428 OPEEATIONS ON THE DIGESTIVE APPARATUS. 



The object of all treatment is, of course, the reduction and re- 

 tention of the hernia, but the means of doing so are various. 

 They are mainly included under four heads. The first method is 

 by bandages ; the second, by external or topical applications ; 

 the third, by surgical operations for the constriction of the tumor; 

 and the fourth, such special treatment as may be required to meet 

 coinjMcations. 



1st. Bandages. — The bandage of retention is essentially a belt 

 buckled around the body, by which a pad is kept over the open- 

 ing of the umbUicus to prevent the escape of the abdominal con- 

 tents, and temporarily perform their office in the subcutaneous 

 hernial sac. It is designed to aid in the mechanical closing of the 

 umbilical opening until that takes place by the process of physio- 

 logical change in the sac and its borders. 



The forms of bandage in use are many and various, among which 

 Peuch and Toussaint name four principal Mnds. A most import- 

 ant requisite in all of them is that while they possess the solidity 

 and fixity necessary to retata the reduced hernia in place, they 

 shall cause the minimum amount of discomfort to the patient. 



The bandage of Marlot, according to Zundel, is the one which 

 best fulfills the three conditions of solidity, fixity and elasticity. 

 It consists of a kind of padded saddle, with straps at its four 

 corners, buckling on two belts, the anterior or pectoral, which sur- 

 rounds the chest like a girth, and the posterior or ventral, which 

 presses the retaining pad against the umbUicy. This pad is a 

 wide hair cushion of a moderate thickness, kept in place and pre- 

 vented from sUpping back by a longitudinal girth connecting the 

 pectoral and the ventral belts. 



The bandage of Massicra is much recommended in Italy. This 

 also is a small saddle with two wide girths passing under the 

 thorax, and pressing against the sternum and the epigastric re- 

 gion, with a steel band corresponding at its posterior extremity 

 with the umbilical ring, forming a plate padded with a hair cushion. 

 The apparatus of Strauss, used in Germany, is made somewhat 

 on the same principle, but is reinforced by a kind of breeches 

 which prevents it from sHpping backward. 



The length of time necessary for a patient to wear a bandage 

 will vary with the dimensions of the hernia — from one to three 

 months, according to Lafosse, being required to obtain a radical 

 cure. Marlot claims that an average of thirty-two days is all that 



