Plate 41--Figure 7
PLATE 41, Fig. 8.--When the serous spermatic tube only closes at the internal ring, as seen at 1, Fig. 4, Plate 41, if a hernia afterwards pouch the peritonaeum at this part, and enter the inguinal canal, we shall then have the form of hernia, Fig. 8, Plate 41, termed infantile. Two serous sacs will be here found, one within the cord, 13, and communicating with the tunica vaginalis, the other, 11, containing the bowel, and being received by inversion into the upper extremity of the first. Thus the infantile serous canal, 13, receives the hernial sac, 11. The inguinal canal and cord may become multicapsular, as in Fig. 8, from various causes, each capsule being a distinct serous membrane. First, independent of hernial formation, the original serous tube may become interruptedly obliterated, as in Plate 40, Fig. 2. Secondly, these sacs may persist to adult age, and have a hernial sac added to their number, whatever this may be. Thirdly, the original serous tube, 13, Fig. 8, may persist, and after having received the hernial sac, 11, the bowel may have been reduced, leaving its sac behind it in the inguinal canal; the neck of this sac may have been obliterated by the pressure of a truss, a second hernia may protrude at the point 1, and this may be received into the first hernial sac in the same manner as the first was received into the original serous infantile tube. The possibility of these occurrences is self-evident, even if they were never as yet experienced. [Footnote]
[Footnote: According to Mr. Lawrence and M. Cloquet, most of the serous cysts found around hernial tumours are ancient sacs obliterated at the neck, and adhering to the new swelling (opera cit.)]
Plate 41--Figure 8
PLATE 42, Fig. 1.--The epigastric artery, 9, being covered by the fascia transversalis, can lend no support to the internal ring, 2, 2, nor to the tube prolonged from it. The herniary bowel may, therefore, dilate the peritonaeum immediately on the inner side of the artery, and enter the inguinal canal. In this way the hernia, 11, although situated internal to the epigastric artery, assumes an oblique course through the canal, and thus closely simulates the external variety of inguinal hernia, Fig. 7, Plate 41. If the hernia enter the canal, as represented in Fig. 1, Plate 42, it becomes invested by the same structures, and assumes the same position in respect to the spermatic vessels, as the external hernia.
Plate 42--Figure 1
PLATE 42, Fig. 2.--The hernial sac, 11, which entered the ring of the fibrous tube, 2, 2, at a point immediately internal to the epigastric artery, 9, may, from having been at first oblique, as in Fig. 1, Plate 42, assume a direct position. In this case, the ring of the fibrous tube, 2, 2, will be much widened; but the artery and spermatic vessels will remain in their normal position, being in no wise affected by the gravitating hernia. If the conjoined tendon, 6, be so weak as not to resist the gravitating force of the hernia, the tendon will become bent upon itself. If the umbilical cord, 10, be side by side with the epigastric artery at the time that the hernia enters the mouth of the fibrous tube, then, of course, the cord will be found external. If the cord lie towards the pubes, apart from the vessel, the hernia may enter the fibrous tube between the cord, 10, and artery, 9. [Footnote:] It is impossible for any internal hernia to assume the congenital form, because the neck of the original serous spermatic tube, 11, Fig. 2, Plate 41, being external to the epigastric artery, 9, cannot be entered by the hernia, which originates internally to this vessel.
[Footnote: M. Cloquet states that the umbilical cord is always found on the inner side of the external hernia. Its position varies in respect to the internal hernia, (op. cit. prop. 52.) ]
