HERNIA (Lat.. ruptures. A protrusion, through an abnormal or accidental opening, of any organ from its natural cavity. Although hernia may occur in many parts of the body, the word is usually restricted to signify protrusion of the abdomiwil viscera. The abdominal viscera arc subject to violent pressure from the dia phragm and the muscles of the abdomen. This pressure forces them outward and downward against the walls of the belly; and if at any point these walls are not sufficiently strong to re sist this pressure. sonic portion of the viscera is driven through them, and a hernial tumor is formed. Certain parts of the abdominal walls. es pecially the iffiminal and erural rings, and the umbilicus, being weaker than others, hernia most frequently occurs at these points. In some in stances hernia is congenital, as from abnormal deficiency of the walls; in other cases it may arise at any period of life as a result of violent bodily exertion. such as straining in lifting, jumping, etc. Sex, age, and occupation scent to have a marked influence on predisposition to her nia. Alen are far more liable I in about the pro portion of four to one) to this disease than women, though they are less so to those forms of the affection known as femoral and umbilical hernia.
A hernia is almost always composed of a sac and its contents. The sac is a portion of the peritoneum (q.v.) corresponding to the aperture at which the hernia protrudes. It is pushed ward by the protruding viseus, and forms a pouch. The contents vary greatly, but generally consist of a portion of the small intestine ticularly of the ileum), forming the variety of hernia known as enterocc/c. Omentum is often found in hernial sacs, together with intestine. Besides the viscera. the sac always contains a certain quantity of fluid secreted by its interior. Hernia is divisible (1) into reducible, or able into the abdomen, irreducible, and lated; and (2) according to its situation. into crural, femoral, umbilical, etc. The treatment of reducible be rain may be palliative or radical. The palliative treatment consists in the application of a truss (q.v.) to retain the protrusion within the cavity of the abdomen. Each particular kind of hernia requires its cial form of truss; and before applying it. the
hernia must be reduced by placing the patient on his back, relaxing the muscles by bending the thigh upon the abdomen, and pressing the tumor back in the proper direction. The truss should then be put on. and should be worn during the day. The means that have been contrived to effect a radical cure are too purely surgical for description in these pages. Below the age of puberty, and if the hernia is recent, a radical cure is sometimes effected by wearing the truss for two or three years. In irreducible hernia the protruded viscera cannot be returned into the abdomen, but there is no impediment to the sage of their contents or to their circulation. In these cases the patient is often liable to dragging pains in the abdomen and to attacks of vomiting. The treatment consists in avoidance of violent exercise and of constipation. and in wearing support for the protection of the tumor. Hernia is said to be strangulated when a portion of in testine or onicntum that is protruded is so tight ly constricted that it not only cannot be returned into the abdomen, but has its circulation arrested. This form is highly dangerous, because, if relief is nut speedily afforded, the strangulated part becomes gangrenous. The causes of strangulation are various, but the condition most commonly arises from a sudden violent effort., by which a fresh portion of intestine is driven into a pre existing hernia, which it distends to such a degree as to produce this complication. The most promi nent early symptoms are flatulence, colicky pains. etc. They are succeeded by vomiting first of the contents of the stomach, then of mucus and bile. and lastly of Lecal matters. owing to inverted peristaltic action. If relief is not obtained, the in flammation that commences in the sac extends to the peritoneum, and the ordinary signs of peri tonitis appear. After a variable time comes gangrene or mortification of the part, and the patient speedily sinks. When reduction is im possible, prompt surgical intervention is neces sary. The hernia is cut down upon and freed from constricting bands with the knife. Where gangrene has set in in the intestine the diseased portion must be cut away and the ends of the intestine reunited.