HERNIA. 



backwards, to expand itself over the iliacus 

 interims and psoas muscles ; and it is therefore 

 called the fascia iliaca. These fasciae are per- 

 fectly continuous as far inwards as the external 

 border of the artery, and form a smooth and 

 strong membranous wall for the abdomen in 

 this situation, rather attached to Poupart's liga- 

 ment than coming off or derived from it.* 

 These fasciae separate at this spot and unite 

 again between the artery and vein, thus forming 

 a sheath for the former vessel : in like manner 

 a separate sheath is formed for the vein, when 

 they again separate and leave a small opening, 

 which is the crural rinr, but unite before they 

 reach Gimbernat's ligament, to the abdominal 

 surface of which they give an investment, but 

 here the fibrous structure is very weak and 

 differs little in appearance from cellular mem- 

 brane. These fasciae then form a flat, broad 

 funnel, which has three apertures at top, and the 

 membranous septa are of the greatest use in 

 binding the anterior and posterior faces of this 

 fuunel together : hence a hernia cannot escape 

 through fn company with the artery nor with 

 the vein, and hence also the vein is not com- 

 pressed nor its circulation interfered with, even 

 although a hernia close to it is in a state of 

 strangulation. This funnel descends on the 

 vessels, to which it becomes firmly attached, at 

 about an inch and a half below Poupart's liga- 

 ment, and, according to some anatomists, is 

 there reflected up again on the vessels forming 

 a cul-de-sac or bag. I thus consider the 

 crural ring properly so called to be an aperture 

 formed by a deficiency in the fascia iliaca and 

 transversal is, just as the internal inguinal ring 

 is formed in the latter membrane alone. It is 

 occupied by a loose cellular tissue, and in 

 general by a small absorbent gland. 



This ring is of a different size in different 

 individuals ; and where it is large, the person 

 may be said to have an hereditary or congenital 

 disposition to the disease ; but a liability to it 

 may arise from accidental circumstances also. 

 It is obvious that in proportion as the space 

 beneath the crural arch is well filled, and the 

 muscles tense and plump, the aperture at the 

 ring must be small ; also that it will be larger 

 according to the greater breadth between the 

 spinous process and the pubis, or as the space 

 under the crural arch is deep. Hence it may 

 be explained why this kind of rupture is fre- 

 quent amongst women who have borne many 

 children, with whom the parietes of the abdo- 

 men are relaxed ; less frequent amongst young 

 and healthy unmarried females, and scarcely 

 known amongst men, the pelvis of the male 

 being narrower, and his muscle better developed 

 by use and exercise. 



The crural arch or Poupart's ligament is 



* Their importance in strengthening this part of 

 the abdomen is proved by an experiment of Mr. 

 Colles. " Make in the aponeurosis which covers 

 the iliac muscle an opening capable of admitting 

 the finger. Pass it between the aponeurosis and 

 surface of the muscle, and you will be enabled, with- 

 out much difficulty, to push the finger under Pou- 

 part's ligament down to the fore part of the thigh." 

 Colles, op. citat. p. 68. 



nothing more than the inferior pillar of the 

 external inguinal ring, and is (as has been before 

 stated) inserted into the crest of the pubis ; but 

 it has another attachment to this bone, which, 

 being in intimate relation with femoral hernia, I 

 have delayed the description of until now. As 

 the ligament approaches the pubis, its inferior 

 edge becomes twisted upwards and backwards 

 towards the linea ileo-pectinea, into which it is 

 inserted for a length of from a half to three 

 quarters of an inch. Its shape is triangular, its 

 posterior attachment being somewhat shorter 

 than its anterior ; and its base, which has its 

 aspect towards the vein, is somewhat lunated. 

 In the male its situation corresponds nearly 

 with the external inguinal ring; and the sper- 

 matic cord rests on it just as it is about to pass 

 from the inguinal canal. 



The fibrous funnel-like sheath already des- 

 cribed is itself lodged within a cavity which 

 may be called the crural canal, and is thus 

 formed. The fascia lata of the thigh in front 

 has two origins, one from the whole length of 

 Poupart's ligament, the other from so much of 

 the linea ileo-pectinea as gives origin to the 

 pectinalis muscle, and from the ligament of the 

 pubis. This latter portion having passed down 

 the thigh unites with the former below the en- 

 trance of the saphena into the femoral vein, 

 below which point they form one continuous 

 sheath for the muscles of the limb. The por- 

 tion, however, which comes from Poupart's 

 ligament requires more attention. At first it 

 lies completely in front of the upper part of the 

 thigh, and of course leaves a triangular space 

 between it and the other portion, in which are 

 lodged the funnel-shaped fascial sheath, with 

 its contents, the artery and vein, lymphatic 

 vessels, and some glands. About half an inch, 

 or in some subjects a little more, below Pou- 

 part's ligament the internal portion of this fascia 

 appears to be wanting, leaving the vessels un- 

 covered by it as far down as the point of union 

 of the two fasciae : I say appears to be wanting, 

 because the fascia lata is really continued over 

 this space, joins the pubic portion internally, 

 and sends a process upwards to be inserted 

 into the linea ileo-pectinea, external to the 

 lunated edge of Gimbernat's ligament, and be- 

 tween it and the edge of the femoral ring ; but 

 it is here so thin and cellulated that it is 

 generally removed in the dissection. When 

 thus disposed of, the firm portion of the external 

 fascia lata, as it passes to join the internal, 

 assumes a lunated form above and below, and 

 thus the entire apparent deficiency is made to 

 appear of an oval figure, the edges of which are 

 crescentic, and which have been called by the 

 different names of Hey's ligament, Burns' liga- 

 ment, and the crescentic edge of the fascia lata. 

 A finger pushed from above through the crural 

 ring will easily feel the superior margin of this 

 aperture, and its influence on hernia in this 

 situation will soon be made apparent. The 

 femoral or crural canal then is from one-half to 

 three-fourths of an inch in length, and is formed 

 by the fascia lata : it is bounded above, anteriorly 

 by Poupart's ligament and posteriorly by the linea 

 ileo-pectinea; below, anteriorly by the crescentic 



