236 PRACTICAL AX A TO MY. 



and put it on the stretch as much as possible. You are to see and study the 

 following structures through the peritoneum (do not remove this yet) : 



1. The plica urachi a peritoneal fold covering the remains of the urachus. 

 This is in the mid-line from the summit of the bladder to the umbilicus. 



2. The plica hypogastrica, covering the remains of the hypogastric arteries. 



3. The deep epigastric arteries and veins, passing upward and inward to 

 enter the sheath of the rectus muscle by passing under the fold of Douglas. 



4. Poupart's ligament and the external iliac vessels leaving the pelvis, to 

 be called femoral in the thigh. Here, too, see the external iliac artery giving oft" 

 its two branches, the deep epigastric and the internal circumflex iliac branch. 



5. The internal abdominal ring, to which you may see plainly the con- 

 stituents of the spermatic cord coming viz., the vas deferens, the spermatic 

 vessels. Locate this ring just to the outer side of the deep epigastric artery. 



6. The femoral canal, called also crural canal. Find this to the inner side 

 of the femoral vein, between Poupart's ligament above and the bone below. To 

 its inner side you will feel the sharp falciform margin of Gimbernat's ligament. 

 This canal is in the femoral sheath, and occupied by fat and connective tissue 

 called the septum crurale or septum femorale. 



7. Inguinal and Femoral Fossae. There are three of these. The internal 

 is between the remains of the urachus and hypogastric artery ; the middle inguinal 

 fossa is between the remains of the hypogastric artery and the deep epigastric 

 artery. The importance of these two fossae is they permit direct inguinal 

 hernia to form. The external inguinal fossa is external to the deep epigastric 

 artery and corresponds to the situation of the internal abdominal ring, and is the 

 location of oblique inguinal hernia. In this connection notice the femoral fossa. 

 This corresponds to the femoral ring, and marks the location of femoral hernia. 



DISSECTION OF FEMORAL HERNIA. 



Find the femoral fossa, covered by peritoneum, just below Poupart's liga- 

 ment, and internal to the femoral vein. Now remove the peritoneum, by pulling 

 the same gently backward and downward. Take the forceps and break up the 

 connective tissue in the femoral canal, the depression corresponding to the 

 femoral fossa just mentioned and internal to the femoral vein. We will consider 

 femoral hernia with reference to (i) the femoral sheath ; (2) the femoral canal ; (3) 

 the coverings of femoral hernia ; (4) contents of the canal ; (5) the relations to 

 other structures ; (6) anatomical factors concerned in reduction ; (7) the deep 

 crural arch. 



The femoral sheath is formed under Poupart's ligament by the meeting 

 and union of the fascia transversalis in front of the femoral vessels and of the iliac 

 fascia behind the femoral vessels. As you will demonstrate on your cadaver, these 

 fasciae unite on the outer side of the femoral artery very close to the vessel ; on 

 the inner side of the vein, however, they leave an interval, one-half of an inch in 

 width, between the femoral vein and Gimbernat's ligament. (Fig. 165.) This 

 interval is the femoral canal. 



The deep crural arch extends in an archiform manner across the femoral 

 sheath, strengthening thereby the transversalis fascia. It is inserted into the 

 spine of the pubes, and may be looked upon as a slip of contribution from the 

 transversalis fascia. 



The femoral sheath contains the following structures : ( i) The femoral arte 

 on the outer side; (2) the femoral vein in the middle: (3) the femoral can 

 internal to the vein. The beginning of the femoral canal not the beginning o 

 the sheath is the femoral ring. The femoral canal contains some connective 

 tissue that you just broke up with your forceps. The special name for this is 



