One cannot state definitely how long a truss should be worn. It depends largely upon the age of the patient and the size of the rupture. A very large proportion of infants and young chil dren may be cured if treatment is carried out under favorable conditions.
Under 12 months of age the cure by truss is 5S per cent.; from 1 year to 5 years. only 10 per cent., and after that practically riii; in acquired hernia the truss-cures at 15 years are 5 per cent.. and at 30 years only 1 per cent. C. R. Golding-Bird (Practitioner, Jan., '96).
After puberty cases of cure become fewer in number, and beyond 20 years of age it may be safely stated that there are few permanent cures by means of a truss. At the Hospital for Ruptured and Crip pled a truss is seldom left off in children until a period of two years has elapsed after the last appearance of the rupture. In infants under 1 year of age the truss may be left off sooner. In young adults the period should be lengthened rather than shortened, and after the age of 20 few cases will be found in which it is safe to discontinue the use of a truss. There is a certain class of cases in which no form of truss will retain the rupture, This applies to very large, scrotal her nia with opening sufficiently large to admit four or five fingers. These her are usually found in middle-aged and elderly people. Operation is in the ma jority of such cases contra-indicated, and the most we are able to do in the way of affording relief is a scrotal bag made of stout material and supported from the shoulders.
After an incarcerated hernia has been replaced in the abdomen seldom occurs. One of two cases wit nessed personally recovered, the other died six days after operation, of hamor rhage. The treatment consists in the application of an ice-bag, with opium internally. Preindlsberger (Wiener klin. \Voch.. Apr. 4, 1901).
The mechanical treatment of umbil ical hernia differs with the age of the patient. In infants and young children no form of belt or truss is satisfactory, for the reason that it seldom retains its place for any length of time. The treat ment used at the Hospital for Ruptured and Crippled is to apply a small pad, con sisting of a wooden button-mold covered with leather, to the hernial orifice. This is held in place by a strip of rubber plaster two inches in width, which en tirely incloses the abdomen. Care should
be taken that the plaster be not applied too tightly and it should be changed at least every ten days. It seldom causes excoriation, and in most cases the rupt ure will be found to have disappeared at the end of six months or a year. Very few cases go beyond puberty without being cured, and hence the impropriety of operating upon these cases.
Umbilical hernia of varying size is of very common occurrence in infants. It is ordinarily cured by adhesive-plaster strapping. The younger the child, the earlier the cure is to be expected. The fear of recurrence or failure is slight. J. C. Hubbard (Boston Med. and Surg. Jou•., July 25, 1901).
Irreducible Hernia.
Any form of hernia may become irre ducible. This condition is, however, more frequently found in umbilical than in any other variety of hernia. It is ex ceedingly rare in children and young adults, and most frequently found be tween the ages of 30 and 60. In irre ducible hernia the contents are most fre quently omentum, omentum alone oc curring in 90 per cent. of the cases. Omentum with bowcl—entero-epiplocele —occurs next in order of frequency. Enterocele—bowel alone—may become irreducible with numerous adhesions, but this condition is rare.
Clinically, irreducible hernia differs but little from reducible hernia, which has already been described, except in the fact that the contents of the sac cannot be replaced in the abdominal cavity. Persons suffering from this form of her nia are liable to frequent attacks of colic,. and are almost always subject to consti pation. In this variety of hernia inflam mation and strangulation are more likely to occur than in reducible hernia.
Treatment of Irreducible Hernia.—If the hernia is not too large and the pa tient is a good subject for operation, an attempt may be made to effect a radical cure. Mechanical measures are, as a rule,. very unsatisfactory. _No form of irre ducible hernia can be treated with an ordinary truss without much discomfort. A truss fitted with a concave pad often proves satisfactory in irreducible hernia of small size; in umbilical and ventral, a stout abdominal belt with a circular, fiat pad, with a slightly-concave pad in herniae of larger size, will furnish all the relief we are able to give for this class. of cases.