ABDOMEN. 



*3 



In and between these several structures ramify 

 the various arteries, veins, lymphatics, and 

 nerves, which constitute the vascular and ner- 

 vous supply to the abdominal parietes. 



1 . The skin on the anterior and lateral parts 

 of the abdomen is thin and smooth, and in 

 some parts covered with hairs, as along the 

 middle line, especially below the umbilicus and 

 over the pubic region. Along the median line 

 the cutaneous follicles are largely developed, 

 and during pregnancy an increased secretion of 

 pigmentum is said to take place, producing 

 a brownish colour of the skin in these regions. 

 In women who have borne children, the 

 skin becomes wrinkled to a considerable de- 

 gree, and the epidermis exhibits, as Winslow 

 has remarked, a great number of lozenge- 

 shaped spaces disposed in a reticular manner.* 



In the epigastric region the skin is much 

 more sensitive during life than in the other 

 parts of the abdomen, and with some persons 

 sympathizes with the stomach in a remarkable 

 degree, so that pressure on it even in the 

 healthy state produces a degree of pain or un- 

 easiness in that organ, or even a tendency to 

 nausea. In the umbilical region we observe a 

 depression, the floor of which is more or less 

 elevated in the centre. This depression is de- 

 nominated the navel or umbilicus, (the dimi- 

 nutive of umboj a nob or button.) It is 

 produced by the firm adhesion of the skin to 

 the subjacent structures, its true nature being 

 that of a cicatrix, occupying the site of a 

 former perforation through which the umbilical 

 arteries and veins and the urachus passed in 

 maintaining the circulation between the foetus 

 and placenta. In very fat persons, the depth 

 of the depression is often very much increased 

 by reason of the great thickness of the abdomi- 

 nal parietes, and in some instances its form 

 assumes that of a slit, and sometimes, instead 

 of a depression, there is a greater or Jess pro- 

 minence of the integument. 



In the lumbar region the skin is thicker and 

 firmer than in the others; and we generally 

 find it in a state of congestion after death, in 

 consequence of the position of the body. 



2. The subcutaneous cellular tissue on the 

 anterior surface of the abdomen has obtained 

 especial attention from anatomists, particularly 

 that portion of it which is found in the hypo- 

 gastric regions. It is denominated the superficial 

 fascia^ and is merely an expanse of cellular 

 tissue possessing the same general characters 



* Winslow's Anatomy, by Douglas, v. ii. p. 160. 



t The application of the term fascia to the sub- 

 cutaneous cellular investment in various parts of the 

 body has occasioned no small degree of confusion 

 among anatomists. A singular degree of confusion 

 exists in Velpeau's description of this fascia : he 

 observes in one place that the deep layers of the 

 subcutaneous cellular tissue constitute the super- 

 ficial fascia, and in the next page states that " the 

 superficial fascia is nothing else than the cellular 

 tissue condensed, whose laminae strongly applied 

 one against the other, are ultimately reduced to 

 somewhat of the aponeurotic form." I shall adhere 

 to this latter definition, and consider superficial 

 fascia as synonymous with subcutaneous cellular 

 tissue. Velpeau Anat. Chirurg. vol. ii. p. 4 and 5. 



as that which is found in all other parts of the 

 body ; it is continued upwards over the thorax, 

 laterally into the region of the back, inferiorly 

 along the thighs, and into the scrotum. It varies 

 in thickness according to the quantity of fat 

 which is deposited in its cells ;* in some in- 

 stances it has been known to possess a thick- 

 ness of three inches. Thin but muscular subjects 

 afford the best examples from which to study 

 the superfical fascia of the abdomen : in such 

 subjects we find it in general of a much denser 

 character than in others, very strong and elastic 

 and easily divisible into laminae, produced, 

 no doubt, by the pressure which it experiences 

 from the weight of the abdominal viscera, and 

 the constant attrition occasioned by the action 

 of the abdominal muscles. In the iliac region, 

 immediately above Poupart's ligament, the 

 density of this fascia is most conspicuous. 

 Here some have regarded it as a fibro-cellular 

 membrane ; but the opaque bands which give 

 it a fibrous appearance are merely the walls of 

 the membranous cells rendered thicker and 

 denser than they are in other parts. I cannot 

 agree with Beclardf that it presents almost all 

 the characters of an aponeurosis, inasmuch as 

 it differs from an aponeurosis in wanting the 

 shining and regular surface, and in possessing 

 a degree of elasticity which never belongs to 

 aponeurotic expansions. The elasticity of the 

 superficial fascia is remarkable, and is by some 

 compared to the elastic expansion over the 

 abdomen of the larger quadrupeds ;J the 

 comparison, however, is inaccurate, inasmuch 

 as they are two distinct tissues, the former 

 being cellular, and the latter the apoueurosis 

 of the oblique muscles, which in some degree 

 partakes of the properties of the yellow elastic 

 fibrous tissue (tissu jaune). 



Inferiorly the superficial fascia moves freely 

 over Poupart's ligament, and is continued over 

 the thigh (see GROIN, REGION OF THE). Along 

 the middle line it is very adherent to the sub- 

 jacent aponeurotic structure (the linea alba) 

 as well as to the skin, a fact which may be 

 remarked of the subcutaneous cellular tissue in 

 other parts of the body, and which was long ago 

 noticed by Bordeu, when he observed that the 

 cellular tissue is constricted (etranglee) in all its 

 median portion, and that its cells (buttons ou 

 pouches) are closed over the axis of the body. 

 When this superficial fascia is dissected off, a 

 very thin layer of cellular membrane, perfectly 

 diaphanous, is found to adhere to the subjacent 

 aponeurotic expansion. This will be found 

 particularly adherent over Poupart's ligament, 

 and is that which is referred to by some ana- 

 tomists (as Manec, Cloquet, &c.,) as a deep 

 process of the superficial fascia which adheres 

 to Poupart's ligament, and so forms a super- 

 ficial septum between the abdomen and thigh. 

 To see this layer the superficial lamina should 

 be raised by commencing the dissection of it 



* Cloquet says it is, as it were, decomposed by 

 the deposition of fat. Recherches Anat. sur les 

 Hernies de 1'Abdomen, p. 11. 



t Diet, de Medecine, art. abdomen. 



$ Vid. Blandin, Anat, Topog. 



B 2 



