Fig. 170. Inguinal Region, left side, 5th layer. Subperitoneal Hernial 

 Orifices. Hip-Joint. Obturator Region. 



The Inguinal Region and neighbouring parte have been exposed layer by layer 

 in an adult male; above Poupart's Ligament the Subperitoneal Hernial Ori- 

 fices are exposed. At the level of Poupart's Ligament Muscles and Vessels are 

 cut across so that the Muscular Compartment and the Vascular Compartment 

 (opening for Femoral Hernia) are seen. Below the Ligament on the inner side 

 a piece of the Pectineus has been cut out so that the opening of the Obturator 

 Canal (external opening of Obturator Hernia) is shewn; on the outer side the 

 Hip-foint has been exposed and the joint cavity widely opened. 



The Hip-Joint lies immediately external to the Artery but on a much 

 deeper plane. The Anterior Crural Xerve lies almost o\er the middle of the 

 Head of the Femur. The Head of the Femur can onl}' be felt from in-front, in 

 ver}' thin people. So that owing to its deep situation and its proximity to the 

 large vessels, the Hip-Joint is not \ery easih' accessible from in front. 



The Internal and External Circumflex Arteries, of considerable size, are 

 given off from the Deep F'emoral Artery, but one of them, occasionally both, 

 may come off from the Common or Superficial Femoral Artery. 



Internal to the vessels is a landmark of some importance. If the Pectineus 

 Muscle be removed the External Obturator Muscle is exposed as it arises from 

 the outer surface of the Obturator Foramen and the Obturator Membrane, and 

 runs outwards to the Digital Fossa. The Membrane closes the Obturator Foramen 

 except at its anterior and external angle; here a small gap hardly Vo^h inch in 

 diameter allows the Obturator Vessels and Nerve to pass. A hernia may protrude 

 through the orifice — Obturator Hernia — its position proves the difficulty of 

 diagnosis, and its close proximity to the Obturator Nerve sometimes causes pain 

 in the area of distribution of the nerve owing to pressure by the Hernia. The 

 figure also shews structures passing under PouPART's Ligament which together 

 with the upper border of the Pelvis forms a large slit-like space divided 

 into two compartments by the Iho-Pectineal F"ascia. This fascia, which is derived 

 from the Fascia covering the Iliacus Muscle and accompanied the Ilio-Psoas down 

 to the Lesser Trochanter of the Femur, is firmly attached to the Ilio-Pectineal 

 Eminence. In the outer compartment is the Ilio-Psoas Muscle with the Anterior 

 Crural Nerve embedded in its anterior surface. In the inner compartment are 

 the Large Vessels and the Pectineus Muscle. Between the Femoral Vein and 

 the outer margin of Gimbernat's Ligament there remains a small space filled 

 by loose connective-tissue; this is the Femoral Ring, the most important spot at 

 which the Peritoneum can readily be pushed forward and give rise to a Femoral 

 Hernia. Here we find situated the Deep Inguinal Lymphatic Glands, one of which 

 goes by the name of Cloquet's Gland. 



A Femoral Canal does not exist (as a preformed Canal) in normal sub- 

 jects. It is the result of the descent of a Femoral Hernia. 



