Essays. I. On the anatomy, physiology, and pathology of the great sympathetic nerve / by James Wilkes. II. On the anatomy of inguinal hernia ; by William Hammond.
- Wilkes, J. (James), active 19th century.
- Date:
- 1833
Licence: Public Domain Mark
Credit: Essays. I. On the anatomy, physiology, and pathology of the great sympathetic nerve / by James Wilkes. II. On the anatomy of inguinal hernia ; by William Hammond. 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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![]ar tissue, which, in the scrotum, forms the two serous tunics of the testis. Continuing to emerge from the abdomen, under cover of the infundibuliform fascia, the hernial sac (formed by the protruded peritoneum) passes with its contents beneath the curved border of the internal oblique and transversalis, or through their separate fibres, according to the course which the cord follows in leaving the abdomen. Having entered the inguinal canal, the Hernia next passes beneath the fibres of the cremasier muscle, and still protrud- ing, at length appears at the external abdomino-inguinal aperture. Proceeding in its progress, it descends in front of the cord into the scrotum ; and separating the fore part of the tunica vaginalis re- flexa from the more external investments, by stretching the cellu- lar tissue which connects them, we observe, that at length the bulk of the Hernia lies in front of the superior part of the testis, constituting scrotal or rather inguino-scrotal Hernia. Such is its ultimate destination in the male ; but, in the female, the Hernia, after passing the external abdomino-inguinal aperture, descends into the loose cellular tissue of the labia pudendi, and becomes inguino- labial Hernia. The investments of this species of Hernia must necessarily vary in the two sexes, which shall be noticed as we pro- ceed. Having traced the course of oblique inguinal hernia till it has become inguino-scrotal, it is necessary that its investments should be examined with reference to Surgery; that is, that we should as- certain through what parts an incision should pass, that should lay open the herniary sac, and expose its contents. Such incision first divides the skin and common integuments, the division of which ex- poses the second covering, viz., the fascia superficialis, which we have before described as becoming converted on the scrotum into the contractile membrane termed dartos, by the developement of a peculiar substance between the lamellse of the fascia. Having di- vided this second covering, we find another fascial investment, coming off from the margin of the external abdomino-inguinal aper- ture : this I have before described as the continuation of the inter- columnar fascia upon the cord and cremaster muscle, under the name of fascia spermatica. This fascia spermatica forms the third investment of this species of Hernia. Dividing this fascia cautious- ly, our incision next exposes the fibres of the cremaster muscle, which forms the fourth covering. Having divided these muscular fibres, we may, with great care, detect the infundibuliform fascia upon the lierniary sac, but it soon becomes incapable of demonstra- tion. This fascia forms the fifth covering, beneath which, and separating it from the anterior surface of the tunica vaginalis re- flex a, we find the sixth covering of the hernial contents; viz., the herniary sac, formed in this Hernia, by that portion of peritoneum which the Hernia has pushed before it when quitting the abdomen. In looking over these investments we find that this Hernia has the same number of coverings as simple Congenital Plernia, the only difference being that the latter lies in closer relation to the testis.](https://iiif.wellcomecollection.org/image/b22275605_0063.jp2/full/800%2C/0/default.jpg)
