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 Anatomist's notebook 
 
 3 1924 024 788 675 
 
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 Library 
 
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 the Cornell University Library. 
 
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 http://www.archive.org/cletails/cu31924024788675 
 
THE ANATOMIST'S NOTEBOOK 
 
PUBLISHED BY THE JOINT COMMITTEB OK 
 
 HENRY FROWDE and HODDER & STOUGHTON, 
 
 AT THE OXFORD PRESS WAREHOUSE, FALCON SQUARE, 
 
 LONDON, E.G. 
 
THE 
 
 ANATOMIST'S Notebook 
 
 A GUIDE TO THE 
 DISSECTION OF THE HUMAN BODY 
 
 BY 
 
 A. MELVILLE PATERSON 
 
 M.D. Edin,, F.R.C.S. Eng. 
 
 PRuFESSOR OF ANATOMY IN THE UNIVERSITY OF LIVERPOOL J EXAMINER IN ANATOMY: 
 
 UNIVEKSITY OF LONDON, CONJOINT BOARD (ROYAL COLLEGES OF SURGEONS 
 
 AND physicians), INDIAN M H DIG AL SERVICE, ETC.; FORMERLY 
 
 EXAMINER IN THE VICTORIA UNIVERSITY, AND 
 
 IN THE UNIVERSITIES OF CAMBRIDGE, 
 
 OXFORD, AND DUIiHAM, 
 
 XONDON 
 
 HENRY FROWDE HODDER & STOUGHTON 
 
 OXFORD UNIVERSITY PRESS WARWICK SQUARE, E.G. 
 
 1914 
 
Richard Clav & Sons, Limited, 
 
 brunswick street, stamford stkeet, s.k., 
 
 and buncay, suffolk. 
 
PREFACE 
 
 The object of this guide is to give help to the student in the study 
 of Practical Anatomy. 
 
 It is intended essentially for use in the Dissecting Room, and is 
 to be supplemented by means of a knowledge of Osteology, and by 
 means of a systematic textbook. 
 
 The following general considerations should be borne in mind 
 in using the book. 
 
 1. Before beginning the dissection of any part, the student 
 should make himself familiar with the bones, and their relations 
 to other structures within the region. 
 
 2. Too much stress cannot be laid on the preliminary study of 
 surface forms, and landmarks, before removal of the skin. 
 
 Each dissector should have associated with him an experienced 
 demonstrator, who should point out to him these surface forms, 
 and the general position of important structures beneath the 
 skin, so that when the dissection is begun it may be made with 
 an inteUigent notion of the parts to be displayed. ^ 
 
 These points are so obviously to be taught and learnt by actuar 
 manipulation and oral tuition, that details have been purposely 
 omitted. 
 
 3. Assistance from a teacher is also advisable in making the 
 skin incisions. A mistake at this stage may interfere considerably 
 with the proper dissection of the part. 
 
 4. The student is strongly urged to make his dissections foe 
 HIMSELF, only seeking the aid of a demonstrator in case of diffi- 
 culties. Drawings and diagrams should be made at the time, and 
 notes should be made of details, after consultation with a teacher 
 or a systematic textbook. 
 
 It is hoped that by such means the dissector will grasp more 
 readily and retain more permanently the facts which he is expected 
 to acquire by a study of Practical Anatomy. 
 
vi PREFACE 
 
 Terminology. — As few changes as possible have been made in the 
 names of Anatomical Structures. The new terminology may be 
 taught, and students have access to it in systematic works ; but it 
 has been thought advisable — as this is intended to be essentially 
 a practical book — to keep the terms as simple as possible, and not 
 to introduce new names without good reason. 
 
 I beg to record my cordial thanks to Dr. W. P. Gowland, Senior 
 Demonstrator of Anatomy in the University of Liverpool, for his 
 able assistance in the preparation of this guide for the press. 
 
CONTENTS 
 
 FACE 
 
 Prrface ... V 
 
 List of Illustrations ix 
 
 Regulations for Dissection xi 
 
 Sections : — 
 
 I Head and Neck ....... i6 
 
 Ear ....... . . 90 
 
 Eye ......... 99 
 
 Brain ........ . 105 
 
 II Upper Limb . 130 
 
 III Thorax . . .... .185 
 
 IV Abdomen 206 
 
 V LowEk Limb 290 
 
 vli 
 
LIST OP ILLUSTRATIONS 
 
 riG. I'AGE 
 
 1. Skin Incisions: Front View ...... 13 
 
 2. Skin Incisions : Back View 14 
 
 3. Skin Incisions: Perineum 15 
 
 4. Dorsal Aspect of Trunk: Cutaneous Nerves . 22 
 
 5. Line of Refleciion of Latissimus Dorsi ... 25 
 
 6. Head and Neck : Superficial Nerves ■ • • • 35 
 
 7. Pterygoid Region : Lines of Sections through Zygoma 56 
 
 8. Lines of Section through the Lower Jaw ... 58 
 
 9. Dissection of the Course of the Maxillary Nerve . 71 
 
 JO. Cutaneous Nerves of the Front of the Trunk. . 138 
 
 If. Cutaneous Nerves of the Front of the Chest and 
 
 Arm .... ..... 139 
 
 12. Cutaneous Nerves of the Back of the Arm and Fore- 
 
 arm .......... 162 
 
 13. Wrist and Palm .... ... 166 
 
 14. Cutaneous Nerves of the Back of thk. Forearm and 
 
 HaNd 176 
 
 5. Perineum (Male) 209 
 
 16. Reflection of the Superficial Fascia of the Groin 
 
 and Anterior Abdominal Wall . . . . .221 
 
 17. Diagram of Folds converging to the Umbilicus on the 
 
 Deep Surface of the Anterior Abdominal Wall . 233 
 
 ix 
 
X LIST OF ILLUSTRATIONS 
 
 FIG. I'AGE 
 
 1 8. Lines of Section of the Innominate Bonk . . .254 
 
 19. Lines of Reflection of the Superficial Fascia of 
 
 THE Buttock 292 
 
 20. Cutaneous Nerves of the Buttock .... 294 
 
 21. Cutaneous Nerves of the Popliteal Space and Back 
 
 OF THE Leg ......... 300 
 
 22. Cutaneous Nerves of the Back of the Thigh and 
 
 Popliteal Space 303 
 
 23. Superficial Structures on the Front and Inner Side 
 
 of the Thigh 309 
 
 24. Femoral Sheath ........ 310 
 
 25. Sole of the Foot . ...... 331 
 
 26. Cutaneous Nerves of the Front of Leg and Dorsum 
 
 OF Foot ... ..... 340 
 
II. 
 
 REGULATIONS FOR DISSECTION 
 
 GENERAL TIME-TABLE 
 
 The body is divided for dissection into Head and Neck, Thorax, Abdo- 
 men (each of which is to be dissected by two students), Upper and 
 Lower Limbs (each of which is to be dissected by one student). 
 
 A Subject on being brought into the Room will be placed on its back for 
 Two Days, during which time the Brain will be removed, and the 
 Perineum dissected. 
 
 III. A Subject, after being two days as above, will be placed on its Face, in 
 which position it will remain for a Week. 
 
 IV. The dissection of the Head and Neck, Superior and Inferior Ex- 
 tremities, is to be commenced on the First Day on which the Subject is 
 placed on its face. The Trapezius below the level of the Shoulder, the 
 Latissimus Dorsi, the Levator Scapute, and Rhomboidei Muscles belong to 
 the Upper Limb, and must be dissected before the Third Day. 
 The other Muscles of the back belong to the Head and Neck, and must 
 be dissected before the subject is turned. During this week the dis- 
 sector of the Lower Limb will dissect the buttock, popliteal space, and 
 back of the thigh. 
 
 V. On the morning of the Tenth Day after the subject has been brought into 
 the Room, it will be turned, and will remain on its back until the Abdo- 
 men and Thorax are completely dissected. The Triangles of the Neck 
 must be dissected within Four Days after the subject has been placed 
 on its back, in order that the Upper Limbs may be removed from the 
 Trunk, and the dissection of the Thorax commenced. 
 
 VI. The dissection of the Thorax is to be commenced on the Fifth Day after 
 the Subject has been turned. 
 
 VII. The dissection of the Abdomen is to be commenced as soon as the Subject 
 is turned ; and its Cavity may be opened as soon as its Parietes are dis- 
 sected, or on the Fourth Day after the Subject has been turned. 
 
 VIII. In arranging the time-table for dissection, Saturday is not counted as an 
 Anatomical day. 
 
pjG. I. SKIN INCISIONS (FRONT VIEW) 
 
 13 
 
KIG 2. —SKIN INCISIONS (BACK VIEW) 
 14 
 
15 
 
i6 
 
 DISSECTION OF THE HEAD AND NECK 
 ORDER OF DISSECTION 
 
 I. Removal of the Brain and Dissection of the Base 
 
 OF the Skull. 
 II. Dissection of the Back. 
 
 III. Triangles of the Neck. 
 
 IV. Face, Anterior Region of the Scalp, and Pterygoid 
 
 Region. 
 V. Submaxillary Region and Tongue. 
 VI. Lacrimal Apparatus and Orbit. 
 VII. Maxillary Nerve and Internal Maxillary Artery 
 
 (Third Part). 
 VIII. Deep Dissection of the Neck. 
 IX. Prevertebral Muscles, Pharynx, and Soft Palate. 
 X. Larynx. 
 
 XI. Cavity of the Mouth. 
 XII. Cavity of the Nose. 
 
 XIII. Cranio-vertebral Articulations. 
 
 XIV. Ear. 
 XV. Eyeball. 
 
 XVI. Brain. 
 
DISSECTION OF THE HEAD AND NECK 17 
 
 I. Removal of the Brain and Dissection of the Base 
 OF THE Skull 
 
 This dissection is to be begun as soon as the subject is brought 
 into the room and while the perineum is being dissected. It 
 should occupy two days. Before beginning the dissection the 
 student should make himself familiar with the bones of the skull, 
 and the articulated cranium, and especially the fossse, fissures, and 
 foramina in the base of the skull. 
 
 A. Removal of the Skull Cap. 
 
 (i) Cut through the tissues of the scalp, right down to the bone, 
 by a sagittal incision carried from the root of the nose to 
 the external occipital protuberance. 
 
 Note the several layers of the scalp. 
 
 (2) Raise the flaps from the bone on each side, removing the 
 
 pericranium from the skull, and draw the flaps outwards 
 towards the ear. 
 
 (3) On reaching the temporal region, it is necessary to cut through 
 
 on each side, the temporal fascia (attached to the tem- 
 poral ridge), and the temporal muscle (arising below it 
 from the temporal fossa). These structures should be 
 reflected along with the tissues of the scalp so as to lay 
 bare the lateral wall of the cranium. 
 
 (4) removal OF THE BONE. 
 
 Two cautions are needed in this operation. 
 (i) Injury to the dura mater and brain should be avoided. 
 (2) When the skull-cap is replaced, after removal of the 
 
 brain, it should fit tightly and have no tendency to 
 
 shift or slip. 
 {a) Make a saw cut through the outer table of the skull, beginning 
 in front about three-quarters of an inch above the supra- 
 orbital arch, and behind at the level of the external occipital 
 protuberance. Do not make a circular incision ; it should 
 he wedge-shafed or spiral. In the former case the skull- 
 cap will fit in an angle at the sides which will prevent 
 slipping. In the latter case, let one lateral incision end 
 behind at a higher level than the other, the two incisions 
 being joined by a " step." 
 
 (b) Having divided the outer table with the saw, the inner 
 table should be broken through with mallet and chisel, so 
 preventing damage to the dura mater. 
 
 (c) Prise off the vault of the skull with the aid of a T-shaped 
 chisel. It is often very closely adherent to the dura mater 
 beneath. The dura mater is now exposed, with pacchio- 
 nian BODIES on each side of the middle lijie, 
 
 B 
 
i8 DISSECTION OF THE HEAD AND NECK 
 
 I. — B. Dissection of the Dura Mater. 
 
 (i) Open the superior longitudinal sinus in its whole length. 
 
 (2) Divide the dura mater by a circular incision half an inch 
 
 above the sawn edge of the skull, leaving it attached in 
 the middle line posteriorly. 
 
 (3) Detach the falx cerebri from the crista galli and draw it 
 
 backwards, out of the median longitudinal fissure of the 
 brain. 
 
 (4) Turn the dura mater back and note the course of the cere- 
 
 bral veins. 
 
 C. Removal of tlie Brain. 
 
 (i) Raise up the frontal portion of the brain, with the olfactory 
 tracts and bulbs, and divide the optic nerves and the 
 internal carotid arteries. 
 
 (2) Divide the diaphragma sell^, and scoop out the pituitary 
 
 body from the sella turcica. 
 
 (3) Divide the third and fourth cranial nerves. The latter 
 
 usually pierces the border of the tentorium cerehelli. 
 
 (4) Divide the tentorium cerebelli as close as possible to its 
 
 attachment to the superior border of the temporal bone, 
 and as far backwards as possible. 
 
 (5) Divide the remaining cranial nerves. 
 
 (6) Draw the whole brain upwards, and cut across the spinal 
 
 cord at its junction with the medulla oblongata at the 
 foramen magnum. Divide also the vertebral arteries 
 as they enter the cranium. 
 
 (7) Remove the brain for preservation and further dissection 
 
 (p. 105). 
 
 D. Structures within the Cranial Cavity. 
 
 (i) Examine the dura mater, with its folds and venous sinuses. 
 Make a dissection of the cavernous sinus and in relation 
 to it trace the course of 
 
 TRIBUTARY SINUSES. 
 
 INTERNAL CAROTID and OPHTHALMIC arteries. 
 
 THIRD, FOURTH, FIFTH and SIXTH CRANIAL NERVES 
 
 through the middle fossa of the skull. 
 
 (2) Meningeal arteries. 
 
 (3) Points of entrance into the skull of the vertebral and 
 
 INTERNAL CAROTID ARTERIES. 
 
 (4) Course of the cranial nerves within the skull, tracing each 
 
 to its point of exit, 
 
19 
 
20 
 
DISSECTION OF THE HEAD AND NECK 21 
 
 II. Dissection of the Back 
 
 This dissection occupies a week {five anatomical days). During 
 the first two days the superficial dissection, and the first two layers of 
 muscles are dealt with; the deeper dissection of the back and 
 removal of the spinal cord occupy the remaining three days. 
 
 A. Superflcial Dissection. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and removal of skin from the scalp and back 
 
 of the neck (fig. 2). 
 
 (3) Reflect the superficial fascia by similar incisions — 
 
 From the middle line of the neck outwards, and 
 From the scalp, above the superior curved line of the 
 occipital bone. 
 
 Secure during this dissection the cutaneous vessels and nerves 
 (fig- 4). 
 
 POSTERIOR PRIMARY DIVISIONS of the fourth, fifth (and some- 
 times sixth) cervical nerves. 
 
 GREAT and the least (third) occipital nerves, which should 
 be traced back to the points at which they pierce the deep 
 fascia. 
 
 occipital artery. 
 
 posterior auricular artery and nerve. 
 
 retrahens aurem muscle. 
 
 small occipital nerve. 
 
 great auricular nerve. 
 
C 2. Great occipital. 
 3. Least occipital. 
 
 ^'\ Posterior primary divisions : 
 
 5" JCervical nerves. 
 
 T 1-12. Posterior primary divisions : 
 
 Thoracic nerves. 
 L 1 , 2, 3. Posterior primary divisions : 
 
 Lumbar nerves. 
 S I, 2, 3. Posterior primary divisions : 
 Sacral nerves. 
 
 Posterior auricular. 
 
 Small occipit<U. 
 
 Great auricular. 
 
 Superficial cervical. 
 
 Lateral branch of ilio-hypogastric. 
 
 Lateral branch of twelfth thoracic. 
 
 Ano-coccygeal. 
 
 Perineal branch of fourth sacral. 
 
 Perforating cutaneous. 
 
 Small sciatic 
 
 Lateral cutaneous. 
 
 FIG. 4. — DORSAL ASPECT OF TRUNK : CUTANEOUS NERVES 
 22 
 
23 
 
24 DISSECTION OF THE HEAD AND NECK 
 
 II. — B. Museles of the Back. 
 
 SUPERFICIAL MUSCLES 
 
 (t) Remove the deep fascia to expose — 
 
 TRAPEZIUS MUSCLE. 
 
 STERNO-MASTOID MUSCLE. 
 
 UPPElt PART OF THE POSTERIOR TRIANGLE. 
 
 \The lower fart of the posterior triangle should he left as 
 far as possible to be dissected from the front.] 
 Secure the spinal accessory nerve, and the nerves to 
 THE trapezius from the cervical plexus. 
 
 (2) Clean the trapezius and latissimus dorsi muscles and 
 
 define the " triangle of auscultation." 
 
 [In conjunction with the dissector of the upper limb.] 
 
 (3) Divide the trapezius muscle one inch from the spines of the 
 
 vertebra. 
 
 [In conjunction with the dissector of the upper limb.] 
 Clean the under surface of the muscle and expose — 
 
 VESSELS AND NERVES TO THE MUSCLE. 
 MUSCLES BENEATH THE TRAPEZIUS. 
 
 (4) Dissect out the second layer of muscles with their vessels 
 
 and nerves. 
 [a) Muscles — 
 
 LEVATOR SCAPULA. 
 RHOMBOIDEUS MINOR. 
 RHOMBOIDEUS MAJOR. 
 
 [In conjunction with the dissector of the upper limb.] 
 (6) Vessels and nerves — 
 
 TWO NERVES TO THE LEVATOR SCAPULA, entering its superficial 
 
 surface near its origin. 
 THE NERVE TO THE RHOMBOIDS, in the angle between the levator 
 
 scapulae and rhomboideus minor. 
 THE TRANSVERSE CERVICAL ARTERY, divided at the anterior 
 
 border of the levator scapulae, into superficial cervical 
 
 and POSTERIOR scapular branches. 
 
 (5) Divide the latissimus dorsi muscle by an oblique incision, so 
 
 as to separate the part of the muscle arising from the spinal 
 column, vertebral aponeurosis and ilium, from the part 
 attached to the scapula and ribs (fig. 5). 
 
FIG. 5, — LINE OF REFLECTION OF THE LATISSIMUS DORSI MUSCLE 
 
 25 
 
26 
 
27 
 
28 DISSECTION OF THE HEAD AND NECK 
 
 DEEP MUSCLES OF THE BACK 
 
 (i) Clean the vertebral aponeurosis, the serratus posterior 
 SUPERIOR, and serratus posterior inferior muscles. 
 
 (2) Divide the serratus posterior superior by a vertical incision 
 
 and turn it medially and laterally; detach the stemo- 
 mastoid from the superior curved line of the occipital bone, 
 to expose and clean the splenius capitis and splenius 
 CERvicis muscles. 
 
 (3) Divide the vertebral aponeurosis by a vertical incision 
 
 about an inch from the middle line, and turn it medially 
 and laterally to expose — 
 The SACRO-spiNALis muscle and its subdivisions. 
 
 (4) Examine the lumbar fascia 
 
 [In conjunction with the dissectors of the abdomen], 
 {a) Draw the ilio-costalis muscle towards the middle line to 
 
 expose the middle layer of the lumbar fascia. 
 (6) Divide the middle layer to see the quadratus lumborum 
 
 MUSCLE. 
 
 [c) Draw this muscle towards the middle line to see the an- 
 
 terior layer of the lumbar fascia. 
 
 [d) Divide the anterior layer to expose the fascia trans- 
 
 versalis. 
 
 [e) Divide the fascia transversalis to expose the extra-peri- 
 
 toneal TISSUE in relation to the colon and kidney. 
 
29 
 
30 DISSECTION OF THE HEAD AND NECK 
 
 DEEP MUSCLES OF THE BACK 
 
 (5) Divide the whole splenius muscle obliquely about its middle 
 
 and turn the parts upwards to the insertion and downwards 
 to the origin, to expose the following structures — 
 
 (a) Muscles — 
 
 COMPLKXUS. 
 LONGISSIMUS CERVICIS. 
 ILIO-COSTALIS CERVICIS. 
 OBLIQUUS SUPERIOR. 
 
 (J) Arteries — 
 
 OCCIPITAL ARTERY and its PRiNCEPS CERVICIS branch. 
 
 (6) Divide the complexus muscle by a transverse incision and 
 
 reflect the parts to expose — 
 
 SUBOCCIPITAL TRIANGLE with the VERTEBRAL ARTERY and 
 
 THE SUBOCCIPITAL NERVE. 
 SEMISPINALIS CERVICIS MUSCLE. 
 POSTERIOR CERVICAL PLEXUS. 
 
 PROFUNDA CERVICIS and PRINCEPS CERVICIS arteries. 
 
 A useful guide to the dissection of the structures beneath the 
 complexus is the great occipital nerve, which should he traced 
 through this muscle, to the interval between the semispinalis 
 cervicis and the obliquus inferior muscle. 
 
 (7) Remove the spinalis dorsi and longissimus dorsi muscles to 
 
 expose the semispinalis dorsi muscle. 
 Remove the semispinalis dorsi to expose the multifidus 
 
 muscle. 
 Remove the multifidus to expose the small muscles of the 
 
 BACK. 
 
31 
 
32 DISSECTION OF THE HEAD AND NECK 
 
 C. Removal of the Spinal Cord. 
 
 (i) Clean the laminae of the vertebrae and divide them with the 
 saw and chisel to expose — 
 
 The Spinal Cord and Membranes. 
 
 (2) Clean the dura mater and the nerve sheaths. Note the 
 
 position of the spinal ganglia. 
 
 (3) Divide the dura mater in situ by a median longitudinal 
 
 incision to expose — 
 
 LIGAMENTA DENTICULATA. 
 ARACHNOID MATER. 
 PIA MATER. 
 SPINAL CORD. 
 NERVE ROOTS. 
 CAUDA EQUINA. 
 CONUS MEDULLARIS. 
 FILUM TERMINALE. 
 
 {4) Divide the nerves outside the dura mater and remove the 
 cord and membranes intact. 
 
 (5) Examine the spinal cord and nerve roots under water. 
 
33 
 
34 DISSECTION OF THE HEAD AND NECK 
 
 III. The Triangles of the Neck 
 
 The subject is placed on its back on the tenth day. During the 
 next fottr days the triangles of the neck, subclavian vessels, 
 AND BRACHIAL PLEXUS must be dissected : so as to facilitate the 
 removal of the upper limbs and the beginning of the dissection of 
 the thorax. 
 
 A. Superficial Dissection. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions (fig. i, p. 13). 
 Reflect the skin by means of two flaps, 
 
 («) One in front to be turned xipwards on to the face, 
 [b) One laterally to be turned backwards to the side of the 
 neck. 
 
 (3) Reflect the superficial fascia in the same way to expose 
 
 [a) The platysma muscle, which should then be reflected in 
 
 one piece from its origin up to the face, 
 
 [b] Cutaneous vessels and nerves (fig. 6). 
 
 ANTERIOR JUGULAR VEIN. 
 EXTERNAL JUGULAR VEIN. 
 SUPERFICIAL CERVICAL NERVES. 
 
 1. Ascending branches. 
 
 SMALL OCCIPITAL. 
 GREAT AURICULAR. 
 SUPERFICIAL CERVICAL. 
 
 2. Descending branches. 
 
 ACROMIAL. 
 
 CLAVICULAR. 
 
 STERNAL. 
 
 CERVICAL BRANCH OF THE FACIAL NERVE. 
 
 (c) Deep fascia. 
 
g ^ 
 
 ^^ 
 
 V 
 
 8°a 
 
 CI. 
 
 Acr. 
 
 / 
 
 Spinal nerves— 
 
 C 2. Great occipital. 
 C 3. Least occipital. 
 
 ^11 Cutaneous branches of ' 
 
 C f,' ( posterior primary divisions. 
 
 S.O. Small occipital. 
 G.A. Great auricular. 
 S.C. Superficial cervical. 
 St. Sternal 
 
 Ac^'^A^iomS }sapro-clavicu.ara..ve,. 
 
 Ccanial nerves- 
 Facial— 
 
 r. Posterior auricular 
 
 2. Temporal. 
 
 3. Malar. 
 
 (. Infra-orbital. 
 T. Butcal. 
 
 Cranial nerves — 
 Facial — 
 
 6, Mandibular 
 
 7. Cervical. 
 
 Trigeminal — 
 
 1. Ophtbalniic. 
 
 a. Supra- trochlear. 
 
 b. Supra-orbital. 
 
 c. fnfra-trochJeaj. 
 U. External nasal. 
 
 2. Maxillary. 
 
 e. Infra-orbital 
 /. Malar. 
 §, Temporal. 
 
 3. Mandibular 
 
 h. Auricuto-temporal. 
 ;. Buccal. 
 k. .\[ental. 
 
 FIG. 0.- 
 
 -SUPERFICIAL NE-RVE OF THE HEAD AND NECK 
 35 
 
36 
 
DISSECTION OF THE HEAD AND NECK 37 
 
 B. Dissection of the Triangles of the Neck. 
 
 \oTE. — In the dissection of the side of the neck the deeper structures 
 in the posterior triangle cannot be dissected on both sides at once. 
 After removal of the deep fascia, therefore, whilst one posterior 
 triangle is being dealt with, the anterior triangle on the opposite side 
 should be dissected. 
 
 (i) Remove the deep fascia and define the boundaries of the 
 TRIANGLES OF THE NECK, by means of the following 
 dissection. 
 
 (a) Clean the sterno-mastoid muscle. 
 
 (i) Define the anterior border of the trapezius muscle. 
 
 (c) Clean the structures occupying the middle line of 
 
 the neck between the chin and sternum. 
 
 (d) Secure both bellies of the omohyoid muscle and clean 
 
 the sterno-hyoid, sterno-thyroid, and thyro-hyoid muscles, 
 and dissect out the nerves supplying them. 
 
 (e) Define the belhes of the digastric and the stylohyoid 
 
 muscles. 
 
 (2) Posterior Triangle, 
 
 Define this triangle and clean the muscles forming its floor. 
 («) occipital triangle. 
 Secure the 
 
 SPINAL ACCESSORY NERVE. 
 BRANCHES OF THE CERVICAL PLEXUS. 
 EXTERNAL JUGULAR VEIN AND ITS TRIBUTARIES. 
 TRANSVERSE CERVICAL AND SUPRA -SCAPULAR ARTERIES. 
 
 [b] SUBCLAVIAN TRIANGLE. 
 
 m. Clean the third part of the subclavian artery, the 
 SUBCLAVIAN VEIN, and the structures in relation to 
 them. 
 
 f3. dissection of the BRACHIAL PLEXUS 
 
 [in conjunction with the dissectors of the -upper limb]. 
 Remove the middle third of the clavicle and the sub- 
 
 clavius muscle, and divide the transverse cervical and 
 
 supra-scapular vessels. 
 Trace the nerves of the brachial plexus through the axilla 
 
 to see the supra-clavicular, axillary and terminal 
 
 branches (see Dissection of I lie Upper Limb, p. 130).- 
 Note especial]}' — 
 
 NERVE TO THE RHOMBOID MUSCLES. 
 NERVE TO THE SERRATUS ANTERIOR. 
 NERVE TO THE SUBCL.WItiS. 
 SUPRA-SCAPULAR NERVE. 
 COMMUNICATION TO THE PHRENIC NERVE. 
 
38 
 
39 
 
40 DISSECTION OF THE HEAD AND NECK 
 
 (3) STERNO-MASTOID MUSCLE AND STERNO-CLAVICULAR ARTICU- 
 LATION. 
 
 {a) Clean and define the sterxo-mastoid muscle and secuit- 
 its nerves and arteries. 
 
 [The spinal accessory nerve is best found by cleaning in 
 its upper fourth the anterior border and under surface of the 
 muscle.] 
 
 [b) Examine the stern o-clavicular articulation. 
 
 [In conjunction with the dissector of the upper limb.] 
 (i) Define the capsule and the following ligaments — 
 Superior (inter-clavicular) ligament. 
 Anterior and posterior ligaments. 
 
 (2) Open the capsule to examine — 
 
 The fibro-cartilage. 
 
 The synovial membranes. 
 
 (3) Define the costo-clavicular (rhomboid) ligament. 
 
 The clavicular head of the sterno-mastoid should now be 
 raised up with the detached portion of the clavicle, in 
 order to expose more clearly the relations of the carotid 
 and subclavian arteries. 
 
41 
 
42 DISSECTION OF THE HEAD AND NECK 
 
 (4) Anterior Triangle. 
 
 {a) DEFINE THE BOUNDARIES OF THE SUEOKDINATE TRI- 
 ANGLES- 
 MUSCULAR. 
 CAROTID. 
 SUBMAXILLARY. 
 
 (i) CLEAN THE INFRA-HYOID MUSCLES, preser\'ing the ANSA 
 
 HYPOGLOSSI. 
 
 Divide these muscles {as low down as possible so as to keep 
 their nerves), and reflect them upwards. 
 
 (c) CLEAN THE COMMON CAROTID ARTERY and examine its 
 
 relations to the 
 
 Pharynx, oesophagus, larynx, trachea and thyroid 
 
 gland. 
 Internal jugular vein. 
 Praevertebral muscles. 
 Vagus, sympathetic, ansa hypoglossi and descending 
 
 hypoglossal and cervical nerves, the external and 
 
 inferior laryngeal nerves. 
 Sterno-mastoid and inferior thyroid arteries. 
 Superior and middle thyroid veins. 
 
 (d) CLEAN THE EXTERNAL CAROTID ARTERY, noting its relations, 
 
 and tracing the course of its branches within the anterior 
 triangle. 
 
 SUPERIOR THYROID. 
 
 LINGUAL. 
 
 FACIAL. 
 
 ASCENDING PHARYNGEAL. 
 
 OCCIPITAL. 
 
 (e) DEFINE THE INTERNAL CAROTID ARTERY and INTERNAL 
 
 JUGULAR VEIN within the carotid triangle. 
 Trace the course of the following nerves and their branches 
 in the neck — 
 
 HYPOGLOSSAL. 
 
 DESCENDING CERVICAL. 
 
 ANSA HYPOGLOSSI. 
 
 VAGUS. 
 
 SYMPATHETIC. 
 
 INTERNAL AND EXTERNAL LARYNGEAL. 
 
 INFERIOR LARYNGEAL. 
 
 PHRENIC. 
 
43 
 
44 
 
45 
 
46 DISSECTION OF THE HEAD AND NECK 
 
 C. Subclavian Artery and Vein. 
 
 (i) Define the first and second parts of the subclavian artery, and 
 the associated part of the subclavian \'ein. 
 
 (2) Dissect out the branches of the artery — 
 
 VERTEBRAI,. 
 
 INTERNAL MAMMARY. 
 
 THYROID AXIS AND ITS BRANCHES. 
 
 SUPERIOR INTERCOSTAL. 
 
 (3) Examine the relations of the artery to 
 Nerves — 
 
 VAGUS. 
 
 PHRENIC. 
 
 SYMPATHETIC AND ANSA, SUBCLAVIA. 
 
 CARDIAC BRANCHES OF THE VAGUS AND SYMPATHETIC. 
 
 Veins — 
 
 INTERNAL .\ND EXTERNAL JUGULAR. 
 
 TRANSVERSE CERVICAL AND SUPRASCAPULAR. 
 
 VERTEBRAL. 
 
 SUBCLA\'IAN. 
 
 INNOMINATE. 
 
 (4) Secure the thoracic duct on the left side and the right 
 
 LYMPHATIC DUCT on the right side. 
 
 D. Examine the relations and structure of THE thyroid body and 
 
 trace its arteries and veins. 
 
 E. Examine the relations of the trache.^ and (esophagus in the 
 
 neck. 
 
 Note especially the inferior thyroid artery and the inferior 
 laryngeal nerve. 
 
 F. Define the parathyroid bodies (superior and inferior). 
 
47 
 
DISSECTION OF THE HEAD AND NECK 49 
 
 IV. Face, Anterior Region of the Scalp, and 
 Pterygoid Region 
 
 A. Dissection of the Face. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Stuff the mouth, nose, and the cavity of the conjunctiva 
 
 with tow, and sew them up along their margins. 
 
 (3) Skin incisions (fig. i, p. 13). 
 
 Reflect the skin completely from the face and the anterior 
 region of the scalp. 
 
 (4) Make a crucial incision in the fascia over the parotid gland ; 
 
 turn aside four flaps and dissect out the gland, tracing the 
 structures associated with its borders — 
 The parotid (Stenson's) duct. 
 
 Arteries — 
 
 SUPERFICIAL TEMPORAL. 
 TRANSVERSE FACIAL. 
 POSTERIOR AURICULAR. 
 
 Veins — • 
 
 TEMPORO-MAXILLARY. 
 
 Nerves — 
 
 BRANCHES OF THE FACIAL NERVE. 
 AURICULO-TEMPORAL NERVE. 
 GREAT AURICULAR NERVE. 
 
 (5) Dissect out the facial muscles including the buccinator, 
 
 and the branches passing to them from the facial nerve. 
 
 (6) Trace the course of the facial artery and vein and their 
 
 branches. 
 
 (7) Dissect out the branches of the fifth nerve on the face, 
 
 and secure their communications with the facial nerve 
 (fig. 6). 
 
 D 
 
Ca' 
 
 C4I 
 
 c4 
 
 / 
 
 / 
 
 CL 
 
 Acr, 
 
 Spinal nerves — 
 C 2. Great occipital. 
 C 3. Least occipital. 
 
 r-i'\ Cutaneous branches of 
 
 C6 ( posterior primary divisions. 
 
 S.O. Small occipital. 
 G.A. Great auricular. 
 S.C. Superficial cervical.' 
 St. Sternal 
 CI. Clavicular 
 Acr. 
 
 ^aSo^I } supra-alavicular nerves. 
 
 Cranial nerves — 
 Facial — 
 
 1. Posterior auricular 
 
 2. Temporal. 
 
 3. Malfur. 
 
 4. Infra-orbital. 
 
 5. BuccaL 
 
 FIG. 6.- 
 
 Cranial nerves — 
 Facial — 
 
 6. Mandibular 
 
 7. Cervical. 
 
 Trigeminal — 
 X. Ophthalmic 
 a. Supra-trochlear. 
 6. Supra-orbital. 
 
 c. Infra-trochlear. 
 
 d. External nasal. 
 
 2. Maxillary. 
 
 e. Infra-orbital. 
 /. Malar. 
 
 g. Temporal. 
 
 3. Mandibular. 
 
 h. Auriculo-temporal. 
 j. Buccal. 
 k. Mental. 
 
 -SUPERFICIAL NERVE OF THE HEAD AND NECK 
 50 
 
51 
 
52 
 
DISSECTION OF THE HEAD AND NECK 53 
 
 B. Dissection of the Scalp. 
 
 Clean the occipito-frontalis muscle and the epicranial 
 APONEUROSIS, and secure the arteries and nerves of the 
 anterior region of the scalp. 
 
 Arteries — 
 
 SUPERFICIAL TEMPORAL. 
 
 SUPRA-ORBITAL. 
 
 FRONTAL. 
 
 Nerves — 
 
 AURICULO-TEMPORAL. 
 
 TEMPORAL BRANCHES OF THE FACIAL. 
 
 TEMPORAL BRANCH OF THE ORBITAL. 
 
 SUPRA-ORBITAL. 
 
 SUPRA-TROCHLEAR. 
 
54 
 
DISSECTION OF THE HEAD AND NECK 55 
 
 . Pterygoid Region, with the muscles of mastication, the 
 
 INTERNAL MAXILLARY VESSELS AND THE MANDIBULAR NERVE. 
 
 (i) Clean the temporal fascia, noting the structures lying on 
 its surface and piercing it. 
 Remove the structures from the surface of the fascia and then 
 divide along the upper border of the zygoma — 
 («) The superficial layer, which should be turned up to show 
 
 the structures between the two layers. 
 (6) The deep layer, the lower half of which should be turned up 
 to expose the temporal muscle. 
 
 (2) Clean the masseter muscle, noting the structures lying on 
 
 its surface and in relation to its borders. 
 
 (3) Trace the following structures through the parotid gland : — 
 Vessels — 
 
 TRANSVERSE FACIAL. 
 SUPERFICIAL TEMPORAL. 
 POSTERIOR AURICULAR. 
 INTERNAL MAXILLARY. 
 
 Nerves — 
 
 FACIAL. 
 
 AURICULO-TEMPORAL. 
 GREAT AURICULAR. 
 
 Remove the substance of the gland, preserving the above 
 structures, and securing the external carotid artery, 
 and the temporo-maxillary vein. 
 
 (4) Remove the structures on the masseter muscle, turning 
 
 forwards the parotid duct and the branches of the facial 
 nerve. 
 
 (5) Separate the zygoma with the saw as completely as 
 
 possible, by means of oblique incisions in front and behind. 
 Note. — Examine the dry skull first to see how completely it is 
 
 possible to do this (fig. 7). 
 Turn down the zygoma with the origin of the masseter 
 
 muscle attached to it, securing during the process 
 
 THE MASSETERIC VESSELS AND NERVE. 
 
 Cut out a piece of the muscle where the vessels and nerve 
 enter it, so as to preserve them, and strip off the masseter 
 down to the angle of the jaw. 
 
 (6) Clean completely the temporal muscle, noting the nerves 
 
 and vessels at its borders. 
 
3. 7.— LINES OF INCISION THROUGH THE ZYGOMA 
 
 56 
 
DISSECTION OF THE HEAD AND NECK 57 
 
 Pterygoid Region — 
 
 (7) Cut off the COEONOID process of the mandible by an obhque 
 
 incision (fig. 8), and turn it up with the temporal muscle 
 attached. 
 
 Avoid injuring the buccal nerve and artery, lying on 
 the buccinator muscle at the anterior border of the temporal 
 muscle. 
 Clean the deep surface of the muscle, and secure its vessels 
 and nerves. 
 
 (8) Clean and isolate the neck of the jaw and remove the ramus 
 
 between the neck and the inferior dental foramen (fig. 8). 
 
 To do this without injuring the subjacent structures, 
 insinuate the handle of the knife beneath the neck of the 
 bone and push it down until it is arrested by the structures 
 entering the inferior dental foramen. 
 
 (9) Expose and clean — 
 
 PTERYGOID MUSCLES. 
 
 BRANCHES OF THE MANDIBULAR NERVE. 
 INTERNAL MAXILLARY ARTERY AND ITS BRANCHES. 
 PTERYGOID PLEXUS OF VEINS. 
 
 Note. — The artery may be concealed in its course 
 through this region 'by the external pterygoid muscle. In 
 that case the muscle must be removed to define it. 
 
 (10) Examine the temporo-mandibular articulation, and 
 
 then disarticulate the condyle, along with the fibro-cartilage 
 and the insertion of the external pterygoid muscle. 
 
 (11) Remove the external pterygoid muscle completely 
 
 [having if necessary first divided the internal maxillary 
 artery]. 
 
 (12) Trace the nerves seen in this region, to their origin from the 
 
 MANDIBULAR DIVISION of the FIFTH NERVE at the foramen 
 ovale. Dissect out the otic ganglion and its communi- 
 cations and branches. 
 
 (13) Remove the lateral pterygoid plate, in order to define the 
 
 INTERNAL PTERVGoiD MUSCLE, which should then be 
 removed to expose — 
 
 TENSOR PALATI MUSCLE. 
 
 PTERYGO-MANDIBULAR LIGAMENT. 
 
 SUPERIOR CONSTRICTOR MUSCLE OF THE PHARYNX. 
 
 ASCENDING PHARYNGEAL ARTERY. 
 
TIG. 
 
 8._UNES OF IKCISION 
 
 THROUGH THE LOWER JAW 
 
 58 
 
59 
 
6o 
 
DISSECTION OF THE HEAD AND NECK 6i 
 
 V. Submaxillary Region and the Muscles of the 
 Tongue 
 
 (i) Revise the superficial dissection of the submaxillary 
 triangle, defining its boundaries, floor, and contents — 
 
 SUBMAXILLARY GLAND. 
 FACIAL VESSELS (AND BRANCHES). 
 MYLOHYOID NERVE AND ARTERY. 
 SUBLINGUAL ARTERY. 
 
 {2) Separate the anterior belly of the digastric muscle from its 
 insertion and turn it aside with its nerve. 
 Divide the facial vessels as they cross the lower border of 
 the jaw. 
 
 (3) Saw through the body of the lower jaw, between the central 
 
 and lateral incisor teeth. 
 Turn upwards the jaw to expose the mylohyoid muscle, 
 with its artery and nerve, and turn backwards the sub- 
 maxillary gland. 
 
 (4) After cleaning the mylohyoid muscle, cut through its nerve, 
 
 and separate the muscle from its origin from the lower jaw. 
 Turn it downwards to expose — 
 
 MUCOUS MEMBRANE OF THE MOUTH. 
 SUBLINGUAL GLAND. 
 
 DEEP PART OF SUBMAXILLARY GLAND. 
 SUBMAXILLARY (wHARTON's) DUCT. 
 MUSCLES : GENIO-HYOID. 
 
 GENIO-HYOGLOSSUS. 
 
 HYOGLOSSUS. 
 
 STYLOGLOSSUS. 
 LINGUAL ARTERY AND ITS SUBLINGUAL BRANCH. 
 LINGUAL NERVE. 
 HYPOGLOSSAL NERVE. 
 
 Dissect out those structures which are grouped round the 
 HYOGLOSSUS MUSCLE. In front of if are the ranine and 
 sublingual arteries, and the loops of communication be- 
 tween the lingual and hypoglossal nerves : on the surface 
 of the muscle are these nerves, with the deep part of the 
 submaxillary gland, and its duct, and the submaxillary 
 ganglion on the lingual nerve; behind its posterior border 
 are the stylopharyngeus and middle constrictor muscles, 
 the stylohyoid ligament, lingual artery, and glossopharyn- 
 geal nerve. 
 
 (5) Divide the hyoglossus muscle to expose more completely — 
 
 LINGUAL ARTERY (and its dorsalis linguse branch) . 
 
 GLOSSOPHARYNGEAL NERVE. 
 STYLOHYOID LIGAMENT. 
 MIDDLE CONSTRICTOR MUSCLE. 
 
62 
 
63 
 
64 DISSECTION OF THE HEAD AND NECK 
 
 VI. Lacrimal Apparatus and Orbit 
 
 A. Lacrimal Apparatus. 
 
 (i) Remove the stitches uniting the eyeHds together, and the 
 packing from the conjunctival sac. 
 Examine the conjunctiva and the eyelids, noting — 
 
 PUNCTA LACRIMALIA. 
 CARUNCULA LACRIMALIS. 
 PLICA SEMILUNARIS. 
 
 (2) Dissect out the attachment of the orbicularis oculi to the 
 
 nasal process of the maxilla. 
 Pass bristles through the puncta lacrimalia into the cana- 
 
 LicuLi, and dissect them out to their junction with the 
 
 lacrimal sac. 
 Reflect the fibres of the orbicularis oculi completely, so as 
 
 to define the position of the lacrimal sac. 
 
 (3) Remove the rest of the orbicularis oculi to expose — 
 
 PALPEBRAL FASCIA. 
 TARSAL PLATES. 
 TARSAL LIGAMENTS. 
 TENSOR TARSI MUSCLE. 
 
 (4) Open the lacrimal sac and pass a probe through it into the 
 
 nasal duct. 
 The termination of the duct in the inferior meatus of the nose 
 will he examined in the dissection of the nasal cavity. 
 
66 DISSECTION OF THE HEAD AND NECK 
 
 B. Orbit. 
 
 (i) Draw forward the eyeball, make an incision in it, and stuff 
 the cavity with tow or cotton-wool, so as to distend the 
 globe of the eye. Draw the eyeball forward with hooks 
 so as to stretch the optic nerve. 
 
 (2) Remove the skull-cap. 
 
 Define the optic foramen and the sphenoidal fissure, with 
 
 the structures passing through them. 
 The CAVERNOUS SINUS and the structures in relation to it have 
 
 already been dissected with the base of the skull (p. 18). 
 Strip the dura mater from the anterior fossa of the skull, 
 
 preserving in relation to the cribriform plate of the ethmoid 
 
 bone, the ethmoidal arteries and the nasal nerve. 
 
 (3) The roof and outer wall of the orbit must now be re- 
 
 moved by the following incisions. 
 
 [a) Make two vertical incisions with the saw through the 
 frontal bone at each margin of the orbit. 
 With mallet and chisel chip out the outline of the roof of 
 the orbit as far back as the sphenoidal fissure, and along 
 the margin of the cribriform plate internally. Leave a 
 portion of the lesser wing of the sphenoid bone bridging 
 over the optic foramen and the sphenoidal fissure. 
 Prise forwards the wedge-shaped segment of bone, and 
 
 expose the periosteum of the roof of the orbit. 
 During this dissection the nasal nerve and the ethmoidal 
 arteries should be looked for in the ethmoidal foramina, 
 [h) It is advisable at this stage to make a further dissection. 
 Divide with the saw the malar bone by a horizontal incision 
 
 at the level of the floor of the orbit. 
 Cut through the squamous part of the temporal bone and 
 the great wing of the sphenoid bone by a saw-cut carried 
 obliquely downwards and forwards to the foramen ovale. 
 Divide the great wing of the sphenoid bone with mallet 
 and chisel just external to the foramen ovale and fora- 
 men rotundum, preserving the maxillary and mandi- 
 bular nerves. 
 Prise out the piece of bone thus separated and expose the 
 
 periosteum of the outer wall of the orbit. 
 During this latter dissection the orbital branch of the 
 MAXILLARY NERVE should be sccured. 
 
DISSECTION OF THE HEAD AND NECK 67 
 
 (4) Remove the periosteum lining the roof of the orbital cavity 
 
 and expose — 
 
 LACRIMAL GLAND. 
 LACRIMAL ARTERY AND NERVE. 
 FRONTAL NERVE. 
 SUPRA-ORBITAL NERVE. 
 SUPRA-TROCHLEAR NERVE. 
 SUPRA-ORBITAL ARTERY. 
 FRONTAL ARTERY. 
 
 Dissect out the following muscles and secure their nerves — 
 RECTUS LATERALIS with the sixth nerve. 
 
 LEVATOR PALPEBRJE SUPERIORIS, and 
 
 RECTUS SUPERIOR, with the upper division of the third nerve. 
 OBLIQUUS SUPERIOR, with the fourth nerve. 
 
 Note that the fourth nerve enters the obliquus superior on 
 its superficial {orbital) surface. The other nerves enter 
 their respective muscles on their ocular surfaces. 
 
 (5) Divide the levator palpebrse superioris, rectus superior, and 
 
 obliquus superior, beyond the point of entrance of their 
 nerves, and turn their parts forwards and backwards. 
 
 Expose and clean — 
 NASAL NERVE, and its branches : — 
 
 LONG ROOT OF CILIARY GANGLION. 
 LONG CILIARY NERVES. 
 INFRA-TROCHLEAR NERVE. 
 
 OPHTHALMIC ARTERY and its branches. 
 
 OPHTHALMIC VEINS. 
 OPTIC NERVE. 
 
 CILIARY GANGLION, and its roots. 
 
 CILIARY NERVES. 
 RECTUS MEDIALIS. 
 RECTUS INFERIOR. 
 OBLIQUUS INFERIOR. 
 
 THIRD NERVE (inferior division) with its muscular branches, 
 and the short root of the ciliary ganglion. 
 
 (6) The obliquus inferior muscle will be seen more completely from 
 
 the front by dividing the conjunctiva beneath the eyeball. 
 
 (7) Clean the sclerotic coat of the eyeball by removal of the 
 
 CAPSULE OF TENON, to See the exact insertions and relations 
 of the muscles attached to it. 
 
 (8) Turn aside the contents of the orbit and dissect out in its 
 
 floor the 
 INFRA-ORBITAL GROOVE, Containing 
 
 INFRA-ORBITAL NERVE and VESSELS. 
 
68 
 
e.^ 
 
70 DISSECTION OF THE HEAD AND NECK 
 
 VII. Maxillary Nerve and Third Part of the 
 Internal Maxillary Artery 
 
 A. (i) The maxillary nerve should be secured as it enters the 
 
 foramen rotundum, and the infra-orbital nerve as it emerges 
 from the infra-orbital foramen (fig. 9). 
 
 (2) The remaining part of the great wing of the sphenoid 
 bone, and the root of the pterygoid process, must be 
 snipped away with bone forceps, to trace the course of the 
 maxiUary nerve to and through the spheno-maxillary 
 FOSSA and the spheno-maxillary fissure to the infra- 
 orbital groove. 
 
 (3) The infra-orbital canal should then be opened up to 
 the infra-orbital foramen to expose the infra-orbital 
 NERVE in its whole course, along with the middle and 
 anterior dental NERVES, occupyiug canals in the wall 
 of the maxillary sinus. 
 
 By these means the nerve is displayed in its whole course, 
 through 
 
 FORAMEN ROTUNDUM. 
 SPHENO-MAXILLARY FOSSA. 
 SPHENO-MAXILLARY FISSURE. 
 INFRA-ORBITAL GROOVE. 
 INFRA-ORBITAL CANAL. 
 INFRA-ORBITAL FORAMEN. 
 
 (4) Follow the branches of the maxillary nerve. 
 
 (5) Clean the spheno-jIaxillary ganglion with its roots 
 and branches. 
 
 B. Clean the Internal Maxillary Artery and follow out its course, 
 
 and its branches in the spheno-maxiUary fossa. 
 
aa. Foramen lotundum. 
 b. Spheno-maxillary fossa. 
 e. Spheno-maxillary fissure. 
 
 d. Infra-orbital groove, 
 
 e. Infra-orbital canal. 
 
 /. Infra-orbital foramen 
 
 FIG. 9. — THE COURSE OF THE MAXILLARY NERVE 
 
 71 
 
72 
 
DISSECTION OF THE HEAD AND NECK 73 
 
 VIII. Deep Dissection of the Neck 
 
 (i) Dissect out the ligaments and muscles connected with the 
 styloid process, noting their relations to the external and 
 internal carotid arteries. 
 
 (2) Divide the styloid process near its root and turn it downwards 
 
 with its ligaments and muscles. 
 
 (3) Examine the relations of the internal carotid artery and internal 
 
 jugular vein to 
 
 LIGAMENTS AND MUSCLES. 
 
 VESSELS. 
 
 NERVES. 
 
 (4) Complete the dissection of the following nerves and their 
 
 branches and connections in this region :— 
 
 FACIAL. 
 
 HYPOGLOSSAL. 
 
 SPINAL ACCESSORY. 
 
 VAGUS. 
 
 GLOSSOPHARYNGEAL. 
 
 SYMPATHETIC GANGLIATED CORD. 
 
 LOOP BETWEEN THE FIRST TWO CERVICAL NERVES. 
 
 PHARYNGEAL PLEXUS. 
 
 (5) Dissect out the ascending pharyngeal artery and define 
 
 the wall of the pharynx. 
 
74 
 
DISSECTION OF THE HEAD AND NECK 75 
 
 IX. Prevertebral Muscles, Pharynx, and 
 Soft Palate 
 
 The head is now to be divided into two parts : an anterior part, 
 associated with the face, pharynx, larynx, trachea and oesophagus, 
 and a ■posterior part, associated with the vertebral column and 
 prsevertebral muscles. 
 
 The separation is made in the following way. 
 
 The dissection is made so as to include with the anterior half the 
 petrous portions of the temporal bones, to be afterwards 
 separated. 
 
 (i) Incisions are to be made with the saw on each side obliquely 
 through the cranium behind the mastoid process in the line 
 of articulation of the temporal and occipital hones. This 
 incision should extend inwards to the jugular foramen. 
 
 (2) A transverse incision is to be made with mallet and chisel 
 transversely through the basilar process about half an inch 
 in front of the foramen magnum. 
 Nerves and vessels should be divided and the anterior part 
 (including the internal carotid arteries) should be separated 
 from the posterior part, comprising the vertebral column 
 and praevertebral muscles. 
 
 A. Fr3vertel)TaI Muscles. 
 Dissect out 
 (i) The praevertebral muscles : — 
 
 SCALENI. 
 
 LONGUS CAPITIS. 
 
 RECTUS CAPITIS ANTERIOR. 
 
 RECTUS CAPITIS LATERALIS. 
 
 LONGUS COLLI. 
 
 INTER-TRANSVERSE MUSCLES. 
 
 (2) Vertebral arteries. 
 
 (3) Anterior primary divisions of the cervical nerves, to display 
 
 their relation to the vertebral artery. 
 This portion of the head should be preserved in water or dilute 
 spirit for the subsequent study of the articulations. 
 
76 
 
DISSECTION OF THE HEAD AND NECK 77 
 
 B. Pharynx. 
 
 (i) Remove from the anterior part of the dissected head each temporal 
 BONE, and preserve it for the dissection of the ear (p. 90). 
 In this process the eustachian tube and the levator palati 
 MUSCLE should he defined, and then separated from the bone 
 and retained with the pharynx. 
 
 (2) Stuff the cavity of the pharjmx with tow, so as to stretch its 
 
 walls, and clean the constrictor and the stylopharyngeus 
 
 MUSCLES. 
 
 Define the intervals above, between, and below the muscles 
 and secure the structures occupying these intervals. 
 
 Reflect the constrictor muscles outwards on one side from the 
 middle line posteriorly, to expose the longitudinal muscles — 
 
 STYLOPHARYNGEUS and 
 PALATOPHARYNGEUS. 
 
 Above the palatopharyngeus is to be seen the fibrous 
 aponeurosis of the pharynx pierced by the 
 
 EUSTACHIAN TUBE. 
 LEVATOR PALATI MUSCLE. 
 ASCENDING PHARYNGEAL ARTERY. 
 
 Note the relations of the Eustachian tube to the levator and 
 tensor palati muscles. 
 
 (3) Open the cavity of the pharynx from behind by a median 
 
 longitudinal incision, remove the tow, and examine its 
 
 Subdivisions — 
 
 NASAL. 
 
 ORAL. 
 
 LARYNGEAL. 
 
 Communications — 
 
 POSTERIOR NARES. 
 EUSTACHIAN TUBES. 
 
 CAVITY OF THE MOUTH (isthmus faucium). 
 
 ADITUS LARYNGIS. 
 CESOPHAGUS. 
 
 FOSSCB 
 
 LATERAL RECESSES. 
 TONSILLAR FOSS/E. 
 VALLECULJE. 
 FOSS^ PYRIFORMES. 
 
 Glands — 
 
 TONSILS. 
 ADENOID GLANDS. 
 
78 DISSECTION OF THE HEAD AND NECK 
 
 C. Soft Palate. 
 
 Pin out the walls of the -pharynx so as to stretch the soft palate and 
 the pillars of the fauces. 
 
 (i) Remove the mucous membrane from the upper surface of the 
 SOFT PALATE and UVULA, and from the adjacent part of the 
 pharynx, to expose in order the muscles of the soft palate : — 
 
 PALATOPHARYNGEUS (SUPERFICIAL FIBRES). 
 
 AZYGOS UVULJE. 
 
 LEVATOR PALATI. 
 
 PALATOPHARYNGEUS (DEEP FIBRES). 
 
 TENSOR PALATI. 
 
 PALATOGLOSSUS. 
 
 (2) Follow the TENSOR PALATI MUSCLE to its Origin, noting its 
 
 relations to the hamular process, internal pterygoid plate, 
 and Eustachian tube. 
 
 (3) Follow the PALATOGLOSSUS and palatophaeyngeus muscles 
 
 through the pillars of the fauces, and define the salpingo- 
 
 PHARYNGEUS MUSCLE. 
 
79 
 
8o DISSECTION OF THE HEAD AND NECK 
 
 X. The Larynx 
 
 (i) Clean and define the muscles, vessels, and nerves associated 
 with the front and sides of the larynx, in relation to the 
 hyoid bone, thyrohyoid membrane, thyroid cartilage, 
 cricothyroid membrane, and cricoid cartilage. 
 The thyroid body and its vessels should be removed. 
 
 (2) Stretch out the walls of the open pharynx, and examine the 
 larynx from behind, noting the 
 Aditus Laryngis, with the 
 
 EPIGLOTTIS. 
 
 ARYTENO-EPIGLOTTIDEAN FOLDS. 
 CUNEIFORM CARTILAGES (wRISBERG). 
 CORNICULATE CARTILAGES (SANTORINl). 
 
 Laryngeal Cartilages, position and relations. 
 
 THYROID. 
 CRICOID. 
 ARYTENOID. 
 EPIGLOTTIS. 
 
 Fossse — 
 
 VALLECULA. 
 
 ■EOSSM PYRIFORMES. 
 
 Remove the mucous membrane of the phar5Tix covering the 
 posterior aspect of the cricoid and arytenoid cartilages, 
 and clean the arytenoid and posterior crico-arytenoid 
 muscles. 
 
 (3) Clean the lateral aspect of the larynx. 
 
 Remove the muscles attached to the hyoid bone, thjrroid and 
 cricoid cartilages, and define the 
 
 HYOID BONE. 
 
 THYROHYOID MEMBRANE. 
 
 THYROHYOID LIGAMENT. 
 
 CARTILAGO TRITICEA. 
 
 KLM AND CORNUA OF THE THYROID CARTILAGE. 
 
 CRICOTHYROID MEMBRANE. 
 
 CRICOID CARTILAGE AND 
 
 CRICOTHYROID MUSCLE 
 
 {with its nerve derived from the external laryngeal nerve). 
 
DISSECTION OF THE HEAD AND NECK 8i 
 
 (4) Detach the cricothyroid muscle, and define more clearly the 
 
 CRICOTHYROID MEMBRANE. 
 
 Examine the connections of the ala of the thyroid cartilage, 
 dissecting out and preserving the superior and inferior 
 lar5nigeal vessels and nerves. 
 
 (5) Detach from the upper border of the ala and superior cornu 
 
 of the thyroid cartilage the thyrohyoid membrane, and 
 ligament; disarticulate the inferior cornu from the cricoid 
 cartilage ; make a vertical incision alongside the isthmus of 
 the cartilage and remove the ala, to expose — 
 
 ANASTOMOSES BETWEEN THE SUPERIOR AND INFERIOR LARYN- 
 GEAL ARTERIES AND NERVES. 
 LATERAL CRICO-ARYTENOID MUSCLE. 
 
 CRICOTHYROID MEMBRANE AND TRUE VOCAL CORDS. 
 OUTER SIDE OF THE ARYTENO-EPIGLOTTIDEAN FOLD. 
 
 (6) Remove the mucous membrane from the outer side of the 
 
 aryteno-epiglottideanfoldto expose the following muscles : — 
 
 ARYTENO-EPIGLOTTIDEUS. 
 
 THYRO-EPIGLOTTIDEUS. 
 
 THYRO-ARYTENOID. 
 
 (7) Make a medial vertical incision through the arytenoid 
 
 MUSCLE and the posterior wall of the cricoid cartilage 
 and trachea, to open the cavity of the larynx. 
 
 Cavity of the Larynx. 
 
 Examine the three subdivisions of the cavity; the 
 FALSE AND TRUE VOCAL CORDS (glottis Spuria and glottis 
 vera) ; and the ventricles. 
 
 (8) Stuff the ventricle and saccule with cotton wool, and define 
 
 their relations and extent by dissecting from their outer 
 surface the muscles of the aryteno-epiglottidean fold. 
 Trace down from the epiglottis the aryteno-epiglottidean 
 membrane, and note its continuity with the false vocal 
 cord. 
 
 (9) Clean the laryngeal cartilages and examine their articu- 
 
 lations and ligamentous connections. 
 
82 
 
83 
 
84 DISSECTION OF THE HEAD AND NECK 
 
 XL Cavity of the Mouth 
 
 A. Clean the buccinator muscle, defining its vessels and nerves, 
 the pterygo-mandibular ligament, and the termination of the parotid 
 (Stenson's) duct. 
 
 Divide transversely the buccinator muscle, and expose the cavity 
 of the mouth from the side. 
 
 B. Examine the boundaries of the cavity. 
 
 C. Examine the form and relations of the tongue : — 
 
 (i) Its MUCOUS MEMBRANE, glands, papillae, foramen caecum. 
 
 (2) connections, anteriorly, laterally, and posteriorly. 
 
 Make a dissection of the muscles of the tongue on one 
 side, and trace the branches of the lingual artery, the 
 hypoglossal, glossopharyngeal, and lingual nerves, into 
 its substance. 
 
85 
 
85 DISSECTION OF THE HEAD AND NECK 
 
 XII. Cavity of the Nose 
 To expose the interior of the nasal cavity — 
 
 (i) Divide with scissors the soft palate and the soft parts of the 
 
 nose on one side of the middle line. 
 (2) Separate the outer wall of the nose from the septum by two 
 
 saw-cuts, one alongside the crista galli, and the other 
 
 through the hard palate. 
 
 A. Examine the cut surfaces, forming the roof and floor of the nose. 
 
 B. Nasal septum. 
 
 (i) Dissect out the nerves and vessels. 
 {2) Examine the bones and cartilages. 
 
 C. Outer wall of the nose. 
 
 (i) Examine the vestibule and agger nasi. 
 
 (2) Examine the spheno-ethmoidal recess, and the opening of 
 
 the sphenoidal air-cell. 
 
 (3) Examine the meatuses of the nose. To see the structures 
 
 and openings in relation to each the turbinate bone arching 
 over it should be raised upwards, 
 (a) Superior meatus, and openings of 
 
 POSTERIOR ethmoidal AIR-CELLS. 
 
 (6) Middle meatus, with the 
 
 HIATUS SEMILUNARIS. 
 
 BULLA ETHMOIDALIS. 
 
 Openings of ETHMOIDAL air-cells (ANTERIOR AND MIDDLE). 
 
 INFUNDIBULUM. 
 
 MAXILLARY SINUS. 
 
 (c) Inferior meatus, and opening of 
 
 NASAL DUCT. 
 
 D. Follow the course of the infundibulum and nasal duct. 
 
 Trace the vessels and nerves of the outer wall of the nose. 
 
 E. Spheno-maxillary fossa from within. 
 
 (i) Remove the mucous membrane from the outer wall of 
 the nose, covering the palate bone, and the internal 
 pterygoid plate. 
 
 (2) Define the spheno-palatine foramen, and the naso- 
 
 palatine nerve and artery. 
 
 (3) Chip away the palate bone, so as to enlarge the spheno- 
 palatine foramen, and trace the naso-palatine nerve to 
 the spheno-palatine ganglion, and the naso-palatine artery 
 to the internal maxillary trunk. 
 
 (4) Clean the spheno-maxillary ganglion from within, and 
 trace its branches, along with the branches of the third 
 part of the internal maxillary artery. 
 
87 
 
DISSECTION OF THE HEAD AND NECK 
 
 XIII. Cranio-vertebral Articulations 
 
 The portion of the head with the vertebral column attached is 
 to be used for this purpose. 
 
 Remove the muscles attached to the vertebral column, and the 
 remaining part of the occipital bone. 
 
 Clean and define the anterior ligaments : — 
 
 ANTERIOR COMMON LIGAMENT. 
 ANTERIOR ATLANTO-AXIAL LIGAMENT. 
 ANTERIOR OCCIPIXO-ATLANTOID LIGAMENT. 
 
 Unless the lamincB of the cervical vertebra have already heen removed, 
 in the dissection of the spinal cord, clean the 
 
 LIGAMENTA SUBFLAVA. 
 LIGAMENTUM NUCH.ffi. 
 INTER-SPINOUS LIGAMENTS. 
 SUPRA-SPINOUS LIGAMENTS. 
 POSTERIOR ATLANTO-AXIAL, AND 
 POSTERIOR OCCIPITO-ATLANTOID LIGAMENTS. 
 
 Cut through the ligamenta subflava and divide the laminse of the 
 cervical vertebrae, and the posterior arch of the atlas. 
 
 Saw through the occipital bone by a transverse incision carried 
 through the foramen magnum just behind the occipital condyles. 
 
 // the spinal cord has not already heen removed, it should now he 
 dissected in accordance with the directions on p. 32. 
 
 The spinal cord and membranes being removed, and the dura 
 mater being detached from the margin of the foramen magnum, 
 clean the — 
 
 POSTERIOR COMMON LIGAMENT. 
 
 POSTERIOR OCCIPITO-AXIAL LIGAMENT. 
 
 CAPSULES ENCLOSING THE ARTICULAR SURFACES OF 
 
 THE CERVICAL VERTEBR.E. 
 
 ATLAS AND AXIS. 
 
 ATLAS AND OCCIPITAL BONE 
 
 (with the accessory LIGAMENTS). 
 
 Cut through the posterior occipito-axial ligament, and dissect 
 out the cruciform ligament, with its horizontal and vertical 
 portions. 
 
 Divide the upper part of the vertical limb of the cruciform liga- 
 ment, and clean the occipito-odontoid ligaments : — 
 
 SUSPENSORY LIGAMENT, AND 
 ALAR LIGAMENTS. 
 
 Disarticulate the several bones and examine their articular 
 surfaces. 
 
89 
 
go DISSECTION OF THE HEAD AND NECK 
 
 XIV. Dissection of the Ear 
 
 The temporal bone, with the pinna attached to it, should now be 
 cleaned. 
 The student should identify the following structures :— 
 
 INTERNAL AUDITORY MEATUS, with the 
 
 FACIAL NEKVK. 
 INTERMEDIATE NERVE. 
 AUDITORY NERVE. 
 AUDITORY ARTERY. 
 
 HIATUS FALLOPII AND GREAT SUPERFICIAL PETROSAL NERVE. 
 
 EUSTACHIAN TUBE. 
 
 TENSOR TYMPANI MUSCLE. 
 
 GLASERIAN FISSURE WITH THE 
 
 CHORDA TYMPANI NERVE, AND 
 TYMPANIC ARTERY. 
 
 EXTERNAL AUDITORY MEATUS. 
 DEEP AURICULAR ARTERY. 
 ORIGIN OF THE LEVATOR PALATI MUSCLE. 
 CAROTID CANAL. 
 JUGULAR FOSSA. 
 
 CANAL FOR THE TYMPANIC BRANCH OF THE GLOSSOPHARYN- 
 GEAL NERVE. 
 STYLOMASTOID FORAMEN, AND 
 
 FACIAL NERVE, AND 
 STYLOMASTOID ARTERY. 
 
 LATERAL (sIGMOId) SINUS. 
 
 Pinna. Examine the form of the pinna ; remove the skin to 
 show its structure and its continuity with the cartilaginous portion 
 of the external auditory meatus. 
 
 External Auditory Meatus. Clean and examine the meatus. Draw 
 upwards the pinna to straighten the meatus, and with an aural 
 speculum examine the appearance of the membrana tympani. 
 
 This can be done still better in the living subject. 
 
 Remove the pinna and the remaining part of the squamous portion 
 of the temporal bone. 
 
 Remove the roof of the external auditory meatus with bone for- 
 ceps, to display its whole course, leaving the peripheral attachment 
 internally of the membrana tympani. 
 
 Note the attachments and inclination of the membrana tympani. 
 
91 
 
92 DISSECTION OF THE HEAD AND NECK 
 
 Tympanic Cavity. Remove the tegmen tympani to expose the 
 tympanic cavity. The bone should be chipped away, beginning 
 on the outer side of the elevation formed by the superior semi- 
 circular canal, and carried backwards to the tympanic attic and 
 MASTOID ANTRUM and CELLS, and forwards to display the canal for 
 the TENSOR TYMPANI muscle, with the opening of the eustachian 
 TUBE below it. 
 
 This dissection leads to the exposure of the tympanic cavity, — 
 
 OSSICLES. 
 
 TENSOR TYMPANI MUSCLE. 
 
 CHORDA TYMPANI NERVE LYING AGAINST THE MEMBRANA TYMPANI. 
 
 AQUEDUCT OF FALLOPIUS. 
 
 PROMONTORY (ON THE INNER WALL). 
 
 Examine the articulations of the ossicles, in situ, and then detach 
 and preserve the incus, leaving the malleus and stapes in position. 
 
 Separate the specimen into two halves, by a sagittal section taken 
 between the lateral and medial walls of the tjmipanum, and 
 through the mastoid process, in the line between the opening of the 
 Eustachian tube in front and the stylomastoid foramen behind. 
 
 The two sections will demonstrate the boundaries and communi- 
 cations of the tympanic cavity. 
 
 Lateral wall — 
 
 MEMBRANA TYMPANI. 
 
 MALLEUS. 
 
 CHORDA TYMPANI. 
 
 Medial wall — 
 
 AQUEDUCT OF FALLOPIUS. 
 
 PROMONTORY. 
 
 FENESTRA OVALIS. 
 
 STAPES. 
 
 FENESTRA ROTUNDA, AND 
 
 SECONDARY TYMPANIC MEMBRANE. 
 
 GROOVES ON THE PROMONTORY FOR THE TYMPANIC PLEXUS. 
 
 Anterior wall — 
 
 CANAL FOR TENSOR TYMPANI. 
 PROCESSUS COCHLEARIFORMIS. 
 EUSTACHIAN TUBE. 
 ITER CHORDS ANTERIUS 
 
 (for chorda tympani nerve). 
 Posterior wall — 
 
 TYMPANIC ATTIC, LEADING TO THE MASTOID ANTRUM. 
 
 PYRAMID. 
 
 STAPEDIUS MUSCLE. 
 
 ITER CHORDS POSTERIUS. 
 
 (for chorda tympani nerve). 
 Floor : a thin plate of bone, which is pierced by the tympanic 
 
 BRANCH OF THE GLOSSOPHARYNGEAL NERVE. 
 
DISSECTION OF THE HEAD AND NECK 93 
 
 In addition to the mastoid antrum and mastoid cells, the section 
 of the mastoid process may display the vertical limb of the 
 AQUEDUCT OF FALLOPius, and the section more posteriorily may 
 open up the lateral (sigmoid) sinus. 
 
 Facial and Auditory Nerves. Saw away with a fretsaw the roof of 
 the internal auditory meatus, to display the 
 
 FACIAL, 
 
 INTERMEDIATE, AND 
 AUDITORY NERVES. 
 
 Follow the nerves outwards to the lamina cribrosa. 
 
 Facial Neive. 
 
 Cut into the aqueduct of fallopius with bone forceps and 
 file, and follow the course of the facial nerve outwards, backwards, 
 and downwards to the stylomastoid foramen. 
 
 Note its relations to 
 
 LABYRINTH. 
 TYMPANIC CAVITY. 
 MASTOID ANTRUM. 
 
 Secure its branches : — 
 
 CONNECTION WITH INTERMEDIATE NERVE. 
 BRANCHES FROM THE GENICULATE GANGLION. 
 
 GREAT SUPERFICIAL PETROSAL. 
 
 BRANCH TO TYMPANIC PLEXUS. 
 
 EXTERNAL PETROSAL. 
 NERVE TO STAPEDIUS. 
 CHORDA TYMPANI NERVE. 
 
94 
 
93 
 
96 DISSECTION OF THE HEAD AND NECK 
 
 Labyrinth. 
 
 The attempt may be made to file away the parts of the petrous 
 portion of the temporal bone so as to demonstrate the osseous 
 labyrinth. 
 
 A better method, however, is to make transverse sections of the 
 
 bone, and be content to make out the main features of the parts of 
 
 the labyrinth and their relations. A horizontal section of the 
 
 bone at a level corresponding to the lower margin of the internal 
 
 meatus internally, and the fenestra ovalis externally, shows the 
 
 following structures in order from before backwards — 
 
 carotid canal, 
 cochlea with 
 
 modiolus. 
 
 osseous spiral lamina. 
 
 basilar membrane. 
 
 reissner's membrane. 
 
 scala media. 
 
 SCALA VESTIBULI. 
 SCALA TYMPANI. 
 VESTIBULE CONTAINING 
 SACCULE, AND 
 UTRICLE. 
 
 SEMICIRCULAR CANALS {in Section). 
 
 SUPERIOR. 
 
 POSTERIOR. 
 
 LATERAL. 
 
 Examine the relations to the internal ear of the stapes in the 
 
 FENESTRA OVALIS, and the SECONDARY MEMBRANE OF THE TYM- 
 PANUM in the fenestra rotunda. 
 
97 
 
98 
 
DISSECTION OF THE HEAD AND NECK 99 
 
 XV. Dissection of the Eyeball 
 
 For the dissection of the eyeball severed ox-eyes should be 
 prese^^■ed in a fresh condition. 
 
 Detach the conjimctiva, muscles, and fat from the globe of the 
 eye, and divide the optic ner\'^e about one-eighth of an inch from 
 its attachment to the sclera. 
 
 First Dissection. 
 
 After examining the cornea, Eind sclera, and the attachment of 
 the optic nerve — 
 
 (i) Cut out the cornea, and expose the anterior chamber, iris, and 
 pupil. Demonstrate the posterior chamber placed between 
 the iris and lens. 
 
 (2) Make an incision through the whole thickness of the sclera, 
 round the equator of the eyeball, and then a series of cuts 
 from the optic nerve to the corneal margin, so as to lift up 
 and remove segments of the sclera from the surface of the 
 choroid coat. 
 
 At the comeo-sclerotic junction there is a certain difficulty in 
 separating the sclera from the subjacent choroid coat, on account 
 of the adhesion of the ciliary muscle. This remains as a circular 
 white band on the pigmented siirface of the choroid. 
 
 Choroid Coat and Iris. 
 
 After examining the choroid and iris, separate the iris from sub- 
 jacent structures, and cut it away from the choroid coat by a 
 circular incision behind the line of the ciliary muscle. 
 
 Examine the deep siu^ace of the iris to see the ciliary processes. 
 
 Crystalline lens. Placing the eyebaU on a soft pad in a 
 shallow dish, examine under water the position and connections of 
 the lens. 
 
 Note the suspensory ligament and zonule of zinn, and blow 
 up the canal of petit with air. 
 
 Retina. Strip off (under water) the choroid coat so as to 
 expose the retina. The hexagonal pigment cell layer of the 
 retina adheres to the choroid, so that the retina appears as a whitish 
 membrane covering the vitreous body. 
 
 Vitreous Body. Remove the lens and examine its form. 
 Strip off the retina, and lay bare the vitreous. 
 
100 
 
DISSECTION OF THE HEAD AND NECK loi 
 
 Second Dissection. 
 
 In a second eye make a circular incision through the sclera, a short 
 way behind the corneal margin. 
 
 Remove the cornea and anterior part of the sclera and expose — 
 
 ANTERIOR CHAMBER. 
 IRIS AND PUPIL. 
 CILIARY MUSCLE. 
 POSTERIOR CHAMBER. 
 
 The ciliary muscle appears after the sclerotic coat is removed as 
 a circular white band adherent to the choroid at its junction with 
 the iris. 
 
 Remove the iris and the anterior part of the choroid, and examine 
 the CILIARY PROCESSES on their deep surfaces. 
 
 Lens. Examine the position and connections of the lens. 
 Note the suspensory ligament and the zonule of zinn, and 
 inflate the canal of petit with air, round the margin of the lens. 
 Note the relation of the lens and its capsule to the iris and ciliary 
 processes and to the hyaloid membrane. 
 
 Remove the lens, and examine its form and structure. 
 
 Vitreous Body. Examine the vitreous body and extract it. 
 
 Retina. Examine the retina, noting the 
 
 MACULA LUTEA. 
 OPTIC DISC. 
 CENTRAL ARTERY. 
 
 Detach the retina from the interior of the globe, and expose the 
 choroid (to which the hexagonal pigment cell layer is adherent). 
 Detach the choroid to see the sclerotic coat from within. 
 
102 
 
DISSECTION OF THE HEAD AND NECK 103 
 
 Third Dissection. 
 
 In a third eyeball, immersed in water, make a section through the 
 equator of the eyeball, cutting through sclerotic and choroid coats, 
 retina, and vitreous body. 
 
 A. IN THE FRONT HALF OF THE EYEBALL — 
 
 Remove the portion of the vitreous body, and examine from behind 
 the position and connections of the lens. 
 
 Divide the ligament of the lens along its margin : remove the lens, 
 and examine its form and structure. 
 
 Ciliary processes and iris. Examine the cUiary processes 
 from behind, noting their relations to the iris, choroid and sus- 
 pensory ligament of the lens. 
 
 B. in the back half of the eyeball — 
 
 Examine the retina, after removal of the remaining part of the 
 vitreous body, and detach it to see the choroid (covered on its deep 
 surface by the hexagonal pigment cell layer). 
 
 Dissect off the choroid to see the deep surface of the sclerotic 
 coat. 
 
104 
 
DISSECTION OF THE HEAD AND NECK 105 
 
 XVI. Dissection of the Brain 
 
 Preservation of the Brain. 
 
 The fresh brain may be preserved by various means. A satu- 
 rated solution of zinc chloride is effective in fixing the brain, and is 
 to be recommended in the case of foetal brains. Corrosive sublimate, 
 formaldehyde, carbolic acid, or dilute alcohol, may be used. When 
 fixed and hardened the brain may be kept for an indefinite time in 
 70 per cent, alcohol. The brain removed from the body in the 
 dissecting-room is usually well preserved and ready for dissection. 
 
 The dissection of the brain is undertaken after the dissection of 
 the head and neck. 
 
io6 DISSECTION OF THE HEAD AND NECK 
 
 I. Superficial Examination 
 
 A. Membranes. 
 
 The dura mater has already been dealt with in the section dealing 
 with the removal of the brain (p. 17). 
 
 The arachnoid and pia mater are to be examined in relation to 
 the convolutions of the cerebrum, and the base of the brain. 
 
 Tear away the arachnoid membrane to disclose the subarachnoid 
 
 SPACES — 
 
 (i) in relation to the cerebral fissures ; 
 (2) at the base of the brain. 
 
 B. Base of the Brain. 
 
 (i) Arteries. — Dissect out the arteries in the base of the brain, 
 and define the circle of willis. Follow the cerebral 
 arteries as far as possible towards their termination. 
 Divide the anterior cerebral artery beyond the junction of 
 the anterior communicating artery, the middle cerebral 
 in the fissure of Sylvius, the posterior cerebral and the 
 three cerebellar arteries. 
 Detach the circle of Willis and associated arteries, and pin them 
 out to make a dry preparation. 
 
 (2) Cranial Nerves. — -Define the superficial origins of the cranial 
 
 nerves, removing the pia mater from the brain, but 
 retaining the attachments of the nerve roots. 
 
 (3) Interpeduncular Space. — Remove the pia mater to expose the 
 
 structures in the interpeduncular space : — 
 
 POSTERIOR PERFORATED SPOT. 
 
 CORPORA ALBICANTIA. 
 
 TUBER CINEREUM, INFUNDIBULUM, AND PITUITARY BODY. 
 
 OPTIC TRACTS. 
 
 OPTIC CHIASMA. 
 
 OPTIC NERVES. 
 
 LAMINA CINEREA. 
 
io8 DISSECTION OF THE HEAD AND NECK 
 
 II. Cerebrum 
 
 A. Superficial Dissection of tlie Cerebral Hemispheres. 
 
 Place the brain on a soft pad so as not to injure its under surface, 
 and detach the arachnoid and pia mater from the convolutions of 
 the cerebral hemispheres. Draw out the pia mater from the 
 fissures, and pack the fissures with a little cotton-wool. 
 
 (i) Define the fissures and convolutions on the outer and 
 under surfaces of each hemisphere. 
 
 (2) Fissure of Sylvius. — Define the extent and subdivision of 
 
 this fissure. Note the convolutions forming the opercula. 
 Separate the opercula, so as to open up the fissure, and 
 follow out the course of the middle cerebral artery. 
 
 (3) Cut away the superior operculum and expose the island of 
 
 Reil. 
 
log 
 
no DISSECTION OF THE HEAD AND NECK 
 
 B. Centrum Ovale and Corpus Callosum. 
 
 (i) Separate slightly the two cerebral hemispheres, and sUce 
 horizontally through the right hemisphere, until the 
 CORPUS CALLOSUM becomes plainly visible in the floor of 
 the median longitudinal fissure. 
 Now tear off the part of the right hemisphere still remaining 
 above the corpus callosum, and pull it outwards to see 
 the fibres of the corpus callosum, radiating into the 
 
 CENTRUM OVALE. 
 
 (2) Examine the upper surface of the corpus callosum, with the 
 
 STRI^ LONGITUDINALES, and the ANTERIOR CEREBRAL 
 ARTERIES. 
 
 (3) Examine the medial surface of the left hemisphere, so 
 
 far as it is visible at this stage. Remove the membranes, 
 and define the fissures and convolutions, tracing the 
 course and branches of the anterior cerebral artery. 
 
Ill 
 
112 DISSECTION OF THE HEAD AND NECK 
 
 C. Lateral Ventricle. 
 
 Make a longitudinal incision in the centrum ovale lateral to 
 the striae longitudinales, extending to within half an inch of the 
 anterior and posterior extremities of the corpus callosum. By this 
 incision the knife is carried into the cavity of the lateral 
 
 VENTRICLE. 
 
 When the cavity is reached, the handle of the knife should be 
 used to raise up the roof of the ventricle, formed by the radiating 
 fibres of the corpus callosum, and the remains of the centrum 
 ovale. 
 
 Remove the roof of the ventricle entirely, and follow forwards 
 and backwards the anterior and posterior horns, into the 
 frontal and occipital poles respectively. Follow the inferior 
 (descending) horn of the ventricle into the temporal pole by 
 cutting out a wedge-shaped portion of the hemisphere. 
 
 Define the forceps minor, forceps major, and tapetum of 
 the corpus callosum. 
 
 Examine next the structures in relation to the walls and floor 
 of the lateral ventricle. 
 
 (i) Floor :- 
 
 CORPUS STRIATUM (CAUDATE NUCLEUS). 
 
 STRIA TERMINALIS. 
 
 OPTIC THALAMUS. 
 
 CHOROID PLEXUS. 
 
 FORNIX (POSTERIOR PILLAR). 
 
 TRIGONE. 
 
 COLLATERAL EMINENCE. 
 
 HIPPOCAMPUS MINOR. 
 
 HIPPOCAMPUS MAJOR. 
 
 Follow the posterior pillar of the fornix and the choroid 
 PLEXUS round the pulvinar of the optic thalamus, into connection 
 with the hippocampus major and the pes hippocampi. 
 
 Note the attachment of the choroid plexus by means of the ependyma 
 to the edge of the fornix and the surface of the optic thalamus. 
 
 (2) Inner Wall : — 
 
 SEPTUM LUCIDUM. 
 
 FORNIX (ANTERIOR PILLAR). 
 
 FORAMEN OF MONRO, 
 
113 
 
114 DISSECTION OF THE HEAD AND NECK 
 
 D. Corpus Striatum. 
 
 (i) Make a series of oblique incisions across the caudate nucleus 
 and the part of the cerebral hemisphere external to it, to 
 expose the structure and relations of the corpus striatum. 
 
 The following parts will be seen : — 
 
 CAUDATE NUCLEUS. 
 INTERNAL CAPSULE. 
 LENTICULAR NUCLEUS. 
 
 PUTAMEN. 
 
 GLOBUS PALLIDUS. 
 EXTERNAL CAPSULE (AND ANTERIOR COMMISSURE). 
 CLAUSTRUM. 
 LAMINA FOSS.S: SYLVII. 
 CONVOLUTIONS OF THE ISLAND OF REIL. 
 
 (2) Make a series of vertical incisions from before backwards 
 through the corpus striatum, to see 
 
 (a) the relations of its parts to the under surface of the 
 brain : — 
 
 ANTERIOR PERFORATED SPOT, 
 
 ISLAND OF REIL, 
 
 APEX OF THE TEMPORAL POLE; 
 
 (b) the continuity of the several nuclei with each other and 
 with the grey matter of the cortex of the brain (nucleus 
 amygdala). 
 
"5 
 
ir6 DISSECTION OF THE HEAD AND NECK 
 
 E. Medial Surface of the Left Hemisphere. 
 
 If a second brain is available, it should he utilized for the examination 
 of the medial surface of the left cerebral hemisphere. 
 
 To remove the hemisphere from the whole brain 
 
 (i) Make a longitudinal incision close to the hemisphere through 
 
 CORPUS CALLOSUM. 
 
 POSXERIOR PILLAR OF THE FORNIX. 
 
 PART OF THE VELUM INTERPOSITUM. 
 
 (2) On the under surface of the brain cut through 
 
 CEREBRAL PEDUNCLE. 
 OPTIC TRACT. 
 TUBER CINEREUM. 
 LAMINA CINEREA. 
 
 (3) The following structures will also be divided : — 
 
 anterior 1 
 
 middle j- commissures. 
 
 posteriorJ 
 
 peduncle of the pineal body. 
 
 The dissector should leave intact as far as possible 
 
 SEPTUM LUCIDUM. 
 
 ANTERIOR PILLARS OF THE FORNIX. 
 
 structures IN THE INTERPEDUNCULAR SPACE. 
 
 Remove the membranes from the medial surface of the 
 detached hemisphere, and examine — 
 (i) Course and branches of the anterior cerebral artery. 
 
 (2) FISSURES and convolutions of the hemisphere. 
 
 (3) Cut surfaces of the 
 
 corpus callosum — splenium, body, genu, and rostrum. 
 
 cerebral peduncle. 
 
 anterior 1 
 
 middle [■ commissures. 
 
 posterior] 
 
 If no other brain is available, the medial surface of the left 
 
 hemisphere should be examined in situ as far as possible. 
 Thereafter the dissection should be repeated on this side for the 
 
 CORPUS CALLOSUM. 
 LATERAL VENTRICLE. 
 CORPUS STRIATUM, 
 
DISSECTION OF THE HEAD AND NECK 117 
 
 F. Fifth and Third Ventricles. Optic Thalamus. Optic Tract. Pineal 
 Body. 
 
 (i) Divide the central part of the corpus callosum by a trans- 
 verse incision, and turn it forwards and backwards, detach- 
 ing from its under surface the septum lucidum in front 
 and the fornix behind. Retain the forceps minor and 
 
 FORCEPS MAJOR. 
 
 Fifth Ventricle. — Examine the cavity and note its boundaries, 
 and its relations to the anterior commissure and anterior 
 piUars of the fornix. 
 
 (2) Cut across the body of the fornix. Turn its parts forwards and 
 
 backwards, and examine the velum interpositum and 
 
 CHOROID plexuses. 
 
 Note the connections of the velum interpositum and choroid 
 plexuses with the inferior horns of the lateral ventricles 
 (great transverse or choroidal fissure). 
 
 Note the veins of galen. 
 
 (3) Turn backwards the velum interpositum and expose the 
 
 cavity of the third ventricle. 
 
 Third Ventricle. — Examine its — 
 
 BOUNDARIES. 
 COMMISSURES AND 
 COMMUNICATIONS. 
 
ii8 
 
DISSECTION OF THE HEAD AND NECK 119 
 
 Pineal Body and its Peduncles. 
 
 In reflecting the velum interpositum care shoiild be taken 
 to dissect out the pineal body, which is lodged in a pocket 
 on its under surface. 
 
 It lies on the superior corpora quadrigemina, and is 
 connected to the optic thalamus by its peduncles. 
 
 Anterior Pillars of tlie Fornix. 
 
 Trace the anterior pillars of the fornix down to the base of 
 the brain, to see their connection with the corpora 
 
 ALBICANTIA. 
 
 The BUNDLE OF viCQ d'azyr Connecting each corpus albi- 
 cans to the optic thalamus should be dissected later, 
 when the optic thalamus is detached from the mid-brain. 
 
 Optic Tlialamus. 
 
 Examine its position, relations and connections. 
 Note specially its connections with the — 
 
 CENTRUM OVALE (oPTIC RADIATIONS). 
 
 CEREBRAL PEDUNCLE. 
 
 INTERNAL CAPSULE. 
 
 MIDDLE "\ 
 
 „ „..,™,„„ J COMMISSURES. 
 
 POSTERIORJ 
 
 PEDUNCLES OF PINEAL BODY. 
 
 CORPORA ALBICANTIA (AND BUNDLE OF VICQ d'aZYR). 
 
 Optic Tract. 
 
 Trace the optic tract backwards round the cerebral peduncle 
 to the basal ganglia and note its connection with the 
 
 OPTIC THALAMUS. 
 CORPORA GENICULATA. 
 CORPORA QUADRIGEMINA. 
 
 Anterior Commissure. 
 
 Dissect the anterior commissure and trace it laterally through 
 the EXTERNAL CAPSULE of the corpus striatum. 
 
120 
 
DISSECTION OF THE HEAD AND NECK 121 
 
 III. Mid-Brain 
 
 Detach the remaining parts of the cerebral hemispheres, and 
 remove the membranes from the mid-brain so as to expose its 
 surfaces. 
 
 (i) Superior surface — 
 
 CORPORA QUADRIGEMINA. 
 
 FRENULUM VELl. 
 
 ORIGINS OP THE TROCHLEAR NERVES. 
 
 SUPERIOR CEREBELLAR PEDUNCLES. 
 
 LATERAL FILLETS. 
 
 SUPERIOR MEDULLARY VELUM. 
 
 LINGULA. 
 
 (2) Lateral surface — 
 
 CORPORA QUADRIGEMINA. 
 BRACHIA CONJUNCTIVA. 
 SUPERIOR PEDUNCLE. 
 LATERAL FILLET. 
 LATERAL SULCUS. 
 CEREBRAL PEDUNCLE. 
 TAENIA PONTIS. 
 
 (3) Inferior surface — 
 
 CEREBRAL PEDUNCLES. 
 POSTERIOR PERFORATED SPOT. 
 OCULO-MOTOR SULCUS. 
 OCULO-MOTOR NERVES. 
 
 Examine the course of the fibres on the surface of the mid- 
 brain. 
 
 Make a series of coronal sections of the mid-brain from before 
 backwards and examine — 
 
 GREY MATTER : CORPORA QUADRIGEMINA. 
 
 AQUEDUCT OF SYLVIUS. 
 
 RED NUCLEUS. 
 WHITE MATTER : SUPERIOR PEDUNCLES. 
 
 FILLET. 
 
 CEREBRAL PEDUNCLES (TEGMENTUM, LOCUS 
 NIGER, CRUSTA). 
 AQUEDUCT OF SYLVIUS. 
 
122 
 
123 
 
124 DISSECTION OF THE HEAD AND NECK 
 
 IV. Hind-Brain 
 
 Remove the membranes from the cerebellum, pons varolii, 
 and medulla oblongata, preserving the nerves in relation 
 with the pons and medulla. 
 
 A. Upper Surface. 
 
 Examine the upper surface of the vermis and cerebellar 
 HEMISPHERES, noting the fissures and convolutions. 
 
 After defining the central lobe and al^e, draw backwards the 
 central lobe to disclose the lingula. 
 
 B. Under Surface. 
 
 Define the form and extent of the pons, medulla, and the 
 under surface of the cerebellum, with the origins of the several 
 cranial nerves. 
 
 Examine the vallecula, and the convolutions of the inferior 
 vermis as far as possible in situ. 
 
 Separate the inferior vermis and meduUa oblongata to display 
 the inferior medullary velum and its foramina. 
 
 Examine the peduncles of the cerebellum and trace them 
 into the cerebellar hemispheres. 
 
 Slice away the superior vermis and the white matter of the 
 cerebellar hemispheres to expose 
 
 ROOF NUCLEI. 
 CORPUS DENTATUM. 
 
 Make a medial (sagittal) section of the vermis, turn aside the 
 two halves of the cerebellum and expose the cavity of the fourth 
 ventricle. Examine the cut surfaces of the inferior vermis to see 
 its lobules, 
 
 NODULE. 
 
 UVULA. 
 
 PYRAMID. 
 
 TUBER VALVULiE. 
 
-125 
 
126 DISSECTION OF THE HEAD AND NECK 
 
 Fourth Ventricle. 
 
 Divide the cerebellar peduncles on each side close to the cere- 
 bellum, and display the cavity of the ventricle. 
 
 Note the attachments of the inferior medullary velum. Examine 
 the boundaries and communications of the fourth ventricle. 
 
 Lateral Boundaries. 
 
 SUPERIOR CEREBELLAR PEDUNCLE. 
 
 MIDDLE PEDUNCLE. 
 
 INFERIOR PEDUNCLE (CONTINUOUS WITH THE RESTIFORM BODY). 
 
 TUBERCLE OF ROLANDO. 
 
 CUNBATE TUBERCLE (CONTINUOUS WITH THE FUNICULUS 
 
 CUNEATUS). 
 CLAVA (CONTINUOUS WITH THE FUNICULUS GRACILIS). 
 
 Floor. 
 
 MEDIAN GROOVE. 
 FOVEA SUPERIOR. 
 FOVEA INFERIOR. 
 EMINENTIA TERES. 
 ACOUSTIC TUBERCLE. 
 ACOUSTIC STRI.E. 
 LOCUS C^RULEUS. 
 ALA CINEREA. 
 
 Communications. 
 
 Above, — ^AQUEDUCT OF SYLVIUS. 
 
 Below, — CALAMUS scRiPTOEius and central canal of the 
 
 SPINAL cord. 
 
 Behind, — (in the inferior medullary velum) 
 foramen of majendie. 
 foramina of key and retzius. 
 
127 
 
128 DISSECTION OF THE HEAD AND NECK 
 
 Pons Varolii and Medulla Oblongata. 
 
 Examine the form of the pons varolii and medulla oblongata, 
 and the attachments of the cranial nerves. 
 
 Note the decussation of the pyramids in the anterior median 
 fissure. 
 
 Trace the continuity of the tracts of the medulla oblongata, with 
 the pons and cerebellum on the one hand, and the spinal cord on 
 the other hand. 
 
 Dissect the pyramids up through the pons into the cerebral 
 peduncle. 
 
 Define the superficial and deep transverse fibres of the pons. 
 
 Make a series of coronal sections through the pons and medulla 
 to show their structure. 
 
129 
 
130 
 
 DISSECTION OF THE UPPER LIMB 
 ORDER OF DISSECTION 
 
 I. Superficial Dissection of the Back. 
 II. Front of the Chest and Axilla. 
 
 III. Shoulder and Scapular Regions. 
 
 IV. Hollow of the Elbow (Antecubital Fossa). 
 V. Front of the Arm. 
 
 VI. Back of the Arm. 
 VII. Front of the Forearm and Wrist. 
 VIII. Palm of the Hand. 
 
 IX. Back of the Forearm and Hand. 
 X. Articulations of the Upper Limb. 
 
DISSECTION OF THE UPPER LIMB 131 
 
 The limb should he bandaged when the subject is brought into the 
 room. 
 
 The dissection of the upper limb is begun on the third day, when 
 the subject is placed on its face. The superficial dissection of the 
 back should occupy two days. On the ninth day the subject is 
 placed on its back ; and the dissection of the front of the chest and 
 axilla is made, occupying four days, when the limb should be 
 removed. 
 
 I. Superficial Dissection of the Back 
 
 A Superficial Structures. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. 2, p. 14). 
 
 (3) Remove the superficial fascia from the middle line outwards 
 
 to expose the following cutaneous nerves (fig. 4). 
 
 POSTERIOR PRIMARY DIVISIONS OF THE THORACIC NERVES. 
 
 LATERAL BRANCHES OF THE THORACIC NERVES. 
 
 POSTERIOR PRIMARY DIVISIONS OF THE UPPER LUMBAR NERVES. 
 
 [in conjunction with the dissector of the lower limb \ 
 
 LATERAL (iLIAC) BRANCH OF THE LAST THORACIC NERVE. 
 LATERAL BRANCH OF THE ILIO-HYPOGASTRIC NERVE. 
 
 B. Trapezius and Latissimus Dorsi Muscles. 
 
 (i) Remove the deep fascia from the middle line outwards and 
 (a) Clean : — 
 
 TRAPEZIUS muscle, 
 
 latissimus dorsi muscle, 
 
 noting its scapular and costal attachments. 
 {b) Define:— 
 
 triangle of auscultation, 
 triangle of petit. 
 
 (2) Divide the trapezius muscle [in conjunction with the dis- 
 
 sectors of the head and, neck] one inch from the spinous 
 processes, turn it outwards, clean its under surface and 
 trace into it 
 
 SUPERFICIAL CERVICAL ARTERY. 
 
 (spinal) ACCESSORY NERVE. 
 
 NERVES FROM THE CERVICAL PLEXUS (C 3 AND 4). 
 
 (3) Examine the origin of the latissimus dorsi muscle, clean 
 
 the vertebral aponeurosis, and then divide the muscle 
 by an oblique incision from the upper to the outer border. 
 Leave the scapular and costal attachments of the muscle 
 intact (fig. 5). 
 Examine the structures beneath the muscle and define its 
 origin from the vertebral aponeurosis and iliac crest. 
 
C 2. Great occipital. 
 3. Least occipital. 
 
 *• \ Posterior primary divisions : 
 I" J Cervical nerves, 
 
 T 1-12. Posterior primary divisions : 
 
 Thoracic nerves. 
 L I, 2, 3. Posterior primary divisions : 
 
 Lumbar nerves. 
 S 1, 2, 3. Posterior primary divisions : 
 Sacral nerves. 
 
 Posterior amricular. 
 
 Small occipital. 
 
 Great auricular. 
 
 Superficial cervical. 
 
 Lateral branch of ilio-hypogastric. 
 
 Lateral branch of twelfth doracic 
 
 Ano-coccygeal. 
 
 Perineal branch of fourth sacral. 
 
 Periorating cutaneous. 
 
 Small sciatic. 
 
 Lateral cutaneous. 
 
 FIG. 4. — CUTANEOUS NERVES OF THE BACK 
 
ino. 5. DISSECTION TO REFLECT LATISSIMUS DOSSI 
 
134 
 
DISSECTION OF THE UPPER LIMB 135 
 
 C. Second Layer of Muscles 
 
 [in conjunction with the dissectors of the head and neck]. 
 (i) Clean the muscles of this layer — 
 
 LEVATOR SCAPULiE. 
 RHOMBOIDEUS MINOR. 
 RHOMBOIDEUS MAJOR. 
 
 (2) Expose the nerves and vessels in relation to them : — 
 
 TWO NERVES TO THE LEVATOR SCAPULA, entering its super- 
 ficial surface near its origin. 
 
 NERVE TO THE RHOMBOIDS in the angle between the levator 
 scapulae and the rhomboideus minor. 
 
 TRANSVERSE CERVICAL ARTERY, dividing at the anterior border 
 of the levator scapulae into superficial cervical and posterior 
 scapular branches. 
 
 (3) Divide the rhomboids near their origins, turn them outwards, 
 
 and trace into them their nerve, and the posterior scapular 
 artery. 
 
136 
 
DISSECTION OF THE UPPER LIMB 137 
 
 II. Front of the Chest and Axilla 
 . Superficial Structures. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. i, p. 13). 
 
 (3) Mamma. — In the female make a crucial incision through 
 
 the superficial fascia over the mamma, and remove it to 
 show the form, structure and extent of the gland. 
 
 (4) Remove the superficial fascia from the middle line outwards 
 
 to expose — 
 
 (a) The origin of the platysma muscle [in conjunction with 
 
 the dissectors of the head and neck]. 
 
 (b) The following cutaneous nerves (figs. 10, 11). 
 
 SUPRA-CLAVICULAR [in Conjunction with the dissectors of the head 
 and necK\. 
 
 ANTERIOR BRANCHES OF UPPER THORACIC NERVES. 
 LATERAL BRANCHES OF UPPER THORACIC NERVES INCLUDING 
 THE INTERCOSTO-BRACHIAL NERVE. 
 
 (c) THE CEPHALIC VEIN. 
 
 {d) THE HUMERAL BRANCH OF THE THORACIC AXIS ARTERY. 
 
a. Superficial cervical nerve. 
 
 b. Sternal 'I 
 
 c. Clavicular J- supra-clavicular. 
 
 d. Acromial j 
 
 T a-i2. Thoracic nerves : anterior primary 
 divisions. 
 
 LT 3-1 r. Thoracic nerves : lateral branches. 
 
 e. Ilio-hypogastric. 
 
 /. Ilio-inguinal. 
 
 g. Geaito-feraoral. 
 
 h. Lateral cutaneous of thigh. 
 
 FIG. 10.— CUTANEOUS NERVES OF THE FRONT OF THE TRUNK 
 138 
 

 St. Sternal \ 
 
 CI. Clavicular >■ supra-clavicular nerves. 
 Act. Acromial ; 
 
 T 2-7. Thoracic nerves : anterior primary 
 divisions. 
 
 t 3-7. Thoracic nerves : lateral branches, 
 
 a. latercosto-brachiah 
 
 b. Internal cutaneous. 
 
 c. External cutaneous. 
 
 FIG. It. — CUTANEOUS NERVES OF THE FRONT OF THE CHEST AND ARM 
 
140 
 
DISSECTION OF THE UPPER LIMB 141 
 
 B. Axilla. 
 
 (i) Remove the deep fascia from the middle Une outwards to 
 expose — 
 
 (a) The pectoralis major muscle in its whole extent. 
 
 (b) The anterior border of the deltoid muscle. 
 
 (c) The cavity of the axilla, which should be cleaned up gener- 
 
 ally to show its boundaries and contents. 
 
142 
 
DISSECTION OF THE UPPER LIMB 143 
 
 (2) Each wall of the axilla should now be dissected in detail, in 
 the following order : — 
 
 [a) Anterior Wall. 
 
 (a) Detach the clavicular head of the pectoralis major 
 completely from its origin to show — 
 The COSTO-CORACOID MEMBRANE and the structures 
 piercing it, including the vessels and nerve to 
 this part of the great pectoral muscle. 
 (/3) Divide the remainder of the pectoralis major 
 internal to the point of entrance of its vessels and 
 nerves and reflect it to show — 
 
 ORIGIN OF THE PECTORALIS MAJOR. 
 PECTORALIS MINOR MUSCLE. 
 NERVES TO BOTH MUSCLES. 
 
 (y) Divide the pectoralis minor internal to the point of 
 entrance of its nerves and reflect it to show — 
 
 BRACHIAL PLEXUS AND ITS BRANCHES. 
 AXILLARY VESSELS AND THEIR BRANCHES. 
 
 It will be found convenient to detach portions of the muscles, 
 so as to retain the nerves in relation to them, in connection 
 with the dissection of the brachial plexus. 
 
 (6) Inner Wall. 
 
 Define the following structures — 
 
 1. Serratus anterior muscle. 
 
 2. Nerves — 
 
 LATERAL BRANCHES OF THE THORACIC NERVES. 
 INTERCOSTO-BRACHIAL NERVE. 
 NERVE TO THE SERRATUS ANTERIOR. 
 
 3. Arteries — 
 
 SUPERIOR THORACIC. 
 
 LONG THORACIC. 
 
 EXTERNAL MAMMARY (if present). 
 
 SUBSCAPULAR (termination) . 
 
144 DISSECTION OF THE UPPER LIMB 
 
 (c) Posterior Wall. 
 
 Define the following structures : — 
 
 SUBSCAPULARIS, TERES MAJOR and LATISSIMUS DORSI 
 
 MUSCLES. 
 SHORT, LOWER and LONG SUBSCAPULAR NERVES. 
 SUBSCAPULAR ARTERY and itS DORSALIS SCAPULA BRANCH. 
 
 {d) Outer Wall. 
 
 Define the following structures : — 
 
 CoRACO-BRACHiALis, and BICEPS musclcs. 
 Axillary vessels and their branches. 
 Cords of the brachial plexus and the nerves pro- 
 ceeding from them. 
 
 Carry out the dissection mentioned below [in conjunction with 
 the dissectors of the head and neck]. 
 
 {a) Take away the middle third of the clavicle. 
 
 (b) Remove the subclavius muscle and draw the arm outwards. 
 
 (c) Examine the axillary vessels and their branches, removing 
 the smaller veins, and then divide the axillary artery and vein 
 between two ligatures. 
 
 {d) Examine the constitution of the brachial plexus, noting 
 
 1. Supra-clavicular Branches (6) — 
 
 N. TO THE SUBCLAVIUS. 
 
 SUPRASCAPULAR. 
 
 N. TO THE RHOMBOIDS. 
 
 N. TO THE SERRATUS ANTERIOR. 
 
 COMMUNICATION TO THE PHRENIC. 
 
 NERVES TO THE PREVERTEBRAL MUSCLES. 
 
 2. Collateral (axillary) branches (6)— 
 
 LATERAL 1 
 
 MEDIAL (-ANTERIOR THORACIC. 
 
 SHORT 1 
 
 LOWER [-SUBSCAPULAR NERVES. 
 
 LONG J 
 
 CIRCUMFLEX. 
 
 8. Terminal Branches (6) — 
 
 MUSCULO-CUTANEOUS. 
 
 MEDIAN. 
 
 ULNAR. 
 
 INTERNAL CUTANEOUS. 
 
 LESSER INTERNAL CUTANEOUS. 
 
 MUSCULO-SPIRAL. 
 
145 
 
146 
 
DISSECTION OF THE UPPER LIMB 147 
 
 C. Removal of the Aim. 
 
 (i) Divide the nerves entering the brachial plexus as follows : — 
 The anterior primary divisions of the fifth, sixth, seventh and 
 eighth cervical nerves, and of the first thoracic nerve, should 
 he divided near the scalene muscles and tied at intervals to 
 a notched stick {to which also the axillary vessels may be 
 fastened). 
 By this means the relationships of the nerves proceeding 
 from the plexus can be preserved and studied in the 
 further dissection of the arm. 
 
 (2) Divide the following muscles : — 
 
 SERRATUS ANTERIOR. 
 LATISSIMUS DORSI. 
 LEVATOR SCAPULAE. 
 OMOHYOID. 
 
148 DISSECTION OF THE UPPER LIMB 
 
 D. Examination of the Sterno-clavicular Articulation 
 
 [in conjunction with the dissectors of the head and neck]. 
 (i) Define the capsule, and the following ligaments : — 
 
 SUPERIOR (inter-clavicular) LIGAMENT. 
 ANTERIOR AND POSTERIOR LIGAMENTS. 
 
 (2) Open the capsule to disclose 
 
 FIBRO-CARTILAGE . 
 SYNOVIAL MEMBRANES. 
 
 (3) Define the costo-clavicular (rhomboid) ligament. 
 
 The dissectors of the head and neck may at this stage dis- 
 articulate the inner third of the clavicle, without detaching the 
 clavicular origin of the sterno-mastoid, in order to facilitate the 
 dissection of the common carotid and subclavian arteries. 
 
149 
 
ISO DISSECTION OF THE UPPER LIMB 
 
 III. Shoulder and Scapular Regions 
 
 A. Identify and revise the various muscles, vessels, and 
 
 NERVES, related TO THE LIMB, AFTER REMOVAL FROM THE 
 TRUNK. 
 
 B. Deltoid Muscle. 
 
 (i) Clean the muscle and define 
 
 {a) The nerves supplying the skin over the muscle, — Supra- 
 ACROMiAL from the neck, — Circumflex appearing round 
 the posterior border or through the muscle in its middle third. 
 
 [b) The arrangement of the muscular fibres. 
 
 (2) Detach the muscle from its extreme origin from the clavicle 
 and scapula, clean its under surface, and turn it down to 
 its insertion to expose 
 
 («) The coracoid process with 
 a. Three ligaments, — 
 
 CORACO-ACROMIAL. 
 
 CONOID "i / V 
 
 ™.™, Wcoraco-clavicular). 
 
 trapezoid j ^ ' 
 
 /8. Three muscles, — 
 
 PECTORALIS MINOR. 
 
 CORACO-BRACHIALIS. 
 
 SHORT HEAD OF THE BICEPS. 
 
 (6) The head of the humerus with 
 a. The subdeltoid bursa. 
 /?. The capsule of the shoulder-joint. 
 y. The following muscles — 
 
 SUBSCAPULARIS. 
 
 SUPRA-SPINATUS. 
 
 INFRA-SPINATUS AND TERES MINOR. 
 
 LONG HEAD OF THE BICEPS. 
 
 (c) The shaft of the humerus with 
 
 CIRCUMFLEX VESSELS AND NERVE. 
 
151 
 
152 DISSECTION OF THE UPPER LIMB 
 
 C. Quadrilateral and Triangular Spaces of the Axilla. 
 
 (i) Define these spaces in relation to the axillary border of the 
 scapula, both in front and behind. 
 
 (2) Trace the posterior circumflex artery and the circumflex 
 nerve through the quadrilateral space; and the dorsalis 
 scapulae artery into the triangular space. 
 
 D. Scapular Dissection. 
 
 (i) Clean the following muscles : — 
 
 SUB-SCAPULARIS. 
 
 INFRA-SPINATUS AND TERES MINOR. 
 
 SUPRA-SPINATUS (sawing through the acromion process to expose 
 it fully). 
 
 (2) Define the ligaments of the scapula and clavicle. 
 
 (3) Reflect the supra-spinatus and infra-spinatus muscles to 
 
 expose 
 
 SUPRA-SCAPULAR ARTERY AND NERVE. 
 
 Anastomoses of the supra-scapular with the posterior 
 SCAPULAR, and dorsalis scapulae arteries. 
 
153 
 
154 DISSECTION OF THE UPPER LIMB 
 
 IV. Hollow of the Elbow 
 
 A. Superficial Structures. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. i, p. 13). 
 
 (3) Reflect the superficial fascia from the middle line inwards 
 
 and outwards to expose 
 (a) The cutaneous nerves (fig. 11). 
 (6) The cutaneous vessels, especially the large veins, 
 (c) The deep fascia, defining the bicipital fascia. 
 
 B. The Space ItseU. 
 
 (i) Remove the deep fascia {-preserving the bicipital fascia) and 
 define the muscles bounding the space : — 
 
 BRACHIO-RADIALIS. 
 PRONATOR TERES. 
 
 (2) Clean and define 
 {a) The floor of the space. 
 
 BRACHIALIS AND SUPINATOR BRKVIS MUSCLES. 
 
 (6) The contents of the space. 
 
 BRACHIAL ARTERY. 
 
 RADIAL ARTERY. 
 
 ULNAR ARTERY. 
 
 TENDON OF THE BICEPS MUSCLE. 
 
 MEDIAN NERVE. 
 
 MuscuLO-spiRAL NERVE dividing into its terminal branches, 
 
 RADIAL and POSTERIOR INTEROSSEOUS. 
 TERMINATION of the PROFUNDA AND ANASTOMOTIC ARTERIES 
 
 and their anastomoses with the radial recurrent and 
 
 ANTERIOR ULNAR RECURRENT ARTERIES. 
 
o 
 
 T4 
 
 
 
 T7 
 
 St. Sternal 1 
 
 a. Clavicular V supra-clavicular nerves. 
 
 Act. Acromial J 
 
 T 3-7. Thoracic nerves ; anterior primary 
 
 ^ divisions. 
 
 t 3-7. Thoracic nerves : lateral branches, 
 a. Intercosto-brachiaL 
 6. Internal cutaneous. 
 c. External cutaneous. 
 
 FIG. II. — CUTANEOUS NERVES OF THE FRONT OF THE CHEST AND ARM 
 
156 
 
DISSECTION OF THE UPPER LIMB 157 
 
 V. Front of the Arm 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (Fig. i, p. 13). 
 
 (3) Raise the superficial fascia from the middle line inwards and 
 
 outwards to expose 
 (a) Cutaneous nerves (Figs. 11, 12). 
 (6) Cutaneous vessels. 
 
 (c) Deep fascia with the aperture for the basilic vein and 
 the internal cutaneous nerve. 
 
 (4) Remove the deep fascia, defining the intermuscular septa, 
 
 and the structures piercing each. 
 
 (5) Clean the structures exposed. 
 
 (a) Muscles — 
 
 BICEPS. 
 
 CORACO-BRACHIALIS. 
 
 BRACHIALIS. 
 
 LONG AND MEDIAL HEADS OF THE TRICEPS. 
 
 (b) Arteries — 
 
 BRACHIAL ARTERY AND ITS BRANCHES. 
 
 (c) Veins — 
 
 VEN^ COMITES. 
 BRACHIAL VEIN. 
 
 (d) Nerves — 
 
 MUSCULO-CUTANEOUS. 
 
 MEDIAN. 
 
 ULNAR. 
 
 MUSCULO-SPIRAL with the following branches — 
 
 INTERNAL CUTANEOUS. 
 
 NERVES TO THE LONG AND MEDIAL HEADS OF THE TRICEPS. 
 
 Preserve carefully the nerve to the medial head [ulnar collateral 
 0/ Krause) which lies on the muscle, and accompanies the 
 ulnar nerve. 
 
St. sternal ~l 
 
 CI. Clavicular > supra-clavicular uerves. 
 Act. AcromialJ 
 
 T 2-7. Thoracic nerves : anterior primary 
 divisions. 
 
 t 3-7. Thoracic nerves : lateral branches. 
 
 a. Xntercosto-brachiaL 
 
 b. Internal cutaneous, 
 
 c. External cutaneous. 
 
 FIG. II. — CUTANEOUS NERVES OF THE FRONT OF THE CHEST AND ARM 
 
 158 
 
159 
 
i6o 
 
DISSECTION OF THE UPPER LIMB i6i 
 
 VI. Back of Arm 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. 2). 
 
 (3) Reflect the superficial fascia to expose 
 
 (a) Cutaneous nerves (fig. 12). 
 
 The internal cutaneous branch, and the upper and lower 
 external cutaneous branches, of the musculo-spiral 
 
 NERVE. 
 
 (6) Deep fascia. 
 
 (4) Remove the deep fascia, defining — 
 
 (a) Intermuscular septa. 
 
 (b) Fascial insertion of the triceps muscle into the deep 
 fascia at the sides of the olecranon process. 
 
 (c) triceps muscle. 
 
 (5) Detach the lateral head of the triceps from its bony origin and 
 
 expose — 
 
 MUSCtlLO-SPIRAL NERVE \ ,„ „ , . 
 
 SUPERIOR PROFUNDA ARTERy)™ ™= ="«^^ °«°°^'^- 
 
 (6) Follow the various branches of the musculo-spiral nerve to 
 
 their destinations in the back of the arm, including the 
 nerve which supplies the medial head of the triceps muscle, 
 the anconeus muscle, and the elbow-joint. 
 
 (7) Follow the superior profunda artery and its branches to the 
 
 elbow. 
 
1. Acromial nerve. 
 
 2. Circumflex. 
 
 3. Internal cutaneous : musculo-spiral. 
 ij. Intercosto-brachial. 
 
 5. Musculo-spiral : upper external cutaneous 
 branch. 
 
 6. Musculo-spiral : lower externa cutaneous 
 
 brandb. 
 
 7. Musculo-cutaneous. 
 
 8. Internal cutaneous. 
 
 9. Radial. 
 
 10. Dorsal branch of ulnar. 
 
 FIG. 12.- 
 
 -CUTANEOUS NERVES OF BACK OF ARM AND FOREARM 
 162 
 
i63 
 
i64 DISSECTION OF THE UPPER LIMB 
 
 VII. Front of Forearm and Wrist 
 
 A. Superficial Structures. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. i). 
 
 (3) Reflect the superficial fascia to expose 
 (a) Cutaneous nerves (fig. 11). 
 
 (6) Cutaneous vessels. 
 
 (c) Deep fascia and the anterior annular ligament. 
 
 (4) Define the anterior annular ligament (fig. 13) and the structures 
 
 passing over it : — 
 
 PALMAR CUTANEOUS BRANCHES OF THE MEDIAN AND ULNAR 
 
 NERVES. 
 PALMARIS LONGUS TENDON. 
 ULNAR ARTERY AND NERVE. 
 SUPERFICIAL VOLAR ARTERY. 
 
t 3-7. Thoracic nerves : lateral branches. 
 
 a. Intercosto-brachial. 
 
 b. Internal cutaneous. 
 
 c. External cutaneous. 
 
 St. Sternal 1 
 
 CI. Clavicular !-supra-clavicular nerves, 
 Acr. Acromial^ 
 
 T 2-7. Thoracic nerves : anterior primary 
 divisions. 
 
 FIG. II. — CUTANEOUS NERVES OF THE FRONT OF THE ARM AND FOREARM 
 
 165 
 
1. Median nerve : palmar branch, 
 
 2. Ulnar nerve : palmar branch. 
 
 3. Muscular branch to muscles oi thumb 
 
 (median). 
 
 4. Ulnar nerve : branch to inner side of little 
 
 finger, 
 
 5. Ulnar nerve : digital branches. 
 ' h Median nerve ; digital branches. 
 
 8. Branch to outer side of forefinger (median). 
 
 9. Branches to thumb (median). 
 
 FIG. 13. — WRIST AND PALM 
 166 
 
167 
 
i68 DISSECTION OF THE UPPER LIMB 
 
 B. Deeper Structures. 
 
 (i) Reflect the deep fascia from the middle line inwards and 
 outwards and clean 
 {a) Superficial muscles. 
 
 PRONATOR TERES. 
 FLEXOR CARPI RADIALIS. 
 PALMARIS LONGUS. 
 FLEXOR CARPI ULNARIS. 
 
 (6) Radial artery and nerve in the forearm, 
 (c) Ulnar artery and nerve in the lower half of the 
 forearm. 
 
 (2) Make the following dissection : — 
 
 (a) Divide the pronator teres muscle near its insertion. 
 {h) Divide the flexor corpi radialis and palmaris longus 
 near their origin from the common tendon. 
 Turning inwards the pronator teres, the deep (ulnar) head of 
 this muscle is exposed separating the ulnar artery from 
 the median nerve {which passes between the two heads of the 
 muscle). 
 This dissection exposes also the origins of the flexor 
 suBLiMis digitorum from the humerus, ulna and radius. 
 This muscle should now be cleaned. 
 
 (3) Divide the following muscles : — 
 
 {a) The radial bead of the flexor sublimis digitorum. 
 
 {b) The common tendon of the flexor and pronator muscles 
 
 near their origin from the medial condyle, 
 (c) Separate the ulnar from the humeral origin of the flexor 
 
 CARPI ULNARIS. 
 
 (4) Turn aside the above muscles to expose 
 {«) Deeper muscles — 
 
 FLEXOR LONGUS POLLICIS. 
 FLEXOR PROFUNDUS DIGITORUM. 
 
 (6) Median nerve and its branches. 
 
 (c) Ulnar artery and nerve and their branches. 
 
 (5) Expose the pronator quadratus muscle, by dividing the 
 
 tendons of the flexor profundus digitorum and flexor 
 longus pollicis in the lower third of the forearm. 
 
169 
 
170 
 
DISSECTION OF THE UPPER LIMB 171 
 
 VIII. Palm of Hand 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. i). 
 
 (3) Remove the superficial fascia to expose 
 («) Cutaneous nerves (fig. 13). 
 
 (b) Palmaeis brevis muscle. 
 
 (c) Palmar fascia, which should be cleaned and defined. 
 
 (4) Detach the pahnaris brevis from its insertion, and turn down 
 
 the pahnaris longus with the palmar fascia to expose the 
 
 Superficial Palmar Arch. 
 
 (5) Clean the muscles of the thenar and hypothenar eminences 
 
 arising from the anterior annular ligament, securing — 
 (a) The branch from the median nerve {appearing just below 
 
 the ligament) to the muscles of the thumb. 
 (6) The deep branches of the ulnar artery and nerve. 
 
 (6) Trace the branches of the superficial palmar arch, and of the 
 
 median and ulnar nerves to the ends of the fingers, noting 
 the branches which the median nerve sends to the backs of the 
 fingers. 
 
 (7) Divide the anterior annular ligament by a medial vertical 
 
 incision and turn it aside together with the ulnae nerve 
 and the superficial palmar arch. 
 
 (8) Follow the median nerve up into the forearm and turn it 
 
 aside. 
 
 (9) Trace the tendons of the long flexor muscles to the wrist, 
 
 thumb and fingers, and define — 
 
 (o) THEIR SYNOVIAL SHEATHS. 
 (6) LUMBRICAL MUSCLES, 
 (c) DIGITAL SHEATHS. 
 
 (10) Dissect out the muscles of the thumb and little finger. 
 
 (11) Turn aside the fiexor tendons and lumbricals and dissect 
 
 out: — 
 
 DEEP BRANCH OF THE ULNAR NERVE. 
 DEEP PALMAR ARCH. 
 
 DEEP TRANSVERSE METACARPAL LIGAMENT. 
 INTEROSSEOUS MUSCLES. 
 
 (12) Divide the oblique and transverse parts of the adductor 
 
 poLLicis muscle, and trace to their origin from the 
 radial artery — 
 
 PRINCEPS POLLICIS ARTERY. 
 RADIALIS INDICIS ARTERY. 
 
Median nerve : palmar branch. 
 
 Ulnar nei^vc : palmar branch. 
 
 Muscular branch to muscles of thumb 
 
 (median). 
 Ulnar nerve : branch to inner side of little 
 
 finger. 
 
 5. Ulnarnervp : digital branches. 
 *' J- Median nerve : digital branches. 
 
 8. Branch to outer side of forefinger (median). 
 
 9. Brandies to thumb (median). 
 
 FIG. 13.— WRIST AND PALM 
 172 
 
173 
 
174 
 
DISSECTION OF THE UPPER LIMB 175 
 
 IX. Back of Forearm and Hand 
 A. Superficial Struetuies. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. 2). 
 
 (3) Remove the superficial fascia to expose 
 
 (a) Cutaneous vessels. 
 
 (b) Cutaneous nerves (fig. 14), especially — • 
 
 RADIAL NERVE. 
 
 DORSAL BRANCH OF THE ULNAR NERVE. 
 
 (c) The deep fascia, defining 
 
 a. The insertion of the triceps muscle at the elbow. 
 
 |3. The POSTERIOR annular ligament of the wrist and the 
 tendons passing beneath it. 
 
 ■y. The attachment of the deep fascia to the posterior border 
 of the ulna. 
 
r. Musculo- spiral : upper external cutaneous. 
 
 2. Musculo -spiral : lower external cutaneous. 
 
 3. Musculo- cutaneous. 
 
 4. Internal cutaneous. 
 
 5. Radial. 
 
 6. Ulnar : dorsal branch. 
 
 FIG. 14. — CUTANEOUS NERVES OF B,^,Q|? OF FOREARM AND HANU 
 
177 
 
 M 
 
178 DISSECTION OF THE UPPER LIMB 
 
 B. Deeper Structures. 
 
 (i) {Preserving the -posterior annular ligament) reflect the deep 
 fascia as far as the posterior border of the ulna, noting the 
 attachments of muscles to this border of the bone. 
 
 (2) Dissect out and clean — 
 
 (a) The superficial muscles on the back of the forearm : — 
 
 BRACHIO-RADIALIS. 
 
 EXTENSOR CARPI RADIALIS LONGUS. 
 
 EXTENSOR CARPI RADIALIS BREVIS. 
 
 EXTENSOR COMMUNIS DIGITORUM. 
 
 EXTENSOR DIGITI QUINTI. 
 
 EXTENSOR CARPI ULNARIS. 
 
 EXTENSOR OSSIS METACARPI POLLICIS \ IN THE LOWER HALF 
 
 EXTENSOR BREVIS POLLICIS / OF THE FOREARM. 
 
 (6) The tendons on the back of the hand and finger, noting 
 the insertions of the lumbricals and interosseous 
 
 MUSCLES. 
 
 (3) Remove the deep fascia from the surface of the anconeus 
 
 MUSCLE, define the muscle, and detach it from the ulna 
 to show the structures beneath it. 
 
 (4) Secure the posterior interosseous nerve and its branches, 
 
 and then divide the following muscles below the entrance 
 of their nerves : — 
 
 EXTENSOR CARPI RADIALIS BREVIS. 
 EXTENSOR COMMUNIS DIGITORUM. 
 EXTENSOR DIGITI QUINTI. 
 
 Divide the extensor carpi ulnaris muscle between its 
 humeral and ulnar origins, above the entrance of its nerve. 
 
 (5) Reflect the muscles so divided to expose : — 
 {a) The deep muscles — 
 
 SUPINATOR BREVIS. 
 
 EXTENSOR OSSIS METACARPI POLLICIS. 
 EXTENSOR LONGUS POLLICIS. 
 EXTENSOR BREVIS POLLICIS. 
 EXTENSOR INDICIS. 
 
 [h] The posterior interosseous artery and nerve and 
 their branches should now be traced to their terminations. 
 
 (6) Clean the radial artery and its branches at the wrist, and 
 
 the dorsal carpal arch and its branches. 
 
 (7) Expose and clean the dorsal interosseous muscles. 
 
 (8) Divide the attachment of the first dorsal interosseous muscle 
 
 to the first metacarpal bone, and reflect it to see the 
 
 INTEROSSEUS PRIMUS VOLARIS MUSCLE. 
 
179 
 
i8o 
 
DISSECTION OF THE UPPER LIMB i8i 
 
 X. Articulations of Upper Limb 
 
 A. Stemo-clavicular Articulation. 
 
 This has been already studied (p. 148). 
 
 B. Scapular Ligaments. 
 
 Note especially — 
 
 SUPRA-SCAPULAR LIGAMENT. 
 
 CORACO-CLAVICULAR (CONOID AND TRAPEZOID) LIGAMENTS. 
 
 CORACO-ACROMIAL LIGAMENT. 
 
 SPINO-GLENOID LIGAMENT (iF PRESENT). 
 
 C. Shoulder-joint. 
 
 (i) Clean the capsule by removal of the muscles which surround, 
 and are inserted into it. 
 
 (2) Define — 
 
 (a) CORACO-HUMERAL LIGAMENT. 
 
 (6) TRANSVERSE HUMERAL LIGAMENT. 
 
 (c) OPENINGS IN THE CAPSULE IN RELATION TO THE TENDONS OF 
 
 BICEPS. 
 
 SUBSCAPULARIS. 
 
 INFRA-SPINATUS (iF PRESENT). 
 
 (3) Open the capsule from behind to expose — 
 
 Tendon of the long head of the biceps. 
 The parts of the gleno-humeral ligament. 
 
 (4) Define the glenoid ligament, noting its connection with the 
 
 capsule, and the long head of the biceps. 
 
l82 
 
DISSECTION OF THE UPPER LIMB 183 
 
 D. Elbow-joint and Superior Radio-ulnar Articulation. 
 
 (i) Define the capsule and special ligaments, noting particularly — 
 
 (a) LATERAL LIGAMENTS OF THE ELBOW JOINT. 
 (6) ORBICULAR LIGAMENT. 
 
 (2) Open the capsule to see the extent of the synovial membrane 
 and the joint surfaces. 
 
 E. Intermediate and Inferior Radio-ulnar Articulations, with the 
 
 Radio-carpal, Inter-carpal, Carpo-metacarpal and Inter-metacarpal 
 Articulations. 
 
 (i) Remove the muscles from the front and back of the forearm, 
 to define: — 
 
 OBLIQUE LIGAMENT. 
 INTEROSSEOUS MEMBRANE. 
 
 (2) Define the capsule and ligaments of the following articula- 
 
 tions — 
 
 INFERIOR RADIO-ULNAR. 
 
 RADIO-CARPAL. 
 
 INTER-CARPAL. 
 
 CARPO-METACARPAL. 
 
 INTER-METACARPAL. 
 
 (3) Divide the dorsal radio-carpal ligament to see the joint 
 
 surfaces. 
 
 (4) Define the attachments of the inter-articular fibro- 
 
 cartilage of the wrist. 
 
 (5) Open the capsule of the inferior radio-ulnar joint to see the 
 
 membrana sacciformis. 
 
 (6) Divide the inter-carpal and carpo-metacarpal ligaments from 
 
 the back to see the articular surfaces. 
 
 F. Metacarpo-phalangeal and Inter-phalangeal Articulations. 
 
 (i) Define the deep transverse metacarpal ligament. 
 
 (2) Define the capsules and special ligaments of the joints, noting 
 
 especially the relation of the extensor tendons, the lum- 
 bricals, and interossei to the dorsal parts of the capsules. 
 
 (3) Open the joints from behind to see the articular surfaces. 
 
i84 
 
185 
 
 DISSECTION OF THE THORAX 
 
 ORDER OF DISSECTION 
 
 I. Thoracic Wall. 
 II. Pleurae and Lungs. 
 
 III. Anterior and Middle Mediastina: Pericardium. 
 
 IV. Heart and Large Vessels. 
 V. Superior Mediastinum. 
 
 VI. Posterior Mediastinum. 
 VII. Thoracic Articulations. 
 
i86 DISSECTION OF THE THORAX 
 
 The dissection of the thorax should be begun as soon as the upper 
 hmbs have been removed from the body — on the fifth day after the 
 subject has been placed on its back. 
 
 I. Thoracic Wall 
 
 A. The upper limbs having been removed, detach the serratus 
 
 anterior and the pectoral muscles, preserving the lateral and 
 anterior branches of the intercostal vessels and nerves. 
 
 The attachments of the obUquus abdominis extemus wiU 
 have been removed already from the ribs by the dissectors of 
 the abdomen. 
 
 B. Intercostal Spaees. 
 
 (i) Qean the external intercostal muscle in each space, 
 with its anterior intercostal aponeurosis. 
 
 (2) Remove these structures to expose the internal intercostal 
 
 MUSCLE. 
 
 (3) Remove the internal intercostal muscles and dissect out in 
 
 each space : — 
 
 (o) INTERNAL MAMMARY VESSELS. 
 
 (6) TRIANGULARIS STERNI MUSCLE. 
 
 (c) INTERCOSTAL NERVES. 
 
 (d) INTERCOSTAL VESSELS. 
 
 (e) PARIETAL PLEURA. 
 
 In one or more spaces cut away the lower border of the rib 
 to see the course and relations of the intercostal vessels 
 and nerves. 
 
 (4) Remove the costal cartilages (from the second to the sixth 
 
 inclusive), to expose completely: — 
 (a) INTERNAL MAMMARY VESSELS and their branches. 
 
 (6) TRIANGULARIS STERNI muSClc. 
 
DISSECTION OF THE THORAX 187 
 
 C. Parietal Pleura. , 
 
 (i) Detach the seventh, eighth and ninth ribs from their costal 
 cartilages. Now remove the ribs from the second to the 
 ninth inclusive. To do this without injuring the subjacent 
 structures, insinuate the finger or the handle of a knife, 
 beneath each rib, raise it up, and divide it as far back as 
 possible with the bone forceps. 
 
 The vessels {occupying the subcostal groove and lying at a 
 higher level than the nerves) are liable to he divided in this 
 dissection. 
 
 The COSTAL PORTION OF THE PARIETAL PLEURA will nOW be 
 
 exposed, with the intercostal vessels and nerves lying 
 upon it. 
 
 (2) Separate the parietal pleura from the structures in contact 
 with it, and define its several parts : — 
 
 (a) COSTAL PLEURA. 
 
 (6) DIAPHRAGMATIC PLEURA. 
 
 \c) DOME OF THE PLEURA. 
 
 (d) MEDIASTINAL PLEURA. 
 
 The PHRENIC NERVE is to be found between the pericardium 
 and the mediastinal pleura. 
 
DISSECTION OF THE THORAX 189 
 
 II. PleurjE and Lungs 
 A. Pleura. 
 
 (1) Make an incision along the anterior margin of the costal layer 
 
 of the pleura, and reflect it outwards to fexpose : — 
 
 LUNGS. 
 
 ROOTS OF THE LUNGS. 
 
 PLEURAL CAVITIES. 
 
 (2) Trace the extent of the pleural cavities : — 
 
 (a) Upwards to the dome. 
 
 (b) Downwards in relation to the diaphragm. 
 
 (c) Backwards to the vertebral column. 
 
 (3) Draw the lung outwards, to see 
 
 (a) The relation of the mediastinal pleura to the root of the'lung. 
 
 (6) The LIGAMENTUM LATUM PULMONIS. 
 
 (4) Draw the lung forwards, to see the continuity of the costal 
 
 with the mediastinal pleura, in front of the vertebral 
 column. 
 
igo DISSECTION OF THE THORAX 
 
 B. Form and Relations of the Lungs. 
 
 Examine and compare the form and relations of the two lungs. 
 
 C. Roots of the Lungs. 
 
 Strip off the pleura from the root of each lung and dissect out 
 
 1. THE STRUCTURES IN RELATION TO EACH ROOT. 
 
 (a) In front. 
 
 (b) Behind. 
 
 (c) Above. 
 
 (d) Below. 
 
 During this dissection take care to secure 
 
 (a) The phrenic nerve in front of the root. 
 
 (6) The VAGUS nerve and posterior pulmonary plexus 
 behind the root, with the anterior pulmonary plexus 
 in front of the root. On the right side the vagus passes 
 downwards medial to the vena azygos major, on the left 
 side it passes in front of the aortic arch. 
 
 2. THE STRUCTURES COMPOSING THE ROOT OF EACH LUNG. 
 
 This dissection should be begun in front, working outwards 
 from the pericardium, to avoid injury to that membrane, 
 and dissecting the component parts of the root into the lung 
 substance. 
 After displa3dng these structures from the front, the lung 
 should be drawn well forwards with hooks, so that the 
 structure and relations of each root may be examined from 
 behind. 
 During the dissection care should be taken to preserve the 
 structures in relation to the root of the lung, including the 
 pulmonary plexuses and the bronchial vessels. 
 
 D. Dissection of the Lungs. 
 
 Keeping the lungs in situ, the intra-pulmonary bronchi, and 
 the ramifications of the pulmonary arteries and veins should 
 now be traced into the substance of each lung. 
 
 Note in the dissection of the right lung the presence of the 
 eparterial bronchus. 
 
igi 
 
192 DISSECTION OF THE THORAX 
 
 III. Anterior and Middle Mediastina: Pericardium 
 
 A. Anterior Mediastinum. This space contains only areolar tissue 
 
 and the remains of the thymus gland. 
 
 B. Middle Mediastinum. 
 
 1. phrenic nerves. 
 
 Trace these nerves down to the diaphragm and [in conjunction 
 with the dissectors of the head and neck] upwards through the 
 superior mediastinum into the neck. 
 
 Note the differences in course and termination on the two sides. 
 
 2. PERICARDIUM. 
 
 Strip the pleura completely from its outer surface, and clean the 
 pericardium, tracing it — 
 
 («) Upwards, in relation to the superior vena cava, aorta, 
 
 PULMONARY ARTERY, and LIGAMENTUM DUCTUS ARTERIOSI. 
 
 (&) Downwards, in relation to the diaphragm and inferior 
 VENA cava. 
 Dissect the pericardium off the diaphragm to show its relations 
 
 to the central tendon and the muscular fibres. 
 Note its connections with the intra-thoracic part of the 
 inferior vena cava. 
 
 (c) Define its relations laterally to the pulmonary veins. 
 
 (d) Draw the pericardium forwards to expose the aorta, with 
 
 the (ESOPHAGUS and vagi nerves in the posterior 
 mediastinum. 
 
 (e) Note the seven fibrous sheaths which the pericardium 
 
 gives to the large vessels — one to the aorta and pul- 
 monary ARTERY, two to the SUPERIOR and inferior 
 VEN.E CAViE, and four to the pulmonary veins. 
 
 3. Examine before opening the pericardium 
 
 (a) SUPERFICIAL CARDIAC PLEXUS. 
 
 This is situated outside the pericardium, just below the 
 aortic arch, and is formed by two fine nerves which 
 descend in front of the aortic arch between the left 
 phrenic and vagus nerves. 
 
 (6) LIGAMENTUM DUCTUS ARTERIOSI. 
 
 This is a fibrous cord, connecting the left branch of the 
 pulmonary artery to the arch of the aorta, immedi- 
 ately outside the pericardium. The left inferior 
 l,ARYNGEAL NgRVE hopks round it, 
 
193 
 
194 DISSECTION OF THE THORAX 
 
 4. Open the pericardium by a crucial incision and expose 
 (a) The interior of the sac, lined by serous pericardium. 
 (6) The HEART invested by serous pericardium. 
 
 (c) The ASCENDING AORTA and PULMONARY ARTERY enclosed in 
 
 a complete sheath of serous pericardium. 
 
 (d) The FOUR pulmonary veins and the superior and in- 
 
 ferior VEN^ CAV^, partially invested by serous peri- 
 cardium. 
 
 (e) The vestigial fold of Marshall, in front of the left 
 
 pulmonary veins. 
 
 (/) The OBLIQUE and transverse sinuses of the pericardium. 
 
 IV. Heart and Large Vessels 
 
 A. Examine in situ the form, position, and relations of 
 
 (1) HEART. 
 
 (2) ASCENDING AORTA. 
 
 (3) PULMONARY ARTERY. 
 
 (4) SUPERIOR AND INFERIOR VEN^E CAViE. 
 
 (5) PULMONARY VEINS. 
 
 B. coronary vessels. Dissect out 
 
 (i) coronary arteries. 
 
 (2) coronary sinus and its tributaries, noting the connection 
 of the OBLIQUE vein with the coronary sinus and the 
 
 VESTIGIAL FOLD OF MARSHALL. 
 
195 
 
196 DISSECTION OF THE THORAX 
 
 C. Cavities of the Heart. 
 
 (i) To open the right auricle — 
 
 (a) Connect the superior and inferior venae cavae by a vertical 
 
 incision along the right margin of the auricle. 
 (6) Make an oblique incision through the anterior waU of the 
 
 auricle to the tip of the auricular appendix, 
 (c) Clear out any clot in the cavity and examine its interior, 
 
 including — 
 
 OPENINGS. 
 FOSSA OVALIS. 
 EUSTACHIAN VALVE. 
 
 (2) To open the right ventricle — 
 
 (a) Pinch the apex of the ventricle {which lies to the right of the 
 afex of the heart) between the finger and thumb, and pass 
 the knife through the anterior and posterior walls. 
 
 (6) Carry the incisions upwards, in front to the origin of the 
 pulmonary artery, and behind to the auriculo-ventricular 
 orifice, along the attachment of the ventricle to the 
 border of the septum. 
 
 (c) Clear out any clot and examine the interior of the cavity, 
 including — 
 
 (a) INFUNDIBULUM. 
 
 (;3) AURICULO-VENTRICULAR (TRICUSPID) VALVE. 
 
 (7) PULMONARY VALVE. 
 
 (3) To open the left ventricle — 
 
 (a) Stab the apex of the heart, and having found the interior 
 of the ventricle, carry incisions up to the base of the 
 cavity, anteriorly and posteriorly, keeping as close to 
 the septum as possible. 
 
 (6) Examine the interior of the cavity, including — 
 
 (o) AORTIC SINUS. 
 
 ($) AURICULO-VENTRICULAR (mITRAL) VALVE. 
 
 (7) AORTIC VALVE. 
 
 (4) To open the left auricle — 
 
 [a) Draw the heart upwards, to expose its dorsal surface. 
 
 (6) Make a transverse incision, connecting the right and left 
 
 pulmonary veins, 
 (c) From the left extremity of this incision, carry a second 
 
 incision forwards to the apex of the auricular appendix. 
 {d) Examine the interior of the cavity and the auricular 
 
 SEPTUM. 
 
DISSECTION OF THE THORAX 197 
 
 D. Large Vessels within the Pericardium. 
 
 Strip off the pericardium investing the large vessels connected 
 with the heart, and dissect out : — 
 
 (1) ASCENDING AORTA. 
 
 (2) PULMONARY ARTERY and its branches. 
 
 (3) LIGAMENTUM DUCTUS ARTERIOSI 
 
 [noting the relation to it of the left inferior laryngeal nerve]. 
 
 (4) PULMONARY VEINS. 
 
 (5) SUPERIOR AND INFERIOR VEN^ CAV.ar. 
 
198 
 
199 
 
200 DISSECTION OF THE THORAX 
 
 V. Superior Mediastinum 
 
 A. Clean and study on each side the relations of — 
 
 (i) Systemic Veins. 
 
 (a) INNOMINATE VEINS and their branches. 
 
 (6) SUPERIOR VENA CAVA, 
 (c) VENA AZYGOS MAJOR. 
 
 (2) Nerves. 
 
 (a) PHRENIC NERVES, notiug their relations to the subclavian 
 vessels, and internal mammary artery. 
 
 (6) VAGI. 
 
 (c) INFERIOR LARYNGEAL NERVES. 
 
 (d) CARDIAC BRANCHES OF THE VAGUS AND SYMPATHETIC. 
 
 (3) Aortic arch and the arteries arising from it. 
 
 (o) INNOMINATE ARTERY. 
 
 (6) LEFT COMMON CAROTID ARTERY. 
 
 (c) LEFT SUBCLAVIAN ARTERY. 
 
 B. Make a dissection to expose 
 
 TRACHEA AND BRONCHI. 
 
 tESOPHAGUS. 
 
 THORACIC DUCT. 
 
 LEFT INFERIOR LARYNGEAL NERVE. 
 
 DEEP CARDIAC PLEXUS. 
 
 (i) Remove the heart, after separating from it the aorta, pulmonary 
 vessels, superior and inferior venae cavse. 
 
 (2) Divide the aorta between the origins of the innominate and 
 
 left common carotid arteries, and turn the parts aside. 
 
 (3) Divide the right pulmonary artery close to its origin and turn 
 
 the parts aside. 
 
 (4) Dissect out the deep cardiac plexus, surrounding the 
 
 bifurcation of the trachea. 
 
 (5) Clean the trachea and main bronchi, (esophagus, thoracic 
 
 duct and left inferior laryngeal nerve. 
 
 (6) Follow the thoracic duct to its termination in the neck 
 
 [in conjunction with the dissectors of the head and neck]. 
 
201 
 
202 DISSECTION OF THE THORAX 
 
 VI. Posterior Mediastinum 
 
 (i) Follow the VAGI NERVES from the posterior pulmonary 
 plexuses to the CESophagus. 
 
 (2) Clean the cesophagus and the oesophageal plexus. Note the 
 
 connections of the great splanchnic nerves with the 
 plexus. 
 
 (3) Clean and define — 
 
 (a) DESCENDING THORACIC AORTA and its branches. 
 
 (b) THORACIC DUCT. 
 
 (c) VENA AZYGos MAJOR and its branches. 
 
 (4) Clean the structures lying on the posterior thoracic wall 
 
 behind the pleura, i. e. — 
 
 {a) INTERCOSTAL VESSELS and NERVES. 
 
 (6) THORACIC SYMPATHETIC CORD and its branches. 
 
 (c) SUPERIOR and inferior v:bnx azygos minores. 
 
 (d) superior INTERCOSTAL VESSELS. 
 
 (e) Connections of the first and second intercostal nerves. 
 
203 
 
204 DISSECTION OF THE THORAX 
 
 VII. Thoracic Articulations 
 
 A. Costo-sternal Articulations. 
 
 These should be studied on a museum specimen. 
 
 B. Costo-vertebral Articulations. 
 
 (i) Clean and define the stellate and costo-transveese 
 
 LIGAMENTS. 
 
 (2) Divide the ligaments and examine the articular surfaces, 
 noting how the first and three lower joints differ from the 
 others. 
 
 C. Vertebral Articulations. 
 
 If the spinal cord has not been removed in the dissection of the 
 back — 
 
 (i) Examine the ligaments of the arches of the vertebrae. 
 
 (2) Remove the spinal cord according to directions already given 
 
 (P- 32). 
 
 (3) Cut through the pedicles and clean the posterior and 
 
 anterior common ligaments. 
 
 (4) Divide an intervertebral disc transversely to show its 
 
 structure. 
 
205 
 
206 
 
 DISSECTION OF THE ABDOMEN 
 
 ORDER OF DISSECTION 
 
 I. Perineum and External Genital Organs. 
 
 II. Anterior Abdominal Wall, with the Spermatic Cord, 
 Testicle, and the Anatomy of Inguinal Hernia. 
 
 III. Abdominal Cavity in General : Peritoneum. 
 
 IV. Mesenteries and Omenta and Visceral Blood-vessels. 
 
 V. Stomach : Intestines : Pancreas : Spleen. 
 
 VI. Liver. 
 
 VII. Form and Structure of Stomach, Duodenum, Pancreas, 
 
 and Spleen. 
 VIII. Kidneys and Suprarenal Capsules, with the Muscles, 
 Vessels and Nerves of the Posterior Abdominal 
 Wall. 
 
 IX. Dissection of the Pelvis. 
 X. Pelvic Articulations. 
 
DISSECTION OF THE ABDOMEN 207 
 
 The dissection of the perineum is undertaken as soon as the 
 subject is brought into the room, and occupies two days. There- 
 after the dissectors wait a week [five anatomical days), while the 
 back is dissected. On the tenth day the body is turned,, and the 
 dissection of the abdominal wall is begun. 
 
 I. Perineum and External Genital Organs 
 
 Male Perineum 
 
 (i) Landmarks and surface anatomy. Examine the penis, 
 scrotum, and anus. 
 
 (2) Pass a urethral catheter into the bladder. Introduce the 
 
 finger into the rectum to feel the back of the prostate 
 
 GLAND. 
 
 (3) Plug the rectum with some tow, and sew up the anal margin. 
 
 Tie the skin of the scrotum to the prepuce, and tie both of 
 them to the end of the catheter. 
 
 (4) Skin incisions (fig. 3). 
 
 A. Ischio-rectel Fossa. 
 
 (i) Remove the skin outwards from the middle line and define 
 
 the SPHINCTER ANI EXTERNUS. 
 
 (2) Make a deep oblique cut through the fat and fascia of the 
 
 buttock to define the border of the gluteus maximus 
 
 MUSCLE. 
 
 (3) Make a deep antero-posterior cut through the fat and fascia 
 
 covering the tuber ischii. 
 
 (4) Clean the ischio-rectal fossa by removing the pad of fat which 
 
 occupies it. Define its walls in the following order : — 
 
 {a) Posterior — 
 
 GLUTEUS MAXIMUS. 
 
 GREAT SACRO-SCIATIC LIGAMENT. 
 
 (6) External — 
 
 TUBER ISCHII. 
 OBTURATOR FASCIA. 
 OBTURATOR INTERNUS. 
 
 (c) Internal — 
 
 SPHINCTER ANI EXTERNUS. 
 LEVATOR ANI. 
 
 [d] Anterior — 
 
 TRANSVERSUS PERINEI. 
 
 Border of triangular ligament. 
 
2o8 DISSECTION OF THE ABDOMEN 
 
 During this dissection the following structures must be 
 secured (fig. 15). 
 
 {a) Along the edge of the gluteus maximus : 
 
 Branches of the sciatic artery, 
 
 The PERFORATING CUTANEOUS NERVE, winding round the 
 gluteus maximus. 
 
 The PERINEAL BRANCH OF THE FOURTH SACRAL NERVE, 
 
 in the angle between the gluteus maximus and the 
 external sphincter. 
 
 (6) Traversing the fat between the ischial tuberosity and the 
 edge of the external sphincter: 
 
 INFERIOR HEMORRHOIDAL VESSELS AND NERVE. 
 
 (c) In relation to the anterior wall of the fossa : 
 
 POSTERIOR SUPERFICIAL PERINEAL VESSELS AND NERVE. 
 
 TRANSVERSE PERINEAL ARTERY. 
 
 TRANSVERSUS PERINEI MUSCLE. 
 
 ANTERIOR SUPERFICIAL PERINEAL NERVE, piercing Or 
 
 passing beneath the transversus perinei. 
 DEEP PERINEAL NERVE, situated On a deeper plane than 
 the foregoing. Secure its branches to the levator ani. 
 
 (d) Along the outer wall : 
 
 Define the course of the internal pudic artery and nerve 
 in their sheath [Akock's canal) in the parietal (obturator) 
 pelvic fascia. 
 
20g 
 
210 
 
DISSECTION OF THE ABDOMEN 211 
 
 . Anterior Urethral Triangle. 
 
 (i) After the skin has been removed, make an incision through 
 the superficial fascia, and inserting the nozzle of the beUows, 
 blow up the subjacent space to see the course of the air 
 beneath the fascia, to the scrotum, penis, and along the 
 spermatic cord to the anterior abdominal wall. 
 
 (2) Reflect the superficial fascia laterally from the middle line 
 
 and dissect out — 
 
 SUPERFICIAL PERINEAL VESSELS AND NERVES. 
 PERINEAL BRANCH OF THE SMALL SCIATIC NERVE. 
 
 This pierces the attachment of the superficial fascia to 
 the pubic arch and is often most easily found by tracing 
 the communications to it from the superficial perineal nerves. 
 
 (3) Clean and define the anterior urethral triangle. 
 {a) The muscles bounding it — 
 
 TRANSVERSUS PERINEI. 
 BULBO-CAVERNOSUS. 
 ERECTOR PENIS. 
 
 (6) The floor of the triangle — 
 
 TRIANGULAR LIGAMENT. 
 
212 
 
DISSECTION OF THE ABDOMEN 213 
 
 (4) Reflect the muscles from their origins — 
 
 (a) BuLBO-CAVEENOSus, to expose the Bulb. Secure the 
 NERVE and ARTERY to the BULB, and the duct of cowper's 
 
 GLAND. 
 
 (b) Transversus perinei, to expose the base of the triangular 
 ligament. 
 
 (c) Erector penis, to expose the crus penis. 
 
 Detach the crus penis from the pubic arch to see the arteries 
 and nerves to 
 
 CORPUS CAVERNOSUM. 
 DORSUM OF THE PENIS. 
 
 (5) Divide the scrotum into two parts by a median incision along 
 
 the raphe. Dissect the penis, cleaning and defining the 
 
 CORPORA CAVERNOSA, the BULB and CORPUS SPONGIOSUM, 
 
 and the vessels and nerves of the organ. 
 
 (6) Divide the triangular Ugament near its attachment to the 
 
 pubic arch and reflect it to expose — 
 
 ^J^^^n fJ.fJ^J'^*"^*^'^ late-^^lly)) and their branches. 
 pudic artery / 
 
 compressor urethra muscle. 
 
 cowper's glands. 
 
 (7) Draw the anus well back with hooks, and define the anterior 
 
 borders of the two levatores ani muscles, as they sweep 
 down behind the deep layer of the triangular liga- 
 ment, on each side of the rectum. 
 Draw the urethra and triangular ligaments well forward, 
 cutting through the anterior fibres of the levator ani if 
 necessary, and expose : — 
 PROSTATE GLAND, Covered by pelvic fascia. 
 
 VASA DEFERENTIA. 
 VESICUL/E SEMINALES. 
 
 Back of the bladder. 
 
214 
 
DISSECTION OF THE ABDOMEN 215 
 
 Female Perineum 
 
 (i) Landmarks and surface anatomy. Examine the anus and 
 vulva. 
 
 (2) Pass a catheter into the bladder. Introduce the finger into 
 
 the vagina and feel the external os uteri and the fornices 
 
 of THE VAGINA. 
 
 (3) Plug the vagina and rectum with some tow. Sew up the 
 
 anal margin ; also the vagina and urethra by a suture 
 carried along the labia minora. 
 
 (4) Skin incisions (fig. 3). 
 
 A. IseMo-reetal Fossa. 
 
 This dissection is carried out in the same way as in the male 
 (p. 207 ; fig. 15). 
 
216 
 
217 
 
2i8 DISSECTION OF THE ABDOMEN 
 
 B. Anterior Urethral Triangle. 
 
 (i) When the skin has been reflected, reflect the superficial 
 fascia laterally from the middle line, dissecting out — 
 
 SUPERFICIAL PERINEAL VESSELS AND NERVES. 
 PERINEAL BRANCH OF THE SMALL SCIATIC NERVE. 
 
 This pierces the attachment of the superficial fascia to the pubic 
 arch and is often most easily found by tracing the communications 
 to it from the superficial perineal nerves. 
 
 (2) Clean and define the anterior urethral triangle. 
 {a) Muscles hounding it — 
 
 TRANSVERSUS PERiNEi (often absent). 
 BULBO-CAVERNOsus (sphincter vaginae). 
 
 ERECTOR CLITORIDIS. 
 
 (6) Floor of the triangle — 
 
 TRIANGULAR LIGAMENT. 
 
 (3) Reflect the muscles from their origins, — 
 
 [a) BULBO-CAVERNOSUS, to expose the bulb of the vagina. 
 Secure the nerve and artery to the bulb, and the duct 
 of Bartholin's gland. 
 
 (&) TRANSVERSUS PERINEI, to expose the base of the triangular 
 hgament. 
 
 (c) erector clitoridis, to expose the crus clitoridis. 
 Detach the crus chtoridis from the pubic arch to see the 
 arteries and nerves to— 
 
 CORPUS CAVERNOSUM. 
 DORSUM OF THE CLITORIS. 
 
 (4) Examine the structure of the clitoris. 
 
 (5) Divide the triangular hgament near its attachment to the pubic 
 
 arch and reflect it to expose — 
 
 (a) PUDic NERVE (situated laterally)"! j ^u • t, 1. 
 (6) PUDIC ARTERY^ ^' ) ^""^ ^^^"^ branches. 
 
 (c) COMPRESSOR URETHRA MUSCLE. 
 
 (d) BARTHOLIN'S GLAND. 
 
219 
 
220 DISSECTION OF THE ABDOMEN 
 
 II. Anterior Abdominal Wall, with the Spermatic Cord, 
 Testicle, and the Anatomy of Inguinal Hernia 
 
 This dissection is begun as soon as the subject is placed on its 
 back. The dissection of the anterior abdominal wall should occupy 
 three days. 
 
 A. Superflcial Structures. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. i, p. 13). 
 
 (3) Make a special dissection of the superficial fascia in 
 
 the inguinal region [in conjunction with the dissector of the 
 lower limb], 
 (a) Make a crticial incision, with one limb oblique and extending 
 along the line of Poupart's ligament, the other limb vertical 
 and crossing the first one about its centre (fig. 16, a, b, c, d). 
 This incision should only extend through the superficial 
 fatty layer of the fascia, and four flaps should be turned 
 aside to expose 
 
 SUPERFICIAL VESSELS. 
 LYMPHATIC GLANDS. 
 ILIO-INGUINAL NERVE. 
 
 {b) Make a transverse incision (ce), extending horizontally 
 inwards from the anterior superior spine of the ilium to the 
 middle line, and a vertical incision (e d) from the inner end 
 of the preceding one to the symphysis pubis. 
 These incisions should extend through both layers of the 
 superficial fascia, and the handle of the scalpel should be 
 insinuated beneath the membranous deeper layer, in 
 order to see its attachments to Poupart's ligament and 
 to the fascia lata of the thigh. 
 
 (c) Trace the fascia down to the scrotum, along the spermatic 
 
 cord, and note its continuity with the dartos muscle. 
 
 *. 
 
 (4) Reflect the remaining part of the superficial fascia of the 
 
 abdominal wall from the middle line outwards to expose 
 Cutaneous nerves (fig. 10). 
 
 ANTERIOR BRANCHES OF THE THORACIC NERVES. 
 ILIO-HYPOGASTRIC NERVE. 
 
 LATERAL BRANCHES OF THE THORACIC NERVES. 
 LATERAL BRANCH OF THE ILIO-HYPOGASTRIC NERVE. 
 
FIG. 1 6, ^REFLECTION OF THE SUPERFICIAL FASCIA OF THE GROIN ANP 
 ANTERIOR ABDOMINAL WALL 
 
a. Superficial cervical nerve. 
 
 b. Sternal 'V 
 
 c. Clavicular Vsupra-clavicular 
 
 d. Acromial j 
 
 T 2-12. Thoracic nerves: anterior primary 
 divisions. 
 
 LT 3-11. Thoracic nerves : lateral branches. 
 
 e. lUo-hypogastric 
 
 /. Ilio-inguinal. 
 
 B. Genito-femoral. 
 
 A. Lateral cutaneous of thigh. 
 
 ^■IG. 10. — CUTANEOUS NERVES OF FRONT OF TRUNK 
 
223 
 
224 DISSECTION OF THE ABDOMEN 
 
 B. Muscles and Fasciae of the Anterior Abdominal Wall. 
 
 Lateral Muscles. 
 
 (i) Clean the obliquus externus abdominis muscle and define— 
 (a) Each of its costal slips of origin. 
 
 {b) Its origin from the aponeurosis of the pectoralis major 
 muscle [in conjunction with the dissector of the upper limb]. 
 
 (c) Its insertions at the groin. 
 
 (d) The external abdominal ring and its pillars. The intee- 
 
 COLUMNAR fibres, and EXTERNAL SPERMATIC FASCIA. 
 
 Make a transverse incision through the aponeurosis of the 
 muscle from the anterior superior spine inwards to the 
 point of junction of the aponeurosis with that of the 
 obliquus internus. 
 
 Make an oblique incision downwards to the symphysis pubis 
 from the medial end of the preceding incision. Turn the 
 flap downwards and laterally and define 
 
 EXTERNAL ABDOMINAL RING. 
 
 EXTERNAL I „„ , .„„ 
 
 INTERNAL | ^'^^^^^- 
 
 EXTERNAL SPERMATIC FASCIA. 
 
 TRIANGULAR FASCIA. 
 
 INTERNAL OBLIQUE and CREMASTER MUSCLES. 
 
 ILIO-HVPOGASTRIC AND ILIO-INGUINAL NERVES. 
 
 Reflect the upper part of the obliquus externus muscle, by 
 detaching it from its costal and iliac attachments, and 
 turning it forwards as far as its attachment to the sheath 
 of the rectus abdominis muscle. 
 
225 
 
226 DISSECTION OF THE ABDOMEN 
 
 (2) Clean the obliquus abdominis internus muscle, separating 
 
 its lower border from the cremaster muscle. 
 Make a transverse incision through the muscle from the anterior 
 
 superior spine to the linea semilunaris. 
 Divide the lower part of the muscle half an inch from its origin 
 
 from Poupart's ligament and turn the flap towards the 
 
 middle line. 
 Reflect the remainder of the obliquus internus by detaching 
 
 it from its origin and turning it forwards. 
 In doing this, the ascending branch of the deep 
 
 CIRCUMFLEX ILIAC ARTERY (which Ucs between the internal 
 
 oblique and transversus abdominis muscles) is a guide to the 
 
 separation of the muscles. 
 
 (3) Dissect out the structures beneath the obliquus 
 
 INTERNUS MUSCLE. 
 TRANSVERSUS ABDOMINIS MUSCLE. 
 
 Nerves in relation to it — 
 
 ANTERIOR BRANCHES OF THE THORACIC NERVES. 
 ILIO-HYPOGASTRIC and ILIO-INGUINAL NERVES. 
 
 CONJOINT TENDON. 
 
 FASCIA TRANSVERSALis, in SO far as it is exposed. 
 
 INTERNAL ABDOMINAL RING and INFUNDIBULIFORM FASCIA. 
 
 SPERMATIC CORD and its coverings. 
 
 DEEP CIRCUMFLEX ILIAC and DEEP EPIGASTRIC ARTERIES. 
 
 (4) Reflect the transversus abdominis muscle by detaching it 
 
 from its origin and turning it forwards to expose com- 
 pletely the FASCIA TRANSVERSALIS. 
 
227 
 
228 DISSECTION OF THE ABDOMEN 
 
 Anterior Muscles. 
 
 (i) Examine the mode of formation of the sheath of the rectus 
 ABDOMINIS MUSCLE, noting the differences — 
 
 (a) On the wall of the thorax. 
 
 (b) Down to a point midway between the umbilicus and 
 
 symphysis pubis. 
 
 (c) Below that point. 
 
 (2) Open the sheath by a vertical incision carried through its 
 
 anterior layer about an inch from the linea alba. 
 Note the line^e transvers.e. 
 
 They are closely adherent to the anterior layer of the sheath. 
 
 (3) Examine the contents of the sheath — 
 
 PYRAMIDALIS MUSCLE. 
 RECTUS ABDOMINIS MUSCLE. 
 DEEP EPIGASTRIC ARTERY. 
 SUPERIOR EPIGASTRIC ARTERY. 
 ANTERIOR THORACIC NERVES. 
 
 (4) Divide the rectus muscle across the middle and examine 
 
 the FOLD OF DOUGLAS. 
 
 Trace the vessels and nerves in relation to the deep surface 
 
 of the muscle. 
 Examine the formation and attachments of the linea alba. 
 
 C. Anatomy of Inguinal Hernia. 
 
 The dissector should now study the formation of the inguinal 
 canal and the anatomy of inguinal hernia. 
 Replace the various structures related to the canal and examine— 
 
 EXTERNAL ABDOMINAL RING. 
 BOUNDARIES OF THE INGUINAL CANAL. 
 INTERNAL ABDOMINAL RING. 
 COVERINGS OF THE SPERMATIC CORD. 
 HESSELBACH's TRIANGLE. 
 
229 
 
230 DISSECTION OF THE ABDOMEN 
 
 D. Dissection of the Spermatic Cord and the Contents of the Scrotum. 
 
 (i) Dissect out the constituents of the spermatic cord and trace 
 them down to the testicle. 
 
 (2) Remove the skin and dartos muscle of the scrotum, and 
 
 define the tunica vaginalis testis. 
 
 (3) Open the tunica vaginalis by a longitudinal incision along 
 
 the anterior border of the testis. Turn the flaps aside 
 and examine its relations to the testis and spermatic cord. 
 
 (4) Study the form and structure of the testis and epididymis. 
 
231 
 
232 DISSECTION OF THE ABDOMEN 
 
 III. Abdominal Cavity in General: Peritoneum 
 
 (i) Open the abdominal cavity by a crucial incision, made 
 vertically through the linea alba from the ensiform cartilage 
 to the symphysis pubis, and transversely at the level of 
 the umbilicus. 
 
 (2) Examine the folds of peritoneum and the inguinal 
 
 POUCHES, on the deep surface of the anterior abdominal 
 wall (fig. 17). 
 
 (3) Locate the various abdominal viscera. 
 
 (4) Study the various folds of the peritoneum forming 
 
 OMENTA. 
 
 MESENTERIES. 
 
 LIGAMENTS. 
 
 (5) Examine the foramen of winslow and lesser sac of the 
 
 peritoneum. 
 Tear through the gastro-hepatic and gastro-coUc omenta to 
 see the extent of the lesser sac of the peritoneum behind 
 the stomach. 
 
a. Umbilicus. d. Obliterated hypogastric artery. 
 
 6. Bladder. <■ Dee^) epigastric artery, 
 
 c, Urachus. /. Falciform and round ligaments of the liver, 
 
 FIG. 17, — DIAGRAM OF THE FOLDS CONVERGING TO THE UMBILICUS ON THE 
 DEEP SURFACE OF THE ANTERIOR ABDOMINAL WALL 
 
 233 
 
234 
 
DISSECTION OF THE ABDOMEN 235 
 
 IV. Mesenteries and Omenta and Visceral Blood-vessels 
 
 (i) Examine the mesentery, noting its position, attachments 
 and relations. 
 
 After turning upwards the transverse colon, with the great 
 omentum and transverse meso-colon, strip off the super- 
 ficial (right) layer of peritoneum forming the mesentery 
 and dissect out — 
 SUPERIOR MESENTERIC VESSELS and their branches. 
 
 SUPERIOR MESENTERIC PLEXUS OF NERVES. 
 LYMPHATIC GLANDS AND LACTEALS. 
 
 (2) Draw the small intestine and mesentery over to the right 
 
 side and clean the inferior mesenteric vessels and 
 their branches. Trace the sigmoid and superior h^emor- 
 
 RHOIDAL ARTERIES intO the PELVIC MESO-COLON. 
 
 (3) Examine the transverse meso-colon, noting its attach- 
 
 ments and contents. 
 
 (4) Study the various omenta, noting their connections and 
 
 contents — 
 
 GREAT OMENTUM. 
 SMALL OMENTUM. 
 GASTRO-SPLENIC OMENTUM. 
 
 (5) Dissect out the cceliac axis artery, clean its branches and 
 
 trace them to their destination. 
 This dissection is made by tearing through the great and 
 small omenta. The stomach can thus be manipulated 
 in various directions and the vessels and their branches 
 can be followed to their destinations. In the dissection 
 care should be taken to secure the veins as well as the 
 arteries of the stomach. The cceliac plexus surrounding 
 the cceliac axis is to be preserved. 
 
 (6) Define the portal vein by following up the mesenteric 
 
 VEINS (superior and inferior) to their junction with the 
 splenic vein. Find the other tributaries of the splenic 
 and portal veins, and trace the latter to the liver behind 
 the head of the pancreas and the duodenum, and in front 
 of the foramen of Winslow. The bile duct, and the 
 GASTRO-DUODENAL and HEPATIC ARTERIES accompany 
 the vein in its course. 
 
236 
 
DISSECTION OF THE ABDOMEN 237 
 
 V. Stomach: Intestines: Pancreas: Spleen 
 
 (i) Examine in situ the relations of the jejunum and ileum, 
 the c^cum and appendix, the ascending, transverse 
 and descending colon. 
 
 (2) Remove the parts mentioned by dividing between two 
 
 ligatures — 
 
 (a) THE small intestine at the duodeno-jejunal flexure, 
 having first ligatured and divided the superior mesenteric 
 vessels just below the point where they cross the duodenum. 
 
 (b) the descending colon, at a point two inches above 
 the pelvic brim, having first ligatured and divided the 
 left colic branch of the inferior mesenteric artery. 
 
 (3) Remove all superfluous peritoneal folds from the gut, wash 
 
 out and clean the portions of the small and large intestine 
 removed, and then study their external characters. 
 
 (4) Open up and note the internal characters of 
 
 JEJUNUM, 
 
 ILEUM, 
 
 COLON. 
 
 (5) The csecum and appendix along with the ascending colon, 
 
 and the last six inches of the ileum, should be separated 
 from the rest of the gut, and then blown up and dried. 
 When dried cut a window in the right wall of the csecum 
 to see the ileo-c^cal valve. 
 
 (6) Study in situ, the position, relations and connections of 
 
 STOMACH, 
 SPLEEN, 
 DUODENUM, 
 PANCREAS. 
 
 These organs will be. removed and their structure studied 
 later (p. 241). 
 
238 
 
DISSECTION OF THE ABDOMEN 239 
 
 VI. Liver 
 
 (i) Examine in situ the position and relations of the Uver. 
 Trace the hepatic artery, bile duct, and portal vein 
 throughout their course to the hilum of the liver. 
 
 (2) Remove the liver by dividing the following structures : — 
 
 ROUND AND FALCIFORM LIGAMENTS, 
 CORONARY AND LATERAL LIGAMENTS, 
 
 BILE DUCT, HEPATIC ARTERY and PORTAL VEIN, between 
 the layers of the 
 
 SMALL OMENTUM, 
 
 INFERIOR VENA CAVA, dividing it SO as to leave its anterior 
 wall in contact with the liver, and its posterior wall in 
 contact with the diaphragm. 
 
 (3) Study the form of the liver, and dissect out : — 
 
 PORTAL VEIN. 
 
 ROUND LIGAMENT. 
 
 DUCTUS VENOSUS. 
 
 INFERIOR VENA CAVA. 
 
 HEPATIC DUCTS. 
 
 HEPATIC ARTERY. 
 
 GALL BLADDER with the CYSTIC DUCT and the CYSTIC VESSELS. 
 
 Note the attachments of the round ligament and ductus 
 venosus to the portal vein and inferior vena cava. 
 
^4" 
 
DISSECTION OF THE ABDOMEN 241 
 
 VII. Form and Structure of Stomach, Duodenum, 
 Pancreas, and Spleen 
 
 Remove the stomach, duodenum, pancreas and spleen by cutting 
 through the oesophagus and vagi nerves at the oesophageal 
 opening in the diaphragm, and separating from the cceliac axis 
 and superior mesenteric arteries, the branches which supply 
 those organs. 
 
 1. Stomach. 
 
 (a) Clean its borders, and examine its external form. 
 
 (6) Make an incision into the stomach along the lesser curvature, 
 passing into the oesophagus on the one hand and into the 
 duodenum on the other hand, to see^ — 
 
 CAVITY OF THE STOMACH. 
 CESOPHAGEAL OPENING. 
 PYLORIC CANAL. 
 PYLORIC VALVE. 
 
 (c) Dissect off the peritoneum, and examine the muscular 
 structure of the stomach. Trace the two vagi nerves on 
 its surface. 
 
 2. Duodenum. 
 
 («) Clean the duodenum, and trace in relation to its second 
 part, the common bile duct and the ducts of the 
 pancreas. 
 
 {b) Open the second part of the duodenum on its right side 
 to see the bile-papilla and the termination of the bile 
 duct and the pancre^.tic ducts. 
 
 3. Pancreas. 
 
 Clean the pancreas and follow its two ducts into its substance. 
 
 4. Spleen. 
 
 Examine the form and structure of the organ, tracing the 
 vessels to the hilum. 
 
243 
 
244 DISSECTION OF THE ABDOMEN 
 
 VIII. Kidneys and Suprarenal Capsules, with the Muscles, 
 Vessels and Nerves of the Posterior Abdominal Wall 
 
 A. Kidneys and Suprarenal Capsules. 
 
 (i) Dissect out the suprarenal capsules on each side, noting 
 the differences in their relations. Secure the arteries, veins 
 and nerves of each capsule. 
 
 (2) Examine the position and relations of the kidney, noting 
 
 the differences on the two sides. 
 
 (3) Trace the vessels and nerves to the hilum of the kidney, 
 
 and define the ureter. 
 Follow the course of the ureter in the abdominal cavity. 
 
 (4) Remove the kidney, after dividing the renal vessels and ureter. 
 Strip the capsule off the kidney as far as the hilum. 
 Dissect the vessels and ureter through the hilum to expose 
 
 the SINUS OF THE KIDNEY with THE PELVIS and calyces 
 
 of THE URETER. 
 
 (5) Make a transverse, vertical section through the kidney to 
 
 show its internal structure. 
 
245 
 
246 DISSECTION OF THE ABDOMEN 
 
 B. Muscles, Vessels and Nerves of the Posterior Abdominal Wall. 
 (i) Sympathetic Nerves. 
 Define the — 
 
 GANGLIATED CORD and RAMI COMMUNICANTES. 
 CCELIAC PLEXUS and SEMILUNAR GANGLIA. 
 AORTIC PLEXUS and AORTICO-RENAL GANGLIA. 
 HYPOGASTRIC NERVES. 
 HYPOGASTRIC PLEXUS. 
 
 (2) Clean and examine the position and relations of the vessels 
 
 ON THE posterior ABDOMINAL WALL. 
 
 (a) Aorta and its branches. 
 
 Collateral — 
 Parietal, 
 
 Visceral (single). 
 Visceral (paired). 
 
 Terminal — 
 
 Middle sacral, 
 Common iliac arteries. 
 
 (6) Dissect out the common and external iliac arteries. 
 Note the relations of each vessel. Trace the course of the 
 branches of the external iliac artery — deep epigastric 
 and deep circumflex iliac — and their branches. 
 
 (c) Inferior Vena Cava and its tributaries. 
 
 EXTERNAL AND COMMON ILIAC VEINS. 
 
 (d) Dissect out the ascending lumbar veins (vense azygos) 
 and the receptaculum chyli. 
 
247 
 
248 DISSECTION OF THE ABDOMEN 
 
 (3) Clean and define the muscles of the posterior abdominal 
 
 WALL, noting their relations to viscera, to vessels and to 
 nerves. 
 
 (a) DIAPHRAGM, noting — 
 
 CRURA and arcuate ligaments, 
 
 FORAMINA for the aorta, (ESOPHAGUS and inferior 
 
 vena cava, 
 other structures piercing the muscle. 
 
 (b) quadratus lumborum. 
 
 (c) PSOAS (major and minor). 
 
 (d) ILIACUS. 
 
 (4) LUMBAR PLEXUS. 
 
 Define the position of the nerves in relation to the muscles 
 of the posterior abdominal wall. 
 
 TWELFTH THORACIC. 
 
 ILIO-HYPOGASTRIC. 
 
 ILIO-INGUINAL. 
 
 GENITO-FEMORAL. 
 
 LATERAL CUTANEOUS OF THE THIGH. 
 
 FEMORAL. 
 
 OBTURATOR. 
 
 SYMPATHETIC GANGLIATED CORD. 
 
 Dissect these nerves back to the inter-vertebral foramina by 
 removal of the psoas muscle, to see the constitution of the plexus. 
 
 During this dissection follow the course of the lumbar vessels 
 and the rami communicantes connecting the sympathetic cord 
 with the spinal nerves. 
 
249 
 
250 
 
DISSECTION OF THE ABDOMEN 251 
 
 IX. Dissection of the Pelvis 
 
 Separate the pelvis from the trunk by — 
 
 (a) dividing the aorta, inferior vena cava, and the muscles and 
 
 nerves of the posterior abdominal wall ; 
 
 (b) making a transverse section through the vertebral column 
 
 between the bodies of the fourth and fifth lumbar 
 vertebrae. 
 
 A. Pelvic Peritoneum. 
 
 Examine the pelvic viscera from above, noting their 
 peritoneal connections. 
 
 PELVIC COLON AND PELVIC MESOCOLON. 
 RECTUM, AND PARARECTAL FOSS«. 
 RECTO-VESICAL POUCH. 
 
 BLADDER, AND THE POSTERIOR, LATERAL, AND SUPERIOR FALSE 
 LIGAMENTS. 
 
 In the female (in addition) — 
 
 Examine the position of the uterus and the broad ligament. 
 
 {a) UTERUS — 
 
 POUCH OF DOUGLAS AND 
 RECTO-UTERINE FOLDS. 
 UTERO-VESICAL POUCH AND 
 UTERO-VESICAL FOLDS. 
 
 (6) BROAD LIGAMENT — 
 
 MESOSALPINX. 
 MESOVARIUM. 
 
 INFUNDIBULO-PELVIC LIGAMENT. 
 FALLOPIAN TUBE AND INFUNDIBULUM. 
 OVARY AND ITS LIGAMENTS. 
 OVARIAN VESSELS. 
 ROUND LIGAMENTS. 
 VESTIGIAL STRUCTURES. 
 
 B. Structures in the Extra-peritoneal Tissue. 
 
 Detach the peritoneum from the pelvic wall and dissect 
 out — 
 
 INTERNAL ILIAC ARTERY AND VEIN AND THEIR BRANCHES. 
 
 OBLITERATED HYPOGASTRIC ARTERY. 
 
 LUMBO-SACRAL CORD AND 
 
 OBTURATOR NERVE. 
 
 URETER. 
 
 VAS DEFERENS (in the male). 
 
 URACHUS. 
 
 In the female (in addition) — 
 
 OVARIAN VESSELS. 
 ROUND LIGAMENT. 
 
252 
 
DISSECTION OF THE ABDOMEN 253 
 
 C. Pelvic Wall. 
 
 (a) Clean and remove the muscles attached to the outer surface 
 
 of the innominate bone. 
 
 (b) Clean the sacro-sciatic ligaments, and the obturator mem- 
 
 brane; define the sacro-sciatic foramina and the ob- 
 turator foramen, and the structures passing through 
 them. 
 
 (c) Remove the acetabular part of the innominate bone 
 
 by the following incisions : — 
 
 1. Separate the ischial spine with bone forceps. 
 
 2. Remove with the saw the acetabular part of the inno- 
 
 minate BONE, along with the outer half of the pubis and 
 ischium (fig. i8). In the process the obturator nerve and 
 artery should be preserved, and the origin of the obturator 
 iniernus should be separated from the deep surface of the 
 pelvic wall and the obturator membrane. 
 OBTURATOR iNTERNus MUSCLE. Examine the origin and 
 course of this muscle, and trace its nerve into its sub- 
 stance. 
 
 D. Parietal Pelvic Fascia. 
 
 {a) Remove the obturator internus muscle, and expose the 
 parietal pelvic fascia lining its deep surface. 
 
 b) The WHITE LINE and the origin of the levator ani are also 
 displayed. The internal pudic artery and nerve should 
 now be followed to the perineum, in their course through 
 the lower part of the pelvic (obturator) fascia in Alcock's 
 canal. 
 
FIG. 1 8. — LINES OF SECTION OF THE INNOMINATE BONE 
 254 
 
255 
 
256 DISSECTION OF THE ABDOMEN 
 
 E. Levator Ani, Ischio-coccygeus and Internal Iliac Vessels. 
 
 (a) The lateral pelvic wall should now be removed still 
 
 further. 
 
 1. Make a vertical cut with the saw through the ihum and 
 
 lateral mass of the sacrum, preserving the structures 
 passing through the great sacro-sciatic foramen — 
 
 PYRIFORMIS MUSCLE. 
 
 GLUTEAL, SCIATIC AND PUDIC ARTERIES. 
 
 NERVES OF THE SACRAL PLEXUS. 
 
 2. Cut through the body of the pubis lateral to the symphysis, 
 
 so as to remove the rami of the pubis and ischium. 
 Turn back the cut portion of bone with the spine of the 
 ischium and the sacro-sciatic ligaments. 
 
 (b) The LOWER (obturator) portion of the pelvic fascia 
 
 should now be removed, and the following structures 
 exposed and cleaned. 
 
 ISCHIO- RECTAL FOSSA. 
 
 LEVATOR ANI. 
 
 ISCHIO- COCCy GEUS. 
 
 PARIETAL BRANCHES OF THE INTERNAL ILIAC ARTERY. 
 
 OBTURATOR NERVE. 
 
 INTERNAL PUDIC NERVE. 
 
257 
 
258 - DISSECTION OF THE ABDOMEN 
 
 , Suspensory Ligament of the Prostate Gland, Lateral and Anterior 
 (pubo-prostatic) Ligaments of the Bladder. 
 
 («) Separate the upper part of the parietal pelvic fascia from the 
 peritoneum lining the pelvic wall. Remove the extra- 
 peritoneal tissue, and dissect out — 
 
 VISCBRAL BRANCHES OF THE INTERNAL ILIAC VESSELS, 
 
 OBLITERATED HYPOGASTRIC ARTERY, 
 
 URETER, 
 
 VAS DEFERENS {in the male), 
 ROUND LIGAMENT (in the female) . 
 
 (6) Clean the pelvic fascia and trace it inwards into relation 
 with the pelvic viscera and pelvic floor, displa3dng — 
 
 RECTAL CHANNEL, 
 
 SUSPENSORY LIGAMENT OF THE PROSTATE {in the male), 
 LATERAL TRUE LIGAMENT OF THE BLADDER, 
 ANTERIOR (PUBO- PROSTATIC) LIGAMENT. 
 
 In the female — 
 
 SUSPENSORY LIGAMENT OF THE VAGINA AND URETHRA. 
 
 Note the relations of the suspensory ligament to the inferior 
 vesical vein,a.nd to thevesicula seminalisz.nd the vas deferens. 
 
259 
 
z6o DISSECTION OF THE ABDOMEN 
 
 G. Pelvic Viscera. 
 1. — 'Position and Relations. 
 
 The rectum being moderately plugged with tow, and a catheter 
 being placed in the urethra and bladder, the pelvic viscera should 
 be dissected in situ on the exposed side. 
 
 Revise the -peritoneal connections of the pelvic colon, rectum and 
 bladder. 
 
 In the female [in addition) : examine the peritoneal connections of 
 the uterus and vagiija, and the broad ligament and its contents. 
 
 (a) Pelvic Colon. 
 
 Examine the position and relations of the pelvic colon, with its 
 meso-colon, and the superior hemorrhoidal vessels. 
 
 Note the abrupt demarcation of colon and rectum, and observe, 
 if present, the constriction formed by the recto-colic valve. 
 
 (b) Rectum. 
 
 Examine the position and relations of the rectum. 
 
 Note its relations behind, to the sacrum and coccyx ; laterally to 
 the peritoneum, extra-peritoneal tissue and levator ani ; anteriorly 
 to the recto-vesical pouch, bladder, ureter, vesiculae seminales 
 and vasa deferentia, and prostate gland. Trace to it the superior 
 and middle hemorrhoidal arteries. 
 
 Clean the surface of the rectum, removing peritoneum and extra- 
 peritoneal tissue down to the pelvic floor. Note that it lies free in 
 a rectal channel, enveloped in extra-peritoneal tissue. 
 
 (c) Anal Canal. 
 
 Examine the position and relation of the anal canal as it pierces 
 the floor of the pelvis. 
 
 In the female : the rectum is related anteriorly to the recto- 
 uterine pouch of DOUGLAS, which separates it from the posterior 
 surface of the uterus and the posterior end of the vagina. 
 
26l 
 
262 dissectio'n of the abdomen 
 
 (d) Bladder. 
 
 Examine the position and relations of the bladder. 
 Remove the peritoneum from its surface and revise the relations 
 to the wall of the organ of — 
 
 URACHUS. 
 
 VAS DEFERENS (in the male). 
 VESicuLA SEMiNALis (JM the Male) . 
 
 URETER. 
 
 VESICAL ARTERIES. 
 
 OBLITERATED HYPOGASTRIC ARTERY. 
 
 In the female : note the relations of the bladder and uterus. They 
 are separated above by the utero- vesical pouch : they are connected 
 by the utero-vesical folds of peritoneum : and the base of the 
 bladder and the cervix uteri are loosely united together by areolar 
 tissue. 
 
 (e) Prostate Gland. 
 
 After revising the suspensory, lateral and anterior ligaments, 
 derived from the pelvic fascia, dissect out the inferior vesical 
 VEIN and trace it forwards to the prostatic plexus. Secure the 
 DORSAL VEIN OF THE PENIS, joining the plexus anteriorly. 
 
 Remove the fascial investments forming the sheath of the prostate 
 gland, and examine its position and relations in situ. Note its 
 connections below with the membranous urethra and the deep 
 layer of the triangular ligament. 
 
 ({) Membranous Urethra. 
 
 Define the deep and superficial layers of the triangular 
 LIGAMENT, and dissect out the structures between them : — 
 
 MEMBRANOUS URETHRA. 
 
 COWPER's GLAND. 
 
 COMPRESSOR URETHRffi MUSCLE. 
 
 INTERNAL PUDIC VESSELS AND NERVE AND THEIR BRANCHES. 
 
 DORSAL VEIN OF THE PENIS. 
 
 The PENIS has already been dealt with (p. 213). 
 
263 
 
264 DISSECTION OF THE ABDOMEN 
 
 In the female — 
 (g) Uterus. 
 Examine the position and relations of the uterus in situ. 
 Revise its peritoneal connections ; and the attachments of the 
 
 BROAD LIGAMENT. 
 
 Dissect out in relation to the uterus : — 
 
 URETER. 
 
 UTERINE ARTERY. 
 ROUND LIGAMENT. 
 OVARIAN LIGAMENT. 
 
 (h) Vagina and Urethra. 
 
 Examine in situ the position and relations of the urethra and 
 vagina. Note the relations of the vagina to the rectum behind, the 
 uterus, bladder and urethra above, and to the perineal body below. 
 
 Examine the course of the urethra and vagina : — 
 
 [a) In the pelvis — 
 in relation to the 
 
 LEVATOR ANl MUSCLE. 
 
 (6) Between the triangular ligaments — 
 in relation to the 
 
 COMPRESSOR URETHRiE MUSCLE. 
 
 INTERNAL PUDIC VESSELS AND NERVES AND THEIR BRANCHES. 
 
 BARTHOLIN'S GLAND. 
 
 (c) In the perineum — 
 in relation to the 
 
 BULB OF THE VAGINA. 
 SPHINCTER VAGINA MUSCLE. 
 VULVA (vestibule). 
 
265 
 
266 DISSECTION OF THE ABDOMEN 
 
 2. — Form and Structure of the Pelvic Viscera. 
 
 Remove the pelvic viscera and examine their structure. 
 
 (a) Rectum and Anal Canal. 
 
 Separate the rectum and anal canal from their connections, wash 
 out the canal, and make a vertical incision through its whole length 
 along its -posterior border, to show the interior of the cavity, and the 
 constrictions and folds in its walls, namely : — 
 
 RECTO-COLIC VALVE. 
 
 PLICA TRANSVERSALIS RECTI. 
 
 ANAL FOLDS AND VALVES. 
 
 (b) Bladder. 
 
 Open the cavity of the bladder, by an incision along its antero- 
 inferior wall and through the apex, to show its interior with the 
 
 RUGOSE MUCOUS MEMBRANE, 
 
 OPENINGS OF URETERS, 
 
 TRIGONE, 
 
 INTERNAL URINARY MEATUS, 
 
 UVULA. 
 
 Pass a -probe into the ureter to demonstrate its oblique passage 
 through the bladder wall. 
 
 (c) In the female — 
 
 Make a similar examination of the bladder, and then examine 
 THE URETHRA. Slit it up aloHg its dorsal surface to expose the 
 lumen of the tube. 
 
 (d) Prostate Gland. 
 
 Clean the surface of the gland to show its form and its fibrous coal. 
 
267 
 
268 DISSECTION OF THE ABDOMEN 
 
 (e) Male Urethra. 
 
 Open the urethra on its dorsal surface by carrying downwards 
 the incision made in the bladder wall, through the substance of the 
 prostate, to expose the prostatic urethra, and through the dorsal 
 wall of the membranous urethra. 
 
 Slit up the dorsum of the penis in the middle line from the external 
 urinary meatus to the membranous urethra, exposing the septum 
 PECTINIFORME between the corpora cavernosa, and the penile portion 
 of the urethra in the corpus spongiosum. 
 
 Examine the interior of the urethra, and note the following 
 points : — 
 
 (1) PROSTATIC URETHRA. 
 
 Direction, length and shape. 
 
 Verumontanum. 
 
 Sinus pocularis. 
 
 Common ejaculatory ducts. 
 
 Prostatic sinuses. 
 
 Prostatic glands and ducts. 
 
 (2) MEMBRANOUS URETHRA. 
 
 Direction, length and shape. 
 
 (3) PENILE PORTION OF THE URETHRA. 
 
 Sinus. 
 
 Fossa navicularis. 
 
 Ducts of Cowper's glands. 
 
 Lacunae. 
 
 External urinary meatus 
 
269 
 
270 DISSECTION OF THE ABDOMEN 
 
 In the female — 
 
 (f) Ovary, Fallopian Tube, Uterus and Vagina. 
 
 (i) BROAD LIGAMENT. Revisc the relations of structures con- 
 tained in the broad ligament. 
 
 (2) OVARY. Examine the position and relations of the ovary, 
 
 and define the 
 
 MESOVARIUM. 
 OVARIAN LIGAMENT. 
 TUBO-OVARIAN LIGAMENT. 
 OVARIAN VESSELS. 
 
 (3) FALLOPIAN TUBE. Examine the position and relations of the 
 
 Fallopian tube and mesosalpinx. 
 Note the 
 
 INFUNDIBULUM. 
 
 FIMBRLE. 
 
 TUBO-OVARIAN LIGAMENT. 
 
 CERVIX. 
 
 AMPULLA. 
 
 ISTHMUS. 
 
 (4) vestigial structures. Examine and dissect out the 
 
 HYDATID OF MORGAGNI. 
 
 EPOOPHORON. 
 
 PAROOPHORON. 
 
 (5) VESSELS. Follow the course and observe the anastomoses of 
 
 the uterine and ovarian arteries between the layers of the 
 
271 
 
272 DISSECTION OF THE ABDOMEN 
 
 (g) Uterus. 
 
 With scissors cut off the folds of peritoneum attached to the 
 uterus, preserving the attachments of the Fallopian tube, ovarian 
 and round ligaments, and leaving the peritoneum adherent to the 
 anterior and posterior surfaces and the fundus of the organ. 
 
 The bladder having been detached from the cervix in front, the 
 latter should be cleaned and defined. 
 
 Examine the form of the uterus — fundus, body, cervix. 
 
 Remove the anterior wall of the body of the uterus to show 
 
 ITS TRIANGULAR CAVITY, 
 
 THE ENDINGS OF THE FALLOPIAN TUBES, 
 
 THE RUGOSE MUCOUS MEMBRANE. 
 
 Remove the anterior wall of the cervix to show 
 
 ITS FUSIFORM CAVITY, 
 PLICS: PALMATE. 
 
 (hj Vagina. 
 
 Make a longitudinal incision through the dorsal wall of the vagina 
 and examine its interior, noting — 
 
 the vaginal part of the cervix, 
 
 the external os uteri, 
 
 the lateral, anterior and posterior fornices. 
 
 the length and shape of the tube. 
 
 columnae rugarum. 
 
273 
 
274 DISSECTION OF THE ABDOMEN 
 
 (i) Pelvic Floor and Wall. 
 
 (i) Divide the rectum from the anal canal, and define the pelvic 
 FLOOR, formed by the — 
 
 SYMPHYSIS PUBIS, 
 
 TRIANGULAR LIGAMENTS (and the structures between them). 
 
 PERINEAL BODY. 
 ANAL CANAL. 
 ANO-COCCYGEAL BODY. 
 
 (2) Clean the pelvic fascia clothing the pelvic wall, defining the 
 
 WHITE LINE and the various vascular foramina in the fascia. 
 
 (3) Remove the pelvic fascia clothing the pelvic wall; expose 
 
 and clean the following muscles :— 
 
 PYRIFORMIS, 
 OBTURATOR INTERNUS, 
 LEVATOR ANI, 
 ISCHIO-COCCYGEUS. 
 
 (4) Follow out the parietal branches of the internal iliac 
 
 ARTERY, and trace the anastomosis between the lateral 
 and middle sacral arteries. 
 
 (5) Clean the nerves on the pelvic wall. 
 
 PELVIC SYMPATHETIC. 
 
 ANTERIOR PRIMARY DIVISIONS OF THE SACRAL NERVES. 
 
 FORMATION OF PLEXUSES — SACRAL AND PUDENDAL. 
 
 (6) Detach the levator ani from its origin, and expose the 
 
 iscHio-RECTAL FOSSA. Remove the obturator layer of the 
 pelvic fascia after tracing the internal pudic vessels and 
 nerve through Alcock's canal, and expose more completely 
 
 the OBTURATOR INTERNUS MUSCLE. 
 
275 
 
276 DISSECTION OF THE ABDOMEN 
 
 X. Pelvic Articulations 
 
 Several of the ligaments of the pelvis have already been dealt with 
 
 during previous dissections, — 
 
 poupart's ligament. 
 
 gimbernat's ligament. 
 
 great and small sacro-sciatic ligaments. 
 
 ilio-lumbar ligament. 
 
 obturator membrane. 
 
 triangular ligaments. 
 
 a. vertebral articulations. 
 
 (i) Examine the articulations between the fifth lumbar vertebra 
 
 and the sacrum. 
 (2) Sacro-coccygeal ligaments. 
 
 B. SACRO-ILIAC LIGAMENTS. 
 
 Posterior. 
 Anterior. 
 
 The oblique ligament lies superficially on the surface of 
 the posterior ligament. 
 
 C. ACCESSORY VERTEBRO-PELVIC LIGAMENTS. 
 
 Ilio-lumbar. 
 
 Sacro- vertebral. 
 
 Sacro-sciatic (great and small). 
 
 D. SYMPHYSIS PUBIS. 
 
 Supra-pubic ligament. 
 Anterior ligament. 
 Posterior ligament. 
 Sub-pubic ligament. 
 Inter-articular fibro-cartilage. 
 
 Unless this has already been done, divide the fibro- 
 cartilage vertically in the middle line to show its 
 structure. 
 
 E. SPECIAL LIGAMENTS OF THE INNOMINATE BONE. 
 
 Poupart's ligament. 
 
 Gimbernat's ligament. 
 
 Obturator membrane. 
 
 Triangular ligament (superficial layer). 
 Divide the anterior and posterior sacro-iliac hgaments, and 
 disarticulate the innominate bone to see the inter-articular 
 fibro-cartilage and the joint-surfaces of the sacro-iliac 
 
 ARTICULATION. 
 
277 
 
278 DISSECTION OF THE ABDOMEN 
 
 Another Dissection of the Pelvis 
 
 The pelvis is to be detached from the trunk, the pelvic viscera 
 and their peritoneal connections are to be examined from above, 
 and the structures dissected out in the extra-peritoneal tissue, as 
 in the previous dissection (p. 251). 
 
 A. — A Medial Sagittal Section is made of the whole pelvis and its 
 contents in the following way : — 
 
 (i) Perineum. 
 
 Having inserted a catheter through the urethra into the 
 bladder, divide the penis into two lateral halves. Divide 
 the scrotum down the middle line into two lateral halves. 
 Slit up the perineum back to the anus. Divide the ano- 
 coccygeal body as far back as to the coccyx. 
 
 (2) The symphysis pubis is to be cut through. 
 
 (3) Sacrum and coccyx. 
 
 Saw through the sacrum and coccyx in the middle line 
 posteriorly. 
 
 (4) Pelvic viscera. 
 
 Continue the urethral incision through the membranous and 
 
 prostatic urethra, and the bladder, so as to divide each into 
 
 two lateral parts. 
 Divide the rectum and anal canal into lateral halves by 
 
 vertical incisions. 
 Each section should be washed out thoroughly, and examined 
 
 separately. 
 
 In the female a similar section is to be made : — 
 
 The vulva, urethra, vagina, and perineal body are to be divided 
 
 into lateral halves by a median incision. 
 The incision through the pelvic viscera includes the medial 
 
 section of the uterus, in addition to the bladder and rectum. 
 
279 
 
28o DISSECTION OF THE ABDOMEN 
 
 B. — Pelvic Viscera. 
 1. — Bladder and Urethra. Examine the position, relations and 
 structure of the bladder and urethra in each section. 
 
 (a) Dissect the peritoneum from the bladder wall, and remove 
 the extra-peritoneal tissue to display the following 
 structures : — 
 
 URACHUS. 
 
 URETER. 
 
 VAS DEFERENS. 
 
 VESICULA SEMINALIS. 
 
 VESICAL VESSELS. 
 
 OBLITERATED HYPOGASTRIC ARTERY. 
 
 OBTURATOR VESSELS AND NERVE. 
 
 {b) Clean the pelvic wall in the neighbourhood of the bladder 
 to demonstrate the connections of the neck of the bladder, 
 posteriorly, laterally and anteriorly. Draw the bladder 
 away from the pelvic wall and define the lateral and anterior 
 (pubo-prostatic) ligaments. 
 Define the suspensory ligament of the prostate gland, 
 and its relations to 
 
 RECTUM. 
 
 BLADDER. 
 
 PROSTATE. 
 
 VESICULA SEMINALIS AND 
 
 VAS DEFERENS. 
 
 URETER. 
 
 INFERIOR VESICAL VEIN. 
 
 In the female — 
 
 Examine the position, relations, and structure of the bladder 
 and urethra. 
 
 {a) Dissect the peritoneum from the bladder wall and remove 
 the extra-peritoneal tissue to display the 
 
 URACHUS. 
 
 URETER. 
 
 VESICAL VESSELS. 
 
 ROUND LIGAMENT OF THE UTERUS. 
 
 OBLITERATED HYPOGASTRIC ARTERY. 
 
 OBTURATOR VESSELS AND NERVE. 
 
 (6) Draw the bladder away from the pelvic wall and define 
 the lateral and anterior ligaments. Define the suspensory 
 hgament of the urethra and vagina. Separate the bladder 
 from the neck of the uterus. 
 
 Note the close connection of the urethra and vagina. 
 
28l 
 
282 DISSECTION OF THE ABDOMEN 
 
 2. — Pelvic Colon. Examine the position, and relations of the 
 pelvic colon, with the pelvic meso-colon and superior 
 HEMORRHOIDAL VESSELS. Note the junction of the colon 
 and rectum, and observe if present the recto-colic valve. 
 
 3. — Rectum and Anal Canal. Examine the position, relations 
 and structure of the rectum and anal canal, and note if 
 present : — 
 
 RECTO-COLIC VALVE, 
 PLICA TRANSVERSALIS, 
 ANAL FOLDS AND VALVES. 
 
 Note the relations of the anal canal in the pelvic floor to 
 the perineal body and the ano-coccygeal body. 
 
 (a) clean the wall of the rectum down to the pelvic floor, 
 removing the peritoneum and extra-peritoneal tissue, 
 and dissecting out its vessels, — superior and middle haemor- 
 rhoidal. 
 
 (b) rectal channel. Remove the extra-peritoneal tissue, 
 and clean the pelvic wall, to display the rectal channel, 
 bounded in front by the suspensory ligament of the prostate 
 gland, laterally by the pelvic wall and levator ani muscle, 
 — clothed in pelvic fascia, — and behind by the sacrum and 
 coccyx. 
 
 (c) Structures in the Lateral Pelvic Wall. 
 Dissect out in the lateral wall of the pelvis the 
 
 URETER, 
 
 INTERNAL ILIAC VESSELS AND THEIR BRANCHES, 
 
 PELVIC PLEXUS OF NERVES. 
 
 Secure the visceral nerves joining the plexus from the second 
 and third sacral nerves. 
 
283 
 
284 DISSECTION OF THE ABDOMEl^ 
 
 4. — Prostate Gland and Male Urethra. 
 
 (a) Dissect out the prostate gland within its sheath, defining 
 its position and relations. 
 
 Examine the prostatic urethra, noting its direction 
 and shape. 
 
 Clean the VAS deferens and vesicula seminalis, and 
 trace the common ejaculatory duct through the prostate 
 gland to its termination in the urethra (verumontanum) ; 
 observe the sinus pocularis. 
 
 (b) membranous urethra. Dissect out the membranous 
 urethra and display its relations and connections. 
 Secure cowper's gland, and the dorsal vein of the penis. 
 
 (c) penile portion of the urethra. Examine the course 
 of the urethra through the corpus spongiosum, noting the 
 sinus, fossa navicularis, and the ducts of Cowper's glands. 
 
 (d) sheath of the prostate gland. The prostate gland 
 should now be shelled out of its fascial sheath and re- 
 moved with the bladder. Its sheath is left, formed of the 
 following parts : — 
 
 (i) Behind and above by the suspensory ligament, 
 dividing to form posteriorly a recto-prostatic layer, and 
 superiorly the lateral true ligament of the Madder. 
 
 (2) Laterally by the pelvic fascia covering the levator ani. 
 
 (3) Below by the deep layer of the triangular hgament. 
 
 (4) Anteriorly by the pubo-prostatic ligament. 
 
 Note the several layers of this ligament, enclosing the pro- 
 static plexus of veins. 
 
 Trace the dorsal vein of the penis to the plexus, and the 
 inferior vesical vein from the plexus to the' internal 
 iliac vein. 
 
285 
 
286 DISSECTION OF THE ABDOMEN 
 
 In the female — 
 
 5. — Ovary, Fallopian Tube, Broad Ligament, Uterus, Vagina. 
 
 (a) Examine each section to see the form and relations of the 
 uterus and vagina. 
 
 Form. 
 
 UTERUS — 
 
 Fundus. 
 
 Body. 
 
 Cervix. 
 
 Vaginal portion of the cervix. 
 
 External os uteri. 
 
 VAGINA 
 
 Fornices, anterior, posterior and lateral. 
 Mucous membrane, columnas rugarum. 
 
 Relations. 
 
 UTERUS — 
 
 Peritoneal connections, 
 
 Utero-vesical folds and pouch. 
 
 Recto-uterine fold's and pouch (Pouch of Douglas). 
 
 BROAD LIGAMENT and structures contained between its layers. 
 Ovary. 
 
 Ovarian ligament. 
 Fallopian tube. 
 Round ligament. 
 Ovarian vessels. 
 Uterine vessels. 
 Ureter. 
 
 VESTIGIAL STRUCTURES — 
 
 Hydatid of Morgagni, 
 
 Epoophoron, 
 
 Paroophoron. 
 
 Note the relations of the cervix uteri to the bladder; and the 
 separation of both uterus and vagina from the rectum by 
 the pouch of Douglas. 
 
 VAGINA — 
 
 relations to the rectum and pouch of Douglas, behind ; 
 to the uterus, bladder, and urethra above ; 
 to the perineal body below. 
 The lateral relations of the vagina will be seen after it is 
 dissected. 
 
287 
 
?88 DISSECTION OF THE ABDOMEN 
 
 (6) DIVIDE THE PERITONEUM reflected from the rectum to the 
 vagina behind, and connecting the uterus to the bladder 
 in front. Trace the ovarian vessels and the round ligament 
 through the broad ligament; divide the ovarian vessels 
 at the pelvic brim ; cut through the attachments of the 
 broad ligament to the pelvic wall and floor, and draw it 
 with its contents away from the pelvic wall with the uterus. 
 
 (c) CLEAN THE PELVIC WALL AND FLOOR by removal of the 
 extra-peritoneal tissue and follow the course of the 
 
 URETER. 
 
 INTERNAL ILIAC VESSELS AND THEIR BRANCHES, PARIETAL AND 
 
 VISCERAL. 
 OBLITERATED HYPOGASTRIC ARTERY. 
 PELVIC PLEXUS OF NERVES. 
 
 (d) CLEAN THE PELVIC FASCIA Covering the lateral wall of the 
 pelvis and define : — 
 
 WHITE LINE. 
 
 SUSPENSORY LIGAMENT OF THE URETHRA AND VAGINA. 
 
 LATERAL 
 
 ANTERIOR 
 
 (e) SEPARATE THE URETHRA AND VAGINA from the lateral wall 
 and floor of the pelvis to see their course and lateral relations 
 to— 
 
 LEVATOR ANI. 
 
 LAYERS OF TRIANGULAR LIGAMENT AND COMPRESSOR URETHRJE. 
 
 BULB AND SPHINCTER VAGINAE. 
 
 (/) REMOVE THE UTERUS AND VAGINA with the broad hgament 
 and associated structures, and examine them as described 
 in the previous dissection (p. 270). 
 
 C. — PeMe Floor and Wall (see previous dissection, p. 274). 
 
 Pelvic Articulations (see previous dissection, p. 276). 
 
28g 
 
290 
 
 DISSECTION OF THE LOWER LIMB 
 
 ORDER OF DISSECTION 
 
 I. Buttock. 
 II. Popliteal Space. 
 
 III. Back of Thigh. 
 
 IV. Front and Inner Side of Thigh. 
 V. Back of Leg. 
 
 VI. Sole of Foot. 
 
 VII. Front and Outer Side of Leg, and Dorsum of Foot. 
 VIII. Articulations of Lower Limb. 
 
DISSECTION OF THE LOWER LIMB 291 
 
 The limb should be bandaged when the subject is brought into 
 the room. 
 
 The dissection of the buttock, popliteal space, and back of the 
 thigh is begun on the third day, and should be completed in a 
 week (five anatomical days). The buttock will occupy at least two 
 days, and the popliteal space will take more than one. These dis- 
 sections must be completed before the subject is placed on its back. 
 
 The dissection of the front and inner side of the thigh is begun 
 on the tenth day, -when the subject is placed on its back, and should be 
 completed in a week, so that the limb may be removed. 
 
 I. Buttock 
 A. Superficial Structuies. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. 2). 
 
 (3) Reflect the superficial fascia by means of the following 
 
 incisions (fig. 19) : — 
 
 A vertical incision along the middle line of the back. 
 
 A horizontal incision at the level of the crest of the ilium 
 
 from the middle line outwards. 
 An oblique incision down the centre of the space from the 
 
 level of the posterior superior iliac spine, to the interval 
 
 between the great trochanter and the tuber ischii. 
 Turn the flaps inwards and outwards, cutting right down to 
 
 the fibres of the gluteus maximus, and disregarding (at first) 
 
 the thin deep fascia. 
 
 Two cautions are necessary in the removal of the superficial fascia 
 in relation to the oblique borders of the gluteus maximus. The 
 upper and lateral border coincides with a sudden thickening of the 
 deep fascia, which should be left intact. The lower and medial 
 border should be defined from the origin to the insertion of the 
 gluteus maximus, and the knife should be kept closely applied to the 
 fibres of the muscle, so as to avoid injury to the small sciatic and 
 perforating cutaneous nerves, which wind round this border. 
 
Missing Page 
 
L 1, Uf 3. Lumbar nerves : posterior primary 
 
 divisions. 
 Si, z, 3. Sacral nerves : posterior primary 
 
 divisions. 
 
 1. Lateral branch of twelfth thoracic. 
 
 2. Lateral branch of ilio-hypogastric. 
 
 4. Ano-coccygeal. 
 
 5. Perineal branch of fourth sacral. 
 
 6. Perforating cutaneous. 
 
 7. Small sciatic 
 
 8. Lateral cutaneous of thigh. 
 
 FIG. 20. — CUTANEOUS NERVES OF THE BUTTOCK 
 294 
 
295 
 
296 DISSECTION OF THE LOWER LIMB 
 
 (3) Define the structures beneath the gluteus maximus. 
 
 (a) THREE BURS>E situated over the 
 
 ISCHIAL TUBEROSITY. 
 
 GREAT TROCHANTER. 
 
 TENDON OF THE VASTUS LATERALIS. 
 
 (b) BONES and ligaments — 
 
 ILIUM. 
 
 SACRUM AND COCCYX. 
 
 GREAT SACRO-SCIATIC LIGAMENT. 
 
 ISCHIAL TUBEROSITY. 
 
 GREAT TOCHANTER OF THE FEMUR. 
 
 (C) MUSCLES — 
 
 Those converging to the great trochanter. 
 
 GLUTEUS MEDIUS AND MINIMUS. 
 
 PYRIFORMIS. 
 
 OBTURATOR INTERNUS AND GEMELLI. 
 
 OBTURATOR EXTERNUS. 
 
 Those radiating from the ischium. 
 
 HAMSTRINGS. 
 QUADRATUS FEMORIS. 
 ADDUCTOR MAGNUS. 
 
 {d) Structures appearing in the intervals between the muscles. 
 (a) Between gluteus medius and pyriformis. 
 GLUTEAL ARTERY (superficial branch). 
 
 (6) Between pjnriformis and superior gemellus. 
 
 GREAT SCIATIC NERVE. 
 SMALL SCIATIC NERVE. 
 INTERNAL PUDIC NERVE. 
 INFERIOR GLUTEAL NERVE. 
 NERVE TO OBTURATOR INTERNUS. 
 NERVE TO QUADRATUS FEMORIS. 
 SCIATIC ARTERY. 
 INTERNAL PUDIC ARTERY. 
 
 (c) Between inferior gemellus and quadratus femoris. 
 
 TENDON OF OBTURATOR EXTERNUS. 
 
 MEDIAL CIRCUMFLEX ARTERY (ascending branch). 
 
 (d) Between quadratus femoris and adductor magnus. 
 
 MEDIAL CIRCUMFLEX ARTERY (termination). 
 
 (4) Clean the gluteus medius muscle and then reflect it from 
 
 its origin to expose — 
 
 GLUTEUS MINIMUS MUSCLE. 
 SUPERIOR GLUTEAL NERVE. 
 DEEP BRANCH OF THE GLUTEAL ARTERY. 
 
 (5) Clean the gluteus minimus muscle, and reflect it from its 
 
 origin to expose — 
 
 DORSUM ILII. 
 
 CAPSULE OF THE HIP JOINT. 
 
 REFLECTED HEAD OF ORIGIN OF THE RECTUS FEMORIS MUSCLE. 
 
297 
 
298 
 
DISSECTION OF THE LOWER LIMB 299 
 
 II. Popliteal Space 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. 2). 
 
 (3) Reflect the superficial fascia from the middle line inwards 
 
 and outwards as far as possible to expose : — 
 
 (a) Cutaneous nerves (fig. 21). 
 
 SMALL SCIATIC. 
 
 SURAL BRANCHES OF THE PERONEAL. 
 
 LONG SAPHENOUS. 
 
 MEDIAL CUTANEOUS. 
 
 (b) Cutaneous vessels. 
 
 LONG AND SHORT SAPHENOUS VEINS. 
 
 (c) Deep (popliteal) fascia. 
 
 (4) Reflect the deep fascia from the middle line inwards and 
 
 outwards as far as possible, and define and clean : — 
 («) The muscles bounding the popliteal space, — 
 
 BICEPS. 
 
 SEMI-TENDINOSUS. 
 
 SEMI-MEMBRANOSUS. 
 
 TWO HEADS OF THE GASTROCNEMIUS. 
 
 PLANTARIS. 
 
 (b) Sartorius and gracilis muscles, and the following 
 vessels and nerves : — 
 
 LONG SAPHENOUS NERVE, WITH ITS INFRA-PATELLAR BRANCH. 
 LONG SAPHENOUS VEIN. 
 
 ANASTOMOTIC ARTERY {superficial branch). 
 These structures should be carefully dissected before the space 
 itself and its contents are defined. 
 
 (5) Clean the contents of the space — 
 
 PERONEAL NERVE \ 
 
 ''^^l^l^f^.l^.^ \ and their branches. 
 
 POPLITEAL ARTERY j 
 POPLITEAL VEIN j 
 
 (6) Define the structures forming the floor of the space — 
 
 Popliteal surface of the femur. 
 
 Posterior ligament of the knee-joint. 
 
 PoPLiTEUS MUSCLE covcred by the popliteus fascia. 
 
V- 
 
 ^/J//t 
 
 X 
 
 femoral branches. 
 terminal branches. 
 
 6. Long saphenous. 
 
 7. PeroAeal : sural branches. 
 
 8. Short saphenous. 
 
 9. Tibial nerve : calcanean branch 
 
 1. Small sciatic : 
 
 2. Small sciatic : 
 
 3. Obturator. 
 
 4. Medial cutaneous. 
 
 5. Long saphenous : infra-patellar branch. 
 
 FIG. 21. — CUTANEOUS NERVES OF THE POPLITEAL SPACE AND BACK OF THE LEG 
 
 300 
 
301 
 
302 DISSECTION OF THE LOWER LIMB 
 
 III. Back of Thigh 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. 2). 
 
 (3) Remove the superficial fascia to expose the branches of the 
 
 SMALL SCIATIC NERVE (fig. 22). 
 
 (4) Reflect the deep fascia to expose : — 
 
 Trunk of the small sciatic nerve. 
 Lateral intermuscular septum. 
 
 HAMSTRING MUSCLES. 
 GREAT SCIATIC NERVE. 
 
 (5) Clean and define : — 
 
 {a) Hamstring muscles, and the nerves which supply them. 
 
 (b) Great sciatic nerve, and its component parts ; 
 
 peroneal nerve with its branches to the biceps 
 
 (short head) and the knee-joint. 
 TIBIAL nerve with its branch to the hip-joint. 
 nerve TO hamstring muscles. 
 Dissect out the branches of these nerves. 
 
 (6) Divide the following muscles, below the point of entrance 
 
 of their nerves, — 
 BICEPS {long head), 
 
 SEMI-TENDINOSUS, 
 
 to expose the membranous origin of the semi-mem- 
 branosus. 
 
 (7) Divide the semi-membranosus muscle below the entrance 
 
 of its nerve, to expose and clean : — 
 
 (a) QUADRATUS FEMORIS MUSCLE. 
 
 (6) Termination of the medial circumflex artery. 
 
 (c) ADDUCTOR MAGNUS MUSCLE and the structures which 
 
 pierce it, viz. — 
 
 PERFORATING ARTERIES. 
 
 MUSCULAR BRANCHES OF THE PROFUNDA FEMORIS ARTERY. 
 
 POPLITEAL VESSELS. 
 
 OBTURATOR NERVE (GENICULATE BRANCH). 
 
1. Lateral cutaneoiis of thigh. 
 
 2. Small sciatic : gluteal branches. 
 
 3. Small sciatic : femoral branches. 
 
 4. Small sciatic : terminal branches. 
 3. Obturator. 
 
 6. Medial cutaneous. 
 
 7. I^ng saphenous : Infra-patellar branch. 
 
 8. Long saphenous. 
 
 9. Peroneal : sural branches. 
 
 PIG. 22. — CUTANEOUS NERVES OF THE BACK OF THE THIGH AND 
 POPLITEAL SPACE 
 
304 
 
DISSECTION OF THE LOWER LIMB ' 305 
 
 IV. Front and Inner Side of Thigh 
 A. Superficial Dissection. 
 
 1. Landmarks and surface anatomy. 
 
 2. Skin incisions and reflection of the skin (fig. i). 
 
 3. Superficial Fascia of the Groin 
 
 [to be examined in conjunction with the dissectors of the 
 abdomen']. 
 
 (a) SUPBRFICIAL LAYER. 
 
 Make a crucial incision (a, b, c, d) through the superficial 
 fatty layer of the fascia, with one limb oblique, and extend- 
 ing along the Une of Poupart's ligament ; the other limb 
 vertical, and crossing the first one about its centre (fig. 
 16). Four flaps of the fatty layer are then to be turned 
 aside to expose: — 
 
 (a) superficial vessels. 
 Arteries — 
 
 Superior external pudic. 
 
 Superficial epigastric. 
 
 Superficial circumflex iliac. 
 Veins — 
 
 Long saphenous. 
 
 Branches corresponding to the small arteries (by 
 dissecting which downwards the student will be 
 guided to the long saphenous vein). 
 
 (b) inguinal and femoral lymphatic glands. 
 
 (c) ilio-inguinal NfiRVE (passing through the external abdomi- 
 
 nal ring). 
 
 (d) spermatic cord. 
 
 (e) femoral branch of the genito-femoral nerve. 
 
 (6) deep layer. 
 
 A transverse incision (c, e) shoUld next be made through 
 the whole thickness of the superficial fascia of the anterior 
 abdominal wall down to the aponeurosis of the obliquus 
 abdominis externus, extending horizontally inwards from the 
 anterior superior spine of the ilium to the middle Une, and 
 a vertical incision (e, d) from the inner end of the proceed- 
 ing one to the symphysis pubis. Insinuate the handle 
 of the knife beneath the membranous deep layer of the 
 fascia, and raise it up to see its attachments to Poupart's 
 ligament and the fascia lata of the thigh. FoUow the 
 fascia down over the spermatic cord into the scrotum, care 
 being taken of the ilio-hypogastric and ilio-inguinal 
 NERVES, which wiU be found emerging through the apo- 
 neurosis of the obliquus abdominis externus and the 
 external abdominal ring respectively, 
 u 
 
FIG. I6. — DISSECTION OF SUPERFICIAL FASCIA OF GROIN 
 
 306 
 
307 
 
3o8 DISSECTION OF THE LOWER LIMB 
 
 4. Superficial Structures on the Front and Inner Side of the TMgh. 
 
 Remove the superficial fascia from the whole of the front 
 and inner side of the thigh to expose : — 
 
 (i) Long saphenous vein and its branches, 
 (ii) Cutaneous nerves (fig. 23). 
 
 ILIO-INGUINAL NERVE. 
 
 FEMORAL BRANCH OF THE GENITO-FEMORAL NERVE. 
 
 LATERAL CUTANEOUS NERVE. 
 
 TWO MIDDLE CUTANEOUS NERVES. 
 
 THREE BRANCHES OF THE MEDIAL CUTANEOUS NERVE. 
 
 LONG SAPHENOUS NERVE WITH ITS INFRA-PATELLAR BRANCH. 
 
 OBTURATOR PLEXUS. 
 
 (iii) Fascia lata, noting its relations, — 
 (a) In the neighbourhood of the patella, defining the lateral 
 
 PATELLAR LIGAMENTS. 
 
 (j8) On the outer side of the thigh, defining the ilio-tibial 
 
 BAND. 
 
 5. Saphenous Opening. 
 
 (a) Define the saphenous opening and the cribriform fascia. 
 
 (6) Cut away from Poupart's ligament the attachments of 
 the falciform ligament, and turn the latter outwards 
 to expose the femoral sheath and its contents 
 (fig. 24). 
 
 FEMORAL ARTERY. 
 
 FEMORAL VEIN. 
 
 LYMPHATICS (iN THE CRURAL CANAL). 
 
I. Ilio-hypogastric. 
 2 Iliomguunal. 
 
 3. Genito-femoral (femoral branch). 
 
 4. Lateral cutaneous of thigh. 
 
 5. 5. Middle cutaneous. 
 
 6. Medial cutaneous : . upper branch. 
 
 7. Medial cutaneous : intermediate brauch, 
 
 8. Medial cutaneous : lower branch, 
 g. Obturator. 
 
 10. Long saphenous : infra-patellar branch, 
 iz. Long saphenous. 
 
 FIG. 23. SUPERFICIAL STRUCTURES ON THE FIlpNT AND INNER SIDE OF 
 
 THE THIGR 
 
FJG, 24. — FEMORAL SHEATH 
 
 310 
 
3" 
 
312 DISSECTION OF THE LOWER LIMB 
 
 B. Sartoiius and Tensor Faseise Latse Muscles, and the Ilio-tibial Band. 
 
 (1) SARTORIUS MUSCLE. 
 
 (a) Clean the muscle from origin to insertion preserving — 
 
 The nerves supplying it. 
 
 The subsartorial fascia (covering Hunter's canal). 
 (&) Note the relations of the muscle to 
 
 Other muscles, at its insertion. 
 
 The cutaneous nerves of the thigh. 
 
 LATERAL CUTANEOUS. 
 
 MIDDLE CUTANEOUS. 
 
 MEDIAL CUTANEOUS. 
 
 LONG SAPHENOUS AND ITS INFRA-PATELLAR BRANCH. 
 
 OBTURATOR. 
 
 (c) Note how the muscle is related to the different segments 
 of the thigh, — 
 In its upper third to Scarpa's triangle. 
 In its middle third to Hunter's canal. 
 In its lower third to the inner side of the knee. 
 
 (2) TENSOR FASCI.E LAT^ MUSCLE. 
 
 Clean the muscle, secure the vessels and nerve entering its 
 under surface, and note its relation to the glutei muscles. 
 
 (3) ILIO-TIBIAL BAND. 
 
 Define the ilio-tibial band together with the fascial layer passing 
 from its under surface to the capsule of the hip-joint. 
 
 By means of the sartorius and tensor fascia latse muscles and the 
 ilio-tibial band, the front of the thigh is divided into two areas — 
 Scarpa's triangle, on the medial side of the sartorius, and the area 
 occupied by the quadriceps muscle lateral to the sartorius and medial 
 to the tensor faseise latse and ilio-tibial band. 
 
313 
 
315 
 
3i6 DISSECTION OF THE LOWER LIMB 
 
 D. Hunter's Canal. 
 
 (i) Turn aside the sartorius muscle, make a vertical incision 
 through the subsartorial fascia, and turn it aside to 
 show its attachment to the muscles bounding Hunter's 
 canal. 
 
 (2) Define 
 
 The boundaries of the canal. 
 The contents — 
 
 FEMORAL VESSELS and branches. 
 
 LONG SAPHENOUS NERVE. 
 
317 
 
3i8 DISSECTION OF THE LOWER LIMB 
 
 E. Quadriceps Femoris Muscle. 
 
 (i) Separate and clean the various parts of the muscle and secure 
 the nerve supplying each. 
 
 (2) Trace the course of the lateral circumflex artery and its 
 
 branches. 
 
 (3) Define the lower (lateral) border of the vastus lateralis 
 
 MUSCLE, divide the muscle across its middle, and turn the 
 parts aside so as to expose the vastus intermedius 
 MUSCLE beneath it. 
 
 {4) Separate the vastus intermedius and vastus medialis so 
 as to expose the bare area of the femur covered by the 
 latter muscle. 
 
I. lUo-hypogastric, 
 
 2 Ilio-inguinal. 
 
 3. Genito-femoral (femoral branch). 
 
 4- Lateral cutaneous of thigh. 
 
 3) 5< Middle cutaneous. 
 
 6. Medial cutaneous : upper branch. 
 
 7. Medial cutaneous : intermediate branch, 
 
 8. Medial cutaneous : lower branch. 
 
 9. Obturator. 
 
 10. Long saphenous : infra-patellar branch, 
 XI. Long saphenous. 
 
 FIG. 23. — SUPERFICIAL STRUCTURES ON THE FRONT AND INNER SIDE OF 
 
 THE THIGH 
 
320 
 
DISSECTION OF THE LOWER LIMB 331 
 
 F. Inner Side of the Thigh. 
 
 (i) Clean the gracilis muscle from origin to insertion, and 
 secure its nerve (from the obturator nerve). 
 Define the interval between the gracihs and adductor longus 
 muscles, and secure the terminal cutaneous branch of the 
 superficial part of the obturator nerve, emerging through 
 this interval. 
 
 (2) Clean the adductor longus muscle from origin to insertion, 
 
 and secure its nerve. 
 Define the interval between the adductor longus and pectineus 
 muscles and expose : — 
 
 SUPERFICIAL PART OF THE OBTURATOR NERVE. 
 ADDUCTOR BREVIS MUSCLE. 
 
 (3) Clean the pectineus muscle and secure its nerve. 
 
 (4) Divide the pectineus, and adductor longus muscles, 
 
 below the entrance of their nerves, and turn them up to 
 expose more completely 
 
 ADDUCTOR BREVIS MUSCLE. 
 
 SUPERFICIAL PART OF THE OBTURATOR NERVE. 
 
 (5) Clean the adductor brevis muscle from origin to insertion 
 
 and secure its nerve. 
 
 (6) Trace the course of the 
 
 {a) superficial division of the obturator nerve. 
 
 (&) PROFUNDA FEMORIS ARTERY AND VEIN. 
 
 (7) Divide the adductor brevis muscle, below the entrance of its 
 
 nerve, and turn it up, together with the superficial division 
 of the obturator nerve, to expose the following structures : — 
 (a) MEDIAL CIRCUMFLEX ARTERY and its branches, 
 
 (6) DEEP DIVISION OF THE OBTURATOR NERVE. 
 
 (c) PROFUNDA FEMORIS ARTERY, with its perforating and 
 
 muscular branches. 
 
 (d) OBTURATOR EXTERNUS MUSCLE. 
 
 (e) ADDUCTOR MAGNUS MUSCLE, noting the relations of the 
 
 origin of this muscle to the origins of the adductor brevis 
 and obturator externus muscles. 
 
322 
 
DISSECTION OF THE LOWER LIMB 323 
 
 G. Disseetion of the Hip-joint and Removal of the Limb. 
 
 (a) Dissection to expose the capsule of the hip-joint. 
 
 (i) Divide the femoral vessels and the femoral nerve near 
 Poupart's ligament. Turn them downwards to expose the 
 psoas and iliacus muscles. 
 
 (2) Follow the psoas and iliacus muscles to their insertions and 
 then divide them at the level of Poupart's ligament, and 
 turn them aside to expose the capsule of the hip joint. 
 
 (b) Examine the capsule of the hip joint. 
 (i) Define its special hgaments, — 
 
 ILIO-FEMORAL. 
 
 PUBO-FEMORAL. 
 
 ILIO-TROCHANTERIC. 
 
 (2) Open the capsule of the joint and examine 
 
 CONTENTS OF CAVITY. 
 
 LIGAMENTUM TERES. 
 
 COTYLOID LIGAMENT, and TRANSVERSE LIGAMENT. 
 
 (3) Rotate outwards the head of the femur and divide the 
 ligamentum teres, and the posterior part of the capsule. 
 
 (c) Trace to the trochanteric fossa 
 
 TENDON OF THE OBTURATOR EXTERNUS MUSCLE. 
 ASCENDING BRANCH OF THE MEDIAL CIRCUMFLEX ARTERY. 
 
 (d) Remove the obturator externus muscle from its origin to display 
 
 the course of the obturator artery. 
 
 (e) Divide the remaining muscles and remove the limb. 
 
 After removal of the limb, revise the attachments of muscles 
 to the innominate bone, the femur, and the upper ends of 
 the tibia and fibula. 
 
324 
 
DISSECTION OF THE LOWER LIMB 325 
 
 V. Back of Leg 
 
 A. Superfleial Struetures. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. 2). 
 
 (3) Make a medial incision in the superficial fascia, and turn it 
 
 aside in two flaps, from the back of the leg, the ankle, 
 and the heel, to expose the following structures, — 
 [a) Cutaneous nerves (fig. 21). 
 
 LONG and SHORT SAPHENOUS. 
 
 TERMINAL BRANCHES of the SMALL SCIATIC. 
 
 SURAL BRANCHES of the PERONEAL. 
 
 CALCANEAN BRANCH of the POSTERIOR TIBIAL (piercing the medial 
 annular ligament). 
 
 (6) Long and short saphenous veins. 
 
 (c) Deep fascia, defining the medial and lateral annular 
 
 LIGAMENTS. 
 
 B. Superficial Muscles. 
 
 (i) Define the upper border of each annular Ugament, and the 
 structures passing beneath it. Note the part played in the 
 formation of the medial annular Ugament, by the se^ptal 
 layer of the deep fascia, intervening between the superficial 
 and deep muscles. 
 
 (2) Remove the deep fascia of the leg above the annular ligaments, 
 
 and clean the superficial muscles, — 
 
 GASTROCNEMIUS. 
 TENDO ACHILLIS. 
 PLANTARIS. 
 SOLEUS. 
 
 (3) Divide the belUes of the gastrocnemius muscle, and the 
 
 PLANTARIS muscle, below the entrance of their nerves and 
 vessels, to expose more completely the soleus muscle. 
 Note— 
 
 NERVE ENTERING ITS SUPERFICIAL SURFACE. 
 
 FIBROUS ARCH Covering the tibial vessels and nerve. 
 
 EXTENT OF THE INSERTION OF ITS MUSCULAR FIBRES intO the 
 
 tendo achillis, 
 
"■/m 
 
 1. Small sciatic : femoral branches. 
 
 2. Small sciatic : terminal branches. 
 
 3. Obturator. 
 
 4. Medial cutaneous. 
 
 3 . Long sapheooua : infra-patellar branch. 
 
 6. Long saphenous. 
 
 7. Peroneal : sural branches. 
 
 8. Short saphenous. 
 
 g. Tibial nerve : calcanean branch. 
 
 FIG. 
 
 21. — CUTANEOUS NERVES OF THE POPLITEAL SPACE AND BACK 
 OF THE LEG 
 
 326 
 
327 
 
328 DISSECTION OF THE LOWER LIMB 
 
 C. Deep Muscles of the Back of the Leg, with the Tibial Vessels and 
 
 Nerve. 
 
 (i) Detach the soleus muscle from its origin from the tibia and 
 turn it outwards to expose : 
 The nerve entering the deep aspect of the muscle. 
 The septal layer of deep fascia covering the deep muscles. 
 
 (2) Remove the septal layer of the deep fascia to expose : 
 
 FLEXOR LONGUS DIGITORUM. 
 TIBIALIS POSTERIOR. 
 FLEXOR LONGUS HALLUCIS. 
 TIBIAL VESSELS AND NERVE. 
 
 (3) Clean the deep muscles : — 
 
 {a) Popliteus muscle, noting its fascia, derived from the 
 tendon of the semi-membranosus muscle, and its relation to 
 vessels and nerves. The origin of the muscle will he exposed 
 later in relation to the dissection of the knee-joint (p. 346). 
 
 (b) FLEXOR LONGUS DIGITORUM, TIBIALIS POSTERIOR, and 
 
 FLEXOR LONGUS HALLUCIS muscles, following their teiidons 
 as far as the upper border of the medial annular ligament. 
 
 D. Tibial Vessels and Nerve. 
 
 {a) Dissect out the anterior tibial vessels, as they proceed 
 forwards between the two heads of origin of the tibialis 
 posterior muscle. 
 Secure the following branches of the artery : — 
 
 SUPERIOR FIBULAR. 
 POSTERIOR TIBIAL RECURRENT. 
 
 (b) Clean the posterior tibial vessels and tibial nerve 
 and their branches, as far down as the medial annular 
 ligament. Note that the peroneal artery occupies a 
 fibrous canal between the origins of the tibiahs posterior 
 and flexor longus hallucis, and is accompanied by the 
 nerve to the latter muscle. 
 
329 
 
330 DISSECTION OF THE LOWER LIMB 
 
 VI. Sole of the Foot 
 . Superficial Structures. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin. 
 
 (3) Reflect the superficial fascia in two flaps by a median incision 
 
 from the heel to the middle toe, down to the level of the 
 PLANTAR FASCIA, which should be cleaned in the process. 
 
 During this dissection expose 
 
 Cutaneous vessels. 
 
 Cutaneous nerves (fig. 25). 
 
 Branches of lateral and medial plantar nerves to the sole of 
 
 the foot. 
 digital branches to the toes. 
 
 These for the most part pierce the plantar fascia at the level of 
 the balls of the toes, but the branches to the lateral side of the little 
 toe and to the medial side of the great toe, pierce the fascia on 
 each side about the middle of the foot. 
 
 PLANTAR FASCIA. 
 
 Make a longitudinal incision on each side of the thick central 
 portion, to see the intermuscular septa. 
 
1. Branch of medial plantar nerve to medial 
 
 side of great toe. 
 
 2, 2, 2. Digital blanches of medial plantar nerve. 
 
 3. Branch of lateral plantar nerve to lateral 
 
 side of little toe. 
 
 4. Digital branch of lateral plantar nerve. 
 
 FIG. 25. — SOLE OF THE FOOT 
 
 331 
 
332 
 
DISSECTION OF THE LOWER LIMB 333 
 
 B. First Layer of Muscles. 
 
 (i) Reflect the plantar fascia as follows : — 
 
 (a) Pass the knife under the central portion and cut horizon- 
 tally backwards to the heel, keeping close to the fascia, so 
 as to detach it from the subjacent flexor brevis digitorum 
 MUSCLE. Detach the fascia from the heel and turn it 
 forwards. 
 
 (b) Separate the thin lateral parts of the fascia from the sub- 
 jacent adbuctor hallucis and abductor digiti quinti 
 muscles, noting — 
 
 (a) On the medial side — 
 The connection of the fascia with the medial annular 
 hgament and with the fascia on the dorsum of the 
 foot. 
 
 (yS) On the lateral side — 
 Its connection with the calcaneo-metatarsal ligament. 
 
 (2) Clean the first layer of muscles. 
 
 FLEXOR BREVIS DIGITORUM. 
 ABDUCTOR DIGITI QUINTI. 
 ABDUCTOR HALLUCIS. 
 
 (3) Define the plantar vessels and nerves, in the intervals 
 
 between the muscles, and secure the branches to the 
 muscles. 
 
334 
 
DISSECTION OF THE LOWER LIMB 335 
 
 Second Layer of Muscles, with the Plantar Vessels and Nerves. 
 
 (i) Detach the origins of the first layer of muscles from the os 
 calcis and turn them aside. 
 
 (2) Dissect out the plantar vessels and nerves, securing their 
 
 muscular and cutaneous branches, and the deep branches 
 of the lateral plantar artery and nerve. 
 
 (3) Clean the second layer of muscles — 
 
 FLEXOR LONGUS HALLUCIS, 
 FLEXOR LONGUS DIGITORUM, 
 FLEXOR ACCESSORIUS, 
 LUMBRICALES, 
 
 securing the nerves to the two last-named series of muscles. 
 
 {4) Trace the tendons backwards and forwards; see their con- 
 nections with one another, examine the digital sheaths, 
 and open them up to see the final insertions of the 
 flexors of the toes. 
 
336 
 
DISSECTION OF THE LOWER LIMB 337 
 
 D. Third Layer of Muscles. 
 
 (i) Divide the accessorius muscle and the tendons of the 
 FLEXORS OF THE TOES, and turn forwards the second layer 
 of muscles, preserving the whole of the lateral plantar 
 
 ARTERY AND NERVE. 
 
 (2) Clean the third layer of muscles and secure their nerves, — 
 
 FLEXOR BREVIS HALLUCIS. 
 
 FLEXOR BREVIS DIGITI QUINTI. 
 
 ADDUCTOR HALLUCIS (TRANSVERSE AND OBLIQUE HEADS). 
 
 E. Fourth Layer of Muscles, and the Plantar Arch. 
 
 (i) Detach the adductor (obliquus) hallucis muscle from 
 
 its origin to expose : — 
 plantar arterial arch and its branches. 
 DORSALis PEDIS ARTERY, and its branches in the sole of the 
 
 foot. 
 Deep branch of the lateral plantar nerve. 
 
 (2) Clean the fourth layer of muscles : — 
 
 plantar and dorsal interossei. 
 
 (3) Define the deep transverse metatarsal ligament. 
 
 F. Lisertions of Tibialis Posterior and Peroneus Longus. 
 
 Follow out to their insertions in the sole of the foot the tendons of 
 
 TIBIALIS POSTERIOR, 
 
 PERONEUS LONGUS. 
 
338 
 
DISSECTION OF THE LOWER LIMB 339 
 
 VTI. Front and Outer Side of Leg, and 
 Dorsum of Foot 
 
 A. Superficial Dissection. 
 
 (i) Landmarks and surface anatomy. 
 
 (2) Skin incisions and reflection of the skin (fig. i). 
 
 (3) Reflect the superficial fascia in two lateral flaps to expose 
 
 (fig. 26)- 
 
 LONG SAPHENOUS VEIN AND NERVE. 
 SHORT S.\PHENOUS VEIN AND NERVE. 
 
 ARCH OF SUPERFICIAL VEINS OH the dorsum o£ the foot. 
 
 SURAL BRANCHES OF THE PERONEAL NERVE. 
 
 MUscuLO-cuTANEOUS NERVE and its branches to the toes. 
 ANTERIOR TiBi.AL NERVE (in the clcft between the first and second 
 toes). 
 
 DEEP FASCIA. 
 
 (4) Clean the deep fascia, noting its relations — 
 [a) Below the knee-joint. 
 
 {b) At the ankle. 
 
 Define the annular ligaments, two anterior and one 
 lateral. 
 
 B. Front of the Leg (Extensor Compartment). 
 
 Divide the deep fascia on the front of the leg by a vertical incision, 
 extending to the upper border of the anterior annular ligament. 
 Turn aside two flaps to expose the extensor compartment, con- 
 taining — 
 
 (a) Extensor muscles. 
 
 TIBIALIS ANTERIOR. 
 
 EXTENSOR LONGUS DIGITORUM and PERONKUS TERTIUS. 
 
 EXTENSOR LONGUS HALLUCIS. 
 
 In removing the deep fascia in this region it must be 
 remembered that it gives origin to the muscles in the upper 
 third of the leg. 
 (6) anterior tibial vessels and nerve, and their branches. 
 
V 
 
 ,o 
 
 ■~\1 
 
 Long sapbenous. 
 
 Long saphenous : infra -p at iMlar branch. 
 
 Musculo -cutaneous 
 Anterior tibial. 
 
 26, — CUTANEOUS NERVES OF THE FRONT OF LEG AND DORSUM OF FOOT 
 
341 
 
342 DISSECTION OF THE LOWER LIMB 
 
 C. Dorsum of the Foot. 
 
 (i) Remove the deep fascia, between and below the anterior 
 annular ligaments to expose 
 
 TENDONS ON THE DORSUM OF THE FOOT AND TOES. 
 EXTENSOR BREVIS DIGITORUM MUSCLE. 
 EXTENSOR BREVIS HALLUCIS. 
 DORSALIS PEDIS ARTERY. 
 ANTERIOR TIBIAL NERVE. 
 
 (2) Detach the extensor brevis digitorum from its origin, 
 
 and turn it aside, and trace the branches of the dors.^lis 
 
 PEDIS ARTERY, and ANTERIOR TIBIAL NERVE. 
 
 (3) Define the attachments of the dorsal interossei muscles 
 
 and the insertions of the lumbricals and interossei. 
 
 (4) Divide the anterior annular ligaments to see the synovial 
 
 sheaths of the extensor tendons. 
 
343 
 
344 DISSECTION OF THE LOWER LIMB 
 
 D. Outer Side of the Leg (Peroneal Compartment). 
 
 (l) Divide the deep fascia on the outer side of the leg by a 
 vertical incision carried down to the lateral annular 
 ligament. Turn the fascia aside to expose the peroneal 
 compartment containing — 
 
 (a) The peronei muscles. 
 
 PERONEUS LONGUS AND BREVIS. 
 
 These should be cleaned and their tendons traced 
 beneath the lateral annular ligament to the outer side 
 of the foot. 
 
 (6) Trace the musculo-cutaneous, anterior tibial and 
 RECURRENT TIBIAL NERVES, from their origin from the 
 peroneal nerve, under cover of the muscles at the 
 upper end of the fibula, to the front of the leg. 
 FoUow the MUSCULO-CUTANEOUS NERVE through the septum 
 between the extensor and peronei muscles. 
 
345 
 
34& DISSECTION OF THE LOWER LIMB 
 
 VIII. Articulations of the Lower Limb 
 
 A. Hip-joint. 
 
 This has ah'eady been dealt with (p. 323). 
 
 B. Knee-joint. 
 
 (i) Revise the relations of muscles, tendons, vessels and nerves 
 to the joint. 
 
 (2) Clean the capsule, and define the attachments of the following 
 
 muscles in the neighbourhood of the joint : — 
 
 QUADRICEPS FEMORIS. 
 
 BICEPS. 
 
 SEMI-MEMBRANOSUS. 
 
 SEMI-TENDINOSUS. 
 
 GRACILIS. 
 
 SARTORIUS. 
 
 ADDUCTOR MAGNUS. 
 
 GASTROCNE.MIUS. 
 
 PLANIARIS. 
 
 POPLITEUS. 
 
 (3) Display the following structures : — 
 
 .INTERIOR PART OF THE CAPSULE. 
 
 EXTERNAL LATER.\L LIGAMENTS (LONG AKD SHORT). 
 
 INTERNAL LATERAL LIGAMENT. 
 
 POSTERIOR LIGAMENT. 
 
 Note the relation of the inferior articular arteries, to 
 the internal, and to the long external lateral ligaments. 
 
 (4) Dissect out the lateral ligaments to show that they are distinct 
 
 from the capsule. 
 
DISSECTION OF THE LOWER LIMB 347 
 
 (5) The following incisions should now be made : — 
 
 [a) A transverse incision through the quadriceps muscle four 
 
 inches above the patella. 
 (6) Two vertical incisions through the vasti muscles from 
 either extremity of the above, extending downwards 
 to the tibia in front of each lateral ligament. 
 The anterior part of the capsule should now be turned down 
 to expose — 
 
 SUBRECXAL BURSA, 
 
 SYNOVIAL MEMBRANE o£ the joint. 
 
 (6) Open the synovial membrane to expose — 
 
 SYNOVI.\L CAVITY, 
 
 UGAMENIUM MUCOSUM, 
 
 LIGAMENTA ALARIA, 
 
 ARTICULAR SURFACES of the FEMUR, PATELLA, and TIBIA ; the 
 
 latter partially covered by the semilunar cartilages. 
 
 (7) Remove the mucous and alar ligaments and examine the 
 
 insertion of the ligamentum patella. 
 
 (8) Dissect out the crucial ligaments, after removal of the 
 
 POSTERIOR ligament of the joint. Note their relations 
 to the synovial membrane. 
 
 (9) Examine the semilunar cartilages, noting — 
 (a) Coronary ligaments. 
 
 (6) Attachments of their anterior and posterior ligaments. 
 
 (c) Trans\'erse ligament. 
 
 {d) Relation of the tendon of the popliteus to the lateral 
 
 semilunar cartilage. 
 {e) Relation of the internal lateral ligament to the medial 
 
 semilunar cartilage. 
 
 (10) Divide the crucial ligaments to see their attachments, 
 
 and dissect out the semilunar cartilages completely, 
 to see their relations and attachments. 
 
 C. Ankle-joint. 
 
 (i) Revise the relations of tendons, vessels and nerves to the 
 
 joint, in front, behind, and laterally. 
 (2) Define the capsule, including 
 
 anterior LIGAMENT. 
 POSTERIOR LIGAMENT. 
 
 LATERAL LIGAMENTS, noting especially the attachments ot 
 these to the bones of the leg and foot. 
 
 ('3) Open the capsule in front to expose 
 
 SYNOVIAL MEMBRANE AND CAVITY. 
 ARTICULAR SURFACES.. 
 
348 
 
DISSECTION OF THE TOWER TIMB 349 
 
 D. Tibio-nbutar. Articulations. 
 
 (i) Superior Arliculation. 
 
 {a) Define the capsule and ligaments. 
 
 {b) Di\'ide the capsule to expose the sjmovial caxaty and joint 
 surfaces. 
 
 (2) Intermediate Articulation. 
 
 Clean the surfaces of the interosseous membrane 
 and define the foramina in it — 
 Above for the anterior tibial artery. 
 Below for the anterior peroneal artery. 
 
 (3) Inferior Articulation. 
 
 [a] Define the interosseous tibio-fibular ligament and 
 
 the transverse ligament. 
 [h) Separate the tibia and fibula by cutting through the 
 
 interosseous membrane and ligament. 
 
 E. Articulations of the Foot. 
 
 (i) Tarsal Joints. 
 
 [a) Remove the muscles, \'essels and nerves, lea\ing intact 
 
 the bony attachments of the following tendons — 
 
 tibialis anterior, 
 tibialis posterior. 
 Clongus. 
 
 peronei -! brevis. 
 
 (tertius. 
 flexors and extensors of the toes. 
 
 (b) Define the inter-tarsal ligaments, noting specially : — 
 
 INFERIOR CALCANEO-NAVICULAR LIGAMENTS. 
 CALCANEO-CUBOID LIGAMENTS. 
 
 (c) Cut through the ligaments to see the articulations of the 
 
 tarsal bones. 
 
 (2) Tarso-metatarsal and Inter-metatarsal Joints. 
 
 [a) Define the ligaments. 
 
 (b) Di\'ide the ligaments to see the several articulations. 
 
 (3) Metatarso-phalangeal and Inter-phalangeal Joints. 
 
 (a) Define the ligaments, and note the share taken by the 
 
 extensor tendons in the formation of the capsules 
 of the joints. 
 
 (b) Divide the capsules on the dorsal aspect to expose the 
 
 joint surfaces. 
 
350 
 
351