Human anatomy; Medicine -- Study and teaching; Palpation
69. =Spine of pubes.=--The spine of the pubes is the best guide to the
external abdominal ring. It cannot easily be felt by placing the finger
directly over it, since it is generally covered by fat. To feel it
distinctly, we should push up the skin of the scrotum and get beneath
the subcutaneous fat. If there be any difficulty in finding it, abduct
the thigh, and the tense tendon of the adductor longus will lead up to
it.
The position of the spine of the pubes is appealed to as a means of
diagnosis in doubt between inguinal and femoral hernia. The spine lies
on the outer side of the neck of an inguinal hernia, on the inner side
of the neck of a femoral.
The spine of the pubes is nearly on the same horizontal line as the
upper part of the trochanter major. In this line, about one full
inch external to the spine, is the femoral ring. Here is the seat of
stricture in a femoral hernia.
70. =Poupart’s ligament, or crural arch.=--The line of Poupart’s
ligament (crural arch) is in most persons indicated by a slight
crescent-like furrow along the skin. It corresponds with a line drawn
not straight, but with a gentle curve downwards from the spine of
the ilium to the spine of the pubes. With the help of the preceding
landmarks it is easy to find the exact position of the external and
internal abdominal rings, and the direction of the inguinal canal.
71. =Abdominal rings.=--The external abdominal ring is situated
immediately above the spine of the pubes. It is an oval opening with
the long axis directed obliquely downwards and inwards. Though its size
varies a little in different persons, yet as a rule it will admit the
end of the little finger, so that we can tell by examination whether
it be free or otherwise. To ascertain this, the best way is to push up
the thin skin of the scrotum before the finger; then, by tracking the
spermatic cord, the finger readily glides over the crest of the pubes
and feels the sharp margins of the ring.
The position of the internal ring is about midway between the spine of
the ilium and the symphysis of the pubes, and about two-thirds of an
inch above Poupart’s ligament.
72. =Inguinal canal.=--The position of the external and internal
abdominal rings being ascertained, it is plain that the direction of
the inguinal canal must be obliquely downwards and inwards, and that
its length in a well-formed adult male is from one and a half to two
inches, according as we include the openings or not. In very young
children the canal is much shorter and less oblique, the inner ring
being behind the outer. With the growth of the pelvis in its transverse
direction, the anterior spines of the ilia become farther apart, and
thus draw the internal ring more and more away from (_i.e._ to the
outer side of) the external.
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