IIIG 



SURGICAL AXD TOPOGRAPHICAL AXATOMY 



inwards to the inner side of the internal ring, and thence to a point about midway 

 between the pubes and iinibilicvis. Here the vessel, which at first lies between the 

 peritoneum and fascia transversalis, perforates the latter and, passing over the fold 

 of Douglas, enters the sheath of the rectus. It then runs ui)wards, closely a]iplicd 

 to the back of that muscle, and, a little above the level of the umbilicus, divides 

 into liranches which anastomose with the epigastric or abdominal In-anch of the 

 internal mammary. 



Lymphatics. — It is sufficiently correct to say here that those above the 

 umbilical line go to the axillary, and those beloAV that line to the femoral 

 glands. 



Nerves. — The lower seven intercostals and the ilio-hypogastric and ilio- 

 inguinal su}>i)ly the abdominal wall. The sixth and seventh intercostals supply 



Fig. 686. — The Viscera as seen ox fully opening the Abdomen withoct 



DiSAKEANGEMENT OF THE INTERNAL PARTS. (After Sarazin.') 



Diaphragm 



REAT OMENTUM 



SMALL INTESTINE 



the skin over 'the pit of the stomach'; the ciglilii the aiva of the middle linea 

 transversa; the tenth that of the umbilicus; the last thoracic, ilio-inguinal, and 

 ilio-hypogastric, the region above Poupart's ligament, and that of the pubes. The 

 ilio-hypogastric supplies the skin over the external ring; the ilio-inguinal that 

 over the cord and scrotum. The last thoracic and ilio-hypogastric cross the iliac 

 crest to supply the skin of the buttock. 



Viscera and visceral regions. — The general form of the abdominal space, 

 and the relations of llic several organs before they are disturbed from their normal 

 positions, are given on pages 959 and 960. The arbitrary regions into which the 

 abdomen is usually divided are described at the end of this article. 



The diaphragm. — The upper limit of the al)domen rises to the following levels: 

 Its central tendon to al)out the lower end of the sternum, or the seventh chondro- 



