INGUINAL HERNIA. 



227 



What is Poupart's Ligament ? The Crural Arch or Poupart's Liga- 

 ment is that portion of the aponeu- FIG 

 rosis of the external oblique muscle 

 which extends from the anterior 

 superior spine of the ilium to the 

 spine of the pubes. Its lower por- 

 tion 3 forms the external pillar of 

 the external abdominal ring, 1 and 

 its reflection along the pectineal line 

 is called Gimbernafs Ligament. 1 

 Other fibres, reflected behind the 

 internal pillar of the ring, 4 upward 

 to the linea alba, are termed the 

 Triangular Ligament. 



What is the Relation of the 

 Epigastric Artery to the Internal 

 Abdominal Ring ? The Epigas- 

 tric artery lies between the trans- 

 versalis fascia and the peritoneum, 

 passing obliquely upwards and in- 

 wards along the lower and inner 

 margins of the internal ring. 5 



What is the Cremasteric Fascia ? It consists of a series of muscular 

 loops, united by areolar tissue, and forming a thin covering over the spermatic 

 cord. The muscular fibres (Cremaster muscle) are supposed to have been 

 originally part of the Internal oblique muscle, but carried down by the testicle 

 in its descent to the scrotum. It does not exist in the female. 



Name the Coverings of Inguinal Hernia. In the oblique form of 

 Inguinal Hernia the coverings are 



1. Skin. 



2. Superficial Fascia, 2 layers. 



3. Intercolumnar Fascia, from the external abdominal ring. 



4. Cremasteric Fascia, from the inguinal canal. 



5. Infundibuliform Process of the transversalis fascia, from the internal 



abdominal ring. 



6. Peritoneum, the proper hernial sac. 



In the direct form of Inguinal Hernia, the coverings are precisely the same, 

 except that the Conjoined Tendon is substituted for the Cremasteric fascia, 

 and the Transversalis Fascia for its Infundibuliform process. 



A yth covering is sometimes enumerated, viz. : the Sub-serous Areolar Tissue, 



