Internal Saphenous Vein 451 



of the internal malleolus, by the inner and back part of the knee, and 

 up the front of the thigh between the two layers of the superficial 

 fascia. It pierces the cribriform fascia, and passes through the 

 saphenous opening into the common femoral vein. Before doing so 

 it receives the veins which correspond to the superficial branches 

 of the common femoral artery from the iliac, epigastric, and pubic 

 regions. A large tributary also joins it from the back of the thigh 

 by winding round the inner side of the limb. 



As a result of pressure upon the inferior vena cava or the common 

 iliac vein of ovarian tumour or in pregnancy the saphenous becomes 

 dilated and thickened varicose (varus, crooked) ; the valves being 

 rendered useless, a wound or ulceration of the vein may then cause 

 fatal bleeding. I have seen a bunch of varicose branches of the vein 

 form a very definite swelling at the base of Scarpa's triangle. The 

 tumour could be emptied by placing the man supine, and it recurred 

 only gradually when he got up again. 



A femoral hernia by pressing against the common femoral vein 

 may so hinder the venous return that dilatation of the surface veins 

 and oedema of the limb may occur. 



The inguinal lymphatic glands are placed between the two 

 layers of the superficial fascia ; they consist of two groups, one lying 

 along Poupart's ligament, the other along the saphenous vein. 



The upper set receive lymph from the abdominal wall below the 

 level of the umbilicus ; absorbents from the penis, scrotum, and anus 

 also enter the innermost glands of this group, whilst those from the 

 buttock and outer side of the thigh enter the outlying ones. Some- 

 times lymphatics from the genitals enter the lower glands as well as 

 the upper. 



The lower group receive the absorbents from the inner side of the 

 foot and leg, and from the thigh. Lymphatic vessels generally run 

 with the veins ; those, therefore, from the outside of foot and leg pass 

 with the external saphenous' vein, and end in the popliteal glands. 



The lymph from all these glands ascends through the iliac and 

 abdominal glands towards the thoracic duct. Inflammation of a 

 gland is commonly called bubo (/3ou/3o>i>, gland). Practically it does 

 not matter in which direction the suppurating gland is opened provided 

 that the undermined and unhealthy skin be removed, and the gland- 

 capsule be scraped out. Infections conveyed from one gland to 

 another may involve the groin in sinuses which have to be opened up 

 before healing can take place. If a sinus run with the lymphatics 

 through the saphenous opening, and into crural canal, it must not 

 be laid open by bold incision but scraped out to its depths, and 

 drained by a short tube. 



The fascia lata is attached to the iliac crest, Poupart's ligament, 

 rami of pubes and ischium, to the great sacro-sciatic ligament, the 

 sacrum and coccyx. It is especially thick on the outer side on account 



GG 2 



