738 



HERNIA. 



Do hermaphroditorum Natura, Leipa. el Bamb. 

 1817." Virey, Article hermaphrodite ou Androgyne, 

 in Nouveau Diction. d'Histoire "Naturelle, Paris, 

 1817. Jacoby, De Mammal ibus Hermaphroditis 

 altcrno laterc in sexum contrarium vergentibus, 

 Berlin, 1818. Lawrence, Article Generation, in 

 Rees" Cyclopaedia, vol. xvi. London, 1819. Feiler, 

 Urber Angeborne Menschliche Missbildungen, &c. 

 Landshut, 1820. Pierquin, Cas d'hermaphro- 

 disme, Montpell. 1823. Henks, Untersuchungen 

 ueber Hermaphroditen, Gerichtliche Median, 

 Berlin, 1824. I'enchieiia-li, Observat. sur quelques 

 pretendus hermaphrodites, Mern. de 1'Acad. de 

 Turin, torn. x. Ritdolphi, Beschreib. einer sell. 

 Mcnschlichcn Zwitterbildung, &c. ; Ahhand. der 

 Konigl. Akad. der Wissens. zit Berlin fiir 1826. 

 Berl. 18^8. Lijipi, Dissert. A natomico-Zootomico- 

 1'isiologiche, &c. Firenze, 1826. Duges, Mem. 

 sur rhermaphrodismc, in Ephcmerides Medicales 

 de Montpellier, torn. i. Montp. 1827. Knox, 

 Outline of a theory of hermaphrodism, in Brew- 

 ster's Edinburgh Journal of Science, vol. ii. p. 322. 

 Edinb. 1830. Mtil/er, BildungsReschichte der 

 Gcnitalien, Dusselclorf, 1830. Gurlt, Lehrb. der 

 Patholog. Anat. di:r Haus-Saugthiere. Bd. II. 

 Berlin, 1831. Mayer, Icones Select* praeparat. 

 Musei Anatom, Bonuensis ; Decas Hermaphrodi- 

 torum, p. 8. Bonn. 1831 ; and Walther's and 

 Gracfe's Journal, &c. Bd. XVII. Beatty, Article 

 Doubtful Sex, in Cyclopaedia of Practical Med. 

 London, 1833. Beck, Medical Jurisprudence, 

 chap. iv. p. 69-81, Doubtful Sex, London, 1836. 

 Isidore St. thluire, Histoire des Anomalies de 

 I'organization, &c. Paris, 1836. Barry, On the 

 Unity of Structure in the Animal Kingdom, and 

 in Jamieson's JBdinb. New Philos. Journ. for April, 

 1837. See also the references in the foot-notes. 



(James Y. Simpson.) 



HERNIA (in morbid anatomy). The pro- 

 trusion of any viscus from the cavity in which 

 it ought naturally to be contained is termed a 

 hernia, and thus the apparent escape of any 

 part from any of the great cavities of the body 

 may seem to constitute the disease : still, how- 

 ever, as the real existence of cerebral or thoracic 

 ruptures rests upon very doubtful authority and 

 is extremely questionable, and as abdominal 

 protrusions are unfortunately equally palpable 

 and frequent, the application of tlie term is 

 usually limited to them. To this frequency 

 many causes seem to contribute. In the walls 

 of the abdomen there are three remarkable 

 natural openings, or perhaps it would be more 

 correct to say, there are three situations so weak 

 and unprotected that they easily yield and per- 

 mit the escape of any viscus that may be di- 

 rected against them with even a moderate de- 

 gree of force : these are, the umbilicus, through 

 which during foetal life the umbilical cord 

 passes; the inguinal canal, which allows the 

 passage of the spermatic cord in the male, and 

 the round ligament of the uterus in the female ; 

 and the crural ring, which transmits the great 

 bloodvessels to the thigh and lower extremity. 

 The nature of the walls too, which are princi- 

 pally composed of muscle, and the condition of 

 the viscera within, loose, liable to change of 

 size ami situation, and subject to irregular pres- 

 sure by the contractions of these muscular walls, 

 dispose to the occurrence of the disease in any 

 of these situations, where the resistance to such 

 pressure is but feeble. Hence herniae are most 

 frequently met with at one of the places al- 



ready mentioned, the umbilicus and the ingui- 

 nal imd femoral canals. But there are other 

 situations* at which protrusions may possibly 

 take place, although fortunately they are infre- 

 quent, such as, at the side of the ensiform car- 

 tilage, at the obturator foramen, at the sacro- 

 ischiatic notch, and between the vagina and 

 rectum in the female. It is also evident that 

 if the muscles or tendons of the diaphragm 

 are wounded, some portions of the contents of 

 the abdomen may escape, thus constituting the 

 varieties of ventral and phrenic hernia?. Ac- 

 cordingly the forms of this disease have been 

 arranged and named from the different places at 

 which they occur, an arrangement of the 

 greatest practical importance ; for as the struc- 

 ture, the size, and shape of each aperture must 

 exert a peculiar influence on the condition of 

 the protruded viscus, on its liability to become 

 incarcerated, on the possibility of its being 

 returned, on the steps to be adopted for this 

 purpose, and above all on the safety and suc- 

 cess of an operation should such be necessary, 

 a knowledge of each of these in connexion with 

 hernia is absolutely indispensable. 



Besides this division of hernia as to situ- 

 ation, there is another of very considerable im- 

 portance derived from the nature of the viscus 

 displaced: thus in abdominal ruptures the con- 

 tents of the tumour may be intestine alone, in 

 which case it is called enteroccle ; or omentum 

 alone, the eplplocele ; or both these may be 

 engaged, constituting the entero-epiploccle. 

 There is not a viscus in the abdomen or pelvis, 

 excepting perhaps only the pancreas and kid- 

 neys, that has not at one time or another 

 formed the contents of a rupture. The stomach 

 has been partially displaced through the dia- 

 phragm, or pushed through the walls of the ab- 

 domen : the duodenum has formed part of a 

 ventral or umbilical hernia : the jejunum or 

 ileum are very likely to be protruded in any 

 situation : the ornentum is often displaced, 

 particularly in inguinal hernia; at the left side : 

 the large intestines from being more fixed are 

 not so frequently thrust out, yet the ccecum and 

 colon are but too often found among the con- 

 tents of a rupture. 1 have seen a large portion 

 of the liver in an umbilical hernia of the infant: 

 Verdierf relates numerous cases of herniae of 

 the urinary bladder ; and PottJ mentions one 

 which renders it nearly certain that the ovaria 

 in females may suffer in a similar manner. 

 However, the natural situation of any riscus 

 within the abdomen is but an uncertain cri- 

 terion by which to judge of the contents of a 

 hernia in its vicinity. The strangest displace- 

 ments have been observed occasionally in the 

 examination of this disease : thus the sigmoid 

 flexure of the colon has been protruded at the 

 right side, and the ccecum and valve of the ileum 

 at the left. In all large and old hcrnise the 

 parts are dragged out of their proper situations, 



* Sur plusicurs hrrnies singulieres. Garengeot, 

 Mi'moires de 1'Academie Royale de Chir. torn. iii. 

 p. 336. Paris edit, in 15 vols. 1771. 



t Mem. de 1'Acad. Royale de Chir. torn. iv. p. 1. 



} Pott's Works, by Earle, vol. ii. p. 210. 



