338 



SURGICAL AXATOMY OF IIERXI.E. 



membrane by the obliteration of the intervening^ canal ; and the hernial pro- 

 trusion occurring after such obliteration has been completed, carries with it a 

 distinct serous investment — the sac. But if this process of obliteration should 

 not take place, and if a hernia should be formed, the protruded part is then 

 received into the cavity of the tunica vaginalis testis, which serves in the place 

 of its sac. In this case the hernia is named congenital (hernia tunicas vaginalis, 

 — Cooper). It is thus designated, because the condition necessary for its for- 

 mation only exists normally about the time of birth ; but the same kind of 



A 



Fi". 



1) 



Fig. 235. — Diagram of a part op the 

 Peritoneum and the Tunica Vagina- 

 lis Testis. 



Ill the first, A, the serous investment of 

 the testis is seen to be continuous with 

 the peritoneum ; while in the second, B, 

 tlie two membranes ai'e shown distinct from 

 each other. 1, the peritoneal cavity ; 2, 

 the testis. 



hernia is occasionally found to be 

 first formed in the adidt, obviously in 

 consequence of the tunica vaginalis re- 

 maining miclosed. and still continuous 

 with the peritoneum. The congenital hernia, should it reach the scrotum, 

 passes below the testis ; and, this organ being emljedded in the protruded 

 viscus, a careful examination is necessary m order to detect its position. This 

 peculiarity serves to distinguish the congenital from the ordinary form of the 

 disease. 



To the second variety of ingumal hernia, in which the distinguishing character 

 depends on the state of the tunica vaginalis testis, the name infantile has been 

 applied (Hey). The hernia in this case is covered with a distinct sac, which is 

 agam invested by the upper end of the tunica vaginalis. The relative position 

 of the two serous membranes (the hernial sac and the tunica vaginalis) may be 

 accoimted for by supposing the hernia to descend when the process of the perito- 

 neum, which accompanies the testis from the aljdomen. has Ijeen merely closed 

 at the upper end, but not obliterated for any length. Hence during an operation 

 in such a case, the hernial sac is met with only after another serous bag (the 

 tunica vaginalis testis) has been divided. The peculiarity here described has 

 been repeatedly found present in the recently formed hemite of grown persons. 

 Tlie term infantile, therefore, like congenital, has reference to the condition 

 of certain parts, rather than to the period of life at which the disease is first 

 formed. 



Li tliefcmaU, oblique inguinal hernia follows tlie course of the round 

 ligament' of the uterus along the inguinal canal, in the same manner as 

 in the male it follows the spermatic cord. After escaping from the 

 external abdominal ring, the hernia lodges in the labium pudendi. 

 The coverings arc the same as those in the male body, with the 

 exception of the cremaster, which does not exist in the female : but it 

 occasionally happens that some fibres of the internal oblique muscle 

 are drawn down over this hernia in loops, so as to hare the appearance 

 of a cremaster (Cloquet). 



A strictly congenital inguinal hernia may occur in the female, the protruded 

 parts being received into the little diverticulum of the peritoneum (canal of 

 Nuck), which sometimes extends into the ingumal canal with the round ligament. 

 But as this process of the peritoneum, in such circumstances, would probably not 

 differ m any respect from the ordinary sac, there are no means of distinguishing 

 a congenital hernia in the female bodj-. 



Eirect inguinal hernia (internal : ventro-inguinal). — Instead of 



