PREVENTION, SYMPTOMS AND TREATMENT l2 ^ 



irritants, phlegmonous inflammation, peritonitis and death may 

 eventuate. 



Firing and cantharidal blistering about the skin of the hernial 

 protrusion is the simplest and safest ; or blistering with an ointment 

 of yellow chromate of potash (1-8) or of calcium dichromate 

 (1-8) on three occasions a week apart. Among the injections into 

 the subcutaneous tissue (at four points equidistant about the ring) 

 are concentrated sterile solution of common salt (3ii at each point), 

 or ten per cent, solution of zinc chloride (using THvii at each point). 

 Recently, melted paraffin has been injected about the ring to fill it up 

 and prevent hernia. 



Among the cruder surgical forms of treatment which have the 

 virtue of simplicity and avoid sepsis of the abdomen are those in 

 which clamps are placed on the skin. This is accomplished by 

 throwing the patient on his back and pulling the skin and hernial 

 sac upwards in a vertical direction. One must be sure, however, 

 that the hernial contents are not included. Then clamps are placed 

 on the neck of the skin pouch, as close to the belly wall as possible, 

 and tightly enough to produce adhesive inflammation of the sac 

 without causing necrosis and sloughing of the parts. The clamps 

 may be held in place by a ligature fastened to the skin. After a 

 number of days the clamp may be removed and if necessary re- 

 placed. 



Metal skewers are sometimes pushed through the subcutaneous 

 tissue on either side of the ring and held together over the hernial 

 protrusion by cords attached to their ends. Sepsis may thus be oc- 

 casioned, however. These methods aim at preventing hernia by 

 the adhesion of the peritoneal surfaces of the sac. In the aponeuro- 

 tic structure of the belly lies the chief strength of the wall. This 

 can only be taken advantage of by open operation and coaptation of 

 the aponeurotic margins. 



All methods in which reliance is placed upon adhesive inflam- 

 mation of the surfaces of the sac are merely palliative and un- 



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