Further considerations on the anatomy of oblique inguinal hernia / by John H. Packard.

  • John Hooker Packard
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Further considerations on the anatomy of oblique inguinal hernia / by John H. Packard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    tfve CfuJ&otV So-M-tf [Reprinted from the Transactions of the American Surgical Association, 1895.] CT1' —y • y i f— l ON THE ANATOMY OF OBLIQUE INGUINAL HER- NIA, WITH SPECIAL REFERENCE TO THE OPERATION FOR ITS RADICAL CURE, AND A DESCRIPTION OF A MODI- FIED PROCEDURE FOR THIS PURPOSE. By JOHN H. PACKARD, M.D., SURGEON TO PENNSYLVANIA HOSPITAL AND TO ST. JOSEPH’S HOSPITAL, PHILADELPHIA. According to the accepted teachings of standard authorities on anatomy and surgery, the hernial sac, in cases of the oblique or indirect inguinal variety, comes down from the abdominal cavity through the tube, derived from the transversalis fascia, which encloses the spermatic vessels and duct, and the lumen of which is the so-called inguinal canal. Among the coverings of this species of hernia is always mentioned the infundibuliform fascia, which is easily demonstrated as a close investment of the constituents of the cord. On this view a soft knuckle of bowel pushes before it the parietal peritoneum, and forces its way into the narrow tube, alongside of the spermatic duct and vessels, stretching the tube open until it emerges at the external ring. One writer distinctly says that the hernia “ forces the internal ring.” And in a work of wide reputation the canal is figured as partly so distended, the dilated and undilated portions being readily dis- tinguishable. It seems to me that if this idea be correct every scrotal hernia would be of the variety known as infantile, having only sac and tunica vaginalis between the bowel and the testis. Moreover, it would seem that the occurrence, rare as it is, of properitoneal