TRUSSES. — No description need be given of the great variety of trusses. The object to be accomplished by a truss should be the complete retention of the hernia without causing discomfort to the patient; there are many forms of trusses which fulfill this object satisfactorily. A good truss should consist of a pad to cover the hernial orifice and a spring or band to hold the pad always in the proper position. Steel is, I believe, the best material for this purpose. A spring should surround the pelvis entirely or in part, and should be so constructed as to retain its place either by its own elastic ity or by the aid of a strap. The two forms of trusses which I consider to best meet the requirements of an ideal truss are the so-called Knight, or cross-body, truss and the Hood. Both these varie ties may he used for single or double truss, and the Knight is quite as satis factory in femoral as in inguinal hernia.
The Hood pattern can be used only in inguinal.
The pad may be made of bard rubber, celluloid, cork, or of wood, covered• with leather. Some cases not retained by this variety of pad may be satisfactorily con trolled by the substitution of a so-called water-pad. These trusses may be made of any size and may be used in the young est infants without discomfort. In in fants and children great care should be taken that the spring be not too strong. The spring itself may be protected by leather, rubber tubing, or hard rubber. In rare cases—for example, emaciated infants—the worsted truss may serve a useful, but temporary, purpose. For routine work it is much inferior to a properly-constructed steel truss.
Thy worsted truss offers to the infant a somewhat greater hope of cure than to the adult. The feeling in Boston is that a truss of worsted is as effective as a more elaborate one, and that, if a cure is to result from truss treatment, it is as likely to follow the wearing of this form as that of any other.
The worsted truss has certain definite advantages over other forms of truss. It is very cheap, and when soiled eau be changed. The soiled one can be washed, and is then ready for use again. A skein can be washed a number of times without injury. When it loses its elas ticity, however, its usefulness is gone.
The truss can be worn in the bath. It is less likely to irritate the skin than a spring truss.
Worsted is ordinarily sold in a skein made up of two laps. A lap, or half of a skein, is sufficient for a truss. The method of application is as follows: The child is placed on his back, the half skein is passed under him and pulled far enough so that the end just reaches the internal ring. The other end is then passed through the loop of this first end and the hernia is reduced. The bunch of worsted made by the looping of one end through the other is adjusted carefully and firmly the hernial opening. and the free end then passed under the leg and fastened. by a bit of bandage to the part on the back. If the skein is so long that there is a mass of extra worsted in the back where the perinea' arm fastens to the horizontal part. a neater and more comfortable truss can be made by rewinding the worsted, mak ing it the proper length. The truss should fit snugly, and should be worn at night as well as during. the (lay. When ever it is to be changed, the child should lie down. Occasionally the skin of the groin becomes chafed. This can be guarded against and prevented in most of the cases by keeping the parts dry and by changing the worsted as often as it becomes soiled by urine or dejee t ions.
The success of the truss depends en tirely on the intelligence of the mother and the care with which she carries out her detailed instructions. She must have an ever-watchful eve on the truss, and readjust it as frequently as it be comes loose. .1. C. IThhhard (Annals of Surgery, Oct., 1901).
The truss should be so applied that the pad rests over the internal ring rather than upon the pubic bone. In scrotal hernia it is better to apply the truss in the horizontal position, care being taken that the contents of the rupt ure be entirely reduced before the truss is put on. In incomplete rupture this is not so important. In infants and young children the truss should be worn both day and night. In adults it may be, in most cases, removed with safety on re tiring. Careful attention to the skin beneath the pad is important, especially in children; frequent bathing with alco hol will be found of great service.