A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments, remedies and applications employed in surgery : the etymology and signification of the principal terms : ... forming together a "catalogue raisonné" of surgical literature (Volume 2).

  • Cooper, Samuel, 1780-1848.
Date:
1823
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments, remedies and applications employed in surgery : the etymology and signification of the principal terms : ... forming together a "catalogue raisonné" of surgical literature (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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    troduced upward and outward into the abdo- minal ring. The precise point at which the hernia most commonly begins, (says Scarpa.) i3 that which corresponds,in lhefceius,to the commu- nication of (lie tunica vaginalis with the pe- ritoneum, and, in the adult, to the passage of the spermatic cord under the transversa muscle. In the sound state, (he peritoneum presents at this part a small funnel-like de- pression, the depth of which increases in pro- portion as the spermatic cord is pulled from above downwards. It is this small pouch, this sort of digital appendage, whose pro- gressive augmentation constitutes the hernial sae. Resting upon the anterior surface of the spermatic cord, it first makes its appear- ance under the inferior edge of the trans- verse muscle ; thence it extends itself in the separation of the inferior fleshy fibres, of the internal oblique muscle, always following the spermatic cord, in front of which it is situa- ted ; and after having in this manner passed through the whole of (he canal, which ex- tends from the iliac region to the pubes, it lastly protrudes at its external orifice, which is the inguinal (or abdominal) ring, properly so called. In all this track, the hernial sac, sis well as tha spermatic cord, is situated above the femoral arch, the direction of which it follows. The canal, which it tra- verses, is of a conical shape, the apex of which is towards the flank, and the base at the external orifice of the ring. (Scarpa, Traili des Hermes, p. 44, 45.) The epigastric artery runs behind the spermatic cord, along the inner margin of the internal opening of the above canal, then upwards and inwards, so as to pass at the distance of half an inch oraa inch from the upper extremity of (he outer opening, or abdominal ring. In common cases of inguinal hernia, the viscera, protruded at the inner opening of the inguinal canal, lie over the spermatic cord, and form a tumour on (he outside of the abdominal ring. When the viscera have entered the above described digital pouch of the peritoneum, but do not protrude through the abdominal ring, the case is sometimes termed an incom- plete inguinal hernia; and complete when they pass out of (hat opening. The viscera may continue for a long while quite within (he inguinal canal, and even become stran- gulated there : sometimes, also, they are prevented from passing further towards the ring by some kind of impediment; and, in this circumstance, if tha hernial sac have any addition made to its contents, it may ex- pand between the external and internal ob- lique muscles, ai Hesselbach had an opportu- nity of seeing in the body of a female. (Ucber den Ursprung, <§»c. der Lcislcn-niid- Schcnkelbrllche, p. 28.) The stricture may take place either at the internal or external opening of the inguinal canal. In recent and small hernia) according to Mr. A. Cooper, I he strangulation is most frequently situated at (he inner opening; in large old ruptii Bl the abdominal ring. V.wn when the parts Yo,.. II. 3 nrc completely prolruded out of the latter opening, the strangulation may exist at the inner one,; but there may occasionally be two strictures, viz. one at each opening. (See Laurence on Ruptures,p. 183, Edit. 3.) The hernial sac descends through the ab- dominal ring over the spermatic cord, and is covered by a fascia, sent oft from (he (endon of the external oblique muscle. Beneath this fascia, (he cremasler muscle is also situ- ated over the sac, which, after it has de- scended a certain way, lies on the tunica vaginalis, as well as the spermatic cord. As the epigastric artery naturally runs first behind the spermatic cord, and then along the inner margin of the internal opening of the ring, and as the viscera are protruded over the cord, they must be situated on the outer side of the artery, which runs first be- hind the neck of the sac, and then on its inner side. Hence, the inner margin of the sac, when inspected on the side towards (he abdomen, seems (o be formed, as it were, by (he track of the vessel. (See Lawrence, p. 179) That this is the ordinary situation of the epigastric artery, in relation to the ingui- nal hernia, is confirmed by the concurrent testimonies of Camper, Chopart, Dcsault, Sabatier, A. Cooper, Hesselbacb, Scarpa, Lc. and by preparations to be seen in almost every museum, In recent inguinal hernia?, the internal and external openings of the ring are at some distance from each other, the first being situ- ated obliquely upwards and outwards in rela- tion to the former; but the pressure of the protruded viscera, gradually forces the inter- nal opening more towards the pubes, and nearer to the abdominal ring, so as to render the posterior side of the neck of the hernial sac, and of the inguinal canal, very short. (Hesselbacli, p. 29.) Thus, in large herniae of long standing, the opening into the abdo- men is almost direct, and the epigastric artery becomes situated nearer the pubes, than in the natural state. Though such is the ordinary direction, in which a bubonocele protrudes, there are oc- casional varieties. In one of these, the vis- cera, instead of descending through the canal of the ring, are hi once thrust through the abdominal ring itself, and the opening into the beliy i3 then direct : the hernial sac, instead of passing on the external side of the spermatic vessels, as is usual, now lies on their inner,or pubic side ; a'ld the epigas- tric artery, which is commonly situated be- hind, now pursues its course, in front of the sac, at its usual distance from the upper and ouU-r un^lc of the abdominal ring. The following is Scarpa's description of the displacement of the epigastric artery in the greater number of cases of inguinal her- nia. This artery, which in the natural stale, runs about (en lines from the abdomi- nal ring, has its situation and direction so changed, in subjects affected with hernia, that it crosses the posterior part of the neck of the hernial sac, and is pushed from the outer to the inner side of the abdominal ring. Im order to comprehend the reason of this