Plate 40—Figure 2.
PLATE 40, Fig. 3.—Hydrocele of the isolated tunica vaginalis.—When the 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.]
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.
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.
