. The anatomy and surgical treatment of abdominal hernia. becomes distended laterally, and spreads so as to occupy the lower partof the abdomen, and then reaches the inner abdominal aperture of the in-guinal canal, through which it becomes forced by the weight and pressureof the superincumbent abdominal viscera, and the action of the abdomina/muscles, diaphragm, and pyramidales. The following is the explanationof the peculiar peritoneal connexion which attends the vesical hernia. Asthe anterior and lateral parts of the bladder are in some degree devoid ofperitoneal covering, the bladder at fir
. The anatomy and surgical treatment of abdominal hernia. becomes distended laterally, and spreads so as to occupy the lower partof the abdomen, and then reaches the inner abdominal aperture of the in-guinal canal, through which it becomes forced by the weight and pressureof the superincumbent abdominal viscera, and the action of the abdomina/muscles, diaphragm, and pyramidales. The following is the explanationof the peculiar peritoneal connexion which attends the vesical hernia. Asthe anterior and lateral parts of the bladder are in some degree devoid ofperitoneal covering, the bladder at first enters the inguinal canal withoutbringing that membrane with it; but as soon as the fundus begins to de-scend, the peritoneum accompanies it; and with the sac thus formed, in-testine and omentum afterwards protrude and produce the triple descent,of bladder behind the peritoneum, of intestine and omentum into the peri-toneum, which the fundus of the bladder causes to descend. The treatment consists in the application of a truss similar to that which42. 330 VESICAL HERNIA. is worn in the common inguinal hernia, and in paying unremitting attentionto the frequent and complete discharge of urine. When the hernia is butsmall, and the bladder only has descended, the case will be more easy ofcure than in a common hernia, because the contraction of the muscularcoat of the bladder may lead to its being drawn out of the inguinal canal;whereas in common inguinal hernia the protruded parts are passive. Butif it has so far descended as to bring with it the peritoneum, and intestineor omentum have descended into the peritoneal bag, the case will then beas difficult to cure as the common hernia. The vesical hernia only ad-mits of cure by a gradual absorption, or an extreme elongation, of theadhesions which unite the bladder to the scrotum. I can hardly conceivethe possibility of this hernia becoming strangulated so as to really requireoperation, unless a calculus has formed in the protruded
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