HERNIA 425 



ligament (Gimbernat's). If the peritoneum is still in position at this point 

 it may exhibit a slight dimpling or depression as it passes over the ring. 

 Strip the peritoneum from the greater part of the iliac fossa. The extra- 

 peritoneal fatty tissue, as it stretches across the femoral ring, will be 

 observed to be denser, stronger, and more fibrous than elsewhere. A 

 special name is applied to this small portion of the extra-peritoneal 

 fatty tissue. Seeing that it is applied to the ring in such a manner as 

 to close the femoral canal at its abdominal end, it is called the septum 

 femorale. The extra-peritoneal fatty tissue should now be dissected back 

 with the handle of the knife, to the same extent as the peritoneum. The 

 fascia iliaca clothing the iliacus and psoas muscles is thus exposed, and 

 the dissector should note that the external iliac vessels lie within and not 

 outside this fascia. 



The student is now in a position to study the manner in which the 

 femoral ring is formed. Let him follow the fascia iliaca and the fascia 

 transversalis towards the inguinal ligament. If the dissection has been 

 carefully performed it will be obvious that, to the lateral side of the external 

 iliac vessels, these two fasciae become directly continuous with each other, 

 and, further, that along the line of union they are both firmly attached 

 to the inguinal ligament. It is evident, then, that no hernial protrusion 

 could leave the abdominal cavity behind the inguinal ligament and lateral 

 to the iliac vessels. 



In the region of the iliac vessels the arrangement of the fascia will 

 be found to be different. Here the fascia iliaca is carried downwards 

 behind the vessels, whilst the fascia transversalis is prolonged downwards 

 in front of the vessels and behind the inguinal ligament. In the region of 

 the thigh they together constitute a funnel-shaped sheath for the femoral 

 artery and vein, and for some lymph vessels ascending to the abdomen. 

 This sheath is divided into three compartments by two vertical partitions. 

 The femoral artery occupies 'the lateral compartment, and the vein the 

 intermediate compartment, whilst the medial compartment, called the 

 femoral canal, is occupied by the lymph vessels and, sometimes, by a small 

 lymph gland. 



An essential difference between these compartments is this that 

 whilst the two lateral are completely filled up, by the artery and vein, the 

 femoral canal is much wider than is necessary for the passage of its 

 contents. Gauge the width of the femoral ring by introducing the point 

 of the little finger. It is readily admitted within the opening. Here, 

 then, is a source of weakness to the abdominal wall, and one which is 

 greater in the female than in the male, seeing that the distance between 

 the iliac spine and pubic tubercle is proportionally greater in the female, 

 and, in consequence, the femoral ring wider. 



When the finger is within the ring, mark the structures which surround 

 it in front, the inguinal ligament, with the spermatic cord or round 

 ligament of the uterus ; behind, the ramus of the pubes, giving origin to 

 the pectineus muscle, which is covered by the pectineal portion of the fascia 

 lata ; medially, the sharp crescentic free border of the lacunar ligament ; 

 and laterally, the external iliac vein. 



It is still more necessary to note the relations of the blood-vessels 

 to the femoral ring. The external iliac vein has been seen to lie to its 

 lateral side. The inferior epigastric artery, as it ascends on the posterior 

 aspect of the abdominal wall, is close to its upper and lateral margin, 

 and sends its pubic branch medially in front of it. More important than 

 any of these is the relation of the obturator artery, when it takes origin 

 from the inferior epigastric. This anomalous vessel may adopt one of 

 three courses: (i) It may follow the course of the pubic artery, an 



