The Opercular Method for the Cure of Hernia.

A. SCHREIBER, M. D., WAUMANDEE, WIS.

It is conceded by most surgeons that the radical operation for hernia is the only course that should be advised. On the other hand the absolute horror of operations in general, entertained by the laity, prevents at least eighty per cent of the afflicted from seeking relief from the surgeon; consequently the truss manufacturer reaps the benefit.

The following procedure seems to me to eliminate the objectionable features of knife, chloroform and truss, bringing the patient to the physician, however, for relief and cure. This method includes the treatment of direct, indirect, femoral, inguinal and umbilical hernias. The operation requires no particular skill and can be performed in the office. The results were absolute in every one of my cases.

The method is to make use of the material which nature amply provides, by invaginating the integument into a cul de sac and plugging up, as it were, the internal ring with the fundus of this cul de sac, and retaining this plug in position with the puckering ligature. Surgical asepsis is necessary, no matter how simple the operation. As a local anesthetic, ethyl chloride is sufficient, although phenol may be applied in a circular manner at the seat of the prospective operation with a swab or brush, or cocaine in two per cent solution can be used.

The operation is performed with a surgeon's straight needle, threaded with a heavy strand of silk worm gut, silk or silver wire. Proceed by pinching up the integument with the thumb and fore finger of the left hand. Pass the needle through the elevated skin, and continue in this manner around a circle, forming a loop with the ligature.

After phenol is used, if applied in full strength, it should be neutralized with alcohol before it destroys the cuticle, as that would permit of adhesion at the puckered orifice of the cul de sac, which would interfere with replacing the tampon, besides the danger of infection would increase.

With the ligature in place, you proceed with your little finger, or with a lead pencil for children, to invaginate the integument enclosed within the circle, into a cul de sac pushing the excess into the canal, and into the internal ring. A little traction on the suture will bring the integument around the finger, so as to retain the internal cul de sac in position. Remove the finger and tampon the cavity, with absorbent cotton.

With a little more traction, tie the ligature to hold the tampon in place, and finish with a bow knot, so as to admit of retamponing when necessary. Apply a wet antiseptic dressing continuously until all the irritation is subdued. The truss the patient formerly wore, can be utilized, if necessary, to retain the dressing in place, and the patient can go about his business with little or no inconvenience.

The ligature can be introduced so as to make the cul de sac circular, oval or oblong. The cul de sac can be pushed through the ring and tamponed, so as to have the largest diameter of the fungus within the abdominal cavity, thus buttoning-holing the internal ring. The pressure of the abdominal contents would retain it in juxtaposition to the internal abdominal wall and perfect adhesions would follow.

With the most of these patients it is desirable that they have internal tonic treatment or medicine to antagonize toxins. I prescribe one-fourth of a grain of calcium sulphide four times a day and an elixir of iron, quinin and strychnin after each meal.

It seems that the results of this method cannot be other than the best. I have operated on but one case. The results were simply perfect. I believe they would be equally perfect in any number of cases. I used the silk worm gut for ligature.

In summing up this method it has the following cardinal points to recommend it: If does away with the knife, with chloroform and with the truss; any physician can perform it; it can be performed in the office; its simplicity will make it popular.

Ellingwood's Therapeutist, Vol. 3, 1909, was edited by Finley Ellingwood M.D.