300 EPIGASTRIC ARTERY. CIRCUMFLEX ARTERY. 



The psoas muscle is at first in contact with it on the outside, 

 and the internal iliac vein on the inside. As it passes under 

 Pou part's ligament, it is immediately anterior to the psoas and 

 iliacus internus muscles, where they are united, and the crural 

 nerve is exterior to it. Before it arrives at the lower edge of 

 Poupart's ligament, it sends off 



The Epigastric Artery, 



Which arises on its internal side, and proceeds downwards 

 and inwards about half an inch ; then it turns upwards and 

 inwards, and continues in that direction for a small distance, 

 after which its course is less oblique. It passes between the 

 peritoneum and the abdominal muscles, at the inner side of the 

 internal abdominal ring, behind the spermatic cord, and the 

 round ligaments in females. 



It generally changes its oblique direction after passing about 

 two inches, and then proceeds in contact with the rectus and 

 very near its external edge ; its ramifications are expended upon 

 the anterior parietes of the abdomen. And after it has arrived 

 as high as the umbilicus, it commonly divides into branches 

 which often inosculate with the ramifications of the internal 

 mammary.* 



The epigastric artery as before observed occasionally comes 

 off from the obturator ; but has then the same ultimate destina- 

 tion, as when it has its usual origin. 



An artery which is rather smaller than the epigastric, arises 

 nearly opposite to it, but rather lower, from the external side of 

 the external iliac. It is called 



The Circumflex Artery of the Os Ilium, 



And proceeds upwards and outwards to the upper margin of 

 the os ilium, along which it continues very near to the spine. 

 It is distributed principally to the abdominal muscle, to the 

 iliacus internus and the psoas, and the parts contiguous. 



* Several respectable surgeons have been taught by experience, that when 

 the abdomen is distended by ascites, the position of the epigastric artery is so 

 much altered, that it will sometimes be found in the middle of the oblique line, 

 which extends from the umbilicus to the superior anterior spine of the ilium. 



