. The anatomy and surgical treatment of hernia. ependent for its nutrition upon the sources of blood-supplyformed by abundant and oftentimes very vascular adhesions, extending quite into thescrotum. Not seldom does it happen that the constriction at the neck of the sac, atthe internal ring, has so changed the structures that it is reduced to an imperfectly vas-cularized, non-elastic band of connective-tissue fibers, compressed together in adherent,plicated folds, as is a bag by the constriction of tying. This disposition of the partsalone reduces its nutrition to such a degree that the hernial
. The anatomy and surgical treatment of hernia. ependent for its nutrition upon the sources of blood-supplyformed by abundant and oftentimes very vascular adhesions, extending quite into thescrotum. Not seldom does it happen that the constriction at the neck of the sac, atthe internal ring, has so changed the structures that it is reduced to an imperfectly vas-cularized, non-elastic band of connective-tissue fibers, compressed together in adherent,plicated folds, as is a bag by the constriction of tying. This disposition of the partsalone reduces its nutrition to such a degree that the hernial sac is dependent upon itsacquired blood-supply for its vitalization. The following plate, from Sir Astley Cooper, is selected as a beautiful illustration ofthe changes which supervene in the peritoneal sac in femoral hernia. These pertain ina greater degree to inguinal hernia, where the sac and contents often assume very muchlarger proportions. In Figure i the hernial sac is small, non-adherent, and well vitalized. It could Plate LVIII. ^..?.. OPERATIVE MEASURES UNDER ANTISEPTIC CONDITIONS IN AMERICA. 357 be returned, doubtless, without damage to its vitality, and, when aseptically suturedat the mouth of the ring, would speedily agglutinate and retain its nutrition. In Figure 2, on the contrary, the peritoneal sac is externally firmly adherent tothe superficial fascia ; while within, the omental contents are closely fixed to its innerlayer. The constriction at the base had almost altogether cut off its blood-supplythrough the plicated folds at the ring. To attempt to utilize the material in a caselike this, which the deformed sac furnishes, folded upon itself and pushed within thering, would very likely be followed by the most disastrous consequences. Fig2ire 4 is worthy of especial study, but not in connection with the present sub-ject, since it illustrates the anatomical deviation of the obturator artery passing beforeand on the inner side of the neck of the sac. This not ve
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Keywords: ., bookcentury1800, bookdecade1890, booksubjecthernia, bookyear1892
