REGIONS OF THE LEG. 



127 



interfering with the comfort, if not with the 

 health, of the entire system. 



It is composed of two bones, the tibia and 

 fibula, with accompanying masses of muscles 

 both before and behind, which act upon the 

 foot. 



If we divide the leg into anterior, external, 

 and posterior regions, we find in the anterior 

 the tibialis anticus muscle, the extensor com- 

 munis digitorum, extensor proprius pollicis, 

 and peroneus tertius ; in the external region, 

 the peroneus longus and brevis ; and poste- 

 riorly, the two gastrocnemii, popliteus, plantaris, 

 tibialis posticus, flexor longus digitorum, and 

 flexor longus pollicis. Among these are run- 

 ning the anterior and posterior tibial and pero- 

 neal arteries, with their accompanying veins, 

 nerves, and absorbents ; all these bound toge- 

 ther, and supported by strong fascial coverings, 

 and enveloped in the general integument. Be- 

 tween this and the fascia just mentioned, is an 

 important layer of cellular tissue, (fascia super- 

 ficialis,) enclosing the two saphenae veins, major 

 and minor, and the superficial nerves and ab- 

 sorbents. 



It may be well to make some few obser- 

 vations upon the external form and characters 

 of the leg, before describing the deeper seated 

 parts. The leg, comprising all that part of the 

 lower extremity between the knee above and 

 the ankle below, is somewhat of a conoidal 

 tapering figure, rather flattened on its anterior 

 and outer aspect, full and round posteriorly. 

 This shape renders permanent compression by 

 means of a bandage very difficult. The con- 

 traction of the gastrocnemii, especially during 

 walking, rarely fails in a short time to separate 

 the turns of the bandage below, causing the 

 lower ones to overlap each other, and producing 

 constriction, irritation, and excoriation of the 

 skin, above the malleoli. If this difficulty 

 were more considered, and the importance of 

 the bandage in diseases of the leg duly appre- 

 ciated, we should see more pains taken in ac- 

 quiring the art of its application than is now 

 common; though we are happy to find that the 

 minor operations of surgery are now beginning 

 to receive much more attention than formerly, 

 and to form a part of the general system of 

 demonstrative instruction. Assuredly the ag- 

 gregate amount of suffering relieved would be 

 far greater by attention to these minutiae of 

 surgery, than by the more striking, though not 

 more important details of operations, which to 

 the mass of practitioners can occur but seldom, 

 if at all. 



The projection of the muscles at the back 

 part of the leg, produced by the two gastro- 

 cnemii, and known under the name of the calf, 

 forms a characteristic peculiar to man. No 

 inferior animal possesses it, not even the ourang 

 outang ; and the feeble and uncertain gait of 

 these animals, when in the erect position, at 

 once demonstrates the value of the muscles of 

 the calf of the leg, and that this position is 

 natural only to man himself. The form and 

 expression of this part of the leg varies much 

 according to age, sex, and general habit. In 

 infancy the gastrocnemii, in common with the 



developement of the whole lower extremity, 

 are small and feeble. The upper extremities 

 are, in early infancy, even larger than the lower ; 

 these latter do not acquire their full growth 

 and proportions till adult age. In the female, 

 the general form of the leg is less marked and 

 prominent, and more rounded than in the male, 

 while, in this last, the leg presents every pos- 

 sible variety of proportion, according as habits 

 of exercise on foot, robust health, or long conti- 

 nued sickness, has invigorated or enfeebled the 

 muscular system at large, or this portion of it 

 in particular. The broad and rounded surface 

 of the calf of the leg is contracting as it de- 

 scends, and at the lower part projects like a 

 kind of cord, representing the tendo Achillis. 

 In contraction, the calf shows two portions, 

 marked out by a double fissure, which indi- 

 cates the situation where the gastrocnemius 

 join the soleus, the lower elevation being 

 formed by this last muscle, which extends 

 lower down the leg than the gastrocnemius. 

 This projection of the soleus is in some much 

 more marked than in others, and is indicative of 

 considerable power when it reaches lower down, 

 much more so than when the whole prominence 

 of the calf is high up. In persons celebrated 

 for pedestrian powers we have observed this 

 projection of the soleus in a marked degree. 



In the anterior region of the leg, the form is 

 considerably flatter than in the posterior, and 

 narrows as we proceed downwards, at the 

 lower part becoming almost round. During 

 extension of the foot, this region is marked by 

 longitudinal elevations and depressions, indi- 

 cative of the situations of the muscles, and of 

 the connecting portions of aponeurosis. An 

 examination of these points will assist us in 

 cutting down upon the arteries here, as the 

 depressions mark the exact boundaries of the 

 muscles, being produced by the aponeurotic 

 processes, which dip between them. 



The integument of the anterior region, gene- 

 rally covered with hair in man, and of a some- 

 what dense structure, enjoys sufficient mobility 

 to admit of wounds being united by the first 

 intention, provided the loss of substance be 

 not great. Not being very extensible, abscesses, 

 tumours, &c., have great difficulty in projecting 

 externally in front of the limb, and consequently 

 for the most part remain more or less flattened. 

 The posterior part of the leg has an integument 

 more soft and elastic, and possessing fewer 

 hairs than the anterior, particularly on the inner 

 side. The position of the skin, with relation 

 to the parts which it covers, occasions a marked 

 difference in the mode of repairing the ravages 

 of extensive ulcerations or sloughings. On 

 the front and outer part of the leg, where the 

 skin is somewhat stretched over the tibia and 

 fibula, the process of cicatrization can only 

 draw together the sound parts to a small de- 

 gree. In consequence the healing process is 

 slower in completion, and the cicatrix less de- 

 pressed in proportion than when it is situated 

 posteriorly. On the contrary, in this latter 

 situation, the skin being stretched only over 

 soft parts, when a considerable portion of it has 

 been destroyed, the contractile force of the new 



