Part 7

Case 4 A. P.--Sicilian. Worker in shoe factory. Age 24. Hernia four months duration. Never retained by truss. Sac extends half way to bottom of scrotum. Pubes shaved, skin sterilized. Operation Aug. 26, 1905. Skin infiltrated to allow passage of large needle without pain. Injection at internal ring of forty minims. Injections into canal of about thirty minims. In attempting to inject paraffin in cold state screw piston syringe broken. All metal syringe used for infiltrating, warmed and filled with melted paraffin. In using syringe to inject the canal near the external ring the needle plugged. Using all force possible the plug forced from needle and over a dram of melted paraffin thrown between the pillars of the external ring. Patient complained of considerable pain. Codeine used one-fourth grain every hour. On the third day after injection skin over the external ring infiltrated and with sharp spoon about a half dram of paraffin removed. Operation painless. Formaldehyde solutions one to five thousand used as moist dressings. Codeine continued for two days longer. Patient lost one week from work. Sept. 24, 1905. No recurrence, no pain or tenderness. Area at former site of hernia slightly more prominent than opposite side, no redness of skin.

Case 5.

Case 5 F. C.--American born, age 18. Private patient. Hernia about size of average marble midway between ensiform cartilage and umbilicus. Spontaneous origin. Injected at office with half dram of paraffin, melting point 115. Operation Dec. 2, 1905. About half dram total quantity used. No reaction when adhesive strip removed on fourth day. Slightly tender on pressure. Examination Feb. 7, 1906. No recurrence, no redness, no pain.

Case 6.

Case 6 J. C.--Italian barber. A. C. C. Disp. Inguinal hernia on right side. Noted three weeks before. Sac protruding through external ring. Injection after infiltration. Forty minims injected about internal ring. Twenty minims in canal. Twelve or fifteen minims thrown between the pillars of external ring. Codeine prescribed but not taken. Parts quite sensitive on third day. No fever. Sleeps well with two pillows under thigh of affected side. Fifth day, no pain, tenderness very much less, able to bend leg almost as freely as ever. Twelfth day impulse at internal ring? (Questionable.) Injection of twenty minims at internal ring, ten into canal and ten between pillars, melting point 104. March 4, 1906. Last examination. No recurrence, no pain or tenderness.

Case 7.

Case 7 A. Y.--Femoral hernia. Female, age 35, A. C. C. Disp. Worker in tailor shop. History of case indefinite as to length of time present. Never been treated in any way. Operation March 21, 1906. Injection of forty minims of paraffin through saphenous opening and about ten minims through Poupart's ligament. Codeine discontinued at end of fourth night. Tenderness slight. No recurrence at end of twenty days. Patient not seen subsequently.

Case 8.

Case 8 E. H.--Marshalltown, Iowa. Private patient. American born. Varicocele on left side and oblique inguinal hernia. Operation April 16, 1906. Infiltration and removal of dilated veins in scrotum. Wound closed and inguinal canal followed by large needle. No blood aspirated and cold paraffin mixture with melting point 115 injected along canal. About forty minims thrown along canal and then puncture made at site of internal ring and half dram diffused at this point.

Personal communication one year later making final payment for operation. Patient cured and grateful.

Case 9.

Case 9--Italian section worker wearing spring truss for holding of inguinal hernia. Strong pressure of truss making marked depression at site of internal ring. Patient injected with dram and half of paraffin of melting point 115. May 20, 1906. Agent deposited along canal and at internal ring. One week later no pain, no tenderness to moderate pressure. Cord somewhat larger than normal and epididimus thickened but not tender. Shreds in urine. Through interpreter information gleaned that epididimus had been somewhat tender following operation. History of acute epididimitis some months before.

Case 10.

Case 10 A. J.--Patient first consulted at Harvey dispensary. Treated for urethral stricture by internal urethrotomy. Subsequently referred to A. C. C. Disp. for treatment. Developed acute appendicitis and operation for removal after development of abscess. Abscess drained and healing of abdominal incision imperfect leaving hernial protrusion internally and near superior angle of scar. Injected with seventy minims of paraffin, 115 melting point, on Aug. 2, 1906. No pain following injection, no discoloration, and no recurrence over a year and a half after operation.

CONCLUSION.

These cases represent the ten first which were seen subsequent to injection. Cases which were injected and which did not return subsequent to injection have not been included as they would be of no value in estimating as to the usefulness of this method. In no instance has an ill consequence been suffered which would cause the patient to seek surgical aid elsewhere, or at least no case has come to the knowledge of the author directly or indirectly.

Large hernia which have gone unreduced for years have not been treated by injection and discretion demands that for some time, or until injection treatments have been practiced upon many patients, that large ruptures which have been outside the abdomen for long periods be left to the surgeon or be injected only by practitioners capable of doing the cutting operation in the advent of the failure of the injection treatment.

The author for his own part has felt no hesitancy in injecting cases which promised a fair degree of success, realizing full well that untoward symptoms of a local character may be overcome by free dissection, removal of the paraffin and restoration of the inguinal canal by the usual surgical means.

CONTENTS

PAGE Foreword 3 Preparation of the skin 10 Preparation of the hands of the operator 12 Preparation of the syringe 15 Preparation of the paraffin 18 Posture of patient for injection 23 Skin infiltration to permit of insertion of long needle without undue pain 25 The effect of paraffin compounds upon the tissues 27 The immediate after effects of the paraffin injections 30 The precaution used to prevent throwing of paraffin into the circulation 32 Factors to be considered in dealing with inguinal hernia 35 Where the injection should be placed 39 The amount of paraffin to be introduced in a given case 42 Technic to be used in injecting inguinal hernia 44 The injection of femoral hernia 51 Injection of umbilical hernia 53 Case reports 69

Cosmetic Surgery

The Correction of Featural Imperfections

CHARLES C. MILLER, M. D.

Very excellent and practical. Southern Practitioner.

Will fill a distinct place in the realm of surgery. Cleveland Medical Journal.

Covers a most important field of special surgery. Southern Clinic.

The book is certainly a valuable contribution to the subject. Ophthalmology.

Has gone far beyond the limits of surgery as understood and practiced in this country. British Medical Journal.