. On retro-peritoneal hernia : being the 'Arris and Gale' lectures on the 'The anatomy and surgery of the peritoneal fossae' : delivered at the Royal College of Surgeons of England in 1897. pies in its earlier stages the righthalf of the abdominal cavity. When a large size has beenattained, the sac may push its way over to the left side, andfinally occupy equally the two halves of the body. A dis-tinction has always been drawn between the two forms ofduodenal hernia, left and right. The complete differencebetween their appearances during the earlier stages ofdevelopment would account for this.
. On retro-peritoneal hernia : being the 'Arris and Gale' lectures on the 'The anatomy and surgery of the peritoneal fossae' : delivered at the Royal College of Surgeons of England in 1897. pies in its earlier stages the righthalf of the abdominal cavity. When a large size has beenattained, the sac may push its way over to the left side, andfinally occupy equally the two halves of the body. A dis-tinction has always been drawn between the two forms ofduodenal hernia, left and right. The complete differencebetween their appearances during the earlier stages ofdevelopment would account for this. Up to the present,however, I believe that no correct explanation, no lawful in-terpretation of the facts often observed, has been suggested. The first hernia which is certainly of this variety wasdiscovered and recorded by Klob on June 12, 1861, in thebody of a male aged thirty-six years. (Sir A. Coopersmesenteric hernia is assumed to be open to doubt.) Thehernia is thus described : On opening the abdomen, onecould see nothing of the small intestine. After turning upthe great omentum and the transverse colon, there appeared,occupying the right half of the abdominal cavity, reaching. RIGHT DUODENAL HERNIA 51 to the middle line, a sac 8 inches long, 6 inches wide, and5 inches deep. The upper portion was covered by the trans-verse mesocolon. To the right lay the ascending , the sac lay in the pelvis. The orifice of the sac layto the left and behind, was about 2 inches in diameter, andwas situated on the third lumbar vertebra. In the thinanterior margin of the orifice lay the ileo-colic artery. Theexplanation of the origin of this hernia given by Klob is thatthe sac developed at the expense of the inferior duodenalfossa of Treitz. This view has been adopted by Jonnescoin his work in the following words : I believe the hernia(right duodenal) to be produced in the inferior duodenalfossa, the non-vascular form, in which the summit touchesthe root of the mesentery. The asce
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