FEMORAL HERNIA. 



273 



Poupart's ligament be carefully Fi s- 144 * 



divided, the sheath may be isolated, 

 and its continuation with the trans- 

 versalis and iliac fascia clearly de- 

 monstrated. In'this view the sheath 

 of the femoral vessels is an infundi- 

 buliform continuation of the abdo- 

 minal fasciae, closely adherent to the 

 vessels a little way down the thigh, 

 but much larger than the vessels it 

 contains at 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 in- 

 fundibuliform interval between the 

 vein and the inner wall of the sheath. 

 The superior opening of this space 



is named the femoral ring; it 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 super- 

 ficial 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 areolar tissue, f which retains the lymphatic 

 gland in its position, and is named septum cmrale ; 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 ligament and the border of the 

 pelvis, is larger than in the male, while the structures which pass through 

 it are smaller. It happens consequently, 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 infundibulifonn 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 the close connexion of the latter 

 with the vessels, will in the next place be forced forwards through the 

 saphenous opening in the fascia lata, carrying before it two additional 

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



* A section of the structures \vhich pass beneath the femoral arch. 1. Poupart's liga- 

 ment. 2, 2. The iliac portion of the fascia lata, attached along the margin of the crest 

 of the ilium, and along Poupart's ligament, as far as the spine of the os pubis (3). 4. 

 The pubic portion of the fascia lata, continuous at 3 with the iliac portion, and passing 

 outwards behind the sheath of the femoral vessels to its outer border at 5, where it 

 divides into two layers; one is continuous with the sheath of t,he psoas (6) and iliacus 

 (7) ; the other (8) is lost upon the capsule of the hip joint (9). 10. The crural nerve, 

 enclosed in the sheath of the psoas and iliacus. 11. Gimbernat's ligament. 12. The 

 femoral ring, within the femoral sheath. 13. The femoral vein. 14. The femo:al ar 

 tery ; the two vessels and the ring are surrounded by the femoral sheath, and thin septa 

 are sent between the anterior and posterior wall of the sheath, dividing the artery from 

 the vein, and the vein from the femoral ring. 



f This areolar tissue is sometimes very considerably thickened jy a deposit of f 

 within its areolae, and forms a thick stratum over the hernial sr: 



