ck of the sac of an external inguinal hernia formed before the
spermatic vessels.

Q. An interval which occasionally occurs between the umbilical ligament
and the epigastric artery.

R and Q. Situations where the direct inguinal hernia occurs when, as in
this case, the umbilical ligament crosses the space named the
internal fossa--the triangle of Hesselbach.

S. Lower part of the right spermatic cord.

T. The bulb of the urethra.

U. External iliac vein covered by the peritonaeum.

V. External iliac artery covered by the peritonaeum.

W. Internal iliac artery.

X. Common iliac artery.

[Illustration: Abdomen, showing bones, blood vessels, muscles
and other internal organs.]
Plate 32

PLATE 33.--The External Inguinal Hernia.

A. Anterior iliac spinous process.

B. The umbilicus.

C. Fleshy part of the external oblique muscle; c, its tendon.

D. Fleshy part of the internal oblique muscle; d, its tendon.

E. Transversalis muscle; e, the conjoined tendon.

F f. The funnel-shaped sheath of the spermatic vessels covering the
external hernia; upon it are seen the cremasteric fibres.

G g. The peritonaeal covering or sac of the external hernia within the
sheath.

H. The external abdominal ring.

I. The crista pubis.

K k. The saphenous opening.

L. The saphena vein.

M. The femoral vein.

N. The femoral artery; n, its profunda branch.

O. The anterior crural nerve.

P. The epigastric vessels overlaid by the neck of the hernia.

Q Q. The sheath of the femoral vessels.

R. The sartorius muscle.

S. The iliacus muscle.

[Illustration: Abdomen and leg, showing blood vessels, muscles
and other internal organs.]
Plate 33

PLATE 34.--The Internal Inguinal Hernia.

The letters indicate the same parts as in Plate 33

[Illustration: Abdomen and leg, showing blood vessels, muscles
and other internal organs.]
Plate 34

COMMENTARY ON PLATES 35, 36, 37, & 38.

THE DISTINCTIVE DIAGNOSIS BETWEEN EXTERNAL AND INTERNAL
INGUINAL HERNIAE, THE TAXIS, THE SEAT OF STRICTURE, AND THE OPERATION.

A comparison of the relative position of these two varieties of herniae
is in ordinary cases the chief means by which we can determine their
distinctive diagnosis; but oftentimes they are found to exhibit such an
interchange of characters, that the name direct or oblique can no longer
serve to distinguish between them. The nearer the one approaches the
usual place of t