THE ABDOMEN 909 



is then to be reflected downwards, partly by using the handle of the scalpel, 

 and partly by using the fingers. Its connection with the external oblique 

 aponeurosis is to be noted ; its attachments along the line of the groin are to 

 be demonstrated ; and the manner in which this fascia, along with the fascia 

 of Camper, is conducted by the spermatic cord into the scrotum to form the 

 tunica dartos (or by the round ligament of the uterus into the labium majus), 

 is to be studied. In the region of the symphysis pubis the suspensory ligament 

 of the penis is to be dissected. The deep fascia is next to be examined. It 

 will be found to be present over the lateral wall of the abdomen, where the 

 external oblique rnuscle is fleshy, but, on being traced forwards, it will be seen 

 to fade away, and' ultimately to disappear, in the region of the aponeurosis of 

 that muscle. 



In the course of the foregoing dissection the superficial arteries, with 

 their accompanying veins, are to be displayed, namely, the superior or 

 superficial external pudic, crossing inwards and upwards over the spermatic 

 cord (or round Ligament of the uterus) to the suprapubic region ; the 

 superficial epigastric, turning upwards over Poupart's ligament a little to 

 the inner side of the centre ; the superficial circumflex iUac, lying below 

 the outer part of Poupart's ligament ; the anterior cutaneous arteries, 

 emerging through the anterior wall of the sheath of the rectus abdominis, 

 in a somewhat irregular manner, and at variable distances from the linea 

 alba ; and the lateral cutaneous arteries, appearing between the serrations 

 of the external oblique in the mid-axillary Une. Simultaneously with the 

 dissection of the foregoing bloodvessels, the following cutaneous nerves 

 should be dissected ; the hypogastric branch of the ilio-hypogastric, piercing 

 the external oblique aponeurosis about an inch above the external abdominal 

 ring ; the anterior cutaneous nerves, emerging through the anterior wall of 

 the sheath of the rectus abdominis in a stragghng manner, some appearing 

 near the linea alba, and others a little farther from it ; the lateral cutaneous 

 nerves, which will be found emerging between the serrations of the external 

 oblique in the mid-axillary line, and each of which (with one exception, which 

 immediately follows) divides into an anterior and a posterior branch ; the 

 undivided lateral cutaneous or iUac branch of the anterior primary division 

 of the twelfth thoracic nerve, which should be shown descending over the iliac 

 crest, about an inch behind the anterior superior iliac spine, to the anterior 

 part of the gluteal region ; and the iliac branch of the iUo-hj^pogastric, descend- 

 ing to the gluteal region over the iliac crest at the junction of the middle and 

 anterior thirds. 



The superficial dissection of the penis and the dissection of the scrotum are 

 next to receive attention. The prepuce and frenum prseputii are to be 

 examined, and the glans penis is to be studied, attention being paid to the 

 meatus urinarius, corona glandis, and cervix. The median raphe of the 

 scrotum is to be noted, and it may be traceable along the under surface 

 of the penis. A catheter is then to be introduced into the bladder, and 

 the penis is to be made tense by fixing it with string to the end of the 

 instrument. The thin skin of the penis is to be carefully removed, and the 

 reddish-coloured underlpng fascia, continuous with the tunica dartos of the 

 scrotum, is to be noted. If not previously dissected, the suspensory ligament 

 is to be displayed, and its bilaminar disposition is to be shown. The fascial 

 investment or sheath of the penis is to be studied, and thereafter the follow- 

 ing structures are to be dissected : the dorsal vein, occupjdng a median 

 position between the corpora cavernosa ; the two dorsal arteries, one 

 on either side of the vein ; the dorsal nerves, each external to the corre- 

 sponding artery; and the dorsal penile branches of the superior or super- 

 ficial external pudic arteries, each lying external to the corresponding 

 main dorsal artery. The dissection of the penis as regards structure is 

 to be postponed until the pelvic cavity is dissected. The scrotum is now 

 to be attended to. Having observed the dark colour and puckered condition 

 of the skin, to the lateral aspect of which twigs of the inguinal nerve are dis- 

 tributed, the dissector is to remove it carefully, and thereafter study the 

 brick-red scrotal fascia, known as the tunica dartos. The relation of the 



