54 ANATOMY OF THE GROIN : HERNIA. 



distance beneath the plica hypogastrica over the back of the rectus muscle. Below 

 the last fossa, and separated therefrom by the inner end of Poupart's ligament, 

 there is often to be recognised another slight depression, the fovea femoralis, over 

 the position of the femoral ring, to the inner side of the external iliac vein and the 

 vas deferens, or the round ligament of the uterus, according to the sex. 



FOKMS or INGUINAL HERNIA. Two principal forms of inguinal hernia are 

 described, which are distinguished according to the part of the canal which they 

 first enter, as well as by the position which they bear with respect to the epigastric 

 artery. Thus, when the hernia takes the course of the inguinal canal from its 

 commencement, it is named oblique, because of the direction of the canal, or 

 external, from the position of its neck with respect to the epigastric artery. On the 

 other hand, when the protruded part, without following the length of the canal, 

 passes at once through its posterior wall at a point opposite the external abdominal 

 ring, the hernia is named, from its course, direct, or, from its relation to the 

 epigastric artery, internal. 



Oblique or external inguinal hernia. In the common form of this hernia 

 the protruded viscus carries before it a covering of serous membrane (the sac 

 of the hernia), derived from the outer fossa of the peritoneum (p. 53) ; and, in 

 passing along the inguinal canal to the scrotum, it is successively invested by the 

 coverings given to the spermatic cord from the abdominal parietes. The hernia 

 and its sac lie directly in front of the vessels of the spermatic cord, and do not 

 extend below the testis, even when the tumour is of large size. 



There are two other varieties of oblique inguinal hernia, in which the peculiarity depends 

 on the condition of the process of peritoneum (JWOCCSSHS vaginalis) that receives the testis 

 when this organ descends from the abdomen. In ordinary circumstances the part of the 

 peritoneal process connected immediately with the testis becomes separated after birth from 

 the general cavity of that serous membrane by the obliteration of the intervening canal ; and 

 the hernial protrusion occurring- after such obliteration has been completed, carries with it a 

 distinct serous investment the sac. But if this process of obliteration should not take place, 

 and if a hernia should be formed, the protruded part is then received into the cavity of the 

 processus vaginalis, which serves in the place of its sac. In this case the hernia is named 

 congenital. It is thus designated, because the condition necessary for its formation only 

 exists normally about the time of birth ; but the same kind of hernia is occasionally found to 

 be first formed in the adult, obviously in consequence of the processus vaginalis remaining 

 unclosed, and still continuous with the peritoneum. The congenital hernia, should it reach 

 the scrotum, passes below the testis ; and, this organ being embedded in the protruded viscus, 

 a careful examination is necessary in order to detect its position. This peculiarity serves to 

 distinguish the congenital from the ordinary form of the disease. 



To the second variety of inguinal hernia, in which the distinguishing character depends 

 on the state of the tunica vaginalis testis, the name infantile has been applied (Hey). The 

 hernia in this case is covered with a distinct sac, which is again invested by the upper end of 

 the tunica vaginalis. The relative position of the two serous membranes (the hernial sac 

 and the tunica vaginalis) may be accounted for by supposing the hernia to descend when the 

 process of the peritoneum, which accompanies the testis from the abdomen, has been merely 

 closed at the upper end, but not obliterated along the front of the cord. Hence during an 

 operation in such a case, the hernial sac is met with only after another serous bag (the 

 abnormal prolongation upwards of the tunica vaginalis testis) has been divided. The 

 peculiarity here described has been repeatedly found present in the recently-formed hernias of 

 grown persons. The term infantile, therefore, like congenital, has reference to the condition 

 of certain parts, rather than to the period of life at which the disease is first formed. 



In the female, oblique inguinal hernia follows the course of the round ligament 

 of the uterus along the inguinal canal, in the same manner as in the male it follows 

 the spermatic cord. After escaping from the external abdominal ring, the hernia 

 lodges in the labium pudendi. The coverings are the same as those in the male 

 body, with the exception of the cremaster, which does not exist in the female ; but 

 it occasionally happens that some fibres of the internal oblique muscle are drawn 



