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0OOO37246S

6000372468

/•

TABLETS

ANATOMY.

THOMAS COOKE, F.R.C.S., Eng.

B.A., B^c, M.D., Paris.

AVD LICRTKBm AT

■DBoaoir vo n» wmiaranB BOtncrAZ.,

■OHOOL OF AKATOMTf PHTnOLOOT, AMI) BCKOXBT.

Being a Synaptis of Demonstratioiu given in the Westmintter Hoepitai Medietd Schoci in the Yeart

1871, -72, .78, -74, -7B.

FOURTH EDITION,

SELECTION OF THE TABLETS BELIEVED TO BE MOST USEFUL TO

STUDESTTS 6ENEBALLT.

*' The ■chemM of may of the arti ot Mleneas maj be aaalysed
in a eort of skeleton, and repreeentod upon tables, with the Tanons
dependencies and oonneotione of the sereral parts and salOffeofes that
belong to them ; and the freqaent reriew of these abstracts and
epitomes wonld tend much to Imprint them on the brain, when they
have been once well learned ; this would keep those learned traces
always open, and assist the weakness of a labonrinf memory."

I8AA0 WATTS, D.D.,

oir " TxB htraomaan or ths ICoid.

••

LONGMANS, GREEN, & CO., PATERNOSTER ROW, LONDON.

1886.

PREFACE TO THE FIRST EDITION.

la a Learaer*8 point of riew Soientiflo faott maji the Anthor thinks, be dlrided Into those wMoh
MB daily met with bj the Btndent^ and whioh soon beoome familiar to him, and those whioh are
learned with oonsiderable pains and afterwards easilj forgotten, and whioh require to be oonstantly
recalled to the mind.

The Anthor has endearonred to deal with the latter olass of facts only. What erery one knows,
WHO has at all stndied Hedidne, he has purposely left ont. Greater condensation is thns obtained. *
To the non-medical reader the Tablets may appear disconneoted| and the descriptions they contain
(if descriptions they may be called) may seem dry and naked. The Author belieras that the Stadait
will easily supply the links, and giro life and shape to the skeleton sketches.

This book is intended neither for the idle, nor for absolute beginners. The idle will find thai H
oontains more details than they will care to master, and that its breyity demands more mental appll*
cation than would be agreeable to any one, whose mina has not been trained to close study.

Beginners, however, who mean to work, may, after attending a lecture, or reading up in one of
the Standard Authors a region they have Just been dissecting, adTantageously roTise the subject in
the Tablets I and these partial revisions will be found to fix the main points in the mind, and to
facilitate the more important rerisional effort, whioh, even the first yearns student is usually called
upon to make, wheneyer his lecturer has finished describing a part, or he himself has finii^ed dis«
seoting one.

The more or less adyanced Students, who are doing, or have done, their work honestly and oon-
soientionsly, are the ones the Author has had mainly in yiew.

Sqttembtrt 187L

PREFACE TO THE FOURTH EDITION.

Fourteen yeamT experience in the use of the Tablets of Anatomy has shown that, from the
point of view of their utility to Students, the Tablets may be divided into two classes :—

I.— Those— the majority, — ^whioh may be considered useful to mo§t Students.
~^ IL— Those which are of use mainly to such as are preparing for the higher excfminoHons.

The Tablets which may be fairly considered to come within Glass I., have alone been introduced into
this « Fourth Bdition, or selection of the Tablets believed to be most useful to Students generally.**

The bulk and price of the work have therefore been considerably reduced.

It hM alBO been thonght desirable to gronp tbe Tablets aooording to the eereral regions of the bodj,
io that the book may beoome a oompanion to the sereral Disseotors' HanaaliL

With a little trouble to the printer and binder it has farther been fonnd possible to arrange the
sereral groups of snbjeots, Bones of Sknll, Bones of Faoe, Pterygo-mazillary Begion, eto. (snohgronps as
form a synopsis, so to speak, of one of the daily classes given by the Author in his prirate Anatomioal
School), in snoh a way that, if it is thonght desirable to divide the book into parts for oonvenienoe in
carrying it abont, the several g^ronps of subjects will be found embodied in $epcarate pamphUu of a site
convenient for thB coat pocket f this has involved however a few unavoidable repititions. The separate
pamphlets are numbered from 1 to 84 on the lower right hand corner of their front page. The Bones
of the Oarpus ft Tarsus have been placed at the end of the volume.

The Tablets coming within Glass II., t.«., those of usemM'nly to such as are preparing for the higher
eiaminations, will be published separately. They will include all the ** Special Dissections,*' etc.

The minute Anatemy, which is now generally taken under the head of Physiology, and such subjects
as have mainly reference to minute anatomy, such as the ear, the eye, eta, have been removed from this
edition. It is intended, however, that the Tablets of Physiology and Histology, thoroughly revised
and brought up to date, shall be published in the same form as the present ; and these publications will
embody notes and explanations intended to facilitate the repetition by the student of the great bulk
of the practical exercises in Physiology by Professors Burdon-SandersoD, Foster ft Langley, and
other authors, which are now frequently demonstrated in the Authoi's private classes.

40, BxuNswicx SquAXx,

ifay, 188S.

BONES OF' TRUNK.

THE VEBTEBBiE.

Present for ezamfnatloiit -

Body - Forms a short oolnmn, whieli presents t

AVf. SvBrxcm - Conrex from side to side, oonoare from abore downwards | presents

numerous small Tasonlar foramina.
FWT. SuBrioi - Gonoave from side to side, flat from abore downwards ; presents

one or more irregnlar apertures for exit of renss basis Tertebm
ZCJJOt A Under Subpaces - Rongh & slightly concave, and snrroanded by a pro.

minent rinu
Pedicles - Join the body to the laminss. They are constrioted, and their oonstriotion giree

rise to the
Notches - Which latter, by the Bnperposition of the rertebrsB, form the intervertebral fora*

minom
LaminSB - Broad h flat, rongh above b, below for the ligamenta snbflaya ; bonnd posteriorly

Foramen - Whioh, by the superposition of the rertebrss, forms the spinal oanaL

Spinous process -Prcjeots backwards from the point of janotion of the laminm

Transverse processes - Two. Project outwards from th^ sides of the arch.

Articular processes - Fonr. Pi ojet t upwards h downwards from the point of Janotion «tf
the pedicles with the laminao. The snperior ones look backwards, the inferior

ones look Torwards.

Ni *— ' Bat little, whioh wonld be applicable to each of the three groups
of Tertebr», can, it is believed, be added to this description.

THE THBEE aBOXTPS of VEBTEBBiE.

CEBVIOAL VERTEBRJB — The ■malleat. Profents -

BODY — Small, broad from aide to side. PreeenU: -
•« Upper Subpacb - Conoave from side to side, and roanded off anteriorly.

UinDKB Surface - Convex from side to tide, and prolonged downwards anterlorij*
AiiTERiOE Surface - Situated therefore on a lower level than the posterior.
F£DTGLES — Arise from lower part of body, and of the two
KOTCHES — The snperior ones are the deepest, and some what the narrowest.
LAMlNiE — Longr and narrow.
FORAMEN — Large and triangrnlar.

SPINOUS PBOC£SS — Projects horizontally backwards, and is short, bifid, A grooved

inferiorly.

TBANSYERSE PBOCESSES — Short, bifid, grooved superiorly, perforated at their

base for passage of vertebral artery i vein, an^ situated on the outer side of the

pedicles, in front of the articular processes.
The exifltence of the foramen at the base ot the cervical transverse pro-
cesses, and the situation of these processes on the outer side of the pedioles,
are owing to tlicir being formed of two roots, which roots correspond, the
anterior one to the transverse processes properly so-called, the posterior

one to the ribs.
ARTICULAB PROCESSES — Form a small vertical column. The superior ones lootc

upwards & backwards, the inierior ones look downwards & forwards.

DOBS AL VERTEBR JB — Intermediate in size. Present t -

BODY — Heart-shaped, thicker behind than in front, and has two demi-faoets on eaoh

side, which facets articulate with the heads of the ribs-
PEDICLES — Arise from upper part of body, and of the two
NOTCHES — The inferior ones are the deepest and broadest.
LAMINA ^ Short & broad.
FORAMEN — Small d( round.

SPINOUS PROCESS — Long, triangular, oblique, and ends in a single tubercle.
TRANSVERSE PROCESSES — Long, thick, obliquely directed outwards h baokwards,
and situated behind the articular processes &* the pedicles. Their extremity is
enlarged, and presents in front an articular facet for tubercle of correspond-

Ing rib.
From the back of the extremity of the few lower dorsal transverse proces*
ses arise three tubercles, termed external, inferior, h superior^ which tuberclea
correspond respectively to the transverse processes of the lumbar vertebrae,
and to the accessory & mammillary tubercles found, the former on the back
of the transverse processes, the latter on the back of the superior articular

processes of the lumbar vertebrse.
ASTICULAR PROCESSES — Nearly vertical. The snperior ones look backwards &

outwards, the inferior ones look forwards & inwards.

LUUB AR VERTEBR JE — The largest. Present : -

BODY — Large, broadest from side to side, rather thicker in front than behind.
PEDICLES — Thick ; arise from upper part of body, and of the two
NOTCHES — The inferior ones ure the deepest & broadest.
LAMINuS — Short, broad & thick.

FORAMEN — Triangular, larger than in the dorsal region, smaller than in the cervical.

SPINOUS PROCESS — Thick, quadrilateral, and ends in a rough vertical border.

TRANSVERSE PROCESSES — Lontr, slender, directed transversely outwards, and

situated in frotU of the arlicular processes, hut behind the pedicles , and in a line

with the external tubercles of tue lower dorsal transverse processes, to which

they correspond.

On the back of each, near its base, is a small tubercle the accessory tubercle,

which points downwards & inwards, and which corresponds to the inferior

tubercles on the lower dorsal trunsvnrse processes.

ARTICULAR PROCESSES ^ Thick, strong & vertical. The snperior ones are concave,

look backwards & inwards, and are farther apart than the inferior ones, which

they embrace. The inferior ones are couvex, look iorwardd A oatwaids, and

are nearer to eaoh other than are the superior ones.

On the back of each superior articular process is a small tubercle, the
WtammiUofy tubercle^ which corresponds to the superior tubercles on the lower

doml traasYM'M processes.

THE THREE GROUPS COMPARED SERIATIM.

Body — CfiRTiOAL - Small, broad from side to side. Preienta: -

Upper Surface - OonoaTe from side to side, & rounded off anteriorly.
Under StSface - Conrez from side to Bide, & prolonged downwards anteriorly.
Anterior Surface - Sitnatfid therefore on a lower lerel than the posterior.
DosBAL - Heart-Bhaped, thicker behind than in front, and haB two demi-faoete on

each Bide which demi>facetB artionlate with the heade of the ribs.
Lumbar - Large, broadest from Bide to side, rather thicker in front than behind.

PddidOS * Cervical -Arine from lower part of body.
Dorsal -Arise from upper part of body.
Lumbar - Thick % arise from upper part of bodj«

Notcll68 ~ Cervical - The superior ones are the deepest, and somewhat the narrowesL
. Dorsal - The inferior ones are the deepest and broadest.
Lumbar - The inierior ones ore the deepest h broadeak

Lamiim - cervical - Long A narrow.
Dorsal - Short h broad.

Lumbar - Short, broad A thick.

•

Foramen Cervical - Large A triangular.
Dorsal - Small & round.
Lumbar - Triangular, larger than in the dorsal, smaller than in the oervloal.

Spinous Process —

Cervical - Projects horizontally backwards, and is short, bifid, h grooved inferiorly.
Dorsal - Long, triangular, oblique, and ends in a single tnberole.
Lumbar - Thick, quadrilateral, and ends in a rough vertical border.

Transverse Processes —

Obrvical - Short, bifid, grooved superiorly, perforated at their base for passage of
vertebral artery h vein, and situated on the outer side of the pedtcies, in front of

tne articular processes.

Dorsal - Long, thick, obliquely directed outwards A backwards, and situated behind

the artuular proceszes 6* the pedicles. Their extremity is enlarged, and preseuts

in front an articular facet for tubercle of oorrespondlng rib.
From the back of the extremity of the few lower dorsal transverse prooes-
ses arise three tubercles, termed external^ inferior^ k superior^ which tubercles
correspond respectively to the transverse processes of the lumbar vertebrae,
and to the accessory & mam miliary tubercles found, the former on the back
of the transverse processes, the latter on the back of the superior articular

proccBses of the lumbar vertebrae.

Lumbar - Long, slender, directed transversely outwards, and situated in front of

the articular processes, but behind the pedicles, and in a line with the external

tubercles of the lower dorsal transverse processes, to which they oorrespood.

On the back of each, near its base, is a small tubercle the accasory tubercle,

which points dowuwards h inwards, and which corresponds to the inferior

tubercles on the lower dorsal transverse processes.

Articular Processes —

Cervical - Form a small vertical column. The snperidr ones look upwards ft back.

wards, the inferior ones look downwards h forwards.
Dorsal - Nearly vertical. The superior ones look backwards ft outwards, the inferior

ones look forwards ft inwards.

Lumbar - Thick, strong ft vertical. The superior ones are concave, look baokwarda

ft i.iwards, and are farther apart than the inferior ones, which they embr&oe.

The inferior ones are convex, look forwards ft outwards, and are nearer to

each other than are the superior ones.

On the back of each superior lumbar articular process is a small

tubercle, the mammillary tubercle^ which corresponds to the superior taberclea

on the low«r dorsal teSMtersn prooti

FECULIAB VEBTEBRS:.

Atlas ^

Are thet

Vide following Tablet

Axis S

7th Cervical Vertebra, or Vertebra PromlnexiB

SpinooB prooeBS thiok, long, prominent, nealjr horizontal i ends in a lingle tober-

ole for ligamentnm nnolm.

TransYerae prooees large, bnt eligbtly grooTod, seldom bifid. Its foramen is

nsoalljr small, sometimes wanting, and seldom gires passage to both

arteiyArsiB*

Ist Dorsal Vertebra

Body broad from side to side and lipped superiorly & behind t presents a oomplete

faoet abore for bead of 1st rib, and a demi-fuoet below for upper faoet on

bead of Snd riU
Spinous process tblok A bnt slightly inolined.

Artioalar prooesses somewhat obllqae, as iu the cerrical rertebnib

9tli Dorsal Vertebra

XJsnally no inferior demi-iSMMl.

10th Dorsal Vertebra

Bat one costal facet (the superior), which is usually oompleia,

11th Dorsal Vertebra

But one costal facet, which is always complete.
TransTerse processes short, and without artioalar fkoots.

12th Dorsal Vertebra

Bat one costal faoet, which is always complete.
Transrerse processes short, and without artioalar facets.

Inferior artioalar fWcets, oonvez and looking forwards & outwards like those of

lumbar yertebrs.

6th Lumbar Vertebra

Body much thicker in front than behind.

Spinoas process small.

Inferior articular processes, farther apart than superior.

TransTerse proGesses, large, thick, slightly inclined upwards.

ATLAS & AXIS.

THE ATLi\S

Presents anterior & posterior arclies, foramen, and lateral maiaae.

ANTERIOR ARCH —Presents:

Antebior Surf. -Convex, in centre of which is a

tubercle for saperior oblique portion of longos colli, and for tnperflolpv
anterior ocoipito-atloid & superficial anterior atlo-azoid Ugamenta
Posterior Surp. - Ooncave, in centre of which is an

cval facets which articalates with odontoid process of axis.
Upper & Lower Borders - For deep anterior ocoipito-atloid A deep anterior alio*

axoid ligamenta
POSTIaRIOR ARCH — Presents just behind the lateral masses the

GroQvci representing the supericr &• inferior intervertebml nakhes, — Th|
saperior grooves, which are the deepest and are sometimes con-
verted into complete foramina, transmit the vertebral arterj A

the suboccipital nerve.

The posterior arch then becomes rounded, and is roagh

above & below for the posterior ocoipito-atloid & posterior atlo-

axoid ligaments. It ends posteriorly in a
tubercle for rectus capitis posticus minor.

FORAMEN "* I'&i'go« ftiid divided by transverse ligament (transverse portion of crucial lij^

ment) into a posterior part, the largest, for spinal cord & its
membranes, and an anterior part, the smallest, which receives

the odontoid process of the axia
LATERAL MASSES -^ Short A thick columns of bone, which present internally, extern ally,

above & below, a
tubercle for the transverse ligament ;
Transverse Process - Large, not bifid nor grooved superiorly, perforated at its

base by a very large foramen ;

Sup, Articular Surf. - Large, oval, concave, converging towards its fellow

anteriorly, and looking upwards, inwards h slightly backwarda

Jnf, Articular Surf, - Bather smaller, flat, circular, and looking downwards

4 inwarda

THE AXIS

Presents the following peculiarities

Body "'^ S^od deal thicker in front than behind. It presents anteriorly a

median ridge 6* two lateral depressions for part of internal or vertical por*

tion of longns colli, and is surmounted by the
Odontoid Process - Tooth-like, presenting ;

Apex - For median or suspensory occipito-odontoid ligament, and, laterally,

for lateral occipito-odontoid, or check ligaments.
JBody - Articular in front & behind for anterior arch of atlas & transversa

ligament.
A^cck - Constricted, and bound down by transverse ligament.

PodidOB ~ Strong & thick, lie beneath the superior articular surface, and are but very slight-
ly grooved superiorly.

Notclies * The superior are very shallow, and lie behind the superior articular surfaces : the

interior ones are much deeper and Ue in front of the correspond-
ing articular surfaces.

Laminsa - Thick & strong.

Foramen - Large, but smaller than that of atlas.

Spinous Process -Thick, bifid, deeply grooved inferiorly.

Transverse Processes - Small, pointed j foramen oblique upwards A outwards.

Articular Sur&ces :

Superior - Best upon the body, pedicles A transverse processes in front of ^t
notchesi and are largo, flat, oirculari and look upwards A out

wards*
/i|/Sn«r •Smallsr, look downwards A forwards, and are similar to those oi

th* othtr oorriosl roriebnoL

THE BIBS.

SfEVft Sternal or True - Gonneeted to the iternnm by their oostal oartil.

ages ; these increase in length from abore downwards.

Fkft False or Asternal - Of which the three first are oonneoled bj their car.

tilages to the cartilage of the rib above, while the two last, or

/hating rids, are entirely disconnected in front. The asternal or

talse ribs decrease in length from above downwards.

The breadth of the ribs decreases from the 1st to the last|

■0 does also the width of tho corresponding intercostal spaces.

The degree of obliquity of the ribs increases from the Ist

to the 9th, and decreases from the 9th to the 12th. It it

most marked between the head & the posterior anglo.

The ribs are both curved & twisted npon themselves.
The carve of the ribs is most marked in the neighbourhood
of the posterior angle. The twist is such that the outer sur-
face of the shad looks slightly downwards behind k slightly
npward.s in front, and that, if the lower border of the shatl
be placed upon a flat horizontal surface from the anterior
extremity of the bone to the posterior angle, the part of tho
bone behind the angle, will be found to pass upwards h in*

ward^

COMMON CHARACTERS — a nb presents two extremities k a shaft

POSTSRIOR EXTRE M ITY "• Presents head, neck & tuberosity.

Hbao - Presents :

two obliqite facets^ a small superior one & a larger inferior one, which
facets articulate with the bodies of two adjoining vertebra^

and are separated by a
horizontal ridge^ to which the interarticular ligament is attached.

Kbck - Flattened from before backwards, about an inch in length ; presents :
Anterior Surf. - Smooth, continuous with inner surface of the shaft.
Posterior Surf - Rough for interosseous oosto.transverse ligament.
Upper Border - Has a rough crest, for superior costo- transverse ligament.
Lffwer Border - More or less rounded.

Tuberosity -Most prominent in the upper ribs. Presents :

Infaior Internal, or Articular Portion - Has a facet for the extremity of
the tranverso process of the inferior of the two vertebrae with

which the head is connected,

Superior External, or Non-articular Portion - Bough for external costo.

^ transverse ligament.

SHAFT — Thin A flat Presents i

Outer Surface - Convex, on which is found posteriorly the

Angle, or Posterior Angle - A rough line obliquo downwards A forwards,
which gives attachment to the tendons of the sacro-lumbalis,
its accessory muscle, & the oervioalis ascendens, and which

separates a

posterior rounded portion, giving attachment to the longfRsimus dorsi,

and increasing in length from the 2nd rib to the 10th, and an

anterior flattened portion, smooth, looking slightly downwards behind

& slightly upwards in front, which presents anteriorly tho

Anterior Angle - Similar to the posterior but more faintly marked.

XmrKX Surface - Concave, looks slightly upwards behind & slightly down-
wards in front, and presents inferiorly a
ridge extending over the posterior two-thirds of the shaft, & most
* marked behind, which ridg^ gives attachment to the internal

intercostal muscles, and forms the inner boundary of the
Crowe - For the intercostal vessels k nerves, which groove is deepest ft

most marked just in front of the angle.

Uffsr Border - Bounded ; gives attachment to both internal & external inter*

costal muscles.
Lower Border - Thin ft sharp. Forms outer boundary, of foregoing groove,

and gives attachment to corresponding external interoostal

mosolai.

AXVTZBZOB SZTRliMITT — Compressed fVom before backwards, presents a

deep oval pit, studded with vascular foramina into which pit tho

oorresponding costal cartilage is received.

PEGULIAB BIBS.

Wbnlt Rib - Broad, flat, hoHsontal, the most onrred, and ninallx the shorteelt lis

SuETACXS - Look upwards A downwards.

C/j^per Surface - Presents posteriorly a

rough impression for scalenus medins, and anteriorly a slightly marked
tu^rcle most prominent internally, for scalenus antions, which taber«

ole separates
two shallow grooves t the anterior one for the subolarian vein, the

posterior one for the sabdavian artery.
Under Surface - Has no ridge nor groove.
BoBDBis - Are turned inwards & outwards.

Inner Border - Conoare, thin ; presents inner part of tubercle Ibr soalenQi

aatieiis.
Ouler Border - Conrez & rounded.
Head * Small, rounded, with a single facet for 1st dorsal vertebra.
Kbck - Short & rounded.

Tuberosity - Large, prominent, situated on outer border.
Akgle - Blended with tuberosity.
AiTTEBiOB ExTBEMiTT - Large k thick.

BoOOnd Bib - ^ longer, less curved, only slightly oblique, and soaroely twisted.
BuBFACBS - Look slightly outwards & inwards.

Outer or Upper Surface - Bough k prominent towards its middle for second k
third digitations of serratus magnus; rough posteriorly for

scalenus posticui.
Inner or Under Surface - Has but a short k slightly marked groove.
TuBBROSTTT k Anolb - Cioso together; the latter slightly marked.

Tenth Bib

Head - Has usually but a single articular facet.

Xleventh Bib

Head - But a single articular facet.

Ko Neck.

No Tuberosity.

Twelth Bib

Head - But a single anterior facet.

Ko Neck.

Ko Tuberosity. •

Ko Angle.

Ke Groove.

The two last ribs are but slightly curved, and are short h pointed,

the twelfth rib being sometimes the shortest of all.

BONES OF SKULL.

THE FBONTAL BONE.

▲rtionlateB witli sphenoid ft ethmoid, and with both parietal, nMal, superior maxillary, laehry* '

mal A malar.
Divided into vortical or frontal, and horizontal or orbito-nasal portions.

VERTICAL OR FRONTAL PORTION — Presents : I

£zt. Surface - Presents in median line :

Median suture^ nsnally obliterated a few years after birth, and below which is the
Nosed eminence ; - and laterally from above downwards:
Frontal eminence;

Superciliary ridge caused by projection of frontal sinnses, broad

inwardly where it joins the nasal eminence ;
Supraorbital arch^ presenting at its inner third the

Supraorhital notch orforanun^ for supraorbital vessels ft nerve,*

and which arch terminates externally and internally in

the external ft internal angular processes.

EXT. ANGULAR PROCESS - Thick ft strong; articulates with malar

bone, and presents externally a part of the
Temporal ridge,

INT. ANGULAR PROCESS -Thinner; articulates with lachrymal bona

and bounds the
Nasal nctchf which articulates with nasal bones ft nasal pro-
cesses of superior maxilla, and presents below the
Nasal spine.

Int. SnrfaCO - Concave. Presents in median line and from below upwards i

Foramen ccecum (completed behind by ethmoid) for small vein to longitudinal

sinus and a process of falx cerebri^
Frontal crest^ which is continued into

Groove for longitudinal sinus ft falx cerebri % — and laterally
Cerebral impressions and
Grooves for branches of anterior ft middle meningeal arteries.

HORIZONTAL OR ORBITO-NASAL PORTION — C(»8.>u of the two

orbital plates separated by the ethmoidal notch.
ORBITAL PLATES -Present:

Under Surface - Concave, on which are seen externally the

Lachrymal fossa for lachrymal gland, and internally the
Fovea trochlearis for pulley of superior oblique.

Upper Surface - Convex, forms part of anterior fossa of base of slcull, ai^d

presents well marked cerebral impressions.

ETHMOIDAL NOTCH - !■ fillo<l '"P by horizontal plate of ethmoid. - The under

surface of its margin presents :
Several half-cells^ which complete ft close the ethmoidal cells, and
Two grooves^ which form part of

Anterior ethmoidal canal for nasal n. ft ant. ethmoidal vessels, and of
Posterior ethmoidal canal for posterior ethmoidal vessels.
In firont of the ethmoidal notch is the

Nasal spinCf which articulates with nasal bones ft perpendicular plate of
the ethmoid and forms part of roof of nose, and on the sides

of which are the
Openings of the frontal sinuses

The circumference of the bone is thick in the vertfosl or frontal portion,
where it is serrated for orticulation with the pnrietals, and is
bevelled at the expense of the inner tabic, above, of the outer tabl^*,
below. In the horiKontal portion the circumference is thin ft serrated
for articulation with the leaser wing of the sphenoid. At the janction
of the two portions of tho bone the circumference presents a largo
triangular roagh surface for articulation with the greater wing of

the sphenoid.

THE OCCIPITAL BONE.

▲rtioulates with parietals, mastoid & petrons portions of temporally sphenoid & atlas, and

presents}

OUTER SURFACE — Convex. Presents from behind forwards i
Ext. occipital protuberance for ligamentnm nncbsD ;
Ext* occipital crest, from which are given off laterally the

Sup. curved line, for trapezius, stemo-mastoid h oooipito-firontalis ; and the
Inf. curved line for recti capitis postici major & minor which are also inserted

into depression below. - Between the two oorved lines are

inserted the oomplexus, uplenins & superior oblique.

FloTttmm magnum for oord and its membranes, spinal accessory nerves k vertebral

arteries, on outer side of which foramen are the

Condyles^ oblong, converging in front, convex from before backwards, looking

downwards & outwards ; rough inwardly for attachment of

check ligaments, and having in front
Ant. condyloid foramen for hypoglossal nerve ; having behind
Post* condyloid fossa sometimes perforated by posterior condyloid fora-
men for a small vein to lateral sinus, and having on their

outer side the
yugidar process for rectus capitis lateralis h lateral oocipito-atloid

ligament;
BasUar process presenting in middle line the

Pharyngeal spine for tendinous raphe & superior oonstrlctor of pharynx, and

laterally a
Rough depression for recti capitis antioi major h minor. ^

ZMNER SURFACE — Concave, presents from behind forwards t

Crucial ridge, to centre of which corresponds the toroular Herophili, and of which the
Upper division ascends to superior angle, and is deeply g^rooved for superior

longitudinal sinus & falx cerebri ;
Inf. division^ or int. occipital crest, descends to foramen magnum whore it

bifurcates; gives attachment to falx cerebelli.
Lateral divisions bound posteriorly the inferior occipital fossss, and are deeply

grooved for lateral sinuses k tentorium cerebelli^
Foramen magnum, near side of which are the

Ant. condyloid foramina & sometimes tho
Post, condyloid foramina.
BasUar groove, which supports medulla oblongata & pons^ and on eaoh side of which

is a half
Groove for inferior petrosal sinus.

BORDERS —Four:

Superior - Form lambdoid sutnre by articulating with parietals.
Inforior - Articulate with mastoid & petrous portions of temporal, and assist

in forming jugular foramen or foramen laoenun posteriuik

ANGLES —Four:

Superior - Beceived between the two parietal bones, and corresponds to

posterior fontanelle.
Inferior - Joins with body of sphenoid about 18th or 80th year.
Lateral *- Beceived between posterior inferior angle of parietal and mastoid
portion of temporal ; presents on its inner surliftoe outer end of groove

for lateral sinus.

THE TEMPORAL BONE.

Is dtiukted at aide of baw of ftkvU^ and artioalatoB with paritUd^ occipital^ sphtnoid^ malar A mfttimr

maxUlaty bona*
Ib divided into squamous, mastoid ft petrous portions.

SQUAMOUS PORTION ""* Presents outer & inner snrfaoes and circumference.

Outer SUT&CO — Conrez, forms part of temporal fossa and presents lower part of

temporal ridgehMxk^, tygomoHc process in front, zxl^ ff moid fossa below.
ZYGOMATIC PBOCESS — First projects outwards, and is broad k flattened from

above downwards. It then twists forwards and presents i
BoaDEBS - upper long & thin for temporal f. ; lower short k thick for masseter.
BuarACES - outer oonvez, inner obncave also for masseter.
Apbx - Serrated, articulates with malar bone.
Base - Presents three roots :

Anterior - Wide & transverselj directed forming eminentia articularis;
Middle - Forms posterior boundary of glenoid fossa |
Posterior - Forms origin of temporal ridge.
GLENOID FOSSA — Is comprised between anterior k middle roots of the sjgoma,

and presents the
Glasbkiak Fissueb - For processus gracilis of malleus, lazator tjmpani m., k

t3rmpanic artery, and dividei the fossa into /
Anterior part - Articular, and covered with cartilage which is prolonged

OTer the eminentia articularis.
Posterior part - Non-articular, bounded behind by yag^nal k auditory

processes k middle root of sygoma,
ZxiXier SnrfaCO — Conoare. Presents cerebral impressions, and grooves for middle

meningeal artery.

CironznforeXlCe — Thin above and behind, where it is bevelled internally and articulates

with parietal; thick in front, where it is slightly bevelled externally and

articulates with great wing of sphenoid.

ULAlSTOID portion — Presents outer k inner surfaces and borders

Oater Surface — Bough; presents:

Mastoid foramen for a vein to lateral sinus, and is prolonged into
Mastoid process for insertion of sterno-mastoid, splenius capitis k trachelo-mastoid,

and on the inner side of which is the
Digastric groove for origin of posterior belly of digastric, and further inwards the
Occipital groove for occipital artery.

Inner Surfoce — Forms part of posterior fossa of base of skull and presents descending

portion of
Groove for lateral sinus.

Borders -Post. & Snp. — Thick k serrated for posterior inferior angle of parietal

and lower border of occipitaL

PETROUS PORTION — vide next Tablet.

PETBOUS PORTION of the TEMPORAL BONE.

Pjramidali directed forwardi ft inwarde and wedged in between the sphenoid & the basi-
lar process of the oooipitaU Preseatf t

Ba86 "— Its exposed part presents the

Meatus omHtorms extemus^ the lower part of which is snrronnded by the
Auditory process^ to which is attached the cartilage of the pinna.

Ap6X — Presents the

Internal orifice of tki carotid canal ; and forms the posterior ft outer bovndarles of the

foramen laoernm medinm.

Antk Sur&ce — Forms posterior botmdary of middle fossa of base of skull, and presents from

before backwards ft ontwardi the t
Internal orifice of the carotid canal,
Depression for Gasserian gaf^ion,

Iliatus Failopii iniYim groove leading to it, both for large superficial petrosal nenre and

petrosal branch of middle meningeal arter/i and near which hiatns

are fireqnently seen

7\oo or three other small foramina for small superficial petrosal nerre, petrosal

branch of glosso-pharyngeal ft branch of glosso-pharyngeal to large

snperQcial petrosal nerve.
Eminence corres p o nd ing to the superior semicircular canal, on the outer side of which is a
Depression corresponding to the cavity of the tympanum.

Post. Sorfoce <— Forms anterior boundary of posterior fossa of base of skull, and presents i
Meatus audiforius intemus for facial nerve and auditory artory ft ne^ve;
Opening ofAqueductus Vestihuli^ior small artery ft vein to vestibule ft a process of the

dura mater.

yr^f . or Basilar Surface -^ Presents in a diagonal line fh>m before backwards ft outwards t
Rough surface for origin of levator palati ft tensor tympani;
Inferior orifice of carotid canal ;
Vaginal process which embraces root of

Styloid procas, which gives attachment from above downwards to the stylo-pharynffeus,

•hyoideus ft -glossus muscles, and to the stylo-hyoid ft .maxillary h^ts.,
Stylo-mastoid foramen for facial nerve ft stylo-mastoid artery. - Behind ft on inner side

of the carotid canal ft vaginal process are the
4gular sufface, which articulates with jugular process of occipital, and the
fugular fossa for sinus of internal jugular vein, which fossa a^^sists in forming
jugular foramen or foramen laoernm posterins, and has near to it t
Opening for Arnold's nerve, on its outer wall.

Opening for Jacobson's nerve, in fVont, on bony ridge between it ft carotid

canal,
Opetting of Aquedstctus Cochlea, in front ft to inner side, close to posterior

border of the petrous bone.

Borders — Three !

SuPERioa -Grooved for superior petrosal sinus ft attachment of tentorium oerebollL
PosTEKioa - Grooved in front for inferior petrosal sinus ; presents jugular fossa behind.
AjirsEiOR " Its IXNER PART articulatos with spine of sphenoid; its outer part is joined by
a suture to the squamoos portion of the bone. In the angle of junction of these

two portions are found the
Canal for the tensor tympani muscle above, and the

Osseous portion of the Eustachian tube below, on the outer side of which latter opening is tha
Canal ofHugmer for exit of chorda tympani.

THE SPHENOID BONE.

18 Situated at front part of base of siciLll, and artioalatea with the 7 other cranial bones & with
Presents for examination : Tomer & both malar h palate bonea^

BODY — Is cnboid, but presents only four free surfaces, the two lateral surfaces being oontinnow
UPPER SURFACE - Presents from befor. backwards"'"^ the wings A pteiygoid procease*
Ethmoidal spim, which articulates with ethmoid ;

SmooSh iurface slightly elevated in median line, and which supports oUaotory nerFoai
Optic groove leading laterally to optic foramen;
Olivary process ;

Pituitary fossa or sdla turcica bounded laterally k in front by middle clinoid processes;
Dorsum sella notched laterally for 6th pair of cranial nerves, and presenting posterior

clinoid processes at its superior angles. On each side of body is the
Cavernous groove curved like an italic ^ for internal carotid artery.
ANTERIOR SURFACE -- Presente in middle Une the

Sphenoidal crest, which articulates with perpendicular plate of ethmoid ; on either side the
Openings of the sphenoidal sinuses, which are partly closed in front by the
Sphenoidal turbinated bones or banes of Bertin, -This surf, articulates laterally with
OS planum of ethmoid, and inferiorly with orbital process of palate bone.
UNDER SURFACE — Presents in middle Une the

Rostrum^ which is received between the also ot the vomer, and is continnons

anteriorly with sphenoidal crest ; on each side of the rostrum is the

Vaginal process, which passes inwards beneath, and articulates with, the

. alaB of the vomer, and externally to which is the

Flerygo-palatine groove, whjfih forms pterygo-palatine canal with sphenoidal

POSTERIOR SURFACE - Articulates with basilar process of occfp?tatl^ne,''^t^^°ct
GREATER WINGS — Present : it unites at age of 18 or 2a

SUPERIOR or CEREBRAL SURFACE — Forms part of middle fossa of base ot

skull, and presents from before backwards at its inner part :
Foramen rotundum for superior maxillary nerve;

Foramen ovale for inferior maxillary & small petrosal nerves k small meningeal artery

on the inner side of which latter foramen is sometimea aoen the
Foramen Vesalii for a small vein;
Foramen spinosum for middle meningeal artery.
EXTERNAL SURFACE •- Is divided by pterygoid ridge into;

Superior part, which enters into formation of temporal fossa, and

Inferior part, which assists in forming zygomatic fossa, and presents posteriorly

Spine of sphenoid for internal lateral ligament of jaw & laxator tympani mnscla
ANTERIOR or ORBITAL SURFACE — Quadrilateral ; assists in forming outer wall of

orbit and sphenoidal k spheno-m axillary fissures, and articulates with frontal
k malar bones. Presents a small spine for lower head of external rectus.

CIRCUMFERENCE.

F£OM Back of Body to Spine - Forms anterior or outer margin of foramen lacemm
medium, in front, and articulates, behind, with petrous portion of temporal b.

F&ou Spine to Tip -Articulates with squamous portion of temporal bone, being

bevelled internally below, externally above.

F&ou Tip to Front op Body - Presents externally a broad triangular surface for
frontal bone, and forms, internally, lower boundary of sphenoidal fissure.

LESSER WINGS or PROCESSES of INGRASSIAS — Long, thin, triangular:
UPPER SURFACE — Smooth, forms part of anterior fossa of base of skull ;
UNDER SURFACE — Forms back of roof of orbit and upper boundary of sphenoidal fissure,

which latter is bounded internally by body of sphenoid, and transmits 3rd,

4th k 6th nerves, and ophthalmic nerve k vein.
ANTERIOR BORDER — Articulates with frontal bone;

POSTERIOR BORDER — Forms at its inner extremity the anterior clinoid process.
INNER EXTREMITY — Presents two roots which bound optic foramen.

PTER7Q0ID PROCESS — ConBists of two plates which bound pterygoid fossa, and are

sopnrntod bolow by a triangular notch filled up by pterygoid process of palate bone. - Its
ANTERIOR SURFACE — Forms posterior wall of spheno-maxillary fossa, and presents

anterior orifice of vidian canal.
EXTERNAL PTERYGOID PLATE — Broad, thin, inclined outwards. Forms inner

k outer walls of sy^omatic k pterygoid fossn respectively, and gives

attachment to internal k external pterygoid muscles.
INTERNAL PTERYGOID PLATE - Narrower k longer. Its

Outer 4 inner surfaces - Form respectively inner boundary of pterygoid fossa k outer

boundary of posterior nares. At its apex it pressat«
JIamular froeess for reflsotion of tendon of tsnsor i^aUtt ilA ftt its bftss
St€^pMdfftMt for origin of that mnNle.

THE ETHMOID BONE.

Light, spongy, onboid, projeotfl downwards from between orbital plates of frontih, and enters

into formation of orbits & nasal foassk
Artionlates with frantalt sphenoid & sphenoidal turbinated bonesy both nasal, superior maxillary^

lachrymal^ palate^ inferior turbinated & vomer.
Hay be divided into three parts :

HORIZONTAL OR CRIBRIFORM PLATE — Eeoeived into ethmoidal

notch of frontaL
Forms part of roof of nose & of anterior fossa of base of skall, and presents in the

median line the

Crista gallic which gives attachment to falx cerebri, and articulates below h

in front with frontal bone, completing foramen coecnm; - and on each side

Three rows of foramina for branches of the olfactory nerve, and more anteriorly ft

Fissure ior nasal branch of ophthalmic nerve.

PERPENDICULAR PLATE — Descends from nnder snrfaco of former, and assistc

in forming nasal septam«
Is more or less inclined to one or other side, and presents numerous grooves for

branches of olfactory nerve.
Articulates in front with frontal spine and nasal bones, behind with crest of sphenoid

k vomer, and joins below with triangular cartilage of nose.

T.ATERAL MASSES — Cuboid, and enclose a number ofirregular cavities, the ethmoid
UA A uj.««mw «m. -^^i^ ^^^^^ which are divided into an anterior & a posterior set. Their

Anterior Upper & Posterior Surfiaces - Present numerous half-cells, which ar«
AUberiux^ up^cx «u * v completed respectively by articulation with

Lachrymal bones & nasal procases of superior maxilla,

Frontal bone,

SpJunoidal turbinated bones & orbital processes of palate bones, - The upper
surface also presents two grooves which assist in forming the

anterior & posterior ethmoidal foramina.

Outer Surface -Presents a thin smooth plate of bone the os planum which forms inner
wubox »iAXM»wo ^^Yi of orbit, and articulates with :

Lachrymal bone, in front ;

Orbital plate of frontal, above ;

Body of sphenoid, \i^\AvA\

Superior maxillary & orbital process of palate bone, below.

Under Surface - Presents under surface of middle turbinated process and the projecting
Unciform process y which articulates \«ith inferior turbinated bone, and assists in

forming inner wall of the antrum of Highmore.

Inner Surface - Forms part of outer wall of nasal fossae, and presents from above down-

warcis bOO

Superior turbinated process, small and corresponding to post, part of nasal fossse ;
Superior meatus, which communicates with posterior ethmoidal celU ;
Middle turbinated process, which extends along whole length of lateral mass;
MiddU meatus, which communicates with the antenor ethmoidal cells (and
throuffh these with the frontal sinus) by means of a wide funnel-shaped
° oanal, the

Jnfimdibulum^

THE PARIETAL BONE.

Artioulatea with its felloir, the occipital, temporal, sphenoid A frontaL - PraMoU t

OUTER SURFACE — Convex, and presents i
Parietal faratmn at npper ft back part|
ParUtal eminence ;
Temporal ridge, below wbioh it forms part of temporal fbssa •

INNER SURFACE ^ Ooncave, and presents :
Cerebral eminences & depressions ;

Furrows, for ramifications of middle meningeal arteryi
Half 'groove for superior long:itndinal sinus & ialx cerebri |
Depressions for Faocliionian bodies.

BORDERS — Fourt

Snperior - Form sagittal suture bj articulating with each other i

Inferior - -Are :

In Fkont - Beyelled externally h OTerlapped by great wing of sphenoid

h squamous portion of temporal i

Bebikd - Serrated for articulation with mastoid portion of temporaL
Anterior - Serrated, and form coronal suture by articulating with frontal.
Posterior - Serrated, and form lambdoid suture by articulating with oooipitaL

ANGLES — Four :

Anterior Superior ft Posterior Superior - Gorrespond to anterior h

posterior fontanelles, and form part of foregoing sutures.
Anterior Inferior - Beceived between frontal & great wing of sphenoid, an

inch above and behind superior external angle of orbit. -> Is
grooved internally and sometimes chanelled for anterior branch

of middle meningeal artery.
Posterior Inferior - Articulates with mastoid portion of temporal, and pre*

■ents part of groove for lateral sinns.

BONES OF FACE.

SUPERIOR MAXILLARY BONE-lst Tablet.

I
Forms the whole of npper jaw by its nnion with ita fellow.
Afisists in forming : !

Roof of mouth, floor A outer wall ofnose^Jloor of orbit ;

Zygomatic & spheno-maxillary fossa ;

Spheno-maxillary h pterygo-maxUlary fissures.

May bo desoribed as presenting a body and four processes, malar, nasal, alveolar & palaiet.

BODY— Hollowed out to form Antrum of Highmore. - Presents :

OUTER SURFACE — Convex. Presents from within outwards & backwards :
Incisive or myrtifomt fossa for depressor alo) nasi.

Canine fossa, large & deep for origin of levator ang^i oris & compressor nasi;

at upper part of which fossa is the
Infrtt'Orbital foramen for infra-orbital vessels & nerve ;
Vertical ridoe, which descends from malar process, and behind which is the
Maxillary tuberosity, which is rough along its posterior border for articalation
with the palate bone & sometimes with pterygoid process of sphenoid.

INNER SURFACE — Divided into two unequal parts by palate process.

PART ABOVE PALATE PROCESS - Presents from before backwards the
Inferior turbinated crest, above and below which are

Two wide antero-posterior grooves, which form part of middle & inferior
meatuses, and the former of which is surmounted by the
Superior turbinated crest, which lies on inner surface of nasal process ;
A deep groove which is converted into nasal duct by articulation with la-

chrymal & inferior turbinated bone? ;

Aperture of Antrum of Highmore very large in disarticulated bono bnt

diminished in articulated skull by ethmoid, lachrymal, inferior

turbinated & palate bones, and presenting inferiorly a fissure

into which is received the maxillary process of the palato bone.

A rough surface which articulates with palate bone and is divided into an

anterior & a posterior portioa by a
Vertical grocrue, which forms part of posterior palatine canal.

PART BELOW PALATE PROCESS -Forms anterior part of roof of mouth-

UPPER SURFACE — Forms greater part of floor of orbit, and is bounded :

On Inner Side - By a thin edge which articulates from before backwards
with lachrymal bone, os planum & orbital process of palate bone.
On Outer Side - By a rounded margin which forms part of spheno-
maxillary fissure.
IN Front - By lower part of circumference of orbit. - It presents behind
Infra'Orbital groove for infra-orbital vessels & nerve, which g^r<k)ve becomes con-
verted in front into
Infra'Orbital canal ; - and at its anterior & inner part a
Depression for inferior oblique muscle.

Antmin of Highmore or Maxillary Sinus - 1« a 'arge cavity hollowed out of

body of the superior maxillary bon^
Its walls correspond to the three surfaces of the body of the bone; they are
very thin, and contain the infra-orbital k ant .& post, dental canals.
Its aperture communicates with the middle meatus of the nasal fossos, and is
much diminished in size, and generally divided into two by articu-
lation with ethmoid, lachrjrmal, inferior turbinated A palate bones.
Several laminse of bone project into its cavity, as do also the roots of the 1st

& 2nd molar teeth, which sometimes perforate ite floor.

SUPERIOB MAXILLABY B0NE--2nd Tablet.

MALAR PROCESS — Triangular, and presents j

Ant. Surface - Concave, forma part of canine fossa;
Post. Surface - Oonoaro, forms part of zygomatic fossa;
Sup. BwC&LCe " Bough for articulation with malar bone.

NASAL PROCESS — Triangular, and presents:

Outer Surface - Conoaye, giyes attachment to orbicularis palpebrarum, tendo oouli,

levator labii superioris alsDque nasL
Inner Surface - Presents from above downwards :

Rough surface, which articulates with ethmoid bone ;
Superior turbinated crest which articulates with middle turbinated bone;
Inferior turbinated crest with the two grooves already described.
Ant. Border - Thin, serrated above for articulation with nasal bone, and continuous

below with margin of the deep notch, which bounds laterally the

anterior aperture of the nasal fosssB.

Post. Border - Presents a groove which forms part of nasal duct, of which groove the
Inner margin articulates with lachrymal bone, while the
Outer margin forms part of circumference of orbit, and presents the
Lachrymal tubercle at its junction with orbital surfaoe.

ALVEOLiAR PROCESS "^ Forms a curve of a semi-horse-shoe shape. Xs thicker

behind than in front, and presents eight alveoli in adults, five in

children.

PALATE PROCESS — Presents :

Upper Surface - Concave from side to side. Forms part of floor of nasal fossa, and

presents in front the
Incisor foramen or foramen of Stenson, which is completed on its inner side by a

thm lamina of bone directed backwards from its anterior to its
posterior border (from the latter of which this lamina remains
disconnected in youth). This foramen leads below into the
Anterior palatine canal formed by the junction of the two bones, into which canal

when it is viewed from below, are also seen to open two other

small foramina, the

Foramina of Scarpa situated in the suture between the two laminao. «

The foramina of Stenson transmit the anterior palatine vessels,

while the foramina of Scarpa transmit the naso-palatine nerves,

of which the right one is said to be posterior to the left.

Under Surface -* Concave, rough, forms part of roof of mouth. - Is channelled

by a

Groove (sometimes by a canal) for the posterior palatine vessels & anterior

or great palatine nerve, and presents behind anterior part of

lower orifice of
Posterior palatine caned.

Inner Border - Baised into a ridge which forms with its fellow a gfroove for vomer,

and presents in firont the
Anterior nasal spine.
Ant. Border - Forms lower part of anterior aperture of nasal fi»8».

Post. Border - Articulates with horizontal plate of palate bone.

THE PALATE BONE-lst Tablet.

Presents horizontal and vertical plates^ -from the point of junction of which two plates the pierynii
/r<v«rx projects backwards & outwards, -while from the npper border of the yertioal plate project

upwards, the orbital process in front, and the sphenoidal process behind.
It articulates with its fellow, the superior maxilla^ sphenoid^ ethmoid, inferior turhnated & vomer.
It assists in forming -principally, the floor & outer wall of the nasal fossa and the roof of the mouthy and
-secondarily, the floor of the orbit^ the pterygoid 9i spheno-mctxillary fossa, and the inner wall of tkc

Antrum of Highmerc

HORIZONTAL PLATE — Presents :

Sup. or Nasal Sub pace -Smooth and concave from side to side, forms posterior pari of floor of

nasal fossa.
Ikp. or Buccal Surpacb - Bough, marked posteriorly by a

Transverse ridge for attachment of aponeurosis of tensor palati, and more externally by a
Deep notch, which assists in forming the posterior palatine foramen. A little farther back,

on the under surface of the pterygoid process, are the
External h posterior small palatine foramina for external and posterior palatine nerres.
Anterior Border - Serrated for articulation with palate process of superior maxilla.
Posterior Border - Free for attachment of soft palate.

Iknbb Border -Thick, surmounted by a ridge, which forms with its fellow a groore Ibr Tomer;

presents posteriorly the
Posterior nasal spine for azygos UYule.

VERTICAL PLATE — Presents:
Ikmes Surpacb - Presents the

Superior & middle turbinated crests, above, between k below which are seen
A narrow & two wider horizontal grooves, which form part resi^eotively of the superior, middle

A inferior meatuses.
Outer Surpacb - Presents towards its middle a

Smooth surface, which forms the inner wall of the spheno-maxillary fossa, and is ]m>longed

inferiorly into a

Vertical groove, which assists in forming the posterior palatine canal. In front of these is a

Rough surface, which articulates with the superior maxilla; and further forwards still a

Narrow smooth surface, which forms part of inner wall of antrum. Behind is a

Rough surface, which articulates above with the pterygoid process of the sphenoid,

below with the superior maxilla
Anterior Border - Thin, irregular, presents a projecting lamina, the

Maxillary process^ which assists in closing the lower part of the orifice of the antrum, and,

forming a schindylesis, penetrates into a fissure of the superior maxilla

at the lower part of that orifice.
Posterior Border - Articulates with the inner plate of the pterygoid process.
Upper Border >- Presents the

Of Htal process in front, the Sphenoidal process behind, which processes are separated by a deep
Notch forming the greater part of the spheno-palatine foramen (which foramen is completed

above by the sphenoidal turbinated bone).

THE PALATE B0NE-2nd Tablet.

PTERYGOID PROCESS — ^^^ ^^ the notch between the two plates of the pterygoid prooeaa

of the sphenoid bone, and preienti:
FosTERiOK Surface - Triangular, concare, forms part of pterygoid fossa.

Two Lateral Surfaces - Hoagh, articnlate with the two plates of the pterygoid process A with

the superior maxilla.
Under Surface - Forms part of the roof of the month, and presents the

External & poiterior small palatine foraviina for external & posterior palatine nerros.

ORBITAL PROCESS — Projects upwards & outwards from the anterior part of the upper border

of the vertical plate, and presents i
Three articular Surfaces - Anterun-^ posterior & internal,^ which join respectively with the suferior

maxillary Aone, the sphenoidal turbinated bone ft the latered mass of the ethmoid.

Two NON-ARTICULAR SURFACES :-

Superior or Orbital - Forms posterior part of floor of orbit ;

External or Spheno-maxillary - Forms part of inner wall of spheno^maxillary fossa, and is

separated from the foregoing by a
Rounded border^ which forms part of spheno-maxillary fissare.

SPHENOIDAL PROCESS — Curves upwards, backwards ft inwards, and presents:

Upper Surface - Articulates with sphenoid ft sphenoidal turbinated bones, and assists in for-
ming pterygo-palatine oanah
Outer Surface - Articulates behind with pterygoid process, and forms in front that small part

of inner wall of spheno-maxillary fossa, which lies behind spheno-palat. foramen
^"^HSR Surface - Concave, forms part of outer wall of na«al fossa. {

THE SMALL BONES of the FACE.

NASAL BONBS — Form bridge of nose. -Narrow A thick aboTO, wide and thin below.

Prea«it:
Outer Surface " Conyez from side to eide, concaTe from above downwards at npper part

Presents seyeral arterial grooves and a foramen for a small veia.
Inner Surface "-^^^^^Bely conred; presents a groove for external branch of nasal nerre.

Borders: . , ,

Superior - Narrow, thick, articulates with frontal ;

Inferior - Broad, thin, joined to lateral cartilage of nose ; has a notch for nasal nerve;
External - Articulates with nasal process of snperior maxillary bone ;
Internal -Thick, articnlates with its fellow; is prolonged backwards into a crest whirh

articulates with nasal spine of frontal A perpendicalar plate of ethmoid.

IiACHRYM AL BONES — Form front part of inner wall of orbit. Present j
Outer Surface - Presents from before backwards ;
Groove, which forms part of nasal dact ;
Ridget which gives attachment to tensor tarsi mnscle ;

Smooth surface, which forms part of inner wall of orbit.

Inner Sur&ce - Presents a farrow corresponding to foregoing ridge ; forms part in frrot

of middle meatos, and articnlates behind with ethmoid bon^.

Borders: . ,

Anterior, Superior, Posterior - Articulate respectively with nasal & internal ansmKr
processes of superior maxillary & frontal bones, and with os planum of ethmoid.

Inferior - Articulates behind with orbital plate of superior maxillary, and, in front, is
prolonged downwards into a pointed process, the hamulus lachrymalu, which arti-
culates with lachrymal process of inferior turbinated bone.

HAIjAB BONBS — Articulate with temporal, frontal, sphenoid k snpericr maxillary bonef,

and form part of outer wall &, floor of orbit, and of temporal & zysrv

matio fossse. Pregect :
Outer Sur&ce - Convex ; presents a small malar foramen for malar branch of tempore

malar nerve, and gives attachment to the sygomatic muscles.
Inner Surface - Articulates internally with superior maxillary bone ^ a rough trian-
gular surface, and is concave externally, where forms part of temporal h zvsd*
malic fossffi and presents a foramen for temporal branch of temporo-malar nerve.
Orbital Process- I'rojecta backwards forming part of outer wall & floor of orbit & of lem-
poral fossa; articulates from above downwards with frontal, sphenoid h superior
maxillary bones, and bounds spheno -maxillary fissure anteriorly. - On its inntrr

surface it presents one or two temporo-malar foramina
Frontal Process - Thick, vertical, articulates with external angular process of frontal
Zygomatic Process - Longj horizontal, articulates with zygomatic process of tomporaL

Borders:

Antero. Superior - Forms lower & outer part of circumference of orbit.
Axtero-Inferior -Articulates with superior maxillary bone.

Postero-Superior & Postero-Infertor - Are continuous with superior and inferirr

margins of sygomatic process.

INFERIOR TURBINATED BONES — Thin, and extend along whole length of

outer wall of nasal fossa. Present :
Outer concave & Inner convex Surfaces, marked by vascular grooves and canals, and

the latter of which looks upwards & inwarda
Upper Border -Which, from before backwards :

Articulates with inferior turbinated crest of superior maxillary ;
Forms lachrymal process, which articulates with lachrymal & superior maxillary

bones and completes nasal duct ;
Presents maxillary process, which curves downwards and outwards over lower

edge of orifice of antrum of Highmore.
Presents ethmoidal process, which ascends to join unciform process of etlmioid.
Lower Border -Is free and slightly thickened.

VOMER — Forms posterior part of nasal septum, and is frequently bent to one or other side.

Presents:
Lateral Surfaces ~ Present vascular & nervous furrows, and naso-palatine groove for

naso-palatine nerve.

Superior Border - Presents a deep groove bounded by two projecting ala, between which

the rostrum of the sphenoid is received, and which are overlapped inferiorly by

the vaginal processes of the same bone.
Inferior Border - Articulates with ridge formed by palate plates of superior maxillary

h palate bones.
Anterior Border - Ib grooved above for articulation with perpendicular plate of eth-
moid and joined below to oartilage of the septnin.
Posterior Border* I'*!^ thicker abova than below I leparates pottarior apertores of

oftlMaatof

INPEBIOB MAXILLARY BONE.

11 onnred upon itaelf, and oonsiflts of a middle horizontal portion, the body, and of two lateral

Tortioal jwrtionB, the rami.

BODY — Presents:

£jXT. surfaces — Conyex from ride to ride and oonoaye from abore downwards.

Presents in median line the
Symphysis^ a vertical ridgo, at the lower part of whioh is the
Menial processy from which the

£xiertki/ od/t^ue Itn^ psLsnesh^okw&rdBf first horizontally, giving attachment
to aepressores labii inferioris & angnli oris, and then obliquely A
becoming continnoas with anterior border of ramns. - Laterally

above the oblique line is the
Incisive fossa for levator menti ; and more externally the
Mental foramen for mental vessels h, nerve.

The Buccinator is attached above oblique line behind, and

the platysma, beiow it, in front.
INT. SURFACE — Concave from side to side and convex from above downwards.

Presents the
Symphysis forming a linear depression, close to which near its middle are the

superior h inferior pairs of
Genial tubercles g^iving attachment respectively to the genio-hyo-glosm &

genio-hyoidci. Below these tubercles begins tho

Internal oblique line or mylo-hyoid ridge for mylo-hyoid muscle, faintly

marked at first, but becoming more distinct as it passes upwards

& backwards. - Above & below this line are seen near the syui.

physis tlie
Sublingual fossa for sublingual gland ;

Hough depression for anterior belly of digastric ; and more externally
Submaxillary fossa for submaxillary gland.

Above posterior extremity of mylo-hyoid ridge is attached

the superior constrictor of the pharynx.
SUP. BORDEiR — Thickest behind, where it is dejected inwards ; presents sixteen

alveolis in the adult, ten in the child.
INF. BORDER — Thickest and sUghtly everted anteriorly.

R A U I — Are quadrilateral, and present ;

EXT. SURFACE — Marked by oblique ridges for masseter.
IKT. SURFACE — Presents near middle

Aperture of inferior dental canaly of which the anterior margin forms a prominent
Spine for internal lateral ligament of lower jaw ; - and from which passes

downwards & forwards the
Mylo-hyoid groorve for mylo-hyoid vessels & nerve, behind which groove is a
Rough surface for internal pterygoid muscle.

UPPER BORDER — Presents the coronoid & condyloid processes separated by

sigmoid notch.
Coronoid process -TrisLTigTiiQ.T, gives attachment by its surfaces & borders to tem«

poral muscle, and presents at its lower it front part a groove
whioh is continued downwards npon tho alveolar process, and
which gives attachment inferiorly to the buccinator muscle.
Condyloid process - Consists of

Condyle - Oblong, convex from side to side and from before backwards &

nearly transverse, its long axis when prolonged, meeting that of

its fellow near anterior margin of foramen magnum.

Ntxh - Flattened from before backwards, convex behind, excavated in

front for external pterygoid muscle, presenting externally a

tubercle for external lateral ligament of jav.

ANTERIOR BORDER — Continuous with external oblique line; thin above,

thicker below where grooved for buccinator.

LOWER & POSTERIOR BORDERS — Thick and form inferiorly the

Angle of the jaw, which gives attachment to masseter & internal pterygoid

muscles and to stylo-maxillary ligament.

HYOID BONE.

Eorfe-sHoa shnped, and snspeaded by Btylo.hyoid ligaments from tips of styloid prooetstt
of temporal bones. GonsiBts in youth of fire parts, the body and the greater ^ leeMr
oomna, whioh parts are joined together by four arthrodia; the oornna nsnally join with
the body, the greater ones towards the middle period of life, the lesser ones in advanced

BODY '^ Qaadrllateral. Present si

Anterior Surface - Oonvez, looks upwards A forwards, and Sa marked by a

orucial ridge. The part aboye the ridge gires attaohment to the hyo-gloasTis,

genio-hyo-glossns & genio-hyoid ; the part below the ridge gxTes attaohment to

the mylo-hyoid| the stylo-hyoid & the aponeurosis of the digastric.

Fostericr Surface * Smooth, conoaye; looks backwards it downwards, and is sepa-
rated from the epiglottis & the thyro*hyoid membrane by a quantity of looio

areolar tisane, in whioh a borsa is nsnally found.

Upper Border * Thick & ronnded ; giyes attaohment to genio-hyo-glossni by its an-

. tenor lip, to thyro^hyoid membrane by its posterior lip.
Lower Border -Thinner; giyes attachment to stemo., omo-, ft thyro-hyoid.

OBIS ATBR CORNU — Projects backwards ft slightly upwards, giying attaohment super,
iorly to the hyo-glossus, internally to the middle constrictor of the pharynx,
and externally to the thyro-hyoid. It diminishes in size from before backwards,
and is flattened from above downwards. Its slightly enlarged extremity gires

attachment to the lateral thyro-hyoid ligament.

LESSEB CORNU — Small, oonioal; projects upwards ft backwards from point of jnnctioa

of body ft greater oomu, and gives attaohment to the stylo-hyoid ligament

SKULL AND FACE IN GENERAL.

UNDEB SURFACE of BASE of SKULL.

Ii bounded from before baokwsrdi by i

Ahmtar atrth 6* Utth of upper jam;

f^^^ A^v^ ^^^^^^ ^^f.^ flTmrff fr frrri^frfffrr fntf fnrm ixgrnnt In mnitcild prooowj,

Superior curved line ofocdpiiu boui.
Grouping points of interest on under snrfaoe of skoU, the latter may be said to present from

before baokwardi:
RoofofMouih;
Posterior Aperture ofNares :

Under Surface of Basilar Process, on eaoh side of wbioh is a
Quadrilateral Space, the angles of whioh are formed by the Goitdtlb of the ocotpitsl

bone, and by the Ptebtgoid, Ztgom atic and Mastoid Paocesses.
Under Surface of Remaining Part of Occipital Bone*

ROOF OF THE MOUTH

Is formed by palate processes of superior maxillary ft horisontal plates of palate bonee, 9ai

is bounded laterally h in front by alveolar arch.

Is concaye, uneven ft marked by a oruoial suture, and presents from before backwards i

outwardf:
Lower openings of anterior palatine canal, into whioh may be seen to open, laterally
Poramen ofStenson for anterior palatine yesselSi and in middle 1^,
Poramina of Scarpa for naso-palatine nerresi
A groove leading to

Posterior palatiru foramen for post, palatine vessels ft ant. or great palatine a;
Transverse ridge for attachment of aponeurosis of tensor palati;
Accessory or small palatine foramina, posterior 6* external^ fas posterior or small, and Ue

external palatine

POSTERIOR APERTX7RE OF THE NARES

Is bonndud by body of sphenoid, horisontal plate of palate bone, and inner plates of pterjgoii

processes, whioh latter present inferiorlr

Hamular process for reflection ot tendon of tensor palati, and superiorly.
Scaphoid fossa for origin of that muscle.
Is divided iuto twoliy vomer, and presents inferiorly

Piiiterior nasal spine for origin of azygos uvulas, and superiorly
Expanded ala of vomer, whioh articulate with rostrum ft with vaginal proee aws of

sphenoid, and on either side of which sre
Pterygfhpalatisu canals formed in part by sphenoid ft in part by palate boo«,

and giving passage to pteiygo-palatine vesaels ft nervet.

UNDER SUTIFACE OF THE BASILAR PROCESS

Presents iii middle line

Pharyngeal spine for median raphe ft superior constrictor of pharynx, and lateraDj,
Bough depressions for insertion of recti capitis antid nugor ft minor.

QUADRILATORAL SPACE— y. next Tablet.

UNDER SURFACE OF THE OCCIPITAL BONE(&i]ui]rtii«PAmT)-Pi«.

Poramen magnum for cord ft its membranes, vertebral arteries ft spinal aecenory

nerves, on outer side of which foramen srt
Condyles of occipital bone having

juguiar process on their outer ride.
Anterior condyloid foramen in front.

Posterior condyloid fossa sometimes perforated \xj Vb» posterior emuhlmi

/oewnem behiai.
£jrt. Occipital Crest giring off latently
Superior &* Inferior curved lines, and ending posteriorly in
External occipital protuberance.

For parts just mentioned see Occipital Bone.

QUADRILATOBAL SPACE.

la formed hj the nnder snrfaoes of the oooipital bone and of the sqiubmoiia 4 petrous por«
tions of the temporal and of the greater wing of the fphenoid, and ie litiuited on either

■ide of the baeilar prooess*
Itii quadrangular.

ITS ANGLES

Are formed by the Oondyles of the oooipital bone and by the Pterygoid, Zygomatio

A Mastoid processes. (Vide these parts in respectire Tablets. )

It ]■ divided in two by a well marked diagonal line obliquely directed from before back*
wards A outwards, and presents points of interest both in front of & behind its

diagonal line.

ITS DIAGONAL LINE

Bztends from the root of the pterygoid to the mastoid process, and presents from be-
fore backwards & outwards the

Foramen laeerum medium closed by cartilage, and crossed superiorly by the

internal carotid artery h the Yidiau nerre;

Rough surface for origin of levator palati k tensor tympanii
Jnf orifice of Carotid Canal \
Vaginal process I

Styloid process, whioh gives attachment to the stylo-hyoid & -maxillary liga-
ments and from above downwards to the stylo-pharyngens, -hyoideus dt

-glossus musdes:
Stylc-mastoid foramen for facial nerve & stylo-mastoid artery.

IN FBONT ft on the OUTER SIDE of the DIAGONAL LINE

Are found from before backwards h outwards the

Foramen ovale for inferior maxillary & small petrosal nerves and small menin-
geal artery, and on inner side of which is sometimes found the
Foramen Vesalii for a small vein;
Foramen Spinosum for middle meningeal artery;

Spine of the Sphenoid for internal lateral ligament of jaw h laxator tympani m.
Openiftgs of the caned for the tensor tympani muscle (above) ^ of the osseous portion

of the Eustachian tube (below).
Glenoid fossa divided by Glaserian fissure into

Anterior part^ covered with cartilage which latter is prolonged over

the emimentia artioularis;
Posterior part non articular, and bounded behind by the vaginal h au-
ditory processes and the middle root of the xygoma.

BEHIND ft on the INNER SIDE of the DIAGONAL LINE

Are the :
>»,v yugular fossa for internal jugular vein. This fossa ass'sts in forming the

Jugular foramen or Foramen Laeerum posterius, of which tho

Anterior or inner part, smaller and separated from the remainder by a
bony ridge, gives passage to the glosso-pharyngeal, pneumo*

gastric h, spinal accessory nerves, while the
Posterior part, the largei, transmits the internal jugular vein ;
juguiar process for rectus capitis lateralis k lateral occipito-atloid ligamont.

Thffe process has in front of it ft to its inner side the
Anterior condyloid foramen for hypoglossal nerve \ behind it ft to its inner n is the
Posterior condyloid fossa sometimes perforated \ij posturior condyloid foramen for

a small vein to lateral sinus.
Openings for JacobsofCs d* AmMa nerves^ and opening ofAqmodnetmt Cocklem*

INNER SURFACE of BASE of SKULL.

fMMBtfl three fon«.

ANTERIOR FOSSA - The hlgheet.

Formed hj orbital platee of firontal, cribriform pUte of ethmoid* leeeer wings «ad front

part of upper ear&oe of bodr of aphenoid
FreieniB the sntiiree between the foregoing bones, and in median line and from abon

downwards and then baokwardi;
Front part of groove for superior longUudmal nmu,
Frontal erestf
Foramen caeum,
Crista gallic
A sligSuy elevated Hebe.

On the side of the two latter ie the

Olfoctory groove deep in front^ where it ie Cbkmed by ozibrilbrm plate of

ethmoid, and preeeatt
Three rows offoranUsui for ol&otory nenresy
Slit4iAe opening for nasal nerye.

Anterior ft postesior ethmoidal foramina for nasal nerre and ant»'

rior & posterior ethnuridal arteiut.

MIDDLE FOSSA — vide next Tablet

POSTERIOR FOSSA -The deepest

Formed by oooipital, petrons ft mastoid i>ortion8 of temporal and posterior inteior angle of

parietal, and bounded in front by dorsum sellsd ft superior border of petrou

bones, and behind, by grooves for lateral sinuses.
Fresents the sutures between the foregoing bones, and in the centre t

Foramen magnum for oord and its membranes, spinal aooeseory nenrea ft Tertebnl

In Front of the Foramen Ifagnnm i« the

Basilar groove^ whioh supports medulla oblongata ft pons, and on the aidee of
which are the petro^oeci^tal sutures^ which are groored in front
for inferior petrosal sinuses and expanded behmd into jugular

foramen or fbramen laoemm posterina

Behind the Foramen Magnom ie the

Internal occipital cresf^ whioh separates the two

Inferior occipital fossce^ and ends in the
Internal occipital protuberance^ whioh is situated at point of Junction of the

Groova for lateral sinuses^ and to whioh corresponds the torculsr

HarophiU.

On the Sides of Foramen Magnom ^re the

Anterior condyloid foramina for hypoglossal nerres, and, occasionally, the
Posterior condyloid foramina for a small vein to lateral sinus \
Jugular foramen or foramen lacerum potteritis^ of which the

Anterior or inner part^ smaller and separated from the remainder
by a bony ridge, giyes passage to glosso-pharyngeal, pneu-
mogastric ft spinal accessory nerres, while the
Posterior part^ larger, transmits the internal jugpilar rein ;
PosUsUr mrface of petrous portion of temporal bone presenting

Internal auditory meatus for fl»cial nerre and auditory artety ft n^
Slit-lihe aperture of Aqueductus VestUmli for small artery ft Tein

and a prooest of dnra mai«r.

XODDLE FOSSA of BASE of SKULL.

li narrow in median line it expanded laterally.

la formed hj body & greater winga of sphenoid, sqnamona portion and anterior anrfkoe of
petrous portion of temporal and anterior inferior angle of parietal, and is bonnded
b/ lesser wings of sphenoid & anterior margin of optic groore, in fix)nt, and by-
superior border of petrous bones behind.

Presents the sntnres between foregoing bones and

In Median Line from before backwards ;

Optic groove leading on either side to

Optic foramen for optic nerve A ophthalmic artery,

OUvary procas^

Seila turcica on each side of which is the
Cavermms groovCf

Dorsum sciia presenting at its npper angles the
PosUrior clinoid processes,

LateraUy:

Cerebral emtneuces & depressions^ and grooves for middle meningeal artery i and

more internally, and from before backwards :
Sphenoidal fissure or fitramen lacerum anierius for 8rd, 4th & 6th nerves, and

ophthalmic nerve ft vein«
Foramen rotundum for superior maxillary nerre^

Foramen ovale for inferior maxillary & small superficial petrosal nerves

and small meningeal artery, (on inner side of which latter

foramen is sometimea seen
Foramen VesalU for a small vein ),
Foramen spinosum for middle meningeal artery.
Foramen lacerum medium dosed with oartilagei

On Anterior Sur&ce of Petroas Bone :

Internal orifice of carotid canals

Depression for Casserian ganglion^

Grooves to Hiatus FallopU for large superficial petrosal nerve and to a maUer

and more external opening for small superficial peirosal

nerve I frequently
Jkoo other small foramina fbr small petrosal branch of glosso-pharyngeal and

branch of glosso-pharj^ngeal to large superficial petrosal nerT%

Eminence corresponding to superior semi-drcular canaL en outer side of

whiokk*
Depression corresponding to cavity of tympani

LATEBAL REGION of the SKULL.

P m t n ta from behind forwards the i
Mastoid process ;
Ext. auditory meatus;

Zygomatic arch A ramus oftAejaw, which two latter arcdi over tiie temporal, ajgomatie

4 apheno-mazillaxy §otsm,

TEMPORAL FOSSA

Is formed by the temporal, frontal. St malar bones, the great wing of the sphenoid,
4 the anterior inferior angle of the parietal, and is deeply eKoavrnted below A

in fraat.
Is bounded above by the temporal ridg^, and opens widely below into the sygoraatie

fossa, the boundary line between the two being the sygomatio aroh St the pterygoid

ZYGOMATIC FOSSA

Is an irregular and imperfectly enclosed space, the incomplete walls of which are formed

on the anterior, inner, upper & outer aspects respeotirBly by tbc

Tuberosity of the sup, ikaxiliary bone^

Ext, pterygoid platet

Under surface of great wing oj sphenoid as fiir as pterygoid ridge, uid sqmaaums

portion if temporal bau-
Zygomatic arch & ramus ofhnverjaw,

Oommnnicates with temporal fossa beneath the zygoma, and with the orbit h epheno*

maxillary fossse through the spheno-mazillary & pterygo-maxillary fissures.

Spheno-Maxillary Fissure - ^^ bounded by superior maxillary, great wing of sphenoid,

malar & palate bones, and joins internally at right angles with ptenrg^

maxillary flnure.
Opens up communications between the orbit and the temporal, sygomatio k

spheno-maxUlary fbesB.
Transmits infraorbital artery, superior maxillary nerre ft ascending or orbital

branches of Meckel's ganglioa.

PterygO-Maxillaxy Fissure - Ib comprised between pterygoid process ft tuberosity of

superior maxillary bonsL
Joins superiorly at right angles with spheno-maxillary fissure.
Transmits internal maxillary artery from sygomatio to spheno-maxillary fossa.

SPHENO-MAXILLARY FOSSA — is the narrow ft vertically elongated space

comprised between the pterygoid process ft the maxillary tuberosity, and bounded

above ft internally by the body of the sphenoid ft the vertical plate of the palate bone.

Its upper part is the point of meeHng of the sphenoidal, spheno-maxillary ft pterygo-

maxillary fissures.

It communicates with the cranium, orbit, sygomatio ft nasal fossae by the foramen rotna.

dnm ft spheno- ft pterygo-maxillary fissures ft the spheno-palatine foramen, and has,

opeiiiiig into it, the vidian, pterygo-palatine, posterior palatine ft aooessory posterior

palatine oaonls.

■THE OBBIT.

Qiiftdrilateral pyramidal fofia looking forwards St oatwards and formed by aeren boaeii
the fironial, ethmoid, iphenoid ( which enter into formation of both orbits), sape<

rior maxillary, malar, lachrymal & palate.
Commimioates with oraniom, and with nasal, temporal, sygomatio & spheno-maxillary

fossae through optic foramen, nasal dnot & spheno-mazillary fissaro.
Presents :

BOOF — Formed by orbital plate of frontal A lesser wing of sphenoid. Is concave, and pre-
sents the sntnre between the foregoing bones, and in front the
Lachrymal fossa fbr lachrymal gland, and a
Dipression (fovea trochlearis ) for pulley of superior oblique.

FLOOR *"" Formed by upper or orbital surface of superior maxillary and orbital processes of

malar it palate bones. Presents the sutures between foregoing bones, the
Infra'-orHial groove for infra-orbital vessels &, nerve, which becomes converted in front into

Infra-orbital canal; and also at its anterior ft inner part a
Depression for inferior oblique muscle.

INNER WALL — Formed from before backwards by nasal process of superior maxillary,

lachrymal, os planum of ethmoid, body of sphenoid. Is antero-posterior

in direction and parallel to its fellow, and presents the sutures between

foregoing bones and the
Lackfymal groove for lachrymal sac,
Crest of lachrymal hone for tensor tarsi muscle.

OUTER WALL — Formed in front by orbital process of malar bone, and behind by ante*

rior or orbital surface of great wing of sphenoid. Is very oblique forwards
ft outwards being nearly at right angles with its fellow, and presents the

suture between foregoing bones, and the
Orifices of one or two malar canals,
Small spine for lower head of external rectus.

ANGLES:

BUP. EXTBBNAL- Presents:

Articulation of frx>ntal with malar bone ft orbital plate of sphenoid.
Sphenoidal fissure ot foramen lacerum anlerius iot 3rd, 4th ft 6th nerves and ophthalmio

nerve ft vein*
BUP. INTEBNAL - Presents

Suture connecting frontal with lachrymal ft os planum, in which suture are the
Anterior ethmoidal canal for nasal nerve ft anterior ethmoidal vessels, and the
Fosterior ethmoidal canal for posterior ethmoidal vessels.
INF. SXTS&NAL- Presents

Spheno^mctxillary fissure for infra-orbital vessels ft nerve and ascending branches of

Heokers ganglion.
INF. INTSBNAL-Presenta

Articulation of superior maxillary ft palate bones with lachrymal ft os planum.

CIROUMFBRENCE OR BASE — Quadrilateral, looks forwards ft outwards. Is

bounded by supra-orbital arch and external ft internal angular processes
of frontal, anterior border of orbital surface ft nasal process of superiof
maxillary, and anterior border of malar bone. Presents

Supra-orhital notch or foramen for snpra*orbital vessels ft nerve ; and assists in forming

Lachrymal groove for lachrymal sac.

— Corresponds to optic foramen for optic nerve ft ophthalmic arteiy.

THE NASAIi FOSSiE.

Two BMrrow irregular oftTlilei oomprlfed between the erbita A eaperior mmtSluj bones,

and between tlie roof of the month ft the front part off ^e baae of the aknlL

Ibnned by ethmoid, sphenoidi frontal, snperior maiillarj, naeal, palate, infbrior tarbin-

ated ft Yomer (all the bonee of the face except malar ft inferior maxillary) .

Oommnnioato with orbit (nasal dnot), month, (anterior palatine oanal), oraniom (olfactory

foramina), spheno-mazillary fossa (spheno-palatine foramen), and with the
frontal, ethmoidal, sphenoidal, ft mazillary sinnsee. — Present:

ROOF " Narrow, and is from before backwards :

ObUpti upwards ft hackwards and formed by nasal bone ft nasal spine of frontal,
HoriMOfUal and formed by oribriform plate of ethmoid,

OHifiu dffwmoards ft backwards and formed by body of sphenmd. - Presents the entorBS

between the foregoing bones and frcm before backwards :

Crowe on nasal bone for outer, branch of nasal nerve ;

ffal/erest tot perpendionlar plate of ethmoid ;

Olfactory foramista ft nasal slit for olfactory and nasal nerves i

Openings of sphenoidal sinuses partly closed by sphenoidal turbinated bones}

Articulation of alee of vomer with body of sphenoid.

JPXfOOR *~ Concaye from side to side, and formed by palate processes of snperior maxillaiyft

palate bones. - Presents the sntnre between foregc£c£ bones ft the
Upper orifice of the anterior paiaUne canal;

Half crest for vomer, which terminates in front ft behind In the
Anterior ft posterior nasal spines,

DTNSR WALL — Formed principally by the perpendionlar plate of the ethmoid above

ft in front, and by the vomer below ft behind, and secondarily by
nasal spine of the frontal, rostmm of sphenoid, crests of snperior maxil-
lary, nasal ft palate bones. Has an angolar defidenoy in fttmt which is
filled np by the cartilage of the septnm. - Is frequently inclined to one
or other side; and presents the sutures between the foregoing bonee and
Vascular ft nervous frirrows ft
Naso'Palatine groove for naso-palatine nerve.

OUTER WALL — Formed by:

iMthrymalhoneh nasal process of superior maxillary ;
Mner surface of ethmoid^ superior maxillary ft inferior turbinated bones ;
Vertical plate of palate bone ft inner plate of pterygoid process, - Presents the sutures between

the foregoing bones and from above dowi^^ards:
Superior turbinated process of ethmoid ;

Superior meatus^ into which open the sphenoidal ft posterior ethmoidal sinuses
and the spheno-palatine foramen. - Both are short and are situated at

the posterior and upper part of the nares ;

Mfiddle turbinated process of ethmoid ;

Middle meatus^ larger than foreg^ng, into which open the Antrum of Highmore
and through the infondibnlum, the anterior ethmoidal oells ft frontal

inferior turbinated bone ;

Inferior tneatus^ the largest, presents in front the opening of the nasal due**

UPPER LIMB

AXILLA; FRONT OF ARM

THE BffAMMA.

Badimentary in the male, small in the female before puberty ; xnoreatee In eize darii ^

pregnancy i after delirery. - Prefects :

POSTERIOR SURFACE, or BASE ^ Somewhat oonoayei nearly oirenlar, bat
•lightly elongated from below upwards & ontwarde. Ilesta npon peotoralia major
& Stscia covering it, and extends from 8rd rib to the 6th or 7th, and from side of

sternnm to axilla.

ANTERIOR SURFACE — Presents, a little below its middle, the nipple snrronaded by

the areola.

Mipple -* Cylindrical or conical i presents at its apex the openings of the laotiferous

dncts. Its surface is of a pink or brownish hue, wrinkled, proTided with

papillm, and, near its base, with some sebaceoas glands. It is snsceptible

of a sort of erection doe mainly to the contraction of its muscular fibi

Areola - Bosy iu the Tirgin ; larger & darker in colour after the second month of
pregnancy A during laotation (when its sebaceous glands enlarge consider-
ably), and also somewhat so during the remainder of life.

CUTAKEGUS NEBVES.

Superfioial Desoending - Several large branches from 3rd & 4th.

Descend between sterno-mastoid A trapezius, and divide into branches;

Steanal - Cross origin of stemo<mastoid to integument of front of cbost ai

far as middle line.

Olayxculab - Cross clavicle (sometimes one of them perforates the bone) ti

integument over pectoralis major A deltoid, communicating with cut:\.

neous branches of the superior intercostal nervt-?.
ACBOMIAL - Over acromion & clavicular origin of trapezius to integument of

outer & back part of shoulder.

Lateral CatanOOOS- Pierce intercostals & serratus mag'aus midway between Tertebr«»

& sternum, and divide into : -
Anierior Offset - Forwards to integument of side of chest & mamma, and to

upper digitations of external oblique.
FosUHor Offset - Backwards to Integument over latisaimus dorsi ft scapula.

The posterior oflfaet of the lateral cutaneous branch of the 2nd
intercostal nerve, is called the intercosto-hMmeral nerve. It orossea the
axilla, joins with lesser internal cutaneous nerve or nerve of Wrisberg
ft with internal cutaneous branch of musculo-spiral, and pleroes deep
fascia to integument of upper inner ft back part of arm i its sixe Tariea
inversely with that of the nerve of Wrisberg. There is frequently a
second interoostchumeral nerve derived from the 3rd intercostal.
Anterior CutaneoUil-The termination of intercostal trunk. Pierce internal inter.

oostals ft pectoralis major by side of sternum, and turn outwards to integn-
ment of mamma ft front of chest. The second joins with the olavionlar

branches of the supertoial cervical plexna.

MUSCLES of UPPER LIMB-lst TABLET.

ANTERIOR THORACIC REGION.

Pectoralis Maior - Anterior surface of inner half of olaviole; oorrespondinjir ^^^^ o'
front of stemnm ; oartilagea of all the true ribi except Ist or 7th or both ; apon-
enroBis of external oblique.

Anterior or outer edge of bicipital groove of humerus. - S. bj internal &
externa] anterior thoracic nerves.

Poctoralis Minor - Outer surface A upper border of the 8rd 4th A 5th ribs near their
extremities.

Inner berder of ooracoid process of scapula. - S. bj internal anterior
thoracic nerve.

Subclavius " Oartilage of first rib in front of rhomboid ligament.

Groove on under surface of middle third of clavicle. - S. by one of the
supra-clavicular branches of brachial plexus.

LATERAL THORACIC REGION.

Sorratus Magnus - By nine digitatieos from outer surface & upper border of eight
upper ribs (the 2nd rib having two digitations).

Whole length of anterior lip of posterior border of scapula, the two upper
digitations being inserted into triangular smooth surface on anterior aspect of
superior angle, the three middle digitations into posterior border between superior
A inferior angles, and the four lower digitations into anterior aspect of inferior
angle. - S. by posterior or long thoracic nerve or external respiratory nerve of
Sir C. Bell.

Iiatlssunns Dorsi - Spinous processes of the 6 or 7 lower dorsal vertebras; by the
posterior layer of lurabar aponeurosis, from the lumbar & sacral spines and
the^ back part of outer lip of crest of ilium ; from outer lip of crest of ilium for
an inch or more in front of lumbar aponeurosis ; from the last three or foar ribs
interdigitating with external oblique ; sometimes by a few fibres from inferior
angle of scapula.

Bottom of bicipital groove of humerus a little higher up than teres m%jor
by a broad flat tendon twisted upon itself. -> S. by long subscapular nerve.

AXILLAItY ABTEBY

Fram outer border of first rib to lower bordei of tendoni of teres m^jor ft Utiiinmiia don^
being either straight or slightly onnred upwards or downwards aooording to pocdtum of

limb, and lying deeply at its origin & saperfioially at its terminalaniL

Kay be diyided into three parts ;

FiBST Paut - Abore peotoralis minor ; rests upon thoracio walL

SscoHD Vamt - Behind peotoralis minor | passes obliquely from thorax to mrm,

Thied Past - Below peotoralis minor i lies on inner side of neck of hnmema.

RELATIONS :

FIB8T PART:

Ih noMT- Peotoralis m8Jor,oosto-ooraooid membrane I oephalio ft aero*

mio-thoraoio Tsins i external anterior thoraoio nerrei
BBBom ft ON Imnu Sidb - First intercostal spaoe, first digitation of asr-

ratns magnns, posterior thoraoio nerve.
On Ixhxb Sidb ft nr Fbomt - Azillaxy Tela.
On Ounm Sidb -Brachial plezns.

SECOND PART:

In Fbont - Peotorales'm^jor ft minor.

Behind - Upper part of snbsoapnlaris ft posterior cord of braohial plexan

On Innbb Sidb - Axillary yein ft inner cord.

On Outbb Sidb - Ooraco-brachialis ft outer oord.

THIRD PART:

In Fbont - Peotoralis major (except at lowest part). Junction of the two

heads of median nerre.
Bbhind - Lower part of subsoapularis, tendons of teres major ft latissimus

dorsiy musoulo-spiral ft circumflex nerres.
On Innbb Sidb -Axillary Tein, inner head of median, ulnar, internal

cutaneous ft lesser internal cutaneous nerres.
On Outbb Sidb • Qtm i iii^braohialisi cater head of median nerre, musculo*

outaaeoua nerrow

BRANCHES of the AZILLABY ARTERY

Yutj oonMenhlj in mode of origin^ nie St number* Are itill nBoell j desoribed after Haller

M being given off ae foUowi, from

FIBSTPART:

8np« Thoracic — Small, inwards along upper border of peotoralig minor, and then

between latter miuole A pectoralie major | anastomoses with intercostales

& internal mammary*
Acromio-thoracio «— Sbort, thiok, from fore part of artery. Forwards to upper

border of peotoralis minor, and diyides into branches t
AcKOMiAL •- Join with snprasoapnlar A with both ciromnflez.
Thobacic - Two or three. To peotorales & serratns mag^ns, and join with

' intercostales A internal mammary.
HuxxRAL - One, rather large. Downwards with oephalio yein between peo-
toralis migor A deltoid.

SECOND PART:

Long Thoracic or Ezt. Mamxnary — Large branch. Along lower border of

peotoralis minor to mamma, peotorales A serratos, and to axillary glande
A snbscapnlaris. Joins with the other thoracic A with sabsoapnlar.
Alar Thoracic — * Small A often wanting. To azillaiy glands A oellnlar iUBu»»

THIRD PART:

Subscapular — The largest) branch. Along Jlower border of snbsoapnlaris to lower

angle of scapnla, where joins with posterior scapular. Oires off twigs to

snrronnding mnsoles, and

DouAUS ScAFULA - Arisos an inch A a half from origin of rabscapnlar. Ronnd

enter border of scapula between teres major, teres minor] A long

head of triceps, and then between teres minor A the bone. Giyes

off t
Brancha to sabsoapnlar fossa between 8abBoapnlaris*s& bono} join with

posterior- A snprasoapnlar.
Descending 6r. between teres mijor A minor.
Brancka to infraspinons fossa i join with posterior- A snprasoapnlar.

Ant. ClrcUXUflex — The smaller. Outwards beneath ooraco-brachialis, short head

of biceps A deltoid, giring off twig to shonlder joint ; joms with following

A with acromial branch of acromio-thoracio.

Post. Circumflex — The larger. Throngh quadrangular space between teres
major, teres minor, long head of triceps A humerus, and round neck of
humerus beneath deltoid. Gives twigs to shoulder joint, and joins with

precediBf A with acromial branch of acromio-thoraoia

BBACHIAI. PLEXUS.

Formed ai followB bj anterior diyisionB of 6th, 6tb, 7th, & 8th oerWeal and let dorsal iulj
Fifth &* Sixth Cervical nnite between anterior & middle soaleni, and form the

ouTiB fbucart ooba
Eighth &* First Dorsal unite behind soalenns antiouB, and form the iKicn
Seventh f ormi alone the middu p&imaet cord. [fbixart oobbi

All three primary oords divide into anterior ^ posterior divisions.
Anterior diviaionB of outer &* middle primary oords form the outbb ooux
Anterior division of inner primary cord forms the iicnbr oobd.
Posterior divisions of oM three primary oords form the fostbriob cosdi.
Broad Y^etween anterior & middle soaleni^ where anterior divisions of the nerves lie
above 2nd part of enbolavian artery ; oontraoted opposite olaviole, where inner k
enter cords lie at fore part of plexns on enter side of Srd part of enbolavian artery
& of 1st part of axillary; again expanded in axilla, where the three oords lie oa
inner, onter & posterior aspeots of 2nd part of axillary, and where they break up

into the large nerves of npper UmK

Commnnioates with the oervioal plexus through loop between 4th & 5th nerves & throogh

branch from 5th nerve to phrenio^ and with middle & inferior ganglia of sjmpathetia

BRANCHES — Am

ABOVE THE CLAVICLE:

Post, or Long Thoracic, or Ext. Respiratorjr of Sir C. BeU - From

5th h 6th nerves, the two roots uniting in substance of sea.

lenua anticus.
Deeply along side of ohest behind axillaiy vessels & oords of brachial

plexus as far as lowest digitation of serratus xnagnns.
Buprascapnlar - From back of trunk formed by union of 5th & 6th.

Backwards & outwards beneath trapesius & through suprasoapnlat
foramen to supraspinous fossa, where lies between supraspina-

tus & the bone.
Bound spine of scapula to infraspinous fossa. - Supplies supra- St infra-

Bpinati (two twigs to each), shoulder- joint h acapnia.
UnSCnlar - ^o rhomboidei & frequently to levator anguli scapula (from 5:h

nerve), subclavius (from 5th & 6th, anastomoses frequently
with phrenic), scaleni & longus colli (variably from 6th 7tfa^

SLh.)
Conunnnicatillg - From 5th cervical to phrenic on anterior soalenua.

BELOW THE CLAVICLE — The branches are given off from the three cards

as follows, firom:
Outer Cord - External anterior thoracic, outer head of median, mus*

oulo-cutaneous or external cutaneous.

Inner Cord - Internal anterior thoracic, inner head of median, ulnar,

internal cutaneous, lesser internal cutaneous or n. of Wrisberg.

Posterior Cord - The three subscapular nerves, mnsculo-spiral i

circumflex
Anterior Thoracic Nerves - Two, connected together by a loop on incei

side of axillary artery.
External oe Superficial -The largest. Grosses both axillary artery A

vein to under surface of pectoralis major.
Internal or Deep - The smallest. Between artery & vein, and gives

twigs to under surface of both pectorales.

Snbscapnlar Nerves - Three :

Upper - The smallest i to upper part of subscapularis.
Lower - To lower border of subscapularis & to teres mnjor ; the latter

muscle having sometimes a separate nerve
LoMe- The largest. Along lower border of subscapularis to latissimns

dorsi

MUSCLES of UPPEB LIMB— 2nd TABLET.

ANTERIOR BRACHIAL REGION.

Biceps :

SuoET Hbad - Tip of coraooid proceiB of scapula in oommon with ooraoo-liraeliialis.

Long Head - Top of glenoid cayitj of fioapula & glenoid ligament.

Back part of bicipital tnberositj of the radiua. - S. by mn5cnlo*ontaneoii8
nerre.

Coraco-brachialis - Tip of ooracoid process of scapula in common with short head of
biceps.

Ronri^h impression a little above middle of Inner surface of shaft of
hnmerus. - S. by muscnlo-cataneoas nerre.

Brachialis Anticus - Lower half of inner & outer surfaces of shafb of humerus;
front of internal & external intermuscular septa.

Under sarface of ooronoid process of ulna. - S. by musculo- outaneous &
musculo-spiral nerves.

BKA.GHIAL ARTERY

Oommenoea at lower border of tendoni of terea miijor ft lattsBliiiiii dorsL
Down inner & anterior aspects of arm in groove along inner border of ooraoo-braohtalis A
biceps, lying at first on inner side, and then in front of, hnmems^ its more pr«ciae
direction being marked by a line drawn from outer side of axilla to midway betweea

condyles of homiaras
Divides into radial & ulnar half an inch below bend of elbow, or opposite neck of radius.

BELATIONS:

ALONG THE ABM:

In TBOiiT - Skin and fosoia, inner border of ooraco-braohialls ft bioeps; mediaii

Bbhind - Long and inner heads of tricepsy snperior profonda artery ft musculo-

spiral nenre ; coraco-brachialis, brachialis anticu.
On Inner Side -> Skin ft fascia, internal cntaneons nerve, basilic vein ; nlnar nerve

in upper part, median nerve in lower pari
On Outee Side - Goraoo-braohialis ft biceps, hnmems in upper partb

AT BEND OF ELBOW:

In jeont - Skin, superficial fascia, median basilic vein, branches of anterior

division of internal cataneous nerve ; bicipital or semilunar
Behind - Brachialis anticus ft elbow joint.
On Inner Side - Pronator radii teres, median nerve.

On Outee Side -Tendon of biceps, sujunator longus, muBOuIo-ontaaeouE ft, mi

onlo-spiral

BRANCHES:

MUBOtllaY — Irregular, to ooraco-braohialis, biceps ft brachialis anticus.

Nutritious! — From near middle of artery. Enters nutrient canal near insertioB
of coraco-brachiaUs, and descends towards lower extremity of the bone.

8up« Profunda "^ From upper part of artery. With musculo*spiral nerve in
g^roove of same name between inner ft outer heads of triceps, and then between
supinator longus ft brachialis anticus, where joins with radial reonrrenL
Gives ofif muscular branches, and an articular branch to back of elbow joint,
which joins with interosseous ft posterior ulnar recurrent, and with inferior

profunda or anastomotioa magna.

InfL Profunda -^ Small, Ijrom near middle of artery. With nlnar nerve ihrongh

internal intermuscular septum, and then between inner condyle ft olecranon i

anastomoses with posterior ulnar recurrent ft anastomotioa magna.

Anastomotioa Magna — From lower part. Through internal intermuscular
septum, and round back of humerus forming an arch above olecranon fossa
with articular branch of superior profunda. Joins with anterior ft posterior

ulnar recurrent ft with inferior profunda.

UPPER LIMB.

II.

FRONT OF FOREARM.

PALM OF HAND.

SUPERPICIAL VEINS.

Hftdial - Oommences at outer side of arch on dorsnm of hand. BeoeiTes braaohes from
back of thnmb A index finger, ascends along front of outer side of fore-arm,
commnnioating with median, and joins at bend of elbow with median oepbalio

to form the cephalic.

Anterior Ulnar - Oommences on anterior aspect of wrist & inner side of palm of hand,
ascends along front of inner side of fore-arm oommnnicating with posterior v^nar
A median, and, at bend of elbow, joins with posterior nlnar, & then with median

basiliOf to form the basiUc.

Posterior Ulnar - Commences at Inner side of arch on dorsum of hand, reoeiring
Tena salvatella from little finger, ascends along back of inner side of forearm, and,
at baud of elbow, joins with anterior nlnar, & then with median basilic, to form the

basilic.

Xdedian " Oommences in superficial structures of palm of hand, ascends along middia
of front of fore-arm communicating with radial & anterior ulnar, and, after re*
ceiying a large branch from renie comites of braohial, diridos at bend of elbow

into median cephalic A median basil :o.

Median Cephalic - Usually the smaller. Ascends in groove between biceps A sup-
inator longas, lying maiuly in front of branches of anterior dirision of external

cutaneous nerre, and joins with radial yein to form the cepb»li&

Uedian Basilic ^ Usually the larger. Ascends in groore between biceps A pronator
radii teres, being more or less surrounded by branches of' anterior divisioa ol
internal ontaneous nerve, and lying in front of braohial artery, from which it is

separated by bicipital or semilnnar fascia.

Cepbalic ^ Somewhat smaller than basilic. Ascends in groove along outer border cf
biceps and then in interspace between pectoralis major A deltoid, in whioh latter
situation it is accompanied by humeral or descending branch of acromio-thoraoio
artery, and ends in axillary rein between coracoid process A dayicle, its opening
being guarded by a pair of ralves. It communicates sometimes with eztemsi
jugular or subcIaTian by a small branch which ascends in flront of olaricla.

Basilic "* Somewhat larger than cephalic. Ascends in groove along inner border of
biceps, pierces deep fascia with internal cutaneous nerre a little below middle of

arm, and ends in one of the brachial Teins or in the Axillary.

N.— Numerous varieties are observed in the disposition of the veins of the
bend of the elbow: the median vein with both its terminal branches may be ea*
iirely wanting, or, the vein itself being wanting, its two terminal branches may

be supplied either by the radial or the anterior nlnar.

MUSCLES of FRONT of FOBEABM.

SUPEBFIOIAL LAYER.

Pronator Radii Teres.

Laeoi or Superficial Head - Inner oondjie & inner border of hnmenu im«

mediately abore It, deep fascia of forearm, intermnscular septum between

it St flexor carpi rskdialis.
Small or Deep Head - Ridge on inner surface of ooronoid process of ulna

below flexor snbUmis digitoram.

Bongh impression on middle of outer surface of shaft of radius. -

S. bj median nerve.

Flexor OarplRadialiB- Inner condyle by common tendon; deep fascia; in-
termuscular septa on either side.

Front of base of 2nd metacarpal bone, & slightly into that of 8rd. -
8. by median nerre.

Pahnaris LongUS - inner condyle by common tendon; deep fascia; inter*
muscular septa on either side.

Anterior annular ligament of carpus and palmar fascia. « S. by
median nerve.

Flexor Oarpi Ulnaris.

Anterior or Inner Head -Inner condyl^^by common tendon ; deep fascia;

intermuscular septum between it & palmaris longus.
Posterior or Oiiter Head - Inner border of olecranon, and by an aponeurosis
which is common to it & to the flexor profundus, from upper two«thirds of
posterior border of shaft of ulna.

Pisiform bone and slightly into annular ligament & baso of 6th
' metacarpal bone. - S. by ulnar nerre.

Flexor Sublimis Digitoruzn.

Inner Head - Inner condyle by common tendon, and internal lateral liga-
ment of elbow -joint.

Middle Head - Tubercle on inner surface of coronoid process of ulna abore
pronator radii teres.

Outer Head - Oblique line on front of radius.

Sides of second phalanges. - S. by median nerre.

DEEP LAYER :

Flexor Frofundns Digitomxn - Depression on inner side of ooronoid process
of ulna, upper two-thirds of anterior & inner surfaces, and, by an apon*
eurosis which is common to it A to flexor carpi ulnaris, from upper two-
thirds of posterior border of shaft of ulna; inner half of interosseous
membrane.

Bases of third phalanges. - S. partly by ulnar nerre, partly by an-
terior interosseous branch of median nerre.

Flexor Longus FoUicis - Upper two-thirds of anterior surface of shaft of
radius; outer half of interosseous membrane; occasionally by a small
slip from inner side of coronoid process.

Base of last phalanx of thumb. - S. by anterior interosseous branch
of median nerve.

Pronator Quadratns * Lower fourth of anterior surface A inner border of
ulna; aponeurosis which covers inner third of the musole.

Lower fourth of anterior surface A outer border of radius. - S. by
anterior interosseous branch of median nerre.

MUSCLES of OUTER SIDE of FOBEABM.

Supinator Longus - Upper two-thirds of external condyloid rid^e of humerus, ex-
ternal intermuscular septum.

Outer side of base of styloid process of radius. - S, by muscnlo-spiral n.

Extensor Carpi Radialis Longior - Lower third of external condyloid ridge of
humerus, external intermuscular septum.

Back of base of second metacarpal bone. - S. by mnsoulo-spiral nerre.

Extensor Carpi RadiaUs Brevior - B**«rnal oondvle of humerus by a tendon
•*^ oommon to it & to superficial muscles of back of forearm ; external lateral l***-^ •

ttent of elbow-joint t deep fascia; intermuscular septa on either side.
Baok of base of tbird mttMArpal boat. - 8. by posUrior iattrof'

BADIAI. AKTEBY

The imaller branch of biftiroatUm of brachial half an inch below bend of elbow or op p oifca

neek of Iodine
Down front of cater lide of forearm to a little to inner Bide of styloid jffooeM of radina.
Bound onter side of oarpns beneath eztenaor tendons of thumb.

Through upper part of first interosseons space between the two heads of abdnotor indlois.
Orer bases of metacarpal bones & interossei, and beneath flexor tendons, Inmbrioales & nerves
to base of 6th metacarpal bone, where inosonlates with ccmmonioating branch of nlnar,
forming deep palmar arch. Lies a finger's breadth aboTO lerel of saperficial palmar

arch.

RELATIONS in FOREARM :

Ik Front - Skin, superficial fascia, deep fascia, supinator longus.

BzHiKB - Tendon of biceps, supinator broTis, pronator radii teres, flexor snblimia

dig^tomm, flexor long^ pollicis, pronator quadratus, lower end of radiuSi

On Outer Side - Supinator longus, radial nerve in middle third.
On Inner Side - Pronator radii teres^ flexor carpi radialis.

BRANCHES:

IN FOBBABH i

Radial recurrent — From upper part. Between brachialis antions & supinator lao«

gus, and anastomoses with interosseous recurrent ft superior profanda..

MuSOOlar — Numerous, to muscles on either side.

A&t. carpal — From lower part. Joins with anterior carpal branch of ulnar beneath

deep flexor tendons ; g^res twigs to articulations of carpna

Bnperflcialis VOlsd — From termination of artery in forearm. Small, and ends ia
msscles of thumb i or of more considerable size, and joins with A oom«

pletes superficial palmar mxok,

ON BACK 07 WBIST :

Post, carpal — Orer back of carpus beneath extensor tendons. Joins with posterior
carpal branch of ulnar to form posterior carpal arch, which anastomoeas
with termination of anterior interosseous artery of forearm, and girea off:

Dorsal Interosseous Arteries of Third ft Fourth Spaces - Anastomose at
upper part of interosseous spaces with perforating branches of deep
palmar arch. - Are usually exhausted in sheaths of tendons, interossei
ft integument over back of first phalanges, but are sometimes larger
than usual, and are then prolonged upon dorsum of fingers in the shape
of dorsal digital branches simHar to those of thumb ft outer eide oi

index, and of toea.

Metacarpal, or Dorsal Interosseous Art. of Second Space — Arises be.

neath extensor tendons of thumb, sometimes in common with posterior car*
pal, and is similar to, but larger than, the foregoing interosseous arteries.

ii> 1 *) Correspond together to a first dorsal interosseous artery.
Dorsales poUlCiS r The former supplies dorsal digital branches to both sides of baok

DnVBftlifi irifliola 1 of thumb, the latter forms the dorsal digital branch of outer side
MJOtSniiB uicucis J Qf i^i^]^ of index.

IN PALM 07 HAND :

*\ Correspond together to a first palmar interosseous artery.
Princeps pollicis r The former supplies palmar digital branches to both sides o(
V9 jx ^t X jii i front of thumb, the latter forms the palmar digital branch of
Radialis indlCiS 3 outer side of front of index.

Perforating — Three. Through upper part of three inoer interosseous spaces, and

anastomose with corresponding dorsal interosseous arteries.

Seep palmar interosseous — Usually three or four, but Tory rariable in sise ft
number. Descend in front of interosseons spaces, join with superficial pal-
mar interosseous branches from superficial palmar arch, and then bifurcate
to form palmar digital branches to 8| fingers on inner side of hand

ULNAR ABTEBY

Hie larger branch of bifliroation of brachial half an inoh below bend of elbow, or oppodte

neck of radiiiB.

Deeplj to near middle of inner border of forearm, Ijing upon brachialiB antions A flexor

profondns and beneath median nerre and all the ■nperfioial mnsclefl except flexor

carpi nlnarie, and being at a distance from nlnar nerre.
Beneath skin and fascia only along front of inner border of forearm, lying, with nlnar nerre

on its inner side, between flexor carpi nlnaris & flexor snblimis digitomm.

Oyer anterior annnlar ligament on enter side of pisiform bone & slightly in front of nerre.

Oroaaes palm of hand beneath skin & fascia and in front of flexor tendons & divisions of

median A nlnar nerres, forming superficial palmar arch. This arch lies on a IotoI

with lower border of abdncted thnmb, a finger's breadth below deep palmar arch,

and nsnally joins with snperficialis ToUe or radialis indioiSi or sometimes with

prinoeps polliois.

BRANCHES:

Ant. ulnar recurrent — Small. Between pronator radii teres & braohlalia
antions, and anastomoses with inferior proAmda A anastomotica magna.

Post, ulnar recurrent — Larger. Beneath flexor snblimis, and then between
olecranon A inner condyle beneath flexor carpi nlnaris, and anastomoses
with interosseons reoorrent, and with inferior profunda A anastomotica

magfna.

InteroSSeoUB — Thick, an inch inlength, to npper border of interosseons membrane,

where divides into t
Amt. Intbbosseous — Down firont of interrosseons membrane with corres-
ponding branch of median nerve and between flexors longns
polliois A profundus digitomm. Behind pronator quadratus, and
through lower part of interosseous memtoine to back of carpus,
where joins witii posterior interosseous A posterior carpal aroh. -
Gives off a long slender twig to median nerve, and their nutrient

arteries to radius A ulna.

Post. Imtebosseous «— Between interceseous membrane A oblique or round

ligament, and then between superficial A deep muscles of back of

forearm to back of carpus, where anastomoses with termination of

anterior carpal A with posterior carpal arch i gives off

Ihtkbosseous Bbcurbent — Beneath anconeus A supinator brevis to

interval between olecranon A external condyle, and anasto*

moses with superior profonda A posterior ulnar recurrent.

Ant. Carpal -* Joins with anterior carpal branch of radial beneath deep flexor

tendons; gives twigs to articulations of carpua.

Post, carpal — Beneath tendon of flexor oarpi nlnaris, and over back of oarpus
beneath extensor tendons, joining with posterior carpal branch of radial,
and forming posterior carpal arch (Tide Badiad artery). Sends a smaU

branch along ' metacarpal bone of little finger*

Communicating — Between abductor A flexor brevis minimi digit!, and joins

with termination of radial to complete deep palmar aroh.

Superficial palmar interosseous ( Digital ) — Usually four, but rather vari.
able in sise A number. Descend with terminal branches of median A ulnar
nerves, first in front of, and then between, the flexor tendons ( and on inner
sideof the innermost), and join with deep palmar interosseous branches
from deep palmar arch. The trunks thus formed divide at clefts between
fingers to form digital branches to 8| fingers on inner side of hand*

MEDIAN & MUSGULO-CUTANEOUS NEBVES.

MEDIAN NERVE.

From inner & outer cords of brachial plexus hy two roots which snrroimd 8rd part of axillai^
artery. - Lies at first on ontor side (more or less so, but never quite in front) of 9ri

part of axillary & npper part of brachial Arteziea

Crosses brachial artery nsaally in firont, and lies on its inner side at bend of elbow.

Between the two heads of pronator radii teres, and down middle of front of forearm, lying

deeply at first between flexor sublimis A flexor profondns digitorom, and then snper«

ficially between tendon of flexor carpi radialis A outermost tendons of flexor anblimis^

Beneath anterior annular ligament to palm of hand, where lies in front of flexor tendona, and

becomes enlarged and flattened, and dividea into two

TERMINAL BRANCHES:

Eztemal - Supplies abductor, opponens & outer head of flexor brevis poUiois, and girm

palmar digital branches to thumb A outer side of index finger,

Interzial " Supplies the two outer Inmbrioales, and gives palmar digital branches to

contiguous tides of index^ middle and ring fingers. -The digital nerves are

superficial to the digital arteries.

LATERAL BRANCHES:

None in npper-arm. In fore-arm:
Muscular - Aiise near elbow; to all the superficial muscles of front of fore-arm except

flexor carpi nlaarij.

Ant. Interosseous —^^^ anterior interosseous artery between flexor longoa pollicia

A flexor profundus digitorum, supplying the former A the outer half of tha

latter, and ends in pronator qnadratos.

Palmar Cutaneous ^ Fipm lower part. Pierces deep fascia a little abore anteriac

annular ligament and supplies integ^ument of palm of hand A ball of tbnmb,

joining with palmar cutaneous branch of ulnar, and with radial or anteri<M

branch of external cntaneaua

MUSCULO-CUTANEOUS or EXTERNAL CUTANEOUS NERVE.

From outer cord of brachial plexus in common with outer head of median.
Through coraco-brachialis, and between biceps A brachialis anticus to a little abore external
condyle, where perforates deep fascia, and divides, behind median oephaUc reii^

intei

Anterior Brancll - Along front of radial side of fore-arm as low as wrist, where liei

in front of radial artery, and joins with radial nerre. Bends filaments ovei

ball of thumb, and accompanies radial artery to back of earpna

Posterior Brancll -* Along back of radial side of fore-arm, joining with radial an^

with external cutaneous branch of muscnlo-apira]
Supplies ooraoo-brachiaUs, biceps A brachialis aations, and lends twigs to humerus A U

•Ibow-jetafc

TJIjNAR, int. cutaneous, & LESSER INT. CUTAN-
EOUS NEBVES.

ULNAR NERVE.

From inner eord of braoliial plans in common with inner head of median, internal ontane.
one & lesser internal ontaneons nerres. - Lies at first on inner side of 8rd part of

azillaiy & upper part of brachial arteries.
Pieroes internal intermnsonlar septnm with inferior profanda, and descends in grooye

between olecranon A internal condyle.
Enters fore-arm between the two heads of flexor carpi nlnaris.

Descends on flexor profttndns, being oorered in npper part of fore-arm by flexor carpi
nlnaris, lying superficially in lower part between tendon of latter muscle A inner-
most tendons of fiexor snblimis digitomm. - Ulnar artery lies on onter side of nerre,

and is distant from it in upper part of fore-arm.
Crosses anterior annular ligament a little behind artery A on onter side of pisiform bone,

and divides into two

TERMINAL BRANCHES:

Snperfloial*^o palmaris brevis, integument & 1} fingers on inner side of hand,

joining with median.

Dqqp * Between abductor ft fiexor brevis minimi dig^ti, and beneath fiexor tendons

with deep palmar arch. Supplies muscles of little finger, interossei, the

two inner lumbricales, adductor pollicis & inner head of fiexor brevis.

LATERAL BRANCHES:

None in upper-arm. In fore-arm i
Articnlar to Elbow Joint - Several, small, arise behind elbow.
Muscular - To fiexor carpi nlnaris & inner half of fiexor profundus.
Palmar Cutaneous - Arises a little below middle of fore-arm. With ulnar artery
to integument of hront of wrist A palm of hand, joining with palmar cata«
neons branch of median A frequently with internal cutaneous.

Dorsal Cutaneous * Large, arises a little above wrist. Winds inwards beneath
tendon of fiexor carpi nlnaris, and supplies integoment A 1 J fingers or

inner side of back of hand. Joining with radial

Articular to the Wrist.
INTERNAL CUTANEOUS NERVE.

From inner cord of brachial plexus in common with inner head of median, ulnar A lesser

internal cutaneous nerves.
Along inner side of brachial artery in front of lesser internal cutaneous, giving off a cata<*

neous filament to integument over biceps.
Pierces deep fascia with basilic vein, and divides into :

Anterior Brancll *- in front of, or sometimes behind, median basilic vein to in«
tegument of front of inner side of fore-arm as low as wrist, frequently

joining with palmar cutaneous branch of ulnar.

Posterior Branch * Over internal condyle to integument of back of inner side of

fore-arm to near wrist, joining with lesser internal cutaneous A dorsal

cutaneous branch of ulnar.

LESSER INTERNAL CUTANEOUS N. or N. of WRISBERO.

From inner cord of brachial plexus in common with inner head of median, ulnar A internal

cutaneous nerves.

Along inner side of axillary vein A brachial artery A behind internal cutaneous nerve to

integument of back of lower third of arm, joining with interccsto-hnmeral A

posterior branch of internal cutaneous.

Xti lise A communications vary considerably. SVequently intercosto-humeral nerve is

Urge^ and takes the place of nerve of wrisbei^, Joining brachial plezns by a small

filament only^ or not at alL

MUSCLES of PALM of HAND.

MUSCLES of the THENAR EMINENCE or MS. of the THUMB.

Abductor Pollicis or Trapezo-phalangeal - Bidge on anterior snrfaoe of trape.
sinm & anterior annular ligament of wrist.

Oater side of base of first phalanx of thumb. - 8. by median nenra.

Opponens Pollicis or Trapezo-metacarpal - Front of trapesinm below the ndgv,

A annular ligament.

Whole length of outer border of metacarpal bone of thumb. - S. by median a.

Flexor Brevis Pollicis or Trapezocarpo-phalangeal.

Outer or SuPiRnciAL Hbad - Lower part of trapesium A anterior annular ligaments
Ikner ok Deep Head - Trapesoides, os magnum, base of 2nd & Srd metacarp^ bonea.
Either side of base of first phalanx of thumb, a sesamoid bone being dera*
loped in each tendon. - 8. by median nerve, & deep branoh of ulnar.

Adductor Pollicis or Metacarpo-phalangeGJ - Lower two-thirds of anterior snr.

face of Srd metacarpal bone.

Inner side of base of first phalanx of thumb. - 8. by deep branch of ulnar a.

MS. of H7P0-THENAR EMINENCE or MS. of LITTLE FINGER.

Fahnaris Brevis - Annular ligament A inner edge of central palmar fascia.

Skin OTcr inner border of hand. - 8. by superficial branch of ulnar nenra.

Abductor Minimi Digiti, or Pisi-phalangeal -Pisiform bone, and slightly from
tendpn of flexor carpi ulnaris.

inner side of base of first phalanx of little finger. •- 8. by deep branch of
ulnar nerre.

Flexor Brevis Minimi Digiti, or Unci-phalangeal - Unciform process of

UDciform bone A annular ligament.

Inner side of base of first phalanx of little finger. - 8. by deep branoh of
ulnar nenre.

Opponens or Adductor Minimi Digiti, or Unci-metacarpal* - UnoifonB

process of unciform bone A annular ligament.

Whole length of inner border of metacarpal bone of little finger. - 8. bj
deep branoh of ulnar nerve.

*These names, expressire of the origin A insertion of the oorres-

ponding muscles, are due to Omyeilhier.

MUSCLES of the CENTRAL PALMAR REQION.

Lumbricales - First, and sometimes 8econd, from outer side of oorrespondini^ deep
flexor tendon. - Thibd and Fourth, from adjoining sides of 2nd A Srd and Sni
A 4th deep flexor tendons respectively.

Outer side of expansion of corresponding extensor tendon on back of
first phalanges. - 8., the two outer by median nerve i the two inner by deep
branch of ulnar nerve.

Palmar Interossei -^^rco. -They arise from the whole length of one side of the meta.
carpal bone of one finger, and are inserted into the same side of the baae of the
first phalanx of the same finger A into the expansion of the extensor tendon
which covers it. - They are Hituated respectively on the inner side of the 2nd
metacarpal bone A index finger, and on the outer side of the 4th A 5th meta.
carpal bones and corresponding ring A little fingers. They adduct these fingers
towards an imaginary line drawn through the long or middle finger. - They
are supplied by the dedp branoh of the ulnar nerve.

Dorsal Interossei - Four - They arise by two heads lh>m the adjacent sidos of two
metacarpal bones, but more extensively from the side of that metacarpal bone,
which corresponds to the finger into which the muscle is inserted. They are
inserted into the corresponding side of the base of the first phalanx of the cor-
responding finger A into the expansion of the corresponding extensor tendon. -
They are situated respectively on the outer side of the 2nd metacarpal booe A
index finger, on both sides of the Srd metacarpal bone A middle finger, on the
inner side of the 4th metacarpal bone A ring finger. The 1st dorsal interosseoas
muscle is larger than the others, and is sometimes called the abductor indicis]
the radial artery passes between its two heads. - They abduct the fingers from
an imaginary line drawn through the long or middle finger. -They are supplied
by the deep branoh of the ulnar nerve.

UPPER LIMB.
III.

PARTS ABOUT SHOULDER,
BACK OF UPPER LIMB.

MUSCLES of XTPPEB LIMB-5th Tablet.

Deltoid - Upper surface & anterior border of onter balf of olaTiole $ tipper surface &
onter border of acromion; whole length of lower lip of posterior border of spine
of Bcapala.

Eongh triangular prominence a little aboTe middle of onter snrfaoe of
shaft of humerus. - S. by cironmfler nerve.

Subscapularis - inner two-thirds of subscapular fossa ; tendinous laminss attached to
ridges of said fossa; aponeurosis which separates it from teres major.

Into lesser tuberosity of humerus and by fleshy fibres into the neok for a
short distance lower down. - S. by the two upper subscapnlar serrefl from
posterior cord of brachial plexus.

SupraspinatlLS - inner two-thirds of supraspinous fossa & fasoia which ooTers it.

Highest of the three facets on greater tuberosity of humerus. - 8. by
suprascapular nerve.

Infraspinatus - inner two-thirds of infraspinous fossa & ridges on its surface ; fascio
which separate it from the teres major & minor.

Middle facet on greater tuberosity of humerus. - S. by suprascapular nerraw

Teres Minor - Upper twcthirds of dorsal aspect of axillary border of scapnla;
intermuscular septa which separate it from infraspinatus & teres major.

Lowest facet on greater tuberosity of humerus and by fleshy flbres
into the neck for a short distance lower down - S. by a branch of circumflex
nerve.

Teres Major - Dorsal aspect of inferior angle of scapula; intermuscular septa which
separate it from infraspinatus & teres minor.

Inner or posterior edge of bicipital groove of humerus. * 8. by a branch
from lower subscapular nerve.

Latissimns Dorsi - spinous processes of the 6 or 7 lower dorsal vertebrss ; by the
posterior layer of lumbar aponeurosis, from the lumbar & sacral spines and
the back part of outer lip of crest of ilium ; from outer lip of crest of ilium for
an inch or more in front of lumbar aponeurosis; from the last three or four ribs
interdigitating with external oblique; sometimes by a few fibres from inferior
angle of scapula.

Bottom of bicipital groove of humerus a little higher up than teres major
by a broad flat tendon twisted upon itself. - 8. by long subscapular nerve.

Levator Angnli ScapnlSd - Posterior tubercles of transverse prooeisei cf the S, 4^ or 5

upper cervical vertebrss between splenius & scalenus ipedius.

Posterior border of scapula between spine & superior angle. - S. by one of
the deep branches of the cervical plexus and by one of the supra-claTienlar
branches of thei brachial plexus.

BllOXnboideus Minor- Lig^inontum nuchas and spinous processes of 7th cervical & 1st

dorsal vertebras.

Posterior border of scapula opposite triangular smooth surface at root of
spine. - S. by one of the deep branches of cervical plexus and by one of the supra-
clayicular branches of the brachial plexus.

Rhmoboidens Major- spinous processes of the 4 or 6 upper dorsal rertebrss and supra-
spinous ligament.

Base of scapula between spine and inferior angle (Qnain, Ellis), or rather

nto a tendinous arch attached to the triangular smooth surface at root of

■pine & to the inferior angle and connected to posterior border of scapula by

a thin membrane (Gray). - 8. by one of the deep branches of the cervical

plexus and by one of the supra-clavicular branches of the brachial plexus.

MUSCLES of UPPER LIMB-6th Tablet.

MUSCLES of BACK of FOREARM.

SUPERFICIAL LAYER.

Extensor Commnilis Digitomin - External condyle of hnmenu bj the oommon
tendon ; doep fasoia ; intermnsoalar septa on either side.

Bases of 2nd & Srd phalanges of the four fingers. - S. by posterior In*
terosseons nerve.

Extensor Minimi Digiti - External oondyle of humerus by the oommon tendon }
deep fascia; intermascnlar septa on either side.

Joins corresponding tendon of extensor oommnnis. The common tendon
thus formed is inserted into bases of 2nd & Srd phalanges of little finger. - S.
by posterior interosseous nerve.

Extensor Carpi Ulnaris - External oondyle of humerus by the oommon tendon ;

middle third of posterior border of shaft of ulna; deep fasoia ; septum between

it & foregoing muscle. Usually it simply covers, but sometimes it arises from,

narrow portion of posterior surface of shaft of ulna internal to the vertical ridge.

Base of metacarpal bone of little finger. - S. by posterior interosseous n.

Anconeus -* Back of outer condyle of humerus; deep fascia.

Bough triangular surface on outer side of olecranon & upper third of
shaft of ulua. - S. by musculo-spiral nerve.

DEEP LAYER.

Supinator Brevis - External condyle of humerus i external lateral ligament of
elbow .joint; orbicular ligament of radius ; triangular depression below lesser
sigmoid cavity & ridge behind the depression.

Inner, anterior, and outer aspects of radius above bicipital tuberosity A
oblique line as low down as insertion of pronator radii teres. - S. by posterior
interosseous nerve.

Extensor Ossis Metacarpi PoUicis -Outer half of posterior surface of shafl of
ulna below insertion ot anconeus; posterior surface of interosseous membrane;
middle third of posterior surface of shaft of radius.

Base of first metacarpal bone. - S. by posterior interosseous nerve.

Extensor Primi Intemodii PoUicis - Posterior surface of radius below fore-
going muscle; interosseous membrane.

Base of first phalanx of thumb. - S. by posterior interosseous nerve.

Extensor Secnndi Intemodii PoUicis - Middle of outer half of posterior sur.

face of shai^ of ulna ; posterior surface of interosseous membrane.

Base of terminal phalanx of thumb. - S. by posterior interosseous nerve.

Extensor Indie is - Posterior surface of shaft of ulna below foregoing muscle;
interosseous membrane.

Joins corresponding tendon of extensor communis. The oommon tendon
thus formed is inserted into bases of 2nd & Srd phalanges of index finger. - S.
by posterior interosseoua nerve.

POSTERIOR BRACHIAL REGION.

Triceps :

Long Head - Rough triangular depression below glenoid cavity of loapula, and

slightly from capsule of shouldor-joint.
Outer Head - Posterior surface of shaft of humerus above musoulo-spiral groove;

outer border of humerus; external intermuscular septum.

Inner Head - Posterior surface of shaft of humerus below musculo-ipiral groove;
inner border of humerus; internal intermuscular septum.

By a strong tendon into back part of upper surface of olecranon process
of ulna. - S. by musoulo-spiral nerve.

BubanCOneUB - Posterior surface of humerus above olecranon fossa.

Posterior ligament of elbow joint. - S. by mnsoulo-spiral nerru.

J .

MXTSCITLO-SPIBAL & CIRCUMFLEX NERVES.

BSUSCULO-BPIRAL NERVE

•• The largest branch of brachial plezu. Ariies from posterior oord In ooramoa with

oironmflejc, and lies at first behind 8rd part of azillarj arterj A nppei

part of braobt&l.
Downwards A ontwards in Aront of tendons of teres m^or A latts^mns dorsi, and in

spiral groove with superior proftmda artoq.
Between braohialis anticas A supinator longns to front of external oondjle, where h

diTides into radial it posterior interosseoos nerres. Its branches are:

MasCUlar - To triceps, anconens, braohialis anticns, supinator longns, ex.

tensor carpi radial is longior.

CutaHOOUS - Three, small, one internal, two external; to integnmeat of

inner A posterior, and of outer A anterior aspects of arm, and cl

outer aspect of fore-aroL
B AT ^TAT- NERVE — The smaller.

Down front of outer side of fore-arm beneath snp'nator lon^s, IjinflT on outer
side of radial artery, which arterj is distant from it in upper third A close
to it in middle third. Winds outwards ft backwards beneath tendon of
supinator longus about three inches abore wrist, pierces deep fascia, and

dirides into branches :
EzTESNAL - The smaller. To outer side ft ball of thumb i joins with

posterior branch of external outaneou.

Iktbxnal - The larger. To integument, ft remainder of S| fingeri en

outer side of hand ; joins with external cutaneous ft with dort&l

cutaneous branch of ulnar. - Adjoiniog sides of middle A rin|

fingers may be supplied by same nerfeg which may be either Uu

radial or the ulose

POSTERIOR XNTEROSSEOnS NERVE — The larger.

Through substance of supinator brevis to back of fore-arm.

Between superficial ft deep muscles of posterior aspect of fore*arm, snpplyiog

them all except anconeus, supinator longus, ft extensor carpi radiaiis longior.
Beneath exteasores secnndi intemodii poUiois ft communis digitomm to back ^1

carpus, where it becomes gangUonio and aapplies artioulationa of wrist.

CZROUMFLEX NERVE

Frrm posterior oord of brachial plexus in oommon with musonlo-spiraL
Downwards ft outwards behind axillary artery in front of subsoapalarts.
Baokwards, with posterior circumflex tosscIs, through quadrilateral spaoe bounded

by teroi major, teres minor, long heal of triceps, ft humenia
Gires off a small twig to shoulder*joint| and dirides into:

Snpdrior BraHOll - ^^^ larger. Bound neck of humerus as far as aater<
lor border of deltoid; sapplies deltoid, and gires off outaneooi
filaments which perforate the muscle tp integument orer lo<rar

part of B^oaMar.

Inforlor BraHCll - ^^e smaller. Sapp!ies teres minor, bacic art

of deltoid, ft integument orer bajk of shoulder} has treq louUy

a gangliform enlargement on branch to teres muwa

MnSCULAIt ATTACHTS. of BS. of UPPER LIMB— lat T.

The mntelM aitoohad to the

CLAVICLE —Are riz in number, md are attaobed as followi t -

Stento-CliidO'Mastoid ^ AsiimAov snrfaoe ft upper bord<«r of inner tbird.
Ptctoralis Major - Anterior snrfaoe A anterior border of inner balf.
J>ei/M^Vppw snrfaoe ft anterior border of outer half.
Tra/mus - Upper snrfaoe ft posterior border of enter tbird.
SuMavuu - OrooYo on nnder snrfaoe of middle tbird.
Sf€rria'CMd^/fyoid''8ometimeB^tTom baok of inner extremity.

SCAPULA — Seventeen in number, and are attaobed as follows t -*

Supraspinahis - Inner two-tbirds of snpraspinons fossa.

Infraspinatus - Inner two-tbirds of infraspinons fossa ft ridges on its snrfaoa.

Tera Major - Posterior aspect of inferior angle.

Teres Minor - Upper two-tbirds of posterior aspeot of azillarj border.

DdtM - Upper snrfaoe ft outer border of acromion, wbole lengtb of lower lip of

pofiterior border of spine.

Trapesius -Upper surface and inner border of acromion, wbole length of upper lip of

posterior I order of spine.

Subscapufaris - Inner two-tbirds of subscapular fossa ft ridges on its surlaoe.

Serratus Magnus - Wbole lengtb of anterior lip of posterior border.

Rhomboideus Major - Posterior border between spine ft inferior ar.gle.

Rhomboideus Minor - Posterior border opposite triangular smootb snrfaoe at root of spinsb

Levator Anguli Seapulee - Posterior border between spine ft superior angle.

Omo-Hyoid - Upper border on inner side of suprascapular notcb.

Zong Head of Triceps - Rougb triangular depression below glenoid oarity.

Pectoralis Minor - Inner border of ooraooid process.

Coraeo^Brachialis i m: » .j

SAort H«d cfBUep, { " '^P •' «"«»"' P'**""-

Long Head of Biceps - Top of glenoid caTitj.

Latissimus Dorsi - Sometimes, from back of inferior angle.

MTJSCULAB ATTACHTS. of BS. of X7PPEB LIMB- 2nd T.

The mnaolei atUohed to the

SDMEBUS — Are twenty.foiir in nnmber, and are attaohed as follows t -

Suproipifwtus - Highest cf the three facets on greater tnberositj.
Infraspinatus - Middle facet on greater titberoBity,

Teres Minor - Lowest facet on greater tuberosity, and by a few fleshy fibres into tho

neck for a short distance lower down.
Subseapularis - Lesser tuberosity, and by a few fleshy fibres into the neck for a short

distance lower dowo

Teres Major - Inner or posterior edge of bicipital groore.

Pedoralis Major - Anterior or outer edge of bicipital groore.

Laiissimus Dorsi - Bottom of bicipital groove.

JDeltoid -'BLovLzh. triangular prominence a little above middle of outer snrAice of shafk

Coraco'Braehialis - Bough impression a little above middle of inner surface of shaft.

Brachialis Anticus - Lower half of inner 9t outer surfaces of shaft.

Inner 6* OtUer Heads of Triceps -

Inner ;i«i</- Posterior surface of shaft below musculo-splral groove, inner borders
Outer head - Posterior surface of shaft above musculcspiral groove, outer border.

Supinator Longus - Upper twcthirds of external condyloid ridge.

Extensor Carpi Radialis Longior - Lower third of external condyloid ridge.

Extensor Carpi Radialis Brevior - External condyle.

Extensor Communis Digitorum - %%

Extensor Minimi Digiti - >«

Extensor Carpi Ulnaris - »

Anconeus - w

Supinator Brevis - n

Pronator Radii Teres (Inner Head) - Inner condyle & internal condyloid ridge im

Fiexor Carpi Radialis - Inner condyle.

Palmaris Longus - »

Flexor Carpi Ulnaris (Anterior or Outer Head) - Inner oondyla,

FUxar SMimis Diiiiorum ( Inner Head) - n

MnSGULAB ATTAGHTS. of BS. of UPPER LIMB— 3rd T.

Tho mnsoles attached to the

RADIUS — Are nine in nnmber^ and are attached aa foUowa i -

Bietps - Back part of bicipital taberosit j.

Supinator Brans - Inner, anterior A onter aapeots of the bone aboye bicipital inberositj

A obllqae line as low down as insertion of pronator radii terei*
' FUxor Sublimis Digitorum (Outer Head) - Obliqne line.

Prwtator Radii Teres - Boagh impressioa on middle of enter surface of abaft.
Flexor Longus PoUicis - Upper two-thirde of anterior sarface of shaft.
Pronator Quadratus - Lower fourth of anterior sorfaoe & outer border.
Extensor Ossis Metacarpi PoUieis - Middle third of posterior surface of shall.
Extensor Primi IntemodH Pollids - Posterior surface of shaft below foregoing.
Supinator Longus - Onter side of base of styloid process.

XJLN A — Are thirteen in nnmberi and are attached as followa i -

Supinator Brevis - Triangular depression below lesser sigmoid oarity A ridge behind th«

depression*
Braehialis AnOcus - Under surface of coronoid process.

Flexor Sublimis Digitorum (Middle Head) - Tubercle on inner inrface of ooronoid process

abore pronator radii teres.
Pronator Radii Teres (Outer Head) - Bidge on inner surface of coronoid process below

flexor sublimis.

Flexor Profundus Digiiorum - Depression on inner surface of coronoid process, upper two*

tnirds of anterior & inner enrfaces, and, by an aponeurosis which is common

to it 9t to flexor carpi ulnaris, upper two-thirds of posterior border*

Flexor Carpi Ulnaris (Posterior Head) - Inner border of olecranon, and by an aponenrosia

which is common to it & to flexor prolundus, upper two-thirds of posterior border*

Triceps -Back part of upper surface of olecranon.

Anconeus - Bough triangular surface on outer side of olecranon & upper third of shaft.
Pronator Quadratus - Lower fourth of anterior surface & inner border.
Extensor Carpi Ulnaris - Middle third of posterior border. Usually it simply covers,
but sometimes it arises from, narrow portion of posterior surface internal to tha

vertical ridge.
Extensor Ossis Metacarpi Pollids - Outer half of posterior surface below insertion of anconeus*
Extensor Secundi Intemodii Pollicis - Middle ot outer half of posterior surface.
Extensor Indieis - Posterior surface below foregoing.

THE SHOULDER-JOINT.

U an enartbrodial artionlatiOD, though not a tjpioal one ; for the glenoid caritj of the aoapnla
is, in oomparison with the head of the hnmeruB, remarkably small & ahaHow, and there
is liitle more than a mere apposition between the two bones. Considerable mobility ia
thns proyided for. Displacement is, on the other hand, prevented to a gremi extent by the
presence of the acromion A ooracoid processes & ooraoo-acromial ligament. — The
articnlar cartilage is thickest in the centre, on the head of th^ hnmeros, thiokest at the

peripheryi on the glenoid oaritj.

LIGAMENTS:

Oapanlar-Froni

NecJk of scapula round margin of ^enoid cavity to

Anatomictil neck of humerus^ extending farthest down hnmems along ita Inner aapeot

This oapsale is thicker aboYe than below. It is strengthened by the ooraco*
homeral ligament externally, by the tendons of the sapra- a infiraspinatas & teres

minor behind, and by that of the snbsoapalaris in front.

It has two, sometimes three openings, through which the synorial mem-
brane is prolonged npon the tendons of the snbsoapalaris & bioeps, and sometimes
upon that of the infraspinatns. The tendon of the long head of the bioeps per-
forates the lower part of the oapsale, and becomes snrronnded, within the joint.

by a complete sheath of synorial membraoe.

It is remarkably loose, and, when the muscles are cot, it admits of the booea
being separated more than an inch. The bones are therefore kept y/y appositioa
less by the ligaments themselyes than by mnsoular action & atmospherio pressure.

CoraCO-lltinieral. or AoCdSSOXy * strong fiat band intimately blended with the capjule,

and extending obliquely frona
Root ^ outer border of coracoid procas to
Front of great tuberosity of humerus.

Glenoid -* Would be better described as an extension of the glenoid oaWty than as a liga«
ment, for, unlike the cotyloid ligament of the hip-joint, it does not assist ia
keeping the bones together. It is a fibro-cartilaginons ring triangular on aeotion;
its thickest portion ib attached to the cironmference of the glenoid oaWty, and its
sharp edge is free. It is continuous aboTo with the tendon of the long head of the

biceps, by the bifurcation of whioh it is partly formed.

SYNOVIAL MEMBRANE — I< prolonged through the above mentioned openings in the

capsule

Upon the tendon of the biceps^ in the shape of a complete sheath, whioh allows the tendon

to traverse the articular cavity without being contained therein;

Upon the tendon of the subscapularis in the shape of a pouch of variable sise comprised

between the tendon & the subscapular fossa ; and sometimes
V($H the tendon of the infra'Spinatus in a similar manner i an independent bursa exist-
ing at other times between the muscle & the infraspinous fossa. - An
independent bursa exists between the upper part of the oapsale A

the coraoo-aoromial ligament A deltoid.

VASCULAR ft NERVE SUPPLY — From the oircomflex k supra-soapular veasels A nerves.

MOVEMENTS — The shoulder joint is the freest of all the joints of the body, and admits uf

movement in every direction. The acromion & coracoid processes A the ooraco-
aoromial ligament prevent displacement upwards of the head of the hnmerus,
and limit, uiless the aoapula be displaoed| the elevation of the arm to abont the

horiaontal pontion.

THE ELBOW-JOINT.

Is a giDglymoid ariionlation befeween the trochlea & the radial tnberoeitj or oapitellom ot
tJie hnmems, on the one hand, and, on the other, the greater sigmoid carity of the nlna & the
oap-shaped depression on the head of the radins. - The artionlar surfaces of tiie radios &

ulna are oontinaons with those of the superior radio-ulnar artionlatioii*

LIGAMENTS -Are I

Anterior - Broad A pretty thick layer of superficial obUqne & deeper vertical fibres

extending from
Inn€r condyle ^ front of humerus just above coronoid fossa to
OrHcular ligamentof radius 6f* under surface of coronoid process ofulna^ - to which

▼ertical & obliqne fibres a few transrerse ones are added.

FOBterior - Thin A membranous j consists of a few irregular fibres mainly trans*

Terse, which connect
Apex 6f* sides of olecranon process to
Mar;gin of olecranon fossa*

External Lateral -Thick, strong, tnangnlar, shorter & narrower than the internal t

from
External condyle to
Orbicular ligament of radius ^ outer border of ulna*

Lltenial Lateral - Thick, strong, triangnlar; longer & broader than foregoing, and

divided into anterior h posterior portions extending respeotively from

Fronts and from lower 6* back part of inner condyle^ respectiyely to
Inner border of coronoid process^ and tnner bordir ofolecranou*

SYNOVIAL MEMBRANE — Lines the coronoid h olecranon foss89, and dips down be-
tween the articular surfaces of the superior racUo-nlnar articulation.

VASCULAR A NERVE SUPPLY - ^^om the superior & inferior profunda, h the radial,

ulnar & interosseous recurrent arteries, and from the ulnar A musculocutaneous

nerves.

MOVEMENTS *- Flexion A extension only, which are limited by the looking of the coronoid

ft olecranon processes in their respective fossaB. - The inner border of the trochlea
descending lower than the outer one, the axis of rotation is oblique downwards A
inwards; the path of motion lies, therefore, in a plane, oblique doWnwards ft out*
wards, which circumstance, as is remarked by Oruveilhier, brings the hand

during fiexion naturally and without effort towards the mouth.

BADIO-ULNAB ABTIGULATIONS.

Three In number, enperior, middlOi A Inferior, the middle one oonsieUng merely of two lig^men ta,

the interosieons ft the obliqae or roand

ST7PEBI0B RADIO-ULNAB ARTICX7LATION - Lateral ginglymm or diarthroeu

rotatorins between cironmferenoe of head of radios, on the one hand, and lesser sig-
moid oavity & inner surface of orbioalar ligament of radins, on the other, the lesser
sigmoid oavity corresponding to the broad inner part, and the orbicnlar ligament to
the narrow enter part of the radial artionlar snrfaoe. - The only ligament is the

Orbicular Ligament - strong flat band, the fonr.fiflhs of a ring, whioh extends,

ronnd head ft npper part of nook of radios, from
Anterior extremity to Posterior extremity of laser sigmoid cavity o/ulna^

The oircomferenoe of its lower border is narrower than that of its npper
border, so that the head of the radins is maintained by it both against tb«
nina ft against the capitellnm of the homerns. Its inner eorfaoe is lined by
the synorial membrane, and forms part of the artioolar sorfaoes of the jotoi
Its outer Borfaoe gives attachment to external lateral ligament of elbow-joiiit

and to Bopinator broTie moscle.!

MIDDLB RADIO-ULNAR ARTICULATION.

Interosseons Ligament - strong aponenrotio plane of fibres whioh pass obliqnely

downwards ft inwards betwees

Contiguous borders of radius &* ulna,-' It is broadest towards middle, perfonkted

inl'eriorly for anterior interosseons vessels, and defloient above from abosti

an inch below toberole of radins, thos leaving for posterior interosseoiii

vessels an opening boonded soperiorly by tb«

Oblicilie or Round Ligament - Narrow fascioolos obUqoe downwards ft oot

wards £n>o)
Coronoid process to
Radius half an inch below bicipital tuberosity.

INTERIOR RADIO-ULNAR ARTICULATON — Lateral ginglymos or. diarthrusii

rotatorios between head of nlna ft sigmoid cavity of radios, to which is added
an arthrodia between under sorfaoe of head of ulna ft the triangular fibro-cartilagi

of the artioolation. -The ligaments are
Ant. Radio-Ulnar - Narrow band from
Anterior extremity of sigmoid cavity to
Front of head of ulna.

Post. Radio-UInar - Narrow band from
Posterior extremity of sigmoid cavity to
Bach of head of ulna*

Triangular Fibro-Cartilage -The principal band of union, triangular, from
Lower margin of sigmoid cavity of radius to
Depression at root of styloid process of ulna.

Its upper ft under sorfaoes are lined respectively with the synovial mem
branes ot the inferior radio-olnar ft radiO'Oarpal articulations, and tbej
come in contact, the one with the head of the ulna, the other with the conei
form bone. Its margins are blended with the surrounding ligaments. I
ia thinnest in the centre, and sometimes perforated; the two syuovial mem
branes above mentioned are then continuous with each othei

Synovial Membrane - le ▼ery loose, and is termed the membrana saedfortmx
It extends between the triangolar fibro-oartilage ft the head of the ulna, ant
beoomes oontinoonsi when the former if perforated, with the iiynovial mem

^ • • •- tmiie of t&e wriet-joial

THE WRISTJ^OINT.

Is a condyloid articnlaiion.

ARTICULAR SURFACES :

The Co!rDTi.B - Is formed bj three bones, the soapboid, semflnnar, A onnef form.

The Beceiyiko Gayitt - Is formed by the nnder snrfaoe of the radins & by the trian-
gular fibro*cartilage of the inferior radio-nlnar articulation. - The nnder snr-
faoe of the radins is diYided by a linear eloYation into two portions, the outer
triangular, the inner quadrilateral, which portions oorre8x>ond respectiYely
to the scaphoid and the semilunar i the cuneiform articulates with the nnder

surface of the triangular fibro-cartilage.

LIGAMENTS :

External Lateral - Short strong band, from

Apex of styloid procas of radius to

Outer side of scaphoid dr* trapenum^ 6^ anterior annular K^meni ofcarput*
Internal Lateral -Bound cord, from

Apex of styloid process of ulna to

Cuneiform ^pisiform bones, &* anterior annular lament.
Anterior -strong & broad membrane, from

Front of head oj ulna, anterior margin of radius &• its styloid process to

Scaphoid, semilunar, cuneiform, &* slightly to os magnum*
Posterior -Thinner, firom

Posterior margin of radius to

Scaphoid^ semilunar 6* cuneiform*

VASCULAR ft NERVE SUPPLY — Anterior k posterior carpal branohee of radial h

nlnar, anterior & posterior interosseous arteries, ascending branches of deep

palmar aroh. - Ulnar narrOi
— All bat rotatioii.

FASGLS A SYNOVIAL MBMBBAKES of the HAND A

WRIST.

FASCIJB — Are rftther llgamenii tban fkioI» proper, and are therefore deeorfbed here.

Anterior Annular Ligament of the Wrist - Oontfuaons abore with deep fawrfsoi

forearm, and below with palmar fascia; extends from
Pisiform hone &* unciform process of unciform to
Tubercle of scaphoid^ dr* ridge on anterior surface oftrapenum*

It Kn pierced by tendon of flexor carpi radialis.

Beneath it pass the flexores snblimie & profnndas dijntomin enclosed in one 83niOTial

sheath, the flexor longns polHois enclosed in another sheath, and the median o.

Into its anterior surface it npper border are inserted a few fibres of the palmaris

longns h flexor carpi ninarii.
From its lower border arise In part the abdnotor, opponens A enter head of flexes

breyis poUiois, and the flexor brevis A opponens minimi digtlL

Posterior Annular Ligament of the Wrist - Thinner than foregoing, from

Cuneiform &* pisiform bones, and lower part of ulna to
Styloid process &* ridges on posterior aspect of radius.

Presents six divisions or compartments lined each of them with a separate sjnoriil
membrane, and which, from witbont inwards, correspond to the following osseoni

groores, and transmit the following muscles:-
/. - Corresponds to shallow groove on outer side of styloid process ofradius, - Tmns-

mits extensores ossis metacarpi &»primi intemodii poUkis.
2» - Corresponds to broad &* shallow groove on posterior aspect of styloid process. -

Transmits extensores carpi radiales longior S* breviar*
J. - Corresponds' to narrow 6* deep groove on back of lower extremity of radius. -

Transmits extensor secundi uUemodii poUidu
4, - Corresponds to broad &* shallow groove on bach of lower extremity of radius. -

Transmits extensores indicis &* communis digitorum.
J*. - Corresponds to groove at point of articulation of radius &* ulna, - Transmtts

extensor minimi digiti.
6» - Corresponds to groove on back of head of ulna, - Transmits extensor caryi

ulnaris.

Palmar Fascia — Consists of

Two Lateral Pobtions - Thin. Cover mnscles of thumb & little finger, and rend pro-
cesses between them.

CsinRAL Portion - Thick, strong, triangular ; firmlj adherent to integument; oorers
saperflcial palmar arch, flexor tendons, & median & ulnar nerres, and gives origin
internally to palmaris brevis. It is narrow aboTe, where it receires expanded
tendon of palmaris long^is, and is attached to anterior annular ligament; an J
broad below, where it divides into four slips bound together by transverse fibres.
Each slip subdivides into two processes, which processes embrace the flexor
tendons, and become attached to bases of first phalanges & glenoid ligaments.
Between the slips are seen the palmar interosseous & digital arteries, the termin&i
branches of the median A ulnar nerves, & the tendons of the Inmbrioales.

SYNOVIAL MEMBRANES — Are articular dt tendinous.

Articular - Vire i -

/. - Membrana Sacciformis of the inferior radio-ulnar articulation.
2. - Synovial membrane of the radio'Carpal articulation, comprised between tho
first row of carpal bones & the under surlace of the radius ft trian-

galar fibro-oartilage.

J. - GenereU synovial membrane of the carpus, comprised between bones of first

row, between bones of second row, between the two rows of boue«,

between the second row of carpal bones & the four inner metaoaipal

bones, and finally between the four inner metacarpal bonaa.

4. - Synovial memtrane of the carpo-metacarpal articulation of the thumb,

5. - Synovial membrane of the articulation between the cuneiform &* pisiform.

Tendinous - 'V'ide Anterior h Posterior Annular Ligament!.

LOWER LIMB.

FRONT & INNER SIDE OF THIGH

MUSCLES of LOWEB LIMB— 1st Tablet.

ILIAC REQION.

Psoas Magnus - Bases of transverse processes of Inmbar Tortebrse, and hj fire slips

from sides of bodies of lambar & last dorsal vertebrae A from eorres«

ponding intervertebral substances; the slips being conneoted bj iendinoas

arches which extend across the constricted part of the bodies of the Tertebrae.

Lesser trochanter of femnr»-S. by anterior branches of lambar nerves.

Psoas Parvns - Sides of bodies of last dorsal & first lambar vertebrie & corresponding
intervertebral snbstance.

IliO'pectineal eminence. - S. by anterior branches of lambar nerves. -
Is frequently absent.

IllaCUS " Ilifto fossa & inner lip of crest of ilium; ilio-lambar ligament; base of
sacrum | anterior superior & anterior inferior spines of iliam A notch between
them { capsule of hip-joint.

Outer side of tendon of psoas, and upper part of line from lesser tro«
chanter to linea aspera in front of peotineos. - S. by anterior oraral nerva.

ANTERIOR FEMORAL REGION.

Tensor VaginsB Pemorls - Anterior superior spinous process and anterior pari of
outer lip of crest of ilium.

Fascia lata about J down enter side of thigh. - S. by superior gluteal nerve.

Sartorins -" Anterior superior spinous process of ilium & upper half of notch below it.

Upper part of inner surface of shaft of tibia covering tendons of gracilis
ft semitendinosus. - S. by middle or internal cutaneous branch of anterior ornral
nerve.

Rsotns Pemoris - Anterior inferior spinous process of ilium (straight tendon) t groove
above brim of acetabulum (reflected tendon).

Upper border of patella in common with vasti & crureus. -> S. by anterior
crural nerve.

Vastus Ezternus - Anterior border of great trochanter & horizontal ridge on its outer
surface) rough line from great trochanter to Hnea aspera; whole length of outer
lip of linea aspera & line from linea aspera to outer condyle j external inter,
muscular septum.

Outer border of patella & slightly into head of tibia. - S. by anterior
omral nerve.

Vastus Intemus - Line from inner side of neck of femur to linea aspera; whole length
of inner lip of linea aspera & line from linea aspera to inner condyle ; inner aor*
face of femur; internal intermuscular septum.

Inner border of patella & slightly into head of tibia. -> S. by anterior
omral nerve.

CrursUS *- Anterior & outer surfaces of femur reaching from anterior intertroohanterio
line to within a few inches of condyles.

Upper border of patella in common with rectus & vasti. - S. by anterior
crural nerve.

Taking the vastus intemus & the cmreus as forming but one muscle, and
describinq: the Quadriceps extensor fenioris as a Triceps^ we may say that the
"VASTUS INTERNUS" arises from: -line from inner side of neck of Ibmar
to linea aspera; whole length of inner lip of linea aspera h line from linea aspera
to inner condyle; nearly whole of inner^ anterior and outer surfaces of shaft of
femur; internal intermuscular septnm ; - and that it is inserted into tendon of
rectus & borders of patella, and slightly into head of tibia,

Subcrureus - Lower part of anterior surface of femur.

Upper part of synovial membrane of knee-joint, - 8. by anterior omral
nerve.

FEMOBAL ABTEBY

OommenoeB beneath Poapart'a ligament midway between antero-anperior spine of ilium A

symphyBifl pubis, and a little to inner side of head of femar.
Passes down f^nt ^ inner side of thigh, being at first at a distance from, and then close to,

the shaft of the bone.

Terminates at Junction of middle and lower thirds of thigh, becoming popliteal arterj in opening

in lower part of addnctor magnns. - Some Authors describe a ccmmon femoral artery

descending as low down as the origin of the du^ femoral, the main trunk below this

branch being called the superficial femoraL
Its direction is marked by a line drawn from midway between antero-superior spine of ilium

and symphysis pubis to inner side of inner condyle of femur.

HEIiATIONS — Must be examined in Scarpa's triangle, or in upper thirds and in middle

third of thigh.

IN SCARPA'S TBZANOLE — The artery divides the triangle into two nearly

equal parts, and has
In Front - Skin, superficial fascia, fascia lata (except opposite saphenous ope-
ning, where latter ia replaced by cribriform fascia), sheath; internal cu-
taneous nerve & filaments of crural branch of gmiito-crural n. ; inguinal

lymphatic glands.
Behind - Posterior part of sheath ; psoas, pectineus, adductor longus ; profunda

artery & vein.
On Innsx Side at Uppeb Part - Femoral vein, which becon\es posterior below.
On Outer Side - Psoas muscle, anterior crural k long saphenous nerves.

IN 2SQDDLE THIRD OF THIGH — It lies behind sartorius in Hunter's canal,
-a deep depression between vaatua intemua & tendons of adductors longus ft
magnus dosed in anteriorly by a band of fasoia,-and has femoral vein behind
it ft to its outer side, and long saphenous nerve to its outer side ft in firont.

BRANCHES:

Superficial Epigastric — Arises close to Poupart's ligament. Through saphe-
nous opening, and then upwards and inwarda in auperficial faacia of abdomen,

and anaatomoaea with deep epigaatric ft internal mammary.

Superficial Circumflex iliac — Ariaea cloae to Poupart'a ligament. Pierces
faacia lata on outer aide of aaphenoua opening, and upwarda ft outwarda be-
low Poupart's ligament to crest of ilium. Anaatomoses with circumflex iliao

ft gluteal arteries.

Superficial or Sup. Sbctemal Pudic — Arises near preceding. Inwards
through saphenous opening, and then acroaa Bi>ermatic cord or round lig^

ment to integument of abdomen, penis ft scrotum, or labia.

Deep or Inf. External Pudic — Arises with or near preceding. Inwarda be-
neath faacia lata, which it pierces opposite pubes, to integument of perinsaum

ft to scrotum or labia.

Proftinda Femoris, or Deep Femoral — Vide next Tablet.

Muscular Brs. — Numerous, and given off along entire course.

Anastomotica magna — Ariaea in Hunter'a canal. Deacenda upon tendon of

adductor magnua, and dividea into:
SuFERViciAL Branch - With internal saphenous nerve to integument of inner

aide of knee.

Deep Brancii - Through substance of vaatua intemua to inner side of front of

knee, and anastomoses with superior internal ft superior external articn.

lar arteries ft with recurrent branch of tibia!.

COLLATERAL OIBCULAT. — Is reestablished after ligature of the common femoral
through the gluteal, iUo-lumbar ft circumflex iliac arteries, which join with
the external circumflex, through the obturator ft sciatic, which join with the
internal droumflex, through the comes nervi ischiadici, which join with
the terminal ft perforating branches of the proftmda . - After ligature of the
•VFBRf iciAL f SMORAL it Is reestablished mainly through the deep femoral ft
iti perforating branchesi whioh join with the Mrtioular branches of the popli<

INTERNAL or LONQ SAPHENOUS VEIN — CommenoM at inner
■ide of aroh on donam of foci. AooompaniM long or internal Mphenona nerw
in front of internal malleoint, along inner tide of leg, ft behind inner oondjlei
it then inolinee forwards along inner aepeot of thigh, and, patting throngh
■tphenont opening, terminatet in the femoral abont an inoh ft a half below
Ponpart't ligament. It receiret nomeront cataneont branohet fh>m le^ ft
thigh, (the branohet from inner ttpeot of thigh freqaentlj noiting into one
large trnnk); and it also receiret near itt termination, the tnperficial epigas.
trio, tnperficial oiroamflez iliao ft taperfioial external pndio. It oommnni.
eatet with the internal plantar, anterior ft posterior tibial, ft femoral, aad
eontaini fh>m two to tix Talres^ whioh Taltes are nsoallj more nnmorona la

the thigh than in the leg.

ANTERIOR CRURAL NERVE.

The largest bnnoh of lambar plexus. — Arises mainly firom Srd ft 4th lumbar Aorree, but

receives also a fasoiooliis firom the 2nd.
Descends through sabstance of psoas, and emerges from lower part of its outer border.
Passes down between psoas ft iliacns, giving off small branches to iliaons ft femoral artery.
Enters thigh beneath Ponpart's ligament half an inch to outer side of femoral artery, and

dirides into anterior ft posterior divisions.

ANTERIOR DIVISION -Gives off i

Uiddlo CutanGOUS Nerve *- Pierces fascia lata ft generally sartorins also ( which

muscle it then supplies ) about three or four inches below Pouparfs ligament^
and divides into two branches to integument of front of thigh as low as
knee. - Joins with crural branch of genito-omral, internal cutaneous ft

internal saphenous.

Zntemal Cutaneous Nerve * Grosses upper part of sheath of femoral vessels giving

off a few cutaneous filaments, and divides into :

AjmcBiOB OB EzTEBNAL Bbakcb - Pierccs fascia lata about lower third of thigh^

and divides into branches to integument of inner ft outer sides of

knee ; joins with middle cutaneous ft long saphenous.

IxirBB OB Posterior Branch - Along posterior border of sartorius, joining in

a plexiform network beneath fascia with long saphenous ft obturator.

Pierces fascia lata a little above inner side of knee; supplies integument of

inner sides of thigh ft upper part of leg, joining with int. saphenous.

Long or Internal Saphenous Nerve - l^he largest branch of anterior dlrision

I arises sometimes from posterior division ).
Along whole length of outer side of femoral artery, lying first at a slight dis-
tance from it, and then close to it.
Pierces fibrous band which extends from vastus intemus to tendons of adduc-
tors longus ft magnus and forms anterior wall of Hunter's canal.
Pierces deep fascia between tendons ofsartorius & gracilis, and joins with internal

cutaneous.

Passes with internal saphenous vein along inner side of leg ft divides into two

branches; one terminates at inner ankle, the other passes in front of

ankle to integument of inner side of foot.
Joins in plexiform network above mentioned with internal cutaneous ft obtura-
tor nerves ; - gives off to integument of front of knee a large branch,
nervus outaneus patell», which, joining with external, middle ft internal
eutaneons nerves ft other branches of long saphenous, forms plexus
pateUfBin front of knee; -gives off numerous branches to integument of

front ft limer side of leg.

POSTERIOR DIVISION - Gives off t
Muscular Branches

To all the muscles of front of thigh except tensor vaginse femoris supplied by

superior gluteal n., and Sartorius supplied by filaments from middle or

sometimes from internal cutaneous nerve, [pectineus is partly supplied by

_ ^, , ^ obturator nerve]

Articular Branches

Two: -one from nerve to vastus extemus, long ft slender ft distributed to front of
capsule; one from nerve to vastus intemus, accompanies deep branch of

anastomotioa magna to inner side of oapsv^'*.

MUSCLES of LOWER LIMB-2nd Tablet.

INTERNAL FEMORAL REGION.

Pectineus ~ Uio. pectineal line ft inrfaoe in front of IL

Upper part of line from troohanter minor to linea Aspen^ ft Into femnr
behind trochanter minor. - S. bj obtnrator or anterior cmral nerrei - bj aooea*
tory obturator nerre when the latter ezista.

Gracilis ~ inner margin of rami of pabes ft isohiam ft lower half of inner margin of bod j
of pabes.

Upper part of inner snrfaoe of shall of tibia aboTO ■emitendinosoa, and
beneath sartoriiiB. - 8. by obturator nerre.

Adductor Longas - Front of pnbea immediately below the oreat ft oloM to angle.

Kiddle third of inner lip of linea aspera between raatna intemns ft ad-
ductor magnus. - 8. by obturator nerre.

Adductor Brevis - Front of pabes for abont two inches below addaotor longns ft
between gracilis ft obtnrator eztemns.

Upper part of linea aspera ft lower part of line from it to lesser trochan-
tcr below ft behind peotinens. - 8. by obturator nerre or anterior ororal nerre.

Adductor Magnus - Lower part of descending ramns of pnbes{ ascending ramna ft
outer side of tuberosity of ischium.

Lower part of line from great trochanter to linea aspera, whole length of
inner lip of linea aspera ft line from it to inner condyle; by a strong tendon
into tubercle at upper ft back part of inner condyle. <-> 8. by obturator ft great
sciatic nerves*

DEEP FEMORAL ABTEBY

From onter & bmok part of femoral one or two inohee below Ponpart'g ligament, and nearly

equals snperficial femoral in site.

Passei:-

Downwards & outwards in front of iliaons, on enter side of femoral arterj;
Downwards & inwards behind femoral Tessels & profunda rein, and in front of

peotinens i
Baokwards between peotinens & addnotor longns ;

Downwards behind adductor longns, in front of adductors breyis & magnns i -
and ends in a small branch, whioh perforates lower part of adductor magnua to mn8«
oles of back of thigh, and anastomoses with inferior perforating & with

branches of popliteaL

BRANCHES:

EXTERNAL CIRCUMFLEX — The larger. From outer side of arterj oloae

to its origin.
Outwards between branches of anterior orural nerre and beneath sarto-

rius & rectus, and divides into branches :

AscENDiNO - Beneath tensor vaginss femoris, and anastomose with gluteal ft

oiroumflez iliaa

Descekdino - Usually three or four & of considerable size. - Beneath rectus
musole to vasti, principally the external. One large branch descends
with nerre to vastus extemua as low as knee, and anastomoses with

artioular branches of popliteaL

Teaksteksb - Smaller. Wind round femur below trochanter major in substance
of vastus eztemus, and anastomose with internal oiroumflez, soiatio

& superior perforating.

INTERNAL CIRCUMFLEX '— ^^ smaller. From inner ft back part dose to

origin.
Backwards between peotinens ft psoas, and winds round inner side of
neck of femur to interval between quadratus femoris and adductor
magnus, and anastomoses with external oiroumflez, sciatic ft supe-
rior perforating. Gives off branches :

Abcsndiko - To adductor muscles, gpracilis ft obturator eztemus i anastomoses

with obturator.
Descendino - Between adduotors brevis ft magnus, whioh it supplies.

Abticulab - Into acetabulum through notch beneath transverse ligament f
supplies adipose tissue, and sends twigs along round ligament to head

of femur.

PERFORATING ^- Usually three ft of good size. - Arise behind adductor longus,

above, in front of, and below, adductor brevis, and pass to back of

thigh, the

BUPBRIOBy — Perforating the adductor magnus above the brevis ( some*

perforating addnotor brevis also) |

MIDDLE, ^- Perforating both these adductors ;

INFEBIOB, — Perforating the adductor magnua below the brevis ;

and supply hamstring muscles ft anastomose with each other,
sciatic, internal circmflez ft termination of profunda, the middle
one, the largest, giving off ascending ft descending branches, and

nutrient artery of femur.

OBTURATOB NERVE.

Arifes matnlj from 3rd ft 4th lumbar nerres, bnfc reeelves also a faioloalat from the flnc

(Sappey, Ilirflohfeldt, & Qnain't diagram of lumbar plexus).
OoBoends throogh inner fibres of psoas, and emerges from inner border of that mnaole

opposite brim of peMa,
Along oater wall of palTis aboTO obturator ressels to upper part of obturator foramens

enters thigh, and diTides infeoi

Antorlor Branch - '^^^ smaller. Descends in front of addnotor breris, and behind p9o-

tinens & addaotor longas, to femoral artery, upon whioh it is distribnted

below the latter mnsole. Girea off branohea t •

Articular - To hip-joint j arises near obturator foramen.

V OSCULAR - To gracilis & addaotor longus, and sometimes to peotineos ft adductor

breris;

AHASTOUOTIC TO IlfTERNAL CUTANEOUS ft InTIRNAL SaPRRNOUS KkXTBS - Arises

opposite lower border of adduotor longus, and forms with the foregoing

nerves a plexiform network beneath deep fascia of thigh.
Sometimes this anterior branch of the obturator nerre, and its oommunioating
offset to tho internal cutaneous ft internal saphenous nerres, are larger
than usual. The latter then give) off cutaneous fllamenta to the akin of
the lower ft inner part of the thigb, and descends aloog the posterior bor.
der of the sartorius to the inner side of the knee-joint; hare it pierces the
deep fascia, communicates again with the internal saphenous nerre (which
is then smaller than usual), and sapplies the skin of the inner side of the

leg as low as its middle.

Posterior Branch - "^^^ larger. Pierces upper fibres of obturator ezternns, and des.

ceads behind adduotor breris in front of adductor magnns; gires off

branohea: >
Muscular - To obturator ezfernus ft addaotor magnus (and to adductor breris,

when the latter is not supplied by the anterior branch of the nerre).
ARTrcuLAR - Through opening in lofrer part of adductor magnus, and upon the pop.

liteal arterj to baok of knee-joint.

ACCESSORY OBTURATOR NERVE

Arises (when it exists) either directly from obturator nerve, or, by separate

filaments, from the 2nd, 8rd, ft 4th lambar.

Descends along inner side of psoas, crosses front of pubes, gets behind peotineoa,

and divides into branches to pectineus ft hip.joint, Oommunioataa with

anterior branch of obturator nerve { the oommunioating branch is aom*.

times large, and is then prolonged as a oataneons nerve to tho thl^h

ft leg (Graj)

LCWER LIMB.
II.

FRONT OF LEG & DORSUM OF FOOT.

MUSCLES of LOWER LIMB— 3rd Tablet.

ANTERIOR TIBIO-FIBULAR REQION.

Tibialis AntictlS - Oater tuberosity ft upper two-thirds of OTtier irar&oe of shaft of tfU» i
adjoining part of the interosseons membrane ; intermnsciilar septum between it
& extensor longns digitoram ; deep fascia.

Inner & under surfaces of internal onneiform bone & base of first meta*
tarsal. - b. by anterior tibial nerre.

SztOXlSOr LongUB Digitorum - Onter tuberosity of tibia ] upper three-fourihs of an-
terior surface of shaft of fibula ; interosseous membrane ; septa between it and
tibialis antioas & peronei muscles ; deep fascia.

Bases of 2nil & 3rd phalanges of four outer toes. - S. by anterior tibial nerre.

Sbctensor Proprias PoUicis -Middle two- fourths of anterior surface of shaft of fibula
internally to extensor longus digitorum ; interosseous membrane.

Base of last phalanx of great toe. - S. by anterior tibial nerre.

P6ro&6UB Tortias - Lower fourth of anterior surface of shaft of fibula ; lower part of
interosseous membrane; intermuscular septum between it & peronena broria.
Base of 6th metatarsal bone. -B. by anterior tibial nerye.

FIBXTLAR REQION.

Feroneus Longns - Head & upper two-thirds of outer surfaee & of anterior ft posterior
borders of fibula ; intermusoular septa between it & muaoles of front ft back of leg ;
deep fascia.

Onter side of base of first metatarsal bone. - S. by musoulo-ontaneons
branch of external popliteal nerve.

PeroHeus Brevis - Lower two- thirds of outer surface of shaft of fibula, passing upwards
. in a pointed process beneath peroneus longus; intermusoular septa between
it & muscles of front ft back of leg.

Base of fifth metatarsal bone. - S. by mosoalo^mtaneons branoh of ezter-
nal popliteal nerrew

MUSCLES of the FOOT.

DOPvSAL REGION.

lEIxtensor Brevis Digitoram - Onter ft uppsr surfaces of greater process of OS
calcis, calcaneo.astragaloid lij^ament, anterior annnlar ligament of tarsus.
First phalanx of great too & outer sides of long extensor tendons
of 2nd, Srd, ft 4th toes. - S. by extci-nal branoh of anterior tibial nerre.

ANTEBIOB TIBIAIi ABTEBY

Anterior & Emaller branch of bifnroation of popliteal opposite lower border of poplitenc

. moBole.
Forwards between the two heads of tibialiB posticus, and between tibia ft fibnla through

opening in npper part of interosseous ligament.
Downwards in front of interosseons ligament, shaft of tibia A ankle joint (where becomei
dorsalis pedis), passing between tibialis anticns & extensor longns digitomm,
between tibialis anticns & extensor proprios pollicis, between tendon of extensor pro-
prins pollicis, which crosses it, and innermost tendon of extensor long^ digitornm ;
- lying in a line from inner side of head of fibala to midway between malleoli, and
being deeply situated, abore, between muscles on either side & beneath tendon cf
extensor proprins^ollicis, and superficially, below, beneath skin, antericr annular

ligament & fascia.
Has two Tens comites. Anterior tibial nerve is first external, then anterior,

then again external to it.

BRANCHES :

Recnrrent tibial — Arises in upper part of leg. Upwards through tibialis anticns
to front of knee, and anastomoses with inf. articular branches of popliteal.

BlasctllSkT — Numerous small branches to muscles on either side.

Malleolar — ^wo ; rather yariable in size. Arise near ankle, and pass, the

IirTEKNAL,-To inner ankle beneath tendons of extensor proprins pollicis & tibia-
lis antious,
ExTEKNAL, -To outor ankle beneath extensor longus digitornm ,

and anastomose respeotiTely with posterior tibial & internal plantar,

and with tarsal & peroneal.

DORSALIS PEDIS ARTERY

From bend of ankle to back of first interosseous spaoe, resting upon bones of tarsus be-
tween tendon of extensor proprins pollicis & innermost tendon of extensor brevis
digitornm, which crosses it near termination^ and having anterior tibial nerve on its

outer side.

BRANCHES :

Tarsal — Arches outwards beneath extensor brevis digitornm, and anastomoses with

metatarsal, external malleolar & external plantar.

Metatarsal — Here or less obliquely forwards in front of preceding. Gives off the

Three outer Dorsal Interosseous Arteries -Along corresponding interosseous

spaces. Are joined by anterior A posterior perforating branches, and

supply dorsal digital branches to 3| toes on outer side of foot.

Dorsal Art. of Great Toe — is the first dorsal interosseous artery, and supplies

dorsal digital branches to li toes on inner side of foot

Conil&Ullicating — Between the two heads of first dorsal interosseous muscle, and

inosculates with external plantar, completing plantar arch. Gives off
plantar digital branoheii to 1| toes on inner side of foot.

EXTERNAL POPLITEAL NEBVE.

The smaller of the two tarmfoEl branolioa of groat soiatlo.
Along^ enter tide of popliteal space olose to bioeps.

Pierces peroneas longaa an inoh below head of fibula, and divides Into anterior tibial

& mnsoalo*oontaneoiis. Giyes off branches : •
Articular - Three; aocompanj the two external artioolar h the reonrreat

tibial arteries to knee-joint.
CaUamous - Two or three; supply integument of enter ft back part of leg;
one, the oommauicaas fibnlaris, orossses outer head of gastroc-
nemius, and Joins the oommunioans tibialis to form external or

short saphenous nerye (Y. next Tablet).
Anterior Tibial Nerve - Beneath extensor longus digitorom to front of interosseona

membrane ; along outer side, in front of, and again along outer
side of anterior tibial artery to front of ankle-joint. - Sapplios

musoles of front of leg, and diyides into i
ExTERHAL Brakcd - Beneath extensor broTis digitorum, which it supplies i

becomes ganglionic, and supplies articulations of tarsnau

Imteknal Bbanch - With dorsalis pedis artery along inner side of dorsam of

foot ; supplies adjoining sides of great h second toes, and joins

with muscnlo^utaneona.
Un8CnlO*CutaiieonB Nervo - Between peronei muscles, which it supplies, and extensor

longua digitorum ; pierces deep fascia about lower third of front

of leg, and divides intoi

IktlenaIi Bbanch - Sapplies inner side of great toe, adjoining sides of 2nd A

8rd toes, & integument of inner side of foot; joins with internal

saphenous k anterior UbiaL

ExTEBNAL Beancu - Snpplios adjoining sides of Srd, 4th, ft 5th toes, and inte^«

umeut of outer side of foot; joins with external or short saphenona.

External Sapkemmt A^rrw^Behind outer malleolus with external
saphenous vein, and supplies integument of outer side of foot
& little toe; joins with musculo-cutaneous. Is eometimea
larger than usual, and then supplies both sides of little toe.

and outer side of 4th.

EZTEBNAL or SHORT SAPHENOUS VEIN * Oommenoesatontar
side of arch on dorsum of foot. Accompanies external or short sap>ieno^s
nerre behind outer malleolus, along outer border of, ft orer, tendo Ajobillis,
and between the two heads of gastrocnemius; it then perforates deep faad*
at lower part of popliteal space, and opens into the popliteal. It reoeiTee
numerous branches from back of leg, and communicates with deep Teins on
dorsum of foot ft behind external malleolus. It is prorided with two Talroa,

one of which is alwavs found near its terminatioii«

LOWER LIMB.

IIL

GLUTEAL REGION, BACK OF THIGH,

POPLITEAL SPACE.

MUSCLES of LOWER— 4th Tablet.

GLUTEAL REGION.

OlutCtU Maximns - Baperlor emrtd Uae on dortnin lUI ft rough nrfiiM be t wietp it A
posterior fifth of crest of ilimn i sides of lower part of ssomm and oooojz ft ten-
dinons expansioa orer baok of sacniin | posterior surfiftoe of great saoro>solatio
ligament.

Fascia lata oorering onter side of thigh, ft rough line ttom great trochaa.
ter to linea aspera. - S. by inferior gluteal nerve.

OlntdUB Medins - Dorsnm ilii between superior ft middle onrreS lines ft outer lip of
crest between them i fascia covering anterior part of the muscle.

Oblique line on outer surface of great trochanter. - 8. bj superior gluteal
nerre.

OIntetUI I^JPfTfiTlff - Dorsum ilii between middle ft inferior ourred lines.

Anterior border of great trochanter. - S. bj superior gluteal nerre.

FyriforniiB - B7 three fleshy digitations from front of sacrum between first, second, third,
ft fourth anterior sacral foramina ft from grooYCS leading ftrom them; margin of
great saoro-sciatic foramen ft anterior surface of great sacro-sciatic ligamentw

Posterior part of upper border of great trochanter. - 8. by one of the mus-
cular branches of sacral plexus.

Obturator Intemns * Whole of inner surface of true pelvis in front of and behind ob.
turator foramen; inner surface of obturator membrane ft fibrous arch which
completes canal for obturator vessels ft nerve.

Upper border of great trochanter in frout of pyriformis. - 8. by one of tha
muscular branches of sacral plexus.

GtoXQBlllUB Superior - Outer surface of spine of ischinm.

Upper part of tendon of obturator iuternns. • 8. by one of the muscular
branches of sacral plexus.

OexnellllB Inferior -Upper part of outer lip of tuberosity of ischium.

Lower border of tendon of obturator internns. - 8. by one of the mnaeular
branches of sacral plexus.

Qnadratns Femoris - Outer border of tuberosity of ischinm.

Upper part of linea quadrati on back of great trochanter. - 8. by one of
the muscular branches of sacral plexus.

Obtorator Extemus - luner two-thirds of outer surface of obturator menbraaet olr.
cumference of obturator foramen, and fibrous eroh which eompletee oanal for
obturator vessels ft nerve.

Digitol fossa of femur. - 8. by obturator aerm.

GLUTEAL ARTERY.

The largest branch of internal iltac, and the oontinoation of iU poate.j«r dirision.
Through great sacro-Bcialio foramen above pjr if oralis, and then between lattar

mnscle and glnteoe medtns, and dirides tntot
SupERriciAL Bbamcu - Gives off numirona bruiches to glotent mazimoa A in-

tegnment orer sacmm;
Deep Branch - Forwards between glatei medina ft minioins, and dirides into:

Superior Division - Along npper border of glateoa mini mas towards an*

terior superior spine of ilinm, and joins with eireamflex iliae.

I.i/arior Division - Crosses glutens minim ns towards great trochanter, and

joins with asoendinj branch of external ormimflaz*

SUPERIOR GLUTEAL NERVE.

From back of lombo-sacral cord.

With gluteal Tdssels through npper pari of great sacro-sciatio foramen abore

pjrriformis, and dirides into:

Superior Branch - Along middle cnrred line on dorsnm ilii with superior

dirision of deep branch of glateal artery* Supplies glutei medins ft

minimus
IxYEiLioR Branch - Directly forwards between glutei medins ft minim ns, whioh

it also supplies, and terminates in tensor ragiue fomoris.

SCIATIC ARTERY,

The larger of the two terminal branches of anterior dirision of internal iliao artery,

and the largest branch of the artery after plateaL
Downwardj in front of pyriformis ft sacral plexus, lying a little behind ft to outer side

of internal pudic
Tiiroagh gfreat sacro-sclatio foramen below pyriformis and between great sciatic nerre

ft pudio ressels ft nerre.
With small sciatic nerre orer gemelli, obturator internns ft quadrat us femoris and in

front of gluteus maximua.
Girea off branches :

Muscular, Arttculab to hip-joint ;

CoCvTCBAL, InFKRIOR QlUTEAL;

Comes Nsari Ischiadici - Long, slender i with, and subsequently within

sheath of, great sdatio nerre to lower part of thigh.

SMALL SCIATIC NERVE.

From lower ft back part of sacral plexus.

With sciatic ressols through lower part of great sacro-sciatio foramen below pyriformis.
Descends beneath i^lntens maximus on inner side of great sciatic nerre.
Along back of thi.?h beneath fascia lata to lower part of popliteal space.
Perforates deep fascia, and accompanies extei^al saphenous rein to skin of back of

leg ; communicates with external sapheuons nerre*
Gires off branches :

Inferior Glxttbal - Sereral, large; to under surface of gluteus maximus.
Irf£RI0r Pudendal - Forwards below taber ischii to skin of periumum and upper

ft inner part of thigh, and to scrotum or labium.
CuTAVXous - DtMcmdin^. To skin of inner ft outer ddes of back of thigh, popliteal

space and back of leg.
Aumding. Wind round lower border of gluteus maximus to integu-
ment oror its surface.

MUSCULAR BRS. OF SACRAL PLEXUS.

To pyriformis, obturator intemus, gemelli ft qnadratus femoris.

The nerre to obturator intemus passes behind spine of ischium and through lesser

sacro-sciatic foramen to inner surface of the muscle.
The gemellns inferior and the qnadratus femoris are supplied by a common branch,

whieh runs between capsule of hip-joint and the obturator iaternus
ft gemeliiy and gires off aa artiealar fllamaat to iho joint.

PUDIO ABTEBT.

The ■mall«r of Um two torminal brMiohao of uitorior dlviokm of InUnial Ulfto arterj.

DetoendB in front of j^jrifonnis ft laoral pleziii, Ijing to the inner lidd ft a litHo in front of

teiatic artery.
With padio nerre throagh lower pert of greet ■eoro*ecietio foremen below pjriformis on inner

eide of soielio nerrea ft Mietic erter j.
Winds ronnd apine of isohinm end re-enters pelrie through lesser saoro-soiatio foramen.

Forwards along enter wall of isohio-rectal fossa below pndio nenre, being ooTored bj obturator
fascia, and lying at first 1| inches above lower extremity of tnber ischii, bnt spproaching

surface as it progresses.
Pierces deep layer of deep perinssal faseia, and ascends along pubio arch between the two

layers of that fascia to near symphysis pubis.
Pierces superficial layer of de^ periueal fascia, and dirides into artery of corpus caTemosam

and dorsal artery of pecis«

It gives off : - Inferior Bmmorrhoiddl^ SuptrficitJ IWitutal^ Transotru Perinaai^ Artery of the

Bulh^ 6^ Artery of the Corpus Cavemotum.

PUDIO NERVE.

Prom lower part of sacral plexus.

With pndio artery through lower part of great saoro-soiatio foramen on in nor side of

great soiatio nerre.
Winds round spine of ischium, and re-enters polris through bs^er saoro-sciatio foramen ,

where it gives off inferior hmnorrhoidal nervo.
Forwards along outer wall of isohio-rectal fossa above pudio artery, both nerve ft artery-
being covered by obturator fascia, and divides into perinmal nerve ft dorsal
V nerve of the peaie.

MUSCLES of LOWER LIMB— 5th Tablet.

POSTERIOR FEMORAL REGION (Hamstring Musceles).

Biceps.

LoNo HxAD - la common with semitendinoBiui from lower ft inner of the two raR*

faces on back part of tnberoBity of isohiam.
Sbobt Head - Whole length of outer lip of linea aspera between adduotor magnna

ft yastns ezternns and from inferior external diriaion of linea aspera to within

two inches of outer condyle.

Outer side of head of fibula bj a strong tendon, which dirides into two

parts to embrace long external lateral ligament of knee-Joint, sends a fibrona

prolongation to outer tuberosity of tibia^ and giyes off aa expansion to fiEMoia of

leg. - S. by great sciatic nerre.

SeinitexidinostlS - in common with long head of biceps from lower ft inner of the two
surfaces on back part of tuberosity of ischium.

Upper part of inner surface of shaft of tibia below gracilis ft beneath sar-
torius - S. by great sciatic ner?e.

Sexnlxnembranosos - Upper and enter of the two surfaces on back part of tnberotity
of ischiam abore ft on outer side of origin of biceps ft semitendinosns.
By a tendon which dirides into three portions, into:

Posterior part of inner tuberosity of tibia, sending an expansion orer

popliteus;
Groove on inner side of inner tuberosity of tibia beneath internal

lateral ligament of knee-joint;

Posterior ft uppep part of outer condyle of femur, forming chief part

of posterior ligament of knee-joint. - 8. by great soiatio nerre.

GBEAT 8CIATI0 MEBVE.

Arises from the lambo-sacral oord ft the four upper laoral narrea, and it the oontiniiaiioa

of the eaorsl plexus.

Through ^reat saoro-BOtatio foramen below piriformis, on outer side of padio Teasels St nerre.

Downwards between trochant er major A tuber isohii, behind external rotator mQSo1c>^s ft

addnctor mag^nns, to lower third of back of thigh, whore it dtTides into external ft In.

ternal popliteaL
Is ooTered bj glaieas maximn) ft biceps. Girea off branches : «

Articular -To back of hip-joint.

Muscuiar - To hamstring mnsoles ft addnotor magniuu

EXTERNAL POPLITEAL NERVE.

The smaller of the two terminal branches of great soiatio.
Along onter side of popliteal spac? olose to biceps.

Pierces pezoueus longos an inch below head of Bbnla, and dirides into anterior tibial

ft mnsculo-contaneons. GItos off branches : —
Ariicular - Three; accompany the two external ariicolar ft the recnrreafe

tibial arteries to knee-joint.

Cuianeoms - Two or three; supply integument of outer ft back part ot leg;

one, the communicans fibalaris, orossaes outer head of gastroc-

nemius, and joins the oommnnioans tibialis to fonn external or

short saphenous nenre (V. next Tablet).

INTERNAL POPLITEAL NERVE.

The l&rger of the two termf nal br&noliefl or great sciatic.

Through middle of popliteal space to lower border of popliteno, where it b(>coTnes posterior

Is first superficial ft external and at a distance from, then superficial A intern •! an^l o on.)

to, popliteal Teasels. -Its branches nro:

Artiaiiar • Three; aooonpanj the two internal ft the azy^^os artim ar

arioried to ic nee-joint.
Muscular - To pastrocnemins, plantaris, popliteas, soleas.

Commumcans Tibiaiu - Between heads of gastroonemins to middle of

baok of leg, where it pierces deep fascia and Joins oommnnicans

fibnla'i^ to form the
External Saphentms Nerve - Behind outer mallcolns with external

saphenous reio, and supplies integnment of enter side of foot

ft little toei joins with mnscnlo-cntaneoas. Is sometimes

larger than nsaal, and then supplies both side? of little toe,

and outer side of 4th.

LITEAL ABTEBY

OoBUBenees »t opening in lower part of addnotor mugnni.

Doimwiirdi ft ontwardfl to baok of knee-joint, and then yertioally downwards to

border of poplitens muoiey where dindea into anterior A poiterior tOdmL

RELATIONS:

Ix Front - Inner A posterior snrfiicefl of fenmr, posterior ligament of kBee-Joinft^

poplitens mnede.

Beuikd - Skin & fiuda ; quantity of fat A lympHatio glands ; semimembranoeiis ;

gastrocneminB, plantariSy solens ; popliteal vein, internal popliteal nerre.

On IxxER Side - Semimembranosus s inner oondjle; inner head of gastrocnemius.

Chr Outer Side -Biceps; outer condyle; outer head of gastrocnemius, plant&ris.

Popliteal vein lies close to artery, and is superficial & external to it except

at lower part, where it crosses to inner side ; it is frequently donble

at lower part. - Internal popliteal nerre is more superficial ft exter.

nal above, and is superficial ft internal below.

BRANCHES:

HffUSCULAB:

Superior — Two or three, small, to hamstring muscles ft TastL Amasto*

mose with perforating ft articular arteries.
Inferior or Sural *- Two, large, to heads of gastrocnemius ft plantaria.

OTTTANEOUS: —A few, slender; arise separately or with suraL Otot gaatroc

nemius to integument of back of leg.

ABTICUL AR — FiTo :

Superior - Two. wind round femur above condyles to front of knee, pas-
sing, tlie
IimxNAL, - Beneath tendon of adductor magnus ;
Bxtbemal,- Beneath tendon of biceps; and both diriding into

Sm/erficial ft deep brs. - to Tasti, femur ft Joint| and anastomosing
with each other, and with inferior articular arteries, anas*
tomotica magna ft descending branch of external cir*

cumflex.
AvygOS"- Arises behind posterior ligament of knee-joint, which it pierces to

supply interarticular ligaments ft syuoyial membrane.
Inferior - Two. Arise beneath gastrocnemius, and wind round head of tibia
beneath internal ft external lateral ligaments, the external artery
passing above head of fibula ft beneath tendon of biceps. Divide
into numerous branches to firont of knee, and anastomose with each
other, and with superior articular ft the recurrent branch of tibial.

LO\ArER LIMB.

IV.

BACK OF LEG; SOLE OF FOOT

POSTEBIOB TIBIAL ABTEBY

Posterior ft larger branoh of biftircafcion of popliteal opposite lower border of poplitena

mnacle.

Downwards & inwards upon tibialis posticus, flexor longns digitoram, lower end of tibia ft

ankle joint, being ooTered bj gastrocnemius, loleiis and deep layer of fascia in npper

two-thirds, and, in lower third, by integnment ft fiucia only on inner side of tendo

Aohillis.
into the two plantar arteries midwaj between internal malleolns ft heel, and between
tendons of tibialis postions ft flexor longns dig^itomm, which are anterior ft internal
to it, and tendon of flexor longna pollids, which lies posterior ft extemaL
Internal popliteal nerre is first posterior ft internal to it, but soon crosses to

its enter side.

BRANCHES :

Peroneal — Arises an inch below lower border of popliteis.

Downwards ft outwards npon tibialis posticus ft flexor longis poUlcia ft between
fibres of latter m:uicl9, and beneath soleos ft deep layer of fascia, and
ends on cater side of os calcis, joining with external malleolar ft axtemal

plantar. Gires off branchea :
Muscular -To solens ft muscles of deep layer, and peronei.

KuTRUSMT TO FiBULA - Downwards in nutrient canal towards lower extremity

of the bone.
CoicicuNiCATiKa TO FosT. TiBiAL - Inwards beneath flexor tendons a little

aboTO ankle Joint.
Ant. Feronbal - The largest branch. Through interosseons membrane two

inches aboye malleoli. Downwards beneath peroneoa tertins io
enter side of tarsns, and joins with external malleolar ft tarsal.

IffuSCUlar — To solens ft mnscles of deep layer.

Nutrient to Tibia — The largest of the nntrient arteries. - Downwards in nntrient

oanal towards lower extremity of the bone.

OoTnnin n icating to Peroneal — Outwards beneath flexor tendons a little abort

ankle JQ&ni
Internal oalcanean ^ To integument ft tkt aboat tendo Aohillii ft heeL

POSTEBIOB TIBIAL NEBVE.

Commenoes at lower border of popKtens.

Beneath aroh of soleae, soperficial maeoles, & deep lajer of fascia to intorral be-
tween inner malleolas Si heel, where it diyides into internal ft external plantar.
Is first internal & posterior to potterlor tibial Tessels, bnt soon passes to thotr

outer side. - Its branches aro:
Afuseu/ar-Ho flexor longns pollicis, flexor longns digitomm, tibialis postioas.
Plantar Cutaneous - Perforates internal annular ligameot to integnment

of heel ft inner part of sole of foot.

MUSCLES of SOLE of FOOT.

FIRST LAYER.

Flexor Brevis Digltorum - Greater taberodtj of 08 oalcisi central part of
plantar fascia; intermuscnlar septa on either side.

Sides of second phalanges of fonr onter toes. - S. bj int. plantar n.

Abductor FoUicis - Greater tnberosity of OS calcis; internal annular liga-
ment ; intermoBcnlar septnm between it and flexor breTis digitomm.

Inner side of base of first phalanx of groat toe. - S. by int. plantar n.

Abductor Minizni Digit! - Lesser tuberositjof os oalcis, greater tuberosity
in front of flexor brevis, and slightly from under surface of oa calcis in
front of taberosities ; plantar fascia; intermuBCular septum between it
& flexor brevis.

Outer side of base of first phalanx of little toe. - 8. by trunk of ex-
ternal plantar nisrve before its bifurcation.

SECOND LAYER.

Flexor Longos Digitorom.

Flexor Accessorius - inner & under surfaoes of oe oalcis by two beads
which embrace the long plantar ligament.

Outer border and upper & under surfaces of tendon of flexor longna
digitorum. - S. by trunk of external plantar nerre before its bifurcation.

LlUXlbricales - Tendons of flexor longus digitorum, the innermost from one.
the others from two tendons.

Inner side of extensor tendons A inner side of bases of first phalan-
ges of four outer toes. - S., the two inner ones by internal plantar nerre,
the two outer ones by deep branch of external plantar.

Flexor Longus Follicis.
THIRD LAYER.

Flexor Brevis Follicis - By a tendinous process from adjoining borders of

cuboid & external cuneiform, & from expansion of tendon of tibialis posticus.

Inner A outer sides of base of first phalanx of great toe, a sesamoid

bone being developed in each tendon of insertion. - 8. by int. plantar n.

Flexor Brevis MinlTni Digit! - Base of 6th metatarsal bone A sheath of

peroneus longus.

Outer side of base of first phalanx of little toe. - 8. by superficial
branch of external plantar nerye.

Adductor Follicis - Bases of 2nd« Srd, A 4th metatarsal bones A sheath of
peroneus longus.

Cater side of base of first phalanx of great toe. - 8. by deep branch
of external plantar nerve.

Transversus Fedis - Head of 5th metatarsal bone A transverse ligamont of
'the metatarsus.

Outer side of base of first phalanx of great toe. - 8. by deep branch
of external plantar nerve.

FOURTH LAYER.

Flantar Interossei - Three. Arise firom lower or plantar half of inner sido
of shaft of 8rd, 4th, A 5th metatarsal bones, and are inserted into inner
side of base of first phalanx of corresponding toes, A into the expansion of
the corresponding long extensor tendon. - They adduot the toes towards
the second toe. - S. by external plantar nerve.

Dorsal Interossei - Four. Arise from the adjacent sides of two metatarsal
bones, as follows: -from the whole extent of the side of the metatarsal
bone which corresponds to the toe into which the muscle is inserted in-
feriorly, from the upper or dorsal half only of the side of the other. The y
are inserted into the corresponding side of the base of the first phalanx ot
the toe to which they belong. -They are found on both sides of the 2liU
toe and on the outer side of the 8rd A 4ith toes. - They abduot therefore
the three middle toes from an imaginary line drawn through the second
toe. «0t by eoEtemal plantar nerre.

THE PLANTAR ABTEBIES

Brsnoliefl of bifuroation of jKMterior tibial beneath intenud ^wimi** ligament ft origin of ab-

daotor poUioiB.

INTERNAL PLANTAR - The smaUer.

FonrarcUi between abdactor pollioiB ft flexor breris digltomm, and ends at extremity of
first metatarsal bone in a small branch which mns along inner border of great
toe, and joins with the oorresponding plantar digital artery from oommnnioating

branch of dorsalis pedis.

EXTERNAL PLANTAR - The larger.

Outwards between flexor brevis digitornm & flexor accessorins, and then forwards be*
tween former muscle ft abductor minimi digiti as far as base of 5ih metatarsal

bone.

Bonnd enter border of flexor acoessorins, and inwards upon interossei ft bases of the

metatarsal bones, -beneath addnctor pollicis, flexor tendons ft Inmbrioales,- to

back of first interosseoos space, where inosculates with oommnnioating branch

of dorsalis pedis, thus completing plantar arch.

BBANCHSS:

Posterior perforating — Three - Throngh back part of three outer interos*
seons spaces, and inosculate with dorsal interosseons branches from

metatarsal.

PlaXltar interosseous (Digital) — Fonr. Forwards npon interosseons spaces
(outermost crossing under surface of 5th metatarsal bone under
cover of abductor ft fiexor brevis minimi digiti), and supply plantar
digital branches to 8^ toes on outer side of foot. The three innermost

giro off the
Amt. PE&70RATIKO ABTEBIES - Three. Through anterior part of three
outer interosseous spaces, and inosculate with the dorsal interot*
Mous branches from metatarsal juit before they biAiroate.

THE PLANTAB NERVES.

Iflt^niftl Plantar Nenre - ^^e larger. With internal planiar artery between abdae.

tor poUiots A flexor brevis digitoram, and divides into foar dig^ital

branches to 8^ toei on inner side of foot. S applies flexor breTia

digitoram, abductor A flexor breris pollicis, two inner Inmbricales,

integament of sole of foot ft artionlations of tarsas; joins with

external plantar.

Sxtemal Plantar Nerve - The smaller, with external plantar artery betvieea

flexors accesBorins ft brevls, and then between flexor brevis ft ab-

dnotor minimi digiti; supplies the first ft the last of these

mascles, and dirides into:

SuPBxriciAL BxAMCH - Sopplies 1} toes on enter side of footy flexor breris

minimi digiti ft interossei of 4th space; Joins with internal

plaQta.r.
Dkxp Bbamcb - Accompanies plantar aroh i supplies remaining interossei A

Inmbricsles, adductor polliots, ft transrersns pedia.

LOWER LIMB.

MUSCULAR ATTACHMENTS

ARTICULATIONS.

MXTSCULAB ATTACHTS. of BS. of LOWEB LIMB— 1st

The musonloB attached to the

IN2701&IINATE BONE — Are thiHy.two in nnmber^ and are attached aa follow! g-

Ilium - Thirteen: -

Gluteus Maximus -> Superior onrved line on dorsum ilii and rovgh rarfaoe between it

h poiterior fifth of oreet.
Gluteus Medius - Doninm ilii A onter lip of crent between superior A middle onrred lines.
Gluteus Minimus - Dorsum ilii between middled inferior ourred lines.
Rectus Femoris (Reflected Tendon) - Groove above brim of aoetabnlnm.

(Straight Tendon) - Anterior inferior spine.
Hiacus - Iliao fossa & inner lip of crest.

.Set/^Wmx - Anterior superior spine A upper half of notoh below It.
Tensor Vagina Femoris - Anterior superior spine A anterior fifth of onter lip of crest.
Obliquus Extemus - Anterior half of outer lip of orest.
Latissimus Dorsi - Posterior half of outer lip of crest.
Internal Oblique - Anterior two- thirds of middlo lip of crest.
Transversalis - Anterior three-fourths of inner lip of crest.

Quadratus Lumborum - Posterior part of inner lip of crest for about two or throe inches

in front of erector Bplo»
Erector Spinet - Posterior superior spine A posterior fifth of inner lip of crest.

Zsclliaxn * Fourteen :-

(gracilis - Inner margin of asoending ramus.

Adductor Magnus - Ascending ramus A outer side of tnberositj.

Obturator Extemus - Circumference of obturator foramen.

TVansuersus Perineei - Inner A fore part of tuberosity.

Erector Penis or Clitoridis - Pubic arch A fore part ot* inner side of tuberosity.

Obturator Intemus - Whole of inner surface of true pelris in front of and behind ob.

^ tr a JL^' -V tnrator foramen.

Gemellus Superior ^

Levator Ani f - Spine.

Coccygeus J

Gemellus Inferior - Upper part of outer lip of tuberosity.

Quadratus Femoris - Whole length of outer lip of tuberosity.

Biceps (Long Head) - lAyner A inner of the two surfaces on back part of tnberosity.

Semitendinosus - Lower A inner of the two surfaces on back part of tuberosity.

Semimembranosus - Upper A outer of the two surfaces on back part of tuberosity.

FnbOS - Twelve :-

Foctineus - Ilio-pectineal line A surface in front of it.

Adductor Longus - Front of body immediately below the orest A close to angle.

Adductor Etevis - Front of body for about two inches below adductor longus A between

. ., ^ ., . . ,, ,, gracilis A obturator extemua.

Adductor Magnus -Lower part of descending ramus. ^

Gracilis - Inner margin of ramus A lower half of inner margin of body.

Obturator Extemus - Circumference of obturator foramen.

Obturate Intemus - Whole of inner surface of true pelvis in front of A behind ob.

n ^ , . . . ^ tnrator foramen.

Rectus affdomtms

^ramidalis ( -Crest

Conjnmd Tend oflnL OkUqui &• Thinsv. J
Levator Ani - Back of body.

MUSCniiAB ATTACHT3. of BS. of LOWEB LIMB-2nd T.

The miiBoiiles attached to the

yBlCDB — Are twenty-fear in nnmber, and are attached a« follows : -

Vasfus Extemus - Aaierior border of ^reat trochanter d; horisontal ridge on its outer sur-
face; rongh line from great troohaater to linea aspera; whole length of enter lip

of linea aspera and line from linea aspera to oater condyle.

Vastus Intemus - Line from inner side of neck of femar to linea aspera ; whole length of

inner lip of linea aspera k line from linea aspera to inner ooadyle ; inner sarfaoe.

Crwreus - Anterior & onter larfaoes from anterior intertrochanteric line to within a few

inches of condyles.
Taking the Tastas internns ft the orarens as forming but one muscle, and
describing the Quadriceps extensor femoris as a Triceps^ we may say that the
"VASTUS INTEBNUS" arises from: - line from inner side of neck of femur
to linea aspera; whole length of inner lip of linea aspera ft line from linea
aspera to inner condyle; nearly whole of inner^ asUerior and outer snrfaoes of

shaft of femur.
Suberureus - Lower part of anterior surface «r
Psoas Magnus - Lesser trochanter.

Jliacus -Upper part of line from trochanter minor to linea aspera in front of pectineuf.
Pectisiius - Upper part of line from trochanter minor to linea aspera, ft into the bone be-

* hind trochanter minor*

Adductor Z^M^ftf - Middle third of inner lip of linea aspera between rastus internns ft ad-
ductor magnus.
Adductor Brevis ^JJppw part of linea aspera ft lower part of line from it to lesser tro«

chanter below ft behind pectineus.

Adductor Magnus - Lower part of line from great trochanter to linea aspera^ whole length

of inner lip of linea aspera ft line from it to inner condyle; by a strong tendon

into tubercle at upper ft back part of inner condyle.

Biceps (Short Head) - Whole length of onter lip of linea aspera between adductor magnus

ft vastus eztemusy and from inferior external diTision of linea aspera to within

two inches of outer condyle.
Gluteus Maximus - Rough line from great trochanter to linea aspera.
Gluteus Medius - Oblique line on outer surface of great trochanter*
Gluteus Minimus - Anterior border of great trochanter.
Pyriformis - Posterior part of nppnr border of gpreat trochanter.
Obturator Intemus - Upper border of great trochanter in front of pyriformis.

G^Zt/^: } Indirectly, by joining tendon of foregoing.

Quadratus Femoris - Upper part of linea quadrat! on back of great trochanter.
Obturator Extemus - Digital fossa.

Gastrocnemius - Depressions at upper and back part of condyles, and lower part of the

two inferior divisions of linea aspera.
Plantaris - Lower part of onter dirision of linea aspera.

Popliteus - Anterior ft deepest part of grooTe on onter side of outer condyle of femur

below tubercle for external lateral ligament of knee-joint.
Semimembranosus - Posterior ft upper part of outer condyle*

MnSCniiAB ATTAGHTS. of BS. of LOWER LIMB— 3rd T.

The miuionlar attaolied to the

*t 'IW A — Are ten in nnmber^ and are attached as followf i -

Tthialis Amicus - Oater tnberoiitj & npper two-thirdi of outer snrfaoe of ahafi
Extensor Longus Digitorum -Oater tnberositj.

Sartorius - Upper part of inner surface of shall covering tendons of gracilis h semiten-

dinosas.
Gracilis - Upper part of inner surface of shaft above semitendinosus, and beneath sartoriui.
Semitendinosus - Upper part of inner surface of shaft below gracilis ft beneath sartorius.
Semimembranosus - Posterior part of inner tuberosity; groove on inner side of inner

tuberosifej.
^ Popliteus - Inner two-thirds of triaugnlar surface on back of upper part of shafl.

SoUus - Middle third of inner border, and oblique line on posterior surface of shaft.

Flexor Longus Digitorum - Posterior surface of shaft below oblique line ft internally to

attachment of tibialis posticus.
TUialis Posticus - Posterior surface of shaft below oblique line ft externally to attach*

ment of flexor longus digitorum.

TIBULA — Are nine in number, and are attached as follows: •

Extensor Longus Digitorum - Upper three*fonrths of anterior surface of shaft.
Extensor Proprius PoUicis - Middle two«fourths of anterior surface of shaft internally to

extensor longua digitorom.
Peroneus Tertius - Lower fourth of anterior surface of shaft.

Peroneus Longus - Head ft upper two«thirds of outer snrfaoe ft of anterior ft posterior bor*

ders.
Peroneus Brevis - Lower two«thirds of outer surface of ahaft, passing upwards in a pointed

process beneath peroneus longa%
Biceps -Outer side of head.

Soieus " Back of head ft upper third of posterior surface of shaft.
Flexor Longus Pollicis - Lower two«thirds of posterior surface of shaft*
Tibialis Posticus - Upper three«fonrths of inner surfaoe of shaft.

THE HIP-JOINT. ^^

Is thi typical onarthrodial artionlation.
ARTICULAR SURFACES:

Acetabnluni ~ l^eep, hemiApherfoal, fnrther deepened in the fresh condition by the ootTloid
dt transTerse ligaments. Looks downwards, ontwards & forwards. Is divided into :
Incomplbtb Abticulab Bino - Broadest above ft behind, and deficient below ft in front.
CxxTBAL Kon-Abticulab Dbpbbbbioh - Oontiniions with cotyloid notch; lodges a mass of

fat, which forms a bed for the ronnd ligament.

Head of Feniur - Forms nearly two*thirds of a sphere, and, in the normal position of the

limb, looks npwards, inwards ft forwards. It presents a little below ft behind its

centre a small circular depression for attachment ef ligamentam teres ; near this

depression the cartilage is thicker than elseirhere.
LIGAMENTS -Are I-

Capsular - Short ft thick, especially aboTe ft in front ; thinner ft looser below ft behind; some-
times perforated beneath psoas. - It extends from
Outer lip of margin of acetabulum wUhin two or three lines of the cotyloid ligament^ and^ opposite

the cotyloid notch, from transverse ligament ^ edge of obturator foramen to

Anterior intertrochanteric line in front ; base of neck of femur, above; and, behind, to back of neck

of femur, within about half an inch from lesser trochanter &• posterior intertrochanteric line*

Zlio-Femoral or AcCOSSOry - A thickened band closely connected with front of oapsnle,

which extends obliquely from
Anterior inferior spine ofiltum to

Lower part of anterior intertrochanteric line*

There are also several other accessory bands, vis., one on the enter side of the

ilio-femoral termed the Ilio-trochanteric, one on the inner side of the ilio-femoral

termed the Pubo'femoral ; also a transverse band at the back of the joint.

Round Ligament or Ligamentam Teres - Interarticalar band about an inch long and

of very Tariable strength ft thickness, attached, on the one hand, to
Depression a little bdcw 6* behind centre of head ofjemur^ and on the other hand, dividing into

two fasoionli, to
Margins of cotyloid notch \ the two fasciculi blending with the transverse ligament. It

conveys a few vessels to head of femur.

Cotyloid " Incomplete fibro.cartilaginous ring triangular on section, preaenting a base attached

to margin of acetabnlnro, and a sharp free edge whioh closely embraces head of femur.

U is thickest above ft behind, and deficient opposite the cotyloid notch, where it is con.

tinned into the transverse ligament. It consists of closely interlaced oblique fibres

arising from the different points of the rim of the bone.
Tran;>verse -- strong fiattened band, a continuation of the foregoing, whioh extends from one

side of the cotyloid notch to the other, transforming it into a complete foramen.

SYNOVIAL MEMBRANE — Invests whole of anterior surface ft greater part of posterior sur-
face of neck of femur, cotyloid ligament, mass of fat at bottom of acetabulum, ft ligamentam
teres. - It communicates sometimes through a small opening in the capsule with the bursa

beneath psoas ft iliaoos.

VASCULAR ft NERVE SUPPLY ~~ From obturator, sciatic ft internal circumflex arteries, and

from great sciatic, obturator ft accessory obturator nerves.

MOVEMENTS -* ^^ flexion, extension, adduction, abduction, rotation ft circumduction. -

Flexion is freer then extension : the thigh can be brought forwards till it touches the ab-
domen, but it cannot be carried backwards to anything like the same extent. Flexion, in fact,
is scarcely interfered with by the posterior part of the capsule, which is thin ft loose j exten-
sion, on the contary, is soon arrested by the ilio-femoral ligament and by the anterior part

of the capsule, which is short ft thick. —

Of the two lateral movements abduction is the freest; it is checked by the action of the
pubo-femoral band. Adduction is checked mainly by the two limbs coming in contact, but
also partly by the action of the ilio*trochanterio band. When however flexion ft addactiou
ate combined, so that one limb passes in front of the other, tiie double movement may be
carried veiy far; it is at last arrested, by the action of the round ligament. The ronnd iiga*
ment is ulso tensed when flexion ft abduction are combined and carried to a considerable

extent, and when the limb is rotated outwards.

Botation inwards is freer than rotation outwards (rotation being measured from the inter-
mediate position whioh the foot normally occupies in standing) ; this is partly due to the
greater laxity of the capsule behind than in front, and partly also to the direction forwards
both of the head of the femur ft of the acetabolum. Botation takes place round an imaginary
line extending from the head of the fomur to the centre of the knee-joint. -> Circumduction, as
all other movements generally, is much less free in the hip than in the sholder>joint.

The weight of the limb at the hip.joint is normally supported by atmospheric pressure : -
In consequence of the complete exclusion of air from the joint through the accurate adapta-
tion of the cotyloid ft transverse ligaments to the head of the femur, the latter is firmly re.
tained in the acetabalmn even after all the soft parts around the joint have been divided ; if
air be allowed to penetrate into the joint through a perforation of the acetabulum fror

within, tie limb will immediately droi

KNEE-J0INT-3rd Tablet.

LIOAMSNTS — Are the: -

Anterior Ligament or Ligamentnm Patelle -strong flat band abont three inohei

long, a oontinnation of tendon of reotnt femorii, which eztenda from
Apex of paiella &* rou^h depnssum bdaw its articular surface to

Lower part of tubercle oftiHa^ being separated from upper part of the tnberole by a
tmall bnrsa. -> It is separated from the synovial membrane of the knee-
joint by a considerable mass of adipose tisane.

Posterior Ligament - Oonsists of three portions (Oraveilhier, Gray) : -

Cbktbal Portion or Lioauentum Posticum Winslowxi (The only portion described either

by Winslow, or by Heath, Qaain, & many modern Authors) - Broad flat
band partly deriyed from tendon of semimembranosns, and which

extepdls obliqnely from
Back part of inner tuberosity of tibia to
Upper 6r» back part of outer condyle of femur*

Two Lateral Portions (Capsule Fibreuse dbs Condtlbs, Cmreilhier) - Closely connec-
ted with tendons of gastroonemins, poplitens, plantaris, and formed chiefly

of yertical fibres extending from
Condyles just above their articular surfaces to

Back of head of tibia. -These lateral portions are looked npon by many anatomists

as a part of the capsular ligameot

Internal Lateral Ligament - Broad flat band from

Back part of inner tuberosity of femur to

Inner tuberosity &* upper part of inner surface of shtrfi of tibia* - CoTera anterior
portion of tendon of semimembranosus i inrerior internal artionlar
vessels, and is covered by tendons of sartorins, gracilis St semitendinosns^

a bursa being interposed.

External Lateral Ligament -Consists of two portions: -

LoNo External Lateral Ligament - Strong rounded cord from
Back part of outer tuberosity of femur to

Outer part of head of fibula. - It is embraced by the two fasciculi into which the ten-
don of the biceps divides, and beneath it pass tendon of popliteus &

inferior external articular vessels.

Short External Lateral Lioament - Accessory & somewhat variable bundle of fibres

intimately blended with capsule, lying behind foregoing h on outer side

of tendon of popliteus, and extending from
Lower &* back part of outer tuberosity of femur to
Apex of styloid process of fibula*

Capsular Ligament - I«ios in contact with the synovial membrane, and beneath the other
ligaments, which it binds together. It is strengthened by expansions from the
fascia lata and from the vaeti, biceps, sartorius h semimembranosus \ the ex-
pansions from the fascia lata & the vasti forming, on either side of the patella,

the so«caUed lateral patellar ligaments. It ia attached to
Femur just above the articular surfaces^
Upper border 6f* sides of patella.
Margins of head of tibia &* semilunar JlbrO'Cartilages,

Cmcial Ligaments - Two, project into the interior of the joint from behind, and cross

each other obliquely like the bars of an X«
Anterior Crucial Ligament -Tl^e most oblique & somewhat the smaller, from

Inner part of rough triangular depression in front of spine of tibia between points of attach-
ment of anterior extremities of both semilunar fibro»cartiiages, and partly also
from anterior extremity of the external semilunar fibro^artil^ie ilsel/Xo
Inner 6* back part of outer condyle of femur.
Posterior Crucial Ligament - The thickest & strongest. Nearly Tertically from

Back part of rough depression behind spine of tibia, behind points of attachment of posterior
extremities of both semilunar fibro^cartilages, and partly from posterior extremity

of external semilunar jibrO'eartilage itself Ui
Anterior 6* outer part of inner condyle of femur ^ front of imtercondyMd notch.

Transverse ft Coronary Ligaments -
Ligamentnm Hucosnm A Llgamenta Alarla -

THE ANKLE-JOINT.

It ft giaglyiiKrfd ftrtionlaMo^,

ABTIODLAB SURFACES: -

The TrocUea - is formed by the upper artionlar iiarfaoe A the two lateral fkoeti of the
astragalus. The npper articular surface is broadest in front, oonTez from before
backwards, & slightly concave from side to side; its outer border is a little longer
than the inner one, and is slightly curved inwards posteriorly. Of the two lateral

facets, the external one is the largest.

The Receiving Cavity - 1» formed by the under surface of the lower extremity ot the
tibia, and by the outer A inner surfaces respeotiyely of the internal dt external
malleoli. The under surface of the lower extremity of the tibia is quadrilateral,
broadest in front, concave from before backwards, and marked by a slight antero-
posterior elevation separating two shallow lateral depressions. Of the articular

facets of the two malleoli, that of the outer one is the largest.

LIGAMENTS -Are: -

Anterior Sb Posterior - Very thin, especially the posterior one, and consisting merely
of a few scattered fibres extending; between the tibia A the astragalus at the mar-
gin of their articular sarfaoes. - The fibres of the posterior ligament are mainly

transversei,

Internal Lateral - Consists of two layers : -

8uF£XJiciAL Latsb, OB DELTOID LiGAMENT - Strong triangular band, which radiates

from
jipex and anterior ^posterior borders of internal malleolus to
Inner part of scaphoid 6* inferior calcaneo'scaphoid ligament; lesser process of os

calcis ; and back part rf inner surface of c^stragahu*
Deep Later (Orureilhier, Gray) - Short thick vertical band from
Apex of internal malleolus to
Inner surface ofastragcdus below its articular facet.

ZiZtemal Lateral - Consists of three separate fasciculi : -

Antebior Fasciculus - Short, thick, nearly horizontally from

Anterior border of external malleolus to

Astragalus in front of its external articular facet.
Middle Fasciculus - Longer, rounded, from

Apex of external malleolus to

Middle ot outer surface ofos calcis.
Posterior Fasciculus - The strongest, deeply situated ; nearly horizontally fW>m

Depression at inner 6f* bacJkpart of external malleolus to

Astragalus behind its external articular facet as far as groove for flexor longus poOicis,

SYNOVIAL MSMBRANB - Communicates with that of the inferior tibio-fibnlar artioulatioiu

VASCULAR ft NERVE SUPPLY — From the malleolar branches of the anterior tibial

and the termination ot the anterior peroneal, and from the anterior tibial nerre*

MOVEMENTS — Are flexion A extension with a slight amount of lateral mobility in the ez«

tended position. - In the flexed position the wide anterior part of the trochlea Ilea
in the narrow posterior part of the receiving cavity, and the posterior fibres of the
lateral ligaments are on the stretch ; all lateral movement is then impossible.
In the extended position the narrow posterior part of the trochlea lies in the wide
anterior part of the receiving cavity, and, the lateral ligaments being relaxed
(except in forced extension), a considerable amount of lateral movement is per-
mitted: -Adduction is prodaoed by the tibialis anticus, abduction by the peronei.
In forced extension, however, the anterior fibres of the lateral ligaments beoomo
tensed, and movement from side to side is again prohibited. - Forced extension fs
accompanied by a slight amount of adduction in oonsequenoe of the outer border
of the trochlea being a little longer than the inner one and slightly cnrred

inwards posteriorly.

FASCIiB & SYNOVIAL MEMBRANES of the TABSXJS.

FASCIA — * Are rather llgamente than faaolas proper, and are therefore deaoribed here.

Anterior^ Anxinlar Ligament - OonsiBts of two portiona oonneoted by a thin inter.

Tening layer of faeoia.

SuFKRios OK YiBTiCAL PoBTioM - Of ooniiderable breadth & oontinnona saper.

iorly with deep fasoia of leg. It extends from lower part of anterior

border of tibia to lower part of anterior border of flbnla.

ijrvBBios OB HoBizoNTAL PoBTioN. - Narrower and continnona anteriorlj with deep

fasoia over dorsum of foot. It extends from upper snrfaoe of os calois, in

front of groove for interoaseoas oaloaneo-astragaloid ligament, to internal

malleolus & inner border of plantar faaoia.
Beneath anterior annular ligament pass from within outwards t -

/. - Tendon of HHalis anticus contained throughout in a synovial sheath.
a, - Tendon of extensor proprim pollicis contained In a synorial sheath
beneath the inferior or horizoDtal portion of the ligament onlj.
J. - Anterior tibial vessels 6* nerve,

4^ - Tendons of extensor longus digitorum 6* ptroneus tettms enclosed

throughout in one sjnorial sheath.

Zntemal Annnlar Ligament - strong fibrous band oontinnous superiorly with

deep fasoia of leg, and giving origin inferiorly to innermost fibres of abductor

polliois. It extends obliquely from internal malleolus to inner surface of os

calois. Beneath it pass from before backwards ft outwards : ->

I. - Tendon of the tibialis postiats contained in a synovial sheath.

M, ^ Tendon of the flexor longus digitorum contained in another synovial

sheath.
J. - Posterior tibial vessels 6* nerve,

4» - Tendon of the flexor longus pollicis also oontained in a synovial sheath,
and situated at a considerable depth in a groove on posterior

surface of astragalus.

ZiZtemal Annular Ligament -I^arrowerft thinner band extending from exter-

nal malleolus to outer surface of os calois, and beneath which pass
Tendons ofperonei both enclosed in one synovial sheath.

87NOVIAL HSMBBANES — Are articular ft tendinous.

Articolar - Six ! -

/. - Synovial membrane of posterior calcaneo-astragaloid articulation*
M, '^ Synovicd membrane common to the anterior ealcaneo-astragaloid 6*

tLstragaUhscaphoid articulations*
^. - Synovial membrane of calcaneO'Cuboid articulation,
4* - General synovial membrane of the tarsus comprised between the
scaphoid ft the three cuneiform bones, between the three ounei.
form bones, between the external cuneiform bone ft the cuboid,
between the middle ft external cuneiform bones on the one
hand and the bases of the 8nd ft Srd metatarsal bones on the
other, between the bases of the Snd ft Srd metatarsal bones. -
Sometimes there is a separate synovial membrane between the

scaphoid ft the cuboid.
J, - Synovial membrane of the articulation between the cuboid and the 4th 6*

Jth metatarsal bones,
6, - Synovial membrane of the articulation between the first cuneiform bone 6*

the first metatarsal.
TendinOUO * ^^^^ Annular Ligaments.

INGUINAL & FEMORAL HERNI^

AND PERINEUM.

SOABPA'S TRIANGLE— 1st Tablet.

!■ a tetMid triAngnlar ilfijinHilun

SituaUd at opper, inner, ft front part of thlgli:

.AMffa^ by Poupart's ligament, MrtoriiiA ft adduetorloncoi: • _^ .

CoHtmued downward* &» inwards into a niperflcial fntrow, which markf podtloB €f fHunI arteiy in

Iti floor i8 formed from withoat inwardi by iUacu, psoat, pectineu, ft imaU part of addoolor bravlib
It contains femoral resseli ft anterior cmial nenre, and the

FARTS CONCERNED IN FEMORAL HERNIA — These paita are:-

SEIN ~ Thin, freely moTable, more or lees studded with hairs at upper ft inner part.

STTPERFIGIAXi FASCIA — Divided into two layers by superfldal Teasels ft nerves ft

lymphatte.

Superficial Later - Thick, areolar, contains a large amount of fat, and is oontinaoiis witb
subcutaneous tissue of surrounding regions; is rather thinner ft less loaded with fat

towards lower part of tiiansleu
Deep Later > ndn ft membranoua. Adherent superiorly to Poupart's ligament. Stretoies
over saphenous opening under the name of *' cribri/orm fastia^ ^ which fuda ia per>

f orated by internal sapbenous vein ft by numerous smaller blood ft lymphatlo vi
and is attached flimly to outer margin of the opening, ft slightly to the tnner margiB.

Saperficial Vessels ft Nerves and Lymphatlo Glands - Are the :

Iniemai saphenous vein ;

Supetjiciat epigasMct superficial circum/Ux iliac, superficial external pmdiemrieriet'^ilXtk
the corresponding veins, which latter oj^lai. mto internal saphenous near its

termination;
Ilithintruinalt crural hranck ofgenito-^rural, 6* external eutaneeus nerves.
Lym^iatic glands - Form two groups. Tliose of the

Superior or abdominal group - Are the smaller, and are placed transversely near
Poupart's ligament; - they receive lymphatics of penis, scrotum, perincon,

lower part ol abdomen ft buttock; - those of the

Inferior or femoral group > Are the larger, and are vertically diqrased round

upper part of sapnenous vein ; > they receive the lymphatics of lower limlw

PE£P FASCIA or FASCIA IjATA — Dense, flbroua. Presents the saphenous opening, for

easier description of which it is usually divided into two portions, the iliac ft the pubic

ILIAO PORTIOH - The thicker. Attached to crest of ilium, Poupart's ligament ft spine of pabea.
Is reflected downwards ft outwards f^m this latter point, flrst bounding the superior
angle, or superior comn of the opening, then forming its outer margin. This outer
margin is ^e falciform Process of Bums: its upper jMrt is often called Hefs femoral
ligament. Superiorly tnis margin overlies the sneau of the femoral veaselft. Infer>
iorly it becomes continuous with pubic portion of the fssda lata by a w^ defined
curved border, which forms the inferior anfl^e, or inferior eomu of the opening.

Ptbio Portioh - Much thinner. Is attached to pubic arch at upper and inner part of thigh,
and is continuous with iliac portion opposite lower oomu of saphencms opening.
Frcnn this point it is prolonged upwards & outwards behind femoral sheath ft In trout

of i>ectineus, and becomes attached to iUo-peetfaieal Una.

Saphenous Opening - is formed therefore by the slitting of the fssda lata ft by the folding
of the two sides of the silt one over the other. It is oval in shs|»e, broad below.

narrow above, U indies long, I an indi wide. Ita

Outer Bouitoart ft ns Superior Aholb or Cormv, - which are promfiient ft well deftned.

are formed by iliac portion of the fascia lata (falclfonn process ft femem

ligament), which portion, as already stated, pastes upwards ft inwards In fironfe

of the femoral sheath, and becomes attadied to Poiqiart's Ugament ft spiae of

pnbes. -Ita

IX5ER Bouin>ART - Depressed ft leas clearly defined, is formed by the publo poraoa of tha

fascia lata, which portion, as already stated, passes upwards ft outwards behind

femoral sheath ft in front of pectineus, and becomes attached to the iUo-peeyneal

llae..lU
IVFBRIOR Anois OR CoRMU - Is formed by the Junction of the iliac ft puUe portions of the
fascia lata just below opening of intsmal s a p he n ous vein into the femoral

FEMORAL SHEATH * Vide next Tablet.

SCABPA'S TBIANGLE— 2nd Tablet

nSMORAL SHEATH - Ii • tUn taba of fawd* divided by two deUeale lepU into thno oompuimtoti.

of which compartments the outermost oontaina the femoral artery A the cniral branch of the
genito-crural nerre, the middle one the femoral vein, and the Innermoet, which is called the femoral

canid, some fat & • lymphatic gland.

It is expanded superiorly, where it is continuous beneath Poupart's ligament with the IssciaB of the

abdomen, the fascia transTersalis & the fascia iliaca passing down to form it. the former in front of,

and the latter behind, the femoral Teasels.
It it narrow inf eriorly, and blenes about two inches below POnpart's ligament vrith. the common areolar

sheatik of the femoral Teasels.

Anterioxly it is coTered bT the iUao portion of the fascia lata (falcifonn process & femoral ligament),

Poupart's ligament, the deep crural arch, and, opposite the saphenous opening, by the cnbiif onn

fwB^a
Posteriorly it rests upon the pubic portion of the fssda lata & the pectineus musde.
Its outer wall is Tertical, lies in fmmffdjate contact with the artery, and is perforated by the crural branch

of ihe genito-crural nerre.

Its inner wall is obUqoa downwards ft outwards from base of Oimbemat's Ugament to inner surface of

femoral Tein. It is pierced superiorly, where it correqKmds to the femoral canal, by numerous

lymphatic vessels, and, Inferiorly, or below the femoral canal, by the internal saphenous vein.

FXSMORAIi OANAL — Is the innermost compartment of the femoral sheath. Or rather it is the naife
row interval comprised, at the upper part of the femoral sheath, between the inner wall of the
sheath & the femoral vein; for it can hardly be said to exist as a distinct canal unless the wall of
the sheath has been separated from the vein either by dissection or by the pressure of a hernia. -

It contains a little fat ft a lymphatic gland.
II extends from the femoral ring to the upper pari of saphenous opening, and measures from i to ^

an inch in length.
It presents four walls ft two openings.

Antikior Wall - Formed by the taacU transvenslis, and supported by Poupart's liga-
ment, deep crural arch, ft iliac portion of fascia lata (fuciform process ft femoral

ligament):
Posterior Wall - Formed by the fascia iliaca; rests upon pubic portion of fascLa lata ft

pectineus mascle;
IHMER Wall - Formed by Junction of fasda transveraalis ft iliaca;
Outer Wall - Formed by the thin septum on inner side of femoral vein;
Superior Opehino, or Fbxoral Bnro - Tide below.
IHVERIOR, OR Saphbhous OPEHiNa > Vide foregoing Tablet

Vemoral Ring - is the opening of the femcnral canal into the abdomen. - Its boundaries are:*

In Front -Poupart's ligament and the deep crural arch;
Behind - Pubes covered by pectineus muscle, ft pubic portion of fssda lata;
IMTERMALLT- Oimbemat's ugament with the triangular ligament, the coniolned

tendon, ft the deep cruru arok
Externally - Femoral vein ft the thin septum between it ft crural canaL
Its relations are as follows:

Femoral vevtt on outer side;
Epigastric artery , crossing upper ft outer angle;

Siermatic cord or round ligament ^ ^ pubic branch o/epieattrtc above ft in front;

Obturator artery, on inner side, in those rare cases in which the artery presents

the double abnormality of arising from the epigastric artery, and of arising

' from that artery at some distance from its root; -the obturator artery then

passes first inwards above the ring, and then downwards into the pelvis

behind Oimbemat's ligament
It is nearly circular, about \ an inch wide in the male, a UtHe wider in the female, and is closed

by the

BBPTVM C&URALE (J. Clo<iuet) - A more or leas condensed layer of superitoneal areolar tissue

adherent to margins of femoral ring, and perforated by numerous apertures for

lymphatics. Its upper surface is concave, and separated from the peritoneum by a

less condensed layer of the same tissue and sometimes by a lymphatio gland ; its

under surface is convex ft turned towards the femoral canaL
The femoral canal ft both its openings are constricted \xy extension & evendon, and relaxed by

flexion ft inversion of the thigh.
OOVERINGS OF FEMORAL HERNIA - Are : -

From Within Outwards : - Peritoneum, subperitoneal areolar tissue (a portion of which,
tldckened ft caused to assume a membranous appearance \sf the pressure of the
hernia, was described by Sir A Cooper under the name ol fascia propria), septum

crmrale, crural sheath, cribfiformfasem, superjieial/ascia^ skin,
TauOU. WUHDI OUTWABM: - Shin, superficial fascia, cribriform fascus, crural sheath,

seHum crurale. subperitoneal areolar tissue, peritoneum.
The deep seated striotwe is to be divided upwards ft Inwards, in which direction no important

▼iisel is likely to b« met with.

100

PARTS GONCEHNED in INGUINAL HERNIA— 1st T.

ftmn the ingolotl & •c]x>tel rMdom. ll^Nmi th«latt«r ire deriTed the mpcrfldalotnreiliisi of large hento.w
•upexllcial coyerings are the lame at thoee of the cord ft teitia. The former comprlaea the parte more
directly ooncemed in the occurence of the protniiion, and In the largical opermtiona therelqr required

SCROTAL REGION — vide " Coyeringi of Coid ft Teatia."

INGUINAL REGION — Bounded hy Poapart'a ligament, median line, horiaontal line through antertor

euperior apine of ilium. Freaenta for examination the following afcrata, between which the Inguinal

canal ia comprlaed.

Skin - Thin, freely moTable, depreaaed over Foupart's ligament

Superficial Fascia - Continuoua with that of thigh, acrotum (dartoa) ft peiinsum. Divided into anperfldal

& deep layera oy the auperfldal yeaaela & nerrea.
SCPBBnciAL Latib - Thick, areolar, & more or leaa dlatended with f^ Paaiea over Ponpart'a ligament

without adhering to It.
Dsxp Latbb - Thin, membranoua, contalna no fat ; adherea to Poupart'a ligament

8UFJSRFIGIAL VESSELS h KE&VES —Are:

Arttrut " Bnperlloial epigaatrio, auperfldal dreumflex lUao, auperfldal external pudie.
Vevu - Ck>rremonding ; open into mtemal aaphenoua.
l^jnm/Aatics - OouTerge towarda the

Superior or Abdominal set of Inguinal Lymphatic Glandt - Three or four, Bnall,
obliquely dlapoaed along Poupart'a ligament; recdye lymphatica of penia, acrotum,

perinaaum, lower part of abdomen A buttock.
Ntrvtt " nio-inguinal, k hypogaatiie branch of ilio-hypogaatria ^

Aponetirosia of Bztemal Oblique - Ita fibrea are oblique downwarda it inwarda, and form in anoceadon
Poupartt ligamtntt Gimbtmatt ligament. Outer or I nftrior filtar of exttmal abdominal ring, Inmor
or Superior /illar. Superficial part of Ltnea Alba by decuaaating with their fellowa, and perhapi alao.
aftor decuaaating, the Triangular Hoament k the Intertohtmnarjihret of opposite tide (Vide Abdominai
Aponenroaea). Continuoua with tnia atrmtum of fibrea la the Intercoluwmar or external eperm^
tic fascia, thm, cloaely adherent to margin of external abdominal ring, and prolonged downwarda

into a tubular prooeaa around cord and teatlai
Lower Part of Internal ObUque ' Thin bt pale. Ita flbrea, which arlae from outer half of Poupart'a
ligament, paaa inwards over spermatic cord (or round ligament), and then curve downwards behsnd it
A behind external abdominal ring & Gimbernat'a ligament, corering inner two-thirda of Heaaelbach'a
triangle and forming part of conjoined tendon m internal oblique & tranarerMdia, and, beoominc
tendinoua, are inaerted over the extent of about half an inch into creat of pubea in front of rectua ana

into tlio-pectineal line behind Oimbeniat'a ligament

The Crbxastbs HnsauB - (Vide " Muadea of the Abdomen " & *: Ooveringa of the Teatlcle "I

la connected with loweat fibrea of internal oblique, and occadonally abo with aome of the loweat

fibrea of tranaveraalia.

ZiOWer Part of TranaversallB - Alao thin & pale, ita fibrei. which arlae from outer third of Poupart'a

ligament, take the aamo courae aa preceding, and. also oecoming tendinoua, are inaerted with them

into creat of pubea and illo-pectineal Une to the extent of about an inch, completing conjoined tendon.

Faada TranaverBalla - Part of the general layer of faada which linea the abdominal ft pelvic cavitlea. In

the inguinal re^^on it ia thick and denae, and preaenta the following pointa of intereat : -

AT CISCOMFEEENCE OF INTERNAL ABDOBIINAL SINO - It is prolonged Into a tubular
proceaa of membrane, the infundilmliform fascia, which deacenda round the ocnd

& teatia, forming VbA fascia propria round the latter.
AT LOWE& PAJELT OF BEOION -Itia, -

Im Front of Femoral Vessels - Flnt thickened into an oblique band adherent to Poupart'a

ligament h termed the deep emral arch, and then continued downwarda beneath

PoujHtft'a ligament in fironl of the veaaela to form anterior wall of femoral ahwth.

Externally to Femoral Vessels - Attached to outer part of Poupart'a ligament, and oon-

tinuoua with faada lUacn.
Internally to Femoral Vessels - Attached to creat of pubea A iUo-pectineal Une behind

conjoined tendon it Gimberaat'a ligament

Thitt part of the faacia tranaveraalia which Ilea above Poupart'a ligament between outer border

of rectua muacle ft epigaatrio artery (Heaaelbach'a triangle) la Intereating aa being the part which

^ forma a covering to direct inguinal heroin.

Sabperltonlal Areolar Tissue - More or len dlatended with fat Forma a bed in which the epigaatrle
artery paaiea upwarda ft inwarda along lower ft inner boundariea of internal abdominal ring ; la oon>

tinned into a looee aheath round the oord.

Peritoneum - Preaenta, before the auperiicial atrato of the abdomhial wall have been dlaiected. the two

Jnguinnl Fossa, internal 6* external, which foaasB correapond reapeotivdy to the external ft Interaal

a b d ominal rlnga, and are aeparated qy an oblique creacentio fold of variable width ft pranhNBO^

lonned by the q^igaalrie ft oUltecatad '

101

PARTS CONCERNED in INGUINAL HERNIA— 2nd T

INGITINAL OR SPERMATIC CANAL

Is an obliqno passage 1| or 2 inebei long sitnated a little above, and parallel lo^
inner half of Poopart's Tgament. It gives passage to the spermatio cord or
round ligament^ and presents for examination its two openings or rings, and its

boundaries or walls.

Ezterxial Abdominal Ring - Triangular & obllqae downwards ft inwards, about 1
inch long ft } inch wide in male but rather smaller in female, bounded later-
ally by external ft internal pillars, above by the interoolumnar fibres, below
by the orest of the pubes. Gives off from its marg^ the interoolumnar oi
external spermatio fascia, which is prolonged into a tubular process around

cord ft testis (V. Abdominal Aponeuroses).

Internal Abdominal Ring - A tubular opening in the fascia transversalis formed
hy the prolongation of this fascia round the cord ft testis (infundibuliform
fascia, fascia propria), oval with large diametbr directed downwards ft out«
wards ; situated midway between anterior superior spine of ilium ft spine of
pubes about } an inch above Poupart's ligament ; bounded above ft externally
by the lower arched fibres of internal oblique ft transversalis, below ft inter*

nally by epigastrio vessels.

Boundaries or Walls - Formed by t

In Faokt - Aponeurosis oiexUrfial oblique along whole length § lowest fibres of

internal oblique along outer third.
Behind - Fascia transversalis along whole length ; conjoined tendon of internal
oblique ft transversalis, ft also triangular ligament along inner third.
Abovb > Arched fibres of internal oblique ft transversalis,
Bblow "Pou^rfs ligament blended posteriorly with faaoia transversalis

14>

102

SURGICAL ANATOMY of INGXnNAL HERNIA.

Principal points of interest are the coTerings of the hernia, and the relations of the neck of the
sac & of the seat of stricture. - For the rest see ** Ingninal Hernia" among Tablets on Snrgerj.

COVERINGS — IMffer in the oblique & direct forms, and are slightly modified also in the

oongenital A infantile varieties of the former, and in the external & internal Tarietiee

of the latter. They are as follows »—

OBLIQUE INGUINAL HERNIA
Of the Adult

FSOM iriTHIN OUTWABDS :

PtTt/onmm, subsfrtms areolar tissue^ infundihulifirm fascia^
cremasteric fascia^ intercolumnar fascia^ superJUuU fascia, skin,
Fbox WITHOUT Inwards :

Skiftf superficial fascia^ iniercolumnar fascia^ aemasteric fascia,
ifijundibuliform fascia, subserous areolar tissue, peritoneum.

Qongenital Variety * Descends directly into tnnioa yaginalis through

ponch of peritonenm which accompanies cord h testis into scrotum,

and which has abnormally remained unclosed. Its coverings are the

same as those of testicle : - Skin, dartos, iniercolumnar fascia, cremasteric

fascia, fascia propria, tunica vaginalis reflexa,

InfiUltile Variety -Descends into the still patent npper part of the imper*
fectly closed pouch of peritoneum, and becomes more or less completely
'invested, especially in front, by the posterior part of the tnnioa vagin.
alis refiexa. Its coverings are the same as those of foregoing rariety
taith two additional layers rf peritoneum

DIRECT mOUINAL HERNIA

Internal or Common Variety - (Protrudes through inner part of Hessel*

bach's triangle, on inner side of obliterated hypogastric artery ).
Fbov within Outwabds :

Peritoneum, subserous areolar tissue, fascia transversalis (the
general f. tr., not the infnndibuliform process) conjoined tendon
(or not^ since it is frequently ruptured instead of being pushed
forwards) iniercolumnar fascia-^ superficial fascia, skin*

FsoM without Inwards :

Skin^ superficial fascia, iniercolumnar fascia, conjoined tendon
(or not), fascia tranwersalis, subserous areolar tissue peritoneum.

External Variety - (Protrudes through outer part of Hesselbach's triangle,
on outer side of obliterated hypogastric artery, ft externally to the
conjoined tendon) -This exceptional form of inguinal hernia, passes
through a considerable portion of the inguinal canal, and greatly re-
sembles the oblique hernia both by presenting a certain degree of
obliquity and by having very nearly the same coverings ; the covering
derived from the cremasteric fascia is alone rather less complete.

BELATIONS OF NECK OF SAC & SEAT OF STBICTXTRE —

The neck of the sao lies

IK OBLIQUE IKGUINAL HERNIA - On outer side of efigastric artery and in
front of spermatic cord, the elements of which may, however, be more or

loss scattered round the neck of the sao.

TN DIRECT INGUINAL HERNIA - On inner side of epigastric artety, in front

A slightly on inner side of spermatic cord.

On account of the uncertainty of the diagnosis between the obliqne h

direct hernias it is an accepted rule in surgery to divide a deep

seated stricture directly upwards from middle of ^Pjkr margin of

constricting ring, that is to say in the direction of the epigastric

103

THE ISCHIO-RECTAIi REGION.

OjT i 'eflpo u da to tlie portion of outlet of pelria aitnated behind a line drawn from front part of ono
tnber iaohli to that of tho other. It ia bounded in front by above mentioned line ; ita apex
ia at point of ooooyx ; ita aides are formed bj tnberoaitiea of ischiam, great aacro-Bciatio

ligaments St great glatei mnsclea.
It oontaina terminal portion of rectum snrronnded bj levatores ani and the internal A external

aphinotera, and on each aide of which ia the iachio-reotal fossa.

It ia triangular in form and depreesed centrally towards anns, ronnd which aperture the tntegu-

ment is thrown into numerous folds, and becomea oontinnoua with mucous membrane of

intestine.
The akin is darlr^ but thicker & leas movable than on perinsBum proper, and oontaina a few

hair-foUiolea.

Tho suboutaneoua areolar tiaaue or auporficial fascia hardly eziata in centre of region, or

over aphinoter ani, which muscle is closely adherent to integument ; but it is abundant

laterally^ where it is loaded with a large amount of fat, and where it dips into and fills

the iaohio>reotal foaaa.

ISCHIO-RECTAL FOSSA

Is a large ezoavation which sinks deeply into pelvis on either side of rectum, and
which is filled with a considerable amount of loose fatty areolar tiaaue.

It ia wide ft triangular at its

Ba86^ - Which corresponds to integument^ but it ia flattened from aide to aide and

diminished in size auperiorly. - Its

Ixmor Wall - I> oblique downwards ft inwards and formed by under surface of

levator ani ft by sphincter, which muaclea are oovered by anal faaoia.

Outor Wall * ^> vertical, and is formed by obturator intemns covered by obturator

fascia ; it presents the puoio vessels ft nerve enclosed ia a sheath of

fasciai

It is bounded t
Above - By junction of anal ft obturator faaoisBii

In Front - By junction of the same fascios superiorly, and, inferiorly, by junction of

the superficial ft deep perinmal fascioe behind transveraus perlnsaii

Behind - By aacro*sciatio ligaments, coocygeus ft the gluteus maxim ns.

The veaaela ft nervea it oontaina are the :

Inferior hamtfrrhoidal, in the centre ;
Pudic, in the outer wall ;
Superficial perimtal^ in front ;

A branch of^Uh scLcral nerve, and branches ef sciatic artery dr* small sciatic nrnve^
behind ; the branohea of the latter nerve winding round lower border

of gluteua maximns.

Above levator ani is the reoto-Ttsioal layer of the pelrio fasoia (7ide Pelvio F.)

104

THE MALE PEBINiEUM.

CdniiiUof thoitneliuwwblehfllOMeiKllilQfpdTlfftiilMloclytoll^ mm tnlMt

iMhU to tbat ef tlM ottier.

It it trlADsnlar In fonn, uul it bonnded Utcnlhr bj nmi of vabm A iiefala uul posteriortj bf wJbon men-

tioned lint. The width of its bue (mther the niuJlest ode of the tilangle) Ii vtiuJly ebont S| iiM^ee

In the male adult, but it la lometlniea conilderablj reduced ; the operation of lateral lithotomr la then

greatly impeded.
The part la eonTez In middle line ft lUghtly depreaied latently, and p re aan t a the following layeia:

glriw - Thin, dark, freely motable, mariced by a prominent median nr/A/, atodded with thin eriap haira, and

provided with nnmerooa aebaceooa f oUldca.
Superficial Taaola ' Divided into two layen.

BuPEBfioZAL Latse -TUck, areotar, oootaina a laife amoont of fkt, and ia oontinnona with aab-

CQtaneona tliaae of turoondlng zcglana.
SUOfB Latsb -Thin ft aponeorotlo ; Ilea in doae contact with the mnaclei.

Oh etiArr stdt it is attached to rami of pabea ft iachla eztemaHy to cnira panla :
Behind it ia connected to central tendinoua point of perinKom: and u prolonged
beneath q>hincteranl, becoming continnoos behind nanareraaaperinHl ft in traoi

of rectum with inferior layer of deep parinaal faada;
In front It is unattached, ft continnooa with dattoa ;

Sup€rwrly It gives off a median septum, which is rather deOdent in front but pretto-

weU marked behlML
It binds down the snperfldal stru ct u res, and bounds Inferlorly, and also, through its attach-
ments, laterally ft behind, a space, in which if urine be effused, this iiuid will be directed
forws^s towards the scrotum, and the lower part of abdomen, and preventad from
paaaing backwarda towards anu8» or outwarda towards thighs. This Isyw is sometimes

called the tu^erficial ftrvmml/nuim.

8iip6irfiolBl Oenito-TJMnary Muaoleg - Are the:
Beectob Puns -Covering the eras ;

AocBisiUTOB URiKJi OB BJAOULATOB Bumm - Spreading out upon bulb of urethra ;
TBUfSYBBgus PXBIH jBi - Separating perinvum proper from iachio-reotal region.

Theae muscles bound a triangular area, which is creased snperflciAlly by the s up erficial
perineal vessels ft nerve, behind which area passes transversely inwards the transvena
perinnal artery, and thronsh which area can oe seen deeply the superficial layer of the
deep perinaeal nad^ In lateral lithotomy the knife is carried backwards ft outwarda

through inner ft back part of thia area on left aide.

Inferior Layer of De^ Perinflsal Faaola, or mangular Ligament of Urethra - Tide below.

Membranoua Portion of Urethra, Compreaaor Urethrs, ft Deep TraasverBUB Pexinel, Pudlo
VesselB ft N., VesselB ft N. of Bulb, Ck>wper's Glands ft their Ducts - vide these parta.

Superior Layer of Deep Perinflaal JTascia -

The deep perineal fasda is a complex structure triangular in form, whidi supports the urethra.

and closes anterior put of outlet of pelvis^
On either tid* it is attached to rami of pnbea ft iachia internally to crura penis ;
Behind It is connected to central tendinous point of perinsum, and is continuous both
with thin fascia on under surface of levator ani, and, behind transversus perinKl,

with deep laysr of snperfldal fasda of peiuueum ;
In/ront it is attached to pubic arch ft sub-pubic ligament.

It eonslsts of two aponeurotlo Isyera which are separated in the centre, but united laterany*

ft behind ; of theae two layera the

AlTXBiOB, IHVEBIOB, OB SUPKBTICIAL UkTBB-The thickest, is Continued downwarda ft forwarda
upon anterior part of membranoua portion of unthra, and ia lost upon the bulb. Thia
layer is perforated bv the nrethra about an inch below nmphyiis puma, by dortal cvm of
*tni» in front of urethra, & Xtj/ndic vtutls 6* ntrot on either side of the vein : it is the onjjr
layer that can properly be called the triangular ligament of the urothra, thoogh the term

is sometimes applied to both layers taken together.

SO8IEBIOB, BUPBBIOB, OB Dbbp Latbb - Thinner. Is continued upwards ft backwards round

posterior part of membranous portion of urethra, and becomes continuous with pdvic tsada.

Between these two lavers an comprised the parta above mentioned, via,, wmw tbfx mm u por^
tion of urethra with comfrettor urethrm A' deep tranxoertut ferimei naucles, pudic veueU

&» nerve with vessel* ^ nerve of Mb, towpe^s gitmds 6>* their dmctt.
Above these parts an found in centra of perin»um the

Prostate Gland ft Neok of Bladder, - and laterally the

A&tarloir Part of Levator Ani ft of Pelvlo Fasda - The latter fasda ia continued nosterloily upon

posterior part of IsTator ani, upon rectum ft between it ft bladder, and belongs as much

to iachio-roctal rvgioD aa ta the petinsML

105

MUSCLES of the MALE PEmNJEUM.

ANAL QROUP.

Spbincter Ani - Tip & back of ooeoyx and enperfioial fascia in front of it.

Central tendinous point of perineam blending with accelerator nrlnaSf
transverans periniei & levator ani. > S. bj inferior hsBmorrhoidal branch of pndiOy
& by anterior division of 4th sacral nerve.

IiOVfttor Ani - Back of pnbes close to symphysis, spine of ischinm, and, between these
two points, from a white band or thickening of the pelvic fascia which marks
point of division of the latter fascia into obturator St recto-vesical layers.

Side A apex of coccyx, median raph6 between coccyx and anus, side of
lower part of rectum blending with sphincter ani, and decussates with its fellow
in front of rectum and below A behind the prostate forming the so-called levator
prostate, which latter fasciculus is sometimes separated from the remainder
of the muscle by a little areolar tissue. - S. by anterior division of 4tb sacral n.

CoCCytfdUB " Spine of ischium ft lesser sacro. sciatic ligament.

Side of coccyx and of lower piece of the sacrum. - S. by anterior divi-
sions of 4th A 5th sacral nerves.

Internal Sphincter - is a thickened circular band of the nnstriped muicnlar
fibres of the intestine.

aENITO-URINART GROUP.

Accelereltpr Urins, ElJacalator Seminis, or Bulbo-cavemons - Central tea-

dinous point of perinssam A median raph6 in front of it.

Its posterior fibres are inserted into the triangular ligament; its middle
fibres decussate above the bulb A corpus spongiosum which they encircle i
its anterior fibres are partly inserted into the corpus cavernosum, and partly
joined above it in a tendinous expansion which covers dorsal vessels A nerves
of penis. - S. by superficial perineaal nerve.

Zrector Penis^ or l8Qliio*cayemoU8 - inner aspect of tuberosity of ischium behind
eras penis and pubic arch on either side, back part of under surface of the
cms.

By a tendinous expansion into fore part of under A outer surfiftoes of crns
penis. - S. by superficial perinssal nerve.

TransversUS Perinsi - inner A fore part of tuberosity of ischinm.

Central tendinous point of perinsDum blending with its fellow, the accel-
erator urines, A sphincter ani. - S. by superficial periassal nerve.

Compressor, or Constrictor UrethrSB - Upper part of pubic arch on either side of
symphysis.

Its fibres surround membranous portion of the urethra, decussating above
A below it. - 8. by pudic nerve.

Deep TransversuS Perinsai - is a thin fasciculus which may or may not be separated
from posterior fibres of foregoing muscle. It decussates with its fellow behind
the bulb, and covers Cowper's gland.

106

FXTDIC ABTEBY.

Tho smaller of the two terminal branches of anterior diriaion of internal iUao artery.

Descends in front of pyiiformis & sacral plezns, lying to the inner side ft a little in (Vont of

Boiatio artery.
With padio nerve through lower part of great saoro-soiatio foramen below pyriformis on inner

side of sciatic nerres ft sciatic artery.
Winds ronnd spine of ischium and re-enters pelvis through lesser saoro-soiatio foramen.

Forwards along outer wall of ischio^rectal fossa below pudio nerve, being covered by obturator
fascia, and lying at first 1| inches abore lower extremity of tuber ischii, but approaching

surface as it progresses.
Pierces deep layer of deep perlnsoal fascia, and ascends along pubic arch between the two

layers of that fascia to near symphysis pubis.
Pierces superficial layer of deep perinssal fascia, and divides into artery of corpus cavemosum

and dorsal artery of penis.
Gives oflf Inf trior Hemorrhoidal, Superficial Ptrimmdl^ Tramvertt Perineal, ^ Artery of the BuJL

107

PUDIG NEIIV2.

From lower part of aaoral plezuf.

With pndio artery tbroagh lower part of great ■aoro-ioiatio foramen on inner tide of

great leiatio nerrOi
Winds round spine of iiehinmy and re-enters pelris throngh lesser laoro-soiaiio foramen,

where it gires off inferior hsBnfiorrhoidal nerre.

Forwards along oater wall of isohio-reotal fossa abore pndio artery, both nerro & artery

being oorered by obturator fasoia, and dirides into perinssal nerre A dorsal

nerre of the peaift

108

PARTS GONGEBNED in LATERAL LITHOTOMYa

Parts to be divided : -

1. Jntegument^ superfieial fasda^ tnferior hetmerrheidal voids ^ nerve;
S. Posterior fibres of accderator urina &* transuersus periruei musdes; ^rdbaKy also iki

transverse pensueal artery and superficial perinaal vessds fy» nerves,

8. Deep perinaal fascia^ left deep traruifersus perinai muscle o* posterior fibres of com"

pressor urethra; the anterior fibres of levator am;
4. Membranous ^ prostatic portions ofurethra^ and part of prostate gland

Parts to be avoided : *

1. The bulb and its artery are endangered if inoiaion is began too far forwards; -
if the artery arises further back than nsnal it is exposed to be divided

whatever oare be taken;

9. The rectum is endangered if incision is begpn too far iowardsj
8. Thepudic artery ^ if incision is carried too far outwards ;

4. Entire breadth of prostate with prostatic veins 6* accessory pudie artery^ if the latter
exist, may be divided it incision into the deep parts is carried too far back-
wards, and the urine may then become infiltrated between the bladder

A rectansa

ABDOMEN.
I.

PERITONEUM, &C.

110

MUSCLES of the ABDOMEN.

Zztemal Oblique - Onter mrfiMe & lower borden of the Mki hmer nh^ f&ierdigito.
ting by fbur or fire tlips with ■erratofl magniu m bj three or foar with
latiBsimiis dorsL

By fleshy flbres into anterior half of outer lip of oreetof iliam, aad !te
aponenroBis furma in snooesaion :
PouparCs ligament;
Gimbemafs ligament;
Outer pillar of external abdominal ring;
Inner pillar of external abdominal ring :

Superficial part of linea alba by deonssating with ite fellow, And

perhape also after deonnating the
Triangular ligament h intercolumnar fascia of opposite side. (Yide ab-
dominal Aponeuroses)

Zntemal Oblique "^ Oater half of Fonparf s ligament ; anterior two-thirds of middle
lip of crest of iliam ; posterior layer of lambar fasoia.

Lower border ot cartila^s of four lower ribsi linea alba; erostofpnbes
& pectineal line behind Gimbemafs ligament to the extent of aboat § an inch,
forming part of the conjoined tendon.

Transversalis - Outer third of Ponpart's ligament; anterior three-fourths of inner
lip of crest of the iimm; inner surface oi cartilages of six lower ribs interdig^ta-
ting with Diaphragm; by lumbar fascia from tips of spinous processes, tips
h bases of transverse processes of all the lambar yertebrss.

Linea alba; crest of pnbes k pectineal line behind Oimbemat's ligament
to the extent of about ) an inch, forming part of the conjoined tendon.

Bectns AbdominiB - By two heads ftom crest of pnbes h ligamentous fibres oorering

symphysis.

Cartilages of tth, ^h ft 7M ribs h side of ensiform cartilage.

This muscle is traversed by from 8 to 6 /mar transversitf irregnlar ten-
dinous intersections, which interrupt the superficial fibres and adhere firmly to
anterior wall of sheath ; these are situated opposite umbilicus^ between umbilicus
& ensiform cartilage, and, frequently, ono or two less complete ones, aesr or
below umbilicus.

Fyramidalis - Front of pubes A anterior pubio ligament.

Linea alba midway between pubes ft umbilioos. - Is often absent on one
or both sides.

Crexnaster - From middle of Foupart's ligament internally to lowest flbres of internal
oblique A transversalis, and by a small pointed tendon from frx>nt of pubes A
sheath of rectus, forming large external, and smaller A less constant internal
bundles. Is the everted gabemaoulum testis with a few additional fibres of the
internal oblique, and sometimes of the transversalis, drawn or pushed down by
tiie testicle daring its descent (Curling).

QuadratuB Lmnbomin.

Ahtebior PottTiON - Upper border of transverse prooesses of the two or three lower
lumbar vertebrae.

Inner half of lower border of last rib.
PosTEBioB Portion - Ilio-lnmbar ligament, .and for about S or 8 inches firom poste-
rior part of inner lip of crest of ilium.

Apices of transverse processes of the 4 upper lumbar Tortebra, and inner
half of lower border of last rib,

N.— These muscles are supplied by the lower interoostal, illo-hypoffastrio, A
ilicin^piinal nerves. The quadratus Inmborum also raoeivee
branches from the anterior dirislons of the kimbar nerrea.

Ill

PERITONEUM -1st Tablet.'

The peritonenm is bj far the most extensiTe A oomplez leroixB memtvaae of the bodj. to tfeioribe fl
oompletelj it ia neoeasaiy to trace :

1. -The two sacB eeparatelj in the rertioal direction A in the middle lines
8. -The two saoB together in the reitical direction;
8. -The greater sac horizontally below the level of the nmbiliouBj

4. -The two sacs together horizontally abore the lerel of the umbilions, or through the

foramen of Winalowi
6. -The ligaments formed by the peritonenm, and the omenta A mesenteries.
Along the colon & npper part of the rectnm the peritonenm is thrown into nnmerons pe&da«
Ions processes filled with adipose tissne and termed the appendices epiploion.

THE TWO SACS SEPARATELY.

THE OREATER SAO. ^

Starting from nmbilicns the peritonenm passes : -
Over anterior wall of abdomen & diaphragm {
Orer npper snrfaoe of lirer, forming suspmstny or falqform Ifg^m/nf &• ^PPt^^ ^y^ 9f

Oyer nnder snrfaoe of lirer to transverse fissure ; '7 H »

To lesser cnrvatnre of stomach k first portion of dnodennm, forming anterior layo
Orer anterior .nrface of stomaol., rflaur^rgastro-k^Uommtum,

Downwards in front of intestine, forming anterior layer of great omentum ;
Upwards to transverse colon, forming posterior layer of great omentum ;
Over nnder surface of transverse colon ;

To spine, forming inferior layer of transverse mesocolon A covering under surface of

transverse portion of duodenom ;
(In the fcstus, also occasionally in the child, and even, though very rarely
in the adult, the layer of peritonenm which continues the posterior layer of
the great omentum ascends in front of the transverse colon without adhering
to it, or adhering to it bat slightly, and then passes backwards to the spine
a^e the transverse 'neso-colon. The transverse meso-colon is then formed by
the peritoneum again passing forwards from the spine to the transverse coton, sur-
rounding the latter, and for the second time passing backwards to the spine. The
pouch between the transverse meso-colon k the posterior layer of the great
omentum subsequently disappears by degrees, adhesions amounting finally to
complete fusion of the two layers into one, being established between the
two walls of the pouch before adult age is reached).

Along superior mesenteric artery, round small intestine and back to spine, forming
Downwards in front of spine & Aorta; mesentery;

Over upper part of rectum, forming meso^reetum;
Forwards :

III Kalb X - To bladder, forming posterior false ligaments of Madder ^ recto*

vesical pouch g

In Femals : -To vagina & uterus, tormimg posterior ligaments of uterus at recto*

vaginal pouch ; and then over uterus h from uterus to bladder,

forming anterior ligaments of uterus ft utero-vesical pouch ;

Over bladder and from bladder to anterior wall of abdomen;

TTp to umbilicus, covering urachus & obliterated hypogastrio arteries.

THE LESSER SAC, or SAC of the OMENTUM.

Begins at the foramen of Winslow.

Foramen of Winslow - is a constriction of the peritoneum bounded bys

iM Frokt - Lesser omentum containing first part of duodenum, hepatio

artery, bile duct h portal vein \
Behind - Right cms of diaphrngrm h inferior vena cavaj
Above - Lobus Spigelii of liver (or rather lo^tns oaudatus) }
Below - Hepatio artery as it passes forwards from Aorta.
Prom this point the peritoneum passes : -

Downwards to lesser curvature of stomach, forming posterior layer of lesser or gastro-
Over posterior surface of stomach ; hepatic omentum*

Downwards in front of intestine and then upwards, forming the two intemal layers of
Over upper surface of transverse colon ; ^"fls/ omentum ;

To spine, forming upper layer of transverse meso<olon;
Over pancreas ;

T6 under sirflMe of liver, forming inferior layer of eormarifUgamtni^ and over posterior

Mrt of under lorfiMt of Urer to faifiii if Willow.

112

PEBITONEITM —2nd Tablet.

The two Sacs traced together in Vertical Direction.

From transverse fissure of liver : -

To lesser cnrvatnre of stomaoli, forming lasir or gastrO'kepatic omentum;

Separate to snrronnd stomach ;

Descend in front of intestine, forming the ttoo anUrior layers of great omentum /

Ascend to transverse colon, forming the two posterior layers of great omentum ;

Separate to snrronnd transverse colon;

Backwards to spine, forming transverse mesocolon;

Separate :

One descends and forms in snooession the mesentery, meso-reotnm, reoto-veaieal

ponch (or recto- vaginal ft ntero-vesioal ponohee), eto.
The other ascends in front of pancreas and passes over back part of under surfiioe

of liver to foramen of Winslow.

(In the foetns^ also oooasionallj in the child, and even, though verj rarely,

in the adult, the two posterior layers of the great omentum ascend in front of

the transverse colon without adhering to it, or adhering to it but slightly, and
then pass backwards together to the spine above ike transverse meso^eolon^ Here
they separate : - One layer descends, and forms in succession the transverse
mesO'Cohmi the mesentery, meso«rectum, Ac. ; the other layer ascends, as above
stated, over the pancreas & liver. The ponch between Uie transverse meso-
oolon ft the great omentum subsequently disappears by degrees, adhesions
amounting finally to complete fusion of the two layers into one, being estab-
lished between the two walls of the pouch before adult age is reached*

Oreater Sac traced Horizontally below Level of Umbilicus.

From median line of anterior wall of abdomen : -

To right iliac fossa, where it forms meso^ccecum ft lower part of ascending mesO'Oolom;
Along lateral ft posterior walls of abdomen to spine, where it meets superior mesenterio

To left iliac fossa, where it forms sigmoid mesocolon ; ^^^^^ ^^ ^""* nwsentery,

Along lateral ft anterior walls of abdomen to median line.

The two sacs traced together Horizontally above Level of Umbilicns

or through Foramen of Winslow.

From median line of anterior wall of abdomen : -

Over anterior ft lateral walls of abdomen ft over right kidney t

Through foramen of Winslow ;

Over front of pancreas ;

To spleen ft then to back of stomach, fondng posterior layer of gastro^sptirde omemtmm;

Over posterior surface of stomach ;

Back to foramen of Winslow, forming posterior layer of lesser or gastro-kepatic omentum ;

Beflected outwards in front of bile duct, hepatic artery ft portal vein, forming anterior

Over front of stomach ; ^y^ of lesser or gastro-h^atic omentum ;

Bound spleen ft to under surface of diphragm, forming anterior layer of gastro-splenu

Over left kidney \ omentum 6- suspensory Ugameni rf spleen ;

0?«r lateral ft anterior walls of abdomen to median line.

113

FEBITONEUM — 8rd Tablet

XjIQAMENTS *"- BeflexionB of peritonenm frosa walla of the abdomen or pelvis to TiBoerft
^ whioh are not |K>rtiong of the intestinal oanaL

Belong to liver, bladder, nteros, ft spleen.

Ligaments of the Liver - Four :

SusPEirsoRT OR Falciporm Lioi^iCEKT -Triangnlar or siokle-shaped fold refleotad
oyer obliterated nmbilioal rein or ronnd ligament, and attached to npptf

surface of lirer, diaphragm, St sheath of reotns.
CoEONAXT LxoAiCENT * Consists of two lajors separated hj a considerable inter-
space, in whioh interspace the posterior border of the liver is connected
to the diaphragm by firm areolar tissue. Its superior layer & the right
half of its inferior layer are formed by greater bag; the left half of its

inferior layer is formed by lesser bag.
IiATiRU. Ligaments -The two triangular ft pointed extremities of coronary liga«

ment. The left one is the longest ft most distinct.

Liganxentfl of the Bladder - Five in number, and termed false ligaments:

Post. False Ligahbmts - The margins of reoto-resioal pouch, in the male, of
utero-Tesical pouch, in the female. Contain obliterated hypogastrio

arteries • ureters.
Lateral False Ligaments - From sides of bladder to sides of pelvis.

Bup. False Ligament - Over uraohus and obliterated hypogastrio arteries to

umbiliousL

Ligaments of the Utems - Six :

Broad Ligaments - From sides of uterus to sides of pelvis. Their free margim

contains from before backwards round ligament, Fallopian tube, ft ovary.

Ant. ft Post. Ligaments - The margins of utero- vesical ft recto- va^nal pouches.

Obliterated hypogastrio arteries ft ureters are contained in both these

folds.
Baspensory Ligament of the Spleen - Connects upper end of spleen to diaphragm.

OHENTA "~ Folds proceeding fi-om one visous to another. Three i

Lesser or Oastro-hepatio Omentnm - From transverse fissure of liver to lesser

curvature of stomach. - Its right free border contains hepatic artery, bile

duct ft portal vein, and forms anterior boundary of foramen of Winslow.

Oreat or Gastro-COliO Omentum - Consists of four layers, of which the most an*
terior ft the most posterior belong to greater bag, and the two internal to
lesser bag. The two anterior layers descend from great curvature of stomach
ft spleen ; the two posterior ascend to transverse colon (at least in adult ; for

arrangement in foetus see foregoing Tablets).

Oastro-Splenio Omentum - Connects hilum of spleen to great onl de sac of
stomach. Contains splenic vessels ft vasa brevia, and is continuous in-

feriorly with great omentum.

Iff SjSSjNTEjRISjS — Folds connecting greater part of intestine to posterior wall of abdomen.

Seven i

Mesentery Proper - Its root extends from left side of 8nd lumbar vertebra to right

sacro-iliac synchondrosis. Its free border contains the small intestine.

It is continuous superiorly with inferior layer of transverse meso-ooloiiy

inferiorly with meso-c»cum ft ascending meso-oolon.

MeS0-C8BCUm - Usually peritoneum merely passes in front of cesoum • iind also merely

in front of ascending colon, forming the

Ascending Meso-colon.

Transverse Meso-COlon - Formed by junction behind transverse colon of the two
ascending layers of the great omentum. Backwards from transverse colon
to spine, where it meets transverse portion of duodenum, and becomes

continuous with mesentery*

Descending MesO-COlon - Similar to ascending meso-oolon.

Sigmoid MesO-COlon - Broad ft well marked fold^ which allows of oonsiderablo

mobility on the part of sigmoid flexure.

JIeS0*rectaBI - Surrounds almost completely first portion of reotum, and coverfi
second portion in front ft at lidas abore^ in firont only towards middle, r

ftt M be'

114

SUPEBIOB MESENTERIC ABTEBY,

From front of aorta jiut below cosliao azui and behind Bplenic rein A pancreas.
Forwards between panoreas ft transyerse portion of dnodenum, and oroues firont of Ibe latter.
GarTos downwards to the right between lajem of mesentery to right iliao foraa^ and inoocii-

lates with its own ileo-oolio branch.

BRANCHES

Inferior PancreatioO-daodenal - Oiren off behind pancreas.

Ascends along concave border of dnodenum and joins with superior panoreaiico«

duodenal.

Vasa intestini tennis - Ten or twelve or more, and arise firom convex side of arierj.
Descend between layers of mesentery and divide each of them into two branches,
by junction of each of which with the neighbouring branch, a first series
of arches is formed, to which 2nd, 8rd, 4th, A even 5th rapidly dimi-
nishing tiers succeed, the terminal branches encircling the intestine

and ramifying in its coats.

Zleo-Colic -The lowest branch from concavity.

Between layers of mesentery towards ileo-colio valve, and divides into :

AsoiNDiNo Branch - To beginning of colon, and inosculates with colica

deztra.
Descending Branch - To end of ileum, and inosculates with termination of

superior mesenteric, both branches forming arches as above.

Colica dextra - From middle of concavity.

Beneath peritoneum and in front of right kidney to middle of ascending colon,

and divides into
Ascending A Descending Branches, - Which inosculate respectively with the

colica media ft the ileo«colio, also forming arches as above.

Colica media - From upper part of concavity.

Between layers of transverse meso-colon towards middle of transverse colon, divi.
ding as preceding arteries^ and similarly inosculating with colica dextra

ft oolioa sinistra.

INPEBIOE MESENTEBIO ABTEBY.

From left side of aorta one or two mches above bifnrcanon.

Descends along left side of aorta and front of psoas towards left iliac fossa, and then, nnde<

the name of superior hsamorrhoidal, curves to the right in front of left common iliao ft

«reter, and descends into the pelvis behind rectum, between layers of meeo-reotnm.

BRANCHES

Colica sinistra "Beneath peritoneum and in front of left kidney to middle of descen-
ding colon, and divides into
Ascending ft Descending Branches, - Which inosculate respectively with
the colica media and the sigmoid arteiy, and supply intestine as

above described.
Sigmoid Artery -Across psoas to sigmoid flexure of colon, and divides into two

branches, which inosculate with colica sinistra and sup. hssmorrhoidal.

Srj>erior hSBmorrhoidal - The continuation of the inferior mesenteric ^

Follows course above described, and divides opposite middle of sacrum into two
br an ohs s, whioh descend on each aide of rectum to near its lower end^

aoi fohi with middle hsunoniioidaL

115

CKELIAG AXIS.

Short thiok tmnk, from front of aorta between pillars of diaphragm.

Forwarda abore pancreas and between lobos Spigelii A right semilunar ganglion on the right, and
left semilnnar ganglion it oardiao end of stomach on the left^ for abont half an inch, and

divides into:

GASTRIC, OR CORONARIA YENTRICULZ -The(nnane.t

Upwards and to the left to oardiao orifice of stomach.

Along lesser cnrrature between layers of lesser or gastro-hepatio omentum to pyloras,
where inosculates with pyloric branch of hepatic ; gives branches to both sur-
faces of stomach.

HEPATIC ' Intermediate in size in the adult ; the largest in the footus.

Upwards and to the right in front of foramen of Winslow, between the two layers and

along right border of lesser or g^tro-hcpatio omentum, — ductus communis

choledochus lying to the right, and the rena port» behind, -> and divides in

transverse fissure of liver into two branches, which accompany divisions of

vena portss A hepatic duct to right A left lobes. Gives o£f branches :

Fylorio ~ ^o pyloms, and along lesser curvature, inosculating with gastric.
GastrO'duodenalis ~ Larg^ ; downwards behind duodenum, and divides into :
Gastko-epiploica dextea - Along greater curvature of stomach between
layers of great omentum, giving branches to both surfaces of stomach
and to omentum, and inosculates with gastro-epiploica sinistra.
Fanceeatico-duodenalis Superioe - Descends between pancreas and duo-
denum and anastomoses with inferior pancreatico-duodonalis, a

branch of superior mesenteric.
OystiC - Arises from right division. - Upwards to neck of gall bladder, and

ramifies on its nnder surface, and between it & liver.

SPLEMIC - ^e largest.

Tortuous course to the lef% behind upper border of pancreas and above splenic vein,

and divides into numerous branches which enter hilum of spleen. -

Gives off:
Pancreaticsd parv»- Numerous, small.

Paxicreatica ZDAgna - From left to right along posterior surface of pancreas.
Vasa brevia - From five to seven in number; between layers of gastro-splenio

omentum to splenic end of stomach.

Oastro-eplploica sinistra - Along greater curvature of stomach between

layers of great omentum, giving branches to both sorfaces of stomach ft

to omentum, and inosculating with gastro-epiploica deztra.

116

THE STOMACH.

If Bitnated in the left hypoohondriao, epigastrioi A part of right bypochondriao

Tegidnif and preaenta :

Ant. Surface -Loolm upwards & forwards, and ia In ooniaot with nnder anrtaoe of

Hrer, diaphragm, and anterior wall of abdomen opposite ^ tf stomach.

Post. Snr&ce - Directed downwards h baolcwards, and oorered with peritoneum of

lesser sac, by which sao it is separated from panoreas, great vessels of abdomen,

omra of diaphragm h solar plexus. Bests npon transTorse meao>oolon.

Great or Splenic End^ Oreat Gnl-de-sac or Fundus - Lies beneath the aiz

lower left ribs, in contact with the spleen to which it ia oonneoted by the

C^stro-splenio omentum.
Lesser or Pyloric End -* ^^ contact with anterior wall of abdomen, nnder anrfaee

of liver, k neck of gall-bladder.
Greater Curvature - Lies above transverse colon, and gives attachment to great

omentum.
Lesser Curvature - Connected to transverse fissure of liver by lesser or gastro-hepatio

omentum, and to under surface of diaphragm by gastro-phrenio ligament.

QBsophageal or Cardiac Opening - Funnel-shaped, and situated above h behind

the pyloric opening^.
Pyloric Opening - Guarded by pylorus, and is more movable than the ossophageaL

When the stomach is distended its greater curvature is elevated k carried
finrwardSi while its anterior surfiAce is turned upwards, and its posterior surface

downwarda.

117

THE SMAIiL INTESTINE.

la a sliglitly narrowing oonrolnied tnlM about 90 feet long, oonneoied to the ipine hj the me*

■entery in the greatest part of ite extent.
II If divided intoi

DUODENUM — Vide below.

E(MALL INTESTINE PROPER — Is rather arbitrarilj dirided, no defined

limit ezisting, intoi

JEJUNUM — The npper two fifths. Wider, thicker, St more vasonlar, and
has its Tilli St Talyals oonniyentes more, and its Payer's patches less,

numerous A dereloped.

ILEUM — The lower three-fifths. Narrower, thinner, & less Tasoalar, and has
its Tilli it its valYnls oonniyentes less, and its Payer's patches more,

numerous A developed.

THE DUODENUM

Is the shortest, widest & thickest part of the small intestine, and has no mesentery. Its
length is from 8 to 10 inches, or about twelve finger breadths. - Into it open by a
common orifice the common bile & pancreatic dacts, and the villi A valvulas conni-
ventes are lai^er A more numerous immediately below this opening than in any

other part of the small intestine. - Its course is :

Upwards &* to the right to under surface of liver &* neck of gall-bladder :
Downwards in front of right kidney ;

Transversely to the l^ to left side of 2nd lumbar Zfertebra, where it is crossed

by superior mesenteric artery^ and where mesentery begins.

RELATIONS:

First| or Ascending Portion -

Above -Under surface of liver A neck of gall-bladder i
Behind - Bight border of lesser omentum, hepatic artery, bile duct,

portal vein.

Seoondi or Descending Portion -

In Fbont - Hepatic fiezure of colon i
Behind - Bight kidney $

On Innex Side - Head of pancreas, ductus communis oholedochus, pan-

oreatico-duodenal arteries.

Thlrdi or Transverse Portion -

In Fxont - Descending layer of transverse meso-oolon, superior mesen*

terio vessels.
Behind - Aorta, inferior vena cava, crura of diaphragm ;

Above -Lower border of pancreas, superior mesenterio vessels.

118

THE LARGE INTESTINE.

About 6 iM long, gaoonlated. Dinliiiahet In else till Jnst abore aaof, wliera It !■ oontidorablx

ei '
Oomisti c/icaeum, ascending^ transverse^ 6* deseending a^an^ sigmoid flexure A reetUMm

OACDM or CAPUT CiECUM COLI — The onLde-sao titnaied below entranoe of small

intestine into the large ; is the most dilated part of colon.

Lies in right iliao fossa, where it is retained by the peritonenm which covers its front h
sides, and sometimes snrronnds it entirely in a distinct fold, the meso>oacam.
Presents :

Appendix Vemilformis - A tnbnlar prolongation fW)m 2 to 6 inches long A of abont
the diameter of a goose-qnill connected with lower A back part of caeca m ;
usnallj directed upwards db inwards behind it, and retained by a fold of peri*

tonenm.

Ilio-Csecal or Ilio-Colic Valve, or Valve of Banhin - Sitnated at entrance of

small intestine into the large at upper inner A back part of cscam.

Formed by two crescentio folds of the mucous & submucous coats A oircnlar mns-

onlar fibres of the gut, which folds are separated by a narrow antero-posterior

apertora
The upper fold is nearly horizontal, and is the smallest.
The lower fold is oblique, and is the largest.

At their points of coalescence they are continued npon wall of gut into two pro«

minent folds, the /nrxj.
Their surface turned towards the small intestine is ooTcred with villi, the otb«r

surface has no villi, and is quite smooth.

ASCENDING COLON -

Upwards to under surface of liver on right side of gall-bladdor, where it curves to the

\e% fatwinfi hefatic /lexmre. .
Bound down against qnadratns lumborum A right kidney by peritoneum whicn covers its
front A sides, and sometimes encloses it in a distinct fold, the ascending meso-oolon.

TRANSVERSE COLON or ARCH of the COLON -

Curves forwards A to the left between confines of umbilical A epigastrio regions to
left hypochondrinm, where it bends downwards, forming splenic flexure. Is very
movable, being comprised between the two ascending layers of great omentum,

which layers join again behind it to form transverse meso-oolon.
Its relations are t

Above — Liver, gall-bladder, great curvature of stomach, lower end of spleen;
In Front - Great omentum, anterior wall of abdomen ;
Behind - Transverse meso-oolon, 8rd portion of duodenum,

DESCENDINO COLON -

Downwards in front of left cms of diaphragm, left kidney A quadratus lumborum to
left iliac fossa, where it ends in sigmoid flexure. Covered by peritoneum in front A
at sides, sometimes entirely surrounded by a distinct fold, the descending mescoolon.

8IOMOID FLEXURE -

Commences at crest of ilium, ascends to right or left, descends, and ends in reetam
opposite left saoro-iliao synchondrosis. Freely movable, being retained by only

a loose fold of peritoneum, the sigmoid meso-ooloB.

119

THEPANCBEAS.

Lies behind Btomaoh & lesser bag of peritonenm opposite first lumbar rertebra. It is long,
narrowy flattened from before baokwardsi ft of a reddish cream-oolonry and presents i

Headj or Right XSnlarged Eztrexnity - Cnryes downwards, and is embraced by oon-
cavity of dnodennm, the daotns commnnis choledochns ft the panoreatioo^
duodenal arteries lyinp between the two organs, the former behind, the latter
in front. -The lower ft back part of the head (sometimes detached from the
remainder of the gland, and then called the lesser pancreas )i passes to the left
behind superior mesentisrio Tessels^ forming the posterior wall of an incomplete

oanal in which these Tessels are enclosed*

•

Bodyi or Central Flattened Portion - Presents i

Amtssios SuKrACB - Convex, corered by peritoneum belonging to lesser bag, ft by

posterior surface ofstomaoh.
PosTEKioK SuRrACB - GoBcave; in relation with:

Pillars of diaphragm, left ptadratus lumdorum, left kidney ^ left suprarenal

capsuU;
Aorta, vena cava, mesenteric vessels, commencement of vena porta, &* left renai

vessels*
Ufpbk Border - Thick, corresponds to coeliac axis, and is deeply groored for splenitf

artery ft veia*
Lower Border - Thinner, separated from transverse portion of duodenum by superior

mesenterio vessels.

Lesser Und, or Tail - Lies a little higher than the head, in contact with left kidney ft
left suprarenal capsule, ft lower ft back part of spleen, to which latter organ it

is slightly adherent.

PANCREATIC DUCT, or CANAL OP WIRSUNO - Bnns firom left to right

through whole length of the gland, lying in the vicinity of its anterior surface
ft lower border. In the head it curves downwards on left side of ductus com-
munis choledochus. Both ducts then perforate together the muscular coat
of the intestine, run side by side for about three-quarters of an inch beneath
mucous membrane, and open by a common orifice situated on inner wall of
descending portion of duodenum a little below its middle, about three or four
inches from pylorus. The duct from the lesser pancreas opens into canal of
Wirsung near its termination, or, sometimes, forms a supplementary canal
which opens separately into duodenum an inch or more above canal of

Wirsung.

STRTJCTTJRS! ""^ The pancreas is a racemose or conglomerate gland and is very similar to

the salivary glands, excepting that its tissue is somewhat softer ft looser.

Vessels ft Kertbs - Arteries from the splenic and superior ft inferior pancreatico*

duodenal. - Veins open into the splenic ft mesenterio. - LymphaHa

ooen into the lumbar glands. - Nerves are from sow plezns.

120

THE SPLEEN.

Is oompreased & OTal in form, Bofl, brittle, ft of a dark reddish-blao colour, and lies in left
bypoohondriam, embracing cardiao end of stomach, to which it is concocted hj gastro-

splenfc omentum. It presents:
Outer SurfaCO *- ConTex, in relation with nnder surface of diaphragm $ corresponds to 9th,

10th, A 11th ribs.
ZnXier Surface ~ Concave. Presents a little behind its middle the hilam, a Tertical fissure

pierced by several irregular foramina for the blood-Tesaels, lymphatics ft

nerves, and is related with:
In Fbont - Great cul-de-sac of stomach ;

BfiuiND - Left crns of diaphragm, left suprarenal capsule ft usually a process of

lesser sac of peritoneum;
Below - Tail of pancreas.

Upper Extremity - Thiclr, rounded, attached to diaphragm by suspensoxj ligament.

Lower Extremity - Pointed, in relation with splenic flexure of colon.

Anterior Border - Thin, frequently notched.

Posterior Border -* Thick, rounded, lies on left kidn^.

121

THE EXTEBNAL BILE DUCTS.

Hepatic Duot <- Formed In transrene flunre by Jnnotion of tne two large ezorotory

dnots from right A left lobes

Downwards ft to the right between the two lajers of leaser or gastro-hepatio

omentnm A behind first portion of dnodennm, having hepatic artery on the

left it rena ported behind, and joins with ojstio duct to form duotns oom«

mnnis oholedoohns. Is abont an inch A a half long, and is intermediate in

■ise between ojstic dact A dnotns oommnnis choledochns.

OALL-BL ADDSR — Pear-shaped, three or four inches long, an inch wide at largest
part J holds from 8 to 12 draohms. Obliqnel/ directed downwards, forwards^
A to the rights A lies in a fissure or fossa on nnder surface of liver between

lobns qnadratns A right lobe proper. Presents;
XTirsEX SuBTACB - Covered by peritonenm, which in mosc cases merely passes over
it ; in relation with hepatio fleznre of colon A first part of dnodennm ; some-
times with pyloric end of stomach. - Occasionally the peritonenm entirely
snrronnds the gall-bladder^ which latter is then connected to tbe liver by a

small mesentery.
Uppeb SuBrACE - Conneoted to the lirer by firm areolar tbtae A vessels ; sometimes

by a small mesentery.
Aktekiob Enlasgid Extuemitt, OB FuKDos - Oorered by peritonenm ; tenches ab-
dominal parietes opposite tip of 10th costal cartilage.
PosTERiOB CoNSTBiOTBD ExTRiMXTTy OB Kbck - Forms two tnms npon itself like an

italioy^ and is oontinned into the cystic dact.

Cystio Duct - Downwards A to tbe left between the two layers A along the right
border of leaser or gastro-hepatio omentnm and behind ascending portion of
dnodennm, having the cystio artery on the left A the vena portas behind^ and
joins with hepatio dnct to form dnotns communis oholedoohns. Is abont an

inch long, and is rather narrower than the hepatio duct.

DaotOB Conmmilis CholedocllUS - Downwards A slightly to the left between the

two layers A along the right border of lesser or gastro-hepatio omentnmy

having hepatic artery on the left A rena ported behind.

Between head of pancreas A descending portion of dnodennm on right side

of pancreatic dnct, and with pancreatico-dnodenal arteries which lie slightly

in front.
Perforates mnscnlar coat of intestine in common with the latter dnct. Both
dncts then mn together for about three-quarters of an inch between coats
of intestine, and, becoming slightly constricted, open by a common A promi-
nent orifice situated on inner wall of descending portion of duodenum a little
below its middle, about three or four inches from pylorus. - The common bile

duot If about three inches long.

122

THE LlVJiiK.

The largeit gland in the body, of a dull reddish brown oolonry dtnated in right hypoohondriac,
epigastrio & part of left hTpoohondriao regions. - Its transverse ft antero^poeterior dia.
meters, and its greatest thiclmess are nsnally abont twelve, six, & three inohes respcctivelj.
It weighs from three to four pounds. - Presents :

UPPER SURFACE — Smooth, convex, divided into right, largest, A most convex lobe,
and left lobe, smaller & flatter, by suspensory or falciform ligament. In relaUos
with under surface of diaphragm, A the six or seven lower ribs, and to a slight eztefnt
in the upright posture A during deep inspirations, especially in women ft childrm,
with anterior wall of abdomen.

UNDER SURFACE — Vide next Tablet.

ANTERIOR BORDER — Thin, inclined downwards ft to the right, notched deeplj
opposite round ft falciform ligaments, and usually more slightly so opposite fau&u
of gall-bladder. In recumbent posture ft during expiration it nsnally corresponds
to lower border of ribs ft costal cartilages, in upright posture ft during deep inspira-
tions, especially in women ft children, it descends a little lower.

POSTERIOR BORDER — Thick ft rounded, especially to the right, in relation witk
pillars ft under surface of diaphragm, to which it is connected by coronary ligament;
and with aorta ft inferior vena cava, for passage of which latter resael it is deeply
grooved ft sometimes channelled.

RIGHT EXTREMITY — Thick ft rounded, attached to 4iaphragm by right lateral
ligament; descends lower than the left.

LEFT EXTREMITY — Thin ft flattened, attached to diaphragm by left lateral liga-
ment | ascends higher than the right.

LIGAMENTS OF THE LIVER — Five in numben

Round Ligazxxent - The obliterated remains of umbilical vein ft ductus venosoa
Ascends in tree margin of falciform ligament from umbilicus to longitudinal
fissure on under surface of liver, where it joins inferior vena cava.

Falciform or Suspensory Ligament ^

Coronary Ligament . . . /Formed by peritoneum. -VidoPeritoneiiiii.

Lateral or Triangular Ligaments •)

123

UNDER SURFACE of the LIVER.

OoBoaTe vxivrm, looki downwards A haekwardR, and ooren Btomaoh, dnodennm, hepatio

flerare of colon, right kidney & right suprarenal oapsule.
Freienta four fissnrefl, one of which is divided into two, and two primary lobea, of which the

right onOi or right lobe proper, presents three sub-lobes or lobuies.

yiSSITBIiS — ^>^ thes

IiOXl^itudizial Fissnre - Separates right ft left lobes, and extends from deep notch on
anterior border as far backwards as posterior border. It is divided into :

UXBILICAL FissuBS - Its anterior & deepest two- thirds, situated in front of trans-
verse fissure; contains umbilical vein in the fGotus, and its obliterated remains in
the adult. Is often bridged over posteriorly by a band of liver substance, the
pons hepaticns.

F188URB FOB THE Ductus Ykkosus - Its posterior A shallowest third ; contains the duc«
tns venosns in the fcetns, & its obliterated remains in the adult.

Transverse Fissure ~ Extends transversely to the right from longitudinal fissure
for about two inches, lying nearer to posterior than to anterior border. - It
transmits hepatic artery, bile duct, portal vein, lymphatics & nerves, the hepatio
artery lying to the left & in front, the bile duct to the right & in front, and the
portal vein behind.

Fissure or Fossa of the Gklll-Bladder - Shallow, broadest in front, nearly parallel
to longitudinal fissure on right side of which it is situated, and extends from an-
terior border to near right extremity of transverse fissure.

Fissure for the Inf. Vena Cava - Extends from behind lobns oandatus to poster-
ior border of liver, where it joins with fissure for ductus venosus. Is often trans-
formed into a complete foramen, by a prolongation of the lobus Spigelii. It gives
exit to the hepatio veins which here open into the inferior cava.

IiOBZSS — Are the:

Bi^t Lobe - 1^0 largest. Presents the three last named fissures, and also, further to
the right, the imprasio colica for hepatic flexure of colon, behind which is the I'm-
prasio renalis for right kidney ft right suprarenal oapsule. - It also presents the
three following sub-lobes :

LoBUS QuADRATVS - Situated in front of transverse fissure, between fissure for the
gall-bladder ft umbilical fissure; quadrilateral ft broadest from before backwards.

LoBUS Spioe!.!! -Situated behind transverse fissure, between fissure for ductus venosus,

ft fissure for inferior vena cava ; more prominent than former, but less regular

in shape. Projects into lesser sac of peritoneum.
IiOBUS Caudatus - A prominent ridge extending from front part of lobns Spigelii to

noder surface of right lobe proper ; forms anterior boundary of fissure for inferior

vena cava ft upper boundary of foramen of Winslow.

Iieft Lobe - ^b smaller than the right. Its under surface rests upon the stomach, and
sometimes extends as far as upper border of spleen.

124

PORTAL SYSTEM.

PORTAXi TRUNK **" Formed bj Jnnotion of splenio A superior metencerio veins behind upper

border of head of pancreas.

Upwards & to the right in right or free border of lesser or g^tro-hepatio omentnm,
lying between ft behind hepatio artery & bile duot, in front of foramen of Winslow.
Expands near right extremity of transverse flssnre of liver into the sinus of the portal
veifii and divides into right branch, tho larger ft shorter, and left branoh, the
smaller ft longer; which branches ramify in portal oanals with branches of hepatio
artery, bile dncts, deep lymphatics, ft nerves. (For distribntion of portal vein
in the liver and its oontinnation into the hepatio 'veins, vide Strnoture of

Liver). - Beoeives veins:
Gastric &* Cystic - The former runs from oardia to pyloms i the latter

frequently opens into right branch of portal vein.

SplOZllO Vein "* Arises by five or six branches of considerable sise, which emerge from

hilam of spleen and join to form one large tmnk, which trunk takes a straight

course from left to right behind npper border of pancreas, below spleoio

artery, and, at npper border of right extremity or head of pancreas, joins

with saperior mesenteric to form the portal trunk. Beoeives veins:

Inferior Mesenteric (Vide below), Vasa Brema^ Left Gastro-Epiptoie^

Pancreatic ^ PisncreaticO'DuadenoL

Superior Mesenteric Vein -* Arises from area of distribution of superior mesenterio

artery, (small intestine, ccecum, ascending portion ft right half of trans-
verse portion of oolon), its branches corresponding to those of the artery.
Its trunk lies to the right ft a little in firont of the artery, and passes with
it in front of transverse portion of duodenum ft behind pancreas, and, at npper
border of head of pancreas, joins with splenio vein to form the portal trunk.

Inferior Mesenteric Vein - Arises from area of distribution of inferior mesen.

teric artery (upper part of rectum, sigmoid flexure, descending
portion ft loft half of transverse portion of oolon), - its superior
bsmorrhoidal branch anastomosing with the middle ft inferior h»m3r-
rhoidal branches of the internal iiiao ft pudio, and thus establishing
an important communication between the portal ft general venous
^sterns, which communication is supplemented, according to
Kiernan, by communications between the right renal vein ft the veioB
of the ascending colon ft duodenum, and by oommunications in the
coronary ligament of the liver between the phrenic ft the superfioial
branches of the portal vein. Ascends beneath peritoneam and
behind transverse portion of duodenum ft paaoreaS| and opens into

spleniew
The portal system contains no valves.

126

ASCENDING VBNONS TRUNKS.

COBIMON ILIAC VEINS — Formed by Jnnoiion of external & fntomal Hfaet oppo.

Bite Bacro-Tertebral ariionlation (some authors say opposite saoro-iliao synchondr*
oeis). Obliquely upwards, the left one more obliquely than the rij^ht, to a little to
the right aide of interrertebral diso between 4th & 5th Inmbar Tertebrea, where they

nnite to form the inferior oaTa.

BIGHT COMMON ILIAC — Shorter A less oblique than the left one | lies at first

behind A then on onter side of its artery. Eeceives

Tributary Branches : -* TluhZtfm^r, A sometimes Uaeral Sacral.

LEFT COMMON ILIAC — Longer ft loore oblique than the right one ; lies at first

on inner side of its artery, and then passes behind artery of right

side. Beoeires

Tributary Branches: - IluhLumhar^ ft sometimes the LcUerai 6* AfiddU

Saeral* - The common iliao reins have ne yalFos.

INFERIOR VENA CAVA — Formed by Janotion of the two common iliacs a little

to the right side of intervertebral diso between 4th ft 5th Inmbar yertebrae.

Along right side of aorta in front of right Inmbar k renal arteries ft right cms of dia«
phragm, passing in snooession behind attached border of mesentery, transrerse por-
tion of dnodennm, pancreas, ft portal tmnk.
Tbrongh groore or canal in posterior border of lirer, where the hepatio Telos open into it.

Perforates central or cordiform tendon of diaphragm between its middle ft right leaflets.

Vntera flbrons bag of perioardinm, becomes inrested anteriorly by serons layer of same
aao, and opens into lower ft back part of right anriole near Interanricnlar septnm,

its opening being guarded by the Eustachian Talve. Beoeires

Tributary Branches : - Middle Sacrai, Lumbar^ Renal^ HepoHe^ Right Sper*
mati€tSu^aren<U^^ Inf trior Phrenic^ the middle sacral sometioiefl

opening into the left common iliac

126

ABDOMINAL AOBTA.

OarTM slightly backwards St to the left from aortlo opening in front of 18th doml
Tortebra to a little to the left of 4th lumbar Tertebra, whore it diTidat

into the two oommoa nil

RELATIONS :

In Fbont -> Lesser oTnentom, stomaoh, ooellao axis, solar pleziwi

Splenic Tein, panoreas, left renal yeini
TransTerse portion of dnodennm, mesentery, aortio plena.

Behind - YertebrsBy left lumbar Teins, receptaoulum ohyli, thoraoio duot.

To THB Bight -Inferior Tena caTa, yena aijgos major, reoeptaonlom chjrlia

thoraoio duot, right aemiluiiar gmnglion.
To TBH Lm - Oord of sympathetic, left semilunar ganglion.

BRANCHES — Phrenic, Coallao Axis, Superior Meaenterio;

Suprarenal, Renal, Spermatic;
Inferior MesenteriCi Lumbar, ft Sacra-Media.

12T

BRANCHES of the ABDOMINAL AOBTA.

InfOrlor PhreniO - Two. Arise separately or by a oommon trunk either trom ooBliao azis,or

from aorta immediately aboTO the latter.
Upwards and outwards behind OBSophagus on left side, behind vena cava on risrht side,

to central tendon of diaphragpn, and diTlde into :
iNTSBJTiLL BsAKOH - To front part of diaphragm oommunioating with its fellow St with

musoaIo«phreniO|
SZTXRNAL Bbanch ~To Bide of thorax, oommunioating with interoostals.
Gives off small superior capsular hfimcka to suprarenal oapsole.

CosliaO Axis - Vida next Tablet.

Superior Meaenterio - Vide next Tablet but oneu

Snprarenal - Two. Small in adult, but in foetus as large as renal. To suprarenal oapsuleSi

anastomosing with capsular branches of phrenic h, renal.
Benal or Smnlgexit - Two. Large, firom sides of aorta Just below superior mesenteric.

Nearly horizontally outwards behind renal Toin, and dlWde, each of them, into four or
fire branches, which penetrate into hilum of kidney in front of pelTis. - Give ofl
small inferior capsular branches to suprarenal capsule, and twigs to peMs h ureter.
Bight artery passes l>ehind inf. vena cava, is longer than left one, and lies a little lower.
Benal arteries yary considerably in coincidence with yariations of kidneys in situation^
size, and number. - They may arise from front of aorta near its bifurcation,
or from oommon or internal iliac; - they may diyide into branches sooner than
usual, or may be replaced by several arteries which arise separately from side
of aorta} - one may be wanting, or there may be a supernumerary artery corres-
ponding to a supernumerary kidney.
Spermatic - Two| long & elender. From front of aorta a little below renal.

Downwards and outwards beneath peritoneum to brim of pelris crossing psoas h uretor

and, on right side, inferior vena cava.
Forwards in front of extomal iliao artory to intomal abdominal ring, being crossed on
right side by termination ot ileum, on left side by sigmoid flexure of colon.
Through inguinal canal and down to back of tostis with other constituents of spermatio
cord, becoming tortuoas near its termination, and giving twigs to epididymis,
whioh twigs Join with artery of yas deferens | pierces tunica albuginea to sub-
stance of testis*
OVABIAN ABTEBY - In female. Same course down to brim of pelvis, then passes down,
wards & inwards to attached margin of ovary between layers of broad ligament
of utoras; joins with uterine on side of uterus ; gives branches to Fallopiaa tuba
and twigs to round ligament^ which twigs are sometimes oontiQued through in-
guinal canal to integument of labium h groin*
Both these arteries are short during first part of foetal life, when testes & ovaries lie
just below kidneys, and become elongated only when these organs desoend into

pelTis.

Inferior Mesenteric - Vide next Tablet but one.

Lumbar - Usually four I from back of aorta.

Bound bodies of lumbar vertebras beneath psoas, the two upper ones passing also
beneath pillars of diaphragm, and those of right side beneath inferior vena

oava I and divide between transverse processes inter

Abdominal Biamch - Behind quadratns lumborum (the lowest one sometimes in front),

and beneath abdominal muscles, joining with epigastric, internal mammary,

interoostals, ilio-lnmbar ft ciroumflex iliac

DOMAL Bbaxch - Sends a spinal branch through intervertebral foramen to oanda

equina ft posterior sarfaoe of bodies of rertebres, and passes backwards to

muscles ft integument of back*
Saora Media - Bmall $ from back of aorta at point of bifurcation.

Deso«nd« upon middle of saorum, anastomosing with both lateral laoraL

128

COMMON ILIAC ABTEBY.

Downwards it on^ardi from biftiroaiioa of aorto a little to the loft of 4ith Inmbtr
▼e'rtebra to opposite saero-rertebral artionlation (some Authors say opposite sacro^niM
synohondrods), where it diTides into external St internal iliaos. Is abont two inohei

long, the right artery being slightly the longer.

BELATIONS :

Right Side:

In Fboiit - Small Intestine, peritonenm, sympatheUo nerre^ ureter

near Ufiwoation.
Bbbikd -> Both oommon lliao Teins.

Ouna 8iDB - Bight oommon iliao Teioi inferior rena oaTa, psoas

mnsel^

Left Side :

In Fbont - Same, pins reotnm St superior hssmorrholdal artery.
Odtsb Sidb - Psoas*

Left Commom IliM Vein - Lies at first on inner side of iU artery, and then

passes beneath artery of right side.
Riiht Commm Iliac Vein - Lies at first behind its artery, and then on its

onter sidsb

BRANCHES — Very small St not named, sometimes Renal A ZUo-lOZIlbar.

129

eztebnaIj hjac abteby.

Downwards h onfcwarda along inner border or psoas, extending from biAiroatlon of oom*
mon iltao opposite sacro-Tortebral artioalation (some Authors say opposite saoro-iUao
synobondrosis ) to beneath Poapart's lisrament midway between anterior superior
■pine of ilinm h symphysiB pubis, where it beoomes femoral .artery. Bather lardrer in

the adolt than internal Uiao ; half the siie in the foetos.

RELATIONS :-

Iv Front - Intestine, peritonenm, thin layer of fasoia derired from
the iliaoi spermatic vesaels & neryes, genital branoh of genito*
cmral nerve, oiroamflez iliao yein, sometimes nreter near orisrin.

BsBiND OH Bight Sidb - External iliao veiny whloh lies on inner tide

at femoral arch.

On Imnbb Sidb - External iliao yein, & yas deferens*

On Outbb Sxdb - Iliao fasoia & psoas masole.

/^ Exiemai Iliae Vein lies altogether on inner side of its artery.
Right External Iliae Vein lies at first on inner aide of its artery, and then

behind it.

BRANCHES : -

Sipigastrio - Somewhat the larger* From front of external iliao a few lines abeye

Fonpart'B ligament.
Descends slightly to reaoh level of the ligament.

Asoends obliquely upwards k inwards in subperitoneal areolar tissnoy passing
behind inguinal oanal & along lower & inner boundaries of internal abdo-
minal ring, and hocking round yas deferens in the male, round round

ligament in the female.

Pierces sheath of rectus between its middle & lower thirds, and ascends behind

the muscle, dividing into muscular & cutaneous branches, which anasto*

mose with lower intercostal?, lumbar, superior epigastric of internal

mammary, & saperfioial epigastric of femoral. - Gives oflT branches i

Obbmistebio - Small, descends upon spermatic cord and supplies oremasteri

anastomoses with spermatio.
FuBiO - Usually small ; descends behind pubes on inner side of femoral ring, and
anastomoses with obturator. Sometimes greatly increased in siae
so as to form the origin, or one of the origins, of the obturator artery,
whloh artery is then said to arise from the epigastric (Vide obturator
artery). - The two epigastrio veins unite into one trunk, which opens

into the external iliao.

Otrcumflez Iliac *" Somewhat the smaller. From outer side of external iliao near

Poupart's ligament.
Upwards & outwards behind the ligament, and along anterior half of inner lip

of orest of ilium, joining with gluteaL
Pierces transversalis, runs backwards between it & the internal oblique, and
joins with ilio-lumbar. Gives oflT numerous muscular branches ; one, rather
large, ascends from anterior superior spine of ilium, and joins with the
epigastrio & lumbar. - The two oiroumflex iliac veins unite into one trunk,
which orosses the external iliao artery and opens into the corresponding y.

130

LUMBAB PLEXUS.

Formed hj anterior diTirions of foar upper latnbar nerres, and situated In inbetaBoe of paoat,

in front of transverse processes of the lombar Tertebrsa

Narrow aboTe, where it nsnally receives a small branoh from last dorsal nerve | broad below,

where it is joined to the sacral plexus by a branoh from 4th Inmbar nenre it by lombo-

■aoral nerra or eord.
Its arrangment is as follows t - (Vide Qaain's diagram).

Ist Lumbar Nerve - Gives offi

IliO'kypogastrie^

IHo'inguinaii

Small part of Gem'/O'Cruralf

Commumcalitig branch to ^nd Lumbar*

2iid Lumbar Nerve - Completes

GmitO'cruralt - and gives off
Greater part of External Cutaneoust and

Communicating branch to 3rd Lumbar^ from whioh oommnnfoating branoh the
Anterior Crural^ Obturator^ ^ Accessory Obturator nerves (when the

latter exists) are partly deriTed,

8rd Lumbar Nerve - Completes

External Cutaneous^ and gives off

Greater part of Anterior Crural^ Obturator 6* Accessory Obturator Narvet (when

the latter exists), and •

CoffimuAUating branch to 4th Lumbar*^

4th Lumbar Nerve - Completes

Anterior Crural, Obturator^ 6r» Accessory Obturator Nenm^ (when the latter

exists), and gives olFa
Large branch to sih Lumbar^lth^x^ large branch forms with the latter nerve

the LumhoSaeral Nerve or Cord*

131

LATERAL BBANGHES of the LX7MBAB PLEXUS.

ILIO-HTPOOA8TRI0 — **rom Ist lumbar.

Emerge9^ from upper pari of outer border of Psoas,
Grosses qnadratus Inmboram.

Perforates transrersalis, and diyides between it h internal obliqne into brancliei t -
Iliao - Fieroet internal & external obliqno Jast above oreet of ilinm, and supplies skin of

gluteal region behind lateral ontaneons branch of twelfth dorsal nerro.

Htfooasteio - Forwards between internal obliqne & transrersalis, oommnnioatiug with

ilio-ingntnal. Pieroes internal oblique h aponeurosis of external oblique

a little abore the external abdominal ring, and supplies skin of hjpogas-

trio region*

ZLIO-INOUINAL *— From let lumbar} smaller than foregoinc^.

Pierces psoas, and crosses quadratus lumbornm immediately bdow ilio-kypogasirie.

Pieroes transrersalis, and communicates with hypogastrio branch of ilio-hypog^trio

between that muscle and the internal obliquci which It pierces a little

further on.
Through inguinal oanal in front of spermatio oord ; and supplies skin of uppar h

inner part of thigh and of scrotum & penis, or of labium pudendL

Is sometimes small, and then ends by Joining the ilio- hypogastric near crest of

ilium ; in that case a branch of the ilio-hypogastric takes the place of the

llio-iDguinaL

OENITO*0RX7RAL -~ From 8nd lumbar nerre, and by a few filaments from the Isc.

Descends obliqaely through stibstanee, and afterwards on anterior surface of psoas^ and

divides into branches : -

Gehital - Over external iliac artery, and through inguinal oanal behind spermatic cord,

to oremaster muscle k scrotum ; - in female behind round ligament to labium.

Gbvbal - Beneath Pouparts ligament on inner side of psoas. Pieroes fascia lata on outer

side of femoral artery, and supplies skin of upper and front part of thigh;

oommunicates with middle ontaneous.

SXTZiBN AL CXTTANEOUS -* From 8nd lumbar ner^e, and, by a few filaments, ih>m the 8rd«

Pierces psoas muscle towards its middle and crosses iliacus*

Passes beneath Poupartfs ligament thnngh notch below anterior superior spine of

ilium, and divides into branches : —
Ajitihxor - Pierces fascia lata about four inches below Poupartfs ligament, and supplies

skin of anterior h outer aspects of thigh as low as knee.
PosTitiOB - Supplies skin of outer k posterior aspect of thigh.

THE DIAPHBAGM.

^ ^^*^ ^i..^, S y ^^ T**S? **'./*• ^" ^"» boriionUl, and the narrow portfwi » hmoO^ vw.
tloal. !♦ preMntf for emnliiatlon iti pointi of origin A the fibrot ariifng fWwn thorn, llToimM ot

«w\Tiffiiia /%w />w^««!v •. .M „ . ^ oordfform tendon, Ita oponlngi^ A hi reletleiia

FOZNTB OF ORIGIN A FIBRES ARISING FROM THEM:

^" rf^S5«l?SS?S2?? ' 1?^** attaohmwit to a narrow h aom'etlnei tendlnone iIIth •» ^iW elde

of which the Qo^ oartflaeree & the ooptal fibres bonnd a narrow trianffular arsa, !Srer the extent

r!i^i.Hl«H^. or wnioh area the plenras * the peritonenm are eeparated only by a little areolar time.

CartHages A Osseotus Portions of the 6 or 7 Lower Riba - Oi^ riie to the lon«r arohed

T lrf.««««4 A •x!*^ *r®!» '^^*®^» •* *^«*' PO*n* o' o"Vn, interdigitate with the transrerealii.

^^2P5P^ A'S^^t^^ Interntim -A thiohened band of the foioia orer the peoai, extending

from ifde of body of lit, it ioinetiinej ftx^m that of 8nd Inmbar Tertebra. to tip of tranirene

T iifl^^UJL *f * K>metimeB to that of 2nd. Giyes rise to arohed fibres similar bnt rather shorter.

^®SS2S?? A««iatraQa EXternnm -A thickened band of the fasoia over qnadratos Inmbornm

i? #!I*^ 'Amelia of posterior abdominal aponenrosis), extending from tip of transverse process

or nrst Inmbar vertebra, St sometimes from that of find, to lower border h apex of last rib.

v«^i^- ^«C9^ J ■««.« M m. mmm ... GiTos rfso to Similar aTohod fibrsB.

^ mrrn A ^®S2??A^yiF^ * Fourth Lnmbar Vertebra by means of the

^-.Z n ^^l^ flbTO-mnsonlar bnndles, which arise by tendinons fibres as follows :
SiOBT Okus -The thickest & longest, from front of bodies h intervertebral snbstanoee of Itt.
v.^ n • SC^> 7 "ometimes of 2nd, 8rd, A 4th Inmbar v.. St from ant. common ligt of spine.
lilFT Onus - The shortest & narrowest, from left side of bodies St intervertebral substances of
ml f'* TOmetimes of 2nd & 8rd lumbar vertebras, St from ant. common li^ of spine.
M^ /, if °°*^5 ascend for a short distance on either side of the aorta, and then become
Jofned in iVont of that vessel by means of a tendinons arch formed by the blendinjf oC
their innermost fibres. The crura then ffive rise, as well as the intervening arch to two
^•''5?.°®""y ®"' *^* ^^^^^ fascicnU of which bellies pass upwards A outwarda to the
oordiform tendon, while the inner ones first decussate in front of the aorU (those of the
right side being the largest St most anterior), then diverjre to surround the oosophagui,
and finally meet again in Iront of it before they end in the central tendon. (In some
very rare oases these fasciculi do not join in front of the ossophagus, a portion of the
•Ulterior mar gin o f the cesophageal opening is then tendinous).
CENTRAL or CORDIFORM TENDON — The common insertion of all the fibres. Haa aomewhai

the shape of a trefoil leaf; and presents anteriorly three leaflets; the right one ia lonfti

broad, it the largest | the left one, long, narrow^ ft the smallest} the middle one short, broad, A

OPENINGS - Are, intermediate in siie.

Large Openings - Three i

AoRTio Opbniko - For aorta, vena asygos major, thoraolo duct St frequently the left oord of the eym.

pathetic. Lies in middle line, and is osteo-fibrons, being bounded behind by bodies of vertebrm,

laterally by tendons of the crura, and in front by the fibrous arch which Joins the latter.

CEsoPHAGBAL Opbniho - For OBSophagus it pnenmogastrio nerves. Lies higher np, & a little to the

left. Is oval in form A entirely muscular, being formed by the inner decussating fascionli of the

fleshy portion of the crura; -in some very rare cases a portion of the anterior margin is fibrous,

& formed by the posterior border of oordiform tendon.

Ofenino roB Infbbiob Ybna Cava - The highest < lies a little to the right between right it middU

leaflets of oordiform tendon. Is quadrilateral it fibrous, being bounded by four bundles of tendia-

SmaU Openings -Trawmit, °" *''"• '"«* »*** •* '*«'»* "«•»

Z^iffAt cord of sympathetic^ 6^ sometimes the left;

Right A* Ufi greats lesser^ 6^ least splanchnic nerves^ either separately or ooi^ointly.

Vena atygos minor, ^ sometimes tie major - These openings vary therefore m number.

RELATIONS -

Of Upper Surface:

Catbballt - Plenrm; lungs. Also at circumference of thorax fbr a considerable though variable ex-
tent, lower ribs & lower intercostal spaces, the lungs not descending under ordinary oiroom.
stances as low as the costal attachments of the diaphragm 9l the point of reflection of the pleare
The lateral portions of the diaphragm are the most movable; their degree of elevation or
depression varies much more than that of the central part in accordance with the reapiratory
movements, and with the degree of distension, or otherwise, of the stomach, intestinea, h utema.
The right lateral portion of the diaphragm, on account of the pressure of the liver on that aide,
rises by one or two ribs' breadths higher than the left, and reaches the level of
In Forced Expiration -4th costal cartilage i
In State of Repose of Thorax - 6th costal cartilage f
In Fortea Inspiration - Line from ensiform cartilage, to bach of 10th rib.
Obhtballt - Heart A base of pericardium, the fibrous layer of which latter sac blends more particu-
larly with the anterior it left part of central leaflet of oordiform tendon, it with the fasoia oovcring
the left anterior costal fibres. The central part of the diaphragm is flattened ft less movable,
and lies on a lower level than the lateral portions, except close to the sternum, in firont, h to the

vertebrm, behind, where, on the contrary, it rises a little higher*

Of Under Snr&ce * This is entirely covered by peritoneum except behind pancreas, Iddtteya ft anpra*

renal capsules, and at points of attachment of coronary ft lateral ligaments of liver, gaatro-phrenio

ligament, ft suspensonr ligament of spleen | it lies in mediate oontaot waik ttver, stomaoh ft apleea.

PELVIS & MALE GENITO-URINARY

ORGANS.

134

PERITONEUM.

Downwards in IWmt of spine it Aortoi

Orer upper part of rootnm, forming meso^rectum;

Forwards:

In MiXBt- To bladder, forming /iiM^Sin(?r/i£v/iSf«s^^ 6* recto-

vaical pnuk ;

In Fskalb s -To ragina h ntems, tfxnA'o^pottenorligammlscftUenu « rtdo-

vagUuU pouch ; and then orer ntems h from ntema to bladder,

forming anterior litamefUs ofutenu & mtenhvesicaifomcA;

Orer bladder and from bladder to anterior wall of abdomen ;

Up to nmbilionsi ooTering nraobns A obliterated hypogastrio arteries.

135

THE PELVIC FASCIA.

Is oontinnoiis with faioia OTer paoaa & iltaoiu and with fasoia trantTenaliBy and if slightl/
adherent to brim of pelvis, eapecially at sidei.

It iB thin poflteriorly, where it covers pyriformis mnscle A caoral plexus, and passes behind
internal iliao vessels whioh perforate it.

In front it forms a single thick layer over obtnrator intemns as low down as a white linear
thickening, whioh linear thickening extends in a carved direction from spine of
ischinm to side of lower part of symphysis pubis, and both gives attachment to
middle fibres of levator ani, and marks point of division of pelvio fascia into recto-
A obtnrator layers, or recto-vesical & obtorator fasoiss.

Beoto- Vesical Fascia -

la continned oyer inner snrfisoe of lerator ani to bladder, prostate or yag^nai
a rectam«

In front it forms anterior tme ligaments of bladder, or pnbo-prostatio ligaments.

Further back it ascends oyer side of prostate, inclosing this gland ft the prostatio
plexns of veins, and is then continned on the bladder forming its lateral trae
ligaments.

Posteriorly it sends a prolongation between the bladder A rectum, whioh prolong-
ation invests the vesionlss

Obturator Fascia -

Descends on portion of obturator intemns mnscle which lies beneath levator ani,
and becomes attached to pnbio arch h saoro-sciatic ligaments.

It forms a oanal for pndio yessels h nerve, and gives off a thin layer, the anal or
isohio*xeotal liMdai to under 'rarlaoe of leyator ani A to third part of reotam.

136

SIDE VIEW of the MALE PELVIS.

How to obtain it (tbe Perinsram haying been previonsly diflseotod) t -

Inoline bladder A reotnm to tbe right.

DiYide on left side obliterated hypogastrio, Tesioal & middle bflamorrhotdal arteries, (and

the nterine & Taginal in female), lateral true ligament of bladder & lerator ani mnsola.
Saw through pnbes externally to left anterior true ligament of bladder.
Divide right oommon iliao artery & left common iliao rein, and saw through aaomm it

ooooyz juBt to the left of middle line.
Detach deep perinaaal fascia & the contained compressor nrethne mosclo flrom rami of pubes

St isohinm.
Introdnce catheter into, and inflate, bladder ; distend rectnm with tow.

What it shows : -

Towards middle t -

CW ecfge of the deep fervuEol fatcia^ cofUaining heitoeen its two layert s •
rw ediges of compressor uretkra 6^ de^ iratuverse muscles;
Membranous portion of urethra ;

Pudic vessels &• nerve with the vessds 6^ nerve of the bulb ;
Cowpef^s giands &* their ducts.

Below and in firont of the deep perinedal fascia : -

Bulb of urethra partly covered by prolongation of anterior or inferior layer of deep peru
nteal fascia, which latter passa dcwn upon it and becomes list om its surface,
AboTe and behind the deep perinieal fascia : -

Cut edges of levator ani muscled of recto-vesieallayer of pduie fascia, which latter is seen

further up to ascmd upon bladder, prostate, 6r* rectum.

The Tiacera of the pelTis and the Teasels A nerres of the right side oaa

now bo examinad ooaTaniantly,

137

THE BEGTUM.

Oommenoes oppoBiie l«ft aaoro-HiM •ynohondTOtla.

Passes downwards & to the right to middle, or to a little to the right of middlei of third

piooe of saonim.
Onrres forwards npon oonoaTitj of saonim St ooooyXf regaining middle line if latter has

been passed.
Inclines downwards & backwards to anns.

Is smooth & cr^lindrioal, not sacoalated ; aboat 8 inches long. Bather narrower aboTO than
sigmoid flexnrey but it increases as it descends, and is greatly dilated Jost aboTe

anns. -Dirided into three partst

DPPER PAKT — Vrom saoro-iliao synchondrosis to middle, or to a little to the right of

middle, of third piece of sacmm } abont 4 inches long.
Almost completely surrounded by meso-rectum.

Separated by small intestine from bladder, in the male, St from ntems St vagina, in the
female i and connected inferiorly with latter organs by the folds of peritonenm
which form margins of recto-yesical & recto-Taginal pouches respectively.
Bests upon pyriformis muscle & sacral plexus of left side.
Has to its left side left ureter ft branches of left internal iliac artery.

MIDDLE PART — From middle of third piece of saomm to tip of coccyx; about 8 inches

long.
CoTored by peritoneum in front St at sides aboTO, in front only towards middle, not

at all below.
In relation below St in front withi

In thb Mali - Triangular portion of base of bladder, Tesiculs seroinales St

▼asa deferentia, and under surface of prostate.
Ih the Fbmalb -Middle part of posterior wall of Tagina, to which it is closely

adherenL

LOWER PART — From tip of coccyx to anus ; about an inch in length.
luTested by the internal St external sphincters St by the leyatores ani.
Separated by a triangular space, the perinssum, from membranous portion of urethra St

bulb, in the male, from vagina, in the female.

STRUCTURE — Presents t

SeiOtlS Coat - CoTers upper St middle parts of rectum, the former almost oomple*
tely, the latter in front St at sides abore, in firont only towards middle, not

at all below*

MnsCUlar Coat - Very thick ; consists of fibres t

ExTEBJTAL Longitudinal - Form a thick uniform layer all round intestine.
Internal Cibculab - Are most numerous at lower end' of rectum, where they

form internal sphincter

Cellular Coat - Forms a loose connection between the muscular ft mucous coats.

MUOOUS Membrane - Thick, yery yascular, fineely movable upon muscular coat.

Presents:
Longitudinal Folds -. Most marked below } due to contraction of sphincter

and disappear on distention.

Psxmanent Txanstshsb Folds, or Folds or Houston - Three principal ones,

semilunar, sometimes half an inch in depth, situated at upper part on

right side, near middle of rectum on left side, and at front part

opposite base of bladder.

Vessels St Nerves - Abtebixs. From superior, middle St inferior hcemorrhoidaU
they form a rich network beneath St within mucous membrane, the meshes
of which network are mainly longitudinal in lower part of rectum, and
connected opposite anus, by large transyerse branches (Qnain).--y bins
Also mainly longitudinal near anus ; open partly into internal iliacs St
partly into inferior mesenteric. - Ltmphatics. Open into glands in hollow
of sacrum, or into lumbar glands. - Kebtxs. From sacral plexus, 4tii
saoral St inferior hoemorrhoidal nenres« and from inferior mesenterio St

hypogastrio plexusea

18a

138

THE KIDNEY.

Is situated In lambar region beliind peritonenm, and extends Trom 11th rib to near <9ne«i el

iliniDy right kidney lying a little lower than left oneu
Presents :

Ant. Surface - ConTez, looking slightly ontwards, ooyered at apper A outer part by peritonenra,

and in relation with;
On Bight Side - Right lobe of liver, descending portion of dnodennm, aaoendincf colon.
On Lett Side - Tail of panoreas, lower end of spleen, descending colon.

Post. SUT&ce - Flat; rests npon 11th A 12th ribs, orns of diaphragm, psoas magnns, and anterior

lamella of aponenrosis of transYersalis, which latter separates it from qnadratns
^ Inmbomm.

Sup. SSxtreznity - Thick, rounded, directed inwards, coyered by suprarenal capsule. Corres-
ponds on lefb side to upper border, on right side to lower border, of 11th rib.
Inf. Extremity - Smaller, flattened, directed outwards. Bescends to near crest of ilium.

Outer Border - Conyex, directed backwards & slightly upwards.

Inner Border - Concaye, directed forwards & slightly downwards. Presents the Jki/mm, m Ion.

gitudinal fissure most marked behind, which leads into the sinus, and contains from

before backwards renal yein, renal artery & oreter.

The kidneys are subject to frequent

VARIATIONS in :

FoBH & Size - One or both being longer A narrower, or shorter ft more ronn-
ded; or one being more or less enlarged A the other proportionately

diminished.
Situation - One or both being situated lower down than usual, oocaBionally

in the peWis.

NuMBEB - There being but one kidney sometimes of a horse-shoe shape ft aitna.

ted in front of the yertebrss^ or there being a supemumeraiy kidney.

THE URETER. '

The excretory duct of the kidney commences in the

Calicetf - small tubes from 7 to 18 in number, which embrace eaoh of them one, two

or more papillso, and join to form the
In/ufuftMat - larger tubes usually three in number, which join to form the
/V/w - funnel shaped dilatation of upper part of ureter compressed from before

backwards, and situated at lower ft back part of hilnm.
The ureter passes :

Downwards ft inwards upon psoas, beneath peritoneum ft upermatio yessela, and, on
^ ^ the right side, on right side of inferior yena caVa*

Uver common or external iUao artery, being coyered by termination of ilenm on the

Forwards ft inwards,- "*^^ "^^' ^^ "^""^^^ ^"""^ ^^~^^"' ^"^ *^^ '^'^'

In the Male - In posterior false ligament of bladder, and on outer side of yas
. _ deferens ft below obliterated hypogastric artery

JH THE Female - In posterior ligament of uterus and oyer side of oeryiz uteri

A . . , . . ft upper part of yagina,-

to posterior angle of tngonum yesicsB, pafsing obliquely throo^h

Ti. • !• n/» A no • 1 « . walls of bladder for about ^ of an inch

It IS from 16 to 18 inches long, and of about the diameter of a crow-quill. *

The calicos, mfnndibula, pelvis ft ureter are formed of fibrous, muscular ft mucous coats. The
muscular coat condste in the greater part of the ureter, of two louRitadinal
layers comprising an intermediate circular one; the epithelium of the mnoSn.

ooat IE spheroidal

139

THE BLADDER

When

Sm^t'-lM deeply sitoated behind pnbes, fa front of reotnm, in the male, of ntems 9t Tagina, in
femalo, and is oompresied from before backwards A triangular with base downwards j
Moderatdy fuUt - Is rounded, and partly fills peWis ;

Z H st e nde d ^ - Beiwmes egg>8haped, oanres slightly forwards, and rises into abdominal oaTity some-
times as high as umbilioas.
Ik Fevalb bladder is normally smaller, thongh sometimes larger through disten-
tion, and is widest from side to side. In Ohildrxn it is oonioal« and points np higher

into abdomen*
Presents:

Ant. SnrfaCQ - Destitute of peritoneam, and in relation with triangular ligament

of nrethra, pnbes & pabo-prostatio ligaments, and with anterior wall of ab.

domen in children, and also in adults when bladder is distended.

Post, Surface - Covered by peritoneum, and separated by ooQTolntions of small

intestine from rectum in the male, and uterus in the female.

Lateral Surfaces - Grossed towards* their middle by obliterated hypogastrio
artery, below 9l behind by ureter, abore & behind in male by Tas deferens,
which latter first crosses hjrpogastrio artery ezlemally, and then passes
between bladder ft ureter. - Ooyered by peritoneum above ft behind hypo-
gastric artery, and rest below ft in front on pelvic fascia.

Apex -Connected to nmbilicus by nrachus ft by obliterated hypogastrio arteries,

behind which it is covered by peritoneum.

Base or Fundus ^ 'I'he enlarged part directed downwards ft backwards. - In

relation with
In the Male - Second portion of rectum, upon which rests the part bounded
by the recto-vesical fold of the peritoneum, the vesiculas seminales ft
vasa deferentia, and the prostate gland. - Is covered behind by peri-
toneum, the recto-vesioal fold descending to about four inches from the
anus when the bladder is distended, and nearly reaching the prostate

when the bladder is empty*
In the Female -Anterior wall of vagina ft lower part of cervix uteri.

Neck -" Directed downwards ft forwards, and now known to be the lowest part of
the bladder both in the male ft female, when in the erect posture ; is sur-
rounded in the male by the prostate gland*

UQAMENTS of the BLADDER

Are five true ligaments, and five false ones formed by peritoneum.

TRU£i LIGAMENTS — Anterior ft Lateral formed by pelvio fascia ft Superior or

Urachns, a remnant of allantois.

ANT. OR PUBO-PBOSTATIO LIGAMENTS — From back of pubes on either
side of symphysis to front of neck of bladder ft upper surface of prostate.
Contain a few muscular fibres passing to bladder, and are separated by

a narrow groove containing dorsal vein of penis.

LATERAL LIGAMENTS — Broad ft thin; formed by reotcvesical layer of pel-
vio fascia as it passes from upper surface of levator ant to capsule of pros-
tate ft side of bladder.

URAOHUS, OR SUP. LIGAMENT — Fibro-mnscular cord extending fi-om apex of
bladder, where it is wide ft expanded, to umbilicus, where it is contracted
and lust in umbilical cicatrix. Sometimes partly pervious, communicating
with bladder, sometimes completely pervious forming umbilical urinary

fistula.
FALSE LIGAMENTS — Posterior, Lateral ft Superior.

POST. FALSE LIGAMENTS — The margins of the reoto-vesical pouch of perito^
nenm in the male, of the utero- vesical pouch in the female, where they
are much smaller. Contain the obliterated hypogastrio arteries ft ureters.

LATERAL FALSE LIGAMENTS — From sides of pelvis to sides of bladder.

SUP. FALSE LIGAMENT — Over orachos ft obliterated hypogaitrio arteries to

nmbtlioiUt

140

OOVEBINGS of the TESTICLE.

Ar0tli«t->

Scrotum - Oonalsti of two layen t

lanouMBirr - Thin it brownish } preiente % few ieVaoeoni folUoles ft thinlj Kattond
oripp hairs, and is divided into two lateral halres bj a median rapbA, which
raph^ IS oontinned forwards on nnder snrfaoe of penis and baokinurds tlong
middle line of perinasnm to anna. Is closely applied to the testes aad is com.
gated transrerselj when the dartos is contracted, that is to say. nsnally in tb«
yonng ft robust, and in all nnder the inflnenoe of cold, and is elongated k
flaccid when the dartos is relaxed, that is to say, nsnally in the debilitated A

aged, and in all nnder the inflnenoe of wannib.

DASfoi - Is a thicic stratum of loose reddish tissue, a modification of the saperfieial
fascia of the surrounding regions, consisting of areolar tissue with nnraeroai
superadded muscular fibres and without any fat ; it sends inwards between
the two testicles a septum, the stfimm scroH, which dirides its cavity into two. -
It Is contractile, but its contractility is slow in its aotton, and espeoially excited

hj oold, not by eleotrioitf.

Interoolmnnar or External Spermatio Fascia - Thin cellular layer derired from

the margins of the external abdominal ring during the descent of the testis, sod
continuous aboTO with the intercolnmnar fibres, which bound that ring superiorly.

OremaBteric Fascia - Consists of the soatterea doodles of fibres of the cremaster ft iniemtl

oblique muscles united by a little areolar tisna

Fascia Propria - Belatively thick layer, the continuation of the f nfundibnliform process of
the £ucia transTersalis, which layer supports both the ovemasteric fascia ft the

tunica raginiJls reflexs.

Tunica Vaginalis - !■ deriyed fVom the peritoneum, of which it is at first a oontinnatioB,
but from which it is subsequently cut off by the closure of that part of the peritonesl
pouchy which extends from the internal aodominal ring to a short distance from the

testicle. - Is dirided into:

VisoBBAL PoBTioN OB TuKiCA Yaoinalis PftoPBfA - Surrouuds the testicle, and oorers

both the upper or outer surface of the epididymis and also the under surface of

its central part or body, penetrating, along its outer border, between it ft the

testicle, and thus forming the t^gUalfwa.

Fabibtal Pobtion, OB Tunica Yaoinalis Bbilbza - Is refiected from the posterior bor«

der of the testicle upon the inner surface of the fascia propria, extending,

howcTer^ a short diotance up the cord upon its anterior ft inner aspecu.

141

THE TESTICLE & EPIDIDYMIS.

THE TESTICLE

Is oral A oomprened laterallj^ and lo Biurpended hy the ipennatio oord m topreientt

Upper Extremity - The largeet, directed forwards & ontwards. Presents a small pednn-

onlated bodj, the hjdatid of Morgagnii probably a remnant of MnUer's dnot.
Lower Extremity -The smaller^ directed backwards & inwards.

Lateral Snr&ces - Looking respeotirelj forwards A inwards, and backwards & ontwards.
Anterior Border - Convex, directed forwards, downwards A ontwards. - All these parts

are free, smooth, and entirely invested bj the tnnioa vaginalis propria.

Posterior Border - straight & flattened, directed backwards, upwards & inwards, covered

hj the epididymis & vas deferens, and only partly invested by the tnnica vaginalis.

The left testicle lies a little lower than the right one, and is frequently a little

larger

THE EPIDIDTMIS

Lies on the posterior border and back part of the onter surface of the testicle, and has

the vas deferens on its inner side. It presents t

Globus Major or Head " ^^ upper enlarged extremityi connected to the testicle by the

efferent ducts of the latter.

Body - I'ree, surrounded by the tunica vaginalis, which dips in between it & the testicle

along its outer border, and connects its inner or posterior border to the posterior

border of the testicle.
Globus Minor or Tail - its lower pointed extremity, attached to the testicle by dense

fibrous tissue.

The tunica vaginalis covers the whole of the upper or outer surface of the

epididymis, as well as the under surface of ite body. - The vas aber-

fans of Haller communicates with the canal of the epididymis or with

*^ the oommeacement of the raa deferens

142

STBXTOTUBE of the TESTICLE & EPIDIDYMIS.

STRUCTURE of the TESTICLE — Presents for ezaminationt -
THREE IMMEDIATE COVERINQS : —

Txmica Vaginalis -Vide Coverings of the testicle.

Tunica Albuginea - Thick, dense, blaish- white, fibrons membrane, ooTered ester
nallj by the tnnioa vaginalis propria except along the points of attack
ment of the epididymis A vas deferens, and reflected into the interior oj
the testicle along its posterior or npper border in the shape of an inoooi
plete vertical septum, the mediastinnm testis or Oorpns Highmoriansm
This latter body supports the vessels A nerves and the excretory dnotf a
the testicle in their passage to or from the gland, and gives off nnmerou
trabecnlas, which radiate towards the whole extent of the inner surface o
the tunica albnginea, and inclose the nnmeroos pyramidal spaces oobi

taining the lobules of the gland sabstaoca

Tunica VasCOlosa or Pia Mater Testis - Consists of a plexus of blood-vesseli
held together by delicate areolar tissue, and formed by the subdivisioart^
the superficial set of brs. of the spermatic artery. Branches g^ven off by thii
plexus, penetrate into the substauoe of the gland, supported by the trabecala.

PROPER SUBSTANCE or PARENCHYMA — Consists of numerons pyramid»l
lobules contained in the pyramidal spaces bounded by the trabeonlss, and pre-
senting a base directed towards the surface of the testicle and an apex directed
towards the mediastinum. Of these lobules the central ones are the larg^v
The degree to which the lobnles are isolated by the trabecnliD is somewhat Tvi«
able, hence the different estimates of their number, 250 (Berrea), 400 (Kra&ie).

£acA iobule consists of from one to three or more iubuli semini/eri^ the numbcf
& the length of which tubuli has also been variously estimated,- 900, aizteenfeet
in length (Monro), 840, two feet & a quarter in length (Lautii). - The diameter of
the tubuli is from ^^ to y|^ of an inch. Tbey consist from without inwaroi of »
delicate fibro-areolar coat, a basement membrane, and sometimes a layer o{
granular nucleated epithelium. The epithelium is absent, however, when tb«
gland is particularly active ; the tubuli are then filled with cells of different siid
Without any regular arangement.

The tubuli seminiferi commence towards the surface of the testicle, eometimal
^ by free ccdcal or blind extremities, but more oomuionly by anastomatio loops. Tbij

are exceedingly convoluted in the peripheral part of the gland ; their oonvoluticci
are of two orders, vis., a fine & regular undulation giving a grannl&r appeu^
ance to the whole of their mass, and a more complicated folding of the nndalatit:
tube. Towards the apices of the lobales they become straighter, and they ooalesoi
into from twenty to thirty straight tubes the vasa recta^ whioh are from -^^ to ^.
of an inch in diameter.

The vcLsa recta enter the mediastinum, and passing upwards & backwarii
they form within that body a network of anastomosing tubules, the reU is^
or rete vasculosum testis.

The rete testis is continued superiorly into from twelve to fifteen or twet?
wua efferentia f

The veisa efferentia perforate the tunica albuginea at the npper & back p*^
of the testicle. In their extra-testicnlar course, whioh is about 6 or 8 incif
long, they are at first straight & relatively wide, but they soon beoome con vole
& slightly narrowed, and form a series of conical masses, the ami vas c ulosis w& ~
latter constitute together the globus major of the epididymis. They aro Liui
with ciliated epithelium.

The excretory ducts of the testide open finally into the oommenoentect a
the canal of the epididymis at apparently narrow intervals, whioh interrvJl
however, are seen, when the oanal of the epididymis is unravelled, to measore &«4

two to three inohea in lea^ia

STRUCTURE of the EPIDIDYMIS — The epididymis consists ofa single tube abed

twenty feet long, by which the tubuli seminiferi open into the vaa deferens. II
is at first very thin & exceedingly convoluted, and of a diameter of aboat ,^ of «fl
inch. It diminishes a little in sixe for a short distance, but it soon increases oca-<
siderably, the thickness of its walls increasing also, and its course becoming le«i
tortuous. A little fine areolar tissue binds its convolutions together, thicker septs
being interposed between the larger masses of ooils termed /^Jer, whioh latter an
mostly transverse in direction. The epithelium of the oanal of the epididxiais S
ciliated (Becker, EolUker). - The Yas aberrans of Haller (Vide spermiatio oord) t
umaUj oonneoted either with the oanal of the epididymis or with the commanoi

mant of Ihs Tas dafai si

143

THE VAS DEFEBENS, VESXCUI*^ SEMINAIiES, & EJA-

OXJLATORY DUCTS.

YAS DEFERENS

Afoendf on iniitr ride of eiyididymia along lower thiee-foiirihs of poeterior border of tee-

tiole,-io wMoH it is attaohed by firm areolar time.
Along baok of ipennaiio oord to external abdominal ring i
Through external abdominal ring, ing^nal oanal & internal abdominal ring;
Downwards, baokwards, inwards to base of bladder, passing on enter side of epigastrio &

obliterated hypogastrio arteries and then on inner side of nreter;
Forwards A inwards between bladder & rectam, along inner side of Tesionla seminalis

becoming enlarged & saoonlaied;
Varrows to a point, and joins opposite base of prostate with dnot of oorresponding vesi-'

enla seminalis, to form the common seminal or ejacnlatorj dnot.

Its oanal is Tory small. Its walls are Tory thick & dense, and consist from without

inwards of a cellular coat, of a mnscnlar coat presenting two longitudinal layers &

an intermediate circular layer of fibres, and of a mucous coat coTored with colum*

nar non-ciliated epithelium.
The yas aberrans of Haller oommunioates with the canal of the*epididymis

or with the oommencement of the yas deferens.

YEBICXTLM BEMINALES

Two lobnlated membranous pouches about 2} inches long obliquely disposed between

base of bladder & second part of rectum, and presenting :
Post. Diverging Eztreznities - Enlarged, and reach as far back as-ter.

mination of ureters.
Ant. Converging Eztrexnities * Pointed i join at base of prostate with termin-
ation of the corresponding vas deferens to form the common seminal or

ejaculatory dact.
tipper BnrflBlce * In contact with base of bladder.

Under SnrfiBlce - Bests upon second part of rectum, from which it is sepa-
rated by a process of the recto-yesical layer of the peMc fascia.
They haTo the enlarged & sacculated vasa deferentia to their inner side, and bound
laterally a triangular portion of the base of the bladder which corresponds

to trigonum vesica).
Saoh Tttdonla seminalis consists of a tube from four to six inches long, and of about the
diameter of a crow quill. This tube is irregularly coiled upon itself, and
gives off numerous coBcal diverticula, which, as well as the coils of the
lube, are bound together by firm areolar tissue. Its walls are thin, and
oonsist of fibrous, muscular A mucous coats, the epithelium of the latter

being squamous.

EJAOULATOBY DUOTS

Two small canals about { of an inch in length formed by the junction opposite the base
of the prostate of the vas deferens with the duct of the vesicula seminlklis.

They pass forwards A inwards through the substance of the prostate along the side of
the verumontanum, and terminate by a slit-like opening upon or within the mar-
gins of the vesicula prostatica or sinus poqplaris.

Their wallfl are thin, and eonsist of a delicate fibrous coat 4k of muioular & muoous oead

144

THE SPEIIMATIO OOBD.

Coniiatfl of the portion of the vaa deferens which extonds from the toatiole to the internal ab*
dominal ring, and of the accompanying arteries, reins, lymphatics, & nerree and oontaini
the Tas aberrans & the organ of Giraldes. These stractares are bonnd together Ij

delicate areolar tissue, and are invested from within ontwarde bj t
TUnica vagina/is, below i
Fascia propria^ along the whole

Cramasterk fascia^ along nearly the whole of the oonrse of the oord;
Jntercolumnar fascia^ dartos & skin of the scrotum^ below the external abdominal

ring.

Vas deferens ~ Lies ^t the back.

Arteries *- Are the spermatic^ the artery of the vas deferens from the superior Tesiealj and the

cremasteric branch of the epig^astrio.
Veins ~ "^^ ^^ spermatic veins, which pass np in front of the vas deferens, forming the
pampiniform plexus^ and then nnite in a single trunk, which acoompaniee the abdomi-
nal portion of the spermatic artery and terminates in the left renal vein, on the left

side, in the inferior vena oara^ on the right
XiyXUphatioS * Terminate in the lumbar glands.

Nerves - Are the ilio'inguinalt the genital branch of the geniUxrural^ frequently a branch d
the ilio-hyx>ogastric, and the spermatic plexus of the sympathetic^ which latter is derired

from the renal, aortic A hypogastric plezneoft
VftS Aberrans (Haller) - a narrow tortuous tube from 1} to 14 inches long, oonneotc:
with the commencement of the vas deferens or with the lower part of the oanal a
the epididymis, and passing upwards for 1 or 2 inches among the other Teasels c:
the spermatic cord. It cuds in a blind extremity, and is sometimes unconnected
with the seminal ducts. It was probably connected in the foBtus with the Wolffiaa

body.

OljgaXl of Oiraldes - a collection of minute convoluted tubules, probably a remnant ot

the Wolffian body, found in the lower & front part of the oord close to the head of

the

145

THB PROSTATE GLAND.

If a pftle firm glandular sirnotiire of about ihe Bise & shape of a horae-oheiniitf litnated beneath
the trigonom veaioo and around the neck of the bladder & oommenoement of the nrethra;
below and behind the symphyBis pubis & the pnbo-prostatio ligaments or anterior tma'Iiga-
ments of the bladder; above & in front of the second part of the rectum and the-point of
decussation of those anterior or inner fibres of the levator ani which form the levator
prostate ; between the two lateral halves of the posterior or ascending layer of the deep
perincBal fascia or triangular ligament, and between the two lateral halves of the ascending
portion of the recto-vesical layer of the pelvic fascia.

II measures normally from 1^ to 1} inches in its antero-postorior diameter, 1} inches {n its
greatest transverse diameter (Sir H. Thompson), ani about } of an inch in depth; these
measurements undergo, however, great variations in old persons, who are frequently the
subjects of enlarged prostate.

Bk consists of two lateral lobes separated behind by a deep notch, and of a third or middle lobe
which is normally but a small rounded or triangular mass fitted in between the two lateral
lobes in the under part of the organ, and lying between the ejaculatory ducts immediately
beneath the neck of the bladder. The degree of development of this middle lobe, is
however, very variable, it being often much enlarged in advanced life, and then pro*
jecting into the neck of the bladder so as to impede the passage of urine.

Dk presents for examination :

BASE — Directed backwards & upwards towards the trigonum vesioiB & the neck of the
bladder, and notched posteriorly.

AP£X — Passes downwards & forwards between the posterior or ascending layers of the
deep perinaaal fascia or triangular ligament.

UPPSR SURFACES — Covered by and connected to the pubo-prostatic ligaments or
ant. true ligaments of the bladder and the front part of the recto-vesical layer of the
pelvic fascia. Is situated about } of an inch below & behind the symphysis pubis, and
presents a slight longitudinal farrow.

UNDBR SURFACES — Bests upon the lower part of the second portion of the rectum
(just opposite the bend between the second & third portions), a process of the recto,
vesical layer of the pelvic fascia beiDg interposed between the two organs. Presents
a slight depression, or sometimes two converging grooves which correspond to the
ejaculatory ducts and which demarcate the central lobe.

LATBRAL SURFACES — Covered by the layers of fascia above mentioned, by those

anterior or inner fibres of the levatores ani which go to form the levator prostataa,

and by the reflections of the peritoneum from the bladder to the sides of the pelvis

which reflections form the lateral false ligaments of the bladder.

It is perforated by the urothra, which usually lies nearer its upper than its lower surface, and

also by the ejaculatory ducts which pass forwards & inwards through the lower part of the

gland along the side of the verumontannm, and terminate by a slit-like opening upon or

within the margins of the vesicula prostatica or sinus pocularis.

STRUCTURE — structurally the prostate presents :

Fibrous Capsule — Distinct from the fibrous investment derived from the two
halves of the posterior or ascending layer of the deep perinsal fascia A from
the recto-vesical layer of the pelvic fascia, and separated from these by prosta-
tic plexus of veins. It sends ofi" fibrous prolongations into the interior of the gland.

Olandular Subtance — Consists of follicular pouches which are grouped
around, and open into, numerous elongated canals, by the junction of which
from twelve to twenty excretory ducts are formed ; these open into the prostatic
sinus on the fioor of the prostatic portion of the urethra.

UuSCUlar Fibres — Are abundant in the fibrous capsule. The urethra is surroun-
ded, as it passes through the prostate, by a thick layer of circular fibres con-
tinuous behind with the fibres of the sphinoder vesicsB, and in front with those
of the membranous portion of the urethra.

Vessels Ss Nerves -^ A&tbribs are derived from the internal pudio, vesical A middls
hsBmorrhoidal. Veins form an important plexus around sides & base of prostate i
they receive in front the dorsal vein of the penis, and open behind into internal
iliac vein. Lucphatics ramify Ini the outer Bur£ftoe of the oapsulSi Kkavxs are
derived from hypogastrio plextMk

146

THE MALE TJBETHBA.

Jfl about 6| Inehei long, aatf oxtonda from nook of bladder to And of j^onb.
It proflonta beneath the pnbea a fixed onrre conoave anperiorlj, and tn front of tba ^mbm la

the flaooid atate of the penia, a aeoond flexible onrre oonoarv inCariorlj;
It ia divided into:-

PROSTATIC PORTION — The wideat dc moat dilatable part, spindle-ahaped, H inxAm
long I paaaes throngh the proatate from baae to apex, lying nearer ita npper than Ha
lower anrfaoe. Ita tranaverae aection ia of a horae-ahoe ahape oonoaTO in fe fio riy.

On ita floor are the following parte: -

TJbethbal Cbx8t, YxRUMoirrAiiTTV OR Oaput OALLiHAOfVia - Longitudinal eloTaiion 8 or 9

linea in length and 1} linea high at ita oentral & higheat part, oonaiating, aooord*

log to Eobelt, of mnaonlar fibrea A ereotile tiaane. On either aide of the oreat

lathe
Fbostatic SiNua - A longitudinal groove into whioh open the dnota of the lateral lobe ef

the proatate. On the front part of the crest is tba

Utbicle, 8int78 PocuLABia on VEaicuuL PB08TATICA - An expanding onl^e-aao, whic^

paaaea backwarda Into the gnbatance of the middle lobe of the proetato for abost

a qaarter of an inoh, and npon or within the margina of whioh are the aliwhks

openinga of the ejaonlatory dicta.

UXUBRANOUS PORTION — ^o ahorteat, and, excepting the meatna, the narroweat part
of the canal. It extenda from apex of proatate to bnlb of oorpna apongioeom, and it
aitnatod between the two layera of the deep perinatal faaola, whioh lajera are pro-
longed aronnd it, the one downwarda A forwarda, the other npwarda i baokwarda
Ita npper anrfaoe ia oonoave anperxorly, } of an inoh long, and aitnatsd abont an izA
below & behind the pnbio aroh, from which arch it ia aeparated by the anterior fibm
of the compreaaor nrethraa mnaole & by the doraal Toaaeia A nerrea of the penia. la
nnder anrfaoe ia oonrex inferiorly, only ^ inoh long (In oonaeqnenoe of the bnlb pro-
jecting baokwarda beneath the nrethra), and aeparated from the reotnm by a tnanp-

lar apace, broad below, narrow abote, the pertnaoa.

BFONGY PORTION — Commenoea within the bnlb below A behind the aymphyaia pabii,
aaoenda a abort diatanoe in front of the aymphyaia within the oorpna apongioms,
cnrvea downwarda with the latter in the flaooid atate of the penia, and ends at the meassi
nrinarina. It ia abont aix inohea long. In the greateat part of ita oonrae it ia nnifon
in aiae, and intermediate between the proatatio A membranona portions ; it is dilates
however, within the bnlb A within the glana penia (in whioh latter aitnation the dUv
tation forma the foaaa naTicnlariB), and ia greatly conatrloted at the mnarm la
tranaverao aeotion ia elongated from aide to aide except within the glana penia, wkfft
it ia elongated vertically. On ita wall«« and more partionUrly on ita floor, are the o;«»>
ioga of nnmerona mnooua glanda, the gl&nda of Littre, whioh openings are direoted f:r-j
warda, and are aometimea large enough to ioteroept the paaaage of email catheiet;
thia ia eapeoially the oaae with one of them, whioh ia aitnated on the npper wall of titl
foaaa navionlaria, and whioh oonatitntea the laonna magna. On the floor of
terior ^ated portion oompriaed within the bnlb, and aometimea termed the

portion, are the openinga of the dnote of Gowper^s

STRUCTURE — Three ooata i -

Mucous Goat - Thin, pale in the proatatio portion, roay in the membranona A

portiona, in which it ia thrown into Jongitndinal folda (exoept when the eainai
diatended with nrine). Covered with columnar epithelinm exoept in the
navionlaria, where the epithelium ia aquamona. Preaenta the glanda of Lit
above deaoribed, whioh glanda are moat abundant in the apongy portioa,

preaenta alao, near the meatna, a few pap

MuSOUlar Goat ~ Gonaiata of external longitudinal A internal oironlar nnatriped

cular fibrea, both moat abundant in the proatatic

Sreotile Goat - Thick in the apongy portion, where it forma the oorpna

(Yide Structure of the Penia). From thia a thin layer of ereotUe Haaeali
longed npwarda round the membranona A proatatio portiona aa far aa tba
of the bladder, forming ia the proatatio portion, aooording to Kobelt^ tbt tv*

montannm or oapat galliaaf

147

STRXTCTXIRE of the PENIS.

CORPORA CAVERNOSA — Anse from the anterior k inner part of the two {eohtal

taberositioB, and from the ascending rami of the ischia & desoending rami of the pubes,
by two pointed prolongations, the crura penis. These pass forwards k inwards, present a
slight enlargement, the bulb of the corpus cavemosum, and unite to form the body of the
penis. - l*he body of the penis presents on its upper surface a narrow median gfrooye for
the dorsal vessels & nerves of the organ, and, on its under snrface a broader groove,
which receives the corpus spongiosum. It ends anteriorly in a rounded extremity over-
lapped by the base of the glans.

CORPUS SPONQIOSUlflE -~ Commenoes between the two converging crura of the

corpora cavernosa by an expanded portion, the bulb of the urethra. This latter is penetrated
superiorly by the membranoas portion of the urethra, is marked inferiorly by a partial
division into two lobes, and is surronnded by the accelerator urine muscle & by a pro*
longation of the anterior or descending layer of the deep perineal fascia. - It passes for«
wards, as an erectile tube, round the spongy portion of the urethra, and terminates in
i^e glans penis, a conical enlargement, which overlaps the anterior rounded extremity of

the two corpora cavernosa.

STRUCTURE of the CORPORA CAVERNOSA & SPONGIOSUM -

They consist of i

7ibrOU8 Investniexit - Thick, dense, firm, especially over the corpora cavernosa^

highly elastic, but incapable of more than a certain degree of distention i

formed of white ft yellow elastic fibrous tissues and of unstriped muscular

fibres disposed longitudinally in the superficial strata, circularly in the

deeper ones.

It forms but an incomplete septum between the two corpora cavernosa

in their points of contact ; - The septum is thick h imperforate behind, but

it ofily consists in front of a few vertical bands arranged somewhat like the

teeth of a comb, and forming the septum pectiniforme*
It gives off numerous trabecolas from its inner surface. - In the corpora
cavernosa the trabeoulse are strongest towards the periphery, and the com-
partments they bound are transversely or circularly disposed & largest
towards the centre. In the corpus spongiosum the trabeoulse are more deli.
oatOy and the compartments are longitudinal & more uniform, except in
the glans penis where their arrangement is somewhat complex.

Erectile Tissue - Consists of afferent arteries, a venous plexus, & efferent veins.
Ari£BSKT Arteries - Are the arteries of the corpora cavernosa ft the arteries
of the bulb, and twigs from the internal pudio & the dorsal arteries of
the penis. Some of the branches of these arteries terminate in capil-
lary plexuses as in other parts of the body. . Others, the hdicine
arteries^ which are said to be especially numerous towards the root of
the penis and to be wanting in the glans, become convoluted, and
forming tendril-like .twigs, project singly or in tufls into the venoua
spaces, and end in dilated extremities which are either open or closed
(Hiiller). This is denied however by Valentin, who describes the
smallest branches of the arteries as ending in wide funnel-shaped

orifices, which open directly into the venoas spaces.

YsMOUS Plexus - Is very intricate. So numerous ft large are the communica*

tione between the veins that the blood appears to be effused into a

system of extra-vascular struct a res.
SwsxxNT Veins - Some emerge from the corona glandis and from the upper
ft under surfaces of the corpora cavernosa, and join the dorsal vein of
the penis \ most pass out at the root of the penis, and join the prosta-
tic plexus ft the pudic veine.
The proper nerves of the cavernous structures ares derived
mainly from the pelvic ft prostatic plexuses of the sympathetic, but
partly ftlso from the pudio nerve.

148

INTEBNAI. ILIAC ABTERY.

Short Uki^ tmk wliieh extends firom biteestion of cemiBoa ifiae aitary oppo m e

Tertebnd articiiladon (aovne Anthora wmj opposite ■scio U\mo aju6baadnm») te
cpper border of great ■acro-sciatiio Ibnmrwj bbst wldeli it dividoi into siitKiar
A posterior divisions.

Uscsllj 1| incbes long, bat ite length waaj rmrj firom | an ibA to S fnohsfc

Sstbcr SBsller in sdnit than tbe cztersal iliae: Twice as laiga ia fioBtas: * Uader ths
name of brpogastrio artefy, it thea eootiBaes Iha cw siM na iliae along sids of
bUddcr^ aad ascends to smbilieM vhen it bseoMSB oaa of Iha aBfaOioal

BELATIONS:

h:i:<^

IvFsoavT-p€

Bcsim — PtTifcrmis, iatcraal iliae

Os Ottsb Sub xxab OBiaoi -Fnas A cilw a ri iliae

Are grvea off as fbi)inr% frosa: •

AMT. IXnJSaOH — SiqiL Middle * Infl Teneal, Middle Hennor-

rhoidalj ud in f iai i i ^ Uterine A Vaginal;
Obtoimlar, Sciatic, Pndle.

KXST. DIVISION — Ilk>-LninlMur« LetanI aeeal, OlnteeL

149

BRANCHES of the INTERNAL ILIAC ARTERY— 1st T.

BRANCHES FROM ANTERIOR DIVISION.

VISCERAL BRANCHES :

Vesical* Two or three; but other twigs pais to bladder from middle haomorrhoidalf

uterine, vaginal, & obturator.

SuPiBiOB Vesical - Is that part of hjpogastrio artery which extends to side d

bladder, and which remains perrious after birUi. Gives off artery of voi

deferens^ and the
Middle Yesical, - Which is often wanting.

IXYEEiOB Vesical - Usually arises in oommon with middle hsBmorrhoidal. To base

of bladder, prostate, h vesioulaa seminales*

Middle HSBinorrhoidal - Joins with superior hemorrhoidal branch of inferior

mesenterio, and with inferior hsBmorrhoidal branch of internal pudio.

Uterine - Downwards to neck of uterus, and then upwards in a tortuous course along
side of body between folds of broad ligament; communicates with ovarian.

Vaginal - Descends upon vagina to neck of bladder & rectum.

NON-VISCERAL BRANCHES :

Obturator * Usnallj arises (2 cases out of 8) from anterior division or sometimet
from posterior division of internal iliao. In one case in 3} it arises from
the epigastric, that is to say that its anastomotic branch with that artery is
enormously increased in size while its proper root is proportionately dimin*
ished. Sometimes both roots are nearly equally developed (1 case in 73).
Occasionally the artery arises from termination of external iliac.

In cases of abnormal origin from epigastric the obturator artery usually
arises from near the root of the latter, and then descends into the pelvis close
to the external iliao vein and on the outer side of the femoral ring. Some-
times, however, it arises from the epigastric higher up, that is to say at a
distance from the root of the latter; it then passes inwards above the femoral
ring and descends into the pelvis on the inner side of that ring behind
Gimberat's ligament. It is in this latter case only that the obturator artery is
exposed to be wounded in the operation for strangulated femoral hernia.
When it arises from the internal iliao it passes forwards along outer wall of pelvis
below obturator nerve, giring off email iliao h vesical branches and a pubio
branch which communicates on back of pubes with its fellow and with the
epigastric.
Through upper part of obturator foramen, and divides into;

Intebnal Bb. - Bound inner margin of obturator foramen ; supplies
obturator & adductor muscles, pectineus & gracilis and anasto-
moses with internal circumflex.
ExTEBKAL Bb. - Bound outer margin of obturator foramen to inter,
val between gemellus inferior ft quadratus femoris, sends an
articular branch to hip.joint through cotyloid notch, and anasto-
moses with external circumflex h, sciatic arteries ; supplies obtu-
rator extemus & the lower external rotator muscles.

Sciatic - The largest of the two terminal branches of anterior division of internal iliao

artery, and the largest branch of the artery after gluteal.
Downwards in front of pyriformis & sacral plexus, lying a little behind ft to outer

side of internal pudio.
Through great sacro-soiatio foramen below pyriformis and between great soiatio

nerve ft pudio vessels ft nerve.
With small sciatic nerve over gemelli, obturator intemus ft quadratus femoris

and in front of gluteus mazimua
Gives off branches:

MuscuLAB, Abticulab to hip«joint|

COCCTGEAL, InrBBIOB GLUTEAL;

Combs Nebvi Iscbiadici - Long, slender; with, and rabsequently
within sheath of, great soiatio nerve to lower part of thigk.

Fndio -Tide next Tablet.

150

BRANCHES of the INTERNAL ILIAC ARTERY— 2nd T.

PUDIG ARTERY.

The imaller of the two terminal branohei of anterior diyision of internal iliao arterj.

Deeoends in front of pyriformiB A sacral plexne, lying to the inner side & a little in firoat ol

soiatio artery.
With pndio nerre through lower part of great saoro-soiatio foramen below pTriformis on inner

side of soiatio nerree A seiatio artny*
Winds ronnd spine of isohinm and re-enters pelvis through lesser saoro-soiatlo foramen.
Forwards along outer wall of isohio-reotal fossa below pndio nerre, being ooTered bj obturator
fasoia, and lying at first 1} inohes above lower extremity of tuber isohii, but appro«ehtng

surfaoe as it progr es ses
Pierces deep layer of deep perinssal fasdai and ascends along pubio aroh between the two

layers of that fascia to near symphysis pubis.
Pieroes superficial layer of deep perinsdal fascia^ and divides into artery of corpus caTomoram

and dorsal artery of penis.

BBANOHES :

Inferior Heemorrlioidal - Two or three, small. - Arise in isohio-reotal foasa,

which they cross to lower part of reotnm A aoos.

Superficial Perinseal - Arises near transversus perinsdi musole, whioh it oroesas

Buperfioi&Uy.
Between accelerator urinas A erector penis to skin of scrotum A dartos,

or of labiom.

Transverse PerinSBal - Small, arises frequently from superficial perinseal.

Inwards below transversus perinni to structures between bulb and anus.

Artery of the Bulb - I«<^i'go ^^^ surgically important.

Inwards to bulb A Cowper's glands between the two layers of deep perinaal

Hay be small or even absent, or may be double. Hay arise earlier and
cross perinsBum Airther back than usual, and would then be rery
liable to be divided in lateral lithotomy. Hay arise from an aooesaory
pndio, and then lie more forward and be altogether out of danger.

Artery of the Coipus CavemOSUm - Pierces cms penis, and runs forwards

in corpus oavernosum by side of septum peotiniforma

Dorsal Artery of the Penis - Between orus and symphysis. Through suspensory
ligament and forwards beneath skin on dorsum of penis to glans & prepuce.

ACCESSORY PUDIO ARTERY — BxcepUonal branch of internal iliac, which

exists when pudio artery, being smaller than usual, fails to give off its two

terminal branches A sometimes even the artery of the bulb*

Arises from near origin of pudio, passes forwards along base of bladder A upper part

off prostate^ pieroes triangular ligament^ and takes the place of terminal por^

tion of normal artery.

151

BBANCHES of the INTERNAL ILIAC A^TEBY-3rd T.

BRANCHES FROM POSTERIOR DIVISION.

ZUo-LniXlbar - AriBes from upper part of posterior dirision.

ABoends beneath psoas to iipper part of iliao fossa, where it diyides into i

Lumbar Branch - To psoas & qnadratus lamboranif commnnioating with last

lumbar artery, and sending a small spinal branch through interver.

tebral foramen between last lumbar vertebra & saorum;

Iliac Branch - To iliacus & ilium, and along crest anastomosing with cironm-

flex iliao.

Lateral Sacral * Usually two, superior A inferior.

Downwards and inwards in front of pyriformis A sacral plexus, and along inner side

of anterior saoral foramina, anastomosibg with middle sacral and

giving off

Dorsal Branches -Through anterior sacral foramina to contents of spinal
canal, and then through posterior sacral foramina to skin & musolei

on back of saorum.

Gluteal - The largest branch of internal iliac, and the continuation of its posterior division.
Through great sacro-soiatio foramen above pjriformis, and then between latter mus*

ole & gluteus medius, and divides into-

SuriRnciAL Branch - Gives off numerous branches to gluteus maximus A iw

tegument over sacrum ;
DiKP Branch - Forwards between glutei medius A minimus, and divides intot
Superior Dwision - Along upper border of gluteus minimus towards an-
terior superior spine of ilium, and joins with circumflex *'liao.
iiifmmr Dioisim -* Crosses gluteus minimus towards great trochanter, «nd

Joins with ascending branches of exttraal circumfles.

152

SACBAL PLEXUS.

Formed by Inmbo-Baoral oord & anterior diviBions of the three firei saoral nerrei^ and part of

that of the fourth.

TriaDgnlar in shape, - its oonstitnent nerre-fibree oonrerging to form one broad flat ooHl,

which leaTes pelvis through lower part of great aaoro^soiatio foramen below pTriformii,

and immediately divides into Small solatio. Great soiatio A Podia
Bests upon pyriformis, and is covered by the pelvio fasoia & by the two terminal branefaa

(soiatio & pndio) of anterior division of internal iliac artarr.

BRANCHES :

Superior Gluteal - From back of lumbo«sacral cord.

With gluteal vessels through opper part of gpreat saoro-tciatio foramen abors

pyriformis, and divides into;
BuPSBioa B&ANCH - Along middle carved line on dorsum ilii with superior divisioa

of deep branch of gluteal artery. Supplies glutei mediua A minimu.
Inferiob Bbamoh - Directly forwards between glutei medius & minimus, whioh it also

supplies, and terminates in tensor vaginse femona

MnSOnlar * To pyriformis, obturator ioternus, gemelli & quadratus femoris. - Tha

nerve to obturator internus passes behind spine of ischium and throm^b
lesser saoro-soiatio foramen to inner surface of the muscle. - Th«
gemellus inferior and the quadratus femoris are supplied by a oommon
branch, whioh rnas between capsule of hip-joint and the obturator intemoi

& gemelli, and gives off an articular filament to the joint

Small Sciatic - From lower & back part of sacral plexus.

With sciatic vessels through lower part of great Bacro-sciatio foramen below

pyriformia
Descends beneath gluteus maximus on inner side of g^at soiatio nerve.

Along back of thigh beoeath fascia lata to lower part of popliteal space.
Perforates deep fascia, and aocompanies external saphenous vein to skin of back
of leg; communicates with external saphenous nerve. Gives off branches:
IiTYEBiOR Gluteal - Several, large s to under surface of gluteus maximus.
InrERioB Pudendal - Forwards below tuber ischU to skin of perinseum and upper &

inner part of thigh, and to scrotum or labium.
CuTAHEOUB - Descending. To skin of inner h outer sides of back of thigh, popliteal

space and back of leg*
Ascending. Wind round lower border of glutena mazimna to integomeofi

over ita aorfisce

Great Sciatic - Vide

PudiC - Vide

HEAD & NECK.

II.

POSTERIOR TRIANGLE OF THE NECK.

154"

POSTEBIOB TBIANGLE of the NECK

Ib bounded by stemo-mastoid, trapeztns & clftTiole.

Its floor is formed from above downwards by splenins capitis, leyator angali scaptlSi
posterior & middle soaleni, and snperior digitaiion of serratus magnu;-
a part of the complexos is sometimes seen ftboro tiie spienias.
It is divided by posterior belly of omo-hyoid into i

Bup. or Occipital Portion -The largest, contains t

Superficial cervical plexus & spinal accessory nerve^
TransverscUis colli artery & vein^
Fat & lymphatic glamls.

Inf. or Clavicular Portion - The smallest, its size yaries greatly with the extnttf

clayionlar attachments of stemo-mastoid & trapezius, situation of oo
hyoid, and elevated or depressed position of shoulder. CoaUlnit
Third part of subclavian artery^
Brachial plexus^

Transversalis humeri h transversalis colU vessds%
External jugular vem^
Fal k fymphatic glands.

155

MUSGIiES.

FlatyBma Myoides -* davide, acromion, faiefa OT«r peotoralis major, deltoid, k
trapeziua.

Innermost fibres decuisate below chin k in front of symphysis; others
are inserted into lower jaw below external oblique line ; oUiers blend with
depressores kbii inferioiis ft angali oris and the other muadea of the motttl^
forming risorios. - S. by superficial cervical plexus and fadal nerve.

Stemo-Cleido-Mastoid or Sterno-Mastoid.

Stbrnal PoRTioir - Upper ft outer part of front of first piece of sternum.
Claticulab Portion - Anterior surface ft upper border of inner third of clavicle.

Anterior border ft outer surface of mastoid process and outer two-thirda

of superior curved line of occipital bone. * S. by deep external branches ol

cervical plexus ft by spinal accessory nerve.

Trapezius - External occipital protuberance ft inner third of superior curved line of
occipital bone ; ligamentum nucha ft spinous processes of the last cervical ft of all
the dorsal vertebrsa ; eupraspinons ligament.

Posterior border of outer third of clavicle^ inner border of acromion;
whole length of upper lip of posterior border of spine of scapula, and
tubercle at outer part of smooth surface at its inner extromity. -> S. by spinal
accessory nerve ft deep branches of cervical plexus.

Levator AngUli ScapuleB *- Posterior tubercles of transverse procesMS of the 8, 4, or ff
upper cervical vertebra between splenius and scalenus mediua.

Posterior border of scapula between spine and superior angle. - S. by one of
the deep branches of the cervical plexus and by one of the supra-clavicular
branches of the brachial plexus.

Splenius - Lower half of ligamentum nuohsB and spinous processes of 7th cervical & six
upper dorsal vertebra.

Splenius Capitis - Mastoid process and outer part of rough surface between sup-
erior ft inferior curved lines of occipital bone.

SPLBNins Ck>LLi ~ Posterior tubercles of transverse processes of the 2, 8, or 4 upper oer^
vical vertebras - S. by external branches of posterior divisions of cerrical nerves.

Scalenus AnticUS-Tubercule on inner border and upper surface of 1st rib.

Anterior tubercules of transverse processes of Srd, 4th, 5th, and 6th oervicaik
vertebrse. - S. by one of the supra-clavicular branches of brachial plexus.

Scalenus Medius - Upper surface of first rib behind groove for subclavian arteiy.

Posterior tubercles of transverse processes of six lower cervical vertebneii
~ S. by one of the supra-clavicular branches of brachial plexus.

Scalenus Posticus - Bad^ of outer surface of 2nd rib.

Posterior tubercules of transverse processes of two or three lower oervioal
vertebrsB. - S. by one of the supra-clavicular branches of brachial nlezua.

158

CEBVICAIi PLEXUS.

Fonned by anterior branohea of fonr npper oerrioal nerrea & loopa oonnecting tbem, and lies beneatik
Btemo-mattoidy in front of levator angoli Boapal89 ft eoalenas mediae ft tbe four upper Tertebnt'.

Commanicatea tbrongh loop between 4th ft 5th nervea with brachial plezna, and, throogb its deep
oommnnioating branohea, with pnenmogaatrio, apinal aoceaaory, hypogloaaal ft anperior oerrical
ganglion of the aympathetio. - Ita anperfioial branohea oommnnioate with £ftoial ft greai cocipiuL

Ita branohea are anperfioial ft deep.

SUPERFICIAL BRANCHES — wind ronnd poaterior border of atemo-maatoid one abon

the other in the following order, whioh ia alao the order in whioh tbej arisa

Small Occipital ~ From 2nd oerrioal ; yariable in aiae ft aometimea double.

Aaoenda behind atemo-maatoid to attoUena anrem ft poaterior belly of oodpitxv
frontalia, and perforatea deep faaoia to integp^ment of baok of aide of head k
upper part of back of pinna ; ita anricnlar branohea being aometimea anpplied
l^ great occipital. Joina with great oooipital, great anricnlar, ft posterior
anrionlar branch of facial. - The aeoond amall occipital, or amalleat oocipiul,
when it eziata, ariaea from 8rd nenre^ and aenda twiga to baok of neck.

Great Auricular - From 2nd ft 8rd oerrioal nerrea.

Ascenda upon aterno-maatoid ft beneath platyama to near lobnle of ear, where i;

diridea into branches:
Au&icuLAR - Sereral, large; to integument of back of pinna, joining with pos-
terior anricnlar branohea of facial ft pnenmogaatric. Some twiga supply
onter anrfaoe of lobnle^ and one reachea enter anrfaoe of pinna throagb

a fisanre between antihelix ft concha
Kastoid - To integument behind ear, joining with post, auricular branch of faciaL ,
Facial - To integument of face, and to parotid gland joining with faoiaL

Superficial Cervical -The largeat; ih>m 2nd ft 8rd.

Crosses stemo-mastoid beneath platysma ft external jugular vein, and diridea into brs. :

AscENDiNO - Given off an ascending twig to external jugular vein, joina with

cerrico-faoial branch of facial, and, supplying platysma, pieroea it to

integument of upper ft front part of neck.
Descending - Pierces platyama to integument of lower ft front part of neck.

Superficial Descending - Several large branohea from Srd ft 4th.

Descend between stemo-mastoid ft trapesius, and divide into branches:

Steenal - Cross origin of aterno-maatoid to integument of front of cheat as

far as middle line.

Glaticulae - Cross claricle (sometimes one of them perforates the bone) to

integument over pectoralis major ft deltoid, communicating with cats*

neoua branohea of the superior intercostal nervea
AoEOKiAX - Over acromion ft olarioolar origin of trapesius to int^ument'of

outer ft baok part of ahoalder.

157

SPINAL ACCESSORY NERVE.

Oonjriiit of two portionSj the portion acoesiory to the pneamogastrio ft the ipinal portioii.

FOBTZON ACCESSORY to the PNEDMOG A8TRIG - The emiUer.

Arises from laUral trad of medulla oblongata bdow pmumogashie. — Beep origin from

grej nucleus on lower part of floor of 4th yentriole.
Joins ganglion of root of pneomogastrio in jugnlar foramen by two or three filaments,

and is entirely added to the pneomogastrio below tiie gan-
glion of the tmnk.
Assists in ioTVoXxi^g pharyngeal^ superior 6* inferior laryngeal brs. of pnenmogastrio.

SPINAL PORTION - The larger.

rises from lateral column of cord as low as Uh or Qtk cervical n. — Deep origin from

anterior horn of grey matter.
Ascends between ligamentiun dentionlatnm k posterior roots of the spinal ns., and

enters skull through foramen magnum.
Passes out through jugular foramen in same sheath as, and on outer side of, pnenmo-
gastrio n. and behind glosso-pharyngeal, joining with aoces*

sorj portion.
Backwards behind hypoglossal & pnenmogastrio, beneath and then behind internal

jugular rein and digastric A stylo-hyoid muscles to upper

part of stemo-mastoid.
Pierces deep fibres of stemo-mastoid, giring branches to it and joining in its sub*

'stance with 8rd oervioal nerrsb
.Crosses posterior triangle of the neck, joining with 2nd, 8rd, 4th h 6th oerfioal ns^

and is distributed to under inzfiMM of traptiiaii

158

SUBCLAVIAN ABTEBY.

From innomiaate artery behind apper border of Bterno-cIaTioalar aritonlaiioa (H^bi 8td«\
from end of transverse portion of aroh of Aorta (left side), to outer border of first hk j

Divided into three parti : -

FIRST PART — From origin to inner border of ioalennsantioas.

SECOND PART -— Lies behind scalenus anttons at a aomewhat Tariable level above eUr.

icle. S hort ; forms higest part of aroh described by the artery. - Relatiosi :
In Front - Scalenus anticus, subclavian vein, phrenio nerve.
Behind - Scalenus medins.
Ab<ru€ - Brachial plexus.
Belmo - Pleura.

Subclavian Vbin lies below h in firont of artery, from which it is separated by

■caieaos autteo^

BRANCHES — Superior Intercostal on right sidei generally no branch oa

leftside.

THIRD PART --* From outer borde)r of scalenus antious to outer border of first rib. Omsssi

lower ft inner part of posterior triangle of neck, lyln^ ia the email tpAoa

bounded by omo«hyoid, clavicle ft scalenus ant. - Rklatioss:

In front - Skin, superficial fascia, platysma, descending branohes of anperfioiAl

cervical plexus, deep fascia, transversalis ooLU veia.

Clavicle, subclavius ft its nerve, transversalis humeri vaisels, eztior*

nal jagular vein with the plexus frequently formed by tHs

Buprasoapolar ft tranaverdalit or \\.
Behind - Scalenus medias.
Above — Brachial plexus, omo-hyoid.
Belcuf " Gator surface of first rib.

SuDCLAViAN VEIN lios below,in front, ft to inner side of artery.

BRANCH --* Frequently the Posterior Scapolari which is otherwise derived

from the transversalis ooliu

159

TH7BOID AXIS.

Short thiok tmnk from front of llrtt part of ■abolayian close to inner
border of soalenas aniloas. Divides almost immediately into : •

Inferior Thyroid -

Snprascapnlar or Transversalis Humeri^

Grosses lower part of scalenus antions ander cover of sterno^mastold*
Oatwards behiod olaviole, beneath omo-hyold.

Beneath trapezius, and over transverse ligament of scapula to sapraspinoas fossa,

where it ramifies between the masole A the bone.

Crosses neck of soapnia to infraspiDotis fossa. - Anastomoses with the other

scapnlar arteries, supplies shoulder-Joint A subsoapularis, and gives off a

small Bupra-aoromial twig.

Transversalis Colli

Crosses apper part of subclavian triangle in front of soaleni & brachial plexus,
passing sometimes between the trunks of the plexus, and divides beneath

trapezius into :

SuPESTiciAL Cervical - Ascends beneath trapezius to muscles & glands of back of

neck, and anastomoses with superficial branch of arteria prtnoeps

cerviois.

PosTSBiOE Scapular - Beneath levator anguli scapulas to superior angle of scapala,

and then along posterior border of the bone beoeath rhomboidei as far

as its inferior angle, anastomosing with the other scapular arteries A

the intercostals. Frequently arises from 8rd part of sabolaTian.

leo

BBAOHIAIi PLEXUS.

Formed m follows bj anterior diTlsioiii of Sib, 6th, 7tb, & 8th oerrioel and let donal at
Fifth ^ Sixth Cervical unite between anterior ft middle Bcaleni, and form tfet

ouret pmi M AET cots
Eighth 6^ First Dorsal nnite behind scalenns antioM, and form the rxni
Seventh forms alone the middle fkimart cord. [prihabt ooia

All three primary oorde divide into anterior ^ posUrunr dieoisions.
Anterior diTisiona oi outer &* middle primary oords form tbe outer oosn.
Anterior division of inner primary oord forms the inner oord.
Posterior diyislons of «/fMf)r^ primary oords form the posterior oorsu
Broad between anterior ft middle soaleni, where anterior diTisions of the nerres ' '
above 2nd part of snbolavian artery; oontracted opposite claTiole, where inner i
enter oords lie at fore part of plexns on outer side of 8rd part of smbolarian an'rr
ft of 1st part of axillary ; again expanded in axilla, where the three oords lie ci
inner, outer ft posterior aspects of 2nd part of axillary, and where they break ''•

into the large nerres of npper lir \

Commxinioates with the oerrioal plexns through loop between 4th ft 6th nerves ft thr ci

branch from 6th nerve to phrenio, and with middle ft inferior ganglia of sy mpaimifr

BRANCHES — Ai«

ABOVE THE CLAVICLE :

Post, or Long Thoracic, or Ext. Respiratory of Sir C. Bell -Fr^

6th ft 6th nerves, the two roots uniting in substance of ki<

lenns anticss
Deeply along side of ohest behind axillary vessels ft cords of bracb*

plexus as far as lowest digitation of serratns magna
Buprascapnlar - From baok of trunk formed by union of 6th ft 6th.

Backwards ft outwards beneath trapezius ft through supraseap^'a
foramen to supraspinous fossa, where lies between snpraapiLA

ins ft the bc*a
Bound spine of scapula to infraspinous fossa. - Supplies supra* ft \nir%

spinati (two twigs to each), shoulder-joint ft scap'.«
UtUSCUlar - ^o rhomboidel ft frequently to levator anguli soapuls (from h-S

nerve), subolavius (from 6th ft 6th, anastomoses fireqnesL'j
with phrenic), soalenl ft longns colli (variably from 6th 7'/ \

i^
Ooxni&UXlicatixig - fVom 6th cervical to phrenic on anterior scalenus.

BELOW THE CLAVICLE — The branches are given off from the three cvrd

as followa, frcs.
Outer Cord - External anterior thoracic, outer head of median, m^

culo-outaneous or external entaneofl

Inner Cord - Internal anterior thoracic, inner head of median, nlnsJ

internal cutaneous, lesser internal cutaneous or n. of Wrisberi

Posterior Cord - The three subscapular nerves, mnsoulo-spira'. i

circam- 3

HEAD & NECK.

II.

ANTERIOR TRIANGLE OF THE NECK.

162

ANTEBIOB TRIANGLE of the NECK.

I8 bounded by ■temo-mastoid, middle line of neok, lower border of Jaw A Hne fim

angle of Jaw to mastoid prooesa
It is divided by anterior belly of omo-hyoid, and by stylo-byoid & posterior heWj d

digastriointo:

Inf. Carotid Trian^e - Bounded by Btemo-mastoid, anterior belly of omo-hyotd, k

middle line of neck i contains beneath stemo^hyoid & -thyratd:
Common carotid artery ^ intemai jugular veint pneumogastric 6f* sympathetic;
Inferior thyroid artery ^ recurrent laryngeal nerve;
Trachea^ thyroid gland^ lower part of larynx.

Slip* Carotid Trian^e - Bounded by stemo-mastoid, anterior belly of omo-hyoid,

stylo-hyoid ft posterior belly of digastric ; contains:
Termination of common carotid artery^ intemal 6* external carvtid arteries, ^ first

branches of the latter:
Superior thyroid^ Itngual^facial^ &* intemal jugular veins;
Fneumogastric^ superior laryngeal^ &* sympcUh!kic nerves :
Hypoglossal 6* descendens noni nerves,
upper part cflarynx^ lower part of pharynx.

Submaxillary Triangle - Bounded by median Une, Jaw-bone ft line from, angle o!

jaw to mastoid process, and by stylo-hyoid ft posterior belly of digutTie;

contaiBS;
Submaxillary gland, facial artery ft vdn ;
Submental artery, mylO'hyoid artery ft nerve;

Lower part of parotid gland, facial nerve, external carotid artery with its posteria

auricular, temporal 6f* intemal maxillary ii-amAa ;

Internal carotid, intemal jugular van, pneumogastric, sympathetic all separated froa

external carotid by stylo-glossus ft -pharyngens ft glosso-pharyngeal a.

163

MUSCLES.

INFRA-HTOID REGION.

Btemo-Hyoid or Stemo-Cleldo-Hyold - Variously from poiterior tterno-clayionlar
ligament, and from npper ft back part of first piece of stemam or back of
inner extremity of olayicle, or from both; sometimes from olariole onlj; ooca-
rionally from cartilage of first rib.

Lower border of body of hyoid bone internally to omo-byoid. - S. by a
branch from loop between descendens ft commnnicans noni neryes.

StemO-Tliyroid - Back of first piece of stemnm below ft internally to stemo-hyoid.

Obliqae line on ala of thyroid oartilage. - S. by a branch from same
source.

Oxno-Hyoid - Uppar border of scapula on inner side of snprasoapnlar notch and some-
times fr^m transrerse ligament.
^ Lower border of body of hyoid bone externally to stemo-hyoid. - S. by a

branch from loop between descendens ft commnnioans noni nerres.

Tliyro-Hyoid - Obliqne line on ala of thyroid cartilage.

Lower border of body ft greater oorna of hyoid bone. - B. by hypoglossal n.

ST7FRA-HY0ID REOION.

Digastric ~ Digastric groove on inner side of mastoid process. - Perforates stylo-hyoid
and is held in connection with body ft great coma of hvoid bone by an apon-
enrotic loop lined with synovial membrane, from which loop it is reflected
upwards ft forwards to

Bongh depression on inner lip of lower border of jaw bone close to sym-
physis. - 8., posterior belly by facial nerye, anterior belly by mylo-hyoid
branch of inferior dental nerre.

Stylo-Hyold - Middle of cater sarface of styloid process.

Body of hyoid bone at its junction with great oomu. > B. by focial nerre.

MylO-Hyoid - Whole length of mylo-hyoid ridge.

Body of hyoid bone ft median raph^ from hyoid bone to symphysis. - 8.
mylo-hyoid branch of inferior dental nerre.

Genio-Hyoid - inferior genial taberole.

Anterior snrfisoe of body of hyoid bone. - B. by hypogloiial nerra.

164

COMMON CABOTID ARTERY.

Right oommon carotid arises from innominate artery behind steno-clavicnlar artUsnlatiotu
Left common carotid arises from highest part of arch of Aorta, is longer, and kaa a thora-

cic portion deeply situated within the thorax.

THORACIC PORTION OF THE LEFT COMMON CAROTID ART.

Upwards & outwards to root of neck. — RELATIONS :

In Faont — Stemnm, stemo-hjoid ft -thyroid, left innominate t., re-

mains of thymus gland.
Behini) — Trachea, oesophagus, thoracic dnot.

On Inner Side — Innominate artery.

On Outer Side — Left pnenmogastric ft phrenic ns. ft left sabdaTian art.,

left long ft pleura.

CERVICAL PORTION OF THE COMMON CAROTID ARTERIES.

Upwards ft outwards from behind stemo-olaTicnlar articulation to npper border of

thyroid cartilage, where divides into external ft internal carotid arts.

Direction from sternal end of clavicle to midway between angle of jaw ft maatmd pr.

In same sheath of deep cervical fascia as int. jugular v. ft pneumogastrio n. Deeply

situated at origin; superficial at termination. — RELATIONS:

In Front, Lower part — Sldn, superf. f., platysma, ant. jugular v., deep t \

Stemo-mastoid, -hyoid, -thyroid, omo-hyoi<^ middle thyr. v.

Upper part — Skin, superfl f. platysma, deep £, inner border of

stemo-mastoid.
Stemo-mastoid art., facial, lingual ft sup. thyroid veins,

desoendena noni a.
iSsHiND — Oervical vertebres, long^ colli, rectus capitis aationa major,

inf. thyroid artery, sympathetic ft recurrent laryngeal as.
On Inner Side — Trachea, thyroid gland, larynx, phaiynz ; inferior thy.

roid aft., recurrent laryngeal a.

On Outer Side — Internal jugular vein, pneumogastrio n. — At lower

part of neck int. jugular v. diverges from artery on ri^ht aid?,

approaches and crosses it on left aide.

EXTERNAL CAROTID ARTERY.

From upper border of thyroid cartilage to interval between neck of condyle ft external andi-

• tory meatus, where divides into temporal ft internal maxillarT.
At its origin it is more superficial ft nearer middle line than int. carotid* -^ RKLA-

TIONS:

Covered bt — Skin, superficial £, platysma, deep f., ant. border of stemo-mastoid;

Lingual ft facial veins, hypoglossal n., digastric ft stylo-hyoid ma.

Parotid gl., facial n., junction of temporaJ ft intomal maxillary vs.
On Inner Side — Wall of pharynx, portion of parotid gland, sup. laryngeal n.
Behind — Sup. laryngealn., stylo-glossus ft -pharyngens, glosso-pharyngeal n., in-
ternal carotid

BRANCHES: Superior Thyroid; Linguali Facial;

Oooipital^ Post. Auricular; ^ Ascending Pharyngeal;
Temporali Int. Mazlllaiy.

165

AITTSBIOB BRANOHES of the BXTEBNAIi OABOTID.

BUPf THYHOID *— AtUm from front of external oarotid oloie to its origin beneath thfm

anterior margin of ttemo^mastoid, and ii qnite snperfloial when this moeole
is disseoted from its sheath^ for the latter then retracts and exixwes the

carotid ressels A their branches.

Toiimnm course upwards & forwards, and then downwards & forwards beneath omo- A

stemo-hyoid & -thyroid to anterior surface of thyroid body. Gives off brsi

Hyoid - Smalls along lower border of hjoid bone beneath thyro-hyc^d, and joins
^^ with its fellow.

8temo-Ma9toid or Superficial Descending - Descends to middle of

stemo-mastoid, crossing carotid yessels.
Snp, Laryngeal -With superior laryngeal nerve to interior of larynx through

outer part of thyro-hyoid membrane.
OricO-Thyroid ~ Small j crowes orioo-thyroid membrane and joins with its fellow.

IiINOXTAXj ~ Arises a little below hydd bone beneath thin anterior margin of stemo-mastoid.
Upwards ft forwards upon middle constrictor to great oomu of hyotd bone.
Horizontally forwards above great oomu beneath hyo-gloesus, digastric ft stylo-hydd.
Upwards on genio-hyo-glossus.

Vbrwards with gustatory nerve on under surface of lingualis inferior, and then beneath
mucous membrane to tip of tongue under name of ranine. - Gives off brs t

Hyoid ^ Small ; along upper border of hyoid bone and joins with its fellow.

DorsaliS LingUSB - Ascends on genio-hyo-glossus to dorsum of tongrne, epi-

glottis, soft palate ft i^nsiL
Bnblingaal - Forwards between mylo-hyoid ft mucous membrane to sublingual

gland.

Ranine *- ^o terminal branoh | joins with its fellow at tip of tongue.

7ACIAXf "^ Arises above preceding beneath thin anterior margin of stemo-mastoid.

Forwards ft upwards beneath posterior belly of digastric ft stylo-hyoid ft submaxillary g1d«
Crosses iaw bone in front 4}f maeseter.

Forwards and upwards to angle of mouth upon buccinator ft beneath platysma.
Upwards beneath zyg^matici and upon levator anguli oris and the levators of the lip ft
ala of the nose to inner oanthus, where becomes angular artery and joins

with ophthalmic.
Is very tortuous in its course. Facial vein lies behind it, and is less tortuous. GKves off

branches :
Inferior or Ascending Palatine - l^ps beneath ramus of jaw. Ascends
between stylo-glossus ft -pharyngeus and then upon superior constric-
tor in front of ascending pharyngeal, and supplies tonsil ft soft palate.

Tonsillar - Ascends upon and perforates sup. constrictor to tonsil ft root of tongue.

Submaxillary - Three or four, to submaxillary gland ft surrounding muscles.

Submental -" Forwards on under surface of mylo-hyoid, and between it and

digastric to symphysis, where ascends upon chin.
Inf. Labial * Forwards beneath depressor angidi oris, below following artery to

tissues of lower lip.

jTif , (Joronary - Forwards beneath depressor ang^nli oris, and tortuous course

through substance of orbicularis and between it ft mucous membrane,

anastomosing with its fellow.
^ Sup. Ck>ronary - Larger and more tortuous i similar course along free edge of

upper lip, giving twigs to ala and artery of septum to septum of nose.

Lateralis Nasi - To ala and dorsum of nose.

Angular ^ To inner oanthus, sujyplying lachrymal sac and anastomosing with

nasal branch of ophthalmic.
All these branches anastomose i^reely with each other, with those of the oppo-
site side, and with the mental, transverse facial, infra-orlsital, ophthaU
miOySoblisgnal, posterior superior or descending palatine and ascending

pharyngeal arteries.

196

aLOSSO-FHABYNGEAL NBBVE.

Thb niallec^ of the three diTleloiui of the 8fch pur. ArUafivm lOena/ trad of mtdtOtm #itoy<b

aicffi pnmmogustrU. — Its deep origin ii from a gre^ nnoleiis on floor of 401 Tontariele.

Through anterior h inner part of Jngolar foramen in front of pneamogastiio ft spinal aeeewory

and in a leparate sheath, grooYing lower border of petrou portion of temporal bone and

presenting two gangbi:
8up. OB JueuLAB G. OB G. ov THV Boor — Small, and inToWes onlj the <mter ilbresi

Inv. ov Pbtbous G. ob G. ov Amdiisoh — Larger, and inTolTes whole of flfarssL
GiTes off from petrous ganglion :

Tympanu branch or JdeohmCs mrvt, iLesoribed below ;

Anastomotio br. to ganffkn of the rod 6* to amiadar kr. of ike fmmmagutrk ;
»nd from a little below the ganglion t

Anastomotic br. io facial nerve» — This branoh pieroes post. beHj of digastris^
Downwards ft forwards in front of pnenmogastrio ft between int. oarotid ft int. Jugular vein.
Beneath styloid process ft mnsoles oonneoted with it to lower border of stjlo-pharjageoL
Onrres inwards npon stylo-pharyngens ft middle oonstriotor.
Beneath hyo-glossus to mnoons membrane of ianoes ft base of tongntb

BRANCHES:

TjmpMAc Br. or JaCObSOn's N, — A^^ms from petrons gaagUon.

Ascends through small oanal in petrons bone to tjmpannm, where dlTides into t

BBS. ov CoMXinnoATioir — ^ earoHd ftam$ and groai 6* trnoB pdrosd

hnmches rffatuL
BBS. ov DiSTBiBunoir — Tofinettra rotfrnda^fmestra avoHs ^ mueoms mm-

hrane ofEustadkioM taM.
Oarotid Brs. — Descend on internal carotid arterj, and join pharyngeal brs. of

pnenmogastrio, snp. laryngeal ft sympathetic.

Fhftiyilgeal Bra. *— ' Three or fonri form pharyngeal plexns by joining oppociia

middle constrictor with pharyngeal brs. of pnenmogastrio^ sap. laryngeal A

sympathetie:
MnSCnlar Brs, — To stylo-pharyngens ft oonstrictors of pharynx.

Tonsillar Brs. — To tonsil, forming tonsillar plexus, brandies of whioh ai« distii*

bnted to soft palate ft
Lln^aal Brs. '— ' To mnoons membrane of baee ft side of toiurae.

197

THE TONQUE— 1st Tablet.

r r c ee n ta for OT i wninfc tton;

BJU32 - Oonneoied io s

SoftpaJaU - Bj anterior pfllari of fanoei |

Pharynx - By superior oonBtrictore of pharynx h nmoons memlmuief
E^igMis • Bf three folde of mnooos membrane, the glouo-epiglottio ligamentf |
Hy<ndbom^'2ij hyo-glossi & genio-hyo-glosfli miuolee.

APSiZ-^BTee.

UPPER SUBFACE OR DORSUM — Bongh in its anterior two-thirda, where it

]^8ent8 the papiUa minima or arnica dfiliformes^ and the papilla media or fungi*

Jvrmesi unooth in itf posterior third, or behind the papillss maxima or circumvallftta^

where it presents the projecting orifioes of nnmerons mnoons glands.

UNDER SURFACE ~ Oonneoted to hydd bone h lower Jaw by hyo-glossi k genio-hyo-
glossi mnsoles, and from sides of whioh the mnoons membrane is refleoted orer
floor of month to inner surfiftce of gnmS| forming in firont a prominent fold, the

fiwnnm linguss.

STRUCTURE of the TONGUE

Presents for examination t

Osteo-fibrons Support - Consists oft

Htoid BOIIB I

Median Fibrous Sbptdx - Thickest behind, where it is attached to epi-
glottis.
Hto-olossal Kekbsaitb - Oonneots nnder surface of tongne to hyoid bone .

To these may be added the

Thick kuoous Membraioi oxr the oobsux op thb oboaXi

Muscular fibres -'V'ide next Tablet

Mucous Mezabrane -Vide next Tablet bnt one.

Vessels ft Nerves.

A&TBRiES - Unguaii inferior or ascending palatine branohei of facial^ ascending

pharyngcM.
Vbins - Partly correspond to arteries, partly open into pterygoid plexos.

LniPHATics -To submaxillary glands.

Nbxtbs -Are the i

Gustatory to mucous membrane of anterior two-thirdfl«
Giosso»pharyngeal to mucous membrane of posterior third ft sides f
ffypegiossal to the muscles.

Internal branch of the superior laryngeal sends a few twigs to mu-
oous membrane of base. — A few small ganglia are found
(KSUiker, Bemak) upon the glosso.pharyngeal and, in tba

sheep h oalf, upon the gustatozj.

108

THE TONGUE— 2nd Tablet.

MUSCULAR FIBRES.

Form extrinrio & intriniio mnielM.

EXTRINSIC MUSCLES

Are the :

^ Stylo-gloSEniS -Anterior k oater aspect of styloid prooeis near its apex k liylo-

mazillarj ligament
Side o^baae of tongue externally to hyo-glossna, dividing into ;
LoNoiTcniNAL POKTiON - Forwards along side of tongne, and blende with

lingnaliB inferior in front of hyo-gloooa
Tbaksyekse portion - Deonseates with hyo-gloune & with its fellow.

Hyo-glossUB -Side of body, lesser coma & whole length of great oomv of byoid

bone ( basio-gloBsns, ohondro-glossns, oerato*gloasiis).
Side of under surface of tong^ue between stylo-glossni A linguaGa

inferior.

Qeni0*]iy0*gl0SSU8 - By a short tendon from superior genial tubercle oe

itfner surface of boiy of jaw-bone close to symphyna
Whole length of under surface of tongue internally to ling^alis ia*

ferior, side of pharynx, body of hyoid bone.

Palato-glossns or Constrictor Isthmi Faaciom - Anterior rarfaoe of

soft palate close to qtuU.
Side of base of tongue, blending with stylo-glossus.

INTRINSIC MUSCLES

Are the : '

LJngualis transversUS -Median septum.

Sided, and sides of dorsum. - Forms the ohief bulk of tho tongna.

Lingnalis Superior- stratum of longitudinal or slightly oblique fibres thidmt

in front, and covering dorsum of tongue beneath the mncosi
membrane to which the indiridual fibres are attached.

Lingnalis Inferior - Longitudinal band of fibres along whole length of under

surface of tongue between hyo-glossua A genio-hyo-gIoaBa&
Blends with stylo-glossus in front of hyo-glossus.

Lingd&lis Pexpendicnlaris -Set of vertioal or slightly oblique fibres tnm

central part of dorsum to sides of under surfisoe^ forming curves

oonoaTe upwards ft oatwarda

The outer parte, or cortex, of the tongue are firm, and consist mainly ol
longitudinal fibres; the central part, or nucleus, ia eoftarg and
oonrists mainly of transnrerae ft rertical fibres intermingled with

adipose tiasaa

199

THE TONGUE— 3rd Tablet

MUCOUS ISEMBRANE.

Thick A rough on anterior two-thirdi of donam, sidea, A tipi thin 4 imootb on

third of dorsam & on under surface.
OonsiBtB of a cntia or corlam dense A very similar to that of the skln^ and of a thiok layer

of sqnamons epitheliam | and presents :

PAFILLjEi — Highly sensitiye rascnlar projeottons divisible into simple and oomponnd.
The former are similar to the papillae of the skin, and cover whole of tongae; the
latter, which are themselves st added with simple papillae, are found on rough
surface only, and are divided according to their dse dt shape into i

FapillSB MaximSB or CircumvallatsS - From 7 to 12 1 situated at Junction of
middle St posterior thirds of dorsum, where they are arranged in two rows
oblique backwards ft inwards, which rows meet at foramen ooecum and form
together an inverted V. They consist of a central conical projection, the
base of Tf hioh is free whfle its apex is attached, which projection is contained
in a cnp.shaped depression bounded itself by a prominent oircalar rim. - The
foramen coecum is the central depresslou, usually large, which lodges the
central papilla, itself frequently small.

PapillSd MediSB or FnHgifonXieB - Club-shaped, and present narrow attached ft
rounded free extremities. Sparingly scattered over anterior two-thirds of
dorsum, collected in greater numbers over sides ft tip.

FapillSD Minimee, or ConicSB et Piliformes - Tapering or cylindrical, closely
packed over whole of rough sarfaoe, and arranged in rows which are vertical
on borders ft tip, and which are, on dorsum, parallel, posteriorly, to the rows
of circumvallate papill», bat, anteriorly, more directly transverse. - The
simple or secondary papillsB borne by the filiform papillae contain a few elastio
fibres, and their epithelial sheaths are prolonged beyond them sometimes to
the extent of forming a pencil of almost hair, like fibres.

In the fungiform ft circumvallate, and probably also in the filiform
papillae, the nerves form plexuses, from which small brush-like filaments are
given off to the secondary papillae. These filaments are believed to terminate
in the deep extremities of spindle-shaped nucleated bodies similar to the
olfactory cells of SoholUe (Billroth, Key).

GLANDS - Are :

Follicular - Aggregated on posterior third of dorsum behind papillae oiroumwiUatse,
and very similar to the follicular recesses of the tonsils.

Xaceznose - ^^^ beneath ft in front of foregoing, and over sides ft under surface of
longna. On under surface near tip they are ooUeoted into two nnall oblong
tal deeeribed by Biandin ft Vohn.

200

THE TASTE-BUDS.

Are flask-like bodies disoovered by Loven ft Bohwalbe in the ihiok epitheliml layer
snrronnds the sides of the oironmrallate papillsd of the base of the tongue, and which harv
also been found of late on some of the fangiform papillsd and on the epiglottis. Tbej are
pyriform in shape. Their bases rest npon the ohorium. Their apices project between the
saperfioial epithelial cells, and present a minnte opening, from which a bundle of thread-Uke
processes are seen to emerpre.

They consist of modified epithelial cells, disposed perpendicularly to the surface, ytUet
cells may be divided into superficial & deep. The suferficial cells are flattened, or ribbon-liki\
tapering at each end, and joined together at their sides, so as to enclose the deeper oells, as, ia
the flower 'bud, the external scales surround the internal folioles. The deeper cells are spiodle-
shaped, enlarged in their middle, where they present a prominent nucleus, and tapering at eityr
end. Their deeper end, which is sometimes branched, passes down into the ohorium, and, it m
said, becomes connected with a nerYe-fibril. Their more superficial end is prolonged into one di
the thread-like processes, which are seen to project from the opening of the taste-bad. Tt«
surrounding epithelial cells are flattened around the taste-buds, so as to enclose them in a ae
or nest.

The taste-buds are now believed not to be oonneoted with the sense of taste^ siDoe ibcy
are found on the epiglottis, which is not endowed with taste.

HEAD & NECK

THE ORBIT.

202

THE ORBIT.

QnAdrilateral pjramidftl fona looking forwards ft oniwardi and fbrmed bj wren boaa^

the flrontali ethmoid, iphenoid ( which enter into formation of both orUta), isp^

rior mazillarj, malar, ladhxymal ft palne.

Oommnnioatei with cranium, and with naaal, temporal, ijgomatio ft Bpheno-mazillaiT

fonsB through optio foramen, nasal dnot ft sphano-maadllacy fiisce.
Presents:

BOOF — Formed by orbital plate of firontal ft lesser wing of sphenoid. laeonoaTe^ aodpn-

sents the sntnre between the foregoing bones, and in frcni tbi
Laekrymal fossa for laorymal gland, and a
Depnssum (fovea trochkaris ) for pnlley of superior oblique.

niOOB "^ Formed by upper or orbital surface of superior maxillaiy and orbital prooenei of

miJar ft palate bones. Presents the sutures between foregoing bones, ti«
Infira^orUtal groove for infra-orbital yessels ft nerre, which beoomes oonyerted in front uts

Infira-orhUal canal; and also at its anterior ft inner part a
Depression for inferior oblique muscle.

INNER WAliL — Formed from before backwards by nasal process of superior mazilUrf ,

lachrymal, os planum of ethmoid, body of sphenoid. Is antero-posteric-

in direction and parallel to its fellow, and presents the sutures between

fivegoing bones and tha
Laekrymal groove tor lachrymal sad.

Crest ofkukrymal bono for tensor UteA muscle.

OUTBR WALL — Formed in front by orbital process of malar bone, and behind by snle.

rior or orbital surface of great wing of sphenoid. Is yery oblique forwmni«
ft outwards being nearly at right angles with its fellow, and presents \i^

suture between foregoing bones^ and tL»
Orifices of one or two malar canals,

SmaU spine for lower head of external rectus.

ANGLES :

SUP. EXTERNAL -Presents!

Ariicuiation of frontal with malar bone ft orbital plate of sphenoid|
Sphenoidal fissure orfiframen laeensm anterius for 8rd, 4th ft 8th nerrea and ophthilBic

nerre ft reir-

SUP. INTERNAL - PresenU

Suture connecting frontal with lachrymal ft os planum, in whioh suture are the
Anterior ethmoidal canal for nasal nerre ft anterior ethmoidal resaels, and the
Posterior ethmoidal cattal for posterior ethmoidal ressals.
INF. BXTBENAL- Presents

Sphesso^masillary fissure for infra-orbital yessels ft nerfa and ascending branches cf

Meckel's gaafUoa.
INF. INTERNAL -Presents

Articulation of superior maxillary ft palate bones with laohrymal ft os plani

OIBOUMFKBENOE OR BASS — Quadrilateral, looks forwards ft outwards.

bounded by supra-orbital arch and external ft internal angular
of frontal, anterior border of orbital surface ft nasal prooeai of eapericr
maxillary, and anterior border of malar bone. Presents

Supra^oriiUU notch or foramen for supra-orbital yessels ft nerye ; and assiata in fornixBf

Nasal groove for laohrymal sac.

APEZ — Gorresponds to optio foramen for optic nerye ft ophthalmic artery.

203

FOURTH NERVE, TBOGHLEABIS or PATHETICUS.

Arises from upper part tltvahteef Vteuaens immediately behind the testis. — Deep origin
is from two grey nnolei situated on floor of aqnedaot of Sylriiis & on nppez

part of floor of 4th yentricle.
Grosses prooessns e oerebello ad testes and winds ronnd nnder surface of oms cerebri

immediately in front of pons YaroliL
Pierces dnra mater in free border of tentorinn oerebelli near posterior olinoid process.
Throngh enter wall of oavemona sinns below 8rd nerre and aboye ophthalmio branch of
the 6th, receiving filaments from ophthalmio branch ft from carotid plexus t
Throngh highest and broadest part of sphenoidal flssure.
Inwards above levator palpebns snperioris to orbital sur&oo of saperior obliqntb

166

POSTEBIOB BRANCHES of the EXTERNAL CAROTID.

OCOIPITAL — AriflM Jvit below futterior belly of digMferio^ and £• oroiied dloM to ili

origin by bjrpogloeaftl nem.
Upimrdt and baokwards beneath posterior belly of digasfcrio, atylo-byoid, ft portion of

parotid gland, orossing internal oarotid artery, internal Jngnlar Tein,
gUMeo-phaxyngeal, pnenmogaetrio ft apinal aooessory nerree, - and then

between maatoid prooeaa ft transrene prooeaa of atlai.
Horisontally backwards in oodpital groore beneath stemo^mastoid, digastrio, spkniu

ft traohelo-mastoidy - and then between trapesins ft oomplens.
Fieroes upper part of trapesins, ascends beneath integnment with great oooipital nervs^

and divides into nunerons branches to upper ft back part of head.

Gives off branches :
MUBOnlar * Nnmerons small ones, and one large one to npper part of stenio-

Aaricular " To back of ear.

Uenlngeal - Through Jugular foramen to dura mater of posterior fc

Arteria FrincepB Cervicis - I)d>o®ncls beneath splenius, and divides into:

BvnMJicuL Bk. - Descends between splenius ft oomplezus, and anaito.

moses with superficial cervical branch of posterior oeapulftr.
pEXP Bb. - Descends beneath ocmplexus, and anastomoses with vertebnl

ft with deep cervical branch of superior interooetsL

POST. AURICULAR — Arises beneath or above digastric ft stylo-hyoid, and asoesdi

under cover of parotid gland ft beneath facial nerve to groove between

cartilage of ear and mastoid process, where divides into

Ant. A Post. Branolies - Which communicate respectively with posterior
branch of temporal ft with occipital, and of which the former gives off

numerous branches to back of ear. — Gives off

8tylO*2Ua8toid Art. ( Sometimes derived from occipital ) . - Through stylo-
mastoid foramen to tympanum ft semidrcnlar canals, joining with tjm*
panic branch of internal maxillary, with which it forms in yonng sab-

JecU a vascular oirole round membrana tympauL

INTERNAL BRANCH of the EXTERNAL CAROTID.

ABOENDINO PHARYNGEAL — Long, denderi fton baok of exiemal (

near its wi^o.

Aioends vertically to base of skull, in front of internal carotid artery tlLd between that

vessel ft side of pharynx, giving off bianobss :
Sbrtenud * Small, irregular, to 8th, 9th, and sympathetio nerves, and adjoining

mnsdea
piiftiyngftal -Three or fourt to the three constrictors, stylo^phaxyngans, Ess-

tachian tube, s(rft palate ft tonaiL
Meningeal -^o ^^^ mater through foramina laoera posterius ft medium, and

sometimes through anterior oondyloid forameo

167

VEINS of HEAD & NECK— Ist Tablet.

JUVnSBZOB JUGULAR VEIN ~ CkmimeiiOM in ■abmixillary Mglon and deioeiidi

beneath platjsma between itemo-maetoid & middle line of neok, and then
deeply beneath Btemo-mastoidy beneath which mnicle it oommnnioatei with
external A internal Jni^ilart, and nraall j also with its fellow by a long^ ft narrow
tranBrerse branoh. Bade ninally in rabolayian oIom to external Jvgnlar, aome*

times in terminal portion of external Jagnlar. BiBceiTefl

lasiRAL Teibutabt BRANCHBi! - ▲ fow lafytigiol tmns ft sometimea an in/mor

thyroid ffeim * Varies e^atly in diOf and ia freqnently abient on one eide

or othw*

ECTEBN AL JUGULAR VEIN — Formed by ooalaeoenoe of temporal, internal
maxillary, ft posterior anrioular, and oommenoes in substanoe of parotid gland
opposite angle of Jaw. Descends perpendionlarly oyer stemo-mastoid ft along its
posterior border, beneath platysma ftoTersaperacialcerTioaln., and, perforating
deep fasoia^ opens into subolarian externally to internal Jngnlar. Has two
pairs of ralyes situated, one at its opening into sabolarian, the other about an

inch ft a half aboTO clayicle. - BeceiTea
LinSAL Tbibutaet BaANCHn t - Suprascapular^ TransvertaUs Coili^ 6* Posienar
External yuptlar, sometimes the Occipital; - and communicates with the
anterior ft internal Jugulars, with the latter by a large branch in sub-
stance of parotid*

INTKBNAL JUGULAR VEIN - The continuation of lateral sinus opposite
Jugular foramen, in which foramen it is expanded into the gu^ or Hum cf tMi
internal mguldr vein. Descends yertioally, lying iirst on outer side of ft a little
behUid internal oarotid, then on outer side of common carotid, and finally, on
the left side, on outer side ft in IVont of common carotid, and, on the right side,
externally to ft at a certain distance from it, in front of first part of subolayian.
The eighth ft ninth neryes lie on inner side ft in front of its sinus; lower down
the spinal accessory crosses the yein posteriorly, and the glosso-phaiyngeal ft
hypoglossal pass forwards on its inner side, between it and the internal carotid i
the pneumogastrio lies along whole of neck between ft behind the two yesselsi
behind the yein are the recti capitis lateralis, anticus msjor, ft the longus colli.
- Joins subolayian b^ind sterno«clayicular articulation to form the innominate,
a pair of yalyes being situated at or a little aboye its termination. -. Beoeiyes

IskTEMAL Tkibutast Beancbes t * Occipital (usually), Facial^ Lingual^ Pharyngeal^ Sup*
mar 6* Middle Thyroid; - and communicates br a large branch with

external Jugular in subitanoe of parotid.

168

CERVICAL PLEXUS.

DEEP BRANCHES — DiTided into Intenua ft eztemaL

INTERNAL -Are,

Communicating - From loop between lai ft Snd oenrieal to |meamogMtrio» bypogloml &
■iiperior oerrioal gMig^Uon of qrmpathetioi and also fift>m 8rd ft 4th to oord of

■jmpathetao below the gangliga.
Mnsonlar-From Ifltft Snd, to reoti capitis antioi major ft minor, and rectos lateralis

Communicans Noni - From Snd ft 8rd.

Downwards ft forwards across sheath of carotid Tessels (sometimes within the abeatk,

and then either in front of or behind internal Jngnlar rein), and, near middle

of necky forms a loop with desoendens noni ; fi^m conTezity of whieh loop

branches are given off to the stemo^hyold ft •thyroid and omo-hjoidL

Phrenio or Int. Respiratoiy of Sir O. Bell - From 8rd»4th9 and nsnallj also from 5U.

Downwards ft inwards in fhmt of scalenus anticns.

Between subclavian rein ft 1st part of subclavian artery croning Internal manmarf,

and receiving a filament from sympathetic, sometimes another from 5th ft 6U

cervical nerves, and occasionally on the left side, one from the ansa hypoigloeBu

Grosses arch of Atnrta ft pulmonary artery, on the left side.

Descends, on the right side, on outer side of right innominate vein ft sup. vena caviu

In front of root of lung ft along side of perioaraum to diaphragm, and divides ia

to branches which perforate the diaphragm and supply it by its under snrCaee.

Both nerves give off twig^ to the pericardium ft pleura, and Join with the phrenic

plexus of the sympathetio, the right nerve sending also a few filamenta to the

_ diaphragmalio gaagtspa.

EXTERNAL —Are:

Communicating - Jdn spinal aooessory in substance of stemo-mastoid, in oodpital

triangle, ft beneath trapesina
MtUOnlar -To stemo-mastoid (ih>m Snd nerve), levator anguli scapulsi (from Srd>, soale.

nus medins ft trapeiius (fkom fcd ft 4th)

169

PKEUMCXa-ASTBIG NERVE.

Arises from lateral tract of medulla oblongata below glossO'Pharyngeai 6f abotfi spinal accessory, — lis deep

origin is from a grey nuolens on floor of fonrih rentriole.
Throngh jngnlar foramen behind glosso-pharyngeal & in same sheath as spinal aooessory.
Presents two ganglia, one in and one below jugnlar foramen :

Sup. oe Juottlab G. ok G. oy the Boot — Small, greyish, ronnded. Anastom. with facial^

rlossO'pharyngealy s final accessory &> sympathetic.
Iny. G. ok G. 07 THE Trunk — Beddish, cylindxical, nearly an inon in leng^. Anastom. with

hypoglossal i spinal accessory, sympathetic , loop between tioo first cervical nerves.
Descends behind & between int. k comm. carotid arteries k int. jngnlar y. and in same sheath |
Then,

On Bight Side :

Between subclavian art. & y. and along side of trachea to back of root of Inng,

where spreads ont into posterior pulmonary plexus.
Along side of oesophagus in the shape of two or more separate cords, which form

oesophageal plexus with nerve of opposite side.
As a single cord along back of oesophagus to posterior surface of stomach, and

joins solar A splenic plexuses.

On Lett Side ;

Between and in front of left comm. carotid & left subclavian arteries behind left

innominate vein.
'Across arch of aorta to back of root of lung, where similarly spreads ont and

joins with its fellow.
Along side of oesophagus as above.

As a single cord along front of cesophagus to anterior surface of stomach, and

join9 left hepatic plexus.

BRANCHES :

Auricular Br. — Arises from g. of the root, and joins with glosso-pharyngeal.

Across jugular fossa & through opening in temporal bone near styloid process s
Between mastoid process A ext. audit, meatus to integument of back of pinna.
Gives off:

Ascending Br., which joins trunk of facial in aqueductus Fallopii|
Descending Br«, which joins auricular branch of facial.

PharyXl^eal Br. — Arises from upper part of ganglion of the trunk ;
Crosses internal carotid art. either in front or behind $

Anast. with glosso-pharyngeal, sup. laryngeal & sympathetic, and forms pha«

ryngeal plexus to muscles & mucous membrane of pharynx.

Sup. Laryngeal N. — Arises from middle of ganglion of the trunk.

Descends by side of pharynx behind int. carotid artery, and divides into:

EXT. LABYNGEAL BB. — Joins with pharyngeal plexus & sup. car.

diac nerve, and supplies crico-thyroid & inf. constrictor.
IKT. LABYNGEAL BB. — Pierces thyro-hyoid membrane to aryte-
noid muscle and mucous membrane of larynx, base of tongue

& aryteno-epiglottidean folds.

Becurr. Laryngeal N. — Ar. in front of, and passes below & behind, subclav. art.

on right side, arch of aorta, on left, giving twigs to deep cardiac plexasj

Behind comm. carotid & inf. thyroid arteries, and in groove between trachea

* A oesophagus.

Beneath inf. constrictor to all the muscles of the larynx except crico-thyroid.
Gives brs. to inf. constrictor, and anastomoses with ext. laryngeaL

Cardiac Brs. — Divided into :

Gervicax Cardiac I ^. J «. rxi. tt _a

Thoracic Cardiac j ^*^® ^®^®« ^^ *^® ^^^^

Pulmonary Brs. — Divided into Anterior and Posterior, and form the ant. A post

pulmonary plexuses. (Vide nerves of the lung.)

C&SOphageal Brs. "-* Arise, some above, but most of them below, the pulmonary.

Gastrio Brs. — Bight pneumogastric supplies post, aspect of stomach and joins 80«

lar & splenic plexuses i left pnenmog. supplies ant. aspect, and joins

left hepatio plexus.

170

HYPOGLOSSAL NERVE.

Arifles by ten or twelve filamenti from groove between anterior pyramid 6* olivary body in a Ixif
oontinnonB with that of the anterior roots of the spinal neryes. These filaneia
form two bnndles which perforate dara mater separately, and pass together throtgl
anterior condyloid foramen. — Its deep origin is fW)m a grey nnolens on lower ptrt

of floor of 4tli yentrida
Passes downwards and forwards between pnenmogastric ft spinal accessory ns., with former d

which it is intimately connected, and between int. jngnlar rein h int. earotid.
Loops ronnd occipital artery and passes forwards aoross external carotid below post, bellf d

digtftne.

Passes beneath posterior belly of digastrio ft stylo-hyoid and crosses hyo-gloasns, near ast

border of which it anastomoses with gustaio:/.
Passes beneath mylo-hyoid to muscles ft snbstance of the tongue.

BBS. OF COMMUNICATION -Join with,

G. of the trunk of the pneumogastrio ; *\

Sup. cervical g. of the sympathetic ; > Arise near base of sknIL

Loop between the two first oenrioal ns. J

Gustatory n. — Arises near ant. border of hyo-glossns.

BBS. OF DISTBIBUTION - Are the:

DeBCendens Noni ** I^ng ft slender. Arises just beneath occipital artery.
Passes downwards ft forwards across sheath of carotid vessels. (Sometiiaei

within the sheath, either over or beneath int. jugular reia).

Near middle of neck forms a loop with Communioans Noni, from ooutcxHT;

of which loop, brs. are given off to stemo-hyoid ft -thyroid ui

omo>bjnii
This br. is believed to derive its real origin principally from the 4
ft 8rd cervical ns., and to have little more than an apparsv
origin from the hypoglossal, due to a temporary adhenoa el
its fibres to those of that nerve. Sometimes, owing to nmTjri
adhesions, it appears to arise from the pneumogastrio «fcii^

wholly or in ptzi

Br8.toThyro-h70id AOeni(>-liyoid--i^riseon8Qrfooeofhyo.gio«Bi. ^
BxB.''to Stylo-gloBSOB, Hyo-^ossos, Genio-hyo-^loBSCui * sab*

taaoe of the tongae. ^ AtIm beneath milo-l

ii]o.liyoi|

171

CEBVIG AL PORTION of the SYMPATHETIO.

Gontiiii on each side of three ganglia, tbo inperior, middle A inferior oerrioal (of which the
middle one is sometimeo wanting), and of their respeotiye branohes of oommnnioation
A dietribntion.

THE THREE GANGLIA:

Superior Cerylcal Gan^ion - ^o ^f:g^ nsnallj fusiform in shape and situated
between the rectus capitis antious major & the internal carotid opposite the 2nd 6*
Zrd cervical vertebra; sometimes irregular in shape A situated a little lower than
usuaL

Middle Cervical Ganglion - When present, is the smallest of the three and is situated
opposite the 5M cervical vertAra in the yioinitj of the inferior thyroid arter/.

Inferior Ceryical Ganglion - intermediate in sixe between the two others, and situated
hetvfeen the neck of the first rib &* the transverse process of the last cervical vertebra on
inner side of superior intercostal artery; is irregular in form, and is frequently
Joined with the first thoraoio ganglion.

THEIB COMMUNICATIONS:

These ganglia communicate with each other through the main oord of the sympathetic,
and with the cerebro-spinal nerves as follows :

SUPEBIOB CEBYICAL GANGLION —With:

Petrosal Ganglion of the Glosso-pharyngeal ;

Both Ganglia of the Pneumogastric ;

Trunk of the Hypoglossal;

Four upper Cervical Nerves - (Sometimes with the two upper nenres
only, the branohes of communication with the 3rd h 4th
nerves occasionally joining the cord of the sympathetic a
little below the ganglion).

MroDLB OBEVIOAL GANGLION — With :

Ftfth &* Sixth Ccrvicol Nerves - (In case of absence of the middle oervi-
oal ganglion the 6th k 6th cervical nerves join with the oord
of the sympathetio between the superior h inferior ganglia.
INFEBIOB CBBYICAL GANGLION — With:
Seventh 6* Eighth Cervical Nerves.

:i T^i:

BBAM CHSS OF DISTRIBUTION - YM« nest Tablet.

172

BBS. of DISTBIB. of the CEBV. G. of the SYMPATHETIG

ThMe ganglU give off branohee to the ndghbouring arteriet and to the TiBoera at followi i

BBS. to the NEiaHBOURING ARTERIES:

SUP. CERVICAL aANGLION - CKres off:

ASCENDING BRANCH to INTEBNAL OABOTID ABTEBY & its BRANCHES -
Large, soft, of a reddiBh grey oolonr, and appears to be the direot oontina&*
tion of the ganglion. It passes along the posterior aspect of internal carotid
artery and divides on reaching the carotid canal into internal & external
branches.
Iktebnal Bbanch - The smaller; ascends on inner side of internal carotid
artery, commnnicating with the enter branch, and goea to form Xht
greater part of the cavemons plexns,
ExTEBifAL Branch - The larger; ascends on enter side of internal carotid
artery, commnnicatiDg with the inner branch, and goes to form tie
greater part of the carotid plezns.

ANTERIOR BRANCHES to EXTERNAL CAROTID ARTERY A its BRANCHES
— Form delicaU pUxusa which accompany the external carotid artery &» i's
branches^ and on the filaments of which small ganglia are sometimes foond. -
From the plexus on the trunk of the external carotid artery a oommanica.
ting branch is given off to the digastric branch of the fac^ nerro; from
the plexus on the facial artery is derived the sympathetio root of the sab.
majdllary ganglion; from the plexus on the internal maxillary artery ii
derived the sympathetio root of the otic ganglion and also a twig to ihs
intumescentia gangliformia of the facial.

MIDDLE CERVICAL GANGLION - Gives off :

THYROID BRANCHES — Accompany the inferior thyroid arcery, oommnnioatiag
with superior cardiac nerve, and reach the thyroid body, in whioh thej
communicate with the recurrent A external laryngeal nerves.

INF. CERVICAL GANGLION - Gives off:

BRANCHES to YERTEBRAL ARTERY ^ Form a plexus round that vesael, aad
oommunioate with the cervical nerves aS high at the 4tlu

BRS. to the VISCERA — Are the:

Cardiac Nerves - Yide Next Tablet.

Pharyngeal Branches of the Superior Cervical Ganglion - Join with tha

pharyngeal branches of the ^osso^pharyngeal^ pneumogastric^ 6^ external laryngeal to
form the pharyngeal plexus, which plexus supplies the muscles h the maoose
membrane of the pharynx.

Thyroid Branches of the Middle Cervical Ganglion - Vide above.

HEAD & NECK.

III.

THE FACE

174

MUSCLES of the FACE— 1st Tablet.

Are the I
OC0IPITO-FB0NTALI3.

Frontal Portion - InnermoBt fibrei are oontinnoiis with pyramldalii naii, Ihe othen

blend with orbionlarii palpebrarum & oorrngator inpercilii.
Ocoipital Portion - Cater two-thirda of superior onrred line of occipital bono^ aad
mastoid portion of temporal.

The intervening epioranial aponenrosis is attached behind, between thi
two occipital portions, to the external occipital protuberance A to the snpenor
cnrred lines } laterally it g^ves attachment to the attrahens & attoUena anrem,
and, becoming considerably thinned, passes over the temporal fascia to the
sygoma. • It is intimately connected to the integnment, loosely to the peri-
craninm.

8., frontal portion by facial nerre, occipital portion by smaU occipital
branch of cerTical plexus & by aoricolar branch of faciaL

UnSCLES of the EAR.

AttoUens Aurem^ or Anricularis Superior - Temporal portion of epicranial

aponenrosis.

Upper and anterior part of helix & upper part of concha. - 8. by smsll
occipital branch of cervical plexus.

Attrahens Aorem, or Anrionlarls Anterior - Lateral prolongation of epioranial

aponeurosis below & in front of preceding.

Front part of helix. - S. by facial nerve.

Betrahens Anrem^ or Auricularis Posterior -Mastoid proceti.

Back of concha - S. by auricular branch of faciaL

IflUSCLES of the NOSE.

mrSCLES of the EYELIDS & ORBIT.

MUSCLES of the MOUTH.

ELEVATOR MUSCLES of the LOWER JAW - Vide following Tableta.

175

MUSCLES of fhe FACE— 2nd Tablet.

mXSOLES OF THE NOSE.

Fyramidalls Nasi - ConUnnooB anperiorlj wifcH innermost fibres of oodpito-frontaUt.

Aponenrosia of compressor nasL

CompreBSOr Nasi - Lower & inner part of canine fosa.

Aponearosis oontinnons with that of its fellow orer brid^ of nose.

Levator Labii Snperioris Alsaqne Nasi - Upper part of nasal prooess of superior

maxilla.

Cartilage of ala of nose and upper lip blending with orbioolaris A lerator
labii BTcperioris proprios.

Depressor AIsb Nasi - Myrtlform fossa or incisor fossa of upper Jaw.

Septum and back part of ala of nose.
Irregular and indistinct fasciculi may be found orer the alar cartilages forming thei
Leyator Peoprius Aljb Nasi Postbeioe oe Dilatatoe Kaeis Postbeioe,
Letatoe Feopbius ALiB Nasi Amtbeioe oe Dilataxoe Kaeis Amteeiob,

COKPEE88OE NaEIUK MiKOE.

MUSCLES OF THE EYELmS.

Orbicularis Palpebrarazn - Anterior surface and edges of tendo ooull, fotemal an-
gular process of firontal, nasal prooess of superior maxilla in firont of lachrymal
g^ooYe.
OsBicuLAE FoETiON -Thiok A red, forms complete ellipses, and blends superiorly with

occipito-frontalis and corrugator supercilii.
Falpebeal oe Ciliaet Foetior * Thin & pale, forms a series of oonoentrio onrres, and
is inserted externally into external tarsal ligament A malar bone.
TENDO OOULI OB TENDO FALFEBBABUM - From nasal process of superior
maxilla in firont of lachrymal grooYC. Crosses anterior aspect of lachrymal sac,
giYing off a fibrous lamina, the reflected portion of the tendo oouli, whioh passes
backwards & inwards behind lachrymal sac to bo attached to ridge on lachzymal
' bone. Bifurcates and is attached to inner extremity of eaoh tarsal cartilage.

Oormgator Supercilii - inner extremity of superciliary ridge of firontaL

Under surface of orbicularis ft occipito-frontalis.

Tensor Tarsi - Bidgo & posterior part of outer surface of lachrymal bone.

Crosses posterior aspect of lachrymal sao, and dirides into two slips which
are inserted into tarsal cartilages near punota laohrymalia. « May be con-
ridered as a deep part of ciliary portion of orUonlaris.

Zievator PalpebrsB Snperioris - Under surlkoe of l e ss er wing of sphanoid la firool of
optic foramen and externally to superior obliqna.
Upper border of tarsal oartilaga.

176

MUSCLES of the FAGE— 3rd Tablet.

MUSCLES of the MOUTH.

Orbionlaris Oris - G<m8iit8 of three porticmB I

LA.BIAL OB Maboikal Pobtion - Continiied nninterniptedlj firom one lip to tlie other
round the oommissures of the mouth.

Facial Pobtion -Central fibres decusBate with, the others are direotlj oontinBou
with, fibres of bnocinator.

ACCE880BT Portion - ConsistB for the upper lip of four fasoionll, the mnsonli aooet-
aorii orbicalaris snperiores, ariaing from superior maxilla opposite inolBor teeth
ft from septum of the nose; and for lower lip, of two fasoiouli, the mnsonli acoot-
sorii orbionlaris inflsriores, from inferior maxilla near the oanine teeth.

Inserted into this mnsole and into the integument ooTering it from the
middle of the upper lip to the middle of the lower lip, are the following musctot
(the last saoepted), whioh all blend more or less with eaoh other : -*

Levator Labii Superioris AlCdque Nasi - Upper part of nasal prooess of superior
maxilla.

Levator Proprlos Labii Superioris - Superior maxillary ft malar bones close to
margin of orbit.

Levator Angoli Oris or Masculas Oaninos - Canine foss* just below infra-
orbital foramen.

ZygoniaticilS Minor - Lower and frt)nt part of malar bonOi

Zygomaticus Major - Halar bone near sjgomatio suture.

Buccinator - Outer surface of alveolar processes of superior ft inferior mazin» oorrei-
ponding to the molar teeth, and from pterygo-maxillary ligament (which latter
is a fibrous band extending fr^m apex of internal pterygoid plate to posterior
extremity of mjlo-hjoid ridge of lower jaw, and whioh gives attachment poeter-
iorlj to superior constrictor of pharynx).

Its fibres are continuous with those of facial portion of orbionlaris oria, the
middle ones decussating, the superior ft inferior ones passing direcUj into oorres«
ponding lip.

Bisorios - Fascia oyer parotid gland ft masseter. -> Is often described as the upper part
of platysma mjoides.

Depressor Angoli Oris or Triangularis Oris -External oblique line of lower jaw

extemallj to mental foramen.

Depressor Labii Inferioris or Quadratus Menti - External oblique line of lowsr

jaw between symphysis ft mental foramen.

Levator Labii Inferioris or Levator Menti - Inoisor fixns of lower jaw.

Integument of ohln olose to median Una

177

FACIAL ABTEBY.

Arises abore preceding beneath thin anterior margin of stemo-mastoid.
Forwards A upwards beneath posterior belly of dlgastrio & stylo-hjoid & sabmazillary gld.
Crosses jaw bone in front of masseter.

Forwards and upwards to angle of month npon bnccinator & beneatli platjsma.
Upwards beneath zygomatioi and npon lerator angnli oris and the levators of the lip &
ala of the nose to inner canthns, where becomes angular artery and joins

with ophthalmic.
Ja Tery tortuous in its course. Facial rein lies behind it^ and is less tortuous. Gives off

branches :

Inferior or Ascending Palatine - I>ip« beneath ramus of jaw. Ascends
between stylo-glossns A .phaiyngens and then upon superior constric-
tor in front of ascending pharyngeal, and supplies tonsil & soft palate.

Tonsillar - Ascends upon and perforates sup. constrictor to tonsil & root of tongue.

Submaxillary " Three or four, to submaxillary gland & surrounding muscles.

Submental - Forwards on under surface of mylo-hyoid, and between it and

digastric to symphysis, where ascends upon chin.
Inf. Labial - Forwards beneath depressor anguU oris, below following artery to

tissues of lower lip.

Inf. Ooronary - Forwards beneath depressor anguli oris, and tortuous oourso

through substance of orbicularis and between it & mucous membrane,

anastomosing vrith its fellow.

Sup. Coronary - Larger and more tortuous ; similar course along free edge of

upper lip, giving twigs to ala and artery of septum to septum of nose.

Lateralis Nasi - To ala and dorsum of nose.

Angular - To inner canthus, supplying lachrymal sac and anastomosing with

nasal branch of ophthalmic.
All these branches anastomose freely with each other, with those of the oppo-
site side, and with the mental, transverse facial, infra-orbital, ophthal-
mioj sublingual, posterior superior or descending palatine and ascending

pharyngeal arteries.

178

TEMPORAL ABTEBY.

CommenoeB in snbstanoe of parotid gland between neck of condyle ft eoctemil anditcny

mettu

Ascends in groore between condyle & external auditory meatnoy and cronea poetenor

root c^sygoo^

ABcendfl for abont two InoheB npon temporal mnaole ft fasoiay and beneath akin ft attn-

hens anrem, with branohea of facial ft aarioalo.temporal nerres, and divides into:

Ant. Temporal -The smaller. Forwards OTer forehead, and joiai

with sapraorbital ft frontal
Post. TexnporsJ - The larger. Upwards ft baokwards, and joins with

posterior anrionlar ft ocopitil.
OiTes off before its division i

Twigs - To parotid gland ft temporo-maxillary artionlation.
Transverse Facial - Forwards through parotid gland, and aoroes face 1»

tween Bteno's duot ft sygomai joins with faoial ft infraorbital

Middle Temporal - Throngh temporal £uoia to temporal mnsde, joining

with deep temporal branches of internal maxillary. Often gires oS

Okbitax Bsamch - To enter angle of orbit along npper border of sygooM A

between the two layers of temporal fascia
Ant. Aoricolar -Two or three small branches to external ear.

179

DUBA

Ariiet from upper fart of lateral tract of meduHa obiongaia in groove Mween elroary 9t r oHf b rm
bodies, — Ite deep origin is from a grey nnoleos on floor of 4th Tentriole h from nuolens
of motor root of 6th nerve, and also, by its acoessorj portion or portio intermedia of

^ Wrisberg, from lateral oolnmn of oord.

Through internal auditory meatna with portio mollis, lying in a c^rooTO npon the latter and

portio imtermedia of Wrisberg lying between the two.
Throngh aqnednotna Fallopii, in whioh mns outwards, backwards, downwards:

Outwards - between ooohlea and vestabnle to hiatus Fallopii, where presents

geniculate ganglion or intnmesoentia gangliformis.
Backwards -in inner, wall of tympanum abore fenestra oralis.
Downwards - to styld-mastoid foramen.
Forwards in substance of parotid gland crossing external carotid artery, and divides behind
ramus of jaw into temporo-faoial ft ceryico-fiboial branches, forming pes anserinus.
Its branches may be divided into luranohes of oommunioation & branches of distribution.

•

BRANCHES OF COMMUNICATION -Aroi
In Meatus Auditorius Intemus :

One or two filaments to Auditobt K«

In Aqneductus Falloppii :

Labob Petrosal N.-to Meckel's ganglion, and supplies levator palaH^aMygosuvu!a ;
Small Petrosal N. - to Otic ganglion, and supplies tensor palati &» tensor tympani;
Ext. Petrosal N. - to sympathetic on middle meningeal artery.

Alter Exit from Stylo-mastoid Foramen:

Branches to : Glosso.phabtnoeal, Pnbumooastbic k Oabotid Plexus - Arise from

posterior auricular nerve & from nerves to stylo-hyoid ft posterior

belly of digastric.
AuBicuLO-TEMPOBAL - From temporo-facial branch.
Great Aubiculab - From posterior auricular & cerrioo-facial branches.

On the Face :

The terminal filaments join with the three divisions of the Fiyth N.

BRANCHES OF DISTRIBUTION - Are:
In AqaednctoB Fallopii :

TYMPANIC BE. - To stapedius 6* laxator tympani;

CHOBDA TTMPAKI - Enters tymp. between membr. tympani & base of pyramid |

Between handle of malleus & long process of incus.

Through canal of Huguier on inner side of Glaserian fissure |

Joins gustatory nerve between the two pterygoid muscles |

To submaxillary ganglion h lingualis superior.

After Exit from Stylo-mastoid Foramen:

POST. AUBICULAB N. - Over mastoid process to integument and retrahens aurem

& posterior belly of occipito-frontalis, and anastomoses with auriou-

laris magnus ft posterior auricular branch of pnenmogastrio.

BBS. TO STYLO-HTOID & POST. BELLT or DIGASTBIC - Arise in common, and
join, the former with carotid plexus, the latter with glosso-pharyngeaL

On the Face :

TEMPOBO-FACIAL BB. - The larger. Anastomoses with auriculo-temporal, and

divides into temporal, malar &* injraorbital branches,
CEBYICO-FACIAL - The smaller. Anastomoses with great auricular, and dirides*

into buccal, supramaxUlary 6f* inframaxillary branches
These terminal branches of the fSksial nerve supply all the muscles ot
expression of the face ft the platysma, and anastomose with *^'^
ophthalmic, superior ft inferior maxillary nerves and wit*

great au*

180

THE SALIVABY GLANDS— 1st Tablet

Are the parotid, snbinazillary & snblingnali and nnmeroni imaller glands aitiiated besaat^
the mnooos membrane of the month. Thej are all conglomerate or raoemoae gU&di.

PAROTID aiiAMD

Lies below A in front of external ear, and Btretches forwards to a Tariable extent on ocser
surface of masseter, often presenting in that situation and jnst below sjgoma, •

small detaohed portion, the sooift parotidia

Is bounded by :

Above - Zjgoma.

Bklow - Line drawn from angle of jaw to stemo-mastoid.
Behind * External auditory meatus, mastoid process, stemo-mastoid, posterior

belly of digaitiie.

Presents t

Outer Surface * Lobulated. CoTered by integument, &8oia & a few fibm of

platjsas.

Inner Surv ace * Prolonged deeply in front of and behind styloid process to>

wards internal carotid & internal jugular Toin, wall of pharynx & dctp

part of glenoid fbcx
Ant. Surface - Grooyed externally for posterior border of ramus, and pro-
longed forwards, internally, between the two pterygoid musclet.
Post. Surface * Bests upon external auditory meatus, mastoid process, 8ten>

mastoid, posterior belly of digastm
Is perforated by seyeral

Arteries - External caroHd with its posterior auricular^ internal maxilUry k

temporal branches, and the trann*erse facial olfiMt of the Ifttter.
Veixs ^Internal maxillary & temporal forming origin of external jugular^ and »
branch of communication between the latter & the internal jagii2sr.
"^i RTES '"Facial^ anriculo^temporal & deep &cial branches of great auricular.

ITS VESSELS h NEBYES aro — Arteries ft Veins, from or to above mentioned
trunks. - Lymphatics, to two or three lymphatic glands in substance k »
surface of parotid, and from thence to superficial & deep glands of neck.
- Nerves, from carotid plexus, auriculo- temporal ft great auricular.

PAROTID DUGT ( Steno's or Stenson's ) ^ Prom anterior border of the glasi,
and frt)m socia parotidis when it exists. - Over masseter a finger's breadth
below zygoma, its direction being marked by a line from lower part of concha to
midway between free margin of the lip ft ala of the nose. Through fkt of cheek h
buccinator, and obliquely beneath mucous membrane, which it perforates opposite

2nd molar tooth of upper jav.

HEAD & NECK.

IV
PTERTGO-MAXILLART REGION

220

ARTICULATIONS of the CBANICTM with the SPINE

Are the occipito-aUmd and oedfita*axoid artIoalation8| from whioh artionlattoiii the a^o-eMi

artionlation oannot well be repar&ted

OGCIPITO-ATLOID ARTICULATION — OonaiBtB of a double artbrodia betww:

condyles of oooipital and superior artionlar snrfaoee of atlas i the oondyles ben:
oonrex from before backwards & inwards and looking downwards ft oniwArds, sft4
the artionlar surfaces of the atlas being oonoaTe from before backwards h inward]

and looking upwards & inwards. The ligaments are: -

CftpSUlftr * Two. Thin ft loose; surrouad the arthrodial articulations. The sjnoml

membranes of these articulations often communicate with that of the
A^ii.r% 1 t». AX11J m— syndesmo-odontoid SkTticulatioa

Ant. Oocipito- Atloid - Two :

Superficial - Strong rounded cord from

Basilar process to - Anterior tubercle ofailas*
Beep - Thin ft oroad membrane from

Anterior margin of foramen magnum to - Upper border of anterior arcJk ofaHai
Post. OCCipito- Atloid - Thin ft broad mttmbrane from

Posterior margin of foramen magnum to - Upper border of posterior arch ef oUoi
it IS perforated on either side b> Tertebral artery ft saboooipital a.
Lateral Oocipito- Atloid - Two. strong bands from

Jugular process to - Base of transverse process ofatieu,

OCCIPITO-AXOID ARTICULATION — Ko direct contaob between the two bonsi,

but the two bones are firmly connected together, nevertheless, by the following ligts: -

OCOipito-Axoid - Strong broad band expanded superiorly, and which may be considered

as a continuation upwards of the posterior common ligament of the bodia

of the yertebrs ; froai

Btuilar groove of occipital^ where it becomes continuous with dura mater d

skull, to - Posterior surface of body of axis. - It oorers and conceals tlu

cruciform ligament
OOCipito-OdOZltoid -- Three, two lateral ft one median.

Lateral Occipito-Odoktoid ob Check Ligaments - Strong rounded cords from

Rough depression on inner side of condyles of occipital to ^Sides of odontoid pr, near its apex*
Hediak or Subpeksort Occipito-Odontoid Ligament - Strong band from

Anterior margin of foramen magnum to - Apex of odonttfid process* - This band ii
situated between, ft blended superiorly, with deep anterior occipito-atijii
ligt., on the one hand, ft upper fasciculus of cruciform Ugt. on the oihdr.
Yebtical Fasciculus of Cruciform Ligt. - Y. below.

ATLO-AXOID ARTICULATION — is a comrlex articulation consisting: L of a

double artbrodia between the articular processes, the articular surfaces <tf whxh
are large, fiat, circular, and inclined downwards ft oatwarda. 2. of a double diar-
throsis rotatorius between the anterior ft posterior sarfaces of the odontoid prooe>s
on the one hand, and the posterior ft anterior surfaces respectiyely of the smterior
arch of the atlas ft of the transTorse ligament, on the other hand, (atlo<4)dontoid ft
syndesmc-odontoid articulations, OruTeilhier). The ligaments are : ••

Capsnlar - Two. Thin, loose, strongest externally ; surround the two arthrodiss.
Ant. Atlo- Axoid - Two :

SuFBRFiciAL - Strong rounded cord from

Anterior tubercle of atlas to - Bast of odontoid proccess ^ front of body ofaxiu
Deep - Thin ft broad membrane from

Lower border of anterior arch ofallcu to - Bast of odontoid process &* front of body efa^

Post. Atlo- Axoid - Thin ft broad membrane from

Lower border of posterior arch ofeUlas to - Upper border of lamina of axis,
TranSYOrsO ~ strong transverse band, broadest in middle, which diyidea ring of atlas intfl

a small anterior part, in which anterior part the neck of the odontoid
process is firmly constricted, and a much larger posterior part, whick
transmits the cord ft its membranes ft the spinal accessory nerres. II

is attached on each side to s

Thbercle on inner surface of lateral mass of atlas - Its anf erior sarfaoe is lined witi

synoTial membrane of syndes mo-odontoid articulation. From its oppei

ft lower borders, or rather fr^m its posterior surface, are Rirenoffcm

fasciculi, which pass upwards ft downwards to be attached, the one to tbt

basilar groove, the other to posterior surf ace of body ofcLxis ; with the trant<

Terse band, these vertical fasciculi torm the cruciform, ligatte%t

The synovial membrane of ihe syndesmo-odontoid articulation oAim

communicates with one or both of those of the ocoipito«atloid anhrodia

HEAD & NECK.

VIII.

NASAL FOSS^, AND DEEP VESSELS

& NERVES OF NECK.

184

MI]SOI^ES of the FACE-6th Tablet

ELEVATOR MUSCLES of the LOWER JAW.

Masseter.

BupBEi iciAL PoniOK - Anterior two-thirdi of lower border of ijgonallc ftrok.

Angle ft lower half of outer enrfaoe of ramna.
Dbbp POBTiON - Posterior third of lower border A inner mirlkoe of sjgomaftie arbh.

Upper half of oater surfaoe of ramus ft ooronoid prooeee. - 8. bj anterior or
smaller diyision of inferior maxillary nerre.

Toxnporal - Whole extent of temporal foesa^ exoept anterior wall, inner iiirfiMO of tssi*
poral fascia.

Apex, inner snrfaoe ft anterior border of ooronoid prooesi down to ite root*
8. by anterior or smaller division of inferior maxillary nerre.

Internal Pterygoid - Pterygoid fossa, and more partionlarly firom inner sarfiMe of si*
temal pterygoid plate, and from groove on pterygoid process of palate bone.

Angle and inner snrfaoe of ramos as high as dental foramen. - 8. by aBte>
rior or smaller diyision of inferior maxillary nerve.

Bztemal Pterygoid.

Uppkk Head - Pterygoid ridge ft portion of nnder nirlkoe of great wing of spheomi

between it and base of pterygoid process.
Lower Hsad - Oater surface of external pterygoid plate ft taberoiity of aaperiar

maxillary and palate bones.

Depression on front of neok of condyle ft interartionlar fibro-oartilage d

temporo-maxillary artioolation. - 8. by anterior or smaller division of iBferior

maxillary nerve.

165

TEMPOBO-MAZILIiAEY ABTXCULATION.

I9 a double or.bilatoral condyloid artionlation (CrnTellhier) oompri«6d between the condyles of
the lower jaw, on the one hand, and the anterior root of the sjgoma ft anterior part of the
glenoid oaTityi on the other. The artionlation is dirided into two by an interartioalar fibro*
cartilage, and presents two synoyial membraneB, of which the npper one is the largest ft
loosest. The interartionlar fibrocartilage is thickest at the periphery, especially behiadi
its upper f nrface is concaro^conTex from before backwards ; its nnder surface is ooncaye;
its circnmferenoe is connected externally to the external lateral ligament, internally ft in
front to the tendon of the external pterygoid. - Occasionally it is perforated in the centre,

the two synorial membranes then oommonioating.

UQAMENTS - Are t

Capsular - ^in ft loose i from

Circumferenci rf gftnrid ^tofUy &* tminefUia arHctUaris to

Neck of Condyle --' ' - ^\

External Lateral - Broad band downwards ft backwards from
Outer surface ^ tubercle of zygoma to
Outer surface 6* posterior border of neck of condyle*

Internal Lateral - Long ft thin band from
Spine ofspkenoid to

Inner margin of dental foramen, -It is related externally the to external pterygoid
muscle, internal maxillary artery, and inferior dental Tessels ft nerre.

Stylo-Maxillary - Long thia band of somewhat secondary importance from
Apex of styloid process to

An^e &^ posterior border of ramus of jaw^ where it spreads ont considerably
and marks the separation between parotid ft submaxillary glands.

MOVEMENTS - Are depression, eleTation, projection, retraction, lateral displacement ft cir-
cumduction. In slight moTcments of eleTation ft depression the condyles simply
rotate on a transTcrse axis upon the interartionlar fibrocartilages. In more
extensiTO moTements not only do the condyles rotate as abore, but they also pass
forwards with the interartionlar fibrocartilages upon the eminentie articn-
lares, the displacement being due to the laxity of the superior synorial mem-
brane ft to the action of the external lateral ligament. This displacement
also takes place on the two sides alternately in the lateral or grinding more-
ment of the Jaw, and on both sides simaltaneoasly in the projection of the

jaw forwards^

186

INTERN Ali MAXILLARY ARTERY.

Commonces in sabstance of parotid gland behind neok of condylo.
Hay be divided into three portions ;

FIBST or MAXILLARY PORTION — Forwards beneath tendon of
external pterygoid, and between neck of condyle A internal later&l

ligament of Jaw, orossing inferior dental nerr*.

GiTOB off T^ympanlOi Middle meningeal, Small meningeal,

Inferior dental

SECOND OP PTERYGOID PORTION — Forwards & npwards on oater

snrfaoe of external pterygoid, between it A temporal mnielt.

Gires off two Deep temponil, Masseteric, Ptexygoid^ A Bnc-

caL
THIRD OP SPHENO-MAXILLARY PORTION - Into spheno-nui.

illary fossa between the two heads of external pterygoid.

Giyes off Alveolap, Infraopbital, Vidian, Pterygo-palatine,
Sap. OP descending palatine, Nasal op Spheno-palatise.

Sometimes the artery passes behind, and along inner surface of, external pterygoid

mnsclei between it & iatenud pterygoii

187

BBANCHES of the INTERNAL MAXZLLABY.

T^ympft'n^ft - Through Glaserian flBtare to tjmpannm, where Joins with Btylo-mastoid*

Mlddlft or Great Meningeal - Through foramen spinosnm, and dividea into:

AjiTEBioa BsAKCH - Aorofs great wing of sphenoid to grooTe or oanal on anterior inferior

angle of parietal, and diWdes into nnmerons branohes to dnra mater St sknlL

FosnsiOB BaANCH - Crosses sqaamoos portion of temporal bone, and divides into similar

branches. Gives twigs to facial nerve through hiatns Fallopii, wbioh twigs

Join with stylo-mastoid.

PtwhII Meningeal *- Arises frequently firom preoedingi through foramen ovale to dnra mater of

middle fossa.

Inferior Dental - Witb inferior dental nerve, similarly dividing oppodte first bicuspid tooth

into incisor & mentai hrancheSt and likewise giving off
MylO'hyoid branch - Along mylchyoid groove to mjlo-hyoid muscle.

Deep TemporsJ - Two, anterior and posterior. Ascend between temporal muscle h perioranium.

Ftexygoid -* Vary in number and precise mode of origin.

Masseteric ~ Through sigmoid notch to masseter.

Buccal - Forwards upon buccinator to structures of cheek, Joininp: with focial.

Alveolar - Descends upon tuberosity of superior maxilla, and dirides into numerous branohes to

molar teeth, gums & lining membrane of antrum*

Infraorbital - Through infraorbital canal with superior maxillary nerve. Bends small twigs

into orbit, and others to front teeth through canals in anterior wall of antrum,

and divides beneath levator labii superioris intot
Ascending branches - To inner angle of eye, whore they join with nasal ;
Descending branches -^o upper lip; join with transverse facial, superior coronary h

buceaL

Vidian -Witb vidian nerve through vidian oanal to upper part of pharynx & Eustachian tubei

gives a twig to tympanum.

PtexygO-Palatine - With pharyngeal or pterygo-palatine nerve through pterygo-palatine canal

to upper part of pharynx & Eustachian tube.

Superior or Descending Palatine - Descends with anterior or great palatine nerve through

posterior palatine oanal, sending twigs to soft palate. Forwards in groove on
hard palate, giving twigs to mucous membrane & gums, and ascends through

incisor foramen to join artery of septum.

Nasal or Splxeno-FalatinO" Through spheno-palatine foramen with superior nasal k naso-

palatine nerves, and divides into :
Imtebval Bbakch oa Abtebt or Bbptux - Downwards ft forwards along septum, and

joins with termination of descending palatine.
BxTiBiTAii Bbakchbs - Two or three to mucous membrane of outer wall of nose, and to

ethmoidal & sphenoidal cells h Antrum*

INFBBIOR MAXILLAB7 NSRVB.

The Urgett of the tlirea dirlilOBi. Both wnaarj 9i motor, Iti two rooti uililng ImmaS^Mi

after their exit flrom foramea otiI&
Dirides a few lines below bate of ahull intoi

ANTERIOR or SMALLER DIVISION - Principally motor. DiTidee into :

MasseteriO Br. - Ootwards abore external pterygoid mnicle and through BgDcti
notch to maeseter. Girefl off a twig to temporo-mazillary artioalation h mme-

times one to temporal mncele.

Deop Temporal Bra. - Two, anterior & posterior. Outwards aboTO external ptenr-
gold muscle and reflected upwards at pterygoid ridg^ to temporal muscle. An
sometimes joined, anterior one with buccal nerre, posterior one with masseterx.

BnCOStl Br. - Pierces external pterygoid, and forwards on buccinator, giring filamenti

to temporal muscle, integument A mucous membrsoe.

Ptorygoid Bm. - Two, to internal & external pterygoid muscles. Branch to int«niil
pterygoid gires off motor root to otic ganglion. Branch to external pterygoid a

frequently derived irom baoct.

POSTERIOR or LAROER DIVISION — Sensory with a few motor fibrea. DiTida

into:
Anrloulo-texnporal N. - Has generally two roots which embrace middle menin?«al

artery. Backwards beneath external pterygoid ft neck of condjle;
Upwards with temporal artery between condyle & external ear under oorer o^

parotid gland, and diTidee intc:
AuaicuLAR Brs. - Inferior & superior, to outer surface of pinna, jch.

ing with great auricaltr.
Tkiiporal Bbs. - Anterior ft posterior; with branches of tempcnl

artery to skin of temporal region ft Term.

Joins facial nerve behind neck of condyle usually by two branches ; giTM

off sensory root of oUo ganglion and filaments to parotid gland k

temporo-maxillaiy artiealatioa

Gustatory or Lingual N. - Between the two pterygoid muscles, where it lies o«
inner side ft in front of inferior dental nerve, and is joined by chorda tympsni;
Abore deep portion of submaxillary gland ft along side of tongue, oroesing Whar-
ton's deet
Supplies mucous membrane of mouth ft gums, submucous glands, conical ft fu-

giform papillfls and mucous membrane of tougsa

GiTes sensory branches to submaxillary ganglion, and anastomoses with hTp(w

glossal nerve on anterior margin of hyo-glossus ft near tip of toug^aa

Inf. Dental N. - Between the two pterygoid musoles, where lies behind ft on ostar

side of gustatory ;
Between ramus ft internal lateral ligament of temporo-maxillaiT articnlatioa so

dental foramen, where gires off nerre to mylo*hyoid masc a
Along inferior dental canal, giving branches to molar ft bicuspii teeth, ft divi.

des at mental foramen into:
Ikcisob Ba. - Onwards in dental canal to canine ft inoisor teeth.
HiHTAL Be. — Divides beneath depressor anguli oris into nnmenm
branches to muscles, skin ft mucous membrane of lower Mp.

SraBTB TO MYLO-HTOID - Along gprooTe on inner surface of ramus to

under surface of mylo-hyoid ft anterior belly of digsstns
N.— All the terminal branches of the 6th nerre upon the fftoa

join with facial nerfa

HEAD & NECK.

V.
SUB-MAXILLART REGION.

190

MUSCLES.

Digastrio "* IMgaitrio grooTo on inner dde of maatoid prooess. - Perfbratoe ttjrlo-bToil
and is held in connection with body & great oomn of hroid bone bjr an tfoo*
enrotio loop lined with synoTial membrane, firom which loop it is rtiiaeui
upwards A forwards to

Bongh depression on inner lip of lower border of jaw bone close to wfm.
phjsis. - S., posterior belly by fadal nerre, anterior belly by mjlo-h/oi
branch of inferior dental nerre.

8tylO*Hyoid - Hiddle of enter surface of styloid process.

Body of hyoid bone at its janotion with great cornn. - S. by facial turn.

l^ylO-Hyoid - Whole length of mylo«hyoid ridge.

Body of hyoid bone & median raphA from hyoid bone to symphysis, -i
roylo«hyoid branch of inferior dental nerTC.

Qonlo-Byoid * inferior genial tubercle.

Anterior Burfaoe of body of hyoid bonei -> S. by hypoglossal nerre.

191

FACIAL ABTEBY.

Arises abore preceding beneath thin anterior margin of sterftO-maBtoid.
Forwards A upwards beneath posterior belly of digastric & stjlo-hyoid & sabmazillarj gid.
Crosses Jaw bone in front of masseter.

Forwards and upwards to angle of month upon bnooinator & beneath platysma.
Upwards beneath sjgomatioi and npon levator angnli oris and the levators of the Ifp &
ala of the nose to inner oanthns, where becomes angular arterj and joins

with ophthalmic.
Is Terj tortnons in its conrse. Facial rein lies behind it, and is less tortooos. Giros off

branches :
Inferior or Ascending Palatine - Dips beneath ramus of jaw. Ascends
between stylo-glossus & -pharyngens and then npon superior constric-
tor in front of ascending pharyngeal, and supplies tonsil & soft palate.

Tonsillar - Ascends npon and perforates sup. constrictor to tonsil & root of tongue.

Submaxillary -- Three or four, to submaxillary gland & surrounding muscles.

Submental *- l^onrards on under surface of mylo.hyoidy and between it and

digastric to symphysis, where ascends upon chin.
Inf. Labisd ~ Forwards beneath depressor anguU oris, below following artery to

tissues of lower lip.

Inf. CSpro T^f^^y - Forwards beneath depressor anguU oris, and tortnons course

through substaaoe of orbicularis and between it & mucous membrane,

anastomosing with its fellow.

Sup. Coronary - Lftrgor and more tortuous; similar course along free edge of

upper lip, giring twigs to ala and artery of septum to septum of nose.

Lateralis Mas! - To ala and dorsum of nose.

Angular - To inner canthus, supplying lachrymal sac and anastomosing with

nasal branch of ophthalmic.
All these branches anastomose freely with each other, with those of the oppo-
site side, and with the mental, transrerse facial, infra-orbital, ophthal-
miO|Sublingnal| posterior superior or descending palatine and ascending

phaiyngeiJ artsriesL

192

THE SALIVABY GLANDS-^nd Tablet.

BXJBMAXILLARY QLAKD

Intermediate in sise between parotid & sablingnal. Preaenta two porilonii

Superflcial Portion - The largeat.

Covered by - Skin, superficial fiMday platjima, deep fiuo!*, bod/ of lower Jav.

Rests upon - Stylo- & hjo-gloesi & mylo-hyoid.

Separated posUrioriy from parotid by - Stylo-mazillaiy ligament.

Grooved posteriorly 6* abo9t by - Facial artery.

Deep Portion -* The smallest.

Prolonged upwards forwards 6* imwardt round Wharton'a dvol^ b a i woo n nylo*

hyoid and hyo- h genio-hyo-gloasi & below giulatoiy norti.

WH ABTON'S DUGT *— Upwards forwards h inwards with deep portioa of the glaal

on inner side of sablingnal gland, and opens on summit of a tmall papilla

on side of freBnum lingnss. Is about S inches long, and has muoh thinasr

walls than Steno's duoti it reoeires a few of the dnotus RiTiniaai.

Timu & Nketbs --Arteries^ firom facial h linguaL - Nerves^ from submaxillary

ganglion, WTB^j^oXtMA & mylo-hyoid brmaoh of iafinior daataL

SUBLmaUAL QLAND

The smallest, flattened, ft almond-shaped.

Projects beneath mucous membrane of floor of mouik in the shape of • finn aniare.

poswonor ciosw
Zies upon mylo-hyoid by side of firmnum lingua & in sublingual fossa of lower

jaw.
ITas bekind it ^ on its inner side genio-hyo-glossus, gustatory aerre, Whartoo'i

duct & deep portion of submaxillary gland.

DUCTUS RIVINIANI — From 8 to SO. Open moat of them direotl/ into the

mouth, some into Wharton's duct. One, longer than the others, tho duct
of Bartholin, which is sometimes deriTod in part from submaxillaTy gland,
aooompanies the Whartonian dnct, and opens into it or near it on floor of

mouth
TisssLS ft NsKTis ^ Arteries^ from sublingual ft submental branches of faoiaL -

A^rws, from gasiatory.

108

HYFOGLOSSAIi NERVE

AriiM bj ten or iwehv ffluBenii from grdtm t dw e m mOtrhr fyrawM 6* Mwy iotfy la a lino
oonilniioiui with that of the antorior looto of the ipliial nenrei. Theoo iUamonto
form two bmdlM whioh perforate dnra mater wparatelj, and pan together through
anterior oondjlold foramen, — Ite deep origin ia from a grej nnolene on lower pari

of floor of ith Tentride.
PaaMi downwards and forwards between pnenmogaetrio A spinal aooessorjr ns., with former of

whioh it is intimatelj oonneoted, and between int. jngnlar rein h int. oarotld.
Loops found oooipital artery and passes forwards aoross external earotfd below post bellj of

digastriou
Passes beneath posterior bellj of digastrio h stylo-hjoid and o ro sses hjo-glossiis^ near ant,

border of whioh it anastomoses with gastsloiy.
Passes beneath mylo-hjoid to mnsoles h snbstanoe of the toogns^

BBS. OF COMMUNICATION - loin with«

G. of the tmnk of the pnenmogaBtrio ; *%

Bnp. cerrioal g. of the sympathetio ; > Arise near base of AsSU

hoop between ibe two first oerrioal ns. J

Gustatory n. — Arises near ant. border of hyo-gl<

BBS. OF DISTBIBXTTION -Are the t

DdSCendens Noni — Long & slender. Arises Just beneath oooipital artory.
» Passes downwards & forwards aoross sheath of oarotid Tsssels. (Sometimes

within the sheath, either orer or beneath inip Jognlar rein).

Near middle of neok forms a loop with Commnnioans Noni, tfom oonTesity

of whioh loop, brs. are giren oif to stemo-hyoid A -thyroid and

omo-hyoid
This br. is belieyed to derive its real origin prinoipally from the 1st
& 2nd oenrioal ns., and to hare little more than an apparent
origin from the bypoglossal, doe to a temporary adhesion of
its fibres to those of that nenre. Sometimes, owing to similar
adhesxons, it appears to arise from the pnenmogastrio either

wholly or In partb
Btb. to Thyro-hyold ft Oenio-hyold — Arise on sorfaoe of hyo-glossna.

Bn. to Stylo-glossos, Hyo-gloasiui, Oenio-byo-^lossos A Bab»»

tanoe of the tongae. — Arise bsneath mjlo-hyoid*

24a

2d2

THE PEBICABDIUM.

fIbro-Mrou mc •ontaSnSiig tb« hmri 4 the oommenoeBient of the Urge re— eli.

Tb« aeroiis Ujer (bms a oomaioii sbflftUi fto the aort* A pulmonary artery as far as
aboni two incbet from tbeir origin. It ia ttaoa reflected apoa the anterior aipeot of tbe
▼enm caTm & pulmonary reina, and npon the inner aorface of tbe fibrona Inje". <•
Marsbaira ^'restigial fold of tbe perioardinm" containing the remains of the lull sop-
erior cardinal Tein of the embryo, may be seen in front of the root of tbe left lang.

Tbe fibroni layer ii prolonged npon the great Tessela of tbe root of tbe necV, and
beoomef oontinooa snperiorly with the deep layer of the deep cerrioal fascia, that is to

•ay with the layer of £Mcia which endoaea tbe omo-byoid mnsolei^ the carotid resseU,

& the trachea.
Tha parioardiam ia conical in ahape, and preientB i *

Antarior Aspect - Oorared by loote areolar tissue & remains of thymns gland, langs, plenra^,
ffjiddle piece of staronm, and costal cartilages of the left side from the 8rd to the 7ih.
POftarior Aipeot - in contact with roota of the langs, cssopbagns & descending aorta.
Lateral AepeotS - Oorerod by plenrm, and crossed by phrenic nenre & snperior phrenic re eela
Apes * Directed upwards npon great Tessels.
Base * Attaohad to oaalral or oordiform tandoni ft to left anterior oostel fibraa of diaphragnu

233

THE HEABT.

Um within tbe perioardinniy between the two Inngf, behind the lower two-tbirdi of tbe
cternnm^ and prcjeote sbont three inches into the left side, & one into the right eide

of the thorax. - It preoenti t

Ba86 * formed bj the ftnriolee, ftttaohed to the gpnat Teeielit directed npwftrde baokwarde
A to the right} oorresponde to the interral between the 5th & 8th dorsal rertebrsBw

Ap6Z - Vormed hj the point of the left Tentride^ directed downwards, forwards & to the left |
•onesponds to the 6th interoostal space of the left sidei two inches below and one

to the inner side of the nipple*

Antorior SurfaOO - Vormed chiefly by right Tentriole, the anterior interrentricnlar groore
^jing near the left border ; ponTeZp looks upwards & forwards, and extends from
lerel of vpper borders of third costal cartilages to a line drawn fh>m lower end of

gladiolus to sitnation of i^pext

Posterior SnX&CO *- Formed ohieflj by left Tcntride, the posterior interrentricnlar groore

lying near the right border i flattened; rests npon diaphragm*

Bi^t Border - I<onft ^hlni rests npon diaphragm | formed by right Tentriole^

Left Border - Bhort thioki mnch less inclined than the right onei formed bj left

Tentride.

28a

234

THE ARCH of the AORTA.

Wrom upper part of left Tentriole to left Me of lower border of bodj of iUi doml Y«iebr»
(some anthoni say Srd, some aaj 5th), deaoribingf a ovrre, the ooiiTezitj of which ii

direoted npwarda & to the right. le dhrided into t -

ASOBNDINO PORTION — Aboat two inohei long. Upwards, forwarda, * to the

right from opposite centre of ttemnm on a IctcI with lower border of Srd
costal cartilages to upper border of 8nd costal cartilage of right aide close to
stemnm. Contained in perioardinm together with track of pnlmonary

artery. - BSLATIOHSs
Ih Fbomt - Palmonary artery, right anricnlar appendix, perioardinm, loose areolar

tissue, remains of thymus gland, atornoa*
Behind - Bight palmonary Teasels, & root of right long.
To THB Bight - Soperior vena oara, right auricle.
To THB Lsn - Trunk of pulmonary artery.

TBANBYERSE PORTION — Backwards ft to the left firom upper border of 2nd

costal cartilage of right side close to sternum to left side of body of Srd dorml
rertebra (some authors say 8nd, some say 4tb). - RELATIONS :

In Fbont - Left pneumogastric & phrenic neryes, cardiac branches of sympathetic^

left lung h plenrs.
Behind - Trachea, osBophagus, thoracic duct, left recurrent laryngeal nerve^

great or deep cardiac plexus.
Abote - Left innominate Toin, innominate, left common carotid, 4 left sobolaTiaa

Bblow - Left bronchus, right pulmonary artery, left recurrent laryngeal nerri^

remains of ductus arteriosus^

DXSOBNDINO PORTION — Along left side of Srd ft 4th to lower border of 4th

dorsal rertebra (some authors say along left side of Snd ft Srd to lower bar«
der of Srd, some say along left side of 4th ft 5th to lower border of 6th), where

it becomes thoracic aorta. - BBLATIONS :
In Front - Pleura, root of left lung.

Behind - Body of 4th dorsal yeriebra (some authors say of Srd, some say of Sch).
To the Bight - (Esophagus, thoracic duct.
To the Ler - Left lung ft pleura.

The aorta is somewhat dilated jost aboTC its origin, where it pr^
sents externally three small bulgings corresponding to the sinuses of
TalsaWa} two of these bulgings are anterior, and one is posterior; and
from the two anterior ones the coronary arteries are seen to ariae. The
most prominent part of the arch lies aboat J of an inch behind the pos-
terior surface of the sternum. The height to which the arch usually
rises in the chest is about I inch below the upper border of the stemua.

BRANCHES — Left or Anterior, A Right or Posterior Coronary,

Innominate, Left Common Carotidj Left Bubolayiam

235

THE THORACIC AORTA.

OommonooB %i left Bi4e of lower border of 4ili donal Teriebrs (■onto Anihort taj Srd. some umf
0th). Deeoends thronfifh poeterior mediasiinaniy oarring sUghtly forward[s and inoUning
■light!/ to the rights and ende at aortio opsning of diaph ragpn in front of ISth dorsal rerte*

bra. - RBLATIONSt

Ix 7bont - Root of left long, perioardinm, (Bsophagoi.

Bbhikd - YertebriB, rena asfgos minor.

To THB Bight - (BsophagnB (aboye), Tena aiygos major, thoraoio dnotb

To THB LxiT - Left lung ft plenra, ooaophagoa (beloir).

BBAMC$HES :

Perioardlao - Small, irregnlar{ forward! to perioardinm.

Bronollial ~ ^be nutrient TosseU of the Inngs. On left eide, generally two arising

from thoraoio aorta one aboye the other; on right side, bnt one nsnallj
arising either from first aortio intercostal, or from front of aorta in common
with artery of left side. Along back of corresponding bronchos, diriding &
Sttbdiridiog npon bronchial tabes, and supplying bronchial glands & cellular

tissue of lung I give a few twigs to ossophagus.

C&CK>plia^6al ~ Usually four or fire from front of aorta. Descend obliquely upon oosopha-

gus anastomosing with each other, and with the oesophageal branches

of the inferior thyroid, inferior phrenic ft gastric.

Posterior Mediastinal - Small irregular branches to glands and cellular tissue of

mediastinum.

Aortio Ixiteroostals - From back of aorta. Usually ten in number, sometimes only

nine, the second intercostal space being sometimes supplied, as well as the
first, by the superior intercoetal branch of the subclarian. To corres-
ponding intercostal space, passing on
Lsn SiPV - Beneath imaller azygos ft left superior intercostal yeins,

and left oord of sympathetic ;

Right Sidb - Round bodies of Tortebrea beneath ossophagus, thoraoio

duct, greater azygos, ft righc oord of sympathetic, - and divide

into anterior ft posterior branches.

AxTEBios Bxakch,obIntbrco8Tal Fbopib - Upon external intercostal muscle and

beneath pleura ft a thin layer of fascia, to lower border of rib abore, and

dirides between the two intercostal muscles into branches t
Superior - The larger} along groore on inner surface of rib above;
Inferior - The smaller; along upper border of rib below, - which branches
supply intercostal muscles, and anastomose with thoracic branches of
axillary ft anterior intercoetal branches of internal mammary.

The three last intercostals are prolonged between abdominal muscles,
and anastomose with epigastric, inferior phrenic ft lumbar; the first one
anastomoses with superior intercostal. - In the intercostal spaces the vein
usually lies abore the trunk of the artery ft its superior branch, and the

norre below.

Pobtbbiob ob Dobsal Bbanch - Backwards on inner side of superior or long costo*

tranarerse ligament with posterior branch of corresponding spinal nerrs^

and divides into branches :
S/inai - Through intervertebral foramen to oord ft its membranes and pes.

^ terior aspect of bodies of rertebrss.

Mueetthr - Dirides into inUmal offset to multifidns spinas ft integument near

ipine^ and external offset^ which passes between saoro-lumbalis ft

longiaiimiu doni to inperfloial mnioiei ft integomeiit

sa6

INNOMINATE ABTEBY.

Arises fWim oommeiioeiiieiit of ftroh of ADiia in firont of left oommon carotid.
Upwards & to the right to upper border of right stemo-olaTioiilar artloixlatioii« where diridee

into right oommon oarotid 4 right snbolaTiaii.
Giyes off ocoasionallT the thyroidea ima. Its length is usually firom an inoh to an inch 4 a

halt— BSLATIONSi
In Fbout — Stemtun, stemo-h^d & -thyroid, remains of thymus glandj
Left innominatedright inferior thyroid veins }
Inf. oervioal oardiao br. of right pnemnogastrio.
Bbrind — Trachea.

On Innsb Side — Left common carotid, remains of thymns gland.
^ On Outbb Sidb — Bight pnenmogastrio n., right innominate vein, pleura.

Thyroidea Trpa. — is very yariable in sise, when present. Usually arises fWnn ta«
nominate^ sometimes tram right oommon oarotid or from Aorta. Aaoends ia

front of traohea to tliTroid ^laad.

COMMON CABOTID ABTEBY.

Bight common oarotid arises from innominate artery behind steno-olaYicnlar artioiilatiott.
Left common carotid arises from highest part of arch of Aorta, is longer, and has a thora.

cic portion deeply situated within the thorax.

THORACIC PORTION OF THE LEFT COMMON CABOTID ART.

Upwards A outwards to root of neck. — BELATIONS :

In Fbomt — Sternum, stemo-hyoid & -tiiyroid, left innominate t., re-
mains of thymns gland.
Behind «— Trachea, OBSophagns, thoraoio duot.
On Inneb Sidb — Innominate artery.

On Ovtbb Sisi— LeftpneumogasMo ft phrenio as. A left subblaTian art.

left lung 4 pleurm

2S/

SUBCLAVIAN ABTEBY.

From innomiaate artery behind apper border of Bternc-oIaWonlar ariicalaUon (right Bide),
from end of transyerse portion of aroh of Aorta (left side), to outer border of first rib.

Dirided into three parte: -

FIRST FART ^^ From origin to inner border of soalemuantioas. Differs on the two sides.

BIGHT SIDE — .Arches upwards & oatwards across root of neok, and is shorter A more

superficial than on left side. - Belatzoits :
In Front - Sterno-o'avicalar articulation, sterno-mastoid, -hyoid, & -thyroid, deep

layer of fascia; - and the artery is crossed by s
Internal & anterior jugular and yertobral reins, pnenmogastrio A

phrenic nerres, and cardiac branches of sympathetic.
Behind - Longus colli^ transverse process of 7th ceryical rertebra, cord of sym«

pathetic^ recurrent laryngeal nerre.
Below •* Pleura.

SuBCLATiAN Yein Ues below & in front of artery immediately behind clavicle.
LEFT SIDE -— Ascend') nearly vertically, and is longer & more deeply situated. - Belatioks t
In Front - Same, plus lefD Inng & pleura, left innominate v., lefb conn, carotid; - and
Pneumogastric & phrenic nerves & cardiac bran'^hes of sympathe-
tic are nearly parellel to the artery.
Behind - Same, plus oesophagus & thoracic duct.

0»/i«'/^9'5.-Traohea, aosophagus^ thoracic duct, left common carotid artery.
On Ou/er S.-Vleura.

BRANCHES — Vertebral, Internal .Mammary, Thyroid Axis - Arise

close together near inner border of scalenus anticus, an
interval measuring usually from ^ an inch to 1 inch being left
between the origin of the artery & its first branch. On the

left side the Superior Intercostal i^iio iisuaiiy arises

from this part of the artery.

238

PNEUMOGASTBIO NERVE.

Arises from laietal tract of medulla oblongata helmo gtosso-pharyngeal 6- above spsHol accasmj, — Ita de^p

origin ia from a grey nnolens on floor of fonrih Tentricle.
Through jugular foramen behind glosao-pharjngeal h in same aheaih aa apinal aoceaiorjr.
Presents two ganglia, one in and one below jngnlar foramen ;

Sup. or Jugular G. or G. Of thb Boot — Small, greyish, rounded. Anastom. with Jadd^

giosso-pharyngealt s final accessory 6f sympatketiL.
Ck?. G. or G. op thb Trunk — Beddish, cylindrical, nearly an inch in length. Anastom. with

hypogiossalt spinal accessory, symfafhetic^ loop between two first cervical nerves
Descends behind & between int. a comm. carotid arteries k int. jngnlar ▼. and in same sheskth;
Then,

On Bight Sidb :

Between Babclavian art. & t. and along side of trachea to back of root of long,

where spreads out into posterior pulmonary plexnj.
Along side of oesophagus in the shape of two or more separate oords, which form

OBSophageai plexus with nerre of opposite side.
As a single cord along back of OBSophagua to posterior surface of stomach, and

joins solar h splenic plexuses.

Oir Lbit Sidb :

Between and in front of left oomm. carotid h left subclavian arteries behind left

innominate rein.
Across arch of aorta to back of root of lung, where similarly spreads oat and

joins with ita fellow.

Along side of oesophagus as abore.

As a single cord along front of oesophagus to anterior surface of stomach, and

joins left hepatic plexus.

BRANCHES:

Auricular Br. — Arises from g. of the root, and joins with glosso-pharyngeaL

Across jugular fossa & through opening in temporal bone near styloid prooeas;
Between mastoid process h ext. audit, meatus to integument of back of pinna.
Gives off:

Ascending Bb., which joins trunk of facial in aquednctus Fallopii;

Descending Br., which joins auricular branch of facial.

Pharyngeal Br. — Arises from upper part of ganglion of the trunk;
Crosses internal carotid art. either in front or behind ;

Anast. with glosso-pharyngeal, sup. laryngeal h sympathetic, and forms pha«

ryngeal plexus to muscles h mucous membrane of pharynx.

8up. Iiaryngeal N. -~ Arises from middle of ganglion of the trunk.

Deaoends by side of pharynx behind int. carotid artery, and divides into:

EXT. LABYNGEAL BB. — Joins with pharyngeal plexus h sup. car-
diac nerve, and supplies crico- thyroid h inf. constrictor.
IKT. LABTNGEAL BB. — Pierces thyro-hyoid membrane to aryte.
noiil muscle and mucous membrane of larynx, base of toc^ue

& aryteno-epiglottidean foId'<

Rocurr. Laryngeal N. — Ar. in front of, and passes below & behind, subclav. i/L

on right side, arch of aorta, on left, giving twigs to deep cardiac plexus ;

Behind comm. carotid h inf. thyroid arteries, and in groove between trachea

h CBSophagoa.
Beneath inf. constrictor to all the muscles of the larynx exoept orico-thyrcad.
Gives brs. to inf. constrictor, and anastomoses with ext. laryngeal

Cardiac Brs. — Divided into !

Cervical Cardiac i TT'ji xr ^xi. rr -a

Thoracic Cardiac { ^'^® ^®^®« ®^ ^^® °®*^

Pulmonary Brs. — Divided into Anterior and PoerERioB, and form the sni. 9t post

pulmonary plexuses. (Tide nerves of the lung.)

CEsophageal Brs. -— Arise, some above, but most of them below, the pnlmonaflr.

Gastrio Brs. —* Bight pneumogastric supplies post, aspect of stomach and Joins so*

lar h splenic plexuses | left pneumog. supplies ant. aapeoi, and joins

left hepatic pU

239

PHRENIC NERVE.

Phrenic or Int. Respiratory of Sir C. Bell - From Srd, 4tii, and usnaliy aif o from 6th

Downwards & inwards in front of scalenus anticns. (oervicalns.

Between sabolavian vein & Ist part of snbolavian artery ororaing internal raammary,

and receiving a filament from sympathetic, sometimes another from 5th & 6th

cervical nerves, and occasionally on the left side, one from the ansa hypoglossi.

Crosses arch of Aorta & pulmonary artery, on tfae left Ride.

Descends, on the right side, on outer side of right innominate vein & sup. yena cava.

In front of root of lung & along side of pericardium to diaphragm, and divides in

to branches which perforate the diaphragm and supply it by its under surface*

Both nerves give off twigs to the pericardium & pleura, and join with the phrenio

plexus of the sympathetioi the right nerve sanding also a few filaments to tho

diaphragmatio gmnglion.

240

CORONARY or CARDIAC VESSELS.

OOBONARY OR CARDIAC ARTERIES — Two. Protw u^^^v ^r« of the im;gi»?«

corresponding to the two anterior Binnses of Tal^ialra jait aboTO free mar^n of temi-

Innar ralref.

Left or Anterior - The smaller. Forwards & to the lefl between pnlmonarf arterf

& left anrionlar appendix, and divides into bratcoHe^ :
HoBizoNTAL - The smaller; alon^ left anricalo-Tentrionlar groore, and joins

with horiiontal branch of ri^ht or posterior coronary.

Descending - The larger; along anterior intorrentrioalar groore to apex of

heart, where it joins with descending branch of right or posterior coronarj.

Rlgllt or Posterior - The larger. Forwards & to the right between pulmontrj
artery & right anrionlar appendix, and then backwards along ri?ht nnrionlo.
Tentrionlar groove, sending a large branch down ri?ht border of heart,

and divides into branches •
Horizontal - The smaller ; along left anricnlo-ventrionlar groove, and joins with

horizontal branch ofjeft or anterior coronarr.
Descbndino - The larger: along posterior interventricnlar groove to apex of herirt,

where it joins with descending branch of leli or anterior ooronarf.

CORONARY OR CARDIAC VEINS.

Oreat Cardiac Vein - Ascends from apex of heart along anterior interventricnlar
groove, tnrns backwards along left anricnlo-ventrionlar groove, receiving
an ascending branch of some size from len« border of heart, and opens into
left extremity of the coronary sinns, its opening being gnarded by two

▼a1ve«.

Posterior Cardiac Vein -Ascends from apex of heart, where it oommnnioates with

preceding, along posterior interventricnlar groove, and opens into ri^^t

extremity of coronary sinos, its openiag being guarded bj a valve. It

receives the veins from the posterior surface of b)th ventricles.

Coronary Sinus - Thick tmnk abont an inch long sitnated at bank part of let
anricnlo-ventricnlar groove, and partly covered A concealed by mnscnlar
fibres of left auricle. It receives tne great & posterior cardiac ve'as, ani
a small vein, the remnant of the left superior cardinal vein of the embryo
(Marshall), which passes downwards & to the right along back part of
left anricle. It opens into the lower & back part of the ri?ht auricle c1o«e
to the septnmi below the opening of the inferior vena cava & Ensrachian

valve. Its opening is guarded by the valve of Thel>esia«.

Small or Anterior Cardiao Veins & Vense Cordis Minimea - Several small

branches, which collect the blood from the anterior surface of the r\iz*''t

ventricle, and from the muscular substance of the heart, and whi'^h op?^

separately into the lower part of the right auricle (foramina Thebesii) ; one

larger than the otherii runs along the right border of the hear>

THORAX.

II.

242

PXJLMONARY VESSELS.

PULMONARY ARTERY.

Short thiok trunk aboat two inches long, whioh oonreyi the renons blood tnm the

right side of the heart to th« langi.
Arises from apex of infaadibnlnm of right rentriole opposite nppar border of 8rd costal

cartilage of left side olose to Btemnm.

Upwards, backwards & to the left, winding spirally in front & then to the lefi of

ascending portion of arch of aoria, the two yessels being contained in one tnbniar

sheath of the serons layer of the perioardinm. - On either side of the artery are the

anrionlar appendices & the coronary arteries ; behind it are the aorta i the le*^

anriole.
Pierces fibrous layer of pericardium, and divides below & in front of transrena portioa

of aroh of aorta into : -

Right Pulmonaxy Artery - The larger & longer. To the right behind aaoendin^

aorta & superior yena cava to root of right lung, in which it lies, both froni
before backwards and from aboye downwards, between the pnlmonary reins

& the bronchus. Diyidee into:
fiuPBRioa Branch - The smaller, to superior & middle lobes.
Inferiob Branch - The larger, to inferior lobe.

Iidfk PalX&OHary Artery - The smaller & shorter, connected at its root by remains of

ductus arteriosus to under surface of arch of aorta. To the left in front of
descending aorta, lying, in root of left lung, above the Toins & the bronchus,
but behind the former & in front of the latter. Diridee into:
Superior Branch - The smaller, to superior lobe.
Injeriob Bbanch - The larger, to inferior lobe.

PULMONARY VEINS.

Usually four. Oommenoe upon the interoellular passages & air-cells In the oapillary
network of the pulmonary artery, but are also continuous with some of the terminal

ramifications of the bronchial arteries.

Their smaller divisions are bat very little larger than the corresponding branches ci

the pulmonary artery, and they accompany these singly, and form a single trunk

for eaoh lobule.

Their larger branches are destitute of ralyes, and form a single trunk for eaoh lobe, the

trunk from the middle lobe of the right lung uniting with that from the upper.

The two trunks from right lung pass behind superioi: vena cava, right anriole & asoend*

ing aorta, and those from lefb lung'cross anteriorly the descending aorta ; all are

invested anteriorly by serous layer of perioardfum.
In the lung the pulmonary vessels are generally found to lie in front of the correspond.
ing bronchial tubes, the artery being above the vein. In the roota of the lungs
the pulmonary veins lie in front of the arteries, and the arteries in front of the
bronohus; and the order from below upwards is veins, arUry^ hvncAtts, on the right
side, veins, bronchus, artery^ on the left. There is somecimes a small distinot vein for
middle lobe of right lung. The two left pulmonary veins often unite into one trunk.

243

THE LXTNGS.

Light, porous, orepitttnt, elMiio.

Of ft pinkish white afe birth, of a mottled siate oolovrln the adnlti the mottling be«
coming darker & darker aa ago advanoes. Smooth & shiniag, marked ont by dark
Itnes into polygonal spacea oorrespondtog to the baiea of the snperfloial lobules,

whioh spaoei are rarionslj crossed by other more delicate lines.

Gonioal in shape, and present : -

Outer SariJElce - Gonvez, deepest behind. Presents on either side a deep fissnre obliqne
downwards & forwards from near apex to base, and, on the right side, another
fissnre oblique upwards & forwards from the middle of the foregoing. By these
fissnres the left lang is divided into two lobes, the right one into three; the inferior
lobe is the largest in both lungs, and the middle lobe of the right side, the smaUest

of all.
Inndr Sarfood - Conoare, deeply excaTated in front, especially on the lefl side, to make

room for the heart; presents the hilnm a littie aboye A behind its middle.

Anterior Border - Thin, oblique, shorter than the posterior, deeply notched inferiorly
on the left side so as to expose the pericardium; comes in contact with its fellow

behind middle of sternum, the pleursd alone being interposed*

Posterior Border - Thick, rounded, rertical, longer than the anterior.

Base - Broad, concaye, oblique downwards & backwards ; rests upon diaphragm, and its
circumference fits into the grooye between the diaphragm & the ribs. Descends

lower down on the left side than on the right.

ApeZ ~ Passes up into root of neck an inch or an inch & a half aboye first rib, and, under
coyer of the scaleni, comes into close contact with first & second portions of sub«

olavian artery.

The Bight Luno is the shortest in consequence of the diaphragm ascending

higher on the right side than on the left; the broadest owing to the inclination

of the heart to the left; and somewhat the largest. - Thb Lxr Luno is the longest^

narrowest^ and somewhat the smcUUst.

THE ROOT of the LXTNQ

Gonsists of the bronchus, pulmonary h bronchial yessels, lymphatic yessels
k glands, and pulmonary plexuses of the pneumogastrio h sympathetic,
which parts are all enclosed in a pleural sheath, and are bound together

by areolar tissue in the following orders
Faosf BsroxB Backwards

On Either Sidex -

Pulmonary veins with the anterior pulmonary plexus ;
Pulmonary artery ;

Bronchus with the bronchial vetselsi lymphatics vessels 6* glands^ and

the posterior pulmonary plexus*
From Bblow Upwards

On Right Side - Pulmonary veins, pulmonary artery, bronchus^ with &o.
On L^t Side - Pulmonary veins^ brvnchus, pulmonary artery.

THE BOOT OF THB BIGHT LUNG — Lies behind the superior yena oaya & the

ri^ht auricle; the yena asygos major arches oyer it from

behind.

THB EOOT OF THB LBFT LUNG — Passes beneath the arch of the aorta ; behind

it are the descending portion of the arch, the ossophagus h
the thoracic duct. - The root of each lung has also in frbns
of it the phrenio nerTOi and behiad it| the pneumogastrio.

S4i

THE flextba:

BniToimdi the inngy lines tbe parietei of the thorax, and forms the lateral bouadarj of tht

mediastloa.
Tracing it horisontally from the stemnm it passes t *

Over costal tartilaga^ ribs^ 6* inUnostal spaeai
Forwards along side of posterior mediastinum ;
Outwards over posterior aspect of root of lung ;

Homul posterior pari of inner surface^ posterior border t outer tmfaee^ anterior border^ antt.
riorpart of the inner surface oflung^ dipping into tke^fissum beimem the lobes/
Inwards over anterior aspect of root of lung ;
Forwards along side of pericardium to sternum^

htferiorly it corers the diaphragm, from which a thin triangular fold, the ligatmntstm latum
pulmonis^ passes np along the side of the perioardinm to the inner surface of the Inng ft to

the lower border of its root.

Superiorly it ascends into the neck an inch or an inoh h a half above the first rib, and, under
oorer of the soaleni, oomes in contact with the first ft second portions of the sabolaTtan

It isthionest ftmost adherent orer the long ft orer the diaphragm. It is thiokest ft least ad«
herent orer the thorado walls. Its inner sarface is covered bj a lajer of pavement epi>

thelinm, and is moistened bj a serooa llud.

Its arteries are from the intercostals, internal mammary, phrenic, inferior thyroid, perieardiae,
ft bronchial. - Its veins correspond to its arteries. - The lymphatics of the visceral layer
Join with those of the long; the lymphatics of the parietal layer join with those of the
mediastina ft the thoraoio walls. - Its nerves are derived from the pulmonary plexuses

(Kolliker), and irom the phrenic ft qrmpathdtic nerves (Lushka).

The two pleurss oome In oontaot behind the middle of the steraom.

THE MEDIASTINX711

Ii the tntoro-pettMrior itptem oompriied betiraea tbe two Imngi & plonni. It is dirided

into threo p«rtB.by the poricardiau, heart, ft large Teeeelfl.

AnteTior Mediastlnnxn - is the part fn front of the perioardinm, heart, 4 large resiela.
It ia narroir abore, where it oontalna the remains of the thymns gland, the origins
of the stemo-hjoid A .th jroid, the npper part of the left internal mammarj Tosaels,
a large quantitj of loose areolar tlssae, ft a few lymphatio glands. It is narrower
still behind the middle pieoe of the sternum, where the two plenne oome in direot
eontaot as low down as the 4th costal cartilage. Quite inferiorlj, in oonseqaenoe
of the notch in the lower part of the anterior border of the left lang, it expands to
the left behind the 4th ft 6th intercostal spaces of the left side; here it oontaiaB the
lower part of the left internal mammary ressels, & that part of the triangalaris

stem! mnsole, which orerlies the apex of the heart.

Middle MediastinnXIl - is the part which contains the pericardiam, heart ft large ressels
(ascending aorta, pnlmonary yessels, superior Tena carai -the inferior vena oara
enters perioardinm throogh opening in cordiform tendon of diaphragm), and also

the phrenic nerres* It is the widest part of the mediastinnm.

PCMrtcrior Mediastizmm - is the part behind the pericardiam, heart, ft large yessels.
It contains the descending aorta, trachea, ossophagns i the yenss asygos migor ft
minor ft the left superior interoostal| the pnenmogastrie ft splanchnic nerres i the

thoraoio duoti flat ft l/mphatic glaods.

Posterior Mediastinum.— in the Ninth Edition of OiwAi'f Anatomw,
ProfMior Tliane onts off the npper part of the medlarStlnnm m hitherto deeorlbed
to form the BuPBmiox Hn>i AimnTM. '* The BvrxBiox Mxni AarnrvM may be ooniidered
" as bonnded below by a plane paaeing ihsonffh the Inwer part of the body of the
" fonrth doieal yertebza behind, and the jnnouon of the maanbrlnm with the body
*' of the etemnm in fronts Its upper limit eoResponde with the enperior aperture
"of the thorax. In front are the manubrinm and the lower enda of the etemo.
"hyold and steme.thyroid mnsoles; and behind are the npper fow dorsal
** vertebne and the lower ends of the longns ooUi mneclea. " It contains the trachea,
*' OBiophagni and thoracic duct ; the whole of the tranarene part of the arch of
" the aorta, the innominate artery, and those parte of the left coounon carotid
** and sabclaWan arteries which are contained within the thorax t the innominate
** TCins and tipper part of the saperior vena cava ( the phrenic and pnenmo-gastrlo
'* nerres, the left recnrrent, and the cardiac nerresi and the caidiac lymphatio
'* glands tnd remains of the thymus gland."— (^>m^'« Anaiom^, Yol. IL, p. 177.)

246

THE TBAGHEA A BBONCHL

THE TRACHEA.

From 6th oenrioal Tvxiebra to Srd donaL Firm^ ronQded, A rapported hy •arlOft.

ginons rings in front, flattened A membranona befaiad.

Relations.

In FaoiTT-

Isthmns of thyroid gland, iniiBrior thyroid Toini, ft thyrotdea ima

artery (when the latter eziftt).

Bemains of thymus gland, led innominate rein, aroh of aorta with

innominate & left oommon oarobtd arteries, great or deep oardiao

plexns, bifnroation of pulmonary artery.
Stemo-hyoid ft -thyroid, anasfeomotio branoh between the anterior

jugular reins, stemnm, fissola, ft skin.
Behind -

CBsophagus, whioh deriates to the left towards lower part of necks

right reourrent laryngeal aerrsL

Ok ElTHES SiDB-

Lateral lobe of thyroid gland t oommon carotid artery, internal jngu.
larrein, pneumogastrio ft aympathetio nerresf inferior thyroid
artexy, left recurrent laryngeal nerre (the right nerre lies some-
what behind the trachea).
Innominate ft oommon carotid arteries, pneumogastric ft left recur-
rent laryngeal nerves ; - and farther ofl^ but internally to the
pleur», right innominate vein ft right phranio nerra^ on the right
side^ left Bubolarian artery ft left phrenlo narre^ on the left^

THE BRONCHI

Commenoe opposite the Srd dorsal Tertebra a little to the left of the middle liaei
the internal septum wliioh marks the separation of the two tabes being elightlj
dsTiated to the left by the preponderanoe in diameter of the right bronohus over
the left one. Both divide in the root of the lung into a large inferior and a
somewhat smaller superior branoh, the former of whioh, on the right side^ givea

off a small branoh to the middle lobe of the right lung.

BIGHT BBONCHUS *- About an inoh in length, wider, more horiaontal than the left
one I enters root of lung opposite 4ch dorsal Tertebra. - It lies behind the
superior vena oaya ft the right auricle; the right pulmonary artery lies at
first below it, and then in front of it| the rena asygoe m%jor arches over it

from behind.

IiBFT BBONCHUS — Smaller, more oblique, nearly two inches long i enters root
of lung opposite 5th dorsal vertebra. - It passes beneath the arch of the aortas
the left pidmonary artery lies at first above it, and then in front of it| behind
it are the dwoowding portion of the aroh, the oesophagus ft the thoraoio dnoW

247

THE aSSOFHAQUS.

Commenoea in middle lina of neok oppodte 6th oerrioal rertebra A lower border of cricoid

cartilage.
DowDwarde A to the left behind traehea, left lobe of thyroid gland A left reonrrent laryngeal

serre, ooming into oloie oontaet with left oommon carotid.

Downwards A to the right behind lower end of trachea & oommenoement of left bronchus,

and between aroh of aorta A thoraoio dnot on the left A the vena asygos major on the

right, regaining middle line opposite 6th dorsal yertebra.
Again to the left between heart A perioardinm in front and lower part of thoraoio aorta be-
hind, being surrounded by the pneumogastrios, whioh tend, the left one to the front, the

right one to the back.
Through oesophageal opening of diaphragm^ and opens into stomach (oardiao or oesophageal

opening) opposite 9th dorsal rertebra.
Is from 9 to 10 inches long.

848

THE VENiE AZ7QOS.

OtfUeoi the blood from the interoofttal ipaoee, md ftrs thrM ia BttmboTf ibo oiftj or, minor, *

left

▼£NA AZTGOS MAJORi or RIGHT AZTGOS - Oommenoes in the rigbt ee.

oending Inmbar yeio, or eometimee in a branoh from the inferior caT» or ibe

ri^rbt renal.
Through aortio opening of diaphraprm on right aide of thoraoio dnot, behind A on

right aide of aorta; - aometimea through right eras.
Along right aide of apine in front of right inlercoatal arteriea to 8rd doraal Tertebra.
Arches forwards oyer root of right Inng, and opena into anperior rena oara jwt

before it entera perioardinm. SeoeiTest

Tribatary Branches : - /^fie or ten lower iniercottal veins of right nde^ vena aty^

mtnor, several small (esophageal, mediastinal ^ spinal veins, the right hrvnchial,

sometimes the right superior intertostal, and oooaaionaUj the l^ —

▼EN A AZTGOS MINOR| or LEFT LOWER AZTGOS — AriaaeiatoflBwend.

ing Inmbar rein, or aometimea in a branoh firom left renaL

Perforates left ems of diaphragm (paasea aometimea through aortio opening), and

ascends along ieft aide of apine in front of left interooatal arteriea to 6th or 7th

dorsal Tertebra^
Crosses spine behind aorta & thoraoio dnot, and opena into Tana aa/goa major.

BooeiTm
Tributary Branches: - ^^^^ ^^ /cv ^^^^^ intereostal veins of left side, several small

mediastinal^ ouopaageal ^ spinal veins.

LEFT UPPER AZTGOS — BeoeiTea the blood from thoae left interooatal Tmna, vaaally

two or three in number, which are aituated between the interooatal Teina that
open into the left lower aa/gos and those that open into the left superior inter-
ooatal. It therefore Taries greatly in aiae, diminiahing aa these latter reins in*
crease, A viee versa ; often it does not exist at all, or one or more of the 6th, 6th,
& 7th left interooaal yeina maj merely open directly into the Tana aaygoa major.
When thet« ia a diatinot left upper aaygoa, it opena either into the aaygoa major,
or into the left lower aaygoa. ^ A few imperfect ralrea are found in the main

aaygoa Teini distinct ralYea are fband in the interooatal toou.

249

THE THORACIC & BIGHT LYMPHATIC DUCTS.

THOBACIO DUCT — OomnenoM In reoeptaoiilnm ohyli, panaa through aortio opening of
diaphragm, and then aeoende in fVont of epine as high as 4th dorsal rertebra, lying
beMnd ossophagns^ between aorta A rena asygos major. It then inolines to the lef^
and ascends first behind aroh of aorta and then behind first portion <A sabolavian
artery of left sidei and finally, opposite upper border of 7th oerrioal vertebra, it arches
forwards above plenra & in front of scalenus anticos, and opens into angle of junction
between left internal jagular & subclayian veins, its opening being gnianSed by a pair
of valves* It is somewhat tortuous in its eonrse, constricted at intervals on account
of the valves it contains} of the size of a goose-quill at its commencement, somewhat
narrower in the thorax, again enlarged at the root of the neck. Somectmes
it bifurcates, its left division taking the usual course, its right division joining
the right lymphatic duct. - It is the common trunk of all the lymphatics of the body,
except those of the right side of the head, neck, & thorax, right upper limb, right

lung, right side of the heart, A part of the oonvez surface of the liver.

BoeoptaonltUXl Cbyli - is a dilatation of the commencement of the thoracic duct,
which lies in front of the 2nd lumbar vertebra, behind & to right side of the
aorta, and between it and the vena asygos major & the right cms of the
diaphragm. It receives the trunks of the lacteal vessels, and four or five

large trunks from the lumbar lymphatlo glands.

BZOHT LYMPHATIC DUCT — I> a short thick trunk from half an inch to an inch in
length and of about a line or a line & a half in diameter, which collects the lymph
from the right side of the head, neok, & thorax, right upper limb, right lung, right
side of the heart, A part of the convex surface of the liver. It opens into the angle
of junction between the right internal jugular & right subclavian veins, its opeaing

being guarded by a pair of valvea

SUPEBIOB INTEBCOSTAIj ARTERY.

From upper & back part of Ist portion of subclavian on lefb side,
of 2nd portion on right side. Passes backwards for a short distance, and
gives ofi* its deep cerTioal branch ; it then descends in front of neck of 1st
rib, or in front of necks of Ist & 2nd ribs on outer side of Ist dorsal gang-
lion of sympathetic, giro? off one or two branches similar to the aortio

intercostals, and joins with the first of the latter arteries.
Deep Cekvical oa Pbofunda Gksvicis - Sometimes arises directly from subclavian.
Backwards between neck of 1st rib A transverse process of 7th cervical
vertebra, and ascends between complexfls A semispinalis colli, anasto-
mosing with vertebral artery A deep branch of arteria princeps oervicis.

250

INTEBIOB of the HEABT.

RIQHT SIDE.

Ii larger in its anrlonlar portion, and haf thinner wallf than the left.
AURICLE -* Dirided into t

Appendix AnrionlSB *- Narrow indented ponohi which orerlapt the aroh eC tbe

aorta, and preients on its inner enrfaoe the mutcuii fecHmati^ which

extend eomewhat into the aniiii
SlnilB - 7he central oarity; preientst -

Opkkiko op the Superiob Yeva Gata - Bomewhat imaner than that of tte
inferior cava; sitaated at the npper A front part; looke down-

wards A forwards, and has near it the
TUhercle of Lower - Small eminence, scarcely Tisible in man, sitnatad on

right wall of auricle between the two rene cam.

OPENiiro Of THE Infebtos YsiTA Gaya - Somewhat larger than that of the

superior cara ; sitnated at the lower A back part near the septam ;

looks upwards ft inwards, and presents the
MtuUtchian Vahe <- Semilunar in form with concaye free, and conTex aW
taobed margins ; situated below the openiog of tbe inferior Tena
cava between it & the anricnlo-Tentrionlar opening, and p as se s up-
wards & to the left to tbe anterior margin of the annnlns oval it.
Small in the adnlt. Gcntains a few mnsonlar fibres.
OranvG Of THE GoaoNABT Sinus - Situated below the opening of the inferior

Tcna ca7a ft the Eostacbian ralye. Presenta the
Coronary Vaheor Vdhe of Thebesius.
FOBAEINA Thbbesii - Some of which are the openings of the Tense cordii

minimiB, while others are but small blind depressions.
AubiculcVentbiculab Openino - With the tricuspid ralre (Vide below).
FoBAHEE Ovale - In the fcDtus. Situated at the lower & back part of septum

above opening of inferior yena oayas replaced in adnlt bj the
Fossa Ovalis - Oval depresstoa surrounded bj a prominent eironlar rim, the
Annulus Ovalis, - and which often presents a small yalmlar open-ng at

its upper pan.

VIiNTRICLSS *— Triangular in shape, and has mnoh thinner walls than the left one.

Prolonged upwards & to the left into the InJundiMum or C^mm

arteriosus. Pre s e nts : -

Aubiculo-Ventbioulab Open iifo - Oval, broadest from side to s>de. Situated

behind the centre of tbe sternum on a level with the 8rd ooetal car-

tilages, on the right side of the aortic ft left anriculo-yentricular

openings. Guarded bj the
TUcMspid Valve - Presents three triangpilar segments, which are attached
superiorly to the margin of the auricnlo-yentrionlar ring A laterally
to each other, and of which the left one is the largest. They are
formed by a central fibrous lamina attached snperiorly to the fib-
rous ring of tbe opening and covered by a dnpUoatnre of the endo-
cardium. Their under surface ft borders give attachment to the

eAardg iem^Moa,
Qnwnio op the Pulhokabt Abtebt - Sitnated at the apez of the conns arte-
riosus opposite the upper border of the third costal cartilage of the

led side close to the sternum. Guarded by the
Similunar Valves - Three; formed of fibrous tissue surrounded by a du-

plicature of the endocardium, and present :

Convex margin - Attached to the fibrous ring of the orifice ;

Free margin <- Slightly concave, strengthened by a bundle of tendiaoos

fibres, presenting in the centre a fibro-oartilaginoua nodnle, the

corpus Araniii, and laterally two thin Innated portions, the

lunula. Above tbe valves are three small pouches, the

Sinuses of Valsalva*

CoLVMNiB Oabnejs - Three sorts, which are attached respectively by one sid^
by both extremities, by one extremity only, to the wall of the vesi*

triolet The latter are thf
Musculi Fapillares - Three or four ; give origin to the Chordm TemHttot*

251

INTEBIOB of the HEART.

LEFT SIDE.

Hm thicker walU than the right, and is imaller In Itf anrionlar portion,

AURICLE -^ Diyided, as is the right, into two part?, the

Appendix AxxriculSB - Loageri narrower, more onrred A indented than on right ildei

and conBtrioted at ite orifice; its mnscnli pectin aii are amaller A less

nnmerona. Orerlaps pnlmonarj artery.
SlnilB - Kore regularly onboid than on right eide. - Preienttt

Ofbkinos of thb Fulxonaat tbiks - Four, at npper part, two on the right oloce

to septum, two on the left, the latter Bometimes uniting.
AoBicuLO-VEiiTaicnLAB Opbkimo - With the Mitral Talra (Vide below).

VBNTBICLS — Bounded A conical; its walls are thicker than those of the right. Presents i

^nBiouLO-YEiiTRTCVLAS Ofxnino - Situated opposite centre of sternum on a lerel
with third costal cartilages, between & behind the aortic A right
aarioulo-Tentiionlar opening^, or rather directly behind the aortic open*
ing (Sibson). Somewhat smaller than on right side. Presents the
Mitral Vahe - Larger, thicker & stronger than the tricuspid. Oonsists of
two principal segments, of which the largest is in front. The chords
tendinesB attached to its under surface are stronger ft thicker, but are

less numerous, than those on the right side.

Aosno Opbniko - Situated behind centre of sternum on a leyel with lower border

of 8rd costal cartilage^ and directly in front of the left aurioulo.Tentri«

oular opening. Presents the

Semilunar Valves - Larger, thicker ft stronger than those of pulmonary

artery ; lunulie wider, corpora Arantii more prominent, and sinuses of

Yalsalya deeper.

OoLUVNii Oasnea - Those attached by one side and those attached by both extre*

mities are smaller ft more numerous. The musculi papillares are but

two in number I but are larger, and are attached, one to the anterior^

the other to the posterior waU of the rentrioleb

252

STBUCTTTBE of the HEAKT— 1st Tablet.

Preaenta for examination the fibrona rings of the arterial A anrionlo-Tentrionlar opeuBgi^

and the mnaooli^ ftbrea.

FIBBOnS RINGS — The aortio A the two anrionlo-Tentrionlar rings lie cloae together behind
the centre of the Btemnin on a lerel with the 8rd ooatal oartilagei, and are b>aad
together by a fibro-cartilagiaona mass which becomes ossified in some of the larger
animals. - The aortic ring lies ia front of the left anricnlo«Tentrionlar; the right
anricnlo-Tentricnlar ring lies between, Sl to the right of, the two others. - The flbrous
nog of the pnlmonary artery is situated at the apez of the infnndibalam opposite the
npper border of the 8rd costal cartilage of the left side close to the sternnm.

These rings gire attachment to the mitral .tricuspid A semilunar TaWes, to the
muscular fibres of the auricles, and to some of the most superficial fibres of the Ten-
tricles. The margin of the arterial rings which is turned towards the anriclea, is
scalloped into three semilunar notches filled up by corresponding projeotions of the
middle ooat of the artery, the attachment of the arteries to the rings being strength-
ened externally by the pericardium and internally by the endooardiaa.

MTTSGUL AR FIBRES *~ -^'^ striated, but are about ( smaller than those of striated mns*
oles generally, and their striation is not so distinct. They diride and anastomose
with each other, and they often contain fat cells. Their perimysium is but scanty.

Fibres of thO Auricles - -^^^rs mostly transrerse, superficial, A common to both

auricles; some howeTor lie deeper, and are proper to each anriclfli

SupEBriOJAL, Transterss, OS Common Fibbbs - Surround mainly the base of the

sinuses, and are most marked anteriorly. Some dip into tbe inter-

anrienlar eepinsL
Dksf ox PxopxB FiBKSS - May be divided intot

Looped Fihrts -Arch oyer each auricle from before backwards, and are si-
tached to the auriculo-Tentrioular rings both in front ft behind.
Annular Fibres - Encircle the appendi'^.es aurlcule, and the renm oavm, pul-
monary h coronary yeins, extending for some distance upon ilie Tmn^

Fibres of the Ventrioles - Vide aext Tablet

253

STKUOTXTBE of the HEART— 2nd Tablet.

FXBBXS OF THE VENTBIOLBS

Form leren layers differing from eaoh other bj the direoUoa of their flbree.

These layers are oontinaons with eaoh other at the apez A at the base of the heurt as
follows I - the Ist, or most external layer, with the 7th, or most internal layer.
tf 2nd, M 6th,

*• 8rd, „ 6th,

The fibres of the 4th or central layer retnm npon thoie of the same set.

Together, the 1st & 7th layers form a hind of donble ring inoloaing all the other layers;
the 2nd and 6th layers, a kind of donble ring inoloaing the SH, 4th, and 6th layers;
the 8rd and 5th layers, a kind of donble ringr inolosinfir the 4th layer. As a oonse*
qnence the donble ring formed by the Ist and 7th layers extendi farther towards the
apex A the base of the heart than the doable ring formed by the Sod A 6th lavers,
whioh latter donble ring extends fat ther than the donble ring formed by the 3rd ft (Sth
layers ; and the 4th or oentral layer is the least extensire of all. This explains the
greater thickness of the walls of the yentrioles towards the middle of their length than
at either extremity. - The outer layers, it may be added, are thinner than the inner
ones.

The fibres of the three enter layers are inclined downwards A to the left on the anterior
aspect of the heart, downwards & to the right on the posterior aspect; and they become
less rertical in each snccessire layer. The fibres of the 4th layer are horisontal or
transyerse. The fibres of the three inner layers are inclined upwards A to the left
on the anterior aspect of the heart, upwards A to the right on the posterior aspect,
crossing the fibres of the three outer layers, and becoming more A more yertioal or
longitndinal in the suocessiye strata.

Some of the superficial fibres, especially those of the posterior surface, pass ronnd and en*
close both yentrioles; the mass of the fibres, howerer, enclose but one yentriole.

In the three outer layers the anterior fibres proper to the left yentriole issue from the inner
A front part of the oorrissponding arterial A auriculo-Tontricnlar openings A from tho
front of the interventricular septum; these anterior fibres pass downwards A to tho
left, with a few of the anterior common superficial fibres, and get to the back part of
the apex. The posterior fibres proper to the left yentriole issue fh>m the outer A back
part of the corresponding arterial A auriculo-yentrioular opening^ A from the baok of
the interrentricnlar septum ; these posterior fibres pass downwards A to the right, with
a somewhat considerable number of the posterior common superficial fibres, and get to
the front of the apex. Here all the fibres, both anterior A posterior, ourl inwards in
a whirl-like manner, the anterior fibres going to form the three inner strata on the
posterior wall of the yentriole, and the posterior fibres going to form the three innei
strata on the anterior wall.

In the right yentriole the fibres of the three outer layers issue partly firom the correspond*
ing arterial A anricnlo-Tentrionlar openings, and are partly continuous with the
posterior common snperficial fibres. Descending spirally from left to right on the
posterior aspect of the heart, and from risrht to fift on the anterior aspeot, they reach
the anterior interrentricnlar grooye. Here a few fibres are continued on to the left
yentriole, forming the anterior common superficial fibres; the greater number pass
backwards, howeyer, in the interyentricular septum, at the baok of whioh they deons«
sate with the fibres of the left yentriole, and blend with the posterior oommon super*
superficial fibres.

It must be added that none of the fibres, except a few of the most snperfioial ones, oan now
be said to arise from the arterial A aurioulo«yentrioalar rings. The strata are merely
oontinued opposite these rings, the soperfloial onet into tho dotp ones« and via

254

NEBVES of the HEART

Are deriyed from the cardiac pleznsei, which plezoset are formed by the cardiAO bimncfaee
of the STmpathetic and of the pneomogastrio d( recnrreat laryngeal*

CARDIAC NERVES — Are the three cardiac nerves of the eympatheUo, the oerrical.

cardiac A the thoracic-cardiac nerref of the pnenmc^gastrio, and the oardiao bran*
ohes of the recurrent laryngeal.

CABDIAO NERVES OF THE SYMPATHETIC — Are three in nnmber,
superior or superficial^ middle orgreat^ 6^ inferior^ and arise normally y9v«» the cor-
responding cervical ganglia. The) snpenor cardiac nerre, howeyer, firequently
arises partly from the commnnicating cord below the soperior ganglion, and the
inferior one partly from the first dorsal ganglion; when the middle ganglion is
absent the middle cardiac nerye arises firom the commnnicating cord between
the superior h inferior ganglia.
These nerves pass downwards & inwards to the base of the heart either singly or in con-
nection with each other or with the other cardiac nerreSy rarying considerably
in their relatire size and in their precise relations to adjoining stmctnres;
when one of them is smaller than nsual one of the others is increased in sixe.

On the right side of the neck the superior &• the middle oardiao nerres
pass downwards behind the common carotid artery, the former passing alao in front
of the inferior thyroid artery ^ recurrent laryngeal nerve. They then cross the
ntbclavian artery either in front or behindi and descend ufon the trachm to the
right side of the great or deep cardiac plexus* - On the left side the superior cardiac
nerve osnally descends into the thorax between 6^ in front ^the 10 C4mtsmm carotid
^ left subclavian arteries and crosses anteriorly the arch of the aorta to the superfe-^
iial cardiac plexus ; sometimes however it lies deeper than nsnal and than psosoi
behind the aorta to the deep cardiac plexos. - The left middle cardiac nerve passes
into the thorax between &* behind the left common carotid &* left subclavian arteries^
and then descends behisui the arch of the aorta to the left side of the deep cardiac

plexus.

The inferior cardiac nerve passes downwards h inwards to the deep car£ac
plexus behisui the subclavian artery ^ and also, on the right side, behind the innominate.

OABDZAC NB. of the PNEUMOO ASTRIC ft BSCDBB. LARYNGEAL

Are divided into :

Cenrioal Cardiac -Are divided into:

Upper Gekvical Casdiac - Small branches which join the oardiao nerrea
of the sympathetic.

LowEK Cervical Cardiac - One large branch which^ on the right side, dee*
cends along the innominate artery and joins one of the oardiao nervee
destined to the deep cardiac plexns, and, on the left side^ crosses the
arch of the aorta to the saperfioial cardiac plexns.

Tlioraoio Cardiac - Arise on the right side both from the tmnk of the pnenmo*
gastric & from its recnrrent laryngeal branch, bnt on the left side from the
recurrent branch only. They all go to the deep oardiao plexoa either singly
or in oranection with the other deep oardiao nerres*

255

THE CAKDIAC PLEXUSES.

The oardiao nerres form two primary oardiao pleznsea termed the nperfloial A tlie deep or
great, and two secondary plexuses, the anterior & the posterior coronary, which two latter
pleznf 68 are derired from the preceding, as are also in part the anterior A the poeterior
pulmonary plexuses.

8TTFERFZCIAL CARDIAO PLEXUS — The smaller. Is situated heneath arch of aorta
in front of right pulmonary artery and on right side of ductus arteriosus. It oom-
munioates by sereral filaments with the left half of the deep cardiac plexus.
It is formed by the lefl superior cardiac nerre of the sympathetic, the left inferior cervical
cardiac branch of the pneumogastrio, and by sereral filaments from the deep cardiac
plexus. It often presents a small ganglion, the ganglion of Wrisberg.
It gires off the greater part of anterior coronary plexus, and seyeral filaments to anterior
pulmonary plexus of left side.

DEEP OB GREAT CARDIAO PLEXUS — The larger. Is situated between trachea

& arch of aorta, its right half lying abore right branch of pulmonary artery, its left

half lying rather on left side of trachea and being connected by seyeral filaments with

the superficial plexus.

It is usually formed by erery one of the cardiac nenres excepting the left superior oardiao

nenre of sympathetic & left inferior cervical cardiac nerye of pneumogastrio.
Its right half sends branches - behind right pulmonary artery to posterior coronary plexus
A to right auricle; -in front of right pulmonary artery, outwards, to right anterior
pulmonary plexus, inwards, in front of pulmonary trunk to anterior coronary plexus.
- Its left half gives off: - several filaments to superficial cardiac plexus, numerous fila«
ments to posterior coronary plexus A to left auricle, a few branches to left anterior
pulmonary plexus.

ANTERIOR CORONARY PLEXUS — !• derived ohiefiy from the superficial oardiao
plexus, but partly also from the deep. It passes forwards between aorta & pulmonary
artery and accompanies the left or anterior coronary artery d( its branches.

POSTERIOR CORONARY PLEXUS — Is derived ohiefiy from the left half of the deep
oardiao plexus, but partly also from the right. Its branches accompany the right or
I>osterior coronary artery and its branches.

The filaments of the coronary plexuses ramify in the substance of the heart and
beneath the pericardium & endocardium. Numerous small ganglia are found upon
them, especially in the vicinity of the boundary rings between the auricles & ventriclesi

SPLANCHNIC NERVES.

UsuaTYy three fn number, and termed grxa/f Usser, A BxtMl

Arise as follows from the sTx or seven lower dorsal ganglia :

Great Splanchnic Nerve - Ganglia from 5th or 6th to 9th or 10th : - Is also con.
nected with the dorsal ganglia above as high as the 8rd, or sometimes even

as high as the Ist.

Lesser SPLAxcnNic Nerve - 10th ft 11th ganglia.

Least Splanchnic Nerve - 12th ganglion.

Pass downwards & inwards upon bodies of vertebreo being either more or less separate A

distinct from each other, or more or less plexiform, and frequently presenting, when

plexiform, either one relatively large ganglion, the ganglion splanchnicum, or several

smaller onea.
Perforate diaphragm conjointly or separately.

Bind, the two first mainly in solar plexus, the last mainly in the renal. - The m^jority-of thf

fibres of the g^at splanchnic nerve descend directly to the semilunar g^nglionof same side

The great splanchnic nerves are white ft firm in texture, aa are also the branch ef

of the superior mesenterio plexus.

256

GANGLIATED CORDS & GANGLIA of STMPATHETIO.

OANGLIATXD OORDB "— I'^o on eaoh lide A along the whole length of tplaal oolnnm, eon*

Yorging inferiorlj npon the oocoyz in the ganglion impar, and being prolonged enperiorly
into the head along internal carotid artery. They are usually eingle, lometimes double,
oocarionally wanting here A there. Belatirely to the eise of the ganglia they are largest

in the dorsal region. They are dirided into :

Oorvlcal Fortion -- I^i®" ^ ^^^^ of transverse prooessss of oerrioal Tertebn» behind
internal jugular yein, and presents three ganglia (Vide Oerrioal portion of Sym-

pathedo).

ThoraciO Fortioxi - I^ies in firont of heads of ribs A interoostal Tessels, beneath pleura,
on outer side of Tense azygos, at first at a small dlstanoe trom^ and then oloee to,

bodies of yertebrsB. It presents eleven or twelve ganglia.

Iitlinbar Portion - Penetrates Into abdomen, on right side through a small opening in
right cms of diaphragm, on left side either through aortio opening or through a
small separate opening in left orus. It lies in front of bodies of Tertebrse on inner
side of psoas, behind inferior vena oava on the right side, behind abdominal aorta on

the left. It presents four or five ganglia

Sacral Portion -* ^^^b ^^ front of sacrum on inner side of anterior saonl foramina, and,

oonyerging towards its fellow inferiorly, usually ends in the ganglion impar.

FBSiVERTEBRAL GANGLIA — Usually three oervioalj eleven or twelve dorsal, four or
fire lumbar, four saoral, one ooooygeal. Here or less oval or triangular in shape, and

elongated from above downwards.

Cervical - Vide cervical portion of sympathetio.

Dorsal - Lie most of them in front of heads of ribs, the nine or ten fittt at a little distance
from, the two or three last close to, bodies of corresponding vertebra; ocoasionaUy
one or two ganglia lie opposite the corresponding intervertebral foramina. They
are smaller than the cervical & lambar. The first one is the largest and is often
blended with the inferior cervical. The last one is usually stellate in shape, and

is sometimes blended with the first lumbar. • They present:

Boots, os Branches or Communication witb the Dobsal Nebves - Usually two in
number: - Either both ascend obliquely upwards A outwards to join the
dorsal nerve above just before its bifarcation, or one ascends as above de-
scribed, and the other descends to join the dorsal nerve below in oorres«
ponding situation. Sometimes one or two ganglia have a third root resulting
firom bifurcation of one of the roots to adjoining dorsal nerves, and even,

occasionally, an additional root to seoond dorsal nerve above.

Intebnal Bbanches, OB Bbanches of Distbibution - Those from five or six upper gang-
lia are small A greyish; the^ mainly supply thoraoio aorta A its branches,
& bodies of vertebrse A their hgaments s those firom third A fourth ganglia join
posterior pulmonary plexus. Those from six or seven lower ganglia are larger
A whiter I they give off a few small branches to aorta, and join to form the

great, lesser, A last splanchnic nerves (7. Solar Plexus).
IilUnbar - Bather larger A mor^istinot than the dorsal, and situated at a greater distanoe
from the corresponding intervertebral foramina, the first one often lying opposite
body of seoond lumbar vertebra, and the last one opposite saoro- vertebral articula-
tion* - They present :

Boon, OB Branches of Communication with the Lumbab Nebves -Two or three for each.

Are longer A more slender than those of dorsal ganglia, and pass beneath the

fibrous arches of psoas in company with lumbar arteries A veins.

Intebnal Bbanches, ob Bbanches of Distbibution - Give a few twigs to bodies of ver-
tebra A their ligaments, and assist in forming the aortio A hypogastric

plexuses.

Sacral - Smaller than the dorsal A lumbar, and diminish in sise as they descend i lie
close ta inner side of anterior sacral foramina, those of opposite sides approximating
as they descend^ and usually blend in front of coccyx in a median ganglion, the

ooccygeal ganglion or ganglion impar. - They present

B00X84 OB Bbanches of Communication with the Saobal Nebves - Usually two for eaoh

ganglion 1 are short A smalL

Imtibxal Bbanches, ob Bbanches of Distbibution - Those of the two upper ganglia join
inferior hypogastric or pelvic plexus; the others descend upon the arteria
■aora media, and supply the sacrum A ooocyx A their ligaments, and the

ooo^geal gland.

THE L AR Y NX.

THE LARYNX~lst Tablet.

CARTILAGES —Nine; three lingle, three palrsi «

THYROID — The largest. Consists of two quadrilateral plates or al€B joined in fh>nt at a«

aonte angle, the highest ft most prominent part of whioh angle is termed the
Onter Surface -Presents on either side the pomum Adamu PreaenUi

0^«f»^Zm<f -For sterno. thyroid & thyro-hjoid; passes obliquely downwards A for-
wards from tubercle near root of superior coma. The snrfaoe behind

gives attachment to inferior constrictor.
Inner Surface - Covered by maoons membrane externally ft above. Presents in

middle line the

Receding Angle - To whioh are attached the trne ft the false vocal cords, the thyro-

arytssnoldei ft -epiglottidei muscles, and the thyro-epiglottio ligament

ft apex of the epigiottia
Upper Border - Deeply notched opposite pomum Adami, rounded ft prominent on

cither side of notch, concave laterally; gives attach, to thyro-hyoid mombr.
Lower Border - Shorter, straighter, connected to cricoid cartilage by crioo-thyroid

membrane ft muscle.
Posterior Border - Thick ft rounded ; gives attachment to stylo* ft palatcpharyngei,

and is prolonged upwards ft downwards req»eotively into the
Superior Cornu - Long, narrow; points upwards, backwards ft inwards, and gives

attachment to lateral thyro«hyoid ligament.

Inferior Cornu - Shorter ft thicker; points downwards forwards ft inwards, and

presents internally a small facet for articulation with cricoid cartilage.

CBICOID — Annular in shape, broad behind, narrow in front; thicker ft stronger, bat

smaller than foregoing. Presents :
Outer Surface - Gives attachment in front ft at sides to orico-thyroideus ft inferior cos-

striotor ; and then presents on either side from before backwards:
7f/^^^/r - Surmoanted by an articular facet, for articulation with lesser oomna of thy-
Broad Rough Depression - For attachm ent of crico-ary tsenoideus postiouB$ ^^id car tila^;
Median Vertical Ridge - For attachment of longitudinal fibres of oesophagus.
Inner Surface - Smooth, lined with mucous membrane of larynx.

Upper Border - inclined downwards ft forwards. Gives attachment in front ft at sides

to cricO'thyroid membrane ft crico-arytaenoideus lateralis, and presents at
its posterior ft highest part, on either side of a slight median notch, two

small oval facets for articulation with arytaenoid cartilages.
Lower Border -Horizontal; connected to first cartilaginous ring of trachea by fibruns

membrane of that canal
ABYTiENOID — Two^ small, pyramidal. Best upon posterior ft highest part of upper bor-
der of cnooid cartilage, and present :
Anterior Surface *- Convex, rough ; gives attachment to false vooal cord ft upper fasei-
Fosterior Surface-Excavatedfor attaoh.of arytaenoideua. o^^" of thyro-arytaoaoideBS.
Internal Surface -* The narrowest, flattened, covered with muoous membrane.
Base - Broad. Presents a smooth concave facet for articulation with oriooid cartilaire,

and three angles, of whioh angles two are prominent ft important, viz,,
AnterO'InLmal Angle "^ouf^ ft pointed; g^ves attachment to trne vooal cord ft to

lower fasciculus of thyro-arytmnoidea.*.

PosterO'Ext. Angle - Short ft rounded; gives attach, to thecrico-arytsBnoidei lateralis 4

Apex -* Pointed, carved backwards ft inwards ; articulates on either side with the P<Mtic us.

OOBNICULA LAEYNGIS or CARTILAGES of SANTORINI — Two small

conical nodules of yellow elastic cartilage sometimes joined to apices of arytieooid

cartilages, whioh apices they prolong backwards ft inwards.

CUNEIFORM CARTILAGES or CARTILAGES of WRISBERG — Two small rods

of yellow elastic cartilage directed upwards ft outwards in free border of aryteoo*
epiglottidean folds a little in front of arytsenoid cartilages; their anterior ex-
tremity is slightly enlarge*].

22PIGLOTTIS *— Median lamella of yellow elastic cartilage !n the form of a leaf with the

stalk below, and the lamina or expanded part above. Presents:
Apex * Long ft narrow; attached by thyro-epiglottio ligament to apper part of reo<^diQg
Base - Broad, rounded, free. ^^«^^ o^ ^7^^ cartilage.

Anterior Surface -Free in its upper part, where it curves forwards towards base of

tongue, to whioh it is connected by the three glosso-epiglottio folds;, ad-
herent below, where it is attached by hyo*epiglottio ligament to upper bor-

der of hyoid bonei
Posterior Surface - Free, smooth, concave from side to side, convex from above down-
wards. Covers superior aperture o\ jarynz during second act of deglutitioa,
and is studded with numerous small pits for the reoeption of mucona glaadc
Lateral Martfins - Convexi directed backwards; connected to arytaenoid cartilages by

the arytceno^piglottidaaa fold*

259

THE LARYNX— 2nd Tablet.

LIGAMENTS — a,«,

EXTRINSIC — Three; oonncot larTiiz to fayoid bone. - Tbej arei

Thyro-Hyoid Membrane - Broad fibro*e1astio membrane from
Upper harder of thyroid cartilage to

Upper border of hyoid bone, being separated from posterior Bnrface of hyoid
bone by a little loose cellnlar tissae in which a bnrsa is nsaally fonnd.
It is thickest towards middle and perforated laterally by superior laryn-
geal Tessels & nerves. Behind it are the epiglottis & the mncons mem*
brane of the base of the tongne, with a considerable amount of adipose

tissue & some mnoous glands*

Lateral Thyro-Hyoid Ligaments - Bounded fibro-elastio cords from
Superior eomua of thyroid cartilage to

Extremities of greater comua of hyoid botte. - These li^^aments often contain a

small oartiiaginons nodule, the cartiiago triticea,

INTRINSIC "^ Connect cartilages of larynx as follows : n the one hand the cricoid

to the thyroid & aryteonoid, on the other the epiglottis to the thyroid. -

They are t

Crico-Thyroid Membrane - Yellow elastic lamina divided intoz
CsNTKAL Portion - Thick, triangular, broadest below; connects
Contiguous margins of cricoid &* thyroid.

Laterai. Portions -Thinner; extend from

Upper border of cricoid cartilage as far back as crico-thyroid arthrfldia to
JLcnoer border of inferior or true vocal cord, uniting firmly with the latter,
especially in front. - The central portion is concealed by crico-thyroid
muscles, except in mesial line, and is crossed by crico-thyroid branches
of superior thyroid arteries; the lateral portions are covered by the thyro*
ft lateral crico-arytienoid musoles, and are lined internally by mucous

membrane of larynx.

CriCO-Tliyroid Capsules - Thin, strongest behind ; enclose the arthrodial
articulations between cricoid & inferior cornua of thyroid, and are

lined internally with synovial membrane*

Posterior Crico-Arytsenoid Ligament - Short but strong band from

Back of cricoid cartilage to
Back of base of arytenoid,

Crico- Arytenoid Capsules - Thin ; surround the arthrodial artionlatione
between upper border of cricoid cartilage & bases of the arytfenoid,

and are lined internally with synovial membrane^
Thyro-Epiglottic Ligament - I'ong ft slender band connecting
Apex of epiglottis to
Upper part of receding angle of thyroid.

Hyo-£ipiglottic Ligament - Somewhat indistinot; extends amidst a ooo«

siderable amount of adipose tissue from
Anterior surface of epiglottis to
Upper border of hyoid bone.

To the fbregoing ligaments must be added t^e superior ft inferior
thyro-arytasnoid described with the vocal cords, and the somewhat
indistinot fibro*oartiIaginous capsules frequently found between the

arytsenoid cartilages ft the ooralonla laryngisu

260

THE LARYNX— 3rd Tablet

ISUSCLKS of the GLOTTIS * Are four on each lidei and one in the middle line.

CriCO*Thyroideil8 - Front A Bides of oriooid oartilage.

Lower border & inferior oomn of thyroid cartilage. - 8* Vt foporior larjn*
goal nerre.

TtUs the thyroid catHlage forwards^ and thus eiongata ^ tmsa ihe voeai cords.

TtayTO"Ar3rt8d21oideilS - Lower part of reoeding angle of thyroid cartilage, h posterior
Burfaoe of orico-thyroid membrane.

By two fasoionli into anterior snrfaoe of arytaenotd oartilage, and into
anterior or internal angle of its base. - 8. by reonrrent laryngeal nerve.

Drews the arytaniid cartilagi forwards f and thus shortens and relaxes the vocal
cords; it also assists in compressing the sacculus latyngis. The former action is that
of its lower h stronger fascioalns, which lies parallel with, ft on the enter side
of, the inferior or true vocal cord; the latter aotion is that of its npper A thinner
fascicniai, which lies on the cater side of the saccalos laryngis.

CriOO*Aryt8enoideil8 Lateralis *- Si^o of npper border of cricoid cartilage.

External or posterior angle of base of arytenoid cartilage. - 8. by reoo^
rent laryngeal nerre.

Rotates the arytanoid cartilages so as to bring together their anterior or internal
angles &* the true vocal cords which are attached to them, and thus constricts the glottis.

CriC0*Aryt8d]10ideus Posticua - Broad depression on side of posterior surface of
cricoid cartilage.

External or posterior angle of base of arytenoid cartilage. - 8. by reear*
rent laryngeal nerve.

/Rotates the arytanoid cartilages so cu to separate their anterior or internal an^
&» the true vocal cords which are attached to them^ and thus dilates the glottis.

ArytSDXIOide'aa - Posterior snrfaoe & enter border of both arytssnoid cartilages, pre-
senting superficial obliqae & deep transverse fibres. - 8. by both the superior &
the inferior or recurrent laryngeal nerves.

Brings together the two arytctnoid cartilages^ and thus constricts theglottist espe*
daily in its posterior part, - Sometimes a small fasciculus, the Kerato^cricoideus
(Herkel), extends, below the preceding, from the oriooid oartilage to tho inferior
oornn of the thyroid oartilage.

miSCLES of the EPIGLOTTIS — Are three in number.

Tbyro-Epl^ottideuB or Depressor Epiglottidis - Inner nrfaoe of the thyroid

oariilage externally to origin of thyro-arytaenoid.

Margin of epiglottis & arytceno-epiglottidean fold.

Depresses the epiglottis, and assists in compressing the sacculus lasyngis,

Arytssno-Epiglottidens Inferior or Compressor Saccoli Laxyngia - Ary.

tSBnoid cartilage jost above false vocal cord.
Har^^in of epiglottis.
Depresses the epiglottis , and assists in compressing the sacculus laryt^gis*

ArytanO-Epiglottideus Superior - Apex of ary t»noid cartilage.

Arytsno-epiglottidean fold.

Constricts the superior aperture of the larynx during the second act of diglutition. ->
The oblique fibres of the arytasnoideus are sometimes considered as belonging to
the arytsno-epiglottidei, which muscles would then decussate in the middle
line behind the horixontal fibres of the arytaonoideus, or arytcsnoidens proper.

261

THE IiARYNX-4th Tablet.

uncons membrane

Lb stretched, on entering the larynx, between the arytsBnoid cartilages & the epiglottis,
forming the arytano'epi^ottidean folds. These contain the thyro- & the arytseoo-
epiglottidean muscles, the oomicnla laryngis k the cartilages of Wrisberg, and a
large amount of loose cellular tissue, the occasional infiltration of which tissne
constitutes the so-called oedema of the glottis.

It is thin, and of a pale rosy colour. It is particularly thin h adherent over the epiglottis,
and still more so oyer the true vocal cords, where it is transparent enough for the
ligamentous fibres to be seen throngh its substance.

Its epithelium is columnar ciliated below the superior Tooal cords, and also, in front, as
high as the middle of the epiglottis; above these points it loses its cilia, and grada*
ally assumes the squamous form. It is squamous oyer the true vocal cords.

It is highly sensitive in the upper part of the larynx.

MXJCOUS GLANDS — Simple tubular, and conglomerate; particularly abundant over
the posterior surface of the epiglottis, in which situation they are received into num.
erous small pits in the substance of the cartilage; but they are found everywhere
beneath the mucous membrane, excepting over the trae vocal cords. The glands of
the sacculus laryngis, from 60 to 70 in number, pour out their secretion upon the in-
ferior or true vocal cords which it is destined to lubricate. The so-called arytanoul
glands are collected into a somewhat large mass in the arytseno-epiglottidean folds,
m front of the ary tsenoid cartilages.

VSSS£LS & N£RV£2S — Arte&ies. Are the laryngeal branches of the superior &
inferior thyroid. - Veins. Open into the superior, middle A inferior thyroid. - Lym-
phatics. Terminate in the deep cervical glands. - Nerves. Are the superior and the
inferior or recurrent laryngeal branches of the pneumogastric, and filaments from
the sympathetic. The superior laryngeal nerve supplies the mucous membrane, the
crico-thyroid muscle, & in part the arytssnoid ; the inferior or recurrent laryngeal
nerve supplies in part the arytenoid, and all the other musoleSi excepting the orioo*
thyroid.

262

THE LARYNX-SthiTablet.

INTERIOR of the LAR7NZ.

Is diTided in two by tbe glottis or rf«a glotticUi.

GLOTTIS or RIMA GLOTTIDI8 — Antero*poiterior opening ooniiriBed fes.
tween the inferior or tme vooal oords in its anterior three-fonrths, and between
the aTytsBnoid cartilages in its posterior fourth.

In tranquil breathing it is triangular with base backwards. It is losenge.
shaped when A1II7 dilated, as in violent inspirations. It is reduced to a narrow
slit when sound is emitted; the vocal oords then lying parallel to each other,
and their degree of approximation & tension increasing with the height of the
sound produced.

In the adult male it is nearly an inch long, and may be dilated to nearly
half an inch. In the female, and in the male before puberty, its dimension! are

about one-third less.

Inferior or Tme Vocal Cords - Extend from near middle of receding angle
of thyroid cartilage below the false vocal cords to anterior or internal
angle of the base of the arytsonoid cartilages. They consist of a strong
band of yellow elastic fibrous tissue, the inferior thyrO'arytemoid ligament^
which band is continuous inferiorly with the lateral portion of the crico-
thyroid membrane, is covered internally by a very thin h adherent layer
of muoons membrane, and is strengthened externally by the thyro.

arytsBnoid muscle.

PART ABOVZS tlie GLOTTIS — ^> broad h triangular, ft presents for exami-
nation : —
Suporior Aperture of tlie LarsnUC -Triangular, obliquely inclined downwards
h backwards, and bounded in front by the epiglottis, h laterally by the

arytsDno-epiglottidcan folds.

Superior or False Vocal Cords - Extend from near middle of receding angle of
thyroid cartilage above the true vooal oords to the anterior surface of the
arytsduoid cartilages; they consist of a fold of mucous membrane con*
taining a thin band of yellow elastic ftbrous tissue, the superior thyrc
arytenoid ligament^ from which a delicate expansion extends over the
sacculus laryngis. They bound superiorly the openings of the

Ventricle of tlie Larynx - Deep oblong saccular depression comprised between
the superior h inferior vocal cords, and corresponding externally to the
thyro«arytsBnoid muscle. It is continued superiorly h in front by a nar*

row opening into the

Sacculus Lartmois ob Lartnoeal Pouch - A prolongation of the foregoing,
which passes upwards & forwards between the superior vocal cord h
the thyroid cartilage, and is covered externally by the thyro-
epiglottideus & by the thin upper fasciculus of the thyro-arytssooid,
and internally by the arytceno-epiglottideus inferior or compressor
eaoculi laryngis. The mucous lining of the pouch is supported by an
expansion from the superior vocal cord, and presents the openings of
firom 60 to 70 mucous glands, whose secretion lubricates the inferior

vocal cords,

PART BSLOW the GLOTTIS — l* flattened from side to side above» circuUr

belowi continuovB inibriorly with oanal of trachea.

THE NERVE CENTRES &
THEIR COVERINGS.

264

COVEBINGS of the BBAIN & CX>BD-l8t Tablet

The immediate oorerlngi of both are Uiree in number, and thoagli preeentlng nariced differ.

ences, ihef bear the same names, datra maUr^ anuhntnd ^fia maitr,

THE DURA MATER — le » thick, dense, fibrons membrane, which is lined intemaHy

by the parietal layer of the arachnoid.

Dura Mater of the Brain - Forms the internal periostenm of the skoU s it is pro.
long^ round all the cranial nerves, blending with their sheaths and becoming
at their point of exit continnoos with the pericranium ; it is also prolonged into
the orbit.

Its onter surface is rongh & fibrillated ; it is most adherent opposite the sntares at
the base of the sknll, and presents superiorly numerous glandule Pacchionii.

Its inner surface is smooth ; it sends three processes inwards, the /alx cereiri and
the Untorium kfalx cerebdlu ii^ the attached marges of which processes are re-
pectively contained the superior longitudinal, the lateral A superior petrosal, k
the occipital sinuses, the falx cerebri having also the inferior longitudinal sinus
in its free margin.

Its arteries are derived from the middle h small meningeal, and from the meningeal
branches of the anterior h posterior ethmoidal, internal carotid, ascending pharjm-
goal, occipital & vertebral, which arteries however supply principallj the bones
of the skull. Its veins, with the exception of the two which accompany the middle
meningeal, join with the diploic veins and open into the sinuses. —Its nerves are
small branches from the fourth cranial nerve, the Casserian ganglion, the ophthal-
mic branch of the fifth, the eighth, A the sympathetic.

Dora Mater of tbe Cord - Differs from that of the brain in that it does not form thQ
internal periostenm of the bodies d( laminSD of the Tcrtebrm, which periosteum is a
distinct fibrous membrane separated from the dura mater by loose areolar tissua
A by a plexus of veins, in that it sends no prolongations inwards, contains do
sinuses, and forms, especially in the cervical h lumbar regions, baft a loose sheaiii
round the cord and the roots of the spinal nerves.

It is attached superiorly to the circumference of the foramen magnum, and aninicr^j
it is slightly adherent along its whole length to the posterior oommon ligament
of the spine.

Laterally when viewed from wilhin^ it is seen to give attachment to the proceeses of
the ligamentum dentionlatam, and to present a double series of foramina for tbo
passage of the anterior & posterior roots of the nerves; when viewed from mUuut
it is seen to form a separate sheath to the roots of the nerves as far as their point
of junction, and then to be continued upon the nerves, forming part of their
neurilemma.

Opposite the terminahon of the cord it blends with the pia mater to form the ligamen-
tum oentrale, which passes down to the back of the coccyx, and which, in its upper
part,*contain8 the filiform prolongation of the grey matter of the oord termed the
filum terminaleu

2«5

COVEBINGS of the BRAIN a;'C0BD-2nd Tablet

THE ARACHNOID

Ib a serous membrane of which the parietal layer lines the dura mater with a layer of squamoiu
epithelial cells, while the visceral layer snrronnds the brain & oord, firom which it is sepa-
rated by the snbaraohnoidean space.

Visceral Layer of the Arachnoid of the Brain — On the upper surfaoa of the

hemispheres it is thin & transparent, and passes oyer the oonTolntions without
dipping into the sulci. - At the base of the brain it is thicker and slightly opaque.
Crossing from side to side between the two temporo-sphenoidal lobes and between the
two hemispheres of the cerebellum & the medulla oblongata, it bounds inferiorly the
anterior ^posterior subarachnoidean spaces.
It is reflected round the cranial nerres in the shape of loose sheaths as far as their point
of exit from the skull, where it becomes continuous with the parietal layer.

Visceral layer of the Arachnoid of the Cord — Forms, especially in the lower part|

but a loose sheath round the cord & the roots of the nerres.
This sheath is single round the two roots of each spinal nerve, and is continued as far as
their exit from the dura mater ; the arachnoid is also reflected orer the processes of
the ligamentum dentiualatum.

THE SUBARACHNOIDEAN SPACE

Is comprised between the pia mater & the yisoeral layer of the arachnoid, and oontaini
the cerebro-spinal fluid. It usually communicates with the general ventricular cavity
of the brain by an opening in the layer of pia mater whioh bounds the fourth ventricle
inferiorly.

It is narrow on the snrfaoe of the hemispheres, but is greatly expanded both at the base
of the brain in the situation of the anterior & posterior subarachnoidean spaces, and
also round the spinal cord.

It is crossed by numerous fibrous bands in the situation of the base of the brain and at
the upper part of the back of the cord, and is partly subdivided by an incomplete
membranous septum which connects the arachnoid with the pia mater opposite the
posterior median fissure.

266

GOVEBINGS of the BBAIN & COBD— 3rd Tablet

THE PIA MATER

On tbe oerebnun ft oerebellnm tlie pla mater Is a delioate areolar membrane, Tsrj thin ft
▼aBonlar. It is thick, denM, and bnt slightlj Tasonlar, on the pons, the omra oerebri ft the
oord.

It IB everywhere intimately adherent to the neryons snbfitancef it dipa down between the
oonrolntione of the oerebmm and the laminio of the oerebellnm, and passes into the ante-
rior and posterior median fissures of the oord| it is prolonged upon the nerree and their

roots.

The pia mater of the brain penetrates into the ventrionlar oavities through the transrene
fissnre, and forms the Telnm interpositnm and the choroid pleznses. - It nsnally prescnU
an opening at the lower extremity of the fourth ventricle, by which opening the subaraoh-
noidean space of the brain ft cord communicates with the rentrioular cavities of the brain.

Tho pia mater of the cord presents anteriorly the linea splendens, a whitish longitudinal fibrous
band, and laterally, the ligamentum dentioulatunu This latter descends along the whole
length of the side of the oord between the anterior ft the posterior roots of the nerves; its
outer edge is denticulated; the denticulations, about twenty-two in number, oross tlie
subarachnoidean space with the arachnoid reflected over them, and become attached to
the dura mater in the intervals of the successive pairs of spinal nerves. The first dentica-
lation is situated opposite the foramen magnum, between the vertebral artery ft the hypo*
glossal nerve. — Opposite the termination of the oord the pia mater blends with the durm
mater to form the ligamentum oentrale, which latter passes down to the back of the ooccys,
and, in its upper part» contains the filiform prolongation of the grey matter of the ooc^
termed the filum terminale.

THE ST7BFACE of the CEBEBBUM. ^^^

The cerebral bemispheree are now desoribed as presenting fire lobes s the firontal, parietal, oooipital
& temporo-Bphenoidal lobeSy and the central lobe or Island of BeU. These lobes are seen most

extensively on the npper or conyez surface of the hemispheres.

UPPER OR CONVEX SURFACE OF THE CEREBRUM : - Frwent.,

FOUR PRINCIPAL FISSURES — Which partly separate the five lobes ;

ASOENDma & HORIZONTAL LIMBS OF THE FISSURE OF SYLYIUS —
The former ascends in front of the central lobe and amongst the frontal
convolutions. - The latter passes backwards behind the central lobe, and
separates the temporo-sphenoidal lobe from the frontal & parietal lobes.

FISSURE OF ROLANDO — Begins near the middle of the longitndinal fissure
and passes downwards & forwards to near the horizontal limb of the
fissure of Sylvius, separating the frontal & parietal lobes.

EXTERNAL PARIETO.OCCIFITAL FISSURE ~ Separates the parietal and

oooipital lobes above. - Is very variable in extent, and is sometimes

scarcely recog^sable except by its being continuous with the internal

parieto-ocoipital fissure, or perpendicular fissure of the inner surface of

the hemispheres.

OUTER SURFACE OF THE FIVE LOBES:

Frontal Lobe - Presents :

Ascending Feontal Convolution - Forms the anterior boundary of the fissure of
Rolando, and is continuous round the lower end of that fissure with the
ascending parietal convolution. It is joined in front to the

SuPERXoa, Kiddle & iNVEKioa TaANsvERSs Feontal Convolutions, - Which pass
forwards one above the other to the anterior extremity of the hemisphere.

Parietal Lobe - Presents !

Ascending Paetetal Convolution - Forms the posterior boundary of the fissure
Rolando, and is continuous below round the lower end of that fissure, with
the ascending frontal convolution. - Behind this convolution are three
complex and variable convolutions termed the parietal lobule, the supra-
marginal convolution A the angular gyrus.

Paeietal Lobule - Is situated on the side of the longitudinal fissure between
the parieto-oooipit^' fissure, & the fissure of Rolando, and, is contin.
nous in front with the upper part of the ascending parietal convolution,
and joined beUnd to the superior occipital by the first annectant con-
volution.

SuPBA-HARoiNAL CONVOLUTION - Is situatod bolow and in front of the preceding
and in front of the ang^ilar gyrus. It is separated from the ascending
parietal convolution by the intra-parietal fissure, and is connected behind
with the angular gyrus.

Angular Gyrus - Is situated behind the preceding, below and behind the par-
ietal lobule. It blends below with the superior A middle temporo-sphe-
noidal convolutions, and is connected behind with the middle occipital

by the second annectant convolution.
Temporo-Spbenoidal Lobe -Presents three well marked antero-posterior con.
volutions, which are superposed to each other.

Sup. Teupobo-Sphenoidal Convolution - Lies between the horizontal limb Oi
the fissure of Sylvius and the parallel fissure, and is continuous behind
with the ang^ar gyrus.

Middle Teuporo-sphenoidal Convolution -Is separated from the lower one by
the .inferior temporo-sphenoidal Assure, and is continuous posteriorly
with the angular gyrus and connected by the third annectant with the
middle occipital convolution.

Xnp.Temporo-sphenoidal Convolution- Is partly seen on the under surface of
the cerebrum, and is connected behind to the third occipital by the fourth
annectant convolution.

Occipital Lobe - Presents three rather badly defined convolutions, which are

Buperposed to each other, and are more or less antero-posterior.
Sup. Occipital Convolution - Is connected to the parietal lobule by the first

annectant convolution.
Kiddle Occipital Convolution - Is connected to the angular gyrus ft to the

middle temporo-sphenoidal convolution by the second and third anneo-

tant convolutions.
Inp. Occipital Convolution - Is connected to the inferior temporo-sphenoidal

convolution by the fourth annectant convolution.

Central Lobe or IsUtnd of Reil -I" deeply situated between the frontal &
temporo-sphenoidal lobes at the bottom of the outer part of the fissure of
Sylvius. It presents five or six oonvolations, which are nearly straight
and mainly directed upwards and outwards^ and of which the po^t'^''*
ones are the largest.

268

UNDEB SURFACE of the CEBEBBUM

riesents from before backwards
IN THE MEDIAN LINE:

Anterior part of the Longitudinal FiSSnre - Bounded bebind by the anterior

extremity or genu of the oorpue oallosmn.

Anterior Extremity or Genu of the Corpus Callosum - Ourres down.

wards and backwards. Its narrowing reflected portion, beak or rostrum,
is connected with the lamina oinerea, and gives off two white bundles, the
peduncles, which cross the anterior perforased space to the entrance of

the fissure of Sylvius.

Lamina Cinerea - A thin layer of grey substance stretching, above the optic com-

miss are, with which it is connected, from the rostrum of the corpus

callosum to the tuber cinereum, and continuous laterally with the grey

matter of the anterior perforated space.

Optic Commissure or Chiasma with the Optic Tracts -Vide Optic Nerve.

Interpeduncular Space - Lozenge-shaped, compriBed between the crura cerebri

and the optic tracts, and containing from before backwards :
Tuber Cinereum with the Infundibuluh & Pituitaet Bodt - The former of
which is a conical eminence of the grey matter of the floor of the 3rd
ventricle connected by a hollow infhndibuliform process, the infundi*
bulum, with the latter, which latter is a small reddish grey vascular
mass divided into an anterior & a posterior lobe, and the nature ol
which, especially in its anterior lobe, is very similar according to Dr
Sharpey, to that of the ductless or vascular glands. It is proportions ■
tely larger in the foDtus, and is then hollow, its cavity being continuou«

with that of the Srd ventricia

Corpora Albicantia - Two small round white bodies formed by the twisting

upon themselves of the anterior crura of the fornix before they pass

up to the optic thalami.

Posterior Perforated Space - Formed by a layer of grey substance, which

constitutes the posterior part of the floor of the 8rd ventricle and is

continuous around the corpora albicantia with the base of the tuber

cinereum. It is perforated by numerous small foramina for the

passage of blood vessels to the optic th^i^w;
Crura Cerebri * Vide Hesocephalon.

LATERALLY :

Under Surface of the Frontal Lobe -Presenting internally the lower end of

the marginal convolution, on the outer side of which is the olfactory

sulcus containing the olfactory nerve and bolb.

Anterior Perforated Space -Formed by a layer of grey substance correspon.

ding to the unaer surface of the corpus striatum, and perforated by

numerous small foramina for the passage of vessels to that body. It im

bounded in front by the •posterior and inner part of the frontal lobe and

the roots of the olfactory nerve, and behind A to the inner side by the

optic tract & commissure, and is continued externally into the

Fissure of Sylvius - Which separates the frontal and temporo-sphenoidal lobes

ana divides on the outer surface of the cerebrum into two branches or

limbs, which enclose the middle lobe or Island of Beil.

Under Surface of the Temporo-sphenoidal Lobe.

Behind these parts appear when the medulla oblongata & cerebellum are

removed, in the median line :

Middle part of the Transverse Fissure - Comprised between the

corpora quadrigemina and the

Posterior Extremity or Splenium of the Corpus Callosum -

Behind which is the

Posterior Part of the Longitudinal Fissure -And latenOiy the
Under Bur&ce of the Occipital lobe.

269

INNEB SUBFACE of the CEBEBBUM

Preients for examination i

Marginal Convolution k ConvoltUum of the Corpus Callosum separated firom eaoh other by the

CallosO'tnargimU Fissure;
Quadrate &* Occipital LobuUs leparated from eaoh other bj the
Internal ParietO'OccipitcU Fissure^ and separated bj the
Calcarine Fissure from the internal temporo-sphenoidal convolutions;
Internal Temporo-sthenoidal Convolutions^ three in nnmber, superior (dentate oonTolntion),
middle (gjrns nncinatns) i inferior, and separated from the foregoing bj the

above-mentioned oaloarine fissore and from eaoh other by the
Dentate 6* Collateral Fissures,

Marginal Convolution - Forms the lateral bonndary of the anterior half of the longitudinal
fiasnre.^ Beginning at the anterior perforated space, it first passes forwards on the
inner side of the olfactory salens as far as the apex of the frontal lobe, and then
onrves upwards h backwards along the upper margin of the hemisphere to a little

behind the fissure of Bolando.

Convolution of the Corpus Callosum or Gyrus Fomicatus - Begins anteriorly with

the foregoing, and then winds backwards along the convex surface of the corpus
callosum from which it is separated by the so-called ventricle. Posteriorly it
joins above with the quadrate lobule, and then, becoming slightly constricted, is
reflected downwards & forwards round the splenium and continued into the gyrus

nncinatns.

Calloso-Marginal Fissure -Separates the two foregoing convolutions along their
whole length, and then ascends to the upper margin of the hemisphere separating

the marginal convolution from the quadrate lobule.

Quadrate Lobule - Quadrilateral. Bounded above, in front, & behind respectively by the
margin of the hemisphere, and by the calloso-marginal & internal parieto-ocoipital

fissures. Blends inferiorly with the gyrus fornicatus.

Occipital Lobule ~ Triangular. Bounded behind, in front, A below respectively by the inner
margin of the hemisphere and by the internal parieto-occipital & calcarine fissures.

Internal Farieto-Occipital Fissure - Separates the two foregoing lobules. It is
continaous superiorly with the external parieto-occipital fissure; inferiorly it

joins with the calcarine fissure.

Calcarine Fissure - Extends horizontally forwards from the apex of the occipital lobe
to the point of junction of the gyrus fornicatus with the gyrus uncinatus. It
separates the occipital lobule from the middle tempore sphcDoidal convolution, and

joins anteriorly with the internal parieto-occipital fissure.

Superior Temporo-Sphenoidal or Dentate Convolution - i« but a narrow band of

grey matter which lies internally to the fascia dentata. It blends anteriorly with

the uncus.

Dentate Fissure*-* Corresponds to the hippocampas major, and separates the dentate

convolution from the gyrus uncinatus.

Middle Temporo-Spbenoidal Convolution or Gyrus Uncinatus - Comprised

between the calcarine h collateral fissures, and extends along nearly the whole
length of the temporo-sphenoidal lobe. It is slightly constricted towards its middle
& enlarged in front & behind ; anteriorly it presents a small hooked prolongation,
the uncus, which curves upwards & backwards, and joins with the dentate convolu-
tion & with the corpus fimbriatum.

Collateral Fissure - Extends along nearly the whole length of the temporo-sphenoidal
lobe, Separating the gyrus uncinatus from the inferior temporo-sphenoidal convolu-
tion. It corresponds towards its middle to the eminentia collateralii.

Inferior Teznporo-Sphenoidal Convolution -Appears both on the inner & under surfaces

of the hemispheresi and is joined behind by the fourth annectant to the inferior

occipital convolution.

270

INTEBNAL STJEtUCTUBE of the HEMISPHERES.

PARTS SEEN BEFORE OPENING THE VENTRICLES :

CentnUll Ovalo Minns -- With the pnnota Tascnlosa & the conrolated margin of

the divided grej matter.

Ventricio of tlld Corpns Callosnm - Comprised between the corpiu callosnm &

the gynu fomicataa.

Centnun Ovale Majns -into whioh the fibres of the corpus oallosnm are continned

on either side.

Corpns Callosnni - Thick stratum of transTerse & radiating white fibres which con-
tieot the two hemispheres; arched from before backwardB, thickest &

broadest behind, thinnest towards centre. It presents:

Upper Sub pace - Convex from before backwards, striated transversely, marked

by a median depressed raphd which is bounded by two slightly elevated

bands termed the nerves of Laneisu More externally, beneath the gyms

fomioatns, are other similar bands, the stria hngihtdmales lateralis.

Ukder Surface - Blended behind with the fornix. In front, where it forms the
roof of the lateral ventricles, it is connected with the fornix by the aeptnoi

Antes TOR Extrbvitt or Genu - Cnrves downwards h backwards, presenting a
narrowing reflected portion, the beak or rostrum* This latter is connected
with the lamina cinerea, and gives off two small white bands or pedufules^
which cross the anterior perforated space to the entrance of the fissnre of

Sylvia^^

Posterior Extremity or Spleniuk - Thick & ronnded. Forms npper boandary
of middle portion of transverse fissure, and is joined in front with the fornix.

271

THE LATERAIi VENTRICLES

OonriBi of a oentral cavity or body, and three prolongations or oomoa.

Central Cavity or Body - Presents :

Boor - Formed by nnder surface of oorpns callosnm.

Innee Wall - Formed by septnm Incidnm.

Floor - Formed from before backwards by the corpus sirialum, tania semicirctdaris^

thalamus opticus, choroid plexus, corpus fimbriaiutn ^fornix*

AlXt. Comn " Passes downwards & outwards round anterior extremity of corpus striatum.

Post. Comu or Digital Cavity - Curves backwards, downwards, outwards, and then
backwards, downwards & inwards in substance of occipital lobe. On inner part of
its floor is the hippocampus minor, a longitudinal eminence which corresponds to

^ calcarine fissure of Huxley.

Middle or Descending Coma - Curves backwards, outwards & downwards round optio
thalamus, and then forwards & inwards to near anterior extremity of tempore-
sphenoidal lobe. Its floor presents the hippocampus major, pes hippocampi, pet
aecessorius, corpus fimbriatum, choroid plexus, fascia dentata A transverse Jissure.

272

S SEEN on FLOOR of LATERAL VENTRICLE

An from before baokwftrdi .

CORPUS STRIATUM — Larg^ pear-sliaped man of grey matter embedded externally in wbtte

■nbstanoe of frontal lobe. Preienti:
Akt. Extbexitt - Broad ; projeote into anterior part of body of lateral rentricle, forming part

of its floor, and into anterior oomn of the same caritj.
Post. Extreuitt - Narrow ; paeaee backwards and ontwards on enter ride of optio ihalamaa.

The oorpns striatum is divided into two portions, tbe intra- & extra-Tentricnlar,
by a layer or stratum of ascending & diverging white fibres which form the /ectm
or the cortma radwta of Reil* Part of these fibres are derived from the inferior or fas-
oioalated portion, and also from the npper part or tegmentum, of the cms cerebri;

part of them originate in the oorpns striatnm.

TCBSNZA SEMICIROUL ARIS — Whitish semi-transparent band of fibres, whioh descends an-
teriorly in connection with anterior cms of fornix, and is lost posteriorly in descending

comn of lateral ventricle ; it partly conceals the vena corporis striati.

OPTIC THALAMUS ■— Large ovoid mass of grey matter white snperfioiallyy similar to corpus
striatum, behind & internally to which it is situated, and similarly traversed by numerous
ascending & diverging white fibres, whioh are partly derived from upper portion of eras
cerebri, olivary fasciculus, fasciculus teres, processus e cerebello ad testes & corpora qnadri-

gemina, and which partly originate in the thalamus. Presents:

Amt. Extreuitt - Narrow, situated behind anterior cms of fornix; forms posterior boundary of

foramen of Monra

Post. Extrexitt - Broad & rounded. Projects into descending oomu of lateral ventricle, aod

is continuous on inner side with tubercula quadrigemina.

TTpper Sub? ace - Anteriorly it forms part of floor of lateral ventricle, and presents a slight
elevation, the anterior tubercle ; posteriorly it is covered by fornix, which rests upon it.

Under Surface - Continuous with posterior rounded extremity. In its posterior part it forms
roof of descending comu of lateral ventricle, and presents two small eminences, tbe
corpora geniculata internum et externum, which are connected respectively with inner &
outer bands of origin of optic tract. In its anterior part it rests upon the eras cerebri,

and is penetrated by the radiating fibres above mentioned.

Inner Surface - Forms lateral boundary of 8rd ventricle. Is joined to its fellow by the middle,
soft, or grey oommissure, and presents inferiorly the grey matter of the interior of the
thalamus uncovered by the white. The superior peduncle of the pineal gland sepa-
rates this surface from the upper.

Outer SuRriCB - Continuous anteriorly with posterior narrow extremity of corpus striatum,

and embedded posteriorly in white substance of temporo-sphenoidal lobe.

CHOROID PLEXUS — ^be thick, convoluted A fringe-like margin of the velum interpositum. -

Yide Velum interposituas.

CORPUS FIMBRIATUM or TiBNIA HIPPOCAMPI —The thin lateral margin of the

posterior cms of the fornix.

FORNIX *— Triangular longitudinal lamella of white matter broad behind, narrow in front, situated
below corpus callosum with which it is joined behind, and to whioh it is connected in frout
by septum Inoidnmi forms roof of third h posterior part of floor of both lateral ventricles.

Presents:
BoDT - Presents t

U/ftr Surface - Joined behind with corpus oallosum, and oonneoted in front to the same

by septum lucidum ; forms posterior part of floor of both lateral ventricles.

Uiuter Sutface - Harked posteriorly by a few transverse & anteriorly converging fibre%
whioh form the tyra* Forms oentrally the roof of 8rd ventricle ; rests laterally upoo

optio thalamu Is covered by velum interposituB.

Amtsrior Crura - Descend behind anterior white oommissure & in front of optio thalamaa
forming anterior boundary of Ibramen of Monro, and pwforate grey substance ol
floor of 8rd ventriole to corpora albioantia, in which they twist upon themselves ; they

then ascend to coiresponding optio thalamaa

PotTBlIOR Crura - Diverge into the desoending oomna of lateral ventricles, beooming oontinuosi
with laaar border of hippooampvs bsi^. Their thin lateral margin is the carpus fm^

Maimm or Ansss JUppteamji,

278

PABTS SEEN in DESCENDING COBNU of LATERAL

VENTRICLE.

HIPFOCAMPUB MAJOR or CORNU AMMONIB - Is » white eminenoe which
onryei downwards, forwards, & inwards along floor of descending comn of lateral
Tentricle, and which corresponds to the dentate fissure & to the reflected portion of the
oonvolotion of the corpos callcsnm or gjru^ fornicatns, which portion has been des<
eribed of late years as the anterior part of the i^^rus uncinalus. It enlarges anteriorly,

and ends in the

FSiS HIFPOCAMPI - ^o anterior ronnded extremity of the hippocampns major; it more
or less resembles the paw of an animal, being marked along its margin by slight notches

or depressions separating ronnded interrening elerationgi

FEB ACCEBBORIUB or EMINENTIA COLLATER ALIB - A small rounded

eminence, simlar to the preceding, sitaated between the two hippocampi at junction of

middle k posterior comna. It corresponds to the collateral fissnre.

CORPUS FIMBRIATUM or TiBNIA HIPPOCAMPI - Tbe prolongation of the

thin lateral margin of the posterior cms of the fornix i is continnons with inner border

of hippocampns major.

CHOROID PLEZUB - Vide next Tablet.

FABCIA DEHTATA * ^o grey serrated border of the dentate conTolntion, which is
separated from the gyms nndnatns by the dentate fissnre of Huxley. It lies beneath

the corpus fimbriatum h the margin of the oboroid plexus.

TRANBVERBE FIBBURE - VMe next Tablet.

274

TBANSVEBSE FISSUBE of the BBAIN A INTRA-

CEKBBBAL POBTION of PIA MATEB.

TRANSVERSE FISSURE OF THE BRAIH

Is of a horse-Bhoe shape, and abont 3 inches wide.

Its central part is horizontal and comprised between the taberonla qnadrigemia* &

the posterior extremity or spleniom of the oorpns callomim.

Its lateral portions onrre downwards & forwards, and are comprised between the

optic thalami & cmra cerebri below & in front and the hippocampi majores St

corpora fimbriata aboTe & behind.
This fUsnre transmits the pia mater into the interior of the brain.

INTRA-CEREBRAL PORTION OF THE PIA MATER

Forms on the one hand the relnm interpositnm A the choroid picznses of the lateral
A the 3rd ventricles^ and, on the other, the choroid plexuses of the 4th yentrlcle.

VolUIXl InterpOBituXXI - is a triangular fold of pia mater which is reflected into the

interior of the brain through the transrerse fissure. It presents :

Cemtbal Portion - Invests pineal gland, and covers under surface of fornix. From
the under surface of this central portion two small vascular fringes, the
choroid plexuses of the 8rd ventricle, hang down into the latter cavity.

Lateral Margins - Spread out on either side beneath the corresponding margin of
the fornix & its continuation, the corpus fimbriatum, into the body A des-
cending comn of the corresponding lateral ventricle, resting, as do the
margins of the fornix, upon the optic thalami. These lateral margins are
thick, convoluted A fringe-like; they constitute the choroid plexuses of the

lateral ventricles further described below.

Posterior Margin or Base - Is turned backwards towards the transverse fissure.
It is continuous with the general pia mater ; it receives the anterior A

posterior ohoroid arteries and emits the vensa GalenL

Anterior Bifid Extrbxitt - Continuous through the foramina of Monro with the
anterior pointed extremities of the lateral margins above described or

choroid plexuses of the lateral ventricles.

Choroid Fleztuses of the Lateral Ventricles - Are nothing more than the thick,

convoluted A ffinge-like margins of the velum interpositnm. When they ars
described separately, that is to say irrespectively of the velum interpositum
of which they are a portion, they may be said to penetrate into the descend-
ing cornua of the lateral ventricle through the lateral portions of the
transverse fissure. Hence they ascend into the body of the lateral ventri-
cle along the side of the oorpns fimbriatum, winding round the posterior
extremity of the optio thalamus. Then continuing along the side of the
fornix, they taper to a point, and passing through the corresponding fore-
men of Monro, they join with each other and with the anterior bifnroated
extremity of the central A thinner portion of the velum interpositum.

Choroid Fleztuses Ofthe 3rd Ventricle -Are two small vascular fringes which
hang down from the xmder surface of the central portion of the velom
interpositum into the oarity of the 8rd ventricle i they diverge slightlj

behind.

Choroid Plexuses of the 4th Ventricle - Are two similar iHnges which project

into the 4th ventricle from the layer of pia mater whioh olosea that ventri-
cle inferiorly ; they pass upwards A outwards from near the point of the
inferior vermiform process to the outer margin of the restiform body.

276

THE THIRD VENTBICLE

is » narrow median fiasnre compriBed between the optio thalami, and extending to tha

^ base of the brain. It preientt i

Roof- Formed bj under snrfaoe of fornix and hy Telnm interpositum.

Ploor - Corresponds to interpednnonlar spaoe on nnder surface of oerebmm, and is formed
from before backwards by the lamina oinerea, tuber oinereum St infundibulum«

corpora albicantia and locus perforatus posticus. It is oblique downwards &

forwards, and is oorered by a thick layer of grey matter. It presents in the foDtus

the opening of the iter ad infundibulum.

Lateral Walls - Formed bj inner surface of optic thalami, which surface is bounded above by
superior peduncles of pineal gland, and is covered below bj part of the grey
matter of the third ventricle prolonged upwards from its floor. - The lateral walls
are joined together by the middle or soft commissure, a transverse band of grey
matter continuous with the remainder of the g^ey matter of the 3rd ventricle.

Ant* Sztrexnity * Formed by anterior crura of fornix. In front of these is the anterior
commissure, a transverse band of white fibres, which perforates laterally the
corpora striata & spreads out into the substance of both hemispheres. - Between
the crura & the optic thalami are the foramina of Monro, through which the
lateral & 3rd ventricles communicate, and the anterior extremities of the velum
interpositum pass from the 8rd into the lateral ventricles to form the choroid

plexuses of the latter.

Post. Zztromity " Formed by posterior commissure, a transverse band of white fibres con-
necting posteriorly the optic thalami. Below this is the opening of the iter a
tertio ad quartnm ventriculum, and above are the tuberoula quadrigemina A the

pineal gland.

For parts above mentioned see foregoing Tablets.

276

THE CEBEBELLUM.

Oblong from Bide to lide & fUtiened from sbore downwftrdi. Preienta two ■nrfkoM k & eirw

onmferencey and ooniiata of two lateral hemiapherwi oonoeoted by a median lobe« the

Termiform prooeif, whioh latter ie divided into two parti, the eaperior & the inferior.

UPPER SURFACE — Flattened on either lidey elightlj elerated in the centre. Preeentei

Superior Verxnifomx Prooess - Presents from before backwards three slight

elerationB, the

LoBVLUS Cemtialis, Honticulus Oebbbblli, k Com isiOBA SiMPLBZy whioh latter

joins with the oommissnra breris of the inferior rermiform prooess.

Lateral Hemispheres - Dirided by a deep fissure into

Artebiob OB Squabe Lobb, the anterior, inner A broader portion, and the
PosTBBiOB OB Sbmilunab Lobb, the narrow, posterior or marginal portion.

UNDER SURFACE — Bonnded & elerated laterally and depressed in the oentre. Presents^

Inferior Vennifonn Process -Lies in a deep depression, the tfoUev or vta/Uatia com*

prised between the two hemispheres, and presents from behind forwards the

GoMMissuBA Bbxtis, Ptbaxid A Utula, the former of which joins with the com*

missnra simplex of the superior Termiform process.

The nmla is situated between the two totuOs, with which it is connected

by a grey oommissnre the /ttrrmoed Aand. Its rounded apez, the nodmU or

laminated htbercU of MaUuame projects into the 4th Tentride, and is con.

neoted with the floconli by a thin ralmlar fold of white snbstanoe, the

posterior medullary vdum or commissura ad floceulum^ whioh fold ie partly

oorered in A ooncealed by the tonsils.

Lateral Hemispheres - Present fire lobes t

Flocculus, Sub-Pedujiculab Lobb, ob Pnbumooastbio Lobulb - Prominent tnft
snbdirided into sereral small laminsB and sitnated below & behind the
middle peduncle of the oerebellnm, behind the roots of the pneomogmstrio

Amygdala ob Tokstl - Bather larger than foregoing and similarly sabdiriOed ;
projects into the raliey on either side of the nrala, to whioh it is oonneoted

by the farrowed band.
DiGASTBZc LoBB - Corresponds in sitnation to the anterior part of the eqaare lobe

of the upper sorfaoe.
Blbndeb Lobb - Corresponds in situation to the posterior part of the foregoieg

square lobe.

PosTESioB Ibvbbiob Lobb - Gorrespouds in situation to the posterior or eemila-

nmr lobe.

CIRCUMFERENCE — Deeply notched in front A behind by the

iBcisuBA Cebbbblli Amtbbiob h PosTEKiOB, - Of which the former embraces the

tuberoula quadrigemina A the superior peduncles, while the latter reoelTss

the falx oerebelli ; - also divided into upper A lower lipe by the

Gbbat Hobizontal F188UBB - Which extends uninterruptedly from one middle

peduncle to the other.
The other fisiures are more or less parallel to the foregoing, and describe
more or less concentric cures conoare forwards h inwards 1 some fissures
howcTer are more or less oblique, and coalesce with the others so aa not to
extend orer the whole breadth of the hemispheres. The largest fiaeures
separate the lobes aboTe described, the smaller ones demarcate the laminm
or folia, which latter corer the surface of the oerebellnm and prqjeet also

into the bottom of the larger fianrss.

277

THE FEDnNCLES of the CEBEBELLXTM.

Superior^ or Frocessus e Cerebello ad ToBtes - ArifM in the laminaB of the

inferior Termiform prooess and also in the interior of the oorpos dentatam,
pastes upwards A inwards on either side of the middle line, being joined
to its fellow by the ralre of Vieossens, and ascends beneath the tnberoala
qaadrigemina to the crura cerebri A optio thalami, partly deoossating in

the middle line.

lUddlei Frocessus e Cerebello ad Pontem or Cms Cerebelli - The

great transyerse oommissare of the oerebellam. Gonnects the laminsB of
the lateral parts of one hemisphere to the corresponding laminn of the
opposite side, and forms the pons Varolii A the deep transTerse fibres of the

mesooephalon.

Inferior^ or Processus e Cerebello ad Medullaxn - If traced from below

upwards, it may be said to proceed from all three oolamns of the oord, $^
from the postero-external bandies of the anterior A middle columns, A
from the fasoicnlns onneatus or external bundle of the posterior column,
the latter bundle being much the largest of the three. It ends in the
laminas of the middle part of the oerebellam, especially in those of the
upper surface.

278

THE MEDULLA OBLONGATA.

The upper enlarged part of spinal cord.

Extends from lower border of Pons Yarolii, aeore, to point ofdeensssHoA of avterlorpjrsmida
belowy which point corresponds pret^ nearly to upper border of aUas.

Flattened from abore downwards and forwards, and presents :

AnrsBcnmeBioi Aspect - Bests upon basilar greore.

Posmo-supSRiOK Aspect - Forms part saperiorlj of floor of 4th TenCriole, and is con*
tinuons inferiorly with posterior sorfiMO of oord.

DiTided, as is the oord, into two lateral halTes, by

AiiTEBo.HEDiiJf FissuEB- Continnons below with that of oord, being pitftlj intempted,

bowerer, by deonssation of anterior pyramids. Tsmiuiatea aboTey jost below the

pons, in a small recess, the foramen ccBcnm.
Postebo-Hedtah Fissukb - Continued above into mentriole of Arantins A postero*

median fissure on floor of 4th yentriole^ and below into postaro-medifta fissiue

of oord*

SUBFACE OF THE MEDULLA OBLONGATA.

Each half presents fitim before backwards between the two median flssureat

Anterior Pyramid - Pyramidal-shaped handle of white fibres, the apparent pro.
longation of anterior column of oord ; narrow below, enlaiged and ronnded off
abore, constricted jnst below the pons. GKtos origin in its iq>per part to Gth
cranial nerre.

OliVftiy Body - Oral prominent mass broader abore than below, shorter than, bst
about as broad as, the pyramid. - It is separated from the pyramid by a narrow
groore, which gires origin to 9th or hypo-glossal nerre, and from the lower p&rt
of whioh numerous arciform fibres are seen to proceed. These wind npwardsi
and outwards round lower end of oliyary body, sometimes crossing its anrfaes.
A few arciform fibres emerge from the anterior median fissure^ and cross anterior
aspect of pyramid (Sappey, Hirschfeld).

Lateral Tract - Ib continuous with lateral column of cord. It is broad below, whore
it includes all that part of the medulla comprised between anterior pyramid
and restiform body ; abore it is pushed backwards, and is narrowed, by the pro-
jection of the olivary body. It is separated from restiform body by a slight
groore situated in a line with posterior lateral fissure of cord, and givea ori^
from abore downwards to the facial, gloeso-pharyngeal, pnenmogastrio A spiasi
accessory nerres.

Restifoim Body or Fasciculus dmeatos - 1» the outer k larger, while the
Posterior Pyramid or Fascicnlns Gracilis - is the inner & smaller portion at «

wide A thick bundle of white fibres continuous below with posterior oolusi
of cord, which bundle direrges from its fellow superiorly, and thus botii
exposes grey matter of floor of 4th Tontriole and forms lower part of later^
boundary of that cavity. This wide & thick bundle used to be called, and is
still sometimes called i^ restiform body. - From its inner edge there projeett
inwards a thin lamina of white matter termed the iiguiat which may be oonsiderel
as forming part of roof of 4th ventricle. Opposite apex of oalamus soriptori^
the posterior pyramid presents an enlargement^ the processus clatHMius, In front of
the prooessus ouneatus, behind h a little below olivary body & in a line wit^^
postero-lateral fissure of cord, is a small greyish eminenoe, the gny MircU ^
Rolando, which is formed by the projection of the substantia gelatinosa.

Chrey Matter of Floor of 4th Ventricle -Vide 4th Ventrioie.

279

THE FOXTBTH VENTBICLE.

Bhomboidal oavity bonnded by the medulla obloagaia A mesooephalon below A in front and
the oerebellnm abore A behind, and closed in inferiorly by the layer of pia matter ex-
tending between these parts. Presents t

FLOOR — Lozenge-shapedy oblique downwards A backwards, oorered by a stratum of grey
matter from which arise the 6th, 7th, 8tb, ft 9thnerres*^yide structure of medulla
oblongata, 2nd Tablet) ; bounded on either side below oy the posterior pyramids
A restiform bodies, and above by the prooeasns e cerebello ad testes. Presents the
following parts, which give rise to the appearance termed the calamm scriptoriuv

Postero-Mbdian Fissure - Continued abore into the aqueduct of SyMus or iter a tertio
ad quartum veDtriculum, below into the rentriole of Arantins or short
upper expanded part of the central canal and into the postero«median

fissure of the cord.
LiHKiB Tbaksteksjb - A few white fibres rery yariable in number sometimes scarcely
recognisable, which emerge from the lower part of the postero-median fis-
sure, oross the eminentie teretes, and join, some of them the orus oere-
belli, others the roots of the auditory nerre \ a few Sometimes ascend to the

locus CGsruleus.

EHiHEMTiiB Teretes - Two spindle-shaped elevations, greyish k slightly marked below,

whiter & more prominent above, due to the fasciculi teretes, as they ascend

beneath the grey matter on either side of the postero-median fissure. - On

either side of these emiuenoes is a

Groote, or rather, in well marked bodies, two small fosse, which lie, the posterior,

inferior A narrowest one, near the lower extremity of the rentricle, and the

anterior, superior A broadest one, opposite the cms cerebellL The latter

fossa leads upwards to the
Locus CasuLEUS - A bluish spot due to an accumulation beneath the surface, of dark

vesicular matter termed the substantia ferruginetu From this spot the
Tinea Yiolacea, - A bluish streak, the continuation upwards of the locus csrnleus,
ascends on the outer side of the eminentia teres to the opening of the aque-
duct of Sylvius.

BOOF ~~ Formed above by the superior peduncles of the oerebellum k the valve of Yieas*
sens, below by the tonsils, the inferior vermiform process with the uvula, the nodule or
laminated tubercle of Kalaoame, A by the posterior medullary velum or oommissura

ad floooulnm. Still lower down is the ligula.

LATERAL BOUNDARIES — Formed by the superior peduncles of the cerebellum

above, and by the diverging restiform bodies k posterior pyramids below.

TIPPER EXTREMITY ~~ Presents the opening of the aqueduct of Sylvius or iter a

tertio ad quartum ventrioulum.

LOWER EXTREMITY "~ Usually presents an opening in the layer of pia mater which
bounds the ventricle inferiorly, through which opening the ventricular oavities of
the brain communicate with the subarachdoidean space of the brain k cord.

Choroid PlOZUSeB of 4th Yentriole - Vide intra-cerebral portion of the pia mater.

280

THE MESOCEPHALON

Ii the oonnaotlng link between tbe ewehnm^ oerebellnm & medulla oblongala. li eooilsta of the

foUowing parte: •
J^nu VarolU or TUber Annulan witb tbe siiperftoial & deep tramrrene ftbree of tbe Middle

PedMmda tfthe CareUlum ;
Crura Cerebri divided into under or fasciculated porHau and upper fart or tigmaUum ;
Inferior Peduncles of the Cerdbdlum^ and Superior PeduncUs with tlie Vahe of Vimssems;
Tubercula Quadrigemina A Pitual Gkmd,

Pons Varolii or Tuber Annulare *- Broad transreree band of wbite fibree wbiob arob like a

bridge from one hemiapberd of tbe oerebellnm to tbe etber, forming laterallj tbe

middle pednnoles of tbe oerebellnm. Preeeata : >

Uhdkk Subfacb - Marked bj a median aballow groove for basilar arterf. CKtoi off laterally
tbe two rootfy anterior email or motor^ posterior large or sensorr, of tbe 6tb pair of

cranial aerres.
Uffeb Bordbk - The most prominent h tbe most oonTex, from beneatb wbiob tbe onira

cerebri are seen to emerge.

Lown BoKDBK -Less prominent h less oonTez, into wbiob tbe anterior pjramids, ollrary
fascicnli h lateral tracts of tbe medulla are seen to penetrate, and from tbe anterior
aspect of wbiob tbe 6tb cranial nerres are sometimes giTon off. - Laterally tbe pons

Yarolii is continned into tbe two

Middle PedimcleB of the Cerebellum or Cmra Cerebelli - Wbioh form ite two lateral

portions.

Grora Cerebri - Two tblek cylindrical or slightly flattened bundles of white fibres about { of an

inch long A rather wider in front than behind, wbiob emerge firom the anterior
border of the pons and pass forwards A outwards to the corpora striata & optio
tbalamL They are crossed externally by the 4th nerre h inferiorly by tbe optio tract,
the anterior border of which latter is slightly adherent to them. Their inner border
bounds posteriorly tbe interpeduncular space, and giTee origin to tbe Srd cranial
nerre. They are divided into an under or fasciculated portion A an upper portion or
tegmentum, between wbiob two portions is a small mass of grey matter, the locus n^er.

Inferior Peduncles of the Cerebellum or Processus e Cerebello ad Medollam -

Two thick bundles of white fibres which deecend from tbe inner & under part of the
cerebellum to tbe back of the medulla, where they join the processus cuneatL^ They

form tbe lower part of the lateral boundary of tbe 4tb TCkntriolo.

Superior Peduncles of the Cerebellum or Processus e Cerebello ad Testes - Two

thick bundles of white fibres which ascend fh>m tbe upper ft inner part of the oere-
bellnm to the testes, forming part of the roof ft of tbe lateral boundary of the 4tb Tea-

triole. They are connected together by tbe

Valve of Vieussens * Thin transparent lamina of white matter narrow in fyront, where it presents

a slight median ridge, tbe frenulum, and, on either side of this, tbe roots of tbe 4th
nerre, broader behind, where it is continued into tbe under surface of tbe superior
Tcrmiform process and is crossed by a few transrerse bands of grey matter prolonged
upwards from the cerebellum. It forms the roof of the aqueduct of Sylvius A a part

of the roof of tbe 4tb Tentriole.

Tnbercula Quadrigemina - Four small rounded eminences separated by a omdal depressioo,

and situated below the posterior extremity or splenium of the corpus oalloeum, abore
A behind the posterior commissure A the Srd yentriole, aboTc A in front of the super-

ior peduncles of the cerebellum & the Talve of Yienssens.

AirrnTOR ob Natbs - Are larger, darker, slightly oblong from before backwards, and connected
with the optic thalami k tbe commencement of tbe optic tracts by two broad white

bands, tbe brackia attteriora*

PosmiOB OB Testes - Are smaller, lighter in colour, more ezaotly rounded, and oonnected

with the optic thalami ft the commencement of the optio tracts by two narrower bandf ,

th^ bracJUa posterioTA.

Pineal Gland or Conarium - Small conical reddish-grey body eitnated between tbe nates,

retained in position by a fold of pia mater deriTed from the under surface of tbe Telam
interpositum, and connected ^th the remainder of the cerebrum by means of a few
transverse fibres belonging to^the posterior commissure, and also by means of its

PiDUKCLBS - Two on each side :

Anterior or Superior - Bun forwards oyer upper A inner part of optic thalami to anterior

crura of fornix, with wbioh tbej unite.
Posterior or Inferior - Descend Tcrtically upon inner surface of optio tbalamL

The pineal gland consists of grey matter with a few white fibres, and is very
rascular. In its interior are one or two small oaTities, which sometimoe oon*
munioate with the Srd Tentricle, and which contain a transparent Tisotd fluid h s

small amount of sabulous matter termed the aurwuhu certbri^

S8l

THE SPINAL COBD

Extends from point of deenstation of anterior pyramids (wUoli point corresponds prettj uMurlj
to the npper border of the atlas) to lower border of bodj of first lumbar Tertebra, where it
terminates in a slender filament, the filam terminale, whioh desoends lor a short distance
into the Ugamentam oentrale.

Is from 15 to 18 inobes long A slightly fiattened from before backwards. Presents two enlarge •
ments, the oerrioal and the lambar. The ceryioal, the larger, extends from the third
oerrioal to the first dorsal rertebra, and is wideat from side to side | the Inmbar, the
smaller, is situated opposite the last dorsal yertebra^ and is wideat firom before backwards.

Presents fissures and columns.

FISSURES :

AmtbecMedzan * Wider than the posterior, and penetrates to abont one
third^of the thickness of the cord, its depth increasing slightly infer*
iorly. It contains a well-marked prolongation of the pia mater, and is
bounded behind by the anterior or white commissure.

Postero-Hedian - Narrower than the anterior. It penetrates to the
Tcry centre of the cord, is most marked above and below, and contains
but a very delicate process of pia mater. It is bounded in front by the
posterior or grey commissure.

Antero-Latebal (So.called) - Consist simply of a linear series of fora*
mina corresponding to the points of emergence of the anterior roots of
the spinal nerves.

Postbro-Lateral 9 Correspond to the line of attachment of the posterior
roots, and lead down to the grey matter.

Postero.Intbbxedtart (Hirschfeldt, Sappey) -Two delicate longitudinal
furrows situated on either side of the postero^median fissure and most
marked in the cervical region.

COLUMNS ~ ^^^ demarcated by the fissures, ana are termea

AsTTXRiOR, Lateral, Posterior and PostxrcMbdian - The two formei
being usually joined under the name of anterolateral, and the postero-
median being usually included in the posterior*

Gives off 81 pairs of nerves.

282

STRUOTUKB of the SPINAL OORD-3rd Tablet.

Ck>ntinaation Upwards of the White Fibres of the Oolnmxis into

the Medulla Oblongata.

Anterior Colunm - ^ tbrast aside in the medalls oblongata by those sntero-internal
fibres of the lateral oolnmn, whioh, after decnssating in the middle line, form the
innermost A grater part of the anterior pyramid of the opposite side. It then

divides into three bundles as follows:

Innermost Bundle - Joins externally the above mentioned antero-internal fibres of

the lateral traot, and forms the smaller A outermost part of the anterior

pyramid of the same side.
MiDDLS Bundle -Sarronnds the olivary nnolens, above whioh it forms, with a few

fibres arising from this nuolens, the olivary fasoionlos or fillet
EXTBRNA.L OR PosTBRioR BuxDLB - Passes upwards A backwards to join the processus
caneatns, and goes to form part of the inferior pedanole of the oerebellam

Lateral Coloxnxi -I)i^i<lo* ^^^ three bundles as follows:

Antbeo- Internal Bundle -Passes forwards A inwafds between the anterior oolnmns,
thrusting these columns aside, and forms, after decussating in the middle
line, the innermost A greater part of the anterior pyramid of the opposite side.

Middle Bundle -Ascends with the fasciculus gracilis beneath the grey matter of

the floor of the 4th ventricle, forming part of the fasoionlos teres.

External or Posterior Bundle -Passes upwards & backwards to join the fasoioalu
ouneatus, and goes to form part of the inferior peduncle of the oerebellam.

Posterior Column - Divides into two bundles as follows :

Internal Bundle or Fasciculus Gracilis - The smaller. Ascends beneath the gnj
matter of the floor of the 4th ventricle, and goes to form part of the fasoi-

onlns teres.

External Bundle or Fasciculus Ouneatus - The larger. Diverares from its fellow st

the apex of the calamus scriptorius, and passes upwards A outwards to fbra

the greater part of the inferior peduncle of the oerebellaau

N.— The reader is here reminded once for all tliat by the " oontinnatioo *' rt
nerve-fibres referred to in this A other Tablets, the Author means, not t j9
oontinuation of the individual tubular fibres (respecting the aboolnte orizii
A termination of which tubular fibres little is yet positively known), bs(
the oontinuation of the several bundles of nerve -fibres, whioh oontiaoattan
if marked by the general direction of the fibres.

283

STRUCTURE of the MEDULLA OBLONGATA-lst Tablet.

ProMnii for esftmlnatioii loogliiidiiial, antero^poBterior ft transyenie fibres, and grey matter.

LONGITUDINAL FIBRES -- Form fire bnndlef oontinaou on the one hand with the colamns of
the cord, and on the other with the longitudinal flbrei of the mesocephalon, t.^., three large
ones, anterior fyramidf lateral tract 6f* fasciculus cuneatus, and two imaller ones, olivary fasciculus

or fillet^ 6* posterior pyramid or fasciculus gracilis.

Their mode of Continuation with the ColumnB of the Cord - is as follows : -

Antebior Ptbamid - With antero^-intemal bnndle of lateral colamn of opposite side, and with
innermost bnndle of anterior column of same side. The former handle forms the innermost
decnssating & bj for greater portion of the anterior pyramid; the latter bnndle forms that
small outer portion of the ant. pyramid, the fibres of which do not decussate in the middle line.

Lateral Taact - With lateral column of same side.

Fasciculus Cumeatus - With external ft greater part of posterior column, and with external or

posterior bundles of anterior A lateral columns al] of same side.

Oliyart Fasciculus ob Fillet - Partly with middle bundle of anterior column of same side ; its

other fibres are derired from the olivary nucleus.

PosTEBioB Pyramid or Fasciculus Gracius - With posterior column of same side.

mode of Continuation with the Longitudinal Fibres of the Meso-cephalon -

Is as follows : -

Amterior Pyramid -Ascends through the mesocephalon to the inferior or fasciculated portion of

the cms cerebri, from whence its fibres are prolonged to the corpora striata.
N.— The cerebellar fibres & the fibres to the olivary body, which are said in some of our
best standard works on Anatomy to be derived from the anterior pyramid, are derived not
from the anterior pyramid itself, that is to say not from the pyramidaLshaped bundle, which,
in the surface descrifOon of the cord, is called the *' anterior pyramid," but from the middle k
external bundles of the anterior column of the cord. (Vide continuation upwards of the white

fibres of the columns of the cord into the medulla oblongata).

Lateral Tract - Divides into three bundles as follows (or rather it is the lateral eolumn of the

cord which thus divides, for the division here referred to takes place a little below the point

of decussation of the pyramids, that is to say below the point which is usually taken as the

boundary between the medulla ft the cord) : -
AnterO'intemal Bundle "V^Awat upwards k inwards, decussating with its fellow, and forms the

innermost & greater part of the anterior pyramid of the opposite side.
Middle Bundle - Ascends with the fasciculus gracilis beneath the grey matter of the floor of the

4th ventricle, forming part of the fasciculus teres.
JSxtemal or Posterior Bundle - Passes upwards k bskokwards to Join the fasciculus cuneatus, and

goes to form part of the inferior peduncle of the cerebellum.
Fasciculus Cuneatus - Passes up to the cerebellum with the external or posterior bundles of the
anterior k lateral columns of the cord, forming with them the inf. peduncle of the cerebellum.
Olivary Fasciculus or Fillet - Divides into two bundles as follows ; - ••

AnterO'intemal Bundle - Ascends through the mesocephalon with the middle bundle of fibres

of the lateral tract, and joins the upper part or tegmentum of the cms cerebri.

Postero-extet nal Bundle - Passes upwards k outwards through the mesocephalon, issues from the

transverse fibres of the pons externally to the cms cerebri, and finally ascends over

the superior peduncle of the cerebellum to the tubercula quadrigemina, decussating

with its fellow above the aqueduct of Sylvius.

PotTBRiOR Pyramid or Fasciculus Geacilis- Ascends with the middle bundle of the lateral column

beneath the grey matter of the floor of the 4th ventricle, forming part of the fascicu.

lus teres.

AMTERO-FOSTERIOB FIBRES -^ Form a median septum most marked at the upper part of
the medulla. They partly decussate with each other (Clarke). Some emerge from the antoro^
median fissure, or pass between the anterior pyramid k the olivary body and emerge below
the roots of the 9th nerve i these two sets form the aroiform fibres mentioned in the surface de-
scription of the medulla. Others emerge from the postero-median fissure, and form the liness

transverssB of the floor of the 4th ventricles

TRANSVERSE FIBRES — The aroiform fibres form a superficial set. A deep set join the olivarv

nuclei k the nuclei contained in the posterior pyramids k processus ouneati.

QRET MATTER -

284

ABTEBIES of the BASE of the BRAIN.

Are the anterior A middle oerebral branohee of the internal carotid and tbe posterior
cerebral of the baaUar^ which are Joined together by the anterior A posterior

commnnicating.

Anterior Corebral - Anterior & amaller of the branches of biftaroatioB of internal caroti'l

opposite inner c atr e mi ^ of fissnre of Sjlrins.
Forwards & inwards towards longitudinal fissnre, being connected with each other bj

Ahtskior CoicxuxiOATZKey - A small branch about two lines in length.
Sound genu and along npper snrfiMC of corpns caUosnm, and join with posterior cer^
braL Qire df small branches to anterior perfbrated space and to inner A

under sarlkces of frontal lobe.

Middle Cerebral -^« larger of the two terminal branches of internal carotid.

Forwards A outwards along fissnre of SjMus, giring twigs to anterior perforatei!
space, and diiides into branches to pia mater of fronta], parietal A temporn.
sphenoidal lobes, and to central lobe or Island of BeiL - Sometimea gires

off anterior choroid.

Posterior Commnnicating - Voy ▼triable in sise.

From back part of internal carotid just before its biftircation.
Backwards parallel to its fellow, and inosculates with posterior osreibraL

Posterior Cerebral - Two ; terminal branches of basilar.

Forwards and outwards for a short distance giring numerous branches to posteriot

perforated space, and join posterior oommunicatiBg.

Backwards A outwards on crura cerebri in firont of Srd nerre, and, earring slighilj

inwards, diride into numerous branches to inner, under, A outer surfaocj

of occipital lobe.

GIRCLE OF WILLIS — Is formed in front, lateraUy A behind respecttrely bj I

Antaior cerebral arUria joined by the anterior amummkoHng^

PntenoT cerebral A muuoir*
Within the circle of Willis are comprised from before backwards the lamia%
oinerea, qptio commissure^ tuber dnereum with the infundibnlum, eoipors

alticantia A posterior perforated space.

285

APPENDIX.

CARPUS & TARSUS

How to Distingaisli Bones of the Carpus into Bight ft Left.

It if easy to reoogniee whether a bone of the carpus belongs to the right or to the left aidt
when it is placed in position as follows :

BOftphoid - Largest articular facet abore ;

Bough transrerse groove behind §
' Tubercle on outer aide.

Semilunar-

Coneifonn -

Plsifonn-

Conrez articular facet aborai •
Largest rough surface in front |
Semilunar articular facet on outer side.

Convex surface partly articular A partly non*articular, sbovoi
Flat surface partly articular parMy non«articular in firontf
Small surflBMe or angle on inner side.

Articular facet behind i

Kon-artioular part of same snrfhoe below.

Concave surface on inner side.

Trftpositun - Saddle-shaped articular facet below }

Bidgein front;
Bough lateral surface on outer side.

Trapezoid * Saddle«shai)ed articular facet below i

Large rough surface behind;
Its projecting part on inner side.

Os Magnum -^ Head above ;

Large rough surface behind;

Projecting part of the same (or tubercle Of tlia base) on inner

Ob Unoifomi -* Unciform process below A in firontf

Its oonoatitj to outer ddob

286

BONES of TARSUS— 1st Bow.

THE ASTRAGALUS

Supports the tibia, rests upon the os calcis, articnlates on either aide with the malleolt
& in front with scaphoid. Is irregnlarly onboid, and presents six snrfacea

Upper Surface - Presents :

Tbochleak Subface - Broadest in front, oonTez from before backwards, slight-

I7 conoaye from side to side ; in front of which torface is the
Upper Surface of the Neck - Bongh for ligaments.

Under Surface - Presents i

Deep Groove - Directed forwards k outwards and broadest in front, for in*

terosseons calcaneo-astragaloid ligament; this grooYe separates

Two Abticular Facets - For os calcis; the posterior one, the' largest, is con.

cave ; the anterior one, the smallest, is convex, continnons with the

anterior articular surface and sometimes divided into two parts, one

for lesser process of os calcis, one for calcaneo-soaphoid ligament.

Inner Surface - Presents z

Tkianovlab Abticulab Facet - Small, continnons with trochlear snrfiue, for in*

ternal malleolus ; below this facet is a
Rough Groove - For deep portion of internal lateral ligament of ankle-joint.
Outer Surface - Presents :

TaiAMouLAB Abticulab Facet - Knoh larger, ooncare from aboye downwards,

also continuous with trochlear snrface ; in front of which is a
Deep Depression - For anterior fascionlns of external lateral ligament of

ankle-joint.

Anterior Surface -Porms the

Head - Oval, oblique downwards h. inwards, h conyex for aoaphoidy oontinuoos
inferiorly with anterior facet of under surface, and sapported bj a

constricted part, the
Neck.
Posterior Surface - Very narrow, and represented merely by a slight

Groove - Oblique downwards k inwards for tendon of flexor kmgoi p<dliciiL

THE OS CALCIS

Irregularly cuboid $ presents six surfaces.

Upper Surface - Presents from before backwards :

Upper Surface of Greater Process - Presenting a rough depresssioii for exten*

sor breyis digxtomm ;
Two Aeticulab Subfaces - For astragalus, and an iuteryening deep groove obliqae
forwards & outwards, and broadest in front for interosseous calcaneo-
astragaloid lif^ament. - The posterior h external facet is conyex, the
largest, and situated on the body of the bone. The anterior or inter*
nal facet is concare, the smallest, and situated on the lesser process;

it is sometimes diyided into two.
Rough Saddle-shaped Surface - Belonging to the portion of the bone which

projects backwards to form the heeL
Under Surface - Bough, conyex from side to side, widest behind. Presents from

behind forwards:

Two Tubercle^ - The internal, the largest, for abductor pollicis h flexor

brevis dig^torum; the external, the smallest, for abductor minimi digiti.

Rough Surface - For outer head of flexor access, k long oaicaneo-cuboid ligt

Tubercle &* Transverse Groove - For short calcaneo-cnboid ligament.

Inner Surface " Concaye for passage of yessels, neryes, & flexor tendons. Gtyes

attachment to inner head of flexor accessorius, and is surmounted by the

Lessee Pbocess, ob Sustentaculum Tali - Which articulates aboye with the

astragalus, is grooyed inferiorly for tendon of flexor longoa pollicis,

and giyes attachment by its inner marg^ to a part of the superfictal

fibres of ttie internal lateral ligament of the ankle-joint.

Outer Surface - Presents towards its middle a

Tubercle^ "For middle fasciclus of external lateral ligament of ankle-joint;

and in front of the tnberds^
Two Grooves - Separated by a slight ridge for tendons of peroneL
Anterior Surface * Concayo-conyex for articulation with cuboid ; is surmounted ex-
ternally by a rough prominent tubercle which is an important guide

in Chopart's amputation.
Posterior Surfkoe * Bough A broad below for insertion of tendo Aohillis A plantaris

inusolei narrow A smooth aboyoi whsrs it ig ooTwrsd by m hnm*

287

BONES of TABSI7S'-2nd Bow.

TdHE SOAPHOID — Pretenlg i

AnTBSiOK Surface - Conyez, broadest externally ; presents

thne triangular facets for the oaneiform.
PosTEKioa Surface - Concave, for head of astragalus, also broadest eztemallj.
Circumference - Bough, conrez above, oonoavo below. Presents below A inter-

nallj a

tubertUj for tendon of tibialis portions; and sometimes eztemallj a

facets foroaboid.

THE CUBOID — Presents i

Articular Surfacea - Three :

Akterior - Presents two facets,

inttfTt smaller, quadrilateral for 4th metatarsal^

ouier^ larger, triangular for 6th metatarsal.
Posterior - Quadrilateral, concavo>oonTez for os oalois.
Ihiermai. -Presents towards middle & upper part a

large anterior facet for external cuneiform ; and sometimes behind this a ^

smaller posterior facet for scaphoid. - The remainder of this surface* is

rough for ligaments.

Non- Articular Surfaces - Three :

Superior - Bough, oblique downwards h outwards.
Inferior - Presents from before backwards :

deep groove oblique forwards h inwards, which transmits tendon of pero-
• neus longus, and is bounded behind by a prominent

ridge for long calcaneo-cuboid ligament, which ridge begins externally

in a prominent
tubercle presenting a small facet for a sesamoid bone ;
rough surface for short calcaneo-cuboid ligament, and part of the flexor

brevis pollicis.
Outer - A mere border notched by oommcncoment of peroneal groove.

THE 0X7NEIF0RM BONES

Three, wedge-shaped, & six sided. All three present
COMMON CHARACTERS:

Dorsal Surf. - Quadrilateral, and rough for ligaments. LooVs obliqnely in-
wards in the internal cuneifcrm, in which bone it also presents a
small groore or facet for tendon of tibialis anticus.
Plantar Surf. — Bough rounded border in the two outermost. In the inner-
most it is a broad rough surface marked behind by a tubercle for

the tibialis posticus.
Posterior Surf. - Triangular & concave from above downwards. They artic-
ulate with the three facets on anterior surface of scaphoid, and

lie in the same transverfie line.
Anterior Surf. - Triangular in the two outermost, kidney-shaped in the
innermost; they articulate with the bases of the three innermost
metatarsal bones. These surfaces present an indented outline :
the middle cuneiform being shorter than the two others, its an-
terior surface is depressed.
Lateral Surf. - Articulate with each other, the cuboid, both sides of the
base of the 2Qd metatarsal bone h the inner side of the base of
the 4th; the lateral surfaces of tho 3rd cuneiform presenting
each of them two facets, and the adjoining surfaces of the 1st 9b
2nd presenting a facet angular in shape & running along the
superior & posterior borders. The inner surface of the internal

cuneiform is a mere rounded border.

DISTINCTIVE CHARACTERS

BETWEEN THE THREE BONES.

Fib ST - Larg size, irregular form, anterior kidney-shaped surface, facet for

tibialis anticus, tuberclo for tibialis posticus.
Second - Small size, squ&re-shape of dorsal surface, angular articular

facet along the upper A back part of its inner surface.
Third - Intermediate size, two facets on both of its lateral surfaces.

BETWEEN THE BONES OF THE TWO SIDES — Are erident in the case of the

first k second cuneiform. To hare the three points necessary ^
place the third one in position all that is requisite is to rema
, that the ant. i^^ternal facet is rather larger than the ant, extent

288

METATARSAL BONES (Distinotive Charaoters).

FIRST METATARSAL BONE — The ihortett A mnoh the thiokert.
Shatt - Very thick & strong.

Tarsal Extremitt - Presenta^k large semiliinar facet for internal onneirorm, bnt has m
lateral articular facets. It is prolonged below & externally into a prominen

tubercle for tendon of peroneas Ion arm
Digital Extremity - Large & broad. Presents inferiorly two groored faoets for sesamoid b!

SECOND METATARSAL BONE —-The longest; reoei^ed posteriorly into the reoes

Tamal Biib«itt - Prewnte , •^''•*" *»■• *»""• »»"«i«»"» »><«•'

Tarsal Foot - Triangnlar, for middle onneiform.

Za/^a/ ^ar//j - Three :- One internal for internal onneiform; two external for ei
temal Cuneiform & 3rd metatarsal. These two latter facets are often divide
into npper h lower halres by a rough horizontal groore for an interosseona li^i

THIRD METATARSAL BONE - A little shorter.
Tarsal Extremitt - Presents:

Tarra/ /<7r/f - Triangular, for external cuneiform.

Lateral Facets * Two : - One internal & one external for 2nd A Srd metatarsal bt. ; th
former ikcet is often diYided into upper & lower halves by an interoneous groor<

FOURTH METATARSAL BONE -

Tarsal Extremitt - Presents:

Tarsal Facet - Quadrilateral, for onboid.

Lateral Facets - Three : - One ext. for 6th metatarsal, two int. for Srd metatarsal A ea
temal cuneiform ; the facet for the external onneiform being sometimes absent

FIFTH METATARSAL BONE — The shortest bnt ona.
Tarsal Extremitt - Presents :

Tarsal Facet - Triangular, out obliquely forwards & inwards, for cuboid |
Internal Lateral Facet - For 4th metatarsal ;
Prominent External Tubercle - For peronens brevis.

N.B. -— The foregoing characters supply the three points requisite to place the bones
position, and therefore to distinguish between right bones and left boD<

METACABPAL BONES (Distinctive CharapCters).

METACARPAL B. OF THUMB — The shortest

Shatt - Thick & broad ; its palmar surface looks inwards.
Carpal Extremitt - Saddle-shaped for trapesium (conrex from before backward
concave from side to side) A broadest externally ; no lateral facet
Digital Extrehitt - Broader A less convex anteriorly than in the other tnetaca

pal bones; presents two small lateral facets for sesamoid bone

METACARPAL B. OF INDEX — The longest.

Carpal Extrehitt - Larger than in the others, and presents posteriorly a pr
longation upwards & inwards towards os magnum. Has four articu'!
surfaces, one saddle-shaped above for trapesoid, and three others f

trapesium, os magnum & Srd metacarpal boo

METACARPAL B. OF MIDDLE FINGER — The longest bnt one.

Garpal Extremitt - Presents a prolongation upwards A outwards behind
magnum, and has four articular faceta, one for os magnum, one for 2i

metacarpal bone, and two for 41

METACARPAL B. OF RING FINGER — Short.

Carpal ExTRBMxrr - Pretty regularly cuboid. Presents five facets for nncifon

OS magnum, 3rd (twoiiBMets), h 6th metacarpal horn

METACARPAL B. OF LITTLE FINGER — The smaUest A the shortest fa

Carpal Extremitt - Has a prominent tubercle on inner side for eztenaor cai

ulnaris ; carpal facet is saddle*shaped for unciform ; only one latei

fhcet for 4th metacarpal bo^

K.B.— The foregoing characters supply the three points requisite to pis

the bones in position, and therefore to distingiush between rig

boDM and left boa

"-^