The Cure of Rupture by Paraffin Injections — John Stuart Mill — John Shaqi
The Cure of Rupture by Paraffin Injections
John Stuart Mill · en
The object of the operator is to secure a diffusion of the injection
through the loose cellular tissues by the directing of the needle in
all directions as it is withdrawn. This diffusion is facilitated by
the nature of the paraffin. It is not to be forgotten that the
vaseline diffuses very readily and extensively and if the operator is
fearful of overinjecting the parts it is best to use it in excess
rather than the harder mixture.
If the needle is simply withdrawn the paraffin is not thrown into the
canal in a regular pencil-like plug but it lumps irregularly with
small diverticula projecting from each irregular mass.
The free moving of the needle point in all directions as the needle is
withdrawn favors the diffusion and avoids the unsatisfactory lumping
of the injection.
THE IMMEDIATE AFTER EFFECTS OF THE PARAFFIN INJECTIONS.
Within twelve hours after the operation the tissues are almost certain
to become quite sensitive to pressure. The reaction may be followed by
considerable pressure pain for a day or two. Should the patient not be
comfortable while at rest, that is sitting about or lying down; then
something should be given to relieve the pain. Codeine is the most
satisfactory agent for preventing the patient from feeling pain during
the most acute stage of the reaction. Codeine does not put the patient
to sleep as does morphine, nor does codeine constipate or make the
skin itch. Codeine is only about one-third or one-fourth as toxic as
morphine and consequently it may be given in a proportionately larger
dose. It may be given in tablet form or in solution by the mouth. The
best way to administer it is in doses of one-half grain every hour
while the patient is suffering actual pain. Tell the patient that it
will relieve him of unpleasant symptoms during the reaction and that
it is undesirable that he should suffer from the reaction. In this way
the patient will be kept quite comfortable during the time that the
reaction is sufficient to cause pain. It is impossible to tell whether
the reaction will be such as to cause any pain or not. In case it does
not develop no internal treatment is necessary. Other agents may be
used to relieve pain, though none offer the advantages of codeine
without disadvantages. It is not advisable to let these patients
suffer from a severe reaction. It is better to meet the first
indications of pain with the free administration of codeine. The
patient should not know the nature of the drug, and as it produces
none of the peculiar effects of morphine it is not really a drug at
all dangerous from the habit forming standpoint.
Local applications of heat or cold may be used if the reaction is well
marked.
THE PRECAUTION USED TO PREVENT THROWING OF PARAFFIN
INTO THE CIRCULATION.