130 
rarely occurs. This we conceive to be a ratio- 
nal and practical explanation of phenomena 
which are otherwise obscure. 
It seems probable that that most troublesome 
ulcer, the varicose, is kept up, and the difficulty 
of its healing produced not by the irritation 
occasioned by the mere vicinity of the enlarged 
veins, but from the actually varicose state of 
the capillaries of the skin at that part; at least 
we have found such a state of the vessels fre- 
quently, if not generally, to co-exist with this 
species of ulcer. The depth of the cellular 
layer (superficial fascia) in which these_veins 
lie should be accurately understood and borne 
in mind iv performing the operation of passing 
a needle under the vein for the cure of varices, 
according to Velpeau’s plan (a method which 
we have shekeed with considerable success.) 
Should the needle be passed so deep as to 
reach the fascia, the inflammation would pro- 
bably be severe, at any rate sufficient to com- 
plicate needlessly the operation. The thickness 
of the cellular layer varies in different subjects, 
according as it is distended more or less with 
fat or with accidental effusion; it is rarely, 
however, less than two lines in depth, thus 
affording abundance of room for the transmis- 
sion of the needle, 
The size of these veins of the leg in the 
healthy state is at the most not larger than a small 
goose-quill, but when varicose they sometimes 
swell to the size of the finger, and we lately 
saw a varicose enlargement of the saphena 
major a little below the knee, of the size of a 
large hen’s egg ; the quantity of blood that may 
in a short time be lost from them may hence be 
conceived. On the anterior region the veins 
are few, and varices but rarely occur compara- 
tively. On the inner region the saphena major 
lies close upon the bone in part of its course, 
and even indents it deeply when distention has 
continued long. In cutting upon the vein in 
this situation, we must bear in mind the conti- 
guity of the internal saphenus nerve, whose 
situation, with relation to the vein, varies much, 
sometimes being before, sometimes behind it. 
We cannot, therefore, lay down any rule for its 
avoidance, unless it be to open the vein parallel 
to its length. The saphena minor has a nerve 
running with it, which in phlebotomy must be 
avoided with the same precaution as the nerve 
on the inner side. 
The two nerves found imbedded in this su- 
perficial layer of the leg are, ist, the internal 
saphenus, which is the largest, and is passing 
from the inner side of the knee to the inner 
side of the foot, accompanying the saphena 
major vein; 2d, the external saphenus or com- 
municans tibialis from the tibial nerve, which 
runs near the saphena minor through the lower 
part of its course. 
Imbedded in the superficial fascia, we also 
find a set of lymphatics, principally on the 
inner side of the leg, receiving part of those 
from the sole and dorsum of the foot, while 
those absorbents which accompany the sa- 
phena minor are receiving their commence- 
ment entirely from the sole of the foot. All 
of these superficial lymphatics ascend to the 
REGIONS OF THE LEG. 
inner side of the thigh, and terminate in | 
inguinal glands. Hence diseases of the st 
cutaneous cellular tissue of the leg exert t 
influence upon the superficial glands of 
groin, and are not unfrequently the caus 
disease in them, which, without due ing 
might erroneously be attributed to di 
the genital organs. ; 
The aponeurosis of the leg forms an im: 
part of its economy. It is a dense tend 
structure, which immediately invests the 
cles, and partly affords them origin. 
quence of its strength and want of e! 
prevents swelling in deep-seated i 
tions, and we are consequently oblig 
divide it early and freely, particularly 
suppuration already exists, and when 
ter would otherwise burrow among the mi 
On the anterior region it is strong, ve 
tinct, and tense. In its superior fifth, it” 
attachment to the fibres of the tibialis a 
extensor communis digitorum, and pe 
longus. Below, it is pierced by the a 
tibial and musculo-cutaneous nerves. 
attached above to the heads of the tibiz 
fibula, and along the crest of the 
stretching from this to the anterior edge 
fibula. At the upper third of the leg, 
processes backwards between the mus 
be attached to the bones, thus forming s 
for the muscles, and affording to their fi 
greater extent of origin. At the lower 
thirds of the leg, the fascia is closely att 
to the intermuscular tissue, but has hen 
septa from its own structure. At th 
third, it binds the tendons firmly de 
places, and by its transverse fibres oppos 
ankle forms the anterior annular 
that part.* From the anterior edge + 
fibula, this fascia passes over the two pen 
muscles, and is again inserted on the po: 
border of the bone, forming a sheath for 
muscles, and dividing them from the 
The observations made above on the } 
treatment of purulent collections 
ally to this anterior portion of the fascia 
leg, on account of its greater strength, di 
and inelasticity. r 
At the back part of the leg, the apor 
is a continuation of that of the ham. — 
consider it as formed of two princi 
one superficial, and the other Pe . 
to the posterior border of the fibula xt 
and to the inner margin of the tibia in! 
the first appears to arise from the exp 
the tendons of the sartorius, gracilis, am 
tendinosus. Applied over the posterior 
of the calf, it is lost below in the fibro- 
tissue surrounding the heel. Thisp ortio 
thin and yielding, it allows deep-seat 
scesses to become superficial with great 
The second layer is a continuation of 
neurosis of the popliteal cavity, and 
between the two layers of muscles; bu 
ting into two, at the point where the sole 
taches itself from the deep parts, on 
divisions follows the anterior surface’ 
Ss 
* See ANKLE-JOINT, REGIONS OF. 
