. Annals of surgery . erior wall is said to be made up of a fascia transversalis. In subjects ofweak musculature, the lower portion of the transversalis is poorly developed,and its giving way marks the starting point of a direct hernia. As the herniaenlarges it spreads across the triangle to the edge of the rectus, and in suchcases a conjoined tendon is a scarcely demonstrable structure. In subjects,however, with a strong musculature, one at times encounters an opening,usually circular in outline, in a well developed conjoined tendon, lying close to * Read before the American Surgical Associat
. Annals of surgery . erior wall is said to be made up of a fascia transversalis. In subjects ofweak musculature, the lower portion of the transversalis is poorly developed,and its giving way marks the starting point of a direct hernia. As the herniaenlarges it spreads across the triangle to the edge of the rectus, and in suchcases a conjoined tendon is a scarcely demonstrable structure. In subjects,however, with a strong musculature, one at times encounters an opening,usually circular in outline, in a well developed conjoined tendon, lying close to * Read before the American Surgical Association. June i. 1923. 300 HERNIA THROUGH THE CONJOINED TENDON the rectus border, with Pouparts ligament below and to its outer side havinga fairly firm fibrous margin made of conjoined tendon fibres. This t\-pe of hernia is no doubt much less frequent in its occurrence thanthe ordinary direct variety, but is not by any means a surgical curiosity; allsurgeons of experience with hernias must have encountered it a number of. Fig. X.—Serai-diaKTammatic dissection of right inguin^ re^on. 4.* Location pf point ofemergence of semiluoar line hernia. B. Usual point of emergence of direct inguinal hernia. times. In the preparation of this paper the writer has reviewed the recordsof eleven cases seen within the last three years at St. Lukes Hospital. It is rather surprising that one sees so little reference to it in tlieliterature. The older editions of Grays Anatomy clearly contrast the twovarieties, and suggest a different relation in the two cases to the obliteratedhypogastric artery-. Erdmann in a sentence says direct hernia often emergesthrough a definite split in the fascia : Downes clearly distinguishes the twotypes of hernia, calling the one direct and the other hernia of the linea semi-lunaris. He brings nut both in the text and drawings the different locationsand anatomical peculiarities of the two hernias. Most descriptions of directhernia fail to mention this variety, hence are
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
