The surgical treatment of the diseases of infancy and childhood / by T. Holmes.
- Timothy Holmes
- Date:
- 1868
Licence: Public Domain Mark
Credit: The surgical treatment of the diseases of infancy and childhood / by T. Holmes. Source: Wellcome Collection.
604/700
![distinct ring, as in the more limited forms of rupture) is too great to admit of any attempt to close it by operation. Hernia There are also cases of hernia in children spoken of in the°Unea common parlance as umbilical, but in which the protru- alba. g-Qn refj]y occurs above the umbilical aperture, and which in strictness of speech should be called hernias through the linea alba. I saw a case of this kind a short time since, in which the hernia was unusually far from the umbilical aperture, lying about an inch above it. Hernia never, as far as I know, occurs in infancy between the umbilicus and the pubes. Such hernias of the linea alba must be treated on the same principle as umbilical hernia proper, but I do not think that the prospect of radical cure is equally good. In the true congenital umbilical hernia there is a distinct ring, which has a natural tendency to close, and may be con- fidently expected to close if the gut can be kept out of the sac. Hernia of the linea alba, on the other hand, bears much more resemblance to ventral hernia. Its cause seems to be relaxation, or perhaps partial laceration, of the tendon in consequence of violent coughing or persistent crying. Such hernias, when reduced, will be found to present no distinct neck, and it must be very difficult to keep the gut fairly within the belly; so that there is less chance of the obliteration of the unnatural opening. On the other hand, there is hardly any danger of strangulation. Congenital Vaginal hernia is very rare in any circumstances, and vaginal. ^^.^ more rardy^ I believe, occurs as a congenital defect. Consequently the accompanying representations of a case of this affection before and after operation may have some in- terest. The patient, whose age was about three years, was under my care at the Hospital for Sick Children. A tumour protruded behind the labia minora, between the urethra and vagina, clearly from an extension of the vesico-vaginal pouch of peritoneum. It contained intestine, which was very easily reducible, leaving a distinct hiatus or ring where it had pro- truded. The protrusion seemed rather on the increase; and considering the serious nature of such a malformation, I thought it desirable to operate. Having reduced the hernia within the belly, I proceeded to dissect flaps of mucous mem-](https://iiif.wellcomecollection.org/image/b20416325_0604.jp2/full/800%2C/0/default.jpg)
