Part 45

The exact position which the epigastric, L, Plate 31, and spermatic vessels, M, bear in respect to the internal ring, is a point of chief importance in the surgical anatomy of the groin; for the various forms of herniae which protrude through this part have an intimate relation to these vessels. The epigastric artery, in general, arises from the external iliac, close above the middle of Poupart's ligament, and ascends the inguinal wall in an oblique course towards the navel. It applies itself to the inner border of the internal ring, and here it is crossed on its outer side by the spermatic vessels, as these are about to enter the inguinal canal.

The inguinal canal is the natural channel through which the spermatic vessels traverse the groin on their way to the testicle in the scrotum. In the remarks which have been already made respecting the several layers of structures found in the groin, I endeavoured to realize the idea of an inguinal canal as consisting of elongations of these layers invaginated the one within the other, the outermost layer being the integument of the groin elongated into the scrotal skin, whilst the innermost layer consisted of the transversalis fascia elongated into the fascia spermatica interna, or sheath. The peritonaeum, which forms the eighth layer of the groin, was seen to be drawn across the internal ring of this canal above in such a way as to close it completely, whilst all the other layers, seven in number, were described as being continued over the spermatic vessels in the form of funnel-shaped investments, as far down as the testicle.

With the ideas of an inguinal canal thus naturally constituted, I need not hesitate to assert that the form, the extent, and the boundaries of the inguinal canal, as given by the descriptive anatomist, are purely conventional, and do not exist until after dissection; for which reason, and also because the form and condition of these parts so described and dissected do not appear absolutely to correspond in any two individuals, I omit to mention the scale of measurements drawn up by some eminent surgeons, with the object of determining the precise relative position of the several parts of the inguinal region.

The existence of an inguinal canal consisting, as I have described it, of funnel-shaped elongations from the several inguinal layers continued over the cord as far as the testicle, renders the adult male especially liable to hernial protrusions at this part. The oblique direction of the canal is, in some measure, a safeguard against these accidents; but this obliquity is not of the same degree in all bodies, and hence some are naturally more prone to herniae than others.

DESCRIPTION OF THE FIGURES OF PLATES 30 & 31.

PLATE 30.

A. The anterior superior iliac spine.

B. The umbilicus.

C. The spine of the pubis.

D. The external oblique muscle; d, its tendon. .

E. The internal oblique muscle; e, its tendon.

F. The transverse muscle; f, its tendon, forming, with e, the conjoined tendon.

G. The rectus muscle enclosed in its sheath.

H. The fascia spermatica interna covering the cord; h, its funnel-shaped extremity.

I, K, L, M. See Plate 31.

N. The femoral artery; n, its profunda branch.

O. The femoral vein.

P. The saphena vein.

Q. The sartorius muscle.

R. The sheath of the femoral vessels.

S. The falciform margin of the saphenous opening.

T. The anterior crural nerve.

U. The pubic portion of the fascia lata.

V. The iliac portion attached to Poupart's ligament.

W. The lower part of the iliacus muscle.

PLATE 31.

A. The anterior superior iliac spine.

B. The umbilicus.