r?74 HUMAN ANATOMY. 



hood is relatively undeveloped ; its outer edge and the vein may then almost touch, 

 h^ s e ghened by the conjoined tendon and Colles's ligament, while some fibres 

 of the iliac ,,,,rtion of the tascia lata and of the deep femoral arch (vide 'infra} 

 also contribute to the formation of the inner boundary. On the outer side is the 

 femoral vein. Behind lies the horizontal ramus of the pubes covered by he origin 

 Of the pectineus muscle and its fascia. In front are Poupart s ligament and the 

 Strong band of fibres running along its deep surface from the anterior superior iliac 

 spine to the pubic spine, and known as the deep femoral arch At the point at which 

 the .heath of the vessels closely embraces them-the lowest limit of the femoral canal 

 -the saphenous opening in tin- fascia lata (described on page 635) has somewhat 

 the same relation to a femoral hernia that the external abdominal ring has to an in- 

 guinal hernia. After emerging from these openings neither hernia is further arrested 

 in its progress by any strong aponeurotic barrier, and they are both therefore more 



likely to increase in size ; but in femoral hernia 



FlGi I497 . the change in direction of the axis of the fundus 



as compared with that of the neck is much 

 more marked. 



In its etiology femoral hernia conforms 

 to the general laws already enumerated (page 

 1759 ). As the knuckle of gut involved presses 

 the peritoneum before it into the femoral ring 

 and down through the femoral canal, it car- 

 ries before it (i) the extraperitoncal tissue ; 

 (2) the septum crurale, when that constitutes 

 a distinct layer ; (3) faz femoral sheath, some- 

 times described as transversalis fascia because 

 "tru'ii fhrouR^ the anterior layer of the sheath is derived from 

 saphenous open- ^.^ structure ; ( 4 ) the cribriform 'fascia ; 

 (5) the superficial fascia ; (6) the skin. 



As the transverse axis of the femoral ring 

 parallel with that of Gimbernat's ligament 

 is, in the erect posture, nearly horizontal, a 

 femoral hernia first descends almost perpen- 

 dicularly. After it reaches the point of close 

 adhesion of the sheath to the femoral vessels it takes the direction of least resistance 

 and protrudes through the saphenous opening. Its neck is, of course, the portion of 

 the sac between the femoral ring and the bottom of the femoral canal. The body is 

 apt to U- small and globular or hemispherical in shape. 



The following anatomical relations will be found of great importance in distin- 

 guishing l>etween femoral and inguinal hernia, (a) The upper edge of a femoral 

 hernia (Iocs not, as a rule, pa>s above the inguinal furrow (page 670), although it 

 may reach it, i.e., the hernia will be below a line drawn from the anterior superior 

 spine of the ilium to the spine of the pubes. This may usually be determined by 

 inspection. 1'Aceptionally, on account of the stronger attachment of the cribriform 

 fascia to the lower edge of the saphenous opening, the hernia finds its direction of 

 least iv-M.mcc after emergence from that opening to be upward, when this sign will 

 'la LOUS. / ' The neck of a femoral hernia is external to the pubic spine, that 

 complete inguinal hernia internal to it. The already described methods for 

 loeating that process ' page 349) may fail in very fat persons, especially in females. 

 In i ; the lower crease that in such persons crosses the abdomen (page 531), 



and which in the mid line n->t> upon the symphysis pubis, will be a reliable guide to 

 the latter point ; the hone may thence he traced" outward to the pubic spine. 



In the reduction of a femoral hernia apt to be difficult on account of the nar- 



si,,n .ilH.nt the x.,|,h,-ni.iis opening. After tin- hernia the axis of the body of which 

 i-, nearly .ii right angle-, with the axis of the neck is drawn downward so that the 

 d. it i- gradually pushed backward and then upward. 



