Title: Surgical Anatomy
Author: Joseph Maclise
Release Date: January 27, 2008 [EBook #24440]
Language: English
Produced by Don Kostuch
...
serous spermatic tube, 6 b, 6 c, becomes obliterated, according to the
normal rule, after the descent of the testicle, 7, the tunica vaginalis,
6 d, is then a distinct serous sac. If a hydrocele form in this sac, it
may be distinguished from the congenital variety by its remaining
undiminished in bulk when the subject assumes the horizontal position,
or when pressure is made on the tumour, for its contents cannot now be
forced into the abdomen. The testicle, 7, holds the same position in
this as it does in the congenital hydrocele. [Footnote] The radical cure
may be performed here without endangering the peritonaeal sac.
Congenital hydrocele is of a cylindrical shape; and this is mentioned as
distinguishing it from isolated hydrocele of the tunica vaginalis, which
is pyriform; but this mark will fail when the cord is at the same time
distended, as it may be, in the latter form of the complaint.

[Footnote: When a hydrocele is interposed between the eye and a strong
light, the testis appears as an opaque body at the back of the tunica
vaginalis. But this position of the organ is, from several causes,
liable to vary. The testis may have become morbidly adherent to the
front wall of the serous sac, in which case the hydrocele will distend
the sac laterally. Or the testis may be so transposed in the scrotum,
that, whilst the gland occupies its front part, the distended tunica
vaginalis is turned behind. The tunica vaginalis, like the serous
spermatic tube, may, in consequence of inflammatory fibrinous effusion,
become sacculated-multilocular, in which case, if a hydrocele form, the
position of the testis will vary accordingly.--See Sir Astley Cooper's
work, ("Anatomy and Diseases of the Testis;") Morton's "Surgical
Anatomy;" Mr. Curling's "Treatise on Diseases of the Testis;" and also
his article "Testicle," in the Cyclopaedia of Anatomy and Physiology.]


[Illustration: Abdomen and scrotum, showing bone, blood vessels
and other internal organs.]
Plate 40--Figure 3.


PLATE 40, Fig. 4.--The serous spermatic tube remaining pervious, a
congenital hernia is formed.--When the testicle, 7, has descended to the
scrotum, if the communication between the peritonaeum, 6 a, and the
tunica vaginalis, 6 c, be not obliterated, a fold of the intestine, 13,
will follow the testicle, and occupy the cavity of the tunica vaginalis,
6 d. In this form of hernia (hernia tunicae vaginalis, Cooper), the
intestine is in front of, and in immediate contact with, the testicle.
The intestine may descend lower than the testicle, and envelope this
organ so completely as to render its position very obscure to the touch.
This form of hernia is named congenital, since it occurs in the same
condition of the parts as is found in congenital hydrocele--viz., the
inguinal ring remaining unclosed. It may occur at any period of life, so
long as the original congenital defect remains. It may be distinguished
from hydrocele by its want of transparency and fluctuation. The impulse
which is communicated to the hand applied to the scrotum of a person
affected with scrotal hernia, when he is made to cough, is also felt in
the case of congenital hydrocele. But in hydrocele of the separate
tunica vaginalis, such impulse is not perceived. Congenital hernia and
hydrocele may co-exist; and, in this case, the diagnostic signs which
are proper to each, when occurring separately, will be so mingled as to
render the precise nature of the case obscure.


[Illustration: Abdomen and scrotum, showing bone, blood vessels
and other internal organs.]
Plate 40--Figure 4.


PLATE 40, Fig. 5.--Infantile hernia.--When the serous spermatic tube
becomes merely closed, or obliterated at the inguinal ring, 6 b, the
lower part of it, 6 c, is pervious, and communicating with the tunica
vaginalis, 6 d. In consequence of the closure of the tube at the
inguinal ring, if a hernia now occur, it cannot enter the tunica
vaginalis, and come into actual contact with the testicle. The hernia,
13, therefore, when about to force the peritonaeum, 6 a, near the closed
ring, 6 b, takes a distinct sac or investment from this membrane. This
hernial sac, 6 e, will vary as to its position in regard to the tunica
vaginalis, 6 d, according to the place whereat it dilates the
peritonaeum at the ring. The peculiarity of this hernia, as
distinguished from the congenital form, is owing to the scrotum
containing two sacs,--the tunica vaginalis and the proper sac of the
hernia; whereas, in the congenital variety, the tunica vaginalis itself
becomes the hernial sac by a direct reception of the naked intestine. If
in infantile hernia a hydrocele should form in the tunica vaginalis, the
fluid will also distend the pervious serous spermatic tube, 6 c, as far
up as the closed internal ring, 6 b, and will thus invest and obscure
the descending herniary sac, 13. This form of hernia is named infantile
(Hey), owing to the congenital defect in that process, whereby the
serous tube lining the cord is normally obliterated. Such a form of
hernia may occur at the adult age for the first time, but it is still
the consequence of original default.


[Illustration: Abdomen and scrotum, showing bone, blood vessels
and other internal organs.]
Plate 40--Figure 5.


PLATE 40, Fig. 6.--Oblique inguinal hernia in the adult.--This variety
of hernia occurs not in consequence of any congenital defect, except
inasmuch as the natural weakness of the inguinal wall opposite the
internal ring may be attributed to this cause. The serous spermatic tube
has been normally obliterated for its whole length between the internal
ring and the tunica vaginalis; but the fibrous tube, or spermatic
fascia, is open at the internal ring where it joins the transversalis