260 ABDOMEN 



greater in the female than in the male, seeing that the 

 distance between the iliac spine and pubic tubercle is pro- 

 portionally greater in the female, and, in consequence, the 

 femoral ring wider. 



When the finger is within the ring, mark the structures 

 which surround it anteriorly, the inguinal ligament, with the 

 spermatic cord or the round ligament of the uterus ; posteriorly, 

 the ramus of the pubis, giving origin to the pectineus muscle, 

 which is covered by the pectineal portion of the fascia lata ; 

 medially, the sharp, crescentic free border of the lacunar 

 ligament ; and laterally, the external iliac vein. 



It is still more necessary to note the relations of the blood- 

 vessels to the femoral ring. The external iliac vein has been 

 seen to lie to its lateral side. The inferior epigastric artery, 

 as it ascends on the posterior aspect of the abdominal wall, 

 is close to the upper and lateral margin of the ring, and it 

 sends its pubic branch medially in front of the ring. More 

 important than any of those relations is the relation of the 

 obturator artery, when it takes origin from the inferior epi- 

 gastric. That anomalous vessel may adopt one of three 

 courses: (i) It may follow the course of the pubic artery, 

 an enlarged form of which it in reality is, and pass medially 

 in front of the ring, and then descend along its medial margin. 

 In that case, the ring is surrounded on all sides, except 

 posteriorly, by important vessels. (2) It may pass downwards 

 and backwards across the femoral ring. (3) It may run 

 downwards between the ring and the external iliac vein 

 (vide Vol. I. p. 244). 



Medial to the femoral sheath the passage of a hernial 

 protrusion behind the inguinal ligament is effectually prevented 

 by the lacunar ligament. 



Femoral hernia is more common in females, and inguinal 

 hernia in males ; and for the very evident reason that, in the 

 female, the femoral canal is relatively larger, whilst in the 

 male the passage of the spermatic cord weakens the inguinal 

 region more than the passage of the small round ligament 

 of the uterus in the female. 



Umbilical Hernia. If the dissector examines the umbilicus 

 he will find that he is dealing with a dense fibrous ring which 

 is fused with the remains of the umbilical vein and the 

 remains of the obliterated parts of the umbilical arteries and 

 the urachus, the whole forming a dense nodule of fibrous 



