Journal : Photographic review of medicine & surgery ; vol. 2., no. 3.
Philadelphia : J. B. Lippincott & Co., 1871-72.
Description : 23-24 p.,  pl. ; ill.: 1 photo. ; 24 cm.
Photograph : mounted albumen.
Subject : Inguinal canal — Hernia.
THE accompanying photograph forcibly represents to what extent a simple inguinal hernia, in the absence of therapeutic measures, may extend. Its possessor, a vagrant, aged 40 years, holds it more as a legacy in trust than a misfortune, as it gives him a hold upon the hand of charity; and even were it possible, would unhesitatingly object to any measures that looked towards a radical cure.
As far as can be learned, the affection was congenital, or at least came on a short time after birth. Originally a double oblique inguinal hernia, it gradually descended into the scrotum, where it remained without support. As the internal abdominal ring was gradually drawn behind the external, thus converting the hernia into one of direct descent, the canal sympathized with the flabby condition of the man, and became enlarged and patulous. At the present time the whole mass of small intestines and omentum seem lodged in the scrotum, and a supplementary sac formed in the left inguinal region. The penis is almost lost in the mass of the swelling, and looks very much like an umbilicus upon a protuberant abdomen. In such a case as this, none of the various operations devised for the radical cure of hernia, as those proposed by Dzondi, Jameison, Gerdy, Signorini, Wutzer, Armsby, Huchenberg, Mayer, Wood, Agnew, and Gross, could be effectually performed. In the first place, hardly enough plastic matter could be effused to obliterate the abdominal aperture; and secondly, experience shows that when the canal is much diminished in length, and increased in diameter, as occurs in this case, where the orifices of the canal are in the same line, and immediately above each other, a cure will generally be impracticable by any method whatever. Professor Gross, however, relates the case of a man, aged 61 years, upon whom he operated for a large scrotal hernia, at the Philadelphia Hospital, in 1861, with perfect success. The parts were cut down upon and approximation effected with three silver- wire sutures, the latter being carried through the muscular edges of the wound.
The introduction of substances into such a large sac as this with a view to excite adhesive inflammation, as has been done in less extensive cases by Belmas, Bowman, and Professor Pancoast, would subject the patient to almost certain peritonitis.
Enlarged inguinal lymphatic glands may sometimes occupy the inguinal canal, resembling a hernia so much as to almost puzzle the pathologist in his dissection for them. I remember presenting a specimen of this kind to the Pathological Society, a report of the same being published in their Proceedings (vol. iii. pp. 156, 157), in which a cluster of these enlarged glands lay along the course of the external iliac artery. Two of the largest of them lay within the inguinal canal, and the point of one had pushed the peritoneum before it and protruded at the external ring. The constriction between the two glands made the resemblance to a strangulated hernia perfect.