The true
Ruptures differ among themfelves, from the places
they poffefs; in that fome happen in the navel; and
thefe are therefore called umbilical hernia's, or Rup-
tures of the navel: Others in the groin, and theſe are
called inguinal: Others, in the bending of the thighs,
and called crural: Others, again, are formed in differ-
ent parts of the furface of the belly, and called ven-
tral, or Ruptures of the belly.
There are, befides, other Ruptures which happen in
other parts, and which, for that reafon, differ from
thefe others; as fome happen in the loins, others in
the vagina; others, again, which are formed at the
holes at the bottom of the haunch-bones; but I fhall
wave fpeaking of all thefe different forts of Rup-
tures, as they happen but very rarely, to engage
our attention here; thefe extraordinary cafes claiming
only the attention of the people of the art or profef-
fion
CHA P. II.
Of the general caufes of Ruptures.
WHAT A
CAUSE 18. PHYSI
HYSICIANS call caufes of dif
IS. eafes every affection againft nature,
which produces, or which concurs to produce, dif-
eafes. The caufes of Ruptures are divided into remoter
or primitive, and into proximate or determining.
B 2
RE

[4]
REMOTE CAUSES. The remote, caufes are thofe,
which arife from the temperament or conftitution,
which the patients bring with them into the world, or
from the difpofition they acquire by their manner of
living. It is not to be doubted, but that children ordina-
rily enough inherit the good or bad qualities of the foul
and body of their parents; fo that there is nothing more
certain, than that robuft parents produce ftrong and
vigorous children; and the delicate, children of the
like delicacy of constitution with themfelves; the gouty,
gouty; and the phthifical, phthifical, &c. And thoſe
who have Ruptures commonly enough children with
the like indifpofitions with themfelves; confequently
the moſt remote caufes of Ruptures may be traced up
to the difpofition which is communicated to the child
at the moment of its conception.
PRIMITIVE CAUSES, WHENCE THEY MOST COM-
MONLY PROCEED. It is much more common to find
the primitive or remote caufes of thefe difeafes in the
manner of living. All the parts which are contained in
the belly, and all thofe which form it, are naturally foften-
ed and relaxed by the too moift air which is refpired;
by the marshy places which are inhabited; by the
too relaxing aliments that are uſed, as the too thin
milk of a nurſe of a bad conftitution; by the oil,
the butter, the too great quantity of water, fmall-beer,
and other the like drinks.
DETERMINING CAUSES. Every thing that is ca-
pable of determining the parts, already relaxed, to
come forth, is confidered as immediate caufes of theſe
diforders. Loud crying, leaping, ftraining, conftipation,
pregnancy, and child-bearing, force the parts contained
in the belly to ftretch, and come out at thofe places
where they happen to find the leaft degree of refift-
ence
NA

[5]
NATURAL OPENINGS. In the belly there are five
natural openings; but which are neither apparent, nor
even furmiſed to be there, by perfons unacquainted with
anatomy; becauſe, like all the other parts, they are co-
vered by the fkin and fat. Of theſe five openings the
navel is the firft; two others are fituated in the groin,
and called rings; two others in the bendings of the
thighs, and called arcades or archs. Thefe openings,
in their natural ftate, are exactly filled by other parts,
which are deftined to come forth of the belly. In the
hole of the navel are the remains of the navel-ftring,
which, during the time the child is in the body of the
mother, ferves to convey nouriſhment to it. Thro
the rings pafs two forts of ftrings, which ferve to fupport
the womb, and are called the round ligaments of the
womb. Below each of the arcades pafs the veffels,
which carry the blood for nouriſhing the inferior ex-
tremity.
PRETERNATURAL OPENINGS. Befides the natu-
ral openings, thro' which the parts contained in the
belly may come out, there are, befides, others very
often formed in all the anterior furface of the belly;
becauſe the parts, which are under the fkin and the fat,
called muſcles, and which ferve to form the belly, are
fufceptible of feparations and divifions, which let out
the caul and the guts. Befides the mufcles, there is
another part, which immediately covers all thofe con-
tain'd in the belly; this part is called the peritoneum.
This peritoneum does not divide; but is capable of
being extended and lengthened confiderably, tho' of a
very delicate texture, its thickneſs refembling nearly that
of a hog's bladder; it always forms a part of the
Rupture, and ferves as a covering to the guts, when
out of the belly, in the fame manner as in it.
It is
called

[6]
called the herniary fac, when out of the belly; an
appellation very fignificant, fince it ferves as a fac to
contain the Rupture.
IMMEDIATE OR DETERMINING CAUSES. In or
der to find the immediate caufes of hernia's or Ruptures,
and at the fame time guard againft them, it fufficeth
to attend to the general idea, which we have juft now
formed from the natural openings in the belly, and
from thofe which may be produced therein in an extra-
ordinary manner, by the feparation of the mufcles.
When the first or primitive caufes have brought the
parts contained in the belly to a ſtate of relaxation, by
the great quantity of moisture communicated to the
blood by the natural conftitution, by the method of
living, or by the air refpired, how inconfiderable foever
the efforts or ftrainings happen to be, the guts will be
difpofed to make their way out of the belly by the
parts, where they find the leaft refiftence. Now, as
they find lefs at the natural openings, or in the parts
difpofed to feparate, they will not fail to come out of
the belly at theſe places, and form one or feveral Rup
zures, according to the greater or lefs degree of refift
ence they meet with in any of thofe parts.
CHAP. III.
Of the figns of true hernia's.
WHAT A
SIGN IS.
THE
HE figns in difeafes are fenfible
marks, which difcover, and diftin-
guifh them from each other. Some of them difcover
the prefent ftate, the character, and the fpecies of the
difeafe s

[7]
difeafe; and they are called diagnoftic. Others again
enable us to judge of the iffue of a difeafe; and theſe
are called prognoftic.
The dia-
DIAGNOSTIC SIGNS OF RUPTURES.
gnoftic figns, common to all true hernia's or Ruptures,
differ according to the progrefs of the diſeaſe. When
the Rupture is just about forming, the patient feels a
fmall pain, like that of an excoriation, or ruffling of
the fkin, and that within the belly; when the Rupture
encreaſes, the patient perceives, on applying the hand,
a fmall fwelling, which difappears upon preffing with
the finger: When entirely formed, collical pains are
from time to time felt in the part of the Rupture, and
which extend to the parts about the navel. The dia-
gnoftic figns, common to all the fpecies of true her-
nia's, do, befides, difcover what parts they confift of,
whether of the gut or caul, or of both together.
Thofe confifting of the gut are known by a fmall rum-
bling noiſe cauſed by the wind and the fluid matters con-
tained in the gut, which rumbling is heard, efpecially,
upon handling the Rupture, in order to procure its
return.
Thofe formed of the caul difcover themfelves, upon
the touch, by a doughy refiftance, like what we feel,
when we come to handle a piece of tripe. In thofe
formed of the gut and caul together, thefe figns are
mixt, that is to fay, they are found combined.
PROGNOSTIC SIGNS OF RUPTURES. In regard
to prognoftic figns, it may be faid, in general, that
Ruptures are very troublefome diforders, when they
are neglected, and come to be atttended with fym-
ptoms: Thofe formed of the gut are more dangerous
than thofe formed of the caul; thofe happening in the
navel and belly, more difficult to cure than thofe
called

[8]
called inguinal; and thofe happening in the bending
of the thigh, are, of all, the moft difficult of cure.
The hernia's of the womb are, in general, more
troubleſome than dangerous.
Thofe of the fundament, called the falling of the
fundament, are the leaft dangerous; but the moft dif-
ficult to cure.
In fine, all of them are fo much the more difficult
to cure, as they are of an older ftanding; confequent-
ly lefs fo in children.
CHAP. IV.
Of the fymptoms of Ruptures.
WHAT A SYM-
PTOM IS.
Ε
E or
a
VERY thing that fupervenes
or happens upon a diſeaſe, and
renders it more grievous, is called a fymptom; as,
for inftance, a flux of blood coming upon a looſeneſs,
a dalirium upon a fever, and the like.
STRANGULATION. Of all the ſymptoms of Rup-
tures, that of the ftrangulation is the moft formidable
and dangerous, and againft which patients fhould be
moſt on their guard, either in preventing it, or feek-
ing out the means of cure, and ufing them inftantly
upon this fymptom; never fo little neglected, it is
impoffible for the experteft furgeon to remedy it.
The death of the late queen is too fenfible an inftance
of this truth, not to be capable of ftriking every pa-
tient; for who could procure be ter means of affiftance
than the upon th's melancholy occafion?
WHAT

[9]
WHAT STRANGULATION IS. By ftrangulation
we underſtand a degree of ftraitening, which hap-
pens thro' the ftrong compreflion of the parts thro'
which the gut paffes, and which no longer fuffer it
to return into the belly. In this cafe, then, the gut is
ftrangled, and this ftrangulation cannot happen with-
out two other fymptoms extremely eafy to be under-
ftood; the first is an inflammation and gangrene; the
fecond, an impediment to the paffage of the feces into
the gut; from whence it neceffarily follows, that the
feces muft return by the mouth, by throwing them up,
if the return of the gut into the belly be not procured,
for the feces to take their ordinary courfe by the
fundament.
Tho' fomeimes it happens, that it is not above
five or fix, hours before the feces return by the mouth;
yet this is not fo commonly the cafe: The vomiting
comes on for the moſt part on the 3d or 4th day;
fometimes not till after 8, 9 and 10 days; but the
patients are afflicted with fuch fymptoms, as by pre-
ceeding the vomiting, anounce and characterize the
ftrangulation of the gut fo diftinctly, that every one
who will but attend, can never miſtake the cafe.
Here follows the detail of the fymptoms.
FIRST, The Rupture grows bigger than ordinary.
SECONDLY, Caufes much pain.
THIRDLY, Baffles all attempts to reduce it.
FOURTHLY, The pain extends as far as round
the navel, if the Rupture be in the bending of the
thigh; if in the navel, the pain, beginning there, ex-
tends to the groin.
C
FIFHLY

[ 10 ]
FIFTHLY, The pains called gripes hold only for
fome minutes; but recur from time to time, and the
diforder they caufe, is daily increafing.
SIXTHLY, Upon thefe gripings comes wind, which
is plentifully diſcharged at the mouth; the patient can-
not diſcharge it by the fundament, notwithſtanding
all the inclination fhe feems to have to do it by that
part.
SEVENTHLY, The patient is troubled with loath-
ings, or an inclination to vomit, which terminate in
a plentiful falivation, thick and glutinous.
EIGHTHLY, At laft the patient throws up the ali-
ments, then come the feces, whofe tafte and fmell are
extremely naufeous.
During the feries and increafe of the fymptoms,
the Rupture fwells, the belly turns hard, and very
big, a fever comes on, and heightens more and more.
But, on the cloſe of the diftemper, the vomitings
flacken, the patient is afflicted with hiccups, the bel-
ly fubfides, and becomes infenfible, the Rupture turns
foft and livid; the fight fails; the pulfe turns inter-
mitting and languifhing, at length is totally loft,
and the patient dies for want of having forefeen the
means of guarding againft a death fhe might have a-
voided.
ADHESIONS. Ruptures are, befides, fubject to
another ſymptom, called adhefion; 'tis an union,
which is made between the parts coming out of the
belly and thofe without it, as the fat and the fkin, &c.
The parts which are attached externally, can no longer
return into the belly.
But how fhould we avoid a danger unknown, how
guard againſt theſe fymptoms, if we are uninftructed
about

[ 11 ]
about them? Poffibly 'tis only by reading; and to ren-
der it the more ufeful, I propofe to defcribe each fpe-
cies of Rupture in particular; after which I fhall
communicate the means to guard againft, and remedy
them.
CHAP. V.
Of the Ruptures of the navel.
OF THE PART.
TH
EXPLANATION HE navel, as I have already
hinted, is a hole deftined to
give paffage into the belly of the infant, during its
ftay in the body of the mother, to what we call the
navel-ftring. It confifts of three forts of veffels; name-
ly, a vein, two arteries, and a canal called urachus :
This ftring is a continuation of the veffels which form
the after-birth, which after-birth is attached to the bot-
tom of the womb. By means of the vein, which is a
part of this ftring, the blood is conveyed from the
mother to the child, for its nouriſhment and growth;
and the blood returned back to the mother by the inter-
vention of the two arteries.
The urachus is a canal coming from the bladder of
the child, for relieving it of the urine, by conveying
it into the blood of the mother. When the child
comes to the world, this ftring is tied up with a thread,
and cut, to prevent the flux of the blood of the child;
fo that the hole of the navel is filled by the navel-ftring,
yet imperfectly enough, as it afterwards comes to fhri-
vel and dry.
C 2
CHA

[ 12 ]
CHARACTER OF THE DISEASE. When we hap-
pen at any time to ftrain much, the gut or the caul
eafily comes out at the hole of the navel, becauſe there
a lefs degree of refiftence is found than any where elſe.
DIFFERENCES AND CAUSES. The Ruptures of the
navel are not only formed at the hole itſelf of the
navel, but fome more commonly happen at the cir-
cumference of this hole, becauſe theſe parts are very
weak, and eafily dilate by any violent efforts, or gentier
efforts often reiterated. Women are very fubject to
this fpecies of Rupture. The reafon is, that, in
pregnancy, the belly is extremely extended, the hole of
the navel enlarged more than in the natural ſtate, or
that its circumference yields and gives way more eafily
than all the other parts; becauſe, as was faid, the cir-
cumference of the navel is weaker than the navel it-
felf.
DIAGNOSTIC SIGNS: The fwelling and elevation
of this part is the characteriſtical mark of the Rupture,
efpecially if this fwelling difappears when abed, or
when preffed with the fingers.
PROGNOSTIC SIGNS. In general this fpecies of
Ruptures is very difficult to cure: The fmall ones, and
recent, are more dangerous than thofe of a longer
ftanding; but thefe of a longer ftanding are of more
difficult cure. Thefe difeafes are very dangerous in
children; but more eafily cured than in perfons of an
advanced age.
SYMPTOMS. The Symptoms of the Ruptures of
the navel are the fame, in general, with thofe in all
the other fpecies of hernias. One, peculiar to and
common in them, is a fpecies of flight colic, lefs
painful than troublefome, which the patients are in-
ceffantly

[ 13 ]
ceffantly afflicted with when up, and which encreaſes
after eating.
CURE. The Art of furgery fupplies three different
means of cure for this fpecies of Rupture. The firft
is what is called the palliative: The fecond, the radi-
cal; and the third, is the means of remedying the
fymptoms.
THE PALLIATIVE CURE is that by means of which
we only attempt to prevent the ſymptoms, by keeping
the parts in the belly by bandages or truffes, which ex-
actly cloſe up the hole, at which the parts come out,
and hinder their coming out when once returned into
the belly. This method of cure fuits the hernias, ac-
companied with inconveniencies, which oppoſe their
radical cure, as thofe of too old a ftanding, thofe of
too confiderable a bulk, and thofe happening to women
who are fubject to have children.
THE RADICAL CURE is that by which Ruptures
are cured by the remedies proper in thefe difeafes;
of which I fhall fpeak in chap. xiv; as in chap. ix. of
the means of removing the fymptoms.
CHAP. VI.
Of the Rupture of the groin.
EXPLANATION
HE Author of nature has fo
TH
OF THE PART. difpofed the belly, that there
are two holes, which anfwer to the parts, called the
groin. Thefe holes are deftined to give paffage from
the belly on each fide in women to a fpecies of round
ftring, called from its figure, the round ligament of the.
womb;

[ 14 ]
womb; it ferves to keep that part in its place. The
holes, thro' which thefe ligaments pafs, are, from their
figure, which is nearly round, called rings. In the
natural ſtate, thefe holes are filled by the parts which
pafs thro' them; but, upon violent ftrainings, they
enlarge gradually, and at laſt give paffage to the gut
or caul, or to both together, out of the belly, and
fuffer them to form the Ruptures of the groin; they
are called inguinal hernias or Ruptures.
ent,
DIFFERENCES. The hernias of the groin are differ-
and have different appellations according to
the place they occupy. Some remain in the bending
of the groin; thefe they call incompleat : Others de-
fcend to the great lip of the natural parts; and thefe are
called compleat.
CAUSES. The particular caufe of inguinal hernias
proceeds from the rings being fituated in the loweſt
part of the belly, which are continually relaxed by a
certain quantity of water found at the bottom of the
belly: If then the determining caufes come to act,
thefe parts being naturally open, and fituated in the
loweſt part of the belly, the guts or the caul infinuate
eafily into them.
The determining caufes are, loud crying, leaping,
the ftrainings made to cough, at ftool, in child-bed,
&c.
The neglect of remedying the incompleat Rupture
of the groin is the moft immediate caufe of the com-
pleat Rupture; for if its progrefs be not ftopp'd by
bandages, it is natural to think that it muſt daily en-
creaſe more and more, and arrive at that pitch, that
all the guts fhall come down to the great lip. Nothing
is more common than fuch forts of Ruptures. They
are

[15]
are fometimes obferved of the bignefs of one's head, and
hanging down to the thighs.
SYMPTOMS. The parts which ought to continue in
the belly, which is their natural place, cannot be thus
difarrang'd, without this confequence, a confiderable
diforder in the ftate of the health; for the guts cannot
come down fo low, and the ftomach at the fame time
not be pulled down and difplaced. As the guts are a
continuation of the ftomach, it then but imperfectly
performs the digeftion of the aliments; the patients are
afflicted with windy colicks; the twitchings, to which the
guts, the ftomach, and other parts contained in the belly,
are fubject, caufe almoft continual weakneffes, which
are improperly afcribed to the cravings of hunger.
It rarely happens, that thefe large hernias are fub-
ject to ftrangulation; but fhould that happen, it is ever
with the moſt imminent danger.
The incompleat hernias are rarely fubject to the
fymptoms above defcribed, yet more than the others fub-
ject to ftrangulation; becauſe the rings, not having loft
their fpring, as in the compleat hernias, are more in
cafe to make an impreffion upon the parts, and hinder
their return, which conftitutes the ftrangulation. It is,
befides, true, that it is eafier to guard againft their
ftrangulation, becauſe eaſier to keep them in with ban-
dages or truffes.
DIAGNOSTIC SIGNS. The incompleat hernia of
the groin is diftinguifh'd by its facility of coming out
and returning again, when not adherent, and by the
figns of the compleat hernia.
The compleat hernia is alfo diftinguifhed by its fa-
cility of returning again, when not adherent: If adhe-
rent, that is, if attach'd to the exterior parts, and form-
ed

[ 16 ]
ed of the gut, we feel in it a certain degree of flexibi-
lity, like that which is felt on compreffing a bladder
not quite full of water: If the hernia be formed of the
caul, on the touch we perceive a foftnefs, like that we
feel in handling a piece of tripe. If the hernia confifts
of both thefe parts, the figns are then mixt; we feel,
in handling the tumour, that flexibility, and at the fame
time, that foftnefs juft now mentioned.
PROGNOSTIC SIGNS. We may affirm of the hernias
or Ruptures of the groin, that the incompleat are more
dangerous than the compleat, and alfo of more eafy
cure; for in the compleat, the difarrangement of the
parts is more confiderable; but the hole of the ring be-
ing larger, they are lefs fubject to ftrangulation.
CURE. The hernias of the groin are fufceptible of
three different methods of cure; of which I fhall fpeak
hereafter, viz. the palliative, the radical, and of that
which confifts in removing their fymptoms.
CHAP.
VII.
Of the crural hernia.
EXPLANATION
In
OF THE PART.
the
the bending of the thigh, juft in
middle, under the ſkin and
the fat, there is an opening to one fide of the ring; this
opening, which is called the crural arcade, has in effect
nearly the figure of a fmall arcade or arch. It ferves
to give paffage out of the belly to the veffels which
carry the blood for the nourishment of the thigh, the
leg, and the foot, and to thofe which reconvey it from
thefe

[ 17 ]
thefe parts. Thefe veffels are called crural, and the
rupture made by this hole is alfo called crural.
This Species of Rupture happens more commonly
to women who have had children than to others.
DIFFERENCES. The crural hernias differ only in
bulk or fize: the biggeft exceed not a hen's egg, but or-
dinarily they are much lefs.
CAUSES. The increaſe of the volume or bulk of the
womb, in proportion as the woman advances in her
pregnancy, is the particular caufe of that fpecies of
hernia, the guts being then obliged to bear in greater
quantity on the fides of the belly; and as in this cafe,
the mufcles are ftretched much, and their openings,
called arcades, are more patent, the guts or the caul
eſcape more eaſily at thefe openings, in the great
ftrainings of women with child in the act of coughing,
at ftool, or in labour.
SYMPTOMS. They are very fubject to adhesions on
account of the continual rubbings or collifions they
undergo in the motion of the thigh. The bandages
being ill-made, contribute thereto much: They are alfo
fubject to ftrangulation.
DIAGNOSTIC SIGNS. The diagnoftic figns of this
fpecies of hernia are the fame with thofe of the incom-
pleat hernia of the groin: The fituation befpeaks its
fpecies, with refpect to the place it occupies.
PROGNOSTIC SIGNS. The crural hernia is very
dangerous, from the difficulty there is of reducing it
into the belly; in cafe of a ftrangulation, the operation
is much more dangerous. The radical cure of it is very
difficult to compafs; nay it is not an eafy matter to
keep it in with bandages; unless they are made with
much care and judgment; fo that one may affirm in
general,
D

[ 18 ]
general, that this fpecies of Rupture is very dange-
rous.
CHAP. VIII..
Of the ventral hernia.
WHAT THE
BELLY IS.
TH
HE belly confifts of foft parts,
which are the fkin, the fat, and the
mufcles. By mufcles we underſtand thofe parts of ani-
mals, which are known by the name of fleſh, which
confifts of red fibres or ftrings, which eafily feparate,
when the meat or flesh is boiled. Thefe ftrings are
joined to each other by other fmaller ftrings of another
fpecies, and which are fo fine and delicate, that the
fight fcarce difcerns them. It is eafy to conceive that
theſe fleshy ftrings may divide and feparate from each
other, by the ftrainings we may happen to exert, and
that the opening, which this divifion forms, may give
paffage out of the belly to the guts and caul with as
much eaſe as the natural holes, of which we have al-
ready spoken. Thefe forts of ruptures, which may
be thus formed, in all the extent of the belly, are cal-
led ventral hernias.
DIFFERENCES. The different places of the belly,
where theſe Ruptures happen, characterize their diffe-
rence; for fome of them may happen about the navel;
others below; others again on the fides of the belly.
In fine, they may happen in all the parts of its furface,
and they ever are Ruptures of the belly, otherwife called
ventral hernias. All of them may be produced by the
gut or caul, or by both together.
CAUSES,

[194]]
CAUSES. The great extenfions the mufcles are ex-
pofed to in pregnancy, and in the dropfy, are the
proximate and moft common caufes of thefe fpecies
of ruptures: yet violent ftrainings may give occafion to
them.
SYMPTOMS.
Of all the fpecies of Ruptures there
is none that fatigues and fpends the patients more; be-
caufe in theſe cafes there is an extreme relaxation
in all the parts of the belly. The continual twitchings
the patients are expofed to, incapacitate them almoft to
walk, they are ever complaining of weakneffes and
finkings, eſpecially after meals, which allow them no
other poſture but that of fitting or lying down. Thefe
Ruptures alfo are fubject to ftrangulation and adhe-
fions.
DIAGNOSTIC SIGNS. The ventral hernias are known
by their foftnefs, their elafticity, and the facility with
which they come out of the belly, and are again re-
turned, eſpecially at their beginning.
PROGNOSTIC SIGNS. Thefe fpecies of hernias are
incurable. They are not fo fubject to ftrangulation as
the other Ruptures, but fhould it happen upon them,
it is highly difficult to remedy; thefe forts of Ruptures
are then very dangerous.
CURE. The palliative cure is the only one that fuits
here, fuch is the application of bandages; but no ban-
dage are of more difficult execution than thofe for
fuch Ruptures: And I may without prefumption af-
firm, that no one, befides myfelf, has hitherto found
out the commodious, and fure means of keeping in
theſe ruptures, fo as to prevent their coming out in
what fituation or pofition foever the patients are put.
D 2
CHAP

[ 20 ]
CHAP.
IX.
Of the means of remedying the ftrangu
lation.
WHAT STRAN-
GULATION IS.
HE ftrangulation, as was faid
in chap. iv. is fo confiderable
Tin
a ftraitning of the gut, formed by the conftriction of the
parts thro' which it comes out of the belly, that its return
is not poffible. In this cafe we fee, that it muſt be
expofed to all the fymptoms, of which I have given a
detail in the fame chapter, and of what importance it
is to remedy it ſpeedily.
THREE MEANS TO BE USED. The ftrangulation is
remedied by three means.
The firft confifts in the
fituation, in which the patient fhould remain. The
fecond, in the ufe of proper remedies. The third, in
replacing the gut.
FIRST MEANS. In the ftrangulation of any ſpecies
of hernia whatever, we muft procure to the parts, which
are too much extended, a fuitable relaxation, to leffen
the ftraitning of the gut. The patient then fhould be
laid upon her back, the buttocks and breaft be raiſed
by means of pillows; by this fituation the exterior
parts of the belly are lefs extended, and the ruptured
guts are made to have a greater tendency to return.
SECOND MEANS. The patient being in this fituation,
the fuitable remedies muſt be forthwith ufed, and thoſe
proper to promote the reduction of the parts. Each
country, each practitioner, has his peculiar remedies;
but as fome of them are approved by all the people of
the

[ 21 ]
the profeflion, and every-where to be met with; 'tis
on fuch I fhall infift, to the 'end that the inftructed
patients may uſe them directly, and till they can have
recourſe to the aid of their furgeon. The coldeft and
the hardeſt water, as that of a pump, thrown imme-
diately upon the Rupture, is the moft efficacious reme-
dy, and which ought to be uſed the firft, if one is fo
happy as to apply it in the firft moments of the difeafe;
if the patient be laid on a bed, and we apprehenfive
of wetting it, it will be fufficient to dip rags in this
water, and applying them on the affected part, fhift
them every minute; to this water may be added half
the quantity of vinegar. It is to be obferved, that this
remedy, which is the moft fovereign of all thofe we
are going to prefcribe, would prove highly dangerous,
not ufed, at leaft, at the very firft; becaufe after
that, it difpofes the guts to a gangrene; but being pro-
perly applied, it promotes the return of the gut with
as much eaſe as the moft dextrous hand, and the moft
accuſtomed to this operation.
If theſe remedies have not been applied, for want
of being able to feize on the critical moment, the pa-
tient must be blooded directly, and that till fhe faints
away, and the furgeon to improve the moment of the
fwooning, (during which all the parts are in a ftate of
relaxation) to procure the return of the Rupture.
But it may happen that this means has not fucceeded,
either thro' the difpofition of the patient, or the little
experience of the furgeon; in that cafe we muſt apply
on the Rupture the remedies capable of relaxing the
ftrangling parts. Nothing is more fitted to produce
this effect than the crum of bread boiled in water or
milk; we may add to it oil. This poultice is wrap-
edd

[ 22 ]
ped up in a ſmall bag of fine cloth: But we here ftill
more uſefully employ warm milk put into a hog's blad-
der, and applied on the ailing part, or an omelet made
with oil; that of nuts is the beft. Thefe applications
fhould be ſhifted every three hours, and during the
ufe of them, the patient to be let the fame quantity of
blood every three hours alfo, taking at each time
6 ounces.
5 or
Whilft we thus labour to procure the relaxation of the
parts which ftrangle the gut, we muſt endeavour to
void the matters which may be evacuated from the
guts, by means of fmall glifters of river water, in
which has been boiled wheat-bran, and into which is
put a tea-fpoonful of fugar or common falt; by thus
voiding the guts, we alfo procure a relaxation to the ex-
terior parts, by bathing and moiftening them.
If thefe remedies prove ineffectual for two days,
we ought not to hefitate a moment to procure the aid of
fome able furgeon, who is to act in confequence of the
violence of the fymptoms; (for then they heighten more
and more) while we wait for his affiftance we muft ap-
ply a poultice made of crum of bread boiled in red
wine.
In all cafes, wherein we ufe crum of bread, it muft
be crumbled very fine and fmooth.
REGIMEN. During the courfe of the difeafe, the
patients muſt have no nouriſhment, becauſe they throw
up all they take, and what is given them is quite loft
upon them; befides, the feeding them excites the
vomiting, which comes on but too often.
A few ſpoonfuls of broth are fufficient at times, and
a few ſpoonfuls of the fimpleft and lighteft drink.
THIRD

[ 23 ]
THIRD MEANS. The replacing the parts, which
is called reduction, is an operation of the hand, which
confifts in procuring the return, into the belly, of the
gut or caul, which were come out.
It is very difficult to give rules on the manner of
performing this operation; befides, it only concerns
the people of the art to be inftructed therein, and fo I
forbear fpeaking of it: Such as are curious of knowing
the general rules, which may be given on it, may con-
fult Mr. Arnaud's book, Chap. XIII. Sect. II. Part 1.
It is enough for the patients to know that they ought
not to quit their bed, after the reduction of the parts,
before they are guarded with a proper bandage, to
ftop up the hole, thro' which the guts or caul were
come out, and prevent this accident from happening
again. As life depends on fuch fort of machines, and
that the patients are incapable of judging of their de-
fects, I am in the following chapter to give the exacteft
rules poffible to judge of their good or ill conftruction,
and thereby enable the patients themſelves to determine
about the advantages and difadvantages which may re-
fult from bandages or truffes well or ill made.
CHAP. X.
Of the truffes proper for the different
Species of Ruptures.
WHAT AT form of a circle, applied round the
TRUSSES are folid bands made in
TRUSS IS.
body, to oppofe the iffuing forth of the Ruptures.
THE

[ 24 ]
THE MATTER OF TRUSSES. The matter of which
truffes are made, is a compofition of iron and ſteel forg-
ed together fo as to acquire a folid confiftence, elaftic and
incapable of warping: This laft matter fhould only
make a third, a half, or two thirds of the trufs, the
reft to be of leather, the whole lined with cloth proper
to guard against the hardneſs of the iron-work.
THE PARTS OF THE TRUSS. It is neceffary to know
the parts of the trufs before we learn to make the proper
application of it, or determine its pofition: Three prin-
cipal parts are to be obferved in the iron-work of the trufs;
the plate, the circle, and the tail. The plate is the an-
terior extremity, deftined to faften a cufhion, which
ought to ſtop up the hole of the belly; on the outfide
of this plate is a hook for faſtening the girdle of leather:
The circle is the part extending from the plate as far as
to the tail; the tail is the pofterior extremity of the
iron-work, to which is faftened the girdle of leather.
The plate or the cufhion is alfo called the point of
compreffion; the tail, the point of fupport.
THE CONDITIONS OF THE TRUSS. The iron-work
fhould be adjuſted in fuch a manner as to apply or fit
exactly quite round the body, as otherwife it would be
apt to bear falfe, or warp, gall the patient, and never
cloſe up the hole exactly, the Rupture be apt to fall out,
the plate of the trufs be galling, and give occafion to
the adheſion, an untoward fymptom, of which we have
fpoke in chap. iv.
TRUSS OF STEEL. The trufs of ſteel is the only
one which may be applied round the body, without
being fubject to any variation or warping, its turn or
rounding being well moulded to the fhape of the body
for which it is made, renders it firm, invariable and
incapable

[ 25 ]
incapable of fhifting place, in what fituation foever the
patients put themfelves.
SPRING-TRUSS. Some workmen have imagined they
gave a great degree of perfection to the trufs by adding
to the cushion a fpring to make it bear downwards,
without confidering that if the compreffion be greater in
the lower part, it is lefs in the upper, where the Rup-
ture takes a new courfe, and ever and anon comes out.
JOINT-TRUSSES. Others have devifed a joint-
trufs, the ufe of which is pernicious; for the trufs,
which ſhould remain firm upon the body in the different
motions of the patients, cannot poffibly do fo, its joints
fuffering it to open and clofe according to the motions
of the patients.
ELASTIC TRUSSES. Many more advantages were
imagined to be found in certain truffes, to which they
have given the name of Elaftic truffes of a new inven-
tion; this elaftic virtue which conftitutes their merit is
very advantageous when this fort of trufs is executed by
an intelligent hand, who knows how to give the degree
of turn or rounding proportioned to the fhape of the
body, on which it is to be applied, a thing extremely
difficult; for otherwiſe it ever bears falfe, galls the pa-
tients, and neither reftrains the Rupture.
TRUSS WITHOUT STEEL. The trufs without fteel has
all the moſt dangerous inconveniencies poffible; and we
cannot too much caution patients againit a machine,
which may eafily miſlead, from the notion of reftraint
and pain at firft excited in the mind by the idea of ſteel,
which enters into the compofition of other truffes; but
if we confider that the cuſhion of the trufs without
fteel has no fix'd point to render it immoveable, we
fhall come eafily to underſtand that it cannot effect an
exact compreffion on the hole of the Rupture, but
E
when

[ 26 ]
when the patient is abed, and that in that cafe moft på-
tients being able to do without a trufs, this fort be-
comes ufelefs, and proves dangerous in all other fitu-
ations, as it prevents not the exit of the Rupture.
Therefore I conclude, from what I have juft faid on
the fubject of truffes, that thofe agreeing the beft are
the fteel-truffes methodically made, that is, made ac-
cording to the nature and fpecies of the malady, and
turned or rounded to the fhape and ftructure of the
bodies of the perfons on which they are to be applied.
But as it fufficeth not that patients have truffes properly
conftructed for them, but further neceffary, they know
how to uſe them to advantage, I fhall in the following
chapter recite the inconveniencies which may happen
upon the uſe of theſe machines.
CHAP. XI.
Of the inconveniencies which may happen
during the ufe of truffes.
THREE GENERAL
INCONVENIENCIES
AY make patients, but lit-
tle attentive to their ail-
MA
ments, lofe all the benefit they fhould otherwife derive
from the ufe of truffes executed according to the rules
of art.
Some arife on the part of the diſeaſe itſelf;
others, of the patients; others again, of the truffes.
INCONVENIENCIES CHARGEABLE TO THE SCORE
OF THE DISEASE. Ruptures of the caul are very
difficult to keep in the belly, becauſe that part being a
fatty membrane, is very flippery. How little fo-
ever

[ 27 ]
ever we neglect the retaining them in the belly, they
are ever encreaſing; patients fhould in that cafe then
fubmit to wear their truffes night and day, and tighter
than in a rupture of the gut.
Sometimes the Rupture is found to confift of the
gut and caul together, and it may happen that in this
cafe the gut enters into, and the caul remains out of the
belly without being able to return on account of fome
adhefions which reftrain it; the patients ought not there-
fore to go without the trufs, as it is neceffary to pre-
vent the coming forth of the gut. Art then directs to
make a trufs that fhall clofe the hole fo as to hinder
the gut from coming out, yet not over-comprefs the
caul, for fear of caufing fome alteration therein.
INCONVENIENCIES TO BE LAID TO THE AC-
COUNT OF THE PATIENTS. The two extremes of
being too thin or too fat are inconveniencies on the part
of the patients, which oppofe the ſtability of the trufs,
and make the ufe of it always difficult, unleſs the
furgeon and the patient, each on their part, give all
the attention neceffary.
In an extreme leannefs, the bones being bare and
uncovered, but for the fkin, and theſe bones themfelves
forming eminencies and pits, the furgeon the moſt
verfed in making of truffes, muft mifcarry, if he em-
ploy not all the attention neceffary to give them the
fhape proportioned to that of the bones; but the
tients, on their part, ought to apply all their care to
keep them in place, as we fhall fee in chap. XIII.
pa-
In an extreme of corpulency, the too great quantity
of fat gives the hips a difformity fo contrary to the
natural ſtate, that the turn of the trufs fhould alfo be
very different from what is affigned it in a moderate
corpulency. And it is very difficult for the trufs to be
E 2
capable

[ 28 ]
capable of producing the effect expected from it, if
the patient herfelf favour not the intentions, and be not
careful to tighten it from time to time.
THE INCONVENIENCIES TO BE MET WITH ON
the
part of the patients, in Ruptures of the navel,
equally arife from the difformity of the belly, which is
more or less prominent, more or lefs thin, tight, or foft,
according to the greater or lefs degree of relaxation un-
dergone by the fkin, the fat and the mufcles in the
ftate of pregnancy, and of confequence the truffes for
thefe forts of Ruptures fhould be as differently con-
ftructed as the fhapes of bellies differ; for if the belly
terminate in a point towards the navel, the point of
compreffion eafily varies; if the navel be found lower
than the hips, the point of fupport or bearing is very
difficult to find; if the belly be more raiſed above the
navel than below it, the trufs tends to fall down below
the Rupture: All thefe differences call for different de-
grees of attention in the make of the truffes, none of
which, in this cafe, are capable of remaining in place,
unless that fort of my invention, of which I fhall fpeak
at the clofe of this chapter.
The more the trufs is apt to vary or fhift, the greater
degree of conftancy the patien fhould put on, to give
it the time to fix or fettle, and the furgeon, on his part,
endeavour to mould and fit it to the body of the patient
by degrees. In perfons extremely thin, we muft not
at firft tighten it to the higheſt pitch, the ufe of it
would then prove difcouraging and infupportable. The
parts, that ferve for feat to it muft infenfibly be made-
accuſtomed to its impreffions. In perfons. extremely
fat, the fame precautions muſt be uſed, becaufe the
fat can fubfide but by little and little under the trufs;
and fo it must be tightened but in proportion as it finks
in

[ 29 ]
in the thickness of the fat, without which it would become
too wide; thefe degrees of attention fhould then be
divided between the patient and the furgeon, till the
trufs has acquired a firm and invariable fituation. The
patients ought not to put off their trufs night and day,
till they are become accuſtomed to it. When the Rup-
tures have a great facility of coming out, as thofe con-
fifting of the caul have, every motion must be avoided
capable of determining the parts to come out, as vio-
lent ftriding, raifing the arms too high, and ftrong
fneezing: Finally, if the belly be bound, the patient
is obliged to ftrain much at ftool, and then it is proper
to procure an open belly by means of glyfters, or mak-
ing her fwallow half an ounce of lenitive electuary; if
notwithſtanding this, fhe be obliged to ftrain in the
leaft at ftool, let her reft her hand on the upper part
of the plate of her trufs, to prevent its afcending; and
this fhe is to do every time fhe fneezes or coughs or blows
her nofe; becauſe in theſe great motions the cuſhion of
the trufs is always determined or apt to afcend, and
then the hole it fhould ftop, is found a little uncover-
ed:
: By all this attention the parts will be gradually
accuſtomed to remain in the belly and acquire the ha-
bitude of not coming out, and the patients being abed,
in that cafe, they may pull off their trufs at night.
INCONVENIENCIES ON THE PART OF THE TRUSS.
We have juft faid that truffes can only gradually
mould themſelves to the bodies of the patients; they
are therefore of themfelves fubject to fome variation,
which muft neceffarily be remedied, to procure them
the utmoft degree of perfection; this perfection confifts,
as I have already faid, in the juft turn or rounding,
and exactly proportioned to the parts on which the
trufs

[ 30 ]
trufs is to be applied; for if it bears falfe, I mean,
if it bears on one part more than on another of the cir-
cumference of the belly, it cannot fail to gall, and the
point of compreffion be vicious and irregular; befides,
this defect makes it fubject to break in the part where is
the void or hollow; this defect is not always perceivable
at the very first time it is applied on, becauſe the or-
namenting, which is new and ftriking conceals its hol-
lows, but after being wore for fome days, the orna-
menting flattens; the fat, which is under the girdle,
fubfides; the leather, which forms the reft of the
circle, lengthens, and the trufs no longer compreffes
in any part of the circumference of the hips, unlefs in
the part which bears falfe. This inconvenience, which
is confiderable, is eafily amended, when we come to
be well acquainted with the manner of ordering thefe
machines: But a defect common to all the truffes made
for the Ruptures of the groin, and thofe of the bend-
ings of the thighs, and for which no one before myſelf
was ever able to find a remedy, is that they bear lefs
on the opening, which they ought to ftop, when one
happens to fit very low, becauſe then the belly finks;
this defect ftands corrected in the truffes of my manner,
to for confiderable a degree of perfection, that the pa-
tients are always furprized at not finding that incon-
venience, after having ufed the common truffes. And
therefore it was found neceffary to order the patients to
fit always high; but that is not poffible to be done every
where, unlefs one was always to have her feat carried
about with her, a thing highly inconvenient in a thou-
fand inftances; this defect is befides to be met with on
many other occafions, as in perfons very thin, when
abed; the cushion of the common trufs never bears on
the hole in fat perfons, in thofe of a reaſonable good
plight

[ 31 ]
plight of body, in like manner as in the thin; the fame
thing is alfo to be found, when they fneeze, blow
their nofe, cough, or are at ftool, and all he means
propofed to remedy this inconvenience, are as embar-
raffing as ufelefs, and in no manner come up to the
fimplicity of my trufs, in which there is found none of
thefe inconveniencies. Here is the proper place to
mention a difcovery, which my application to be of
fervice to perfons of my own fex, put me upon, in
reflecting on the lot of many women, whofe delicacy
of conftitution incapacitates them to go their full time
with child.
The moſt common caufe of mifcarriages is the
fame with that of Ruptures, it arifes from the relaxa-
tion of all the parts of the belly, both internal and ex-
ternal, and takes rife in the too great quantity of fero-
fities, which water the ligaments, which ought to keep
in place each of the parts contained in the belly. Now
the ligaments of the womb are ſo often relaxed by the
ferofities abounding in the blood, that that part remain-
ing unfupported, on account of the weaknefs of its
ligaments, it is impoffible the child fhould come to
its full time, becauſe it determines by its weight the
womb to remain in the loweft parts of the belly; and
not finding there fufficient room to grow, dies thro
the conſtraint it undergoes.
The means I have found to remedy thefe troublefome
diforders are as fimple as the following reafoning,
which I ufe to prove its efficacy. The ligaments of
the womb, and the mufcles of the lower belly being
too much relaxed, the growth of the child is prevented,
becauſe the womb tends too much towards the loweſt
part of the belly, where it is ftraitened for room, the
muſcles of the belly not being ſtrong enough to fupport
it

[ 32 ]
it forwards: If by the means of a trufs fufficient to ba-
lance the relaxation of thefe parts, that defect may be
fupplied, it is not to be doubted but that women fub-
ject to mifcarriages will happily go their full time:
The experience of upwards a hundred women, to
whom I have given this relief, proves it; having often
mifcarried, before the ufe of my trufs.
It is made of a flexible matter without any iron-
work at all, but ftrong enough to refift the weight of the
belly. It ſtretches in proportion to the growth of the
child; nothing is more eafy to apply and to wear;
it puts pregnant women, the moft fubject to mifcar-
riages, in a condition to walk and go by any carriages;
and it becomes fo commodious to them, by giving
a degree of firmnefs to the whole body, that many wo-
men ufe it out of the time of their pregnancy. But it
proves, befides, highly ufeful to women, whofe belly,
being very heavy and pendulous, hinders them to walk,
and to perfons to whom it is not poffible to apply the
common truffes of the navel.
CHAP. XII.
A method for taking the meafures of the
truffes, neceffary for perfons afflicted
with ruptures.
PE
ERSONS, who would incline to procure truffes
for themſelves, not always living near great towns,
where they are commonly made, have need of in-
ftructions to enable them to fend their exact meaſure,
I imagine it to be uſeful for fuch, to put them on the
eafy

[ 33 ]
eafy method of taking exactly the dimenfions of their
own bodies, and to infift more particularly on fome
circumftances they ought to obferve in relation to the
different fpecies of Ruptures."
FIRST, The patient fhould give a particular detail, in
an inftructive memorial, of her conftitution and age;
whether fhe be maid or married woman; the date of
her Rupture; and whether the place fhe lives in be
moift and marshy, or dry.
SECONDLY, She fhould, as much as may be, re-
collect the caufe, which has determined or occafioned
her Rupture, whether a blow, a fall, a fit of coughing,
a fudden effort or ftraining, or child-bearing.
THIRDLY, She muft determine nearly the fize of
the Rupture, and on what fide it lies.
FOURTHLY, She muft fet down precifely its place,
if in the groin or bending of the thigh.
FIFTHLY, Whether or no it re-enters, and whether,
in re-entring, it returns more difficultly in a ſtanding
than lying poſture.
SIXTHLY, When the Rupture is in the bending of
the groin, it is neceffary to diftinguifh whether it de-
fcends as low as the fide of the natural parts.
SEVENTHLY, If it is in the bending of the thigh,
it is neceffary to ſpecify, whether it be round or long.
EIGHTHLY, If there are two Ruptures, it is necef-
fary to hint which is the biggeft.
NINTHLY, It must be remarked, whether the
perfon be fat or thin, or only in a tolerable good
plight of body.
TENTHLY, It muſt be hinted, whether the patient
has one hip bigger than the other, which is a very com-
mon cafe; or if there be any other deformity, it is ne-
F
ceffary

[ 34 ]
eeffary not to fail defcribing it, and fetting down its
place with ink upon the meafure.
To this memorial the patient may add the meaſure
of her body, taken with a flip of paper of a proper
length. Whether the Rupture be fingle or double, in
the groin, or bending of the thigh, it is fufficient to lay
the middle of the flip of paper immediately over the
part where the clift of the breech ends, and to join
the two ends of the paper above the place where the
top of the natural parts re-unite.
If the rupture be in the navel, in the fame manner
will be taken the fize of the belly, by laying the middle
of the flip of paper on the part of the back which an-
fwers to thofe of the fides, which are between the ribs
and the bones of the hips, and by joining the two ends
of the paper over-against the part where the middle
of the paper has been laid behind the back; if the Rup-
ture be precifely at the meeting of the two ends of the
flip of paper, that muft needs be fpecified in the me-
morial; if not, it is neceffary to mark exactly at what
diftance from this meeting of the two ends of the flip
the Rupture lies, whether a quarter of an inch, half an
inch, or one or two inches above or below.
Çare alfo may be taken to fpecify in the memorial,
1mo. The part of the navel the Rupture occupies,
either the middle or its circumference, either lies above
or below it, or to one fide. 2do, If it is of an old or
recent ftanding. 3tio, Its fize. 4to, Its fhape. 5to,
If it re-enters or not. 6to, If the navel be higher or
lower than the bone of the hips. 7mo, If the belly be
hard or very foft; 'tis moreover neceffary to know,
whether the patient has had children, and how many.
All

[ 35 ]
All thofe particulars are very neceffary to be men-
tioned, in order to execute with care the truffes proper
in each of theſe circumftances, and render them as com-
modious as ufeful, when the patients on their part fhall
ufe the neceffary care in their juft application: On this
head I am to prefcribe fome rules in the following chap-
ter.
CHAP.
XIII.
On the manner of putting on the truf-
fes; neceffary precautions to be ob-
ferved, previous to the laying or adjust-
ing them.
HE trufs would become abfolutely unferviceable,
TH
if improperly adjuſted. It is, therefore, of im-
portance to the patients, to have rules to follow for
their juft application. Thefe rules are the fame for
perfons of what age foever, even for children at the
breaft.
The ufe of the trufs is to ftop the hole, at which the
rupture comes out, in order to prevent its coming
out; we muſt for that purpoſe begin with reducing it
back into the belly.
The Ruptures, unaccompanied with fymptoms, re-
enter with facility enough of themfelves, when the
patients are abed; of confequence, the morning, at the
hour of waking, is the time to apply the trufs. To
do it with eafe, of what nature foever, or in what part
foever the Rupture be, we pafs the girdle below the
F 2
back,

[36]
back, and approach with one hand the cufhion of the
trufs over-againft the part of the Rupture; with the
other we examine whether any thing remains out of the
belly; afterwards, laying hold with this laft hand on the
girdle of the trufs, we pull it to ourſelves to-
wards the cufhion, whilft with the other we fix the
cufhion directly upon the part where the Rupture ap-
peared before reduction: We at the fame time faften.
the girdle to the hook, which is on the outfide of the
cufhion.
To procure the proper pofition to the trufs, the
lower border of the girdle fhould be behind the back,
immediately above the clift of the breech. When we
are fure it has gained its due pofition, we muſt then
tighten it fufficiently: For this purpoſe we lay hold on
the girdle with one hand, at the part where it joins to
the iron-work of the trufs, and we pull it fucceffively
by flipping the hand as far as to its extremity; while
with the other hand we hold the cuſhion fteady on the
part where it ſhould be placed; if it were not fup-
ported, it would fhift to one fide of the thigh, and no
longer be found on the hole of the Rupture. It is not
neceffary that the trufs be too flack, and neither muſt
it be too tight. You will obferve to tighten it from
time to time; fat people fhould particularly mind this,
becauſe the longer they ufe the trufs, the fat finks un-
der the girdle, which of confequence becomes too flack;
which is the reafon that the over-flackening of the girdle
is charged on its lengthening: And it alſo happens that
the girdle of the trufs is found hid by the pads which the
fat forms both above and below, when the fat has
been entirely flattened under the girdle by its reiterated
compreffions.
Almoft

[ 37 ]
Almoſt all the patients have the cuftom of placing
the cufhion of their trufs too low, efpecially fuch whofe
Ruptures fall down pretty low, without confidering,
that the buſineſs is only to ftop the hole, to prevent
the parts from coming out; for when the cuſhion is
placed fo low, the hole remaining unftopped, the Rup-
ture comes out above the cufhion of the trufs.
When the patients are thin, the trufs fails not to af-
cend, eſpecially when they are abed: In this cafe we
muft ufe a ſmall ftrap, which is fixed to the trufs; we
pafs it under the thigh, and faften it to the iron-hook,
which ferves to fix the girdle; but we muft obferve, that
it ought to be put under the leather of the girdle, as
otherwiſe it would be always apt to loofen.
When there is a neceffity of wearing the trufs of
nights, we must take care to adjuft or put it in order
before we get out of bed of a morning, and as the mo-
tions we give ourſelves lower or raiſe it behind, we
muft not fail replacing it in its due pofition, as other-
wife the cuſhion would not bear exactly upon the hole.
With refpect to children who are not cleanly, we
muft be careful of fhifting their truffes every day, to
prevent the ordure from heating or fretting them.
In plump fat children, the girdle fhould behind be
a good finger's breadth above the clift of the breech;
in the thin, it fhould immediately touch the clift, or
even be a little lower.
We muſt be ever cautious in fhifting their trufs,
that the Rupture does not fall out again; for this pur-
pofe, we muſt have ready at hand that which is to
replace the other, and lay the finger on the hole, till the
fecond trufs is adjuſted.
CHAP.

[ 38 ]
CHAP. XIV.
Of the radical cure of Ruptures.
Br
Y radical cure we mean fuch as removes a difeafe
to its very root. The radical cure of Ruptures
is, therefore, that, by means of which we may cure
thefe diforders, without apprehenfion of any return. Is
this poffible? 'Tis what may be eafily proved.
But as I fhould be obliged to tranfcribe word for
word what Mr. Arnaud has at large to fo good purpoſe
writ on this fubject, fuch as would fatisfy themfelves
of this truth may confult the book of that author, chap.
xiv. fect. ii. parti.
All I can fay to prevail on the patients not to fuf-
fer themſelves to be difcouraged, as commonly thoſe
are, who are afflicted with thefe diforders, is, that there
are none for which there is a greater variety of reme-
dies known. The only queftion is to know how to ap-
propriate them to the conftitutions of the patients, their
age, their fex, the climates they inhabit, and to know
how to diftinguish the fpecies of Ruptures which are
curable from thofe which are incurable. 'Tis with
thefe infirmities as with all the others; fuch a one can-
not be cured by a remedy, which ten or a fcore others
have found the good effects of, becauſe the circumftances
differ. This is the reafon, why the remedies of the
good women do fometimes much good, and very often
a great deal of harm.
CHAP

[ 39 ]
CHAP. XV.
Of the Ruptures of the womb, otherwife
called the inverfion of the womb, re-
laxation of the womb, falling of the
womb; the relaxation and inverfion of
the vagina.
WHAT THE
WOMB IS.
THE womb is the principal or-
gan of generation, it fituated
between the bladder and ftreight gut. The womb is
of the fhape of a pocket-flafk; it is divided into two
parts; the one called the neck, the other the body of
the womb: Its neck is terminated by an opening, cal-
ed the orifice; it anfwers to the bottom of the vagina;
its body is the largeſt part; it is feated in the lower bel-
ly beyond the vagina, fo that we can only reach to the
neck of the womb, when we introduce the finger into
the part.
The womb is hollow within, and kept in its place
by four ligaments; two called the broad, and two the
round.
'Tis thefe ligaments we are principally to regard, in
order to form a juft idea of the Ruptures of the womb:
Thefe ligaments are capable of an extraordinary degree
of extenfion; otherwife the womb could not place
itſelf in the belly, by ftretching in the time of preg-
nancy; but would continue in its natural place, and be
there ftraitned and confined.
The

[ 40 ]
The broad ligaments cover all the exterior bottom
of the womb. They are there firmly attached; they
rife on each fide, and ftretch, by enlarging, to proceed
to faften on the parts which cover the hip bones inter-
nally: 'Tis a fort of very ftrong membrane.
The round ligaments are fo called from their round
figure like a cord; they are as big as the quill of a
raven; of a nature refembling that of the broad
ligaments; for they are properly only a divifion of
them; they come out of the belly at the holes which
are in the groin, by which the Ruptures of the groin
happen; they proceed to faften themſelves to the bone
of the thigh. The womb is kept in place by thefe four
ligaments.
The vagina is a canal, confifting of a very thick
membrane, capable of dilating and contracting; this
canal ferves for an emunctory or drain to the flowings
from the womb.
INVERSION OF THE WOMB. The womb being the
principal organ of generation, it fometimes happens,
that in child bearing the infide of this comes out at its
opening or orifice, in the manner as turning a purfe in-
fide out; this diforder has, befides, other caufes; but
thefe very rare. The being over-fat is one in particular.
This diftemper is fo diftinctly handled in Mr. Arnaud's
book, chap xxiv. fect. ii. p. 1. that I thither refer
fuch as would be further informed about it: I could
only copy this author, and that would be to difguft
him.
RELAXATION OF THE WOMB. Tho' the term re
laxation of the womb be improper, I fhall however
make uſe of it, becauſe all authors do fo: For it is
not the womb that relaxes; 'tis its ligaments, which
lengthen-

[ 41 ]
lengthening, fuffer the womb to quit its natural place,
and thus to fall down more or lefs into the vagina.
When the ligaments are only relaxed to a certain
pitch, this is what is properly called the relaxation of
the womb, becauſe it is come down lower than the
place it naturally occupies, but comes not out of the
vagina.
FALLING OF THE WOMB. When the womb comes
out at the vagina, then that fpecies of Rupture is called
the falling of the womb: This diforder may be more
or lefs confiderable, according as it comes out more or
lefs; there are fome, in whom, for want of mind-
ing it, it hangs down as low as the middle of the thighs,
and then it grows in bigness to a pitch as fometimes to
become as big as the head of a child.
The vagina re-
RELAXATION OF THE VAGINA.
laxes too, and that either in part or in whole; if in part
only, the diforder is called, the relaxation of the vagina;
if in whole, the inverfion of the vagina; then it forms an
eminence, which comes out of the natural parts.
CAUSES. The general and particular caufes of thefe
diforders are the fame with thofe contributing to form
the other Ruptures; of confequence young women
are fubject to them. 'Tis true they are not fo much ex-
pofed to them, as the married; but there are fome in
whom the womb falls, and the vagina relaxes to the
higheſt pitch.
Married women are more fubject to them, becaufe
in pregnancy the ligaments of the womb are extremely
lengthened, by the weight of the child it contains: Al-
fo thoſe who are not tender enough of themfelves, after
delivery, by keeping at reft and not ſtirring, are more
fubject to thefe infirmities than others,
G
SYMP-

[ 42 ]
SYMPTOMS. The fymptoms of thefe diforders
differ according to the cafe. When there is only a re-
laxation of the womb, the patients feel fome pain to-
wards the loins, and at the top of the thighs. They walk
with lefs facility, and are never better than when fitting,
or abed.
When the womb comes out a little at the vagina,
befides what I have juft faid, the patient has a defire
to make water often, or a difficulty in making
dmow to giflat
it.
When the womb is in whole come out, it is expofed
to the rubbing of the thighs, and to receive the impref-
fions of the urine, which runs upon it in making wa-
ter, which caufes it to fmart, occafions painful excori-
ations, and confiderable ulcers. ddf an gid an on
Theſe fymptoms are followed by thofe which attack
the womb itfelf; it is inflated and hardened, and then it
is very difficult to effect its return.
The fymptoms which accompany the relaxation of
the vagina and its inverfion, are not fo confiderable, un-
lefs when it carries along with it the womb; for then
the patients feel the fame pains in the loins and thighs
as in the falling of the womb. But, in the fimple re-
laxation of the vagina, there is no pain.
DIAGNOSTIC SIGNS. Thefe diforders are known
by the fymptoms. I have juft mentioned, excepting the
fimple relaxation of the vagina, which can only be
known by a fort of fwelling or inflation, felt at its en-
trance.
PROGNOSTIC SIGNS. In thefe four diforders, the
relaxation and inverfion of the vagina are the moſt
difficult to cure, tho' without any danger to life; the
relaxation, or falling of the womb, juft beginning,
-42
is

[43]
is eafily enough cured, when the diftemper is not of an
old ftanding: It even happens fometimes, that after
a new pregnancy, if the patient be tender of her felf in
her lying-in, and keep her bed clofe, fhe is cured with-
out the aid of any remedies.
But the grand fymptoms to which the womb is fub-
ject, when it comes out entirely, are fufficient to mani-
felt the danger, and the difficulty there is to cure the
patients.
CURE. The relaxations and falling of the womb,
the relaxations and inverfions of the vagina, are fufcep-
tible, as the other fpecies of Ruptures, of a twofold
cure, the radical and the palliative.
I fhall not engage in the detail of the first, that
would carry me too far, and I could not abridge it,
without omitting things too neceffary; it may be feen
in chap. xxv and xxvi. fect. ii. P. I. of Mr. Ar-
naud's work.
The palliative cure, which is the moſt uſed, con-
fifts in keeping in place the relaxed or difplaced parts
by the means of peffaries.
Peffaries are inftruments which ferve to keep the
womb and the vagina in place, and to hinder their de
parting too much from their natural ftate. The com-
mon ufe of thefe machines, which are made in different
forms and fhapes, according to the notions of him who
applies them, or the nature of the malady, has inconve-
niencies fo confiderable, that the advantage derived from
them is worfe than the difeafe itself; befides, that we
are obliged to introduce them into the part with violence,
and keep them there without fcarce ever removing them;
thefe peffaries are always made either of matters fubject to
corruption, as cork and wood; or incorruptible, as
G 2
gold

[ ]
44]
44 gold or ivory, which hurt the womb or the vagina;
this caufes a flow of matter extremely fetid, with
which the patients themfelves are always offended, and
often thoſe who approach them.
Thefe reafons have put Mr. Arnaud on contriving a
fort of peffaries, with all the advantages we can defire,
and without any of the inconveniencies of the others. It
is the only peffary I would advife patients to ufe, and
whofe defcription is very clearly given in that author's
book chap. xxvii, fect. ii. P. I.
CHAP. XVI.
Of the relaxation of the fundament.
WHAT THE FUN-
DAMENT IS.
TH
HE fundament is the ex-
tremity of the guts, which
terminate in a round opening, with a power to
open and cloſe. Its ufe is to allow the difcharge of
the excrements and wind out of the belly.
The extremity of the gut, which ends at the funda-
ment, is fometimes relaxed; and comes out by turning
itfelf, juft like the finger of a glove, when we pull the
glove by turning it.
This malady happens very commonly to children;
women are alfo fubject to it fometimes.
CAUSES. The cauſe of this relaxation confifts for the
moft part
in the too great quantity of ferofities, which
water this part; the palfy of the mufcles of the funda-
ment contributes fometimes too.
But ftrainings determine this diftemper; as crying in
children, conftipation in perfons in years, and the
effort exerted in child-bearing.
SYMP-

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SYMPTOMS. It is rare that this malady is accom
panied with untoward fymptoms; being fo incommodi-
ous, people never put off the looking out for the proper
aid. But were the procuring the return of the gut
neglected, an inflammation would be formed in it, and
a gangrene might feize upon it, which would expofe
the patients to a very great risk.
DIAGNOSTIC SIGNS. This distemper is known by
the eminence or lengthening formed by the gut of the
fundament.
PROGNOSTIC SIGNS. According to what we have
juft feen of the fymptoms of this diftemper, it is eaſy
to judge, that it is dangerous, when neglected.
CURE. We remedy this diftemper by procuring the
return of the gut, and retaining it, when returned ;
or by employing the remedies proper to fortify and
ftrengthen it. All theſe means are recited in chap.
xxviii. of Mr. Arnaud's book.
IT
CHAP. XVII.
of falfe hernia's.
T now remains to fpeak of falfe hernia's. Thefe
diftempers are fo rare in the fex, that I might well
paſs them over in filence; yet as I have feen fome inftan-
ces, and that they were taken for Ruptures; I think it
not from the purpoſe to give a general notion of them.
WHAT A FALSE HERNIA IS. We underſtand by
falfe hernias, tumours that happen in the parts where
the true Ruptures are formed; they are called falfe, be-
cauſe they impofe upon us, by giving room to think
them true Ruptures, unless we carefully confider them.
DIF-

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DIFFERENCES. There are two fpecies of them;
fome confift of water; theſe are called hydroceles;
others, of flesh, or thick, hard, and vifcid humours;
thefe are called extraneous bodies.
The hydroceles fometimes fhew themfelves in the
bendings of the thighs, in the groin, and in the lips of
the natural parts; there may be formed of them two in
the navel.
The extraneous bodies are formed at the entrance of
the vagina, and in its cavity; fometimes alfo they are
attached to the neck of the womb.
DIAGNOSTIC SIGNS.
The falfe hernias are known
by the impoffibility there is of procuring their return;
to the difference of true Ruptures, which return eafily
to the belly, or at leaft have returned before they have
got adhefions, or are become of enormous bulk; but
hydroceles, how fmall and recent foever they be, ne-
ver return.
It is the fame as to extraneous bodies, thefe return not;
but they are diftinguifhed from hydroceles, as they are
quite apart and feparate from the parts to which they
are attached; hydroceles, on the contrary, unite with
the parts where they grow.
PROGNOSTIC SIGNS. We may fay, that thefe di-
ftempers are attended with no uneafinefs; they are rather
incommodious than dangerous.
CURE. Hydroceles are cured by tapping, or dif-
cuffing them by refolvents; they are, befides, cured
by compreffions, by the means of fome proper bandages
or truffes.
As to extraneous bodies, thefe are deftroyed by liga-
ture or incifion.
FINI S