Chap, xvi.] HERNIA. 307 



the canal and consequently the obliquity of the hernia 

 are considerably reduced. Thus the axes of the two 

 forms of rupture do not present such differences as to 

 make their nature at once obvious. The direct hernia, 

 however, on reduction, will pass directly back into the 

 belly, while the indirect will, even in old cases, take a 

 slight but appreciable direction outwards. After the 

 reduction of the direct hernia, the edge of the rectus 

 muscle may be readily felt to the inner side of the aper- 

 ture, and the pulsation of the epigastric artery will 

 probably be detected on its outer side, features that 

 are both lacking in the oblique variety. From the 

 slight inducement offered to its progress, and from its 

 insignificant neck, the direct hernia is usually small 

 and globular, while for opposite reasons the oblique 

 rupture may attain large size> and tends to assume a 

 pyriform outline. 



Forms of oblique hernia depending; upon 

 congenital defects in the " vaginal process.' 1 

 The descent of tfie testis. It is well known that the 

 testis in the foetus descends from the region of the 

 kidney into the scrotum by making a way through the 

 abdominal wall that is afterwards known as the in- 

 guinal canal. 



Its descent is preceded by the passage into the 

 scrotum of a process of the peritoneum, the vaginal 

 process. The testicle usually enters the internal ring 

 about the seventh month of foetal life, and by the 

 eighth month is in the scrotum. The testis is guided 

 to its final resting place by the gubernaculum, a band 

 of muscular fibres. This band is attached below to 

 the anterior abdominal parietes, to the pubes near the 

 root of the penis, to the bottom of the scrotum, and to 

 "the tuber ischii and sphincter ani (Lockwood). The 

 last named attachments serve to explain the occasional 

 passage of the testis beyond the scrotum into the 

 perineum (testis in perineo). In one example of this 



