90 



FEMORAL HERNIA. 



The superior horn of this crescentic process is twisted and in- 

 serted in the crest of the pubes external to, but continuous with, 

 Gimbernat's ligament, and is called Heyh ligament. 



The pectineal portion of the fascia lata is upon the pubic side ; it is 

 thinner than the sartorial and passes behind the sheath of the vessels. 

 The sheath of the vessels is formed of condensed cellular tissue, 

 and may be considered a prolongation of the fascia transversalis and 

 fascia ihaca. It is usually compared to the tubular portion of a funnel ; 

 the abdominal portions of these fasciae constituting the larger part of 

 the funnel. Numerous perforations exist in the sheath of the vessels 

 for the passage of veins and absorbents, which renders it cribriform. 

 One of these perforations can be seen where the sheath is laid open, 

 and also the saphena vein entering the femoral vein.*^ Since the artery 

 and vein are cylinders, it must be evident that there must be some 

 structure filling up the intervening spaces, and also the space** be- 

 tween the vein and Gimbernat's ligament,*^ or else there would be a 



deficiency of structure. 

 ^^ Now this space is the 



crural ring^^ and is fill- 

 ed up with loose cellular 

 tissue and a lymphatic 

 _ gland. This cellular 



\ J^ JX^^^^^^^S^I^^4t tissue is called by some 



"^ ' the crural septum, by 



others fascia propria. 

 A weakness of this sep- 

 tum between the cavity 

 and tube of the funnel 

 predisposes to hernia. 

 The crural or femoral 

 ring is bounded in front 

 by Poupart's ligament ; 

 behind, by the bone ; on the inside, by Hey's and Gimbernat's liga- 

 ment; on the outside by the vein. The femoral vessels,** ^^ with their 

 sheath, together wilh theiliacus internus'' and psoas magnus^ muscles, 

 pass out under Poupart's ligament, and thus fill the crural arch. 



The intestine in femoral hernia pursues the following course. 

 The peritoneum, as in all other instances, is at first distended and 

 forms the hernial sac ; this distension takes place at the crural ring, 

 this being the only spot where it can occur under the crural arch ; 

 the crural septum or fascia propria is now stretched and thickened ; 

 gradually yielding, it forms the next covering of the gut. With these 

 it descends the sheath of the vessels, and when it gets below the fal- 

 ciform process, emerges at one of the foramina for veins or absor- 

 bents ; then it comes in contact with the cribriform and superficial 

 fascia, which in fact are the same structure ; these form another 

 covering, and the skin forms the last. 



