FEMORAL HERNIA. 1193 



The sup> rri'-t't! inguinal lymphatic glands, placed immediately beneath the 

 integument, are of large size and vary from eight to ten in number. They are 

 divisible into two groups : an upper, disposed irregularly along Poupart's ligament, 

 which receive the lymphatic vessels from the integument of the scrotum, penis, 

 parietes of the abdomen, perineal and gluteal regions, and the mucous membrane 

 of the urethra ; and an inferior group, which surround the saphenous opening in 

 the fascia lata. a few being sometimes continued along the saphenous vein to a 

 variable extent. This latter group receive the superficial lymphatic vessels from 

 the lower extremity. 



The ilio-inguinal nerve arises from the first lumbar nerve. It escapes at the 

 external abdominal ring, and is distributed to the integument of the upper and 

 inner part of the thigh to the scrotum in the male and to the labium in the 

 female. The size of this nerve is in inverse proportion to that of the ilio-hypo- 

 gastric. Occasionally it is very small, and ends by joining the ilio-hypogastric : 

 in such cases a branch of the ilio-hypogastric takes the place of the ilio-inguinal, 

 or the latter nerve may be altogether absent. The crural branch of the genito- 

 crural nerve passes along the inner margin of the Psoas muscle, beneath Poupart's 

 ligament, into the thigh, entering the sheath of the femoral vessels, and lying 

 superficial and a little external to the femoral artery. It pierces the anterior layer 

 of the sheath of the vessels, and, becoming superficial by passing through the fascia 

 lata. it supplies the skin of the anterior aspect of the thigh as far as midway 

 between the pelvis and knee. On the front of the thigh it communicates with 

 the outer branch of the middle cutaneous nerve, derived from the anterior crural. 



The deep layer of the superficial fascia is a very thin fibrous layer, best marked 

 on the inner side of the long saphenous vein and below Poupart's ligament. It is 

 placed beneath the subcutaneous vessels and nerves, and upon the surface of the 

 fascia lata. to which it is intimately adherent at the lower margin of Poupart's 

 iigament. It covers the saphenous opening in the fascia lata, is closely united to 

 its circumference, and is connected to the sheath of the femoral vessels corre- 

 sponding to its under surface. The portion of fascia covering this aperture is 

 perforated by the internal saphenous vein and by numerous blood- and lymphatic 

 vessels : hence it has been termed the cribriform fascia, the openings for these 

 vessels having been likened to the holes in a sieve. The cribriform fascia adheres 

 closely both to the superficial fascia and to the fascia lata. so that it is described 

 by some anatomists as a part of the fascia lata. but it is usually considered (as in this 

 work) as belonging to the superficial fascia. It is not till the cribriform fascia has 

 been cleared away that the saphenous opening is seen, so that this opening does 

 not in ordinary oases exist naturally, but is the result of dissection. A femoral 

 hernia in passing through the saphenous opening receives the cribriform fascia as 

 one of its coverings. 



The deep layer of superficial fascia, together with the cribriform fascia, having 

 been removed, the fascia lata is exposed. 



The Fascia Lata has been already described with the muscles of the front of 

 the thigh (page 506). At the upper and inner part of the thigh, a little below 

 Poupart's ligament, a large oval-shaped aperture is observed after the superficial 

 fascia has been cleared away : it transmits the internal saphenous vein and other 

 smaller vessels, and is called the saphenous opening. In order the more correctly 

 to consider the mode of formation of this aperture, the fascia lata in this part of the 

 thigh is described as consisting of two portions, an iliac portion and a pubic portion. 



The iliac portion is all that part of the fascia lata on the outer side of the 

 saphenous opening. It is attached externally to the crest of the ilium and its 

 anterior superior spine ; to the whole length of Poupart's ligament as far internally 

 as the spine of the os pubis ; and to the pectineal line in conjunction with Gimbernat's 

 ligament. From the spine of the os pubis it is reflected downward and outward, 

 forming an arched margin, the outer boundary or falciform process or superior 

 cornu of the saphenous opening. This margin overlies and is adherent to the 

 anterior layer of the sheath of the femoral vessels; to its edge is attached the 



