(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Biodiversity Heritage Library | Children's Library | Advanced Microdevices Manuals | Linear Circuits Manuals | Supertex Manuals | Sundry Manuals | Echelon Manuals | RCA Manuals | National Semiconductor Manuals | Hewlett Packard Manuals | Signetics Manuals | Fluke Manuals | Datel Manuals | Intersil Manuals | Zilog Manuals | Maxim Manuals | Dallas Semiconductor Manuals | Temperature Manuals | SGS Manuals | Quantum Electronics Manuals | STDBus Manuals | Texas Instruments Manuals | IBM Microsoft Manuals | Grammar Analysis | Harris Manuals | Arrow Manuals | Monolithic Memories Manuals | Intel Manuals | Fault Tolerance Manuals | Johns Hopkins University Commencement | PHOIBLE Online | International Rectifier Manuals | Rectifiers scrs Triacs Manuals | Standard Microsystems Manuals | Additional Collections | Control PID Fuzzy Logic Manuals | Densitron Manuals | Philips Manuals | The Andhra Pradesh Legislative Assembly Debates | Linear Technologies Manuals | Cermetek Manuals | Miscellaneous Manuals | Hitachi Manuals | The Video Box | Communication Manuals | Scenix Manuals | Motorola Manuals | Agilent Manuals
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

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

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. 



I 






mm 















■ 



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 



BY 



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 

[All rights reserved] 



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 

1 



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. 

5 



6 



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; '■ 

t 



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 



11 



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- 



I 



Flexor Longus Pollicis-- 
Pronator Radii Teres — 



Anterior Border — 



Pronator Quadratus 



Brachio-radialis 



« 



I 



.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 



14 



HANDBOOK OF ANATOMY 



convex backwards ; the carpal ends or bases of all, except the 
first, are more or less wedge-shaped, and the heads of all are 
rounded. 

The first metacarpal is the shortest and stoutest of the five 



Abductor 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. 



16 



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 



17 



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 


anterior 






fifth ribs and fascia 




thoracic 






covering them 








Latissimus 


From the spines of the 


The floor of the bi- 


Third sub- 




dorsi 


lower six thoracic, 
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 


anterior 




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 

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 









18 



HANDBOOK OF ANATOMY 



Shoulder-Joint, between the head of the humerus and the 
glenoid cavity of the scapula. 

A ball and socket joint, permitting of particularly free move- 
ment as the socket is very shallow and much smaller than the 
ball. Movement can take place 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 



19 



The capsule is very loose, so that were it not for atmospheric 
pressure the humerus could be pulled at least an inch away 
from the scapula ; this adds to the mobility of the joint. 

Glenoid ligament, a band of circular fibres round the edge of 
the glenoid fossa to deepen the socket. 

Transverse humeral ligament bridges over the bicipital groove 
and allows the tendon of the biceps to pass 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 



20 



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. 



21 



w 

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 






in 


Pectoralis 
major 


See Sterno - Clavicular 


Joint 






Latissimus 
dorsi 


See Sterno - Clavicular 


Joint 




Circum 


duction — a 


combination of all these 


movements 


i 



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. 



22 



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 



23 



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. 



24 



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 



25 



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 


Anterior 




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 



27 



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). 



28 



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 


anterior 




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 

i 


metatarsals (see Lum- 
bricales) 





MUSCLES OF FOREARM 



29 



Action. 
Flexion 


i 

Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Flexor 


From the middle half of 


j The palmar surface of 


Anterior 




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 







30 



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. 



32 



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 



33 



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 Wrist-Joint 



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 



The ulnar side of the 
base of the first 
phalanx 



Median 



Ulnar 



Median 



Median 



Ulnar 



Ulnar 



34 



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 

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 



35 



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 






i 





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 

39 



40 



HANDBOOK OF ANATOMY 



below the spine is another tubercle, called the posterior inferior 
spine ; from this the edge of the bone curves sharply forwards, 
forming the great sciatic notch. 

The ilium has two surfaces — internal and external. The 
external one is sometimes termed the 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 



42 



HANDBOOK OF ANATOMY 



the pubis in front. The part above this line is called the false 
pelvis ; the part below, the true pelvis. 

The false pelvis is bounded by the expanded wings of the 
ilium and the upper part of the sacrum, and supports the 
abdominal contents. The true pelvis is much smaller, and is 
bounded above by the ilio-pectineal lines and the upper margin 
of the pubis, and its walls are formed by the lower part of the 
sacrum, the bodies and rami of the ischium and pubis. 

Differences between Male and Female Pelvis. — The upper 
margin of the true pelvis is often called the brim, or inlet, of 




Acetabulum 



Symphysis 
Pubis 

Fig. 12. — 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 



44 



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 



\M 



Gluteal Ridge and 
Gluteus Maximus 



Medullary Foramen 



Vastus Internus J_ 



w 



Adductor Longus /«-»•# "\ 

t— 

1 



-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 






m 



k\ 



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 



46 



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. 



48 



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 



IX 



y 



— 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. 

4 



50 



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 



52 



HANDBOOK OF ANATOMY 



Tuber Calcis 



Sustentaculum Tali 

Tibialis Posticus — 
Peroneus Longus. 



Tibialis Anticus 



Abductor Hallucis and 
Inner Head of Flexor 
Brevis Hallucis 
Outer Head of Flexor 
Brevis Hallucis, Adduc- 
tor Obliquus Hallucis, 
and Adductor Trans- 
versa Hallucis 



Flexor Longus Hallucis 




-Abductor Minimi Digits 



S N. 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 



Anterior 

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, 



56 



HANDBOOK OF ANATOMY 



and definite bands of longitudinal fibres are strengthened as 
follows : 

The Ilio-Femoral ligament (Y-shaped ligament of Bigelow) is a 
triangular ligament attached by its apex to the root of the 
anterior inferior spine and margin of the 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. 



Anterior 

crural 



Nerve from 

the lumbar 

plexus 



Anterior 
crural 



HIP-JOINT 
MUSCLES ACTING ON THE JOINT— Continued. 



57 




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 



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 



Obturator 



KNEE-JOINT 

MUSCLES ACTING ON THE JOINT— Continiied. 



59 



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 

1 


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 



60 



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 



61 



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). 



62 



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 



64 



HANDBOOK OF ANATOMY 



synovialis patellaris. In addition it forms at the patellar end 
wing-like expansions — the plica alares — which are usually loaded 
with fat. 

MUSCLES ACTING ON THE JOINT. 



Action. 



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 



Tibial 



Tibial 



Anterior 
crural 



Anterior 
crural 



TIBIO-FIBULAR JOINTS 



65 



MUSCLES ACTING ON THE JOINT— Continued. 



Action. 
Exten- 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Vastus 


From the lower two- 


The upper and inner 


Anterior 


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 


Anterior 




(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 

5 



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 



67 



The Posterior ligament is attached to the edges of the tibia 
and astragalus, and receives some fibres from the external 
malleolus. The transverse ligament of the inferior tibio-fibular 
joint strengthens this aspect of the ankle-joint. The liga- 
ment on the external aspect of the joint is divided into three 
parts : 

1. Anterior Part of the ligament from the anterior border of 
the external malleolus to the astragalus in front of the articular 
surface. 



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 



69 



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, 



70 



HANDBOOK OF ANATOMY 



of the arch is the astragalus. The bones of the foot are really 
arranged in two longitudinal columns. The inner one consists 
of the os calcis, scaphoid, three cuneiforms, and first, second, 
and third metatarsals ; the outer one consists of the os calcis, 
cuboid, and fourth and fifth metatarsals. In this way the 
weight is evenly distributed to the front of the foot, which is 
necessary in the upright position, as the line of gravity falls 
in front of the knee-joint. The arch is kept in shape by the 
plantar ligaments 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 


Anterior 




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 


Anterior 




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 


Anterior 




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 


Anterior 




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 

i 


tibial 

i 

., . j 

• 



MUSCLES OF ANKLE-JOINT 



71 



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 







72 



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 



73 



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 



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 



External 
plantar 



External 
plantar 



Internal 
plantar 



74 



HANDBOOK OF ANATOMY 



MUSCLES ACTING ON THE METATARSO-PHALANGEAL 
JOINTS— Continued. 



Action. 


Muscle. 


Origin. 


Insertion. Nerve-supply. 


Abduc- 


Dorsal 


By two heads from the 


The first and second 


External 


tion 


interossei 


adjacent sides of the 
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 

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 



75 



External Plantar Artery — 



Peroneus Brevis — 



Posterior Perforating 

Artery 

First Digital Artery 

Plantar Arch 

Second Digital A. 

Third Digital A. 

Fourth Digital A. 



Anterior Perforating 
Artery 




/ Internal Calcaneal Artery 

, Posterior Tibial Artery 



^Internal Plantar Artery 



—Tibialis Posticus 



.Flex. Longus Digitorum 

Flex. Longus Hallucis 
Flexor Accessorius 



Tendon of Abd. Hallucis 

Plantar Branch of 
• Dorsalis Pedis Artery 
■ Communicating Branch 



- Arteria Magna 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 

78 



VERTEBRA 



79 



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- 



80 



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 



4 th 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 



81 



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. 



82 



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 



84 



HANDBOOK OF ANATOMY 



st Thoracic 




ist Lumbar 



<&^ 



istC. 



.istT. 



[stL. 



J3 



Sacrum 
Coccyx 

Fig. 30.— Spinal Column. 



.ist Co. 



STERNUM 



85 



front of the chest. At rest its upper end is opposite the lower 
border of the second dorsal vertebra, and its lower end opposite 
that of the tenth. 



Interclavicular Notch 




Clavicular Surface 



Fcr i st Costal Cartilage 



Fig. 31.— Sternum. 



Ossification. — Several centres are developed before birth v 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 



87 



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. 



88 



HANDBOOK OF ANATOMY 



The eleventh and twelfth ribs are very much shorter and 
smaller than the others. Their anterior extremities are pointed 
and tipped with cartilage, but are free and non-articulating. 

Ossification. — The shaft is almost completely ossified before 




Fig. 33.— Thorax. 



birth. Secondary centres for the head and tubercle appear 
before puberty, and the whole rib is fused by the twenty-fifth 
year. 

The Thorax as a whole is barrel-shaped, narrower above than 



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 



90 



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 




it 

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 



91 



The Muscles of the Back can again be divided into transverse 
and longitudinal. The transverse muscles are those which 
connect the shoulder girdle with the spinal column, and the 
longitudinal ones those that cause extension of the back and 



Complexus 



Cervicahs Ascendens. 



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 : 



92 



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 



93 



The Muscles of the Abdomen are arranged in three directions 
— longitudinal, transverse, and oblique. The longitudinal ones 
straight up the front, flex the trunk, helped by the oblique ones 
when both sides act together. When the oblique muscles act 
singly, rotation of the trunk takes place. The longitudinal 
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 



Same as 
above 



94 



HANDBOOK OF ANATOMY 



MUSCLES (BOTH SIDES TOGETHER) ACTING ON THE 
SPINAL COLUMN. 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Flexion 


Longus 


From the bodies and 


The bodies and trans- 


Anterior 




colli 


transverse processes 


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- 


Anterior 




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 



95 



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 





96 



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 



97 



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 

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 




2 9 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 x x 

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 acting 1 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 

or 

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 



Same as 
above 



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 




i 


Retrac- 


Temporal 


See above 






tion 


(posterior 
fibres) 








Lateral 


External ) 








move- 
ment Internal J 

1 


Pterygoid of one side 










1 



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 



i 

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. 

1 


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 


3 






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 



19 



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 

9 



130 HANDBOOK OF ANATOMY 

kidney — a thin- walled funnel-shaped sac formed by the junc- 
tion of several calyces inside the kidney ; the pelvis rapidly 
narrows to form the ureter. 

The Ureter is a duct with a small lumen and thick muscular 
walls. It is about 9 inches in length. The upper half or rather 
more lies in the abdominal cavity, the rest in the pelvis. The 
ureter passes downwards and inwards lying on psoas, and, 
crossing the iliac artery, it enters the pelvis. It then passes 
down on the side wall of the pelvis under the peritoneum, 
curving backwards close to the great sciatic notch. At the level 
of the ischial spine it bends inwards and enters the bladder 
about an inch from the middle line. 

The Pelvic Organs. — The pelvis contains the bladder, the 
rectum, and the internal genital organs. The bladder lies an- 
teriorly close against the pubic bones, the rectum posteriorly 
close against the sacrum (see Section VI.), and the internal 
genital organs between the two. They are all covered 
superiorly by peritoneum. 

The bladder is a hollow organ with muscular walls capable of 
great distension. When empty and contracted, it lies entirely in 
the pelvis just behind the symphysis pubis; when distended, it 
rises above the pelvis into the abdominal cavity. Superiorly it 
is covered by peritoneum reflected from the anterior abdominal 
wall and the sides of the pelvis, and is in relation with the coils 
of the small intestine. The under surface lies on the symphysis 
pubis and the bodies of the pubic bones ; externally it is in contact 
with the levator ani and obturator internus muscles on each 
side. Posteriorly it is separated from the rectum by the uterus 
and vagina in the female, and the seminal vesicles in the male. 
The lower part of the bladder only moves in position very 
slightly. During distension the side and upper walls expand 
and rise into the abdominal cavity. In the posterior wall of 
the bladder are the openings of the two ureters and the urethra. 
The three openings form an equilateral triangle with the apex 
downwards and the sides are about 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. 



44 



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 


I 3- 


Internal Maxillary 


2 3- 


Facial 


Coronary Arteries (from 


14. 


Superficial Temporal 


24. 


Occipital 


Ascending Aorta) 


IS- 


Vertebral 


2 5- 


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. 

10 



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 

11 



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, 

(c) Superficial circumflex iliac, 

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 

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 

Wm 

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- 

12 



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 the 1 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. 

13 



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. 



B 



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 


i 

| 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 „„,.. : .,.,, i A\ 

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 



I 



III 



I ■ 



mm 



■