FEMORAL HER.XIA. UPPER PART OF THIGH. 1031 



OF THE PARTS CONCERNED IN FEMORAL HERNIA. 



The hernia distinguished as ' femoral ' leaves the abdomen at the groin, 

 under the margin of the broad abdominal muscles, and upon the anterior 

 border of the hip-bone, immediately at the inner side of the large 

 femoral blood-vessels. After passing downwards for about an inch or less, 

 the hernia turns forwards to the fore part of the thigh at the saphenous 

 opening in the fascia lata ; and when it has reached this point the swelling 

 may be felt and seen. 



The muscles of the abdomen, beneath the edge of which the femoral 

 hernia escapes, are represented by the aponeurotic band of the external 

 oblique muscle, which is commonly known as Poupart's ligament, but 

 which, in connection with the ferrnoral hernia, is named the femoral or 

 crural arch. Extending from the anterior superior iliac spine to the pubes, 

 this band widens at its inner end, and, inclining or folding backwards, is 

 fixed to a part of the pectineal line, as well as to the pubic spine of the 

 hip-bone. The small triangular portion attached to the pectineal line is known 

 as Gimbernat's ligament (Hey). The outer edge of this part is concave and 

 sharp ; with other structures, to be presently described, it forms the inner 

 boundary of the aperture through which the hernia descends. The breadth 

 and strength of Gimbernat's ligament vary in different bodies, and with 

 its breadth the size of the opening which receives the hernia will likewise 

 vary. 



The space comprised between the femoral arch and the excavated margin 

 of the pelvis is occupied by the conjoined psoas and iliacus, with the ante- 

 rior crural nerve between those muscles, and the external iliac artery and 

 vein at their inner side. Upon these structures the fascia which lines the 

 abdomen is so arranged as to close the cavity against the escape of any 

 part of the viscera, except at the inner side of the blood-vessels. But the 

 arrangement of the parts situate thus deeply (towards the cavity of the 

 abdomen) will be most conveniently entered upon after those nearer to the 

 surface shall have been examined. To this examination we now proceed. 



The general disposition of the superficial fascia met with on removing the 

 common integument from the groin has been described (p. 292). In con- 

 nection with the present subject it will be enough to mention the following 

 facts. The deeper layer of this structure adheres closely to the edge of 

 the saphenous opening, and the careful removal of it is necessary in order 

 adequately to display that aperture. Where it masks the saphenous open- 

 ing, the deep layer of the superficial fascia supports some lymphathic 

 glands, the efferent vessels of which pass through it ; and the small por- 

 tion of the membrane so perforated is named the cribriform fascia. The 

 superficial and the deep fasciae adhere together along the fold of the 

 groin likewise ; and this connection between the two membranes serves the 

 purpose, at least, of drawing the integument the more evenly into the fold 

 of the groin, when the limb is bent at the hip-joint. 



By Scarpa the deep layer of the superficial fascia which covers the abdomen was 

 described as an emanation from the fascia lata, extended upwards over the external 

 oblique muscle.* But different modes of viewing the continuity of such structures 

 depend very much on the manner of conducting the dissection. In the present case, 

 for example, the fascia may be said to proceed from above or from below, according 

 as the parts are dissected from the abdomen downwards, or from the thigh upwards. 



* A Treatise on Hernia, translated by Wishart, p. 247. 



