Superficial Fascia 297 



the spermatic cord the right and left sheets of the fascia are attached 

 to the pubic crest nearer to the symphysis, blending with each other ; 

 this layer also forms an investment for the penis ; on the scrotum and 

 penis it joins with the more superficial layer of fascia, which there loses 

 its fat and assumes non-striated muscular fibre instead. Some of its 

 fibres pass into the suspensory ligament of the penis. 



When air is pumped, by the movements of expiration, beneath the 

 deep layer of the superficial fascia upon the chest, as after the fracture of 

 a rib, emphysema cannot descend beyond Poupart's ligament ; but if the 

 air pass superficial to this layer the emphysema might extend down 

 the thighs. When pus descends beneath this fascia it is guided to the 

 penis and scrotum, and not to Scarpa's triangle. 



It is this deep layer of the superficial fascia which confines urine 

 which is extravasated after the urethra has been ruptured in front of 

 the triangular ligament. The urine cannot pass backwards into the 

 ischio-rectal fossa, or on to the thighs, because of the attachment of the 

 fascia to the base of the triangular ligament and the rami of the ischium 

 and pubes. It passes, therefore, around the scrotum and penis, along 

 the front of the spermatic cord, and up into the inguinal region. The 

 firm connection of the fascia to Poupart's ligament and to the iliac 

 crest prevents the fluid wandering down the front of the thigh or on to 

 the buttock. (In making free incisions for the escape of the extrava- 

 sating fluid, the surgeon must remember that a swelling along the 

 cord may possibly be due to the presence of an inguinal hernia.) 



The anterior wall of the abdomen is freely movable over the 

 viscera, and offers so little resistance that, in a buffer-accident, liver, 

 stomach, intestine, or arterial trunk may be ruptured without the 

 surface of the body showing any bruise or discoloration. Moreover, 

 a blow in the epigastric region may be followed by immediate death 

 without the supervention of either external or internal ecchymosis ; 

 this result is probably due to concussion of the subjacent solar plexus. 

 It is asserted that hospital nurses used occasionally to adopt a rough 

 and ready method of abdominal compression in dealing with their 

 hysterical patients, by sitting upon them. In the female this is supposed 

 to affect the ovaries alone, but it is evident that the large abdominal 

 plexuses are all more or less influenced by it. 



A house-surgeon should never refuse admission to the wards, at any 

 rate for a time, to a person who has received injury to the abdomen ; 

 it is impossible to say by outward inspection how serious it may be. 



After the integument of the abdomen has been over-stretched, as 

 by an ovarian tumour, or pregnancy, it does not return to its original 

 smooth condition, but remains permanently flecked by whitish scars 

 called lima albicantes. These marks are, therefore, evidence merely 

 of antecedent distension of the abdomen, not necessarily of pregnancy. 



The umbilicus (diminutive of umbo, boss of shield) is a fibrous 

 cicatrix in the linea alba, opposite the third lumbar vertebra ; it is the 



