- •Inguinal hernia, in which the protrusion of the intestine is limited to the region of the groin.
- •Inflammation of the pleura, often as a complication of a disease such as pneumonia, accompanied by accumulation of fluid in the pleural cavity, chills, fever, and painful breathing and coughing.
- •London University College:
- •VI preface.
- •VIII preface.
- •Introductory to the study of anatomy as a science.
- •X table of contents.
- •XII table of contents.
- •10 Commentary on plates 1 & 2.
- •(Page 13)
- •14 Commentary on plates 3 & 4.
- •I. Temporal artery, with its accompanying vein.
- •(Page 17)
- •18 Commentary on plates 5 & 6.
- •I. Occipital artery crossing the internal carotid artery and jugular vein.
- •(Page 21)
- •I. Layer of the cervical fascia, which invests the sterno-mastoid and trapezius muscles.
- •(Page 25 )
- •28 Commentary on plates 9 & 10.
- •I. Left sterno-thyroid muscle, cut.
- •( Page 29)
- •32 Commentary on plates 11 & 12.
- •I. A layer of fascia, encasing the lesser pectoral muscle.
- •I. Thoracic half of the greater pectoral muscle.
- •(Page 33)
- •34 Commentary on plates 13 & 14.
- •36 Commentary on plates 13 & 14.
- •(Page 37)
- •40 Commentary on plates 15 & 16.
- •(Page 41)
- •42 Commentary on plates 17,18, & 19.
- •44 Commentary on plates 17, 18, & 19.
- •I. Tendon of flexor carpi radialis muscle.
- •I. Tendon of second extensor of the thumb.
- •(Page 45 )
- •46 Commentary on plates 20 & 21.
- •(Page 49)
- •52 Commentary on plate 22.
- •Description of plate 22.
- •I I*. Eighth pair of ribs.
- •(Page 53 )
- •54 Commentary on plate 23.
- •56 Commentary on plate 23.
- •Description of plate 23.
- •I I*. Right and left lungs collapsed, and turned outwards, to show the heart's outline.
- •(Page 57 )
- •Description of plate 24.
- •(Page 61 )
- •62 Commentary on plate 25.
- •64 Commentary on plate 25.
- •Description of plate 25.
- •66 Commentary on plate 26.
- •68 Commentary on plate 26.
- •Description of plate 26.
- •(Page 69)
- •70 Commentary on plate 27.
- •72 Commentary on plate 27.
- •Description of plate 27.
- •I. Superficial epigastric vein.
- •(Page 73)
- •74 Commentary on plates 28 & 29.
- •76 Commentary on plates 28 & 29.
- •I. The sartorius muscle covered by a process of the fascia lata.
- •I. The femoral vein.
- •(Page 77)
- •80 Commentary on plates 30 & 31.
- •(Page 81)
- •I. Transversalis muscle.
- •(Page 85)
- •86 Commentary on plates 35,36,37, & 38.
- •88 Commentary on plates 35, 36, 37, & 38.
- •I. The new situation assumed by the neck of the sac of an old external hernia which has gravitated inwards from its original place at h.
- •90 Commentary on plates 39 & 40.
- •Plate 39--Figure 2
- •Plate 39--Figure 3
- •Plate 40--Figure 1.
- •Plate 40--Figure 2.
- •Plate 40--Figure 3.
- •92 Commentary on plates 39 & 40.
- •Plate 40--Figure 4.
- •Plate 40--Figure 5.
- •Plate 41--Figure 1
- •Plate 41--Figure 2
- •94 Commentary on plates 41 & 42.
- •Plate 41--Figure 4
- •Plate 41--Figure 5
- •Plate 41--Figure 6
- •Plate 41--Figure 7
- •Plate 41--Figure 8
- •Plate 42--Figure 1
- •Plate 42--Figure 2
- •96 Commentary on plates 41 & 42.
- •Plate 42--Figure 3
- •Plate 42--Figure 4
- •(Page 97)
- •98 Commentary on plates 43 & 44.
- •Plate 45.--figure 1
- •Plate 45.--figure 4
- •102 Commentary on plates 45 & 46.
- •Plate 45.--figure 5
- •Plate 45.--figure 6
- •Plate 46.--figure 1
- •Plate 46.--figure 2
- •104 Commentary on plates 45 & 46.
- •(Page 105)
- •106 Commentary on plate 47.
- •Description of plate 47.
- •(Page 109)
- •110 Commentary on plates 48 & 49.
- •112 Commentary on plates 49 & 49.
- •(Page 113)
- •114 Commentary on plates 50 & 51.
- •116 Commentary on plates 50 & 51.
- •I I. The glutei muscles.
- •(Page 117)
- •118 Commentary on plates 52 & 53.
- •Plate 54, Figure 1.
- •122 Commentary on plates 54, 55, & 56.
- •Plate 55--Figure 1
- •Plate 55--Figure 2
- •Plate 55--Figure 3
- •124 Commentary on plates 54, 55, & 56.
- •Plate 57.--Figure 1.
- •126 Commentary on plates 57 & 58.
- •Plate 57.--Figure 15.
- •Plate 58.--Figure 1.
- •Plate 58.--Figure 2.
- •128 Commentary on plates 57 & 58.
- •(Page 129)
- •130 Commentary on plates 59 & 60.
- •Plate 59.--Figure 3.
- •Plate 59.--Figure 12.
- •132 Commentary on plates 59 & 60.
- •Plate 60.--Figure 6
- •134 Commentary on plates 61 & 62.
- •136 Commentary on plates 61 & 62.
- •Plate 62.--Figure 6.
- •138 Commentary on plates 63 & 64.
- •Plate 63,--Figure 1.
- •Plate 64,--Figure 8.
- •142 Commentary on plates 65 & 66.
- •146 Commentary on plates 67 & 68.
- •148 Commentary on plates 67 & 68.
- •I I. The venae comites.
- •(Page 149)
- •International donations are gratefully accepted, but we cannot make
- •Including how to make donations to the Project Gutenberg Literary
(Page 73)
74 Commentary on plates 28 & 29.
Poupart's ligament is not stretched tensely in a right line, like the string of a bow, between the points, C and D. With regard to these points it is lax, and curves down towards the thigh like the arc of a circle. The degree of tension which it manifests when the thigh is in the extended position is chiefly owing to its connexion with the fascia lata. If in this position of the limb we sever the connexion between the ligament and fascia, the former becomes relaxed in the same degree as it does when we flex the thigh upon the abdomen. The utmost degree of relaxation which can be given to Poupart's ligament is effected by flexing the thigh towards the abdomen, at the same time that we support the body forwards. This fact has its practical application in connexion with the reduction of herniae.
Immediately above the middle of Poupart's ligament, at the point E, Pl. 28, we observe the commencement of a separation taking place among the fibres of the aponeurosis. These divide into two bands, which, gradually widening from each other as they proceed inwards, become inserted, the upper one into the symphysis pubis, the lower into the spine and pectineal ridge of this bone. The lower band identifies itself with Poupart's ligament. The interval which is thus formed by the separation of these fibres assumes the appearance of an acute triangle, the apex of which is at E, and the base at D. But the outer end of this interval is rounded off by certain fibres which cross those of the bands at varying angles. At this place, the aponeurosis, thus constituted of fibres disposed crossways, is elongated into a canal, forming an envelope for the cord, K. This elongation is named the "external spermatic fascia," and is continued over the cord as far as the testicle. In the female, a similar canal encloses the round ligament of the uterus. From the above-mentioned facts, it will appear that the so-called "external abdominal ring" does not exist as an aperture with defined margins formed in the tendon of the external oblique muscle. It is only when we divide the spermatic fascia upon the cord at K, that we form the external ring, and then it must be regarded as an artificial opening, as at D, Pl. 29.
The part of the groin where the spermatic fascia is first derived from the aponeurosis, so as to envelope the cord, varies in several individuals; and thereupon depends, in great measure, the strength or weakness of the groin. In some cases, the cord becomes pendulous as far outwards as the point E, Pl. 28, which corresponds to the internal ring, thereby offering a direct passage for the hernial protrusion. In other instances, the two bands of the aponeurosis, known as the "pillars of the ring," together with the transverse fibres, or "intercolumnar fascia," firmly embrace and support the cord as far inwards as the point K, and by the oblique direction thus given to the cord in traversing the inguinal parietes, these parts are fortified against the occurrence of hernia. In Pl. 28, the cord, K, will be observed to drop over the lower band of fibres, ("external pillar of the ring,") and to have D, the crista pubis, on its inner side. In Pl. 29, the upper band of fibres ("internal pillar of the ring") may be seen proceeding to its insertion into the symphysis pubis. When a hernial tumour protrudes at the situation K, it is invested, in the same manner as the cord, by the spermatic fascia, and holds in respect to the fibrous bands or pillars the same relations also as this part.
After removing the tendon of the external oblique muscle, A a, Pl. 28, together with its spermatic elongation, E, we expose the internal oblique, F E, Pl. 29, and the cremaster, constituting the fourth inguinal layer. The fleshy part of this muscle, F E, occupies a much greater extent of the inguinal region than does that of the external oblique. Whilst the fleshy fibres of the latter terminate on a level with C, the iliac spine, those of the internal oblique are continued down as far as the external abdominal ring, E D h, and even protrude through this place in the form of a cremaster. The muscular fibres of the internal oblique terminate internally at the linea semilunaris, g; while Poupart's ligament, the spinous process and crest of the ilium, give origin to them externally.
COMMENTARY ON PLATES 28 & 29. 75
At the linea semilunaris, the tendon of the internal oblique is described as dividing into two layers, which passing, one before and the other behind the rectus abdominis, thus enclose this muscle in a sheath, after which they are inserted into the linea alba, G. The direction of the fibres of the inguinal portion of the muscle, F E, is obliquely downwards and forwards, and here they are firmly overlaid by the aponeurosis of the external oblique.
The cremaster muscle manifests itself as being a part of the internal oblique, viewing this in its totality. Cloquet (Recherches anatomiques sur les Hernies de l'Abdomen) first demonstrated the correctness of this idea.
The oblique and serial arrangement of the muscular fibres of the internal oblique, F, Pl. 29, is seen to be continued upon the spermatic cord by the fibres of the cremaster, E e. These fibres, like those of the lower border of the internal oblique, arise from the middle of Poupart's ligament, and after descending over the cord as far as the testicle in the form of a series of inverted loops, e, again ascend to join the tendon of the internal oblique, by which they become inserted into the crest and pectineal ridge of the os pubis. The peculiar looping arrangement exhibited by the cremasteric fibres indicates the fact that the testicle, during its descent from the loins to the scrotum, carried with it a muscular covering, at the expense of the internal oblique muscle. The cremaster, therefore, is to be interpreted as a production of the internal oblique, just as the spermatic fascia is an elongation of the external oblique. The hernia, which follows the course of the spermatic vessels, must therefore necessarily become invested by cremasteric fibres.
The fascia lata, H, Pl. 28, being strongly connected and continuous with Poupart's ligament along its inferior border, the boundary line, which Poupart's ligament is described as drawing between the abdomen and thigh, must be considered as merely an artificial one.
In the upper region of the thigh the fascia lata is divided into two parts--viz., H, the iliac part, and L, the pubic. The iliac part, H, which is external, and occupying a higher plane than the pubic part, is attached to Poupart's ligament along its whole extent, from C to D, Pl. 28; that is, from the anterior iliac spinous process to the crista pubis. From this latter point over the upper and inner part of the thigh, the iliac division of the fascia appears to terminate in an edge of crescentic shape, h; but this appearance is only given to it by our separating the superficial fascia with which it is, in the natural state of the parts, blended. The pubic part of the fascia, L, Pl. 28, which is much thinner than the iliac part, covers the pectineus muscle, and is attached to the crest and pectineal ridge of the os pubis, occupying a plane, therefore, below the iliac part, and in this way passes outwards beneath the sheath of the femoral vessels, K I, Pl. 29. These two divisions of the fascia lata, although separated above, are united and continuous on the same plane below. An interval is thus formed between them for the space of about two inches below the inner third of Poupart's ligament; and this interval is known as the "saphenous opening," L h, Pl. 28. Through this opening, the saphena vein, O, Pl. 29, enters the femoral vein, I.
From the foregoing remarks it will appear that no such aperture as that which is named "saphenous," and described as being shaped in the manner of L h, Pl. 28, with its "upper and lower cornua," and its "falciform process," or edge, h, exists naturally. Nor need we be surprised, therefore, that so accurate an observer as Soemmering (de Corporis Humani Fabrica) appears to have taken no notice of it.
Whilst the pubic part of the fascia lata passes beneath the sheath of the femoral vessels, K I, Pl. 29, the iliac part, H h, blends by its falciform margin with the superficial fascia, and also with N n, the sheath of the femoral vessels. The so-called saphenous opening, therefore, is naturally masked by the superficial fascia; and this membrane being here perforated for the passage of the saphena vein, and its tributary branches, as also the efferent vessels of the lymphatic glands, is termed "cribriform."