It is not
possible to distinguish by any special character a hernia of this
nature, when already formed, from one which occurs in the condition of
parts proper to Fig. 1, Plate 41, or that which is described in the note
to Fig. 2, Plate 41; for when the intestine dilates the tube, 11, into
the form of a sac, this latter assumes the exact shape of the sac, as
noticed in Fig. 1, Plate 41. The hernia in question cannot enter the
tunica vaginalis. Its position in regard to the epigastric and spermatic
vessels is the same as that mentioned above.

[Illustration: Abdomen, showing bone, blood vessels
and other internal organs.]
Plate 41--Figure 3

PLATE 41, Fig. 4.--If the serous spermatic tube, 11, be obliterated or
closed at the internal ring, 1, thus cutting off communication with the
general peritonaeal membrane; and if, at the same time, it remain
pervious from this point above to the tunica vaginalis below, then the
herniary bowel, when about to protrude at the point 1, must force and
dilate the peritonaeum, in order to form its sac anew, as stated of Fig.
1, Plate 41. Such a hernia does not enter either the serous tube or the
tunica vaginalis; but progresses from the point 1, in a distinct sac. In
this case, there will be found two sacs--one enclosing the bowel; and
another, consisting of the serous spermatic tube, still continuous with
the tunica vaginalis. This original state of the parts may, however,
suffer modification in two modes: 1st, if the bowel rupture the
peritonaeum at the point 1, it will enter the serous tube 11, and
descend through this into the cavity of the tunica vaginalis, as in the
congenital variety. 2nd, if the bowel rupture the peritonaeum near the
point 1, and does not enter the serous tube 11, nor the tunica
vaginalis, then the bowel will be found devoid of a proper serous sac,
while the serous tube and tunica vaginalis still exist in communication.
In either case, the hernia will hold the same relative position in
regard to the epigastric artery and spermatic vessels, as stated of Fig.
1, Plate 41.

[Illustration: Abdomen, showing bone, blood vessels
and other internal organs.]
Plate 41--Figure 4

PLATE 41, Fig. 5.--Sudden rupture of the peritonaeum at the closed
internal serous ring, 1, though certainly not impossible, may yet be
stated as the exception to the rule in the formation of an external
inguinal hernia. The aphorism, "natura non facit saltus," is here
applicable. When t