1 KMliKAl. AKTF.UY. 



239 



which is culled its cril>rif'i>rm ]>tntwn, and 

 over the course of the femoral artery, across 

 which, tliev art; placed <ibli<|iicly : they arc 

 sc|>:nated from the vessel by the superficial 

 lamina of the iliac portion of the fascia, anil 

 by the prolongation of the lii ia transversalis, 

 with the interposed cellular .structure; and 

 they derive numerous arterial and venous 

 branches from the main trunks beneath : those 

 branches, which are given off jwrtly by the 

 vcv-els themselves, and partly by their super- 

 ficial pudic, superficial epigastric, and su- 

 perficial anterior iliac branches, pass through 

 the interposed structures in order to reach 

 the glands ; in doing so they carry with them 

 sheaths from the fascia lata, which is prolonged 

 upon each as it escapes, and thus they become 

 the means of establishing that connection be- 

 tween the fascia in the groin and the subcu- 

 taneous stratum, in which the glands are 

 enveloped, which is considered to influence 

 so remarkably the course of femoral hernia. 

 The glands of the second set are less nu- 

 merous, are situate farther from Poupart's 

 ligament than the former, being below the 

 entrance of the saphena ; they are also deeper 

 seated, lying upon the fascia lata, and they 

 arc placed with their longer diameter parallel, 

 or nearly so, to the femur and to the course 

 of the artery. Their relation to the artery is 

 not in all cases the same, inasmuch as the 

 disposition of neither part is strictly uniform, 

 but usually one or two of them lie over the 

 \rssel, or immediately on either side of its 

 course; their relation to it, however, is, in 

 the natural condition of the parts, not of great 

 consequence; for in such case they may be 

 easily held aside during operation if necessary, 

 and thus both they and their lymphatic vessels 

 be saved from injury. 



The relation of the inguinal glands, more 

 particularly the superior, to the femoral artery 

 suggests several inferences. 1st, That the 

 very commencement of the artery's course, 

 although the situation in which the vessel is 

 nearest to the surface, and that in which it 

 can be most easily distinguished by its pulsa- 

 tion, is yet not the most eligible part at which 

 to expose it, since the glands and their vessels 

 cannot, by any precaution of the surgeon, be 

 pn Heeled certainly from injury. 2dly, That 

 pha'-icdenic ulceration of the glands of the 

 groin must be attended with great danger from 

 the vicinity of the great vessels. 3d)y, That 

 hemorrhage consequent upon such ulceration 

 docs not necessarily proceed from those vessels 

 themselves; but that it may, anil in the ma- 

 jority of cases in the first instance probably 

 does arise from the branches supplying the 

 glands ; and, 4th, That the groin is likely to be 

 the seat of pulsating tumours requiring to be 

 distinguished from aneurism. 



The third covering of the artery is the 

 superficial lamina of the iliac portion of the 

 fascia lata. This portion having covered the an- 

 terior surface of the iliacus and psoas muscles 

 as far as the middle of I'oupart's ligament, 

 along which it is attached from without inward, 

 divides at that point into two lamina , a deep 



one :uid a superficial one; the former | 

 inward and backward from the h^aniert, upon 

 the psoas muscle, to the ilio-pectineal eminence 

 of the os innominatum, into which it i-. in- 

 serted, continued thence upward, upon the 

 inside of the muscle, along the brim of the 

 pelvis into the fascia iliaca, and downward 

 across the capsule of the ilio-femoral articula- 

 tion, to which it is also attached : it is in 

 fact that part of the fascia iliaca, (for the fascia 

 iliaca and the iliac portion of the fascia lata 

 are one and the same expansion, distinguished 

 from each other only by Poupart's ligament,) 

 which is situate upon the inside of the psoas 

 magnus, and which forms the outer wall of 

 the femoral canal, being interposed between the 

 femoral artery and the muscle. At the ilio- 

 pectineal eminence it also meets and is iden- 

 tified with the pubic portion of the fascia 

 lata, which is attached to the pectineal line 

 of the pubis, in continuation with this deep 

 lamina of the iliac portion, covers the pecti nal is 

 muscle, and is situated immediately behind 

 the vessels. When that part of the deep 

 lamina of the iliac portion of the fascia lata 

 which extends from Poupart's ligament to the 

 ilio-pectineal eminence has had the prolonga- 

 tion of the fascia downward detached from it, 

 it appears as an oblique partition dividing 

 the crural arch into two parts, an external 

 containing the iliacus and psoas muscles widi 

 the crural nerve, and an internal containing 

 the femoral vessels. 



The second lamina of the iliac portion of 

 the fascia lata the superficial one passes 

 inward across the femoral vessels, superficial 

 to them and to the prolongation of the fascia 

 transversalis, until it has reached the inside 

 of the vessels : it is at the same time attached 

 above, in front of the vessels, and in con- 

 tinuation with the iliac portion itself, to the 

 inferior margin of Poupart's ligament, from 

 its middle to the base of its third insertion 

 Gimbernat's ligament, and upon their inside 

 along the base of the latter ligament as far 

 as the pectineal line of the pubis, into which 

 it is finally inserted, external to the base of 

 Gimbernat, between it and the insertion of 

 the fascia transversalis upon the inside of the 

 aperture of the femoral sheath, and where 

 it is also identified with the pubic portion 

 of the fascia attached along the same line : 

 from thence it is \mited to the anterior surface 

 of the pubic portion of the fascia lata, down- 

 ward along the inside of the vessels. The 

 superficial lamina of the iliac portion is thus 

 thrown across the front of the vessels, and 

 by the disposition, which has been detailed, 

 the fascia lata encloses the vessels between the 

 two laminae, and forms, by means of them 

 and their connection at either side, a canal, 

 within which are contained the vessels and 

 the prolongation of the fascia transversalis 

 covering them in front. The constitution of 

 the canal, as described, may be considered 

 to extend from Poupart's ligament until the 

 artery is about to be covered by the sartorius, 

 from whence its anterior wall is formed, through 

 the remainder of the vessel's course, by another 



