Inguinal Hernia in the Female.
The operative treatment of inguinal hernia in the female has received but little attention from most surgeons. Championniere was the first to urge it. His method was to excise the round liga ment with the sac; but this we believe to be entirely unnecessary and not with out objection. The method we have employed has been practically Bassini's method for the male, with the single step of the transplanting of the cord omitted. The incision through the aponeurosis is the same; the same tissues are included in the deep layer of sutures. The round ligament can, in all cases, be freed from the sac, and when this has been done and the sac has been dissected high up beyond the internal ring, it is ligated and excised; the ligament is al lowed to drop back into its original place and the tissues are sutured over it. In the deep layer interrupted sutures of kangaroo-tendon are employed, and in the aponeurosis a continuous suture of the same material.
{Including adults, Dr. Bull and I have operated upon 100 cases of inguinal her nia in the female. Of these 53 were adults and 47 children. Of the adults, 23 were well upward of 2 years; 15 from 1 to 2 years; 5 not traced; S operated on less than 1 year. Of chil dren, 17 were well upward of 2 years; 20 were well over 1 year. Total female adults and children, 00 cases were well over 1 year; 40 cases were well over 2 years. WILLIASI B. COLEY.] Feminine hernia of every type, unat tended with organic changes or compli cated by serious internal disease, should be treated by surgical intervention. As this is quite invariably free from danger in the non-strangulated, and the pros pects of permanency in effects are greater than in the male, it may be generally recommended.
For the "hernial condition," the wide diastasis of the median or ex tensive atrophic changes in the lateral muscles of the abdominal walls, with the resulting "pot-belly," surgery can ac complish little, if anything. The treat ment of this infirmity must be prophylac tic. The pregnant woman with a marked tendency to a sagging forward of the ab dominal walls should be girded up by a properly adjusted circular support; and when labor is violent or very protracted, muscular overstrain should be relieved by the use of the forceps or manual sup port of the overdistended abdomen. Thomas H. Manley (N. Y. Med. .four., Dee. 23, '99).
Femoral Hernia.
In this variety of hernia the bowel protrudes through the femoral ring un derneath Poupart's ligament. It pene trates the crural femoral or crural canal, the small space extending from the femoral ring to the saphenous opening of the fascia lata. On its inner side is Gimbernat's ligament; on the outer the femoral vein and its floor, as found by the pubes, covered by the pectinous muscle. The peritoneal sac of a femoral hernia is always acquired. When it ad vances beyond the saphenous opening it usually becomes much larger. The hernia proper is formed by the skin, the superficial fascia, the cribriform fascia, the sheath of the vessels, the septum cru rale, and the peritoneum. Its neck is at the femoral ring, where constriction occurs from the edge of Gimbernat's 1 i g ament. Although generally small, it occasionally attains large proportions. Besides intestine, the omentum is often found in the hernial cavity.
Femoral hernia seldom occurs before puberty, and is much more common in women than in men.