A system of operative surgery: based upon the practice of surgeons in the United States, with a bibliographical index and historical record of many of their operations during a period of two hundred and thirty-four years (Volume 2).

  • Smith, Henry H. (Henry Hollingsworth), 1815-1890.
Date:
1856
Catalogue details

Licence: Public Domain Mark

Credit: A system of operative surgery: based upon the practice of surgeons in the United States, with a bibliographical index and historical record of many of their operations during a period of two hundred and thirty-four years (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    Shortly after taking its position in the scrotum, the tube-like pro- cess of the peritoneum, which then extends from the scrotum to the abdomen, is obliterated, though sometimes it remains open (con- genital hernia, congenital hydrocele), or is only closed at points (encysted hydrocele, hydrocele of the cord). The process of fascia transversalis (extra peritoneal cellular tissue), which had been pro- truded in a pouch like the peritoneum, but contracted into a tube- like prolongation on the cord, is then gradually changed, and loses its dense characters, except on the surface next to the peritoneum, where it presents a funnel-shaped depression at and around the cord, whilst the remaining layers contract upon the cord and are diminished in character and distinctness. A portion of intestine or omentum (hernia) pressing against the peritoneum at the same point of the abdominal parietes, does the same thing as the testicle did, that is, pushes a portion of the peri- toneum in advance of it, unless the sac formed by the descent of the testicle had not been cut off from its connections with the general peritoneal cavity, when it passes directly into the same sac as the testicle (congenital hernia). On reaching the fascia transversalis, it also slightly distends it into a sort of pouch; but, as the pressure is continued, the edges of this pouch at the point of pressure become thickened, especially in old hernia, and take on a defined shape, thus constituting the in- ternal ring, whilst the centre is either absorbed or converted into a reticulated structure (fascia propria), and then the tumor, passing on, takes a position in front of the cord, but also a little towards the median line of the body. Being here beneath the fibres of the transversalis and internal oblique muscles (cremaster), it escapes through the external ring, pushes before it the cellular tissue which usually fills up this ring (intercolumnar fascia), and, pressing it against the superficial fascia, the two become blended in one, and there only remains the additional covering of the skin. In ope- rating upon an inguinal hernia, there are, therefore, usually found the skin, superficial fascia, cremaster muscle, fascia propria and sac, all of which must be divided before the contents of the tumor can be made apparent. The only bloodvessels about this class of tumors are the small artery and vein, before spoken of as being found directly beneath the superficial fascia, and the epigastric artery and vein which is directly beneath the peritoneal fascia. The arteria ad cutcra abdo-