When debilitated, all strains and exertions should be care fully avoided until the health is built up, and the relaxation overcome.
Treatment. The palliative treatment of hernia is by reduction and retention. Reduction consists in returning the protruding intestine to its proper place through the opening by which it escaped. This is accomplished either by manipulation or by a surgical operation. Retention is effected by wearing a mechanical appliance called a truss.
As soon as the tumor protrudes, or the "bowel comes down," the patient should assume the recumbent posture, with his shoulders and feet elevated. The patient or an attendant should grasp the hernia, and with gentle, but gradually increasing pressure upon the tumor attempt to replace it. At the same time let the patient knead the bowels upward by pressing upon the integument, so that the intestine may, as far as possible, be pushed away from the point of protrusion. Sometimes the contraction of the muscular fibres at a point where the hernia makes its exit is so great that the tumor cannot be replaced. In this case the system should be relaxed with lobelia (not given in doses to produce vomiting), and as soon as the patient is thoroughly under its influence, the manipulations may be resumed. When there is any difficulty experienced in putting back the "breach," or rupture, professional assistance should be promptly summoned. After the reduction of the rupture, a truss should be properly adapted, applied, and constantly worn, to prevent the protrusion of the intestine.
Of the latter instruments there are several hundred varieties for sale throughout the country. With the exception of about one-half dozen forms, which embody the true principles of a proper truss, they are, without exception, harmful. Unless proper support be given to the walls of the abdomen, and that without constant pressure, a truss does harm; then, too, the shape of the pad must be such as to avoid pressure where it is not required; otherwise, as in the case where a small ring is worn upon a finger, there is a gradual loss of strength and a depression formed in the healthy tissue, which can be plainly seen and felt. In this way trusses do harm, and such evil consequences may follow the improper application of a good truss.
Surgical Treatment. When the hernia has become strangulated and cannot be returned by manipulation, a surgical operation is necessary. Whenever the necessity for such a procedure is apparent, it should be performed immediately, for the greater the delay the greater the liability to fatal results. The operation consists in cutting down upon the strangulated bowel, thus relieving it of its constriction and facilitating its replacement. It is a delicate operation, and must be skillfully performed. After the operation, the patient requires appropriate hygienic treatment.
The Radical Cure. A small percentage of cures will follow the proper use of a good truss, and the advertisements of the so-called rupture cures are founded upon such cases. These impostors pretend that the use of some vaunted salve, ointment, or styptic lotion, applied on the outside, will heal and cure the deep-seated separation of the muscular fibres. The truss in these cases is the curative means in the small number that are relieved, and for it but few dollars should be charged instead of the exorbitant prices demanded by these impostors.
Improvements in surgery in this age of wonders, have kept apace with the advances in electricity and other branches of science. Diseases and deformities which only a few years ago were considered incurable are now overcome and cured with certainty and without risk or suffering. Especially is this true with reference to hernia or rupture.
Our specialists have devoted much attention to the radical cure of rupture, or breach, with the most gratifying results. Formerly we employed and advocated the use of the injection treatment only. This method was tested and brought to a most efficient and practical stage, so that we now apply it in the treatment of over eighty per cent. of the cases that are presented at our Institution. This plan of cure, as used by us, is a great advance over that of any similar one in use, throughout the country. Our fluid is much more safe in its effects, never gives rise to the troublesome abscesses and inflammation that is common to the use of the injection fluids that have been advised on the Heatonian method. The fluid we use is a bland and healing agent, which produces an exudation behind the cords that surround the inguinal rings, and forms a well defined truss pad of moderate size in such position that the rupture cannot pass by it and appear externally. It causes also an adhesive inflammation limited to the hernial sac, that completely closes it.