In the literature, gastric attacks and overfeeding are not excluded. Among Jewish children hernia is not a rare but a common condition (Langton). All other causes, such as straining, and bearing clowin which bring about an increase of abdominal pressure, are rare in children but become more important as the child nears puberty.
The hernire developed in childhood with the anatomical course and the etiological conditions described, do not differ in their patho logic and anatomic nature from hernice in adults. The hernial sac and its contents are of the same character, only correspondingly more delicate and less developed.
Symptoms and Diagnosis.—The diagnosis of hernia is dependent upon a knowledge of the hernial sac, its contents and the opening. This knowledge is obtained exactly as in adults. The inguinal hernim of children, however, are characterized mostly by an easier reduction, as hornix in children are almost always smaller and either make only- a protuberance in the inguinal region or extend along the whole length of the inguinal canal as a sausage-shaped swelling. They seldom form large swellings in the serotum and when present here, there is often a coil of intestine adherent. These scrotal hernne, as those containing the cecum, or mesenteric contents, or an ovary, arc frequently not reduci ble. The diagnosis of abdominal hernia, is the same as in adults; in diaphragmatic hernhe the sac is hard to detect.
The symptoms are mani fested solely from the location of the abdominal organs (stomach and intestines). Gastric disturb ances, vondting, eventual depres sion of the gastric region, pressure symptom from the organs of the chest, e.yanosis, dyspncea, cha»ge in the position of the heart and variations in the pulmonary note.
The diagnosis of strangulation often first made at autopsy-. Dis turbances of a general character are not prominent in children afflicted with herniai, with the exception of the diaphragmatic form, because the child does not or cannot make complaint. Yet there are many- nervous disorders, such as irritability, lassitude in play-, as well as gastric disturb anc es ; vomiting; eructations; irregularity of bo)vels, which are frequently- observed when many severer and less distant symptoms have already been established.
Differential diagnosis from infantile dis orders, aS hyclrocele or delayed descent of the testicle must be made in the inguinal hernia. of children more commonly than in grown persons. Differential diagnosis from hydrocele is not always easy. A-et it can be made upon thorough examination and recognition of the following characteristics of hydroeele: failure of reposition, transparency, hollow percussion sound and the needle puneture (with a fine hypodermic syringe). In the differential diagnosis from an undeseended testicle, it is necessary to determine the absence of the testicle from its proper place, as well as the contents of the hernial sae. Abdominal hernia do not present difficulties in differential diagnosis. It is often most difficult to diagnose a diaphragmnatie hernia, and it cannot always be differentiated from other disorders.
In regard to the pathology of hernife, fecal accumulations, inflam mation and strangulation,—all these are referred to in books on surgery. Here those details are only dismissed which are necessary from the general physiology and the pathology of childhood.
in children, with the exception of diaphrag matic hernia give a very favorable prognosis. -With continued and firm retention of the hernia, and sometimes even without taking any such measure, the hernial opening contraets. The general growth of the child lengthens the inguinal canal, enlarges the swollen bowels and thickens the fatty part, and so leads to healing. Most hernife of childim heal in this w-ay without intervention and this is especially- the case with infants. Those hernia, which outlast the first year of life, and those which arise later, often have on the contrary less tendency toward cure. There always remains the question with all spontaneous reductions of hernia), whether those afflicted with hernite in earlier life are not in later life predisposed to recurrence.
Strungulations of hernia' are rare in children, somewhat more frequent in infants and are mostly caused by constipation.