Diagrams of the Nerves of the Human Body: Exhibiting Their Origin, Divisions ...

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DIAGRAMS

OF THE NERVES

OF THE HUMAN BODY.

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PRESLEY BLAKISTON, Publisher,

1012 WALNUT ST, PHILADELPHIA, PA.

DIAGRAMS

OF THE

NERVES

OF THE HUMAN BODY.

EXHIBITING THEIR ORIGIN, DIVISIONS AND CONNECTIONS, WITH THEIR

DISTRIBUTIONS TO THE VARIOUS REGIONS OF THE CUTANEOUS

SURFACE AND TO ALL THE MUSCLES.

BY

WILLIAM HENRY FLOWER, F.R.S.

THIRD HDITION.

PHILADELPHIA:

PRESLEY BLAKISTON.

i012 WALNUT STREET.
1881..

BOSTON MEDICAL LIBRARY

MTHE
FRANCIS A. COUNIWAY

UBRARY OP MEDICINE

ILLUSTRATIONS.

PLATE I. The Cranial Nerves,

I. The Olfactory Nerve. 2. The Optic Nerve. 3. The Third Nerve {Motor Oculi). 4. The
Fourth Nerve {Pathetic or Trochlear), 5. The Fifth Nerve {Trifacial or Trigeminal^ 6. The

Sixth Nerve {Abducens Oculi),

«

PLATE II. The Cranial Nerves.

I. (vii) The Facial Nerve, or Portio Dura of the Seventh Pair. 2. (viii) The Auditory Nerve
Portio Mollis of the Seventh Pair. 3. (ix) The Glosso-Pharyngeal Nerve. 4. (x) The Pneu-
mogastric or Vagus Nerve — the Par Vagum of the Eighth Pair. 5. (xi) The Spinal-Accessory
Nerve. 6. (xii) The Hypoglossal Nerve.

PLATE III. The Spinal Nerves.

The distribution of the Cervical and Dorsal Nerves is shown.

PLATE IV. The Spinal Nerves.

The remaining Spinal Nerves, including the Lumbar Plexus and the Sacral Plexus.

PLATE V. The Sympathetic System of Nerves.

The Trisplanchnic, Ganglionic, or Nervous System of Organic Life. i. Cervical Ganglia. 2.
Thoracic Ganglia. 3. Lumbar Ganglia. 4. Sacral Ganglia. 5. Coccygeal, or Ganglion Impar.

PLATE VI. The Distribution of the Cutaneous Nerves.

Showing the sources from which the sensibility of the different regions of the Cutaneous Surface is
derived.

PREFACE.

These diagrams were originally published in i860. They were designed by the author while engaged

in teaching anatomy in the medical school attached to the Middlesex Hospital. They have no pretensions

«
to enlarge the boundaries of the knowledge already existing upon the subject to which they relate, but

aim only at placing that knowledge in a form easily accessible, as well to students as to those whose avo-
cations no longer afford the time or opportunity for anatomical investigations.

The distribution of all the nerves of the body, so far as the branches have received distinctive appella-
tions, is shown, and their divisions are traced to the muscles, and to the various regions of the cutaneous
surface. To afford greater facility for reference, the names of the muscles are printed in red letters ;
those of the nerves being in black.

It must be clearly understood that the plates are only diagrams or plans,, aarf that in reducing- to a
plane surface objects which are in reality superimposed at various distances, and which sometimes cross
one another, their mutual relations and proportions must often be disarranged.

In the plexuses and other parts which vary somewhat in different subjects, the average distribution in
in its most simple form has been selected for illustration ; and in difficult or disputed points, such as the
connecting branches of the cranial nerves, only those which are established on good authority are
introduced.

As few things tend to embarrass the student so much as a diversity of nomenclature, that used in the
sixth edition of Quain's Elements of Anatomy, by Dr. Sharpey and Mr. Ellis, has been adopted throughout.

The principal materials for the composition of these diagrams have been obtained by repeated dissec-
tions ; but the author desires to acknowledge the assistance derived from the above-named work, from
that of Swan, and from the beautiful plates of Hirschfeld and Leveill^.

In the second edition, published in 1872, the size of the diagrams was considerably reduced, the con-
venience and portability of the work being thereby increased, without any detriment to its clearness or legi-
bility. In revising the plates, the author availed himself of some suggestions for which he was indebted to
the kindness of Professor Turner, of Edinburgh, and of Mr. J. Beswick Perrin. Some additional slight
emendations have been made in the present edition.

Royal College of Surgeons of England,
December, i88c.

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EXPLANATION OF THE PLATES.

PLATES I AND II.

THE CRANIAL NERVES.

Under this name are included the twelve pairs of nerves arising from the cerebro-spinal axis, which
are transmitted to their destination through apertures in the base of the skull.

The numerical nomenclature of the cranial nerves, introduced by Willis, had become so completely in-
corporated into our medical, anatomical, and physiological literature before its errors were discovered, that
it would be impossible now to discard it altogether. The arrangement of Sommerring, in which each of the
five pairs of nerves forming the seventh and eighth of Willis are recognized as distinct, is more correct, and
is already very generally used upon the Continent. In the diagram the two systems are placed for com-
parison in contiguous columns.

In the first explanatory column the superficial or apparent origins of the nerves only are given.
Although the deep or real origins are unquestionably of greater physiological importance, they are so com-
plex and in many cases still so incompletely made out, that they could not have been accurately stated in
that concise form required in a tabular exposition.

Most of the cranial nerves are connected by fine filaments with branches of the sympathetic system.
The physiological import of these communications being still imperfectly understood, the words to and
from applied to them must be taken in an anatomical sense only, and not necessarily as implying the pre-
sumed direction of the current of nerve force.

The first plate illustrates the distribution of the first six pairs of cranial nerves.

I. The Olfactory Nerve is specially appropriated to the sense of smell. Although commonly de-
scribed as a nerve, this with its expanded extremity should more properly be considered as a portion of
the encephalon, as it contains much gray matter, has no sheath or neurilemma, and is homologous to the
more fully developed olfactory lobes of the lower animals.

From the under surface of the bulb about twenty delicate nerves are given off; these pass through
the foramina in the cribriform plate of the ethmoid bone, and are distributed to the mucous membrane
lining the upper two-thirds of the nasal fossae.

8

II. The Optic Nerve is the special nerve of the sense of sight, and terminates in the retina. The
nerves of opposite sides are connected together at the commissure. From their origin up to this point,
being in the form of flattened bands, they are called optic tracts.

III. The Third Nerve (Motor Oculi) is entirely motor in its function. It supplies branches to five
of the seven muscles of the orbit, and one (the short root) to the ophthalmic ganglion, thereby giving motor
power to the iris.

IV. The Fourth Nerve (Pathetic or Trochlear) is the smallest of the cranial nerves, and termin-
ates in the superior oblique muscle of the eyeball. It communicates with the sympathetic, and often with
the ophthalmic division of the fifth, and according to Bidder, whose observation has been confirmed by
Hirschfeld, gives a recurrent filament to the dura mater.

V. The Fifth Nerve (Trifacial or Trigeminal) resembles the spinal nerves in having two roots,
one endowed with sensory, the other with motor power; but the. similarity is only partially carried out, in-
asmuch as the motor root is of very small size and of comparatively limited distribution.

It is the principal nerve of common and muscular sensibility to the face, confers motor power on the
muscles of mastication, and one of its branches contains filaments appropriated to the special sense of taste.
As in the spinal nerves, the sensory root has a gangliform enlargement upon it (the Casserian ganglion).
From this proceed the three main branches or divisions of the nerve. The two upper divisions are purely
nerves of common sensation, while the lower, into which alone the motor root passes, is of very complex
character, having among its branches —

1. Simple nerves of sensation (inferior dental; auriculo-temporal ; buccal).

2. Nerves which convey motor power to certain muscles, and probably, like the spinal nerves, con-

tain sensory fibres also.

3. A nerve of ordinary sensation and special sense combined (gustatory), and which by the addi-

tion of the chorda tympani from the seventh nerve contains motor filaments.

The branches of the fifth nerve towards their termination communicate freely with those of the
seventh, and confer sensibility upon the muscles of the face, which receive their motor power from the
latter.

In connection with this nerve are four small ganglionic masses, containing gray matter ; each of these
appears to be in communication (by roots^ with a motor, a sensory, and a sympathetic nerve, and to give
branches of distribution to contiguous structures.

VI. The Sixth Nerve (Abducens Oculi) is the motor nerve of the external rectus muscle of the
eyeball.

The second plate shows the distribution of the remaining six pairs of cranial nerves.

VII. The Facial Nerve, or Portio dura of the seventh pair (Willis), is purely a nerve of motion, and
is distributed to the muscles of the face. Besides those named in the diagram in direct connection with it
the seventh appears also to supply through the large superficial petrosal (which after being joined by a
branch from the sympathetic, receives the name of Vidian, and enters Meckel's ganglion) some of the
muscles of the soft palate, and through the chorda tympani the intrinsic muscular fibres of the tongue.
Before their termination in the muscles, its branches communicate freely with the sensory fibres of the
fifth nerve.

VIII. The Auditory Nerve, or Portio mollis of the seventh pair (Willis), is the special nerve of the
sense of hearing, and is distributed to the internal ear.

IX. The Glosso- Pharyngeal Nerve gives filaments through its tympanic branch to some parts of the
middle ear, but it is chiefly distributed to the mucous membrane lining the upper part of the pharynx, the
Eustachian tube, the arches of the palate, the tonsils, and to the sides of the posterior part of the upper
surface of the tongue. It is a nerve of the special sense of taste, and of ordinary sensation to the parts
which it supplies, and is the chief centripetal nerve engaged in the action of deglutition. It is doubtful
whether it contains any motor filaments which are not derived from its communication with other nerves.

X. The Pneumogastric or Vagus Nerve, the Par vagum of the eighth pair (Willis), has a most ex-
tensive distribution, giving branches to the pharynx, larynx, trachea, lungs, heart, oesophagus, and stomach.
Its main trunk being of great length, it has been necessary in the diagram to give it a curve so as to adapt
it to the size of the paper. It has numerous communications with other nerves, both cranial, spinal, and
sympathetic, and its functions appear to be of very mixed character, partly motor, partly sensitive, and
partly of a nature allied to those of the nerves of the sympathetic system.

XI. The Spinal-Accessory Nerve is apparently entirely motor in its function. It arises from the
upper part of the spinal cord, a considerable portion of it joins the pneumogastric (whence its name,
"nervus spinalis ad par vagum accessorius'')^ the remainder is distributed to the sterno-cleido-mastoideus and
trapezius muscles.

XII. The Hypoglossal Nerve. The ninth pair in the system of Willis supplies all the extrinsic
muscles of the tongue, as well as certain others in connection with the hyoid bone. Its proper function
appears to be exclusively motor, such sensibility as it possesses being probably derived through its free
communication with the spinal nerves.

lO

PLATES III AND IV.

THE SPINAL NERVES.

The nerves which arise from the spinal cord have each two roots. Of these the posterior is some-
what larger than the other, has a ganglion situated upon it, and is composed solely of filaments which con-
vey sensory impressions toward the cerebro-spinal centre. The anterior root, which has no ganglion, con-
sists on the other hand of fibres which transmit motor power from the centre to the muscles. After the
union of these roots, the resultant nerve is of mixed function, containing both motor and sensory fibres.

Directly the nerves issue from the intervertebral foramina, they divide into two branches ; one of
which, comparatively small, is directed posteriorly, and supplies the skin and muscles of the back. The '
anterior branches form the large nerves which are distributed to the neck, the lateral and anterior parts of
the trunk, and the extremities.

The spinal, like the cranial nerves, are symmetrically disposed on the two sides of the body. There
are thirty-one pairs, divided for the convenience of description, as follows : cervical, eight ; dorsal, twelve ;
lumbar, five ; sacral, five ; coccygeal, one.

In Plate III the distribution of the cervical and dorsal nerves is shown.

The anterior branches of the upper four constitute the cervical plexus ; those of the four lower
cervical, together with a large branch from the first dorsal, form the brachial plexus. The anterior
branches of the dorsal nerves are called intercostal. Those below the third have not been represented in
the diagram, as they all resemble each other, running forwards between the ribs, supplying the intercostal
muscles, and giving off lateral and anterior cutaneous nerves to the surface of the chest.

Small filaments which pass from the anterior branches of all the spinal nerves near their commence-
ment to the ganglia of the sympathetic system have been omitted here, to avoid the risk of obscuring any
portions of the special objects of the diagram, but they will be seen in Plate V.

Plate IV illustrates the distribution of the remaining spinal nerves. The anterior branches of the first
three lumbar nerves and the greater part of that of the fourth constitute the lumbar plexus. The large
nervous cord formed by part of the fourth, and the whole of the fifth lumbar, together with the first three
and part of the fourth sacral nerves (anterior branches), is called the sacral plexus.

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PLATE V.

THE SYMPATHETIC SYSTEM OF NERVES.

The nerves of this system, also called trisplanchnic, ganglionic, or nervous system of organic life,
are chiefly destined to supply the viscera. They have abundant communications with the cerebro- spinal
nerves, in which the fibres of the two systems appear mutually to interchange.

The small ganglia, connected with the fifth cranial nerve, are generally considered as belonging to
the sympathetic system. They have been figured in Plate I, and are not repeated here. The ganglia on
the glosso-pharyngeal and pneumogastric nerves, and those on the posterior roots of the spinal nerves,
are also by some anatomists reckoned as part of it.

The remaining, and by far the largest portion (which is illustrated in this plate), consists of two
chains of ganglia connected by intervening cords, situated in the posterior part of the neck, thoracic, and
abdominal cavities, one on each side of the vertebral column, arid extending from the upper part of the
cervical region as far as the coccyx, where they unite in a single small ganglion {G. impar). Each chain
usually consists of twenty-four or twenty-five ganglia, having a generally symmetrical disposition on the
two sides of the body. Each ganglion is connected above and below with the neighboring ganglion of
the chain ; externally it has communication with one or more of the spinal nerves, and internally it sends
off branches which mostly enter into the formation of certain large plexuses (prevertebral) situated near
the median line in the visceral cavities of the body. These, after receiving further accessions from nerves
of the cerebro-spinal system, send off branches for distribution to the various organs of the neck, thorax,
abdomen and pelvis. In these plexuses are situated many ganglia, each of which appears to be a centre
for the development or modification of nerve force. This portion of the system, like the parts which it
supplies, shows an absence of bilateral symmetry. The branches in reaching their destination almost
always accompany bloodvessels, forming a fine network around them.

In the diagram, to avoid useless repetition and obscurity, only one side of such parts of the sympa-
thetic system as are double and symmetrical is given, therefore only one of the ganglionated cords with
the ascending cranial branch from the first ganglion appears. The cardiac plexus is, like the organ it
supplies, single ; the cardiac nerves on both sides converging into it. The solar and hypogastric plexuses
are also single, and situated in the median line. On each side of the former, where the great splanchnic
nerve joins it, a large ganglion (semilunar) is placed. Of the secondary plexuses derived from it, the
diaphragmatic, supra-renal, renal, and spermatic are double, as are the arteries they accompany ; but the
hepatic, coronary, splenic, superior and inferior mesenteric, and aortic are single and asymmetrical.

The hypogastric plexus divides below into two parts, which are situated on either side of the pelvic
cavity, and give off the inferior haemorrhoidal and vesical plexuses, with prostatic and cavernous, or
ovarian, vaginal, and uterine branches, according to the sex of the subject. It will be observed that this
portion of the system is abundantly reinforced by branches which enter into it directly from the sacral
nerves, besides those that pass through the ganglionated cord.

12

PLATE VI.
DISTRIBUTION OF THE CUTANEOUS NERVES.

This diagram is intended to Show the sources from which the sensibility of the different regions of
the cutaneous surface is derived.

The position of the dotted lines which form the boundaries must be regarded only as approximative,
as the exact distribution of the cutaneous nerves varies somewhat in -different subjects, and as they
interlace and communicate freely where they come in contact.

In order to trace the surface nerves to their connection with the cerebro-spinal axis with greater
facility, an initial reference is given below the name of the branch to the main trunk or plexus from which
it proceeds.

The explanation of these references is as follows : —

First (ophthalmic) division of fifth cranial nerve.
Second (superior maxillary) division of the same.
Third (inferior maxillary) division of the same.
Cervical Plexus.
Brachial Plexus.
Lumbar Plexus.
Sacral Plexus.

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