COLUMBIA LIBRARIES OFFSITE HEALTH SCILNC! S STANDARD HX64058484 QM23 S08 Resume ol lectures o GlD0^2l SoS Columbia Untomitp intljeCttptfltogork College of iPfjpgtaatis anb burgeons Hiferarp Digitized by the Internet Archive in 2010 with funding from Columbia University Libraries http://www.archive.org/details/resumoflectureOOsouc RESUME LECTURES ON ANATOMY Edmond Souchon, M. D.5 PROFESSOR OF ANATOMY AND CLINICAL SURGERY TULANE UNIVERSITY OF LOUISIANA. NEW ORLEANS: L. Graham & Son, Ltd., Printers, 207-211 Baronne St. 1895. PREFACE. This simple resume of the Lectures on Anatomy, delivered be- fore the Medical Students of the Tulane University, is intended solely to assist them in the study of the most important points of this branch, which is one hard to teach, hard to learn, hard to remember and yet of great importance, since it is the foundation of all medical studies. It is a branch which can not be guessed. It is one which can only be learned practically, and which it is almost impossible to the greatest number to study after leav- ing the college ; hence another reason for studying it well once and at once. This resume should be carefully studied at home by the stu- dents before coming to the college. The resume of the coming lecture should be studied a day or two in advance to profit well by the lecture, the dissections, the drawings and the microscopic preparations which may be exhibited at the lecture. The resume of the lecture of the day should be well studied at night. After a set of organs have been described the resume of those organs should be studied over. All that does not require to be seen to be remembered has been left out of this resume. In order to assist the students in studying over and over, a list of numbered questions with corresponding numbers in the text has been placed at the end of the book. It will enable them to examine themselves and to become familiar with those ques- tions, which will be the same that they will have to answer in the examining room. To assist the students also in the Dissecting Rooms, the poste- rior surface of the organs is described last, though systematically it should come second. But as this study implies a removal of the organ or a great disturbance in the parts not yet studied, those parts should be studied first and then the posterior surface. EDMOND SOUCHON, M. D. RESUHE OF GENERAL HISTOLOGY. CELLS. 1 Shape. Cells are spherical or lenticular, polygonal or cu- bical, cylindrical or columnar, conical or pyriform, spindle- shaped, stellate and prickly. Number. Cells form either single layers or many layers (stratified or laminated). 2 Structure. Cells are composed of a cell- membrane and of cell-contents or protoplasm, which is a fluid containing granu- lations, pigment and a nucleus, containing itself a fluid and a nucleolus. Some cells, such as the white blood corpuscles, have no cell membrane, and are formed of a mass of jelly-like matter with or without a nucleus. The nucleus is a little cell in itself. Some cells, such as the blood cells in man, have no nucleus. Some cells have many nuclei, such as the giant cells of the red marrow of bones. The nucleolus is comparatively unimportant . 3 The Vital Properties of Cells are absorption, assimila- tion, growth, secretion, excretion, motion (ameboid or cili- ated), and death or destruction (by desquamation, dissolu- tion, fatty, pigmentary or calcareous degeneration), and multiplication by gemmation or budding, and by segmenta- tion or cleavage. EPITHELIAL TISSUE. 4 Definition. Epithelial tissue is formed of cells lining the surface of the skin, mucous membrane and glands. It is almost always stratified. The epithelial tissue of the skin is called the epidermis} that of the mucous membrane and glands is called the epithelium. ENDOTHELIUM. 5 Definition. Endothelium is the cells lining the interior of the heart, blood vessels and serous membranes. It is always in a single layer. CONNECTIVE TISSUE. 6 Varieties. It presents the following varieties : 1st, the transparent ; — 2d, the granular ; — 3d, the fibril- lated (presenting lymph spaces and lymph corpuscles) : — 4 TISSUES. 4th, the corpusculated (presenting the so-called connective tissue corpuscles) ; — 5th, the pigmented ; — 6th, the mucoid or gelatinous formed by large connective tissue corpuscles which branch and anastomose so as to form alveoles ; — 7th, the adenoid, lymphoid or retiform, formed of branched corpuscles forming alveoles filled with lymphoid cells. FIBROUS TISSUE. 7 Definition. Fibrous tissue is formed of closely united bundles of connective tissue. ELASTIC TISSUE. 8 Definition. Elastic tissue is composed of flattened band- like fibres much wider than those of the connective tissue. It curls when cut. Varieties. It presents : — 1st. A variety characterized by narrow fibres. — 2d. A variety characterized by broad fibres with notched edges and perforated substance. ADIPOSE TISSUE. 9 Definition. Adipose tissue is formed of fibrils of con- nective tissue in the meshes of which are deposited fat cells. Structure, Fat cells have a distinct membrane, contain fluid oil and a nucleus. GLANDULAR TISSUE. 10 Varieties and Characters. 1st. The Racemose Glands resemble a bunch of grapes. The dilatations are the acini, and the stems, large and small, are the ducts. They are simple or composite. 2d. The Tubular Glands have the form of a canal. They are simple or composite, and straight or convoluted, and with a mere closed extremity or an extremity which terminates by a dilatation or pouch. 3d. The Open Glandular Follicles are vesicles which present a small opening through which the secretions are discharged. 4th. The Closed Glandular Follicles are vesicles de- prived of opening and discharging their contents by rupt- ure (ovaries). They are not to be confounded with the fol- licles of the lymphoid organs, such as isolated follicles of the small intestines, Peyer's patches, lymphatic gland follicles. 11 Structure of- Glands. In a general way the bottom of the gland is the secreting part and is usually lined and filled with peculiar gland cells; — the excretory ducts are lined by a columnar epithelium. PECULIARITIES OF THE TISSUES. 5 PECULIARITIES OP THE TISSUES. N. B. — Peculiarities are points which are usually special to a tissue or organ alone, seldom to two or three. 12 Peculiarities of Epithelial Tissue. It is found ou all surfaces in contact with the exterior directly (skin, mucous surfaces) — It is always laminated. — The Deep Cells are always round or oval and soft. — The Superficial Cells have little or no vitality. — It is deprived of vessels. — Nerve Fibrils form hair-cells, in some places, which terminate between the cells. Peculiarities of Endothelium. It is found in the cavities which do not communicate with the exterior (serous surfaces) — It is always in a single layer. 13 Peculiarities of Connective Tissue. The most common variety is the fibrillated. — The fibres are round and wavy. — The corpuscles present branches or processes. — It has no capillaries distributed to it properly. Peculiarities of Fibrous Tissue. Is dense connective tissue. Peculiarities of Elastic Tissue. It curls when cut — The broad variety presents holes and forms the fenestrated membranes — It has no capillaries. 14 Peculiarities of Adipose Tissue. It presents fat cells in meshes of connective tissue — It has capillaries ; they form a network around each fat lobule. 15 Peculiarities of Glandular Tissue. The Racemose Glands are found in a general way on the skin and on the mucous membranes. — The capillaries are peculiar. In Resume, the following are racemose glands: — Glands of the mucous membrane of the intestinal tract from the lips to the cardia, but not further, except the duodenal gland — The Salivary Glands are compound glands — The Liver. — The Pancreas. — (Hands of the mucous membrane of the bladder — Prostate (Hands — Cowpers' Glands — Glands of the mucous membrane of the Urethra. — Glands of mucous membrane of larynx, trachea, bronchi — The Lungs are a sort of racemose glands. — The Glands of mucous membrane of the Nasal Cavities — Lachrymal Glands and Caruncula. — Glands of the Skin: the Sebace- ous. Racemose Glands present lobes, lobules and acini. Some Racemose Glands present an am xsonj -, ,■ >-as tor surfaces. Relations, J All Thick Borders ought to be subdivided into two edges or lips and an interstice. Give for each : peculiarities, inser- tions and relations. Angles or Extremities: same as borders. Base and Apex: same also. Structure : Color. Consistency: Density, Friability, Elasticity, Retractility. Envelopes or Goats: Thickness, Resistance, Elasticity. Ex- ternal Surface (relations, adhesions). Internal surface (re- lations, adhesions, processes from internal surface, reflec- tion into the interior of the organ). Stroma : is delicate or apparent; is composed of connective tissue, or elastic or smooth muscular fibres. Proper or Characteristic Elements: Cells, Tubes, Fibres. Prisms. Vessels: Capillaries, Arteries, Veins, Lymphatics. Nerves. Excretory Duct of a Gland (as a separate organ). Lining Membrane of a Hollow Organ : Thickness, Con- sistency. Elasticity, Adherent Surface (degree of adhesion) : Free Surface: color, peculiarities, epithelium, glands. Chemical Composition : Organic. Inorganic Elements. Development or Anatomy of the Ages. Peculiarities or Varieties, or Anomalies due to Sex. Habits, Trades, Constitutions, Individualities. Nationalities. Races. LIPS — CHEEKS — VESTIBULE — TEETH . RESUME OF THE DIGESTIVE ORGANS. 17 Enumeration. The organs concerned in digestion are the lips, the cheeks, the vestibule, teeth, tongue, hard and soft palates, tonsils, parotid, submaxillary and sublingual glands ; the pharynx, oesophagus, stomach, duodenum, jejunum, ileum, caecal appendix, caecum, ascending colon, transverse colon, descending colon, sigmoid flexure, rectum, anus, liver, pancreas and spleen. LIPS. 18 Structure. The lips are composed: — 1st, of a Cutaneous layer; — 2d, of a muscular layer formed principally of the orbicular muscle, closely attached to the skin; — 3d, of a cellulo -glandular layer formed of loose areolar tissue and simple racemose glands ; — the labial artery runs through the layer; — 1th, of a mucous layer. N~. B. — The lymphatics of the median line of the lower lip discharge into the digastric glands — and the other lym- phatics of both lips discharge into the submaxillary lym- phatic glands. CHEEKS. 19 Structure. The cheeks are formed : — 1st, of a Cutaneous layer; — 2d, of an adipose layer represented specially by a lit- tle mass of fat situated between the buccinator and the masseter; — 3d, of & muscular layer, formed posteriorly by the masseter and anteriorly by the buccinator pierced by Steno's duct; — 4th, of a glandular layer, represented by a small group of simple racemose glands, called the molar glands, and clustered on the buccinator, where Steno's duct perforates it; — 5th, of a mucous layer, which is covered with microscopic papillae. VESTIBULE. 20 Definition. Is the space limited in front by the lips and cheeks and behind by the teeth. When the teeth are clinched, the vestibule communicates with the mouth proper by an opening limited by the last molar teeth, and the vertical branch of the inferior maxilla. THE TEETH. 21 Number. There are two sets. — The temporary or milk teeth number twenty, ten for each jaw. The permanent set number thirty-two, sixteen for each jaw; two" central incisors, two lateral incisors, two canines, four small molars or bicuspids, six large molars or multi- cuspids, the last of which are called the wisdom teeth. GUMS — TONGUE. 9 Each tooth presents ;i crown, a neck, a root or fang. Shape. The Incisors have a cutting crown and a single root; — the Canines have a conical crown and a single, but long root; — the Small Molars have a crown presenting two points (biscupids), a single root, but broad and slightly grooved ; — the Large Molars have a crown presenting four points (multicuspids), and from two to five roots; — the Wisdom Tooth has the smallest crown and presents but a single root, but it is very broad and deeply-grooved. 22 Structure. The Crown possesses two envelopes, — the Cuticle of the Enamel, which has no apparent structure, — and the Enamel itself, composed of prismatic fibres dis- posed in superimposed layers and having a different direc- tion in each layer. The Root has also two envelopes, — the Alveolar Periosteum — and the Cement, which resembles bony tissue, presenting cement corpuscles and canalicules. Tlte Proper Substance of the Teeth is the Ivory or Dentine; — it exists in the crown and root alike : — it is composed of canalicules extending from the cavity of the tooth to the enamel and cement. The Interior of the Teeth presents a cavity containing the Pidp of the Tooth, — it is a projection of the alveolar perios- teum,— and is composed of delicate connective tissue with capillaries and nerve fibres. THE GUMS. 23 The Gums are formed of thickened mucous membrane covering the alveolar borders. THE TONGUE. 24 Shape. The tongue is, at rest, triangular aud flattened. The Base or Root is the posterior part. The Apex or Tip is the free end. The Under Surface is attached along the middle of the floor of the mouth, and presents a fold of mucous mem- brane called the frenum, — on the side of which are the openings of the ducts of Wharton ; — this attached portion is the body. The Upper Surface presents the papilla? — and the glands of the mucous membrane. 25 Structure. The riucous Membrane presents on the anterior two-thirds the papilla1, which are the Circumvallate or Calyciform. — The Capitate or Fungiform, — and the Conical or Filiform. They are all processes or projections of the mucous mem- brane and have the same structure as that membrane, — the circumvallate and the capitate present, buried in the epithelium, the taste goblets, which are a mode of termina- tion of the fibrils of the gustatory nerve. 10 PALATES. The fluscles of the Tongue are: the Genio-hyoglossus , which is the protruder ; — the Myoglossus, which is the de- pressor or retractor, or muscle which draws the tongue in ; — the Styloglossus, which is the elevator muscle ; — the Lin- guals, which make the tongue convex from before back- ward ; — the Palato-pharyngeus, or constrictor of the poste- rior arches, — and the Palato-glossus, or constrictor of the anterior arches. — The tongue possesses also Intrinsic fibres which curve it into a gutter and give it the various other shapes it is susceptible of having. The Nerves of the Tongue are the Lingual, from the In- ferior maxillary, which is the gustatory nerve ; — the Glosso- pharyngeal, which skives sensibility to the mucous membrane of the root, — and the Hypoglossal, which is the motor nerve of the tongue. HARD PALATE. 26 Shape and Consistency. Some palates are deep and others are shallow. — In some the mucous membrane is soft and in others it is hard. — Both the shape and consistency are im- portant factors in fitting plates of teeth. Structure. The hard palate is composed, — 1st, of a Mu- cous layer closely adherent to the periosteum in the anterior third of the palate ; — 2d, of a Glandular layer, composed of simple racemose glands, which are more numerous in the posterior third; — 3d, of an Osseous layer, formed in front by the palatine process of the superior maxilla and behind by the horizontal plate of the palate bones. — The Arteries are the descending palatine from the internal maxillary, and the ascending palatine from the facial. SOFT PALATE. 27 Shape. Is quadrilateral. The Anterior Surface is concave, and smooth. The Posterior Surface is convex and is continuous with the floor of the posterior nares. The Upper or Adherent Border is attached to the posterior margin of the hard palate. The Lower or Free Border presents on the median line the Uvula, — and on each side the Anterior and the Posterior Pillars of the fauces. — Between the arches are found the Tonsils. — The Strait or Passage between the arches of the two sides is the Isthmus. 28 Structure. The Soft Palate is composed from below up- ward : 1st. Of a Lower mucous layer lined with pavement epi- thelium.— 2d. Of a Thick layer of simple racemose glands. — 3d. Of a Fibrous layer or fascia attached to the bones of the hard palate. — 4th. Of a Muscular layer composed of the Elevator of the Uvula, the Elevator of the palate, the Ten- TONSILS — PAROTID GLANDS. 11 sor of the palate, the Constrictor of the anterior arches, the Constrictor of the posterior arches. — 5th. Of a s< <<>,iks Coa /. 38 URETER — BLADDER. URETER. 103 Direction and Course. The ureter descends obliquely in- wards along the psoas muscle, — enters the pelvic cavity, — crossing the angle of bifurcation, of the iliac vessels — and, curving forwards and inwards in the vesical fold of the peritoneum, — reaches the fundus of the bladder. Shape. The ureter has the shape of a long, narrow and thin tube. The Anterior Surface is in relation with the peritoneum and base of bladder. The Upper Extremity is continuous with the pelvis. The Lower Extremity opens into the bladder — in a valve- like manner. The Posterior Surface is in relation with the psoas, — then the angle of bifurcation of the iliac vessels, — then the pelvic areolar tissue, the rectum, the spermatic duct and the semi- nal vesicles. Structure. The ureter is composed: — 1st, of an External Fibrous and slightly elastic and muscular layer ; — 2d, of a thin Mucous Coat. BLADDER. 104 Shape. The bladder when distended is ovoidal. The Anterior Surface is deprived of peritoneum except sometimes near the apex; — it is in relation with the pubis. The Posterior Surface is covered by peritoneum; — it is in relation with the upper part of the rectum. The Lateral Surfaces are covered by peritoneum only in their upper and back part. The Apex gives attachment to the urachus. The Base of Fundus is in relation with the prostate in front and the rectum behind ; — on the sides it is in relation with the seminal vesicles, the spermatic ducts and ureters. The Neck of the Bladder is situated in advance of the fundus, — is funnel-like, — is in relation with the anterior and lateral ligaments of the bladder. 105 Structure. The bladder is composed : — 1st, of a Peritoneal Coat which covers only its posterior surface and the upper back part of the lateral surfaces ; — 2d, of a layer of Longi- tudinal Muscular Fibres originating from the pubis and pros- tate below and above from the urachus ; — 3d, of a Layer of Circular Fibres which thicken and form the Sphincter; — 4th, of a Layer of Plexiform Fibres; — 5th, of a Mucous Coat which presents at the back a depressed portion called the Bas-fond, and in front a triangular space called the Trigone, the angles of which are formed by the urethra and the two ureters. PROSTATE. 39 PROSTATE. 106 Shape. The prostate is triangular. The Lateral Surfaces are in relation with the pelvic areolar tissue. The Under Surface presents sometimes a middle Lobe and two lateral lobes : — it is in relation with the rectum. The Base is directed backwards — it is in relation with the apices of the seminal vesicles and the ejaculatory ducts. The Apex is directed forwards — it is in contact with the membranous portion of the urethra. The Upper Surface forms the floor of the prostatic portion of the urethra — it presents the urethral crest, the utricle. the openings of the ejaculatory ducts and of the ducts of the prostate itself. Structure. The prostate is composed, — 1st, of an External or Fibrous Coat; — 2d, of a Proper Substance composed of smooth muscular fibres and of simple racemose glands. which open into the prostatic urethra. 107 Peculiarities of the Supra=Renal Capsules. Their size is remarkable; the older the subject the smaller they are. Their color is peculiar, yellow brown. Also their shape : a liberty cap. Also their situation : over the kidney, with which they have no connection, neither anatomical nor physiological. Their structure is peculiar in< containing some special stellate bodies. It has a cavity in its centre ; the only lymphoid gland having it, except the pituitary body. The arteries are numerous, specially compared with the size of the organ. Peculiarities of the Kidneys. Their color is peculiar (like the liver)- They are situated at the deepest part of the abdominal cavity: The right is lower than the left. Their shape is unique : that of a bean. The hilum is one of the most distinct (like the liver)- The upper extremity is the largest (like the spleen). The posterior surface is free from peritoneum and can lie entered from behind without injuring the peritoneum. It possesses a cellulo-adipose capsule (a unique instance). Its proper tissue is characteristic. The cortical is unique. The pyramids are unique. The harder of the two substances is in the centre. The dichotomous division of the canalicules is unique. It is the only tubular gland that is Lobulated (pyramids of Ferrein) with the testicles. 40 PROSTATE. The Malpighian Corpuscle is unique (it is very different from the splenic corpuscle). The Glomerule is unique. The Capillary Arterial Portal System is unique. The Arteries are very large in proportion to the organ. The smaller branches run between the pyramids of Fer- rein in a peculiar way. The Veins are peculiarly larger than the arteries ; they carry red Wood. They originate not from the glomerule, but from the cap- illary plexus, etc. The superficial Venous Capillaries originate on the sur- face of the kidney in a star-like arrangement called the Stars of Verheyn. The left is lower than the right. They carry purer blood than the arteries. The vessels are in front of the pelvis and are away from the knife in operations on the kidney and pelvis. 108 Peculiarities of the Excretory Apparatus of the Kidneys. Is very peculiar. The real beginning of the apparatus is the canicules from the corpuscles to the calices. The balance is represented by the calices, the pelvis, the ureter, the bladder, the urethra. Peculiarities of the Calices. Are unique : no similar arrangement exists anywhere else. Peculiarities of the Pelvis. Is also unique : nothing similar is found anywhere else. 109 Peculiarities of the Ureters. Are peculiar on account of their length and size. Also on account of their mode of termination into the bladder. Peculiarities of the Bladder. Is the largest receptacle found on the course of any ex- cretory apparatus. Its shape is unique, having two apices, the neck and the urachus. The anterior surface is deprived of peritoneum. The urachus is unique. The Base is also deprived of peritoneum. The Neck with a sphincter is unique, in an excretory ap- paratus. It has three sets of fibres (like the stomach). The Mucous Coat is reticulated (like the gall bladder). Its bas-fond is unique. The trigone is unique. The Arteries are numerous, three on each side. The Veins form a plexus around the neck. The nerves of the neck come from the hypogastric plexus. — The nerves of the base come from the sacral plexus. .MALE ORGANS OK GENERATION — SCROTUM — TESTICLE. 41 Peculiarities of the Prostate. Is unique. Its size increasing with age is unique. Its color is fleshy (like the thyroid body and thymus). Its shape is unique. Its urethral crest and utricle are unique. Its being- traversed by the urethra and ejaculatory duds is unique. Its stroma of smooth muscular fibres is unique. Its excretory ducts are numerous (like the sublingual). It is the analogue of the female uterus, but the uterine glands are tubular. The Veins surrounding it are numerous. MALE ORGANS OF GENERATION. 110 Enumeration. The male organs of generation consist of the Scrotum, the Testicle, the Epididymis, the Spermatic Duct, the Seminal Vesicles, the Ejaculatory Ducts, the Penis, and the Urethra. SCROTUM. 111 Structure. The scrotum is composed : 1st, of the Skin or Scrotum Proper-. 2d, of the Dartos and Dartoic Tunic, composed of elastic and smooth muscular fibres. 3d, of the Erythroid Tunic, formed by the Cremaster mus- cle. 4th, of the Fibrous Tunic, corresponding to the Fascia Tran sversalis. 5th, of the Vaginal Tunic, which is a serous membrane lining the inner surface of the fibrous tunic and the outer surface of the testicle and epididymis. TESTICLE. 112 Shape. The testicle resembles a pigeon's egg, slightly flat- tened transversely. The External Surface, the Internal Surface and the Ante- rior Border are convex and smooth. The Posterior or Upper Border adheres to the epididymis except in the middle. The Anterior or Upper Extremity and the Posterior or Lower Extremity are convex and smooth. Structure. The testicle is composed: — 1st, of a Serous Layer formed by the vaginal tunic: — 2d, of the Albugineous or Fibrous Goat, very strong and unyielding — thickened at the back part of the testicle to form the mediastinum; — it contains the longitudinal mediastinal ducts which open into 42 EPIDIDYMIS — SPERMATIC DUCT. the vascular cones of the epididymis; — 3d, of Alveoles con- taining the Seminiferous Canalicules which open into the mediastinal ducts and which are lined by the special Sperm Cells. EPIDIDYMIS. 113 Shape. The Epididymis is elongated and narrow, and re- sembles a leech. The Upper Surface is partly free and partly adherent to the fibrous portion of the vaginal tunic. The Under Surface is adherent to the testicle in front and behind, — but is free in the middle. The Anterior Extremity or Head is firmly attached to the testicle. The Posterior Extremity or Tail is also adherent to the testicle. Structure. The epididymis is composed: — 1st, of a Serous Coat from the vaginal tunic; — 2d, of a Fibrous or Albugine- ous Coat similar to that of the testicle ; — 3d, the Head is composed of a dozen convoluted tubes called the Spermatic Cones which originate from the mediastinal ducts and ter- minate in a single coarse convoluted tube, — the Canal of the Epididymis forming the body and tail of the organ ; it is continuous with the spermatic duct. SPERMATIC DUCT (VAS DEFERENS). 114 Direction and Course. The spermatic duct ascends with the spermatic vessels in the scrotum; — it traverses the in- guinal canal, — then curves into the pelvic cavity to reach the side of the bladder and the fundus, where it joins the excretory duct of the seminal vesicle. Shape. It is a long, small, hard duct. The Surfaces are in relation: — In the Scrotum, with the ves- sels behind which it is situated ; — in the Inguinal canal the duct rests on the floor; — at the Internal Inguinal Orifice it becomes separated from the vessels ; — in the Pelvis it rests on the sides of the bladder, crossing the ureter ; — beneath the fundus it lies to the inner side of the seminal vesicles. The Outer Extremity is continuous with the canal of the epididymis. The Inner Extremity is continuous with the duct of the seminal vesicle — and forms with it the ejaculatory duct. Structure. The spermatic duct is very thick, with a small capillary channel. It is composed: — 1st, of a Fibrous Coat and — 2d, of a Mucous Coat lined by a stratified columnar epithelium. SPERMATIC CORD — E.TACULATORY DUCTS — PENIS. 4-'> SPERMATIC CORD. 115 Structure. The spermatic cord is composed of the 8pt r- matic duct, the spermatic artery, the spermatic veins, lym- phatic vessels, sympathetic nervous filaments; of areolar tissue and of a portion of the fibrous layer of the scrotum and cre- master muscle. SEMINAL VESICLES. 116 Shape. The seminal vesicles are flattened oval bodies. The Under Surface is convoluted — it is in relation with the rectum. The External Border is convex and sacculated. The Internal Border is in relation with the spermatic duet. The Posterior Extremity is rounded and free. The Anterior Extremity gives rise to the ejaculatory duct ; — it is in relation with the base of the prostate. The Upper Surface is in relation with the base of the bladder. Structure. The seminal vesicles are composed : — 1st, of an External Fibrous Coat; — 2d, of a Coarse Tube closed at its posterior extremity, convoluted into a mass presenting di- verticles ; — the walls of this tube are formed of a flbro-mus- cular coat lined by a reticulated mucous layer with cylin- drical epithelium. EJACULATORY DUCTS. 117 Shape. The ejaculatory ducts are conical tubes. The Surfaces and Borders are intimately adherent to the prostatic tissue. The Posterior Extremity communicates with the seminal vesicle and ejaculatory duet. The Anterior Extremity opens into the urethra by a slit- like orifice on the side of the utricle. Structure. The Ejaculatory ducts are composed of a Fibro- Muscular layer lined by Mucous Membrane. PENIS. 118 Structure. The penis is composed, from the surface to tin- deep parts : — 1st, of the Skin ; — 2d, of a Dartoic Layi >•; — 3d. of a Fibro-elastic Sheath binding together the three bodies forming the bulk of the penis ; — 4th. of the Two Cavi rnous Bodies composed of an external albugineous fibrous layer and of alveoles into which the capillary arteries open by a free extremity and from which the venous radicles origi- 44 MALE URETHRA — COWPER'S GLANDS. nate by a dilated extremity; — 5th, of the Spongy Body, which is traversed by the urethra ; — it pre- sents in front an expansion called the Glans Penis and one behind called the Bulb of the nrethra; — it has the same structure as the cavernous bodies, only the fibrous layer is thinner and the alveoles smaller. MALE URETHRA. 119 Dimensions. The male urethra measures from eight to ten inches ; — the prostatic measures one inch and a quar- " ter, — the membranous three-quarters of an inch — and the spongy about six inches. Diameters. The meatus is the narrowest part; — then it expands to form the Navicular Fossa — and contracts again along the spongy body ; — the membranous portion is nar- rower than the spongy but is dilatable; — the prostatic por- tion is the widest and is the most dilatable. Direction. In the flaccid state it presents two curves and re- sembles an italic #; — in the straightened or erect state there is but one curve, the permanent curve, with the concavity di- rected upwards ; — it extends from the bulb to the bladder, passing through the middle perineal fascia ; — it has its cen- tre a little behind the pubis. Shape. The urethra is cylindrical, in a general way. The External Surface adheres closely to the structures which it traverses. The Internal Surface presents in the spongy portion and on the upper wall principally blind pouches. — In the bulbous portion, on the floor, it presents the orifices of Couper's glands. — In the prostatic portion it presents on the floor also the urethral crest, the utricle, the opening of the ejacu- latory ducts and of the prostatic ducts. Structure. The urethra is composed : — 1st, Of a Mucous Membrane with a columnar epithelium and simple racemose glands; — 2d, Of a Fibro-elastic and Muscular Submucous Layer; — 3d, In its course from the bladder to the meatus, the canal thus constituted is reinforced by the organs which it traverses ; i.e.,. the prostate, membranous urethra and spongy body, which form additional coverings or walls. COWPER'S GLANDS. 120 Dimensions. Cowper's glands are about the size of a cow- pea. Situation. They are situated in the folds of the middle perineal fascia. Structure. They are racemose glands; — the ducts open on the floor of the bulbous urethra. PECULIARITIES OF THE .MALE ORGANS OP GENERATION. 4.") PECULIARITIES OF THE MALE ORGANS OF GENERATION. Peculiarities of the Scrotum. The thinness of the Skin is noticeable when not corru- gated (like the penis and lids). The Hair follicles are particularly large. The Dartoic Tunic corresponds to the subcutaneous areo- lar tissue in other situations. It is very abundant. It is mixed with smooth muscular fibres. Fat never accumulates in it (like the lids and penis). The Erythroid Tunic and Cremaster Muscle are unique. The Fibrous Tunic corresponds to the pericardium and to the dura mater. The Vaginal Tunic is peculiar in having been formed by the peritoneum. Peculiarities of the Testicles. Are unique. That one is larger and hangs lower than the other is peculiar. Their shape is unique. The thickness of the fibrous coat is peculiar. The presence of the Mediastinum is peculiar. The Mediastinal Ducts are unique. The division of the interior into alveoles is more marked here than anywhere else. The lobulated condition is shared by the kidneys. The diverticles on the seminiferous canalicules are unique. The sperm cells lining the canalicules are unique (the peptic glands recall this, i. e., the presence of peculiar cells lining some tubular glands). The Artery is peculiar for its origin so far away from the organ. — Also for its slender size. — Also for its close at- tachment to the spermatic duct. The Capillaries form a peculiar layer on the walls of the alveoles. The Lymphatics discharge in the pelvis glands. The Nerves are peculiar, and pressure on the organs pro- duces a characteristic sickening feeling. Peculiarities of the Epididymis. It is unique. It is the beginning of the excretory apparatus of lie- testicle, which comprises the mediastinal duct, the cones and canal of the epididymis, — the spermatic duct, the seminal vesicles, the urethra. Its shape is unique. Its fibrous coat is thick and unyielding (like the testicle and the sclerotic). 46 PECULIARITIES OF THE MALE ORGANS OF GENERATION. The spermatic cones are unique. The Canal of the Epididymis is unique. "•23 Peculiarities of the Spermatic Duct. It is remarkable for its length ; it is the longest of all ex- cretory ducts. Its independence from the veins and other parts of the spermatic cord is peculiar. It joins another duct (like the common bile duct). Its small size is peculiar. Also the thickness of its walls and its small calibre (like the parotid). The Spermatic Artery is closely attached to it. Its veins are loose and away from it. Peculiarities of the Spermatic Cord. It recalls the umbilical cord. Only, it has but one artery and several veins, whereas the umbilical cord has one single vein and several, i. e., two arteries. The Veins are loose and away from the spermatic duct. — They terminate on the right in the Inferior Cava and on the left into the Renal Vein. Peculiarities of the Seminal Vesicles. Are the analogues of the gall bladder and the urinary bladder. Their shape is peculiar. The sacculated or grooved appearance of their surface is peculiar. The partitioned appearance of the interior is unique. They possess smooth muscular fibres in their walls (like the gall bladder). Peculiarities of the Ejaculatory Ducts. They resemble the Common Bile Duct. They are peculiar in traversing the prostate gland itself. 124 Peculiarities of the Penis. It is unique in all respects. It corresponds to the female clitoris. The skin is thin (like the lids and scrotum). The Dartoic layer has not so many muscular fibres as the scrotum. The Two Cavernous Bodies are unique. — The Two Roots are peculiar. — Their Anterior Blunt Extremity is peculiar. — The absence of communication with the spongy body is peculiar. — Their Fibrous Coat is peculiarly thick and un- yielding (like testicle, epididymis, sclerotic). The Spongy Body is peculiar. — Its expansion anteriorly to form the glans and posteriorly to form the bulb is peculiar. The Structure of these three bodies is peculiar ; that of all erectile tissue (like the spleen). The Penis has two arteries to one vein. PERICARDIUM — HEART. 47 The Capillaries have ;i corkscrew course and terminate by opened extremities. The Capillaries Proper are replaced by the cavities of tie- erectile tissue. The Venous Capillaries begin by an open dilated ex- tremity. The Vein is unique. — It has no valves. The Lymphatics from the skin empty into the inguinal glands, while those of the deeper structures empty in the pelvic gland. The Nerves terminate in the glans in peculiar corpuscles. Peculiarities of the Hale Urethra. It is peculiar in its length. In its varying diameters (like the oesophagus). In its direction, presenting a changeable and a permanent curve. It is remarkable because it traverses three different struct- ures or regions. Its internal surface presents the blind pouches, also the urethral crest, the utricle, the slit-like openings of the ejaculatory ducts, the many openings of the prostate glands and openings of Cowper's glands. Peculiarities of Cowper's Glands. Are peculiar in their situation. Also because they correspond to the glands of Bartholin in the female. PERICARDIUM. 125 1st, The Fibrous Pericardium. Shape. The fibrous pericardium is conical. The Anterior Surface is in relation with the sternum. The Lateral Surfaces are in relation with the phrenic nerves, the pleura and lungs. The Base is closely attached to the aponeurotic diaphragm. The Apex surrounds the large vessels at the base of the heart. The Posterior Surface is in relation with the trachea. bronchi, oesophagus, aorta. 126 2d, The Serous Pericardium. Course. The serous pericardium invests the interior of the fibrous pericardium — it is then reflected upon the surface of the heart. HEART. 127 Shape. The heart is conical, a little flattened from before backwards. The Anterior Surface presents the anterior interventricu- lar and auriculo-ventricular grooves — the initial portions of the aorta and pulmonary artery.— the lefl and right auricular appendages. 48 PECULIARITIES OF THE ORGANS OP CIRCULATION. The Upper or Left Border is the sharpest. The Lower or Right Border is the broadest and is almost straight; — it rests upon the aponeurotic diaphragm. The Base is turned upwards and to the right ; it presents the pulmonary artery, the aorta, the descending cava, the upper or left pulmonary veins. The Apex or Point corresponds to the fifth intercostal space, a little below and to the right of the left nipple. The Posterior Surface presents the posterior interventric- ular and auriculo -ventricular grooves, the ascending cava, the great coronary vein and the two lower or right pulmo- nary veins. STRUCTURE OF THE HEART. 128 The heart is composed : 1st, of the Visceral Layer of the serous pericardium. 2d, of a Muscular Layer. — In the Auricles there is a su- perficial common circular layer and a separate loop-like set of fibres for each auricle, attached to the fibrous rings of the orifices; — there is a set of circular fibres around the orifices of the large veins. In the Ventricles there is the same arrangement, but at the apex the fibres penetrate into the ventricles and form the Fleshy Columns or Muscles. — The fibres are striated, are narrow and anastomose. 3d, of an Internal Serous Layer called the Endocardium, lining the interior of the cavities of the heart. In the Auricles, the Inner Wall presents the inter-auricular septum or oval fossa ; — the Outer Wall presents the orifice of the auricular appendage ; — the Anterior Wall presents nothing special ; — the Posterior Wall presents on the right side the orifice of the ascending and descending cava and on the left side the orifices of the pulmonary veins ; — the Lower Wall presents the auriculo -ventricular orifice and valve. In the Ventricles we find the Fleshy Columns or Muscles and Tendinous Cords ; — the Inner Wall forms the interven- tricular septum, — the Anterior and Posterior Walls and the Apex are covered with fleshy columns ; — the Base presents the auriculo-ventricular orifices and valves, the tricuspid on the right and the mitral on the left; — it presents also the Pulmonary and Aortic Orifices guarded each by a set of semi-lunar valves. PECULIARITIES OF THE CENTRAL ORGANS OF CIRCULATION. 129 Peculiarities of the Fibrous Pericardium. It is most peculiar and almost unique. Its walls resemble the fibrous tunic of the scrotum. RESPIRATORY ORGANS — LARYNX. 4!l It was rendered necessary here from the lack of any other support for the serous pericardium. Its base corresponds to the point of the heart. This base is attached to the aponeurotic diaphragm. The lateral surfaces are lined by a serous membrane, the pleura; it is therefore placed between two serous mem- branes. The phrenic nerves take support on the lateral surfaces. Peculiarities of the Heart. Is a unicpie organ in the body. The whole of it is peculiar and must be studied as such. A most peculiar feature is that although it is an organ which is not under the influence of our will, yet its fibres are striped fibres. Besides, those fibres are narrower than anywhere else. Also they anastomose, which is a unique instance. The arteries are numerous. They originate below the edge of the semilunar valves. They fill during ventricular diastole and by arterial sys- tole. They form two circles, one in the interventricular groove and the other around the base in the auriculo-ventricular groove. The veins form two groups. Those of the left heart centre into the Great Cardiac Vein, which presents an effective valve. It is the only vein of the heart having an effective valve. The right heart is drained by the peculiar veins of Thebe- sius. The Nerves come from the peculiar cardiac plexus. Three from the sympathetic and three from the cervical plexus. They present the Ganglion of Remak at the base of tin- heart. The inhibitory or moderating nerve is the sympathetic. RESPIRATORY ORGANS. 130 Enumeration. The organs of respiration are: the Larynx. Trachea, Bronchi, Lungs, Pleura, Thyroid Body and Thy- mus Gland. LARYNX. 131 Shape. The larynx is triangular and prismatic. The Base is turned upwards and corresponds t<» the hyoid bone. The Apex is turned downwards and is continuous with the trachea. The Anterior Border presents a projection called Adams Apple; it is subcutaneous. 4 50 STRUCTURE OF THE LARYNX. The Lateral Surfaces are in relation with the sterno-hyoidy omohyoid, thyro-hyoid and sterno-thyroid and the skin. The Lateral Borders give attachment to the pharynx. The Posterior Surface is situated in the lower portion of the pharynx. — It presents from above downward the Epi- glottis and its Folds (the middle and lateral glosso-epiglottic and the aryteno-epiglottic) — the orifice of the larynx, — a square surface, corresponding to the cricoid cartilage. The Interior of the Larynx presents the upper glottic space ; — the upper or false vocal cords, — the ventricle, — the lower or true vocal cords limiting the glottis or rima, — the inter- arytenoid space, — the inferior or lower glottic space. STRUCTURE OF THE LARYNX. 132 The larynx is composed: of bone, cartilages, fibro -cartilage, articulations, muscles, mucous membrane, vessels and nerves. 1st. The Bone is the hyoid. 2d. The Cartilages are the thyroid, cricoid, arytenoid, cuneiform and corniculate. 3d. The Fibro=Cartilage is the epiglottis. 4th. The Articulations of the larynx are the crico-thy- roid (median or anterior and lateral or posterior); — the crico-arytenoid, — the aryteno-thyroid (or ligaments of the true and the false vocal cords) ; — the ligaments of the epi- glottis, which are the hyo-epiglottic, the thyro-epiglottic, the aryteno-epiglottic, and the glosso-epiglottic. 5th. The Muscles are the crico-thyroid, — the thyro-epi- glottic,— the aryteno-epiglottic superior, — the aryteno-epi- glottic inferior, — the crico-arytenoid lateral, — the crico-aryt- enoid posterior, — the arytenoid. The muscle which opens the glottis is the crico-arytenoid posterior. The muscles which close the glottis are the arytenoid and the crico-arytenoid lateral. The muscle which tenses and elongates the vocal cords is the crico-thyroid. The muscle which relaxes and shortens the vocal cords is the thyro-arytenoid. 6th. The Mucous Membrane is lined by a ciliated epithe- lium— it has numerous simple racemose glands. 7. The Nerves of the Larynx are : 1st, the Superior Laryngeal, distributed to the crico-thyroid and to the mucous membrane ; — 2d, the Inferior or Recurrent Laryngeal, distrib- uted to all the other muscles and also to the mucous mem- brane. TRACHEA — BRONCHI. •">! TRACHEA. 133 Shape. The trachea is cylindrical, but flattened behind. The Anterior Surface presents ridges and grooves corre- spondingto the cartilages and their spaces. — It is in relation in the neck with the isthmus of the thyroid body, the middle thyroid artery aud vein, the fascia and skin ; — in tin chest, with the left innominate vein, the arch of the aorta and the pericardium. The Lateral Surfaces present also ridges and grooves. They are in relation — in the neck with the lobes of tin- thy- roid body, the sterno-thyroid, the sterno-hyoid, the carotid and the recurrent laryngeal; — in the chest on the right with the innominate artery, the right carotid, and on the left with the left carotid and the arch. The Upper Extremity is continuous with the trachea. The Lower Extremity divides into the right and left bronchi. The Posterior Surface is flattened; — it has no rings and is membranous. — It is in relation all along with the oesoph- agus and pneumo-gastric nerves. 134 Structure. The trachea is composed : 1st, of Cartilaginous Segments connected by Fibrous Tissue; — 2d, the Posterior Wall is altogether membranous; — 3d, of a layer of Trans- verse, smooth muscular fibres; — 4th, of a layer of Longitudi- nal elastic fibres; — 5th, of a Mucous layer with a ciliated epithelium — and provided with simple racemose glands. BRONCHI. 135 Shape. The Bronchi are cylindrical, but flattened behind. The Anterior Surface presents cartilaginous ridges and fibrous interstices. — It is in relation with the pericardium, pulmonary artery aud veins, and bronchial artery and veins ; — the right is in relation with the descending cava. The Upper Surface on the right is arched over by the great azygos vein, — and on the left by the arch of the aorta. The Under Surface gives attachment to the ligamenl of the bronchi and to the broncho-phrenic ligament. The Posterior Surface is flat and membranous. — It is in relation on the right with the azygos vein and on the left with the aorta. The Internal Extremity is continuous with the trachea. The External Extremity penetrates into the lung. — where it divides diehotomouslv. each division ending in a dilated extremity which forms the pulmonary lobule. 136 Structure. The Large or Extra-Pulmonary Bronchi have the same structure as the trachea. — The Medium-sized Bron- chi have also the same structure, hut the cartilage segments form complete rings. — In the Smaller Bronchiihe cartilages 52 LUNGS — PLEURA. gradually disappear. — In the Terminal &nd.mCapillary Bronchi, there exists only a fibro-elastic layer with circular smooth fibres and a lining mucous membrane. LUNGS. 137 Shape. The lungs are conical. The External Surface is convex; — it presents the interlo- bar fissures dividing the right lung into three lobes and the left into two lobes. The Internal Surface is concave; — it presents near the middle a deep groove, the Mlum through which the bronchi, the veins and the pulmonary artery, the bronchial artery and the nerves penetrate into the lung and the correspond- ing veins and the lymphatics come out ; — all those elements are surrounded by the pleura and form the root or pedicle of the lung. The surface behind the hilum corresponds to the posterior mediastinum. The surface in front corresponds to the pericardium and heart. The surface above to the superior mediastinum. The Anterior Border is thin and rests on the pericardium. The Base .or Under Surface corresponds to the dia- phragm. Th,e Apex extends above the level of the first rib into the supra-clavicular region, — where it is in relation with the large vessels and nerves of that region. The Posterior Border is thick — it lies on the side of the vertebral column. 138 Structure. The lungs are composed: — 1st, of a Serous or Pleural Coat ; — 2d, of a Fibro-elastic Coat situated under- neath it; — 3d, the Proper Tissue is composed of alveoles called lobules, which may be considered as the dilated ter- mination of the capillary bronchi; — the interior of the lob- ules present innumerable small depressions or pouches, which are the air vesicles. — The walls of the lobules and air vesicles are formed of delicate connective and elastic tis- sue;— they are lined by delicate epithelial plates; — 4th, the Arteries are the pulmonary and the bronchial or nu- trient ; — 5th, the Veins are the bronchial and the pulmo- nary. PLEURA. 139 Shape. The pleura has the shape of a conical bag. The External Surface lines the walls of the chest and is then reflected on the lungs. The Internal Surface is reflected upon itself. PECULIARITIES OF THE ORGANS OF RESPIRATION. 53 PECULIARITIES OF THE ORGANS OF RESPIRATION. 140 Peculiarities of the Larynx. It is a unique organ in the body. The whole of it is peculiar and must be studied as such. The True Vocal Cords are its most peculiar poiuts. The Ventricle of the larynx is also remarkable. The Connective Tissue of the epiglottic fibres must be noticed. The Arytenoid Cartilages are the centre or pivol of the whole larynx, because the vocal cords are attached to them behind, and because of this, almost all the importanl mus- cles of the larynx are attached to them. The Cricoid is the first ring of the trachea. The Nerves are peculiar. — The Inferior Recurrent Laryn- geal nerve specially by its origin, its course, its termina- tion. 141 Peculiarities of the Trachea. Is a unique organ. Its elasticity is remarkable. The flat part of its posterior surface is remarkable. The presence of the inferior recurrent laryngeal nerve in the groove is noticeable. The alternating of incomplete cartilaginous rings and of fibrous rings is peculiar. The presence of transverse muscular fibres posteriorly is noticeable. Peculiarities of the Extra=Pulmonary Bronchi. All the above remarks apply to them. Besides, that the right bronchus is larger, more horizontal than the left, is remarkable. Peculiarities of the fledium Intra=Pulmonary Bronchi. Are peculiar because their cartilaginous rings encircle the whole diameter of the tube, but this cartilage is broken up into several segments. Peculiarities of the Smaller Intra=Pulmonary Bronchi. The cartilages disappear gradually. Peculiarities of the Terminal or Capillary Bronchi. They possess smooth muscular fibres. They terminate by a dilatation which forms the pulmonary lobules. Peculiarities of the Lungs. Their shape is peculiar (like the supra-renal capsules). Also their difference in size. Their divisions in lobes is peculiar. The uneven number of the lobes is peculiar. The hilum is one of the best marked. The large blood vessels are all in front of the bronchi. The Apex extending above the first rib into the supra- clavicular space is noticeable. 54 THYROID BODY. The structure is peculiar. They may be considered as compound racemose glands, the air vesicles representing the acini. The tissue forming them is noticeable ; all fibrous and elastic. The air vesicles are lined by the peculiar epithelial plates. It has two separate peculiar Circulatory Currents, the Pulmonary and the Bronchial. The size and course of the Pulmonary Artery is remark- able, its termination unique. The presence of four Pulmonary Veins to one artery is unique; — the Veins carry red blood. The capillaries form three plexuses around the lobules. The Bronchial Arteries are remarkably small, because they are only the nutrient arteries and the lungs being very porous contain but little solids and these are formed of tis- sues requiring but very little nutrition. They do not form a part of the lobular plexuses. The Bronchial Veins open into the Azygos and into the Superior Intercostal. The Lymphatics open into the bronchial glands at the bifurcation of the trachea. 142 Peculiarities of the Pleura. Is the most extensive serous membrane next to the peri- toneum. The two pleurae limit the four mediastina. ISTHMUS OF THE THYROID BODY. 143 Shape. The Isthmus is quadrilateral. The Anterior Surface is in relation with cervical fascia and skin. The Upper Border gives rise to the pyramidal process, which ascends to the hyoid bone. The Lower Border receives the middle thyroid artery when it exists. The Lateral Borders are continuous with the lobes. The Posterior Surface is firmly attached to the trachea. LOBES OF THE THYROID BODY. 144 Shape. The lobes of the thyroid body are conical. The External Surface is covered by the sterno-hyoid and omo-hyoid. The Outer Border is in relation with the carotid, the jugu- lar, the pneumo -gastric. The Inner Border is attached below to the isthmus, — but above it is separated from its fellow by the trachea. The Apex is turned upwards. THYMUS — MEMBRANES OF THE BRAIN. 55 The Base is turned downwards and projects beyond the isthmus. The Internal Surface is in relation with the trachea, the cricoid and thyroid cartilages and the recurrent laryngeal nerve. 145 Structure. The thyroid body is composed: — 1st, of an External or Fibrous Coat; — 2d, of a Proper Tissut composed of alveoles resembling closed spaces or vesicles lined by a single layer of cells and filled with a granular fluid. 4 THYMUS. 146 Shape. The thymus consists of a pair of unequal lateral lobes, sometimes connected by a short isthmus. The Anterior Surface is in relation with the sternum. The Posterior Surface is in relation with the aorta, the pulmonary artery, the pericardium, the left innominate vein and the trachea. Structure. The thymus is composed: — 1st, of an External or Fibrous Coat; — 2d, of a Proper Tissue divided into hollow lobules attached to a hollow stem; — the walls of the lobules are formed of a Cortical and a Medullary portion. — Both portions are composed of alveoles containing lymphoid ct Us and peculiar concentric bodies. 147 Peculiarities of the Thyroid Body. Its color is peculiar. Its shape also: two lobes and an isthmus (like the thy- mus). It presents the peculiar pyramidal process. The adhesion of the isthmus to the trachea is peculiar. Its structure is peculiar, as presenting closed vesicles lined by a single layer of cells and filled with a granular fluid. It has five arteries of good size. They strike the orgau at the angles. Peculiarities of the Thymus. The older the subject the smaller the organ. The situation is peculiar. Its irregular shape is peculiar; sometimes it presents two lobes united by a sort of isthmus. Its structure is unique: hollow lobules attached to a hol- low stem. However, the structure of the walls of the lobules is fund- amentally the same as the other lymphoid organ (a cavity is found also in the supra-renal capsules: also in the pitu- itary body; vesicles are found in the thyroid body). MEMBRANES OF THE BRAIN. 148 Enumeration. The Brain is surrounded by the Dura Mater, the Arachnoid, the Sub-arachnoid Space with the Cerebro-spinal Fluid, and the Pia Mater. 56 CEREBRAL DURA MATER — ARACHNOID — PIA MATER. CEREBRAL DURA MATER. 149 Shape. The Dura Mater lias the shape of an irregular sac. The External Surface adheres closely to the bones; — it presents the branches of the middle meningeal artery. The Internal Surface is pearl-like; — it is lined by the arachnoid. It presents the cerebral falx, the cerebellar falx, the ten- torium. It presents also the sinuses of the dura mater, which are the superior longitudinal, the inferior longitudinal, the straight, the posterior occipital, the lateral sinuses, the anterior occipital or transverse, — the inferior petrosal, the superior petrosal, the cavernous and the circular. Structure. The dura mater is composed: — 1st, of an Ex- ternal layer corresponding to the periosteum; — 2d, of a Middle purely fibrous; — 3d, of an Internal or Serous layer corresponding to the arachnoid. CEREBRAL ARACHNOID. 150 Shape. The Cerebral Arachnoid is a shut sac. The External Surface, on the parietal portion, lines the dura mater y — on the visceral or cerebral portion it is sepa- rated from the pia mater by areolar tissue and the cerebro- spinal fluid ; — it passes over the sulci and eminences of the brain like a bridge, The Internal Surface is reflected upon itself. The Cavity of the Arachnoid contains no fluid. CEREBRAL SUB-ARACHNOID SPACE AND CEREBRO-SPINAL FLUID. 151 Shape. Is a fluid layer in which the brain and spinal cord float. CEREBRAL PIA MATER. 152 Shape. The Cerebral Pia Mater resembles an irregular sac. The External Surface is in contact with the sub-arachnoid areolar tissue and fluid. The Internal Surface is in relation with the cortical sub- stance of the brain. — It dips down between the convolu- tions. Structure. The pia mater is formed essentially of the finest capillaries, held together by very delicate fibres of connective tissue. THE BRAIN — CEREBRUM — CALLOUS BODY. 57 THE BRAIN. 153 Enumeration. The Brain comprises the Cerebrum, the Cerebellum, the Varolian Bridge ami tin- Oblong Medulla. The Cerebrum comprises the two hemispheres, the three lobes, anterior, middle, posterior, the pituitary body, the white bodies, the cerebral peduncles, the callous body, the fornix, the interposed veil, the pellucid septum, the ven- tricles, the pineal gland and the quadrigeminal bodies. CEREBRUM. 154 Shape. The Cerebrum resembles the half of an ovoid. The Upper or Convex Surface presents the longitudinal fissure and the hemispheres covered with convolutions. The Under Surface or Base presents, — on the middle Urn . the anterior extremity of the longitudinal fissure and of the callous body, the optic nerves, the pituitary processes and body, the white bodies, the cerebral peduncles, the inter- peduncular space, the posterior perforated space, the pos- terior extremity of the callous body, the posterior extremity of the longitudinal fissure. It presents on the sides the under surface of the hemi- spheres, the olfactory nerves, the anterior perforated space, the Sylvan fissure enclosing the Island of Reil, the anterior or frontal lobe, the temporo-sphenoidal lobe, the posterior or occipital lobe. The Anterior or Small Extremity is in relation with the frontal fossa. — It presents the longitudinal fissure. The Posterior or Large Extremity is in relation with the posterior cerebral fossa, cerebral falx and the tentorium. Structure of the Cerebrum. The Grey Matter exists on the surface of the convolutions, in the cavity of the venl ri- des, and in the optic beds and striated bodies. The White Matter consists of longitudinal and transverse fibres. The Grey Substance of the Convolutions is formed of sev- eral layers of nerve cells of different sizes and colors. The Capillaries are very abundant in the grey matter and comparatively few in the white ; — they present a character- istic arborescent arrangement. The Peduncles of the Cerebrum are composed of three layers of longitudinal fibres coming from the cerehellum and oblong medulla, and of a layer of grey matter. CALLOUS BODY. 155 Shape. The Callous Body is quadrilateral. The Upper Surface is convex and striated. — It is free in the middle, where it is seen as a bridge connecting the two hemisphei-es. 58 CAVITIES OF THE CEREBRUM — TRIGONE OR FORNIX. The Anterior Border or Extremity is continuous with the optic nerves, — it closes in front the cavity of the brain; — it presents the anterior angles or horns, which are prolongations of the lateral ventricles. The Posterior Border or Extremity is free ; it leaves the cavity of the brain open beneath it. — It presents the pos- terior angles or horns, which are prolongations of the lateral ventricles. The Under Surface is concave. — It adheres to the trigone or fornix in the middle, — on the sides it forms the roof of the lateral ventricles. The Lateral Borders pass downwards and inwards into the white substance of the hemispheres. — They present the lateral angles or horns, which are also prolongations of the lateral ventricles. Structure. The callous body is composed of transverse white fibres. CAVITIES OF THE CEREBRUM. 156 Boundaries and Divisions. The interior of the cerebrum presents a large cavity bounded below by the base of the cerebrum, above by the callous body, and laterally by the hemispheres. This large cavity is subdivided by two transverse septa, represented by the trigone and interposed veil, into a lower story called the middle or third ventricle, and into an upper story which is itself subdivided into two lateral halves by the pellucid septum and the trigone, called the two lateral ventricles of the cerebrum. TRIGONE OR FORNIX. 157 Shape. The trigone is triangular when seen from above. The Upper Surface — in the middle is adherent to the cal- lous body and pellucid septum ; — on the sides it forms a part of the floor of the lateral ventricles. The Borders are attached to the interposed veil and to the optic beds. Tho Apex presents the two anterior pillars which limit in front the foramen of Monro, — they terminate in the white bodies, or corpora albicantia. The Base presents the two posterior pillars which curve for- ward into the lateral horns. The Under Surface is broad behind and narrow in front. — It is in relation with the interposed veil and forms with it the roof of the middle ventricle. Structure. Is composed of white substance throughout. INTERPOSED VEIL — PELLUCID SEPTUM — LATERAL VENTRICLES. 59 THE INTERPOSED VEIL. 158 Shape. The Interposed Veil is triangular. The Upper Surface is attached to the trigone and forms in part the floor of the lateral ventricles. The Lateral Borders are attached to the optic beds. The Apex sends a process through each foramen of Monro. The Base is continuous with the pia mater. The Under Surface presents the choroid plexus and the veins of Galen. Structure. It has the same structure as the pia mater. PELLUCID SEPTUM. 159 Shape. The Pellucid Septum is triangular. The Lateral Surfaces form the inner walls of the lateral ventricles. The Upper Border is attached to the under surface of the callous body. The Lower Border is attached to the trigone. The Base is attached to the anterior extremity of the cal- lous body. The Apex occupies the angle formed by the callous body and the trigone. Structure. The pellucid septum encloses a small cavity called the Septal Ventricle or Fifth Ventricle, — the inner walls of which are lined with grey matter; — the outer walls are formed of white substance. — The cavity sometimes com- municates with the middle ventricle by the Aqueduct of Vieus- sens or Winslow. LATERAL VENTRICLES. 160 Shape. The Lateral Ventricles are flattened from above downwards. The Upper Wall or Roof is formed by the callous body. The Lower Wall or Floor is formed by the trigone and the interposed veil resting on the optic beds. The Inner Wall is formed behind by the adhesion of the trigone to the callous body and in front by the pellucid sep- tum. The Outer Wall is formed by the intra- ventricular portion or nucleus of the Striated Body. — It gives rise to the Middh Horn, which is the longest and which curves forward and inward into the sphenoidal lobe; — Its floor presents the Great Hippocampus, presenting along its inner border the fimbriated body and the dentated band; — the floor presents also another small eminence, the Small Hippocampus. The Anterior Extremities of the lateral ventricles are the Anterior Horns. 60 MIDDLE VENTRICLE — PINEAL GLAND — QUADRIGEMINAL BODIES. The Posterior Extremities are the Posterior Horns. Structure. The Striated Bodies are composed of two len- ticular nuclei separated by the diverging fibres of the cere- bral peduncles ; — below are found the tonsillar nucleus and the claustrum. The Hippocampus is an inverted convolution with the grey substance in the centre. MIDDLE VENTRICLE. 161 Shape. The Middle Ventricle is funnel-shaped aud flat- tened laterally. The Upper Surface or Roof is formed by the interposed veil and trigone. The Lower Surface or Floor is formed by the ehiasma, the infundibulum, the white bodies, the posterior perforated space and the cerebral peduncles. The Anterior Surface or Wall is formed by the callous body, the anterior pillars of the trigone and the anterior white commissure. The Posterior Surface or Wall presents the orifice of the aqueduct of Sylvius — and the posterior white commissure. The Lateral Surfaces or Walls are formed by the Optic Beds, which are lined with grey matter and present the grey commissure-, — the anterior tubercle, — the posterior tubercle — and the internal and external geniculate bodies — con- nected with the quadrigeminal bodies. Structure. The Optic Beds are lined on their free surface by grey matter and contain also a mass of grey matter traversed by the fibres of the cerebellum. PINEAL GLAND. 162 Shape. The Pineal Gland is conical. The Upper Surface is in relation with the pia mater and the posterior border of the callous body. The Base gives attachment to the peduncles of the pineal gland. The Apex is turned backwards and is free. The Under Surface is in relation with the quadrigeminal bodies. Structure. The pineal gland is composed chiefly of grey matter ; it has a small cavity often containing sandy matter. QUADRIGEMINAL BODIES. 163 Shape. The Anterior or Nates are oblong; — the Posterior or Testes are hemispherical bodies. The Surfaces are smooth. CEREBELLUM — VAROLIAN URIIN ill. 61 The Internal and External Extremities are connected with the geniculate bodies. Structure. The quadrigeminal bodies arc formed of white substance enclosing a little grey matter. CEREBELLUM. 164 Shape. The cerebellum is oblong and flattened from above downwards. The Under Surface presents laminae and grooves. It presents on the middle line, the valley, the inferior ver- miform process with the nodule, the uvula, pyramid, fur- rowed bands, the valves of Tarini and the swallow's nest. It presents on the sides, the hemispheres, the posterior, middle and anterior lobe, the tonsillated lobules and the flocculus. The Circumference of the Cerebellum presents behind a notch to receive the falx — and on the sides a deep hor- izontal fissure. The Upper Surface presents also laminae and grooves, — the superior vermiform process, — the valve of Vieussens, — the superior peduncles of the cerebellum, — the hemispheres of the cerebellum. 165 Structure. The surface of the cerebellum is composed of grey matter — and the interior of white substance mostly. — However, it contains in its interior a capsule of grey matter called the dentated body. — The arrangement of the grey matter as viewed upon a section is that of a tree, the arbor vitce. The grey matter of the laminae comprises an external grey layer of molecular matter, — a middle layer of ganglionic cells of Purkinje, — of an internal rust layer. — a nuclear layer, — and of abundant arborescent capillaries. VAROLIAN BRIDGE. 166 Shape. The Varolian Bridge is a quadrilateral white body. The Anterior Surface is convex ; — it presents a groove for the basilar artery; — it is in relation with the basilar pro- cess of the occipital bone. The Lateral Surfaces give origin to the middle peduncles of the cerebellum. The Upper Surface is connected with the cerebral peduncles. The Under Surface is connected with the oblong medulla. The Posterior Surface forms the upper part <>f the floor of the cerebellar ventricle. Structure. The Varolian Bridge is composed of alternate layers of grey and white substance, containing vertical and transverse fibres. 62 OBLONG MEDULLA — VENTRICLES — EPENDYMA. OBLONG MEDULLA. 167 Shape. The Oblong Medulla is pyramidal. The Anterior Surface presents the anterior median fissure, — the pyramidal body, — the olivary body, — the groove of origin of the hypoglossal nerve, — the arciform fibres — and the lateral tract. The Lateral Surfaces present the restiform bodies. The Posterior Surface presents the lower portion of the floor of the cerebellar ventricle, — the posterior median fissure, — the posterior pyramids. The Base is continuous with the Varolian Bridge. The Apex is continuous with the spinal cord. 168 Structure. The Grey Substance of the oblong medulla is situated on the floor of the cerebellar ventricle, in the oli- vary bodies and at the bottom of the lateral tract. — The olivary bodies contain a dentated body. The White Substance is composed of longitudinal and trans- verse fibres and of the arciform fibres. The anterior pyramids decussate partially. CEREBELLAR VENTRICLE. 169 Shape. The Cerebellar Ventricle, or Fourth Ventricle, is lozeng-eshaped. The Upper Surface or Roof is formed above by the valve of Vieussens, the superior peduncles of the cerebellum and the under surface of the cerebellum, — which itself presents the nodule, the uvula and the tonsils ; — below it is formed by the reflected pia mater and arachnoid. The Anterior Surface or Floor is formed above by the pos- terior surface of the Varolian Bridge and below by the ob- long medulla. — It presents the posterior median fissure, grey matter, transverse white fibres, the calamus scriptorius. The Upper Angle or Extremity presents the aqueduct of Sylvius. The Middle or Lateral Angles present the point of exit of the fibres of origin of the auditory nerve. The Lower Angle or Extremity presents an opening formed by the reflected pia mater and arachnoid. EPENDYMA. 170 Definition. The Ependyma is the delicate transparent serous membrane lining all the ventricles. COMMUNICATION OF THE VENTRICLES. 171 1st. The Septal Ventricle sometimes communicates with the middle ventricle by the aqueduct of Vieussens ; — the Middle Ventricle communicates with the Lateral by the for- PECULIARITIES OF THE CENTRAL ORGANS OF INNERVATION. 63 amen of Monro ; — also with the Cerebellar ventricle by the aqueduct of Sylvius. 2d. The Lateral Ventricles communicate with the anterior sub-arachnoid space through the transverse fissure of the brain ; the Cerebellar communicates with the posterior sub- arachnoid space through the opening of the lower angle. PECULIARITIES OF THE CENTRAL ORGANS OF INNERVATION. 172 Peculiarities of the Cerebral Dura Mater. Its pearl-like color is remarkable. Its shape is noticeable. Also its loose adhesion to the bones of the vertex and its strong attachment to the bones of the base. The presence of the large Middle Meningeal Artery is no- ticeable. It is lined by a serous membrane (like the pericardium). The processes called the falx and the tentorium are unique. Also the numerous venous sinuses. The sinuses are all at the base except the superior and inferior longitudinal. The Cavernous Sinus is traversed by the internal carotid and several nerves. They communicate with the extra cranial veins at several points. Its purely fibrous structure, lined by a serous membrane, is noticeable. Peculiarities of the Cerebral Arachnoid. It passes over the sulci like a bridge. It forms subserous spaces. It contains no fluid. Peculiarities of the Cerebro=Spinal Fluid. It is unique. It is rendered necessary because the brain is encased in an unyielding bony case ; this in its turn is rendered neces- sary because of the exposed situation of the brain. Peculiarities of the Cerebral Pia Mater. It is the analogue of the periosteum of bones. It dips down between the convolutions. It penetrates into the brain and forms the interposed veil. Its structure is remarkable. 173 Peculiarities of the Cerebrum. Its grey color is peculiar, — also the white .-nidi' of most parts. Its shape is unique. Also the longitudinal fissure, the hemispheres, the con- volutions, the sulci. Its sylvian fissure and the division of each hemisphere into lobes recalls that of the lungs. 64 PECULIARITIES OF THE CENTRAL ORGANS OF INNERVATION. Its base is the most important and noticeable part, be- cause there we find the peculiarities and the large nerves and vessels. The Island of Reil, at the bottom of the sylvian fissure, is unique. The presence of the large Ganglionic Cells of Purkinje are peculiar. The Arteries form the Circle of Willis and are found at the base. No large arteries penetrate its tissue : they first break up in the pia mater. The Veins of the surface discharge into the Superior Longitudinal Sinus. Those of the interior into the Straight Sinus. The Capillaries of the convolutions present a character- istic arborescent arrangement. Peculiarities of the Peduncles of the Cerebrum: are unique. Peculiarities of the Callous Body: are unique. However, it may be considered as an isthmus joining two lobes. The absence of grey matter in its substance is noticeable. 174 The Peculiarities of the Cavities of the Cerebrum. They correspond to those of the heart. The communication with the surface is through the trans- verse fissure. This transverse fissure is the only opening. The presence in these cavities of masses of grey matter (the striated bodies and the optic beds) is remarkable. The separation of these cavities by the trigone, the inter- posed veil, the pellucid septum is unique. The presence of a cavity in the septum is unique. The lateral Horns of the Lateral Ventricles winding around the peduncles are noticeable. 175 Peculiarities of the Pineal Gland. It is unique. Its cavity containing sandy matter is unique. Peculiarities of the Quadrigeminal Bodies. They are also unique. Their connection with the optic beds is noticeable. Peculiarities of the Cerebellum. Its size is remarkable. Its color also. Also its peculiar shape. Also some of its peculiarities : specially the valves of Tarin, the swallow's nest, the peduncles, the valve of Vieussens. The lamella? replacing here the convolutions are notice- able. They have the same structure and the same capillaries as the convolutions. SPINAL CORD. (J.-. The presence of the Arbor Vitae aud of the dentated body is peculiar. Peculiarities of the Varolian Bridge. It is unique. Its situation at the junction of the other parts of the brain which it unites is remarkable. Its white color is noticeable. The direction of its fibres in its substance is noticeable. The large Basilar artery resting on it is to be noted. Peculiarities of the Oblong Medulla. Its white color is peculiar (like varolian bridge, cerebral peduncles). Its size, the smallest of all the parts of the brain, is to be noted. The origin from it of numerous most important nerves is noticeable. The decussation of its fibres is unique. Peculiarities of the Cerebellar Ventricle. Its situation between the Varolian Bridge and the Oblong Medulla is peculiar. Its size also is peculiar. Its shape, lozenge- shape, is remarkable. The presence of grey matter on its floor is noticeable. Also the origin there of the auditory nerves. 176 The Communication of the Ventricles. They communicate between themselves and with the ex- terior of the brain, through the Aqueduct of Winslow. the foramen of Monro, the Aqueduct of Vieussens, the Trans- verse Fissure of the brain and the lower angle of the cerebel- lar ventricle. MEMBRANES OF THE SPINAL CORD. 177 Enumeration. The envelopes of the spinal cord are the Dura Mater, the Arachnoid, the Cerebro-spinal Fluid and the Pia Mater. DURA MATER OF THE SPINAL CORD. 178 Shape. The dura mater of the spinal cord has the shape of a long tube. The External Surface is unattached to the periosteum. — It gives attachment to the dentated lif/aiin »f of the cord. The Upper Extremity is attached to the occipital fora- men. The Lower Extremity is closed and is attached to the sacrum. Structure. It is composed of simple fibrous tissue 5 66 CEREBROSPINAL FLUID — SPINAL CORD. ARACHNOID OF THE SPINAL CORD. 179 Shape. The arachnoid of the cord resembles a long double tube. The External Surface lines the dura mater and is then re- flected upon the cord. The Internal Surface is reflected upon itself. The Upper Extremity is continuous with the cerebral arachnoid. The Lower Extremity forms a closed bag around the mare's tail. Structure. It is a purely serous membrane. CEREBRO-SPINAL FLUID. 180 The Cerebro=spinal Fluid forms a regular layer around the cord, specially during the arterial diastole of the brain. PIA MATER OF THE SPINAL CORD. 181 Shape. The Pia Mater of the spinal cord has the shape of a tube. The External Surface gives off the dentated ligament to the dura mater — and sends off a prolongation or sheath around each nerve. — It is in relation with the sub-arachnoid areolar tissue and the cerebro-spinal fluid. The Internal Surface adheres intimately to the cord, which seems compressed by it. The Upper Extremity is continuous with the pia mater of the brain. The Lower Extremity presents the coccygeian ligament. Structure. It is more fibrous and less vascular than the cerebral pia mater. SPINAL CORD. 182 Shape. The Spinal Cord is cylindrical with a cervical and a lumbar enlargement. The Posterior Surface presents the posterior median As- sure,— the posterior white commissure, — the posterior col- umns (or postero-lateral columns). The Lateral Surfaces present the antero-lateral fissure, — the lateral columns, — the postero-lateral fissure. The Upper Extremity is continuous with the oblong me- dulla— it presents the neck; — it corresponds to the occipi- tal foramen. The Lower Extremity is pointed ; — it gives attachment to the caudal ligament. The Anterior Surface presents the anterior median fis- sure,— the anterior white commissure, — the anterior col- umns of the spinal cord. NOSE. 67 183 Stiucture. The spinal cord is composed externally of white substance. Internally, of grey substance, having- the shape of two cres- cents united by a transverse grey band; — the extremities of the crescents are called the horns and correspond to the ori- gin of the nerves ; — the anterior horns have large multipolar cells — and the posterior horns small multipolar cells ; — the processes all communicate with one another and with the fibres of the white substance. 184 Peculiarities of the Dura Mater of the Spinal Cord. Its shape is peculiar — that of a long tube. It is unattached to the bones except at the foramens. It presents the peculiar dentated ligament. Peculiarities of the Arachnoid of the Spinal Cord. Its shape is peculiar ; that of a long tube. It forms a closed bag around the mare's tail. Peculiarities of the Cerebro=Spinal Fluid. Is only present during the arterial diastole of the brain. Peculiarities of the Pia Mater of the Spinal Cord. Its shape is peculiar. It presents the dentated ligament and the caudate liga- ment. It seems to constrict the cord. It is more fibrous and less vascular. 185 Peculiarities of the Spinal Cord. It is unique. Its color is peculiar. Its length also; it stops at the second lumbar vertebra. Its shape is peculiar. Its grooves and fissures are peculiar, — specially the respiratory tract in the cervical region. The presence of the Caudate Ligament is peculiar. Its structure is unique. The White matter is on the outside. The Grey matter is in the interior and forms two crescents joined by a transverse band. The arrangement of the nerve cells is peculiar. No large artery penetrates its substance. The Capillaries are characteristic. NOSE. 186 Shape. The nose is a pyramidal eminence. The Anterior Border is called the bri External Ocular Motor or sixth nerve, and the Superior Oblique, which receives the pathetic or fourth nerve. EYELIDS. 207 Structure. The Eyelids are composed: — 1st, of a Cu- taneous layer; — 2d, of a Muscular layer formed by the orbic- ular;— 3d, of a Fibro-Cartilaginous layer formed by the two tarsal cartilages and the broad ligament; — 4th, of a , Tendinous Layer in the upper lid only, formed by the ex- panded tendon of the elevator muscle of the upper lid ; — 5th, of a Mucous Layer or conjunctiva forming the carun- cula, the semilunar folds and the lachrymal lake; — 6th, of Glands which are the glands of the skin (sweat and seba- ceous), the glands of the free margin (which are the ciliary glands on the anterior lip and the Meibomian glands on the posterior lip and the caruncula), — the glands of the con- junctiva, which are simple racemose glands. EYEBROWS. 208 Structure. The Eyebrows are formed: — 1st, of Hairs ; — 2d, of Skin; — 3d, of the Superciliary Muscle; — 4th, of the Superciliary Eminence of the Frontal Bone. LACHRYMAL APPARATUS. 209 Enumeration. The tears are secreted by the Lachrymal Glands, situated in the upper and outer part of the orbit and lid; — they are discharged through fine Excretory Darts on the outer part of the upper eyelid. The Orbicular Muscle spreads them over the cornea, and at the same time directs them towards the Lachrymal Lake at the internal angle of the eye. They are absorbed there by the Lachrymal Points, — and conducted into the Lachrymal Canals, which are situated in the substance of the two direct tendons of the orbicular. — They are then discharged into the Lachrymal Sac, the outer wall of which is membranous, — and then into the Nasal .Canal and the Inferior Meatus. 210 Peculiarities of the Eyeball and Envelopes. Is unique. Peculiarities of the Cornea. Is irregular. Its continuation with the sclerotic is unique. The presence of the Elastic Laminae is peculiar. The Corpuscles are noticeable (like bone, cement, tendon. connective tissue). The fluid between the meshes is remarkable (like the vit- reous body). The absence of capillaries is remarkable. 74 LACHRYMAL APPARATUS. Peculiarities of the Sclerotic. It is peculiar for its color (like the albugineons of testicle). Also its shape (like a shell). The insertion of muscles to it is unique. The perforations for the vorticose veins are unique. The perforation for the optic nerve also. Its continuation with the cornea is unique. The brown color of the inner surface is unique. Its unyielding structure is remarkable. Peculiarities of the Choroid. It is peculiar for its color (like the iris). Also for presenting the choroid zone. Also the ciliary Processes". Also the ciliary ligament. Its clean cut perforation by the optic nerve is noticeable. The difference in the outer and inner pigment cells is re- markable. Its great vascular structure is rare (like the iris). The Arteries are the very numerous posterior short ciliaries. The Veins form the peculiar unique Vorticose Veins. The Capillaries form a special membrane, the membrane of Ruysch, whose vessels are stellate. The Nerves are abundant. Peculiarities of the Retina. It is peculiar by its color in the dead. Also its thorough transparency in the living. Its thinness is noticeable. Its anterior serrated extremity is unique. Its continuation behind with the optic nerve is unique. Also the optic papilla with the vessels emerging from it. Also the transverse fold and the yellow spot. Also the numerous layers, specially considering the thin- ness of the membrane. The Stroma is peculiar and unique (like the spinal cord). Also its pigmentary layer (as in the choroid). Also its limiting membranes (as in dermis and cornea). Also its layers of Rods and Cones, unique. Also the nuclear layers (as in cerebellum). Also the Ganglionic Cells. Also the layers of the Optic Nerve Fibres. The Central Artery and Veins are unique. 211 Peculiarities of the Vitreous Body. It is unique (it recalls the cornea). Its consistency is unique. The Zone of Zinn is peculiar. Also the Beaded Canal. Also its structure recalling the Cornea and the tissue of the umbilical cord. Also the absence of vessels in the adult. PECULIARITIES OF TDK APPENDAGES OF THE BYE. 75 Peculiarities of the Crystalline Lens. It is unique. Also is its shape. Also numerous and important organs near its circum- ference. Its structure is unique. Its capsule is unique. Its fibres are unique. Its meridians are unique. The central portion is the harder, whereas usually it is the softer. The absence of nerves and vessels is peculiar. Peculiarities of the Iris. It is a unique organ. The variation of color of the anterior surface is unique. The permanence of color of the posterior surface is no- ticeable, The pupil is unique. The muscular fibres are peculiar. The Arteries are numerous ; long ciliary, anterior short ciliary. The Veins open in the peculiar circular sinus. The Capillaries form two rings. The Nerves come from a ganglion, the ophthalmic Peculiarities of the Aqueous Humor. It is unique — (resembles the endolymphs, the cerebro- spinal fluid). The rapidity of its reproduction is unique (as the cerebro- spinal fluid). PECULIARITIES OF THE APPENDAGES OF THE EYE. 212 Peculiarities of the Orbital Fascia. Is unique as an apparatus of suspension. Tenon's Capsule is peculiar. Peculiarities of the fluscles of the Eyeball. They are peculiar because all (excepting one) originate from the same spot. The Four Straight are peculiar because they are inserted in the anterior segment regularly around the cornea. The Two Oblique are peculiar in being inserted on tin'' posterior segment and on its outer part. The Great Oblique is noticeable because it is the only muscle reflected through a regular pulley. The Small Oblique is peculiar in being coiled as it were around the eyeball. The Nerves of these Muscles arc peculiar in their distri- bution. The filaments to the iris are peculiar. 76 ORGANS OF HEARING — PAVILION OR AURICLE. Peculiarities of the Eyelids. Are unique. Their skin is remarkable for its thinness (as in the penis). The Tarsal Cartilages are unique. The Broad Ligament is unique, dividing the lids into two distinct layers (like Tenon's Capsule). The termination of the Tendon of the Elevator Muscle of the Eyelid is unique. The Mucous Layer is peculiar in forming the semilunar fold and the lachrymal lake. The Caruncula is unique. The Meibomian Glands are peculiar (like the Ceru- minous). The Veins behind the broad ligament form the Ophthal- mic vein. The Veins in front form the facial vein. The Lymphatics behind discharge into the deep glands. Those in front into the parotid and the submaxillary glands. Peculiarities of the Eyebrows. Are unique. Peculiarities of the Lachrymal Apparatus. Is also unique. The Gland has two portions. The Excretory ducts are multiple (as in the sublingual, prostate). The Lachrymal Lake is unique. Also the Lachrymal Points. Also the Lachrymal Ducts. The Lachrymal Sac is noticeable (like the gall bladder, urinary bladder, seminal vesicles). The Nasal Canal is remarkable. The purely mechanical uses of the secretions is notice- able. ORGANS OF HEARING. 213 Enumeration. The organs of hearing are composed of the External Ear, comprising : — 1st. the Pavilion and External Auditory Canal ; — 2d, the Middle Ear, comprising the tym- panum and the Chain of Ossicles, the Mastoid Cells and the Eustachian Tube; — 3d, the Internal Ear, comprising the Vestibule, the Semi-circular Canals and Cochlea, each hav- ing a bony, a membranous and a liquid portion; — 4th, the Internal Auditory Canal lodging the Auditory Nerve. PAVILION OR AURICLE. 214 Shape. The pavilion is oval; — it resembles the expanded end of a trumpet crushed inwardly. The Surfaces present the helix, — the fossa of the helix, — EXTERNAL AUDITORY CANAL — TYMPANUM OP THE EAR. It the anti-helix. — the fossa of the anti-helix. — the concha, — the tragus, — the anti-tragus — and a notch. The Upper Extremity or Base is rounded. The Lower Extremity or Apex forms the lobule. 215 Structure. The pavilion is composed : — 1st, of a Cutaneous layer; — 2d, of a Fibro-elastic Cartilage forming the bulk of the pavilion; — 3d, of Intrinsic Muscles, which are the great muscle of the helix, the small muscle of the helix, the mus- cle of the tragus, the muscle of the anti-tragus, the trans- verse muscle; — 4th, of the Extrinsic Muscles, which are the anterior auricular, the superior auricular and the posterior auricular. EXTERNAL AUDITORY CANAL. 216 Direction. The External Auditory Canal is directed in- wards and forwards; — it also curves upwards and then downwards. Shape. The External Auditory canal, at its beginning, is oval; — in the middle it is slightly flattened. The Anterior Surface is in relation with the parotid and lower maxilla. The Posterior Surface is in relation with the mastoid pro- cess. The Upper Border is convex and smooth. The Lower Border is concave as a whole but presents the projection of the tragus. The Outer Extremity is continuous with the pavilion. The Inner Extremity is in relation with the tympanum. 217 Structure. The external auditory canal: — 1st, is lined throughout with Skin presenting the Ceruminous Glands: — 2d, the Inner Portion is osseous and formed by the temporal bone; — 3d, the Outer Portion is formed of a cartilaginous gutter below and of a membranous portion above, like the trachea. TYMPANUM OR DRUM OF THE EAR. 218 Shape. The Drum of the Ear is irregularly circular or flattened. The Outer Wall is formed by the Tympanic Membram . often called simply the tympanum; — it is connected with the mallet and anvil. The Inner Wall presents the promontory. — the apex of the osseous canal of the tensor muscle of the mallet. — the oval window corresponding to the vestibule. — the round window corresponding to the cochlea. — the pyramid lodg- ing the stapedius muscle, — and the ridge of the Fallopian canal situated above the oval window. The Anterior Wall presents the orifice of the Eustachian tube. 78 OSSICLES OF THE TYMPANUM — LINING MEMBRANE. The Posterior Wall presents the orifice leading into the mastoid cells. The Upper Wall or Roof is formed by a thin plate of bone separating the Tympanum from the cranial cavity. The Lower Wall or Floor presents the glenoid fissure lodg- ing the cord of the Tympanum and the Laxator Muscle of the mallet. OSSICLES OF THE TYMPANUM. 219 Shape. The Ossicles of the Tympanum are named, after their shape, the Mallet, the Anvil, the Lenticular Bone and the Stirrup. They form an irregular chain from the tympanic mem- brane to the oval window which is closed by the stirrup. Ligaments. They are held together and are fastened to the surrounding structures by various ligaments. fluscles. The muscles which act upon them are the Tensor Muscle (of the mallet), the Muscle of the Stirrup, the Large Laxator Muscle (of the mallet) and the Small Laxator Muscle (of the mallet). LINING MEMBRANE. 220 The tympanum is lined by a mucous membrane, which is the prolongation of the pharyngeal mucous membrane through the Eustachian tube; — it is prolonged into the mastoid cells. MASTOID CELLS. 221 The mastoid cells are irregular cavities in the substance of the mastoid process — communicating with the tympanum — and lined by a mucous membrane, which is a continua- tion of the membrane of the tympanum. EUSTACHIAN TUBE. 222 Direction. The Eustachian tube is directed obliquely in- wards, forwards and downwards. Shape. The Eustachian tube on a longitudinal section re- sembles two cones joined at their apices near the centre of the canal. The Surfaces are in relation with the parotid gland. The Outer Extremity opens on the lower part of the wall of the tympanum. The Inner Extremity opens by an expanded orifice on the side of the pharynx. 223 Structure. The inner three-fifths are composed of a grooved cartilaginous portion below, and of a membranous portion above. The outer two-fifths are formed of osseous VESTIBULE — SEMI-CIRCULAR CANALS — COCIILKA. 7!) tissue. — Both portions are lined with ;i mucous membrane, which is continuous with that of the pharynx. 224 Relative Position of the Parts Composing the Internal Ear. The Vestibule is between the tympanum and the internal auditory canal. — The Semi-circular Canals are situated above the vestibule. — The Cochlea is situated in front of the vesti- bule ; its base corresponds to the bottom of the internal auditory canal. VESTIBULE. 225 Shape. The Vestibule is irregularly oval. The Surfaces or Walls present the crest of the vestibule, — the pyramidal eminence presenting the Inferior Cribri- form Spot, — the hemi-elliptical fossa, — the sulcif orm fossa, — the orifices of the semi-circular canals, one of which presents the vestibule, — the orifice of the Superior Cribri- form Spot, — the orifice of the aqueduct of the vestibular scala of the cochlea, — the oval window corresponding to the stirrup and to the tympanum, — the round window or orifice of the tympanic scala of the tympanum. 226 Structure. The vestibule is composed: — 1st, of bony walls distinct from the petrous bone; — 2d, of a delicate periosteum lining of the walls; — 3d, of a liquid layer ealled the perilymph; — 4th, of a membranous layer formed of a delicate membrane moulded on the bony walls and in which the vestibular branches of the auditory nerve termi- nate opposite the cribriform spots ; at that point are found the otoliths; — 5th, of a liquid contained in its interior and called the endolymph. SEMI-CIRCULAR CANALS. 227 Shape. The Semi-circular canals represent each more than half of a circle. The Surfaces or Walls are in relation with the surrounding bony tissue. The Extremities open into the vestibule. 228 Structure. The Semi-circular canals are composed : — 1st, of bony walls distinct from the petrous bone; — 2d, of a delicate periosteum lining these walls; — 3d, of a liquid layer called the perilymph; — 4th, of a membranous layer formed of a delicate membrane moulded on the bony walls ; — 5th, of a liquid contained in its interior and called the endolymph. COCHLEA. 229 Shape. The Cochlea is Conical and resembles a snail. The Base is applied to the bottom of the auditory canal. The Apex is directed forwards and outwards. 80 INTERNAL AUDITORY CANAL — ORGANS OF HEARING. The External Surface is in relation with the osseous tissue of the petrous bone. The Internal Surface encloses a cavity divided by an osteo- membranous lamina into the upper or tympanic scala, the middle or intra-membranous scala and an inferior or vestibular scala . 230 Structure. The Tipper and Lower Scala? are composed: — 1st, of a bony wall; — 2d, of a delicate periosteum; — 3d, of a liquid called the perilymph; — 4th, of a layer of cells corresponding to the outer surface of the membranous por- tion of the spiral lamina. The Middle Scala is formed : — 1st, of an upper and lower membranous wall; — 2d, of a layer of lining cells; — 3d, of a liquid called the endolymph ; — 4th, of cells called the supporting cells ; — 5th, of peculiar fibres called the pillars or fibres of Corti; — 6th, of peculiar hair cells which are the termination of the fibrils of the auditory nerve. INTERNAL AUDITORY CANAL. 231 Direction. The Internal Auditory Canal is directed ob- liquely downwards, forwards and outwards. Shape. It is cylindrical. The External Surface is in relation with the petrous bone. The Inner Surface is lined by dura mater. The Internal or Cranial Extremity is situated on the pos- terior surface of the petrous bone. The External Extremity or Bottom presents above the orifice of the aqueduct of Fallopius for the facial nerve, and below the orifice for the vestibular and cochlear nerves. 232 Structure. The internal auditory canal is composed : — 1st, of an osseous layer distinct from the petrous bone ; — 2d, of a fibrous layer formed by the dura mater; — 3d, of a serous layer formed by the arachnoid. PECULIARITIES OF THE ORGANS OF HEARING. 233 Peculiarities of the Pavilion. Is unique excepting the Fallopian tube, which resembles it. The irregularities of the surfaces are noticeable. Its cutaneous and cartilaginous structure is peculiar (like the nose). It is very vascular ; when the cord of the tympanum is cut the capillaries become engorged. Peculiarities of the External Auditory Canal. Has a noticeable course. The presence of the tympanic membrane at its internal extremity is unique. The Ceruminous Glands are peculiar (like the Meibo- mians). PECULIARITIES OF THE ORGANS OF HEARING. 81 The structure of the canal, half fibro-cartilaginons and half osseous, is peculiar (like Eustachian tube, trachea). Peculiarities of the Tympanum or Drum of the Ear. It is unique. The Tympanic Membrane is unique. The Round and Oval windows with their membranes are unique. The Chain of Ossicles, with their ligaments and muscles. are unique. The thin plate of the upper wall is noticeable. The presence of the Glenoid fissure and the cord of the tympanum are peculiar. The Lining membrane coming from the Pharynx is re- markable. It presents the peculiar nerve of Jacobson. Peculiarities of the flastoid Cells. They are noticeable. They resemble the ethmoid, cells. Peculiarities of the Eustachian Tube. It is unique. Its direction is noticeable. Its shape also (two cones joined by their apices). The opening into the pharynx is unique. Its structure, half fibro-cartilaginous and. half osseous, is noticeable (like the external auditory canal). 234 Peculiarities of the Internal Ear. Is noticeable in all particulars. Peculiarities of the Vestibule. It is unique. The cribriform spots are noticeable. The presence of the perilymph, of the membranous vesti- bule, of the endolymph are peculiar to this internal ear. The termination of the fibrils of the vestibular nerve and the otoliths is unique. The fact that the bony walls of the vestibule, canal and cochlea are separate from the petrous bone is unique. Peculiarities of the Semi=Circular Canals. Are unique in all particulars. The absence of nerve terminations is noticeable. Peculiarities of the Cochlea. It is unique. Its shape is unique. The base being applied to the bottom of the Internal Auditory Canal is noticeable. The division of the interior into three scales is peculiar. The fibres of Corti are peculiar. The course and termination of the Cochlear nerve is peculiar. Peculiarities of the Internal Auditory Canal. It is unique. G 82 SKIN — HAIRS — GLANDS OF THE SKIN. The presence at the bottom of two large divisions is no- ticeable. The presence in its interior of three nerves is noticeable. The Auditory Nerve is a soft nerve. The Petrous bone is traversed by the aqueduct of Fallo- pius lodging the facial nerve, which on its coarse gives off the peculiar cord of the tympanum. . SKIN. 235 Layers. The Skin is composed of the Epidermis and Der- mis. The Epidermis presents the following layers : — 1st, the Cuticle, composed of flattened cells ; — 2d, the Transparent Layer, dimly striated; — 3d, the Granular Layer, formed of flattened spindle-shaped cells ;— 4th, of the Mucous Layer., composed of soft, round or oval cells; — 5th, of a Layer of Pigmented Cells in the negro; — 6th, of a Basement Mem- brane separating the deepest cells of the mucous layer from the papilla?. The Dermis presents: — 1st, the Papillary Layer, formed of vascular and nervous papillas, presenting the Tactile Corpuscles; — and 2d, the Dermis Proper, composed of con- nective tissue and a few smooth muscular fibres. HAIRS. 236 Structure. The Hair Follicle is a depression of the skin. It is composed: — 1st, of an External Layer, corresponding to the dermis proper ; — 2d, of an Internal Transparent Layer, corresponding to the basement membrane of the skin; — 3d, of the External Root Sheath, corresponding to the mucous layer; — 4th, of the Internal Root Sheath, corresponding to the cuticle and composed of a layer corresponding to the granular layer of the skin, and of a layer corresponding to the transparent layer of the skin ; — 5th, at the bottom is the Hair Papilla supporting the hair bulb. The Hair Bulb is formed of an agglomeration of soft, round, oval and elongated cells. The Body of the Hair is composed of : — 1st, the Cuticle ; — 2d, of the Fibrous or Cortical layer; — and 3d, of an In- ternal or Medullary layer. GLANDS OF THE SKIN. 237 The glands of the skin are : — 1st, the Sebaceous Glands, situ- ated in the dermis proper and almost all opening into the hair follicles; they are racemose glands; — 2d, the Sweat Glands, situated in the meshes of the deep surface of the dermis ; they are convoluted tubular glands. NAILS — ORGANS OF LOCOMOTION. 83 NAILS. 238 Structure. The nails arc composed, from without in- wards:— 1st, of a Horny Layer, corresponding to the epider- mis of the skin ; — 2d, of a Mucous Layer; — 3d, of ;i Papillary Layer forming the matrix. 239 Peculiarities of the Skin. It resembles very much the mucous membranes. The fact that the superficial layer of the epidermis or the cuticle is composed of fiat, dry, dead cells is noticeable. Also that the deep layer or mucous layer is composed of round and oval soft and living' cells. The Pigmented Cells in the negro are peculiar. The absence of all vessels and nerves in the above layers is noticeable. The Papillae are peculiar (like in the tongue only). The termination of the fibrils of the nerves into the tactile corpuscles is peculiar. Also the appearance of the capillaries, poplar-like, as in the tongue. Peculiarities of the Hair. They are peculiar to the skin. The hair follicle is noticeable. Also the hair papilla. The structure of the hair bulb is peculiar. The absence of all vessels and nerves is noticeable. 240 Peculiarities of the Sebaceous Glands. They are peculiar to the skin. Their opening into the hair follicles is peculiar. The Ceruminous Glands are varieties of sebaceous glands. The Meibomian Glands also. Peculiarities of the Nails. They are unique. The fact that they correspond to the cuticle in other situ- ations is noticeable. Absence of intermediate capillaries is remarkable. ORGANS OF LOCOMOTION. CARTILAGES. 241 Structure. Cartilages are composed : 1st. Of an investing membrane called the Perichondrium. 2d. Of a Matrix or Interstitial Substana which is amor- phous, homogeneous or granular. 3d. Of Cartilage Lacuna lined by a capsule containing fluid and one or more nucleated cells. 84 BONES — RESUME OF POINTS CONCERNING THE VERTEBRAE. 242 Varieties. There are the following varieties of cartilage : the true cartilage (deprived of matrix), the fibro -cartilage , and the fibro-elastic cartilage. BONES. 243 Chemical Composition of Bones. The Earthy Elements are phosphates and carbonates of lime, which form the two- thirds. They are demonstrated by macerating a bone in a diluted acid. The Organic Elements form one-third. They are demonstrated by burning a bone. 244 Structure of Bones. Bones are composed : 1st. Of an envelope, the Periosteum, the outer layer of which is fibrous, but the inner is formed of cells and capil- laries. 2d. Of a Proper Tissue composed of the Haversian Canals, which contain the blood vessels. 3d. Of the Lacuna? and Canalicules which convey the serum of the blood throughout the substance of the bone. 4th. Of the Medulla or Marrow, which is either yellow or red. It is composed of alveoles containing fat cells, and in the red marrow peculiar cells called medulla-cells and the multi- nucleated cells or giant-cells. RESUHE OF POINTS OF SPECIAL INTEREST CONCERNING THE VERTEBRAE. 1. CERVICAL VERTEBRAE. 245 The body presents two tubercles; — the transverse processes are grooved and present orifices for vertebral arteries ; — the spinal orifice is large and triangular; — the spinal process is bifid. 246 First Cervical or Atlas : The body is narrow ; it is re- placed by two arches ; the spinal orifice is very large ; the front is filled by the odontoid process ; the articular sur- faces are very large; — the spinous process is nearly absent. Second Cervical or Axis : is characterized by the odon- toid process. Seventh Cervical : is characterized by a prominent spinous process. 2. DORSAL VERTEBRA. 247 The body presents articular facets; — the spinal orifice is small and round ; — the spinous process is large and oblique ; LUMBAR VERTEBRAE — SACRUM — SPINE IX GENERAL. 85 — the transverse processes present articular facets for tin- ribs. 248 First Dorsal. The body presents a full facet. Ninth Dorsal. The body presents ;i demi-facet above. Tenth Dorsal. The body presents only one facet which is entire. Eleventh Dorsal. The body presents only one facet which is entire; — the transverse processes present no articular facets for ribs. Twelfth Dorsal. Same; the inferior articular surfaces are convex and turned outwards. 3. LUMBAR VERTEBRA. 249 Lumbar Vertebrae. The body presents no tubercle, no facet; — the spinal orifice is small and triangular; — the spinous process is short and thick; — the transverse processes are long and present processes resembling rudimentary ribs; — the upper articular process presents a marked tuber- cle. Fifth Lumbar. The inferior articular facets are wider apart; — the transverse processes are larger and thicker. SACRUM. 250 The Anterior Surface presents, — on the middle line, trans- verse ridges ; — and on the sides the anterior sacral foramina. The Posterior Surface presents, — on the middle line, the spinous processes; — and on the sides, the sacral grooves. posterior sacral orifices and transverse processes. The Base presents, — on the middle line, the articular sur- face for the fifth lumbar, the orifice of the sacral canal — and on the sides, the round edge of the brim, and a fiat sur- face above. The Lateral Surfaces present — above, the articular surface, which is lined in front with cartilage, but behind is rough ; — beloiv, the surface presents a border giving attachment to the sacro-sciatic ligaments. The Apex presents the orifice of the sacral canal, and the articular surface for the coccyx. SPINE IN GENERAL. 251 Direction. The Spine presents a convexity in the cervical region, a concavity in the dorsal region, a second convexity in the lumbar region and a second concavity in the sacral. — Besides, it presents a left lateral concavity opposite the upper dorsal vertebra? for the lodgment of the aorta. Shape. The spine has the shape of two pyramids opposed by their bases, the sacral and the vertebral. Besides, the cervical vertebra- represent a pyramid whose 86 BONES OF THE SKULL — FRONTAL. apex joins the apex of the pyramid formed by the dorsal vertebrae. The Anterior Surface presents the bodies of the vertebra?. The Lateral Surfaces present the intervertebral foramina, tbe pedicles, the transverse processes, the articular pro- cesses. The Posterior Surface presents the spinous processes and the laminae. The Upper Extremity articulates with the occipital. The Inferior Extremity is formed by the coccyx; — it gives attachment to the anal sphincter. The Spinal Canal is large and oval in the cervical region ; — it is smaller and round in the dorsal region ; — it enlarges again in the lumbar, where it is also oval. BONES OF THE SKULL. 252 Enumeration. The Bones of the Cranium are: — on the Median line and Single, the Frontal, Ethmoid, Sphenoid, Occipital; — on the Sides and Double, the Parietal and Tem- poral. FRONTAL. 253 1st. The Vertical Portion or Frontal Proper. The Anterior Surface presents on the median line: the ridge or suture between the two halves of the bone, — the nasal eminence articulating with nasal bones, — the nasal notch and the nasal spine or process. It presents on the sides the frontal eminence or protuber- ance,— the superciliary eminence or ridge corresponding to the frontal sinus, — the supra-orbital notch or foramen, — the internal angular or orbital process, — the external angu- lar or orbital process. The Posterior Surface presents on the median line the groove of origin of the superior longitudinal sinus, — the frontal crest giving attachment to cerebral falx, — the caecal foramen. It presents, on the sides, the frontal fossa, presenting emi- nences and depressions corresponding to the convolutions, and the Pacchionian depressions. 254 2d. Horizontal Portion or Orbital Vaults. The Inferior Surface presents on the median line the eth- moidal notch articulating with ethmoid, — the nasal spine, — the openings of the frontal sinus. It presents on the sides the orbital fossa or concavity of the vault, — the lachrymal fossa. The Upper Surface presents on the median line the eth- moidal notch, — and on the sides the orbital vault or convex- ity of the vault, presenting eminences and depressions cor- responding to the convolutions. ETHMOID. ^7 '17)7) 3d. Lateral Portions. The External Surface forms part of the temporal fossa ; — it is separated by the temporal ridge from the temporal por- tion of the bone. The Internal Surface forms part of the anterior cerebral fossa. The Upper Border of the Frontal is serrated, beveled and articulates with the parietal hones; — it forms the fronto- parietal suture. The Inferior Border is not serrated, — it articulates with the sphenoid. The Upper Angle of the Frontal articulates with the re- ceding' angle of the two parietal; — it forms the anterior fontanelle. The Outer Angle (external angular or orbital process) ar- ticulates with the malar bone. ETHMOID. 256 Situation. The Ethmoid is situated in the ethmoidal notch of the frontal bone in front of the sphenoid, protruding into and forming all the upper part of the nasal cavities. 257 1. The Horizontal or Cribriform Plate presents on the median line the caeeal foramen, the crista-galli, an eminence for the attachment of the cerebral falx. It presents on the s'uhs the olfactory groove for the olfactory nerve, — the foramina for the filaments of the olfactory nerve, — the posterior notch articulating with the sphenoid. 258 2. The Perpendicular Plate presents surfaces and bor- ders. The Surfaces form the upper part of the nasal septum. The Upper Border is attached to the horizontal plate. The Lower Border articulates with the triangular cartilage of the septum. The Anterior Border articulates with the nasal spine (of the frontal). The Posterior Border articulates with the rostrum of the sphenoid and the vomer. 259 3. The Lateral Masses or the Ethmoid Cells present also surfaces and borders. The Upper Surface articulates with the ethmoidal notch of frontal. The Anterior Surface articulates with the Lachrymal bone and nasal process of superior maxilla. The Inferior Surface articulates with the superior maxilla itself. The Posterior Surface articulates with the sphenoid and palate bones. The External Surface is called the Os Planum; — it is smooth, thin, — forms part of the orbit, — articulates above 88 SPHENOID — BODY OF SPHENOID — LESSER WINGS. with the frontal, in part with the lachrymal, below with the superior maxilla and palate bones, behind with the sphe- noid. The Internal Surface forms the upper part of the exter- nal wall of the nasal cavities ; — it presents two processes, called the superior and middle turbinated processes, and in front a surface for the filaments of the olfactory nerves. 260 4. The Ethmoid Cells form two groups not communicating with each other, the anterior or frontal and the posterior or sphenoidal. SPHENOID. 261 Situation. The sphenoid is situated at the base of the skull, between the occipital and the frontal. It articulates with the other cranial bones. It presents a Body, Two Large Wings, Two Small Wings, and Two Pterygoid Processes. BODY OF SPHENOID. 262 The Upper Surface presents on the Median line: smooth surfaces giving passage to the olfactory nerve ; — the optic grooves for the optic nerves; — the pituitary fossa; — the square surface for oblong medulla. It presents on the sides the optic foramen, — the anterior clinbid processes, — the orifice or notch communicating with the cavernous sinus, — the posterior clinoid processes. The Anterior Surface presents on the median line, the ante- rior sphenoidal spine; — it articulates with the ethmoid. It presents on the sides the orifice leading into the sphe- noidal sinus, — the sphenoidal turbinated bones, which are two thin curved plates of bone partially closing the orifice of the sphenoidal sinus. The Inferior Surface presents on the median line, the ros- trum or sphenoidal spine articulating with the vomer. It presents on the sides the vaginal process wnich forms a groove articulating with the wing of the vomer ; — the ptery- gopalatine groove articulates with the palate bone and forms the ptery go-palatine canal. The Posterior Surface articulates with the occipital ; — it is often united with it. The Lateral Surfaces present above the cavernous groove; — below they are blended with the great wing. THE LESSER WINGS OR UPPER WINGS. 263 The Upper Surface is smooth and is in relation with the anterior lobe of the brain. The Under Surface forms part of the roof of the orbit. The Anterior Border articulates with frontal. GREATER WINGS — PTERYGOID PROCESSES OR LOWER W1XOS. 89 The Posterior Border is smooth, free, — and tonus the upper boundary of the sphenoidal fissure. The Base presents the anterior clinoid processes and the optie foramen. The Apex terminates in a sharp point. GREATER WINGS OR MIDDLE WINGS. 2(54 The Upper Surface presents the round foramen, — the oval foramen, — the Vesalian foramen, — the spinous foramen, — the spinous process, — and the fossa forming part of the middle cerebral fossa. The Inferior Surface presents a surface forming the roof of the zygomatic fossa, — the oval foramen — and the spinous foramen. The External Surface presents the pterygoid ridge which separates this surface from the inferior surface, — the sur- face forming part of the temporal fossa. The Internal or Anterior Surface forms part of the outer wall of the orbit ; — behind, it forms part of the sphenoidal fissure ; — below, it forms part of the sphenopalatine ori- fice and of the ptery go-maxillary fissure. The Anterior Border articulates with the malar bone. The Superior Border articulates with the frontal bone and parietal bone. The External Border articulates with the squamous tem- poral bone. The Posterior Border articulates with the petrous temporal bone. The Internal Border is blended with the body. PTERYGOID PROCESSES OR LOWER WINGS. 265 The Anterior Surface above forms the posterior boundary of the spheno-maxillary fossa, — and presents a groove form- ing the ptery go -maxillary canal ; — be low it articulates with the palate bone. The Posterior Surface presents the scaphoid fossa — and the pterygoid fossa, which is limited by the inner and outer pterygoid plates. The External Surface forms part of the zygomatic fossa. The Internal Surface forms the outer boundary of the posterior nares. The Base is attached to the body of the greater wing: — it presents the Vidian canal — and the round foramen. The Apex is notched; — it presents the hamular process con- nected with the inner plate, — it articulates with the palate. 90 OCCIPITAL — PARIETAL BONES. OCCIPITAL. 266 Situation. The Occipital is situated at the posterior part of the skull. The External Surface presents on the median line a smooth surface for the occipital-frontal muscle, — the external occip- ital protuberance, — the occipital crest, — the occipital for- amen with the tubercles for the check ligaments, — the bas- ilar process. It presents on the sides — the superior curved line, — the inferior curved line, — the posterior condyloid fossa and foramen, — the jugular process, — the occipital condyle, — and the anterior condoloid fossa and foramen. The Internal Surface presents on the median line a groove for the superior longitudinal sinus, — 'the internal occipital protuberance with the press of Herophilus, — the internal occipital crest with grooves for the occipital sinus, — the oc- cipital foramen,— with anterior condyloid foramen, — the basilar groove, for oblong medulla. It presents on the sides : — the cerebral fossa, — the groove of the lateral sinus, — the cerebellar fossa, — the jugular process, — the depression for the terminal groove of lateral sinus, — and the anterior condyloid foramen. The Upper Border is serrated; — it articulates with the pari- etal bones and forms the lambdoid suture. The Inferior Border between the external angle and jugular process articulates with the mastoid temporal bone ; — be- tween the jugular process and the anterior angle it articulates with the petrous bone — and forms the jugular foramen or posterior lacerated foramen. The Upper Angle articulates with the parietal bones — and forms the posterior fontanelle. The External Angle articulates with parietal bones — and the mastoid process. The Anterior Angle articulates with the body of sphenoid. PARIETAL BONES. 267 The External Surface presents the parietal foramen, — a smooth surface for the occipito-frontal muscle, — the tempo- ral ridge, — the parietal eminence or protuberance — and the surface of temporal fossa. The Internal Surface presents a groove for the superior longitudinal sinus, — the Pacchionian depressions, — the parietal fossa, — the grooves for middle meningeal artery, the main branch starting from the anterior inferior angle ; — the groove for the terminal portion of lateral sinus. The Anterior Border is serrated; — it articulates with the frontal, forming the coronal suture. TEMPORAL BONES. !)1 The Upper Border is serrated; — it articulates with its fel- low— and forms the bi-parietal or sagittal suture. The Posterior Border is serrated — and articulates with the occipital, forming the lambdoid suture. The Inferior Border is beveled; — it articulates with the squamous temporal bone. The Inferior Anterior Angle articulates with the frontal and sphenoid. The Superior Anterior Angle articulates with the frontal — and forms the anterior fontanelle. Superior Posterior Angle articulates with the occipital, — and forms the posterior fontanelle. The Inferior Posterior Angle articulates with the mastoid temporal bone. TEMPORAL BONES— SQUAMOUS PORTION. 268 The External Surface presents a surface forming- the tem- poral fossa, — the posterior limit of the temporal ridge, — the Zt/f/onuitic Process. The external surface of this process is subcutaneous ; — it forms the external boundary of the temporal fossa. The upper border gives attachment to the temporal fascia. The lower border gives attachment to the masseter. The apex articulates with the malar bone. The base presents the exterior transverse root of the zy- goma — the zygomatic tubercle for the attachment of the external lateral ligaments; — the articular eminence,— the glenoid fossa, — the posterior root, which is continuous with the posterior limit of the temporal riclge. The Internal Surface presents eminences and depressions for the convolutions of the brain, — and grooves for the middle meningeal artery. The Upper Border articulates with the parietal bone — and forms the squamous suture. The Anterior Border articulates with the greater wing of the sphenoid. The Inferior Border is blended with the petrous boue. MASTOID PORTION. 269 The External Surface is rough — and presentsthe mastoid foramen. The Internal Surface presents the terminal groove of the lateral sinus. The Posterior Border articulates with the occipital. TI13 Anterior Border is blended with the squamous and petrous bones. The Base articulates with the parietal. The Apex presents the mastoid process. — the digastric groove — and the groove for the occipital artery. 92 PETROUS PORTION — BONES OF THE FACE — VOMER. PETROUS PORTION. 270 The Anterior Surface presents from within outwards : the fossa for the Gasserian ganglion, — the groove for the small petrosal nerve, — the hiatus of Fallopius for the large petrosal nerve, — the projection of the superior semi-cireular canal, — and the thin roof of the tympanum. The Posterior Surface presents from within outwards — the internal auditory meatus, — the aqueduct of the vesti- bule. The Inferior Surface presents a rough surface for muscu- lar attachments, — the orifice of carotid canal, — the jugular fossa, — the jugular surface, — the stylo-mastoid foramen, — the styloid process, — the vaginal process, — the posterior glenoid fossa, — and the auditory process. The Anterior Border presents a free portion which articu- lates with the spinous process of the sphenoid ; — in the re- ceding angle we find the orifices of the Eustachian tube and of the canal for the tensor muscle of the mallet; — it is partly blended with the squamous portion. The Upper Border presents the superior petrosal sinus. The Posterior Border presents a groove for the inferior petrosal sinus, — the notch for the jugular foramen. The Base is blended with the squamous and mastoid bones ; — it presents the external auditory meatus. The Apex articulates with the sphenoid and the occipital ; — it presents the internal orifice of the carotidian canal. BONES OF THE FACE. 271 The Upper Jaw comprises thirteen bones, which are : on the Middle Line, the Vomer; — on the Sides, the Nasal, Lachrymal, Inferior Turbinated, Palate, Superior Maxillar and Malar Bones. The Lower Jaw contains only the Inferior Maxillary Bone. VOMER. 272 Situation. The Vomer is situated at the back part of the nasal septum. The Surfaces are alternately concave and convex. The Upper Border presents a groove articulating with the rostrum of the sphenoid ; — it presents also laminas or wings articulating with the vaginal process of the sphenoid. The Lower Border articulates with the palate processes of the superior maxillary bone. The Posterior Border is free and concave ; — it separates the posterior nares. The Anterior Border articulates with the ethmoid, — and also with the septal cartilage of the nose. SUPERIOR MAXILLARY BONE — NASAL BONE. 93 SUPERIOR MAXILLARY BONE. 273 The Internal Surface presents the nasal process, the inter- nal surface of which presents two ridges for articulation, with the middle and inferior turbinated bones, and between them the middle meatus; — the lachrymal groove and sac, — the nasal canal, — the inferior meatus, — the opening of the antrum of Highmore, — an articular surface, — the maxillary fissure for the process of the palate bone. The Palate Process presents an Upper Surface forming part of the floor of the nasal cavity, — an Under Surface forming the roof of the mouth and hard palate ; — an Outer Border blended with the bone, — an Inner Border articulating with its fel- low,— a Base traversed by the anterior palatine (incisive) canal, — an Apex or Posterior Border articulating with the palate bone. The External Surface presents the nasal process (external surface) — the anterior margin of the orbit, — the infra-or- bital foramen, — the canine fossa, — the incisive or myrti- form fossa, — the ridge of the alveole of the canine tooth. The Upper Surface forms the floor of the orbit. It presents the infra-orbital groove, — a depression for the insertion of the inferior oblique muscle, — the malar pro- cess articulating with the malar bone. The Posterior Surface presents the posterior margin of the orbit or anterior boundary of spheno-maxillary fissure, — the orifices of the posterior dental canals, — a concave surface corresponding to the malar process and to the zygo- matic fossa. The Anterior Border articulates with the nasal bone. It presents a notch giving attachment to the lateral carti- lage of the nose, — the anterior spinous process of superior maxilla. The Superior Border presents the apex of the nasal process articulating with frontal bone, — the lachrymal groove, where it articulates with the lachrymal bone ; — further back it articulates with the ethmoid and palate bones. The Inferior Border is called the alveolar process; — it pre- sents the sockets for the teeth. The Posterior Border is called the tuberosity of tin supi ri>>r maxilla; — it forms the pterygo-maxillary fissure. — articu- lates with the palate bone, — and forms the posterior pala- tine canal NASAL BONES. 274 Situation. The Nasal Bones form the upper part of bridge of the nose. The Outer Surface gives attachment to muscles. The Inner Surface forms part of the nasal cavities. — ami presents a groove for a branch of the nasal nerve. 94 LACHRYMAL BONES — INFERIOR TURBINATED BONES. The Anterior Border articulates with its fellow; — it pre- sents a groove articulating with the nasal spine of the fron- tal and with the ethmoid. The Posterior Border articulates with the nasal process of the superior maxilla. The Apex articulates with the frontal bone. The Base articulates with the lateral nasal cartilage — and presents a notch for the nasal nerve. LACHRYMAL BONES. 275 Situation. The Lachrymal Bones are situated on the front part of the inner wall of the orbit. The External Surface presents a groove for the lachrymal canal, — a ridge for the attachment of the tensor muscle of the tarsal cartilages, — and a surface forming part of the orbit. The Internal Surface forms a part of the nasal cavity. The Anterior Border articulates with the nasal process of the superior maxilla. The Posterior Border articulates with the ethmoid. The Apex articulates with the internal angular process of the frontal. The Base presents the lachrymal process articulating with the inferior turbinated bone, — the lower edge of the verti- cal crest ;— - it articulates with superior maxilla. INFERIOR TURBINATED BONES. 276 Situation. The Inferior Turbinated Bones are situated on the outer wall of the nasal fossa, immediately below the ori- fice of the antrum. The Internal Surface is convex, — is ragged and per- forated;— it forms the inferior meatus. The Upper Border articulates with the superior maxilla. — Behind, it articulates with the palate bone. The Lower Border is free and rounded. The Anterior Extremity is pointed. The Posterior Extremity is also pointed. PALATE BONES. Situation. The Palate Bones are situated back of the nasal fossas, resting on the posterior border of the superior maxilla. They present an horizontal and a vertical plate. HORIZONTAL PLATE. 277 The Upper Surface forms the back part of the floor of the nasal cavities. VERTICAL PLATE — MALAR BONES. '.»."> The Under Surface forms the back part of the root' of the mouth or hard palate. The Anterior Border articulates with the palate process of the superior maxilla. The Internal Border articulates with its fellow and the vomer. The Posterior Border is free — and gives attachment to the soft palate. The External Border is blended with the vertical plate. VERTICAL PLATE. 278 The Internal Surface presents the superior meatus — the middle turbinated crest, — the middle meatus, — the inferior turbinated crest, — the inferior meatus. The External Surface forms a part of the pterygo-maxil- lary fossa ; — it articulates with the superior maxilla. The Anterior Border forms part of the edge of the an- trum. The Inferior Border is blended with the horizontal plate. The Posterior Border presents a groove articulating with the pterygoid process of the sphenoid ; — the pterygoid pro- cess or tuberosity of the palate articulating with the notch of the apex of the pterygoid process of the sphenoid. The Upper Border presents — the Orbital Process, present- ing three articular surfaces : the anterior or maxillary, the internal or ethmoidal, the posterior or sphenoidal and two facets for connection, an upper or orbital and an external or zygomatic. It presents also the Spheno-palatine Notch and the Sphe- noidal Process. The upper surface of the sphenoidal process articulates with the sphenoidal turbinated bone; — the inner surface of the nasal forms part of the wall of the nasal cavity; — the outer surface forms part of the spheno-maxillary fossa and articulates with the pterygoid process of sphenoid ; — the an- terior border forms part of spheno-palatine foramen — and the posterior border articulates with the pterygoid process. MALAR BONES. 279 Situation. The Malar Bones form the prominence of the cheeks. The External Surface presents the malar foramina. The Internal Surface forms the outer wall of the temporal fossa. The Anterior Surface forms part of the orbit. The Superior Border forms part of the margin of the orbit. The Anterior Border articulates with the malar process of the superior maxilla. 96 INFERIOR MAXILLARY BONE — HORIZONTAL PORTION OR BODY. The Inferior Border forms part of the zygomatic arch. The Posterior Border is smooth above — and limits the temporal fossa; — it articulates below with the zygomatic process. The Internal Border articulates with the frontal above and the sphenoid below. INFERIOR MAXILLARY BONE. Situation. The Inferior Maxillary forms the lower jaw. HORIZONTAL PORTION OR BODY. 280 The External Surface presents on the middle line the symphysis — and the mental process. It presents on the sides the incisive fossa, — the mental foramen (below the root of the second bicuspid), — the ex- ternal oblique line, — a subcutaneous surface, — the groove for the facial artery. The Internal Surface presents on the middle line the sym- physis and the genial tubercles, — two upper and two lower. It presents on either side — the fossa for the sublingual gland, — the digastric fossa, — the internal oblique line or mylohyoid ridge, — the submaxillary fossa. The Superior Border presents the alveoles or sockets for the teeth. The Inferior Border or Base is smooth, — it is subcuta- neous. PERPENDICULAR PORTIONS OR RAMI. 281 The External Surface gives attachment to the masseter muscle. The Internal Surface presents the posterior orifice of the interior dental canal, — the spinous process for internal lat- eral ligament, — mylohyoid groove, — rough surface for in- ternal pterygoid. The Anterior Border is partly blended with the horizontal portion. The Upper Border presents the coronoid process for the temporal muscle, — the sigmoid notch, — the condyloid pro- cess,— presenting on the neck a tubercle for the external ligament, — the pterygoid fossa. The Posterior Border is smooth, — it joins the inferior border and forms the angle of the jaw. The Inferior Border is continuous with the base. RESUME OF THE SITUATION OF THE BONES OP THE HEAD. 97 RESUME OF THE SITUATION OF THE BONES OF THE HEAD AND OF THEIR VARIOUS PARTS. BONES OP THE SKULL. 282 On the Middle Line, from before backwards. The frontal, — the plate of the ethmoid, — the body of the sphenoid, — the basilar process of the occipital bone, — also the vertical portion of the occipital. On the Sides : The lateral portion of the frontal or frontal eminences, — the horizontal portion, — the vertical portion, — the Lesser wing* of the sphenoid, — the lateral mass of the ethmoid. the greater wing, — the petrous bone, — the parietal, — the squamous portion, — the mastoid, — the lateral part of the horizontal and the vertical portion of the occipital. BONES OF THE FACE. 283 The Upper Jaw is composed of thirteen bones. They form four rows. The First Row is formed by the Vomer alone on the middle line. The Second Row comprises from before backwards, the the nasal, lachrymal, the inferior turbinated and the palate. The Third Row is formed by one bone alone, the superior maxilla. The Fourth Row is also formed by one alone, the malar. N. B. — All the bones are situated to the inside of the superior maxilla except the malar. The Superior Maxilla is the bone of the face, like the sphenoid is the bone of the skull. It articulates with all the bones of the face and with a number of bones of the skull. The Ethmoid protrudes into the nasal cavities. The Inferior Turbinated Bones rest on the inner surface of the superior maxilla. The Palate Bones rest on the posterior surface of the superior maxilla. The Lower Jaw is formed bv one bone only, the Lower • Maxilla. SUTURES OF THE SKULL. 284 The Sutures of the Upper Region or Vertex are: On the middle line, — the interfrontal, — the anterior fonta- nelle, — interparietal or sagittal. — the posterior fontanelle. On the sides, — the fronto-parietal or coronal. — parieto- occipital or lambdoid. The Sutures of the Lateral Surfaces are the fronto- 98 CRANIO -FACIAL SUTURES — EXTERIOR OF SKULL. malar, — malo-sphenoidal, — splieno -frontal, — sphenoparie- tal,— spheno - squamous, — parieto - mastoid, — masto-occip- ital. The Sutures of the Base or Basilar Sutures are, on the middle line, the occipito-sphenoidal. On the sides, the spheno-petrosal, — sphenosquamous, — petro-squamous, — occipito-petrosal, — occipito-mastoid. CRANIO-FACIAL SUTURES. 285 Have received no special names except the Transverse Suture, which is formed by the junction of the frontal with the facial bones ; — it extends from the exter- nal angle or orbital process on one side to the opposite side ; — it connects the frontal with the nasal, lachrymal, supe- rior maxilla, ethmoid, sphenoid and malar bones; — it con- nects the sphenoid with the malar bones ; — it connects the malar bone to the zygomatic process of temporal bone. FACIAL SUTURES. Have no special names. EXTERIOR OF SKULL. 286 Upper Region or Vertex. It is bounded, — in front by the nasal eminence and superciliary ridges ; — laterally by the temporal ridges ; — behind by the external occipital pro- tuberance. It presents on the middle line — the nasal eminence, — the interparietal suture or sagittal suture. It presents on the sides — the superciliary ridges, — frontal eminences, — fronto-parietal or coronal sutures — the parietal eminences — and the parieto -occipital or lambdoid sutures. 287 Lateral Region of Skull. It is bounded — above by the curved line of the temporal bone; — in front by a line ex- tending from the external angular process of the frontal to the angle of the jaw; — behind by a line from the extremity of the superior curved line to the angle of the jaw. 288 1st. Mastoid Region : It is bounded — in front by the ante- rior root of the zygoma, — above by a line drawn from the posterior root of the zygoma to the end of the masto-pari- etal suture ; — and below by the masto-occipital suture. It presents: — A part of the squamous bone, — the mastoid process, — the mastoid foramen, — the articular eminence, the glenoid fossa, — the glenoid fissure, — and the external auditory meatus. 289 2d. Temporal Fossa: It is bounded — in front, above and behind by the temporal ridge, — externally by the zygomatic arch, — internally by the pterygoid ridge. It is formed by the frontal, malar, parietal, temporal and sphenoid bones. INFERIOR REGION OR EXTERIOR OF THE BASE OF SKULL. 99 Its- sutures are the transverse facial, coronal, spheno- parietal, squaino-parietal, squamo-sphenoidal. 290 3d. Zygomatic Fossa: It is bounded — in front by the tuberosity of the superior maxilla. — behind by posterior border of the pterygoid process, — above by the pterygoid ridge, — belowhy the alveolar border of the superior maxilla, — internally by the external plate of the pterygoid process, — externally by the zygomatic arch and ramus of the jaw. Tt presents the spheno-maxillary fissure, — and th»j ptery- go-maxillary fissure. 291' 4th. Maxillary Fossa (or Pterygo=Maxillary Fossa): It is bounded — in front by the superior maxilla, — behind by the pterygoid process, — above by the body of the sphenoid, — internally by the vertical plate of the palate bone. It presents three fissures, the sphenoidal, spheno-maxillary and pterygo-maxillary ; — five orifices: one internal, the spheno-palatine ; three posterior, the round, the vidian, and the pterygo-palatine ; one inferior, the posterior palatine canal or maxillo-palatine. It communicates with four rarities, the orbital, nasal, cranial and zygomatic. INFERIOR REGION OR EXTERIOR OF THE BASE OF SKULL. 292 It is bounded — in front by the incisor teeth of the upper jaw ; — laterally by the alveolar arch, lower border of malar, a line from the zygoma to the mastoid process and extremity of the superior curved line ; — behind by the superior curved line of the occipital bone. It presents several regions. 293 1st. Palato=Pterygoid Region : It presents on the middle line, — the anterior palatine canal, for vessels and nerves of the same name, — the articulation of the palate processes of the superior maxilla, — the articulation of the horizontal plates of the palate bones, — the posterior border of the vomer. It presents on the sides, — the alveolar process. — the in- ferior surface of the palate processes of the superior max- illa,— the inferior surface of the horizontal plate of the palate bone, — the posterior nares, — the hamular process for the reflection of the tensor muscle of the palate. — and inner lamina of pterygoid process, — the pterygoid fossa. for insertion of the internal pterygoid muscle, — the outer lamina of the pterygoid proeess for insertion of external pterygoid muscle, — the scaphoid fossa for insertion of the tensor muscle of the palate. — the pterygoid or vidian canal. 294 2d. The Occipital Region presents on the middlt Mm — the sphenooccipital suture, — the basilar process, — the occipital foramen for oblong medulla and vertebral arteries, — the 100 ANTERIOR REGION OF SKULL: FACE — ORBITS. external occipital crest for the nuchal ligament, — the external occipital protuberance. It presents on the sides — the anterior condyloid fossa and foramen for the hypoglossal nerve, — the occipital condyle articulating with the atlas, — the posterior condyloid fossa and foramen for a small vein, — the under surface of occip- ital for muscular attachment, — the inferior curved line for same, — and the superior curved line for same. 295 3d. The Sphenoidal Region presents — the under surface of the greater wing forming — the roof of the zygomatic fossa — the oval foramen for inferior maxillary nerve; — the spinous foramen for middle meningeal artery, — the spinous process of sphenoid. 296 4th. The Petrous Region presents — the petro- sphenoidal articulation — and middle lacerated foramen (formed by the articulation of apex of petrous bone with the body of sphenoid and — by articulation of anterior border of petrous bone with posterior border of greater wings), — the canal for the Eustachian tube, — a rough surface for muscular at- tachment,— the inferior orifice of carotid canal, — the vagi- nal process, — the posterior glenoid cavity, — the auricular process, — the external auditory meatus, — the petro-occipi- tal foramen or posterior lacerated foramen (with jugular foramen for jugular vein, glosso-pharyngeal, pneumo-gas- tric and spinal accessory nerves), — the styloid process for attachment of stylian muscles and ligaments — and the stylo -mastoid foramen for facial nerve. 297 5th. The Squamous Region presents — the sphenosquam- ous suture, — the anterior root of zygoma with articular em- inence,— the glenoid fossa which articulates with the con- dyle of the inferior maxilla, — the glenoid fissure which lodges the laxator muscle of tympanum, cord of the tym- panum, and slender process of the malleus. 6th. The Mastoid Region presents — the occipito-mastoid suture, — the mastoid foramen for a vein to lateral sinus, — a groove for the occipital artery, — the digastric groove for digastric muscle, — the mastoid process for sterno-mastoid muscle. ANTERIOR REGION OF SKULL: FACE— ORBITS. 298 The Orbits are formed by seven bones : frontal, ethmoid, sphenoid, superior maxillary, lachrymal, palate, malar. The Roof is formed by the frontal and lesser wing of sphe- noid.— It presents — a depression for the pulley of the su- perior oblique muscle — and one for lachrymal gland. The Floor is formed by the superior maxillary, malar and palate bones. — It presents a depression for insertion of in- ferior oblique muscle — and the infra-orbital groove, The Inner Wall is formed by the lachrymal, ethmoid, ANTERIOR REGION OF SKULL: FACE — ORBITS. lUJ sphenoid and palate bones. — It presents the lachrymal groove and the lachrymal crest . The Outer Wall is formed by the malar and sphenoid bones. — It presents the orifices of the two malar canals. The Superior Internal Angle presents — the fronto-lach- rymal suture, — the fronto-ethmoidal suture, — the eth- moidal foramina. The Superior External Angle presents — the fronto-malar — and fronto-sphenoidal sutures, — and the sphenoidal fis- sure or anterior lacerated foramen. The Inferior Internal Angle presents — the .sutures of the lachrymal and superior maxillary bones — and of the eth- moid and palate bones. The Inferior External Angle presents the sphenomaxil- lary fissure. The Circumference or Base of Orbit is bounded — inter- nally, by the nasal process of the superior maxillary bone and the internal angular process of the frontal with the lachrymal canal ; — above, by the supra-orbital arch with foramen; — externally, by the external angular processes of frontal and malar bones; — and below, by the malar bone and superior maxilla. The Apex presents the optic foramen, formed by the small wing- of the sphenoid. 299 2d. Nasal Fossae. Boundaries : The Nasal Fossa1 are formed by fourteen bones: — three of the cranium, frontal, ethmoid and' sphenoid, — and all the bones of the face, ex- cept the malar and inferior maxillary. The Roof is formed by the nasal bones, nasal spine of frontal, cribriform plate of ethmoid and sphenoidal turbi- nated bones. The Floor is formed by the palate process of the superior maxillary, — and the horizontal plates of the palate bones. It presents — the orifice of anterior palatine canal. The Inner Wall is formed by the ethmoid, vomer and sep- tal cartilage. The Outer Wall is formed by the nasal process, lachrymal bone, ethmoid, superior maxilla and vertical plate of palate bone. It presents — the surface for the filaments of the olfact- ory nerve, — the superior turbinated bone. — the superior meatus with ethmoid and sphenoid openings. — the middle meatus with openings of the antrum, — the inferior turbi- nated bone, the inferior meatus and orifice of nasal canal. The Posterior Nares are bounded — nhun by the sphenoid, — internally by the vomer, — externally by vertical plate of palate bone, — below by the horizontal plate. The Anterior Nares are bounded by the superior maxillary and nasal bones. 102 INTERIOR OF SKULL AS A WHOLE. INTERIOR OF SKULL AS A WHOLE. 300 Divisions : Upper Region or Roof, and Lower Region or Base. Boundaries : Circular line passing one inch above nasal eminence of frontal — and behind one inch above external occipital protuberance. 301 The Upper Region or Roof presents, on the middle line — the frontal crest, — the inter-frontal and sagittal sutures, — the groove for the superior longitudinal sinus, — the Pac- chionian depressions. On the sides : — the parietal fossa, — the arterial grooves, — the depressions for convolutions, — the coronal or fronto- parietal suture, — the lambdoid or parietooccipital suture. The Base presents the anterior, middle, and posterior cere- bellar fossa?. 302 Anterior or Frontal Cerebral Fossa : It is formed by the cribriform plate of the ethmoid, the frontal, and small wings of sphenoid. It presents on the middle line — the frontal crest, — the blind foramen, the surface of the grey root of the optic nerve. It presents on the sides — the olfactory grooves with the foramina of the cribriform plate, eminences and depressions for convolutions. 303 Middle or Sphenoidal Cerebral Fossa: It is formed by the body of the sphenoidal greater wings, — squamous portion of temporal bone, — and anterior sur- face of petrous portion. It presents on the middle line the olivary process — and the pituitary foss.a. It presents on the sides — the optic foramina — the anterior and posterior clinoid processes giving attachment to the tentorium,— the groove for cavernous sinus, — the sphe- noidal fissure giving passage to the ophthalmic vein, the third, the fourth, the first branch of the fifth, and the sixth nerves; — the round foramen for superior maxillary nerve, — the spinous foramen for middle meningeal artery, — the oval foramen for inferior maxillary nerve, — the middle lac- erated foramen for arterioles and the petrosal nerves ; — the internal orifice of the carotidian canal, — the depression for the Casserian ganglion, — the groove for small petrosal nerve, — the projection of superior semi-circular canal, — the roof of tympanum, — the groove for superior petrosal sinus, — the eminences and depressions for convolutions — and grooves for arteries. 304 The Posterior or Occipital or Cerebellar Fossa: It is formed by the occipital bone, — posterior surface of petrous bone — and a small portion of the parietal. It presents on the middle line — the basilar groove for the FORAMENS OF THE BASF OF THE ENTEBIOK OF THE SKULL. 103 oblong medulla, — the occipital foramen wild the anterior condyloid foramen, — the occipital crest for cerebellar t'alx. — the internal occipital protuberance for cerebral falx. — the depression for the press of Herophilus. On the sides — the internal auditory meal us for the facial and the auditory nerves, — the depressions for the convolu- tions, the posterior lacerated foramen or jugular foramen or occipito -petrosal suture, — the termination of lateral si- nuses,— the masto-occipital surface, — the cerebellar fossa. — the beginning of lateral sinuses. FORAMENS OF THE BASE OF THE INTERIOR OF THE SKULL AND ORGANS SITUATED THEREIN. 305 Anterior or Frontal Cerebral Fossa. On the Middle Line — Blind foramen, so-called, for venule anastomosing with the superior longitudinal sinus. On the Sides — Cribriform plate of the ethmoid, giving passage to the filaments of the olfactory nerves. Middle of the Sphenoidal Cerebral Fossa. Ou the Middle Line — Pituitary fossa. On the Sides — Optic foramen for optic nerve and ophthal- mic artery. Sphenoidal Fissure (or Anterior Lacerated foramen), giv- ing passage to the ophthalmic vein, the third, the fourth, the first branch of the fifth and the sixth cranial nerves. Cavernous sinus, — giving passage to the internal carotid artery and the nerves just mentioned. Round foramen, for the fifth Superior Maxillary nerve. Spinous foramen, for the Middle Meningeal artery. Oval foramen, for the Inferior Maxillary nerve. Middle Lacerated Foramen (spheno-petrosal suture), giv- ing passage to arterioles and to petrosal nerves. Internal Orifice of Carotidean Canal for Internal Carotid Artery. Groove for Superior Petrosal Sinus. Posterior or Occipital or Cerebellar Fossa. On the Middle Line — Occipital foramen, giving passage to the oblong medulla — the spinal accessory — the vertebral arteries. On the Sides — Anterior Condyloid foramen for the hypo- glossal nerve. Internal Auditory Canal for the auditory, the facial and the nerve of Wrisberg. Groove for Inferior Petrosal Sinus. Posterior or Lacerated Foramen or Jugular Foramen (/'.<.. Occipito-petrosal suture ) . Jugular vein — the glossopharyngeal — pneumo-gastric — spinal accessory. Mastoid Foramen for mastoid vein. Lateral Sinuses, with Press of Herophilus. 104 POINTS CONCERNING THE RIBS, STERNUM AND CLAVICLE. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE RIBS. 30G Number: There are Twelve Ribs on each side. Division : There are seven true or vertebro-costal ribs, three false or vertebro-chondral ribs, and two floating ribs. Direction : The ribs are twisted. The Head presents two facets for articulation with the ver- tebrae. The Neck presents on its upper border a crest for the costo- transverse ligament. The Tuberosity presents a facet for articulation with the transverse process of a vertebra. The Angle of the Rib is a marked ridge. The Inferior Border of the body is grooved for the inter- costal vessels and nerves. The Anterior Extremity articulates with the costal car- tilage ; — this extremity is lower than the posterior extrem- ity, corresponding horizontally behind to the head of the second rib above it. 307 First Rib: The head presents a single facet, — it presents the scalene tubercle, — a groove for the subclavian artery — and also one for the vein ; — there is no angle or twist. Second Rib: It presents a roughness for the posterior sca- lene and the great serrate muscles. Tenth Rib: It presents a single facet on the head. Eleventh Rib: It presents a single facet on the head; — it has no tuberosity; — the anterior extremity is pointed. Twelfth Rib: It presents a single facet on the head; — it has no neck, — no tuberosity, — no groove ; — it has a pointed extremity. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE STERNUM. 308 Divisions.. The Sternum is divided into the handle or first piece, the blade or second piece; — the articulation of the two pieces persists sometimes late in life. — The ensiform cartilage is the point or third piece. It presents articular facets for the costal cartilages and for the clavicle. The Posterior Surface is in relation with the innominate ves sels, pericardium and heart. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE CLAVICLE. 309 1st, a facet to articulate with the sternum ; — 2d, a tubercle for the attachment of the sterno-mastoid muscle and inter- clavicular ligament ; — 3d, a roughness for the costo-clavicu- POINTS CONCERNING THE SCAPULA, HUMERUS AND ULNA. L05 lar ligament; — 4th, a roughness of the subclavian muscle ; — 5th, convexity in front for attachment of great pectoral muscle — and also a concavity for the origin of the deltoid ; 6th, concavity behind for attachment of sterno-mastoid ; — 7th, also convexity for the attachment of the trapezius ; — 8th, a facet for articulation with the acromion ; — 9th, ;i roughness of the costo-clavicular ligaments. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE SCAPULA. 310 The Scapula presents: 1st, the subscapular fossa ; — I'd. the supra-spinal fossa; — 3d, the spine of the scapula — and acromion; — 4th, the infra-spinous fossa; — 5th, the cora- coid process — for coraco-brachial, small pectoral and short head of the biceps ; — 6th, the origin of the long head of the biceps ; — 7th, the glenoid cavity ; — 8th, a roughness for the origin of long head of the triceps ; — 9th, an axillary border j — 10th, a spinal border; — 11th, a superior or coracoid bor- der. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE HUMERUS. 311 They are: — 1st, the head, which articulates with the glenoid cavity; — 2d, the anatomical neck for the insertion of the capsular ligament; — 3d, the lesser tuberosity for the inser- tion of the subscapular; — 4th, the greater tuberosity with three facets for the insertion of the supra-spinous. infra- spinous, and small round; — 5th, the bicipital groove for the long head of biceps, the anterior ridge for great pectoral ; — 6th, the surgical neck; — 7th, the roughness for the del- toid;— 8th, the musculo-spiral groove for the profunda artery and the musculo-spiral nerve ; — 9th, an outer border ; — 10th, an inner border; — 11th, the olecranon fossa: — 12th, the coronoid fossa; — 13th, the internal condyle; — 14th, the trochlea for the ulna; — 15th, the groove for the edge of the head of the radius; — 16th. the small head of the humerus for the head of the radius ; — 17th, the external condyle. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE ULNA. 312 They are: — 1st, the olecranon process; — 2d. the coronoid process; — 3d, the greater sigmoid notch or cavity articulat- ing with the humerus; — 4th, the lesser sigmoid notch artic- ulating with the radius; — 5th, the roughness for the an- terior brachial muscle; — 6th, the outer border for the insertion of the interosseous ligament; — 7th. the neck of 106 POINTS CONCERNING THE RADIUS, CARPUS AND METACARPUS. the ulna; — 8th, the head of the ulna articulating below with the triangular fibro-cartilage, cuneiform bone and on the side with the radius; — 9th the styloid process for inter- nal lateral ligament; — 10th,- the groove for the insertion of the triangular ligament. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE RADIUS. 313 They are: — 1st, the head articulating above with the small head of the humerus — and laterally with the lesser sigmoid notch of the ulna; — 2d, the neck of the radius; — 3d, the bicipital tubercle for the tendon of the biceps; — 4th, the oblique line; — 5th, the roughness for the round pronator; — 6 th, the inner border for the interosseous ligament; — 7th, the supinator tubercle ; — 8th, the lower extremity articulat- ing with the semilunar and scaphoid bones ; — 9th, the artic- ular facet for the head of the ulna; — 10th, the styloid pro- cess for the external lateral ligament; — 11th, the grooves for the tendons. RESUME OP THE POINTS OF SPECIAL INTEREST CONCERNING THE CARPUS. 314 The Carpus is composed of two rows of bones. The First Row comprises — the scaphoid, resembling a boat and articulating with the radius ; — the semilunar, resembling a crescent and articulating also with the radius; — the cuneiform or pyramidal, resembling a wedge and articulating with the fibro-cartilage and ulna; — the jiisi form, resembling a pea, articulating with the cuneiform and giving attach- ment to the ulnar carpal flexor. The Second Row comprises — the trapezium, articulating with the metacarpal bone of the thumb; — the trapezoid, smaller than the trapezium ; — the os magnum, projecting upwards between the scaphoid and the semilunar; — the unciform bone, having a hook-like process for the attach- ment of the annular ligament. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE METACARPUS. 315 They are: — 1st, facets for articulation with the carpal bones ; — 2d, lateral facets for articulation with one another; — 3d, an anterior border for tendinous insertions; — 4th, a head articulating with the first phalanx ; — 5th, lateral tuber- cles for the insertion of the lateral ligaments. The first metacarpal hone or metacarpal bone of the thumb has no lateral facets and does not articulate with the others. The last metacarpal bone presents no inner lateral facet. POINTS CONCERNING THE PHALANGES AND [NNOMINATE BONE. 10/ RESUME OF POINTS OF SPECIAL INTEREST CONCERNING THE FIRST PHALANGES. 31G They are: — 1st, a cavity articulating with the head of tin* metacarpal bones; — 2d, a rough surface for the insertion of the sheath of the flexor tendons; — 3d. the lower extremity presents the shape of a small pulley or trochlea, i. <., two small eminences or heads separated by a groove ; — it articu- lates with the second phalanx. RESUME OF THE POINTS OF SPECIAL INTEKEST CONCERNING THE SECOND PHALANGES. The Upper Extremity presents two small cavities sepa- rated by a ridge and articulates with the first phalanx ; — rough borders for the insertion of the tendons of the super- ficial flexor. The Lower Extremity presents a pulley. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE THIRD PHALANGES. The Tipper Extremity presents two small cavities separated by a ridge. The Lower Extremity has the shape of a horseshoe — and is rough for the insertion of the deep flexor. The Thumb has no second phalanx. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE INNOMINATE BONE. 317 Divisions. It comprises three portions, the Ilium. Pubis and Ischium. The Outer Surface presents the superior curved line : — a rough surface for the great gluteal; — the middle curved line; — a rough surface for the middle gluteal ; — the infe- rior curved line ; — a rough surface for the small gluteal ; — a groove for the reflected tendon of straight femoral muscle; — the acetabulum for the reception of the head of the femur; — the back cavity of the acetabulum not lined with cartilage and lodging the round ligament ; — the acetab- ular or cotyloid notch; — the obturator foramen; — the obturator canal; — a groove for the tendon of the internal obturator; — the tuberosity of the ischium. The Inner Surface presents — a rough surface tor liga- ments,— the auricular facet articulating with the sacrum ; — the internal iliac fossa. — the brim of the pelvis, — a square surface corresponding to the acetabulum; — the obturator canal and the obturator foramen. 108 POINTS CONCERNING THE PELVIS IN GENERAL. The Upper Border or Iliac Crest gives attachment to the oblique and transverse muscles. The Anterior Border presents the anterior superior spinous process for the sartorius and Poupart's ligament; — a notch; — the anterior inferior spinous process for the straight femoral muscle; — a notch; — the pectineal emi- nence;— the horizontal branch of the pubis; — the ilio- pectineal line; — the spine of the pubis; — the crest of the pubis ; — the angle of the pubis. The Internal Border presents the descending branch of the ischium for the origin of the cavernous bodies and the great adductor. The Posterior Border presents — the tuberosity of the ischium, — the lesser sacro-sciatic notch ; — the spine of the ischium, — the greater sacro-sciatic notch; — the posterior inferior spinous process; — the posterior superior spinous process. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE PELVIS IN GENERAL. 318 The Upper Strait or Inlet is limited — behind by the sacrum, — laterally by the pelvic brim of the innominate bone — and in front by the pubis. The Diameters are the antero-posterior, from sacro -vertebral angle to pubic symphysis, — the transverse or bi-iliac; — the oblique, extending from pectineal eminence to opposite sacro- iliac symphysis. The Upper Plane is the surface included by those limits. The Axis of the Upper Strait is the line passing perpen- dicularly through the centre of the upper strait; — it is directed backwards and downwards ; — the upper extremity of the line corresponds to the umbilicus, — the lower ex- tremity to the lower part of the concavity of the sacrum. The Lower Strait or Outlet is limited — behind by the sacrum and coccyx ; — laterally by the great sacro-sciatic liga- ment ; — anteriorly by the arch of the pubis and the ischium. The Diameters are antero-posterior or coccy-pubic, trans- verse or bi-ischiatic. The Lower Plane is the surface included by those limits. The Axis of the Lower Strait is the line passing per- pendicularly through the centre of the lower plane; — it is directed backwards and upwards; — it corresponds to the axis of the vagina ; — its upper extremity corresponds to the upper part of the sacrum. RESUME OF THE DIFFERENCES BETWEEN THE MALE AND FEMALE PELVIS. 319 In the Male pelvis the vertical diameters are the longest and the horizontal are the shortest. POINTS CONCERNING THE FEMUR, PATELLA AND TIBIA. 109 In the Female Pelvis the antero-posterior and the trans- verse diameters are the longest and the vertical the shortest. In Short, the Female pelvis is wider but lower; — whereas the male pelvis is narrower but higher. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE FEMUR. 320 They are : — 1st, the head, articulating with the acetabulum and presenting a depression for the round ligament ; — 2d, the neck, which is intracapsular in front but extracapsular behind; — 3d, the small trochanter; — 4th, the anterior in- tertrochantic line or spiral line ; — 5th, the great trochanter for the pelvic muscles ; — 6th, the digital depression for the internal obturator; — 7th, the inner upper branch of rough line to great trochanter ; — 8th, the outer upper branch of rough line to great trochanter; — 9th, the rough line of the femur for the adductor muscles ; — 10th, the inner lower branch of the rough line with the tubercle for the great adduc- tor ; — 11th, the outer lower branch of the rough line ; — 12th, the condyles, — united in front — and separated behind by the intercondyloid notch for the spine of tibia and the insertion of the crucial ligaments; — 13th, the outer tuberosity; — 14th, the groove for the popliteus, and, — 15th, the inner tuberosity with the tubercle for the tendon of the great adductor. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE PATELLA. 321 The Posterior Surface, the upper two-thirds of which are lined with articular cartilage ; the lower third is not, and is out of the joint. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE TIBIA. 322 They are : — 1st, the head presents the glenoid cavities ; — 2d, the spine of the tibia for the insertion of the cross liga- ments ; — 3d, the internal tuberosity; — 4th, the groove for the semi-membranous; — 5th, the external tuberosity — 6th, a facet articulating with the fibula; — 7th, the tubercle of the tibia; — 8th, the anterior border or shin; — 9tb, the ex- ternal border or interosseous ridge; — 10th, the space for popliteal muscle ; — 11th, the oblique line; — 12th, the in- ternal malleolus; — 13th, the posterior grooves for the ten- dons;— 14th, the facet for articulation with the fibula; — 15th, the facet for articulation with the astragalus. 110 POINTS CONCERNING THE FIBULA AND TARSUS — LIGAMENTS. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE FIBULA. 323 They are : — 1st, the head, presenting the styloid process and a facet articulating with the tibia; — 2d, the neck; — 3d, the internal border or interosseous ridge ; — 4th, the external malleolus, — a rough surface for the interosseous ligament; — an articular facet for the astragalus — and depressions for the lateral ligament. RESUME OF POINTS OF SPECIAL INTEREST CONCERNING THE TARSUS. 324 The First Row comprises the Astragalus and the Cal- caneum. The Astragalus presents — a head articulating with sca- phoid,— a neck, — facets for articulation with the tibia and malleoli and with the two upper facets of calcaneum; — a groove between these two facets for the interosseous liga- ment,— depression on the posterior surface for the external lateral ligament, — a groove for the long flexor of the great toe. The Calcaneum presents — articular facets for the astraga- lus — a groove between the two ; — the lesser process of the calcaneum, — the greater process of the calcaneum, — the in- ner tuberosity, — the outer tuberosity, — the tubercle (on external surface) for the external lateral ligament, — grooves for the peroneal muscles separated by a ridge. 325 The Second Row comprises the scaphoid, the three cuneiforms and the cuboid. The Scaphoid presents — an anterior surface articulating with the astragalus; — articular surfaces for the three cuneiforms; — the tubercle of the scaphoid for the insertion of the tarsal ligament. Cuneiforms. The internal cuneiform is the largest, the middle is the smallest, and the external the middle-sized one. They present articular facets for articulation with the sca- phoid, with one another and with the metatarsal bones. The Cuboid presents articular facets for the calcaneum and the last two metatarsals ; — a groove for the tendon of the long peroneal muscle. Metatarsal Bones and Phalanges : Same as in the fingers. LIGAMENTS. 326 Structure. The Simple Fibrous are formed of white tissue alone. The Fibro-Elastic have more or less elastic fibres. The Elastic are formed of elastic fibres alone (yellow elastic ligaments between the lamina? of the vertebras). SEROUS MEMBRANES — CLASSIFICATION OF JOINTS. Ill The Fibro- Cartilaginous have more or less cartilaginous t is sue in them (intervertebral discs). The Cartilaginous have no fibres in them (synarthrodia] joints). SYNOVIAL AND SEROUS MEMBRANES IX GENERAL. o27 Structure. They are composed : 1st, of a Basement Membrane formed of connective tissue. 2d, of an Epithelium composed of tesselated cells. Synovial membranes present adipose masses and vascular processes. The Adipose Masses, at one time erroneously termed the Haversian glands, — consist simply of fat cells contained in a fold or projection of the synovial membrane. The Vascular Processes present an analogous structure, but their bulk is formed of a great number of capillaries which give them their red coloration and cause them to re- semble in structure the choroid plexuses of the cavities of the brain. In these Synodal Membranes the endothelium and base- ment membrane stop where the cartilage begins. In Other Serous Membranes the Visceral Portion, or the portion which invests the organs, consists only of the endo- thelium. Synovial fluid contains lymph corpuscles. CLASSIFICATION OF JOINTS. 328 1. Synarthrodial. Sutures (seams) Dentated: Tooth-like processes, as in interparietal sutures. Serrated: edges like teeth of a saw, as in interfrontal sutures. Limbous: bev- eled margins and dentated processes, as in the fronto- parietal suture. Squamous have beveled margins overlapping each oilier, as in squamo-parietal. Harmonic: opposition of contiguous rough surfaces, as in the intermaxillary suture. Schindylesis: a border fitting in a groove, as vomer and sphenoid. Gomphosis: teeth in their sockets. 2. Diathrodial. Fnarthrodial or Ball and Socket: shoulder and hip. Condyloid: temporo-maxillary, atlo-occipital. Mutual Adaptation: trapezo-phalangeal, sterno-clavicnlar. Ginglymoid or Hinge-lih : elbow, knee. Pivotal or Rotary: odontoid, radio-ulnar. Artkrodial: facets in contact; articular processes of the vertebra?. 3. Amphiarthrodial : with partial synovial membrane (sym- physis) without synovial membram (bodies of vertebra')- 112 PECULIARITIES OR CHARACTERISTICS OF JOINTS. PECULIARITIES OR CHARACTERISTICS OF EACH KIND OF JOINT. 329 Synarthrodia! Joints or Immovable Joints. Are found only in the head. Articular Surfaces: Vary according to location. Ligaments: A cartilaginous substance between the bones. Synovial Membrane: None. Movements: None. Diarthrodial or Movable Joints. JV. B. — The Articular Surfaces are all lined with cartilage. Enarthrodial or Ball and Socket Joints. (Scapulo-humeral, coxo-femoral. ) Articular Surfaces: On one of the bones, a socket with a nbro-cartilaginous rim ; a head on the other bone. Ligaments: A capsular ligament. It always presents a band of reinforcement often called by a special name (coraco-humeral, ileo-femoral). Muscular Ligaments: The joint is usually surrounded by short, strong muscles. Synovial Membrane: Is usually well developed. Movements: All the movements, flexion, extension, abduc- tion, adduction, circumflexion, rotation on its axis. Condyloid Joints. (Temporo-maxillary articulation. ) Articular Surfaces: An elongated head on one bone and a similar cavity on the other. Inter-Articular Fibro- Cartilage: Sometimes exists (temporo- maxillary). Ligaments: Always capsular. Sometimes presents a band of reinforcement. Synovial Membrane: Is well developed. It is sometimes divided into two by the cartilage. Movements: All except the rotation on axis. Mutual Adaptation Joints. (Sterno -clavicular, trapezo-phalangeal. ) Articular Surfaces: They are concave in one direction and convex in the other, and are so opposed to each other as to adapt themselves to each other. Inter -Articular Fibro- Cartilage: Is sometimes found (as in the sterno -clavicular). Ligaments: A capsular ligament mainly. Synovial Membrane: Is well marked. Movements: All except rotation on axis. Ginglymoid or Hinge=like Joints. (Elbow, knee.) Articular Surfaces: On one bone, two prominences ; on the other, two cavities. Inter-articular Fibro- Cartilage: Exists in some. Ligaments: Lateral ligaments, which are the strongest in ARTICULATIONS OF THE BONES OF THE VERTEX OF BKULL. 1 L3 some situations, an anterior and a posterior more or Less evident and strong. Synovial Membrane: Is usually extensive. Movements: Only flexion and extension. Pivotal or Rotary Joints. (Odontoid, radio-ulnar. ) Articular Surfaces: A head with a sharp neck on one bone, and a partial cavity on the other. Ligaments: Usually a strong- band, the lower border of which is shorter than the upper so as to strangle the head as it were. Muscular Ligaments: Usually a group of short, round muscles surround the joint. Synovial Membrane: Is usually small. Movements: Those of rotation of one-quarter of a circle. Arthrodial Joints. (Articular processes of vertebra?.) Articular Surfaces: Usually small facets, plane, or con- cave, or conyex. Ligaments: A short, limited capsule. Synovial Membrane: Is very limited. Movements: A mere gliding motion. Amphiarthrodial Joints or Partly flovable Joints. 1st Variety: Amphiarthrodial Joints With Synovial Membrane (pubis, sacro-iliac). Articular Surfaces: A small part only of the bones in con- tact is lined with cartilage ; the larger part is rough for lig- amentous attachments. Ligaments: The most important is always a strong inter- osseous ligament — presents also more or less important peripheral ligaments. Synovial Membrane : Is more limited. Movements: Are very limited. 2d Variety: Amphiarthrodial Joints Without Synovial Membrane such as between the intervertebral discs. Articular Surfaces: Are all rough. Ligaments: Are strong bands of fibro- cartilaginous tissue. Synovial Membrane: Is absent ; however, the centre of the ligament presents a spot softer than the balance. Movements: Are still more limited than in the other variety. ARTICULATIONS OF THE BONES OF THE VERTEX OF THE SKULL. 330 They are all synarthrodia Is. They are all serrated or dentated. 114 RESUME OF THE IMPORTANT JOINTS. ARTICULATIONS OF THE BONES OF THE SIDES OF THE SKULL. They are in the temporal fossa. They are all synarthrodials. They are all squamous. ARTICULATIONS OF THE BONES AT THE BASE OF THE SKULL. They are all synarthrodials. They are all harmonic sutures. ARTICULATIONS OF THE BONES OF THE FACE. They are synarthrodials They are all harmonic sutures. ARTICULATIONS OF THE BONES OF THE UPPER JAW WITH THE BONES OF THE HEAD. They are all synarthrodial. They are slightly serrated. RESUME OF THE iriPORTANT JOINTS. ARTICULATION OF THE LOWER JAW WITH THE BONES OF THE HEAD OR TEMPORO- MAXILLARY ARTICULATION. 331 The Temporo=Maxillary. Class : Condyloid. Articular Surfaces: Glenoid Cavity of temporal bone, Con- dyle of Inferior Maxillary, — Inter-articular fibro-cartilage. Ligaments: Capsular, External Lateral, — Internal Lateral or spheno-maxillary (origin, spinous process of sphenoid; insertion, inner surface of ascending branch of inferior maxillary) ; — Posterior Ligament or Stylo -maxillary (origin, styloid process ; insertion, angle of jaw) ; — Pterygo-maxillary Ligament (origin, pterygoid process; insertion, inner sur- face of ascending branch of maxillary). Synovial Membrane: Is double, one above and one below the cartilage. Movements: Flexion, extension, abduction, adduction, i. e., all except rotation on axis. ARTICULATIONS OF OCCIPITAL, YKKTKI'.k.i: AND RIBS. 1 1 5 ARTICULATIONS OF OCCIPITAL WITH ATLAS AND AXIS. 332 These bones arc joined by their bodies, their Laminae, their articular surfaces. The most interesting- of all these are the articulations of the odontoid process with the atlas and the occipital. They are : Class: Pivotal. Ligaments: All the most interesting Ligaments arc in the interior of the spinal canal. 1, Superficial occipito-axoid ; — 2, middle occipito-axoid ; — 3, deep occipito-trausverse ; — 4, transverse ligament (Origin and Insertion, inner surface of occipital foramen) ; — 5, axoido-transverse (completes the crucial ligament); — 6, occipito-odontoid ; 7, odonto-atloid (Insertion, to tu- bercle on inner surface of atlas). ARTICULATIONS OF THE VERTEBRAE. 333 The Vertebra? articulate by their bodies, their lamina?; their articular processes are their spinous processes. Ligaments : The most important ligaments are 1st. Anterior Vertebral, a strong fibrous band extending all along the anterior surface of the bodies of the verte- bra?. 2d. The Intervertebral Discs, situated between the bodies and composed of strong fibro -cartilaginous fibres arranged in a semi-circular ring. — They are unique. 3d. The Posterior Vertebral Ligament, situated in the in- terior of the vertebral canal, is a fibrous band extending ;ill along the posterior surface of the bodies. 4th. The Yellow Elastic Ligaments joining the laminae — they are thick and strong and thoroughly elastic. — They are unique. 5th. The Capsular Ligaments around the articular pro- cesses. 6th. The Supra=5pinous Ligaments joining the spinous processes. ARTICULATIONS OF THE RIBS. 334 The articulations of the Ribs are all Amphiarthrodials. The Heads of the Ribs articulate with the bodies of the vertebra?. The Ligaments are an interosseous ligament extending from the ridge on the head to the intervertebral disc. — by an anterior fan-shape ligament. The Tuberosities of the Ribs articulate with the apes ><( the transverse processes. 116 ARTICULATION OF SACRUM AND COCCYX, ULNA AND RADIUS. The Ligaments are — an interosseous ligament situated between the neck of the rib and the transverse process — a superior or castro-transverse ligament, — a posterior liga- ment. The Anterior Extremity of the Ribs articulate with the chondral cartilages and are synarthrodial. The Chondral Cartilages articulate with the sternum and are also synarthrodial. ARTICULATION OF THE SACRUM AND COCCYX. Is an arthrodial articulation. The Ligaments are an anterior, a posterior and two laterals. STERNO-CLAVICULAR ARTICULATION. 335 Class : Mutual adaptation. Articular Surface : Facets on Clavicle, facets on Sternum; Inter articular Cartilage . Ligaments : Anterior, Posterior, Superior or Interclavicular . Movements : All except rotation on axis. SCAPULO-HUMERAL. 336 Class: Enarthrodial, or ball and socket. Articular Surfaces: Glenoid Cavity of scapula deepened by a fibro-cartilaginous ring around the margin; — Head of Humerus. Ligaments : Capsular ligament and Cor aco -humeral — Long head of biceps ; — supra-spinous, — infra-spinous, — small round and subscapular muscles. Synovial Membrane is very extensive. Movements : All : flexion, extension, abduction, adduction, circumduction and rotation on its axis. THE ELBOW JOINT. 337 Divisions. It comprises the articulation of the humerus with the radius and ulna, and the articulation of the upper extremity of the radius with the ulna. ARTICULATION OE HUMERUS WITH ULNA AND RADIUS. Class: Ginglymoid or hinge-like. Articular Surfaces: Humerus: the trochlea and the small head of the humerus. — Ulna: great sigmoid notch formed by the olecranon process and coronoid process. — Radius: concave facet at upper extremity. ULNO-RADIAL, RADIO-CARPAL ARTICULATION. 11 i Ligaments : Anterior and Posterior, weak ; — Internal Lat- eral (Origin, internal condyle; Insertion, two heads into olecranon process and coronoid process); External IjN. 1 1!) Ligaments: Capsular (Origin, margin of acetabulum; In- sertion in front to the anterior intra-trochanteric Line; be- hind, it grasps the neck below the head like the radio-ulnar ligament); — Ilio-femoral (Origin, anterior inferior spinous process; Insertion, small trochanter); — Round ligament (Origin, margin of back of cavity of acetabulum ; [nserl ion. pit in head of femur) . Synovial Membrane sometimes communicates with the se- rous bursa and the psoas-iliac. Movements: Flexion, extension, abduction, adduction, cir- cumduction and rotation. KNEE JOINT OK TIBIO-FEMORAL. 345 Class : Ginglymoid or hinge-like. Articular Surfaces. Femur: the two condyles united in front but separated behind. — Tibia: the two glenoid cavi- ties separated by the spine of the tibia. — Patella: articular facets occupying the upper two-thirds of its posterior sur- f a ce . — Semilunar Fibro-ca rtilages . Ligaments: Anterior or Patellar, very strong (Origin, pa- tella ; Insertion, anterior tuberosity of tibia) ; — Posterior lig- ament, or ligament of Winslow, strong (Origin and Inser- tion, outer condyle of femur to inner tuberosity of tibia, and margin of condyles and tuberosities) ; — External liga- ment, strong and cord-like (Origin, outer condyle; Inser- tion, styloid process of fibula) ; — Interosseous or Crucial liga- ments (Origin, inner surface of condyles; Insertion, in front and behind spine of tibia) ; — Adipose ligaments (Origin, patella; Insertion, spine of tibia); — Internal and External Patellar ligaments (capsular) (Origin, border of patella ; Insertion, tuberosities of tibia). Synovial Membrane is very extensive, — it sends a large process under the biceps — and also small ones under the patellar ligament. flovements : Flexion and extension. UPPER TIBIO -PERONEAL ARTICULATION. 346 Class : Arthrodial. Articular Surfaces: Each bone presents a round facet. Ligaments: They are: an auterior, strong; a posterior, strong. Synovial Membrane : Sometimes communicates with that of the knee. riovements : A gliding motion. LOWER TIBIO-PERONEAL ARTICULATION. Class : Amphiarthrodial. Articular Surfaces : Each bone presents a small facet ami a more extensive rough surface. 120 ANKLE JOINT, TARSUS ARTICULATIONS. Ligaments : They are anterior strong and a posterior also strong. Synovial Membrane : It also communicates with that of the ankle joint. ANKLE JOINT OR TIBIO-TARSAL. 347 Class : Ginglymoid. Articular Surfaces. Leg: lower extremity of tibia; inter- nal malleolus ; external malleolus. — Foot: three facets on astragalus. Ligaments : Anterior and Posterior, weak ; — External Lat- eral, strong (Origin, apex of malleolus ; Insertion, astrag- alus in front and behind, calcaneum in middle) ; — Internal Lateral, ligament, strong (Origin, internal malleolus; In- sertion, astragalus and calcaneum). Synovial Membrane is extensive — it communicates with that of the lower tibio-peroneal articulation. flovements : Flexion and extension. ARTICULATIONS OF THE TARSUS. 348 1st. Articulation of Astragalus and Calcaneum. Class : Arthrodial. Articular Surfaces: Two facets on each bone. Ligaments : Interosseous, strong (in grooves between the facets) ; — Capsular, weak (around the facets). Synovial Membrane: It communicates with that of all the articulations of the tarsus. Movements : Gliding motion. ARTICULATION BETWEEN THE FIRST AND SECOND ROWS. 349 Class : Arthrodial. Articular Surfaces : Facet on head of Astragalus articu- lating with scaphoid; — facet on Calcaneum articulating with cuboid. Ligaments : Dorsal Ligaments: Dorsal calcaneo-cuboid ; interosseous or Y ligament (from calcaneum to cuboid and scaphoid) ; astragalo-scaphoid. Internal Ligament: Calcaneo-scaphoid, bridging over head of astragalus ; very strong. Plantar Ligaments: Long plantar or calcaneo-cuboid; short plantar or calcaneo-cuboid. Movements : Gliding motion. 350 Articulations of the iletatarsal : Are the same as those of the hands. The great toe has no separate articulation. RESUME OP MUSCLES. 121 riUSCLES. RESUME OF STRUCTURE OF THE MUSCULAR TISSUE. There are two sorts of Muscular Fibres, the smooth mus- cular and the striped muscular fibres. 351 Striped fluscular Fibres are composed — 1st, of an Envel- ope called the Myolemma ; — 2d, of a, Proper Substanci com- posed of muscular fibrils — composed themselves of minute particles called the Sarcous Elements) — 3d, of Capillaries which run parallel with the muscular fibres. Smooth Muscular Fibres are composed of fusiform nu- cleated cells, which unite together to form muscular fasci- cules or bundles. RESUME OF THE STRUCTURE OF TENDONS. 352 Tendons are composed of an Envelope, — of bundles of dense connective tissue, — of elastic fibres, — of connective tissue corpuscles. APONEUROSES OR FASCLE. 353 Structure. They are formed of fine bundles of connective tissue. RESUHE OF MUSCLES (ORIGIN, INSERTION AND ACTION). MUSCLES OF THE HEAD. CRANIAL REGION. 354 Occipito=frontal : Origin, superior curved line of occipital : Insertion, skin over eyebrow. AURICULAR REGION. Anterior Auricular : Origin, zygoma; Insertion, helix. Posterior Auricular: Origin, mastoid process: Insertion, concha. Superior Auricular: Origin, temporal fascia; Insertion, concha. PALPEBRAL REGK >X . Palpebral Orbicular: Origin, direct tendon, from nasal process of superior maxilla: reflected tendon, from crest of lachrymal bone; Insertion, skin of outer region of eyelid. Tensor of the Tarsal Cartilages: Origin, membrane of lachrymal sac; Insertion, lachrymal points. 122 MUSCLES OF THE HEAD. Superciliary or Contractor of the Eyebrows: Origin, superciliary ridge ; Insertion, skin of the eyebrow. NASAL EEGION. 355 Pyramidal : Origin, nasal bone ; Insertion, skin between the eyebrows. Common Elevator of Wing of Nose and Upper Lip : Origin, nasal process ; Insertion, wing of nose and skin of upper lip. Dilator of the Nostrils : Origin, median cartilage of nose ; Insertion, wing of nostrils. Compressor of Nostrils : Origin, incisive fossa of superior maxilla; Insertion, skin of septum and wings of nostrils, BUCCAL OR ORAL REGION. 356 1st. Orbicular Muscle : Origin and Insertion, skin. 2d. Elevators of Upper Lip, Common Elevator (see above), Proper Elevator : Origin, margin of orbit; Inser- tion, skin of lip. 3d. Elevator of the Commissures: Small Zygomatic: Origin, malar bone; Insertion, skin of lip. Great Zygomatic : Origin, malar bone and zygoma ; Inser- tion, skin of lip. 4th. Proper Elevator of Commissure or Canine Muscle: Origin, canine fossa; Insertion, skin of lip. 5th. Retractors of the Commissures: Risorius: Origin, formed by the highest fibres of the platysma ; Insertion, skin of lip. Buccinator : Origin, pterygo-maxillary ligament, alveolar processes of the two maxillae ; Insertion, skin of angle of mouth. 6th. Depressor of the Commissure : Triangular Muscle: Origin, oblique line of inferior maxilla; Insertion, skin of angle. 7th. Depressor of the Lower Lip : Square Muscle of Chin: Origin, base of inferior maxilla; Insertion, skin of lip. 8th. Elevator of the Lower Lip : Origin, symphysis of maxilla; Insertion, skin of lip. TEMPORO-MAXILLARY REGION. 357 Masseter : Origin, zygoma and malar bone; Insertion, outer surface of vertical branch of lower maxilla. Action, elevates lower jaw. Temporal: Origin, temporal fossa; Insertion, coronoid process of inferior maxilla. Action, same. PTERYGO-MAXILLARY REGION. External Pterygoid : Origin, inferior surface of wing of sphenoid and external surface of pterygoid process ; Inser- MUSCLES OP NECK. L23 Hon, depression in neck of condyle. Ad ion, causes the grinding" motion of the jaw. Internal Pterygoid: Origin, pterygoid fossa: Insertion, in- ner surf ace of vertical branch of inferior maxilla. Action, same. MUSCLES OF NECK. SUPERFICIAL REGION. 358 1st. Platysma : Origin, oblique line of inferior maxilla and skin of angle; Insertion, skin over the clavicle. Action, stretches the skin of the neck. Sterno=cleido Mastoid : Origin, sternum and internal ex- tremity of clavicle; Insertion, mastoid process. Action, rotates the face to the opposite side ; when both act they extend the head. SUPRA-HYOID REGION. 359 Digastric: Origin, digastric groove of occipital: Insertion, inner surface of inferior maxilla. It pierces the tendon of the stylo-hyoid where this is attached to the hyoid bone. Action, raises the larynx. Stylo=hyoid : the name indicates origin and insertion. Mylo=hyoid : Origin, internal obliqne line of inferior max- illa ; Insertion, hyoid bone. Action, raises the larynx. Geni<>=nyoid : Origin, inferior genial tubercle of inferior maxilla; Insertion, hyoid bone. Action, raises the larynx. INFRA -HYOID REGION. Sternohyoid, Sternothyroid, Thyrohyoid, Omo=hyoid ; The names indicate origin and insertion. They are de- pressors of the larynx and jaw. ANTERIOR VERTEBRAL REGION. 360 Large Anterior Strait: Origin, tubercles of transverse processes of the four upper cervical vertebrae; Insertion, bas- ilar process of occipital bone. Small Anterior Strait: Origin, transverse process of at- las ; Insertion, basilar process of occipital. Lateral Strait: Origin, transverse process of atlas; In- sertion, jugular process of occipital. Long Cervical Muscle — Inner Portion : Origin, bodies of upper cervical vertebrae ; Insertion, bodies <>f upper dorsal vertebra?. Action, all act as active ligaments. Lower Portion: Origin, bodies of dorsal vertebrae; Inser- tion, transverse processes of fifth and sixth cervical vertebrae. Upper Portion: Origin, transverse processes of upper cer- vical vertebrae: Insertion, tubercle on anterior surf ace of atlas. 124 MUSCLES OF BACK. LATERAL VERTEBRAL REGION. 361 Anterior Scalene: Origin, anterior tubercles of four upper cervical vertebras ; Insertion, tubercle on first rib. Middle Scalene: Origin, posterior tubercles of cervical vertebras; Insertion, first rib , behind groove for subclavian artery. Posterior Scalene: Origin, posterior tubercles of cervical vertebras ; Insertion, second rib. MUSCLES OF BACK. FIRST LAYER. 362 Trapezius : Origin, superior curved line of occipital nuchal ligament, spinous processes of dorsal vertebras ; In- sertion, spine of scapula ; posterior convexity of clavicle. Action, raises the shoulder by its upper fibres and depresses it by its lower fibres ; when both muscles act, the shoulders are drawn towards the spine. The upper fibres rotate the head to the opposite side; the two sides acting simulta- neously extend the head. Great Dorsal : Origin, crest of ilium, spinous processes of sacrum and lumbar vertebras, lower ribs ; Insertion, bicipi- tal groove of the humerus. Action, adducts the arm. SECOND LAYER. Elevator of Scapula: Origin, transverse processes of three upper cervical vertebras ; Insertion, upper part of spinal border of scapula. Rhomboid : Origin, spinous processes of lower cervical and upper dorsal vertebras ; Insertion, lower portion of the spinal border of the scapula. Action, raises the lower angle of the scapula. Inferior Serrate : Origin, spinous process of lower dorsal and upper lumbar vertebras; Insertion, lower ribs (body). Action, depresses the lower ribs. THIRD LAYER. Splenious (spinous occipito-transverse) : Origin, spinous processes of six upper dorsal and two lower cervical; Insertion, transverse processes of three upper cervical and outer portion of rough space of occipital bone. Action, rotates the head to the same side. Superior Serrate : Origin, spinous process of last two cer- vical and upper two dorsal vertebras ; Insertion, body of upper ribs. Action, raises the upper ribs. FOURTH LAYER. 363 Complexus (or transverso-occipito-mastoid) : Origin, transverse processes of five upper dorsal and four lower MUSCLES OF HACK. 125 cervical; Insertion, inner half of rough surface of occipital bone, a portion being attached to the mastoid process (les- ser complexus or trachelo-mastoid) . Cervical Digastric (biventer cervicis) is the inner por- tion of the complexus, which presents a tendinous portion in its middle part. Action, extends the head and rotates it to the same side. Spinal Erector: 1st, Common Mass: Origin, sacro-iliac gutter; Insertion, divides into sacro-lumbal and long dorsal ; 2d, Sacrolumbal (or ilio-costal) ; Ascending portion: Origin, crest of ilium; Insertion, ribs near angle; Ac- cessor)/ or Descending portion (same insertion) ; Ascend- ing cervical (or costo-transverse) ; Origin, angle of four upper ribs; Insertion, transverse processes (posterior tubercles) of three lower cervical vertebra? ; 3d, Long Dorsal (or sacro- transverso-costal); 1st, is prolonged into the neck as the Transverse Cervical: Origin, transverse processes of six upper dorsal vertebra?; Insertion, transverse processes of six lower cervical vertebra?; 2d, Dorsal Spinous: Origin. spinous processes of the two upper lumbar and two lower dorsal ; Insertion, eight upper dorsal spinous processes; 3d, Semi-spinal of Back {under the dorsal spinous) is prolonged into the neck (which is under the complexus); Origin. transverse processes of lower dorsal vertebra?: Insertion, spinous processes of upper dorsal vertebra?; 4th, Semi- spinal of Neck is under the complexus; Origin, transverse processes of the four upper dorsal vertebra* and articular processes of the lower four cervical vertebra- ; Insertion, spinous processes of four upper cervical vertebra?. FIFTH LAYER. 364 Multifid or Transverse Spinal or Rotator Muscle of Spine. Origin, transverse processes; Insertion, spinous processes. Large Posterior Straight: Origin, spinous processes of axis; Insertion, lower rough surface of the occipital: Ac- tion, is an active ligament. Small Posterior Straight: Origin, spinous process of atlas; Insertion, same but inner portion : Action, the same. Inferior or Great Oblique or Atlo=axoid : Origin, spinous processes of axis; Insertion, transverse process of atlas. Action, rotates the head. Superior or Small Oblique or Atlo=occipital : Origin. transverse process of atlas; Insertion, occipital bone behind: Action, the same. Interspinal (in neck only) : between the spinotis process - Intertransverse Huscles between transverse proci are active ligaments. Extensor of Coccyx: Origin, sacrum; Insertion, coccyx. 126 MUSCULAR LAYERS OF NECK — MUSCLES OF CHEST. MUSCULAR LAYERS OF NECK. 365 (Posterior Cervical Region.) FIRST LAYER. Trapezius. SECOND LAYER. Elevator of Scapula ; Splenius. THIRD LAYER. 1st, Complexus (comp rising1 trachelo-mastoid and cervical digastric) ; 2d, Transverse Cervical ; 3d, Ascending Cervical. FOURTH LAYER. 1st, Cervical Spinous; 2d, Posterior Straight and Oblique ITuscles. FIFTH LAYER. 1st, Semi=spinal of neck or cervical portion of multifid muscle ; 2d, Supra=spinous (in neck only) ; 3d, Inter- spinous ; 4th, Intertransverse muscles. MUSCLES OF THE CHEST. 366 Great Pectoral Muscle: Origin, sternum, middle ribs; anterior convexity of clavicle ; Insertion, bicipital groove of the humerus (outer edge) ; Action, adducts the arm. Small Pectoral : Origin, external surface of the third, fourth and fifth ribs; Insertion, coracoid process; Action, depresses the outer angle of the scapula, and raises the upper ribs. Subclavian fluscle : Origin, under surface of the clavicle ; Insertion, first rib. Great Serrate Muscle : Origin, external surface of the upper eight ribs; Insertion, spinal border of the scapula. Action, draws the scapula forwards or raises the ribs. Intercostals : Origin, the border of the rib above ; Insertion, the border of the rib below. N. B. — The External Intercostals start from the trans- verse processes of the vertebra? and do not reach the an- terior extremities of the ribs. The Internal Intercostals start from the angle of the ribs and reach the sternum. Action, when the first rib is fixed they are inspirators ; when the last rib is fixed they are expirators. Supra=costals : Origin, apex of transverse processes of ver- tebrae; Insertion, second rib below; Action, raise the ribs. Infra=costals (are inside the chest) : Origin, surface of the rib from the angle to the tuberosity ; Insertion, second rib below ; Action, same as the intercostals. MUSCLES OF SHOULDEB — MUSCLES OP ARM. 127 Triangle Sternal Muscle: Origin, ensiform cartilage and the sternum; Insertion, the third, fourth, fifth and tin' sixth costal cartilages; Action, unknown. MUSCLES OF THE SHOULDER. 3G7 Deltoid: Origin, anterior concavity of the clavicle, acro- mion, and spine of scapula ; Insertion, V-shaped surface or deltoid eminence of the humerus; Action, abducts the arm. Supra=spinous : Origin, supra-spinous fossa; Insertion, upper surface of greater tuberosity of humerus; Action, the same ; is especially an active ligament. Infra=spinous : Origin, infra-spinous fossa; Insertion, mid- dle surface of the greater tuberosity of the humerus ; Action. rotates the arm outwards. Small Round: Origin, middle of axillary border of the scapula; Insertion, lower surface of the greater tuberosity of the humerus ; Action, rotates the arm outwards. Great Round: Origin, axillary border of scapula near lower angle; Insertion, posterior ridge of the bicipital groove of the humerus ; Action, it rotates the arm inwards ; is also an adductor. Subscapular: Origin, subscapular fossa ; Insertion, smaller tuberosity of humerus; Action, it rotates the arm inwards: is also an active ligament. MUSCLES OF THE ARM— MUSCLES OF ANTERIOR REGION OF THE ARM. 368 Coracho=brachial : Origin, coracoid process; Insertion. border of the humerus (middle). Action, draws the arm forward. Biceps: Origin, long head, apex of glenoid cavity of scapula; short head, coracoid process; Insertion, bicipital tubercle of radius (back part). Action, flexes the arm and supinates the forearm. Anterior Brachial: Origin, lower half of anterior surface of humerus ; Insertion, base of coronoid process of the ulna. Action, flexes the arm. MUSCLES OF THE POSTERIOR REGION OF THE ARM. 369 Triceps: Origin, long head ; axillary border of scapula be- low glenoid cavity; external head (external vast): poste- rior surface of humerus above spiral groove ; internal head (internal vast); posterior surface of the humerus below spiral groove ; Insertion, base of olecranon process of the ulna. Action, extends the forearm. Subanconeous : Origin, lower part of the posterior surface of humerus ; Insertion, synovial membrane; Action, draws the synovial membrane from between the bony surfaces. 128 MUSCLES OF FOREARM. MUSCLES OF THE FOREARM. MUSCLES OF THE ANTERIOR REGION OF THE FORE- ARM. SUPERFICIAL LAYER. 370 Round Pronator: Origin, inner condyle of the humerus ; Insertion, outer surface of radius. Radiocarpal Flexor : Origin, inner condyle of humerus ; Insertion, base of second metacarpal bone. Long Palmar (or middle radio-carpal flexor) : Origin, inner condyle of the humerus ; Insertion, anterior annular ligament. Ulno=carpal Flexor : Origin, inner condyle of the hume- rus and olecranon process of the ulna ; Insertion , pisiform bone. MIDDLE LAYER. Superficial Common Flexor of Fingers: Origin, inner condyle of the humerus, coronoid process of ulna and ob- lique line of the radius ; Insertion, lateral borders of second phalanges. DEEP LAYER. Deep Common Flexor: Origin, anterior surface of ulna (upper three- fourths) ; Insertion,- bases of the third pha- langes.' Long Flexor of Thumb : Origin, anterior surface of radius (upper three -fourths) ; Insertion, base of last phalanx of thumb. Square Pronator : Origin, anterior surface of ulna (lower fourth) ; Insertion, anterior surface of radius (lower fourth). MUSCLES OF EXTERNAL OR RADIAL REGION OF THE FOREARM. 371 Long Supinator: Origin, upper part of outer border of humerus; Insertion, styloid process of radius. Long Radiocarpal Extensor : Origin, lower part of the outer border of the humerus ; Insertion, back of base of the second metacarpal bone. Short Radiocarpal Extensor : Origin, external condyle of humerus ; Insertion, back of the base of the third metacar- pal bone. Short Supinator : Origin, external condyle of the humerus Insertion, upper fourth of the shaft of the radius. MUSCLES OF FOREARM, HAND, AND ULNAR REGION. L29 MUSCLES OF POSTERIOR REGION OF THE FOREARM. SUPERFICIAL LAYER. 372 Anconeus: Origin, external condyle of the humerus ; Inser- tion, upper fourth of the outer surface of tin- ulna. Common Extensor of Fingers : Origin, the outer condyle of the humerus ; Insertion, hy a middle slip into the bases of the second phalange and by two lateral slips into the bases of the last phalanges. Extensor of Little Fingers: Origin, outer condyle of the humerus; Insertion, unites with the fourth tendon of the common extensor. Ulno=carpaI Extensor: Origin, outer condyle of the hu- merus and posterior surface of ulna (middle); Insirtion. base of fifth metacarpal bone. DEEP LAYER. 373 Extensor of Metacarpal Bone of Thumb or Long Ab= ductor: Origin, middle of ulna, interosseous membrane, lower part of radius; Insertion, base of the metacarpal bone of the thumb. Extensor of First Phalanx of Thumb: Origin, middle of ulna, interosseous membrane, lower part of radius ; Inser- tion, base of first phalanx. Extensor of Second Phalanx of Thumb: Origin, middle of ulna: Insertion, the base of the second phalanx. Extensor of Index Finger: Origin, middle of the ulna and interosseous membrane; Insertion, base of the last phalanx. MUSCLES OF THE HAND— MUSCLES OF EXTERNAL OR RADIAL OR THENAR REGION. 374 Abductor of Thumb: Origin, annular ligament and trape- zium; Insertion, outer part of the first phalanx. Opposing or Opponens : Origin, annular ligament and trape- zium; Insertion, outer border of first metacarpal bone. Short Flexor of Thumb: Origin, anterior head: annular ligament, trapezium and scaphoid; posterior head: OS magnum, trapezoid, and base of the third metacarpal ; In- sertion, outer and inner tubercles of the first phalanx of the thumb. Adductor of the Thumb: Origin, the third metacarpal bone : Insertion, inner tubercle of the first phalanx. MUSCLES OF THE INTERNAL OK ULNAR OR HYPOTHENAR REGION. 375 Short or Small Palmar JTuscle : Origin, annular ligament ; Insertion, the skin. 9 130 MUSCLES OF PALMAR REGION — MUSCLES OF ABDOMEN. Adductor of Little Finger : Origin, annular ligament and pisiform bone ; Insertion, outer tubercle of the base of first phalanx of little finger. Short Flexor of Little Finger : Origin, annular ligament and pisiform bone ; Insertion , outer tubercle of the base of the first phalanx. Flexor of the Metacarpal Bone of the Little Finger, or Opponens : Origin, unciform process; Insertion, inner bor- der of fifth metacarpal bone. MUSCLES OF THE MIDDLE OR PALMAR REGION. 376 Lumbrical Muscles: Origin, tendons of the deep flexor; Insertion, extensor tendons of the finger; Action, assists interosseous muscles in extending the fingers. Interosseous Muscles : Origin, lateral surfaces of metacar- pal bones; Insertion, base of the first phalanx : Action, ab- ductors and adductors. MUSCLES OF EXTERIOR OF THE ABDOMEN. 377 Great Oblique or External Oblique: Origin, iliac crest, Poupart's ligament, superior spinous process, spine and angle of the pubis ; Insertion, linea alba, outer surface of the eight lower ribs ; Action, compresses the viscera, de- presses the lower ribs. Small or Internal Oblique: Origin, iliac crest, Poupart's ligament, crest of pubis ; Insertion, linea alba, free border of the costal cartilages of the asternal ribs; Action, the same. Transverse : Origin, lumbar aponeurosis and through it to the spinous and transverse processes of the lumbar verte- bras, iliac crest, crest of pubis ; Insertion, linea alba, internal surface of the eight lower ribs and their cartilages ; Action, the same. Abdominal Straight: Origin, crest of pubis; Insertion, outer surface of the cartilages of the middle ribs ; Action, same ; flexes the trunk. Pyramidal: Origin, crest of pubis; Insertion, linea alba; Action, is the tensor of the linea alba. MUSCLES OF THE INTERIOR OF THE ABDOMEN. 378 Diaphragm : Origin, bodies of first four lumbar (the right or anterior pillar descends to the fourth, the left or posterior pillar reaches only the third) ; internal and external arcuate ligaments ; inner surface of the asternal ribs and of the false ribs : Insertion, cordiform tendon ; Action, increases the depth of the chest and raises the lower ribs. Square Lumbar: Origin, iliac crest, ilio-lumbar ligament, MUSCLES OF THIGH. L3j transverse processes of the Lumbar vertebrae; Insertion, lasl rib; Action, depresses the Lower rib or steadies ii. Small Psoas: Origin, bodies of last dorsal and firsl Lumbar vertebra?; Insertion, ilio-pectineal eminence; Action, is tin- tensor of the iliac fascia. Large Psoas Huscle: Origin, bodies ami transverse pro- cesses of last dorsal and all the Lumbar vertebrae ; Insi rtion, small trochanter of femur; Action, flexes the thigh and rotates it outwards. Iliac fluscle: Origin, iliac fossa: Insertion, small tro- chanter; Action, the same as psoas. MUSCLES OF ANTERIOR REGION OF THIGH. 379 Tensor of Femoral Fascia: Origin, anterior superior spine of the ilium; Insertion, femoral fascia. Sartorius: Origin, auterior superior spinous process of the ilium; Insertion, upper part of crest of tibia; Action, tiexes the leg' aud crosses it in front of the other leg; it tiexes the thigh also. Quadriceps Extensor: 1st. Straight: Origin, anterior inferior spinous process of the ilium and adjoining groove ; Insertion, patella and tuber- cle of the tibia ; Action, extends the leg. 2d. External Vast: Origin, root of great trochanter, rough line and outer lower branch of this rough line ; Insertion. tendon of straight muscle and outer border of the patella. 3d. Internal Vast: Origin, inner surface of the femur, rough line and inner lower branch of this line ; Insertion, tendon of straight muscle and inner border of the patella. 4th. Crureus: anterior surface of the femur: Insertion, upper border of the patella. Sub=Crureus: Origin, lower part of anterior surface of the femur; Insertion, synovial capsule. MUSCLES OF THE INTERNAL REGION OF THE THIGH. 380 Gracilis: Origin, branches of the pubis and ischium; In- sertion, crest of the tibia: Action, is an adductor of tin' thigh and a flexor of the leg. Pectineus : Origin, ilio-pectinal Line; Insertion, line from small trochanter to rough line : Action, is an adductor and a rotator outwards. Long Adductor: Origin, anterior surface of the pubis; In- sertion, middle third of the rough line of the femur. Short or Small Adductor: Origin, anterior surface of the pubis; Insertion, upper third of rough line of femur. Great Adductor : Origin, anterior surf ace of the branches of the pubis and ischium and internal borders of the ttlber- 132 MUSCLES OR LEG, FOOT AND GLUTEAL REGION. osity of the ischium ; Insertion , whole of rough line and tubercle on inner condyle of the femur. Action, they adduct the thigh. MUSCLES OF THE ANTERIOR REGION OF THE LEG. 381 Anterior Tibial Muscle : Origin, upper two-thirds of the outer surface of the tibia; Insertion, inner cuneiform bone. Action, flexes the foot and turns its inner border upwards. Extensor Huscle of Great Toe : Origin, middle third of fibula and interosseous membrane; Insertion , base of the second phalanx of great toe. Long Extensor of the Toes : Origin, upper two-thirds of fibula and interosseous membrane; Insertion, base of the second and third phalanges. Third or Small Peroneal : Origin, is a division of the long extensor of the toes ; Insertion, base of the last metatarsal bone; Action, flexes the foot and turns the outer border upwards. MUSCLES OF THE EXTERNAL REGION OF LEG. 382 Short Peroneal: Origin, lower half of fibula; Insertion, base of last metatarsal bone; Action, extends the foot. Long Peroneal : Origin, upper half of the fibula; Insertion, base of the first metatarsal bone ; Action, extends the foot and turns the outer border of the foot upwards. MUSCLE OF DORSAL REGION OF FOOT. 383 Short Extensor of the Toes : Origin, calcaneum and cuboid; Insertion, tendon of the long extensor of the toes. MUSCLES OF THE GLUTEAL REGION. 384 Great Gluteal: Origin, iliac crest, posterior sacro-sciatic ligament, sacrum and coccyx ; Insertion, crural fascia and outer branch of rough line of femur; Action, rotates the thigh outwards and supports the trunk upon the femur. JTiddle Gluteal : Origin, between the two curved lines of innominate bone ; Insertion, outer surface of great trochan- ter; Action, the same. Small Gluteal : Origin, below the inferior curved line ; In- sertion, interior border of the great trochanter ; Action, ro- tates the thigh inwards. Pyriform : Origin, anterior surface of the sacrum; Inser- tion, upper border of great trochanter; Action, rotates the thigh outwards. Superior Gemellar: Origin, spine of ischium; Insertion, MUSCLES OF POSTERIOR REGION OF THIGH AND LEG. 133 tendon of internal obturator; Action, rotates the thigh out- wards. Inferior Qemellar : Origin, tuberosity of the ischium ; In- sertion, tendon of internal obturator; Action, the same. Internal Obturator: Origin, inner surface of obturator membrane and margin of obturator foramen ; Insertion, up- per border of the great trochanter; Action, the same. Square Femoral : Origin, tuberosity of the ischium ; Inser- tion, posterior border of the great trochanter; Action, the same. External Obturator: Origin, outer surface of obturator membrane and margin of obturator foramen; Insertion, digital fossa on inner surface of great trochanter ; Action, the same. MUSCLES OF THE POSTERIOR REGION OF THE THIGH. 385 Biceps : Origin, long head, tuberosity of the ischium ; short head, middle third of rough line of femur; Insertion, head of the fibula; Action, flexes the leg. Semitendinous : Origin, tuberosity of the ischium ; Inser- tion, anterior tuberosity of tibia; Action, flexes the leg. Semi=membranous : Origin, tuberosity of ischium ; Inser- tion, 1st, through Winslow's ligament to external condyle of femur ; 2d, posterior surface of head of the tibia ; 3d, groove on inner tuberosity of the tibia; Action, flexes the leg. MUSCLES OF THE POSTERIOR REGION OF THE LEG. SUPERFICIAL LAYER. 386 Gastrocnemius: Origin, by two heads above the condyles of the femur ; Insertion, tendon of Achilles. Soleus : Origin, outer head: upper third of the posterior surface of fibula ; inner head : oblique line of the tibia ; Insertion, tendon of Achilles and through it to the calca- neum. Plantaris : Origin, outer condyle of the femur: Insertion, inner border of the tendon of Achilles ; Action, extends the foot. DEEP LAYER. Popliteal: Origin, groove on outer surface of the outer condyle of the femur; Insertion, posterior surface of the tibia above oblique line; Action, flexes the leg: it is an active ligament. Long Flexor of Toes : Origin, posterior surface of the tibia; Insertion, bases of the last phalanges. Posterior Tibial : Origin, interosseous membrane, tibia and 134 MUSCLES OF FOOT — PECULIARITIES OF MUSCLES. fibula ; Insertion, scaphoid and inner cuneiform bone ; Action, extends the foot and turns its inner border upwards. Long Flexor of Great Toe : Origin, posterior surface of the fibula ; Insertion, base of the second phalanx. MUSCLES OF THE FOOT.— MUSCLES OF THE INTERNAL REGION— MUSCLES OF GREAT TOE. 387 Adductor of Great Toe: Origin, internal tuberosity of ealcaneum, internal cuneiform and first metatarsal ; Inser- tion, inner side of the first phalaux. Short Flexor of Great Toe : Origin, cuboid and external cuneiform bones; Insertion, base of the first phalanx by two tendons. Adductor of Great Toe : Origin, calcaneo-cuboid ligament, base of the second and third metatarsal ; Insertion, outer side of base of first phalanx. Transverse Muscle : Anterior extremities of metatarsal bones ; Insertion, outer side of base of the first phalanx. MUSCLES OF THE EXTERNAL PLANTAR REGION.— MUSCLES OF THE LITTLE TOE. 388 Abductor of Small Toe : Origin, ealcaneum and fifth meta- tarsal ; Insertion, outer side of base of last phalanx. Short Flexor of Small Toe : Origin, cuboid and fifth meta- tarsal; Insertion, base of the first phalanx. MUSCLES OF THE MIDDLE PLANTAR REGION. 389 Short Flexor: Origin, ealcaneum and internal annular lig- ament; Insertion, borders of the second phalanges. Accessory Flexor: Origin, ealcaneum; Insertion, outer bor- der of tendons of long flexor of toes. Lubricals : Origin, angle of tendons of long flexor of toes ; Insertion, inner side of the first phalanges. Interosseous: Origin, lateral surface of metatarsal bones; Insertion, bases of first phalanges of toes. PECULIARITIES OF THE HUSCLES IN PARTICULAR. (Ninety -two Muscles.) 390 Flexor Muscles are always more numerous. MUSCLES OF THE BACK. The Trapezius is remarkable for its large surface. The Great Dorsal also. CRANIAL REGION — MUSCLES OF PACE — MAXILLARY REGION. L35 The Complexus originates from the transverse processes, and is inserted in the occipital close to the middle line; it is the reverse with most of the other muscles of the region. The Cervical Digastric is one of the few double-bellied muscles. The others are the digastric, the great oblique of the eyeball, the occipito-frontal, the omo-hyoid. The Spinal Erector is remarkable for the multiplicity of its insertions through fasculi which are attached to all the bony prominences of the hack: spinous processes, transvcrx- processes, articular processes, neck of the ribs, angles of ribs. The Posterior Straight and Oblique Muscles arc really the active ligaments of the articulations of the head with the vertebral column. CRANIAL REGION. The Occipito=frontal is the largest donble-bellied muscle. It is separated from the periosteum by a loose layer of connective tissue which forms a real serous bursa. Its origin is bony; its insertion is cutaneous. MUSCLES OF THE FACE. All the muscles of the face and of the cranial region, ex- cept the Masseter, are cutaneous muscles ; that is, they have a bony origin and a cutaneous insertion. All such cutaneous muscles (including the platysma of the neck) are supplied by the facial nerve. All the muscles of the face form groups around the ori- fices, and are dilators or constrictors of those orifices. The Orbicular Muscle of the Lips is the only thoroughly cutaneous muscle, since it is not connected with bone at any point. The Palpebral Orbicular is noticeable for its action, which spreads the tears over the cornea and at the same time directs them towards the lachrymal lake at the inner angle, where they are absorbed by the lachrymal points. The Buccinator is perforated by Steno's Duct. TEMPORO-MAXILLARY REGK >N. The flasseter is the only muscle forming a part of the face which is not a cutaneous muscle; it is supplied by the fifth pair. The Temporal is remarkable for its strength, for its unique insertion in the strong coronoid process, Cor it- en- casement in a fibro-osseous fossa. 136 MAXILLARY REGION — MUSCLES OF NECK — HYOID REGION. PTERYGO -MAXILLARY REGION. The External Pterygoid : Has two heads, between which is found the internal max- illary artery. It is inserted also into the fibro-cartilage of the temporo- maxillary articulation and compels that cartilage to follow the movement forward of the condyle. MUSCLES OP THE SUPERFICIAL REGION OF THE NECK. 391 The Platysma is the largest cutaneous muscle, containing the most muscular fibres. The Sterno=cleido Mastoid : Is a most important surgical muscle. It divides the side of the neck into two large triangles. Its relations with the large vessels of the neck are of the greatest importance, as will be described in the surgical an- atomy of the neck. MUSCLES OF THE SUPRA-HYOID REGION. The Digastric: Is one of the four double-bellied muscles. It gives its name to a surgical region, the digastric tri- angle. The StyIo=hyoid is noticeable because its tendons are perforated by the Digastric. The Mylo=hyoid forms the floor of the mouth ; all that is below it is outside of the mouth ; all that is above it is in the mouth. Its fibres cross to the other side. It forms a sort of diaphragm. The Geniohyoid is above the mylo-hyoid, i. e., inside the mouth. MUSCLES OF THE INFRA-HYOID REGION. The Sternohyoid is a guide in tracheotomy. The Omo=hyoid : Is a double-bellied muscle. It is remarkable for its irregular course. It is connected in its middle with the cervical fascia, which is itself adhered to the Subclavian vein. MUSCLES OF THE CHEST, SHOULDER AND ARM. 137 MUSCLES OF THE CHEST. The Great Pectoral : Is remarkable for its size, shape, structure. Its lower border forms the anterior boundary of the axilla. The Small Pectoral divides the course of the axillary ves- sels into three portions : above it, under it and below it. The Subclavian is an active ligament. The Great Serrate is noticeable for its extent. The Intercostals are remarkable for the difference in the direction of the fibres in the externals and the internals. The Sternal Triangle Muscle is noticeable for the difficulty to understand its use. MUSCLES OF THE SHOULDER. 392 The Deltoid : Is really the only abductor muscle of the arm. It is supplied by one nerve only, the circumflex. The Supra=spinous, the Infra=spinous, the Small Round and the Subscapular are really active ligaments of the Scapulo-humeral articulation. MUSCLES OF THE ARM. The Coracobrachial : Is the guide to tne axillary and brachial arteries. It is perforated by the Musculo-spiral nerve. The Biceps — Has two heads — The long Tendinous Head runs through a joint, the only instance of the kind. — Its insertion is very limited, but very strong. — The biceps is the guide to the brachial artery. — It gives off an expansion which separates the basilic vein from the brachial artery. The Triceps Extensor — Has three very distinct heads : an only instance. — The Outer and the Inner Heads are sep- arated by the spiral groove of the humerus containing the musculo-spiral nerve. — Its insertion to the base of the olecranon process is very limited. MUSCLES OF ANTERIOR REGION OF THE FOREARM. 393 All the four muscles of the superficial layer originate from the internal condyle. The Long Palmar is inserted into a fascia, the palmar fascia, an only instance. The Ulno=Carpal Flexor: Presents at its origin an arch under which passes the ulnar nerve. The tendon of insertion presents a sesamoid hone, the pisi- 138 MUSCLES OF THE FOREARM AND HAND. form (like the patella, the flexors of the thumb and of the big toe). It is the guide to the Ulnar Artery. MUSCLES OF THE DEEP LAYER OF THE FOREARM. The Superficial Flexor forms a layer of itself. The Deep Flexor and the Long Proper Flexor of the Thumb form a separate layer of themselves. All the tendons of the flexors are surrounded at the wrist by a large common synovial sac which sends a sheath to the thumb and to the little finger, but not to the other fingers. In the fingers the tendons of the Deep flexor perforate those of the superficial flexors. — In the fingers the tendons have a strong sheath which stops at the base of the last phalanx. — The Square Pronator forms a layer of itself. MUSCLES OF THE EXTERNAL REGIONS OF THE FOREARM. The Long Supinator forms the outer boundary of the outer groove of the elbow. — It has a long, flat tendon. — It is the guide to the radial artery. The Radiocarpal Extensors are crossed over by the deep muscles of the posterior region. The Short Supinator : Is wrapped around the radius. It is traversed by the radial nerve. MUSCLES OF THE POSTERIOR REGION OF THE FOREARM. The four muscles of the superficial layer originate from the external condyle. The Anconeus is an active ligament. The tendons of the extensors are joined by transverse bands. The four muscles of the deep layer go to two fingers only, the thumb and the index ; three to the thumb, the extensors of the last phalanx, of the first phalanx, of the first meta- carpal bone : one to the index finger, the extensor of the index. MUSCLES OF THE HAND. The Opposing muscle of the thumb is possessed only by man and monkey. The two heads of the Short Flexor of the thumb are separated by the tendon of the Long Flexor. MUSCLES OF THE VERTEBRAL REGION AND ABDOMEN. 139 The Adductor muscle of tin- thumb is noticeable for its broad origin and narrow insertion. All those muscles are inserted into two small sesamoid bones. The Lumbrical Muscles are of a peculiar shape. — They originate from a tendon, the flexor, and are inserted into ,-i tendon, the extensor. The Interosseous are also peculiar in their uneven dis- tribution to the fingers. MUSCLES OF THE VERTEBRAL REGION. 394 The Anterior Straight Huscles are active ligaments. The Anterior Scalene and its Tubercle is the guide to the Subclavian Artery and Vein, to the Brachial Plexns, to the Phrenic Nerve, to the Vertebral Artery, to the Pleura. MUSCLES OF THE EXTERIOR OF THE ABDOMEN. The Pyramidal : Is the tensor muscle of the white line. The Abdominal Straight: Is encased in a fibrous sheath. It presents transverse bands. The inner borders limit the white line and are guides in laparatomies. The Epigastric and the Internal Mammary anastomose in its substance. The Obliques and the Transverse : Are broad and flat. — Their fibres are differently directed in each layer. — They are continuous with those of the opposite side, through the fascia?, passing in front and be- hind the straight muscle. The External Oblique forms Ponpart's ligament. The Lower Fibres of the Internal Oblique and of the transverse form the Cremaster Muscle. The Posterior Border of the two obliques form the an- terior boundary of a slot, limited behind by the anterior border of the common mass of the Spinal Erector; impor- tant surgically. MUSCLES OF THE INTERIOR OF THE ABDOMEN. The Diaphragm : Is the most perfect of all the diaphragms of the body (The others are the mylo-hyoid and the elevator of the amis.) Its situation is remarkable and unique, in the interior of the body and dividing it into two large compartments. It is broad, flat, curved. Its centre is aponeurotic ; it is a kind of digastric. 140 MUSCLES OF PELVIS AND THIGH. It presents several openings : oesophagus and inferior cava. Its centre is attached to the pericardium. It contracts from the centre to the periphery. It receives a spinal nerve on each side and no other. It is the essential muscle of respiration. The Small Psoas : Is sometimes wanting. Is the tensor muscle of a fascia, like the long palmar and the tensor of the femoral fascia. The Large Psoas : Is the softest muscle in the body. It contains the lumbar plexus in its substance. It forms the lateral boundaries of the inlet of the pelvis. It is one of only two muscles which may suppurate primarily. It contains the crural nerve in its sheath. The Iliac : Is also a soft muscle. It also may suppurate primarily. MUSCLES OF THE INTERIOR OF THE PELVIS. 395 The Elevator of the Anus : Closes the cavity of the pelvis after the manner of a small diaphragm, perforated only by the rectum. The Pyriform : Is covered over by the large nerves of the Sacral Plexus. It originates in the pelvis, but terminates outside of it. The Internal Obturator : also originates in the pelvis, but terminates outside of it. No other muscles do this but these two. MUSCLES OF THE ANTERIOR REGION OF THE THIGH. The Tensor of the Femoral Fascia. Is the largest of the tensors (the other four are the long palmar, the pyramidal of abdomen, the small psoas, the plantaris). — It is also almost entirely encased into the femoral fascia (like the abdominal straight). The Sartorius : Is the longest and the narrowest muscle in the body. It crosses the thigh and the femoral vessels obliquely. It is a most important surgical muscle. The Quadriceps Extensor : Is the only quadruple muscle in the body. Its tendon is the patellar ligament. The patella is a sesamoid bone developed in the tendon. The deep fibres called the subcrureus are inserted into the synovial membrane. Its arterial branches are numerous and large. MUSCLES OF THIGH, LEG, FOOT AND GLUTEAL REGION. HI MUSCLES OF THE INTERNAL REGION OF THE THIGH. The Gracilis : Is the muscle that projects under the skin of the inner region of the thigh when the thighs are open. It joins the Sartorius and the semi-membranous to form the goose's paw. The Three Adductors: Are the muscles of walking. They are all triangular in shape. They all originate from the pubis and ischium. They are all attached to the rough line of the femur. The great adductor presents a special long tendon. It also forms part of Hunter's Canal. The Pectineus : Is truly also an adductor. MUSCLES OF ANTERIOR REGION OF THE LEG. The Extensor of the Great Toe : Is covered over above by the Anterior Tibial and the Common Extensor. Its tendon is a guide to the Dorsal Artery. The Third Peroneal : Is only a part of the Common Extensor. MUSCLES OF THE EXTERNAL REGIONS OF THE LEG. The Peroneals : Wind around the lower part of the bone and this causes the twist in the fibula. The musculo-cutaneous nerve winds through their upper extremity. Are the analogue of the radio-carpal extensors. The Tendon of the Long Peroneal crosses obliquely the sole of the foot and is the tensor muscle of the arch of the foot. MUSCLES OF THE BACK OF THE FOOT. The Short Extensor of the Toes : Its tendons are inserted into the tendons of another muscle (like the lumbricals and the interosseous, the acces- sory flexor of the toes). MUSCLES OF THE GLUTEAL REGION'. 396 The Great Gluteal : Is the thickest muscle in the body. It forms the buttock. 142 MUSCLES OF THIGH AND LEG. The Pyriform "| Are specially the pelvic tro- The Internal Obturator ! chanterian muscles which are The External Obturator [the active ligaments of the The Square Femoral J the Coxo-fenioral articulation. The Gemellar Muscles: Are part of the internal obturator. The other Gemellar Muscles of the body belong to the calf of the leg. MUSCLES OF THE POSTERIOR REGION OF THE THIGH. The Biceps : Is the analogue of the biceps of the arm. There are only two biceps in the body (arm and thigh). It forms the outer upper boundary of the popliteal space. The internal saphenous nerve is on the inside of it. The Semitendinous: Forms the inner upper boundary of the popliteal space. It contributes to form the goose's paw. The Semimembranous : Forms more particularly the upper inner boundary of the popliteal space. It is the guide to the popliteal artery. MUSCLES OF THE SUPERFICIAL POSTERIOR REGION OF THE LEG. The Gastrocnemii and The Soleus : Form a triceps, tbe Sural Triceps. The tendon is called the Achilles Tendon. The Piantaris : Is a peculiar little muscle. It corresponds to the long palmar of the forearm. It is the tensor muscle of Achilles Tendon. MUSCLES OF THE DEEP LAYER OF THE POSTERIOR REGION OF THE LEG. The Popliteal : Is the analogue of the anconeus. It is an active ligament. It forms the floor of the lower part of the popliteal space. The other muscles of this layer are remarkable for the change in their relative situations above and below. The Long Flexor of the Great Toe in the leg is on the outside, and in the foot is on the inside. The Long Flexor of the Toes is in the leg on the inside, and in the foot is on the outside. MUSCLES WHICH ARK INTERESTING OR IMPORTANT. 143 The Posterior Tibial is in the Leg in the middle and 18 OB the inside on the fool . M USCLES OF TH E PL ANT A R R EGION. Are similar to those of the hand. There is no opposing muscle. There is an additional flexor, the Short Flexor. There is an Accessory Flexor, peculiar in that it is inserted into the tendon of the long common flexor. It is the only muscle inserted to a tendon by fleshy fibres. riUSCLES WHICH ARE SPECIALLY INTERESTING OR IMPORTANT. ( Th irty-eigh t Muscles . J 397 In the Back: — Spinal Erector — Posterior Straight and Oblique. In the Head: — Occipitofrontal. — Muscles of the Face — Internal Pterygoid. In the Keck: — Platysma, — Sterno-mastoid, — Digastric, — Mylo-hyoid, — Omo-hyoid. In the Chest: — Great Pectoral, — Great Dorsal, — Inter- costals. In the Shoulder: — Deltoid, — Supra-Spinous, — Infra-Spi- nous, — Small Round, — Subscapular. In the Arm: — Coraco -brachial, — Biceps. In the Forearm: — Ulno-carpal Flexor, — Radio-carpal Flexor, — Tendons of the Flexors and their Synovial Sac. — Long Supinator, — Short Supinator. In the Hand: — Opposing, — Lumbricals. In the Vertebral Region: — Anterior Scalene. In the Abdomen: — Diaphragm, — Psoas Iliac In the Anterior Region of the Thigh: — Sartorins, — Great Adductor. In Anterior and Lot' rat Regions of Leg: — Proper Extensor, — Long Peroneal. In the Gluteal Region: — The Pelvi-trochanterian. In the Posterior Region of tin Thigh: — Biceps. — Semi- membranous. In the Posterior Regiqn of the L< or more nuclei. They resemble pus corpuscles. They frequently have granular contents. Movements: They have active movements, as explained in describing cells in general. 10 146 BLOOD PLATS — STRUCTURE OF ARTERIES AND VEINS. BLOOD PLATS OR HEMATOPLATS. 402 Size : They are one-third to one-half smaller than the red blood corpuscles. Shape : They are large granules, Or pale, circular or oval discs. FREE NUCLEI. Number : They exist in great numbers. — (Ranvier.) BLOOD PIGMENT OR HEMATINE. Color : Is dark brown or black. Shape : Is a powder. STRUCTURE OF ARTERIES. 403 General Structure. Arteries are formed of three coats : 1st. The External or Fibrous Goat is the most resistant. 2d. The Middle or Elastic and Muscular Goat is formed of alternate layers of elastic and muscular tissues. The fibres pursue a longitudinal and a circular course around the vessel ; the muscular fibres are of the smooth kind. The elastic fibres are fine fibres and broad fibres, which present round or oval openings and form the so-called Perforated or Fenestrated Membrane. 3d. The Internal or Serous Goat is composed of a thin and delicate basement membrane, lined with a single layer of elongated polygonal cells. 404 Structure in Particular, According to Size: 1st. In large arteries the external fibrous coat is compara- tively thin ;— the middle or elastic is the thickest ; — the in- ternal is also thick. 2d. In the middle-sized arteries the fibrous coat is thickest. 3d. In the smallest arteries the middle coat consists of muscular tissue only and is the thickest ; — the smaller the artery, the more abundant is the muscular tissue. Vessels : are the Vasa Vasorum. — The arteries come from the small neighboring arteries and not from the trunk they supply. — The veins empty into the contiguous larger venous branches. STRUCTURE OF VEINS. 405 They have the same general structure as the arteries, with few but important differences. The External Fibrous Goat is thicker and more resistant than that of the arteries ; — it gradually increases in thick- ness from the smallest to the largest. CAPILLARIES — DESCRIPTION OF ARTERIES. 147 The Middle or Musculo-elastic Coat is comparatively thin ; — the .smaller the vessel, the thinner the coat. The Infernal or Serous Coat is like that of the arteries. It forms valves. Venous Sinuses are venons channels which are dug in the substance of an organ and which are deprived of external and middle coats, these being replaced by the tissue of the organ itselT ; the interior is lined by the internal coat of veins. Vessels of Veins : same as for arteries. CAPILLARIES. 406 Direct Communication exists between arteries and veins without the intervention of capillaries, as in matrix of nails, tip of nose, fingers and toes. The Smallest Capillaries are found in the nervous central system and the largest in the marrow of bones. Serous Capillaries, i. e., vessels admitting only the serum of the blood without blood corpuscles, do not exist. ARTERIAL CAPILLARIES Are composed of a thin, delicate layer of smooth muscu- lar fibres — and of a lining of longitudinal nucleated endo- thelial cells. VENOUS CAPILLARIES Have the same structure, except that the muscular fibres are much fewer. CAPILLARIES PROPER OR INTERMEDIATE CAPILLARIES. They are formed of a single layer of transparent elon- gated cells or plates with oval nuclei, — united together by thin layers of a cement substance. They are endowed with vital contractility (Strieker). If capillaries are abnormally distended the cement sub- stance between the cells is liable to yield and give rise to minute holes or mouths, and thus permit blood corpuscles to pass through. DESCRIPTION OF THE ARTERIES IN PARTICULAR. 407 Remark. Only the branches of some consequence in oper- ating or in establishing collateral circulation will be con- sidered. 148 CARDIAC AND PULMONARY CIRCULATION. Divisions. There are three different and independent cir- culatory circuits : the circulation of the heart, the circula- tion of the lungs and the general or systemic circulation. CARDIAC CIRCULATION. The Arteries are the two Cardiac or Coronary Arteries, which are the first branches giving off from the aorta. Owing to the contracted condition of the heart during the ventricular systole, the blood enters these vessels during the cardiac diastole, which is the opposite with all the other arteries. They run along the interventricular and auriculo -ven- tricular grooves, and anastomose freely. The Veins are : 1st. The Great Cardiac or Coronary Vein or Sinus, which returns almost all the blood of the heart. It runs in the anterior interventricular and the left auriculo -ventricular grooves. And it opens into the right auricle above and to the inner side of the ascending cava. Its orifice is guarded by an effective valve, the Valve of the Thebesius. 2d. The Veins of Thebesius, are small venules from the right side of the heart which open directly into the right auricle. PULMONARY CIRCULATION. 408 It comprises the Pulmonary Circulation Proper, for the oxygenation of the blood, and the Bronchial Circulation, for the nutrition of the bronchi and the tissues of the lungs. PULMONARY CIRCULATION PROPER. The Artery is the Pulmonary Artery, which carries black or venous blood. It originates from the right ventricle. It winds around, and passes under, the first part of the aorta and divides into the right and left pulmonary ar- teries. The right subdivides into three large branches, one for each lobe. And the left into two large branches only. Their divisions follow the bronchi and finally form a del- icate plexus beneath the epithelium of the the air vesicles. The Veins succeed the arterial capillaries and form the Four Pulmonary Veins, the two right or upper veins and the two left or lower. They also follow the bronchi and open into the left auricle of the heart. Their orifices have no valves ; they carry red blood. BRONCHIAL AND SYSTEMIC CIRCULATION — AORTA. 1 4!> BRONCHIAL CIRCULATK )X. The Arteries are the two Bronchial Arteries. They originate from the aorta. They follow the bronchi and their divisions, but do not reach the air vesicles. Their small size compared to the lung is easily accounted for by the small amount of solid tissue the lungs contain and the nature of that tissue, which everywhere else also possesses very few capillaries. The Veins are the Bronchial Veins; they follow the arteries and open in the azygos. GENERAL OR SYSTEMIC CIRCULATION— AORTA. 409 Origin : from the left ventricle. Course : It describes an Arch which presents an ascending, a transverse, and a descending portion, and which ends on the left side of the third dorsal vertebra. It then becomes the Thoracic Aorta, which gradually comes in front of the vertebra? and passes through an opening in the diaphragm opposite the first lumbar vertebra. It is then called the Abdominal Aorta, and is situated almost on the middle line in front of the vertebra?, and di- vides opposite the fourth lumbar vertebra into the two Common Iliac arteries. Situation or Relation. The Arch is in relation : In Front, with Left Innominate Vein and the sternum. Behind, with the trachea. Below, with the divisions of the pulmonary arteries, the auricles and the root of the left lung. Above, with the branches originating from it. On the Outside, with the Superior Cava. On the Inside, with origin or trunk of the pulmonary artery. The Thoracic Aorta is in relation with the following organs : The Vertebral Column : on the left above and on the mid- dle line below. The CEsophagus : it crosses it obliquely, so that above it is on the median line, whereas the aorta is on the left; in the middle of the course the oesophagus is right over the aorta, and below the oesophagus is on the left of the median line and the aorta is on the median line. The Great Azi/(/os Vein is on the right of the aorta. The Thoracic Duct is also on top of it. The Pleura : on the left side only. The Abdominal Aorta is in relation : In Front, with the mesentery. 150 AORTA — INNOMINATE ARTERY — CAROTID. Behind, with the vertebral column. On the Right, with the Inferior Cava. On the Left, with the mesentery. BRANCHES OF THE ARCH OF THE AORTA. 410 They are the Innominate, the Left Carotid and the left Sub- clavian. INNOMINATE ARTERY. Situation or Relations. It is in relation : In Front, with the Left Innominate Vein, the sternum and the sterno -clavicular articulation. Behind, with the trachea. Externally, with the Left Superior Cava. Internally, with the Left Common Carotid. Branches: It gives rise occasionally only to the Middle Thyroid, which ascends in front of the trachea and is dis- tributed to the thyroid body. COMMON CAROTID. 411 Origin : The Bight originates from the innominate, but the Left comes directly from the aorta. The Left is therefore longer and more deeply seated. Course: It ascends along the vertebral column to the up- per border of the thyroid cartilage, where it divides. Situation or Relations. In Front, below it is entirely covered by the sterno-mas- toid ; in the Middle it is covered only by the edge of that muscle ; above, it is not covered at all by it, but by the veins, the fascia and skin. Behind, with the vertebral column, the pneumo- gastric and the sympathetic. Internally, with the trachea, oesophagus, larynx and thy- roid body. Externally, with the internal jugular vein, which overlaps it considerably. Branches : Opposite the upper border of the thyroid carti- lage it divides into the External and the Internal Carotids. It gives rise to no collateral branches. EXTERNAL CAROTID. 412 Origin : Upper border of the thyroid cartilage. Situation and Course : It is situated at first a little to the inner side of the internal carotid, — then ascends outside of the stylo-hyoid and digastric ; — it is crossed by the hypo- glossal nerve ; — it then penetrates the parotid gland on the inner side of the ramus of the jaw ; — and opposite the tern- INTERNAL CAROTID. 1 5 1 poro-maxillary articulation it divides into the Internal Maxillary and the Temporal. 413 Branches: Are the Superior Thyroid, the Lingual, Facial, Occipital, Internal Maxillary and the Temporal. 1. The Superior Thyroid is distributed to the upper angle of the thyroid body. 2. The Lingual in apart of its course runs parallel to the great horn of the hyoid bone, one-quarter of an inch above it — it is covered by the fibres of the hyo-glossus muscle. — The hypoglossal nerve is above it and parallel to it. 3. The Facial crosses the posterior part of the submaxil- lary gland. — Strikes the face at the anterior inferior angle of the masseter. — Runs towards the commissure of the mouth. — Then in the labio-genial fold towards the wing of the nose, — and then in the naso-genial fold to the internal an- gle of the eye, where it is called the Angular. — It inoscu- lates with the terminal branch of the ophthalmic called the JSfasal. It gives off the two Labial or Coronary arteries and the Submental. 4. The Occipital is situated deeply under the sterno-mas- toid and trapezius, to the inner side of the mastoid process. It supplies the occipital region. It gives off the Descending Cervical (or Princeps Cervices) which anastomoses with the Posterior Ascending Cervical (or Profunda Cervicis) of the Superior Intercostal. 5. The Internal Maxillary is directed from the articulation obliquely forwards and inwards, — it passes between the two heads of the internal pterygoid muscle. — It passes through the spheno-palatine foramen. — It is distributed to the nasal cavities under the name of the SpJieno-palatin? or Nasal. It gives off the Middle Meningeal, which enters the cra- nium through the spinous foramen; — the Descend ing Pala- tine to the soft palate; — the Inferior Dental to the lower teeth. 6. The Temporal is distributed to the temporal region. It gives off the Transverse Facial, which is sometimes quite large. INTERNAL CAROTID. 414 Origin : Upper border of thyroid cartilage. Course : It ascends along the vertebral column to the base of the skull. — It then passes through the Carotid Canal of the petrous bone. — It then proceeds forward through the Cavern- ous Sinus. — At the end of the sinus it curves backwards, — gives rise to the ophthalmic, — and divides into its terminal branches, the Anterior and the Middle Cerebral Arteries. 152 SUBCLAVIAN ARTERY. Situation or Relations in the Neck. In Front, with the veins and fascia, then the stylo-hyoid and digastric, then the parotid gland. Behind, with the vertebral column, the pnenmo- gastric, sympathetic. Internally, with the larynx, pharynx, tonsil. Externally, with the internal jugular vein. 415 Branches : Are the Ophthalmic, Anterior and Middle Cere- orals. 1. The Ophthalmic passes into the orbit through the optic foramen, on the outer side of the optic nerve. — It crosses over the nerve to reach the inner wall of the orbit, — which it follows to the internal angle ; — there it is called the Nasal and inosculates with the angular of the facial. It gives off the Lachrymal to the lachrymal gland, — An- terior Ciliary to the iris, — the Long Ciliary to the iris, — the Posterior Short Ciliary to the choroid, — the Central Ar- tery of the Retina. 2. The Anterior Cerebral is distributed to the anterior part of the great interhemispheric fissure and to the anterior lobes of the brain. It communicates with its fellow by means of the Anterior Communicating. 3. The Middle Cerebral is distributed to the Sylvian fissure and to the middle lobe especially. It gives off the Posterior Communicating, which anas- tomoses with the posterior cerebral from the basilar. SUBCLAVIAN ARTERY. 416 Origin : The Eight originates from the Innominate Artery. The Left originates directly from the Aorta. It is therefore longer and more deeply seated than the right. Course : It arches over the pleura, — passes between the two scalenes, — and terminates at the lower border of the first rib. Divisions : It has three portions : the first inside the scalenes., the second between the scalenes and the third outside the scalenes. Situation and Relations : The First Portion, or Inside the Scalenes, is in relation: In Front, with the subclavian vein, the pneumo -gastric and the recurrent. Behind, with the cervical plexus. Above, with the Thoracic Duct, or the Right Lymphatic Duct. Below, with the pleura. Internally, with the common carotid. Externally , with the border of the scalenes. SUBCLAVIAN ARTERY. 153 The Second Portion, or Between the Scalenes, is in rela- tion : In Front, with the anterior scalene and its tubercle, which separates it from the subclavian vein. Behind, with the middle scalene. Above, with the brachial fiexus. Below, with the groove of the first rib. The Third Portion, or Outside the Scalenes, is in rela- tion: In Front, with the clavicle. BeJi hid, with the brachial fiexus. Beloir, with the first rib. Above, with the skin, the subclavian muscle. 417 Branches : They all originate to the inner side of the scalene muscles. They are : the Vertebral, the Inferior Thyroid, the Supe- rior Intercostals, the Internal Mammary, the Anterior Scapu- lar and the Posterior Scapular (Transverse Cervical). Three originate from a common trunk, called the Thyroid Axis: the Inferior Thyroid, the Anterior Scapular and the Posterior Scapular. 1. The Vertebral enters the foramen of the tranverse pro- cess of the sixth cervical vertebra. — It ascends through all the foramina above. — It winds around the atlas. — It enters the cranium between the occipital bone and the posterior arch of the atlas. — It joins its fellow and forms the Basilar Artery. The Vertebral gives off the Anterior and Posterior Spinal Arteries to the oblong medulla and spinal cord, — and the Inferior Cerebellar to the cerebellum. The Basilar Artery is situated on the middle line of the Varolian bridge — it divides into the two Posterior Oi n brals. These receive the Posterior Communicating Artery from the internal carotid, thus completing the Circle of Willis, which is formed in front of the anterior cerebral and the anterior communicating from the internal carotid. The basilar gives off also the Middle and Superior Cere- bellar to the cerebellum. 2. The Inferior Thyroid passes behind the internal jugular vein and internal carotid artery. — It is distributed to tin- lower angle of the thyroid gland. 3. The Anterior Scapular follows the posterior border of the clavicle. — It is distributed to the supra and infra-sphious fossa?. 4. The Posterior Scapular or Transverse Cervical crosses obliquely backwards over the subclavian artery and the nervesof the brachial plexus.— It passes under the trapezius and descends along the posterior border of the scapula, under the name of Posterior Scapular.— At the inferior angle of the scapular it anastomoses with the subscapular artery. 154 AXILLARY ARTERY — BRACHIAL ARTERY. 5. The Superior Intercostal is distributed to the two or three superior intercostal spaces. It gives off the Posterior Ascending or Deep Cervical, which anastomoses with the descending cervical of the oc- cipital. 6. The Internal Mammary descends behind the intercostal cartilages, one-quarter of an inch to the outer side of the sternum. It penetrates the abdominal straight muscle, being called the Descending Epigastric. It terminates by inosculating with the deep ascending epigastric from the external iliac. AXILLARY ARTERY. 418 Origin : Lower border of the first rib. Course : It begins at the lower border of the first rib, below the subclavian and clavicle. — It traverses the axillary space in its axis.— It terminates at the lower border of the tendons of the great pectoral and great dorsal muscles, where it becomes the brachial. Situation or Relations : It is in relation : In Front, with the vein, the nerves and the fascia. Behind, with the joint and the humerus. Above, with the correo -brachial, which is the guide to it. Below, with the long head of the triceps and the tendon of the great dorsal. 419 Branches : Are the Long Thoracic, the Subscapular and the Posterior Circumflex. 1. The Long Thoracic runs between the small pectoral and the great serrate, to which it is mostly distributed. 2. The Subscapular is a very large and important branch. It anastomoses freely with the perforating branches of the intercostals and the scapulars. 3. The Posterior Circumflex is large. It winds around the posterior part of the surgical neck of the humerus; — it anastomoses with the scapulars and the deep brachial. BRACHIAL ARTERY. 420 Origin : Lower border of the tendon of the great pectoral. Course : It descends vertically to below the articular line of the elbow in front of the insertion of the biceps. — It di- vides therein to the Radial and the Ulnar. Situation or Relations : Its relations vary above the elbow and at the elbow. Above the Elbow, it is in relation : Internally, with the median nerve, which crosses it ob- liquely, the fascia, the skin. Externally, with the anterior brachial. RADIAL ARTERY — ULNAR ARTERY. L55 Anteriorly, with the border of the biceps, which is a guide to it. Posteriorly, with the humerus. At the Bend of the Elbow : It occupies the inner groove. It is in relation : In Front, with the Median Vein, the Expansion of the biceps and the Two Brachial Veins. Behind, with the Anterior Brachial. Externally with the Tendon of the Biceps. Internally, with the Median Nerve and the Round Pro- nator. 421 Branches : are the Superior and Inferior Deep Brachial and the Great Anastomotic. 1. The Superior Deep Brachial runs in the spiral groove, together with the musculo-spiral nerve, and anastomoses with the recurrents. 2. The Inferior Deep anastomoses with the ulnar recur- rent arteries. 3. The Great Anastomotic does the same. RADIAL ARTERY. 422 Origin : From the bifurcation of the brachial, below the bend of the elbow. Situation and Course : It follows the radius and the long supinator muscle, which is the guide to it; — it winds around the outer part of the wrist, under the extensor tendons of the thumb ; — it passes through the first interosseous space ; — it enters the palm of the hand, where it becomes the Deep Palmar Arch. Branches. It gives off : 1st. The Recurrent Radial Artery, which anastomoses with the deep brachial. 2d. The Superficial Palmar or Volar to the Superficial Palmar Arch. 3d. The Carpals. 4th. Metacarpals. 5th. Dorsal and Palmar Arteries of the thumb and index fingers. 6th. The Deep Palmar Arch, which is situated behind all the tendons, resting upon the upper part of the metacarpal bones. The Arch is completed by a dee]) branch from the ulnar. — It gives off the Interosseous and Collateral arteries of the fingers. ULNAR ARTERY. 423 Origin: From the bifurcation of the brachial, below the bend of the elbow. 156 BRANCHES OF THE AORTA. Situation and Course: It passes under the round pro- nator and superficial flexor; — it follows the ulno-carpal flexor, which is the guide to it, to the pisiform bone ; — there it crosses the palm of the hand in front of the flexor tendons ; — it forms the Superficial Palmar Arch. 424 Branches. It gives off : 1st. The Anterior Ulnar Recurrent. 2. The Posterior Ulnar Recurrent, which anastomoses with the inferior deep brachial and the great anastomotic. 3d. The Anterior Interosseous. 4th. The Posterior Interosseous, which gives off the In- terosseous Recurrent, which anastomoses like the others. 5th. The Anterior and Posterior Carpal arteries. 6th. The Deep Communicating Artery to the Deep Palmar Arch. 7th. The Superficial Palmar Arch, which gives off the Digitals which join the interosseous to form the Collaterals of the Fingers. BRANCHES OP THE THORACIC AORTA. 425 It gives off: 1st, the Bronchial to the bronchi; — 2d, the Intercostals , to the nine lower intercostal spaces; — these give off the Lateral Perforating Branches, which anastomose with the Subscapular (axillary). BRANCHES OF THE ABDOMINAL AORTA. 426 They are: — 1st, the Coeliac Axis: It originates on aline with the upper border of the neck of the pancreas ; — it divides into the Gastric, distributed along the smaller curva- ture of the stomach; — the Hepatic, which enters the liver through the transverse fissure; — the Splenic, which runs along the upper border of the pancreas and ends in the spleen. 2d. The Superior Mesenteric. It originates along the in- ferior border of the neck of the pancreas. It is distributed to all the small intestines and to the right half only of the large intestines. 3d. The Inferior Mesenteric. It originates lower down — it is distributed to the left half only of the large intestines ; — on the rectum it divides into the two Superior Hemor- rhoidal arteries, which extend as low down as the anus. 4th. The Supra=renals. They are distributed to the supra- renal capsules. 5th. The Renals. They are very large; — the right is the lower; — they are situated behind the vein and in front of the pelvis of the ureter. 6th. The Two Spermatic. They originate below the renal ; — they descend along the psoas muscle; — they run through COMMON ILIAC — INTERNAL ILIAC. \')1 the inguinal canal ; — they descend into the scrotum ; — they are distributed to the epididymis and testicles. 7th. The Two Phrenic. They are distributed to the dia- phragm. 8th. The Lumbars. They are distributed between the psoas and square lumbar muscles. 9th. The Middle Sacral. It descends along the middle line of the sacrum. COMMON ILIAC. ■427 Origin : From the bifurcation of the aorta at the fourth lumbar vertebra. Course: It runs along the psoas muscle to the sacro-iliac junction. — Here it divides into the Internal and External Iliacs. Situation or Relations : In Front, it is covered by the peritoneum and ureter. Behind, it rests on the psoas. Internally, with the vein. Branches : None. INTERNAL ILIAC. 428 Origin : From the bifurcation of the common iliac opposite the sacro-iliac articulation. Course : It descends toward the upper part of the great sacro-sciatic notch. — There it divides into visceral branches, parietal intra-pelvic branches and parietal extra-pelvic branches. Situation or Relations : In Front, with the peritoneum and the ureter. Behind, with the sacro-iliac junction. Internally, with the vein. 429 The Visceral Branches are : The Three Vesicals. The Uterine, a very large branch, penetrating at the neck. The Vaginal. The Parietal Intra=PeIvic Branches are: The Iliolumbar, situated at the upper part of the artic- ulation.— It anastomoses with the lumbars (aorta). The Obturator, running forward along the brim of the pelvis and then through the obturator canal. — It anasto- moses with the circumflex (femoral). The Lateral Sacral, anastomosing with the middle sacral (aorta). The Parietal Extra=Pelvic Branches arc: The Gluteal: It passes out through the upper pari of the great sacro-sciatic notch above the pyriform muscle. It is distributed between the two layers formed by the three gluteal muscles. 158 EXTERNAL ILIAC — FEMORAL. The Ischiatic : It passes out through the lower part of the great sacro-sciatie notch below the border of the pyriform muscle, in company with the internal pudic and the sciatic nerve. It is distributed to the muscles of the upper back part of the thigh. It anastomoses with the Deep Femoral. The Internal Pudic : It passes out of the pelvis through the lower part of the great sciatic notch. — It winds around the spine of the ischium to penetrate into the small sacro- sciatic notch. — It runs along the ascending branch of the ischium. Upon reaching the root of the penis it terminates on the back of the penis as the Dorsal Artery. Brandies: It gives rise to the following: The Bulbous, to the bulb, important because of its size. The Cavernous, to the Cavernous Bodies. EXTERNAL ILIAC. 430 Origin : From the bifurcation of the common iliac, opposite the sacro-iliac articulation. Course : It extends from the sacro-iliac junction to Pou- part's ligament. — There it becomes the femoral. Relations .- It is situated to the outer side of the border of the psoas muscle. — It is covered by the peritoneum; — it is crossed by the'spermatic duct ; — it is on the outer side of the vein. 431 Branches : They are the Circumflex Iliac and the Epigastric. 1st. The Circumflex Iliac runs along the iliac crest and Poupart's ligament. It is distributed to the psoas and the abdominal muscles. 2d. The Epigastric (deep or ascending) runs along the inner side of the internal abdominal ring towards the bor- der of the abdominal straight. It penetrates the muscle and anastomoses with the inter- nal mammary. FEMORAL. 432 Origin : From the external iliac, at Poupart's ligament. Course : It extends from Poupart's ligament to the opening in the great adductor muscle. — There it becomes the poplit- eal. Situation or Relations : Above, it occupies the middle of Scarpa's triangle; — it lies to the inner side of the sartorius, the psoas-iliac and ante- rior crural nerve ; — it is on the outer side of the vein. In the middle of the thigh it is covered by the sartorius, — is on the inner side of the internal vast muscle, — in front of the vein. POPLITEAL. 1 59 Below the middle it lies in Hunter's canal, — on the inner side of the vastus interims, — on the outer side of tin- sarto rius, — in front of the vein. 433 Branches: They are the Deep Femoral, Anterior Circum- flex and Great Anastomotic. 1st. The Deep Femoral is really a bifurcation of the femoral. It originates about one inch below Poupart's ligament. It is situated on the outer side of the femoral, between it and the psoas-iliac tendon. It runs down in the groove between the adductors and the internal vast muscle. It gives off Perforating Branches, which go to the poste- rior part of the thigh and anastomose with the ischiatic. 2d. The Anterior Circumflex often arises from the deep femoral. It winds around the posterior part of the neck of the femur. It anastomoses with the obturator and the ischiatic. 3d. The Great Anastomotic originates above the ring of the great adductor. It descends along the tendon of this muscle. It anastomoses with the articuiars from the popliteal. POPLITEAL. 434 Origin : From the femoral, at the ring of the first ad- ductor. Course : It extends from the opening of the great adductor to the arch of the soleus, where it divides into the Anterior and Posterior Tibials. Situation or Relations : Above the joint, it lies on the femur — to the outer side of the tendon of semi-membranous, — to the inner side of the vein and the popliteal nerve, — the latter being itself to the outer side of the vein. Opposite the joint, it rests on the posterior ligament. — is covered by the vein, — which is itself covered by the nerve. Below the joint, it rests upon the popliteal muscle and the tibia, — is on the outer side of the nerve and the vein, but considerably overlapped by the vein. 435 Branches: They are the Articular Arteries. 1. The Superior External and Internal Articuiars. 2. The Inferior External and Internal Articuiars, which are distributed to the interior of the joint. They anastomose with the great anastomotic of the femoral. 3d. The Middle or Azygos Articular is distributed to the interior of the joint. 160 TIBIAL— DORSAL ARTERY — PLANTAR. ANTERIOR TIBIAL. 436 Origin : From the popliteal, at the arch of the soleus. Situation and Course : It pierces the upper part of the interosseous membrane. — It descends between the anterior tibial muscle and the long extensor of the great toe to the anterior tarsal ligament. — There it becomes the Dorsal of the Foot. Branches : The Recurrent Tibial, which ascends on the outer side of the front of the knee. It anastomoses with the articulars and great anastomotic. DORSAL ARTERY OF THE FOOT. 437 Origin : From the anterior tibial, at the anterior tarsal lig- ament. Situation and Course : It extends from the anterior tarsal ligament to the posterior extremity of the first interosseous space. — There it becomes the Perforating or Communicating, which inosculates with the internal plantar artery. It is situated on the tarsal bones. — It is covered by the skin. — Is on the outer side of the tendon of the extensor of the great toe. Branches : They supply the tarsus, metatarsus and the great toe. POSTERIOR TIBIAL. 438 Origin : From the popliteal, at the arch of the soleus. Situation and Course : It extends from the arch of the soleus to the internal tarsal ligament, where it divides into the internal and external plantar. It descends on the middle line to the groove between the posterior tibial muscle and long flexor of the toes ; — lower down it inclines to the inner side of the ankle, — there it is situated between the tendons of the long flexor of the toes and the long flexor of the great toe, and is covered by the skin and fascia. The Posterior Tibial Nerve above is on the inner side ; — in the middle it crosses the nerve, — and below it is on its outer side. Branches : Only one, the Peroneal, which descends along the fibula and divides into an Anterior and a Posterior Peroneals. EXTERNAL PLANTAR. 439 Origin : From the posterior tibial, at the internal tarsal lig- ament. Situation and Course : It is the continuation of the pos- terior tibial. — It extends from the internal annular liga- INTERNAL PLANTAR — PECULIARITIES OF ARTERIES. Hil ment to the posterior extremity of the first interosseous space. — It inosculates with the dorsal of foot. It is at first directed outwards and forwards between the short fiexor of the toes and the accessory muscle to reach the fifth metatarsal bone. — There it turns towards the pos- terior extremity of the first interosseous space, forming the plantar arch, which rests on the posterior extremity of the metatarsal bones. Branches : The Plantar Arch, which supplies the four outer toes. INTERNAL PLANTAR. 440 Origin: From the posterior tibial, at the internal tarsal ligament. Branches : Are lost in the muscles of the internal region of the foot. PECULIARITIES OF ARTERIES IN PARTICULAR. 441 Large Arteries are superficial at one end and deep at the other. The Innominate Artery: Is crossed at right angle by the left Innominate vein. It is short and large, — it is the shortest of all large arteries. It seldom gives rise to collateral branches. The Common Carotid : It is crossed by the sterno-mastoid. It gives rise to no branches. The External Carotid : Is crossed by the hypoglossal nerve. The Lingual runs parallel to the hyoid bone and to the hypoglossal nerve. The Occipital gives rise to the Descending Cervical (a sur- gical collateral branch). The Internal Carotid : Runs through a long channel, the carotidean canal. It runs also through a sinus, the cavernous sinus. It forms the anterior segment of the circle of Willis, a surgical collateral branch. It gives rise to no branches in the neck, nor in the canal nor in the sinus. The Subclavian : Is crossed by the phrenic nerve, the pneumo-gastric, the recurrent laryngeal, the thoracic duct on the Left and by the right lymphatic duct on the right. The Left Subclavian is longer and situated more deeply than the right. The tubercle of the anterior scalene is the guide to the subclavian artery. 11 162 PECULIARITIES OF ARTERIES. It gives rise to the Vertebral and to the Superior Inter- costal, which itself gives rise to the Ascending Cervical, a surgical collateral branch. It presents the thyroid axis; i. e., one short branch giving rise to three arteries. All its branches originate from the first portion. It gives rise to no branches in the middle and third por- tions. The Vertebral : Ascends through an interrupted bony canal. It winds around the lateral mass of the atlas. The Right aud the Left unite to form the Basilar. The Branches of the Basilar form the posterior segment of the circle of Willis. The Internal Mammary : Anastomoses with the Epigastric, and it is the only direct anastomose between the supra and the infra-diaphragmatic circulations. The Posterior Cervical (or Cervical Transverse) crosses the Subclavian artery and the branches of the brachial plexus. 442 The Axillary Artery : It is pronged by the median nerve. It gives rise to the subscapular, a large surgical collateral branch. The Brachial :_ Is crossed obliquely by the median nerve, which is usually on top of it. It gives rise to the Superior Profunda, an important sur- gical collateral branch. The Radial gives rise to the Recurrent Radial, the Volar and the Deep Palmar Branch, all important collateral sur- gical branches. The Ulnar gives rise to the Recurrent Ulnar, the Inter- osseous, the branch of the Superficial Palmar Arch, all im- portant surgical collateral branches. 443 The Arch of the Aorta : It is the only arch of the kind except azygos vein and thoracic duct. It is crossed obliquely by the Innominate Vein. It is wound around by the Pulmonary Artery. It is also wound around by the Left Recurrent Laryngeal Nerve. The Thoracic Aorta is crossed obliquely by the oesophagus. The Abdominal Aorta and Branches will be studied with the arteries of the organs. The Common Iliac gives rise to no branches. The Internal Iliac: Is crossed by the ureter at its origin. PECULIARITIES OF THE ARTERIES OF THE ORGANS. 163 It gives rise to the Ischiatic, a most important surgical collateral branch. The External Iliac: Gives rise to no branches until near its termination. Then it gives rise to the Epigastric, an important surgical collateral branch. It is crossed by the ureter and the spermatic duct. The Femoral : Is crossed obliquely by the Sartorius. A portion is contained in a fibrous canal, — Hunter's Canal. It gives rise to the Profunda and the Great Anastomotic, two important surgical collateral branches. The Popliteal: Is deeply seated. It is crossed oblicpiely by the vein and the nerve. It gives rise to the articulars, important surgical collat- eral branches. The Anterior Tibial : Gives rise to the Recurrent Tibial, a surgical collateral branch. It gives rise also to the Dorsal, which inosculates with the External Plantar. The Posterior Tibial gives rise to the Peroneal, a surgical collateral branch. It gives rise also to the External Plantar, which forms the Plantar Arch and inosculates with the Dorsal. PECULIARITIES OF THE ARTERIES OF THE ORGANS. ORGANS OF DIGESTION. 444 Lips: The Coronary Arteries reach the lips at the commissure. They are between the muscular and mucous layers in the glandular layer. teeth : The Inferior Dental Artery runs through a bony canal. Tongue : The Ranine arteries are dangerously large beyond the an- terior half. Tonsils : The Tonsillar branch is large, and is adherent to the tissue in chronic tonsillitis ; hence hemorrhage. The Internal Carotid is close to its external surface. Parotid Gland : The External Carotid divides in its substance behind the condyle. 164 ORGANS OP URINATION — ORGANS OP GENERATION. Submaxillary Gland : The facial artery crosses its posterior extremity. Pharynx : The Internal Carotid is in relation with the lateral walls. (Esophagus : It is crossed obliqnely by the aorta. Stomach : It is surrounded by an arterial circle. Small Intestines : They are supplied by one artery alone, the Superior Mesenteric. Large Intestines : The right half is supplied by the Superior Mesenteric. The left half by the Inferior Mesenteric, which terminates by the Superior Hemorrhoidal to the rectum. Rectum : Is supplied by the Three Hemorrhoidals. The Superior Hemorrhoidals are the largest and most dangerous. Anus : Is supplied by the Inferior Hemorrhoidals, which are small. Liver: The Hepatic Artery is remarkable for its small size. Spleen : The Splenic Artery is remarkable for its large size. ORGANS OF URINATION. 445 Kidneys : The Renal Arteries are remarkable for their large size. The right is lower than the left. They are in front of the calices and pelvis, and behind the veins. They form a Capillary Arterial Portal System. They carry darker blood than the veins. Bladder: It is well provided with arteries ; three branches on each side. ' ORGANS OF GENERATION. Testicles : The Spermatic Arteries are long and slender. Spermatic Duct: The Spermatic Artery is closely attached to it. Penis : It has two Dorsal Arteries. They terminate by dilated extremities. THE HEART — ORGANS OP RESPIRATION, SPECIAL SENSE. 105 THE HEART. 44G Has Two Coronary Arteries. They originate below the Sigmoid valves. They fill up during ventricular diastole and by arterial systole. ORGANS OF RESPIRATION. Lungs : The Bronchial Arteries: Are remarkably small. They are the nutrient arteries. The Pulmonary Artery: Is remarkably large for the organs. It contains dark blood. It terminates by three capillary plexuses. Thyroid Body : It is remarkably vascular for its size. It has five Thyroid Arteries. CENTRAL ORGANS OF INNERVATION. Cerebral Dura Mater: It presents the Middle Meningeal Artery. Cerebral Pia Hater : It is remarkably vascular. Cerebrum : The arteries form the circle of Willis. No large arteries penetrate its substance. Cerebellum : It is not as well supplied with arteries as the cerebrum. Spinal Cord : It presents the two long anterior and posterior Spinal Arteries. ORGANS OF SPECIAL SENSE. 447 Choroid: It is provided with numerous arteries. Retina : It presents the Central Artery of the Retina, which is unique in its course in the optic nerve. The terminal divisions of this artery are remarkable. Iris: It is remarkably vascular. It receives the arteries from two sources : the Posterior Long Ciliary and the Anterior Short Ciliaries. ORGANS OF HEARING. Nothing special. 166 ORGANS OF LOCOMOTION — DIRECTION OP ARTERIES. ORGANS OF LOCOMOTION. Bones : The Long Bones specially possess a Nutrient Artery. The Petrous Bone is traversed by the Internal Carotid. The Inferior Maxilla is traversed by the Inferior Dental Artery. Articulations : Many of these are surrounded by Arterial Articular Circles. Muscles: The Internal Pterygoid is traversed by the Internal Max- illary. ORGANS OF CIRCULATION. Arteries : The Arteries of Arteries come from neighboring branches and from the trunk itself. Veins : Arteries of Veins come from neighboring branches. LINES INDICATING THE DIRECTION OF THE MAIN ARTERIES AND MUSCLES WHICH ARE GUIDES TO ARTERIES. 448 1st. Innominate. Line from the middle of the sternal junction to the sternal tendon of the sterno-mastoid. 2d. Common, External and Internal Carotids. Line from sterno -clavicular articulation to space between mastoid process and angle of lower jaw. Guide: the sternocleido- mastoid muscle. Bifurcation of Common Carotid. Opposite upper border of thyroid cartilage. 3d. Lingual. Line parallel to great horn of hyoid bone, one-third inch above it. Guide: hyoglossus muscle and hypoglossal nerve. 4th. Facial. 1st. Line from great horn of thyroid carti- lage to anterior inferior angle of masseter. — 2d. Line from anterior inferior angle of masseter to angle of lip. — 3d. Line from angle of lip to groove of wing of nose. — 4th. Line from groove of nose to angle of eye. 5th. Internal Maxillary. Immediately behind the condyle of the jaw. 449 6th. Subclavian Artery. Line corresponding to the middle of space between posterior border of sterno-mastoid and anterior border of trapezius. Guide: anterior scalene and its tubercle on the first rib. 7th. Axillary (1st portion) Infra-clavicular region. Line below anterior convexity of clavicle. Guide: small pectoral and the axillary vein. DIRECTION OF ARTERIES. 167 8th. Axillary in Axillary Space. Liiie from apex of axilla to middle of space between tendons of great pectoral and great dorsal. Guide; coraco-brachial and the two heads of the median nerve. 9th. Subscapular Artery. Inner part and lower end of glenoid cavity. Guide: tendon of the great dorsal. 10th. Brachial. Line from pit of axilla to middle of bend of elbow. Guide: above, coraco-brachial; in middle, biceps and median nerve; below, tendon of biceps and median nerve. 11th. Radial in Forearm. Line from middle of bend of elbow to styloid process. Guide: the long supinator. 12th. Radial Along Outer Border of Wrist. Line from tubercle of supinator to upper extremity of first interros- seous space. Guide: tendons of extensors of metacarpal bone and phalanges of thumb, which it crosses diagonally. 13th. Ulnar. Line from middle of bend of elbow to inner side of pisiform bone. Guide: ulno-earpal flexor. 11th. Superficial Palmar Arch. Line of the thumb sepa- rated widely from the fingers. 15th. Deep Palmar Arch. Same line, but half an inch nearer the wrist. 16th. Internal Mammary. About one-quarter inch to outer side of border of sternum. 17th. Epigastric. Line from middle of Poupart's liga- ment to umbilicus. 18th. Common and External Iliac. Line from right of middle of Poupart's ligament to two inches below the um- bilicus. Guide: psoas muscle. 19th. Gluteal Artery (point of emergence at buttock). Junction of middle with inner third of a line from the pos- terior superior spine of ilium to great trochanter rotated inward. 20th. Internal Pudic. Junction of lower and middle third of a line from outer side of tuberosity of ischium to poste- rior superior spine of pubis. 21st. Ischiatic. Same place, but nearer the middle of the line. 22d. Bulbous Artery (from Internal Pudic). Horizontal line midway between anus and root of scrotum. 23d. Femoral Artery. Line from middle of Poupart's ligament to tubercle of great adductor (upper two-thirds). Guide: sartorius muscle. 21th. Popliteal. Line, axis or middle of the hams of the space. Guide: semi-membranous muscle, the vein and the nerve. 25th. Anterior Tibial. Line from head of fibula to middle of intermalleolar space. Guide: anterior tibial muscle. 26th. Dorsal Artery. Line from middle of intermalleolar 168 CIRCULATORY CIRCUITS. space to first interosseous space. Guide: tendon of long extensor of great toe (artery on outer side). 27th. Posterior Tibial. Line from middle of popliteal space to middle of space between internal malleolus and calcaneum. Guide : tendon of the posterior tibial muscle. 28th. Peroneal Artery. Line from middle of popliteal space to posterior border of external malleolus. Guide: long flexor of great toe. 29th. Plantar Arch. Line from posterior extremity of fifth metatarsal bone to posterior extremity of first meta- tarsal. CIRCULATORY CIRCUITS. 454 There are three different and independent circulatory cir- cuits : the Cardiac, the Pulmonary and the General or Sys- temic. The Cardiac Circuit corresponds to the two Cardiac Arte- ries, to the Great Cardiac Vein and to the Veins of The- besius. The Pulmonary Circuit comprises the Bronchial Circula- tion and the Pulmonary Circulation. The Bronchial Circuit corresponds to the Two Bronchial Arteries and to the Bronchial Veins. The Pulmonary Circuit Proper, corresponds to the Pul- monary Artery and to the Four Pulmonary Veins. The General or Systemic Circuit comprises the Supra- Diaphragmatic and the Infra-Diaphragmatic circulations. These Two Circuits communicate together through the anastomose of the Internal Mammary with the Epigastric in front, and behind by the anastomose of the Lower Inter- costals with the Lumbar Arteries. The Venous communi- cations are through the veins accompanying the arteries and through the anastamoses of the origin of the azygos with the lumbar veins. The Supra=Diaphragmatic Circuit corresponds to the Arch and its Branches and to the Superior Cava Vein and its Branches. It presents a Cephalic and a Brachial Circuit. The Cephalic Circuit corresponds to the Branches of the Carotids and the Jugular Veins. The Cephalic Circuit is subdivided into the Exterior and the Interior Circuits. The Exterior Circuit corresponds to the External Carotid, the Facial and Temporal Arteries, and to the External Jugu- lar Vein. The Interior Circuit corresponds to the Internal Carotid and to the Internal Jugular Vein. The Brachial Circuit or Circuit of the Upper Extremity corresponds to the Subclavian, Axillary, Brachial, Radial ARTICULAR ARTERJAL CIRCLES. 109 Ulnar Arteries and to the Veins of the same name joining into the Innominate Vein. 455 The Infra=Diaphragmatic Circuit corresponds to the Tho- racic and Abdominal Aorta, and to the Inferior Cava Vein. It comprises the following peculiar circuits : The Portal-Hepatic Circuit, which corresponds to the Cceliac Axis of the Two Mesenteric arteries and to the Formative Branches of the Portal Vein and to the Hepatic Veins. The Renal Circuit is formed by the Renal Arteries and Veins. — It presents the peculiar Arterial Portal System of the Malpighian Corpuscles. The Penile Circuit corresponds to the Two Dorsal Arteries and to the Single Dorsal Vein. The Circuits in the Pregnant Uterus present three divi- sions.— The Circulation of the Uterine Walls corresponds to the Ovarian and Uterine Arteries and their Veins. — The Cir- culation of the Embryo or of the Umbilical Vesicle and — The Circulation of the Foetus or Placental Circulation, pre- sents the peculiar Venous Hepatic Branch, the Oval For- amen and the Arterial Aortic Duct. The Circuit of the Pelvis corresponds to the Internal Iliac and its Veins. The Circuit of the Lower Extremity corresponds to the Iliacs and Divisions and of their Veins. ARTICULAR ARTERIAL CIRCLES. 456 Each large articulation is surrounded by a circle of arteries which are the collateral channels by which the circulation is re-established when the main trunks are ligated. Thus : Neck and Trunk. Anastomoses of : Superior Thyroid with Inferior Thyroid. Occipital and its Descending Cervical Branch with the Superior Intercostal and its Ascending Cervical Branch. The Vertebral with the Internal Carotid through the circle of Willis. The Nasal of Ophthalmic with the Nasal of the facial. Arm and Trunk. Anastomoses of: Scapulars of Subclavian with Subscapular and Circum- flex of the Axillary aud Ascending of Profunda of Bra- chial. Subscapular, Long Thoracic , Circumflex, Beep. Brachial and Scapulars of Subclavian with Perforating Aortic Inter- costals. Elbow : Anastomoses between the two Profunda? and the Anastomotic of the Brachial with the Recurrent Radial, Recurrent Ulnar, Recurrent Interosseous. Wrist and Hand : Anastomoses through the Palmar Arches. Anastomoses of the Interosseous and the Carpals. 170 IMPORTANT BRANCHES OP ARTERIES. Anastomose between the Supra=diaphragmatic and the Infra=diaphragmatic Arteries through the anastomoses of : Internal Mammary and Epigastric. Intercostals and Epigastric. Lumbar Arteries with the last Intercostals. Trunk and Thigh. Anastomoses of : Ischiatic with Profunda. Circumflex Iliac with the Lumbar Arteries. Circumflex and Obturator with Epigastric and Internal Mammary. Knee Joint. Anastomoses of : The four Articulars with the great Anastomotic and with Recurrent Tibial. Ankle and Foot. Anastomoses of the — Dorsal with the External Plantar. Dorsal with the Peroneal. Anterior Tibial with the Peroneal. ENUMERATION OF THE MOST IMPORTANT BRANCHES OF ARTERIES NECESSARY TO UNDERSTAND THE ESTABLISHMENT OF THE COLLATERAL CIRCULA- TION AFTER THE LIGATURE OF ARTERIES. 457 External Carotid: — Superior Thyroid, — Lingual, — Facial, — Occipital, giving rise to Descending Cervical, — Internal Maxillary, — Temporal. Internal Carotid : Nasal, the terminal branch of the Ophthalmic. Anterior Cerebral, giving rise to the Anterior Communi- cating. Middle Cerebral, giving rise to the Posterior Communi- cating. Subclavian Artery: Vertebral, forming the Basilar, which divides into the Posterior Cerebrals. Inferior Thyroid. Superior Intercostal, giving rise to the Ascending Cervical. Internal Mammary. Anterior Scapular (or Supra-scapular). Posterior Scapular (or Transverse Cervical). Axillary: — Long Thoracic, — Subscapular, — Posterior Cir- cumflex. Brachial : — Superior Deep Brachial, — Inferior Deep Brachial, — Great Anastomotic. Radial : — Recurrent Radial, — Palmar or Volar, — Carpals, — Metacarpals, — Deep Palmar Arch. Ulnar: — Anterior Ulnar, — Posterior Ulnar, — Anterior In- terosseous,— Posterior Interosseous, — Recurrent Interos- seous,— Carpals, — Metacarpals, — Branch to Deep Palmar Arch, — Superficial Palmar Arch. SURGICAL COLLATERAL BRANCH OF ARTERIES. 171 458 Thoracic Aorta : — Intercostal s. Abdominal Aorta : — Lumbar*. Internal Iliac. Visceral Branches: — Vesical, — Uterine, — Vaginal. Parietal Intra-pelvic: — Ilio-lumbar, — Lateral Sacral, — Obturator. Parietal Extra-pelvic : — Gluteal, — Ischiatic, — Internal Pudic. External Iliac: — Epigastric, — Circumflex Iliac. Femoral: — Deep Femoral, giving rise to Perforating, — Anterior Circumflex, — Great Anastomotic. Popliteal : — Superior Articulars, Internal and External. — Middle Articulars, — Inferior Articulars, Internal and Ex- ternal. Anterior Tibial : — Recurrent Tibial. Dorsal of the Foot, terminating into the Perforating and Communicating. Posterior Tibial : Peroneal, giving rise to Anterior and Posterior Peroneals. External Plantar forming the Plantar Arch, inosculating with the Perforating. SURGICAL COLLATERAL BRANCH OP THE MAIN ARTERIES. 459 It is the branch which is commonly the great anastomotic medium by which the blood is carried to the parts beyond the ligated trunk. In some situations we find also a smaller accessory eollatera-l surgical branch. The Common Carotid and the Internal Carotid form really but one artery, and its surgical collateral branch is the External Carotid. The Surgical Collateral branch of the External Carotid is the Occipital Artery, on account of its Descending Cer- vical branch which anastomoses with the Ascending Cervi- cal branch of the Superior Intercostal from the Subclavian. The Surgical Collateral Branches of the Internal Carotid are the Anterior and Posterior Communicatins: of the circle of Willis. The Surgical Collateral Branch of the Subclavian is the Vertebral, because of its free anastomoses with the circle of Willis. The Accessory Branch is the Ascending Cervical from the Superior Intercostal, on account of its anastomoses with the Descending Cervical from the Occipital of the External Carotid. The Surgical Collateral Branch of the Axillary is the Subscapular. — The Accessory Branch is the Posterior Cir- cumflex. 172 COLLATERAL CIRCULATION AFTER LIGATURE. The Surgical Collateral Branch of the Brachial is the Superior Deep Brachial. — The Accessory Branch is the Great Anastomotic. The Surgical Collateral Branch of the Radial is the Re- current Radial. — The Accessory Branches are the Volar and the Superficial Palmar Arch. The Surgical Collateral Branches of the Ulnar are the In- terosseous, Anterior and Posterior, because of the anastomo- ses through the Recurrent Ulnar with the Deep Brachial and below with the Carpal Arteries from the Radial and Ulnar. The Accessory Branch of the Ulnar is the Deep anas- tomotic branch to the Deep Palmar Arch. 460 The Surgical Collateral Branches of the Thoracic Aorta are the Intercostal Arteries, because of the anastomoses with the Subscapular. The Surgical Collateral Branches of the Abdominal Aorta are the Lumbar, which anastomose with the Ilio-lumbar. The Common and the External Iliacs form really but one artery, and the Surgical Collateral Branch is the Internal Iliac. — The Accessory Branch is the Ischiatic. The Surgical Collateral Branch of the External Iliac is the Epigastric. — The Accessory Branch is the Circumflex Iliac. The Surgical Collateral Branch of the Femoral is the Deep Femoral, on account of its anastomoses above with the Ischiatic from the Internal Iliac and below with the Articulars from the Popliteal. — It is the typical surgical collateral branch. — The Accessory Branch is the Great Anas- tomotic. The Surgical Collateral Branch of the Popliteal is the Anterior Tibial, because it anastomoses above with the Ar- ticulars and Great Anastomotic and below through the Per- forating Artery with the External Plantar, Posterior Tibial and the Anterior Peroneal. The Surgical Collateral Branch of the Posterior Tibial is the Peroneal, because it anastomoses through its anterior terminal branch with the Tarsal arteries from the Dorsal and the Anterior Tibial. COLLATERAL CIRCULATION AFTER LIGATURE (i. e., HOW THE PARTS BEYOND THE LIGATURE ARE SUPPLIED). 461 Guide. Name in order each important branch originating from the ligated artery (above or below the point of liga- ture), and say with what artery it anastomoses. Collateral Circulation After Ligature of the Innominate. Anastomoses of the branches of the External Carotid with their fellow of the opposite side. Anastomoses of the Two Internal Carotids in the Circle of COLLATERAL CIRCULATION AFTER LIGATURE. 173 Willis through the Anterior Communicating of the Anterior Cerebrals. Anastomoses of the Two Vertebrals in the Circle of Willis through the Two Posterior Cerebrals of the Basilar. Anastomoses of Descending Cervical from Occipital with the Ascending Cervical of the Superior Intercostal (sub- clavian). Anastomoses of Long Thoracic and Subscapular of axillary with Perforating Aortic Intercostals. Collateral Circulation After Ligature of the Common Carotid. Anastomoses of External Carotid with its fellow. Anastomoses of Descending Cervical (external carotid) with the Ascending Cervical (superior intercostal of sub- clavian). Anastomoses of Internal Carotid with its fellow in the circle of Willis through the Anterior Communicating. Anastomoses of Internal Carotid with the Vertebral in the circle of Willis through the Posterior Communicating. Collateral Circulation After Ligature of the External Carotid. Anastomoses of its Branches with their fellows. Anastomoses of Facial with Nasal (ophthalmic). Anastomoses of Descending Cervical (occipital) with As- cending Cervical (superior intercostal subclavian). Collateral Circulation After the Ligature of the Inter- nal Carotid. Anastomoses of Nasal (ophthalmic) with Facial (exter- nal carotid). Anastomoses with its Fellow in the circle of Willis through the Anterior Cerebral. Anastomoses of the Posterior Cerebral with the Vertebral in the circle of Willis. 462 Collateral Circulation After the Ligature of the First Portion of the Subclavian, i. e., inside the origin of all its branches. Anastomoses of Vertebral with its fellow in the circle of Willis through the Basilar. Anastomoses of the Inferior Thyroid with the other Thy- roids in the Thyroid Body. Anastomoses of the Superior Intercostal through the As- cending Cervical with the Descending Cervical of the Occip- ital (external carotid). Anastomoses of the Internal Mammary with the Epigastric (external iliac). Anastomoses of the Anterior Scapular with Subscapular (axillary). Anastomoses of the Subscapular and Long Thoracic (axil- lary) with Perforating Intercostal (aorta). Collateral Circulation After the Ligature of Second, or 174 COLLATERAL CIRCULATION AFTER LIGATURE. Third Portions of the Subclavian, i. e., outside the ori- gin of all its branches ; and Collateral Circulation After the Ligature of the First Portion of the Axillary, i. e., above the Small Pectoral, i. e., above the origin of the Long Thoracic (axillary). These three ligatures are practically all the same as re- gards the collateral circulation. Anastomose of the Scapulars (subclavian) with the Sub- scapular (Axillary). Anastomose of the Long Thoracic with Perforating Inter- costals. Anastomose of Subscapular with Perforating Intercostals. Anastomose of Circumflex with the Two Scapulars of the Subclavian . Collateral Circulation After the Ligature of the Axillary in its Third Portion, i. e., below the origin of the Sub- scapular, and 463 Collateral Circulation After Ligature of the Brachial Above the Origin of the Superior Deep Brachial. These two ligatures are practically the same. Anastomose of the Subscapular (axillary) with the As- cending Branch of the Superior Deep Brachial. Anastomose of the Circumflex (axillary) with same. Collateral Circulation After Ligature of the Brachial Below the Superior Deep Brachial, but Above the Infe= rior Deep Brachial. Anastomoses of the Superior Beep Brachial with Recurrent Radial and the Elbow Circle. Collateral Circulation After Ligature of the Brachial at the Bend of the Elbow, i. e., below the origin of all its branches. Anastomose of the Superior Beep Brachial with Recurrents and Elbow Circle. Anastomoses of the Inferior Beep Brachial with same. Anastomoses of the Great Anastomotic with same. Collateral Circulation After the Ligature of the Radial Alone. Anastomoses through the Two Palmar Arches. Collateral Circulation After the Ligature of the Ulnar Alone. Anastomoses through the Two Palmar Arches. Collateral Circulation After the Ligature of the Radial and Ulnar Simultaneously. Anastomoses of the Interosseous with the Carpals and Metacarpal Arteries (from radial and from ulnar). 464 Collateral Circulation After the Ligature of the Com= mon Iliac. Anastomoses through Branches of Internal Iliac. Anastomose of Ilio-lumbar (internal iliac) with Lumbars (aorta). COLLATERAL CIRCULATION AFTER LIGATURE. 17.") Anastomoses of Visceral Branches of internal iliac with their fellows. Anastomose of Lateral 'Sac ral (internal iliac) with Middle Sacral (aorta). Anastomoses through Brandies of the External Iliac. Anastomose of Fj>i(/astric (external iliac) with Internal Mammary (subclavian) . Anastomose of Circumflex Iliac (external iliac) with Lum- bars (aorta). Collateral Circulation After the Ligature of the Inter= nal Iliac. Anastomoses of Vesical Brandies (internal iliac with their fellows). Anastomose of Ilio-lumbar (internal iliac) with Lumbars (aorta). Anastomose of Obturator (internal iliac) with Circumflex (femoral). Anastomose of Lateral Sacral (internal iliac) with Middle Sacral (aorta). Anastomose of Ischiatic (internal iliac) with Deep Fem- oral. Collateral Circulation After Ligature of the External Iliac. Anastomose of Epigastric with Internal Mammary (sub- clavian). Anastomose of Circumflex Iliac with Lumbars (aorta). Anastomose of Circumflex (femoral) with Obturator (in- ternal iliac). Anastomose of Deep Femoral w/th Ischiatic (internal iliac). 465 Collateral Circulation After Ligature of the Common Femoral. Anastomose of Beep Femoral with Ischiatic (internal iliac). Anastomose of Circumflex (femoral) with Obturator (in- ternal iliac). Collateral Circulation After the Ligature of the 5uper= ficial Femoral Above the Origin of the Great Anas= tomotic. Anastomoses of Beep Femoral with Articidars (popliteal). Collateral Circulation After the Ligature of the Pop= liteal Above the Posterior Ligament. Anastomoses of Great Anastomotic (femoral) with Re- current Tibial and the Inferior Articnlars. Anastomoses of Superior Artieulars (popliteal) with the Inferior Articnlars (popliteal). Collateral Circulation After the Ligature of the Pop= liteal Below the Posterior Ligament. Anastomose of the Great Anastomotic (femoral) with Recurrent Tibial (anterior tibial). 176 VEINS OF SYSTEMIC CIRCULATION. Anastomose of all the Articulars (popliteal) with Recur- rent Tibial. Collateral Circulation After the Ligature of the An= terior Tibial. Anastomose of Dorsal Artery with External Plantar (posterior tibial). Collateral Circulation After the Ligature of the Pos= terior Tibial. Anastomoses of External Plantar with Dorsal Artery (an- terior tibial). Collateral Circulation After the Ligature of the Per= oneal. Anastomoses of Dorsal Artery (anterior tibial) with An- terior and Posterior Peroneals. Collateral Circulation After Simultaneous Ligature of the Anterior and Posterior Tibials. Anastomoses of Dorsal Artery (anterior tibial) with Ante- rior and Posterior Peroneals. Anastomoses of External Plantar (posterior tibial) with Dorsal Artery and the Anterior and Posterior Peroneals. Collateral Circulation After the Simultaneous Ligature of the Anterior Tibial, Posterior Tibial and Peroneal. Anastomoses through muscular branches. RESUME OF THE VEINS OF THE SYSTEJTIC CIRCULATION. 466 Divisions : The veins above the diaphragm all end in the Superior or Descending Cava, and all the veins below the diaphragm end in the Inferior or Ascending Cava. SUPERIOR OR DESCENDING CAVA VEIN. Course. It extends from the junction of the two innomi- nate veins which form it to the upper part of the right auricle. Situation or Relations. The Superior Cava is in relation : In Front, with the first intercostal space, the second costal cartilage, the corresponding portions of the border of the sternum and the second intercostal space. Behind, with the root of the right lung. Externally, with the apex of the right lung. Internally, with the origin of the aorta. Collateral Branches : The Great Azygos. — It is situated in the posterior mediastinum, to the right of the vertebral column and thoracic duct ; — it arches over the pedicle of the right lung ; — it empties into the descending cava. — It re- turns the blood from the intercostal spaces, except the three INNOMINATE VEIN — INTERNAL JUGULAB VEIN. 177 upper. — Its formative branch communicates with the renal, and even the ascending cava. Formative Branches: The left and right innominate veins. LEFT INNOMINATE VEIN. 467 Course : It is much the longer, having to cross over to the right side to form the ascending cava. Situation or Relations. It is in relation : In Front, with the upper border of the sternum, about one-quarter of an inch below it ; also the right sterno- clavicular articulations. Behind, with the left subclavian artery, left common carotid, innominate artery, pneumo-gastric nerve, phrenic nerve, thoracic duct. Collateral Branches: It receives all the veins which ac- company the branches of the subclavian artery, except the scapulars. It receives also the great thoracic duct. Formative Branches : Left internal jugular and sub- clavian. RIGHT INNOMINATE VEIN. 468 Course: Is remarkably short. Situation or Relations. It is in relation : In Front, with the right sterno-elavicular articulation. Behind, with the innominate artery. Collateral and Formative Branches: Same as for left in- nominate, except that it receives the right lymphatic duct instead of the thoracic duct. INTERNAL JUGULAR VEIN. 469 Course: It extends almost perpendicularly from the base of the skull to the superior cava. Situation or Relations. It is in relation : In Front, below, with the tendon of the sterno-mastoid ; in the middle, with its anterior border only; above, with the skin and fascia. Behind, with the vertebral column, the pneumo-gastric and the sympathetic Internally, with the common carotid and the internal carotid. Externally, with the deep cervical lymphatic glands, the parotid gland and the pterygoid muscles. Collateral Branches: The veins which accompany the brandies of the external carotid artery, except the internal maxillary! the posterior auricular and temporal veins (which are the formative branches of the external jugular). 12 178 SINUSES. Formative Branches : The two lateral sinuses and the in- ferior petrosal sinus. LATERAL SINUSES. 470 Situation and Course: They extend horizontally from the Press of Herophilus on the left side of the internal occipital protuberance to the mastoid process ; — then they curve in- wards and downwards to the jugular foramen. Collateral Branches: 1st, Veins from cerebellum and diploe; — 2d, Mastoid Vein; — 3d, Superior Petrosal Sinus, which originates from the cavernous sinus and runs along the superior border of the petrous bone. Formative Branches : The superior longitudinal sinus, the straight sinus and the occipital sinus. SUPERIOR LONGITUDINAL SINUS. 471 Situation and Course. It corresponds to the convex or adherent border of the cerebral falx. — (This sinus, the Cavernous Sinuses and Lateral Sinuses are the largest sinuses of the brain. J Collateral Branches : Cerebral and diploic veins. Formative Branches : Superior nasal vein, which passes through the so-called blind foramen. - STRAIGHT SINUS. 472 Situation and Course. It is situated at the base of the cerebral falx, where it joins the tentorium. Collateral Branches: 1st, the cerebral veins; — 2d, the inferior longitudinal sinus, which is a small venous tract corresponding to the free or concave border of the cerebral falx. Formative Branches : The Veins of Galen from the inter- posed veil. OCCIPITAL SINUSES. 473 Situation and Course: They are two small tracts, situ- ated on the margin of the occipital foramen. INFERIOR PETROSAL SINUSES. Situation and Course. They are situated along the pos- terior border of the petrous bone ;— they extend from the cavernous sinus to the jugular foramen. Collateral Branches : The Transverse Sinus, which is situ- ated iu front of the occipital foramen, and which establishes a transverse communication with the same sinus on the other side. Formative Branches : The cavernous sinuses. SINUSES — ANASTOMOSES BETWEEN VENOUS CIRCULATIONS. 170 CAVERNOUS SINUSES. 474 Situation and Course. They are situated on the sides on the pituitary body. They contain the internal carotid artery, the third, fourth, first branch of the fifth and the sixth pairs of nerves. Collateral Branches : 1st, Cerebral Veins; — 2d, the Circu- lar Sinus, which surrounds the pituitary body in the sella turcica and which establishes a communication with the cavernous sinus on the other side. Formative Branches: The Ophthalmic Vein, which returns the blood from all the parts contained in the orbit behind the broad ligaments of the lids. — It inosculates with the facial vein at the internal angle of the eye. CLASSIFICATION OF THE SINUSES. 475 Important Sinuses : The only important sinuses are the Lateral, the Superior Longitudinal, the Straight, the Supe- rior Petrosal, Inferior Petrosal, the Transverse and the Cav- ernous. The Cerebral Sinuses are the first three, the Lateral, Su- perior Longitudinal and the Straight, which return the blood from the brain alone. The Superior Longitudinal receives the blood from the surface of the brain. The Straight Sinus receives the blood from the interior Of the brain through the interposed veil and the Veins of Galen. The Orbital Sinuses are the Cavernous and the Inferior Petrosal Sinuses, which return the blood from the orbit through the ophthalmic vein. Anastomotic Sinuses: The Superior Petrosal Sinus is an anastomotic branch between the Cerebral and the Orbital Sinuses. It cor- responds to the posterior communicating artery. The Transverse is an anastomotic branch between the cavernous sinuses of the two sides. It corresponds to the anterior communicating artery. The two Lateral Sinuses anastomose through the Press of Herophilus. ANASTOMOSES BETWEEN THE INTRA-CRANIAL AND THE EXTRA-CRANIAL VENOUS CIRCULATIONS. .476 1st. Anastomose of the facial with the ophthalmic at the internal angle of the eye. 2d. Anastomose of the superior nasal vein with the supe- rior longitudinal sinus. 180 SUBCLAVIAN VEIN. 3d. Anastomose of the superficial parietal veins with the superior longitudinal sinus by means of the veins of Sar- torius, which pass through the parietal foramina. 4th. Anastomose of the superficial occipital veins with the lateral sinuses by means of the mastoid veins, which pass through the mastoid foramen. 5th. Anastomose of the deep veins of the outside of the base of the cranium with the lateral sinus by means of the condyloid vein, which passes through the posterior condy- loid foramen. 6th. Anastomose between the superficial veins and the sinuses by means of the Diploic Veins. SUBCLAVIAN VEIN. 477 Course: It extends from the innominate vein to the outer border of the first rib, where it becomes the axillary. Situation or Relations : The Subclavian Vein is in rota- tion: In Front, with the sterno-clavicular articulation. Behind, with the subclavian artery, from which it is sepa- rated by the anterior scalene, the pneumo-gastric and phrenic nerves. Below, with the pleura and the first rib. Above, with the large lymph ducts and the skin. Collateral Branches : 1st. Of all the veins accompanying the branches of the subclavian artery it receives only the Anterior and Posterior Scapular veins, but it receives the anterior, external aud posterior jugular veins, and the cephalic. 2d. The Anterior Jugular runs downwards, along the the anterior border of the sterno-mastoid, — then outwards across the sternal and clavicular tendons of this muscle. — It opens into the subclavian just behind the posterior bor- der of the clavicular ten don. — It is situated above the fascia and underneath the platysma and skin. — It returns the blood from the superficial median parts of the neck. 3d. The External Jugular extends from the space between the mastoid process and the angle of the jaw, downwards and backwards, to the junction of the posterior border of the sterno-mastoid and the clavicle. — It crosses the sterno- mastoid at an acute angle; also the fibres of the platysma. — It is situated over the cervical fascia and underneath the skin and platysma. — It often receives the posterior jugular and the anterior and posterior scapular veins. — It is formed by the junction of the temporal aud internal maxillary veins. 4th. The Posterior Jugular is deeply seated between the muscles of the back of the neck ; — it is often of large size. — It terminates in the external jugular about the middle of the neck. AXILLARY VEIN. 181 5th. The Branch from the Cephalic crosses over the clavicle and opeus near the border of the trapezius. Formative Branch : The axillary. AXILLARY VEIN. 478 Course. It extends from the outer border of the first rib to the tendons of the great dorsal and great pectoral. Situation or Relations: The Axillary Vein is in relation : In Front, with the costo-clavicular membrane and the small pectoral muscle. Behind, with the axillary artery, which it uncovers a little only beyond the small pectoral muscle. Collateral Branches: 1st, All the reins which accompany the branches of the axillary artery, the subscapular vein especially; — 2d, it often receives the Deep Basilic Vein; — 3d, the Cephalic, which extends from the elbow to the clavicle; — it ascends along the outer border of the biceps, then lies in the pectoro-deltoid groove — and opens into the axillary immediately below the clavicle, — after giving off a superficial branch to the subclavian vein. Formative Branches : Are the deep and the superficial veins of the upper extremity. The Beep Veins are the two brachial veins which accom- pany the brachial artery ; they are themselves formed by the two deep radial veins and the two deep ulnar veins. The Superficial Veins are the Median, the Superficial Radial, the Superficial Ulnar, the Median Basilic, the Median Cephalic, the Basilic and the Cephalic. The Median Vein runs along the middle of the fore- arm, from the wrist to the bend of the elbow, where it divides into the median cephalic and the median basilic. The Median Cephalic passes upwards and outwards, and is joined by the superficial radial vein. The Median Basilic runs along the inner groove, crossing obliquely the brachial artery, the deep brachial veins and the median nerve, from which it is separated by the fibrous ex- pansion of the biceps ; it is joined by the superficial ulnar. — It receives a large anastomotic branch from the deep veins. The Superficial Radial ascends along the index finger and thumb, and then on the radial side of the front of forearm to the bend of the elbow, where it joins the median cephalic, the two forming the cephalic vein. The Superficial Ulnar ascends along the little finger, then along the ulnar side of the front of the forearm to the bend of the elbow, where it joins the median-basilic to form the basilic vein. The Basilic Vein ascends along the inner border of the biceps to the lower third of the arm, where it pierces the fascia and joins one of the deep brachial veins. 182 ASCENDING CAVA VEIN — COMMON ILIAC VEIN. The Cephalic Vein ascends subcutaneously along the onter border of the biceps, then between the deltoid and the pec- toral to near the clavicle, where it discharges into the axillary. INFERIOR OR ASCENDING CAVA VEIN. 479 Course. It extends from the fourth lumbar vertebra to the right auricle of the heart. Situation or Relations. It is in relation : In Front, with the mesentery, the head of the pancreas, the special groove of the liver and the fibrous opening in the diaphragm. Behind, witn the vertebral column and pillar of dia- phragm. On the Left with the Aorta. On the Right with the psoas. Collateral Branches: It receives the portal hepatic system of veins, the reno-genital veins and the parietal veins. 1st. The Portal Vein is formed by the Splenic and the Su- perior Mesenteric Veins. Previously to joining the splenic, the Superior Mesenteric receives the Inferior Mesenteric. The Portal Vein extends from the neck of the pancreas to the transverse fissure. — It is situated in the left of the gastro-hepatic omentum, behind the common bile duct and the hepatic artery, in front of the foramen of Winslow and the ascending cava. It ascends into the interior of the liver. In the lobules its capillaries and those of the arteries are succeeded by the capillary radicles of the hepatic veins, which all gather in the centre of the lobules. The hepatic radicles finally form three large Hepatic Veins which open into the ascending cava, along the upper border of the liver. The walls of the hepatic veins adhere to the hepatic tissue and remain gaping when cut across. 2d. The Reno=genital veins are the supra-renal, the renal and the spermatic veins. 3d. The Ascending Cava receives also the parietal veins, the phrenic, the lumbar and the spinal veins. Formative Branches : Are the two common iliac veins. COMMON ILIAC VEIN. 480 Situation and Course: It extends from the sacro-iliac junction to the ascending cava. The Right? is at first on the inner side of the artery, then passes under to its outer side. The Left is larger and longer than the right. — It is at first ILIAC VEINS — FEMORAL VEIN — POPLITEAL VEIN. L83 under the left artery, then crosses in front of the fourth lumbar vertebra and passes under the right artery. They arc both eovered by the peritoneum and are crossed by the ureters. Collateral Branches: The iUo-lumbar, the lateral sacral and the spinal veins. Formative Branches are the internal and the external iliac veins. INTERNAL ILIAC VEIN. 481 It corresponds to the artery, but is placed behind it. EXTERNAL ILIAC VEIN. Situation and Course: It extends from Poupart's liga- ment to the sacro-iliac articulation. — There it joins the internal iliac to form the common iliac. — Near the crural arch it is on the inner side of th3 artery, but higher up it passes under it and then is on its outer side. Collateral Branches: The circumflex iliac veins and the deep epigastric veins. Formative Branch is the femoral vein. FEMORAL VEIN. 482 Situation and Course: It follows the artery. — Beneath Poupart's ligament it is on the inner side of the artery; — in the middle third of the thigh it is behind it ; — at the lower third it is on the outer side. Collateral Branches: 1st. The Veins corresponding to branches of thje arteries. 2d. The Internal Saphenous Vein, which is a superficial vein. — It ascends along the inner side of the foot — and then in front of the inner malleolus and the internal border of the tibia. — It ascends behind the inner condyle of the femur; — thence upwards and a little forwards — to the special open- ing for it, the saphenous opening, in the fascia lata, about one inch below Poupart's ligament. Formative Branch is the popliteal. POPLITEAL VEIN. 483 Course: It extends from the ring in the great adductor to arch of the soleus. Situation and Relations : Above the knee it is on the outer side of the artery and on the inner side of the nerve. Opposite the knee it covers the artery and is covered by the nerve. 184 PECULIARITIES OF VEINS IN PARTICULAR. Below the knee it lies on the inner side of the artery and on the outer side of the nerve. 484 Collateral Branches : Are the deep veins and the external saphenous vein. 1st. The Deep Veins are the branches accompanying the articular arteries. 2d. The Short Saphenous Vein ascends along the outer border of the foot, — passes behind the external malleolus, — ascends along the outer border of the Achilles tendon, — and thence along the middle line of the back of the leg to the middle of the popliteal space ; — there it opens into the popliteal vein. Formative Branches are the deep veins of the leg and foot which accompany the arteries : the two anterior tibial veins, the two dorsal veins of the foot, the two posterior tibial veins, the two external and internal plantar veins, and the two peroneal veins. PECULIARITIES OF VEINS IN PARTICULAR. 485 Large Arteries are accompanied by only one large vein ex- cept the brachial, which has two small ones. Veins going through muscles or coming from muscles are the only ones provided with valves. Large Veins are always alongside or on top of arteries, never under, with but two or three exceptions, which will be explained further. Often the vein is the more superficial and is first met by the Tmife. They often overlap the artery considerably. The Superior Cava receives but one collateral branch, the great Azygos, which arches over the pedicle of the right lung. The Left Innominate crosses from the left to the right and is, therefore, much longer than the right. It receives the Thoracic Duct. The Right Innominate is much shorter. It receives the Right Lymphatic Duct. The Innominate Veins receive almost all the branches which correspond to the arterial branches of the subclavian arteries. The Internal Jugular Vein adheres to the posterior lacer- ated foramen. It usually adheres close but loosely to the sterno-mastoid. It anastomoses freely with its fellow through the lateral sinus. The Inferior Thyroid, the Lingual and the Facial Veins, branches of the Internal Jugular, cross on top of the corre- sponding arteries. The Head has two remarkable Superficial Veins, the Frontal and the Temporal. PECULIARITIES OF VEINS OF SOME ORGANS — DIGESTION. 185 The Face has a Superficial Vein, the Facial. It follows the artery, but runs a straighter course. [t inosculates with the ophthalmic at the internal angle of the eye. 486 The Neck has peculiar superficial or subcutaneous veins, which are the External and the Anterior Jugular Veins. (We have also similar subcutaneous veins in the arm and leg, none in the trunk.) The Subclavian Vein adheres to the fascia of the omo-hy- oid. The Axillary Vein overlaps the artery considerably, espec- ially in its two first portions. The Brachial Veins are two in number, whereas there is but one femoral vein. The Upper JExtremiti/ has peculiar superficial or subcuta- neous veins, which are the Median Basilic and the Median Cephalic, the Cephalic and the Basilic. The Thoracic Walls are drained by a peculiar vein, the Great Azygos, which arches over the pedicle of the right lung to discharge into the Superior Cava. The Inferior Cava Vein is much larger after receiving the Hepatic Veins ; also after receiving the Renal Veins. The peculiarities of these veins have already been de- scribed. The Common Iliacs and the External Iliacs pass under the arteries. The Femoral Vein winds around the artery so that above it is internally, then posteriorly in the middle of the thigh, then externally in Hunter's canal. The Popliteal Vein crosses the artery obliquely. It is on the top of the artery. It is below the nerve. The Lower Extremity has two peculiar superficial or subcu- taneous veins : the Long or Internal Saphenous, and the Short or External Saphenous. PECULIARITIES OF THE VEINS OF SOME 0RQAN5. ORGANS OF DIGESTION. 487 Lips: The veins of the Upper Lip discharge into the Facial, which itself inosculates with the ophthalmic, and these with the Cavernous Sinus and the Sinuses of the Brain. Tongue : The Ranine Veins are visible through the mucous membrane. Parotid : The Temporal and the Internal Maxillary Veins join the substance of the parotid to form the External Jug- ular. 186 ORGANS OF URINATION — ORGANS OF GENERATION. Stomach, Small and Large Intestines to Anas. — Their Veins form the Portal System. — They have no valves. Spleen : Its veins also form the portal system. — It has no valves also. The venous capillaries begin by dilated extremities. Liver : It receives the Portal Vein. It presents the Central Intra-lobular Hepatic Vein. The Hepatic Veins discharge along the npper border into the Ascending Cava, instead of coming out of the organ at the hilum. ■ The hepatic veins adhere to the hepatic tissue and remain gaping when cut across. They have no valves. There are two hepatic veins for the right lobe. There is only one for the left lobe. ORGANS OF URINATION. 488 Kidneys : Renal Veins. The Right is lower than the left. The Left is longer than the right, and crosses over from the left to the right. They are remarkable for their size. They originate from the capillary plexus around the lobules. They have no valves. They contain redder blood than the arteries. The Right receives the Spermatic Veins direct. They anastomose with the lowest branches of the Azygos. Bladder : The neck is surrounded by a well marked plexus, which receives the Dorsal Vein of the Penis. Prostate : It is also surrounded by a plexus of veins. ORGANS OF GENERATION. Scrotum : Its veins discharge into the superficial veins. Testicle and Epididymis: The veins follow the Spermatic Duct. They are loosely connected with the duct, whereas the arteries are closely attached to the duct. On the Right they discharge into the Renal Vein. On the Left they discharge into the Pampiniform plexus. They have no valves. Penis : Has one Single Dorsal Vein. It originates by open dilated extremities. It discharges into the Vesical Plexus. It has no valves. HEART — ORGANS OF RESPIRATION AND INNERVATION. 187 HEART 489 The Proper Tissue or Walls present the Great Coronary Vein and the Small Veins of Thebesius. The Great Coronary Vein: Returns the blood from the tissues or walls of the thick left heart. It has valves in its course. It presents the Thebesian Valve, at its opening into the right auricle. The Small Veins or Veins of Thebesius: They return the blood from their right walls and open directly into the auricle. The Right Auricle receives: The Veins from the walls. The Superior Cava returning the blood from all the supra- diaphragmatic parts of the body. The Inferior Cava,. returning the blood from all the infra- diaphragmatic parts of the body. The Left Auricle receives: The Four Pulmonary Veins. They have no valves. They contain red blood. The left Pulmonary Veins are longer. ORGANS OF RESPIRATION. 490 Bronchi : Their Veins are separate or distinct from the pulmonary veins. They discharge into the Azygos veins, or some close branch. Lungs : They present the four Pulmonary Veins. They originate from the walls of the air vesicles. They have no valves. They discharge into the left auricle. The left are longer. They contain red blood. Thyroid Body : The Veins are large and numerous. CENTRAL ORGANS OF INNERVATION. 491 Dura Mater of Brain : It presents the Sinuses of the Brain, already described. Cerebral Veins. Superficial Cerebral Veins: They are situated in the pia mater. They open into the Superior Longitudinal Sinus, against the course of the blood. 188 ORGANS OP SPECIAL SENSE — BONES — MUSCLES. They discharge in the various neighboring sinuses. Beep Cerebral Veins: They originate from the choroid plexuses, and from the walls of the interior cavities. They form the Veins of Gallen, situated in the substance of the Interposed Veil. The Veins of Gallen emerge through the transverse fissure of the brain and open into the Straight Sinus. Spinal Veins : Are large and numerous. They empty during ventricular systole, and make room for the cerebro-spinal fluid from the cranium. ORGANS OF SPECIAL SENSE. 492 Nose: Its veins discharge into the parotid and the facial, which inosculates with the ophthalmic. Nasal Cavities : The Veins at the Roof anastomose with the Superior Longitudinal Sinus. Eyeball and Orbit : All the veins behind the Broad Ligament discharge into the ophthalmic, and these same discharge into the Cavern- ous Sinus. Choroid : Its veins are the Four Vorticose Veins. They emerge from the eye at a point different from the point of entrance of the arteries. The Capillary Veins are also Vorticose. Retina : The vein, like the artery, divides in the optic papilla into an upper and lower arched branch. Iris : Its veins discharge into the Circular Sinus or Canal of Fontana. Eyelids ; All the veins in front of the Broad Ligament discharge into the Facial. All the veins behind it discharge into the Ophthalmic. BONES. 493 Diploe of Bones of Skull : Presents Sinuses. Venules are usually attached to the bony tissue, hence hemorrhages and sepsis. MUSCLES. All veins which traverse muscles, or which come from them, are provided with valves. ARTERIES AND VEINS — LYMPHATIC SYSTEM. 189 ARTERIES AND VEINS. Veins of Arteries and of Veins, i. e., Veins of the Walls of Arteries and of Veins : They discharge into neighboring small venules, not into the main trunk. RESUME OF THE LYMPHATIC SYSTEM. 494 Structure of Lymphatic Vessels: They have the same structure as the small veins. The radicles of the lymphatics originate : — 1st, in spaces between the fascicules of the connective tissue called the lymph spaces; — 2d, in the spaces between the so-called fol- licles of the lymphoid organs and called the lymph sinuses; — 3d, on the surface of the serous membranes by minute orifices. X. B. — There is nowhere any communication between the lymph radicles and the capillaries, either direct or indirect. 495 Structure of Lymphatic Glands. They are composed of : 1st. A Cortical and a Medullary portion . 2d. An Envelope or Capsule, which is formed of delicate fibrous tissue. 3d. A Proper Substance, which is composed of alveoles filled with lymphoid cells. 4th. Of Afferent Lymphatics, which penetrate the periph- ery of the gland and terminate by a free opening into the alveoles. 5th. Of Efferent Lymphatics, which originate also by free openings and come out through the hilum. LYMPH. 496 The anatomical elements are the Lymph Corpuscles, which resemble the white corpuscles of the blood. The lymph corpuscles are few before passing through the lymphatic glands ; the lymph (and the chyle) receive their corpuscles from lymphatic glands. CHYLE. 497 The anatomical elements are the Chyle Corpuscles. They are analogous to the lymph corpuscles. Chyle presents also fatty granules, oil globules, free nuclei and few red blood corpuscles. The Granular Substance of the chyle poured into the large 190 THORACIC DUCT — LYMPHATIC DUCT. veins of the neck disappears as the blood passes through the lungs. Like the lymph, chyle contains no corpuscles before enter- ing the lymphatic glands, but they are numerous after leav- ing the glands. The milky appearance of the chyle in mammals is due to innumerable minute dust-like particles formed by globules of fat enclosed in a layer of albumen. The Coagulum of Lymph and Chyle may become red by exposure to air. THORACIC DUCT. 498 Length : It is about one foot long. Situation and Course : It extends from the fourth lumbar vertebra to the junction of the left internal jugular and subclavian veins. It ascends in front of the vertebral column lying to the right of the aorta and to the left of the ascending cava. It passes into the chest through the aortic opening of the diaphragm, and ascends between the aorta on the left and the great azygos vein and oesophagus on the right. At the upper part of the chest it arches over the left sub- clavian artery to open as already described. Its opening is guarded by a valve. Collateral Branches : It receives all the lymphatics from the glands of the left side of the head and neck, left arm, left side of chest. Formative Branches are the lymphatics from the lumbar and aortic glands, which themselves receive the lymphatics from the glands of the abdominal and pelvic viscera and walls (both sides), and from the two lower limbs. RIGHT LYMPHATIC DUCT. 499 Length : It is not more than one inch long. Situation and Course : It extends from the right supra- clavicular region to the superior mediastinum. It is situated behind the right subclavian artery, near its junction with the common carotid. It arches over the right subclavian artery. It opens at the point of junction with the right internal jugular and subclavian veins. Its opening is guarded by a valve. Collateral and Formative Branches : It receives all the superficial and deep lymphatics from the right side of the face, neck and chest; also from the right upper ex- tremity SITUATION OF LYMPHATIC GLANDS. 191 SITUATION OF THE LYMPHATIC GLANDS AND THEIR AFFERENT AND EFFERENT VESSELS. 2f. B. — The Beep Lymphatics follow the deep vessels to reach their glands. The Superficial Lymphatics follow the main superficial vein of the region to reach their glands (as facial, ulnar, basilic, internal saphenous veins). HEAD. 500 1st. The Buccal Glands (on buccinator muscles) receive lymphatics from the frontal region, which run along the frontal and facial veins and discharge into the deep cervical glands. 2d. The Parotid Glands receive the lymphatics from the ear, temple, outer part of the eyelids, upper part of the cheek, and discharge into the deep cervical glands. 3d. The Posterior Auricular Glands receive lymphatics from the skin of neighboring parts and discharge into the deep cervical glands. 4th. The Occipital Glands receive lymphatics from the occipital region and discharge into the deep cervical glands. NECK. 501 Superficial Lymphatic Glands : 1st. The Digastric Glands receive the lymphatics from the middle of the lower lip and discharge into the deep cervical glands. 2d. The Submaxillary Glands receive the lymphatics from the outer part of the lips and discharge into the deep cervical glands. 3d. The Supraclavicular Glands receive lymphatics from the skin of neighboring regions and discharge into the large lymphatic ducts. Deep Lymphatic Glands : The Upper Carotid or Cervical and Deep Parotid receive the lymphatics from the meninges, cerebrum, nasal cavities, pharynx, mouth, temporal and orbital fossa?, and discharge into the inferior carotid glands. The Inferior Carotid or Cervical Glands receive the lymphatics from the pharynx, larynx, trachea, oesophagus and thyroid gland, and discharge into the large ducts. UPPER EXTREMITY. 502 Superficial Glands: The Epitrochelar Glands receive the inner lymphatics of 192 CHEST — ABDOMEN. palmar extract of forearm— and discharge into the axillary glands. Deep Lymphatic Glands: The radial, ulnar, and brachial (very small glands) are situated along the arteries ;— they discharge into the axillary glands. Axillary Glands : 1st. Group: around the axillary artery and vein; — they receive all the vessels from the above glands, the neck, upper umbilical region of back and the shoulders. — They discharge into the subclavian glands. 2d. Group: along the lower border of the great pectoral : — they receive lymphatics from epigastrium, mammary glands, the sides of the chest. — They discharge into the subclavian glands. Subclavian Glands (around subclavian vessels) : they re- ceive all the vessels from the above glands. — They discharge into the large ducts. CHEST. 503 1st. The Anterior Mediastinal Glands receive lymphatics from the diaphragm and the convexity of the liver, — and dis- charge into large ducts. 2d. Internal Mammary Glands receive lymphatics from parts supplied by the artery — and discharge into the large ducts. 3d. Superior Mediastinal Glands or Cardiac Glands re- ceive lymphatics from the heart, pericardium and thymus gland, — and discharge into the thoracic duct. 4th. The Intercostal Glands receive lymphatics from parts supplied by the arteries, — and discharge into the large ducts. 5th. The Posterior Hediastinal Glands or Aortic and Oesophageal receive lymphatics from oesophagus, aorta and areolar tissue, — and discharge into the large ducts. 9th. The Bronchial Glands receive lymphatics from the bronchi and lungs, — and discharge into the thoracic duct. ABDOMEN. 504 1st. The Gastric Glands (along the concave border) re- ceive the lymphatics from stomach; — the efferent lym- phatics discharge into aortic glands. 2d. The Hepatic Glands (in gastro-hepatic omentum) receive lymphatics from liver and stomach; — the efferent lymphatics discharge into aortic glands. 3d. The Splenic Glands (in the hilum and gastro- splenic omentum) receive lymphatics from spleen and stomach ; — the efferent lymphatics discharge into the aortic glands. 4th. The flesenteric Glands receive lymphatics from the intestines; they are the lacteals; — they discharge into the thoracic duct. PELVIS — LOWER EXTREMITY. L93 5th. The Lumbo-psoas Glands (in front of insertions of psoas muscles) receive lymphatics from supra-renal cap- sules, kidney, body of the uterus, oviduct, ovary, testicles ; — they discharge into the thoracic duct. 6th. The Aortic Glands extend from aortic opening to the bifurcation; — they receive lymphatics from stomach, in- testines, liver, spleen, pancreas; — they discharge into the thoracic duct. PELVIS. 505 1st. The Sacral Glands receive the lymphatics from the rectum, bladder, neck of uterus, seminal vesicles and pros- tate ; — they discharge into the thoracic duct. 2d. The Internal Iliac Glands receive the lymphatics from rectum, bladder, neck of uterus ; — they discharge into the lumbar glands. 3d. The Gluteal and Ischiatic Glands are situated along the course of the gluteal vessels ; — they receive the lym- phatics accompanying the gluteal, ischiatic and obturator arteries; — they discharge into the internal iliac glands. 4th. The External Iliac Glands receive the lymphatics accompanying the epigastric and circumflex iliac arteries ; — they discharge into the lumbar glands. LOWER EXTREMITY. 506 1st. Superficial Glands. Superficial Inguinal : The External Glands receive the lymphatics from the skin of the buttocks and loins. The Middle receive the lymphatics from the skin below the umbilicus (outer half). The Internal receive the lymphatics from the inner half of the skin of the buttocks, loins, perineum, anus, scrotum, penis, vulva, and origin of mucous membrane of vagina. They all discharge into the deep scarpal glands. The Superficial Scarpal or Saphenous Glands receive all the superficial lymphatics of the thigh and leg, — aud dis- charge into the deep scarpal glands. 2d. Deep Glands. The Deep Scarpal or Femoral Glands receive the lymphatics from the popliteal glands and the superficial glands, — and discharge into the external iliac glands. The Popliteal Glands and Anterior Tibial Glands receive the lymphatics from the parts supplied by the vessels — and discharge into the Scarpal glands. 13 194 CAPILLARIES OF TISSUES AND ORGANS. PECULIARITIES OF LYMPHATICS. 507 The Lymphatics of the right side of the head, neck, arm and chest, discharge into the Right Lymphatic Dnct. The Lymphatics of the balance of the body, i. e., of the left side of head, neck, arm, chest, of both sides of the ab- domen and back, and of the two lower limbs, discharge into the Great Thoracic Duct. The Lymphatics, whether Deep or Superficial, follow the veins, except those of the middle of the lower lip, which open directly into the Digastric Glands. The Lymphatic Glands are always on top of the veins. Around the orifices of the body, the lymphatics of the or- gans developed from the External Blastoderm discharge into the superficial glands of the organ ; those of the Mu- cous Blastoderm in the deep glands. On Serous Membranes, lymphatics originate by open ex- tremities. PECULIARITIES OF THE CAPILLARIES OF SOflE TISSUES AND ORGANS. (JV. B. — Unless otherwise mentioned, the blood capillaries are meant.) TISSUES. 508 Connective Tissue: The lymphatics originate in the lymph spaces. Adipose Tissue : The capillaries form a globular network around the lob- ules. Glandular Tissue : In the Racemose and Follicular Varieties, the capillaries form a globular network around the lobules. In the Tubular Glands they run parallel to the tubes. On cross section they present a radiating appearance. ORGANS OF DIGESTION. 509 Teeth : The capillaries form a characteristic network in pulp. Tongue : The capillaries form a characteristic tree-like arrange- ment. It is poplar-like, i. e., long and narrow in the conical papilla?. It is oak-like, i. e., broad and low in the fungiform. Stomach : The capillaries of the Tubular Glands alone are peculiar. ORGANS OF URINATION — MALE ORGANS OF GENERATION. L95 Duodenum, Jejunum and Ileum : Thet blood vessels form a capillary plexus under the epi- thelium of the villi, m the substance of the stroma. The lymphatics, called lacteals, originate by a closed dilated extremity in the centre of the villi. Anus : Its venous capillaries are the remotest of the portal system. Liver : The capillaries of the Portal Vein and of Hepatic Artery form around each lobule a plexus which sends branches into the interior of the lobule. The Hepatic Veins orig'inate in the centre of the lobules by the Central Intra-lobular veins, a unique case in the body. Spleen : The Arterial Capillaries open into the microscopic alveoles by a free extremity. There are no Immediate Capillaries proper ; they are re- placed by microscopic alveoles. The Venous Capillaries originate by dilated orifices on the inner walls of the microscopic alveoles. The Lymphatic Capillaries originate from peculiar spaces in the adenoid tissue, called " lymph spaces" between the microscopic alveoles. ORGANS OF URINATION. 510 Kidney: The Arterial Capillaries circulate between the Pyramids of Ferrein in a peculiar branching way, and give off the branches which form the Glomerule of Malpighi. From this Glomerule originates a small capillary vessel, still arterial, which breaks up into a second set of capilla- ries at the initial point of the tubules. Thus it forms an arterial capillary portal system, a unique instance. The Venous Capillaries originate from the peritubular plexus and not from the glomerule. The Superficial Venous Capillaries originate in a star-like arrangement called the Stars of Verheyn. MALE ORGANS OF GENERATION. Testicles : The Capillaries form a vascular layer on the walls of the alveoles before being distributed to the seminiferous tubules (like the pia mater and the periosteum). Penis : The Arterial Capillaries have a corkscrew course — and terminate into the microscopic alveoles by open extremities. 196 ORGANS OP RESPIRATION, INNERVATION, SPECIAL SENSE. The Intermediate Capillaries or Capillaries Proper are re- placed by the microscopic alveoles. The Venous Capillaries originate from the microscopic alveoles by free dilated extremities. All this as in the spleen. ORGANS OF RESPIRATION. 511 Lungs: The Capillaries of the Bronchial Arteries and Veins do not reach the interior of the lobules. The Capillaries of the Pulmonary Arteries and Veins form three sets of capillaries : one around the lobules, one between the air vesicles, and one under the epithelial plates. CENTRAL ORGANS OF INNERVATION. Brain : The Capillaries form a plexus in the pia mater before penetrating the brain substance. They are much more abundant in the grey matter. In the convolution, and especially the lamellae, they present a characteristic arborescent arrangement. In the Spinal Cord : The Capillaries form a plexus in the pia mater before penetrating the nerve tissue. They are more numerous in the grey matter. They form two crescent-like sets, united by a transverse set. ORGANS OF SPECIAL SENSE. 512 In the Nose. The Tip has no intermediate capillaries, and the arteries empty directly into the veins. In the Cornea. There are no capillaries. There exists a peculiar set of Corneal Corpuscles and anastomosing Canalicules. In the Choroid. The Capillaries form a separate special layer, the mem- brane of Ruysch. — There the capillaries present a peculiar stellate or spoke-like arrangement. In the Retina. The Capillaries form a distinct layer, the membrane of Jacobson. In the Iris. The Capillaries have a corkscrew-like course. They form a plexus around the greater circumference and a smaller one around the pupil. ORGANS OF LOCOMOTION — STRUCTURE OF NERVES. 197 111 the Skin. The Capillaries form peculiar tree-like projections into the papillae (like the tongue). N. B. — At the tip of the nose, in the matrix of the nails, at the tip of the fingers and toes the arterioles run directly into venules without the interposition of capillaries proper. ORGANS OF LOCOMOTION. 513 In the Bones. The Capillaries form a plexus in the periosteum and in the medullary membrane proper before penetrating into the bony tissue. They penetrate into the bony tissue by the Haversian Canals. The finest capillaries are in the Haversian Canal. They do not penetrate into the lacunae and canalicules. In the Muscles. The Capillaries run parallel to the fibres and interchange anastomotic branches. STRUCTURE OF NERVES. 514 The nerves are composed of an envelope called the Neu- rilemma, and of contents, the Medulla and the Axis- Cylinder. The Neurilemma is composed of fine, delicate, structureless membrane. The riedulla is a fluid, transparent, fatty substance. The Axis=Cylinder is composed of very fine homogeneous fibrils. Forms and Varieties. Neurilemma. — Sometimes it is quite thick, and gives the edges of the fibres the aspect of a double line (double con- tour). Sometimes it is so thin as to be considered absent by some (as in the optic and auditory nerves). Medulla. — In the dead state it is coagulated. Sometimes it is almost entirely absent, as in the fibres of the sympathetic (fibres of Remak). TERMINATION OF NERVES. 515 By Loops: is not admitted by all anatomists. By Free Extremities: i. e., at the end of the nerve the axis-cylinder divides into a number of small fibrils (vestib- ular nerves). 198 NERVOUS GANGLIA — CRANIAL NERVES. By End Bulbs of Krause : i. e., nrinute corpuscles in the interior of which the axis-cylinder passes and terminates in a coiled plexiform mass, or in a bulbous extremity (mu- cous membrane). By Tactile Corpuscles: i. e., minute bodies which are simi- lar to the end bulbs, but complete in structure and more highly sensitive. By Pacinian Corpuscles, composed of a capsule of many concentric layers of connective tissue and fluid, presenting in the centre a cavity in which the axis-cylinder terminates in a bulbous extremity (palm of hand — genitals — mesen- tery). By Hair=Cells: i. e., the axis-cylinder terminates into a nerve cell, the other extremity of which gives off a number of delicate fibrils (taste-goblets, middle scale of ear, olfac- tory nerve). By peculiar Rods and Cones, as in the retina. STRUCTURE OF NERVOUS GANGLIA. 516 Nervous Ganglia are formed of an Envelope of fibrous tissue, and of Nerve Cells, whose poles receive the axis- cylinder of nerves. RESUnE OF THE CRANIAL NERVES. 517 1st. Olfactory. It originates from the anterior perforated space. — It runs along the olfactory groove, — it terminates by an enlargement called the bulb. From the bulb are given off filaments which descend through the cribriform plate and are distributed to the upper third only of the Schneiderian Membrane. — The filaments terminate in the peculiar hair cells. 518 2d. The Optic. It originates from the quadrigeminate bodies and optic beds.. It winds around the peduncles of the cerebrum. — the two nerves join to form the chiasma, where the fibres decussate. The Optic Nerve Proper is round; — it starts from the chi- asma, enters the orbit through the optic foramen with the ophthalmic artery,— strikes the eyeball a little below and to the inner side of the axis, — passes through the sclerotic, — expands to form the retina.— It finally terminates in peculiar bodies, called the rods and cones. 519 3d. The Common Ocular Hotor. It originates from the inner side of the cerebral peduncles. It passes through the cavernous sinus — it enters the orbit through the sphenoidal fissure.— It is distributed to the CRANIAL NERVES. 199 sphincter of the iris and to all the muscles in the orbit, ex- cept the superior oblique and the external straight. 520 4th. Pathetic. It originates from the valve of Vieus- sens. — It winds around the cerebral peduncle, — it passes through the cavernous sinus, — it enters the orbit through the sphenoidal fissure. It is distributed to the superior oblique alone. 521 5th. Tri=facial. It originates from the middle peduncle of the cerebellum by a large sensory root, which expands to form the Gasserian ganglion, — and by a small motor root which is independent and joins the inferior maxillary nerve beyond the Gasserian ganglion, to be distributed specially to the masticator muscles. The Gasserian Ganglion gives off the ophthalmic nerve, the superior and the inferior maxillary nerves. 522 The Ophthalmic passes through the cavernous sinus ; — it enters the orbit through the sphenoidal fissure, — and is distributed to the ophthalmic ganglion, the lachrymal gland, the skin of the forehead (the frontal nerve) and the skin of the wing of the uose (the nasal nerve). It presents the Optic or Lenticular Ganglion, situated on the side of the optic nerve ; — its branches are the Ciliary Nerves to the iris. The Superior Maxillary leaves the cranium through the round foramen. It bridges over the spheno-maxillary fossa. It runs through the infra-orbital canal; — it emerges upon the face at the infra-orbital foramen to become the Infra-or- bital nerve; — it is distributed to the skin of the middle third of the face. — In the spheno-maxillary fossa it gives off a branch to Meckel's ganglion. Collateral Branches : To the upper teeth and to the skin of the temple. It presents the SpJieno-Palatine or Meckel's Ganglion, situ- ated between the nerve and spheno-palatine foramen ; — its filaments are distributed to the nasal cavities, palate and pharynx. The inferior Maxillary comes out through the oval fora- men.— It gives off: 1st, branches to the masticator muscles; — 2d, branches to the ear and temple (the auriculo- temporal;— 3d, the gustatory or lingual to the tongue, which receives the cord of the tympanum, and the fila- ments of which terminate in the taste corpuscles or gob- lets ; — 4th, the inferior dental to the lower teeth. It presents the Otic or Arnold's Ganglion, situated on the inner side of the inferior maxillary nerve, and supplying the pterygoids and the tensor of the palate. 523 6th. External Ocular Motor or Abductor. It originates from the groove 'between the Varolian bridge and the ante- rior pyramid. 200 CRANIAL NERVES. Jt passes through the cavernous sinus and enters the or- bit through the sphenoidal fissure. It is distributed to the external straight muscle alone. 524 7th. Facial. It originates from the lioor of the cerebellar ventricle. It enters the internal auditory canal ; — it passes through the aqueduct of Fallopius, where it gives off the cord of the tympanum to the gustatory; — comes out through the stylo- mastoid foramen; — winds around the ramus of the jaw; — passes through the parotid gland to its anterior border, and it divides into branches. It is distributed to all the cutaneous muscles of the face, i. e., muscles with a bony origin and a cutaneous insertion. 525 8th. Auditory. It originates from the floor of the cerebel- lar ventricle ; — it runs through the internal auditory canal in close apposition to the facial; — it is distributed to the membranous vestibule and the membranous cochlea; — in the cochlea its filaments terminate in the peculiar hair cells. 526 9th. Glosso=pharyngeal. It originates from the groove be- tween the olivary body and the restiform body. It leaves the cranium through the jugular foramen; — it passes in front of the internal carotid artery. It is distributed to the muscles and mucous membrane of the pharynx and also to the mucous membrane at the back part of the tongue.. 527 10th. Pneumo=gastric. It originates from the respiratory tract, below the glosso-pharyngeal. It leaves the cranium through the jugular foramen ; — it descends behind the internal jugular vein and internal carotid artery and primitive carotid; — it passes down be- tween the subclavian vein and artery on the right, and on the left between the vein and the arch in front of the left common carotid ; — upon entering the chest it follows the oesophagus — and it reaches the stomach. The left nerve reaches the liver; — the right nerve the so- lar plexus. Collateral Branches are: 1st, the Pharyngeal to the pharynx; — 2d, the Superior Laryngeal to the crico-thyroid muscle alone and to the mucous membrane; — 3d, the Infe- rior or Recurrent Laryngeal, which winds around the sub- clavian artery on the right and the arch of the aorta on the left, ascends between the trachea and the ossophagus and is distributed to all the muscles of the larynx, except the crico-thyroid; — 4th, the Cervical and Thoracic Cardiac nerves; — 5th, the (Esophageal; — 6th, the Bronchial and Pulmonary branches. 528 11th. Spinal Accessory. It originates from the lower part of the respiratory tract of Bell. It leaves the cranium through the jugular foramen. It passes outward. It is distributed to the sterno-mastoid and trapezius. SPINAL NERVES — CERVICAL AND BRACHIAL PLEXUS. 201 529 12th. Hypoglossal. It originates from the groove between the anterior pyramid and the olivary body. It comes out through the anterior condyloid foramen ; — it descends between the vein and artery ; — it crosses the ex- ternal carotid ; — ■ it runs parallel to the lingual artery and terminates in the tongue. Collateral Branches to the muscles of the infra-hyoid re- gion (deseendens noni) after anastomosing with a branch from the cervical plexus. RESUME OF THE SPINAL NERVES. 530 The Posterior or Sensory Roots originate from the postero- lateral grooves. They present a Ganglion in the intervertebral foramen. The Ant prior or Motor Roots originate from the antero- lateral groove. They join the posterior branch beyond the ganglion. The Two Sets of Roots form a Single Nerve which, at its emergence from the intervertebral foramen, divides into 1st, a Posterior Branch , distributed to the muscles of the back ; 2d, an Anterior Branch, which anastomose together and form the spinal plexuses : cervical, brachial, lumbar, sacral. CERVICAL PLEXUS. 531 It is formed by the anastomoses of the anterior branches of the first four cervical nerves. It gives off muscular branches to the surrounding muscles, and cutaneous branches to the skin of the mastoid region, ear, neck, clavicle and acromion. The two most remarkable branches are : 1st- The Phrenic, which originates from the third and fourth ; — descends in front of the anterior scalene ; — passes between the subclavian vein and artery on the right, and the vein and the arch of the aorta on the left; — it lies be- tween the pericardium and the pleura; — it ends in the diaphragm. 2d. The Branch which anastomoses with tin Descendens Noni from the hypoglossal (communicans noni). BRACHIAL PLEXUS. 532 It is formed by the anastomoses of the anterior brandies of the lower four cervical and first dorsal nerves. It is situated between the scalenes, above the subclavian artery and vein. — Lower down it surrounds the axillary artery. 202 CUTANEOUS, MUSCULO-SPIRAL, MEDIAN AND ULNAR NERVES. Collateral Branches : Are all muscular and distributed to the neighboring muscles. Terminal Branches : Are the internal cutaneous nerves, the circumflex, the musculo-spiral, the musculo-cutaneous, the median and the ulnar. INTERNAL CUTANEOUS NERVES. Are distributed to the skin of the inner region of the arm. CIRCUMFLEX. It winds around behind the neck of the humerus. It is distributed to the deltoid and small round muscle. MUSCULO-SPIRAL. It follows the spiral groove of the humerus ; — it reaches the elbow, — where it divides into the radial and posterior interosseous. The Radial follows the long supinator to the wrist, where it turns backward and is distributed to the back of all the fingers, except the little finger and the outer half of the ring finger. The Posterior Interosseous passes through the short supina- tor and is distributed to all the muscles of the back of the forearm. MUSCULO-CUTANEOUS. It perforates the coraco -brachial. It descends between the biceps and brachial muscle ; — it reaches the outer part of the elbow; — it is distributed to the skin of the outer region of the forearm. MEDIAN. It descends between the fascia and the brachial artery, crossing the artery obliquely ; — at the elbow it passes under the arch of the round pronator, — descends between the su- perficial and the deep flexors to the wrist ; — there it is in front of the tendons ; — it passes under the carpal ligament; — it is distributed to the muscles of the thumb and to the skin of the palmar surface of all the fingers, except the little finger and the outer half of the ring finger. ULNAR. It descends along the internal intermuscular septum to the elbow; — it passes under the two heads of the ulno- carpal flexor; — it follows this muscle to the wrist on the inner side of the pisiform bone. INTERCOSTAL, LUMBAR AND SACRAL PLEXUS NERVESi 203 It is distributed to the muscles of the little finger and to the skin of the palm of the little finger and inner half of the ring finger. Above the wrists it gives off a branch which funis to the back and is distributed to the skin of the back of the same fingers. Below the wrist it gives off a deep branch, which passes down into the palm of the hand with the deep branch of the ulnar artery; — it supplies all the deep muscles of the palm of the hand, except the outer two lubricals. INTERCOSTAL NERVES. 533 They are the anterior branches of the upper dorsal nerves. They accompany the intercostal arteries in the intercostal spaces. They give off a branch to the Sympathetic and the Lateral Cutaneous Xerres to the thorax. LUMBAR PLEXUS. 534 It is formed by the anterior branches of the upper four lum- bar nerves. It is situated in the substance of the psoas muscle, in its posterior portion. Collateral Branches are : 1st. The Ilio-hypogastric, the Ilio-Inguinal, the External Cutaneous and the Genito-crural, which supply the lower abdominal walls, the skin, of the upper part of the thigh and of the scrotum. 2d. The Obturator, which follows the obturator artery. Terminal Branch : Is the anterior Crural Nerve. It comes out under Poupart's ligament, lying on the inner side of the psoas and in the same sheath ; — it lies to the outer side of the femoral artery. It is distributed to the muscles aud skin of the anterior region of the thigh, and also to the skin of the internal re- gion of the leg by means of the Saphenous Iferve, which travels in the sheath of the vessels to the knee, where it becomes subcutaneous. SACRAL PLEXUS. 535 It is formed by the anterior branches of the last lumbar and the four upper sacral nerves. // is situated in the pelvis, in front of the pyriform muscle. Collateral Branches : Are distributed to the muscles of the buttock — and to the skin of the back of the leg through 204 GREAT SYMPATHETIC NERVE. the Small Sciatic, which follows the ischiatic artery and be- comes subcutaneous below the popliteal space. Terminal Branch : Is the Great Sciatic Nerve. Situation: In front of the pyriform muscle. Course and Divisions: It leaves the pelvis through the lower part of the great sacro-sciatic notch, below the pyri- form muscle; — it is placed midway between the great tro- chanter and the ischiatic tuberosity, — it descends along the back part of the thigh, resting on the great adductor and covered over by the biceps ; — at the lower third of the thigh it divides into the internal and external popliteal nerves. The Internal Popliteal continues the course of the nerve to the arch of the soleus; — there it becomes the Posterior Tibial nerve, which descends along with the posterior tibial artery; — behind the internal malleolus it becomes the Plantar Nerve, which divides into the Internal and the Ex- ternal Plantar Nerves. The External Popliteal Nerve {or Peroneal Nerve) follows the tendon of the biceps ; — it pierces the origin of the long peroneal muscle, — and divides into the Anterior Tibial Nerve, which follows the anterior tibial artery — and the Musculocutaneous, which passes forward between the pero- neal muscles and extensor of the toes and, piercing the fascia, becomes cutaneous. Distribution: In short, the Great Sciatic Nerve is distrib- uted to the sMn of the posterior region of the thigh, and of all the leg and foot, except the internal region of the leg ; to the muscles of the posterior region of the thigh, and of all the leg and foot. GREAT SYMPATHETIC NERVE. 536 It forms a Chain of Ganglia connected by nerves — extend- ing from the base of the cranium to the coccyx. The most important ganglia are the Upper, Middle and Inferior Cervical. It is situated on the side ot the vertebral column. Afferent Branches. Each ganglion receives a communi- cating branch from the anterior branch of a spinal nerve. Efferent Branches. Each ganglion gives off: — 1st, the fil- aments which accompany the Arteries and their Branches, which form plexuses around them, and thus reach the viscera ; — 2d, Branches having an Independent Course: the three Sympa- thetic Cardiac nerves, originating from the cervical ganglia — and the three Splanchnic Nerves, which originate from the lower thoracic ganglion, pierce the diaphragm and terminate in the solar plexus. PECULIARITIES OF NERVES IN PARTICULAR. 205 PECULIARITIES OF NERVES IN PARTICULAR. CRANIAL NERVES. 537 The Olfactory : Is a soft nerve. It presents a grey bulb. It is transmitted through a cribriform plate. Its terminal fibrils end in hair-cells between the epithe- lium. The Optic : Is a soft nerve. It has a long white root called the optic bandelette. It is pierced by the Central Artery of the Retina, a unique case. It terminates into a papilla. It expands to form the retina. Its terminal fibrils are the rods and cones. The Common Ocular Motor: It passes through the cavernous sinus. The Pathetic : Is remarkably small. Presents a peculiar, long course. It also passes through the cavernous sinus. It is distributed to one muscle only, the Great Oblique, which receives no other supply. 538 The Tri=facial : It presents a Sensory Root, which alone forms the Gasse- rian Ganglion. The Motor Root does not enter the ganglion. This motor root supplies the masticator muscles only. The Three Divisions present each a Ganglion : the Optic or Lenticular, Meckel or Spheno-palatine, Arnold or Otic. It gives rise to a nerve of special sense, the Gustatory, a unique instance of a nerve of special sense coming from another nerve. The Gustatory anastomoses with the facial (a motor nerve), through the Cord of the Tympanum, a unique in- stance of the anastomose of a motor nerve with a nerve of special sense. The terminal fibrils of the Gustatory or Lingual end into peculiar bodies, the Taste-Goblets. The Ophthalmic Branch of the Tri-facial traverses also the cavernous sinus. It is the only nerve that gives off the three kinds of branches, motor, sensory and special sense. The External Ocular Motor: It traverses also the cavernous sinus. It is distributed to one muscle only, the External Straight. 206 PECULIARITIES OF NERVES IN PARTICULAR. The Facial : It presents a peculiar course through the Internal Audi- tory Canal, through the Aqueduct of Fallopius, and through the Parotid Glaud. It gives rise to the Cord of the Tympanum. It supplies all the cutaneous muscles of the face, head and neck. The Auditory : It is a soft nerve (like the olfactory and optic). Between it and the facial is found the peculiar nerve of Wrisberg. It penetrates into a bony canal, the Internal Auditory Canal.* It penetrates into the Vestibule and the Cochlea, through cribriform plates (like the olfactory). Its fibrils end in nerve cells in the Vestibule, between the Auditory dust or otoliths (a unique instance). They end in the Cochlea in a peculiar manner, in the liquid of the middle scale. 539 The Glosso=Pharyngeal : It originates from the respiratory tract. It winds around the internal carotid, between it and the internal jugular vein. The Pneumo=gastric: It has a long course. It originates from the respiratory tract. It descends behind the Carotid and the Jugular. It gives rise to the Recurrent Laryngeal. It takes support on the oesophagus. The Left terminates into the liver. The Right terminates into the Solar plexus. It has an extensive distribution, to almost all the organs supplied also by the Great Sympathetic (respiration circula- tion, digestion). For that reason it is called by some the Small Sympa- thetic. The Spinal Accessory : Originates from the respiratory tract, i. e., from the sides of the cervical portion of the spinal cord. It ascends back into the cranial cavity. It divides at the exit from the jugular foramen into the branches to the Sterno-mastoid, and the branch which is the real origin of the recurrent laryngeal nerve. The Hypoglossal : Goes through a foramen by itself. Winds around the jugular vein and the internal carotid. Below it crosses the external carotid. Further on it is parallel to the lingual artery. It gives off the Descendens Noni. I'KCULIAKITIKS OF THE SPIXAL NERVES. 207 PECULIARITIES OF THE SPINAL NERVES. 540 The Posterior or Sensory Root presents a ganglion. The Anterior or Motor Root joins the posterior root beyond the ganglion (like the Gasserian Ganglion). The Posterior Spinal Branches: Are almost all small and comparatively unimportant. The Superficial Branches of the Cervical Plexus: Are cutaneous. The Deep Branches. Are museular. The Phrenic is the most important ; it is peculiar in its course. The Brachial Plexus. Has collateral branches which are all museular. The terminal branches go to the upper extremity. The Musculocutaneous. Pierces the coraco-brachial (like the radial and the mus- culo-cutaneous of lateral popliteal). The Median : Prongs the axillary artery. It crosses obliquely, the brachial artery being on top. The Circumflex: Winds around the neck of the humerus. It supplies the deltoid only, which receives no other supply. The Musculo=Spiral winds around the spiral groove of the humerus . The Radial winds around the head of the radius and the short supinator. It is the only nerve supplying the extensors of the hand. The Ulnar can be compressed between the ulnar and hume- rus at the elbow. 541 The Intercostal Nerves : Present perforating branches which are the painful spots in intercostal neuralgia. The Lumbar Plexus : Gives rise to one important branch only, the Crural. The Sacral Plexus : Gives rise to one important branch only, the Great Sciatic. This Great Sciatic is the largest and the longest nerve in the body. It supplies the four-fifths of the lower extremity. It accompanies no large artery nor vein. The Musculocutaneous Branch winds around the head <>t the fibula and the peroneal muscles (like the radial). The Internal Popliteal Is on top of the Popliteal vein and artery. It crosses the artery obliquely. 208 RESUME OF SURGICAL ANATOMY. GREAT SYMPATHETIC. It originates from ganglions and from branches from the spinal nerves. They form Peculiar Plexuses presenting Peculiar Gan- glions. The Branches from these Plexuses take support upon the arteries to reach their final distribution. RESUME OF SURGICAL ANATOMY. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE REGION OF THE SKULL. 542 1st. The Superior Longitudinal Sinus corresponds to a line drawn over the head, from the nasal protuberance to the external occipital protuberance. 2d. The Lateral Sinuses correspond to an horizontal line drawn from the external occipital protuberance to the ante- rior border of the mastoid process. 3d. The Middle Meningeal Artery corresponds to a point about an inch and a half behind the external angular pro- cess of the frontal bone, and an inch and a half above the zygoma. 4th. The Lower Level of the Anterior Lobe in Front corresponds with a straight line drawn across the forehead, just above the eyebrows. 5th. The Lower Level of the Middle Lobe corresponds to a line drawn from the external angular process of the frontal bone to the upper part of the external auditory canal. 6th. The Lower Level of the Posterior Lobe corresponds to a line drawn from the meatus to the occipital protuber- ance. 7th. The Cerebellum is situated below this line. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE REGION OF THE FACE. 543 1st. The Supraorbital Notch corresponds to the junction of the inner third with the middle third of the orbital mar- gin. 2d. The Infraorbital Foramen corresponds to the root of the first bicuspid of the upper jaw. * 3d. The Mental Foramen corresponds to the root of the first bicuspid of the lower jaw. RESUME OF ZYGOMATIC FOSSAE, PAROTID, CAROTIDS. 209 4th. The Facial Artery is felt at the anterior inferior angle of the masseter . — Its course is represented by a line ex- tending' from that angle to the corner of the month, then along the naso-labial fold to the wing of the nose; thence the internal angle of the eye. 5th. The Facial Vein runs a straight course represented by a line extending from the internal angle of the eye to the anterior inferior angle of the masseter. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE REGION OF THE ZYGOMATIC AND PTERYGO-MAXILLARY FOSSAE. 544 1st. Steno's Duct runs one-quarter of an inch below the zygoma. 2d. Beyond the Masseter and Ramus of the Jaw is the zygomatic fossa, — in which are found the inferior dental nerve, the pterygoid muscles, the internal maxillary artery, and the lingual or gustatory nerve. 3d. Beyond the Zygomatic Fossa is found the pterygo- maxillary fossa, — which contains the termination of the internal maxillary artery, the superior maxillary nerve and Meckel's ganglion. RESUME OF THE POINTS OF SPECIAL INTEREST CON- CERNING THE REGION OF THE PAROTID. 545 1st. Steno's Duct emerges from the anterior border of the gland, about one-third of an inch below the zygoma. 2d. The Facial Nerve crosses its substance in the upper third. 3d. The Temporal Artery emerges from its substance in front of the tragus. 4th. The External Carotid is between it and the inner part of the neck of the condyle. 5th. The Internal Maxillary is situated between it and the condyle of the jaw. 6th. The Internal Jugular, the Internal Carotid, the Glosso=pharyngeal, Pneumo=gastric, Spinal Accessory, and Hypoglossal correspond to the deep part of its poste- rior surface. RESUME OF THE POINTS OF SPECIAL INTEREST CON- CERNING THK REGION OF THE CAROTIDS. 546 The Carotid is on the inner side of the internal jugular vein, which overlaps it considerably. The Pneumo=gastric and Sympathetic descend into the groove behind the vein and artery. 14 210 RESUME OP SUPRA-HYOID AND INFRA-HYOID REGION. In the lower third the vessels are entirely covered by the tendons of the sterno-mastoid ; — the inferior thyroid artery is behind the carotid. In the middle third they are covered merely by the ante- rior border of the sterno-mastoid. In the upper third the muscle is behind them ; — they are under the skin and fascia. — There the common carotid divides. The external carotid is crossed by the hypoglossal nerve ; — it gives off the superior thyroid, lingual, and facial. — The jugular vein receives there the superior thyroid, lingual and facial veins, which cross over the arteries to reach the jugular. RESUME OF THE POINTS OF SPECIAL INTEREST CON- CERNING THE LATERAL SUPRA-HYOID REGION (DIAGASTRIC TRIANGLE). 547 1st. The Facial Artery crosses the posterior extremity of the submaxillary gland. 2d. The Hypoglossal Nerve is above and parallel to the upper border of the hyoid bone. 3d. The Lingual Artery has the same course as the nerve, but is underneath the fibres of the hyoglossus muscle. RESUME OF THE POINTS OF SPECIAL INTEREST . CONCERNING THE INFRA-HYOID REGION. 1st. The Isthmus of the thyroid body crosses the second and third rings of the trachea. 2d. The Anterior Jugular and the Middle Thyroid artery sometimes run on the middle line. 3d. The Innominate Vein and Artery in children are superficial on the right of the lower part of this region. 4th. The Thymus in children is also superficial. 5th. The Recurrent Laryngeal Nerve is in the groove between the trachea and oesophagus. The External Jugular Vein crosses the region obliquely, downwards and backwards. Its course is represented by a line extending from the space between the condyle and the auditory canal to the middle of the clavicle, behind the insertion of the sterno- mastoid. The Sterno-mastoid Muscle is the guide to the region. The Lymphatic Glands lie under the muscle, on the outer surface of the Internal Jugular Vein. They are small and insignificant in health, but when diseased they are large and become adherent to the vein. RESUME OF ANTERIOR MEDIASTINUM. 21 1 The Internal Jugular Vein is on the outer side of the artery. It is usually a little adherent to the muscle and follows it when the muscle is pulled away. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE ANTERIOR MEDIASTINUM. 548 Sternum : The Top corresponds to the second dorsal vertebra* The Junction of the First and Second Pieces corresponds to the second rib, to bifurcation of the trachea, to the third dorsal vertebra. The End of the Sternum Proper corresponds to the tenth dorsal vertebra and to the lower border of the heart. Ribs: The Nipple of the Male is between the fourth and fifth ribs, about three-quarters of an inch to the outer side of their cartilages. The Lowe)- Border of the Great Pectoral corresponds with the direction of the fifth rib. The Scapular lies on the ribs from the second to the sev- enth. The Interior Extremity of the Third Bib corresponds to the body of the sixth dorsal vertebra (and about so for the others). The Apex of the Heart corresponds to the fifth intercostal space. Lungs : They leave uncovered a circle two inches in diameter, the centre of which is midway between the nipple and the end of the sternum. Heart: The Parts of the Heart Behind the Sternum are the pul- monary artery, the arch of the aorta, the inner half of the auricles and the inner half of the ventricles. The Parts to the Bight of the Sternum are: The Outer Half of the Right Auricle corresponding to the third and fourth spaces. The Superior Cava, corresponding to the first and second spaces. The Parts to the Left of the Sternum are: The Outer Half of the Ventricles, corresponding to the third, the fourth and the fifth spaces. The Base of the Heart corresponds to the upper border of the third costal cartilage. The Apex corresponds to the fifth intercostal space. It is one inch below the left nipple and one inch to the inner side of it. 212 RESUME OF SUPERIOR MEDIASTINUM, CLAVICULAR REGION. The Lower Border of the Heart corresponds to the lower end of the second piece of the sternum. The Aortic Valves correspond to the third intercostal space, close to the left side of the sternum. The Pulmonary Valves correspond to the left third costo- sternal articulation. The Tricuspid Valves correspond to the middle of the ster- num, about the level of the fourth cartilage. The Mitral Valves correspond to the third intercostal space, one inch to the left of the sternum. All the Valves are partially covered by the ear applied over the sternal end of the third intercostal space. RESUME OF POINTS OF SPECIAL INTEREST CON- CERNING THE SUPEIOR MEDIASTINUM. 549 Organs Contained on the Hiddle Line: Thymus gland, — left innominate vein, — ascending and transverse aorta; — pulmonary artery, — origin of innomi- nate artery and of left carotid, — the trachea and bifurca- tion,— oesophagus, vertebral column. Organs Situated on the Right Side : Sterno-clavicular articulation, — internal mammary arte- ry,— left and right innominate veins, — superior cava: — right subclavian vein and artery, — right lymphatic duct; — phrenic nerve, pneumo-gastric, — recurrent laryngeal, — right vertebral artery, — and sympathetic. Organs Situated on the Left Side : Sterno-clavicular articulation, — internal mammary arte- ry,— left innominate vein, — left subclavian vein, — origin of the left common carotid and left subclavian arteries, — tho- racic duct, — phrenic, — pneumo-gastric — and recurrent laryngeal nerves, descending aorta, — left vertebral artery — and sympathetic. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE SUPRA-CLAVICULAR REGION. 550 1st. The Anterior and External Jugular Veins open into the subclavian behind the junction of the sterno-mastoid and the clavicle. 2d. The Cephalic Vein opens above the middle part of the clavicle. 3d. The Anterior Scapular (or Supra=scapular) Artery runs along the posterior border of the clavicle. 4th. The Posterior Scapular crosses obliquely over the subclavian artery and the nerves, backwards and outwards. 5th. The Lymphatic Glands are on the veins. 6th. The Subclavian Vein is behind the clavicle. RESUME OF CLAVICULAR REGION AND ARM. 213 7th. The Artery is behind the vein separated by the ten- don of the anterior scalene. 8th. The Nerves of the Brachial Plexus are behind and above. 9th. The Phrenic Nerve is on the anterior scalene near its inner border. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE INFRA-CLAVICULAR REGION. 551 The Great Pectoral lies over the vessels. The Vessels are covered directly by the costo-coracoid mem- brane and small pectoral muscle. Inside the Small Pectoral the vein is in front of the artery ; — there the cephalic opens into the axillary vein. Outside of the Small Pectoral the vein is a little below the artery; — the brachial plexus is external to the artery. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE AXILLARY REGION. 552 After cutting through the fascia : The Ulnar and the Internal Cutaneous are on the inner side of the artery. The Median Nerve is commonly on the outer side of the artery; above, its roots embrace the artery like a prong. The Lymphatic Glands are on the vein. The Axillary Vein lies on the inner side of the artery, but almost covering- it. The Artery is on the outer side of the vein. It is parallel and closely applied to the coraco-brachial. which is the snide to it. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE INTERNAL REGION OF THE ARM. 553 After penetrating the fascia : The Median Nerve crosses the artery obliquely so that in the upper part of the region it is situated on the outer side of the artery, between it and the edge of the biceps. In the middle it is on top of the artery and of the veins : sometimes. At the lower part it is situated at the inner side of the arteries and of the veins. The Region presents from without inwards ; The Inner Edge of the Biceps, which is a guide to the artery- 214 RESUME OF ELBOW AND WRIST. The Median Nerve as explained above. The Brachial Veins covering the artery almost en- tirely. The Brachial Artery. The Internal Aponeurotic Band. The Ulnar Nerve. The Inner Head of the Triceps. RESUME OF THE POINTS OF SPECIAL INTEREST CON- CERNING THE INTERNAL REGION OF THE BEND OF THE ELBOW. 554 There are two lateral regions or grooves, and one middle region or depression. The Internal Lateral Region or Groove : Is limited on the inside by the round pronator and on the outside by the biceps. It presents successively : The Median Brachial Vein under the skin ; it crosses the artery obliquely. The Expansion of the Biceps. The Tendon of the Biceps on the outer part of the region. The Brachial Veins covering the artery. The Brachial Artery to the inner side of the tendon. The Median Nerve to the inner side of the artery and next to the round pronator. The External Lateral Region or Groove : Is limited on the inside by the biceps and on the outside by the long supinator. It presents the Cephalic Vein under the skin. Under the fascia it presents the terminal part of the Su- perior Deep Profunda Artery. Also the Musculo-spiral nerve. The Middle Region or Depression corresponds to : The bifurcation of the brachial arteries. The junction of the deep veins. The anastomotic branch between the deep veins and the ' median basilic vein. The Subscapular Artery and Vein are situated on the anterior border of the scapula. The Circumflex Artery and Nerve wind around behind the neck of the humerus. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE WRIST 555 1st. Anterior Region. It presents on the Middle Line the anterior carpal ligament; — the synovial sac of the flexor tendons, — with the median nerve in front of it. RESUME OF HAND, POSTERIOR MEDIASTINUM, HACK. 215 It presents on the Ulnar Side the ulnar artery and nerve outside the tendon of the ulno-earpal flexor and pisiform bone. It presents on the Radial Side the radial artery alone (no nerve) inside the tubercle of the long supinator. 2d. External Region. It presents on the radial border the radial artery (without the nerve) which crosses obliquely the pit of the extensor tendons of the thumb. 3d. Posterior Region. It presents the tendons of the extensor muscles. RESUME OP THE POINTS OF SPECIAL INTEREST CONCERNING THE REGION OF THE PALM OF THE HAND. 556 It presents successively : 1st. The Superficial Palmar Arch under the fascia, on a line with the extended thumb. 2d. The Lower Cul=de=sac of the Synovial Sac. 3d. The Deep Palmar Arch under the tendons, having the same direction as the superficial arch, but one-third of an inch higher up. RESUME OP THE POINTS OP SPECIAL INTEREST CONCERNING THE POSTERIOR MEDIASTINUM. 557 1st. Aorta and (Esophagus : Above, the aorta is on the left and the oesophagus is on the right. In the Middle, the aorta is on the middle line and the oesophagus in front, on the median line also. Below, the aorta is on the median line still and the oesoph- agus still also in front of it, but on the left. 2d. The Pneumo=gastric Nerves follow the oesophagus. 3d. The Great Azygos Vein is situated on the right side of the vertebra?. 4th. The Thoracic Duct : Below, lies between the aorta and the great azygos. Above, opposite the fourth dorsal vertebra, it ascends to the left of the oesophagus, lying between it and the aorta. 5th. The Great Sympathetic lies on the heads of the ribs. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE LATERAL REGION OF THE BACK. 558 1st. The Space between the Sixth and Seventh Ribs cor- responds to the upper border of the liver. 2d. Tenth Rib. The liver comes in contact with the ribs. 216 RESUME OF SPINAL REGION AND ABDOMEN. 3d. The Eleventh Rib on the left side corresponds to the lower extremity of the spleen. 4th. Twelfth Rib. The most accessible point of the kidney is below the last rib and the outer edge of the spinal erector. 5th. The Lower Extremity of the Kidney (also the um- bilicus) corresponds to the spine of the third lumbar ver- tebra. 6th. The Colon is situated one inch to the outer side of the outer border of the spinal erector. 7th. The Highest Point of the Ileum corresponds to about the spine of the fourth lumbar vertebra. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE MIDDLE REGION OF THE BACK OR SPINAL REGION. 559 The Fourth Cervical Vertebra (body) corresponds to the end of the pharynx — beginning of oesophagus, — cricoid cartilage, — phrenic nerve, — beginning of brachial plexus. The Third Dorsal Vertebra, to bifurcation of trachea, — base of heart, — origin of aortic, — pulmonary arteries, — junction of the two pieces of the sternum. The Eighth Dorsal Vertebra, to aponeurotic centre of dia- phragm,— lower border of heart, — Tower extremity of sternum (not appendix). The Twelfth Dorsal Vertebra, to the aortic diaphragmatic opening, — cardia, — lowest part of pleura. The First Lumbar Vertebra, to the coeliac axis, — solar plexus, — renal vessels, — pelvis of the kidney. The Second Lumbar Vertebra, to the termination of the spinal cord. — receptacle of the chyle, — pancreas, — duode- num. The Third Lumbar Vertebra, to the umbilicus, — lower border of kidney. The Fourth Lumbar Vertebra, to bifurcation of aorta, — highest point of the ileum. The Fifth Lumbar Vertebra, to promontory of sacrum ; — the end of the median spinal foramen corresponds to the interval between the spine of the last lumbar vertebra and that of the first sacral vertebra. RESUME OF THE ORGANS OF INTEREST CONTAINED IN THE REGIONS OF THE ABDOMEN. 560 Right Hypochondrium : Right lobe of liver and gall bladder, — pylorus, — duodenum, — head of pancreas, — right bend of colon, — upper part of right kidney,— supra- renal capsule. RESUME OF MALE PERINEUM AND INGUINAL REGION. 217 Epigastrium : Middle of left half of liver with its grooves ; middle and pyloric end of stomach, — body of pancreas, — aorta, — coaliac axis, — superior mesenteric artery, — solar plexus, — thoracic duct, — pillars of diaphragm. Left Hypochondrium : Left lobe of liver, — cardia, — large extremity of stomach, — spleen, — tail of pancreas, — left bend of colon, — upper part of left kidney and capsule. Umbilical Region: Transverse colon, — jejunum, — third portion duodenum, — aorta, ascending cava, — thoracic duct, — fourth lumbar vertebra. Right Lumbar : Jejunum, — ascending colon, — lower part of right kidney, — pelvis and ureter. Left Lumbar : Jejunum, — descending colon, — left kidney, lower half ; — pelvis and ureter. Hypogastrium : Ileum, — bladder when distended, — uterus in pregnancy, — rectum on the left, — promontory, — hollow of sacrum, first and second pieces. Right Iliac: Ileum, — caecum and appendix, — external iliac vessels, — iliac and psoas muscles. Left Iliac : Ileum, — sigmoid flexure, — external iliac vessels, — iliac and psoas muscles. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE MALE PERINEUM. 561 1st. The Central Point of the Perineum corresponds to a point on the raphe, midway between the centre of the anus and the spot where the scrotum joins the perineum. The perineal muscles all meet there. The bulb lies above this point. The artery of the bulb never runs below it. It corresponds to the membranous urethra in front of the prostate and neck of the bladder. 2d. The Two Safety Lines of the Perineum are: 1st, the median line : — 2d, the horizontal line passing ' through the centre of the perineum. 3d. The Dangerous Zones are : — 1st, on the sides of the middle line and above the transverse line; — 2d,- along the ascending ramus of the ischium, where the internal pudic artery lies. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE INGUINAL REGION (ILIO-INGUI- NAL). 562 1st. Pou part's Ligament corresponds to a line joining the anterior superior spine of the ilium to the spine of the pubis. 2d. The Lymphatic Glands are immediately under the skin, on Poupart's ligament. 218 RESUME OF UPPER FEMORAL, REGION. 3d. The External Abdominal Ring lies between the spine of the pubis and the angle of the pubis. — It gives passage to the spermatic cord in the male and the round ligament in the female. — It is situated immediately above the spine. 4th. The Inguinal Canal contains the spermatic cord in the male and the round ligament in the female. 5th. The Internal Abdominal Ring is midway between the anterior superior spinous process of the ilium and the spine of the pubis, and about two-thirds of an inch above Pou- part's ligament; — the cord is situated at the lower and in- ternal angle Of this ring. — The epigastric vessels are situ- ated on the inner half of this ring. — They correspond to a line drawn from the middle of Poupart's ligament to the umbilicus. 6th. The Peritoneum presents usually : — 1st, an External fossa or depression on the outer side of the epigastric artery, and corresponding to the external abdominal ring ; — 2d, a Middle Fossa, situated between the obliterated umbilical ar- tery and the inner side of the epigastric artery correspond- ing to the external abdominal ring, — an Internal Fossa situ- ated between the obliterated umbilical artery and the urachus. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE UPPER FEMORAL REGION •(SCARPA'S TRIANGLE). 563 Under the skin are found : 1st. The Lymphatic Glands. 2d. The Long Saphenous Vein. 3d. The Cribriform Fascia. 4th. The Opening of the Internal Saphenous Vein is through the cribriform fascia. 5th. The Sartorius is on the outer side of the Crural nerve and of the artery. It is situated below the inner third of Poupart's ligament, and about one inch and a half external to the pubic spine. 6th. The Anterior Crural Nerve is on the outer side, in the sheath of the psoas-iliac muscle. 7th. The Femoral Artery is between the nerve and the vein, in the same sheath with the vein. It corresponds to the upper third of a line extending from the middle of Poupart's ligament to the tubercle of the great abductor. 8th. The Deep Femoral is given off about one inch and a half below Poupart's ligament; — it is situated on the pos- terior and external part. 9th. The Femoral Vein is on the inner side of the artery and overlaps it to some extent. RESUME OF THIGH, FOOT AND GLUTEAL REGION. 219 10th. The Crural Canal corresponds to the deep lymphatics, and is on the inner side of the vein. 11th. The Abdominal Opening of this canal is limited in front by Ponpart's ligament, — externally by the femoral vein, — posteriorly by the pubis, — and internally by the sharp edge of Gimbernat's ligament. It is half an inch to the inner side of the femoral artery. It is about one inch external to the spine of the pubis. It is below the line of Poupart's ligament. When the obturator artery originates from the external iliac it curves along the upper and internal portion of the opening. RESUME OF THE POINTS OF SPECIAL INTEREST CON- CERNING THE INTERNAL REGION OF THE THIGH (MIDDLE THIRD). 564 1st. The Internal Saphenous Vein is on the inner part of the region, between the skin and fascia. 2d. The Sartor i us covers the vessels. 3d. The Artery is deeply seated in the groove or angle formed by the adductors and internal vast. This groove is completed by an aponeurotic arch into a canal (Hunter's canal). 4th. The Vein is situated above on the inner side of the artery, but lower down it is behind the artery. RESUME OF THE POINTS OF SPECIAL INTEREST CON- CONCERNING THE DORSAL REGION OF THE FOOT. 565 The Dorsal Artery is subcutaneous. It rests on the tarsal bones and is on the outer side of the tendon of the extensor of the great toe.' RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE UPPER COXO-FEMORAL REGION. 566 The Top of the Trochanter corresponds to Nelaton's line, drawn from the anterior superior spine to the most promi- nent part of the tuberosity of the ischium. — The head of fl>< femur faces in the same direction as the internal condyle of the femur. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE GLUTEAL REGION. 1st. Gluteal Vessels and Nerves. Their point of emer- gence corresponds to the inner third of a line drawn from 220 RESUME OF POPLITEAL AND MALLEOLAR REGION. the posterior superior spine of the ilium to the top of the great trochanter rotated inwards. 2d. The Ischiatic Vessels and the Sciatic Nerve emerge about half an inch below the gluteal ;— the nerve is exter- nal to the artery; — they are nearer to the ischium than to the trochanter. 3d. The Internal Pudic Vessels and Nerve emerge at a point corresponding to the inferior third of a line drawn from the outer side of the ischium to the posterior superior spine ; — they are on the inner side of the ischiatic vessels and nerve. RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE POPLITEAL REGION. 567 Under the skin : 1st, The External Saphenous Vein is situated on the mid- dle line of the leg. It dips down through the fascia and between the heads of the gastrocnemii. 2d. Above the Ligament of the Joint the internal pop- liteal nerve is on the outer side of the vein. The vein is on the outer side of the artery. The artery is on the inner side of the vein and is next to the bone. The semi-membranous is the guide to it. 3d. Opposite the Ligament of the Joint, between the two condyles of the femur, the nerve is on top of the vein. The vein on top of the artery. The artery on top of the ligament. 4th. Below the Joint, the nerve is on the inner side. The vein on the outer side of it. And the artery on the outer side of the vein, and resting on the popliteal muscle and the tibia. The internal head of the Gastrocnemius is the guide to it. 5th. The External Popliteal Nerve is between the tendon of the biceps and the outer head of the gastrocnemius. RESUME OF POINTS OF SPECIAL INTEREST CON- CERNING THE INTERNAL MALLEOLAR REGION. 568 1st. The Posterior Tibial Artery is covered by the skin and fascia, — it is situated between the tendons of the long flexor of the toes and the long flexor of the great toe. 2d. The Tendon of the Posterior Tibial is in front, next comes the tendon of the long flexOr of the great toe, and then the long flexor of the toes. DEVELOPMENT OF THE OVUM. -J21 RESUME OF THE POINTS OF SPECIAL INTEREST CONCERNING THE PLANTAR REGION. 569 The External Plantar Artery is deeply seated, lying next to the bones, — it corresponds to a line drawn from the middle of the internal malleolus to the posterior extremity of the last metatarsal bone. DEVELOPHENT OF THE OVUM. RESUME OR GENERAL DESCRIPTION— VITELLINE MEMBRANE. 570 The ovum is composed of the Vitelline Membrane, con- taining the Vitellus or Yolk. The ovum meets the spermatoza in the first third or fourth of the oviduct. MULBERRY MASS. 571 The Vitellus undergoes then a process of Segmentation or Cleavage, the result of which is to convert the granular contents of the vitellus into a mass of nucleated cells, called the Mulberry Mass. By this time the ovum has reached the uterus. DECIDUAL 572 In the uterus, the lining membrane surrounds the ovum in a peculiar manner, and forms the Decidua Reflex around the ovum, — the Decidua Serotina under the ovum, — and the Decidua Vera, which lines the rest of the uterine cavity. VITELLINE CHORION. 573 The Vitelline riembrane (or covering of the ovum), which lies immediately beneath the decidua reflex, and the decidua serotina become then covered all over with villi, which are implanted in these decidua?; — it forms the First Chorion or the Vitelline Chorion. This chorion is transitory and disappears as* soon as the vessels are developed. BLASTODERM. 574 Now, the cells of the surface of the Mulberry Mass unite together, are flattened and condensed so as to form a mem- 222 AMNION, CHORION AND UMBILICAL VESICLE. brane called the Blastoderm, which lies immediately be- neath the vitelline membrane. On the surface of the blastoderm appears the Embryonal Spot, composed of a line called the Primitive Line of the Emory 'o, surrounded by the Transparent and the Dark Areas. The blastoderm then divides into two laminae : An External or Serous Lamina, or Epiblast, which will form a part of the embryo, the amnion and the blasto- dermic chorion, And the Internal or Mucous Lamina, or Endoblast, which will form the umbilical vesicle and some of the in- ternal organs of the embryo. , The Middle Lamina or Mesoblast is between the two. AMNION. 575 The External or Serous Blastoderm forms the Amnion and the Amniotic Cavity by arching over the two extremi- ties of the embryo and then over the whole of the abdominal and dorsal aspects of the embryo. That portion of the blastoderm which forms the amnion is the Reflected Portion. That portion which still remains in contact with the vitel- line membrane is the Parietal Portion. The space or cavity between the parietal and the reflected portions contains the umbilical vesicle and the allantois. The cavity formed by the reflected portion, or the amnion > contains the embryo. BLASTODERMIC CHORION. 576 The external surface of the parietal blastoderm becomes covered with innumerable Hollow Villi, forming the second or blastodermic chorion. UMBILICAL VESICLE AND ITS VESSELS. 577 As the Amniotic cavity is formed and extends, the Internal or Mucous Layer of the blastoderm assumes the form of a pediculated vesicle, which becomes more and more pedicu- lated as»the amnion enlarges. This internal lamina is divided by the abdominal opening or umbilicus of the embryo into two portions : One is contained in the abdominal cavity of the embryo ; — the other expands externally; it forms the Umbilical Vesicle Proper. The membrane of the vesicle bears vessels called the ALLANTOIS, CHORION AND PLACENTA. --■', Omphalo=mesenteric Vessels. They form the first or transitory circulation of the em- bryo. They disappear as soon as the placental vessels are de- veloped. ALLANTOIS. 578 When the amnion is about half formed there originates from the caudal extremity of the embryo a vesicle, which is the Allantois. It rapidly expands, occupies a large portion of the cavity between the amnion and the blastodermic chorion. As it expands the umbilical vesicle is atrophied. It bears vessels, the Umbilical Arteries and Veins, which belong to the second or permanent circulation of the em- bryo or placental circulation. ALLANTOID CHORION. 579 The allantois sends membrano-vascular prolongations, which fill the cavity or the hollow villi of the blastodermic cho- rion. Those prolongations form the Third or Vascular Chorion or the Allantoid Chorion. PERMANENT CHORION. 580 The blastodermic chorion and allantoid chorion, uniting together, form the Permanent Chorion, so-called because a portion of it ultimately forms the placenta. As this permanent chorion develops the vitelline chorion and membrane atrophy. In progress of time the villi of that portion of the blasto- dermic and allantoid chorions which correspond to the reflex decidua become atrophied and blended with the atrophied vitelline chorion, decidua reflex and decidua vera, which, together with the amnion, form the walls of the amniotic cavity. PLACENTA. 581 The decidua serotina, on the contrary, enlarges consider- ably, and the villi which correspond to it ultimately form the Cotyledons or Lobules of the placenta. The decidua serotina forms the Foetal Portion of the pla- centa. The serotina itself forms the Haternal Portion of the placenta. 224 DEVELOPMENT OF THE EMBRYO. UMBILICAL CORD. 582 As the allantois expands it becomes more and more pedicu- lated. It is that pedicle, together with the amnion and the re- mains of the umbilical vesicle, that will form the umbilical cord. RESUME OF DEVELOPMENT OF THE EMBRYO. 583 The First Trace of the Embryo is a Clear Elliptical Spot, which dilates above and below. It presents behind the Vertebral Gutter, in which the Dorsal Cord lies. — It forms ultimately the intervertebral discs. It is then converted into a canal by the Dorsal Lamince. The Abdominal Cavity of the embryo is closed gradually by the Ventral Lamince. The Limbs appear (towards the fourth and fifth week) in the shape of paddles, the pedicle ultimately forming the limb and the expansion the hand and foot. The Sides of the Face and the Neck are closed or formed by the Branchial Arches separated by the Branchial Fissures. The Nose and Middle of Upper Lip and the incisor teeth are formed by a small bud from the forehead. The Drum of the Ear, the Eustachian Tube, the Exter= nal Ear and the External Auditory Canal are formed by the first branchial fissure. The Teeth Sacs are depressions of the mucous membrane. — The tooth papilla is the analogue of the skin and hair pa- pilla.— The enamel is secreted by the sac, the dentine by the papilla. — The teeth sacs of the second teeth are off- shoots of the sacs of the first teeth. 584 The (Esophagus is developed independently at the expense of a special agglomeration of cells ; — it is at first solid. The Stomach, Intestines and Rectum are formed by the lengthening and coiling up of the intra-abdominal portion of the internal or mucous blastoderm ; — from the lower or rectal extremity springs the pedicle of the allantois. The Liver is a pediculated offshoot of the intestines. The pedicle forms the ducts. The body is developed by lobules and lobes which fuse together. The Spleen is a diverticle from the stomach. It is also developed by lobules and lobes which fuse together. The Pancreas originates like the liver. 585 The 5upra=renal Capsules originate independently; — they are at first larger than the kidney, then they diminish in size. DEVELOPMENT OF THE EMBRYO. 225 The Kidneys originate independently — and by separate lobes which fuse. The Pelvis and Ureter are also developed independently, — and then connect with the kidney and bladder. The Bladder is formed by the dilatation of the origin of the pedicle of the allantois ; — the upper portion of the pedi- cle of the allantois forms ultimately the uraclius. The Urethrals developed separately with the external gen- ital organs. 586 The Ovaries and Testicles are developed at the expense of the Wolffian Bodies. These are situated in the lumbar re- gion.— They are glandular organs provided with a duct, which opens into the cloaca. The gland forms the ovaries and testicles, — the duct forms, in the male, the guiding cord, — and in the female the round ligament. The Spermatic Canal and Seminal Vesicles are developed from the Canals of Midler, — they extend from the lumbar region to the rectal cavity of cloaca. The Fallopian Tubes, Uterus and Vagina are formed by the coalescence of the two Canals of Muller. 587 The External Organs of Generation are developed sepa- rately and independently from the internal organs, — they coalesce in course of development. The Larynx is developed from the fourth branchial arch. The Trachea, Bronchi and Lungs are pediculated off- shoots from the oesophagus ; the pedicle forms the bronchi and trachea. The Thyroid Body is developed independently. The Thymus also; it diminishes after birth. 588 The Heart is developed separately ; — it is the first organ which acts. At first it is a cylinder, giving rise above to arteries which supply the embryo and the umbilical vesicle, and receive below the corresponding veins. When the Allantois and Placenta are developed: 1st. The umbilical vein, which returns arterial blood from the placenta to the ascending cava, gives off a large branch to the left branch of the portal vein, through which a large amount of this placental blood goes to the liver. 2d. There exists an orifice between the auricles, through which the blood of the ascending cava vein is directed im- mediately into the left auricle. 3d. The pulmonary artery is connected with the aorta by a canal (ductus arteriosus), through which half of the blood of the right ventricle is directed immediately into the aorta. 589 The Spinal Cord is developed from the internal blastoderm in the vertebral gutter. 15 226 APPEARANCE OF THE MAIN ORGANS. It is at first a flat membrane, but later on curves its edge and forms a central canal, which becomes obliterated in the course of time. The Brain is developed from the spinal cord by three dil- atations or cerebral vesicles. 590 The Membranes of the Eye and the Optic Nerve are de- veloped from the first cerebral vesicle ; — the transparent media are developed independently from the intermediate blastoderm. — The lids and lachrymal apparatus from the skin. The Membranous Internal Ear is an emanation from the third cerebral vesicle; — the osseous labyrinth is developed independently of the petrous bone ; — the drum of the ear, Eustachian tube, external and internal auditory canals are formed by the first branchial fissure; — the external ear em- anates from the skin. The Nose Proper is formed from the frontal tubercle ; — the nasal cavities are formed by the second branchial fis- sure;— the olfactory nerve (root, bulb, and filaments) is a vesicular prolongation of the first cerebral vesicle. The Skin and Appendages are developed at the expense of the external blastoderm. 591 The Bodies of the Vertebra? are the first bones which ap- pear on the sides of the dorsal cord, in the vertebral gut- ter.— Some bones are developed directly into bone, whereas others are first cartilaginous, then bony.. — The main parts of bones are developed separately by primary points of ossi- fication.— Secondary parts are developed by supplemental and secondary points on the parts first developed. As age advances, bones lose organic matter and become light and brittle. The Muscles are developed at the expense of the external blastoderm ; — those of the back appear first. LAWS OF DEVELOPMENT. 592 1st. Law of Unity of Organization and of Transitory Development, by virtue of which each transitory stage of the development of most of the important organs corre- sponds to a permanent condition in some of the lower animals. 2d. Law of Symmetry, bv virtue of which the body gen- erally and each organ, whether single or double, is origin- ally divisible into two parts, each half growing towards the median line, where they meet and fuse. EPOCH OF APPEARANCE OF THE MAIN ORGANS. 593 First Week : The ovum reaches the uterus at the end of the first week. APPEARANCE OF THE MAIN" ORGANS. 227 Second Week: The vitelline chorion is formed. Third and Fourth Weeks: The blastoderm, umbilical vesicle and first trace of embryo. At end of First Month the pancreas, lungs, liver, allantois and Wolffian bodies are developed. First half of Second Month: The amnion, allantois, gen- ital organs, intestines and lungs are formed. Second half of the Second Honth : Kidney, stomach, spleen, umbilical cord and placenta are formed. Third Month : The embryo has acquired definite shape and all the organs are distinct. Fourth rionth : The embryo assumes the name of foetus; the muscles contract perceptibly and the foetal heart is audi- ble. 594 At Birth the bones of the top and sides of cranium are not yet united. The anterior fontanelle corresponds to the angle of the frontal parietal, And the posterior fontanelle to the angle of the occipital and parietal bones. In Resume : End of First Week: Ovum reaches the uterus. End of Fourth Week: First trace of the embryo. End of Second Half of Second Month: Umbilical cord aud placenta are formed. End of Third Month: The embryo has its definite shape and all the organs are distinct. End of Fourth Month: The embryo is called a foetus; the muscles contract perceptibly, the foetal heart is audible. At Birth, as above. QUESTIONS ON ANATOHY. GENERAL HISTOLOGY. 1. Describe the Shape and the number of Cells. 2. Give a Resume of the Structure of Cells. 3. Describe the Vital Properties of Cells. 4. Define Epithelial Tissue. 5. Define Endothelium. 6. Name the Varieties of Connective Tissue. 7. Define Fibrous Tissue. 8. Define Elastic Tissue, its Varieties. 9. Define Adipose Tissue. 10. Name the Varieties and Characters of Glandular Tissue. 11. Describe the Structure of Glands. 12. Describe the Peculiarities of Epithelial Tissue and of En- dothelium . 13. Describe the Peculiarities of Connective, Fibrous and Elastic Tissue. 14. Describe the Peculiarities of Adipose Tissue. 15. Describe the Peculiarities of Glandular Tissue. 16. Describe the Guide to Describe an Organ. DIGESTIVE ORGANS. 17. Name the Organs concerned in Digestion. 18. Describe the Structure of the Lips. 19. Describe the Structure of the Cheeks. 20. Describe the Vestibule. 21. Describe the Number and the Shape of the Teeth. 22. Describe the Structure of the Teeth. 23. Describe the Gums. 24. Describe the Shape, Base, Surfaces and Tip of the Tongue. 25. Describe the Structure of the Tongue. 26. Describe the Hard Palate. 27. Describe the Shape, Surfaces and Borders of the Soft Palate. 28. Describe the Structure of the Soft Palate. 29. Describe the Tonsils. 30. Describe the Shape, Surfaces, Borders, Apex and Base of the Parotid. 31. Describe the Structure of the Parotid. 32. Describe the Shape, Surfaces and Extremities of the Sub- maxillary Gland. 33. Describe the Structure of the Submaxillary Gland. QUESTIONS ON ANATOMY. 229 34. Describe the Shape. Surfaces and Extremities of the Sub- lingual Gland. 35. Describe the Structure of the Sublingual Gland. 3(i. Describe the Shape, Surfaces, Base and Apex of tin- Pharynx. 37. Describe the Structure of the Pharynx. 38. Describe the Dimensions and Direction of the (Esophagus. 39. Describe the Surfaces, Borders and Extremities of the (Esophagus. 40. Describe the Structure of the (Esophagus. 41. Describe the Shape and Walls of the Cavity of the Abdo- men. 42. Describe the Dividing- Lines of the Regions of the Abdo- men. 43. Name the Organs contained in the Epigastric aud Hypo- chondriac Regions. 44. ' Name the Organs contained in the Umbilical and Lumbar Regions. 45. Name the Organs contained in the Hypogastric and Iliac Regions. 46. Name the Divisions of the Peritoneum. 47. Name the Folds of the Peritoneum. 48. Name the Viscera invested or not invested by the Perito- neum. 49. Describe the Shape, Surfaces, Borders and Extremities of the Stomach. 50. Describe the Structure of the Stomach. 51. Describe the Shape, Surfaces, Borders and Extremities of the Duodenum. 52. Describe the Structure of the Duodenum. 53. Describe the Shape, Surfaces and Extremities of the Jeju- num. 54. Describe the Structure of the Jejunum. 55. Describe the Shape, Surfaces and Extremities of the Ileum. 50. Describe the Structure of the Ileum. 57. Describe the Ca?cal Appendix. 58. Describe the Shape, Surfaces, Apex and Base of the Caecum. 59. Describe the Structure of the Caecum. 60. Describe the Shape. Surfaces and Extremities of the As- cending Colon. 61. Describe the Shape. Surfaces and Extremities of the Transverse Colon. 62. Describe the Shape. Surfaces and Extremities of the De- scending Colon. 63. Describe the Shape, Surfaces and Extremities of the Sig- moid Flexure. 64. Describe the Structure of the Sigmoid Flexure. 65. Describe the Shape. Surfaces and Extremities of the Rec- tum. 230 QUESTIONS ON ANATOMY. 66. Describe the Structure of the Rectum. 67. Describe the Shape, Surfaces and Extremities of the Auus. 68. Describe the Structure of the Anus. 69. Describe the Peculiarities of the Lips and Cheeks. 70. Describe the Peculiarities of the Teeth and Gums. 71. Describe the Peculiarities of the Tongue. 72. Describe the Peculiarities of the Hard and of the Soft Palate. 73. Describe the Peculiarities of the Tonsil and of the Parotid. 74. Describe the Peculiarities of the Submaxillary and Sub- lingual Glands. 75. Describe the Peculiarities of the Pharynx. 76. Describe the Peculiarities of the (Esophagus. 77. Describe the Peculiarities of the Cavity of the Abdomen and Peritoneum. 78. Describe the Peculiarities of the Stomach. 79. Describe the Peculiarities of the Duodenum. 80. Describe the Peculiarities of the Jejunum and of the Ileum. 81. Describe the Peculiarities of the Ileo-csecal Valve and of the Caecal Appendix. 82. Describe the Peculiarities of the Csecum and of the Colons. 83. Describe the Peculiarities of the Sigmoid Flexure and of the Rectum. 84. Describe the Peculiarities of the Anus. 85. Describe the Peculiarities and Characteristics of the Mucous Membrane and Digestive Tract to the (Esoph- agus inclusively. 86. Same for the Stomach to the Anus. 87. Describe the Shape, Upper Surface, Upper Border and Lower Border of Liver. 88. Describe the Extremities and the Under Surface of the Liver. 89. Describe the Structure and Excretory Apparatus of the Liver. 90. Describe the Shape, Surfaces, Borders and Extremities of the Pancreas. 91. Describe the Structure of the Pancreas. 92. Describe the Shape, Surfaces, Borders and Extremities of the Spleen. 93. Describe the Structure of the Spleen. 94. Describe the Peculiarities of the Liver. 95. Describe the Peculiarities of the Pancreas. 96. Describe the Peculiarities of the Spleen. URINARY ORGANS. 97. Name the Urinary Organs. 98. Describe the Supra-renal Capsules. 99. Describe the Shape, Surfaces, Borders and Extremities of the Kidney. QUESTIONS ON ANATOMY. S->\ 100. Describe the Structure of the Kidney. 101 . Describe the Calices. 102. Describe the Pelvis (Renal). 10:5. Describe the Ureter. 104. Describe the Shape Surfaces. Apex, Base and Neck of the Bladder. 105. Describe the Structure of the Bladder. 106. Describe the Prostate. 107. Describe the Peculiarities of the Supra-renal Capsules and of the Kidneys. 108. Describe the Peculiarities of the Excretory Apparatus of the Kidneys. 109. Describe the Peculiarities of the Ureters. Bladder and Prostate. 110. Name the Male Organs of Generation. 111. Describe the Structure of the Scrotum. 112. Describe the Testicle. 113. Describe the Epididymis. 114. Describe the Spermatic Duct. 115. Describe the Structure of the Spermatic Cord. 116. Describe the Seminal Vesicles. 117. Describe the Ejaculatory Ducts. 118. Describe the Structure of the Penis. 119. Describe the Male Urethra. 120. Describe Cowper's Glands. 121. Describe the Peculiarities of the Scrotum. 122. Describe the Peculiarities of the Testicle and of the Epi- didymis. 123. Describe the Peculiarities of the Spermatic Duct, Sper- matic Cord, Seminal Vesicles and Ejaculatory Ducts. 124. Describe the Peculiarities of the Penis, of the Male Urethra and of Cowper's Glands. HEART. 12."). Describe the Fibrous Pericardium. 126. Describe the Serous Pericardium. 127. Describe the Shape, Surfaces, Borders. Base and Apex of the Heart. 128. Describe the Structure of the Heart. 129. Describe the Peculiarities of the Pericardium and of the Heart. ORGANS OF RESPIRATION. 130. Name the Organs of Respiration. 131. Describe the Shape, Base, Apex, Borders, and Surfaces of Larynx. 132. Describe the Structure of the Larynx. 232 QUESTIONS ON ANATOMY. 133. Describe the Shape, Surfaces and Extremities of the Trachea. 134. Describe the Structure of the Trachea. 135. Describe the Shape, Surfaces and Extremities of the Bronchi. 136. Describe the Structure of the Bronchi. 137. Describe the Shape, Surfaces, Borders, Base and Apex of the Lungs. 138. Describe the Structure of the Lungs. 139. Describe the Pleura. 140. Describe the Peculiarities of. the Larynx. 141. Describe the Peculiarities of the Trachea, of the Bronchi, and of the Lungs. 142. Describe the Peculiarities of the Pleura. 143. Describe the Isthmus of the Thyroid Body. 144. Describe the Lobes of the Thyroid Body. 145. Describe the Structure of the Thyroid Body. 146. Describe the Thymus. 147. Describe the Peculiarities of the Thyroid Body and of the Thymus. BRAIN AND SPINAL CORD. 148. Name the Membranes of the Brain. 149. Describe the Cerebral Dura Mater. 150. Describe the Cerebral Arachnoid. 151. Describe the Cerebral Sub-Arachnoid Fluid. 152. Describe the Cerebral Pia Mater. 153. Name the Various Parts of the Brain. 154. Describe the Cerebrum. 155. Describe the Callous Body. 156. Give the Boundaries and Divisions of the Cavities of the Cerebrum. 157. Describe the Trigone. 158. Describe the Interposed Veil. 159. Describe the Pellucid Septum. 160. Describe the Lateral Ventricles. 161. Describe the Middle Ventricle. 162. Describe the Pineal Gland. 163. Describe the Quadrigeminal Bodies. 164. Describe the Shape, Surfaces and Circumference of the Cerebellum. 165. Describe the Structure of the Cerebellum. 166. Describe the Varoliaii Bridge. 167. Describe the Shape, Surfaces, Base and Apex of the Oblong Medulla. 168. Describe the Structure of the Oblong Medulla. 169. Describe the Surfaces and Angles of the Cerebellar Ven- tricle. 170. Define the Ependyma. QUESTIONS ON ANATOMY. 233 171. Describe the Ventricles. 172. Describe the Peculiarities of the Envelopes of the Brain. 178. Describe the Peculiarities of the Cerebrum, of the Pe- duncles, of the Callous Body. 174. Describe the Peculiarities of the Cavities of the Cerebrum. 17"). Describe the Peculiarities of the Pineal Gland, of the Quadrigeminal Bodies, of the Cerebellum, of the Varo- lian Bridge, of the Oblong Medulla and of the Cerebellar Ventricle. 176. Describe the Communication of the Ventricles. 177. Name the Membranes of the Spinal Cord. 178. Describe the Dura Mater of the Spinal Cord. 179. Describe the Arachnoid of the Spinal Cord. ISO. Describe the Cerebro-spinal Fluid of the Spinal Cord. 181. Describe the Pia Mater of the Spinal Cord. 182. Describe the Shape, Surfaces and Extremities of the Spinal Cord. 183. Describe the Structure of the Spinal Cord. 184. Describe the Peculiarities of the Envelopes of the Spinal Cord. 185. Describe the Peculiarities of the Spinal Cord. 186. Describe the Shape, Surfaces, Borders and Extremities of the Nose. 187. Describe the Structure of the Nose. 188. Describe the Shape, Surfaces and Extremities of the Nasal Cavities. 189. Describe the Structure of the Mucous Membrane of the Nasal Cavities. 190. Describe the Peculiarities of the Nose and Nasal Cavities. 191. Name the Parts Comprising the Eyeball. 192. Describe the Shape, Surfaces and Circumference of the Cornea. 193. Describe the Structure of the Cornea. 194. Describe the Sclerotic. 195. Describe the Shape, Surfaces and Extremities of the Choroid. 196. Describe the Structure of the Choroid. 197. Describe the Shape, Surfaces and Extremities of the Retina. 198. Describe the Structure of the Retina. 199. Describe the Vitreous Body. 200. Describe the Shape, Surfaces and Circumference of the Crystalline Lens. 201. Describe the Structure of the Crystalline Lens. 202. Describe the Shape. Surfaces and Circumference of the Iris. 203. Describe the Structure of the Iris. 204. Describe the Aqueous Humor. 205. Describe the Orbital Fascia. 206. Describe the Muscles of the Eyeball. 234 QUESTIONS ON ANATOMY. 207. Describe the Structure of the Eyelids. 208. Describe the Structure of the Eyebrows. 209. Describe the Lachrjmial Apparatus. 210. Describe the Peculiarities of the Eyeball and of its Envelopes. 211. Describe the Peculiarities of the Contents of the Eye- ball. 212. Describe the Peculiarities of the Appendages of the Eye. 213. Name the Parts forming the Organs of Hearing. 214. Describe the Shape, Surfaces and Extremities of the Pavilion. 215. Describe the Structure of the Pavilion. 216. Describe the Direction, Shape, Surfaces, Borders and Ex- tremities of the External Auditory Canal. 217. Describe the Structure of the External Auditory Canal. 218. Describe the Drum of the Ear. 219. Describe the Ossicles of the Tympanum. 220. Describe the Lining Membrane of the Tympanum. 221. Describe the Mastoid Cells. 222. Describe the Direction, Shape, Surfaces and Extremities of the Eustachian Tube. 223. Describe the Structure of the Eustachian Tube. 224. Describe the Relative Position of the Parts comprising the Internal Ear. 225. Describe the Shape and Surfaces of the Vestibule. 226. Describe the Structure of the Vestibule. 227. Describe the Shape, Surfaces and Extremities of the Semi- circular Canals. 228. Describe the Structure of the Semi-circular Canals. 229. Describe the Shape, Base, Apex and Surfaces of the Cochlea. 230. Describe the Structure of the Cochlea. 231. Describe the Direction, Shape, Surfaces and Extremities of the Internal Auditory Canal. 232. Describe the Structure of the Internal Auditory Canal. 233. Describe the Peculiarities of the External and of the Middle Ears. 234. Describe the Peculiarities of the Internal Ear. 235. Name the Layers of the Skin. 236. Describe the Hair and Follicle. 237. Name the Glands of the Skin. 238. Describe the Structure of the Nails. 239. Describe the Peculiarities of the Skin. 240. Describe the Peculiarities of the Glands of the Skin. 241. Describe the Structure of Cartilage. 242. Describe the Varieties of Cartilage. 243. Describe the Chemical Composition of Bones. 244. Describe the Structure of Bones. 245. Describe the Points of Special Interest concerning the Cervical Vertebra? in General. QUESTIONS ON ANATOMY. 235 246. Describe the First, Second, and Seventh Cervical Verte- bras. 247. Describe the Dorsal Vertebra' in General. 248. Describe .the First, Ninth. Tenth, Eleventh and Twelfth Dorsal Vertebra1. 241). Describe the Lumbar Vertebrae. 250. Describe the Points of Special Interest Concerning the Sacrum. 251. Describe the Spine in General. 252. Name the Bones of the Skull. 253. Describe the Vertical Portion of the Frontal Bone. 254. Describe the Horizontal Portion of the Frontal Bone. 255. Describe the Lateral Portions of the Frontal Bone. 25(>. Describe the Situation of the Ethmoid. 257. Describe the Horizontal Plate of the Ethmoid. 258. Describe the Perpendicular Plate of the Ethmoid. 259. Describe the Lateral Masses of the Ethmoid. 260. Describe the Ethmoid Cells. 261. Describe the Situation of the Sphenoid. 262. Describe the Body of the Sphenoid. 263. Describe the Lesser Wings of the Sphenoid. 264. Describe the Greater Wings of the Sphenoid. 265. Describe the Pterygoid Process of the Sphenoid. 266. Describe the Occipital Bone. 267. Describe the Parietal Bone. 268. Describe the Squamous Portion of the Temporal Bone. 269. Describe the Mastoid Portion of the Temporal Bone. 270. Describe the Petrous Portion of the Temporal Bone. 271. Name the Bones of the Face. 272. Describe the Vomer. 273. Describe the Superior Maxillary Bone. 274. Describe the Nasal Bone. 275. Describe the Lachrymal Bone. 276. Describe the Inferior Turbinated Bone. 277. Describe the Horizontal Portion of the Palate Bone. 278. Describe the Vertical Plate of the Palate Bone. 279. Describe the Malar Bone. 280. Describe the Horizontal Portion of the Inferior Maxilla. 281. Describe the Vertical Portion of the Inferior Maxilla. 282. Give a Resume of the Situation of the Bones of the Skull. 283. Give a Resume of the Situation of the Bones of the Face. 284. Name the Sutures of the Skull. 285. Name the Cranio-facial Suture. 286. Describe the Upper Region or Vertex of Skull. 287. Describe the Boundaries of the Lateral Regions of the Skull. 288. Describe the Mastoid Region of the Skull. 289. Describe the Temporal Fossa. 290. Describe the Zygomatic Fossa. 291. Describe the Pterygo-maxillary Fossa. 236 QUESTIONS ON ANATOMY. 292. Give the Boundaries of the Inferior Region of the Exte- rior of the Skull. 293. Describe the Palato-pterygoid Region of the Skull. 294. Describe the Occipital Region of the Skull. 295. Describe the Sphenoidal Region of the Skull. 296. Describe the Petrous Region of the Skull. 297. Describe the Squamous and Mastoid Regions of the Skull. 298. Describe the Orbit. 299. Describe the Nasal Fossae. 300. Describe the Divisions and the Boundaries of the Interior of the Skull. 301. Describe the Upper Region or Roof of the Interior of the Skull. 302. Describe the Anterior or Frontal Cerebral Fossa. 303. Describe the Middle or Sphenoidal Fossa. 304. Describe the Posterior or Occipital Fossa. 305. Describe the Foramens of the Base of the Interior of the Skull and the Organs Situated therein. 306. Name the Points of Special Interest Concerning the Ribs. 307. Name the Points of Special Interest Concerning the First, Second, Tenth, Eleventh, and Twelfth Ribs. 308. Name the Points of Special Interest Concerning the Ster- num . 309. Name the Points of Special Interest Concerning the Clavicle. 310. Name the Points of Special Interest Concerning the Scapula. 311. Name the Points of Special Interest Concerning the Humerus. 312. Name the Points of Special Interest Concerning the Ulna. 313. Name the Points of Special Interest Concerning the Radius. 314. Name the Points of Special Interest Concerning the Carpus. 315. Name the Points of Special Interest Concerning the Metacarpus. 316. Name the Points of Special Interest Concerning the Phalanges. 317. Name the Points of Special Interest Concerning the Innominate Bone. 318. Name the Points of Special Interest Concerning the Pelvis in General. 319. Name the Differences Between the Male and Female Pelvis. 320. Name the Points of Special Interest Concerning the Femur. 321. Name the Points of Special Interest Concerning the Patella. 322. Name the Points of Special Interest Concerning the Tibia. QUESTIONS ON ANATOMY. 2:>7 '■'>'2'-\. Name the Points of Special Interest Concerning the Fibula. 324. Name the Points of Special Interest Concerning the First Row of the Tarsus. 325. Name the Points of Special Interest Con jerning tin- Sec- ond Row of the Tarsus. 326. Describe the Structure of Ligaments. 327. Describe the Structure of the Synovial Membranes in General. 328. Describe the Classification of Joints. 821). Describe the Peculiarities of Each Kind of .Joint. 330. Describe the Articulations of the Bones of the Ver- tex of the Skull. 331. Describe the Temporo-maxillarv Articulation. 382. Describe the Articulations of the Occipital with the Atlas and Axis. 333. Describe the Articulations of the Vertebrae. 334. Describe the Articulations of the Ribs. 335. Describe the Sterno-clavicular Articulation. 336. Describe the Scapulo-humeral Articulation. 337. Describe the Articulations of the Elbow. 338. Describe the Upper Ulno-Radial Articulation. 339. Describe the Lower Ulno-Radial Articulation. 340. Describe the Radio-carpal Articulation of Wrist Joint. 341. Describe the Intercarpal Articulations. 342. Describe the Sacro-iliac Articulation. 343. Describe the Symphysis Pubis Articulation. 344. Describe the Coxo-femoral Articulation. 345. Describe the Knee Joint or Tibio-femoral Articulation. 346. Describe the Upper Tibio-Peroneal Articulation. 347. Describe the Ankle Joint or Tibio-tarsal Articulation. 348. Describe the Articulations of the Astragalus and Calca- neum. 349. Describe the Articulations between First and Second Rows of the Tarsus. 350. Describe the Articulations of the Metatarsus. 351. Describe the Structure of Muscular Tissue. 352. Describe the Structure of Tendons. 353. Describe the Structure of Aponeuroses and Fascia?. 354. Describe the Muscles of the Cranial, Auricular, and Pal- pebral Regions. 355. Describe the Muscles of the Nasal Region. 356. Describe the Muscles of the Buccal or Oral Region. 357. Describe the Muscles of the Temporo-maxillarv Region. 358. Describe the Muscles of the Superficial Region of the Neck. 359. Describe the Muscles of the Supra-hyoid Region. 360. Describe the Muscles of the Anterior Vertebral Region. 361. Describe the Muscles of the Lateral Vertebral Region. 362. Describe the Muscles of the First. Second and Third Lay- ers of the Back. 238 QUESTIONS ON ANATOMY. 363. Describe the Muscles of the Fourth Layer of the Back. 364. Describe the Muscles of the Fifth Layer of the Back. 365. Describe the Muscular Layers of the Neck. 366. Describe the Muscles of the Chest. 367. Describe the Muscles of the Shoulder. 368. Describe the Muscles of the Anterior Region of the Arm. 369. Describe the Muscles of the Posterior Region of the Arm. 370. Describe the Muscles of the Anterior Region of the Fore- arm. 371. Describe the Muscles of the External or Radial Region of the Forearm. 372. Describe the Muscles of the Superficial Layer of the Pos- terior Region of the Forearm. 373. Describe the Muscles of the Deep Layer of the Posterior Region of the Forearm. 374. Describe the Muscles of the External Region of the Hand. 375. Describe the Muscles of the Internal Region of the Hand. 376. Describe the Muscles of the Middle or Palmar Region of the Hand. 377. Describe the Muscles of Exterior of the Abdomen. 378. Describe the Muscles of the Interior of the Abdomen. 379. Describe the Muscles of the Anterior Region of the Thigh 380. Describe the Muscles of the Internal Region of the Thigh 381. Describe the Muscles of the Anterior Region of the Leg 382. Describe the Muscles of the External Region of the Leg 383. Describe the Muscles of the Dorsal Region of the Foot. 384. Describe the Muscles of the Gluteal Region. 385. Describe the Muscles of the Posterior Region of the Thigh. 386. Describe the Muscles of the Posterior Region of the Leg. 387. Describe the Muscles of the Internal Regions of the Foot. 388. Describe the Muscles of the External Plantar Region. 389. Describe the Muscles of the Middle Plantar Region. 390. Describe the Peculiarities of the Muscles of the Back, of the Cranial Region, of the Face, of the Temporo-maxil- lary Region, and of the Ptery go -maxillary Region. 391. Describe the Peculiarities of the Muscles of the Neck and of the Chest. 392. Describe the Peculiarities of the Muscles of the Shoulder and of the Arm. 393. Describe the Peculiarities of the Muscles of the Forearm and Hand. 394. Describe the Peculiarities of the Muscles of the Vertebral Region and of the Abdomen. 395. Describe the Peculiarities of the Muscles of the Interior of the Pelvis, of the Anterior and Internal Regions of the Thigh, of the Anterior and External Regions of the Leg, and of the Back of the Foot. 396. Describe the Peculiarities of the Muscles of the Gluteal Region, of the Posterior Region of the Thi^h, of the QUESTIONS ON ANATOMY. 239 Posterior Reg-ion of the Leg, and of the Muscles of the Plantar Region. 397. Name the Muscles which are Specially Interesting or Im- portant. 398. Name the Muscles of Special Surgical Importance. 399. Name the Anatomical Elements of the Blood. 400. Describe the Red Blood Corpuscles. 401. Describe the White Blood Corpuscles. 401'. Describe the Blood Plates and the Free Nuclei. 403. Describe the General Structure of Arteries. 404. Describe the Structure of Arteries in Particular, accord- ing to Size. 405. Describe the Structure of Veins. 406. Describe the Structure of Capillaries. 407. Describe the Divisions of the Systemic Circulation and the Cardiac Circulation. 408. Describe the Pulmonary and Bronchial Circulations. 409. Describe the Aorta. 410. Describe the Branches of the Arch of the Aorta. 411. Describe the Common Carotid. 412. Describe the Situation and Course of the External Car- otid. 413. Describe the Branches of the External Carotid. 414. Describe the Situation and Course of the Internal Carotid. 415. Describe the Branches of the Internal Carotid. 416. Describe the Situation and Course of the Subclavian Ar- tery. 417. Describe the Branches of the Subclavian Artery. 418. Describe the Situation and Course of the Axillary Artery. 419. Describe the Branches of the Axillary Artery. 420. Describe the Situation and Course of the Brachial Artery. 421. Describe the Branches of the Brachial Artery. 422. Describe the Radial Artery. 423. Describe the Situation and Course of the Ulnar Artery. 424. Describe the Branches of the Ulnar Artery. 425. Describe the Branches of the Thoracic Aorta. 420. Describe the Branches of the Abdominal Aorta. 427. Describe the Common Iliac Artery. 428. Describe the Situation and Course of the Internal Iliac Artery. 429. Describe the Branches of the Internal Iliac Artery. 430. Describe the Situation and Course of the External Iliac Artery. 431. Describe the Branches of the External Iliac Artery. 432. Describe the Situation and Course of the Femoral Artery. 433. Describe the Branches of the Femoral Artery. 434. Describe the Situation and Courseof the Popliteal Artery. 435. Describe the Branches of the Popliteal Artery. 430. Describe the Anterior Tibial Artery. 437. Describe the Dorsal Artery of the Foot. 240 QUESTIONS ON ANATOMY. 438. Describe the Posterior Tibial Artery. 439. Describe the External Plantar Artery. 440. Describe the Internal Plantar Artery. 441. Describe the Peculiarities of the Innominate Artery, the Carotids and the Subclavian. 442. Describe the Peculiarities of the Brachial Artery, the Radial and Ulnar. 443. Describe the Peculiarities of the Aorta, the Iliac Arteries, the Femoral, Popliteal and Tibials. 444. Describe the Peculiarities of the Arteries of the Organs of Digestion. 445. Describe the Peculiarities of the Arteries of the Organs of Urination and Generation. 44G. Describe the Peculiarities of the Arteries of the Heart, of the Organs of Respiration and of Innervation. 447. Describe the Peculiarities of the Arteries of the Organs of Special Sense and of the Organs of Locomotion and Circulation. 448. Describe the Lines Indicating the Direction of, and the Muscle which is the Guide to, the Innominate Artery, the Common, External, and Internal Carotid Arteries, the Bifurcation of the Common Carotid Artery, the Lingual and the Facial Arteries. 449. Describe the Lines Indicating the Direction of, and the Muscle which is the Guide to, the Subclavian, the Axil- lary, the Subscapular, the Brachial Arteries, and Radial Artery in the Forearm. 450. Describe the Lines Indicating the Direction of, and the Muscle which is the Guide to, the Radial Artery, the Ulnar and the Palmar Arches. 451. Describe the Lines Indicating the Direction of, and the Muscle which is the Guide to, the Internal Mammary Artery, the Epigastric, the Common Iliac, the External Iliac, the Gluteal Artery. 452. Describe the Lines Indicating the Direction of, and the Muscle which is the Guide to, the Internal Pudic Artery, the Ischiatic, the Bulbous and the Femoral. 453. Describe the Lines Indicating the Direction of, and the Muscle which is the Guide to, the Popliteal Artery, the Anterior Tibial, the Dorsal Artery, the Posterior Tibial, the Peroneal and the Plantar Arch. 454. Describe the Supra-diaphragmatic Circulatory Circuits. 455. Describe the Infra-diaphragmatic Circuits. 456. Describe the Articular Arterial Circles. 457. Enumerate the Most Important Branches of Arteries Necessary to Understand the Establishment of the Collateral Circulation after the Ligature of Arteries Above the Arch. 458. Same of the Arteries Below the Arch. QUESTIONS ON ANATOMY. 241 4.")<). Surgical Col lateral Branches of the Main Arteries Above the Arch. 4(H). Surgical Collateral Branches of the Main Arteries Below the Arch . 461. Describe the Collateral Circulation after the Ligature of the Innominate and of the Carotids. 462. Describe the Collateral Circulation after the Ligature of the Subclavian and of the Axillary. 463. Describe the Collateral Circulation after the Ligature of the Brachial, Radial and Ulnar. 464. Describe the Collateral Circulation after the Ligature of the Iliacs. 465. Describe the Collateral Circulation after the Ligature of the Femorals, Popliteal, Tibials. 466. Describe the Ascending Cava Vein. 467. Describe the Left Innominate Vein. 468. Describe the Right Innominate Vein. 469. Describe the Internal Jugular Vein. 470. Describe the Lateral Sinuses. 471. Describe the Superior Longitudinal Sinus. 472. Describe the Straight Sinus. 473. Describe the Occipital Sinuses. 474. Describe the Cavernous Sinuses. 475. Describe the Classification of the Sinuses. 476. Describe the Anastomoses Between the Intra-cranial and the Extra-cranial Venous Circulation. 477. Describe the Subclavian Vein. 478. Describe the Axillary Vein. 479. Describe the Ascending Cava Vein. 480. Describe the Common Iliac Vein. 481. Describe the Internal and External Iliac Vein. 482. Describe the Femoral Vein. 483. Describe the Popliteal Vein. 484. Describe the Branches of the Popliteal Vein. 485. Describe the Peculiarities of Veins in Particular, to the Veins of the Face Inclusively. 486. Describe the Peculiarities of the Veins of the Neck and of the Remainder of the Veins. 487. Describe the Peculiarities of the Veins of Some Organs. to the Veins of the Liver Inclusively. 488. Describe the Peculiarities of the Veins of the Organs of Urination and Generation. 489. Describe the Peculiarities of the Veins of the Eeart. 490. Describe the Peculiarities of the Veins of the Organs of Respiration. 491. Describe the Peculiarities of the Wins of the Central Organs of Innervation. 492. Describe the Peculiarities of the Veins of the Organs of Special Sense. 242 QUESTIONS ON ANATOMY. 493. Describe the Peculiarities of Veins of the Bones, Muscles and Vessels. 494. Describe the Structure of Lymphatic Vessels. 495. Describe the Structure of Lymphatic Glands. 496. Describe the Lymph. 497. Describe the Chyle. 498. Describe the Thoracic Duct. 499. Describe the Right Lymphatic Duct. 500. Describe the Lymphatic Glands of the Head. 501. Describe the Lymphatic Glands of the Neck. 502. Describe the Lymphatic Glands of the Upper Extremity. 503. Describe the Lymphatic Glands of the Chest. 504. Describe the Lymphatic Glands of the Abdomen. 505. Describe the Lymphatic Glands of the Pelvis. 506. Describe the Lymphatic Glands of the Lower Extremity. 507. Describe the Peculiarities of the Lymphatics. 508. Describe the Peculiarities of the Lymphatics of the Tissues. 509. Describe the Peculiarities of the Lymphatics of the Organs of Digestion. 510. Describe the Peculiarities of the Lymphatics of the Or- gans of Urination and of Generation. 511. Describe the Peculiarities of the Lymphatics of the Or- gans of Respiration and of Innervation. 512. Describe the Peculiarities of the Lymphatics of the Or- gans of Special Sense. 513. Describe the Peculiarities of the Lymphatics of the Organs of Locomotion. 514. Describe the Structure of Nerves. 515. Describe the Termination of Nerves. 516. Describe the Structure of Nervous Ganglia. 517. Describe the Olfactory Nerve. 518. Describe the Optic Nerve. 519. Describe the Common Ocular Motor. 520. De*scribe the Pathetic Nerve. 521. Describe the Tri-facial. 522. Describe the Ophthalmic, Superior Maxillary and Inferior Maxillary Nerve. 523. Describe the External Ocular Motor. 524. Describe the Facial. 525. Describe the Auditory. 526. Describe the Glossopharyngeal. 527. Describe the Pneumo-gastric. 528. Describe the Spinal Accessory. 529. Describe the Hypoglossal. 530. Describe the Spinal Nerves (Roots). 531. Describe the Cervical Plexus. 532. Describe the Brachial Plexus and Branches. 533. Describe the Intercostal Nerves. 534. Describe the Lumbar Plexus and Branches. 535. Describe the Sacral Plexus and Branches. QUESTIONS. ON ANATOMY. 24!! 536. Describe the Great Sympathetic Nerve. 537. Describe the Peculiarities of the Olfactory Nerve, the Optic, the Common Ocular Motor and Pathetic. 538. Describe the Peculiarities of the Tri-facial, the External Ocular Motor, the Facial and the Auditory. 539. Describe the Peculiarities of the Glossopharyngeal, the Pneumo -gastric, the Spinal Accessory and the Hypo- glossal. 540. Describe the Peculiarities of the Spinal Nerves. 541. Describe the Peculiarities of the Intercostal Nerves, of the Lumbar and Sacral Plexus and Branches. 542. Describe the Points of Special Interest Connected with the Region of the Skull. 543. Describe the Points of Special Interest Connected with the Region of the Face. 544. Describe the Points of Special Interest Connected with the Zygomatic and Pterygo-maxillary Fossae. 545. Describe the Points of Special Interest Connected with the Region of the Parotid. .546. Describe the Points of Special Interest Connected with the Region of the Carotids. 547. Describe the Points of Special Interest Connected with the Lateral Supra-hyoid Region. 548. Describe the Points of Special Interest Connected with the Anterior Mediastinum. 549. Describe the Points of Special Interest Connected with the Superior Mediastinum. 550. Describe the Points of Special Interest Connected with the Supra-clavicular Region. 551. Describe the Points of Special Interest Connected with the Infra-clavicular Region. 552. Describe the Points of Special Interest Connected with the Axillary Region. 553. Describe the Points of Special Interest Connected with the Internal Region of the Arm. 554. Describe the Points of Special Interest Connected with the Bend of the Elbow. 555. Describe the Points of Special Interest Connected with the Region of the Wrist. 556. Describe the Points of Special Interest Connected with the Region of the Palm of the Hand. 557. Describe the Points of Special Interest Connected with the Posterior Mediastinum. 558. Describe the Points of Special Interest Connected with the Lateral Region of the Back. 559. Describe the Points of Special Interest Connected with the Middle Region of the Back, or Spinal Region. 560. Describe the Organs Contained in the Region of the Abdomen. 561. Describe the Points of Special Interest Concerning the Male Perineum. 244 QUESTIONS ON ANATOMY. 562. Describe the Points of Special Interest;..Gbucerning the Inguinal Region. 563. Describe the Points of Special Interest Concerning SearpaTs Triangle. 564. Describe the Points of Special Interest Concerning the Internal Region of the Thigh. 565. Describe the Points of Special Interest Concerning the Dorsal Region of the Foot. 566. Describe the Points of Special Interest Concerning the Upper Coxo-femoral and Gluteal Regions. 567. Describe the Points of Special Interest Concerning: the Popliteal Region. 568. Describe the Points of Special Interest Concerning the Internal Malleolar Region.. 569. Describe the Points of Special Interest Concerning the Plantar Region. 570. Describe the Vitelline Membrane. 571. Describe the Mulberry Mass. 572. Describe the Deciduee. 573. Describe the Vitelline Chorion. 574. Describe the Blastoderm. 575. Describe the Amnion. 576. Describe the Blastodermic Chorion. 577. Describe the Umbilical Cord and its Vessels. 578. Describe the Allantois. 579. Describe the Allantoid Chorion. 580. Describe the Permanent Chorion. 581. Describe the Placenta. 582. Describe the Umbilical Cord. 583. Describe the Development of the First Trace of the Em- bryo, the Vertebral Gutter, the Abdominal Cavity, the Limbs, the Face, Nose, Lips, Drum of the Ear, Eusta- chian Tube, External Auditory Canal and External Ear, and the Teeth. 584. Describe the Development of the (Esophagus, Stomach, Intestines, Rectum, Liver, Spleen, Pancreas. 585. Describe the Development of the Urinary Organs. 586. Describe the Development of the Internal Organs of Generation. 587. Describe the Development of the External Organs of Generation. 588. Describe the Development of the Heart. 589. Describe the Development of the Spinal Cord and Brain. 590. Describe the Development of the Organs of Special Sense. 591. Describe the Development of the Bones and Muscles. 592. Describe the Laws of Development. 593. Describe the Epoch of Appearance of the Main Organs and the Condition of the Cranium at Birth. 594. Describe the Appearance at Birth of the Bones of the Cranium. ^ 0 COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the library rules or by special arrangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE " C28(842)MSO %c% -COLUMBIA UNIVERSITY LIBRARIES fhsl.stx) QM 23 S08 C.1 Resume of lectures on anatomy