830 SURGICAL ANATOMY OF FEMORAL HERNIA. 



their comparative frequency being, according to Cloquet, as one to five. It 

 occurs far more frequently in men than women, on account of the larger size 

 of the external ring in the former sex. It differs from the oblique in its 

 smaller size and globular form, dependent most probably on the resistance 

 offered to its progress by the transversalis fascia and conjoined tendon. It 

 differs also in its position, being placed over the pubes, and not in the course 

 of the inguinal canal. The epigastric artery runs on the outer or iliac side of 

 the neck of the sac, and the spermatic cord along its external and posterior 

 side, not directly behind it, as in oblique inguinal hernia. 



SURGICAL ANATOMY OF FEMORAL HERNIA. 



The dissection of the parts comprised in the anatomy of femoral hernia should be performed, 

 if possible, upon a female subject free from fat. The subject should lie upon its back ; a block 

 is first placed under the pelvis, the thigh everted, and the knee slightly bent, and retained in 

 this position. An incision should then be made from the anterior superior spinous process of 

 the ilium along Poupart's ligament to the symphysis pubis ; a second incision should be carried 

 transversely across the thigh about six inches beneath the preceding ; and these are to be con- 

 nected together by a vertical one carried along the inner side of the thigh. These several in- 

 cisions should divide merely the integument ; this is to be reflected outwards, when the super- 

 ficial fascia will be exposed. 



The superficial fascia at the upper part of the thigh, consists of two layers, 

 between which are found the cutaneous vessels and nerves, and numerous 

 lymphatic glands. 



The superficial layer is a thick and dense cellule-fibrous membrane, in the 

 meshes of which is found a considerable amount of adipose tissue, varying in 

 quantity in different subjects; this layer may be traced upwards over Poupart's 

 ligament to be continuous with the superficial fascia of the abdomen; whilst 

 below, and on the inner and outer sides of the limb, it is continuous with the 

 superficial fascia covering the rest of the thigh. 



This layer should be detached by dividing it across in the same direction as the external in- 

 cisions ; its removal will be facilitated by commencing at the lower and inner angle of the space, 

 detaching it at first from the front of the internal saphenous vein, and dissecting it off from the 

 anterior surface of that vessel and its branches ; it should then be reflected outwards, in the 

 same manner as the integument. The cutaneous vessels and nerves, and superficial inguinal 

 glands are then exposed, lying upon the deep layer of the superficial fascia. These are the in- 

 ternal saphenous vein, and the superficial epigastric, superficial circurnflexa ilii, and superficial 

 external pudic vessels, as well as numerous lymphatics ascending with the saphenous vein to the 

 inguinal glands. 



The internal saphenous vein is a vessel of considerable size, which ascends 

 obliquely upwards along the inner side of the thigh, below Poupart's ligament. 

 It passes through the saphenous opening in the fascia lata to terminate in the 

 femoral vein. This vessel is accompanied by numerous lymphatics, which 

 return trie lymph from the dorsum of the foot and inner side of the leg and 

 thigh ; they terminate in the inguinal glands, which surround the saphenous 

 opening. Diverging from the same point are the superficial epigastric vessels, 

 which run across Poupart's ligament, obliquely upwards and inwards, to the 

 lower part of the abdomen ; the superficial circumflexa ilii vessels, which pass 

 obliquely outwards along Poupart's ligament to the crest of the ilium ; and the 

 superficial external pudic vessels, which pass inwards to the perineum and 

 scrotum. These vessels supply the subcutaneous areolar tissue and the integu- 

 ment, and are accompanied by numerous lymphatic vessels, which return the 

 lymph from the same parts to the inguinal glands. 



The superficial inguinal glands are arranged in two groups, one of which is 

 disposed above and parallel with Poupart's ligament, and the other below the 

 ligament, surrounding the termination of the saphenous vein, and following 

 (occasionally) the course of that vessel a short distance along the thigh. The 

 upper chain receives the lymphatic vessels from the penis, scrotum, lower part 



