Prognosis is favorable in the present-day asepsis and method of treatment when operated upon early, except in the very small and the very weak, or in premature children. Very large hernia., those clifficult to replace, as a-ell as hernim hard to keep back, can be freely operated on to-clay without hesitation, when the general condition of the child will permit. Yet this is necessary in only a few cases,—ftecording to Alaass, in only one per cent. The diaphragmatic hernia, alone are an exception. :Most of the children afflicted with this form die in early childhood, only a few reach a more advanced age, and are always threat ened with severe disorders of nutrition, of respiration, or of circulation.
most important means for avoiding the formation of hernia, and for preventing their irreducibility or strangu lation is to guard against or overcome the gastric attacks of children and the prevention of meteorismus due to overfeeding. All other preventive measures are of less importance or are (like the avoidance of weakness from other diseases) harder to carry out.
consists in replacing and holding back firmly the inguinal hernia hy means of a truss covered with rubber, Willa fits closely to the body and does not press too tightly, and pro duces no eczema. Soft feathers or glycerinated absorbent cotton pads are recommended to prevent skin irritation, using one or two daily, keeping the skin clean and well powdered, and wrapping the truss with fresh muslin each day. Instead of the truss, a dressing of woollen strands is sometimes recommended.
The injection of alcohol iSchwalbel directly- in the. internal abdomi nal ring can be triecl. For older children, an essential faetor in the cure is moderate outdoor games and gymnastic exercises. These arc, not harmful with a well-fitting truss, on the contrary they are beneficial in so far as they strengthen the abdominal muscles. Those. exercises should be selected which strengthen the abdominal muscles and caus.e. no
increase in the intra-abdominal pressure.
In the infant the strugg.le of trying to sit and attempting to stand (which should not be hindered but rather allowed to be. tried spon taneously and for a long while) is a lively exercise for strengthening the. abdominal muscles.
If the expectant treatment for one year does not bring about cure. an operation should be performed and the child should not wear the truss longer than is helpful. Irreducible hernim likewise need surgical intervention, as well as those difficult to hold back, and those in whom eczema easily develops. In strangulated hernia, surgical intervention should be undertaken without clelay. Prolonged taxis, with its great dangers, should be guarded against and also the danger of narcosis in the infant. When complicated with an undescended testicle, especially when the testicle remains in the inguinal canal, it is necessary to deter mine absolutely whether the hernia can be replaced and the testicle can be held easily- outside the inguinal canal. If such is the case a truss may bc tried; but if any difficulty is experienced it is advisable to seek surgical interference. The hydrocele is best treated by puncture and injection of iodine. Yet a subsequent hamorrhagic condition is some times unavoidable.
Small Immix of the linea alba often heal spontaneously. Their treatment, which can only be surgical, is dependent upon actual trouble of the digestive organs. Lateral abdominal hernia) heal generally by closure with compresses or pads or are overcome by palliative treatment.
If there is incarceration or gre.at difficulty of retention an operation is also indicated. For severe diaphragmatic hernia, with strangulation an operation is the only procedure.. Even then the outcome is doubtful unless the lately proposed suture of the diaphragm from the pleural cavity is attempted.