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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![Lefore remarked the causes tending to an erroneus judwmenfc of liic case, the wise surgeon would always adopt tlie safety incision of Sir A. Cooper, who advises an incision directly upwards; a practice founded upon anatomical considerations, and tested hy repeated trials. The third species of Inguinal Hernia, is by some termed direct Hernia, because not traversing the inguinal canal, it passes directly forwards from the a])domen, through the external abdomino-inguin- al aperture. By Hepelbach, this Hernia is termed Hernia inter- na, because the mouth of the herniary sac in this species, is situat- ed on the inner side of the epigastric artery, with respect to the mesial line of the body. In considering the structure of the inguin- al canal, we have seen that the abdominal contents are prevented from protruding under ordinary circumstances, Istly, by the obliqui- ty of the canal through which the cord emerges; and 2ndly, by the strength of the posterior parietes of the canal, opposite the external abdomino-inguinal aperture. The posterior boundary of the canal at that point is formed by the united tendon of the internal oblique and transversalis muscles, as they pass to be inserted into the pubis and Girabernat's ligament. Behind the transversalis muscles, is si- tuated the fascia transversalis; and, in addition to these parts, in order to strengthen still farther this portion of the abdominal parie- tes, so exposed to pressure, we find a number of tendinous fibres running obliquely from the linea alba to Poupart's ligament, by which disposition these parts are rendered lighter and more resisting, as the pressure becomes more intense. Thus strengthened, we should be inclined to consider hernial protrusion at this point as nearly im- possible, were it not that dissection has proved its existence. The direct Inguinal Hernia may be the result of relaxation, rather than violence; and when so^ the Hernia takes the following course :— carrying before them the peritoneum, which lies upon that portion of the fascia transversalis, lining the inter7ial surface of the trans- versalis muscle, opposite the external abdomino-inguinal aperture; the hernial contents having thus formed a sac, push before them the fascia transversalis: then pushing forwards the conjoined tendon of the internal oblique and transversalis muscles, and also the diagonal fibres, passing from the linea alba to Poupart's ligament, the Hernia makes its appearance at the external abdomino-inguinal aperture. At this point it emerges, and becomes covered by the fascia sperma- tica, as it passes from the margin of the external aperture of the In- guinal canal to invest the cord and cremaster. If the Hernia pro- trude farther, it may become slightly covered as it descends into the scrotum, by the internal margin of the cremaster muscle. If the cremaster be not much developed, this covering is wanting, and the sac receives its next covering from the fascia superficialis, and lastly, from the skin and integuments. If then, we divide the investments of a direct Inguinal Hernia from the surface of the body, till we arrive within the sac, supposing the Hernia to have been the result of gradual relaxation of the posterior parietes of the inguinal canal.](https://iiif.wellcomecollection.org/image/b22275605_0065.jp2/full/800%2C/0/default.jpg)
