44 LANDMARKS MEDICAL AND SURGICAL. 



furrow begins at the angle between the scrotum and the 

 thigh, passes outwards, and is gradually lost between the 

 top of the trochanter and the anterior superior spine of the 

 ilium. It runs right across the front of the capsule of the hip- 

 joint. For this reason it is a valuable landmark in amputa- 

 tion at the hip-joint. The point of the knife should be intro- 

 duced externally where the furrow begins, should run precisely 

 along the line of it, and come out where it ends ; so that the 

 capsule of the joint may be opened with the first thrust. In 

 suspected disease of the hip pressure made in this line, just 

 below the spine of the ilium, will tell us if the joint be tender. 

 Effusion into the joint obliterates all trace of the furrow, 

 and makes a fulness when contrasted with the opposite 

 groin. 



95. Saphenous opening 1 . In most persons there is a 

 natural depression over the saphenous opening in the fascia 

 lata, where the saphena vein joins the femoral. The position 

 of this opening is just below the inner third of Poupart's liga- 

 ment, and about an inch and a half external to the spine of 

 the pubes. This is the place where the swelling of a femoral 

 hernia first appears : therefore it ought to be carefully exa- 

 mined in cases of doubt. 



96. Femoral ring-. The position of the femoral ring, 

 through which the hernia escapes from the abdomen, is, on a 

 deeper plane, about half an inch higher than the saphenous 

 opening, and immediately under Poupart's ligament. As the 

 plane of the ring is vertical in the supine position of the body, 

 the way in which we should try to reduce a femoral hernia is 

 by pressure, applied first in a downward direction, afterwards 

 in an upward. The intestine protruded has to pass back 

 under a sharp edge of fascia, namely, the upper horn of the 

 saphenous opening (known as Hey's ligament). At the same 

 time we bend the thigh, to relax the fascia as much as 

 possible. 



A good way to find the seat of the femoral ring with 

 precision is the following : Feel for the pulsation of the 

 femoral artery on the pubes ; allow half an inch (on the inner 

 side) for the femoral vein ; then comes the femoral ring. 



