280 INGUINAL HERNIA. 



tissue. It is attached inferiorly to the reflected margin of Poupart's 

 ligament and to the crest of the ilium ; internally, to the border of the 

 rectus muscle ; and, at the inner third of the femoral arch, is continued 

 beneath Poupart's ligament, and forms the anterior segment of the 

 crural canal, or sheath of the femoral vessels. 



The internal abdominal ring is situated in this fascia, at about mid- 

 way between the spine of the os pubis and the anterior superior spine 

 of the ilium, and half an inch above Poupart's ligament ; it is bounded 

 upon its inner side by a well-marked falciform border, but is ill denned 

 around its outer margin. From the circumference of this ring is given 

 off an infundibiliform process, which surrounds the testicle and sper- 

 matic cord, constituting the fascia propria of the latter, and forms the 

 first investment to the sac of oblique inguinal hernia. It is the 

 strength of this fascia, in the interval between the tendon of the rectus 

 and the internal abdominal ring, that defends this portion of the pari- 

 etes from the frequent occurrence of direct inguinal Jiernia. / 



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INGUINAL HERNIA. 



Inguinal hernia is of two kinds, oblique and direct. 



In OBLIQUE INGUINAL HERNIA the intestine escapes from the cavity 

 of the abdomen into the spermatic canal, through the internal abdo- 

 minal ring, pressing before it a pouch of peritoneum which constitutes 

 the hernial sac, and distending the infundibiliform process of the trans- 

 versalis fascia. After emerging through the internal abdominal ring, 

 it passes first beneath the lower and arched border of the trans versalis 

 muscle ; then beneath the lower border 6f the internal oblique muscle ; 

 and finally through the external abdominal ring in the aponeurosis of 

 the external oblique. From the transversalis muscle it receives no in- 

 vestment; while passing beneath the lower border of the internal 

 oblique it obtains the cremaster muscle ; and, upon escaping at the 

 external abdominal ring, receives the intercolumnar fascia. So that the 

 coverings of an oblique inguinal hernia, after it has emerged through 

 the external abdominal ring, are, from the surface to the intestine, the 



Integument, 



Superficial fascia, 



Intercolumnar fascia, 



Cremaster muscle, 



Transversalis, or infundibiliform fascia, 



Peritoneal sac. 



The spermatic canal, which, in the normal condition of the abdomi- 

 nal parietes serves for the passage of the spermatic cord in the male, 

 and the round ligament with its vessels in the female, is about one 

 inch and a half in length. It is bounded in front by the aponeurosis 

 of the external oblique muscle ; behind by the transversalis fascia, and 

 the conjoined tendon of the internal oblique and transversalis muscle ; 

 above by the arched borders of the internal oblique and transversalis ; 



