. Abdominal hernia : its diagnosis and treatment. 1 I showing the enortnous size which scrotal may attain by neglect. Right obliqueinguinal hernia (scrotal) in a man over 70 years of age. SO, but in some persons with abnormally short canals theartery runs lower down, and while actually tlie protrusion isoblique, it has every appearance of a direct hernia. It mustbe remembered therefore in operating, that the deep epigastricartery may be found at either side of the neck of the hernialsac. TYPES OF INGUINAL HERNIA. 59 Hernire of the direct type are not met with as frequently inwomen as i
. Abdominal hernia : its diagnosis and treatment. 1 I showing the enortnous size which scrotal may attain by neglect. Right obliqueinguinal hernia (scrotal) in a man over 70 years of age. SO, but in some persons with abnormally short canals theartery runs lower down, and while actually tlie protrusion isoblique, it has every appearance of a direct hernia. It mustbe remembered therefore in operating, that the deep epigastricartery may be found at either side of the neck of the hernialsac. TYPES OF INGUINAL HERNIA. 59 Hernire of the direct type are not met with as frequently inwomen as in men, and the reasons for this are shown in therecent studies of Marie Dunati (Arclikio per Ic SlicnzcMedischc, No. 3, 1905; Abstract Medical Record. July 8,1905). He believes that the smaller number of the directinguinal type that we find in women, is due to the differentformation of the inguinal canal in tlie two , and to estab- FlG. Showing oblique inguinal (labial) hernia in a woman of 45 years. lish this conclusion he has dissectetl 52 cadavers of both sexes,31 women. 21 men, and has found marked differences inthem. The aponeurosis of the insertion of the great obliquemuscles has linear interstices, which are much larger in themale than in the female. The pillars of the internal obliqueare stronger in front of the canal in women. The arciformfibres (inter-crural) are in women often mingled with crossfibres which strengthen the ring, which are absent in men. The 60 ABDOMINAL HERMA. orifice of the external inguinal ring is generally smaller infemales than in males. It is generally situated higher and alittle more external in men than in women, contrary to whathas been supposed t(i be the case. The aponeurosis of the largeoblique, which forms the anterior wall of the canal, is muchstronger in the female sex than in the male. The lowermargin of the ring in women is more horizontal, that in the Fig. 21.
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