*62 SURGICAL ANATOMY OF INGUINAL HERNIA. 



Poupart's ligament at the inner side of the Internal oblique, being connected with 

 that muscle, and also occasionally with the Transversalis. It passes along the 

 outer side of the spermatic cord, descends with it through the external ring upon 

 the front and sides of the cord, and forms a series of loops, which differ in thick- 

 ness and length in different subjects. Those at the upper part of the cord are 

 exceedingly short, but they become in succession longer and longer, the longest 

 reaching down as low as the testicle, where a few are inserted into the tunica 

 vaginalis. These loops are united together by areolar tissue, and form a thin 

 covering over the cord, the fascia cremasterica. The fibres ascend along the inner 

 side of the cord, and are inserted, by a small pointed tendon, into the crest of the 

 os pubis and front of the sheath of the Rectus muscle. 



It will be observed, that the origin and insertion of the Cremaster are precisely 

 similar with those of the lower fibres of the Internal oblique. This fact affords an 

 easy explanation of the manner in which the testicle and cord are invested by 

 this muscle. At an early period of foetal life, the testis is placed at the lower 

 and back part of the abdominal cavity, but, during its descent towards the scrotum, 

 which takes place before birth, it passes beneath the arched border of the Internal 

 oblique. In its passage beneath this muscle some fibres are derived from its 

 lower part, which accompany the testicle and cord into the scrotum. 



It occasionally happens that the loops of the Cremaster surround the cord, 

 some lying behind as well as in front. It is probable that, under these circum- 

 stances, the testis, in its descent, passed through, instead of beneath, the fibres of 

 the Internal oblique. 



In the descent of an oblique inguinal hernia, which takes the same course as 

 the spermatic cord, the Cremaster muscle forms one of its coverings. This muscle 

 becomes largely developed in cases of hydrocele and large old scrotal hernia?. 

 JSTo such muscle exists in the female, but an analogous structure is developed in 

 those cases where an oblique inguinal hernia descends beneath the margin of the 

 Internal oblique. 



The Internal oblique should be detached from Poupart's ligament, separated from the Trans- 

 versalis to the same extent as in the previous incisions, and reflected inwards on to the sheath of 

 the Rectus (fig. 385) . The circumflexa ilii vessels, which lie between these two muscles, form a 

 valuable guide to their separation. 



The Transversalis muscle has been previously described (p. 284). Its lower part 

 is partly fleshy and partly tendinous in structure ; this portion arises from the 

 outer third of Poupart's ligament, and arching downwards and inwards over the 

 cord, terminates in an aponeurosis, which is inserted into the linea alba, the crest 

 of the pubes, and into the pectineal line to the extent of an inch, forming together 

 with the Internal oblique, the conjoined tendon. Between the lower border of 

 this muscle and Poupart's ligament, a space is left in which is seen the fascia 

 transversalis. 



The inguinal or spermatic canal contains the spermatic cord in the male, and 

 the round ligament in the female. It is an oblique canal, about an inch and a 

 half in length, directed downwards and inwards, and placed parallel with, and 

 a little above, Poupart's ligament. It communicates, above, with the cavity of 

 the abdomen, by means of the internal abdominal ring, which is the point where 

 the cord enters the spermatic canal ; and terminates, below, at the external ring. 

 It is bounded, in front, by the integument, the superficial fascia, and by the apo- 

 neurosis of the External oblique throughout its whole length, and by the Internal 

 oblique for its outer third ; behind, by the conjoined tendon of the Internal 

 oblique and Transversalis, the triangular ligament, transversalis fascia, and the 

 sub-peritoneal fat and peritoneum ; above, by the arched fibres of the Internal 

 oblique and Transversalis ; below, by the union of the fascia transversalis with 

 Poupart's ligament. That form of protrusion in which the intestine follows the 

 course of the spermatic cord along the spermatic canal, is called oblique inguinal 

 hernia. 



