Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
The region which extends from the umbilicus to the point of the coccyx
is marked upon the cutaneous surface by a central raphe dividing the
hypogastrium, the penis, the scrotum, and the perinaeum respectively
into equal and similar sides. The umbilicus is a cicatrix formed after
the metamorphosis of a median foetal structure--the placental cord, &c.
In the normal form, the meatus urinarius and the anus coincide with the
line of the median raphe, and signify omissions at stated intervals
along the line of central union. When between these intervals the
process of union happens likewise to be arrested, malformations are the
result; and of these the following are examples:--Extrusion of the
bladder at the hypogastrium is caused by a congenital hiatus at the
lower part of the linea alba, which is in the median line; Epispadias,
which is an urethral opening on the dorsum of the penis; and
Hypospadias, which is a similar opening on its under surface, are of the
same nature--namely, omissions in median union. Hermaphrodism may be
interpreted simply as a structural defect, compared to the normal form
of the male, and as a structural excess compared to that of the female.
Spina bifida is a congenital malformation or hiatus in union along the
median line of the sacrum or loins. As the process of union along the
median line may err by a defect or omission, so may it, on the other
hand, err by an excess of fulfilment, as, for example, when the urethra,
the vagina, or the anus are found to be imperforate. As the median line
of union thus seems to influence the form of the hypogastrium, the
genitals, and the perinaeum, the dissection of these parts has been
conducted accordingly.
By removing the skin and subjacent adipose membrane from the
hypogastrium, we expose the superficial fascia. This membrane, E E E*,
Fig. 1, Plate 50, is, in the middle line, adherent to B, the linea alba,
and thereby contributes to form the central depression which extends
from the navel to the pubes. The adipose tissue, which in some subjects
accumulates on either side of the linea alba, renders this depression
more marked in them. At the folds of the groin the fascia is found
adherent to Poupart's ligament, and this also accounts for the
depressions in both these localities. From the central linea alba to
which the fascia adheres, outwards on either side to the folds of both
groins, the membrane forms two distinct sacs, which droop down in front,
so as to invest the testicles, E**, and penis in a manner similar to
that of the skin covering these parts. As the two sacs of the
superficial fascia join each other at the line B, coinciding with the
linea alba, they form by that union the suspensory ligament of the
penis, which is a structure precisely median.
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