1206 SURGICAL AND TOPOGRAPHICAL AXATOMY 



purposes, one of ])assing beneath and thus picking up the other one, the flexor 

 longus halhicis. Further, it draws the four smaller toes firmly against the ground, 

 the object of the smaller toes being, as far as possible, to grip the ground. (8) 

 Tlie same authority points out that the possession by the great toe of two phalanges 

 only is to enable it to form a firm solid base, on which not only the flexor longus 

 haliucis and the peroneus longus act, but also the smaller muscles, by holding this 

 toe down and keeping it straight in all its length. The two heads of the short 

 flexor, the abductor and adductor, ' one pulling one way and one in the 

 opposite direction, and like the two reins of a bridle when both are jiulled together, 

 have a joint or a collective action.' The above three short muscles are to l)e 

 regarded as one set of flexor muscles whose ol>ject is to hold down the first phalanx 

 finnly, so that the powerful flexor longus haliucis, acting on the second, exerts all 

 its influence on a straight great toe. 



Fig. 769 is introduced here to remind the student of the ari-angement of the 

 superficial lymphatics of the lower extremity. 



These folloAV chiefly the saphena veins, and enter the inguinal (page 667) and 

 popliteal glands. The superficial lymphatics of the buttock enter the outer, and 

 those over the adductor muscles the innermost group of the inguinal glands. 



The deep lymphatics of the loAver limb, comparatively few in number, follow 

 the course of the deeper vessels. After passing through some four or five glands 

 deeply placed about the popliteal vessels (these glands also receive the lymphatics 

 along the external saphenous vein) the lymph is carried up by lymphatics along 

 the femoral artery to the deep femoral or inguinal glands. These are found 

 around the upper part of the femoral vessels; one verv often occupies the femoral 

 canal. 



Fig. 770 shows the distribution of the superficial nerves on both aspects of 

 the limb. 



TRU REGIONS OF THE ABD03IEN 



By WILLIAM AXDERSOX, F.R.C.S. 



As the plan of segmenting the ventral surface of the abdomen by means of two 

 horizontal and two vertical or nearly vertical lines, has survived the test of tiine, 

 it might be assumed that it is a resource of some practical value to the physician 

 and surgeon. It is, however, a curious fact that, although the nine historical 

 regions of the abdomen have been universally accepted in British and continental 

 schools for at least forty years, and may be traced back to a very much more 

 remote period, no attempt has ever been made to secure uniformity in the plan of 

 their delimitation. Almost every anatomical writer has, in fact, elected to follow a 

 system of his own, with the result that there are at the present moment nearly a 

 score of different schemes in our recognised text-books. There is little doubt that 

 it were better to abandon altogether the pretence of a regional subdivision than to 

 employ terms which have no scientific meaning, but it may be hoped that some 

 accord will soon be arrived at. 



Whatever system be adopted, it is necessary that the boundary ' lines ' should 

 lie converted into planes carried through the wdiole depth of the abdomen, and 

 defined on the dorsal as well as on the ventral surface of the trunk, and that the 

 structures cut tlirough by these planes should be noted, as well as those comprised 

 within the regions which they separate. It should, of course, be recognised that 

 the relations so defined can only be approximate, on account of the wide range of 

 physiological variation in the position of the al)dominal contents; hut this being 

 understood, a regional type Avould be of material service in medical education. 



If we retain the subdivision into nine segments, it remains only to consider the 



