FEMORAL HERNIA 1137 



layers below; (c) persistence of tlie original process of peritoneum; (r/) a long 

 mesentery or suspensory ligament of the intestines. :Mr. Lockwood has shown 

 that the mesentery is relatively larger in infancy, and that there is a rapid decrease 

 after the second year. In adults its length is about eight inches, and any 

 lengthening of the mesentery beyond this point is likely to be combined with a 

 protuberant l)elly. He shows further, with regard to the range of descent or 

 the excursus of the intestines, that it is extremely rare to find a mesentery so short, 

 or attached so high, as to prevent the intestines' escaping or being drawn from the 

 abdomen. 



The long mesentery of infancy and childhood is usually associated with consid- 

 eralde downward df^scent of the intestine; and in the adult it is quite common to 

 tind that the small intestines will pass an inch and a half beyond the right crural 

 arch, one inch l)eyond the pul)es, and up to the left crural arch. 



(3) Stretching of the abdominal walls l)y pregnancies, etc. 



(4) Increase of the volume and weight of the parts within: e.g. omentum by 

 deposit of fat in it. 



(5) Sex. Thus, men have larger inguinal rings. Women have a larger femoral 

 arch, and one less Avell filled in by muscles, and with less strong fasciae meeting, 

 e.g. iliac and transversalis. 



(6) Cough, asthma, bronchitis, habitual fretfulness or crying. 



(7) Straining to expel urine, as with phimosis, stricture, stone in bladder, etc. 



(8) Straining in defecation. 



(9) Lifting heavy weights. 



(10) Results of wounds or abscesses which have weakened the abdominal wall. 



(11) Whatever diminishes the abdominal cavity, e.g. tight lacing. 



FEMORAL HERNIA 



As many of the parts concerned here are also met with in inguinal hernia, one 

 description, given now, will suffice. 



\\\ih. regard to descriptions of the inguinal and femoral regions, it is always 

 well to bear in mind the following: — (1) That the so-called rings and canals are 

 merely weak spots in the inguinal and femoral regions, and that they do not exist 

 distinctly, and do not get beyond the potential stage, unless made by a scalpel or 

 a hernia; (2) that at the fold of the groin most of the layers blend together, and 

 that descriptions of them as separate layers, for convenience sake in learning them, 

 are more or less artificial; (3) that the description of these layers has been most 

 needlessly complicated by the number of terms used, many of which are simply 

 substitutes for others; (4) many of these terms are not only useless but incorrect, 

 e.g. saj)henous, crural, etc. 



Parts concerned in femoral hernia. (1) Skin and superficial fascia of 

 groin. — The latter consists of two layers: (a) Superficial layer of superficial 

 fascia. — Fatty, met with over the whole groin, and continuous with the superficial 

 fascia of the rest of the body. (6) Deep layer of superficial fascia. — Thin and 

 membranous, only met with over the lower tliird of thi' alxlominal wall and to 

 the inner side of the groin. It is continu<)Us through the scrotum with the deep 

 layer of the superficial fascia of the perinjeum. Just below Poupart's ligament it 

 is joined to the fascia lata. From these two facts it results that in ru])ture or 

 giving way of the urethra the extravasated urine may come forwards by way of the 

 genitals (page 1124) and from the continuity of the fascia make its way on to the 

 abdomen, but not down on to the thigh. 



Between the two layers of superficial fascia lie the superficial glands of the 

 groin, the superficial branches of the common femoral artery, one or two cutaneous 

 nerves, and some veins descending to the saphenous opening to join the long 

 saphena vein. 



(2) Poupart's ligament. — This is also known as the crural arcli, a misnomer, 

 as 'crus' means leg. A description of its .'^hape and attachments is given on page 

 1114. Owing to the connection of the fascia lata to its lower l)order, the 

 'saphenous opening,' which is situated in tiie fascia lata, and has its upper cornu 



