DARRACH, William (1796-1865), Philadel- 
phia physician, the third son of Dr. Wil- 
liam Darrach, was born in Philadelphia, June 
16, 1796, at 7th, and Chestnut Sts. and was 
baptized by the Rev. Ashbel Green, July 17. 
1796 at the Second Presbyterian Church, Phil- ] 
adelphia. His paternal ancestry were of 
Scotch-Irlsh descent and settled in George- 
town. Kent County, Maryland, before the 
Revolutionary War. His mother was the eld- 
est daughter of Thomas Bradford and Mary 
Fisher. Thomas Bradford was the great 
grandson of William Bradford, who accom- 
panied William Penn to Philadelphia. He 
was the first printer in the middle colonies 
and was printer to the government for many 
years, and later was a vestryman of Trinity 
Church in New York. 
Dr. Darrach received his early education in 
Philadelphia and attended the preparatory 
and collegiate departments of the University 
of Pennsylvania. He then entered the Junior 
class at Nassau Hall, Princeton, where he re- 
ceived the degrees of A. B. and A. M. He 
was a student in the office of Dr. Philip 
Syng Physick, (q. v.) where he continued for 
three years. In 1818 he became resident phy- 
sician to the Philadelphia Almshouse, where 
he was associated with Drs. Berrien, Mosely, 
McClelland, Gwathmey, Freeman and Bees- 
ley. While he was there a severe epidemic of 
typhus fever broke out and some of his notes 
on this disease are still preserved. 
In the spring of 1819 he received the degree 
of Doctor of Medicine from the University 
of Pennsylvania. Soon afterwards he sailed 
for Europe where he spent three years in 
England, Scotland, France and Italy. Among 
the men h« studied under were John Aber- 
nethy. Sir Benjamin Brodie, Herbert Mayo, 
Sir Charles Bell and Astley Cooper. He was 
a pupil in the Charter House Eye Infirmary 
and in the Lock Hospital and attended the 
lectures of Lawrence, Tyrrell, Babington and 
Gregory. In Paris he attended lectures at the 
Jardin des Plantes, College de France and 
Duplessis and L’Ecole de Medecin. He fol- 
lowed the clinics at the Hotel du Dleu, La 
Charity and L’Hopital de St. Louis. He also I 
studied comparative anatomy with Blainville 
and diseases of the skin with Alibert. In ad- 
dition he received instruction in surgery from 
Roux, Boyer, Caffroir, Larrey and Scrapa in 
Italy. 
After his return from Europe he started 
as a general practitioner and continued till 
the time of his death. He early became a ] 
physician to the Philadelphia Medical Dis- 
pensary, a position he maintained for several 
years, and was then elected its consulting I 
physician. He was appointed physician and I 
surgeon to the Eastern Penitentiary, the I 
duties of which he fulfilled for ten years. I 
He will be remembered by cases reported I 
to the Pathological Society of Philadelphia, I 
and especially by his folio lithographed I 
plates, Drawings of the Anatomy of the I 
Groin,” Phila., 1830. The drawings were I 
made by Chasal from dissections by Darrach I 
while in Paris in 1820. The dissections were I 
facilitated by forcing air into the different I 
planes of the tissues and they were made I 
from the standpoint of the anatomist and the I 
surgeon interested in cutting for a strangu- I 
lated hernia. I 
He was a member of the Philadelphia Med- I 
ical Society, of the County Medical Society, I 
the College of Physicians and of the Academy I 
of Natural Sciences. From 1843 to 1854 he I 
took an active part in supporting the Penn-1 
sylvania Medical College as a member of the 
faculty and as president for part of the time. 
He occupied the chair, of theory and nractice 
of medicine. 
He married April 26, 1826, Margarett/i Mon- 
ro, the daughter of Dr. George Moore. She 
died in 1841. There were seven cJuldren: 
Dr. George Monro Darrach^*x)r*"Tames 
Darrach (still living in 1916 in his 89th year) 
and Dr. William Darrach, Jr., and four 
daughters. In 1845 he married Miss Gobrecht 
who bore him six children. He was a mem- 
ber and an officer in the Presbyterian Church. 
He died May 6, 1865. 
William Darrach. DR. G. M. DARRACH DEAD 
PHYSICIAN WAS 83 YEARS OLD 
PIONEER IN MEDIC AT. PROFESSION 
WAS CHARTER MEMBER OF MARION 
COUNTY SOCIETY—DEATH COMES 
IN ST. LOUIS. 
Eugene N. Darrach, secretary of the In- 
terstate Car Company, received a tele- 
gram late yesterday afternoon announc- 
ing the death of his father, Dr. George 
Monro Darrach, at St. Louis, and left last 
night for that city. The news was en- 
tirely unexpected, as Dr. Darrach, though 
an octogenarian, had been In robust 
health. Death was caused by grip and 
complications resulting from it. 
Dr. Darrach was born In Philadelphia, 
Feb. 20, 1827, and had just passed his 
eighty-third birthday. He graduated from 
the Pennsylvania Medical College soon 
after attaining his majority and came to 
this city in 1853. He assisted in organ- 
izing the Marion County Medical Society 
and was one of its charter members. 
Devoted to Profession. 
He engaged actively in the practice of 
his profession for many years and will 
be remembered by the older physicians 
as a man of generous impulses, always 
sympathetic with the afflicted and deeply 
imbued with love for his profession. Since 
his retirement from active practice he had 
been making his home with his son in 
tills city and with another son in St. 
Louis, with whom he was staying when 
attacked by his fatal illness. 
His wife, who was a daughter of John 
W. Hamilton, the first auditor of Marion 
County, died four years ago. The body 
will be brought here and interred at 
Crown Hill from the residence of E. N. 
Darrach, 2027 North New* Jersey street. 
Dr. Darrach is survived* by four sons, 
C. S. of St. Louis, .1. H. of Washington. 
D. C., and F. M. and E. H. Darrach of 
this city. DRAWINGS 
OF THE 
ANATOMY OT THE GROIN: 
WITH 
ANATOMICAL REMARKS. 
BY 
WvDARRACH, M. D. 
PROFESSOR OF the PRINCIPLES AND practice of medicine in the medical 
DEPARTMENT OF PENNSYLVANIA COLLEGE; FELLOW OF THE COLLEGE 
OF PHYSICIANS OF PHILADELPHIA; ONE OF THE CONSULTING 
PHYSICIANS OF THE PHILADELPHIA DISPENSARY; 
CONSULTING PHYSICIAN OF THE EASTERN 
PENITENTIARY OF PENNSYLVANIA, 
ETC. ETC. 
PHILADELPHIA: 
LINDSAY & BLAKISTON, 
N. W. CORNER OF FOURTH AND CHESTNUT STREETS. 
1844. Entered according to Act of Congress, in the year 1844, by 
W. Darrach, M. D. 
in the Office of the Clerk of the District Court of the Eastern District of 
Pennsylvania. 
Merrihew 8c Thompson, Printers, 
JVo. 7 Carter's Alley. TO 
PHILIP S. PHYSICK, M.D., 
PROFESSOR OF ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA, 
AND 
JAMES RUSH, M.D., 
THE FOLLOWING PAGES ARE RESPECTFULLY INSCRIBED, 
AS A PUBLIC ACKNOWLEDGMENT 
OF THE MANY ADVANTAGES DECEIVED FROM THEIR 
PROFESSIONAL INSTRUCTION BY 
THE AUTHOR. THE SECOND EDITION 
OF THIS WORK 
IS DEDICATED TO THE CLASS OF THE MEDICAL DEPARTMENT 
OF THE 
PENNSYLVANIA COLLEGE, 
OF THE 
SESSION OF 1 843-4. CONTENTS. 
CHAPTER I. 
On the Term Fascia. 
Various meanings of the term, - - - - 17 
Fascia super ficialis, - - - - - - 18 
Fascia propria, 19 
Origin of these phrases, 19 
Fascial system, - - - - - - 19 
Extension of the terra, - - - - - 20 
Structure of the fascial system, 20 
Difference between fascia, dura mater, &c. - - 20 
Elements of fascia, - - - - - - 21 
Fascia iliaca, - - - - - - - 22 
Fascia lata, 23 
Ligamentous disposition of fascia, 24 
Fibres reflected from fascia, > - - - 25 
Abrupt termination of fibres, - - - - 25 
Apparent irregularity of fibres, - - - - 26 
Septa, -------- 2 6 VIII 
CONTENTS, 
Substitute for muscularity, 27 
Fascia of the gluteus muscle, - - - - 27 
Fascia of the deltoid muscle, - - - - 2S 
Semilunar edges, - - - - - - 29 
Conclusion, ..--.--30 
CHAPTER II. 
Description of Plate I. ----- 32 
SECTION I. 
Subcutaneous Adipous Tissue. 
Location, --33 
Quantity, --33 
Structure, 34 
Cysts, 34 
Filaments, 36 
Variety of appearance of the filaments, - - 36 
Uses of the filaments, ------ 37 
Extent, 40 
Subcutaneous Cellular Tissue. 
Structure, 41 
Properties and uses, - - - - - - 41 
Comparison of the subcutaneous adipous and cellular, 44 
tissues, 44 CONTENTS. 
IX 
Fascia Snperjicialis. 
Origin of the phrase, - 45 
Disposition of its cells and laminse, - - - 46 
Outer laminae, 4Q 
Deeper seated crural laminae, - - - - 47 
Deeper seated abdominal laminae, - - - 47 
Cellular sheath of the spermatic cord and testicle, - 48 
Method of dissecting the groin, 49 
SECTION II. 
Pathological Observations. 
Inflammation of the adipous tissue, 50 
Inflamed cysts, 52 
Stricture, 53 
Disorganization, 53 
Circumscribed, and extensive abscess, 54 
Indications and plan of treatment, - - - 54 
Phlegmon, 55 
Anthrax, 56 
Paronychia, 57 
Phlegmonous erysipelas, ... 53 
Cellular variety, 61 
Adipous variety, 62 
Cellular-adipous variety, 63 X 
CONTENTS. 
Generic treatment in Phlegmon, - 64 
Anthrax, - - - 66 
Paronychia, - - - 66 
Phlegmonous erysiplas, - 66 
Dr. Dobson’s method, - - - - _ _ 66 
Mr. Lawrence’s method, - - - - - 67 
Mr. Hutchinson’s method, 72 
Encysted tumours, 73 
CHAPTER HI. 
Description of Plate II. 1 _ 75 
SECTION I. 
■Tendon of the External Oblique Muscle of the %/lbdomen. 
Structure, 
Direction of the fibres, _____ §3 
Abdominal ring, 83 
Split in the tendon, - _ _ _ _ _ 33 
Lesser curve, _______ 84 
Greater curve, _______ 34 
Two abdominal fasciculi of fibres, - - - 84 
Crural fasciculus of fibres, - - - - §7 
Interlaced portion of the tendon, - - - - 88 
Reflected portion, 89 
External scattered fibres of the crural fasciculus, - 90 
Internal scattered fibres of the crural fasciculus, - 91 XI 
CONTENTS. 
SECTION II. 
The Internal Oblique Muscle of the Abdomen. 
Insulated portion, 93 
SECTION III. 
The Transversalis Muscle of the Abdomen. 
Insulated fibres, - - - - - - - 93 
SECTION IV. 
Cremaster Muscle. 
Origin and insertion, 94 
CHAPTER IV. 
Description of Plate III. 96 
SECTION I. 
Fascia Transversalis. 
Structure, 102 
Interlacement with the crural sheath, - - 102 
Internal abdominal ring, - - . - 103 
Seat of ventro-inguinal hernia, : - - 103 XII 
CONTENTS. 
SECTION II. 
Crural Sheath. 
Form and septa, 104 
Under portion, - - - - - - -104 
Upper portion, 106 
Two inner layers of the upper portion, - - 106 
Three outer layers, 106 
Connexion with the pectineal fascia, - - 106 
Connexion with the pubis, - 107 
Sigmoid twist, 107 
Triangular opening, - . - - - 108 
Folded edge of the process, 108 
Crescentic edge, - - - - - - '108 
Connexion with the folded edge of the tendon, - 109 
Connexion with the single or inner edge, - - 110 
Connexion with the fascia transversalis, - - 110 
Crural or Femoral Hernia. 
Ventro-crural passage, 112 
“ “ formed by the fascia lata, - 113 
Upper aperture, 114 
Lower aperture, 114 
Variation in size, 114 
Course of the bowel, - - - - -115 
Stricture of the upper aperture, - - - 115 
Stricture of the lower aperture, - - - - 116 CONTENTS. 
XIII 
Treatment, 116 
Stricture by the entire passage, - - - 116 
Treatment, - - -116 
Stricture of the crescentic edge, - - - 117 
Addenda, 118 PREFACE. 
The original drawings of this publication were executed 
by M. Chasal of Paris, from dissections made by the author, 
in the Pavilions de VEcole de Medicine., during the winter 
of eighteen hundred and twenty. 
Those of the present edition of this work,—reduced in 
size,—have been executed by Mr. M. S. Weaver of Phila- 
delphia. 
It is hoped, that what is here offered will be acceptable 
to the profession, by its adding something to pathology, and 
to precision in practice; by showing the mechanical means 
employed in the human subject, to connect the anterior pa- 
rietes of the abdomen with the lower extremities; and by 
furnishing some observations on points of anatomy hitherto 
unnoticed. 
1 hese points are,—The curvilinear pubal boundary of 
the subcutaneous adipous tissue, as exemplary of similar 
limits in other parts of this tissue :—the dissimilarity in the 
formation and uses of the crescentic and semilunar edges of 
the fascia lata :—the arrangements and mechanical uses of 
three fasciculi of fibres, situated on the tendon of the ex- 
ternal oblique muscle of the abdomen :—a minute descrip- 
tion of the external and internal abdominal rings of the 
muscular fasciculi about the latter, and of those belonging 
to the spermatic cord the interlacement of the tendon of 
the external oblique with the sartorial portion of the fascia 
lata:—the five layers of fibres composing the crural sheath; 16 
PREFACE. 
—and lastly, the ligament-like process of the fascia lata, 
which makes the seat of stricture in crural hernia. 
Of the anatomical and pathological remarks which accom- 
pany the drawings, those contained in the first and second 
chapters are unavoidably lengthened into digressional es- 
says. The object of the one, is to endeavour to free the term 
fascia from the obscurity in which surgical writers have in- 
volved it: and of the other, to establish a practical distinction 
between the subcutaneous adipous and the subcutaneous cel- 
lular tissues; and by an analysis of the latter, to demonstrate, 
that the method for an easy and complete dissection, not 
only of the groin, but of other parts of the body—nay, of 
animal structure generally, consists in ascertaining the 
arrangement of the cellular tissue by means of inflations, 
and in carefully removing the laminse in the order of that 
arrangement. DRAWINGS 
O F 
THE ANATOMY OF THE GEOIN. 
WITH A FEW ANATOMICAL REMARKS. 
CHAPTER I. 
ON THE TERM FASCIA. 
As the word fascia is variously used by surgi- 
cal and anatomical writers, and will frequently 
occur in the descriptions of the plates and in the 
subjoined remarks, which are here respectfully 
offered to the medical profession, it may be pro- 
perly made the subject of a few introductory ob- 
servations. 
Various meanings of the term. — The term 
fascia designates, in some instances, parts which 
differ essentially in formation and use; in other 
instances, it is employed in such a manner as to 
make an arbitrary division of the same structure ,* 18 
ANATOMY OF THE GROIN. 
and occasionally it is found to draw undue at- 
tention to portions of the body which can have no 
surgical and comparatively very little anatomical 
importance. 
This indefinite use of the term has indirectly 
produced perplexity; and even dislike to the term 
itself. It has further brought discredit on all 
anatomical displays of fascia; causing them to be 
regarded as the artificial work of the knife, not a 
development of structure. Thus the subject has 
ceased to interest before a complete knowledge of 
it has been attained, and by many has been aban- 
doned as unworthy of investigation. There is a 
fascial system, however, which may be traced as 
distinctly as the serous or mucous system, and the 
knowledge of which is in many respects important. 
Fascia superJicialis*—The phrase fascia super- 
ficial refers to no part of this fascial system. It 
means only the subcutaneous cellular tissue, 
situated on the abdomen and upper part of the 
thigh. In inguinal hernia, the protruded bowel 
carries before it the cellular tissue, situated under- 
neath the tendon of the external oblique muscle; 
and having arrived at the abdominal ring, carries 
also before it the cellular tissue, (or fascia super- ANATOMY OF THE GROIN. 
19 
ficialis) situated on the outer surface of the same 
tendon. A second sac is thus formed on the pro- 
truded bowel exterior to that made by the perito- 
neum. This outer sac is inaccurately said to 
be formed by the fascia superficialis. It consists 
of this, and the cellular sheath of the spermatic 
cord. The term fascia has thus, for surgical 
purposes, been applied to cellular tissue, com- 
pacted and thickened by disease and mechanical 
pressure. 
Fascia propria.—In a like sense is used the 
phrase fascia propria. 
The tumour of crural hernia is also found to 
have, very generally, a sac outside that of the 
peritoneum. This is said to be made of the 
(tfascia propria”' that is, of the condensed and 
protruded cellular tissue, situated on the outside 
of the peritoneum, between this and the fascia 
transversalis. 
Origin of the above phrases.—The term, as 
above employed, has no anatomical signification. 
Fascia superficialis and fascia propria are surgical 
phrases, given to internal and external abdominal 
portions of the extensive cellular system, in order 
to facilitate a description of hernial sacs, into 20 
ANATOMY OF THE GROIN. 
the formation of which these portions partially 
enter, and by being compacted, &c. in old cases 
of hernia, have become important membranes. 
Fascial system.—A very different meaning is 
to be attached to the word fascia in the ex- 
pressions, fascia lata, fascia iliaca, fascia transver- 
salis. In these and many other instances the 
word fascia designates a fibrous membrane. 
Extension of the term.—The terra may be ex- 
tended also to parts having other names, such as 
aponeurosis plantaris and palmaris, the crural 
sheath and the fibrous channels of veins. All these 
are but parts of the same fascial system, and have 
radically the same structure. 
Structure of the fascial system.—The structure 
of the fascial system is essentially that of parallel 
inelastic shining fibres, united by cellular tissue 
and unconnected with muscularity. 
Fascia, in some places, consists of cellular mem- 
brane strengthened and rendered less elastic by a 
few of the above mentioned fibres, wdiich traverse 
the laminae in parallel lines: this is true of the 
upper part of the fascia iliaca. In other places 
(the back part of the thigh for example) it resem- 
bles such tissues as the dura mater and sclerotica ANATOMY OF THE GROIN. 
21 
From these, however, it essentially differs in its 
organization. 
Difference between fascia and dura mater, 
fyc.—The dura mater is composed of an outer layer 
of opake, whitish, non-fibrous matter, and an in- 
ner layer having a polished surface; fibres are 
found only irregularly distributed on the falx and 
tentorium. The sclerotica consists of an interlace- 
ment of fibres. But the strong fibrous portions 
of the fascial system have the same structure as 
the more delicate cellular parts. The fibres are 
parallel, inelastic and shining. The difference in 
strength and thickness, arises exclusively from the 
assemblage of the fibres being closer, and the 
number of their layers being increased. The 
fibres of the different layers, whether two or more, 
decussate each other; but in no instance do they 
interlace. 
Elements of fascia.—The fascial system is then 
composed of two elements, of opposite properties. 
The cellular tissue, which is the bond of union of 
the fibres, possesses the power of dilatation and con- 
traction ; or in other words, elasticity and contrac- 
tility : whilst tho shining fibre is, like tendon or 
ligament, destitute of these qualities. As therefore. 22 
ANATOMY OF THE GROIN. 
the one or other of these ingredients predominates, it 
will modify the character of the structure, permit- 
ting it to be clastic and contractile when the fibres 
are few, and making it unyielding when they 
abound; more so in that case, in which the fibres 
are in close contact and in several layers. A 
membrane is thus formed, well suited to facilitate, 
increase, and direct the action of muscles, protect 
the large arteries, veins and nerves in the extrem- 
ities, and to furnish a secure medium of attach- 
ment between the extremities and the trunk, in 
addition to that made by the ligament of the 
joints. 
The different parts of the fascial system will be 
found variously modified by their localities and 
connections. Nevertheless, if the phrase may he 
allowed, the parallel uninterlaced, inelastic shining 
fibrous structure is its uniform generic character. 
This is equally true of the lower orders of animals 
as of man. 
Fascia iliaca.—The fascia iliaca, at the origin of 
the iliac muscle, is a delicate transparent mem- 
brane, separable into laminae, between which are 
frequently found layers of fat: these laminae are 
only distinguishable from mere cellular tissue, ANATOMY OF THE GROIN. 
23 
by their unyielding aponeurotic fibres, which 
traverse the laminse in parallel lines to give 
strength to the membrane, and render it proportion- 
ably inelastic. 
Fascia lata.—The fascia lata, on the contrary, is 
a thick opaque membrane, especially on the back 
of the thigh, where it is very dense and unyielding. 
These two membranes are part of the same 
tissue. The apparent difference of structure de- 
pends on the greater or less quantity of the apo- 
neurotic fibres* 
The fascia lata deserves more notice. It con- 
sists of several layers of parallel aponeurotic 
fibres, which decussate at various angles without 
interlacing. The most superficial of these layers 
encircles the entire limb horizontally ' at the inside 
of the knee, and at the line of separation of the 
extensors and flexors of the thigh, it is detached 
from the deeper layers; to preserve, in the one 
instance, the proper relative position of the two 
great masses of crural muscles, and in the other, 
to counteract the tendency to separation in the 
hamstrings when the leg is extended. The fibres 
of this superficial layer are found also at the inside 
of the knee, in union with the diverging tendon of 24 
ANATOMY OF THE GROIN. 
the sartorius; forming with it, an external fibrous 
covering of the joint. Above the knee they con- 
stitute the fascial covering of the vastus internus, 
and by passing over the vena saphena contribute 
to form its fibrous sheath or channel. Higher up 
the thigh, where this vein is more anteriorly 
situated, these superficial fibres pass under the 
vessel, and become the fascial covering of the sar- 
torius. This muscle is contained in a sheath of 
its own. 
From the above description it appears that this 
superficial layer of the fascia lata is a common 
envelope to the thigh; and if the examination be 
extended to the leg, it will here be found to serve 
the same purpose. The most comprehensive view 
to be taken of this layer of unyielding fibres is, 
that they are bands or strings, so applied from the 
hip to the ankle, as to make a common bond of 
union for all the parts of the lower extremity. 
Ligamentous disposition of fascia.—The inter- 
nal layers of the fascia lata, unlike the above, are 
limited in their use and extent. They are spread 
over the extensors and flexors of the thigh, to 
form their proper sheaths; and they make, by 
means of a sygmoid flexion, a ligamentous attach- 
ment to the pubis. 25 
ANATOMY OF THE GROIN. 
Fascia is also elsewhere arranged in the form 
of ligaments. From the aponeurosis plantaris, 
which is a part of the system under consideration, 
two separate portions pass off, to be attached to 
the metatarsal bone of the great toe; other portions 
pass from the anterior part of the aponeurosis, to 
be bound about the roots of the front tarsal bones. 
A similar ligamentous disposition is to he found 
in the palm of the hand. 
Fibres reflected from the fascia.—Fascia, in 
some parts of the body, has some of its fibres re- 
flected off at several points of its external surface. 
This is generally the case in every part of the 
posterior half of the body; more remarkably on 
the hack part of the thighs. As the fascia super- 
ficialis is absent here, the derm and the fibrous 
fascia are separated only by a stratum of adipous 
matter. Through this stratum a tissue of strong 
fibres traverses, passing into the fascia below, and 
into the derm above, so as firmly to connect the 
integuments with the proper covering of the 
muscles. The external surface of the aponeurosis 
plantaris above noticed, exhibits the same arrange- 
ment. 
Abrupt termination of fibres.—Fascia presents 26 
ANATOMY OF THE GROIN. 
an instance of an abrupt termination of its fibres 
at the origin of the pectoralis minor. This 
muscle, and the exposed intercostals are covered 
with the same fascia; on the intercostals it is 
strong and fibrous: it preserves this character on 
the pectoral to a limited extent from its origin; 
there it becomes a delicate transparent membrane, 
and nearer the axilla is nothing else than the loose 
cellular tissue which every where enters into the 
> 
substance of muscle. 
Apparent irregularity of fibres.—In that por- 
tion of the fascia of the pelvis, which passes off 
from the covering of the obturator internus to the 
sides of the bladder, described by Colles, there is 
an apparent irregularity in the direction of the 
fibres—seemingly an interlacement. This is owing 
to an addition of small tendons, belonging to some 
muscular fasciculi of the levator ani, which ad- 
here to its under surface. They are no part of the 
fascia. The appearance of irregularity, here 
produced by them, may be elsewhere seen, and 
arises likewise from the addition of extraneous 
fibres. The structure of fascia, we repeat, is 
universally that of parallel fibres. 
Septa.—Throughout the muscular system, septa 27 
ANATOMY OF THE GROIN. 
will be found given off from the inner surface of 
the enveloping fascia, so as to separate muscles, 
or sets of muscles, and encase them in sheaths. 
Such is the thick membrane, which originates 
from the linea aspera of the os femoris; and that 
which insulates the perineal muscles. In some 
instances the fascial sheath of the muscle is 
formed without the intervention of these septa; as 
in that of the sartorius. 
Substitute for bony attachment.—Fascia, in 
some places, is but a surface for muscular attach- 
ment, in the place of bone. All the interosseous 
ligaments, and the membrane which is found in 
the foramen ovale of the pelvis, are examples in 
point. 
Fascia of the gluteus maximus.—The gluteus 
maximus presents a peculiarity of arrangement 
which deserves separate notice. The fascia, 
although comparatively very delicate, is rendered 
capable of resisting the powerful actions of this 
muscle by means of its connections with the 
integuments, and the numerous septa which it 
sends off from its under surface. This muscle, 
without its admirably disposed fascia, would be 
an unwieldy mass of flesh, ill suited for its im- 28 
ANATOMY OF THE GROIN. 
portant actions. The external surface of the 
fascia of the gluteus is so connected with the 
adipous structure and thereby with the derm, that 
the integuments are made to co-operate in its 
purposes. The internal surface, by its septa, so 
divides the gluteus into an assemblage of small 
muscles, and so insulates each of them, that not 
only more power is bestowed on the entire muscu- 
lar mass, but also a thick fibrous covering is 
rendered thereby useless. 
Fascia of the deltoid.—The deltoid illustrates 
the same admirable economy. This muscle has, 
in a great degree, the same relation to the upper 
extremity, that the gluteus maximus has to the 
lower. For many reasons, it should be powerful 
yet small; which objects are accomplished in the 
following happy manner. The muscular mass is 
separated into two assemblages of small muscles : 
one of which has its origin from the humerus, and 
its insertions on the clavicle, and the spine of the 
scapula; the other takes its origin from the inter- 
mediate spaces on these bones, and, passing down 
between the former, dips its small tendons under 
their origins, and makes insertions. A sort of 
dove-tailing is thus produced. This arrangement ANATOMY OF THE GROIN. 
29 
alone increases the aggregate power of the muscle; 
and, by one assemblage counteracting the other, 
directs this power upon the joint, and with greater 
uniformity ; but when each small portion has a 
lateral resisting surface afforded by a fascial sheath, 
the power of the deltoid must be yet more 
augmented. 
Semilunar edges.—Semilunar edges are occa- 
sionally found in fascia. One may be found in 
the deep seated fascia which covers the triceps 
adductor femoris, at the spot where the profundus 
passes off from the femoral artery to enter this 
mass of muscles. Another is to be seen in the 
axilla formed by the humeral fascia, where the 
inner superficial vein joins the subclavian. And 
a third, which has been made the subject of much 
surgical controversy, exists in the fascia lata where 
the vena saphena unites itself to the great femoral 
vein. They appear to be altogether subservient 
to blood vessels. Without them it is difficult to 
understand, how large arterial branches can obtain 
a safe ingress to the muscular masses which are 
enveloped in fascial sheaths, and also how the 
common trunk of the superficial veins can form a 
union with the great venous trunks of the extremi- 30 
ANATOMY OF THE GROIN. 
ties. The crural semilunar edge, though identically 
the same formation with the two mentioned, and 
others which may be found in the fascial sys- 
tem, presents a different appearance to a super- 
ficial observer, owing to its vicinity to a crescentic 
edge above it in the same fascia. This last should 
not be confounded with the semilunar edge, as it 
results from a different cause, and serves a different 
end. It arises from a sygmoid twist or flexion 
which the fascia lata makes in forming itself into 
a ligament, to be inserted into the side of the 
pubis, below the attachment of the reflected por- 
tion of the tendon of the external oblique muscle 
of the abdomen. 
Conclusion.—It appears from this partial and 
desultory glance at various parts of the fascial 
system, that the modifications of it are very numer- 
ous. They are nevertheless identified in structure 
and use, and distinguished every where, by the 
shining, inelastic, parallel fibres unconnected with 
muscularity. It would be difficult to form a 
definition equally comprehensive and accurate. 
Some portions of the system may be said to be 
cellular membrane traversed in parallel lines by 
the fibres above noticed; whilst other portions 31 
ANATOMY OF THE GROIN. 
may be defined—an assemblage of these parallel 
fibres in one or more decussating layers, formed 
into a membrane by the intervention of cellular 
tissue. But, under all modifications, they are the 
attendants of muscles; to protect them—and to 
facilitate, increase, and, in a degree, direct their 
power. 32 
ANATOMY OF THE GROIN. 
CHAPTER II. 
DESCRIPTION OF PLATE I. 
This plate exhibits, on the right side of the 
subject, the derm reflected from the abdomen, 
penis and scrotum, upon the thigh, to display the 
subcutaneous adipous tissue; and, on the left side, 
this adipous tissue, also reflected, to display the 
subjacent laminated cellular tissue, called “ fascia 
superficialis.55 
A A The reflected derm dissected from the abdomen, 
penis and scrotum. 
B The subcutaneous adipous tissue spread over 
the groin and thigh, 
b b b The right portion of the curvilinear 
pubal edge of the abdominal subcutaneous 
adipous tissue. 
C The reflected subcutaneous adipous tissue of the 
left side. 
d d The abdominal portion of the laminated cellular 
tissue of the integuments, called by surgical 
writers, fascia superficialis. Flate I. 
jr- 
''ftww 
TSinri/iir- jJjUJi. ANATOMY OF THE GROIN. 
33 
e e The crural portion of the same tissue, 
f f f f g g The genital portion of it, found, unlike the two 
other portions, in immediate contact with 
the derm, never covered with the adipous 
tissue : f f f f the scrotal, g g the prepucial 
portion. 
SECTION I. 
THE ADIPOUS AND CELLULAR TISSUES OF THE 
INTEGUMENTS. 
The adipous and cellular tissues of the integu- 
ments are essentially different parts of the body; 
being unlike in their location, structure and uses. 
THE SUBCUTANEOUS ADIPOUS TISSUE. 
Location.—The adipous tissue of the integu- 
ments, a small portion of which is displayed under 
B, in Plate I. is found in immediate contact with 
the derm, in every part of the body, except the 
penis and scrotum, (as shown in Plate I.) the ex- 
ternal parts of the female organs of generations, 
the perineum, the axillae, and the eye-lids. 
Quantity.—It varies in quantity. On the nates, 
xmd the soles of the feet it is most abundant: 34. 
ANATOMY OF THE GROIN. 
over the ankle, knee, wrist, and elbow joints, the 
anterior part of the neck, and the cranium, it is 
spread into a thin layer. An examination and 
comparison of the different portions of the entire 
tissue, will show that the stratum is thicker, and 
more compact on the posterior than on the anterior 
surface of the body. The quantity varies also in 
respect to age, sex, temperament, and health: 
being greatest in infancy, in the female, particu- 
larly after her seventh climacterick, and in healthy 
persons of a naturally cheerful temper; and least 
in old age, in the male, and in individuals afflicted 
with chronic diseases, and with physical and 
mental irritability. 
Structure.—This tissue consists of an assem- 
blage of delicate transparent cysts filled with fat; 
and of adventitious filaments, which traverse the 
cysts in various directions. 
The cysts of the adipous tissue.—The cysts of 
the adipous tissue vary in size, and shape. They 
are large and irregular on the abdomen; on the 
face they are small and spheroidal, presenting a 
granulated appearance. They vary also at differ- 
ent distances from the derm. Those in immediate 
contact with the derm are minute and uniform; 35 
ANATOMY OF THE GROIN. 
those in the substance of the tissue are larger; 
whilst those situated more interiorly, where the 
adipous unites with the subjacent cellular tissue, 
lose the distinct form of independent cysts,—these 
cysts being changed into irregular communicating 
cells containing oblong flakes of fat. 
A satisfactory demonstration of these transpa- 
rent cysts is easily made by an examination of the 
contained adipous matter, which, becoming solid 
at death, presents thereby a true cast of their size 
and shape, Their form may also be shown by a 
process of long maceration, which converts the 
fat into adipocere, and the derm into a soft gelati- 
nous mass separable by washings. The exterior 
surface of the adipous tissue is thus exhibited as 
papillous. This appearance is owing to the pro- 
jection of the outer lobules, or cysts, which, in 
some parts of the surface, are more or less 
obliquely inclined, whilst in others they are verti- 
cal, and more obtuse. These conoidal projections 
are, in their natural state, bedded in the derm. 
Its under surface is thereby filled with innumerable 
pits or depressions, answering to the adipous pro- 
jections. This pitted surface of the derm is well 
exhibited by subjecting the integuments to partial 30 
ANATOMY OF THE GROIN. 
maceration and subsequently to the action of 
alcohol. The derm is enlarged to many times its 
ft 
natural thickness by the first process, and becomes 
hardened by the second, which, at the same time, 
softens and detaches the adherent adipocere. 
Thus are disclosed not only the conical pits of 
the under surface of the derm, but also the fila- 
ments of the adipous tissue; which are now to be 
noticed. 
The filaments of the adipous tissue.—The fila- 
ments of the adipous tissue, proceeding from the 
under surface of the derm, traverse irregularly 
the interstices of the lobules of fat, or rather of 
their cysts, and are lost, on the anterior part of 
of the body, in the laminated cellular tissue, and 
on the posterior, where the laminated cellular 
tissue is wholly wanting, in the fascial system 
covering the muscles. 
Variety of appearance.—They are modified in 
their nature and uses by contiguous textures. In the 
tissue itself they are diaphanous and membranous. 
At the under surface of the derm they are opaque 
whitish fibres, thready prolongations as it were, 
of the derm. At the under surface of the adipous 
tissue, of the abdomen, and of the anterior parts ANATOMY OF THE GROIN. 
37 
of the extremities, they are changed into laminated 
cellular membrane. On the soles of the feet, the 
nates, the hack of the thighs, and other posterior 
parts of the body, they are inelastic shining fibres. 
The first, second, and fourth of these modifications 
are best demonstrated by dissection of the last 
named parts. Here the filaments can be distinctly 
traced from the derm, through the adipous tissue, 
into the fibrous coverings of the muscles. In the 
substance of the thick and compact adipous tissue, 
they retain the transparent membranous character; 
when traced towards the skin, they are found to 
become gradually an opake dermoid matter, and 
in the fibrous envelop of the muscles, they are 
imperceptibly changed to inelastic shining fibres, 
reflected from that strong fascial system. 
Uses of the filaments.—The filaments of the 
adipous tissue have several uses. 
First. They are partial capsules to the cysts. 
These membranous sacs need such external sup- 
ports ; without them they would be liable, owing 
to their extreme tenuity, to be ruptured by the 
accumulation of their own secretions, viz. the 
contained semifluid adipous matter. 
Second. They are a common bond of union 38 
ANATOMY OF THE GROIN. 
of the otherwise isolated cysts. Without them, the 
encysted lobules of fat would have no connexion 
y 
with each other except simple contact. They 
would be perpetually liable to displacement; and 
to gravitate—like serous effusions of the cellular 
tissue in debilitated and dropsical persons. These 
filaments are found in every portion of the adipous 
tissue, traversing in all directions; and from them 
the entire structure derives its strength and con- 
tinuity. Their entanglements confine the encysted 
lobules to their proper places, and thus enable 
them to give shape and proportion to the body, 
under all its varying postures and actions, and un- 
der all circumstances of pressure, both from within 
and without. 
Third. They connect the adipous tissue with 
the contiguous textures. By them this tissue is, 
exteriorly, fastened to the pitted surface of the 
derm; and, interiorly, to the subjacent cellular 
tissue, or to the fascial system. 
Fourth. From the above mentioned connexions, 
we may perceive that they are the common bond 
of union between the derm and the adipous and 
cellular tissues—the parts which in the human 
subject constitute that compound mass called the 
integuments. These several structures, having 39 
ANATOMY OF THE GROIN. 
distinct and peculiar functions, would, without 
the bond of the filaments, reciprocally interfere 
with each other, and be destitute of the aggregate 
character of the integuments. The nature of 
the connexion here described is most readily de- 
monstrated in the nates and the sole of the foot. 
Fifth. They serve the purpose of tendons. 
The fibres of the subcutaneous muscles of many 
quadrupeds have their origins and insertions in 
these filaments. The same is true of the pla- 
tysma myoids in the human subject, and of the 
scattered fibres of subcutaneous sphincter muscles. 
Ignorance of this fact has caused the difficulty 
which is generally experienced in the dissection of 
the sphincter ani. All its fibres are curved on the 
coccygeal half of the anus; those more deeply 
seated are continued round the intestine, then 
decussate, and are prolonged so as to cover the 
bulb of the urethra: the superficial fibres, instead 
of going to the bulb, radiate from their curvature, 
and after separating into distinct fasciculi, are 
attached to the filaments of the adipous tissue. 
Another example, equally striking, of the tendi- 
noid use of these filaments, is afforded by the 
outermost fibres of the orbicularis palpebrse. 40 
ANATOMY OF THE GROIN. 
The mass of this muscle terminates in a common 
tendon at the nose, while several exterior fasciculi, 
scattered from it, enter the adipous tissue and adopt 
its filaments as their tendons. 
The filamentous insertion of the diverging fibres 
of the two muscles above noticed, makes their 
functions different from the masses whence they 
respectively issue. They are not properly to be 
regarded as sphincters, but rather as the corruga- 
tors of the integuments. The radiating wrinkles 
about the anus, and those of the external canthus 
of the eye, commonly called crow-feet, are ascrib- 
able to the action of these fibres. 
Finally. It may be worth inquiry, whether 
these filaments may not be the medium through 
which the blood vessels and nerves are conveyed 
to the secreting cysts, the derm, and to the 
chorion. 
THE LAMINATED CELULLAR TISSUE. 
Extent.—The laminated cellular tissue of the 
integuments is less extensively spread than the 
adipous: it is very thin on the posterior parts of 
the trunk and cranium • it abounds on the anterior ANATOMY OF THE GROIN. 
41 
surface of the thorax, abdomen, and extremities: 
in the eye-lids, labia pudendi, penis, scrotum, and 
perineum, the adipous tissue being absent, it is in 
immediate contact with the derm. It does not 
exist in the integuments of the nates, back of the 
thighs, palms of the hands, and soles of the feet; 
here the adipous tissue is alone interposed between 
the derm and the strong enveloping fascia of the 
muscles. 
Structure.—This tissue has not the three-fold 
composition of the adipous. It consists simply 
of transparent laminse, which are so connected with 
each other as to make communicating cells of 
various forms and sizes. 
Properties and uses.—It possesses elasticity 
and contractility in a greater degree than most of 
the other textures of the body. By these proper- 
ties it is adapted to those parts which are subject 
to constant motion, as the joints and neck; to 
those which have alternate variation in size, as the 
abdominal parietes; and to those which are at 
the same time altered in form and size, as the 
axilla, perineum, genital organs, and eyelids. The 
eye-lids, when closed, have considerable breadth, 
and comparatively little when open. The axilla ANATOMY OF THE GROlfl. 
is a circumscribed hollow when the arm hangs by 
the side; but when the humerus is elevated, this 
hollow is changed into a plane. The perineum 
has only the breadth of a few lines when the 
thighs are closed, but when they are widely sepa- 
rated its breadth is very much increased. These 
changes are readily allowed by the yielding and 
restoring powers of this tissue. The penis and 
scrotum, more than any other parts of the body, 
vary at times in size and shape, and are therefore 
accommodated to the necessities of these wide 
variations, by an abundant possession of this 
elastic tissue. 
In all these parts the adipous tissue would 
be unsuitable, from its want of elasticity, and 
from its accumulated fat.* If these parts should 
become fat with the other portions of the integu- 
ments, the eye-lids would be moved with difficulty 
or altogether closed; the arms would be cushioned 
out at an angle with the body, the lower limbs 
permanently separated, and motion in both in- 
* It is not denied, that the cysts of this tissue possess elas- 
ticity and contractility, equally with the laminae of the cellular 
tissue; hut these properties are rendered inactive by the fat 
they contain and the filaments which bind them. ANATOMY OF THE GROIN. 
43 
stances rendered difficult and awkward; nor 
would the presence of this adipous tissue in the 
genital systems he less embarrassing to the 
functions of these parts. A knowledge of the 
absence of this tissue from the labia pudendi, 
and perineum explains why, in the last stage of 
delivery, these parts—a mass of elastic tissue— 
readily yield to afford a passage to the head of the 
child, and subsequently contract their ordinary size. 
The properties of the tissue under consideration 
render it a substitute for muscularity, where the 
presence of the muscle would be inconvenient, as 
in the scrotum. The motion of this part is com- 
monly attributed to a subcutaneous muscle called 
the dartos. Since, however, few pretend to have 
seen this muscle; since the contraction and relax- 
ation of the part cannot be explained on the 
received laws of muscularity; and further, since 
contractility does not belong exclusively to muscu- 
lar fibre, but is found in every living animal solid, 
nay, in the blood itself—the gratuitous assumption 
of the existence of the dartos cannot be admitted. 
The changes of size and form in the scrotum, 
excited by temperature, by passion, and by a 
variety of other causes, depend on the contractility 44 
ANATOMY OP THE GROIN. 
of the subcutaneous cellular tissue, and not on 
muscularity. 
Comparison of the subcutaneous-adipous and 
cellular tissues.—It appears from the above des- 
criptions, that the subcutaneous-adipous and the 
subcutaneous-cellular tissues differ essentially 
from each other : the one being an assemblage of 
secreting cysts, lobules of fat, and connecting fila- 
ments; the other an assemblage of transparent 
laminae formed into communicating cells: the 
former being well adapted to protect subjacent 
parts from contusion, and to give beauty of form 
by affording an uniform surface on which the 
skin may be smoothly stretched; the latter to 
promote and facilitate the motion of subjacent 
parts. 
It appears, also, that the two tissues cannot be 
substituted for each other. The adipous tissue of 
the sole of the foot would not suit the eye-lid, nor 
the subdermal cellular tissue of the eyelid suit 
the sole of the foot. The back of the thighs, the 
nates, and indeed the entire posterior surface of 
the body, call for the compact-inelastic-adipous 
tissue: whilst on the anterior surface, the thorax, 
and abdomen being in a state of continual con- ANATOMY OF THE GROIN. 
45 
traction and distension, and the anterior muscles 
of the extremities being less firmly hound by 
fascia, the cellular tissue becomes indispensable 
for facilitating their movements. And though the 
adipous tissue does exist on these anterior parts, 
its filaments have not their usual unyielding cha- 
racter, but assume the elastic-contractile nature 
of the cellular tissue. 
The distinction which has thus been pointed 
out between the above mentioned tissues, is also 
demonstrated by comparative anatomy. 
Fishes generally are destitute of both these sub- 
cutaneous tissues. Between the scales and the 
muscles nothing intervenes but a dermoid envelop. 
The integuments of birds have the cellular, but 
not the adipous tissue. 
Among the quadrupeds, swine and other pachy- 
derm animals have the adipous and not the cellular 
tissue. 
FASCIA SUPERFICIALIS. 
The fascia superficialis, displayed on the left 
side of Plate I. deserves a few remarks. It is part 
of the subcutaneous cellular tissue. 46 
ANATOMY OF THE GROIN. 
Origin of the phrase.—The phrase fascia super- 
ficialis originated with surgical authors, in their 
descriptions of hernial sacs. The laminae of the 
cellular tissue, which are in immediate contact 
with the protruded peritoneum and bowel, being, 
by pressure, irritation, and adhesive inflammation, 
so condensed and thickened as to become an outer 
or superficial sac for the protruded tumour, have 
been called a fascia. Thus has arisen the phrase 
superficial fascia, or fascia superficialis, which sub- 
sequently has not been limited to signify only the 
laminae involved in the hernial tumor, but, through 
inadvertence, has been given to all the subcu- 
taneous cellular tissue of the abdomen and of the 
anterior part of the thigh. 
Disposition of its cells and laminae.—On the 
subject of this misnamed portion of the cellular 
tissue, the following circumstances, relating to the 
disposition of its cells and laminae, are worthy of 
notice. 
Outer laminae.—If air be forced into the cells of 
the outer laminae of this fascia superficialis, at any 
point on the surface of the abdomen or the anterior 
part of the thigh, it will freely pass over the abdo- AjnATOMY of the groin. 
47 
minal, crural, genital and perineal regions ; demon- 
strating that these regions have a common subcu- 
taneous cellular covering. 
Deeper seated crural laminae.—But when air is 
forced into the cells of the deeper seated laminae, 
its diffusion will be partial. The inflation being 
made from any point on the anterior part of the 
thigh, the air will not without the strongest effort 
pass above the inguinal line: the cellular tissue of 
the thigh will be found distended, that of the 
abdomen remaining collapsed. The air will 
force a passage by the crural ring into the iliac 
regions, thereby separating the peritoneum from 
the fascial covering of the iliac and psoas mus- 
cles. 
Deeper seated abdominal laminae.—Again air 
blown into the deeper seated laminae, from any 
point on the abdomen, will also be limited by the 
inguinal line. It will distend the surface of the 
penis, together with the scrotum and perineum, 
without in the least affecting the thigh, nor can 
the air be made to pass into the crural region, even 
when the pressure is augmented, owing to the ad- 
herence and reflection upwards of the deeper 
seated abdominal laminae at the inguinal line. 48 
ANATOMY OF THE GROIN. 
Increased pressure in this case will drive the 
air backward into the abdominal ring, between 
its edges and the subjacent uninflated cellular 
sheath of the spermatic cord and testicle. By this 
last inflation the inner surface of the tendon of the 
external oblique is separated from the rest of the 
abdominal parietes. 
Cellular sheath of the spermatic cord and testicle. 
—The cellular sheath of the spermatic cord and 
testicle is a distinct portion of the fascia super- 
ficialis. This is proved by the fact, that no air 
passes into its cells by a forcible inflation from any 
of the above mentioned points: they remain 
collapsed beneath two distended portions of 
cellular tissue. This deeply seated vaginal portion 
may he traced up along the cord, and through the 
abdominal ring. From this place it diverges until 
it reaches the internal abdominal ring. It then 
enters this ring and becomes the cellular tissue 
between the peritoneum and the fascia transversa- 
lis and iliaca. 
Air forced into it from below, completely 
insulates the tunica vaginalis testis, and passing 
along the cord, distends the diverging portion 
into a funnel-shaped hag. The air, having then ANATOMY OF THE GROIN. 
49 
reached the internal ring, enters between the 
peritoneum and fascia transversalis, and may be 
made to mix with that which, in the second experi- 
ment of inflation above mentioned, passed from 
the thigh into the iliac region, by the way of the 
crural ring. 
From what has been said, it is manifest that 
the abdominal subcutaneous portion of the cellu- 
lar system—the fascia superficialis—is not an 
undefined mass; but that its laminae have an 
orderly arrangement, which may be demonstrated 
by anatomical analysis: and also that what has 
been ascertained to be the condition of a part of 
this tissue, will be found to be that of the entire 
tissue throughout the body. 
Method of dissecting the groin.—The four 
modes of inflation described above, point out the 
the method for an easy and complete dissection of 
the groin. For this purpose, the dissector should 
first inflate and remove the extensive superficial 
laminae common to one side of the abdomen, half 
of the scrotum, the whole of the penis, and the 
anterior part of the thigh. He should next in- 
flate and remove the deeper seated laminae common 
to the abdomen, penis and scrotum; and after- 50 
ANATOMY OF THE GROIN. 
wards those belonging exclusively to the thigh, 
which communicate, however, by the crural ring, 
with the cellular tissue of the cavity of the pelvis. 
He should further inflate and remove the laminae 
which constitute the cellular sheath of the cord 
and testicle, which communicate, by the abdo- 
minal ring, with the cellular tissue situated 
between the muscles of the abdomen and between 
the fascia transversalis and peritoneum. Finally, 
the dissector should remove, successively, the 
abdominal muscles. He will thereby make the 
displays of the groin which are exhibited in the 
drawings which accompany these remarks. 
SECTION II. 
PATHOLOGICAL OBSERVATIONS. 
The above anatomical analysis of the adipous 
and cellular tissues suggests a few pathological 
observations. 
Inflammation of the adipous tissue.—The 
adipous tissue, in common with the rest of the 5) 
ANATOMY OF THE GROIN. 
body, is liable to inflammation, but its symptoms 
and progress are modified by the mechanical con- 
nexion and the vital properties of its constituent 
parts. These modifications of the inflammatory 
action are most evident in the sole of the foot, 
palm of the hand, the nates, and the back of the 
thigh. Here the structure of the tissue is most 
distinct, and its connexions with contiguous parts 
stronger and more immediate. 
The structure is a compound of very dissimilar 
elements, consisting, as has been shown, of cysts, 
fat and filaments. 
The filaments are endowed with a degree of 
life, analogus to that of tendon, ligament and 
derm; exhibiting mechanical rather than active 
vital properties, and though this obscure vitality 
renders them less liable to irritation, yet when 
inflamed they readily mortify and slough. 
The fat, being only a secretion, and therefore 
possessing in itself no vital function, cannot, 
merely as a secretion, be the subject of morbid 
action; but it may become, if retained under 
some circumstances, an irritant to its enveloping 
cysts. 
The cysts, unlike the two former constituents, are 52 
ANATOMY OF THE GROIN. 
organized secreting membranes, consisting of 
arteries, veins, absorbents, and nerves; subject to 
change in size, and alteration in structure; and 
susceptible of the adhesive, serous, and more 
particularly the suppurative inflammation. 
The connexions of the subcutaneous adipous 
tissue with contiguous parts are, first, those made 
with the derm by means of innumerable dermoid 
filaments, and secondly, those generally made, by 
means of fibrous filaments, with the unyielding 
fascia of the muscles—in some places with, and 
in others without, the intervention of the laminated 
cellular tissue. 
These connexions concur with the structure of 
the tissue in aggravating the ordinary inflamma- 
tory action. 
The progress and symptoms of inflammation 
in the adipous tissue may now be satisfactorily 
traced. 
Inflamed cysts.—When an irritant is here 
applied, the vascular cysts become inflamed, the 
fat and filaments remaining unaffected. In this 
state, the fat is either removed by absorption, or 
if retained, becomes in time, an additional irritant, 
and augments the inflammatory condition of the ANATOMY OF THE GROIN. 
53 
cysts. This constitutes the first morbid state of 
the tissue. 
Stricture.—The second state is that of stricture. 
In this state, coagulable lymph and serum are 
effused, blood vessels are enlarged, and the whole 
tissue thereby rendered full and tense. If the 
contiguous textures yield to this fulness, the in- 
flamed tissue has space for enlargement; but if 
the contiguous textures be unyielding, presenting 
a thick derm on the one side, and on the other a 
dense fascia; and if also the adipous tissue between 
them be firmly fastened to both, at innumerable 
points, by traversing filaments which partake of 
their unyielding nature, then this tissue must be 
painfully and dangerously strictured. The stric- 
ture, practically regarded, may be said to have a 
double cause, viz. the derm and the filaments; the 
one binding the tumefied tissue, and the other 
acting upon it, like innumerable transverse cords 
passing from the derm to the fascia. 
Disorganization.—The third state is that of dis- 
organization. The vascular cysts are too delicate 
to sustain long the inflammatory action under the 
the aggravation from a strictured condition of the 
tissue. They soon mortify. The filaments, also, 54 
ANATOMY OF THE GROIN. 
from being stretched and from contiguous sym- 
pathy, become at length inflamed, and slough. 
Circumscribed or extensive abscess.—The fourth 
state is that of circumscribed or of extensive ab- 
scess. The lymph, lympho-serous, serous, and sero- 
purulent, fluids now disappear, and give place to 
pus and flloating shreds of sloughy matter, which 
are the detached mortified filaments and cysts*. 
The above anatomico-pathological analysis of 
subcutaneous inflammation leads to the following 
indications and plan of treatment. 
Indications and plan of treatment.—The indi- 
cations in the first stage are, to remove the 
primary irritant, and arrest the inflammatory 
action. These are affected by general and local 
antiphlogistic measures. In the second, it is to 
relieve stricture. This is fulfilled by deep 
incisions into the derm of the affected part, more 
or less extensive and deep as the particular case 
may require. The indication in the third and 
fourth stages is to remove the confined pus and 
* As the remarks are intentionally confined, here, to the 
morbid changes of the adipous tissue, nothing is said of the 
derm and fascia, or of the constitutional symptoms. ANATOMY OF THE GROIN. 
55 
dead matter. This also may be accomplished by 
incisions through the derm. The subsequent 
treatment should be so directed as to arrest the 
suppurative tendency, promote granulations, di- 
minish the cavity of the abcess, and establish the 
skinning of the openings. But the most important 
object to he kept in view in treating the inflam- 
mation, is the relief of stricture. All the other 
indications lead but to a palliating and “expec- 
tant” practice. This alone will remove the in- 
flammation before it produces disorganization, 
abscess, and sinking of the system. 
The pathology thus derived from an anatomical 
analysis of the integuments, when applied to the 
several diseases, phlegmon, anthrax, paronchia, 
and certain cases of phlegmonous erysipelas, will 
from the resemblance discoverable among them, 
lead to the establishment of a similar mode of 
treatment. 
Phlegmon.—Phlegmon, properly so called, is 
not usually found on the scrotum, penis, labia, 
perineum, and eye-lids, where the subcutaneous 
adipous tissue is wanting. These parts, when 
primarily or secondarily inflamed, become cede- 
matous. The common seat of phlegmon, that 56 
ANATOMY OF THE GROIN. 
in which it is most painful and tedious, is in the 
compact adipous tissue of the posterior surface of 
the body. When it occurs on the anterior surface, 
where the cellular tissue is united with the adipous, 
the inflammation is milder. 
These circumstances may show that phlegmon 
is a disease of the subcutaneous adipous tissue 
and that it exhibits its genuine character when 
seated in those parts of this tissue which are 
entirely separated from the cellular tissue. 
What is the nature of phlegmon? It is a 
circumscribed inflammation originating in the 
cysts of the adipous tissue, tending outward, and 
involving* the skin. What is the cause of the 
extreme and continued pain? It is the stricture 
induced by unyielding filaments, and by the derm 
which binds the subjacent inflamed tissue. And 
what is the core, as it is commonly called? It is 
the sloughed filaments resulting from the stricture. 
Such is the pathology of phlegmon disclosed by 
anatomical analysis. 
Anthrax.—Anthrax is distinguishable from 
phlegmon by the wider compass of inflammation, 
by a peculiar burning, by its mottled modena 
colour, and by its greater obstinacy. But, with 57 
ANATOMY OF THE GROIN. 
these differences, the two diseases are assimilated 
by the primary seat of inflammation in each being 
in the subcutaneous adipous tissue. Nor is it a 
slight circumstance in favour of the radical simi- 
larity in the two cases, at the same time that it 
serves to explain the cause of the greater severity 
of anthrax, that this last disease is located in the 
most unyielding portions of the adipous tissue. 
All the peculiarities of anthrax cannot however 
he explained by the structure of the affected part. 
It has indeed a character, which from the circum- 
stances of its occurrence might be wholly ascribed 
to advanced age, feeble constitution and intempe- 
rate habits. Nevertheless, the binding influence 
of the thick derm, dense-fibrous fascia, and un- 
yielding filaments in and about the inflamed parts, 
aggravates all the symptoms. A strictured con- 
dition will thereby be produced, and disorganiza- 
tion of the adipous tissue will follow ; the cysts 
and filaments being changed into adherent sloughy 
shreds. 
Paronychia.—Paronychia, also, has its origin in 
the subcutaneous adipous tissue. This remark 
does not apply to that variety called paronychia 
maligna which has its primary seat in the parts 58 
ANATOMY OF THE GROIN. 
about the bone, and in the bone itself; nor to that 
seated on the outside of the derm, commonly 
i 
called a runround; it includes only the cases of that 
variety which is familiarly named whitloe, and 
which is of by far the most frequent occurrence. 
This is an inflammation attended with insufferable 
throbbing pain, rapid disorganization, and profuse 
and extensively pervading suppuration; three 
circumstances, which the stricture, caused by the 
derm, and by the filaments of the tissue itself, 
superadds to simple inflammation. 
Phlegmonous erysipelas.—The generic charac- 
ter of the above noticed complaints, belong also 
to certain cases of phlegmonous erysipelas. 
Before these cases can be pointed out, it is 
' i 
necessary to abandon the commonly received 
definitions of this disease, as too vague ;• and to 
* The most recent and approved definitions are those given 
by Mr. Lawrence in his observations on the nature and treat- 
ment of erysipelas, read in 1827, before the Medico-Chirurgicai 
Society of London, and subsequently published in the fourteenth 
volume of its Transactions. (See page 36.) One of them is 
in the following words :—“Erysipelas phlegmonosum, an acute 
iaflammation of the skin and cellular tissue, with firm, general 
and deep red swelling of the affected part, ending quickly in 
suppuration and sloughing.” ANATOMY OF THE GROIN. 
59 
present a new one, established on the anatomical 
analysis of the adipous and cellular tissues. 
If it be admitted that a tissue consisting of cysts, fat, and 
filaments is different from one which consists simply of lamina, 
disposed into communicating cells, these two tissues having also 
a different location, and different uses, then the phrase cellular 
tissue, in the above definition, cannot anatomically embrace in 
its signification both the subcutaneous adipous and the subcutane- 
ous cellular tissues. 
Mr. Lawrence’s definition, viewed in this light, includes only 
a very few cases of the disease, viz. those situated where the 
integuments consist but of skin and cellular tissue. 
The second page of the treatise alluded to, contains the 
following definitions: first, “ phlegmonous erysipelas, the 
highest degree of the affection, involving the cellular and adi- 
pous membranesecond, “phlegmonous erysipelas, an inflam- 
mation of the skin in conjunction with that of the subjacent 
adipous and cellular tissue 
Although the two subcutaneous tissues are specified in these 
definitions, yet the use of the words membrane and tissue in the 
singular number, shows that these tissues are not recognized 
as essentially different, exhibiting different symptoms when in- 
flamed, and requiring a different treatment. 
A fourth definition is implied in the following clause of page 
67 of the same publication: “the subjacent adipous and cellu- 
lar textures.” This phraseology is anatomically correct. But 
since both the textures here named do not exist in all parts of 
the integuments, the extract allows a definition which will ex- 
clude those cases of phlegmonous erysipelas situated where the 
cellular tissue only, and those where the adipous only, are 
present. 60 
ANATOMY OF THE GROIN. 
Erysipelas phlegmonosum is an acute in- 
flammation OF THE SKIN, SUBSEQUENTLY IN- 
VOLVING that of the subdermal portion of 
THE INTEGUMENTS. 
This definition has a generic character, embra- 
cing three practical varieties of phlegmonous 
erysipelas hitherto unnoticed; which will be 
described after briefly noticing the phrase subder- 
mal portion. 
The suhdermal portion of the integuments is, 
according to its varied locality, cellular tissue, or 
adipous tissue, or a modified union of both. If, 
for example, it refers to certain isolated spots of 
the integuments, viz. the eye-lids, perineum, labia, 
penis, and scrotum, it consists of cellular tissue: 
if it refers to the posterior surface of the body, 
particularly the nates, and back of the arms and 
thighs, together with the palms of the hands and 
soles of the feet, it consists of adipous tissue : 
It is evident, however, from the tenor of the treatise, that 
Mr. Lawrence did not design to limit the signification of his 
definitions, but, on the contrary, to extend it to all cases of the 
disease in whatever part of the integuments they might occur. 
Such is the inaccurate anatomical character of the most com- 
monly received definitions of phlegmonous erysipelas. ANATOMY OF THE GROIN. 
61 
and lastly, if it refers to the anterior surface, 
especially to the abdomen and front of the thighs, 
it consists of a modified union of both the cellular 
and adipous tissues. 
The three varieties of phlegmonous erysipelas 
thus designated are, 
Cellular variety of phlegmonous erysipelas.— 
First. An erythema with a subjacent serous 
inflammation and tumefaction. 
This variety includes cases situated on the 
scrotum, penis, labia, perineum, and eye-lids, 
where the subdermal portion of the integuments 
is cellular tissue; and might therefore be properly 
called the cellular variety.* Though in this 
tissue, suppuration and sloughing are not unfre- 
quently the effect of inflammation, yet serum is 
its more usual product. This fluid pervades and 
and distends all the communicating cells of the 
tissue: whilst the derm, freed from the binding 
filaments of the adipous tissue, and being in imme- 
diate contact with the laminae of the cellular 
* The cases of this variety should more practically be ar- 
ranged under Mr. Lawrence’s second species of erysipelas, i. e. 
cedematous erysipelas. Medico-Chirurgical Transactions, Vol. 
XIV. page 36. 62 
ANATOMY OF THE GROIN. 
tissue, and partaking of their delicate and elastic 
nature, yields to the augmentation of the subja- 
cent swelling. Thus an unrestrained tumefaction 
takes place which requires the discharge of effused 
fluids; and, in nowise, the removal of stricturing 
agents. 
The deep seated erysipelas of the eye-lid affords 
a familiar example of this variety.* 
Adipous variety of phlegmonous erysipelas.— 
Second. An erythema with a subjacent phleg- 
monous inflammation of a deep red colour, ac- 
companied with tension, and ending quickly in 
sloughing and profuse suppuration; but without 
that excessive tumefaction which characterizes 
the cellular cases under the first head. 
This, which may be called the adipous variety, 
from its occurring on parts where the adipous 
tissue constitutes the subdermal portion of the 
integuments, includes those cases of phlegmonous 
r * The subdermal cellular tissue of this part is also frequently 
affected with chronic oedema, in aged persons. The lower 
eye-lids in dyspeptics are often permanently bloated by effusion, 
the form of semilunar sacs. The same is more or less true 
of the other specified isolated portions of the integuments which 
have no adipous tissue. ANATOMY OF THE GROIN. 
63 
erysipelas which have the same generic character 
with phlegmon, anthrax, and paronychia. The 
resemblance of these three complaints consists in 
each being an inflammation of the subcutaneous 
adipous tissue. Now this second variety differs 
from them only in being primarily an inflammation 
of the skin; but this cutaneous inflammation is 
soon followed by that of the subjacent adipous 
tissue; which continues after the erythema de- 
clines, and thus becomes the principal disease, 
constituting the affirmed resemblance. The quick 
sloughing and profuse suppuration which mark 
this variety, are owing to the connexions and 
structure of the adipous tissue; and would not 
exist without their influence. 
Cellular-adipous variety of phlegmonous erysi- 
pelas.—Third. An erythema with phlegmonous 
and serous inflammation. The cases of this 
variety are situated on the anterior surface of the 
body where the subdermal portion of the integu- 
ments consists of a modified union of both the 
cellular and adipous tissues. 
Tension and tumefaction are both present in the 
early stage of these cases, but not to the degree in 
which they respectively exist in the other varieties. 64 
ANATOMY OF THE GROIN. 
In the close of the disease sloughing and suppu- 
ration take place, though less extensively than in 
the second variety, and always with a deep seated 
serous effusion. 
It appears from the brief notice taken of phleg- 
mon, anthrax, paronychia, and certain cases of 
phlegmonous erysipelas, first, that notwithstanding 
their respective peculiarities, they are all inflam- 
mations which do not of themselves subside until 
disorganization and sloughing have been produced- 
second, that they have this character from involv- 
ing the adipous tissue : and third, that the injuri- 
ous consequences alluded to are immediately 
owing to a slrictured condition, produced in part 
by the filaments of this tissue itself, but mainly 
by the unyielding nature of the contiguous tex- 
tures; for where, as on the back of the thigh, 
the derm is thickest, the fascia dense, and the 
filaments numerous and strong, interlacing the 
the tissue, and closely connecting it to rigid con- 
tiguous parts; there the aggravated cases of the 
above named diseases are to be found—particu- 
larly, the genuine cases of phlegmonous erysipelas. 
Generic treatment in phlegmon, anthrax, 
paronychia, and phlegmonous erysipelas.—The ANATOMY OF THE GROIN. 
65 
similitude above shown to exist among the several 
diseases, phlegmon, anthrax, paronychia, and cer- 
tain cases of phlegmonous erysipelas, leads to a 
generic plan of treatment. This consists in 
making incisions through the shin and subdermal 
portion of the integuments; with the intention 
not only of emptying the blood vessels and drain- 
ing off effused fluids, but principally for the pur- 
pose of removing the constriction produced by 
the unyielding solids, viz. the derm, the fascia, 
and the filaments. 
In phlegmon, this practice should be resorted 
to at an early period: for since a strictured state 
of the adipous tissue exists in the first stage of 
the complaint, and is a principal cause of the 
severity of the subsequent symptoms, it should be 
speedily removed by one or two deep and free 
incisions through the derm and into the inflamed 
tissue. The fear of giving pain might seem to 
present an objection to this practice. But if the 
skin, the chief seat of sensation, be rapidly and 
dexterously divided, the pain will be incon- 
siderable ; particularly if opium be given to lessen 
sensibility, and if position and pressure, when 66 
ANATOMY OF THE GROIN. 
practicable, be employed to diminish the afflux of 
blood to the part. 
In anthrax, incisions have been recommended 
with a view to alter a supposed peculiar action. 
It better accords with the pathology taught above, 
to employ this practice to relieve aggravated ten- 
sion of the inflamed adipous tissue. 
In paronychia it is common to have recourse to 
the knife merely to remove the sequelae of inflam- 
mation. But admitting the doctrine, that in this 
complaint, the derm and filaments are stricturing 
an inflamed tissue,—a deep and free incision 
should be made as soon as the least tension or 
throbbing is perceptible: by this early use of the 
knife, inflammation is arrested before disorgani- 
zation and abscesses are produced. 
Phlegmonous erysipelas, calls for three modes 
of incision, suitable to the three above specified 
varieties of the disease. 
The first consists of numerous punctures made 
with a lancet into the inflamed part. 
Dr. Dobson’s Method.—This method originated 
with Dr. Dobson.* He calls it his “mode of 
* See his letter to Mr. Lawrence, published in the fourteenth 
volume of the London Medico-Chirurgical Transactions. ANATOMY OF THE GROIN. 
67 
abstracting blood” as a substitute for leeching. 
The number of punctures he advises, to use 
nearly his own words, varies according to the 
extent of the disease, but is rarely under ten, and 
seldom exceeds fifty; the depth of each puncture 
also varies according to the greater or less tume- 
faction of these parts : from two to four-tenths of 
an inch, however, he considers the proper respec- 
tive depths. He repeats the punctures to the 
number and extent required, about twice a day, 
and often in bad cases three or four times. The 
quantity of blood which these punctures discharge, 
although sometimes considerable, should not 
create alarm, since it soon spontaneously ceases. 
The punctures themselves heal in a few hours, and 
scarcely leave a scar. 
The author of this method makes a general 
application of it in all cases of erysipelas, but it 
is intended in these pages to limit its use to the 
cellular variety of phlegmonous erysipelas; not in 
order to relieve stricture, but to reduce an inordi- 
nate distension, by allowing a free discharge of 
blood and effused serum. 
Mr. Lawrence’s method.—The second mode 
consists in “ one or two deep and long incisions.” 68 
ANATOMY OF THE GROIN. 
4"This practice was proposed by Mr. Lawrence. 
In page the sixty-seventh of his observation on 
erysipelas, he says, 
“ The most powerful means of arresting the 
complaint is by making incisions through the in- 
flamed skin and the subjacent adipous and cellular 
textures, which are the seat of disease. These 
incisions are followed very quickly, and sometimes 
almost instantaneously, by relief and cessation of 
the pain and tension; and this alleviation of the 
local suffering is accompanied by a corresponding 
interruption of the inflammation, whether it be in 
the stage of effusion, or in the more advanced 
period of suppuration and sloughing. The red- 
ness of the skin is visibly diminished during the 
flow of blood from the incisions; in twenty-four 
hours it usually disappears, and the skin itself is 
found wrinkled from the diminution of the general 
inflammatory tension. The immediate relief, 
although very desirable to the patient, is however 
of less consequence than the decided influence of 
the practice in preventing the further progress of 
the disorder; and this important result has never 
failed to occur, within my experience, when 
the case has been a proper one for the practice, ANATOMY OF THE GROIN. 
69 
and the state of the patient has admitted of its 
being fairly tried. 
“The treatment by incisions is suited to various 
stages of the complaint; but it is employed to 
greatest advantage in the beginning, since it pre- 
vents the further extension of inflammation, and 
the occurrence of suppuration and sloughing. 
The redness and swelling gradually subside; the 
surface of the cut granulates, and heals rapidly. 
At a more advanced period, the incisions limit the 
extent of suppuration and gangrene; at a still 
later time, they afford the readiest outlet for matter 
and sloughs, and facilitate the commencement and 
progress of granulation and cicatrization. When 
the matter is fully discharged, and the sloughs, 
whether of the skin or cellular membrane, have 
separated, a healthy granulatory surface is left, 
and no great difficulty is experienced in effecting 
cicatrization, unless the destruction of the skin 
should have been very extensive, for in this case 
the cicatrix forms slowly and is liable to give way 
again.55 
The objections which have been made to this 
bold practice of Mr. Lawrence lie only against 
its general application to the three above esta- 70 
ANATOMY OF THE GROIN. 
blished varieties of phlegmonous erysipelas.* In 
his twenty-second case, “an incision was made 
along the whole breadth of each eye-lid and 
through the entire depth of the inflamed and 
* Mr. Hutchinson, in page 219 of Volume XIV. of the 
London Medico-Chirurgical Transactions, condemns this prac- 
tice in the following words : “ I do loudly protest against the 
practice of making the incisions of such length, as recommended 
by Mr. Lawrence, both as unnecessary, and not so likely to 
stop the progress of the disease, where it is spread over a Made 
surface, as several small incisions made on different parts 
where the disease is found to be most active ; for it will have 
been seen by the closely observing surgeon, that when this 
disease has run on to suppuration or to gangrene, abscesses or 
gangrenous patches are occasionally found to have taken place 
in different parts laterally distant, and having no communication 
with each other. Now, if one long incision be made in a direct 
line through the middle of the inflamed surface, according to 
Mr. Lawrence, the disease may be still unsubdued, though 
greatly lessened on each side of it, to a certain distance. But 
supposing the disease be found to occupy a space from the 
trochanter to the toes, including the whole circle of the thigh, 
leg, and foot, which I have witnessed in two or three cases, 
wherein eighteen incisions were certainly made of an inch and 
a half in length, will one or even two incisions of fourteen 
inches in length arrest such an extent of disease ? My experi- 
ence teaches me that they will not, and hence it is, that I have 
stated, that in such desperate cases we must have recourse to 
such a number of small incisions, according to the extent of 
inflamed surface, as will arrest the disease.” ANATOMY OF THE GROIN. 
71 
swoln cellular stricture.* He states that the 
palpebrae were enormously sivoln and shining,” 
i. e. distended by serum. Now this constitutes, 
as has been shown above, the cellular variety of 
phlegmonous erysipelas, like that which occurs in 
the perineum, labia, penis, and scrotum where the 
adipous tissue is absent, and calls exclusively for 
the early employment of the mode of puncturing 
recommended by Dr. Dobson. 
The practice of long and deep incisions seems 
also injudicious in cases which involve a great 
extent of surface. 
But this practice of Mr. Lawrence is indis- 
pensable in the adipous variety of phlegmonous 
erysipelas, where the chief indication is the relief 
of stricture. 
The subcutaneous adipous tissue, when uncon- 
nected with a subjacent cellular tissue, as on the 
back of the thigh for example, is, so to speak, 
hide bound on its outer surface, resisted by dense 
fascia on its inner, whilst within its substance the 
tumid cysts are pressed upon by binding filaments. 
This three-fold mode of constriction produces the 
* See page 133 of his Observations, &c. 72 
ANATOMY OF THE GROIN. 
rapid sloughing and profuse suppuration which 
characterizes this variety of the disease. Eai'ly, 
deep and long incisions are, therefore, absolutely 
required to give the inflamed adipous tissue a free 
release. 
Mr. Hutchinson’s method.—The third mode 
consists in making several deep but short incisions 
into those parts of the affected surface where the 
disease is most active. Mr. Hutchinson, who in- 
troduced this practice, recommends the early re- 
course to it, with the view to prevent fascial and 
sub-cellular suppuration and gangrene.* This 
mode is peculiarly suited to the adipous-cellular 
variety of phlegmonous erysipelas. Since this va- 
riety is characterized by only a moderate degree 
of distension and stricture, these short but numer- 
ous incisions answer a two-fold object: First, they 
relieve the moderate degree of stricture; and, Se- 
condly, remove any deep seated distension. 
Each of the three modes of incision, above spe- 
cified, is recommended by its respective author in 
all cases of phlegmonous erysipelas, to the exclusion 
of the rest. But, if the subcutaneous adipous and 
* See Volume V. of the London Medico-Chirurgical Tran- 
sactions. ANATOMY OF THE GROIN. 
73 
subcutaneous cellular tissues are essentially differ- 
ent in their structures and uses ; and if this differ- 
ence gives rise to three varieties in the disease, the 
impropriety of a general application of any one of 
them to all cases is at once apparent. Each has 
its own sphere of usefulness. 
The generic practice by incision, which has thus 
been shown to be curative in phlegmon, anthrax, 
paronychia, and phlegmonous erysipelas, is also 
applicable to the strictured condition of every 
other disease of the integuments.* Nor need the 
practice be confined to the human species: all 
animals, which have a thick derm or a subdermal 
adipous tissue, or both, may derive benefit from it 
in the diseases of these parts. 
Encysted Tumours.—In closing these patholo- 
gical observations, it may not be out of place to 
add a remark upon Encysted Tumours of the in- 
* Bubo, for example, sometimes becomes what is called a 
burrowing ulcer; venereal eruptions, also, assume occasionally 
this character: both are ulcerations of the 'subdermal tissue, 
which detaches the derm. These burrowing ulcers may exist 
before and after the venereal action is destroyed by mercury. 
Under the first condition, the treatment is to use mercury freely 
and divide the overhanging detached derm, and under the 
second, to employ incisions alone. 74 
ANATOMY OF THE GROIN. 
teguments. Some of them seem to be cysts of the 
adipous tissue, enlarged and altered by disease. 
Those on the anterior surface of the body, being 
but slightly attached to the surrounding parts, are 
removed with comparative ease ; whilst those on 
the posterior surface, being secured by strong fila- 
ments of the adipous tissue which require division, 
are extracted with difficulty. These are the fila- 
ments which were described in a former page as 
possessing, in certain parts of the integuments, the 
fibrous nature of the strong fascial covering of 
muscles. Plate II. 
jyr.S. Weaver tW. 
T. Sinclair 's Ij^ ANATOMY OF THE GROIN. 
75 
CHAPTER III. 
DESCRIPTION OF PLATE II. 
This plate exhibits, on the left side of the sub- 
ject, the integuments reflected upon the thigh, to 
display the tendon of the external oblique muscle 
of the abdomen, the fascia lata, and three adven- 
titious fasciculi of fibres. On the left side, a fur- 
ther dissection is made, to expose the subjacent 
structure. 
Left Side. 
A The reflected derm and subdermal adipous 
tissue. 
B B The subjacent cellular tissue, called fascia su- 
perficialis, reflected from the fascia lata, and 
tendon of the external oblique. 
C C C The fascia lata. 
a C a The portion of the fascia lata which covers 
the sartorius muscle; forming the ante- 
rior part of its sheath : it may therefore 
with propriety be called the sartorial 
portion. 76 
ANATOMY OP THE GROIN. 
11 The outer pair of anterior super- 
ficial crural nerves, appearing 
at the anterior superior spi- 
nous process of the ilium, and 
passing under this sartorial 
portion of the fascia lata. 
b C b The portion of the fascia lata which covers 
the pectineus muscle; to be called, there- 
fore, the pectineal portion of the fascia 
lata. 
22 The semilunar edge of the pec- 
tineal portion of the fascia 
lata. 
ccCc The funnel-shaped portion of the fascia 
lata; being the external laminae of the 
sheath of the crural vein, artery, and 
nerve; and called the crural sheath, or, 
the vaginal portion of the fascia lata. 
33 The branches of the vena sa- 
phena at its junction with the 
ensheathed crural vein. 
444 The cribriform surface of the 
crural sheath, called so, on 
account of the numerous small 
perforations made by the en- 
trance of absorbent vessels. 
The fibres of this part of the ANATOMY OF THE GROIN. 
77 
sheath interlace with those of 
the pectineal portion of the 
fascia lata; the line of inter- 
lacement extending from the 
semilunar edge of this portion 
to within a few lines of the 
pubis. 
555 Converging fibres of the sheath, 
forming a ligament-like pro- 
cess. This process makes an 
attachment to the edge of the 
pubis, immediately behind that 
made by the tendon of the ex- 
ternal oblique muscle. In ef- 
fecting this horizontal attach- 
ment, the process makes a 
sigmoid twist, in consequence 
of which a crescent edge is 
formed extending downward 
and obliquely outward. This 
edge is called the crescentic 
edge of the fascia lata: to dis- 
tinguish it from the semilunar 
edge of the pectineal portion 
of the fascia lata, it may be 
termed the crescentic edge of 
the vaginal portion of the 
fascia lata. 78 
ANATOMY OF THE GROIN. 
d d A deeper seated lamina of the fascia lata. 
It proceeds from the inner edge of the 
tendon of the external oblique*, and is 
thence continued downward, to contri- 
bute to the formation of the crural sheath. 
6 A well defined arched opening 
for the passage of the middle 
pair of anterior crural nerves, 
figured in the plate. 
e e e One of the three adventitious fasciculi of 
fibres above referred to. This fasciculus 
is evidently derived from the fascia lata; 
near its origin, the fibres are twisted into 
a cord; further off, they diverge so as to 
be scattered on the external and internal 
surfaces of the tendon of the external 
oblique muscle of the abdomen. As this 
fasciculus proceeds from the thigh, it may 
be called the crural fasciculus. 
ODD The tendon of the external oblique muscle of the 
abdomen. 
g g g, g g g The other two adventitious fasciculi of 
fibres above referred to. They are de- 
* Called Gimbernat’s ligament, or inner edge of the tendon, 
&c. The fibres of the deeper seated lamina are erroneously 
drawn in a direction from above downward. They have the 
general direction as the other fibres of the fascia lata. ANATOMY OP THE GROIN. 
79 
rived from the opposite side of the abdo- 
men, apparently from the tendon of the 
internal oblique muscle. From this ori- 
gin, as it seems, they first appear on the 
outside of the tendon of the external ob- 
lique, then disappear, and again issuing 
as two distinct converging fasciculi, pass 
over the split in the tendon of the ex- 
ternal oblique; from this spot the fibres 
of the two fasciculi diverge, and proceed- 
ing downward, they are continued over 
the reflected edge of the tendon upon the 
fascia lata, viz. upon its ligament-like 
process 555, and its deeper seated la- 
mina d d. As these fasciculi proceed 
from the abdomen, they may be called 
the two abdominal fasciculi. 
h h h The diverging termination of some of the 
fibres of the tendon of the external ob- 
lique, called the upper pillar of the ab- 
dominal ring. 
i i i The termination of other fibres, called the 
lower pillar of the ring. 
k k The spermatic cord passing out at the oval 
opening, called the abdominal ring. 
This opening is made by the two pillars 
above noticed, and the two adventitious 
fasciculi of fibres. 80 
ANATOMY OF THE GROIN. 
Right Side. 
A The reflected integuments. 
BBB The fascia lata. 
a a The external lamina of the fascia lata, divided 
and reflected, to expose the inner lamina (or 
layer) of the crural sheath. 
b b b The inner layer of the crural sheath, the up- 
per part of which is exposed on the left 
side of the plate, and noticed under the 
letters d d. 
c c A portion of the sartorius muscle, also ex- 
posed by the reflection, together with the 
inner anterior nerves, and the destination 
of the middle anterior crural nerves. 
C The external oblique muscle reflected upon the 
thigh. 
d d d The portion of the tendon which interlaces 
its fibres with those of the sartorial portion 
of the fascia lata. It may properly be called 
the interlaced portion of the tendon of the 
external oblique muscle. 
d e e e The portion of the tendon which is reflected 
inward, and has its fibres inserted ulti- 
mately into the pubis in radiating lines. 
This is called the reflected portion of the 
tendon; the edge made by the reflection is 
termed PouparVs ligament; the inner, or ANATOMY OF THE GROIN. 
81 
true edge of the tendon, is termed Gimber- 
naVs ligament. 
f f f The inner diverging fibres of the crural fas- 
ciculus, noticed on the left side of the plate 
under e e e. They pass in at the arched 
opening marked 6 on the left side, are 
scattered on the inner surface of the tendon, 
and are united with other fibres coming 
from the mesial line of the abdomen. 
D The internal oblique. 
g g g The spermatic cord removed from its natural situa- 
tion, covered with its cellular sheath, and con- 
nected with the cremaster muscle and nerve. 
F F A muscular fasciculus, which is not intimately con- 
nected with either the internal oblique or trans- 
versalis muscles. Its tendon passes into the fi- 
brous interlacement over the pubis. It seems 
to be an insulated portion of the internal oblique. 
H Another fasciculus of insulated muscular fibres 
belonging to the transversalis, rather than to 
any other muscle; and having delicate tendons 
inserted into the pubis. 
i i i A few delicately formed but strong fibres, having 
an obliquely vertical direction : they embrace 
the pubal part of the funnel-shaped sheath. 
k A small portion of the fascia transversalis, appear 
ing in the midst of the three above noticed parts. 82 
ANATOMY OF THE GROIN. 
m The upper portion of the crural sheath: it may be 
called the abdominal portion, since it is situated 
above the lower edge of the tendon of the ex- 
ternal oblique muscle,—or the transversalis 
portion, since it is interlaced, at its upper edge 
(or brim), with the fascia transversalis. 
SECTION L 
TENDON OF THE EXTERNAL OBLIQUE MUSCLE 
OF THE ABDOMEN. 
Structure.—The tendon of the external oblique 
muscle of the abdomen* is composed of parallel 
fibres; each proceeding from a distant muscular 
fasciculis, and having a separate insertion. 
* The external surface of the tendon of the external oblique 
is coated with a thin and merely perceptible layer of elastic 
matter, resembling that of the yellow ligament found so abun- 
dantly on this tendon in herbivorous animals. 
In these animals, such as the deer for example, this yellow 
ligament is a thick plaited membrane, covering the entire sur- 
face of the tendon. In birds it does not exist. 
By its elasticity, it safely and conveniently permits those 
variations to which the abdomen, with its many causes of dis- 
tension, is liable. ANATOMY OF THE GROIN. 
83 
Directions of the fibres.—The directions of 
these tendinous fibres vary: those in the upper 
abdominal regions ascend obliquely from the 
muscle: those in the middle regions are transverse: 
whilst those of the iliac and hypogastric regions 
proceed obliquely downward. 
Abdominal ring.—In the hypogastric portion 
of this membranoid tendon, on both sides, there 
is an opening called the abdominal ring, which 
deserves particular notice. It is an oval, laid 
obliquely downward in the course of the fibres of 
the tendon, the lesser transverse curve being 
towards the pubis. Its margin is formed by a 
union of these fibres with others proceeding from 
the opposite side of the abdomen. 
The isosceles triangular split in the tendon.— 
The hypogastric portion of the tendon is, for the 
space of two inches from the pubis, so separated 
in the direction of its fibres, as to make an isosceles 
triangular opening, with the base at the pubis. 
The diverging fibres, by overlapping those which 
run next to them, form thick and corded edges on 
the sides of the aperture. Those same fibres 
again separate and are lost in a fibrous interlace- 84 
ANATOMY OF THE GROIN. 
merit at the pubis. This divergency causes the 
fibres at the two sides of the opening (called the 
two pillars of the ring) to decussate, and thereby 
form the lesser transverse curve of the abdominal 
ring. 
The tendon of the external oblique only con- 
tributes, then, to the formation of the abdominal 
ring, and does not complete it. 
The greater transverse curve.—The greater 
transverse curve of the oval, required as a security 
against a further splitting of the tendon, is made 
by adventitious fibres represented in Plate II. 
under the letters g g g> g g g> and called the two 
abdominal fasciculi. They both pass across the 
triangular opening of the tendon; the innermost 
of them presenting a well defined edge, which 
constitutes the greater transverse curve of the 
oval, and completes the abdominal ring. 
The two abdominal fasciculi of fibres.—These 
two abdominal fasciculi of fibres deserve further 
notice. 
First. The action of the muscle, if unrestrained, 
would lengthen the split in the tendon throughout 
the whole course of the fibre, and thereby render ANATOMY OF THE GROIN. 
85 
the spermatic cord liable to displacement and the 
bowels to protrusion : but these adventitious fasci- 
culi, by their deep origin on the opposite side of 
the abdomen, their interlacement above the pubis, 
their interlacement also with the tendon above the 
split, and by their connexions with the fascia lata, 
firmly retain the portions of the tendon above and 
below the abdominal ring in a due degree of 
approximation; and thereby prevent those injurious * 
consequences. 
Second. They connect the abdomen and thigh: 
the fibres of the inner fasciculus are distributed 
over the reflected portion of the tendon and the 
ligament-like process of the fascia lata; and those 
of the outer are in like manner distributed over 
the reflected tendon and an inner layer, d d, of the 
crural sheath. These delicate fibres, which may 
seem at first sight unworthy of notice, are, there- 
fore, by their origin in the opposite side of the 
abdomen, and their interlacements, made a very 
important bond of union between the thigh and 
the abdominal parietes. 
Third. They have a surgical importance hitherto 
overlooked, in strangulated inguinal hernia. Al- 
though every part in the ring presses equally upon 86 
ANATOMY OF THE GROIN. 
the tumour, nevertheless there is one part, the 
division of which will most effectually relieve the 
stricture. This part is the greater transverse 
curve formed by the innermost of the two fasci- 
culi. 
Without these fasciculi there would he no stric- 
ture. For in their absence the triangular opening 
of the tendon would he gradually enlarged by the 
protruding of the hernial tumour. In the opera- 
tion, therefore, for strangulated inguinal hernia, 
those fibres which proceed from the opposite side 
of the abdomen, rather than those of the tendon 
of the external oblique of the affected side, are to 
be divided : and the precise spot for the division is 
at the crossing of the fibres of the innermost 
fasciculus. 
Finally. If the fasciculi under notice, proceed 
from the internal oblique muscle of the opposite 
side, as those of the two pillars do from the exter- 
nal oblique, then all the fibres which compose the 
ring are traceable to muscle. 
This view involves the important question 
whether the size of the abdominal ring can really 
be affected by muscular action? 
The contraction of the external oblique muscle ANATOMY OF THE GROIN. 
87 
would, if unresisted, approximate the pillars of 
the ring; that of the internal oblique of the 
opposite side would not only do the same, but 
also shorten the transverse diameter of the oval; 
and their combined action, consequently, would 
render the abdominal ring smaller without altering 
its shape. 
The ring, therefore, when diminished in size by 
muscular action, may stricture a hernial tumour, 
and that stricture may be relieved, without the 
division of its margin, when muscular relaxation 
allows the enlargement of the ring. 
These remarks are made not without some 
hesitation. Still, they very satisfactorily explain 
the effect of blood-letting in strangulated hernia, 
and increase the importance of a recourse to the 
taxis. 
The crural fasciculus of fibres.—There is on 
the tendon a third fasciculus of fibres, figured 
under the letters e e e of Plate II. which proceeds 
from the fascia lata and scatters its fibres diverg- 
ingly on both surfaces of the tendon. The use of 
this crural fasciculus, in the mechanism of the 
groin, will be better understood after the destina- 
tion of the tendon below the ring has been shown. 88 
ANATOMY OF THE GROIN. 
This part of the tendon may be divided into two 
portions : First, that which makes a strong inter- 
laced attachment to the fascia lata. Second, that 
which has its fibres turned inward to form a 
triangular reflexion, the base being attached to the 
pubis. 
The interlaced portion of the tendon.—The 
first or interlaced portion is represented in Plate 
II. under the letters d d d: it is shown also on 
the left side of the same Plate under the letters 
e e e. 
The fibres are of unequal length 5 being succes- 
sively shorter as they approach the anterior superior 
spinous process of the ilium. This inequality 
allows a connexion to be made with the fascia lata 
in an oblique line—or, as it may be’called, the line 
of the groin, which is subordinate to the motions 
of the hip-joint, and the same with that shown to 
exist in the fascia superficialis.* 
This oblique crural connexion extends from the 
anterior superior spinous process of the ilium to 
the place of exit of the middle anterior pair of 
nerves; and is made by the fibres of the tendon 
* See page 48. ANATOMY OF THE GROIN. 
89 
overlapping alternately the horizontal fibres of 
the fascia lata. The tendon and fascia are woven 
into each other, and constitute thereby one of 
the strongest attachments which exist between 
the abdominal parietes and the thigh. 
The reflected portion of the tendon.—The 
second or reflected portion is displayed under the 
letters d e e e on the right side of Plate II., un- 
folded and turned down upon the thigh. Its fibres, 
situated between the above mentioned interlaced 
portion and the lower pillar of the ring, are all 
reflected inward so as to present a folded edge : 
extending in an oblique downward line from the 
place of exit of the middle anterior nerves to the 
pubis. 
This edge is called PouparPs Ligament. The 
inner, single and real edge of the tendon is called 
GimbernaP s Ligament. 
The reflected portion of the tendon, included 
between these two edges, has a triangular form, 
presenting a base about a half inch in breadth, 
which is inserted into the pubis. This base con- 
tains every fibre of the reflected portion, each of 90 
ANATOMY OF THE GROIN. 
which is fastened into the aponeurosis of the 
bone. 
At the angle opposite to the base, a fastening 
is also needed. Here, the interlacement with the 
fascia lata is discontinued, and the inward reflec- 
tion of the fibres of the tendon commences. 
Every contraction of the external oblique there- 
fore will tend to separate the reflected from the 
interlaced portion, and then to unfold the re- 
flexion. 
At this weak point, the crural fasciculus of 
fibres is placed. It is a portion of the fascia lata 
originating at the anterior superior spinous pro- 
cess of the ilium, and lying as a twisted cord, on 
the oblique line of interlacement of the tendon and 
fascia. 
The external fibres of the crural fasciculus.— 
This cord sends off one set of diverging fibres, 
which are scattered in curved lines upon the exter- 
nal surface of the tendon, to he united with fibres 
of the outer abdominal fasciculus; and another 
set, 'which, passing in at the point of reflexion of 
the tendon, are scattered upon its internal surface 
and unite with fibres belonging to the supuhal 
ligament. ANATOMY OF THE GROIN. 
91 
By this distribution of fibres, the crural fasci- 
culus fastens the reflected portion of the tendon 
as securely to the fascia lata, as the other portion 
of the lower edge of the tendon is secured by the 
interlacement. It stays the tendon down to the 
thigh at the point of reflexion, and effectually 
prevents muscular contraction from splitting or 
unfolding it. 
The above examination of the tendon of the 
external oblique furnishes the following summary: 
first, the abdominal ring is made of two sets of 
fibres, and seemingly varies in size from muscular 
action : secondly, the part of the ring to be divided 
in the operation for strangulated inguinal hernia, 
is formed by the inner abdominal fasciculus of 
fibres, and not by the fibres of the tendon of the 
external oblique: thirdly, the crural and the outer 
abdominal fasciculus of fibres co-operate to 
strengthen the tendon and prevent an extension of 
its triangular opening: fourth, the membranoid 
tendon inserts its fibres into the linea alba, the 
supubal interlacement, the sides of the pubis, and, 
in four different modes, into the fascia lata; viz. 92 
ANATOMY OF THE GROIN. 
by an interlacement of a portion of its lower edge; 
by the crural fasciculus which holds the tendon 
at the point of reflexion and termination of the 
interlacement; by the outer abdominal fasciculus 
which connects the inner edge of the reflected 
portion of the tendon with an inner layer of the 
crural sheath; and, lastly, by the inner abdominal 
fasciculus which binds together the reflected edge 
of the tendon and the ligament-like process of the 
fascia lata. 
SECTION II. 
THE INTERNAL OBLIQUE MUSCLE OF THE 
ABDOMEN. 
The fibres of this muscle are directed upward 
from their origin, and terminate in a broad tendon, 
making by its division into two layers, a sheath 
for the recti muscles. 
An insulated portion of the internal oblique.— 
Below this ascending portion of the internal ANATOMY OF THE GROIN. 
93 
oblique, there is a small portion, figured under the 
letters F F in Plate II. having its fibres directed 
obliquely downward, and terminating in a tendon, 
which, instead of contributing to form the sheath 
of the recti muscles, passes into the fibrous inter- 
lacement above the pubis, and is continued 
through it, as it would seem, to become the two 
abdominal fasciculi g g g, g g g. 
SECTION III. 
THE TRANSVERSAL IS MUSCLE OF THE 
ABDOMEN. 
A remark similar to that on the internal oblique 
may be made relative to the lower portion of the 
transversalis muscle. 
Insulated fibres of the transversalis.—Below 
the compact mass of transverse fibres which con- 
stitute this muscle, there are a few scattered 
muscular fasciculi, represented under the letter 
H. in Plate II. They originate about the place 94 
ANATOMY OF THE GROIN. 
of exit of the spermatic cord, called the internal 
abdominal ring, whence they obliquely descend, 
and are inserted, by means of long tendinous 
threads, into the pubis. Thus arranged, they 
embrace vertically and support the horizontal 
fibres of the funnel-shaped crural sheath; and 
lie between that sheath and the reflected portion 
of the tendon of the external oblique. 
SECTION IV. 
THE CREMASTER MUSCLE. 
Tjio. cremaster muscle is composed of distinct 
fasciculi, which at their origin are separated from 
each other, and are collected together upon the 
spermatic cord. 
It is generally regarded, as being a part of the 
internal oblique muscle, and as originating from 
the inner surface of Poupart’s ligament. 
Origin.—A careful dissection will show the 
inaccuracy of this opinion. It originates from ANATOMY OF THE GROIN. 
95 
that portion of the fascia lata which is situated 
between the fascia transversalis and the line of 
interlacement of the tendon of the external 
oblique. Each separate muscular fibre has a 
long tendinous thread both at its origin and inser- 
tion : the one is interlaced with the fibres of the 
fascia lata, and in its course adheres to the inner 
surface of the tendon of the external oblique, from 
which it is easily separated; the other is united to 
the spermatic cord. 96 
ANATOMY OF THE GROIN. 
CHAPTER IV. 
DESCRIPTION OF PLATE III. 
This plate exhibits, on the right side, the fascia 
transversalis, the crural sheath, and the mode of 
their connexion with each other: and on the left 
side, the ligament-like process of the fascia lata; 
showing its manner of attachment to the pubis, 
and the seat of crural hernia. 
Right Side. 
A The reflected integuments of the abdomen and 
thigh. 
B The reflected fascia superficialis. 
C The reflected external oblique muscle of the abdo- 
men. 
a a The lower portion of its tendon, divided 
in order to show that all its fibres are 
inserted into the pubis more, outwardly Plate lit. 
«• U.Slrr 
• ' *avcr cle-l-. 
T. SinrJairlf Inffu ANATOMY OF THE GROIN. 
97 
than has been generally believed, and 
that none of them, therefore, can 
possibly contribute to form the seat of 
crural hernia. 
D The internal oblique muscle of the abdomen. 
b b A section of the muscular fasciculus which 
sends its tendon into the supubal fibrous 
interlacement. Some of the fibres of 
this tendon seem to be continued through 
this interlacement, and to become the 
abdominal fasciculi, figured under g g g, 
g g g in Plate II. 
E The transversalis muscle of the abdomen. 
c c Some muscular fibres, originating at the 
place of exit of the cord, and inserted 
into the pubis by long tendinous threads. 
These fibres are represented in Plate II. 
under the letter H, and more particu- 
larly noticed in the third section of 
Chapter III. 
F The cremaster muscle, detached from the sper- 
matic cord and reflected upon the thigh, origi- 
nating from the fascia lata, within the inter- 
lacement of this fascia with the tendon of the 
external oblique and outside the fascia transver- 
salis,—separated from the transversalis muscle 
by the circumflex iliac artery. (See the fourth 
section of Chapter III.) 98 
ANATOMY OF THE GROIN. 
d d d The fascia transversalis, showing the oblique and 
longitudinal direction of its fibres; their inter- 
lacement with the upper edge of the crural 
sheath on each side of the spermatic cord; and 
the place of exit of the circumflex iliac artery. 
e e e The conical part of the cellular sheath of the 
spermatic cord. It is continuous with the 
cellular tissue found between the fascia trans- 
versalis and the peritoneum. At the under 
part of it two curved lines are exhibited, formed 
by the vas deferens and the epigastric artery, 
which last is traced by a dotted line. 
f f f f The abdominal or transversalis portion of the 
crural sheath, showing its connexion with the 
fascia transversalis by means of a strong inter- 
lacement. 
The space bounded by the margin of the 
and the edges of the two portions of the fascia 
transversalis on each side of the conical cellular 
sheath of the spermatic cord, is called the inter- 
nal abdominal ring. It is an aperture present- 
ing three strong fibrous edges, two of which 
are longitudinal, made by the fascia transversa- 
lis, and one horizontal, made by the crural 
sheath. Through this deep seated triangu- 
lar opening, the bowel, covered by the perito- 
neum, passes from the abdominal cavity into ANATOMY OF THE GROIN. 
99 
the cellular sheath of the spermatic cord, to be- 
come an inguinal hernia. By it, also, in some 
instances, the bowel is strangulated. 
g g g The crural sheath below the tendon of the exter- 
nal oblique. 
h h Absorbent glands, Avith their vessels which pass 
into the pelvic cavity through an opening in the 
crural sheath. 
i An incipient ventro-inguinal hernia, found in one 
of the dissections. 
Left Side. 
A The reflected integuments. 
B The reflected fascia superficialis. 
C The sartorial portion of the fascia lata. 
I) The vaginal portion of the fascia lata. 
a a A superficial layer of fibres, dissected from 
this portion, to show the line of sepa- 
ration between the sheath of the cru- 
ral vessels and that of the sartorius 
muscle. 
b b Branches of the vena saphena, entering 
the ensheathed crural vein, by a com- 
mon trunk. 
d d d The crescentic edge of the vaginal por- 
tion or crural sheath. 
d d u The ligament-like process of the vaginal 100 
ANATOMY OF THE GROIN. 
portion of the fascia lata,—the true seat 
of stricture in crural hernia. (See Plate 
II. 5 5 5, and the description.) 
E The pectineal portion of the fascia lata. 
c c The semilunar edge of the pectineal 
portion. 
e e e The deep fissure between the pectineal 
and the vaginal portion of the fascia 
lata. 
g g i i Divided iand displaced portions of the tendon of 
the external oblique, showing, first, that the 
portion i i is interlaced with the fascia lata (See 
d d d, in the description of Plate II.); second, 
that the portion g g is more outwardly inserted 
into the pubis than the ligament-like process of 
the fascia lata, thereby demonstrating, again, 
that no part of the tendon of the external 
abdominal muscle contributes, in any degree, 
to form a seat of stricture in crural hernia. 
k k k The abdominal or transversalis portion of the 
crural sheath, showing its origin from the iliac 
portion of the fascia lata. 
mm A portion of the fascia transversalis; exhibiting 
its connexion with the part, k k k, of the crural 
sheath, and its change into cellular membrane, 
as it ascends upon the abdomen, 
nnn The spermatic cord. ANATOMY OF THE GROIN. 
101 
GGG The peritoneal sack, 
p p The distended bladder, 
r r r The brim of the pelvis. 
s t The crural vein and artery with their principal 
branches, situated behind the fascia transversa- 
lis and dipping into the crural sheath. 
The space bounded by the crural veins, the brim 
of the pelvis, r r r, and the ligament-like process 
of the fascia lata, d d u, is a small conical or 
thimble-like cavity, into which the end of the 
little finger may be thrust. This will be 
hereafter named the ventro-crural passage. 
Through it the bowel passes, in crural hernia. 
SECTION I. 
FASCIA TRANS VERS A LIS. 
Some portions of the fascial system consist of 
a single layer of inelastic shining fibres, travers- 
ing the cellular tissue in parallel lines to a cer- 
tain distance and then abruptly terminating, so as 
to form a fibrous structure continuous with cellu- 
lar membrane, or to make this cellular mem- 
brane in certain places, fibrous. The cellu- 
lar tissue, between the peritoneum and the 102 
ANATOMY OF THE GROIN. 
transversalis muscle, is thus made fibrous in the 
iliac and hypogastric regions, as shown under the 
letters d d d, on the left side of Plate III. and 
partially on the left side, under the letters m m. 
This is called the fascia transversalis. 
Structure.—It is a fibrous membrane, consist- 
ing of a single layer of parallel inelastic shining 
fibres, immediately connected with the cellular 
tissue which is situated on the outside of the 
peritoneum, and which is protruded before the 
testicle to form the cellular sheath of the sper- 
matic cord. 
Interlacement with the crural sheath.—In the 
iliac regions, the fibres are oblique; elsewhere 
they are vertical. Those over the pubis, are in- 
serted into the hone; the rest are interwoven with 
the horizontal fibres of the third or abdominal 
layer of the crural sheath, thereby preserving its 
funnel shape, and constituting the internal inter- 
lacement which connects the abdominal parietes 
with the thigh. 
An absence of the fibres where the vessels of 
the cord pass out and the vas deferens enters, as 
shown by the letters e e e, causes the fascia to be 
separated into two columns, one on the left and ANATOMY OF THE GROIN. 
103 
the other on the right of the split occupied by 
the cord. 
Internal abdominal ring.—The opening thus 
formed has received the name of the internal 
abdominal ring. From it the bowel issues in in- 
guinal hernia. It is a triangular aperture, covered 
by the cellular sheath of the spermatic cord, 
whose margin consists of three unyielding fibrous 
edges : the lower one made by the crural sheath; 
the others by the fascia transversalis. Obliquely 
over this inner part of the internal abdominal 
aperture, pass the muscular fasciculi, described 
under the letter H of Plate II. and under the 
letters c c of Plate III. It may be a question, 
whether these fasciculi can modify the size of the 
aperture. 
Seat of ventro-inguinal hernia.—The incipient 
ventro-inguinal hernia, represented under the 
letter i, on the right side of Plate III. shows that 
the seat of this species of rupture is in the fascia 
transversalis; and that it is made by an artificial 
opening in the longitudinal parallel fibres. This 
suggests the propriety of a lateral incision to re- 
lieve it when strangulated. 104 
ANATOMY OP THE GROIN. 
SECTION II. 
THE CRURAL SHEATH. 
The sheath which includes the crural vein, 
artery and nerve, resembles in structure, the 
other fibrous sheaths or channels of vessels 
throughout the body. They are all formed from 
the fascia of muscles, which consists of parallel 
inelastic fibres and cellular tissue. Now, fascia 
being an uninterlaced structure, allows by the 
separation of its layers, the formation, in its 
substance, of channels for trunks and large 
branches of arteries, veins and nerves. The ves- 
sels are thus ensheathed by the fascia. 
Form and Septa.—The crural sheath is funnel- 
shaped, divided by two septa into three channels,* 
through which the crural nerve, artery and vein 
separately pass from the abdomen to the thigh. 
The peculiarity in the form of this sheath, is in no 
* There is also a fourth channel on the inside of the vein, 
made by the ligament-like process of the fascia lata, filled by 
absorbents, cellular tissue, and occasionally by an absorbent 
gland, which will be more particularly noticed hereafter. ANATOMY OF THE GROIN. 
105 
way caused by the contained parts : but results ex- 
clusively from the double relation which the crural 
sheath holds respectively to the abdomen and 
the thigh. 
Under portion.—The crural vessels and nerve, 
being situated in an angular depression, one side 
of which is formed by the pectineus, and the 
other by the lower portions of the psoas and 
iliacus muscles, the fascial covering of these 
muscles will necessarily constitute the under 
portion of the crural sheath. 
The fascia enveloping the pectineus is part of 
the fascia lata; that over the lower portions of 
the psoas and iliacus is a continuation of the fas- 
cia which covers them in the iliac region of the 
abdomen, and is called the fascia iliaca. To pre- 
serve, therefore, this arbitrary division of the 
same fascial structure, it may be said, that the 
under portion of the crural sheath is formed, on 
the inner side, by the fascia lata, and on the outer 
side by the fascia iliaca. A description most 
suitable, however, to the present state of Anatomy, 
would be, that the under portion of the crural 
sheath, on the inner side is formed by the pecti- 
neal portion, and, on the outer side, by the iliac 106 
ANATOMY OF THE GROIN. 
portion of the common fascial covering of the 
lower extremities. 
Upper portion.—The upper* portion of the 
crural sheath, from its many important connexions, 
requires a minute description. 
The drawings exhibit it in different stages of dis- 
section : viz. under 5444cccd d on the left; 
and under a a b b b m on the right side of Plate 
II. Also, under g g g f f f on the right, and under 
d d d D k k k a a on the left side of Plate III. 
Two inner layers.—This upper portion consists 
of five layers of fibres. The deepest of them 
covers the nerve only, and passing under the 
artery and vein, is again lost in the fascia 
lata: the second layer above, covers the nerve 
and artery, and passing under the vein, is also 
lost in the fascia : the rest cover the nerve, artery, 
and vein. Thus are formed, in the sheath, the 
two septa which separate the contained parts from 
each other. 
Three outer layers.—The three outer layers of 
the sheath, just mentioned, deserve further notice. 
* The words upper and under, as here used, signify above 
and below the contents of the sheath, the body being supine. ANATOMY OF THE GROIN. 
107 
They are triangular, and make five different con- 
nexions; a knowledge of which is necessary for 
a full understanding of the mechanism of the 
the groin; it will also show the true seat of stric- 
ture in crural hernia. 
Connexion with the pectineal fascia.—One of 
these connexions is made with the pectineal por- 
tion of the fascia lata, in a line on the inside of 
the crural vein, represented under the letters e e e 
on the left side of Plate II. It extends from the 
semilunar edge of the pectineal fascia, to within 
a few lines of the pubis. 
Connexion with the pubis.—A second connex- 
ion is that made with the pubis. The fibres con- 
verge to form a ligament-like process, shown 
under the letters d d d on the left side of Plate Hi 
This process, when detached from the pubis, is 
found to be a flat fibrous strap, being a line in 
thickness, and half an inch in breadth at its pubal 
end, having an upper horizontal and a lower 
oblique edge, and presenting a vertical surface. 
The re-attachment to the pubis will necessarily 
turn the line of the pupal end from a vertical to a 
horizontal position, and thereby make a permanent 
sigmoid twist in the process. 108 
ANATOMY OF THE GROIN. 
This twist produces the three following effects. 
First, It separates the fibres of the ligament- 
like process from those connected with the pecti- 
neal fascia, so as to form an angle and consequent- 
ly a triangular opening between the abdomen and 
thigh. 
Through this natural aperture, the superficial 
absorbents of the lower extremity enter the pelvic 
cavity, and the bowel, in crural hernia is forced 
out. 
Folded edge of the process.—Second. It forms 
a reflected or folded edge in the process, dividing 
it thereby into an upper horizontal and an under* 
oblique portion. The former is quadrangular, 
and bounded on three of its sides respectively, by 
the line of the pubal connexion, by the horizontal 
and by the folded edge; the latter is triangular 
and bounded on two of its sides, by the folded 
and oblique edges. This lower triangular portion 
is the seat of stricture in crural hernia; and 
is the part to be divided. 
Crescentic edge.—Third. It makes the crescen- 
* In the use here of the words upper and under, the body is 
supposed to be in the erect position. ANATOMY OF THE GROIN. 
109 
tic edge of the crural sheath, represented on the 
left side of Plate III. under the letters d d d. 
The outermost layer of fibres is thrown, by the 
convergency which forms the ligament-like pro- 
cess, into radiating lines or plaits, the lowermost 
of which is curved by the sigmoid twist; thereby 
forming the crescent-shaped edge. This edge 
should not he confounded with the semilunar edge 
of the pectineal portion of the fascia lata. 
The three connexions, which remain to be des- 
cribed, are those by which the crural sheath is 
firmly attached to the parietes of the abdomen. 
They are made by the upper edges of the three 
outer layers of the sheath, which project one above 
the other. 
Connexion with the folded edge of the tendon.— 
The external layer is attached to the folded edge 
of the tendon, called Poupart’s ligament. This 
attachment is exclusively made by those deep 
seated and compacted laminae of the fascia super- 
ficialis which form the inguinal line. When the 
cellular bond is removed, the folded edge and 
the external layer part from each other; the for- 
mer drawing upwards to a straight tine, whilst the 
latter, in falling at its middle, presents a line of 110 
ANATOMY OF THE GROIN. 
increased curvature, which is definitely marked on 
the left side of Plate II. 
The long semilunar opening shows the second 
layer of the sheath under the letters d d. It is 
more extensively displayed on the right side of 
Plate II. under the letters h b b. 
Connexion with the single or inner edge of the 
tendon.—This layer is connected with the inner 
or single edge of the tendon, called Gimbernat’s 
ligament. But these are both too deeply seated to 
derive the means of union from the fascia superfi- 
cialis; and the fibres being parallel, it cannot be 
effected by interlacement. The connexion is 
therefore made by the outer abdominal fasciculus. 
The fibres of this fasciculus, having passed below 
the abdominal ring, diverge, and reaching the fold- 
ed edge of the tendon, are turned round it; then 
traverse the reflected portion, and meeting the 
inner edge, are reflected down upon the layers of 
the sheath; thus forming a fibrous bond of union 
between the inner edge of the tendon and the 
second layer of the sheath. 
Connexion with the fascia transversalis.—The 
third layer of the sheath is connected with the 
lower edge of the fascia transversalis. ANATOMY OF THE GROIN. 
Ill 
This layer, called in the description of Plate 
II. the abdominal or transversalis portion of the 
sheath, is represented, on the right side of Plate 
II. under the letter m;* on the left side of Plate 
III. under the letters f f f; and on the right side 
of the same under the letters k k k. 
The fibres of this third layer intersecting at 
right angles those of the fascia transversalis, a 
strong interlacement is allowed between these 
fibrous membranes, similar to that which has 
been shown to exist between the fascia lata and 
the tendon of the external oblique. 
By means of this third connexion, the upper 
edge of the funnel shaped-sheath is sustained in a 
vertical position, and prevented from collapsing 
on the contained vessels; an inner medium of 
attachment being thus made between the parietes 
of the abdomen and the lower extremities. 
CRURAL OR FEMORAL HERNIA. 
In what manner are the contents of the abdo~ 
* The letters b b b on the same side of Plate II. designate 
the second layer, which terminates at the inner edge of the 
tendon; and the letters a a, the external layer, which terminates 
at its outer and folded edge. 112 
ANATOMY OF THE GROIN. 
minal cavity protruded, so as to form a tumour on 
the anterior of the thigh ? 
, The shortest answer to this question is, that a 
natural opening exists between the abdomen and 
thigh. Air blown into the deep seated crural 
portion of the fascia superficialis will find its way 
upward, and inflate the cellular tissue between 
the peritoneum and fascia transversalis: and 
so the reverse. A bowel, therefore, forced on the 
outlet, may, by gradually enlarging it, pass out: 
and the more easily, if the effort is made during 
infancy, before the parallel fibres of the fascial 
system have fully acquired their inelastic unyield- 
ing character. 
Ventro-crural passage.—This outlet is a tri- 
lateral passage situated at the pubis, on the inside 
of the crural vein: one of its sides being this 
vein, and therefore convex; the second being the 
pectineal fascia; and the third, namely, the ante- 
rior, which is inclined inward, being the triangular 
portion of the ligament-like process. This open- 
ing, lying between the abdomen and thigh, may 
he properly called the ventro-crural passage. 
This passage is not formed by the tendon of the 
external oblique muscle of the abdomen; for ANATOMY OF THE GROIN. 
113 
First, the pubal connexion of the reflected por- 
tion of this tendon is made exterior to that of the 
ligament-like process of the fascia lata, as is 
shown under the letters a a, on the right, and 
under the letters g g, on the left side of Plate III.: 
Second, the inner edge of the tendon is situated 
on the outside of the third or abdominal layer of 
of the crural sheath, and so intimately united 
with the second layer of the sheath, that in care- 
fully dissecting off the tendon, this layer will also 
be removed as if both were the same fibrous 
membrane. 
Formed by the fascia lata.—The ventro-crural 
passage is formed by the lower triangular portion 
of the ligament-like process of the vaginal portion 
of the fascia lata:—it is the result of the sigmoid 
twist which this process of converging fibres 
makes in attaching itself horizontally to the 
pubis. 
Upper aperture.—The upper aperture of the 
passage is pointed out on the left side of plate III. 
by the figure of a hook, whose point is fixed in 
the passage. It is an isosceles-triangle laid hori- 
zontally, having a convex base, formed by the 114 
ANATOMY OF THE GROIN. 
crural vein; the posterior portion of the margin 
being the raised edge of the pubis, and the ante- 
rior the folded edge of the ligament-like process. 
Lower aperture.—The lower aperture is not 
represented in the drawings; its location is, how- 
ever, indicated by the course of the absorbent 
vessels proceeding from the glands h h on the 
right side of plate III. These vessels enter the 
pelvic cavity by this lower aperture of the ventro- 
crural passage. It also is triangular, yet differs 
in position from the upper aperture in being 
oblique and having its base reversely placed. The 
lower portion of the margin is the upper edge of 
the layers of the crural sheath, which are inter- 
laced in the pectineal fascia; the upper is the 
oblique edge of the triangular portion of the liga- 
ment-like process. 
Variation in size.—The ventro-crural passage 
varies in size; but not from muscular action. The 
fibres composing it, unlike those of the abdominal 
ring, are not united to muscle. The variation is 
produced by the position of the thigh; when it is 
flexed inward, the ligament-like process becoming 
relaxed and somewhat raised, the passage is en- ANATOMY OF THE GROIN. 
115 
larged; when turned downward and outward, the 
process becomes tense and falls, so that the pas- 
sage is narrowed, and the lower triangular aper- 
ture, being obliquely situated, has its angle opposite 
the base rendered more acute. 
The bowel in producing a crural hernia takes 
the following course. 
Course of the bowel.—It enters the upper aper- 
ture, and though this may he somewhat enlarged by 
pressure on the crural vein, yet it is here liable to 
be strictured by the unyielding anterior and pos- 
terior portions of the margin. Its progress in 
this passage is obliquely inward, by reason of the 
inclination of the triangular portion of the process. 
At its exit from the small oblique aperture below, 
it turns round the upper oblique edge, and is 
forced upward and outward until it has reached 
the crescentic edge of the sheath, when its upward 
course turns obliquely inward, until lodged on the 
tendon of the external oblique. 
In this course the bowel may he strictured in 
four ways. 
Stricture of the upper aperture.—First. A 
small cul de sac of intestine, lodged in the passage 
may he enlarged by various causes, and strictured 116 
ANATOMY OF THE GROIN. 
by the folded edge of the process, when rendered 
tense by the outward rotation of the thigh. 
Stricture of the lower aperture.—Second. The 
bowel, having passed the lower aperture, may be 
also strictured by the oblique edge of the tri- 
angular portion of the process. The part of the 
bowel beyond the lower aperture, by being turned 
upward, forms an angle with that which fills the 
passage; and in this angle the oblique edge is 
fixed, ready to produce stricture when made tense. 
Treatment.—The relief, in the two above in- 
stances, is afforded by retaining the thigh in an 
inward and upward position, in order to relax the 
ligament-like process; and by elevating the lower 
part of the trunk in order that the bowels, by 
their weight, may co-operate with the external 
pressure in reducing the protruded portion. 
Stricture by the entire passage.—Third. The 
bowel may so completely fill the passage as to be 
strictured, not by the upper and lower edge only, 
but also by the entire triangular portion of the 
process, even when this is most relaxed. This 
constitutes strangulated crural hernia, and de- 
mands a speedy use of the knife. 
Treatment.—The operation, which the above ANATOMY OF THE GROIN. 
117 
views of structure, teach, consists in dividing the 
tr iangularportion of the ligament-like process of 
the vaginal portion of the fascia lata, from the 
middle of its oblique edge, upward to its folded 
edge. 
Stricture of the crescentic edge.—Finally. The 
bowel may so accumulate in quantity, particularly 
if omentum be protruded with intestines, as not 
only to rise above the crescentic edge of the crural 
sheath, but likewise to he strictured by this edge. 
This superficial stricture is to be relieved by a 
crucial division of the integuments and fascia 
superficialis, which press the bowel against the 
unyielding crescentic edge. 118 
ADDENDA. 
A 
The drawing by my worthy friend, Mr. M. S. 
Weaver, of the magnified fibrous tissue, contained 
in an additional Plate to the present edition, is 
intended to illustrate the remarks on this subject 
contained in the first Chapter, on the mechanical 
structure of fascia, its various important uses, 
and by contrasting it with other parts of the 
fibrous system, to show more strikingly that fascia 
consists essentially of iminterlaced parallel un- 
yielding fibre and elastic cellular tissue. Upon 
this simple and admirable mechanism depends the 
easy and complete adaptation of fascia to various, 
and apparently contradictory, uses. 
It was intended to have introduced these illus- 
trations in the previous edition, as drawn from the 
original dissections at the Pavilion of the Ecole 
de Medicine, in 1820, under magnifying glasses, 
but unavoidable circumstances prevented This  Pihrous Tissue .—Plate 3V. 
outer layer 
Duj'cl. mates'. 
polished inner lagrer. 
Tentorium.. 
Fibres re/uctmt Thom, the tas cut 
The » 
Sderqtiea.. 
Fascia Litn . 
jFascia. f /su cu - 
M.S.lVearer del- 
X Smcltnrs Jjitfu 119 
ANATOMY OF THE GROIN. 
was, at the time, a subject of regret, and it is now 
a subject of greater regret, that in presenting 
them to the class in this second edition, the author, 
by being deprived of the opportunity of confirm- 
ing the original dissections, has been forced to 
depend on his memory and the text in directing 
the lithography. 
A doubt exists, therefore, on his mind as to the 
accuracy of the interlaced tissues of the sclero- 
tica. He hopes, however, that the object of illus- 
trating the text has been attained, and that the 
class will attribute any want of accurary which 
their future anatomical examination may detect to 
the above circumstance. 
B 
The author, as far back as 1819, was deeply 
impressed with the fact, that the fibrous system 
has not been made a special and immediate object 
of dissection, and more particularly that portion 
of this system which is termed fascia. Like the 
cellular tissue, it has been considered in the 
anatomical room, so to speak, as waste-stuff, to 
be removed in the display of the muscles, veins, 120 
ANATOMY OF THE GROIN. 
nerves, and viscera. To understand its mecha- 
nism and expose its entire disposition throughout 
the animal economy became an object of investi- 
gation whilst enjoying the anatomical advantages 
at the Pavilion of the Ecole de Medicine; but cir- 
cumstances hastened his departure from Paris, 
and never since has an opportunity been afforded 
of prosecuting his design beyond that displayed 
in the anatomy of the groin, together with the 
fascia of the pelvis, and the axilla and fibrous 
sheath of muscles, which have not yet been pub- 
lished. He has been gratified, however, to find 
that this field of anatomical research has been 
entered by others, and that excellent exhibitions of 
much of the system have been subsequently dis- 
played in MM. Bourjery and Jacob’s Descriptive 
and Physiological Anatomy. 
C 
The investigation of the fascial structure natu- 
rally divides itself into five parts, viz.—1st, that 
of ascertaining the mechanism of the tissue; 
2d, that of tracing its disposition throughout the 
various structures in all the classes of the animal 
kingdom; 3d, that of examining vegetable organi- ANATOMY OF THE GROIN. 
121 
zation for an analogous structure; 4th, that of 
obtaining any vestige of it in crystalline matter; 
5th, that of deducing from the whole field of 
facts the laws of the fibrous system. 
D 
It was not long after the author had entered 
upon the investigation in question, that he per- 
ceived the intimate connexion which exists between 
the system under consideration and the cellular 
tissue, and that it is but a modification of this uni- 
versal tissue, made by the addition of parallel 
unyielding shining fibres. It was under this 
view that he perceived the intimate structure of 
fascia; and was enabled to form the definition that 
has been presented in the first Chapter, viz. that it 
consists of unyielding shining fibres, traversing 
in parallel lines, more or less closely, and in one 
or more strata, the ubiquitous elastic cellular 
tissue. 
E 
Fascia, then, consists of two elements of oppo- 
site properties, viz. the unyielding shining fibres, 
and the elastic cellular tissue. The former gives 122 
ANATOMY OF THE GROIN. 
strength to the structure, enabling it to firm- 
ly hold together parts which, without it, by their 
natural action, would be injuriously parted; and 
also, at the same time, to keep them in due approxi- 
mation. It presents also a surface of resistance 
from which to reflect, in proper directions, the 
movements created by muscular contraction. The 
latter, the cellular tissue, being the surface on 
which the capillary system is spread, and thereby 
the medium of conveyance of the vital fluid to all 
animal structure, sustains the vitality of these 
unyielding fibres; and at the same time, by its 
possessing an elastic property, (a property so mark- 
ed in the cellular tissue, that this deserves to be 
called the elastic tissue,) it endues the fascial 
structure with an elastic property, which, by the 
peculiarities of its unyielding fibres, is not inter- 
fered with. Fascia thus, by its fibres, has firmness, 
and by its cellular tissue, has motion—two oppo- 
site properties of great importance in all struc- 
ture. 
F 
A knowledge of fascia implies that of the 
properties and disposition of the cellular tissue. 
This also, therefore, must be made by the student ANATOMY OF THE GROIN. 
123 
of anatomy, a special and immediate object of dis- 
section. The investigation will become exceed- 
ingly interesting, resulting in a synthetical know- 
ledge of animal mechanism. The analysis of mus- 
cles, veins, nerves, and viscera, which constitutes 
the ordinary labour of practical anatomy, leaves 
the mind in a very desultory and unsatisfactory 
state: whilst tracing out, as a separate and distinct 
task, the entire disposition, and also ascertaining 
all the properties and uses of that neglected 
cellular tissue which is cast, as waste-stuff, from 
the forceps of the dissector, will enable the mind 
to perceive the parts, which have been analysed, 
restored to their unity of structure by a common 
bond of union. And not only will it be found, 
that muscle, vessel, nerve, viscera, and other 
animal structure is appropriately lodged in the 
common mould of cellular tissue, but also 
that it enters as an element into each of said 
structures: that the serous membrane, arachnoid, 
pleura, and peritoneum; the mucous tubes, sur- 
faces and sacs; the synovial sacs; the fasiculi of 
muscles, the lining membrane of the cavities of 
the heart, and of the arteries, veins, and absorbents, 
are all united by it to the organs they serve. 124 
ANATOMY OF THE GROIN. 
Is not this ubiquitous cellular tissue the 
medium which conveys the vital fluid to each part 
for its nourishment, its support and growth? may 
it not he a medium of sympathy, metastasis, and 
magnetic fluid? And is it not the destroyer of 
the momentum of the heart, to prevent pulsation 
everywhere throughout the delicate tissues of the 
body?—acting thus against an internal momen- 
tum as the cancellous structure of bone does 
against all the external momenta. 
It possesses the properties of dilatation andcon- 
traction, which most likely serves as an expulsive 
power to the pulmonary air cell, and enables it to 
serve each organ in all their various motions and 
modifications of size and shape, as is evident in 
the diastoles and systoles of the heart, the motions 
of the brain, the distension and contraction of the 
stomach and intestines, and more admirable than 
in all else, the enormous change in the size of the 
uterus slowly through a period of nine months in 
in gestation, and quickly in labour in about as 
many hours. 
G 
A knowledge of the cellular tissue is important 
in pathology. Andral and others are satisfying ANATOMY OF THE GROIN. 
125 
medical men that animal tissues are not thickened 
and hardened, hut rendered friable and softened 
by acute inflammations. And that the morbid 
thickness and hardening is a subsequent process 
effected in the interstitial cellular tissue, and that 
hence arise incurable ulcers, permanent stricture, 
chronic disorders, and anormal pulsation. 
H 
There may he exceptions to the position that 
cellular tissue is an element of every tissue. Pa- 
thological facts give good grounds of belief that 
it exists in the substance of the brain, but where 
is the direct anatomical evidence of it? and of its 
existence in the derm, and in several parts of the 
\ 
fibrous tissue,—the sclerotica, for example, as ex- 
hibited, in Plate IV.? Other illustrations there, 
however, demonstrate its undoubted existence in 
fascia, and shows also its various uses. In the 
fascia iliaca, for example, it abounds, preserving 
even its laminated arrangements, and its inter- 
posed lobes of fat. In the fascia transversalis 
as exhibited in Plate III. under the letters 
m m, it appears an unlaminated membrane, 126 
ANATOMY OF THE GROIN. 
abounding in the inelastic tissue below, and being 
destitute of it above, and by this very arrange- 
ment giving not only firmness but elasticity to 
the abdominal parietes at the groin, supporting its 
lower fibrous portion by its broad thin expansion 
above, as the long, attenuated, unattached, floating, 
and elastic line of the field spider suspends this 
insect in the air. In the fascia lata the inelastic 
parallel fibres are represented more abundantly 
and in diagonal strata, so that the interposed 
cellular tissue has been altogether a subordinate 
element of the structure. The fascia lata is 
thereby possessed of the two opposite properties of 
firmness and elasticity. It is by their combined 
operation that fascia presents a surface of varying 
degrees of resistance to muscular action. 
The drawing which represents the unyielding 
parallel fibres reflected from the fascia to unite 
and become changed to the thread-like prolonga- 
tions of the derm of the sole of the foot, show 
the fibres so closely in contact with each other, 
as almost to exclude the elastic and nutritive 
cellular tissue. This constituent, however, is 
more sufficiently evident in the drawing which 
represents the ligamentous disposition of fascia ANATOMY OF THE GROIN. 
127 
and also in that exhibiting the strata of the fascia 
lata. By means of this elastic constitutent the 
pubal ligament of the fascia lata is enabled to 
vary the tightness of the twist of the fibres, and 
thereby to contract and dilate with the motions of 
the abdominal parietes. 
There are several specimens of the ligamentous 
disposition of fascia to be met with in the body. 
None of them, however, are of so much import- 
ance as that above referred to. It exhibits the 
twist which the fascia lata makes in attaching 
itself ligamentously to the pubis; and hence results 
that free inner edge, which is the ACTUAL 
seat of stricture of the bowel in strangulated 
crural hernia. It thus demonstrates that the 
SEAT OF CRURAL HERNIA IS NOT MADE BY 
EITHER POUPART’S OR GlMBERNAT?S LIGAMENTS 
WHICH BELONG TO THE TENDON OF THE EX- 
TERIOR OBLIQUE MUSCLES, HOF by the CRESCEN- 
TIC EDGE OF THE FASCIA LATA, RS Supposed by 
Hey, but by the free inner edge of the 
LIGAMENTOUS PROCESS OF SAID FASCIA.