The People's Common Sense Medical Adviser in Plain English Part 145

Any person writing to me must send stamped addressed envelope if wanting an answer.

J.W. THOMPSON, St. John, Whitman Co., Wash.

CASE 2A-223. INFLAMMATION OF THE BLADDER. RETENTION OF URINE.

WORLD'S DISPENSARY MEDICAL a.s.sOCIATION, Buffalo, N.Y.:

[Ill.u.s.tration: E.A. Brown, Esq.]

_Gentlemen_--I had been a terrible sufferer for many years with Bladder trouble. I had experienced the greatest discomfort, and tried in vain to find relief. I was persuaded to go to the Invalids' Hotel and Surgical Inst.i.tute, I went and while there submitted to a course of treatment that gave me relief, and was entirely satisfactory. Three years have elapsed and I continue well. I take the greatest pleasure in making public my cure. No sufferer going there can fail to receive all the benefit to be derived from medical treatment. The staff of physicians are skillful and of large experience; the attendants kind and attentive, and the Inst.i.tution, in all its appointments, not to be excelled in the country. I had been told by other physicians, Jealous at your success, not to go to your place, but I am now more than pleased that I disregarded their advice.

E.A. BROWN, Corfu, N.Y.

RUPTURE. (BREACH OR HERNIA.)

By the term _Hernia_, we mean a tumor, which is formed by the displacement of the intestines, the omentum (covering of the bowels), or both, and which protrudes from the abdominal cavity. The most common varieties are _umbilical, inguinal_ and _femoral_ hernia. Children are most subject to umbilical, males to inguinal, and females to femoral, hernia.

[Ill.u.s.tration: Fig. 1.

Indirect Inguinal Hernia.

Sketched from a case subsequently cured by our improved method of treatment. ]

CAUSES. These are either _predisposing_ or _exciting_. Any thing which occasions general or local muscular debility, as dropsy, pregnancy, abscesses, wounds, obstructions to natural evacuations, etc., is a predisposing cause of hernia. The exciting cause is pressure applied to the contents of the abdomen, as straining in evacuating the bowels and bladder, lifting heavy weights, or violent physical exertion.

SYMPTOMS. The only characteristic symptom of hernia is the presentation of an elastic, or doughy tumor of variable size, which either gradually or suddenly makes its appearance. There is flatulence, uneasiness, and sometimes pain in the abdomen.

Sharp and dull pains frequently recurring and confined to the locations where ruptures appear should receive attention. Examination will not infrequently reveal a small enlargement. If a hernia, this will usually disappear after a night's rest and may not be again noticed until the next day, or for several days. On coughing, with the finger applied to the enlargement, a sensation of an impulse (succussion), or slight additional protrusion will be felt

The trouble appears at any time of life, an a.n.a.lysis of seventy thousand cases indicating that it is most common in debilitated persons, and that there is a constant decrease in the frequency of the affection from the first to the thirteenth year, after which rupture is more and more frequently met with as age advances.

[Ill.u.s.tration: Fig. 2.

This figure ill.u.s.trates a case of Femoral Hernia which was radically cured by our improved method. This tumor is a little lower on the thigh than in cases of inguinal hernia. Femoral Hernia is most common to females, and inguinal in males.]

INGUINAL HERNIA (see Fig. 1) is more common than all other forms of rupture. It is more frequently met with in men, and when severe there is usually a ma.s.s of intestine which falls into the s.c.r.o.t.u.m and has an evil effect, by pressing upon the t.e.s.t.i.c.l.e. The protrusion follows the spermatic vessels and hence it usually appears low down in the abdomen and on one or both sides of the pubic bone.

FEMORAL HERNIA (see Fig. 2), most common in women of mature life, is felt as a lump below the strong ligament in the groin which forms the line of separation between the thigh and the abdomen. On its outer side and close to it can be felt the beating or pulsation of the large artery of the thigh.

UMBILICAL HERNIA (see Fig. 3) appears at or near the navel and is most common in children. It may be present from birth, or it may result from fretting and crying at any period of childhood.

[Ill.u.s.tration: Fig. 3.

UMBILICAL HERNIA.

Sketched from a case subsequently cured by our new method.]

Sufferers from any form of rupture are constantly subject to the danger of strangulation. This occurs when, from any cause the free return of the contents of the protruded part of the intestine is prevented. It is an accident of a serious nature, inasmuch as nearly fifty per cent. die if not carefully operated upon, and with the most skillful treatment, one in four cases terminates in death.

Every individual should guard against rupture by maintaining, by proper exercise, diet, and rest, a condition of vigor and tonicity of the muscular system.

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 a.s.sume the rec.u.mbent 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 a.s.sistance 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.

[Ill.u.s.tration: Fig. 4.

The above cut fairly ill.u.s.trates a case of Double Inguinal Hernia, complicated with Hydrocele, cured at the Invalids' Hotel and Surgical Inst.i.tute.]

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.

[Ill.u.s.tration: Fig. 5.

This figure ill.u.s.trates a Double Inguinal Hernia, of large size, which was permanently cured by our improved method of treatment. The left side (_b_) shows the _direct_ descent of the bowel into (_c_) the s.c.r.o.t.u.m, while on the right side (_a_) the rupture is indirect, the bowel descending through the internal ring and inguinal ca.n.a.l.]

THE RADICAL CURE. A small percentage of cures will follow the proper use of a good truss, and the advertis.e.m.e.nts 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 percent. of the cases that are presented at our Inst.i.tution. 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 pa.s.s by it and appear externally. It causes also an adhesive inflammation limited to the hernial sac, that completely closes it.

This treatment is rendered _entirely painless_ by the use of a solution which is injected underneath the skin with a fine hollow needle attached to a small syringe, and which tends to produce complete local anaesthesia, or loss of feeling so that the procedure is thoroughly and carefully carried out without any risk or discomfort.

The needle used by us for the treatment of the hernia is so perfected that any possible injection of the fluid into the abdominal cavity, or upon the coating of the intestine, is an impossibility, and in no way can an injection be made into a blood vessel or nerve so as to produce any discomfort or trouble. We thus avoid all the risks that pertain to the usual plan of injection.

There is a small percentage of cases, as before stated, in which this form of treatment is not likely to give a permanent cure, from the fact that the omentum or intestine has become adherent externally, to the sac, or in the s.c.r.o.t.u.m, to the coverings of the t.e.s.t.i.c.l.e. This makes the complete replacement of the rupture without cutting an impossibility, and in such cases even where the hernial opening is closed, treatment by injection only would not result in a permanent cure.

Our aim is to treat all cases of rupture that we undertake in such a manner that _by no possibility can the deformity return_. We therefore have for the cure of these cases another method, by which with our local anaesthetic fluid, we are able to perform a surgical operation without any distress whatever to the patient. The greatest risk of the old operation for rupture was the danger of general anaesthesia with chloroform or ether, or some similar agent. The great majority of individuals cannot bear the inhalation of the large quant.i.ties of these anaesthetics necessary to secure loss of feeling without consequent nausea, and at times an effect upon the heart that often results seriously. The risk from the anaesthetic is much greater than from the surgical procedure. By our method, this risk is entirely done away with.

The pain dispelling fluid enables our operator to pursue his method WITHOUT GIVING THE PATIENT ANY PAIN OR DISCOMFORT WHATEVER. During the operation he is in full possession of all his faculties, and can a.s.sist in any way desired by coughing, or straining, in order, at any time, to complete the protrusion of the rupture and show its entire extent of surface when the sac is laid bare. We then replace the rupture completely; suture the sac so that the rupture will have no pocket into which to descend, and then firmly unite the rings by a plan that we have invented, and BY WHICH THEY ARE MADE MORE STRONG AND FIRM THAN IN THEIR ORIGINAL STATE.

Early in our experience, and while using the plan of treatment that is usually employed for the radical cure of rupture, we had occasional relapses of the difficulty, but since using our improved method we have had no such trouble. We can a.s.sure our patients that there is less risk of the appearance of the rupture at the point where the operation is performed than there is of a new breach forming. The success of this treatment has been invariable. None of the plans of treatment that we pursue for the cure of rupture tend to keep the patient in bed more than a few hours. There is little or no pain, after either of our plans of treatment, and out of the many hundreds which we have treated and perfectly cured, in no instance have we had any inflammation or serious manifestation--there being no fever or general reaction. It is a matter of great surprise to our patients, who undergo our treatment for the radical cure of rupture, that by our varied methods, the object is accomplished with so little discomfort and with no pain whatever.

From two to three weeks' personal attention of our specialist, is usually all that is required even in the worst cases.

NO TRUSS IS NEEDED AFTER OUR TREATMENT. WE CONSIDER A CASE CURED ONLY WHEN THE PATIENT IS ABLE TO DO WITHOUT A TRUSS OR SUPPORT IN ALL THE USUAL WALKS AND VOCATIONS OF LIFE.