Volume 1

The cyclopaedia of anatomy and physiology / edited by Robert B. Todd.

Date:
1836-1859
Catalogue details

Licence: Public Domain Mark

Credit: The cyclopaedia of anatomy and physiology / edited by Robert B. Todd. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    22/837 page 5
    reflected backwards, outwards, and a little upwards, they are likewise inserted into the linea ilio-pectinea, which commences at the spine of the pubis. The lower margin of the tendon is thus folded back a little as it arches over the excavation between the pubis and ilium, so as to present towards the abdomen a slight channel-like excavation, which affords origin to the muscular fibres of the internal oblique as well as to those of the transver- salis, whilst it has the appearance of a rounded ligamentous cord towards the thigh. In this manner is formed Poupart's ligament, which, contrary to what its usual name denotes, is not a distinct ligamentous cord, but the in- ferior margin of the external oblique stretched from pubis to ilium, and folded a little upon itself. By its superior margin it is continuous with the fibres of the tendon of the external oblique, which fall obliquely upon it; by its in- ferior margin it is intimately connected with the fascia lata of the thigh ; externally it is inserted into the anterior superior spine of the ilium; and by its pubic extremity it has three attachments, 1. to the body of the pubis; 2. to the spine of the same; and 3. to the linea ilio-pectinea, constituting what has been called Gimbernat's ligament, which has a sharp slightly crescentic margin directed backwards and outwards to- wards the femoral vessels.* (See Groin, Region of the.) The external abdominal ring is a triangular opening, situated obliquely ; the superior angle being directed upwards and outwards, and its base, represented by a line uniting the pubic insertions of the two pillars, resting upon the pubis. The superior angle is formed evidently by the separation of the fibres of the aponeu- rosis, the primitive direction of which is the same as that of a perpendicular from the apex to the base of the triangle, viz. downwards and in- wards, (sacrad and pubad.) This separation, however, is strengthened, and the angle round- ed by some tendinous fibres which inter- sect the oblique ones nearly at a right angle, arising as a cord of variable thickness from Poupart's ligament, and passing upwards and inwards over the apex of the ring, gradually separating into several tendinous fibres. These fibres are sometimes very strong, at other times very feeble and scarcely perceptible; but it rarely, if ever, happens that they are completely absent ; they have been termed interculumnul bunds. I have seen them so strong that they could be distinctly dissected off the external oblique aponeurosis, like a separate tendinous expansion; but most fre- quently they are so united to the aponeurosis as to render it impossible to remove them without injury to it. These fibres are evi- dently intended, as Scarpa expresses it, to fix the limits of the inguinal ring, and to oppose the further divergence of the tendi- nous pillars towards the side. They are * The terms crural arch, and ligament of Fallopivs, are also used synonymously with Poupart's liga- ment. Velpcau calls it bandelctte ilio-pubienne du grand oblique. equally met with, although not nearly so much developed, in women and children as in men ; and Mr. Lawrence asserts that in old hernias they are particularly strong. I cannot, confirm this remark from my own observation, as in my dissections of old hernia?, I have not found them particularly developed; nor is itcon- sistent with the general result of pressure from within on tendinous fibres to believe that such pressure would produce an increase of deve- lopment in them. The size of the external abdominal ring is greatest in the male subject, but here it varies considerably, sometimes closely embracing the cord as it passes through it, and at others appearing much too large foV it. In the male the parts which pass through it are the sper- matic cord, enveloped in its proper tunic, and in one of condensed cellular membrane pro- longed from the fascia transversalis, a branch of the genito-crural nerve, the cremaster mus- cle, the cremasteric artery, and the spermaticus superficialis nerve. In the female, we find the round ligament of the uterus, covered and accompanied by similar parts, excepting the cremaster. From the margin of the external abdominal ring, a cellular expansion or fascia is carried over the cord or round ligament, and has been denominated fascia sperntatica. This fascia consequently forms a covering of any hernia that may be protruded through the external ring; and, accordingly, in old hernia: we find it greatly thickened. Its formation is simply in accordance with what we find oc- curring in all parts of the body, viz. that when any part passes through an opening in a fibrous membrane, it carries with it a cellular expan- sion from the margin of that opening. This we observe in the passage of the vena cava through the diaphragm, of the urethra through the triangular ligament or deep perineal fascia. This view confirms the opinion of Sir A. Cooper, that this fascia is a production from the margin of the ring itself. The external oblique muscle is covered in all its extent by the superficial fascia ; its costal margin is related to the serratus magnus,and to the latissimus dorsi, with which muscle it is also in close relation by its posterior margin, being sometimes slightly overlapped by the anterior margin of the latissimus, but at others separated from that muscle by a triangular interval through which the fibres of the obliquus inter- nus appear: inferiprly the fascia lata of the thigh is related to the margin of the external oblique muscle, both as it covers the gluta;i,and as it lies in front of the thigh. Along the middle line the aponeuroses of opposite sides meet at the linea alba, and superiorly the mus- cular fibres are related to and sometimes con- nected by a fleshy slip with those of the pecto- ralis major, and the aponeurosis is continuous with that of the same muscle.* When the ex- * By its position, the direction of its fibres, and the short distance to which its fleshy portion extends forwards, the external oblique corresponds so much to the external intercostals, that one is led to say that it represents them in the abdomen.—3/cr'nrl.
    digitised image 1
    digitised image 2
    digitised image 3