THE ABDOMEN. 381 



umbilicus, the tenth the region of the umbilicus, and the eleventh just below, 

 being about opposite the fold of Douglas, while the twelfth supplies the region 

 above the pubes. 



The iliohypogastric emerges through the external oblique about 2 or 3 cm. 

 above the external ring, while the ilio-inguinal emerges through the external ring 

 and supplies the parts adjacent. From this distribution it is evident why disease 

 posteriorly, such^aiPcaries of the spine or pleurisy, will cause pain to be complained of 

 in the corresponding distribution anteriorly. Incisions through, or along the outer 

 edge of the rectus, Will divide the nerves supplying it, and cause paralysis of the 

 muscle. Incisions made across the lateral muscles of the abdomen cannot be 

 efficiently repaired 'by sewing the cut muscles together, because this does not restore 

 the function of the nerves which have been divided. 



ABDOMINAL INCISIONS. 



These are made through all portions of the abdominal walls according to the 

 organs it is desired to gain access to. They should be so planned as to avoid unnec- 



, 



Kocher's, for bile passages 



Battles' incision, for 

 appendix 



McBurney's, for appendix 



Gastrostomy 

 Gastric ulcer, etc. 



_ Oblique incision for the 

 kidney 



Pelvic operations 



Pfannenstiel incision 



Km. 393. Incisions for abdominal operations. 



essarily wounding the muscles, arteries, and nerves. It having been found that 

 incisions through fascia alone are more liable to be followed by hernia than those 

 through muscles, incisions through the linea alba and lineae semilunares are to be 

 avoided. Incisions through the recti muscles are best made" near their inner edge. If 

 made in the outer edge the nerves supplying the muscle will be divided, causing sub- 

 sequent paralysis and weakness. If made through the middl-e, only the nerves supply- 

 ing the inner half will be divided, but the main trunks of the deep and superior 

 epigastric arteries will be cut and cause troublesome bleeding. There is least harm 



