306 Anatomy Applied to Medicine and Surgery. 



then the cribriform fascia, and, lastly, the superficial layer 

 of the superficial fascia and the skin. The protruded 

 intestine changes its direction twice a point to be re- 

 membered in the application of the taxis for its reduction. 

 The first change in direction occurs as the bowel reaches a 

 point, a little below the middle of the saphenous opening, 

 where it turns forwards so as to distend the cribriform 

 fascia in front of it. One reason for this change in direc- 

 tion is, that the fibrous sheath is here, i.e., one inch below 

 Poupart's ligament, closely adherent to the areolar sheath 

 of the vein, so that the bowel cannot descend along the 

 vein any farther, and another reason is, that the lower 

 margin of the saphenous opening is closely applied to the 

 vein, thus forming a thin partition which separates the 

 long saphenous from the femoral vein, and, therefore, of- 

 fers an obstruction to the further descent of the bowel. The 

 second change in direction is, when the bowel, pushing 

 the cribriform fascia in front of it, arches up- 

 wards, towards Poupart's ligament, over the upper or 

 falciform boundary of the saphenous opening. This 

 change may be influenced by the direction and termination 

 of the superficial epigastric, the circumflex iliac ' and the 

 external pudic veins, since they come from above and pass 

 downwards to the femoral vein through the saphenous 

 opening, and would, therefore, support, cradle-like, the 

 hernia and direct it upwards towards the abdomen. The 

 mesentery may be another factor in this turning upward 

 of the intestine, since the traction exercised by it, while 

 the bowel continues to be forced downwards, would tend 

 to curl the latter upwards. To properly apply the taxis,. 

 the above path must be borne in mind, so that, the pro- 

 truded bowel would have to be directed downwards, back- 

 wards and upwards, i.e., so as to cause it to retrace the 

 course it took in its descent. In spite of the fact that the 



