[Reprinted from The Medical News, November 19, 1892.] 
NEW INSTRUMENT FOR THE CURE OF HERNIA 
By ALEXANDER DALLAS, M.D., 
OF NEW YORK. 
The treatment of hernia is still so unsatisfactory that 
any means that will simplify the process and improve 
the results must prove of interest to the profession. The 
new instrument devised by me for this purpose is appli- 
cable in inguinal and femoral herniae (which form 90 per 
cent, of all the cases), and its simplicity and efficiency 
will prove its own indorsement. As shown in the ac- 
companying cut, it consists of a head and shaft or 
handle. The head is flattened, and its point smooth and 
blunted. Its anterior and posterior surfaces and outer 
edge are covered with fine, needle-pointed serrations, 
while its inner edge is smooth and occupied by a deep 
groove. The cover of the shaft is movable, and, while 
the instrument is being introduced, is pushed forward so 
as to cover completely all the serrations and present a 
perfectly smooth, rounded surface. By removing the 
end screw, the instrument can be taken apart and easily 
cleansed. 
Method of using. The patient is placed on his back, 
with the pelvis elevated; the parts are thoroughly 
cleansed in the usual way, and local anesthesia is 
produced by the injection of a 4 per cent, cocaine- 
solution. 
A transverse incision, one inch long, is then made 
through the integument, the subcutaneous tissue sepa- 
rated, the cord gently lifted to the inner side,- and the 
instrument introduced with the groove embracing the 
cord. It is slowly insinuated along the canal until its 2 
end is felt free in the abdominal cavity ; the cover is 
then drawn back, exposing the serrations, and the in- 
strument is carefully withdrawn, abrading and freshen- 
ing, in its withdrawal, the whole interior surface of the 
canal, except the narrow portion where the cord lies, 
which is protected by the groove. During withdrawal, 
also, the fingers are pressed over the canal to prevent 
unnecessary effusion of blood. The external wound is 
at once firmly sealed with iodoform collodion; a firm 
compress is applied to keep the walls of the canal in 
apposition, and is kept in place by adhesive plaster and 
a spica bandage. There is no reaction, and the oper- 
ation is devoid of danger. In two or three days firm 
agglutination has taken place, and the canal is obliter- 
ated. A light truss with a grooved pad (described else- 
where) is then applied, and the patient allowed to go 
about. The truss can be discarded in one or two 
months, when the parts have acquired sufficient 
strength. 
To attain the best results four things are essential: 
i, perfect asepsis; 2, an instrument large enough to 
slightly distend the canal; 3, the avoidance of unneces- 
sary effusion of blood ; 4, the use of a grooved pad which 
will give efficient support without undue pressure over 
the canal. 
Indications. It can be used in all cases of congenital 
inguinal hernia, even of long standing; in all "recent" 
cases of acquired inguinal and femoral hernias, or even 
in cases that have lasted some time when the normal 
contour of the canal still persists. It will thus be seen 
that its field of usefulness is very wide. Unlike the 
Heaton and the Schwaller methods, it is not painful, 
while its mode of application is exact, and its results 
prompt and definite. By its use truss-treatment can be 
largely dispensed with, and the operation for the 
" radical cure," with its dangers and uncertainties, can 
be limited to cases of long-standing associated with ad- 
hesions or other complications. 3 
The instrument is made by Tiemann & Co., whom I 
have to thank for their courtesy and promptness in 
carrying out my ideas. In the instrument for femoral 
hernia the handle is suitably curved and the groove for 
the femoral vein is slightly wider and more shallow, 
while, in the after-treatment, the leg is kept well flexed, 
so as to permit of the better approximation of the walls 
of the canal.