satisfactory in ruptures which can be readily returned.
In very small or large hernias, and in those which are not reducible,
the action of the truss is not so effective. In irreducible ruptures
there is likely to be constipation and colic produced, and
strangulation is more liable to occur. A truss having a hollow pad may
prove of service in small irreducible ruptures, but no truss is of
much value in large hernias of this kind. Every person with a
reducible rupture should wear a proper truss until the rupture is
cured by some means. Such a truss should keep in the hernia without
causing pain or discomfort. It should be taken off at night, and
replaced in the morning while the patient is lying down. In cases
where the protrusion appears during the night a truss must be worn day
and night, but often a lighter form will serve for use in bed. To test
the efficiency of a truss let the patient stoop forward with his knees
apart, and hands on the knees, and cough. If the truss keeps the
hernia in, it is suitable; if not, it is probably unsuitable.
Operation for complete cure of the hernia is successful in 95 cases
out of 100, in suitable subjects, in the ruptures in the groin. The
death rate is but about 1 in 500 to 1,000 operations when done by
surgeons skilled in this special work. Patients with very large and
irreducible hernias, and those who are very fat and in advanced life,
are unfavorable subjects for operation. In young men operation--if it
can be done by a skillful surgeon and in a hospital with all
facilities--is usually to be recommended in every case of rupture.
Umbilical hernias and ventral hernias, following surgical operations,
may be held in place by a wide, strong belt about the body, which
holds a circular flat or hollow plate over the rupture. These have
been the most difficult of cure by operation; but recent improvements
have yielded very good results--thirty-five cures out of thirty-six
operations for umbilical rupture, and one death, by Mayo, of
Rochester, Minn.--and they are usually the very worst patients, of
middle age, or older, and very stout.

Umbilical rupture in babies is very common after the cord has dropped
off. There is a protrusion at the navel which increases in size on
coughing, straining, or crying. If the rupture is pushed in and the
flesh is brought together from either side in two folds over the
navel, so as to bury the navel out of sight, and held in this position
by a strip of su