1034 SURGICAL ANATOMY OF HERNLZE. 



Cloquet to possess in some cases considerable density ; and, from being 

 the only barrier in this situation between the abdomen and the top of the 

 thigh, it was named by that observer the crural septum (septum crurale). 

 But this structure is no more than areolar tissue with enclosed fat, and it 

 forms oftentimes but a very slight partition. On clearing it away, the ring 

 is displayed (fig. 346). It is a narrow opening, usually of sufficient size to 

 admit the end of the fore finger ; the size, however, varies in different 

 cases, and it may be said to increase as the breadth of Gimbernat's ligament 

 diminishes, and the converse. It is larger in the female than in the male 

 body. On three sides the ring is bounded by very unyielding structures. 

 In front are the femoral arches ; behind is the hip-bone covered by the 

 pectineus muscle and the pubic layer of the fascia lata ; on the outer side 

 lies the external iliac vein, but covered with its sheath ; and on the inner 

 side are several layers of fibrous structure connected with the pectineal 

 line namely, Gimbernat's ligament, the conjoined tendon of the two 

 deeper abdominal muscles, and the fascia transversalia, with the deep 

 femoral arch. The last-mentioned structures those bounding the ring at 

 the inner side present respectively a more or less sharp margin towards 

 the opening. 



Femoral canal. From the femoral ring, which is its orifice, the canal 

 continues downwards behind the iliac part of the fascia lata (its falciform 

 process), in front of the pubic portion of the same membrane, and ends at 

 the saphenous opening. It is rather less than half an inch in length ; but 

 in its length the canal varies a little in different cases. 



Blood-vessels. Besides the femoral vein, the position of which has been 

 already stated, the epigastric artery is closely connected with the ring, lying 

 above its outer side. It not unfrequently happens that the obturator artery 

 descends into the pelvis at the outer side of the same opening, or imme- 

 diately behind it ; and in some rare cases that vessel turns over the ring to 

 its inner side. Moreover, an obturator vein has occasionally the same 

 course ; and small branches of the epigastric artery will be generally found 

 ramifying on the posterior aspect of Gimbernat's ligament. In the male 

 body, the spermatic vessels are separated from the canal only by the femoral 

 arch. 



To the foregoing account of the anatomical arrangement of the parts con- 

 cerned in femoral hernia, may be added certain measurements, showing the 

 distances of some of the most important from a given point. They are 

 copied from the work of Sir A. Cooper : * 



MALE. FEMALE. 



From the symphysis pubis to the anterior spine of / - . , 



the ilium . | 5 i mches - 6 mches - 



From same point to the middle of the iliac vein . . 2^ ,, ... 2f ,, 



,, to the origin of the epigastric artery 3 ,, ... 3 ,, 

 ,, to the middle of the lunated edge \ 03 



of the fascia lata . . . j 6 * *1 



,, to the middle of the femoral ring . 2 ,, ... 2| ,, 



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, after the passage of about half an inch, it undergoes a change 

 of direction, bending forward at the saphenous opening ; and, as it 

 increases in size, it ascends over the iliac part of the fascia lata and the 

 femoral arch. The hernia thus turns round those structures, passing from 



* On Crural Hernia, p. 5. 



