chap, xvi.i HERNIA. 287 



afford it ample opportunities for increase. When the 

 hernia has passed through the saphenous opening it 

 tends to mount upwards over Poupart's ligament, in 

 the direction of the anterior superior iliac spine. Even 

 when it overlaps the ligament considerably it can 

 hardly be mistaken for an inguinal hernia, since it 

 must always lie to the outer side of the pubic spine. 

 The upward tendency of a femoral hernia has been 

 variously explained. It has been ascribed to a 

 supposed curve in the crural canal, the concavity of 

 which is forwards. Scarpa believed it to receive its 

 direction from the frequent flexion of the thigh. 

 Probably one of the most important factors in the 

 matter is the unyielding character of the lower edge 

 of the saphenous opening. This edge tends to direct 

 the gut forwards, while the traction upon the 

 mesentery, that is inevitable as the rupture proceeds, 

 may be conceived as favouring an upward direction. 

 The coverings of a hernia that has found its way 

 beneath the skin are often very scanty. 



Relations. When a hernia occupies the crural 

 canal there are in front of it the skin and super- 

 ficial fasciae, the iliac part of the fascia lata, the 

 crural arches, the cribriform fascia, and the anterior 

 wall of the crural sheath. Behind are the pos- 

 terior wall of the crural sheath, the pubic portion 

 of the fascia lata, the pectineus muscle, and the bone. 

 The boundaries of the femoral ring are, in front, 

 Poupart's ligament and the deep crural arch ; behind, 

 the bone covered by the fascia lata and the pectineus ; 

 on the inner side, the conjoined tendon, Gimbernat's 

 ligament, and the inner part of the deep crural arch ; 

 on the outer side, the femoral vein in its sheath. The 

 spermatic cord lies (in the male) just above the anterior 

 border of the ring, and the epigastric artery skirts its 

 upper and outer part. The little pubic branch of this 

 artery passes round the ring to ramify over Gimbernat's 



