Paraffin

“ Surely a liquid of any kind injected into a blood vessel will give cause for trouble, even if the temperature of [242] the setting of such a paraffin be high or low. The employment of the paraffins of a melting point above 120° F. in cold form is difficult, if not impossible, even with the latest pattern of screw syringe which is quite true, but there is no need of using such paraffin nor any liquefied paraffin, since any such preparation of about the melting point of 110° F. will serve every purpose overcoming all the objections of the advocates of those using any other. ”

“ THE AMOUNT OF PARAFFIN TO BE INTRODUCED IN A GIVEN CASE. The tendency is to overinject a case. One must not forget that the tissues will probably thicken to twice the size of the mass injected. The operator must estimate as nearly as possible the size of the tract to be filled and then aim to throw in enough to about half fill it. The diffusion of the paraffin will usually safely hold the hernia when the patient rises from the table. ”

“ THE PRECAUTION USED TO PREVENT THROWING OF PARAFFIN INTO THE CIRCULATION. In all cases precautions should be taken to avoid throwing of the paraffin mixture directly into the circulation. This is accomplished by passing the needle slowly into the tissues which are to be injected and while the needle is passing through the tissues it should have a strong vacuum suction upon it so that should it strike a vein the blood will immediately begin to flow into the needle. To illustrate how easily blood may be sucked from a vein a hypodermic with a glass barrel may be taken armed with a small needle. ”

“ On distillation in a current of superheated steam, ozokerite yields a candle-making material resembling the paraffin obtained from petroleum and shale-oil but of higher melting-point, and therefore of greater value if the candles made from it are to be used in hot climates. ”

“ Paraffin in the solid state will seldom if ever escape along the side of the plunger within the barrel of the instrument when the all metal paraffin syringe is used and the all metal syringe is the only instrument which should be used for paraffin injections.
The screw piston is preferable to the sliding piston under all circumstances as it gives the operator a better control over the injection. Injections are made with the paraffin compounds cold so that considerable pressure must be brought to bear to cause the harder mixtures to flow through a long needle. ”

“ Quinlan has invented a so-called paraffin heater, as shown in Fig. 285, in which the paraffin is kept in solution by the syringe being surrounded by a continuous flow of hot water. A plain and very objectionable syringe is shown in the illustration, and while the preparation in the syringe is thus kept in [233] a liquid state the solidification in the needle is not overcome. ”

“ Operation May 14, 1905. Area sterilized. Small area of skin infiltrated with a one percent solution of cocain. Paraffin melting point 108, injected over area of prominence of bubonocele and into upper portion of canal. Two punctures made a dram and a half of paraffin injected. Parts sensitive for three days so that patient walked without bending thigh at hip joint. No temperature. Local applications. Codeine given in quarter grain doses every two hours. Fourth day parts much less sensitive, can bend leg freely in sitting or walking. ”

“ It is then put into 95 per cent alcohol, thence into the stain; and after staining, the section is washed, dehydrated, cleared and mounted. Cover-glass preparations of paraffin sections are made by floating the sections with glossy side downward on warm water (just below the melting-point of the paraffin) until they straighten out and are perfectly flat. They are then floated on to cover-slips covered with a thin film of albumin-glycerin, the albumin having previously been coagulated by passing the smeared cover-slips through the flame quickly so that they do not scorch or burn. ”

“ The skin about the needle hole is then gently washed with a fifty-per-cent solution of hydrogen peroxid, dried with a sterile cotton sponge and the opening sealed with a drop of collodion. Subsequent treatment of the parts will be considered later.
14. Solidification of Paraffin in Needle.—This occurs only when paraffins of high melting points are employed in liquid form in the syringe, and is due to the rapid cooling of the paraffin in the small metallic cannulæ, or needle, wherein it sets more readily, since the volume contained therein is very small, often not more than two or three drops. ”

“ After dehydration the specimen is placed in a clearing agent—chloroform or xylol—both of which are suitable when embedding in paraffin. The clearing agents replace the alcohol in the cells, and at the same time render the tissues transparent. From the clearing agent the specimen is placed in a weak solution of paraffin, dissolved xylol, or chloroform. The strength of the paraffin solution is gradually increased until it consists of pure paraffin. ”

“ Furthermore, when paraffin is injected in liquid form, especially when so rendered by a temperature necessarily even higher than the actual melting point, there is danger of searing the entire site intended for injection—a condition inducive to no good and a burning of the skin where the necessary superheated needle enters it, causing a punctate scar, more or less painful during the time required to heal the wound. ”

“ Dr. Morris: It might with you and you might need to use a harder paraffin. There are a great many kinds of paraffin. The paraffin ser [Pg 108] ies is a large one in chemistry. The one I find best for our locality is the common parowax that you can find in any grocery store. I use just the pure straight thing but in your country you are further south and may need a different one. It does melt some in the middle of a hot day and will be nearly fluid sometimes but it hardens up when the sun goes down.
Mr. Foster: Were the grafts kept in cold storage? ”

“ The infiltration of skin or canal being complete the needle must be withdrawn and the syringe emptied and the plunger pressed down so that the empty syringe is attached to the needle through which the paraffin injection is to be made when the operator has assured himself that the needle has been passed as far as desired without traversing or puncturing a vein. ”

“ Before injecting a hernia the operator should be thoroughly acquainted with the manner of diffusion of paraffin in the tissues. This experience can be gained by the making of numerous injections into the carcass of a small animal and the subsequent careful dissection of the animal. A dead cat, dog, rabbit, or chicken may be used for experimental injections and many such injections should be made. ”

“ The probability of escaping confinement is a great incentive to a patient to submit to an injection, when he would refuse operation.
Injections are not necessarily unphysiologic as the sufferer from a hernia has a physiologic deficiency which the paraffin accurately fills with normal connective tissue.
The dangers of injection can be eliminated. The technic is not difficult even when all precautions are taken. ”

“ Eckstein, on July 24, 1901, rehearses these objections and advocates the use of “Hart paraffin,” or paraffin with a melting point of 57-60° C. (140° F.) . His method was taken up by Brœckært, Baratoux, Brindel, Watson Cheyne, Walker Downie, Leonard Hill, Lake, Scanes Spicer, Karewski, and other prominent surgeons abroad, and by Parker, Harmon Smith, Hamilton, Quinlan, Connell, and others in the United States.
Drs. Lynch and Heath were the first American physicians to place themselves on record in the employment of the method of Gersuny for the correction of nasal deformities. ”

“ If the canal is plugged up tightly and marked [Pg 29] 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. ”

“ Worker in shoe factory. Age 24. Hernia four months duration. Never retained by truss. Sac extends half way to bottom of scrotum. Pubes shaved, skin sterilized. Operation Aug. 26, 1905. Skin infiltrated to allow passage of large needle without pain. Injection at internal ring of forty minims. Injections into canal of about thirty minims. In attempting to inject paraffin in cold state screw piston syringe broken. All metal syringe used for infiltrating, warmed and filled with melted paraffin. In using syringe to inject the canal near the external ring the needle plugged. ”

“ 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 ill consequences of hyperinjection should not be forgotten. It is the error to which the beginner is most liable.
[Pg 39] WHERE THE INJECTION SHOULD BE PLACED. Some operators have been content to insert a needle over the approximate site of the internal ring and then to force it downward until it lies as close to the internal ring as they can approximate and then to throw in a mass of paraffin sufficient to occlude the canal at this point.
If the needle is inserted about half an inch above the middle of Poupart's ligament it will be over the site of the normal internal ring. ”

“ The veins of [Pg 34] the cord are found rather closely around the cord and the cord usually lies below and behind the sac so that should the operator aim to carry his needle point along rather high in the canal he will be least likely to encounter these vessels. It is not to be forgotten that the veins of the cord are particularly likely to be somewhat dilated in these cases of hernia and the operator is taking more or less of a hazard in neglecting the suction technic outlined. It is not safe to trust to the fact that the paraffin is injected in a solid state as is asserted by some operators. ”

“ The alcohol solution is the least irritating of effective antiseptics and it is the solution in which needles and leather washers should be kept, so that they are at all times ready for use.
[Pg 13] THE SYRINGE. The sterilized paraffin syringe should not be handled until the hands have been scrubbed. The washers and needles, just before using, should be removed from the alcohol solution. It is unnecessary to wash the alcohol from the fingers, washers or needles, in fact, it is preferable to leave it upon them. ”

“ Never been treated in any way. Operation March 21, 1906. Injection of forty minims of paraffin through saphenous opening and about ten minims through Poupart's ligament. Codeine discontinued at end of fourth night. Tenderness slight. No recurrence at end of twenty days. Patient not seen subsequently.
[Pg 66] Case 8.
Case 8 E. H.—Marshalltown, Iowa. Private patient. American born. Varicocele on left side and oblique inguinal hernia. Operation April 16, 1906. Infiltration and removal of dilated veins in scrotum. Wound closed and inguinal canal followed by large needle. ”

“ The claim of Eckstein, that paraffins of low melting points are more likely to be absorbed, has not been substantiated in actual practice, since we now know that any and all of these injections, irrespective of their melting points, are absorbed in time, giving place to connective tissue, and that rarely, if ever, is there a true and complete encapsulation or encystment of the mass thus introduced. Even the hard paraffins are split up in time into minute pearllike particles which are displaced by the growth of tissue arising from the presence of the foreign substance. ”

“ Take two cylinders of paraffine wax, one made into an ordinary candle, the other into a gigantic facsimile of one, and then stand both upon their bases. To the small one nothing happens. The big one, however, begins to settle, the base actually made viscous by the pressure of the weight above. ”

“ Then Fafner put on my father's tarnhelm and escaped with his treasure to the heath, where he hid it in a cave among the rocks. But, fearful lest it be taken from him, he assumed the form of a frightful dragon, that he might protect it better.
And there he lies day and night, [33] guarding the entrance of the cave, and leaves it only when he goes to drink at a neighboring spring. No one has dared attack him, for no one has the strength to match him. ”

“ He had already, as a believer in the theory of magnetism, introduced into England the celebrated ‘weapon salve’ of Paracelsus, which healed the severest wound by sympathy—not being applied to the wound itself, but to the weapon or instrument that had caused it. The recipe, as formulated by Paracelsus, would hardly be approved by modern practitioners: ‘Take of moss growing on the head of a thief who has been hanged and left in the air, of [Pg 187] real mummy, of human blood still warm, one ounce each; of human suet, two ounces; of linseed-oil, turpentine, and Armenian bole, of each two drachms. ”