QM 34 B86+ 1892 .1 CORNELL UNIVERSITY LIBRARY Price 8s. 6d. © DISSECTIONS ILLDS E Graphic Ifoanbboofc tot Stubents of Ifouman Ertatom\> BY C. GORDON B ROD IE, F.R.C.S. SEKIOJi DlftlONSTKATOR OF ANATOMY, MIDDLESEX HOSPITAL MEDICAL SCHOOL ASSISTANT SURGEON" NOKTH-WEST LONDON HOSPITAL WITH PLATES DRAWN AND LITHOGRAPHED BY PERCY HIGHLEY %, . : IN PO UR PAR TS *&£?. PART I.-THE UPPER LIMB WITH 17 COLOURED PLATES TWO-THIRDS NATURAL SIZK WHITTAKER & CO. LONDON AND NEW YORK MAYER & MELTZER, 71 GREAT PORTLAND STREET, LONDON, W. Instruments for SURGERY of the BRAIN & SPINAL CORD. ORIGINAL MAKERS OF Mr. VICTOR HORSLEY'S Instruments. TREPHINES, SAWS, FORCEPS. ELEVATORS AND GOUGES. Qniineptic Instruments. SCALPELS ALL MADE IN ONE PIECE. ANTISEPTIC TREPHINES each 15/- Set of Three Sizes, fitting Handle, in case, £2. 7s. 6d. LARYNGOLOGICAL INSTRUMENTS. Makers to the HOSPITAL FOR DISEASES OF THE THROAT, Golden Square, Central London Throat and Ear Hospital, London Throat Hospital, Great Portland Street, and to the Throat Departments of all the principal London Hospitals. GYNECOLOGICAL INSTRUMENTS. Makers to the Hospital FOR Women, Soho Square, and many of the leading Specialists. Write for Special List of Gynaecological Instruments, post-free on application. DISSECTING INSTRUMENTS. DRESSING IMPLEMENTS. DISSECTING CASES from 10/6 POCKET CASES from 25/- P. M. CASES from £2. 2s. P. M. GLOVES 7/6 SPLINTS and DRESSINGS of all kinds kept in Stock. MAYER & MELTZER, 3nstrument makers to "DlnlversitB College ttospltal and to tbe Crown agents (or tbe Colonies. SOLE ADDRESS IN ENGLAND— 71 GREAT PORTLAND STREET, LONDON, W. BRANCHES AT MELBOURNE AND CAPE TOWN. DISSECTIONS ILLUSTRATED A GBAPHIC HANDBOOK FOB STUDENTS OF HUMAN ANATOMY BY C. GOEDON BEODIE, F.E.C.S. SENIOR DEMONSTRATOB OP ANATOMY, MIDDLESEX HOSPITAL MEDICAL SCHOOL ASSISTANT SURGEON NORTH-WEST LONDON HOSPITAL WITH PLATES DRAWN AND LITHOGRAPHED BY PERCY HIGHLEY I IN" FOXTB -£>-&. R T S Paet I -THE UPPEE LIMB WITH SEVENTEEN COLOURED PLATES (Two-thirds Natural Size) AND TEN DIAGBAMS QM 34.B8 6 rn i892 VerS,,V "^ v.1 Dissections illustrated ! jg"l924~024~7gj-gg^-- WHITTAKEE & CO. LONDON AND NEW YOEK 9 A. cys-yf vl PRINTED BY SFOTTISWOODE AND CO., NEW-STREET SQUARE LONDON PEEFACE In designing these plates the author has had in his mind the valuable assistance rendered to him in the first years of his curriculum by the magnificent plates of Professor Ellis, which, however useful they may be, are too large to be portable, and too expensive for most students to obtain. In order to get over these difficulties, the plates, instead of being life-size, are reduced by one-third, thus making a convenient and portable book; and it is hoped that the price will place these ' dissections ' within the reach of all those who care for a graphic representation of Anatomy. A picture or a diagram of anatomy is far more useful in fixing the position of parts than a mere written description; moreover, it, is the best means of teaching the relations of the different structures, and so impressing them upon the memory that they can be easily recalled when later the student is engaged in surgical or medical work. The best picture is of course the body itself, and it is here that the student must lay, by careful dissection, a good and sound foundation of his anatomical work. The author ventures to place these plates before the student as portraying the different structures in their normal positions which he has to search for and display during his dissections. Thus they will serve as models, and further will recall the work already done when revising his anatomy previous to an examination. And, moreover, when in after-years he has settled down into the staid and prosperous practitioner, the author hopes that, should any anatomical difficulty arise when there is no subject to refer to, these plates may serve to fill a gap by showing the relations of the different structures to one another, and thus recall work long since relegated to the background. iv PREFACE The dissections only aim at showing the ordinary detail which any careful worker can dissect for himself, and not unnecessary minutiae. The various structures have been kept also as closely as possible in their normal relations to each other. No pains have been spared to make the plates correct, and especially in regard to the diagrams, which are mostly from original work by the author during his demonstratorship at the Middlesex Hospital Medical School. To Mr. Percy Highxey great credit is due for the masterly way in which the plates have been both drawn from nature and placed on stone, and also for rapidly grasping and representing artistically the intentions of the author. All the small cuts have been drawn from the skeleton, and in introducing the outline of the bones — a new feature — the relative positions of bony landmarks to the cutaneous tissues have been shown. The author tenders his sincere thanks to Mr. Hensman for the kind way in which, at some personal inconvenience, he read through and criticised the letterpress at the final revision ; and also for the facilities which he afforded the author in allowing the use of the material from which the dissections were made. To Mr. Dobbin the author returns thanks for help in the dis- section of some of the plates. 0. Gordon Brodie. 30 Haeley Street, Cavendish Square, W. 1892. PLATE I. THE AXILLA, SUPERFICIAL VIEW. The cutaneous nerves which supply the front of thorax and upper arm are indicated by black lines in the accompanying diagram, viz. : — (a) Sternal, (b) clavicular, (c) acromial branches from the cervical plexus (3 and 4 c) ; (d) anterior, and (e) lateral cutaneous branches of the inter - costals ; (/) branches from circumflex ; (g) upper branches of the internal cutaneous. The position of the bones is shown in faint outline. The axilla is a pyramidal space with the base directed downwards and outwards, and covered in by dense fascia ; and the apex directed upwards and inwards between the clavicle and first rib. The boundaries are : — In front : Pectoralis major and minor, costo-coracoid membrane, and subclavius muscle. Behind: Subscapularis, latissimus dorsi, and teres major muscles. Externally : Coraco-brachialis and biceps muscles, and humerus. Internally : About five ribs, their intercostals, and five serrations of serratus magnus. It contains the axillary vessels and brachial plexus of nerves running along its outer wall, with their branches. Lymphatic glands : one set along the line of the vessels receiving the lymph from the arm ; another along the edge of the pectoralis major, receiving the lymph from the breast and front of thorax ; and a third set along the line of the subscapular vessels, receiving the lymph from the back of thorax. There are also lateral branches of the intercostal nerves, and the space is filled with a packing of fat. The intercosto-humeral nerve, the lateral cutaneous branch of the second inter- costal nerve, usually sends a branch to join the nerve of Wrisberg ; but if the latter is larger than usual, it will in turn give off one to join the intercosto-humeral, as in the plate. The first intercostal nerve usually sends no lateral cutaneous branch, but it is occasionally present (vide Plate III.) and then generally joins the nerve of Wrisberg, giving a twig to join the intercosto-humeral. The nerve-twig marked (7) is a special branch of the musculo-spiral to the lower fibres of the internal head of the triceps, and from its course parallel to, and being sometimes bound up with, the ulnar nerve, it is called the ulnar collateral. The posterior or long thoracic is also known as the external respiratory nerve of Bell. a erf cd -a CD fl, A n £ U-t o p erf CQ cj 03 ,crf -4-3 erf S-H O -a a o a a ^ CD •■— » cD cd a ,a n a a . o :2 rS "« .2 -> >* 3 n ro erf a a "erf s a a erf u CD 02 H O CQ . 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THE AXILLA, DEEP VIEW. The pectoralis major has been cut across about its centre, and the ends turned inwards and outwards in order to expose the pectoralis minor and the deeper parts of the axilla. The costo-coracoid membrane was extremely thin, and was removed with the fibro-areolar tissue lying between its lower edge and the upper border of the pectoralis minor ; the sheath of the vessels was also removed. It is a deeper dissection of the same axilla, as in Plate I. The plate shows well the doubling up of the fibres of the pectoralis major at their insertion, the inferior fibres of origin being folded up so as to he beneath the upper ones, thus having a higher insertion into the humerus along the outer border of the bicipital groove. It also shows a fibrous intersection, not uncommonly found running between the pectoralis minor and the coraco-brachialis muscles from the tip of the coracoid process. In this body the intercosto-humeral, instead of giving a branch to join the nerve of Wrisberg (6), receives one from it (16), the nerve of Wrisberg being much larger than usual. The costo-coracoid membrane is a fibrous structure, varying much in thickness in different subjects, which is attached above to the borders of the inferior surface of the clavicle, thus enclosing the subclavius muscle. Its lower border is condensed into a fibrous band, the costo-ooracoid ligament, which stretches between the cartilage of the first rib and the coracoid process. The membrane is stronger externally, forming a fairly strong band between the clavicle and the coracoid process. Its deep surface is blended with the sheath of the axillary vessels. This latter is funnel-shaped and derived from the deep cervical fascia covering the scaleni muscles. The costo-coracoid ligament is a representative of the_ prolonged coracoid element seen in monotremes, etc. ; it frequently contains cartilage nodules. 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H ft ■c ° 3 ft 03 > .-a P. 3 q o o M ^Ph CQ CQ Fh &h O 3 S § .ft * Ph fl O a cs»T(iiocc)t>coaoH PLATE IV. THE BEND OF THE ELBOW. In this plate is delineated the arrangement of the superficial veins and cutaneous nerves at the bend of the elbow; the basilic vein has been afterwards traced up to the point where it pierces the deep fascia to join the venaa comites of the brachial artery. The common arrangement of these veins is as follows : — the median vein (a), which begins in radicals over the ball of the thumb, runs up the middle of the forearm, and divides into two about the lower border of the bicipital fascia — an inner branch, the median basilic (e), and an outer, the median cephalic (b) — giving off a branch (k) which pierces the deep fascia of the arm to join the deep veins. The median cephalic is joined just above the outer condyle by the radial vein (c), which begins in radicals upon the dorsal aspect of the first interosseous space, and runs up the outer side of the forearm pos- teriorly, turning forwards at the elbow to join the median cephalic. The conjoined vein is then termed cephalic (d) ; it runs up along the outer side of the biceps, piercing the fascia opposite the insertion of the deltoid, and, coursing up between this muscle and the pectoralis major, it pierces the sheath of the axillary vessels, and opens into the third portion of the axillary vein, it may communicate with the external jugular by means of a branch passing over the clavicle. The median basilic — the inner and usually the larger branch — is joined by the anterior (h) and posterior ulnar veins (g), either separately or conjointly, opposite the internal condyle ; it is then called the basilic vein, and, running up the inner side of the arm, pierces the fascia about the middle, joining the venaa comites of the brachial to form the axillary vein. The anterior ulnar vein begins in radicals over the hypothenar eminence (the ball of the little finger), while the posterior begins in radicals upon the dorsal aspect of the fourth interosseous space, receiving the vein of the little finger (vena salvatella). The arrangement of these veins may be likened to an ornamental M, but this is not always well marked; PLATE IV. MUSCLES A Placed on the deep fascia of the arm over the biceps muscle. B Placed on the semilunar or bicipital fascia. C Deep fascia of the forearm. X Position of the lowest superficial lymphatic gland in upper limb. VESSELS a Median vein. b Median cephalic. c Radial vein. d Cephalic vein. e Median basilic. / Ulnar veins, common trunk. g Posterior ulnar veins. h Anterior ulnar vein. k Communication of median with deep veins. Basilic vein. NERVES 1 Internal cutaneous, anterior division. 2 Internal cutaneous, posterior division. 3 External cutaneous. 4 Posterior branch of external cutaneous. Upper external cutaneous branch of musculo-spiral. A twig from the internal cutaneous, supplying the skin in front of biceps. 7 Nerve of Wrisberg. It may be taken as a general rule that the external cutaneous nerve passes beneath the median cephalic vein, and that one or two branches of the internal cutaneous nerve usually pass over the median basilic, while the others pass beneath it. It is important to remember that the median basilic vein is only separated by the bicipital fascia from the brachial artery which lies beneath it ; and thus, in the olden days when bleeding was the fashion, the artery was frequently injured, and arterio-venous aneurisms were not uncommon. Supra-condyloid lymphatic gland. — This, the lowest lymphatic gland (or glands) in the arm, is placed about an inch above the internal condyle, along the course of the basilic vein ; it receives all the lymphatics from the ulnar side of the forearm and fingers, and most of those from the radial ; some lymphatics from the latter, however, running up along the cephalic vein to reach the glands in the axillary space. Dis , . « Lett ^ C. G. Bro&ie Hitiharb -imp PLATE V. THE INNER VIEW OF ARM AND BRACHIAL ARTERY. The cutaneous nerves of the front of the arm are (a) circum- flex ; (6) intercosto-humeral, just along the anterior fold of the axilla ; (c) the internal cutaneous, a branch of which pierces the fascia above the main nerve ; (d) the upper external cutaneous branch of the musculo - spiral ; (e) the lesser internal cutaneous; (/) the external cutaneous. The inferior profunda artery is occasionally absent, and is also very variable in size and origin, and may arise in conjunction with the superior profunda, then running down with the ulnar nerve. In the plate it is shown arising by two trunks, one which has been called the inferior profunda (/) (firstly because it arises from about the normal place of origin, and secondly because it pierces the internal intermuscular septum), the other which is called an accessory branch (e), and arises from the superior profunda. Another branch of the brachial, the vas aberrans, ' usually present, but often as a minute vessel, not admitting complete injection, arises close to or with the superior profunda, and descends over the median nerve supplying the biceps. Its downward continuation, when present, joins either the radial artery, or more rarely the ulnar, and may be minute, moderate or large enough to replace, or simulate the brachial, which then appears to overlie the median nerve. When of moderate size, it may replace the brachial origin of the radial (rarely the ulnar), giving rise to the common condition called high bifurcation of the brachial.' (Macalister.) Note on the Goraco-brachialis. — Professor Wood ' has shown that in mammals this muscle consists of three portions : — 1. The coraco-brachialis brevis, represented in man by a fibrous arch, rarely by muscle, arising from the coracoid process and inserted into the humerus just below the subscapularis. 2. The coraco-brachialis medius, or the coraco- brachialis of man. 3. The coraco-brachialis longus arises with the medius, being connected at its origin with the pectoralis minor, and passes down internal to it to join the internal intermuscular septum, in which it is usually traceable as far as the internal condyle. It is usually represented in man by a fibrous band passing from the lower part of the muscle to the intermuscular septum. The coraco-braehial apparatus is found best developed in those animals 'which use the fore limbs for prehension, climbing, swimming, digging, etc., and appears to refer more to the wants and habits, than the pedigree or relationship of the animal.' The musculo -cutaneous nerve may either pierce the medius, or more usually it passes between the medius and longus. Jowrn. of Anat. and Phys. vol. 10 a CD > En c3 O CQ c3 S •i-H M O CD CQ -*3 ■s.g_ 3 'cl .-s a Qj ft s«: _i x -4-> El c3 :a rn ft s m o A rt cj a cd o W Pm J ITS rH c3 o . CD 02 . 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THE CIRCUMFLEX NERVE AND SCAPULAR QUADRILATERAL. In this dissection the attachment of the deltoid to the spine of the scapula has been cut through and the spine sawn across at its junction with the acromion process ; the whole muscle and bone were then turned outwards, to expose the circumflex nerve and posterior circumflex artery. When viewed rfrom the back, with the arm abducted from the side, the quadrilateral space or scapular quadrilateral is formed by the bone above, the long head of the triceps below, externally by the teres major, and the teres minor internally ; but seen from the front, the teres minor is replaced by the axillary border of the subscapularis. Coming through the space are the posterior circumflex vessels and circumflex nerve. The. branch of the circumflex artery marked (g) passes down to anastomose with one from the superior profunda, and it is this branch that usually enlarges and takes the place of the circumflex when, in abnormal conditions, that artery is not given off from the axillary, or vice versd. The circumflex nerve is a good illustration of Hilton's law, that the main nerve to a joint not only supplies it, but also some of the muscles which act on the joint, as well as the skin over those muscles, thus securing during movement the true balance of force and friction. The fibres of origin of the infra-spinatus from the spine of the scapula overlap the upper portion of the origin from the infra-spinous fossa. 26 CO CD CO CD a CO CD a 'ft O PS EH o M 5+-I ft CO <4H o o d a o rH -+3 p*"^ CD CO c3 ri CD > o 'a o S-i o cS CD a rd d .-s CD D3 a g CS CD +3 c3 CD C+H Sao ^2 2- 3 ^+H O CD o M o 43 ^ -s ,°3 o -r=> CD O c3 -d • rn o3 a g 53 CO ai g ac CO rd ,2 CD ft c3 +3 r-l CO O ^ o O O a w. 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The long and external heads of the triceps have been detached from the common tendon below, and turned outwards ; the fascial expansion, which comes off from the lower and external part of the triceps, and covers the anconeus, has been partly reflected to expose that muscle. The nerve to the anconeus has been traced through the fibres of the internal head of the triceps. The cutaneous nerve-supply of the back of the arm is shown in the adjoining diagram : : — (a) Acromial branches of cervical nerves ; (b) cutaneous branches from circumflex ; (c) upper, and (d) lower external cutaneous branches of the musculo-spiral ; (e) internal cutaneous branch of the musculo-spiral ; (/) intercosto- humeral ; (g) nerve of Wrisberg ; (h) posterior branch of the internal cutaneous. The close proximity of the musculo-spiral nerve to the bone, as it lies in the musculo-spiral groove, should be noted, as it is thus rendered liable to pressure- injuries : e.g. pressure of a badly-made crutch may produce paralysis, the so-called ' crutch-palsy.' During the dissection of this region, do not forget to examine the course of the ulnar nerve behind the internal condyle, which it grooves, lying against the internal lateral ligament before it passes into the forearm between the two heads of the flexor carpi ulnaris. Whilst in the groove it is covered by a band of fibrous tissue which passes across from the back of the condyle to the olecranon : this is the degenerate remains of a muscle, the epitrochleo-anconeus, which exists pretty constantly in the lower mammals, including a few of the primates, but is not seen in the anthropoid apes. It is also important to remember the relation of the ulnar nerve to the joint in excising the elbow, lest it should be damaged during the operation. 28 H Oh o 2^ ■a ■§ O rft> I ■ fl ^ ! o g I g o ! ° 1 P * °n a. a ° 3 P-< -4-=> E-l 5 «§ o "H 5 <» " *a 53 H CD O CO|->-XN TJ „! o . 2 _5> q=l ° a rf cp .1-4 „ KJ *H a a § 02 H o alis lo exten: pi uln O o 3 «H S 02 •1 "3 c longus. carpi ra tendon o xtensorc fe m .3 3 o o C3 4H to ft a> o upinato: xtensor Dmmon dge of e hfflfqcQHaH :*: -i 2 z o a. ce ?-■ o -r-l F-4 CD & P CO «4-4 O a o • 1-4 CO V 3 r— 1 . c3 cS .3 n3 a ss CD c3 *4-( o -4-3 U a =2 ?-4 ft n o -4-3 o ft 'S =4-4 a a • I— I 6D c3 a p O m • H3 CO -4-3 rg CD P CD ^ A CD a o -a a -3 O rt c3 a a ca m H c3 o -4^ CD > CD .p Co O en ■*= P S £ CD a •rH f-1 CD CO CO CD 125 g^h5 «o t- 00 o> n ,a CO ca CO C3 -a ft o 03 4H CO p o CD o ■a J -a p p g CD .a I-H O "3 -43 CS CD a P a a H O n C3 CD CD -4J -*3 +? a M , 1 w s CD c3 CD ( _ H a CD -4-3 CD c€ -a a -443 }h CD -43" CD CJD-2 a w •1 * CD o a p CD a-| be -4-3 ft ft ft w o a ■r-i CD CO 13 J TH io C4-4 O rO cS rv3 CD ^1 CD .a la a ha CD CD a . o o o "S a a J3 y C.'J.Drudie PLATE XVII. THE DORSUM OF THE HAND. This dissection shows the structures on the dorsum of the hand. In order to show more clearly the nerve-supply on the back of the hand and fingers, the following diagram has been introduced : — (e) dorsal branch of ulnar ; (/) radial nerve ; (g) twigs from the digital branches of the median supplying the dorsal aspect of the phalanges ; (h) twigs from the palmar digital branches of the ulnar which supply chiefly the lateral aspects of the little and half the ring finger. Those twigs on the ulnar side of the little finger could not be shown for want of space. The six different compartments of the posterior annular ligament are, starting from the radial side : — I. For the extensor ossis metacarpi and primi internodii pollicis. II. For the extensor carpi radialis longior and brevior. III. For the extensor secundi internodii pollicis. IV. For the extensor communis digitorum and extensor indicis. V. For the extensor minimi digiti. VI. For the extensor carpi ulnaris. The synovial sheath of the extensor secundi communicates with that of the extensores carpi radiales as they cross each other. 34 PLATE XVII. MUSCLES A Extensor communis digitorum. B Extensor minimi digiti. C Extensor carpi ulnaris. D Extensor ossis metacarpi pollicis. E Extensor primi internodii pollicis. F Extensor secundi internodii pollicis. G Extensor indicis. H Extensor carpi radialis brevior. I Extensor carpi radialis longior. K Dorsal interossei ; the first is some- times called the abductor in- dicis. P V Vineulse. Adductor pollicis, sending an expansion on to the extensor secundi internodii pollicis. Posterior annular ligament ; the six different compartments are indicated by numerals. Expansion from the interossei to the extensor tendons (on the radial side it is also joined by the expansion from the lumbricales). Abductor minimi digiti. Flexor ossis metacarpi minimi digiti. VESSELS a Radial artery. b Dorsales pollicis. c Dorsalis indicis. d Metacarpal. e Posterior carpal of radial. / Metacarpal arteries from posterior carpal arch. g Posterior terminal branch of' anterior interosseous. h Radialis indicis. * Terminal branch of posterior interosseous. 1 Radial. NERVES I 2 Dorsal branch of ulnar. The common extensor tendon for the little finger runs down parallel to that of the ring, and only branches away from it towards the lower part of the interosseous space, then joining the radial of the two tendons, into which the extensor minimi digiti divides. PL . XV ■vi*':v Dissei Hankarb imp A New and Revised Edition. Twelfth Edition, post Svo. 10s. 6d. H0BLYN 7 S DICTIONARY OF TERMS USED IN MEDICINE AND THE COLLATERAL SCIENCES, Revised and Enlarged by J. A. P. PRICE, B.A., M.D. Oxon. Assistant Surgeon to the Royal Berkshire Hospital ; late Physician to the Royal Hospital for Children and Women. ' the changes in the present Edition (the twelfth) are mainly those of addition, and the Editor hopes that the selection of several new words and phrases, more particularly those relating to bacteriology, will render the work even more useful than it has been in the past. The Greek " k " has been invariably rendered by the letter " c," except where general usage has accepted the letter "k," as, for instance, in "kinetic," " keratitis," &c. ; to paragraphs in which occur the names of celebrated physicians, surgeons, anatomists, &c, are appended the periods during which they lived.' Preface. London: "WHITTAKER & COMPANY, Paternoster Square. STANDARD MEDICAL BOOKS. Fifth and Revised Edition, crown 8vo. 9*. HILTON'S REST AND PAIN. Lectures on the Influence of Mechanical and Physiological Rest in the Treatment of Accidents and Surgical Diseases, and the Diagnostic Value of Pain. Edited by W. H. A. Jacobson, M.A., M.Ch. 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