I MAC AKTKKIES. 



841 



ii it and the fascia transversalis ; it ap- 

 to (lie inner margin of the 



ing, and ill its m-crtlc to tin: pi ' ' 



line it meets and is identified with (niul-. 



ligament; il is i losely adherent to the sin 



, mil hi'iii'i- thai 



present^, in appearance of thickness and s: 

 upon the inside ii|' ih, ill , |. ring, winch i 

 not rcalU pixsess. 1'roni the inferior margin 

 of the internal oblique and from the superior 

 side of the crural arch the ' muscle 



Is upon the anterior and external part of 

 the .spermatic process, forming one of the 

 coverings of the process within the inguinal 

 canal, of course concealing it after the ill 

 of the aponeurosis of the external oblique, and 

 requiring to be detached from the arch along 

 with the lower fibres of the internal oblique in 

 order that the process may be fairly expo-, d. 



The deep structures of the anterior wall of 

 the iliac fossa are also three, viz., tin 



HMtlii, the I. isc KI propria, and the peri- 

 toneum. 



1. The fascia transv, rsahs is most remark- 

 alile iii the iliac region, but it is not con- 

 fined to it, being to be traced upward to 

 the surface of the diaphragm, and backward 

 round the interior of the lateral walls of the abdo- 

 men. In the iliac region this fascia is interiorly 

 h'rst identified with the fascia iliaca from a short 

 distance behind the anterior superior spinous 

 process of the ilium to the outer side of the 

 external iliac artery, or about the middle of the 

 crural arch ; the line of its connection with the 

 fascia iliaca runs downward, forward, and in- 

 ward, at a short distance within the crest of 

 the ilium and the crural arch, approaching the 

 latter, howeier, as it descends, until at the 

 outside of the artery it touches it; it il 



this line into two l.umiue which 

 enclose the circumflex iliac artery between 

 them ; there is, therefore, an interval between 

 the arch and the line of connection of the two 

 fascia' in which the fascia ihaca intervenes, and 

 to the surface of this part of the fascia it is 

 that the internal oblique and transverse muscles 

 are attached. In the second place the fascia 

 uausversalis descends into the thigh beneath 

 the crural arch, between it and the iliac vessels, 

 and forming the front of their sheath; and, 

 thirdly, it is attached upon the inside of the 

 vessels, along the pectmeal line of the pubis 

 posterior to tiie conjoined tendon of the internal 

 oblique and transverse muscle-, between it and 

 the peritoneum, and separated by it from the 

 spermatic process, which is in front of both. 



Internally the fascia Iransversalis is con- 

 nected to the edge of the tendon of the rectus. 

 Midway between the superior anterior spi- 

 nous process of the ilium and the spinous pro- 

 cess of the puhes. and at from half to three- 

 fourths of an inch above the crural arch, the 

 spermatic j >|te- from the al)> 



descending within a cylindrical prolongation of 

 the fascia by which the process i- em loved, and 

 which thus forms a sheath for the process, By 

 detaching this prolongation from the fascia 

 around the process, a circular aperture is 

 formed in the fascia, which is the deep in- 



guinal ring, the situation of which lias been 



just defined. On the inside of In 



ihe artery in the forme. 

 ext the ring, in the latter at tim 

 outer of the two v. 



'2. The fascia propria is a cellular stratum in- 

 terposed between the peritoneum and the struc- 

 tures of the abdominal walls which it lines ; it 

 varies in thickness and condition at d;; 

 parts and in different subjects ; at times it con- 

 tains adeps, at others it is purely cellular, or 

 forms a condensed expansion ; in the iliac 

 region it is thicker upon its posterior than its 

 anterior wall ; on the latter it increases in 

 thickness as it descends towards the crural 

 arch, being so thin towards the umbilicus that 

 the peritoneum adheres very closely to the ten- 

 dinous expansion of the muscles; at the deep 

 inguinal ring it is more dense, and the perito- 

 neum, the fascia transversalis, and it, are more 

 intimately connected than at either side; ex- 

 ternal to the ring, between it and the spinous 

 process of the ilium, it is so free that the pe- 

 ritoneum may be separated without difficulty 

 from the interior of the fascia transversalis, 

 and along the crural arch it forms, from the 

 external iliac artery outward, a soft mass, 

 sometimes thick, occupying the interval left 

 between the peritoneum and the fascia trans- 

 versalis, at the reflection of the former from 

 the iliac fossa to the anterior wall : upon this 

 wall it encloses the epigastric vessels, the um- 

 bilical ligament, and the spermatic vessels, and 

 not only does it extend universally over the in- 

 terior of the abdominal walls but it is prolonged 

 through their several apertures upon the parts 

 which pass through them, as in the case of the 

 spermatic vessels. 



From the anterior wall of this region it passes 

 to the posterior, where it lines the iliac fossa, 

 and connects the peritoneum or the viscera to 

 the iliac fascia; at the outer part of the 

 it is remarkably free, soft, and easily lacerated, 

 so that the peritoneum can be detached, pro- 

 bably with greater facility at this than at any 

 other situation ; at its inner part it is even more 

 abundant, thicker the nearer to the crural arch, 

 forming the investment by which the iliac ves- 

 sels are inclosed, and descending thence into 

 the pelvis. 



Lastly, the peritoneum of the anterior wall 

 is continuous inferiorly with that of the iliac 

 fossa, being reflected from the one to the other 

 at the distance of live or six lines above the 

 crural arch a fact deserving of much attention, 

 since it permits the external iliac artery to be 

 secured without disturbing the membrane. In 

 its reflection from one wall of the region to 

 the other it leaves immediately above the crural 

 arch, between itself, the fascia transversalis, 

 and the fascia iliaca, a triangular interval of 

 some lines, occupied by the fascia propria, 

 and at limes at least by one or more lymphatic 

 glands; this space is widest at the iliac artery 

 and diminishes as it extends outward ; this fact 

 also deserves attention, inasmuch as it points 

 out where the fascia transversalis may be di- 

 vided, if necessary, in the operation of expo- 



