IRLF
FOR STUDENTS OF MASSAGE
MARGARET E. EJORKEGREN
SECOND EDITION
PRICE Of- NET
HANDBOOK OF ANATOMY FOR STUDENTS
OF MASSAGE
HANDBOOK OF ANATOMY
FOR STUDENTS OF MASSAGE
BY
MARGARET E. ^BJORKEGREN
TEACHERS' CERTIFICATE, INCORPORATED SOCIETY TRAINED MASSEUSES
INTER. (M.B.) LOND.
SECOND EDITION
WITH 73 ILLUSTRATIONS
TAKEN FROM "A MANUAL OF ANATOMY," BY A. M. BUCHANAN,
M.A., M.D., PROFESSOR OF ANATOMY, ANDERSON'S COLLEGE, GLASGOW
LONDON
BAILLIERE, TINDALL & COX
8, HENRIETTA STREET, COVENT GARDEN
1917
A II rights rcstrved
M. Z 6
6 fc
/'Y
PREFACE TO THE SECOND EDITION
IN preparing the Second Edition I have made numerous altera-
tions and small additions which I trust will improve the useful-
ness of the book, the principal alteration being the considerable
enlargement of the chapter on Surface Markings, which I
recognized was not adequate to the standard required by the
examinations of the Incorporated Society of Trained Masseuses.
MAEGAEET E. BJOEKEGEEN.
LONDON,
May, 1917.
377330
PREFACE TO THE FIRST EDITION
THIS book has been compiled with the object of meeting a want,
to which my attention was repeatedly called by my students
when preparing them for the examinations of the Incorporated
Society of Trained Masseuses. No book dealing with Anatomy >
especially arranged for students of massage, has yet been
written, and I have endeavoured to make good this deficiency to
the best of my ability. It is hoped that this small volume will
be found to embody all the ground covered by the syllabus
of this Society for its examinations in Massage and Swedish
Remedial Exercises.
Professor A. M. Buchanan of Glasgow has been good enough
to allow me to select what illustrations I have thought necessary
from his " Manual of Anatomy." I take this opportunity of
tendering him my sincere thanks for his courtesy. Through his
kindness I am thus able to offer my readers a far better and more
freely illustrated book than would have been possible if special
figures had had to be made. In a few of the illustrations some
parts are shown which are not referred to in the text. As the
pointers to them appeared in the original figures, it was con-
sidered advisable to retain them, since their removal might
have caused damage.
Within the scope of a small work it is obviously impossible to
include more details and explanations than are absolutely neces-
sary; but it will, I hope, be found sufficiently full and accurate
to render it a useful textbook for those attending classes and
lectures on Massage, and afterwards to be of assistance to them
in their practice.
MAEGARET E. BJORKEGREN.
LONDON,
September, 1914.
CONTENTS
SECTION PAGK
I. INTRODUCTION - - - 1
II. SHOULDER GIRDLE AND UPPER LIMB - - 5
III. PELVIC GIRDLE AND LOWER LIMB - - 39
IV. VERTEBRAE, RIBS, AND MUSCLES OF TRUNK 78
V. BONES AND MUSCLES OF HEAD - 100
VI. DIGESTIVE SYSTEM - 116
VII. DUCTLESS GLANDS, KIDNEYS AND PELVIC ORGANS - - 127
VIII. RESPIRATORY ORGANS - - 131
IX. HEART AND BLOODVESSELS OF HEAD, NECK AND TRUNK 137
X. BLOODVESSELS OF THE UPPER LIMB - - 157
XI. BLOODVESSELS OF THE LOWER LIMB - 163
XII. LYMPHATIC SYSTEM - 169
XIII. BRAIN, SPINAL CORD, NERVES OF TRUNK, AND SYMPATHETIC
SYSTEM ......... 172
XIV. CERVICAL PLEXUS - 181
|XV. BRACHIAL PLEXUS AND NERVES OF UPPER LIMB - - 184
XVI. LUMBAR AND SACRAL PLEXUS AND NERVES OF LOWER LIMB 192
XVII. CRANIAL NERVES 204
XVIII. SURFACE MARKINGS - - - - - - 210
INDEX ....... 224
LIST OF ILLUSTRATIONS
ITAUA
1. THE EIGHT CLAVICLE (SUPERIOR VIEW) - - 6
2. THE EIGHT SCAPULA (POSTERIOR VIEW) - - 7
8. THE EIGHT HUMERUS (ANTERIOR VIEW) - - 0
4. THE EIGHT EADIUS AND ULNA (ANTERIOR VIEW) - - 11
5. BONES OF THE EIGHT HAND (ANTERIOR VIEW) - - 14
6. MUSCLES OF THE SHOULDER-JOINT - - 18
7. THE ELBOW-JOINT - 22
8. MUSCLES OF THE "UPPER ARM _ 24
9. MUSCLES OF THE FOREARM (DORSAL ASPECT) - - 27
10. MUSCLES OF THE HAND (PALMAR ASPECT) - - - 32
11. INNOMINATE BONE - - 40
12. PELVIS - - 42
13. FEMUR _ 44
14. TIBIA AND FIBULA (ANTERIOR SURFACES) - - 46
15. TIBIA AND. FIBULA (POSTERIOR SURFACES) - - 48
16. BONES OF FOOT (DORSAL SURFACE) - - 50
17. BONES OF FOOT (PLANTAR SURFACE) - 52
18. HIP- JOINT - - 55
19. MUSCLES AND CUTANEOUS NERVES OF LEG (POSTERIOR VIEW) - 60
20. MUSCLES AND CUTANEOUS NERVES OF LEG (ANTERIOR VIEW) - 61
21. KNEE-JOINT (POSTERIOR VIEW) _ 62
22. ANKLE-JOINT - - - 67
23. MUSCLES OF LEG - - 69
24. SHORT MUSCLES AND ARTERIES OF FOOT _ 75
25. A TYPICAL VERTEBRA - - - > - 78
26. SACRUM (ANTERIOR SURFACE) . . 80
27. SACRUM (POSTERIOR SURFACE) _ 81
28. ATLAS . . 31
29. Axis - ------ 82
30. SPINAL COLUMN _ g4
31. STERNUM . . _ - 85
32. A TYPICAL EIB . 87
33. THORAX - _ - 88
34. VERTEBRAL LIGAMENTS . 90
x LIST OF ILLUSTRATIONS
FIG. PAGE
35. MUSCLES OF THE BACK - 91
36. MUSCLES OF THE ABDOMEN - - 92
37. INTERCOSTAL MUSCLES - 97
38. THE LATERAL KEGION OF THE SKULL (NORMA LATERALIS) 101
39. THE EXTERNAL BASE OF THE SKULL - 103
40. THE FRONTAL BONE 104
41. THE OCCIPITAL BONE 105
42. THE EIGHT TEMPORAL BONE 106
43. THE SUPERIOR MAXILLA - 108
44. THE INFERIOR MAXILLA (MANDIBLE) 109
45. THE TEMPORO-MANDIBULAR JOINT - 111
46. THE PERITONEUM - 118
47. THE STOMACH 119
48. THE SALIVARY GLANDS 123
49. THE LIVER 124
50. THE SPLEEN - 128
51. THE PHARYNX 132
52. THE LARYNGEAL CARTILAGES 133
53. THE PLEURA 135
54. THE HEART - 138
55. THE AORTA - 141
56. THE AORTA IN THE THORAX, AND THE PRINCIPAL ARTERIES OF
THE HEAD AND NECK - 144
57. THE ABDOMINAL AORTA 147
58. THE INFERIOR MESENTERIC ARTERY AND ITS BRANCHES - - 150
59. VEINS AND GLANDS OF HEAD AND NECK - 153
60. THE BRAIN (SIDE VIEW) 172
61. BASE OF THE BRAIN 173
62. CUTANEOUS NERVES OF TRUNK 178
63. NERVES IN POSTERIOR TRIANGLE OF NECK 182
64. VESSELS AND NERVES IN NECK - - 183
65. THE BRACHIAL PLEXUS 184
66. CUTANEOUS NERVES OF UPPER LIMB (POSTERIOR SURFACE) 187
67. CUTANEOUS NERVES OF UPPER LIMB (ANTERIOR SURFACE) 188
68. LUMBAR PLEXUS 193
69. SACRAL PLEXUS 196
70. MUSCLES AND CUTANEOUS NERVES OF LEG (POSTERIOR VIEW) 200
71. MUSCLES AND CUTANEOUS NERVES OF LEG (ANTERIOR VIEW) 201
72. NERVES OF HEAD AND FACE 207
73. PLANE OF ABDOMEN - - - - - - 213
SECTION I
INTRODUCTION
ANATOMY means really the study of the body, its different
parts and their functions, comprising histology, physiology, and
many other sciences ; but the generally accepted definition is,
that the science of anatomy is the study of the body as far
as it can be done by dissection and the naked eye. It is
necessary, therefore, to have certain well-defined terms for the
purposes of description ; it is always assumed that the body is
in the erect position with the arms by the sides, the palms
turned forwards and the thumbs outward.
Sections are generally taken through the three following
planes :
1. Transverse, or horizontal plane.
2. Sagittal — a vertical plane in the antero -posterior direction.
3. Frontal — a vertical plane at right angles to the sagittal.
The Mesial Plane is the sagittal one that divides the body
in two halves, and is represented in front by the anterior
median line, and behind by the posterior median line : the two
halves are supposed to be symmetrical ; but like all things of
Nature's manufacture, are not rigidly so. Certain unpaired
organs, that are not in the middle line, also render the two
halves asymmetrical.
The terms internal and external are used to express positions
nearer to, or farther from, the middle line respectively; the
terms dorsal and ventral are positions nearer the back or front
of the body respectively; posterior and anterior are synonymous
with dorsal and ventral ; superior and inferior indicate nearer the
head or the feet respectively. In the case of the limbs, the
1
^HANDBOOK OF ANATOMY
terms proximal and distal are used to indicate positions near
to or distant from the trunk.
The body consists of a bony framework, the component parts
of which are jointed together, the joints being the fulcrums
of the levers formed by the muscles. As well as the skeletal
and muscular systems, the circulatory, respiratory, digestive,
and nervous systems also have to be studied.
The Skeletal System. — The bones are classed as long, short,
flat, or irregular, according to their shape. They are all laid
down in cartilage in the embryo, and become ossified at different
stages. Various centres of ossification are laid down in different
parts of the bone, so that each part can continue growing
until the adult size is reached, by which time the different
centres of ossification have coalesced and the bone is completely
ossified. A sesamoid bone is one that is developed in a tendon
passing over a joint where there is a great deal of friction.
Joints are formed by the ends of two bones in apposition to
one another. Fibrous bands, called " ligaments," hold them to-
gether, and these generally join one another so as to form a
complete capsule round the joint. The opposed ends of the
bones are covered with cartilage of a particularly tough kind
to prevent wear by friction. In some cases where the joint has
constant work — e.g., the knee-joint — an extra piece of cartilage
in the form of a disc is found between the bones. The whole
structure is lined by synovial membrane — a thin membrane
which secretes a fluid for the purpose of lubrication.
The skeleton consists of a vertebral column which supports the
trunk, and on the top of which is the head, on the freely
movable cervical vertebrae ; the lower end of the vertebral
column is firmly welded together to support the weight of the
body. The upper half of the body — the thorax — is protected
by a bony framework formed by the ribs, which are elastic
and freely movable, to give free play to the lungs. The lower
half of the trunk, the abdomen, has only partial bony pro-
tection and a strong muscular wall composed of three layers
of muscles with the fibres arranged in different directions, so
that they can exert strong contractile force.
The limbs are similiar in structure as to the number and
INTRODUCTION 3
arrangement of their bones and joints; but in every particular
it will be noticed that the upper limb is constructed with a view
to wide scope of movement and lightness, whereas the con-
struction of the lower limb tends to stability and weight. They
are each attached by a ball-and-socket joint to a bony girdle.
But compare the shoulder girdle with the pelvic : the socket in
the one case is shallow and much smaller than the ball; in
the other the ball is received into a deep socket that covers it
up to the neck. The shoulder-girdle is connected anteriorly
to the trunk by a loose gliding joint, and posteriorly slung
by muscles. The pelvic girdle is firmly welded together in
front, and behind is almost immovably joined to the lower
vertebrae, whose joints are completely ossified. The reason
for this is easily seen when the functions of the upper and
lower limbs are compared.
The Muscular System. — The flesh of the body consists of
:a number of muscles which are attached at each end to bones.
They are capable of contraction, the attachment from which
they pull being termed the " origin," and the one on which they
pull, the " insertion." A muscle or its tendon passes over one or
more joints, and its principal action is on the joint nearest the
insertion.
The Circulatory System. —The tissues are nourished by the
blood, which is carried to all parts by the arteries and returned
T)y the veins. The heart is the starting-point of the system,
and by its action the blood is sent on its way at a certain
pressure.
The Respiratory System consists of an air passage from
the mouth and nose to the lungs, the latter situated in the
thorax, where the blood is reoxygenated.
The Digestive System consists of the alimentary canal,
iDy which food is taken in at the mouth, passed down to the
stomach and duodenum to be digested, into the small intestine
to be absorbed, and the residue into the large intestine to be
excreted. Accessories to the digestive system are the organs
which secrete digestive juices and pour them into the alimentary
canal.
The Nervous System is in two parts — the cerebro-spinal
4 HANDBOOK OF ANATOMY
and sympathetic. The cerebro-spinal, consisting of the brain
and spinal cord, is formed largely of grey matter, which con-
sists of the actual nerve cells, and sends distributing fibres in
every direction, so that each muscle receives both an efferent
and afferent branch. The sympathetic is an accessory system.
The whole body is covered by a thin tough membrane called
the " deep fascia," which closely invests the muscles, and send&
down processes, or dividing septa, between them. From the
deep fascia and the intermuscular septa many of the muscles'
get additional origins, and in some cases muscles are inserted
into adjacent fascia as well as bones. Outside this is the super-
ficial fascia, a thin friable membrane enclosing fat in its
meshes. This fascia is also found in spaces between muscles,
bones, and organs to prevent jarring and give elasticity. Over
all is the skin, from which the hair and nails are developed.
SECTION II
THE SHOULDER GIRDLE AND UPPER LIMB
THE upper limb is articulated to the trunk by means of a
ball-and-socket joint between the humerus and scapula. The
limb is slung to insure as much mobility as possible, the joint
being a very loose one, and the scapula is attached to the trunk
by muscles between it and the vertebras at the back, and to the
clavicle in front. The scapulae and clavicles form what is known
as the Shoulder Girdle.
The bones to be described in the shoulder girdle and upper
limb are the following :
Clavicle, articulated internally to the sternum ; externally, to
the acromion process of scapula.
Scapula, articulated externally to acromial end of clavicle and
to head of humerus.
Humerus, articulated above to glenoid cavity of scapula ;
below, to heads of ulna and radius.
Ulna, articulated above to internal condyle of humerus and to
head of radius ; below, to triangular fibro-cartilage of wrist-
joint.
Radius, articulated above to external condyle of humerus and
to head of ulna ; below, to the scaphoid and semilunar bones of
the carpus.
Carpus, articulated above to radius ; below, to five metatarsals.
Metatarsals, articulated above to bones of carpus ; below, to
phalanges.
Phalanges : First row — articulated above to metatarsals ;
below, to second row of phalanges.
Second row — above, to first row of phalanges ; below, to
third row of phalanges.
() HANDBOOK OF ANATOMY
Third row — above, to second row of phalanges.
The Clavicle is a long bone having a prismatic shaft, and at
its inner (sternal) end a rounded head ; while its outer (acromial)
end is flattened into a more or less square shape. The shaft
forms a double curve, being convex forwards internally and
convex backwards externally ; the upper surface, subcutaneous
throughout, is rounded and smooth ; the anterior border is
rough, internally for the attachment of the pectoralis major,,
and externally for that of the deltoid; the posterior border
is roughened internally for the attachment of the sterno-mastoid,
and externally, where the acromion process begins, there is a
tubercle, called the conoid tubercle, for the attachment of the
conoid ligament. The inferior surface is also rough ; at its
Acromial Facet
Sternal
Extremity
FIG. 1. — THE RIGHT CLAVICLE (SUPERIOR VIEW).
sternal end there is a deep pit for the attachment of the
rhomboid ligament, and in its middle third a groove for the
subclavian muscle ; from the conoid tubercle, outwards and
forwards, proceeds an oblique ridge for the attachment of the
trapezoid ligament.
The clavicle articulates internally with the upper end of the
sternum, and externally with the acromion process of the scapula.
Ossification. — The clavicle is the first bone of the body to
ossify, the process commencing in the shaft very early in foetal
life. The secondary centre, or epiphysis, appears at the sternal
end in adult life, and ossification is complete about the twenty-
fifth year.
The Scapula is a flat, triangular bone having two surfaces,
anterior and posterior, and three margins, vertebral, axillary, and
BONES OF SHOULDER GIRDLE 7
superior. Between the upper and second fourth of the vertebral
border on the posterior surface there starts a process, which
passes right across the dorsum of the bone, and ends in the
acromion process. From the external end of the superior border
projects a beak-like process called the coracoid. Immediately
to the inner side of the root of the coracoid process is the
suprascapular notch.
Posterior Belly of Omo-hyoid.
Supraspinous Fossa and Supraspinatus \
Superior Angle '
Levator Anguli bcapul«e
I
Spine
For Tendon
of Trapezins
Rhomboideus Minor
Rhomboideus Major
Infraspinous Fossa
and Infraspinatus
Groove for Dorsalis
Scapulae Artery
Suprascapu
' Notch
lar Coracoid
Process Trapezius
Great
^capular Notch
Glenoid Cavity
Infraglenoid Ridgs
and L< ng Head
of Triceps
•»>*. Axillary Border
N Teres Minor
*-. Teres Major
""•-». Inferior Angle
Latissimus Dorsi
FIG. 2.— THE RIGHT SCAPULA (POSTERIOR VIEW).
The superior angle (vertebral end of superior border) is more
or less rectangular, and the inferior angle very acute. At the
junction of the outer end of the superior border and the upper
end of the axillary border is the glenoid cavity, a pyriform,
slightly concave area, which receives the head of the humerus,
thus forming the shoulder- joint. The coracoid process arises
just internal to the glenoid cavity, and, bending on itself forwards
8 HANDBOOK OF ANATOMY
and outwards, overhangs the glenoid surface ; it is very much
roughened for the attachment of muscles and ligaments.
The anterior, or ventral, surface of the bone is concave, and
has several rough lines on it, caused by the attachment of the
subscapular muscle. The axillary border on this surface is full
and rounded, the vertebral border being roughened. Both
borders give attachment to muscles.
The posterior dorsal surface is divided into an upper smaller
fossa and a lower larger fossa by the spine, which runs from
the vertebral border outwards and upwards to the glenoid
cavity. Both fossse give attachment to muscles. The spine
is separated from the edge of the glenoid cavity by the great
scapular notch ; the posterior border is subcutaneous, and is
lipped for the attachment of muscles; at the great scapular
notch it is flattened to form the acromion process, which passes
forwards and outwards to overhang the joint, and gives attach-
ment to muscles and ligaments.
The scapula articulates by means of the glenoid cavity with
the head of the humerus, and by the acromion process with the
acromial end of the clavicle.
Ossification. — At birth the coracoid and acromion processes,
the glenoid cavity, and vertebral border are still cartilaginous.
Secondary centres appear in these from birth up to puberty,
and the bone is complete about the twentieth year.
The Humerus is a long bone with a shaft and two extremities ;
it is the bone of the upper arm. It has a rounded head forming
about one-third of a sphere, which is bounded by the anatomical
neck, a shallow depression all round the head, much less marked
inferiorly. On the outer side of the head is the great tuberosity,
which becomes continuous with the shaft, and has facets for
the attachment of muscles. On the anterior surface of the
upper end is the lesser tuberosity, which also becomes con-
tinuous with the shaft. Between the two tuberosities lies the
bicipital groove, which gives attachment to the adductor
muscles. Below the head and tuberosities the bone decreases
in size, and this is called the " surgical neck," as it is the part
most easily fractured.
The shaft is cylindrical above, but gets flatter lower down.
BONES OF LOWER LIMB
Anatomical Necl
A Large Nutrient Foramen x
Great Tuberosity and
fcupraspinatus
Infraspinatus ~
/ 'IA
Jiimall Tuberosity and Subrcapukvis
Surgical Neck
.Bicipital Groove
Latissimus Dorsi
Pectoralis Major
Teres Major
Deltoid—
— -.Coraco-brachialh
Medullary Foramen
Brachio-rad ialis
Brachialis Anticus
Txternal Supracondylar Ridge.
Internal Supracondylar Ridge
'-Extensor Carpi Radialis Longior //
Radial Fossa
External Epicondyle.(
Common Origin of •'
Extensor Carpi Radialis Brevier
Kxtensor Communis Digitorum
Extensor Minimi Digiti
Kxtensor Carpi Ulnaris, and
-Supinator Radii Brevis
Capitellum
Trochlea
,Coronoid Fossa
k Superficial Head of Pronator
Radii Teres
Internal Epicondyle
v Common Origin of
Flexor Carpi Radialis
Palmaris Lnngus
Flexor Sublimis Digitorum, and
Small Head of Flexor Carpi
Ulnaris
FIG. 3. —THE RIGHT HUMERUS (ANTERIOR VIEW).
10 HANDBOOK OF ANATOMY
The bicipital groove passes down its anterior surface, directed
slightly to the inner side, and gradually fades away. About
the middle of the inner and outer surfaces are rough surfaces
for the insertions of the coraco-brachialis and deltoid respectively.
On the posterior surface a shallow groove — the musculo-spiral
groove — winds from within outwards, separating the origins of
two heads of the triceps. The lower end of the shaft is flattened
and expanded into two condyles, of which the inner is larger
than the outer. From each of these condyles a ridge runs up
for about one-third of the shaft. Between the two condyles are
the trochlear and capitellar surfaces for the articulation of the
ulna and radius respectively. The trochlea is a grooved surface,
which winds spirally round the inferior end of the bone and
shows on the posterior surface. The capitellum is on the outer
side of the trochlea, a small, rounded surface which shows only
on the anterior surface. Above the trochlea, both anteriorly
and posteriorly, are small, round fossse, the coronoid and ole-
cranon respectively, for articulation with the processes of the
ulna in extreme flexion and extension.
The humerus articulates, by means of its rounded head, with
the glenoid cavity of the scapula, and at its inferior end with
the ulna and radius.
Ossification. — The primary centre for the shaft appears before
birth. Secondary centres for the two tuberosities and the head
appear during the first few years of life, and these three first
unite, forming an epiphysis, which unites with the shaft as a
whole in adult life. A similar arrangement is observed with
the condyles and articular surfaces of the lower end, which
also form a separate epiphysis.
The Ulna, the inner bone of the forearm, is a long bone
with a shaft and two extremities. The head is formed of two
processes, the olecranon posteriorly and the coronoid anteriorly.
The olecranon process forms a continuation of the shaft, and is
hollowed out anteriorly for articulation with the trochlear sur-
face of the humerus. Tne coronoid process juts out from the
anterior surface of the shaft, and its upper surface is in con-
tinuation with the anterior surface of the olecranon process, the
two between them forming the semilunar notch or sigmoid fossa..
BONES OF UPPER LIMB
11
Head of Radius
Neck
Olecranon Process
Semilunar Notch r
Sigmoid Fossa
,Coronoid Process
..Flexor Sublimis Digitorumi
Brachialis Anticus
Posterior part of Bicipital —
Tuberosity and Tendon
of Biceps
Supinator Radii Brevis 4—
Anterior Oblique Line •- _ _.
Medullary Foramen i —
Flexor Longus Pollicis .-- j- —
Pronator Radii Teres —
r
Medullary Foramen
.-Anterior Border
Flexor Profundus Digitorunt
Anterior Border .-.
Pronator Quadratus
._l| Pronator Quadratus
Brachio-radialis _.
--Head
. _ Styloid Process of Ulna.
Styloid Process of Radius
FIG. 4.— THE RIGHT RADIUS AND ULNA (ANTERIOR VIEW).
12 HANDBOOK OF ANATOMY
On the outer side of the upper end of the shaft is another articular
surface, the radial notch, for articulation with the head of the
radius. The posterior surface of the olecranon is smooth and
subcutaneous. Just below the coronoid process is a rough
tuberosity for the insertion of brachialis anticus. The shaft
is triangular for about two-thirds of its length, then tapers
gradually, and becomes smooth and rounded. It has three sur-
faces— anterior, inner, and outer — and three borders — posterior,
inner, and interosseous. The posterior border is subcutaneous
throughout its .length. The lower end of the bone is much
smaller than the upper, and nearly circular. On its inner surface
it has a projection, the styloid process, pointing downwards,
and on its outer surface an articular facet for the lower end of
the radius. The inferior surface is smooth for articulation
with the triangular nbro-cartilage of the wrist- joint.
The ulna articulates above with the trochlear surface of the
humerus by means of the semilunar notch, and below with the
articular disc of the wrist-joint ; on its outer surface it articulates
with the radius at either extremity.
Ossification. — The centre for the shaft appears before birth,
and secondary centres for the olecranon process and the lower
end of the shaft appear later to form epiphyses which unite with
the shaft in adult life.
The Radius, the bone on the outer side of the forearm, is a
long bone with a shaft and two extremities • it differs from the
ulna in having a small rounded head and a shaft which gradually
widens out so that the lower extremity is much larger and
triangular in shape. The head is circular, with a cup-shaped
depression on its superior surface; it has a narrow articular
surface all round for articulation with the radial notch of the
ulna. Immediately below the head it is somewhat constricted to
form a neck, and then widens out again into the shaft. The
shaft is triangular in section, having three surfaces — anterior,
outer, and posterior — and three borders, the interosseous one
being the only well-defined one, as the surface is rounded and
confluent with the other two. At the upper and inner side of the
anterior surface is the bicipital tuberosity for the insertion of
the biceps, and from the lower jedge of that the oblique line
BONES OF UPPER LIMB 13
passes across the anterior surface of the bone to the middle o£
the outer border. The lower end of the shaft is distinctly
triangular ; the edge of the narrow interosseous surface articu-
lates with the lower end of the ulna; the anterior surface is
smooth and concave, the posterior having a series of grooves for
the extensor tendons to work in. On the radial border is a
styloid process similar to that of the ulna.
The radius articulates above by means of the upper surface of
its head with the capitellum of the humerus, and the lower end
articulates with the scaphoid and semilunar bones of the carpus ;
on its interosseous surface it articulates at both ends with the
ulna.
Ossification. — Similar to that of the ulna.
The Carpus consists of eight bones arranged in two rows of
four. The proximal row beginning from the radial side are
scaphoid, semilunar, cuneiform, and pisiform.; the distal row,
beginning from the radial side, are trapezium, trapezoid, os mag-
num and unciform. They are all small irregular-shaped bones
articulating with one another. The bones are articulated so
that their united surface is convex backwards.
The pisiform is the smallest of the bones and is a little round
bone resting entirely on the palmar surface of the cuneiform ; it,,
with the hook of the unciform, forms the projection on the
ulnar side of the wrist ; the tubercle of the scaphoid and ridge
of the trapezium form the projection on the radial side of the
wrist.
The unciform is distinguished by having a hook-like process
on its palmar surface.
The proximal row of bones articulates above with the radius
and triangular fibro-cartilage, and below with the distal row of
bones. The distal row of bones articulates below with the five
metatarsal bones; the first metatarsal with the trapezium; the
other four fitted into the trapezoid, os magnum, and unciform.
Ossification. — One centre for each bone appears after birth,
and the carpus is usually completely ossified at puberty.
The Metacarpus consists of five bones; they are all long
bones, with a shaft and two extremities. The shafts are con-
stricted in the middle and curved so that they are slightly
14
HANDBOOK OF ANATOMY
convex backwards ; the carpal ends or bases of all, except the
first, are more or less wedge-shaped, and the heads of all are
rounded.
The first metacarpal is the shortest and stoutest of the five
Abductor Pollici
Opponens Pollicis
Superficial Head of Flexor ......
Brevis Pollicis
Ext. Ossis Metacarpi Poll.----^
Deep Head of Fflex. Brevis Pollicis- -
Flexor Carpi Radialis J~ ~
Opponens Pollicis
Extensor Brevis Pollicis --
Extensor Longus
Poll.
Flexor Longus Poll.
^. Flexor Carpi Ulnaris
Abductor Minimi Digiti
-Adductor Obliquus Pollicis
__Opponens Minimi Digiti
Abductor M ini mi Digit!
and Flexor Brevis
Minimi Digiti
Flexor Sublimis DigitorunUc
Flexor Profundus Digitorum
FIG. 5.— BONES OF THE RIGHT HAND (ANTERIOR VIEW).
and has a saddle-shaped base for articulation with the^rapezium.
It supports only two phalanges.
The second metacarpal is the longest, and the other three
gradually decrease in length. They articulate with one another
at their carpal ends, and with the trapezoid, os magnum, and
JOINTS OF SHOULDER GIRDLE 15
iinciform in order. Each of the four inner metacarpals supports
three phalanges.
The third metacarpal has a styloid process from its base on
the radial side.
Ossification. — The four inner metacarpals have a primary
centre for the shafts and bases developed before birth,* and the
heads form a secondary epiphysis. The first metacarpal has the
head and shaft formed from the primary centre and the base
from the secondary centre.
The Phalanges are fourteen in number, two on the first
metacarpal and three each on the other four. The first
phalanx is the largest of the three, the terminal ones being
much smaller. They are short stout bones articulating with the
metacarpals and one another.
The terminal phalanges have flattened distal extremities to
support the nails.
Ossification. — Similar to that of the first metacarpal bone.
Sterno-Clavieular Joint, between the sternal end of the
clavicle and the outer part of the upper edge of the sternum.
A gliding joint, so only gliding movements possible. There
are no movements round a distinct axis, but movements which
depress or raise the scapula will cause the clavicle to move also,
in both its joints.
Ligaments. — The joint is surrounded by a capsule attached to
the edges of the articular surfaces of the bones, which is
strengthened to form anterior and posterior ligaments. In.
addition there is a meniscus, or disc of fibro-cartilage, between
the two articular surfaces.
Accessory Ligaments : Inter clavicular } attached to the sternal
end of the clavicle and the suprasternal notch. It is continuous
with the one of the other side. This ligament prevents the end
of the clavicle being raised up too much when the acromial end
is depressed as in carrying heavy weights.
Rhomboid, attached to the under surface of the sternal end of
the clavicle and the upper surface of the first costal cartilage ;
it limits the movements of the clavicle when the arms are raised
over the head.
The synomal membrane lines the two joint cavities which are
separated by the meniscus.
16
HANDBOOK OF ANATOMY
Aeromio-Clavieular Joint, between the acromial end of the-
clavicle and the acromion process of the scapula.
A gliding joint similar in movement and function to the
ster no-clavicular joint. The two joints give elasticity and
increased movement tct the shoulder girdle.
Ligaments. — A capsule surrounds the joint, which is strength-
ened to form superior and inferior ligaments. There is often a
meniscus of fibro-cartilage to be found in this joint too, but not
invariably.
Accessory Ligaments: Coraco-clavicular between the acromial
end of the clavicle and the coracoid process of the scapula. It
is in two parts, viz. —
Conoid — a triangular ligament attached by its apex to the
upper surface of the coracoid process and by its base to the
conoid tubercle of the clavicle.
Trapezoid — a ligament on the outer side of the conoid and
attached to the upper surface of the coracoid process and to the
oblique line from the conoid tubercle.
MOVEMENTS OF SHOULDER GIRDLE TAKING PLACE AT STERNO-
AND ACROMIO-CLAVICULAR JOINTS.
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Eleva-
tion
Trapezius
(upper
Inner third superior
curved line of occipital
i
Outer third of the pos- Spinal ac-
terior surface of the cessory
fibres)
bone and external oc-
clavicle ; inner border and nerves
cipital protuberance
of the acromion pro-
from the
from the ligamentum
nuchae, the spine and
cess, and the upper
border of the spine of
cervical
plexus
supraspinous liga-
the scapula, and the
ments of the seventh
rough triangular sur-
cervical, and all the
face at the base of the
thoracic vertebrae
spine
Levator
Posterior tubercles of
The upper fourth of the Cervical
anguli
the transverse pro-
vertebral border of the plexus ;
scapulae
cesses of the upper
cervical vertebrae be-
scapula from the spine
to the angle
posterior
scapular
tween scalenus medius
and splenius colli
Rhom-
Spines of the thoracic
The vertebral border of Posterior
boideus
vertebrae, second to
the scapula from the 1 scapular
major
fifth inclusive
spine to the lower !
angle to a membranous
band attached by the
extremities
MUSCLES OF SHOULDER GIRDLE
17
MOVEMENTS OF SHOULDER GIRDLE TAKING PLACE AT STERNO-
AND ACROMIO-CLAVICULAR JOINTS— Continued.
Action
Muscle.
Origin.
Insertion.
Nerve-supply.
Eleva-
Rhom-
Spines of seventh cer-
The vertebral border of
Posterior
tion
boideus
vical and first thoracic
the scapula opposite
scapular -
minor
vertebrae
the base of the spine
Sterno-
A narrow head from
Outer surface of mastoid
Spinal
mastoid
the anterior surface of process, and the outer
accessory
sternum, and also from half of the superior
and cervica
inner third of upper
curved line of the oc-
plexus
surface of clavicle
cipital bone
Depres
Trapezius
See Elevation
sion
(lower
fibres)
Subclavius
Upper surface of first
Middle third of under
Brachial
costal cartilage
surface of clavicle
plexus
Pectoralis
minor
EYom the anterior part
of upper border of
third, fourth, and
Outer half of upper sur-
face of coracoid process
External
and internal
anterior
fifth ribs and fascia
thoracic
covering them
Latissimus
From the spines of the
The floor of the bi-
Third sub
dorsi
lower six thoracic,
cipital groove on the
scapular
and of all the lumbar
humerus
vertebras ; the pos-
%
terior part of the iliac
crest , slips from the
lower four ribs and
the inferior angle of
the scapula ; and deep
<
fascia covering back
Pectoralis
From the inner half of
The outer lip of the
External
major
(lower
the anterior surface
of the clavicle : from
bicipital groove on
the humerus
and internal
anterior
fibres) half the anterior sur-
thoracic
face of the sternum in
its whole length ; and
from the cartilages of
the upper six ribs
For-
Serratus
From outer aspect of
The ventral surface of
Posterior
wards
magnus
upper eight or nine
the vertebral border
thoracic
ribs
of the scapula in its
whole length
Pectoralis
See Depression
major
Pectoralis
See Depression
minor
Back-
Trapezius
See Depression
wards
Rhom-
See Elevation
boids
IJatissimus
See Depression
dorsi
18
HANDBOOK OF ANATOMY
Shoulder-Joint, between the head of the humerus and the
glenoid cavity of the scapula.
A ball-and-socket joint, permitting of particularly free move-
ment as the socket is very shallow and much smaller than the
ball. Movement can take place roiind three axes, viz.—
Transverse — flexion and extension.
Antero-posterior — abduction and adduction.
Vertical — rotation in and out.
Supraspinatus
- Infraspinatus
:^|E- vj-~ Teres Minor
Teres Major *
Tares Branch of Dorsalis
Scapulae Artery
Dorsalis Scapulae Artery \r
Triangular Space
Nerve to Teres Minor, wirh-"
Gangliform Enlargement
— Posterior Circumflex Artery
and Circumflex Nerve in
Quadrangular Space
- Pectoralis Major
- - Deltoid
FIG. 6.— MUSCLES OF THE SHOULDER- JOINT.
Ligaments. — A capsule surrounds the joint attached to the
anatomical neck of the humerus and the edge of the glenoid
fossa outside the ligament. Inferiorly the attachment of the
capsule runs down a little way 011 the shaft of the humerus.
MUSCLES OF SHOULDER
19
The capsule is very loose, so that were it not for atmospheric
pressure the humerus could be pulled at least an inch away
from the scapula ; this adds to the mobility of the joint.
Glenoid ligament,, a band of circular fibres round the edge of
the glenoid fossa to deepen the socket.*
Transverse humeral ligament bridges over the bicipital groove
and allows the tendon of the biceps to pass under it.
C Draco-humeral ligament between the root of the coracoid
process and the upper surface of the head of the humerus.
Gleno-humeral ligaments, three in number, from the anterior
edge of the glenoid fossa to the anterior surface of the head of
the humerus. «
All these ligaments are in reality part of the capsule.
Accessory Ligaments : Coraco-acromial ligament, a strong band
of fibres passing between the coracoid and acromion processes.
This arches over the top of the joint and prevents dislocation
upwards.
The tendons of subscapularis, supra- and infra-spmatus are
closely applied to the capsule of the joint as they near their
insertions, so strengthening it; but it will be noticed that the
joint is weak inf eriorly, having no strengthening ligaments in
that aspect.
The tendon of the biceps from the edge of the glenoid fossa !
passes through the joint over the head of the humerus, emerging
from under the transverse ligament.
The synovia! membrane is Very extensive, lining all the joint, j
and is prolonged down on the tendon of the biceps.
MUSCLES ACTJING ON THE JOINT.
Action. Muscle.
— 1 —
Origin.
Insertion.
Nerve-
supply. ' ;
Flexion; Deltoid
i (anterior
fibres)
! ' .
Outer third of! anterior
surface of ^clavicle ;
outer border, of acro-
mion process ; lower
edge spine of 'scapula ;
and deep fascia
In a V-shaped impres-
sion half-way down
the outer surface of
the humerus^
Circum-
flex
Pectoralis
See Sterno - Cjlavicular
Joint
major
I • • .
••• -
20
HANDBOOK OF ANATOMY
MUSCLES ACTING ON THE JOINT— Continued.
Action.
Muscle.
Origin.
.nation. .-£-
Flexion
Coraco-
With short head of
Into a rough linear Musculo-
(con
brachialis
biceps from tip of
impression half - way cutaneous
tinned)
coracoid process
down the inner sur-
face of the humerus
Subsoapu-
laris
From the whole of the
subscapular fossa and
Lesser tuberosity of
humerus and capsule
First and
third sub-
the groove along the
of shoulder-joint
scapular
axillary border, ex-
cepting at the angles
of the bone
Biceps
1. Short head from the
tip of the coracoid
Rough posterior por-
tion of bicip'ital
Musculo-
cutaneous
process with coraco-
brachialis.
2. Long head from> the
tubercle of radius, and
by a prolongation of
the fascia of the deep
edge of the glenoid
fascia of the forearm
fossa at the root of
(see Bioipital Fascia,
the coracoid process
p. 37)
Exten- Deltoid
See Flexion
sion (post-fibres)
Teres major
From the lower third of
Inner lip of bicipital
Second
the axillary border of
groove
sub-
the dorsum of the
scapular ;
scapula, and from deep
nerve
fascia
Infra-
spinatus
From the infraspinous
fossa and deep fascia
The middle facet on Supra -
the great tuberosity scapular
of the humerus
Latissimus
See Sterno - Clavicular
Joint
dorsi
Triceps
1. Long head from a
By one tendon inserted Musculo-
rough surface on the
axillary border of the
on the posterior part spiral
of the upper end of
scapula just below the
the olecranon process
glenoid fossa.
of the ulna
2. Outer head from
posterior surface of
humerus between the
musculo-spiral groove
and the insertion of
teres minor, a linear
impression
3. Inner head from the
posterior surface of
the humerus, from the
musculo-spiral groove
almost to the condyles
and deep fascia
ELBOW-JOINT
21
MUSCLES ACTING ON THE JOINT—
Action.
Muscle. origin. Insertion.
Nerve-
supply.
Abduc-
Deltoid
See Flexion
tion
Supra -
spinatus
From the supraspinous
fossa and deep fascia
To the uppermost facet
on the great tuber-
osity of the humerus
Snpra-
scapular
Adduc-
Pectoralis See Sterno - Clavicular
Joint
tion
major
Latissimus
See Sterno -Clavicular Joint
dorsi
Teres major
See Extension
Coraco-
See Flexion
brachialis
Biceps See Flexion
(short head)
Triceps
See Extension
(long head)
Teres minor
From the upper two- To the lowest facet on
Circum-
thirds of the axillary ; the great tuberosity
border of the scapula of the humerus
flex
Weight of
limb
Rotation
Infra-
See Extension
out
spinatus
Teres minor See Adduction
Rotation
Teres major
See Extension
in
Pectoralis See Sterno -Clavicular
Joint
major
»
Latissimus See Sterno - Clavicular Joint
dorsi
Circum duction — a
combination of all theseimovements
The Elbow-Joint, between the trochlear and capitellar surfaces
of the humerus, and the sigmoid fossa of the ulna and depression
on the head of the radius.
A hinge-joint permitting of movement round only one axis, viz. —
Transverse-— flexion and extension.
Ligaments. — The capsular ligament is complete and strength-
22
HANDBOOK OF ANATOMY
ened by various bands of fibres. It is attached to the upper
borders of the fossae on the anterior and posterior surfaces of
the humerus and the lower aspects of the condyles (not enclosing
them in the joint cavity )} round the margin of the olecranon pro-
cess and the inner and anterior margin of the coronoid process,
and round the lower edge of the articular surface surrounding
the head of the radius — i.e., just above the neck. It will thus be
Orbicular Ligament
Anterior Ligament
.. Internal Epicondylcs
Tendon of Biceps .....
{reflected)
— Brachialis Anticus
(reflected)
Oblique Ligament
FIG. 7.— THE ELBOW- JOINT.
seen that the elbow-joint encloses within its cavity the superior
radio-ulnar joint.
Anterior Ligament, from the upper margins of the coronoid
and supracapitellar fossa? on the humerus to the margin of the
coronoid process and the orbicular ligament of the radio-ulnar
joint. The fibres of this ligament are arranged in several
directions to give strength.
Posterior Ligament, from the upper margin of the olecranon
RADIO-ULNAR JOINTS
23
fossa of the humerus to the anterior margin of the upper aspect
of the olecranon process of the ulna.
Internal Lateral Ligament is arranged in three parts, forming
a triangle : (1) From anterior border of inner condyle to the
margin of the coronoid process; (2) from the inferior and
posterior border of the condyle to the olecranon process ; ami
(3) from the olecranon process to the coronoid process.
External Lateral Ligament, from the lower border of the outer
condyle of the humerus to the orbicular ligament on the radius.
MUSCLES ACTING ON THE ELBOW-JOINT.
Action.
Muscle.
Origin.
Insertion.
Nerve-
supply.
Flexion
Biceps
See Shoulder-Joint
Brachialis
anticus
From lower two-thirds
of anterior surface of
shaft of humerus and
the intermuscular
septa, enclosing above
the insertion of the
deltoid
The rough tubercle on
the anterior surface
of the coronoid pro-
cess of the ulna and
the anterior ligament
of the elbow-joint
Musculo-
cuta-
neus
Brachio-
radialis
See Radio-Ulnar Joints
Pronator
radii teres
See Radio-Ulnar Joints
Flexors of
wrist and
fingers
See Wrist and Phalang
eal Joints
«
Extensors of
wrist (during
pronation)
See Wrist and Phalang
eal Joints
Exten-
sion
Triceps
See Shoulder- Joint
Anconeus
From posterior surface
of outer condyle of
humerus
The outer surface of
olecranon process,
back of ulna and deep
fascia
Musculo-
spiral
Extensors of
wrist and fingers during
supination
Cartilage covers the articular surfaces of the joint as usual,
but is not prolonged into the fossae on the humerus, where pads
of fat are placed. There is also a narrow gap in the cartilage
24
HANDBOOK OF ANATOMY
covering the surfaces of the olecranon and coroiioid processes,
thus separating the two.
The synovial membrane lines all the joint, including those
parts not covered by cartilage, and is continuous with that
lining the superior radio-ulnar joint.
The Radio-Ulnar Joints, between the extremities of the
opposing surfaces of the radius and ulna. These joints are
Clavicular part of Pectoralis Major
Clavicular part of Deltoid x
Coraco-brachialis
Sterno-costal part
of Pectoralis
Major
Latissimus Dorsi and
Teres Major
Biceps.
Long Head of Triceps
Brachialis Anticus.
Supinaior Radii
Brevis
Brachio-radialis
Obliquus Ext Abdominis
Serratus Magnus
Internal Head of Triceps
--.Brachialis Anticus
..Pronator Radii Teres
-Flexor Carpi Radia'is
• Palmaris Loneus
Flexor Carpi Ulnaris
FIG. 8. — MUSCLES OF THE UPPER ARM.
both gliding joints, and by their means the radius is enabled to
turn round on the ulna, causing pronation and supination of the
hand. (Pronation = palm downwards ; supination = palm upwards.)
Superior Radio-Ulnar Joint, between the head of the radius
and the radial notch on the outer surface of the ulna.
Ligaments. — Orbicular ligament, a ring of strong tendinous
fibres attached to the extremities of the radial notch on the ulna
MUSCLES OF FOREARM
25
and encircling the head of the radius; the lower edge of the
ring is smaller than the upper, so that the radius is as it were
suspended by its head.
Accessory Ligament : Oblique ligament, a thin band from the
outer surface of the coronoid process of the ulna to the radius,
where it is attached just below the bicipital tuberosity.
The synovial membrane lines the joint, and is continuous with
that of the elbow-joint.
Inferior Radio-Ulnar Joint, between the inner surface of the
inferior end of the radius and the outer surface of the inferior
end of the ulna; the inferior surface of the lower end of the
ulna is also included in the joint by means of the articular disc
of cartilage which excludes the ulna from the wrist-joint.
MUSCLES ACTING ON THE RADIO-ULNAR JOINTS.
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Supina-
tion
BracLio-
radialis
From the upper two-
thirds of the external
The styloid process of
the radius
Musculo-
spiral
(snpinator
supracondyloid ridge
longus)
of the humems
Supinator
From the external con-
The upper part of the
Posterior
brevis
dyle of the hum eras ;
shaft of the radius, ! interosseous
the external lateral
reaching from the
and orbicular liga-
neck to the oblique
ments ; the triangular
line, and from the
surface of the ulna
anterior border of
just below the radial
notch and the deep
the bicipital tubercle
round to the posterior
fascia
border
Prona-
tion
Pronator
radii
From the common
flexor tendon on the
The rough oval impres-
sion half-way down
Median
teres
internal condyle of the
the outer surface of
humerus, the lower
the shaft of the
part of the ridge above
radius
the inter -muscular
septa and the deep
fascia, and a slip from
the inner side of the
coronoid process of the
ulna
Pronator
From the lower fourth
The outer border of
Anterior
quadratiis
of the ventral surface
the lower fourth of
interosseous
of the ulna
the ventral surface
of the radius
26 HANDBOOK OF ANATOMY
The Triangular Mbro- Cartilage separates the two joints ; it is.
attached by its apex to the outer surface of the styloid process
of the ulna, and by its base to the edge of the inner surface of
the lower end of the radius below its articulation with the
ulna.
Ligaments. — The capsule is very imperfect, consisting of a few
transverse fibres which* connect the bones ventrally and dorsally.
The synovial membrane lines the joint and passes over the
.upper surface of the triangular fibro-cartilage.
The Interosseous Membrane is a strong fibrous membrane
stretched between the radius and ulna, and attached to their
inter osseous borders. Above, it extends to within about an inch
of the head of the radius, leaving a gap for the passage of the
dorsal inter osseous vessels ; below, it reaches down to the ex-
tremities of the bones. The direction of the fibres is downwards
from the radius to the ulna.
The Wrist (Radio-Carpal) Joint between the distal end of the
radius and the triangular fibro-cartilage, and the proximal row
of carpal bones.
The joint is a condyloid one, capable of movement through
two axes :
Antero-posterior — flexion and extension.
Transverse — abduction and adduction.
In the ordinary position of the hand the end of the radius and
articular disc are in contact with the scaphoid and semilunar
bones, but in adduction (the hand bent to the ulnar side) the
cuneiform bone is pushed outward and comes in contact with
the triangular fibro-cartilage instead of the capsule of the joint.
Ligaments. — A capsule completely surrounds the joint, and is
attached to the edges of the articular surfaces, and is carried up
to the edge of the lower end and styloid process of the ulna. It
has well-defined strengthened portions.
Anterior Carpal ligament, attached above, to the lower edge
of the radius, the styloid process of the ulna, and the anterior
border of the triangular fibro-cartilage; below, to the palmar
surfaces of the scaphoid, semilunar, and cuneiform bones. Some
fibres may be carried on to the os magnum.
Posterior-carpal ligament, attached above to the lower end of
MUSCLES OF FOREARM
27'
Triceps
Anconeus —
Extensor Communis—
Digitorum
Extensor Minimi Digiti-
Extensor Carpi Ulnaris-
Dorsal Branch of
Ulnar Nerve
Posterior Annular
Ligament
Extensor Minimi Digit
(in two parts)
Biceps
Brachio-radialis
Extensor Carpi Radialis Longiov
Extensor Carpi Radialis Brevior
Supinator Radii Brevis
Posterior Interosseous Nerve
Extensor Ossis Metacarpi
Pollicis
Extensor Brevis Pollicis
Radial Nerve
Extensor Longus Pollicis
Extensor Indicis
; Extensor Brevis Pollicis
;«.
Extensor Indicis
._ Extensor Longus Pollicis.
FIG. 9.— MUSCLES OF THE FOREARM (DORSAL ASPECT).
28 HANDBOOK OF ANATOMY
the radius and below to the dorsal surfaces of the proximal row
of bones.
Internal Lateral ligament, attached above to the styloid process
of the ulna, and below to the ulnar side of the cuneiform and
pisiform bones.
External Lateral ligament, attached above to the styloid pro-
cess of the radius, and below to the tubercle of the scaphoid.
The synovial membrane completely lines the joint cavity, and
may be continuous with that of the inferior radio-ulnar joint if
the articular disc be perforated.
The Interearpal Joints between the bones of the carpus are
all gliding joints, and they have numerous ligaments between
the adjacent bones ; in addition to this, the carpus is surrounded
by a complete capsule.
The synoviaf membrane lines the joint, and may have a
separate division for the articulation between the cuneiform
and pisiform bones.
Muscles acting" on the Joint. — These both ventrally and
dorsally are arranged in two sets, superficial and deep ; on the
flexor (ventral) surface, the superficial group comes from the
inner condyle of the humerus, and the deep ones from the
ventral surfaces of the ulna and radius ; on the extensor (dorsal)
surface the superficial group comes from the outer condyle of the
humerus, and the deep ones from the dorsal surfaces of the ulna
and radius. Thus both superficial groups act on the elbow-
joint.
The Carpo-Metacarpal Joints, between the five metatarsal
bones and the distal row of carpal bones; the first metatarsal
bone articulates with the trapezium, and the four inner meta-
tarsals articulate with the other three bones.
First Carpo-Metaearpal Joint, between the base of the first
metacarpal bone and the distal surface of the trapezium. The
articulating surfaces of the joint are saddle-shaped, so that
movements occur round three axes.
Transverse — flexion and extension.
Antero-posterior — abduction and adduction (to middle line
of hand).
Longitudinal — rotation.
MUSCLES OF FOREARM
Although this is not a ball-and-socket joint, a certain amount
of circumduction is possible, and the movement of opposition — i.e.
bringing the thumb right across the hand — is due to a combina-
tion of flexion, adduction, and rotation.
Ligaments. — A capsule surrounds the joint which has strength-
ening bands in it, forming four ligaments.
The synovial membrane lines the joint, which is quite separate
and distinct.
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Flexion
Flexor
From common tendon
Palmar surfaces of base ; Median
carpi
on inner condyle of
of second metacarpal
radialis
humerus and deep
bone and a small slip
fascia
to third metacarpal
' Palmaris
From common tendon
Surface of anterior an- Median
longus
and deep fascia
nular ligament and
central part of palmar
fascia
: Flexor
From common tendon
To the pisiform bone,
Ulnar
carpi
on inner condyle and
and continued on to
ulnaris
deep fascia, the inner
the hook of the unci-
border of the olecra-
form and the base of
non process, and the
the fifth metatarsal
upper three-fifths of
the posterior border
of the ulna
Flexor
From the common flexor
The muscle divides into
Median
sublimis
tendon ; the internal
four tendons ; these
digitorum
lateral ligament of
the elbow-joint and
split to allow the
tendon of flexor pro-
•
deep fascia ; the inner
fundus digitorum to
border of coronoid
pass through, and,
process of ulna (above
after uniting again,
that of pronator
each tendon divides
radii t ore's).; the
into two parts to be
oblique line of the
inserted into the sides
radius
of the second phal-
*»
anges of the four inner
metatarsals
Flexor
From the upper two-
The muscle divides into Ulnar and
profundus
thirds of the anterior
four tendons, each of anterior
digitorum
and internal surfaces
of the ulna up to the
which passes through
the corresponding
interosseous
(median)
inner surface of the
tendon of flexor sub-
olecranon process;
limis digitorum to be
inner half of middle
inserted in the bases
third of the inter-
of the terminal phal-
osseous membrane and
anges of the four inner
deep fascia
metatarsals (see Lum-
bricales)
30
HANDBOOK OF ANATOMY
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Flexion
Flexor
From the middle'half of
The palmar surface of
Anterior
(contd.)
longvis
the anterior surface of
the base of the ter-
interosseous
pollicis
the shaft of the radius
minal phalanx of the
and the correspond-
ing half of the inter-
thumb
osseous membrane
Exten-
• Extensor
From the ventral sur- The dorsal surface of
Musculo-
sion
carpi
face of the lower third the base of the second spiral
radialis
longior
of the outer supra-
condyloid ridge of the
metacarpal bone
humerus, the inter-
muscular septum, and
the common extensor
•
tendon on the outer
condyle
1
Extensor
From the common
The dorsal surface of; Posterior
carpi
extensor tendon, the
the base of the third
intejrosseous
radialis
external lateral liga-
metacarpal bone
brevior
ment of the elbow-
joint and deep fascia
Extensor
From the common
The muscle divides into
Posterior
communis
extensor tendon and
four tendons, to be
mtefosseous
1
digitorum
deep fascia inserted in the four
inner digits. Each
one passes down the
j
:
back of the hand and
,
spreads out over the
knuckle ; it then
divides into three
:
slips — the middle one
is inserted into the
1
base of the second
phalanx, and the side
ones join together to
be inserted into the
base of the terminal
•
phalanx
Extensor
From the common Into the .expansion of
Posterior
minimi
extensor tendon and 1 the extensor tendon
interosseous
digiti
deep fascia on the back of the
first phalanx of the
: little finger
Extensor
From the common ! The ulnar side of the
Posterior
carpi
tendon and i deep i base of the fifth meta-
interosseous
ulnaris
fascia and middle half
carpal bone
of the posterior border
of the ulna
Extensor
From the upper half of ' The radial side of the
Posterior
ossis
the outer surface of the base of the first meta-
interosseous
metacarpi
ulna ; the middle third carpal
pollicis
of the dorsal surface of
the radius and inter-
osseous membrane
'
JOINTS OF HAND
Action.
Muscle.
Origin.
Insertion.
The dorsal surface of
the base of the first
phalanx of the thumb
Nerve-supply.
Exten-
sion
(contd. )
Extensor
brevis
pollicis
From the dorsal surface
of the radius below
extensor ossis meta-
carpi pollicis and
the interosseous mem-
brane
Posterior
interosseus
Extensor
longus
pollicis
From the middle third
of the dorsal surface
of the ulna and the
interosseous m e m-
brane below exten-
sor ossis metacarpi
pollicis
The dorsal surface of
the base of the second
phalanx of the thumb
Posterior
interosseous
Extensor
indicis
From the dorsal surface
of the ulna below
extensor longus polli-
cis and from the inter-
osseous membrane
The expansion of the
tendon of extensor
communis digitorum
on the first finger
Posterior
interosseous
Abduc-
tion
Flexor
carpi
radialis
See Flexion
Extensors
See Extension
carpi
radialis
longior
and
brevior
-
Extensors
of thumb
See Extension
Adduc-
Flexor
See Flexion
tion
carpi
ulnaris
Extensor
See Extension
carpi
ulnaris
The other carpo-metacarpal joints are formed between the
bases of the four inner metacarpals and the trapezoid, os magnum,
and unciform. They are freely moving gliding joints.
Ligament. — A common capsule surrounds all four joints, which
includes also the intermetacarpal joints. There are numerous
interosseous ligaments binding* them all together.
A synovial membrane lines all the joint cavities, which com-
municate with one another.
Metaearpo-Phalang-eal Joints are between the heads of the
inetacarpal bones and the bases of the first phalanges.
32
HANDBOOK OF ANATOMY
The first one differs from the rest in being a hinge-joint ; the
others are modified ball-and-socket, so that movement takes
place round two axes :
Transverse — flexion and extension.
Antero-posterior — abduction and adduction.
Flexor Carpi Ulnaris -
Flexor Sublimis Digitcrum fj r
Anterior Annular ^_
Ligament
Abductor Minimi
Digiti
Flexor Brevis Minimi.
Digiti
Opponens Minimi
Digiti
3rd Palmar Inteross.
4th Dorsal Inteross.
2nd Palmar Inteross
3rd Dorsal Inteross.*—""
and Dorsal Inteross.,
Flexor Carpi Radialis
Flexor Longus Pollicis
— NJr. Abductor Pollicis (cut)
Opponens Pollicis
. Superficial Head of Fiercer
Brevis Pollicib
Add. Obliquus
Pollicis
Add. Trans.
Pollios
XAbductor
Pollicis (cut)
-- — Flexor Longus
Pollicis
-~.ist Dors.. I
Interosscons
-^ist Palmar
Interosseo.is
^-.ist Lumbricalis
FIG. 10.— MUSCLES OF THE HAND (PALMAR ASPECT).
Ligaments. — A capsule, completely surrounds each joint, which
is very much weaker on the dorsal surface, where the joint is
strengthened by the expansion of the extensor tendon.
Ulnar and Radial Lateral ligaments, strong cord-like bands
MUSCLES OF THUMB 33
attached to the tubercles on the sides of the heads ot the
metacarpal bones and the bases of the phalanges.
The Palmar ligaments are plates of fibre-cartilage attached
firmly to the phalanges, but only loosely to the metacarpals, so
that during movements of the joints they can glide up ancL
•down. In this plate two sesamoid bones are developed in the
thumb, and one on the radial side of the forefinger.
Synovial membrane lines the capsule of each joint.
Transverse Metacarpal ligament consists of bands of transverse
fibres, which connect the palmar ligaments of the four inner
metacarpo-phalangeal joints. This binds together the distal
-extremities of the bones.
Interphalang-eal Joints. — These joints are all hinge-joints,
.allowing movements round one axis only :
Transverse — flexion and extension.
Their ligaments and synovial membrane are similar to those
•of the metacarpo-phalangeal joints.
MUSCLES ACTING ON THE JOINTS.
FIRST METACARPO-PHALAXGEAL AXD INTERPHALANGEAL JOINT.
Action.
Muscle.
Origin. Insertion.'
Nerve-supply.
Flexion
Flexor
See Wrist-Joint
lougus
pollicis
Flexor
1. Radial half lower Radial side base of
Median
brevis
border anterior annu- first phalanx
pollicis
lar ligament and the
ridge on the trape-
zium
2. Ulnar side of base of Ulnar side of base of
Ulnar
first metacarpal first phalanx
Abductor
From the tubercle of The radial side of the
Median
brevis
the scaphoid, the base of the first
pollicis
ridge of the trape- phalanx and the cap-
ziimi, the radial part sale of the joint
of the anterior surface
of the annular liga-
ment
Opponens
From the ridge on the The whole of the radial
Median
pollicis
trapezium and the ; border and the radial
anterior surface of the half of the palmar
annular ligament surface of the first
metacarpal
HANDBOOK OK ANATOMY
KIKST MKTACAKl'O-IMIALANCJKAL AND INTERPHALAHGEAL
.10 1 NT— Conti.nu.l.
Aetion.
Muacla.
Origin. lino,rti"n.
Nerve-supply.
Adductor
From the palmar snr- The ulnar side of the
Ulnar
obliquus
faces of the os trape-
base of the first
pollicis
y.ium and trapexoid,
phalanx
the OS magnum and
bases of the second,
third, and fourth
Adductor
From the lower two-
'The ulnar side of the
Ulnar
trans-
thirds of the median
base of the first
versns
rid^e on the palmar
phalanx
pollicis
surface of the third
mctacarpal
Exten-
Abductor
See Wrist -Join!
sion
longus
pollicis
Extensor
See Wrist-Joint
longus
pollicis
Extensor
See Wrist-Joint
brevis
pollicis
Adduc-
Adductor
See Flexion
tion
obliquus
pollicis
Adductor
See Flexion
trans-
vorsus
pollicis
Flexor
See Flexion
brevis
pollicis
Opponens
See Flexion
pollicis
First
From the adjacent sides
The radial side of the
1' nar
dorsal
of the first and second
index -finger on the
inter-
metacarpal bones
dorsal expansion of
osseous
the extensor tendon,
the capsule of the
nietacarpo-phalan^'eal
joint and the side of
the first phalanx
Abdno-
Abductor
See Flexion
tion
brevis
pollicis
Abductor
See Wrist-Joint
lOlltfUS
pollicis
Extensors
See Wrist-Joint
of thumb
:n dnotion an
I rotation are carried on
t by a combination ofthel.se muscles
MUSCLES OF FINGERS
35
KETAOARPO AND INTERPHALANGEAL JOINTS OF FOUR
INNER DIGITS.
Action.
MuHde.
Origin.
Insertion.
Nerve-supply.
Flexion
Flexor
See Wrist-Joint
-
subliinis
digitorum
Flexor
See Wrist- Joint
profundus
digitorum
Lunibri-
Four muscles arising
cales
from the tendons of
Hexor profundus digit-
orum
Two radial
From the»radial sides of
Similar to the dorsal
Median
ones
the tendons for the
interosseous muscle.
index and middle
See Thumb-Joints
fingers
Two ulnai
ones
From the adjacent sides
of the second and
Similar to the dorsal
interosseous muscle.
Ulnar
third, and third and
See Thumb-Joints
fourth tendons
Interossei
Three ; the first from
Ditto
Ulnar
palmar
the ulnar side of the
second rnetacarpal,
the two others from
the radial side of the
fourth and fifth meta-
carpals respectively
Dorsal
Four, each arising from
Ditto
Ulnar
the adjacent sides of
the metacarpal bone
(in lie'
fifthfinger
only :
Flexor
From ulnar part of
Ulnar side of base of
Ulnar
brevis
anterior surface of
first phalanx of little
niininii
annular ligament and
finger
digiti
hook of unciform
Exten-
Extensor
Sei- Wrist-Joint
sion
communis
digitorum
Extensor
See Wrist- Joint
indicis
Extensor
See Wrist-Joint
minimi
digiti
Lumbri-
See Flexion
calcs
Inti-rossci
See Flexion
36
HANDBOOK OF ANATOMY
METACARPO AND INTERPHALANGEAL JOINTS OF FOUR
INNER DIGITS— Continued.
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Abducti
on from the
ulnar side of the liand
Lumbri-
See Flexion
cales
Flexor
See Flexion
brevis
miiiimi
digiti
Opponens
minimi
Similar to flexor brevis
minimi digiti
The lower three-fourths
of the ulnar margin
Ulnar
digiti
and palmar surface of
the fifth metacarpal
From
the middle
line of the middle finger:
Dorsal
See Flexion
interossei
Abductor
From the palmar sur-
Ulnar side of base of I Ulnar
minimi
face of the pisiform
first phalanx of little
digiti
bone
finger
Adducti
on to the
middle line of the middle
finger
Palmar
See Flexion
i1
interossei
The Deep Fascia of the shoulder and upper limb is attached
to the clavicle, acrornion, and spine of scapula. It encases all
the muscles, and is continuous with the deep fascia of the back
and the axilla ; it is then continued down the arm,, covering all
the muscles, and at the elbow sends in processes called inter-
muscular septa, which separate the muscles of the front of the
arm from those of the back, also affording additional surface for
the origins of muscles. In front of the elbow it is attached to
the condyles of the humerus and olecranon process of the ulna,
and covers in the antecubital fossa, and receives a crescent-
shaped expansion from the tendon of the biceps called the
bicipital fascia ; it is continued down the forearm, closely invest-
ing the muscles and sending septa between them. At the wrist,
on both dorsal and ventral surfaces, there are bands of strong
transverse fibres to hold down the tendons, called respectively,
posterior and anterior annular ligaments of the wrist-joint.
The deep fascia then invests the muscles of the hand forming
anteriorly a particularly strong triangular piece — the palmar
fascia — which sends four processes to be inserted into the digital
sheaths.
DEEP FASCIA . 37
Costo- Coracoid Membrane, a process of the deepjfascia cover'
ing pectoralis minor, which, after splitting to enclose subclavius,
becomes attached to the first costal cartilage and the coracoid
process. The membrane itself is thin and pierced by superficial
vessels, but the piece between the costal cartilage and coracoid
process is much stronger, and is called the costo-coracoid liga-
ment.
Axillary Fascia, a particularly strong fascia forming the floor
of the axillary space, from the edge of the pectoralis major in
front to the latissimus dorsi and teres major behind ; it is con^
tinuous with the deep fascia of the arm.
Bicipital Fascia, a strong band of fascia from the tendon of
the biceps, which joins the deep fascia covering the front of the
elbow. It separates the brachial artery from the median basilic
vein.
Anterior annular ligament, a band of transverse fibres in the
deep fascia attached on the ulnar side to the pisiform bone and
the hook of the unciform, and on the radial side to the scaphoid
and trapezium. It bridges across the concavity of the carpus
and holds the flexor tendons in place. All the tendons pass
under it, except palmaris longus and flexor carpi radialis, the
latter piercing the ligament to reach its insertion. The ulnar
artery and nerve cross over the ligament".
Posterior annular ligament, a 'transverse band of fibres in the
deep fascia, attached to tne external border of the lower end of
the radius, and the internal border of the lower end of the ulna.
This is a much weaker and less important band than the anterior
one. All the tendons pass underneath it, the ulnar and radial
nerves passing over it.
The fascia is divided underneath into six compartments for
the passage of the tendons, which lie in grooves in the bone.
1 . Extensor ossis metacarpi "1 .
„. . in the nrst groove on the ex-
pollicis . ... e ...
,,_: . ,,. . ternal side of the radius.
Jbxtensor brevis pollicis J
2 . Extensor carpi radiales, } .
un the second groove,
longior and brevior
3. Extensor longus pollicis in the third groove.
38 HANDBOOK OF ANATOMY
4. Extens<jr communis digi-^j
torum Vin the fourth groove.
Extensor indicis
5. Extensor minimi digiti in the groove between the ulna and
radius.
6. Extensor carpi ulnaris in the groove of the ulna.
Digital Sheaths, strong fibrous sheaths which hold down the
flexor tendon of the fingers. They are attached along the edges
of the palmar surfaces of the phalanges and interphalangeal
joints, and continuous with the palmar fascia.
The Axilla is the hollow space in the armpit through which
the axillary vessels and the cords of the brachial plexus pass to
reach the arm. It is cone-shaped, with the apex upwards.
The apex is bounded by the superior border of the scapula,
the first rib, and the clavicle, and is covered in by the costo-
coracoid membrane.
The floor is formed of the deep fascia.
The posterior wall is formed by subscapularis, teres minor,
teres major, and latissimus dorsi, the lower free edge of which
is called the posterior fold.
The anterior wall is formed by pectoralis major, the lower free
edge of which is called the anterior fold.
The inner wall is formed by the upper digitations of the
serratus magnus. The outer wall is formed by the long head of
triceps and the humerus.
The contents are the axillary vessels, the cords of the brachial
plexus with their branches, some lymphatic glands and fat.
The Antecubital Fossa is the triangular space in front of the
elbow-joint, covered in by deep fascia and the bicipital fascia.
Its boundaries are, above, a line drawn between the condyles of
the humerus, on the inner side pronator radii teres, and on the
outer side brachio-radialis.
In the fossa the brachial artery breaks up into its branches.
SECTION III
PELVIC GIRDLE AND LOWER LIMB
THE pelvic girdle consists of three bones firmly joined together,
with two of which the two femurs articulate by means of ball-
and-socket joints ; the pelvic girdle and lower limb are analogous
to the shoulder girdle and upper limbs (see comparison in
Section I.).
The bones forming the pelvis are the two innominate bones,
joined together in front at the symphysis pubis and articulating
with the sacrum behind.
The Innominate Bone is a large, flat irregular-shaped bone
-consisting of three parts, which at birth are distinct, but in
adult life become fused together in the same way that epiphyses
fuse with the shafts in long bones. The three parts are re-
spectively the ilium, ischium, and pubis, which join together to
form the acetabulum, a deep socket which receives the head of
the femur.
The Ilium forms a fan-shaped expansion, the top edge of
which, the crest of the ilium, is thickened to give attachment to
muscles. About two inches from the anterior end is a rough
tubercle, which is the highest point of the crest, and can easily
be felt in the living subject. The crest forms an S- shaped curve,
the anterior half being convex outwards. The ends are termed
respectively the anterior and posterior superior spines. The
anterior margin of the ilium extends from the anterior superior
spine to the margin of the acetabulum, of which the ilium forms
the upper two-fifths. Halfway down the anterior margin is a
rough tubercle called the anterior inferior spine.
The posterior margin extends from the posterior superior
spine to the posterior margin of the acetabulum. A little way
39
40
HANDBOOK OF ANATOMY
below the spine is another tubercle, called the posterior inferior
spine ; from this the edge of the bone curves sharply forwards,
forming the great sciatic notch.
The ilium has two surfaces — internal and external. The
external one is sometimes termed the glutealj as it has three
'1 ransversalis Abdommis
Obliquus Interims Abdominis, X
Middle Gluteal Line
Crest
Obliquus Externus Abdominis
Latissimus Dors!
Superior Gluteal Line
Posterior Superior.-
Iliac Spine
Posterior Inferior
Iliac Spine
Great Sciatic Notch -
Isch:al Spine —
Gemellus Superior
Snail Sciitic Notch -
Gemelius Inferior"
Obturator Groove
Semimembranosus
^miterdinostis and Long Head
Biceps
Tuber Ischi
Adductor Mag
.Tensor Fasciae
Femoris
Anterior Superior
Iliac Spine
-Inferior Gluteal Line
Anterior Inferior Spine
— and Straight Head of
Rectus Femoris
,-Acetabulum
,.Cotyloid Notch
, Pubic Spine
f Pubic Crest and
Rectus Ahdominis
._ Pubic Angle
,, Adductor Longus
Symphysis Pubis
>Gracilis
escending Pubic Ramus
N Adductor Magnus
ischial Ramus
FIG. 11.— INNOMINATE BONE.
well-marked ridges — superior, middle, and inferior — which limit
the origins of the gluteal muscles. The internal surface of the
bone is divided into two parts — the posterior part, which takes
up nearly half, is a rough auricular -shaped surface for
articulation with the sacrum ; while the anterior part, which is
PELVIC BONES . 4t
smooth, has a sharp well-defined oblique ridge, the ilio-pectineal
line, from the auricular surface to the front of the bone. This
marks the line of fusion with the pubis, and also divides the
true pelvis from the false pelvis. Above the ilio-pectineal line
the bone forms the shallow iliac fossa.
The Ischium consists of a body and two rami — superior and
inferior. The body forms the inferior and posterior two-fifths
of the acetabulum, and from the posterior border of the body
projects a sharp spine — the ischial spine. From the body the
superior ramus passes downwards and back, and from its inferior
extremity the inferior ramus passes forwards at an acute angle,
to join the inferior ramus of the pubis. The angle of the two
ischial rami forms a large tubercle — the tuberosity of the
ischium — and between this and the ischial spine above, the
edge of the bone is curved forwards to form the small sciatic
notch.
The Pubis consists of a small triangular body with two rami —
superior and inferior. The superior ramus completes the re-
maining one-fifth of the acetabulum, and the inferior ramus
passes backwards to join the inferior ramus of the ischium, thus
enclosing the obturator, or thyroid foramen. The upper part of
the body projects forwards to form the crest of the pubis, which
externally ends in a small spine or tubercle which joins the ilio-
pectineal line. The inner border of the body consists of a long,,
narrow, oval surface which articulates with its fellow of the
opposite side by means of an intermediate disc of cartilage.
The Acetabulum is practically half a sphere, and is directed
downwards and forwards. It has a sharp, well-defined margin,
which is interrupted infer iorly, forming the cotyloid notch.
Ossification. — At birth there are three primary centres, one in
each bone. Afterwards secondary centres appear for the ischial
tuberosity and spine, and inner part of the body of the pubis.
The whole bone is usually fused together by the twenty-fifth year.
The Sacrum, articulating with the innominate bones, completes
the pelvis. (For description of sacrum, see the Vertebrae, in.
Section IV.)
The Pelvis is divided into two parts by the ilio-pectineal line,
which extends from the sacro-iliac joint behind to the spine of
42
HANDBOOK OF ANATOMY
the pubis in front. The part above this line is called the false
pelvis; the part below, the true pelvis.
The false pelvis is bounded by the expanded wings of the
ilium and the upper part of the sacrum, and supports the
abdominal contents. The true pelvis is much smaller, and is
bounded above by the ilio-pectineal lines and the upper margin
of the pubis, and its walls are formed by the lower part of the
sacrum, the bodies and rami of the ischium and pubis.
Differences between Male and Female Pelvis. — The upper
margin of the true pelvis is often called the brim, or inlet, of
Acetabulum
Symphysis
Pubis
FIG. 12.— PELVIS.
the pelvis. This is heart-shaped in the male and oval in the
female owing to the shape of the upper part of the sacrum,
Avhich in the male is more prominent.
The angle formed by the bodies of the two pubic bones at the
symphysis — i.e., the pubic arch — is a right angle in the female
and an acute angle in the male. The ischial spines are turned
inwards in the male and project straight from the ischium in
the female.
The coccyx is turned forwards in the male and as a rule
firmly joined to the sacrum. In the female it is straighter and
has a movable joint.
BONES OF LOWER LIMB 43
From these differences it will be seen that the true pelvis is
altogether more roomy in the female and the outlet wider, which
is necessary for the purposes of childbirth.
The Femur is a long bone with a shaft, and two extremities.
It articulates above with the acetabulum of the os innominatum
and below with the head of the tibia and the patella.
The Upper Extremity consists of a rounded head forming
half a sphere, which is joined to the shaft, at an angle of 127*5
degrees, by the neck, a stout bar of bone, an inch or more in
length. The cartilage-covered part of the head has a wavy
outline where it joins the neck, and just below the summit is a
small fossa for the insertion of the ligamentum teres. The two
trochanters of the femur are situated on the posterior aspect of
the upper end of the shaft, the great trochanter being placed
externally and the small trochanter internally. Where the neck
joins the shaft a distinct line is seen, the intertrochanteric line
in front, and behind where it is more prominent it is called the
intertrochanteric ridge (crista intertrochanterica) . Just above
the middle of this ridge is the quadrate tubercle. The great
trochanter overhangs the neck above, and in the depression thus
formed is found the digital fossa for the tendon of obturator ex-
ternus. On its external surface is an oblique line running from
above downwards and forwards. The small trochanter is a
rounded eminence confluent with the shaft below.
The Shaft is cylindrical in shape and convex forwards,
increasing in size gradually from above downwards. At its
lower end it is flattened to support the condyles. The shaft is
smooth except on its posterior surface, where a narrow longitu-
dinal ridge is found — the linea aspera. This has distinct inner
and outer lips, which separate inf eriorly, each passing down to
its own condyle and enclosing a smooth triangular space — the
popliteal surface. Where the inner lip meets the condyle is a
small tubercle — the adductor tubercle.
The Lower Extremity of the femur is flattened and recurved
posteriorly to form two condyles, between them being the deep
intercondylic notch. In front they are united to form a smooth,
flat surface for the patella. The inner condyle is longer and
narrower than the outer one; but as the femur in its normal
44
HANDBOOK OF ANATOMY
Head. .Neck
Depression for
Liganientum Teres -
Ilio psoas ".«.
Small Trochanter
Spiral Line
Adductor Brevis
Vastus Interims
Adductor Longu
y- I I
j d.J Gluteal Ridge and
*'• ,' | j I Gluteus Maximus
Internal Supracondylar
Fudge and hxpansion from Tendon
of Adductor Magnus
Adductor Tubercle
and Adductor Magnus
Internal Tuberosity/
Digital Fossa and Obturator Externus,
^Quadrate Tubercle
Gluteus Medius
-Great Trochanter
-4 Medullary Foramen
Summit of Linea Aspera
Outer Lip of Linea Aspera
Inner Lip of Linea Aspera _/_ J ;
External Supracondylar Ridge
_ J Popliteal Surface
External Tuberosity
External Condyle
Internal Condylei Intercondylar Fossa
FIG. 13.— FEMUR.
BONES OF LOWER LIMB 45
position is placed obliquely — i.e., the upper extremities being
widely separated by the pelvis — while the lower extremities are
in apposition to one another, the inferior surfaces normally
are in the same horizontal plane ; whereas if the femur is held
vertically, the inner condyle projects downwards below the
outer one. The inner surface of the inner condyle and the
outer surface of the outer condyle are subcutaneous, and each
possesses a pronounced tuberosity for the attachment of
ligaments.
The Inferior Surface of the femur is cartilage covered for
articulation with the head of the tibia. It is more or less
crescentic in form, the convexity being forwards. The anterior
part is called the trochlea, and articulates with the patella.
The inferior surfaces of the condyles are convex in both direc-
tions. That of the outer one is wider than the inner, and
rises to a higher, point on the anterior surface of the shaft.
They each articulate with the tibia by means of a meniscus
of cartilage, which separates the bones from one another.
Ossification. — There is one primary centre for the shaft before
birth, secondary centres appearing for the head, trochanter and
lower extremity. (This latter may appear just before birth.)
The whole bone is fused together by the twenty-second year.
The Patella is the largest sesamoid bone in the body, and
is formed in the tendon of the quadriceps extensor in front
of the knee-joint. It is triangular in shape, with the apex
downwards. The anterior surface of the bone is slightly convex .
The posterior surface is much more rounded, and has a ridge
which divides it into two parts longitudinally, of which the
inner one is the smaller. This ridge glides between the two
condyles of the femur.
Ossification. — The patella does not begin to ossify till about
the third year, and is complete at puberty.
The Tibia is the inner bone of the leg. It is a long bone
with a shaft and two extremities, and articulates above with
the condyles of the femur and the upper end of the fibula ;
below, with the lower end of the fibula and one tarsal bone, the
astragalus.
The Upper Extremity is much expanded, and forms two
46
HANDBOOK OF ANATOMY
External Tuberosity of Tibia .,
Biceps Femoris '
Head of FibuIa-J
Peroneus Longus
Extensor Proprius Hallucis
Antero-external Border.
— Internal Tuberosity of Tibia
Tubercle
"^Gracilis
NV 5artorius
^ Semitendinosus
External Surface and
Tibialis Anticus
- Anterior Border or Crest
Postero-external Border ..
Peroneus Brevis \
Internal Border
Peroneus Tertius
Triangular Subcutaneous. ___
Surface
External Malleolus.-A---
Internal Malleolus
FIG. 14. — TIBIA AND FIBULA (ANTERIOR SURFACE*).
BQNES OF LOWER LIMB 47
tuberosities to support the condyles of the femur. The outer
one somewhat overhangs the shaft. On the upper aspects
of these are two smooth semicircular surfaces for the articular
menisci, and between them in the centre a rough elevation,
the intercondyloid spine. Where the outer tuberosity over^
hangs the shaft is a small articular facet for the head of the
fibula. On the posterior surface of the inner tuberosity is a
short horizontal groove for the semimembranosus muscle. In
front of the lower part of the two tuberosities is a large
tubercle, the upper half of which is smooth and covered
by a bursa ; the lower, rough, for the attachment of the
ligamentum patellae.
The Shaft is triangular in shape, having an anterior, internal,
and external borders, and internal, external, and posterior
surfaces. The anterior border is sharp and subcutaneous, form-
ing what is known as the shin. The internal surface is also
subcutaneous, except in its upper fourth. On the posterior
.surface is seen the oblique, or popliteal, line, which runs from
the outer tuberosity to the internal border at T:he junction of
the upper and middle thirds. The posterior surface is divided
into two parts by a vertical line dropped from the middle of the
oblique line.
The Lower Extremity is expanded and becomes quadrilateral.
The external surface has a large articular area for the lower
end of the fibula, and the internal surface is continued down-
wards into a triangular process, called the internal malleolus,.
whose outer surface is confluent with the inferior surface of
the shaft, and articulates with the astragalus. On the posterior
surface just external to the malleolus there are two grooves for
the passage of tendons.
Ossification. — At birth the shaft is almost completely ossified,
and a centre has appeared in the upper extremity. Very early
the centre appears for the lower extremity, and the whole bone
is fused together by the twenty-fourth year.
The Fibula is a long, slender bone on the outer side of the
leg. It articulates above with the outer tuberosity of the tibia,
and below with the lower end of the tibia and the outer surface
of the astragalus.
48
HANDBOOK OF ANATOMY
Semimembranosus
Internal Tuberosity of Tibia -
Tibial Spine
•' » Popliteal Notch
,-Styloid Process of Fibula
Popliteal Surface and — — .
Popliteus
Soleus
Oblique Line
Tibialis Posticus
Medullary Foramen
Tnternal Border
Flexor Longus Digitorum —
1
— ~{ — -- Soleus
Posterior Surface
I Postero external Bolder
Flexor Longus Ka'.lucis
Medullary Foramen
H-
1 Peroneus Brevis
Postero-extennal Border
Antero-external Border
Tip of Internal Malleolus,
Groove for Tibialis Posticus and
Flexor Longus Digitorum
Peroneal Groove
Tip of External Malleolus
Groove for Flexor
T.-n-us Hallucis
. 15. — TIHIA AND FIBULA (POSTERIOR SURFACES),
BONES OF LOWER LIMB 49
The Upper Extremity is irregularly rounded, and has on its
internal surface a facet for articulation with the tibia, and just
.above this is a pointed process — the styloid process.
The Shaft is very irregular in shape and twisted on itself, but
.a very narrow anterior surface can be distinguished between
the interosseous and external borders. The external border
splits below to form a triangular subcutaneous area on the
outer malleolus, and behind this line is the external surface.
The surface next the external surface is the posterior surface,
which is divided by a sharp ridge. (This ridge may be mistaken
for the interosseous ridge, but that can be determined by follow-
ing up the line from the triangular surface on the malleolus.
This line is the external border of the anterior surface.)
The Lower Extremity is flattened and expanded to form the
-external malleolus, on the internal surface of which is the facet
for articulation with the outer surface .of the astragalus. Just
behind this facet is the digital fossa for the insertion of a
ligament.
Ossification is similar to that of the tibia, except that the
centre for the shaft is the only one that appears before birth.
The Tarsus is composed of seven bones — the astragalus, os
'calcis, scaphoid, cuboid, and three cuneiforms.
The Astragalus is the uppermost bone, and, articulating with
the tibia and fibula, supports the weight of the body. It is
•of irregular cubical form, and on the upper, inner, and outer
surfaces is one large confluent articular facet, fitting into the
;space enclosed by the under surface of the tibia, and the two
malleoli. This facet is saddle-shaped, and is broader in front
than behind. Anteriorly is a somewhat constricted neck sup-
porting the rounded head, which articulates with the scaphoid
bone. On the inferior surface is a large concave facet for
articulation with the os calcis. A deep groove divides this facet
into two parts, the anterior part articulating with the susten-
taculum tali, while the posterior part rests on the body of the
•os calcis. A strong interosseous ligament is inserted in this
groove. Posteriorly the bone is divided by a groove, oblique
from above downwards and inwards, into two tubercles. In
the groove runs the tendon of tibialis posticus.
4
50
HANDBOOK OF ANATOMY
Tuber Calcis
Os Calcis (Neck)
Tubercle for Middle Fasciculus -
of External Lateral Ligament
Peroneal Spine or Ridge ..
Extensor Brevis Digitorum . - - \
Cuboid
Peroneus Brevis-
Peroneus Tertius*-
External Cuneiform-"^
s /
Extensor Longus Digitorum "N-
Astragalus
Navicular (Scaphoid>
Groove for Tibialis
Anticus
Internal Cuneiform
Middle Cuneiform
- Innermost Tendon of
Extensor Brevis
Digitorum
Extensor Proprius-
Hallucis
Fro. 16. — BONES OF FOOT (DOUSAL SURFACE),
BONES OF FOOT 51
The OS Calcis is the largest bone of the tarsus. It is roughly
cubical, with a projection posteriorly, forming the heel. The
upper surface has anteriorly two facets, divided by a groove
to correspond with the facets on the under surface of the
astragalus. On the outer side of the anterior facet is a rough
surface for muscular origins. The anterior surface has a smooth,
convex surface articulating with the cuboid bone. Posteriorly,
the tuberosity, which is confluent with the body of the bone,
1ms a surface divided into three parts. The upper part is
smooth and covered by a bursa, the middle portion is roughened
for the attachment of the tendo A-chillis, and the lower part
is rough and confluent with the inferior surface. On the inner
surface of the body is the sustentaculum tali, a stout projection
of bone supporting the astragalus. On the outer surface is the
peroneal spine, a small tubercle separating the tendons of
peroneus longus and brevis.
The plantar surface is slightly concave from before back-
wards, and roughened for the attachment of muscles and
ligaments. Posteriorly, there are two tubercles, of which the
inner one is the larger.
The Scaphoid is a flat, oval bone, compressed from before
backwards, the long axis being horizontal. It articulates pos^
teriorly with the head of the astragalus, and anteriorly with the
three cuneiform bones. The inner surface of the bone projects
beyond the inner border of the foot, and forms a rounded
tubercle easily felt in the living subject.
The Cuneiform Bones are three in number — internal, middle,
and external. They articulate posteriorly with the scaphoid,
and anteriorly with the first, second, and third metatarsals.
They are wedge-shaped in form, with the points downwards, the
first being the largest, and not so pointed inferiorly as the
others. This arrangement helps to keep the concave plantar
surface presented by the bones of the foot.
The Cuboid Bone is roughly cubical, and lying on the outer
side of the foot articulates posteriorly with the anterior surface
of the os calcis and anteriorly with the fourth and fifth meta-
tarsals. On its inner side it articulates with the external cunei-
form bone. On the plantar surface is an oblique ridge running
52
HANDBOOK OF ANATOMY
Tuber Calcis
Sustentaculum Tali
Tibialis Posticus
Peroneus Longus
Tibialis Anticus
Abductor Hallucis and.
Inner Head of Flexor
Brevis Hallucis
Outer Head of Flexor-
Brevis Hallucis, Adduc-
tor Obliquus Hallucis,
and Adductor Trans-
versus Hallucis
Flexor Longus Hallucis '
Abductor Minimi Digiti
Outer Head of Flexor
Accessorius
Tuberosity of 5th
Metatarsal and
Peroneus Brevis
Adductor Obliquus
Hallucis
.— .Abductor Minimi
Digiti and Flexor
Brevis Minimi
Digiti
Flexor Brevis Digitorum
Flexor Longus Digitorum
FIG. 17. — BONES OF FOOT (PLANTAR SURFACE).
BONES OF FOOT 53
from without inwards and forwards, and just in front of this a
groove for the tendon of peroneus longus.
Ossification. — The astragalus and the os calcis are partially
ossified at birth. The other bones commence early in life, and
the tarsus is completely ossified by the twentieth year.
The Metatarsus resembles the metacarpus, and consists of five
long bones articulating with the tarsus behind and supporting
the phalanges in front.
The first metatarsal is the shortest and stoutest and the second
metatarsal the longest. The fifth metatarsal has a prominent
tubercle projecting backwards from the outer side of the base,
which can easily be felt in the living subject. The metatarsals
articulate with one another by their bases.
Ossification. — Similar to that of the metacarpus.
The Phalanges of the toes resemble those of the fingers in
shape and number (fourteen in all). They are, however, much
smaller proportionately^ and in the smaller toes the second and
third phalanges are often compressed to mere nodules.
Ossification. — Similar to that of the fingers.
Articulations of the Pelvis.
Lumbo-SaCPal Joint. — This takes place between the fifth
lumbar vertebra and the sacrum, and is similar to the other
intervertebral joints. It has, however, an accessory ligament, the
lateral lumbo-sacral ligament, which is attached to the front of
the transverse process of the fifth lumbar vertebra and the front
of the sacrum close to the sacro-iliac joint.
SaCPO-Iliac Joint between the articulating portion of the
wing of the ilium and the similar auricular surface on the
sacrum. The joint surfaces are very closely applied to one
another, so that movement is limited, as great stability is required
rather than free movement. The joints are just movable enough
to prevent absolute rigidity, and their roughened surfaces prevent
gliding to any extent.
Ligaments. — A capsular ligament surrounds the joint, which is
strengthened by transverse fibres dorsally and ventrally.
The synovial membrane is rudimentary.
Accessmy Ligaments : The Ilio-Lumbar ligament extends from
54 HANDBOOK OF ANATOMY
the tip of the transverse process of the fifth lumbar vertebra to
the iliac crest just behind its highest point. It is in reality a
thickened portion of the lumbar fascia.
The Great Sciatic Ligament is triangular in shape. It is
attached to the posterior inferior spine of the ilium, the tuber-
osity of the ischium, and to the posterior aspects of the lower
part of the sacrum. It fills the gap between the innominate
bone and sacrum, and, by completing the great and small sciatic
notches, forms the great and small sacro-sciatic foramina.
The Small Sciatic Ligament is also triangular ; it lies vent rally
to the great sciatic ligament, and is attached by its base to the
last two segments of the sacrum, and by its apex to the spine of
the ischium.
The Symphysis Pubis is an immovable joint between the two
pubic bones. The articular surfaces are covered with cartilage
as usual, and have, in addition, an interarticular disc of cartilage
welding them firmly together. There are ligaments all round
the joint, the most important being the subpubic ligament, which
is in the arch of the pubis and separated from the triangular
ligament of the perineum by a small interval. The subpubic
ligament is attached to the interarticular ligament and the
descending rami of the pubic bones. There is no synovial
membrane.
The Triangular Ligament of the perineum helps to complete
the pelvic walls, and stretches across between the descending
rami of the pubic bones. It occupies a horizontal position, and
has superior aud inferior surfaces. Posteriorly it fuses with the
deep fascia of the perineum.
The Obturator Membrane fills the obturator foramen, leaving
superiorly a small canal, through which vessels and nerves pass.
There are no muscles acting on these joints in the ordinary
way, the joints being for the sole purpose of preventing absolute
rigidity, so that the pelvis will "give" to the pull of the muscles
as required.
The Hip- Joint takes place between the head of the femur and
the acetabulum of the innominate bone.
It is a true ball-and-socket joint, so has movement round three
axjes :
HIP-JOINT
Transverse — flexion and extension.
Antero-posterior — abduction and adduction.
Vertical — rotation in and out.
Ligaments. — The Transverse Ligament is composed of strong
fibres, which bridge across the notch in the margin of the
acetabulum, leaving a gap through which vessels and nerves can
pass.
The Cotyloid Ligament surrounds the margin of the aceta-
bnlum and deepens the socket. Its free edge is somewhat
constricted, and grasps the head of the femur.
Pubo-femoral Band
.interior Inferior Iliac Spine
Ilio-femoral Band
(Y Ligament
of Bigelow;
Anterior
Obturator Membrane
FIG. 18.— HIP- JOINT.
A capsule completely surrounds the joint. It is considerably
thicker superiorly. This capsule differs from that of the
shoulder- joint in not allowing the ball to be drawn from the
socket to any considerable extent. The ligament is attached
above to the margin of the acetabulum and below to the cotyloid
and transverse ligaments. On the neck of the femur it is
attached above to the root of the great trochanter, in front to
the intertrochanteric line, below to the root of the small tro-
chanter, and behind a little way above the intertrochanteric
ridge. The fibres of the capsule are arranged in both the
circular and longitudinal directions to give additional strength,
56 HANDBOOK OF ANATOMY
and definite bands of longitudinal fibres are strengthened as-
follows :
The Ilio- Femoral ligament (Y-shaped ligament of Bigelow) is a
triangular ligament attached by its apex to the root of the
anterior inferior spine and margin of the acetabuluin and by its
base to the intertrochanteric line. At the base the sides are
thicker than the centre, hence its name.
The Pubo- Femoral ligament, attached to the acetabular end
of the ramus of the pubis and the inferior aspect of the neck of
the femur.
The Ischio-Capsular ligament attached above to the ischium
just in front of the small sciatic notch ; the lower end becomes
merged in the capsule.
The Ligamentum teres is a flattened band of tissue attached by
one end to the fossa on the summit of the head of the femur and
by the other end to the sides of the notch in the margin of the
acetabulum. A pad of fat occupies the bottom of the aceta-
bulum.
The synovial membrane completely lines the joint and the
ligaments, and hangs in loose folds between the articular margin
and the attachment of the capsule on the neck of the femur.
MUSCLES ACTING ON THE JOINT.
Action.
Flexion
Muscle.
Origin.
Insertion.
Outer side of tendon of
psoas ; anterior sur-
face of small tro-
chanter, and shaft of
femur below
Nerve-supply.
Anterior
crural
Iliacus
From a wide origin
round the margin of
the iliac fossa
Psoas
From theintervertebral
discs, and adjacent
margins, side of
bodies, and transverse
processes of lumbar
vertebrae
Apex of small trochantei
of femur
Nerve from
the lumbar-
plexus
Sartorius
From the anterior supe-
rior spine of the ilium,
and half the notch
below it
Inner surface of shaft of
tibia just below the
tuberosity
Anterior
crural
Rectus
femoris
See Quadriceps Extensor
(Knee-joint)
HIP-JOINT
MUSCLES ACTING ON THE JOINT— Continued.
57
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Flexion
(c&ntd. )
Pectinens
From'the triangular sur- j Into the upper half
face of the pubic bone 1 (about 2 inches) of
Anterior
crural
behind the crest
the line from the
small trochanter to
the linea aspera
Gracilis
From the edge of the
Into the inner side of
Obturator
symphysis pubis and
the tibia, just below
a small portion of the
the tuberosity behind
border of the adjoin-
sartorius
ing pubic arch
Exten-
Gluteus
From the area on the
The gluteal ridge (from
Inferior
sion
maximus
posterior part of the
dorsum ilii between
the root of the great
trochanter) and the
gluteal
the crest and the
deep fascia covering
superior curved line ;
the thigh
the tendon of erector
spinse ; posterior sur-
face of sacrum, and
great sciatic ligament
Glutens
From the area on the
Into the oblique line on
Superior
medius
dorsum ilii between
the outer surface of
gluteal
the superior curved
the great trochanter
line and crest above
and the middle curved
line below ; and deep
fascia
Gluteus From the area on the
The anterior surface of
Superior
minimus dorsum ilii between
the great trochanter
gluteal
the middle and in-
ferior curved lines
Biceps
From the lower and
The head of the fibula,
Great
femoris
inner half of the
and by a slip to the
sciatic
ischial tuberosity ;
outer tuberosity of
and short head, from
the tibia
the whole length of
the outer lip of the
linea aspera, and the
upper two-thirds of
| the outer supra-con -
dyloid ridge and inter-
muscular septum
Semi-
From the lower inner
The inner side of shaft
Great
tendinosus
facet on the ischial
of tibia, below the
sciatic
tuberosity with the
gracilis and behind
long head of biceps
sartorius
Semi-
From the upper outer
The horizontal groove
Great
mem-
facet on the ischial on the posterior sur-
sciatic
branosus
tuberosity
face of the inner
tuberosity of the tibia
HANDBOOK OF ANATOMY
MUSCLES ACTING ON THE JOINT— Continued.
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Exten-
sion
(contd.)
Adductor
maguus
From a curved origin on
the inferior surface of
the ischial tuberosity,
and the lower border
of the ischial ram us
and that of the pubis
The space below the
insertion of quadratus
femoris, the whole of
the linea aspera, the
inner supracondyloid
ridge and intermuscu-
lar septum of the
femur, and the adduc-
tor tubercle
Obturator
Abduc-
tion
Tensor
fascia
femoris
From the anterior supe-
rior spine of the ilium
and the crest just
behind
The ilio-tibial band at
the level of the great
trochanter
Superior
gluteal
Gluteus
medius
(anterior
fibres)
See Extension
Gluteus
See Extension
minimus
(anterior
fibres)
Adduc-
tion
Adductor
longus
By a rounded tendon
from the anterior sur-
face of the body of
the pubis between the
crest and the sym-
physis
The middle half of the
inner lip of the linea
aspera in front of
adductor magnus
Obturator
Adductor
brevis
From the front of the
body and descending
ram us of the pubis
Into the lower two-
thirds of the line lead-
ing from the small
trochanter to the linea
aspera behind pec-
tineus
Obturator
Adductor
See Extension
magnus
Gracilis
See Flexion
Pectineus
See Flexion
Rotation
in
Gluteus
medius
(anterior
fibres)
See Abduction
Gluteus
minimus
(anterior
fibres)
See Abduction
KNEE-JOINT
59
MUSCLES ACTING ON THE JOINT— Continued.
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Rotation
Tensor
See Abduction
in
fasciae
(contil]
femoris
Rotation
Pyriformis
From the middle part
A facet on the inner
Nerve from
out
of the anterior surface ! aspect of the upper
the sacral
of the sacrum ; and
border of the great
plexus
the upper margin of
trochanter
the great sciatic notch
Obturator
From the inner surface
Just behind pyriformis
Nerve from
internus
of the bone surround-
the sacral
| and
ing the obturator for-
plexus
gemelli
amen and from the
membrane ; the ge-
raelli, one from the
ischial spine, the
other from the tuber-
osity (either side of
. !'
the small sciatic notch)
Obturator
From the lower half of
The digital fossa at the ! Obturator
externus
the obturator mem- , inner aspect of the
brane and the bone
upper border of the
surrounding
great trochanter
Qnadratus
From the outer margin
The quadrate tubercle
Nerve from
femoris
of the ischial tuber-
and line beyond
the sacral
osity
plexus
This act
ion is helped by a great
many of the other muse
les.
Circumd
uction — a combination
of the other movements.
The Knee-Joint is formed between the condyles of the femur
and the superior surface of the head of the tibia. The posterior
surface of the patella also enters into the joint.
A hinge-joint capable of movement round one axis only :
Transverse — flexion and extension.
A capsule surrounds the joint. It is, however, incomplete in
wfront where the tendon of the quadriceps extensor takes its
place. It has, as usual, distinct bands of fibres forming
strengthening fibres ; but they are not sufficient, so that expan-
sions from the tendons of adjacent muscles are also found.
The Anterior Ligament (ligamentum patellae) is a strong flat
band, the tendon of the quadriceps extensor, attached to the
.apex and margins of the patella, and continued on to be inserted
60
HANDBOOK OF ANATOMY
Gluteus Medius ....
Gluteus Maximus .
Biceps —
Semitendinosus —
Semimembranosus ._
Crureus
Gracilis
Internal Popliteal Nerve
Sartorius —
Gastrocnemius —
Soleusj ". Jl"_"
Flexor Longus
Digitorum
Peroneus Longus
TendoAchillis-
Tibialis Posticus
Plantaris
j|- Hio-hypogastric Nerve
. Lateral Cutaneous of
Tzth Thoracic Nerve
"Posterior Divisions of
first three Lumbar
Nerves
-..Posterior Divisions of
Sacral Nerves
....Post. Div. ofCocc. N.
...Perforating Cutan. N.
_Gluteal Branches of
Small Sciatic Nerve
"Post. Branch of Ext.
Cutaneous Nerve
Small Sciatic Nerve
(Outline)
Femoral Branches of
Small Sciatic Nerve
Ext. Cutaneous N.
(Anterior Branch)
LiM Small Sciatic Nerve
Posterior Branch of Int.
Cutaneous Nerve
Lateral Cutaneous of
External Popliteal
Nerve
Ramus Commun. Fib.
Ramus Comm,un. Tib.
... Ext. Saphenous Nerve
It::-* Branches of Internal
Saphenous Nerve
FIG. ,19. — MUSCLES AND CUTANEOUS NERVES OF LEG (POSTERIOR VIEW).
MUSCLES OF LOWER LI Ml?
61
Obliquus Externus Abdominis
Gluteus Medius ..
Tensor Fasciae Femoris
Psoas Magnus
Adductor Longus -
Gracilis -
Rectus Femoris -
Ilio-tibial Band -
Vastus Externus —
Vastus Internus —
Ext. Abdominal Ring
Ligamentum Patella-
Vjastrocnemms-
Peroneus Longus
Soleus
Kxt. Longus Digitorum
Kxt. Propnus Hallucis
Tibialis Auticus
Peroneus Tertiu.
Anterior Annular
Ligament
— Ext. Cutaneous Nerve
... Crural Branch of Genito-
cniral Nerve
... Inguinal Nerve
— Saphenous Opening
-.Mid. Cutaneous Nerve
Int. Saphenous Vein
Int. Cutaneous Nerve
(Outline)
Ant. Branch of Internal
Cutaneous Nerve
Patellar Plexus of Nerves
Patellar Branch of Internal
Saphenous Nerve
Int. Saphenous Nerve
Int. Saphenous Vein
Post. Branch of I nternal
Cutaneous Nerve
Cutaneous Part of Musculo-
cutaneous Nerve
-' Calcaneo-plantar Nerve
-. Int. Saphenous Nerve
(Terminal Part)
FIG. 20. — MUSCLES AND CUTANEOUS NERVES OF LEG (ANTERIOR VIEW).
62
HANDBOOK OF ANATOMY
into the anterior tubercle of the tibia. Expansions of the vast!
tendons, called lateral patellar ligaments, augment this.
The Posterior ligament is attached superiorly to the popliteal
surface of the femur just above the intercondyloid notch and the
two condyles; below to the posterior border of the head of the
tibia; on the fibular side, is an opening for the tendon of
Anterior Crucial •
Ligament
External Semilunar
Fibro-cartilage
Synovial Membrane
Long External Lateral.
Ligament
Posterior Superior -
Tibio-fibular
Ligament
Internal Semilunar
Fibro-cartilage
;ffl r'^^^^M - synovial M<^rane
^^.^•>'S3K».Internal Lateral
Ligament
" Post. Accessory Bundle
Posterior Crucial
Ligament
FIG. 21.— KNEE-JOINT (POSTERIOR VIEW).
popliteus. The tendon of semimembranosus forms an ex-
pansion to strengthen the ligament, called the oblique popliteal
ligament.
The Internal Lateral ligament is a strong, flat band, rather
wider in the middle. It is attached above to the inner surface of
the internal condyle just below the adductor tubercle, and below
to the inner surface of the internal tuberosity of the tibia,
KNEE-JOINT 6a
reaching round to the part above the groove for semimem-
branosus.
The External Lateral ligament is a rounded ligament attached
above to a tubercle on the outer surface of the external condyle
and below to the head of the fibula in front of the styloid pro-
cess ; at its attachment it splits the tendon of biceps. This
ligament is inside the capsule and not part of it.
The Inir a- Articular Ligaments. — The ligaments inside the
knee-jointure more important than the intra- articular ligaments
of any other joint.
The Crucial ligaments are two rounded tendinous bands at-
tached to the head of the tibia and the non-articular surfaces of
the condyles of the femur ; they are called anterior and posterior,
according to their tibial attachment. The Anterior Crucial liga-
ment is attached to the head of the tibia just in front of the
spine, and passes upwards and backwards, to be attached to the
posterior part of the inner surface of the external condyle.
This ligament is tense during extension. The Posterior Crucial
ligament is attached to the head of the tibia behind the spine,
and passes upwards and forwards, to be attached to the anterior
part of the outer surface of the internal condyle. This ligament
is tense during flexion.
The Semilunar Cartilages are placed between the articulating
surfaces of the tibia and femur ; they each have a thick convex
outer border attached to the surface of the tibia, and a concave
inner border ending in horns, anterior and posterior. The
internal one forms nearly a semicircle. The anterior horn is
attached just in front of the anterior crucial ligament, and the
posterior horn just in front of the posterior crucial ligament
between it and the spine. The external one is nearly circular,
its two horns being attached one each side of the spine.
The transverse ligament is a rounded band stretched between
the anterior margins of the two semilunar cartilages.
The synovial membrane is very large and complicated. It
completely invests the capsule, all the interarticular liga-
ments, and a pad of fat which is found beneath the patella,
where it forms a fold attached to the patella and the anterior
part of the intercondyloid notch. This is called the plica
«64 HANDBOOK OF ANATOMY
synovialis patellaris. In addition it forms at the patellar end
wing-like expansions — the plica alares— - which are usually loaded
with fat.
MUSCLES ACTING ON THE JOINT.
Action.
Flexion
Exten-
sion
Muscle.
Hamstrin
Biceps
Semi-
membran-
Semiten-
dinosus
Sartorius
Gracilis
Gastroc-
nemius
Plaritaris
Popliteus
Quadr
Rectus
femoris
Vastus
externus
Origin.
gs, consisting of —
See Hip-Joint
By two heads— (1) On
the upper part of the
external condyle and
supracoridyloid ridge ;
(2) from the space
between the internal
condyle and the ad-
ductor tubercle
From the lower third of
the outer supracondy-
loid ridge
By a tendon from the
outer surface of the
external condyle
oeps extensor, consisting
The straight head from
the anterior inferior
spine of the ilium and
the reflected head
from a groove just
above the acetabulum
From the anterior sur-
face of the shaft of
the femur in front of
the great trochanter
round to the outer lip
of the linea aspera and
its upper half ; deep
fascia
Insertion.
Nerve-supply.
The tendo Achillis in-
serted in the middle
part of the posterior
surface of the os calcis
The tendo Achillis, or a
separate insertion on
its inner side
The triangular surface
on the upper part of
the posterior surface
of the tibia above the
oblique line
of four parts
The upper border of
the patella and the
ligamentum patella?
The upper and outer
border of the patella
and the ligamentum
patellae
Tibial
Tibial
Tibial
Anterior
crural
Anterior
crural
TIB JO- FIBULAE JOINTS
65
MUSCLES ACTING ON THE JOIST— Continued.
Action.
Muscle,
( >rigin.
Insertion.
Nerve -supply.
Exten-
Vastus
From the lower two-
The upper and inner Anterior
sion
internus
thirds of the inter-
border of the patella crural
|
trochantoric line, the
and the ligamentum
inner lip of the linea
patellae
aspera, and upper
two-thirds of the line
!
from the linea aspera
to the inner condyle ;
deep fascia
Crureus
From the anterior and
The deep surface of the
Anterior '
(vastus
outer surfaces of the
tendons of rectus
crural
inter-
upper twTo-thirds of
femorisand the vasti,
medius)
the shaft of the
and the ligamentum
femur ; the lower half
patelLe
i
of the outer lip of the
linea aspera and the
line leading to the
outer condyle ; deep
fascia
The Tibio-Fibular Joints are two in number, between the
opposing surfaces of the extremities of the tibia and fibula. The
fibula forms a lateral support for the ankle-joint, and is not
required to have any independent movement, so these joints
simply provide a certain amount of elasticity, and are slightly
.gliding.
The Superior Tibio-Fibular Joint is formed between the small
oval facet on the inner surface on the head of the fibula, and
the facet on the posterior part of the external tuberosity of the
tibia. It is surrounded by a capsule and several strengthening
ligaments, more or less defined.
The synovial membrane is sometimes continuous with that of
the knee-joint.
The Inferior Tibio-Fibular Joint is formed between the op-
posing surfaces of the lower ends of the tibia and fibula; this is
not always a separate joint, but may be only a series of liga-
ments accessory to the ankle-joint. The ligaments are particu-
larly strong.
The Anterior Inferior Tibio-Fibular ligament is a strong band
66 HANDBOOK OF ANATOMY
of fibres attached to the front of the lower end of the tibia and
the outer malleolus.
The Posterior Inferior Tibio-Fibular ligament is also a strong"
band of fibres attached similarly on the posterior aspect of the
bones.
The Transverse Inferior Tibio-Fibular ligament is attached to
the posterior inferior border of the tibia, and the pit or fossa on
the posterior part of the inner surface of the external malleolus.
The Interosseous ligament connects the opposing surfaces; it
is continuous above with the interosseous membrane, and
attached in front and behind to the ligaments.
The synovial membrane lining the joint cavity is continuous
with that of the ankle-joint.
The Interosseous membrane attached to the interosseous borders
may be considered an accessory ligament to these joints. It
joins the inferior tibio-fibular joint below and may join the
superior tibio-fibular joint above, but there is always an opening
in its upper part for the anterior tibial vessels. Its fibres are
mainly directed downwards and outwards.
The Ankle- Joint, between the upper, inner, and outer surfaces
of the astragalus and the lower ends of the tibia and fibula.
It is a hinge joint, capable of movement round one axis only :
Transverse — flexion arid extension.
Owing to the shape of the articular surface of the astragalus,
which is wider in front than behind, a slight side to side rocking
movement can be produced during extension, as in this position
the narrower portion of the astragalus is in the tibio-fibular
socket. During flexion the wider part of the astragalus is forced
into the socket, and the joint is, so to speak, " locked," and
inversion and eversion of the foot can only be performed by out-
side force. This movement takes place in the joint between the
cuboid and os calcis, and between the astragalus and scaphoid,,
not at all in the ankle-joint itself.
A capsule completely surrounds the joint, and has various
strengthened parts.
The Anterior ligament is a thin ligament attached above to the
anterior edge of the tibia, and below to the upper border of the*
head of the astragalus. A pad of fat fills the hollow between.
ANKLE-JOINT
67
The Posterior ligament is attached to the edges of the tibia
and astragalus, and receives some fibres from the external
malleolus. The transverse ligament of the inferior tibio-fibular
joint strengthens this aspect of the ankle-joint. The - liga-
ment on the external aspect of the joint is divided into three
parts :
1. Anterior Part of the ligament from the anterior border of
the external malleolus to the astragalus in front of the articular
surface.
.Anterior Inferior Tibio-fibular
Ligament
Anterior Band of External
Lateral Ligament
Posterior Inferior —
Tibio-fibular Lig.
Posterior Band of...
Ext. Lat. Lig.
Middle Ban
iixt. Lat. Lig.
Peroneus Longus [
Peroneus Brevis
FIG. 22. — ANKLE-JOINT.
2. Middle Part of the ligament from the lower border of the
external malleolus to the external surface of the os calcis just
above the peroneal spine ; this is a strong rounded cord.
:>. Posterior Part of the ligament from the fossa on the inner
surface of the external malleolus to the external tubercle on
the posterior surface of the astragalus ; this is the strongest of
the three parts.
The Deltoid ligament is the one on the inner aspect of the
joint ; it is triangular in shape and attached by its apex to the
68 HANDBOOK OF ANATOMY
lower part of the internal malleolus, and by its base to the inner
surfaces of the scaphoid, astragalus, and os calcis, in one con-
tinuous line.
The synovia! membrane lines the joint and is continued up into
the inferior tibio-fibular joint. Pads of fat are found in front
and behind the joint, and in the socket where the three bones
meet.
The Intertarsal Joints are all gliding joints. They are sur-
rounded by capsules which are divided into definite bands of
fibres, as in the intercarpal joints. There are, however, three
ligaments of special importance, as they are mainly responsible
for supporting the longitudinal arch of the foot.
The Inferior Calcaneo-Navicular or Spring ligament is an
extremely strong band of fibro-cartilage. It is attached by one
end to the sustentaculum tali of the os calcis, and by the other
to the plantar surface of the scaphoid. Some of its fibres radiate
upwards to join the deltoid ligament.
The Inferior Calcaneo-Cuboid ligaments are two in number ;
the superficial or long plantar ligament is attached by one end to
the plantar surface of the os calcis in front of the tuberosities,
and by the other to the ridge of the cuboid and passing over
the groove to the bases of the third, fourth and fifth meta-
tarsals.
The deep or short plantar ligament is attached to the front of
the plantar surface of the os calcis, and to the plantar surface of
the cuboid just behind the ridge ; this is a short band of great
strength.
The tarso-metatarsal joints, intermetatarsal joints, metatarso-
phalangeal joints, and interphalangeal joints all resemble the
corresponding joints in the hand; but the movement is very
limited, as the foot is for the purpose of supporting the weight
of the body, and strength rather than flexibility has to be con-
sidered. The toes can be spread to a certain extent, constituting
abduction and adduction at the metatarso-phalangeal joints.
This movement takes place about a line drawn through the
second toe, not the middle one. Inversion — the movement of
raising the inner border of the foot — and eversion — raising the
outer border of the foot — has already been described. This can
ARCHES OF FOOT
69
be done by outside force when the ankle is flexed, or voluntarily
when the foot is on the ground.
The Arches of the Foot. — The foot having to support the
whole weight of the body, that weight is distributed among
its component parts by the arrangement of two arches at
right angles to one another — longitudinal and transverse.
External Popliteal Nerve
Tendon of Biceps _
Long External Lateral
Ligament
Peroneus Longus
Peroneus Brevis
TendoAcbillis....
Extensor Proprius Hallucis
Extensor Longus Digitorurn
Peroneus Tertius
-— Upper Division of Ant. Annular Ligament
f Lower Division of Ant. Annular Lig.
, Extensor Brevis Digitorum
Tendon of Peroneus> Tertius
FIG. 23. — MUSCLES OF LEG.
The Longitudinal Arch consists of a solid stable pier pos-
teriorly — the os calcis ; and an elastic resilient pier anteriorly,
which is much broadened out and consists of several parts, so
that stability is not sacrificed to resilience. The summit, or roof,
70
HANDBOOK OF ANATOMY
of the arch is the astragalus. The bones of the foot are really
arranged in two longitudinal columns. The inner one consists
of the os calcis, scaphoid, three cuneiforms, and first, second,
and third metatarsals; the outer one consists of the os calcis,
cuboid, and fourth and fifth metatarsals. In this way the
weight is evenly distributed to the front of the foot, which is
necessary in the upright position, as the line of gravity falls
in front of the knee-joint. The arch is kept in shape by the
plantar ligaments, plantar fascia, and tendon of tibalis posticus
which act as ties.
The Transverse Arch is most marked at the tarso-rnetatarsal
joints. The outer border of the foot is lower than the inner, so
that when the two feet are placed side by side the transverse
arch is complete.
MUSCLES ACTING ON THE ANKLE-JOINT.
Action.
Muscle.
Origin.
Insertion. Nevve-supply.
Flexion
Tibialis
From the external
The anterior part of the Anterior
anticus
tuberosity and upper inner surface of the i tibial
two-thirds of the outer first cuneiform and
surface of the shaft of
bane of the first meta-
the tibia : the inter-
tarsal
osseous membrane and
deep fascia
Extensor
From the outer tuber-
The muscle divides into
Anterior
communis
osity of the tibia and
four tendons, and is
tibial
digitorum
the upper two thirds
inserted into the four
of the anterior surface
outer toes in the same
of the shaft of the
manner as the exten-
fibula and deep fascia
sors of the fingers
Extensor
From the anterior sur-
The base of the terminal
Anterior
proprius
hallucis
face of the shaft of
the fibula in its middle
phalanx of the great
toe (hallux)
tibial
three fifths ; internal
to that of extensor
communis digitorum
and the interosseous
membrane
Peroneus
Is really part of exten-
The dorsal surface of Anterior
tertius
sor commuuis digit- the base of the fifth I tibial
orum, and arises from metatarsal
the lower part of the
anterior surface of the
fibulaand interosseous
membrane
MUSCLES OF ANKLE-JOINT
MUSCLES ACTING OX THE ANKLE-.lOINT-CW/////'fv/.
71
Action,
Muscle.
Origin.
Insertion. Nerve-supply.
Exten-
sion
Gastrou- f
nemius
These constitute the gro
and extend the ankle
up called calf muscles,
by raising the heel when '
Plantaris I
Soleus V
the foot is on the gro
movement from true
and — a slightly different
extension of the ankle .
Gastroc-
See Knee- Joint
nemius
-
Plantaris
See Knee-Joint
Soleus
(1) From the posterior
Tendo Achillis
Tibial
surface of the head
.
i and upper two-thirds
1 of the shaft of the
fibula ; (2) from a
fibrous arch between
the tibia and fibula ;
(3) from the oblique
line and middle third
of the inner border of
the tibia
Tibialis
From the upper three-
The plantar surfaces of
Posterior
postieus
fourths of the shaft of
all the bones of the i tibial
the fibula between the i foot except the first
oblique line and the metatarsal. As the
interosseous border ; | tendon passes round
the external tuber- the internal malleolus
osity of the tibia and
a slip is inserted into
the inner half of the
the sustentaculum tali
upper two-thirds of
the shaft below the
oblique line ; the in-
terosseous membrane
and deep fascia
Flexor
From the middle half
The muscle divides into
Posterior
longus
of the posterior sur-
four tendons, which
tibial
digitorum
face of the shaft of
are inserted into the
the tibia internal to
bases of the terminal
that of tibialis pos-
phalanges of the four
tieus and deep fascia
outer toes (cf. flexor
profundus digitorum)
Flexor
From the lower two-
The base of the terminal
Posterior
longus
hallucis
thirds of the posterior
surface of the shaft of
phalanx of the great
toe
tibial
the fibula and the
deep fascia
Inver-
Tibialis
See Flexion
sion and
anticus
Adduc-
tion
Tibialis
See Extension
postieus
s
72
HANDBOOK OF ANATOMY
MUSCLES ACTING ON THE ANKLE-JOINT—
Action.
Muscle.
( )rigin. Insertion.
Nerve-supply.
E version
Peroncus
From the head and
The tendon passes
Musculo-
and
Abduc-
longus
upper two-thirds of
the outer "surface of
through the groove in
the cuboid, and is in-
cutaneous
tion
the shaft of the fibula 1 serted on the outer
surface of the first
cuneiform and the
base of the first meta-
tarsal
Peroneus
From the lower two-
The tubercle and outer
Musculo- i
brevis
thirds of the outer surface of the base of
cutaneous
surface of the shaft of the fifth metatarsal
the fibula
MUSCLES ACTING ON THE METATARSO-PHALANGEAL JOINTS,
I
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Flexion
Flexor
See Ankle-Joint
longus
digitorum
Acces-
sorius
The outer head from The upper aspect of the
the outer border of tendons of flexor
External
plantar
the plantar surface of ! longus digitorum for
the os calcis and the \ second, third, and
long plantar liga- fourth toes
ment ; the inner head
from the inner surface
of the os calcis and
long plantar ligament
Lumbri-
The first from the tibial j The dorsal expansions First
I
cales
side of the innermost i of the extensor ten- lumbricales
tendon of the- flexor dons, etc., similar to from inter-
longus digitorum ; the i the lumbricales in the nal plantar ;
others from the adja- hand
the others
cent sides of the three j
from exter-
outer tendons
nal plantar
Flexor
See Ankle-Joint
longus
hallucis
Flexor
From the inner part of i The tendon divides to Internal
brevis
hallucis
the plantar surface of allow that of flexor ! plantar
the cuboid and the longus hallucis to
tendon of tibialis pos-
pass, and is inserted
ticus
into the sides of the
base of the first ;
phalanx of the great .,
toe
i
MUSCLES OF FOOT
73
MUSCLES ACTING ON THE METATARSO-PHALANGEAL
JOINTS— Continued.
Action.
Muscle.
Origin.
Insertion .
Nerve-supply.
Flexion
(contd. )
Flexor
brevis
digitorum
Flexor
brevis
minimi
digiti
From the greater
tubercle on the plantar
surface of the os calcis ;
from the plantar fascia
and the deep fascia
! From the base of the
fifth metatarsal bone
The second phalanges
of the four outer toes
(cf. insertion of flexor
sublimis digitorum in
the hand)
The outer side of the
base of the first
phalanx of the little
toe
Internal
plantar
External
plantar
Interossei
See Abduction and Ad-
duction
Exten-
sion
Extensor
longus
digitorum
See Ankle-Joint
Extensor
brevis
digitorum
From the upper surface
of the os calcis in front
of the articulation
The innermost tendon
is inserted into the
base of the first
phalanx of the great
toe, the others into
the dorsal expansions
of the next three toes
Anterior
tibial
Extensor
proprius
hallucis
See Ankle-Joint
Adducti
on : to the
middle line of the second
toe
Adductor
obliquus
hallucis
From the plantar sur-
face of the bases of
the second, third, and
fourth metatarsal
bones
The outer side of the
base of the first
phalanx of the great
toe
External
plantar
Adductor
trans -
versus
hallucis
From the capsules of
the outer four meta-
tarso - phalangeal
joints and the trans-
verse metatarsal liga-
ment
The outer side of the
base of the first
phalanx of the great
toe
External
plantar
Plantar
interossei
From the tibial sides of
the third, fourth, and
fifth metatarsal bones
respectively
With the dorsal muscles
on to the tibial sides
of third, fourth, and
fifth toes
External
plantar
Abducti
n : from t
he middle line of the seco
id toe
Abductor
hallucis
From the inner side of
the greater tuberosity
on the plantar surface
of the os calcis and
the plantar ligament
The inner side of the
base of the first
phalanx of the great
toe
Internal
plantar
74
HANDBOOK OF ANATOMY
MUSCLES ACTING ON THE METATARSO-PHALANGEAL
JOINTS— Continued.
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Abduc-
Dorsal
By two heads from the
The first and second
External
tion
interossei
adjacent sides of the
muscles are inserted
plantar
(contd. )
metatarsal bones
on the tibial and fibu-
lar side of the second
toe respectively ; the
two outer muscles are
inserted on the fibular
side of the third and
fourth toes into the
dorsal expansions
Abductor
From both tubercles on
The outer side of the
External
minimi
the plantar surface of base of the first
plantar
digiti
the os ealcis, the ; phalanx of the little
plantar fascia, and
toe
deep fascia
MUSCLES ACTING ON THE INTERPHALANGEAL JOINTS.
Action.
Muscle.
Origin.
Flexion
Extension
Flexor brevis digitorum
Flexor longus digitorum
Flexor longus hallucis
Extensor longus digitorum
Extensor brevis digitorum
Interossei
Lumbricales
Extensor proprius hallucis
See Metatarso-Phalangeal Joint
See Ankle-Joint
See
See
See Metatarso-Phalangeal Joint
See
See
See Ankle-Joint
The short muscles of the toes in the sole of the foot are
arranged in four layers beneath the plantar fascia. Starting
at the outermost layer, they are —
First layer : Abductor hallucis, flexor brevis digitorum, ab-
ductor minimi digiti.
Second layer : Lumbricales and accessories, and the tendons
of the long flexor muscles.
Third layer : Flexor brevis hallucis, adductores hallucis,
flexor brevis minimi digiti.
Fourth layer : Interossei (plantar and dorsal) and tendons of
peroneus longus and tibialis posticus.
MUSCLES OF FOOT
75
.External Plantar Artery
Peroneus Brevis
Posterior Perforating
Artery
First Digital Artery
Plantar Arch
Second Digital A.,
Third Digital A.
Fourth Digital A.
Anterior Perforating.
Artery
/ Internal Calcaneal Artery
^Posterior Tibial Artery
^-Internal Plantar Artery
.Tibialis Posticus
--.Flex. Longus Digitorum
- - Flex. Longus Hallucis
— — -> -Flexor Accessorius
— Tendon of Abd. Hallucis
Plantar Branch of
--Dorsalis Pedis Artery
Communicating Branch
- Arteria Magna Hallucis
FIG. 24.— SHORT MUSCLES AND ARTERIES OF FOOT.
76 HANDBOOK OF ANATOMY
The Deep Fascia of the lower limb is continuous with that
of the trunk, and that of the thigh is attached to the crest of
the ilium, the pubic arch and symphysis, the great sciatic
ligament, and Poupart's ligament; below it is attached to the
patella, the tuberosities of the tibia, and the head of the fibula.
On the* front of the thigh it is very thick, especially over
the region of Scarpa's triangle, where there is an opening
for the internal saphenous vein. On the outer surface of the
thigh there is a strong band in the fascia, the ilio-tibial band,
attached above to the iliac crest, and below to the outer tuber-
osity of the tibia. At the knee it forms the lateral ligaments
of the patella attached to the patella and the tuberosities of
the tibia. Just above the knee the deep fascia sends in ex-
pansions, intermuscular septa, which are attached to the supra-
condyloid ridges. On the back of the thigh the fascia is
especially thick over the popliteal space, where it is pierced
by the external saphenous vein.
Femoral Sheath. — A facial investment for the femoral
vessels, formed by the deep fascia covering Scarpa's triangle
above, and an expansion of the internal fascial lining of the
abdominal wall which goes down deep to the vessels, so en-
closing them between two layers of fascia. It is divided into
three compartments — the outer one for the artery, the inter-
mediate one for the vein, and the inner one for a lymphatic
gland ; this latter division is known as the crural canal.
The deep fascia of the leg is continuous with that of the thigh,
and passing down the leg sends in septa between the muscles.
At the ankle it is attached to the malleoli and the os calcis, and
forms the annular ligament.
The Internal Annular ligament is attached to the internal
malleolus and the tuberosity of the os calcis. A number of
important structures pass beneath it — viz., tendon of tibialis
posticus, tendon of flexor longus digitorum, post, tibial artery,
post, tibial nerve, tendon of flexor longus hallucis.
The External Annular ligament is attached to the external
malleolus and the os calcis, and the tendons of peroneus longus
and brevis pass beneath it.
Across the front of the ankle there are usually three bands
PLANTAR FASCIA 77
of fascia, but occasionally more are found. The extensor
tendons of the ankle pass beneath the uppermost one, and the
anterior tibial vessels and nerve pass over it.
In the sole of the foot the fascia forms the very important
Plantar Fascia attached to the tuberosity of the os calcis ; an-
teriorly it spreads out and divides into five slips, which are
attached to the digital sheaths of the toes. From the sides a
thinner layer of fascia spreads out to cover the muscles and
sends in intermuscular septa. The plantar fascia is instru-
mental in preserving the arch of the foot.
SECTION IV
VERTEBRAE, RIBS, AND MUSCLES OF TRUNK
THE vertebrae, thirty-three in number, articulating together,
form the spinal column. They are named according to the
region in which they are placed :
Cervical : 7 — neck region.
Dorsal : 12 — thoracic region.
Lumbar : 5 — abdominal region.
Sacral : 5 — pelvic region.
Coccygeal : 4 — caudal region.
™ Body
Superior Articular
Process
t J. Spine
<^/
FIG. 25.— A TYPICAL VEKTEBRA.
The vertebrae are all constructed on the same plan, but differ
slightly from one another in the various regions according to
their necessities.
A typical vertebra consists of a body more or less cylindrical
78
VERTEBRAE
in shape ; the sides and upper and lower surfaces are slightly
concave. Posteriorly, two short, stout processes — the pedicles —
are formed; these support flattened laminge, which fuse in the
middle line ; thus, the posterior surface of the body, the
pedicles, and the laminse form a bony canal through which the
spinal cord runs. The pedicles are not as deep vertically as the
bodies, so that between the pedicles of two adjacent vertebras
there are spaces left — the intervertebral foramina — through
which the spinal nerves emerge. Immediately in front of the
pedicles are other processes — the transverse, to which the
muscles of the back are attached, and on the upper and lower
surfaces of the pedicles are articular processes (four in all) for
the articulation of the vertebrae one with another. At the
junction of the laminae a third process is developed, called the
spine, for the attachment of muscles.
PRINCIPAL VARIATIONS IN VERTEBRAE OF DIFFERENT REGIONS.
Vertebra.
Body.
Spine.
Transverse Process.
Cervical (first
and second de-
scribed separ-
ately)
Dorsal
Oval in shape
Heart- shape,
with facets for
heads of ribs
Short and bifid
at the free end
Long, thin, and
pointing down-
wards
Small, and with a foramen
through which the verte-
bral artery runs
Have small facets for artic-
ulation with the tubercle
of the rib
Lumbar
Kidney-shape
Short, stout, and
horizontal
Point horizontally out-
wards, with several
tubercles for attachment
of muscles
The Sacral vertebrae are all fused together into one bone,
called the sacrum.
The Sacrum is a triangular bone formed of the five sacral
vertebra?, whose bodies and transverse processes have become
fused together, distinct ridges being seen at the line of fusion on
the anterior surface.
The anterior surface is concave from above downwards, and
has four foramina on each side of the middle line for the
passage of nerves. These are homologous with the inter-
vertebral foramina, and, through the fusion of the transverse
processes with one another, appear both anteriorly and pos-
SO HANDBOOK OF ANATOMY
teriorly. Above, the margin is projecting, forming the promon*
tory of the sacrum. This is more marked in the male than the
female.
The posterior surface is convex from above downwards, and
Superior Articular Process
Ala
Inferior Lateral Angle
4th Anterior Sacral Foramen
FIG. 26.— SACRUM (ANTERIOH SURFACE).
has the four foramina on each side, similar to the anterior
surface. In the middle line the spines of the vertebrae still
persist as four tubercles.
On each side of the upper part of the bone are the lateral
masses, large stout masses of bone, on the external aspects of
which are the surfaces for articulation with the innominate
bone.
VERTEBRAE
81
Superior Articular Procer.s
Rudimentary Articular Processes (fused) Ligamentous Surface .
, Auricular Surface
\ \
Transverse Procesi *\||n
(rudimentary)
Outlet of Sacral Canal _-
Notch for sih Sacral Nerve
2nd Posterior Sacral
Foramen
v Inferior Lateral Angle
% Sacral Cornu
FIG. 27.— SACRUM (POSTERIOR SURFACE).
Anterior Tubercle
Odontoid Facet
Tubercle for Transverse Ligament
Costal Process
f Superior Articular Process
t Costo-transverse
/ Foramen
Transverse Process
Vertebrarterial
Groove
Posterior Tubercle
FIG. 28.— ATLAS.
82
HANDBOOK OF ANATOMY
The Coccyx consists of four rudimentary vertebras, which are-
generally fused together, and often fused with the sacrum.
Special Vertebrae.
The First Cervical vertebra, or Atlas, differs from the typical
vertebra?. It consists of a ring of bone supporting laterally,
the lateral masses which articulate above with the condyles
of the occipital bone, and below with the second cervical
vertebra. Posteriorly, it has a rudimentary spine, and on the
posterior surface of the anterior arch is a small facet for
articulation with the odontoid peg of the axis, or second cervical
vertebra. The transverse processes, similar to those of the-
other cervical vertebras, are attached to the lateral masses.
Atlantal Facec
^ Odontoid Process
Groove for Transverse Ligament
Superior Articular Process
Superior
Notch
I Inferior
Notch
Costo-trans verse Foramen
Spine
Lamina
Inferior Articular Process
FIG. 29.— Axis.
The Second Cervical vertebra, or Axis, has the odontoid!
process projecting from the upper surface of its body, which
articulates with the anterior arch of the atlas. The superior
articular surfaces are large and nearly circular, to correspond
with the inferior articular processes of the atlas.
The Seventh Cervical vertebra is called the vertebra
proininens owing to the spine, whiclj ends in a broad, single
tubercle, and is markedly prominent at the root of the neck.
The Dorsal, or thoracic, vertebras are characterized by having
articular facets on their bodies for the heads of the ribs, and
STERNUM 83
on the transverse processes for the tubercles of the ribs. The
facets 011 the bodies are usually placed midway on adjacent
bodies, so that a demi-facet is found on the upper and lower
margins of bodies.
The Vertebral Column as a whole. The vertebra are so
articulated that the bodies, transverse processes, and spinous
processes are all superimposed. This causes posteriorly two
longitudinal grooves, one each side of the spine, in which are
placed the longitudinal muscles of the back.
Viewed from the side, it is seen that the column forms
a series of curves, slightly forward in the cervical region,
markedly backward in the thoracic region, and forward again
in the lumbar region. The sacrum, again, is convex backwards,
and the junction of the fifth lumbar vertebra with the sacrum is
called the sacro-vertebral angle, which is always very marked.
Ossification. — Centres for the bodies and neural arches appear
before birth. At puberty, epiphyses for the different processes
and upper and lower surfaces of the bodies appear. All become
completely fused about the twenty-fifth year.
The Sternum, or Breast-Bone, is in the middle of the upper
part of the anterior wall of the thorax. It articulates on each
side with the upper seven ribs and the clavicle. It consists of
three parts — the manubrium or presternum, the body, and the
ensiform or xiphoid cartilage.
The Manubrium is separate from the body, although occa-
sionally it is found to be fused. It is a flattened, four-sided
bone, the upper end being wider than the lower. At the
superior angles it articulates with the first rib on each side,
and immediately in front of this articulation on the upper
margin are the facets for articulation with the clavicles, be-
tween which is the suprasternal notch. At its junction with the
body is found the articulation for the second rib.
The Body of the Sternum is a long-shaped flat bone, with its
f-ddes notched for articulation with the second to the seventh ribs
inclusive. At its upper end it articulates with the manubrium,
and at the lower end is attached the ensiform cartilage, a pointed
process which is partly ossified.
The Sternum lies obliquely downwards and forwards in the
84
HANDBOOK OF ANATOMY
ist Thoracic
ist Lumbar
StC.
istT.
• ist L.
Sacrum
Coccyx
FIG. 30.— SPINAL COLUMN.
.ist Co.
STERNUM
85
front of the chest. At rest its upper end is opposite the lower
border of the second dorsal vertebra, and its lower end opposite
that of the tenth.
Jnterclavicular Notch
Clavicular Surface
Fcr ist Costal Cartilage
FIG. 31. — STERNUM.
Ossification. — Several centres are developed before birth, the
whole becoming fused about the fortieth year.
86 HANDBOOK OF ANATOMY
The Ribs.
The Ribs (costae) are twenty -four in number, twelve on each
side. They articulate posteriorly with the dorsal vertebrae,
and anteriorly with the sternum and one another (except the
eleventh and twelth, which are free at their anterior ends),
thus forming the lateral walls of the thorax.
A rib is a long, narrow, flat bone, consisting of a head and
neck attached to the shaft. The head is somewhat expanded,
and has on its inner surface a facet for articulation with the
Vertebrae, the lower half of which corresponds with the facet
on the upper margin of the body of the vertebra corresponding
with it, so that each rib articulates with the body of the vertebra
with which it is in numerical sequence, and with the body of the
one above. Thus, the seventh rib articulates with the upper
margin of the body of the seventh vertebra and the lower margin
of the body of the sixth. Below, the head is constricted to form
a neck, and where it joins the shaft there is a tubercle on the
posterior surface. The tubercle has a facet to articulate with
the transverse process of the vertebra numerically correspond-
ing with it. The shaft is long, flat, and narrow. It is convex
laterally, but the curve is much sharper posteriorly than
anteriorly, and where the curve is sharpest there is a rough,
oblique ridge on the external surface ; this is called the angle.
On the first rib the tubercle and angle coincide. They gradually
separate, being farthest apart on the eighth rib, and approach-
ing one another again on the lower ones. The shaft of the rib
is also twisted on itself, so that, if laid on a flat surface, one end
is always raised up. This is most marked in the middle ones, and
not found at all in the first, second, and twelfth. The upper
border is thick and rounded, the lower one thin and sharp, and
on the inner surface of the lower border is a groove for vessels
and nerves. The anterior end of the shaft is slightly expanded
and hollowed out for the attachment of the costal cartilage,
by means of which the ribs articulate with the sternum or one
another.
The first rib is much smaller than the others, quite flat, and
forms nearly a semicircle. On its upper surface, about midway,
RIBS
87
is a groove for the subclavian artery. On the inner border, about
.an inch from the anterior extremity, is the scalene tubercle.
The surfaces are directed upwards and downwards.
Subcostal
Groove \
Medullary -
Foramen
Ang
MCCK
^Upper Facet on Head
.Ridge for Interarticular
Ligament
_ Lower Facet on Head
Articular Part of Tubercle
Ligamentous Part of Tubercle
'jHead
Sternal
Kxtremity
Fiu. 32.— A TYPICAL RIB.
The second rib resembles the first in shape and in having
no twist, but is a good deal larger. The surfaces are directed
obliquely, similarly to those of the other ribs.
88
HANDBOOK OF ANATOMY
The eleventh and twelfth ribs are very much' shorter and
smaller than the others. Their anterior extremities are pointed
and tipped with cartilage, but are free and non-articulating.
Ossification. — The shaft is almost completely ossified before-
FIG. 33.— THORAX.
birth. Secondary centres for the head and tubercle appear
before puberty, and the whole rib is fused by the twenty -fifth
year.
The Thorax as a whole is barrel-shaped, narrower above than
VERTEBRAL JOINTS 89
below, and compressed antero-posteriorly. The inlet, or superior
aperture, is kidney-shaped, its plane oblique, sloping down-
wards and forwards. The lower aperture is curved, and slopes
upwards along the twelfth rib to the tip of the eleventh, along
the cartilages of the tenth, ninth, eighth, and seventh ribs
to the ensiform cartilage. This aperture is closed by the
diaphragm.
Joints of the Vertebral Column.
The vertebras articulate together by their bodies and the
transverse processes. Each individual joint has not much power
of movement, but, taken altogether, the range of movement of
the spine as a whole is considerable.
Intercentral Articulations. — These take place between the
flattened surfaces of the bodies of the vertebras. Between the
two surfaces is a cartilaginous disc, the inter vertebral disc. In
the cervical and lumbar region the disc is thicker in front than
behind, and the reverse in the dorsal, thus helping to form the
curves.
The Anterior Longitudinal ligament runs the whole length of
the spinal column on the anterior surface, from the first cervical
vertebra to the upper margin of the sacrum, and is firmly
attached to the intervertebral discs as it passes over them.
The Posterior Longitudinal ligament resembles the foregoing,
but is placed inside the spinal canal on. the posterior surfaces of
thedpodies.
Interneural Articulations. — These take place between the
articulating processes on the pedicles of adjacent vertebras.
These are gliding joints, each surrounded by a thin capsule
lined by a synovial membrane. In addition, the ligamenta flava
binds together the laminas. This ligament is inside the spinal
canal, and resembles the anterior and posterior longitudinal
ligaments in being continuous throughout the length of the
spinal column.
The spinous processes are attached to one another by inter-
spinous ligaments. In continuity with them are the supra -
spinous ligaments, which extend all along the spinal column
from tip to tip of the spines. In the cervical region these are
'X) HANDBOOK OF ANATOMY
particularly developed, forming a partition between the muscles
of the two sides, and called the ligamentum nuchae.
The atlas and the axis have several additional ligaments join-
ing them together, one being a transverse ligament, which is
attached to the dorsal surface of the anterior arch of the axis,
and passes behind the odontoid peg of the axis.
The spinal column as a whole is freely movable, and permits
of movement round three axes —
Transverse — flexion and extension.
Antero-posterior — lateral flexion.
Vertical — rotation.
Posterior Band of Superior
Costo-transverse Ligament
Anterior Band of Superior
Costo-transverse Ligament
_ . Anterior Common
Ligament
_Inlerverttbral
Anterior Costp-central '
or Stellate Ligament I
Interarticular Ligament
FIG. 34. — VERTEBRAL LIGAMENTS.
The articulations of the ribs, both with the vertebra) and the
sternum, are by means of gliding joints, which allow the ribs
to be raised and lowered by the muscles to perform the act of
"breathing.
Muscles of Trunk.
The actions of the muscles of the trunk are very complex.
They are arranged in two main sets —
Muscles of the back.
Muscles of the abdominal wall.
MUSCLES OF BACK
91
The Muscles Of the Back can again be divided into transverse
-and longitudinal. The transverse muscles are those which
connect the shoulder girdle with the spinal column, and the
longitudinal ones those that cause extension of the back and
Complexus
Cervicahs Ascendens,._
Splenius
Serratus Posticus Superior
..Vertebral Aponeu-
rosis
Musculus Accessorius .-J,
Longissimus Dorsi
Ilio-costalis,. —
.. Serratus Posticu
Inferior
FIG. 35. — MUSCLES OF THE BACK.
the movements of the pelvis (as in locomotion), which corre-
spond with those of the spinal column. The movements of
the head on the spinal column will be considered in another
section.
The muscles are arranged in four layers. Starting with the
most superficial they are —
HANDBOOK OF ANATOMY
1. Trapezius and latissiinus dorsi.
2. Levator anguli scapulae and rhomboids.
3. Serrati postici superior and inferior, splenius capitis
splenius cervicis.
4. Erector spinae and complexus.
Pectoralis Major
Serratus Magnus —
Latissimus Dorsi .
Obliquus Externus
Abdominis
Petit's Triangle
~ Middle Linea
Transversa
Umbilicus
'^..Umbili
Rectus Abdominis
Anterior Superior
Iliac Spine
.Poupart's Ligament
"External Abdominal
Ring
FK;. 36. — MUSCLES OK THE ABDOMEN.
Beneath these muscles are a lar«v number of smaller ones
that move the vertebrae on one another — e.g., rotatores, inter-
spinals, etc.
MUSCLES OF BACK
93
The Muscles of the Abdomen are arranged in three directions
— longitudinal, transverse, and oblique. The longitudinal ones
straight up the front, flex the trunk, helped by the oblique ones
when both sides act together. When the oblique muscles act
singly, rotation of the trunk takes place. The longitudinal
muscles on the posterior wall of the abdomen extend the spme~
when both act together. Acting singly, they flex the spine
laterally. The transverse muscles of the abdominal wall are
mainly used to keep the contents of the abdomen in place and
to add to the strength of the wall, but help in flexion with the
others.
Some of the muscles causing flexion and extension of the
cervical part of the spine are situated in the neck and attached
to the head ; these must not be confused with the muscles that
specially move the head on the spine.
(For Flexion and Extension of Spinal Column, see pp. 94
and 95.)
The movement of lateral flexion of the spinal column takes
place by the muscles of flexion and extension acting together
on one side. In the cervical region, however, there are a group
of muscles which cause lateral flexion of that part.
Artiun.
Muscle.
< )rigin.
Insertion.
Nerve-supply.
Lateral
flexion
Scalenus
anticus
From the transverse
processes of the third,
fourth, fifth, and sixth
cervical vertebrae
The scalene tubercle
and ridge -on the first
rib
Anterior
primary
divisions of
lower four
or five cervi-
cal nerves
Scalenus
medius
From the transverse
processes of the lower
cervical vertebra-
(second to sixth in-
clusive)
On the first rib behind
the groove for the
subclavian artery
Same as
above
Scalenus
posticus
From the transverse
processes of the fourth,
fifth, and sixth cervi-
cal vertebra;
The outer surface of the
second rib about the
middle
Same :is
above
94
HANDBOOK OF ANATOMY
MUSCLES (BOTH SIDES TOGETHER) ACTING ON THE
SPINAL COLUMN.
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Flexion
Longus
From the bodies and
The bodies and trans-
Anterior
colli
transverse processes
of the first three
verse processes of the
upper cervical verte-
primary
divisions of
thoracic and last th ree
L
brae
the upper
cervical vertebra
cervical
nerves
Psoas
See Hip-Joint
Rectus
By two heads from the
The front of the ensi-
Anterior
abdominis
symphysis and crest
form cartilage and
primary
of the pubis
seventh, sixth, and
divisions of
fifth costal cartilages
the lower
six thoracic
nerves
Obliquus
externus
From the outer surfaces
of the lower eight ribs
The external lip of the
iliac crest in its
Same as
above
abdominis
interdigitating with
anterior half and into
(external
serratus magnus and
a broad aponeurosis
oblique)
latissimus dorsi
covering the anterior
abdominal wall. By
this means it is
attached to the pubic
crest, and the lower
free edge of the
aponeurosis forms
Poupart's ligament
Obliquus
From the lumbar fascia,
The outer surfaces of
Same as
internus
the anterior half of
the last three ribs, and
above
abdominis
the iliac crest, and
forming an aponeuro-
(internal
the outer half of Pou-
sis into the seventh,
oblique)
part's ligament
eighth, and ninth
costal cartilages and
-
linea alba
Trans-
From the inner surfaces
The fibres form an apo-
Same as
versalis
of the lower six costal
neurosis, which joins
above
cartilages interdigi-
with that of the other
tating with the dia-
side to form the linea
phragm ; the lumbar
alba ; and below joins
fascia, anterior half of
the lower part of the
internal lip of iliac
obliquus internus to
crest, and outer third
form the conjoint ten-
of Poupart's ligament
don attached to the
•
crest of the pubis
MUSCLES OF BACK
95
MUSCLES (BOTH SIDES TOGETHER) ACTING ON THE SPINAL
COLUMN— Continued.
Action.
Muscle. Origin.
Insertion.
Nerve-supply.
Exten-
Com- From the transverse
Between the superior
Posterior^
sion
plexus processes of the upper
six thoracic and lower
and inferior" curved
lines of the occipital
primary
divisions of
four cervical vertebrae
bone near the middle
the spinal
line
nerves
Splenius | From lower half of liga-
capitis mentum nuclue and
Splenius capitis into the
mastoid process and
Same as
above
and spines of seventh cer-
cervicis vical and upper six
outer part of superior
curved line of occipi-
dorsal A^ertebrre
tal bone ; splenius
cervicis into the trans-
verse processes of the
upper cervical verte-
brae
Serratus
From the ligamentum
By slips into the second,
Same as
posticus
uuchae and spines of
third, and fourth ribs
above
superior
seventh cervical and
tirst four dorsal verte-
brae
f
,
Serratus
From the spines of the
By slips into the last
Same as
posticus
last two thoracic and
four ribs
above
; inferior
first two lumbar verte-
brae
Erector
From the posterior half
Divides into three por-
Same as
spinee
of the iliac crest, the
tions : (1) Ilio-costa-
above
posterior sacro - iliac
lis, by slips into the
ligament, the back of
the sacrum, and spines
lower six ribs ; (2) the
longissimus dorsi, by
of all the sacral and
outer slips into all the
lumbar vertebra
ribs and inner slips
into the transverse
processes of the upper
lumbar and all the
dorsal vertebrae ; (3)
spinalis dorsi, into the
spines of the upper
dorsal vertebrae
Quadra.tus Posterior part of iliac
Inner part of lower
First three
lumborum' crest, ilio-lumbar liga-
border of twelfth rib,
or four
ment, and transverse
and transverse pro-
lumbar
processes of the lower
lumbar vertebra?
cesses of upper lumbar
vertebrae
nerves
96
HANDBOOK OF ANATOMY
Poupart's ligament — the thickened free edge of the external
oblique muscle from the anterior superior spine of the ilium to
the spine of the pubis.
The movement of rotation of the spinal column can be
defined as the approximation of the twelfth rib of the one side
to the iliac crest of the other. It is carried out by the diagonal
: muscles of the trunk. Thus rotation to the left — i.e., turning
the body so tha"t the right twelfth rib is brought nearer to the
left iliac crest, is caused by the following muscles :
Right obliquus externus abdommis.
Left obliquus interims abdominis.
Left latissimus dorsi.
Left serratus posticus inferior.
Rotation to the right, by the opposite muscles acting together.
This movement is made possible by the directions of the fibres
of the muscles concerned, and the fact that the external oblique
muscle of each side is inserted into the ivhole of the pubic crest,
so that the right external oblique gets some of its fibres inserted
into the left pubis, and vice versa, consequently is able to pull
its own side of the trunk over to the other.
Muscles of the Thorax.
This group of muscles can equally well be called the muscles of
respiration, as they are the ones that raise the ribs or otherwise
enlarge the cavity of the thorax, and make respiration possible.
Muscle.
Origin.
Diaphragm From the ventral surface of
the ensi form cartilage ; from
I the ventral surfaces of the
cartilages of the lower six ribs
interdigitating with trans-
versalis ; by two crura from
the fronts of the bodies of
the upper lumbar vertebrae —
three on the right side, two
on the left — which decussate
in front of the aorta ; and
from the arcuate ligaments,
which are thickenings in the
fascia covering psoas and
quadratus lurnborum
Insertion.
It is inserted into a
large trilobed central
tendon, which is de-
veloped in the muscle
itself, and has no
bony attachment
Nerve-supply.
Phrenic
INTERCOSTAL MUSCLES
97
Inspiration, caused by the elevation of the ribs and depression
of the diaphragm.
The intercostal muscles fill up the spaces between the ad-
jacent ribs. They are arranged in two sets, external and internal,
eleven pairs of each.
Expiration, caused by the slackening of the muscles, the
weight of the thorax, and the elasticity of the lungs. The
triangularis sterni is a special depressor of the ribs, and some
anatomists consider the internal intercostal muscles to be so
also.
Internal Mammary
Artery
External Intercostal Muscle
Interchondral Part
cf Internal
Intercostal Muscle
External Intercostal Muscle
Interosseous Part of Internal
Intercostal Muscle
FIG. 37. — INTERCOSTAL MUSCLES.
Action.
Muscle.
Origin.
Insertion.
Nerve- supply.
Inspira-
tion
External
intercostal
From the lower border
of the rib between the
tubercle and the costal
cartilage. The fibres
go downwards and
forwards in series with
the fibres of the ex-
ternal oblique
The upper border of the
rib below from the
tubercle to the costal
cartilage
Intercostal
The
space in fr
ont over the costal cartil ages is tilled by the ante
intercostal aponeu rosis
rior
98
HANDBOOK OF ANATOMY
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Inspira-
Internal
From the lower border
The upper border of the
Intercostal
tion
intercostal
of the costal carti-
rib below from the
(contd.)
lage and inner edge of
sternum to the angle
the subcostal groove ;
of the rib
from the sternum to
the angle of the rib.
The fibres go down-
wards and backwards
in series with the
fibres of the internal
oblique
[
The
space beh
ind, between the angles
and the tubercles of the
ribs, is filled;
by the posterior intercos
tal aponeurosis
Scaleni
See Back Muscles
Serrati
See Back Muscles
postici
Depres-
sors of
Triangu-
laris
From the back of the
4hsiform cartilage and
The cartilages of the
second to sixth ribs
Intercostal
the ribs
sterni
sternum as high as
inclusive
in expi-
the third costal carti-
ration
lage.
Internal
See above
intercostal
Abdomi-
See Flexion of Spinal
nal
Column
muscles
Several other muscles are used in acts of extraordinary or
forced inspiration, namely :
Quadratus lumborum.
Pectorales major and minor.
Serratus magnus.
Latissimus dorsi.
Sterno-mastoid .
^Extensors of the back.
The Deep Fascia of the trunk forms a complete investment
for all the muscles. In the upper part of the body it is similar
to the deep fascia of the limbs, forming an outside covering, and
sending in septa between the muscles ; but in the lumbar and
abdominal regions it is rather more complicated.
LUMBAR FASCIA 99
The Lumbar Fascia is attached to the lumbar vertebrae in
three layers — the outermost layer, to the spines ; the middle
layer, to the transverse processes; the innermost layer, to the
bodies, near the roots of the transverse processes.
The outermost layer covers the dorsal surface of erectpr_
spinae.
The middle layer lies between erector spinae and quadra tus
lumborum.
The innermost layer covers the ventral surface of quadratus
lumborum.
The middle layer then splits into two, so that four layers of
fascia are formed for the three layers of abdominal muscles.
1. Covers the outer surface of external oblique.
2. Lies between external and internal oblique.
3. Lies between internal oblique and transversalis.
4. Covers -the inner surface of transversalis.
At the outer border of rectus abdominis these four layers
now join again to form two layers, which pass one in front of,
the other behind, rectus abdominis, forming what is called the
sheath of the rectus ; this takes place in the upper three-
fourths of the muscle. In the lower fourth both the layers of
fascia pass in front of the rectus, so that on its ventral surface
three-fourths of the way down there is a free edge of fascia,
known as the fold of Douglas.
SECTION V
P
BONES AND MUSCLES OF HEAD
THE term skull includes all the bones making up the head. This
comprises the bones which enclose the brain — i.e., the cranium,
and the bones composing the skeleton of the face.
The bones of the cranium are — The occipital, sphenoid,
ethmoid, frontal, the two parietals, and the two temporals.
The bones of the face are — The vomer, the mandible, and
pairs of maxillae, malar, palate, lachrymal, nasal, and inferior
turbinate.
The hyoid bone is usually described with those of the skull.
All the bones of the head and face are joined together by
immovable joints (sutures), except the mandible.
The skull, as a whole, is studied from five aspects — from
the front, the side, the back, the top, and the base.
Norma Frontalis — the skull viewed from the front. This
is limited above by the smooth convex upper part of the frontal
bone, and below by the teeth of the upper jaw, if the mandible
be disarticulated. The eye-sockets are formed by the lower
part of the frontal bone, which in the middle articulates with
the two nasal bones to form the bridge of the nose. The
lower border of the eye-sockets is formed, internally, by the
maxillae and externally, by the malar bones, which give promi-
nence to the cheeks. The two maxillae articulate in the middle
line below the nasal opening, to form the upper jaw; below
hangs the mandible, or lower jaw, which articulates on each
side by a very loose joint with the temporal bone.
Nopma Lateralis (the side view of the skull). — In this view
it can be seen distinctly which bones form the face and which
the cranium. A line drawn from the middle of the lower border
100
NORMA LATERAL!^ L ; 101
of the frontal bone to the mastoid process of the temporal bone
indicates the boundary. The cranium is of oval shape, with
the long axis going backwards and downwards. The bones
FIG. 38. — THE LATERAL REGION OF THE SKULL (NORMA LATERALIS).
I, I, Frontal ; II, II, Parietal ; III, Occipital ; IV, Great Wing of Sphenoid ;
"\T Q^ti^i wts-vii.-* 1>^%,4-C^« «r T^««« .t«._1 . "\fT tf j_ *J T»_ A« f» m
1, Bregma ; 2, Superior Temporal Ridge ; 3, Inferior Temporal Ridge ; 4, Occipital
Point ; 5, Auricular Point ; 6, Mental Foramen ; 7, Lachrymal Groove ;
8, Glabella.
composing 'it from before backwards, are — The frontal, parietal,
temporal, and occipital. In this view it can also be seen that
10_> LHAHD1300K OF ANATOMY
the malar articulates with a process of the temporal. Between
this process and the opening of the ear is the articulation of
the mandible.
Norma Oceipitalis (the back view of the skull) shows the
rounded shape of the back of the head and the joints of the
occipital and parietal bones, called the lambdoid suture.
Norma Vertiealis (the view of the skull from above). — This
varies very much with different individuals, and may be nearly
circular or a long oval. The T-shaped sutures of the large
bones forming the vault is seen : the two parietal bones join in
the middle line ; and anteriorly, where the parietals join the
frontal, and posteriorly, where the parietals join the occipital,
are situated the openings called the anterior and posterior
fontanelles, found on the head at birth. These are due to the
ossification of the several bones not being complete.
Norma Basalis (the view of the base of the skull, without the
mandible). — In front is seen the row of upper teeth, between
them being the processes of the maxillae forming the roof of the
mouth. Behind this is the sphenoid bone which, as it were, bolts
together the whole skull underneath. The pterygoid plates,
two on each side, hang down for the attachment of muscles,
and the great wings of the sphenoid pass out on each side to
articulate with the temporal bones. Articulating with the body
of the sphenoid bone is the basilar process of the occipital bone,
and behind this is seen the opening for the passage of the
spinal cord. On each side of the opening are the prominent
articular facets for articulation with the first vertebra. There
are numerous foramina on the base of the skull for the passage
of the cranial nerves.
The Frontal bone consists of three parts : a frontal part,
forming the forehead; an orbital part, forming the upper
margins of the eye-sockets; and a nasal part which helps to
form the bridge of the nose.
The frontal part is convex in both its diameters, most marked
just above the orbital margins.
• The orbital part consists of the two rounded margins, separated
from one another by the nasal notch. At the inner third of the
margin is a deep groove, or may be a foramen, for the passag'e of
FIG. 39.— THE EXTERNAL BASE OF THE SKULL.
Ant. Palatine Fossa 18.
Post. Nasal Spine 19.
Post. Border of Vomer 20.
Facial Surf, of Sup. Maxilla 21.
Hamular Process of Int. Pterygoid 22.
Plate of Sphenoid 23.
Pterygoid Fossa 24.
Ext. Pterygoid Plate 25.
Zvgomatic Process of Malar 26.
Zygoma of Temporal 27.
Pharyngeal Tubercle (pointer 28.
crosses Foram. Lacerum Med.) 29.
Eustachian Groove 30.
Groove for Chorda Tympani ji.
Nerve
Petrous Portion of Temporal (Ori- 32.
gin of Levator Palati) 33.
Carotid Foramen 34.
Ext. Auditory Meatus 35.
Ext. Auditory Process 36.
Basion
Bas
Mastoid Process
Jugular Foramen
Ant. Condvlar Foramen
Digastric Groove
Occipital Groove
Post. Condvlar Foramen
Sup Curved Line of Occipital
Inf. Curved Line
Ext. Occipital Crest
Ext. Occipital Protuberance
Opisthion
Foramen Magnum
Right Occipital Condyle
Foram. Lacerum Medium
at +
Vaginal Proc. of Tymp. Plate
Mastoid Foramen
Stylo- Mastoid Foramen
Styloid Process
Tympanic Plate (Tost, part of
Glenoid Fossa)
37. Spii'ous Proc. of Sphenoid
38. Ant. part of Glenoid Fossa
*39V Foramen Spinosum
46". ^Foramen Ovale
\fj.' Foramen Vesalii
42. Preglenoid Tubercle
43. Eminentia Articularis
44. Zygomatic Fossa
45. Iniratemporal Crest
46. Temporal Division of Great
Wing of Sphenoid
47. Spheno-Maxillary Fissure
48. '1 uberosity of Sup. Maxilla
49. Ext. Access. Palat. Foramen
50. Post. Access. Palat. Foramen
51. Post. Palatine Foramen
$2'. Right Post. Naris (pointer crosses
ridge for Tensor Palati)
53. Groove for Descend. Palat. Artery
54. Horiz. Plate of Palate Bone
55. Palat. Proc. of Sup. Maxiiia
104
HANDBOOK OF ANATOMY
the supra-orbital nerve ; the margins end in the external angular
processes.
The nasal part is roughened and projects backwards for the
articulations of the nasal bones and other bones which are inside
the face.
The frontal bone articulates with the parietal bones above,
Parietal Border
Superior Temporal Ridge
Inferior
Temporal Ridge
Frontal Eminence
Temporal Surface for
Temporal Muscle
\
N External
Angular Process
Lachrymal Fossa
Glabella / J
Nasal Process
• \ n
i Superciliary Rjdge
Supra:pi'bltal Notch
Nasal Sni-*
FIG. 40.— THE FRONTAL BONE.
with the malar bones by the outer extremities of the orbital
margins, with the great wing of the sphenoid externally, just
beyond the orbital margins.
The Parietal bones are two square-shaped bones, convex
outwardly in both diameters. They articulate above with one
another, anteriorly with the frontal bone, posteriorly with the
occipital bone, and below with the temporal and sphenoid
bones.
OCCIPITAL BONE
105-
The Occipital bone consists of three parts arranged around
the foramen magnum — a large hole for the passage of the spinal
cord. The posterior part is triangular in shape, the apex being
upwards, and is convex outwardly in both diameters. About the
centre of this surface is a tubercle — the external occipital protu-
Upper or Interparietal part
of Tabular Portion
External Occipital Crest 1 ^External Occipital Protuberance
Highest Curved Line", \ 1 / / Superior Curved Line
^ Y / ^>^
Inferior Curved Line
Lateral Angle
Inferior Lateral
Border of
Tabular Portion
v Jugular Process
Posterior Condylar Fossa and
Foramen (latter inconstant)
Anterior Condylar Foramen
Pharyn?eal Tubercle on
Basilar Process
FIG. 41.— THE OCCIPITAL BONE.
berance — and from this curves out on each side the superior
curved lines; a short distance below are the inferior curved
lines. On each side of the foramen magnum are the condyles
for articulation with the atlas. They are large oval masses
of bone with an articulating surface convex in both directions -r
106
HANDBOOK OF ANATOMY
in front and behind are found the anterior and posterior con-
dylar foramina, the former of which transmits the hypoglossal
nerve. The basilar process, in front of the foramen magnum,
is a stout bar of bone articulating with the body of the
sphenoid.
The occipital bone articulates with the two parietals above,
with the sphenoid in front and below, externally with the
temporals, and below with the atlas.
, Squamous Portion
Supramastoid Crest
Parietal "Notch \
Post. Root of
Zygoma
JVlastoid" Foramen
Mastoid Portion
External Auditory Meatus
Ant. Part of Glenoid Fossa
Post. Part of Glenoid Fossa
(Tympanic Plate)
Styloid Process
FIG. 42. — THE RIGHT TEMPORAL BONE.
The Temporal bone consists of a plate of bone, having on its
lower border three processes. The inner part of the temporal
bone supports the bony part of the ear, the aperture of which
is seen just behind the root of the zygomatic process at the
lower border of the squamous part (flat plate). The zygomatic
process is a bar of bone projecting horizontally forwards. Just
in front of the root is the surface for articulation with the
SPHENOID BONE 107
mandible and internal to the root ; the styloid process, a slender
process of bone, projects vertically downwards. The mastoid
process is a stout conical-shaped process behind the opening of
the ear, its apex pointing forwards and downwards. »
The temporal bone articulates by means of the upper border
of the squamous part with the sphenoid (great wing), parietal^
and occipital bones, and by the zygomatic process with the
malar bone.
The Sphenoid bone consists of a small body with several
paired processes, the important ones being the great wings and
the pterygoid plates. The latter, four in number, project
downwards behind the nose. The great wings have at their
extremities triangular surfaces, which articulate with the
frontal, parietal, and temporal bones ; these lock the sides of the
cranium anteriorly. The body lies between* the ethmoid (which
articulates with the nasal parts of the frontal bone) and the
basilar process of the occipital bone, so locks the cranium in
the antero-posterior direction. The great wings also form part
of the orbital cavity, and between the great wing and the lesser
wing is the sphenoidal fissure at the back of the orbital
cavity through which the first part of the fifth nerve passes.
The foramen rotundum and foramen ovale are in the great
wing.
Bones of the Face.
The MaxillSB unite to form the upper jaw; the body is pyram-
idal in form, and hollow, and has on it the infra-orbital foramen,
through which part of the fifth nerve emerges. On the anterior
border is a deep notch — the nasal notch ; above the nasal notch
the edge of the bone is rough to articulate with the nasal and
frontal bones, below which it unites with its fellow of the
opposite side. The inferior or alveolar border is ridged ex-
ternally, and from it project the upper row of teeth; on the
inner surface the palatal process, a flat plate of bone, projects
horizontally inwards to form the roof of the mouth. The
upper border is smooth and rounded, and forms the inner
half of the lower border of the orbjtal margin, and ends in
a rough process for articulation with the malar bone ; the pos-
108
HANDBOOK OF ANATOMY
terior border is smooth and rounded, and hangs free at the
back of the mouth. The hollow space enclosed is called the
antrum of Highmore.
The maxilla articulates with the nasal, frontal, and malar
bones, and its fellow of the opposite side.
The Malar bone, or cheek-bone, forms the most prominent
part of the cheek ; the bone is convex outwardly and more or
Nasal Process
For Lachrymal Bone
For Nasal Bone
Lachrymal Tubercle
Lachrymal Notch
Orbital Surface
Infra-orbital Groove
Openings of ,
Post Dental Canals
._ Nasal Notch
-.Anterior Nasal
Spine
Tuberosity
Zygomatic Surface 4
I
Malar Process
Palatal Process
1 Canine Fossa
Infrn.orbital Foramen
FIG. 43. — THE SUPERIOR MAXILLA.
less square in shape, three of the angles being prominent. The
superior angle articulates with the external angular process of
the frontal bone, and the upper half of the inner side of the
malar bone forms the outer half of the lower border of the
orbital margin ; the lower half of the inner border articu-
lates with the maxilla : the fourth angle articulates with the-
MANDIBLE
109
zygomatic process of the temporal bone, completing the
arch.
The Mandible, forming the lower jaw, is horseshoe in shape,
with vertical processes at the ends. The body supports on its
upper border the lower row of teeth, and near the middle line
on the outer surface is the mental foramen through which the"
mental nerve emerges. In the middle line of the body a faint
ridge can be seen, the symphysis, indicating that the bone was
developed in two halves and fused in the middle line. On the
Left
Left Condyle
Condylar
Tubercle
Impression for Temporal
Muscle
Incisor Fossa
AJental Protuberance ,'
Mental Tubercle
Posterior
--Border of Ranms
Angle
Mental Foramen
FIG. 44. — THE INFERIOR MAXILLA (MANDIBLE).
inferior border on each side of the symphysis is the digastric
fossa, a small concave surface for the digastric muscle, and on
the inner surface of the bone is found an oblique line or ridge,
the mylo-hyoid ridge, slanting from above downwards and
forwards.
The posterior vertical portions are called rami; they pass
upwards from the posterior extremities of the body of the bone
forming the angle of the jaw, which varies with different
110 HANDBOOK OF ANATOMY
individuals. On the inner surface of the bone is a large foramen
for the inferior dental nerve, and overhanging it a small spur
of bone, called the lingula. The ramus ends above in two
processes — the coronoid anteriorly and the articular condyle
posteriorly. Between them is a notch — the sigmoid notch.
The mandible articulates with the temporal bone.
The Hyoid bone is a small U-shaped bone lying between the
mandible and the larynx, and connected to the skull by liga-
ments from the styloid process of the temporal bone ; it is not
articulated with any bones.
The bone cpnsists of a small body with two large processes,,
the great cornua projecting backwards and, where the great
cornua join the body, two small pointed processes, the lesser
cornua, projecting obliquely upwards.
The hyoid bone has a large number of muscles attached to it,,
and owing to its loose connection with the skull gives great
mobility to this region.
Joints of the Skull.
All the joints of the head and face, with the exception of the
temporo-mandibular, are sutures. These are immovable joints
formed by dentated edges fitted together and firmly united by
means of cartilage.
Temporo-Mandibular Joint between the condyle of the man-
dible and the articular hollow at the root of the zygomatic
process of the temporal bone.
The joint is a very movable one, the condyle being almost
cylindrical in shape, with its long axis directed outwards and
forwards. The articular or glenoid fossa is saddle-shaped,
being concavo-convex from behind forwards. The joint is
divided into an upper and lower part by a meniscus of fibro-
cartilage, which compensates for the difference in shape of the
two surfaces.
Owing to this construction the joint is particularly movable,
and the two joints need not always act simultaneously, but can
do so alternately, which gives a lateral movement to the jaw.
The movements possible are —
Transverse axis — raising and depressing of mandible.
TEMPORO-MANDIBULAR JOINT
111
During depression — protrusion and retraction.
Alternate — lateral motion.
A combination of all these movements produces a rotatory
movement of the jaw.
Ligaments. — A capsule surrounds the joint completely, but
internally it is very thin; it is attached to the meniscus all
round.
Temporo-Mandibular ligament from the outer half of the lower
border of the zygoma to the posterior border and lateral
Capsular Ligament
Styloid Process
Zygoma
- Coronoid Process
- Spheno-mandibular
(Internal Lateral)
Ligament
Stylo-mandibular Ligament -
Mylo-hyoid Groove
FKJ. 45. — THE TEMPOKO-MANDIBULAR JOINT.
surface of the neck of the mandible (the part supporting the
condyle) .
A synovia! membrane lines both compartments of the joint,
which may be continuous through a perforation in the cartilage.
Accessory Ligaments : Spheno-mandibular from the spinous
process of the great wing of the sphenoid bone to the lingula
on the inner surface of the mandible.
Stylo-Mandibular, from, the tip of the styloid process of the
temporal bone to the posterior border of the angle of the
mandible.
.12 HANDBOOK OF ANATOMY
Articulation of Skull with Spinal Column.
The skull articulates with, the spinal column by means of the
condyles of the occipital bone and the articular facets on the
lateral masses of the atlas. The condyles are convex in both
lateral directions, and the facets concave, so the joint is freely
movable round two axes.
Transverse — flexion and extension.
Antero-posterior — lateral flexion.
A combination of these movements causes rotation or "rolling."
A capsule, which is complete, surrounds both the joints.
A synovia! membrane lines both the joint cavities.
Accessory Ligaments. — These are very numerous and more
important than the ligaments of the actual joints.
Odontoid ligaments, are three in number, one from the apex of
the odontoid peg and one on either side; these latter are called
check ligaments.
Occipito-Atlantoid ligaments, anterior and posterior ; their
membranous structure continuous with the capsules of the
joints, thus forming a complete ligament between the foramen
magnum and the anterior and posterior arches of the atlas.
Posterior Occipito-Axoid ligament, a continuation upwards of
the posterior longitudinal ligament.
Ligamentum Cruciatum, a cross- shaped ligament, the hori-
zontal part formed by the transverse ligament of the atlas, the
vertical bars being attached to the occipital bone and axis
respectively.
Muscles acting1 on the Joints of the Skull.
The muscles of the head and face are divided into four sets :
1. Muscles of the scalp.
2. Muscles of expression.
3. Muscles of mastication.
4. Muscles connecting the skull to the spinal column.
1: The Muscles of the Scalp are the occipito-frontalis muscle
:and the muscles of the external ear.
The OeeipitO-Frontalis muscle does not act on any joint.
MUSCLES OF MASTICATION
113
The posterior part of the muscle fibres, arising from the outer
two-thirds of the superior curved line of the occipital bone,
are inserted into the epicranial aponeurosis; the anterior part
arises from the epicranial aponeurosis and blends with muscles
round the orbital margins.
The epicranial aponeurosis is a thick fascial membrafio
^attached posteriorly to the superior curved lines of the occipital
bone, laterally to the temporal bone ; anteriorly, it blends with
t*he deep fascia.
Nerve-supply — facial.
2. The Muscles of Expression are a large number of small
muscles in the face which generally have bony origins, but are
inserted into the fascia or blend with other muscles ; they are
in three groups, associated with the eye, the nose, and the
mouth.
Nerve supply — facial.
3. The Muscles of Mastication are those acting on the
temporo-mandibular joint, causing movement of the lower jaw ;
the muscles which depress the lower jaw are muscles of the
neck, not true muscles of mastication.
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
Raising
Masseter
From the anterior two-
The outer surface of the
Inferior
or
thirds of the lower
ramns and angle of
maxillary
closing
border of the zygoma
the lower jaw
division of
of the
and the inner surface
the fifth
jaw
in its whole length
Temporal
The whole of the tem-
The inner surface and
Same as
poral fossa and fascia
apex of coronoid pro-
above
covering it
cess and anterior bor-
der of the ramus of
J
the lower jaw
Internal
From the inner surface
The inner surface of the
Same as
pterygoid
of the external ptery-
angle of the lower jaw
above
goid plate and from
the tuberosity of the
maxilla
; Protra- External From the under surface
The anterior border of
Same as
sion
pterygoid
of the great wing of
the neck of the lower
above
the sphenoid and the
i jaw, the inter-articu-
«.
outer surface of the
lar cartilage, and the
external pterygoid
capsule
plate
Internal
See above
pterygoid
114
HANDBOOK OF ANATOMY
Action.
Muscle.
Origin.
Insertion.
Nerve-supply.
«
~ -
Protru-
Temporal
From the under surface
sion
(anterior
of the great wing of
(contd. )
fibres)
the sphenoid and the
outer surface of the
external pterygoid
plate
Retrac-
Temporal
See above
tion
(posterior
fibres)
Lateral
External 1
move-
(
r
Pterygoid of one side
ment
Internal J
The Buccinator muscle is also a muscle of mastication, but has
no action on the jaw ; it is the muscle of the cheek, and by its
contraction prevents food from collecting on one side.
Muscle.
Origin.
Insertion.
Nerve-supply,
Buccinator
From the alveolar arches
of the upper and lower
jaw and from the pterigo-
mandibular ligament
The fibres pass forward and
blend with the muscles
round the mouth
Branches
from both
fifth and
seventh
nerves
MUSCLES OF THE NECK WHICH DEPRESS THE LOWER JAW
Action.
Muscle.
Origin.
Insertion.
Nerve -supply.
Depres-
sion
Digastric
Posterior belly from the
digastric groove in
front of the mastoid
The oval impression on
the lower border of
the mandible close to
Branch
from
inferior
process. This ends' in
the symphysis
dental
a tendon which is
connected by a band
of fascia to the body
of the hyoid bone.
The anterior belly
arises from this, and
is directed forwards
and upwards
Suprahyo
id muscles — i.e., those w
jaw, and are inserted in
hich have their origin^ o
to the hyoid bone
n the lower
4. The muscles causing Movements of the Head — i.e., those
connecting the skull to the spinal column.
(1) Flexion and extension — the muscles of both sides acting
together.
MOVEMENTS OF HEAD
115
Action.
Muscle.
Depressor
Origin. * Insertion.
Nerve-supply.
Flexion
|s of the jaw when tempo ro-mandibular joint is fix
ed
Infrahypi
Recti capi
on the ]
d muscles — i.e., between hyoid bone and sternum
tis antici major and min or, small muscles having
esser cervical vertebrae a nd their insertions on th
process of the occipital bone
their origins
e basilar
Exten-
sion
Sterno- From the anterior sur-
mastoid j faceofthemanubrium
sterni and the inner
third of the upper
border of the clavicle
The outer surface of the
mastoid process and
the superior curved
line of the occipital
bone
Spinal
accessory
Splenius
capitis
See Extension of Spinal
Column
Com-
plexus
See Extension of Spinal
Column
Obliquus
inferior
From the spine of the
axis
The transverse process
of the atlas
Post
primary
divisions
Kectus ca
atlas
pitis posticus major and
to the occipital bone be
minor from the spine of
hind the foramen magn
the axis and
um
(2) Lateral movement — the muscles of one side acting alone.
Action.
Lateral
flexion
Muscle.
Origin.
Insertion.
Sterno-
mastoid
See Extension
Splenius
capitis
See Extension
Com-
plexus
See Extension
Obliquus
superior
From the transverse
process of the atlas
The occipital bone beneath complexus
Rectus ca
from
the s
pitis lateralis, a small m
the transverse process of
ide of the foramen magn
uscle in series with the other recti
the atlas to the occipital bone at
um
Rotation
Sterno-m
astoid
Splenius
capitis
Complexu
s
Recti capi
ti postici (major and mi
nor)
1
' Obliqui
(superior and inferior)
SECTION YI
THE DIGESTIVE SYSTEM
THE digestive system includes the alimentary canal and various
organs connected with it. The greater part of the digestive
system lies within the abdomen. The alimentary canal consists
of the following parts : Mouth, pharynx, oesophagus, stomach,
duodenum, small intestine (jejunum, ileum), large intestine,
rectum ; and the organs connected with it are — salivary glands,
liver, pancreas. The whole of the alimentary canal consists of
structures formed of one or more muscular coats lined with
mucous membrane.
The Mouth is the first division of the alimentary canal, and
contains the parts necessary for mastication and the openings
of the ducts of the salivary glands. The food passes from the
mouth into the pharynx, a large space at the back of the nose
and mouth, containing in its lower half the greater part of the
tongue and the larynx. The pharynx ends at the level of the
sixth cervical vertebra, and from it pass the larynx and trachea
in front and the oesophagus behind.
The (Esophagus is the part of the digestive canal which leads
from the pharynx to the stomach. It is a muscular tube, flat-
tened by the trachea and the other structures lying on it. It lies
in the thorax and extends from the sixth cervical vertebra to
the eleventh dorsal vertebra, where it passes through the dia-
phragm and enters the stomach. It is closely applied to the
vertebral column, lying behind the other structures in the
thorax.
The Abdominal Cavity, which contains the rest of the
alimentary canal, is bounded above by the diaphragm, below
by the pelvic floor, posteriorly by the lumbar vertebras, and
116
PERITONEUM 117
anteriorly and laterally by the abdominal muscles and iliac
bones. The false pelvis is included in the abdominal cavity.
The abdomen is divided up into nine regions by two horizontal
lines and two vertical lines.
The subcostal line, the upper of the two horizontal ones, is
drawn round the trunk at the level of the lower border of the
tenth costal cartilage. The intertubercular line — the lower
horizontal one — is drawn at the level of the tubercles on the
crests of the iliac bones, about two inches behind the anterior
superior spine. This is the highest point of the iliac crests.
The vertical or Poupart's lines are drawn from a point midway
between the anterior superior spine of the ilium and the sym-
physis of the pubis.
By this means we have three regions in the middle line — the
epigastric, umbilical, and hypogastric, and laterally the hypo-
chondrium, lumbar, and iliac regions.
The Peritoneum is a serous sac which lines the abdominal
cavity and invests all the structures. It is a thin membrane,
secreting sufficient fluid to keep the whole surface lubricated
and to enable the organs to move easily over one another. The
peritoneum is really one sac, and its arrangement is very com-
plicated, as it invests all the organs and connects them with the
abdominal wall.
The connections of the organs to the abdominal wall and to
one another are called by three different names :
Omenta — folds of peritoneum connecting the stomach with
any other organ.
Mesenteries — folds of peritoneum connecting the intestines
with the abdominal wall.
Ligaments — folds of peritoneum connecting organs (not parts
of the alimentary canal) to one another or to the abdominal
wall.
Following the peritoneum up the anterior abdominal wall, it
passes over the under surface of the diaphragm ; from the pos-
terior edge of that it is reflected back over the upper surface of
the liver. It then turns round the anterior edge of the liver
and, forming the anterior fold of the small omentum, meets the
stomach ; it covers the anterior surface of the stomach and hangs
118
HANDBOOK OF ANATOMY
down in a large fold called the great omentum. The posterior
fold of the great omentum passes up over the posterior surface
of the colon, where it is carried by the vessels to the posterior
abdominal wall, and is carried off that, by the vessels, in a fan-
shaped process — the mesentery — which invests the small intestine.
After passing round the small intestine it again goes back to
the posterior abdominal wall, where it passes down over the
Parietal Peritoneum
Outline of Diaphragm
Gastro-hepatic Omentum ?
Transverse Meso-colon
Great Omentum
The Mesentery
Parietal Peritoneum
FIG. 46. — THE PERITONEUM.
rectum and the upper part of the pelvic organs to the anterior
abdominal wall. This constitutes the great sac of the peri-
toneum. The small sac covers the posterior half of the under
surface of the liver, forms the posterior fold of the small omen-
tum, and covers the posterior surface of the stomach; it then
forms a fold inside that of the great omentum, and passes up
over the anterior surface of the colon, back to the posterior
abdominal wall.
STOMACH
119
The Stomach is a pyriform sac with two openings — the oeso-
phageal or cardiac, opening, and the pylorus, opening into the
duodenum. The stomach has two ends, two surfaces, two
curvatures, and two openings.
The large cardiac end is directed backwards and to the left
and the narrow pyloric end is directed to the right. The
stomach lies in the left hypochondrium and left half of the
epigastrium, under the left cupola of the diaphragm. In
•extreme extension it may reach down below the subcostal plane.
Cardiac end
(Esophagus
Pyloric end
Duodenum
Great Curvature
THE STOMACH.
The length of the stomach is 10 to 11 inches and its greatest
diameter 4 to 4| inches ; its capacity as a rule does not exceed
40 ounces (1 quart).
The stomach is composed of three layers of muscles with their
fibres running in different directions, which insures thorough
contractions of all parts taking place during digestion. When
empty, the stomach in the healthy state is not collapsed, but
contracted.
The stomach lies in a cavity surrounded by other organs,
and to this cavity is often given the name of the stomach
chamber.
120 HANDBOOK OF ANATOMY
The Stomach Chamber. — The roof is formed of the under
surface of the left lobe of the liver and the left cupola of the
diaphragm; this latter slopes down behind and forms the
posterior wall. The anterior wall is formed by the abdominal
wall between the ribs on the left and the liver on the right.
The floor on which the stomach rests is formed by the top of the
left kidney and suprarenal capsule, the gastric surface of
the spleen, upper surface of the pancreas, and coils of small
intestine.
The Intestines are divided into three parts — the duodenum;
the small intestine, consisting of jejunum and ileum ; and the
large intestine. The structure of the duodenum and small intes-
tine is alike ; they consist of two muscular coats — an inner circular
layer and an outer longitudinal layer. The mucous membrane
is covered by a number of villi, small processes about ^ inch
long, and closely set all over the surface; they are for the
purposes of absorption. In order to increase the surface, the
mucous membrane is arranged in a series of circular folds
called valvulce conniventes. On the surface of the mucous
membrane are found also Peyer's patches, which are small aggre-
' gations of lymphoid tissue about J inch long ; there are about
thirty-five to forty of them usually found, most marked in young
subjects.
The Duodenum is really the first part of the small intestine, and
starts at the pyloric orifice of the stomach, on the left side of
the body of the first lumbar vertebra. It is a C-shaped organ,,
closely applied to the back wall of the abdomen. It starts at
the level of the first lumbar vertebra, passes downwards and to
the right as low down as the third lumbar vertebra and, turning
upwards, ends on the left side of the body of the second lumbar
vertebra at the duodeno-jejunal flexure, being the point at
which the jejunum, or second part of the small intestine,,
begins.
In the curve of the duodenum lies the head of the pancreas,
the body passing to the left between the two ends. The
duodenum lies on the vena cava and aorta and the two psoas
muscles. It touches the right kidney, and is covered by coils of
small intestine.
INTESTINES 121
On the inner surface of the duodenum just behind the pylorus
is seen a small prominence — the bile papilla — on which is the
common opening of the bile and pancreatic ducts.
The Jejunum is the second part of the small intestine, and the
Ileum is the third part. They measure about 20 feet together,
and start at the duodeno-jejunal flexure, ending by the junc-
tion of the ileum with the large intestine at the colic valve.
The coils of the small intestine lie in the abdominal cavity,
varying considerably in their disposition, as they are in continual
movement.
There is very little difference between the jejunum and ileum,
and the transition of one to the other is gradual. The ileum is
smaller in diameter, has fewer valvulae conniventes and a larger
number of Peyer's patches than the jejunum.
The Large Intestine consists of several parts — the csecurn,
ascending, transverse, and descending colons, sigmoid flexure of
colon, and rectum.
The structure is similar to that of the small intestine except
that it has no villi and the longitudinal coat of muscle consists
of three longitudinal bands, so that the organ has a sacculated
appearance.
Small processes of peritoneum distended with fat called
appendices epiploictf hang from the outer wall of the large
intestine.
The Caecum is a small sac about 2-J inches long and 3 inches
wide which forms the blind end of the large intestine and lies-
below the colic valve, or entrance of the ileum into the large
intestine ; it lies in the right iliac fossa in front of the psoas
muscle. Just below the colic valve, the appendix opens out
from the caecum. It is a small blind process, very often with no
lumen at all, about 3J inches long; it lies behind the caecum,,
generally pointing upwards and to the left, but the position is
very variable.
The Ascending* Colon (length about 8 inches) is the continua-
tion upwards of the caecum. It lies in the groove between the
right psoas and quadratus lumboruni, and the front of the right
kidney. When it reaches the liver it forms the hepatic flexure
by bending at an angle to the left and is continued as —
122 HANDBOOK OF ANATOMY
The Transverse Colon (length about 20 inches) which forms
a loop across the abdomen. It passes in front of the duodenum
and pancreas and behind the stomach ; it then passes upwards
and backwards until it reaches the base of the spleen, where it
forms the splenic flexure by turning sharply downwards and
becoming —
The Descending1 Colon (length about 6 inches). It lies on
the front of the left kidney, then in the groove between psoas
and quadratus lumborum. It is covered by coils of small
intestine.
' The Sigrnoid Flexure, or iliac and pelvic colons, are the con-
tinuation of the descending colon. The latter ends at the iliac
crest and is continued as the iliac colon, which crosses the left
iliac fossa; then entering the true pelvis crosses over to the
right and back to the middle line, where it is continued as the
rectum, beginning at the level of the third sacral vertebra.
The Rectum is the dilated end of the large intestine, ending in
the anal canal, at a point just below the level of the tip of the
•coccyx and 1J inches in front of it. It is an S- shaped organ
about 6 inches long, and closely follows the curve of the sacrum.
The anal canal is about 1 inch long, and is a slit-like passage
passing between the two levator ani muscles, which, joining in
the middle line, form the floor of the* pelvis.
The Digestive Glands consist of the salivary glands, of which
there are three pairs ; the liver; and the pancreas.
The Parotid Gland, the largest of the three, lies in a hollow
just in front of the ear. Above, it reaches up to the zygoma
and is intimately associated with the temporo-mandibular
joint. Anteriorly, a process of the gland passes forwards over
the masseter muscle. It extends as far down as the angle
of the jaw and slightly backwards over the sterno-mastoid
muscle.
The duct (Stenson's) leaves the gland at the anterior border,
passes forwards over the masseter, and pierces the buccinator to
reach the inside of the mouth.
The facial nerve passes through the parotid gland and in its
substance breaks up into branches.
The Submaxillary Gland is the next largest ; it lies in a recess
SALIVARY GLANDS
123
iust inside the angle of the mandible. It lies on the mylohyoid
muscle and posteriorly is in contact with the sterno-masi
muscle. , -,
The duct (Wharton's) leaves the deep surface ot
and passing forwards beneath the mylohyoid muscle pier<
floor of the mouth under the tongue.
The Subling-ual Gland is a small gland which
floor of the mouth under the tongue, covered only by mucc
membrane.
Stenscm s Duct
Rivini
\;
Wharton's Duct
FIG. 48.— THE SALIVARY GLANDS.
The ducts (of Rivini) are numerous and small, and pierce the
mucous membrane covering the gland.
The Liver is the largest of all the digestive glands. It lies
beneath the right cupola of the diaphragm and against the ribs
on the right side of the body. Its function is to secrete the bile,
which is carried to the duodenum by the bile-duct. On the bile-
duct is a small diverticulum — the gall bladder — in which the
bile is stored until required.
The liver lies mainly in the right hypochondrium, but the
thin left side of it reaches as far as the left Poupart plane. Its
lower border extends from the sixth costal cartilage on the left
side to the tenth rib on the right side ; it very often extends
124
HANDBOOK OF ANATOMY
downwards a little lower on the right side. The upper limit,
anteriorly, corresponds with the line of the diaphragm — i.e., the
fifth intercostal space on the right, and the sixth costal cartilage
on the left, with a depression in the middle. The mass of the
liver is divided into right and left lobes by the falciform liga-
ment, a fold of peritoneum connecting the liver with the anterior
abdominal wall and diaphragm.
The liver has two surfaces — visceral and parietal. The
Parietal surface lies above, against the diaphragm — anteriorly,
Inferior Vena Cava
Lobus Spigelii
Venosal Fissure
CEsophageal Groove
Vena Portae
Lobus Caudatus
Impressio Suprarenalis
Uncovered Area of Right Lobe
Impressio Duodenalis
Impressio Renali&
c*sticDuct
Impressio Gastric
on Left Lobe
Tuber Omentale
Hepatic Artery
Hepatic Duct ' , ! Gall-bladder
J Lobus Quadratus
Round Ligament Ductus Communis Choledochus
FIG. 49.— THE LIVER.
against the abdominal wall, laterally, against the ribs, from
which it is separated by the diaphragm, posteriorly, also against
the diaphragm. The whole of the liver is covered by peritoneum
except a small portion of the posterior surface known as the
"uncovered area/' which is in direct relation with the dia-
phragm.
The " uncovered area " is a small portion of the liver which
lies between the two coronary ligaments, the folds of peritoneum
passing from the liver to the abdominal wall. On the "uu-
PANCREAS 125
covered area" is a small triangular impression made by the
right suprarenal capsule, and to the left of this a deep groove
into which fits the vena cava. To the left of the vena cava lies
the Spigelian lobe, a small prominent portion of liver substance.
To the left -of the Spigelian lobe lies the groove for the osso-
phagus.
The Visceral surface is a sloping surface looking obliquely
downwards, backwards, and to the left. It lies upon the
stomach, intestines, and right kidney.
The visceral surface of the left lobe lies on the cardiac portion
of the stomach and the lesser curvature where the small omentum
is attached. The stomach makes a deep concave impression on
the liver, and above, the liver substance bulges out, forming the
omental tuberosity. The visceral surface of the right lobe is
divided into two portions by the gall-bladder, the portion on the
left being called the quadrate lobe. Between the left lobe and
the quadrate lobe is the portal fissure, to which the small omen-
tum is attached. In the portal fissure lie the portal vein,
hepatic veins, and hepatic artery. On the right of the gall
bladder are three impressions — that of the duodenum just above,
and to the right that of the right kidney, and below, the hepatic
flexure of the colon (see Fig. 49).
The Hepatic Duct is formed by the union of the ducts from
the right and left lobes, and joined by the cystic duct from the
common bile-duct, which lies in the portal fissure.
The Gail-Bladder is a diverticulum of the bile-duct to form a
reservoir for the bile. It is a pear-shaped bag, the wide end of
which usually protrudes below the inferior border of the liver
and touches the abdominal wall at the level of the ninth costal
cartilage on the right side.
The Pancreas is a long, narrow gland lying transversely on
the posterior abdominal wall. It has no true capsule, so
the lobulations are apparent. In shape the pancreas can be
compared to a J turned on its side thus c.. It is divisible
into a head, body, and tail. The head lies in the curve of the
duodenum, the body on the posterior abdominal wall crossing
in front of the left kidney, and the tail comes in contact with the
spleen. Behind the head of the pancreas are the vena cava and
126 HANDBOOK OF ANATOMY
aorta. The upper surface of the body is wide (in transverse
section the body is triangular), and forms part of the floor of the
stomach chamber, and the anterior surface is in relation with
the coils of the small intestine.
The whole of the pancreas is covered by peritoneum, except
the posterior surface, which is closely applied to the abdominal
wall and kidney.
The Pancreatic Duct commences at the tail of the organ. It
emerges at the head, and, meeting the bile-duct, the two pierce
the wall of the duodenum and open by a common orifice.
SECTION VII
THE DUCTLESS GLANDS, KIDNEYS AND PELVIC ORGANS
THE Ductless Glands are a number of organs in different
parts of the body, which, as their name implies, have no ducts,
but pour their "internal secretion" direct into the vascular
system. The principal ones are the lymphatic glands, the thy-
roid gland, suprarenal capsules, and spleen.
The Thyroid Gland is a very vascular structure situated at the
upper end of the trachea, and extending upwards on the sides of
the larynx. It consists of three parts, two lateral lobes joined
in the middle line by the body. It is always relatively larger in
the female and child than in the male.
The lateral lobe is triangular in shape, the base extends as
far down as the fifth or sixth ring of the trachea, and the apex
reaches up to the side of the thyroid cartilage. It is covered
by some of the infrahyoid muscles and the sterno-mastoid
muscle, and posteriorly it touches the oesophagus and common
carotid artery.
The body is a narrow band uniting the lower ends of the
lateral lobes and lying on the second and third rings of the
trachea.
The Spleen is one of the abdominal organs, but not connected
with digestion. It is the largest of the ductless glands.
It lies in the left hypochondrium in the mid-axillary line reach-
ing from the upper border of the ninth rib to the upper border
of the twelfth, its long axis being in the same direction as that
of the tenth rib. It has an irregular shape. The outer surface
is convex and more or less oval, and closely applied to the dia-
phragm which separates it from the ribs. The visceral surface
is divided into three parts by ridges, which join to form a more
127
128
HANDBOOK OF ANATOMY
or less prominent apex in the centre. The upper and largest
part has a deep concave impression formed by the stomach ; the
two lower parts are in contact respectively with the left kidney
and the splenic flexure of the colon. At the lower border of
the gastric impression is the hilus, where the bloodvessels and
nerves enter, and just below this is the impression made by the
tail of the pancreas.
The spleen is almost completely covered by peritoneum, and two
folds pass from it connecting it with the stomach and kidney,
called, respectively, the gastro-splenic and lieno-renal ligaments.
Hiium „:
. Anterior Basal Angle
- Pancreatic Impression
Internal Basal Angle
FIG. 50. — THE SPLEEN.
The Suprarenal Capsules are two small triangular bodies
Testing on the upper ends of the kidneys.
The right suprarenal capsule is in contact anteriorly with the
vena cava and the liver ; posteriorly it is in contact with the
diaphragm, and its inferior surface rests on the anterior in-
ternal aspect of the upper end of the kidney. The peritoneum
covers a very small portion of the anterior surface.
The left suprarenal capsule has a rounded apex, so is more
semilunar than triangular. It is also placed lower down on
the inner border of the left kidney instead of on the upper end.
The greater part of the anterior surface is in contact with the
stomach, and is covered with peritoneum ; the lower remaining
part is behind the pancreas. Posteriorly the left suprarenal
KIDNEYS 129
-capsule is in contact with the left cms of the diaphragm and
the inner border of the kidney.
The Kidneys are a pair of organs placed on the posterior
wall of the abdomen, which secrete the urine : the urine is
carried by means of the ureter to the bladder, situated in the
pelvis, which opens to the exterior by means of the urethra.
They are bean-shaped organs lying on the posterior wall
of the abdomen, with their long axes vertical and the hilus
placed towards the middle line. The position of the kidneys
varies somewhat with the individual, but as a rule the right
kidney is at a lower level than the left. The greater part of
the kidneys lies to the inner side of a line drawn vertically up-
wards from the mid-point of Poupart's ligament (this is not the
same as the mid-Poupart plane). The posterior surface of the
kidney is closely applied .to the diaphragm, psoas, and quad-
ratus luinborum muscles, and tendon of transversalis in front
of the twelfth rib and transverse processes of the first three
lumbar vertebrae. The lower end is usually from 1J to 2
inches above the crest of the ilium, and is farther from the
middle line than the upper. The kidneys lie entirely behind
the peritoneum, and are held in position by a quantity of fat.
The kidney is slightly rotated in position so that the hilus pro-
jects forward.
On the upper end of each kidney is a ductless gland, the
suprarenal capsule (described above).
The relations of the anterior surface differ on the two
kidneys. The right kidney has on its anterior surface, above
and internally, the suprarenal capsule. Below that a large
part of the surface is in contact with the visceral portion of
the liver, and below that the kidney is in contact with the
duodenum and the beginning of the transverse colon.
On the anterior surface of the left kidney, above and inter-
nally, is the impression of the suprarenal capsule ; just below is
a small surface in contact with the stomach, and below again
the pancreatic surface. To the right of these there is the gastric
surface, and the lower end is in contact with the jejunum in-
ternally and the transverse colon externally.
At the hilus below the renal artery is the pelvis of the>
9
130 HANDBOOK OF ANATOMY
kidney — a thin-walled funnel-shaped sac formed by the junc-
tion of several calyces inside the kidney; the pelvis rapidly
narrows to form the ureter.
The Ureter is a duct with a small lumen and thick muscular
walls. It is about 9 inches in length. The upper half or rather
more lies in the abdominal cavity, the rest in the pelvis. The
ureter passes downwards and inwards lying on psoas, and,
crossing the iliac artery, it enters the pelvis. It then passes,
down on the side wall of the pelvis under the peritoneum,,
curving backwards close to the great sciatic notch. At the level
of the ischial spine it bends inwards and enters the bladder
about an inch from the middle line.
The Pelvic Organs. — The pelvis contains the bladder, the
rectum, and the internal genital organs. The bladder lies an-
teriorly close against the pubic bones, the rectum posteriorly
close against the sacrum (see Section VI.), and the internal
genital organs between the two. They are all covered
superiorly by peritoneum.
The bladder is a hollow organ with muscular walls capable of
great distension. When empty and contracted, it lies entirely in
the pelvis just behind the symphysis pubis ; when distended, it
rises above the pelvis into the abdominal cavity. Superiorly it
is covered by peritoneum reflected from the anterior abdominal
wall and the sides of the pelvis, and is in relation with the coils;
of the small intestine. The under surface lies on the symphysis
pubis and the bodies of the pubic bones; externally it is in contact
with the levator ani and obturator internus muscles on each
side. Posteriorly it is separated from the rectum by the uterus
and vagina in the female, and the seminal vesicles in the male.
The lower part of the bladder only moves in position very
slightly; during distension the side and upper walls expand
and rise into the abdominal cavity. In the posterior wall of
the bladder are the openings of the two ureters and the urethra.
The three openings form an equilateral triangle with the apex
downwards and the sides are about I inch long.
SECTION VIII
THE RESPIRATORY ORGANS
THE Organs of Respiration are the lungs and trachea, the
latter being the passage by means of which air is carried from
the pharynx to the lungs.
Breathing consists of the acts of inspiration and expiration;
in the former, air is drawn into the pharynx through either the
nose or mouth and conveyed by means of the trachea to the
lungs ; the air is expelled in the same way.
The upper part of the air passage, the larynx, is specially
modified by cartilages and muscles to produce sounds — i.e., the
voice — during expiration.
The Pharynx is a large space behind the nose and mouth in
the lower part of which are the openings of the larynx and
oesophagus ; the pharynx is compressed laterally, and its anterior
wall is practically non-existent, the lateral walls being attached
to the sides of the nasal, buccal and laryngeal orifices. The
posterior wall is attached by areolar tissue to the muscles in
front of the first six cervical vertebrae, and above, it is attached
to the basilar process of the occipital bone and to the temporal
bones.
The upper part of the pharynx is almost separated off from
the lower part by the soft palate, which projects backwards from
the palatal processes of the maxillary bones, and in this upper
part is found the orifices of the Bustachian tube and the pharyn-
geal tonsil. Below the soft palate is the tonsil on each side.
Below this the pharynx rapidly narrows as it passss the opening
of the larynx and becomes the oesophagus.
The Larynx is the upper part of the air passage, and is placed
in front of the fourth, fifth, and sixth cervical vertebrae. It con-
131
132
HANDBOOK OF ANATOMY
sists of several cartilages held together by muscles. The largest —
the thyroid cartilage — consists of two large plates of cartilage
joined at an angle in the middle line ; in the male this angle is
about 90 degrees, and projects forward, forming what is called
the "Adam's apple." Below the thyroid cartilage is the cricoid
cartilage, in shape like a signet ring with the narrow part in
front. The interval between the two can easily be felt in the
Frontal Air-Sinus
Superior Meatus
Superior Concha
»' Spheno-ethmoidal Recess
Inferior Meatus
Hard Palate (in section) ^TlCI
Tongue
Mandible (in section) ._
Genio-hyo-glossus
Genio-hyoid
. Sphenoidal Air-Sinus
__ Middle Concha
Middle Meatus
— Inferior Concha
— .Eustachian Orifice
— Salpingo-pharyngeal
....Soft Palate
Epiglottis
.... Pharynx
Ventricle of Larynx
Thyroid Cartilage
Cricoid Cartilage
Trachea
FIG. 51.— THE PHAKYKX.
(Esophagus
living subject. The thyroid cartilage is joined by a strong
membrane to the hyoid bone, and from its inner side the
epiglottis, a cartilaginous process, projects upwards to the back
of the tongue.
The Trachea is the continuation of the air passage ; it begins
just below the cricoid cartilage at the level of the sixth cervical
vertebra and ends at the fourth thoracic vertebra by dividing into
two bronchi. The trachea is a muscular tube kept permanently
LARYNX
133
patent by rings of cartilage, which, however, are not complete
posteriorly, so the organ is not quite cylindrical. These cartila-
ginous rings are continued in the bronchi.
The trachea follows the curve of the vertebral column, so
passes obliquely backwards as it descends. It is in the middle
line until the bifurcation is reached, where it lies slightly to the
right.
The Bronchi pass obliquely downwards aud outwards from
the bifurcation of the trachea to the roots of the lungs. The
Superior Cornu of Thyroid
Cartilage
Isthmus (Pomum Adami) «
^~«*Crico-thyroid Ligament
Cricoid Cartilag=
FIG-. 52. — THE LARYNGEAL CARTILAGES.
right bronchus is shorter and wider than the left, and is not so
obliquely placed. The bronchi have several branches passing to
the different lobes of the lungs.
The Lung's lie within the pleural cavities of the thorax. A
perfectly healthy lung lies quite free within its own pleural sac,
attached only by its root ; but as a rule adhesions between the
lung and pleura are found. The right lung is larger than the
left, the proportion being about eleven to ten . It is also shorter
and wider.
The lungs take the shape of the pleural cavities, and are
conical structures having an apex which projects above the level
of the first rib for about half an inch, and a concave base
which is adapted to the cupola of the diaphragm, on which it
rests. The outer surface is smooth and convex, except for shal-
low grooves made by the ribs, and the inner surface has the
134 HANDBOOK OF ANATOMY
impressions of the organs against which it lies. The lower
border of the outer surface of the lung is thin and reaches
down between the diaphragm and the ribs to the level of the
lower border of the sixth rib in front; the eighth rib in the mid-
axillary line; then passes horizontally inwards, reaching the
vertebral column at the level of the tenth rib. The bases of the
lungs are in relation with some of the abdominal organs, the
diaphragm intervening. Thus, the base of the right lung rests
upon the right lobe of the liver, whilst the base of the left lung
is in relation with the left lobe of the liver, the fundus of the
stomach, and the spleen.
On the anterior and lower part of the inner surface of each
lung is a deep recess made by the pericardium (this is deeper in
the left than the right) , and above the pericardial concavity is
the hilum of the luiig, where the bronchial vessels and nerves
enter, constituting the root of the lung. On the left lung, above
and behind the hilum is a broad shallow groove made by the
descending thoracic aorta.
The left lung is divided into two lobes by a groove reaching
into the hilum ; it starts above on the outer surface just below
the apex and passes obliquely forwards and downwards to the
base near the middle line. The right lobe is divided by a
similar line into two, which, however, cuts the base nearer the
outer side. The inner and upper lobe is then subdivided by a
horizontal line passing inwards and forwards from about the
middle of the first line.
The lungs entirely fill the thoracic cavity except for the space
in the middle occupied by the trachea, oesophagus, large vessels,
heart, and roots of the lungs.
The Roots of the Lung's are formed by a number of structures
which pass into each lung at the hilum ; they consist of the pul-
monary veins, the pulmonary artery and the bronchus, nerves,
lymphatic vessels and glands.
The Pleura is a serous membrane which invests the lungs and
lines the thoracic cavity. It is analogous to the peritoneum of
the abdomen, and performs the same function — i.e., forms a
lubricated covering, so that the organs can move freely in the
cavity. The part lining the cavity is called the parietal pleura,
LUNGS . 135
and the part covering the lungs the visceral pleura. The
latter is very thin and adherent to the lung, and dips into all the
fissures.
The parietal pleura is named according to the part over which
it passes. The cervical pleura rises up to the level of the neck
of the first rib. Owing to the oblique position of the latter, the
pleura is about an inch and a half above the level of the clavicle ;
it is strengthened by Sibson's fascia, a strong membrane
attached to the seventh cervical vertebra and the inner margin
of the first rib. The costal pleura lines the inner surfaces of
STERNUM
FIG. 53.— THE PLEURA.
the ribs and the intercostal spaces ; it reaches to the sternum
in front and the bodies of the vertebrae behind. The
diaphragmatic pleura covers the surface of the diaphragm
except for the middle part, occupied by the pericardium, and a
narrow strip at the costal attachment. The mediastinal pleura
passes back from the sternum to the vertebral column and lines
the space (mediastinum) between the lungs. As it passes back
it is reflected by the root on to the lung, and becomes the visceral
pleura (see Fig. 53). Below the root of the lung the two layers
hang down in a deep fold called the ligamentum latum pulmonis.
The parietal pleura is bigger than the lungs require at rest,
136 HANDBOOK OF ANATOMY
and is not quite so big as the entire cavity, the line of reflection
being —
Right pleura : Anterior, down the middle line of the sternum
to the back of the ensiform cartilage, along the seventh costal
cartilage, and across the bony extremities of the eighth and
ninth ribs. In the mid-axillary line the pleura reaches its-
lowest limit — that of the bony tip of the tenth rib. It then
ascends slightly, cutting across the eleventh rib to the middle of
the twelfth rib and on to the first lumbar vertebra. The
posterior line of reflection is to the left of the mid-line of the
vertebral bodies, the aorta intervening between them.
Left pleura : This only differs from the right in the anterior
line of reflection. Opposite the fourth costal cartilage the left
pleura deviates to the left, leaving a small area of pericardium
uncovered. It cuts 'across the fifth, sixth, and seventh costal
cartilages to the bony tip of the eighth rib, after which the line
of reflection resembles that of the right pleura.
SECTION IX
•
HEART AND BLOODVESSELS OF HEAD, NECK AND TRUNK
The Heart.
THE Heart is a four-chambered muscular organ situated in
the thorax, in the space between the lungs, and resting on the
diaphragm. Its function is to receive the blood from the veins
and to propel it through the arteries.
The shape of the heart is that of a cone ; it has an apex, a
base, and two surfaces (inferior and antero-superior) . A shallow
groove runs round the heart transverse to its long axis, sepa-
rating the upper auricular portion from the lower ventricular
portion. The division of the upper portion into two auricles is
only faintly marked, but a distinct groove divides the lower
portion into two ventricles.
The heart is enclosed in a fibro-serous sac — the pericardium —
which separates it from the surrounding organs. It rests on
the diaphragm, the long axis pointing obliquely downwards,,
forwards, and to the left. On the surface of the body its position
is marked by a quadrilateral area, the boundaries of which are
as follows :
Eight side — a line slightly convex outwards from the upper
end of the third costal cartilage to the sixth, its greatest
distance from the middle line being 1| inches.
Base — from the lowest point on the right side to the fifth in-
tercostal space on the left side, 3J inches from the middle line.
This point marks the position of the apex of the heart.
Left side — a line slightly convex outwards from the left ex-
tremity of the base line to the lower border of the second inter-
space on the left side, 1 inch from the mid-line.
137
138 HANDBOOK OF ANATOMY
Upper line — a line slightly convex downwards connecting the
upper extremities of the right and left sides.
The Base of the Heart is formed by the auricles, and is
directed upwards, backwards, and to the right. It lies opposite
the sixth, seventh, and eighth dorsal vertebrae, separated from
them by the oesophagus and descending aorta. It has six
orifices — the superior and inferior venae cavas entering the
Superior Vena Cava t*^f*9f^S
^.Aorta
Right Auricular Appendix
Right Auricle ^
, Pulmonary Artery
,Conus Arteriosus
Right Coronary Artery
. Left Ventricle
- Left Coronary Artery
Apex
FIG. 54.— THE HEART.
right auricle, and the four pulmonary veins entering the left
auricle.
The Apex of the Heart is formed entirely by the left ven-
tricle. It is directed downwards, forwards, and to the left, and
is separated from the anterior thoracic wall by the left lung
and pleura.
The Inferior Surface is formed by the ventricular portion of
the heart, and rests upon the central tendon of the diaphragm
and the muscular part to the left of the tendon.
The Antero- Superior Surface is directed backwards, upwards,
-and to the left. It lies behind the area of the anterior thoracic
HEART 139
wall mapped out above, and is divided into an upper and lower
part by the auriculo- ventricular groove. At this point are the
orifices of the pulmonary artery and aorta from the right and
left ventricles respectively.
The Interior of the Heart. — Internally the heart is com-
pletely divided into right and left halves by. a septum indicated
on the outside by the longitudinal grooves. The transverse
septum is not complete, as each auricle communicates with the
ventricle below by a valvular opening.
The Auricles are almost cubicle in form and each possesses a
well-marked process from its upper angle, which projects for-
wards on the outside of the heart, known as the auricular ap-
pendix. The walls are lined with a serous membrane — the
endocardium — and are smooth except in the region of the
appendix, where there are a few muscular fibres, known as
the musculi pectinati. The right auricle receives posteriorly the
.superior vena cava above and the inferior vena cava below, the
orifice of the latter being guarded by the rudimentary Eus-
tachian valve. The left auricle resembles the right' auricle,
except that it has four openings in its posterior wall— the
orifices of the pulmonary veins.
The Ventricles are conical in form and very muscular, the
left ventricle being larger and thicker-walled than the right.
The longitudinal septum is so placed that the apex of the heart
is formed entirely by the left ventricle. The right ventricle is
•continuous with the right auricle, its base giving origin to the
pulmonary artery. The right auriculo- ventricular orifice is
guarded by the tricuspid valve, and the orifice of the pulmonary
artery is also guarded by a valve composed of three cusps. The
left ventricle is continuous with the left auricle, its base giving
origin to the aorta. The left auriculo-ventricular orifice is
guarded by the mitral or bicuspid valve, and the orifice of the
aorta by the aortic valve composed of three cusps.
The cavities of the ventricles are lined with endocardium,
and are smooth except for the muscle fibres, which are more
numerous and more pronounced than those of the auricles.
Each cavity can be divided into two — the body of the ventricle
and the vestibule of the vessel to which it gives origin.
140 HANDBOOK OF ANATOMY
The muscles are of three kinds :
Columns Carneas — bundles of muscle-fibre raised in relief on>
the walls of the ventricle.
Papillary Muscles — which are attached at each end to the-
walls of the ventricles, but are free in the middle. These pre-
vent over-distension.
Chordae Tendinese — thin bundles of muscle-fibre from the
bases of the papillary muscles to the apices of the cusps of
the valves.
The Valves of the Heart and large vessels are circular
orifices with semilunar flaps of muscle (cusps) projecting inwards
from the circumference. These meet in the middle and com-
pletely close the orifice. A rush of blood pushes these forward,
and the cusps automatically close the orifice when the flow
ceases. This keeps the blood flowing in one direction and
prevents regurgitation.
The Pericardium is a fibro-serous sac surrounding the heart.
It is attached to the diaphragm all round the inferior surface
of the heart, and is prolonged upwards, being gradually lost
on the great vessels. The inferior vena cava pierces the peri-
cardium posteriorly.
The Arteries.
The arteries are the bloodvessels which leave the heart and
break up into capillaries for the supply of the tissues. There
are two systems of circulation — the pulmonary, consisting
of the pulmonary artery leaving the right ventricle and
ending in the pulmonary veins which enter the left auricle;,
and the systemic, consisting of the aorta leaving the left ven-
tricle and ending in the superior and inferior venae cavae which
enter the right auricle.
The Pulmonary artery arises from the base of the right
ventricle of the heart. It is a short vessel about 2 inches long.
It passes upwards to the left of the ascending aorta, and termi-
nates by dividing into right and left pulmonary arteries, which
enter the roots of the right and left lungs respectively.
The Aorta rises from the base of the left ventricle of
the heart. It passes upwards, backwards, and to the left,.
AORTA
141
forming an arch, which, on reaching the vertebral column,
passes downwards as far as the body of the fourth lumbar
vertebra, where it terminates by dividing into the two common
Trachea
.. Left Common Carotid Artery
Scalenus Anticus Muscle
.. Left Pneumogastric Nerve
Left Subclavian Artery
(Third Part)
Left Phrenic Nerve
..Left Superior Intercostal
Artery
__ Cervical Cardiac Branches
of Left Symp. and Vagus
_. Superficial Cardiac
Plexus
_.. Left Bronchus
FIG. 55.— THE AORTA.
iliac arteries. For convenience of description it is divided
into four parts : (1) The ascending aorta, (2) the arch of the
aorta, (3) the descending thoracic aorta, (4) the abdominal
aorta.
142 HANDBOOK OF ANATOMY
The Ascending Aorta arises from the base of the left ven-
tricle opposite the lower border of the third left costal cartilage.
It passes upwards, forwards, and to the right, terminating in
the arch of the aorta at the level of the junction of the right
second costal cartilage with the sternum.
Branches. — Right and left coronary arteries, which supply the
heart muscle.
The Arch of the Aorta lies behind the lower part of the nianu-
brium, and begins at the termination of the ascending aorta,
terminating as the descending aorta opposite the lower border
of the body of the fourth dorsal vertebra. The arch passes
upwards, backwards, arid to the left in front of the trachea, and
curving over the pulmonary artery ; it then passes backwards to
the left of the trachea and turns downwards.
Branches of the Arch of the Aorta supply the head and neck
and upper limb. The branch on the right side — the innominate
artery — is a very short trunk, which divides almost at once into
right common carotid and right subclavian arteries; the left
common carotid and left subclavian arteries are given off from
the arch itself.
The Descending Aorta extends from the termination of the
arch at the fourth dorsal vertebra, and ends at the opening in
the diaphragm opposite the twelfth dorsal vertebra, by becoming
the abdominal aorta. It lies on the vertebral column and is in
contact anteriorly with the root of the left lung, the pericardium,,
the oesophagus, and the crura of the diaphragm.
The branches are divided into two sets, visceral and parietal,
supplying the muscles of the thorax and its contents.
The Abdominal Aorta extends from the middle of the body
of the last dorsal vertebra to the left side of the body of the
fourth lumbar vertebra, where it divides into the two common
iliac arteries. The bifurcation^ in the intertubercular plane.
It lies on the vertebral column, and anteriorly is in contact with
the solar plexus, the third part of the duodenum, the mesentery,
peritoneum, and coils of small intestine. The pancreas is
separated from the aorta by the splenic vein and superior
mesenteric artery.
Branches. — The branches are divided into two sets — visceral
AORTA 143
and parietal — and each set is again divided into paired and un-
paired groups, which supply the viscera, the muscles of the
trunk and the lower limbs.
The lumbar arteries which supply the muscles of the trunk
arise down the sides of the aorta opposite the bodies of the
lumbar vertebras.
The Common Carotid arteries vary slightly at their com-
mencement ; otherwise they are similar in course and dis-
tribution.
The Bight Common Carotid artery arises from the innomi-
nate artery behind the right sterno-clavicular articulation; the
left arises direct from the arch of the aorta about an inch below
the left sterno-clavicular articulation. They both terminate at the
level of the upper border of the thyroid cartilage of the larynx,,
or the lower border of the third cervical vertebra. They are
separated from one another — below by the trachea and oeso-
phagus, above by the pharynx.
The common carotid artery is enclosed in a fibrous sheath
with the vagus nerve and internal jugular vein. It lies on
scalenus anticus and longus colli muscles below, and rectus
capitis anticus major above, and is covered by sterno-mastoid.
On its outer side lies the internal jugular vein, which slightly
overlaps it below.
Branches. — The artery bifurcates at its termination, forming
the external and internal carotid arteries.
The External Carotid artery extends from the bifurcation of
the common carotid artery to the back of the neck of the man-
dible, where it terminates by dividing into the superficial tem-
poral and internal maxillary arteries.
Branches. — Occipital.
Superficial temporal.
Internal maxillary, and five other branches which
supply the face, tongue, pharynx, and larynx.
The Occipital artery runs upwards under the mastoid process
to the back of the scalp, and terminates near the inner end of
the superior curved line of the occipital bone. By dividing into-
branches it supplies the scalp and surrounding structures.
The Superficial Temporal artery commences in the parotid
144
HANDBOOK OF ANATOMY
FIG. 56. — THE AORTA IN THE THORAX, AND THE PRINCIPAL ARTERIES OF
THE HEAD AND NECK.
1. Arch of the Aorta
2. Aortic Isthmus
3. Aortic Spindle
4. Descending Aorta
5. Coronary Arteries (from
Ascending Aorta)
6. Innominate Artery
7. Left Common Carotid
8. Left Subclavian
9. Right Common Carotid
10. Right Suhclavian
n. External Carotid
12. Internal Carotid
13. Internal Maxillary
14. Superficial Temporal
15. Vertebral
16. Internal Mammary
17. Thyroid Axis
1 8. Inferior Thyroid
19. Transverse Cervical
20. Suprascapular
21. Superior Thyroid
22. Lingual
23. Facial
24. Occipital
25. Posterior Auricular
26. Ascending Pharyngeal
27. Transverse Facial
28. Aortic Intercostals
gland and runs straight up, terminating about 2 inches above
the zygoma by dividing into branches. It supplies the scalp
and surrounding structures.
CAROTID ARTERIES 145
The Internal Maxillary artery commences in the parotid gland
and passes inwards to supply the teeth and structures behind
the superior maxilla and mandible.
The Internal Carotid artery commences at the bifurcation of
the common carotid and terminates in the brain by dividing into
branches. At first it lies on the outer side of the external
carotid, but passes behind it and gets to the inner side. It
passes up at the back of the parotid gland and reaches the brain
by means of the carotid canal in the temporal bone.
The Subclavian arteries also vary slightly at their com-
mencement, the right subclavian artery commencing at the
bifurcation of the innominate artery behind the right sterno"
clavicular articulation, and the left subclavian artery commencing
from the arch of the aorta behind the lower part of the manu-
brium sterni. The artery arches up over the apex of the lung,
and passing between scalenus anticus and medius, it ends at the
lower border of the first rib by becoming the axillary artery.
The scalenus anticus, in crossing the subclavian artery divides it
into three parts — the first part being internal to the muscle, the
second behind it, and the third on the external side. The
third part of the artery is separated from scalenus medius by
the cords of the brachial plexus.
Branches. — From the first part :
Vertebral, thyroid axis, internal mammary.
From the second part : Superior intercostal.
The Vertebral artery arises from the subclavian artery just
between scalenus anticus and longus colli. It passes backwards
;and upwards through the foramina in the transverse processes
•of the cervical vertebrae, and entering the foramen magnum, ter-
minates by uniting with its fellow of the opposite side to form
the basilar artery. The basilar artery divides again, and the
branches are united by the posterior communicating arteries to
the internal carotid arteries to form the Circle of Willis for the
free supply of the brain.
The Thyroid Axis is a very short trunk, which ends by
dividing into three — the inferior thyroid, transverse cervical,
and suprascapular — which supply the shoulder and adjacent
parts.
10
146
HANDBOOK OF ANATOMY
The Internal Mammary artery passes down on the pleura sup-
plying the adjacent parts — the diaphragm and the upper part
of the anterior abdominal wall.
Thfe Superior Intercostal artery passes backwards over the
pleura to the neck of the first rib. There it divides into two
branches for the supply of the upper two intercostal spaces.
The Branches of the Thoracic Aorta are divided into two
groups — visceral and parietal. The visceral branches supply the
bronchi, oesophagus, and pericardium, and several small branches
to structures in the vicinity. The parietal supply the inter-
costal muscles and the upper surface of the diaphragm.
The Intercostal arteries, of which there are nine pairs, supply
the nine lower intercostal spaces. Each artery passes back-
wards behind the pleura and runs in the groove at the lower
border of each rib. The Subcostal pair of arteries are in series
with this, and run in the groove on the twelfth rib.
The Branches of the Abdominal Aorta are in two groups
— visceral and parietal. The visceral branches supply the abdom-
inal organs, the parietal branches supply the abdominal walls.
Visceral.
Parietal.
Paired.
Unpaired.
Paired.
Unpaii'ed.
Suprarenal
Cceliac axis
Inferior phrenic
Middle sacral
Renal
Superior mesenteric
Lumbar (four pairs)
Spermatic or
Inferior mesenteric
Common iliac
Ovarian
The order in which the branches arise from the abdominal
aorta is as follows :
1. Inferior phrenic.
2. Cceliac axis.
3. Middle suprarenal.
4. Superior mesenteric.
5. Eenal.
6. Spermatic or ovarian.
7. Inferior mesenteric.
8. Middle sacral.
9. Common iliac.
ABDOMINAL AOETA
147
The Paired Parietal Branches. — The Inferior Phrenic arteries
are the first branches which curve off the aorta as it enters
the abdomen. They supply the under surface of the diaphragm.
The Lumbar arteries, of which there are usually four pairs,
arise in series with the intercostal arteries. They pass back-
Diaphragm
Superior Capsular
Arteries
Suprarenal Body
Mid. Capsular Artery
Inf. Capsular Artery
Renal Artery.
Inferior Vena Cava
Right Spermatic Artery.
Right Ureter —
Aorta —
Right Common Iliac.
Artery
External Iliac Artery
External Iliac Vein
Inf. Phrenic Arteries
Coeliac Axis
Superior Mesenteric
Artery
. .Lumbar Artery
. _Quadratus Lumborum
. Psoas Magnus
..Inferior Mesenteric
Artery
..Iliacus
— .Left Spermatic Artery
'Left Common Iliac Vein
"'-.Middle Sacral Artery
Bladder
Rectum
FIG. 57.— THE ABDOMINAL AORTA.
wards over the bodies of the lumbar vertebrae and between the
adjacent transverse processes. They pass behind psoas and
cross quadratus lumborum to get between the muscles of the
anterior abdominal wall.
The Common Iliac arteries are formed by the bifurcation of
the aorta at the lower border of the fourth lumbar vertebra.
148 HANDBOOK OF ANATOMY
They terminate opposite the lumbo-sacral joint by dividing into
external and internal iliac. The common iliac arteries lie on the
bodies of the fourth and fifth lumbar vertebrae and on psoas,
and are separated anteriorly and externally from the coils of the
small intestine by the peritoneum.
Branches. — Internal iliac.
External iliac.
The Internal Iliac artery arises opposite the lumbo-sacral
articulation and passes down into the true pelvis, terminating
opposite the upper border of the great sciatic notch by dividing
into anterior and posterior divisions, giving off numerous
branches which supply the pelvic wall and viscera, buttock,
thigh, and external genital organs.
Posterior division —
Parietal : Ilio-lumbar ~\ supply the muscles of the iliac
Lateral-sacral Jfossa and front of sacrum.
Gluteal, passes out above pyriformis to supply
the gluteal muscles.
Anterior division —
Visceral : supply the bladder and internal genital organs.
Parietal : Obturator, supplies the obturator muscles.
Sciatic, passes out below pyriformis and sup-
plies the muscles on the upper part of the
thigh.
Internal pudic — passes out below pyriformis,
and, crossing the ischial spine with the
pudic nerve, it enters and supplies the
perineum.
The External Iliac artery arises opposite the sacro-iliac joint,
and, passing outwards and forwards along the brim of the
pelvis, it passes under the mid-point of Poupart's ligament and
becomes the femoral artery. It lies on psoas and iliacus, and is
separated from the colon and small intestine by the peritoneum.
Branches. — Deep epigastric and deep circumflex iliac supply
the muscles and skin of the anterior abdominal wall.
ABDOMINAL AORTA 149
The Unpaired Parietal Branch.— The Middle Sacral artery
is a small artery arising from the back of the aorta just before
its bifurcation. It passes down the middle of the sacrum, sup-
plying the muscles and joints in the vicinity.
The Paired Visceral Branches. — The Suprarenal arteries
consist of three pairs of arteries for the supply of the suprar-
renal capsule. The middle pair arises from the aorta direct,
the others are branches of adjacent arteries.
The Renal arteries arise opposite the second lumbar vertebra
just below the superior mesenteric. Each passes transversely
outwards over the crus of the diaphragm and the upper part
of psoas to the hilum of the kidney. The right artery is a
little longer than the left and often lower in position. It passes
behind the inferior vena cava, the head of the pancreas, and
the middle of the duodenum. The left artery lies behind the
pancreas.
The Spermatic or Ovarian arteries arise just below the renal
arteries. The spermatic arteries run downward and outwards
through the inguinal canal to supply the testicles. The ovarian
arteries are much shorter, and pass straight down into the pelvis
and supply the ovaries.
The Unpaired Visceral Branches.— The Coeliac Axis arises
from the front of the aorta just after it has entered the ab-
domen. It is very short (about half an inch), and divides
almost at once into three branches :
1. Gastric.
2. Splenic.
3. Hepatic.
The Gastric artery runs upwards and to the left to the oeso-
phagus, and passes along the smaller curvature of the stomach
between the layers of the small omentum to join the pylorio
branch of the hepatic artery.
The Splenic artery runs behind the stomach along the upper
border of the pancreas. It passes between the two layers of
the lieno-renal ligament and enters the hilum of the spleen.
The Hepatic artery runs along the head of the pancreas to
the first part of the duodenum. It then passes upwards to the
150
HANDBOOK OF ANATOMY
transverse fissure of the liver and divides into right and left
branches. It gives off two branches — the pyloric, which goes to
the pylorus and supplies both sides of the stomach ; the gastro-
duodenal, whose terminal branches supply the larger curvature of
the stomach, the head of the pancreas, and the duodenum.
FIG. 58. — THE INFERIOR MESENTERIC ARTERY AND ITS BRANCHES
(AFTER TIEDEMANN).
1. Superior Mesenteric Artery
2. Middle Colic
3. Inferior Mesenteric
4. Left Colic
5. Arteriae Sigmoideae
6. Superior Hemorrhoidal
7. Transverse Colon
8. Descending Colon
9. Iliac Colon
10. Pelvic Colon
The Superior Mesenteric artery arises half an inch below the
cceliac and opposite the first lumbar vertebra. It crosses
obliquely downwards over the head of the pancreas to the root
of the mesentery. It gives off numerous branches which supply
VEINS 151
the duodenum, small intestine, and ascending and transverse
colons.
The Inferior Mesenteric artery arises a short distance above
the bifurcation of the aorta. It passes downwards over the left
psoas and becomes the superior haemorrhoidal. It supplies the
descending colon and the rectum.
f
The Veins.
The veins are formed by the aggregation of the capillaries,
and return the blood to the heart. They,, like the arteries, are
arranged in two sets — pulmonary and systemic. The pulmonary
veins enter the left auricle of the heart by four openings, and
the systemic veins — i.e., the coronary sinus, and superior and
inferior venae cavae — enter the right auricle by three openings.
The Pulmonary veins are found in the alveoli of the lungs,
and form a single large vessel for each lobe. In the root of
the right lung the veins from the upper, and middle lobes join
together,, so that two veins pass out from the root of each
lung to enter the left auricle.
Systemic Veins. — The systemic veins, three in number, all
enter the right auricle.
The coronary sinus returns the blood from the walls of the
heart only. The superior vena cava returns the blood from the
head, neck, upper limbs, thoracic wall, and a part of the pos-
terior abdominal wall. The inferior vena cava returns blood
from the lower limbs, and the walls and organs of the abdomen
and pelvis.
The veins of the body wall and limbs are arranged in two
sets — superficial and deep. The superficial veins run in the
superficial fascia, and the deep veins accompany the arteries,
usually as venae comites. The superficial veins ultimately pierce
the deep fascia to unite with the deep veins. The visceral veins,
of which there is usually one accompanying the artery, end
in the deep systemic veins, with the exception of the portal
vein.
The Coronary Sinus lies between the left auricle and left
ventricle, and terminates in the lower and back part of the
152 HANDBOOK OF ANATOMY
right auricle. It receives the blood from the walls of the
heart.
The Superior Vena Cava is formed at the lower border of
the first right costal cartilage by the junction of the two in-
nominate veins, descends to the level of the third right costal
cartilage, where it enters the right auricle. Anteriorly it is
overlapped by the right lung, and pleura and the ascending
aorta.
Tributaries. — Vena azygos major.
Small pericardial veins.
The Vena azygos major is the upward continuation of a vessel
known as the right ascending lumbar vein, which connects
together the lumbar veins of the right side. It passes through
the aortic opening in the diaphragm, up the posterior thoracic
wall, and arches over the root of the right lung to enter the
superior vena cava. It receives the right intercostal veins and
the vena azygos minor superior and inferior, which receive the
lumbar and intercostal veins of the left side.
The Innominate Vein of each side is formed behind the
sternal end of the clavicle by the union of the internal jugular
with the subclavian vein. The two innominate veins unite to
form the superior vena cava behind the first right costal
cartilage; consequently the left one is longer than the
right.
The tributaries are the veins corresponding to the arteries in
that region — viz., internal mammary, inferior thyroid, vertebral,,
pericardial, and bronchial.
The Internal Jugular vein commences as the direct continua-
tion of the lateral sinus of the brain, and passes through the
jugular foramen to reach the neck, uniting behind the sternal
nd of the clavicle with the subclavian vein to form the -innomi-
nate vein. It lies on the outer side of the common carotid
artery, and on the left side overlaps it in front at its
lower end.
Tributaries. — Sinus in the brain.
Veins from the wall of the pharynx, the tongue,,
and the veins accompanying the thyroid
arteries.
JUGULAR VEINS
153
Common facial, formed by union of facial and
a terminal branch of the temporo-maxillary
veins, which drain the muscles of the face and
fore-part of the scalp.
Occipital vein, which drains the back part of
the scalp.
Posterioi Auricular Lym-.^
phatic Glands
Occipital Vein ~\^L.
Occipital Lymphatic
Gland
Posterior Auricular Vein
Posterior Division of..
Temporo- Maxillary
Vein
Superficial Cervical «^="—~~
Lymphatic Glands "~~"--
Posterior Jugular _
Vein
External Jugular Vein --
Transverse Cervical
Vein
____ Frontal Vein
Supra-orbital Veia
_______ Angular Vein
Superficial Temporal
Vein
Internal Maxillary
Vein
Temp. -Maxillary Vein
-Facial Vein
Ant. Div. of Temporo-
Maxillary Vein
Submax. Lymph. Glands
Common Facial Vein
Internal Jugular Vein
Lingual Vein
Superior Thyroid Vein
Middle Thyroid Vein
Anterior Jugular Vein
Suprasternal Lym-
phatic Gland
Suprascapular Vein and Supraclavicular
Lymphatic Glands
FIG. 59. — VEINS AND GLANDS OF HEAD AND NECK.
The Subclavian vein is the direct continuation of the axillary
vein. It commences at the lower border of the first rib and
passes in front of scalenus anticus, which separates it from the
artery, and terminates behind the sternal end of the clavicle
by uniting with the internal jugular vein to form the innomi-
nate vein.
154 HANDBOOK OF ANATOMY
Tributary. — External jugular formed on the surface of the
sterno-mastoid by the union of the terminal branch of the
temporo-maxillary with the posterior auricular vein, which drain
the outer side of the head and neck.
The Inferior Vena Cava is formed opposite the right side
of the body of the fifth lumbar vertebra behind and external
to the right common iliac artery by the union of the common
iliac veins. It passes up the posterior wall of the abdomen
to the right of the aorta and on the right crus of the dia-
phragm, and passes through the latter at the level of the eighth
dorsal vertebra. It then pierces the pericardium and enters
the lower and back part of the right auricle. The vessel lies
below on the bodies of the lumbar vertebrae, the right psoas,
and the right crus of the diaphragm, the right renal artery,
and suprarenal capsule. Anterior to it are the right common
iliac artery, the third part of the duodenum, head of the pan-
creas, the portal vein, the first part of the duodenum, and the
posterior surface of the liver. On its left side are the aorta and
the left crus of the diaphragm.
Tributaries. — Hepatic.
Inferior phrenic.
Suprarenal.
Renal.
Lumbar.
Spermatic or ovarian.
The Hepatic veins are two in number, which .open into the
inferior vena cava just below the diaphragm, and bring the
blood from the liver which has entered it through the hepatic
artery and portal vein.
The Inferior Phrenic veins are formed by the venae comites of
the arteries supplying the diaphragm.
The Suprarenal veins are one each from the suprarenal
capsules. Sometimes the one on the left side enters the left
renal vein.
The Renal veins each issue from the hilum of the kidney, the
left one being longer than the right. The left one crosses in
front of the left psoas, the left crus of the diaphragm, and
the aorta just below the superior mesenteric artery, and lies
PORTAL SYSTEM 155
behind the pancreas and the last part of the duodenum. The
right renal vein passes behind the duodenum.
The Lumbar veins, of which there are four pairs, are formed
by tributaries from the lateral and posterior walls of the ab-
domen. They are also connected together by the azygos veins,
.anastomosing vessels passing upwards.
The Spermatic or Ovarian veins are formed by the pampini-
form plexuses surrounding the testicles or ovaries. The vein
on the right side enters the inferior vena cava, that on the left
usually enters the left renal vein.
The Common Iliac veins are formed by the union of the
external iliac and internal iliac veins opposite the brim of the
pelvis behind the internal iliac artery. They pass upwards and
inwards, and unite to form the inferior vena cava opposite the
fifth lumbar vertebra.
Tributaries. — External iliac.
Internal iliac.
Ilio-lumbar, small veins from the iliac fossa and
adjacent parts.
The Internal Iliac vein is formed at the upper border of the
great sciatic notch by the union of veins corresponding to the
branches of the internal iliac artery, except the ilio-lumbar
branches. It lies behind and slightly to the inner side of the
corresponding artery.
The External Iliac vein is the continuation of the femoral vein,
:and commences on the inner side of the femoral artery.
Passing upwards and inwards along the brim of the pelvis, it
ends by joining the internal iliac to form the common iliac
The Portal System.— The portal vein is formed by tribu-
taries from the whole of the alimentary canal (except the lower
part of the rectum), the spleen and the pancreas, and conveys
the blood thus collected to the liver. The tributary veins corre-
spond at first with the arteries supplying these organs, but the
terminal veins differ somewhat. The inferior mesenteric vein
joins the splenic vein, and they join with the superior mesentric
Tein to form the portal vein. The portal vein is a short wide
vessel about three inches long, which commences behind the
156 HANDBOOK OF ANATOMY
neck of the pancreas in front of the left border of the inferior
vena cava. It passes upwards behind the pancreas, duodenum,,
and common bile-duct, and enters the transverse fissure of the
liver.
The Middle and Inferior Haemorrhoidal veins which drain the
lower part of the rectum, enter the internal iliac vein, and thus
connect the vena cava and portal systems.
SECTION X
THE BLOODVESSELS OF THE UPPER LIMB
Arteries of the Upper Limb.
THE blood-supply of the upper limb is derived from the con-
tinuation of the subclavian artery, which at the lower border
of the first rib changes its name and becomes the axillary
artery.
Axillary Artery. — From the lower border of the first rib to
the lower border of the teres major.
The axillary artery passes through the axillary space, and lies
on, successively, upper digitation of serratus magnus, sub-
scapularis, latissimus dorsi, teres major, and is covered by pec-
tor alis major and minor.
The pectoralis minor muscle crosses the middle third of the
artery and divides it into three parts.
The three cords of the brachial plexus lie respectively to the
inner, outer, and posterior sides of the artery.
The axillary vein lies along the inner side of the artery.
Branches. — From first and second parts :
Several thoracic branches to supply the neighbouring parts.
From third part :
1. Subscapular, which arises opposite the lower border of the
scapularis and supplies the adjacent muscles and inner wall of
axillary space.
2. Anterior and Posterior Circumflex, which enclose the sur-
gical neck of the humerus and supply the shoulder-joint and
adjacent muscles (see Fig. 6).
The axillary artery is continued as the brachial artery, which
passes down to supply the upper arm.
Brachial Artery. — From the lower border 'of teres major to
the antecubital fossa, where, at the level of the neck of the
157
158 HANDBOOK OF ANATOMY
radius, it terminates by dividing into the radial and ulnar
arteries.
The brachial artery passes downwards and outwards, and lies
on, successively, long head of triceps, insertion of coraco-
brachialis, brachialis anticus, and is covered by the inner border
of biceps.
In its upper half the median and ulnar nerves lie re-
spectively on the external and internal sides of the artery, and at
the middle the median nerve crosses over to the inner side of
the artery, while the ulnar nerve passes to the back of the arm,
Branches. — 1. Superior Profunda, runs downwards and back-
wards with the musculo-spiral nerve to the back of the arm.
2. Inferior Profunda, runs downwards and backwards with the
ulnar nerve to the back of the elbow-joint.
3. Anastomotic pierces the internal intermuscular septum and
passes also to the back of the elbow-joint.
4. Small muscular branches are given off to the adjacent
muscles.
Radial Artepy. — The radial artery is the smaller of the two
terminal branches of the brachial artery, but the more direct
continuation of the parent trunk. It passes down the outer
side of the forearm, and at the wrist winds round the trapezium
to reach the back of the hand ; it then comes back through the
first interosseous space, and anastomoses with the deep branch
of the ulnar artery to form the deep palmar arch.
It lies successively on insertion of biceps, supinator brevis,
pronator radii teres, radial head of flexor sublimis digitorum,
flexor longus pollicis, pronator quadratics, anterior ligament of
wrist- joint.
It is covered by inner border of supinator longus (brachio-
radialis) in its upper two-thirds. The lower third is sub-
cutaneous.
The radial nerve is in relation to the artery in its middle
third, and lies on its outer side.
Branches. — 1. Superficial Volar, which arises just above the
wrist, and, passing down over the ball of the thumb, anasto-
moses with the superficial branch of the ulnar artery to form
the superficial palmar arch.
ULNAR ARTERY 159-
2. Anterior Carpal, given off at the wrist and anastomoses with
a similar branch of the ulnar artery.
3. Posterior Carpal, a small branch which passes backwards
and anastomoses with a similar branch from the ulnar artery to
form the posterior carpal arch.
4. Muscular branches for the supply of the adjacent muscles.
Ulnar Artery. — The larger of the two terminal branches of
the brachial artery arises in the antecubital fossa, and terminates
in the palm of the hand by forming the palmar arches.
It lies successively on brachialis anticus, flexor profundus
digitorum, pronator quadratus, anterior annular ligament.
It is covered by the (pronator radii teres, flexor sublimis digi-
torum, flexor carpi radialis, palmaris longus, flexor carpi ulnaris)
superficial group of flexor muscles from internal condyle of
humerus, and in its lower third is subcutaneous.
The median nerve crosses it above, being separated from the
artery by the deep head of pronator radii teres, and on its inner
side lies the ulnar nerve.
Branches. — 1. Common Inter 'osseous, a very short trunk arising
in the antecubital fossa, and dividing into the anterior and
posterior interosseous arteries.
(a) The Anterior Interosseous artery runs down on the an-
terior surface of the interosseous membrane to the upper border-
of pronator quadratus, where it pierces the membrane and
terminates in the posterior carpal arch.
(b) The Posterior Interosseous artery passes down the back of
the forearm between the superficial and deep muscles which it
supplies, and ends by anastomosing with the anterior interosseous
artery and the posterior carpal arch.
2. Anterior Carpal, a small branch given off just above the
wrist, which anastomoses with a similar branch from the radial
artery to form the anterior carpal arch.
3. Posterior Carpal, a small branch which passes backwards
and anastomoses with a similar branch from the radial artery
to form the posterior carpal arch.
The ulnar artery crosses over the annular ligament, and ter-
minates in the palm of the hand by dividing into superficial
and deep branches.
160 HANDBOOK OF ANATOMY
The Superficial Palmar Arch is formed at the level of the
distal border of the abducted thumb by the anastomosis of the
superficial volar branch of the radial artery with the superficial
terminal branch of the ulnar artery.
It lies on flexor brevis minimi digiti, opponens minimi digiti,
and tendons of flexor sublimis digitorum. It is covered by
palmar fascia and integument.
The Deep Palmar Arch is formed about three-quarters of an
inch above the level of the superficial arch, by the anastomosis
of the radial artery with the deep terminal branch of the ulnar
artery.
It lies deeply in the palm on the bases of the metacarpal
bones and the interossei muscles, and is covered by the flexor
tendons. From the arches branches are given off for the
supply of the muscles and fingers.
The back of the hand and fingers are supplied by branches
given off from the radial artery while it lies on the back of the
trapezium.
Veins of the Upper Limb.
The veins of the upper limb are arranged in two sets — super-
ficial and deep. Both sets open eventually into a common
trunk, known as the axillary vein, which continues as the sub-
clavian vein to the innominate vein.
The Deep veins consist of vense comites arranged in the
usual way, which open into the axillary vein.
The Axillary vein commences as the continuation of the
basilic vein opposite the lower border of teres major, and ter-
minates at the lower border of the first rib by becoming the
subclavian vein. Its muscular relations are similar to those
of the axillary artery, from which it is separated in the lower
part of its course by the ulnar nerve, and above by the inner
cord of the brachial plexus. To the inner side of the axillary
vein lie the groups of axillary glands.
Tributaries. — 1. Vense Comites of the brachial artery at the
lower border of the subscapularis muscle.
2. Cephalic vein at the upper border of pectoralis minor.
ULNAR VEINS 161
3. Tributaries corresponding to the branches of the axillary
artery.
The Superficial veins commence in the superficial fascia of
the palm and dorsum of the hand, and of the fingers.
The superficial veins of the palm and palmar surface of the
fingers are relatively small, and after forming a small irregular
plexus end in the median and anterior ulnar veins of the
forearm.
On the dorsal aspect of the fingers are the dorso-lateral
veins, which ascend along the dorso-lateral borders of each digit.
They receive tributaries from all the tissues of the fingers, and
terminate in a dorsal venous plexus, or arch, which lies at the
level of the bases of the four inner metacarpal bones. The arch
finally terminates in the radial and posterior ulnar veins of
the forearm.
There are four superficial veins in the forearm :
1. The Median vein which commences on the dorsal aspect
of the base of the thumb. It turns round the radial border of
the wrist, and, passing up the middle of the forearm, terminates
by dividing into the median cephalic and median basilic veins.
Tributaries. — (I) Deep Median vein, a short vessel which con-
nects the deep and superficial veins at the elbow-joint.
(2) Tributaries from the adjacent tissues.
2. The Radial vein commences in the dorsal venous plexus of
the hand and runs up the outer border of the forearm, receiving
tributaries from the adjacent tissues. It ends at the outer side
of the elbow by joining the median cephalic vein to form the
cephalic vein.
8. The Anterior Ulnar vein commences at the base of the
little finger, and, passing up the ulnar side of the anterior surface
of the forearm, ends in -the basilic vein.
4. The Posterior Ulnar vein (usually considerably larger than
the anterior) commences in the dorsal venous plexus, and
ascends along the dorsal side of the ulnar aspect of the fore-
arm. It terminates by joining the median basilic vein to form
the basilic vein.
The median cephalic and median basilic veins are formed by
the division of the median vein ; they are both short vessels.
11
162 HANDBOOK OF ANATOMY
The median cephalic vein passes upwards and outwards, and
opposite the external condyle of the humerus joins the radial
vein to form the cephalic vein. The median basilic vein similarly
forms the basilic vein opposite the internal condyle by joining
with the anterior and posterior ulnar veins.
The upper arm contains only two large veins.
1. The Basilic vein commences opposite the inner side of the
bend of the elbow, and passing upwards on the inner side of
biceps to the middle of the arm it pierces the deep fascia, and
opposite the lower border of teres major becomes the axillary
vein.
2. The Cephalic vein commences at the outer side of the bend
of the elbow and ascends* on the outer side of biceps. It then
pierces the deep fascia, and passing between the adjacent
borders of the deltoid and pectoralis major muscles, it pierces
the costo-coracoid membrane and enters the third part of the
axillary vein.
SECTION XI
THE BLOODVESSELS OF THE LOWER LIMB
Arteries of the Lower Limb.
THE blood-supply of the lower limb is derived from the con-
tinuation of the external iliac artery, which, passing under
Poupart's ligament, changes its name and becomes the femoral
artery, which passes from the lower border of Poupart's liga-
ment to the opening in the insertion of adductor magnus.
The Femoral artery passes through Scarpa's triangle, then
enters Hunter's canal.
Scarpa's triangle is a muscular space situated in the upper
anterior portion of the thigh : it is triangular with the apex
downwards ; the base is formed by Poupart's ligament, the outer
side by sartorius, the inner side by adductor longus ; in the
floor are seen ilio-psoas, pectineus and adductor brevis ; the con-
tents are femoral artery and vein, anterior crural nerve, and
lymph glands.
In Scarpa's triangle it lies on, successively, posterior part of
femoral sheath, pubic portion of fascia lata, psoas, pectineus,
adductor longus (upper part), and is covered by skin and fascia,
superficial glands and vessels. On the outer side of the artery
above lies the anterior crural nerve, and lower down the internal
;saphenous nerve.
The femoral vein lies behind the artery in the lower part of
"Scarpa's triangle, passes to its inner side above, and is separated
from the artery by the outer septum of the femoral sheath.
Hunter's canal is a potential space between the adductor
muscles and vastus internus, covered by sartorius ; the contents
are the femoral artery and vein, and long saphenous nerve.
In Hunter's canal the artery lies on, successively, adductor
163
164 HANDBOOK OF ANATOMY
longus, adductor magnus, and is covered by sartorius, and on the
outer side lies vastus internus.
The long saphenous nerve enters the canal with the artery,,
and crossing over passes out on its inner side.
The femoral vein lies behind the artery on its outer side below
and on its inner side above.
Branches (in Scarpa's triangle) :
(1) Superficial external pudic,
(2) Superficial epigastric,
(3) Superficial circumflex iliac,
all of which supply the lower part of the abdominal wall and
superficially the external genital organs,
(4) Muscular,
(5) Deep external pudic,
(6) Profunda,
all of which supply the muscles on the front and inner side of
the thigh, the profunda sending off a number of perforating
branches, which curve backwards and outwards round the femur.
In Hunter's canal (near the lower end) :
(7) Anastomotica magna, which anastomoses with the termina-
tions of the other branches and the articular branches of the
popliteal artery.
The femoral artery is continued as the popliteal artery, which
lies in the popliteal space at the back of the knee-joint.
The Popliteal Space is a diamond-shaped space at the back of
the knee, covered in by a very strong fascia; above, the
Boundaries are the ham-strings, biceps on the outer side, semi-
tendinosus and semimembranosus on the inner side ; below, the
two heads of the gastrocnemius ; the floor is formed by the
posterior surface of the femur, and popliteus. The contents are
the popliteal artery and vein, the popliteal nerves and lymphatic
glands.
Popliteal Artery. — From the opening in the insertion of
adductor magnus to the lower border of popliteus, where it ter-
minates by dividing into the anterior and posterior tibial arteries.
The artery descends with an outward inclination to the space
between the condyles of the femur, and then continues vertically
downwards. It is in contact in front with the popliteal surface
POSTERIOR TIBIAL ARTERY 165
of the femur, posterior ligament of knee-joint, posterior surface
of popliteus, and is covered by outer border of semimembranosus,
and adjacent borders of heads of gastrocnemius. On its outer
side above lies the internal popliteal nerve, which crosses its
middle and lies on its inner side below.
The Popliteal Vein lies behind the artery below, then crosses
its middle, lying between it and the internal popliteal nerve, and
passes upwards on its outer side.
Brandies. — Muscular to the adjacent parts.
Articular to the knee-joint (five in number) .
Posterior Tibial Artery. — The larger of the two terminal
branches of the popliteal artery commences at the lower border
of popliteus and terminates at the lower border of the internal an-
nular ligament midway between the tip of the internal malleolus
and the os calcis. It ends by dividing into the internal and
external plantar arteries. The artery lies between the deep and
superficial groups of muscles on the back of the leg, and is in
contact in front from above downwards with tibialis posticus,
flexor longus digitorum, posterior surface of tibia, posterior
ligament of ankle-joint. It is covered by, successively, gas-
trocnemius, soleus, skin and fascia, internal annular ligament,
origin of abductor hallucis.
The internal popliteal nerve lies above on the inner side of the
artery, and crosses it about an inch and a half below its origin,
and is continued down its outer side.
The artery is accompanied by venae comites, one on each side.
Beneath the internal annular ligament the tendons of tibialis
posticus and flexor longus digitorum lie in the front of the artery
and that of flexor longus hallucis behind it.
Branches. — 1. Muscular to soleus and the deep muscles.
2. Cutaneous to skin of back of leg.
3. Internal Malleolar to the inner surface of the
internal malleolus, which anastomoses with a
similar branch of the anterior tibial artery.
4. Peroneal, the largest branch of the posterior
tibial artery, arises about an inch below the
lower border of popliteus, and, curving
outwards, supplies the peroneal muscles.
166 HANDBOOK OF ANATOMY
Internal Plantar Artery. — The smaller of the two terminal
branches of the posterior tibial artery passes forwards along the
inner side of the foot between abductor hallucis and flexor
brevis digitorum to the head of the first metatarsal bone, where
it unites with a branch of the dorsalis pedis artery, the termina-
tion of the anterior tibial artery.
External Plantar Artery.— The larger of the two terminal
branches runs outwards and forwards between flexor brevis
digitorum on the inner side and accessorius and abductor minimi
digiti on the outer side to the base of the fifth metatarsal bone,
It then passes inwards across the bases of the metatarsal bones,
where on the outer side of the first one it terminates by anas-
tomosing with the dorsalis pedis artery, thus forming the plantar
arch (see Fig. 24).
Branches. — 1. Internal calcaneal.
2. Muscular.
3. Cutaneous.
From the arch —
4. Digital branches — four in number — running on the outer
side of the little toe and the plantar surfaces of the interosseous
muscles.
5. Perforating arteries — three in number — anastomosing with
the dorsal arteries.
6. Articular to the tarsal joints.
Anterior Tibial Artery.— The smaller of the two terminal
branches of the popliteal artery passes forward above the inter-
osseous membrane and runs down the front of the leg and
terminates by becoming the dorsal artery of the foot from the
lower border of popliteus to the front of the ankle. It lies on,
successively, anterior surface upper two-thirds of interosseous
membrane, shaft of tibia, anterior ligament of ankle-joint.
On the inner side of the upper two-thirds lies the tibialis
anticus, and in the lower third the extensor longus hallucis
crosses over and lies on the inner side. On the outer side of the
upper two-thirds lie respectively extensor longus digitorum and
extensor longus hallucis, and the last part of the artery lies
between the tendons of these two muscles.
The anterior tibial nerve lies on the outer side of the artery,,
FEMORAL VEIN 167
and at the ankle lies between it and the outermost tendon of
extensor longus digitorum. The artery is accompanied by venaa
comites.
Branches. — 1. Muscular to adjacent parts.
2. Cutaneous to skin of front of leg.
3. Internal malleolar anastomoses with posterior
tibial.
4. External malleolar anastomoses with peroneal.
Dorsalis Pedis artery is the direct continuation of the anterior
tibial artery from the front of the ankle-joint to the posterior
extremity of the first interosseous space, where it anastomoses
with the external plantar artery to form the plantar arch. It
lies on, successively, anterior ligament of the ankle-joint, head
of the astragalus, navicular bone, inter cuneiform ligaments.
It is covered by skin and fascia and the lower part of the
anterior annular ligament.
The internal terminal branch of the anterior tibial nerve lies
on the outer side of the artery, between it and the extensor
brevis digitorum.
The tendon of extensor proprius hallucis lies on the inner side,
Branches. — 1. Cutaneous to skin of dorsum of foot.
2. Dorsalis hallucis runs on first interosseus muscle and sup-
pies first and second toes.
3. Metatarsal arises just before termination of artery, and,
running outwards, gives off branches to supply the digital clefts,
Veins of the Lower Limb.
The veins of the lower limb are arranged in a similar manner
to those of the upper limb, in two groups — superficial and deep.
The Deep veins consist of venge comites accompanying all the
arteries in the leg, which unite to form the Popliteal vein at the
lower border of popliteus. The popliteal vein passes upwards
through the popliteal space, at first on the inner side of the
artery and above on the outer side ; it then passes through the
opening in adductor magnus and becomes the femoral vein.
The Femoral vein is the direct continuation of the popliteal
vein. It ascends through Hunter's canal and Scarpa's triangle,
168 HANDBOOK OF ANATOMY
and, passing under Poupart's ligament on the inner side of the
femoral artery, becomes the external iliac vein.
The Superficial veins of the lower limb are two in number
— the internal or long saphenous vein and the external or short
saphenous vein.
The veins on the toes are arranged similarly to those of the
fingers, and form plexuses on the sole and dorsum of the foot,
which enter the external and internal saphenous veins re-
spectively.
The Internal Saphenous vein is formed by the veins on the
inner side of the sole and dorsum of the foot. It passes upwards
in front of the internal malleolus, and, passing behind the inner
border of the tibia, it runs up the leg to a point behind the
internal condyle of the femur. Then, coursing outwards and
forwards, it passes up the inner side of the thigh and terminates
in the upper part of Scarpa's triangle in the femoral vein.
The External Saphenous vein is formed by the veins on the
outer side of the sole and dorsum of the foot. It passes behind
the external malleolus and up the back of the leg to the lower
part of the popliteal space, where it enters the popliteal vein.
SECTION XII
LYMPHATIC SYSTEM
THE Lymphatic System is the means by which the liquid
portion of the blood which exudes into the intercellular spaces
is gathered up and returned to the blood, passing through the
lymphatic glands on its way. The lymph capillaries gather up
the fluid from the spaces, and enter a definite system of vessels,
which carry the lymph to the groups of glands. Vessels leave
these glands, and the lymph is carried to its final destination
in the big veins at the root of the neck by one of the two ter-
minal lymph vessels.
The Thoracic Duct is the larger of the two terminal vessels.
It commences in the Receptaculum chyli (really a dilation of
the vessel) which lies beneath the right crus of the diaphragm.
The duct passes through the aortic opening in the diaphragm,
and passes up on the right of the vertebral column. At the level
•of the fifth thoracic vertebra it crosses over to the left side, and
passes up to enter the left innominate vein. The Receptaculum
chyli receives the lymph from the lower extremities and the
whole of the abdomen. The thoracic duct receives lymph from
the left half of the thorax, the left upper extremity, and the left
side of the head and neck.
The Right Lymphatic Duct is a very short vessel, not always
present, about an inch long, which enters the right innominate
vein. It receives lymph from the right half of the thorax, right
upper extremity, and the right side of the head and neck.
The Lymphatic Glands and their vessels are arranged in two
sets — superficial and deep — and are usually to be found on the
course of the big veins and large spaces where there is con-
nective tissue. The two sets anastomose with one another freely.
169
170 HANDBOOK OF ANATOMY
Head and Neck.
Occipital Glands, upon the upper part of trapezius or corn-
plexus, drain the occipital region of the scalp and upper and
back part of the neck.
Mastoid Glands, on the upper part of sterno-mastoid and the
mastoid bone, drain the parietal region of the scalp and the ear.
Facial Glands, small glands in different parts of the face, in-
cluding several small groups situated beneath and behind the
masseter muscle, draining the different parts of the face.
Superficial Cervical Glands lie superficial to the sterno-mastoid
along the course of the external jugular veins. They drain the
superficial part of the neck and mastoid region. There are also
numerous small groups draining the tongue, front of the neck,,
pharynx, and larynx (see Fig. 59).
Deep Cervical Glands are in two groups, one beneath the
sterno-mastoid lying along the course of the internal jugular
vein. The other, embedded among the cords of the brachial plexus,,
is termed the supraclavicular group. These glands receive
tributaries from the surrounding tissues and the groups of
glands above them.
Upper Extremity.
Anteeubital Glands, two or three small glands in front of
the elbow, which drain the anterior surface of the forearm.
They are not always present.
Axillary Glands. — These are arranged in four groups — (1)
along the axillary vessels, (2) along the upper part of the axillary
and the subclavian vessels, (3) between pectoralis major and
serratus magnus, (4) along the subscapular vessels on the pos-
terior wall of the axilla. They drain the upper limb and
adjacent parts.
The Superficial Lymphatic Vessels of the upper limb begin
by fine plexuses on the fronts of the fingers and palms of the
hand. These converge to form vessels running along the sides
of the fingers and back of the hand, and finally larger vessels
are formed which follow the course of the veins and receive
tributaries from the surrounding tissues, passing up to join the
LYMPHATIC GLANDS 171
antecubital and axillary glands. The Deep Lymphatic Vessels
commence in the deeper tissue, and follow the course of the
deep vein to the glands.
Lower Extremity.
Anterior Tibial Gland, on the front of the upper part of-
the interosseous membrane, drains the front of the leg.
Popliteal Glands, several glands in the popliteal space lying
along the course of the vessels. These receive the tributaries
from the anterior tibial gland and from the calf of the leg and
foot.
Femoral Glands are in two sets — superficial and deep. They
are all in Scarpa's triangle, arranged along the course of the
vessels and along Poupart's ligament. They drain the whole of
the lower limb.
The Lymphatic Vessels of the lower extremity are arranged
in a very similar manner to those of the upper.
Trunk.
There are a large number of groups of glands in the
abdomen and thorax which lie along the course of the vessels
and in connection with the organs, and enter mainly the
thoracic duct as described above. The lateral walls of the trunk
are drained by the axillary and femoral groups of glands. The
anterior walls are drained by some of the visceral groups, and
the back is drained by groups of glands lying along the front
of the vertebral column.
SECTION XIII
BRAIN, SPINAL CORD, NERVES OF TRUNK, AND
SYMPATHETIC SYSTEM
THERE are two nervous systems described in the body — the
cerebro-spinal and sympathetic. The cerebro -spinal can be
divided into central and peripheral parts, the central part con-
Cerebral Hemisphere
/// Pons Varolii
Medulla Oblongata
FIG. 60.— THE BRAIN (SIDE VIEW).
sisting of the brain and spinal cord, which send branches to
the periphery. The sympathetic system consists of two chains
of ganglia which communicate with the peripheral part of the
•cerebro-spinal system by means of efferent and afferent branches.
172
BRAIN
173
The brain is enclosed by the cranium, and the lower and
hind-part of the brain, called the medulla, is prolonged through
the foramen magnum of the occipital bone into the vertebral
canal. The upper part of the brain — the cerebrum — is the
larger; it is divided longitudinally by a deep cleft into two
halves, each of which are divided again into lobes, correspond-
Olfactory Bulb
Olfactory Tract
Optic Nerve
Optic Commissure -mnjpr
Optic Tract
Third Nerve
Fourth Nerve
Fifth Nerve
Sixth Nerv
Facial Nerve
Pars Intermedia -'
Auditory Nerve '"
Glosso-pharyngeul Nerve -
Pneumogastric Nerve
Spinal Accessory Nerve
Hypoglossal Nerve
Locus Perforates -
Anticus
- Tuber Cinereum
Corpus Albicans
Crus Cerebri
Locus Perforatus-
Posticus
Pons Varolii
Medulla Oblongata
Spinal Cord
FIG. 61. — BASE OF THE BRAIN.
ing with, in shape and position, the bones of the cranium —
namely, frontal, parietal, temporal, and occipital. These are
again subdivided by numerous clefts or sulci.' Beneath the
occipital lobes of the cerebrum lies the cerebellum, or hind-brain,
much smaller than the cerebrum. It also is divided longitu-
dinally into two principal lobes, which are again subdivided by
174 HANDBOOK OF ANATOMY
: sulci, which, however, are very much shallower than those of
the cerebrum.
Looking at the base of the brain, it is seen that two thick cords
of white matter issue from the cerebrum. These are called the
cerebral peduncles, and joining them together is the pons
varolii, which is seen to consist of transverse fibres, the ends
of which pass into the cerebellum. Below the pons varolii is
the upper end of the bulb or medulla oblongata, which lies on
the upper aspect of the basilar process of the occipital bone.
The medulla tapers somewhat sharply, and is continued as the
spinal cord.
From each side of the pons varolii and the medulla, issue
the larger number of the twelve pairs of cranial nerves, which
supply the tissues of the head and neck.
In transverse section the brain is seen to consist of white
matter with a covering about quarter of an inch thick of grey
matter, both of which are folded into convolutions and sulci.
There are also nuclei of grey matter embedded in the white.
The cerebellum is of similar structure.
The brain has three membraneous coverings, named, respec-
tively, dura mater, arachnoid mater, and pia mater.
The Dura Mater is a tough membrane which lines the inside
of the cranium, and is closely attached to it. It dips down into
the great longitudinal fissure, and forms a pocket, or sinus. It
also sends a process into the fissure between the cerebrum and
cerebellum, called the tentorium cerebelli, in the edges of
which are found sinuses. These sinuses are for the collection
of venous blood.
The Arachnoid Mater is a more or less areolar structure which
connects the pia mater with the dura mater.
The Pia Mater is a very thin epithelium which covers the brain
substance, and follows intimately all the convolutions and sulci.
In it numerous small bloodvessels ramify.
Blood-Supply of the Brain.
The blood-supply of the brain is very free, and is derived
from four large arteries — the internal carotid and vertebral
arteries of each side. These enter through the carotid canal in the
SPINAL CORD 175
temporal bone and the foramen magnum respectively. On the
lower surface of the medulla they anastomose together to
form the circle of Willis, from which branches are derived
which supply freely the different parts of the brain.
There are no veins proper in the brain ; the venous blood is
collected in the blood-spaces or sinuses in the dura mater, which-
finally leave the cranium by the jugular foramina as the internal
jugular veins.
The Spinal Cord.
The spinal cord occupies the upper two-thirds of the verte-
bral canal. It extends from the margin of the foramen magnum
of the occipital bone to the level of the upper border of the
second lumbar vertebra. At its upper end it is continuous with
the medulla oblongata of the brain, at its lower end it tapers,
forming a pointed extremity called the conus medullaris, from
the end of which comes a slender thread called the filum ter-
minale. The cord is a cylindrical structure, slightly flattened
before and behind, and is considerably smaller than the canal,
which allows movements of the vertebral column to take place
without jarring the cord.
The cord has three coverings continuous with those of tne
farain — viz., dura mater, arachnoid mater, and pia mater. The
cord is suspended within the dura mater by two ligaments, which
project laterally in its whole length, called the ligamenta dentic-
ulata. These extend outwards, and are attached to the inner
surface of the dura mater by tooth-like projections.
The cord is not of uniform thickness throughout, but is con-
siderably thickened in the lower cervical and upper lumbar
regions. The cord similarly to the brain has a longitudinal fissure
running down its posterior surface, which grooves it nearly to
the centre. There is a shallower anterior furrow, and two very
shallow grooves, one on each side of the posterior crus. These
are called the postero-lateral grooves.
On transverse section the cord is seen to consist also of grey
and white matter, but the grey matter is entirely embedded in
the white, and has a minute central canal running through
it, which communicates above with one of the ventricles of
the brain. The grey matter forms a column which extends
176 HANDBOOK OF ANATOMY
the whole length of the cord, and in transverse section re-
sembles in shape the letter H, the four ends of which are called
horns.
There are thirty-one pairs of spinal nerves, which are attached
by two roots each to the lateral aspects of the cord opposite the
anterior and posterior horns of grey matter on each side respec-
tively. These nerves come through the intervertebral foramina,,
and are named according to the vertebrae below which they
emerge, except in the case of the cervical ones. The first
nerve comes out between the occipital bone and the atlas, so^
that there are eight pairs of cervical nerves, twelve pairs of
dorsal nerves, five pairs of lumbar nerves, five pairs of sacral
nerves, and one pair of coccygeal nerves. As the cord itself
ends in the upper lumbar region, the lower nerves lie in the ver-
tebral canal, forming what is known as the cauda equina, and
emerging in order through the intervertebral foramina.
The spinal nerves are attached to the cord by two roots —
anterior and posterior — which join together inside the vertebral
canal so that a mixed nerve — i.e., formed by the junction of the
two roots — emerges from the intervertebral foramen. It im-
mediately divides into anterior and posterior divisions.
The posterior divisions supply the skin at the back of the
head, neck, shoulder, buttock, and trunk, and the longitudinal
muscles of the back. Each divides into two parts — an internal
and external trunk. In the upper half of the body the in-
ternal trunks are cutaneous, the external ones muscular; in
the lower half of the body the reverse is the case. The pos-
terior divisions of the first and second cervical nerves vary a
little.
First cervical nerve (suboccipital) does not divide into internal
and external'trunks, and gives off no cutaneous branches. Mus-
cular branches to complexus, rectus capitis posticus major and
minor, obliquus superior and inferior.
Second cervical nerve (great occipital) supplies the skin at the
back of the head as far as the vertex, and communicates with
the other cutaneous nerves of that region.
Muscular branches to complexus, obliquus inferior, and other
muscles on the back of the neck.
THORACIC NERVES 177
Third cervical nerve is called the least occipital nerve, and
is rather small, but its distribution is similar to that of the
posterior divisions of the other spinal nerves.
The anterior divisions of the rest supply the trunk and the
limbs. They form what are called plexuses, which are groups
of nerves joined up together. There are five plexuses — viz. r
Cervical plexus, formed by cervical nerves 1, 2, 3, and 4,
supplies the muscles and skin of the neck.
Brachial plexus, formed by cervical nerves 5, 6, 7, 8, and a
branch of the first dorsal nerve, supplies the upper limb.
Lumbar plexus, formed by a branch of the twelfth dorsal
nerve, lumbar nerves 1, 2, 3, and a branch of the fourth lumbar
nerve, supplies the anterior, inner, and outer surfaces of the
thigh.
Sacral plexus, formed by lumbar nerves 4 and 5, and sacral
nerves 1, 2, 3, supplies buttock, posterior surface of thigh and
leg and foot.
Pudendal plexus, formed by a branch of the third sacral
nerve, sacral nerves 4 and 5, and the coccygeal nerve, supplies
the perineum.
The anterior divisions of the twelve dorsal or thoracic nerves
supply the skin and muscles on the anterior and lateral surfaces
of the trunk. The first eleven are intercostal, the twelfth lies
below the last rib.
The Intercostal Nerves are much alike in their course
and distribution, but some of them differ slightly from the
others.
A typical thoracic nerve enters the posterior end of the
subcostal groove, and lies between the intercostal muscles.
Coursing forwards, it pierces the internal intercostal muscle
about the middle of the chest wall, and lies on the pleura. Near
the middle line it pierces again the internal intercostal musck
and the aponeurosis of the external intercostal, and supplies
the skin over the front of the chest corresponding to the an-
terior half of the space to which it belongs.
Branches. — Cutaneous, a lateral cutaneous branch is given off
in the mid-axillary line to the skin over the space to which it
belongs ; it divides into anterior and posterior branches.
12
178
HANDBOOK OF ANATOMY
Muscular, to the intercostal muscles.
First thoracic nerve divides into two parts. The upper larger
part passes over the neck of the first rib, enters the neck behind
the subclavian artery , and joins with the other nerves forming
Hypogastric Branch. „
of Jlio-hypogastric
Intercosto-humeral
-• -Additional Intercostc
humeral
Lateral Cutaneous
1 2th Thoracic
Iliac Branch of Ilio-
hypogastric
FIG. 62. — CUTANEOUS NERVES OF TRUNK.
the brachial plexus. The lower part enters the subcostal groove
and supplies the intercostal muscles, but as a rule has no
cutaneous branches.
Second thoracic nerve has the same course as a typical thoracic
nerve, but the lateral cutaneous branch, called the intercosto-
SYMPATHETIC SYSTEM 179
humeral nerve, is of unusually large size. It crosses the axilla
and supplies the skin of the armpit, and the inner side of
the posterior surface of the arm as far as the elbow.
Third thoracic nerve is a typical one, except that the pos-
terior half of the lateral cutaneous branch also extends into
the arm, and' supplies a small portion of the posterior surface
of the root of the limb.
Fourth, fifth, and sixth thoracic nerves are typical.
Seventh, eighth, ninth, tenth, and eleventh thoracic nerves at
the anterior ends of their intercostal spaces pierce the attach-
ment of the diaphragm and the transversalis abdominis, and
pass forwards between the latter and obliquus internus. " Their
anterior ends become cutaneous by piercing the sheath of the
rectus and the muscle itself. They supply the intercostal
muscles of their own spaces and the abdominal muscles, and
help to supply the diaphragm. Their cutaneous branches are
similar to those of the typical nerves.
Twelfth thoracic nerve passes downwards under psoas and
then passes forwards, similarly to those just above it. It gives
off a large lateral cutaneous branch, which, passing down
between the abdominal muscles, becomes cutaneous just above
the iliac crest, and supplies the skin of the buttock as far
down as the great trochanter of the femur.
The Sympathetic System.
The sympathetic system consists of two long chains of
ganglia lying one on each side of the vertebral column, ex-
tending from the base of the skull to the coccyx. The ganglia
:are connected to the spinal cord by white rami communicantes
given off by some of the spinal nerves (second thoracic to
second lumbar and three or four sacral) as they emerge from
the inter vertebral foramina. The ganglia send grey rami com-
municantes back to the cord. Above, the chain ends by a plexus
of nerves sent into the cranial cavity on the internal carotid
artery, and below, the two terminal ganglia communicate with
one another.
The ganglia send branches of supply to vessels, viscera, in-
voluntary muscles, and glands.
180 HANDBOOK OF ANATOMY
In the cervical region there are only three ganglia on each
side, but below this there is a ganglion on each side opposite
each vertebra.
The ganglia in the cervical and thoracic regions form plexuses
on the vessels in their vicinity, and also form plexuses to supply
the pharynx, larynx, heart, and lungs. In addition they com-
municate with the lumbar ganglia by means of the splanchnic
nerves, which pierce the diaphragm to join the solar plexus.
The Splanchnic Nerves, three in number, are formed by
branches from the fifth to the twelfth thoracic ganglia.
The Solar Plexus consists of three parts — the coeliac plexus-
and the two semilunar ganglia. They lie behind the stomach,,
on the aorta, just above the coeliac axis. They send out
branches, which form subsidiary plexuses, accompanying the-
branches of the artery to the various organs.
The Aortic Plexus is the continuation on the front of the aorta
of the solar plexus, and, like the latter, forms subsidiary plexuses
on the branches of the vessel.
SECTION XIV
CERVICAL PLEXUS
THE cervical plexus is formed by the anterior primary divisions
of the first four cervical nerves. The nerves emerge from the
intervertebral foramina behind the vertebral artery, and each
nerve is joined at once by a communicating branch from the
sympathetic ganglion. The plexus lies on the scalenus medius
muscle, and is covered by sterno-mastoid. The four nerves join
with another, forming a series of loops, from which the branches
of distribution arise.
Branches. — (1) Cutaneous to head, neck, and shoulder.
(2) Muscular to muscles of neck and diaphragm.
(3) Communicating to vagus, spinal accessory, hypoglossal,
and sympathetic.
(1) The Cutaneous branches appear in the posterior triangle of
the neck. The three ascending ones turn upwards over posterior
border of sterno-mastoid, the three descending ones to the
clavicular region.
Ascending Branches : (a) Small occipital supplies skin on back
of ear and on scalp over mastoid process.
(b) Great auricular crosses sterno-mastoid obliquely upwards,
and supplies the scalp behind the ear, the lower part of the
pinna, and the skin over the lower part of the masseter and
the parotid gland.
(c) Superficial cervical crosses straight over the sterno-mastoid
and supplies the skin over the anterior triangle of the neck.
Descending Branches : One large trunk is formed whic
descends from beneath sterno-mastoid. It extends through the
posterior triangle of the neck and supplies . the skin over the
181
182
HANDBOOK OF ANATOMY
clavicle by dividing into three parts — sternal, clavicular, and
acromial.
(2) The Muscular branches of the plexus are in two sets —
internal and external, according to their relation to the sterno-
mastoid muscle.
External branches passing outwards to posterior triangle
Attrahens Auriculam
Attollens Auriculam .
Retrahens Auriculam
Occipitalis-
Great Occipital Nerve-
Levator Anguli Scap
Great Auricular Nerve ..
Spinal Accessory Nerve .-
Branches from Third and Fourtn
Cervical Nerves to Trapezius
Scalenus Mediu
Supra-acromial Nerve
Trapezius..
Small Occipital Nerve- -
Splenius Capiti
_.Frontalis
]• Oi bicularis Palpebrarum
Levator Labii
Superioris Alaeque Nasi
.Levator Labii Superioris
Zygomaticus Minor
?^l.Zygomaticus Major
Masseter
. Orbicularis Oris
..Depressor Labii Inferioris
--Depressor Anguli Oris
—Levator Menti
Anterior Belly of Digastric
Sterno-hyoid
'Anterior Belly of Omo-hyoid
. Sterno-cleido-mastoid
. Superficial Cervical Nerve
..Suprasternal Nerve
.JSupraclavicular Nerve
Scalenus Anticus
/ i
Posterior Belly of Omo-hyoid bubclavian Artery (third part)
FIG. 63. — NERVES IN POSTERIOR TRIANGLE OB' NECK.
supply sterno-mastoid, levator scapulse, trapezius and the
scaleni, and communicate with the spinal accessory nerve.
Internal branches passing inwards to anterior triangle supply
the prevertebral muscles, genio-hyoid, and infrahyoid muscles,
CERVICAL PLEXUS
183
and communicate with the vagus and hypoglossal. There is a
special branch to the diaphragm called the phrenic nerve.
The Phrenic nerve is formed by branches from the third,
fourth, and fifth cervical nerves. It passes down on scalenus
anticus, and enters the thorax between the subclavian artery and
Socia Parotidis
Stensen's Duct
Parotid Gland
Transverse Facial Artery i
Mental Artery
Facial Artery
Lingual Artery
External Carotid Artery..
Superior Laryngeal Artery
Superior Thyroid Artery.^
Pneumogasti
Internal Jug
Common Carotid Artery..1
Anterior Belly of Omo-hyoid...\ .JIj]?
Ascending Cervical Artery...
Inferior Thyroid Artery,..
..Superficial Temporal Artery
^. Internal Maxillary Artery
Posterior Auricular
Artery
^Occipital Artery
i. Great Occipital
Nerve
Internal Carotid
Artery
-^Deep Cervical
Glands
-- Phrenic Nerve
— Scalenus Anticus
Muscle
—Transverse Cervical
Artery
Subclavian Artery (first part) \ "^
\% Suprascapular Artery
Thyroid Axis
FIG. 64. — VESSELS AND NERVES IN NECK.
vein.
It reaches the diaphragm by passing between the peri-
cardium and pleura in front of the root of the lung. The nerve
gives off some branches to the upper surface of the diaphragm,
then pierces the muscle and supplies the under surface. It also
gives off pleural, pericardial, and hepatic branches.
SECTION XV
BRACHIAL PLEXUS AND NERVES OF UPPER LIMB
THE Braehial Plexus is formed by the anterior division of the
fifth, sixth, seventh, and eighth cervical nerves, and the greater
part of the first thoracic nerve. The second thoracic nerve,
To Cervical Plexus —
To Braehial Plexus,
Third Root of Phrenic (inconstant)
Nerve to the Rhomboids
Nerve to Subclavius
' **£/* «*a\,Ajt/uiai.
^
External Anterior Thoracic
Circumflex
Musculo-spiral \
Outer Root of Median
Musculo-cutaneous
Median
* Posterior Thoracic (Ext.
Respiratory N. of Bell).
First Intercostal
\
\ " Upper or Short Subscapular
\ 'Internal Anterior Thoracic
\ Middle or Long Subscapular
\ \ Lower Subscapular
XN Nerve of Wrisberg
N Inner Root of Median
Internal Cutaneous
Ulnar
FIG. 65. — THE BRACHIAL PLEXUS.
although not part of the plexus, helps in the innervation of the
arm through the intercosto-humeral nerve.
The nerves forming the plexus appear in the posterior triangle
184
BRACHIAL PLEXUS 185
of the neck, and, passing between scalenus medius and aiiticus
with the subclavian artery, they accompany the axillary artery
to the shoulder and upper limb.
As the nerves enter the posterior triangle they form the three
primary cords —
First primary cord : Fifth and sixth nerves joined together.
Second primary cord : Seventh nerve alone.
Third primary cord : Eighth cervical and first thoracic joined
together.
As soon as the three cords are formed they each divide into
anterior and posterior divisions to form the secondary cords,
which are named according to their relation to the axillary
artery.
Outer cord : Anterior divisions of first and second primary
cords.
Inner cord : Anterior division of third primary cord.
Posterior cord : Posterior divisions of all three primary cords.
The nerves supplying the shoulder and arm are derived from
these three cords — viz. :
Outer cord : Musculo-cutaneous, outer head of median, external
anterior thoracic nerves.
Inner cord : Ulnar, inner head of median, internal anterior
thoracic, internal cutaneous, and lesser internal cutaneous nerves.
Posterior cord : Circumflex, three subscapular and musculo-
spiral nerves.
Before the nerves join up to form the cords, a few branches
are given off which are called Supraclavicular nerves to dis-
tinguish them from the branches derived from -the secondary
cords which are called the Infraclavicular nerves.
Supraelavieular Nerves. — Muscular branches to scaleni, sub-
clavius, and longus colli.
Posterior scapular supplies the rhomboids and levator anguli
scapulas.
Long thoracic supplies serratus magnus. It pierces scalenus
medius and enters the axilla between the artery and serratus
magnus. This nerve is also called the respiratory nerve of Bell.
Suprascapular supplies supra- and infraspinatus and articular
branches to the shoulder-joint. It passes down to the superior
186 HANDBOOK OF ANATOMY
border of the scapula, then through the suprascapular foramen
and winds round the great scapular notch.
Infraelavieular Nerves. — The anterior set from the inner and
outer cords supply the chest and front of the limbs, the posterior
set of nerves from the posterior cord supply the shoulder and
the back of the limb.
Anterior Thoracic Nerves. — The external anterior thoracic
nerve arises from the outer cord, and the internal one from the
inner cord. They pass down one on each side of the axillary
artery, and are finally distributed to pectoralis major and
minor.
Museulo-Cutaneous nerve from the outer cord lies first
between coraco-brachialis and the axillary artery; it then lies
between biceps and brachialis to the bend of the elbow. It
becomes cutaneous between biceps and brachio-radialis, and
ends by supplying the skin on the outer side of the forearm.
Branches. — Muscular to biceps, brachialis anticus and coraco-
brachialis (this last nerve is not really a branch of musculo-
cutaneous, but is an independent branch from the sixth and
seventh cervical nerves incorporated with it).
Cutaneous. — Anterior branch supplies the outer half of the
anterior surface of the forearm as far as the ball of the thumb.
The posterior branch supplies the upper three-fourths of the
outer half of the posterior surface of the forearm.
Median nerve arises by two roots — one from the outer cord
and one from the inner. The outer head passes down on the
outer side of the axillary artery, and the inner head crosses over
at the beginning of the brachial artery to join it. The complete
nerve then passes down on the outer side of the brachial artery,,
and crosses over it to the inner side, at the level of the inferior
profunda branch about the middle of the arm. At the elbow it
lies on the inner side of the artery beneath the bicipital fascia
and the median basilic vein, and passes into the forearm between
the two heads of pronator radii teres, the deep head of which
separates the nerve from the ulnar artery. The nerve then
passes down the forearm between the superficial and deep
muscles, and enters the palm of the hand beneath the anterior
annular ligament on the outer side of the flexor tendons. In the
MEDIAN NERVE
187
hand it lies beneath the palmar fascia and superficial palmar arch,
and divides into its six terminal branches.
Branches. — There are none in the upper arm.
In the forearm: 1. Articular to the elbow-joint.
2. Muscular to pronator radii teres, palmaris longus, flexor
carpi radialis, flexor sublimis digitorum, flexor longus pollicis,
and flexor profundus digitorum.
Supra-acromial
-Cutaneous Branch of
Circumflex
-Internal Cutaneous of
Musculo spiral
- 1 ntercosto -humeral
•Lower External Cutaneous
of Musculo-spiral
Nerve of Wrisberg
Posterior Branch of Internal
Cutaneous
•Posterior Branch of Musculo-
cutaneous
•Radial
-Dorsal Branch of Ulnar
FIG. 66.— CUTANEOUS NERVES OF UPPER LIMB (POSTERIOR SURFACE).
3. Anterior Interosseous passes down the anterior surface of
interosseous membrane with the artery of the same name and
beneath the pronator quadratus. It terminates by supplying the
wrist-joint, and in its course supplies flexor longus pollicis, outer
188
HANDBOOK OF ANATOMY
half of flexor prof undus digitorum, pronator quadratus, and twigs
to the bones, periosteum, and interosseous membrane.
4. Palmar Cutaneous branch (not always present) arises in the
lower third of the forearm, pierces the deep fascia, and supplies
the skin of the palm.
Supraclavicular
Anterior Branches of Lateral Cutaneous
Supra-acrouiial ',
Suprasternal
Cutaneous Branch of
Circumflex
Upper External Cutaneous™,
of Musculo-spiral
Branch of Radial
Anterior Cutaneous
~" ' Twi"s: of Internal Cutaneous
x-~ Tntercosto-humeral
...Anterior Branch of Internal Cutaneous
.._. Posterior Branch of Internal Cutaneous
---- Anterior Branch of Musculo-cutaneous
[ Twig of Ulnar
(occasional)
^._- Palmar Cutaneous of Ulnar
Palmar Cutaneous of Median
FIG. 67. — CUTANEOUS NERVES OF UPPER LIMB (ANTERIOR SURFACE).
In the hand : 1 . Muscular to abductor pollicis, opponens
pollicis, superficial head of flexor brevis pollicis, and the two
lumbricales on the radial side.
2. Cutaneous to the skin of the thumb, the first and second
fingers, and the radial half of the third finger. These nerves
ULNAE NERVE 189
turn over the tops of the fingers and supply the posterior surface
of the terminal phalanges.
Ulnar nerve arises from the inner cord of the brachial plexus.
It lies between the axillary artery and vein, and passes down on
the inner side of the brachial artery in front of triceps. In the
lower half of the arm it passes behind the internal intermuscular
septum with the inferior profunda artery lying anterior to the
inner head of triceps, and reaches the interval between the
internal condyle of the humerus and the olecranon process. It
enters the forearm between the two heads of flexor carpi ulnaris
and passes down between it and flexor profundus digitorum on
the inner side of the ulnar artery. It passes into the hand over
the anterior annular ligament on the radial side of the pisiform
bone, and divides beneath palmaris brevis into its terminal
branches.
Branches. — There are none in the upper arm.
In the forearm : Articular to the elbow-joint.
Muscular to flexor carpi ulnaris and the inner half of flexor
profundus digitorum.
Cutaneous. — Palmar supplies the skin over the ulnar side of
the wrist, the hypothenar eminence, and ulnar side of palm.
Dorsal supplies the skin on the ulnar side posterior surface of
wrist and hand, the little finger and ulnar side of third finger.
In the hand : Muscular to palmaris brevis. It then divides
into terminal branches superficial and deep.
Superficial. — Cutaneous to anterior surface of little finger and
ulnar side of third finger.
Deep. — Muscular to all the muscles of the hand except those
supplied by the median nerve.
Internal Cutaneous nerve arises from the inner cord of the
brachial plexus. In the upper part of its course it lies super-
ficial to the artery and the ulnar nerve. It then pierces the
deep fascia about the middle of the inner side of the arm, and
accompanies the basilic vein to the elbow, where it divides into-
its two terminal branches.
Branches. — In the upper arm a branch which supplies the
lower half of the anterior surface on its inner side.
In the forearm there are two branches — one supplies the
190 HANDBOOK OF ANATOMY
anterior surface of the inner side of the forearm as far as the
wrist, the other supplies the upper three-fourths of the posterior
surface of the inner side.
Lesser Internal Cutaneous arises from the inner cord of the
brachial plexus. It supplies the skin of the upper half of the
arm on the inner side.
Circumflex nerve' from the posterior cord passes down behind
the axillary artery and goes through the quadrilateral space in
company with the posterior circumflex artery. It winds round
the surgical neck of the humerus and ends in the deltoid (see
Fig. 6).
Branches. — Muscular to the teres minor and deltoid muscles.
Articular to the shoulder- joint.
Cutaneous to the skin over the deltoid and upper half of the
arm.
The Musculo-Spiral nerve is the continuation of the posterior
cord of the brachial plexus. It passes through the axilla behind
the axillary artery, and down the arm behind the brachial artery
on the long head of triceps. It then courses downwards and
outwards in the musculo-spiral groove with the superior pro-
funda artery, separating the heads of the triceps. The nerve
then pierces the external intermuscular septum, and lies in
front of the external condyle of the humerus between brachialis
anticus and supinator longus, where it ends by dividing into the
radial and posterior inter osseous nerves.
Branches. — On the inner side of the humerus :
1. Internal Cutaneous supplies the skin of the upper third of
the inner side of the arm.
2. Muscular to the three heads of triceps.
At the back of the humerus :
Muscular to the three heads of triceps and anconeus.
On the outer side of the humerus :
1. Cutaneous. — A superior branch supplies the skin on the
outer side and back of the lower third of the arm and the upper
half of the back of the forearm. An inferior branch supplies
the skin in the upper two-thirds of the back of the forearm on
the inner side of the area supplied by the musculo- cutaneous
nerve.
MUSCULO-SPIEAL NERVE 191
2. Muscular to brachialis anticus, supinator longus, and
•extensor carpi radialis longior.
3. Radial nerve passes down the upper two-thirds of the
forearm external to the radial artery and covered by supinator
longus. It pierces the deep fascia on the outer side of the lower
third of the forearm, and passes to the back of the wrist. It
supplies the skin on the back of the wrist, the radial side of the
back of the hand and the back of the thumb, first and second
fingers, and radial side of the third finger as far as the second
phalanges, the rest being supplied by the median nerve.
4. Posterior Interosseous nerve is entirely muscular and articu-
lar in its distribution. It reaches the back of the forearm by
passing from under supinator longus round the outer side of the
radius, and pierces supinator brevis. On the back of the forearm
it passes beneath the extensor muscles with the posterior inter-
osseous artery, then gets on the interosseous membrane by
passing beneath extensor longus pollicis, and terminates in a
gangliform enlargement on the back of the wrist.
Branches. — Articular to the carpal joints.
Muscular to extensor carpi radialis brevis, supinator brevis,
and all the extensor muscles on the back of the forearm.
Subseapular Nerves. — There are three subscapular nerves
arising from the posterior cord of the brachial plexus. They
all pass down behind the axillary artery, and are all purely
muscular :
First or short subscapular nerve to subscapularis.
Second or lower subscapular nerve to teres major.
Third or long subscapular nerve to latissimus dorsi.
SECTION XVI
LUMBAR AND SACRAL PLEXUS AND NERVES OF
LOWER LIMB
THE anterior divisions of the remaining spinal nerves — viz., five
lumbar, five sacral, and one coccygeal — form the lumbo-sacral
plexus, which supplies the lower part of the trunk and the lower
limb. For convenience of description the plexus is divided into
three parts — lumbar, sacral or sciatic, and pudendal.
The lumbar plexus is formed by the first four lumbar nerves
and a branch of the twelfth thoracic.
The sacral or sciatic plexus is formed by part of the fourth
lumbar, the fifth lumbar, and the first three sacral nerves.
The pudendal plexus is formed by branches from the second
and third sacral nerves, the fourth and fifth sacral nerves, and
the coccygeal nerve. This plexus supplies mainly the perineum.
The Lumbar Plexus is formed by the anterior divisions of the
first three lumbar nerves, a part of the fourth, and a small
branch from the twelfth thoracic nerve. It is placed deeply in
the substance of psoas just in front of the transverse processes
of the lumbar vertebrae. On emerging from the intervertebral
foramina, and after communicating with the sympathetic system,
the nerves divide to form the plexus.
The first and second nerves divide into upper and lower parts.
The upper part of the first nerve joins with the branch from the
twelfth thoracic and forms the ilio-inguinal and ilio-hypogastric
nerves. The lower part of the first nerve and the upper part of
the second join to form the genito-crural nerve. The lower part
of the second nerve, the third nerve, and the upper part of
the fourth nerve divide into anterior and posterior parts. The
anterior parts join to form the obturator nerve, and the posterior
parts form the anterior crural nerve ; from the posterior parts of
192
ILIO-HYPOGASTRIC NERVE
193
the second and third nerves,, branches are given off, which join
to form the external cutaneous nerve. Before these divisions
take place branches are given off from the lumbar nerves to
supply quadratus lumborum and psoas.
Ilio-Hypogfastrie Nerve, formed by the branch from th*
twelfth thoracic nerve and the upper part of the first lumbar
nerve. It emerges from psoas, and passes between the trans-
I2.T.
DORS.LUMB.N.
'----.•_ Lumbo-sacral Cord
FIG. 68.— LUMBAR PLEXUS.
versalis and obliquus internus muscles above the crest of tho
ilium, and becomes cutaneous in the lower part of the anterior
abdominal wall.
Branches. — Muscular to abdominal muscles.
Cutaneous. — Iliac branch which corresponds to the lateral
cutaneous branches of the thoracic nerves, and supplies the skin
over the upper part of the buttock. Hypogastric branch, which
supplies the skin over the pubis.
13
194 HANDBOOK OF ANATOMY
Ilio-Inguinal nerve in origin and course resembles the ilio-
hypogastric nerve, but pierces the abdominal wall lower down,,
and becomes cutaneous by passing through the external abdom-
inal ring and spermatic fascia.
Branches. — Muscular to the abdominal wall.
Cutaneous to skin over the symphysis pubis, the upper and
inner part of Scarpa's triangle, and the upper part of the
external genital organs.
Genito-Crural nerve arises from the first and second lumbar
nerves, which unite in the substance of psoas. The nerve
passes down on the outer side of the external iliac vessels and
becomes cutaneous just above Poupart's ligament, and supplies
the skin over Scarpa's triangle, external to the ilio-inguinal
nerve. A small branch passes upwards to the external genital
organs.
External Cutaneous nerve arises from the second and third
lumbar nerves. The nerve crosses the iliacus muscle to the
anterior superior spine of the ilium. It then pierces the origin
of sartorius, and becomes cutaneous a few inches below this
point, where it divides into anterior and posterior terminal
branches.
Branches. — Anterior supplies the skin on the outer side of the
front of the thigh almost to the knee.
Posterior supplies the skin on the outer side of the buttock
below the great trochanter and the skin of the upper two-thirds
of the outer side of the thigh.
Obturator nerve arises from the second, third, and fourth
lumbar nerves. The nerve emerges from the inner border of
psoas behind the common iliac vessels. It passes forwards with
the obturator artery, and goes through the groove in the thyroid
foramen, where it divides into two branches — superficial and
deep. This nerve supplies the muscles and skin on the inner
side of the thigh.
The Superficial part of the obturator nerve enters the thigh
beneath pectineus, and, passing down the inner border of
adductor longus, anterior to gracilis, it finally divides into two»
terminal branches, one of which enters Hunter's canal.
Branches. — Articular to the hip-joint.
ANTERIOR CRURAL NERVE 195
Muscular to adductor longus, gracilis, adductor brevis, and
pectineus (occasionally) .
Cutaneous becomes superficial in the middle third of the thigh,
and supplies skin of the lower two-thirds of the inner side of the
thigh, and ends in the subsartorial plexus. The terminal branch,
which enters Hunter's canal, ramifies over the femoral artery.
The Deep part of the obturator nerve pierces obturator ex-
ternus and passes down between adductor brevis and adductor
magnns ; it then passes through adductor magnus, and, entering
the popliteal space, terminates by supplying the knee-joint.
Branches. — Muscular to obturator externus, adductor magnus
and adductor brevis (if not already supplied by the superficial
part) .
Articular to the knee-joint.
The Anterior Crural nerve arises from the second, third, and
fourth lumbar nerves behind the obturator nerve. It is formed
in the substance of psoas, and, emerging from its outer border,
it passes down between psoas and iliacus, and enters the
thigh by passing under Poupart's ligament on the outer side of
the femoral vessels. In Scarpa's triangle it breaks up into
branches to supply the front of the thigh.
Branches. — In the abdomen : Muscular to iliacus.
In Scarpa's triangle : Muscular to pectineus, sartorius, and
quadriceps extensor.
Articular to the hip and knee joints.
Cutaneous. — The cutaneous branches are in three sets — middle
and internal cutaneous and long saphenous.
Middle Cutaneous nerve arises in two parts — the external and
internal. They supply the skin on the lower three-fourths
of the front of the thigh, and end in the patellar plexus.
Internal Cutaneous nerve lies in Scarpa's triangle on the
outer side of the femoral vessels, over which it crosses, and,
dividing into three branches, all of which terminate in the
patellar plexus, supplies the skin on the lower two-thirds of the
inner side of the thigh.
The Long Saphenous nerve arises in Scarpa's triangle. It
passes down with the femoral vessels through Hunter's canal, at
the lower end of which it crosses over the tendon of adductor
196
HANDBOOK OF ANATOMY
ma'gnus and becomes cutaneous on the inner side of the knee-
joint by passing between sartor ius and gracilis. It passes down
the inner side of the leg with the internal saphenous vein, and
supplies the skin of the front and inner side of the leg and
posterior half of the dorsum and inner side of the foot.
The Patellar Plexus is formed by the branches of the
cutaneous nerves supplying the skin in front of the knee — viz.,
To Lumbar Plexus „
Perforating Cutaneous
To CoccygeaJ Plexus
Pudic
FIG. 69. — SACRAL PLEXUS.
B
1, i, i. Nerve to Quadratus Femoris
2, 2, 2. Nerve to Obturator Internus
3, 3, 3. Small Sciatic Nerve
4 S. Fourth Sacral, giving a Branch to
Sacral Plexus
V. Visceral Branches
M. Muscular Branches
T.C. Terminal Cutaneous Branches
the long saphenous, internal and middle cutaneous, all branches
of the anterior crural nerve, and sometimes a branch of the
external cutaneous nerve.
The Sacral OP Sciatic Plexus is formed by the anterior divi-
sions of the fourth and fifth lumbar nerves and the first three
sacral nerves. The plexus is formed on the anterior surface of
pyriformis, all the nerves joining to form a large triangular trunk
SCIATIC PLEXUS 197
which passes through the sacro -sciatic foramen as the great
sciatic nerve, which supplies the back of the thigh and the
whole of the leg and foot (excepting that part of skin supplied
by the saphenous nerve) ; small branches arise from the anterior
and posterior surfaces of the plexus to supply the parts in the
vicinity. The great sciatic nerve ends at the popliteal space By
dividing into tibial and peroneal nerves (internal and external
popliteal nerves). In reality this division can be traced all the
way up to the plexus, so that the nerve is really constituted in
two parts, but for purposes of description it is easier to call the
upper part one trunk — namely, the great sciatic.
The plexus is formed by the lower part of the fourth lumbar
nerve joining the fifth lumbar nerve, which, known as the lumbo-
sacral cord, passes into the pelvis over the sacro-iliac articulation,
and on pyriformis joins the first and second and upper part of
third sacral nerves. The three sacral nerves also send branches
to the pudendal plexus, so that no distinct line can be drawn
between them.
Branches from the plexus (other than great sciatic) :
Anterior. — Muscular to quadratus femoris, obturator internus
and gemelli.
Articular to hip- joint.
Posterior. — Muscular to pyriformis and glutei (superior and
inferior gluteal nerves).
Articular to knee-joint (via the nerve to biceps) .
Cutaneous to skin on back of thigh (small sciatic).
Superior Gluteal nerve arises from the fourth and fifth
lumbar and the first sacral nerves. It passes through the
sacro-sciatic foramen, with the gluteal artery above pyriformis,
and supplies gluteus medius and minimus and tensor fasciae
femoris.
Inferior Gluteal nerve arises from the fifth lumbar and first
and second sacral nerves. It passes through the sacro-sciatic
foramen beneath pyriformis, and supplies gluteus niaximus.
Small Sciatic nerve passes through the sacro-sciatic foramen
below pyriformis, with the sciatic artery and inferior gluteal
nerve. It enters the thigh at the lower border of gluteus maxi-
nius, and, piercing the deep fascia, it supplies the skin on the
198 HANDBOOK OF ANATOMY
tack of the thigh and over the calf of the leg. It is a purely
cutaneous nerve.
Branches. — Perineal arises at the lower border of gluteus
maximus, and, passing inwards, supplies the skin over the peri-
neum and external genital organs.
Gluteal arise beneath gluteus maximus, and, passing round its
lower border, supply the skin over the lower half of the
buttock.
Femoral in two sets — internal and external — supply the skin
on the back of the thigh.
Sural. — Two or more branches which pierce the fascia over
the popliteal space and supply the skin over the calf of the leg
for a variable distance.
The Great Sciatic nerve passes through the sacro-sciatic
foramen below pyriformis between it and the superior gemellus.
Covered by gluteus maximus, it passes down, into the thigh,
accompanied by the sciatic artery and a special artery of its own
(arteria comes nervi ischiadici) . It lies in the hollow between
the great trochanter and the tuberosity of the ischium, and enters
the thigh beneath the lower border of gluteus maximus. Lying
between it and the origin of the hamstrings, it is comparatively
superficial. In the thigh it lies on adductor magnus, and is
covered by the hamstrings, and at a variable point between
the sacro-sciatic foramen and the upper part of the pop-
liteal space divides into the internal and external popliteal
nerves.
Branches. — Muscular to the hamstrings and short head of
biceps.
Articular to the knee-joint.
The External Popliteal Nerve. — One of the terminal branches
of the great sciatic nerve passes beneath the tendon of biceps
obliquely through the upper and outer part of the popliteal
space ; it then passes over the outer head of gastrocnemius, and
just below the head of the fibula divides into its terminal
branches, the anterior tibial and musculo-cutaneous nerves.
Branches. — Cutaneous to the skin over the calf of the leg.
Peroneal communicating joins a similar bra'nch from the tibial
nerve to form the short saphenous nerve.
INTERNAL POPLITEAL NERVE 199
Muscular. — Recurrent tibial, which, passing forwards, supplies
tibialis anticus (upper fibres).
Articular. — Branches to the knee-joint and tibio-fibular articu-
lation from the recurrent tibial.
The Anterior Tibial nerve passes beneath peroneus longus
and the extensors of the toes to the front of the leg. With the
anterior tibial artery it lies on the interosseous membrane and
the lower part of the tibia. Passing beneath the anterior
annular ligament, it divides on the dorsum of the foot into its
terminal branches.
Branches. — Muscular to tibialis anticus, extensor proprius
liallucis, extensor longus digitorum and peroneus tertius, and
extensor brevis digitorum (from its external terminal branch).
Articular to ankle-joint and tarsal and metatarsal joints
(from its external terminal branch).
Cutaneous from the internal terminal branches. The nerve
passes along the dorsum of the foot on the outer side of the
dorsalis pedis artery and supplies the skin of the cleft, between
the first and second toes.
The Musculo- Cutaneous nerve passes down the leg, lying
between the peronei and the extensor muscles. In the lower
third of the leg it pierces the deep fascia and divides into its
two terminal branches — internal and external.
Branches. — Muscular to peroneus longus and brevis.
Cutaneous to the lower third of the skin of the leg, and, passing
over the anterior annular ligament, to the dorsum of the foot, the
inner side of the great toe and the skin of the clefts between the
toes, not excepting the one also supplied by the anterior tibial
nerve.
The Internal Popliteal Nerve.— One of the terminal branches
of the great sciatic nerve, from the upper part of the popliteal
space to the lower border of the popliteus muscle, where it is
continued down the leg. It lies at first beneath semimem-
branosus; then, crossing the popliteal vessels to their inner
side, it lies on popliteus and is covered by gastrocnemius
and plantaris. It then passes down the back of the leg
between the superficial and deep muscles with the posterior
tibial vessels, at first on their inner side, but crossing over in the
200
HANDBOOK OF ANATOMY
middle of the leg the nerve lies on their outer side in the lower
half. It divides into its terminal branches, the internal and
Gluteus Medius
Gluteus Maximus
Biceps -
Semitendinosus -
Senjimembranosus
Crureus
Gracilis
Internal Popliteal Nerve—
Sartorius .......
Gastrocnemius
Ilio-hypogastric Nerve
Lateral Cutaneous of
i2th Thoracic Nerve
Posterior Divisions of
first three Lumbar
Nerves
Posterior Divisions of
Sacral Nerves
Post. Div. of Cocc. N.
Perforating Cutan. N^
Gluteal Branches of
Small Sciatic Nerve
Post. Branch of Ext.
Cutaneous Nerve
Small Sciatic Nerve
(Outline)
r~ -----Femoral Branches of
Small Sciatic Nerve
;:-Ext. Cutaneous N.
(Anterior Branch)
' Small Sciatic Nerve
Posterior Branch of Int.
Cutaneous Nerve
Lateral Cutaneous of
External Popliteal
Nerve
Ramus Commun..Fib.
Ramus Commun. Tib.
Ext. Saphenous Nerve
Branches of Internal
Saphenous Nerve
Soleus{ ~_~^1";
Flexor Longus
Digitorum ......
Peroneus Longus
Tendo Achillis
Tibialis Posticus
Plantaris ._
FIG. 70. — MUSCLES AND CUTANEOUS NERVES OF LEG (POSTERIOR VIEW).
external plantar nerves, beneath the internal annular liga-
ment.
INTERNAL POPLITEAL NERVE
201
Branches. — In the popliteal space :
Muscular to gastrocneniius, plantar is, soleus, and popliteus.
Obliquus Externus Abdominis Ext. Abdominal Ring
Giuteus Medius
Iliacus—
Tensor Fasciae Femoris
Psoas Magnus
Pectineus
Sartorius
Adductor Longus
Gracilis
Rectus Femoris
Ilio-tibial Band
Vastus Externus-
Vastus Internus-
Ligamentum Patellae *•-
Gastrocnemius
Peroneus Longus
Soleus
Kxt. Longus Digitorum
Ext. Proprius Hallucis
Tibialis Antirus
Peroneus Tertiu.
Anterior Annular
Ligament
.— Ext. Cutaneous Nerve
Crural Branch of Genito-
crural Nerve
Inguinal Nerve
— Saphenous Opening
_--. Mid. Cutaneous Nerve
Int. Saphenous Vein
^..4 Int. Cutaneous Nerve
(Outline)
Ant. Branch of Internal
Cutaneous Nerve
-- Patellar Plexus of Nerves
_.._ Patellar Branch of Internal
Saphenous Nerve
- Int. Saphenous Nerve
Int. Saphenous Vein
... Post. Branch of Internal
Cutaneous Nerve
Cutaneous Part of Musculo-
cutaneous Nerve
' Calcaneo-plantar Nerve
Int. Saphenous Nerve
(Terminal Part)
FIG. 71. — MUSCLES AND CUTANEOUS NERVES OF LEG (ANTERIOR VIEW).
The latter nerve winds round the lower border of the muscle
and enters its deep surface, giving off a branch to tibialis
posticus.
202 HANDBOOK OF ANATOMY
Articular. — Several to knee-joint, and one to the upper tibio-
fibular joint, and to tar sal and metatarsal joints through the
short saphenous nerve.
Cutaneous. — The tibial communicating, pierces the deep fascia
in the middle third of the leg, where it is joined by the peroneal
communicating, to form the short saphenous nerve which supplies
the skin on the back of the leg, and, passing behind the external
malleolus, supplies the ankle and heel and outer side of the foot
and little toe.
In the back of the leg:
Muscular to soleus, tibialis posticus, flexor longus hallucis and
flexor longus digitorum.
Cutaneous to the skin of the heel and the posterior part of
the sole of the foot by a branch called the internal calcanean.
Internal Plantar Nerve. — A terminal branch of the posterior
tibial nerve arises beneath the internal annular ligament, and
passes forwards between abductor hallucis and flexor brevis
digitorum with the internal plantar artery.
Branches. — Muscular to abductor hallucis, flexor brevis digit-
orum, flexor brevis hallucis, and first lumbrical.
Articular to inner tarsal and metatarsal joints.
Cutaneous to the inner half of the sole of the foot and the
three and a half toes on the inner side.
The External Plantar Nerve, one of the two terminal
branches of the posterior tibial nerve, arises beneath the internal
annular ligament, and passes outwards with the external plantar
artery between flexor brevis digitorum and accessorius.
Branches. — Muscular to all the muscles in the sole of the foot
except those supplied by the internal plantar nerve ; the inter-
ossei, and three lumbricals on the outer side.
Articular to the tarsal and metatarsal joints.
Cutaneous to the skin of the outer half of the sole of the foot
and the one and a half toes on the lateral side.
The Pudendal Plexus is formed by branches from the anterior
division of the first three sacral nerves, of the fourth and fifth
sacral nerves, and the coccygeal nerves. It is formed on the
back wall of the pelvis, and is distributed to the perineum
{mainly by the pudic nerve) except for a few visceral branches.
PUDIC NERVE 203
Branches. — From the plexus :
Muscular to levator ani, coccygeus, and external sphincter.
Cutaneous to the lower part of the buttock by means of a
branch called the perforating cutaneous nerve.
The Pudic nerve arises from the second, third, and fourth
sacral nerves ; it passes through the sacro-sciatic foramen, and
lies on the spine of the ischium on the inner side of the internal
pudic artery. It then enters the perineum with the artery
through the small sacro-sciatic foramen. The nerve supplies
all the muscles and skin of the perineum.
SECTION XVII
CRANIAL NERVES
THERE are twelve pairs of cranial nerves emerging on each
side of the base of the brain, which supply the tissues of the
head and neck (see Fig. 61).
Name of Nerve.
Function.
Exit from Brain.
Distribution.
1. Olfactory
Sensory
Olfactory bulb
To mucous membrane of nose
2. Optic
Sensory
Optic thalamus
To eyeball
3. Oculo -motor
Motor
Crus cerebri
To muscles of eyeball
4. Trochlear
Motor
Superior medul-
lary velum
To muscle of eyeball
5. Trigeminal
Mixed
Pons varolii
Sensory to face, tongue, and
teeth ; motor to muscles of
mastication
6. Abducent
Motor
Junction of pons
and medulla
To muscle of eyeball
7. Facial
Mixed
Pons varolii
Motor to muscles of scalp and
face ; sensory to tongue
8. Auditory
Sensory
Pons varolii
To internal ear
9. Glosso-
pharyngeal
Sensory
Medulla
To tongue and pharynx
10. Pneumogas-
tric or vagus
Sensory
Medulla
To pharynx, oesophagus, stomach,
and respiratory organs
11. Spinal acces-
sory
Mixed
Medulla
Accessory to vagus ; motor to
trapezius and sterno-mastoid
12. Hypoglossal
Motor
Medulla
To muscles of tongue
above table shows briefly the essential points as to the
functions and distributions of the nerves, but some of them must
be described in fuller detail.
204
TRIGEMINAL NERVE 205
5. The Trig-eminal nerve arises from the outer surface of the
pons varolii, and passes forward on the base of the skull to the
apex of the petrous portion of the temporal bone. There it
divides into three trunks :
(1) Ophthalmic — entirely sensory.
(2) Superior maxillary — entirely sensory.
(3) Inferior maxillary — sensory and motor.
(1) The Ophthalmic division passes through the sphenoidal
fissure and divides into three branches — (a) lachrymal, (6)
frontal, and (c) nasal. The lachrymal nerve passes along the
outer side of the orbit and supplies the lachrymal gland, the
conjunctiva and skin of the outer corner of the eye. The
frontal nerve passes forwards in the upper part of the orbit,
and divides into the supraorbital and supratrochlear nerves,
which pass through the supraorbital notch and inner corner
of the eye respectively, and supply the skin of the forehead
and scalp, the supraorbital nerve reaching as far back as the
vertex. The nasal nerve enters the nose to supply the mucous
membrane, and sends an external branch to supply the skin of
the lower part of the nose.
(2) The Superior Maxillary division passes through the fora-
men rotundum in the root of the pterygoid process, passes
through the orbit, and emerges on the face through the infra-
orbital foramen. Before reaching the face the nerve gives off
three dental branches for the supply of the upper teeth, and
two branches, the temporal and malar respectively, which emerge
from foramina in the malar bone, and supply the skin over that
bone and the fore-part of the temple. The infraorbital nerve
itself divides into numerous branches, which are arranged in
three sets — palpebral for the skin of the lower eyelid, nasal
for the skin on the side of the nose, and labial for the skin of
the upper lip.
(3) The Inferior Maxillary nerve passes through the foramen
ovale in the base of the skull and enters the pterygoid region ;
it gives off branches to supply the muscles of mastication —
viz., temporal, masseter, internal and external pterygoid, and
buccinator. It then gives off five named branches — (a) the
206
HANDBOOK OF ANATOMY
buccal, which supplies the skin over the buccinator muscle and
the mucous membrane inside the cheek; (b) the auriculo-
temporal, which supplies the skin over the temple and the
scalp just above ; (c) the inferior dental, which supplies the
lower teeth ; (d) the lingual, which supplies the mucous
membrane covering the anterior two-thirds of the tongue;
(e) the mental, which supplies the skin over the chin.
Trigeminal
nerve
/"Lachrymal
Ophthalmic -j Frontal
^Nasal
/Supraorbital
\Supratrochlear
Superior maxillary
Inferior maxillary
Dental
Malar
Temporal /Talpebral
Infraorbital -I Nasal
Motor branches (Labial
Buccal
Auriculo-temporal
Inferior dental
Lingual
Mental
7. The Facial nerve passes out from the border of the pons
varolii and through a canal in the petrous portion of the
temporal bone. It emerges from the skull through the stylo-
mastoid foramen, and breaks up in the substance of the parotid
gland to supply the muscles of the face. Directly after emerg-
ing from the stylo-mastoid foramen the nerve gives off three
small branches, which supply respectively the stylo-hyoid, pos-
terior belly of digastric, and the intrinsic muscles of the ear, and
this latter also gives a branch to the posterior belly of occipito-
frontalis.
In the parotid gland the nerve breaks up into two main
divisions — the temporo- and cervico-facial — each of which divides
into three sets of branches. This arrangement is called the
pes anserinus.
The Temporo-Faeial divides up into — (1) temporal, (2) malar,,
and (3) infraorbital branches, which supply the muscles of ex-
pression in their vicinity.
CERVICO-FACIAL NERVE
207
The Cervieo-Faeial divides up into — (1) buccal, (2) superior
mandibular, and (3) inferior mandibular, all supplying muscles
of expression; the latter branch supplies also the platysma
muscle.
TemporG-facial Division of Facial Nerve
Temporal Branches of Facial Nerve
Ma'ar Branches of Facial Nerve
Branch of Lachrymal Nerve-
Supra-orbital Nerve
(in two divisions)
.... Infratrochlear Nerve
Malar Nerve
Term. Br. of Nasal M,
Infra-orbital N.
Infra-orbital
Branches of
Facial Nerve
Long Buccal
Nerve
Mental Nerve
Parotid Gland
x> Buccal Branches of Facial Nerve
''Supramandibular Brs. of Facial Nenrfr
nframandibular (Cervical) Branches
of Facial Nerve
External Jugular Vein
Auriculo-temporal Nerve
Posterior Auricular Nerve
Great Occipital Nerve.
Facial Nerve at Stylo-.--'*
mastoid Foramen
Digastric Branch of
Facial Nerve
Cervico-facial Division of
Facial Nerve
Small Occipital Nerve
Great Auricular Nerve
Superficial Cervical Nerve
FIG. 72. — NERVES OF HEAD AND FACE.
1, Sterao-cleido-mastoid ; 2, Trapezius.
Facial
Muscular
branches
to stylo-hyoid,
etc.
Temporal
Malar
Infraorbital
fBuccal
Cervico - facial j Superior mandibular
[Inferior mandibular
208 HANDBOOK OF ANATOMY
9. The Glosso-Pharyng'eal nerve emerges from the surface
of the medulla oblongata, and passes through the jugular
foramen with the pneumogastric and spinal accessory nerves.
It passes down between the internal carotid artery and the
jugular vein, then between the internal and external carotid
arteries, and passes inwards to reach the tongue. The nerve
supplies the stylo-pharyngeus muscle and the mucous membrane
of the tongue and pharynx.
10. The Pneumogfastric or VagUS nerve emerges from the
surface of the medulla oblongata, and passes through the
jugular foramen with the glosso-pharyngeal and spinal ac-
cessory nerves. The nerve lies in the carotid sheath lying
between the artery and the jugular vein. It then enters the
thorax behind the large veins (on the right side it crosses the
subclavian artery, on the left it Ties between the common carotid
and subclavian arteries and crosses the arch of the aorta). As
the nerves cross the arteries they each give off the recurrent
laryngeal branches — the one hooking round the subclavian
artery, and the other round the arch of the aorta. The nerve
then passes behind the root of the lung, where it breaks up
into branches to form the posterior pulmonary plexus, from
which it sends two branches to join with similar ones from
the other nerve to form a plexus in front of the oesophagus.
A branch from the left nerve then passes down in front of the
oesophagus, one from the right behind the oesophagus, and
terminates by supplying the stomach and other abdominal
organs.
The pneumogastric nerve supplies —
In the neck — laryngeal and cardiac branches.
In the thorax — laryngeal, pulmonary, and cesophageal
branches.
In the abdomen — stomach and branches to the coeliac,
splenic, renal, and hepatic plexuses.
11. The Spinal Accessory nerve is formed in two parts — one
in the medulla oblongata, the other from the spinal cord — the
two roots unite to form one trunk, which passes through the
jugular foramen with the glosso-pharyngeal and pueumogastric
HYPOGLOSSAL NERVE 209
nerves. It passes down in the carotid sheath, and ends by sup-
plying sterno-mastoid and trapezius.
12. The Hypogflossal nerve emerges from the surface of the
medulla oblongata and passes through the anterior condyloid
foramen. It then passes down the neck on the outer side of
the internal carotid artery, and hooks round the occipital
artery to reach the tongue, the intrinsic muscles of which it
supplies.
14
SECTION XVIII
SURFACE MARKINGS
The Head.
ABOUT the head, the important structures whose positions are
required are the nerves ; these have already been indicated in
their own section.
The Neck.
The neck is divided up into compartments by the fascial pro-
cesses dipping in between the muscles. The most important one
is the central or visceral compartment, bounded anteriorly by the
pretracheal fascia, posteriorly by the pre vertebral fascia, and
laterally by the fascia enveloping the vascular compartment
which contains the carotid artery, internal jugular vein, vagus
nerve, and a chain of lymphatic glands ; they all lie just under-
neath the sterno-mastoid.
The central or visceral compartment lies in the middle line of
the neck, and extends from the base of the skull into the medias-
tinum ; anteriorly it is divided by the hyoid bone into supra- and
infrahyoid portions. Below the hyoid bone can be felt the
cartilages of the larynx covered by a thin layer of muscles ; and
below them again the thyroid gland, whose middle portion lies
over the second, third, and fourth rings of the trachea.
The trachea starts at the level of the sixth cervical vertebra,
and divides at the level of the fourth dorsal vertebra ; it
gradually recedes as it passes down, and at the level of the upper
border of the sternum is 1^ inches from the surface.
The Thorax.
The thorax has been divided up into areas by the use of trans-
verse and vertical lines :
210
SURFACE MARKINGS 211
Mid-sternal — indicated by a furrow between the origins of the
pectoralis major muscles.
Mid-clavicular — a line dropped from the mid-point of the
clavicle ; should be continuous with the vertical Poupart line,
.and passing through the tip of the ninth costal cartilage.
Parasternal — a line drawn midway between the side of the
sternum and the mid-clavicular line, and passes through the tip
of the eighth costal cartilage.
Mammary region — between two transverse lines drawn at the
levels of the third and sixth chondro-sternal articulations.
The upper border of the sternum is on a level with the lower
border of the second dorsal vertebra, and about 2 inches
distant from it. The junction of the manubrium with the body
of the sternum forms a marked prominence — Ludwig's angle ; at
this point the second costal cartilage articulates,
The Lung's. — The apex of the lung extends upwards for one
to two inches above the anterior extremity of the first rib, and is
indicated by a curved line drawn from the upper border of the
sterno-clavicular articulation to the junction of the inner and
middle thirds of the clavicle, the highest part of the curve being
from J inch to 1^ inches above the clavicle. The apex of the
right lung is J inch higher than that of the left. The subclavian
artery lies on the cervical pleura covering the apex of the
lung.
The anterior border of the right lung is indicated by a line
•drawn from the upper border of the sterno-clavicular articulation
to the centre of the manubrium, and thence vertically downwards,
slightly to the left of the middle line, to the level of the sixth' or
seventh costal cartilage.
The anterior border of the left lung is indicated by a similar
line as far as the fourth costal cartilage ; thence along the lower
border of the cartilage to the parasternal line, then downwards,
to the upper border of the sixth costal cartilage in the para-
sternal line.
The lower border of the lung is the same on both sides, and is
indicated by a line drawn from the lowest point of the anterior
border along the sixth costal cartilage to the mid-clavicular line,
and then curving slightly downwards across the chest to the
212 HANDBOOK OF ANATOMY
spine of the tenth dorsal vertebra ; this line crosses the eighth
rib at the side and the tenth rib at the back.
The pleura is a little larger than the lungs, especially inf eriorly..
The Heart.
The surface markings of the heart are already given on p. 137-
The Abdomen.
The abdomen is most prominent in the region of the umbilicus,
which is situated normally below the mid-point between the
infrasternal] notch (formed by the seventh costal cartilage and
lower border of sternum) and the symphysis pubis, a little below
the level of the highest part of the iliac crest and opposite the
fourth lumbar vertebra; in obese or pendulous abdomens it
may be considerably below this level.
The anterior abdominal wall is limited above by the infra-
sternal notch and costal margin, and below by the fold of the-
groin and crest of the pubes.
In a spare subject the recti and supra-umbilical portion of
the linea alba are easily seen; if the outline of the rectus is-
obscured by fat, the outer border is indicated by a line drawn
from the tip of the ninth costal cartilage down as far as the um-
bilicus, then curving forward to the pubic spine. In the angle
between the outer border of the rectus and the ninth costal
cartilage on the right side lies the gall-bladder.
The abdomen is arbitrarily divided into nine regions, by two-
vertical and two horizontal planes.
The mid-clavicular lines, continued downwards, cut Poupart's
ligament in the mid-point between the anterior superior iliac
spine and the pubic symphysis. (Note that this point is not the-
mid-point of Poupart's ligament.) In the abdomen these are
called the Poupart planes.
The upper (infracostal) plane is at the level of the lowest part
of the tenth costal cartilage, and passes through the third
lumbar vertebra.
The lower (inter tubercular) plane is at the level of the tubercles-
of the iliac crests, and passes through the fifth lumbar vertebra,
,The subdivisions of the upper zone are called the epigastric
SURFACE MARKINGS
213
and right and left hypochondriac regions ; of the middle zone, the
umbilical and right and left lumbar regions ; of the lower zone,
the hypogastric and right and left iliac regions.
The transpyloric plane is midway between the suprasternal
notch and the symphysis pubis; it passes through the first
lumbar vertebra and almost always through the pylorus ; hence
its name.
Livep
.Transverse
Co Jon.
Ascending
Colon
FIG. 73. — PLANE OF ABDOMEN.
The Liver. — In front the lower border of the liver can readily
be felt as it crosses the costal angle ; it passes from the eighth
costal cartilage on the left side to the tip of the tenth on the
right, and in the mid-line crosses the transpyloric plane. In the
mid-axillary line it is a little below the level of the lowest part
of the tenth right costal cartilage. The upper border reaches
214 HANDBOOK OF ANATOMY
from the fifth interspace on the left side to the fourth interspace
on the right (both points in the mid-clavicular line).
The Stomach. — The stomach lies almost entirely in the left
half of the epigastric and the left hypochondriac regions. The
cardiac orifice lies 4 inches from the surface at a point over
the seventh left costal cartilage, 1 inch from the sternum ; the
pylorus is generally about 1 inch to the right of the mid-line
in the transpyloric plane ; its position varies slightly according
to the state of distension of the stomach. The highest part of
the fundus of the stomach lies under the left cupola of the
diaphragm, and reaches the fifth interspace in the mid-clavicular
line, a little above and behind the apex of the heart ; the lowest
part of the great curvature lies between the transpyloric and
infracostal planes.
Small Intestine. — The coils of the small intestine lie mainly
in the umbilical and hypogastric regions.
Large Intestine. — The csecum, which is in the right iliac
region, is in contact with the anterior abdominal wall just above
the outer third of Poupart's ligament; its position otherwise
varies according to its dilatation ; when empty, it is generally
covered by coils of small intestine. The orifice of the appendix
is opposite " McBurney's point," located on the surface at the
junction of the upper and middle thirds of a line drawn from*
the umbilicus to the right anterior superior iliac spine.
The ascending colon lies deeply in the right lumbar region
upon the quadratus lumborum and the right kidney.
The hepatic flexure lies immediately to the right of the gall-
bladder beneath the tenth costal cartilage.
The transverse colon crosses the upper part of the umbilical
region; it forms a U-shaped loop which reaches for a variable
distance below the umbilicus ; when the intestines are distended
it may ascend in front of the stomach.
The splenic flexure reaches upwards behind the stomach, and
touches the lower extremity of the spleen.
The descending colon lies deeply in the left lumbar region.
The iliac and pelvic portions of the colon lie in the left iliac
fossa and true pelvis respectively.
The Kidneys. — Unless enlarged or displaced, the kidneys can
SURFACE MARKINGS 215
seldom be felt through the abdominal wall. The right kidney as
a rule lies a little lower than the lef t, and a little further from
the mid-line. For practical purposes the hilum of the kidney
may be regarded as opposite a point J inch internal to the
tip of the ninth costal cartilage ; and a line joining the two hili
is in the transpyloric plane.
The Abdominal Aorta. — The abdominal aorta commences
about 1 inch above the transpyloric plane, and bifurcates a
little to the left of the mid-line on a level with the highest part
of the iliac crest, generally about f inch below the umbilicus,
opposite the fourth lumbar vertebra.
The Back.
In the middle line of the back is the spinal furrow, along
which the spines of the vertebrae can be easily palpated,
becoming more distinct when the spine is flexed.
The spine of the first dorsal vertebra is more prominent than
that of the vertebra prominens (seventh cervical), the third dorsal
is on a level with the root of the spine of the scapula, the
seventh dorsal with its inferior angle, the fourth lumbar with
the highest part of the iliac crest, and the second sacral with
the posterior superior iliac spine.
Over the upper sacral region is a flattened triangular area, the
angles of which correspond with the posterior superior iliac
spines and the third sacral vertebra.
Above the spine of the scapula is the suprascapular region ;
the levator anguli scapulae and trapezius muscles can easily be
seen by shrugging the shoulders. The lower border of the
trapezius is indicated by a line from the twelfth dorsal spine to
the root of the spine of the scapula.
The upper border of the latissimus dorsi is indicated by a line
extending outwards from the sixth dorsal spine across the angle
of the scapula.
The outer border of the erector spinse is indicated by drawing
a line from a point on the iliac crest 3 J inches from the mid-line
upwards and outwards to the angles of the ribs. The outer
border of quadratus lumborum lies external to that of the erector
spinas at the iliac crest and internal to it at the twelfth rib.
216 HANDBOOK OF ANATOMY
As a rule the tip of the twelfth rib lies 2 inches vertically
above the centre of the iliac crest.
The " triangle of Petit" is a narrow triangular space formed
by the outer border of latissimus dorsi, the posterior border
of obliquus externus, and the iliac crest.
The Kidneys. — The upper limit of the kidney is indicated by
a line drawn transversely at the level of the eleventh dorsal
spine, the lower limit by one at the level of the third lumbar
spine. About a third of the kidney lies above the lower margin
of the twelfth rib, the left kidney about J inch higher than
the right. The most external point of the outer border lies
4 inches from the mid-line and the hilum lies H inches from
the mid-line between the tips of the transverse processes of the
first and second lumbar vertebrae.
The Diaphragm and Liver. — Posteriorly the right arch of
the diaphragm and the right lobe of the liver extend upwards to
the level of the angle of the scapula (eighth rib), while the left
arch lies 1 inch lower; the central tendon is on a level with
the eighth dorsal spine. The right lobe of the liver is covered
posteriorly by the eighth to the twelfth ribs.
The Spleen is situated in the left hypochondrium behind the
cardiac end of the stomach, and is overlapped by the ninth,
tenth, and eleventh ribs, the long axis corresponding to that of
the tenth rib.
The anterior angle is at the level of the ninth interspace in the
mid-axillary line. The vertebral angle lies 1J inches external to
the tenth dorsal spine. The inferior angle lies opposite the
eleventh interspace on a level with the first lumbar spine : with
these points the whole organ can be mapped out.
The Upper Extremity.
The Shoulder. — The shaft of the clavicle is subcutaneous
throughout. The tip of the acromion lies a little external to and
in front of the outer end of the clavicle; and its outer border
can be followed round along the spine of the scapula, the root
of which is on a level with the third dorsal vertebra. The
inferior angle and internal border of the scapula are easily felt.
The tip of the coracoid process can be felt at the anterior border
SURFACE MARKINGS 217
of the deltoid 1 inch below the point joining the middle and
outer thirds of the clavicle. Internal to the coracoid process is
a triangular depression between pectoralis major and deltoid ; in
this depression can be felt the axillary artery.
The rounded contour of the shoulder is formed by the upper
end of the humerus covered by the deltoid; both tuberosities can
be felt ; the head of the humerus can be felt through the axilla.
The Axilla. — The anterior fold of the axilla is formed by the
lower border of pectoralis major and the posterior fold by latis-
simus dorsi and teres major ; between the two folds is the prom-
inence of coraco-brachialis, behind which can be felt the third
part of the axillary artery. High up in the axilla a few
lymphatic glands can be felt.
The Upper Arm. — The anterior and posterior borders of the
deltoid can be traced in their whole extent; just under the
posterior border, about half-way down, the circumflex, artery and
nerve and the musculo-spiral nerve enter the arm. The internal
supracondyloid triangle, limited by the internal intermuscular
septum posteriorly, and whose floor is formed by the inner part
of brachialis anticus, contains many important structures ; from
without inwards, the brachial artery, the median nerve, the lower
part of the basilic vein, the internal cutaneous nerve, and two or
three lymphatic glands.
The external intermuscular septum extends upwards from the
external condyle to the insertion of the deltoid, and is pierced a
third of the way down by the musculo-spiral nerve.
The posterior compartment of the upper arm is occupied by
the triceps, the tendon of which can be felt at its insertion into
the olecranon.
The brachial artery, overlapped above by coraco-brachialis and
below by biceps, can be felt throughout the whole length of the
internal bicipital furrow. The course oi. the vessel is mapped
out by a line drawn from the inner border of the coraco-
brachialis, at the level of the posterior fold of the axilla, to a
point (opposite the neck of the radius) J inch below the middle
of the bend of the elbow.
The cephalic vein ascends internal to the outer edge of triceps
to the interval between the deltoid and pectoralis major.
218 HANDBOOK OF ANATOMY
The line of the median nerve is the same as that of the brachial
artery. The course of the ulnar nerve is mapped out by a line
extending from the posterior fold of the axilla behind coraco-
brachialis to the back of the internal condyle of the humerus.
The course of the musculo-spiral nerve is mapped out by a line
drawn from the point where it pierces the intermuscular septum
(the junction of the upper and middle thirds of a line extending*
from the insertion of the deltoid to the external condyle) to the
front of the external condyle; and obliquely upwards to the
point where the posterior fold of the axilla joins the upper arm.
The Elbow.
The head of the radius can be felt 1 inch below the external
condyle of the humerus when alternately pronating and supinating
the flexed forearm.
The median vein is seen to bifurcate J inch below the middle
of the bend of the elbow ; deep to this, beneath the fascia, is the
bifurcation of the brachial artery.
The biceps tendon can be traced vertically through the centre
of the bend of the elbow with the forearm flexed.
The Forearm and Hand.
The lower half of the radius is easily felt, and the anterior
border of the lower extremity forms a ridge 1 inch above the
ball of the thumb, and just below is the radio-carpal articulation.
Upon the middle of the posterior border of the lower extremity
is the radial tubercle between the tendons of extensor longus
pollicis and extensor carpi radialis brevior.
The posterior border of the ulna is subcutaneous throughout,
and its lower extremity forms a rounded prominence anterior to
which is the styloid process. Between the two lies the tendon of
extensor carpi ulnaris.
The carpal bones form an arch bridged by the anterior annular
ligament; the bony attachments of the latter form important
landmarks.
The tubercle at the base of the third metacarpal can be felt
If inches below the tubercle on the back of the lower end of the
radius.
SURFACE MARKINGS
The prominences of the knuckles are formed by the heads of
the metacarpal bones.
Anteriorly, the metacarpo-phalangeal articulations are situated
| inch above the level of the web of the fingers.
The course of the radial artery is indicated by a line drawn
from the bifurcation of the brachial artery to the tubercle of the^
scaphoid.
The upper third of the ulnar artery follows a curved line from
the bifurcation of the brachial artery to the inner side of the-
anterior surface of the forearm ; the lower two-thirds are on a
line drawn from the front of the internal condyle to the pisiform
bone. The course of the ulnar nerve corresponds to the whole of
that line.
The median nerve may be mapped out by a line drawn from a
point midway between the mid-point of the bend of the elbow
and the internal condyle to a point midway between the two
styloid processes.
The radial nerve follows the radial artery in the upper part of
its course ; at the junction of the middle and lower thirds of the
forearm it winds round beneath supinator longus to the back of
the forearm.
The summit of the superficial palmar arch is on the mid-point
of a line drawn from the lowest transverse crease on the wrist to
the root of the middle finger. The deep arch lies transversely
midway between the lower border of the anterior annular
ligament and the superficial arch.
The Lower Extremity.
The buttock extends from the crest of the ilium above to the-
gluteal fold below. The highest point of the iliac crest is on a
level with the fourth lumbar spine ; the anterior superior spine of
the ilium limits the groin externally ; the posterior superior spine^
indicated on the surface by a dimple, is on a level with the
second sacral spine, and corresponds to the middle of the sacro-
iliac joint. A hand's breadth below the tubercle of the crest
is the great trochanter of the femur, which is best felt if the
limb is slightly abducted and rotated.
Nelaton's line, drawn from the anterior superior spine of the-
220 HANDBOOK OF ANATOMY
ilium to the ischial tuberosity, crosses the hip at the level of the
upper border of the great trochanter.
The ischial tiiberosity, in the erect posture, is overlapped by
the lower border of glutens maximus; it can be felt a little
above the inner part of the gluteal fold. If the hip be rotated
inwards, the lesser trochanter can be felt above the outer end
of the gluteal fold.
Anteriorly the buttock is limited by the tensor fascise femoris
muscle.
At a point corresponding to the junction of the upper and
middle thirds of a line drawn from the posterior superior spine
of the ilium to the ischial tuberosity, the gluteal artery and great
sciatic nerve enter the buttock ; from this point the nerve passes
downwards and outwards upon the ischium to a point midway
between the tuberosity and the great trochanter.
The Back of the Thigh,
The hamstring muscles are thrown into prominence by standing
on tiptoes, or by flexing the leg against resistance ; at the same
time a well-marked furrow indicating the external intermuscular
septum of the thigh is seen ; behind this furrow is the biceps,
and in front of it the vastus externus.
The course of the great sciatic nerve corresponds to the upper
half of a line extending from a point midway between the ischial
tuberosity and the great trochanter to the middle of the
popliteal space ; the small sciatic nerve, indicated by the same
line, descends superficial to the biceps, while the great sciatic
nerve lies under cover of it.
The external popliteal nerve can be felt as it descends im-
mediately behind the tendon of biceps and the head of the fibula.
The internal popliteal nerve and popliteal vessels are indicated
by a line drawn from a point a little internal to the upper angle
of the popliteal space, to a point midway between the condyle
of the femur, and thence down the middle of the space to the
level of the lower part of the tubercle of the tibia.
SURFACE MARKINGS 221
The Front of the Thigh.
Poupart's ligament, in the fold of the groin, divides the front
of the thigh from the abdomen. Comparative measurements of
the length of the limbs are made from the anterior superior
spine of the ilium to either of the malleoli with the pelvis
horizontal.
The long saphenous vein is indicated by a line drawn from the
adductor tubercle of the femur to the lower part of the saphenous
opening (1^ inches below and external to the pubic spine).
The course of the femoral artery is mapped out, with the
thigh slightly flexed and rotated outwards, by a line drawn from
a point midway between the anterior superior spine and the
symphysis pubis, to the adductor tubercle of the femur ; the
upper third of this line corresponds to the part of the artery in
Scarpa's triangle, and the middle third to that in Hunter's canal.
The Knee.
The patella can be easily outlined and moved from side to side
with the knee extended and the quadriceps relaxed; with the
quadriceps contracted the patellar ligament can be traced to its
insertion. In semiflexion, the inner margin of the internal
condyle, the upper border of the inner tuberosity of the tibia,
and the lower part of the patella, are distinctly visible, and
together bound a triangular depression which overlies the line of
the joint and the anterior part of the internal semilunar cartilage.
The Leg1.
The inner surface of the tibia is subcutaneous throughout.
The shaft of the fibula, somewhat posterior to the tibia, is only
subcutaneous just above the malleolus.
The extensor and peroneal muscles, when thrown into action,,
are mapped out on the surface by grooves corresponding to the
intermuscular septa.
The cutaneous part of the musculo-cutaneous nerve corresponds
to the lower half of a line drawn from the anterior border of the
head of the fibula to the anterior border of the external malleolus.
The anterior tibial artery enters the leg two inches below the
222 HANDBOOK OF ANATOMY
tubercle of the tibia ; in the upper two-thirds of its course it lies
on the interosseous membrane ; in its lower third it lies on the
front of the tibia and terminates in front of the ankle-joint mid-
way between the two malleoli.
The short saphenous vein, which lies a little to the outer side of
the tendo Achillis, gradually reaches the middle of the calf and
ascends to the popliteal space. The internal saphenous vein and
nerve lie along the inner border of the tibia.
The course of the posterior tibial artery is indicated by a line
drawn from the lower angle of the popliteal space to a point
midway between the internal malleolus and the tendo Achillis.
The peroneal artery, beginning three inches below the head of
the fibula, is indicated by a line from that point to one midway
between the external malleolus and the tendo Achillis.
The Foot.
The tip of the external malleolus is J inch lower and f inch
posterior to that of the internal 'malleolus. The line of the ankle-
joint can be felt on either side of the extensor tendons, and when
the foot is extended a prominence is formed by the anterior part
of the superior articular surface of the astragalus below the
anterior border of the lower end of the tibia.
A finger's breadth below the tip of the internal malleolus is
the sustentaculum tali ; 1J inches in front of the latter is the
tubercle of the scaphoid ; close above it is the tendon of tibialis
posticus.
A finger's breadth below the tip of the external malleolus is
the peroneal tubercle of the os calcis, a guide to the two peronei
tendons.
The line of the tarso-metatarsal joints extends nearly 1 inch
further forwards on the inner than on the outer surface of
the foot.
The metatarso-phalangeal joints are situated one inch behind
the web of the toes.
Crossing the front of the ankle-joint, from within outwards,
are the tendons of tibialis anticus, extensor longushallucis, extensor
longus digitorum} and peroneus tertius. The extensor brevis digi-
torum forms a fleshy pad over the calcaneo-cuboid joint. The
SURFACE MARKINGS 223
abductor hallucis forms a fleshy pad along the inner border of
the foot.
The dorsalis pedis artery is mapped out by a line drawn from a
point midway between the two malleoli (the termination of the
anterior tibial artery) to the hinder end of the first interosseaus
space. The internal saphenous vein and nerve lie between the
internal malleolus and the tendon of tibialis anticus ; the external
saphenous vein and nerve follow the tendon of peroneus brevis.
The internal plantar vessels and nerves lie along a line drawn
from the under surface of the inner tuberosity of the os calcis to
the interval between the first and second toes. The external
plantar vessels and nerves are on a line drawn from the middle of
the under surface of the heel to the fourth toe; the course of
the plantar arch is mapped out by a line drawn across the sole
from the inner side of the base of the fifth metatarsal to the
hinder end of the first interosseous space.
INDEX
ABDOMEN, 212-13, 214
Abdominal cavity, 116, 117
wall, 125, 126, 212, 214, 215
Abductor hallucis, 223
minimi digiti, 74
Accessorius, 74
Acetabulum, 39, 41
Acromion, 36, 216
'; Adam's apple," 132
Alimentary canal, 3, 116
Alveolar border, 107
Anal canal, 122
Anatomy, definition of, 1
Antrum of Highmore, 108
Aorta, 126, 136, 140-41
abdominal, 141, 142, 215
arch of, 141, 142, 143
ascending, 140, 141, 142
branches of, 142-3
descending thoracic, 134, 141-2
Aortic valve, 139
Appendices epiploicse, 121
Appendix, 121, 139, 214
Arachnoid mater, 174, 175
Arm, upper, 217 seq.
Arteries, 3, 137
anastomotic, of elbow, 158
of aorta, 140-41
axillary, 157, 162
brachial, 157-8, 217, 218, 219
carotid, common, 127, 143,
145, 210
external, 145
internal, 145, 174
carpal, 159
circumflex, 157, 217
coaliac axis, 149
dorsalis pedis, 167, 223
femoral, 148, 163-4, 221
gastric, 149
gluteal, 220
hepatic, 125, 149-50, 154
iliac, 147-8, 154
innominate, 143
intercostal, 146
interosseous, of arm, 159
of lower limb, 163 seq.
14C.
144,
Arteries of upper limb, 157 seq.
lumbar, 147
mammary, internal, 144, 146
maxillary, internal, 145
mesenteric, inferior, 151
superior, 143, 150-51, 154
occipital, 143
ovarian, 149
palmar arches, 160, 219
peroneal, 165, 222
phrenic inferior, 146, 147
plantar, 166
popliteal, 164-5
profunda, of arm, 158
pulmonary, 134, 139, 140
radial, 158-9
renal, 129, 149
sacral, middle, 149
spermatic, 149
splenic, 149
subclavian, 87, 142, 145-6, 211
subcostal, 146
subscapular, 157
suprarenal, 149
temporal, superficial, 143
thyroid axis, 146
tibial anterior, 166-7, 221, 223
posterior, 76, 165, 222
ulnar, 158, 159, 160, 219
vertebral, 145, 174
volar, 158
Articulation, chondro -sternal, 211
lumbo -sacral, 148
metacarpo-phalangeal, 219
radio -carpal, 218
sterno -clavicular, 143, 145
Articulations, intercentral and inter
neural, 89
Astragalus. See Bones
Atlas. See Bones
Auricles, 137, 138, 139
Auricular appendix, 139
Auriculo-ventricular groove, 139
orifice, 139
Axilla, 36, 38, 217, 218
Axillary border, 8
Axis. See Bones
224
INDEX
225
Back (the), 215-16
Biceps. See Muscles
Bicipital furrow, 217
groove, 130
Bicuspid valve, 130
Bile, 123, 125
papilla, 121
Bladder, 129
Bones, classification of, 2
astragalus, 45, 49, 51, 222 '
atlas, 82
arches of, 112
axis, 82
carpal, 30, 218
aarpus, 5, 13
clavicle, 5, 6, 211, 217
shaft of, 216
coccyx, 42, 82
of cranium, 100
cuboid, 49, 51, 53
cuneiform, 13, 26, 49, 51
ethmoid, 100, 107
femur, 43
adductor tubercle of, 221
fibula, 47, 65-66
head of, 220, 221, 222
shaft of, 221
frontal, 100, 101, 102, 104
of head, 100 seq, 1 14 seq.
humerus, 5, 8-10, 217, 218
hyoid, 110, 210
ilium, 39-41, 53
spines of, 39-40, 54
innominate, 39
ischium, 39, 41, 42, 54, 220
lachrymal, 100
malar, 100, 102, 104, 108, 109
mandible, 100, 100-10, 111
manubrium sterni, 83, 211
maxillae, 100, 102, 131
metacarpal, 219
metatarsal, 70, 223
occipital, 100, 101, 102, 105-6
protuberance, external, 105
os calcis, 49, 51, 70, 222
parietal, 100, 102, 104
phalanges, 5, 15, 31
pisiform, 13, 219
pubis, 39, 41, 42, 56
radius, 5, 12-13, 23, 218
ribs, 2, 86? 88, 90, 215, 216
angle of, 86
sacrum, 41, 42, 53, 79, 83
promontory of, 80
scaphoid, 5, 49, 51, 70
scapula, 5, 6-8, 215
angles of, 216
spine of, 36, 215, 216
semiluriar, 5, 13
«esam6id, 2
Bones, sphenoid, 100, 102, 107
great wings of, 107
sternum, 83, 210, 211, 212, 214
tarsus, 49, 53
temporal, 100, 101, 106-7, 110
tibia, 45-47, 221, 222
tubercle of, 220
trapezium, 13
turbinate inferior, 100
ulna, 5, 10-12, 23, 218
unciform, 13
vertebrae, 2, 78-9
cervical, 82-3, 210, 215
dorsal (thoracic), 82, 210, 21 it
215
joints of, 89
laminae of, 79
lumbar, 211, 213, 215, 216
prominens, 215
sacral, 215
spines of, 80, 212, 215
vomer, 100
Brachialis anticus. See Muscles
Brain, 171 seq.
blood-supply of, 173 seq.
coverings of, 174
Bronchi, 133-4
Bronchial nerve, 134
vessels, 134
Buttock, 219
Csecum, 121, 214
Capitellar surface, 21
Capitellum, 10
Cardiac end of stomach, 119, 216
opening of stomach, 119
orifice, 214
i Cartilage, costal, 37, 86, 123, 124, 125,
136, 137, 142, 211, 212, 213,
214, 215
cricoid, 132
ensiform, 83, 89, 136
of larynx, 210
semilunar, 63, 221
thyroid, 127, 132, 143
xiphoid. See Ensiform
Cauda equina, 176
Cerebellum, 173
Cerebral peduncles, 174
Cerebro- spinal system, 172
Cerebrum, 173
Circle of Wjllis, 145, 175
Circulatory^ system, 3
Clavicle. See Bones
Coccyx. See Bones
Colon, ascending, 121, 213, 214
descending, 122, 213, 214
iliac, 122, 214
pelvic, 122, 214
transverse, 122, 213, 214
15
226
HANDBOOK OF ANATOMY
Colons, 118
Condyle, external, 217, 218
internal, 219, 221
of femur, 220
Conus medullaris, 175
Coraco-brachialis.- See Muscles
Coracoid process. See Process
Costse. See Ribs
Costal angle, 213
attachment, 135
margin, 212
Cranium, 101 seq.
Crural canal, 76
Cuboid. See Bones
Cuneiform. See Bones
Deltoid, 217, 218
Diaphragm, 89, 96, 116, 120, 129, 133,
134, 135, 137, 140, 142, 146,
147, 216
arches of, 216
crura of, 142, 149
cupola of, 214
Digestive system, 3, 116 seq.
Digital sheaths, 36, 38
of toes, 77
Dorsal vertebra. See Bones: Vertebrae
spine, 215, 216
Ducts, bile, 121, 125, 126
cystic, 125
hepatic, 125
lymphatic, 169
pancreatic, 121, 126
of Rivini, 123
Stenson's, 122
thoracic, 169
Wharton's, 123
Duodeno-jejunal flexure, 120, 121
Duodenum, 3, 116, 120-121
Dura mater, 174, 175
Endocardium, 139
Epigastric region of abdomen, 117
Epigastrium, 119
Epiglottis, 132
Erector spinae, 215
Ethmoid. See Bones
Eustachian tube, 131
valve, 139
Expiration, 97, 131
Expression, muscles of, 112
Extensor brevisdigitorum*
carpi radialis brevior
ulnf.ri* See Muscles
longus digitorum
hallucis
pollicis
Extensors, 37
Extremity, lower, 219-20
upper, 216-17
Face, muscles of, 112
Fascia, axillary, 36
bicipital, 36
deep, of lower limb, 76
of perineum, 54
of shoulder and upper limb,
36,37
of trunk, 98
lumbar, 54, 99
palmar, 36
plantar, 70, 74, 77
pretracheal, 210
pre vertebral, 210
Sibson's, 135
superficial, 4
Femoral sheath, 76
Femur. See Bones
Fibula. See Bones
Filum terminale, 174
Fold of Douglas, 99
Fontanelles, 102
Foot (the), 222-3
arches of, 69
Foramen magnum, 175
mental, 109
obturator, 41, 59
ovale, 107
rotundum, 107
Foramina, intervertebral, 79
jugular, 174
sacro-sciatic, 54
Forearm, 218-19
Fossa, antecubital, 36, 38, 159
articular (glenoid), 110
coronoid, 10, 22
digastric, 109
digital, 49
glenoid (articular), 110
iliac, 41, 121, 122, 214
olecranon, 10
pelvic, 214
sigmoid, 10, 21
supracapitellar, 22
Frontal bone. See Bones
Fundus of stomach, 134
Gall-bladder, 123, 124, 125, 212, 214
Ganglia, 171, 178-9
semilunar, 180
sympathetic, 179
Gastric surface, 129
Genital organs, 130, 148
Glands, antecubital, 170
axillary, 160, 170
cervical, 170
ductless, 127, 129
facial, 170
femoral, 171
of head and neck, 170
of lower extremity, 170
INDEX
227
Glands, lymphatic, 76, 127, 134, 169, 217
mastoid, 170
occipital, 170
pancreas, 125
parotid, 122, 145
popliteal, 171
salivary, 116, 122
sublingual, 123
submaxillary, 122-3
thyroid, 127, 210
of trunk, 171
of upper extremity, 170
Glenoid cavity, 7, 8, 10
fossa, 18
ligament, 19
Gluteal fold, 220
surface, 40
Gluteus maximus. See Muscles
Grey matter of brain, 174
spinal cord, 175
Groin, fold of, 212
Hand, pronation and supination of, 24
Head, bones of, 100
movements of, 114
muscles of, 112
surface markings of, 210
Heart, 3, 134, 137 seq.
apex of, 137, 138, 139, 214
base of, 137, 138
interior, 139
orifices of, 138
surface, anterior inferior, 138-9
superior, 138
valves of, 140
Hepatic artery, 125
flexure, 121, 125, 214
veins, 125
Hilum of kidney, 149, 215, 216
spleen, 149
Hilus, 128, 129
Horns of grey matter, 175-6 Q
Humerus. See Bones
Hunter's canal, 163, 167, 194, 195; 221
Hyoid. See Bones
Hypochondrium, 119, 123, 127
Hypogastric region of abdomen, 117
Ileum, 116, 120, 131
Iliac crest, 117, 212, 214, 215, 219
region, 117
spine, 214, 215, 219, 221
Ilio-tibial band, 76
Ilium. See Bones
Infracostal line, 213
plane, 214
Infrasternal notch, 212
Inguinal canal, 149
Innominate bone. See Bones
Inspiration, 97, 131
Intercostal spaces, 124, 135, 137, 146
Intermuscular septa, 218, 220, 221
Interosseous membrane, 222
space (first), 223
Intertrochanteric line, 55, 56
ridge, 55
Intertubercular line, 117
plane, 213
Intervertebral disc, 89
Intestines, 3, 116, 117, 118, 120-21, 214
Ischial spine, 41, 42
tuberosity, 220
Ischium. See Bones
Jejunum, 116, 120, 121
Joints, 2
aero mio- clavicular, 16
muscles acting on, 16-17
ankle, 66, 222
muscles acting on, 70
calcaneo -cuboid, 222
carpo-metacarpal, 28-9
elbow, 21-24
muscles acting on, 23
hip, 54 seq.
muscles acting on, 56 seq.
intercarpal, 28
intermetacarpal, 31
interphalangeal, 33
muscles acting on, 74
intertarsal, 68
knee, 2, 59
muscles acting on, 64
lumbo -sacral, 53
metacarpo-phalangeal, 31, 32
muscles acting on, 33
rnetatarso-phalangeal, 68, 222
muscles acting on, 25
radio -ulnar, 24, 25
muscles acting on, 25
sacro-iliac, 53, 219
shoulder, 18
muscles acting on, 112
skull, 110
niuscles acting on, 112
sterno- clavicular, 15
symphysis pubis, 54
tarso-metatarsal, 68, 222
temporo-mandibular, 110
muscles acting on, 114
tibio-fibular, 65-66
vertebral, 89-90
wrist, 26
Kidneys, 129-30, 214-15, 216
Knee (the), 221
Knuckles, prominences of, 219
Lachrymal bone, 100
Lambdoid suture, 102
228
HANDBOOK OF ANATOMY
Larynx, 116, 131-2,210
Leg (the), 221-2
Ligament, definition of, 2
Ligamenta denticulata, 175
flava, 89
Ligaments, of acromio-clavicular joint,
16, 19
annular, 37, 76, 89, 166, 167, 218,
219
of atlas, 90
of axis, 90
calcaneo-cuboid, 68
navicular (spring), 68
carpal, 26-28
coraco-acromial, 19
coraco-clavicular, 16
coraco -humeral, 19
conoid, 16
costo-coracoid, 36
cotyloid, 55
crucial, 63
deltoid, 67-8
of elbow- joint, 21-23
falciform, 124
gastro- splenic, 128
glenoid, 19
gleno- humeral, 19
ilio-femoral (Y-shaped of Bigelow),
56
ilio -lumbar, 53
interclavicular, 15
interspinous, 89
ischio-capsular, 56
lieno-renal, 128
longitudinal, 89
lumbp-sacral ^lateral), 53
occipito-atlantoid, 112
occipito-axoid, 112
odontoid, 112
palmar, 33
patellar, 62, 63, 221
of perineum, 54
plantar, 68
Poupart's, 76, 96, 129, 167, 171,
194, 195, 212, 214, 221
pubo -femoral, 56
radial lateral, 32
of radio-ulnar joint, 24, 25, 26
rhomboid, 6, 15
sciatic, 54
spheno -mandibular f 111
stylo -mandibular, 111
subpubic, 54
supraspinous, 89
temporo -mandibular, 111
transverse (humeral), 19; (meta-
carpal), 33 ; (hip-joint), 55 ;
(knee-joint), 63
trapezoid, 6, 16
ulnar, 32
Liganientum cruciatum, 112
nuchse, 90
patellae, 47-59
teres, 56
Limb, upper, 5 seq.
Limbs, 2-3
Linea alba, 212
Lingula, 110, 111
Liver, 116, 123-5, 213-14, 216
Ludwig's angle, 211
Lumbar region, 214
spine, 216
Lungs, 3, 97, 131, 133-4, 135, 140, 211.
12
roots of, 134
Lymphatic capillaries, 168
vessels, 168, 169-71
McBurney's point, 214
Malar. See Bones
Malleoli, 76, 221, 222, 223
Malleolus, external, 49, 66, 67
internal, 47, 68
Mammary region, 211
Mandible. See Bones
Manubrium sterni. See Bones
Mastication, muscles of, 112
Maxillae. See Bones
Mediastinum, 135, 210
Medulla oblongata, 173
Mesenteric region, 149
Mesial plane, 1
Mid-axillary line, 134, l'*6, 213,
216
Mid-clavicular lines 212, 214
plane, 213
Mid-Poupart plane, 129
Mitral valve, 139
Muscles of abdomen, 92-3 '
abductor brevis poll., 33, 34
hallucis, 73, 74, 223
0 longus poll., 34
minimi digiti, 35
accessorius, 72
adductor, 8
brevis, 58
longus, 58
magnus, 58
obliquus hall., 73
trans versus hall., 73
obliquus poll., 34
trans versus poll., 34
anconeus, 23
of back, 90-91
biceps, 20, 21, 22
femoris, 57, 64
brachialis anticus, 12, 23
brachio-radialis, 23, 25
buccinator, 114, 122
chordae tendinese, 140
INDEX
229
Muscles, columnse cornese, 140
complexus, 92, 95, 115|
coraco-brachialis, 10, 20, 21
crureus, 65
deltoid, 10, 20, 21
diaphragm, 96
digastric, 109, 114.
epicranial aponeurosis, 113
erector spinse, 92, 95, 99
of expression, 114 ^t ^
extensor, 221
brevis dig., 73, 222
poll., 31, 34
carp. rad. brevier, 30, 31, 218
longior, 30, 31
umaris, 30, 31, 218
communis dig. (hand), 30, 35
(foot), 70
indicis, 31, 35
longus dig., 222
hall., 222
poll., 30, 33
minimi dig., 30, 35
ossis metacarp. poll., 30
proprius hall., 70, 73
extensors of back, 98
flexor brevis dig., 74
hall., 74
minimi dig. (hand), 35
(foot), 73
poll., 33
carpi radialis, 29, 31
ulnaris, 29, 31
longus dig., 72, 73
hall., 72, 74
poll., 33
profundus dig., 29, 35
sublimis dig., 29, 35
gastrocnemius, 64, 71
gluteus maximus, 57
medius, 57, 58
minimus, 57, 58
gracilis, 57, 58, 64
hamstring, 220
iliacus, 56, 148
infraspinatus, 20, 21
intercostal ext., 97
int., 98
interossei, dorsal (hand), 34, 35
palmar (hand), 35
plantar (foot), 74
interspinal, 92
latissimus dorsi, 17, 20, 21, 38, 92,
96, 98, 215, 216, 217
levator anguli scapulae, 16, 92, 215
ani, 122, 130
longus colli, 94, 143, 145
lumbricales (foot), 72
(hand), 35
masseter, 113, 122
Muscles of mastication/ 113-14
mylohyoid, 123
obliquus ext. abd., 94
inf., 115
int., 94
sup., 115
obturator ext., 59
int., 59, 130
occipito-frontalis, 112
opponens min. dig., 34
poll., 33, 34
palmaris longu^, 29, 37
papillary, 140
pectineus, 57, 58
pectoralis major, 17, 19, 21, 98,
211, 217
minor, 17, 98
peroneal, 221
peroneus brevis and longus, 222,
223
tertius, 70, 222
plantaris, 64, 71
popliteus, 64
pronator quadratus, 25
radii teres, 23, 25
psoas, 56, 94, 120, 121, 122, 129,
130, 147, 148, 149
pterygoid ext. and int., 113
pyriformis, 59
quadratus femoris, 59
lumborum, 95, 129, 147, 214,
215
quadriceps, 221
rectus abdominis, 94, 99
sheath of, 99
cap. ant., 143
cap. post., 115
femoris, 56, 64
rhomboid, 92
rhomboideus major, 16
minor, 17
rotatores, 92
sartorius, 56, 64
scalenus anticus, 93, 143
medius, 93, 145
posticus, 93
of scalp, 112
soleus, 71
splenius cap., 92, 95, 115
cerv., 92, 95
sterno-mastoid, 17, 98, 115, 123,
127, 210
subclavius, 6, 17, 37
subscapular, 8
supinator brevis and longus, 25
supraspinatus, 21
temporal, 113
tensor fasciae fern., 58, 59, 220
teres major, 20, 21, 38, 217
minor, 21, 38
230
HANDBOOK OF ANATOMY
Muscles of thorax, 96
tibialis anticus, 70, 71
posticus, 71
transversalis, 94
trapezius, 16, 17, 92, 215
triangularis sterni, 98
triceps, 10, 20, 21, 23, 38, 217
of trunk, 90
vastus ext., 64, 220
int., 65
Muscular system, 3
Musculi pectinati, 139
Musculo-spiral groove, 10
Mylohyoid ridge, 109
Neck, compartments, of 210
glands of, 169
mid-clavicular and sternal areas of,
211
surface markings on, 210
"surgical," 8
Nelaton's line, 219
Nerves, auriculo-temporal, 206, 207
buccal, 206, 207
cervical, 176, 181
cervico -facial, 206, 207
circumflex, 184, 190, 217
coccygeal, 176, 192
cranial, 174, 204 seq.
crural, 192, 194, 195
cutaneous, 189-90, 193, 194, 217
dental, 110, 204, 205
dorsal, 176
facial, 206
frontal, 206
genito -crural, 192, 194
glosso-pharyngeal, 208
gluteal, 197
hypoglossal, 209
ilio-hypogastric, 192-3
ilio-inguinal, 193
infraclavicular, 185, 186
infraorbital, 205
intercostal, 177 seq.
interosseous, 187-8, 191
labial, 205
lachrymal, 205
lingual, 206
lumbar, 177, 192
malar, 205
mandibular, 207
maxillary, 205-6
median, 158, 159, 186-9, 217, 218,
219
musculo-cutaneous, 186, 199, 221
musculo-spiral, 190, 217, 218
nasal, 205
obturator, 192, 194
occipital, 176, 177
ophthalmic, 205
Nerves, palpebral, 205
peroneal (ext. popliteal), 198
phrenic, 183
plantar, 202, 223
pneumogastric (vagus), 208, 210
popliteal, 198, 199-200, 220
post-scapular, 185
pudic, 203
radial, 191, 219
respiratory (of Bell), 185
sacral, 177, 196-7
saphenous, 195-6, 197, 222, 223
sciatic, 197-8, 220
spinal, 176
accessory, 208-9
subscapular, 191
supraclavicular, 185-6
temporal, 205
temporo -facial, 206
thoracic, 177-9, 192
tibial, 165, 200
branches of, 199, 201
trigeminal, 205, 206
ulnar, 161, 218, 219
vagus. See Pneumogastric
Nervous system, 3-11
systems, 171
Norma basalis, 102
frontalis, 100
lateralis, 100-101
occipitalis, 102
verticalis, 102
Notches, cotyloid, 41
intercondyloid, 62, 63
nasal, 102, 107
radial, 12, 24
scapular, 8
sciatic, 40, 41, 54, 56, 130, 148
semilunar, 10, 12
sigmoid, 110
suprascapular, 7
(Esophageal opening, 119
(Esophagus, 116, 131, 138, 143
Olecranon. See Process
Omenta, 117, 118
Omental tuberosity, 125
Omentum, great, 118
small, 125, 149
Orbital cavity, 107
margins, 104
Os calcis. See Bones
Ossification, 6, 8, 10, 13, 15, 41, 45, 47,
49, 53, 83, 85, 88
Ovaries, 149, 155
Palate, soft, 131
Palmar arches, 15% 160
Pancreas, 116, 125-6, 142
Pancreatic surface, 129
INDEX
231
Parasternal line, 211
Parietal bone. See Bones
surface of liver, 124
Patella, 221
Pelvic floor, 116, 222
girdle, 3, 36
organs, 117
walls, 54, 148
Pelvis, 39, 41-42, 214, 221
articulations of, 53 seq.
false, 42, 91, 117
of kidney, 129-30
male and female, 42
movements of, 91
small, 122
true, 42
Pericardial concavity, 134
Pericardium, 134, 135, 137, 140
Perineum, triangular ligament of, 54
Peritoneum, 117-18, 121, 124, 126, 128,
134, 148
Payer's patches, 120, 121
Phalanges. See Bones
of foot, 53
of hand, 15
Pharyngeal tonsil, 131
Pharynx, 116, 131-2
Pia mater, 174, 175
Pisiform. See Bones
Plantar arch, 165, 223
surface, 51
vessels (internal), 223
Pleura, 133, 134-5, 138, 211-12
Pleural cavities, 133
sac, 133
Plexus, definition of, 177
aortic, 180
brachial, 177, 178, 183-4
cervical, 177, 181-3
cceliac, 180
lumbar, 177, 192-203
lumbo -sacral, 192 seq.
pampiniform, 155
pudendal, 177, 192, 202-3
sacral, 177, 196-7
sciatic. See Sacral
solar, 180
Plica alares, 64
synovialis patellaris, 64
Pons varolii, 174
Popliteal space, 220, 222
vessels, 220
Portal fissure, 125
system, 155-6
vein, 125
Postero -lateral grooves, 175
Poupart planes, 212, 213
Poupart's ligament. See Ligaments
lines, 117, 211
Presternum, 83
! Process, acromion, 5, 7, 8, 10, 19
articular condyle, 110
basilar, of occipital bone, 102, 106,
107
conoid, 15
coracoid, 7, 8, 19, 36
coronoid, 10, 12, 22, 23, 110 _ _
mastoid, 101, 107, 143
mesentery, 118
odontoid, 82
olecranon, 10, 12, 22, 23, 36, 217
palatal, 107, 131
spinous, 89, 111
styloid, 12, 13, 26, 28, 49, 63, 107,
110, 218
temporal, 102
transverse, of lumbar vertebrae, 129,
216
zygomatic, 106, 107, 109
Pterygoid plates, 102, 107
Pubes, crest of, 212
Pubic arch, 76
Pubis. See Bones
Pyloric branch of hepatic artery, 150
end, 119
orifice, 120
plane, 213
Pylorus, 119, 121, 213, 214
Quadrate lobe, 125
Radius. See Bones
Kami, 109-10
communicantes, 179
Receptaculum chyli, 169
Rectum, 116, 122, 130
Rectus, 99, 212
Respiratory organs, 131 seq.
system, 3
Ribs. See Bones
Rivini, ducts of, 123
Sacral region, 215
Sacro- vertebral angle, 83
Sacrum. See Bones
Sagittal plane, 1
Saphenous opening, 221
Scalene tubercle, 87
Scarpa's triangle, 76, 163, 167, 171,
194, 195, 221
Semilunar bones. See Bones
Semimembranosus, tendon of, 62
Septum, intermuscular, 217
Serratus magnus. See Muscles
! Sesamoid bones. See Bones
! Shoulder, 3, 5 seq., 16, 17, 216-17
| Sigmoid flexure, 121, 122
Skeletal system, 2-3
Skull, articulation with spinal column,
112
232
HANDBOOK OF ANATOMY
Skull, definition of, 100
ligaments of, 112
movements of, 112
muscles acting on joints of, 112
Sphenoidal fissure, 107
Spigelian lobe, 125
Spinal canal, 89
column, 89-91
movements of, 90, 175
cord, 4, 79, 102, 105, 175 seq.
furrow, 215
nerves. See Nerves
Spine, 8, 215
anterior superior, 117
of ilium, post, sup., 220
lumbar, 216, 219
pubic, 221
sacral, 219
Spleen, 127-8, 214, 216
Splenic flexure of colon, 122, 214
Stenson's duct, 122
Sternum. See Bones
Stomach, 3, 116, 119, 122, 213, 214, 216
chamber, 119, 120, 126
Subcostal line, 117
Subscapularis. See Muscles
Supinator longus, 219
Supraclavicular groups (of glands),
Supracondyloid triangle, 217
Suprarenal capsules, 120, 125, 128-9,
149
Suprascapular region, 215
Suprasternal notch, 213
Surface-markings, on abdomen, 212-13
aorta, 215
arm, 217-18
axilla, 217
back, 215-16
diaphragm, 216
elbow, 218
foot, 222-3
hand, 218-19
head, 210
heart, 212
intestines, 214
kidneys, 214-15, 216
knees, 221
leg, 221-2
liver, 213-14, 216
lower extremity, 219-20
lungs, 211-12
neck, 210
shoulder, 216-17
spleen, 216
stomach, 214
thigh, 220-21
thorax, 210
upper extremity, 216-18
Sustentaculum tali, 49, 51, 222
Sympathetic system, 4, 172, 179-80
Symphysis pubis, 212, 213, 221
Tarsus. See Bones
Temporal bone. See Bones
Tendo Achillis, 51, 222
Tendons of biceps, 19, 63
of diaphragm, 138, 216
extensor, 13, 30
of ankle, 77
ext. longus poll., 218
flexor, 36, 74, 76
infraspinatus, 19
peroneus, longus and brevis, 53,
74, 76, 218
of popliteus, 62
of quadriceps extensor, 59
semimembranosus, 62
subscapularis, 19
supraspinatus, 19
tibialis anticus, 222, 223
posticus, 49, 76, 222
of trans versalis, 129
vasti, 62
Testicles, 149, 155
Thigh, 220, 221
Thoracic aorta. See Aorta
cavity, 134
wall, 138, 139
Thorax, 2, 88-9, 210-11
Thyroid axis, 148
Tibia. See Bones
Trachea, 116, 131, 132-3, 143, 210
Transpyloric plane, 213, 214, 215
Transverse plane, 1
Trapezium. See Bones
Triangle of Petit, 216
Triceps. See Muscles
Tricuspid valve, 139
i Trochanters, 219, 220
! Trochlear surface, 12, 21
Tubercle, adductor, 62
conoid, 6
of iliac crest, 219
radial, 218
of scaphoid, 33, 222
of tibia, 222
Tuberosity, bicipital, 12
o mental, 125
of tibia, 221
Turbinate. See Bones
Ulna. See Bones
Umbilical region, 117, 214
Umbilicus, 212, 214, 215
Unciform bones. See Bones
" Uncovered area" of liver, 124-5
Ureter, 120, 130
Urethra, 129
INDEX
233
Urine, 12!)
Uterus, 130
Vagina, 130
Valvulse conniventes, 120, 121
Veins, axillary, 157, 160
azygos major, 152
basilic, 160, 161, 162, 217
cephalic, 160, 161, 162, 217
coronary, 142
sinus, 151, 152
dorso -lateral, 161
facial, 153
femoral, 167
hsemorrhoidal, 156
hepatic, 125, 154
hypogastric, 155
iliac, 155
ilio -lumbar, 155
innominate, 152
intercostal, 152
jugular, 143, 153, 154, 210
lumbar, 152, 155
mammary, 152
median, 161
basilic, 36
occipital, 153
of lower limb, 167 seq.
of upper limb, 160 seq.
ovarian, 155
phrenic, 154
Veins, portal, 151, 154, 155
pulmonary, 138, 151
radial, 161
renal, 154-5
saphenous, 76, 168, 221, 222, 223
spermatic. See Ovarian
subclavian, 152, 153, 160
superficial, 151, 161
suprarenal, 154
systemic, 151
temporo -maxillary, 153
ulnar, 161
visceral, 151
Vena azygos, 152, 154
Vense cava?, 120, 125, 128, 138, 139,
140, 149, 151, 152, 154
Ventricles, 137, 138, 139, 140, 142
Vertebrse. See Bones
Vertebral border, 8
column, 2, 83
• joints of, 89-90
Villi, 120
Visceral surface, 125, 127
Wharton's duct, 122
Willis, circle of, 145, 175
Wings of sphenoid bone, 1 1 1
Zygoma, 111, 122, 145
Zygomatic process. See Process
rt, Tindati tf: Cox, 8, Hmntlta S •/•««, C«.<.,it cft/x/e/
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