No matter what precautions are taken, paraffin deposited in the
tissues causes an increased flow of blood to the parts. The reaction
is in the nature of a distinct active hyperemic state and it is
sufficient to cause the proliferation of connective tissue. Even if
pure white vaseline alone is injected there will be such connective
tissue proliferation and if the paraffin is deposited close along the
peritoneal surfaces of the sac sufficient of a circulatory disturbance
will be produced to result in the sticking together of the serous
surfaces of the sac and such sticking together of the walls will mean
an elimination of the patency of the sac, one of the essential
features of a radical cure.
The paraffin compound number one is of such consistency that it is
unlikely to be absorbed and properly placed with discretion it will
favor the retention of the hernia by acting as a plug. This plugging
action is not likely to be successful if the paraffin is simply thrown
in as a mass, as it will be displaced, and when displaced it will make
undue traction upon parts with which it is intimately connected so
that should the paraffin be thrown in in the form of an irregular mass
closing only a small part of the canal and such displacement occur the
patient may suffer considerable discomfort.
The corking action of the paraffin is not to be disregarded, yet at
the same time it must be remembered that the injection must be so
diffused that the supporting mass has quite a universal support from
all the tissues from the internal ring clear out to the external ring.
It must also be remembered that the paraffin thrown into the tissues
causes a thickening of the tissues and should the canal be filled with
paraffin with the thickening which so rapidly develops the canal will
be unduly crowded.
If the canal is plugged up tightly and marked pressure is made upon
the nerves of the cord at one point it is likely that discomfort will
be produced which will last for some time.
Object of operator.
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all directions as it is withdrawn.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If the needle is simply withdrawn the paraffin is not thrown into the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.