1915 Journal of the American Medical Association  
Bull and Coley,1 in a report of 1,500 cases of hernia, give only two cases of this type, and a later report by the same observers of 2,032 operations for hernia notes only six cases of epigastric hernia. John Phil¬ lips2 reported only forty-two out of 7,500, a percentage of 0.56. Quain,3 on the other hand, gives the per¬ centage of 5 per cent. Quain divides epigastric hernia anatomically into two classes: First, simple fat tumors or properitoneal lipomas, which protrude through a cleft in the
more » ... gh a cleft in the linea alba and do not possess a proper peritoneal sac ; and second, true hernias with a sac of peritoneum, in which sac hernial contents may or may not be found. The invariable appearance of these hernias above the umbilicus and never below it is due to the anatomic relations of the recti muscles, which, below the umbili¬ cus, come closely together, while above that point an appreciable interval exists between their sheaths, which is occupied by areolar tissue. The production of her¬ nia of this type is therefore much easier in the upper abdomen than in the lower.
doi:10.1001/jama.1915.02570310048017 fatcat:tdnsk4ip6nf6nduzr5koat6j7y