ANATOMY OF FEMORAL HERNIA. 427 



The femoral hernia, as the most important, will be noticed presently ; 

 but the student must refer to some special treatise for information re- 

 specting the other abdominal hernia?. 



Dissection. The abdomen may be now opened to see the cords and 

 the depressions on the posterior surface of the abdominal wall. A trans- 

 verse cut may be made through the umbilicus across the front of the ab- 

 domen ; and on holding up the lower half of the wall, fibrous cords will 

 be seen ascending to the umbilicus from the pelvis. 



Cords of the abdominal wall. In the middle line is the prominence of 

 the remains of the urachus, which reaches from the summit of the bladder 

 to the umbilicus. On each side is another cord of the obliterated hypo- 

 gastric artery ; this is directed from the side of the pelvis to the umbili- 

 cus, and lies usually behind or close to the epigastric artery, near Poupart's 

 ligament. 



Fossce. With this disposition of the cords, two fossae are seen near 

 Poupart's ligament, one on each side of the obliterated hypogastric artery ; 

 they correspond with the situation of the internal and external abdominal 

 rings, and with the places where the external and internal (common kind) 

 hernia? occur. 



But occasionally the cord of the obliterated hypogastric is moved in- 

 wards from the epigastric artery, to the line of junction of the outer with 

 the inner two-thirds of the triangular space through which the direct 

 hernia comes. In this position of the cord there will be three fossae on 

 the lower part of the abdominal wall ; viz., an inner between it and the 

 urachus, a middle one between it and the epigastric vessels, and an exter- 

 nal outside the epigastric artery. And there may be one, two, or three 

 inguinal hernia?, on each side of the body, according to the depth of the 

 fossa?, and the predisposition to protrusion of the intestine. 



FEMORAL HERNIA. In this hernia the intestine leaves the abdomen 

 below Poupart's ligament, and descends in a loose membranous sheath 

 around the femoral vessels. Only so much of the structures will be de- 

 scribed here as can be now seen, the rest are noticed fully in the dissection 

 of the thigh. 



Dissection. The dissection for the femoral hernia is to be made on the 

 left side of the body. 



The lower portion of the abdominal wall is to be divided from the um- 

 bilicus to the pubes. The peritoneum is to be detached from the inner 

 surface of the wall near Poupart's ligament, by means of a transverse cut 

 just above that band; and is to be raised from the iliac fossa. The layer 

 of the subperitoneal fat is to be separated in the same way, but before this 

 can be done, it will be necessary to cut through the spermatic cord at the 

 abdominal ring; as this layer is raised, some lymphatic glands will be 

 laid bare by the side of the iliac vessels. Any loose tissue remaining is 

 to be taken away to show the upper opening of the membranous crural 

 sheath containing the femoral vessels, and the interval (crural ring) on 

 their inner side (fig. 141). In this dissection the genito-crural nerve is 

 seen on the iliac artery. 



Afterwards the fascia transversalis and the iliac fascia are to be traced 

 to Poupart's ligament, to see the part that each takes in the production of 

 the crural sheath. 



Anatomy of femoral hernia. The membranes concerned in the femoral 

 hernia are, the peritoneum ; the subperitoneal fat ; the transversalis and 



