. Surgery, its principles and practice . ue hernial sac. An ordin-ary lipoma, superficial to the fascia,will be more movable than a her-nia; it will show no impulse oncoughing, and one can usually makeout the fact that there is no con-nection with the abdominal women, even in cases of adherent omentum, one can usually get some impulse on coughing, and not infre-quently the contents of the hernial sac become noticeably enlarged. Thecontents of the hernial sac usually consist of omentum alone. Graser (vonBergmanns Surgery, article on Hernia) states that the majority of casescontain ome
. Surgery, its principles and practice . ue hernial sac. An ordin-ary lipoma, superficial to the fascia,will be more movable than a her-nia; it will show no impulse oncoughing, and one can usually makeout the fact that there is no con-nection with the abdominal women, even in cases of adherent omentum, one can usually get some impulse on coughing, and not infre-quently the contents of the hernial sac become noticeably enlarged. Thecontents of the hernial sac usually consist of omentum alone. Graser (vonBergmanns Surgery, article on Hernia) states that the majority of casescontain omentum and transverse colon, but this has not been found inthe cases observed at the Hospital for Ruptured and Crippled. Symptoms.—In many cases there are practically no symptoms,while in others the symptoms appear more severe than might be expectedfrom so small a hernia. Nausea and vomiting, discomfort, dull draggingpains in the epigastrium, are the most common symptoms. Treatment.—While some authorities (Macready) state that epigas-. FiG. 63.—^Ventral Hernia. 92 HERNIA. trie hernias are best treated with an umbiHcal truss, others, includ-ing Graser, say that trusses are generally useless, and a small epigastrichernia in itself is perfectly harmless. There is no chance of effecting acure of an epigastric hernia by mechanical treatment, and while thedanger of strangulation in this type of hernia is not great, there is apractical certainty that the hernia will increase in size and will prove asource of greater and greater annoyance and discomfort. For thesereasons I believe a radical operation is indicated in all cases in whichthere are no contraindications. The type of operation to Ije recommendedis the Mayo operation for umbilical hernia. The results of this opera-tion for epigastric hernia observed at the Hospital for Ruptured andCrippled have thus far been perfect. Hernia at the outer border of the rectus muscle (hernia linea semilu-naris) has been described by Macreacly
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