. Surgery, its principles and practice . een undertaken on a large scale. In this variety of interstitial hernia thesac, after emerging from the external ring,extends upward, resting upon the aponeu-rosis of the external oblique, lying betweenthe latter and the superficial fascia. It ispractically always associated with unde-scended or maldescended testis and is notnearly so rare as is generally believed. Inproof of the comparative frequency of in-guino-superficial hernia, it may be statedthat it was found in no less than 26 casesout of a total of 123 cases of undescendedtestis associated with
. Surgery, its principles and practice . een undertaken on a large scale. In this variety of interstitial hernia thesac, after emerging from the external ring,extends upward, resting upon the aponeu-rosis of the external oblique, lying betweenthe latter and the superficial fascia. It ispractically always associated with unde-scended or maldescended testis and is notnearly so rare as is generally believed. Inproof of the comparative frequency of in-guino-superficial hernia, it may be statedthat it was found in no less than 26 casesout of a total of 123 cases of undescendedtestis associated with hernia in which op-eration for the radical cure was done at theHospital for Ruptured and Crippled. Ihave operated upon ten additional cases inadults. The accompanying cuts (Figs. 35,36) show very clearly the position of the sac. Etiology.—Macready* states that when the sac ascends upon theexternal oblique a gap is usually, if not always, present in that muscle,so that the external and internal rings coincide, it is as if the anterior. Fig. -Inguino-superficialHernia. INGUINAL HERNIA. 65 abdominal wall were absent. As the hernia cannot descend upon thethigh on account of the attachment of the abdominal fascia to Poupartsligament, it must ascend in the hne of least resistance. This explanation I believe to be incorrect, based, as it was at that time, upon avery small number of reported cases, and most of these lacking in accurate anatomicdescription. Furthermore, few, if any, cases in children had then been reported,and it is these cases in early life that naturally offer the best opportunities for astudy in etiology. Our own cases have failed to show a single gap in the externaloblique, and instead we have found a perfectly normal inguinal canal; but the sac,instead of entering the scrotum, is turned abruptly upward and outward 2 to 3inches, until, in some cases, it nearly reaches the anterior superior spine. Mostof the children were between six and ten years of age, and
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