bladder
should be emptied; for this organ, in its distended state, rises above
the level of the pubic bone, and may thus be endangered by the incision
through the stricture--especially if Gimbernat's ligament be the
structure which causes it.

[Footnote: "The seat of the stricture is not the same in all cases,
though, in by far the greater number of instances, the constriction is
relieved by the division upwards and inwards of the falciform process of
the fascia lata, and the lunated edge of Gimbernat's ligament, where
they join with each other. In some instances, it will be the fibres of
the deep crescentic (femoral) arch; in others, again, the neck of the
sac itself, and produced by a thickening and contraction of the
subserous and peritonaeal membranes where they lie within the
circumference of the crural ring."--Morton (Surgical Anatomy of the
Groin p. 148).]

An incision commencing a little way above Poupart's ligament, is to be
carried vertically over the hernia, parallel with, but to the inner side
of its median line. This incision divides the skin and subcutaneous
adipose membrane, which latter varies considerably in quantity in
several individuals. One or two small arteries (superficial pubic, &c.)
may be divided, and some lymphatic bodies exposed. On cautiously turning
aside the incised adipose membrane contained between the two layers of
the superficial fascia, the fascia propria, 9, Figs. 4, 5, Plate 46, of
the hernia is exposed. This envelope, besides varying in thickness in
two or more cases, may be absent altogether. The fascia closely invests
the sac, 12; but sometimes a layer of fatty substance interposes between
the two coverings, and resembles the omentum so much, that the operator
may be led to doubt whether or not the sac has been already opened. The
fascia is to be cautiously slit open on a director; and now the sac
comes in view. The hernia having been drawn outwards, so as to separate
it from the inner wall of the crural canal, a director [Footnote] is
next to be passed along the interval thus left, the groove of the
instrument being turned to the pubic side. The position of the director
is now between the neck of the sac and the inner wall of the canal. The
extent to which the director passes up in the canal will vary according
to the suspected level of the stricture. A probe-pointed bistoury is now
to be slid along the director, and with its edge turned upwards and
inwards, according to the