H. S. Stannus 
15 
shape of the finger of a glove, some several inches long and curving downwards 
(Plate IV, (14)). Writing recently E. M. Coruer in doubting the commonness of 
congenital sacs in hernia in general, as insisted on by some writers, has shewn in a 
series extending to between two and three thousand observations that herniae in 
children are often multiple and associated particularly with a ventral hernia, a 
diastema, which though very rare at birth is common in young children and of the 
nature of a true hernia. He believes that this ventral protrusion, which is certainly 
not congenital, is caused by increased abdominal pressure due to gaseous distension 
of the bowels the result of fermentative processes, and that other herniae are due 
to the same cause. Among native children abdominal distension is almost the 
rule, "pot-bellied" is an expression always used in speaking of them. This dis- 
tension is due largely, I believe, to fermentative processes, and also a second factor, 
absent in European children, namely enlarged spleen. Of 50 children under the 
age of 5 years taken from among those with umbilical hernia, 43 or 86 "/^ were 
found to have the ventral protrusion as described by Corner. 18 of these had 
enlarged spleens and 20 shewed a considerable abdominal distension. In none 
was any other hernia found. In these cases we see par excellence the effect of 
intra-abdominal pressure, in producing first ventral hernia and secondly umbilical 
hernia. The weakness of the umbilical scar is due, I have little doubt, to the 
method of treating the cord at birth. The custom prevailing among many is to 
bind the whole cord and placenta on to the child's abdomen till it separates ; 
with othei'S the gi-eater part of the cord is so treated after severing the placenta ; 
in any case there must be considerable tension, I think, at the umbilicus and 
sepsis is more likely to occur. Cursham Corner has said that the size of the 
bulging is proportional to the length of cord left proximal to the ligature, and 
the same principle adapted to natives who use no ligature may be true, and 
thus account for the very " long " umbilical hernias. 
I am therefore inclined to agree with Corner that the umbilical and the ventral 
herniae of children are due largely to intra-abdominal pressure, but though my 
numbers are small, the absence of any other hernia among my cases must be 
taken to mean that for their production there is another factor to be taken into 
account, and that is, I believe, in Corner's cases some congenital structural 
anomaly, namely a congenital sac, and, conversely, I think congenital sacs are 
uncommon among natives of this country. 
(19) Malformations of the Extremities. Various forms of Congenital Talipes 
are met with which call for no special comment. 
A peculiar condition characterised by symmetrical shortening of the humeri 
has been observed and forms the subject of a paper by Dr S. A. Kinnier Wilson 
and myself referred to above ; certain deformities of the hands and feet are also 
therein dealt with. 
Since this paper was written I have seen three other cases of Congenital 
Humeral Micromely, one of which I mention here as there is a family history of 
