The relation of the inguinal glands, more particularly the superior, to the femoral artery suggests several inferences. 1st, That the very commencement of the artery's course, although the situation in which the vessel is nearest to the surface, and that in which it can be most easily distinguished by its pulsa tion, is yet not the most eligible part at which to expose it, since the glands and their vessels cannot, by any precaution of the surgeon, be protected certainly from injury. 2dly, That phagedenic ulceration of the glands of the groin must be attended with great danger from the vicinity of the great vessels. 3dly, That hemorrhage consequent upon such ulceration does not necessarily proceed from those vessels themselves; but that it may, and in the ma jority of cases in the first instance probably does arise from the branches supplying the glands ; and, 4th, That the groin is likely to be the seat of pulsating tumours requiring to be distinguished from aneurism.
The third covering of the artery is the superficial lamina of the iliac portion of the fascia lata. This portion having covered the an terior surface of the iliacus and psoas muscles as far as the middle of Poupart's ligament, along which it is attached from without inward, divides at that point into two lamina, a deep one and a superficial one ; the former passel inward and backward from the ligament, upon the psoas muscle, to the ilio-pectineal eminence of the os innominatum, into which it is in serted, continued thence upward, upon the inside of the muscle, along the brim of the pelvis into the fascia iliaca, and downward across the capsule of the ilio-feinoral articula tion, to which it is also attached : it is in fact that part of the fascia iliaca, (for the fascia iliaca and the iliac portion of the fascia lata are one and the same expansion, distinguished from each other only by Poupart's ligament,) which is situate upon the inside of the psoas magnus, and which forms the outer wall of the femoral canal, being interposed between the femoral artery and the muscle. At the ilio pectineal eminence it also meets and is iden tified with the pubic portion of the fascia lata, which is attached to the pectineal line of the pubis, in continuation with this deep lamina of the iliac portion, covers the pectinalis muscle, and is situated immediately behind the vessels. When that part of the deep lamina of the iliac portion of the fascia lam which extends from Poupart's ligament to the ilio-pectineal eminence has had the prolonga tion of the fascia downward detached from it, it appears as an oblique partition dividing the crural arch into two parts, an external containing the iliacus and psoas muscles with the crural nerve, and an internal containing the femoral vessels.
The second lamina of the iliac portion of the fascia lata—the superficial one—passes inward across the femoral vessels, superficial to them and to the prolongation of the fascia transversalis, until it has reached the inside of the vessels: it is at the same time attached above, in front of the vessels, and in con tinuation with the iliac portion itself, to the inferior margin of Poupart's ligament, from its middle to the base of its third insertion Gimbernat's ligament, and upon their inside along the base of the latter ligament as far as the pectineal line of the pubis, into which it is finally inserted, external to the base of Gimbernat, between it and the insertion of the fascia transversalis upon the inside of the aperture of the femoral sheath, and where it is also identified with the pubic portion of the fascia attached along the same line : from thence it is united to the anterior surface of the pubic portion of the fascia lata, down ward along the inside of the vessels. The
superficial lamina of the iliac portion is thus thrown across the front of the vessels, and by the disposition, which has been detailed, the fascia lam encloses the vessels between the two lamina', and forms, by means of them and their connection at either side, a canal, within which are contained the vessels and the prolongation of the fascia transversalis covering them in front. The constitution of the canal, as described, may be considered to extend from Poupart's ligament until the artery is about to be covered by the sartorius, from whence its anterior wall is formed, through the remainder of the vessel's course, by another and deeper layer of the fascia. The canal thus formed, to which the author would apply, with Cloquet, the term femoral canal, is widest at its upper extremity, i.e. at Poupart's ligament; from whence, as it descends, it contracts in width until it has passed the entrance of the saphena, beyond which it continues of nearly uniform capacity to its termination. The diminution in the transverse extent of the canal is due to the direction of the line of union between the superficial lamina of the iliac portion and the pubic portion of the fascia, which, as has been already stated, inclines outward as it descends from the pectineal line of the pubis to the point at which the saphena joins the femoral vein. In the interval between Poupart's ligament and the junction of the two veins the superficial lamina is thinner, less aponeu rotic, and more of a cellular character than other parts of the fascia ; but it is subject to much variety in this respect : in all cases it is thinner and weaker internally than externally, but in some it is throughout distinct and un broken, unless by the passage of vessels, and presents aponeurotic characters as decidedly as many other parts of the expansion ; while in others it is cellular, indistinct, and even fatty, not easily distinguishable from the subcuta neous structure, and so thin as to seem de ficient toward its inner part, or to have its line of union with the pubic portion inter rupted at one or more points. The extent and connections of this portion of the fascia will be most satisfactorily displayed by first detaching Poupart's ligament, upon its abdo minal side, from the fascia transversalis as it. descends beneath the ligament, and then care fully insinuating the handle of a knife down ward beneath the ligament and the superficial lamina of the iliac portion of the fascia lata, between them and the prolongation of the fascia transversalis : this done, the superficial lamina may, with the guidance of the instru ment beneath it, be satisfactorily traced.