COVERINGS OF A FEMORAL HERNIA. 



1035 



behind them to their anterior surface. 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 iliac spine of the 

 hip-bone. Hence its greatest diameter is transverse. 



Fig. 712. VIEW OF THE RELATION OP 

 THE VESSELS OF THE GROIN TO A 

 FEMORAL HERNIA, &c. (from R. 

 Quain). | 



In the upper part of the figure a 

 portion of the flat muscles of the 

 abdomen has been removed, displaying 

 in part the transversalis fascia and 

 peritoneal lining of the abdomen ; in 

 the lower the fascia lata of the thigh is 

 in part removed and the sheath of the 

 femoral vessels opened : the sac of the 

 femoral hernial tumour has also been 

 opened. 



a, anterior superior spinous process 

 of the ilium ; b, aponeurosis of the ex- 

 ternal oblique muscle above the exter- 

 nal inguinal aperture ; c, the abdomi- 

 nal peritoneum and fascia trans- 

 versalis ; d, the iliac portion of the 

 fascia lata near the saphenic opening ; 

 e, sac of a femoral hernia ; 1, points 

 to the femoral artery ; 2, femoral vein 

 at the place where it is joined by the 

 saphenic vein ; 3, epigastric artery and 

 vein passing up towards the back of 

 the rectus muscle ; + , placed upon, 

 the upper part of the femoral vein 

 close below the common trunk of the 

 epigastric and an aberrant obturator artery ; the latter artery is seen in this case to pass 

 close to the vein and between it and the neck of the hernial tumour. 



Coverings of the hernia. The sac which is pushed before the protruded 

 viscus, is derived from the external fossa of the peritoneum ; except, how- 

 ever, when the cord of the obliterated umbilical artery is placed outside its 

 ordinary position, in which case the serous membrane furnishes the sac 

 from its internal fossa. After the sac, the hernia carries before it the sub- 

 serous membrane (septum crurale of Cloquet), which covers the femoral 

 ring, and likewise an elongation from the sheath of the femoral vessels. 

 These two structures combined constitute a single very thin 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. 



Diagnosis. Passing over the general symptoms of abdominal hernise and 

 the means of forming the diagnosis between a hernia and several other dis- 

 eases with which it is liable to be confounded, subjects which fall within 

 the province of treatises on practical surgery, the observations to be made 

 in this place may be limited to the anatomical circumstances which charac- 

 terise femoral hernia, and serve to distinguish it from the inguinal form of 

 the complaint. When the inguinal hernia descends to the scrotum or to 

 the labiuin pudendi, and when the femoral hernia extends some distance 



