HERNIA 259 



tissue, as it stretches across the femoral ring, will be ob- 

 served to be denser, stronger, and more fibrous than elsewhere. 

 A special name is applied to that small portion of the extra- 

 peritoneal fatty tissue. Seeing that it is applied to the ring 

 in such a manner as to close the femoral canal at its ab- 

 dominal end, it is called the septum femorale. 



Dissection. With the handle of the knife dissect away the 

 extra-peritoneal fatty tissue in the area from which the peri- 

 toneum has been displaced. The fascia iliaca covering the 

 iliacus and psoas muscles will then be exposed, and the dissector 

 should note that the external iliac vessels lie inside and not 

 outside that fascia. 



The dissector is now in a position to study the manner in 

 which the femoral ring is formed. He should follow the 

 fascia iliaca and the fascia transversalis towards the inguinal 

 ligament. If the dissection has been carefully performed it 

 will be obvious that, to the lateral side of the external iliac 

 vessels, these two fasciae become directly continuous with each 

 other, and, further, that along the line of union they are both 

 firmly attached to the inguinal ligament. It is evident, then, 

 that no hernial protrusion could leave the abdominal cavity 

 behind the inguinal ligament lateral to the iliac vessels. 



In the region of the iliac vessels the arrangement of the 

 fascia will be found to be different. There the fascia iliaca 

 is carried downwards behind the vessels, whilst the fascia 

 transversalis is prolonged downwards in front of the vessels 

 and behind the inguinal ligament (Fig. 1 16). In the region of 

 the thigh the two fasciae form a funnel-shaped sheath for the 

 femoral artery and vein, and for some lymph vessels ascend- 

 ing to the abdomen. The sheath is divided into three com- 

 partments by two antero-posterior partitions. The femoral 

 artery occupies the lateral compartment, and the vein the 

 intermediate compartment, whilst the medial compartment, 

 called the femoral canal, is occupied by the lymph vessels and, 

 sometimes, by a small lymph gland. 



An essential difference between the compartments is that 

 whilst the lateral two are completely filled up by the artery 

 and vein, the femoral canal is much wider than is necessary 

 for the passage of its contents. Gauge the width of the 

 femoral ring by introducing the point of the little finger. It 

 is readily admitted within the opening. Here, then, is a 

 source of weakness to the abdominal wall, and one which is 

 ii 17 a 



