198 



ANATOMY OF THE ABDOMEN, ETC. 



by the iliac portion of the infundibuliform fascia and part 

 of the pubic side of the fascia lata ; its external wall is the 

 septum, forming the division between the canal and the 

 vein, and its internal wall, Gimbernat's and Hey's liga- 

 ment, covered with their portion of the infundibuliform 

 fascia. The epigastric artery is in close relation to the 

 upper and outer side of the crural ring, and the obturator 

 artery, when given off from the external iliac, dips down- 

 ward along its outer and inferior edge ; in a certain num- 

 ber of instances this artery arises from a trunk common to 

 it and the epigastric, in which case it curves around the 

 ring to descend upon its inner side ; the obturator vein 

 may follow the same course. It will be seen that this dis- 

 tribution of the artery exposes it to be wounded in dividing 

 the crural ring, in an operation for strangulated femoral 

 hernia ; observation, however, having shown that the point 

 of constriction is ordinarly in the fascia lata and not in the 

 ring, the danger, which formerly was so properly dreaded, 

 has disappeared before a more enlightened practice. 



The spermatic cord is separated from the crural ring by 

 Poupart's ligament. 



The preceding description shows that a knuckle of intes- 

 tine, entering the crural ring, finds little or nothing to 

 oppose its protrusion at the saphenous opening, externally ; 

 and although while in the canal it must be much constricted, 

 from the unyielding nature of its walls, the hernia may, 

 after emerging, expand into a tumor of considerable size. 

 The blending of the superficial fascia with the fascia lata, 

 just below the saphenous opening, prevents the hernia from 

 descending below that point, and arrived at this obstruction, 

 it turns upward toward Poupart's ligament. The practical 

 importance of this fact, in connection with attempts at 

 reduction by taxis, is of course obvious ; to return the 

 hernia within the abdominal cavity, pressure must first be 

 exerted downward, then backward and upward. 



The intestine, in descending, must carry before it the 

 following coverings ; first, the peritoneum, then the septum 

 cm rale, and that portion of the infundibuliform fascia 

 which, forming the anterior wall of the canal, is perforated 

 by the saphena vein, these two latter constituting what is 

 called the fascia propria of the hernia ; and, externally 

 to the saphenous opening, the cribriform fascia, the superfi- 

 cial fascia, and the integument. 



