chap, xvi.] HERNIA. 283 



beginning at the higher point first. Supposing oblitera- 

 tion to have taken place at these two points, the 

 vaginal process between them will be represented 

 by an isolated tube. This soon shrinks, closes, and 

 dwindles to an insignificant fibrous cord. It may, 

 however, remain patent in part, and if fluid accumu- 

 lates in this patent portion, an " encysted hydrocele of 

 the cord " is produced. As regards the mode of closure, 

 three contingencies may happen, each giving rise to a 

 particular form of hernia : (1) The " process " may not 

 close at all ; (2) it may close at the upper point only ; 

 and (3) it may close at the lower point only. 



(1) When the vaginal process is entirely open, gut 

 can readily descend at once into the scrotum. Such a 

 condition is called a congenital hernia. (2) When 

 the process is closed only at the internal ring, there 

 appears to be merely a thin septum between the 

 peritoneal cavity and the cavity of the tunica 

 vaginalis. The gut pressing upon this septum may 

 push it before it, or come down behind it. In 

 either case, three layers of peritoneum would have 

 to be cut through before the gut could be reached. 

 This is known as an infantile or encysted 

 hernia. The condition of parts that favours the 

 development of this rupture serves also to explain 

 those anomalous cases of congenital hernia that appear 

 suddenly and for the first time in adult life. Here, 

 under some unwonted exertion, the septum above 

 described gives way and the gut at once passes into 

 the cavity beyond, and so appears in the condition of 

 a congenital hernia. (3) In the last-named circum- 

 stance a tubular process of peritoneum leads down as 

 far as the top of the testicle, and there ends, the normal 

 tunica vaginalis being beyond. Hernia into this 

 process is called a hernia into the funicular 

 process. 



In the first of these forms the testicle is quite 



