Ventral Hernia.—"Ventral" is a gen eral term applied to hernia) occurring in parts of the abdomen other than the um bilicus, especially those following oper ative procedures, such as laparotomy. It may also result from abscess of the ab dominal wall, defective development, muscular rupture, etc. Strangulation is rarely witnesses', owing to the nature of the orifice. Its treatment is that recom mended for umbilical hernia.
The results of operation for the radi cal cure of umbilical and ventral hernia have been more or less disappointing.
[Dr. Bull and I have operated upon 34 cases of umbilical and ventral hernia; of these 15 were ventral, including 3 epi gastric and 11 hernia following lapa rotomy; 4 following appendicitis opera tions in which the wound had been left open. In the total number of cases of umbilical and ventral hernia there were 12 relapses out of 21 cases traced; 9 re lapsed during the first year; 3 of the umbilical were strangulated, with 2 re coveries. WILLIAM B. COLEY.] The large percentage of relapses oc curring in umbilical hernia is explained by the fact that these cases are mostly very unfavorable for radical cure. They are stout women in middle age with a great abundance of fat and very little muscular tissue in the abdominal wall. EPIGASTRIC HERNIA.—This is a gen eral term applied to forms of hernia oc cupying the space between the end of the sternum and the umbilicus. These tumors are sometimes discerned with difficulty and are apt to cause symptoms usually referred to gastric disorders.
In young persons suffering from gas tric disorders a careful examination sometimes reveals the presence of small tumors, no larger than a hazel-nut, in the Linea alba. between the ensiform ap pendix and umbilicus, at the site of an inseriptio tendinea in the rectus. These hernial protrusions usually contain omentum, and, as the sac cannot readily he felt, the tumors may be mistaken for lipomata of the abdominal walls. They give rise to severe pains and vomiting. The radical operation for hernia causes a complete disappearance of the dis turbances. Von Bergmann (Wiener med. Woch., No. 5, '91).
Especial attention called to hernia in the linen, alba. These are often very small, varying in size from a pea to a walnut, usually above the navel. may be
multiple, and occur generally in men from 20 to 50 years. All the author's twelve cases were among the working classes. They are most apt to contain only subperitoneal fat, but may consist of omentmn or intestine. The symptoms are the same in any ease. These are very various. There may be no disturb ance at all, or the symptoms may come on suddenly and be more severe. In the typical case there is colicky. pain, increased by pressure, radiating toward the shoulder or giving the girdle-sensa tion; there are generally recurring at tacks of pain and vomiting. Kuttner (Alitteilungen aus der Grenzgebeiten der Med. and Chic., vol. i, No. 5, '97).
Epigastric hernia should include all hernia which are found in the area bounded above by the xyphoid cartilage, below by the umbilicus, and on the sided by the cartilages of the ribs. They so commonly appear in the linen alba in comparison with other sites that they have been termed "hernia in the linen. alba." In a series of 16,800 cases of all varieties of hernia examined by Berger there were 137 cases of epigastric hernia, some of the cases occurring alone, some in combination with other forms of her nia. It is very exceptional to find these cases in subjects less than 18 years of age, and most of the subjects of such a form of hernia are between 25 and 50. Astley Cooper, however, reported 2 con genital cases, and some few cases have been reported as beginning in early childhood. The vast majority of eases are in males of the working-class. As a rule, the onset is insidious. The patient complains for some time of stomach symptoms before the hernia appears ex ternally or when the hernia is so small as to escape detection without a careful examination. In not a few cases, how ever, there has been a traumatism, fol lowed by very acute local and general symptoms, and the tumor has appeared within a few hours. Lothrop (Boston Med. and Surg. Jour., Feb. 25, '97).
The size of the hernia and the conse quent disability are of much interest, the hernire ranging in size between that of an egg and a child's head. The weak ness and discomfort caused by these her nim are very mach the same as in hernia following laparotomy.