Plate 41--Figure 4
PLATE 41, Fig. 5.--Sudden rupture of the peritonaeum at the closed internal serous ring, 1, though certainly not impossible, may yet be stated as the exception to the rule in the formation of an external inguinal hernia. The aphorism, "natura non facit saltus," is here applicable. When the peritonaeum suffers dilatation at the internal ring, 1, it advances gradatim and pari passu with the progress of the protruding bowel, and assumes the form, character, position, and dimensions of the inverted curved phases, marked 11, 11, till, from having at first been a very shallow pouch, lying external to the epigastric artery, 9, it advances through the inguinal canal to the external ring, 4, and ultimately traverses this aperture, taking the course of the fibrous tube, 3, down to the testicle in the scrotum.
Plate 41--Figure 5
PLATE 41, Fig. 6.--When the bowel dilates the peritonaeum opposite the internal ring, and carries a production of this membrane before it as its sac, then the hernia will occupy the inguinal canal, and become invested by all those structures which form the canal. These structures are severally infundibuliform processes, so fashioned by the original descent of the testicle; and, therefore, as the bowel follows the track of the testicle, it becomes, of course, invested by the selfsame parts in the selfsame manner. Thus, as the infundibuliform fascia, 2, 3, contains the hernia and spermatic vessels, so does the cremaster muscle, extending from the lower margins of the internal oblique and transversalis, invest them also in an infundibuliform manner. [Footnote]
[Footnote: Much difference of opinion prevails as to the true relation which the cord (and consequently the oblique hernia) bears to the lower margins of the oblique and transverse muscles, and their cremasteric prolongation. Mr. Guthrie (Inguinal and Femoral Hernia) has shown that the fibres of the transversalis, as well as those of the internal oblique, are penetrated by the cord. Albinus, Haller, Cloquet, Camper, and Scarpa, record opinions from which it may be gathered that this disposition of the parts is (with some exceptions) general. Sir Astley Cooper describes the lower edge of the transversalis as curved all round the internal ring and cord. From my own observations, coupled with these, I am inclined to the belief that, instead of viewing these facts as isolated and meaningless particulars, we should now fuse them into the one idea expressed by the philosophic Carus, and adopted by Cloquet, that the cremaster is a production of the abdominal muscles, formed mechanically by the testicle, which in its descent dilates, penetrates, and elongates their fibres.]
Plate 41--Figure 6
COMMENTARY ON PLATES 41 & 42. 95
PLATE 41. Fig. 7.--When an external inguinal hernia, 11, dilates and protrudes the peritonaeum from the closed internal ring, 1, and descends the inguinal canal and fibrous tube, 3, 3, it imitates, in most respects, the original descent of the testicle. The difference between both descents attaches alone to the mode in which they become covered by the serous membrane; for the testicle passes through the internal ring behind the inguinal peritonaeum, at the same time that it takes a duplicature of this membrane; whereas the bowel encounters this part of the peritonaeum from within, and in this mode becomes invested by it on all sides. This figure also represents the form and relative position of a hernia, as occurring in Figs. 1 and 3, 5, and 6, Plate 41.
