Full text of "Handbook of anatomy for students of massage, etc"

See other formats

HANDBOOK OF ANATOMY

FOR STUDENTS OF MASSAGE

MARGARET E. BJORKEGREN

m*»

PRICE 3/6 NET

rom the Library of
tortiva Institute - Seattle

Mill/
EFERENCE ITEM

>o not remove from campus

l-This resource on loan from

The Cainnech
House Library

This resource may not be borrowed without
permission of the Librarian.

■

MM)

■

■ I

SIS

^fc^.K.u*Xs

tL^<

Digitized by the Internet Archive
in 2013

http://archive.org/details/handbookofanatomOObjrk

\. \

HANDBOOK OF ANATOMY FOR STUDENTS
OF MASSAGE

HANDBOOK OF ANATOMY
FOR STUDENTS OF MASSAGE

MARGARET E. BJORKEGREN

Teachers' Diploma, Incorporated Society Trained Masseuses
Inter. (M.B.) Lond.

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 AND COX

8, HENRIETTA STREET, COVENT GARDEN
1914

PBEFACE

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

vi PREFACE

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.

MARGARET E. BJORKEGREN.

London,

September, 1914.

CONTENTS

SECTION PAOE

I. Introduction - 1

II. Shoulder Girdle and Upper Limb - - - 5

III. Pelvic Girdle and Lower Limb - - - 39

IV. Vertebra, Iiibs, 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

XL Bloodvessels of the Lower Limb - 163

XII. Lymphatic System ------ 168

XIII. Brain, Spinal Cord, Nerves of Trunk, and Sympathetic

System ------- 171

XIV. Cervical Plexus - - 180
XV. Brachial Plexus and Nerves of Upper Limb - - 183

XVI. Lumbar and Sacral Plexus and Nerves of Lower Limb - 191

XVII. Cranial Nerves - - 203

XVIII. Surface Markings - - - 209

Index -------- 213

LIST OF ILLUSTRATIONS

KM;. PAGE

1. The Right Clavicle (Superior View) - 6

2. The Right Scapula (Posterior View) .... 7

3. The Right Humerus (Anterior View) 9

4. The Right Radius and Ulna (Anterior View) - - 11

5. Bones of the Right 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 Bonk - 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 -------- 81

29. Axis --------- 82

30. Spinal Column - - - 84

31. Sternum - ------ 85

32. A Typical Rib - 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 Right Temporal Bone .... 106

43. The Superior Maxilla - - 108

44. The Inferior Maxilla (Mandible) - 109

45. The Temporo-Mandibular Joint ----- 111

46. The Peritoneum ------- ng

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) - - - - - - 171

61. Base of the Brain ------- 172

62. Cutaneous Nerves of Trunk - 177

63. Nerves in Posterior Triangle of Neck - 181

64. Vessels and Nerves in Neck - 182

65. The Brachial Plexus - - ... 183

66. Cutaneous Nerves of Upper Limb (Posterior Surface) - 186

67. Cutaneous Nerves of Upper Limb (Anterior Surface) - 187

68. Lumbar Plexus ------- 192

69. Sacral Plexus ------- 195

70. Muscles and Cutaneous Nerves of Leg (Posterior View) - 198

71. Muscles and Cutaneous Nerves of Leg (Anterior View) - 199

72. Nerves of Head and Face - 206

73. Arteries of Head and Neck - - - - - 211

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

2 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 and 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 similar 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 function 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 by either 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
by 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 is in two parts — the alimentary canal,
by 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 also in two parts — the cerebro-spinal

4 HANDBOOK OF ANATOMY

and sympathetic. The cerebrospinal, 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 sends
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 vertebrae at the back, and to the
clavicle in front. The scapulas 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

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

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.

Suprascapular Coracoid
Posterior Belly of Omo-hyoid. Notch Process

Supraspinous Fossa and Supraspinatus \

Superior Angle t ! ,

Levator Anguli Scapula; '■

Spine

Trapezius

For Tendon \*v v
of Trapezius
Uhomboideus Minor

Rhomboideus Major..
Infraspinous Fossa__
and Infraspinatus

Groove for Dorsalis_ _
Scapulae Artery

Deltoid

Great

Scapular Notch

Glenoid Cavity

Infraglenoid Ridge

and Long Head

of Triceps

*-»% Axillary Border
^ 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 fossae 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 UPPER LIMB

Anatomical Neck
A Large Nutrient Foramen %
Great Tuberosity and
Supraspinatus

lnlraspinatus ~"
Surgical Neck —

Head

T> / >\

JSmall Tuberosity and Subscapularis

.Bicipital Groove
Latissimus Dorsi

Pectoralis Major- —-

Teres Major

Deltoid--

Brachio-radialis —

Brachialis Anticus —
External Supracondylar Ridge.

Coraco-brachialis

— Medullary Foramen

Internal Supracondylar Ridge

Extensor Carpi Radialis Longior.

Radial Fossa-
External Epicondyle \

Common Origin of x
Fxtensor Carpi Radialis Brevior
Extensor Communis Digitorum
Extensor Minimi Digiti
Extensor Carpi Ulnaris, and
Supinator Radii Brevis

Capitellum

Trochlea

„Coronoid Fossa

_Superficial Head of Pronator
Radii Teres

Internal Epicondyle

v Common Origin of
Flexor Carpi Radialis
Palmaris Longus
Flexor Sublimis Dieitorum, 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 of 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
fossae, the coronoid and olecranon 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. The 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

Head of Radius

.Olecranon Process

Semiluna Notch or
* Sigmoid Fossa

.Coronoid Process

.Flexor Sublimis Digitorum

Neck

Posterior part of Bicipital

Tuberosity and Tendon
of Biceps

Supinator Radii Brevis— —
Anterior Oblique Line

.Brachialis Anticus

Medullary Foramen-

Flexor Longus Pollicis--
Pronator Radii Teres —

Anterior Border —

Pronator Quadratus

Brachio-radialis

.Medullary Foramen

.Anterior Border

.Flexor Profundus Digitorum

.. Pronator Quadratus

._ Head

._ Styloid Process of Ulns

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 fibro-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 olecranom 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 tri-
angular 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 edge of that the oblique line

BONES OF UPPER LIMB 13

passes across the anterior surface of the bone to the middle of
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

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 Pollicis
Opponens Pollicis „

Superficial Head of Flexor.^ »
Brevis Pollicis
Ext. Ossis Metacarpi Poll.----..

Deep Head of Flex. Brevis Pollicis- -'

Flexor Carpi Radialis

Opponens Pollicis

Extensor Brevis Pollicis

.Flexor Carpi Ulnaris
— Abductor Minimi Digiti
_ - Adductor Obliquus Pollicis

Extensor Longus

Poll.

Flexor Longus Poll.''

_ -Opponens Minimi Digiti

Abductor Minimi Digiti

and Flexor Brevis

Minimi Digiti

Flexor Sublimis Digitorum»__
Flexor Profundus Digitorum

Fig. 5. — Bones of the Right Hand (Anterior View).

and has a saddle- shaped base for articulation with the trapezium.
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

unciform in order. Each of the four inner metacarpals support
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- Clavicular 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 : Interclavicular, 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.
Limits the movements of the clavicle when the arms are raised
over the head.

The synovial membrane lines the two joint cavities which are
separated by the meniscus.

HANDBOOK OF ANATOMY

Acromio-Clavicular Joint, between the acromial end of the
clavicle and the acromion process of the scapnla.

A gliding joint similar in movement and function to the
sterno-clavicular joint. The two joints give elasticity and
increased movement to 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-

Trapezius

Inner third superior

Outer third of the pos-

Spinal ac-

tion

(upper

curved line of occipital

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

cess, and the upper

cervical

nuchae, the spine and

border of the spine of

plexus

supraspinous 1 i g a-

the scapula, and the

ments of the seventh

rough triangular sur-

cervical, and all the

face at the base of

thoracic vertebrae

the 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

scapula from the spine

posterior

cervical vertebrae be-

to the angle

scapular

tween scalenus medius

and splenitis colli

Rhom-

Spines of the thoracic

The vertebral border of

Posterior

boideus

vertebrae, second to

the scapula from the

scapular

major

fifth inclusive

spine to the lower
angle to a membranous
band attached by its
extremities

MUSCLES OF SHOULDER GIRDLE

MOVEMENTS OF SHOULDER GIRDLE TAKING PLACE AT STERNO-
AND ACROMIOCLAVICULAR 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 mas-

Spinal

niastoid

the anterior surface of

toid process, and the

accessory

sternum, and also from

superior curved line

and cervical

inner third of upper

of the occipital bone

plexus

surface of clavicle

Depres-

Trapezius

See Elevation

sion

(lower
fibres)

Subclavius

Upper surface of first

Middle third of under

Brach ial

costal cartilage

surface of clavicle

plexus

Pectoralis

From the anterior part

Outer half of upper

External

minor

of upper border of

surface of coracoid

and internal

third, fourth, and

process

fifth ribs and fascia

thoracic

covering them

Latissimus

From the spines of the

The floor of the bi-

Third sub-

dorsi

lower six thoracic,
and of all the lumbar
vertebne ; 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

cipital groove on the
humerus

scapular

Pectoralis

From the inner half of

The outer lip of the

External

major

the anterior surface

bicipital groove on

and internal

(lower

of the clavicle ; from

the humerus

fibres)

half the anterior sur-
face of the sternum in
its whole length ; and
from the cartilages of
the upper six ribs

thoracic

For-

Serratus

From outer aspect of

The ventral surface of

Posterior

wards

magnus

Pectoralis
major

Pectoralis
minor

upper eight or nine
ribs

See Depression

the vertebral border
of the scapula in its
whole length

thoracic

Back-
wards

Trapezius

See Depression

Rhom-

See Elevation

boids

Latissimus

See Depression

dorsi

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 round three axes, viz. —

Transverse — flexion and extension.
Antero-posterior — abduction and adduction.
Vertical — rotation in and out.

praspinaius

- Infraspinatus

Teres Minor

Teres Major — ""

Teres Branch of Dorsalis'
Scapulae Artery
Dorsalis Scapulas Artery in'
Triangular Space
Nerve to Teres Minor, with-'
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 on the shaft of the humerus.

MUSCLES OF SHOULDER

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 through.

Coraco-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 ; Acromioclavicular ligament, a strong
band of fibres passing between the coracoid and acromion pro-
cesses. This arches over the top of the joint and prevents
dislocation upwards.

The tendons of subscapular is, supra- and infra-spinatus 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 inferiorly, having no strengthening ligaments in
that aspect.

The synovial membrane is very extensive, lining all the joint,
and is prolonged down on the tendon of the biceps.

MUSCLES ACTING ON THE JOINT.

Action.

Muscle.

Origin.

Insertion.

Nerve-
supply.

Flexion

•

Deltoid

(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 - Clavicular

Joint

major

Coraco-
brachialis

With short head of
biceps from tip of
coracoid process

Into a rough linear
impression half - way
down the inner sur-
face of the humerus

Musculo-
cutaneous

HANDBOOK OF ANATOMY

MUSCLES ACTING ON THE JOINT— continued.

Action.

Muscle.

Origin.

Insertion.

Nerve-
supply.

Flexion

Biceps

1. Short head from the
tip of the coracoid
process with coraco-
brachial.

2. Long head from the
edge of the glenoid
fossa at the root of
the coracoid process

Rough posterior por-
tion of bicipital
tubercle of radius, and
by a prolongation of
the fascia to the deep
fascia of the forearm
(see Bicipital Fascia,
p. 36)

Musculo-
cutaneous

Exten-
sion

Deltoid

(post-fibres)

See Flexion

Teres major

From the lower third of
the axillary border of
the dorsum of the
scapula, and from deep
fascia

Inner lip of bicipital
groove

Second

sub-
scapular
nerve

Infra-
spinatus

From the infraspinous
fossa and deep fascia

The middle facet on
the great tuberosity
of the humerus

Supra-
scapular

Latissimus
dor si

See Sterno - Clavicular

Joint

Triceps

1. Long head from a
rough surface on the
axillary border of the
scapula just below the
glenoid fossa.

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

By one tendon inserted
on the posterior part
of the upper end of
the olecranon process
of the ulna

Musculo-
spiral

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

Supra-
scapular

Adduc-

Pectoralis

See Sterno - Clavicular

Joint

tion

major

Latissimus
dorsi

See Sterno - Clavicular

Joint

ELBOW-JOINT

MUSCLES ACTING ON THE JOINT— continued.

Action.
Adduc-

Muscle.
Teres major

Origin.

Insertion.

Nerve-
supply.

See Extension

tion

Coraco-
brachial

Biceps
(short head)

Triceps
(long head)

See Flexion
See Flexion
See Extension

Teres minor

From the upper two-
thirds of the axillary
border of the scapula

To the lowest facet on
the great tuberosity
of the humerus

Circum-
flex

Weight of

limb

Rotation

Infra-

See Extension

out

spinatus
Teres minor

See Adduction

Rotation

Teres major

See Extension

Pectoralis
major

See Sterno - Clavicular

Joint

Latissimus
dorsi

See Sterno - Clavicular

Joint

Circum

duction — a

combination of all these

movements

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-
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
seen that the elbow-joint encloses within. its cavity the superior
radio-ulnar joint.

HANDBOOK OF ANATOMY

Anterior Ligament, from the upper margins of the coronoid and
supracapitellar fossae 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
fossa of the humerus to the anterior margin of the upper aspect
of the olecranon process of the ulna.

Anterior Ligament

Internal Epicondyle

Orbicular Ligament

Tendon of Biceps
(reflected)

Brachialis Anticus
(reflected)

. Oblique Ligament

— The Elbow-Joint.

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 ; and
(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.

Cartilage covers the articular surfaces of the joint as usual,
but is not prolonged into the fossae on the humerus, where pads

RADIO-ULNAR JOINTS

of fat are placed. There is also a narrow gap in the cartilage
covering the surfaces of the olecranon and coronoid 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.

MUSCLES ACTING ON THE ELBOW-JOINT.

Action.
Flexion

Muscle.

Origin.
See Shoulder-Joint

Insertion.

Nerve -
supply.

Biceps

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-
neous

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

The Radio-Ulnar Joints, between the extremities of the
opposing surfaces of the radius and ulna. These joints are
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.

HANDBOOK OF ANATOMY

Ligaments. — Orbicular ligament, a ring of strong tendinous
fibres attached to the extremities of the radial notch on the ulna
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.

Sterno-costal part
of Pectoralis

Major

Clavicular part of Pectoralis Major
Clavicular part of Deltoid

Coraco-brachialis

Latissimus Dorsi and
Teres Major

Biceps..

Long Head of Triceps

Brachialis Anticus

Supinator Radii % ^*^^^w mM* uTwEm , Obliquus Ext. Abdominis

Brachio-radSns^^i Willi llffl^. Serratus Magnus

^^W^i\l////% W^mm^ilUmr ^ Internal Head of Triceps

*""■"-> Brachialis Anticus
Pronator Radii Teres

-Flexor Carpi Radia'is
-Palmaris Longus
Flexor Carpi Ulnaris

Fig. 8. — Muscles of the Upper Arm.

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.

iMUSCLES OF FOREARM

The Triangular Fibro-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 ventrallyand 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
interosseous borders. Above, it extends to within about an inch
of the head of the radius, leaving a gap for the passage of the
dorsal interosseous 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.

MUSCLES ACTING ON THE RADIOULNAR JOINTS.

Action.

Muscle.

Origin.

Insertion.

Nerve-supply.

Supina-

Brachio-

From the upper two-

The styloid process of

Musculo-

tion

radialis

(supinator

longus)

thirds of the external
supracondyloid ridge
of the humerus

the radius

spiral

Supinator

From the external con-

The upper part of the

Posterior

brevis

dyle of the humerus ;
the external lateral
and orbicular liga-
ments ; the triangular
surface of the ulna
just below the radial
notch and the deep
fascia

shaft of the radius,
reaching from the
neck to the oblique
line, and from the
anterior border of the
bicipital tubercle
round to the posterior
border

interosseous

Prona-

Pronator

From the common

The rough oval impres-

Median

tion

radii

flexor tendon on the

sion half-way down

teres

internal condyle ot
the humerus, the
lower part of the
ridge above the inter-
muscular septa and
the deep fascia, and a
slip from the inner
side of the coronoid
process of the ulna

the outer surface of
the shaft of the radius

Pronator

From the lower fourth

The outer border of the

quadratus

of the ventral surface
of the ulna

lower fourth of the
ventral surface of the
radius

interosseous

26 HANDBOOK OF ANATOMY

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
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 ulna 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 Intercarpal 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 synovial membrane lines the joint, and may have a
separate division for the articulation between the cuneiform
and pisiform bones.

MUSCLES OF FOREARM

Triceps

Anconeus

Extensor Commun
Digitorum

Extensor Minimi Digiti

Extensor Carpi Ulnaris

Dorsal Branch of
Ulnar Nerve

Posterior Annular
Ligament

Extensor Minimi Digiti
(in two parts)

Biceps

Brachio-radialis

Extensor Carpi Radialis Longior
Extensor Carpi Radialis Brevior
Supinator Radii Brevis

Posterior Interosseous Nerve

Extensor Ossis Metacarpi
Pollici*

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).

HANDBOOK OF ANATOMY

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 conies 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.

Action.

Muscle.

Origin.

Insertion.

Nerve-supply.

Flexion

Flexor

From common tendon

Palmar surfaces of base

Median

carpi

on inner condyle of

of second metacarpal

radial is

humerus and deep
fascia

bone and a small slip
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
border of the olecra-
non process, and the
upper three-fifths of
the posterior border
of the ulna

the hook of the unci-
form and the base of
the fifth metatarsal

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
deep fascia ; the inner
border of coronoid

split to allow the
tendon of flexor pro-
fundus digitorum to

pass through, and,

process of ulna (above

after uniting again,

that of pronator

each tendon divides

radii teres) ; 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

digitorum

and internal surfaces

which passes through

interosseous

of the ulna up to the

the corresponding

(median)

inner surface of the

tendon of flexor subli-

olecranon process;

mis 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)

MUSCLES OF FOREARM

Action.
Flexion

Muscle.

Origin.

Insertion.

Nerve-supply.

Flexor

From the middle half of

j The palmar surface of

longus

the anterior surface of

the base of the ter^

interosseous

pollicis

the shaft of the radius
and the correspond-
ing half of the inter-
osseous membrane

i minal phalanx of the
thumb

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

of the outer supra-

metacarpal bone

longior

condyloid ridge of the
humerus, the inter-
muscular septum, and
the common extensor
tendon on the outer
condyle

Extensor

From the common

The dorsal surface of

Posterior

carpi

extensor tendon, the

the base of the third

interosseous

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

interosseous

digitorum

deep fascia

inserted in the four
inner digits. Each
one passes down the
back of the hand and
spreads out over the
knuckle ; it then
divides into three
slips — the middle one
is inserted into the
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

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 deep

base of the fifth meta-

interosseous

ulnaris

fascia and middle half
of the posterior border
of the ulna

carpal bone

Extensor

From the upper half of

The radial side of the

Posterior

ossis

the outer surface of

base of the first meta-

interosseous

metacarpi

the ulna ; the middle

carpal

pollicis

third of the dorsal

surface of the radius

and interosseous mem-

brane

HANDBOOK OF ANATOMY

Action.

Muscle.*

Origin.

Insertion.

Nerve-supply.

Exten-
sion

Extensor
brevis
pollicis

From the dorsal surface
of the radius below
extensor ossis m eta-
carpi pollicis and
the interosseous mem-
brane

The dorsal surface of
the base of the first
phalanx of the thumb

Posterior
interosseous

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-

Flexor

See Flexion

tion

carpi
radialis

Extensors

carpi

radialis

longior

and
brevior

Extensors
of thumb

See Extension
See Extension

Adduc-
tion

Flexor

carpi

ulnaris

Extensor

carpi

ulnaris

See Flexion
See Extension

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-Metacarpal 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.

JOINTS OF HAND 31

Anteroposterior — abduction and adduction (to middle line
of hand).

Longitudinal — rotation .

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.

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.

Metacarpophalangeal Joints are between the heads of the
metacarpal bones and the bases of the first plalanges.

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.

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
attached to the tubercles on the sides of the heads of the
metacarpal bones and the bases the phalanges.

The Palmar ligaments are plates of fibro-cartilage attached
firmly to the phalanges, but only loosely to the metacarpals, so
that during movements of the joints they can glide up and
down. In this plate two sesamoid bones are developed in the
thumb, and one on the radial side of the forefinger.

HANDBOOK OF ANATOMY

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.

Flexor Carpi Ulnaris
Flexor Sublimis Digitorum

Anterior Annular
Ligament

Abductor Minimi.
Digiti
Flexor Brevis Minimi,
Digiti

Opponens Minimi

Digiti

3rd Palmar Inteross.

4th Dorsal Inteross.

2nd Palmar Inteross

Flexor Carpi Radialis
Flexor Longus Pollicis

Abductor Pollicis (cut)

Superficial Head of Flexor
Brevis Pollicis

3rd Dorsal Inteross.--
2nd Dorsal Inteross.,-'

st Palmar
nterosseous

^.ist Lumbricalis

Fig. 10. — Muscles of the Hand (Palmar Aspect).

Interphalangeal 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 OF THUMB

MUSCLES ACTING ON THE JOINTS.
FIRST METACARPOPHALANGEAL AND INTERPHALANGEAL JOINT.

Action.

Flexion

M uscle .

Flexor
longus
pollicis

Flexor
brevis
pollicis

Abductor
brevis
pollicis

Opponens \
pollicis 1

Adductor j

obliquus j

pollicis j

Adductor
trans-

versa
pollicis

Exten-
sion

Abductor j
longus j
pollicis

Extensor
longus
pollicis

Extensor
brevis
pollicis

Adduc-
tion

Adductor
obliquus '
pollicis

Origin.

See Wrist-Joint

1. Radial half lower
border anterior annu-
lar ligament and the
ridge on the trape-
zium

2. Ulnar side of base of
first metacarpal

From the tubercle of
the scaphoid, the
ridge of the trape-
zium, the radial part
of the anterior surface
of the annular liga-
ment

From the ridge on the
trapezium and the
anterior surface of the
annular ligament

From the palmar sur-
faces of the os trape-
zium and trapezoid, j
the os magnum and |
bases of the second,
third, and fourth
metacarpals

From the lower two-
thirds of the median
ridge on the palmar
surface of the third
metacarpal

See Wrist-Joint

See Flexion

Insertion.

Nerve-supply

Radial side base of
first phalanx

Ulnar side of base of
first phalanx

The radial side of the
base of the first
phalanx and the cap-
sule of the joint

The whole of the radial
border and the radial
half of the palmar
surface of the first
metacarpal

The ulnar side of the
base of the first
phalanx

Median

Ulnar

Median

Ulnar

HANDBOOK OF ANATOMY

FIRST METACARPOPHALANGEAL AND INTERPHALANGEAL

JOINT — Continued.

Action.

Muscle.

Origin.

Insertion.

Nerve-supply.

Adduc-
tion

Adductor
trans-
versa
pollicis

Flexor
brevis
pollicis

Opponens
pollicis

See Flexion

See Flexion
See Flexion

First
dorsal
inter-
osseous

From the adjacent sides
of the first and second
metacarpal bones

•

The radial side of the
index - finger on the
dorsal expansion of
the extensor tendon,
the capsule of the
metacarpo- phalangeal
joint and the side of
the first phalanx

Ulnar

Abduc-
tion

Abductor
brevis
pollicis

Abductor
longus
pollicis

Extensors
of thumb

See Flexion
See Wrist-Joint
See Wrist-Joint

Circum

duction an

d rotation are carried ou

t by a combination of the

se muscles

METACARPO AND INTERPHALANGEAL JOINTS OF FOUR
INNER DIGITS.

Action.

Muscle.

Origin.

Insertion.

Nerve-supply.

Flexion

Flexor
sublimis
digitorum

Flexor
profundus
digitorum

Lumbri-
cales

Two radial
ones

See Wrist-Joint

Four muscles arising
from the tendons of
flexor profundus digit-
orum

Frcftn the radial sides of
the tendons for the
index and middle
fingers

Similar to the dorsal
interosseous muscle.
See Thumb-Joints

Median

MUSCLES OF FINDERS

METACARPO AND INTER PHALANGEAL JOINTS OF FOUR
INNER DIGITS— Continvcd.

Action.

Muscle.

Origin.

Insertion.

Nerve-supply

Flexion

Two ulnar

From the adjacent sides

Similar to the dorsal

Ulnar

ones

of the second and
third, and third and
fourth tendons

i n terosseous muscle .
See Thumb-Joints

Interossei

Three ; the first from

Ditto

Ulnar

palmar

the ulnar side of the
second metacarpal,
the two others from
the radial side of the
fourth and fifth meta-
carpals respectively

Dorsal

Four, each arising from
the adjacent sides of
the metaearpal bone

Ditto

Ulna

On the

fifth finger

only :

Flexor

From ulnar part of

Ulnar side of base of

Ulnar

brevis

anterior surface of

first phalanx of little

minimi

annular ligament and

finger

digiti

hook of unciform

Exten-

Extensor

I See Wrist-Joint

sion

communis
digitorum

Extensor

See Wrist-Joint

indicis

Extensor

See Wrist-Joint

minimi

digiti

Lumbri-

See Flexion

cales

Interossei

See Flexion

Abducti

oufromthe

Lumbri-
cales

Flexor

brevis

minimi

digiti

ulnar side of the hand
See Flexion

See Flexion

Opponens

Similar to flexor brevis

The lower three-fourths

Ulnar

minimi

minimi digiti

of the ulnar margin

digiti

and palmar surface of
the fifth metacarpal

From

the middle

Dorsal
interossei

line of the middle finger :
See Flexion

Abductor

From the palmar sur-

Ulnar side of base of

Ulnar

minimi

face of the pisiform

first phalanx of little

digiti

bone

finger

Adducti (

)n to the

middle line of the middle

finger

Palmar

See Flexion

interossei

36 HANDBOOK OF ANATOMY

The Deep Fascia of the shoulder and upper limb is attached to
the clavicle, acromion, and spine of scapular. 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 in-
vesting 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 respec-
tively, 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.

Costo-Coracoid Membrane, a process of the deep fascia covering
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 super-
ficial vessels, but the piece between the costal cartilage and
coracoid process is much stronger, and is called the costa-cora-
coid ligament.

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

DEEP FASCIA 37

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 the 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 \ .

nolliris l*n ^ne ^rs^ groove on the ex-

Extensor brevis pollicis J ternal side of the radius'

2. Extensor carpi radiales, 1 . ■■

, j -i • S-in the second groove,

longior and brevior J °

3. Extensor longms pollicis in the third groove.

4. Extensor communis digi-'j

torum fin the fourth groove.

Extensor in die; is J

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 point upwards, and
is filled with fat and glands.

The apex is bounded by the superior border of the scapula,
the first rib, and the clavicle, and is covered in by the costo-cora-
coid membrane.

The floor is formed of the deep fascia.

38 HANDBOOK OF ANATOMY

The posterior wall is formed by subscapulars, 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 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.

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

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 gluteal, as it has three

Transversalis Abdominis
Obliquus Interims Abdominis^
Middle Gluteal Line

Latissimus Dorsi

Crest

Obliquus Externus Abdomini

Superior Gluteal Line

Posterior Superior.-
Iliac Spine

Posterior Inferior
Iliac Spine

Great Sciatic Notch '

Ischial Spine
Gemellus Superior
Small Sciatic Notch- _
Gemellus Inferior"
Obturator Groove„-

Semimembranosus
Semitendinosus and Long Head
Biceps

Tuber Ischii

^Tensor Fascia;
Femoris

v Anterior Superior
Iliac Spine

Inferior Gluteal Line

Anterior Inferior Spine

and Straight Head of

Rectus Femoris

^-Acetabulum

Cotyloid Notch

• Pubic Spine
' Pubic Crest and

Rectus Abdominis
_ Pubic Angle
> Adductor Longus
Symphysis Pubis

> Gracilis

Adductor Magnus*

Descending Pubic Ramus
s 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 41

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 inferiorly, 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 Vertebras, 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

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. — Pelvls.

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, which
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 inwards in the male and as a rule
firmly joined to the sacrum. In the female it is more straight
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 about
125 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 inferiorly separate, 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

HANDBOOK OF ANATOMY

Head , ■ Neck

Depression for
Ligamentum Teres ._-

Digital Fossa and Obturator Externus
Quadrate Tubercle

Gluteus Medins
..Great Trochanter

Ilio-psoas %-M?

Small Trochanter -V fig

Spiral Line iy | ]

Vfl

Adductor Brevis -.

/,/m

Gluteal Ridge and
Gluteus Maximus

Medullary Foramen

Vastus Internus J_

Adductor Longus /«-»•# "\

t—

-Summit of Linea Aspera
.Outer Lip of Linea Aspera

Inner Lip of Linea Aspera

Internal Supracondylar

Ridge and Expansion from Tendon

of Adductor Magnus

External Supracondylar Ridge

Adductor Tubercle
and Adductor Magnus

Popliteal Surface

^_ External Tuberosity
I External Condyle

Internal Tuberosity'

I *- i

Internal Condyle Intercondylar Fossa

Fio. 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
creseentic 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 slighty 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

HANDBOOK OF ANATOMY

Tibial Spine

External Tuberosity of Tibia-

Biceps Femoris
Head of Fibula.

Peroneus Longus

Extensor Proprius Hallucis

Antero-external Border

Postero-externai Border ._,

Peroneus Brevis

External Surface and

Tibialis Anticus

Anterior Border or Crest

Internal Boraer

Peroneus Tertius

Triangular Subcutaneou
Surface

External Malleolus — L_

nternal Tuberosity of Tibia

Tubercle

Gracilis
Sartoriu!
Semitendinosus

Internal Malleolus

Fig. 14. — Tibia and Fibula (Anterior Surfaces^

BONES 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 semimembranous 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 patellas.

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 the 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.

HANDBOOK OF ANATOMY

Tibial Spine
Semimembranosus J \ Popliteal Notch

^•Styloid Process of Fibula

Internal Tuberosity of Tibia -

Popliteal Surface and
Popliteus

Soleus
Oblique Line -

Tibialis Posticus

Medullary Foramen

Internal Border

Flexor Longus Digitorum

— r Soleus

H-

- Posterior Surface

- Postero external Bolder

-Flexor Longus Hallucis
.. Medullary Foramen

■Peroneus Brevis

• Postero-extennal Border

• Antero-external Border

Tip of Internal Malleolus
Groove for Tibialis Posticus and

Flexor Longus Digitorum : T*" Peroneal Groove

Tip of External Malleolus
Groove for Flexor
Longus Hallucis

Fig. 15.— Tibia 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.

HANDBOOK OF ANATOMY

Tuber Calcis

Os Calcis (Neck)

Tubercle for Middle Fasciculus
of External Lateral Ligament

Peroneal Spine or Ridge — 1 ^ » ////,
\\ ( ^>

Extensor Brevis Digitorum

Cuboid

Peroneus Brevis-J^

Peroneus Tertius^'
External Cuneiform

Astragalus

— Navicular (Scaphoid)

Groove for Tibialis

Amicus
Internal Cuneiform

Middle Cuneiform

- Innermost Tendon of

Extensor Brevis

Digitorum

Extensor Proprius
Hallucis

./ n
\ '
Extensor Longus Digitorum -N-

Fig. 16.— Bones of Foot (Dorsal 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,
has 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 Achillis, 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 infer iorly 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

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-
versa Hallucis

Flexor Longus Hallucis

-Abductor Minimi Digits

SN. Outer Head of Flexor
Accessorius

Tuberosity of 5th
. Metatarsal and
Peroneus Brevis

Adductor Obliquus
Hallucis

if I t \^v-i>^.._. Abductor Minimi
>H/> I Xi 4»l. -i Digiti and Flexor

revis Minimi
Digiti

Flexor Brevis Digitoiurrv

Flexor Longus Disjitorum

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-Sacral 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 lumbosacral 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.

Sacro-Iliae 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.

Accessory Ligaments : The Tlio-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 ventrally
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 and 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
axes:

HIP-JOINT 55

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-
bulum and deepens the socket. Its free edge is somewhat
constricted, and grasps the head of the femur.

Anterior Inferior Iliac Spine -

Ilio-femoral Band
(Y Ligament
of Bigelowj

Intertrochanteric ,

Line

Pubo-femoral Band

urator 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,

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 acetabulum 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.

Iliacus

Psoas

Sartorius

Rectus

femori

Origin.

Insertion.

From a wide origin i Outer side of tendon of
round the margin of | psoas ; anterior sur-
the iliac fossa face of small tro-

chanter, and shaft of
femur below

From the intervertebral Apex of small trochanter
discs, adjacent mar j of femur
gins, side of bodies,
and transverse pro-
cesses of lumbar ver-
tebrae

From the anterior supe
rior spine of the ilium,
and half the notch
below it

See Quadriceps Extensor (Knee-Joint)

Inner surface of shaft of
tibia just below the
tuberosity

Nerve-supply.

crural

Nerve from

the lumbar

plexus

Anterior
crural

HIP-JOINT
MUSCLES ACTING ON THE JOINT— Continued.

58 HANDBOOK OF ANATOMY

MUSCLES ACTING ON THE JOINT— Continued.

Action.

Exten-
sion

Abduc-
tion

Muscle. Origin.

Adduc-
tion

Adductor From a curved origin on
magnus the inferior surface of
the ischial tuberosity,
and the lower border
of the ischial ramus
and that of the pubis

Tensor I From the anterior supe-
fascire rior spine of the ilium

femoris | and the crest just
behind

Rotation
in

Insertion.

Nerve-supply.

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, alid the adduc-
tor tubercle

The ilio-tibial band at
the level of the great
trochanter

Gluteus

medius

(anterior

fibres)

Gluteus

minimus

(anterior

fibres)

Adductor
longus

Adductor
brevis

See Extension

By a rounded tendon
from the anterior sur-
face of the body of
the pubis between the
crest and the sym-
physis

From the front of the
body and descending
ramus of the pubis

Adductor
magnus

Gracilis

Pectineus

Gluteus
medius
(anterior j
fibres)

Gluteus j See Abduction
minimus
(anterior !

fibres)

The middle half of the
inner lip of the linea
aspera in front of
adductor magnus

Into the lower two-
thirds of the line lead
ing from the small
trochanter to the linea
aspera behind pec-
tineus

See Extension

See Flexion
See Flexion
See Abduction

Obturator

Superior
gluteal

Obturator

KNEE-JOINT

MUSCLES ACTING ON THE JOINT— Continiied.

Action.

Muscle.

1 >rigin.

Insertion.

Nerve-supply.

.Rotation
in

Tensor

fascife
femoris

See Abduction

Ratal ton
out

Pyriformis

From the middle part
of the anterior surface
of the sacrum : and
the upper margin of
the great sciatic notch

A facet on the inner
aspect of the upper
border of the great
trochanter

Nerve from

the sacral

plexus

Obturator
internus

and
gemelli

From the innei surface
of the bone* surround-
ing the obturator for-
amen and from the
membrane; the ge-
melli, one from the
ischial spine. the
other from the tuber-
osity (either side of
the small sciatic notch)

Just behind pyriformis

Nerve from

the sacral

plexus

Obturator
externus

From the lower half of
the obturator mem-
brane and the bone
surrounding

The digital fossa at the
inner aspect of the
upper border of the
great trochanter

Obturator

Quadratus
t'emoris

From the outer margin
of the ischial tuber-
osity

The quadrate tubercle
and line beyond

Nerve from

the sacral

plexus

This act

ion is helped by a great

many of the other muse

les.

Circumd notion — a combination

of the other movements, j

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
front 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 fiat
band, the tendon of the quadriceps extensor, attached to the
apex and margins of the patella, and continued on to be inserted

HANDBOOK OF ANATOMY

Gluteus Medius

Gluteus Maximus

Biceps
Semitendinosus

Semimembranosus

Internal Popliteal Nerve
Sartorius —

Ilio-hypogastric Nerve

Lateral Cutaneous of

12th 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)
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

Fig. 19. — Muscles and Cutaneous Nerves of Leg (Posterior View).

MUSCLES OF LOWER LIMB

Obliquus Externus Abdc

Gluteus Medius

Tensor Fasciae Femori
Psoas Magnus
Pectineus W

Ext. Abdominal Ring

Ligamentum Patella- 1|UV1|J||

gastrocnemius

Peroneus Longus

Soleus -

Ext. Longus Digitorum -

Ext. Proprius Hallucis ._

Tibialis Anticus

Peroneus Tertiu.

Anterior Annular

Ligament

Ext. Cutaneous Nerve

Crural Branch of Genito-

crural Nerve
Inguinal Nerve

Saphenous Opening
Mid. Cutaneous Nerve

Int. Saphenous Vein

Int. Cutaneous Nerve
(Outline)

A.nt. Branch of Internal
. Cutaneous Nerve

Patellar Plexus of Nerves
Patellar Branch of Internal

Saphenous Nerve
Int. Saphenous Nerve
Int. Saphenous Vein
Post. Branch of 1 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).

HANDBOOK OF ANATOMY

in the anterior tubercle of the tibia. Expansions of the vasti
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
popliteus. The tendon of semimembranosus forms an ex-

Anterior Crucial •
Ligament

External Semilunar jjjt

Fibro-cartilage
Synovial Membrane

Long External Lateral
Ligament
Posterior Superior- -
Tibio-fibnlar
Ligament

.Internal Semilunar
Fibro-cartilage

. Synovial Membrane

Internal Lateral
Ligament
" Post. Accessory Bundle

Posterior Crucial
Ligament

Fig. 21. — Knee-Joint (Posterior View).

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 63

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
tendon is inside the capsule and not part of it.

The Intra- Articular Ligaments. — The ligaments inside the
knee-joint are 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

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.

Muscle.

Flexion Hamstrin

Biceps

Semi-
membran-
osus

Semiten-
dinosus

Sartorius

Gracilis

Gastroc-
nemius

Origin.

Insertion.

Exten-
sion

Plantaris

Popliteus

Quadri

Rectus
femoris

Vastus
externus

js, consisting of-

See Hip -Joint

By two heads — (1) On
the upper part of the
external condyle and
supracondyloid ridge;
(2) from the space
between the internal
condyle and the ad-
ductor tubercle

From the lower third of The tendo Achillis, or a
the outer supracondy- separate insertion on
loid ridge its inner side

The tendo Achillis in-
serted in the middle
part of the posterior
surface of the os calcis

By a tendon from the
outer surface of the
external condyle

The triangular surface
on the upper part of
the posterior surface
of the tibia above the
oblique line

Nerve-supply,

ceps extensor, consisting of four parts

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

The upper border of
the patella and the
ligamentum patelhe

The upper and outer
border of the patella
and the ligamentum
patellae

Tibial

Anterior
crural

TIBIO-FIBULAR JOINTS

MUSCLES ACTING ON THE JOINT— Continued.

Action.
Exten-

Muscle.

Origin.

Insertion.

Nerve-supply.

Vastus

From the lower two-

The upper and inner

sion

intcrnus

thirds of the inter-
trochanteric line, the
inner lip of the linea
aspera, and upper
two-thirds of the line

border of the patella
and the ligamentum
patellae

crural

from the linea aspera

to the inner condyle ;

deep fascia

Crureus

From the anterior and The deep surface of the

(vastus

outer surfaces of the tendons of rectus

crural

inter-

upper two-thirds of femoris and the vasti,

medins)

the shaft of the and the ligamentura
femur ; the lower half patellae

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 of

66 HANDBOOK OF ANATOMY

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 and 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 be performed by outside
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

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.

Posterior Inferior
Tibio-fibular Li".

Posterior Band of.^
Ext. Lat. Lig. "--.... A

Anterior Inferior Tibio-fibular
Ligament

Anterior Band of External
Lateral Lieament

Middle Band of
Ext. Lat. Lig.

Peroneus Longus

Peronens Brevis

Fig. 22.— Ankle-Joint.

1. 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.

3. 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 synovial 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 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 up-
wards to join the deltoid ligament.

The Inferior Galcaneo-Cuboid ligament 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

be done by outside force when the ankle is tiexed, 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

Tendo Achillis ..

Extensor Proprius Hallutis
Extensor Longus Digitorum
Peroneus Tertius

— Upper Division of Ant. Annular Ligament
Lower Division of Ant. Annular Lig.
^Extensor Brevis Digitorum
Tendon of Peroneus Tertius

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,

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 and plantar fascia, which act as ties.

The Transverse Arch is most marked at the tarso-metatarsal
joints. The outer border of the foot is lower than the inner, so
that when the two feet are placed side by side the tranverse
arch is complete.

MUSCLES ACTING ON THE ANKLE-JOINT.

Action.

Muscle.

Origin.

Insertion.

Nerve-supply.

Flexion

Tibialis

From the external

The anterior part of the

anticus

tuberosity and upper
two-thirds of the outer
surface of the shaft of
the tibia ; the inter-
osseous membrane and
deep fascia

inner surface of the
first cuneiform and
base of the first meta-
tarsal

tibial

Extensor

From the outer tuber-

The muscle divides into

communis

osity of the tibia and

four tendons, and is

tibial

digitorum

the upper two thirds
of the anterior surface
of the shaft of the
fibula and deep fascia

inserted into the four
outer toes in the same
manner as the exten-
sors of the fingers

Extensor

From the anterior sur-

The base of the terminal

proprius

face of the shaft of

phalanx of the great

tibial

hallucis

the fibula in its middle
three fifths ; internal
to that of extensor
communis digitorum
and the interosseous
membrane

toe (hallux)

Peroneus

Is really part of exten-

The dorsal surface of

tertius

sor communis digit-
orum, and arises from
the lower part of the
anterior surface of the
fibula and interosseous
membrane

the base of the fifth
metatarsal

tibial

., . j

•

MUSCLES OF ANKLE-JOINT

MUSCLES ACTING ON THE ANKLE-JOINT— Continued.

Action,

Exten-

Mu>cle.

Origin.

Insertion.

Nerve-supply.

Gastroc- (

These constitute the gro

up called calf muscles,

sion

n em ins

and extend the ankle

by raising the heel when

Plantaris 1

the foot' is on the gro

und — a slightly different

Soleus I

movement from true

extension of the ankle

Gastroc-

See Knec-Joint

nemius

Plantaris

See Knee-Joint

Soleus

(1) From the posterior
surface of the head
and upper two-thirds
of the shaft of the
fibula ; (2) from a
fibrous arch between

Tendo Achillis

Tibial

•

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

posticus

fourths of the shaft of
the fibula between the
oblique line and the
interosseous border ;
the external tuber-
osity of the tibia and
the inner half of the
upper two-thirds of
the shaft below the
oblique line ; the in
terosseous membrane
and deep fascia

all the bones of the
foot except the first
metatarsal. As the
tendon passes round
the internal malleolus
a slip is inserted into
the sustentaculum tali

tibial

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
the tibia internal to
that of tibialis pos-
ticus and deep fascia

are inserted into the
bases of the terminal
phalanges of the four
outer toes (cf. flexor
profundus digitorum)

Flexor

From the lower two-

The base of the terminal

Posterior

I longus

thirds of the posterior

phalanx of the great

tibial

hallucis

surface of the shaft of
the fibula and the
deep fascia

toe

Inver-

Tibialis

See Flexion

sion and

anticus

Adduc-

tion

j Tibialis
! posticus

See Extension

HANDBOOK OF ANATOMY

MUSCLES ACTING ON THE ANKLE-JOINT— Continued.

Action.

Muscle.

Origin.

Insertion.

Nerve-supply .

Eversion

Peroneus

From the head and

The tendon passes

Musculo-

and

longus

upper two-thirds of

through the groove in

cutaneous

Abduc-

the outer surface of

the cuboid, and is in-

tion

the shaft of the fibula

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-

brevis

thirds of the outer
surface of the shaft, of
the fibula

surface of the base of
the fifth metatarsal

cutaneous

MUSCLES ACTING ON THE METATARSOPHALANGEAL JOINTS.

Action.

Muscle.

Origin.

Insertion.

Nerve-supply.

Flexion

Flexor

longus

digitorum

See Ankle-Joint

Acces-

The outer head from

The upper aspect of the

External

sorius

the outer border of
the plantar surface of
the os calcis and the
long plantar liga
ment ; the inner head
from the inner surface
of the os calcis and
long plantar ligament

tendons of flexor
longus digitorum for
second, third, and
fourth toes

plantar

Lumbri-

The first from the tibial

The dorsal expansions

First

cales

side of the innermost

of the extensor ten-

lumbricales

tendon of the flexor

dons, etc , similar to

from inter-

longus digitorum ; the

the lumbricales in the

nal plantar ;

others from the adja-

hand

the others

cent sides of the three

from

outer tendons

external
plantar

Flexor

See Ankle-Joint

longus

hallucis

Flexor

From the inner part of

The tendon divides to

Internal

brevis

the plantar surface of

allow that of flexor

plantar

hallucis

the cuboid and the
tendon of tibialis pos-
ticus

longus hallucis to
pass, and is inserted
into the sides of the
base of the first
phalanx of the great
toe

MUSCLES OF FOOT

MUSCLES ACTING ON THE METATARSOPHALANGEAL
JOINTS— Continued.

Flexion

Exten-
sion

Adducti

Muscle.

Flexor

brevis

digitornra

Flexor

brevis

minimi

digiti

Interossei

Extensor

longus

digitorum

Extensor

brevis
digitorum

Extensor
proprius
hallucis

on : to the

Adductor
obliquus
hallucis

Origin.

Nerve -supply.

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

See Abduction and Ad-
duction

See Ankle-Joint.

From the upper surface
of the os calcis in front
of the articulation

See Ankle-.Toint

The second phalanges
of the four outer toes
(cf. insertion of flexor
sublimis digitorum in
the hand)

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

middle line of the second toe

Adductor
trans-
versa

hallucis

From the plantar sur-
face of the bases of
the second, third, and
fourth metatarsal
bones

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

Internal
plantar

The outer side of the External
base of the first plantar
phalanx of the little
toe

i Plantar From the tibial sides of
interossei j the third, fourth, and

fifth metatarsal bones

respectively

Abducti

on : from t

Abductor
hallucis

With the dorsal muscles
on to the tibial sides
of third, fourth, and
fifth toes

he middle line of the second toe

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

Anterior
tibial

External
plantar

Internal
plantar

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
metatarsal bones

muscles are inserted
on the tibial and fibu-
lar side of the second
toe respectively ; the
two outer muscles are
iuserted on the fibular
side of the third and
fourth toes into the
dorsal expansions

plantar

Abductor

From both tubercles on

The outer side of the

External

minimi

the plantar surface of

base of the first

plantar

digiti

the os calcis, the
plantar fascia, and
deep fascia

phalanx of the little
toe

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 Aukle-Joint

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; beginning
at the outermost layer :

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

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 Halluci

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 symphisis, 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 fascial 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

VERTEBRA, 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.

Superior Articular
Process

{ _J Spine

Fig. 25. — A Typical Vertebra.

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

VERTEBRA

in shape ; the sides and upper and lower surfaces are slightly
concave. Posteriorly, two short, stout processes — the pedicles —
are formed ; these support flattened laminse, which fuse in the
middle line ; thus, the posterior surface of the body, the
pedicles, and the laminae 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 verte-
bra) there are spaces left — the intervertebral foramina — through
which the spinal nerves emerge. Immediately in front of the
pedicles are other processes — the tranverse, 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 vertebra' one witli another. At the
junction of the laminae a third process is developed, called the
spine, for the attachment of muscles.

PRINCIPAL VARIATIONS IN VERTEBRA OP DIFFERENT REGIONS.

Vertebra.

Body.

Spine.

Transverse Process.

Cervical (first

Oval in shape

Short and bifid

Small, and with a foramen

and second de-

at the free end

through which the verte-

scribed separ-
ately)
Dorsal

bral artery runs

Heart - shape,

Long, thin, and

Have small facets for artic-

with facets for

pointing down-

ulation with the tubercle

heads of ribs

wards

of the rib

Lumbar

Kidney-shape

Short, stout, and

Point horizontally out-

horizontal

wards, with several tuber-
cles for attachment of
muscles

The Sacral vertebra are all fused together into one bone,
called the sacrum.

The Sacrum is a triangular bone formed of the five sacral
vertebras, whose bodies and transverse processes have become
fused together, distinct ridges being seen at the line of fusion.

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-

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 (Anterior 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 articular surfaces for articulation with the inno-
minate bone.

VERTEBRAE

r> .. . . , n Superior Articular Process

Rudimentary Articular Processes (fused) T •

■Ligamentous Surface
\ Auricular Surface

Transverse Process
(rudimentary)

Outlet of Sacral Canal „-
Notch for 5th Sacral Nerve

2nd Posterior Sacral
Foramen

Inferior Lateral Angle

Sacral Cornu

Fig. 27.— Sacrum (Posterior Surface).

Anterior Tubercle

^Odontoid Facet

Tubercle for Transverse Ligament
Costal Process

, Superior Articular Process

Costo-transverse
Foramen

Transverse Process

Vertebrarterial
Groove

- Posterior Tubercle

Fig. 28.— Atlas.

HANDBOOK OF ANATOMY

The Coccyx consists of four rudimentary vertebrae, which
are generally fused together, and often fused with the sacrum.

Special Vertebrae.

The First Cervical vertebra, or Atlas, differs from the typical
vertebras. 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 vertebrae, are attached to the lateral masses.

Atlantal Facet

Odontoid Process

Groove for Transverse Ligament

Superior Articular Process

Superio
£\otch

. Inferior
Body J Notch J

Costo-transverse 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 altas.

The Seventh Cervical vertebra is called the vertebra
prominens owing to the spine, which ends in a broad, single
tubercle, and is markedly prominent at the root of the neck.

The Dorsal, or thoracic, vertebrae 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 on 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 the upper middle 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
sides 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

HANDBOOK OF ANATOMY

st Thoracic

ist Lumbar

<&^

istC.

.istT.

[stL.

Sacrum
Coccyx

Fig. 30.— Spinal Column.

.ist Co.

STERNUM

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.

Interclavicular Notch

Clavicular Surface

Fcr i st Costal Cartilage

Fig. 31.— Sternum.

Ossification. — Several centres are developed before birthv the
whole becoming fused about the fortieth year.

m 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 twelfth, 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
vertebras, the lower half of which corresponds with the facet
on the upper margin of the body of the vertebra corresponding
Avith it. 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
always sticks 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,
is a groove for the subclavian artery. On the inner border, about

RIBS

an inch from the anterior extremity, is the scalene tubercle.
The surfaces are directed upwards and downwards.

The second rib resembles the first in shape and in having

Medullary
Foramen

Nec'K

Angle

Subcostal
Groove \

Articular Part of Tubercle

Part of Tubercle

Fig. 32.— A Typical Rib.

no twist, but is a good deal larger. The surfaces are directed
obliquely, similarly to those of the other ribs.

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

VERTEBRA], 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 Articulation*. — These take place between the
flattened surfaces of the bodies of the vertebras. Between the
two surfaces is a cartilaginous disc, the intervertebral 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
the bodies.

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 laminae. 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

HANDBOOK OF ANATOMY

particularly developed, forming a partition between the muscles
of the two sides, and called the ligamentum nucha?.

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.
An fcero-posterior — lateral flexion
Vertical — rotation .

Posterior Band of Superior
Costo-transverse Ligament
Anterior Band of Superior

Costo-transverse Ligament

Anterior Costo-central
or Stellate Ligament

Interarticular Ligament

I li till— - Anterior Common
Ligament

Intervertebral

Fig. 34.— Vertebral Ligaments.

The articulations of the ribs, both with the vertebrae 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

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.

Musculus Accessorius •

Longissimus Dorsi

Ilio-costalis, —

Splenius

Serratus Posticus Superior

Vertebral Aponeu-
rosis

. Serratus Posticus
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 :

HANDBOOK OF ANATOMY

1. Trapezius and latissimus dorsi.

2. Levator anguli scapulas and rhomboids.

3. Serrati postici superior and inferior, splenius capitis and
splenius cervicis.

4. Erector spinas and complexus.

Pectoralis Major

Serratus Ma^rnu:

Latissimus Dorsi

Obliquus Externus
Abdominis

Petit's Triangle

T-«7- Middle Linea
illflljifflr Transversa

Rectus Abdominis

Anterior Superioi-

Hiac Spine

.Poupart's Ligament

External Abdominal
Ring

Fig. 36. — Muscles of the Abdomen.

Beneath these muscles are a large number of smaller ones
that move the vertebras on one another — e.g., rotatores, inter-
spinals, etc.

MUSCLES OF BACK

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
musgles on the posterior wall of the abdomen extend the spine
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.

Action.

Lateral
flexion

Muscle.

Origin.

Insertion.

Nerve-supply.

Scalenus From the transverse The scalene tubercle

anticus | processes of the third, and ridge on the first

fourth, fifth, and sixth rib

cervical vertebrae

Scalenus
medius

From the transverse
processes of the lower
cervical vertebrae
(second to sixth in-
clusive)

On the first rib behind
the groove for the
subclavian artery

Scalenus From the transverse j The outer surface of the
posticus j processes of the fourth, second rib about the

fifth, and sixth cervi-
cal vertebrae

middle

Anterior
primary
divisions of
lower four
or five cervi-
cal nerves

Same as
above

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-

colli

transverse processes

verse processes of the

primary

of the first three

upper cervical verte-

divisions of

thoracic and. last three

bra

the upper

cervical vertebne

cervical
nerves

Psoas

See Hip-Joint

Rectus

By two heads from the

The front of the ensi-

abdominis

symphysis and crest

form cartilage and

primary

of the pubis

seventh, sixth, and
fifth costal cartilages

divisions of

the lower

six thoracic

nerves

Obliquus

From the outer surfaces

The external lip of the

Same as

externus

of the lower eight ribs

iliac crest in its

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

muscle forms Pou-

part's ligament

Obliquus

From the lumbar tascia,

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
cartilages interdigi-
tating with the dia-
phragm ; the lumbar
fascia, anterior half of
internal lip of iliac
crest, and outer third
of Poupart's ligament

neurosis, which joins
with that of the other
side to form the linea
alba ; and below joins
the lower part of the
obliquus internus to
form the conjoint ten-
don attached to the
crest of the pubis

above

MUSCLES OF BACK

MUSCLES (BOTH SIDES TOGETHER) ACTING ON THE SPINAL
COLU M N— Con tinned.

Action.

Muscle.

Origin.

Insertion.

Nerve-supply.

Exten-

Corn-

From the transverse

Between the superior

Posterior

sion

plexus

processes of the upper

and inferior curved

primary

six thoracic and lower

lines of the occipital

divisions of

four cervical vertebra

bone near the middle
line

the spinal
nerves

Splenius

From lower half of liga-

Splenius capitis into the

Same as

capitis

mentum nuclide and

mastoid process and

above

and

spines of seventh cer-

outer part of superior

cervicis

vical and upper six
dorsal vertebrae

curved line of occipi-
tal bone ; splenius
cervicis into the trans-
verse processes of the
upper cervical verte-
brae

Serratus

From the ligamentum

By slips into the second,
third, and fourth ribs

Same as

posticus

nuchas and spines of

above

superior

seventh cervical and
iirst four dorsal verte-
bras

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

spinae

of the iliac crest, the
posterior sacro - iliac
ligament, the back of
the sacrum, and spines
of all the sacral and

tions : (1) Ilio-costa-
lis, by slips into the
lower six ribs ; (2) the
longissimus dorsi, by-
outer slips into all the
ribs and inner slips

above

lumbar vertebrae

into the transverse

processes of the upper

lumbar and all the

dorsal vertebrae ; (3)

spinalis dorsi, into the

spines of the upper

dorsal vertebrae

Quadratus

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

cesses of upper lumbar

nerves

lumbar vertebra;

vertebrae

HANDBOOK OF ANATOMY

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 that the right twelfth rib is brought nearer to the
left iliac crest, is caused by the following muscles :

Right obliquus externus abdominus.
Left obliquus internus 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 whole 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.

Inspiration, caused by the elevation of the ribs and depression
of the diaphragm.

Muscle.

Origin.

Insertion.

Nerve-supply.

Diaphragm

From the ventral surface of
the ensiform cartilage ; from
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 lumborum

It is inserted into a
large trilobed central
tendon, which is de-
veloped in the muscle
itself, and has no
bony attachment

Phrenic

INTERCOSTAL MUSCLES

Action.

Muscle.

Origin.

Insertion.

Nerve-supply.

Inspira-

External

From the lower border

The upper border of the

Intercostal

tion

intercostal

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

rib below from the
tubercle to the costal
cartilage

The

space in fr

ont over the costal cartil
intercostal aponeu

ages is filled by the ante
rosis

rior

Internal

From the lower border

The upper border of the

Intercostal

intercostal

of the costal carti-
lage and inner edge of
the subcostal groove ;
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

rib below from the
sternum to the angle
of the rib

The

space beh

Scaleni

Serrati
postici

ind, between the angles
by the posterior intercos

See Back Muscles

and the tubercles of the
tal aponeurosis

ribs, is filled

§>^¥\_ Internal Mammary
Artery

External Intercostal Muscle

Interchondrnl Part

cf Internal
Intercostal Muscle

External Intercostal Muscle

Interosseous Part of Internal
Intercostal Muscle

Fig. 37. — Intercostal Muscles.

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.

HANDBOOK OF ANATOMY

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.

Action.

Muscle.

Origin.

Insertion.

Nerve-supply.

Depres-

Triangu-

From the back of the

The cartilages of the

Intercostal

sors of

laris

ensiform cartilage and

second to sixth ribs

the ribs

sterni

sternum as high as

inclusive

in expi-

the third costal carti-

ration

Internal
intercostal

Abdomi-
nal
muscles

lage

See above

See Flexion of Spinal
Column

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.

The Lumbar Fascia is attached to the lumbar vertebra? 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 erector
spinae.

The middle layer lies between erector spinae and quadratus
lumborum.

LUMBAR FASCIA 99

The innermost layer covers the ventral surface of quadra tus
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
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.

Norma 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 LATERALIS

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

Fk;. 38. — The Lateral Region of the Skull (Norma Lateralis).

I, I, Frontal; II, II, Parietal'; III, Occipital; IV, Great Wing of Sphenoid;
V, Squamous Portion of Temporal ; VI, Mastoid Portion of Temporal ;
VII, Zygoma ; VIII, Malar ; IX, Nasal ; X, Superior Maxilla (Nasal Process) ;
XI, Lachrymal; XII, Ethmoid (Os Planum) ; XIII, Inferior Maxilla.

1, Bregma ; 2, Superior Temporal Ridge ; 3, Inferior Temporal R^dge; 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 the

102 HANDBOOK OF ANATOMY

malar articulates with a process of the temporal. Between this
process and the opening of the ear is the articulation of the
mandible.

Norma Occipitalis (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 Verticalis (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 maxillse 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 either 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 either 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 passage of

29 28 27 ->6

Fig. 39. — The External Base of the Skull.

Ant. Palatine Fossa

Post. Nasal Spine

Post. Border of Vomer

Facial Surf, of Sup. Maxilla

Hamular Process of Int. Pterygoid
Plate of Sphenoid

Pterygoid Fossa

Ext. Pterygoid Plate

Zygomatic Process of Malar

Zygoma of Temporal

Pharyngeal Tubercle (pointer
crosses Foram. Lacerum Med.)

Eustachian Groove

Groove for Chorda Tympani
Nerve

Petrous Portion of Teirmoral (Ori-
gin of Levator Palati)

Carotid Foramen

Ext. Auditory Meatus

Ext. Auditory Process

Basion

18. Mastoid Process
10- Jugular Foramen

20. Ant. Condylar Foramen

21. Digastric Groove

22. Occipital Groove

23. Post. Condvlar Foramen

24. Sup Curved Line of Occipital

25. Inf. Curved Line

26. Ext. Occipital Crest

27. Ext. Occipital Protuberance

28. Opisthion

29. Foramen Magnum

30. Right Occipital Condyle

31. Foram. Lacerum Medium

at +

32. Vaginal Proc.ofTymp. Plate

33. Mastoid Foramen

34. Stylo-Mastoid Foramen

35. Styloid Process

36. Tympanic Plate (Post, part of

Glenoid Fossa)

37. Spinous Proc. of Sphenoid

38. Ant. part of Glenoid Fossa

39. Foramen Spinosum

40. Foramen Ovale

41. Foramen Vesalii

42. Preglenoid Tubercle

43. Eminentia Articularis

44. Zygomatic Fossa

45. Infratemporal Crest

46. Temporal Division of Great

Wing of Sphenoid

47. Spheno-Maxillary Fissure

48. Tuberosity of Sup. Maxilla

49. Ext. Access. Palat. Foramen

50. Post. Access. Palat. Foramen

51. Post. Palatine Foramen

52. Right Post. N.nris (pointer crosses

ridge for Tensor Palati)

53. Groove for Descend. Paint. Artery

54. Horiz. Plate of Palate Bone

55. Palat. Proc. of Sup. Maxilla

104

HANDBOOK OF ANATOMY

the supraorbital 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,
with the malar bones by the outer extremities of the orbital

Parietal Border

Superior Temporal Ridge

Inferior
Temporal Ridge

Frontal Eminence

Temporal Surface for
Temporal Muscle

Lachrymal Fossa

v External
Angular Process
v Superciliary Ridge
Supra-orbital Notch

Nasal Process

nternal Angular Process

Nasal Spine

Fig. 40.— The Frontal Bone.

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 spheroid
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 » External Occipital Protuberance

Highest Curved Line"v

I Superior Curved Line

Inferior Curved Line

Lateral Angle

" Inferior Lateral
Border of
Tabular Portion

v Jugular Process

Posterior Condylar Fossa and
Foramen (latter inconstant)
Anterior Condylar Foramen

Jugular Notch
Condyle

Pharyngeal 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 either 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 ;

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

External Auditory Meatus'

Zygoma

Ant. Root of Zygoma
^ (Eminent. Artie.)

Ant. Part of Glenoid Fos-a

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 hone, 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 b}^ 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 bodv 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 rotund um and foramen ovale are in the great
wing.

Bones of the Face.

The Maxillae 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 orbital 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 less

Nasal Process

For Lachrymal Bone
Lachrymal Tubercle xx

Lachrymal Notch \ \

Orbital Surface

i
Infra-orbital Groove I

For Nasal Bone

Openings of
Post Dental Canals'"""

__ Nasal Notch

.Anterior Nasal
Spine

Tuberosity J
Zygomatic Surface J

Malar Process

Palatal Process
ncisor Fossa
Canine Fossa

Infra-orbital Foramen

Fig. 43. — The Superior Maxilla.

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

Sigmoid Notch

Left Coronoid Process

Impression for Temporal
Muscle

Incisor Fossa

Mental Protuberance '

Mental Tubercle

Left Condyle

Condylar
Tubercle

Neck

Posterior
— Border of Ramus,

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 consists 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, project 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 ,
also the two joints do not always act simultaneously, but alter-
nately, which gives a lateral movement to the jaw. The move-
ments possible are —

Transverse axis — raising and depressing of mandible.

TEMPOROMANDIBULAR 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

Capbuiui Ligament

Styloid Process

Zygoma
Coronoid Process

Spheno-mandibular

(Internal Lateral;
Ligament

Stylo-mandibular Ligament

i
Mylo-hyoid Groove

Fig. 45. — The Temporo-Mandibular Joint.

surface of the neck of the mandible (the part supporting the
condyle) .

A synovial membrane lines both compartments of the joint,
which may be continuous through a perforation in the cartilage.

Accessory Ligaments : Spheno-mandilubar from the spinous
process of the great wing of the sphenoid bone to the lingula
on the inner surface of the mandible.

Stylo-Mandilubar, from the tip of the styloid process of the
temporal bone to the posterior border of the angle of the
mandible.

112 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.

Tranverse — 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 synovial 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
membraneous 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 Cruciatiim, 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 Oceipito-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 membrane
attached posteriorly to the superior curved lines of the occipital
bone, laterally to the temporal bone ; anteriorly, it blends with
the 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 j
the muscles which depress the lower jaw are muscles of the
neck, not true muscles of mastication.

Action.

Muscle.

Raising

closing

of the

jaw

Masseter
Temporal

Internal
pterygoid

Protru-
sion

External
pterygoid

Internal
pterygoid

Origin

From the anterior two-
thirds of the lower
border of the zygoma
and the inner surface
in its whole length

The whole of the tem-
poral fossa and fascia
covering it

From the inner surface
of the external ptery-
goid plate and from
the tuberosity of the
maxilla

From the under surface
of the great wing of
the sphenoid and the
outer surface of the
external pterygoid
plate

See above

Insertion.

The outer surface of the
ramus and angle of
the lower jaw

The inner surface and
apex of coronoid pro-
cess and anterior bor-
der of the ramus of
the lower jaw

The inner surface of the
angle of the lower jaw

The anterior border of
the neck of the lower
jaw, the inter-articu-
lar cartilage, and the
capsule

Nerve-supply.

Inferior I
maxillary j
division of |

the fifth j

Same as
above

114

HANDBOOK OF ANATOMY

Action.

Muscle.

Origin.

Insertion.

Nerve-supply.

Protru-

Temporal

From the under surface

sion

(anterior
fibres)

of the great wing of
the sphenoid and the
outer surface of the
external pterygoid
plate

Retrac-

Temporal

See above

tion

(posterior
fibres)

Lateral

External )

move-
ment Internal J

Pterygoid of one side

The Buccinator muscle is also a muscle of mastication, but lias
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-

Digastric

Posterior belly from the

The oval impression on

Branch

sion

digastric groove in

the lower border of

from

front of the mastoid

the mandible close to

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 origins 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.

Origin.

Insertion.

| Nerve-supply

Flexion

Exten-
sion

Depressor s of the jaw when tempo

In f rahy oi

Recti capi
on the 1

Ster:

d muscles-

between

ro-mandibular joint is fix
hyoid bone and sternum

tis antici major and min or, small muscles having

esser cervical vertebra* a rid their insertions on th

process of the I occipital bone

From the anterior sur- The outer surface of the

mastoid face of the manubrium mastoid process and

sterni and the inner the superior curved

third of the upper line of the occipital

border of the clavicle bone

Splenius
capitis

Com-
plexus

Obliquus
inferior

Rectus ca
atli

See Extension of Spinal Column
See Extension of Spinal Column

From the spine of the The transverse process
axis of the atlas

their origins
e basilar

Spinal
accessory

Post-
primary
divisions

pitis posticus major and minor from the spine of the axis and
to the occipital bone beihind the foramen magn um

(2) Lateral movement — the muscles of one side acting alone.

1 1

Action, j Muscle. Origin.

Insertion.

Lateral
flexion

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 complexns

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

Recti capi

ti postici (major and mi

nor)

Obliqui

(superior and inferior)

SECTION VI
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,
small intestine (duodenum, 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 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 vertebrae, 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 diif erent 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

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

Small Curvature
Pyloric end
Duodenum i

Curvature

Fig. 47 —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 T^ 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 valvulse 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 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 vertebras. 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 beyond 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 caecum,
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 epiploicse hang from the outer wall of the large
intestine.

The Caecum is a small sac about 2J 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 lumborum, 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 Descending* Colon (length about 6 inches). It lies on
the front of the left kidney, then between psoas and quadratus
lumborum. It is covered by coils of small intestine.

The Sigmoid 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 small 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 1^ 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 Salivary Glands, of which there are three pairs, are
situated at the side of the face.

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 Submaxillary Gland is the next largest ; it lies in a recess
just inside the angle of the mandible. It lies on the mylohyoid
muscle and posteriorly is in contact with the sterno-mastoid
muscle.

SALIVARY GLANDS

123

The duct (Wharton's) leaves the deep surface of the gland
and passing forwards beneath the mylohyoid muscle it pierces
the floor of the mouth under the tongue.

The Sublingual Gland is a small gland which lies on the
floor of the mouth under the tongue, covered only by mucous
membrane.

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

iStensen 5 Duct

t-rr-'— Ducts of _
Rivini

Wharton's Duct

Fig. 48. — The Salivary Glands.

on the right side of the body. Its function is to secret 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
downwards a little lower on the right side. The upper limit,
anteriorly, corresponds with the line of the diaphragm — I.e., the

124

HANDBOOK OF ANATOMY

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,
against the abdominal wall, laterally, against the ribs, from
which it is separated by the diaphragm, posteriorly, also against

Inferior Vena Cava

(Esophageal Groove

Lobus Spigelii
Venosal Fissure

Lobus Caudatus

i Impressio Suprarenalis

Uncovered Area of Right Lobe

Impressio Duodenalis

Impressio Renalis

Vena Portae

Impressio Gastric
on Left Lobe

Cystic Duct

Tuber Omentale

Hepatic Artery i

Hepatic Duct

Impressio Colica

j 1 Gall-bladder

J Lobus Quadratus
Round Ligament Ductus Communis Choledochus

Fig. 49.— The Liver.

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 " un-
covered area" is a small triangular impression made by the
right suprarenal capsule, and to the left of this a deep groove

PANCREAS 125

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 oeso-
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 Gall 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
aorta. The upper surface of the body is wide (in transverse
section the body is triangular), and forms part of the floor of the

126 HANDBOOK OF ANATOMY

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 is 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 lineo-renal ligaments.

Hilum

— • Anterior Basal Angle
- Pancreatic Impression
Internal Basal Angle

The Spleen.

The Suprarenal Capsules are two small triangular bodies
resting on the upper ends of the kidneys.

The right suprarenal capsule is in contact anteriorly with the
vena cava and the liver ; prosteriorly 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
semi-lunar 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.

The kidney is a bean-shaped organ lying on the posterior
wall of the abdomen, with its long axis 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 kidney 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 lumborum 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

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 1 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 lung's.

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 Eustachian tube and the pharyn-
geal tonsil. Below the soft palate is the tonsil on each side.
Below this the pharynx rapidly narrows as it passes 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
living subject. The thyroid cartilage is joined by a strong

Frontal Air-Sinus

Superior Meatus

Superior Concha
»' Spheno-ethmoidal Recess

Inferior Meatus M^
Hard Palate (in section) ZTlZ^ll ' l?j$.%£s
Tongue II n '/>">*

Mandible (in section)

,. Sphenoidal Air-Sinu-
Middle Concha

Middle Meatus
— Inferior Concha
—Eustachian Orifice

° .wnnr— Salpingopharyngeal

Fold

..Soft Palate

^J| Epiglottis

£fiU. Pharynx

Genio- hyo-glossus

Genio-hyoid '

Ventricle of Larynx /
Thyroid Cartilage
Cricoid Cartilage •'

(Esophagus

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 and outwards from
the bifurcation of the trachea to the roots of the lungs. The

Isthmus (Pomum Adami)

■^--Superior Cornu of Thyroid
Cartilage

Inferior Cornu

^.Crico- thyroid Ligament

Cricoid Cartilage'

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 onter 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 lung, 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,

LUNCiS

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.

Tlie 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,
tbe pleura is about an inch and a half above the level of the
clavicle. This 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 the ribs and the intercostal spaces. It reaches to

Pleura
(visceral layer)

Pleura
(parietal layer)

Fig. 53.— The Pleura.

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.

136 HANDBOOK OF ANATOMY

The parietal pleura is bigger than the lungs require at rest,
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 ensif orm 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 :

Right 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 cavae entering the
right auricle, and the four pulmonary veins entering the left
auricle.

The Apex of the Heart is formed entirely by the left ven-

Superior Vena Cava

Aorta

Right Auricular Appendix

Right Auricle

Right Coronary Artery -

Pulmonary Artery

,Conus Arteriosus

(Infundibulum)
^,'Left Auricular Appendix

Left Ventricle

— Left Coronary Artery

Anex

Fig. 54.— The Heart.

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 pectmati. 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 pulmonaiy
artery is also guarded by a valve composed of three cusps. The
left ventricle is continuous Avith 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 Cornese — bundles of muscle-fibre raised in relief on
the walls of the ventricle.

Papillary Muscles — which are attached at either end to the
walls of the ventricles, but are free in the middle. These pre-
vent over-distension.

Chordae Tendinse — 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
iliac arteries. For convenience of description it is divided

Trachea

Innominate
Artery

Rt. Superior —

Intercostal

Artery

Arch of.
Aorta

Left Common Carotid Artery
Scalenus Amicus Muscle

Left Pneumogastric Nerve

Left Subclavian Artery

(Third Part)
Left Phienic Nerve

Left Superior Intercostal
Artery

Cervical Cardiac Rranches
of Left Symp. and Vagus

Superficial Cardiac
Plexus

... Left Bronchus

Fig. 55. — The Aorta.

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 carti-
lage. 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 manu-
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, and 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. — Innominate on the right side.
Left common carotid.
Left subclavian.

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.

Branches. — Nine pairs of intercostal arteries.

Small branches of supply to the bronchi, peri-
cardium, and oesophagus.

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 is 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
and parietal — and each set is again divided into paired and un-
paired groups.

AORTA

143

Visceral .

Parietal.

Paired.

Unpaired.

Paired.

Unpaired.

Suprarenal

Henal

Spermatid or
Ovarian

Coeliac axis
Superior mesenteric
Inferior mesenteri c

Inferior phrenic
Lumbar (four pairs)
Common iliac

Middle sacral

The order in which the branches arise from the abdominal
aorta is as follows :

1. Inferior phrenic.

2. Coeliac axis.

3. Middle suprarenal.

4. Superior mesenteric.

5. Renal.

6. Spermatic or ovarian.

7. Inferior mesenteric.

8. Middle sacral.

9. Common iliac.

The lumbar arteries arise down the sides of the aorta oppo-
site the bodies of the lumbar vertebras.

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 Common Carotid arteries vary slightly at their com-
mencement ; otherwise they are similar in course and dis-
tribution.

The Right Common Carotoid 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.

HANDBOOK OF ANATOMY

Fig. 56.— The Aorta in the Thorax, and the PrincipalTArteries of
the Head and Neck.

Arch of the Aorta

10.

Right Subclavian

20.

Suprascapular

Aortic Isthmus

ii.

External Carotid

21.

Superior Thyroid

Aortic Spindle

12.

Internal Carotid

22.

Lingual

Descending Aorta

I3-

Internal Maxillary

23-

Facial

Coronary Arteries (from

14.

Superficial Temporal

24.

Occipital

Ascending Aorta)

IS-

Vertebral

25-

Posterior Auricular

Innominate Artery

16.

Internal Mammary

26.

Ascending Pharyngeal

Left Common Carotid

*7-

Thyroid Axis

27.

Transverse Facial

Left Subclavian

18.

Inferior Thyroid

28.

Aortic Intercostals

Right Common Carotid

19.

Transverse Cervical

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

CAROTID ARTERIES 145

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

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
gland and runs straight up, terminating about 2 inches above
the zygoma by dividing into branches. It supplies the scalp
and surrounding structures.

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.

146 HANDBOOK OF ANATOMY

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
second 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 colei. It passes backwards
and upwards through the foramina in the transverse processes
of the cervical vertebras, 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.

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.

The 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.

ABDOMINAL AORTA

147

The Branches of the Abdominal Aorta are in two groups
— visceral and parietal. The visceral branches supply the
abdominal organs, the parietal branches supply the abdominal
walls.

The Paired Parietal Branches. — The Inferior Phmnic arteries
are the first branches which curve off the aorta as it enters
the abdomen. They supply the under surface of the diaphragm.

Oesophagus

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

-j(T-Cceliac Axis

...J/' '(/..Superior Mesenteric
Artery

Lumbar Artery

Quadratus Lumborum

. . Psoas Magnus

— Inferior Mesenteric
Artery

Iliacus

--.Left Spermatic Artery

Left Common Iliac Vein
Middle Sacral Artery

Rectum Rladder

Fig. 57. —The Abdominal Aoeta.

The Lumbar arteries, of which there are usually four pairs,
arise in series with the intercostal arteries. They pass back-
wards over the bodies of the lumbar vertebrae and between the
adjacent transverse processes. They pass behind psoas and

148 HANDBOOK OF ANATOMY

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.
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 vertebras 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 Uiac 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 /fossa 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.

ABDOMINAL AORTA 149

Branches. — Deep epigastric and deep circumflex iliac supply
the muscles and skin of the anterior abdominal wall.

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 supra-
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 Cceliac 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 pyloric
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.

150

HANDBOOK OF ANATOMY

The Hepatic artery runs along the head of the pancreas to
the first part of the duodenum. It then passes upwards to the
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-

Fig.

58.— The Inferior Mesenteric Artery and its Branches
(after Tiedemann).

i. 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

duodenal, whose terminal branches supply the larger curvature of
the stomach, the head of the pancreas, and the duodenum.

The Superior Mesenteric artery arises half an inch below the
coeliac and opposite the first lumbar vertebra. It crosses

VEINS 151

obliquely downwards over the head of the pancreas to the root
of the mesentery. It gives off numerous branches which supply
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.

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.

152 HANDBOOK OF ANATOMY

The Coronary Sinus lies between the left auricle and left
ventricle, and terminates in the lower and back part of the
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 carti-
lage ; 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
end 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.

osterioi Auricular Lym- ..
phatic Glands

Occipital Vein —

Occipital Lymphatic-
Gland
'osterior 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 Vein

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 Veir
--Middle Thyroid Vein

.V- 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 cms 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 vertebra?, the right psoas,
and the right cms 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 cms 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 vense 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 cms 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 hypogastric veins opposite the brim of the
pelvis behind the hypogastric artery. They pass upwards and
inwards, and unite to form the inferior vena cava opposite the
fifth lumbar vertebra.

Tributaries. — External iliac.
Hypogastric.

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
vein.

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
vein 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 Hemorrhoidal veins which drain the
lower part of the rectum, enter the hypogastric 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-
toralis 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 two-thirds the median and ulnar nerves lie re-
spectively on the external and internal sides of the artery, and in
its lower third 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 oif to the adjacent
muscles.

Radial Artery. — 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 quadratus, 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. 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 pronator radii teres, flexor sublimis digi-
torum, flexor carpi radialis, palmaris longus, flexor carpi ul-
naris (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 Interosseous, 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.

The Superficial Palmar Arch is formed at the level of the
lower border of the abducted thumb by the anastomosis of the

160 HANDBOOK OF ANATOMY

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 venae 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. Venm Comites of the brachial artery at the
lower border of the subscapularis muscle.

2. Cephalic vein at the upper border of pectoralis minor.

3. Tributaries corresponding to the branches of the axillary
artery.

ULNAR VEINS 161

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. — (1) 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.

3. 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.

The median cephalic vein passes upwards and outwards, and
opposite the external condyle of the humerus joins the radial

162 HANDBOOK OF ANATOMY

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
artery.

SECTION XT
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.

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.

In Hunter's canal the artery lies on, successively, adductor
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). — (a) Superficial external pudic,

(b) Superficial epigastric,

163

164 HANDBOOK OF ANATOMY

all of which supply the lower part of the abdominal wall and
superficially the external genital organs.

2. Muscular,

3. Deep external pudic,

4. 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) :

5. Anastomotica magna, which anastomoses with the termina-
tions of the other i 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.

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
of the femur, posterior ligament of knee-joint, posterior surface
of popliteus, and is covered by outer border of semimembranosus,
adjacent borders of heads of gastrocnemius. On its outer side
above lies the tibial (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 tibial nerve, and passes up-
wards on its outer side.

Branches. — Muscular to the adjacent parts.

Articular to the 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 super-
ficial groups of muscles on the back of the leg, and is in contact
in front from above downwards with tibialis posticus, flexor

PLANTAR ARTERIES 165

longus digitorum, posterior surface of tibia, posterior ligament
of ankle-joint. It is covered by, successively, gastrocnemius,
soleus, skin and fascia, internal annular ligament, origin of
abductor hallucis.

The tibial nerve lies above on the inner side of the artery, and
crosses it about an inch and a half below its origin, and is con-
tinued down its outer side.

The artery is accompanied by vena) comites, one on either side.

Beneath the internal annular ligament the tendons of tibialis
posticus and flexor longus digitorum lie in front of the artery,
and that of flexor longus hallucis behind it.

Branches. — 1. Mu.sc/idar 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 of popliteus, and, curving outwards,
supplies the peroneal muscles.
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 —

166 HANDBOOK OF ANATOMY

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,
and at the ankle is between it and the outermost tendon of
extensor longus digitorum. The artery is accompanied by venas
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, intercuneiform 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.

FEMORAL VEIN 167

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-
plies 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 venae 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,
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 dilatation 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.

168

LYMPHATIC GLANDS 169

Head and Neck.

Occipital Glands, upon the upper part of trapezius or com-
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 supra-clavicular groups. These glands receive
tributaries from the surrounding tissues and the groups of
glands above them.

Upper Extremity.

Antecubital 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

170 HANDBOOK OF ANATOMY

antecubital and axillary glands. The Deep Lymphatic Vessels

commence in the deeper tissue, and follow the course of the
deep veins 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

Occipital
Pole

Pons Varolii
Medulla Oblongata

Fig. 60. — The Brain (side view).

Frontal
Pole

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.

171

172

HANDBOOK OF ANATOMY

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
largest ; 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 m

Optic Tract -tjiwOTCEP* —
Third Nerved- -O"" \

Fourth Nerve

Fifth Nerve
Sixth Nerve -
Facial Nerve J
Pars Intermedia
Auditory Nerve-'
Glosso-pharyngeal Nerve -
Pneumogastric Nerve
Spinal Accessory Nerve

Fissure of Sylvius
_ Broca's Area

Locus Perforatus
Anticus

Tuber Cinereum

Corpus Albicans
Crus Cerebri

Locus Perforatus
Posticus

- Pons Varolii

-.Medulla Oblongata

Hypoglossal Nerve

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

BRAIN 173

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 either 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 membranous 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 also found sinuses. These sinuses are for the col-
lection 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

174 HANDBOOK OF ANATOMY

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 the
brain — 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 tranverse 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

SPINAL CORD 175

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.

176 HANDBOOK OF ANATOMY

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. :

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 muscle
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.

THORACIC NERVES

177

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
the brachial plexus. The lower part enters the subcostal groove

Ham

Hypogastric Branch. „_(j^3fc^ ',■ ■ ■ 1 1 'Mil,
of Ilio-hypogastric

- - -Intercosto-humeral

- Additional Intercosto-

humeral

--# Lateral Cutaneous
1 2th Thoracic

._Iliac Branch of Ilio-
hypogastric

Fig. 62.— Cutaneous Nerves of Trunk

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-

178 HANDBOOK OF ANATOMY

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 an-
terior 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 intervertebral 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.

SYMPATHETIC SYSTEM 179

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 cceliac 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 which
descends from beneath sterno-mastoid. It extends through the
posterior triangle of the neck and supplies the skin over the

180

CERVICAL PLEXUS

181

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-
7nastoid muscle.

External branches passing outwards to posterior triangle

Attrahens Auriculam

Attollens Auriculam

Retrahens Auriculam

Occipitali

Great Occioital Neive-
Complexus
Small Occipital Nerve-

Splenius Capitis.

Levator Anguli Scapulae.

Great Auricular Nerve --ilj|f™
Spinal Accessory Nerve .-1-Lm
Branches from Third and Fourtn
Cervical Nerves to Trapezius "
Scalenus Medius

Supra-acromial Nerve
Trapeziu

Scalenus Anticus

Posterior Belly of Omo-hyoid

Frontalis

Orbicularis Palpebrarum

Levator Labii
_._ Superioris Alasque Nasi
.-L-.Levator Labii Superioris
j^H2^- VZygomaticus Minor
LJi=^~^-Zygomaticus Major

Masseter

— -. Orbicularis Oris

.Depressor Labii Inferioris
--Depressor Anguli Oris
—Levator Menti

-Anterior Belly of Digastric

no-hyoid
... Anterior Belly of Omo-hyoid
at _ Sterno-cleido-mastoid

^..Superficial Cervical Nerve

.Suprasternal Nerve
^Supraclavicular Nerva

Subclavian Artery (third part)

Fig. 63. — Nerves in Posterior Triangle of Neck.

supply sterno-mastoid, levator scapulae, 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 infra-hyoid muscles,

182

HANDBOOK OF ANATOMY

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 :

i ' Parotid Gland

Transverse Facial Artery

Mental Artery

Facial Artery
Lingual Artery

Superficial Temporal Artery
^. Internal Maxillary Artery

._ Posterior Auricular
Artery

Occipital Artery
r-T-- -'

■•<■**—-/■ Great Occipital

Nerve

Internal Carotid

Artery

External Carotid ...
Superior Laryngeal Artery / f!li _
Superior Thyroid Artery ."O^

Pneumogastric Nerve {-JIM
Internal Jugular Vein-L^M^.
Common Carotid Artery. XMH^Sr
Anterior Belly of Omo-hyoid _\\. _| 'fJjk
Ascending Cervical Artery X UW\

""fair*

Inferior Thyroid Artery __M™iP

Subclavian Artery Cfirst part)

--"Deep Cervical

Glands

Phrenic Nerve

-Scalenus Amicus
Muscle
Transverse Cervical
Artery

■^X^CW^1

\ 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 Brachial 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 —
Tc Brachial Plexus^

Third Root of Phrenic (inconstant)
Nerve to the Rhomboids
Nerve to Subclavius

Suprascapular

External Anterior Thoracic

Circumflex
Musculo-spiral \

Outer Root of Median
Musculocutaneous

Median

4.C.

5.C.

7.C.

8.C.

I.T.

2.T.

Posterior Thoracic (Ext.
Respiratory N. of Bell).
First Intercostal

\ \ Upper or Short Subscapular
\ \ Internal Anterior Thoracic
\ Middle or Long Subscapular
Lower Subscapular
Nerve of Wrisberg

Root of Median
lternal Cutaneous

Mjlnar

Fig. 65. — The Brachial Plexus.

although not part of the plexus, helps in the innervation of the
arm through the inter costo-humeral nerve.

The nerves forming the plexus appear in the posterior triangle

183

184 HANDBOOK OF ANATOMY

of the neck, and, passing between scalenus medius and anticus
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.

Supraclavicular Nerves. — Muscular branches to scaleni, sub-
clavius, and longus colli.

Posterior scapular supplies the rhomboids and levator anguli
scapulse.

Long thoracic supplies serratus magnus. It pierces scalenus
medius and enters the axilla between the1 artery and serratus
magnus. This nerve is also called the respiratory nerve of Bell.

Suprascapular supplies supra- and infra-spinatus and articular
branches to the shoulder-joint. It passes down to the superior

BRACHIAL PLEXUS 185

border of the scapula, then through the suprascapular foramen
and winds round the great scapular notch.

Infraclavicular 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 either side of the axillary
artery, and are finally distributed to pectoralis major and
minor.

Musculo- 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 an-
terior 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. 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 hand it lies beneath the palmar

186

HANDBOOK OF ANATOMY

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 sublimus digitorum ; also to flexor longus
pollicis and flexor profundus digitorum.

, Supra-acromial

-Cutaneous Branch of
Circumflex

-Internal Cutaneous of
Musculo-spiral

- Intercosto-b umeral

Lower Externa! Cutaneous
of Musculo-spiral

Nerve of Wrisberg

Posterior Branch of Internal
Cutaneous

Posterior Branch of Musculo-
cutaneous

•Radial

•Dorsal Branch of Ulna!

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

MEDIAN NERVE

187

half of flexor profundus 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 Suprasternal

Anterior Branches of Lateral Cutaneous
Supra-acromial ',

Cutaneous Branch of.
Circumflex

Upper External Cutaneous
of Musculo-spiial

branch of Radial-

Anterior Cutaneous

"""-•Twig of Internal Cutaneous
*-. I ntercosto-humeral

Anterior Branch of Internal Cutaneous

Posterior Branch of Internal Cutaneous

— Anterior Branch of Musculocutaneous

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

188 HANDBOOK OF ANATOMY

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

MUSCULO-SPIRAL NERVE 189

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 and goes through the quadrilateral space in com-
pany 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 interosseous nerves.

Brandies. — 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.

190 HANDBOOK OF ANATOMY

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.

Subscapular 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

191

192

HANDBOOK OF ANATOMY

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-Hypograstric Nerve, formed by the branch from the
twelfth thoracic nerve and the upper part of the first lumbar
nerve. It emerges from psoas, and passes between the trans-

I2.T

Lumbosacral Cord

Lumbak Plexus.

versalis and obliquus interims muscles above the crest of the
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.

OBTURATOR NERVE 193

Ilio-Ingfuinal 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.

194 HANDBOOK OF ANATOMY

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
magnus ; 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

SCIATIC PLEXUS

195

magnus and becomes cutaneous on the inner side of the knee-
joint by passing between sartorius 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

Superior .
Gluteal '

foiating Cutaneous

To Coccygeal Plexus

Pudic
Fig. 69.— Sacral Plexus.

i. Nerve to Quadratus Femoris

2. Nerve to Obturator Interims

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 or 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

196 HANDBOOK OF ANATOMY

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 interims
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 maximus.

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-
mus, and, piercing the deep fascia, it supplies the skin on the

GREAT SCIATIC NERVE 197

back 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
called the 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 maxi-
mus. 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 popliteal space divides into tibial and peroneal nerves
(internal and external popliteal nerves).

Branches. — Muscular to the hamstrings and short head of
biceps.

Articular to the knee-joint.

The Peroneal (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 branch from the tibial
nerve to form the short saphenous nerve.

198

HANDBOOK OF ANATOMY

Muscular. — Recurrent tibial, which, passing forwards, supplies
tibialis anticus (upper fibres).

Gluteus Medius

Gluteus Maximus

Biceps —

Semitendinosus —

Semimembranosus —
Crureus —

Gracilis

Internal Popliteal Nerve
Sartorius

Gastrocnemius ,

Ilio-hypogastric Nerve

Lateral Cutaneous of

12th Thoracic Nerve
--r:-" Posterior Divisions of
first three Lumbar
Nerves

-..Posterior Divisions of
Sacral Nerves

... Post. Div. of Cocc. N.
.. Perforating Cutan. N.
..Cluteal 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)

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

Flexor Longus
Digitorum

Peroneus Longus

Tendo Achillis

Tibialis Posticus ..
Plantaris -

Fig. 70. — Muscles and Cutaneous Nerves of Leg (Posterior View).

Articular. — Branches to the knee-joint and tibio-fibular articu-
lation from the recurrent tibial.

ANTERIOR TIBIAL NERVE

199

The Anterior Tibial nerve passes beneath peroneus longus
and the extensors of the toes to the front of the leg. With the

Obliquus Externus Abdominis

Gluteus Medius

Ext. Abdominal Ring

l.'iacus —

Tensor Fascia: Femoris

Psoas Magnus

Pectineus

Sartorius

Adductor Longus - l-lfi

Gracilis
Rectus Femoris
Ilio-tibial Band

Vastus Externus
Vastus Internus —

Ligamentum Patella

gastrocnemius-

Peroneus Longus
Soleus

Ext. Longus Digitorum

Ext. Proprius Hallucis
Tibialis Anticus
Peroneus Tertiu. *"
Anterior Annular
Ligament

.- Ext. Cutaneous Nerve

_. Crural Branch of Gcnito-

crural 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
nt. 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).

anterior tibial artery it lies on the interosseous membrane and
the lower part of the tibia. Passing beneath the anterior

200 HANDBOOK OF ANATOMY

annular ligament, it divides on the dorsum of the foot into its
terminal branches.

Branches. — Muscular to tibialis anticus, extensor proprius
hallucis, 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 Tibial (Internal Popliteal) Nerves. — 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 semi-
membranosus ; 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
middle of the leg the nerve lies on their outer side in the lower
half. It divides into its terminal branches, the internal and
external plantar nerves, beneath the internal annular ligament.

Branches. — In the popliteal space :

Muscular to gastrocnemius, plantaris, soleus, and popliteus.
The latter nerve winds round the lower border of the muscle
and enters its deep surface, giving off a branch to tibialis
posticus.

PLANTAR NERVES 201

Articular. — Several to knee-joint, and one to the upper tibio-
fibular joint, and to tarsal 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.

202 HANDBOOK OF ANATOMY

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 iDternal 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

The 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.

203

204 HANDBOOK OF ANATOMY

5. The Trigeminal 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 maxillar}- — sensory and motor.

(1) The Ophthalmic division passes through the sphenoidal
fissure, and divides into three branches — (a) lachrymal, (b)
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

TRIGEMINAL NERVE

205

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
Frontal i c? u n

(Supratrochlear
Nasal

( Dental
J Malar
j Temporal
[infraorbital
Motor branches [Labial
Buccal

Auriculotemporal
Inferior dental
Lingual
Mental

Superior maxillary

Inferior maxillary

(Palpebral
1 Nasal

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-
frontal.

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-Facial divides up into — (1) temporal, (2) malar,
and (3) infraorbital branches, which supply the muscles of ex-
pression in their vicinity.

206

HANDBOOK OF ANATOMY

The Cervico-Facial 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.

Temporo-facial Division of Facial Nerve
Temporal Branches of Facial Nerve

Ma'ar Branches of Facial Nerve

Branch of Lachrymal Nerve

Auriculotemporal Nerve

Posterior Auricular Nerve-
Great Occipital Nerve. --

Facial Nerve at Stylo-. --
mastoid Foramen ,JU

Digastric Branch of "
Facial Nerve
Cervico-facial Division of *'
Facial Nerve

Supra-orbital Nerve
■v* (in two divisions)
Infratrochlear Nerve

Malar Nerve
Term. Br. of Nasal N

Infra-orbital N.
Infra-orbital
Branches of
Facial Nerve

Lone Buccal
Nerve

Small Occipital Nerve

Great Auricular Nerve
Superficial Cervical Nerve

Mental Nerve

Parotid Gland
\ Buccal Branches of Facial Nerve
Supramandibular Brs. of Facial Nerve
I nframandibular (Cervical) Branches
of Facial Nerve

External Jugular Vein

Fig. 72. — Nerves of Head and Face.
1, Sterno-cleido-mastoid ; 2, Trapezius.

Facial

Muscular

branches

to stylo-hyoid,

etc.

(Temporal
/Temporo-facial -j Malar

(Infraorbital

I Buccal
(Cervico - facial -J Superior mandibular
Inferior mandibular

VAGUS NERVE 207

9. The Gl0SS0-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 lies 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 oesophageal
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 pneumogastric

208 HANDBOOK OF ANATOMY

nerves. It passes down in the carotid sheath, and ends by sup-
plying sterno-mastoid and trapezius.

12. The Hypoglossal nerve emerges from the surface of the
medulla oblongata and passes through the anterior condy-
loid 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.

SECTION XVIII
SURFACE MARKINGS

It is necessary, especially in massage, to know the relative
positions of various structures on the surface of the body, and
these are generally determined by their position with regard to
different bony points or other structures easily seen or felt. The
more important ones are appended.

Lung's. — Apex, one to two inches above the anterior extremity
of the first rib, then from the upper border of the sterno-clavicu-
lar articulation to the centre of the manubrium, thence a straight
line on the right side to the sixth or seventh costal cartilage
(on the left side to the fourth costal cartilage, then about one
inch horizontally to the left, and then vertically downwards to
the same level as that on the right side), diagonally outwards
and downwards to the level of the eighth rib in the mid-axillary
line and the tenth rib at the back.

Pleura follows the lungs above in front, but extends as low as
the tenth rib in the mid-axillary line and the twelfth rib at the
back.

Heart. — See Section IX.

Liver. — Upper level in front, from the fourth interspace on
the right to the fifth interspace on the left ; thence diagonally
across to the tenth right costal cartilage, extending nearly to the
eleventh rib in the mid-axillary line.

Gall- Bladder, just under the tip of the ninth right costal
cartilage

Stomach. — Cardiac orifice, one inch from the sternum at the
level of the seventh left costal cartilage and four inches deep
from the surface. Pylorus, three to four inches below the infra-
sternal notch opposite the first lumbar vertebra. The highest

209 14

210 HANDBOOK OF ANATOMY

part of the stomach is at the level of the fifth interspace in the
mid-clavicular line above and behind the apex of the heart.

Kidneys. — The left kidney lies one and a half to two inches
from the mid-line, its upper end level with the eleventh lumbar ver-
tebra, and the lower end level with the second lumbar vertebra.
The right kidney is slightly lower and farther from the mid-
line.

Spleen, in the mid-axillary line on the left side opposite the
ninth, tenth, and eleventh ribs, its long axis being in the same
direction as the tenth rib.

Appendix, at the junction of the lower and middle thirds
of a line drawn from the umbilicus to the anterior superior spine
of the right ilium.

Carotid Vessels, from behind the sterno-clavicular articula-
tion to a point midway between the mastoid process and angle
of lower jaw.

Third Part of Subclavian Artery, can be pressed against the
first rib above the clavicle behind the posterior border of sterno-
mastoid.

Course Of Subclavian Artery, from behind the sterno-clavicu-
lar articulation to the middle of the clavicle in a curved line
with the convexity upwards.

Brachial Plexus, above and behind the third part of the sub-
clavian artery.

Coracoid Process, to be felt at the anterior border of the
deltoid one inch below the junction of the middle and outer
thirds of the clavicle.

Axillary Artery, in the triangular space internal to the cora-
coid process — i.e., between pectoralis major and deltoid.

Small Tuberosity Of Humerus, one inch external to and
below the coracoid process.

Brachial Artery, from the inner border of coraco-brachialis,
at the level of the posterior fold of the axilla to opposite the
neck of the radius, half an inch below the bend of the elbow.
The arm to be abducted and rotated out.

Median Nerve, same as brachial artery.

Ulnar Nerve, from the beginning of the brachial artery to the
back of the internal condyle.

SURFACE MARKINGS

211

MllSCUlo-Spiral Nerve, from the point at the junction of the
upper and middle thirds of a line drawn from the insertion of
the deltoid to the external condyle. From this point it courses
obliquely downwards and forwards to the front of the external
condyle where it divides.

Superior Palmar Arch, at the mid-point of a line drawn from
the middle of the lowest transverse crease on the wrist to the

root of the middle finger.

M. ii;

Transverse Facial Artery

„„ Superficial Tem-
per.-.! Artery

Stensen's Duct-
Buccinator Muscle

Facial Artery
Submental Artery

Lingual Artery

Sup. Lar. Art. and Nerve

Thyrohyoid Muscle

Superior Thyroid Artery

Post. Belly of Omo-hyoid
Subclavian Artery
(third part)

Internal Maxillary
Artery
pfw..,- Posterior Auricular
Artery
— Occipital .Artery

hyoid Muscle

- - Post. Belly of Digastric
Hypoglossal Nerve

Descendens Cervicis

Nerve
""External Carotid
Artery

— Sterno-cleido-mastoid
~ Trapezius

Transverse Cervi-
cal Artery
Suprascapular
(», Artery

*Wv^«»2fcw 5„„,..:.,.,,iA\

Fig. 73. — Arteries of Head and Neck.

Deep Palmar Arch, from three-quarters to one inch above the
superficial arch.

Femoral Artery, from the mid-point of Poupart's ligament to
the adductor tubercle on the upper and back part of the
internal condyle. The thigh to be flexed and rotated outwards.

Posterior Tibial Artery, from the lower angle of the popliteal
space to a point midway between the internal malleolus and the

212 HANDBOOK OF ANATOMY

tendo Achillis. The internal malleolus is farther forward and
higher than the external

Peroneal Artery, from a point three inches below the head of
the fibula to a point between the external malleolus and the
tendo Achillis.

Astragalus. — The superior articular surface can be felt when
the foot is extended. The posterior surface is felt below and
behind the internal malleolus.

Os Calcis. — The sustentaculum tali can be felt a finger's
breadth below the internal malleolus and 1^ inches behind the
tubercle of the scaphoid ; and the peroneal tubercle can be
felt a finger's breadth below the external malleolus.

Tendon of Tibialis Posticus, from a point behind the tip of
the internal malleolus to the tubercle of the scaphoid.

Tendons crossing- the Front of the Ankle-Joint, from
within outwards — tibialis anticus, extensor longus hallucis,
extensor longus digitorum, peroneus tertius.

Extensor Brevis Digitorum, the fleshy pad to be felt on
the outer side of the dorsum of the foot over the calcaneo-
cuboid joint.

Dorsalis pedis Artery, from a point midway between the two
malleoli to the hinder end of the first interosseous space.

Internal Plantar Vessels and Nerves, from a point midway
between the os calcis and the internal malleolus to the plantar
surface of the interval between the first and second toes.

External Plantar Vessels and Nerves, from the middle of
the plantar surface of the os calcis to the plantar surface of the
fourth toe.

INDEX

Abdominal cavity, 116, 117
Abductor minimi digiti, 74
Accessories, 71
Acetabulum, 39, 41
Acromion, 36
" Adam's apple," 132
Alimentary canal, 3, 116
Alveolar border, 107
Anal canal, 122
Anatomy, definition of, 1
Angle of rib, 86
Antrum of Highmore, 108
Aorta, 125, 136, 140-141

abdominal, 141, 142

arch of, 141, 142, 143

ascending, 140, 141, 142

branches of, 142-3

descending thoracic, 134, 141-2. 146
Aortic valve, 139
Appendices epiploica?, 121
Appendix, 210

Arachnoid mater, 172, 173, 174
Arteries, 3, 137

anastomotic, of elbow, 158
of aorta, 140
abdominal, 147
thoracic, 146

axillary, 157, 162, 210

brachial, 157-8, 210

carotid, common, 127, 143, 144, 145,
210
external, 145
internal, 145, 173

carpal, 159

circumflex, 157

cceliac axis, 149

dorsalis pedis, 166-7, 212

femoral, 148, 163-4, 211

gastric, 149

hepatic, 125, 150, 154

hypogastric, 155

iliac, 148-9, 154

innominate, 143

intercostal, 146

interosseous, of arm, 159
of lower limb, 163 scq.
of upper limb, 157 seq.

Arteries, lumbar, 147

mammary, internal, 147

maxillary, internal, 145

mesenteric, inferior, 151

superior, 142, 149, 150, 154

occipital, 145

ovarian, 149

palmar arches, 159, 211

peroneal, 165, 212

phrenic, inferior, 146, 147

plantar, 165-6, 212

popliteal, 164

profunda, of arm, 158

pulmonary, 134, 139, 140

radial, 158-60

renal, 129, 149

sacral, middle, 149

spermatic, 149

splenic, 149

subclavian, 86, 143, 145, 210

subcostal, 146

subscapular, 157

suprarenal, 149

temporal, superficial, 145

thyroid axis, 146

tibial anterior, 166

posterior. 76, 164, 211

ulnar, 158, 159, 160

vertebral, 146, 173

volar, 158
Articulation, lumbo-sacral, 148

sterno-clavicular, 143, 145
Articulations, intercentral, 89

interneural, 89
Astragalus. See Bones
Atlas. See Bones
Auricles, 137. 138, 139
Auricular appendix, 139
Auriculo- ventricular groove, 139

orifice, 139
Axilla, 37
Axillary border, 8
Axis. See Bones

Bicipital groove, 8, 10

tuberosity, 12
Bicuspid valve, 139

213

214

HANDBOOK OF ANATOMY

Bile, 123, 125 '

papilla, 121
Bladder, 129
Bones, classification of, 2

astragalus, 45, 49, 51, 212

atlas, 82

arches of, 112

axis, 82

carpal, 30

carpus, 5, 13

clavicle, 5, 6

coccyx, 42, 43, 82

of cranium, 100

cuboid, 49, 51

cuneiform, 13, 26, 49, 51

ethmoid, 100, 107

femur, 43

fibula, 47, 65-66

frontal, 100, 101, 102, 104

humerus, 5, 8

hyoid, 110

cornua of, 110

ilium, 39-41, 53

spines of, 39-40, 54

innominate, 39

lachrymal, 100

malar, 100, 102, 104, 108, 109

mandible, 100, 109-10, 111

manubrium sterni, 83

maxillae, 100, 102, 131

occipital, 100, 101, 102, 105-6

oscalcis, 49,51, 70, 212

parietal, 100, 102, 104

phalanges, 5, 15, 31

pisiform, 13

pubis, 39, 41, 42, 56

radius, 5, 12-13, 23

ribs, 2, 86, 88, 90

sacrum, 41, 42, 53, 79, 83
promontory of, 80

scaphoid, 5, 49, 51, 70

scapula, 5, 6-8

spine of, 33, 36

semilunar, 5, 13

sesamoid, 2

sphenoid, 100, 102, 107

sternum, 83

tflTSllS 4-Q ^)^

temporal, "l 00, 101, 106-7, 100-111

tibia, 45-47

trapezium, 13

turbinate, 100

ulna, 5, 10-12, 23

unciform, 13

vertebrae, 2, 78-79

cervical, 82-83

dorsal (thoracic), 82

spines of, 80
vertebral border, 8

column, 2, 83

Bones, vertebral, joints of, 89

vomer, 100
Brain, 171 seq.

blood supply, 173 seq.

coverings of, 173
Bronchi, 132, 133
Bronchial nerve, 134

vessels, 134

Caecum, 121
Capitellar surface, 21
Capitellum, 10
Cardiac end, 119

opening, 119
Carotid canal, 145, 173
Carpus, 5, 13

Cartilage, costal, 36, 86, 117, 123, 124,
125, 136, 137, 142

cricoid, 132

ensiform, 83, 89, 136

semilumar, 63

thyroid, 127, 132, 143

xiphoid. See Ensiform
Cauda equina, 175
Cerebellum, 172
Cerebral peduncles, 173
Cerebro-spinal system, 171
Cerebrum, 172
Circle of Willis, 146, 174
Circulatory system, 3
Clavicle. See Bones
Coccyx. See Bones
Cceliac axis, 149
Colic valve, 121
Colon, ascending, 121

descending, 122

iliac, 122

pelvic, 122

transverse, 122
Colons, 118
Conus medullaris, 174
Coraco brachialis, 10
Costae. See Ribs
Costal attachment, 135
Cranium, 101 seq.
Crural canal, 76
Cuboid. See Bones
Cuneiform. See Bones

Diaphragm, 89, 96, 116, 120, 129, 133,
134, 135, 137, 140, 142, 146, 147

crura of, 142, 149
Digestive canal, system, 3, 116 seq.
Digital sheaths, 36, 37

of toes, 77
Ducts, bile, 121, 125, 126

cystic, 125

hepatic, 125

lymphatic, 168

pancreatic, 121, 126

INDEX

215

Ducts of Rivini, 123

Stenson's, 122

thoracic, 168

Wharton's, 123
Duodeno-jejunal flexure, 120, 121
Duodenum! 3, 116, 120-121
Dura mater, 172, 173, 174

Endocardium, 139

Epigastric region, 117
Epigastrium, 119
Epiglottis, 132

Ethmoid. See Bones
Eustachian tube, 131

valve, 139
Ex juration, 98, 131
Expression, muscles of, 112
External occipital protuberance, 105

Face, muscles of, 112
Fascia, axillary, 36

bicipital, 36
•deep, of lower limb, 76
perineum, 54

shoulder and upper limb, 36, 37
trunk, 98

lumbar, 54, 98

palmar, 36, 37

plantar, 70, 74, 77

Sibson's, 135

superficial, 4
Femoral sheath, 76
Femur. See Bones
Fibula. See Bones
Filum terminale, 174
Fold of Douglas, 99
Fontanelles, 102
Foot, arches of, 69
Foramen, mental, 109

obturator,

ovale, 107

rotundum, 107
Foramina, intercostal, 79

jugular, 174

sacro-sciatic, 54
Fossa, anticubital, 36, 38, 159

coronoid, 10, 22, 24

digastric, 109

digital, 49

glenoid, 110

iliac, 41, 121, 122

obturator, 41

olecranon, 10

sigmoid, 10, 21

supracapitellar, 22
Frontal bone, 100, 101, 102, 104
Fundus of stomach, 134

Gall-bladder, 123, 124, 125, 209
Ganglia, 171, 178-9

Ganglia, semilunar, 179

sympathetic, 180
Gastric surface, 1 29
Genital organs, 130, 148
Glands, antecubital. 169

anterior tibial, 170

axillary, 160, 169

cervical, 169

ductless, 127, 129

facial, 169

femoral, 170

of head and neck, 169

of lower extremity, 169

lymphatic, 76, 127, 134. 168

mastoid, 169

occipital, 169

pancreas, 125

parotid, 122, 145

popliteal, 170

salivary, 116, 122

sublingual, 123

submaxillary, 122

thyroid. 127

of trunk, 170

of upper extremity, 169
Glenoid cavity, 7, 8, 10

fossa, 18

ligament, 19
Gluteal surface, 40
Great wings of sphenoid bone, 107
Grey matter of brain, 4, 173
spinal cord, 174

Hand, pronation and supination of, 23
Head, bones of, 100

glands of, 119

movements of, 114

muscles of, 112
Heart, 3, 134, 137 seq.

apex of, 137, 138, 139

base of, 137, 138

interior, 139

orifices of, 138

surface, anterior superior, 138
inferior, 138

valves of, 140
Hepatic artery, 125

flexure, 121, 125

veins, 125
Hilum of kidney, 149

spleen, 149
Hilus, 128, 129
Horns of grey matter, 174-5
Humerus. See Bones
Hunter's canal, 163, 167, 193, 194
Hyoid. See Bones
Hypochondriuin, 119, 123, 127

Ileum, 116, 120, 121
Iliac region, 117

216

HANDBOOK OF ANATOMY

Ilio-tibial band, 76

Ilium. See Bones

Inguiual canal, 149

Innominate bone, 39

Inspiration, 96-97, 131

Intercostal spaces, 124, 135, 137, 146

Intertrochanteric line, 55, 56

ridge, 55
Intertubercular line, 117

plane. 11
Intervertebral disc, 89
Intestines, 3, 116, 117, 118, 120-121
Ischial spine, 41, 42
Ischium, 39, 41, 42, 54

Jejunum, 116, 120, 121
Joints, 2

acromio-clavicular, 16

muscles acting on, 16-17
ankle, Q6

muscles acting on, 70
carpo-metacarpal, 30-31
elbow, 21

muscles acting on, 23
hip, 54

muscles acting on, 56
intercarpal, 26
intermetacarpal, 31
interphalangeal, 32

muscles acting on, 68, 74
inter tar sal, 68
knee, 2, 59

muscles acting on, 64
lumbo- sacral, 53
metacarpo-phalangeal, 31, 32

muscles acting on, 33
metatarso-phalangeal, 68

muscles acting on, 74
radio-ulnar, 23-25

muscles acting on, 25
sacro-iliac, 53
shoulder, 18

muscles acting on, 19
skull, 110

muscles acting on, 112
sterno-clavicular, 15
sympbysis pubis, 54
tarso-metatarsal, 68
temporo-mandibular, 110

muscles acting on, 114
tibio-fibular, 65-66
vertebral, 89-90
wrist, 2, 26

Kidneys, 129-130, 210

Lachrymal bone, 100
Lambdoid suture, 102
Laminae of vertebrae, 79
Larynx, 116, 131-132

Ligament, definition of, 2
Ligamenta denticulata, 174

flava, 89
Ligaments, accessory, 53

coraco-clavicular, 1, 6
interclavicular, 15

of acromio-clavicular joint, 16, 19

anterior annular, 166

of atlas, 90

of axis, 90

conoid, 5

coraco-humeral, 19

coronary, 24

costo-coracoid, 36

cotyloid, 55

deltoid, 67

falciform, 124

of femoral sheath, 76

gastro-splenic, 128

glenoid, 19

gleno-humeral, 19

ilio- fern oral (Y-shaped of Bigelow),
56

inferior calcaneocuboid, 4

interspinous, 89

lateral patellar, 62
lumbo-sacral, 53

lineo-renal, 128

oblique popliteal, 92

occipito-atlantoid, 112

odontoid, 112

palmar, 31, 32

plantar, 70

post-longitudinal, 89

post-occipito axoid, 112

Poupurt's, 76, 129, 167. 170, 193,
194

pubo-femoral, 56

radial lateral, 31

rhomboid, 5, 6, 15

sciatic, 54

spheno-mandibular, 111

stylo-mandibular, 111

subpubic, 54

supraspinous, 89

temporo-mandibular, 14

transverse humeral, 19
metacarpal, 32

trapezoid, 5, 6, 16

ulnar, 31
Ligamentum cruciatum, 112

latum pulmonis, 135

nucha?, 90

patellae, 47, 59

teres, 56
Limb, upper, 5
Limbs, 2 3
Lingula, 110, 111
Liver, 116, 123-125, 209
Lobes of brain. 172

INDEX

217

Lungs, 3, 98, 131, 133-134,136, 140, 209

roots of, 134
Lymphatic capillaries, 168

vessels, 134, 168, 169-170

Malar. See Bones

Malleolus, external, 49, 66, 67, 76

internal, 47, 68, 76
Mandible. See Bones
Manubrium sterni. See Bones
Mastication, muscles of, 112
Maxillae. See Bones
Mediastinum, 135
Medulla oblongata, 173
Membrane, costo-coracoid, 36, 37
interosseous, 25
mucous, 116, 120, 123
obturator, 41, 54

synovial, 2, 15, 19, 22, 24, 25, 26,
31, 53, 54, 56, 63, 65, 66. 68, 89,
111, 112
Mesenteries, 117
Mesial plane, 1
Mid-axillary line, 134, 136

Poupart plane, 129
Mitral valve, 139
Muscles of abdomen, 92-93

abductor brevis poll. , 33, 34
hallucis, 73, 74
longus poll., 92-93
minimi digiti, 35, 174
accessorius, 72
adductor, 8
brevis, 58
longus, 58
magnus, 58
obliquus hall., 73

trans versus, 73
obliquus poll., 33

transversus, 33, 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 tendinae, 140
columnae corneae, 140
complexus, 92, 95, 115
coraco-brachialis, 10, 19, 21
crureus, 65
deltoid, 10, 19, 20
diaphragm, 96
digastric, 109, 114
epicranial aponeurosis, 113
erector spina;, 92, 95, 98, 99
of expression, 114
extensor brevis dig., 73, 212
brevis poll., 30, 33

! Muscles, extensor carp. rad. brevior, 29,
30
longior, 29, 30
ulnaris, 29, 30

communis dig. (hand), 29, 35
(foot), 70, 73

indicis, 30, 35

longus poll., 30, 33

mimini digiti, 29, 35

ossis metacarp. poll., 29

proprius hall., 70, 73
extensors of back, 99
flexor brevis dig., 73

brevis hall., 74

brew minimi digiti (hand), 35
(foot), 73

brevis poll., 33, 34

carpi radialis, 28, 30, 36

carpi ulnaris, 28, 30

longus dig., 71, 72
hall., 71, 72
poll., 33, 34

profundus digitorum, 28, 34

sublimis digitorum, 28, 31
gastrocnemius, 64, 71
gluteus maximus, 57

medius, 57, 58

minimus, 57, 58
gracilis, 57, 58, 64
iliacus, 56, 148
infraspinatus, 20, 21
intercostal, ext., 97

int., 97, 98
interossei dorsal (hand). 34, 35
(foot), 73, 74 '

palmar (hand), 35

plantar (foot), 73
interspinal, 92
latissimus dorsi, 17, 20, 21, 38, 92,

96, 98
levator anguli scapulae, 16, 92
levator ani, 122, 130
longus colli, 94, 144, 146
lumbricales (foot). 72

(hand), 34, 35
masseter, 113, 122

of mastication, 114
mylohyoid, 122, 123
obliquus ext. abd., 94

inf., 115

int., 94

sup., 115
obturator externus, 59

internus, 59, 130
occipito-frontalis, 112
opponens minimi digiti, 35
opponens pollicis, 33, 34
palmaris longus, 28, 36
papillary, 140
pectineus, 57. 58

218

HANDBOOK OF ANATOMY

Muscles, pectoralis major, 17, 19, 20, 21,
98

minor, 17, 98
peroneus brevis, 72

longus, 72

tertius, 70
plantaris, 64, 71
popliteus, 64
pronator quadratus, 25
pronator radii teres, 23, 25
psoas, 56, 94, 120, 121. 122, 129,

130, 147, 148, 149
pterygoid, ext., 113

int., 113
pyriformis, 59
quadratus femoris, 59

lumborum, 95, 129, 148
rectus abdominis, 94, 99
sheath of, 99

cap. ant., 144-5

cap. post., 115

femoris, 56, 64
rhomboid, 92
rhomboideus major, 16

minor, 17
rotatores, 92
sartorius, 56, 64
scalenus anticus, 93, 97, 144

medius, 93, 97, 145, 156

posticus, 93, 97

of scalp, 112
semimembranosus, 57, 64
semitendinosus, 57, 64
serratus magnus, 17, 98

post, inf., 92, 95, 97

post, sup., 92, 95, 97
soleus, 71

splenius cap. and cer., 92, 95, 115
sterno-mastoid, 17, 98. 115, 122,

127
subclavius, 6, 17, 36
subscapular, 8
supinator brevis, 25
supraspinatus, 20
temporal, 113
tensor fascise fern., 58, 59
teres major, 20, 21, 38

minor, 21, 38
of thorax, 96
tibialis anticus, 70, 71

posticus, 71, 212
transversalis, 94
trapezius, 16, 17, 92
triangularis sterni, 98
triceps, 20, 21, 23

of trunk, 90
vastus externus, 64

internus, 65

muscular system, 3
Musculi pectinati, 139

Musculo-spiral groove, 10
Mylo-hyoid ridge, 109

Neck', glands of, 169

surgical, 8
Nerves, auriculo- temporal, 205
buccal, 205, 206
cervical. 175. 180, 183 seq.
cervico- facial, 205, 206
circumflex, 182
coccygeal, 175, 191
cranial, 173, 203
crural, 191, 193, 194
cutaneous, 188-9, 193, 194
dental, 110, 204, 205
dorsal, 175
facial, 205
frontal, 205
genito- crural, 191, 193
glosso-pharyngeal, 207
gluteal, 196
humeral, 177-8
hypoglossal, 208
ilio-hypogastric, 191-2

inguinal, 191-3
infraclavicular, 184, 185
infraorbital, 204
intercostal, 176 seq.
interosseous, 189, 190
labial, 204
lachrymal, 204
lingual, 205
lumbar, 175, 191
malar, 204
mandibular, 206
maxillary, 204-5
median, 158, 159, 185-8, 210
musculo- cutaneous, 185

branches, 185, 200
musculo-spiral, 189, 211
nasal, 205
obturator, 191, 193
occipital, 175, 176
ophthalmic, 204
palpebral, 204

peroneal (ext. popliteal), 197
phrenic, 182
plantar, 201
pneumogastric, 207
popliteal, 200, 201
post, scapular, 184
pudic, 202
radial, 190
respiratory (of Bell), 184

sacral, 175, 191

saphenous, 194

sciatic, 196-7

spinal, 175

spinal accessory, 207

subscapular, 190

INDEX

219

Nerves, respiratory supraclavicular, 184
temporal, 204
tempore- facial, 205
thoracic, 176, 183 seq. , 191

tibial, 165, 199

branches of, 200, 201

trigeminal, 204, 205

ulnar, 210

vagus. Sec Pneumogastric
Nervous system, 3-4
Nervous systems, 171
Norma basalis. 102

frontalis, 100

lateralis, 100

occipitalis, 102

verticalis, 102
Notch, cotyloid, 1 1

intercondyloid, 62, 63

nasal, 102, 107

radial, 12, 24

scapular, 8

sciatic, 40, 41, 51, 56, 130, 148

semilunar, 10, 12

sigmoid, 110

suprascapular, 7

(Esophageal opening, 119
(Esophagus, 116, 131, 138, 143
Omenta, 117, 118, 125
Omental tuberosity, 125
Omentum, great, 118

small, 125, 149
Orbital cavity, 107

margins, 104
Ossification, 6, 8, 10, 13, 15, 41, 45, 47,

49, 53, 83, 85, 88
Ovaries, 149, 155

Palate, soft, 131
Palmar arches, 158, 159-160
Pancreas, 116, 125-126, 142
Pancreatic surface, 129
Parietal bone, 100, 102, 104

surface of liver, 124
Pelvic floor, 116, 122

girdle, 3, 39

organs, 117

wall, 148
Pelvis, 39, 41-42

articulations of, 53 seq.

false, 42, 91, 117

male and female, 42

movements of, 91

of kidney, 129-130

small, 122

true, 42
Pericardial concavity, 134
Pericardium, 134, 135, 137, 140
Perineum, triangular ligament of, 54
Peritoneum, 117-118, 121, 124, 126, 128,
134, 148

Peyer's patches, 120, 121
Phalanges. See Bones

of foot, 53

of hand, 15
Pharyngeal tonsil, 131
Pharynx, 116, 131-132
Pia mater, 173, 174
Pisiform. See Bones
Plantar arch, 165

surface, 51
Pleura, 133, 134-135, 138, 209
Pleural cavities, 133

sac, 133
Plexus, definition of, 176

aortic, 179

brachial, 176, 177, 183-184 (Sect.
XVI.), 210

cervical, 176, 180-182 (Sect. XIV.)

celiac, 179

lumbar, 176, 191-202

lumbo-sacral, 191 seq. (Sect. XVI.)

pampiniform, 155

patellar, 195

pudendal, 176, 191, 201-2

sacral, 176, 195-6

sciatic. See Sacral

solar, 179
Plica alares, 64

synovialis patellaris, 64
Pons varolii. 173
Portal fissure, 125

system, 155

vein, 125
Postero-lateral grooves, 174
Poupart plane, 123
Poupart's ligament, 167, 170, 193, 194

lines, 117
Presternum, 83
Process, acromion, 5, 7, 8, 16, 19

articular condyle, 110

basilar, of occipital bone, 102,
106

coracoid, 7, 8, 19, 36

coronoid, 10, 12, 21, 22, 23, 110

mastoid, 101, 107, 145

maxilla?, 112

mesentery, 118

odontoid, 82

olecranon, 10, 12, 21, 22, 23, 36

palatal, 107, 131

spinal. 89, 111

styloid, 12, 13, 25, 26, 49, 63, 107,
110, 112

transverse of lumbar vertebra?, 129,
147
Pterygoid plates, 102, 107
Pubic arch, 76
Pubis. See Bones
Pyloric branch of hepatic artery, 150

end, 119

220

HANDBOOK OF ANATOMY

Pyloric orifice, 120
Pylorus, 119, 121

Quadrate lobe, 125

Radius. See Bones
Rami, 109, 110

communicantes, 178
Receptaculum chyli, 168
Rectum, 116, 117, 121, 122, 130

sheath of, 99
Respiratory organs, 131

system, 3
Ribs. See Bones
Rivini, ducts of, 123

Sacro- vertebral angle, 83

Sacrum. See Bones

Sagittal plane, 1

Scalene tubercle, 87

Scaphoid. See Bones

Scapula. See Bones

Scarpa's triangle, 76, 162, 163, 167, 170,

193, 194
Semimembranosus, 62
Semilunar bones, 5, 13
Seminal vesicles, 130
Septa, intermuscular, 36
Serratus niagnus, 38
Sesamoid bones, 2, 45
Shoulder girdle, 3, 5, seq (Sect. II. ), 16
Sigmoid flexure, 121, 122
Skeletal system, 2, 6, 10
Skull, articulation with spinal column,
112

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

cord, 4, 79, 102, 105, 174 szq.

nerves, 79
Spine, 8

anterior superior, 117

intercondyloid, 47

ischial, 130

peroneal, 51, 67
Spleen, 127-128. 210
Splenic flexure of colon, 122
Stenson's duct, 122
Sternum. See Bones
Stomach, 3, 116, 119, 122, 209

chamber, 119, 120, 126
Subcostal line, 117

plane, 118
Subscapularis, 38

Supraclavicular groups (of glands), 169
Suprarenal capsules, 120, 124, 127, 128

149
Surface-markings, ankle-joint, 212

appendix, 210

astragalus, 212

axillary artery, 209

brachial artery, 210
plexus, 210

carotid vessels, 210

coracoid process, 210

dorsalis pedis artery, 21 2

extensor brevis digiti, 212

gall-bladder, 209

heart, 209

humerus (small tuberosity), 210

kidneys, 210

liver, 209

lungs, 209

median nerve, 210

musculo-spiral nerve, 211

os calcis, 212

palmar arches, 211

peroneal artery, 212

plantar vessels and nerves, 212

pleura, 209

spleen, 210

stomach, 209

subclavian artery, 210

tibial artery, 211

tibialis posticus, tendon, 212

ulnar nerve, 210
" Surgical neck," 8
Sustentaculum tali, 49, 51
Sympathetic system, 4, 171, 178-179

Tarsus, 49, 53

Temporal bone, 100, 101, 167, 110,

111
Tendo Achillis, 51
Tendons of biceps, 63

of diaphragm, 138

extensor, 13, 31
of ankle, 77

flexor, 36

infraspinatus, 19

peroneus, longus and brevis, 5, 53,
74, 76

of popliteus, 62

of quadratus extensor, 59

semimembranosus, 62

subscapularis, 19

supraspinatus, 19

tibialis posticus, 49

of transversalis, 129

vasti, 62
Testicles, 149, 155
Thoracic cavity, 134

wall, 138, 139
Thorax. 2, 88-9

INDEX

221

Thyroid axis, 146
Tibia. See Bones
Trachea, 116, 181, 132-3, 143
Transverse plane, 1 , 1 22
Trapezium. See Bones
Triceps, 10, 38
Tricuspid valve, 139
Trochlear surface, 12, 21
Tubercle, adductor, 62

conoid, 5
Turbinate, 100. See Bones

Ulna. See Bones

Umbilical region, 117

Unciform. See Bones

" Uncovered area" of liver, 124-5

Ureter, 129, 130

Urethra, 129

Urine, 129

Uterus, 130

Vagina, 130

Valvule con ni ven tes, 120, 121

Veins, axillary, 145, 153, 157, 160

azygos major. 152

basilic, 146, 160, 161, 162

carotid, 146

cephalic, 160, 161, 162

coronary, 142

sinus, 151, 152

dorso-lateral, 161

facial, 153

femoral, 167

hemorrhoidal, 156

hepatic, 125, 149, 154, 155

hypogastric, 155

iliac, 141, 142, 154, 155

ilio-lumbar, 155

innominate, 143, 145, 152, 153

intercostal, 152

Veins, jugular, 144, 145, 152, 153, 154,
174

lumbar, 143, 152, 155

mammary, 146

median, 36, 161

occipital, 145, 153

of lower limb, 167
upper limb, 160

ovarian, 155

phrenic, 154

portal, 151, 154, 155

pulmonary, 104, 138, 139, 140, 151

radial, 161

renal, 154-5

saphenous, 76, 167

spermatic, 155

subclavian, 152, 153, 154, 160

superficial, 151, 161

suprarenal. 154

systemic, 140, 151

temporo-maxillary, 153

ulnar, 152, 3 61

vena cava, 152, 154

vertebral, 146

visceral, 151
Vena azygos, 152, 154
Venae cava, 120, 125, 128, 138, 139, 140,
149, 151. 152, 154
comites, 151, 154, 166
Ventricles, 137, 138, 139, 140, 142
Vertebrae. See Bones
Villi, 120
Visceral surface, 125, 127

Wharton's duct, 123
Willis, circle of, 146, 174
Wings of sphenoid bone, 111

Zygoma, 111, 122, 145
Zygomatic process, 106, 107, 109

tiaiUiere, llndau and Cox, 8, Henrietta street, Luwtun

III

I ■

■

Internet Archive Audio

Featured

Top

Images

Featured

Top

Software

Featured

Top

Books

Featured

Top

Video

Featured

Top

Mobile Apps

Browser Extensions

Archive-It Subscription

Save Page Now

Full text of "Handbook of anatomy for students of massage, etc"

See other formats