3^8 SURGICAL APPLIED ANATOMY. [Chap. xvi. 



condition I found it necessary to divide a band passing 

 from the tuber ischii to the testis before I could place 

 the gland in the scrotum. 



Following the gubernaculum upwards, it is attached, 

 first of all, to the vaginal process, which, therefore, 

 descends before the testis, then to- the gland and 

 epididymis, and, lastly, to the peritoneum about the 

 bowel (caecum, ileum, or mesentery on the right side, 

 and sigmoid flexure on the left side). The latter connec- 

 tions serve to explain the condition of infantile hernia, 

 in which a bag or diverticle of peritoneum is drawn 

 down into the scrotum after the testis (Lockwood). 

 This diverticle can then become the sac of a hernia. 



The vaginal process is often found open at birth, 

 but it is more usually found cut off from the peritoneal 

 cavity, the portion thus isolated forming the tunica 

 vaginalis. This vaginal process will have a narrowed 

 part or neck, as it passes along the inguinal canal, and 

 will be free to enlarge again on reaching the scrotum. 

 The manner in which it is cut off is as follows. It 

 becomes obliterated in two places, at the internal ring 

 and at a spot just above the epididymis, the obliteration 

 usually beginning at the higher point first. Supposing 

 obliteration to have taken place at these two points, 

 the vaginal process between them will be represented 

 by an isolated tube. This soon shrinks, closes, and 

 dwindles to an insignificant fibrous cord. It may, 

 however, remain patent in part, and if fluid accumu- 

 lates in this patent portion, an " encysted hydrocele of 

 the cord " is produced. As regards the mode of closure, 

 three contingencies may happen, each giving rise to a 

 particular form of hernia: (1) The "process" may not 

 close at all ; (2) it may close at the upper point only ; 

 and (3) it may close at the lower point only. 



(1) When the vaginal process is entirely open, gut 

 can readily descend at once into the scrotum. Such a 

 condition is called a congenital hernia. Here the 



