The Public Service
Journal of the American Medical Association
Anonymous Communications will not be noticed. Every letter must contain the writer's name and address, but these will be omitted, on request. TIIH TRUSS IN INGUINAL HERNIA 'I'o the Fdilnr: -l ¡mi looking for literature which will slve me statistics as to tiie relative merits and demerits of tbe use oí tbe truss for inguinal hernia as against the operative treatment Of course, i realize that operation Is the best treatment, but i warn some figures to show tbe morbidity nnd the mortality rates of
... mortality rates of the truss. Clyde 1<\ Ross, Anderson, S. ('. Answer.-It is impossible to give absolute figures concern-Ing the morbidity nnd mortality rate of inguinal hernia treated with trusses. Hernia is a common affliction; carefully made estimates indicate that about one individual in twenty-five has a hernia, 75 per cent, being males, and that inguinal hernia forms about 80 per cent, of the total number. Whnt percentage of these patients wear trusses it is Impossible to say, but judging from the enormous number of trusses sold, it must be very large. Men will be found who have inguinal hernias and who are doing all kinds of hard work, which shows that the average inguinal hernia does not interfere materially with a man's working capacity, but men with large irreducible or uncontrollable hernias are certainly very much incapacitated. The great danger to which an individual with a hernia is subject, is, of course, strangulation, and while the hernia itself, if properly cared for, may not interfere with the person's ability 10 work, the particular work which he may be doing may greatly increase the chances of strangulation. It is difficult to estimate the frequency with which strangulation takes place, but some general idea may be gained from the number of strangulated hernias operated on in the large hospitals. Sultan was able to collect from seven German eünies reports of 1,42!) strangulated hernias operated on with 2!lt> deaths, or a mortality of 20.7 per cent. The mortality following the radical operation for hernia is practically nilless than 0.5 per cent. Taking into consideration the great frequency of hernia, the number of operations for strangulation, the high mortality of operations under these conditions and the xery low, or practically no, mortality of operations for the radical cure, it has been estimated that the average person with a hernia runs about three times the risk of dying from his hernia by not having it operated on that he does by having if operated on and cured, to say nothing of the annoyance of constantly wearing n truss. efficient as phenol as a local antiseptic." and tbe use of a -l per cent, alcoholic soliu am of picric acid as a disinfectant of Bkln, forty-eight hours after vaccination, is advocated. How was ihis efficiency of picric acid demonstrated? Also refer ma to a description uf (irilupner's tes! for early cardiac fatigue, Ciiaiu.ks Howabd Mii.i.Kii, San Leandro, Cal. AtySWEB. -In the original article by Schamberg and Koliuer (Lancet, Nov. is, 1911), the method of determining the bactericidal power is described. The lest organisms employed were the llacillus typhoBUS nnd the StaphylooOOOUS al'lius. These were subeulliired in bouillon at least three times before being used. Twenty-four-hour old cultures were well shaken and filtered through sterile filter paper and 0.1 cm. of each was used as a dose. The standard of germicida! power was that employed by Anderson and McClintie, which is known ns the Hygienic Laboratory phenol coefficient. The experiments were carefully performed, so that the results are presumably reliable. A description of Griiupner's method, with probably a reference to the original, is given in an article by Cabot and Bruce in the Am.