The mortality is exceedingly small. Of 1100 operated cases, includ ing 20 per cent. infants, we lost only four; two of these succumbed to epidemics (house infection) that happened to prevail, one to pneumonia two days after operation and one eight hours after operation to status thymieus, established at autopty. Thus only the last two cases arc directly attributable to the operation, and they refer to infants at a time when we still anesthetized them. This was one of the reasons that caused us to discard ana•sthesia, even ether slumber, in hernia opera tions on infants.
Operation for inguinal hernia on a female child does not materially differ front that on a male child. Absence of the seminal cord farilitates the closure of the inguinal ring, but aggravates the search for thi inguinal sac, especially in a small hernia and where there is abundant adipose tissue, since they may be confused with h lipoma (see Tumors). Should the ovaries be prolapsed, they should of course always be replaced in position. The round ligament. should be spared, if possible.
A truss should not be worn after operation, as it would only have an injurious effect upon t muscular closure. Older children should refrain from physical exercise forsix months after operation, or at least from such exercise as would increase the dominal pressure from relaxation of the anterior abdominal muscles (as in swimming). Otherwise the children may be considered normal. Trusses and similar bandages should now only have historical value, except in cases where the matic condition of the patient ders an operation absolutely sible. If, however, a truss is worn at all, it should be done without in terruption, as a single unguarded cough may loosen the agglutinations of many months. In younger children a bilateral truss should be applied
from the first, as it is less easily displaced and affords protection to both inguinal canals, the predisposition to hernia being usually bilateral. In infants the truss should be changed and dried more frequently, and the material from which it is made should therefore be selected accordingly.
Fiedler suggested wool trusses, which can be recommended owing to their cheapness and easy arrangement. The following is his description of the same taken from the Centralblatt !Ur Chirurgic, 1906: "The improvised truss consists of a skein of white wool of about 20-30 threads. This is made into a loop 35-45 cm. in length according to the size of the little patient. Two narrow white linen apron-strings arc attached to one end of the loop. Zephyr wool, ready in skeins of about the required length, is for sale in the stores.
Fig. 37f shows the loop ready for use. The hernia being reduced, the loop is placed around the abdomen like a belt. The end carrying the linen bands is drawn through the loop, as shown in Fig. 37g. A small, firm ball of clean cotton wool is placed in the inguinar region, the cross point of the loop to rest upon the same. The end of the loop is drawn tight around the thigh and the linen bands are tied to the belt.
The elastic pressure of the wool skein, tightly drawn over the ball of cotton wool, is quite sufficient to prevent the prolapse of the hernia. Instructions are given to have half a dozen of these wool loops in readi ness, so that a clean one may be applied each time the child is changed. The child may be bathed without removing the bandage.
For bilateral hernia two loons should, of course, be applied.
The arrangement is cleanly, simple, inexpensive, and thoroughly reliable.