1026 



SURGICAL ANATOMY OF HERNO2. 



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. 



Fig. 707. 



B. 



Fig. 707. DIAGRAMS OP A PART OF THE 

 PERITONEUM AND THE TUNICA VAQINA- 

 LIS TESTIS. 



In the first, A, the serous investment of 

 the testis is seen to be an elongation from 

 the peritoneum ; while in the second, B, 

 the two membi-anes are shown distinct from 

 each other. 1, the peritoneal cavity ; 2, 

 the testis. 



To the second variety of inguinal 

 hernia, in which the distinguishing 

 character depends on the state of the 

 tunica vaginalis testis, the name " in- 

 fantile " has been applied (Hey). The hernia in this case is covered with a 

 distinct sac, the peculiarity consisting in the circumstance of the rupture 

 with its sac being 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 for any length. 

 As the tunica vaginalis at this period extends upwards to the wall of the 

 abdomen, the hernia, in its descent, soon meets that membrane and becomes 

 invested by it. The exact mode of the investment has not yet been clearly 

 made out by dissection. It may be that the hernia passes behind the upper 

 end of the large serous tunic of the testis, which then laps round the sac 

 from before, or that the tunica vaginalis is inverted from above so as to 

 receive the hernia in a depression. But the fact most material for the sur- 

 geon is fully ascertained namely, that during an operation in such a case, 

 the hernial sac is met with only after another serous bag (the tunica vagi- 

 nalis testis) has been divided. The peculiarity here described has been 

 repeatedly found present in the recently formed hernia 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 down over this hernia in 

 loops, so as to have the appearance of a cremaster (Cloquet). 



A strictly congenital inguinal hernia may occur in the female, the pro- 

 truded parts being received into the little diverticulum of the peritoneum 

 (canal of Nuck), which sometimes extends into the inguinal canal with the 

 round ligament. But as this process of the peritoneum, in such circum- 

 stances, would probably not differ in any respect from the ordinary sac, 

 there are no means of distinguishing a congenital hernia in the female 

 body. 



