DR. William Coleypresented a child, eleven months old, with a hernial protrusion about the size of a goose-egg in the left lumbar region. According to the statement of the child's parents, it had been noticed since birth, and was probably due to a congenital malformation of the abdominal parietes, allowing this mass to protrude through the triangular space between the latissi mus dorsi and the posterior free border of the external oblique.
Dr. Coley said that under this class of so-called lumbar herniae have been included various forms of rupture in which the protrusion occurs between the eleventh or twelfth rib and the crest of the ilium. The cases thus far on record are so few in number that they have not been accurately tabulated. Many of the so-called lumbar hernia are traumatic in origin, and should not be properly classed as such.
The speaker said this was the second case of the kind he had seen. The first was in a child seventeen months old. The hernia was considerably smaller than in this and was oper ated on by Dr. William T. Bull about five years ago ; and Dr. Whitman, who still has the case under his observation on account of a spinal curvature, reports that there has been no recurrence up to the present time. That patient was presented to the So ciety by Dr. Coley some years ago. The usual treatment in children consists of some sort of mechanical support, followed later by an operation, if advisable.
Dr. Coley said that lumbar hernia is three times as frequent in adults as in children.