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Show 210 0F FEMORAL HERNIA. or FEMORAL HERNIA. Further, in my remarks on the additional plate of the mus- cles of the abdomen, in speaking of Gimbernat, Append. p. 5. I have said, the opinion that it is not on the external margin of the ligament that the tension in hernia was found, but more internally, under the ligament, and towards the pubis, is no conceit (as I had then heard it spoken of), but resulting from the natural state of the parts. To say, however, that the inner margin of the tendon of the external oblique is always, or even most frequently, the place of strangulation, I conceive to be an error; for still I say, that it is the sudden angle which the dilated gut makes with its straightened part in the neck of the sac, which causes the strangulation; in other words, that as the gut and sac rise from the hollow in the top of the thigh, on the forepart of‘ the tendon of the abdominal muscle, that which produces the acuteness of its turn, (the outer margin of the ligament, where it has thrown ofl‘ its two circular fasciae) is the part in which the strangulation is seated for the most A, the femoral artery. B, the femoral ligament. C, the tigament of the womb, coming out from the ring. D, an undescribed fascia, which goes down to the bone, and is con- tinued over the joint. E, another ligament on the inside of the space through which the femoral hernia descends. I conceive that this arch on the inside of the femoral vessels, is the place where the stricture is most frequently found, and round which the neck of the sac turning, the intestine is strangulated. : wom M0997") part. ,m,,,n", ,H.. hthhl \IIIIIIIIIIESF 'l. i We know that the lower part of the tendon of the external oblique muscle is tied down by the fascia of the thigh; but we know also that the herniary tumour is in truth under the fascia, which is at this place more like the common cellular substance, having thickness from the quantity of fat, and firmness from an intermixture of tendinous filaments. Fascia: not only go upwards, on the inside of the abdomin~ al muscles, and on the iliaeus internus, as described by MR Cooper, but two thin and strong ligaments or fascize p215" The femoral hernia cannot force its way downward. Sometimes remaining small, it lurks in the groin, and is strangulat- ed before it forms any considerable tumour ; but oftener it is forced up from the hollow, and rises somewhat, so that I have seen it mistaken by surgeons, both of London and Edinburgh, for inguinal hernia. Tans-Knowing the nature of the tendon under which this hernia passes, we see the necessity of somewhat a dilTerent intention in the exertion we use in this case, from that which We propose in the operation for inguinal hernia ; for while we down, the one over the hip-joint, and the other over the 05 p11" relax the fascia of the thigh, and the abdominal muscles, we bis; and these really convert the opening under the Poupart'S must press the tumour down into the hollow, before we at- ligament into an arch ; and betwixt these two tendinous membranes, the femoral hernia descends, and is strangulated. tempt to return it under the ligament. To press it directly into the belly, as it were, or to force it upward, is to push the tumour from the direction in which it must pass to be reduced. |