The Inguinal Region . 191 



tinues downwards, obliquely, parallel to and about half an 

 inch from Poupart's ligament, to end at the centre of the 

 external ring. The aponeurosis of the external oblique is 

 divided after inserting a director under the upper angle of 

 the external ring, and the cut edges of the aponeurosis 

 dissected free, exposing the sac and cord, which are iso- 

 lated en masse. The sac is now separated from the cord 

 and, after being opened to see that there is no bowel or 

 omentum adherent to its interior, is ligated and removed. 

 The transversalis and the internal oblique are sutured to 

 Poupart's ligament, beneath the cord, the cut aponeurosis 

 is united over the cord and the wound closed. 



The statistics of Macready show that 85% of hernia 

 in the female are inguinal, and the method of treatment in 

 this sex differs very little from that of the male. In the 

 female, the round ligament replaces the spermatic cord 

 and the projection of the peritoneum around it is termed 

 the "canal of Niick." 



The management of this round ligament in the radical 

 cure for hernia in the female, is very simple, since it is 

 left undisturbed, so that, the internal oblique and the con- 

 joined tendon are sutured to Poupart's over the round 

 ligament, whereas, in the male, the union of these struc- 

 tures takes place beneath the cord. Coley has reported a 

 series of one hundred and thirty- four cases of inguinal her- 

 nia in the female operated on by him without a single re- 

 lapse. 



Hernia, affecting the abdominal parietes, may occur 

 elsewhere than at the inguinal region. It may be due to 

 weakness, or rupture of a muscle, or to a wound in any 

 part of the abdominal wall other than the umbilicus, under 

 which circumstances it is termed ventral hernia, but 

 should the protrusion occur at the umbilicus it is styled 

 umbilical hernia. Umbilical hernia of children may be 

 congenital, or may be what is termed infantile. The for- 



