562 DISSECTION OF THE THIGH. 



tion of the septum is now visible, but its characters are ascertained in the 

 dissection of the abdomen (p. 42<s). 



FEMORAL HERNIA. In this kind of hernia there is a protrusion of in- 

 testine into the thigh beneath Pou part's ligament. And the gut descends 

 in the crural sheath, being placed on the inner side of the vein. 



Course. At first the intestine takes a vertical direction in its progress 

 from the abdomen, and passes through the crural ring, and along the crural 

 canal as far as the saphenous opening. At this spot it changes its course, 

 and is directed forwards to the surface of the thigh, where it becomes 

 elongated transversely; and should the gut protrude still farther, the tumor 

 ascends on the abdomen, in consequence of the resistance being less in this 

 direction than on the front of the thigh. 



The winding course of the hernia may suggest to the dissector the direc- 

 tion in which attempts should be made to replace the intestine in the ab- 

 dominal cavity. With the view of making the bowel retrace its course, 

 it will be necessary if the protrusion is small to direct it backwards and 

 upwards ; but if the hernia is large it must be pressed down first to the 

 saphenous opening, and afterwards backwards and upwards towards the 

 crural canal and ring. 



During the manipulation to return the interne to its cavity the thigh 

 is to be raised and rotated inwards, in order that the margin of the saphe- 

 nous opening and the other structures may be relaxed. 



Coverings. As the intestine protrudes it is clothed by the following 

 layers, which are elongated and pushed before it from within outwards. 

 First is a covering of the peritoneum lining the abdomen, which forms the 

 hernial sac. Next one from the septum crurale across the crural ring. 

 Afterwards comes a stratum from the crural sheath, unless the hernia 

 bursts through an aperture in the side. Over this is spread a layer of the 

 cribriform fascia. And, lastly, there is an investment of the superficial 

 fat or fascia, together with the skin. 



The coverings may vary, or may be conjoined in different degrees ac- 

 cording to the condition of the hernia. In some instances the prolonga- 

 tion from the crural sheath is wanting. Further, in an old hernia the 

 covering derived from the septum crurale is united usually with that from 

 the crural sheath, so as to form one layer, the fascia propria (Cooper). 

 In general, in an operation for the relief of the strangulated bowel, the 

 surgeon, after dividing the subcutaneous fat, can recognize but little of the 

 coverings enumerated by anatomists until he meets with that of the sub- 

 peritoneal fat or septum crurale. 



Diagnosis. This hernial tumor is generally smaller than inguinal, and 

 does not extend into the scrotum in the male, or the labium in the female ; 

 and if its neck can be traced below Poupart's ligament, it can be distin- 

 guished certainly from an inguinal hernia. 



Seat of stricture and division of it. The strangulation of a femoral 

 hernia may be situate either outside or inside the neck of the sac. 



The external stricture may be found opposite the margin of the saphe- 

 nous opening, or deeper in, opposite Poupart's ligament. It may be re- 

 moved by cutting down on the neck of the tumor at the inner side, and 

 dividing the constricting band arching over the neck of the hernia in this 

 situation, without opening the sac. 



The stricture inside the neck of the sac is occasioned by the thickening 

 of the peritoneum. For its relief the neck of the sac is to be laid bare, 

 as if there was an external stricture ; and if the intestine cannot be passed 



