ABDOMINAL WALL. INGUINAL REGION. 1071 



towards the scrotum in the male, or to the labia in the female (pp. 257 

 and 437). He will also examine the external abdominal ring, its pillars, 

 the intercolumnar fascia, and the emergence of the spermatic cord in tha 

 male, or the round ligament of the uterus in the female (pp. 964 and 986) ; 

 and he will notice the terminal branches of the ilio-inguinal and ilio-hypo- 

 gastric nerves (p. 660). 



The integument is next to be removed from the upper part of the 

 abdomen, and along with it the subcutaneous fat ; only a sufficient thick- 

 ness of superficial fascia being at first left to preserve the cutaneous nerves. 

 These will be found in two ranges, the one situated near the middle line, 

 and consisting of the anterior branches of the lower intercostal nerves, the 

 other range emerging laterally, and consisting of the lateral cutaneous 

 branches of the same nerves (p. 657). Let the external oblique muscle then 

 be fully dissected, its posterior border being brought, if possible, into 

 view (p. 248). The aponeurosis of the external oblique muscle is next to ba 

 divided by au incision carried transversely inwards from the anterior superior 

 spine of the ilium, the inferior part of the aponeurosis being left for future 

 examination ; and the dissector will proceed to separate successively the 

 attachments of the muscle to the crest of the ilium and each of the eight 

 lower ribs, and will reflect the muscle towards the middle line as far as it 

 admits of it. The internal oblique muscle, having next been examined, is to 

 be reflected in the same way, and the transversalis muscle exposed and 

 examined (pp. 250, 253). 



The deeper parts involved in the descent of inguinal hernia are now to be 

 studied. For this end, the remaining part of the aponeurosis of the external 

 oblique muscle is to be divided along its inner attachment, down to the 

 syrnphysis pubis ; the lower border of the internal oblique muscle is to be 

 examined, and, in the male, the cremasteric muscular fibres which are con- 

 tinuous with it are to be followed down to the testicle. The lower parts of 

 the internal oblique and transversalis muscles are to be successively detached 

 from Poupart's ligament and turned inwards, and their conjoined tendon is 

 to be made evident. The fascia transversalis, with the internal abdominal 

 ring, is now brought into view, and the subperitoueal fat may be seen 

 shining through it (p. 258). The student will observe particularly the 

 structures which lie in contact with the spermatic cord in its course from the 

 internal to the external abdominal ring, and which are described as forming 

 the walls of the inguinal canal (p. 963). He will also raise the fascia trans- 

 versalis, and note the infundibuliform fascia and the circumflex iliac and 

 epigastric arteries (p. 432) ; and will acquaint himself with the relations of 

 the latter to the direct and oblique varieties of inguinal hernia, and with the 

 coverings which these hernine receive in their descent (p. 1029). 



Poupart's and Gimbernat's ligaments may now be examined from the 

 deep aspect, and, by separating the subperitoneal fat from the junction line 

 of the fascia transversalis and fascia iliaca, the student will obtain a view of 

 the deep crural arch, the crural ring, and the septum crurale (p. 258) 

 structures which are to be noted in relation to femoral hernia (p. 1033). 

 He will then open the sheath of the rectus muscle ; dissect it and the 

 pyramidalis muscle (p. 253) ; follow the epigastric artery in the substance 

 of the rectus muscle from below, and the abdominal branch of the internal 

 mammary artery from above ; and will, at the same time, examine the 

 deficiency in the lower part of the posterior wall of the sheath of the rectus 

 muscle, and the semilunar folds of Douglas (p. 250). 



3. Male Genital Organs. If the subject be a male, the penis ought at 



