COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX00025232 nn^i^ 3A3 Columbia (Hnitiew^ftp CoQese of 3^^v&itmnsi anb ^urseonsf Hibrarp A TREATISE Uth^- isai. c y^^7r"^^r^ :^/ A TRBATISB A/->t-^^ Practical Anatomy: FOR Students of Anatomy and Surgery. HENRY C. BOENNING, M.D., tECTURER ON ANATOMY AND SURGERY IN THE PHILADELPHIA SCHOOL OF ANATOMY ; DEMONSTRATOR OF ANATOMY IN THE MBniCO-CHIRURGICAL COLLEGE ; DEMONSTRATOR OF ANATOMY IN THE PHILADELPHIA DENTAL COLLEGE ; LECTURER ON DISEASES OF THE RECTUM IN THE MEDICO-CHIRURGICAL COLLEGE, ETC. ILLUSTRATED WITH 198 WOOD-ENGRAVINGS. \ Philadelphia and London : F. A. DAVIS, PUBLISHER. 1891. Entered according to Act of Congress, in the year 1891, by F. A. DAVIS, In the Office of the Librarian of Congress, at Washington, D. C, U. S. A. Philadelphia, Pa., U. S. A.: The Medical Bulletin Printing House, 1231 Filbert Street. (i) perichondrium. These cells are of the greatest im[)or- tance ; some are concerned in the ibrmatien of marrow, while others become the osteoblasts described by Gegen- bauer. 8 PRACTICAL ANATOMY. It must be. remembered that the formation of bone is not a simple process of calcification, but the result of the functional activity of the osteoblasts. The formation of all the spaces and canals in cartilage and bone is due to absorption. The canals formed by the process described are known as medullary sinuses, and are lined by osteoblasts and medullary cells. Through the agency of the osteoblast, layers of bone begin to encroach concentrically upon the medullary sinuses, forming the primary lamellae surrounding the Haver- sian canals, which these medullary sinuses ultimately become. The formation of the lacunae and canaliculi is not definitely settled. Briefly, the process is probably as follows : The medullary sinuses or canals, as previously stated, are lined by layers of osteoblasts, from three to seven deep. The peripheral layer undergoes bony trans- formation, and then the next, and thus layer after layer ossifies, forming the concentric lamellae of the Haversian system. The nucleus of the osteoblast resists the change described, although the cell-wall and contents ,in part undergo ossific transformation. The nucleus remains as a space or cavity, which is gradually fashioned into a lacuna. The formation of the canaliculi is not under- stood, although it is probable that the contents of the osteoblasts are not entirely absorbed, but that delicate fibres of protoplasm remain, radiating from the nucleus and communicating with the adjoining cell, and that these fibres ultimately become the canaliculi. In the inter-membranous form of ossification, the first evidence is the formation of a vascular centre, from which rays of fibro-cartilaginous material issue. This material is calcified, and then passes through the process of ossifica- tion already described. THE SKELETON. \) THE SKELETON. The skeleton is that arrangement of bones wliich supports the soft structures of the body. It consists, in the adult, of 200 bones, as follows : — ( Cranium ^ ^ oo ^'^'^ \ Face, . . . . . u\ ^^ Vertebral column, including sacrum, and coccyx, . 26 Upper extremities, 64 Ribs, sternum, and os hyoides, . . . .26 Lower extremities, . 62 200 The bones are divided into four classes, — long, short, flat, and irregular. A long bone presents a shaft, two extremities, and has a medullary cavity. The shaft is cylindrical or prismatic, hollow, filled with yellow mar- row, contained within a delicate investing membrane called the endosteum, which lines the medullary cavity. It is a hollow cylinder of compact tissue, which becomes thinner toward the extremities ; these are expanded and bulky, and serve for articulation. About tlie centre of a long bone is the nutrient foramen ; it enters the medullary canal and transmits an artery to the marrow. The direction of the nutrient foramen and canal is dif- erent in difl"erent bones : in the long bones of the upper extremities it is directed toward the elbow-joint ; in the femur, toward the hip-joint ; and in the bones of the leg, toward the ankles. A short bone is thick, irregular, cuboidal, and con- sists of a shell of compact bone inclosing spongy tissue, the alveoli of which are filled with red marrow. Tlie short bones are those of the tarsus and carpus. A flat bone is plate-like in form, and consists of two tables of compact bone held together by cancellated tissue. In the bones of the skull the tables of the flat 10 PR ACTIO A L ANATOMY. bones are of different degrees of density ; the outer table, less dense, is tough and elastic ; the inner is denser and harder, and consequently brittle. The flat bones are used mainly for protection, and also afford broad surfaces for muscular attachment. Irregular bones are extremely irregular in outline, and commonly consist of a shell of dense bone inclosing spongy tissue, the interstices of which are filled with red marrow. Bones present certain points for examination, — ele- vations and depressions, ridges and grooves, surfaces, lines, foramina. A blunt elevation is called a tubercle or tuberosity ; a depression may be slight or pit-like or deep, or shallow and extensive, when it is designated a fossa. Ridges may be rounded or sharp ; in the latter case they are called crests. Grooves may be shallow, as the mus- culo-spiral groove on the humerus, or deep. Surfaces may be rough or smooth. Lines may be rough, sharp, spiral, or broad. Besides these, a number of other terms are employed : thus, the spine is a sharp, thorn-like process ; a trochanter, a huge blunt elevation for the attachment of muscles ; condyles are oblong elevations of bone covered with cartilage, arranged in pairs ; an articular surface is a plane, of more or less extent, cov- ered with cartilage. In the growing skeleton the shafts of many bones are separated from their extremities by layers of cartilage ; such an extremity constitutes an epiphysis, which remains separated from the shaft until both have attained their full development, when the layer of cartilage ossifies. Where a blunt process of bone grows out from the shaft it is called an apophysis. If the ex- tremity of a bone forms a single rounded prominence, covered with cartilage, it is called a head ; a constriction just below the head of a bone is known as the neck. THE SKULL. 11 THE SKULL. The sknll is formod of twenty-two bones ; of these, eight enter into tlie formation of the cranium and four- teen into the construction of the face. The bones of the cranium are arranged singly and in pairs. Tlie single bones are the frontal, ethmoid, sphenoid, and occipital; those in pairs, the parietal and the temporal. THE FRONTAL BONE. The frontal bone is located at the anterior part of 2 '>^-^. up 'Y" *. <•< 1 S/iln 2. —Frontal Bone, Outer Sfrface. the cranium and forms the forehead. It consists of a vertical and liorizontal portion. The vertical portion is convex from side to side and from above downw-ard; midway between its superior and inferior border, on each side of the median line, are tw^o rounded elevations, known as the frontal eminences, the bases of which, in well-marked specimens, are about the size of a silver half-dollar ; below these, directed horizontally outward, are the rounded superciliary ridges which mark the 12 PRACTICAL ANATOMY. position of the frontal sinuses ; below these are the supra-orbital ridges, where the vertical and horizontal portions join. These ridges present at their inner third a notch or foramen, known as the supra-orbital, and which transmit the supra-orbital nerve and artery. The ridges terminate externally in well-marked processes of bone, known as the external angular processes, which are ser- rated for articulation with the frontal process of the malar; internally, they approach one another and ter- minate in the internal angular processes, also serrated for articulation, with the superior maxillary and nasal ; they are separated by a mass of bone, slightly elevated, from one-half to three-quarters of an inch in breadth, and known as the glabella. The supra-orbital ridges are strongly arched, and assist in forming the rim of the orbits. Passing down midway, dividing the bone into halves, is the remains of the frontal suture, well marked in young bones. It indicates the line of union of the two halves of the bone. The superior border of the frontal bone is strongly indented and toothed for articu- lation with the parietal bones ; laterally it is beveled for articulation with the great wing of the sphenoid. Pass- ing upward and backward, in a curved direction from the external angular process, is the commencement of the temporal ridge. The process of bone posterior to the ridge forms an angle with the vertical portion, and assists in the formation of the temporal fossa. Projecting down- ward midway from between the internal angular processes is the nasal spine, which articulates in front with the posterior borders of the nasal bones, and behind with the anterior border of the ethmoid. The inner surface of the vertical portion is concave in every direction, and presents a number of shallow depressions for the accom- modation of the convolutions of the brain. Besides tliese, TIIK FRONTAL BONE. 13 there are some sharp, pit-Uke depressions which lodge the Pacchionian glands, — small fibrous bodies developed on the outer surface of the dura mater. Running along the middle line from the superior border to a pit in front of the ethmoidal notch is the frontal crest, which gives attach- ment to the falx cerebri and lodges the longitudinal sinus. The horizontal portion consists of two orbital plates, separated by a deep, broad notch, — the ethmoidal. These plates present for examination inferior and superior sur- .^ Sun.i'axiU Tui^ iati ^ i,oja.l Spait, Jnrnany ^rt if R»t^ ^ AV/* Fig. 3.— Frontal Bone, Inner Surface. faces, posterior and ethmoidal borders. The inferior sur- face is strongly concave and smooth, the superior slightly convex and marked by the convolutions of the brain. Just within the external angular process is a shallow de- pression which lodges the lachrymal gland. Behind the internal angular process is a small tubercle, sometimes a depression which gives attachment to the pulley of tlie superior oblique muscle. The orbital plates are thin and translucent, consisting of compact tissue only. The posterior border articulates with the lesser wing of the 14 PRACTICAL ANATOMY. sphenoid ; the ethmoidal border, thickened and cellular, articulates with the ethmoid. Two shallow grooves are observed traversing this border, one anterior and one posterior, and which, when articulated with the ethmoid, form the anterior and posterior ethmoidal foramina. Along the anterior part of the ethmoidal border large openings are observed, which lead into almond-shaped cavities behind the supra-orbital ridges. These cavities are the frontal air sinuses, and are separated from each other in the median line by a plate of bone. They are formed by the divergence of the tables of the frontal bone ; on a vertical section they appear triangular ; their largest diameter is horizontal. The superior border of the frontal articulates with the two parietal bones and the greater wing of the sphenoid ; the external angular process with the malar ; the internal angular process with the nasal and superior maxillary. The frontal bone develops from two centres, which appear near the centre of the frontal eminences. These centres first ap- pear about the third month of fcetal life. THE PARIETAL BONES. The parietal bones, two in number, are located at the sides and vault of the skull behind the frontal bone. They articulate with each other at the vertex of the skull, and form the interparietal or sagittal suture. Each bone has four borders, four angles, and two sur- faces, and is traversed from the anterior to the posterior border by a curved line, the temporal ridge, continuous with the temporal ridge on the frontal bone. The tem- poral ridge divides the external surface into two portions, the upper and lower, the upper surface being the larger and smooth, the lower surface the smaller and marked by faint irregularities and minute foramina ; it assists in form- THE PARIETAL BONES. 15 ing the temporal fossa. Xear the upper posterior angle Fig. 4— Parietal Bone, Outer Surface. is a foramen, the parietal, which transmits a vein to the longitudinal sinus. About the centre of tlie bone is the Ani.Tnfir.inq1d Fig. 5.— Pakietal Bone. Inner Surface. parietal eminence. The inner surface is impressed by 16 PRACTICAL ANATOMY. the convolutions of the brain, and also presents several grooves, which are best marked and most constant near the anterior inferior angle. The grooves lodge the middle meningeal artery and its branches. The superior border is slightly beveled at the expense of the inner surface, and, when the bones are articulated, it assists in forming a groove which lodges the continuation of the superior longitudinal sinus. Depressions for the Pacchi- onian bodies are also observed. The superior border articulates with its fellow in the middle line of the skull, forming a deeply serrated and denticulated suture. The anterior border articulates with the frontal bone by tooth- like processes, which firmly interlock with similar proc- esses of the frontal bone. The anterior inferior angle, with part of the inferior border, articulates with the great wing of the sphenoid. The inferior border is concave, and is beveled on its outer surface to articulate with the squamous portion of the temporal ; posteriorly the in- ferior border articulates with the mastoid portion of the temporal bone. The posterior border articulates with the occipital by means of well-marked dentate processes. The parietal bone develops from one centre, which appears about the third month. THE OCCIPITAL BONE. The occipital bone is situated at the back and base of the skull. It is strongly curved, forming an arch of about one-third of a circle. Viewed posteriorly it is diamond-shaped. It presents for examination two su- perior lateral and two inferior lateral borders, an exter- nal and an internal surface, and a basilar process. The superior borders meet above at the apex of the bone, and articulate with the posterior borders of the parietal bones by means of tooth-like processes. The inferior borders THE OCCIPITAL BONE. 17 articulate with the temporal bones ; the upper half with the mastoid portion, the lower lialf with the petrous part of the temporal bone. The upper lialf merely abuts against the mastoid portion; the lower half has project- ing a well-marked process of bone — the jugular process — which articulates with the jugular surface of the petrous portion of the temporal. Anterior to the jugular process is the jugular notch, which, with the jugular fossa on the petrous portion of the temporal, forms the Fig. 6.— OcciprTAL Bone, Outek Surface. jugular foramen for the transmission of the lateral sinus down the neck. The inferior lateral borders are sepa- rated anteriorly by a thick quadrilateral process of bone, the basilar process, which, in the developing skeleton, articulates with the sphenoid, but after the twenty-fifth year the layer of cartilage between them ossifies and the occipital and sphenoid form one bone. The outer sur- face is convex, and midway between the apex and fora- men magnum presents the external tuberosity for the attachment of the ligamentum nuchae; branching out 18 PRACTICAL ANATOMY. from each side of this are the superior curved lines. Running from the tubercle to the foramen magnum is a sharp ridge of bone, the external crest, from which passes, midway between the superior curved lines and the fora- men magnum, the inferior curved lines. The bone above the superior curved lines is smooth ; below it is rough, for the attachment of muscles. At the junction of the posterior portion with the basilar process is the foramen magnum, which transmits the spinal cord some nerves, vessels, and membranes. This opening is oval in outline, the larger part of the oval being posterior ; viewed internally, it appears larger than when looked at from the outer surface. Placed at each side, anterior to its transverse diameter, are the occipital condyles, which approach each other anteriorly, their axes crossing about one inch in front of the foramen magum ; they serve for articulation with the atlas. In front of each condyle is the hypoglossal foramen for the transmission of the hypo- glossal nerve. This foramen is always present, and is of large size. Behind the condyle a foramen is often found, known as the posterior condyloid ; it transmits a vein to the lateral sinus. The inner surface of the occipital bone is concave, slightly impressed by the convolutions of the brain, and is divided into four shallow fossae by the occipital cross, the vertical limb of which affords attachment to the falx cerebelli and falx cerebri ; it lodges the superior longitudinal sinus. The horizontal limbs give attach- ment to the tentorium cerebelli and lodge the lateral sinuses. At the point at which they cross, the longi- tudinal and lateral sinuses meet, forming the torcular Herophili. The superior fossae lodge the posterior lobes of the brain; the inferior fossae, the cerebellum. The superior surface of the basilar process is smooth, con- TIIK OCCIPITAL BONE. If) cave from side to side, and ascends from the foramen magnum. It lodges the medulla oblongata. The inferior surface is rough, for muscular attachment ; it presents the pharyngeal spine, which is not, as a rule, prominent, but affords attachment to the raphe of the pharynx. At the sides of the anterior part of the foramen magnum are small tubercles for the attachment of the check ligaments. The inner aspect of the bone is beveled as it approaches the foramen magnum, and pre- Fig. 7.— Occipital Bone, Inner Surface. sents on each side the "anterior condyloid or hypoglossal foramen. The jugular process and a portion of the inferior lateral border are grooved for the lateral sinus. The occipital bone develops by four centres, one for the posterior part, one for each condyle, and one for the basilar process ; these centres appear about the second month. It belongs to the class of flat bones. At birth it CK)nsists of four pieces, which ossify to form a single bone about the sixth year. 20 PRACTICAL ANATOMY. THE TEMPORAL BONES. The temporal belong to the class of irregular bones. They are situated at the sides and base of the skull, and present three portions, — the squamous, mastoid, and petrous. The squamous portion is a thin plate of bone, which presents for examination an inner and outer sur- face and a border. At its superior part the border is convex, beveled at the expense of its inner surface, and articulates with the inferior border of the parietal. The ^ait«i4Jonim Fig. 8.— Left Temporal Bone, Outer Surface. anterior and inferior part of the border articulates with the sphenoid. The squamous portion is translucent ; it is composed of dense bone, and contains no diploic structure. Its outer surface, smooth and slightly con- vex, presents some shallow grooves for the deep temporal arteries. It assists in forming the temporal fossa, which is limited posteriorly by the temporal ridge, separating ,the squamous from the mastoid portion. Projecting horizontally forward from the lower and posterior part of the squamous portion is the zygomatic process, the THE TEMPORAL BONES. 21 extremity of whicli is serrated for articulation with the malar bone. The zygoma arises from the side of the temporal bone by three roots. The posterior root is the temporal ridge ; the middle root passes down in front of the external auditory meatus, limiting the glenoid fossa posteriorly ; the anterior root forms a well-marked tu- bercle, which passes downward and inward in front of the glenoid fossa, and becomes lost in the eminentia articularis. The superior border of the zygoma is long, thin, and sharp, and has attached to it the two leaflets of the temporal aponeurosis. The inferior border, shorter than the superior, thick and rounded, forms two arches, the first between the extremity and the tubercle. This arch affords attachment to the masseter muscle. The second arch, deeper and much shorter than the first, is between the anterior and the middle roots of the zygoma, and assists in forming the roof of the glenoid fossa. The internal surface of the squamous portion is marked by depressions for the convolutions of the brain, and grooved along its posterior portion by the middle meningealjiij;ery. The mastoid portion is behind and below the tem- poral ridge. It articulates superiorly with the parietal bone, and posteriorly with the occipital. Its borders are broad and blunt, posteriorly slightly serrated. It is a rough, bulky process of bone, terminating inferiorly in a tubercle called the mastoid process. In the posterior border is the mastoid foramen, which is sometimes placed in the suture between the mastoid portion and the occipital bone. The inferior portion of the mastoid process presents two grooves upon its inner face. The external, or digastric, is for the attachment of the digas- tric muscle ; the inner groove not so strongly marked, 22 PRACTICAL ANATOMY. • is for the passage of the occipital artery. A section of the mastoid process shows that it is celkilar, and its cells, which corammiicate with the tympanum, are lined by a continuation of the tympanic mucous membrane. The inner surface of the mastoid portion is deeply grooved for the passage of the lateral sinus. In front of the mastoid portion, and behind the middle root of the zygoma, is the trumpet-shaped opening of the external auditory meatifs, surrounded by a rough ring of bone, the auditory process, to which is attached the external ear. The external auditory meatus is a canal which passes slightly downward and forward to the tympanum, from which it is separated by the membrana tympani. The length of this canal in the bone is about three- fourths inch. It is about one-fourth inch in diameter. The glenoid fossa is a deep cavity in front of the ex- ternal auditory meatus. It is bounded anteriorly by the tubercle of the zygoma and the eminentia articularis; posteriorly, by the middle root of the zygoma and the vaginal process ; internally, by the vaginal process and the eminentia articularis. It is about three- fourths inch in depth, one-half inch antero-posterioiiy, and is crossed obliquely from behind, forward and downward, by the Glasserian fissure, which begins just below the middle root of the zygoma, and passes downward and forward to the angle between the petrous and squamous portions of the temporal bone. It communicates with the tympanum, transmits the laxator tympani muscle and the tympanic branch of the internal maxillary artery, and lodges the processus gracilis of the malleus. The canal of Hugier is just in front of the Glasserian fissure, and transmits the chorda tympani nerve. The roof and posterior wall of the glenoid fossa are trans- lucent, and can be readily crushed in by a force projected THE TEMPORAL BONES. 23 against them. A penetration of the roof of the Glas- serian fissure will enter the cranial cavity, and may injure the inferior surface of the temporq-sphenoidal lobes of the brain. The posterior wall is a frail partition, formed by the vaginal process. It separates the glenoid fossa from the external auditory canal. The petrous portion of the temporal bone is not seen at the side of the skull. It springs from the inner sur- face of the temporal bone, and projects forward and in- f0,rie tMl Jfefartttum fn Dum Zbaxua Audutft ^pntot JitmUiraiLtr Canat Fig. 9.— Left Temporal Bo>-e, Inner Surface. ward, forming an angle of 35 degrees with the squamous portion of the bone. In shape, it is the frustum of a trilateral pyramid lying upon its side. Its base is applied to the inner surface of the squamous and mastoid por- tions. It presents for examination an anterior, a pos- terior, and an inferior surface, and an apex. The anterior is smooth and polished, and presents, near its junction with the squamous portion, an elevation which marks the position of the superior semi-circular canal. Below this is a depression, beneath which is the tym- 24 PRACTICAL ANATOMY. panum ; the bone separating the tympanum from the cranial cavity is very thin and translucent. Internal to this is the hiatus Fallopii, which transmits the large petrosal nerve. A smaller opening frequently exists for the transmission of the smaller petrosal nerve, another branch of the facial. Near the apex is a depression, about the size of a lentil, which accommodates the gan- glion of Gasser. The bone at the apex is slightly CtinaltforJEtiiia-eKtan t/tlre arid Teiuojt-tymjKinCmuseU tCVATOR PAL AT T.c'j-jh Qu-aiTilaUrnl Surface O^tvinj of taraticl. eaiial- Cantilfor Jacobsont in A^unOicms Cor/tlau: "IZ^^^j^B^vyJlll^^'C^ffir,] «TyLO-PllA«YNOE0S Canai fitr ArrwU't nerve Ju^uJjzT jbasd Vaginal proceti Sbt/ltrii praeets Stylo- mastmA: foramen JttyiilriT Surface AuricuhiT fiaturo Fig. 10.— Left Temporal Bone, Inferior Surface of the Petrous Portion. notched, to accommodate the internal carotid artery as it curves into the cranial cavity. At the junction of the petrous and squamous portions is the remains of a suture, which marks the line of separation between the petrous and squamous portions. The posterior surface forms a steeper incline than the anterior, and presents for examination the internal auditory meatus, which is placed about the centre. This canal is about three hues in THE TEMPORAL BONES. 25 diameter and from two to four lines in depth. At the hottom is placed a vertical, cribriform plate, through which the auditory nerve passes to the labyrinth. At the upper part of the vertical plate is a foramen, about the size of a broom-straw. It leads into a canal called the aquseductus Fallopii, and transmits the facial nerve. External to the auditory meatus is a canal called the aquaeductus vestibuli, which 'communicates with the vestibule of the labyrinth and transmits a small vein. A sharp process of bone gives attachment to the dura mater. The inferior surface is very irregular, and pre- sents twelve points for examination. These are placed along the anterior and posterior borders, and a few mid- Avay between. Those along the posterior border, begin- ning at the apex, are* (1) the quadrilateral rough surface ; (2) the aquseductus cochlea ; (3) the jugular fossa, near the anterior portion of which is seen (4) a foramen which transmits the auricular branch of the pneumogastric nerve. External to the jugular fossa is (5) the jugular surface for articulation with the jugular process of the occipital bone. Along the anterior bor- der, beginning at the apex, we have : the quadri- lateral rough surface ; (6) the opening of the carotid canal ; (7) the vaginal process which passes backward, inclosing (8) the styloid process, posterior to which, and at its base, is observed (9) the stylo-mastoid foramen, the termination of the aquaeductus Fallopii ; external to the stylo-mastoid foramen is (10) the auricular fissure for the transmission of a branch of the pneumogastric ^ nerve ; in the partition between the carotid canal and the jugular fossa is (11) Jacobsen's foramen for the transmission of a branch of the glosso-pharyngeal nerve to the tympanum ; in the angle between the petrous and squamous portions is (12) the Eustachian tube, leading 26 PRACTICAL ANATOMY. into the tympanum. The quadrilateral rough surface affords attachment to muscles. The aquaeductus cochlea transmits a vein from the cochlea, and frequently a small artery is seen entering the canal by the side of the vein. The jugular fossa is deep, and, with the jugular notch on the occipital bone, forms the jugular foramen. The carotid canal passes vertically upward one-fourth inch, then bends at right angles, runs horizontally forward for another fourth of an inch, and terminates at the apex. That part of the anterior surface of the petrous portion overlying the carotid canal is notched for the passage of the artery upward to the base of the brain. A vertical, antero-posterior section of the petrous portion shows that it approaclies an equilateral triangle. Its superior border is grooved for the lodgment of the superior petrosal sinus and for the attachment of the tentorium cerebelli. The petrous portion does not contain any spongy tissue. In it is found an excess of the mineral matter. The temporal bone is developed by two prin- cipal centres, — one for the zygomatic and squamous part, and the other for the petrous and mastoid portion. The styloid process and the auditory process have each a separate centre. These centres appear near the end of the second month. The temporal bone contains the organs of hearing, which will be described with the ear. THE SPHENOID BONE. The sphenoid bone is situated at the base of the skull. It articulates with the orbital plates of the frontal anteriorly, and with the basilar process of the oc- cipital posteriorly. It also articulates with all the otlier bones of tlie cranium, binding them firmly and solidly together, and with five bones of the face, — the two malar, the two palate, and the vomer. It presents for exam- THE SPHENOID BONE. 27 illation a body, two greater wings, two lesser wings, and two pterygoid processes. When viewed from the front it resembles a bat with wings extended. The body is hollow, cuboidal in form, and presents superior, in- ferior, anterior, and posterior surfaces. The greater and lesser wings spring from the sides of the body. The superior surface from before backward presents the fol- lowing points : The ethmoidal spine for articulation with the ethmoid ; this is a smooth surface of bone, slightly grooved on each side of the median line for the accom- modation of the olfactory tracts ; anteriorly, it forms a MUdlt. CUitaid praees _.- .. • « ' Toramtn Optieu- . OvaU YiQ. 11.— Sphenoid Bone, Upper Surface. spine which is received in an angle at the posterior por- tion of the ethmoid. This surface is continuous laterally with the upper surface of the lesser wings. Behind the ethmoid spine is the optic groove, which lodges the optic chiasm ; it terminates at each side at the optic foramen. Behind the optic groove is the olivary body, an ovoidal mass of bone which slightly overhangs a fossa posterior to it, called the sella turcica, which lodges the pituitary body. At the sides of this fossa, behind the olivary body, are the middle clinoid processes, — slight elevations which give attachment to the dura mater. Overhanging the 28 PRACTICAL ANATOMY. sella turcica posteriorly is a plate of bone which termi- nates at each side in well-marked processes, — the posterior clinoid. This plate is notched at the sides for the passage of the sixth pair of nerves, and is also centrally notched for the accommodation of the infundibulum. The su- perior surface behind the posterior clinoid processes forms a descending quadrilateral plate of bone, the os planum of the sphenoid, which is continuous with the superior surface of the basilar process of the occipital. It is smooth and polished, and supports the pons Varolii. At its posterior inferior angle it is grooved for the passage of the sixth nerve. At each side of the body the su- perior surface presents a well-marked groove, slightly sinuous, which lodges the cavernous sinus and the in- ternal carotid artery ; it is called the cavernous groove. The anterior surface presents in the median line a vertical, plate-like process of bone, called the sphenoidal crest. It articulates with the vertical plate of the ethmoid, and assists in forming the septum nasi. The sphenoidal crest is not simply a projection from the sur- face, but extends into the interior of the body, forming a vertical partition. After the age of puberty the body is hollow, forming the sphenoidal air sinuses. These sinuses are frequently subdivided by other bony par- titions, and are hned by a continuation of the Schnei- derian mucous membrane of the nose, with which they communicate. On each side of the crest the large, irregular openings of these sinuses are observed. They are largely covered in by small scroll-like bones, — the sphenoidal turbinated. Laterally, the anterior surface articulates with the os planum of the ethmoid ; its upper border, with the frontal ; its lower, with the orbital proc- ess of the palate bone. The inferior surface presents, in the middle line, the rostrum, — a ridge of bone contin- THE SPHENOID BONE. 29 nous with the crest ; it fits in the angle formed by the diverging alse of the vomer. At each side are curved ridges of bone, called the vaginal processes, for articula- tion with the alae of the vomer. Between the vaginal and pterygoid processes is the pterygo-palatine groove, which is formed into a canal by articulation Avith the sphenoidal process of the palate ; it transmits the pterygo- palatine vessels and the pharyngeal nerve. The pos- terior surface, before the twentieth year, is covered by a layer of cartilage which separates it from the basilar ftaygoid LAXATOR TYMfAM Fia. 12.— Sphenoid Bone, Anterior Surface. process of the occipital. After the twentieth year this cartilaginous plate ossifies, and the sphenoid and occipital form one bone. Projecting from the sides of the upper part of the body of the sphenoid are two thin, sabre- like processes, — the lesser wings. These are placed hori- zontally, their surfaces looking up and down. The anterior border is serrated for articulation with the or- bital plate of the frontal. The posterior border is thin and smooth, and is received in the fissure of Sylvius. It projects at its inner posterior portion, and forms a triangular process of bone called the anterior clinoid 30 PRACTICAL ANATOMY. process. Its surlaces are smooth, — the upper poKshed, — and form part of the floor of the anterior fossa of the skull. The mferior surface, near its junction with the body, is slightly roughened for attachment of the recti muscles. It forms the posterior part of the roof of the orbit and the superior boundary of the anterior lacerated foramen. The lesser wings arise by obliquely-placed and flattened roots, which are perforated by the optic fora- mina for the transmission of the optic nerves and the ophthalmic arteries. They are frequently considered as arising by two roots each. The greater wings arise from the sides of the body of the sphenoid by broad, flattened roots, and curve upward, outward, and forward. Each wing presents three surfaces, — a superior, an an- terior, and an external. The superior surface passes obliquely upward, outward, and forward. Its posterior projecting extremity is called the spine. It is strongly concave from front to back, is smooth, impressed by the convolutions of the brain, and enters into the forma- tion of the middle cranial fossa. At its junction with the body anteriorly, it is pierced by the foramen rotun- dum, — a round foramen which is directed horizontally forward. Near its junction with the body posteriorly, is the foramen ovale, — an oval foramen, the axis of which is vertical. Near the extremity of the greater wing, pos- teriorly is the foramen spinosum. These are the prin- cipal foramina ; in addition , there are some minute foramina for the entrance of vessels into the bone; one of these, between the foramen ovale and the body of the sphenoid, is known as the foramen of Vesalius, and trans- mits a small vein. The anterior surface of the greater wing is quadrilateral, smooth, slightly concave from above downward, and at its lower posterior part presents one or two small tubercles for the origin of the lower THE SPHENOID BONE. 31 head of the external rectus muscle ; occasionally, tlie inferior rectus also has a point of origin close to the lower head of the external rectus. One or two small foramina are occasionally observed ; they transmit small vessels. The plane of the anterior surface is directed nearly vertically ; it looks obliquely forward and inward, and forms the outer posterior wall of the orbit. The external surface is divided by the pterygoid ridge into a superior and an inferior portion. The superior surface forms part of the side of the skull, and is about an inch and a half long by one-half to three-fourths of an inch broad. It is concave from before backward, and assists in forming the temporal fossa. A few small foramina are seen which transmit small, nutrient vessels. The inferior surface extends from the pterygoid ridge to the base of the pterygoid process, and assists in forming the roof of the zygomatic fossa. The pterygoid ridge is about an inch and a half long, and runs from the orbital plate to the spine of the great wing. The upper an- terior margin of the greater wing articulates with the frontal ; the upper posterior portion articulates with the anterior inferior angle of the parietal. The posterior border articulates with the squamous portion of the temporal. The spine is received into the angle between the squamous and petrous portions of the temporal bone. The anterior border of the orbital surface articu- lates with the malar. The pterygoid processes arc two strong, somewhat irregular processes of bone, consisting each of two plates of bone joined anteriorly. Each process arises from the rmder surface of the body and greater wing, and is directed vertically downward. At the base of the pter}- goid process is the Vidian canal; it passes horizontally backward above its root. This canal transmits the 32 . PRACTICAL ANATOMY. petrosal nerve to Meckel's ganglion, which is situated in the spheno-maxillary fossa. The anterior border of the pterygoid process is broad at the base. Passing down- ward from the Vidian canal is a groove which, in the articulated skull, assists in forming one of the posterior palatine canals. The inner edge of the anterior border is rough, for articulation with the vertical plate of the palate bone. The lower portion of the anterior border is cleft, forming the pterygoid notch, which articulates with the tuberosity of the palate bone. Posteriorly the two plates diverge, the inner being longer, but narrower, than the outer. It terminates in a hook-like process of bone, called the hamular process. The outer plate, broader but shorter than the inner, is directed obliquely backward and outward. Between the plates at the base is a shallow depression, the scaphoid fossa, below which is the ptery- goid fossa, bounded externally by the external plate, internally by the internal plate, and in front by the tuberosity of the palate. The pterygoid plates are - mainly for muscular attachment. The sphenoid bone develops by ten centres, which appear from the end of the second month to the middle of the third. At birth it consists of three pieces, which do not join before the end of the first year. THE ETHMOID BONE. The etlimoid is an irregular bone, and consists of a vertical and a horizontal plate, arranged in the form of a cross, and hanging from the lateral edges of the horizontal plate are the two lateral masses. It is an exceedingly fragil® bone about the size of an English walnut. It is placed in the middle line of the skull, and fills the ethmoidal notch of the frontal. It articulates witli thirteen bones, — the fj.:ontal anteriorly, the splienoid THE ETHMOID B(>TlE. 33 posteriorly, and with eleven bones of the face. It is placed between the two orbits, and helps to form the inner wall of each orbital cavity. It also assists in form- ing the floor of the anterior fossa of the cranium and the roof and sides of the nasal cavities. The vertical portion of the ethmoid above the horizontal plate is a smooth, triangular piece of bone with a sharp edge. It somewhat resembles a cock's crest, and hence is called the crista galli. Its sides are somewhat bulged, and it is frequently hoUow, inclosing a small air sinus. It serves for the Witi taf.'turbinattd 6. Fig. 13.— Ethmoid Bone. attachment of the falx cerebri. The vertical plate below the horizontal portion is thin, quadrilateral in outline, presenting the anterior superior and inferior borders, the posterior superior and inferior borders, and two surfaces. It assists in forming the septum of the nose, and is generally slightly inclined to one side. It is some- what roughened and grooved on its surfaces, and presents many minute foramina near its junction with the hori- zontal plate. The anterior superior border articulates with the frontal and nasal. The triangular cartilage of 34 PRACTICAL ANATOMY. the nose is attached to the anterior inferior border. The posterior superior border articulates with the crest of the sphenoid ; the posterior inferior, with the vomer. The horizontal plate is perforated on each side of the crista galli with rows of foramina, and is, therefore, called the cribriform plate. It is placed between the two orbital plates of the frontal, filling the ethmoidal notch, and helps to form the anterior fossa of the skull. Its superior surface is narrow and grooved for the olfactory tracts and bulbs. The foramina, fifteen to eighteen in number, are ^ Mfnoidac Fig. 14.— Ethmoid Bone. (Right lateral mass removed.) arranged in three rows, and transmit the branches of the olfactory nerve to the nose. At the side of the crista galli is the nasal fissure for the passage of the nasal branch of the ophthalmic nerve. Anteriorly the cribri- form plate is notched and expanded into two wings, which articulate with the frontal spine, and posteriorly is a deeper notch for articulation with the rostrum of the sphenoid. These articulations form " groove-and-tongue joints" (schindylesis). The lateral masses are pendent from the lateral edges of the cribriform plate. They con- sist of two vertical masses of thin-walled cells, some of THE ETHMOID BONE. 35 which, in the disarticulated bone, appear as cavities on the surface, but with similar depressions on the adjoining bone all these broken cells are completed. The lateral mass presents for examination an external and an in- ternal surface, and an anterior inferior and posterior border. The external surface presents a number of broken cells, and a smooth, rectangular plate of bone, the OS planum, which forms part of the inner wall of the orbit. This plate, at its upper border, presents two notches, which, with similar notches on the frontal bone, form the anterior and posterior ethmoidal foramina. The OS planum articulates along its superior border with the frontal; anteriorly, with the lachrymal; the inferior border, with the superior maxillary ; and the posterior, with the sphenoid and the palate. Below the os planum is an unciform or hook-like process of bone, which passes downward and articulates with the superior maxillary, and helps to close the antrum of Highmore. The inner surface of the lateral mass is very irregular. It is rough, and grooved for the passage of branches of the olfactory bulbs. Running obliquely downward and backward from the upper posterior portion is the superior turbinated process (rudimentary in man), while below, at its inferior border, is the middle turbinated process, — a scroll-like, elongated plate of bone, with its convexity presenting upward and inward. The cells of the ethmoid are divided into anterior and posterior, separated by a more or less complete bony partition ; they communicate with the frontal and sphenoidal sinuses, and with the nasal fossa. The ethmoid develops from three centres; one for the vertical plate and one for each of the lateral masses and its attached horizontal portion. The centres first appear about the fifth month. 36 PRACTICAL ANATOMY. THE NASAL BONES. The nasal are two small, quadrilateral, flat bones, which are placed in the middle line of the skull, below the frontal, and form the bridge of the nose. They present for examination four borders and two surfaces. The superior border is short, thick, and serrated for articulation with the internal angular process of the frontal. The inner border is slightly beveled at the expense of its inner surface ; it is thicker above than below, and articulates in the middle line with its feUow. The external border is thin and rough and is strongly curved, and articulates with the superior maxillary bone. f/ti^ JTrontal B. «^^ "»* > FroTieal Spine. MrpeTuUviuar J*iaU if Ethmoid, groove for tuuai nerve (Outer surface.) (Inner surface.) Fig. 1-5.— Nasal Bones. The inferior border is thin and sharp, and often irregular (" frayed out "). The external surface is smooth, and perforated by a few small foramina ; it is concave from above downward, convex from side to side. The inter- nal surface is concave from side to side, convex from above downward; it presents a slight sinuous groove, passing from the superior to the inferior border, for the nasal nerve. The posterior lip of the inner border is prominent, and forms, with its fellow, the nasal crest for articulation with the spine of the frontal bone and the vertical plate of the ethmoid. The nasal bone develops from one centre, which appears about the second month. THE MALAR BONES. 37 THE MALAR BONES. The malar are two irregular bones which form the osseous support to the cheeks. They are irregularly quadrilateral, and present for examination a body and four processes, — the frontal, orbital, maxillary, and zygo- matic. The body has an external and an internal sur- face. The external surface is convex, smooth, and, near its upper border, presents the malar foramen, the opening of the temporo-malar canal, which transmits some small branches of the superior maxillary division of the fifth nerve. The posterior surface is concave, and presents a ttialn patmtt linxgh (Outer surface.) (Inner surface.) Fig. 16.— Malar Bones. rough surface for articulation with the superior maxillary bone ; it enters into the formation of the temporal and zygomatic fossae. The frontal process is strong and thick, its edges are rounded, and its articulating end is serrated for articulation with the external angular process of the frontal. The orbital margin is arched, with its concavity presenting upward. The orbital process is a curved, shelf-like plate, which projects back- ward from the orbital margin and descends from the frontal process downward and inward ; it assists in form- ing the outer wall and floor of the orbit, and presents the inner opening of the temporo-malar canal. Its 38 PRACTICAL ANATOMY. anterior border is rounded, and forms part of the orbital ridge ; its posterior border is rough, and articulates, behind the frontal process, with the frontal; lower down, with the great wing of the sphenoid ; the inner third articulates with the superior maxillary. Just external to its articulation with the superior maxillary is a smooth, non-articular surface, which enters into the formation of the spheno-maxillary fissure. The maxillary process is a rough, trilateral surface, which articulates with the superior maxillary bone. The zygomatic process is strong, and serrated for articulation with the extremity of the zygoma. The inferior border of the malar bone is on a line with the zygoma. It develops from one centre, which appears about the second month. THE SUPERIOR MAXILLARY BONE. The superior maxillary are two triangular bones forming the upper jaw and the greater part of the osseous structure of the face. Each bone articulates with nine bones, — the frontal, ethmoid, nasal, malar, lachrymal, vomer, inferior turbinated, palate, and with its fellow, with which its alveolar process forms an arch, the superior dental, in which the teeth are placed. Each bone assists in the formation of three cavities, — the orbital, nasal, and buccal; two fossae, — the spheno- maxillary and the zygomatic; and two fissures, — ^^the pterygo-maxillary and the spheno-maxillary. It pre- sents for examination a body and four processes, — nasal, malar, palatine, and alveolar. In the adult the body is cuboidal, hollow, and forms an air sinus, known as the antrum of Highmore, which begins to develop about the fifth year. The superior surface of the body is smooth, triangular, and presents a groove, the infra- orbital, which begins at the posterior border and curve THE SUPERIOR MAXILLARY BONE. 39 slightly outward and downward, enters the substance of the bone, and terminates below the anterior border, at the infra-orbital foramen ; a branch of this canal descends in front of the antrum in the substance of the bone. The infra-orbital canal transmits the superior maxillary division of the fifth nerve. The Circumference of the Superior Surface. — The inner border anteriorly is notched, smooth, and assists in forming the lachrymal canal; behind this it is tuitrtJt. lnri*M f»**» Pttteri*rD*iitttl Camalt nllury Tulirotity, ^^'* Fig. 17.— Superior Maxillary Bone. serrated, somewhat cellular, and articulates from before backward with the lachrymal, lower border of the os planum of the ethmoid, and the orbital surface of the palate. The posterior border is directed obliquely backward and outward, is somewhat rounded, presents at its centre the beginning of the infra-orbital groove, and forms the greater part of the lower boundary of the spheno-maxillary fissure. The anterior border is directed obliquely outward and backward ; at its angle with the posterior border is a rough, trilateral, irregular 40 PRACTICAL ANATOMY. surface of bone, the malar process, with which the malar articulates. The lower margin of this surface looks obliquely downward and forward, and is more or less straight ; the upper margin is concave and terminates posteriorly in a hook-like process, which articulates with the great wing of the sphenoid. This process projects from the side of the superior maxilla, its lower border being horizontally notched, affording attachment for the masseter muscle. The posterior margin is also concave and vertical. The anterior border of the su- perior surface, internal to the malar process, is smooth, rounded, and forms part of the circumference of the orbit. The posterior surface of the body is directed nearly vertically downward, is bluntly rounded, and presents along its inner border a groove, which, when articulated with the vertical plate of the palate, is converted into the posterior palatine canal. Along the posterior border are several foramina, — the posterior dental, which trans- mit nerves and vessels to the molar teeth. At the lower portion is the post-molar tubercle, prominent after the eruption of the wisdom-tooth. After the ab- sorption of the alveolus, consequent upon loss of the teeth, the post-molar tubercle frequently disappears. At its lower portion it articulates with the tuberosity of the palate, and sometimes with the pterygoid process of the sphenoid. The posterior border of the superior maxillary forms the anterior boundary of the pterygo- maxillary fissure, and limits the spheno-maxillary fossa anteriorly. The internal surface forms part of the outer wall of the nose and mouth. It is divided by a horizontal process of bone, the palatine, which projects inward from the line of junction of the lower with the middle third of the inner surface. That THE SUPERIOR MAXILLARY BONE. 41 portion above the palatine process enters into the forma- tion of the outer wall of the nose ; that portion below assists in forming the cavity of the mouth. Above the palatine process, near the posterior border of the bone, is an opening leading into the antrum of Highmore, which is a cavity about the size of a hickory-nut. The opening leading into the antrum is very large and irregular in the disarticulated bone, but, in the articu- lated skull, processes of the turbinated, ethmoid, and BonM fartmOy etoii^f (f*(ftct tfAitr. marlitJ in eudui* SAmCd Lffaiff TllTiinattJ — Ari. Kasal^vc BrittU Fig. 18.— Superior Maxillary, Inner Surface. palate bones close in the antrum, leaving only a small orifice, which communicates with the middle meatus of the nose. The nasal mucous membrane is con- tinued through this opening, and lines the antrum. Upon section it is trilateral, frequently subdivided by delicate lamellre of bone, and often presents upon its floor conical projections, which correspond to the apices of the roots of the first and second, and sometimes the last, molar teeth. Its walls are thin and trans- lucent, and, if probes of whale-bone are inserted in the 42 PRACTICAL ANATOMY. posterior and anterior dental canals, these are seen to run in the outer wall of the antrum ,^ skirting its lower portion. Running in the roof of the maxillary sinus is the infra-orbital canal, the floor of which is quite thin.* At the junction of the internal with the superior sur- faces are a series of broken cells. Below the antrum the bone is smooth, concave, and continuous with the superior surface of the palatine process. Running from the lower portion of the opening of the antrum down- ward and forward is a fissure for articulation with the maxillary process of the palate bone. Posterior to the antrum the inner surface is rough, and articulates with the external surface of the vertical portion of the palate, which converts a groove on the inner surface of the superior maxillary into a canal, — the posterior palatine ; it passes downward and slightly forward, and transmits the posterior palatine nerve from Meckel's ganglion. At the anterior portion of the inner surface is a trilateral plate of bone, the nasal process, about one and one-half inches in length and three-fourths inch in width. At its upper por- tion is a ridge called the superior turbinated crest, and at its lower portion another ridge, the inferior turbinated crest, which articulate with the middle turbinated process of the ethmoid and the inferior turbinated bone, respect- ively. Behind the nasal process, between it and the antrum, is a deep, groove, the lachrymal, which is con- verted into a canal by articulation with the lachrymal and inferior turbinated. It lodges the nasal or lachrymal duct, and terminates in the inferior meatus of the nose. All that portion of the inner surface of the nasal process between the superior and inferior turbinated crests enters into the formation of the middle meatus of the nose. *A study of the position of tiiis canal is important in excision of the second division of the fifth nerve by Garretson's operation. THE SUPERIOR MAXILLARY BONE. 43 That portion oi' the inner suriace below the inferior tur- binated crest assists in forming the inferior meatus of tlie nose. Below the palatine process the bone is rough and uneven, and, extending liorizontally backward from the posterior edge of the palate process, is a roughened ridge for articulation with the angle of junction of the vertical and horizontal portions of the palate bone. The anterior surface of the superior maxillary looks forward, outward, and slightly downward. Just below the orbital ridge is the infra-orbital foramen, through which the second division of the fifth nerve emerges upon the face. This foramen is slightly oval, its ante- rior or upper margin forming a lip or ridge, which over- hangs the foramen, and which becomes lost upon each side of it. The bone just below is grooved. The infra- orbital foramen is commonly on a line with the second bicuspid tooth. Below and somewhat posterior to the infra-orbital foramen is a triangular, shallow depression, — the canine fossa ; it forms the anterior wall of the antrum, and is quite translucent. It gives origin to the levator anguli oris muscle. In front of this is a vertical eleva- tion, the canine eminence, which marks the position of the root of the canine tooth. Anterior to the canine eminence is the incisive fossa, — a depression above the lateral incisor tooth; it gives origin to muscles. The inner border of the anterior surface, above the palatine process, presents a large, semi-heart-shaped notch, — the opening of the nose anteriorly. This notch begins at the nasal process ; its border is smooth ; it curves down- ward, outward, and then horizontally forward, terminat- ing in a sharp-pointed process, which, when articulated with its fellow, forms the anterior nasal spine. The nasal process is a triangular plate of bone, which projects upward and forward. Its anterior border articulates 44 PRACTICAL ANATOMY. with the nasal; its apex, thick and serrated, with the frontal ; its posterior projecting edge, with the lachrymal, forming the lachrymal canal. The external surface is smooth, slightly concave, and presents a few nutrient foramina, and affords attachment to muscles. The pos- terior border is grooved by the lachrymal duct. The inner surface has been described. The palate process is a thick, spongy, shelf-like plate of bone, which projects horizontally inward from the inner surface of the supe- rior maxillary. It begins at the anterior surface of the bone, and passes backward, terminating posteriorly on a Une just above the anterior portion of the second molar tooth, and nearly opposite the posterior surface of the malar process. The palatine process presents for exami- nation a superior and inferior surface, a posterior and internal border. The superior surface is concave from side to side, smooth, and forms the floor of the nose. The inferior surface is rough, perforated by many nutri- ent foramina, and is slightly grooved for the passage of vessels. The inner border is thick. Along its upper sur- face it is thrown into a sharp lip, which, in the articulated skull, forms a crest that is continued backward from the anterior nasal spine ; it articulates with the vomer. The anterior portion of the palatine process is thicker than the posterior ; its inferior surface is curved upward and backward, beginning at the necks of the incisor teeth. The inner border behind the central incisor is grooved (sometimes it presents a canal), and, when articulated with its fellow, forms the anterior palatine canal. It transmits the anterior palatine vessels. The posterior border is thin, rough for articulation with the palate, and concave on the upper edge. The alveolar process is a temporary structure, and but little developed prior to the eruption of the teeth. It entirely disappears in THE SUPERIOR MAXILLARY BONE. 45 edentulous subjects. As it serves for the secure accom- modation of the teeth, it is best seen in perfect dentures. The alveolar process consists largely of spongy bone. It is broader behind than in front, and presents eight prin- cipal cavities for the teeth, those for the molar teeth being subdivided by lamellae of bone, forming separate sockets for the roots. These sockets are of different Ant.pal4xHF9e \ Canal JPtramerv Feraitten' of Scarjpet ihst.j>ulaHfte (xut€Uf \ / .Areessory jtalatUu^ Fig. 19.— Roof of the Mouth. (Formed by the palatine processes of the superior maxillary bones and the palatine processes of the palate bones.) sizes ; thus, the canine socket is the deepest, the socket for the first molar the broadest. The direction of the axes of the sockets is upward, and for the anterior teeth also slightly backward, giving to the teeth their forward projection, as is well seen in the negro. The outer sur- face of the alveolar process is thrown into vertical eleva- tions and depressions, which mark the position of the roots of the teeth and the intervals between them. The 46 PRACTICAL ANATOMY. alveolar border abruptly constricts the necks of the teeth, but does not fit around them tightly ; the teeth can be rattled in their sockets in the recently cleaned skull ; this, of course, under normal circumstances, can- not be done, as the soft structures serve to pack the teeth firmly in position. The superior maxillary develops by four centres, which appear at the beginning of the third month. One centre serves for the development of the nasal and facial portions, including the anterior wall of the antrum. A second centre is for the development of the malar and orbital portion, with the lateral and posterior parts of the bone. From a third centre the inner surface and pos- terior portion of the palatine process develop. The an- terior portion of the palate process and the anterior part of the bone up to the canine tooth are developed by a separate centre. The line of junction between this in- cisive portion and the rest of the bone occasionally per- sists as a suture, a condition which in some of the lower animals is the rule, forming a separate piece of bone, the intermaxillary, particularly well seen in the skulls of sheep. When this centre does not appear, a cleft exists at the anterior part of the roof of the mouth, constitut- ing one form of harelip and cleft palate. THE LACHRYMAL BONE. The lachrymal is a delicate, flat, quadrilateral bone, situated at the inner wall of the orbit; articulating ante- riorly with the nasal process of the superior maxillary, above with the orbital plate of the frontal, posteriorly with the OS planum of the ethmoid, and inferiorly with the orbital plate of the superior maxillary, and the in- ferior turbinated bone. It is about four lines in width by eight lines long. It is translucent, and, other than THE PALATE BONES. 47 nA Frontdt the articulating borders, presents for examination an ex- ternal and an internal surface. The external surface is smooth, and divided by a ridge into an anterior grooved and a posterior flat portion. The ridge, known as the lachrymal ridge, terminates inferiorly in a well-marked, hook-like process, which projects forward and articulates with the superior maxillary. In front of the lachrymal ridge is the groove, which, when the bone is articulated with the nasal process of the superior maxillary, forms the lachrymal canal. Posterior to the lachrymal ridge the bone is smooth and forms part of the inner wall of the orbit. The internal surface is roughened and at times cellular; it articulates with the ethmoid and in- ferior turbinated. This bone develops from one centre, which appears in the second month. THE PALATE BONES. The palate consist of two irregu- lar bones, placed at the posterior portion of the nose, flie outer wall and floor of which they assist in forming. They enter into the formation of the roof of the mouth and floor of the orbit, and form part of the inner wall of the maxillary sinus (antrum of Highmore). The palate bones also assist in forming three fossae, — the pterygoid, zygomatic, and spheno-maxillary ; and one fissure, — the spheno-maxillary. Each presents for ex- amination a vertical and a horizontal portion arranged in the form of the letter L, and projecting upward from the superior border of the vertical limb are two proc- esses,— a large anterior, the orbital, and a small pos- terior, the sphenoidal. The horizontal portion presents Fig. 20.— Lachrymal Bone. 48 PRACTICAL ANATOMY. for examination a superior and an inferior surface, an anterior, inner and a posterior border. The anterior border is thin and serrated for articula- tion with the posterior border of the palatine process of the superior maxillary. The inner border is thick, rough, and spongy; its upper edge is turned up in a prominent lip, which, when articulated with its fellow of the oppo- site side, forms the crest with which the vomer articu- lates, and is continuous with the crest of the palatine process of the superior maxillary bone. The posterior »1 A Fig. 21.— Palate Bone. (Viewed posteriorly.) •(•■IttHTAI. .ri«Te Fig. 22.— Palate Bonb. (Inner surface.) border is thin, concave from side to side, and terminates in the middle line posteriorly in a spine forming in the articulated skull, — the posterior nasal spine. The superior surface is smooth, concave from side to side, and forms the posterior portion of the floor of the nose. The in- ferior surface is smooth, but slightly irregular. Near the posterior border is the palatine ridge, which curves out- ward and backward and affords attachment to the tensor palati muscle. External and anterior to the palatine ridge is a groove which passes upward upon the external surface of the vertical plate. This groove is converted THE PALATE BONES. 49 into the posterior palatine canal in articulation with the superior maxillary. The vertical portion presents for ex- amination an internal and external surface, an anterior and posterior border, and the orbital and sphenoidal processes. The internal surface is smooth, and is crossed by two oblique ridges, — the superior and inferior turbi- nated crests for articulation with the middle turbinated process of the ethmoid and the inferior turbinated bone, respectively. Below the inferior turbinated crest the bone is concave, and forms the posterior part of the in- ferior meatus of the nose; between the crests the surface is slightly concave, and forms part of the middle meatus. The surface is frequently grooved for small vessels, and occasionally presents a foramen near the posterior border. The external surface, above the angle of junction with the horizontal plate, is rough for articulation with the inner surface of the superior maxillary. Above the rough surface is a quadrilateral, smooth, slightly concave surface, which helps to close the antrum of Highmore. Along the posterior portion of this surface the bone is thrown into a lip, which slightly conceals the posterior palatine groove. This groove curves from above slightly forward, downward, and backward, and is larger below than above. In the articulated skull the opening of the canal is just above the wisdom-tooth. The anterior border is thin, sharp, and irregular; it extends from the orbital to the horizontal process. At its middle it pre- sents a projecting, vertical plate of bone, the maxillary process, which assists in closing the antrum. The pos- terior border is concave, rather thick, irregular, grooved, and terminates at its lower portion in the tuberosity, which is a transversely expanded piece of bone, serrated at its edges for articulation with the internal and external pterygoid plates, with an intervening, smooth, concave 50 PRACTICAL ANATOMY. surface, which completes the pterygoid fossa anteriorly. At the junction of the horizontal portion with the tuber- osity are several foramina, leading into canals, — the acces- sory posterior palatine. The orbital process is a hollow wedge, which projects from the upper anterior border of the vertical plate ; it is about one-half inch antero- posteriorly, one-half inch vertically, and one-fourth inch transversely. It presents five surfaces, two of which are non-articular and three articular. The non-articular sur- faces are the orbital and zygomatic ; the articular are the ethmoidal, maxillary, and sphenoidal surfaces. The orbital surface is triangular and smooth, and is directed upward and forward and outward, and assists in forming the floor of the orbit. The zygomatic surface is quadri- lateral in outline, smooth, is directed outward, backward, and slightly downward. It limits the spheno-maxillary fossa anteriorly. The angle of junction of the zygomatic and orbital surfaces is smooth and rounded, and forms part of the anterior boundary of the spheno-maxillary fissure. The ethmoidal surface is directed forward, in- ward, and upward; it articulates with the lateral mass of the ethmoid behind and below the os planum. Occa- sionally the cavity of the orbital process communicates with the cells of the ethmoid. The maxillary surface is directed forward, downward, and outward, is trilateral in outline, and slightly rough for articulation with the upper part of the posterior border of the superior maxil- lary. The sphenoidal is directed backward, inward, and upward. It is a quadrilateral surface, the margins of which are roughened for articulation with the sphenoidal turbinated bone. The sinus of the orbital process is sufficiently large to hold a currant; its walls are thin and translucent, its floor (maxillary surface) being frequently cribriform. The sphenoidal process projects from the THE VOMER. 51 back part of the upper border, overhanging the posterior border. It is trilateral, compressed from side to side, and presents for examination an anterior, posterior, and supe- rior border, and two surfaces, — the external and internal. The posterior border is thin, irregular, and articulates with the pterygoid process. The superior border is flat- tened, and overhangs the superior meatus; it is slightly roughened, and articulates with the sphenoidal turbinated bone. The anterior border is concave, smooth, and rounded, and forms the posterior boundary of the spheno- palatine notch. The external surface is divided by a longitudinal crest into an anterior non-articular and a posterior articular, grooved surface, which assists in form- ing the posterior palatine canal. Anterioi* to the ridge the bone is smooth, and leads into the spheno-palatine foramen. The internal surface is smooth, strongly con- cave from above downward, and assists in forming the superior meatus of the nose. Between the sphenoidal and orbital processes is the spheno-palatine notch or foramen; it is oval in form, its long axis being almost vertical in the articulated skull. Its boundary anteriorly is smooth, broad, and formed by the posterior inferior border of the orbital process. Posteriorly, the border is sharp; small spiculae or spines of bone sometimes project from the circumference, subdividing it. This notch is converted into a foramen by the sphenoidal turbinated bone. It transmits the spheno-palatine vessels and nerves. The palate bones develop from a single centre, which appears at the external border of the horizontal plate about the third month. THE VOMER. The vomer is a flat, translucent, quadrilateral bone, which articulates posteriorly with the rostrum of the 52 PRACTICAL ANATOMY. sphenoid and below with the nasal crest formed by the articulation of the horizontal processes of the superior maxillary and palate bones. It assists in forming the partition, or septum, of the nose. It presents two sur- faces and four borders,— superior, anterior, inferior, and posterior. It is somewhat diamond-shaped, its outline being not unlike that of an arrow-head. The surfaces are smooth. Running obliquely from behind, forward and downward, is the naso-palatine groove, transmitting the naso-palatine nerve ; it terminates, in the articulated skull, at the anterior palatine canal. The surfaces of the vomer form part of the inner wall of the nasal cavities. The -:*w^ 10-HVS.OLMIU* iier'NYOiDCV* jti^biyiJ Jt-^' Bo dy Fig. 26.— Left Hai.f of Inferior Maxillary Bone, Inner StTRPACB. constitutes the alveolar process, which is narrower in front than behind, and presents sixteen sockets for the. reception of the teeth. The alveoh for the incisor teeth are conical pits, compressed laterally. They are about half an inch in depth, their apices recede from the anterior surface of the bone, and their axes are in- cHned slightly outward. The incisor teeth readily drop out of their sockets after the removal of the soft structures. The canine alveoli are the deepest sockets of the lower jaw ; their axes are placed vertically ; they are conical pits, laterally slightly compressed, and oval on section ; the long axis of the oval is directed outward, THE INFERIOR MAXILLARY. 57 forming an angle of about 40° with the median line. The sockets of the bicuspids are conical pits, compressed antero-posteriorly. Their sections are oval, the long axis of the oval in the first bicuspid being about 50°, that of the second aH^t 60°. The vertical axis of the cuspid sockets is directed slightly inward. The sockets for the three molar teeth are each double, a partition of bone passing transversely across the cavity, subdividing it into an anterior and posterior socket ; these are for the lodgment of the roots of the molar teeth. The septum between the roots is thick in the first molar, less so in the second, and thinnest and irregular in the third. Along the median line the partition is .bulged, both anteriorly and pos- teriorly ; this is best seen in that across the first molar socket. In all molar sockets the anterior division is broadest and largest. The cavity for the wisdom-tooth is not regular in form. The fig.27.-showingangula- o TioN OF Tooth-Sockets. vertical axes of the molar teeth are inclined inward, the second more than the first, and the last are generally most strongly inclined. The object of the inclination of the axes of the lateral sockets of the lower jaw is to enable the lower teeth to articulate or strike against the upper, and, as the lower jaw is broader than the upper, this can only be effected by an inward inclination of the axes of the teeth, and hence of their sockets. Behind the last molar is a triangular, rough depression, the post-molar fossa, well marked in some of the lower animals. The alveolar border is slightly everted anteriorly, slightly inverted posteriorly. The rami of the inferior maxillary bone are two 58 PRACTICAL ANATOMY. strong, flat, quadrilateral processes of bone at right angles to the body. They present for examination an external and internal surface ; an anterior, posterior, su- perior, and inferior border; an angle, and two processes. The external surface is smooth, flat, and presents some elevations and ridges for the attachment of the masseter muscle. The internal surface is very uneven. About its centre is the inferior dental foramen, leading into the inferior dental canal, which is directed obliquely down- ward and forward. The approach to the inferior dental foramen from above is funnel-shaped and grooved at the expense of the inner surface of the ramus. Over- lapping the foramen is a sharp lip of bone, deeply-notched on its upper edge ; it gives attachment to the internal lateral ligament of the jaw. Running downward and forward from the lower border of the inferior dental fora- men is a well-marked groove, the mylo-hyoid, which lodges the mylo-hyoid artery and nerve. At the posterior lower portion is a well-marked, shallow fossa, the pos- terior margin of which is very rough; it serves for the attachment of the internal pterygoid muscle. Above the foramen the bone is flattened and beveled up to the superior border. The anterior border is thin and sharp, and continuous with the external oblique line ; it terminates above in a flattened, triangular process, the coronoid, which gives attachment to the temporal muscle. The superior border is strongly concave and sharp, and forms the sigmoid notch ; it runs from the coronoid process anteriorly to the condyloid process, which projects upward and backward from the posterior angle of the superior border. It is a strong process of bone, compressed antero-posteriorly, and surmounted by the condyle, which articulates with the glenoid fossa of the temporal bone. The condyle is directed outward THE INFERIOR MAXILLARY. 59 and slightly forward, forming an angle of about 15 degrees with a transverse line bisecting the two glenoid cavities. It is about three-fourths of an inch trans- versely, one-fourth of an inch antero-posteriorly. It is slightly convex from side to side, and strongly convex from front to back. The articular surface extends down- ward upon the posterior border of the process, and deeper internally than externally. Below the articulating sur- face, anteriorly, is a depression at which the external pterygoid is inserted, and lower down the bone becomes somewhat constricted, forming the neck. The posterior surface of the process is convex from side to side and firom above downward. The posterior border is slightly concave from above downward; it is smooth and rounded, and directed downward and somewhat forward. The inferior border is the continuation of the lower border of the body; at the junction with the posterior border it forms an angle which is markedly obtuse in infancy and old age ; in the adult, between twenty and fifty years, it approximates a right angle. The posterior border of the angle gives attachment to the stylo- maxillary ligament. The inferior maxillary develops by two principal centres, one for each half, which meet and join at the symphysis, forming one bone. The shape and general appearance of the inferior maxillary differ at different periods of life ; thus, at birth it consists of two halves, the angle is very obtuse, and the alveolus is undeveloped, although it contains the sockets of the temporary teeth and the germs of the permanent set. In the adult the angle is nearly a right angle, all the ridges and processes are strongly defined and developed, the alveolar process is strong and complete, constricting the necks of the teeth. In old age the bone recedes and approximates its 60 PRACTICAL ANATOMY. infantile characteristics, the angle is again very obtuse, the alveolar process absorbed, and the mental process pointed and prominent. The skull is an ovoid structure with a flattened and irregular base. It consists of two portions, — the cranium and the face. In the adult male these two are of nearly equal proportions ; in infancy the cranial portion is nearly Fig. 28.— a Laterai- View of the Skull. 1. Inferior maxilla. 2. Angle of inferior maxilla. 3. Condyle of inferior maxilla. 4. Mastoid portion of temporal. 5. Occipital. 6. Zygoma. 7. Coronoid process of inferior maxilla. 8. Malar bone. 9. Superior maxilla. 10. Nasal bone. 11. Frontal bone. 12. Temporal bone. 13. Parietal bone. 14. Superciliary ridge. eight times as large as the facial. In adult females the cranium constitutes about three-fifths and the face two- fifths of the bulk of the skull. The bones which enter into the formation of the skull are, with the exception of the inferior maxillary, immovably articulated togetller, and comprise the synarthrodial joints. On the surface THE SKULL. 61 of the skull are a number of irregular linear markings, which are the lines of articulation between the different bones ; they are called the seams or sutures. Three of these have received special names : the coronal, between the frontal and parietal bones ; the sagittal, between the two parietal ; and the lambdoid, between the parietal and occipital bones. Sutures are also named from the bones between which they are placed ; thus, the fronto-parietal, the inter-parietal, the parieto-occipital, the temporo-sphe- noidal, the naso-maxillary, the temporo-maxillary, the maxillo-malar, and others. Some of the sutures are very irregular and deeply dentated ; such are the fronto-pari- etal, the inter-parietal, the parieto-occipital. Others are formed by the beveled edge of one bone resting against the beveled edge of another, as in the anterior part of the temporo-parietal articulation and the spheno-parietal. Some simply abut, as the inter-nasal, inter-maxillary, spheno-occipital (prior to the ossification of the interposed plate of cartilage), part of the spheno-temporal. Some form a groove-and-tongue joint, as is the case with the vomer in its articulations with the palate and the palatine processes of the superior maxillary, and also with the ros- trum of the sphenoid. All the sutures are most marked in early life ; later, some of them undergo ossification, and are thus obscured or altogether obliterated. The cranial portion of the skull forms an osseous case, which is ovoidal in shape and contains the brain. Its capacity in the highest (xanthochroic) races is about one hundred cubic inches. As a general rule, the lower the race, the less the capacity of the brain-case. An antero-posterior section of the cranium is oval, the smallest end of the oval being anterior. A transverse section approximates a circle. These sections also exhibit the mechanical construction of the cranium, 62 PRACTICAL ANATOMY. which is such as to effectually resist violence to the organ which it contains. The cranium is about seven inches long, five inches at its widest part, and five inches high from the vertex to the base. Its circumference is about nineteen inches. Its walls average three-sixteenths inch in thickness. If divided in the median line, it is found not to be absolutely symmetrical. Marked asymmetry of the cranium is frequently observed in the insane, and also in the criminal classes. The skull presents for examination five regions, — a superior, an inferior, two lateral, and an anterior. The superior region is known as the vertex, or summit. It is bounded in front by the superciliary ridges and the glabella ; behind, by the superior curved lines of the occipital; laterally, by a hne drawn from the superior curved line of the occipital to the temporal ridge, and thence to the external angular process of the frontal. The vertex is formed by the frontal, the two parietal, and the occipital bones. From before backward are seen, on each side of the median line : the frontal eminence, the remains of the frontal suture, the parietal eminence or boss, the parietal fora- men, and, in some skulls, at the angle of articulation between the two parietal and the apex of the occipital, a separate piece of bone, sometimes a number, consti- tuting islands of bone held firmly in position by dentated processes. They are called Wormian bones. They are also found, but less frequently, at the junction of the coronal and sagittal sutures. In some of the lower ani- mals, as the sheep, they are the rule. The development of Wormian bones in these positions is due to the deposit of separate ossific centres. In the foetus the bones of the cranium are not fully developed, hence not solidly articulated, and, by slight pressure, their edges, particu- larly those forming the vertex, can be made to overlap. THE SKULL. 63 The most marked lack of full development is seen at the junction of the frontal, coronal, and sagittal sutures, where a diamond-shaped or quadrilateral opening exists, which does not close before the second year. At the junction of the sagittal and lambdoid sutures is a narrow, elongated opening, caused by the divergence of the posterior part of the superior borders of the parietal bones, and, as before stated, it is at this place principally that Wormian bones are developed. Such openings are also met with at the sides of the skull, at the temporo-parietal and parieto-sphenoid articulations. In the infant, these openings in the skull pulsate syn- chronously with the action of the heart, and hence they are called fontanelles; the anterior are situated at the frontal, sagittal, and coronal sutures ; the posterior, at the junction of the sagittal and lambdoid sutures. These two fontanelles should be carefully studied, as they are of great importance to the obstetrician in determining the position of the head of the foetus. The internal surface of the vertex is smooth, strongly concave, and presents a number of slight elevations and depressions, which correspond with the convolutions of the brain. Running along the median line, from front to back, is the groove which lodges the superior longitudinal sinus. This groove is penetrated by many minute foramina, which transmit veins to the sinus. Two of these, the parietal, are of larger size. They are situated near the posterior superior angle of the parietal bone. The inner surface of the vertex also presents grooves at its sides for meningeal arteries. Of these the deepest and most important is that which passes up from the anterior inferior angle of the parietal bone. It lodges the middle meningeal arter}*. The base of the skull presents for examination an 64 PRACTICAL ANATOMY. external or inferior surface and an internal or superior surface. The external surface extends from the incisor ;•<*' Ant.pala*inlifitf/i Wntmit* left Nato-palM. n httUKiUeAnl.fml/tt wjt. TmntmUt rigMlfanfalat.n. ^fiMuid.ffe. ^PaUt*. TtiiMii TrMram. tr-eM»i*n*-itkauit/yiraia,mJ^nt iTot rrnnv Fig. 29.— Base of Skui-Ij, External Subfack. teeth anteriorly back to the superior curved lines of the occipital, and laterally to the zygomatic processes and a THE SKULL. 65 line drawn from the third root of the zygoma back to the superior curved line of the occipital. It is exceed- ingly irregular and rough, and is divided into two por- tions,— the cranial and the facial. The former occupies the posterior two-thirds and the latter the anterior third of the base. The bones entering into the formation of the inferior surface of the base are, from behind forward, the occipital, two temporal, sphenoid, vomer, two palate, and two superior maxillary ; in all, nine bones. About the middle of the cranial portion of the base is the foramen magnum, the position of which varies somewhat in the different races; as a rule, it is farther posterior in the inferior races than in the higher; in the anthropoid apes it approaches the posterior part of the skull. At each side of the foramen magnum anteriorly are the condyles for articulation with the atlas; behind the condyles are the posterior condyloid foramina, which transmit veins to the lateral sinuses. Passing backward from the foramen magnum to the external occipital pro- tuberance is the occipital crest, from Avhich the inferior curved lines branch outward and downward. At the sides of the crest, between the curved lines, the bone is slightly shallow and rough, for the attachment of mus- cles. In front of the condyles are the large anterior condyloid or hypoglossal foramina, for the transmission of the hypoglossal nerves. Tliese foramina penetrate the bases of the condyles and pass horizontally forward. External to the condyles, and in front of a line drawn from the mastoid process to the anterior portion of the condyle, is the foramen lacerum posteriorus, or jugular foramen. It is irregularly ovoidal in form, the large end of the oval being directed toward the mastoid process ; its axis is directed obliquely outward and backward, forming an angle of from 35 to 45 degrees with the 5 66 PRACTICAL ANATOMY. transverse diameter of the skull. It is bounded pos- teriorly by the occipital bone, anteriorly by the petrous portion of the temporal. It is formed by the jugular notch of the occipital and jugular fossa of the temporal bone. Its axis is curved, being directed at first upward, then horizontally backward. It transmits the jugular vein, the glosso-pharyngeal, pneumogastric, and spinal accessory nerves. External to the jugular foramen is the stylo-mastoid foramen, out of which the facial nerve emerges from the skull. Anterior to the jugular foramen is the opening of the carotid canal, which at first passes vertically upward, then horizontally inward and forward; its upper inner wall is deficient. In front of the carotid foramen, in the angle between the petrous and squamous portions of the temporal bone, is the rough, funnel- shaped opening of the Eustachian canal, which leads into the tympanum ; it is directed obliquely backward and outward and is divided horizontally by a partition of bone, — the processus cochleariformis. The lower part of the canal serves as an air-vent (it is the Eustachian canal proper) to the tympanum. The upper canal lodges the laxator tympani muscle. In front of the foramen magnum is the rough quad- rilateral basilar process, continuous in the adult skull with the body of the sphenoid, with which it joins just behind the vomer. The sides of the basilar process assists in forming the middle lacerated foramen, which is bounded externally by the apex of the petrous portion of the temporal bone, anteriorly by the base of the pterygoid process and posterior border of the great wing of the sphenoid, and internally by the basilar process of the occipital. It is triangular, with the base of the tri- angle directed forward, and in the recent state is filled with cartilage, which, however, is penetrated by small THE SKULL. 67 canals for the transmission of meningeal arteries to the brain ; it is also traversed horizontally by the large petrosal nerve, which enters the Vidian canal at the base of the pterygoid process. The interval between the petrous and squamous portions of the temporal is occu- pied by the great wing of the sphenoid, which here pre- sents two foramina, — the foramen spinosum and the foramen ovale. The latter is placed external to the base of the pterygoid process, and transmits the third division of the fifth pair of nerves. External and posterior to the foramen ovale is the foramen spinosum, in the spinous process of the great wing of the sphenoid; it trans- mits the middle meningeal artery. In front of these foramina the base is concave from side to side, and forms the roof of the zygomatic fossa. External to the petrous portion of the temporal is the glenoid fossa for articula- tion with the condyle of the inferior maxillary bone. It is limited posteriorly by the post-glenoid tubercle (the second root of the zygoma), the wall of the meatus au- ditorius externus, and the vaginal process; anteriorly, by the tubercle of the zygoma and the eminentia articu- laris. Its axis is directed outward and somewhat forward. The plane of the cranial portion of the base is directed forward and upward. The facial portion of the base is anterior to a line drawn through the tubercles of the zygoma. It drops abruptly from the anterior part of the cranial portion of tlie base, its plane being directed nearly horizontal, and, if continued backward, would strike the posterior margin of the foramen magnum. The facial portion of the base is formed behind by the pteiTgoid processes, between which are the posterior nasal openings, separated by the vomer. Projecting posteriorly, in the middle line, is the posterior nasal spine, which gives attachment to the uvula. 68 PRACTICAL ANATOMY. The facial portion of the base forms the roof of the mouth; it is limited anteriorly by the posterior face of the incisor and canine teeth, laterally by the inner face of the bicuspids and molars. It is trilateral in outline, a foramen being found at each angle, — in front the ante- rior palatine, and at each of the posterior angles the posterior palatine foramen. Running backward, from the anterior palatine foramen to the posterior nasal spine, is the palatine crest, formed by the articulations of the inner borders of the horizontal portions of the superior maxillary and palate bones. The upper surface of the base forms the floor of the cranial cavity and supports the brain. It is divided into three fossae, — anterior, middle, and posterior. The anterior is the smallest, and is situated on the highest plane; the posterior is the largest, and occupies the lowest portion of the cranial cavity; the middle fossa is on a lower plane than the anterior. The anterior fossa is bounded in front and at the sides by the frontal bone, and is limited behind by the posterior border of the lesser wing of the sphenoid and orbital plate of the frontal. It supports the ante- rior lobes of the brain. It is convex from side to side and smooth, although impressed by the convolutions of the brain. In the middle line is the crista galli of the ethmoid, which affords attachment to the falx cerebri. On each side are the olfactory foramina in the cribriform plate of the ethmoid; these foramina transmit the fila- ments of the olfactory nerves to the nose. In front of the crista galli is a pit called the foramen caecum, which sometimes exists as a canal, and transmits a small vein ; it is the point of origin of the great longitudinal sinus. The middle fossa is strongly concave and irregular; it supports the temporo-sphenoidal and middle lobes of the brain. It is limited in front by the posterior edge of the THE SKULL. 69 lesser wing of the sphenoid and orbital plate of tlie frontal and the great wing of the sphenoid, which, with the squamous portion of the temporal, forms also its Oracnfir Syptr. t-^jituJ-Stm,, droovftr Atilt-r MimnytalA CriJtn CalU Slit for Hfytml ru AntcruT Silmindnll^ Orifu,, fir Olfoet^r^ yur-.tt FoiUrUr £Am(,U»1 T, Etiiuidat Spint Ojitu arttvt. _^ — : Jbiterlcr Cliiuii3 pna. XtiJJU CUaout pTt€- "^ MH^I PttUritT CUtuM^roa T»ri liueran vudmoL. Crifi^ ,f Cfrottd Canai Btft,t$4!on f„ CtUMTian GavgUom Xtata, Auditor. Intmut- ^t^ /<"■ Durn-Jf^t^r ^uji. J'ltrcdal yrtvr^ Fmr. laetram pajUriiu A'Utru'r Cc^iyhidTK-t JLfutiUuit. Vntiiuli Totttrur Cend-]l,iUTm Jftulfid frt. Fig. 30.— Flook of the Cranium. outer boundary. Behind, the middle fossa is bounded by the anterior surface of the petrous portion of the temporal. The principal foramina are: the anterior 70 PRACTICAL ANATOMY. lacerated, which is under the cover of the lesser wings of the sphenoid; the foramen rotundum, the foramen ovale, the middle lacerated, the foramen spinosum, the hiatus Fallopii, and the opening of the carotid canal. The pos- terior fossa is bounded in front by the posterior surface of the petrous portion and the incline of the basilar process of the occipital bone ; laterally by the occipital, parietal, and mastoid portion of the temporal. It is strongly con- cave in every direction, and lodges the cerebellum, the medulla, and the posterior lobes of the brain. The principal foramina are the posterior lacerated, anterior condyloid, and the foramen magnum. The posterior condyloid and the mastoid, when present, transmit veins. The interior of the cranial cavity presents certain grooves, some of which are constant and invariable in position. These grooves lodge the blood-sinuses which are formed by the divergence of the layers of the dura mater. The principal grooves are the following: The groove for the superior longitudinal sinus; it begins at the foramen caecum, and, gradually growing broader, curves back- ward along the median line, terminating at the internal occipital protuberance. A slight groove is continued downward toward the foramen magnum for the accom- modation of an ascending sinus. The grooves for the lateral sinuses are very large and important. They pass horizontally outward from the internal occipital protuber- ance, on the horizontal limb of the occipital cross, as far forward as the mastoid portion of the temporal, then curve downward behind the petrous portion, then inward, and terminate at the posterior lacerated foramina, through which the lateral sinuses pass, assuming the name of jugular vein. The superior and inferior petrosal sinuses groove the superior and posterior borders of the petrous part of the temporal, and communicate with the lateral THE ORBITAL CAVITIES. 71 sinuses. At each side of the body of the sphenoid, ex- tending from the anterior lacerated foramen backward in a sinuous manner, is the groove for the cavernous sinus. In addition to these grooves, upon the inner surface of the cranium we have canals ramifying freely in the diploic structure of the cranial bones, wliich lodge veins or blood- sinuses ; these blood-channels can be exposed by rasping away the outer table of the cranial bones. The base of the skull is exceedingly interesting. A line drawn through the apices of the mastoid processes will bisect the foramen magnum and pass just beliind the occipital condyles. In the lowest races, as the Austra- loid, this line passes through the condyles near their anterior border, owing to the recession of the foramen magnum in the lower races. A line drawn transversely through the auditory meatuses will pass through the jugular foramina, the anterior part of the occipital con- dyles, and touch the anterior margin of the foramen magnum, A line drawn just in front of the glenoid fossae will pass through the foramen ovale and tlie line of junction between the occipital and sphenoid bones. The plane of the base of the cranium anteriorly is on a line with the upper border of the zygomatic processes. Betw'een the superior and inferior surfaces of the base anteriorly is the facial portion of the skull, present- ing the openings of the orbital and nasal cavities. The orbital are two pyramidal cavities below the frontal bone. Their axes diverge and are directed out- ward, forming an angle of 40 degrees. The apex is posterior at the optic foramen. The base is the large, irregularly circular opening which forms the circumfer- ence of the orbit. Seven bones enter into the formation of each orbital ca\4ty. They are the frontal, sphenoid, malar, superior maxillary, ethmoid, lachrymal, and 72 PRACTICAL ANATOMY. palate. As the frontal, ethmoid, and sphenoid are com- mon to both cavities, the two orbital cavities together are formed of but eleven bones. At the apex of the orbit is the optic foramen, which transmits the optic nerve and ophthalmic artery. External to this is the anterior lacerated foramen, a triangular opening directed upward and outward. It transmits the third, fourth, ophthalmic division of the fifth, and sixth pair of nerves, and the ophthalmic vein. It communicates with the spheno- maxillary fissure, which passes outward and downward from the inner portion of the foramen lacerum anterius. The roof of the orbit is strongly concave, and is formed by the horizontal plate of the frontal, and, posteriorly, the under surface of the lesser wing of the sphenoid. The outer wall, directed obliquely outward and forward, is formed by the great wing of the sphenoid and the malar bone. The inner wall, directed backward, slopes slightly downward and outward, is formed principally by the lachrymal and ethmoid. The floor, slightly concave, is formed by the superior maxillary, malar, and palate. The orbital cavities contain the eyes and their muscular ap- paratus, and afi'ord these delicate organs protection from injury by the strong and prominent orbital ridge which forms the circumference of the cavity. The nasal cavities are placed in the middle of the face, between and below the orbits. They have open- ings anteriorly and posteriorly. The anterior opening is somewhat heart-shaped, the apex being above ; the pos- terior openings, two in number, are elliptical, their long axes are directed vertically, and they open into the pharynx. Owing to the absence of the triangular car- tilage in the prepared skull, the anterior opening is not divided. The nasal are two wedge-shaped cavities, sepa- rated from each other by the vertical plate of the etli- THE NASAL CA^^TIES. 73 moid and the vomer. The thick end of the wedge is at the floor of the nose, the thin end at the upper part of the nasal cavities. The outer wall of the nose inchnes strongly inward as it passes upward ; the septum or par- tition is nearly perpendicular. The nasal cavities pre- sent for examination an inner and outer wall, a floor T.fn*?»cuii Jneuive fctta Fig. 31.— Facial Portion of SKrLL. and a roof, an anterior and a posterior opening. The inner wall is formed almost entirely of a thin, bony par- tition, consisting of the vertical plate of the ethmoid and the vomer. In the recent state, the triangular notch at the anterior part of tlie septum is completed by the tri- angular cartilage, which extends to the anterior open- 74 PRACTICAL ANATOMY. ings of the nose and assists in supporting the soft structures. The entire partition is called the septum nasi. It is smooth, covered with periosteum and mucous membrane. The outer wall is exceedingly irregular, and is formed by the superior maxillary, lachrymal, palate, inferior turbinated, and internal plate of the pterygoid process. Traversing the outer wall from front to back are the superior and middle turbinated processes of the ethmoid and the inferior turbinated bone. These SniU Xatd Sfim if TrmtalBmi MmiaaiirUunfStiauU Jba.Natal Sjii. PaZatt trot. cfSu-p.Max. Palaa £toc, fTFa/aU tott.NcLtal Spim 4n^. PAlauiu CanaZ Jfmte-lathrymal Camnt infumiiliUam. Ouur WaR - J.euATyTnai VtxeifoTwJflrpe ^ ditto ■Inft-n^r Turhvnatei ■falatt Fig. 32.— Nasal Meatuses. divide each nasal cavity into three horizontal passages, — the superior, middle, and inferior meatuses. The infe- rior is situated below the inferior turbinated bone, the middle between the middle turbinated process of the ethmoid and the inferior turbinated bone, the superior above the middle turbinated process. Of these, the largest is the inferior meatus. It is bounded below by the floor of the nose ; at its anterior part is the opening of the lachrymal canal. The middle meatus occupies the posterior two-thirds of the nasal cavity. THE BUCCAL CAVITY. 75 Anteriorly it presents the opening of tlie frontal and eth- moidal sinuses, and about its centre is the opening of the antrum of Highmore. The superior meatus, situated at the posterior third of the nasal cavity, communicates with the posterior ethmoidal cells and the sphenoidal sinus. The floor of the nose is formed by the superior surface of the horizontal processes of the superior maxil- lary and palate bones. It is smooth, slightly concave from side to side, and broader at the centre than at either extremity. The roof consists of three portions, — anterior, middle, and posterior. The anterior portion slopes downward and forward, and is formed by the nasal bones and the spine of the frontal ; the middle portion is horizontal, and is formed by the cribriform plate of the ethmoid ; the posterior is the anterior and under surface of the body of the sphenoid, which slants backward and downward. The anterior opening, with the triangular cartilage in place, is semi-cordiform ; the posterior opening is elliptical. The cavity of the mouth is below the nasal cavities and extends in the skull, from the inner surface of the alveolar processes of the superior and inferior maxillary bones and the inner surfaces of the teeth, backward to the posterior border of the hard palate. It presents for examination a roof (the hard palate) and anterior and lateral boundaries. The roof is formed by the horizontal processes of the superior maxillary and palate. It is rough, concave from side to side and from front to back, and presents in the median line a ridge, which is more or less well marked. Behind the central incisor teeth is the anterior palatine canal ; on each side posteriorly, and just internal to the last molar tooth, is the opening of the posterior palatine canal, and running forward from this is a well-marked groove for the artery and 76 PRACTICAL ANATOMY. nerve. The anterior and lateral boundaries are formed by the alveolar processes, teeth, and inferior maxillary bone. On the lateral region of the skull is the temporal fossa, limited above by the temporal ridge, in front by the external angular process of the frontal and the posterior concave surface of the malar. Externally, and arching across, is the zygomatic process of the temporal. Internally, and below, is the pterygoid ridge. The fossa is cuneiform in shape, the base of the wedge being directed anteriorly. It is formed by the frontal and great wing of the sphenoid anteriorly, and the squamous portion of the temporal posteriorly; the malar bone is in front. Near the posterior part of the fossa are some shallow grooves for the deep temporal arteries. The temporal muscle arises from the entire extent of the fossa. The zygomatic fossa is situated below the temporal fossa ; it is bounded in front by the posterior surface of the superior maxillary and its malar process, and the posterior surface of the malar bone ; above, by the infe- rior surface of the great wing of the sphenoid and the inferior surface of the anterior portion of the temporal ; externally, by the zygoma and inferior maxillary bone ; internally, by the external pterygoid plate; below, by the alveolar process of the superior maxillary ; and, pos- teriorly, by the eminentia articularis. The spheno-maxillary is a triangular fossa, situated at the upper inner, anterior part of the zygomatic fossa. It is bounded anteriorly by the posterior border of the superior maxillary ; posteriorly, by the anterior border of the pterygoid process ; above, by the under surface of the body of the sphenoid and zygomatic surface of the orbital process of the palate, and, internally, by the THE SKULL. 77 external surface of the vertical plate of the palate. This fossa lodges Meckel's ganglion, and is traversed by the superior maxillary division of the fifth nerve. Five important foramina open into it, three posteriorly, — the foramen rotundum, the Vidian, and the pterygo-palatine ; on the inner wall is the spheno-palatine, and below the posterior palatine. In addition, small nutrient foramina open into this fossa. The spheno-maxillary fossa com- municates externally with the zygomatic fossa; anteriorly, with the orbit; internally, with the nasal, and, poste- riorly, with the cranial cavity. Three fissures centre in the spheno-maxillary fossa, — the sphenoidal, the spheno- maxillary, and the pterygo-maxillary. The sphenoidal passes upward, outward, and forward ; the spheno-max- illary downward, forward, and outward ; and the pterygo- maxillary vertically downward. The fissures are : The sphenoidal, triangular in shape, is between the greater and lesser wings of the sphenoid at the posterior part of the orbit, and has been described as the " foramen lacerum anterius." The spheno-maxil- lary fissure is bounded anteriorly and below by the posterior edge of the orbital surface of the superior maxillary and the malar ; above, by the lower margin of the orbital surface of the great wing of the sphenoid. It communicates with the spheno-maxillary and zygo- matic fossae. The pterygo-maxillary fissure is bounded anteriorly by the posterior border of the superior maxil- lary ; posteriorly, by the anterior border of the pterygoid process. This fissure is a continuation downward of the spheno-maxillary fossa. A study of the skull entire is of much importance in the general science of anthropology, and a few facts bearing upon craniology may here be not uninteresting. 78 PRACTICAL ANATOMY. The skull differs in form in different races, in the sexes, and at the various ages or periods of life. Age. — The skull in infancy presents an immensely large cranial and a small facial portion, the facial portion being but one-eighth as large as the cranial. The air- sinuses, such as the frontal, maxillary, and sphenoidal, are entirely undeveloped ; the diploic structures are not formed until about the tenth year. The alveolar proc- esses are but little developed, containing, however, the developing deciduous teeth and the germs of the perma- nent set. None of the articulations are firm, although such sutures as the frontal and that between the two halves of the inferior maxillary are beginning to give evidences of ossification. Large gaps are seen at different parts of the skull, notably at the anterior and posterior part of the superior surface, constituting the fontanelles. The original centres of ossification are exceedingly prominent, as is seen in the frontal and parietal eminences. These eminences or bosses serve as " fenders " to the skull of the infant, protecting the structures within from serious .injury. In the adult female, the cranial portion of the skull predominates, constituting about three-fifths, the facial portion constituting but two-fifths of the skull. In the adult male, the cranial and facial portions are nearly equal. This is due to the greater development in the male of the large facial air-sinuses, and the nor- mally larger formation of the facial bones. In old age the skull undergoes a retrograde change ; the teeth fall out, the alveolar processes become absorbed, the sym- physis menti becomes elevated and protrudes owing to the greater obliquity of the angle of the inferior maxillary, the air-sinuses diminish in size, and the cra- nial portion again largely predominates ; in fact, the entire skull diminishes in size, the cranial as well as CRANIOMETRY. 79 the facial portion, but iii the latter the change is more rapid and relatively much greater than in the former. Sex. — The differences in the skulls of the sexes are not apparent before adult age, and again diminish as senility advances. In the adult male skull, as already stated, the facial and cranial portions are nearly equal ; in the female skull the cranial portion is the larger. The female skull presents fewer departures from its in- fantile characters than the skull of the male ; this is especially seen in the development of the facial sinuses. The facial angle in the female skull is, as a general rule, less acute than in the skull of the male. The weight of the male skull will average about twelve and a half ounces ; the female skull averages about eleven ounces, making a difference of about 12 per cent, between the male and female skulls. All of the ridges, grooves, and other anatomical points are less prominent in the female skull than in the skull of the male. Race. — The greatest difference exists in the skulls of the different races, and the study of these differences constitutes the science of craniology. Probably first in importance in the determination of race by a study of the skull is craniometry, or the measurement and proportions of the skull. If a horizontal section is made through the cranium just above the supra-orbital ridges, and the vault removed, the section presented is an oval. If the long diameter of this oval is taken to represent 100, and the transverse diameter measures 80 per cent, or more of the long diameter, the skull is called a broad, or brachycephalic, skull. If the transverse diameter is less than 75 per cent, of the long diameter, the skull is called a narrow, or dolichocephalic, skull. If the transverse diameter measures from 75 to 80 per cent, of the long diameter, the skull is called mesocephalic, — ^a term sug- 80 PRACTICAL ANATOMY. gested by Broca. This system of measures constitutes the cephalic index of Retzius, which is generally stated to be 80, or 78, or 75, which means so many per cent, of the long diameter, and is of much practical importance in differentiating between the skulls of different races, thus: The Mongol races are brachy cephalic ; the Lapps have the most brachycephalic skulls, the cephalic index in these people often rising as high as 90. Contrasted to these are the cephalic indices of the negroes, Caledo- nians, Australians, and others. In these people the cephalic index is about 72. The highest types of the white races have a skull the cephalic index of which is about 78. In taking these measurements it must be re- membered that they are to be taken at the extreme points on the section. Another series of measurements, in which the vertical diameter is compared with the trans- verse, is also interesting, but less important than the in- dex already discussed. In order to obtain the vertical diameter, a transverse section should be made vertically from the junction of the coronal and sagittal sutures, slightly oblique, downward, and backward, so that the lower portion of the section shall pass just in front of the occipital condyles. This measurement determines the relation of breadth to height, but, owing to the varia- tions in the shape of the skull in the same races, it is not of much importance. An illustration, however, is not uninteresting ; it must be understood, however, that the basis of measurement is the length of the head, as before described, and which is taken as 100. The index of height (vertical index) in the Kaffir is 73, in the Hotten- tot 711; both skulls are dolichocephalic, with an index of 72; this, as can be seen at a glance, may at times serve to distinguish different skulls whose ordinary cephalic indices may be alike. Many other measure- CRANIOMETRY. 81 ments have been made, and, though interesting, are so variable and uncertain that but Httle practical importance attaches to them. Some are so wildly extravagant as hardly to reach even the dignity of a speculation. It is important to ascertain the capacity of the cranium, and this depends somewhat upon the method employed. The best substances with which to fill the cranium are shot and water; if water is used, it is necessary to adjust a thin, very elastic, and highly distensible gum bag to the interior of the cranium, and then proceed to fill it; the liquid, of course, molds the gum bag accurately to the interior of the cranium. The water is then drawn off and carefully measured. When shot is employed the large openings must be filled with wax, and great care should be taken to allow the shot to roll in very gently, so as to avoid "packing." The capacity of the cranium is, as a general rule, greater in the higher than in the lower races. The female crania of any race are less capacious than the male crania of the same race. The capacity of the crania of the present century is, in all cases where the opportunities for study and comparison exist, larger than the crania of ten or twenty centuries ago. The average capacity is about 94 cubic inches in the superior races, while in 15 Australians it was 65 cubic inches.* As a general rule, it may be stated that, the greater the intellectual development of a race, the greater the capacity of the brain-case. The well- formed cranium of the European will measure 7i inches long, 5| inches broad, and 5i inches in height; in cir- cumference, about 21^ inches. The face presents certain measurements of decided interest. The average breadth of the face of the Briton is about 5 inches, the Hotten- tot averages 4J inches, and the Chinese 5^ inches. The *See Morton, " Crania Americana." 6 82 PRACTICAL ANATOMY. length of the face from the naso-frontal articulation, or transverse suture, differs also in different races. In the Esquimaux it is about 5^ inches; in the South African negroes, 4| inches. Illustrations can be very largely multiplied, but the reader is referred to special treatises on the subject. The skull also presents certain "angles;" thus, if two planes are draw^n vertically at the sides of the skull, they approach or recede from one another at their upper extremities. In order to facilitate the taking of such angles, the parietal goniometer (Quatrefage's) should be used. The facial is probably the most important angle in the discrimination of skulls. Of these there are a multi- tude ; that of Camper, having been the first suggested, is frequently alluded to. It consists of a line drawn from the glabella to the edge of the middle incisor tooth ; this line is intersected by one drawn from the middle of the external auditory meatus to the anterior and inferior borders of the floor of the nose. An angle is here formed which varies from 70 to 80 degrees, and which diminishes as we pass from the higher to the lower races. The angle of Cloquet, when the alveolus is preserved, has some advantages ; it consists of a line drawn from the glabella to the neck of the central incisor, and this is crossed by a line drawn through the external auditory meatus to the same point. Jacquart's angle, when the alveolus is absent, is probably the best ; it consists of a line drawn through the external auditory meatus to the anterior nasal spine, and a vertical line drawn from the glabella to the base of the anterior nasal spine. If skulls are examined comparatively, by means of the facial angle, it must be remembered that the same angle should in all cases be employed, and the angle used should be noted, otherwise the measurements would THE SPINE. 83 result in confusion. When the skull of a negro is viewed in profile, it is observed that the superior maxil- lary bones project, that the teeth are thrust obliquely forward, and tliat the malar bones also project for- ward. If a line is drawn in such a skull from the glabella to the mental process, it will fall considerably behind the canine teeth. Such a skull is called prog- nathous, and occurs largely in the natives of Africa and Oceanica. An orthognathous skull is one in which the facial structures do not project beyond a vertical line dropped from the glabella ; in such a skull the teeth are generally fixed in a vertical position. The " Caucasian" race of Blumenbach are mostly orthognathous. Many other details of great interest are beyond the purposes of this book, and the reader is referred to the numerous treatises on this subject. THE SPINE. The spine, or vertebral column, consists of twenty- six bones, including the sacrum and coccyx. The ver- tebrae, twenty-four in number, are piled one upon another, forming a strong, flexuous, tapering column which rests on the base of the sacrum. The vertebrae are divided into three groups, — superior or cervical, middle or dorsal, and inferior or lumbar. Each vertebra presents for examination a body, two pedicles, two laminae, a spinous process, two transverse processes, and two pairs of articular surfaces. The body is in front; it is a cylindroid mass of bone, and forms, with the ver- tebrae above and below, the pillar of support to the head and upper extremities. Its superior and inferior sur- faces are articular, slightly concave, and elevated at the circumference into a rim or lip. In front and at the 84 PRACTICAL ANATOMY. sides the body is concave from above downward, convex from side to side, and presents numerous foramina for the passage of vessels. Posteriorly it is flattened, slightly concave from side to side, and presents the opening of the sinus of the body, leading into a small cavity which lodges the veins of the body of the ver- tebrae. The opening is frequently double. The ped- icles are two strong processes of bone, laterally somewhat compressed. They project from the upper, outer, pos- terior portion of the body, and are directed obliquely backward and slightly outward and upward. They are deeply notched below, slightly notched above, forming, when articulated with the vertebrae above and below, the intervertebral foramina. The laminae are two strong, plate-like structures, which are continued backward from the pedicles, and are directed downward and inward, joining in the middle line to form the spine of the ver- tebra. Their upper and lower borders are rough, for the attachment of ligaments. The spinous process is formed by the fusion of the two laminae behind. In the dorsal region the spines are directed obliquely downward ; their apices are not cleft, but are more or less tuberous ; the upper border is sharp. In the lumbar region they are strong and broad and are directed horizontally back- ward ; the upper and lower borders are sharp and their extremities rough. In the cervical region the apices of the spines are cleft, and, except the seventh cervical, but little developed. The spinous processes serve for the attachment of muscles. The transverse processes project horizontally outward, in the cervical region, from the junction of the body and the pedicles; in the dorsal and lumbar regions, from the junction of the pedicles and laminae. In the cervical region they are perforated by the vertebral foramen, for the transmission of the THE SPINE. 85 FiQ. 33.— The Vertebral Column, or Spine. FiQ. 34.— Relation of the Vertebr.« to THE Neck and Trunk. 86 PRACTICAL ANATOMY. vertebral artery; in the dorsal region their extremities anteriorly present an articulating surface, for articulation with the tubercles of the ribs ; in the lumbar region they are thin and sharp. The articular surfaces consist of two pairs, — the superior and inferior. They are situ- ated at the junction of the pedicles with the laminae. The upper ones, in the cervical region, are directed upward, looking slightly backward ; in the dorsal region their faces are directed obliquely backward and upward, becoming, in the lower dorsal and lumbar region, nearly vertical. The inferior pair, in the upper cervical verte- brae, look downward and forward, but in passing down MiilerifrTuhrelt istTriin4.Fric. hitimtTTulcTtU «/2Va»V .fr, f*Silt4rM>r.Articalar BmMt nttTurArdtidaT^neiU Fig. 35.— a CEEVicAii Vertebra. the vertebral column their faces become directed grad- ually more and more forward, looking slightly down- ward; in the lower dorsal and lumbar regions the plane of the articular surfaces is nearly vertical. A vertebra, as has been seen, consists of a solid segment anteriorly, from the sides and back part of which project the ped- icles, which are continued backward into the laminae, thus forming two lateral arches joined together pos- teriorly, and forming the spinous process. These arches inclose a large foramen, which, in the articulated spine, forms an osseous canal which lodges the spinal cord. The cervical vertebrae are seven in number, and this THE SPINE. 87 number is the same in all the mammalia, with a few ex- ceptions. A cervical vertebra is distinguished by the foramen in its transverse process, the large size of the spinal foramen, the nearly horizontal position of the articular surfaces, and the bifid spinous process. The body is small, concave above, with a rather prominent rim, and is convex below. The transverse processes present two projections, — the anterior and posterior tubercles. The laminae are narrow, long, and thin, and slightly overlap. The first, second, and seventh cervical are peculiar. The first cervical, or atlas, articu- lates above with the skull. It has neither body nor Tiibereff- Traat.PToef^\. ■Faram-n /ap Vertebrai AftK Groove fer V^retA Artf and 1.'.' C*rv.^trvs Spin. Proe., Fig. 36.— The Atlas. spinous process, and consists of two arches — anterior and posterior — and two lateral masses. The anterior arch — about one-sixth of the bone — presents anteriorly a tubercle, posteriorly a slightly concave articular facet, for articulation with the odontoid process of the axis. The anterior arch is convex from side to side anteriorly ; posteriorly, it is concave. The posterior arch forms nearly one-half of the circumference of the bone ; it terminates posteriorly in a rudimentary spinous process, or tubercle, for the attachment of muscles. On the upper surface of the posterior arch, just behind the articular surface for the condyles of the occipital bone, 88 PRACTICAL ANATOMY. is a well-marked groove for the passage of the vertebral artery. The lateral masses present the superior and in- ferior articular surfaces. The superior articular surfaces are strongly concave, oval or reniform ; their axes are directed forward and outward ; they receive the condyles of the occipital bone. The inferior articular surfaces are fiat, directed downward and slightly inward to articu- late with the axis. Projecting inward from the inner borders of the lateral masses are the tubercles for the attachment of the transverse ligament, which passes be- hind the odontoid process of the axis, holding it in place against the anterior arch of the atlas ; posterior to the ^rtu. Strf.ftr Trant.Htf- Fig. 37.— The Axis. transverse ligament is the spinal foramen for the trans- mission of the cord. The transverse processes project from the outer border of the lateral mass and are broad and strong. The axis is distinguished by a strong, pivot-like process, the odontoid, which projects upward from its body. This process is, in fact, the detached body of the atlas joined to the body of the axis. It forms the axis on which the atlas, and with this the head, rotates. The body presents anteriorly a ridge, and on each side of the ridge a depression for the attachment of muscles. It is prolonged below into a prominent lip, which overlaps the anterior part of the body of the vertebra below. Pos- THE SPINE. 89 teriorly, the body is liat ; inferiorly, concave from front to back. From the upper surface projects the conical odontoid process, which is sHghtly constricted at the base, and terminates above in a strong, blunt apex. On its anterior surface is the oval articular facet for articula- tion with the anterior arch of the atlas. At the base of the odontoid process, on each side, are well-marked nutrient foramina, sometimes two or more in number. The superior surfaces are fiat, and look upward and slightly outward. They are placed upon the pedicles. Encroaching upon the transverse processes, they over- hang the vertebral foramina. The inferior processes pre- sent forward and downward. The transverse processes pro- ject strongly downward, and are traversed by the vertebral canal, which at first ascends, then curves horizontally out- ward. The laminae are strong ; sharp above, thick below. On the upper surface are the ver- fig. 38.-seventh cervical, ob i i Vektebka Prominens. tebral grooves, which lodge the vertebral arteries as they pass behind the superior articular surfaces. Nutrient foramina, some of large size and rather constant in position, exist on the superior sur- face of the laminae. The spinous process is bifid below. It affords attachment to muscles. The seventh cervical, known as the vertebra promi- nens, is distinguished by its long, spinous process, which is neither split nor bifid. It serves for the attachment of the ligamentum nuchae, or suspensory ligament of the head. The dorsal vertebrae, twelve in number, present the following characters : Their bodies are heavier and larger 90 PRACTICAL ANATOMY. than in the cervical region. At the sides of the bodies, near the base of the pedicles, are two semi-oval, articu- ffu£rrlc7 Artie. Amn Divii.fa,eet fir hraS. cfSH Eaeitfij- Tuhrch c/Ita ujaettfn'hta.i ^fiil Inftr. ArticPrcet Fig. 39.— a Dorsal Vertebra. lar facets, placed at the upper and lower borders ; in the articulated spine they form articular surfaces for the (An ntttTwJoftt aioiith }^'btmil4M9 &m» \~jari)!,cneirtfae4r No.faca on TyaniAnh uAitAu An triHrffdttt infti'.ATUe.twa. mtturardt Fig. 40.— PEcuiiiAK Dorsal Vertebra heads of the ribs. The transverse processes are thick and strong, clubbed at the extremities, and project back- THE SPINE. 91 ward and outward. They present anteriorly a shallow, concave, articular surface for articulation with the tubercle of the rib. The pedicles are laterally some- what flattened and project directly backward, encroach- ing upon the spinal foramen, making the dorsal portion of the spinal canal the least capacious. The upper dorsal vertebrae resemble the lower cervical, the lower dorsal, the lumbar. The first, tenth, eleventh, and twelfth have an entire facet at the side of the body ; the ninth, a semi-facet above ; the rest have a semi-facet above and below. The transverse processes of the eleventh and twelfth have no articular surface. Xiprn Artie > Prte- Fig. 41.— a Lumbar Vertebra. The lumbar vertebrae, five in number, are the largest vertebrae of the spinal column. The body is broad, slightly concave above and below, and presents strongly- curv^ed rims. The pedicles are thick and of great strength. The superior articular surfaces look inward and slightly backward, their plane being nearly vertical. The inferior articular surfaces are directed outward and slightly forward. The laminae are heavy plates of bone, which form a blunt, quadrilateral, spinous process, which projects horizontally backward. The transverse proc- esses, directed backward and outward, are thin, blade- like, and light, in proportion to the rest of the bone. 92 PRACTICAL ANATOMY. Each vertebra develops from three primary centres, which appear about the middle of the second month. The primary' centres are one for the body and one for each lateral arch. Besides these, six secondary centres appear later in life, completing the transverse and spinous processes, and in the articular plates on the superior and inferior surfaces of the body. Exceptions. — The atlas develops by three centres, — one for the anterior arch and one for each lateral mass. The axis develops by six centres, — one for the body and one for each lateral arch, and three for the odontoid process. The lumbar vertebrae have, in addition to the number for the other vertebrae, a centre for each tubercle behind the superior articular surface. The spine, viewed laterally and in profile, presents two anterior convex and two anterior concave curves, — the former in the cervical and lumbar, and the latter in the dorsal and sacral regions. These curves are largely due to the form of the bodies of the vertebrae, which, in the cervical region, are thicker anteriorly than posteriorly; in the dorsal region they are thicker posteriorly, and in the lumbar, especially the fifth lumbar, thicker anteriorly than posteriorly, as in the cervical region. The spinal canal is largest in the cervical, next in the lumbar, and smallest in the dorsal region. There is a Umited motion in every intervertebral articulation, but, by the combined movement of the vertebrae upon one another, a great variety of movements, such as bending and lateral rotation of the trunk and head, are possible. The articu- lations between the cervical vertebrae admit of the great- est motion, next in the lumbar, and least in the dorsal. The direction of the spines of the dorsal vertebrae down- ward locks them together, and the position and plane of the articular surfaces also serve to give rigidity to this THE SACRUM. 93 part of the spinal column. The vertebrae gradually increase in size from the axis to the first dorsal, then decrease to the fifth dorsal, and then increase in size from the fifth dorsal to the fifth lumbar. The intervertebral foramina are largest in the lumbar, next in tlie cervical, and smallest in the dorsal region. THE SACRUM. The sacrum is a wedge-shaped bone, which sets be- tween the two ossa innominata. It presents for exam- FiG. 42.— The Sacrum, Anterior Surface. ination a base, an apex, two lateral borders, and an anterior and posterior surface. The base presents upward, and supports the spinal column. The apex, directed downward, articulates with the coccyx. The lateral borders articulate with the ossa innominata. The bone is flattened antero-posteriorly, and strongly curved. The anterior surface is smooth, markedly concave from above downward, slightly so from side to side. About an inch on either side of the median line are the four 94 PRACTICAL ANATOMY. anterior sacral or intervertebral foramina for the transmis- sion of the sacral nerves. They are arranged in pairs. The first pair are the largest ; the others decrease gradu- ally in size from the first to the last. The first and second pairs are ovoid, sometimes reniform, with the long axes vertically ; the superior, inner, and inferior borders are abrupt and rounded. Externally the ap- proach to the foramina is by a broad, shallow groove. The third pair are round. The fourth pair are oval, with 4:he long axis obliquely upward and outward. Running horizontally between the sacral foramina are well-marked ridges, which indicate the original separa- tion of the bone into five pieces. At the junction of the anterior surface and base the sacrum presents a promi- nent, sharp lip, called the promontory, which intensifies the angle formed by the articulation of the sacrum and the last lumbar vertebra. The posterior surface is irregular and rough. Run- ning along the median line is a strongly-marked, irregu- lar crest, formed by the incomplete fusion of the rudimentary spinous processes. About an inch on each side are the posterior sacral foramina, arranged in pairs and opposite the anterior. They transmit the posterior sacral branches of the spinal nerves. The posterior sacral foramina are smaller in size than the anterior, but liave nearly the same form. The superior pair are over- lapped by a sharp plate of bone along their inner borders, and below terminate in a groove. The posterior surface mainly afi'ords attachment to muscles and ligaments. The superior portion, or base, presents a central articulating surface, the opening of the sacral canal, and at the sides of the articulating base expanded surfaces of bone called the alee. The articulating surface is broad, con- vex anteriorly, flattened posteriorly, surrounded by a THE SACRUM. 95 prominent rim, which in front curves downward to form the promontory. The alse project laterally; they are trilateral, rough surfaces, continuous with the anterior surface by a rounded border. Numerous foramina pene- trate these surfaces and afford exit to a great number of veins. The apex articulates with the coccyx. It is deficient behind, exposing the termination of the sacral canal be- tween two well-marked processes, which project down- Fig. 43.— The Sacrum, Postekior Surface. ward, and known as the sacral cornua. The lateral bor- ders of the sacrum serve principally for articulation with the ossa innominata. The articular surfaces are ear-shaped, and are designated the auricular surfaces ; they measure about two and three-fourths inches long, by one inch in width. Just behind the auricular surfaces, near the upper part of the bone, is the digital fossa, for the attach- ment of strong ligaments. Below the auricular surfaces the bone is rough, for the attachment of the sacro-sciatic 96 PRACTICAL ANATOMY. ligaments. If a vertical section through the median line of the sacrum is made, the sacral canal, continuous with the spinal canal, is laid open. It is large above, but be- comes rapidly contracted as it descends toward the apex. The canal is flattened antero-posteriorly ; opening into it are the four pairs of anterior and posterior sacral fora- mina for the transmission of the sacral nerves. The sacrum is dveloped by thirty-five centres, which appear at the end of the second month of foetal life, and in the upper segments of the bone. Each segment ossi- fies separately ; they become joined together by distinct ossific centres, the lowest two first, and this process ex- tends upward until the five segments form the one bone, which is not completed before the twenty-fifth year. The coccyx is a rudimentary bone and consists of four segments ; its base articulates with the apex of the sacrum. BONES OF TRUNK. THE HYOID BONE. The hyoid bone is situated in front of the bodies of the third and fourth cervical vertebree ; it gives attach- ment to the muscles of the tongue, and is not articulated with the skeleton. The bone forms a half-circle, the convex portion presenting anteriorly. It consists of a body, two greater and two lesser cornua. The body is the central thick portion of the bone ; it is flattened, and presents an anterior and posterior surface, superior and inferior borders. The anterior surface, convex from side to side, presents a median vertical ridge crossed by a horizontal line dividing the surface into four shallow fossae, which afi'ord attachment to the muscles of the tongue. Tlie posterior surface is smooth and rounded, and gives attachment to the thyro-hyoid membrane. The superior border is bluntly rounded; the inferior THE STERNUiM. 97 border, curved and irregular, is slightly everted. Articu- lating with the sides of the body are the greater comua, and attached to the body by a plate of cartilage are two epiphyseal cartilages, — the lesser cornua. The greater cornua are somewhat flattened, taper from before back- ward, and terminate in clubbed extremities, which give attachment to the thyro-hyoid ligaments. The articula- tion between these processes and the body rarely persists beyond the fiftieth year. The lesser processes project slightly upward and backward from the body just above the articular surfaces for the greater cornua ; they are short, conical processes, which afford attachment to the stylo-hyoid liga- ments. The hyoid is an eminently elastic bone, consisting of equal por- tions of organic and earthy matter. The cor- nua are largely cartilagi- nous in character. This bone develops by five centres, one for the body and one for each cornu. THE THORAX. The thorax is formed by the sternum and costal cartilages in front, the bodies of the vertebrae behind, laterally by the ribs. It is an osseo-cartilaginous struc- ture, flattened antero-posteriorly, is highly elastic, and susceptible of an increase in all its diameters by the action of the muscles of respiration. It contains the heart, lungs, great vessels and nerves. THE STERNUM. The sternum, or breast-bone, is a flat bone situated in the median line, articulating with the clavicle above ^x Onu-hjuridl QgoMk!^ 8(eni«-kymt; Fig. 44.— The Hyoid Bone. 98 PRACTICAL ANATOMY. and at the sides with the costal cartilages. It presents three portions, — an upper manubrium, middle gladiolus, CrRNO-CtDDO. HAGTQID ^^ Fig. 45.— Steknum and Costal Cartilages. and inferior or ensiform appendix. The manubrium is a heavy, flattened, trilateral plate of bone, which pre- THE STERNUM. 99 sents for examination an anterior and posterior surface; superior, inferior, and latei*al borders. The anterior sur- face, convex from side to side, gives attachment to the fibres of the pectorahs major and sterno-mastoid muscles. The posterior surface, flat, gives origin to the sterno- thyroid and sterno-hyoid muscles. The superior border is thick, notched and rounded, and presents, at the angles of the superior and lateral borders, the concave articular surfaces for the clavicles. The lateral border presents, above, the articular facet for the first costal car- tilage ; this border then passes downward and inward, presenting at the angles with the inferior border a half- facet for the articulation with the second costal cartilage. The inferior border is rough and covered with cartilage, by which it articulates with the second piece of the sternum, — the gladiolus. The gladiolus, four to five inches long, one and one-half inches broad, one-third of an inch thick, is a flat plate of bone, presenting anteriorly four transverse ridges, which mark the original division of the bone into five pieces ; the lower ridge is faintly developed. From this surface arise the fibres of the pectoralis major muscle. The posterior surface also pre- sents the transverse ridges, but less marked. It presents a number of foramina for the passage of vessels. The lateral borders present four complete and superior and inferior half-notches. These notches are at the ends of the transverse ridges, and serve for the articulation of the costal cartilages. Between them the bone is concave and rounded. The superior border articulates with the manubrium, and presents at each angle the half-notch. The inferior border articulates with the ensi- form appendix, and presents at each angle also a half- facet. The ensiform appendix, largely cartilaginous in char- 100 PRACTICAL ANATOMY. acter, is thin, often curved, and terminates in a blunt point, which is sometimes bifid. Occasionally a foramen perforates the appendix. At each superior angle is a half-facet for articulation with the costal cartilage of the seventh rib. The ensiform appendix affords attachment below to the Hnea alba, posteriorly to some fibres of the diaphragm. The sternum is developed by six centres : one for the manubrium, four for the gladiolus, and one for the upper part of the ensiform appendix. THE COSTAL CARTILAGES are arranged in ten pairs, of which the upper five are true costal cartilages and the lower five false. The true costal cartilages are those which pass directly from the sternal extremity of the rib to the sternum ; the false costal cartilages are those which are more or less con- nected together. They are highly elastic, cartilaginous structures, which seldom undergo ossific change. The cartilages are flattened, the upper ones rather less, being- oval on section. They increase in length from the first to the seventh ; the upper four are directed nearly hori- zontally inward, the fifth and those below pass upward and inward ; the sixth and seventh are connected by a single broad piece of cartilage ; the eighth is attached to the seventh, and is also inserted into its inferior border about an inch external to the sternum ; the ninth and tenth are similarly arranged. The anterior extremities of the eleventh and twelfth ribs articulate with short, spur-hke pieces of cartilage, the apices of which are free. THE RIBS. The ribs consist of twelve pairs of flat bones, which assist in forming the posterior, lateral, and anterior wall of the chest. They are divided into five true, five false, THE RIBS. 101 and two floating. The upper five are the true ribs; thev arch outward from the vertebral column, and are continued to the sternum, each by a single piece of costal cartilage (the true costal cartilages). The false ribs are the sixth, seventh, eighth, ninth, and tenth, and are JiafU mrtieiif»r'/t'ttt Single mrttcfmc Fig. 46.— The Peculiar Ribs. articulated anteriorly with the sternum through the medium of the false costal cartilages. The eleventh and twelfth are the floating ribs. A rib presents for exami- nation a head, a neck, a tuberosity, shaft, angle and sternal extremity. The head, flattened, reniform in out- line, presents two articular facets, — an upper smaller and 102 PRACTICAL ANATOMY. a lower larger, separated by a well-defined horizontal ridge. The neck, flattened antero-posteriorly, is rough for the attachment of ligaments and muscles. It is about one inch long, and lies in front and above the transverse process of the vertebra below. At the pos- terior inferior part of the neck, at the junction of the neck with the shaft, is the tuberosity, — a rough elevation of bone, well marked in the upper ribs. It presents an articular surface for articulation with the extremity of the transverse process of the vertebra below. The shaft is a flat, curved portion of the bone, which arches for- ward to the costal cartilage. It presents for examination an external and internal surface, superior and inferior borders, an angle and sternal extremity. The external surface, convex from above downward, curved from behind forward, presents, external to the tuberosity, the angle, at which the shaft makes an abrupt bend forward and downward. The angle becomes gradually farther removed from the tuberosity in passing from the second to the tenth rib. It is an oblique ridge, which aff'ords attachment to the dorsal aponeurosis. The inner surface of the shaft is convex from above downward, and pre- sents some small foramina for the nutrient vessels to the bone. The superior border is smooth and rounded ; the inferior border is sharp and grooved along the inner sur- face for the passage of a branch of the intercostal artery and nerve. The sternal extremity is oval, concave, cov- ered with cartilage, and articulates with the convex head of the costal cartilage. The ribs, with some exceptions (eleventh and twelfth), are developed by three centres, — one for the head, one for the tuberosity, and one for the shaft. The first, second, tenth, eleventh, and twelfth ribs are peculiar. The first rib difl'ers in that its vertebral end, or head, has but one articular surface ; it has no THE fJIIEST. 103 ;in<»le; the shaft is flattened from above downward, and presents on its upper surface two shallow grooves, — the inner for the subclavian vein and the outer for the sub- clavian artery. Between these grooves, at the inner border, is the tubercle for the insertion of the scalenus anticus muscle. The under surface has no groove for the intercostal vessels. It is not twisted on its axis, and rests on a plane wliich both extremities and the shaft touch. The second rib has a slight angle, is but little twisted on its axis, and presents an ill-defined groove along its mferior border posteriorly. The tenth rib has a single articular surface on the head, and the angle 'is not so strongly marked. The eleventh and twelfth ribs have no tuberosity — a single articular surface; the eleventh a slightly-marked angle, and the twelfth none at all. The eleventh and twelfth ribs have no attachments to the sternum. THE CHEST. The chest is an osseo-cartilaginous cage, which in general form may be said to be a truncated cone, flat- tened antero-posteriorly. It is formed behind by the twelve dorsal vertebrae and the ribs to their angles; lat- erally, by the shafts of the ribs; anteriorly, by the shafts of the ribs, costal cartilages, and sternum. Its transverse diameter exceeds the antero-posterior at every plane. Its antero-posterior diameter increases decidedly in pass- ing from the upper to the lower part of the chest. This is due to the increasing length of the fourth, fifth, sixth, seventh, and eighth ribs and costal cartilages thrusting the sternum forward as it descends, and to the strong anterior concaAe curve of the bodies of the dorsal ver- tebrae. The upper opening of the chest is an osseous ring formed by the first dorsal vertebra, the first ribs and 104 PRACTICAL ANATOMY. first costal cartilages, and the manubrium. The lower opening of the chest is irregular and is Hmited anteriorly by the ensiform appendix, the costal cartilages, the free extremities of the eleventh and twelfth ribs, the twelfth rib, and twelfth dorsal vertebra. Along the median line, posteriorly, are the spines of the dorsal vertebrae, and on either side the chest presents the broad dorsal grooves, which are about one and a half inches in depth close to the spinous processes, but which become Fig. 47.— The Osseous Thorax. 1, manubrium ; 2, gladiolus ; 3, xiphoid appendix ; 4, first dorsal vertebra ; 5, last dorsat vertebra ; 6, first rib. shallow externally toward the angles of the ribs, which serve to limit the grooves. They lodge the dorsal muscles, especially the fourth and fifth layers. Later- ally, the chest is convex from before backward; ante- riorly the chest is flattened, though prominent below, due to the advance of the lower part of the sternum. In the lower animals, as a rule, the chest is flattened from side to side, so that naturally they rest upon the side ; in man the converse is true, for in conditions of muscular relaxation and at death he gravitates upon his back. THE UPPER EXTREMITY. 105 THE UPPP]R EXTREMITY. THE SHOULDER. Thie shoulder is formed by the clavicle and the scap- ula, and serves to connect the upper extremity with the trunk. THE CLAVICLE is classed among the long bones, although it does not possess a medullary cavity. It is shaped like the letter S, and presents two curves, — a sternal anterior convex and a scapular anterior concave. It articulates with the sternum and acromial process of the scapula, and forms Fig. 48.— The Left Clavicle, Upper Surface. the only osseous connection of the superior extremity with the skeleton. It is placed horizontally; its articulations, arthrodial=>^X (KT. VieiTOIIVM CSMMHWt t MT. Minini oiaiTi Fig. 55.— Radius and Ulna, Posterior Aspect. osity, a rough mass of bone, which affords attachment to the biceps tendon. The shaft is prismatic, presenting 118 PRACTICAL ANATOMY. three borders — anterior, posterior, and internal — and three surfaces — anterior, posterior, and external. The anterior border, also called the oblique line, starts below the tuberosity and terminates at the styloid process ; the posterior border, rounded, terminates below in the pos- terior portion of the styloid process ; the internal border is sharp, and affords attachment to the interosseous liga- ment. The surfaces afford attachment to muscles. The lower end of the radius is a cuboidal mass of bone, which presents a posterior, an outer, an anterior, an inner, and an inferior surface. The posterior surface, quadrilateral in form, is convex from side to side, and from above downward. It presents three grooves, which run in the direction of the axis of the bone. They are an outer, broad and shallow, which lodges the tendons of the extensor carpi radialis longior and brevier ; the middle groove, narrow and deep, for the tendon of the extensor secundi internodii pollicis ; the inner groove, broad and shallow, for the extensor tendons of the index and little fingers and the common extensors. The outer surface is narrow and triangular, and ter- minates below in a strong, conical process of bone, — the styloid process. It presents two grooves, — an anterior, for the tendon of the extensor ossis metacarpi pollicis, and a posterior, for the tendon of the extensor primi internodii pollicis. The anterior surface is broad, con- cave from above downward, flattened from side to side ; it serves for the attachment of the pronator quadratus muscle. The inner surface, quadrilateral and flattened, presents a slight concave, articular surface for the side of the head of the ulna. This articular surface is called the sigmoid cavity of the radius. The inferior surface is entirely articular, and triangular in outline. Its base is at the inner surface and its apex at the styloid process ; THE CARPUS, OR WRIST. 119 it is concave from before backward, strongly so from side to side, and presents a slight ridge dividing the surface into two articidar facets, the outer for the scaphoid and the inner for the semilunar. It is seen that the articula- tion at the wrist is formed by the radius above and the scaphoid and semilunar below, the ulna being blocked out of the articulation by the interarticular fibro- cartilage. The radius develops by three centres, — one for the upper extremity and head, one for the shaft, and one for the lower extremity. THE CARPUS, OR WRIST. The carpus, or wrist, is made up of eight short bones, arranged in two rows. The first or proximal row are the scaphoid, semilunar, cuneiform, and pisiform. Those of the second or distal row, the trapezium, trapezoid, os magnum, and unciform. Each bone is cuboidal in form, and presents six surfaces. The anterior or palmar and the posterior or dorsal surfaces are rough, and serve for the attachment of ligaments. Together they form a series of close articulations, admitting of but little movement. Each bone is developed by one centre, except the unciform, which has two, — one for the unci- form process and one for the rest of the bone. The pisiform is a sesamoid bone developed in the tendon of the extensor carpi ulnaris. THE SCAPHOID The scaphoid articulates above with the radius, below with the trapezium and trapezoid, and internally with the semilunar and os magnum. The internal surface, small and tuberculated, gives attachment to the external lateral ligaments of the wrist-joint; the dorsal surface enters into the formation of the dorsum of the wrist ; the 120 PRACTICAL ANATOMY. palmar surface, rough and grooved, helps to form the osseous palm. THE SEMILUNAR. The semilunar articulates above with the radius, ex- laearpat Fig. 56— Carpus, Metacarpus, and Phalanges, Dorsal Surface. ternally with the scaphoid, internally with the cuneiform, inferiorly with the os magnum and unciform. The palmar surface is the larger and is rough ; the dorsal, rouah for ligramentous attachment. OS MAGNUM. 121 THE CUNEIFORM. The superior surface of the cuneiform is rough and non-articular; the inferior surface articulates with the unciform ; the external surface articulates with the semi- lunar above and the unciform below. The internal sur- face projects and affords attacliment to the external lateral Ugament of the wrist. The dorsal surface is rough for the attachment of ligaments. The anterior or palmar surface presents an articular facet for the pisiform bone. THE PISIFORM. The pisiform, about the size of a large pea, is co- noidal in form ; its base presents an articular surface for articulation with the cuneiform. THE TRAPEZIUM. The trapezium articulates superiorly with the scaphoid, inferiorly with the first metacarpal bone, internally with the trapezoid and base of the second metacarpal bone. The palmar surface is grooved for the tendon of the flexor carpi radialis. The dorsal surface is rough. THE TRAPEZOID. The superior surface of the trapezoid articulates with the scaphoid ; the inferior surface articulates with the second metacarpal ; the external surface articulates with the trapezium ; the internal surface articulates with the OS magnum ; the anterior and posterior surfaces are rough. OS MAGNUM. The OS magnum is placed in the centre of the osseous palm ; the superior surface articulates with the semilunar; the inferior surface with the third metacarpal principally, also slightly with the second and fourth ; the external 122 PRACTICAL ANATOMY. surface articulates with the trapezoid ; the internal sur- face articulates with the unciform ; the palmar surface is broad and flat; the dorsal surface is broad, flat, and rough, for the attachment of ligaments. THE UNCIFORM. The unciform articulates above with the semilunar, below with the fourth and fifth metacarpals, externally with the OS magnum, and internally with the cuneiform. The posterior surface is rough; the anterior surface pre- sents the hook-like, unciform process ; it projects down- ward from the junction of the palmar borders of the external and inferior surfaces; the anterior annular ligament is attached to it. These carpal bones, together with the five metacar- pals, form the osseous palm. The carpus proper, con- sisting of the two rows of bones, is convex from side to side on the dorsal aspect and concave from side to side on the palmar surface, where it presents prominences along both the external and internal borders for the attachment of the anterior annular ligament, which is attached externally to the scaphoid and trapezium, in- ternally to the unciform process and the pisiform bone. THE METACARPUS. The metacarpus is made up of five long bones, each of which develop by two centres. The first metacarpal articulates with the trapezium and the first phalanx of the thumb; it presents a base, shaft, and head. The base is cuboidal and fits firmly against the trapezium ; the shaft is prismoidal in form, convex on the dorsal surface, concave on the palmar. The head is broad and presents two condyles for articulation with the first pha- lanx of the thumb. It is the shortest, thickest and strongest metacarpal bone. THE METACARPUS. 123 The second metacarpal articulates above with the trapezoid, and laterally with the trapezium, os magnum, and third metacarpal ; its distal extremity articulates VLR«OR.eAVl Or*'/:.."*" »ltll«ll •KlVIt MIMI VkKKOR OttlS MBT Fig. 57.— Carpus, Metacarpus, and Phalanges, Palmar Surface. with the first phalanx of the index finger. Its base is large, cuboidal; the shaft long, prismoid, presenting a dorsal and two lateral surfaces; the head is rounded; the articular surface, as in the other metacai^pal bones, 124 PRACTICAL ANATOMY. extends some distance on the anterior surface of the head, terminating in the inner and outer tubercles for the attachment of the lateral ligaments. The third metacarpal articulates with the os magnum and second and third metacarpals ; the distal extremity articulates with the first phalanx of the middle finger. The fourth metacarpal articulates at the carpus with the unciform, slightly with the os magnum, and also with the third and fifth metacarpals ; its distal end articulates with the first phalanx of the ring-finger. The fifth metacarpal bone is the smallest and articu- lates above with the unciform and fourth metacarpal, below with the first phalanx of the little finger. All these metacarpal bones are prismoid, having a posterior or dorsal surface and two anterior lateral sur- faces. Each bone is bowed, concave on the anterior sur- face from end to end, and convex posteriorly. Their distal extremities, or heads, are rounded, and form the knuckles in flexion of the phalanges. Together with the bones of the carpus they make the osseous palm, which is convex posteriorly and concave anteriorly. THE PHALANGES. The phalanges are fourteen in number, — two for the thumb and three for each of the fingers. They are long bones, each developed by two centres. Each bone pre- sents a base, shaft, and head, or distal extremity. The phalanges of the first row are strong, cylindri- cal, flattened, and each presents a broad base for articu- lation with the head of a metacarpal. The shaft is flat- tened. The heads present two feebly-marked condyles for articulation with the bones of the second row. The phalanges of second row are similar to those of the first, but smaller ; the thumb has no second phalanx. THE LOWER EXTREMITY. 125 Tlie phalanges of the third row are the smallest ; on the anterior surface of the distal extremity they present the elliptical pulp plates, — rough surfaces which support the pulp. The distal phalanx of the thumb is the largest. THE LOWER EXTREMITY. THE OS INNOMINATUM. The OS innominatum, an irregular bone, forms, with its fellow, the anterior and lateral walls of the pelvis. It develops in three separate pieces, which become solidified into one bone at about the twentieth year. The upper portion is called the ilium ; the anterior portion, the pubes; the inferior portion, the ischium. The ilium is the broad, flattened, and expanded por- tion of the bone ; the two ilia form the false pelvis, and support the abdominal viscera. The ilium presents for examination an outer and inner surface, a superior border or crest, an anterior and posterior border. The outer surface looks outward, down- ward, and backward. It is smooth, convex in front, concave behind, and is marked by three curved lines, — the superior, middle, and inferior. The superior is short, be- gins about an inch anterior to the posterior superior spine, and curves downward and backward. The middle curved line begins about an inch behind the anterior superior spine, and terminates near the great sacro-sciatic foramen. The inferior curved line begins near the anterior inferior spine, and terminates near the lower part of the great sacro-sciatic foramen. Below the inferior curved line is a depression for the attachment of the reflected tendon of the rectus. The inner surface is bounded above by the crest, an- teriorly by the anterior border, posteriorly by the posterior border, and below by a prominent ridge called the ilio- 126 PKACTICAL ANATOMY. pectineal liue. This surface is smooth and concave for the anteiior three-fourths of its extent, and is called the venter of the ilium. Posteriorly it is flattened, rough above for the attachment of ligaments; below it presents an ear-shaped, articular surface, called the auricular sur- FiG. 58.— OS LxxosixsATrM, OrxER Sfeface. face, for articulation with the sacnim. The crest, or superior border, presents a double curve; it terminates anteriorly in the anterior superior spine, posteriorly in the posterior superior spine, and presents two lips, — outer and inner; also, an intermediate surface for the attach- ment of muscles. The anterior border presents the two. THE OS INNOMINATUM. 127 spinous processes, superior and inferior, separated by the superior notch ; below the inferior spine is the inferior notch. The spinous processes are about one and one- half to two' inches apart ; they serve for muscular attach- ment. The posterior border presents the superior and inferior spines, separated by a notch; below the inferior spine is a deep notch, called the greater sacro-sciatic. The posterior inferior spine is prominent and strong, and gives attachment to ligaments. The pubic portion of the os innominatum makes the anterior part of the pelvis ; it presents a body and de- scending ramus. The body presents four surfaces — su- perior, inferior, anterior, and posterior — and an inner and outer extremity. The anterior surface is rough, for the attachment of muscles; the posterior surface is smooth and makes the upper part of the anterior wall of the pelvis; the superior surface presents, about three- fourths of an inch from the inner extremity, a conical elevation of bone, called the spine. Running inward from the spine is the crest for attachment of the rectus muscle. Passing outward from the spine is the begin- ning of the ilio-pectineal line, which runs outward and backward, becoming strongly marked; it limits the venter of the ilium, and, in the articulated pelvis, divides the upper, or false, from the lower, or true, pelvis. The in- ferior surface is smooth, and forms part of the upper boundary of the obturator foramen and presents a shal- low groove for the passage of the obturator nerve and vessels. The inner extremity presents an oval surface; its long diameter is directed vertically; it is roughened, and affords attachment to the interarticular fibro-carti- lage, interposed between the two pubic bones. Passing downward and outward from the inner ex- tremity of the body is the descending ramus. The outer 128 PRACTICAL ANATOMY. extremity is continuous with the iUum and ischium, the Hues of union passing through the acetabulum, — a large, cup-like, articular cavity on the outer side of the os in- nominatum. Of the acetabulum the ilium makes two- fifths, the pubes one-fifth, and the ischium two-fifths. The descending ramus, broad above, becomes thinner, and forms the inner boundary of the obturator foramen. Fig. 59.— Os Innominattjm, Inner Sxtrfacb. Its anterior surface is rough, for the attachment of mus- cles ; posteriorly it is smooth, and enters into the formation of the anterior wall of the pelvis. Its inner border pre- sents the pudic groove, — a shallow groove formed by the eversion of the anterior margin of the ramus ; it accom- modates the pudic vessels and nerve. Its outer border is sharp, and forms part of the circumference of the obtu- THE OS INNOMINATUM. 129 rator foramen; it affords attachment to the obturator membrane. The inferior extremity of the ramus is con- tinuous with the ascending ramus of the ischium. The ischium is the most inferior part of the os in- nominatum. It consists of two parts, — the body and the ascending ramus. The body, placed vertically, is a wedge-like mass of bone, presenting three surfaces, — ex- ternal, internal, and posterior; a superior portion, which enters into the formation of the acetabulum; and an in- ferior, broad, expanded part, called the tuberosity. The external surface is rough, for the attachment of muscles ; at its upper part is the prominent rim of the acetabulum, of which the ischium makes two-fifths. The internal surface is a smooth plane of bone, which descends verti- cally from the ilio-pectineal line, and forms the lateral wall of the pelvis ; it is called the plane of the ischium. The posterior surface begins practically at the posterior inferior spine of the ilium, beneath which is a deep notch, the greater sacro-sciatic, formed into a foramen by the lesser sacro-sciatic ligament, which is attached to the spine of the ischium, — a spur-like projection from the posterior border of the bone, about three and one-half inches below the posterior inferior spine. The spine of the ischium projects directly backward, as a rule, in the female, while in the pelvis of the male sex it not unfre- quently curves strongly inward; it varies in length from one-half to three-fourths of an inch. Below the spine of the ischium is the lesser sacro-sciatic notch, converted into a foramen by the greater sacro-sciatic ligament. The foramen thus formed is about an inch in diameter, and I transmits the tendon of the internal obturator muscle, the internal pudic vessels and nerve. Below the lesser sacro-sciatic notch the posterior surface presents two de- pressions for the origin of the ham-string muscles. The ■ 130 PRACTICAL ANATOMY. inferior portion of the ischium is called the tuberosity (in German, the " Sitz-beine," as the tuberosities support the weight of the body in the sitting posture). It presents an outer and inner border and an intermediate surface of bone. To the outer lip is attached the quadratus femoris and adductor magnus muscles. The inner lip presents a sharp crest, for the attachment of the great sacro-sciatic ligament; above this is the groove for the internal pudic A^essels and nerve ; it affords attachment also to the trans- versus perinei and erector penis muscles. The inter- mediate surface is rough, for the attachment of muscles. The ascending ramus of the ischium is slender and flat- tened, and joins the descending ramus of the pubes, com- pleting the obturator foramen. Its external surface is rough, for muscular attachment; internally it is smooth and forms part of the anterior wall of the pelvis ; at its inferior part is the continuation of the groove for the pudic vessels and nerve. Its inner border is everted, and affords attachment to the crus penis. The outer border is sharp, and forms part of the circumference of the obturator foramen, and affords attachment to the obtu- rator membrane. On the outer surface of the os innominatum, near its centre, is a large, cup-like cavity for articulation with the head of the femur. It is called the acetabulum, or coty- loid cavity. It presents a rim and inner surface. The rim is prominent, elevated above the surface of the bone, strong and heavy above, but deficient at its inferior por- tion, where it presents a notch — the cotyloid — for the passage of vessels and nerves into the hip-joint. The inner surface presents a ribband of articular cartilage, which skirts the inner margin of the cavity. It is about one inch broad and deficient below. The central por- tion is rough, for the attachment of the round ligament THE PELVIS. 131 of the hip-joint. The obturator foramen is a large hole, bounded above by the bodies of the ischium and pubes, below by the rami of the pubes and ischium, and poste- riorly by the anterior border of the ischium. It is tri- angular in form, smaller in the female than in the male, and gives attachment to the thyroid or obturator mem- brane. Its upper border presents a groove for the obturator vessels and nerve. The OS innominatum develops by three centres, — one for the ilium, one for the ischium, and one for the pubes; in addition, there are four or five secondary centres. The three segments unite in the condyloid cavity, of which the ilium forms the upper two-fifths, the ischium the posterior and lower two-fifths, and the pubes the anterior and lower one-fifth. The rami of the ischium and pubes unite about the seventh year. THE PELVIS. The pelvis is formed by the two ossa innominata, sacnim, and coccyx. It is a ring of bone, through which the weight of the trunk, head, and upper extremities is transmitted to the lower extremities. It consists of two parts, — an upper, expanded portion, the false pelvis ; an inferior, cylindrical part, the true pelvis. The false pelvis is deficient anteriorly ; laterally and posteriorly it is formed by the expanded ilia and lumbar vertebrae. It is separated from the true pelvis by the ilio-pectineal ridge or line, which begins at the spine of the pubes and terminates at the promontory of the sacrum. The inlet to the true pelvis, called the superior strait, is formed by the ilio-pectineal ridge. It is elliptical in outline, somewhat encroached upon posteriorly by the promontory of the sacrum. The true pelvis is a curved cylinder of bone, longer posteriorly than anteriorly, and 132 PRACTICAL ANATOMY. terminates at the outlet or inferior strait, which is very- irregular, and formed laterally by the tuberosities of the ischia and pos- teriorly by the tip of the coccyx. Be- tween the tuberosi- ties of the ischia anteriorly is the pubic arch, formed by the rami of the ischia and pubes. FIG. 60.-THE PELVIS. rpi cinien'or strait A A, antero-posterior diameter ; B B, transverse diameter ; -L Xic oi.4^\^x±wi OLic«,iu C C, two oblique diameters ; 1, sacro-iliao ligament ; 2, anterior -i i. JZ or lesser sacro-sciatic ligament; 3, posterior or great sacro-sciatic meaSUrOS aOOUt 11 VO ligament. inches transversely and about four inches antero-posteriorly. The true pelvis is about four and a half inches in diameter. The inferior strait measures about four inches transversely and about four and a half inches ante- ro-posteriorly. The depth of the true pelvis is about two inches anteriorly, about four and a half inches posteri- orly. The axis of the true pelvis is a line equidistant be- tween the anterior and posterior walls of the pelvis. The pelvis is tilted up- ward and forward, so that the promontory of the sacrum is about four inches higher than the upper border of the Fig. 61.— The Axis of the Pelvis. a b, plane of the superior strait (brim) ; o i, plane of the inferior strait (outlet) ; c, the point where these two planes would meet, if prolonged; »i n, a horizontal line; e/, axis of brim ; g k, axis of cavity : p q r s t, various points taken on the sacrum to show the plane of the cavity at each point. THE FEMUR. 133 pubes. The plane of the superior strait forms an angle of about 60 degrees ; the plane of the inferior strait varies, but approximates the horizontal. The pelvis presents some sexual differences ; tlius, in the vigorous adult — MALE. 1. The bones are heavy. 2. Osseous processes and mar- gins are strongly devel- oped. 3. Ilia compressed, 4. Diameter through the cot3ioid cavities con- tracted. 5. The diameters less than stated above. 6. The pelvis is deep. 7. Diameters of inlet and out- let irregular. 8. The ischia approach each other. 9. The pubic angle or arch acute. 10. The spines of the ischia are strong, often turned in. 11. Large obturator foramen. FEMALE. 1. Comparatively light. 2. Comparatively slight. 3. Ilia expanded. 4, Broader. 5. More than stated above ; pelvis more capacious. 6. Shallow. 7. Diameters of inlet and out- let uniform and larger. 8. The ischia are everted. 9. The pubic angle or arch obtuse. 10. The spines of the ischia small, point backward. 11. Smaller and triangular. THE FEMUR. The femur, or thigh-bone, is the longest and strongest bone in the body. It consists of a shaft and two ex- tremities. The upper extremity presents a head, neck, and greater and lesser tuberosities. The head is globu- lar, and makes three-fifths of a sphere. It is rough and dimpled at its summit, for the attachment of the round ligament. It is slightly compressed antero-posteriorly. Its axis is directed upward and inward. The neck is strong and flattened antero-posteriorly. Its upper 134 PRACTICAL ANATOMY. •nWKM nruaut (, onnu border is rounded and slightly concave ; the lower border arched, rough, and thick, and terminates at the lesser trochanter. The anterior sur- face is convex, and presents many foramina for transmission of nu- trient vessels; the posterior sur- face is convex and smooth. At birth the neck is nearly continuous with the axis of the shaft ; in the adult it forms an angle of about 115 degrees; in old age it de- creases, being often a right angle, or even less. The great trochanter is a cuboidal mass of bone, which projects upward from the upper end of the shaft. It presents an external and internal surface; an- terior, superior, and posterior bor- ders. The external surface is rect- angular in outline and rough, for the attachment of muscles. The internal surface is small, and pre- sents the digital fossa, — a depres- sion which affords attachment to the tendon of the external obtu- rator muscle. The superior border presents several facets for the at- tachment of muscles. The ante- rior border is rough and continuous with the anterior intertrochanteric Fig. 62.— The Femur, Ante- line ; the Dostcrior border is promi- RioR Surface. ' r i ^ nent and rounded, and is continu- ous with the posterior intertrochanteric line. The lesser trochanter is a conical projection of bone from the poste- THE FEMUR. 135 rior internal portion of the base of the neck of the femur. It gives attachment to the conjoined tendon of the iliacus and psoas magniis. The .1: tl'^. anterior intertrochanteric line is rough, and serves for the attachment of the capsular ligament of the hip-joint. It runs obliquely downward and inward from the greater to the lesser trochanter. The posterior intertrochanteric line is very strongly marked, con- cave above, and affords at- tachment to the capsular ligament. It runs from the posterior border of the greater trochanter to the lesser trochanter. Passing down the posterior part of the shaft from the middle of the posterior intertro- chanteric line is the quad- rate line, a rough surface, one-fourth inch wide and about two inclies long. It gives attachment to the tendon of the quadratus femoris muscle. The shaft of the femur is cylindrical. It presents posteriorly the linea aspera, which runs the entire length of the shaft. It presents two well-marked lips, an inner and outer, and an inter- MruTua Fig. 63.— Thk Femur, Posterior Surface. 136 RACTICAL ANATOMY. mediate surface. The outer lip begins at the outer part of the great trochanter, and curves downward and in- ward, and then outward, to the outer epicondyle. The inner lip begins at the lesser trochanter and terminates at the inner epicondyle. At the lower fourth of the femur the divergence of the inner and outer lips of the linea aspera leaves a triangular, flat space, called the popliteal space. The linea aspera serves for the attach- ment of muscles. The shaft of the femur is cylindrical and slightly bowed for- ward. The inferior ex- tremity is the most ex- panded portion of the bone, and presents the inner and outer condyles for articulation with the tibia. They are separ- ated by the intercondyloid notch posteriorly, and, to some extent, below. The condyles project behind the plane of the posterior surface of the femur for nearly one inch. Their anterior surface is in the same plane as the anterior sur- face of the shaft. The inner condyle is the longer and larger; the outer condyle is the shorter and thicker. The articular surface passes upward some distance on the anterior surface of the condyles, but higher over the external than over the internal condyle. Just above each condyle is a prominent tubercle,- — the inner and outer epicondyles ; to the inner is attached the tendon of the great adductor; to the outer epi- condyle are attached the lateral ligaments of the knee- FiG. 64.— Section op the Head of Femur, showing Lamella. The fibres, A, by their rigidity, and the fibres, B, by their tenacity, tend to tlie support of the weight, ■while the latter fibres interlace with the arciform fibres, F. THE PATELLA. 137 joint. The inner epicondyle is the larger and most marked. The shaft of the femur is a cylinder of compact or dense bone ; the extremities are bulky, containing can- cellated tissue covered by a thick shell of dense bone. The structure of the femur is such as to give the greatest longitudinal resistance for the quantity of bone it con- tains. The cancellated contents of the upper extremity are disposed in a series of curved plates, thus increasing the elasticity and carrying power of the head and neck of the bone. The femur develops by five centres, — one for the shaft, one for the condyles, one for the head, and one for each of the trochanters. THE PATELLA. The patella is situated at the front of the knee-joint, and is the fulcrum over which the common extensor (Anterior surface. ) (Posterior surface. ) Fig. 65.— The Right Patella. muscle of the thigh acts. It is a sesamoid bone which remains cartilaginous up to the third or fourth year, the earliest indication of a centre of ossification being seldom met with before the twentieth month. It is shaped some- what like a horse-chestnut, and presents an anterior and posterior surface, — an upper broad portion, the base, and a lower, somewhat pointed, called the apex. The 138 PRACTICAL ANATOMY. anterior surface is ridged, convex, and presents many foramina leading- into the bone. The posterior surface presents an oval articular surface divided into two un- equal facets, — the outer, large for articulation with the external condyle of the femur; the inner, smaller for articulation with the inner condyle. The base presents upward, and has attached to it the four-headed ex- tensor muscle. The apex is bluntly pointed, and serves for the attachment of the anterior ligament of the knee- joint, called the ligamentum patellae. The patella develops by one centre; it belongs to the class of irregular bones. Its cancellous tissue is often arranged with the lamellae disposed transversely. The outside, compact shell is dense and rather thick. THE TIBIA. The tibia, or shin-bone, is the inner bone of the leg ; it belongs to the class of long bones, and presents a shaft and an upper and lower extremity. The shaft is thick, strong, and prismatic in form ; has three borders, — an- terior, inner, and outer; and three surfaces, — external, internal, and posterior. The anterior border is long, curved, prominent, and sharp, and constitutes the "shin;" it begins at the outer side of the head of the tibia, and curves downward and inward, then slightly outward, and, finally, by curving strongly inward, terminates at the internal malleolus ; for its middle three-fifths it is sharp and subcutaneous. The inner border is rounded and thick ; it begins at the inner side of the head and terminates in the internal malleolus. The outer border is rather sharp, faces the inner border of the fibula, and serves for the attachment of the interosseous membrane. The internal surface is smooth and subcutaneous, and looks forward and inward. The external surface is some- THE TIBIA. 139 9liff^^'fjrr»9ft what rougli, for the attachment of the tibiahs anticus muscle ; below, it is slightly twisted so as to present for- ward. The posterior surftice is broad and flattened and presents at its upper part an ii*<»« oblique ridge, which runs from the outer border downward and inward across to the inner border. Just below the ob- lique line is the nutrient fora- men, which passes downward. The inferior portion presents the grooves for the flexor mus- cles as they pass to the foot. The superior extremity or head is cylindroid in form and much expanded ; its upper sur- face is flat and presents two shallow articular surfaces for the condyles of the femur ; be- tween these are two blunt, conical processes, — the spines for the attachment of the crucial ligaments. A short dis- tance below the articular sur- faces, anteriorly, is the tuber- osity of the tibia, — a marked ovoidal mass of bone to which the ligamentum patellae is at- tached. Externally, is a small articular facet for the head of fig.66.-the tibta and fibula, AxTEKioR Surface. the fibula. Posteriorly, the head is flattened and enters into the formation of the popliteal space. The inferior extremity is large and cuboidal; presents an anterior, posterior, internal, and 140 PRACTICAL ANATOMY. external surface, and an articular end. The anterior sur- face, over which, the extensor tendons pass, is slightly con- cave and smooth; the posterior surface presents the grooves for the tibialis posticus, flexor longus digitorum, and flexor longus poUicis. The external surface, convex from before backward, is continued downward as a quad- rangular process of bone, called the inner malleolus, which projects about three-fourths of an inch below the articular surface for the upper s-urface of the astragalus. On the outer side of the internal malleolus is the articular surface for the inner side of the astragalus. The external surface presents a triangular articular surface for the fibula. The inferior surface presents a trilateral articular surface for the astragalus, it is broad externally, smaller where it becomes continuous vn.th the articular surface of the outer side of the inner malleolus. In structure, the tibia presents a bulky head made of a shell of dense bone, inclosing a large quantity of can- cellous tissue, arranged so as to present many large alveolar spaces. The lamellae of the cancellous tissue are strong and thick, although short, and frequently pre- sent the Haversian system of canals. The bone de- velops by four centres, — one for the shaft, one for the upper extremity, one for the lower extremity, and one for the malleolar process. THE FIBULA, OR SPLINT-BONE. The fibula, or splint-bone, is the outer bone of the leg. It is long and slender, and belongs to the class of long bones. It presents a shaft, upper extremity, or head, and lower extremity, or outer malleolus. The shaft is pris- moid, slightly twisted, and presents a well-marked inner border for attachment of the interosseous ligament. The posterior border is well-marked; the anterior border is TUK TARSUS, OR ANKLE. 141 ^IjUajm rounded. The surfaces are slightly rough, Tor the attach- ment of muscles. The head is pyramidal in form, pre- sents an inner articular surface for the side of the head of the tibia; the external, ante- rior, and posterior surfaces are rough, for the attachment of ligaments; from its upper part projects the styloid process, to which is attached the tendon of „„ the biceps muscle. The infe- rior extremity projects an inch to an inch and a quarter below the inferior surface of the tibia, and forms the outer malleolus. Posteriorly it presents the groove for the tendons of the peroneus longus and brevis. Externally it is subcutaneous; internally it presents the articu- lar surface for the tibia; below is the articular surface for the outer side of the astragalus. The outer malleolus is some- what pointed below, and serves for the attachment of liga- ments. The fibula develops by three centres, — one for the shaft, one for the upper, and the other for the lower ex- fig..67.— the tibia and fibula. Posterior Surface. tremity. THE TARSUS, OR ANKLE. The tarsus, or ankle, is composed of seven bones, — astragalus, os calcis, scaphoid, cuboid, external, middle, U2 PRACTICAL ANATOMY. and internal cuneiform. Two bones — the os calcis and astragalus — form the posterior part of the tarsus; the vinoNii •tllHCUf Urtdim ^ encvis oiciToRuii lONQUS PSbhlSIV Fig. 68.— The Tarsus, Metatarsus, and Phalanges, Dorsal Surface. other five the anterior portion. They belong to the class of short bones; each develops by a single centre except THE OS CALCIS, OR HEEL-BONE. 143 the OS calcis, which has an additional one, by which tlie posterior portion is completed. The bones remain carti- laginous for some time after birth; in fact, complete ossification does not occur in some of them before the fifteenth year. THE ASTRAGALUS. The astragalus is the uppermost bone of the tarsus. It articulates above with the tibia, and laterally with the malleoli. It presents for examination a head, neck, and superior, inferior, external, internal, and posterior sur- faces. Tlie head is in front ; it is rounded, and articulates with the scaphoid; behind the head the bone is con- stricted, and Ibrms the neck. The superior surface pre- sents a quadrilateral articular surface for the inferior extremity of the tibia; it is convex from before back- ward, and concave from side to side. The internal sur- face presents an articular surface for the internal malle- olus. It is continuous with the articular surface on the superior portion of the bone. The external surface pre- sents an articular facet for the external malleolus continu- ous with the superior articular surface. This arrange- ment of the superior and lateral articular surfaces on the astragalus makes a sa'ddle of articular surfaces on the bone. Inferiorly the astragalus presents a large articular surface, divided into a larger posterior and a smaller anterior portion by a deep groove, for the attach- ment of interosseous ligaments. The anterior articular facet rests on the inferior calcaneo-scaphoid ligament, the posterior on the upper surface of the os calcis. Posteriorly, the astragalus presents a groove for the long flexor of the great toe. THE OS CALCIS, OR HEEL-BONE, The OS calcis, or heel-bone, is the largest bone of the tarsus. It presents six surfaces, — anterior, posterior, 144 PRACTICAL ANATOMY. superior, inferior, internal, and external. The superior is divided into an anterior articular and a posterior free surface. The articular portion is divided by a groove which is opposite to the groove on the inferior surface of the astragalus, and serves for the attachment of inter- osseous ligaments. The posterior portion of the upper surface is rough, convex from side to side, slightly concave from before backward; it projects behind the astragalus for an inch and a half, and is practically the lever to the posterior surface of which is attached the tendo Achillis. The inferior surface is rough, convex, and somewhat irregular. It presents posteriorly the inner and outer tuberosities; the inner, much the larger, rests directly on the ground. Anterior to the tuberosities the bone is un° even and aiFords attachment to muscles and ligaments. The internal surface is concave for the passage of the flexor tendons and plantar vessels and nerves to the foot. The external surface is irregular; it presents a tubercle for attachment of the middle fasciculus of the external lateral ligament; also, the grooves for the peroneus brevis (above) 'and peroneus longus (below). The an- terior surface articulates with the cuboid; it is a square facet, placed at right angles with the axis of the bone ; at its outer edge is a tubercle, which is located immedi- ately behind the articulation and forms a surgical land- mark. The posterior surface gives attachment to the tendo Achillis ; it is smooth above, but convex and blunt. THE SCAPHOID. The scaphoid articulates posteriorly with the astraga- lus, anteriorly with the three cuneiform, externally with the cuboid. Its upper surface is convex from side to side, and rough ; inferiorly it is rough also for the attach- ment of ligaments. From its inner side projects a THE INTERNAL CUNEIFORM. 145 tubercle, which serves as a guide to tlie astragalo- scaphoid articulation, externally broad and rough, and presents an articular surface for the cuboid ; anteriorly are the three facets for the cuneiform bones ; the pos- terior surface is slightly concave for the head of the astragalus. THE CUBOID. The cuboid articulates anteriorly with the fourth and fifth metatarsal, posteriorly with the os calcis, internally with the scaphoid and external cuneiform. The superior surface is slightly convex and rough ; the external sur- face is narrow, and notched by the tendon of the long peroneal muscle ; inferiorly it is irregular, and presents at its anterior part a groove, which accommodates the tendon of the peroneus longus muscle in its passage across the sole of the foot; behind the groove is the tuberosity of the cuboid for the attachment of plantar ligaments. The internal surface is rough, but presents two articular facets, — the posterior or smaller for the scaphoid, the anterior or larger for the external cunei- form. The anterior surface presents two articular sur- faces, which are practically continuous ; the inner, quadrilateral in form, is for the fourth metatarsal ; the outer is triangular, and is for the articulation of the fifth metatarsal bone. The posterior surface is large, slightly concave, and articulates with the os calcis. THE INTERNAL CUNEIFORM. The internal cuneiform articulates posteriorly with the inner facet on the scaphoid, anteriorly with the first metatarsal bone, externally with the second metatarsal and the middle cuneiform. Its upper surface is convex and rough; internally it is rounded and subcutaneous; inferiorly it is irregular, and presents a tuberosity for the 10 U6 PRACTICAL ANATOMY. attachment of the tendon of the tibiaUs posticus ; exter- nally are the two articular surfaces for the middle cunei- ,oiimiiEu tficenlC 1U» IHIVIt HtuOltf Seamaid (ItrALiB MtTievai Fig. 69.— The Taesu.s, Metatae-stts, axd Phalanges, Plantar Surface. form behind and the second metatarsal in front, separated by a rough surface for the attachment of ligaments. THE METATARSAL BONES. 147 THE MIDDLE CUNEIFORM. The middle cuneiform presents five surfaces, — supe- rior, external, internal, anterior, and posterior. The superior surface is quadrilateral and rough ; the external presents the surface for articulation with the external cuneiform ; the internal presents an articular strip along the superior border for articulation with the internal cunei- form ; the posterior surface is triangular, and articulates with the second facet on the scaphoid ; the anterior surface articulates with the second metatarsal. The middle cuneiform is the smallest, and is shorter than either the external or internal, being mortised in between them. THE EXTERNAL CUNEIFORM. The external cuneiform articulates posteriorly with the third facet of the scaphoid ; externally with the cuboid, and, by a small facet, with the side of the fourth metatarsal; internally with the middle cuneiform, and, by a small facet, with the second metatarsal ; anteriorly with the third metatarsal. Its superior surface is rect- angular and rougli ; inferiorly is a rounded border ; the internal and external surfaces, in addition to the articular facets, are also rough, for the attachment of ligaments. THE METATARSAL BONES. The metatarsal bones are five in number, — first, second, third, fourth, fiftli. They are long bones, and present a shaft, two extremities, and a medullary cavity, filled, in the adult, with yellow marrow. The shaft is compressed from side to side and slightly bowed, so as to be convex on the upper surface. The distal ex- tremity is called the head, and is rounded in front; the proximal extremity, or base, is cuboidal, and flattened to articulate with the tarsal bones. 148 PRACTICAL ANATOMY. The first metatarsal, or metatarsal of the great toe, is the largest and strongest ; the second is the longest, and is wedged in between the internal and external cunei- form bones, and articulates with the middle cuneiform ; the fifth metatarsal presents the spine, — a rough, pointed process of bone, which projects outward and backward from the base. THE PHALANGES. The phalanges are fourteen in number, — two for the great toe, three for each of the four outer toes. They are minute long bones. The distal row present at the end of their plantar surfaces the pulp plates similar to those on the phalanges of the hand. The metatarsal bones and the phalanges are each developed by two centres. The foot is thus seen to be composed of twenty-six bones, — fourteen phalanges, five metatarsal, and seven tarsal. These bones are so formed and articulated as to produce a convex superior surface, or dorsum, and a concave plantar surface. The bones at the outer side of the foot touch a plane, upon which they are placed at nearly all points. The inner border is raised or arched. The bones along the outer border of the foot are the os calcis, cuboid, fifth metatarsal, and phalanges; those along the inner border are the os calcis, astragalus, sca- phoid, internal cuneiform, first metatarsal, and pha- langes. The articulation between the astragalus and scaphoid and os calcis and cuboid are on a line called Chopart's, indicated by a plane passing directly in front of the crest of the tibia, transverse to the long axis of the foot. The tarso-metatarsal articulations are arranged as follows : — The first metatarsal articulates with the internal cunei- form ; the second metatarsal articulates with the middle THE PHALANGES. 149 cuneiform ; the third metatarsal articulates with the external cuneiform ; the fourth and fifth metatarsals articulate with the cuboid. The first metatarsal articulates with the tarsus at a plane most anterior to all these. The metatarso-tarsal articulation forms a curve passing outward and back- ward, the fifth metatarso-tarsal joint being most posterior ; the second metatarsal is mortised in between the internal and external cuneiform bones ; its articulation with the middle cuneiform is more than a half-inch posterior to the joint of the internal cuneiform and first metatarsal. JOINTS AND LIGAMENTS. 1. A joint is a place of normal contact between bones. 2. A joint is a natural breach in the continuity of the skeleton. 3. A joint consists of the approximation of the articular parts of bones, covered by cartilage and held in position by ligaments. Three elements are found in joints, — bone, cartilage, and ligaments. Bone has been described. Cartilage, or Hyaliue Cartilage. Fibro-cartilage. Cartilage Cells. Fig. 70.— Diagram of Cartilages. gristle, is a non-vascular structure, divided into two kinds, — temporary and permanent. The temporary car- tilage is that which precedes the structure of bone; thus the cartilaginous mold of the femur is first formed, and subsequently converted into or displaced by the bone elements proper. The permanent cartilage is found covering the articular ends of bones, and gener- ally persists as cartilage during the life of the individual. Cartilage is divided into three classes, — (1) hyaline, (2) fibro-cartilage, and (3) elastic. The hyaline carti- (150) JOINTS AND LIGAMENTS. 151 lasres consist of a homooreneous substance of firm con- sistence, in which there are imbedded a number of groups of cells, each group occupying a cavity lined by a distinct capsule. The temporary, articular, and costal cartilages are of this variety, and all, with the exception of the articular class, are covered by the perichondrium, — a fibrous investing membrane in which ramify the nutrient vessels. The fibro-cartilages present a blending of the features of the hyaline cartilage with white fibrous tissue; all the interarticular cartilages belong to this class. The elastic cartilages consist of a mixture of the hyaline cartilage with yellow elastic fibrous tissue ; they are limited to the larynx and ear. Fibrous tissue is of two kinds, — white and yellow. The white is very widely distributed and enters into the formation of the various cellular connective tissues and the fasciae, and forms the skeletal structures of the various glands. It consists of bundles of fibres which are disposed parallel one to another ; they do not run in a straio;ht line, but are wavv or undulate in their course. Each bundle is composed of very delicate fibrillse meas- luing 4 0 0 0 0 ^0 2 0 0 0 0 i^^^h in thickness. A drop of acetic acid placed upon white fibrous tissue causes it to swell up. become indistinct, and lose its physical charac- ters. It is developed from fusiform cells, which closely pack side by side, become elongated, and split up into the fibrillte. The yellow fibrous tissue is elastic and consists of twisted, curling fibres from 2'o^"oo ^^ toVo ^^^^^ "^ thickness. Their genesis is by the stellate connective- tissue corpuscles of Yirchow. It is probable that only the polar extremities of these cells change into the yellow 152 PRACTICAL ANATOMY. fibre. Acetic acid does not affect it. It is found in all elastic ligaments, such as the ligamentum nuchse, those of the larynx, ligamenta subflava, and the elastic coat of arteries. Articulations, or joints, are divided into freely mova- ble, partly movable, and immovable. The freely movable are called the diarthrodial, and are divided into four classes : — 1. Arthrodial. These are gliding joints, such as the thyro-cricoid and acromio-clavicular articulations. 2. Enarthrodial. Ball-and-socket joints, such as the shoulder and hip. 3. Gingiymus, or hinge-joint, as the knee and inter- phalangeal. 4. Diarthrosis rotatoria, or lateral hinge-joints, as the superior radio-ulnar. The partly-movable joints are called the amphiar- throdial ; they are such as the intervertebral. The immovable articulations are divided into three classes : — (a) Dentata ; by tooth- like processes. (b) Serrata ; by saw- tooth-like proc- esses. (c) Limbosa ; by bev- eled margins and tooth-like proc- esses. ' (A) Sutura vera (true sutures) ; articu- late by interlock- ing processes. 1. Sutura. < (B) Sutura notlia (false sutures) ; ar- ticulate by apposi- tion. (a) Squamosa ; by beveled margins. (6) Harmonia ; by abutting surfaces. 2. Schindylesis, or groove-and-tongue articulation, as the ethmoidal spine with the ethmoid, and the articula- tion of the vomer with the rostrum of the sphenoid. 3. Gomphosis, or socket-like joint, as the teeth. TEMPORO-MAXILLARY ARTICULATIONS. 153 ARTICULATIONS OF THE HEAD. The only movable articulation is the temporo-max- illary ; all the other bones of the head are immovably articulated together. Temporo-maxilla ry. Bones: Condyles of inferior maxillary and glenoid cavity. Ligaments : Capsular. Origin — Neck of condyle. Insertion — Circumference of glenoid cavity. Interarticular Fibro-cartilage. Origin — Capsular ligament and external lateral ligament. Insertion — Tendon of external pterygoid and capsular ligament. T7„„„„,^ . ^ T . r.,-,.^ . ^ Fig. 71.— Temporo-maxillary Articu- LxTERNAL Lateral. nations. 0. • f-p V, 1 "■• temporal bone ; h, inferior maxillary bone ; c, riCim JLUberCle capsular Hgament; ♦ . , Levator Mentl X->f^^ ^^ t^tM^"-'^ Origin — At each side of septum, incisive fossa below alveolar process. Insertion — Skin at lower part of chin. Nerve — Facial. ^, Orbicularis Oris. Origin — Sphincter of the mouth. Consists of two thick serai-elliptical planes of muscular fibres, which surround the mouth. ^ Insertion — A few fibres are attached to the superior maxillary and two conical fasciculi, pass upward to the sides to the anterior nasal spine, and are inserted into the upper lip. The depression between these bundles is immediately below the septum nasi. Nerve — Facial. MUSCLES OF THE FACE. 183 •-''Buccinator. Origin — Anterior edge of pterygo-maxillary ligament ; also, from the alveolar process above and below the molar teeth. Insertion — Is a bipenniform muscle. The fibres pass forward and are continuous with those of the orbic- ularis oris. Nerves — Facial and inferior maxillary. Fig. 83.— Temporal. Muscle. RiSORIUS. Origin — Fascia over masseter muscle. Insertion — Angle of mouth. Nerve — Facial. Masseter. Origin — Two portions, superficial and deep. Super- ficial, from inferior border of malar and inferior 184 PRACTICAL ANATOMY. border of anterior portion of zygoma ; deep portion, from inferior border of zygoma. Insertion — Angle and external surface of the ramus of the inferior maxillary. Nerve — Inferior maxillary. ^ Temporal. Origin — Temporal fossa. Insertion — Superior and anterior portion of coronoid process of inferior maxillary. Nerve — Inferior maxiUary nerve. Fig. 84.— Pterygoid Muscles. 1, lower head of external pterygoid; 2, upper head of external pterygoid; 3, iutemal pterygoid. Internal Pterygoid. Origin — Pterygoid fossa. Insertio7i — Inner side of angle of inferior maxillary. Nerve — Inferior maxillary. External Pterygoid. Origin — Two heads : first, pterygoid ridge and bone below on great wing of sphenoid; second, outer surface of external pterygoid plate. MUSCLES OF THE NECK. 185 Insertion — Neck of inferior maxillary, below the con- dyle. Nerve — Inferior maxillary. muscles of the neck. Platysma Myoides. Origin — A superficial plane of muscular fibres passing obliquely up the neck from the clavicle between the layers of the superficial fascia. Insertion — Into the inferior maxillary and fascia of face. Nerves — Facial and supei^ficial branch of cervical plexus. Sterno-claviculo-mastoid. Origin — Two heads, one a round tendon from the sternum. The clavicular origin is fleshy and about one and one-half inches broad. Insertion — It passes upward and backward, divides the side of the neck into two great triangles, and is inserted on the mastoid portion of the temporal and the occipital bones. Nerves — Spinal accessory and branches from cervical plexus. Sterno-hyoid. Origin — Posterior surface of manubrium and inner end of clavicle. Insertion — Inferior border of anterior part of os hyoides. Nerve — Descendens noni. Sterno-thyroid. Origin — Posterior surface of manubrium. Insertion — Oblique line on thyroid cartilage. Nerve — Descendens noni. Thyro-hyoid. Origin — ObHque line at side of thyroid cartilage. 186 PRACTICAL ANATOMY. Insertion — Body and greater cornu of hyoid bone. Nerve — Hypoglossal. Omo-hyoid. Origin — From the hyoid bone to scapula. Body of hyoid bone. Is a bibellied muscle (having a central tendon). Fig. 85.— Muscles op Neck. Insertion — Passes downward, sends its tendon through a loop of deep cervical fascia attached to the first rib, then passes across to the transverse ligament of the scapula, to which the fibres are attached. Nerve — Descendens noni. Digastric. Origin — Also a bibellied muscle. Digastric fossa of the mastoid portion of the temporal. Its tendon MUSCLES OF THE NECK. 187 passes through the stylo-hyoid muscle, by which it is held against the hyoid bone. Insertion — Is inserted into the digastric depression of the posterior surface of the symphysis menti. Nerves — Inferior maxillary and facial. Stylo-hyoid. Origin — Styloid process. Insertion — At junction of body and greater cornu of hyoid. Nerve — Facial. Genio-hyoid. Origin — Inferior genial tubercle. Insertion — Central part of body of hyoid. Nerve — Hypoglossal. Mylo-hyoid. Origin — Mylo-hyoid ridge for its entire length. Insertion — Body of os hyoides and central raphe. Nerve — Inferior dental. Genio-hyoglossus. Origin — Superior genial tubercle ; body of hyoid near the centre ; it spreads out fan-like. Insertion — Inserted into the under surface of tongue, from tip to base. Nerve — Hypoglossal. Hyoglossus. ^ Origin — Side of body, lesser cornu, and full length of greater cornu of hyoid bone. Insei'tion — Inserted into the under surface of the side of the tongue. Nerve — Hypoglossal. LiNGUALIS. ^ Origin mid Insertion — Runs along under surface of tongue from base to tip ; lies between the hyoglossus 188 PRACTICAL ANATOMY. and genio-hyoglossus. It is a bundle of muscular fibres about as thick as a lead-pencil. Nerve — Chorda tympani. Styloglossus. Origin — Styloid process and stylo-maxillary ligament. Insertion — Side of tongue into hyoglossus and lingualis. Nerve — Hypoglossal. I ^Palatoglossus. ^ Origin — Forms anterior pillar of fauces, from soft palate on each side of uvula. Insertion — Arches outward and forward, and is in- serted into the side of tongue. Nerve — Meckel's ganglion. ^ Levator Palati. Origin — Quadrilateral rough surface of petrous por- tion of temporal bone. Insertion — Passes obliquely downward and inward, and is inserted into the soft palate. Nerve — Vidian, from facial. Tensor Palati. Origin — Scaphoid fossa and Eustachian tube. Its central tendon winds around the hamular process. Insertion — It then passes inward at right angles, be- comes fleshy, and is inserted by a broad aponeu- rosis into the soft palate. Nerve — From otic ganglion. AzYGOs Uyul^. Origin — Two fasciculi pendent from the posterior nasal spine. Insertion — Soft palate. Nerve — Vidian, from facial. c-'' Palato-pharyngeus. Origin — Forms posterior pillar of fauces ; arises from soft palate. MUSCLES OF THE NECK. 189 Insertion — Arches downward, outward, and backward ; inserted into sides of pharynx and thyroid cartilage. Nerve — Meckel's gangUon. Fig. 86.— Constrictor MrscLES of Pharynx. 1, orbicularis oris; 2, buccinator; 3, superior constrictor; -t, middle constrictor; 5, inferior constrictor ; 6, mylo-hyoid ; 7, h^oglossus. yO^jo Superior Constrictor. Origin — Internal pterygoid plate, hamnlar process, tendon of tensor palati, posterior edge of pterygo- maxillary ligament and mylo-liyoid ridge. 190 PRACTICAL ANATOMY. Insertion — The fibres pass backward, upward, and inward; they meet those of the opposite muscle behind the pharynx, and are inserted into the tendinous raphe of the pharynx, which is at- attached to the pharyngeal spine of basilar process of occipital. Nerve — Glosso-pharyngeal. />^ Middle Constrictor. Origin — Greater and lesser cornu of hyoid bone and stylo-hyoid ligament. Insertion — Passes outward and backward and meets the muscle of opposite side, and is inserted into the tendinous vertical raphe. Nerve — Glosso-pharyngeal. ^ Inferior Constrictor. 0?%m~Side of thyroid and cricoid cartilages. Insertion — Passes outward and backward and meets fibres of opposite muscle, and is inserted into the tendinous vertical raphe. Nerves — Glosso-pharyngeal and external laryngeal. St YLO:£HAR YNGEJIg . Origin — Styloid process. Insertion — Sides of pharynx between superior and middle constrictors. Nerve — Glosso-pharyngeal. Rectus Capitis Anticus Major. Origin — Anterior tubercles of transverse processes of third, fourth, fifth, and sixth cervical vertebrae. Insertion — Basilar process of occipital. Nerve — Suboccipital. Rectus Capitis Anticus Minor. Origin — Lateral mass of atlas. Insertion — Basilar process. Nerve — Suboccipital. muscles of the neck. 191 Rectus Lateralis. Origin — Transverse process of atlas. Insertion — Jugular process of occipital. Nerve — Suboccipital. LoNGUS Colli. Origin — Three portions: (1) superior oblique, from anterior tubercles of transverse processes of third, fourth, and fifth cervical vertebrae ; (2) inferior oblique, from anterior tubercles of transverse proc- esses of fifth and sixth cervical vertebrae ; (3) ver- tical portion, from bodies of upper three dorsal vertebrae and lower two or three cervical. Insertion — Superior oblique portion passes upward and is inserted into anterior tubercle of atlas. In- ferior oblique portion passes downward, and is inserted into the bodies .of first and second dorsal vertebrae. Vertical portion, into the bodies of the second, third, and fourth cervical. Nerves — Cervical and brachial plexuses. Scalenus Anticus. Origin — Anterior tubercle of the transverse process of the third, fourth, fifth, and sixth cervical vertebrae. Insertion — Passes downward and outward, and is in- serted on the tubercle on the first rib, between the grooves for the subclavian vein and artery. Nerve — Cervical plexus. Scalenus Medtus. Origin — Posterior tubercles of transverse process of all the cervical vertebrae except the atlas. Insertion — On first rib, behind groove for subclavian artery. Nerves — Cervical and brachial plexuses. Scalenus Posticus. Origin — Posterior tubercles of sixth and seventh cer- vical vertebrae. 192 PRACTICAL ANATOMY. Insertion — Posterior part of second rib. Nerve — Brachial plexus. muscles of the thorax. Eleven External Intercostals. Origin — Inferior border of rib, above. Insertion — Superior border of rib, below. Nerves — Intercostals. Eleven Internal Intercostals. Origin — Inferior border of rib, above. Insertion — Superior border of rib, below. Nerves — Intercostals. The external intercostals pass downward and forward, and extend from tubercle of the ribs to costal cartilages. The internal intercostals pass upward and inward, and begin anteriorly at the sternum and extend back- ward to the angle of ribs. Twelve Levatores Costarum. Origin — Apices of transverse processes of dorsal ver- tebrae. Insertion — Pass downward and outward, and are in- serted posterior to angles of ribs. Nerve — Intercostals. Infracostales. Origin — Fibres arise from inner surface of rib. Insertion — Into ribs below. Nerve — Intercostal. Triangularis Sterni. Origin — Lower part of inner surface of sternum and costal cartilages. Insertion — Costal cartilages of third, fourth, and fifth ribs. Nerve — Intercostal. Diaphragm. The diaphragm is a fibro-muscular partition be- THE DIAPHRAGM. 193 tween the thoracic and abdominal cavities. It arises posteriorly by two crura, which arc flat, ligamentous bands attached to the anterior surface of the' bodies of the lower four lumbar vertebrae; also, it arises from the ligamenta arcuata interna and externa, wliich are fibrous arches thrown over the psoas magnus and quadratus lum- borum muscles, the ligamentum arcuatum internum being attached to the side of the body of the first lumbar vertebra and attached to tlie base of the transverse process Fig. 87.— The Diaphkagm. 1,2,3, central cordiform tendcm; 4, middle leaflet; 5, ligamentum arcuatum exter- num; 6, ligamentum arcuatum internum ; 8, right crus ; 10, left crus ; U, aortic opening; 12, oesophageal opening ; 13, opening for vena cava; 14, psoas magnus: 15, quadratus lura- borum. of the second lumbar vertebra ; it is continuous with the crus. The ligamentum arcuatum externum extends from the base of transverse process of second lumbar vertebra to the apex of the last rib. The diaphragm also arises by a number of digitations from the inferior circumfer- ence of the chest ; therefore, from the tip of the eleventh rib, the costal cartilages of the false ribs, and the tip of the ensiform cartilage. From these points of origin the fibres pass inward to the central tendon, which con- sists of a trefoil aponeurosis of white, fibrous tissue. 13 194 PRACTICAL ANATOMY. There are three important openmgs in the diaphragm : 1. The aortic, bounded posteriorly by the bodies of the vertebrae, latterly and anteriorly by the crura, which are continuous along their inner borders, forming a fibrous margin or arch, beneath which passes the aorta. 2. The oesophageal opening, in front of the aortic, is elliptical in form ; it is made by the decussation of the planes of muscular fibres attached to the crura ; the muscular fibres from the right cms pass to the left ; those from the left crus pass to the right, and two inches in front of this again decussate, making an elliptical opening for the passage of the oesophagus and pneumogastric nerves. This arrangement of decussating fibres makes a sphinc- ter for the lower end of the oesophagus, or cardiac end of stomach. 3. To the right of the oesophageal opening, in the right leaflet of the central tendon, is the quadrate opening for the passage of the ascending vena cava. It is so constructed that traction on the tendon of the diaphragm will enlarge it. The opposite is true of the oesophageal opening. The diaphragm is supplied by the two phrenic nerves from the cervical and brachial plex- uses, arches well into the chest, but approximates a plane when in a state of marked contraction. MUSCLES OF THE BACK. The muscles of the back are disposed in five layers. Muscles of tlie First Layer. Trapezius. Origin — Ligamentum nuchae, superior curved line of occipital bone, spine of seventh cervical vertebra, spines of all dorsal vertebrae. Insertion — Into upper border of spine of scapula outer one-third of posterior border of clavicle. Nerve — Spinal accessory, MUSCLES OF THE BACK. 195 Latissimus Dorsi. Origin — Spines of six lower dorsal vertebrae, spines of all the lumbar vertebrae, spines of all the sacral vertebrae. Insertion — Passes upward and outward, and is inserted Fig. 88.— Muscles of the Back. 1 and 2. trapezius: 3, spine of scapula: 4. latissimus dorsi: 5, deltoid: 6, infra-spi- Batus: 7. external oblique: 8 and 9, gluteal muscles: 10. levator anguli scapulae; 11, rhomboideus minor : 12. rhomboideus major ; 13 and 14, splemus capitis et colli : 15, vertebral aponeurosis; 16, serratus posticus inferior; 17, supra-spinatus ; IS, infra-spinatus ; 19, teres minor ; 20, teres major ; 21, triceps ; 22, serratus magnus. into the posterior lip of bicipital groove of the humerus, with the tendon of the teres major. Nerve — Subscapular of the brachial plexus. Muscles of the Second Layer. Levator Anguli Scapuli. Origin — Posterior tubercles of transverse process of 196 PRACTICAL ANATOMY. the first, second, third, and fourth cervical ver- tebree. Insertion — Superior angle of scapula and posterior border for one inch. Nerve — Brachial plexus. Rhomboideus Major. Origin — Spines of the first, second, third, and fourth dorsal vertebrae, Lisertion — Passes downward and outward, and is inserted into the vertebral border of scapula. Nerve — Brachial plexus. Rhomboideus Minor. Origin — Lower part of ligamentum nuchae and spine of seventh cervical. Insertion — Passes outward and downward, and is in- serted into the vertebral border of the scapula above the rhomboideus major. Nerve — Brachial plexus. Muscles of the Third Layer. Serratus Posticus Superior. Origin — Lower part of ligamentum nuchae, spine of last cervical and spines of upper two dorsal vertebrae. Insertion — -Passes downward and outward, and is inserted into the posterior surfaces of the second, third, fourth, and fifth ribs, beyond their angles. Nerves — Posterior branches of cervical. Serratus Posticus Inferior. Origin — Spines of eleventh and twelfth dorsal and first and second lumbar vertebrae. Insertion — Passes outward and upward, and is in- serted into the posterior surface of the ninth, tenth, eleventh, and twelfth ribs. Nerves — Dorsal. muscles of the back. 197 Splenius Capitis et Colli. Origin — Lower half of ligamentum nuchae, spine of seventh ceivicaL spme of six upper dorsal vertebrae. Insertion — Passes upward and divides ; the outer division is inserted into the mastoid portion of the temporal, the inner into the posterior tubercles of transverse processes of second, third, and fourth cervical vertebrae. Nerves — Posterior branches of dorsal and cervical nerves. Muscles of the Fourth Layer. Erector Spin^. Origin — The mass of muscle filling in the grooves at the side of the spines of the vertebra? in the lumbo-sacral region. It arises from the sacro-ihac groove, spines of lumbar vertebrae, posterior surface of sacrum, posterior one-third of inner lip of crest of ilium. Insertion — Passes upward ; divides into the sacro- lumbalis and longissimus dorsi. Nerves — Lumbar and dorsal. Sacrolumbalis. Origin — From erector spinae (outer division). Inserted by six tendons into angles of six lower ribs. Nerves — Do rsal . Accessory, or Musculus Accessorius ad Sacrolum- BALEM. Origin — From six tendinous insertions of sacrolum- balis Inserted by tendons into angles of six upper ribs. Nerves — Dorsal. Cervicalis Ascendens. Origin — From four upper tendons of insertion of the accessory muscle. 198 PRACTICAL ANATOMY. Insertion — Into the posterior tubercles of third, fourth, and fifth cervical vertebrae. Nerves — Posterior cervical. LONGISSIMUS DORSI. Origin — Inner division of erector spinse. Insertion — To transverse processes of lumbar and dorsal vertebrae and into the eight upper ribs by the long tendons between neck and angles. Nerve — Dorsal. Transyersalis Colli. Origin — From transverse processes of third, fourth, fifth, and sixth dorsal vertebrae. Is a continuation of the longissimus dorsi. Insertion — Inserted by five tendons into the transverse processes of third, fourth, fifth, sixth, and seventh cervical vertebrae. Nerves — Posterior cervical. Tu ACHELO- MA STOID . Origin — Transverse processes of third, fourth, fifth, and sixth dorsal vertebrae and from three or four lower cervical. Insertion — Mastoid process of temporal. Nerves — Posterior cervical. Spinalis Dorsi. Origin — Spines of first and second lumbar and spines of eleventh and twelfth dorsal. Insertion — Spines of second, third, fourth, fifth, sixth, and seventh dorsal verteBrae. Nerves — Posterior dorsal. Spinalis Colli. Origin — Spines of fifth, sixth, and seventh cervical and first and second dorsal vertebrae. Insertion — Spine of the axis. Nerves — Posterior cervical. MUSCLES OF THK BACK. 199 COMPLEXUS. Origin — By six or seven tendons from transverse processes of fiftli, sixth, and seventh cervical and first, second, and third dorsal. Insertion — Between superior and inferior curved lines of occipital by broad insertion. Nerves — Posterior cervical. BlVENTER CeRVICIS. Origin — From transverse processes of third, fourth, and fifth cervical vertebrae. Insertion — Superior curved line of occipital to the inner side of complexus. Nerves — Posterior cervical. Muscles of the Fifth Layer. Semispinalis Dorsi. Origin — Transverse processes of sixth, seventh, eighth, ninth, tenth, eleventh, and twelfth dorsal vertebrae. Insertion — Into the spinous processes of the first, second, third, and fourth dorsal vertebrae and sixth and seventh cervical. Nerves — Posterior dorsal. Semispinalis Colli. Origin — Transverse processes of first, second, third, and fourth dorsal vertebrae and articular processes of lower three cervical vertebrae. Insertion — Spinous processes of the second, third, fourth, and fifth cervical vertebrae. Nerves — Posterior dorsal. MULTIFIDUS SpIN.E. Origin — Lies in the groove at the side of the spinous processes attached to the spinous, articular, and transverse processes from sacrum to axis. Insertion — The tendons pass upward and inward, and 200 PRACTICAL ANATOMY. are inserted into the laminse and spines of the verte- brae above. Nerves — Posterior cervical, dorsal, and lumbar. ROTATORES SpIN^. Origin — Eleven on each side of the spines of the dor- sal vertebrae. Each arises from upper and back part of transverse process. Insertion — Into the lower border of the vertebrae above. Nerves — Posterior dorsal. Rectus Capitis Posticus Major. Origin — Spine of axis. Insertion — Inferior curved line of occipital. Nerves — Suboccipital. Rectus Capitis Posticus Minor. Origin — Posterior tubercle on atlas. Insertion — Anterior to the inferior curved line of occipital. Nerve — Suboccipital. Obliquus Superior. Origin — Transverse process of atlas. Insertion — Passes upward and is inserted below the superior curved line of occipital. Nerve — Suboccipital. Obliquus Inferior. Origin — Tip of the spine of the axis. Insertion — Apex of transverse process of atlas. Nerve — Suboccipital SUPRASPINALES. Origin — Fibres of muscles which pass between the apices of the spines of the cervical vertebrae. Nerves — Posterior cervical. Interspinales. Origin — Six on each side in the cervical region, two MUSCLES OF THE ABDOMEN. ' 201 or three in the dorsal region, lour in the lumbar region, one between the last lumbar and sacrum. Insertion — Small bundles of muscular fibres, arranged in pairs, which pass between the spinous processes. Nerves — Dorsal . Extensor Coccygis. Origin — Posterior surface of sacrum ; it is rudimentary. Insertion — Posterior surface of coccyx. Nerves — Posterior sacral. Intertransversales. Origin — Six pairs on each side in the cervical region, three or four in the dorsal region, four in the lumbar region. Insertion — Pass between the transverse processes in the cervical region ; the bundles are separated by a distinct interval. Ne rves — Dorsal . muscles of the abdomen. External Oblique. Origin — Eight inferior ribs by eight fleshy digitations interdigitating with the pectoralis major and the serratus magnus. Insertion — Inserted into the anterior one-third of the crest of the ilium, and into Poupart's ligament, which is the reduplicated inferior edge of the aponeurosis attached to the anterior superior spine of the ilium and the spine of the pubes. The muscle, by its aponeurosis, is also inserted into the linea alba for its entire length. The aponeurotic tendon passes entirely in front of the sheath of the rectus muscle. Just above the point of insertion of Poupart's ligament, the fibres of the aponeurosis of the ex- ternal oblique diverge, leaving a triangular opening 202 PRACTICAL ANATOMY. with its base toward the linea alba ; this is the external inguinal ring. Nerves — Ilio-lumbar and ilio-hypogastric. Internal Oblique. Origin — Outer half of Poupart's ligament, anterior half of crest of ilium, and lumbar fascia. Fig. 89.— Muscles of the Abdomen. 12, external oblique ; 16, rectus abdominis ; 17, pyramidalis ; 18, internal oblique ; 19, quadratus lumboriim. Insertion — The iliac fibres are inserted into the three lower ribs ; those from Poupart's ligament pass upward and inward, become aponeurotic, the aponeurosis reaches the outer border of the rectus muscle and splits, forming the sheath for the rectus (one leaflet passing in front, the other behind). The inner or lower fibres arch upward and out- ward, become aponeurotic ; the aponeurosis joins MUSCLES OF THE ABDOMEN 203 that of the transversaUs and passes entirely in front of the rectus, forming- the conjoined tendon of the external oblique and trans versalis. Nerves — lUo-lumbar and ilio-hypogastric. Transversa LIS. Oi'igin — Outer one-third of Poupart's ligament, two- thirds of inner lip of crest of ilium, inner surfaces of cartilages of the six lower ribs, interdigitating with the fibres of the diaphragm, and from the lumbar fascia connected with the spines of the lumbar vertebrae. Insertion — It passes transversely across the abdomen, becomes aponeurotic, the aponeurosis being attached to the linea alba ; it passes behind the sheath of the rectus except for its lower one-fourth, where it joins the aponeurosis of the internal oblique, forming the conjoined tendon which passes down in front of the rectus and is attached to the upper border of the pubes. Nerves — Ilio-inguinal and ilio-hypogastric. Rectus Abdominis. Origin — Passes from the ensiform cartilage to pubis. Arises from cartilages of fifth, sixth, and seventh ribs and ensiform cartilage. Insertion — Passes downward, becoming narrower, and is inserted on crest of pubis. This muscle shows four or five transverse tendinous intersections. Nerve — Ilio-hypogastric. Pyramidalis. Origin — Superior border of pubis and anterior pubic ligament. Insertion — Passes upward in front of rectus, and is inserted into linea alba below umbilicus. Nerve — Ilio-inguinal. 204 PRACTICAL ANATOMY. QUADRATUS IjUMBORUM. Origin — Ilio-lumbar ligament, posterior part of crest of ilium, and upper border of transverse process of third, fourth, and fifth lumbar vertebrae. Insertion — Into the last rib and by tendons into the transverse processes of third, fourth, and fifth lumbar. Nerves — Ilio-hypogastric and lumbar. The lumbar fascia is made by the division of the trans versalis fascia into the three leaflets which are at- tached to the vertebrae. The anterior leaflet is attached Fig. 90.— Transverse Section of Abdomen, showing the Arrangement OF THE Lumbar FASci.ffl. to the anterior surface and base of the transverse proc- esses of the lumbar vertebrae, and to the lower border of the last rib. The middle layer is attached to the apices of the transverse processes, and the posterior leaflet is attached to the apices of the spinous processes. Be- tween the anterior and middle leaflets is the quadratus lumborum muscle, and between the middle and posterior leaflets is the erector spinse mass of muscles. The sheath of the rectus muscle is formed by the separation of the nponeurosis of the internal oblique into an ante" MUSCLES OF THE UlTEK EXTREMITIES. 205 rior and posterior leaflet, except at the lower fourth of the rectus, where the entire aponeurosis passes in front of the muscle, with the aponeurosis of the transversalis making the conjoined tendon of the transversalis and internal oblique. The linca alba, or white line, extends along the median line from the ensiform cartilage to the pubis. It is formed by the union of the aponeuroses of the abdom- inal muscles, and presents about its centre the umbilical foramen for the transmission of the structures of the umbilical cord in the foetus. In the adult it is obliter- ated, the cicatrix being firmly adherent to the skin. The linea alba is traversed by very few vessels and nerves. The outer border of the rectus corresponds to the shallow, semilunar grooves known as the semilunar lines. Muscles of the Upper Extremities. Pectoralis Major. Origin — Inner half of clavicle, outer half of sternum, cartilages of true ribs. Insertion — Passes upward and outward, and is inserted into the anterior lip of the bicipital groove on the humerus. Nerve — Anterior thoracic, from brachial plexus. Pectoralis Minor. Origin — Anterior surface of third, fourth, and fifth ribs. Insertion — Coracoid process of scapula. Nerve — Anterior thoracic, from brachial plexus. SUBCLAVIUS. Origin — Cartilages of first rib. Insertion — Under surface of the clavicle, about its centre. Nerve — Posterior thoracic of brachial plexus. 206 practical anatomy. Serratus Magnus. Origin — By nine fleshy digitations from eight upper ribs, about one and one-half inches from the articu- lation of rib with costal cartilage. Insertion — Posterior or vertebral border of scapula. Nerve — Posterior thoracic of brachial plexus. Deltoid. Origin — External half of anterior border of clavicle, outer border of acromion, lower border of spine of scapula. Insertion — Deltoid surface on outer side of humerus, about its middle. Nerve — Circumflex, from brachial plexus. Subscapular. Origin — Subscapular fossa. Insertion — Lesser tuberosity of humerus. Nerve — Subscapular, from brachial plexus. SUPRA-SPINATUS. Origin — Supra-spinous fossa. Insertion — Highest facet on great tuberosity of hu- merus. Nerve — Subscapular. Infra-spinatus. Origin — Infra-spinous fossa. Insertion — Middle facet on tuberosity of humerus. Nerve — Subscapular. Teres Minor. Origin — Upper two-thirds of dorsal surface of axillary border of scapula. Insertion — Lowest facet on tuberosity of humerus. Nerve — Circumflex. Teres Maj*or. Origin — Posterior surface of the inferior angle of the scapula. MUSCLES OF THE UPPER EXTREMITIES. 207 Insertion — Posterior lip of bicipital groove of humerus, with latissimus dorsi. Nerve — Subscapular. CORACO-BRACHIALIS. Origin — Coracoid process. Insertion — Rough surface on inner side of humerus, opposite to the insertion of deltoid. Nerve — External cutaneus. Fig. 91.— Muscles of Shoulder and Fig. 92.— Triceps Muscle. Arm. 1, exttrnal bead ; 2, icapular head ; 4, inisrtion. 4, iubacapularis ; .5, teres major ; 6, coraco-brachi- alia ; 7, biceps. Biceps. Origin — Two heads, — long head from upper part of the glenoid cavity, short head from the coracoid process. Insertion — Tuberosity of the radius. The tendon gives off a strong fascia at the bend of the elbow, which blends with the deep fascia. Nerve — External cutaneus. 208 practical anatomy. Brachialis Anticus. Origin — Anterior surface of lower half of humerus. Insertion — Base of coratoid process of ulna. Nerves — External cutaneus and musculo-spiral. Triceps. Origin — Three heads, — long head from lower part of glenoid cavity, middle head from posterior surface of humerus above musculo-spiral groove, short head from posterior surface of humerus below musculo-spiral groove. Insertion — Olecranon process of ulna. Nerve — Musculo-spiral. Sub anconeus. Origin — Posterior surface of lower part of humerus, beneath the triceps. Insertion — Posterior ligament of elbow-joint. Nerve — Musculo-spiral. ANTERIOR MUSCLES OF THE FOREARM. Superficial Layer. Pronator Badii Teres. Origin — Two heads, — first from internal epicondyle, second from coronoid process of ulna. Insertion — Outer side of radius, about its middle. Nerve — Median . Flexor Carpi Radialis. Origin — Internal epicondyle. Insertion — Base of metacarpal of index finger. Nerve — Median. Palmaris Longus. Origin — Internal epicondyle. Insertion — Passes downward in front of annular liga- ment, and expands into the deep palmar fascia. Nerve — Median. anterior muscles of the forearm. 209 Flexor Carpi Ulnaris. Origin — By two heads, — first from internal epicon- dyle, second from inner side of olecranon and from posterior border of ulna. Insertion — Pisiform bone and metacarpal of little finger. Nerve — Ulnar. Flexor Sublimis Digitorum. Origin — Largest of the superficial layer from internal epicondyle, from coronoid process of ulna, from ob- lique line of radius. Insertion — Divides into four tendons, which pass beneath the annular ligament and are inserted at the sides of the bases of the second phalanges of the fingers. Nerve — Median . Deep Layer. Flexor Profundus Digitorum. Origin — Upper two-thirds of shafl of ulna, from base of coronoid process, from ulnar half of interosseous membrane. Insertion — Divides into four tendons, which pass be- neath the annular ligament, then perforate the tendon of the flexor sublimis digitorum, and are inserted into the bases of the third phalanges. Nerves — Ulnar and anterior interosseous of the median. Flexor Longus Pollicis. Origin — Upper two-thii'ds of radius, radial half of interosseous membrane, and from base of coronoid process. Insertion — Base of last phalanx of thumb. Nerve — Anterior interosseous. Pronator Quadratus. Origin — Lower one-fourth of anterior surface of the idna. 14 210 PRACTICAL ANATOMY. Insertion — Lower one-fourth of anterior and outer surface of radius. Nerve — Anterior interosseous. muscles on the radial side of forearm. Supinator Longus. Origin — Upper half of external condyloid ridge of humerus. Insertion — Styloid process of radius. Nerve — Musculo-spiral. Extensor Carpi Radialis Longior. Origin — From external condyloid ridge of humerus. Insertion — Posterior surface of the bases of the meta- carpal Ijone of index finger. Nerve — Musculo-spiral. Extensor Carpi Radialis Brevior. Origin — From external Gpndyloid ridge below the extensor carpi radialis fe«i*i*fe7and external epicon- dyle. Insertion — Posterior surface of the base of the meta- carpal of the middle finger. Ne)'ves — Musculo-spiral and posterior interosseous. posterior muscles of forearm. SuiDerjicial Layer. Extensor Communis Digitorum. Origin — External epicondyle and intermuscular septa. Insertion — Divides into four tendons, \vhich are in- serted on the dorsal and lateral surfaces of the first, second, and third phalanges. Nerve — Posterior interosseous. Extensor Carpi Ulnaris. Origin — External epicondyle of middle one-third of posterior surface of ulna. POSTERIOR MUSCLES OF FOREARM. 211 Insertion — Dorsal surface of base of metacarpal of little finger. Nerve — Posterior interosseous. Extensor Minimi Digiti. Origin — External epicondyle, intermuscular septa. Inserticm — Di\ides into two ten- dons on back of hand, one of wliich communicates with the common extensor ten- don, passes forward, and is inserted into the sides and posterior siirface of the first, second, and third phalanges. Nerve — Posterior interosseous. Anconeus. Origin — External epicondyle. Insertion — Outer surface of ole- cranon and upper part of shaft of ulna. Nerve — Musculo-spiral. Deep Layer. Supinator Breyis. Origin — External epicondyle, external lateral ligament, or- bicular ligament, ridge on outer surface of olecranon and upper part of ulna. Insertion — Fibres curve around the radius, and are inserted at the anterior and inner border of the radius, about its middle third. Nerve — Posterior interosseous, which pierces the muscle. Fig. 93.— Posterior Mtjs- CLEs OF Forearm. I, biceps; 2. bracliidlis nnticus ; 3, triceps; 4. supinator longus; 5. exten- sor carpi radi.ilis longior; 6, extensor carpi radialis brevior; 7, Insertion of extensor radialis longior and brevior; S, extensor cnmmnnis digitorum ; 9 ex- tensor minimi digiti; 10. extensor carpi ulnaris ; 11, anconeus; 12, ex- tensor carpi ulnaris ; 1.^, 14, extensors of thumb ; 1,5, annular ligament. 212 PRACTICAL ANATOMY. Extensor Indicis. Origin — Posterior surface of ulna, interosseous mem- brane. Fig. 94.— Extensor Tendons of Hand. 1, extensor primi internodii pollicis ; 2, first dorsal interosseous ; 3, extensor indicia ; 4, extensor communis; .5, extensor communis: this tendon sends lateral processes to the extensor tendons of the middle and little fingers ; 6, annular ligament. Insertion — Into the dorsal surface of second and third phalanges. Nerve — Posterior interosseous. muscles of the hand. 213 Extensor Ossis Metacarpt Pollicis. Origin — Posterior surface of shaft of ulna below the anconeus, from interosseous membrane, from middle third of shaft of radius. Insertion — Dorsal surface of base of metacarpal of thumb. Nerve — Posterior interosseous. Extensor Primi Internodii Pollicis. Origin — Lies to the inner side of the metacarpal of the thumb, from lower third of shaft of .radius and interosseous membrane. Insertion — Dorsal surface of base of first phalanx of thumb. Nerve — Posterior interosseous. Extensor Secundi Internodii Pollicis. Origin — Posterior surface of shaft of ulna and inter- osseous membrane. Insertion — Base of last (or second) phalanx of thumb. Nerve — Posterior interosseous. muscles of the hand. Of the Thumb. Abductor Pollicis. Origin — Ridge on trapezium and annular ligament. Insertion — Radial side of base of first phalanx. Nerve — Median . Opponens Pollicis. Origin — From trapezium and annular ligament, ex- ternal to abductor pollicis. Insertion — Radial side of metacarpal of thumb for entire length. Nerve — Median . Flexor Brevis Pollicis. Origin — Two heads, — first, trapezium and annular 2U PRACTICAL ANATOMY, ligament; second, from trapezoid, os magnum, and base of third metacarpal. Fig. 95.— Flexob Tendons and Muscles of Hand. 1, abductor pollicis ; 2, flexor brevis polliois ; 3, abductor minimi digiti ; 4, adductor poUicis ; 5, lumbricales ; 6, 7, tendons of flexor sublimis digitorum ; 8, flexor muscles passing beneath annular ligament ; 9, annular ligament; 10, flexor longus pollicis. Insertion — At the sides of the base of first phalanx of thumb. Nerve — Median. Adductor Pollicis. Origin — Entire length of metacarpal of middle finger. MUSCLES OF THE HAND. 215 Insertion — Inner side of base of first phalanx of thumb. Nerve — Uhiar. Of the Little Finger. Abductor Minimi Digiti. Origin — Pisiform bone. Insertion — Uhiar side of the base of first phalanx of little finger. Nerve — Ulnar. Opponens Minimi Digiti. Origin — Placed deeply, arises from unciform process. Insertion — Inserted into the whole length of fifth metacarpal along its idnar side. Nerve — Ulnar. Flexor Brevis Minimi Digiti. Origin — From tip of unciform process and annular ligament. Insertion — Base of first phalanx of little finger with the abductor minimi digiti. Nerve — Ulnar. T» -n Of the Palm. Palmaris Brevis. -^ Origin — From annular ligament and fascia. Insertion — Passes transversely to\vard the ulnar side, and is inserted into the skin. Nerve — Ulnar. Lumbricales. Origin — Four in number, from sides of tendons of deep flexor. Insertion — Into the aponeurosis of the extensor com- munis digitorum, at the radial side of the bases of first phalanges. Nerves — Median and uhiar. Palmar Interosseous Muscles. Origin — Three in number, from entire length of second, fourth, and fifth metacarpal bones ; that of 216 PRACTICAL ANATOMY. the second metacarpal comes from tlie ulnar side, those of the fourth and fiflh from the radial side. Insertion — They are inserted into bases of first plia- langes, and are adductors toward the middle finger. Nerve — Uhiar. Dorsal Interosseous Muscles. Origin — Four in number ; they are bipenniform mus- cles, and arise from the sides of the metacarpal bones : the first, from the sides of the metacarpal of thumb and index finger ; the second, from those of the index and middle fingers ; the fourth, from those of the ring and little fingers. Insertion — The first is inserted into the radial side of the base of the first phalanx of index finger; the second, into the radial sides of base of first phalanx of middle finger ; the third, on same bone on the ulnar side; the fourth, on base of first phalanx of ring-finger on ulnar side. They are abductors from the middle finger. Nerve — Ulnar. Muscles of the Lower Extremities. Psoas Magnus. Origin — Transverse processes and sides of bodies of lower two dorsal and all the lumbar vertebrae. Insertion — On the lesser trochanter. Nerves — Anterior lumbar. Psoas Parvus. Origin — Rudimentary, from last dorsal and first lumbar. Insertion — Ihac fascia, near ilio-pectineal eminence. Nerves- — Anterior lumbar. Iliacus. Origin — ^From inner surface of ilium, ilio-lumbar liga- ment, and base of sacrum. MUSCLES OF THE LOWER EXTREMITIES. 217 Insertion — Lesser trochanter, by a tendon common to it and the psoas magnus. Nerve — Anterior crural. Tensor VAGiNiE Femoris. Origin — Anterior superior spine of ilium and external lip of anterior one-sixth of crest of ilium. Insertion — It passes down be- tween the two leaflets of the fascia lata, to which it is attached. Nerve — Superior gluteal. Sartorius. Origin — The anterior superior spine of ilium. , Insertion — Passes obliquely across the thigh, an(j[ is at^ . ' tached to the inner si^e of head of tibia. v i / Nerve — Anterior crural. ^'"^'^^ Rectus Femoris. Origin — Two heads, — first, from anterior spine of ilium ; second, from just above ace- tabular cavity. Insertion — A bipenniform mus- cle inserted on the upper part of patella, and is con- tinued as the ligamentum patellae to the tuberosity of tibia. Nerve — Anterior crural. Vastus Externus. Origin — Great trochanter, shaft of femur, whole length of external lip of linea aspera. Fig. 96.— Anterior Femoral Region. 4, extensor vaginse femoris : 5, sartorius ; 6, rectus ; 7, vastus ex- ternus ; 8, vastus iuternus ; 9. patella ; 10, iliacus; 11, psoas; 12, pectineus; 13, adductor longus ; 14, adductor magnus ; 15, gracilis. 218 PRACTICAL ANATOMY. Insertion — Folds around the outer surface of the shaft of femur, becomes aponeurotic, and is strongly at- tached to the tendon of the rectus femoris. Nerve — Anterior crural. Vastus Internus. Origin — Internal hp of linea aspera for its whole length, and shaft of femur. Insertion — Folds around the inner side of femur, and is ' strongly attached to the tendon of the rectus femoris. Nerve — Anterior crural. Crureus. Origin — Anterior surface of femur between origin of the vasti. Insertion — Into the tendon of the rectus femoris. Nerve — Anterior crural. SUBCRUREUS. Origin — Rudimentary, beneath the crureus from the shaft of femur (often absent). Insertion — Tendon of crureus. Nerve — Anterior crural. The rectus, vasti, and crureus are four muscles which have a single tendon of insertion, on the patella. Coming from such an extensive area of origin, the muscle (quadri- ceps extensor femoris), considered as a whole, is one of great power, sufficient, under certain conditions, even to fracture the patella. The tendon is broad and flat and incloses the patella, the greater mass of the tendinous fibres passing over the anterior surface of the bone, to be inserted on the tuberosity of the tibia. Gracilis. * Origin — Anterior surface of ramus of pubes and ischium. Insertion — Upper inner surface of head of tibia. Nerve — Obturator. MUSCLES OF THE LOWER EXTREMITIES. 219 ' pVBfSt Pectineus. Origin — Linea ilio-pectinea for about two inches ex- ternal to Gimbernat's ligament. Insertion — On line lead- ing from trochanter minor to linea aspera. Nerve — Obturator. Adductor Longus. Origin — Anterior sur- face of pubes. Inseiiion — Middle third of linea aspera. Nerve — Obturator. Adductor Breyis. Origin — Anterior sur- face of body and de- scending ramus of pubes. Insertion — Upper fourth of linea aspera. Nerve — Obturator. Adductor Magnus. Origin — Anterior sur- face of the rami of ischium and pubes. Insertion — Inner lip of linea aspera for its whole length, and by a rounded tendon into the inner tuber- cle above the internal condyle. Nerve — Obturator. Gluteus Maximus. Origin — Posterior part of the dorsum of the ilium Fig. 97.— Adductor Muscles of Thigh. 1, obturator extcrnus ; 2, adductor longus ; 3, adductor brevis ; 4, adductor magaus. 220 PRACTICAL ANATOMY. above superior curved line, posterior surface of sacrum and coccyx. Insertion — E-ough line leading from great trochanter to linea aspera and fascia lata. Nerve — Small sciatic. Gluteus Medius. Origin — Dorsum of ilium between superior and middle curved lines and crest of ilium. Insertion — Oblique line on outer sur- face of the great trochanter. Nerve — Superior glu- teal. Gluteus Minimus. Origin — From dor- sum of ilium be- tween middle and the inferior curved lines. Insertion — Anterior surface of great trochanter. Nerve — Superior glu- teal. Pyriformis. Origin — From anterior surface of sacrum between the anterior sacral foramina. insertion — Passes out of the pelvis by the greater sacro-sciatic foramen, and is inserted into the upper border of the great trochanter. Nerve — Small sciatic. Obturator Internus. Origin — Stretched across the obturator foramen is the Fig. 98.— Deep Muscles of Glutbai. Region. 1, ilium; 2, sacral spine; 3, .Ttfachment of s.icro- iliac ligaments ; 4, tuberosity of iscliium ; 5, greater sacro-sciatic ligament ; 6, lesser sacro-sciatic ligament 7, greater trochanter; 8, glutens minimus; 9, pyriform lU, superior gemellus ; 11, tendon of obturator internua 12, gemellus inferior ; 13, quadratus femoris ; 14, adduc- tor magnus; 15, vastus exteruus; 16, biceps; 17, gra- cilis ; 18, semitendinosus. MUSCLES OF THE LOWER EXTREMITIES. 221 aponeurotic obturator membrane, presenting at its upper part the opening for the obturator vessels and nerve. From the inner surface of this membrane arises the obturator internus muscle ; it also arises from the posterior surface of the rami of th^ ischium and pubes and the margins of the obturator foramen. Insertion — Passes out of the pelvis by the lesser sacro- sciatic foramen, and is inserted into the upper border of the great trochanter. Nerves — Small sciatic and sacral plexus. Gemellus Superior. Origin — A bundle of muscular fibres above the tendon of the obturator internus ; arises from the margin of the lesser sacro-sciatic foramen and spine of ischium. Insertion — Upper border of great trochanter, with tendon of obturator internus. Nerve — Sacral plexus. Gemellus Inferior. Origin — Similarly arranged as the gemellus superior ; arises from tuberosity of ischium. Insertion — Great trochanter with obturator internus. Nerve — Sacral plexus. Obturator Externus. Origin — Outer surface of obturator membrane, rami of pubes and ischium. iTisertion — Digital ibssa. Nerve — Obturator, from lumbar plexus. QUADRATUS FeMORIS. Origin — Outer surface of tuberosity of ischium. Insertion — Quadrate line on femur. Nerve — Sacral plexus. Biceps. Origin — Two heads, — the long head from lower facet 222 PRACTICAL ANATOMY, on external surface of tuberosity of the ischium ; short head, from the linea aspera about its middle third. * Insertion — Head of fibula ; it is the outer ham-string • muscle. Nerve — Great sciatic. Semimembranosus. Origin— T\\e innermost ham- string ; from posterior or up- per facet on outer surface, and posterior border of tuber- osity of ischium. Insertion — Inserted by three tendons, — the inner, attached to inner side of head of tibia ; the middle, blending with the posterior ligaments of the knee-joint ; the outer, * inserted above the outer con- dyle of the femur. This ar-, rangement of the tendons makes, in fact, the posterior ligament of the knee-joint. Nerve — Great sciatic. Semitendinosus. Origin — From facets common to it and the biceps. Insertion — Upper part of inner surface of head of tibia. • Nerve — Great sciatic. The biceps is the external ham-string; the semi- membranosus and the semitendinosus are the two internal ham-strings; they limit the popliteal space laterally. Fig. 99.— Posterior Femo- KAL Region. 1, gluteus meJius; 2, gluteus raaximus; 3. vastus exteruus ; 4, biceps; 6, semitendinosus; 7, semi- membranosus: 8, gracilis. MUSCLES OF THE LOWER EXTREMITIES. 223 Tibialis Anticus. Origin — Outer surface of shaft of tibia, interosseous membrane. • Insertion — Dorsal and inner side of base of meta- tarsal of great toe. Nerve — Anterior tibial. Extensor Longus Digitorum. Origin — Anterior upper part of fibular and interosseous membrane. Tnsertioii — Divides into four tendons, to be inserted upon the four outer toes similarly to the insertion of the common extensor of the fingers. Nerve — Anterior tibial. Extensor Proprius Pollicis. Origin — Anterior surface bf middle third of fibula and interosseous membrane. Insei'tion — Passes down be- tween the tibialis anticus and extensor longus digi- torum ; inserted at the base of the last phalanx of the great toe. Fig. 100.— Anterior Muscles OF Leg. 3, tibialis ."(nticus; 4, extensor longus digitorum ; .5. extensor proprius pollicis; 6, peroueus tertius; 7, pei'oneui tougus : 8, peroueus brevis. Nerve — Anterior tibial. Peroneus Tertius. Origin — Lower fourth of anterior part of fibula and interosseous membrane. Insertion — Upper surface of the base of metatarsal of little toe. Nerve — Anterior tibial. 224 practical anatomy. Peroneus Longus. Origin — Head and upper two-thirds of the Outer part of the shaft of fibula. Insertion — Passes down behind the outer malleolus, lying in the same groove as the peroneus brevis, then through a groove on the inferior surface of the cuboid, and is inserted on the inferior surface of the base of the metatarsal of the great toe. Nerve — Musculo-cutaneus. Peroneus Brevis. Origin — From lower two-thirds of the anterior surface of the shaft of fibula. Insertion — Passes behind the outer malleolus, and is inserted into the outeX-part of the-bJi..se_Qf the me.tar tarsal of the little toe. Nerve — Musculo-cutaneus. The tendons of the peroneus longus and brevis pass behind the external malleolus. Gastrocnemius; Origin — With the soleus forms the calf of the leg ; arises by two heads from above the outer and inner condyles of the femur. Insertion — About the lower third, becomes tendinous and receives the insertion of the soleus, forming the tendo Achillis, which is inserted on the posterior surface of the os calcis. Nerve — Internal popliteal. Soleus. Origin — From posterior surface of head of fibula, posterior surface of upper third of shaft of tibia and its oblique line. Insertion — On the tendon of the gastrocnemius, form- ing the tendo Achillis. Nerve — Internal popliteal. MUSCLES OF THE LOWER EXTREMITIES. '):).n Plantaris. Origin — Rudimentary, from just above the outer head of gastrocnemius, r^-'''^ >-v-/-^«':^• - /,'- ■ •' Insertion- -Passes down between the gastrocnemius, forming the tendo Achillis. Nerve — Internal popliteal. POPLITEUS. Origin — Outer side of external condyle. ffh^jenyuM^ Insertion — Passes obliquely down- ward and inward, and is in- serted along the inner border of the upper third of tibia. Nerve — Internal popliteal. Tibialis Posticus. Origin — Arises between the flexor longus digitorum, from posterior surface of interosseous mem- brane, posterior surface of shaft of tibia, from oblique line, from upper two-thirds of shaft of fibula. Insertion — Crosses in front of flexor longus digitorum, and is inserted on the tuberosity of scaphoid, internal cuneiform, and base of metatarsal of great toe. - . The tendon lies in the / aftterior groove on the posterior surface of the'^- ternal malleolus. Nerve — Posterior tibial. Flexor Longus Pollicis. Origin — Lower two-thirds of posterior surface of shaft of fibula, a small portion of posterior surface of interosseous membrane. 15 Fig. 101. — PosTERiOB Muscles of Leg. 4, popliteus; 5, gastrocne- mius; 6, teudo Achillis; 8, teo- doDS of peruneus longns and brevis : 9, tibialis posticus and flexors. 22f^ PRACTICAL ANATOMY. , Insertion — Lies in the posterior groove behind the inner malleolus, in the groove on the astragalus, and is inserted on the base of last phalanx of great toe. Nerve — Posterior tibial. Flexor Longus Digitorum. Origin — Posterior surface of shaft of tibia, below oblique line. ky^SJ^ Insertion — Lies in the middle groove on the posterioi surface of internal malleolus, passes beneath the arch of the os calcis, and divides into four tendons, which are inserted on the bases of the last pha- langes of the four outer toes; these tendons per- forate the tendons of the flexor brevis digitorum. Nerve — Posterior tibial. MUSCLES OF THE FOOT. Dorsal Region. Extensor Breyls Digitorum. Origin — Outer surface of os calcis, from annular liga- ment and calcaneo-astragaloid ligament. Insertion — Passes inward across the foot and divides into four tendons, which are inserted on the dorsal surface of the four inner toes. Nerve — Anterior tibial. Plantar Region. Plantar muscles are divided into four layers : — First Layer. Abductor Pollicis. Origin — Inner tubercle of os calcis. Insertion — Liner side of base of first phalanx of great toe. Nerve — Internal plantar. Flexor Brevis Digitorum. Origin — Inner tubercle of os calcis. MUSCLES OF THE FOOT. 227 Insertion — l)i\idcs into four tendons, which are per- forated by tlie tendons of the flexor longiis di<>i- i^ i torum ; inserted on the sideSof second phalanges/ ^'^'' Nerve — Internal plantar. Abductor Minimt Digiti. Origin — Outer tubercle and inferior surface of os calcis. Insertion — Outer side of base of first phalanx of little toe. Nerve — External plantar. Second Layer. Flexor Accessorius. Origin — Two heads, — outer, from in front of outer tubercle; inner. from in front of ^ inner tubercle. rs<'^<^'^ Insertion — Posterior edge of the tendon of flexor longus digi torum. Nerve — External plantar. Four Lumbricales. Origin — From sides of tendons of long flexor. Insertion — Each muscle is inserted on the inner side of the bases of first phalanges of the four outer toes. Nerves — Internal and external plantar. Third Layer. Flexor Erevis Pollicis. Origin — From inner part of cuboid and outer cunei- form, and tendon of posterior tibial. Fig. 102.— Second Lavek of Mus- cles OF Foot. 1, flexor accessorius; 2, flex. long, digitorum; 3, flex. long, pollicis. 2'28 PRACTICAL ANATOMY. Insertion — Inserted by two tendons into the inner and outer sides of base of first phalanx of great toe. Nerve — Internal plantar. Adductor Pollicis. Origin — Bases of second, third, and fourth metatar- sals, and sheath of tendon of peroneus longus. Insertion — Outer side of base of first phalanx of great toe. Nerve — External plantar. Flexor Brevis Minimi Digiti. Origin — Base of metatarsal of little toe and sheath of peroneus longus. Insertion — Outer side of base of first phalanx of little toe. Nerve — External plantar. Transyersus Pedis. Origin — Under surface of head of metatarsal of little toe. Insertion — Outer side of base of f^rst phalanx of great toe. f Nerve — External plantar. Fourth Layer. Palmar Interossei. Origin — Three in number, from base and inner sides of shaft of third, fourth, and fifth metatarsals. Insertion — Inner side of base of first phalanx of the same toe. Nerve — External plantar. The palmar interossei are adductors toward the second toe. Dorsal Interossei. Origin — Four in number, bipenniform muscles from adjoining side of the metatarsal bones. MUSCLES OF PKllINKLM .\.\D ISCIIIO-KECTAL REGION. 229 Insertion — The dorsal iiiterossei are inserted on the inner side of the bases of first phalanges of the second, third, and fourth toes, and on the outer side of the bases of the second, third, and fourtli toes. Nerve — External plantar. The dorsal interossei are abductors from the second toe. The second toe receives tlie insertion of two inter- osseous muscles, — one on the inner, the other on the outer side of the base of the phalanx. MUSCLES OF THE PERINEUM AND ISCHIO-RECTAL REGION. In ilie Male. Accelerator Urin^. Orhjin — A bipenniform muscle, from central tendon of perineum in front of anus ; the tendon lies be- neath the urethra, in the median line. Insertion — The muscular fibres curve around the ure- thra, encircle the bulb, and are lost on its upper surface. Nerve — Perineal. Erector Penis. Origin — Inner border of ascending ramus of ischium and ramus of pubes. Insertion — Ends in aponeurosis, which is inserted into the side and under surface of crus penis. Nerve — Perineal. Transversus Perin^i. Origin — Inner surface of tuberosity of ischium. Insertion — Passes inward and forward, and is inserted on the central tendon of perineum just anterior to the anus. Nerve — Perineal. Levator Ani. Origin — Attached to the inner sides of the true pelvis, 280 PRACTICAL ANATOMY. arises from posterior surface of body of pubes, spine of ischium, and obturator ligament, extending from spine of ischium to posterior surface of pubes. This Ugament is formed by the junction of the obturator with the recto-vesical fascia. Fig. 103.— MrscLES of the Perineum. Insertion — Into coccyx and sides of rectum and sphincter, side of prostate gland ; it forms a sling, which supports the pelvic viscera. Nerve — Perineal. Compressor Urethra. Origin — From border of ramus of pubes, and passes down and surrounds the membranous urethra. Nerve — Perineal. MUSCLES OF PERINEUM AND rSCHIO-RECTAL REGION. 231 CORRUGATOR CUTIS Ani. Origin — Subcutaneous fibres of muscular tissue, largely involuntary, which wrinkle the skin around the anus. Insertion — Skin around anus. Nerve — Perineal, External Sphincter Ani. Origin — Plane of muscular fibres subcutaneous and attached to the skin; arises from tip of coccyx. Insertion — Tendinous centre of perineum after ellip- tically surrounding the anus. Nerve — Fourth sacral. Internal Sphincter Ani. Origin — A ring of muscle around the lower end of the rectum, about one-fourth of an inch thick, tliree- fourths to one and one-half inches wide. Insertion — Is a mixture of voluntary and involuntary fibres. Nerves — Sacral and sympathetic plexuses. In the Female. The special muscles in this region are : — Sphincter Vaginae. Surrounds the vaginal orifice; it is a continuation of the external sphincter ani, and is in- serted anteriorly into the corpora cavernosa clitoridis. Erector Clitoridis. Similar in its attachments to the erector penis. Transversus Perin^i. Like its attachments in the male. Compressor Urethra. Like its attachments in the male. Sphincter Ani, External and Internal. Like their attachments in the male. Coccygeus. Like its attachments in the male. Levator Ani. Attached below to sides of rectum and THE VASCULAR SYSTEM. ARTERIES. The arteries are vessels which convey blood from the heart to the tissues and organs. The largest arteries are the aorta and pulmonary. The aorta springs from the left ventricle and transmits oxygenated blood to every part of the body. The pulmo- nary artery comes from the right ventricle and conveys the blood charged with carbonic oxide to the lungs, there to be oxygen- ated. An artery, as it follows its course, branches repeatedly, often dichotomously, and forms frequent anastomosis among its branches. Each time an artery gives off a branch its diameter decreases ; where an artery such as the abdominal aorta divides into the two large trunks each trunk has an area larger than one-half the area of the main vessel, and the combined area of the two vessels is larger than the area of the main tnink. The combined area of all the ultimate branches of the arterial tree is many times more than the area of the aorta. The arteries are highly elastic, both in diameter and length, and under the impulse of the blood-wave stretch in length and swell in diameter. They are composed of three coats, — external or fibrous, middle or muscular, and internal or serous. The inner and middle coats are closely adherent. The external (232) Fig. lot— Diageam of the ClKCULATION. A, heart : B, vena cava : C, right auriele: D, right ventricle; E. pulmo- nary arterr : F. pnlmonie capillaries : G, left auricle : H, left Tentricle ; I, aorta ; 1, syBtemic capillaries. ARTERIES. 233 coat is cellular in character, composed principally of white fibrous tissues arranged in a reticulated manner ; there are also found some elastic and muscular fibres. The middle coat in the aorta and large vessels is a dense, thick cylinder of yellow elastic tissue. As the vessels become smaller in size the elastic fibres become mixed with the involuntary muscular fibres, and in vessels of the size of the ulnar the muscular tissue nearly entirely replaces the yellow elastic fibres. The muscular fibres encircle the vessel, and are also disposed in longitudinal bundles. The internal or serous coat presents, like any other serous membrane or sac, three layers : First, a free or epithelial ; second, a middle or basement membrane ; third, an outer or fibrous layer. The epithelial consists of a single layer of flat epitlielial cells accuratelv joined together by an intercellular cement-substance resembling gelatin ; here and there, however, a slight fissure be- tween the cells can be seen. Second, a basement-mem- brane consisting of a homegeneous membrane supported by the skeletal, reticulated, connective-tissue cell-layer. Third, a fenestrated membrane composed of white and yellow elastic fibres. As arteries become much reduced in size they lose some of their physical characters, and when they are very small and but two coats are distinguishable they take the name of arterioles. "While capillaries are the small- est radicles of the arterial system, measuring on an average about one three-thousandth of an inch in diameter, they present, as a rule, but a single coat, the inner, and frequently of this only the epithelial layer exists. Thus, hi the capillaries of the lungs, brain, and liver the only structure presented by the capillary is a single layer of epithelial cells jointed at their edges. 234 PRACTICAL ANATOMY. THE AORTA. The aorta springs from the base of the left ventricle, curves upward toward the right, then forms an arch the convexity of which is superior ; it then passes down the Fig. 105.— The Aokta. 1, third cervical nerve ; 2, fourth cervical nerve ; 3, pnenmogastric nerve; 4, fifth cer- vical nerve ; .5, hraehial plexus ; 6, phrenic nerve ; 7, lines of reflection of pericardium ; 8, cervicalis ascendens artery ; 9, scalenus antious ; 10, inferior thyroid artery ; 11, super- ficialis colli artery ; 12, phrenic nerve; l.S, posterior scapular artery; 11, svipra-scapular artery; 15, subchavian artery; 16, superior intercostal artery; 17, internal mammary artery; 18, pnenmogastric nerve ; 19, phrenic nerve ; 20, appendix of left auricle. left side of the vertebral column through the aortic opening in the diaphragm, and divides at the fourth lumbar ver- tebra into the two common iliacs. The aorta is divided THE AORTA. 235 into an arch, the thoracic portion and the abdominal por- tion. The arch of the aorta is liorseshoe-shaped. It begins at the left ventricle of the heart (about the level of the fourth dorsal vertebra), curves upward, forward, and to the right on a level with the second right costal cartilage, forming the ascending portion of the arch. It then curves transversely backward and to the left to the lower border of the second dorsal ^•erteb^a, forming the transverse portion ; then descends to the left of the vertebral column to the fifth dorsal vertebra, whence it is continued down the spine under the name of the thoracic aorta. The arcli of the aorta sends off five branches. From the ascending part of the arch are the right and left coronary : — Right Coronary. — Branch from the aorta immediately above its origin ; lies in right auriculo-ventricular groove ; sends a branch down posterior interventricular groove. Left Coronary. — Branch from the aorta immediately above its origin ; lies in the anterior interventricular groove and anastomoses with the descending branch of the right coronary. From the transverse part of the arch are the innomi- nate, left carotid, and left subclavian : — Innominate. — From superior part of right side of arch. The largest branch of the arch passes upward to tlie right sterno-clavicular joint, where it divides into the right sub- clavian and right common carotid. Left Carotid. — Passes upward behind the manubrian and terminates in the neck on a level with the thyroid cartilao-e. where it divides into the external and internal carotids. The common carotid give off no branches. Left Subclavian. — The last vessel from the arch of the aorta curves into the root of the neck and terminates at the lower border of the first rib. 236 PRACTICAL ANATOMY. THE SUBCLAVIAN ARTERY. The subclavian artery curves up into the root of the neck, and at the lower border of the first rib becomes the axillary. As the scalenus anticus muscle passes over the subclavian to be inserted on the tubercle on the first rib. it divides the innominate into three parts, the first part being internal to the inner border of the scalenus anticus, the second part behind the scalenus anticus, the third external to the scalenus anticus. The branches of the subclavian are four in number, — two ascending and two descending; the ascending are the vertebral and thyroid axis from the first part of the subclavian ; the descending are the internal mammary and superior inter- costal ; of these the internal mammary comes from the second part of the subclavian; there are no branches from the third part. THE VERTEBRAL ARTERY. The vertebral artery passes up along the side of the cervical vertebrae through the foramina in the transverse processes, and passes behind the articular surface on the atlas, enters the skull through the foramen magnum, joins its fellow and forms the basilar artery, which passes for- ward beneath the pons Varolii, and divides into the pos- terior cerebral arteries. The vertebral sends off branches as follows: — In the Neck. Lateral Spinal. — Seven or eight branches which pass through the intervertebral foramina and divide into anterior and posterior branches. Muscular. — Distributed to the deep muscles of neck. In the Cranium. Anterior Spinal. — From the upper part of the ver- tebral. It anastomoses with its fellow and forms the THE THYROID AXIS. 237 median descending artery, which is continued by anas- tomosis the entire length of the spinal cord. Posterior SpiimJ. — Unites with its fellow and forms through anastomosis the descending median spinal artery. Fig. 106.— Base of Brain, showing Circle of Willis. 1, olfactory bulb; 2. optic nenes; 3, anterior perforated space; 4, traetus opticus; 5, cms cerebri: 6. third pair of nerves; 7, fourth pair of nerves; 8, tifth pair of nerves; 9, sixth pair of nerves ; 10. pyramid: 11. olivary body; 12. vertebral artery: 1.3, anterior spinal artery ; 14, anterior terebral artery ; 1.% lamina cinerea; 16. middle cerebral artery ; 17, tuber cinereuTn; 18. corpora albicantia : 19, posterior perforated space; 20, posterior cerebral artery ; 21, anterior cerebellar artery ; 22, pons Varolii ; 23, posterior inferior artery ; 24, seventh aiid eighth pairs of nerves; 25, ninth, tenth, and eleventh pairs of nerves; 26, twelfth pair of nerves ; 27, cerebellum. Posterior Meningeal. — Enters foramen magnum, and . j is distributed to the menin^s. ^ntyuuJoM/youk tn>\Ar'iajuAn.^ Posterior Inferior. — Winds around the upper part of medulla and is distributed to the cerebellum. S^^UAV«t/< 238 PRACTICAL ANATOMY. THE BASILAR ARTERY. The basilar artery runs along the median line of the under surface of the pons Varolii. It is formed by the union of the two vertebral arteries and sends off : — Anterior Cerehellar. — Passes to the under surface of cerebellum. Transverse. — Four to six pairs distributed to inferior surface of cerebellum. Superior Cerehellar. — Pass around the crura and are distributed to meninges. Posterior Cerebral. — Two terminal ; wind around the crura and anastomose with the middle cerebral. At the base of the brain is a vascular circle, the circle of Willis. It is formed by nine vessels, — the two pos- terior cerebral (terminal branches of the basilar), the two posterior communicating (branches of the internal caro- tid), the two anterior cerebral (branches of the internal carotid), the two internal carotids, and the anterior com- municating between the two anterior cerebral arteries within. This anastomosis surrounds the structures of the interpeduncular space. THE THYROID AXIS. The thyroid axis sends off: — Inferior Thyroid. — Supplies the inferior portion of the thyroid gland. It sends off the laryngeal, tracheal, oesophageal, and ascending cervical ; the last named passes up the neck and anastomoses with the ascend- ing pharyngeal. Supra.-scapnlar. — Runs across the neck over the transverse ligament of the scapula and is distributed to the supraspinatus Transversalis Colli. — Runs transversely across the neck to the vertebral border of the scapula, along THE AXILLARY ARTERY. 239 whicli it runs to anastomose at the inferior angle with tlie subscapular. The Internal Mammary. — Runs along the poste- rior surface of the anterior wall of the chest and sends off:— Phrenic. — Accompanies the phrenic nerve. AiHerior Costal. — Five to seven branches to inter- costal spaces. Mediastinal. — To anterior mediastinum. Pericardiac. — To outer surface of pericardium. Perforating. — Perforate the intercostal spaces and are distributed to the mammary gland. Sternal. — Nutrient to sternum. 3Iuscular. — To intercostals and triangularis sterni. Superior Ej)igastric. — Anastomoses with deep epi- gastric of the external iliac. Superior Intercostal. — Distributed to the two upper intercostal spaces. It sends off the profunda cervicis to anastomose with the princeps. cervicis of the occipital. THE AXILLARY ARTERY. The axillary artery is the continuation of the sub- clavian ; it begins at the lower border of the first rib and becomes the brachial at the lower border of the pectoralis major muscle. It runs midway between the anterior and posterior borders of the axilla and is crossed by the^ pec- toralis minor muscle, which divides it into three parts ; from the first part above the pectoralis minor are given oft' two vessels : — Superior Thoracic. — Passes inward and supplies ,the muscles of the chest. Acromio-thoracic. — A short trunk which divides into the acromial, distributed to the shoulder, and the thoracic, to the pectoral muscles. w/ 240 PRACTICAL ANATOMY. From the second part behind the pectoralis minor come off: — Long TJioracic. — Passes inward along the inferior border of the pectoraHs major. Fig. 107.— Diagram of Axilla. 1, axillary artery ; 2, brachial artery ; 3, acromio-thoraoic artery ; 4, superior thoracic artery; !>, subscapular artery; 6, dorsalis scapulae artery; 7, posterior circumflex artery; 8, superior profunda artery; 9, posterior thoracic nerve; 10, long subscapular nerve; 11, median nerve ; 12, cephalic vein ; 13, musculo-cutaneous nerve ; 14, teres major muscle. Alar Thoracic- — Two or three branches (small) to side of chest. From the third part, below pectoralis minor, are given off:— Subscapular. — The largest branch of the axillary runs THE RADIAL ARTERY. '241 along the anterior surface of the subscapular muscle and anastomoses with the posterior scapular. Anterior Circumjiex. — Encircles the neck of the luimerus. Posterior Circumflex. — Encircles the neck of the humerus. THE BRACHIAL ARTERY. The brachial artery is a continuation of the axillary, and runs down the hnier side of arm and terminates at the bend of the elbow, w'here it divides into the radial and ulnar. It sends off: — Superior Profunda. — Runs in the musculo-spiral groove, supplies the muscles, and anastomoses with, the recurrent branches at the bend of the elbow. Inferior Profunda. — Anastomoses with the ulnar recurrent, and is distributed to internal condyle. Nutrient. — Supplies the humerus. Anastomotica Magna. — Arises above elbow-joint and anastomoses with the profunda and recurrent arteries. Muscular. — To muscles of arm. THE RADIAL ARTERY. The radial artery, smaller than the ulnar, passes down along the radial side of forearm. It is subcuta- neous for its lower third, then passes over the back of the base of the metacarpal of the thumb, and runs dow^n between the two heads of the first dorsal inter- osseous muscle into the palm of the hand, lying on the bases of the metacarpals, and forms the deep palmar arch. The radial sends oft" three sets of vessels. In the Forearm. Radial Recurrent. — Passes up and anastomoses with the superior profunda. Muscular. — To tlie muscles of the forearm. 16 242 PRACTICAL ANATOMY. Superficialis Voice. — Given off above the muscles of the thumb, which it crosses and anastomoses with uhiar. At the Wrist Anterior Carpal. — To the wrist. Posterior Carpal. — To the wrist. Metacarpcl. — To first interosseous space. Dorsalis Pollicis. — One or two vessels along back of thumb. Dorsalis Indicis. — One or two vessels along back of index finger. In the Hand. Princeps Pollicis. — Supplies palmar aspect of thumb. RadiaJis Indicis. — Radial side of index finger. Interosseous. — Three or four that pass forward and anastomose with digital. Perforating — Anastomoses with dorsal interosseous. THE ULNAR ARTERY. ^ The ulnar artery, larger than the radial, passes deeply through the muscles along the ulnar side of the forearm and sends off: — Anterior Ulnar Recurrent. — Passes up and anasto- moses with the anastomotica magna and profunda. Posterior Ulnar Recurrerd. — Passes up and anasto- moses with the anastomotica magna and profunda. Inter osseoiis. — Divides into (a) anterior, which runs along the interosseous membrane anteriorly ; (b) poste- rior, which runs along the interosseous membrane posteriorly. Muscular. — To muscles of forearm. Anterior Carpal. — To muscles of wrist-joint. Posterior Carpal. — To wrist-joint. Communicating. — Anastomoses with the radial, com- pleting the deep arch. THE EXTERNAL CAROTID ARTERY. 243 Digital. — Four in number ; pass to the webs of fingers and divide into two branches, which run along the sides of the fingers and terminate in anastomotic plexuses at the ends of the fingers. The superficial arch is the palmar continuation of the ulnar ; it lies on a line drawn transversely across the hand from the web of thumb; the deep palmar arch formed by the radial lies higher up, — a fact of surgical interest. THE COMMON CAROTID ARTERY. The common carotid artery on the right side is a branch of the innominate ; on the left side it comes from the arch of the aorta. It divides just below the hyoid bone into the internal and external carotid. THE EXTERNAL CAROTID ARTERY. The external carotid artery passes up the neck, giving off large branches that supply the neck, face, and head with blood. It sends off eight branches. They are : Three Anterior. Superior Thyroid. — Arises on a level with the hyoid bone, and sends off four branches : the hyoid, sterno- mastoid, crico-thyroid, and superior laryngeal. Lingual. — Arises above the superior thyroid ; sends off the hyoid, sublingual, dorsalis lingua, and ranine. Facial. — Arises just below the angle of inferior max- illary, runs through the submaxillary gland, crosses the inferior border of inferior maxilla just in front of mas- seter ; it is very tortuous, and gives off ten branches : — IN THE NECK. FACIAL BRANCHES. Ascending palatine, Muscular, . Tonsillar, Inferior labial, Submaxillary, Inferior coronary, Submental. Superior coronary, Lateral nasal, Angular. 244 PRACTICAL ANATOMY. Tloo Posterior. Occipital. — Arises opposite to facial, passes backward, lies in occipital groove, and sends off muscular, auricu- lar, meningeal, and arteria princeps cervicis, which runs dow^n and anastomoses with the profunda cervicis. Fig. 108.— Arteries of Face and Head. 1, common carotid ; 2, internal carotid ; 3, external carotid ; 4, occipital ; 5, superior thyroid ; 7, lingual ; 9, facial ; 10, temporal ; 11, submental : 12, trans- verse facial; 13, inferior labial: 15, 17, inferior and superior coronary; 19, lateral nasal ; 21, angular. Posterior Auricular. — Arises in parotid gland, often beneath it, and sends off stylo-mastoid and auricular. Temporal.— Axhe^ in the parotid gland, crosses the zygoma, and divides into the anterior and posterior terminal branches. The temporal sends off the trans- verse facial, anterior auricular, and middle temporal. THE INTERNAL CAROTID ARTERY. 245 Internal Maxillary. — Arises in the substance of paro- tid gland at right angles to the temporal artery, passes behind posterior border of inferior maxillary below con- dyle, to be distributed to the deep structures of the face. Its branches are di^■ided by the external pterygoid muscle into those of the first, second, and third portions. Those of the first portion are the inferior dental, middle men- ingeal, small meningeal, and tympanic. Those of the second part are the deep temporal and muscular. Those A B c Fig. 109.— Internal Maxillary Artery. A, third portion ; B. second portion ; C, first portion. from the third part, descending palatine, spheno-palatine, pterygo-palatine, Vidian, infra-orbital, alveolar. One Ascending. Ascending. — Arises just above the point of bifurca- tion of the common carotid, and sends off muscular, pharyngeal, and meningeal branches. THE INTERNAL CAROTID ARTERY. The internal carotid artery gives off no branches in the neck. It enters the carotid canal of the petrous part of temporal bone, makes three bends and runs for- ward in the cavernous groove of the sphenoid. Its A 246 PRACTICAL ANATOMY. branches in the carotid canal are the Umgaiiic, — one or two small vessels to the middle of the ear. In the cav- ernous groove are given off the arteri|e__receptaciili,- the anterior meningeal, and the ophthalmic. The ophthalmic is a large branch passing through the anterior lacerated foramen, and gives off orbital and ocular branches. The orbital branches are : — Lachrymal. — To the lachrymal gland. Sapra^orhital. — Passes through the supra-orbital loramen. Posterior Ethmoidal. — To ethmoidal cells. Anterior Ethmoidal — To ethmoidal cells. Palpebral. — To the eyelids. Nasal. — Anastomoses with the angular of facial. Fro7ital. — To frontal region and scalp. The ocular branches are : — \ Muscular. — To orbital muscles, fe ] Ciliary. — Long, short, and anterior to eyeball. \Arteria Ce^itralis Retinae. — Pierces optic nerve and supplies retina. The cerebral branches of the internal carotid are : — A7iterior Cerebral. — Passes forward and inward and curves around the anterior portion of corpus callosum lying in the longitudinal fissure ; it sends branches to the meninges. Middle Cerebral. — Lies in the fissure of Sylvius and sends branches to the meninges. Posterior Communicating. — Passes back to the pos- terior cerebral. Anterior Choroid. — Arises external to the posterior communicating. Is distributed to the structures of the descending cornu of lateral ventricle. The two anterior cerebral arteries are connected by a short trunk called the anterior communicating. THE THORACIC AORTA. 247 THE THORACIC AORTA. Bcijins at the left side of tlie lower border of the fourth dorsal vertebra ; at the aortic opening it becomes the abdominal aorta. The thoracic aorta sends off the pericardiac, bronchial, posterior mediastinal, and oesopha- geal and ten pairs of intercostals to the lower intercostal spaces. THE ABDOMINAL AORTA. Commences at the aortic opening of diaphragm and divides at the lower border of the fourth lumbar vertebra into the common iliacs. It sends off: — Phrenic. — Two or three branches to under surface of diaphragm. Cceliac Axis. — The coeliac axis divides into three branches: 1. Gastric, runs along the lesser curvature of the stomach from cardiac end to pylorus. It anas- tomoses with the pyloric branch of the hepatic and distributes branches to both sides of the stomach. 2. Hepatic, passes to the liver; it gives off the pyloric, gastro-duodenalis, which divides into the pancreatico- duodenal and the gastro-epiploica dextra, and the cystic to gall-bladder. The former anastomoses with the pancreatico-duodenal of the superior mesenteric, and the latter with the gastro-epiploica sinistra of the splenic, forming the anastomoses around the greater curvature of the stomach. 3. Splenic, sends off branches to pancreas and the gastro-epiploica sinistra. Superior Mesenteric. — Supplies small intestine and ascending and transverse colon. It sends off five branches : 1. Inferior pancreatico-duodenal, anastomosing with the vessel of same name from gastro-duodenalis. 2. Colica media, sending branches to the transverse and ascending colon ; it anastomoses on the right with the colica dextra, on the left with ascending branch of the 248 PRACTICAL ANATOMY. Fig. 110.— Diagram of the Course and Relations of the ABDOMiNAii Aorta and Vena Cava Inferior and their Branches. 1, ilio-hypogastric nerve ; 2, ilio-inguinal nerve ; 3, external cutaneous nerve ; 4, anterior crural nerve. colica sinistra, — a branch of the inferior mesenteric. 3. Colica dextra, to the ascending colon, anastomosing with the colica media and ilio-colic. 4. Ilio-colic, sends THE COMMON ILIAC ARTERIES. 249 branches to the caecum and small intestine, anastomosing with the colica dextra and vessels of the small intestine. 5. Vasa intestini tenuis, a number of branches to the small intesthie. The arteries to the intestines exhibit a remarkable series of anastomoses ; they are not directly distributed, but form arches and loops, and from the .convexities of these the branches pass to the intestines. "^ Inferior Mesenteric. — Supplies the descending- colon and sigmoid flexure of the rectum. It sends off three branches : 1. The colica sinistera, supplies the dscending colon and anastomoses above with the colica media, below with the sigmoid. 2. The sigmoid are several branches distributed to the sigmoid flexure of the colon. 3. The superior hsemorrhoidal, the terminal branch, anastomoses freely with the other vessels distributed to the rectum. Supra-renal. — Are a pair of small branches which pass outward to the supra-renal capsules. Renal. — Are a pair of large vessels coming off at right angles from the aorta and distributed to the kid- neys. Each vessel subdivides into four or five branches. Spermatic. — A pair of vessels which pass to the testes of the male. They are displaced by the ovarian in the female, and run in the inguinal canal, with the spermatic cord. In the female they are sliorter and pass between the layers of the broad ligaments to the ovaries. Lumbar. — Are four or five pairs which come ofl" at right angles to the aorta and are distributed to the lumbar muscles. Sacra Media. — A branch which runs down the middle of the sacrum. It is given off" from the bifurcation of the abdominal aorta into the two common iliacs. THE COMMON ILIAC ARTERIES. The abdominal aorta, on tlie left side of the body of the fourth lumbar vertebra, divides into the right and left 250 PRACTICAL ANATOMY. common iliac arteries, which diverge and, after running downward for two and one-half inches, give off the internal iliacs, which supply the pelvic contents, and the external iliacs, which are the continuation of the common trunks. The common iliac arteries give off no branches. THE INTERNAL ILIAC ARTERIES. The internal iliac is about one and one-half inches long and divides into an anterior trunk and a posterior trunk. The anterior trunk sends off seven branches in the male and nine branches in the female : — In the Male. 1. Superior Vesical. — The hypogastric artery in the foetus carries the venous blood back to the placenta. After birth it is obliterated, that portion running to the bladder only remaining previously, and it supplies the fundus of the bladder. 2. Middle Vesical. — Supplies the neck of the bladder. 3. Inferior Vesical. — Supplies the neck of the blad- der and the vesiculse seminales. 4. Middle HcemorrJioidal. — Supplies the rectum; anastomoses with the other haemorrhoidal arteries. 5. Obturator. — Passes out of the pelvis by the obtu- rator foramen ; supplies the muscles in its course. It may come off with the deep epigastric. , 6. Internal Pudic. — One of the terminal branches of the anterior trunk ; passes out of the pelvis below the pyriformis, crosses the spine of the ischium, and re-enters the pelvis through the lesser sacro-sciatic foramen. It then runs along the rami of the ischium and pubes and finally divides into the dorsal artery of the penis and the artery of the bulb. The internal pudic sends off: (a) Inferior hsemorrhoidal, to the lower part of rectum. (h) Superficial perineal, to the superficial perineal struc- THE EXTERNAL ILIAC ARTERY. 251 tures. (c) Transverse perineal, to the muscles; lies on transversus perinei. ((/) Artery of the bulb, short and thick ; runs to tlie bulb, {e) x\rtery of the corpus cav- ernosum ; pierces the crus penis and is distributed to it. (/) Dorsal artery of the penis; supphes prepuce and glans. 7. Sciatic. — The other terminal branch of the an- terior trunk passes out of pelvis with the internal pudic. It sends off muscular branches, articular branches, and a branch to the sciatic nerve. In the Female., in Addition. 8. Uterine. — Ascends at the side of the uterus be- tween tlie layers of the broad hgament and is distributed to the uterus. 9. Vaginal. — Supplies the lower part of the vagina. The Posterior Trmik. The posterior trunk sends off: — IJio-Jwiibar. — Is a recurrent branch that supplies the muscles in the iliac fossa and the lumbar region. Lateral Sacral. — Two or three branches which enter the anterior sacral foramina and anastomose with the sacra media and the arteries of the spinal canal. Gluteal. — Passes out of the pelvis above the pyri- formis and divides into a deep and superficial branch, which supplies the skin and the gluteal muscles. Tliis vessel forms free anastomoses among its branches. THE EXTERNAL ILIAC ARTERY. The external iliac artery is the continuation of the common iliac, which passes beneath Poupart's hgament, and is continued down the thigh as the femoral artery. Just before it passes out of the pelvis, beneath Poupart's ligament, it sends off the Deep Epigastric. — Runs upward and inward in the 252 PRACTICAL ANATOMY. anterior wall of the abdomen, perforates the sheath of the rectus, which it supplies, and anastomoses with the descending branch of the internal mammery. It sends off branches to spermatic cord, to the pubes, and to the muscles. Sometimes it arises in common with the obturator. Deep Circumflex. — E-uns upward and outward be- tween the transversalis and the internal oblique, close to the crest of the ilium. It supplies the muscles of the outer and anterior part of abdomen. THE FEMORAL ARTERY. The femoral artery is a continuation of the external iliac. It passes beneath Poupart's ligament midway be- tween the anterior superior spinous process and the spine of the pubes; a line drawn from this point to the inner side of the internal condyle of the femur will overlie the artery. It sends off the following branches : — Superficial Epigastric. — Arises from the femoral artery half an inch below Poupart's ligament, passes upward and inward, and supplies the integument of the abdomen. Superficial Circumflex Iliac. — Comes off opposite to the superficial epigastric, passes upward and outward, and is distributed to the integument of the abdomen. Superficial External Ptidic. — Supplies integument of inner side of groin, the scrotum, and integument of penis. Deep External Pudic. — Supplies the skin of peri- neum and scrotum and muscles. Profunda. — Almost as large as the femoral; it passes down deeply and sends off (a) the External Circumflex, supplies the structures on anterior and outer part of the thigh; (b) the Internal Circumflex, supplies the struc- tures on anterior and inner part of the thigh ; these ves- THE ANTERIOR TIBIAL ARTERY. 253 sels form an anastomosis below the great trochanter of the femur ; (c) the Three Perforating, perforate the ad- ductor magnus. Muscular. — To muscles of thigh. Anastomotica Magna. — Is gi\en off on a level with the lower tliird of the thigh, just before the femoral enters Hunter's canal, Avliich is an oblique canal through the adductor magnus, close to the inner side of the femur. The anastomotica magna supplies the integument and inosculates with the recurrent tibial. As the femoral passes through the adductor magnus, it becomes the popliteal and runs down through the popliteal space. POPLITEAL ARTERY. The popliteal artery is the continuation of the femoral, and begins at the opening in the adductor magnus mus- cle. It lies deep in the popliteal space, and sends oif : — Superior External Articular. — Winds around the femur, supplies muscles, and forms free anastomoses. Superior Internal Articular. — Winds around the femur, supplies muscles, and forms free anastomoses. Inferior External Articular. — Winds around the tibia, supplies muscles, and forms free anastomoses. Inferior Internal Articular. — Winds around the tibia, supplies muscles, and forms free anastomoses. Azygos Articular. — Supplies ligaments and synovial sac of knee-joint. Gntaneous. — Supplies skin of calf of leg. Muscular. — Supplies muscles of popliteal region. At the lower border of the popliteal muscle the popliteal artery divides into the anterior and posterior tibial. THE ANTERIOR TIBIAL ARTERY. The anterior tibial artery passes through the foramen, in the upper part of the interosseous membrane, runs 254 PRACTICAL ANATOMY. along its anterior surface to the foot, where it becomes the dorsal artery. The anterior tibial sends off : — Recurrent Tibial. — Anastomoses with the anasto- motica magna and articular branches from popliteal. Muscular. — To muscles of the anterior region of leg. Internal Malleolar. — Supplies ankle-joint and anas- tomoses with the other vessels in that region. External Malleolar. — Supplies the ankle-joint and anastomoses with the other vessels in that region. THE DORSALIS PEDIS ARTERY. The dorsalis pedis artery is the continuation of the anterior tibial. It forms an arch on the dorsum of the foot, and sends off: — Tarsal. — Supplies extensor brevis digitorum. Metatarsal. — Passes across foot and gives off three interosseous. T'he Interosseous. — Supply the contiguous sides of the dorsal aspect of the toes. The Communicating. — Perforate interosseous struct- ures and communicate with the plantar. Dorsalis Polllcls. — Supplies great toe and second toe. THE POSTERIOR TIBIAL ARTERY. The posterior tibial artery begins at the lower border of the popliteus muscle, and passes down the leg be- tween the superficial and deep groups of muscles; it then passes behind the internal malleolus, into the sole of the foot. The posterior tibial sends off: — Muscular. — To the muscles of leg. JVutrient. — To tibia; this is the largest nutrient artery to any bone. Comrni(77icafing.-— Passes between posterior tibial and peroneal muscles. Internal. — Two or three vessels to inner side of heel. VEINS. * 255 PeroneaL^^ Avises an inch below origin of posterior tibial artery. It is almost as large as the posterior tibial, and runs down between the superficial and deep group of muscles to the fibular side of the leg. Its branches are the muscular and the nutrient to the fibula. The posterior tibial becomes the plantar artery, which di- vides into the internal plantar and the external. The internal is small, and supplies the inner side of the foot. The external plantar is large, runs outward to the base of the fifth metatarsal, then curves deeply inward, form- ing the plantar arch, which is completed by a communi- cating branch from the dorsalis pedis. The external plantar sends off (a) the Perforating, which anastomoses with the dorsalis pedis ; (h) the Digital, four or five vessels to the toes. Each branch runs forward to the web of the toe, then divides into two branches, which are distributed to the adjoining sides of the toes. THE PULMONARY ARTERY. The pulmonary artery, about two inches long, arises from the right ventricle, and carries venous blood to the lungs. It divides into the right and left pulmonary, which pass to the right and left lungs respectively, then divide and subdivide, and finally form plexuses or anastomoses, reticular in character, around the air-cells ; they are so arranged that the diameter of tlie mesh is less than the diameter of the capillary. The pulmonary capillaries are exquisitely delicate, and consist of a single layer of endothelial cells jointed together by an albuminoid cement-substance. VEINS. The systemic veins are vessels which carry the venous blood to the heart. They begin in the capillaries, grad- ually increase in size, and terminate in the ascending and 256 PRACTICAL ANATOMY. descending venae cavse, which empty into the right auricle. The pulmonary veins, four in number, convey oxygenated blood from the lungs to the left auricle. Veins, like arteries, have three coats. The outer or areolar, the middle or muscular or fibrous, and the inner or epithe- lial. These coats are relatively thinner than in the arte- ries ; so that a vein, when cut across, will collapse, while an artery remains patulous and cylindrical. Veins inter- communicate freely and often form large plexuses. All veins, with the few exceptions of those in which the blood gravitates to the heart, when the subject is in the erect posture, are supplied with valves, the positions of which can be distinguished on the exterior of the vein by slight constrictions. The area of the venous vsystem is esti- mated to be two and one-half times as much as the ar- terial system, owing to the larger size of the veins and the greater number of the venous radicles. In general the veins are erratic in distribution, and anomalies are constantly met with. The smaller arteries, as a rule, have two accompanying veins called the vense comites ; the larger arterial trunks, as the popliteal, femoral, axil- lary, and subclavian, have but one vein. The veins of the cranium are called sinuses ; of these there are two kinds, — those which run in the substance of the bone and those which are formed by a separation of the leaflets of the dura mater. The veins are classified into those of the head, neck, upper extremities, trunk, and lower extremities. Those of the head and of the neck are the superficial and deep. The superficial set are temporal, facial, internal maxil- lary, posterior auricular, occipital, and temporo-maxillary. These veins follow the course of the arteries ; they freely communicate with each other, and at the angle of the lower jaw unite with more or less regularity, to form THE VEINS OF THE NECK. 257 the external jugular. The facial generally empties iulo the internal jugular. THE VEINS OF THE NECK. External Jugular. — Begins in the substance of the parotid gland, runs down the neck from the angle of the inferior maxillary to the middle of the clavicle, and empties into the subclavian. Posterior External Jugular. — Empties into the exter- nal Jugular about its middle ; comes from posterior part of the neck. Anterior Jugular. — Formed by the submaxillary veins, passes down the anterior part of the neck, and empties into either the external jugular or subclavian. Internal Jugular. — Begins at the posterior lacerated foramen, and is the continuation of the great lateral siniis of the brain. It runs deeply down the neck to the outer side of the carotid, and empties into the subclavian to make the innominate. YertehraJ. — Runs down the spine beside the vertebral artery and empties into the innominate. The deep veins of the head are diploic sinuses, canals in the diploic substance of the cranial bones. The veins in these canals adhere to the walls and remain open on section. The sinuses of the dura mater are a simple separation of the layers of the dura mater, and are lined by endothelium. They are : — Superior Longitudinal. — Begins at the foramen caecum, in front of the cristi galli. It runs along, the median line of the skull to the internal occipital pro- tuberance, where it divides into the tw o lateral ; the point of division is called the torcular Herophili. Inferior Loiigitudinal. — Along the free border of the falx cerebri; terminates posteriorly in the straight sinus. Straight. — Is the continuation backward of the 17 258 PRACTICAL ANATOMY. inferior longitudinal along the median line of the upper surface of the tentorium cerebelli; it empties into the superior longitudinal. Lateral. — Formed by the division of the superior longitudinal. Pass horizontally outward on the horizontal grooves of the occipital cross, then curve down behind FiG. Ill — Diagram showing the Ceeebkal Sinuses in Profile. 1, superior longitudinal sinus ; 2. inferior longitudinal sinus ; 3, straight sinus, deriv- ing blood from 1 and also from the veins of Galen (II) ; Nos. 1, 2. and 3 bound the falx cerebri ; 4, the torcular Hernphili, where four sinuses meet; 5, lateral sinus; fi, superior petrosal sinus, joining the lateral sinus (.i) with the cavernous sinus (8) ; 7, inferior petro- sal sinus, joining the eavet-imus sinus (S) with the jugular vein (9) ; 8, cavernous sinus; 9, internal jugular vein formed by two sinuses (o and 7); lU, occipital sinus ; 11, venae Galeni ; 12, vein passing to nasal cavity ; 13, foramen otecain. the petrous bone, and terminate at the posterior lacerated foramina. OccipitO:!. — Two small sinuses from the sides of the foramen magnum; they empty into the lateral sinuses near the point of their communication with the superior longitudinal. Cavernous. — Consists of a series of cells opening into one another ; lies in tlie cavernous groove at the side of the body of the sphenoid. It drains the orbit, receiving the ophthalmic vein. THE VEINS OF THE NECK. 259 Pltuitari/, or Circalar. — Encircles the sella turcica. It connects the cavernous sinuses. Transverse. — Connects the two great petrosal sinuses. It is placed at the articulation of the os planum of the sphenoid with the basilar process of the occipital. Vv^^ Fig. 112.— Diagram showing the Venous Sinuses of the Dura Mater. A, anterior fossa of skull ; B. middle fossa- C, posterior fossa ; FS, frontal sinus; I, torcular Ilerophili ; 2, 2, lateral sinuses ; 3, 3, occipital sinuses : 4, 4. superior petrosal sinuses ; 5, 5, inferior petrosal sinuses : 6, transverse sinus ; 7. 7. cavernous sinuses: 8, circular sinus, 9, opening into internal ju!;\ilar vein ; 10. ophthalmic vein, communicating with cavernous sinus (7) ; 11, a branch joining the occipital and inferior petrosal sinuses ; 12, veins from posterior condyloid foramen to lateral sinus. Great Petrosal. — Is the continuation backward of the cavernous sinus. It lies in the suture between the petrous part of temporal and the side of the basilar process. Lesser Petrosal. — Lies in the superior border of the petrous part of temporal and connects the lateral and the cavernous sinuses. 260 PRACTICAL ANATOMY. VEINS OF THE UPPER EXTREMITY. The veins of the upper extremity are superficial and Ixl deep. The superficial run in the superficial fascia; are, therefore, subcutaneous, and can be seen as bluish, com- pressible, linear elevations. The superficial veins are : — Median. — Formed by the union of small veins on the anterior part of forearm. It runs toward the elbow, bifurcates Y-like, and sends one branch to the basilic and the other to the cephalic. Ulnar. — Three or four veins which drain the ulnar side of the forearm; it becomes a single trunk, receives the branch from the median, and continues deeply up the arm as the basilic. Radial. — Drains the radial side of forearm; at the bend of the elbow it receives the branch from the median, and continues up the arm as the cephalic. Medio-hasilic. — The sliort branch from the basilic to the median. It is crossed by the internal cutaneous nerves, and lies on the brachial artery. Medio-ce_pTialic. — The other short terminal branch of the median to the cephalic. It is the vein ordinarily selected for phlebotomy. Cei^halic. — Is the continuation of the radial and medio-cephalic. It passes up the outer side of the arm, lies in the groove between the deltoid and pectoralis major, and empties into the axillary. Basilic. — Formed by the union of the ulnar with the medio-basilic, runs up the inner side of arm, pierces the deep fascia, and empties either into the vena comites of the brachial artery or into the axillary vein. The deep veins are : — Vena Comites. — Two veins to each artery ; as a rule, one at each side. Axillary. — The continuation upward of the basilic. THE VEINS OF THE TRUNK. ' "^ 261 It receives the vena comites and cephalic. At the lower border of the first rib it becomes the Subclavian. — The large venous trunk which lies an- terior to the subclavian artery. It begins at the lower border of the first rib and unites behind the sterno- clavicular articulation with the internal jugular, forming the innominate. It drains the superficial veins of the neck. VEINS OF THE LOWER EXTREMITY. Veins of the lower extremity are superficial and deep ; the supei-ficial are : — Long Saphenous. — Begins by a venous arch on the foot, passes up the inner side of the leg, and gradually increases in size. It receives the superficial veins of the lower extremity, passes through the saphenous open- ing of the fascia lata, and terminates in the femoral. Sho7't Saphenous. — Begins at the outer side 6f the foot, runs up the back part of leg, and empties into the popliteal vein. The arteries of the leg have vena comites., which unite at the lower part of the popliteal space and form the Popliteal Vein. — Receives the deep veins of the leg and knee-joint, runs up to the canal in the adductor magnus muscle, and becomes the Femoral. — The femoral accompanies the femoral artery. It receives two important tributaries, — the long saphenous and profunda femoris veins. THE VEINS OF THE TRUNK. External Iliac. — The continuation of the femoral passes beneath Poupart's ligament, joins the internal iliac, and forms the common iliac vein. It receives the deep epigastric and deep circumflex iliac veins. Internal Iliac. — Made up of the vena comites of the 262 PRACTICAL ANATOMY. gluteal, sciatic, internal pudic, obturator, and other veins which accompany the branches of the internal iliac artery. It also drains the venous plexuses of the pelvis, as the prostatic and hsemorrhoidal. In the female it drains the vesical, vaginal, uterine, and rectal plexuses. The hsemorrhoidal plexus is formed by the anastomoses of the superior middle and inferior hsemorrhoidal veins. This plexus is also drained by the inferior and superior mesenteric veins, wliich terminate in the portal vein. The dorsal vein of the penis consists of two branches which drain the blood from the organ. These two branches unite, form a single trunk, which pierces the suspensory ligament of the penis and the triangular liga- ment, and empties into the prostatic plexus. The pros- tatic plexus surrounds the neck of the bladder. The vaginal plexus^ largely composed of erectile tissue, sur- rounds the lower portion of the vagina. The uterine plexuses are at the superior angles and sides of the uterus ; they drain the uterine sinuses. The common iliac veins are formed by the union of the external and internal iliacs, and unite to the right of the fourth lumbar vertebra to form the ascending vena cava. The vena cava ascendens passes upward along the right side of the vertebral column, lies in the fissure in the posterior border of the liver, passes through the quadrate opening of the diaphragm, and enters the pos- terior and inferior portion of the right auricle. Its tributaries are the lumbar veins, the right spermatic, renal, supra-renal, phrenic, and hepatic. The lumbar consists of three or four pairs of veins that drain the structures in the lumbar regions. The spermatic veins arise in the spermatic or pampiniform plexus, at the pos- terior part of the testicle ; they pass through the ingui- nal canal ; the right empties into the ascending vena PORTAL VEIN. 263 cava, the left into the left renal vein. The left spermatic has comparatively few valves. The renal veins retnrn the hlood from the kidneys ; tlie supra-renal from the supra-renal c-a psules. The jtortal vein is formed by the superior and infe- rior mesenteric, the gastric, and splenic. It drains the intestinal tract, enters the liver, breaks up into a system of capillaries, which become confluent, and finally ter- minate in three hepatic, which empty into the ascending vena cava. At the transverse fissure of the liver the portal vein divides into a right and left branch, which give off the vaginal branches ; these send off the interlobular; and the branches of the interlobular are the lobular, which are the smallest branches of the portal system. They pass through the lobule, empty into the central or intra-lobular ^ein, which empties into the sublobular; these open into the small hepatic, which, by joining to- gether, form the three or five hepatic veins that empty into the ascending vena cava as it lies in the pos- terior fissure of the liver. The innominate veins, two in number, are formed by the union of the internal jugular and the subclavian of each side. The right is shorter than the left, and joins the left innominate behind the costal cartilage of the first rib on the riglit side, forming the descending vena cava. The innomi- nate veins receive the internal mammary, inferior thy- roid, and superior intercostal veins. The descending or superior vena cava, formed by the union of the two innorainates, is about three inches long, and terminates in the superior posterior part of the riglit auricle. The superior vena cava receives the vena . azygos major, which runs along the right side of the bodies of the dorsal vertebrae and receives the vena azygos minor and the intercostal veins. The veins of 264 PRACTICAL ANATOMY. the spine freely communicate with one another; they are Aery abundant, and are divided into the veins of the cord, those of the bodies of the vertebrae, those of the meninges of the cord, and the external veins. LYMPHATICS. Lymphatics, or absorbent vessels, are found in all the tissues of the body except the cartilage, epidermic struc- tures, cornea, and white matter of the brain and cord. Tney are delicate, transparent vessels, and have three coats, — an outer areolar, middle fibro-muscular, and inner epithelial. They are abundantly supplied with valves. The origin of the lymphatic vessels has been an open question. Most probably they begin in intercellular spaces, which, by communicating, become lymph-sinuses. These sinuses are lined by cells at first irregularly placed, then pavement in character, showing, however, here and there openings between the cells called the stomata. These minute capillaries communicate freely, forming a plexiform anastomosis, from which the lymphatic vessel proper starts. Scattered along the course of the lym- phatics are a great number of ovoidal solid bodies, vary- ing in size from a small pea to an almond. These are the lymphatic glands. On section they are seen to be formed of, first, an outer, fibrous capsule, which sends inward a number of septa that divide the gland into alveoli, which constitute the cortical portion. It is light in color and deficient at the hilum, a linear depression at one part of the gland, at which the blood- vessels enter and pass out. The medullary portion is dark in color and granular in appearance. The lym- phatic that leaves the gland is called the efi'erent. Iti passes out through the hilum, and is connected with the medullary portion. The afferent vessels, those which LYMPHATICS OF THE UPPER EXTREMITY. 265 run to the gland, penetrate the cortical portion at all points. The alveoli of the cortical portion are filled up with interlacing fihres from the septa, forming a plexi- form net-work, and called the alveoli of the alveoli, or secondary alveoli. They are filled up with lymphoid corpuscles, — the proper lymph-gland pulp. The medul- lary portion is formed of delicate trabecuUe, vessels and cells. The lymphatics are divided into the superficial and deep. The former run in the superficial fascia ; the latter accompany the large blood-vessels. Lymphatics are classified into those, first, of the head and neck; second, of the upper extremity ; third, of the trunk ; fourth, of the lower extremity. LYMPHATICS OF THE HEAD AND NECK. The lymphatics of the head and neck run in the supei*ficial fascia and converge about the angle of the jaw, where a number of lymphatic glands are found about the course of the vessels. The deep lymphatics from the nose and mouth communicate with the deep lymphatic glands at the sides of the internal jugular vein. The lymphatics of the cranium pass out through the foramina at the base of the skull and enter the deep lymphatic glands. The lymphatics of the neck are divided into the superficial and deep. The former run in the superficial fascia, from the angle of the jaw to the middle of the clavicle. Just above the clavicle numerous glands are found in the groove between the trapezius and the sterno-mastoid. The deep lymphatics of the neck ac- company the carotid artery. They consist of a chain of six or eight glands. LYMPHATICS OF THE UPPER EXTREMITY. The lymphatics of the upper extremity are divided into the superficial and deep. The former run in the super- 266 PRACTICAL ANATOMY. ficial fascia. At the bend of the elbow, above the mternal epicondyle, are two or three glands, which are apt to enlarge after mjury or disease of the hand and arm. In the axilla both the deep and superficial sets of lymphatics join and communicate freely with lymphatic glands placed upon the course of the vessels. The lymphatics of the upper extremity empty on the right side into the Fig. 113.— Lymphatics of Head and Neck. 1, Internal jugular vein; 2, deep cervical glands. right lymphatic duct ; on the left side, into the thoracic duct. LYMPHATICS OF THE TRUNK. The glands of the thorax are the anterior and pos- terior mediastinal. The former are anterior to the peri- cardium, and lie in the loose areolar tissue above the diaphragm. The posterior mediastinal consist of a LYMPHATICS OF THE TRUNK. 267 chain of glands at the sides of the aorta. Tlie lymphatic vessels are abundant, and freely communicate with the adjoining glands. The bronchial glands cluster around the bifurcation of the trachea and communicate with the mediastinal. The lymphatics of the heart accompany the blood-vessels. They terminate in a plexus around the aorta, and ultimately enter the thoracic duct. The other glands and lymphatics of the chest are found on the oesophagus, and also following the blood-vessels. They are such as the intercostals and internal mammary. The rigid Jf/mjjJiatic duct is a short trunk, about one-tenth of an inch in diameter; it runs for about one and one-half inches, and terminates at the junction of the right sub- clavian and internal jugular veins. It receives the lym- phatics of the right side of the head and neck, right upper extremity, right chest and contents. The thoracic ihict is the great lymph-channel of the body. It receives the lymph from all parts of the body except those which communicate with the right lymphatic duct. It is three- sixteenths of an inch in diameter and about twenty inches long, and passes from in front of the second lum- bar vertebra to the left subclavian vein, into which it empties. Its lower end is sacculated, about two inches long, three-eighths of an inch in diameter, and is called the receptaculum chyli. It receives the lumbar lym- phatics and the trunks of the lacteals, which are the lymphatics of the intestines. It passes into the thoracic cavity through the aortic opening, receives the lymphatics of the left side of the chest and contents, runs along the left side of the vertebral column, and empties into the left subclavian vein near its junction with the internal jugular vein. The lymphatics of the small intestine are called the lacteals. After the digestion of food they are filled with chyle, and appear as white streaks running through 268 PRACTICAL ANATOJUY. tlie mesentery. They begin in a plexiform arrangement in the viUi of the intestines, unite to form two or three FIG. 114.— Lactkals During Intestinal Digestion. A, lacteals of mesentery ; B, mesenteric glands; C, efferent chyle-ducts ; D, receptaculum chyli. large trunks, and empty into the thoracic duct. They run between the layers of the mesentery and communi- LYMPHATICS OF THE LOWER EXTREMITY. 269 cate with the mesenteric glands, which are very numer- ous. The pelvic lymphatic system consists of three sets of deep layers of lymphatics and glands, — the external iliac, internal iliac, and the sacral. They are formed of chains of glands connected by the lymphatic vessels. The superficial lymphatics of the perineum, scrotum, and penis communicate with the inguinal chain of lymphatics placed over and above Poupart's ligament. The lym- phatics of the clitoris and nymphae are similarly arranged. LYMPHATICS OF THE LOWER EXTREMITY. The lymphatics of the lower extremity are divided into the superficial and deep. The superficial lymphatics run in the superficial fascia and accompany the internal saphenous vein. They communicate with the inguinal glands, which are grouped about the saphenous opening and lie below Poupart's ligament. These inguinal glands also communicate wath the lymphatics from the side of the penis and scrotum. The superficial lymphatics of the gluteal region accompany the arteries and communi- cate with the pelvic glands. The deep lymphatics com- municate with the glands of the popliteal space and accompany the femoral vein, and enter the pelvic and lumbar glands. THE NERVOUS SYSTEM. NERVOUS TISSUE. Nervous tissue is of two kinds, — gray or vesicular, and white or fibrous. These two kinds of tissue, associ- ated in varying amounts and positions, form the essential Fig. 115.— Nerve-Fibres. I, a, medullateii nerve-fibre ; b, non-medullatecl nerve-fibre ; 2, non-medullated nerve- fibre : 3, nerve-fibres witli Ranvier's nodes ; 4, nerve-fibre treated with osmic acid ; 5, nerve- fibre showing axis-eylinder ; (i, nerve-fibre sliowingn, neurilemma; v, medullary aheath : t, axis-cylinder. elements of the nervous system, which is divided into two great systems, — the cerebro-spinal and the sympathetic. The cerebro-spinal axis is contained within the cranium and spinal canal, and sends out a number of pairs of nerves that bring the several parts of the body into close connection with the central axis. The sympathetic sys- (270) NERVOUS TISSUE. 271 tern consists of a chain of ganglia on each side of the spinal column, connected with each other and with the cerebro-spinal axis. It is the system of organic life, and hence controls the development, growth, and nutrition Fig. 116.— Ganglionic Celi, and Branching Fibres. 8t, cell body ; m, nucleus ; mc. nucleolus ; pir. protoplasmic prolongations ; tf, (ixis- cylinder fibres; tn, axis-cylinder prolongations. of the body, while the cerebro-spinal system is the system of animal life and brings the individual into relations with the exterior world through his special senses and the operations of his reason and will. 272 PRACTICAL ANATOMY. The gray or vesicular matter consists of vesicles or diameter cells, wliich vary in size from irnV-n to -g-^-n inch in To 0 0 "" 30 0 They are globular, with one, two, or more Fig. 117.— Structure of Nerve-Elements. 1. primitive fibrilla ; 2, axis-cylinder : .?, Remak's fibres : 4. medullated varicose fibre ; 5, 6. meduUated fibre, with Schwann's sheath: C, nenrilemma; t, t, Ranvier's nodes: b, white substance of Schwann; d. cells of the endoneurium : a. axis-cylinder: x. myelin drops: 7. transverse section of nerve-filire : x. nerve-fibre acteand of Reil. In, island of Reil ; So, sulcus centralis ; Gca, Gcp, gyrus centralis, anterior and posterior ; Fop, fiasura parieto-occipitalia. tudinal fissure. It begins at the inner side of the orbital lobe and passes upward and backward to the junction of the calloso-marginal and Rolandic fissures. Behind, it is the quadrate convolution, which is separated from the cuneate lobule by the parieto-occipital fissure. These three convolutions — the marginal, quadrate, and cune- ate— are all placed along the free border of the longi- tudinal fissure. FISSURES OF TilE CEREBRUM. 285 The gyrus foriiicatus, or arched convolution, arises in common with the marginal, and curves upward and backward over the corpus callosum, and becomes con- tinuous with the quadrate and uncinate convolutions. The interval between the corpus callosum and gyrus fornicatus has been called the ventricle of the corpus callosum. The uncinate, or hippocampal gyrus, arises below the posterior bulbous part of the corpus callosum and passes horizontally forward for about two inches, and Fig. 124.— Convolutions on the Median Aspect of the Right Hemisphere. CC, corpus callosum divided longitudinally; Of. gyrus fornicatus: H. gyrus hippo- campi; h, sulcus hippocampi ; U. uncinate gyrus; em. calloso-marginal fissure : Fl, first frontal convolution ; c, terminal portion nf fissure of Rolando ; A. ascending frontal convo- lution; B, ascending parietal convolution and paracentral lobule; Pi', prsecuneus, or quadrate lobule ; Oz. cuncus ; Po, parieto-occipital fissure ; o. transverse occipital fissure; oc. calcarine fissure ; oc'. superior, oc", inferior ramus of the same ; D. gyrus descendens ; xi, gyrus occipito-temporalis lateralis ; T5, gyrus occipito-temporalis medialis. terminates in a hook-like process, which curves upward and backward over the anterior extremity of the dentate fissure. The fissures on the inner surface of the cerebrum are : — The caUoso-margmal, which separates the marginal convolution from the gyrus fornicatus and communicates with the fissure of Sylvius. T\\e paneto-occipital., sepa- rates the quadrate from the cuneate lobule and passes 286 PRACTICAL ANATOMY. downward and forward, dividing into two branches, one of which communicates with the calcarine fissure. The calcariiie fissure is a short, deep, horizontally placed fis- sure below the posterior bulbous part of the corpus callo- sum. It causes an elevation on the floor of the posterior cornu of the lateral ventricle, called the calcar, or hippo- campus minor. Above the uncinate gyrus is a short, deep fissure, which extends deeply into the descending cornu of the lateral ventricle, forming on its floor and inner aspect the fascia dentata. Below the uncinate convolution is a long fissure, called the collateral. It causes an elevation on the floor of the posterior cornu of the lateral ventricle, designated the emmenentia col- lateralis. The base of the brain is flattened and irregular, and presents for examination the frontal and temporo- sphenoidal lobes, the pons Varolii, medulla oblongata, cerebellum, and a number of structures along the median line. From before backward, the following points are seen : — 1. Longitudinal Fissure. — The deep, vertical, longi- tudinal fissure that divides the two hemispheres of the cerebrum. It is bridged by the corpus callosum. 2. Corpus Callosum. — The white, transverse com- missure between the two cerebral hemispheres. It is about four inches long, and is placed about the junction of the upper three-fifths and lower two-fifths of the inner surface of the cerebrum. It is bodily advanced so as to encroach upon the anterior portion of the cerebral hemispheres. 3. Olfactory Bulbs., Tracts^ and Roots. — The first pair of nerves. The bulbs are the anterior enlarged extremities of the olfactory tracts. They lie on the cribriform plate of the ethmoid, through which they send numerous filaments into the nose. The tracts lie BASE OF THE BRAIN. 287 in a sulcus Avhich separates the marginal from the in ternal orbital convolution. 4. Fissure of Sf/h'lus. — Entirely separates the froatal from the temporo-sphenoidal lobe. It begins external to the anterior perforated space. Fig. 125.— Base of Brain. 1, olfactory btilb; 2, optic nerves; S. anterior perforated space: 4. tractus opticns ; 5, erus cerebri; fi, third pair of nerves; 7, fourth pair of nerves ; 8. tiftli pair of nerves ; 9, sixth pair of nerves; 10, pyramid; 11. olivary body; 12. vertebral artery; 13. anterior spinal artery ; 14. anterior cerebral artery ; 1.5, lamina cinerea ; 16. fissure of Sylvius, which lodges the middle cerebral artery ; 17. tuber ciuereum ; 18. corpora albicantia ; 19. posterior ^ perforated space; 20. posterior cerebral artery; 21, superior cerebellar artery; 22, pons Varolii : 23, anterior cerebellar artery; 24. seventh and eighth pairs of nerves; 25, ninth, tenth, and eleventh pairs of nerves ; 26, twelfth pair of nerves ; 27, cerebellum. 5. Anterior Perforated Space. — Continuous with the lamina cinerea and tuber cinereum is a triangular layer of gray matter, at the inner part of the fissure of Sylvius. 288 PRACTICAL ANATOMY. It is numerously perforated for the passage of vessels to the corpus striatum. 6. Lamina Ginerea. — A gray layer continuous with the termination of the corpus callosum. It lies below the chiasm of the optic nerves. 7. Optic Nerues, Chiasm and Tracts. — The second pair of nerves. The tracts begin at the corpora genicu- lata, curve around the outer part of the crura cerebri; cross, forming the chiasm, which sends off the optic nerves. 8. Tuber Ginereimi.—rThe gray, dome-shaped struc- ture that extends between the cvura, cerebri. It forms the floor of the third ventricle. 9. Pituitary Body and Infundihidum. — The infun- dibulum is a funnel-shaped process of the tuber cinereum. It hangs down and is drawn slightly forward. It pre- sents a central canal. Attached to it is the pituitary body, — a trilobed structure situated in the sella turcica. 10. Corpora Alhicantia. — Located near the poste- rior part of the tuber cinereum, formed by reduplication of the anterior pillars of the fornix. 11. Posterior Perforated Space. — Behind the corpora alhicantia ; transmits vessels to the optic thalami. 12. Crura Cerebri. — Formed by the continuation of the fibres of the medulla. As they emerge from behind the pons the two crura diverge. They are about one inch broad, one and three-fourths inches long, and con- tain a central gray portion, — the locus niger. 13. Third Pa ir of Nerves. — Motor oculi, wind around the under side of the crura. 14. Fourth Pair of Nerves. — Patheticus, emerge from around the outer border of crura. 15. Pons Varolii. — Consists of white and gray mat- ter. The white fibres run both transversely and longi- BASE OF THE I5KAIN. 289 tudiiially. The traiisv(n-s(; are the commissural fihres between the two hemispheres of the cerebellum, inter- woven by the longitudinal fibres forming the crura. 16. FIftJi Pair of Nerves. — Arise by two roots from each side of the pons, about three-quarters of an inch external to the median groove. 17. Sixth Pair of Nerves. -^^AhAwcen?,, arise in the groove between the anterior pyramids and olivary body, just behind the pons. 18. MedaUa Oblongata. — Cuboidal in form, is the upper enlarged portion of the . spinal cord. 19. Twelfth Pair of Nerves. — Arise in the same groove as the sixth. • 20. Seventh, Eighth, Ninth, Tenth, and Eleventh Pairs of Nerves. — Arise in the groove between the olivary body, lateral tract, and restiform body. 21. Cerebellum, or After-Brain. — Lies in the lower occipital fossae. It fits like a saddle over the upper part of the medulla. A horizontal section below the convolutions throuah the two hemispheres is oval in outline, and has been called the centrum ovale minus. This section shows the exterior cortical portion of the brain and the white, fibrous portion witliin, on which are seen numerous red points, — the puncta vasculosa, — which are the minute blood-vessels of tlie white matter cut across. A section through the cerebral hemispheres on a level wdth the corpus callosum is called the centrum ovale majus. This section exposes the upper surface of the corpus callosum, which is the great transverse commissure between the two cerebral hemispheres. On its upper surface are seen some longitudinal elevations of white fibres called the nerves of Lancisi. The upper surface of this com- missure is slightly wavy from front to back. The under 19 290 PRACTICAL AX ATOM V surface forms the roof of the lateral ventricles, which are two. symmetrical, cuboidal, serous sinuses, presenting for examination a roof, a floor, an inner wall and an outer wall, an anterior cornu, a posterior cornu, and a middle cornu. The roof of the lateral ventricle, formed by the corpus callosum. as above stated, is arched from front to Sim Ccl Fig. 126.— Ce>'tetjm Ovale Majts. Ccl, corpns callosnm ; Lt, ligamentnm tectum : Sim, etrise longitudinales. back. The floor of each ventricle is made up of the following: structures : — Corpus striatum, Optic thalamus, Edffe of fornix, Taenia semicircularis, Choroid plexus, Fornix. The floor of the ventricle is very irregular. The outer wall is formed by the fibres of the cerebral hemi- THE LATERAL VENTRICLES. 291 sphere. The inner wall is formed by the septum luci- dum, which is the vertical partition between the right and left lateral ventricles. The anterior cornii is an extension of the lateral ventricle into the anterior lobe. ah JVC^ Fig. 127.— Transverse Section of the Human Brain Through THE Basal Ganglia. NC. caudate nucleus ; NC, the araygdiila : LN. lenticular nucleus ; TH, optic thalamus: F. frontal lobe: TS. temporo-siiliennidal lobe: O. occipital lobe: Cls, claus- trum ; IK, thalino-lenticular portion of internal capsule : K. knee of same : IK', caudo- lenticular portion of same ; EK, external capsule : f. fornix cut across ; In. insula, or island of Reil ; Op. depth of Sylvian fissure; mc. middle commissure; ph, posterior horn of lateral ventricle; ah, anterior horn of same; SI, septum lucidum. The middle cornu curves downward behind and beneath the optic thalamus into the middle lobe. The posterior cornu extends backward into the posterior lobe. The corpus striatum, one of the great basal ganglia, is striated on section, and consists of a mixture of white and 292 PRACTICAL ANATOMY. gray matter. It is pear-shaped, the larger end of the pear presenting forward and projecting into the anterior and inferior part of the lateral ventricle. Along its upper sur- face is a group of ganglionic cells called the caudate nu- cleus. Within the substance of the corpus striatum is the lenticular nucleus, — another arrangement of ganglionic nerve-cells. The corpus striatum rests on the anterior portion of the cms cerebri of each side. The greater portion of it is imbedded in the cerebral hemispheres, and is known as the extra- ventricular portion, while that part which presents within the ventricle is known as the intra- ventricular portion. The tcenia semicircularis is a lon- gitudinal commissure which arises anteriorly in common with the anterior pillar of the fornix, and curves back- ward and outward in the groove between the optic thala- mus and corpus striatum, and becomes finally lost in the middle cornu of the lateral ventricle. The oj^tic thala- mus is placed behind and to the inner side of the corpus striatum ; it is an ovoidal structure, and rests upon the crus cerebri of each side. It is composed of an external white portion and an internal mixed portion of gray and white matter. A collection of ganglionic cells in the interior of the optic thalamus, arranged in the form of a sickle, is called the falciform nucleus. The anterior extremity of the optic thalamus is pointed and forms the posterior boundary of the foramen of Monro. The posterior extremity is broad and rounded, and presents two elevations, — the external and internal geniculate bodies, — which are the termini of the optic tracts. The upper surface is convex and rounded. Its outer portion forms part of the floor of the lateral ventricle. Its inner portion is covered by the fornix, from which it is sepa- rated by the velum interpositum and its fringe-like border, the choroid plexus. The inner surface of the THE LATERAL VENTRICLES. 293 optic tlialamus forms the outer wall of the third ventricle. The choroid plexus is the edge of the velum interpositum thrown into a fringe-like border of capillary vessels. It passes from the lateral into the third ventricle through the foramen of Monro. The edge of the fornix is called the corpus fimbriatum, and rests upon the choroid plexus. The /ormx is a longitudinal commissure of white fibres, which arises in common with the corpus callosum. It curves forward and downward, diverging from the under surface of the corpus callosum ; it is separated from it by the septum lucidum. As it passes for- ward it becomes narrow, and divides into the two anterior crura, which pass down behind the anterior commissure to the posterior part of the tuber cine- reum, where they become reduplicated and form the corpora albicantia. The posterior crura curve down- ward into the middle cornua of the lateral ventricle, and lie upon the hippocampi. The edge of each posterior crus is called the corpus fimbriatum. The under sur- face of the fornix is striated, which arrangement has been called the lyra. The anterior cornu extends into the frontal lobe, and curves forward, outward, and down- ward around the anterior portion of the corpus striatum. The posterior cornu extends into the occipital lobe, and curves backward, downward, and inward. On its floor is a curved elevation, called the calcar, or hippo- campus minor. It is formed by an involution of brain- substance over the calcarine fissure. Between the posterior and middle cornua is an elevation due to the extension inward of the collateral fissure. It is called the collateral eminence. The middle cornu curves back- ward, outward, downward, forward, and inward behind and beneath the optic thalamus, and deeply into the sub- stance of the temporo-sphenoidal lobe. On its floor are 294 PRACTICAL ANATOMY, seen (1) the hippocampus major, (2) pes hippocampi, (3) corpus iimbriatum, (4) choroid plexus, (5) dentate fascia, and (6) the transverse fissure of the brain. The hippocampus major is an elevation formed by the invo- lution of the dentate fissure. It is rounded, curved, and terminates in an enlarged nodular extremity called the Kdih^^^^ Fig. 128.— Vertical Section Through the Adult Brain. pes hippocampi. It is covered by a layer of gray matter more or less jagged along its inner free border, and called the fascia dentata. The corpus fimbriatum is the edge of the posterior pillar of the fornix. The transverse fissure, a strongly- curved fissure bounded above by tlie common origin of THE THIRD VENTRICLE. 295 the corpus callosiim and fornix, below by the tiibercuhi quadrigemina and optic tlialami, and laterally and above on each side by the corpus fimbriatum of the middle cornu. The septum lucidum is the vertical partition between the lateral ventricles. It is attached above along the median line of the under surface of the corpus callosum, bclo^v along the median line of the upper surface of the fornix. It consists of two laminae of white and gray matter inclosing a small serous sinus, — the fifth ventricle. Immediately below the fornix is the velum inter- positum, — a process of pia mater transmitted by the transverse fissure. It is triangular in shape, and pre- sents along its free borders the choroid plexus. Two similar tufted choroid plexuses hang down from its under surface into the third ventricle. Running longi- tudinally along its upper surface are two large veins, — the venae galeni, — which receive the blood from the choroid plexuses, and also from the corpora striata. They empty into the straight sinus. The third ventricle is located between the two optic thalami. It is bounded above by the fornix, from which it is separated by the velum interpositum ; laterally, by the inner surfaces of the optic thalami and the peduncles of the pineal gland; the floor, by the structures of the inter- peduncular space at the base of the brain ; in front, by the anterior pillars of the fornix ; behind, by the anterior aspect of the corpora quadrigemina and the aqueduct of Sylvius. The third ventricle is lined by gray matter, and is crossed by three commissures, — the anterior, white, placed in front of the anterior pillars of the for- nix, passes between the corpora striata ; the middle, gray, passes between the optic thalami ; and the poste- rior, white, between the optic thalami ; it supports tlie pineal gland. Four openings lead into the third ventricle, 296 PRACTICAL ANATOMY. — anteriorly, the two foramina of Monro ; bounded in front by the anterior pillars of the fornix ; behind, by the anterior extremities of the optic thalami. Each trans- mits the choroid plexus. The aqueduct of Sylvius leads from the third to the fourth ventricle ; it is lined by Fig. 129.— Horizontal Section of Bkain, showing Third Ventricle. gray matter, and perforates the base of the tubercula quadrigemina. The infundibulum, pendent from the tuber cinereum, leads to the pituitary body. It is patu- lous in the foetus, but exists as a funnel-shaped pit in the adult. THE FOURTH VENTRICLE. 297 The pineal gland is a reddish, conoidal body, which rests upon the upper surface of the posterior commissure of the third ventricle and tlie tubercula quadrigemina. It is invested and held in position by the velum interposi- tum, and is attached to the inner upper part of the optic thalami by two slender white peduncles, which conjoin anterior to their attachment to the pineal gland. It is formed principally of gray matter. It contains a small amount of earthy salts. The tubercula quadrigemina, situated behind the third ventricle, extends between the posterior extremities of the optic thalami. It consists of two pairs of rounded elevations, — the upper or larger, called the nates; the lower, the testes. They are connected with the optic thalamus by the anterior and posterior commissural bands. In structure they are composed principally of gray matter. The aqueduct of Sylvius passes through their base ; it leads from the third to the fourth ventricle. The fourth ventricle is situated in the upper surface of the medulla. It is a diamond-shaped depression, about an inch and a half long and one incli wide. It is bounded above by the processus e cerebello ad testes and the valve of Vieussens ; below, by the diverging posterior columns and restiform bodies; and laterally, at the middle, by the middle peduncles of the cere- bellum. Its roof is formed by the inferior vermiform process of the cerebellum. Projecting into the fourth ventricle are two or three fringes of pia mater known as the choroid plexuses of the fourth ventricle. The floor of the fourth ventricle is formed by the posterior surface of the transverse commissure of the gray matter of the cord and medulla exposed by the divergence of the posterior columns and restiform bodies. 298 PRACTICAL ANATOMY. It presents the posterior median longitudinal fissure,wliich is quite shallow, and on each side a round bundle of fibres running the entire length of the floor of the fourth ventricle, and called the fasciculi teretes. Islands Zn>is. VenirieuhsS tiftats. y^ ^xruiica-m. . liiu:kcnv'<^tr(< . '•)^eisEntiac\\. Fig. 130.— Floor of Fouktii Ventricle. of ganglionic cells impart a lighter tint of color to parts of the floor of the fourth ventricle, and are called the blue spots and violet streaks of the floor of the ventricle. The processus e cerebello ad testes are white fibres wliii h I THE MEDULLA OBLONGATA. 299 pass from the cerebellum upward to the testes. The valve of Vieussens stretches between the two processus e cerebello ad testes at their point of entrance into the tiibercula quadrigemina. It is a fold of gray matter which forms the roof of the aqueduct of Sylvius. The medulla oblongata is the iippei' enlarged part of the spinal, cord. It is about one and one-half inches long, one inch broad, and three-quarters of an inch thick. It rests upon the upper surface of the basilar process of the occipital bone, and is limited above by the pons Varolii. It presents an anterior and posterior me- dian fissure, which divide the medulla into two sym- metrically arranged halves, each of which presents the anterior pyramid, lateral tract and olivary body, resti- forra body and posterior pyramid. The anterior pyramid is separated from its fellow by the anterior median fissure. It consists of bundles of white fibres which at the lower part of the medulla interlace with those of the other pyramid, forming the decussation of the pyramids. The lateral tract, external to the anterior pyramid, presents at its upper part the olivary body, placed with its long diameter in the direction of the fibres of the tract. Its lower portion is crossed by a number of curved fibres. A section of the olivary body discloses the dentate cap- sule,— an open capsule of gray matter. The restiform body, continuous with the posterior column of the cord, is a large, rounded tract of white fibres placed between the lateral tract and the posterior pyramid. The posterior pyramids, continuous with the posterior median columns of the cord, are separated from each other by the posterior median fissure. At the in- ferior part of the fourth ventricle the posterior pyra- mids and the restiform bodies diverge widely and form the inferior lateral boundary of the fourth ventricle, 300 PRACTICAL ANATOMY. and then pass to the cerebellum and form its inferior peduncles. The pons Varolii is the great commissure at the base of the brain, connecting the hemispheres of the cerebel-, lum with the cerebrum and medulla. It rests on the basilar process of the occipital and os planum of the sphenoid, and presents an inferior convex surface, a supe- FiG. 131.— Medulla Oblongata, Pons, Cekebellxjm, anb Cbura Cerebri, Seen from in Front. rior and inferior border. The borders are sharply defined, — the anterior curved from side to side, the inferior slightly concave. The inferior surface presents a median longitudinal groove, in which reststhe basilar artery. About one inch on either side of the median groove is the origin of the fifth pair of nerves — nearer the anterior than the inferior border. Externally the pons narrows and enters the cerebellum, forming its middle pe- TIIK CEKEBELLUM. 301 dimcles. The upper surftice of the pons forms ])art of the floor of the fourtli ventricle. Its fibres are divided into transverse and longitudinal. Of the former there are two planes — superficial and deep. The longitudinal layers are likewise separated into two sets: the first passes upward between the transverse planes; the deep Fig. 132.— The CEREBELttrM, Upper Surface. set, above the deep transverse plane, forms part of the fibres of the floor of the fourth ventricle. The cerebelliun is situated beloAv the posterior lobes of the cerebrum. It is lodged in the inferior occipital fossae. It w'eighs about five and one-half to six ounces. It is about four inches transversely, two and one-half inches antero-posterioiiy, two inches vertically at the thickest part. It is composed of a gray cortex and a white medullary portion, in which there is imbedded an 302 PRACTICAL ANATOMY. open gray capsule, called the corpus dentatum. It con- sists of two symmetrical hemispheres joined together by a central constricted commissural portion. The upper surface is flattened, slightly convex, and presents- two lobes, — a large anterior, the quadrate, and a narrower portion, the semilunar. Along the median line is the transverse commissure called the superior vermiform process, which begins at the anterior notch and termi- nates at the posterior notch of the cerebellum. Three slight eminences along the superior vermiform process Fig. 133.— The Cerebelltjm, Inferior Surface. have received names. They are the central, anterior, and posterior lobes. The inferior surface of the cerebellum is irregular and uneven. Each hemisphere presents four lobes, — the tonsillar, digastric, slender, and posterior in- ferior. The inferior vermiform process is depressed, and presents from behind forward the short commissure, the pyramid, the uvula, the nodule, and arching outward from each side of the nodule is a lamina of white matter called tlie velum. At eacli extremity of the velum is the flocculus, — a group of miniature convolutions. The THE SPINAL COHD. 303 3Ncll rorebellum pvescnts a great, iiiun- ber of fissures. One, the great horizontal fissure, is of larae size, and divides the cerebellum into an upper and lower portion. If a vertical section is made through the cerebellum, a remarkable ar- rangement of the gray cortical matter into laminae is observed. It is called the arbor vitae cere- belli. THE SPINAL CORD. The spinal cord is that por- tion of the cerebro-spinal system situated in the spinal canal. It is invested by three membranes, — the dura mater, the arachnoid, and the pia mater. The dura mater of the cord differs from the dura mater of the brain, firstly, in that it is a loose, tubu- lar sac which is not adherent to the bones of the spinal canal ; secondly, it does not send proc- esses into the cord ; and, thirdly, its lamellae do not diverge to form blood-sinuses. It is attached to the margins of the foramen mag- num, and forms tubular sheaths for the anterior and posterior roots of spinal nerves. Its lower end becomes blended with the periosteum of the sacrum and coccyx. The arachnoid, as in the 304 PRACTICAL ANATOMY. brain, is a shut serous sac having a closely attached parietal and a loosely attached visceral layer. The pia mater, thick, less vascular than in the brain, sends processes into the principal fissui'es of the cord and at the sides forms the dentate ligament, — a series of processes attached to the dura mater, and which help to sustain the cord in position. The spinal cord is about sixteen inches long. It extends from the atlas to the first lumbar vertebra, weighs about an ounce and a half, and consists of a cylinder of nerve- tissue which terminates below in a leash of nerve-bundles called the cauda equina. The white substance of the cord is on the exterior; the gray matter, arranged in the s Fig. 185.— Section of Spinal Coed and Membranes. • 1, dura mater; 2, arachnoid membrane: 3, ganglion on posterior root; 4, anterior root of spinal nerve ; 5, subarachnoid space ; 6, posterior branch of spinal nerve ; 7, anterior branch of spinal nerve. form of the letter H on transverse section, is within. The cord presents two enlargements, — the cervical and lum- bar,— corresponding to the roots of origin of the brachial and lumbar plexuses, respectively. The cord is divided into two symmetrical halves by the anterior and posterior median fissures. The anterior median fissure extends the entire length of the cord, and is continuous with the same fissure of the medulla. It is not as deep as the posterior median fissure, which, like the anterior, extends the entire length of the cord and is continuous with the median fissure on the floor of the fourth ventricle. Each half of the cord presents four columns, — the anterior, lateral, posterior, and posterior median ; separated by THE SPINAL CORD. 305 SENSORY. Neck and scalp Neck and shoulder Shoulder " Arm Hand . Front of thorax Ensiform area Abdomen (Umbilicus 10th) / Buttock, upper ^ part Groin and scrotum front outer side Thigh front L inner side Leg, inner side ' Buttock, lower part Back of Thigh Leg and REFLEX. Scapular Epigastric Abdominal Cremasteric Knee reflex except _ Foot inner part Perinaeum and Anus Skin from coccyx to Anus Gluteal Foot clonus Plantar Fig. 136. 20 306 PRACTICAL ANATOMY. three fissures, — the antero-lateral, postero-lateral, and posterior. The antero-lateral fissure is the line of emergence of the filaments of the anterior roots of spinal nerves. It is just external to the anterior cornu of the gray matter of the cord. The postero-lateral fissure, a slight groove, gives origin to the posterior roots of spinal nerves. The ex- tremity of the posterior cornu of gray matter extends quite up to the postero-lateral groove. The posterior L — --.-/ — L P P P P Fig. 137.— Teams verse Section of the Spinal Cord. p, posterior horns ; a, anterior horns ; PR, posterior roots ; AR, anterior roots ; A, the white anterior, LL, the lateral, PP, the posterior columns. fissure separates the posterior median and the posterior columns of the cord. It is a faintly marked groove, deeper in the cervical than in any other region. The anterior column is a tract of white fibres continuous with the anterior pyramid of the medulla. The lateral col- umn, between the two lateral fissures, is the largest column of the cord. It is a tract of white fibres con- tinuous with the lateral tract of the medulla. The posterior column is a tract of white fibres betAveen the THE SPINAL CORD. 307 posterior median and lateral columns of the cord. It is contimious with the restiform body of the medulla. The posterior median column is a narrow tract of white fibres continuous with the posterior pyramid of the medulla. Fig. 138.— Half Section Through the Lumbar Cord. 1, posterior root ; 2, inner portion of posterior root : 3. posterior commissure ; 4, central canal ; 5, fibres of anterior commissure ; 6, fibres of anterior root. The gray or vesicular substance of the cord is in the interior, invested by the white, fibrous structure. It con- sists of two crescents connected by commissural fibres. The anterior segment of tlie gray crescent is called the 308 PRACTICAL ANATOMY. anterior cornu. Imbedded in it are a number of large motor cells, which are intimately connected with the anterior roots of spinal nerves. The posterior segment of the gray matter, or posterior cornu, contains smaller groups of polar cells, connected with the posterior roots of spinal nerves. In the centre of the gray commissure is the opening of the central canal, impervious in the adult. It is lined by endotlielium and opens just below the calamus scriptorius of the fourth ventricle. In the adult nothing remains of it except a pit called the fora- men caecum, below the calamus scriptorius. The two halves of the cord are also associated by the anterior and posterior white commissures, which pass from side to side in front and behind the gray commissure. The gray matter of the cord is best developed in the cervical, next in the lumbar, and least in the dorsal region. CRANIAL NERVES. Twelve pairs of nerves take their origin from the brain. They are : — ' 1. Olfactoiy (special sense — smell). - 2. Optic (special sense — sight). - 3. Motor oculi (motion). 4. Pathetic (motion). 5. Trifacial (sensation and motion). 6. Abducens (motion), 7. Facial (motion). 8. AudltoiT (special sense — hearing), 9. Glosso-pharyngeal (special sense and sensation). 10. Pneumogastric (motion and sensation). 11. Spiiial accessory (motion and sensation). 12. H3'poglossal (motion). 1. Olfactory Nerve. — Origin, by three roots: (1) middle lobe of brain ; (2) from corpus striatum ; (3) from gyrus fornicatus. These three roots unite, form- ing the olfactory tract, which is about one-eighth inch CRANIAL NERVES. 309 wide, one and a half inches long, and terminates in the olfactory bidb, which rests on the cribriform plate of the ethmoid. Here it sends off from eighteen to twenty filaments, which pass through the foramina of the cribri- form plate, and are distributed to the mucous membrane of the nose. Fig. 139.— The Base of Skull, with the Nerves which Escape FROM ITS Foramina. The cranial nerves are numbered in their customary order. 2. Optic Nerve. — Origin, from the optic chiasm, which is formed by the interlacement of the optic tracts. The chiasm consists of three sets of fibres : one set pass- ing from the optic tract directly to the optic nerve of the same side ; another set passing from the optic tract to the opposite optic nerve ; the third set being commis- sural between the optic nerves and between the optic 310 PRACTICAL ANATOMY. tracts. The optic nerves pass forward through the optic foramina in the lesser wings of the sphenoid, pierce the sclerotic and choroid, and are distrihuted in the retinae. 3. Motor Oculi Nerve. — Origin, from inner side of cms cerebri, just in front of pons. Runs along side of body of sphenoid, passes through the anterior lacer- ated foramen, and is distributed to all the muscles of the orbit, except the external rectus and superior oblique. It furnishes the motor root to the lenticular ganglion, and, through it, animates the sphincter muscle of the iris. 4. Patheticus Nerve. — Origin, from the outer side of the criis. It is a small nerve, and passes through the anterior lacerated foramen to the superior oblique muscle. 5. Trifacial Nerve. — Origin, by two roots from the side of pons. A large sensory and a small motor root, separated by some of the fibres of the pons. It is the largest cranial nerve. The sensory is the larger root, and is distributed to the structures of the upper, lateral, anterior, and deep parts of the head. The two roots pass forward and outward to the' apex of the petrous part of the temporal bone ; here the sensory root enters a large semilunar ganglion, the Gjasserian, while the motor root passes beneath it. The (|p,sserian ganglion rests directly on the surface of the bone beneath the dura mater. It is semilunar in shape, the convexity being anterior. It sends off three branches, — ophthal- mic, superior maxillary, and inferior maxillary. The ophthalmic supplies sensation to the contents of the orbit, to the skin above the orbit and of the nose, and to the mucous membrane of the anterior part of the nasal cavities. It sends off three branches,— lachrymal, frontal, and nasal. The lachrymal is distributed to the struct- ures of the orbit. The frontal divides, near the anterior CRANIAL NERVES. 311 opening of the orbit, into several branches. One, the supra-orbital, passes througli the supra-orbital ibramen, and is distributcxl to the skin of the IVontal region. The other passes downward, and is distributed to the skin of the side of the nose. The nasal passes forward to the anterior ethmoidal foramen, enters the cranium, and passes through a slit-like opening at the side of the crista galli into the nose, and supplies its mucous membrane with sensation. Lenticular GangVion.- — Associated with the ophthal- mic nerve is a small sympathetic ganglion, lens-shaped, and placed at the posterior part of the orbit, between the optic nerve and external rectus. It is imbedded in fat, and is about the size of a hemp-seed. It has three roots, — a sensory from the nasal branch of the ophthal- mic, a motor from the third nerve, and a sympathetic from the cavernous plexus. Tlie branches of the lentic- ular ganglion are the short ciliary, which pass forward and are distributed to tlie eye. The superior maxillary nerve supplies sensation to the structures associated with the upper jaw. It passes forward through the foramen rotundum, across the upper part of the sphcno-maxillary fossa, enters the infra-orbital canal and emerges at tlie infra-orbital foramen. The branches of the superior maxillary consist of three sets, — the spheno-palatine, infra-orbital, and facial. The splieno- l)alaiine hranclies are: 1. The orbital^ w^liich divides into the temporal and malar, the former distributed to the temporal region, the latter to the malar region. Both nerves emerge through foramina in the malar bone. 2- The spheno-palatine are two sensory roots to Meckel's ganglion. 3. Posterior dental^ one or two in number, enter canals which open on the posterior border of the superior maxillary and supply the molar teeth, communi- 312 PRACTICAL ANATOMY. eating- with the anterior dental. Iiifra-orhiial branch : The anterior denial., given oft" near the infra-orbital fora- men, supplies the front teeth and communicates with the posterior dental, forming the dental loop, from which filaments pass oft' to the apical foramina, to be distrib- uted to the pulp of the teeth. The canal which contains the dental loop is in the outer wall of the antrum of Highmore. The facial branches are : 1. Palpebral, to the eyelids. 2. Nasal, to the skin of the nose. 3. Labial, to the upper lip. 4. Septal, to the septum nasi. Meckel's Ganglion. — Meckel's ganglion is located in the spheno-palatine fossa, being pendent from the supe- rior maxillary nerve, from which it receives its sensory root. It is about as large as a lentil. It receives its motor root from the facial, through the Vidian ; its sym- pathetic root from the carotid plexus. It sends off ascending and descending branches. The ascending- consist of a few filaments, distributed to the orbit ; the descending branches supply the nose, roof of the mouth, soft palate, and pharynx. They are numerous and im- portant, and divided into three sets, — anterior, middle, and posterior. The more important branches are: the anterior palatine, which passes through the posterior palatine canal and is distributed to the roof of the mouth ; the middle palatine passes dov^^n the posterior palatine canal, and is distributed to the soft palate and uvula ; the posterior pass down the posterior palatine canal, and are distributed to the soft palate, post-nasal pharynx, and Eustachian tube ; the naso-palatine, or nerve of Cotunius, passes to the septum nasi, grooves the vomer, and runs obliquely downward and forward to the anterior palatine canal ; it suppUes the mucous mem- brane, periosteum, and hard palate, and communicates with the anterior palatine. Other branches pass to the CRANIAL NERVES. 313 parietes and septum nasi. The Vidian nerve is com- monly described as a branch of Meckel's ganglion. It passes horizontally backward through the Vidian canal, and communicates with the large petrosal of the facial ; a filament also communicates with the carotid plexus of the sympathetic. The inferior maxillary supplies sensation to the lower teeth, gums, contents of oral cavity, skin of the lower lip, and lower part of the face. Its motor root is distributed to the muscles of mastication. One of its branches — the gustatory — contributes to the special sense of taste. The inferior maxillary passes forward and downward from the Casserian ganglion to the foramen ovale,% accompa- nied by the motor root, which joins the inferior maxillary division just beneath the greater wing of the sphenoid. Tha, nerve then divides into an anterior and posterior trunk. The anterior trunk receives the motor root, and is distributed to the muscles of mastication, namely, to the masseter, buccinator, temporal, and the pterygoids. The posterior trunk divides into three portions, — the inferior dental, gustatory, and auriculo-temporal nerves. The inferior dental enters the inferior dental canal, supplies the teeth, and, at the mental foramen, sends forward a filament to supply the incisor teeth. The bulk of the nerve emerges at the mental foramen, breaks up into a leash of fibres, which are distributed to the integument of the chin and adjoining surface. Just before this nerve enters the inferior dental foramen it gives off the mylo-hyoid, which is distributed to the mylo-hyoid muscle and submaxillary gland. The auriculo-temporal accompanies the temporal artery. It arises by two roots, between which runs the middle meningeal artery. It gives sensation to the tem- poral region, side of head, and ear. 314 PRACTICAL AXATO-MT. The orustatory is distributed to the mucous membrane of tongue, and is a nerve of special sense and common sensation. It is joined by the chorda tympani, from ^vhich it receives its properties as a nerve of taste. It passes deeply to the floor of the mouth, where it is sub- mucous and is distributed to the mucous membrane of the anterior part of the tongue. The SuhmaxiUarij Ganglion. — The submaxillar}^ ganglion is situated aboAe the submaxillary gland, and is connected with the gustatory, from which it receives its sensory root. Its motor root comes from the facial, through the chorda timpani. Its sympathetic root is derived from the plexus around the facial artery. It is about the size of a hemp-seed, and distributes its branches to the surrounding structures. TJie Otic Ganglion. — A small split-pea-shaped gan- ghon, placed just below the foramen ovale. It receives its sensory and motor roots from the inferior maxillary, its sympathetic root from the carotid plexus. Its branches run to adjoining stnictures ; one animates the tensor tympani muscle; others are distributed to the muscles of the soft palate. 6. Abducexs. — Supphes the external rectus. It arises m the groove between the anterior pyramid and oliAary body, just below the pons. It nms along the side of the body of the sphenoid, leaves the cranium by the anterior lacerated foramen. Ivins; on its lower boundaiy, and is distiibuted to the external rectus. 7. Facial. — Tlie neive of motion to most of the muscles of tlie face. It arises posterior to the olivary body, in the groove between it and the restiform body. It passes forward and outward and enters the internal auditory meatus, in common witli the eicfhth nerve, lying upon it. It enters the aqueduct of Fallopius, i CRANIAL NERVES. 315 through which it runs, and emerges under cover of the parotid gland from the stylo-mastoid Ibramen. It runs through the parotid gland and a])pears at the side of the face as a web-like plexus called the pes anserinus. The facial sends off two sets of communicating branches, — Fig. 140.— Nerves Distribited to thk Face and Head. 1. superficial cervical: 2. platvsma myoides (muscle); 3. stemo-mastoid (muscle) ; 4, spinal accessory ; 3, auricularis maitnus : (5. ■>ccipitalis minor : 7, great occipital : S, poste- rior auricular; 9. facial; 10, iut'ra-maxillary : 11. siipra-niaxiilary ; 12. mental; 13, buccinator (muscle) : 14. buccal: 15, iufra-orbital ; 1(5. malar and infra-orbital nerves: 17, temporal : IS, termination of temporo-malar : l!'. termiaatiou of nasal : 2ll. termination of infra-trochlear : 21, termination of supra-troclilear ; 22, temporal branch of auriculo-tem- poral ; 23, 24, supra-orbital. intra-cranial and extra-cranial. The intra-cranial com- municating- branches are with the auditorv ; with Meek- el's ganglion, by the large petrosal nerve, which passes through the hiatus Fallopii and joins the Vidian ; with the otic ganglion, by the lesser petrosal nerve ; with the 316 PRACTICAL ANATO-MY. sympathetic plexus around the external carotid and middle meningeal arteries. The extra-cranial commu- nicating branches are with, the pneumogastric, giosso* pharyngeal, great auricular, carotid plexus, auriculo- temporal, and the fifth pair. The other branches of the facial are: 1. In the aquaeductus Fallopii, the tym- panic, distributed to the stapedius and laxator tympani. 2. Chorda tympani, given off from the lower part of the aquseductus Fallopii, enters the tympanic cavity through a small foramen at its posterior part. It arches upward between the handle of the malleus and incus, and emerges by a foramen near the anterior inferior angle of the tympanum, enters the canal of Huguier, which is parallel with the Glaserian fissure. It joins the gusta- tory and is distributed to the submaxillary gland and the mucous membrane of the tongue. The facial, as it appears at the side of the face, breaks up into a number of branches distributed to the several muscles, and sends off the digastric, stylo-hyoid, and temporal to these muscles. The posterior auricular, transverse facial, tem- poro-facial, and cervico-facial are distributed to muscles in these regions. 8. Auditory. — Arises below the seventh pair, from the same groove posterior to the olivary body, between it and the restiform body. It passes forward and out- ward with the facial and enters the internal auditory meatus, lying beneath the facial. It passes through the vertical cribriform plate of the internal meatus, divides into two sets of branches, — those distributed to the cochlea and those distributed to the semicircular canals. (See the Internal Ear.) 9. Glosso-pharyngeal. — Arises below the auditory, in the groove between the olivary and restiform bodies. Its deep origin is from the lower part of the floor of the CRANIAL NERVES. 317 fourth ventricle. It passes through the posterior lacer- ated foramen, lies upon the stylo-phar} ngeus and middle constrictor muscles, then runs along the inner surface of the hyogiossus muscle and is distributed to the mucous membrane^ of the tongue, pharynx, tonsils, and mouth. This nerve presents two ganglionic enlargements, — one just above the jugular foramen (the jugular ganglion), the other within the jugular canal (the petrosal gan- glion). The branches of the giosso-pharyngeal are : the communicating, with the pneumogastric and sympathetic ; the tympanic, which is distributed to the promontory of the tympanum ; the muscular, and its terminal branches to the pharynx, palate, tonsils, and tongue. 10. Pneumogastric. — A motor and sensory nerve distributed to pharynx, larynx, heart, lungs, liver, and intestines. It arises by a series of fibres from the groove between the olivary and restiform bodies, below the origin of the g'losso-pharyngeal. Its deep origin is from the floor of the fourth ventricle, close to the origin of the giosso-pharyngeal, and associated with the nucleus of the fifth pair. It passes out of the skull by the posterior lacerated foramen, and presents in this region two gan- glia,— that of the root and that of the trunk, the latter situated just below the jugular foramen. The pneumo- gastric passes down the neck in the sheatli of the carotid artery, between it and the internal jugular vein, but on a plane posterior to them, down to the sixth cervical verte- bra, where its course on the two sides of the neck is different. On the right side the pneumogastric lies on the subclavian artery, aijd runs down along the right side of the trachea to its bifurcation ; it passes behind the right bronclius to the posterior part of the oesopha- gus, passes through the cesophageal opening in the dia- phragm, and is distributed to tlu^ stomacli, forming 318 PRACTICAL ANATOMY. intimate anastomoses with the solar plexus. On the leijt side it enters the chest to the left of the common carotid, lies on the arch of the aorta, passes behind the root of the lung and down the anterior part of the oesophagus, to be distributed to the stomach, duodenum, and liver. The branches of the pneumogastric are divided into three sets, — cervical, thoracic, and abdominal. The cer- vical branches are : 1. The auricular, which enters a fora- men in the jugular notch on the posterior inferior border of the petrous part of the temporal bone, and is distributed to the structures of the tympanum. It escapes by the auricular fissure, and is distributed to the integument of the ear. 2. A pharyngeal branch, which forms a plexus on the pharyngeal muscles. It is the motor nerve to the constrictors. 3. The superior laryngeal is the sensory nerve to the larynx, being distributed to the mucous membrane. 4. The recurrent laryngeal, on the right, winds around the innominate artery from before back- ward, and is distributed to the muscles of the larynx, which it animates. On the left side it lies in front of the arch of the aorta, and winds around its inferior border below the ductus arteriosus. It ascends to the larynx, and is distributed to the muscles of the corre- sponding side. 5. The cardiac branches, four or five in number, are distributed to the ganglia of the heart, lungs, and oesophagus. In the abdomen the pneumo- gastric is distributed to the stomach, omenta, liver, and communicates freely with the sympathetic ganglia. 11. Spinal Accessory. — Consists of two portions, — the upper, arising from the groove between the olivary and restiform bodies ; lower, arising from the antero-lateral fissure of the cord by numerous filaments, and as low down as the third cervical vertebra. It enters the fora- men magnum, arches over to the posterior lacerated SPINAL NERVES. 319 foramen, througli which it passes to tlie upper inner part of the sterno-mastoid muscle, wliich it pierces, and is finally distributed to tlie trapezius. Its branches are communicating with glosso-pharyngeal, pneumogastric, and cervical nerves, and muscular branches to the sterno-mastoid and trapezius. 12. Hypoglossal Nerve. — Is the motor nerve of the tongue. It arises in the groo\e between the anterior pyramid and olivary body, above the plane of the pneu- mogastric. Its fibres of origin are numerous. The nerve passes through the anterior condyloid or hypoglos- sal foramen, descends deeply in the neck, and is distrib- uted to the tongue-muscles. It sends off branches of communication to the pneumogastric, cervical, and sym- pathetic nerves, and a descending branch (the descendens noni), which forms a loop, on the anterior part of the sheath of the cervical vessels, with the communicans nojoi, formed by branches from the second and third cer- vical. From this loop branches pass to the sterno-hyoid, sterno-thyroid, and omo-hyoid muscles. SPINAL NERVES. There are 31 pairs of nerves that arise from the sides of the spinal cord. They are arranged in five regions : — Cervical, 8 pairs. Dorsal, 12 " Lumbar, 5 " Sacral, 5 " Coccygeal, .1 pair. They arise by two roots, — an anterior or motor, from the antero-lateral fissure, and a posterior or sensory or ganglionic, from the postero-lateral fissure. The anterior roots are the smaller. The posterior or larger has a ganglion on it. The two roots unite in or near the 3*20 PRACTICAL ANATOMY. intervertebral foramina and form a mixed nerve, which divides into posterior smaller and anterior larger branches, the latter forming the plexuses from which the nerves are derived that are distributed to the periphery. Cervical Nerves. The first cervical emerges from the spinal canal above the atlas; the last cervical, between the last cervical and first dorsal vertebra. The anterior branches of the upper four cervical nerves unite to form the cervical plexus, which rests upon the levator anguli scapulae and scalenus anticus muscles. It is formed by communi- cating filaments passing from the first to second, second to third, third to fourth nerves, and sends off two sets of branches, — superficial and deep. The superficial branches are divided into the ascending and descending. The ascending branches are : — 1. Superficialis colli, from second and third cervical; winds around the posterior border of sterno-mastoid and is distributed to the side and anterior part of the neck. 2. Auricularis magnus, from second and third cervi- cal ; winds around posterior border of sterno-mastoid and divides into branches to the face, ear, and occiput. It is the largest superficial branch. 3. Occipitalis minor, from second cervical; winds around posterior border of sterno-mastoid and is distrib- uted to the occipital region. The descending branches are the sternal, clavicular, and acromial, to the regions named. The deep branches of the cervical plexus are : — 1. The phrenic — the most important — from the third and fourtli cervical; runs down the neck, lying on the scalenus anticus, then on tlie subclavian artery, descends BRACHIAL PLEXUS. 321 in the middle mediastinum by the side of the p(>ricardium, and is distributed to the diaphragm. 2. Communicans noni, from second and third cervical ; joins the descendens noni on the sheath of the cervical vessels. 3. Communicating-, with cranial nerves. 4. Muscular, to cervical muscles. The posterior division of the cervical nerves commu- nicate but irregularly, and are distributed to the muscles and integument at the back of the -neck. Brachial Plexus. The brachial plexus rests upon the scaj£inis_niedi]is muscle, and is formed by the q,nterior branches of the fifth, sixtli, seventh, and eightli cervicaljierves and first dorsal. In one hundred dissections of this plexus, made during the last twelve years, and which were photo- graphed, I do not find any two photographs alike. The arrangement of the plexus can best be understood by the following formula : 3 nerves + 2 nerves =: 2 trunks + 3 cords,— or, briefly, 3N + 2N zr 2T + 3C. In ex- planation, let it be remembered that five spinal nerves enter into the brachial plexus ; that the fifth, sixth, and seventh unite to form the ujjper trunk ; and tliat the eighth cervical and first dorsal unite to form the lower trunk ; here we get 3N + 2N, which equals the sum of (). Draw a line through the plexus internal to the two trunks formed by tlie five nerves, thus : — y 21 322 PRACTICAL ANATOMY, and the rest of the formula becomes clear, formmg 2 trunks plus 3 cords, or m full (3N + 2N = 2T + 3C), and from the cords the principal branches of the brachial plexus are given off. The figure 5 is the key to the plexus. The branches of the brachial plexus are divided into those given off abo^^ the clavicle and those below. Those above the clavicle are : — 1. Muscular, to muscles of neck. 2. Communicating, a filament from fifth cervical to phrenic. 3. External respiratory, from the fifth and sixth cer- vical ; supplies serratus magnus muscle. 4. Supra-scapular, from fifth and sixth cervical ; runs through the supra-spinous foramen, supplying the pos- terior scapular muscles. Below the clavicle the branches are numerous, and are distributed to the trunk and shoulder and the arm, forearm, and hand. They are : — 1. The a^teri^, thoracic, two or three in number, arise from the upper and lower cords, and are distributed to the chest-muscles. 2. The circumflex, arises from the posterior cord, winds around the neck of the humerus, and is distrib- uted to the shoulder-joint, deltoid, teres minor, and in- tegument. 3. The subscapular, two or three branches from the posterior cord, supply the subscapular muscles. 4. The external cutaneous, from the outer cord of brachial plexus, pierces the coiiaiiDJ^LadiiaLmuscle, passes beneath the biceps, and appears beneath the medio- cephalicj^ein. It supplies the elbow-joint and integu- ment of elbow along outer side of forearm. 5. The median is formed by a branch from the outer and one from the inner cord. These unite and form the BRACHIAL PLEXUS. 323 nerve, which passes down the median line of the arm and forearm, Iwirnth the ant(;rior annnlar ligament ; it is nltimately distributed to the palmar surface of all the digits except the little finger and adjoining side of ring- finger. It sends off numerous branches in the forearm to the muscles and the anterior interosseous, which runs along: the median line of the interosseous membrane and supplies the deep muscles. It terminates beneath the pronator quadratus in a ganglion. 6. The ^uhiar is the continuation of the inner cord, and runs along the inner side of arm, passes l^phind the ijiternnl e])icondvle. along the ulnar side of forearm, and terminaJtas in the skin of the little finger and adjoining side of ring-finger. The ulnar sends off numerous branches to the muscles of the forearm and the integu- ment, along the inner side of forearm and hand. 7. The internal ^jitaneous, a small branch from the inner or lower cord, runs down the inner side of arm, becomes subcutaneous, passes av^er the medio-basilic vein, and is distributed to the integument of inner and posterior part of forearm. 8. The lesser interiial cutaneous, or nerve of Wris- berg, arises from the inner cord above the internal cuta- neous. It is commonly joined by a branch from one of the intercostal nerves, called the intercosto-humeral. It is distributed to the integument along the inner side of elbow and forearm. 9. The muscnlnrspiral js the continuation of the posterior cm-d. and is the largest branch of the plexus. It runs downward and outu^ard, winds around the hu- merus from \yithin_ha£ikii:anl. lying in the musculo-spiral m-oove, and descends bctwcHui the orioinsjif-the-brach-i- nljg^ntifng nnrl t;npiiiqfnv Inn^n;^ mnsplps tO the elboW, where it divides into the iiailiaL and posterior interosse- 324 PRACTICAL ANATOMY. ous. The radial nerve accompanies the radial artery, and is distributed to the muscles of the forearm and thjimb, and to the integument of the dorsal surface of the thumb, index, and middle fingers. The posterior interosseous- pierces the supinator hrevis. and descends deeply along the posterior part of forearm, and termi- nates above the wrist-joint in a ganglionic enlargement. The musculo-spiral nerve sends oif branches to the muscles of the forearm and cutaneous branches to the integument in the region of the elbow along its outer side. Dorsal Nerves. The dorsal nerves are smaller than any other spinal nerves except the last sacral and coccygeal. They con- sist of twelve pairs. The last pair emerge between the las't dorsal and first lumbar vertebra. They arise from the cord on a higher plane than the foramina through which they pass and divide into an anterior and posterior branch. The anterior form the intercostal nerves. They run between the intercostal muscles, send off a number of branches to the wall of the chest, and terminate near the sternum in the cutaneous branches, which supply the skin and superficial structures at the anterior part of chest. The posterior branches are distributed to the muscles of the back and the integument. Lumbar Nerves. The lumbar nerves are five in number. The last lumbar makes its exit between the last lumbar vertebra and sacrum. The roots are very long and large, and unite in the intervertebral foramina. As they emerge they divide into smaller posterior and larger anterior branches. The posterior branches are distributed to the muscles of the back and the integument in this and the gluteal region. The upper four lumbar nerves form the LUMBAR PLEXUS. 325 Lumhar Plexus. A communicating branch passes from the first to the second ; others from the second to the third and from tlie third to the fourth. The branches of the plexus are: — 1. The iho-hypogastric and the iho-inguinal, from the first kimbar nerve. 2. The genito-crural and a branch to the external cutaneous and a large branch to the anterior crural from the second lumbar nerve. 3. The external cutaneous and anterior crural and a branch to the obturator from the third lumbar ner^•e. 4. The obturator, accessory obturator, a branch to anterior crural, and a connecting branch to the fifth lumbar from the fourth lumbar nerve. The plexus is imbedded deeply in the substance of the psoas magnus muscle. 1. The ilio-hypogastric, from first lumbar, runs along the inner surface of tlie posterior wall of the abdominal cavity, pierces the transversalis, and is distributed to the integument of the gluteal and liypogastric regions. 2. The ilio-inguinal, from the first lumbar below the ilio-hypogastric, follows the inguinal canal and is dis- tributed to the integument of pubes, scrotum, and groin. 3. The genito-crural runs along the anterior surface of the psoas magnus. It arises from the second lumbar. It is distributed to the cremaster muscle in the male, and the round ligament in the female. Another branch sup- plies the skin along the inner part of the thigh. 4. The external cutaneous, from the third lumbar, receives a branch from tlie second lumbar. It runs along the crest of the ilium and appears just below the attachment of Poupart's ligament to the spine of the ilium. It is distributed to the skin along the outer and anterior part of the thigh. 326 PRACTICAL ANATOMY. 5. The anterior crural is the longest branch of the lumbar plexus. It arises from the third lumbar and receives branches from the second and fourth lumbar. It descends in the substance of the psoas near the outer border and emerges a short distance above Poupart's ligament, passes beneath Poupart's ligament external to the femoral artery, and is distributed to the muscles and integument of the anterior part of the thigh. The anterior crural sends off superficial and deep branches. The superficial are the middle cutaneous, distributed to the skin along the anterior part of thigh, and the internal cutaneous, distributed to the skin along the inner part of the thigh. The deep branches are the long saphenous, which accompanies the femoral artery as far as Hunter's canal and is distributed to the integument of the inner part of the knee-joint and inner side of leg. It accom- panies the long saphenous vein as far down as the foot. The other deep branches are the muscular and articular, the latter being distributed to the knee-joint. 6. The obturator from the fourth lumbar receives a branch from the third. It runs along the inner border of the psoas, passes through the obturator foramen, and is distributed to the integument along the inner part of the thigh near the knee-joint. It sends off a small branch to the hip-joint. 7. The accessory obturator arises by two filaments from the fourth lumbar. These frequently unite and the nerve is distributed to the skin of the pubes. It is sometimes wanting. 8. The fifth lumbar nerve is called the lumbo-sacral cord. It receives a filament of communication from the fourth lumbar, and curves down into the pelvis to join the sacral plexus. It is the largest communicating nerve in the entire spinal series. SACRAL PLEXUS. 327 Sacral Nerves. The sacral nerves are five in number. Tlie upper four emerge from the anterior and posterior sacral foramina. The fifth sacral, which is very small, makes its exit between the sacrum and coccyx. The sacral nerves are derived from the cauda equina and have the longest roots. Their upper three are large ; the fourth is small. Their anterior divisions unite with the lumbo-sacral cord to form the sacral plexus. Sacral Plexus. This plexus is simple in construction, being formed by the union of the lumbo-sacral cord, first sacral, second sacral, and third sacral, with some filaments from the fourth sacral nerve, in a large, broad, flat band of nerve- fibres one inch wide, which sends off the following branches: — The giyat sciatic is the largest nerve in .the body. It is practically the continuation of the sacral plexus and emerges from the pelvis by the greater sacro-sciatic foramen below the pyriform muscle. It passes down the posterior median part of the thigh and leg into the foot, and is distributed to the muscles of the ])osterior part of the thigh and of the leg and foot, and also sup- plies the skin of nearly the entire lower extremity with sensation. Its branches are articular to the hip-joint, muscular, and it divides above the popliteal space into internal popliteal the larger and external pgpliteal the smaller branch. The internal popliteal descends through the middle of the popliteal space to the leg, where it lies upon the deep muscles. It sends off cutaneous and muscular branches and the external saphenous, which is distributed to the integument at the back of the calf of the leg. It 328 PRACTICAL ANATOMY. receives a communicating branch, called the communi- cans peronei, from the external popliteal. The posterior tibial, the continuation of the internal popliteal, descends upon the deep muscles of the leg to the inner malleolus, where it divides into the internal and external plantar. It sends branches to the muscles of the leg. The inter- nal plantar is between the first and second layers of the muscles of the foot, and is distributed to the four inner Fig. 141.— Digital Nerve.s and their Trunk Connections. A, internal plantar: B, external plantar; C, deep branch of external plantar; D, first digital ; E, second digit."il ; F, third digital ; G, fourth digital ; H, fifth digital ; I, external digital; 1, branches to first tue : 2, branches to second toe ; 3, bi-anches to third toe; 4, branches to fourth toe ; 5, branches to fifth toe. toes. The external plantar, the smaller, is distributed to the little toe and adjoining side of the fourth toe. The external popliteal runs along the outer part of the popliteal space behind the tendon of the biceps, winds around below the head of the fibula, and descends along the anterior surface of the interosseous membrane as the anterior tibial. It sends off a cutaneous branch to com- municate with the short saphenous, called the communi- cans poplitei, or peroneal. The anterior tibial sends off SACRAL PLEXUS. 329 muscular, cutaneous, and articular branches, the latter to the ankle-joint, and is distributed to the dorsal suriacc of the loot and toes. It sends off nlso the musculo- cutaneous, which arises near the upper third of the leg, pierces the peronei muscles, and is distributed to the muscles along the outer side of the leg- and the integu- ment as far down as the dorsum of the foot. The small sciatic passes through the greater sacro- sciatic foramen witli the great sciatic nerve, and supplies the gluteus maximus and the integument of the perineum and inner part of thigh. It becomes cutaneous, and is dis- tributed to the lower part of thigh and upper part of leg. The pudic nerve passes througli the greater sacro- sciatic foramen to the inner side of small sciatic. It winds around the outer part of the spine of the ischium, enters the lesser sacro-sciatic foramen, and runs forward and upward along the inner surface of the inferior border of the rami of the ischium and pubes. It sends off the in- ferior haemorrhoidal, which crosses the ischio-rectal fossa and is distributed to the lower part of the rectum. The perineal is distributed to the structures of the perineum. It divides into several branches, which supply the muscles and integument. The dorsal nerve of the penis passes forward with the vessels, and is finally distributed to the glans, prepuce, and skin of the penis. " In the female this nerve is distributed to the glans clitoridis and asso- ciate parts. The superior gluteal leaves the pelvis above pyriform muscle, and divides into several branches, which supply the glutseus minimus, medius, and tensor vaginae femoris. The muscular branches are distributed to the pelvic muscles, the gemelli, and quadratus femoris. The articular are small branches to the ilio-sacral articulations. 330 PRACTICAL ANATOMY. THE SYMPATHETIC. The sympathetic serves to connect and bind the several parts of the body sympathetically together. It consists of a number of ganglia placed at each side of the spinal column, and connected together by communi- cating fibres. Each ganglion consists of an investing fibrous membrane, and from this are given ofi" delicate fibrous septa, forming a neuroglia for the support of the nerve cells and fibres. In each ganglion there are groups of multipolar cells, naked axis-cylinders, the fibres of Remak, and ordinary nerve-fibres. The ganglia are connected together chain-like by interganglionic nerve-fibres, and receive a number of branches from the cerebro-spinal system. The branches of distribution are frequently arranged in the form of plexuses on the blood-vessels, and to the viscera. Excluding the sympa- thetic ganglia associated with the fifth pair of nerves and previously considered, there are three pairs of ganglia in the cervical, twelve pairs in the dorsal, four pairs in the lumbar, four or five pairs in the sacral, and one terminal ganglion placed at the side of the third coccygeal ver- tebra. The superior cervical ganglion lies on the ante- rior surface of the rectus capitis anticus major, and behind the deep cervical vessels. It sends branches in every direction, and forms the carotid and cavernous plexuses. Just above the anterior communicating artery, the sympathetic chains communicate, forming the gan- glion of Ribes. The superior cervical ganglion sends off the superior cardiac nerve to the cardiac plexus. The second or middle cervical ganglion, placed to the side of the fifth cervical vertebra, rests upon the anterior surface of the scalenus medius muscle. Its most important branch is the middle cardiac, the largest THE SYMPATHETIC. 331 c c c ^ _. (J) _• p- >« ■B ^ c -o m (- 0» o> :^ t-* :3* u> fO i< X c Ed 3.3 ;=d;=d;:3d^CH5^<\ » ^0. CA c/> <^ c >j '^i.S -rs TT y -5 T \S^ CK s> i:^ n /o o T 3 < 3 /a ra V> /5, 7:4 ViscerA FiQ. 142.— Diagram of the Spinal, Sympathetic Nervous System and Connections. 332 PRACTICAL ANATOMY. of t-he cardiac. It is distributed to the deep cardiac plexus. The third or inferior cervical ganglion is placed at the side of the seventh cervical vertebra, and rests on the neck of the first rib. Its most important branch is the inferior cardiac, and is distributed to the deep cardiac plexus. The sympathetic ganglia of the thorax consist of a chain of ganglia placed on either side of the spinal column, resting on the heads of the ribs and covered by the pleura. Their branches are distributed in every direction. The most important are the greater splanchnic, lesser splanchnic, and renal splanchnic. The greater splanchnic arises by filaments from the lower six dorsal ganglia. It is a nerve of considerable size, white in color, descends, and pierces the crus of the diaphragm, and terminates in the solar plexus. The lesser splanchnic arises from the ninth and tenth gan- glia, accompanies the greater splanchnic, and enters the solar plexus. The renal splanchnic, often wanting, arises from the lower two dorsal. ganglia, and terminates in the renal plexus. The solar plexus is a great sympathetic ganglion, which surrounds the cceliac axis. It is formed by two semilunar ganglia and connecting fibres, and these receive the splanchnics and termination of the pneumo- gastrics. The solar plexus sends branches in all directions and forms retiform plexuses around all of the branches of the abdominal aorta. It is through the blood-vessels that the sympathetic reaches the viscera. The lumbar part of the sympathetic presents four ganglia placed at the side of the spine, internal and pos- terior to the psoas. Its branches are freely distributed to the vessels and viscera. The sacral ganglia, four or five in number, are placed along the inner line of the THE SYMPATHETIC. 333 anterior sacral foramina, and converge as they meet to join in the terminal ganglion, or ganglion Impar. They send numerous branches to the pelvic vessels and viscera, and form secondary plexuses such as the superior hypo- gastric, placed between the iliac arteries anterior to the sacrum. The inferior hypogastric plexus is imbedded in the substance of the perineum, and sends branches to the rectum, prostate, bladder, and corpora cavernosa in the male, or the clitoris, vagina, and uterus in the female. In the heart, uterus, kidney, intestines, and other organs there are numerous sympathetic ganglia distrib- uted through the substance of the viscera. About the heart there are three Avell-defined plexuses which com- municate with the cervical sympathetic ganglia through the cardiac nerves. They are also intimately connected with the pneumogastrics and spinal nerves. THORACIC VISCERA. THE THORAX. The thorax is the osseo-cartilaginous case which con- tains the heart and lungs. In shape it is the frustum of a cone compressed antero-posteriorly, and it is due to this antero-posterior flattening that man in conditions of extreme relaxation gravitates upon the back. In the lower animals, as a rule, the chest is flattened from side to side, and under similar conditions, or at death, they rest upon the side. It is supported posteriorly by the spine, formed ante- riorly by the sternum, and front and back and at the sides by the ribs. The construction of the thorax is such as to enable the ribs to rotate on their axes and enlarge the transverse diameters of the chest. The upper open- ing of the thorax is formed by the first ribs, sternum, and first dorsal vertebra. It is nearly circular in form, and transmits the trachea, oesophagus, great vessels and nerve.s, and some muscles. The lower opening is very large and irregular. It is formed by the last dorsal vertebra, the twelfth ribs, the apices of the eleventh ribs, the costal cartilages of the sixth, seventh, eighth, ninth, and tenth ribs, and the ensiform cartilage. Stretched across it is the diaphragm, which separates the thoracic from the abdominal cavities. The antero-posterior diameter of the chest is two-thirds the transverse. It is deeper posteriorly than anteriorly, the ensiform cartilage being on a level with the ninth dorsal vertebra ; the upper border of the sternum is on a (334) THE HEART. 335 level with the second dorsal vertebra. In tlie intervals between the ribs are the intercostal muscles. Posteriorly the thoracic cavity is concave along the spine, and along either side of it are the broad, concave, posterior walls formed by the ribs. The sternum is directed obliquely downward and forward. THE HEART. The heart lies near the centre of the chest and is in- vested by a strong, loose, fibro-serous sac, the pericardium. Fig. 143.— Diagram of the Heart. a, left ventricle ; b. riglit ventricle ; c, left .auricle ; d. right auricle ; f, aort;a ; g, g, pul- monary arteries; h, inferior vena cava; i, superior vena cava; k. orifice of the superior ven.a cava ; 1. orifice of inferior vena cava: m, orifice of coronary vein : o. left pulmonary veins; p, right pulmonary veins; r, orifices of right pulmonary veins; s, orifice of left pulmonary veins. That portion of the chest-cavity posterior to the pericar- dium is called the posterior mediastinum, that portion in front the anterior mediastinum ; the heart lies in the middle mediastinum. The pericardium is a loose, fibro-serous sac, which contains the heart and origin of the great vessels, to 336 PRACTICAL ANATOMY. which it is closely adherent. The serous lining of the pericardium consists of two layers, — the visceral and parietal. The visceral layer closely invests the heart and roots of the great vessels, and is reflected on the inner surface of the fibrous layer of the pericardium. Both parietal and visceral surfaces are smooth and ghstening. A small amount of fluid is found within the sac. The heart is contained witliin the pericardial sac. It is a hollow, muscular organ, conical in form, and situated in the middle mediasti- num between the two lungs.. It is placed obliquely, the base is above, the apex below, and it extends from the right third costo-sternal articulation to the fifth intercostal space on the left side, about one and one-half inches to the left of the sternum. It is held in position by the great vessels which spring from its base, and is entirely free to move throughout the rest of its extent. It is about five inches long, three inches transversely, and two and one-half inches antero-posteriorly ; roughly speaking, it is about the size of the fist. It weighs from eight to ten ounces in the female and from nine to eleven ounces in the male. It consists of two ven- tricles and two auricles ; the auricles, right and left, are two cuboidal sinuses, wliich recei\'e the blood ; below these are placed the ventricles, which force the blood into the pulmonary artery and aorta. A vertical sep- Fig. 144.— Right Side of Heart. Right AUKICLE AND RIGHT VeNTKICLE LAID Open. a, apex ; b, right Tentricle ; d, pulmonary artery : e, f, chordae tendinse ; p, aorta; 3, superior vena cava; 5, inferior vena cava. THE HEART. 337 turn divides the heart into a right, or venous, and a left, or arterial side. The right auricle is a cuboidal blood-sinus, into which empty the descending and ascend- ing venae cavae. It presents a principal shius and an appendix. Its walls are about as thick as stout wrap- ping-paper, and present on their inner surface five open- ings, two valves, and some relics of foetal structure. The openings are : — Superior Vena Cava. — The large venous trunk which drains the upper half of the body. It opens into the upper anterior part of the auricle, the axis of Fig. 145.— Arrangement of Muscular Fibres around the Auricles AND Great Vein.s. I. mnscnlar fibres on the left auricle; v.p., fibres on the pnlmonary veins ; V, the left ventricle. II. muscular fibres on the superior vena cava ; a, opening of vena azygos ; V, auricle. its current being anterior to that of the ascending vena cava and directed to the tricuspid opening. ^^ round the openings of the vena cava the circular fibres of the auricles are reduplicated, but there are no valves. Inferior Vena Cava. — Returns the blood of the lower half of the body. The axis of its current Hes behind that of the superior vena cava and is directed against the septum auricularum. The opening of the coronary sinus is to the right of tlie tricuspid opening. It drains the blood from the 22 338 PRACTICAL ANATOMY. heart, and is protected by the coronary valve, — a semi- lunar fold of the endocardium. It opens into the auricle. The sinus will admit the end of the little finger, is about one and one-half inches long, and is formed by the right and left coronary and oblique veins of the heart. The foramina thehesii are numerous minute openings of the small veins of the auricles. The right auriGido-ventricular or tricuspid opening is the opening from the auricle into the ventricle ; it will admit the ends of three fingers, and measures accu- rately four and five-sixths inches ; it is the largest open- ing at the base of the heart, and is strengthened by a strong ring of white fibrous tissue, which afi'ords attach- ment to the tricuspid valves and gives origin to the muscular layers of the heart. The E'listacJiian valve is a semilunar fold of the endocardium, extending between the anterior margin of the ascending vena cava and the tricuspid opening. In the foetus it helps to direct the column of blood to- ward the foramen ovale. On the septum between the auricles is an oval depression, the fossa ovalis, which corresponds to the position of the foramen ovale in the foetus ; it is sur- rounded by an elevated margin, the annulis ovalis. The auricular appendix is an ear-like extension of the right auricle. It passes to the left and lies upon the root of the pulmonary artery. It presents a number of cylindrical interlacing bundles of muscular fibres, form- ing the musGidi pectinati. The Right Ventricle. The right ventricle is placed immediately below the right auricle. It is conoidal in form ; its walls are about three-sixteenths of an inch thick. It presents two open- THE RIGHT VENTRICLE. 339 ings, the tricuspid and pulmonary ; two valves, the tricuspid and semilunar ; the columnae carneae and chordae tendineae. The tricuspid opening has been described. The pulmonary opening is the constricted orifice at the summit of the right conus arteriosus. It will admit the thumb, and measures accurately three and one-half inches in circumference. The tricuspid valves consist of three leaflets, — the inner, between the pulmonary orifice and tricuspid open- ing ; the anterior, and posterior. Their edges are joined together at their attachment to the tricuspid fibrous ring. They are formed by a reduplication of the endocardium and re-inforced by bundles of fibrous tissue. Each leaflet is triangular in form and is attached by its free end to the chordte tendineae, which are inserted at three difler- ent places on the valve, — first, on the central thickened part of the valve ; second, on the free margin of the valve ; third, on the valve at its insertion into the tri- cuspid fibrous ring. The semilunar valves are three semilunar folds or festoons of the endocardium, placed at the beginning of the pulmonary artery ; they open into the vessel, have thickened edges, and present at their middle a fibro- cartilaginous nodule, the corpus Arantii, which serves to close the valve perfectly, thus preventing regurgitation. The coJumnce carnem are bundles of muscular fibres disposed in three difterent ways. Some are mere ridges on the inner surface of the ventricle, others are attached by their two extremities, and the third set are attached by one extremity to the ventricle ; the other is con- tinued as a tendinous cord (the chordae tendineae) to the valve. The left auricle h smaller than the right; its walls 340 PRACTICAL ANATOMY. are thicker ; it is a cuboidal sinus, with an auricular extension to the right and across the root of the pulmo- nary artery ; it presents the openings of the pulmonary veins and the mitral opening. The four openings of the pulmonary veins are at the upper posterior part of the auricle ; they have no valves, but the circular fibres of the auricle are disposed around them as a thickened layer, and prevent, in a measure, the reflux of blood. The left auriculo-ventricular or mitral opening will admit two fingers ; accurately, it measures three and eleven- twelfths inches. It is strengthened by a fibrous ring, which surrounds it and affords attachment to the mitral valve and the layers of the muscular fibres of the left ventricle. In the interior of the appendix auriculae are the musculi pectinati, arranged as on the right side ; on the septum auricularum is the reverse of the annulus and fossa ovalis. The Left Ventricle. The left ventricle, longer, but less capacious, than the right, forms the posterior part and apex of the heart. Its walls are from one-third to one-half inch thick, and thickest about the middle of the ventricle. It presents for examination the Auriculo-ventricular or mitral opening, which is to the left of the aortic opening. It will admit two fingers, and measures accurately three and eleven-twenty-fourths inches. It is strengthened by a strong ring of fibrous tissue, to which are attached the mitral valves and the muscular layers of the heart. The aortic opening, at the summit of the left conus arteriosus, will admit the index finger, and measures accu- rately three and one-sixth inches. It is surrounded by a strong ring of fibrous tissue, which afi'ords attachment THE LEFT VENTRICLE. 341 to the semilunar valves, aorta, and muscular structures of the heart. The semilunar valves, three in number, are formed by the reduplication of the endocardium, and consist of three festoons with a central tibro-cartilaginous nodule — the corpus Arantii — on each. They are much stronger than on the right side. The mitral valves guard the auriculo-ventricular orifice. They are triangular leaflets of the endocardium attached to the fibrous ring around the mitral orifice ; thev are united by their edges for a short distance, and 8 '-J Fig. 146.— Base of the Heart, Both AuRiciiES Removed. rV, riglit auricle ; IV, left auricle : rK, right ventricle ; IK, left ventricle ; 1, coronary furrow ; 2, right, 3, left auriculo-ventricular ; 4, origin of the aorta ; 5, aortic semilunar valves ; 6, origin of the pulmonary artery ; 7, its semilunar valves ; 8, auricular septum. are held in place by the chordae tendinese. One leaflet is placed between the mitral and aortic orifices ; the other, to the left of the mitral opening. The chordis tendinese are attached as on the right side. The columnije cavnece are stronger and larger than on the right side, but are disposed in a similar manner. The conns arteriosus of each ventricle is the funnel- shaped approach to the pulmonary and aortic openings. These openings are the most constricted part of the conus arteriosus of either ventricle. They are smooth throughout and lined by tightly adherent endocardium. 342 PRACTICAL ANATOMY. The endocardium is the serous hning of the lieart and is continuous with the inner coat of the great vessels. It is considerably modified where it enters into the forma- tion of the valves, being in these situations re-inforced by bundles of fibrous tissue and some muscular fibres. It lines the interior of the ventricle, columnse carnese, and chordae tendineae. The structure of the heart consists of planes of mus- FiG. 147.— Course op the Muscular Fibres op the Heart. A, on the anterior surface ; B, view of the apex with the vortex ; C, course of the fibres ■within the ventricular wall ; D, fibres passing into a papillary muscle. cular fibres arranged so as to effectually empty the cavities of the heart and exert sufficient force to drive the blood through all parts of the vascular system. These planes of muscular fibres arise from the fibrous rings at the base surrounding the auriculo-ventricular, pulmonary, and aortic orifices. They are divisible into three principal layers : the oblique, transverse, and spiral. The transverse layer is thick and strong and encircles the THE LARYNX. 343 two ventricles ; in like manner the two auricles arc sur- rounded by a transverse plane of muscular fibres. Ulti- mately the fibres are lost upon the cardiac septa and in the columnae carneae, thence to be inserted by the chordae tendinese upon the valves. Tlie muscular fibre of the heart is not invested by sarcolemma and consists of striated, branched, and nucleated fibres. THE LARYNX. The larynx is placed in the median line on the upper part of the trachea. It is a pyra- midal box composed of cartilages, fibrous tissue, and muscles. The cartilag-es are nine in number: three single, — thyroid, cricoid, and emglottis; and three pairs, — ar^en,oid, cuneiform, and cor- nicula laryngis. The tliyroid consists of two quadrilateral plates of cartilage imited in front at an acute angle. Each plate is smooth and the posterior border terminates in the superior and inferior cornua. The angle of junction forms a projection at the anterior part of the neck called the pomum Adami, or Adam's apple. The cricoid is a ring of cartilage shaped like a seal- ring, the narrow^ part in front. Posteriorly it presents two superior facets for the arytenoid cartilages, and laterally a flicet for articulation with the thyroid. The epiglottis is a leaflet of yellows-fibre cartilage which is attached to the receding angle between the two plates of the tliyroid. Its normal position is ^•ertical, but Fig. 148.— Vertical, Section OF Larynx. 1. body of hyoid bone ; 2, epiglot- tis ; 3, thyro-hyoid membrane ; 4, gresit cornu of hyoid ; 5. false vocal cord : 6, thyro-hyoid ligament; 7, ventricle of larynx ; 8, thyro-hyoid membrane ; 9, true vocal cord ; lU. aryteno-epiglot- tidean fold ; U, thyroid cartilage ; 12, superior cornu of thyroid ; 14, aryte- noides muscle ; 16. arytenoid cartilage ; 18, coracoid cartilage. 344 PRACTICAL ANATOMY. on elevation of the larynx, as in swallowing, it is de- pressed and serves to cover the glottis. The arytenoid cartilages are trilateral pyramids which rotate on their bases. They are placed upon the upper posterior part of the cricoid. Upon the apex of each cartilage is placed a small nodule of fibro-car- tilagCj the cornicula laryngis. The cuneiform are two plates of cartilage placed in the aryteno-epiglottidian folds. The ligaments of the larynx are intrinsic and ex- trinsic ; the extrinsic are the two thyro-hyoid ligaments which connect the superior cornua of the thyroid carti- lage with the greater cornua of the hyoid bone and the thyro-hyoid membrane, which is stretched between the upper border of the thyroid cartilage and the inferior border of the hyoid bone. The intrinsic ligaments are : The crico-thyroid membrane, passes between the inferior border of the thyroid cartilage and superior border of the cricoid, and is composed of yellow elastic tissue ; two capsular ligaments, for the crico-thyroid articulations : two capsular crico-arytenoid ligaments. These liga- ments are much thicker posteriorly. The two epiglottic ligaments from the posterior part of the body of the hyoid to the anterior surface of the epiglottis are a plane of elastic fibres. The thyro-epiglottic ligament is a long, narrow band of elastic fibres, which runs from the upper part of the epiglottis to the inner surface of the thyroid cartilage near the median line. The giosso-epiglottic folds, formed by the reduplication of the mucous mem- brane, are the two lateral and the median. The muscles of the larynx consist of eight pairs. They are those which control the vocal cords and those of the epiglottis. The muscles of the vocal cords are : — THE LARYNX. 345 Crico-ihyroid. — From side of cricoid ; passes back- ward, and is inserted into the side of thyroid. Posterior Crko-arytenoid. — From posterior broad surface of cricoid into angle of arytenoid. cricoid angle of Lateral Crico-arytenoid. — From side of beneath the cover of the thyroid into outer arvtenoid. Arytenoid. — Three sets of fibres, right and left oblique and transverse between the arytenoids. Thyro-arytenoid. — From anterior angle of arytenoid to receding angle of thyroid. Those of the epiglottis are : — Tliyro-epigJottic. — Inner . ^ . v ■ ^^^ -. ^ _ surface of thyroid to epiglottis. Superior A ry teno-ep i glot- tic.— Fibres pass from aryte- noid to epiglottis in aryteno- epiglottic folds. Inferior Aryteno-epig Jot- tic. — From arytenoid to side of larynx, over the sacculus lanngis. Within the larynx are also several folds arranged in pairs. The aryteno-epiglottic inclose the fibres of the aryteno-epiglottic muscles. These folds form the sides of the inlet to the larynx, which is broad in front, where it is completed by the epiglottis ; narrow behind, where it is formed by the apices of the arytenoid cartilages. Im- mediately below this fold is the cavity of the laryx, which is limited below by the inferior border of the cricoid cartilage. It is traversed on each side, from front to back, by the superior or false and the inferior or true vocal cords. The false vocal cords are formed by the thyro-arytenoid muscles, which are covered by the Fig. 149.— The Human Glottis. 1, tongue ; e, epiglottis : pe, pharyngo-epi- glottic fold ; ae, aryteno-epiglottic fold ; ph, pos- terior wall of pharynx ; c, cartilage : ts, superior thyro-arytenoid fold : ti. inferior fold ; o, glottis. 346 PRACTICAL ANATOMY. mucous membvaue lining the larynx. Below the false are the true vocal cords, formed of yellow elastic tissue and invested by mucous membrane. They are attached closely together in the receding angle of the thyroid car- tilage ; they pass horizontally backward and are inserted on the anterior angles of the arytenoids ; each vocal cord is about one-sixth of an inch wide and about five-eighths of an inch long, but susceptible, by virtue of its elas- ticity, of considerable elongation. Between the false and true vocal cords is the ventricle of the larynx, a depression w^hich communicates with the sacculus laryn- gis, a large mucous crypt ; upon its surface the fibres of the inferior thyro-epiglottic muscles are distributed. The mucous membrane of the larynx continues with that of the trachea, mouth, and pharynx, is reflected over all the structures in the larynx. On the true vocal cords it is very thin and tightly adherent ; above the false cords it is covered principally by squamous epethelium ; below, it is of the ciliated variety. THE TRACHEA. The trachea, or wind-pipe, is a membrano-cartilagi- nous, cylindrical tube about five inches long, and ex- tends from the fifth cervical to the third dorsal vertebra. It is about three-fourths of an inch in diameter, and terminates below in the right and left bronchi. The right is short, wide, and nearly horizontal in direction ; the left is long, narrow, and oblique. If a section be made just above the bifurcation of the trachea, a septum is observed to extend upward between the two bronchi; it inclines to the left ; in fact, it looks as if the right bronchus were continued or thrust into the trachea. This arrangement explains the tendency of foreign bodies to lodge in the right bronchus. The trachea consists of THE LUNGS. 347 sixteen to twenty incomplete cartilaginous rings connected by fibrous tissue and muscular fibres ; the deficiency of the rings is posterior. In the interval between their ends extends the trachcalis muscle, a band of involuntary mus- cular fibres disposed longitudinally. The mucous mem- brane is of the ciliated variety. THE PLEURA. The pleurae are two flattened serous sacs interposed between the lungs and the walls of the chest. Each lung is entirely invested except at the hilum ; the pleurae are then reflected over the pericardium, inner surface of the chest, and thoracic surface of the diaphragm ; a fold of pleura extending from the root of the lung to the diaphragm is called the broad ligament of the lung. The parietal layer extends upward about one and a half inches above the first rib; it is impressed by the subclavian artery, which rests upon it. THE LUNGS. The lungs are a double organ, right and left, sepa- rated by the structures in the middle mediastinum ; they consist of five lobes, — these of myriads of lobules, and each lobule of clusters of air-cells. Each lung is conoidal in form, and presents an apex, a base, an anterior and posterior border, an inner and outer surface. The apex projects above the level of the first rib ; the base is broad, concave, and rests on the upper surface of the diaphragm ; the anterior border is thin, sharp, and meets the anterior border of the other lung, except at the lower third, where that of the left lung recedes, exposing the pericardium to the extent of the area of a silver dollar ; the posterior border is bluntly rounded and broad, and longer than the ante- rior ; the anterior surface is convex and smooth, and is 348 PRACTICAL ANATOMY. applied to the wall of the chest; the inner surface is flattened, slightly concave, for the accommodation of the heart, and posteriorly presents the hilum, for the entrance of the bronchi, vessels, and nerves. The right lung presents three lobes ; the left lung two. The lobes are formed by deep fissures, commencing at the anterior border and extending deeply upward and inward. The left lung is the longer; the right the broader and heavier. The two lungs weigh forty-two Fig. 150.— Heart and Lungs. 1, right ventricle ; 3, right auricle : 5, pulmonary artery ; 9, aorta ; 10, supe ior cava ; 20, root of lung ; 21, 22, 23, upper, middle, and lower lobes of right lung ; 24, 25, upper and lower lobes of left lung. ounces, have an average specific gravity of about 0.5, and hence float in water ; but, if consolidated by in- flammatory eflusions, or if collapsed, or prior to the re- spiratory act, they will sink in water. At birth, the lungs are of a rose-pink in color ; but, as age advances, they become darker, often mottled and bluish. On the sur- face of the lungs are seen polygonal spaces, about the size of a split pea, which correspond to the lobules. The structure of the lungs can best be understood by THE LUNGS. 349 a consideration of the air-sacs of a frog. These consist of membranous sacs, which are filled by the act of deglu- tition. They present upon their inner surfaces numerous reticulations, forming pits, which are the air-cells proper. The capillary vessels are freely distributed to the minute partitions between the pits, and the blood is exposed to the action of the air. In the human subject we have a similar arrangement, but very much dwarfed in size, — an arrangement of a microscopic sac, presenting numerous reticulations, forming pits or air-cells, the entire sac of cells being called a cluster. Ten to forty clusters make a lobule, which is surrounded by areolar tissue, containing much yellow elastic and some in- voluntary muscular fibres, which also form the nidus for the ramification of arterioles, venules, nerves, and the lym- phatics. To further elucidate the structure of the lungs, it is necessary to follow the course of a bronchus, which, upon entering the hilum, divides and subdivides repeatedly, until it has attained the diameter of one-fiftieth of an inch, when it loses its encircling rings, which are replaced by delicate cartilaginous plates ; these then become entirely membranous, and terminate in the air-sacs, these air-sacs being simple dilatations, very similar to the large air-sacs of the frog ; they present along their walls a reticulated arrangement of the lining mucous membrane ; these reticulations form numerous pit-like, polyhedral air-cells, separated by very delicate septa, in which the capil- laries ramify; they all open into the common air-sac, and Fig. 151.— Two Clusters of Air- Cells. 350 PRACTICAL ANATOMY. the space between them is designated the intercellular passage. The air-cells are about one-two-hundredth inch in depth. The pulmonary capillaries form a close net-work, the meshes of which are less than the diameter of the vessels. Their walls are extremely delicate, con- sisting of a single layer of endothelial cells, supported on a skeletal basement membrane. In the septa, the capillaries are often disposed in a single layer, exposing them to the action of the air on both sides of the septum. The pulmonary artery does not nourish the lung, which depends for its nutrition on the blood which flows in the bronchial arteries. THE ORGANS OF DIGESTION. The alimentary canal and its appendages comprise the organs of digestion. It begins at the mouth and terminates at the anus, and consists of a tube about twenty-eight feet long, which undergoes many changes in name and position, arrangement and form. The mouth is the commencement of the alimentary canal; it is an ovoidal cavity, containing the tongue, teeth, and openings of the ducts of the salivary glands. It is bounded above by the hard palate, laterally by the cheeks, anteriorly by the lips, below by the mylo-hyoid muscles; posteriorly it opens into the pharynx. The lining mucous membrane is of the squamous variety and rich in mucous glands. O^^osite^the^^seco]^^^ molar is a papilla, which presents the opening of the parotid duct ; on the floor of the mouth, at each side of the fraenum linguae, is the opening of Wharton's duct, the duct of the submaxillary gland. The ducts of the sublingual gland, eight to fifteen in number, open on the floor of the mouth. The gums are fibrous structures, closely attached to the periosteum, and covered by the lining mucous membrane, which is intimately adherent. THE TEETH. 351 THE TEETH.* Human teeth are o:5seous in character and are ivory- hke bodies, placed in the jaws for the purposes of masti- cation, articulation, and contour. Normally fifty-two teeth make their appearance during life ; these are divided into two sets, for child and adult life. The first, known as the primary, temporary, deciduous, or milk set of teeth, consists of twenty — ten for either jaw. The second, or permanent, consists of thirty-two, of which the first tooth making its appearance is the first or six- FiG. 152.— Temporary Teeth. year-old molar, so named because it erupts about the sixth year. The temporary teeth are classified on each side, from the median line backward, into two incisors (one central and one lateral incisor), one cuspid or canine, and two molars, the first and second, in each jaw. In the permanent set the incisors and cuspids corre- spond in number and position to those of the temporary, but tlie molars are replaced by the first and second bicuspids or premolars, and posterior to these we find the first, second, and third molars ; the third molar is often termed the "dens sapientiae," or "wisdom tooth." *The section on the teeth has been prepared by T. S. Heinekeu, D.D.S., of New Jersey, and E. E. Caspersonii, D.D.S., of Australia. 352 PRACTICAL ANATOMY. A tooth is said to consist of a crown, neck, and root or roots. The crown is all that portion found normally above the gum ; the neck the narrow, constricted por- tion between the crown and root at the edge of the gum. The root is that portion imbedded in the alveolus; its end is termed the apex. Physical Characteristics of the Teeth. — In placing this description before the reader, and by means of which he will be enabled to distinguish any normal tooth, we wish him to bear in mind that abnormally he may find a variety of deviations. The second upper bicuspids Fi&. 153. — Permanent Teeth. are sometimes found with two roots ; either of the superior bicuspids with three ; molars occasionally have four, even five roots. The writer has in his possession a second lower molar with five cusps and three roots ; one with five cusps is very rarely met with. C The crown of each tooth has five surfaces, viz., the labial or buccal, that next the lip or cheeks; the lingual, next the tongue, — sometimes called the palatal in the upper teeth ; the two approximal surfaces, — that nearest the median line being called the mesial, that farthest away the distal ; and the cutting edge or masticating sur- THE TEETH. 353 face, according to whether it is an incisor or one of the bicuspids or molars. Permanent Teeth. — Upper incisors: the labial and Fig. 154.— Diagram of Premolar Tooth, with Alveolus. A, bony wall of alveolus: lo, enamel prisms : zh, enamel casting; h. spaces in the base of the enamel prisms ; D. dentine : dc. dentinal tnbnles ; fh, g\im. with alveolar periosteum below It; C, cement; ch, cement spaces; fb, tooth-pulp; i, nerve entering pulp; v, pulp blood-vessels. lingual surfaces are shovel-shaped, the former convex, the latter concave ; the approximal surfaces are trian- gular in shape, with the base at the neck, the distal 351 PRACTICAL ANATOMY. corner rounded, and by this peculiarity we can distin- guisli to which side the tooth belongs ; the cutting edge is convex ; when first erupted three cusps are noticeable on it, which correspond to the cornua of the pulp, and are gradually worn off by usage; on the Ungual sur- face we find three ridges correspondiiig to these cusps ; on the same surface, near the neck, is usually a small prominence called the cingulum, and beneath a depres- sion termed the basilliar pit; the termination of the enamel on the gum line is concavo-convex, the former on the approximal surfaces, the latter on the labial and lingual ; the roots are conical in shape. The upper centrals are distinguished from the upper laterals in that the root of the former is irregularly rounded, while the latter is slightly flattened. It is also one-third larger than the lateral. The mesial surface of the lateral is often slightly concave and the distal more convex, that corner being also more rounded and the cin- gulum more marked and nearly always present; indeed, it is more frequently found in the upper laterals than any other teeth. The lower incisors differ from the upper in being smaller, the cutting edges straight, and the angles at both mesial and distal corner equally well defined, in having no cingulum, and the roots are flat and longer in comparison to the crown than the upper. The lower centrals and laterals are very much alike, except that the former is the smaller of the two. The cuspids are thicker, stronger, and in every way larger than the incisors. The upper has three ridges, prominently marked, especially the central one, which divides the labial surface. The mesial surface is larger than the distal; the lingual surface is concave, excepting for a prominent ridge, which makes it appear almost THE TEETH. 3o5 convex. The enamel on the approximal surfaces termi- nates in an obtuse angle, with vertex toward the cusps and most readily distinguished on the distal surface. The root is prominent and long, and, on cross-section, like a rounded triangle. AVe are enabled to tell on which side the tooth belongs by the slope from cusp to mesial surface being shorter than that from cusp to distal surface. The lower cuspids resemble the upper, but are dis- tinguished by being smaller. The lingual and labial surfaces are more distinctly convex, and the root is flat- tened. The enamel at the approximal surfaces is curved at the neck ; occasionally that of the mesial side is angu- lar, like the upper. The bicuspids or premolars have crowns, on section, almost like a rounded square. The first upper bicuspid has a buccal and lingual cusp, separated by a fissure, which bifurcates at each termination and runs over on the mesial surface. The former is the larger cusp, and the slope from cusp to the distal surface is longer than that to the mesial. The root bifurcates. The second bicuspid is distinguished by being larger than the first ; the fissure does not run over on the mesial surface, and its root is not bifurcated, but oval, and compressed by a groove which runs down the centre on each side. The inferior first bicuspid is the smallest of the bicus- pids, and is the only one which is not marked by a fissure ; the buccal cusp turns in very much, and the lingual is small and often rudimentary. Its cusps are connected by a ridge, on either side of which is a p!t. The inferior second bicuspid has a semilunar fissure running mesio-distally with its convexity toward the lingual surface, and a second fissure sometimes running 356 PRACTICAL ANATOMY. over on the lingual surface, generally dividing the lingual cusp into two. The roots of both lower bicuspids are oval in shape. The first superior molar has a large crown, and is in out- line like a rounded rhomboidal; the buccal and lingual surfaces are convex and the approximal flattened. It has four cusps, on the masticating surface of which the mesio-lingual is the largest, the mesio-buccal next in size, ArtB.ptxZctHrtA \ daxal FoTttnutv ^ Scarpet \^ Jhst.jiaicOine Gautlf \/ Aeeessori/ />alcUini .fhretrnenr Fig. 155.— The Upper Permanent Teeth in Position. then the disto-buccal, and, smallest of all, the -»disto- lingual. The mesio-lingual cusp is connected with the disto-buccal by a ridge, and around each other cusp is a fissure, — one running mesio-bucally and the other disto-lingually. This fissure often runs over on the lin- gual surface. It has three roots, — one lingual and two buccal, the lingual being largest and round; the buccal roots are flat, and the anterior larger than the posterior. The second superior molar resembles the first, but THE TEETH. 357 has generally the following distinctions: the disto-lingual cusp is more rudimentary; the disto-lingual fissure does not run over on the lingual side, and tlie roots have a tendency to stand closer together. The third superior molar is the smallest ; it has three cusps separated by fissures, which terminate in the centre in a depression. The roots have a still greater tendency to come together, and are often confluent. The inferior first molar has five cusps, — three buccal and two lingual, — separated by fissures, one running mesio-distally and one from this fissure lingually sepa- rating the last-mentioned cusps, and two running from the mesio-distal fissure, separating the three buccal cusps. It has two roots, — an anterior and posterior, — of which the first is the larger and flatter. The inferior second molars differ from the first in having only four cusps and a crucial fissure, Avhich gen- erally extends over on the buccal surface and terminates near the gum in a depression. The roots have a tend- ency to curve backward. The third inferior molar is very much like the first, except that the roots have even a greater tendency than those of the second to curve backward, and are more confluent. Temporary Teeth. — The temporary teeth are smaller, but closely resemble, in form, those of the permanent set. The enamel terminates abruptly, and is the dis- tinguishing feature when in doubt. The crown of the upper first molar has usually three cusps ; the upper second, four ; the inferior first molar, four ; and the second, five. Structure of Teeth. — On dissection w^e find a tooth to consist of pulp, dentine, enamel, cementum, and the pericementum or peridentium. 358 PRACTICAL ANATOMY. The pulp is that portion contained within the pulp cavity and canal or canals. That part within the former is termed the bulb, and corresponds in general outline to the shape of the tooth, having a cornu or horn for each cusp. That within the canal is termed the radicle, one being found in each root. The pulp is composed of a num- ber of fine blood-vessels, ramifying in a mass of delicate connective tissue, and a number of cells. Many of these on the outside of the pulp (odontoblasts) have processes, — ^long, delicate prolongations, — continued into the dental tubuli. It is the means of nu- trient supply and sensation; it is also essential to the preser- vation of translucency and for the vital resistance of the tooth. On its death, the organ gradu- ally loses its translucency, be- ing devitalized, and becomes discolored and opaque. Such a tooth is, however, not dead, as the cementum, and even perhaps part of the dentine, continues to receive nourish- ment through the peridentium for years. ^ The dentine is that hard substance which forms the principal bulk of the tooth, extending from the pulp cavity and canal on the inside to the enamel and cementum on the outside. It is composed of dental tubuli and their contents, imbedded in intertubular tissue, a dense, homogeneous substance. The former are minute tubes, having an external diameter averaging about -^-^-^-(j inch, and internally yo^oo inch. They extend Fig. 156.— .Section Throitgh a Canine Tooth. A, cTOSta petrosa. with large bone-eor- puscles ; B, interglobular substance ; C, den- tinal tubules. THE TKETH. 359 in a double curved or wavy direction from both the enamel and dentine to the pulp. In their course they divide and subdivide dichotomously, giving- to the sur- face of the dentine, when cut, a striated appearance. They are filled with a delicate rod of protoplasm, which is continuous with the processes of the odontoblasts on the surface of the pulp. No nerve-filaments liave been found in dentine, but this protoplasm is probably the medium through which painful sensations are trans- mitted to the nerves of the pulp. The cliemical compo- sition of dentine is about twenty-eight per cent, organic matter and se\enty-two inorganic or earthy matter, con- sisting of phos- phate and carbo- nate of lime, and traces of fluoride of lime, phosphate of magnesium, and other salts. Sec- ondary dentine is a formation of dentine within the walls of the pulp-cavity, due to an external or internal irritant which has stimulated certain odontoblasts. The enamel is the external covering of the crown, and is the hardest and most brittle structure of the body. It is composed almost entirely of inorganic matter, con- taining only from about three to five per cent, of inor- ganic material. In arrangement, it is made up of hexagonal prisms, radiating from the centres of develop- ment, one for each cusp, and thus in the fissures we oflen have the enamel imperfectly protecting the dentine by the formation of V-shaped spaces, wliich allow ingress to various external causes of decay. It is thickest on Fig. 157.— Enamel Prisms. A, in longitudinal view : B. in cross-section. 360 PRACTICAL ANATOMY. the articulating surfaces, and most of all over the cusps ; thinnest toward the neck, where it is overlapped by the cementum. The cementum, or crusta petrosa, is the thin layer of material covering the roots and extending from the apex to neck. In structure and resemblance, it is the most anal- ogous of all tooth-substance to bone, containing sparingly lacunae and canaliculi, and about 30 per cent, of organic matter. In single-rooted teeth the cementum is thickest at the apex, in multi-rooted teeth at the bifurcation. The pericementum is that membrane which envel- ops the root of the tooth and fills the space intervening between it and the wall of the alveoli. It is analogous to the periosteum of the bone, and performs the double function of nourishing the cementum on the one side and bone on the other. Tooth-development begins about the sixth week of foetal life. Along the whole length of the foetal gum is a projecting ridge, termed the " dental ridge," due to the excessive activity of the Malpighian layer of epithelial cells, which, for want of space, necessarily crowd up the corneous layer. This same activity pro- duces, in like manner, the dental groove in the gum, also filled with epithelial cells, and running along under the ridge. This groove gradually becomes deeper, extending into the deeper layer, and a hollow sack is formed, whiph gradually closes at the top and the groove becomes obliterated by the closure of the Malpighian layer. This sack has the appearance of a pear hanging by a stem, with the blossom end downward, and is pressed in to accommodate the advancing papillae, which are the makers of the future pulp and dentine. Tlie stem becomes the gubernaculum, or the future enamel organ of the accom- panying permanent tooth, by a similar dipping down on THE TEETH. 361 the lingual side. The papilla grows still deeper into the pear-shaped body, or stellate reticulum, as it is now termed, because of the stellate-shaped cells it contains, and thus forms a double cap over the papilla, the lower tunic of which is the enamel organ, consisting of cylindrical epithelial cells, which probably absorb the stellate cells, becoming calcified, forming the enamel prisms, and so the process goes on from within outward, until the enamel is completely calcified. While the enamel is thus being calcified the same process is taking place with the dental papillae, but in the opposite direction. The continuous layers of odon- toblasts which now occur here calcify from Avithout in the papilla, receding till it forms the future pulp in- closed wdthin its now formed pulp cavity and canal, with its minute apical foramen for the transmission of the nerves and vessels so essential to the future welfare of the tooth. It is important to remember that the com- plete formation of the apical foramen does not take place for some years after the eruption of the tooth. The cementum is formed from the soft connective tissue of the dental sac. "When the tooth is erupted the enamel is also covered by a thin layer of cement, which wears off. It is about the i^q^-j^-^ inch in thickness and is named Nasmyth's membrane. 2'able of Eruption of Temporary Teeth. Central incisors, lower, 5 to 7 months. Central incisors, upper, 7 to 8 Lateral incisors, lower. 8 to 9 Lateral incisors, upper. 9 to 10 First molars, lower, . 11 to 12 First molars, upper. . 13 to 14 Cuspids or canines, lower, . . 17 to 18 Cuspids or canines, upper, . . 19 to 20 Second molars, . 23 to 30 362 PRACTICAL ANATOMY. Table of Eruption of the Permanent Teeth. First molars, . . . . . 5 to 7 j'ears. Central incisors, Lateral incisors, First bicuspid, Second bicuspid, Lower cuspids. Second molars. Upper canines. Wisdom, 6 to 8 7 to 9 9 to 10 10 to 11 10 to 12 n to 14 13 to 15 17 to 45 The teeth of the lower jaw, as a rule, precede the tipper by a few months. Method of Eruption. — When the enamel is com- pletely formed and the calcification of the other tissues of the tooth is sufficiently advanced to enable it to bear the pressure to wliicli it is to be afterward subjected, its eruption takes place, the tooth making- its way through the gum, which is absorbed by the pressure of the crown against it. The tooth itself is advanced by the increas- ing size of the root. At the same time the septa betvi^een the dental sacs, at first fibrous in structure, ossify and constitute the alveoli. While the teeth are in place they are firmly attached to the peridental membrane, and on removal of the tooth the alveoli finally become absorbed. THE SALIVARY GLANDS. r The salivary glands consist of three pairs — the parotj^, submaxillary, and sublingual — and numerous simple fol- licles imbedded in the mucous membrane of the mouth. The parotid gland is situated in front and below the ear, wedged in between the mastoid portion of the temporal bone and the posterior border of the ramus of the lower jaw ; it is irregularly lobiilated, grayish in color, and formed of lobes wliich are made up of lobules, and these are composed of frequent branching tubules which dilate THE SALIVARY GLANDS. 363 and form the salivary alveoli. These are lined by salivary cells, uniniicleated granular cells, which almost entirely fill the alveoli. Interposed between the cells and base- ment membrane are collections of minute, dark, granular cells, forming zones and crescents. The external carotid artery is deeply imbedded in the substance of the parotid gland, and the posterior auricular and transverse facial are given off in its substance. The facial nerve enters its inner posterior part and emerges near its anterior border. The duct of the parotid, or Steno's duct, is about two and a half inches long ; it runs transversely across Fig. 158.— Section of a Salivary Gland. the masseter on a level with the necks of the upper teeth, then pierces the buccinator and opens on a papilla just above the upper second molar. It is about one-eighth of an inch in diameter, and feels like a whip-cord. It presents three coats, — outer or fibrous, muscular, and mu- cous. The suhmaxUlary gland is situated beneath the mylo- hyoid muscle, in the submaxillary triangle, under cover of the inferior maxillary bone. It weighs about two drachms, is about one and a lialf inches long, and has a single duct, the duct of AVharton, which opens at 364 PRACTICAL ANATOMY. the sides of the traenum of the tongue. Its structure is like that of the parotid. The suhlingual gland is situated above the mylo- hyoid muscle ; it weighs about one drachm, and opens by numerous ducts on the floor of the mouth ; one of these — tlie duct of Bartholine — opens into Wharton's duct. In structure it resembles the parotid and sub- maxillary. The secre- tion of the salivary glands is watery, hav- ing a specific gravity of 1005 ; it contains many other ingredi- ents,— an organic fer- ment ptyaline, which acts on starches and transforms them into dextrine. THE PHARYNX. large Fig. 159.— Pharynx Laib Open Behind. FROM 1, styloid process; 2. body of occipital ; 3, septum nasi; 4, middle turbinated bone: .'>, posterior uaris ; 6, inferior tur- binated bone ; 7, soft palate ; 9, uvula; 10, tonsil; 11, back of tongue; 12, epiglottis; 13, arytaeno-epiglottidean fold; 14, tip of arytsenoid cai'tilage ; 1.% oesophagus ; 16, back of cricoid cartilage. The pharynx is the musculo-mem- branous sac which is attached above to the basilar process of the occipital bone, and into which open the posterior nares, the Eustachian tube, the mouth, larynx, and oesophagus. It is about five inches long, and termi- nates on a level with the fifth cervical vertebra in the oesophagus, with which it is continuous ; it is composed of three coats, — muscular, fibrous, and mucous. The muscular coat is formed by the constrictors ; the fibrous coat, between the muscular and mucous, is attached to THE PHARYNX. 365 the basilar process of the occipital bone and the under surface of the petrous portion of the temporal, and becomes thinner as it passes down, and is gradually lost on the sides of pharynx ; the mucous coat above is covered by columnar epithelium ; below, by squamous cells ; in it are imbedded numerous mucous glands. The pharynx is separated Fig. 160.— Median Section of the Head. Vp, position of the soft palate during rest ; 1, orifice of Eustachian tube ; Vcl and Vc2, flrst and second cervical vertebrae ; E. epiglottis ; G, glottis ; 4, arytenoid cartilage ; 5, cricoid cartilage ; 3, thyroid cartilage ; 2, liyoid bone, from the vertebral column by a quantity of loose con- nective tissue. In front it is irregularly attached to the internal pterygoid plate, pterygo-maxillary ligament, side of the tongue, hyoid bone, thyroid and cricoid cartilages. In contact with its outer surfaces are the internal carotid artery, the internal jugular vein, and ninth, tenth, eleventh, and twelfth pairs of nerves, and the cervical 366 PRACTICAL ANATOiMY. sympathetic. Two glandular organs — the tonsils — are placed on either side, between the pillars of the fauces. Their bases are applied opposite to the course of the great vessels, — an important fact to remember in opera- tions on these structures. THE (ESOPHAGUS. The musculo -membranous tube, which leads from the pharynx into the stomach, is about nine inches long, and extends from the fifth cervical to about the ninth dorsal vertebra. It passes down in front of the bodies of the vertebrae, through the posterior mediastinum and through the oesophageal opening of the diaphragm, and enters the cardiac end of the stomach. It has three coats, — muscular, fibrous, and mucous. The muscular or outer is formed by longitudinal and circular fibres ; the fibrous coat consists of loose cellular connective tissue ; the mucous coat is thrown into longitudinal rugse, and is covered with squamous epithelium. The oesophagus is in relation in the neck with the trachea anteriorly, and laterally with the great vessels. In the thorax it descends in the posterior mediastinum, having in front the structures of the root of the lungs, and, lower down, the pericardium. It is covered la|:erally by the pleurae. The pneumogastrics descend upon it, — the right behind, the left in front. The continuation of the ali- mentary tract is situated in the abdominal cavity. ABDOMINAL YISCEHA. THE ABDOMEN. The abdomen is the largest cavity in the body. It is limited above by the diaplirngm, below by the upper plane of tlie true pelvis. It is ovoidal in shape, and is bounded behind by the spine, psoas and quadratus muscles ; anteriorly and at the sides, by the ribs, ab- dominal muscles, and the ihac bones. It is lined by a serous membrane, — the peritoneum, — which is also re- \ Fig. 161.— The Abdomen. (The dotted lines represent the planes that divide the abdomen into nine regions.) fleeted around the abdominal viscera, and serves to keep them in place. There are six openings into the abdomi- nal cavity, namely, the aortic; oesophageal; the opening for the vena cava; in the Ibetus, the umbilicus; and below, the openings of the inguinal canals. Normally, these are sufliciently strong to resist the hernia of the abdominal viscera. The abdominal cavity is divided into nine regions (367) 368 PRACTICAL ANATOMY. or chambers by two transverse and two vertical planes. The upper transverse plane cuts the abdominal cavity at a level with the costal cartilage of tlie ninth rib; the lower plane on a level with the summits of the crests of the iliac bones. These divide the abdominal cavity into three portions, — a superior, middle, and inferior. These are again divided by two vertical planes, each drawn through the costal cartilage of the eighth rib and through the middle of Poupart's ligament, subdividing the ab- dominal cavity into nine regions, or chambers. The middle regions are : the epigastric above, umbilical in the middle, and the hypogastric below. Those at the sides are : the hypochondriac above, the lumbar at the sides of the umbilical, and the inguinal below. The following structures are located in these regions : — Right Hypochondriac. The right lobe of the liver, gall-bladder, the duodenum, pan- creas, hepatic flexure of the colon, upper part of the right kid- ney, and the right supra-renal capsule. RigJit Lumbar. Ascending colon, lower part of the right kidney, and some con- volutions of the small intestines. Sight Inguinal. The caecum, appen- dix cseci, ureter, and iliac vessels. Epigastric. The middle and py- loric end of the stomach, left lobe of the liver and lobulus Spigelii, the pancreas, aorta, ascend- ing vena cava and cce- liac plexus. Umbilical. The transverse colon, part of the great omen- tum and mesentery. Left Hypochondriac. The splenic end of the stomach, the spleen and extremity of the pancreas, the splenic flexure of the colon, upper half of the left kidney, and the left supra-renal capsule. Left Lumbar. Descending colon, part of the omentum, lower part of the left transverse part of the kidney, and some con- duodenum, and some convolutions of the je- junum and ileum, and great vessels. Hypogastric Convolutions of tlie small intestine, the blad- der in children, and in adults if distended, the uterus during preg- nancy, great vessels, anc] lumbar plexug. volutions of the small intestine Left Inguinal. Sigmoid flexure of the colon, ureter, and iliac vessels. THE PERITONEUM. 309 THE PERITONEUM. The peritoneum is a serous sac which lines the walls of the abdomen and is reflected upon the viscera, which it more or less completely invests. In order best to under- stand its arrangement with reference to the viscera, this diagram, representing a vertical antero-posterior section through the me- dian line of the body, should be closely studied. Now begin at the under surface of the dia- phragm anteriorly, and marked 1 in the dia- gram, and draw a line to represent the peritoneum nearly up to the pos- terior abdominal wall ; then draw another line, beginning posteriorly at 2, forward so as to meet the line first drawn. These lines represent the anterior and posterior leaflets of the peritoneum, which meet above the liver and descend upon its superior surface, form- ing the suspensory ligament of the liver. Upon reaching the upper surface of the liver they again diverge, the anterior leaflet passing in front of the liver, the posterior behind it ; but again meet at the transverse fissure of the liver, having invested that organ. Thence they pass by tliis to the superior curvature of the stomach, forming Fig. 162.— a Vertical Section showing THE Arrangement of the Layers OF THE Peritoneum. D, diaphragm ; L, liver; S, stomach: P, pancreag; D, duodenum ; C, colon ; I, small intestine : D, blad- der ; R, rectum ; 3, posterior surface of liver ; 4, fora- men of AVinslow ; 5, great omentum ; 6, lesser omentum : 7. mesocolon ; 8. 9, lesser cavity of peritoneum ; 10, mesenterv ; 11, recto-vesical fold. k 24 370 PRACTICAL ANATOMY. the gastro-hepatic omentum, which includes the hepatic vessels and nerves. On reaching the superior curvature of the stomach again they separate, the anterior leaflet passing in front, the posterior behind the stomach, which they invest, the two leaflets again meeting at the greater curvature. They then pass down together for from six to twelve inches, hanging like an apron in front of the intes- tines ; together they make an abrupt bend upward, the an- terior layer becoming posterior, the posterior leaflet an- terior, and they reach the anterior portion of the transverse colon, where they again separate, the posterior leaflet passing over the transverse colon and the anterior leaflet beneath it. They invest the colon and again meet along its posterior surface, and together proceed to the posterior wall of the abdomen, forming the meso-colon. Now the two layers separate ; the posterior leaflet, which became by the ascent of the apron (or great omentum) the superior layer, runs up along the posterior abdominal wall, over the anterior surface of the duodenum and pan- creas, and joins the leaflet whence it started, at the under surface of the diaphragm, and marked in the diagram 2. The anterior leaflet (now the lower leaflet of the meso- colon) passes down to the superior mesenteric vessels, and upon these to the small intestine, which it surrounds or invests and then passes back to the spine, forming the mesentery. It runs along the spine for a short distance and is reflected over the rectum and for some distance along its anterior wall ; thence to the posterior surface of the upper part of the vagina and the posterior surface of the uterus, forming a pouch called Douglas's cul-de- sac ; thence over the fundus uteri, along its anterior surface to the bladder, investing its upper portion only, and is then reflected along the anterior wall of the abdomen to the point of starting, and marked 1 in THE STOMACH. . 371 the diagram. It will tlius be seen tliat the peritoneum forms two sacs, — a smaller, formed by the posterior, and a larger, formed by the anterior layer. These two sacs communicate behind the gastro-hepatic omentum and may be likened to an hour-glass with a smaller globe at right angles to a larger. The constricted opening between them is behind the gastro-hepatic omentum, and is called the foramen of Winslow. The peritoneum is reflected from the cardiac end of the stomach to the hilum of the spleen, forming the gastro-splenic omentum, which con- tains the splenic vessels and nerves. In the male the peritoneum is a shut sac ; in the female the Fallopian tubes open into the peritoneal cavity. The viscera entirely invested by peritoneum are the liver, stomach, spleen, transverse colon, upper part of duodenum, the small intestine, sigmoid flexure of colon, first part of rectum, ovaries, and uterus. The viscera partially in- vested by peritoneum are the kidneys, supra-renal capsules, pancreas, lower part of duodenum, ascending and de- scending colon, caecum, second portion of rectum, vagina, and bladder. The peritoneum, by its reflec- tions to the viscera, forms their ligaments, and three omenta, — the gastro-hepatic or lesser, the greater, and the gastro-splenic. THE STOMACH. The stomach is a remarkable dilatation of the alimen- tary canal, and is tlie principal organ of digestion. When distended it is conoidal in form, bent so as to present a short superior concave curve and a long inferior convex curvature. It measures about twelve inches long, four and a half inches in its vertical diameter, and three and a half inches antero-posteriorly. It weighs about five ounces ; it lies transversely across the upper part of the abdominal cavity, beneath the diaphragm, extending 372 PRACTICAL ANATOMT. from the left hypocTiondrium across the epigastric into the right hypochondriac region. Its left extremity is broad, blunt, and large, and is called the cardiac end ; it is attached to the spleen by the gastro-splenic omentum. The right extremity, or pylorus, is constricted ; it lies near the end of the eighth cos- tal cartilage. The pyloric orifice, or outlet of the stomach, communicates with the duodenum, and consists of an oblique ori- fice through a ring of mus- cular fibres. The oesopha- geal orifice is funnel-shaped and is situated to the right of the cardiac end, upon the upper portion of the organ. The lesser or supe- rior curvature runs be- tween the pylorus and oesophagus; it aifords at- tachment to the lesser omentum. The greater or inferior extends between the oesophagus and pylorus and affords attachment to the greater omentum. The anterior surface of the stomach is convex and is in contact with the abdominal wall ; posterior surface, also convex, lies upon the great vessels, the solar plexus, and pancreas. The stomach presents four coats, — serous, muscular, cellu- lar, and mucous. The serous coat is derived from the peritonium. The muscular coat consists of planes of involuntary fibres arranged circularly, longitudinally, and Fig. 163.— Glands of the Fundus OF THE Stomach. THE SMALL INTESTINE. 373 oblique. The circular layer is the principal plane of fibres ; the longitudinal are most abundant near the curv- atures; the oblique fibres are scattered, although disposed in a layer over the cardiac end. The cellular coat is formed of loose cellular tissue, which connects the muscular and mucous coats. The mucous lining of the stomach is thick, smooth, pale pink in color, and, when the stomach is collapsed, thrown into numerous longitudinal wrinkles, — the rugse. The mu- cous membrane presents under the microscope a honey- comb arrangement of shallow, pit-like depressions, about ^^^ inch in diameter. At the bottom of these alveoli the peptic and mucous follicles open. They are both simple follicles, lined by columnar epithelium ; in the peptic glands numerous spheroidal cells are imbedded among the columnar epithelium ; these are active agents in the elaboration of the gastric juice. The mucous crypts are very abundant about the pylorus. The free surface of the stomach is lined by columnar epithelium. THE SMALL INTESTINE. The small intestine is a musculo-membranous tube, about twenty feet long. It is divided into three parts, — the duodenum, jejunum, and ileum. The duodenum is about ten inches long ; its diameter is greater than any other part of the small intestine ; it is comparatively fixed in position by the peritoneum ; it curves around the head of the pancreas, and at first ascends, then descends, and then runs transversely across the front of the spine. The ascending portion is about two inches long, invested by the layers of the lesser omentum ; it is commonly found stained with bile ; the descending por- tion, about three inches long, passes down in front of the right kidney ; it receives the common bile and pancreatic 874 PRACTICAL ANATOMY. duct near the middle, along its inner side ; the trans- verse portion is about five inches long, and becomes nar- rower, and terminates in the jejunum to the left of the second lumbar vertebra. The jejunum is about eight feet long ; it begins at the duodenum and terminates in the ileum ; it is more capacious and more vascular than the ileum. The ileum is a highly convoluted portion of the small intestine ; it is ten to twelve feet long, and ter- minates in the right inguinal region in the caecum. The ileum is the narrowest part of the small intestine ; its walls are thin and less vascular than those of the jejunum. The small intestine has four coats, — serous, muscular, cellular, and mucous ; the ileum, jejunum, and first part of duodenum have a peritoneal investment. The mus- cular coat consists of circular and longitudinal fibres; the cellular coat consists of loose connective tissue. The mucous membrane lining the small intestine is thick, covered by columnar epith'elium, and presents for exam- ination : the valvule© conniventes ; villi ; mucous crypts, or follicles of Lieberkiihn; Brunner's glands, in the duodenum; solitary glands ; and agminate glands, forming Peyer's patches. The valvulse conniventes are transverse folds of mucous membrane, extending one-third around the intestine, and about one-third inch in depth ; they are found in the second and third parts of the duodenum, throughout the jejunum, and gradually disappear in the upper part of the ileum. The valvulse conniventes are arranged spirally around the interior of the intestines. Tlie villi contain the intestinal termini of the lacteals ; they are about four millions in number, and are scattered throughout the whole length of the small intestine ; they are minute, conical elevations, covered by columnar epithelium, and contain lacteals, blood-vessels, nerves, THK SMALL INTESTINE. 375 connective and lymplioid tissue. The follicles of Lieber- kiihn are simple mucous crypts, and are found through- out the mucous membrane of the small intestine ; they are similar in structure to the mucous Ibllicles of the stomach. Brunner's glands are racemose glands im- bedded in the mucous membrane of the duodenum. The solitary glands are found most abundantly in the lower Fig. 164.— Section of Intestine, showing the Villi. •The blood-vi-ssels. c, and the lacteMls. li. have heen injected. The blind ending, or .-1 - 1 _ . .. .t .1 1. t_ . 1 _- . . 1 1^1 i... ti.^ — ..:ii..«.. ....* ..1. ..r *u« simple loop of the bUic-k lacteal blood-vessels. to be surrounded by tlie capillary uet-wurk of the part of the ileum ; they consist of a delicate, skeletal, interlacing fibrous structure, supporting lymplioid ele- ments. They are grayish bodies, ovoidal in form, and measure from two to three millimetres in diameter ; they are surrounded by villi and mucous follicles. Pcyer's patches are formed by aggregations of tlie solitary gland, forming oval patches twenty to thirty in number, found principally in the lower part of the ileum ; they are 376 PRACTICAL ANATOMY. placed opposite to the attachment of the mesentery. The patches are ahout three-fourths mch wide, one and one- half inches long, but vary both in size and shape ; they are surrounded by villi and mucous crypts. THE LARGE INTESTINE. The large intestine begins in the right inguinal region and terminates at the anus. It is about five feet long. Throughout the whole of its extent it is sacculated and covered by columnar epithelium. It is divided into the ascending, transverse, and descending colon and the rec- tum. The ascending colon begins as a blind pouch, the caecum, which is the largest part of the colon. It is situated in the right inguinal region and is held in posi- tion by the peritoneum, which, as a rule, covers the anterior surface and sides of the caecum. Attached to its lower posterior part is the appendix vermiformis, — a rudimentary C8ec4im. It is about four inches long, about as thick as a pencil, and often entirely invested by peri- toneum. The ileum enters the caecum at its inner side, the opening being designated the ileo-caecal valve. These valves are placed horizontally, and they are formed by the reduplication of the mucous membrane of the caecum and muscular fibres. When these are cut tlie valve dis- appears, and the opening gapes widely and is funnel- shaped. The iliac surface of the valve is covered with villi. The upper portion of the ascending colon passes upward to tlie under surface of the liver. Its sides and anterior surface are covered by peritoneum. Beneath the liver it bends at right angles and becomes the transverse colon, and is entirely surrounded by peritoneum, which holds it to the posterior wall of the abdomen by the meso-colon. In the left liypochondriac region beneath the spleen it bends abruptly downward, becoming the THE LARGE INTESTINE. 377 descending colon, which is covered anteriorly and at the sides by peritoneum, and terminates in the convolutions of the colon called the sigmoid flexure, which is held in position by the sigmoid meso-colon. It terminates in the rectum, which is a cylinder about eight inches long. It begins at the left side of the lumbo-sacral articulation, curves slightly to the right, then follows the curve of the sacrum, and finally bends abruptly backward to termi- nate at the anus. It is divided into an upper, middle, and inferior portion. The upper part is about three and one-half inches long, passes downward to the upper bor- der of the third piece of the sacrum. It is invested by peritoneum and held in place by the meso-rectum. The middle part, about three inches long, terminates on a level with the tip of the coccyx. The lower portion extends from the tip of the coccyx to the anus, and is about one and a half inches long. It is encircled by the internal sphincter and forms the posterior limit to the perineum. The large intestine has four coats, — serous, muscular, cellular, and mucous. The serous coat is formed by the peritoneum. It covers the anterior sur- face and sides of the caecum, ascending colon, and de- scending colon. It entirely invests the transverse colon, the sigmoid flexure, and the first or upper part of the rectum. The muscular coat consists of longitudinal and circular fibres. The longitudinal fibres are collected into three bands about half an inch in width. They are only about three-fifths as long as the large intestine, and by their attachment to the sides of the gut cause the saccu- lation or pouching. The fibres of the bands become difliised on the surface of the sigmoid flexure. They are placed nearly equidistant, and generally are arranged, one anteriorly, one along the inner side, and one along the outer side of the colon. The circular fibres form a 378 PRACTICAL ANATOMY. continuous layer, thicker at the ridges between the pouches and in the lower part of the rectum; re-inforced by some voluntary fibres, they form a band one and one- half inches broad, one- third of an inch thick, which forms the internal, the main sphincter of the rectum. The cellular coat consists of loose connective tissue. The mucous coat is of a grayish color, and thrown into a great number of transverse semilunar wrinkles ; it has no villi. It is lined by columnar epithelium. In the rec- tum it is thick and vascular, and loosely connected with the muscular coat. When empty it is thrown into nu- merous longitudinal wrinkles, which disappear as disten- sion occurs. Three, sometimes four, folds of mucous membrane at right angles to the axis of the rectum form a series of shelves for the support of the weight of the faecal matter. The anus is the external opening of the rectum. It forms an^antero-posterior slit-like opening between the buttocks, posterior to a line across the tuberosities of the ischia. The skin surrounding this orifice is pigmented, and presents numerous short, stiff hairs. Beneath the skin are a series of delicate bundles of muscular fibres, called the comigator cutis ani, wdiich throw the skin into a number of wrinkles, and which radiate from the anal aperture. The external sphincter consists of an elliptical plane of voluntary fibres, which surround the anus. It is about a millimetre in thickness, and lies beneath the skin. A critical examination of the anus shows that, when contracted, it is puckered into from seven to twelve slightly nodular elevations, — the ex- tremities of the anal columns. In the intervals between the nodules are minute pouches, which are not infre- quently subject to excoriations and ulceration. The large intestine is studded with mucous follicles. It also THE LIVER. 379 presents a number of solitary glands, especially in the caecum and ascending colon. THE LIVER. The liver is the largest gland in the body ; it is situ- ated in the right hypochondriac, but extends across the epigastric into the left hypochondriac region ; it is of a dark reddish-brown color, weio-hs about three and one- -^ p half pounds, is dense, but friable, and measures about ' twelve inclies long, three inches at its thickest part, and six inches in its greatest breadth ; it is a semi-ovoidal organ, smooth and convex above, flattened and some- what irregular below, the large part of the oval being to the right. Superiorly it is divided by the suspensory ligament into a large right and a small left lobe ; infe- riorly it presents five lobes and five fissures, practically between the right and left lobes. The anterior border is thin ; it presents a deep notch between the right and left lobes ; the posterior border is thick and rounded, and is held to the diaphragm by the layers of the coro- nary ligament. The upper surface of the liver is on a level with the fifth rib ; the anterior border corresponds with the inferior border of the chest. The liver changes its posi- tion sliglitly during respiration, descending in inspiration and rising a trifle higher in expiration. It has five lobes, five ligaments, five fissures, and five sets of vessels. The lobes are the right and left, and between them, on the inferior surface, are the quadrate. Spigelian, and caudate lobes. The right lobe forms seven-eighths of the mass of the liver; it is quadrangular in form, convex on the superior surface, flattened below, and pre- sents a shallow, anterior depression for the colon ; poste- riorly it is impressed by the right kidney. The left lobe 380 PRACTICAL ANATOMY. is triangular, and separated from the right lobe, above, by the suspensory ligament ; below, by the longitudinal fissure. The lobus Spigelii is connected with the right lobe by the caudate lobe. The quadrate lobe is situated anteriorly between the fissure for the gall-bladder and the longitudinal fissure. The five fissures are placed between the right and left lobes on the inferior surface of the liver ; they are arranged in the form of a letter A, the expanded limbs being anteriorly ; they are named the longitudinal, fissure for the ductus venous, fissure for the gall-bladder, fissure for the vena cava, and the transverse fissure. The lon- gitudinal fissure begins at the notch at the anterior border, and lodges the round ligament (in the foetus, the umbili- cal vein) ; the continuation backward of the longitudinal fissure lodges a fibrous cord, which is the obliterated re- mains of the ductus venous ; the fissure for the gall- bladder, placed between the quadrate and right lobes, lodges the gall-bladder. Posteriorly the liver is deeply grooved by the ascending vena cava. The transverse fis- sure transmits the hepatic artery, ducts, lymphatics, nerves, and portal vein ; it forms the cross-bar of the letter A. The ligaments are the suspensory from the diaphragm, the right and left lateral, and the coronary, all formed by the layers of the peritoneum. The ligamentum teres is the obliterated umbilical vein. The vessels of the liver are the hepatic artery, hepatic veins, hepatic duct, portal vein, and lymphatics. The hepatic artery, a branch of the coeliac axis, enters the transverse fissure and is dis- tributed to the portal canals. The hepatic duct arises in the lobules of the liver by capillaries which ultimately form the right and left duct ; these join near the trans- verse fissure, form one duct, which empties with the pan- creatic into the descending portion of the duodenum. THE LIVER. 381 The hepatic vems empty into the vena cava. The lym- phatics are numerous and are distributed through the portal canals. The portal vein enters the liver at the transverse fissure and divides into a right and left branch ; these give off vaginal branches that run in the portal ca- nals; from these are given off the interlobular; and these send off numerous vessels into the lobule, called the lobular. The lobular are the smallest radicles of the portal system ; they all converge toward the centre of the lobule and run into the middle lobular or intralobular veins, which empty into the sublobular, and these form the hepatic, three or five in number, which open into the ascending vena cava as it lies in the fissure in the posterior border of the liver. The nerves of the liver are the pneumogastric and sympa- thetic. In structure the liver is composed of great num- bers of lobules held together by delicate connective tissue, arteries, ducts, veins, lymphatics, and nerves, the entire mass being invested by a serous coat, the peritoneum, and a fibrous coat, which is blended with the serous in- vestment; it is refiected into the interior of the liver as the capsule of Glisson. An examination of the lobules shows them to be about one-twelfth of an inch in diam- eter, and, viewed in the erect position, they may be said to be conoidal in form with undulate sides ; so that a vertical section gives a foliated outline. The bases, by mutual pressure, are polygonal in outline. Fig. 165.— Transverse Section of Lobules of Liver. a, interlobular Tein ; b, intralobular or central vein. 382 PRACTICAL ANATOMY. Each lobule is surrounded by a plexus of the inter- lobular veins, which send off the lobular capillaries. These make an intricate net-work in the interior of the lobule, but ultimately empty into the intralobular vein, which runs from apex to base, through the axis of the lobule and empties into the sublobular vein. The bases of the lobules are applied to the sublobular veins, and these become the common drain for the lobules. The interspaces between the lobular capillaries are occupied by the hepatic cells, which are spheroidal in form and are about y-gVo" i^^^^ ^^^ diameter. They consist of a sponge-work of protoplasm containing one or more distinct nuclei. The cell is devoid of cell-wall. The nuclei present bright nucleoli. The substance of the cell presents biliary coloring matter and oil-globules. The bile-ducts begin as intercellular passages, which probably open on the periphery of the lobule and form the interlobular plexuses, which may be considered to be the real commencement of the hepatic duct. THE GALL-BLADDER. The gall-bladder is situated in the fissure for the gall- bladder, and, when moderately distended, is pear-shaped, the large end of the pear projecting beyond the anterior border of the liver. It is about four inches long, one inch broad, and will hold from an ounce to an ounce and a half. It is held in position by the peritoneum. It presents a broad anterior end, the fundus, the body, and the neck. It has four coats : serous, muscular, fi.brous, and mucous. The internal or mucous coat is tinged a bright yellow, and presents numerous wrinkles, which give it some resemblance to a honey-comb. Near the neck the mucous membrane forms valvular folds. The gall-bladder is lined by cohimnar epithelium. The ductus THE SPLEEN. 383 communis choledochus is Ibrmcd by the union of the hepatic duct with the duct of the gall-bladder. The latter is about one inch long ; its lining mucous membrane is arranged in a spiral manner. This arrangement prob- ably assists in filling the gall-bladder. The common bile- duct is about three inches long, is joined by the duct of the pancreas, and empties into the descending portion of the duodenum. THE PANCREAS. The pancreas is situated behind the peritoneum, just above the superior mesenteric vessels. It is about six inches long, one and a half inches at its greatest breadth, and one inch at the thickest part. It weighs about three ounces. It is a flat, tongue-like organ, which has no distinct investing capsule. It presents a a head, body, and tail. The head is received in the curve of the duodenum ; the body is behind tlie stomach; the tail is small and pointed, and is in relation with the spleen. The upper border is thick, and presents the splenic groove for the accommodation of the splenic artery. The pancreatic duct runs through the middle of the gland from the tail to the head. It is called the duct of Wirsung, and is joined by a second duct, — the duct of Greenhow, — which arises from the lower part of the head of the pancreas. It is essentially a compound racemose gland, resembling the salivary glands. THE SPLEEN. The spleen is a ductless gland. It is situated in the left hypochondrium ; it is of a dark-bluish color, about six inches long, three broad, an inch and a half thick, and weighs about five ounces. It is dense but friable, and is entirely invested by peritoneum. It is convex externally, slightly concave on the inner surface, where 384 PRACTICAL ANATOMY. it presents a longitudinal fissure — the hilum ; its anterior border presents a notch. The spleen is invested by a fibrous coat, which contains involuntary muscular fibres and much yellow elastic tissue in its structure. It is reflected into the organ at the hilum, forming the large splenic canals. Its under surface sends off" trabeculse, which constitute the skeleton of the spleen. In truth, the spleen may be said to consist of a sponge-work of fibrous trabeculse, derived from the fibrous coat. The meshes of the trabeculse hold the splenic pulp. This consists of a dark-red substance, consisthig of interlacing connective-tissue cells, forming a skeletal arrangement to support the pulp, which consist of blood-corpuscles in all stages of development and decay and free haemoglobin. The splenic artery breaks up into minute capillaries, the walls of which consist of proliferating lymphoid elements. The capillaries open directly into the meshes of the spleen. The Malpighian corpuscles of the spleen are collections of lymphoid elements along the course of the arterioles ; they are nodular masses, about one-fiftieth inch in diameter. The changes effected in the blood in the spleen are briefly the genesis of white corpuscles out of the lymphoid tissue ; possibly, the genesis of the red corpuscle, and certainly the destruction of eff*ete cor- puscular elements and the liberation of the haemoglobin. THE KIDNEYS. The kidneys, two in number, are placed against the posterior wall of the abdomen behind the peritoneum. They extend from the twelfth rib to the crest of the ilium, the right being a trifle lower than the left. They are about four inches long, two broad, and one thick ; weigh about five ounces, — a little less in the female ; of a dark-red color, friable — being readily torn — and com- THE KIDNEYS. 385 posed of an aggregation of tubular glands inclosed in a delicate, transparent, fibrous, investing structure, — the capsule of Bowman. The kidney presents for examination an anterior and posterior surface, inner and outer border, and a superior and inferior extremity. The anterior sur- FiG. 166.— Naked-Eye Appearance of the Kidney. 1. cortex; 1'. medullary rays ; 1". luliyrinth ; 2. medulla; 2', papillary portion of the medulla: 2", boundary layer of the medulla; 3. transverse section of tubules in boundary layer ; 4, fat of renal sinus ; .i. artery : *. transversely coursing medullary rays ; A, branch of renal artery ; C, renal calyx ; U, ureter. face is convex and covered by peritoneum ; the posterior surface is somewhat flattened. The outer border is convex and rounded ; the inner border presents a notch leading into a vertical fissure — the liilum, which opens into the sinus of the kidney. The superior extremity is rounded and larger than the inferior ; upon the superior 25 386 PRACTICAL ANATOMY. extremity rests the supra-renal capsule. Each kidney is imbedded in a quantity of firm fat. If a section is made of the kidney it is seen to con- sist of two portions, — an outer or cortical, and an inner or medullary. The cortical matter consists of convoluted tubuli, Malpighian corpuscles, and vessels. The medul- lary portion consists of from sixteen to twenty conical masses of straight tubuli, called the pyramids of Malpighi. The cortical substance makes one-third, the medullary two-thirds of the section. The sinus of the kidney is occupied by the pelvis of the ureter, which is the upper dis- tended portion of the tube ; it presents three funnel- shaped depressions, called the infundibula, — the su- perior, middle, and infe- rior. The lining mucous membrane is thrown into ridges, which subdivide the infundibula into twelve to eighteen alveoli, called Fig. 167.— Longitudinal Section op A Malpighian Pyramid. PF, pyramids of Ferrein ,■ RA, branch of renal artery ; RV, lumen of a renal vein receiving an in- terlobular vein; VK. vasa recta; PA, apex of a renal papilla ; b, b, embrace the bases of tlie renal lobules ; h, cortex ; i, boundary or marginal zone ; k, papillary zone. the calyces. The apices of the Malpighian pyramids present at the bottom of the calyces. A minute examination of the apex of the pyramid reveals the open mouths of numerous tubuli, which should be carefully followed, so as to understand the structure of the kidney. The tubule proceeds in a straight direc- THE KIDNEYS. 387 tion for a short distance and divides ; each branch tlien proceeds in a straight direction and divides ; and thus, a single tubule at tlie apex of the pyramid will have 7 and 8. Ascending limb of Henle's loop tube. Subcapsular layer with- out Mai pighian cor- puscles. 12. First part of col- lecting tube. 11. Distal convoluted tubule. A> A. CORTE.X. 10. Irregular tubule. 3. Proximal convo- luted tubule. 9. Wavy part of as- cending limb. 2. Constriction or neck. 4. Spiral tubule. 1. Malpighian tuft surrounded by Bowman's capsule. 8. Spiral part of as- cending limb of Henle's loop. B. Boundary Zo>t:. 5. Descending limb of Henle's loop tube. 6. Henle's loop. 15. Tubule of Bellini lO C. Papillary Zone. Fig. 168.— Diagram of the Course of the Ubiniferous Tubules. branched into a number of tubuli at the base of the pyra- mid ; all the tubuli in the pyramid run in a straight direc- tion, and are called the tubuli of Bellini. When it reaches the base of the pyramid the tubule sends off a 388 PRACTICAL ANATOMY. Fig. 169.— Blood-Vessels and Uriniferous Tubules of the Kidney. A, capillaries of the cortex; B, of the medullary ; a, interlobular artery ; 1, vas afferens ; 2. vas efferens; r, e, vasa recta ; c, veuae rectae ; v, v, interlobular vein ; S, origin of a vena stellata ; i, i, Bowman's capsule and glomerulus ; x, x, convoluted tubules ; t, t, Henle'sloop ; n, n, junctional piece ; o, o, collecting tubes ; 0, excretory tube. number of curved branches called the collectmg tubes ; these become much twisted, convoluted, and form the con- voluted tubes of Ferrein, a name applied to all the tiibuli THE KIDNEYS. 389 of the kidney, except the straight tubes of BelHni in the pyramids. The curved or collecting tubule terminates in the distal convoluted tubule, this in the irregular tubule which leads into the loop of Henle, a contracted portion of the tubule, and which terminates in the spiral tubule. The spiral tubule terminates in the proximal convoluted tubule, which becomes contracted and then expands, form- ing the capsule of the Malpighian corpuscle. The Fig. 170.— The Secreting Portion.s of the Kidney. II. Bowman's capsule and glomerulus ; a, vas afferens ; e. vas efferens ; c. capillary net- work of the cortex: k. enilotlielium of the capsule; h, origin of a convoluted tubule; III, "rodded" cells from a convoluted tubule; 2. seen from the side, with, g. inner granular lone: 1, from the surface ; IV, cells lining Henle's loop; V, cells of a collecting tube; VI, section of an excretory tube. straight tubuli are lined with columnar epithelium throughout ; the convoluted tubuli, up to the corpuscle, present a varied epithelium ; in general, it may be said to be of the glandular type. The epithelium rests on a basement membrane, which is supported by a delicate fibrous coat. The cortical substance dips down between the pyra- mids, forming the columns of Bertin. A single tubule becomes so multiplied by repeated divisions as to form a cone or pyramid, and the pyramids of Malpighi may be 390 PRACTICAL ANATOMY. defined to be a collection of cones or pyramids already described, and invested by delicate fibrous tissue. The renal arteries enter the hilum and break up into a number of branches, which penetrate the columns of Bertin and reach the bases of the pyramids, over which they form anastomotic arches. From these are given oif two sets of branches, the medullary (arteriolse rectae) and the cortical. The former supply the pyramids ; the latter pass outward toward the periphery and send off numbers of capillary branches, which are very delicate and terminate in a spheroidal tuft of anastomosing capil- laries located within the Malpighian capsule. The for- mation of the capsule is not fully understood, but it is supposed to be made by invagination, the tuft of capil- laries resting within the capsule invested by the lining cells. Some believe it to hang free in the capsule ; others claim that the tuft distends-the capsule, but is shut out from the tubule by a partition layer of cells. The venous capillaries leave the corpuscle and follow the course of the arteries. THE URETER. The ureter or duct of the kidney runs from the pelvis of the kidney to the bladder. It is about seventeen inches long, half as thick as a lead-pencil, and is com- posed of three coats, — a fibrous, a muscular, and a mucous. The fibrous coat is continuous with the cap- sule of Bowman and is lost on the bladder. The mus- cular coat is formed by longitudinal and circular fibres, which become thinner toward the bladder. The mucous coat is formed of columnar epithelium in difierent stages of development, resting on a basement membrane. The mucous membrane is thrown into slight longitudinal folds. The upper, expanded part of the ureter forms the pelvis of the kidney. It dips into the infundibula THE THYROID CLAND. 391 and forms the calyces. The lower end pierces obliquely the under surface of the bladder, and, after runnin<>' about three-fourths of an inch in the wall of the bladder, opens at a posterior angle of the triangle at the base of the bladder. THE SUPRA-RENAL CAPSULES. The supra-renal capsules are ductless glands situated behhid the peritoneum, upon the kidney. They are of a yellowish color, flattened, weigh about two drachms, and measure about one and a half inches in length. They have an outer cortical and an inner medullary portion. The cortical substance consists of columns perpendicular to the surface ; the medullary portion is of a dark-brown color and pulpy consistence. The cortical columns are derived from tlie inner sur- face of the fibrous capsule which invests the gland. They are abundantly supplied with vessels. THE THYROID GLAND. The thyroid gland is placed like a saddle across the upper part of the trachea; it presents the two lateral lobes and the isthmus ; it is brownish-red in color, and weighs about one and a half ounces. The isthmus covers the second and third rings of the trachea ; it is about one- half to three-fourths of an inch wide ; the lobes are two inches long and about one inch in width ; the gland is inclosed in a fibrous capsule, whicli sends inward sup- porting septa, dividing the gland into lobes and lobules; the lobules are formed of closed vesicles, lined by a single layer of cuboidal epithelium. Tlie vesicles are filled with a gelatinous fluid, containing disintegrating red corpuscles and free hcemoglobin. The blood-capillaries and lymphatics form extensive plexuses around the vesicles. The thyroid has no duct. 392 PRACTICAL AN ATOM r. THE THYMUS GLAND. The thymus gland, with the thyroid, supra-renal cap- sules, and spleen, belongs to the ductless glands; it attains its greatest development about tlie second year, when it begins to atrophy, and, by the sixteenth year, has entirely disappeared ; it consists of two lobes, situated in the anterior mediastinum, extending as low as the fourth costal cartilage ; it is pink in color and lobulated, and weighs, when bestd eveloped, about an ounce ; the lobes are formed of lobules, which present a cellular, cortical, and medullary portion ; it is essentially a gland formed of lymphoid elements, and is probably concerned in the formation of red blood-corpuscles. PELVIC VISCERA, INCLUDING ORGANS OF GENERATION. THE PELVIS. The pelvis is bounded above by the superior plane of the true pelvis, formed by tlie linea ilio-pectinea, and the sacral promontory ; below, by the levator ani muscle and the pelvic fasciae; laterally and in front, by the ischia and pubes. It is a curved cylinder, which contains the bladder, rectum, uterus and its appendages, in the female; in the male, it contains the bladder, seminal vesicles, prostate, and rectum. THE BLADDER. The bladder is a musculo-membranous sac, which, whien moderately distended with urine, is ovoidal in form, and then measures about five inches in length and three in width, and holds about one pint. When empty its walls are in contact, and it forms a small, triangular sac, placed deeply in the anterior part of the pelvic cavity ; it presents for examination a summit, body, base, and neck ; the summit is rounded, and has attached to it the urachus, — a fibrous structure, the remains of the allantois, and which passes upward to the umbilicus ; at the sides of the urachus are the obliterated hypogastric arteries ; the summit of the bladder, behind the urachus, is invested by peritoneum ; the anterior parts of the sum- mit and body are in contact with the abdominal wall, when the organ is sufficiently distended. The body of the bladder is convex, and covered posteriorly by peritoneum ; at its sides are the vasa deferentia, curving downward (393) 394 PRACTICAL ANATOMY. toward the base ; also the ureters. The base of the blad- der rests on the second part of the rectam, is triangular in form, and measures, when the organ is moderately distended, about two and a half inches from angle to angle. Passing backward to the rectum are two folds of peritoneum, — the recto- vesical. In the female the base of the bladder is firmly attached to the cervix uteri and upper part of the vagina. The neck of the bladder is the opening leading into the urethra ; in tlie male it is surrounded by the prostate gland. The bladder is held in position by five true and five false ligaments ; the true are the two pubo-prostatic, the two lateral, and the urachus ; the false are the two lateral, the two posterior, and the superior, and are formed by the peritoneum. The bladder has four coats, — serous, muscular, cellular, and mucous. The serous coat is derived from the peritoneum ; it covers the posterior surface of the bodyand summit and the upper part of the base. The muscular coat consists of longitudinal and circular planes of fibres. The oblique muscles of Bell are delicate bands which pass across the openings of the ureters and are inserted near the neck of the bladder. The cellular coat is loose, and connects the muscular with the mucous coats. The mucous coat is thin, of a pinkish color, and when the organ is distended it is thrown into numerous folds or wrinkles. The epithelium is flat and squamous on the surface, columnar and transitional deeper down. Numerous racemose glands are found imbedded in the mucous membrane. At the base of the bladder is the triangle ; the ante- rior angle is at the opening of the urethra, the posterior angles at the openings of the ureters. The triangle is smooth, and closely adherent to the muscular coat. It is not thrown into wrinkles. At the opening of the urethra THE MALE URETHRA. 395 is a slight elevation of the mucous membrane, called the uvula. The arteries of the bladder are derived from the internal iliacs, the nerves from the hypogastric plexuses. THE MALE URETHRA. The male urethra is a canal, from eight to nine inches long, which runs tli^'ough the corpus spongiosum of the penis. It is divided into a prostatic, membranous, and spongy portion. The prostatic is the widest and most dilatable part. The urethra passes through the gland, in the middle line, above its centre. It meas- ures about one and one-quarter inches in length ; its transverse section forms a curve through the prostate, the convexity being upward. The following points are presented in the prostatic urethra. The veru montanum is a linear elevation of the mucous membrane on the floor of the prostatic portion. It becomes much distended during the erection of the penis, and prevents the regur- gitation of the semen. On either side of the veru mon- tanum is a sinus, upon the floor of which open numerous prostatic ducts. At the anterior part of the veru mon- tanum is the sinus pocularis, within which open the ejacu- latory ducts. The membranous portion is that part of the urethra between the two layers of the deep perineal fascia ; it measures three-quarters of an inch along the upper and one-half of an inch along the inferior portion. It is encroached upon inferiorly by the prostate, and curves beneath the subpubic ligament. The spongy portion, about six inches in length, terminates at the meatus urinarius. The bulb of the urethra is the commence- ment of the spongy portion of the canal ; it is dilated, and rests on the anterior surface of the anterior leaflet of the deep perineal fascia, called the triangular ligament. Near the termination of the urethra is the fossa navicu- 396 PRACTICAL ANATOMY. laris, — an expanded portion of the canal. The meatus is the smallest part of the urethra ; it is a vertical, slit- like opening, which hecomes elliptical when distended by the passing column of water. It is about one-quarter of an inch long, and is bounded laterally by two slightly- developed labia, joined by delicate comraissures. The mucous membrane of the urethra is continuous with that of the bladder, and externally with that of the glans. In the non-distended state the spongy and mem- branous urethra is tlirown into longitudinal folds, and a section exhibits the urethra as a transverse slit, with its walls in contact. In the glans penis the flaccid urethra is a vertical slit. The entire urethral mucous membrane is studded with minute, tubular, mucous glands, known as the glands of Littre. One of these glands, called the lacuna magna on account of its size, is situated on the upper wall of the fossa navicularis. The epithelium is squamous and transitional, and columnar in the fol- licles and ducts. The muscular coat of the urethra con- sists of two layers, — an outer longitudinal and an inner circular. Their use is to expel the last drops of urine evacuated from the bladder into the urethra ; they prob- ably also assist in the ejaculation of the semen. THE PROSTATE GLAND. The prostate gland surrounds the neck of the bladder. It resembles a horse-chestnut in size and form, and is placed behind the symphysis pubis, and rests on the ante- rior wall of the rectum. Its broadened base surrounds the neck of the bladder. Its apex encroaches on the mem- branous urethra. It weighs about half an ounce ; is about one inch long, one and one-quarter inches broad, and three-fourths of an inch thick, and consists of two large, svmmetrical, lateral lobes and a small central lobe. THE PENIS. 397 The prostate is pierced by tlie ejaculatory ducts and urethra. The ducts empty anterior to the veru montanum, on the floor of the prostatic uretlira. The prostate is of a irravish color, and consists of a stroma of involuntary muscular tissue and some connective tissue. It is invested by a tibro-muscular capsule. A muscular investment is also given to the urethra, as it runs through the prostate. In the alveoli of the sponge-work of muscle and some fibrous tissue is the glandular substance of the prostate. It is composed of dilated follicles, which empty hito ducts. They open on the floor of the prostatic urethra. The prostate undergoes changes at different ages; thus, it is relatively slightly developed in infancy, and very apt to undergo great enlargement at old age, and may become infiltrated with small calculi of organic matter and car- bonate of lime. cowper's glands. Between the two leaflets of the deep perineal fascia are Cowper's glands, each about the size of a pea. They are of a grayish color, and each has a duct which opens on the floor of the bulbous urethra. THE PENIS. The penis is the genito-urinary organ, composed of erectile tissue. Its lower portion transmits the urethra. It presents for examination a root, a body, and the glans. The root consists of two crura, which are attached to the ascending rami of the ischia and descending rami of the pubes. Anterior to the symphysis pubis they join and form the corpora cavernosa. A fibrous ligament passes down from the pubes and constitutes the suspensory ligament of the penis. The body of the penis is that portion between the root and the glans. In the flaccid state it is cylindrical and pendent ; in the erected state it 398 PRACTICAL ANATOMY. is trilateral or prismoidal in form and firm and erect in position. Its upper surface is broad, and is called the dorsum. The skin of the penis is very thin and loosely attached to the underlying structures ; at the gians it be- comes reduplicated, forming a cuff of skin, which covers the glans, and is called the prepuce. The superficial fascia rarely contains any fat-vesicles except at advanced age. The glans penis is covered by mucous membrane, which also lines the inner surface of the prepuce. The extremity, or glans, is _ fashioned like a horse-chest- nut, with its broad base attached to the body of the penis. At the apex of the glans is the vertical meatus urinarius. At the inferior part is the frsenum, a fold of mucous membrane between the labia of the meatus and the prepuce. The glans presents a rounded border, the corona ; behind this is the cervix, which is provided with numerous sebaceous follicles, the glands of Tyson, which secrete sebaceous matter having a strong odor. The penis is formed of the two corpora cavernosa above and side by side, and the corpus spongiosum be- neath, in the groove between the corpora cavernosa. The corpora cavernosa are two cylindrical structures, which consist of an exterior fibrous coat, from the inte- rior of which trabeculae pass off and form a fibrous sponge-work or net-work, which contains the erectile tissue in its meshes. The two corpora cavernosa are but imperfectly separated by an incomplete septum, called the pectiniform septum. Erectile tissue consists of a plexus of anastomosing veins or venous sinuses, which, when filled, entirely distend the meshes in the fibrous sponge- work of the corpora cavernosa. During active erection the blood in the sinuses is arterial and bright-red. In the flaccid state of the organ the blood is dark in color. The veins terminate principally in the dorsal vein, AA^hich THE TESTES. 399 pierces the suspensory ligament and empties into the prostatic and pelvic plexuses. The corpus spongiosum commences in front of the triangular ligament as an enlargement called the bulb. It incloses the urethra, and lies beneath and between the two corpora cavernosa. Anteriorly it becomes much expanded, and forms the glans, which is applied against the anterior blunt ends of the corpora cavernosa. The arteries of the penis are derived from the internal pudics and are distributed to the trabeculte of the corpora cavernosa and empty into the sinuses. The artery of tlie bulb, also a branch of the internal pudic, supplies the corpus spongiosum. THE TESTES. The testes are two ovoidal organs, which secrete the semen ; they are developed in the abdominal cavity, but about birth descend, through the contraction of a fibrous structure, — the gubernaculum, — into the scrotum, — a fibro-serous pouch or bag which hangs behind and below the penis. The scrotum is divided into sym- metrical hah'cs by the raphe ; the skin and underlying dartos are pigmented, and present numerous short, stiff hairs and sebaceous follicles ; it is thrown into a great number of rugae by the contraction of the involuntary muscular fibres in its structure. From the inner surface of the dartos a septum is given off, which divides the scrotum into two pouches, within which the testicles lie. invested by the intercolumnar fascia, cremaster muscle and fascia, the infundibuliform process of the transverse fascia, and the tunica vaginalis. The intercolumnar fascia is a thin, delicate lamina, carried in front of the testicle as it passes through the external inguinal ring ; the cremaster muscle and fascia are derived from the lower border of the internal oblique and transversalis ; the transverse fascia -ICO PRACTICAL ANATOMY. invests the cord, having been carried before the testis in its descent. The tunica vaginahs is a fold of peritoneum pushed before the testis ; after birth its connection with the abdominal peritoneal cavity is obliterated. It invests the testicles and lines the interior of the scrotal pouch. The testes are suspended by the spermatic cord, which are formed of arteries, veins, nerves, lymphatics, and the Fig. 171.— Spermatozoa. 1, human fX 60il), the head seen from the side : 2, on edge : k, head ; m, middle piece ; f, tail ; e, terminal filament ; 3, mouse ; 4, bothriocephalus latus ; 5, deer ; 6, mole ; 7. gi'een woodpecker; 8, black swan; 9, from a cross between a goldfinch (m) and canary (f) ; 10, cobitis. vas deferens or excretory duct of the testicle. These structures conjoin at the internal abdominal ring, and pass along the inguinal canal to the testis. The testes are ovoidalin form, about one and three-fourths inches long, and weigh about an ounce each, and each is surmounted by a tail-like body, — the epididymis, — which consist of a body and the globus major (the head) above; the globus minor (the tail) below. The testis is invested THE TESTES. 401 with the tunica vaginahs, — a serous sac derived from tlie peritoneum. The tunica albuginea is the white, fibrous, investing structure of the testis ; it sends off fibres from the upper surface of the testicle, forming an incomplete septum, and also trabeculse, which support the glandular structure. The tunica vasculosa consists of a plexus of capillaries, which lines the inner surface of the tunica albuginea. The testes are tubular glands ; the tubuli are highly convoluted, each about eight feet in length, and about five hundred in number; they are about y|^o i^^^h in diameter, and consist of a basement membrane, upon which are several layers of cells ; the cells of the inner- most layer become fibrillar, and undergo transformation into the spermatozoa, which are simply modified epithe- lial, ciliated cells. The tubules, in groups of from three to five, are in- closed in delicate fibrous tissue, derived from the tunica albuginea ; each group constitutes a lobule ; near the ter- mini of the tubules they become straight, and unite to form twenty or thirty larger ducts, each about one- fiflieth inch in diameter, wliicli run along the upper border to the head of the epididymis ; these larger ducts are called the vasa recta and unite so as to form about fifteen vessels, which perforate the tunica albuginea and become convoluted, forming the globus major of the epi- didymis. Each convolution of the globus major con- sists of a tubule six or seven inches long, and these open into a large, single, highly-convoluted tube, which forms the body and globus minor of the epididymis. So extraordinary are the convolutions of the tube forming the body and tail of the epididymis, that it measures, wlien carefully unraveled, about twenty feet. The globus minor terminates in the vas deferens. It is a strong, fibrous duct, which feels not unlike a whip-cord, and is 26 402 PRACTICAL ANATOMY. about one-eighth inch in diameter, and passes up the spermatic cord to the internal abdominal ring; it then descends into the pelvis, at the side of the bladder, to its base, where it runs along the inner side of the semi- nal vesicle ; here it becomes much enlarged and saccu- lated ; it then becomes contracted, unites with the duct of the seminal vesicle, and forms the ejaculatory duct, w^hich opens on the floor of the prostatic urethra, in front of the veru montanum. THE SEMINAL VESICLES. The seminal vesicles are two tubular saculated struct- ures which serve as reservoirs for the semen. They are situated against the base of the bladder. Each sac is about two and one-half inches long and one-third of an inch in width. They consist of a single convoluted tube having a series of pouches or alveoli. When uncoiled each seminal vesicle is found to be a long tube about one- twelfth of an inch in diameter and five inches long. It terminates in a narrow duct, which joins the vas deferens to form the ejaculatory duct, which is about an inch long and opens in front of the veru montanum. The seminal vesicles have an outer fibrous, a middle muscular,, and an internal mucous coat. The mucous membrane of the vasa recta and epididymis is of the ciliated variety; throughout the vas deferens and ejaculatory duct it is of the columnar varietv. THE FEMALE ORGANS OF GENERATION. The female organs of generation are divided into external and internal. The external are the mons veneris, the labia majora, the labia minora, the clitoris, meatus urinarius, vaginal orifice, — all comprised under THE FEMALE ORGANS OF GENERATION. 403 the name of vulva. The mons veneris is a cushion of fat placed above the piibes. It is covered with hair. The labia majora are two folds which elliptically surround the genito-urinary fissure. They are continuous above, but become less marked as they descend. They are con- nected posteriorly by the posterior commissure. The skin of the labia is pigmented, covered by short hair, and is lined internally by mucous membrane. Stretched between the posterior extremi- ties of the labia is a delicate fold of mucous membrane, the fourchette. The depression between it and the posterior commissure is called the fossa navicularis. The labia minora are two well-marked folds of mucous membrane which pro- ject from the inner border of each labium and are continu- ous with one another across the clitoris, where they sepa- rate into two layers inclosing the clitoris, forming its pre- puce. They are entirely defi- cient at the posterior third of the genital fissure. Tliey con- sist of mucous membrane inclosing erectile tissue. They are abundantly supplied with mucous and sebaceous glands. The clitoris is situated in the median line, below tlie junction of the labia majora anteriorly and between the labia minora. It arises by two crura from the rami of the ischium and pubes, and consists of two adjoining corpora cavernosa surmounted by a glans. Fig. 172.— The Vulva. 1. labia majora; 2. fonrchette ; .S, labia minora; 4, clitoris: 5, meatus urinarius: 6, vestibule; 7, orifice of vagina; H. hymen; 9. oriftcc of duct of vulvo-vaginal giand ; 10, anterior commissnre; II, anus. 404 PRACTICAL ANATOMY. It is bound down by the labia minora, and when erected simply advances toward the vaginal orifice. Below the clitoris is a triangular space called the vestibule, at the lower part of which, about three-fourths of an inch below the clitoris, is the meatus urinarius. It presents, as a rule, a prominent border. Below the meatus is the vaginal orifice, which is partially closed in the virgin by a thin, membranous fold called the hymen. This structure is commonly a semilunar fold stretched across the opening posteriorly, but it may be a diaphragm with a central opening or a number of apertures, circular, elliptical, or linear. It may be rudimentary or immensely thickened and fibrous, and its absence or destruction is never to be taken as a test of the chastity of the indi- vidual. After its rupture, small, nodular elevations surround the vaginal orifice called the myrtiform car- uncles. The glands of Bartholine are situated at the sides of the vagina near its orifice. They are about the size of a pea and open by long ducts anterior to the vagina, close to the meatus. Below the mucous membrane of the vestibule is a quantity of erectile tissue arranged in the form of two bulbs connected by an intermediate por- tion. The pelvic or internal genito-urinary organs are the bladder, urethra, vagina, uterus. Fallopian tubes, ova- ries, and associate parts. THE URETHRA. The urethra is a membranous canal about one and a half inches in length. It extends from the neck of the bladder to the meatus. It runs in the anterior wall of the vagina, is about one-quarter of an inch in diameter, but highly distensible, and has three coats, — muscular, 'erectile, and mucous. The erectile coat is analogous to the corpus spongiosum of the male. THE VAGINA. 405 THE VAGINA. The vagina is a curved cylindrical canal which ex- tends from the vulva to the uterus. It is about four inches along the anterior and six inches along the pos- terior wall, and is attached above to the cervix uteri. Its orifice is the most constricted portion. It presents three coats, — erectile, muscular, and mucous. The Fig. 173.— Natural Position of the Pelvic Organs, with Full Bladder. erectile coat consists of an abundant venous plexus, supported by connective tissue. The muscular coat has an outer circular and an inner, thick, longitudinal layer of fibres. The mucous membrane is loosely attached to the muscular coat, presents anteriorly and posteriorly a vertical column, from which pass off numerous transverse rugae. They are all obliterated when the organ is dis- tended. The epithelium of the vagina is of the squa- 406 PRACTICAL ANATOMY. mous variety. The vagina is interposed between the bladder and rectum. It corresponds to the axis of the pelvis, but is a movable organ, and its position is influ- enced by the degree of distension of either the bladder or rectum. On section, its walls are seen to be in con- tact, and it appears as a transverse slit. THE UTERUS. The uterus is the organ of gestation. It is a mus- cular organ, having thick walls and a small cavity. In the virgin, it is pear-shaped and sets in the upper portion of the vagina as a cork in the neck of a bottle. It is slightly flattened antero-posteriorly. Its upper broad end pre- sents forward and up- ward; its lower end is directed downward and backward, and forms an angle with the vagina. It is one inch thick, two inches broad, and three inches long. Its walls are about half an inch thick, and it weighs about one and a half ounces. It is divided into a fundus, body and neck. The fundus is the upper portion of the organ. It is broad, convex, and covered by peritoneum. The body may be said to represent the frustum of a cone, which begins at the fundus and narrows toward the cervix. Anteriorly its upper part is covered by peri- toneum, which also covers the posterior surface of the body. Laterally it aff'ords attachment to the Fallopian Fig. 174.— Internal Genital, Organs. U, \iterus (anterior surface) ; O O', ovaries ; P P', fim- briae ; C, intra-vagiual portion of cervix ; K R', round liga- ments ; V V, vagina laid open; L L', broad ligaments; M, ovarian ligament; T T', Fallopian tubes. THE UTERUS. 407 tubes, ligaments of the ovaries, and tlie round ligaments. The vessels ascend at the sides of the body. The cervix, or neck, is the constricted portion around which is attached the vagina. The inferior extremity of the uterus presents in the upper part of the vagina. At its centre is the OS uteri, which is the outlet of the uterine canal. It is a transverse opening, about the size of a flattened straw. The os is bounded by the anterior short and thick lip, and the posterior long and narrow lip. The uterus is held in place by three pairs of ligaments, formed by the peritoneum : two anterior, the utero-vesical ; two poste- FiG. 175.— Internal Genital Organs, showing Cavity of Uterus and Fallopian Tubes. A. fundus : B. cavity of body of tlie uterus : O. cavity of cervix ; D D, canals of Fallo- pian tubes cut open t E E, fimbriated extreuiities laid open ; F F, ovaries, with Gr.ialiaa follices ; G, cavity of vagina; H H, ovarian ligaments; G G, round ligaments. rior, the utero-rectal, which form the lateral boundaries of Douglas's cul-de-sac ; and the two lateral, or broad ligaments, attached to the sides of the uterus. They pass outward to the sides of the pelvic cavity, dividing it into an anterior and posterior portion. The cavity of the uterus is divided into the cavity of the cervix and the cavity of the body, each about one and a quarter inches long. The cavity of the cervix is fusiform in shape, and communicates with the cavity of the body through the ostium internum. The mucous membrane along the anterior and posterior walls of the cavity of the cervix presents longitudinal columns, from which j)ass 408 PRACTICAL ANATOMY. oblique folds. The entire arrangement is designated the arbor vitae uterina. The cavity of the body is triangular, flattened from front to back, and communicates with the cavity of the cervix at the inferior angle by the ostium internum. The superior angles lead into the Fallopian tubes, the orifices being each about the diameter of a bristle. The anterior and posterior v^^alls are in contact. The uterus has three coats, — serous, muscular, and mucous. The serous coat is derived from the peritoneum, which invests the posterior surface of the body, passes over the fundus, and descends as far as the upper half of the anterior surface of the body, whence it is reflected on the bladder. The muscular coat, composed of involuntary fibres, is about one-half inch thick, and disposed in three layers, the ex- ternal consisting of a plane of fibres, which cover the organ. These Fig. 176.— Section of Utekus Through fibres COnverffC 3.t the THE Ostium Internum. o angles and form the round ligaments, some fibres passing over the Fallopian tubes and the ligaments of the ovary. The superficial plane of muscular fibres is an erectile plane, and assists in disposing the organ in a position favorable to fecundation. The middle layer is thick and irregular in distribution. The inner layer consists of two spiral laminae arranged around the superior angles and the openings of the Fallopian tubes, for which they form a sort of sphincter. The mucous coat adheres closely to the muscular coat ; it is continuous with the mucous membrane of the Fallopian tubes and the vagina. In the cavity of the body it is ciliated, but only a few ciliated epithelia are found in the cavity of the cervix, where the prevailing epithe- THE OVARIES. 409 lium is columnar. Great numbers of mucous follicles are imbedded in the mucous membrane of the uterus. Sometimes they become closed and then distend, forming slight elevations, called the ovula of Nabotli. The uter- ine arteries are remarkably tortuous, and anastomose freely. The veins are sinuses which channel the sub- stance of the organ. The uterus is extraordinarily sup- plied with sympathetic nerves. These form multiple ganglia in the substance of the organ. FALLOPIAN TUBES. The Fallopian tubes transmit the ova from the ova- ries into the cavity of the uterus. They are two tubes, each about four inches long, which extend transversely outward from the superior angles of the uterus. They are inclosed within the free border of the broad liga- ment, and terminate externally in an expanded opening, the ostium abdominale, surrounded by fringe-like proc- esses,— the fimbriae. The tube has three coats, — serous, from the peritoneum, muscular, and mucous. The last is thrown into numerous longitudinal folds, and is cov- ^ ered by ciliated epithehum. THE OVARIES. The ovaries are two almond-sized and shaped bodies, situated in the broad ligament and attached to the outer extremity of the Fallopian tube by one of the fimbriae and by the other end through the ligament of the ovary to the angle of the uterus behind the Fallopian tube. They are of a yellowish color, slightly irregular on their surface. Each ovary is composed of a loose, fibrous investment, from which is derived the stroma or sponge-work of the ovary, and in the meshes of which are the Graafian vesi- cles. The stroma consists of fibro-muscular structure, vessels, and nerves. A Graafian vesicle, when mature. 410 PRACTICAL ANATOMr is about the size of a pea, consisting of two coats, — an outer fibro-vascular and an inner, called the ovi capsule, and which is lined hy a layer of cells. These at a certain place accumulate and form a bed, the discus proligerus, in which the ovum is imbedded. The ova are formed by the involution of the germ epithelium from the surface of the ovary. They are gradually inclosed by the stroma and removed from the surface. Fig. 177.— Section of an Ovaey. e, germ epithelium ; 1, large-sized follicles ; 2, 2, smaller-sized follicles ; o, ovum within a Graafian follicle ; t, t, blood-vessels of the stroma ; g, cells of the membrana granulosa. The ovum is a perfect cell, having a thick cell-wall, nucleus, and nucleolus. It is about j^-^ inch in diameter. Its cell-wall is called the vitelline membrane; it is broad, clear, and shining, and appears as a bright ring ; the dark, granular contents are known as the vitellus, or yelk, and within this is imbedded a bright, clear nucleus, about one-fourth the diameter of the ovum. It is called the germinal vesicle, and contains a dark nucleus, — the germinal spot, which measures about ^^-Vo inch in diam- eter. Before puberty the Graafian vesicles are undevel- THE MAMMARY GLANDS. 411 oped, and scattered profusely through the ovary. They measure about j^-^ inch in diameter. At puberty they begin to mature, approach the surface of the ovary, and burst. The ruptured vesicle becomes distended with blood, forming the corpus luteum, which is a yellowish scar left after the rupture of the vesicle. This process is repeated in the human subject, during her menstrual life, regularly \inder normal conditions every twenty-eight days until interrupted by fecundation. Lying near the ovaries is the organ of Rosenm tiller, — a relic of foetal life. The round ligaments are attached to the angles of the uterus in front of the Fallopian tubes ; they are about four inches and a half long, and run along the inguinal canal, to become lost in the structure of the labia majora. The ligament of the ovary is formed of muscular fibre, and is attached to the superior angle of the uterus behind the Fallopian tubes. THE MAMMARY GLANDS. In the female the mammary glands are two large hemispherical structures placed upon the anterior part of the chest between the third and the seventh ribs. They undergo remarkable development at puberty, in- crease in size during pregnancy, and subserve the func- tion of lactation. They are surmounted by a conical structure, — the nipple. The skin of the nipple, and for some distance surrounding it, is deeply pigmented and abundantly provided with large sebaceous follicles. The gland-tissue of the mammse consists of lobes, these of lobules, these of clusters of vesicles. They are lined by epithelium which, during lactation, undergoes fatty change. The vesicles empty into minute tubuli, these into larger, and finally converge to form from fifteen to twenty ducts that open on the surface of the nipple. 412 PRACTICAL ANATOMY. They form slight dilatations, which become milk reser- voirs. Between the lobes of the mammee is a large amount of fat. The lobules are held together by con- nective tissue. The breasts are abundantly supplied with blood. SPECIAL SENSES. THE EYE. The eye is the organ of sight. It is placed in the orbital cavity, which protects it from injury. The eye- ball is movable in all directions by the muscles attached Fig. 178.— Diagram of a Horizontal Section Through the Human Eye. 1, cornea ; 2, sclerotic ; 3, choroid ; 4, ciliary processes : 5, suspensory ligament of lens : 6, so-called posterior chamber between the iris and the lens : 7, iris ; 8. optic nerve : 8', en- trance of central a'tery of retina; 8". central depression of retina, or yellow spot; 9, anterior limit of retina ; 10. hyaline membrane; U, aqueous cli.amber; 12, crystalline lens; 13, vitEBOos humor; 14, circular venous sinus which lies around the cornea ; a a, antero- posterior, and b b, transverse axes of bulb, to it, and is capable of a wide range of vision. It is imbedded in a quantity of loose fat, from which it is separated by a flattened serous sac, — the capsule of Tenon. The eyeball consists of the segments of two spheres, — a smaller anterior, constituting one-sixth, and (413) 414 PRACTICAL ANATOMY. a larger posterior portion, which forms five-sixths of the eyeball. The eyeball measures twenty-five millimetres antero-posteriorly, twenty-four millimetres transversely, and twenty-three millimetres vertically. It is held in place by the optic nerve, muscles, and palpebral struc- tures. The optic nerve enters the posterior portion of the eyeball a trifle to the nasal side of the centre ; it pierces the two outer coats, and expands to form the retinae. The visual axes of the eyeballs are parallel ; the axes of the orbits diverge. The eyeball presents three coats or tunics, — the outer, formed by the sclerotic and cornea; the middle, formed by the choroid, ciliary processes, and the iris; and the inner, called the retina. The refracting media are the vitreous and aqueous humors and the crystalline lens. The accessory refract- ing media are the cornea and capsule of the lens. THE SCLEROTIC. The sclerotic is a dense, white, fibrous structure which invests the posterior five-sixths of the eyeball, and serves to maintain it in form. It is thicker at the posterior part, where it presents numerous foramina for the trans- mission of vessels, and called the lamina cribrosa. It is about one millimetre in thickness, smooth externally, grooved internally by the ciliary nerves. The cornea is the transparent segment which forms the anterior one- sixth of the eye. It is about one millimetre thick, non- vascular, almost circular, and sets in the anterior margin of the sclerotic like the crystal of a watch on its case. It is composed of five layers, — the outer, the conjuncti- val mucous membrane, formed of flat, transitional, and columnar cells ; the second, or anterior elastic lamina, composed of dense fibrous tissue, and measures about TTo'o ^"^^^ ^^^ thickness ; the central layer, or true cornea, THE CHOROID. 415 is continuous with tlie sclerotic, and is formed of fifty or sixty loosely-woven layers of fibrous tissue lield togetlier by a cement substance. In the meshes of these lamellae are the corneal spaces, containing- connective-tissue cells. Tlie posterior elastic lamina is a brittle, homogeneous structure about y qV o ^^^^^^ ^^^ thickness. When fractured, its tendency is to roll inward. The internal epithelial layer consists of a single layer of fiat cells lining the posterior surface of the cornea. THE CHOROID. The choroid is the vascular tunic of the eye ; it is attached to the sclerotic by delicate connective tissue, — the lamina fusca, — and invests the posterior, five-sixths of the eyeball ; it terminates abruptly at tlie ciliary liga- ment, and divides, forming the iris and ciliary processes. The choroid is formed of an outer, coarse, vascular, and an inner capillary layer, containing scattered pigment cells. Posteriorly it is pierced by the optic nerve. The ciliary ligament is a band of involuntary muscular fibres, about three millimetres in width, thicker in front than behind, and attached to the anterior portion of the cho- roid, to tlie anterior margin of the sclerotic, and inter- nally to the iris and ciliary j)rocesses. The iris is a circu- lar, vertical, miiscular, perforated curtain, suspended between the cornea and crystalline lens ; it presents an anterior and posterior surface, and the perforation or pupil. The surfaces are covered by flat cells, continuous with the endothelial lining of the cornea. A few fibres pass at intervals from the posterior elastic lamina of the cornea; they constitute the pectiniform ligament of the iris. The spaces between these fil)res are the spaces of Fontana. These communicate with a circular sinus, — the canal of Schlemm, — which runs near the junction 416 PRACTICAL ANATOMY. of the ciliary ligament with the sclerotic. The posterior surface is of a deep-purple color, which is due to a layer of pigment-cells, and is called the uvea. The iris is formed of circular and radiating fibres, and, when viewed poste- riorly, the arrangement resembles a wheel ; the circular or sphincter fibres are arranged hub-like around the pupil, the dilator fibres spoke-like from the pupil to the circumference. The hub fibres of the iris surround the pupil and form its sphincter, which is supplied by the third nerve ; the spoke fibres dilate the pupil ; they are supplied by the sympathetic. The ciliary processes are sixty to eighty minute, pointed processes, each about one- tenth inch long, and formed by an involution of the deeper layer of the choroid. They form a pigmented band, which rests upon and impresses the anterior sur- face of the suspensory ligament of the lens ; these im- pressions are frequently pigmented, and constitute the zone of Zinn. THE RETINA. The retina is the nervous tunic of the eyeball ; it is formed by the expansion of the optic nerve, and termi- nates anteriorly, in an irregular, frayed-out margin, — the ora serrata. The retina presents the optic disk, the entrance of the optic nerve, and which is pierced by the arteria centralis. Vision at this point is wanting. About one-tenth inch to its other side, and at the prin- cipal focus of the rays of light, is the yellow spot of Sommering ; at this point vision is most acute. The retina here is very thin, and is formed mainly by the close grouping of the cones. At the centre of the yellow spot is a depression, — the fovea centralis. The retina is composed, from without inward, of the following ten layers : — • 1. The pigmentary layer is applied to the choroid; THE RETINA. 417 it consists of a pavement of accurately-joinled hexagonal pigmented cells. 2. The layer of rods and cones, or Jacob's mem- brane, consists of rods and cones, arranged perpendicu- larly to the surface. They each consist of an inner and outer segment, connected together by a cement sub- stance. The outer segments arc transversely striated, the inner segments striated and granular. 3. External limit- ing membrane, a lam- ina of cellular tissue. 4. Outer nuclear layer, consisting of bipolar cells trans- ^Trsely striated, called rod granules. They are connected by one extremity with a rod ; the other enters the outer molecular layer. The cone -granules, less in number, are multipolar, nucleated cells, which are con- nected by numerous processes with the cone, and terminate internally in a single pole, which passes into the outer molecular layer. 5. The outer molecular layer consists of a net-work of delicate fibres, with some ganglion cells. It has a granular appearance. 6. The inner nuclear layer consists of bipolar, nuclear cells, the poles of which communicate with a ganglion cell and a rod or cone. 27 Fig. 179.— Diagram of the Formation OF TiiK Retina. N, optic nerve ; K, retiua ; p, pigment layer ; c, choroid. 418 PRACTICAL ANATOMY. 7. The inner molecular layer is a thick layer, gran- ular in appearance, which is formed of a dense net-work of fibres, imbedded in which are some ganglion cells. 8^ Ganglion cell-layer, a single layer of large flask- shaped cells, having an inner pole, which communicates with an optic-nerve fibre, and several external branched poles, which pass into the inner molec- ular layer. 9. Optic-nerve fibre- layer consists of a layer of naked axis-cylinders, which pierce all the other layers of the retina. They radiate from the disk, and also form fre- quent plexuses. Some communicate with the ganglion cells, others pass outward through the molecular layer. 10. The membrana limitans interna is formed of cellular tissue. The retina is sup- ported by a connective- tissue stroma, arranged between the internal and external limiting membranes. Between these pass columns of connective tissue, from which pass off" skeletal supporting fibres. The Humors of the Eye. — The aqueus fills both the anterior and posterior chambers of the eye. It contains a trace of chloride of sodium, is alkaline in Fig. 180.— Vertical Section op Human Retina. a, rods and cones ; b, external, j, internal limiting membranes; c, external, and f, internal nuclear layers ; e, external, and g, internal granular layers; k, blood- vessel and nerve-cells ; i, nerve-fibres. THE HUMORS OF THE EYE. 419 reaction, and weighs about four grains. The anterior chamber is bounded in front by the cornea, behind by the anterior surface of the iris. Tlie posterior chamber is hmited in front by the iris, behind by the suspensory hgament and cihary processes. In the foetus a dehcate mem- brane, the membrana pupil- laris, is stretched across the pupil. It becomes absorbed about the seventh month. The vitreous humor is in- closed in a sac called the hyaloid membrane. It fills the posterior four-fifths of the eyeball. It is transparent, albuminous, and slightly gelatinous. Anteriorly it is concave, and accommodates the crystalline lens. A leaflet of the hyaloid membrane passes to the margin of the lens, forming its suspensory ligament. The interval be- tween this and the lens forms a canal, the sinus of Petit. In the foetus very delicate septa are found throughout the vitreous humor. Run- ning through the centre of the vitreous is the canal of Stilling, formed by the hya- loid membrane. The crystalline lens is a biconvex, plastic body, in- vested by a capsule. It is placed behind the pupil, and rests in a depression in tlie vitreous humor. In front it Fig. 181.— Layers of the Retina. Pi. hexagonal pigment cells ; St, rods and cones: Le. e.xternal limiting membrane ; iinK. e.xternal nviclear layer ; augr, e.Nternal granu- lar layer: inK. internal nuclear; ingr, internal granular : Ggl. ganglionic nerve-cells : O. fibres of optic nerve : Li. internal limiting mem- brane ; Rk. tibres of Miiller : K, nuclei ; Sg, spaces for the nervous elements. 420 PRACTICAL ANATOMY. is in. contact with the iris. Its margin is overlapped by the ciliary processes. The capsule is a homogeneous membrane, about -g-oVo" inch thick, which, when rup- tured, has a strong tendency to roll inward. It is separated anteriorly from the lens proper by a single layer of transparent cells, which after death absorb moisture, become cloudy, forming the liquor Morgagni. The lens is about one-third of an inch transversely and one-quarter of an inch thick. It is an albuminoid struc- ture, formed of numerous laminge, soft externally, be- coming firmer, and inclosing a hard nucleus. The laminae consist of hexagonal prisms, with serrated edges, accurately adjusted to each other. Each prism measures about g^oVo" ^^^^ ^^ thickness. They are ar- ranged to form three segments, — best demonstrated by immersing the lens in strong alcohol. The appendages of the eye are the orbital muscles, — described in the earlier part of the book, — the eyelids and eyebrows, the conjunctiva, lachrymal gland and sac, and nasal duct. The eyelids are two thin folds placed in front of the eye. The upper is the larger and more movable. When the lids are separated they disclose an elliptical fissure the angles of which are called the canthi. At the outer canthus the lids are joined at an acute angle. The inner canthus presents a triangular notch called the lacus lacrymalis. At the commencement of the lacus is a rounded elevation on each lid ; upon the surface of each opens the punctum lacrymale. The eyelids are composed of skin, cellular tissue, the fibres of the orbicularis palpebrarum, tarsal carti- lages and ligaments, Meibomian glands, and conjuctiva. The upper lid presents, also, the aponeurosis of the levator palpebrae superioris. The skin is very thin, the THE APPENDAGES OF THE EYE. 421 cellular tissue lax, and contains no fat. The palpebral fibres of the orbicularis are thin, pale, and more movable than the rest of the muscle. The tarsal cartilages are two thin, crescent-shaped fibroid structures, each about one inch long-, placed on the free margin of the lids, along which they present a nearly straight, thick edge. Ex- tending between the outer extremities of the tarsal carti- lages are ligamentous fibres which are attached to the malar bone. The inner extremities are attached to the nasal and lachrymal bones by the tendo oculi. The fibrous aponeurosis of the lids extends between the border of the tarsal cartilages beneath the orbicularis palpebrarum to the circumference of the orbit. The Meibomian glands are situated between the con- junctivae and the fibrous aponeurosis of the lids. They are about fifty in number in both lids, less in the lower than in the upper, and resemble miniature strings of beads. They are disposed parallel to each other and open on the free edge of the tarsal cartilage, which they groove. They are compound sebaceous glands. The eyelashes or cilia are short, strong, curved hairs which form a fringe to each lid. They are arranged in a double or triple row and curve outward. The eye- brows are two curved elevations of the skin above each orbit and are covered with hair. The conjunctiva lines the under surface of the eyelids and is reflected over the anterior part of the sclerotic and cornea. It is a mucous membrane, thick and vascular over the lids, loosely connected to the sclerotic ; non- vascular and very thin on the cornea, but everywhere abundantly supplied with nerves. The plica semi- lunaris is a fold of the conjunctiva at the inner canthus, at the outside of tlie caruncula lacrymalis, which is tlie rounded, red elevation in the lacus lacrymalis. 422 PRACTICAL ANATOMY. The lachrymal gland is situated in a depression at upper, outer angle of the orbit. It is about the shape and size of the kernel of a small almond, and resembles the salivary glands in structure. It has about ten short ducts which open upon the upper, outer part of the conjunctiva. The lachrymal canals begin in the papilla lacrymalis at the puncta and lead into the canaliculi, w^hich pass inward and terminate in the lachrymal sac. The lach- rymal sac is situated anteriorly to the lachrymal ridge on the lachrymal bone. It is the upper dilated portion of the nasal duct. Anteriorly it is covered by the tensor tarsi muscle and an aponeurosis from the tendo oculi. The nasal duct is a fibro-membranous canal about one inch long, which opens into the inferior nasal meatus. THE EAR. The ear is the organ of hearing, and is divided into three parts, — the external, middle, and internal ; the external ear presents the pinna, which is formed of yel- low fibro-cartilage, folded so as to convey the vibrations of sound to the external auditory meatus. The following names have been applied to the different prominent folds : The helix is the prominent rim ; in front of this is the antihelix, and between them is the fossa of the helix ; the antihelix divides above, and incloses a slight depression, — the fossa of the antihelix; within the antihelix is a deep cavity, — the concha; the antihelix is notched below, and limited by an anterior nodule — the tragus — and a posterior nodule, — the antitragus. The inferior portion of the pinna is soft and thick and devoid of cartilage, and forms the lobule ; it is held to the side of the head by an anterior and posterior liga- ment. The muscles of the pinna are extrinsic and intrinsic. The extrinsic have been described ; they are THE EAR. 423 the attollens, attrahens, and retrahens aurem. The intrinsic muscles pass between the different parts of the pinna ; they are named tlic helicus major and minor, the tragicus and anti- tragicus, the trans- verse and the oblique. The auditory canal, or meatus auditorius externus, is also a portion of the exter- nal ear ; it extends from the concha to the membrana tym- pani, and presents an external cartilaginous and an internal osseous portion, and is, there- fore, an osseo-cartilagi- nous canal, cylindroid in form. Its vertical diameter externally exceeds the transverse at the mem- brana tympani. The transverse diameter is the greatest; it is about one and a quarter inches long, and runs forward, inward, and curves slightly upward. Its inner extremity presents a groove for the at- tachment of the tympanic membrane. This groove is complete, except the superior portion, where it is notched. The skin lining this canal is thin and tightly adherent, and externally presents a number of sebaceous i>lands, which form the cerumen, or ear-wax. Fig. 182.— External, Middle, and Internal Ear. 1, external ear ; 2, middle ear ; 3, internal ear ; 4, pinna ; 5, helix ; 6, antihelix ; 7, fossa navicularis : .S, fossa innorai- nata ; 9, tragus; It), antitragns; U, concha; 12. lobe; 13, meatus auditorius externus; 14, tympanic membrane; 1.5, promontory ; 16, foramen rotundum ; 17, posterior wall of the tympanum; l,S, ossicula auditus; 19, Eustiichian tube; 20, narrow canal, containing the tensor tympani muscle; 21, vestibule ; 22. semicircular canals, the superior, posterior, and horizontal; 23. ampulla;; 24, cochlea; 2.'>, prominence caused by the scala vestibuli ; 2t>, scala tympani. Fig. 183.— The Pinna. 424 PRACTICAL ANATOMY. THE MIDDLE EAR. The middle ear, or tympanum, is an irregular, cu- boidal cavity, situated within the petrous portion of the temporal bone. It is separated from the auditory canal by the tympanic membrane. It is traversed by a chain of bones, which convey the vibrations of sound from the tympanic membrane to the internal ear, and is filled with air and communicates with the pharynx by the Eustachian Fig. 184.— Left Tympanum and Auditory Ossicles. A. G., external meatus ; M. membrana tympani, which is attached to the handle of the malleus, n. and near it the short process, p; h, head of the malleus: a. incus: K'. its short process, with its ligament; 1, long process: s. Sylvian ossicle: S. stapes: A x, A x, the ax s of rotation of the ossicles, shown in perspective : t, line of traction of the tensor tym- pani. The other arrows show the movements of the ossicles when the tensor contracts. tube. The cavity of the tympanum is about one-sixth inch in depth, one-fourth inch vertically, and three- eighths inch antero-posteriorly. It is irregularly cu- boidal, and presents six walls for examination. The outer is formed by the membrana tympani, which is attached to a ring of bone. It presents three apertures, — the anterior and posterior, for the transmission of the chorda tympani nerve, and tlie Glnserian fissure. The posterior THE MIDDLE EAR. 425 aperture (iter chorda posterius) is about the centre of tlie angle between the outer and posterior walls of the tym- panum ; it leads into a canal, wliich terminates in tlie aquaeductus Fallopii, and serves for tlie entrance of the chorda tympani into the tympanic cavity. The anterior aperture (iter chorda anterius) opens above and in front of the ring of bone, for the attachment of the tympanic membrane ; it leads into a fine canal (Huguier), which runs parallel with the Glaserian fissure ; through it the chorda tympani leaves the tympanum. The Glaserian fis- sure, continued from the glenoid fossa, opens just below the anterior aperture for the chorda tympani ; it lodges the long process of the malleus, and transmits the laxator tympani muscle. The inner wall of the tympanum presents the oval win- dow, the round win- dow, the promontory, the pyramid, the open- ing for the stapedius, and the ridge formed by the aquaeductus Fallopii. The oval window (fenestra ovalis) leads from the tympanum into the vestibule ; it is closed by the lining membrane of the tympanum and vestibule, and has applied to it the base of the stapes. The round window (fenestra rotunda), a nearly circular openhig below and behind the fenestra ovalis ; it is placed at the bottom of a depression, and communicates with the cochlea ; it is closed by Scarpa's membrane (membrana Fig. 185.— Diagram of the ExTEENAii Sur- face OF THE Left Tympanic Mem- brane. a. head of the malleus ; b. incus ; e, joint between mal- leus and incus; between c and d is the flaccid portion of the membrane ; ax. axis of rotation of ossicles. The deeply- shaded central portion is called the "umbo." 426 PRACTICAL ANATOMY. tympaui secondaria). The promontory, in front of the fenestra rotunda, is a hollow, dome-like elevation, formed by the first turn of the cochlea ; it presents two or three grooves, for the tympanic plexus. The pyramid, cone-shaped, is placed behind the fenestra rotunda. Tt is hollow, and contains the stapedius muscle. At the apex of the pyramid is a minute orifice, which transmits the tendon of the stapedius. The aquseductus Fallopii skirts the upper and posterior por- tion of the inner wall. It contains the facial nerve. The posterior wall presents the openings of the mastoid cells. The anterior wall is separated from the carotid canal by a thin plate of bone. It presents the opening of the Eustachian tube, the processus cochleariformis, and the opening of the canal for the tensor tympani muscle. The Eustachian tube is about one and one-half inches long, and is directed downward, forward, and inward. It is an osseo-cartilaginous canal ; the osseous portion is about one-half inch in length ; the cartilaginous portion, one to one and one-half inches long, opens trumpet-like into the pliarynx. The processus cochleariformis is a thin plate of bone, which separates the Eustachian tube below from the canal above and transmits the tensor tympani muscle. The membrana tympani is an oval, translucent mem- brane, which is placed obliquely at the bottom of the external auditory canal. It presents three layers, — ex- ternal, or cuticular; middle, or fibrous; and internal, or mucous. The handle of the malleus descends between the fibrous and mucous layers to about the centre. Externally it is concave, but it changes its position slightly under the pressure of the air within the tym- panum. THE MIDDLE EAR. 427 The ossicles of the tympanum are the malleus, incus, and stapes. They constitute a chain of bones, which trans- mit the vibrations of sound from the membrana tym- pani to the internal ear. The malleus presents a head, neck, and three processes. The head articulates with the incus. The handle is the vertical process attached to the membrana tympani. The processus gracilis gives attach- ment to the laxator tympani muscle. It passes outward nearly at right angles to the handle, and lies in the Glase- Fig. 186.— I. The Mechanics of the \t ditor\ Os-,icLi.& II SECTIO^ OF THE :MIDDLE E.\R. I. a, malleas ; h, incus : am, long process of incus ; s, stapes : the arrows show the direc- tion of motion. II. G, external auditory canal ; M. t., membrana tympani ; C, tympanum ; H, malleus ; L S., superior ligament : S, stapes. rian fissure. The short process is a tubercle on the root of the handle. It gives attachment to the tensor tympani. The incus presents a body and two processes. The body articulates with the malleus. The processes are: the long and short, at right angles witli one another. The short process is attached to the posterior wall ; the long process, parallel with the handle of the malleus, terminates in the lenticular process, which articulates wdth the head of the stapes. 428 PRACTICAL ANATOMY. The stapes, or stirrup, presents a head, neck, two branches, and an oval-shaped base, which is apphed to the fenestra ovahs. The ossicula are articulated and held together by capsular ligaments. The joints are covered by cartilage and lined by synovial membranes. They are also attached to the walls of the tympanum by delicate, ligamentous bands, and are moved by the three muscles : — Tensor Tympani, Origin — Petrous portion of temporal bone. Insertion — E-uns backward in the canal above the processus cochleariformis and terminates in a tendon, which is inserted into the root of the handle of the malleus. Laxator Tympani. Origin — From the spine of the sphenoid. Insertion — E,uns backward through the Glaserian fis- sure, and is inserted on the neck of malleus above the processus gracilis. Stapedius. Origin — From within the pyramid. Insertion — Neck of stapes. The mucous membrane is reflected over the different structures within the tympanum. THE internal EAR. The internal ear consists of the osseous and mem- branous labyrinth. The osseous labyrinth contains the vestibule, semicircular canals, and cochlea. The mem- branous labyrinth presents the utricle, saccule, and membranous cochlea and semicircular canals. The os- seous labyrinth is developed in the substance of the petrous portion of the temporal bone. The cochlea is in front ; the vestibule is the central THE INTERNAL EAR. 429 communicating cavity between the cochlea and semicir- cular canals, and is in contact with the inner wall of the tympanum. It is ovoidal, and measures about one-fourth inch in its long diameter. It presents the oval window, to which the base of tlie stapes is applied. Opposite to this is the fovea hemisph8erica,a depression which lodges the saccule. At the bottom of the fovea hemisphserica are a number of foramina, forming the macula cribrosa, which transmit filaments of the auditory nerve ; also, on the inner wall, is an elevation, — the pyramidal emi- nence. The opening of the aqugeductus vestibuli is at the lower posterior part. Above the fovea hemisphserica is the fovea semi-elliptica, which lodges the utricle. The three semi- circular canals communicate witli the posterior portion of the vesti- bule by five orifices. The cochlea opens in front by an elliptical l^^^^^'T.l' llllt^^^ opening into the scala vestibuli . °f''ipe^ h, horizontal. a„d s. pos- rr,-. 1 . • 1 1 terior semicircular canals of the left ihe three semicu'cular canals side. The cochlea is seen to the left of the figure. constitute each five-sixths of a circle ; they are about one-twentieth inch in diameter, slightly compressed, so that the section is an ellipse, and at their origin each is dilated into an ampulla. They are named the superior, posterior, and external, and each canal is at right angles to the others. The superior and posterior open by a common canal; the external opens separately. The cochlea is a conical structure about one-quarter inch at the base and one-quarter inch in height. The apex is directed forward and outward and slightly down- ward. It consists of a central, tapering, tubular axis, — the modiolus, — around which is wound a spiral canal for two and a half turns. The modiolus transmits branches Fig. 187.— External, Ap- 430 PRACTICAL ANATOMY. of the auditory nerve to the cochlea ; it terminates in the apex of the cochlea (called the cupola) in a funnel- -. T ^ shaped dila- ^ ^V Nation, defi- cient at one side. The spiral canal of the coch- lea is about one and a half inches long, de- creases in size as it B ascends, and terminates in the rounded apex, — the cupola. It is about one-tenth inch in diameter, and pre- sents at its commence- ment: 1. the fenestra rotunda, which commu- nicates with the tympa- num. 2. The foramen ovale, which communi- cates with the vestibule. 3. The opening- of the aquseductus cochlea. The spiral canal is divided by an osseo- membranous partition into an upper canal, the scala vestibuli, and a lower canal, the scala tyrapani. Along the circumference of tlie lower portion of the scala vestibuli is the scala Fig. 18S.— Scheme of the Labyrinth AND Termination of the Auditory Nerve. I. Transverse section of a turn of the cochlea. II. A, ampulla of a semicircular canal : a, p, auditory cells; p. provided with a fine hair : T, otoliths. III. Scheme of the human labyrinth. IV. Scheme of a bird's laby- V. Scheme of a fish's labyrinth. rinth. THE INTERNAL EAR. 431 media. The kiinina spiralis is the spiral bony plate which projects nearly at right angles from the modiolus, and which incompletely separates the scala. It consists of two lamellie, between which pass the branches of the auditory nerve. Attached to the free edge of the osseous spiral plate is the membranous spiral lamina, which is at- tached to the inner surface of the cochlea ; it completes the separation of scala vestibuli from the scala tympani. Fig. 189.— Scheme of the Ductus Cochlearis and the Organ OF CORTI. N, cochlear nerve: K, inner, and P. outer hair-cells ; n, nerve-fibrils terminatini; in P ; a, a, supporting cells ; d. cells in the sulcus spiralis ; z. inner rod of Corti ; Mb. Corti, mem- brane of Corti.or the membrana teetoria ; o, the memhrana reticularis; H, G, cells filling up the space near the outer wall. The membranous spiral lamina is formed of the following structures: The membrana basilaris; it is a delicate basement membrane stretched between the free edge of the bony lamina and the inner surface of the cochlea, where it becomes thickened and ligamentous, forming the ligamentum spirale. The investing endostium on the upper surface of the osseous lamina spiralis becomes thick- ened and forms the membrane of Todd. This divides into 432 PRACTICAL ANATOMY. two lips : an' upper, the labium vestibulare, and a loAvcr, the labium tympanicum ; the groove between them is designated the sulcus spiralis. Attached between the labium vestibulare and the modiolus is the membrane of Reissner, which is attached to the inner wall of the cochlea, and subdivides the scala vestibuli into a lower, smaller canal, the scala media, and the larger, upper canal. Fig. 190.— I. Section Theough thr Uncoiled Cochlea. II. Section Throttgh THE Terminal Nerve-Apparattts of the Cochlea. I. F.r., Fenestra rotunda; H, the helicotrema; St., the stapes. II. z. Huschke's proc- ess ; b', hasiUir membrane; e, Corti's arch; g, supporting cells; h, cylindrical cells; i, Deiter's hair-cells ; c, membrana teetoria ; n, nerve-fibres ; n', non-medullated nerve-fibres. the scala vestibuli proper. Between the membrane of Reissner and the labium vestibulare arises the membrane of Corti, which passes outward parallel with the mem- brana basilaris, and is inserted on the inner wall of the cochlea, forming a canal called the ductus auditorium; it contains the organ of Corti. The organ of Corti consists of upward of three thousand arches, which spring from the labium tympanicum by the rods of Corti, and conjoin THK ORGAN OF TASTE. 433 the outer rods of Corti placed upon the membrana basil- aris. The arcli rises nearly to the under surface of the membrane of Corti. The rods of Corti are modified epithelial cells, some of which are ciliated. The scalse vestibuli, media, and tympani communicate in the cupola by an opening called the helicotrema. The osseous labyrinth is lined by a delicate endosteum covered by epithelium, and which secretes a thin fluid, called the perilymph. THE MEMBRANOUS LABYRINTH. The membranous labyrinth is a very delicate serous sac contained within the osseous labyrinth. The mem- branous semicircular canals are about one-third of the diameter of the osseous canals, from which they are separated by the perilymph; they open into the utricle; the saccule is connected with the utricle by a delicate canal, and by means of the canalis reunions communi- cates with the scala media of the cochlea. The mem- branous labyrinth is distended by a thin fluid, — the endolymph, — which it secretes. On the surface of the utricle and saccule are two small calcareous concre- tions,— the otoliths. The auditory nerve enters the internal auditory meatus and divides into two branches, — cochlear and vestibular ; the latter is distributed to the membranous semicircular canals, utricle, and saccule. The cochlear branch enters the modiolus, and is probably ultimately distributed to the ciliated cells of the organ of Corti. THE ORGAN OF TASTE. The tongue is a conoidal muscular organ, having an attached base and a free, movable point, or tip. It is contained within the buccal cavity, and while at rest its 28 434 PRACTICAL ANATOMY. sides and tips are in contact with the hngual surfaces of the upper teeth. Tt is covered by mucous membrane, in which are imbedded the organs of taste. The mucous membrane invests the dorsum, lateral surfaces, and tip, from which it is reflected to the floor of the mouth, forming its fraenum. It is composed of two principal layers, — the cutis vera and epidermis. The cutis vera is a strong, fibrous, papillary structure intimately adherent to the muscular tissues of the tongue. The epiderm is epithelial in character. The papillae of the tongue are E J Fig. 191.— Strttcttjre of the Gustatory Organs. I. Transverse section of a circnmvallate papilla : W, the papilla ; v, v, the wall in sec- tion ; R, R, the circular split of fossa ; K, K, the taste-bulbs in position ; N, N, the nerves. II. Isolated taste-bulbs: D. supporting or protective cells; k, under end ; E, free end open, with the projecting apices of the taste-cells. III. Isolated protective cells, d, with a taste- cell, e. prominent and very abundant, and are divided into three classes, — the fungiform, the filiform, and the circumval- latse. The fungiform are papillary elevations, about the size of a mustard-seed, scattered over the dorsum of the tongue. They are deep red in color, and are seen princi- pally at the sides and tip. The filiform papillae give to the mucous membrane its velvety appearance. They are very numerous, especially at the anterior two-thirds of the tongue. They are arranged in rows, whicli run outward and forward from the median line of the ton"fue, and THE ORGAN OF SMELL. 435 consist of minute conical papillae, from which spring numerous filiform processes. The circumvallatae papillae are near the base of the tongue, and are about the size of a small pea. They vary from eight to ten in number, and are arranged like the letter V, with the point of the V at the base of the tongue. Tlie papillae consist of a fibrous structure, supporting capillaries, lymphatics, and nerves, and are invested with a basement membrane, cov- ered by epithelial cells. In the circumvallate and fungi- form papillae are the " taste goblets," Avhich consist of a nest of perpendicular, spindle-shaped, ciliated cells, into which the axis-c}iinders of nerves can be traced. They are surrounded by large, flat, nucleated cells and spindle cells. The cilia project above the free surface of the epithelium. Imbedded in the mucous membrane are also a great number of mucous follicles and some lymph- oid tissue. The epithelium is squamous. The chorda tympani nerve supplies the anterior two-third, the glosso- pharyngeal the posterior one-third of the mucous mem- brane of the tongue. THE ORGAN OF SMELL. The organ of smell is situated in the mucous mem- brane of the nasal cavities. The nose is the projecting osseo-cartilaginous struc- ture, triangular in outline, placed in the median line of the face. At its inferior portion are two oval apertures separated by a projection of the septum nasi. The nasal bones and nasal processes of the superior maxillae form the osseous portion of the nose, which is completed by the two upper and two lower lateral and the triangular septal cartilages. Numerous small muscles act on the integument of the nose. They have been described. 436 PRACTICAL ANATOMY. The Schneiderean mucous membrane is closely ad- herent to the periosteum. It is continuous with the skin of the face at the anterior nares, and continuous with the mucous membrane of the pharynx at the posterior nares. It is also continuous with the mucous lining of the lachrymal duct, the frontal, sphenoidal, and maxillary sinuses. It is thick and vascular over the turbinated bones and septum nasi. Anteriorly the epithelium is squamous. In the inferior meatus it is ciliated; above it is columnar and imbedded in it are the olfactory cells, Avhich consist of spindle-shaped, nucleated cells having an external hair-like process which projects slightly above the level of the mucous membrane. The other extremity is continuous with a filament of the olfactory nerve. Numerous mucous ciypts are imbedded in the mucous membrane, and in the walls are seen spheroidal nucleated cells which appear to be intimately associated with the branches of the olfactory nerves. THE SKIN. The skin is the fibro-elastic investing structure of the body. It is the organ of touch and contains the sweat and sebaceous glands and hair-follicles, and serves for the protection of the deeper structures. It is thickest on the sole of the foot and palm of the hand and on the back, and thicker on the outer than the inner surface of the extremities. It is thinnest on the eyelids and penis. Its average thickness is about -^-^ inch. It is divided into two layers, — the superficial and deep. The former is called the epiderm, the latter the cutis vera. Each of these is subdivided into two layers ; the epiderm into a superficial called the stratum corneum, and a deep layer, the rete mucosum. The layers of the cutis vera are the THE SKIN. 437 superlicial or papillar} and the deep or areolar layer. The epiderm is composed of cells. The deepest are columnar and present, in the colored races, numerous pigment cells ; in the white races these are but few in number and scattered. Gradually, in passing toward the surface, the cells become flattened, lose their nuclei, be- come changed hi their chemical properties, and are dis- .1 err*- -^--}4 Fig. 192. — Section of the Skin. posed in strata of flat, scale-like cells, the outer layer of which is constantly exfoliated. The true skin is sepa- rated from the epiderm by a homogeneous basement mem- brane which invests the papillary layer. The papillary layer consists of papillae, each about y^^ inch high, -^^-^ inch thick. They consist of a fibrous, skeletal structure, supporting ca])illary vessels and nerves, and, in certain localities, special nerve end-organs. The areolar layer is 438 PRACTICAL ANATOMY. below the papillary ; it merges with the superficial fascia, to which it is attached by connective tissue. The areolar layer contains within its meshes fat- vesicles, sweat-glands, hair- follicles, and serves as a nidus for the ramification of vessels and nerves. The hair and nails are appendages of the skin and consist of modifications of the epidermis. The sebaceous glands secrete the sebum, an oily substance which lubri- cates the skin. They consist of small, racemose glands, and frequently open in a hair-follicle. Fig. 193.— Various Kinds of Epithelial Cells. A, columnar cells of intestine ; B, polyhedral cells of the conjunctiva ; C, ciliated coni- cal cells of the trachea; D, ciliated cell of frog's mouth : E, inverted conical cell of trachea; F, squamous cell of the cavity of the mouth, seen from its broad surface ; G, squamous cell, seen edgeways. The sweat-glands are tubular, excretory glands. They have a long duct leading from the gland, which lies in the subcutaneous connective tissue. The nerves terminate in the skin in three different ways : (1) the Pacchionian corpuscles, (2) the bulbs of Krause, and (3) the tactile corpuscles of Wagner. 1. The Paccliionian corpuscles are ovoidal masses of fibrous tissue, containing within a central canal a termi- nal axis-cylinder. They are about y^ ^ inch in diameter, and are found principally in the connective tissue of the fingers and toes. 2. The end bulbs of Krause are THE SKIN. 431) minute capsules of connective tissue, about whicli are twined the axis-cylinders. They are found in the con- junctiva, glans penis and glans cUtoris, and prepuce. 3. The tactile corpuscles of Wagner, or fir-cone bodies, are formed of connective tissue, about which the axis-cylin- ders form plexuses. They are found in the papillae, and are the especial organs of touch. REGIONAL ANATOMY. THE NECK. The neck is the constricted, cylindrical segment ex- tending between the head and trunk ; it varies in form in the sexes, and at diiFerent ages ; in the young adult male it is laterally compressed, and presents, in the median line anteriorly, the projecting larynx; at the sides are the prominent, oblique, rounded elevations, which mark the sterno-mastoid muscles ; posteriorly, the neck is flattened. In the young adult female the neck is nearly cylindrical, but slightly broader at its base. In infancy it presents numerous transverse or circular grooves and folds, due to the accumulation of fat in the subcutaneous structures. At old age the skin is wrin- kled and presents two prominent folds, which pass from the sides of the cliin downward and backward; they correspond to the anterior edges of the platysma muscles. Up to an advanced period the skin of the neck is loosely attached to the subcutaneous structures; in operations in this region it is necessary to fix or steady it by pressure or traction, to preserve the relations of the in- cisions to the deeper structures. The superficial fascia is separable into two layers, between which pass the fibres of the platysma myoides muscle, which arises over the clavicle and passes obliquely upward, to be inserted on the fascia of the lower part of the face. Some of its fibres blend with the fibres of the orbicularis oris. The deep leaflet of the superficial fascia is very thin and membranous. The deep fascia — a thin, fibrous, investing structure — is exceedingly complex in (440) THE NECK. 4-41 its ramifications ; it is tliirk over tlie trachea and great vessels, for which it forms sheaths ; it is attached poste- riorly to the superior curved line of the occipital hone, to the ligamentum nuchse, and the spine of the scapula; also, to the spines and transverse processes of the cervical vertebrae ; it passes forward to the posterior border of the sterno-mastoid muscle, where it splits into two leaf- lets, to invest the muscle. The superficial layer becomes continuous witli the superficial layer of tlie opposite side ; tlie deep layer joins the superficial layer anterior to the sterno-mastoid ; it then dips down and surrounds the internal jugular vein, common carotid artery, and pneumogastric nerve, forming tlieir sheatli ; it is then reflected over the pliarynx, making its fibrous coat. It forms, by its reflexions and reduplications, sheaths for the vessels, nerves, and muscles, and is attached to all the prominent osseous structures ; its attachment to the first rib forms the pulley for the play of the tendon of the omo-hyoid muscle. Between the superficial and deep .fascii3e are numerous superfcial veins and nerves. Of these, the most important is the external jugular vein, which arises near the angle of the jaw and empties into the subclavian vein, just above the middle of the clavicle. The anterior jugular vein is inconstant ; it is usually found near the anterior median line of the neck, and opens generally into the subclavian. A number of the superficial branches of the cervical plexus are seen running upward, transversely, and downward. Of these the great auricular, derived from the second cervical, emerges behind the sterno-mastoid, and is distributed to the facial and auricular regions. The small occipital, from the second or third cervical, runs along the poste- rior border of the sterno-mastoid, and is distributed to the occipital region. The descending nerves are dis- 442 PRACTICAL ANATOMY. tributed to the shoulder, clavicular, and sternal regions. A number of lymphatic glands are found within and beneath the superficial fascia. When the deep cervical fascia is opened, the sterno-mastoid muscle is brought prominently into view ; it arises from the mastoid por- tion of the temporal and the adjoining occipital bone, passes obliquely downward and forward, and is inserted Fig. 194.— Lymphatics of Head and Neck. 1, internal jugular vein ; 2, deep cervical glands. by a tendon into the sternum, and, by a broad, muscular insertion, upon the clavicle. This muscle divides the side of the neck into two great triangles, — the anterior and posterior. The anterior great triangle is bounded above by the lower border of the inferior maxillary and a line drawn from its angle to the mastoid process ; in front, by the median line ; behind, by the anterior border THE NECK. 44o of tlie sterno-mastoid. The posterior great triangle is bounded in front by the posterior edge of the sterno- mastoid ; behind, by the anterior border of the trape- zius ; and below, by the clavicle. The anterior great triangle is subdivided into three lesser triangles, — the submaxillary, the carotid, and the inferior. The sub- maxillary triangle is bounded above by the lower jaw ; below and in front, by the anterior belly of the digastric; and behind, by the posterior belly, witli some of the fibres of the stylo-hyoid muscle. The digastric muscle arises anteriorly below the genial tubercles, and passes downward to the liyoid bone. Its mesial tendon pierces the tendon of the stylo-hyoid, and the posterior, fleshy belly is inserted in the digastric fossa of the mastoid portion of the temporal bone. This triangle is covered by a double leaflet of deep cervical fascia ; in the inter- val between them some lymphatic glands are frequently observed. Beneath the deep fascia and within the triangle is the submaxillary gland, usually pierced by the facial artery. Some veins, lymphatics, and adipose tissue are also exposed. The floor of this triangle is formed by the mylo-hyoid and hyoglossus muscles, the latter being crossed by the hypoglossal nerve in its transit to the tongue. The carotid triangle is bounded above by the posterior belly of the digastric, below^ by the anterior belly of the omo-hyoid, and behind by the edge of the sterno-mastoid. The omo-hyoid muscle arises from the inferior surface of the body of the hyoid bone, passes downward beneath the sterno-mastoid, and becomes tend- inous. Its tendon passes through a loop of the deep cervi- cal fascia, and the posterior fleshy belly is inserted on the transverse ligament and upper border of the scapula. The floor of the carotid triangle is formed by the thyro- 444: PRACTICAL ANATOMY. * hyoid, hyoglossus, the inferior and middle constrictors of the pharynx, the greater cornu of the hyoid bone, and the pharyngeal aponeurosis. The middle of the carotid triangle is on a level with the upper border of the thyroid cartilage. It contains the bifurcation of the common carotid artery, the external and internal carotid, the Fig. 195.— Muscles of Neck. jugular vein, and the pneumogastric nerve, inclosed within a sheath, upon which descend the descendens and communicans noni nerves, communicating and forming a loop beneath the omo-hyoid muscle. On either side of the median line of the neck are two flat, ribbon-like muscles, — the sterno-hyoid and tlie sterno-tliyroid. Be- neath them is the thyroid gland, which rests like a saddle THE NECK. -l-AS across the upper part of the trachea. Its lobes encroach upon the mlcrior triangles, wliich are bounded on each side above by the omo-hyoid, posteriorly by the sterno-mastoid, and anteriorly by the median line. Its floor is formed by the scalenus anticus and the longus colU muscles. It con- tains, beneath the cover of the sterno-mastoid, the common carotid arter)% internal jugiilar vein, the pneumogastric and phrenic nerves, the trachea, and thyroid gland. The posterior triangles are: the superior, or suboccipital, and the inferior, or subclavian. The superior triangle is bounded in front by the posterior border of the sterno- mastoid, below by the posterior belly of the omo-hyoid, and posteriorly by the trapezius. Its Hoor is formed by the scalenus anticus, scalenus posticus, levator anguli scapulae, and the splenius muscles. It is crowed by the spinal accessory nerve, -the transversalis colli jirtery and vein, and contains bi;anches of the cervical plexus, lymphatics, and adipose tissue. The subclavian triangle is bounded below by the clavicle, anteriorly and above by the sterno- mastoid, posteriorly and above by the posterior belly of the omo-hyoid. Its floor is formed by the scalenus medius, scalenus anticus, and scalenus posticus,, the first rib, and some of the fibres of the serratus magnus. It contains the third part of the subcla\ian artery^ which curves downward beneath the middle of the clavicle into the axilla. The subclavian ^ein is in front of the artery, but at a lower level. The brachial plexus lies on the scalenus medius muscle, above the subclavian artery. A quantity of fat and some lymphatics are also found in this triangle. When the sterno-mastoid muscle is removed the deeper structures of the neck are exposed. The most important are: the carotid artery, internal jugular vein, subclavian artery and vein ; tlxe pneumogastric. phrenic, 446 PRACTICAL ANATOMY. liypoglossal, and spinal accessory nerves ; the thoracic duct on the left side, and on the right side the right lymphatic duct. The common carotid artery on the right side is a branch of the innominate ; on the left side it comes from the arch of the aorta. It passes obliquely up the neck in a line from the sterno-clavicular articulation to the angle of the jaw, and at the upper border of the thyroid cartilage it divides into the external and internal carotids. The external carotid in the neck sends off the superior thyroid, lingual, and facial to the structures anterior to the vessel ; passing backward are the occipital and • pos- terior auricular. The ascending pharyngeal is deeply placed behind the external carotid; it is given off just above the bifurcation. External to the carotid artery is the internal jugular vein, a capacious but delicate venous trunk. , It begins at the jugular foramen, at the base of the skull, and receives the blood from the sinuses and superficial and deep parts of the head and neck. It lies in the same sheath with the carotid artery, from which it is separated by a cellular interval. The descendens noni from the hypoglossal forms a loop upon the sheath with the communicans noni, derived from the second or third cervical. The subclavian artery is divided into three portions by the scalenus anticus muscle, — from the first part, between the muscle and the origin of the vessel, are given oif the thyroid axis, the vertebral, and internal mammary; from the second part, behind the scalenus anticus, comes off the superior intercostal ; the third portion gives off no branches. The subclavian artery arises about an inch above the clavicle ; it rests on the cervical pleura, scale- nus medius muscle, and the first rib. The subclavian vein is in front of the artery, but on a lower level ; it receives the external jugular and the transverse cervical veins. THE AXILLA. 447 The phrenic and pneumogastric nerves pass between the subclavian artery and vein, the pneurnogastric lying nearer the median line. The pneumogastric nerve in the neck presents, just after it emerges Irom the jugular foramen, a gangliaform enlargement, which sends off numerous filaments of communication. It runs down the neck within the sheath of the carotid artery and internal jugular vein, between but behind these vessels. It sends off a motor branch to the pharynx, the superior laryngeal, a sensory nerve to the larynx and the recur- rent laryngeal, which is given off on tlie right side as the nerve passes over the subclavian artery; it then winds beneath and behind this trunk, runs upward to the larynx, to which it is the motor nerve. On the left side the recurrent laryngeal is given off below tlie arch of the aorta ; it then runs behind this vessel along the trachea to the larynx. The phrenic nerve is derived from the third and fourth cervical ; it crosses the scalenus anticus, passes into the chest between the subclavian artery and vein. It is external to the pneumogastric. The hypoglossal passes down under cover of the ramus of the inferior maxillary ; it enters the submax- illary triangle, crosses the great vessels, and curves for- ward to the tongue ; it sends off the descendens noni. The spinal accessory nerve pierces the upper portion of the sterno-mastoid, crosses the posterior superior triangle, and is distributed to the trapezius. THE AXILLA. The axilla is a pyramidal space wdiich is bounded in front by the pectoral muscles ; behind, by the latissimus dorsi, teres major, and subscapular is. Externally it is 4 is PRACTICAL ANATOMY. limited by the humerus ; internally, by the upper four or five ribs covered by the serrate muscle ; the apex is above, and corresponds to the entrance of the axillary vessels and the brachial plexus of nerves. When the arm is placed at right angles to the trunk, the axilla, limited by the prominent lower anterior and posterior- borders, is seen to be a marked concavity, narrower ex- ternally than internally. The skin is rather closely ad- herent, covered by a growth of short hair. Numerous sebaceous follicles, secreting an mictions, highly-odorous fluid, and sweat-follicles, are imbedded in the skin in this region. When the skin is removed the superficial fascia is seen. It is loaded with fat, as a rule, and pre- sents some superficial veins, nerves, and lymphatics. The deep fascia is aponeurotic, and incloses the deeper structures. An incision should be made through the pectoralis major and minor, through the layer of cellular fascia beneath the pectoralis minor, and these structures turned aside. There will now be exposed the axillary vein and artery and their branches, the brachial plexus and its branches, and a cluster of lymphatic glands im- bedded in a quantity of loose fat. The axillary vein lies in front of the artery ; it is the continuation of the basi- lic vein, and receives the vena comites, numerous small branches, and the cephalic. The axillary artery is the continuation of the subclavian ; it lies behind and to the outer side of the vein ; they are in\ested with a quantity of loose cellular tissue. The larger branches of the ax- illary artery are the long thoracic, which is often con- cealed beliind the lower border of the pectoralis major ; the subscapular, which runs down the anterior surface of tlie subscapular muscle ; the circumflex, external and internal, distributed to the neck of the humerus. The THE AXILLA. 449 axillary artery and vein bisect the axilla and run close to the outer wall, against the Immerus. The brachial plexus surrounds the axillary artery, lying on a plane posterior to it. The branches from the outer and inner cords unite in front of the artery to form Fig. 196.— Dissection of Axilla. 1, axillary artery ; 2, brachial artery; 3. aeromio-thoracic artery; 4, siifierior thoracic artery ; 5, subscapular artery ; 6. dorsalis scapiilse artery ; 7, posterior circumflex artery ; 8, superior profunda artery; 9, posterior thoracic nerve; lU, long subscapiJar nerve; 11, median nerve ; 12, cephalic vein ; 13, musculo-cutaneous nerve ; 14, teres major muscle. the median nerve, which passes down in front of the vessels. To expose more fully the branches of the plexus it is necessary to remove the axillary vein. The axillary space is crossed by some lateral cutaneous branches of 29 450 PRACTICAL ANATOMY. the intercostal nerves. One of these, from the second intercostal, communicates with the lesser internal cuta- neous. It is called the intercosto-humeral nerve, and is ultimately distributed to the integument near the elbow. The lymphatic glands of the axilla communicate with the cervical. They are of from ten to fifty in number and of variable size. THE PERINErM. The male perineum is the diamond-shaped space limited in front by the scrotum, behind by the tip of the coccyx, laterally by the tuberosities of the ischia, the rami of the ischia and pubes, and the greater and lesser sacro-sciatic ligaments. A line drawn transversely through the tuberosities of the ischia subdivides this region into an anterior, the perineum proper, and a pos- terior, the ischio-rectal region. The skin of the peri- neum is pigmented, tightly adherent, thrown into numer- ous fine, transverse rugae, and presents a median raphe, continuous with the raphe of the scrotum. It is covered by scattered, short, stiff hairs. Over the ischio-rectal region the skin is less firmly attached to the subcutaneous structures ; the pigmentation is strongly marked about the anus, which is situated in the median line midway between the perineum and the coccyx. It presents numerous folds radiating from the anal aperture. Upon removing the skin of the perineum the superficial fascia is exposed. This fascia consists of two layers, — super- ficial and deep. The superficial layer is continuous with the outer layer of the superficial fascia of the abdomen, thighs, and ischio-rectal region, and is loaded with fat. The deep layer of the superficial fascia is continuous with the deep layer of the superficial fascia of the abdomen. In the perineum it is much thickened and firmly attached THE PERINEUM. 451 to tlie ascending- rami of the ischia and pubes and invests the deeper perineal structures. It passes backward to the posterior border of the transversus perinei, around which it is reflected. It then becomes very much thick- ened and fibrous, and passes forward, being firmly at- FiG. 197.— Muscles of the Perineum, with Superficial Vessels AND Nerves. 1, triangular ligament : 2. tendinous centre of the perineum ; 3, transversus perinei ; 4, ischio-rectal fossa ; 5, inferior pudendal nerve ; 6. transversalis perinei artery ; 7, super- ficialis perinei artery; 8, external haemorrhoid artery and nerve. tached to the ascending rami of the ischia, descending rami of the pubes, and the subpubic ligament. It is pierced by the urethra and the dorsal vein of the penis, and is commonly called the triangular ligament. It is also known as the superficial layer of the deep perineal fascia. 452 PRACTICAL ANATOMY. The deep layer of the deep perineal fascia is a delicate membranous structure, which is derived from the deep layer of the superficial fascia as it curves around the posterior border of the transversus perinei muscles. It passes to the anterior and upper surface of the prostate gland. The perineal fasciae are very simple in their arrange- ment. They inclose the important structures of the perineum. When the deep layer of the superficial fascia is removed the following structures are brought into view : The transversus perinei, erector penis, and accel- erator urinae muscles ; the transverse and superficial perineal arteries and ;ierves, the corpus spongiosum and bulb, and the corpora cavernosa. The transversus perinei arise from the inner surfaces of the tuberosities of the ischia and pass transversely inward, and are inserted on the central tendon of the perineum. They are each about as thick as a lead-pencil. The erector penis on each side arises from the inner surface of the tuberosity of the ischium and is broadly inserted upon the corpus caver- nosum. The accelerator urinse is a bipenniform muscle ; it surrounds the corpus spongiosum and bulb, and may be said to arise from the central tendon ; it is inserted at the sides of the crus penis. In the triangular interval between the accelerator urinae and erector penis the superficial perineal artery and nerve are seen. The floor of this triangle is the superficial layer of the deep perineal fascia (the triangular ligament). When the accelerator urinse is removed, the corpus spongiosum and bulb of the urethra are brought into view ; they are in the median line, and inclose the urethra. When the superficial layer of the deep perineal fascia (triangular ligament) is re- moved, the following structures are brought into view : Artery of thebulb,Cowper's gland, internal pudic artery, THE PERINEUM. 453 and membranous urethra. The artery of the bulb is a short branch of the internal pudic ; it is distributed to the bulb. The internal pudic artery runs along the ascending ramus of the ischium, and gives off the artery to the corpus cavernosum. Cowper's gland is a small, yellow, lobular mass, about the size of a pea ; its duct opens into the bulb of the urethra. The membranous urethra is that portion of the canal between the superficial and deep layers of the deep perineal fasciae ; removal of the deep layer of the deep perineal fascia exhibits the pros- tate and lower portion of the bladder. The ischio-rectal region comprises that portion of the perineum behind the transversus perinei muscles ; it pre- sents at the centre the anal opening, surrounded by a superficial stratum of muscular fibres, — the external sphincter. On either side of the rectum is a conoidal space filled with fat ; traversing the space are the super- ficial hoemorrhoidal vessels and nerves. AVhen the fat is removed it brings into view the levator ani muscle, which supports the pelvic organs. In the female the perineum consists of some of the external genitalia (already described, page 403) and the following modifications : The urethra, which opens between the labia minora, at the bottom of the vestibule, is a short canal three-fourths of an inch long ; in fact, simply a membranous urethra imbedded in the anterior ^wall of the vagina. The opening of the vagina is guarded in the virgin state by the hymen, which is, in fact, a thin, incomplete prolongation of the superficial layer of the deep perineal fascia, lined by mucous membrane. The orifice of the vagina is surrounded by a superficial, flat, sphincter muscle, continuous with the superficial sphincter of the rectum. The perineum proper is that wedge-shaped mass of tissue between the vagina and 454 PRACTICAL ANATOMY. rectum; the base is below; it is formed of the trans- versus perinei, sphincters of the vagina and rectum where they are attached to the central tendon, and a mass of fibro-muscular tissue of variable height and thickness. Numerous arteries and veins, branches of the pudic and hsemorrhoidal, supply the perineum; it IS also freely supplied with nerves communicating with the uterine and pelvic plexuses of the sympathetic. SCARPA'S TRIANGLE. Scarpa's triangle is situated at the upper anterior por- tion of the thigh ; it is bounded above by Poupart's ligament, externally by the sartorius muscle, internally by the adductor longus. Its floor is formed from within outward by the pectineus, psoas magnus, and iliacus. The femoral vein, artery, and crural nerve pass from the middle of Poupart's ligament to the apex of the tri- angle ; the vein is to the inner side, the artery in the middle, and the nerve externally. The artery and vein are inclosed in a sheath ; the nerve is to the outer side. Near the anterior superior spine of the ilium emerges the external cutaneous nerve, and passes to the skin along the outer side of the thigh. Just after its exit from beneath Poupart's ligament, the anterior crural nerve breaks up into superficial cutaneous and deep mus- cular branches. One of the latter — the long saphenous — passes down the thigh with the femoral artery. About two inches below Poupart's ligament the femoral artery gives off the profunda, which supplies the muscles of the thigh. The femoral continues down the thigh and becomes the popliteal. The femoral vein receives numer- ous venous radicles ; the most important branch is the long saphenous, which drains the superficial structures from the ankle to the groin. FEMORAL HERNIA. 455 FEMORAL HERNIA. Femoral liernia is the protrusion of some of the ab- dominal viscera through the femoral ring. The super- ficial fascia over Scarpa's triangle consists of two layers: the superficial layer is thick and loaded with fat ; be- neath it are some of the superficial arteries, veins, nerves, and lymphatics. The long saphenous vein is tlie most important structure ; it passes through the saplienous opening of the fascia lata, and opens into the femoral vein. That portion of the deep layer of the superficial fascia, attached to the margins of the saphenous opening, is called the cribriform fascia ; it is perforated for the passage of numerous veins and small arteries. Clustered about the long saplienous vein are a number of lymphatic glands arranged in a double chain ; the upper set com- municate with the lymphatics of the external genitalia, the lower with the lymphatics of the thigh and leg. The deep fascia, or fascia lata, is aponeurotic, and presents at the upper part of Scarpa's triangle the saphenous opening ; to its margins the cribriform fascia is attached and must be removed befo¥e the aperture can be plainly seen. It is oval in outline, about one inch in its longest diameter, and presents a well-marked, sharply-defined, outer border, known as the falciform process or Hey's ligament. It passes over the femoral vessels, and is at- tached to Poupart's ligament and continued through Gimbernat's ligament to the pubes. Inferiorly it forms a sharply-defined loop ; the inner border is less defined than the outer ; it passes beneath the femoral vessels and becomes continuous with the femoral sheath. The sheath for the femoral vessels is formed in front by a continuation of the transverse fascia beneath Poupart's ligament ; the iliac fascia completes it behind. The femoral vein and artery enter the sheath and pass down 456 PRACTICAL ANATOMY. the thigh. To the inner side of the vein there exists an interval called the femoral ring, but filled with cellular tissue. Of all the parts below the femoral arch (formed by Poupart's ligament) this space is the point of least resistance ; hence, in femoral hernia the protrusion en- gages almost uniformly at this point at the inner side of the vein. The coverings for femoral hernia, it will be seen, are, from within outward, the peritoneal sac, the cellular tissue (septum crurale) to the inner side of the vein, the sheath of the vessels, the cribriform fascia, superficial fascia, and skin. INGUINAL HERNIA. Inguinal hernia may be indirect or direct. The skin at the lower part of the abdomen is thin and loosely attached to the subcutaneous tissues, in which ramify the superficial arteries, veins, and lymphatics. The deep fascia is very thin, and is adherent to the linea alba. Beneath the deep fascia is the aponeurotic tendon of the external oblique muscle ; its lower border is much thick- ened and cord-like ; it is attached to the anterior superior spine of the ilium and the spine of the pubes, and is called Poupart's ligament. The direction of the fibres of the tendon of the external oblique is downward and inward, and that portion inserted upon the pubes is split, forming a long triangular separation of the fibres of the tendon, called the external inguinal ring. The base of this opening is at the pubes ; the inner edge is called the inner column; the outer is called the outer column. Between the two columns the deep fascia is slightly thickened and attached to the margins of the ring, form- ing the intercolumnar fascia. When this is removed, the finger can be placed directly against the conjoined INGUINAL HERNIA. 457 tendon of the transversalis and iiitenial oblique ; this tendon fortifies the external ring. When the external oblique is removed the internal oblique, separated by fine connective tissue, is brought hito view. From its lower border a number of loops of muscular fibres — the cre- FiG. 198.— Dissection for Inguinal Hernia. A, external oblique; B B. internal oblique: C, transversalis: D, conjoined tendon; E, rectus abdominis with sheath opened ; F, fascia transversalis; H, creroaster; I, infun- dibular fascia. master muscle — descend upon the spermatic cord, and between the loops a delicate connective tissue (cremaster fascia) holds them in their relative positions. Beneath the internal oblique is the transversalis ; its tendon unites with the internal oblique and forms the conjoined tendon, which is broadly inserted upon the pubes behind the 458 PRACTICAL ANATOMY. external inguinal ring. Beneath the transversalis is the transversalis fliscia, which presents, about midway be- tween the anterior superior spine of the ilium and the spine of the pubes, the internal inguinal ring, — a round aperture whicli will admit the point of the little finger. It leads into a funnel-shaped prolongation over the sper- matic cord (in the female, the round ligament). This funnel-shaped continuation is known as the infundibuli- form process of the transverse fascia. The inguinal canal is about two inches long. It be- gins at the internal inguinal ring and terminates at the external inguinal ring. It transmits the spermatic cord in the male, and the round ligament in the female. The testicle in foetal life is lodged within the abdominal cavity, out of which it is drawn by the contraction of a fibro-muscular cord, the gubernaculum, which is attached to the bottom of the scrotal sac. In its descent the testi- cle pushes before it a fold of peritoneum, which ultimately becomes the tunica vaginalis. As it passes through the opening in the transverse fascia it carries with it a proc- ess, the infundibuliform, which surrounds the testes and cord, and the testicle in its further descent carries along some of the fibres of the internal oblique, forming the loops of the cremaster muscle. Generally at birth the testicle is within the scrotum, and the communication between the tunica vaginalis and the peritoneal cavity is closed^ The descent of indirect inguinal hernia follows the course of the descent of the testicle; hence, the coverings for oblique hernia are as follow: Peritoneal sac, infundibuliform process of transverse fascia, cremaster muscle and fascia, intercolumnar fascia, superficial fascia, and skin. In direct inguinal hernia the gut does not enter the internal inguinal ring; it forces the structures of the INGUINAL HERNIA. 459 abdominal wall directly through the external inguinal ring, and the coverings for direct inguinal hernia, from without inward, are: Skin, superficial fascia, inter- columnar fascia, conjoined tendon, some other soft structures, such as the fibres of the rectus abdominis, transverse fasciae, and the peritoneal sac. INDEX. Abdomen, 367 apertures found in, 367 boundaries of, 367 muscles of, 201 regions of, 868 viscera of, 368 Acetabulum, 130 Acromion, 107 Air-cells, 349 -sacs of lung, 349 Alae of nose, 435 of vomer, 52 Alimentary canal, 350 Alveoli, sockets of, 57 of lower jaw, 56 of stomach, 373 of upper jaw, 44 Amphiarthrosis, 152 AmpullfB of semicircular canals, 429 of tubuli lactiferi, 411 Anastomosis of arteries, 233 Ankle-joint, 168 Annulus ovalis, 338 Antihelix. 433 fossa of, 423 Antitragus, 422 Antrum of Higlimore, 41 Anus, 378 muscles of, 331 Aorta, 234 abdominal, 247 branches of, 247 arch of, 235 ascending part of, 835 branches of, 235 descending part of, 235 of branches of, 235 transverse portion of, 235 descending, 235 sinuses of, 235 thoracic, 247 branches of, 247 Aponeurosis of deltoid, 306 of external oblique, in inguinal region, 204 of occipito frontalis, 176 pharyngeal, 189 Apophysis, 10 Appendages of eye, 420 of skin, 438 of uterus, 409 Appendix, ensiform, 99 of left auricle, 339 of right auricle, 338 vermiformis, 376 Aqua labyrinthi, 433 Aquyeductus cochleae, 25 Fallopii, 25 Sylvii, 296 vestibuli, 35 Aqueous chamber, epithelial lining of, 413 humor, 418 Arachnoid membrane of brain, 277 of cord, 803 Arantii corpora, 839, 341 Arbor vitae of cerebellum, 303 uterinus, 408 Arch, palmar, deep, 243 superficial, 243 plantar, 254 Arm, arteries of, 339 bones of. 111 muscles of, 205 nerves of. 321 veins of, 360 Arterise receptaculi, 246 Artery or Arteries, 232 anastomoses of, 232 capillary, 238 distribution of, 233 general anatomy of, 232 systemic, 234 acromial thoracic, 230 alar thoracic, 240 alveolar, 243 anastomotica magna of brachial, 241 of femoral, 253 angular, 243 aorta, 334 articular, of knee, 353 ascending cervical, 238 pharyngeal, 245 posterior, 244 axillary, 339 branches of, 389 azygos articular, of knee, 253 basilar, 238 brachial, 241 branches of, 241 bronchial, 247 of bulb of urethra, 251 (461) 462 INDEX. Artery or Arteries calcanean, inter- nal, 254 carotid, 243 common, 243 external, 243 internal, 245 carpal of radial, 241 of ulnar, 242 posterior, of radial, 241 of ulnar, 242 of cavernous body, 250 centralis retinae, 246 cerebellar, 238 cerebral, 246 cervical, ascending, 288 superficial, 238 cervicis princeps, 244 profunda, 239 choroid, anterior, 246 ciliary, 246 anterior, 246 long, 246 short, 246 circle of Willis, 238 circumflex of arm, 241 anterior, 241 posterior, 241 iliac, 252 superficial, 252 of thigh, 252 external, 252 internal, 252 cceliac axis, 247 colica dextra, 248 media, 247 sinistra, 249 comes nervi ischiadici, 251 phrenici, 239 communicating, anterior, of brain, 246 posterior, of brain, 246 of ulnai-, 242 coronary, of heart, 235 inferior, 235 left, 235 of upper lip, 243 of lower lip, 243 of corpus cavernosum, 251 cricothyroid, 243 cystic, 247 cervical, 244 palmar arch, 243 temporal, 244 dental, inferior, 245 descending palatine, 245 digital, of plantar, 243 of ulnar, 243 dorsal, of lumbar, 249 of penis, 251 dorsalis poUicis, 242 Artery or Arteries, dorsalis indicis, 242 linguse, 243 pedis, 254 branches of, 254 peculiarities of, 254 penis, 251 pollicis of foot, 254 scapulae, 241 epigastric, deep, 251 peculiarities of, 252 , relation of, to external ring, 457 to internal ring, 457 superior, 239 superficial, 253 ethmoidal, 246 facial, 243 transverse, 244 femoral, 252 branches of, 252 deep, 252 frontal, 243 gastric, 247 gastro-duodenalis, 247 epiploica dextra, 247 sinistra, 247 gluteal, 251 deep, 251 superficial, 251 hsemorrhoidal, external, 250 inferior, 250 • middle, 250 superior, 249 hepatic, 247 hyoid branch of lingual, 243 of superior thyroid, 243 ileo-colic, 248 iliac, circumflex, deep, 253 common, 249 left, 248 right, 248 external, 251 internal, 250 ilio-lumbar, 251 infra-orbital, 243 innominate, 235 intercostal, 247 interosseous of ulnar, 343 dorsal of foot, 254 of hand, 242 of radial, 242 labial inferior, 243 lachrymal, 246 laryngeal, 243 inferior, 243 superior, 243 lateral sacral, 251 spinal, 336 lateralis nasi, 243 INDEX. 463 Artery or Arteries, lingual, 243 long ciliary, 246 thoracic, 241 lumbar, 249 malleolar, 354 external, 254 internal, 254 mammary, internal, 239 masseteric, 243 maxillary, internal, 245 median, 242 of forearm, 237 of spinal cord, 237 mediastinal, 247 posterior, 247 meningeal, from ascending pharyngeal, 245 anterior, from carotid, 246 inferior, from occipital, 244 middle, from internal maxil- lary, 245 posterior, from vertebral, 237 small, from internal maxillary, 245 mesenteric, inferior, 249 superior, 247 metacarpal, 242 metatarsal, 254 middle cerebral, 246 sacral, 251 musculo-phrenic, 245 mylo hyoid, 245 nasal, 243 of ophthalmic, 246 nutrient of femur, 252 fibula, 254 humerus, 241 radius, 242 tibia, 254 ulna, 242 obturator, 250 occipital, 244 oesophageal, 247 ophthalmic, 246 orbital, 246 ovarian, 249 palatine, ascending, 245 descending, 245 inferior, 245 palmar arch, deep, 241 superficial, 243 interossese, 242 palpebral, 246 pancreatic, 247 pancreatico-duodenalis, 247 inferior, 247 perforating arteries, 247 from mammary artery, 239 from plantar, 254 from profunda, 253 Artery or Arteries, perforating, in- ferior, 253 middle, 253 superior, 253 pericardiac, 247 perineal, superficial, 250 transverse, 251 peroneal, 255 phrenic, 247 plantar external, 255 internal, 253 princeps cervicis, 244 poUicis, 242 profunda of arm, inferior, 241 superior, 241 cervicis, 239 femoris, 252 pterygoid, 245 pterygopalatine, 245 pudic, 250 external, 252 deep, 250 internal, 250 peculiarities of, in female, 251 pulmonary, 255 pyloric, 247 radial, 241 arch of, 241 branches of, 241 radialis indicis, 242 ranine, 243 recurrent interosseous, 243 radial. 241 tibial, 254 ulnar, anterior, 343 posterior, 243 renal, 249 sacra media, 251 sacral, lateral, 251 scapular, posterior, 239 sciatic, 251 short ciliary, 246 sigmoid, 249 spermatic, 249 spheno-palatine, 245 spinal, anterior, 236 splenic, 247 sterno-mastoid, 243 stylo-mastoid, 244 subclavian, 236 branches of, 236 sublingual, 243 submaxillary, 243 submental, 243 subscapular, 240 superficialis volse, 243 supra-orbital, 246 -renal, 249 -scapular, 238 464 INDEX. Artery or Arteries, temporal, 244 anterior, 244 deep, 245 thoracic, acromial, 239 alar, 240 aorta, 247 long, 240 superior, 240 thyroid, inferior, 243 middle, 243 superior, 240 axis, 238 tibial, anterior, 253 branches of, 254 posterior, 254 branches of, 254 recurrent, 254 tonsillar, 243 transverse, of basilar, 238 facial, 244 transversalis colli, 238 tympanic, from internal carotid, 246 from internal maxillary, 245 ulnar, 242 arch of, 243 branches of, 242 relations of, in hand, 242 in wrist, 242 recurrent, anterior, 242 posterior, 242 uterine, 251 vaginal, 251 intestini tenuis, 249 vertebral, 236 vesical, inferior, 236 middle, 250 superior, 250 vestibular, 246 Vidian, 245 Arthrodia, 152 Articulations, 150, 152 acroniio clavicular, 160 ankle, 168 calcaneo-astragaloid, 169 -cuboid, 169 carpal, 163 carpo-metacarpal, 165 classification of, 152 costo-clavicular, 160 -sternal, 156 -transverse, 156 -vertebral, 155 elbow, 161 hip, 165 immovable, 152 knee, 166 metacarpal, 165 metacarpophalangeal, 165 metatarsal, 170 Articulations, metatarso-phalan- geal, 171 mixed, 152 movable, 152 occipito-atloid, 154 -axoid, 154 of pelvis, 157 with spine, 157 phalanges, 165, 171 pubic, 159 radio-carpal, 163 -ulnar, inferior, 162 middle, 162 superior, 162 sacro-coccygeal, 158 -iliac, 157 -sciatic, 158 scapular, 160 scapulo-clavicular, 160 shoulder, 161 of spine with cranium, 154 sterno-clavicular, 159 of sternum, 156 tarsal, 169 tarso-metatarsal, 170 temporo-maxillary, 153 tibio-fibular, inferior, 168 middle, 168 superior, 168 of vertebral column, 155 wrist, 163 Astragalus, 143 Atlas, 87 Auricle of heart, appendix of, 338, 340 Axes of pelvis, 132 Axis, 88 Axis-cylinder of nerve-tubes, 273 Back, muscles of, 194 Ball-and-socket joint, 153 Bartholine, duct of, 364 Bladder, 393 arteries of, 395 base of, 394 body of, 393 fundus of, 394 interior of, 394 ligaments of, 394 neck, 394 nerves of, 395 shape, position, and relations of. 393 structure of, 394 trigone of, 394 Blue spot of fourth ventricle, 298 Body of vertebra, 83 Bone, 1 apophyses of, 10 canaliculi of, 4 INDEX. -^65 Bone, cancellous tissue of, 2 cells. 4, 7 analysis of, 7 compact tissue of, 2 development of, 6 eminences and depressions of, epiphyses of, 10 Haversian system of, 3 lacunae of, 3 lamellai of, 5 marrow of, 5 microscopic structure of, 2 number of, 9 ossification of, 7 periosteum of, 6 astragalus, 143 atlas, 87 axis, 88 carpal, 119 clavicle, 105 coccyx, 96 cranial, 9 cuboid, 145 cuneiform of carpus, 121 of tarsus, 145 ethmoid, 83 facial, 9 femur, 133 fibula, 140 frontal, 11 hand, 123 humerus. Ill hyoid, 96 ilium, 125 innominate, 125 ischium, 129 lachrymal, 46 maxillary, inferior, 54 superior, 38 metacarpal, 122 metatarsal, 147 nasal, 36 occipital, 16 OS calcis, 143 OS magnum, 121 parietal, 14 patella, 137 pelvic, 131 phalanges of foot, 148 of ha^nd. 124 pisiform. 121 pubic, 127 radius, 116 ribs, 100 sacrum, 93 scaphoid of carpus, 119 of tarsus. 144 scapula, 107 semilunar, 120 si)henoid, 26 10 Bone, sphenoidal spongy, 28 sternum, 97 tarsal, 141 temporal, 20 tibia, 138 trapezium, 121 trapezoid, 121 processes of turbinated, inferior, 53 of ethmoid, middle, 35 superior, 35 ulna, 114 unciform, 122 vertebra prominens, 89 vertebra, cervical, 36 dorsal, 89 lumbar, 91 sacral, 93 vomer, 51 Wormian, 62 Brain, 274 arachnoid of, 277 base of, 286 dura mater of, 276 interior of, 290 lateral ventricles of, 290 lobes of, 282 membranes of 276 subdivision into parts, 274 upper surface of, 281 vpeight of, 274 Bronchi, 346 mode of subdivision in lung, 346 septum of, 346 structure of, in lobules of lung, 349 Calamus scriptorius, 308 Calcar, 293 Canal, anterior dental, 42 palatine. 45 for Arnold's nerve, 25 auditory, 22, 423 carotid, 25 incisive, 45 infra-orbital, 39 for Jacobson's nerve, 25 malar, 37 naso-palatine, 52 anterior, 45 pterygo-palatine, 29 sacral, 96 Canaliculi of bone, 4 Capsule of Glisson, 381 of Bowman, 385 Carpus, 119 Cartilage or Cartilages, 156 arytenoid. 344 cells ol', 150 cricoid, 343 466 INDEX. Caitilivge or Cartilages, cnneiforra, 344 of epiglottis, 343 fibro-, 150 hyaline, 150 interarticular, 151 reticular, 150 structure of, 151 thyroid, 343 yellow, 156 Casserian ganglion, 310 Cavity, cotyloid, 130 glenoid, 110 of pelvis, 132 Cells of bone, 4 ethmoidal, 35 hepatic, 382 mastoid, 21 Centrum ovale majus, 290 minus, 289 Cerebellum, 301 corpus dentatum of, 303 hemispheres of, 302 laminae of, 303 lobes of, 302 lobulus centralis, 302 median lobe of, 302 peduncles of, 300 structure of, 303 valley of, 302 weight of, 301 Cerebrum, 279 base of, 286 commissures of, 289 convolutions of, 280 crura of, 288 fissures of, 282 general arrangement of, 282 gray matter of, 279 hemispheres of, 279 interior of, 290 lobes of, 280 peduncles of, 288 structure of, 279 sulci of, 282 under surface of, 286 ventricles of, 280 Choroid coat of eye, 415 Choroid plexus of lateral ventricle, 293 Clavicle, 105 development of, 107 Clitoris, 403 frsenum of, 403 prepuce of, 403 Clusters of air-cells, 349 Coccyx, 96 Cochlea, 428 central axis of, 429 cupola of, 430 Cochlea, lamina spiralis of, 431 modiolus of, 429 scala tympani of, 430 vestibuli of, 430 spiral canal of, 430 Colon, 376 ascending, 376 descending, 376 sigmoid flexure of, 377 transverse, 376 Columnae carnese of left ventricle, 339, 340 of right ventricle, 339 Columns of Bertin, 389 Commissures of brain, anterior,295 middle, 279 posterior, 279 great, 279 Conus arteriosus, 341 Convolution, development, 279 Convolution of corpus callosum, 285 of longitudinal fissure, 284 Convolutions, primary, 280 secondary, 280 number of, 280 of cerebrum, cortical substance of, 280 of frontal lobe, 282 of parietal lobe, 283 of occipital lobe, 283 of temporo-sphenoidal, 283 of island of Reil, 284 of orbital lobe, 283 of inner surface of hemisphere, 284 structure of, 280 white matter of, 279 of hyoid bone, 97 Cornua of sacrum, 95 Corpora albicantia, 288 geniculata, 292 striata, 291 Corpus callosum, 286 fimbriatum, 293 Corpuscles, Malpighian, of kidney, 389 of spleen, 384 Corti, organ of, 432 Cotunnius, nerve of, 312 Cowper's glands, 397 Craniometry, 79 Crest of ilium, 126 of tibia, 138 occipital, external, 17 internal, 19 sphenoidal, 28 turbinated, of palate, 49 Crista galli, 34 Crura cerebri, 288 INDEX. 467 Ciil)()!cl bone, 145 Cuneiloim bone of foot, 145 of hand, 121 external, 147 internal, 145 middle, 147 Curvatures of spine, 85, 93 DiARTHROSIS, 153 rotatorius, 153 Digestion, organs of, 350 Duct or Ducts, of Bartboline, 3G4 biliary, 383 common choledocli, 383 of Greenbow, 383 of liver, 383 lymphatic, riglit, 366 of pancreas, 383 parotid, 363 Steno's, 363 Whartons, 363 Wirsung, 383 Duodenum, 373 Ear, 432 auditory canal, 433 auricle of, 423 cochlea, 429 external, 423 helix of, 433 internal, 438 labyrinth, 429 membranous, 433 middle, 424 ossicula of, 427 pinna, 423 semicircular canals, 429 tympanum, 424 vestibule, 429 Elbow-joint, 161 Eminence, canine, 43, 55 frontal, 11 ilio-pectineal, 131 parietal, 15 Eminentia articularis, 33 collateralis, 893 i Endocardium, 343 Epiphyses, 10 Ethmoid bone, 33 cribriform plate of, 34 development of, 35 lateral masses of, 35 perpend icuhxr plate of, 33 OS planum of, 35 unciform process of, 35 Eustachian tube. 426 Eye, 413 appendages of, 420 cliambers of, 414 ciliary ligament, 415 Eye, ciliary muscle, 415 processes, 416 humors of, 418 aqueous, 418 crystalline lens, 419 vitreous, 419 membrana pupillaris, 419 choroid, 415 conjunctiva, 421 cornea, 414 hyaloid, 419 iris, 416 Jacob's, 417 retina, 416 sclerotic, 414 pupil of, 418 uvea of, 416 Eyebrows, 430 Eyelashes, 420 Eyelids, 430 cartilage of, 431 Meibomian glands of, 481 muscles of, 430 tarsal ligament of, 431 Face, bones of, 36, 73 Fallopian tubes, 409 fimbriated extremity of, 409 Falx cerebelli, 377 cerebri, 376 Fascia dentata, 394 fibro-areolar, 151 Fasciculi teretes, 298 Female organs of generation, 403 caruncuJaj myrtiformes, 404 clitoris, 403 fossa navicularis, 403 fourcbette, 403 fr?enulum pudendi, 403 glands of Bartholine, 404 liymen, 404 labia majora, 403 minora, 403 mons veneris, 403 nymphae, 403 uterus, 406 vagina, 405 vestibule, 403 Femur, 133 development of, 137 structure of, 136 Fibro-cartilagc, 150 acromioclavicular, 160 intervertebral, 155 of knee, 168 of lower jaw, 153 pubic, 159 radio-ulnar, 162 semilunar, 168 sternoclavicular, 159 468 INDEX. Fibro-cartilage, triangular, 163 Fibrous tissue, white and yellow, 151 Fibula, 140 Fissure, auricular, 25 horizontal, of cerebellum, 303 longitudinal, of cerebrum, 379 of liver, 380 pterygo-maxillary, 77 spheno maxillary, 77 of Sylvius, 283 Fissures of brain, calloso-mar- ginal, 385 inner surface of cerebrum, 285 parieto-occipital, 385 calcarine, 286 collateral, 386 longitudinal, 286 Rolando, 282 parieto-occipital, 283 transverse, 294 of cord, anterior and posterior median, 304 Follicles of Lieberkuhn, 374 Foot, bones of, 141 ligaments of, 169 Foramen caecum of frontal bone, 13 of medulla oblongata, 308 carotid, 25 condyloid, 18, 65 dental, inferior, 58 ethmoidal, 35 incisive, 45 infra-orbital, 43 intervertebral, 84 jugular, 65 lacerum anterius, 70 medium, 70 posterius, 70 magnum, 18, 65 mastoid, 21 mental, 56 of Monro, 393 ovale of splienoid, 30 palatine, anterior, 45 posterior, 68 parietal, 15 ' pterygoid, 38 pterygo-palatine, 29 rotunduni, 30 sacro-sciatic, 129 spheno-palatine, 51 spinosum, 30 stylo-mastoid, 25 supra-orbital, 13 vertebral, 87 Vesalii, 30 of Winslow, 371 Foramina, malar, 37 Foramina, olfactory, 34 sacral, 94 Thebesii. 338 Forearm, bones of, 115 Fornix, 293 Fossa, canine, 48 digastric, 21 digital, 134 glenoid, 21 iliac, 125 infra-spin ous, 107 incisive, 43 jugular, 25 navicular of urethra, 396 of vulva, 403 occipital, 18 ovalis, 338 pituitary, 27 pterygoid of sphenoid, 33 scaphoid, 32 of sliuli, anterior, 68 middle, 68 posterior, 69 subscapular, 109 supra-spinous, 107 temporal, 76 zygomatic, 76 Fourchette, 403 Frontal bone, 11 air-sinus, 14 Gall-bladder, 383 duct of, 383 fissure for, 380 structure of, 383 valve of, 383 Ganglion or Ganglia, 373 Arnold's, 314 of Andersch, 317 cardiac, 331, 333 carotid, 330 Casserian, 310 cephalic, 311, 312, 314 cervical, inferior, 333 middle, 330 superior, 330 ciliary, 311 on cii-cumflex nerve, 333 diaphragmatic, 333 of fifth nerve, 311, 312, 314 of fourth ventricle, 298 glosso-pharyngeal, 317 impar, 333 on interosseous nerve, posterior, 333 jugular, 317 lenticular, 311 lumbar, 333 Meckel's, 313 mesenteric, 331 INDEX. 469 GanglioQ or Ganglia, ophthalmic, 311 otic, 314 petrous, 317 pneuiuouastric, 317 renal, 332 of Ribes, 330 of root of vagus, 317 sacral, 333 semilunar, of abdomen, 333 of fifth nerve, 310 of svmpathetic, 332 solar, 332 sphenopalatine, 312 of spinal nerves, 319 submaxillary. 314 of sympathetic nerve, 331 thoracic, 332 of trunk of vastus, 317 of Wrisberg. 332 Ganglion cells, 271 Gladiolus, 99 Gland, agminate, 375 Brunner's, 374 Cowper's, 397 lachrymal, 422 of Littre, 396 Meibomian, 421 Peyer's, 375 prostate, 396 solitary, 374 Pacchioni, 13 Gliding movement, 150 Groove, bicipital, 113 infra-orbital, 42 lachrymal, 42 Grooves on radius, 118 Growth of bone, 6 Gyri operti, 384 Gyrus fornicatus, 385 Hand, bones of, 119 ligaments of, 164 Haversian canals, 3 Heart, 335 annular fibres of auricles, 342 auricles of, 337 circular fibres of, 343 conus arteriosus, 341 endocardium, 342 fibres of auricles, 343 of ventricles, 342 fibrous rings of, 341 foetal relics'^in, 338 left auricle, 339 ventricle, 340 muscular structure of, 343 right auricle, 337 ventricle, 338 septum ventriculorum, 836 Heart, size and weight, 336 spiral fibres of, 342 structure of 336 valves of, 339, 340 vortex of, 342 Hernia, direct inguinal, 456 coverings of, 457 femoral, 455 coverings of 456 inguinal, 456 Hiatus Fallopii, 24 Highmore, antrum of, 38 Hippocampus major, 294 minor, 293 Humerus, 111 Hj^oid bone, 96 development of, 97 Ileum, 373 Ilium, 125 Incus, 427 Inferior maxillary bone, 54 alveolar, 57 Infundibulum of brain, 388 Innominate bone, 125 development of, 131 Interarticular cartilage, 150 of jaw, 153 of knee, 168 of pubes, 159 of radio-ulnar joint, 163 of scapulo-clavicular joint, 160 of sterno-clavicular joint, 160 Intercellular substance of carti- lage, 150 Intestine, large. 376 cellular coat of, 377 ileo-caecal valve, 376 mucous membrane of, 378 muscular coat of, 377 serous coat of, 376 small, 373 cellular coat of 374 divisions of. 373 glands of, 3T4 mucous coat of, 374 muscular coat of 374 serous coat of, 374 simple follicles of, 375 valvuhie conniventes, 374 villi of. 374 Ischium, 130 Jacobson's nerve, canal for, 25 Jaw, lower, 54 ligaments of, 153 rami of, 57 sj^mphysis of, 54 Jejunum. 373 Joints, 150 470 INDEX. Kidneys, 384 artery of, 390 calyces of, 386 cortical substance of, 386 hilum of, 385 infundibula of, 386 Malpigliian bodies of, 380 mammillae of, 386 medullary substance of, 387 papilUe of, 386 pelvis of, 38G pyramids of Ferrein, 389 of Malpighi, 386 sinus of, 386 tubes of Ferrein, 388 tubuli uriniferi, 387 veins of, 390 weight and dimensions of, 384 Knee-joint, 168 Labia pudendi majora, 403 minora, 403 Labyrinth, membranous, 433 Lachrj'mal gland, 433 bones, 46 Lacteals, 367 Lacunae of bone, 4 Lamina cinerea, 888 Larynx, 343 cartilages of 343 cavity of, 345 glottis, 345 interior of, 345 ligaments of, 344 mucous membrane of, 346 muscles of, 345 superior aperture of, 344 ventricle of, 346 vocal cords of, false, 345 inferior, 346 true, 346 Leg, bones of, 139 ligaments of, 165 Lenticular ganglion, 311 Ligament or Ligaments, structure of, 151 acromio-clavicular, superior, 160 alar, of knee, 167 of ankle, anterior, 168 lateral, 168 annular, of ankle, 168 anterior, 168 external, 168 internal, 168 of radius and ulna, 163 of wrist, anterior, 103 posterior, 103 anterior, of knee, 168 astragalo-scaphoid, 169 atlo-axoid, anterior, 169 Ligament or Ligaments, broad, of lung, 347 calcaneo-cuboid, internal, 169 long, 169 short, 169 superior, 169 calcaneo-scaphoid, superior, 170 capsular, 171 carpo-metacarpal, 165 of carpus, 163 check, 154 common vertebral, anterior, 155 posterior, 155 conoid, 160 coraco-acromial, 160 -clavicular, 160 coracoid, 160 coronary, of knee, 168 costo-clavicular, 160 cotyloid, 166 crico-arytenoid, 344 -thyroid, 344 crucial, of knee, 167 deltoid, 169 of elbow, 161 glenoid, 161 glosso-epiglottidean, 344 of hip, 166 hyo-epiglottic, 344 ilio-femoral, 166 -lumbar, 158 interarticular, of ribs, 155 interspinous, 155 intertransverse, 155 intervertebral, 155 of jaw, 153 of knee, 167 of larynx, 344 of liver, 380 lumbo-iliac, 158 sacral, 158 metacarpal, 165 metacarpo-phalangeal, 165 metatarsal, 170 metatarso-phalangeal, 171 mucosum, 167 odontoid, 154 orbicular, 163 of pelvis, 157 plantar, 170 long, 170 posterior, of knee, 167 posticum Winslowii, 167 pterygo-maxillary, 153 pubic, anterior, 159 radio-carpal, 163 radio-ulnar, anterior, 163 round, of hip, 166 sacro-iliac, anterior, 157 oblique, 157 INDEX. 471 Ligament or Ligaments, sacroiliac, posterior, 157 sacro-sciatic, anterior, greater, 158 lesser, 158 of scapula, IGO scapulo-clavicnlar, IGO of shoulder, 161 stellate, 155 stylo-maxillary, 153 subflavous, 155 subpubic, 159 supra-spinous, 155 thyrohyoid, 344 tibio-fibular, 168 -tarsal, 169 transverse, of hip, 166 of knee, 167 of scapula, 160 of tibio-fibular, 168 trapezoid, 160 of wrist, 163 Ligamenta alaria, 167 subflava, 155 Ligamentum mucosum, 155 patellae, 163 Linea aspera, 135 ileo-pectinea, 132 quadrati, 135 Liver, 379 arteries of, 381 ducts of. 381 fibrous coat of, 379 fissures of 380 ligaments of, 379 lobes of 379 lobules of, 381 situation, size, and weight, 379 structure of, 381 vessels of 380 Lower extremity, bones of, 125 Lungs, 347 air-sacs of 349 capillaries of 350 clusters of 347 lobes and fissures of 348 lobules of 349 structure of 347 subdivision of bronchi in, 349 weight, color, etc., 348 Lymph-sinuses, 264 Lymphatic duct, right, 267 Lymiihatic glands, 264 axillary, 366 bronchial, 267 of elbow, 266 inguinal, deep, 269 superficial, 269 of lower extremity, 269 mediastinal, 266 Lymphatic glands of neck, 265 of thorax, 267 of upper extremity, 265 Lymphatics, 264 abdomen, 267 arm, 265 bladder, 269 cervical, 265, 266 chest, 267 clitoris, 269 cranium, 265 face, deep, 265 superficial, 265 groin, 269 head, 265 intestines, 268 lacteals, 267 large intestine, 267 lower extremity, 265 lung, 266 mesenteric, 267 neck, 265 origin of 264 ovaries, 269 pelvis, 269 penis, 269 prostate, 269 rectum, 269 scrotum, 269 small intestine, 267 testicle, 269 thoracic duct, 267 thorax, 266 thyroid, 265 trunk, 265 upper extremity, 265 uterus, 269 vagina, 269 Magnum (os) of carpus, 121 Malar bone, 37 Malleolus, external, 141 internal, 140 Malleus, 427 Mammary gland, 411 Manubrium of sternum, 98 Marrow of bone, 5 Mastoid cells, 22 portion of temporal bone, 21 Meatus auditorius externus, 20 internus, 23 of nose, inferior, 74 middle, 74 superior, 74 urinarius, female, 404 male, 396 Meckel's ganglion, 312 Mediastinum, anterior, 335 middle, 335 posterior, 335 472 INDEX. Medulla oblongata, 299 Membrana pupillaris, 414 tympani, 426 secundaria, 425 Metacarpus, 122 Metatarsus, 147 Motor oculi, 316 Mouth, 350 Muscles, minute anatomy, 172 of animal life, 172 aponeurosis, 176 arrangement of fibres, 173 fasciculi of, 174 fibrils of, 174 insertion of, 175 involuntary, 174 of organic life, 174 sarcous elements of, 174 sheath of, 174 striped, 173 unstriped, 174 voluntary, 174 Muscle or Muscles, 172 of abdomen, 207 abductor minimi digiti, of foot, 227 of hand, 215 pollicis, of foot, 226 of hand, 213 accelerator uringe, 229 accessorius ad sacro-lumbalem, 197 pedis, 227 adductor brevis, 219 longus, 219 magnus, 219 pollicis, of hand, 214 of foot, 228 anconeus, 211 arytaeno-epiglottideus inferior, 345 superior, 345 arytsenoideus, 345 attollens aurem, 178 attrahens aurem, 178 azyeos uvulae, 188 of Bell, 394 biceps, of arm, 207 of leg, 221 biventer cervicis, 199 ])rachialis anticus, 208 buccinator, 183 cervicalis ascendens, 197 coccygeus, 231 compressor nasi, 180 narium minor, 180 urethrfe, 230, 231 constrictor pliaryngis inferior,190 medius, 190 superior, 189 Muscle or Muscles, coraco-brachi- alis, 207 corrugator supercilii, 176 corrugator cutis ani, 231 crico-arytaenoideus lateralis, 345 posticus, 345 crico-thyroid, 345 crureus, 218 deltoid, 206 depressor alse nasi, 180 diaphragm, 192 digastric, 186 dilator naris, anterior, 180 posterior, 180 erector elitoridis, 231 penis, 229 spinae, 197 extensor brevis digitorum, 226 carpi radialis brevior, 210 longior, 210 ulnaris, 210 coccygis, 201 communis digitorum, 210 indicis, 212 longus digitorum, 223 minimi digiti, 211 ossis metacarpi pollicis, 213 primi internodii pollicis, 213 proprius pollicis, 223 secundi internodii pollicis, 213 flexor accessorius, 227 brevis minimi digiti, of foot, . of hand, 215 brevis digitorum, 226 pollicis, of foot, 227 of hand, 213 carpi radialis, 208 ulnaris, 209 digitorum profundus, 209 sublimis, 209 longus digitorum, 226 pollicis, of foot, 225 of hand, 209 gastrocnemius, 224 gemellus inferior, 221 superior, 221 genio-hyoglossus, 187 -hyoid, 187 gluteus maximus, 219 medius, 220 minimus, 220 gracilis, 218 hyoglossus, 187 iliacus, 216 infra-costal, 192 infra-spinatus, 296 intercostal, 192 external, 192 internal, 192 INDEX. 473 Muscle or Muscle*, interossei, dor- sal, 21iS palmar, 215 plantar, 228 interspinales, 200 intertransversales, 201 latissimus clorsi, 195 levator anguli oris. 182 scapuke, 195 ani, 229, 231 labii inferioris. 182 superioris, 182 alaeque nasi, 180 menti, 182 palati, 188 palpebrse, 177 superioris, 177 levatores costarum, 192 lingualis, 187 longissimus dorsi, 198 longus colli, 191 lumbricales, of foot, 227 of hand, 215 masseter, 183 multifidus spinae, 199 mylo-hyoid, 187 obliquus abdominis externus, 201 internus, 202 capitis inferior, 200 superior, 200 oculi inferior, 179 superior, 179 obturator externus, 221 internus, 220 occipito-frontalis, 176 omo-hyoid, 186 opponens minimi digiti, 215 pollicis. 213 orbicularis oris, 182 palpebrarum, 176 palato-glossus, 188 -pharyngeus, 188 palmaris brevis, 215 longus, 208 pectineus, 219 pectoralis major, 205 minor, 205 peroneus brevis, 224 lonsus, 224 tertlus, 223 plantaris, 225 platysma myoides, 185 popliteus, 225 pronator quadratus, 209 radii teres, 208 psoas magnus, 216 parvus, 216 pterygoid, external, 184 internal, 184 pyramidalis abdominis, 203 Muscle or Muscles, pyramidalis nasi, 180 pyriformis, 220 quadratus femoris, 221 lumborum, 204 menti, 182 quadriceps extensor femoris, 218 rectus abdominis, 203 capitis anticus major, 190 minor. 190 posticus major, 200 minor, 200 femoris, 217 lateralis, 191 oculi externus, 178 inferior, 178 internus, 178 superior, 178 retrahens aurem, 178 rhomboideus major, 196 minor, 196 risorius of Santorini, 183 rotatores spinoe, 200 sacro-lumbalis, 197 sartorius, 217 scalenus anticus. 191 medius, 191 posticus, 191 semimembranosus, 222 semispinalis colli, 199 dorsi, 199 semitendinosus, 222 serratus magnus. 206 posticus inferior, 196 superior, 196 soleus, 224 sphincter ani, external, 231 internal , 231 vagime, 231 spinalis colli, 198 dorsi, 198 splenius, 197 capitis, 197 colli, 197 steruo-cleido-mastoid, 185 -hyoid, 185 -thyroid, 185 stylo-glossus, 188 -hyoid, 187 -piiaryngeus. 190 subanconeus, 208 subclavius, 205 subcrureus, 218 subscapularis, 206 supinator brevis, 211 longus, 210 supra-spinales, 206 supra-spinatus, 206 temporal, 184 474 INDEX. Muscle or Muscles, tensor palati, 188 tarsi, 177 vaginiB femoris, 217 teres major, 206 minor, 206 thyro-arytsenoideus, 345 -epiglottideus, 345 -hyoid, 185 tibialis anticus, 223 posticus, 225 trachelo-mastoid, 198 transversalis abdominis, 203 colli, 198 transversus pedis, 228 perinsei, 239, 231 trapezius, 194 triangularis menti, 182 sterni, 192 triceps extensor cubiti, 208 vastus externus, 217 internus, 218 zygomaticus major, 181 minor, 181 Nasal bones, 36 fossae, 72 Nates of brain, 297 Negroid brain-weiglit, 275 Nerve or Nerves, cerebro-spinal, 270 composition of, 270 neurilemma of, 273 cells, 273 abducens, 314 accessory obturator, 326 acromial, 322 auditory, 316 auricular, of auricularis mag- nus, 320 of auriculotemporal, 313 posterior, from facial, 315 of second cervical, 320 of small occipital, 320 of vagus, 317 auricularis magnus, 320 cardiac, 330, 331 inferior, 331 middle, 331 of pneumogastric, 317 superior, 330 cardiacus magnus, 330 minor, 332 cavernous, of penis, 329 cervical, anterior, 320 posterior, 320 superficial branches of, 320 cervico-facial, 320 chorda tympani, 316 ciliary, long, 311 Nerve or Nerves, ciliary, short, 311 circumflex, 322 clavicular, 322 coccygeal, 326 cochlear, 316 communicans noni, 321 peronei, 328 of Cotunnius, 312 cranial, 303 anterior crural, 326 cutaneous, of accessory obtura- tor, 326 of arm, external, 322 internal, 323 lesser internal, 323 of cervical plexus, 320 circumflex, 322 coccygeal, 326 crural, anterior, 326 dorsal nerves, 324 dorsalis penis, 329 external , 325 haemorrhoidal inferior, 329 ilio-hypogastric, 325 -inguinal, 325 intercostal, 324 internal, 326 of iscliio-rectal region, 329 lateral of dorsal, 324 of intercostal. 324 lumbar, 324 median, 322 musculo-cutaneous, 332 -spiral, 323 obturator, 326 palmar, 324 perineal, 329 peroneal, 328 plantar, 328 popliteal, external, 328 internal, 327 middle, 326 radial, 323 sacral, 327 sciatic, lesser, 329 small, 329 of thorax, anterior, 322 lateral, 322 tibial, anterior, 328 posterior, 328 ulnar, 323 dental, anterior, 813 inferior, 313 posterior, 312 descendens noni, 319 digastric, from facial, 316 digital of foot, dorsal, 339 plantar, 339 of hand, dorsal, 324 palmar, median. 324 INDEX. 475 Nerve or Nerves, dorsal, 324 anterior branches of, 334 posterior branches of, 324 of penis, 329 eighth pair, 31G of eyeball, 311 facial, 314 fifth, 310 fourth, 310 frontal, 311 gastric branches of vagus, 318 genito-crural, 325 glosso-pharyngeal, 316 gluteal, inferior, 329 superior, 329 gustatory, 314 of heart, 330 haemorrhoidal, inferior, 329 hypoglossal, 319 iliohypogastric, 325 -inguinal, 325 incisor, 313 infra-orbital of facial, 316 -trochlear, 311 intercostal, 324 intercosto-humeral, 323 interosseous anterior, 323 posterior, 323 Jacobson's, 318 labial, 316 lachrymal, 311 of Lancisi, 289 laryngeal, 318 inferior, 318 recurrent, 318 superior, 318 lingual, of glosso-pharyngeal, 317 lumbar, 324 branches of, 324 roots of, 324 lumbosacral, 326 malar branch of facial, 816 masseteric, 313 maxillary, inferior, 313 superior, 311 median, 322 mental, 313 motor oculi, 313 musculo-cutaneous, of abdomen, 325 of arm, 322 from peroneal, 329 musculospiral, 323 mylohyoid, 313 nasal, from Meckel's ganglion, 312 of ophthalmic, 311 from superior maxillary, 312 from Vidian, 312 Nerve or Nerves, naso-palatine, 312 ninth, 316 obturator, 325 accessory, 325 occipital of facial, 316 great. 320 small, 320 from third cervical, 320 occipitalis major, 320 minor, 320 oesophageal, 332 olfactory, 308 ophthalmic, 310 optic, 309 palatine, 312 anterior, or large, 318 posterior, or small, 312 palmar cutaneous of median, 323 ulnar, 323 palpebral, 311 par vagum, 317 pathetic, 310 perineal, 329 superficial, 329 peroneal, 328 petrosal, small, 315 superficial external, or large, 315 pharyngeal, of external laryn- geal, 318 of glosso-pharyngeal, 317 of Meckel's ganglion, 313 of pneumogastric, 318 of sympathetic, 331 phrenic, 320 plantar, cutaneous, 329 external, 328 internal, 328 pneumogastric, 317 popliteal, external, 328 internal, 327 portio dura, 314 mollis, 316 pterygo-palatine, 312 pudic, 329 pulmonary, from vagus, 318 radial, 323 recurrent laryngeal, 318 renal splanchnic, 332 respiratory, external, 322 internal. 320 sacral, 327 roots of, 327 saphenous, external, or short, 328 internal, or long, 326 sciatic, great, 327 small, 329 seventh, 314 sixth, 314 \' 476 INDEX. Nerve or Nerves, spermatic, 325 spheno-palatine, 312 spinal accessory, 318 splanchnic, great, 332 lesser, 332 renal, or smallest, 333 splenic, 331 stylo-hyoid of facial, 316 subclavian, 322 suboccipital, 320 subscapular, 322 superficialis colli, 322 supra-clavicular, 323 -maxillary, of facial, 316 -orbital, 311 -scapular, 323 sympathetic, 330 cephalic portion of, 330, 331 cervical portion of, 330 lumbar portion of, 333 pelvic portion of, 333 thoracic portion of, 332 temporal, of auriculo -temporal, 313 deep 313 of facial, 316 temporo-facial, 316 third or motor oculi, 310 thoracic, anterior, 323 cardiac, 331 posterior, 323 tibial, anterior, 328 posterior, 328 of tongue, 319 tonsillar, 317 trifacial, 310 trigeminus, 310 tympanic, of facial, 316 of glosso-pharyngeal, 317 ulnar, 323 uterine, 333 vaginal, 333 vagus, 317 branches of, 318 ganglia of, 317 Vidian, 312 of Wrisberg, 333 Nervous substance, microscopical appearance of, 370 Nervous system, general anatomy of, 270 of animal life, 270 cerebro-spinal axis, 274 cortical substance, 279 fibrous nervous matter, 270 ganglia, 273 gray matter, 273, 307 of organic life, 330 sympathetic, 330 composition of, 373 Nervous system, sympathetic, gelatinous fibres of, 373 tubular fibres of, 371 vesicular matter, 272 white or medullary substance of, 373 Neurilemma, 3 Neuroglia, 273 Nidus hirundinis, 302 Nose, bones of, 36 meatuses of, 72 Notch, cotyloid, 130 ethmoidal, 13 sacro-sciatic, greater, 139 lesser, 129 sigmoid, 58 supra-scapular, 109 Occipital bone, 16 crests of, 18 (Esophagus, 366 structure of, 366 Olfactory bulb, 28)5 nerve, 308 Olivary bodies of medulla ob- longata, 299 Optic commissure, 388 nerve, 309 thalami, 292 Orbits, 71 Os calcis, 143 hyoides, 96 innominatum, 135 magnum of carpus, 131 planum, 35 Ossification of bone, 6 intra-cartilaginous, 6 inter-membranous, 6 Osteology, 1 Otic ganglion, 314 Ovary, 409 corpus luteum of, 411 Graafian vesicles of, 409 ligament of, 411 shape, position, and dimensions of, 409 stroma of, 410 Ovula of Naboth, 409 Pacchionian depressions, 13 bodies, 277 Palate, hard, 45 bone, 47 Pancreas, 383 duct of, 383 structure of, 383 Parietal bones, 14 Parotid gland, 363 Patella, 137 Patheticus, 310 INDEX. 477 Pelvic viscera, 393 Pelvis, arteries of, 131, 393 axes of, 132 brim of, 133 cavity of, 132 diameters of, 132 male and female, diflferences of, 133 Penis, 397 arteries of, 399 body of, 397 corpora cavernosa, 398 corpus spongiosum, 398 dorsal artery of, 399 nerve of, 399 vein, 398 glans, 398 prepuce of, 398 root of, 397 suspensory ligament of 397 Perforated space, anterior, 287 posterior, 288 Pericardium, 335 Peritoneum, 369 folds of 369 lesser cavity of, 371 ligaments, 371 mesenteries, 370 omenta of, 370 reflections of, 369 Pes hippocampi, 294 Phalanges, of foot, 148 of hand, 124 Pliarynx, 364 aponeui'osis of, 365 mucous membrane of, 365 muscles of, 364 Pia mater of brain, 278 Pineal gland, peduncles of, 295- 297 Pinna of ear, 422 cartilage of, 422 muscles of, 422 Pisiform bone, 121 Pituitary body, 288 Pleura, 347 cavity of, 347 parietal layer of, 317 reflections of 347 visceral layer of, 347 Plexus of nerves, aortic, 332 brachial, 321 cardiac, anterior, 332 deep, or great, 332 superficial, 332 carotid. 314 cavernous. 311 cervical, 320 coeliac, 332 cystic, 333 Plexus of nerves, diaphragmatic, 332 hivmorrhoidal. inferior, 333 superior, 333 hepatic, 333 hvpogastric, 333 lumbar, 325, 332 meningeal, 316 oesophageal, 332 prostatic, 262, 333 pulmonary, anterior, 330 posterior, 330 pyloric, 331 renal, 331 sacral, 327, 332 solar, 330 vaginal, 262 hfemorrhoidal. 262 pampiniform, 262 uterine, 262 Pons Varolii, 300 Process or Processes, acromion, 107 alveolar, 56 angular, external, 12 internal 12 auditory, 22 basilar. 17 clinoid. anterior, 69 middle, 69 posterior, 69 condyloid, of lower jaw, 59 coracoid, 109 coronoid, of lower jaw, 58 of ulna, 114 ethmoidal, of inferior turbinated, 53 cerebello ad testes, 297 frontal, of malar, 37 hamular, of sphenoid, 32 of Ingrassias, 29 jugular, 17 lachrymal, of inferior turbinated bone, 53 malar, of superior maxillary, 38 mastoid, 21 maxillary, of inferior turbinated, 53 of malar bone. 37 nasal, 38 odontoid, of axis. 88 olecianon, 114 olivary, of palate, 48 palatine, of superior maxillary, 44 pterygoid, of palate bone, 49 of sphenoid. 31 spinous, of ilium, 125 of sphenoid. 31 of tibia, 138 478 INDEX. Process or Processes, spinous, of vertebrae, 83 styloid, of radius, 118 of ulna, 116 transverse, of vertebrae, 84 unciform, 122 of ethmoid, 35 vaginal, of sphenoid, 28 of temporal, 25 vermiform, of cerebellum, 302 zygomatic, 21 Promontory of sacrum, 94 Prostate gland, 396 lobes of, 397 position of, 396 size and shape of, 396 structure of, 396 changes in, 397 Protuberance, occipital, external, 17 internal, 18 Pubes, 127 symphysis of, 132 Puncta vasculosa, 289 Pyramids, anterior, 299 decussation of, 299 of Ferrein, 389 of Malpighi, 386 posterior, 299 Radius, 116 Ramus of ischium, 129 of lower jaw, 58 of'pubes, 127 Receptaculum chyli, 267 Rectum, 878 folds of, 378 Regional anatomy, 440 axilla, 447 femoral hernia, 463 inguinal hernia, 466 neck, 440 perineum, 450 Scarpa's triangle, 454 Restiform bodies of medulla oblon- gata, 299 Retina, 416 Ribs, 100 common characters of, 101 false, 100 floating, 100 peculiar, 102 true, 100 Ridge, internal occipital, 18 mylo-hyoidean, 55 pterygoid, 31 superciliary, 11 temporal, 76 Rosenmiiller, organ of 411 Rostrum of sphenoid bone, 28 Saccule, 433 Sacrum, 93 cornua of, 95 development of, 96 structure of, 96 Salivary glands, 362 structure of, 362 Scaphoid bone, of foot, 144 of hand, 119 Scapula, 107 Scarpa's triangle, 454 Sclerotic, 414 Seminal vesicles, 402 Shoulder-joint, bones of, 107, 111 Sinus or Sinuses, cavernous, 258 circular, 259 coronary, 337 of diploe, 257 of dura mater, 257, 277 lateral, 258 longitudinal, inferior, 257 superior, 257 maxillary, 41 occipital, 258 petrosal, greater, 259 lesser, 259 pituitary, 259 straight, 257 sphenoidal, 28 transverse, 259 uterine, 262 Skin, anatomy of, 436 appendages of, 438 Skull, 60, 77 angles, 79-83 anterior region of, 71 base of, 63 cerebral or internal surface, 68 fissures of. 77 fossa of, 68 lateral region of, 76 sutures of 61 vertex of, 62 Smell, organ of, 435 Spermatic cord, 400 Spermatozoa, 401 Sphenoid bone, 26 development of, 32 Sphenoidal spongy bones, 28 Spinal cord, 303 arachnoid of, 303 arrangement of gray and. white matter in, 304 central canal of, 308 columns of, 304 dura mater of, 303 fissures of, 304 gray matter of, 307 ligamentum denticulatum of, 304 membranes of, 303 ' INDEX. 479 Spinal colt], pia mater of, 303 white niiitter of. 304 Spinal nerves. 319 ganglia of, 319 roots of, anterior, 319 posterior, 319 Spine, 83 curves of, 92 in relation to structures of back, 85 of ischium, 129 nasal, anterior, 73 posterior, 67 pharyngeal, 17 of pubes, 127 of scapula, 107 Spleen. 383 capillaries of, 384 fibrous elastic coat of, 384 fissure of, 384 hilum of, 384 Malpighian corpuscles of, 384 proper substance of, 384 structure of, 384 suspensory ligament of, 383 trabeculae of, 384 Squamous portion of temporal bone, 26 Stapes, 427 Steno's duct, 363 Sternum, 97 Stomach, 371 cellular coat of, 373 curvatures of, 371 fundus of, 372 follicles of, 372 glands, 373 mucous glands of, 373 mucous membrane of, 373 muscular coat of, 372 orifices of, 372 peptic glands of, 373 pyloric end of, 372 structure of, 372 Subarachnoid fluid, 278 space of brain, 278 Sublingual trland, 364 duct of, 364 Submaxillary gland, 363 duct of, 303 ganglion, 314 Sulci of cerebrum, 279 Superior maxillary bone, 38 articulations of, 38 development of, 46 Supra- renal capsules, 391 structure of, 391 Suture, coronal, 61 cranial, 61 frontal, 61 Suture, fionto-nialar, 60 -niaxiihuy, 60 lambdoid , 61 Synovial, of wrist, 164 tarsal, 170 System, Haversian, 2 T^NiA semicircularis, 292 Tarsus, 141 Taste, organ of, 433 Teeth. 351 bicuspid, 356 canine, 354 cement of, 358 cortical substance of, 858 crown of, 352 crusta petrosa of, 358 deciduous, 351. 357 dentine of, 358 development of, 360 enamel of, 359 eruption of, 361 eye, 354 fang of, 352 growth of, 360 incisors, 353 intertubular tissue of, 358 milk, 351 molar, 356 permanent, 353 pulpcavitv of, 358 roots of, 358 structure of, 358 temporary, 357 tubuli of, 359 wisdom, 351, 357 Tempoial bone, 20 mastoid portion of, 21 petrous portion of, 23 squamous portion of, 20 Tendo-oculi, 421 Tentorium ccrebelli, 276 Testes, 399 of biain, 297 coverings of, 399 tunica albuginea, 401 vaginalis, 400 vasculosa, 401 gubernaculum, 399 lobules of, 401 lymphatics of , 400 mode of descent of, 400 size and weight of, 400 structure of, 401 tubuli seminiferi of, 401 vas deferens of, 402 vasa efferentia of, 401 recta, 401 Thigh, bone of. 133 I Thoracic duct, 267 480 INDEX. Thorax, 103, 334 ^ bones of, 103 openings of, 334 Thjanus gland, 393 Thyroid gland, 391 Tibia, 138 structure of, 140 Tonsils, 366 Torcular Herophili, 18 Trachea, 346 cartilages of, 346 structure of, 346 Trapezium bone, 121 Trapezoid bone, 121 Trifacial nerve, 310 Trochanters, greater and lesser, 134 Trochlea of humerus, 114 Tubes, Fallopian, 409 Tuber cinereum, 288 Tubercle, conoid, 108 genial, 56 of zygoma, 21 Tubercula quadrigemina, 297 Tuberosities of humerus, greater and lesser. 111 of tibia, 139 Tuberosity of ischium, 130 maxillary, 46 of palate bone, 48 of radius, 117 Tubuli of Ferrein, 388 of Bellini, 387 of Henle, 389 uriniferi, 887 Turbinated bone, inferior, 53 middle, 53 superior, 53 Tympanum, 424 cavity of, 424 membrane of, 426 mucous membrane of, 426 muscles of, 428 ossicula of, 427 Ulna, 114 Unciform bone, 123 Upper extremity, bones of, 105 Ureters, 390 Urethra, female, 404 male, 395 bulbous portion of, 395 membranous portion of, 395 prostatic portion of, 395 spongy portion of, 395 structure of, 396 veru montanum of, 395 Uterus, 406 appendages of, 406 arbor vitae of, 408 cavity of, 407 Uterus, cervix of, 407 fundus of, 406 ligaments of, 407 nerves of, 409 shape, position, etc., of, 406 structure of, 408 vessels of, 409 Utricle of vestibule, 433 Vagina, 405 columns of, 405 orifice of, 402 Valve, Eustachian, 338 mitral, 340 semilunar, aortic, 339, 311 pulmonic, 339, 341 tricuspid, 339 of Vieussens, 297 Valvulse conniventes, 374 Vein or Veins, general anatomy of, 255 anastomoses of, 256 coats of, 256 plexus of, 256 valves of, 256 articular, of knee, 261 auricular, posterior 256 axillary, 260 azygos, 263 major, 263 minor, 263 basilic, 260 basi-vertebral, 264 brachial, 260 cava, inferior, 262 superior, 263 cephalic, 260 cerebellar, 257 cerebral, 257 circumflex iliac, 262 superficial, 262 of corpora cavernosa, 262 of corpus spongiosum, 262 of diploe, 257 dorsal, of penis, 262 epigastric, 262 superficial, 262 facial, 256 femoral, 261 gastric, 263 hsemorrhoidal, 263 of head, 256 hepatic, 262 iliac, common, 262 external, 261 internal, 261 innominate, 263 intercostal, 263 superior, 263 interlobular. 263, 381 INDKX. 481 Vein or Veins, jugular, anterior, 257 external, 257 posterior, 257 • internal, 257 lobular, 263 of liver, 381 longitudinal sinus, interior, 257 superior, 257 lumbar, 262 mammary, internal, 263 maxillary, internal, 256 median, 260 basilic. 260 cephalic, 260 mesenteric, inferior, 263 superior, 263 of neck, 257 occipital, 256 ophthalmic, 258 phrenic, 263 popliteal, 261 portal, 263 profunda femoris, 261 radial, 260 renal, 262 saphenous, external or short, 261 internal or long, 261 spermatic, 262 splenic, 263 subclavian, 261 sublobular, 263 supra-renal, 262 • temporal, 256 middle, 256 temporo-maxillary, ?56 thyroid, inferior, 263 ulnar, anterior, 260 of upper extremity and thorax, 260 vaginal, of liver, 263 of vertebrte, 257 Velum interpositum, 295 Venaj Galeni, 295 ' Venter of ilium, 125 of scapula, 109 Ventricle of brain, third, 295 fourth, 297 fifth, 295 of heart, left, 340 right, 338 of larynx, 346 Vertebra prominens, 89 Vertebrae, 83 cervical, 86 coccygeal, 96 development of, 92 dorsal, 89 general characters of, 83 lumbar, 91 sacral, 93 Vertex of skull, 62 Vidian nerve, 312 Villi, 374 Violet streaks of fourth, ventricle, 298 Vocal cords, false, 345 inferior, 346 superior, 345 true, 346 Vomer, 51 alae of, 52 development of, 53 Vulva, 403 White substance of brain, 273 of Schwann, 273 Wormian bones, 63 Xanthochroic races, 275 brain -weights, 275 Zygoma, 21 School of Anatomy, i:Z13 arxd. ItZlS Clne:rry Stre:e;t, PHILADELPHIA. The school is open for practical work in Anatomy and Operative Surger}' from September 1st to June 1st. The hours are from 8 a.m. to 10 p.m. Close attention is given to the Avork of each student, the classes being under the direction of able and experienced demonstrators. fe;e:3. Dissection, including Lectures and Demonstrations, $10.00 Material, Each Part 1-00 Operative Surgery, including Material and Use of Instruments. For Classes of Four or More, Each, . . . . 15.00 Foe Classes of Three, Together, . . . . 50.00 For Classes of Two, Together 40.00 Foe One Person, . . . • • • • • 30.00 For further information, address HENRY C. BOBNNING, M.D., 1113 AND 1115 Cherry Street. Or the Following Demonstrators : T. T. BLAND, M.D. BERNARD BERENS, M.D. A. B. HIRSH, M.D. T. C. SANGREE, M.D. J. W. CROSKEY, M.D. T. B. EARLEY, M.D. R. F. LONGACRE, M.D. Andrew Drummond, Janitor. SEPTEMBER, 1891. @ ATALOGUE In place of repeated revisions, Supplements to tliis Catalogue will be issued at intervals of about every three niontlis. These supplements will be regularly mailed to all those who will favor us with their name and address. OF THE Medical Publications OP r. A. DAVI5, Medical PuBLisiiER ^ B00K5ELLER, 1231 riLBERT 5TREET, FHlLAbELFHlA, FA. Branch Offices; NEW YORK CITY— 117 W. Forty-Second St. CHICAGO— 24 Lakeside Building, 214-220 S. Clark Street. ATLANTA— 69 Old Capitol. LONDON, ENG.—40 Berners Street, Oxfora Street, W. Order from Nearest Office. For Sale by all Booksellers. SPECIAI. NOTICE. PRICES of books, as given in our catalogues and circulars, include full prepayment of postage, freight, or express charges. Cus- tomers in Canada and Mexico must pay the cost of duty, in addition, at point of destination. N. B. — Remittances should, be made by Express Money-Order, Post-Oflace Money-Order, Registered Letter, or Draft on Ne-w York City, Philadelphia, Boston, or Chicago. We do not hold ourselves responsible for books sent by mail ; to insure safe arrival of books sent to distant parts, the package should be registered. Charges for registering (at purchaser's expense), ten cents for every four pounds, or less. INDEX TO CATALOGUE. PAGE Annual of the Universal Medical Sciences 27, 28, 29 Anatomy. Practical Anatomy — Boenning 4 Structure of the Central Nervous Sys- tem— Edinger 8 Charts of the Nervo-Vascular System- Price and Eagleton 17 Synopsis of Human Anatomy — Young . . 25 Bacteriology. Bacteriological Diagnosis — Eisenberg . . 8 Clinical Charts. Improved Clinical Charts— Bashore ... 3 Consumption. Consumption : How to Prevent it, etc. — Davis •• . 7 Domestic Hygiene, etc. The Daughter : Her Health, Education, and Wedlock — Capp 5 Consumption : How to Prevent it, etc. — Davis 7 Plain Talks on Avoided Subjects — Guernsey 9 Heredity, Health, and Personal Beauty — Shoemaker 21 Electricity. ; Practical Electricity in Medicine and Surgery— Liebig and Rohe 12 Electricity in the Diseases of Women — Massey 13 Fever. Fever: its Pathology and Treatment- Hare 10 Hay Fever— Sajous 19 Gynecology. Lessons in Gynecology— Goodell 9 Heart, Lungs, Kidneys, etc. Diseases of the Heart, Lungs, and Kidneys— Davis 7 Diseases of the Heart and Circulation in Children— Keating and Edwards ... 12 Diabetes : its Cause, Symptoms, and Treatment — Ptirdy 17 Hygiene. American Resorts — James 11 Text-Book of Hygiene— Rohe 18 Materia Medica and Thera- peutics. Hand-Book of Materia Medica, Phar- macy, and Therapeutics— Bowen ... 4 Ointments and Oleates— Shoemaker ... 21 Materia Medica and Therapeutics— Shoe- maker 22 International Pocket Medical Formulary — Witherstine 26 (2 Miscellaneous. PAGE Book on the Physician Himself— Cathell . 5 Oxygen— Demarquay and Wallian .... 7 Record-Book of Medical Examinations for Life Insurance — Keating 11 The Medical Bulletin, Monthly 13 Physician's Interpreter 15 Circumcision — Remondino 18 Medical Symbolism— Sozinskey 23 International Pocket Medical Formulary —Witherstine 26 The Chinese : Medical, Political, and Social— Coltman 31 A, B, C of the Swedish System of Educa- tional Gymnastics — Nissen 32 Lectures on Auto-Intoxication — Bouchard , 32 Nervous System, Spine, etc. Spinal Concussion — Clevenger 6 Structure of the Central Nervous System —Edinger S Epilepsy; its Pathology and Treatment- Hare 10 Lectures on Nervous Diseases — Ranney . 30 Obstetrics. Childbed : its Management : Diseases and Their Treatment— Manton 13 Eclampsia— Michener and others 15 Obstetric Synopsis— Stewart 24 Pharmacology . Abstracts of Phai-macology — Wheeler . . 25 Physiognomy. Practical and Scientific Physiognomy— Stanton 30 Physiology. Physiology of the Domestic Animals- Smith 23 Surgery and Surgical Operations. Circumcision — Remondino 18 Principles of Surgery— Senn 20 Swedish Movement and Massage. Swedish Movement and Massage Treat- ment—Nissen 15 Throat and Nose. Journal of Laryngology and Rhinology . 11 Hay Fever— Sajous 19 Diphtheria, Croup, etc.— Sanne 19 Lectures on the Diseases of the Nose and Throat— Sajous 31 Venereal Diseases. Syphilis : To-day andnn Antiquity— Buret 4 Neuroses of the Genito-Urinary System in the Male— Ultzmann 24 Veterinary. Age of the Domestic Animals— Huide- koper 32 Physiology of the Domestic Animals- Smith 23 Visiting-Lists and Account- Books. Medical Bulletin Visiting-List or Physi- cians' Call-Record 14 Physicians' All-Requisite Account-Book . 16 ) Bashore's Improved Clinical Chart. For the SEPARATE PLOTTINa of TEMPERATURE, PULSE, and RESPIRATION. Designed for the Convenient, Accurate, and Permanent Daily Recording of Cases in Hospital and Private Practice. By HARYHY B. BASHORE, 9I.D. COPYEIGHTED, 1888, BY F. A. DAVIS. SO Oliarts, iaa Ta-Tolct T^oTm.. Size, S 22: 12 incites. Price, in the United States and Canada, Post-paid, 60 Cents, Net ; Great Britain, 2s. 6d. ; France. 3 fr. 60. The above diagram is a little more than one-fifth (1-5) the actual size of the chart and shows the method of plotting, the upper curve being the Temperature, the middle the Pulse, and the lower the Respiration. By this method a full record of each can easily be kept with but one color ink It is so arranged that all practitioners will find it an invaluable aid in the treatment of their patients. On the back of each chart will be found ample space conveniently arranged for recording "Clinical History and Symptoms" and "Treatment." By its use the physician will secure such a complete record of his cases as will enable him to review them at any time. Thus he will always have at hand a source of individual improvement and benefiC in the practice of his profession, the value of which can hardly be overestimated. A Text-Book on Practical Anatomy. Including a Section on Surgical Anatomy, B}^ Henry C. Boenning, M.D., Lecturer on Anatomy and Surgery in the Philadelphia School of Anatomy ; Demonstrator of Anatomy in the Medico-Chirurgical College ; Demonstrator of Anatomy in the Philadelphia Dental College ; Lecturer on Diseases of the Rectum in the Medico-Chirurgical College, etc., etc. Fully illustrated throughout with about 200 Wood-Engravings. In one handsome Octavo volume, printed in extra-large, clear t_ype, making it specially desirable for use in the dissecting room. Nearly 500 pages. Substantially bound in Extra Cloth. Also in Oil-Cloth, for use in the dissecting-room without soiling. Price, post-paid, in the United States, $2.50, net; Canada (duty paid), $2.75, net; G-reat Britain, lis. ; France, 16 fr. 20. BOWEW Hand-Book of Materia Wledica, Pharmacy, and Therapeutics. By Cuthbert Bowen, M.D., B.A., Editor of" Notes on Practice." The second volume in tlie Physicians'' and Students^ Ready Refer- ence Series. One 12mo volume of 370 pages. Handsomely bound in Dark-Blue Cloth. Price, post-paid, in the United States and Canada, $1.40, net; in Great Britain, 8s. 6d. ; in Prance, 9 fr. 25. EXTRACT FROM THE PREFACE — " While this is essentially a Student's Manuat., a large amount of matter has been incorporated which, it is hoped, will render it a useful refer- ence-book to the Young Gkabuate who is just enterhig on his professional career, and more particularly the individual whose sphere of work demands a more practical acquaintance with pharmaceutical processes than is required of the ordinary city practitioner. Great care has been taken throughout the book to familiarize the student with the best methods of administer- ing the various drugs he will be called upon to use, and with this object a large number of standard prescriptions have been selected from the works of the most eminent authorities, which he can either adopt, with modifications to suit particular cases, or use as models on which to construct his own formulae." This excellent manual comprises in its 366 pages about as much sound and valuable information on the subjects indicated in its title as could well be crowded into the com- pass. The book is exhaustively and correctly indexed, and of a convenient form. The pai)er, press-work, and binding are excellent, and the typography (long primer and brevier) is higlily to be commended, as opposed to the nonpareil and agate usually used in compends of this sort, and which are destructive to vision and temper alike. — St. Louis Med. and Surg. Jour. In goin.^ through it, we have been favorably impressed by the plain and practical sugge.s- tions in regard to prescription writing, and the metric system, and the other things which must be known in order to write good and ac- curate prescriptions. — Medical and Surgical Reporter BURET Syphilis : To-day and in Antiquity. By Dr. F. Buret (Paris). Translated from the French, with the author's permission, by A. H. Ohmann-Dumesnil, A.M., M.D., Professor of Dermatology and Syphilology in the St. Louis College of Physicians and Surgeons. To be completed in three 12mo volumes. Yolume I, Syphilis in Antiquity. In Press. Ready in October, 1891. (4) CAPP Her Health, Hducation, and Wedlock. The Daughter. Homely Suggestions to Mothers and Daughters, Bv WiLTJAM M. Capp, M.D., Pliiladelphia. This is just such a book as ;i t'amil}' iihysician wouhl advise his lad.y patients to obtain and read. It answers many questions which every busy practitioner of medicine has put to him in tlie sick-room at a time wlien it is neither expedient nor wise to impart the information souglit. It is complete in one l;)eautifully printed (large, clear type) 12nio volume of 150 pages. Attractively bound in Extra Cloth, Price, post-paid, in the United States and Canada, $1.00, net ; In Great Britain, 5s. 6d. ; France, 5 fr. 20. In the 114 pages allotted to lilm he has com- l)resseil an aiuount of homely wisdom on the physical, mental, and moral development of the female child from birth to maturity which is to 1)0 found elsewhere in only the great hook of experience. It is, of course, a book for mothers, but is one so void of offense in expression or ideas that it can safely be recom- mended for all whose minds are sufficiently developed to appreciate its teachings.— P/u7a- il' Ipliia Public Ledger. Many delicate subjects are treated with skill and in a manner which cannot strike any one as improper or bold. The absolute ignor- ance in which most young girls are .allowed to exist, even until adult life, is often productive of much misery, both mental aiul physical. Quite a number of books written by physi- cians for popular use have been prepared in sucli a way that the professional man can read between the lines strong bids for popular favor, etc. These objectionable features will not be found in Dr. Capp' s 6/-oc/ntre, and for this reason it is worthy the confidence of physicians.— Jiedicai News. CATHBLL Book on the Physician Himself And Things that Concern his Reputation and Success. By D. W. Cathell, M.D., Baltimore, Md. Being the Ninth Edition (enlarged and thorouglily revised) of the " Physician Himself, and what he should add to his Scientific Acquirements in order to Secure Success." In one handsome Octavo Yolume of 298 pages, bound in Extra Cloth. Thousands of physicians have won success in their chosen profession through the aid of this invaluable work. This remarkable book has passed tlirougli eight (8) editions in less than five j'ears. It has just undergone a thorougli revison by tlie author, ■who has added much new matter covering many points and elucidating many excellent ideas not included in former editions. Price, post-paid, in the United States and Canada, $2.00, net; in Great Britain, lis. 6d. ; France, 12 fr. iO. I am most favorably impressed with the wisdom and force of the points made in "The Physician Himself," and believe the work in the hands of a young graduate will greatly en- hance his chances for professional success. — From Prof. D. Hayes Agnew, Phila., Pa. We strongly advise every actual and intend- inc; practitioner of medicine or surgery to have '• The Physician Himself," and the more it in- fluences his future conduct the better he will he.— From the Canada Medical and Surgical Journal, Montreal. In the present edition the entire work has been revised and some new matter introduced. The publisher's part is well done ; paper is good and the print large; altogetlier it is a very readable and enjoyable hoo]i..— Montreal Medical Journal, We have read it carefully and regret much that we had not done so earlier and followed its precepts. The book is fuH of good advice. Get it at once. — Pacific Record of Medicine and Surgery. We cannot imagine a more profitable invest- ment for the junior practitioner than the pur- chase and caieful stndv of -'The Physician Himself." — Occidental Medical Times. To the physician who has discovered that there is something else besides dry l)ook -learn- ing needed to make him a desirable visitor at the bedside, we commend this volume, that he may assimilate some of the ready crystallized worldly wisdom which otherwise he may be many years acquiring by natural processes.— North Carolina Medical Journal. (5) CLBVBNGEB Spinal Concussion. Surgically Considered as a Cause of Spinal Injury, and Neuro- LOGICALLY RESTRICTED TO A CERTAIN SyMPTOM GrOUP, EOR WHICH IS Suggested the Designation Erichsen's Disease, as One Form op the Traumatic Neuroses. By S. V. Clevenger, M.D., Consulting Physician Reese and Alexian Hospitals; Late Pathologist County Insane Asylum, Chicago; Member of numerous American Scientific and Medical Societies ; Collaborator American jSTaturalist, Alienist and Neurologist, Journal of Neurology and Psj'chiatry, Journal of Nervous and Mental Diseases ; author of " Comparative Physiology and Psychology," " Artistic Anatomy,^" etc. This work is the outcome of five years' special study and experience in legal circles, clinics, hospital and private practice, in addition to twenty years' labor as a scientific student, writer, and teacher. The literature of Spinal Concussion has been increasing of late 3'ears to an unwieldy shape for the general student, and Dr. Clevenger has in this work arranged and reviewed all that has been done by observers since the days of Erichsen and those who preceded him. There are abundant illustrations, particularly for Electro-diagnosis, and to enable a clear comprehension of the anatomical and pathological relations. The Chapters are: I. Historical Introduction; II. Erichsen on Spinal Concussion; III. Page on Injuries of the Spine and Spinal Cord; IV. Recent Discussions of Spinal Concussion ; V. Oppenheim on Traumatic Neuroses ; VI. Illustrative Cases from Original and all other Sources; VII. Traumatic Insanity; VIII. The Spinal Column; IX. Symptoms ; X. Diagnosis ; XI. Pathology ; XII. Treatment ; XIII. Medico-legal Considerations. Other special features consist in a description of modern methods of diagnosis by Electricity, a discussion of the controversy concerning hysteria, and the author's original pathological view that the lesion is one involving the spinal sympathetic nervous S3'stem. In this latter respect entirely new ground is taken, and the diversity of opinion con- cerning the functional and organic nature of the disease is afl'orded a basis for reconciliation. Every Physician and Lawyer should own this work. In one handsome Royal Octavo Volume of nearly 400 pages, with thirty Wood-Engravings. Price, post-paid, in United States and Canada, $2.50, net; in Great Britain, 14s. ; in Prance, 15 fr. The reader will find in this toook the best discussion and summary of the facts on this topic, whicli will make it very valualile to every physician. For the specialist it is a text-book that will be often consulted.— 17)6 Journal of Inebriety. The work comes tnUy up to the demand, and the law and medical library, to be com- plete, cannot be without it. — Southern Medical Record. This work really does, if we may be per- mitted to use a trite and hackneyed expres- sion, "fill a long-felt want." The subject is treated in all its bearings ; electro-diagnosis receives a large share of attention, and the chapter devoted to illustrative cases will be found to possess especial importance. The author has some original views on pathology. — Medical Weekly Review. (6) DAVIS Consumption: Hoiiv to Present it, and Ho-w to L,ive 'witli it. Its Nature, Causes, Prevention, and the Mode of Life, Climate, Exercise, Food and Clothing Necessary for its Cure. By N. S. Davis, Jr., A.M , M.D., Professor of Principles and Practice of IMedicine in Chicago Medical College; Physician to Mercy Hospital; ]\Iember of the American Medical Association, Illinois State Medical Society, etc., etc. 12mo. In Press. DAVIS Diseases of the Heart, Lungs, and Kidneys. By N. S. Davis, Jr., A.M., M.D.. Professor of Principles and Practice of Medicine in Chicago Medical College; Physician to Mercy Hospital; Member of the American Medical Association, Illinois State Medical Society, etc., etc. In one neat 12mo volume. No. in the Physicians' and Students' Ready- Referenee Series. In Preparation. DE3IABQUAY 0\ f\ A Practical Investigfation of tlie Clinical On OXyOen. ana Xherapeutlc value ©f the cases in Medical and Surg^ical Practice, With Especial Reference to the Yalue and Availability of Oxygen, Nitrogen, Hydrogen, and Nitrogen Monoxide. By J. N. Demarquay, Surgeon to the Municipal Hospital, Paris, and of the Council of State; Member of the Imperial Society of Surgery; Correspondent of the Academies of Belgium, Turin, Munich, etc ; Officer ol" the Legion of Honor, Chevalier of the Orders of Isabella-the-Catholic and of the Conception, of Portugal, etc. Translated, with notes, additions, and omissions, by Samuel S. Wallian, A.M., jM.D., Member of the American Medical Association; Ex-Presi- dent of the Medical Association of Northern New York; Member of the New York County Medical Society, etc. In one handsome Octavo Volume of 316 pages, printed on fine paper, in the best style of the printer's art, and illustrated with 21 Wood-Cuts. Price, post-paid, in United States, Cloth, $2.00, net; Half-Russia, $3.00, net. In Canada (duty paid). Cloth, $2.20, net; Half-Russia, $3.30, net. In Great Britain, Cloth, lis. 6d. ; Half-Russia, 17s. 6d. In Prance, Cloth, 12 fr. 40; Half-Russia, 18 fr. 60. For some years past there has been a growing demand for something more satisfactory and more practical in the way of literature on the subject of what has, by common consent, come to be termed "Oxygen Therapeutics." On all sides professional men of standing and ability are turning their attention to the use of the gaseous elements about us as remedies in disease, as well as sustainers in health. In prosecuting their inquiries, the first hindrance has been the want of any reliable, or in any degree satisfactory, literature on the subject. This work, translated in the main from the French of Professor Demarquay, contains also a very full account of recent English, German, and American ex- periences, prepared by Dr. Samuel S. "Wallian, of New York, whose experience in this field antedates that of any other American writer on the subject. This is a handsome volume of 300 pages, in large print, on good paper, and nicely illus- trated. Although nominally pleading for the use of oxygen inhalations, the author shows in a pliilostiphical manner how much greater good physicians might do if they more fully appreciated the value of fresh airexercise and water, especially in diseases of the lungs, kid- neys. an(t skin. We commend its perusal to our readers. — 27ie Canada Medical Hecord. The book should be widely i-ead, for to many it will bring tlie addition of a new weapon to their therapeutic armament. — Northivestern Lancet. Altogether the book is a valuable one, which will be found of service to the busy prac- titioner who wishes to keep abrea.st "of the improvements in therapeutics. — Medical News. (7) BISMNBMMG Bacteriological Diagnosis. Tabular Aids for Use in Practical Work. By James Eisenberg, Ph.D., M.D., Yienna. Translated and aug- mented, with the permission of the author, from the latest German Edition, by Norval H. Pierce, M.D., Surgeon to the Out-Door Depart- ment of Michael Reese Hospital; Assistant to Surgical Clinic, College of Physicians and Surgeons, Chicago, 111. This book is a novelty in Bacteriological Science. It is arranged in a tabular form in which are given the specific characteristics of tlie various well-established bacteria, so that the worker may, at a glance, inform himself as to the identity of a given organism. They then serve the same function to the Bacteriologist as does the " Chemical Analysis Chart " to the chemist, and the one will be found as essential as the other. The Greatest care has been taken to bring the work up to the present aspect of Bacteriology. In one Octavo volume, handsomelj^ bound in Cloth. Ready Soon. Price, post-paid, in the United States and Canada, $1.50, net ; in Great Britain, 8s. 6d. ; in Trance, 9 fr. 35. JEDIJS^GEM Twelve Lectures on the Strocture of the Central nervous System. EoR Physicians and Students. By Dr. Ludw-ig Edinger, Frankfort-on-the-Main. Second Revised Edition. With 133 Illustrations. Translated by Willis Hall Vittum, M.D., St. Paul, Minn. Edited by C. Eugene Riggs, A.M., M.D., Pro- fessor of Mental and Nervous Diseases, University of Minnesota ; Member of the American Neurological Association. The illustrations are exactly the same as those used in the latest German edition (with the German names translated into English), and are very satisfactoiy to the Physician and Student using the book. The work is complete in one Roj^al Octavo volume of about 250 pages, bound in Extra Cloth. Price in United States and Canada, post-paid, $1.75, net ; Great Britain, 10s. ; France, 12 fr. 20. One of the most instructive and valiiable works on the minute anatomy of the human brain extant. It is written in the form of lec- tures, profusely illustrated, and in clear lan- guage. The hook is worthy of the highest enconiums, and will, undoubtedly, command a large sale. — The Pacific Record of Medicine and Surgery. Since the first works on anatomy, up to the present day, no work has appeared on the sub- ject of the general and minute anatomy of the central nervous system so complete and ex- haustive as this work of Dr. Ludwig Edinger. Being himself an original worker, and having the benefits of such masters as Stilliiig, Weigeit, Geilach, Meynert, and others, he has succeeded in transforming the mazy wilder- ness of nerve fibres and cells into a district of well-marked pathways and centres, and by so doing has made a pleasure out of an anatomi- cal bugbear. — The Southern Medical Record. Every point is clearly dwelt upon in the text, and where description alone might leave a subject obscure clever drawings and dia- grams are introduced to render misconception of the author's meaning impossible. The book is eminently practical. It unravels the intri- cate entanglement of different tracts and paths in a way that no other book has done so explicitly or so concisely. — Northwestern Lancet. (8) GOODELJL Lessons in Gynecology. By William Goodell, A.M., M.D., etc., Professor of Clinical Gyne- cology'^ in the Universitj' of Pennsylvania. This exceeclingl3'- valuable work, from one of the most eminent specialists and teachers in gynecology in the United States, is now offered to the profession in a ranch more complete condition than either of the previous editions. It embraces all the more important diseases and the principal operations in the field of gynecology, and brings to bear upon them all the extensive practical experience and wide reading of the author. It is an indispensable guide to every practitioner who has to do with the diseases peculiar to women. Third Edition. With pL2 illustrations. Thoroughl}' revised and greatly enlarged. One volume, large octavo, 578 pages. Price, in United States and Canada, Clotli, $5.00 ; Full Sheep, $6.00. Discount, 20 per cent., making it, net, Cloth, $4.00; Sheep, $180. Postage, 27 cents estra. Great Britain, Cloth, 22s. 6d. ; Sheep, 28s., post-paid. Prance, 30 fr. 80. It is too good a book to have been allowed to remain out of print, and it has unquestionably been missed. The author has revised the work with special care, adding to each lesson such fresh matter as the progress in the art ren- dered necessary, and he has enlarged it by the insertion of six new lessons. This edition' will, without question, be as eagerly sought for as were its predecessors. — Atnerican Journal of Obstetrics. His literary style is peculiarly charming. There is a directness and simplicity about it which is easier to admire than to copy. His chain of plain words and almost blunt expres- sions, his familiar comparison and homely illustrations, make his writuigs, like his lec- tures, unusually entertaining. The substance of his teachings we regard as equally excel- lent.— Philadelphia Medical and Surgical Reporter. Extended mentioir of the contents of the book is unnecessary ; siiffioe it to sav that every important disease found in the female sex is taken up and discussed in a common- sense kind of a way. V^'e wish every ph>sician in America could read and carry out the sug- gestions of the chapter on "the sexual rela- tions as causes of uterine disorders — conjugal onanism and kindred sins." The ilepartment treating. of nervous counterfeits of uterine diseases is a most valuable one. — Kansas City Medical Index. GUEBWSIJY Plain Talks on Avoided Subjects. By Henry N. Guernsey, M.D., formerly Professor of Materia Medica and Institutes in the Hahnemann Medical College of Philadelphia ; author of Guernsey's " Obstetrics," including the Disorders Peculiar to Women and Young Children ; Lectures on Materia Medica, etc. The following Table of Contents shows the scope of the book : Contents. — Chapter I. Introductory. II. The Infant. III. Child- hood. lY. Adolescence of the M.ale. V. Adolescence of the Female. VI. Marriage: The Husband. YII. The Wife. Till. Husband and Wife. IX. To the Unfortunate. X. Origin of the Sex. In one neat 16mo volume, bound in Extra Cloth. Price, post-paid, in the United States and Canada, $1.00; Great Britain, 6s. ; Prance, 6 fr. 20. (9) HAUB Epilepsy: Its Pathology and Treatment. Being an Essay to which was Awarded a Prize of Four Thousand Francs by the Academie Royale de Medecine de Belgique, December 31, 1889, By HoBAET AiiORY Hare, M.D. (Univ. of Penna.), B.Sc, Professor of Materia Medica and Therapeutics in the Jefferson Medical College, Pliila. ; Physician to St. Agnes' Hospital and to the Children's Dispensary of the Chil- dren's Hospital ; Laureate of the Royal Academy of Medicine in Belgium, of the Medical Society of London, etc. ; Member of the Association of American Physicians. iVo. 7 in the Physicians' and Students' Beady -Reference Series. 12mo. 228 pages. Neatly bound in Dark-blue Cloth. Price, post-paid, in United States and Canada, $1.25, net; in Great Britain, 6s. 6d. ,■ in Prance, 7 fr. 75. It is representative of the most advanced i ' It is remarkable for its clearness, brevity, and views of the profession, and the subject is ; beauty of style. It is, so far as the reviewer pruned of the vast amount of superstition and 1 knows, altogether the best essay ever written nonsense that generally obtains in connection upon this important subject.— iTaJisas City with epilepsj-. — Medical Age. j ; Medical Index. Everv physician -who would get at the gist ! ™, .^ , - • ^. , ^ -u of all that is worth knowing on epilepsv. and IL ^he task of preparmg the work must haj-e who would avoid useless research among the !! ^een most laborious but we thmk that Dr. mass of literarv nonsense which pervades all ' Hare will be repaid for his efforts bv a wide medical libraries, should get this work.-'— 27ie i appreciation of the work by the profession; Sanitarian i '^^^ ^^^ book will be instructive to those who I . have not kept abreast with the recent litera- It contains all that is known of the pathology i ture upon this subject. Indeed, the work is a of this strange disorder, a clear discussion of , sort of Dictionary of epilepsy — a reference the diagnosis from alUed neuroses, and the guide-book upon the subject. — Alienist and very latest therapeutic measures for relief. 1 1 Neurologist. HARE Fever: Its Pathology and Treatment. Being the Boyi^ston Prize Essay of Harvard University for 1890. Containing Directions and the Latest Information Con- cerning THE Use of the So-Called Anti- pyretics IN Fever and Pain. By HoBART Amory Hare, M.D. (Univ. of Penna.), B.Sc, Professor of Materia Medica and Therapeutics in the Jefferson Medical College, Pliila.; Physician to St. Agnes' Hospital and to the Children's Dispensary of the Chil- dren's Hospital; Laureate of the Royal Academy of Medicine in Belgium, of the Medical Society of London, etc.; Member of the Association of American Physicians. No. 10 in the Physicians' and Students' Ready-Reference Series. 12mo. Xeatly bound in Dark -blue Cloth. Hlustrated with more than 25 new plates of tracings of various fever cases, showing beautifully and accurately the action of the Antipyretics. The work also contains 35 carefully prepared statistical tables of 249 cases showing the untoward effects of the antipyretics. Price, post-paid, in the United States and Canada, $1.25, net; in Great Britain, 6s. 6d. ; in Prance, 7 fr. 75. As is usual with this author, the subject is '; the most interesting of its excellent group, thoroughly handled, and much experimental '} the Physicians' and Students' Ready-Iie/e^-- and clinical evidence, both from the authors ji ence Series. — The Dosimetric Medical Review. experience and that of otliers. is adduced in support of the view taken. — Xew York Medical Abstract. The author has done an able piece of work in 'showing the facts as far as they are kno\vn concerning the act'on of antipyrin, anti- febrin, phenacetin, thallin, and salicylic acid. The reader will certainly And the work one of Such books as the present one are of service to the student, the scientific therapeutist, and the general practitioner alike, for much can be found of real value in Dr. Hare's book, with the additional advantage that it is up to the latest researches upon the subject. — Univer- sity Medical Magazine. (10) JA3IES American Resorts, with Motes upon their Climate. By BusHROD W. James, A.M., M.D., Member of the American Public Healtli Association, and the Academy of Natural Sciences, Philadelphia; the Societ}^ of Alaskan Natural History and Ethnology, Sitka, Alaska, etc. With a translation from the German, by Mu. S. Kauffmann, of those chapters of "Die Klimate der Erde " written by Dr. A. Wocikof, of St Petersburg, Russia, that relate to North and South America and the Islands and Oceans contiguous thereto. This is a unique and valuable work, and useful to physicians in all parts of the country. We mention a few of the merits it possesses: First. List of all the Healtli Resorts of the country, arranged according to their climate. Second. Contains just the information needed by tourists, invalids, and those wlio visit summer or winter resorts. Third. The latest and best large railroad map for reference. Foxirth. It indicates the climate each one should select for health. Fifth. The author has traveled extensively, and most of his suggestions are practical in reference to localties. In "One Octavo volume. Handsomely bound in Cloth. Nearly 300 pages. Price, post-paid, in the United States and Canada, $2.00, net; Great Britain, Us. 6d. ; France, 12 fr. ■iO. Taken altogether, this is by far the most comiilete exposition of the subject of resorts that ])as yet been put foith, and it is one that every physician must needs possess intelligent information WYion.- Buffalo Med. & Surg. Jour. The special chapter on the therapeutics of clin^ate . . is excellent for its precautionary suggestions in the selection of climates and local conditions, with reference to known pathological indications and constitutional predispositions. — T%e Sanitarian. The book before us is a very comprehensive volume, giving all necessary information con- cerning climate, temperature, humidity, sun- shine, and indeed everything necessary to be stated for the beneftt of the physician or invalid seeking a health resort in the United States. — Southern Clinic. Journal of Laryngology and Rhinology. Issued on the First op Each Month. Edited by Dr. Norris Wolfenden, of London, and Dr. John Macintyre, of Glasgow, with the active aid and co-operation of Drs. Dundas Grant, Barclay J. Baron, Hunter Mackenzie, and Sir IMorell Mackenzie. Besides those specialists in Europe and America who have so ably assisted in the collaboration of the Journal, a number of new correspondents have undertaken to assist the editors in keeping the Journal up to date, and furnishing it with matters of interest. Amongst these are: Drs. Sajous, of Philadelphia; Middlemass Hunt, of Liver- pool; Mellow, of Rio Janeiro; Sedziak, of Warsaw; Draispul, of St. Petersburg, etc. Drs. Michael, Joal, Holger, Mygind, Prof. Massei, and Dr. Valerius Idelson will still collaborate the literature of their. respective countries. Price, 13s. or $3.00 per annum (inclusive of Postage). For single copies, however, a charge of Is. 3d. (30 cents) will he made. Sample Copy, 25 Cents. KEATII^G Record-Book of Medical Examinations For Life Insurance. Designed by John M. Keating, M.D. This record-book is small, neat, and complete, and embraces all the prin- cipal points that are required by the different companies. It is made in two sizes, viz.: No. 1. covering one hundred (100) examinations, and No. 2, covering two hundred (200) examinations. The size of the bookis7x3f inches, and can be conveniently carried in the pocket. U. S. and Canada. Great Britain. France. No. 1. For 100 Examinations, in Cloth, - • $ .50 Net 3s. 6i 3 fr. 60 No. 2. For 200 Examinations, in Full Leather, with Side Flap, ... - 1.00 " 6s. 6 fr. 20 (11) KEATIWG and JEJD WARDS Diseases of the Heart and Circulation. In Infancy and Adolescence. With an Appendix entitled " Clinical Studies on the Pulse in Childhood." By .John M. Keating, M.D., Obstetrician to the Philadelphia Hospital, and Lecturer on Diseases of Women and Children; Surgeon to the Maternity Hospital; Physician to St. Joseph's Hospital; Fellow of the College of Phj^sicians of Philadelphia, etc.; and William A. Edwards, M.D., Instructor in Clinical Medicine and Physician to the Medical Dispensary in the University of Pennsylvania; Physician to St. Joseph's Hospital; Fellow of the College of Physicians; formerly Assistant Pathologist to the I^hiladelphia Hospital, etc. Illustrated by Photographs and Wood-Engravings. About 225 pages. Oc- tavo. Bound in Cloth. Frice, post-paid, in the United States and Canada, $1.50, net; in Grreat Britain, Ss. 6d. ; in France, 9 fr. 35. Drs. Keating; and Edwards have produced a work that will give material aid to evevy doctor in his practice among children. The style of tlie book is graphic and pleasing, the diagnostic points are explicit and exact, and the therapeutical resources include the novel- ties of medicine as well as the old and tried agents. — Pittsburgh Med. Review. It is not a mere compilation, hut a systematic treatise, and bears evidence of considerable labor and observation on the part of the authors. Two fine photographs of dissections exhibit mitral stenosis and mitral regurgita- tion ; there are also a number of wood-cuts. — Cleveland Medical Gazette. LIBBIG and HOSE Practical Electricity in Medicine ^ Surgery. By G. A. LiEBiG, Jr., Ph D., Assistant in Electricity, Johns Hopkins University ; Lecturer on Medical Electricity, College of Physicians and Surgeons, Baltimore ; Member of the American Institute of Electrical Engineers, etc. ; and George H. Rohe, M.D., Professor of Obstetrics and Hygiene, College of Physi- cians and Surgeons, Baltimore ; Visiting Physician to Bay View and City Hos- pitals ; Director of the Maryland Maternite ; Associate Editor "Annual of the Universal Medical Sciences," etc. Profusely Illustrated by AVood-Engravings and Original Diagrams, and published in one handsome Royal Octavo volume of 383 pages, bound in Extra Cloth. The constantly increasing demand for this work attests its thorough relia- bility and its popularity with the profession, and points to the fact that it is already the standard work on this very important subject. The part on Physical Electricity, written by Dr. Liebig, one of the recognized authorities on the , science in the United States, treats fully such topics of interest as Storage Bat- teries, Dynamos, the Electric Light, and the Principles and Practice of Electrical Measurement in their Relations to Medical Practice. Professor Rohe, who writes on Electro-Therapeuti^is, discusses at length the recent developments of Electricity in the treatment of stricture, enlarged prostate, uterine fibroids, pelvic cellulitis, and other diseases of the male and female genito-urinary organs. The applica- tions of Electricity in dermatology, as well as in the diseases of the nervous system, are also fully considered. Frice, post-paid, in the United States and Canada, $2.00, net; !n Great Britain, Us. 6d. ; France, 12 fr. 40. Any physician, especially if he be a beginner in electro-therapeutics, will Vie well repaid by a careful study of this work by Liebig and Rohe. For a work on a special subject the price is low, and no one can give a good ex- cuse for remaining in ignorance of so impor- t!\nt a subject as electricity in medicine. — Toledo Medical and Surgical Reporter. The entire work is thoroughly scientific and practical, and is really what the authors have aimed to produce, "a trustworthy guide to tlie application of electricity in the practice of medicine and Surgery." — New York Medical Times. In its perusal, with each succeeding page, we have been more and more impressed with the fact that here, at last, we have a treatise on electricity in medicine and surgery which amply fulfills its purpose, and which is sure of general adoption by reason of its thorough excellence and superiority to other works in- tended to cover the same field. — Pharmaceu- tical Era. After carefullv looking over this work, we incline to the belief that the intelligent physi- cian who is familiar with the general subject will be greatly interested and profited. — American Lancet. (12) MASSBY Electricity in the Diseases of Women. With Si'ecial REFEiiEiNCE to the ArPLiCAxioN of Strong Currents. By G. Betton IVIassey, M.D., Phj^siciaii to the Gynaecological Department of the Howard Hospital ; late Electro-therapeutist to the Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases ; Member of the American Neuro- logical Association, of the Philadelphia Neurological Society, of the Franklin Institute, etc. Second Edition. Revised and Enlarged. With New and Original Wood-Engravings. Handsomely bound in Dark-Blue CMoth. 240 pages. 12nio. iVo. 5 in the Physicians' and Students' Ready-Reference Series. This work is presented to the profession as the most complete treatise yet issued on the electrical treatment of the diseases of women, and is destined to fill the increasing demand for clear and practical instruction in the handling and use of strong currents after the recent methods first advocated by Apostoli. The whole subject is treated from the present stand-point of electric science with new and original illustrations, the thorough studies of the author and his wide clinical experience rendering him au authority upon electricity itself and its therapeutic applications. The author has enhanced the practical value of the work by including the exact details of treatment and results in a number of cases taken from his private and hospital practice. Price, post-paid, in the United States and Canada, $1.50, net; in Great Britain, 8s. 6d. ; in France, 9 fr. 35. A new edition of this practical manual at- tests the utility of its existence and the recog- nition of its merit. The directions are simple, easy to follow and to put into practice ; the tcronnd is well covered, and nothing is assumed, the entire book being the record ot experience. — Journal of Nervous and Mental Diseases. It is only a few months since we noticed the first edition of this little book; and it is only necessary to add now that we consider it the best treatise on this subject we have seen, and that the improvements introduced into this edition make it more valuable still. — Boston Medical and Surgical Journ. The style is clear, but condensed. Useless detaile are omitted, the reports of cases lieing pruned of all irrelevant material. The book is an exceedingly valuable one, and represents an amount of study and experience which is only appreciated after a careful reading. — Medical Jiecord. 3IAWTOW Childbed; Its Management; Diseases and Their Treatment. By Walter P, M.\nton, M.D., Visiting Physician to the Detroit Woman's Hospital ; Consulting Gyniecologist to the Eastern jMichigan Asylum ; President of the Detroit Gynaecological Society ; Fellow of the American Society of Ob- stetricians and Gynaecologists, and of the British Gynaecological Society ; Member of Michigan State Medical Society, etc. In one neat 12mo volume, Ao. in the Physicians' and Students' Ready -Reference Series. In Preparation. Medical Bulletin. A Monthly Journal op Medicine and Surgery. Edited by John V. Shoemaker, A.M., M.D. Bright, original, and read- able. Articles by the best practical writers procurable. Every article as brief as is consistent with the preservation of its scientific value. Therapeutic Notes by the leaders of the medical profession throughout the world. These, and many other unique features, help to keep The Medical Bulletin in its present position as the leading low-price Medical 3Iouthly of the world. Subscribe now. TEHMS : $1.00 a year in advance in United States, Canada, and Mesico. Foreign Subscription Terms : England, 5s. ; France, 6 fr. ; Germany, 6 marks; Japan, 1 yen; Australia, 5s.; Holland, 3 florins. (13) The Medical Bulletin Visiting-List or Physicians' Call Record. Arranged upon an Original and Convenient Monthly and Weekly Plan for the Daily Recording of Professional Yisits. Frequent Rewriting of Names Unnecessary. THIS Visiting-List is arranged so that the names of patients need be written but ONCE a month instead of four times a month, as in the old-style lists. By means of a new feature, a simple device consisting of stub or half LEAVES IN THE FORM OF INSERTS, the first Week's visits are recorded in the usual way, and the second week's visits are begun by simply turning over the half-leaf without the necessity of rewriting the patients' names. This very easily under- stood process is repeated until the mouth is ended and the record has been kept complete in every detail of visit, charge, credit, etc., and the labor and time of entering and ti'ansferring names at least three times in the month has been saved. There are no intricate rulings ; not the least amount of time can be lost in comprehending the plan, for it is acquired at a glance. THE THREE DIFFERENT STYLES MADE. The No. 1 Style of this List provides space for the daily record of seventy different names each mouth for a year ; for physicians who prefer a List that will accommodate a larger practice we have made a No. 2 Style, which provides space for the daily record of 105 different names each month for a year, and for physicians who may prefer a Pocket Record-Book of less thickness than either of these styles we have made a No. 3 Style, in which "The Blanks for the Record- ing of Visits in" have been made into removable sections. These sections are very thin, and are made up so as to answer in full the demand of the largest practice, each section providing ample space for the daily record op 210 dif- ferent NAMES for two months ; or 105 different names daily each month for four months ; or seventy different names dailj^ each month for six months. Six sets of these sections go with each copy of No. 3 Style. SPECIAL FEATURES NOT FOUND IN ANY OTHER LIST. In this No. 3 Style the printed matter, and such matter as the blank forms for Addresses of Patients, Obstetric Record, Vaccination Record, Cash Account, Birth and Death Records, etc., are fastened permanently in the back of the book, thus reducing its thickness. The addition of one of these removable sections does not increase the thickness more than an eighth of an inch. This brings the book into such a small compass that no one can object to it on account of its thickness, as its bulk is very much less than that of any visiting- list ever published. Every physician will at once understand that as soon as a section is full it can be taken out, filed away, and another inserted without the least inconvenience or trouble. Extra or additional sections loill he furnished at any time for 15 cents each or §!l. 7 5 per dozen. This Visiting-List contains calen- dars, valuable miscellaneous data, important tables, and other useful printed matter usually placed in Physicians' Visiting-Lists. Physicians of many years' standing and with large practices pronounce it THE Best List they have ever seen. It is handsomely bound in fine, strong leather, with flap, including a pocket for loose memoranda, etc., and is furnished with a Dixon lead-pencil of excellent ciuality and finish. It is compact and con- venient for carrying in the pocket. Size, 4x6J inches. IIsT THCIS-EIEi ST'X'nUES- net prices. ?I.D. Endorsed by leading anatomists. Clearly and beautifully printed upon extra durable paper. PAKT I. The Nerves Gives in a clear form not only the Cranial and Spinal Nerves, show- in}^ the formation of the differeiic Plexuses ami their branches, but also the complete distribution of the .Sympathetic Nekvks. PART II. The Arteries — Uives a unique grouping of the Arterial system, showing the divisions and subdivisions of all the vessels, beginning from the heart and tracing their CONTINUOUS distribution to the periphery, and sliowiug at a glance the terminal branches of each artery. PAKT III. The Veins. — Shows how the blood from the periphery of the body is gradually collected by the larger veins, and these coalescing forming still larger vessels, until they finally trace themselves into the Right Auricle of the heart. It is therefore readily seen that "The Nervo- Vascular System of Charts " offers the following superior advantages : — 1. It is the only arrangement which combines the Three Systems, and yet each is perfect and distinct in itself. 2. It is the only instance of the Cranial, Spinal, and Sympathetic Nervous Systems being represented on one chart. 3. From its neat size and clear type, and being printed only upon one side, it may be tacked up in any convenient place, and is always ready for freshening up the memory and reviewing for examination. Price, post-paid, in United States and Canada, 50 cents, net, complete ; in Crreat Britain, 3s. 6d. ; in France, 3 fr. 50. For the student of anatomy there can pos- I Its price is nominal and its value inestimable, sibly be no more concise way of acquiring a , No student should be without it. — Pacific knowledge of the nerves, veins, and arteries of the human system. It presents at a glance their trunks and branches in the great divis- ions of the body. It will save a world of tedi- ous reading, and will impress itself on the mind as no ordinary vade nieeum, even, could, ji and Sure/. Jour. Mecord of Medicine and Surgery. These are three admirably arranged charts for the use of students, to assist in memor- izing their anatoyiical sudies. — Buffalo Med. PUBDY Diabetes: Its Cause, Symptoms anl^ Treatment By Chas. W. Purpy, M.D. (Queen's University), Honorary Fellow of the Royal College of Physicians and Surgeons of Kingston ; Member of the College of Physicians ami Surgeons of Ontario ; Author of "Bright's Disease and Allied Affections of the Kidneys ;" iMember of the Association of American Physicians ; Member of the xVmerican Medical Association ; Member of the Chicago Academy of Sciences, etc. Contents. — Section I. Historical, Geographical, and Climatological Con- siderations of Diabetes Mellitus. II. Physiofogical and Pathological Considera- tions of Diabetes Mellitus. III. Etiology of^Diabetes Mellitus. IV. Morbid Anatomy of Diabetes ^Mellitus. V. Symjjtomatology of Diabetes Mellitus. VI. Treatment of Diabetes Mellitus. VII. Clinical Illustrations of Diabetes Mellitus. VIII. Diabetes Insipidus ; Bibliography. 12mo. Dark Blue Extra Cloth. Nearly 200 pages. With Clinical Illus- trations. No. S in the Physicians' and Students' Ready-Reference Series. Price, post-paid, in the United States and Canada, $1.25, net; in Qreat Britain, 6s. 6i ; in France, 7 fr. 75. This will prove a most entertaining as well as most interesting treatise upon a disease ■which frequently falls to the lot of every practitioner. The work has been written with a special view of bringing out the features of the disease as it occurs in the United States. The author has very judiciously arranged the little volume, and it will offer many pleasant attractions to the practitioner. — Nashville Journal of Medicine and Surgery. While many monographs have been pub- lished which have dealt with the subject of diabetes, we know of none which so thoroughly considers its relations to the geographical conditions which exist in the United States, nor which is more complete in its summary of the svmptomatology and treatment of this affection. A number of tables, showing the percentage of sugar in a very large number of alcoholic beverages, adds very considerably to the value of the work. — Medical News. (17) MBMONDINO Circumcision : Its History, Modes of From the Earliest Times to the Present; with a History of Eunuchism, Hermaphrodism, etc., as Observed Among all Races AND Nations; also a Description of the Different Operative Methods of Modern Surgery Practiced upon the Prepuce. By P. C. Remondino, M.D. (Jefferson) ; Member of the American Medical Association; Member of tlie ximerican Public Health Association; Vice-President of the State Medical Society of California, and of the Southern California Medical Society, etc., etc. No. 11 in the Physicians' and Students' Ready-Reference Series. About 350 pages. 13mo. Handsomely bound in Dark-Blue Cloth. Just Ready. Frice, post-paid, in the United States and Canada, $1.25, net; in Great Britain, 8s. 6d. ; in France, 7 fr. 75. Cheap Edition (paper hinding), United States and Canada, 50 cents, net, post-paid; Gfreat Britain, 4s. 3d. ; France, i fr. 20. HOME lene. A Comprehensive Treatise on the Principles and Practice, of Pre- ventive Medicine from an American Stand-point, By George H. Rohe, M.D., Professor of Obstetrics and Hygiene in the College of Physicians and Surgeons, Baltimore ; Member of the American Public Health Association, etc? Every Sanitarian should have Rohe's "Text-Book of Hygiene" as a work of reference. Of this New (second) edition, one of the best qualified judges, namely, Albert L. Gihon, M.D., Medical Director, U. S. Navy, In charge of U. S. Naval Hospital, Brooldyn, N. Y., and ex-President of the American Public Health Association, writes : "It is the most admirable, conc\?,e resume of the facts of Hygiene with which I am acquainted. Prof Rohe's attractive style makes the book so readable that no better presentation of the important place of Pre- ventive Medicine, among their studies, can be desired for the younger members, especially, of our profession. Second Edition, thoroughly revised and largely rewritten, with many illustrations and valuable tables. In one handsome Royal Octavo volume of over 400 pages, bound in Extra Cloth. Price, post-paid, in United States, $2.50, net; Canada (duty paid), $2.75, net ; Great Britain, 14s. ; France, IS fr. 20. In short, tlie work contains brief and prac- tical articles on hygienic regulation of life, under almost all conditions. One prominent feature is that there are no superfluous words ; every sentence is direct to the point sought. It is, therefore, easy reading, and conveys very much information in little space. — Tlie Pacific Record of Medicine and Surgery. Truly a most excellent and valuable work, comprising the accepted facts in regard to preventive medicine, clearly stated and well arranged. It is unquestionably a work that should be in the hands of every physician in the country, and medical students will find it a most excellent and valuable text-book. — The Southern Practitioner. The tii'st edition was rapidly exhausted, and the book justly became an authority to physi- cians and sanitary officers, and a text-book very generally adopted in the colleges throughout America. The second edition is a great improve- ment over the first, all of the matter being thor- oughly revised, much of it being rewritten, and many additions being made. The size of the book is increased one hundred pages. The book has the original reconiniendation of being a handsomely-bound, clearly-printed octavo volume, profusely illustrated with re- liable references for every branch of the subi'ect matter. — Medical Record. The wonder is how Prof. Rohe has made the book so readable and entertaining with so much matter necessarily condensed. .The book is well printed with good, clear type, is attractive in appearance, and contains a number of valuable tables and illustrations that must be of decided aid to the student, if not to the general practitioner and health officer. Altogether, the manual is a good ex- ponent of hygiene and sanitary science from the present American stand-point, and will repay with pleasure and profit any time that may be given to its T^evasal.— University Medi- cal Magazine. (18) SAJOUS UAV ITCIICD ^"^ "® Successful Treatment tjy Superficial PIMY rLl/LlA Organic Alteration of the Kasal Mucous Slembrane. By Charles E. Sajous, M.D., formerly Lecturer on Rhinology and Laryugoloi-y in Jetfersou Medical College; Vice-President of the American Luryngological Association; Officer of the Academy of France and of Public Instruction of Venezuela ; Corresponding Member of the Royal Society of Belgium, of the Medical Society of Warsaw (Poland), and of the Society of Hygiene of France; Member of the American Philosophical Society, etc., etc. With 13 Engravings on Wood. 103 pages. 12mo. Bound in Cloth. Beveled Edges. Price, post-paid, in the United States and Canada, $1.00, net; in Great Britain, 6s.; France, 6 fr. 20. SAWNE Diphtheria, Croup: Tracheotomy and Intubation. From the French of A. SannI Translated and enlarged by Henry Z. Gill, M D., LL.D., late Pro- fessor of Surgeiy in Cleveland, Ohio. Sanne's work is quoted, directly or indirect!}', by every writer since its publication, as the highest anthorit^^ statistically, theoretically, and practicaU3\ The translator, having given special study to the subject for many years, has added over fifty pages, including the Surgical Anatomy, Intubation, and tlie recent progress in other branches, niakino" it, beyond question, the most complete work extant on the subject of- Diplitheria in the English language. Facing the title-page is found a very fine Colored Lithograph Plate of the parts concerned in Traciieotoniy. Next follows an illustration of a cast of the entire Trachea, and bronchi to the third or fourth division, in one piece, taken from a i:)hotograph of a case in which the cast was expelled during life from a patient sixteen 3-ears old. This is the most complete cast of any one recorded. Over fifty otlier illustrations of the surgical anatom}- of instruments, etc., add to tlie practical value of the work. A full Index accompanies the enlarged volume, also a List of Authors, making altogether a very handsome illustrated volume of over 680 pages. Canada United States. (duty paid). Great Britain. France. Price, post-paid, Cloth, - $4.00, Net $140, Net 22s. 6d. 24 fr. 50 Leather, 5.00, " 5.50, " 28s. 30 fr. 30 The siilijoct of intubation, so recently re- 11 titioner. — St. Louis Med. and Surgical Journ. vived in thi.s c., Professor of Materia Medica, Phar- macoloiry, Therapeutics, and Clinical Medicine, and Clinical Professor of Diseases of the Skin in the Medico-Chirurgical College of Philadelphia, etc., etc. The author concisely concludes his preface as follows : "The reader may thus obtain a conspectus of the whole subject of Inunction as it exists to-day in the civilized world. In all cases the mode of preparation is given, and the thera- peutical application described seriatim, in so for as may be done without needless repetition." Second Edition, revised and enlarged. 298 pages. 12mo. Neatly bound in Dark-Blue Cloth. No. 6 in the Physicians' and Students' Ready-Reference Series. Price, post-paid, in the United States and Canada, $1.50, net; in Great Britain, 8s. 6d. ; in France, 9 fr. 35. It is invaluable as a ready reference when ointments or oleates are to" be nsed, and is serviceable to both druggist and physician. — Canada Medical Record. To the physician who feels uncertain as to the best form in which to prescribe medicines bv wav of the skin the book will prove valu- able, "owins to the many prescriptions and forniul.TB which dot its pages, while the copious index at the back materially aids in making the book a useful one.— Medical News. SHOEMAKBIt Materia Medica and Therapeutics. With Especial Reference to the Clinical Application of Drugs. Being the Second and Last Volume of a Treatise on Materia Medica, Pharmacology, and Therapeutics, and an Independent Volume upon Drugs. By John V. Shoemaker, A.M., M.D., Professor of Materia Medica, Pharmacology, Therapeutics, and Clinical Medicine, and Clinical Professor of Diseases of the Skin in the Medico-Chirurgical College of Philadelphia; Physician to the Medico-Chirurgical Hospital, etc., etc. This, the second volume of Shoemaker's "Materia Medica, Pharmacology, and Therapeutics," is wholly taken up with the consideration of drugs, eacli remedy being studied from three points of view, viz. : the Preparations, or Materia Medica; the Physiology and Toxicology, or Pharmacology; and, lastly, its Therapy. It is thoroughly abreast of the progress of Therapeutic Science, and is really an indispensable book to every student and practitioner of medicine. Royal Octavo, about 675 pages. Thoroughly and carefully indexed. Price, in United States, post-paid, Cloth, $3.50; Sheep, $4,50, net. Canada (duty paid). Cloth, $4.00; Sheep, $5.00, net. Great Brit- ain, Cloth, 20s. ; Sheep, 26s. France, Cloth, 22 fr. 40; Sheep, 28 fr. 60. The first volume of this work is devoted to Pharmacy, G eneral Pharma- cology, and Therapeutics, and remedial agents not properly classed with drugs. Ro3''al Octavo, 353 pages. Price of Volume I, post-paid, in United States, Cloth, $2.50, net; Sheep, $3.25, net. Canada, duty paid. Cloth, $2.75, net; Sheep, $3.60, net. Great Britain, Cloth, 14s. ; Sheep, 18s. France, Cloth, 16 fr. 20 ; Sheep, 20 fr. 20. The volumes are sold separately. SHOEMAKER'S TREATISE ON MATERIA MEDICA, PHARMACOLOGY, AND THERA- PEUTICS STANDS ALONE. (1) Among Materia Medica text-books, in that it includes every officinal drug and every preparation contained in the United States Pharmacopoeia. (3) In that it is the only work on therapeutics giving the strength, composition, and dosage of every officinal i)ieparation. (3) In giving the latest investigations with regard to the physiological action of drugs and tlie most recent applications in therapeutics. (4) In combining with officinal drugs the most reliable reports of the actions and uses of all the noteworthy new remedies, such as acetanilid, antipyrin, bromoform, exalgin, pyok- tanin, pyridin, somnal, spermine (Brown-Sequard), tuberculin (Koch'slymph), sulphonal, thiol, urethan, etc., etc. (5) As a complete encyclopaedia of modern therapeutics in condensed form, arranged alpha- betically for convenience of reference for either physician, dentist, or pharmacist, when immediate information is wanted concerning the action, composition, dose, or antidotes for any officinal preparation or new remedy. (6) In giving the physical characters and chemical formulae of the new remedies, especially the recently-introduced antipyretics and analgesics. (7) In the fact that it gives special attention to the consideration of the diagnosis and treat- ment of poisoning by the more active drugs, both officinal and non-offlcinal. (8) And unrivaled in the number and variety of the prescriptions and practical formulaj, representing the latest achievements of clinical medicine. (9) In that, while summarizing foreign therapeutical literature, it fully recognizes the work done in this department by American physicians. It is an epitome of the present state of American medical practice, which is universally acknowledged to be the best practice. (10) Because it is the most complete, convenient, and compendious work of reference, being, in fact, a companion to the United States Pharmacopoeia, a drug-encyclopaedia, and a therapeutic hand-book all in one volume. material compressed in so limited a space. The book will prove a valuable addition to the physician 's library. — Occidental Med. Times. It is a meritorious work, with many unique features. It is richly illustrated by well-tried prescriptions showing the practical ayiplica- tion of the various drugs discussed. In short, this work makes a pretty complete encyclo- paedia of the science of therapeutics, conve- nientlv arranged for handy reference. — Med. World. The value of the book lies in the fact that it contains all that is authentic and trust- worthy aboTit the host of new remedies which have deluged us in the last five years. The pages are remarkably free from useless infor- mation. Tlie author has done well in following the alphabetic.Tl order.— iV^. Y. Med. Record. In iierusing the pages dovoted to the special consideration of drugs, their pharmacology, physiological action, toxic action, and therapy, one is constantly surprised at the amount of (22) S31ITH: Physiology of the Domestic Animals. A Text-Book for Veterinary and Medical Students and Practitioners. By Robert Meade Smith, A.^M., ^I.D., Professor of Comparative Physi- ology ill University of Pennsylvania; Fellow of the College of Physicians and Academy of the ^Tatural Sciences, Philadelphia; of American Physiological Society; of the American Society of Naturalists, etc. This new and important work, the most thoroughly complete in the English language on this subject, treats of the physiology of the domestic animals in a most comprehensive manner, especial prominence being given to the subject of toods and fodders, and the character of the diet for the herbivora under different conditions, with a full consideration of their digestive peculiarities. Without being overburdened with details, it forms- a complete text-book of physiolog}' adapted to tlie use of students and practitioners of both veterinary anil human medicine. This work has already been adopted as the Text-Book on Physiology in the Veterinary Colleges of the United States, Great Britain, and Canada. In one Handsome Ro}-al Octavo Volume of over 950 pages, profusely illustrated with more than 400 Fine Wood-Engravings and many Colored Plates. United States. Camda fduty paid). Great Britain. France. Price, Cloth, . - $5.00, Net $5.50, Net 28s. 30 fr. 30 " Sheep, . • 6.00 " 6.60 " 32s. 36 fr. 20 A. LiArTABD. M.D., H.F.R.C. V.S., Pro- fessor of Anatfimy, Operative Surgery, and Sanitary Medicine in the American \ eterinary Collefre". New York, writes: — "I have exam- ined the wurk of Dr. R. M. Smith on the 'Physiology of the Domestic Animals.' and con- sider it one of the best additions to veterinary literature that we have had for some time." E. M. Re.adixg, A.M., M.D.. Professor of Physiology in the Chicago Veterinary College, writes: — "I have carefully examined tlie 'Smith's Physiolosy." published by you. and like it. It i.s" comj rehensive, exhaiistive. and complete, and is especially adapted to those who desire to ol>tain a full knowledge of the principles of physiology, and are not satistied with a mere smattering; of the cardinal points." Dr. Smith's presentment of his subject is as brief as the status of the science permits, and to this much-desired conciseness he has added an equally welcome clearness of statement. The illustrations in the work are exceedingly good, and must prove a valuable aid to the full understanding of the te-Kt.— Journal oj Comparative Jledicine a?irf Surgery. Veterinary practitionei"s and tiraduates will read it with pleasure. Veterinary stmlents will readily acquire needed knowieds;e from its pages, and veterinary schools, which would be well equipped for the work they aim to perform, cannot ignore it as their tcxt-book in physiology. — American Veterinart/ Jieview. Altogether. Professor Smith's "Physiology of the Domestic Animals" is a happy" produc- tion, and win be hailed with delight in both the human medical and veterinary medical worlds. It should tind its place, besides, in all agrricultural libraries. — Paul Paquix, M.D., V.S., in the Weekly Medical Sevieiv. The author has judiciously made the nutri- tive functions the strong point of the work, and has devoted special attention to the sub- ject of foods and digestion. In looking through other sections of the work, it appears to us that a just proportion of space is assigned to each, in view of their relative importance to the practitioner. — London Lancet. SOZIXSKEY Medical Symbolism. Historical Studies in tlie Arts of Healing^ and Hygfiene. of "The Culture of By Thomas S. Sozinskey, M.D., Ph.D., Author Beauty." "The Care and Culture of Children," etc. 12mo. Xearly 200 pages. Xeatly bound in Dark-Blue Cloth. Appropri- ately illuslrated with upwarcf of thirty (30) new Wood-Engravings. No. 0 in the Physicians' and Students' Ready-Reference Series. Price, post-paid, in United States and Canada, $1.00, net ; Great Britain, 6s. ; France, 6 fr. 20. He who has not time to more fully study the more extended records of the past, will highly prize this little book. Its interesting discourse upon the past is full of suggestive thought. — American Lancet. Like an oasis in a dry and dusty desert of medical literature, through which we wearily stagarer. is this work devoted to medical svni- bolisra and mythology. As the author aptlv quotes: " Wha"t some fight braines may esteerh as foolish toyes, deeper judgments "can and will value as sound and serious matter."— Can- adian Practitioner. In the volume before us we have an admira- ble and successful attempt to set forth in order those medical symbols which have come down to us. and to exidaiii on historical grounds their significance. An astonishing amount of information is contained within the covers of the book, and every page of the work bears token of the painsfaking genius and erudite mind of the now unhappily deceased author. — London Lancet. (23) STBWAUT Obstetric Synopsis. By John S. Stewart, M.D., formerly Demonstrator of Obstetrics and Chief Assistant in the Gynsecological Clinic of the Medico-Chirurgical College of Philadelphia: with an introductory note by William S. Stewart, A.M., M.D., Professor of Obstetrics and Gynaecology in the Medico-Chirurgical College of Philadelphia. By students this work will be found particularly useful. It is based upon the teacliings of such well-known authors as Playfair, Parvin, Lusk, Galabin, and Cazeaux and Tarnier, and contains much new and important matter of great value to both student and practitioner. With 42 Illustrations. 202 pages. 12mo. Handsomely bound in Dark- Blue Cloth. No. 1 in the Physicians' and Students' Beady -Reference Series. Price, post-paid, in the United States and Canada, $1.00, net ; in Grreat Britain, 6s,,' France, 6 fr. 20. curately described. — Buffalo Medical and Surgical Journal. It is clear and concise. The chapter on the development of the ovum is especially satis- factory. The judicious use of bold-faced type for headings and italics for important statements gives the book a pleasing typo- graphical appearance. — Medical Record. This volume is done with a masterly hand. The scheme is an exceHient one. The whole is freely and most admirably illustrated with well-drawn, new engravings, and the book is of a very. convenient size. — St. Louis Medical and Surgical Journal. DeLaskib Miller, M.D., Professor of Obstetrics, Rush Medical College, Chicago, 111., says : — "I have examined the 'Obstetric (Synopsis,' by Jolin S. Stewart, M.D., and it gives me pleasure to characterize the work as systematic, concise, perspicuous, and authen- tic. Among manuals it is one of the best." It is well written, excellently illustrated, and fully up to date in every respect. Here Ave find all the essentials of Obstetrics in a nutshell, Anatomy, Embryology, Physiology, Pregnancy, Labor, Puerperal State, and Ob- stetric Operations all being carefully and ac- TILTZMAl^N The Neuroses of the Genito-Urinary System in the Male. With Sterility and Impotence, By Dr. R. Ultzmann, Professor of Genito-Urinary Diseases in the Uni- versity of Vienna. Translated, with the author's permission, by Gardner W. Allen, M.D., Surgeon in the Genito-Urinary Department, Boston Dispensary. Full and complete, yet terse and concise, it handles the subject with such a vigor of touch, such a clearness of detail and description, and such a directness t'O the result, that no medical man who once takes it up will be content to lay it down until its perusal is complete, — nor will one reading be enough. Professor Ultzmann has approached the subject from a somewhat different point of view from most surgeons, and this gives a peculiar value to the work. It is believed, moreover, that there is no convenient hand-book in English treat- ing in a broad manner the Genito-Urinary Neuroses. ,. Synopsis of Contents. — First Part — I. Chemical Changes in the Urine in Cases of Neuroses. II. Neuroses of the Urinary and of the Sexual Organs, classified as : (1) Sensory Neuroses; (2) Motor Neuroses ; (3) Secretory Neuroses. Second Part — Sterility and Impotence. The treatment in all cases is described clearly and minutely. Illustrated. 12mo. Handsomely bound in Dark-Blue Cloth. No. 4 in the Physicians' and Students' Ready -Reference Series. Price, post-paid, in the United States and Canada, $1.00, net ; in Great Britain, 6s. ; in France, 6 fr. 20. This book is to be highly recommended, owing to its clearness and brevity. Altogether, we do not know of any book of the same size which contains so much useful information in such a short space. — Medical News. Its scope is large, not being confined to the one condition, — neurasthenia, — but embracing all of the neuroses, motor and sensory, of the genito-urinary organs in the male. No one who has read after Dr. Ultzmann need be re- minded of his delightful manner of presenting his thoughts, which ever sparkle with original- ity and appositeness. — Weekly Med. Review. It engenders sound pathological teaching, and wiu aid in no small degree in throwing light on the management of many of the dif- ficult and more refractory cases of the classes to which these essays especially refer.— r/ie Medical Age. (24) WJSIJJELJEIl Abstracts of Pharmacology. By II. A. Wheelrr, M.D. (Registered Pliariuacist, No. 34G8, Iowa). Pre- pared for the use of Plij-sicians and Pharmacists, and especially for the use of Students of Medicine and Pharmacy, who are preparing for Examination in Colleges and before State Boards of Examiners. This book does not contain questions and answers, but solid pages of abstract information. It will ])e an almost indispensable companion to the prac- ticing Pliarmacist, and a very usel'ul reference-book to the Physician. It contains a brief but thorough cxjilanation of all terms and processes used in practical l)harma('y, an abstract of all that is essential to be known of each officinal drug,, its preparations and therapetic action, with doses; in Chemistry and Botany, much that is useful to the Physician and Pharmacist; a general working formula for each class and an abstract formula for each officinal preparation, and many of the more popular unofficinal ones, together with their doses; also many sj-mbolic formulas; a list of abbreviations used in prescription writing; rules governing incompatibilities; a list of Solvents; tests for the move common drugs; the habitat and best time for gathering plants to secure their medical properties. Tiie l)ook contains 180 pages, 5^ x 8 inches, closely printed and on the best paper, nicely and durably bound, containing a greater amount of information on \he above topics than any other work lor the money. Price, post-paid, in United States and Canada, $1.50, net; in Great Britain, 8s. 6d. ; in France, 9 fr. 35. YOTIJSG Synopsis of Human Anatomy. Being a Complete Compend of Anatomy, Including the Anatomy of the ylscera, and numerous tables. By Jamks K. Youxg, M.D., Instructor in Orthopoedic Surgery and Assistant Demonstrator of Sur^ry, University of Pennsj-lvania; Attending Orthopaedic Surgeon, Out-Patient Department, University Hospital, etc. While the author has prepared this work especially for students, sufficient descriptive matter has been added to render it extremely valuable to the busy practitioner, particularly the sections on the Viscera, Special Senses, and Sur- gical Anatomy. The work includes a complete account of Osteology, Articulations and Ligaments, ]\Iuscles, Fascias, Vascular and Nervous Systems, Alimentary, Vocal, and Respiratory and Genito-Urinary Apparatus, the Organs of Special Sense, and Surgical Anatomy. In addition to a most carefully and accurately prepared text, wherever possible, the value of the work has been enhanced by tables to focilitate and minimize the labor of students in acquiring a thorough knowledge of this important subject. The section on the teeth has also been especially prepared to meet the requirements of students of dentistry. Illustrated with 7fi Wood-Engravings. 390 pages. 12mo. No. 3 in the Physicians' and Students' Ready -Reference Series. Price, post-raid, in United States and Canada $1.10, net ; Great Britain, 8s. 6d. ; France, 9 fr. 25. Every unnecessary word has been excluded, out of VcRard to the very limited time at the medii-al student's disposal. It is also good a.s a reference-book, as it presents the tacts about wliich he wishes to refresh his memory in the briefest manner consistent with clearness. — iVpjf York Mprlical Journal. As a companion to the dissecting- table, and a convenient reference for the practitioner, it has a definite field of usefulness. — Pittsburgh Medical Hcvieiv. The book is much more satisfactory than the "remembrances " in vogue, and yet "is not too cumbersome to be carried around and read at odd moments — a property which the student will readily appreciate. — Weekly Medical Review. (25) WITHERSTINB The International Pocket Medical Formulary Arranged Therapeutically, By C. Sumner Witherstine, M.S., M.D., Associate Editor of the "Annual of the Universal Medical Sciences ;" Visiting Physician of the Home for the Aged, Germantown, Philadelphia ; Late House-Surgeon Charity Hospital, New York. More than 1800 formulae from several hundred well-known authorities. With an Appendix containing a Posological Table, the newer remedies included ; Important Incompatibles ; Tables on Dentition and the Pulse ; Table of Drops in a Fluidrachm and Doses of Laudanum graduated for age ; Formulae and Doses of Hypodermatic Medication, including the newer remedies ; Uses of the Hypo- dermatic Syringe ; FormuUe and Doses foi' Inhalations, Nasal Douches, Gargles, and Ej^e-washes ; Formula} for Suppositories ; Use of the Thermometer in Dis- ease ; Poisons, Antidotes, and Treatment ; Directions for Post-Mortem and Medico-Legal Examinations ; Treatment of Asphyxia, Sun-stroke, etc. ; Anti- emetic Remedies and Disinfectants ; Obstetrical Table ; Directions for Ligations of Arteries ; Urinary Analysis ; Table of Eruptive Fevers ; Motor Points for . Electrical Treatment, etc. This work, the best and most complete of its kind, contains about 275 printed pages, besides extra blank leaves — the book being interleaved throughout — elegantly printed, with red lines, edges, and borders; with illustrations. Bound in leather, with side flap. It is a handy book of reference, replete with the choicest formulas (over 1800 in number) of more than six hundred of the most prominent classical writers and modern practitioners. The remedies given are not only those whose eflBciency has stood the test of time, but also the newest and latest discoveries in pharmacy and medical science, as prescribed and used by the best-known American and foreign modern autliorities. It contains the latest, largest (66 formulse), and most complete collection of hypodermatic formuloB (including the latest new remedies) ever published, with doses and directions for their use in over fifty different diseases and diseased conditions. Its appendix is brimful of information, invaluable in office work, emergency cases, and the daily routine of practice, It is a reliable friend to consult when, in a perplexing or obstinate case, the usual line of treatment is of no avail. (A hint or a help from the best authorities, as to choice of remedies, correct dosage, and the eligible, elegant, and most palat- able mode of exhibition of the same.) It is compact, elegantly printed and bound, well illustrated, and of conve- nient size and shape for the pocket. The alphabetical arrangement of the diseases and a thumb-letter index render reference rapid ajid easy. Blank leaves, judiciously distributed throughout the book, afford a place to record and index favorite formulae. As a student, the physician needs it for study, collateral reading, and for recording the favorite prescriptions of his professors, in lecture and clinic;- as a recent graduate, he needs it as a reference hand-book for daily use in prescribing (gargles, nasal douches, inhalations, eye-Avashes, suppositories, incomyjatibles, poisons, etc.); as an old practitioner, he needs it to refresh his memory on old remedies and combinations, and for information concerning newer remedies and more modern approved plans of treatment. No live, progressive medical man can aflFord to be without it. Price, post-paid, in United States and Canada $2.00, net ; Great Britain, lis. 6d. ; France, 12 fr. 40. enough of incompatibilities before commenc- It is sometimes important that such prescrip- tions as liave been weU established in tlieir usefulness be preserved for reference, and this little volume serves such a purpose better than any other we have seen. — Columbus Med- ical Journal. To the young physiciun just starting out in practice this little book will prove an accept- able companion. — Omaha Clinic. As long MS "combinations" are sought, such a book will be of value, especially to those who cannot spare the time required to learn ing practice to avoid writing incompatible and dangerous prescriptions. The constant use of such a book by such prescribers would save the pharmacist much anxiety. — Tfie Drug- gisLr Circular. In judicious selection, in accurate nomen- clature, in arrangement, and in style, it leaves nothing to be desired. The editor and the publisher are to be congratulated on the pro- duction of the very best book of its class.— PitUburgli Medical Review. (26) Annual of the Universal Medical Sciences. A Yearly Report of the Progress of the General Sanitary Sciences Turouuhout the World. EcUtud b}' Chaklks E. Sajous, M.D., formerly Lecturer on Laryngology and Rhinology in Jefferson Medical College, Philadelphia, etc., and Seventy Associate Editors, assisted by over Two Hundred Corresponding Editors and Collaborators. In Five Ro^'^al Octavo Volumes of about 500 pages each, bound in Cloth and Half-Russia, Magnificently Illustrated with Chromo-Lithographs, Engravings, Maps, Charts, and Diargrams. Being intended to enable any physi- cian to possess, at a moderate cost, a complete Contemporary History of Universal Medicine, edited by many of America's ablest teachers, and superior in every detail of print, paper, binding, etc., a befitting continuation of such great works us "Pepper's System of Medicine," "xVshhurst's International Encyclopaedia of Surger)'," "Buck's Reference Hand-Book of the Medical Sciences." SOLD ONLY BY SUBSCRIPTION, OR SENT DIRECT ON RECEIPT OF PRICE, SHIPPING EXPENSES PREPAID. Subscription Price per Year (including the " SATELLITE " for one year) : In United States, Cloth, 5 vols., Royal Octavo, $15.00; Half-Russia, 5 vols., Royal Octavo, $20.00. Canada (duty paid), Cloth, $16 50; Half-Russia, $22.00. Great Britain, Cloth, £i 7s. ; Half- Russia, £5 15s. Prance, Cloth, 93 fr. 35 ; Half-Russia, 12i fr. 35. The Satellite of the " Annual of the Universal Medical Sciences." A Monthly Review of the most important articles upon the practical branches of Medicine appearing in the medical press at large, edited by the Chief Editor of the Annual and an able staff. Published in connection with the Annual, and for its Subscribers Only. Editorial Staff of the Annual of the Universal Medical Sciences. CONTRIBUTORS TO SERIES 1888, 1889, 1890, 1891. Editor-in-Chief, CHARLES E. SAJOUS, M.D., Philadelphia. SENIOR ASSOCIATE EDITORS. Agiiew. D. Haves, >r.D.. LL.D.. Philadelphia, series i>f 188.S. IS.sO. Baldv, J. M.. M.D.. Philadelphia. 1891. Barton. J. M., A.M., M.D., Philadelphia, 1889, 1S90, 1&91. Birdsall, W. R.. M.D.. New York, 1889. 1890, 1891. Brown, F. W.. M.D.. Detroit. 1800. 1891. Bruen, Edward T.. M.D., Philadelpliia, 1889. Brush, Ed A-ard X., M.D., Philadelphia, 1889, 1890. 1S9I, Cohen. J. Solis, M.D., Philadelphia, 1888, 1889, 1890. 1891. Conner, P. S.. :\r.D., LL.D., Cincinnati, 1888. 1889. 1890, 1891. Curriev, A. F., A.B., M.D., New York, 1889, 1890, 1891. Davidson, C. C. :\r D.. Philadelphia. 1888. Davis. N. K., A.M., M.D.. LL.D., Chicago, 1888, 18,89. 1890. 1891. Delafield, Fi aneis, M.D., New York. 1888. Delavan. D. Brvson, M.D., New York, 1888, 1889,1X90, 1891. Draper, F. Wiiithiop. A,>L, M.D., New York, 18.88. l.^SM. 1890. 1891. Dudley, Edward C, M.D., Chicao;o, 1888. Ernst." Harold C, A.M., M.D., Boston, 1889, 1890, 1891. Forties, William S., M.D., Philadelphia, 1888, 1889 1890 Garrets'on, J. E., M.D., Philadelphia, 1888, 1889. Gaston, J. McFadden, M,D., Atlanta, 1890, 1891. Gihoii. Albert T,., A.M., M.D., Brooklyn, 1888, 1889. 1890. 1891. Goodoii. William, M.D., Philadelphia, 1888, 1889. 1890. Grav, T^andon Carter, M.D., NewYork, 1890, 1891. Griffith. .T. P. Crozer, M.D., Philadelphia, 1889, 1890. 1891. Guilford, S. H., D.D.S., Ph.D., Philadelphia, 1888. Guite'ras. John, M.D., Ph,D., Charleston, 1SS8. 18S9. Haiiiiltort. John B.. 'M.D., LL.D., Washington, 1888. 1889, 1890. 1891. Hare. Hobart Aniorv. :M.D., B.Sc, Philadel- phia. 1888, 1889. 1890. 1891. Henrv. Frederick P., M.I)., Philadelphia, 1889, 1890. 1891. Holland, J. W., M.D.. Philadelphia, 1888. 1889. Holt. L. Emniett, M.D., New York, 1889, 1890, 1891. Howell. W. H.. Ph.D., M.D., Ann Arbor, 1889. 1890, 1891. Hun. Henry, M.D.. Albany, 1889. 1890. Hooper. Franklin H., M.D.. Boston, 1890. 1891. Ingal.s. E. Fletcher, A.M., M.D., Chicago, 1889, 1890. 1891. Jaggard, W. W., A.M., M.D., Chicago, 1890. Johnston, Christopher, M.D., Baltimore, 1888, 18.89. Johnston, W. W., M.D., Washington, 1888, 1889, 1890, 1891. (27) SENIOR ASSOCIATE EDITORS (continued), Keating, John M., M.D., Philadelphia, 1889. Kelsev, Charles B., M.D., New York, 1888, 1889, ISdO, 1891. Keyes, Edward L., A.M., M.D., New York, 1888, 1889, 1890, 1891. Knapp, Philip Coombs, M.D., Boston, 1891. Laplace, Ernest, A.M., M.D., Philadelphia, 1890, 1891. Lee, John G., M.D., Philadelphia, 1888. Leidy, Joseph, M.D., LL.D., Philadelphia, 1888, 18S9, 1890, 1891. Longstreth, Morris, M.D., Philadelphia, 1888, 1889, 1890. Loomis, Alfred L., M.D., LL.D., New York, 1888, 1889. Lymau, Henry M., A.M., M.D., Chicago, 1888. M'cGuire, Hunter, M.D., LL.D., Richmond, 1888. Manton, Walter P., M.D., F.R.M.S., Detroit, 1888, 1889, 1890, 1891. Martin, H. Newell, M.D., M.A., Dr. Sc, F.R.S., Baltimore, 1888, 1889. Matas, Rudolph, M.D., New Orleans, 1890, 1891. Mears, J. Ewing, M.D., Philadelphia, 1888, 1889, 1890, 1891. Mills, Charles K., M.D., Philadelphia, 1888. Minot, Chas. Bedgwick, M.D., Boston, 1888, 1889, 1890, 1891. Montgomery, E. E., M.D., Philadelphia, 1891. Morton, Thos. G., M.D., PhUadelphia, 1888, 1889 jMunde',' Paul F., M.D., New York, 1888, 1889, 1890, 1891. Oliver, Cliarles A., A.M., M.D., Philadelphia, 1889, 1890, 1891. Packard, John H., A.M., M.D., Philadelphia, 1888, 1889, 1890, 1891. Parish, Wm. H., M.D., Philadelphia, 1888, 1889, 1890. Parvin, Theophilus, M.D., LL.D., Philadel- phia, 1888, 1889. Pierce, C. N., D.D.B., Philadelphia, 1888. Pepper, William, M.D., LL.D., Philadelphia, 1888. Ranney, Ambrose L., M.D., New York, 1888, 1889, 1890. Richardson, W. L., M.D.,Boston, 1888, 1889. Rockwell, A. D., A.M., M.D., New York, 1891. Rohe', Geo. H., M.D., Baltimore. 1888, 1889, 1890, 1891. Sajoiis, Chas. E., M.D., Philadelphia. 1888, 1889, 1890. 1891. Sayre, Lewis A., M.D., New York, 1890, 1891. Seguin, E. C, M.D., Providence, 1888, 1889, 1890, 1891. Senn, Nicholas, M.D., Ph.D., Milwaukee, 1888, 1889. Shakspeare, B. O., M.D., Philadelphia, 1888. Sliattuck, F. C, M.D., Boston, 1890. Smith, Allen J., A.M., M.D., Philadelphia, 1890, 1891. Smith, .T. Lewis, M.D., New York, 1888, 1889, 1890, 1891. Spitzka, K. C, M.D., New York, 1888. Starr, Louis, M.D., Philadelphia, 1888, 1889, 1890. 1891. Stimson. Lewis A., M.D., New York, 1888, 1889, 1890, 1891. Sturgis, F. R., M.D., New York, 1888. Suddutli, F. X., A.M.. M.D., F.R.M.S.; Minne- apolis, 1888, 1889, 1890, 1891. Thomson, William, M.D., Philadelphia, 1888. Thomson. Wm. H., M.D., New York. 1888. Tiflanv, L. McLane, A.M., M.D., Baltimore, 1890, 1891. Turnbull. Clias, S., M.D., Ph.D., Philadelphia, 1888, 1889, 1890 1891. Tyson, James, M.D., Philadelphia, 1888, 1889, 1890. Van Harlingen, Arthur, M.D., Philadelphia, 1888, 1«89, 1890, 1891. Vander Veer, Albert, M.D., Ph.D., Albany, 1890. Whittaker. Jas. T., M.D., Cincinnati, 1888, 1889, 1890, 1891. Whittier, E. N., M.D., Boston, 1890, 1891. Wilson, .Tames V., A.IM., M.D., Philadelphia, 1888. 1889. 1890, 1891. Wirgman, Chas., M.D., Philadelphia, 1888. Witherstine, C. Sumner, M.S., M.D., Phila- delphia, 1888, 1889, 1890, 1891. White, J. William, M.D,, PhUadelphia, 1889, 1890, 1891. Young, Jas. K., M.D., Philadelphia, 1891. JUNIOR ASSOCIATE EDITORS. Baldy, J. M., M.D., Philadelphia, 1890. Bliss. Arthur Ames, A. M., M.D., Philadelphia, 1890, 1891. Cattell, H. W., M.D., Philadelphia, 1890, 1891. Cerna, David, M.D., PhD., Philadelphia, 1891. Clark, J. Payson, M.D., Boston, 1890, 1891. Crandall, F. M., M.D., New York, 1891. Cohen, Solomon Solis, A.M., M.D., Philadel- phia, 1890, 1891, Cryer, EL. M., M.D., Philadelphia, 1889. Deale, Henry B., M.D., Washington, 1891. Dolley, C. S., M.D., Philadelphia, 1889, 1890, 1891. Dollinger, Julius,^ M.D., Philadelphia, 1889. Dorland, W. A., M.D., Philadelphia, 1891. Freeman, Leonard, M.D., Cincinnati, 1891. Goodell, W. Constantine, M.D., Philadelphia, 1888, 1889, 1890. Gould, Geo. M., M.D., Philadelphia, 1889, 1890, Greene, E. M.. M.D., Boston, 1891. Griffith, J. P. Crozer, M.D., Philadelphia, 1883. Hoag, Junius, M.D., Chicago, 1888. Howell, W. PI., PhD., B.A., Baltimore, 1888, 1889. Hunt, William, M.D., Philadelphia, 1888, 1889. Jackson, Henry, M.D., Boston, 1891. Kirk, Edward C., D.D.S., Philadelphia, 1888. Lloyd, James Hendrie, M,D., Philadelphia, 1888 McDonald, Willis G.,M.D., Albany, 1890. Penrose, Chas. B., M.D., Philadelphia. 1890. Powell, W. M., M.D., Philadelphia, 1889, 1890, 1891. Quimby, Chas. E., M.D., New York, 1889. Sayre, JReginaldH., M.D., New York, 1890, 1891. Smith, Allen J., A.M., M.D., Philadelphia, 1889 1890 Vickery, H.F., M.D., Boston, 1891. Warfield. Ridgelv B., M.D., Baltimore, 1891. Warner. Frederick M., M.D.. New York, 1891. Weed. Charles L., A.M., M.D., Philadelphia, 1888, 1889. Wells, Brooks H., M.D., New York, 1888, 1889, 1890 1891 Wolff, Lawrence, M.D., Philadelphia, 1890. Wyman, Walter, A.M., M.D., Washington, 1891. ASSISTANTS TO ASSOCIATE EDITORS. Baruch, S., M.D., New York, 1888. Beatty, Franklin T., M.D., Philadelphia, 1888. Brown, Dillon, M.D., New York, 1888. Buechler, A. F., M.D., New York, 1888. Burr, Chas. W., M.D., Philadelphia, 1891. Cohen, Solomon Solis, M.D., Philadelphia, 1889. Cooke, B. G., M.D., New York, 1888. Coolidge, Algernon, Jr., M.D., Boston, 1890. Currier, A. F., M.D., New York, 1888. Daniels, F. H., A.M.. M.D., New York, 1888. Deale, Henry B., M.D., Washington, 1890. Eshner, A. A., M.D., Philadelphia, 1891. Gould George M., M.D., Philadelphia, 1888. Grandin, Egbert H., M.D., New York, 1888, 1889. Greene, E. M., M D., Boston, 1890. Guite'ras, G. M., M.D.. Washington, 1890. Hance, I. H., A.M., M.D., New York, 1891. Klingenschmidt, C. H. A., M.D., Washington, 18S0. . ,„„, Martin, Edward, M.D., Philadelphia, 1891. McKee, E S., M.D., Cincinnati, 1889, 1890, 1891. Myers, F. H., M.D.. New York, 1888. Packard, F. A., M.D.. Philadelphia, 1890. Pritchard. W. B., M.D., New York, 1891. Sangree, E. B., A.M., M.D., Philadelphia, 1890. Sears, G. G., M.D., Boston, 1890. Shulz, R. C, M.D.. New York, 1891. Souwers. Geo. F., M.D., Philadelphia, 1888. Taylor, H. L., M.D., Cincinnati, 1889, 1890. Va'nsant, Eugene L., M.D., Philadelphia, 1888. (28) ASSISTANTS TO ASSOCIATE EDITORS-(continued). Vickery, H. F., xM.L)., liostun, 1«K). Warner, F. M., M.D., New York, 1888, 1889, isyo. Wells, Brooks H., M.D., New York, 1888. W.'u.lt, E. C, M.I)., New York, 1S,S,S. Milder, W. H., M.D., Cineiiuiati, 1889. Wil>oii, (_'. Meijrs, M.D., PhiUulcliiliia. 1S89. Wilson, W. U., M.D., riiiladelpliia, 1891. CORRESPONDING STAFF. EUROPE. Antal, Dr. Gesa v., rnda-Pestli, Hungary. ISagiiit-ky, Dr. A., Berlin, Geruiany. Baratoux, Dr. J., Paris, Fiai\ce. Barker, Mr. A. E. J ., London, England. Barnes, Dr. Fancoui-t, London, England. Bayer, Dr. Carl, Prague, Axistria. Bouclint, Dr. E., Paris, France. liourneville. Dr. A., Paris, France. Bramwell, Dr. Byron, Edinburgh, Scotland. Carter, Mr. WUliaui, Liverpool, England. Caspari, Dr. G. A., Moscow, Russia. Chiralt y Selma, Dr. V., Seville Spain. Cordes,'Dr. A., Geneva, Switzerland. D'Estrees, Dr. Debout, CJontrexeville, France. Diakonoff, Dr. P. .1., IVIoseow, Russia. Dobrashian, Dr. G. S., Constantinople, Tur- kcj'. Doleris, Dr. L., Paris, France. Doutrelepont. Prof., Bonn, Germany. Doyon, Dr. H., Lyons, France. Drzewiecki, Dr. Jos., Warsaw, Poland. Dubois-Reymond, Prof., Berlin, Germany. Ducrey, Dr. A., Naples, Italy. Dujardin-Beaumetz, Dr., Paris, France. Duke, Dr. Alexander, Dublin, Ireland. Eklund, Dr. F., Stockholm, Sweden. Fokker, Dr. A. P., Groningen, Holland. Fort, Dr. J. A., Paris, France. Fonrnier, Dr. Henri, Paris, France. Franks, Dr. Kendal, Dublin, Ireland. Fremy, Dr. H., Nice, France. Fry, Dr. George, Dublin, Ireland Golowina, Dr. A., Varna, Bulgaria. Gouguenheim, Dr. A., Paris, France. Haig. Dr. A., London, England. Hanion, ^Ir. A., Paris, France. Harley, ^Ir. V., Lond(5n, England. Harley, Mr. H. R., Nottingham, England. Harley, Prof. Geo., London, England. Harpe, Dr. de la, Lausanne, Switzerland. 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