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The patients suffering from hernia are of two kinds: (a) Those Buy Protonix Online in whom surgical interference must be immediately instituted, because the life of the individual is threatened — such cases as strangulated, infected, incarcerated, and verv' large and irreducible hernias. ( b) Those in whom opera- tion can be delayed for a limited or reasonable period of time. In the latter class of cases the in- dividuals are usually deprived of a great many of life's pleasures, health being impaired and the fear of the hernia's becoming strangulated at any time causing great uneasiness of mind and therefore serious hamjierinu in the usual routine of dailv life. •Read before the Ha ah Hospital Clinical Society. August .-J, 1913] THHR.U'ELTIC XUTF.S. .579 llie coiitiinioiis wearing of a truss is a misfortune that no young person likes, and Protonix Mg ougiit not to sul)- init to unless forced to do so l)v contraindication> to an operation. I have made a careful inve?tiga- tion of various forms of trusses, and rej^jret to state that I have as yet failed to discover one that would thorou.i:hly til, ancl pcrtorni the task it is designed for — by this 1 mean to say that the head (-)r pad of the truss never thoroughly seals the margin of tiie opening of the tumor's point of emergence. li shoidd he immovable and not press too hard, for inulue iiressure cuts off the circulation and innerva- tion of the parts, which weakens the abdominal wall and in inguinal hernia is liable to injure tlie cord and testis. What I found almost without ex- ception in people wearing Buy Protonix trusses was, that the frame and head of the Order Protonix truss pressed too hard, so that the skin underneath was pale, Purchase Pantoprazole Online numb, and ini- perfectely nourished. The fascia and niu.scles, 1 suppose, suffer similarly. The hernial tumor often comes out above or below the head of the truss, and. as a result of this mechanical irritation of the jjaris. pain is produced and a local inflammation, whic'i is followed by serious adhesions, rendering subse- quent operations difficult and hindering very much the expected radical cure. When operating; fur hernia in trussworn patients one often finds the bladder adherent to the sac, and many an ace dent has happened in such cases where the bladder was seriously damaged by carelessly stripping it away from the sac. \'arious parts of the gut are often so adherent to Purchase Protonix one another, and sometimes to the sac, that one finds difficulty in separating them, and re- ducing such adherent structures in mass leads to serious postoperative complications. We also very often find, in large hernias, an irritated and even an inflamed appendix in the sac Cheap Protonix ; which necessitates re- moval, and thus adds to the gravity of the case so far as prognosis is concerned. The exceptional cases, such as tube or ovary in the sac, no d uljt you have heard of, and they also bother the operator seriously, to say nothing of the really dangerous cases, such as strangulated, gangrenous, or inflamed gut, with its complications, which are well kn iwn to you and need not be further discussed. From the foregoing pathological considerations one might imagine the mortality of hernias to be Pantoprazole Online very great, and the prognosis grave. Yet, looking up various statistics, I Buy Pantoprazole could not find one author who gave the mortality rate higher than two per cent. Does it pay, however, Order Pantoprazole Online to lose even* two patients out of one hundred cases? No, I say, emphatically no. A herniotomy in the early stage of the condition is an extraperitoneal operation, and your patient runs hardly any risk under ordinary aseptic precautions. It seems to me that a great many people have an enormous dislike Generic Pantoprazole to trust themselves in an uncon- scious state to others, and that may mean the anes- thetist, or even the surgeon himself, and the nurses. Some dread greatly the aftereffects of the anes- thesia, with its possible complications. Such peop'e can easily be operated upon under a local anes- thetic, such as cocaine, novocaine, beta eucaine. Buy Pantoprazole Online <,tc.. in various strengths, according to the preference of the operator. Lately, injections of sterile water have been used very successfully, and the most re- cent local anesthetic emjjloyed is the solution of ((uinine and urea hydrochlorine, from 0.25 to one per cent. A general anesthesia, however, is always the best if there are no contraindications, as in dis- eases of the heart or kidney, to its use. Contraindications. There is no such thing as con- traindication to oi)erating Cheap Pantoprazole Purchase Pantoprazole in class a, as given above. Contraindications to operating in class b are thise general diseases that menace life and health, such as general tuberculosis in an active state, diabetes mellitus, grave heart diseases, malignant growths, pregnancy in the late stages, blood diseases, such as pernicious anemia, hemophilia, Ifodgkin's disease, sjilenic anemia. C.raves's disease, etc. Age and sex arc no contraindications, except in the very young (under one year of age). Although I have condemned the truss and en- deavtjred to show clearly the uselessness of its ap- plication, you are liable to lose many a patient if you insist on operation. I would therefore recom- mend Buy Cheap Pantoprazole the following rules for a Order Pantoprazole well fitting truss (which is naturally very hard to obtain). 1. The head or pad should l)e of soft and yielding material.

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