. The principles and practice of modern surgery . gs. Varieties.—There are four varieties. The oblique,—direct,—conge-nital,—and encysted. (1.) The oblique inguinal hernia is the most common. It takes preciselythe same route as the testicle takes in its passage from the abdomen intothe scrotum. It commences as a fulness or swelling at the situation of theinternal abdominal ring, that is to say, a little above the centre of Poupartsligament,—next passes into the inguinal canal (and in this stage is calledbubonocele)—and if the protrusion increase, it projects through the externalring, and desce
. The principles and practice of modern surgery . gs. Varieties.—There are four varieties. The oblique,—direct,—conge-nital,—and encysted. (1.) The oblique inguinal hernia is the most common. It takes preciselythe same route as the testicle takes in its passage from the abdomen intothe scrotum. It commences as a fulness or swelling at the situation of theinternal abdominal ring, that is to say, a little above the centre of Poupartsligament,—next passes into the inguinal canal (and in this stage is calledbubonocele)—and if the protrusion increase, it projects through the externalring, and descends into the scrotum of the male, or labium of the coverings of this hernia are, 1, Skin. 2, A strong layer of condensedcellular tissue, derived from the superficial fascia of the abdomen, in whichthe external epigastric artery ramifies. With this is mostly incorporated,3, the fascia spermatica,—a tendinous layer, derived from the interco-lumnar bands, a set of semicircular fibres which connect the two margins Fig. of the external ring. Under this lies, 4, the cremaster muscle,—sometimescalled tunica communis. 5. Next comes the fascia propria,—a cellularlayer continuous with the fascia transversalis of the abdomen ; and lastly,6, the sac. The internal epigastric artery is always internal to the neck * Travers, case of Hernia, &c., Med. Chir. Trans., vol. xxiii. ■{■This diagram, copied from Tiedemann, gives an internal view of the parts con-cerned in the formation of hernia; and on the left side shows the usual place at whichdirect inguinal hernia protrudes. 37* 438 INGUINAL HERNIA. of the sac. The spermatic cord is generally behind the sac; but, in oldcases, the parts which compose the spermatic cord are separated by thetumour, so that the vas deferens and spermatid artery lie sometimes infront, sometimes on either side of it. 2. The direct inguinal hernia bursts through the conjoined tendon of theinternal oblique and transversalis muscle
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