The Inguinal Region. 189 



not infrequently, pushes the conjoined tendon in front of 

 it, or, separates the fibres forming this tendon, or, may, 

 on the other hand, appear external to this tendon and 

 occupy the canal for a variable distance, but, in any case, 

 the neck of the sac is internal to the epigastric vessels. 

 Direct inguinal hernia forms about seven per cent, of all 

 inguinal hernise. In discussing the descent of the testicle, 

 reference was made to a process of peritoneum that pre- 

 ceded it. This usually becomes obliterated beginning 

 above at the internal ring, and below, at the testicle. 

 Should, however, it remain patent, then a portion of the 

 bowel could easily drop or slip into it, resulting in what is 

 known as, congenital hernia. Again, if the process be- 

 comes obliterated, at the lower part, only, and the rest re- 

 mains patulous, the bowel could go as far downwards as 

 the top of the testicle only, in place of lying below it, or, 

 on a level with it, as in the congenital form, and, when this 

 condition is present, it is termed hernia into the funicular 

 process. Lastly, should the upper part only, become obliter- 

 ated, then the bowel may be forced downwards, behind 

 this closed sac infantile hernia or it may insinuate itself 

 at the point of junction, i.e., at the summit of this obliter- 

 ated process encysted hernia. 



Taxis. The taxis may be employed in the attempt to 

 reduce a hernia that does not go back readily. To effect 

 reduction by taxis, the surgeon steadies the neck of the sac 

 with one hand, while, with the other he endeavors to make 

 the bowel traverse the course it took in passing down, 

 hence, he should guide it, upwards, outwards and back- 

 wards. Taxis should be very gently employed and should 

 not be persevered in, but should be regarded as rather pre- 

 liminary to operative interference. 



Operative Treatment. The seat of stricture 

 in a strangulated oblique inguinal hernia may be either at 



