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Updated: June 12, 2025
Yet I saw as many instances of fractured limbs, hernia, and other accidents there, as I ever saw on the earth; for when they fall from great heights, or miscarry in the feats of activity which they ambitiously attempt, it inflicts the same injury upon them, as a fall nearer the ground does upon us.
In quadrupeds the main weight of the abdominal viscera is supported by the ribs and by strong pectoral and abdominal muscles. The weakest part of the latter group of muscles is in the region of Poupart's ligament, above the groin. Inguinal hernia is rare in other vertebrates because this weak part is relieved by the pressure of the viscera.
Of course Guy de Chauliac would not have been able to operate so freely on hernia and suggest, following his own experience, methods of treatment of penetrating wounds of the abdomen only that he had learned the lessons of antiseptic surgery which had been gradually developed among the great surgeons of Italy during the preceding century.
Hernia that does not descend into the scrotum he calls bubonocele. For operation the patient should be placed on the back, and, the skin of the inguinal region being stretched by an assistant, an oblique incision in the direction in which the blood vessels run should be made. The incision should then be stretched by means of retractors, until the contents of the sac can be lifted out.
In this form of hernia the size of the sac is sometimes enormous, the accompanying illustration showing extreme cases of both scrotal and labial hernia. Umbilical hernia may be classed under three heads: congenital, infantile, and adult. Congenital umbilical hernia occurs most frequently in children, and is brought about by the failure of the abdominal walls to close.
Recently Joly described congenital hernia of the stomach in a man of thirty-seven, who died from collapse following lymphangitis, persistent vomiting, and diarrhea. At the postmortem there was found a defect in the diaphragm on the left side, permitting herniation of the stomach and first part of the duodenum into the left pleural cavity.
In the womb, it may be in various ways; by humours, and abscesses and ulcers, by the narrowness of the veins and passages, or by the adipose membrane in fat bodies, pressing on the neck of the matrix, but then they must have hernia, zirthilis, for in men the membrane does not reach so low; by too much cold or heat, the one vitiating the action, and the other consuming the matter through the wrong formation of the uterine parts; by the neck of the womb being turned aside, and sometimes, though rarely, by a membrane or excrescence of the flesh growing at the mouth or neck of the womb.
In the case of Roux in 1891 the hernia existed on both sides. The uterus has been found twice only in crural hernia and three times in umbilical hernia. There is one case recorded, according to Debierre, in which the uterus was one of the constituents of an obturator hernia. Sometimes its appendages are found with it.
Unless the laceration is extremely small, protrusion of the stomach or some other viscera into the thoracic cavity will almost invariably result, constituting the condition known as internal or diaphragmatic hernia. Pare relates the case of a Captain who was shot through the fleshy portion of the diaphragm, and though the wound was apparently healed, the patient complained of a colicky pain.
She lived twenty years without any inconvenience except that due to a slight hernia on the left side. The child died at the end of a fortnight. In a very exhaustive article Harris of Philadelphia has collected nearly all the remaining cases on record, and brief extracts from some of them will be given below. In Zaandam, Holland, 1647, a farmer's wife was tossed by a furious bull.
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