FEMORAL HERNIA. 61 



it crosses over the upper and inner part of the femoral sheath to join Poupart's 

 and Gimbernat's ligaments, its terminal portion being often distinguished as the 

 femoral ligament or Hey's ligament. The femoral ligament crosses the antero-internal 

 aspect of the femoral canal, and the closed extremity of that passage lies immediately 

 behind the upper part of the saphenous opening. 



Descent of the hernia. When a femoral hernia is being formed, the protruded 

 part is at first vertical in its course ; but at the lower end of the canal it bends 

 forwards through the saphenous opening, and, as it increases in size, ascends over the 

 iliac part of the fascia lata and the femoral arch. Within the canal the hernia is very 

 small, being constricted by the unyielding structures which form that passage ; but 

 when it has passed beyond the saphenous opening, it enlarges in the loose fatty layers 

 of the groin ; and, as the tumour increases, it extends outwards in the groin towards 

 the anterior superior iliac spine. 



Coverings of the hernia. The coverings of a femoral hernia in order from 

 within outwards are, the peritoneum (which forms the sac), the septum femorale 

 and the sheath of the femoral vessels. ' These two structures combined constitute a 

 single covering, known as the fascia propria of the hernia (Cooper). It sometimes 

 happens that the hernia is protruded through an opening in the sheath, which there- 

 fore in that event does not contribute to form the fascia propria. Lastly, the hernia 

 is covered by the cribriform fascia stretching across the saphenous opening, the 

 superficial fascia, and the skin. 



