Reprinted from the New York Medical Journal 
for February 20, 1897. 
A CASE OF 
CONGENITAL UMBILICAL HERNIA. 
By ANDREW J. McCOSH, M. D. 
Baby McC., male. Born at term. Parents well 
formed and healthy, as are their three older children. 
On birth a tumor the size of a large orange was noticed 
at the navel. Bowels had moved and there had been 
no vomiting. Admitted into the Presbyterian Hospital 
September 19, 1896, when thirty-six hours old. A well- 
developed baby. At the umbilicus, a roundish tumor; 
diameter, three inches and a half, height above abdom- 
inal wall, two inches and a half; color of surface, dark 
purplish; covered not by skin, but only by the mem- 
branes of the cord, through which could be indistinctly 
seen the liver and intestines moving up and down on 
inspiration and expiration. Tumor partly reducible. 
Manipulation of tumor caused apparently no discom- 
fort. Temperature, 100°; pulse, 130; respiration, 34. 
Treatment consisted in covering the hernia with rubber 
tissue wet with salt solution. 
September 21st.-Baby apparently comfortable, tak- 
ing plenty of nourishment. Bowels had moved. Tem- 
perature, 101°. Operation advised. 
23 d.-1Temperature, 102° to 103°. No vomiting, 
but somewhat restless, and child looked ill. Covering 
of the hernia had assumed a dull brownish appearance, 
and there was some odor. 
Copyright, 1807, bt D. Afplbton and Company. 2 
CONGENITAL UMBILICAL HERNIA. 
24th.-Operation. No anaesthetic. Surface of her- 
nia covered by a foul sloughing membrane without vi- 
tality, except near its attachment to the abdominal wall. 
This membrane was pulled off with forceps, which ex- 
posed to view the liver and transverse colon. The re- 
mainder of the membrane (covering of the hernia) was 
cut away by an incision carried around the base of the 
tumor, the liver and intestines being held back with 
hot gauze pads. That portion of the liver which was 
contained in the sac was covered by a tenacious, partial- 
ly sloughing exudate, which was scraped off with con- 
siderable difficulty, and as a result there was some super- 
ficial laceration of its surface and some bleeding, which 
was controlled by pressure. When expulsive efforts 
were made by the baby probably about one third of its CONGENITAL UMBILICAL HERNIA. 
3 
liver protruded through the gap in the abdominal wall. 
A few whiffs of chloroform were now given so that the 
protruding viscera could be more easily returned. The 
incision around the base of the hernia had exposed the 
recti muscles, the edges of which, with the fasciae and 
skin, were united by interrupted sutures of silk. Ap- 
proximation of the edges of the wound was somewhat 
difficult on account of the tension. A strip of rubber 
tissue was inserted into the peritoneal cavity for drain- 
age. 
There had been apparently no pain during the opera- 
tion, which was followed by moderate shock only. 
25th.-Seems comfortable, takes nourishment. No 
vomiting. 
26th.-Pulse failing. Cyanosis. Death.