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Jacob Dissinger Albright.

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venience experienced. Beyond the discomfort of the patient,
there is no undesired effect. After the effects of one injec-
tion have worn off, another may be given, no matter whether
it is in three days or two weeks. Instruct the patient to
report as soon as the soreness has disappeared, when you will
again treat him. No interference with the ultimate cure
will be experienced if the injections are given at longer inter-
vals than as indicated by the disappearance of the soreness,
but the period in which the cure will be effected will neces-
sarily be lengthened. Should sympathetic swelling occur in
either the cord or adjacent structures, no alarm need be felt.
Injury to the cord or vessels is impossible if directions for
introducing the needle are followed. If it should occur
through clumsy work at this point, and much swelling
occur, treat as you would inflammation anywhere. I have
never seen a case of this sort, but have heard of it through
other writers.

In the Female the same general rules apply, but invagi-
nation can scarcely be accomplished. In large herniae a
manipulation that approaches invagination can be prac-
ticed, but in the smaller cases this is impossible. Here the
round ligament is used as a guide for depth, and after grasp-
ing the integument with the forefinger and thumb of the
left hand, pass the needle through it from above downward
on a line with the body, so that after the needle has pierced
the tissues and passed through them, the point will be located
under the finger and thumb.

After the needle has been introduced, still elevating the
tissues, raise the syringe so that it will be at right angles to
the body, pointing directly downward. The injection should
always be made where the protrusion first appears, and the
needle should be introduced directly over this spot. This
point should be marked with a blue pencil while the patiert



120 HERNIA.

is standing, so as to easily locate it while lying down. The
round ligament can easily be located by its tough, cord-like
touch.

The injection should be made at about the same depth
as this ligament is felt. While women are not as easily
treated as men, the operation is not at all difficult, and if
properly injected, they will be cured in less time than a simi-
lar hernia in a man, as the hernial canal is usually smaller.
Flabby abdominal walls render a cure more difficult and
tedious.

After four to six injections have been made, or more
in large and long standing cases, and the hernia has not been
down during that time, and there is reason to suppose that
the treatment has progressed favorably, a test may be made.
Be sure to instruct the patient not to dare to make an effort
to test himself during the treatment, but insist that he fol-
low instructions in this particular explicitly. The manner
of making a test is similar to the diagnosis of hernia. The
first test should be made while the patient is lying down.
Remove the truss and instruct the patient to cough. If no
impulse is noted while in this position, the patient may rise
and the experiment be repeated. Always press your hand
firmly against the parts while the patient coughs for a test,
so that in case there should be a weakness present, the her-
nia would not descend and thus do considerable damage to
the adhesions which had formed. If no impulse is noticed
while patient coughs while standing, the treatment may be
discontinued temporarily, but the patient instructed to con-
tinue wearing his truss for a month or more, and report at
the end of that time. The night support may now be dis-
continued. After a month the patient is again tested, and if
no impulse is felt, the case may be discharged with direc-
tions to wear the truss for another month while at work, if
a laboring man, but to remove it while about the house or
when not at work. After that time it may be discarded
altogether. If the patient's occupation is of a light nature,



HERNIA. 121

the truss may be discarded entirely after wearing it a month
after the test.

In case an impulse is noticed when the test is made, the
treatment must be continued as before, and occasionally
tested until the desired results are obtained.

After a few injections are made, small nodules will be
noticed to be forming in the canal. This is as it should be,
and represents the new tissue formation which is taking
place and which is necessary to the closure of the canal. In
large herniae, where the canal is more distended and the
surface much larger, two injections may be given at one
visit, one nearer the outer margin of the ring, and the other
more toward the inside. Young and middle aged persons
make the best subjects, although persons well advanced in
years can be cured if sufficient time is allowed. Old per-
sons usually require larger doses than others on account of
their tissues not being as highly vascular and active in pro-
ducing the exudate as in younger persons. Infants and
children under five or six years of age are usually unsatis-
factory patients, as they cannot describe the degree of inflam-
mation present, they usually cry and struggle during the
treatment, which causes the hernia to descend, remove or
disturb the truss if not continually watched, and as a rule
cause more vexation than their parents are willing to pay
for. If you should accept children for treatment, do not fall
into a common error and treat them for half the usual fee, as
after a short experience you will regret it. If I should ever
undertake to cure a child of the age given, my charges would
be a certain fee per treatment and no promises made. Chil-
dren of the ages of eight to ten years are excellent subjects,
and are usually rapidly and perfectly cured.

In Double Hernia, each side may safely be treated at
each visit, the soreness resulting being no more than if only
one side is injected.

Some physicians advise the use of an anesthetic before
introducing the needle, usually cocaine, but this is entirely
unnecessary. The pubic tissues are not sensitive, and in



122 HERNIA.

persons with hernia are usually thinner than in sound per-
sons. Use a sharp needle and introduce quickly and none
will complain of the very slight pain caused by the prick of
the needle. Others recommend the addition of cocaine to
the fluid. This may be necessary with some fluids, but I
have never heard any one complain of more than a slight
burning, and not more than can easily be borne for a few
minutes. Again, the use of cocaine combined with the
fluid is not theoretically nor practically of value. Before the
cocaine could anesthetize the membrane, the irritants would
make their presence felt, as cocaine requires a short time
in which to act. If cocaine is ever used inside, it should be
injected a minute or two before the fluid. I have no use for
it and do not advise it. With either of the fluids given here
it is unnecessary. A hot water bag before and after injec-
tion, is also sometimes recommended. It is applied directly
over the seat of the hernia after the injection has been made,
and allowed to remain five or ten minutes.

SPECIAL DIRECTIONS.

Read Carefully.

In order that these directions may be fully and clearly
understood, a brief outline of the anatomy of hernia will be
given. A thorough familiarity with this subject is essential
for the correct diagnosis and proper treatment of hernia.

OBLIQUE INGUINAL HERNIA.

This variety of hernia is sometimes called Indirect or
External Oblique. In this variety the intestines escape from
the abdominal cavity at the internal ring, where the sper-
matic cord passes out of the abdomen, taking the same
course as the cord along the inguinal canal, through the ex-
ternal ring and into the scrotum. When a hernia passes
through the external ring it is termed a complete hernia, if
not, an incomplete. The external form of hernia is so called
because it passes, in its descent, to the outer side of, or



HERNIA.



123



external to the epigastric artery. The cord is always behind
the hernia.

DIRECT OR INTERNAL INGUINAL HERNIA.

In this variety the protrusion passes directly through
the abdominal walls and descends through the external ring
into the scrotum. It is called internal, because it passes, in
its descent, to the inner side of the epigastric artery.

In some cases this form of hernia breaks into the. ingui-
nal canal and passes down through it. In the majority of
cases, however, it passes directly through the tissues and
into the external ring. If a direct hernia passes into the
inguinal canal but does not pass through the external ring,
it is called an incomplete direct hernia. Direct hernia is not
near as frequently met with as the oblique form, the per-
centage being probably one in five or eight. The differen-
tial diagnosis between the two varieties can be made by the
location of the point at which protrusion is first noticed,
being more external in the oblique form.

The direction in which a direct hernia descends is
always more directly downward, or may even be slightly out-
ward from the point at which the protrusion is first noticed,
while in the oblique, it is always downward and inward
pointing toward the pubic bone. Bearing in mind the direc-
tion of the inguinal canal, the diagnosis can easily be made.
When the two forms exist in the same person, as I have
seen several times, the diagnosis is likely to be difficult,
unless this possibility is borne in mind.

Either of the other varieties of hernia are readily
recognized and no special reference need be made to them
here. A careful detailed study of hernia will materially
benefit any practitioner who wishes to make a success of the
injection method of treatment.



124 HERNIA.



Where to Deposit the Fluid.

In Oblique Hernia, invaginate the canal with the left
forefinger, as directed in the general directions, carrying the
end of the finger well up to the internal ring, where the
hernia escapes from the abdomen. Introduce the needle as
directed before, about half an inch below this point, and after
the needle has been passed through the tissues, direct its
point upward toward the internal ring. As the finger in the
canal is elevating the tissues, the needle can be turned in this
manner without touching any of the contents of the canal.
Deposit the fluid as close to the internal ring as possible,
rotating the needle somewhat during the expulsion of the
fluid, so as to distribute it well. When the internal ring can-
not positively be located, as is the case frequently in large
herniae, deposit the fluid well up in the canal, where the
protrusion first appears.

In Direct Hernia, if the breach in the abdominal wall
can be outlined, deposit the fluid, well distributed, in the tis-
sues just below this point. As no canal can be determined
in this form of hernia, it usually makes its first appearance
at the external ring, and when the location of the breach
cannot be determined, deposit the fluid just inside of the
external ring. More judgment is necessary to treat this
variety of hernia than any other, as no two cases are exactly
alike. Bear in mind the principles of the treatment ; to
cause adhesions between the tissues through which the in-
testines escape, and deposit the fluid accordingly.

In all cases, begin the treatment at the highest point that
shows weakness. If this rule is not followed, the lower
portion of the canal or course of the hernia will become
closed and cannot be invaginated, thus rendering further
treatment impossible. As the upper portion closes, make the
injections lower down.



HERNIA. 125

Femoral Hernia. The injection treatment of hernia
was first only advocated as a cure for Oblique or Direct
Hernia., but its well known principle has been successfully
applied to the treatment of Femoral Hernia, also. Accurate
instructions for treating this variety cannot easily be given,
as the characteristic features of different cases vary. Any-
one who has had experience in treating other forms, and
who will exercise judgment, will be able to treat these cases
by following the lines of the general principles of the method,
making the injections always close to the point at which the
protrusion first appears, and gradually closing the femoral
canal through which it descends. Retention, is of course,
essential.

Umbilical Hernia. In this form of hernia no canal
exists. A breach in the abdominal wall, in the vicinity of
the umbilicus, allowing the protrusion to escape. Sometimes
it burrows under the skin and descends to some extent. A
cure of this form of hernia necessarily implies an approxi-
mation and connection of the edges of the breach, a process
impossible without surgical interference. Some of these
cases can, however, be relieved to some extent, by the follow-
ing procedure : A hard rubber spring truss having a pad large
enough to suit the case, with a button large enough to afford
good retention, should be obtained. Injections should be
made, two or three at each visit, around the edges of the
breach, and repeated as in other forms of hernia. By this
method the skin and muscles which are often detached, can
again be united, and the opening which permits the hernia to
descend between them is thereby closed.

In these cases there is usually an abundance of loose,
flabby, skin and tissue, which often defeats all attempts to
improve the condition.

The operation of dividing the skin and bringing the
edges of the ruptured muscles into contact, and stitching
them together, is one that requires but little surgical ability,
and the results are usually such that will warrant it. A firm
support should always be worn.



126 HERNIA.



THE RAPID METHOD OF CURE.

By repeating injections as often as the sensitiveness of
the patient will allow, any form of inguinal hernia can be
cured in a comparatively short time, varying from one-
third to one-half the time required by the regular method.
The procedure is as follows :

The patient must be willing to desist from all work or
exercise for a period of from ten to twenty days, according
to the case, and for the greater part of the time must remain
in a reclining position.

Repeat the injections as often as the patient's condition
will allow, giving him to understand that he must expect
a considerable degree of soreness. The injections are usually
made every two or three days, and the truss must be worn
constantly, day and night. The pressure thus given will
keep the parts in contact and will thus cause a rapid closure
of the canal. Some cases will not allow an injection every
two days, on account of too much inflammation, and it
should only be repeated when the patient tells you that
although there is a considerable degree of soreness present,
he will be able to stand a little more. Beyond the discomfort
of the patient there will be no unpleasant features, and as in
the regular method, no danger.

After treatment has been thus continued for ten to
twenty days, according to the progress of the case, the patient
may resume moderate exercise, still wearing the truss, and
the treatment continued as may be necessary. After this
period of treatment, tests may be made, as in the other
method. Before making the tests, it is well to wait three
or four days without an injection, to allow the inflammation
to subside and the adhesions to become firm. Continue the
treatment as directed until no impulse is felt on coughing.
Preliminary tests may be made at any time while the patient
is lying down. The standing test is the one referred to as
deferred until the inflammation has subsided.



HERNIA. 127

After the treatment is discontinued, the patient should
wear the truss as directed in the regular method, and dis-
card gradually.

In persons in whom difficulty is experienced in retaining
the hernia, a week's treatment by this method will usually
result in success in this particular, when the treatment can be
completed by the regular method.

Careful attention to these directions will be productive
of but one result, a complete and permanent cure in all
curable cases. A little experience will make any physician
an adept in the application of the treatment, and will be
productive of the highest degree of success.

A WORD OF ASSURANCE.

If there is any one question asked more frequently by
physicians who are interested in this method of curing
hernia, than any other, it is this : Is there no danger of Per-
itonitis, Orchitis, Cellulitis, injuring the Epigastric Artery,
etc.? My answer is candidly and positively, "No, None
Whatever." Not a single unfavorable symptom has ever
occurred in my practice, nor has any been reported to me
by the many physicians who have used my fluids. The
reports of such accidents that are sometimes seen in medical
journals are the result either of an unsafe fluid or clumsy
operating. I have been treating hernia seven years, and
have not in a single instance been called to account for pro-
ducing more than a moderately severe degree of inflamma-
tion. As before mentioned, this will occur when too large
doses are injected, but I have never prescribed as much as
a piece of ice to relieve it. My only advice has been, "take
a rest if you feel like it, it will be all right in a day or two."

These strong inflammations always benefit the patient a
great deal, and calling attention to this will usually be suf-
,cient compensation to them for their temporary incon-
venience.



128 HERNIA.



OTHER INJECTION FLUIDS FOR HERNIA.



The great interest that is being manifested on all sides
in this successful method of treating hernia, naturally results
in a number of different compounds being employed as
agents to produce the irritation and inflammation necessary
to effect a cure, many of which are doubtless of value. A
number of the better known formulae will here be given.
These have been obtained from medical journals and from
physicians who originated them and used them in their prac-
tice. Such comments as suggest themselves are appended
thereto.

Dr. Souder's Formulae.

In a series of articles published by Dr. Souder, the fol-
lowing formulae are given.

Fluid No. i.

1^ Zinc Sulphate gr. ij .

Creasote TTt iij.

Fid. Ext. Hamamelis.

Glycerine aa TT\, xxx.

Mix. Inject 2 to 4 minims.

Fluid No. 2.

^ Fl. Ext. Quercus Alba ' .'. fl. § iv.

Reduce by heating to fl. § j .

Alcohol fl. I j.

Acid Carbolic Til ij .

Mix. Inject 1 to 3 minims. Repeat when reaction has
disappeared. This formula has been discarded as it causes
too much pain.



HERNIA. I29

Fluid No. 3.

1$ Guaiacol.

Beechwood Creasote aa 171. ij.

Zinc Sulphate gr. ij.

Fl. Ext. Hamamelis TIX xxx.

Glycerine ni xxx.

Mix. Inject 2 to 3 minims.

This fluid is the same as No. 1, with the addition of the
guaiacol.

It is the formula now used by the doctor, and the one
on which he depends in the majority of cases.

The Heaton Formula.

I£ Ext. Quercus Alba gr. xiv.

Fid. Ext. Quercus Alba fl. 5 j.

Morphia Sulphate gr. ij.

Mix and heat in a capsule over a sand bath until a
homogeneous solution is formed.

Dr. Heaton's formula is sometimes given in which four
grains of morphine sulphate are added to the above quan-
tity. The quantity injected varies from five to fifteen drops,
as may be required.

After Heaton came Warren, who employed this fluid.

I£ Fl. Ext. Quercus Alba % viij.

Reduce to § ij by heat.

Alcohol, 90 % 3 vi.

Ether Sulphuric 3 iv.

Morphine Sulphate gr. iv_

Mix. Inject 15 to 20 minims in small and recent her-
niae, and 25 to 50 minims in large or old herniae.

"This fluid will cause a marked reduction of pulse and
temperature, and it may be necessary to put a hot water bot-



I'30 HERNIA.

tie to the patient's feet. This reduction may last as long as
forty-eight hours and give a decided advantage in obtaining
a more local effect of the irritant." Dr. Souder used this
combination on six patients and all suffered intense pain for
days thereafter. The use of a fluid that causes such disas-
trous results is entirely unwarranted.

The Fidelity Fluid. I have on several occasions seen
this fluid stated to be Fluid Extract of Ergot. Any physi-
cian who has ever seen this fluid, could not possibly make
this assertion. It is no more ergot than tincture of green
soap. The following formula was given me by a physician
who obtained it from one of the operators of the company,
with the assurance that it is the correct formula. When
compounded, it makes a fluid identical in appearance and
odor, with the genuine.

I£ Acid Carbolic 95 %

Glycerine.

Alcohol aa p. e.

Tr. Iodine q. s. to color

to the color of sherry wine.

Dr. Walking's Fluid.

This fluid is one of those for which the formula is given
in such a manner that it cannot be prepared without further
instructions.

1^ Complex Salts of Aldehyde 30 %

Iodo-ethylate of Guaiacol 30 %

Sulpho-tannate of Zinc 20 %

Free Guaiacol 5 %

Beech wood Creasote 15 %

The following note follows the formula : "These rare
and expensive chemicals are separately prepared and then
combined in strict conformity with their respective affinities
and dosage, and dissolved in an antiseptic medium."



HERNIA. 131

Dr. Robinson's Fluid.

I> Acid Carbolic, 95 % fl. 3 ij.

Glycerine, C. P fl. 5 iv.

Tr. Iodine, U. S. P fl. 3 ij.

Potassium Permanganate 5 j .

Caramel gr. xv .

"Mix. First add the glycerine to the carbolic acid, after
which add the iodine and caramel, and then the potassium
salt in crystals. Allow it to stand for about three weeks,
shaking daily. At the end of this time it is ready for use.
Inject eight drops at a time."

In this formula two points that are neither pharma-
ceutically correct not therapeutically indicated, stand out so
prominently that they demand criticism. The first is, the
addition of potassium permanganate to an organic compound.
This salt of potassium is such a strong oxidizing agent that
it undoubtedly impairs the value of an otherwise plausible
formula. The second is, the addition of caramel. What indi-
cation is met by the addition of burnt sugar to a formula for
this purpose is more than can be imagined. Caramel is used
for only one purpose in pharmacy, as a coloring agent. The
color of a hernial fluid is certainly immaterial to its effect.
Giving the dose in drops is also faulty.

O. E. Miller's External Astringent. The O. E. Mil-
ler Hernia Cure Company were among the first to revive this
method, some ten or fifteen years ago. Their injection fluid
was the same as the Heaton formula, while externally they
used a preparation known as "External Astringent." It was
given to the patient for use every night. The formula was
furnished by a physician who conducted one of the offices of
the company. He states that he "made gallons of it."

External Astringent.
1^ Tr. Iodine Comp.

Soap Liniment aa p. e.

Mix. On standing for a week or two, with frequent



132 HERNIA.

shaking, this mixture loses its iodine color and becomes a
clear fluid at the bottom with the oily substance in the lini-
ment at the top. When shaken, it becomes milky in appear-
ance.

Dr. Provost's Fluid.

^ Guaiacol, pure n\ xxx.

Zinc Sulphocarbolate gr. x.

Creasote, Beechwood Tl\ xxx.

Glycerite of Tannin q. s. ad. fl. 5 j.

Mix. Reduce 10 to 50 % with alcohol and inject four
or five drops of the weakest solution, gradually increasing
to twelve drops. Increase strength of solution according to
reaction.

There are hundreds of other formulae floating about
medical journals, many of which are similar to those already
given, while others do not commend themselves sufficiently
to give them room. With this collection of formulae, there
is surely no necessity to wish for any more. A few others
are however given under "Secret Systems Exposed."



TRUSSES. 133

TRUSSES.

No matter how thoroughly the subject is understood; no
matter how carefully the treatment is given ; no matter how
much is claimed for the injection fluid used, hernia cannot
be cured by the injection method unless the , patient is
properly fitted with a suitable truss. Three-fourths of the
unsuccessful or unsatisfactory results following this treat-
ment can be directly traced to lack of attention to this
important detail.

Fully one-half of the trusses in daily use do not fit the
persons wearing them. Careful observation is the basis of
this assertion, and it can be verified by anyone desiring to
do so.

This condition of affairs is due to several causes ; the
chief of which is the general custom of physicians to refer
their ruptured patients to instrument dealers and druggists,



Online LibraryJacob Dissinger AlbrightThe general practitioner as a specialist : a treatise devoted to the consideration of medical specialties → online text (page 9 of 25)