Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
PLATE 42, Fig. 4.--The external hernia, from having been originally
oblique, may assume the position of a hernia originally internal and
direct. The change of place exhibited by this form of hernia does not
imply a change either in its original investments or in its position
with respect to the epigastric artery and spermatic vessels. The change
is merely caused by the weight and gravitation of the hernial mass,
which bends the epigastric artery, 9*, from its first position on the
inner margin of the internal ring, 1, till it assumes the place 9. In
consequence of this, the internal ring of the fascia transversalis, 2,
2, is considerably widened, as it is also in Fig. 2, Plate 42. It is the
inner margin of the fibrous ring which has suffered the pressure; and
thus the hernia now projects directly from behind forwards, through, 4,
the external ring. The conjoined tendon, 6, when weak, becomes bent upon
itself. The change of place performed by the gravitating hernia may
disturb the order and relative position of the spermatic vessels; but
these, as well as the hernia, still occupy the inguinal canal, and are
invested by the spermatic fascia, 3, 3. When an internal hernia, Fig. 1,
Plate 42, enters the inguinal canal, it also may descend the cord as far
as the testicle, and assume in respect to this gland the same position
as the external hernia. [Footnote]
[Footnote: As the external hernia, Fig. 4, Plate 42, may displace the
epigastric artery inwards, so may the internal hernia, Fig. 1, Plate 42,
displace the artery outwards. Mr. Lawrence, Sir Astley Cooper, Scarpa,
Hesselbach, and Langenbeck, state, however, that the internal hernia
does not disturb the artery from its usual position three-fourths of an
inch from the external ring.]
[Illustration: Abdomen and scrotum, showing bone, blood vessels
and other internal organs.]
Plate 42--Figure 4
PLATE 42, Figs. 5, 6, 7.--The form and position of the inguinal canal
varies according to the sex and age of the individual. In early life,
Fig. 6, the internal ring is situated nearly opposite to the external
ring, 4. As the pelvis widens gradually in the advance to adult age,
Fig. 5, the canal becomes oblique as to position. This obliquity is
caused by a change of place, performed rather by the internal than the
external ring. [Footnote] The greater width of the female pelvis than of
the male, renders the canal more oblique in the former; and this,
combined with the circumstance that the female inguinal canal, Fig. 7,
merely transmits the round ligament, 14, accounts anatomically for the
fact, that this sex is less liable to the occurrence of rupture in this
situation.
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