See also:

• HERNIA (Lat. hernia, perhaps from Gr. Epvos, a sprout)

HERNIA (See also:

• LAT

Lat. hernia, perhaps from Gr. Epvos, a sprout)  , in See also:

• SURGERY
• SURGERY (Fr. chirurgie, from Gr. Xetpoupyfa, i.e. hand-work)

surgery, the protrusion of a viscus, or See also:

• PART

part of a viscus, from its normal cavity; thus, See also:

• HERNIA (Lat. hernia, perhaps from Gr. Epvos, a sprout)

hernia cerebri is a protrusion of See also:

• BRAIN (A.S. braegen)

brain-substance, hernia pulmonum, a protrusion of a portion of See also:

• LUNG

lung, and hernia iridis, a protrusion of some of the See also:

• IRIS

iris through an See also:

• APERTURE (from Lat. aperire, to open)

aperture in the cornea . But, used by itself, hernia implies a protrusion from the abdominal cavity, or, in See also:

• COMMON

common See also:

• LANGUAGE (adapted from the Fr. langage, from langue, tongue, Lat. lingua)

language, a " rupture." A rupture may occur at any weak point in the abdominal See also:

• WALL (O. Eng. weal, weall, Mid. Eng. wal, wane, adapted from Lat. vallum, rampart; the original O. Eng. word for a wall was wag or tenth)
• WALL, RICHARD (1694-1778)

wall . The common situations are the See also:

• GROIN

groin (inguinal hernia), the upper part of the thigh (femoral hernia), and the See also:

• NAVEL (O. Eng. nafela, a word common to Teutonic languages; of. Ger. Nobel, Swed. nafvel; the Sanskrit is nabhila; the English root is also seen in " nave," the hub of a wheel)

navel (umbilical hernia) . The more movable the viscus the greater the liability to protrusion, and therefore one commonly finds some of the small See also:

• INTESTINE (Lat. intestinus, internal, usually in neuter plural intestina. from intus, within)

intestine, or of the fatty See also:

• APRON (a corruption arising from a wrong division of " a napron " into " an apron," from the Fr. naperon, napperon, a diminutive of nappe, Lat. mappa, a napkin)

apron (omentum), in the hernia . The See also:

• TUMOUR (Lat. tumor, a swelling)

tumour may contain intestine alone (enterocele), omentum alone (epiplocele), or both intestine and omentum (entero-epiplocele) . The predisposing cause of rupture is abnormal length of the suspensory membrane of the bowel (the mesentery), or of the omentum, in See also:

• CONJUNCTION (from Lat. conjungere, to join together)

conjunction with some weak spot in the abdominal wall, as in an inguinal hernia, which descends along the See also:

• CANAL
• CANAL (from Lat. canalis, " channel " and " kennel " being doublets of the word)

canal in which the spermatic See also:

• CORD (derived through the Fr. corde, from the Lat. chorda, Gr. xop(5rt, the string of a musical instrument)

cord lies in the male and the See also:

• ROUND (O. Fr. rond, Lat. rotundus, the Fr. is the source also of Du. rond; Ger., Swed., Dan. and Nor. rond)

round See also:

• LIGAMENT (Lat. ligamentum, from ligare, to bind)

ligament of the womb in the See also:

• FEMALE

female . A femoral hernia comes through a weak spot in the See also:

• ABDOMEN (a Latin word, either from abdere, to hide, or from a form adipomen, from adeps, fat)

abdomen to the inner See also:

• SIDE
• SIDE (mod. Eski Adalia)

side of the See also:

• GREAT

great femoral vessels; a ventral hernia takes See also:

• PLACE (through Fr. from Lat. platea, street; Gr. IrAar6s, wide)

place by the yielding of the scar See also:

• TISSUE (Fr. tissu, tissue, participle of tisser, Lat. texere, to weave)

tissue See also:

• LEFT

left after an operation for See also:

• APPENDICITIS

appendicitis or ovarian disease . The exciting cause of hernia is generally some over-exertion, as in lifting a heavy See also:

• WEIGHT

weight, See also:

• JUMPING

jumping off a high wall, straining (as in difficult micturition), See also:

• CONSTIPATION (from Lat. constipare, to press closely together, whence also the adjective " costive ")

constipation or excessive coughing . The pressure of the See also:

• DIAPHRAGM (Gr. Scat/pay,aa, a partition)

diaphragm above and the abdominal wall in front acting on the abdominal viscera causes a protrusion at the weakest point . Rupture is either congenital or acquired . A See also:

• CHILD
• CHILD, FRANCIS JAMES (1825-1896)
• CHILD, L
• CHILD, LYDIA MARIA (1802-1880)
• CHILD, SIR FRANCIS (1642-1713)
• CHILD, SIR JOHN (d. 1690)
• CHILD, SIR JOSIAH (163o - 1699)

child may be See also:

• BORN, IGNAZ, EDLER VON (1742–1791)

born with a hernia in the inguinal or umbilical region, the result of an See also:

• ARREST (Fr. arrester, arreeter, to stop or stay)

arrest of development in these parts; or the rupture may be acquired, first appearing, perhaps, in adult See also:

• LIFE

life as the result of a See also:

• STRAIN (through O. Fr. straindre, estraindre, mod. i treindre, from Lat. stringere, to draw tight, related to stress, stretch, string, &c.)

strain or hurt . Men suffer more frequently than See also:

• WOMEN

women, because of their See also:

• PHYSICAL

physical labours, because they are more liable to accidents, and because of the passage for the spermatic cord out of the abdomen being more spacious than that for the round ligament of the womb .

At first the rupture is small, and it gradually increases in bulk . It varies from the See also:

• SIZE

size of a See also:

• MARBLE (from Lat. marmor, Gr. pApµapos, shining stone)

marble to a child's See also:

• HEAD (in 0. Eng. heafad; the word is common to Teutonic languages; cf. Dutch hoofd, Ger. Haupt, generally taken to be in origin connected with Lat. caput, Gr. KerbOvi7)
• HEAD, SIR EDMUND WALKER, BART
• HEAD, SIR FRANCIS BOND, BART

head . The swelling consists of three parts—the coverings, See also:

• SAC

sac and contents . The " coverings " are the structures which See also:

• FORM (Lat. forma)

form the abdominal wall at the part where the rupture occurs . In femoral hernia the coverings are the structures at the upper part of the thigh which are stretched, thinned and matted together as the result of pressure; in other cases there is an increase in their thickness, the result of repeated attacks of inflammation . The " sac " is composed of the peritoneum or membrane lining the abdominal cavity; in some rare cases the sac is wanting . The See also:

• NECK (O. Eng. hnecca; the word appears in many Teutonic languages; cf. Dutch ride, Ger. Nacken; in O. E. the common word was heals; cf. Ger. Hals)

neck of the sac is the narrowed portion where the peritoneum forming the sac becomes continuous with the See also:

• GENERAL
• GENERAL (Lat. generalis, of or relating to a genus, kind or class)

general peritoneal cavity . The neck of the sac is often thickened, indurated and adherent to surrounding parts, the result of chronic inflammation . The "contents" are bowel, omental See also:

• FAT (O.E. fdett; the word is common to Teutonic languages, cf. Dutch vet, Ger. Fett, &c., and may be ultimately related to Greek Irian, and =apos, and Sanskrit pivan)

fat, or, in See also:

• CHILDREN, LAW RELATING TO

children, an ovary . The hernia may be reducible, irreducible or strangulated . A " reducible " hernia is one in which the contents can be pushed back into the abdomen . In some cases this reduction is effected with ease, in others it is a See also:

• MATTER

matter of great difficulty .

At any moment a reducible hernia may become " irreducible," that is to say, it cannot be pushed back into the abdominal Cavity, perhaps because of inflammatory adhesions in and around the fatty contents, or because of extra fullness of the bowel in the sac . A " strangulated " hernia is one in which the circulation of the See also:

• BLOOD

blood through the hernial contents is interfered with, by the pinching at the narrowest part of the passage . The interference is at first slight, but it quickly becomes more pronounced; the pinched bowel in the hernial sac swells as a See also:

• FINGER

finger does when a See also:

• STRING

string is tightly See also:

• WOUND (O. Eng. wund,connected with a Teutonic verb, meaning to strive, fight, suffer, seen in O. Eng. winnan, whence Eng. " win ")

wound round its See also:

• BASE

base . At first there is congestion, and this may go on to inflammation, to infection by micro-organisms and to See also:

• MORTIFICATION

mortification . The rapidity with which the See also:

• CHANGE (derived through the Fr. from the Late Lat. cambium, cambiare, to barter; the ultimate derivation is probably from the root which appears in the Gr. «a urmu', to bend)

change from See also:

• SIMPLE

simple congestion to mortification takes place depends on the tightness of the constriction, and on the virulence of the bacterial infection See also:

• HORN
• HORN (a common Teutonic word, cognate with Lat. cornu; cf. Gr. Kipas)
• HORN (Lat. cornu; corresponding terms being Fr. cor, trompe; Ger. Horn; Ital. corno)
• HORN, ARVID BERNHARD, COUNT (1664-1742)
• HORN, PHILIP DE MONTMORENCY, COUNT

horn the bowel . As a See also:

• RULE

rule, the more rapidly a hernia forms the greater the rapidity of serious change in the conditions of the bowel or omentum, and the more urgent are the symptoms . The constricting See also:

• BAND

band may be one of the structures which form the boundaries of the openings through which the hernia has travelled, or it may be the neck of the sac, which has become thickened in consequence of inflammation—especially is this the See also:

• CASE
• CASE, JOHN (d. 1600)

case in an inguinal hernia . Reducible Hernia.—With a reducible hernia there is a soft compressible tumour (elastic when it contains intestine, doughy when it contains omentum), its size increasing in the erect, and diminishing in the See also:

• HORIZONTAL

horizontal posture . As a rule, it causes no trouble during the See also:

• NIGHT

night . It gives an impulse on coughing, and when the intestinal contents See also:

• ATE

ate pushed back into the abdomen a gurgling sensation is perceptible by the fingers . Such a tumour may be met with in any part of the abdominal wall, but the See also:

• CHIEF (from Fr. chef, head, Lat. caput)

chief situations are as follows . The inguinal region, in which the neck of the tumour lies immediately above Poupart's ligament (a cord-like ligamentous structure which can be See also:

• FELT (cognate with Ger. Filz, Du. vilt, Swed. and Dan. fill; the root is unknown; the word has given Med. Lat. filtrum, " filter ")

felt stretching from the front of the See also:

• HIP

hip-See also:

• BONE (a word common in various forms to Teutonic languages, in many of which it is confined to the shank of the leg, as in the German Bein)
• BONE, HENRY (1755-1834)

bone to a See also:

• RIDGE (a word. common to many Teutonic languages, meaning " back," whether of a man or an animal, cf. German Rucke)
• RIDGE, WILLIAM PETT (1864- )

ridge of bone immediately above the genital See also:

• ORGANS

organs); the femoral region, in the upper part of the thigh, in which the neck of the sac lies immediately below the inner end of Poupart's ligament; the umbilical region, in which the tumour appears at or near the navel .

As the inguinal hernia increases in size it passes into the scrotum in the male, into the labium in the female; while the femoral hernia gradually pushes upwards to the abdomen . The palliative treatment of a reducible hernia consists in pushing back the contents of the tumour into the abdomen and applying a See also:

• TRUSS (from O. Fr. trusser, trosser, torser, trousser, to pack, bind, gird up, Low Lat. tortiare, formed from tortus, twisted, torquere, to twist; cf. " torch " and " trousers," also trousseau, a bride's outfit, literally a small pack or bundle)

truss or elastic bandage to prevent their again escaping . The younger the patient the more See also:

• CHANCE (through the O. Fr. cheance, from the Late Lat. cadentia, things happening, from cadere, to fall out, happen; cf. " case ")

chance there is of the truss acting as a curative See also:

• AGENT (from Lat. agere, to act)

agent . The truss may generally be left off at night, but it should be put on in the See also:

• MORNING

morning before the patient leaves his See also:

• BED
• BED (a common Teutonic word, cf. German Bett, probably connected with the Indo-European root bhodh, seen in the Lat. fodere, to dig; so " a dug-out place " for safe resting, or in the same sense as a garden " bed ")

bed . If, after the hernia has been once returned, it is not allowed again to come down, there is a See also:

• PROBABILITY (Lat. probabilis, probable or credible)

probability of an actual cure taking place; but if it is allowed to come down occasionally, as it may do, even during the night, in consequence of a cough, or from the patient turning suddenly in bed, the weak spot is again opened out, and the improvement which might have been going on for See also:

• WEEKS, EDWIN LORD (1849-1903)

weeks is undone . It is sometimes found impossible to keep up a hernia by means of a truss, and an operation becomes necessary . The operation is spoken of as " the See also:

• RADICAL (Lat. radix, a root)

radical treatment of hernia," in contra distinction to the so-called "palliative treatment" by means of a truss . It should not be spoken of as the radical cure, forskilfully as the operation may have been performed it is not always a cure . The principles involved in the operation are the emptying of the sac and its entire removal, and the See also:

• CLOSURE (Fr. clooture)

closure of the opening into the abdomen by strong sutures: and, in this way, great advance has been made by See also:

• MODERN

modern surgery . Without tiresome delay, and the tedious and sometimes disappointing application of trusses, the weak spot in the- abdominal wall is exposed, the sac of the hernia is tied and removed, and the canal by which the rupture descended is blockaded by buried sutures, and with no material See also:

• RISK

risk to life . Thus the patient's worries become a thing of the past, and he.is rendered a See also:

• FIT

fit and normal member of society . Experience has shown that very few ruptures are unsuited for successful treatment by operation .

No boy should now be sent to school compelled to See also:

• WEAR

wear a truss, and so hindered in his See also:

• GAMES, CLASSICAL

games and rendered an See also:

• OBJECT

object of remark . Irreducible Hernia.— The See also:

• MAIN (from the Aryan root which appears in " may " and " might," and Lat. magnus, great)
• MAIN (Lat. Moenus)

main symptom is a tumour in one of the situations already referred to, of See also:

• LONG, GEORGE (1800-1879)
• LONG, JOHN DAVIS (1838– )

long See also:

• STANDING

standing and perhaps of large size, in which the contents of the tumour, in whole or in part, cannot be pushed back into the abdomen . The irreducibility is due either to its large size or to changes which have taken place by indurations or adhesions . Such a tumour is a See also:

• CONSTANT, BENJAMIN (1845-1902)

constant source of danger: its contents are liable, from their exposed situation, to injury from See also:

• EXTERNAL

external violence; it has a constant risk of increase; it may at any See also:

• TIME (0. Eng. Lima, cf. Icel. timi, Swed. timme, hour, Dan. time; from the root also seen in " tide," properly the time of between the flow and ebb of the sea, cf. O. Eng. getidan, to happen, " even-tide," &c.; it is not directly related to Lat. tempus)
• TIME, MEASUREMENT OF
• TIME, STANDARD

time become strangulated, or the -contents may inflame, and strangulation may occur secondarily to the inflammation . It gives rise to dragging sensations (referred to the abdomen), See also:

• COLIC (from the Gr. K6Aov or KwAov, the large intestine)

colic, See also:

• DYSPEPSIA (from the Gr. prefix Sur-, hard, ill, and 'irirreiv, to digest)

dyspepsia and constipation, which may See also:

• LEAD
• LEAD (pronounced iced)

lead to obstruction, that is to say, a stoppage may occur of the passage of the contents of that portion of the intestinal canal which lies in the hernia . When an irreducible hernia becomes painful and See also:

• TENDER

tender, a See also:

• LOCAL

local See also:

• PERITONITIS

peritonitis has occurred, which resembles in many of its symptoms a case of strangulation, and must be regarded with suspicion and anxiety . Indeed, the only safe treatment is by operation . The treatment of irreducible hernia may be palliative; a " bag truss " may be worn in the See also:

• HOPE, ANTHONY
• HOPE, THOMAS (c. 1770-1831)

hope of preventing the hernia getting larger; the bowels must be kept open, and all irregularities of See also:

• DIET

diet avoided . A See also:

• PERSON, OFFENCES AGAINST THE

person with such a hernia is in constant danger, and if his general See also:

• CONDITION (Lat. condicio, from condicere, to agree upon, arrange; not connected with conditio, from condere, conditum, to put together)

condition does not contra-indicate it he should be submitted to operative treatment . That is to say, the surgeon should cut down on the hernia, open the sac, See also:

• DIVIDE

divide any omental adhesions, tie and cut away indurated omentum, return the bowel, and See also:

• COMPLETE

complete the radical operation by closing the aperture by strong sutures . In Strangulated Hernia the bowel or omentum is being nipped at the neck of the sac, and the flow of blood into and from the delicate tissues is stopped . The symptoms are—See also:

• NAUSEA (from Gr. vain, a ship)

nausea, vomiting of bilious matter, and after a time of faecal-smelling matter; a twisting, burning See also:

• PAIN (from Lat. poena, Gr. robin, penalty, that which must be paid: O. Fr. peine)
• PAIN, BARRY (1867– )

pain generally referred to the region of the navel, intestinal obstruction; a See also:

• QUICK

quick, wiry See also:

• PULSE

pulse and pain on pressure over the tumour; the expression grows anxious, the abdomen becomes tense and See also:

• DRUM (early forms drome or dromme, a word common to many Teut. languages, cf. Dan. tromme, Ger. Trommel: the word is ultimately the same as " trumpet," and is probably onomatopoeic in origin; it appears late in Eng. about the middle of the 16th century)

drum-like, and there is no impulse in the tumour on coughing, because its contents are practically pinched off from the general abdominal cavity .

Sometimes there is complete See also:

• ABSENCE (Lat. absentia)

absence of pain and tenderness in the hernia itself, and in an aged person all the symptoms may be very slight . Sooner or later, from eight See also:

• HOURS, CANONICAL

hours to eight days, if the strangulation is unrelieved, the tumour becomes livid, crackling with See also:

• GAS

gas, mortification of the bowel at the neck of the sac takes place, followed by extravasation of the intestinal contents into the abdominal cavity; the patient has hiccough; he becomes collapsed; and See also:

• DIES, CHRISTOPH ALBERT (1755-1822)

dies comatose from blood-poisoning . The treatment of a, strangulated hernia admits of no delay; if the hernia does not "go back " on the surgeon trying to reduce it, it must be operated on at once, the constriction being relieved, the bowel returned and the opening closed . There should be no treatment by hot-See also:

• BATH
• BATH, THOMAS THYNNE
• BATH, WILLIAM

bath or See also:

• ICE (a word common to Teutonic languages; cf. Ger. Eis)

ice-bag: operation is urgently needed . An anaesthetic should be administered, and perhaps one See also:

• GENTLE (through the Fr. gentil, from Lat. gentilis, belonging to the same gens, or family)

gentle See also:

• ATTEMPT (Lat. adtemptare, attentare, to try)

attempt to return the contents by pressure (termed " taxis") may be made, but no prolonged attempts are justifiable, because the condition of the hernial contents may be such that they cannot See also:

• BEAR
• BEAR, BLACK
• BEAR, BROWN
• BEAR, GRIZZLY
• BEAR, ISABELLINE
• BEAR, WHITE

bear the pressure of the fingers . " Think well of the hernia," says the See also:

• APHORISM
• APHORISM (from the Gr. a4oA'ecv, to define)

aphorism, " which has been little handled." The taxis to be successful should be made in a direction opposite to the one in which the hernia has come down . The inguinal hernia should be pressed upwards, outwards and backwards, the femoral hernia downwards, ' backwards and upwards . The larger the hernia the greater is the chance of success by taxis, and the smaller the hernia the greater the risk of its being injured by manipulation and delay . In every case the handling must be absolutely gentle . If taxis does not succeed the surgeon must at once cut down on the tumour, carefully dividing the different coverings until he reaches the sac . The sac is then opened, the constriction divided, care being taken not to injure the bowel . The bowel must be examined before it is returned into the abdomen, and if its lustreless See also:

• APPEARANCE (from Lat. apparere, to appear)

appearance, its dusky See also:

• COLOUR (Lat. color, connected with celare, to hide, the root meaning, therefore, being that of a covering)

colour, or its See also:

• SMELL (connected etymologically with " smoulder " and " smoke ")

smell, suggests that it is mortified, or is on the point of mortifying, it must not be put back or perforation would give rise to septic peritonitis which would probably have a fatal ending .

In such a case the damaged piece of bowel must be resected and the healthy ends of the bowel joined together by See also:

• FINE

fine suturing . Matted or diseased omentum must be tied off and removed . Should peritonitis supervene after the operation on See also:

• ACCOUNT
• ACCOUNT (through O. Fr. acont, Late Lat. comptum, cornputare, to calculate)

account of bacillary infection, the bowels should be quickly made to See also:

• ACT (Lat. actus, actum)

act by repeated doses of See also:

• EPSOM

Epsom salts in hot See also:

• WATER

water . A person who is the subject of a reducible hernia should take great care to obtain an accurately fitting truss, and should remember that whenever symptoms resembling' in any degree those of strangulation occur, delay in treatment may prove fatal . A surgeon should at once be communicated with, and he should come prepared to operate . (E .