258 FEMORAL HERNIA. 



Poupart's ligament. If the sheath be opened, the artery and vein 

 will be found lying side by side, and occupying the outer two-thirds 

 of the sheath, leaving an infundibiliform interval between the vein 

 and the inner wall of the sheath. The superior opening of this 

 space is named the femoral ring; \t is bounded in front by Poupart's 

 ligament, behind by the os pubis, internally by Gimbernat's ligament, 

 and externally by the femoral vein. The interval itself serves for 

 the passage of the superficial lymphatic vessels from the saphenous 

 opening to a lymphatic gland, which generally occupies the femoral 

 ring ; and from thence they proceed into the current of the deep 

 lymphatics. The femoral ring is closed merely by a thin layer of 

 subserous cellular tissue,* which retains the lymphatic gland in its 

 position, and is named septum crurale ; and by the peritoneum. It 

 follows from this description, that the femoral ring must be a weak 

 point in the parietes of the abdomen, particularly in the female, 

 where the femoral arch, or space included between Poupart's liga- 

 ment and the border of the pelvis, is larger than in the male, while 

 the structures which pass through it are smaller. It happens con- 

 sequently, that if violent or continued pressure be made upon the 

 abdominal viscera, a portion of intestine may be forced through the 

 femoral ring into the infundibiliform space in the sheath of the 

 femoral vessels, carrying before it the peritoneum and the septum 

 crurale, this constitutes femoral hernia. If the causes which give 

 rise to the formation of this hernia continue, the intestine, unable to 

 extend further down the sheath, from its close connexion to the ves- 

 sels, will in the next place be forced forwards through the saphenous 

 opening in the fascia lata, carrying before it two additional cover- 

 ings, the sheath of the vessels, or fascia propria, and the cribriform 

 fascia, and then curving upwards over Poupart's ligament, will 

 become placed beneath the superficial fascia and integument. 



The direction which femoral hernia takes in its descent is at first 

 downwards, then forwards, and then upwards; and in endeavouring 

 to reduce it, the application of the taxis must have reference to this 

 course, and be directed in precisely the reverse order. The cover- 

 ings of femoral, hernia are the 



Integument, 

 Superficial fascia, 

 Cribriform fascia, 

 Fascia propria, 

 Septum crurale, 

 Peritoneal sac. 



The fascia of the leg is strong in the anterior tibial region, and 

 gives origin by its inner surface to the upper part of the tibialis anti- 

 cus, and extensor longus digitorum muscles. 



* This cellular tissue is sometimes very considerably thickened by a deposit of fat 

 within its cells, and forms a thick stratum over the hernial sac. 



