DESCENT AND COVERINGS OF FEMORAL HERNIA. 773 



and supports a small lymphatic gland, by which it is separated from the subserous 

 areolar tissue and peritoneum. Its under surface is turned towards the femoral 

 canal. The septum crurale is perforated by numerous apertures for the passage 

 of lymphatic vessels, connecting the deep inguinal glands with those surrounding 

 the external iliac artery. 



The size of the femoral canal, the degree of tension of its orifices, and, conse- 

 quently, the degree of constriction of a hernia, vary according to the position of 

 the limb. If the leg and thigh are extended, abducted, or everted, the femoral 

 canal and its orifices are extremely tense from the traction on these parts by 

 Poupart's ligament and the fascia lata, as may be ascertained by passing the 

 finger along it. If, on the contrary, the thigh is flexed upon the pelvis, and, at 

 the same time, adducted and rotated inwards, the femoral canal and its orifices 

 become considerably relaxed ; for this reason, the limb should always be placed 

 in the latter position when the application of the taxis is made in attempting the 

 reduction of a femoral hernia. 



The septum crurale is separated from the peritoneum by a quantity of loose 

 subserous areolar tissue. In some subjects this tissue contains a considerable 

 amount of adipose substance, which, when protruded forwards in front of the sao 

 of a femoral hernia, may be mistaken for a portion of omentum. 



Descent of the Hernia. From the preceding description, it follows, that the 

 femoral ring must be a weak point in the abdominal wall ; hence it is, that when 

 violent or long-continued pressure is made upon the abdominal viscera, a portion 

 of intestine may be forced into it, constituting a femoral hernia ; and the larger 

 size of this aperture in the female serves to explain the frequency of this form 

 of hernia in women. 



When a portion of intestine is forced through the femoral ring, it carries before 

 it a pouch of peritoneum, which forms what is called the hernial sac ; it receives 

 an investment from the subserous areolar tissue, and from the septum crurale, and 

 descends vertically along the crural canal in the inner compartment of the sheath 

 of the femoral vessels as far as the saphenous opening ; at this point, it changes 

 its course, being prevented extending further down the sheath, on account of its 

 greater narrowness and close contact with the vessels, and also from the close 

 attachment of the superficial fascia and crural sheath to the lower part of the 

 circumference of the saphenous opening ; it is, consequently, directed forwards, 

 pushing before it the cribriform fascia, and curves upwards on to the falciform 

 process of the fascia lata and lower part of the tendon of the External oblique, 

 being covered by the superficial fascia and integument. While the hernia is 

 contained in the femoral canal, it is usually of small size, owing to the resisting 

 nature of the surrounding parts ; but when it has escaped from the saphenous 

 opening into the loose areolar tissue of the groin, it becomes considerably enlarged. 

 The direction taken by a femoral hernia in its descent is at first downwards, then 

 forwards and upwards ; this should be borne in mind, as in the application of the 

 taxis for the reduction of a femoral hernia, pressure should be directed precisely 

 in the reverse order. 



Coverings of the Hernia. The coverings of a femoral hernia from within out- 

 wards are peritoneum, subserous areolar tissue, the septum crurale, crural sheath, 

 cribriform fascia, superficial fascia, and integument. 



Varieties of Femoral Hernia. If the intestine descends along the femoral canal 

 only as far as the saphenous opening, and does not escape from this aperture, it is 

 called incomplete femoral hernia. The small size of the protrusion in this form 

 of hernia, on account of the firm and resisting nature of the canal in which it is 

 contained, renders it an exceedingly dangerous variety of the disease, from the 

 extreme difficulty of detecting the existence of the swelling, especially in corpulent 

 subjects. The coverings of an incomplete femoral hernia would be, from without 

 inwards, integument, superficial fascia, falciform process of fascia lata, fascia 

 propria, septum crurale, subserous cellular tissue, and peritoneum. When, how- 

 ever, the hernial tumour protrudes through the saphenous opening, and direct? 



