Human anatomy; Medicine -- Study and teaching; Palpation
The so-called ‘linea semilunaris,’ at the outer border of the sheath of
the rectus, corresponds with a line, drawn slightly curved (with the
concavity towards the linea alba), from the lowest part of the seventh
rib to the spine of the pubes. This line would be in an adult about
three inches from the umbilicus; but in an abdomen distended by dropsy
or other cause, the distance is increased in proportion.
It is important to know the position of the ‘lineæ transversæ,’ or
tendinous intersections across the rectus abdominis. There are rarely
any below the umbilicus, and generally three above it. The first is
about the level of the umbilicus. The second is about four inches
higher--that is, about the level of the lowest part of the tenth rib.
These are the principal lines, and they divide the upper part of each
rectus into two nearly quadrilateral portions, an upper and a lower:
of these, those on the right side are a trifle larger than on the
left. We see these muscular squares pretty plainly in some athletic
subjects. Much more frequently we see them, too much exaggerated, on
canvas and in marble. Artists are apt to exaggerate them, and make the
front of the belly too much like a chess-board. It is lucky for them
that all the world do not see with anatomical eyes.
A familiarity with the shape and position of these divisions of the
rectus is of importance, lest we should, in ignorance, make a mistake
in our diagnosis. A spasmodic contraction of one of these divisions,
particularly the upper, or a collection of matter within its sheath,
has been frequently mistaken for deep-seated abdominal disease.
In the erect position, the anterior superior spines of the ilia are a
little below the level of the promontory of the sacrum. The bifurcation
of the aorta is on about the level of the highest part of the crest of
the ilium.
62. =Umbilicus.=--The umbilicus is not midway between the ensiform
cartilage and the pubes, but rather nearer to the pubes. In all cases
it is situated above the centre of a man’s height. It is a vulgar error
to say that when a man lies with legs and arms outstretched, and a
circle is drawn round him, the umbilicus lies in the centre of it. This
central point is in most persons just above the pubes.
In very corpulent persons two deep transverse furrows run across the
abdomen. One runs across the navel and completely conceals it. The
other is lower down, just above the fat of the pubes. In tapping
the bladder above the pubes in such a case, the trochar should be
introduced where this line intersects the linea alba.
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