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LESSONS 
 
 IN 
 
 EOR 
 
 m 
 
 THE USE OF DISSECTORS. 
 
 By W. E. HORNER, M. D. 
 
 ADJUNCT PHOFESSOH OP ANATOMY IN THE UNIVEHSITT OF PENNSTIVANIA, ONE 
 OF THE SURGEONS OF THE PHILADEEPHIA ALMS-HOUSE, &C. 
 
 SECOND EDITION. 
 
 PHILADELPHIA: 
 
 H. C. CAREY & I. LEA— CHESNUT STREET. 
 
 18S7. 
 
/ 
 
 \ 
 
 ■V: 
 
 V\r t /t r 
 
 Eastern District of Pennsylvania, to wit; 
 
 ********* BE IT REMEMBERED, That on tlie twenty-sixtli day of June, in 
 * SEAi. t the forty -seventh yeai’ of the Independence of the United States of 
 ********* America, A. D. 1823, WiUiam E. Horner, M. D. of the said District, 
 hath deposited in this Office tlie title of a Book, the right whereof he claims 
 as author in the words following, to wit: 
 
 “ Lessons in Practical Anatomy, for the Use of Dissectors. By W. E. Horner, 
 “ M. D. Adjunct Professor of Anatomy in the University of Pennsylvania, 
 “one of the Surgeons of the Philadelphia Alms-House, &c.” 
 
 In conformity to the act of the Congress of the United States, entitled 
 “ An act for the encouragement of learning, by securing the copies of maps, 
 charts, and books, to the authors and proprietors of such copies during the 
 times therein mentioned.” And also to the act, entitled “An act supple- 
 mentary to an act entitled ‘ An act for the encouragement of learning, by 
 securing tlie copies of maps, chaiiis, and books, to the authors and proprie- 
 tors of such copies during the times therein mentioned,’ and extending the 
 benefits thereof to the arts of designing, engraving, and etching historic^ and 
 other prints.” 
 
 (Signed) D. CALDWELL, 
 
 Clerk of the Eastern District of Pennsylvania. 
 
PHILIP S. PHYSICK, M. D. 
 
 PROFESSOR OF ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA. 
 
 Dear Sir, 
 
 Permit me to dedicate to you this little work, 
 proceeding from a course of Anatomical Studies, in 
 which your patronage has been incessantly active, and 
 which, without your disinterested protection and en- 
 couragement, might probably have long since been 
 relinquished. I consider it a feeble and insufficient 
 testimony of the large debt of gratitude that I owe 
 you, and wish that it was more worthy of your ‘notice; 
 however, as it is the best at present in my power, I 
 hope that it will be accepted in the sense in which it is 
 offered. That a life so usefully employed as yours in 
 mitigating the ills of human existence, and in enlarging 
 the boundaries of the science of medicine, may be 
 protracted through a long series of years with undi- 
 minished physical and mental vigour, is the sincere 
 prayer of. 
 
 Dear Sir, 
 
 Your Obedient Servant, 
 
 W. E. HORNER. 
 
 Philadelphia, July 1st, 1823. 
 
https://archive.org/details/lessonsinpractic01horn 
 
 
CONTENTS 
 
 Page 
 
 Preface, vii 
 
 Introduction — On Dissecting, and on the method of making Ana- 
 tomical Preparations, . . - - - xv 
 
 PART I. 
 
 Op the Head and Neck, ..... i 
 
 Chap. I. External Parts of the Head and Neck, - - 1 
 
 Sect. I. Of the Muscles and Fascise of the Head and Neck, 2 
 
 II. Of the Glands of the Head and Neck, - - 23 
 
 III. Of the Blood vessels of the Neck and Head, - 29 
 
 IV. Of the Nerves of the Head and Neck, - - 38 
 
 Chap. II. Of the Internal Parts of the Head and Neck, - - 60 
 
 Sect. I. Of the Brain and Spinal Marrow, - - - 50 
 
 II. Of the Brain and Spinal Marrow according to 
 
 Gall and Spurzheim, - - - - 75 
 
 III. Of the Eye, - - - - - - -110 
 
 IV. Of the Ear, 127 
 
 V. Of the Nose, 140 
 
 VI. Of the Mouth, 144 
 
 VII. Of the Pharynx and (Esophagus, ... 149 
 
 VIII. Of the Larynx, - - - - - -153 
 
 PART II. 
 
 Of the Trunk, ...... 163 
 
 Chap. I. Of the Thorax, ..... 153 
 
 Sect. I. Of the Muscles in front, and on the sides of the 
 
 Thorax, .... 163 
 
 II. Of the Viscera of the Thorax, - - 166 
 
 Chap. II. Of the Abdomen, .... is9 
 
 Sect. I. Of the Muscles of the Abdomen, - - 190 
 
 II. Of the Parts concerned in Inguinal Hernia, 201 
 
 III. Of the Parts concerned in Femoral Hernia, 209 
 
 IV. Of the Contents of the Abdomen, - - 218 
 
 V. Of the Diaphragm, &c. - - - 255 
 
VI 
 
 CONTENTS. 
 
 Page 
 
 Chap. III. Of the Male Pelvis, .... 260 
 
 Sect. I. Of the Viscera of the Male Pelvis, - - 261 
 
 II. Of the Perineum and the Fascia of the Male 
 
 Pelvis, - - - - - 281 
 
 Chap. IV. Of the Organs in the Female, for the Generation and 
 
 Nourishment of the Infant, - - 295 
 
 Sect. I. Of the Female Pelvis, ... 295 
 
 II. Of the Female Mamma, ... 300 
 
 Chap. V. Of the Nerves and Vessels of the Trunk, - . - 314 
 
 Sect. I. Of the Nerves, .... 314 
 
 II. Of the Blood vessels, ... 323 
 
 III. Of the Thoracic Duct, ... 335 
 
 Chap. VI. Of the Muscles of the Back, ... 338 
 
 PART III. 
 
 Of the Extremities, ..... 353 
 
 Chap. I. Of the Upper Extremities, ... 353 
 
 Sect. I. Of the Fascia, .... 353 
 
 II. III. Of the Muscles, ... 354 
 
 IV. Of the Blood vessels, ... 382 
 
 V. Of the Nerves, .... 397 
 
 Chap. II. Of the Lower Extremities, ... 406 
 
 Sect. I. Of the Fascia, .... 406 
 
 II. Of the Muscles, .... 409 
 
 III. Of the Blood vessels, - - - 440 
 
 IV. Of the Nerves, - - - - 454 
 
 PART IV. 
 
 Of the Ligaments, ..... 466 
 
 Chap. I. Ligaments of Trunk, .... 456 
 
 Sect. I. Ligaments of Head and Spine, - - - 466 
 
 II. Ligaments of Thorax, .... 470 
 
 III. Ligaments of Pelvis, - - - - . 472 
 
 Chap. II. Ligaments of the Upper Extremities, - - 475 
 
 III. Ligaments of the Inferior Extremities, - - 482 
 
 PART V. 
 
 Of the Integuments, - - - - - 491 
 
 Chap. I. Skin, . ..... 491 
 
 II. Hair, ...... 495 
 
 HI. Nads, ...... 496 
 
 IV. Sebaceous Organs, .... 496 
 
 Index, ....... 497 
 
PREFACE. 
 
 \ 
 
 The following sheets were put together with a hope 
 of their contributing, in some measure, to facilitate 
 the most dijSicult and important part of a medical 
 education, the study of Anatomy. They are the result 
 of many dissections performed in the course of ten 
 years by myself, and by the young men who have con- 
 fided in me by submitting to my instructions. The 
 arrangement is in some respects unusual, as regards 
 a work on Practical Anatomy; but has arisen from 
 much reflection on the subject, and from a careful 
 observation of that course which students are most 
 disposed to adopt when left to themselves. There are 
 but few men possessed of moderate activity of mind 
 who do not, in the prosecution of a study even new to 
 them, adopt some labour-saving means, overlooked 
 and sometimes unknown, to such as are much further 
 advanced. It has happened to me frequently, while su- 
 ‘ perintending the studies of others, to observe this 
 
Vlll 
 
 PREFACE. 
 
 fact, and that none of the books in common use an- 
 swered continually for reference; either in conse- 
 quence of the actual plan of the books not being 
 suitable to the course of dissections, or in consequence 
 of the partition of the subject among several students 
 causing the dissection of one person to interfere with 
 that of another. The idea of founding a text-book 
 to suit the latter arrangement, was thus suggested ; and 
 I trust therefore that the present treatise will, in most 
 cases, be found to answer either where several students 
 dissect together on the same subject, or where the 
 student dissects alone upon a section of the body. 
 
 In the original conception of the work it appeared 
 to me that I might introduce advantageously remarks 
 on Morbid Anatomy, on Surgical Operations, and on 
 Physiology; but in computing the number of pages 
 that the descriptive anatomy alone would occupy, I 
 found that such a mass of materials would become 
 a system, and interfere much with the simplicity 
 and conciseness that I wished to predominate in 
 the character of the performance. I have therefore 
 intentionally indulged very seldom in such remarks; 
 but in case of the present effort meeting the sanction 
 of public approbation, may be tempted at a future day 
 
PREFACE. 
 
 IX 
 
 to give an additional volume appropriated to these 
 subjects. As the introduction of such observations 
 is very common in manuals of Anatomy, I will state 
 why it has not been imitated in the present. In 
 my own progress as a student, I had a hand-book of 
 the kind, but it very frequently happened that the 
 subject I was engaged in dissecting, had none of the 
 diseases or morbid appearances that the page I was 
 reading, referred to. The author indeed seemed to 
 labour under the presumption that the young anatomist 
 was working on just such a subject as he had in view; 
 and therefore blended his morbid and descriptive 
 anatomy so much by alternate sentences for each, 
 and sometimes in the same sentence, that the eye could 
 not, without much trouble, distinguish what was want- 
 ed. A positive inconvenience was thus sustained. In 
 regard to surgical operations, the young student seldom 
 performs them in his first period of (^ssections; his 
 mind is closely and laboriously occupied in pursuing 
 the dissection, in getting out the parts properly, and 
 he thinks he has quite enough to do in following the 
 most simple description. As regards physiology, the 
 reasons just stated must apply with more force to it. 
 
 I do not wish to be understood as assigning a diminished 
 
 b 
 
X 
 
 PREFACE. 
 
 importance to Morbid Anatomy, on the contrary, I 
 have the highest opinion of its value, as the whole prac- 
 tice of medicine is founded on it; I mean only that a 
 text-book for young students should present the task 
 of Anatomy in its most simplified form. When the 
 parts become familiar and well understood by frequent 
 dissection, the advanced student may then draw in as 
 many collateral branches as he chooses, and he will 
 never attempt it without pleasure and instruction. At 
 this point any of the treatises on surgery, morbid ana- 
 tomy, and physiology will answer his purpose. 
 
 I have been concise on another subject: Directions 
 how to proceed; to which some Anatomists give the 
 highest importance, so high indeed that in many in- 
 stances the subject matter is lost in the directions how 
 it is to be found out. In the opinions of some, I may 
 here have fallen into error: my general intention has 
 been, in all cases, to assist by directions where the 
 novelty and obscurity of the operation left no clew for 
 the student; but where the dissection or mode of ex- 
 amination was a plain appeal to common sense, con- 
 nected with common powers of vision, I have thought 
 it superfluous, and even ridiculous to write down what 
 
PREFACE. 
 
 XI 
 
 was to be done. In the common operation of walk- 
 ing, it would be quite philosophical to tell a being of 
 another world, who knew nothing of this, and was 
 differently constituted, that it was accomplished by 
 putting one leg before the other ; but perhaps there is 
 no human being, in the rational exercise of his facul- 
 ties, who would thank any one for such information. 
 On this ground I have omitted many directions; but 
 it is not improbable that things which seem perfectly 
 plain and appreciable to one in the daily exercise of 
 Anatomy, may be more obscure to another less oc- 
 cupied with it. 
 
 It will be seen that the work consists of three Parts 
 the Head and Neck, with the contained organs, form 
 one part, the Trunk a second, and the Extremities a 
 third. The division is obviously artificial, as probably 
 every other plan must be ; for in following the details 
 of Anatomy, it is impossible to avoid chasms in the 
 description. The human body is a whole, but made 
 up of such a multitude of parts that no mind can com- 
 prehend or receive at once all of them. In this di- 
 
 ^ This arrangement has been slightly altered in the second 
 edition but not in such a way as to affect the general plan of the 
 work. 
 
XII 
 
 PREFACE. 
 
 lemma, each writer will probably have an arrange- 
 ment, which to him, appears better than all others. 
 It may be asked, why I have put the most difficult 
 part of Anatomy first? I answer, that it is only first 
 to him who chooses to study it first. The plan 
 of the book enables the student to commence with 
 either of the parts, with nearly equal advantage. In 
 adopting the actual arrangement, the most prominent 
 objection in my mind to it, was the necessity of repeat- 
 ing the same observations in different places. In writing 
 I have had this continually in view ; and though it could 
 not always be avoided, I have nevertheless endeavoured 
 to curtail so much its frequency, that, I trust, it will 
 not be considered a fault of much magnitude. 
 
 In regard to recent observations in Anatomy, I have 
 for the most part quoted them when they were of 
 such a cast as to be comprehended in the general ob- 
 ject of the work. I have also added a few new things 
 of an original character with myself ; they consist prin- 
 cipally in a muscle at the inner canthus of the eye, 
 not heretofore described; and in an explanation of the 
 method of closing the upper part of the glottis in 
 swallowing or vomiting, not commonly given by 
 physiologists. 
 
PREFACE. 
 
 xiii 
 
 It may be asked why, with such a quantity of simi- 
 lar works in circulation, I have taken the trouble to 
 write this? I reply candidly, because I think their 
 plans and manner of execution do not hit precisely the 
 case for which they are intended. I have however 
 neither the disposition or intention to decry them, 
 because my own ware is in the market. I have felt 
 much, their value in many respects, and take pleasure 
 in giving my feeble tribute of praise to the works of 
 Messrs. Fyfe, Bell, Shaw, and the London Dissector, 
 among the English ; and to the works of MM. Mar- 
 jolin and Maygrier, among the French. On the sub- 
 ject of Hernia, I am much indebted to Sir Astley 
 Cooper and to Mr. Laurence. On the Anatomy of 
 the Pelvis, to Messrs. Colles and Breschet. Among 
 the Systematic Treatises on Anatomy, I owe much 
 to Dr. Wistar’s System, to Bichat, Sabatier, Portal, 
 Bell, and above all to the very splendid and surpass- 
 ing work of Antonius and Caldani published in Ve- 
 nice, which contains all things excellent in our art, 
 selected from Soemmering, Loder, Meckel, Scarpa, 
 Vicq. D^Azyr, the Hunters, Gall and Spurzheira, &c. 
 &c., which was put into my hands by the liberality of 
 Dr. Physick. 
 
INTRODUCTION. 
 
 On Dissecting, and on Anatomical Preparations. 
 
 The dress of a student of anatomy should consist of 
 an apron, extending from the neck to half-way down 
 the legs; and of a pair of sleeves, attached to the apron 
 or not, according to the fancy of the wearer. It should 
 be so loose as to give him perfect freedom in all his 
 motions. The instruments are contained in a box, 
 called a Dissecting Case. They should consist of four 
 knives, one single hook, one double hook, one pair of 
 forceps, one pair of scissors, one blow pipe, and two 
 crooked needles. 
 
 Cleanliness is of the first importance ; the dissector 
 should, therefore, never suffer his table to become foul 
 from blood or pieces of flesh standing on it, neither 
 should he suffer blood to remain in the different de- 
 pressions about the subject, when it can be conveni- 
 ently got out. He should keep a sponge for himself, 
 for v/here a sponge is used by several it becomes 
 nobody’s business to clean it ; the consequence is that it 
 is seldom fit for use. When the integuments of a sub- 
 ject are laid open, the parts exposed either dry or 
 putrefy rapidly. A constant rule is hence established 
 not to turn down more skin than the freedom of dissec- 
 tion requires, and to save it as much as possible to cover 
 
XVI 
 
 INTRODUCTION. 
 
 the parts again, when the dissection is suspended for an 
 interval. When there is not enough of it for this pur- 
 pose, a damp cloth, several folds thick, should be at 
 hand to assist in covering. 
 
 The knife should be held like a writing pen in the 
 right hand ; when muscles are dissected it should be 
 exclusively used for cutting, as the scissors do not 
 answer. The integuments or the parts covering the 
 muscles, should be held perfectly tense with the other 
 hand, or with the forceps. The knife should be pass- 
 ed with a steady and light stroke in the direction of 
 the muscular fibres, and in such a way as just to graze 
 them. This latter rule is indispensable; no one can 
 dissect a muscle well without observing it, and it should 
 be continually present to the mind of the student. 
 
 OF INJECTIONS.* 
 
 There are three kinds of injections in use among 
 anatomists, the Coarse, the Fine, and the Minute; 
 which are applied to the filling of the arteries and of 
 the veins, in order to demonstrate their courses more 
 satisfactorily. 
 
 * Swammerdam first used wax injections and that about the 
 year 1672. Corroded preparations were first made by Francis 
 Nicholls, Professor of Anatomy at Oxford, about the beginning 
 of the last century. Rouhaut, a surgeon of the King of Sar- 
 dinia, first dissolved glue to inject small vessels with. Hom- 
 berg of Paris, proposed a mixture of equal parts of tin, bismuth 
 and brass, wherewith to inject blood-vessels by means of a pneu- 
 matic apparatus for forcing it in. 
 
INTRODUCTION, 
 
 xvii 
 
 No. I. 
 
 For Coarse injection take the following ingredients : 
 
 Y ellow Bees-wax, pure, sixteen ounces, 
 
 Bleached Rosin, eight ounces. 
 
 Turpentine Varnish, by measure, six ounces.* 
 
 Or, No. IL 
 
 Yellow Resin, two pounds. 
 
 Yellow Wax, one do. 
 
 Turpentine Varnish, a sufficient quantity to make the 
 mixtxire flexible when cold.t 
 
 Or, No. III. 
 
 Tallow, two pounds. 
 
 White Wax, ten ounces, 
 
 Common Oil, six ounces, 
 
 Venice Turpentine, four ounces.^ 
 
 Mix and liquefy them over a slow jfire; or^ what is 
 still better, in boiling water. 
 
 For making either mixture red; add Vermilion ^iij. 
 
 do. do. yellow; King’s Yellow, ^ijss. 
 
 do. do. white; Best Flake White, §vss. 
 
 * Fyfe,....Pole. t Nicholls. | Munro. 
 
 c 
 
xviii 
 
 INTRODUCTION. 
 
 
 
 C Best Flake White, 5iijss. 
 pale blue; ^ 
 
 C Blue Smalt, ^ujss. 
 
 do. 
 
 do. 
 
 do. 
 
 do. 
 
 , dark blue; Blue Verditer, gxss. 
 
 do. 
 
 do. 
 
 black; ■ Lamp-Black, ^i. 
 
 f Powdered Verdigris, ^ivss. 
 
 do. 
 
 do. 
 
 green; < Best Flake White, ^iss. 
 ( Gamboge, powdered, ^i. 
 
 No. IV. 
 
 For Fine injection take the following: 
 
 Brown Spirit Varnish, ^iv. 
 
 White Spirit Varnish, ^iv. 
 
 Turpentine Varnis'h, ^i. 
 
 Mix and heat. 
 
 To make this mixture red; add Vermilion, ^i. 
 
 do. 
 
 do. 
 
 yellow; King’s Yellow, ^i^. 
 
 do. 
 
 do. 
 
 white; Best Flake White, ^ij. 
 
 do. 
 
 do. 
 
 , , , C Fine Blue Smalt, 5iss. 
 
 * ^ Best Flake V lute, jr 
 
 do. 
 
 do. 
 
 dark blue; Blue Verditer, ^iv. 
 
 do. 
 
 do. 
 
 black; Lamp-Black, jss. 
 
 Or, No. V. 
 
 According to Dr. Munro, a fine injection may be obtained, by 
 pouring oil of turpentine on any finely powdered colouring 
 matter, till it reaches a proper consistence. 
 
INTRODUCTION. 
 
 JSIX 
 
 No. VI. 
 
 For Minute injection take the following : 
 
 Most Transparent Glue, broken to pieces, or Isinglass,* §viij. 
 
 Let the mixture stand till it is dissolved, which 
 will take from one to two days. Then heat it gently 
 till it is uniform, or a perfect size is made. 
 
 To make this mixture red; add Vermilion, 5v. 
 
 In all of these formulae for Injections, it is of the 
 utmost importance to success in throwing them in, to 
 have the colours in the purest condition and reduced 
 to the finest powder by levigation or trituration. In 
 Philadelphia they are found, for the most part, in a 
 state fit for use in the Druggist’s, and Painter’s and 
 Glazier’s shops. But to render injection still more 
 
 ' The Isinglass is much more expensive, but more minute. 
 
 Water, 
 
 ifeiss. 
 
 Mix. 
 
 do. do. yellow; King’s Yellow, ^iv. 
 
 do. do. white; Best Flake White, ^v. 
 
 do. do. blue; Fine Blue Smalt, ^viij. 
 
 do. do. black; Lamp-Black, ^i. 
 
XX 
 
 INTRODUCTION. 
 
 certain it is better to strain the mixtures after the 
 colours are added, through a fine flannel cloth, which 
 will arrest the impurities both in the original mixture 
 and in the colouring ingredients. 
 
 No. VII. 
 
 A commodious preparation, and, for the most part, a 
 very successful one, has been in use amongst us for 
 many years. It is also much approved, I have un- 
 derstood, in other parts of the United States, and is 
 commonly called, the Cold Injection. To make it, take 
 
 White Lead and Red Lead, of each ^iv. 
 
 Linseed Oil enough to form a thick paste by rubbing them 
 well together. Liquefy this paste with Turpentine Varnish, 
 ^viii. 
 
 Just before injecting sprinkle this mixture wuth cold 
 water. The advantage of it is, that it does not re- 
 quire the subject to be previously heated. The colour 
 may be improved with vermilion.* 
 
 These ingredients are used in various proportions by 
 
 * As making a mixture for each time one has to inject is 
 rather troublesome, a larger quantity of the ingredients with 
 the exception of the vaimish may be blended, and then kept 
 fluid for a long period by pouring water into the vessel. After 
 the varnish is once added the mixture must be used immediately, 
 as it then begins to thicken. 
 
INTRODUCTION. 
 
 XXI 
 
 different anatomists, and it may be found advantageous 
 to increase or diminish their relative quantity accord- 
 ing to circumstances. The Red Lead is more drying 
 than the White, and is sometimes used without the 
 other as follows: 
 
 No. VIIL 
 
 Red Lead. • 
 
 Linseed Oil sufi&cient to bring it to tbe consistence of putty. 
 
 Then equal parts of Spirits of Turpentine and Turpentine 
 Varnish, until it is reduced to a semifluid state. 
 
 Just before injecting sprinkle it with a little water and stir it.*' 
 
 White Lead, treated in the same way with linseed 
 oil and turpentine varnish, may have its colour chang- 
 ed to fancy hy any of the colouring matters mentioned. 
 It is not necessary to strain these lead mixtures. 
 
 No. IX. 
 
 When the student wishes only to prosecute the dis- 
 section of the vessels without making a preparation of 
 them, the following injection will answer. 
 
 Tallow, ibij. 
 
 Turpentine Varnish, ^x. 
 
 Red Lead, 
 
 Mix. 
 
 This mixture retains it fluidity, when melted, for 
 a long time, and may be thrown from the arch of the 
 
 Charles Bell’s system of Dissections, London, 1809. 
 
XXll 
 
 INTRODUCTION. 
 
 aorta through the primitive and many of the secon- 
 dary arterial trunks, without heating the subject. Its 
 cheapness makes it very advantageous. 
 
 The success of this injection will be increased by 
 throwing in first, a syringe full of Nos. IV. or V. pro- 
 perly heated, with a view of warming somewhat the 
 vessels and removing their rigidity . 
 
 In the use of these formulae excepting Nos. ATI. ATII. 
 and IX. it is indispensable to warm the subject thoroughly 
 by previous immei’sion in water hot enough to excite 
 the sensation of scalding in the finger. If the water 
 be warmer it will cause the parts to contraet and be- 
 come rigid instead of softening them. The injections 
 must be of a proportionate temperature. 
 
 The more limited the range of an injection is, the 
 more likely it will be to succeed well, as the force of 
 the syringe is thereby concentrated. Hence a rule is 
 established to put the pipe as near as possible to the 
 part intended to be injected. 
 
 No. I. is used for corroded and dried preparations. 
 Nos. II. and III. for the latter alone. Nos. IV. and V. is 
 sometimes used as the precursor to the three first. 
 No. AT. is adopted in wet preparations and such as are 
 intended to demonstrate minute vascularity. Nos. ATI. 
 and VIII. answers remarkably well for dried prepara- 
 
INTRODUCTION. 
 
 xxiii 
 
 tions ; it takes about twenty-four hours to harden ; the 
 part injected should, therefore, not be disturbed till 
 the expiration of that period. 
 
 The student acquainted with the circulation of the 
 blood will always know where to fix his pipes when 
 an injection is to be accomplished, whether arterial 
 or venous, or both. It is therefore unnecessary to 
 extend this paper by describing the method of pro- 
 ceeding in each individual preparation, general rules 
 being suflBlcient, and to the intellectual mind much 
 more acceptable. 
 
 DRIED PREPARATIONS. 
 
 Whenever a section of the body, as the head, the 
 arm, leg, or any other part, is to be injected, the arte- 
 rial pipe must be fixed into its principal trunk or 
 trunks : and the venous pipe into one of the extreme 
 branches. A very common, and, indeed, the most 
 frequent source of misfortune to the young anatomist, 
 is the neglecting to take up such vessels as were cut 
 in the separation of the part. It may be avoided by 
 blowing into the pipes when fixed, whereby all the 
 ramifications being inflated, such as are cut can be thus 
 easily found out and secured. 
 
 Male subjects, from birth till the age of twenty-five 
 or thirty, answer best for dried preparations of the 
 
XXIV 
 
 INTRODUCTION. 
 
 ■ greater part of the arterial system. After thirty, few 
 subjects answer well in consequence of a profusion 
 of adeps blending itself with the muscles, and not un- 
 frequently of a diseased state of the arterial system. 
 
 In dried preparations the arteries should be fairly 
 traced in all their ramifications, and the muscles sepa- 
 rated from each other. Every thing not essential 
 to the object of the preparation must be cut away. 
 When the part is fully dissected, care should be taken to 
 put every portion of it in a proper posture, and to fix 
 it so till it becomes stiff by exposure to the air. The 
 muscles are to be kept asunder by strips of wood. 
 
 When the preparation is thoroughly dried, and not 
 before, it should be varnished. But previously to 
 the latter process, it should be washed twice with 
 a solution of caustic potash, in order to remove a 
 greasy coat which it is apt to form on its surface. It 
 should afterwards be washed with water to remove the 
 soap that results from the application of the potash. 
 Soap-boiler’s ley answers perfectly, in the place of the 
 caustic potash of the shops. Dried preparations suf- 
 fer much from insects, and the best security for them 
 is obtained by immersion in a solution of corrosive 
 sublimate, till they become impregnated with it; they 
 may afterwards be put in position and dried. If they 
 are too large to subject to this process, even after they 
 
INTRODUCTION. 
 
 XXV 
 
 are dried, they may be washed four times advan- 
 tageously with this mixture. 
 
 Corrosive Sublimate ^i- 
 
 Muriate of Ammonia, Jiss. 
 
 Water, ifci. 
 
 At the two last washings add to the foregoing 
 Common Glue, dissolved, ^i. 
 
 The glue makes the mixture adhere to the prepara- 
 tion, and' also furnishes for the varnish a basis or ground, 
 which makes it stick and dry well. Two thin coats 
 of copal varnish must afterwards be laid on with a soft 
 brush. 
 
 CORRODED PREPARATIONS. 
 
 The heart, lungs, liver, spleen, pancreas, kidneys, 
 and penis, are most commonly chosen in making corrod- 
 ed preparations. Their vessels, excretory ducts, and 
 cavities, as the case may be, should be distended mo- 
 derately with No. I. observing to give to each system 
 in the structure of the viscus a colour different from 
 the rest. The successful injection of these requires 
 good management, because, if too much force be used, 
 extravasation will occur and the preparation will be 
 materially disfigure^. 
 
INTRODUCTION. 
 
 xxvi 
 
 After injecting it;, the preparation is to be laid in a 
 mixture of three parts of muriatic acid; with one of 
 water, which corrodes the fleshy part and leaves the 
 injection exposed. The process of corrosion occupies 
 from three weeks to two months, according to the bulk 
 of the viscus. The acid becomes weakened during the 
 time, and we should, therefore, every week, add 
 enough of the fresh, to bring it to its original strength. 
 
 When the fleshy part is converted in a soft pulp, the 
 preparation must be taken out of the mixture with the 
 greatest care and subjected to a small gentle stream 
 of water, which washes off the pulp and leaves the 
 vessels bare. If the corroding process be unfinished, 
 the part must be replaced in the acid mixture and 
 kept there till it is completed. On the pulp being 
 removed, let the preparation remain floating in water 
 for twenty hours in order to remove any acid which 
 may adhere to it; then dry it by suspension in the air 
 or by laying it on a heap of soft carded cotton, covered 
 with a thin cambrick cloth, in order to prevent the 
 cotton from sticking to its vessels. 
 
 • 
 
 As corroded preparations break from the slightest 
 violence, I have latterly used with great improvement to 
 their strength, a size of isinglass, into which they were 
 dipped; by repeated applications of this they become 
 well coated with it, and thereby too strong to be in- 
 jured by slight jars. 
 
INTRODUCTION. 
 
 XXVU 
 
 The preparation should be fixed on a plaster of , 
 Paris pedestal, and varnished by dipping it into copal 
 varnish diluted with one-half its quantity of spirits of 
 turpentine. It should, after drying, be varnished in 
 the same way once more. Such preparations, when 
 kept under glass bells or cases, are among the most 
 beautiful that can be made. 
 
 WET PREPARATIONS. 
 
 Minute injections generally, and all morbid derange- 
 ments, are proper subjects for wet preparations. The 
 natural structure of many parts is also very advan- 
 tageously displayed in this way. The article previ- 
 ously to being put up, should be steeped in water, 
 changed daily, till all the blood is out. 
 
 Spirits of wine, spirits of turpentine, and a solution 
 of corrosive sublimate, are each excellent for suspend- 
 ing such preparations in. The latter answers parti- 
 cularly well for eyes and for thin membranous parts, 
 as an intestinej &c. Two grains of corrosive subli- 
 mate, with an equal quantity of muriate of ammonia, 
 to an ounce of water, make a solution sufficiently anti- 
 putrescent for an eye, and which contracts the pre- 
 paration much less than spirits of wine. When larger 
 bodies are preserved the quantity of corrosive subli- 
 mate must be increased proportionately. 
 
xxviii INTRODUCTION. 
 
 Bottles for wet preparations should have wide 
 mouths, short necks, and broad heavy bottoms. The 
 preparation being properly displayed and suspended, 
 the mouth of the bottle must be secured with a blad- 
 der; over this must be placed sheet lead, about the 
 thickness of a quarter of a dollar, and trimmed so 
 as to correspond in size with the top of the bottle ; 
 over this lead, another piece of bladder is to be 
 stretched and secured. The outside bladder, being 
 properly trimmed, should be varnished twice with 
 copal varnish coloured with lampblack. 
 
 QUICKSILVER INJECTIOKS. 
 
 These constitute a beautiful and interesting depart 
 ment in the occupations of the practical anatomist. 
 The parts most frequently subjected to this process 
 are the lymphatics and lacteals. In the extremi- 
 ties we introduce the tube at the point farthest from 
 the heart, and having injected one trunk, the pipe 
 must be withdrawn and introduced into another, and 
 so on till all the trunks are filled. In injecting for the 
 lacteals we must introduce the pipe into a lacteal trunk 
 in the mesentery and inject backwards; as the lacteals 
 are, on the intestine itself, for the most part, too 
 small to admit of its introduction into them. 
 
 The Liver has a great many lymphatics in its peri- 
 toneal coat; the^ may be injected from one of the 
 
INTRODUCTION. 
 
 XXIX 
 
 trunks on the broad ligament. It is unnecessary to 
 preserve the whole liver ; a section of it half an inch 
 thick, dried and hung in spirits of turpentine answers 
 very well. 
 
 The Parotid Gland injected with quicksilver, from 
 its duct, affords a fine preparation. The injection must 
 be made before the gland is removed from the body ; 
 the blood should afterwards be soaked out, and the 
 gland dried and hung in spirits of turpentine. 
 
 The VesiculsB Seminales and the Testicles of the 
 adult, are also excellent subjects for this kind of prepa- 
 ration. The lactiferous ducts of the mammse are very . 
 favourably displayed in the same manner ; they are 
 injected separately from the nipple.^ A woman who 
 has died during lactation is the best subject for it. 
 
 The hand of a thin, aged female may be readily in- 
 jected, both arteries and veins, by a pipe fixed into 
 the radial artery. After it is filled it should be mace- 
 rated in water frequently changed, till all the blood is 
 removed and the cuticle comes off; it should then be 
 dried and varnished. 
 
 * Bristles should be previously introduced into each duct, 
 and ■withdrawn successively as the injection advances, other- 
 wise we may commit the mistake of injecting a duct twice. As 
 each duct is injected, it should be secui-ed with a ligature. 
 
XXX 
 
 l^^TRODUCTION. 
 
 The Veins of the kidney of a cat are said to afford a 
 beautiful preparation with quicksilver. 
 
 PREPARING BONES. 
 
 Bones are best prepared by maceration in warm 
 weather, and a dropsical subject is much better than 
 any other, from the marrow being less abundant and 
 mixed with serum. The skeleton should be roughly 
 cleaned and put into a macerating vessel, the brain 
 being removed. The water should be changed daily 
 as long as it is discoloured by the blood. Afterwards 
 it should be left till putrefaction has softened and dis- 
 solved all the ligaments and soft parts. The skeleton 
 should then be taken out and washed well in clean 
 water with a little ley added to it. It is then to be 
 dried and is fit for use. If the maceration be pro- 
 perly conducted no bleaching is necessary ; if other- 
 wise, the process adopted in whitening linen and cot- 
 ton clothing answers well, that is, exposure to the sun. 
 frequent wetting with water, and chlorine. 
 
 A cranium from four to ten years old treated in tliis 
 way affords a fine preparation for studying its bones 
 in a state of separation. To accomplish the latter it 
 is only necessary to fill its cavity mth peas or beans 
 after the maceration is over, and to immerse it in warm 
 water. The beans in a short time begin to swell and 
 
INTRODUCTION. 
 
 XXXI 
 
 open the sutures completely. The bones of the face 
 must be taken asunder with the fingers. 
 
 In order to show the animal part only of bone, take 
 a section of it and immerse it in an acid mixture com- 
 posed of muriatic acid one ounce, and water one quart. 
 In from one to four months, according to the size and 
 solidity of the bone, the calcareous part will be taken 
 away by the acid. On such a preparation one may 
 demonstrate the pliability and the lamellated and 
 fibrous texture of the hardest bone. 
 
 A bone, by being thrown into a strong fire, will 
 have all its animal part destroyed and. nothing but the 
 calcareous left. This preparation is the reverse of 
 the last. 
 
 To demonstrate the vascularity of bone, cut off the 
 limb of a foetus, or of a young child, and fix a pipe into 
 the principal artery. By filling the part with the 
 size injection, the vessels of the bone will also be 
 injected. Remove the flesh when it becomes cold, 
 and macerate in water till the blood is washed out. 
 Place the bone in the acid mixture just mentioned till 
 the calcareous part is removed j soak it in pure water 
 again for a day, then dry it, and finally immerse it in 
 spirits of turpentine to make it transparent. 
 
INTRODUCTION. 
 
 xxxii 
 
 ON FUMIGATION. 
 
 The air of rooms where dead bodies are kept, as 
 well as the walls and furniture, become exceedingly 
 offensive; to correct which we resort to the following 
 mixture with great advantage. 
 
 Take Black Oxyd of Manganese, ji. 
 
 Comnaon Salt, 
 
 Sulphuric Acid, 
 
 Water, 
 
 The water and the acid should be previously mixed 
 and allowed to cool. Then stir all the ingredients well 
 together in a stone vessel. 
 
 When the room is abandoned for the night, close 
 its doors and windows and commence this fumigation. 
 The next morning it will be found much sweetened, 
 and on ventilating freely its atmosphere will loose still 
 more of its offensiveness and be in a great measure 
 renovated. 
 
 The fumes of this mixture are very penetrating; 
 they give their peculiar smell to clothing for several 
 
 ^ . • 
 3y- 
 
 5vi. 
 
 5iss. 
 
INTRODUCTION. 
 
 XXXlll 
 
 days, and rust metallic surfaces intensely. All articles, 
 therefore, which are not intended for such depuration 
 should be removed. 
 
 Students of Anatomy, have their fears much excited on the 
 score of the constitutional symptoms, arising from small wounds 
 inflicted during their dissections ; under an erroneous impression, 
 that a specific virus is, thereby, introduced into the system. 
 Inconveniences of this kind, though they do occasionally occur, 
 are by no means frequent; and are just as apt to be produced 
 from the prick of a needle, of a brier, or of an oyster-shell. The 
 first intimation of such mischief, is the part becoming painful, 
 red, and swollen, and the arm getting somewhat stiff; if in the 
 eai-ly stage of these symptoms, a blister be applied according to 
 the recommendation of Dr. Physick, the person live light, and 
 take a saline cathaidic, the treatment is almost invariably suf- 
 ficient for-the cure. Such accidents are much more liable to 
 occur from the prick of a spicula of bone, than from any other 
 cause to which the Anatomist is exposed, furnishing thereby, 
 a useful hint for him, never to break a bone, but always to saw it 
 oft' smoothly. 
 
 c 
 
LESSONS 
 
 IN 
 
 PRACTICAL ANATOMY. 
 
 PART I. 
 
 OF THE HEAD AND NECK. 
 
 CHAPTER I. 
 
 Of the External Parts of the Head and JVeck. 
 
 The integuments of the head are rem&rkably thick 
 and hard, but give the sensation, when felt externally, 
 of being a very thin layer spread over the hones. The 
 latter is particularly the case as far as the hair extends. 
 They consist of skin, and below it of small, compact, 
 granulated masses of fat enclosed in the cells of a cellu- 
 lar substance, which has very much of a ligamentous 
 character, and adheres closely to the muscle and ten- 
 dinous matter beneath. 
 
 The muscles of the face should always be dissected 
 as early as possible after death; under the most favour- 
 able circumstances they are difficult for the student to 
 make out, and are rendered unintelligible to him in a 
 
 A 
 
OF THE HEAD AND NECK. 
 
 2 
 
 few days by the changes which their diminution of 
 volume, infiltration, and confusion of colour with con- 
 tiguous parts, produce. 
 
 I would also advise one side of the face and neck to 
 be appropriated exclusively to the dissection of the 
 fasciae, muscles, and glands; every thing, therefore, 
 should be removed which interferes with a thorough 
 examination of them. The student having accomplish- 
 ed this, may afterwards work on the other side of the 
 subject for the blood-vessels and nerves. To trace the 
 arteries properly, they ought to be filled previously 
 with common injection; tallow, coloured with red lead, 
 answers very well ; it is of less importance to inject the 
 veins. It is unnecessary to heat the subject for such 
 injection. 
 
 Section I. 
 
 Of the Muscles and Fasciae. 
 
 The OcciPiTO-FRONTALis muscle consists of tw’o 
 symmetrical parts, and coming from the back of the 
 head is inserted into the front of it; it has four bellies 
 of muscular fibres, two behind and twm before, con- 
 nected by a thin tendon which covers all the top of the 
 head. The dissection of this muscle is difficult, from 
 the close adhesion of its tendon to the pericraniiun be- 
 
MUSCLES AND FASCIA. 
 
 3 
 
 lowj and to the integuments of the head above. It 
 is best, therefore, to commence by making one incision, 
 through the integuments only, fi’om the root of the nose 
 to the fore end of the sagittal suture, and another from 
 the commencement of the first along the upper margin 
 of the eyebrows to the external angular process of the 
 os fronds ; by raising up this flap it leads to the dissec- 
 tion of the whole muscle. 
 
 It arises from the superior transverse ridge of the os 
 occipitis by tendinous and fleshy fibres, which form two 
 distinct bellies about an inch and a half long, one on 
 each side of the bone. Its tendon, when carefully 
 traced, will be found terminating a little in front of the 
 coronal suture in the two anterior fleshy bellies which 
 cover the whole front part of the os fronds. The in- 
 ternal edges of these latter are in conjimcdon below. 
 
 It is inserted fleshy, on each sjde, into the superior 
 margin of the orbicularis ocuii and corrugator super- 
 cilii, and by its nasal slip into the internal angular pro- 
 cess of the os fronds and into the root of the os nasi. 
 
 It pulls the skin of the head backw’ards and for- 
 wards, and throws the forehead into horizontal wrin- 
 kles. It also elevates the supercilia. 
 
 The Compressor Naris arises by a pointed begin- 
 ning from the root of the ala nasi ; it spreads like a fan 
 over the lateral parts of the nose below, is inserted into 
 its fellow of the opposite side, on the dorsum of the 
 nose, and into the lower part of the os nasi, where it is 
 connected with the nasal slip of the occipito frontalis. 
 
4 
 
 OF THE HEAD AND NECK. 
 
 This muscle consists of thin and pale fibres imme- 
 diately under the skin. If it act from both extremi- 
 ties, by its curved fibres being made straight, it will 
 compress the nostril ; but if it act from its dorsal mar- 
 gin assisted by the nasal slip of the occipito frontalis, it 
 will dilate the ala nasi, and has, therefore, been called 
 dilatans nasum by Columbus. 
 
 The Orbicularis Palpebrarum is a broad circu- 
 lar muscle, lying immediately under the skin of the 
 eyelids, and over the tarsi cartilages. It covers the 
 whole front of the bony orbit and extends from four to 
 eight lines beyond its margin, being connected to sub- 
 jacent parts by cellular tissue ; its temporal section is 
 fastened to the temporal fascia beneath. 
 
 It arises fleshy from the internal angular process of 
 the frontal bone and from the upper edge of the round 
 hoinzoutal tendon that fixes the internal commissure of 
 the eyelids to the nasal process of the superior maxilla. 
 These fibres perform the circuit of the eyelids, and, 
 coming around to the internal canthus again, are insert- 
 ed into the orbitar margin of the nasal process, and of 
 the orbitar process of the upper maxilla, into the lower 
 edge of the horizontal tendon, and into tlie nasal pro- 
 cess just beneath it. 
 
 The Ciliaris muscle is the internal mai-gin of the 
 orbicularis planted on the edges of the tai’si cartilages. 
 
 As the Orbicularis muscle is fixed at its nasal and 
 temporal sections more than elsewhere, it is obvious 
 
MUSCLES AND FASCIA. 
 
 o 
 
 that the contraction of its circular or curved fibres by 
 making them straight, mil close the eyelids and wrinkle 
 the skin on them. This muscle frequently has a slip 
 fi’om its lower border to the upper lip, anterior to the 
 2ygomaticus minor. 
 
 The CoRRUGATOR SuPERCiLii is placed at the in- 
 ternal end of the superciliary ridge. It arises from the 
 internal angular process of the os frontis, and passing 
 obliquely upwards and outwards between the lower 
 edge of the occipito frontalis and the upper edge of 
 the orbicularis, is concealed by them. It is inserted 
 into the former principally, but its fibres also blend 
 with the latter. 
 
 It draws the forehead into vertical wrinkles. 
 
 The Levator Labii Superioris Aljeque Nasi is 
 fixed just at the side of the nose. It arises by a point- 
 ed production from the nasal process of the superior 
 maxilla at the external canthus of the eye, and by a 
 broad origin from the anterior margin of the orbitar 
 process of the same bone. Passing downwards it is 
 inserted into the side of the ala nasi, and into the up- 
 per lip, being narrower below than above. 
 
 It draws the upper lip and the ala nasi upwards. 
 
 The Levator Anguli Oris is a small muscle con- 
 cealed very much by the last; it arises from the ante- 
 rior part of the superior maxillary bone, between the 
 
6 
 
 OF THE HEAD AND NECK. 
 
 foramen infra-orbitarium and the first small grinder, and 
 is inserted into the corner of the mouth. 
 
 It raises up the angle of the mouth. 
 
 The Zygomaticus Minor is a small muscle some- 
 times deficient, arising from the fore part of the os 
 malse 5 it descends obliquely and is inserted into the 
 upper lip just above the corner of the mouth. 
 
 The Zygomaticus Major, being just on the out- 
 side of the last and much larger, aiises from the malar 
 bone externally, at its posterior inferior part just above 
 the lower edge, where this bone contributes to form 
 the zygoma, and passing obliquely downwards it is in- 
 serted into the corner of the mouth, by running into the 
 depressor anguli oris. 
 
 These two last muscles di-aw the corner of the mouth 
 towards the cheek bone, or obliquely upwards and Out- 
 wards as in smiling. 
 
 The Depressor Labii Superioris Aljeque Nasi 
 is concealed by the orbicularis oris and by the levator 
 labii superioris alseque nasi. To get a view of it the 
 upper lip must be inverted and the lining membrane 
 of the mouth removed on the side of the frsenum of the 
 lip. This muscle arises from the inferior part of the 
 upper maxilla in front of the alveolar processes for the 
 dens caninus and the incisores, and is inserted into the 
 
MUSCLES AND FASCIA. 
 
 / 
 
 side of the ala nasi and into the contiguous part of the 
 upper lip. 
 
 It depresses the upper lip and the ala nasi'. 
 
 The Depressor Anguli Oris arises broad and 
 fleshy from the base of the lower jaw on the side of the 
 chin ; being somewhat triangular, its apex is inserted 
 into the corner of the mouth. ’ 
 
 This muscle draws the corner of the mouth down- 
 ~ wards. It lies immediately under the skin, and blends 
 above with the zygomaticus major and with tlie leva- 
 tor anguli oris. 
 
 The Depressor Labii Ixferiorts is in part be- 
 neath the last muscle, and, like it, arises broad and 
 fleshy from the basis of the lower jaw on the side of 
 the chin ; its fibres pass obliquely upwards and inwards 
 and are inserted into the whole side of the lower- lip. 
 
 It draws the lip downwards. 
 
 These two last muscles are much obscured by being 
 mixed with a quantity mf adipose matter ; the skin, also 
 is closely blended with them, and the roots of the beard 
 penetrate between the intervals of their fibres. 
 
 The Levator Labii Inferioris, being placed be- 
 neath the depressor labii inferioris, is demonstrated by 
 turning downwards the lower lip and dissecting away 
 its lining membrane on the side of the frmnum ; it will 
 then be seen to arise in front of the alveolar process of 
 
OF THE HEAD AND NECK. 
 
 the external incisor and the canine tooth, and pass- 
 ing obliquely downwards to be inserted into the lower 
 lip. 
 
 It elevates the lower lip. 
 
 The Buccinatoe muscle arises from the root of the 
 coronoid process of the lower jaw bone, from the back 
 part of the upper maxilla near the pterygoid process 
 and from the roots of the alveolar processes of both 
 bones as far forwards as the dentes bicuspides. It is in- 
 serted into the corner of the mouth and into the con- 
 tiguous parts of the upper and lower lip. 
 
 It draws the corners of the mouth directly back- 
 wards. 
 
 The Orbicularis Oris is a circular muscle just 
 beneath the skin, much blended with adipose matter 
 externally, but more plain on the surface contiguous to 
 the lining membrane of the mouth. It constitutes a 
 considerable part of the thickness of the lips, and sur- 
 round the mouth entirely. It has no bony origin, but 
 arises from the fibres of the several muscles which join 
 each other at the corner of the mouth, and, therefore, 
 consists of two semicircular planes, one for the upper, 
 and the other for the lower lip. 
 
 It is the antagonist to most of the other muscles of 
 the mouth. From its superior part a pyramidal slip 
 goes to the tip of the nose, called by Albinus, Nasalis 
 Labii Superioris. 
 
MUSCLES AND FASCIA. 
 
 9 
 
 The Masseter is placed immediately under the 
 skin, and forms the fleshy protuberance on the back of 
 the face before the ear. It arises tendinous and fleshy 
 from the malar process of the upper maxilla, and from 
 the inferior edge of the malar bone between the maxil- 
 lary and zygomatic sutures; it arises also from the 
 temporal bone between the zygomatic suture and the 
 tubercle. The masseter covers all the exterior surface 
 of the ramus of the lower jaw, as low down as its base. 
 It is divided into two portions, which lie one beneath 
 the other; the internal is the smaller, and is inserted 
 tendinous into the outer part of the root of the coronoid 
 process. The external extends from the malar bone to 
 the angle of the inferior maxilla, where it is inserted 
 tendinous and fleshy. A part of the internal portion 
 may be seen at the zygomatic suture behind the exter- 
 nal, without the latter being raised up. 
 
 It closes the jaws. 
 
 The Temporalis lies on the side of the head occupy- 
 ing its middle inferior region ; it is covered externally 
 by a thick ' dense tendinous membrane, the fascia tem- 
 poralis, which arises from the semicircular ridge on the 
 side of the cranium, and is inserted into the upper mar- 
 gin of the zygoma. By removing this fascia, the tem- 
 poral muscle is seen to arise fleshy from its inner sur- 
 face, from the semicircular ridge on the side of the os 
 ffontis and parietale its whole length, also from the sur- 
 faces of bone, between this ridge and the zygoma in- 
 
 B 
 
10 
 
 OF THE HEAD AND NECK. 
 
 eluding a part of the frontal bone, the lower part of the 
 parietal, and the squamous portion of the temporal. 
 From this extensive origin, the fibres converge to* 
 wards the zygoma and are inserted tendinous into the 
 coronoid process of the lower jaw, surrounding it on 
 every side ; some of these tendinous fibres in front go 
 down nearly as low as the last dens molaris. 
 
 The temporalis receives a small accession of fleshy 
 fibres from the internal face of the zygoma. It pulls 
 the lower jaw directly upwards. 
 
 Of the Muscles of the A^eck. The dissection of this 
 part can now be advantageously pursued; with this 
 view, make one incision through the skin, along the 
 clavicle and upper edge of the sternum, another from 
 the chin, over the thyroid cartilage to the sternum, 
 and a third from the chin to the upper part of the ear. 
 
 The flap which is thus marked out it to be raised 
 carefully without cutting up a superficial membrane 
 that lies immediately below the skin called Fascia Su- 
 perficialis. This fascia is a continuation of the one 
 placed in front of the abdominal muscles, which passes 
 from them to the thorax and afterwards to the neck. 
 Its connexion with the clavicle and sternum is not very 
 strong, and it goes from them along the neck to the 
 face, being slightly fastened to the base of tlie lower 
 jaw in advance of the masseter muscle. It is spread 
 over the parotid gland, is fixed to tlie mastoid process, 
 to the meatus auditorius, and to Uie zygoma : in the lat- 
 
MUSCLES AND FASCIA. 
 
 11 
 
 ter place it is continuous in some measure with the fas- 
 cia temporalis. The existence of this membrane is 
 thought, by Mr. Colles of Dublin, to obscure very much 
 the affections of the neck and of the parotid gland, 
 checking the development of tumours, rendering their 
 fluctuation and particular feel very equivocal, and giv- 
 ing a wrong course to their pus when they suppurate. 
 The fascia superficialis is better marked over the paro- 
 tid gland, and about the base of the jaw, than lower 
 dow. 
 
 The Platysma Myoides muscle, or the Musculus 
 C uTANEUS, is immediately beneath the fascia superfi- 
 cialis ; covers a very considerable portion of the side 
 of the neck ; and extends from the thorax obliquely to 
 the face. 
 
 It arises from the condensed cellular membrane on 
 the upper part of the pectoralis major muscle and the 
 deltoid, just below the clavicle and nearly the whole 
 length of this bone. Its fibres are much more pale 
 than those of other muscles, are collected into longitu- 
 dinal fasciculi, constituting a plane of scarcely a line in 
 thickness, and terminate in the integuments of the lower 
 jaw and cheek. It is slightly attached to the lower jaw, 
 and sometimes has the appearance of running into the 
 muscles of the lower part of the face. 
 
 When the whole muscle is in action it elevates the 
 skin of the neck. The external jugular vein is seen 
 running nearly in the. centre of it in the same direction 
 
12 
 
 OF THE HEAD AND NECK 
 
 with the fibres of this muscle between it and the sterno- 
 mastoid. 
 
 The, Sterno-Cleido-Mastoideus is beneath and 
 decussates the last muscle. It forms always a promi- . 
 nent feature in the outline of the neck, passing obli- 
 quely from the upper front part of the thorax to the 
 bas(Tof the cranium. 
 
 It arises tendinous and fleshy from the edge of the 
 upper part of the sternum, and fleshy from the ster- 
 nal end of the clavicle. These origins are separated by 
 a considerable fissure ; they soon unite and are insert- 
 ed tendinous into the mastoid process and into part of 
 the transverse ridge of the occipital bone next to it. 
 
 It draws the chin towards the sternum. This mus- 
 cle is to be detached from its origin, and allowed to 
 hang aside by its insertion, in order to get at the parts 
 beneath. We shall then see two narrow, handsome 
 ribbon-like muscles on each side of the middle line of 
 the trachea; they are the sterno-hyoideus and sterno- 
 thyroideus. But before we go to the dissection of 
 them, it is necessary to look at another fascia of the 
 neck. 
 
 When the origin of the sterno-cleido-mastoideus is 
 turned to one side, beneath the fascia superficialis and 
 somewhat separated from it by a lamina of cellular 
 adipose matter, is seen the Fascia Profunda of the 
 neck. This membrane arises from the larynx, forms a 
 thin capsule to the thyroid gland, and, being closely 
 
MUSCLES AND FASCIA. 
 
 13 
 
 attached to its inferior margin, it descends by invest-' 
 ing the sterno- hyoid and thyroid muscles, being strong 
 and well marked on their anterior surfaces. It is firm- 
 ly fastened to the upper edge of the sternum, the ster- 
 « nal end of the cla\dcle, and to the cartilages of the first 
 ribs, forming an elastic and resisting membrane from 
 the larynx to the thorax. By turning off the sterno- 
 hyoid and thyroid muscles from their attachment to 
 the sternum, the fascia profunda will be seen still more 
 distinctly passing behind them from the inferior mar- 
 gin of the thyroid gland to the upper bone of the ster- 
 num, this lamina of it being inserted into the sternum 
 twelve or fifteen lines below its upper edge. It en- 
 closes or surrounds the transverse vein and the arteria 
 innominata. Beneath the fascia profunda, are the 
 trachea, the roots of the arteries of the head and upper 
 extremities, and the trunks of their veins. There is 
 much loose cellular and adipose matter placed at the 
 lower part of the neck beneath this fascia, between it 
 and the trachea, through which the thyroid veins with 
 their ramifications pass. This last circumstance must 
 always render suppurations and operations in the part 
 highly dangerous, as the pus will form fistulsB under 
 the sternum ; moreover, the continual motion of the 
 part in respiration prevents adhesion from occurring, 
 and, therefore, disposes to ulceration. An ingenious 
 idea on the uses of this fascia and of the sterno- hyoid 
 and thyroid muscles as connected with it, was suggest- 
 ed by the late Allan Burns ; he conceived that they 
 
14 
 
 OF THE HEAD AND NECK. 
 
 were a defence to the upper part of the thorax, and 
 sustained the atmospheric pressure, which, without 
 them, would fall upon the trachea and produce difficul- 
 ty of breathing, from the air not passing through the 
 larynx sufficiently rapidly to keep pace with the dila- • 
 tation of the thorax. He illustrates the opinion by a 
 case very much in point, of a gentleman who had lost 
 thirfascia and the muscles by suppuration, and who was 
 afterwards incommoded by atmospheric pressure upon 
 the trachea at this point. ^ 
 
 The external borders of the fascia profunda are con- 
 tinued into the sheaths of the gi’eat vessels of the 
 neck. It and the fascia superficialis are also continu- 
 ous with each other along the anterior edge of the ster- 
 no-cleido-mastoideus. 
 
 Within the inferior maxilla, at its angle, a ligament- 
 ous expansion arises from the pterygoideus externus 
 muscle, and is spread out between the styloid process 
 and the ramus of the lower jaw. This membrane is 
 joined by the fascia superficialis at its inferior edge, 
 just before the upper part of the sterno-mastoideus, 
 which increases its breadth downwards in the neck, giv- 
 ing it somewhat the condition of a vertical septum of 
 
 Dr. Lawrance informs me that this fascia profunda is v ell 
 developed in the neck of a cat, and that having occasion to re- 
 move it in an experiment; the respiration of the animal was 
 conducted with great difficulty, amounting almost to suffocation. 
 This is a good confirmation of Mr. Burns’s hypothesis. 
 
MUSCLES AND FASCIA. 15 
 
 that region, and at its lower edge it runs into the theca 
 of the great vessels of the neck. Through its lower 
 part, penetrate the stylo-hyoideus and digastricus mus- 
 cles, and the upper part separates the parotid from 
 the submaxillary gland. It is felt like a cord extend- 
 ing downwards and backwards below the angle of the 
 maxilla inferior. It is connected at its internal edge 
 with the compages of the nerves and vessels oT-the 
 part in such a manner as to forbid description, but the 
 practical anatomist will find no difficulty in discovering 
 and understanding it. 
 
 Below this septum a round ligament like a nerve 
 passes from the extremity of the styloid process to the 
 appendix of the os hyoides. 
 
 The Sterno Hyoideus arises thin and fleshy on 
 the interior of the thorax from the approximated sur- 
 faces of the cartilage of the first rib, the clavicle, and 
 the first bone of the sternum ; it passes upwards, some- 
 what obliquely and is inserted into the inferior edge 
 of the base of the os hyoides. 
 
 It draws the os hyoides towards the sternum. 
 
 The Sterno Thyroideus is beneath the last and 
 concealed in a considerable degree by it. It arises 
 fleshy from the interior surface of the sternum, about 
 an inch below its upper margin, and from the cartilage 
 of the first rib ; diminishing in breadth somewhat as it 
 
16 
 
 OF THE HEAD AND NECK. 
 
 ascends, it is inserted obliquely into the side of the thy- 
 roid cartilage 
 
 It draws this cartilage towards the sternum. 
 
 The Thyreo Hyoideus, arises obliquely from the , 
 side of the thyroid cartilage externally, and is inserted 
 into a part of the base and nearly all the cornu of the. 
 os hyoides. It looks like a continuation of the last. 
 
 Use ; To draw up the thyroid cartilage. 
 
 The Omo Hyoideus passes obliquely across the neck 
 from the superior edge of the scapula to the os hyoides. 
 It is a thin narrow muscle divided into two bellies, one 
 at each end, by an intermediate tendon, its inferior part 
 is concealed by the trapezius muscle, its middle, where 
 the tendon exists, crosses the great vessels of the neck 
 and is covered by the sterno-cleido-mastoid muscle, 
 and its upper extremity is over-lapped by the platysma 
 myoides. 
 
 It arises from the scapula just behind the notch in its 
 superior costa, and curving somewhat downwards in its 
 course is inserted into the lower edge of the base of the 
 os hyoides next to its cornu. 
 
 It draws the os hyoides dowTiwards. 
 
 The Digastricus is a double-bellied muscle at the 
 upper side of the neck, passing from tlie back pai’t of 
 the base of the head to the chin. It arises from the 
 fossa of the temporal bone at the inside of the mastoid 
 process, principally fleshy ; as the muscle descends to- 
 
MUSCLES AND FACI^. 
 
 17 
 
 wards the os hyoides, a round tendon forms its middle 
 part, which passes through the stylo hyoideus muscle, 
 and is fixed, by a ligamentous loop, to the cornu of the 
 os hyoides. After this the muscle becomes again fleshy, 
 and is inserted into the inside of the base of the maxilla 
 inferior at the side of the chin. It receives an acces- 
 sion from the base of the os hyoides. ^ 
 
 It draws the os hyoides upwards. By raising the 
 posterior belly of this muscle we get a better view of 
 the styloids, which are three in number, and placed 
 within it. 
 
 The StyloHyotdeus, being the more superficial of 
 the three, arises tendinous from the middle and inferior 
 part of the styloid process of the temporal bone, and 
 being perforated, as mentioned, by the tendon of the 
 digastricus, is inserted tendinous into the cartilaginous 
 juncture of the base and cornu of the os hyoides. 
 
 It draws the os hyoides upwards and backwards. 
 
 The Stylo Glossus is within and above the other; 
 it arises from the upper internal part of the styloid 
 process, tendinous and fleshy, and is inserted into the 
 side of the root of the tongue forming thereby a part of 
 its structure. 
 
 It draws the tongue backwards. 
 
 The Stylo Pharyngeus is more deeply situated 
 than either of the other two muscles. It arises from the 
 
 c 
 
18 
 
 OF THE HEAD AND NECK. 
 
 inner side of the styloid process near its root, and is in- 
 serted into the side of the pharynx between the middle 
 and upper constrictors, opposite the tonsil gland. It 
 afterwards continues between the lining membrane of 
 the pharynx and the middle and lower constrictors, to 
 the posterior margin of the thyroid cartilage. 
 
 It draws the larynx and pharynx upwards. 
 
 The Mylo-Hyoideus forms the floor of the mouth, 
 and suspends the tongue ; it arises from a ridge at the 
 root of the alveolar processes of the lower jaw extend- 
 ing from the last dens molaris to the chin. Its fibres 
 converge towards a white tendinous line placed between 
 it and its fellow, and extending from the base of the 
 os hyoides to the chin. This muscle lies above so as 
 to be concealed by the anterior belly of the digastricus, 
 and when it contracts, it draws tlie os hyoides upwards 
 and projects the tongue. 
 
 The Genio-Hyoideus is immediately above the last, 
 by turning down the anterior edge of which, it is seen. 
 It arises tendinous from the tubercle on the posterior 
 side of the symphysis of the lower jaw, and increasing 
 somewhat in breadth, is inserted into the anterior pai't 
 of the base of the os hyoides. 
 
 It draws the os hyoides upwards and forwards. By 
 removing this muscle we bring into view 
 
 The Genio-Hyo-Glossus, which arises also tendin- 
 
MUSCLES AND FASCIA. 
 
 19 
 
 ous from the tubercle on the inside of the maxilla 
 inferior, near the symphysis, and is inserted into the 
 base of the os hyoides and into the tongue its whole 
 length, constituting a part of its substance. The mus- 
 cles of the opposite sides are in contact and throw the 
 tongue into a great variety of positions, according to 
 the fibres which are brought into action. 
 
 The Hyo-Glossus is just on the exterior of the last. 
 It arises from the base and part of the cornu of the os 
 hyoides broad and fleshy, and is inserted into the side 
 of the tongue. It draws the tongue inwards and down- 
 wards. 
 
 The Lingualis may also be seen in part in this dis- 
 section. It is one of the intrinsic mfiscles of the tongue, 
 and lies on the outer side of the last. For a further 
 account of the muscles of the tongue, see the article 
 Mouth. 
 
 There are four pairs of muscles situated behind the 
 pharynx and oesophagus close to the cervical vertebrae, 
 which can only be seen imperfectly in this dissection. 
 
 1. The Longus Colli is next to the middle line 
 of the vertebrae, and arises from the sides of the bodies 
 of the three superior vertebrae of the back, and from 
 the anterior edges of the transverse processes of the 
 five lower cervical vertebrae. Its fibres pass somewhat 
 
20 
 
 OF THE HEAD AND NECK. 
 
 obliquely upwards and inwards to be inserted into the 
 front of the bodies of all the cervical vertebrae. 
 
 It bends the neck forwards and to one side. 
 
 2. The Rectus Capitis Interxus Major arises 
 tendinous and fleshy from the fronts of the transverse 
 processes of the third, fourth, fifth and sixth cerrical 
 vertebrae, forms a considerable fleshy belly, and is in- 
 serted into the cuneiform process of the os occipitis just 
 before the condyle. It is placed on the outside of the 
 longus colli, and bends the head forwards. 
 
 3. The Rectus Capitis Internus Minor arises 
 fleshy from the front of the body of the first cerrical 
 vertebra near its transverse process, and is inserted 
 under the rectus major before the root of the condy- 
 loid process of the occipital bone. 
 
 It bends the head forwards. 
 
 4. The Rectus Capitis Lateralis arises fleshy 
 from the front of the transverse process of the atlas, 
 and is inserted tendinous and fleshy into the ridge on 
 the outside of the condyle of the occiput, leading from 
 it to the mastoid process. It pulls the head a little to 
 one side. 
 
 On the outside of these muscles, passing from the ex- 
 terior edges of the cervical vertebi’se to the upper parts 
 
MUSCLES AND FASCIA. 
 
 21 
 
 of the thorax, are the Scaleni muscles, three in num- 
 ber, and named from their situation. 
 
 1. The Scalenus Anti cus arises by three distinct 
 tendinous heads from the transverse processes of tlie 
 fourth, fifth and sixth cervical vertebrse, and is insert- 
 ed tendinous and fleshy into the upper edge of the first 
 rib just anteriorly to its middle. 
 
 2. The Scalenus Medius arises by distinct ten- 
 dons from the transverse processes of all the cervical 
 vertebrse, and is inserted tendinous and fleshy into the 
 the upper part of the first rib, in all the space from its 
 middle to its tubercle. 
 
 3. The Scalenus Posticus arises from the trans- 
 verse processes of the fifth and sixth cervical vertebrse, 
 and is inserted into the upper face of the second rib 
 just anterior to its tubercle. 
 
 These muscles are concealed by the sterno-cleido-mas- 
 toideusand the anterior edge of the trapezius; to be 
 well seen, the clavicle should be loosened from the ster- 
 num and thro\vn off to one side. The third Scalenus 
 is best seen in dissecting the muscles of the spine, and 
 resembles very much one of that class to which Albinus 
 gives the name of Levatores Costarum. All the Scaleni 
 elevate the ribs and bend the neck to one side. They 
 are particularly interesting as connected with the course 
 of the large blood-vessels and nerves of the upper ex- 
 
22 
 
 OF THE HEAD AND NECK. 
 
 tremity, which will be more particularly alluded to iu 
 the dissection of the axilla. 
 
 This is a proper place also for looking at the Pterygoid 
 muscles; they are, however, but imperfectly seen. The 
 only way to get a very good view of them is to make 
 the dissection on a vertical section of the head, or on a 
 head'detached from the cervical vertebrae, which can 
 be done very conveniently when we are engaged in the 
 study of the nose, or of the pharynx. 
 
 The Pterygoideus Externus arises fleshy from 
 the outer side of the external pterygoid process of the 
 sphenoid bone, from the tuber of the upper maxilla, and 
 from the under surface of the temporal process of the 
 sphenoid bone. It passes outwards and backwards hori- 
 zontally, and is inserted into the inner side of the neck 
 of the inferior maxilla and into the capsidar ligament of 
 the articulation. 
 
 The Pterygoideus Ixternus arises by tendinous 
 and fleshy fibres from the internal plate of the ptery- 
 goid process of the sphenoid bone at the outer side of 
 the Eustachian tube. It fills up the most of the ptery- 
 goid fossa, and passing downwards and backwards, is 
 inserted tendinous and fleshy into the interior face of 
 the angle of the lower jaw. 
 
 Both of these muscles are important in mastica- 
 
GLANDS. 
 
 23 
 
 t’lon^ they close the jaws, throw the lower one forward, 
 and produce the grinding motion by acting alternately. 
 
 SECTIO^' II. 
 
 Of the Glands of the Head and JWek. 
 
 The Thyroid Grand, (Gland. Thyroidea,) consist- 
 ing of two lobes united by an isthmus, is placed on each 
 side of the upper part of the trachea, extending up- 
 wards laterally by the cricoid cartilage to the thyroid. 
 It resembles a pair of saddle-bags in its general outline, 
 the upper edge, however, being very much excavated 
 or crescentic, with the horns pointing upwards. The 
 isthmus passes over the second ring of the trachea, and 
 is firmly fixed to it by a short cellular substance. Duver- 
 ney and Soemmoring in their plates represent a muscle, 
 passing on the left side of the larynx, from the base of 
 the os hyoides to the upper edge of the thyroid gland, 
 to which they give the name of Muscidus Glandulse 
 Thyroidese. Its occurrence in this country is, I pre- 
 sume, exceedingly rare, as out of several hundred sub- 
 jects which I have superintended the dissection of, but 
 one example of it has been noticed. 
 
 It may be observed, however, that a process of the 
 isthmus looking like a muscular slip is frequently form- 
 ed on the left side, and goes up to the base of the os 
 
24 
 
 OF THE HEAD AND NECK. 
 
 hyoides, and that sometimes a few filaments are detach- 
 ed to the gland from the thyreo -hyoid or crico hyoid 
 muscles. 
 
 This gland is covered by the sterno- hyoid and thyroid 
 muscles. It is of a dark brown colour, has a capsule 
 from the contiguous cellular membrane or fascia, be- 
 sides its own proper coat. The structure of it is very 
 imperfectly understood; the most that we know is, that 
 it is extremely vascular; when cut into or inflated 
 it exhibits a great number of cells communicating with 
 each other, of different sizes, and containing an unctu- 
 ous and somewhat transparent fluid, and that it has no 
 excretory duct. 
 
 On each side of the neck are three large salivary 
 glands, the Parotid — the Submaxillary — and the Sub- 
 lingual. 
 
 The Parotid Glaxd (GlandulaParotis) isthemost 
 considerable of the three, and its form is very irregu- 
 lar, depending on the space into which it is crowded. It 
 reaches from the zygoma downwards to tlie angle of the 
 jaw, occupying the space from the mastoid process and 
 meatus auditorius to the ramus of the jaw, and extend- 
 ing from the skin externally to the styloid process, 
 styloid muscles and the tendon of the digastricus 
 internally ; it is there only separated from the internal 
 carotid artery by these parts internally ; its connexions 
 are numerous and exceedingly intricate. It is removed 
 in the dead subject from the contiguous parts with great 
 difficulty, and in the living subject its complete and safe 
 
GLANDS. 
 
 25 
 
 extirpation is probably impracticable. The portio dura 
 nerve and several large branches of the external caro- 
 tid have to penetrate directly through its substance in 
 order to arrive at their destinations. 
 
 It has been observed that this gland is covered exter- 
 nally by an extension of the fascia superficialis of the 
 neck ; from the interior face of this fascia many prolon- 
 gations are sent out, which penetrate the gland in every 
 direction, separating its lobules from each other and 
 conducting the blood-vessels and nerves through its sub- 
 stance. The substance of the gland is formed of small 
 rounded granulations of a light pink colour, united into 
 lobules of various forms; an arteriole may be injected, 
 going to each of them. 
 
 The parotid gland is elongated at its anterior mar- 
 gin into a point, lying on the posterior part of the mas- 
 seter muscle. From the upper part of this point pro- 
 ceeds the parotid duct across the masseter muscle, 
 about eight lines below the zygoma; and according 
 to the observations of Dr. Physick, in a line from the 
 under part of the lobe of the ear to the tip of the nose. 
 The parotid duct, (Ductus Stenonianus, ) is about the size 
 of a crow quill ; it arises from the granulations of the 
 gland, by ramuscles which, unite successively, to form 
 it. The gland is sometimes divided into two lobes, in 
 which case each has an excretory duct that joins the 
 other, half an inch in front of the anterior edge of 
 the gland. The common duct lies close to the masse- 
 ter muscle, and may easily be overlooked by the young 
 
 D 
 
36 
 
 OF THE HEAD AND NECK. 
 
 anatomist ; forwards it dips over the edge of this mus- 
 cle into a fatty mass between it and the buccinator, and, 
 perforating the latter, has its orifice in the mouth, 
 opposite the second large molar tooth of the upper 
 jaw. 
 
 At the posterior part of this duct, between it and the 
 zygoma, a small gland, is situated, varying in its size 
 and form, and called by Haller the accessory of the 
 parotid. It is not always found. 
 
 The Submaxillary Glakd (Gland. Sub-Maxil- 
 laris) is irregularly ovoid. It is situated below the mus- 
 culus cutaneus in the space bounded by the digastric 
 muscle below, the mylo hyoid towards the mouth, and 
 the body of the lower jaw externally, — and is in con- 
 tact with the facial ?irtery. It almost touches the paro- 
 tid gland behind, being separated from it only by the 
 septum sent in from the fascia superiicialis, and at the 
 posterior edge of the mylo hyoideus it touches the sub- 
 lingual gland. 
 
 Its structure is the same with that of the parotid 
 gland, except the capsule of cellular membrane with 
 its internal -prolongations, being much looser. It has 
 an excretory duct, (Ductus Whartoiiianus, ) arising in 
 the same way by ramuscles, but much thhiuer and 
 more extensible than the parotid duct ; it peneti’ates 
 between the back edge of the mylo hyoid and the hyo- 
 glossus muscles, and continues between tlie genio-hyo- 
 glossus and the sublingual gland : from the latter it re- 
 
GLANDS. 
 
 27 
 
 ceives occasionally several branches, it terminates by 
 an orifice on the side of the fraenum linguae near its 
 anterior edge. 
 
 The Sublingual Gland (Glandula Sublingualis) 
 is placed under the lining membrane of the mouth be- 
 tween the side of the tongue and the mylo hyoid mus- 
 cle, and being oblong it is parallel with the genio-hv|>- 
 glossus where the latter is about to join the tongue. 
 
 This gland is not uniform in the arrangement of its 
 excretory ducts. Sometimes it has fifteen or twenty 
 excretory orifices in the lining membrane of the mouth; 
 on other oecasions several of these short ducts are col- 
 lected into one or two principal trunks which open 
 either direetly into the mouth or into the duct of Whar- 
 ton. By turning up the tip of the tongue, the pro- 
 jection of this gland is readily seen, as well as several 
 salivary granulations, or little glands, which border 
 on it. 
 
 Lymphatic Glands. Medical men are often con- 
 sulted on the subject of indurated and not very pain- 
 ful swellings in the neck, which most frequently are 
 enlarged lymphatic glands. In a course of dissections 
 these should by no means be overlooked, as they are 
 very numerous. They vary much in size and number; 
 being for the most part flattened ovals, some are not 
 more than two lines in their long diameters; others 
 
28 
 
 OF THE HEAD AND NECK. 
 
 are nine or ten lines long. They are both superficial 
 and deep-seated. 
 
 Between the skin and the insertion of the stenio- 
 mastoid muscle there are from four to six ; in the inter- 
 stice just above the clavicle between the posterior edge 
 of the sterno-mastoid muscle and the anterior edge of 
 the trapezius, bordering on the external jugular vein, 
 tl^^re are half a dozen. Between the skin and the paro- 
 tid gland there are two, one above and the other below. 
 On the submaxillary gland, and at its anterior and pos- 
 terior extremities, there are eight or nine. It is sup- 
 posed, by respectable surgeons, that the reputed cases 
 of extirpation of the parotid and of the submaxillary 
 gland, have amounted actually only to the removal of 
 some of these lymphatic glands in a state of enlarge- 
 ment. 
 
 The deep-seated lymphatic glands are also very 
 abundant; along the course of the great cer^*ical ves- 
 sels, but principally between them and the anterior 
 edge of the trapezius muscle, there are about twenty. 
 Between the lower edge of the thyroid gland and the 
 sternum on the trachea there are four, and this chain 
 is continued downwards towards the heart by the exist- 
 ence of several on the side of the oesophagus, trachea, 
 and great blood-vessels. 
 
BLOOD VESSELS. 
 
 29 
 
 Section III, 
 
 Of the Blood-vessels of the JVeck and Head. 
 
 The Right Carotid Artery is a branch of the 
 arteria innominata, and the left a branch of the aorta; 
 their course differs somewhat at first, the right be- 
 ing more oblique, afterwards the course and distribu- 
 tion are uniform in both. A regular ascent is perform- 
 ed in front of the cervical vertebrae at the side of the 
 oesophagus and pharynx, no branch being sent off till 
 the carotid is near the os hyoides and just below its 
 cornu. Here it divides into two branches of nearly 
 equal size, the internal and the external carotid ; the first 
 is intended for the brain, and the last for the external 
 parts of the neck and head. In the lower part of the 
 neck the carotid is covered by the sterno hyoideus and 
 thyroideus and the anterior edge of the sterno-cleido- 
 mastoideus, and at an inch and a half below its bifurcation 
 it is crossed obliquely by the omo-hyoideus muscle. 
 This point may be ascertained before the skin is open- 
 ed by a horizontal line drawn across the neck over the 
 first ring of the trachea, and consequently below the 
 larynx. In its whole course it is involved with the par 
 vagum, sympathetic and descendens noni nerves. 
 
 Parallel with the larynx the carotid may be felt pul- 
 
30 
 
 OF THE HEAD AND NECK. 
 
 sating very distinctly, being there covered only by the 
 pjatysma myoides. It is contained in a sheath of con- 
 densed cellular membrane common to it, the internal 
 jugular vein and the par vagum nerve. 
 
 The External Carotid, (Carotis Externa) at the 
 place of bifurcation, is interior and anterior to the in- 
 ternal carotid, and it immediately begins to send oft' 
 branches as follow : 
 
 1. The Arteria Thyroidea Superior passes in a 
 meandering dii’ection to its principal destination tlie 
 thyroid gland, through which it is minutely distribut- 
 ed, anastomosing freely with the other arteries of the 
 same body. In its course it sends off the larjmgeal 
 branch, which penetrates to the muscles of the larynx, 
 either between the os hyoides and thyroid cartilage or 
 the thyroid and cricoid. It also sends off some smaller 
 branches to contiguous parts. 
 
 2. The Arteria Lingualis arises just above tlic 
 last ; it goes very near the cornu of the os hyoides. 
 crossing it obliquely by penetrating the hyo-glossus 
 muscle. At the root of the tongue it sends off a trans- 
 verse branch (the Dorsalis Linguae), and a little furtlier 
 forwards it divides into two branches, one going to the 
 Sublingual Gland (the Ramus Sublingualis), the otlier 
 distributed through the tongue (the Ranina). 
 
BLOOD VESSELS. 
 
 31 
 
 3. The Arteria Factalis arises near and above 
 the other; it is tortuous, passing under the stylo hyoid 
 and the tendon of the digastric muscle. It is much in- 
 volved with the submaxillary gland, to which it sends 
 branches. The submental branch arises from it here, 
 which passes forwards to the symphysis of the jaw, 
 near the exterior margin of the mylo hyoid muscle. 
 
 The Arteria Facialis mounts over the lower jaw just 
 before the masseter muscle ; to the latter it sends a 
 branch ; fowards it sends another towards the front of 
 the chin called Inferior Labial. On a line with the cor- 
 ner of the modth, it sends to the lips the Inferior and 
 the Superior Coronary Arteries, which are very tortu- 
 ous and surround the mouth, anastomosing freely with 
 those of the other side. 
 
 After this the facial artery ascends to the internal 
 canthus of the eye, sending off intermediately a branch 
 to the ala nasi, and another which anastomoses with the 
 inferior orbitar artery ; at the internal canthus it anas- 
 tomoses with branches from the ophthalmic and termi- 
 nates. 
 
 4. The Arteria Pharyngea Inferior arises from 
 the carotid opposite to the lingual ; it is small, being dis- 
 tributed on the pharynx and sending a branch upwards 
 through the foramen lacerum to the dura mater 
 
 5. The Arteria Occipitalis is large, and arises op- 
 posite to the facial and sometimes higher u]i. It crosses 
 
32 
 
 OF THE HEAD AND NECK. 
 
 over the internal jugular vein and the eighth pair of 
 nerves, passes the base of the cranium under the inser- 
 tion of the muscles going to the mastoid process, and 
 is distributed to the parts lying on the occipital bone, 
 its upper branches anastomose with those of the tem- 
 poral artery. 
 
 Its collateral branches are, one to the dura mater 
 through the posterior foramen lacerum, or the mas- 
 toid foramen, another to the interior parts of the ear, 
 and a considerable one to the complexus and adjacent 
 muscles of the neck. 
 
 6. The Posterior Auris, or Arteri a Stylo M as- 
 TOiDEA, arises from the carotid at the lower edge of the 
 parotid gland, and passes backwards and upwards be- 
 tween the meatus externus and the mastoid process, to 
 terminate behind the ear. It is distributed principally 
 to the contiguous superficial parts, but one branch goes 
 up the stylo mastoid foramen, to the tympanum and to 
 the labyrinth. 
 
 The External Carotid, while detaching these 
 branches, becomes very deeply situated under the di- 
 gastric and stylo-hyoid muscles, and the inferior end of 
 the parotid gland; afterwards it penetrates the sub- 
 stance of the gland, becoming much involved in it, and 
 sending off several small twigs. It ascends through the 
 gland and exhibits itself superficially just before the 
 meatus externus, in mounting over the root of the zygo- 
 
BI.OOD VESSELS. 
 
 33 
 
 ma. When on a line with the neck of the jaw bone 
 it sends off a very large branch, the internal maxiljary, 
 to the parts underneath the ramus of the bone. The 
 origin of this branch is to be considered as the termina- 
 tion of the name external carotid, and the trunk is 
 afterwards called temporal. 
 
 The Arteria Temporalis goes to the side of 
 the head ; while it is still bedded in the parotid, it 
 sends off the Transversalis Faciei, which crosses the 
 masseter muscle below the Parotid Duct, and is distri- 
 buted to the contiguous parts. The temporal artery 
 then rises over the zygoma, where a branch leaves it 
 which penetrates the temporal fascia, and is distributed 
 to the muscle beneath, this is the middle temporal artery. 
 
 The temporal artery having got an inch or so above 
 the zygoma, divides into an anterior and a posterior 
 branch . The first is distributed forwards on the temple, 
 inosculating with its fellow of the other side, and with 
 the facial and the ophthalmic artery. The second is 
 distributed laterally on the parietal region, also anasto- 
 mosing with its fellow of the opposite side and with the 
 occipital artery. 
 
 The Arteria Maxillaris Interna can be got at 
 only by removing the ramus of the jaw j it winds around 
 the neck of the inferior maxilla, and proceeds in a very 
 tortuous manner to the bottom of the zygomatic fossa^ 
 touching in its course, the inferior surface of the tem- 
 
 E 
 
34 
 
 OF THE HEAD AND NECK. 
 
 poral bone. It passes between the intenial and exter- 
 nal pterygoid muscles immediately after leardng the 
 carotid artery; and sends off, several branches, gene- 
 rally in the following order ; 
 
 1. To the cavity of the tympanum through the gle- 
 noid fissure. 
 
 2. The lesser meningeal, to the dura mater through 
 the foramen ovale. 
 
 3. The gi’eater meningeal, to the dura mater through 
 the foramen spinale. From this trunk sometimes pro- 
 ceeds the lesser meningeal to the dura mater through 
 the foramen ovale. 
 
 4. The inferior maxillary,, to the teeth of the lower 
 jaw through the posterior m.ental foramen. 
 
 5. Two branches to the temporal muscle, the first is 
 the posterior deep, the second the anterior deep tempo- 
 ral artery. 
 
 6. Branches to the pterygoid muscles and to the 
 masseter. 
 
 7. A branch to the buccinator and zygomaticus major. 
 
 8. The alveolar artery to the great and small molar 
 teeth of the upper jaw. 
 
 9. The infi’a orbitar, through the infra orbitar canal 
 to the canine and incisor teeth, and to the cheek. 
 
 10. The superior palatine artery through the poste- 
 rior palatine canal to the soft palate. 
 
 11. The superior pharyngeal artery to the upper 
 part of the pharynx. 
 
 12. The spheno palatine, which is the terminating 
 
BLOOD VESSELS. 
 
 35 
 
 branch to the internal maxillary artery, and is very 
 minutely distributed to the Schneiderian membrane by 
 two trunks, one on the septum of the nose, and the 
 other on its 'external side. 
 
 The Internal Carotid Artery, (Carotis Interna) 
 at its comnmncement, is generally dilated like an inci- 
 pient aneurism ; it curves much in getting to the fora- 
 men caroticum, and is in contact with the par vagum 
 and sympathetic nerves; it sends off no intermediate 
 branches. In the canal, it gives a branch to the tym- 
 panum, and as it lies on the side of the sella turcica, it 
 gives the anterior and posterior arteries of the caver- 
 nous sinus. Its subsequent history is merged in that of 
 the ophthalmic and cerebral arteries. 
 
 The following arteries belonging to the neck are de- 
 rived from the subclavian, as it is about to get between 
 the scaleni muscles. 
 
 1. The Arteria Vertebralis which goes into the 
 canal of the transverse processes of the neck at the sixth 
 vertebra, and, following its course, enters the foramen 
 magnum occipitis to be distributed to the brain. It is 
 very tortuous at the first and second vertebrae. 
 
 2. The Arteria Thyroidea Inferior, which 
 passes up obliquely to the thyroid gland between th,e 
 great vessels of the neck and the vertebrae ; in its dis- 
 
36 
 
 OF THE HEAD AND NECK. 
 
 tributioii it anastomoses very freely with the othei- 
 thyroid arteries. 
 
 3. The Cervicalis Anterior, a small artery, and 
 which is distributed along the course of the scaleni mus- 
 cles. It comes frequently from the inferior thyroid, or 
 some other branch of the subclavian. 
 
 4. The Cervicalis Posterior; it is vei’y tortuous, 
 and runs horizontally across the root of the neck, to the 
 trapezius muscle and the subjacent ones. It arises most 
 frequently, either from the subclavian or the inferior 
 thyroid. 
 
 The Veins of the Face and external parts of the 
 Head correspond so nearly with the distribution of the 
 arteries, that they may be considered as having the 
 same course; to undertake the description of them, there- 
 fore, would be almost a repetition of what has been 
 said. 
 
 Towards the angle of the jaw they are collected into 
 a common trunk, the external jugular (Jugularis Ex- 
 terna,) which crosses obliquely the sterno-cleido-mastoid 
 muscle under the platysma myoides in the direction of 
 the fibres of the latter, and runs into the subcla\Tan vein 
 just behind the clavicle at the posterior edge of the 
 sterno-cleido-mastoid muscle. Sometimes the external 
 jugular, almost immediately after its formation, joins 
 the internal jugular. On other occasions the facial vein 
 
BLOOD VESSELS. 
 
 37 
 
 joins the external jugular; and the temporal vein, with 
 slight accessions from the side of the face, forms a trunk 
 which descends almost vertically under the platysma 
 myoides and outside of the sterno-cleido-mastoideus 
 to join the subclavian vein in front bf the scaleni mus- 
 cles. The varieties are in short, too numerous to be 
 recounted in this work. 
 
 The Internal Jugular Vein (Jugularis Interna) 
 may, with propriety, be considered as the great venous 
 trunk of the brain, being a continuation of the lateral si- 
 nus. It lies on the outside of the internal and of the 
 common carotid artery, enclosed in the same sheath, de- 
 scends into the upper mediastinum in contact with the 
 pleura, and is joined at the internal edge of the scale- 
 nus anticus muscle by the subclavian vein. This jugu- 
 lar vein is occasionally much dilated, and in the con- 
 tractions of the right auricle, spreads over the carotid 
 artery. One vein is sometimes much larger than the 
 other. 
 
 The Upper Thyroidal Veins discharge into the 
 internal or external jugulars; the Lower Thyroidal 
 Veins into the transverse or subclavian veins ; some- 
 times a trunk is formed across the upper edge of the 
 sternum from one subclavian to the other, and above the 
 great transverse vein ; into this the inferior thyroidal 
 veins discharge in whole or in part. The variety of 
 arrangement is here also too great to admit of a standard 
 description. 
 
38 
 
 NERVES OF THE HEAD AND NECK. 
 
 Section IV, 
 
 Of the JVerves of the Head and Aeck. 
 
 A JiiNUTE dissection of these will scarcely be under- 
 taken by the young student ; to perform it successfully 
 requires much time, patience, and address ; when, by ad- 
 vanced study, the two latter are obtained, the labour will 
 be fully compensated, by the pleasure and information 
 it affords. For a very minute dissection a lean subject 
 is indispensable ; for a common one, it is less important, 
 and much of the dissection may be performed on the 
 subject appropriated to the arteries. 
 
 The PoRTio Dura comes out at the stylo-mastoid 
 foramen, is almost immediately afterwards deeply invol- 
 ved in the parotid gland, and di\udes into fasciculi in 
 its substance. Emerging at different points it is dis- 
 tributed very minutely on the side of the face, sending 
 branches to the temple which join those of the supra- 
 orbitar nerve, branches to tlie cheek which join those 
 of the infra-orbitar nerve, branches to the chin which 
 join those of the inferior maxillary nerve, and brandies 
 to the upper part of the neck, which join those of the 
 superior cervical nerves. 
 
NERVES. 
 
 39 
 
 Tlie distribution of this nerve is too minute to admit 
 of more than a general reference to it. Its branches 
 join each other frequently, forming the net-work call- 
 ed pes anserinus. The dissection of it should be com- 
 menced at the stylo-mastoid foramen, or in the parotid 
 gland, and the skin should be raised only as its branches 
 are exposed; without this precaution the dissection 
 will fail. 
 
 The Trigeminus, or Fifth Pair of Nerves, comes 
 next. Its branches are brought into view by sawing 
 off the ramus of the lower jaw and detaching it entirely, 
 observing to leave the pterygoid muscles by cutting 
 close to the bone through their insertions ; when the 
 adipose and cellular membrane is then cleared away, 
 the second and third branches of this nerve are seen 
 deep in the bottom of the zygomatic fossa. For the dis- 
 tribution of the first or ophthalmic trunk, see the 
 
 Auxiliary parts of the eye.” 
 
 The Second, or Superior Maxillary branch of 
 the Fifth, comes out of the cranium through the fora- 
 men rotundum, and is firet seen in the upper part of 
 the pterygoid fossa. It immediately sends forwards a 
 branch into the infra-orbitar canal of the upper jaw 
 bone, which passes, through it, comes out at the infra- 
 orbitar foramen, and terminates by branches on the 
 cheek. This is the infra-orbitar nerve, which just be- 
 fore entering the canal, sends off two twigs to supply 
 
40 
 
 OF THE HEAD AND NECK. 
 
 the three or four last molares, and which forwards sends 
 off the anterior dental nerve to supply the small mo- 
 larj canine, and incisor teeth. 
 
 Afterwards, the Superior Maxillary Nerve passes 
 downwards in two divisions, to a level with the spheno 
 palatine foramen ; here they unite, form the spheno pala- 
 tine ganglion, or the ganglion of Meckel, from which 
 proceed the Pterygoid, the Lateral Nasal, and the Pa- 
 latine Nerves. 
 
 The Pterygoid Nerve, retrograding through the 
 foramen of the same name, gets into the cavity of the 
 cranium through the anterior foramen lacerum at the 
 point of the petrous portion of the temporal bone and 
 there divides; one branch joins the carotid artery, 
 (see Sympathetic Nerve,) and the other passing into 
 the vidian foramen has a singular course through the 
 ear. (See Chorda Tympani.) 
 
 The Lateral Nasal Nerve consists of several 
 filaments passing from the spheno palatine ganglion; get- 
 ting into the nose they are distributed to the pituitary 
 membrane of the outside of the nose, and also to the same 
 membrane which covers the septum. One of the 
 branches of the latter makes a long sweep, dips into the 
 foramen incisivum, and, according to M. J. Cloquet, 
 forms a ganglion with its fellow near the bottom of the 
 canal. With this ganglion communicate branches of 
 the palatine nerve. 
 
NERVES. 
 
 41 
 
 The Palatine Nerve passes through the posterior 
 palatine canal to the roof of the mouth; it there divides 
 into filaments supplying the lining membrane, the soft 
 palate, the uvula, and the tonsils. In its way down- 
 wards, it sends several small twigs to that portion of 
 the pituitary membrane which covers the inferior tur- 
 binated bone. 
 
 The Inferior Maxillary Nerve, or the Third 
 Branch of the Fifth Pair, comes through the foramen 
 ovale into the zygomatic fossa, and divides immediately 
 into two branches, one of which is distributed in mi- 
 nute ramifications to the muscles of mastication, as the 
 pterygoid, masseter, and temporal; it also sends a 
 branch, the size of a knitting-needle, which joins the 
 portio dura on the face, and, in order to get to it, ad- 
 heres closely to the neck of the inferior maxilla. 
 This last branch, from being blended with the portio 
 dura, must, of course, as long as it remains undivided, 
 render nugatory the section of the portio dura for tic 
 doloureux. 
 
 The Second Branch of the Inferior Maxillary Nerve 
 passes between the pterygoid muscles and divides into 
 two trunks ; one of which proceeding to the tongue is 
 the Lingual or Gustatory nerve, and the other going to 
 the lower jaw bone is the proper Inferior Maxillary 
 Nerve. The first in its progress between the pterygoid 
 muscles is joined by the chorda tympani ; it there passes 
 above the mylo-hyoid muscle near the duct of Whar^ 
 
 F 
 
42 
 
 OF THE HEAD AND NECK. 
 
 ton, and advancing to near the end of tlie tongue is 
 divided very minutely among the papilla. The infe- 
 rior maxillary nerve enters the posterior maxillary fora- 
 men ; but while doing so despatches a branch to the sub- 
 maxillary gland and the muscles under the jaw; it 
 then continues in a canal in the spongy part of the bone, 
 dismissing ramifications to all the teeth successively. 
 Much of the nerve, however, which is spent upon the 
 contiguous muscles, remains to come out at the anterior 
 maxillary foramen. 
 
 In order to proceed properly in this dissection of 
 the Nerves of the Neck, the skin must be carefully 
 raised from the sterno-clei do-mastoid muscle; by which 
 means we shall see the spinal accessory nerve emerging 
 from the muscle, and after having given a few branches 
 to it, passing backwards to be distributed on the anteri- 
 or edge of the trapezius muscle. 
 
 By detaching the sterno mastoid muscle from its 
 origin and turning it aside, the spinal accessory nerve 
 will be seen ; coming from the posterior foramen lacerum 
 where it adheres to the Par Vagum, Glosso-Pharjmgeal 
 and Ninth pair ; and passing obliquely behind the in- 
 ternal jugular vein downwards and backwards, in oMer 
 to reach the sterno mastoid muscle. 
 
 At this stage of the dissection a multitude of nervous 
 filaments is seen upon the neck going to its muscles, in- 
 teguments and other parts, and interwoven with its 
 blood-vessels. They form an intricate plexus derived 
 
NERVES. 
 
 43 
 
 from various combinations of the eighth and ninth pairs, 
 the sympathetic and the proper cemdcail nerves, the 
 detailed description of which is too elaborate for a dis- 
 sector’s manual. It is best, therefore, for the atten- 
 tion to be confined to leading trunks. 
 
 The Glosso-Pharyngeus is a small nerve coming 
 from under the internal jugular vein, adhering to it, 
 and to the other branches of the eighth pair, by con- 
 densed cellular membrane ; it passes to the tongue be- 
 tween the stylo-glossus and stylo-pharyngeus muscles, 
 and on the outside of the internal carotid artery. F ollow- 
 ing the course of the stylo-glossus muscle at its internal 
 edge, it gets to the root of the tongue, where it is dis- 
 tributed on its side and middle, and to the papillge 
 maximse. In its course, it sends several branches to 
 the muscles of the pharynx, and to its internal mem- 
 brane. 
 
 The Ninth Pair, or the Nervus Hypoglossus, is 
 also very deeply seated, where it emerges from the 
 cranium at the anterior condyloid foramen. Adhering 
 for some distance to the par vagum, by condensed cellu- 
 lar membrane, it abandons the par vagum by getting 
 between the internal carotid artery and the internal 
 jugular vein, and crossing them obliquely about half an 
 inch below the glosso-pharyngeus. It descends much 
 lower in the neck than the glosso-pharyngeal, forming 
 a large curve with the convexity downwards. It is the 
 
44 
 
 OP THE HEAD AND NECK. 
 
 next large nerve below the glosso-pharyngeal, the order 
 of descent being first the lingual branch of the fiftli pair, 
 the glosso- pharyngeal second, and the ninth nerve 
 third. 
 
 In its descent the Ninth nerve winds externally 
 around the external carotid artery, just below the ori- 
 gin of the occipital artery. Here it is below the pos- 
 terior belly of the digastricus, and the stylo hyoideus. 
 It then passes forwards somewhat horizontally under the 
 external jugidar vein towards the root of the tongue, 
 where it is at the side of the hyo-glossus muscle a little 
 above the os hyoides, and crossed externally by the 
 stylo hyoideus and the tendon of the digastricus. It 
 now ascends on the inside of the mylo hyoideus, and 
 divides abruptly into many ramifications distributed to 
 all the muscles of the tongue, from the space between 
 the genio-hyo-glossus and lingualis muscles. 
 
 Where the Ninth nerve winds externally around 
 the external carotid, it dismisses the Descendens Noni. 
 The latter descends externally along the common 
 carotid, connected with its theca as far as midway be- 
 tween tbe sternum and os hyoides; and unites \Hth 
 ramifications from, the first, second, and third cervical 
 nerves, to form a bow under the sterno mastoid muscle. 
 Above this bow the descendens noni detaches branches 
 to the upper parts of the sterno hyoid and thyroid mus- 
 cles, and from the bow branches proceed to the lowei 
 parts of these muscles. 
 
NERVES. 
 
 45 
 
 The Par Va GUM, an important nerve, is immediately 
 seen on separating the common carotid, and the inter- 
 nal jugular from each other. It lies in the sheath of 
 these vessels at their back part and between them. 
 Emerging from the cranium at the posterior foramen 
 lacerum it is somewhat swollen, adheres to the ninth 
 nerve and to the superior cervical ganglion of the inter- 
 costal. It then leaves them after a short distance, as- 
 sumes the position, just expressed, and maintains it 
 down the neck till it reaches the upper margin of the 
 thorax. 
 
 Shortly after quitting the cranium, it sends to the 
 middle constrictor of the pharynx, the Nervus Pharyn- 
 geus. 
 
 Just below the pharyngeal nerve, the Laryngeus 
 Superior is sent olf, which descends obliquely under 
 the Internal Carotid, and divides at the posterior edge 
 of the thyro-hyoid membrane into an internal and ex- 
 ternal branch. The former being the largest and 
 above, proceeds between the os hyoides and the thy- 
 roid cartilage under the thyro-hyoideus muscle, to the 
 internal parts of the larynx where it is distributed by 
 minute ramifications to the arytenoid muscles, epi- 
 glottis and lining membrane. The external branch de- 
 scending, is disposed of by ramifications to the pharynx, 
 to the lower part of the larynx, and to the thyroid 
 gland. 
 
 In the upper part of the thorax, or the lower part 
 of the neck, the par vagum abandons the common ca- 
 
46 
 
 OF THE HEAD AND NECK. 
 
 rotid, and passes before the subclavian artery on the 
 right side, and before the aorta on the left. Immedi- 
 ately after passing these vessels it divides into an an- 
 terior and a posterior trunk ; the first is the continu- 
 ed par vagum, the second the recurrent or the inferior 
 laryngeal. 
 
 The Laryngeus Inferior has the same distribution on 
 both sides, but it is to be observed that on the right, it 
 winds around the subclavian artery, and on the left it 
 winds around the arch of the aorta. The nerve is then 
 deeply situated on the side of the trachea, and ascends 
 to the larynx, sending branches to the trachea, the 
 oesophagus and the thyroid gland. It is minutely dis- 
 tributed by terminating ramifications to the small mus- 
 cles of the larynx, and to its lining membrane. One 
 of its branches at the inferior part of the larynx, com- 
 municates with filaments from the laryngeus superior. 
 
 The Laryngeus Inferior has branches connecting it 
 with the inferior cervical ganglion of the sympathe- 
 tic; the cardiac plexus; and the pulmonary plexus of 
 nerves. 
 
 The Nervus Sympatheticus is also on the back 
 part of the great vessels of the neck close to the verte- 
 brae ; it is commonly said to be in their sheath ; this, 
 however, is a loose, if not an inaccurate style of speech, 
 as by passing a knife handle below the sheath and rais- 
 ing it up, it will be seen that the sympathetic is uof one 
 of its contents; but, on the contrary, that it is fasten 
 
NERVES. 
 
 47 
 
 ed somewhat tightly to the longus colli, and the conti- 
 guous muscles, by cellular membrane. 
 
 The sympathetic nerve arises by filaments of the 
 pterygoid and of the sixth nerve, which form a net- 
 work in the carotic canal around the artery ; a little 
 above or below the termination of the canal, they unite 
 by two principal trunks to form one nerve. This cord 
 is close to the eighth and ninth nerves and opposite to 
 the second cervical vertebra, it swells out into the Su- 
 perior Cervical Ganglion ; it then descends, and, oppo- 
 site to the space between the fifth and the sixth cervi- 
 cal vertebrse, it forms the Middle Cervical Ganglion, 
 which is much smaller and more irregular than the first. 
 The sympathetic is traced with some difficulty from 
 this, in consequence of the numerous branches coming 
 from it ; a trunk, however, may be found, as the con- 
 tinuation of it, which passes to the interval between 
 the head of the first rib and the transverse process of 
 the last cervical vertebra, where another enlargement 
 occurs, denominated Inferior Cervical, or First Thora- 
 cic Ganglion. 
 
 The First Ganglion is increased by filaments from the 
 sub -occipital, the first, second and third cervical nerves, 
 and the eighth and ninth. The Second Ganglion re- 
 ceives filaments from the fourth, fifth and sixth cervi- 
 cal nerves. The Third Ganglion receives filaments 
 from the sixth and seventh cervical, and the first and 
 second dorsal nerves. From these ganglions proceed the 
 cardiac nerves. 
 
48 
 
 OF THE HEAD AND NECK. 
 
 The Nervus Phrenicus isa small, straight, insulat- 
 ed nerve coming principally from the third cervical, 
 but also derived, in part, by filaments from the second 
 and fourth. It is found on the humeral side of the great 
 vessels of the neck, removed a considerable distance 
 from them and lying upon the anterior face of the sca- 
 lenus anticus muscle. It descendsinto the thorax between 
 the subclavian artery and vein, and within the anterior 
 end of the first rib. 
 
 Each of the Cervical Nerves, including the sub-occi- 
 tal, after its ganglion is formed by the posterior fascicu- 
 lus of the spinal marrow, exists as a trunk which is join- 
 ed by the anterior fasciculus of the same. This com- 
 mon ti’unk gets out between the transverse processes of 
 the cervical vertebrae, and is immediately divided into an 
 anterior and a posterior branch. The posterior branches 
 are distributed to the muscles and to the integuments 
 which lie on the posterior part of the cervical verte- 
 brae, but the anterior branches are variously disposed 
 of. The sub-occipital and the three first cervical nerves 
 have their anterior branches going principally to the 
 muscles which arise from the transverse processes of the 
 vertebrae, and to the skin of the neck. Each of these an- 
 terior branches is united by filaments to the nerve above 
 and below it, and a sort of plexus is formed which lies 
 over the levator scapulae muscle. Filaments are also 
 sent from the anterior branches of the cervical nerves 
 which join with the spinal accessory nerve, tlie hypo- 
 
NERVES. 
 
 49 
 
 glossal, the portio dura, the sympathetic, and the phre- 
 nic in various ways, which are too numerous to be men- 
 tioned here. 
 
 The Axillary Plexus, from which the nerves of 
 the upper extremity are principally derived, arises 
 from the anterior branches of the four inferior cervical 
 nerves and of the first dorsal. These branches are much 
 larger than the posterior, and emerge between the an- 
 terior and the middle scalenus muscle. They send some 
 very small filaments to the lower and middle cervical 
 ganglions of the sympathetic. 
 
 F 
 
PART I. 
 
 CHAPTER II. 
 
 Section I. 
 
 Of the Encephalon or Brain, and Spincd Marrcyic. 
 
 The best way to get at the Brain, both in public and 
 private dissection, is to make a cut through the scalp 
 across the top of the head from ear to ear, then to 
 turn down the scalp over the face, and behind the back 
 of the neck. The scull cap may be separated by a 
 saw carried only through the external table just above 
 the tips of the ears, and about an inch above the super- 
 ciliary ridges. With the aid of an iron wedge and a 
 mallet the bone is afterwards easily broken through 
 and separated from the dura mater. Bichat breaks the 
 scull cap to pieces with a hammer and then removes it. 
 
 The medullary mass placed within the ca%dty of the 
 cranium is termed in common language Brain. It af- 
 fords the following parts for separate examination. 1 , 
 The Membranes. 2. The Cerebrum. 3. The Cere- 
 
BRAIN, AND SPINAL MARROW. 51 
 
 bellum. 4. The Pons Varolii and the Medulla Ob- 
 longata. 
 
 I . The membranes are three : The Dura Mater. 
 Tunica Arachnoidea, and Pia Mater. 
 
 The Duka Mater lies immediately in contact with 
 the bones of the cavity of the cranium, being closely 
 connected to them by blood-vessels and filaments of 
 fibres. It is a white, shining, semitransparent me%^ 
 brane consisting of two layers, the internal of which 
 forms several processes. The most conspicuous is the 
 Falx Major, which arises from the centre of the ante- 
 rior part of the sphenoid bone, from the crista galli of 
 the SBthmoid, from under the whole of the middle line 
 of the frontal bone, the sagittal suture, and superior 
 part of the occipital bone as far as the juncture of 
 the limbs of its cross. It is narrow before and broader 
 behind, where it joins with the tentorium. 
 
 The next process is the Tentorium, which forms an 
 arch slightly convex above, and crescentic in its gene- 
 ral figure. It is connected to the horizontal limbs of 
 the occipital cross, to the superior ridge of the petrous 
 bones, and to the posterior clinoid apophysis on each 
 side. Immediately under the centre of the tentorium, 
 and running towards the occipital foramen, is the Lesser 
 Falx. On each side of the sella turcica is a process of 
 dura mater forming its lateral boundaries. At the an- 
 terior -edge of the tentorium is the Foramen Ovale 
 
52 
 
 OF THE HEAD AND NECK. 
 
 through which the cerebrum and cerebellum unite by 
 their crura. 
 
 In the angle formed by the reflection of the internal 
 lamina of the dura mater from the external, are some 
 large triangular cavities called Sinuses. The first is 
 the Superior Longitudinal Sinus, which commences by 
 a small beginning near the crista galli. It enlarges by 
 a continual accession of veins from the pia mater and ter- 
 minates at the occipital cross. On cutting into it, we 
 sgc it lined by a delicate smooth membrane ; — its sides 
 retained together by many little tendinous chords call- 
 ed the Chordae Willisii; — and the veins of the pia ma- 
 ter running into it obliquely forwards, so as to produce 
 the elfects of valves. In this sinus, also under the dura 
 mater near the top of tlie brain are many small bodies 
 of various sizes, the Glandulae Pacchioni, from a line or 
 less to three or four lines in diameter. One of the largest 
 of these bodies, on each side, actually protrudes from 
 the surface of the brain through the dura mater, and 
 makes a deep pit into the parietal bone, near the sagit- 
 tal suture. 
 
 From the posterior extremity of the longitudinal 
 sinus proceeds on each side in the posterior margin of 
 the tentorium, the Lateral Sinus, terminating in the 
 foramen lacerum posterius. 
 
 At the inferior edge of the falx major between its 
 duplication, is the Inferior Longitudinal Sinus. And 
 at the junction of the falx major and tentorium is the 
 Fourth sinus, formed by the inferior longitudinal sinus 
 
BRAIN AND SPINAL MARROW. 
 
 53 
 
 and a vessel from the interior of the brain called the 
 Vena Galeni. It joins the superior longitudinal sinus 
 at the internal occipital protuberance where the gene- 
 ral meeting of the vessels is called Torcular Hiero- 
 phili. 
 
 Around the pituitary gland, in the sella turcica, is 
 the Circular Sinus of Ridley; and at the side of the 
 sella turcica is the Cavernous Sinus. On the occiput 
 and about the petrous , bone there are several smaller 
 sinuses which, together with the circular and cavernous, 
 empty into the lateral. 
 
 The Dura Mater is supplied with nerves from the 
 fifth pair which are traced with some difficulty. Its 
 principal artery is from the internal maxillary, and 
 passes through the foramen spinale, making the deep 
 arborescent indentations in the parietal bones. There 
 are some other branches derived from the internal caro- 
 tid and vertebral. The veins accompany the arteries, 
 and do not discharge into the sinuses. 
 
 Within the Dura Mater and covering the whole ex- 
 terior surface of the pia mater, is a delicate transparent 
 membrane with no red vessels in its composition, the 
 Tunica Arachnoidea. If forms an uniform covering, 
 not dipping into the convolutions of the encephalon. It 
 may be seen distinctly on the superior surface of the 
 brain like a shining, smooth surface to the Pia Mater, 
 but cannot readily be raised up from it. On the basis 
 of the brain it is a lamina naturally separating itself 
 
54 
 
 OF THE HEAD AND NECK. 
 
 about the medulla oblongata and the contiguous parts, 
 from the membranes between which it is placed. The 
 Dura Mater is simply in contact, but does not adhere 
 to it ; some anatomists, however, as Bichat, believe 
 that it lines the internal surface of the Dura Mater, 
 having the same reflections as a synovial membrane. It 
 secretes the lubricating fluid which facilitates the mo- 
 tions of the brain. 
 
 The PiA Mater is a tenderand highly vascular mem- 
 brane, lying in close eontact with the brain, dipping 
 into its convolutions and spread over the surface of its 
 ventricles in a manner difficult to be understood with- 
 out dissection. It is much thinner and more delicate 
 in the cavities of the brain than exteriorly, and seems 
 there more like a vascular net- work than a perfect mem- 
 brane. It is highly useful in conducting vessels into 
 the substance of the brain by being so extensively 
 spread over its surface, and by dividing them minutely 
 before they penetrate it. 
 
 Its blood vessels are exceedingly numerous, being re- 
 ceived from the vertebral and internal carotid arte- 
 ries at the basis of the cranium in the manner which 
 will be explained at the end of the chapter. Its veins, 
 are all inserted into the sinuses of the dura mater, and 
 therefore do not accompany the arteries. 
 
 2. The Cerebrum fills by far the greater part of 
 the carity of the cranium, and extends from tlie tento 
 
BRAIN AND SPINAL MARROW. 
 
 55 
 
 rium and anterior basis of the cranium to the vault. It 
 is partially divided above by the falx major, into two 
 equal parts called Hemispheres, and below we see that 
 each of these hemispheres is sub-divided into three 
 lobes. The Anterior Lobe is upon the orbitar process 
 of the frontal bone; the Middle Lobe in the middle fossa 
 of the basis of the cranium; and the Posterior Lobe 
 upon the tentorium. Between the anterior and middle 
 lobes there is a deep indentation, the Fossa, or Fissura 
 Magna Sylvii ; formed by the edge of the little wings 
 of the sphenoid bone, which prescribe their boundaries. 
 The middle and posterior lobes are not so well separated 
 from each other. 
 
 The external surface of the cerebrum is arranged 
 into many convolutions which, at a little distance, give 
 it the appearance of intestines. The pia mater, dip- 
 ping down to the bottom of them keeps their opposite 
 faces in contact. If a section be made into the brain, 
 it will be seen to consist of matter of different colours 
 and consistence. The external matter, varying from a 
 line to three or four in depth, is the Cineritious or 
 Cortical ; is of a yellowish red colour ; somewhat less 
 consistent than the other; and covers all the convolu- 
 tions. Within the cortical is the Medullary Matter, 
 which is of a white colour, with small spots or dots of 
 red, owing to the blood-vessels. 
 
 Proceeding to an examination of the interior struc- 
 ture, by separating the hemispheres, we shall see that 
 just below the edge of the falx major they adhere by 
 
56 
 
 OF THE HEAD AND NECK. 
 
 the pia mater of the opposite sides. Dissect this ad- 
 hesion through, which brings into view a broad expan- 
 sion of medullary matter, the Corpus Callosum, extend- 
 ing from the anterior to the posterior edge of the falx, 
 and marked in its centre by two white lines, running 
 longitudinally and slightly curved with their convexi- 
 ties towards each other. Between these lines is a fossa 
 called Raphe. Other lines not so distinct pass laterally 
 and at right angles to the first two. By pulling the 
 hemisphere still more from its fellow, we bring into view 
 its edge, which laps over the corpus callosum and is se- 
 parated from it by a fossa running the whole length of 
 the latter. 
 
 The hemispheres above the corpus callosum must 
 now be removed by a sharp knife, whereby a view is 
 got of the Centrum Ovale of Vieussens, and also of the 
 connexion formed between the hemispheres by the Cor- 
 pus Callosum. The centrum ovale is properlv speak- 
 ing the oval nucleus of medullary matter which is left 
 when the cortical is scraped or cut away, but is most 
 commonly described as the oval disk which is formed by 
 the aforesaid section. The corpus callosum is placed 
 in its middle, and forms the great medullary commis- 
 sure between its two sides, and, also the roof of the 
 lateral ventricles. 
 
 By removing the corpus callosum the Lateral Ven- 
 tricles, one on each side, are brought into view. They 
 are very irregular ca\uties consisting each of three pi*o- 
 
BRAIN AND SPINAL MARROW. 
 
 57 
 
 cesses or cornua, and extending from the anterior to the 
 posterior portions of the hemispheres. In the anterior 
 lohe is the Anterior Cornu separated only hy the Sep- 
 tum Lucidum from its fellow. In the middle lobe is the 
 Inferior or Middle Cornu passing in a winding direc- 
 tion downwards and forwards ; and in the posterior lobe 
 is the Posterior Cornu, also called Digital Cavity. 
 
 In the anterior cornu of the lateral ventricle is the 
 Corpus Striatum, a long convex body, broad before and 
 coming to a point behind ; it is cineritious or cortical 
 externally and medullary within; when scraped the 
 latter looks fibrous. At the posterior part of the cor-^ 
 pus striatum is the Thalamus Nervi Optici, a large con- 
 vex body, the surface of which is medullary and the 
 interior cortical ; it has a node on its upper and another 
 on its posterior side, of different sizes in different sub- 
 jects. Between the thalamus and the corpus striatum 
 is a streak of medullary matter called Taenia Striata. 
 
 In the posterior cornu of the lateral ventricle is a 
 rising called Hippocampus Minor ; and in the inferior 
 cornu is a larger rising the Hippocampus Major, pass- 
 ing to its bottom and increasing in breadth as it descends. 
 Its lower end puts on the appearance of a claw, being 
 called, from that cause, Pes Hippocampi. 
 
 A considerable part of the Thalami Nervorum Opti- 
 corum is concealed by the Fornix, a triangular arched 
 body of medullary matter narrow before and broad be- 
 hind, and extending from the anterior to the posterior 
 extremities of the thalami. It commences forwards by 
 
 H 
 
58 
 
 OF THE H^AD AND NECK. 
 
 two crura very much curved, with their concavity back- 
 wards, and which arise deeply from the sides of the 
 thalami near their union with the corpora striata. These 
 crura come afterwards into contact, increase much in 
 breadth, conceal the thalami, and form this triangular 
 body which posteriorly is lost in the back of the cor- 
 pus callosum and the hippocampi majores. The angle 
 formed by the back and lateral margins is elongated and 
 accompanies the hippocampus major for some distance, 
 in the form of a thin crus which is easily demonstrated 
 by raising it on the knife handle. This crus is the 
 Corpus Fimbriatum, or Taenia Hippocampi, The un- 
 der surface of the fornix is called Lyra. 
 
 The Septum Lucidum, is fixed between the lateral 
 ventricles, at their fore part ; is connected above to the 
 corpus callosum, and below to the fornix. It consists of 
 two laminae with a cavity between them at their front, 
 called occasionally the fifth ventricle. To get a good 
 view of the septum lucidum, it should be examined as 
 the corpus callosum is raised up. In many subjects, 
 particularly when there has been a small dropsical effu- 
 sion into the ventricles, the septum looks like a continu- 
 ation of the middle of the fornix, a lamina of it being 
 contributed by the internal margin of each crus. 
 
 Under the fornix and lining the cavities of the late- 
 ral ventricles, as well as the other ventricles, is placed 
 a very delicate reflection of pia mater with many ves- 
 sels in it, but so very thin that it can scarcely be rais- 
 ed up as a perfect membrane. Tliis membrane gets 
 
BRAIN AND SPINAL MARROW. 
 
 59 
 
 into the lateral ventricles from the fossa of Sylvius and 
 under the back of the corpus callosum. Along the hip- 
 pocampus major and the exterior margin of the fornix^ 
 on each side, is placed a fold of it quite loose and float- 
 ing, and consisting of a great congeries of small veins 
 and arteries. This fold is the Plexus Choroides, which 
 becoming smaller anteriorly, dips under the anterior 
 crus of the fornix, and its veins unite into a large trunk 
 which runs under the fornix to terminate posteriorly 
 in the vena Galeni. That portion of the pia mater 
 lying under the fornix and bounded on each side by 
 the plexus choroides, is called the Velum Interposi- 
 tum. 
 
 The fornix should now be raised with the velum in- 
 terpositum, by cutting through its anterior crura and 
 turning it backwards, which gives a more perfect view 
 of the thalami. From these bodies on the opposite 
 sides being in contact, a kind of junction, the Commis- 
 sura Mollis is formed by their convexities. Anterior to 
 this junction is a triangular space called Vulva. It is 
 here that the lateral ventricles communicate, under the 
 anterior crura of the fornix, with the third ventricle. 
 The communication is the Foramen of Monro. Be- 
 hind tTbe commissura mollis is a similar triangular space, 
 the Anus. The Third Ventricle is brought fully into 
 view by separating the thalami, and we shall find that 
 it is formed of the space between them. At its lower 
 front part is an open way, the Iter ad Infundibulum, 
 leading to the basis of the brain, and at its posterior 
 
60 
 
 OF THE HEAD AND NECK. 
 
 part is the aqueduct of Sylvius, or the Iter e Tertio 
 ad Quartum Ventriculum. 
 
 The Tubercula Quadrigemina, or Nates and Testes, 
 are situated at the posterior part of the thalami, the nates 
 being above. They are each about three or four lines in 
 diameter; consist of medullary and cineritious matter; 
 and constitute a means of communication between the 
 cerebrum and cerebellum by being united to the valve 
 of the brain, which is inserted into their lower part. 
 
 The Pineal Gland, a small oval cineritious body, is 
 found on the top of the nates. It is commonly four 
 lines in its longest diameter, and contains a small quan- 
 tity of calcareous luattei', feeling and looking like fine 
 sand, which however, is, occasionally collected into 
 one or more irregular masses a line in diameter. This 
 sandy matter is the Acervulus Cerebri. The pineal 
 gland is situated between the nates and the back of the 
 fornix, being closely connected with the under surface 
 of, and surrounded by, the velum interpositum, so that, 
 most frequently, when this membrane is raised along 
 with the fornix, the pineal gland is torn from its place. 
 If we are careful to avoid this accident, we shall find, 
 passing along the upper edge of the thalami, on each 
 side, above the commissura mollis, a medullary streak 
 the Peduncle of the pineal gland, which'goes from the 
 latter to the anterior crus of the fornix. 
 
 At the anterior part of the third ventricle, just below 
 the crura fornicis, and seen between their curvature 
 where they diverge, is the Commissui’a Anterior, a 
 
BRAIN AND SPINAL MARROW. 
 
 61 
 
 medullary line near the corpus striatum, passing from 
 the lower anterior part of one thalamus, to the other. 
 At the back part of the third ventricle, just under the 
 pineal gland, is the Commissura Posterior passing in 
 the same way from one thalamus to the other. 
 
 The Valve of the Brain, is seen by cutting off the 
 posterior lobes of the cerebrum, removing the tentori- 
 um, and dissecting away the pia mater just behind and 
 below the tubercula quadrigemina. It passes up as a 
 broad lamina of medullary matter an inch wide, from 
 the central part of the cerebellum to the inferior por- 
 tion of the testes. By introducing a probe from the third 
 ventricle through the aqueduct of Sylvius, it will be seen 
 that this valve forms the roof of the fourth ventricle; and 
 that it is thinner in its middle than on either side. 
 
 The further examination of the Encephalon should 
 be prosecuted by detaching it from the basis of the cra- 
 nium and turning it out, the nerves being left as long 
 as possible, and the spinal marrow also. When inver- 
 ted it has the following parts uppermost. The anterior 
 and the middle lobes of the Cerebrum ; The two lobes 
 of the Cerebellum ; The Pons Varolii or Tuber Annu- 
 lare ; and the Medulla Oblongata. 
 
 The Cerebellum is remarkable for the difference 
 between its size and that of the Cerebrum, as it occu- 
 pies only the space between the tentorium and the 
 posterior fossse of the basis of the cranium. It is dhi 
 
62 
 
 OF THE HEAD AND NECK. 
 
 ded into two hemispheres or lobes by the falx minor. 
 Though covered by the same membranes, its appearance 
 differs from that of the cerebrum in consequence of its 
 having no regular convolutions. In their place is sub- 
 stituted longitudinal fissures separating its surface into 
 laminae, and passing for the most part horizontally; 
 they penetrate to very different depths, from four lines 
 to eight or more, thereby increasing the surface for the 
 entrance and exit of the vessels. The upper surface 
 of the cerebellum is slightly convex corresponding with 
 the concavity of the tentorium ; The under surface has 
 a double convexity corresponding with the double con- 
 cavity in the inferior part of the occipital bone. The 
 upper central part of it, just above the fourth ventricle 
 is called vermis; and is the fundamental portion of Gall. 
 
 When the cerebellum is cut into, its substance is found 
 to be firmer than that of the cerebrum, and the cor- 
 tical matter bears apparently a more considerable pro- 
 portion to the other than it does in the cerebrum. The 
 medullary matter is found principally in its centre, and 
 sends off processes in every direction into the cortical. 
 From this circumstance the medullary matter has an ar- 
 borescent outline upon all vertical sections made into the 
 cerebellum. Hence the name of Arbor Vitae, which is 
 merely expressive of this arrangement vithout designa- 
 ting any particular part of it. But if horizontal cuts 
 be made the arbor vitae resemblance is not manifested, 
 and the proportion of medullary matter appears more 
 oonsiderable. The two Crura of the cerebellum one on a 
 
BRAIN AND SPINAL MARROW. 
 
 63 
 
 side pass from the medullary portion, being in fact a mere 
 continuation of it, and separated from each other by the 
 fourth ventricle. They are inserted into the posterior 
 upper part of the Pons Varolii. 
 
 The Pons Varolii is between the anterior part of the 
 cerebellum and the posterior part of the middle lobes of 
 the cerebrum. It is nearly spherical on its inferior sur- 
 face, and about sixteen lines in diameter ; is divided into 
 two halves by a middle longitudinal fissure with trans- 
 verse ridges passing from it on each side. It is formed 
 of the crura cerebri and cerebelli. In its substance is 
 much cortical matter, arranged into striae running in 
 different directions. The Crura Cerebri arise from the 
 medulla of all the lobes, make their first appearance at 
 the back of the anterior, and between the middle lobes ; 
 their internal margins touch ; they pass backward to be 
 connected with the anterior superior part of the tuber 
 and are lost in its substance. They are formed of a 
 mixture of medullary and cineritious matter ; the latter 
 predominates in one part, and from its particular colour 
 is called Locus Niger. The Pons Varolii, thus constitu- 
 ted by the blending of the substance of the four crura, 
 is fixed upon the posterior part of the body of the sphe- 
 noid bone and on the cuneiform process of the os occi- 
 pitis. 
 
 The Medulla Oblongata is that portion of ence 
 phalic substance between the Pons and the superior 
 
64 
 
 OF THE HEAD AND NECK. 
 
 margin of the first cervical vertebra. Arising from 
 the back of the former, it swells considerably almost 
 immediately, and then tapers down gradually to form 
 the commencement of the spinal marrow. There is a 
 circular indentation above defining its boundaries with 
 the Pons, but below there is none. A longitudinal 
 fissure on its fore part divides it equally. On each side 
 of this fissure above, is an oblong eminence called 
 Corpus Pyramidal e, coming to a point below, and dis- 
 appearing gradually. On the outer side of that again, 
 and separated from it by a fissure on the side of the 
 medulla oblongata, is an ovoidal and still more prominent 
 convexity, but not so long, called Corpus Olivare. And 
 on the outside of this is another and smaller eminence, 
 the Corpus Pyramidale Laterale, or Corpus Restiforme. 
 The Medulla Oblongata consists of medullary matter 
 externally, and cineritious internally. By lifting it up 
 from the cerebellum and dissecting away the tunica 
 arachnoidea and pia mater, a good view may be got of 
 the Fourth Ventricle of the brain, which is closed be- 
 low and separated from the spinal canal by these mem- 
 branes. It will now be easy to understand that the 
 parietes of the fourth venfricle are formed by the valve 
 of Vieussens and by the cerebellum, above and poste- 
 riorly ; by the pons Varolii anteriorly; by the Medulla 
 Oblongata below ; and by the Crura Cerebelli laterally. 
 The posterior face of the Medulla is marked by an 
 arrangement of its surface corresponding in some mea- 
 
BRAIN AND SPINAL MARROW. 
 
 65 
 
 sure vvilh the slit and nib of a writing pen, from which 
 it has the name of Calamus Scriptorius. 
 
 Between the Crura Cerebri at their anterior part are 
 two small round bodies, three lines thick, in contact 
 with each other; they are the Corpora Albicantia or 
 EminentisB Mammillares. They are placed in a cineriti- 
 ous substance, the Pons Tarini, forming with them the 
 floor of the third ventricle. 
 
 The Infundibulum is a flat funnel-shaped tube 
 alluded to in the account of the third ventricle, but 
 best seen in this period of the dissection. It is 
 placed just before the corpora albicantia, and passes 
 from the third ventricle to the pituitary gland, having 
 its apex in contact with the latter, and its broad part 
 opening into the ventricle. It is generally impervious 
 at its apex. It is cineritious externally, which gives it 
 a red cast, and medullary internally. 
 
 The Glandula Pituitaeia occupies the sella tur- 
 cica, and is somewhat spherical, being about six or 
 seven lines in diameter. Its structure is firm and re- 
 sisting, formed of a tough cineritious matter externally, 
 and of a kind of medullary internally. It is almost 
 concealed by a close reflection of dura mater over it. 
 
 There are nine pairs of nerves going from the basis of 
 
 I 
 
66 
 
 OF THE HEAD AND NECK. 
 
 the brain, and named numerically by beginning in 
 front.* 
 
 The 1st Pair, the Olfactory (Nervi Olfac- 
 TORii,) appropriated to the nose, arise by three striae 
 from the corpora striata, and make their appearance 
 on the back and inferior part of the anterior lobes. 
 Their structure is soft and pulpy, and they are protect- 
 ed from the weight of the brain by being deposited in 
 a triangular groove formed by a convolution. They 
 swell out into bulbs at their fore part on the sides of the 
 the crista galli, and perforate the cribriform plate of 
 the (Ethmoid bone by numerous filaments. They get a 
 coat from the dura mater which gives them great 
 strength, and are then distributed as mentioned in the 
 account of the nose. 
 
 The 2nd Pair, the Optic Nerves (Nervi Optici,) 
 are of considerable magnitude, and differ somewhat in 
 their texture from the other nerves in consequence of 
 having a general investment of pia mater before it sur- 
 rounds their particular fasciculi; and also from hav- 
 ing more medullary matter in them. They arise from 
 the posterior parts of the thalami and make their appear- 
 ance between the middle lobes and the crura cerebri. 
 There is a very close intertexture of the nerves of the 
 
 * This is the most usual classification of the nerves but is ob- 
 jectionable in many respects. (See Descriptive Anatomy.) 
 
BRAIN AND SPINAL MARROW. 
 
 67 
 
 opposite sides just before the infundibulum, so that it 
 is a question whether they decussate each other, or sim- 
 ply unite. Being the nerves of vision, they pass to the 
 ball of the eye, through the foramina optica and are ex- 
 panded into the retina. 
 
 The 3rd Pair, (Motores Oculorum,) arise from 
 the inner margins of the crura cerebri near the pons va- 
 rolii by several filaments. They pass outwards and pene- 
 trate the dura mater near the posterior clinoid process 
 and traversing the upper part of the cavernous sinus 
 they get into the orbits through the foramina lacera. 
 They are distributed to the muscles of the eye, except 
 the obliquus superior and rectus externus, and contri- 
 bute to the ophthalmic ganglion. 
 
 The 4th Pair, (Trochleares. ) Each arises by two 
 filaments which quickly unite, from the valve of Vieus- 
 sens just below the tubercula quadrigemina. It is not 
 larger than a common semng thread, and makes its ap- 
 pearance at the anterior lateral margin of the pons 
 varolii. It penetrates the edge of the tentorium not far 
 from the entrance of the third nerve, and running in 
 an investment of dura mater through the cavernous 
 sinus at'^the outer side of this nerve, it afterwards 
 crosses it above, and getting into the orbit through the 
 foramen laceriun, is appropriated to the trochlearis 
 muscle. 
 
68 
 
 OF THE HEAD AND NECK. 
 
 The 5th Pair, (Trigemini,) are the largest of all. 
 Each arises by two or three portions, the anterior being 
 smallest, from the side of the tuber annulare just where 
 it is blended with the crus cerebelli. Their fibres are 
 collected into one cord, which passes into a canal of the 
 dura mater, lying on the anterior part of the petrous 
 bone. They are not connected to the canal except at 
 its lowest part, where they receive a coat from it. The 
 nerve is then expanded like a fan, into seventy or eighty 
 filaments. At the circumference of the latter is a 
 brownish substance the ganglion of Gasser, from the con- 
 vexity of which pass off three great divisions, named 
 from their appropriations ; the Ophthalmic nerve which 
 goes out of the cranium at the foramen lacerum of the 
 orbit; the Superior Maxillary, at the foramen rotun- 
 dum; and the Inferior Maxillary, at the foramen ovale. 
 
 The 6th Pair, (Motores Externi.) Each nerve 
 arises from the commencement of the medulla oblongata 
 between the tuber annulare and corpus pyramidale. It 
 passes forward through the dura mater, in a canal, of 
 the cavernous sinus, on the inside of the fifth nerve, 
 and lying between this nerve and the carotid artery, it 
 detaches one or more filaments to form the commence- 
 ment of the sympathetic nerve, and which accompanies 
 the carotid artery through the carotid canal to the neck. 
 The trunk of the motor externus then gets into the orbit 
 through the foramen lacerum and is appropriated to the 
 rectus externus muscle of the eye. 
 
BRAIN AND SPINAL MARROW. 
 
 69 
 
 The 7th Pair, is composed of two nerves, the Portio 
 Mollis and the Portio Dura. The first arises from 
 the posterior face of the medulla oblongata, where it 
 forms the fourth ventricle, being separated from its fellow 
 of the opposite side by the slit of the calamus scriptorius. 
 The second, or portio dura, arises from the place of 
 junction of the pons, medulla oblongata, and crus ce- 
 rebelli., A third nerve which, at a little distance, joins 
 the portio dura, and is a mere fibril called Portio Me- 
 dia, arises near the latter. The seventh nerve, thus 
 constituted of a hard and of a pulpy portion, dips into 
 the meatus auditorius internus. The mollis goes to the 
 ear and is spent upon the labyrinth ; the dura, passing 
 along the aqueduct of Fallopius, gets out at the stylo- 
 mastoid hole and goes to the face. 
 
 The 8th Pair, consists of three portions having diffe- 
 rent destinations: The Glosso-Pharyngeal ; the Par Va- 
 guin or Pneumo-gastric ; and the Spinal Accessory nerve 
 of Willis. The two first arise near each other from the 
 side of the Medulla Oblongata, behind the Corpora Oli- 
 varia, at the Corpora Pyramidalia Lateralia. The Clos- 
 so-Pharyngeal is before the other, and consists of one 
 cord. The Par Vaguin is composed of several fasci- 
 culi having a flattened appearance, which afterwards 
 unite together. The Spinal Accessory has a remark- 
 able origin from the Medulla Spinalis, occasionally as 
 low down as the seventh cervical nerve, between the 
 anterior and posterior fasciculi. Its fibres successively 
 
70 
 
 OF THE HEAD AND NECK. 
 
 form a round trunk, which passing up the spinal canal and 
 then into the cavity of the cranium through the foramen 
 magnum, is associated with the nerves just mentioned; 
 it is assisted also by contributions from the side of the 
 Medulla Oblongata. The eighth pair passes out of the 
 cranium at the posterior foramen lacerum, anterior to 
 the internal jugular vein, and separated from it by a 
 spine of bone as well as by a process of dura mater. 
 The distinction of the nerves from each other is also 
 kept up here, by processes of dura mater between 
 them. They adhere on the outside of the cranium 
 and then part for their different destinations ; the 
 Glosso-pharyngeal for the tongue and pharynx, the 
 Par Vagum for the lungs and stomach, and the Spi- 
 nal Accessory for the muscles and integuments of the 
 neck. 
 
 The 9th Pair, (Linguales.) Each nerve arises 
 from the side of the medulla oblongata at the groove 
 between the corpus pyramidale and olivare, by three 
 or four fasciculi. These fasciculi unite into a trunk, 
 which gets from the cranium through the anterior 
 condyloid foramen, and is distributed to the tongue. 
 
BRAIN AND SPINAL MARROW. 
 
 71 
 
 Of the Medulla Spinalis. 
 
 This is a continuation of the medulla oblongata, con- 
 tained in the vertebral canal ; passes down as far as the 
 first or second vertebra of the loins; and there ter- 
 minates in a eonical point. It has the same number of 
 membranes with the Brain; to wit, the Dura Mater, 
 Tunica Arachnoidea and Pia Mater. 
 
 The Dura Mater resembles very mucli the same 
 membrane of the brain except that it has more elasti- 
 city. It does not adhere closely to the bone, but lies 
 loosely enveloping the spinal marrow and nerves, until 
 it touches the foramina through which the latter pass 
 out. The spinal cavity is lined its whole length by a 
 ligamentous membrane which strengthens the articula- 
 tions of the vertebrae, being in close contact with them. 
 Between this membrane and the dura mater is inter- 
 posed a soft, watery and vascular fat, which forms a sort 
 of bed for the dura mater and fills up many of the in- 
 equalities between the two membranes. At the egress 
 of the dura mater from the cranium just around the 
 foramen magnum, it adheres closely to the ligamentous 
 lining. 
 
 The Pia Mater is in close union with the Medulla 
 Spinalis, and is commonly found with its veins inject- 
 ed after the same way, with the pia mater of the brain ; 
 it is, however, not so vascular. 
 
7 % 
 
 OF THE HEAD AND NECK. 
 
 The Tunica Arachnoidealies loosely between the dura 
 and the pia mater, preserving a character of extreme 
 tenuity and transparency; it may be elevated any where 
 with a pair of forceps ; continues downwards to the end 
 of the spinal cavity, and connects the fasciculi of nerves 
 together. 
 
 On each side of the spinal marrow running between 
 the anterior and posterior fasciculi of nerves, is a 
 narrow semitransparent band, called Ligamentum Den- 
 ticulatum, fixed beneath the tunica arachiioidea, and 
 connected to the pia mater by cellular substance. It 
 is first observed arising at the occipital foramen; it 
 then descends between the lateral fasciculi of nerves, 
 being united to the pia mater by its internal edge. 
 As the ligament passes between the^ anterior and poste- 
 rior fasciculi of nerves, it detaches little round tooth-like 
 processes, fixed to the inner surface of the dura mater, 
 and carrying the tunica arachnoidea along with them. 
 From these processes it derives its name. 
 
 The Medulla Spinalis from being a continuation of the 
 medulla oblongata, like it consists of two kinds of mat- 
 ter, cortical and medullary. The latter is placed ex- 
 ternally. The medulla spinalis has anteriorly and pos- 
 teriorly a fissure penetrating almost to its centre and ex- 
 tended its whole length, which divides it into two 
 equal parts. These halves are again di\dded each into 
 anterior and posterior portions by a long lateral fissui’e 
 which is not so deep or long as the other. These seve- . 
 ral divisions of the spinal maiTOW being connected by 
 
BRAIN AND SPINAL MARROW. 
 
 4 0 
 
 the internal cineritious matter, when a horizontal cut is 
 made, the latter puts on a crucial appearance. 
 
 From the anterior and posterior sections of the spi- 
 nal marrow flat fasciculi of nerves proceed, which pene- 
 trate the dura mater separately and derive a coat from 
 it. This coat exists for some distance as a sheath, 
 united to the nerve by loose cellular substance, but is 
 closely fixed to it near the intervertebral foramen. The 
 posterior fasciculus, at this place, forms a ganglion 
 which sends out a nerve at its fore part; this nerve, 
 just at its origin, is united to the anterior fasciculus, 
 and thus forms the commencement of the spinal nerve. 
 As soon as the spinal nerve clears the foramen between 
 the bones, it sends branches backwards to the muscles of 
 the spine, others forwards to join the sympathetic, and 
 the middle trunk goes according to the part of the body 
 to be supplied. 
 
 There are thirty pairs of spinal nerves ; seven to the 
 neck, twelve to the back, five to the loins, five to the 
 sacrum, and one which passes between the occiput and 
 first vertebra called Sub-occipital. The nerves of the 
 neck, from their origin to the intervertebral holes, are 
 short and nearly horizontal ; those of the back pass ob- 
 liquely downwards, increasing in obliquity as they de- 
 scend. The lumbar and sacral nerves are extremely 
 oblique, the lowest being almost vertical ; they arise 
 very much in a cluster close to each other, and form, 
 while still within the dura mater, the Cauda Equina. 
 
74 
 
 OF THE HEAD AND NECK 
 
 Of the Blood Vessels of the Brain and Spinal 
 MarroiO. 
 
 The brain is supplied by the Internal Carotids and 
 the Vertebral Arteries. The former, passing in a very 
 tortuous manner through the canal in the temporal 
 bones, appear in the cavernous sinus at the sides of the 
 anterior clinoid processes. They there send off, each 
 anteriorly, the ophthalmic artery through the optic 
 foramen, and, in a short space afterwards, the Arte- 
 ria Communicans, a branch which goes backwards, to 
 join the posterior artery of the cerebrum ; the main 
 trunk is continued into the fossa of Sylvius, and forms 
 the Arteria Media Cerebri, and from this is sent off the 
 Arteria Anterior which supplies the anterior lobe of the 
 brain and the corpus callosum. The arteria anterior com- 
 municates by a short transverse branch with its fellow. 
 
 The Vertebral Artei-ies come up through the forameu 
 magnum and unite with each other at the posterior 
 part of the pons varolii, to form the basilar arterjC 
 
 The Basilar artery divides anteriorly into two 
 branches which run to the posterior lobes of the brain : 
 they constitute the Arterise Posteriores Cerebri. From 
 the basilar near the vertebrals, arises, on each side, a 
 
BRAIN AND SPINAL MARROW. 
 
 75 
 
 trunk, the Arteria Inferior Cerebelli ; and from its an- 
 terior part the Arteria Superior Cerebelli. The cir- 
 cle of Willis is formed by the anterior bifurcation of the 
 basilar, connected to the internal carotids by the Arte* 
 riae Communicantes. 
 
 The veins of the brain have been mentioned as all 
 emptying into the sinuses of the dura mater. 
 
 The arteries of the spinal marrow are derived from 
 the vertebrals, intercostals, and arteries of the neck. 
 The veins accompany the arteries forming sinuses on the 
 outside of the dura mater, one on each side, which 
 empties into the occipital and lateral sinus, anasto^ 
 mosing, however, very freely with a plexus of veins 
 which surrounds the spinal column. 
 
 Section II. 
 
 Of the Jhiatomy of the Brain and Spinal Marrcrw, 
 according to Gall and Spurzheim. 
 
 I HAVE thought proper to add this section on account 
 of the interest felt in Philadelphia, for the peculiar 
 tenets of these gentlemen, and because I am persuaded 
 
76 
 
 OF THE HEAD AND NECK. 
 
 that th air’s is a very improved and simplified mode of 
 studying the anatomy of the brain, and of the nervous 
 system. Whatever may be the ultimate fate of their 
 physiological opinions, it ought to have no influence on 
 their anatomical observations, as the two subjects are in 
 their nature distinct. One is an obvious matter of fact, 
 and, for the most part, as susceptible of demonstration 
 as the contents of the thorax ; the other rests on a more 
 uncertain foundation, is therefore liable to error, and 
 should not be considered as having passed its period of 
 infancy, and the ordeal of public criticism. 
 
 The -brain and spinal marrow, these gentlemen say, 
 consist of two kinds of substance, cineritious and fibrous. 
 The first is found abundantly on the surface of the 
 brain, within its substance at particular places, and dif- 
 fused through the spinal marrow. Its consistence is 
 pulpy and gelatinous, varying in degree in different 
 subjects, and of a yellowish-red colour for the most 
 part. It is exti^emely vascular, in consequence of which, 
 some anatomists have considered it to consist entirely 
 of blood-vessels, but Albinus and Soemmering have 
 both proved by injections, that there is some other 
 substance which is probably secreted by them. This 
 substance is the matrix or soil of the nervous fibres 
 constituting the other part of the brain. 
 
 A very general error has prevailed in regard to 
 what is called the medullary portion of the brain ; some 
 consider it to be solid, others that it consists of hollow 
 tubes, some that it has no vessels, others that it consist^ 
 
BRAIN AND SPINAL MARROW. 
 
 77 
 
 entirely of them. The fact is that it is fibrous, whicli 
 may be demonstrated by scraping it from the centre to 
 the circumference in the direction of its fibres, by boil- 
 ing its convolutions in oil, or macerating them in nitric 
 or muriatic acid diluted with alcohol. For these reasons 
 Messrs. Gall and Spurzheim reject the term Medul- 
 lary as communicating a false idea, and call it the Ner- 
 vous Mass. 
 
 The Spinal Marrow in worms and caterpillars, 
 consists of a series of ganglions united to each other by 
 nervous branches, giving it the form of a chord with 
 small tubercles of various shapes and sizes. For every 
 superficial ring or segment of these animals, there is 
 one of these knots or ganglia for the origin of nerves, 
 and the size and number of the nerves emanating from 
 one of these ganglia, mil always be in proportion to 
 the size of the ganglion itself. In fishes, amphibia, 
 and birds the same arrangement prevails, only in not 
 so distinct a shape, the ganglia being nearer to each 
 other, and with the uniting bands forming a chord of 
 more equal size, swollen ‘however where large nerves 
 go off. The same knotted conditidn is observed in the 
 mammalia and in man, but not so evidently in the lat- 
 ter; one may, however, be convinced of it by removing 
 the spinal marrow, detaching the tunica arachnoidea, 
 and observing the profile between the eye and the 
 light. The outline is every where more or less wav- 
 ing, corresponding vith the origins of the nerves, the 
 
78 
 
 OF THE HEAD AND NECK. 
 
 largest swellings being where the nerves of the extre- 
 mities go olf; which are the largest nerves of the me- 
 dulla spinalis. The spinal marrow, for these reasons, 
 is enlarged from the third vertebra of the neck to the 
 first dorsal; it is then gradually diminished to the tenth 
 dorsal; it afterwards enlarges to the first lumbar verte- 
 bra, and forms an elongated point where it terminates. 
 
 In the medulla spinalis are two fissures going in a 
 vertical direction, one in the middle before, and the 
 other in the middle behind, which divide it into two 
 equal parts or halves; the first is wider and more visi- 
 ble, the second is deeper. There are no lateral verti- 
 cal fissures, as some anatomists assert. At the bottom 
 of the anterior fissure the two halves of the spinal mar- 
 row are united by transverse fibres which pass from 
 side to side, forming a layer, and at the bottom of the 
 posterior fissure there is also a corresponding layer of 
 fibres uniting the two halves, but passing longitudinally. 
 
 The medulla spinalis is medullary or fibrous exter- 
 nally, and eineritious or cortical within. The cineri- 
 tious substance forms a distinct arch in each half, which 
 has its concavity laterally, its two extremities will of 
 course be before and behind. The fasciculi of nervous 
 fibres follow the course of the ends of these arcs from 
 within outwards, some coming out before, and others 
 behind; the consequence of which is, that there are 
 on each side two rows of nervous fibres, an anterior and 
 a posterior. The posterior fasciculi are the larger, fi’om 
 
BRAIN AND SPINAL MARROW. 
 
 79 
 
 which cause, probably, it is that the posterior fissure 
 penetrates more deeply. 
 
 The Encephalon is considered by all anatomists to 
 consist of Cerebrum or Brain, and of Cerebellum or lit- 
 tle Brain, each of which is formed of two symmetrical 
 halves called Hemispheres. Besides which there ex- 
 ist the Pons Varolii and the Medulla Oblongata, till 
 lately considered as emanations from the Cerebrum and 
 the Cerebellum. 
 
 * 
 
 On each side of the Medulla Oblongata there are 
 three protuberances ; the most anterior is the Corpus 
 Pyramidale, just behind it is the Corpus Olivare, and 
 behind it again is the Corpus Restiforme ; these pro- 
 jections being named from their exterior configuration. 
 The medulla oblongata consists of cortical and fibrous 
 or medullary matter. The latter is eomposed of fas- 
 eiculi which may be traced into the brain above, and 
 into the spinal marrow below. Messrs. Gall and 
 Spukzheim consider the eerebral mass to arise from 
 these fasciculi instead of the latter coming from the 
 cerebral mass, as is most conlmonly taught and believed. 
 The corpora pyramidalia, like the other eminences, are 
 fibrous, and their fibres arise in a peculiar manner from 
 the lower part of the medulla objongata. This pecu- 
 liarity consists in the fibres of the right corpus p}Ta- 
 midale arising from the left side of the medulla oblon- 
 gata, and the fibres of the left corpus pyi’amidale aris 
 
80 
 
 OF THE HEAD AND NECK. 
 
 irig from the right side of the medulla oblongata. These 
 - fibres decussate each other an inch and a quarter be- 
 low the pons varolii, sometimes in single bands, but 
 commonly by an intertexture of three, four, or five fas- 
 ciculi from each side. When traced, their origin is 
 found to be in the cortical substance of the lower part 
 of the medulla oblongata. This arrangement is readily 
 seen by stripping off the pia mater and tunica arachnoi- 
 dea, and then separating the two sides of the fissure in 
 front of the medulla oblongata. 
 
 This peculiarity in the origin of the pyramids is sup- 
 posed to explain the fact of blows on one side of the 
 head paralysing the opposite side of the body, as the 
 same fibres are continued from the origin of the pyra- 
 mids to the part of the brain which is injured in these 
 cases. In regard to the other portions of the medulla 
 oblongata, the fibres of w^hich they consist have no 
 such arrangement, but arise fairly on the side to which 
 they belong ; are continued into the cerebral mass above 
 and communicate with the medulla spinalis below. 
 
 The Cerebellum. 
 
 The Cerebellum consists of two lobes or hemispheres 
 separated in part by a fissure, which makes them very 
 distinguishable from each other. By opening this 
 fissure behind we get a view of another or third part 
 of the cerebellum, called by many anatomists Vermis. 
 
BRAIN AND SPINAL MARROW. 
 
 81 
 
 but by G. and S. the Fundamental Portion. They are 
 induced to give it this name as it expresses in a measure 
 a fact of some importance, viz. that it always exists in 
 animals that have a cerebellum, whereas, the lateral 
 parts or lobes do not. Fishes and reptiles are in the 
 latter predicament, but all warm-blooded animals, with 
 man at their head, have the lobes. 
 
 In man the cerebellum is more complicated and per- 
 fect, nevertheless, a constant uniformity is observed in 
 all animals in regard to the origin from the medulla ob- 
 longata. In the interior of the medulla oblongata -on 
 each side, within the corpus restiforme, an accumulation 
 of cineritious substance is observed from which springs 
 an elementary chord of fibrous matter. This chord in- 
 creases as it ascends towards the cerebellum, and near 
 the latter is covered by the auditory nerve and its gang- 
 lion. These should be carefully scraped away; we 
 then see the fasciculus of fibres entering into the inte- 
 rior of the hemisphere of the cerebellum. Proceed- 
 ing two or three lines, the fibrous chord meets with a 
 collection of cineritious matter of an oval shape with 
 serrated edges, called CorpXxs Dentatum. The fibres 
 become so blended with this body, that it is impossible 
 to pursue them in any determinate course. The cor- 
 pus dentatum is considered as a ganglion or accumula- 
 tion of cineritious substance, for the purpose of giving 
 origin to more fibres in the cerebellum. Accordingly 
 several new fasciculi of medullary or fibrous matter 
 arise in it, and ramify in different directions towards 
 
 L 
 
82 
 
 OF THE HEAD AND NECK. 
 
 the periphery of the cerebellum. Wherever a large 
 ramification of fibres departs from it, the quantity of 
 cineritious substance about its root is increased, hence 
 results the fringed or serrated margin. That the cor- 
 pus dentatum, is a pabulum for the fibrous structure of 
 the cerebellum, seems proved by the fact, that the 
 greater number of viviparous animals have the cerebel- 
 lum proportionably smaller than man, and in them the 
 corpus is so little developed that they are said by some 
 to be destitute of it. 
 
 The Corpus Dentatum detaches inwardly a large 
 branch which contributes, with a corresponding one 
 from the other side, to form the Vermis, or the Fun- 
 damental Portion of the Cerebellum. In the vermis, 
 the fibrous or medullary matter radiates by seven 
 branches towards its circumference, their extremities 
 and subdivisions being covered by cineritious mat- 
 ter. 
 
 The corpus dentatum also sen'ds off other branches 
 which go upwards, downwards, and outwards, towards 
 the periphery of the hemisjftiere ; expand into horizon- 
 tal layers, and have their peripheral extremities cover- 
 ed with the cineritious substance. Such as are nearest 
 to the middle of the cerebellum are longest, and the 
 others gradually decrease in length as they are nearer 
 the place where the original chord entered the corpus 
 dentatum. If the cerebellum be cut vertically through 
 the middle of the corpus dentatum, eleven principal 
 
BRAIN AND SPINAL MARROW. 
 
 83 
 
 branches are found proceeding from it; but this num- 
 ber diminishes if the eut be made near the circumfer- 
 ence of the cerebellum. It is this arborescent arrange- 
 ment which, resembling the Thuya, or Tree of Life, 
 gives occasion to the name Arbor Vitse. 
 
 Horizontal or transverse cuts of these branches or 
 leaves present only a white substance ; therefore, ana- 
 tomists are wrong in maintaining that the quantity of 
 the cineritious mass is more considerable in the cerebel- 
 lum than in the brain.” 
 
 Commissures of the Cerebellum. 
 
 A description of fibrous matter exists in the cere- 
 helium which cannot be traced, either to the primitive 
 fasciculi from the corpora restiformia, or to the new 
 fibres derived from the corpus dentatum. These fibres 
 come from the cineritious matter on the surface of the 
 cerebellum, pass in various directions through the di- 
 verging fibres; but always so as to converge towards 
 the anterior external margin of the cerebellum, where 
 they form a large and thick layer of fibrous matter. The 
 anterior fibres cross in front of the tuber annulare, but 
 the middle and posterior pass transversally through it, 
 getting between the longitudinal bands of the tuber an- 
 nulare which are distributed to the hemispheres of the 
 cerebellum. These transverse fibres, from the opposite 
 sides of the cerebellum, unite with their congeners, in the 
 middle vertical line of the pons varolii. The pons varoliiis 
 
84 
 
 OF THE HEAD AND NECK. 
 
 therefore, the place of union for the fibrous structure 
 of the two hemispheres of the cerebellum, and as such 
 is called, by M M. Gall and Spurzheim, the Great 
 Commissure of the Cerebellum. 
 
 Considerable light is thrown upon this subject by com- 
 parative anatomy, for this great commissure has its di- 
 mensions always in strict proportion to the development 
 of the lateral parts or hemispheres of the cerebellum. 
 In the mammalia generally, as the lateral parts of the 
 hemispheres are small, the tuber annulare is small. In 
 fishes, and reptiles, it does not exist at all, because they 
 have no hemispheres to the cerebellum. On the con- 
 trary, in man, the hemispheres of whose cerebellum are 
 so large, the tuber annulare is remarkably broad and 
 prominent, so much so as to conceal the origins of seve- 
 ral nerves which are visible in other animals, and, there- 
 fore, to assume fallaciously the appearance of giving 
 origin to them. 
 
 Although such animals as are destitute of hemis- 
 pheres are without the great commissure of the cere- 
 bellum, yet as they all have the fundamental portion, 
 so they have a Lesser Commissure belonging to it. This 
 commissure is formed of the fibres which come from 
 the upper and lower parts of the fundamental portion, 
 and join each other in constituting the ^ alvula Cere- 
 belli, or the Valve of Vieussens, which runs upwards 
 and forwards to join the Inferior Tubercula Quadrige- 
 
BRAIN AND SPINAL MARROW. 
 
 85 
 
 mina or the Testes. This primitive commissure of the 
 cerebellum forms, in common description, the roof of 
 the fourth ventricle. 
 
 The Cerebrum. 
 
 The cerebrum is derived from the corpora pyra- 
 midalia under the following circumstances. As the 
 pyramids are about entering the pons varolii, they con- 
 tract so as to give the appearance of a neck. The pons 
 varolii has a considerable quantity of cineritious sub- 
 stance in it ; the fibres of the corpora pyramidalia, in 
 passing through, are divided into several fasciculi which 
 derive an increment from the cineritious matter, some 
 of the fibres being disposed in layers and others inter- 
 woven with transverse cords coming from the cere- 
 bellum. Besides the filaments from the corpora pyra- 
 midalia, others arise from the posterior part of tlte 
 medulla oblongata and from the corpora olivaria to pene- 
 trate into the pons varolii. The several fasciculi thus 
 formed from the different points of the medulla oblon- 
 gata by passing through the cineritious substance of the 
 pons varolii are so reinforced and multiplied that on 
 issuing from the latter they form the pedunculi or crura 
 of the brain. And as in man, the inferior or pyrami- 
 dal fasciculi receive the greatest accession of new 
 fibres ; they, therefore, form two-thirds of these crura. 
 
 In order to see the course just described of the fibres 
 of the medulla oblongata, remove its membranes and 
 
86 
 
 OF THE HEAD AND NECK. 
 
 those of the pons, and make an incision one line deep 
 through the front of the pons from the crus of the cere- 
 brum to the base of the corpus pyramidale of the same 
 side. With the handle of a scalpel introduced to the 
 bottom of the incision, scrape or push the surface of the 
 pons towards the crus of the cerebellum on the one 
 hand, and towards the middle line af the pons on the 
 other. We thus obtain a distinct sight of the trans- 
 verse medullary fasciculi constituting the anterior super- 
 ficial layer of the pons also called the great commissure 
 of the cerebellum, and when all these are removed we 
 see plainly the longitudinal fibres coming from the 
 pyramidal bodies ; by scraping still deeper, more of 
 the fibrous structure of the tuber annulare is brought 
 into view. 
 
 The anterior and external fibres of the crura of the 
 cerebrum are derived from the continuation and the 
 successive increase of the primitive pyramidal bundles, 
 or the corpora pyramidalia. The incessant reinforce- 
 ment of these fibres is produced by their meeting con- 
 tinually in the Tuber Annulare and the Crura Cerebri 
 with cineritious substance. At the upper extremity of 
 the crus where the optic nerve crosses it, the corpus 
 striatum, a large mass of cineritious substance, exists, 
 and with which blend the fibres of the crus, whence an 
 immense number of new fibres is generated and added 
 to the course of the others. These fibres, shortly after 
 their origin, begin to diverge, and being expanded in 
 several directions terminate in the convolutions of the 
 
BRAIN AND SPINAL MARROW. 
 
 87 
 
 anterior and middle lobes of the brain ; not in all of the 
 convolutions belonging to these lobes> but in the inferior, 
 anterior, and exterior. In this way the original fibres 
 of the corpora pyramidalia may be traced through the 
 medulla oblongata, tuber annulare, crura cerebri, and 
 corpora striata, to their terminations. 
 
 The fibrous fasciculi on the posterior and external 
 part of the medulla oblongata formed by the corpora 
 olivaria, and a few others just behind, ascend in the 
 same manner as those of the corpora pyramidalia; 
 through the transverse fasciculi of the pons varolii 
 which come from the cerebellum. By meeting also 
 with cineritious substance they are multiplied, but less 
 considerably than the fasciculi from the corpora pyra- 
 midalia. They form the interior and posterior part of 
 the crura cerebri and pass through the thalami nervo- 
 rum opticorum. The thalamus consisting principally 
 of cineritious substance, through which the fasciculus 
 of the corpus olivare has to pass, the fasciculus has an 
 accession of many new fibres. M M. Gall and 
 Spurzheim reject the opinion of the optic nerve aris- 
 ing from the thalamus, and rather consider the thala- 
 mus as one of the ganglions of the brain, from its being 
 appropriated to the production of a great number of 
 fine fibres, which ascend in a diverging direction, and 
 which at their exit from the superior margin of this 
 ganglion form large fasciculi. The anterior fasciculi 
 of the thalamus penetrate the corpus striatum where it 
 •forms a part of the lateral ventricle, and receive from 
 
88 
 
 OF THE HEAD AND NECK. 
 
 it a considerable accession of new fibres. All the 
 several fasciculi of the thalamus, by radiating very 
 widely, are finally distributed in the convolutions of 
 the posterior lobes of the brain, and in the superior 
 convolutions of the anterior and the middle lobes. 
 
 From the pyramidal fasciculi passing through the 
 corpora striata and being there multiplied, and from 
 the olivary fasciculi passing through the thalami and 
 being there also multiplied, the corpora striata and the 
 thalami are said to be ganglions, or an apparatus of in- 
 crease where many new fibres arise and join othei’s. 
 By such arrangement new cerebral fasciculi are added 
 to the old in the same way that many branches might 
 be engrafted upon the stock of a tree. 
 
 Commissures of the Cerebrum. 
 
 The Hemispheres of the Brain offer the same 
 phenomena as the cerebellum in regard to the two 
 orders of nervous fibres. The fibrillse which come 
 from the crura cerebri in expanding in order to form 
 the duplicatures or convolutions at the periphery of the 
 hemispheres, stop, as has been observed, with their 
 points in the cineritious substance. But it is certain 
 that besides these fibres there may be demonstrated in 
 all the circumference of the hemispheres beyond the 
 tissue on which rests the base of the convolutions, a 
 particular nervous substance, which appeal’s to be at 
 first spread in layers, and which is afterwards united 
 
BRAIN AND SPINAL MARROW. 
 
 89 
 
 into filaments, and lastly into distinct fasciculi. These 
 fasciculi converge or incline towards the interior of the 
 brain in order to form with their congeners of the op- 
 posite side, a commissure between the two hemispheres. 
 In some convolutions of the part folded below the pos- 
 terior lobe, this converging mass may be followed in 
 an uninterrupted bed till it forms distinct J&laments. 
 For this reason it is that we presume that this white 
 and soft substance to be met with in all the convolutions, 
 is continued every where in the same manner to the 
 commissures, although it be not susceptible of distinct 
 demonstration.” 
 
 ‘‘ As these fibres converge, and as they have in 
 every part a different course, and indeed in some places 
 one altogether different from the diverging fibres, or 
 such as come from the base of the brain, particularly 
 in the anterior and posterior parts of it : As, besides 
 this, they are separated from them, and much softer 
 and more white, we believed ourselves authorized to 
 consider them as a particular nervous system.” 
 
 The Corpus Callosum, or Great Commissure, is 
 therefore, derived from the converging or returning 
 fibres of the hemispheres of the cerebrum ; the fibres 
 from the opposite sides uniting at the raphe. The 
 anterior and posterior lobes are so disposed, that their 
 returning fibres do not cross transversely, but in a 
 radiated manner ; hence the great commissure is shorter 
 than the hemispheres, as it occupies only their middle 
 
 M 
 
90 
 
 OF THE HEAD AND NECK. 
 
 part. Also as these fibres are eollected very much in 
 consequence of their converging, the anteiior and pos- 
 terior edges of the corpus callosum are thicker than its 
 middle, and present the appearance of a fold not unlike 
 that of the pectoralis major at the arm-pit. 
 
 The CoMMissURA Anterior is derived from the 
 converging fibres of the front convolutions of the middle 
 lobes. These fibres pass through the corpora striata 
 without adhering to them, and present on both sides 
 of the brain the form of a bow with its convexity for- 
 ward. 
 
 The CoMMissuRA Posterior is derived from the 
 posterior convolutions of the middle lobes of the brain, 
 and from some of those of the posterior lobes. It also 
 consists of converging nervous fibres, which are lost in 
 the posterior duplicature of the Commissura Magna. 
 It forms, at its junction with its fellow, a fiat band and 
 not a round chord, and is much smaller than the anteri- 
 or commissure. The Middle Commissure of the cere- 
 brum is a mass of very soft and delicate transvei’se fibres, 
 going from one thalamus to the other, in the space 
 between the anterior and posterior commissures. These 
 transverse fibres are almost always torn, upon separat 
 ing the hemispheres. 
 
 Several other parts of the cerebrum are considei’ed 
 as commissures by G. and S., or consisting of converg- 
 ing fibres, as the T»nia Striata, the Posterior Crura of 
 
BRAIN AND SPINAL MARROW. 
 
 91 
 
 the Fornix, and the Lyra or under surface of the For- 
 nix. They do not consider the obliquity of the course 
 of the fibres of these bodies, an objection to their 
 being commissures, inasmuch as the returning filaments 
 of the middle parts of each hemisphere, are the only 
 ones which have a transverse direction. 
 
 The Septum Lucidum is also a commissure arising 
 by a fasciculus of fibres sometimes strongly marked, 
 from the most internal convolution, at the anterior ex- 
 tremity of the middle lobe, on each side. It ascends, in 
 front of the anterior commissure, above the junction of 
 the optic nerves, and is spread into a delicate membrane, 
 forming with its fellow the septum of the lateral ven- 
 tricles. Between the two laminae composing it, is a 
 cavity called the fifth ventricle of the Brain. These 
 laminae are extended through the middle of the great 
 commissure, and assist in forming the raphe by means of 
 perpendicular fibres, the direction of which is diverg- 
 ing towards the convex or superior part of the great 
 commissure. 
 
 It is probable that all the nerves of animal life have 
 those commissures and at any rate they are visible in 
 many other places. For example, they exist in the 
 transverse fibres at the bottom of the anterior fissure of 
 the spinal marrow and of the medulla oblongata, in the 
 latter of which we must take care not to confound them 
 with the decussation of the pyramids. And besides 
 this, the longitudinal band at the bottom of the posterior 
 
92 
 
 OF THE HEAD AND NECK. 
 
 fissure, extending the whole length of the spinal mar- 
 row, keeps its several nerves concatenated. The trans- 
 verse band behind the commissure of the cerebellum 
 in mammiferous animals, the junction of the tubercula 
 quadrigemina and the transverse band at the origin of 
 the fourth pair of nerves are similar unions or commis- 
 sures. 
 
 It is not possible to say with propriety that these 
 commissures are positive unions of the converging 
 fibres, from the corresponding parts on each side ; for 
 a perpendicular cut through the middle line of the 
 corpus callosum, of the tuber annulare, and the middle 
 of the spinal marrow, demonstrates perpendicular 
 strisB accompanied with blood-vessels. Possibly the 
 vertical laminae on each side of the middle line, may 
 form a seam by juxtaposition; but it is more proba- 
 ble that the converging fibres are continued across 
 these. 
 
 Besides the commissures, there are Transverse Bands 
 Complicationes Transversse,) which should be attend- 
 ed to. Messrs. G. and S. consider them as correspond- 
 ing with the transverse bands at the joints of straw. 
 They say that at every point of considerable increase 
 there is one of them, as at the lower end of the Cor- 
 pus Olivare, in the middle of the Crus Cerebri, at tlie 
 external margin of the optic nerve in the Crus Cerebri, 
 between the Thalamus and Corpus Striatum, at the ex- 
 ternal margin of the Corpus Striatum. 
 
BRAIN AND SPINAL MARROW. 
 
 93 
 
 The Emuse^ttije Mammilla res are separated in 
 the human subject, but adhere so as to form only one 
 body in other mammalia. Each eminentia contains three 
 cords, two internal and one external. The external 
 unites with the transverse band under the optic nerve 
 in the crus cerebri. The foremost of the two internal 
 cords unites with the anterior crus of the fornix of the 
 same side, and the other sinking into the interior of the 
 thalamus, unites with another transverse band. They 
 are true ganglions. ^ 
 
 The Pineal Gland is erroneously named, as it has 
 nothing of a glandular structure, but is composed of 
 cineritious and medullary substance. Four nervous 
 threads are produced in it which go to contiguous 
 parts, two on each side ; one goes along the superior 
 internal margin of the thalamus, and ends in one of 
 the transverse fasciculi found in the divergent fibres. 
 The second goes backwards and downwards, and ad- 
 heres to the commissure of the Tubercula Quadri- 
 gemina. 
 
 “ The Pituitary Gland is a collection of cineri- 
 tious substance, placed behind the junction of the optic 
 nerves. It is obviously traversed by white filaments 
 which arise in it, and it is prolonged into the Infundi- 
 bulum.” 
 
 The Tubercula Quadrigemina. The anterior 
 
94 
 
 OF THE HEAD AND NECK. J 
 
 ones or the nates, are evidently ganglions for the ori- 
 gins of the optic nerves, (see the account of these 
 j nerves.) They are flattened and somewhat cineritious 
 I externally, and are united to each other by a strong 
 * -and broad fasciculus, considered as a commissure of 
 the optic nerves. The testes are of a more conical 
 ^|; and elevated form, the medullary matter in them is 
 I more external, and they have also a transverse band 
 which unites them. The use of the testes is unknown, 
 but they are supposed to give origin to the olfactory 
 nerves, though it cannot be demonstrated. 
 
 Of the Ventricles and Convolutions of the Brain. 
 
 It has been stated that the brain has two ordei’s of 
 medullary fibres, the one called diverging, because 
 they have their rudiments in the medulla oblongata, 
 and are so spread as to have their extremities termi- 
 nating near the periphery of the brain, in the cineri- 
 tipus substance forming it. The other order of fibres 
 is called converging, because they pass from the cir- 
 cumference of the brain to the interior parts or mid- 
 dle line, and constitute the Commissures. These con- 
 verging fibres cross the diverging at various angles, 
 sometimes obliquely, sometimes in a rectangular direc- 
 tion. It is uncertainy^vhence they proceed, whether 
 they are derived from the imperceptible and curved 
 extremities of the diverging fibres in the same way that 
 the veins are continuations of the arteries, or who- 
 
BRAIN AND SPINAL MARROW. 
 
 95 
 
 ther they are a new creation in the cortical circumfer- 
 ence of the brain where they have their primitive radi- 
 cles, in a manner Corresponding with the origins of other 
 nerves in the dilferent ganglions. As the diverging 
 fibres or mass is extended in every direction towards 
 the circumference of the brain, and as the converging 
 fibres come from all parts of the same circumference, 
 and form large layers in the upper portion of the brain, 
 as for instance the corpus callosum, it results that be- 
 tween the two orders of fibres there are vacuities ; and 
 these are called the ventricles of the brain. 
 
 The Convolutions of the Brain have generally been 
 considered by anatomists, as intended merely to increase 
 its surface, in order that the blood-vessels of the pia 
 mater might have more convenient access to it. This 
 opinion is renounced by Messieurs Gall and Spurz- 
 HEiM on account of its being too mechanical, and they 
 think, that the convolutions are the result of a more 
 important and finished arrangement, which is as fol- 
 lows. 
 
 Immediately after the diverging fibres decussate the 
 converging, which they do at the external margins of 
 the ventricles, they separate from each other and are 
 prolonged into the convolutions, forming a fibrous ex- 
 pansion. These fibres are not all of the same length, 
 for some stop near the sides of the ventricles at the bases 
 of the convolutions, and others are extended to the sur- 
 face of the brain. By such arrangement the convolu- 
 
96 
 
 OF THE HE AH AND NECK. 
 
 tions are also of different depths. Each convolution 
 consists of two layers of the diverging fibrous or medul- 
 lary matter, which are symmetrical, are in juxtaposi- 
 tion, and adhere to each other by their contiguous sur- 
 faces. Besides this, as has been several times stated, 
 each convolution has its covering of cineritious 
 matter, about a line or a line and a half deep. The 
 medullary fibres penetrate somewhat into the internal 
 face of this covering, from which it is paler and more 
 firm than the exterior surface. The fibrous matter be- 
 ing successively inserted into the sides of the cortical 
 covering of the convolutions, its quantity of course is 
 diminished at the summit of tlie convolution ; hence 
 each simple convolution is wider at its base than at its 
 summit. Some of the convolutions however reverse 
 this rule, for they are flattened or depressed at their 
 summits, like a ridge or duplicature of cloth ha\-ing its 
 top pushed a little inwards. The convolutions do not 
 all stand out in a radiated direction as regards the cen- 
 tre of the brain, for some of them are bent either to one 
 side or the other. 
 
 Each convolution, besides being formed by the ends 
 of the diverging fibres covered with cineritious matter 
 has, in its structure, nervous fibres more minute and 
 soft than the diverging ones. These are the com- 
 mencements of the converging fibres, and can be seen 
 only in the convolutions of the posterior lobes of the 
 brain; the inference, however, is made that they exist 
 in all the convolutions. It is these fibres which accu- 
 
BRAIN AND SPINAL MARROW. 
 
 97 
 
 Ululate at their decussation with the diverging ones, or 
 immediately after, into the large fasciculi which form 
 the ventricles and the commissures. 
 
 If we separate a convolution from the brain and make 
 a perpendicular cut across it, the cut surface is plain 
 and exhibits no mark of being divisible into two lami- 
 nse. Yet it does consist of two laminae with their op- 
 posite faces in contact, and agglutinated in all proba- 
 bility to each other by a loose cellular tissue. This fact 
 is proved by the effects of hydrocephalus, for here the 
 water acting constantly with a distending foi'ce, sepa- 
 rates the two laminae of fibrous matter and sometimes 
 effaces the appearance of convolution, converting it into 
 a membrane. The prolongations or convolutions of the 
 cerebellum are formed after the same fashion, except 
 that they are divided into branches and leaves and 
 are smaller than those of the brain. 
 
 In the case of a woman affected with hydrocephalus, 
 Dr. Gall found the following condition of the brain. 
 The cerebral mass was distended into a large bladder, by 
 which the total or partial disappearance of all the con- 
 volutions had been produced. In places where they 
 had disappeared entirely, the cineritious substance was 
 of almost uniform thickness. All the interior surface 
 of the enlarged ventricles was perfectly white, and, in 
 a majority of places, not only the nervous fibres were 
 distinctly seen, but the blood-vessels which accompany 
 them. The ventricles contained about four pints of 
 
98 
 
 OF THE HEAD AND NECK. 
 
 clear and limpid water. The fibrous structure and the 
 blood-vessels had no where been impaired. This 
 woman died at the age of fifty-four of an inflammation 
 of the bowels, but from her earliest infancy she had 
 been afflicted with hydrocephalus. She was not very 
 thin, and was as active and intelligent as women of her 
 class in general. This observation led to a train of re- 
 flections which terminated in Dr. Gall separating, 
 artificially, the two laminse of the convolutions of the 
 brain. 
 
 His plan is to remove the pia mater from the whole 
 surface of the brain, and then to introduce the fingers 
 through the inferior part of the brain into the inferior 
 process of the lateral ventricle along the course of the 
 tsenia striata. By this means they may be carried into 
 the body of the lateral ventricle, and by gently extend- 
 ing and separating them, the convolutions are easily 
 unfolded into a membrane without destropng their 
 fibres. During this operation a slight resistance is felt 
 at the circumference of the ventricles, and at the base 
 of the convolutions, at the place where the diverging 
 and converging fibres cross each other. But the tissue 
 which connects them being lacerated, the remainder of 
 the separation is efiected without much difficulty. All 
 the interior of the cerebral expansion, thus produced, 
 resembles a case of hydrocephalus: the fibrous sti’uc- 
 ture being unimpaired, white, and smooth, and covered 
 externally by the cineritious matter. 
 
 The crossing of the two orders of fibres is easily de 
 
BRAIN AND SPINAL MARROW. 
 
 99 
 
 monstrated, but they cannot be detached from each 
 other without tearing their texture; this, however, 
 may likewise take place in hydrocephalus, by the slow 
 and uniform pressure of the water continually increas- 
 ing in the ventricles. 
 
 A much easier way to demonstrate the convolution 
 as consisting of two layers, is to remove it from the 
 rest of the cerebral mass and to make a transverse cut 
 through it, from its summit to its base ; by a gentle 
 pressure then with the finger and thumb from the 
 summit to the base, the two laminae of fibrous matter 
 may be readily separated from each other, leaving 
 their faces, which were in contact, smooth and unin- 
 jured. 
 
 Take a section of the periphery of the hemisphere 
 which has been detached a little distance from the cir- 
 cumference of the ventricles, and consequently nearer 
 the surface than the intertexture which unites the di- 
 verging and converging fibres. If the convex part of 
 this be laid in the palm of the hand so as to allow the 
 weight of the section to operate in drawing tlie convo- 
 lutions asunder, a very slight additional elfort will be suf- 
 ficient to separate them and to show that their laminae are 
 only agglutinated to each other. While this process 
 is going on, a little groove or fissure is seen at the place 
 of separation, as well as the perpendicular direction of 
 the fibres and of the blood-wessels. 
 
i.oo 
 
 OF THE HEAD AND NECK. 
 
 Let the sections of the brain be hardened for some 
 time in alcohol, or in nitric or muriatic acid diluted 
 with alcohol, or be boiled in oil for ten or twelve mi- 
 nutes, the laminae of the convolutions may then be sepa- 
 rated without difficulty, (and only in the middle line 
 where they are joined together,) by pressing from their 
 summit to their base with the finger and the thumb. 
 The fibrous expansion will be demonstrated clearly, 
 but there will be no vestige or appearance of lacerated 
 fibres. 
 
 The following experiment is thought by the author 
 of this system, to prove incontestably that each convo- 
 lution consists of two fibrous layers, and that these 
 layers do not grow together, but are lightly adherent 
 the one to the other. By blowing with a small tube 
 transversally on a convolution, the convolution is 
 broken to pieces, and no distinct result follows ; but by 
 blowing with the same pipe in the direction in which 
 the natural fissure of the convolution is supposed to 
 exist, the convolution splits from top to bottom. By 
 trying the same experiment on a convolution somewhat 
 depressed at its summit, it opens at the base by a sim- 
 ple fissure, and at the superior part this fissure is ex- 
 tended towards each angle by being bifurcated. By 
 injecting water in the direction of a fissure through a 
 finely pointed syringe, the separation of the convolu- 
 tions is made with still greater facility than with air, 
 so that the water passes for the distance of an inch or 
 more into the convolution, and even extends itself into 
 
BRAIN AND SPINAL MARROW. 
 
 101 
 
 the convolutions communicating with this one : of which 
 the examiner may be assured by cutting olf the tops of 
 such convolutions. This last experiment will succeed 
 by injecting the water in a transverse direction upon a 
 convolution ; so soon as the water has washed away the 
 lamina first opposed to it and gets to the middle, it 
 extends itself laterally in the direction of the fissure 
 of the convolution.* 
 
 Under the conclusiveness of such demonstrations the 
 authoi’S of the system very justly complain, that in- 
 stead of considering the convolutions both of the Cere- 
 brum and Cerebellum as consisting of two laminae of 
 fibrous- matter placed one against the other and cover- 
 ed by cineritious substance, anatomists still continue to 
 talk of a substance in the convolutions, which is white, 
 soft, and pulpy. 
 
 Of the JVerves of the Head. 
 
 These nerves are studied in a way the reverse of the 
 old systematic plan. The most of them can be traced 
 very satisfactorily to the medulla oblongata, and there- 
 fore they are considered from below upwards. Gall 
 breaks up the association forming the 8th pair, and de- 
 scribes each as a distinct nerve. 
 
 * In all these experiments on the convolutions, it is better to 
 have the pia mater removed previously. 
 
102 
 
 OF THE HEAD AND NECK. 
 
 The Accessory Nerve, forms a natural com- 
 munication between the nerves of the neck and those 
 of the head, for some of its branches arise in the neck 
 and others in the head. They all come from the pos- 
 terior segments of the spinal marrow and medulla 
 oblongata; but their origin varies in different in- 
 dividuals, and in the two sides of the same individual, 
 sometimes beginning at the fifth, and sometimes at the 
 seventh cervical nerves. They arise for the most part 
 by single threads which unite successively into a com- 
 mon chord, but sometimes these threads are multiplied, 
 and then form a single chord, which joins with the 
 main nerve. 
 
 This nerve is spent upon the Sterno-Mastoid and 
 Scapular Muscles, and upon the Pharynx. Hence the 
 sympathy of the stomach and oesophagus with these 
 muscles. The convulsive motions of tlie shoulders, 
 oesophagus and pharynx, in hydrophobia, and the stiff- 
 ness of the shoulder and sterno-mastoid muscle in sto- 
 mach complaints. 
 
 The Hypoglossal Nerve, arises in part between 
 the Corpus Pyramidale and Olivare, and partly below 
 them. Its threads issue after the manner of the spinal 
 nerves, separately. These threads unite and form thi'ee 
 or four fasciculi, which join successively into a common 
 chord. The hypoglossal nerve is distributed to the 
 tongue and to all the muscles attached to the os hyoides 
 and to the salivary glands. It is connected also by 
 
BRAIN AND SPINAL MARROW. 
 
 103 
 
 anastomosis to nearly all the nerves found in the neck 
 and throat. It does not taste, but acts in the motions 
 of the tongue performed in mastication, deglutition, 
 &c. Gall says its communication with the cervical 
 nerves, explains how the voice is lost in injuries of the 
 cervical medulla. 
 
 The Par Vagum, or Nerve of Voice, arises by 
 numerous filaments from the side of the medulla ob- 
 longata between the corpus olivare and restiforme, 
 nearer the latter. At their origin these filaments are 
 distinct, but they afterwards unite to form a flattened 
 cylinder, which passes out with the internal Jugular 
 vein. It is united with nearly all the nerves of the 
 neck by anastomosis, and being distributed to the 
 larynx, lungs and stomach, it performs an extremely 
 interesting part in the animal economy. From this we 
 understand how its injuries impair the voice; how 
 nausea, cough and vomiting follow the tickling of the 
 pharynx ; the connexion between the speech and the 
 voice, &c. ; and the oppression and cough from sordes 
 in the stomach. 
 
 The Glosso-Pharyngeal Nerve, composed of 
 several filaments, arises from the medulla oblongata near 
 the tuber annulare, and just above the par vagum. It 
 is united by ramifications in the neck to the facial and 
 sympathetic, and is spent upon the constrictors of the 
 pharynx, and the muscles of the tongue. 
 
104 
 
 OF THE HEAD AND NECK. 
 
 All the nerves as yet described correspond veiy 
 closely with those of the spinal marrow, inasmuch as 
 they arise in the cineritious substance placed interiorly 
 in regard to the point at which they issue, and unite 
 into one or several fasciculi. The nerves that follow 
 have the peculiarity of being successively produced by 
 cineritious substance, and of uniting in the cerebral 
 mass into a fasciculus which rises towards its surface, 
 being more or less visible according to circumstances. 
 
 The Motor Externus. The origin of this nerve 
 is better seen in the bullock or sheep than in the hu- 
 man subject. In man it sometimes appears to come 
 from the tuber or medulla oblongata, or from between 
 the two, according to the breadth of the tuber. But 
 arising, in fact, from the lower part of the medulla 
 oblongata, it ascends the whole length of the pyra- 
 mids at their side in the form of a little fasciculus, 
 and divides commonly behind the pons into two smaller 
 fasciculi which depart from the common mass of the 
 medulla, one behind the other. The pons varolii be- 
 ing much larger in man than in the animals just men- 
 tioned, frequently some of its transverse fibres cover 
 the motor externus at its point of departure. In this 
 case it appears to arise from the pons, and as its fila- 
 ments do not all come from the same place, a different 
 origin is assigned to them. 
 
 The Facial Nerve is considered to arise from the 
 
BRAIN AND SPINAL MARROW. 
 
 105 
 
 place of union between the pons, medulla oblong, and 
 crus cerebelli, but its origin is better illustrated in the 
 sheep than in the human subject, in the former of 
 which it departs from the medulla below the posterior 
 edge of the pons. It ascends as a fasciculus in the 
 medulla oblongata between the corpus pyramidale 
 laterale and the glosso-pharyngeal nerve, to a trans- 
 verse band at the back edge of the pons in these ani- 
 mals. Passing below this band it pierces it at the 
 internal edge of the auditory nerve. When in the 
 human subject, there is an appearance of this nerve 
 arising from the pons, it is a consequence of the pons 
 being broad enough to conceal a part of its origin. 
 
 This nerve explains the motions of the face in laugh- 
 ing or in crying, and the pains in the head and ears 
 during the toothach. 
 
 The Auditory Nerve. On the anterior face of 
 the fourth ventricle, transverse white medullary strise 
 exist, supposed to be the origin of this nerve. These 
 strim vary in number and distinctness in different in- 
 dividuals, being arranged sometimes in rays, occasion- 
 ally as pencils, at other times they are parallel. Often 
 those of one side are higher than those of the other; 
 sometimes they form little bands and then again are 
 rounded and projecting, being, in all cases, separated 
 from each other by a fissure in the median line. Gall 
 says he has never seen their decussation from the 
 opposite sides, spoken of by Portal. Many of these 
 
 o 
 
106 
 
 OF THE HEAD AND NECK. 
 
 medullary strisB go to the auditory nerve, but others 
 go in part to the anterior lobules, or thrust themselves 
 into the middle of the cerebellum. 
 
 Mammiferous animals want these medullary striae; 
 one may, therefore, assert confidently,' that many of 
 the filaments of the auditory nerve arise in the cineri- 
 tious substance of the fourth ventricle. This cineri- 
 tious substance is in less quantity in man, but forms an 
 oblong elevation called Ruban Gris by the French 
 anatomists; in the sheep, hog, horse, ox, it is the 
 size of a pea. This body may be considered the gan- 
 glion of the auditory nerve, and is placed precisely 
 where this nerve winds around the corpus restiforme, 
 its size being always proportionate to that of the audi- 
 tory nerve. 
 
 In animals, immediately behind the pons a large 
 transverse band is extended from one auditory nerve 
 to the other, which passes above all the other ascending 
 nervous fasciculi with the exception of the pyramids. 
 In man it is covered by the posterior part of the pons, 
 and is considered by Gall as a commissure of the 
 auditory nerves. 
 
 The Trigeminus, or 5th Pair. Comparative ana- 
 tomy affords the surest aid in regard to the origin of 
 this nerve, also, according to Gall. In fish the 
 ganglion from which this nerve proceeds is insulated, 
 and its nervous fibres from tlieir beginning are separa- 
 
BRAIN AND SPINAL MARROW. 
 
 107 
 
 ted from the common mass. In mammiferoiis animals 
 a large fasciculus exists at the exterior edge of the 
 under surface of the medulla oblongata, which passes 
 beneath the transverse band already mentioned, and 
 projects itself between it and the pons. In the ape 
 and in man this fasciculus is covered in part by the 
 pons, hence the opinion prevails that it arises at the 
 side of the pons. By removing cautiously the poste- 
 rior part of the pons till the fasciculus of this nerve be 
 reached, it will then be easy to follow its entire course 
 to the lower part of the exterior edge of the corpus 
 olivare. In this manner it will be seen very readily, 
 that even in the interior of the pons it divides into 
 threfe principal fasciculi, and that its fibres are increased 
 by the cineritious substance in different places.” 
 
 The Trochlearis, 4th Pair, arises from the side 
 of the valve of the brain, but much lower down than 
 is generally supposed, sometimes by one filament, 
 and at others by several. Gall observes, that at the 
 place indicated generally as its origin, it only projects 
 from the valve, which is a very different thing from its 
 actual origin. 
 
 The Motor Oculi, 3rd Pair, issues from the inter- 
 nal edge of the peduncles of the brain between the pons 
 and the eminentise mammillares. Its origin penetrates 
 to the third ventricle, but is separated from it by an 
 interposed stratum of medullary matter. Many fila- 
 
108 “ 
 
 OF THE HEAD AND NECK. 
 
 ments compose its roots which are reinforced by addi- 
 tions from the cineritious substance called Pons Tarini, 
 but it has no filament from the eminentise mammillares, 
 as has been asserted. 
 
 The Optic Nerve, in man, but more distinctly 
 in mammiferous animals, comes as a large fasciculus of 
 fibres from the nates, winds around the exterior edge 
 of the optic thalamus, where it is united to a consider- 
 able mass of cineritious substance, called Corpus Geni- 
 culatum Externum, and is by it reinforced. So far the 
 fasciculus is attached to the optic thalamus, but after- 
 wards is only placed upon the peduncle of the cerebrum 
 to which it adheres, by its anterior edge being united 
 to the neighbouring cerebral fibres. In front of tliis, 
 the nerve becomes rounder and adheres to a firm bed 
 of cineritious substance, (tuber einereum,) and receives 
 from it, particularly above, several nervous filaments 
 which unite to each of its sides. The optic nerve is 
 so much reinforced by these filaments that the increase 
 of its bulk is very perceptible, particularly after its 
 junction with its fellow. 
 
 In birds the optic nerve comes very distinctly from 
 the nates, which establishes more fully that it must 
 have the same origin in man and in the mammalia. In 
 the left hemisphere of the brain of a deranged female, 
 Dr. Gall found the thalamus almost destroyed by an 
 ulcer, the corpus striatum and the hemisphere much 
 diminished, but the optic nerve of the same side 
 
BRAIN AND SPINAL MARROW. 
 
 109 
 
 remained entire and like its fellow. The nates were 
 in a natural state. When, on the contrary, he has 
 found the optic nerve dwindled away, it has been at- 
 tended with a corresponding diminution of the nates 
 which belongs to it. In the horse, bullock, deer, &c. 
 the optic thalami are smaller than in man, while the 
 optic nerves themselves are larger; no proportion 
 therefore exists between them, while it does exist as 
 regards the nates. 
 
 Messieurs Gall and Spurzheim believe that the 
 optic nerves decussate each other, and they quote the 
 experience of Dr. Soemmering, who had observed the 
 fact in seven one-eyed men; and in the horse, the dog, 
 the hog, the cat, the goat, the rat, and the rabbit. 
 
 The Olfactory Nerve issues from the cineritious 
 substance, in the- inferior surface of the hemispheres. 
 Its first filaments are seen at the anterior part of the 
 internal convolutions of the middle lobes; they are soft 
 and delicate, and are surrounded for some distance by 
 cineritious substance. These filaments approach each 
 other and form commonly three principal roots, the 
 internal of which is shorter and broader than the two 
 external. The most exterior, which is the longest, 
 may be followed to the bottom of the fissura sylvii. 
 These are the only nerves of which there is any doubt 
 whether they take their origin in the hemispheres or 
 not, but even if they do, they are not continuations of 
 the medullary fibres of the hemispheres. 
 
no OF THE HEAD AND NECK. 
 
 Section III. 
 
 Of the Eye. 
 
 The hairs on the superior edge of the orbit arc 
 called Supereilia, and on the edges of the eyelids the 
 Cilia. 
 
 The Orbicularis Palpebrarum muscle being removed, 
 immediately beneath it are the two Tarsi Cartilages, 
 which form the margins and a considerable part of the 
 breadth of the upper and of the lower eyelids. The 
 upper cartilage is of a semi- oval figure, the broadest 
 part being not quite half an inch; the lower cartilage is 
 of an uniform breadth, not exceeding in any part one- 
 fourth of an inch. Their external extremities are 
 united with each other and kept in their places by a 
 ligamentous expansion connecting them with the orbi- 
 tar margin of the malar bone, and internally they are 
 fixed to the nasal process of the superior maxillary 
 bone by the tendon which affords origin in part to the 
 orbicularis palpebrarum. The edges of these bodies 
 are slanting so that a gTOOve is formed posteriorly where 
 they are in contact, by which the teal's are conducted 
 to the inner corner of the eye. Near the internal ex- 
 tremity of each, but not in tlie cartilage itself, is to be 
 found in the centre of a small eminence a foramen, 
 the Punctum Lachrymale, capable of receiving a 
 
THE EYE. 
 
 Ill 
 
 bristle, and which being the orifice of a canal, the 
 Ductus Lachrymalis, conveys the tears into the Saccu- 
 lus Lachrymalis. 
 
 On the posterior surface of the tarsi cartilages, are 
 placed several white tortuous canals in contact with 
 each other, and having their extremities on the edges 
 of the eyelids; they are the glands of Meihomius, 
 and secrete an unctuous substance. In the upper lid 
 are about thii’ty, and in the lower about twenty. 
 
 At the internal junction of the eyelids is placed the 
 Caruncula Lachrymalis, a small granulated body infe- 
 rior in size to a grain of wheat. 
 
 The ball of the eye is connected to the lids by a de- 
 licate, vascular, and highly sensible membrane, the Tu- 
 nica Conjunctiva, which is spread over its anterior third, 
 not excepting the cornea, but there it becomes perfectly 
 transparent. At the inner corner of the eye, the con- 
 junctiva is thrown into a fold, the Valvula Semilunaris, 
 corresponding with the membrana nictitans of some 
 animals. 
 
 The Lachrymal Ducts are under the skin of the 
 internal canthus, are three-eighths of an inch long, and 
 terminate by separate foramina in the sacculus lachry- 
 nialis. There is a sort of flap of tlie internal mem- 
 brane of the sac which falls over these orifices. 
 
 The Lachrymal Sac occupies all the concavity 
 
112 
 
 ' OF THE HEAD AND NECK. 
 
 in the os unguis, and extends from a short distance 
 above the tendon of the orbicularis muscle to the cavity 
 of the nose, under the anterior part of the inferior 
 spongy bone ; it is contracted to the size of a small crow- 
 quill at its nasal orifice, and there assumes the name of 
 Ductus ad Nasum. A duplicature of the membrane 
 of the nose resembling a valve, is frequently found at 
 this orifice. 
 
 The Lachrymal Gland for the secretion of tears is 
 placed in the superior and external part of the orbit, 
 near its margin, it is about five-eighths of an inch long, 
 and half an inch wide, being flattened so as to suit the 
 parts with which it is in contact. It is placed on the out- 
 er side of the tunica conjunctiva, and sends five or six 
 small ducts through it, whose orifices are in the tunica 
 conjunctiva of the upper eyelid near the external junc- 
 tion of the tarsi cartilages. 
 
 The muscles in the orbit are as follow : 
 
 1. Levator Palpebra: Superioris, arises near 
 the superior margin of the optic foramen, and is insert- 
 ed into the upper margin of the superior cartilage of 
 the eyelid. Use, to di*aw the lid upwards. 
 
 2. Levator Oculi, or Rectus Superior, arises from 
 the superior margin of the optic foramen, and is inserted 
 into the upper part of the ball of the eye near the 
 
THE EYE. 
 
 113 
 
 cornea, by a flat tendon. It turns the cornea up- 
 \vards, 
 
 3. Depressor Oculi or Rectus Inferior, arises from 
 the inferior margin of the optic foramen, and is insert- 
 ed into the lower part of the hall of the eye near the 
 cornea. It draws the cornea downwards. 
 
 4. Adductor Oculi or Rectus Internus, arises from 
 the internal margin of the optic foramen, and is insert- 
 ed into the internal part of the ball of the eye near the 
 cornea. It draws the cornea inwards. 
 
 5. Abductor Oculi or Rectus Externus, arises from 
 the external margin of the optic foramen, and is insert- 
 ed into the external part of the ball of the eye. It turns 
 the cornea outwards. 
 
 6. Obliquus Superior, arises from the internal 
 margin of the optic foramen, runs along in contact with 
 the orbitar plate of the os frontis, passes through the 
 trochlea near its internal angular process, and, being 
 enclosed in a sheath sent off from the trochlea, its round 
 tendon is inserted about half-way between the cornea 
 and optic nerve in the superior and internal part of the 
 eye. It turns the cornea outwards and downwards. 
 
 7. Obliquus Inferior, arises from the orbitar plate 
 of the superior maxillary bone near the os unguis, and 
 
 p 
 
114 
 
 OF THE HEAD AND NECK. 
 
 is inserted into the outer part of the eye -hall half- 
 way between the cornea and optic nerve. It turns 
 the cornea inwards and downwards. 
 
 8. Tensor Tarsi. At the internal canthus of the 
 orbit is a small muscle belonging to the internal commis- 
 sure of the eye-lids which has not been properly ob- 
 served before and is omitted in the descriptions of the 
 part given by the most eminent writers on Anatomy. 
 That it does not belong to either of the above, or to 
 the Orbicularis Palpebrarum, a reference to very minute 
 accounts of them by the best authorities will prove. 
 
 This muscle is about three lines broad and six lines 
 long ; it arises from the posterior flat surface of the os 
 unguis near its junction with the os sethmoides, and 
 passes forwards and outwards, lying on the posterior face 
 of the lachrymal ducts. As it approaches the commissure 
 of the lids, it splits into two parts nearly equal, each of 
 which is appropriated to a duct, and inserted along its 
 course almost to the punctum lachrymale. 
 
 To get a distinct view of it, the eyelids must be se- 
 parated from the eye and turned over the nose, leaving 
 the tendinous attachment of the orbicularis and ciliaris 
 muscles. The valvula semilunaris being brought into 
 sight by this process, must be dissected away, and also 
 the fat and cellular membrane underneatli it. The mus- 
 cle is now seen, and by passing bristles through the 
 lachrymal ducts its connexion \\T,th them is rendered evi- 
 dent, at the same time that we get a good idea of its size. 
 
THE EYE, 
 
 115 
 
 origin, and insertion. While making this inspection, by 
 turning the muscle somewhat aside, we shall be ren- 
 dered sensible of another fact of some importance, that 
 the attachment of the inner commissure of the eye-lids 
 to the internal canthus of the orbit is imperfectly des- 
 cribed, even by miatomists of much minuteness in their 
 accounts. It is attributed exclusively to the tendon of 
 the orbicularis muscle, so much so that in the opera- 
 tion for fistula lachrymalis we are strictly enjoined not 
 to cut through the tendon, lest a puckering of the eye- 
 lids be produced by their line of extension being de- 
 stroyed. The fact, on the contrary, is, that a ligamentous 
 matter behind this tendon passes between the internal ends 
 of the eyelids and the posterior flat surface of the os un- 
 guis, so that admitting the tendon of the orbicularis to 
 be cut through, this ligament, assisted by the little mus- 
 cle described, would prevent the dreaded deformity. 
 The internal extremity of this posterior ligament is at 
 least half an inch from the insertion of the orbicularis 
 tendon into the nasal process, and it brings the eyelids 
 into the curve commonly seen at their junction. The 
 lachrymal ducts are involved in this posterior ligament, 
 passing along it into the sac instead of going along the 
 edges of the commissure, as commonly described, just 
 under the skin. 
 
 The muscle attempted to be described must influence 
 considerably the position of the puncta lachrymalia by 
 drawing them towards the ball of the eye and keeping 
 them in close contact with it; it is, therefore, a very 
 
116 
 
 OF THE HEAD AND NECK* 
 
 ejBicient means for regulating so far the lachrymal pass- 
 ages and for securing the course of the tears. I am in- 
 debted to Dr. Physick for a further suggestion in 
 regard to its use, which appears highly probable. 
 In cases of extreme emaciation it is well known that the 
 adipose matter around the ball of the eye is more or 
 less absorbed, causing the eye to sink deeper into the 
 orbit, and consequently to retire somewhat from the 
 lids. The effect of the muscle is to draw the lids back- 
 wards and to keep them applied on the ball. Again, 
 in the elevation of the upper lid, or rather the draw- 
 ing of it within the orbit by the levator palpebrse, the 
 tendency of the margin of the lid is to leave the ball ; 
 the upper part of the little muscle ob\dates this ten- 
 dency. As such appears to be the actions of the part, 
 I must, therefore, coincide with him in calling it Ten- 
 sor Tarsi, a name expressive of its functions. 
 
 I am acquainted with a lady and a gentleman who 
 possess in a striking degree, the use of this muscle, its 
 action in them being increased much beyond what is 
 commonly observed. It is demostrated by an ability 
 to draw both the eyelids of one eye towards the nose, 
 at the same time shortening so much the space between 
 the puncta lachrymalia and the junction of the eyelids, 
 that the puncta are buried in the corner of the eye and 
 carried out of sight. 
 
 It would be interesting to know what is its healthy 
 influence on the condition of the sacculus lachrymalis 
 and lachrymal ducts in forwarding the tears from the 
 
THE EYE. 
 
 117 
 
 eye to the nose, and whether we are right in attribut- 
 ing this circumstance entirely to the capillary attrac- 
 tion of the pi^cta and to the pressure of the orbicu- 
 laris muscle.* 
 
 It is somewhat surprising that the idea of an appara- 
 tus, more perfect than what is commonly described for 
 regulating the position of the puncta lachrymalia, had 
 not occurred before, and that anatomists in the dissec- 
 tion of the part had not observed it. The latter, I 
 think, has arisen from the manner in which the dissec- 
 tion for the muscles of the eyelids is generally perform- 
 ed; removing the skin and exposing the orbicularis 
 and ciliaris muscles, we think the dissection completely 
 made, whereas this highly interesting part of the struc- 
 ture is unattended to. Also in working for the lachry- 
 mal ducts and sac this muscle is indiscriminately cut 
 away with the orbicularis. 
 
 The puncta lachrymalia have a power noticed by 
 Richter, of projecting themselves beyond the plane of 
 the eyelid in which they lie, and have an equally obvi- 
 ous power of retracting themselves so as to do away all 
 appearance of prominence.! I do not understand the 
 cause of the first motion, but the second depends upon 
 the muscle just described. 
 
 The Ball of the Eye is composed of several coats and 
 humours. As the human subject can seldom be obtain- 
 
 * Chapman’s Journal for 1824. 
 
 tMy attention was first called to it by Dr. Harlan. 
 
118 
 
 OF THE HEAD AND NECK. 
 
 ed sujSiciently fresh for a proper display of the struc- 
 ture, it is recommended to use the eyes of sheep, bul- 
 locks, or pigs, which can be got at any ^e. The eye 
 is to be removed from the orbit and cll^ired of its fat, 
 and muscles. Anatomists have devised various means 
 for fixing it for dissection, and any of them will answer 
 sufficiently well ; for my own part I have never found 
 any thing necessary besides a common saucer, and water 
 enough in it to float the organ ; the specific gravity of 
 this fluid approaches so nearly to that of the eye, that 
 it affords a very good support to its delicate membranes, 
 and sufficient stability for most purposes of examina- 
 tion. 
 
 The Tunica Sclerotica, the first coat of the eye, is to 
 be examined by opening the ball very freely and turning 
 out all of its contents. We shall then see that it has 
 considerable thickness, being of a compact fibrous tex- 
 ture, possessed of little elasticity, and therefore well cal- 
 culated for giving support to the interior structure. It 
 is white and tendinous like the dura mater, and has few 
 vessels or nerves. It is connected behind to the optic 
 nerve, where it is perforated by several small holes for 
 the passage of the nerve, and before to the Cornea. 
 
 The Cornea is a pei’fectly transparent membrane, 
 consisting of many laminae united by a delicate cellular 
 substance. It is much more convex than the sclerotica, 
 and is united to it by a broad sloping edge, where the 
 
THE EYE. 
 
 119 
 
 two membranes adhere very firmly to each other, by the 
 sclerotica overlapping the cornea. They may be sepa- 
 rated by putrefaction. The cornea in a healthy state has 
 no red blood circulating through it. It is covered ; be- 
 fore by the tunica conjunctiva, which there becomes as- 
 similated in its sensible properties to it ; and behind by 
 the capsule of the aqueous humour. 
 
 An eye being floated in the manner just mentioned, 
 a puncture is to be made with a lancet or sharp-point- 
 ed scalpel, through the sclerotica about half way from 
 its centre ; and the blunted blade of a pair of scissors 
 being introduced through the opening, a circular cut 
 should be made all around, taking great care not to in- 
 jure the coat below. By making radiated sections to 
 the optic nerve from this circular one, we shall be able 
 to peel off, with but little difficulty, all the posterior 
 part of the sclerotica, observing however, to leave the 
 optic nerve. What remains of the anterior part of the 
 sclerotica may be easily drawn away along with the 
 cornea. This stage of the dissection gives a good view 
 of the Tunica Choroides ; of a white circle called 
 the Ciliary Ligament seeming to terminate it before, 
 and of the Iris placed upon the fore part of the eye, 
 an opening in the middle of which affords a glimpse of 
 the internal structure. 
 
 The Tunica Choroides lines all the interior of the 
 sclerotica and is a much thinner and more delicate mem 
 
120 
 
 OF THE HEAD AND NECK. 
 
 brane than it; it appears blacky and is covered on the 
 outside with a flocculent cellular substance connecting 
 it with the sclerotica. Its black colour depends upon a 
 large quantity of colouring matter deposited principally 
 on its inner surface, and called Pigmentum Nigrum. 
 The tunica choroides abounds with blood-vessels, which 
 make it look perfectly red in living animals devoid of 
 the black pigment. It has a singular arrangement of 
 veins which can be made distinct only by injection. 
 They are called Vasa-Vorticosa. It is well furnished 
 with nerves, which appear like flattened pieces of white 
 thread lying on its outside. If the Iris be torn away, 
 the anterior edge of the membrane is seen terminating 
 in a fringe called Corpus Ciliare, and this fringe, if 
 closely observed, will be seen to consist of a great num- 
 ber of short and distinct processes, covered with pig- 
 mentum nigrum. 
 
 The Iris is a membrane placed across the eye just 
 behind the cornea; it is highly vascular, but ha%-ing a 
 large quantity of pigmentum nigrum on its posterior 
 surface, the vessels are not evident in a Imng state. Its 
 anterior surface determines the colour of the eye. In 
 its centre is a round hole called the Pupil, for admit- 
 ting light, which is increased or diminished by the ac- 
 tion of circular and radiated fibres composing the body 
 of the membrane. In the foetus the pupil is closed 
 by the Membrana Pupillaris till the seventh month. 
 
THE EYE. 
 
 121 
 
 The Ciliary Ligament is a circle of whitish sub- 
 stance, consisting of shortfibres, which are placed around 
 the anterior part of the eye, and serve to connect 
 strongly the Iris with the Tunica Choroides ; and these 
 again with the anterior edge of the Sclerotica and the 
 margin of the cornea. In it is a canal called the 
 Aqueduct of Fontana. 
 
 Having finished the examination of these parts; 
 with two pair of fine forceps strip olf the whole of the 
 Tunica Choroides. This is one of the nicest manipula- 
 tions in the whole dissection, and must therefore be 
 done with great care. If it be well executed, the most 
 delicate membrane in the human frame, will be found 
 lining the choroid coat; it was lately discovered in Dub- 
 lin, by Mr. Jacobs, and may be satisfactorily demon- 
 strated, by commencing at the optic nerve with the ex- 
 tremity of a knife-handle, and turning the membrane 
 down, by scraping towards the anterior part of the eye. 
 It extends from the optic nerve to the anterior edge of 
 the Retina. 
 
 Beneath the Tunica Jacobi, is placed the Retina, a 
 delicate, transparent, and pulpy membrane, extending 
 from the optic nerve distinctly to the commencement of 
 the Ciliary Striae of the Choroid Coat; and some anato- 
 mists maintain that it goes on as far as the circumference 
 of the Crystalline Humour, which is by no means so ob- 
 vious. The optic nerve, after penetrating the cribri- 
 
 Q 
 
122 
 
 OF THE HEAD AND NECK. 
 
 form part of the Tunica Sclerotica, forms a bulb on its in- 
 side; from this bulb the membrane called Retina, is ex- 
 panded over the interior surface of the eye. The Retina 
 consists of two layers ; the internal is a very delicate 
 and a vascular net- work, consisting of fine meshes ; the 
 external is the proper nervous matter, having a con- 
 sistence not much stronger than common mucus. In 
 the centre of the optic nerve is seen the artery which 
 supplies the Retina, called the Arteria Centralis ; the 
 branches of veins correspond with the arterial ramifica- 
 tions, and it is the former which we commonly see dis- 
 tended with blood in our dissections. In the centre of 
 the Retina is the foramen of Soemmering, surrounded 
 by a yellow spot, and having a fold connecting it to the 
 bulb of the optic nerve. Impressions made on the 
 Retina are supposed, generally, to be the cause of 
 vision, and of the contractions and dilatations of the 
 pupil. Dr. Physick believes, in regard to the latter, 
 that the Iris is immediately stimulated by the light, as 
 he has seen cases where the motions of it were activ^e, 
 and well marked in paralysis of the Retina. 
 
 The Humours of the Eye are three, the Vitreous, 
 Crystalline, and Aqueous. They are all perfectly 
 transparent, but differ much in their consistence and 
 structure. 
 
 The Vitreous occupies nearly all the eye posterior to 
 the Iris; it is like melted glass, from whence its name. 
 When minutely examined, it is found to consist of a 
 fluid like water contained in a very delicate membrane 
 
THE EYE. 
 
 123 
 
 or capsule, which is cellular; the peculiar consistence of 
 it is therefore derived from the latter. This capsule, 
 called Tunica Hyaloidea, is fixed at the bottom of the 
 eye by a branch of the central artery of the Retina, 
 and before, by a close adhesion to the Ciliary Body. 
 The Retina lies loose upon it. 
 
 The Crystalline Humour is fixed on the anterior part 
 of the Vitreous just behind the pupil. It is a double 
 convex lens, about three and a half or four lines in di- 
 ameter, the posterior convexity of which is mbch the 
 greatest. Its consistence is that of half dissolved glue, 
 but it becomes more solid towards the centre. By put- 
 ting it in boiling water for half an hour, it becomes 
 hard and opake, and one is enabled to unravel its 
 structure. It consists entirely of concentric lamellse, 
 ■which, with a needle, may be separated into very fine 
 fibres. It is enclosed in a capsule of the same shape, 
 and between it and the capsule is found a small quantity 
 of transparent fluid called Liquor Morgagni. Anato- 
 mists do not agree in regard to the origin of the cap- 
 sule, some thinking that it is entirely derived from the 
 tunica hyaloidea, others that it is totally distinct from 
 it. The Professor of Anatomy in this University, is 
 decidedly in favour of the first opinion ; and common in- 
 spection on the sheep’s eye favours it; the tunica hy- 
 aloidea there approaches the circumference of the lens, 
 and then splits into two laminae, one going before and 
 the other behind it. But if this be really the case, 
 
124 
 
 OF THE HEAD AND NECK. 
 
 the stnicture of the tunica hyaloidea is unquestionably 
 much altered, especially in front, as the capsule there 
 is possessed of more thickness, is elastic, and cuts very 
 much like the thin shavings of a finger nail, which in- 
 duce me to believe in the separate existence of the 
 capsule. In the tunica hyaloidea surrounding the cir- 
 cumference of the capsule of the lens, is placed the 
 Canal of Petit, which, when inflated or injectedis seen to 
 be divided in a radiated manner by a number of incom- 
 plete partitions. 
 
 The Aqueous Humour is placed between the lens 
 and the cornea, and is nearly as thin as water. The 
 Iris floats in it, which has occasioned the division of 
 the space occupied by the aqueous humour into An- 
 terior and Posterior Chambers of the Eye ; all the 
 space of the aqueous humour behind the Iris is called 
 the Posterior Chamber, and all the space before the 
 Iris is called Anterior Chamber. Both of these cham- 
 bers are said by M. J. Cloquet to be lined by the cap- 
 sule of the aqueous humour; this membrane, however, 
 is not very evident except on the posterior surface of 
 the Cornea. 
 
 The ball of the eye and the muscles surrounding it, 
 are imbedded in a considerable quantity of adipose 
 matter, the profusion of which, in health, gives pro- 
 minence to the organ ; and the absorption of which, in 
 disease, produces the sunken eye. 
 
THE EYE. 
 
 125 
 
 Of the Vessels and JVerves met ivith in the Orbit. 
 
 To display these parts, the roof of the orbit must 
 be entirely removed. The Internal Carotid Artery, as 
 it lies near the anterior clinoid process of the Sphenoid 
 Bone, detaehes a large branch the Ophthalmic ; which 
 in passing through the optic foramen is first under the 
 optic nerve, then gets to the outside of it, and finally 
 winds over to the inside of the nerve. Near the pos- 
 terior part of the eye it sends off* a branch which pene- 
 trates to the centre of the optic nerve, and is distri; 
 buted to the retina. It also divides into several 
 branehes which go to the Laehrymal gland; — to the 
 muscles of the Eyeball; — to the Tunica Choroides, con- 
 stituting the Ciliary Arteries; — and finally, branches 
 which pass through the anterior and posterior sethmoi- 
 dal foramina and through the superciliary foramen. At 
 the bottom of the orbit, and coming out at the infra- 
 orbitar foramen upon the face, is found a large branch 
 of the Internal Maxillary Artery. 
 
 The Veins of the orbit have very much the same 
 course with the arteries, some being connected with the 
 facial vein at the internal angle of the eye, and passing 
 into the external jugular; and others, sending a trunk 
 through the foramen opticum, which runs into the 
 cavernous sinus, and consequently into the lateral 
 sinuses. 
 
126 
 
 OF THE HEAD AND NECK. 
 
 Five trunks of Nerves are to be found in the Orbit. 
 
 1st. The Optic, which is expanded into the Retina. 
 
 2d. The Third Pair, or Motor Oculi, which passing 
 through the foramen lacerum superius into the orbit, di- 
 vides into two branches. One goes to the upper part of 
 the orbit, and is distributed to the Levator Oculi and the 
 Levator PalpebrsB Superioris ; the other goes to the 
 Adductor, the Depressor, and the Obliquus Inferior. 
 From it is sent a filament which runs to the Lenticular 
 or Ophthalmic ganglion; the latter is situated on the out- 
 side of the optic nerve near its entrance into the orbit. 
 
 3. The Trochlearis, or Fourth pair of nerves, is 
 exclusively appropriated to the Obliquus Superior 
 muscle, and also gets into the orbit through the su- 
 perior foramen lacerum. 
 
 4. The Motor Externus, or Sixth nerve, passes 
 through the superior foramen lacerum of the orbit, and 
 is spent on the Musculus Abductor. 
 
 5. The first branch of the Fifth nerve, or the Oph- 
 thalmic, passing also through the foramen lacerum, 
 divides into the Frontal, Nasal, and Lachrymal. The 
 first has but little to do with the Orbit, as it simply 
 passes along its superior part to get out upon the fore- 
 head, through the supra-orbitar foramen and Trochlea 
 
THE EAR. 
 
 127 
 
 of the os frontis. The second passes along the inner 
 side of the orbit, sends a filament to the Lenticular 
 ganglion : another through the anterior sethmoidal fora- 
 men which goes ultimately to the nose, and what re- 
 mains is distributed to the lachrymal sac and the con- 
 tiguous parts. The third branch goes to the Lachry- 
 mal Gland, whence its name. 
 
 Section IV. 
 
 Of the Ear. 
 
 The organ of hearing may, for the purpose of study, 
 be divided into three parts, the boundaries of which, 
 even by nature, are well defined; to wit, the External 
 Ear, the Tympanum, and the Labyrinth. 
 
 1. The External Ear consists of the structure ex- 
 terior to the head ; and of the passage called Meatus 
 Auditorius Externus, leading to the interior of the 
 petrous portion of the temporal bone. 
 
 The part, in common language called Ear, is priu‘ 
 cipally cartilaginous, but to the lower edge of the car- 
 tilage is appended a softer structure consisting of de- 
 
128 
 
 OF THE HEAD AND NECK. 
 
 licate granulated adeps, with a kind of tendinous cel - 
 lular membrane. The cartilaginous portion is called 
 Pinna, the other Lobus- The pinna presents a very 
 unequal surface both on the outside and on the inside. 
 The former being the part employed in collecting rays 
 of sound and converging them through the meatus ex- 
 ternus, merits our principal attention. The deep con- 
 cavity in the middle of it, is called Concha. In tlie up- 
 per part of the concha, and dividing it into two un- 
 equal fossae, we find a ridge of cartilage commencing, 
 which is traced in the form of a scroll along the cir- 
 cumference of the pinna till it terminates insensibly in 
 the posterior part of the lobus. This fold is the Helix ; 
 within it is a ridge of cartilage which is the Antihelix, 
 terminating above by a bifurcation. On the anterior 
 part of the concha, and overlapping it obliquely, is tlie 
 cartilaginous process called Tragus, and opposite to it 
 at the lower end of the antihelix is the Antitragus. 
 Under the fold of the helix is the Cavitas Innorainata, 
 and between the bifurcation of the antihelix is the 
 Scapha. 
 
 The Meatus Auditorus Externus is about one inch 
 in depth, calculating from the bottom of the concha ; 
 it proceeds obliquely forwards in a 0001*80 correspond- 
 ing to the situation of the petrous bone, and besides 
 that, has a curve with the convexity upwards. The 
 internal half is bony, but the outer half is composed of 
 cartilage and of ligamentous matter. If the skin be re- 
 
THE EAR. 
 
 129 
 
 moved from the ear it will be seen that the concha is 
 formed not entirely by cartilage, but at the bottom of 
 it, and connecting it and the commencement of the helix 
 with the tragus, is a ligamentous expansion which con- 
 tributes also to the meatus externus. In the tragus car- 
 tilage, near the bone, are found two fissures filled up with 
 elastic ligamentous substance ; they are the Incisurae. 
 The wdiole of this arrangement of cartilaginous and 
 membranous matter is highly favourable to the exercise 
 of the sense, as the former, by its resistance, is well 
 calculated for reverberating sound, and the latter affords 
 great facility of motion as a kind of hinge is formed by 
 the incisursB. The cartilaginous is joined to the bony 
 meatus by the exterior edge of the petrous bone being 
 rough and irregular for this purpose; there are also 
 three ligaments one, sent to a point above the mastoid 
 process, one to the zygomatic process, and a third to 
 the temporal aponeurosis. 
 
 The External Ear is covered by a delicate skin hav- 
 ing a great number of sebaceous follicles in it ; as the 
 skin descends into the meatus it becomes still more de- 
 licate and sensible, is beset with hairs, and under it are 
 found, in considerable numbers, the glandulse cerumi- 
 nosse which secrete the wax. 
 
 On the external ear are five muscles, w’hieh can sel- 
 dom be seen distinctly enough to merit the name. On 
 the superior and anterior part of the helix is the He- 
 Ucis Major; on its inferior part is the Helicis Minor; 
 
 -R 
 
130 
 
 OF THE HEAD AND NECK. 
 
 on the anterior side of the tragus is the Tragicus; on 
 the anterior part of the antitragus is the Antitragicus; 
 and on the cranial side of the ear is the Transversus 
 Auris. 
 
 In most persons there are also three muscles appro- 
 priated to the movement of the external ear, upon the 
 head, and which, though sufficiently well developed, are 
 scarcely ever employed. The Attollens Auricula?, 
 which arises by a broad membrane from the tendon 
 of the occipito frontalis and the fascia of the temporal 
 muscle, and is inserted into the prominence made by 
 the Scapha or Fossa Navicularis. The Anterior Auri- 
 culsB which arises from the temporal fascia just above 
 the posterior part of the zygoma, and is inserted info 
 the anterior part of the helix. And the Retrahens 
 Auriculae, consisting of two or three slips, the inferior 
 of which arises from the root of the mastoid process, 
 and is inserted into the prominence made by the concha 
 below ; while the second slip arises from the temporal 
 bone higher up than the former, to be inserted also 
 into the back of the concha above the first. The names 
 of these muscles express their action. 
 
 2. The Tympanum is situated in the outer part of the 
 Petrous Bone, and is separated from the Meatus Ex- 
 ternus by a partition called Membrana Tympani. The 
 meinbrana tympani is placed very obliquely, just at the’ 
 bottom of the meatus, its upper part being the out- 
 ermost. It is not flat, but has its centre drawn inwards 
 
THE EAR. 
 
 131 
 
 by the handle of the malleus. It consists of four layers, 
 the cuticle, the true fkin, the proper membrane, and 
 the lining membrane of the tympanum. When suc- 
 cessfully injected, it shows a high degree of vascu- 
 larity. The two outer layers are easily separated from 
 the others, and do not partake much of their vascula- 
 rity. 
 
 The tympanum contains a great deal of curious and 
 interesting structure ; its depth is about three lines ; its 
 antero-posterior diameter, six lines; and its vertical 
 diameter rather more. On its superior posterior part 
 is an oval opening communicating with an extensive 
 cellular arrangement in the Mastoid Portion of the 
 temporal bone ; and on its anterior side is seen the 
 canal of Eustachius going to the Posterior Nares. In 
 thd bottom and central part of the tympanum, is a 
 striking convexity, the Promontory, just above the 
 superior edge of which is the Foramen Ovale, and be- 
 low and somewhat behind it, is the Foramen Rotun- 
 dum. On the posterior surface of the tympanum, in 
 a line with the foramen ovale, is a very small bony pro- 
 cess, the Pyramid, which is hollow, and has a hole in 
 its apex. 
 
 Four small bones are found in the tympanum, which 
 form a chain between the membrana tyinpani and the 
 Labyrinth ; they are the Malleus, Incus, Os Orbiculare, 
 and Stapes. 
 
132 
 
 OF THE HEAD AND NECK. 
 
 The Malleus is placed before the others, and con- 
 sists of a spherical head, a necff 'just below the head, 
 uniting it with a tapering handle; a long and crooked 
 projection on the anterior part of the neck, called Pro- 
 cessus Gracilis, and a short one on the outside below 
 the other, called Processus Brevis, which sends out a 
 round ligament* to the edge of the tympanum. 
 
 The Incus resembles somewhat a molar tooth, with 
 two fangs widely separated, and one much longer than 
 the other. The superior and anterior part of the'body 
 of the bone is excavated for articulating with the head 
 of the Malleus. From the lower part of the body pro- 
 ceeds the Processus Loagus; and from the back part 
 looking into the orifice of the mastoid cells is the Pro- 
 cessus Brevis. 
 
 The Os Obbiculare is a flattened sphere about 
 the size of a mustard-seed, placed between the extre- 
 mity of the long process of the Incus and the Stapes. 
 
 The Stapes resembles very much a stirrup-iron, 
 and is placed horizontally at right angles with the mah 
 leus. It has a small head, articulating with the os or- 
 biculare, from which proceed an anterior and a poste- 
 rior crus. On the inner side of each crus is a fossa run- 
 
 * This ligament is described by some as the Laxator Tyin- 
 pani Minor Muscle. 
 
THE EAR. 
 
 133 
 
 ning its whole length. The crura diverging in their 
 progress and gently bent, are united by a broad base, 
 which corresponds in its dimensions with the foramen 
 ovale over which it is placed. 
 
 To get a good view of the malleus and incus, We 
 must cut away the superior margin of the tympanum, 
 their bodies will then be seen placed vertically and 
 in contact, a complete articulation being formed by 
 them. 
 
 The cavity of the tympanum is lined by a delicate 
 and vascular membrane, continued through the Eus- 
 tachian tube from the pharynx, and into the Mastoid 
 Cells. The little bones are all covered by a reflection 
 of the same, and the foramen rotundum is closed up 
 by it. 
 
 There are three muscles appropriated to the move- 
 ment of these bones, t>^m to the Malleus, and the other 
 to the Stapes. 
 
 The Laxator Tympani, placed in the glenoid fis- 
 sure of the temporal, and arising from the spinous pro- 
 cess of the sphenoid bone, is inserted into the processus 
 gracilis of the Malleus. It draws the Malleus out- 
 wards, and consequently relaxes the membrane of ^le 
 tympanum. 
 
 The Tensor Tympani arises from the cartilage of 
 the Eustachian tube, lies in its upper bony part, and is 
 
134 
 
 OF THE HEAD AND NECK. 
 
 inserted by a tendon into the neck of the malleus; a 
 little below the processus gracilis. It draws the handle 
 of the malleus inwards. 
 
 The Stapedius occupies the conical cavity of the 
 pyramidal process, and is inserted by a delicate round 
 tendon into the head of the Stapes. It draws this bone 
 backwards. 
 
 3. The Labyrikth. To obtain a good view of 
 this structure, a foetal bone must be procured, as 
 the labyrinth is more accessible in it and nearly as fully 
 developed as in the adult. The petrous bone here has 
 a condensed but thin structure on its surface, which 
 being removed, brings into view a soft and cellular bone 
 easily managed with a pen-knife. By paring it away- 
 we come in contact with the labyrinth, which is readih 
 recognized by its hardness and brittleness, and may be 
 got out with but little trouble. Having proceed- 
 ed thus far, the labyrinth is seen to consist of three 
 parts; above and posteriorly are the Semicircular 
 Canals, in the centre is the Vestibule, and below is the 
 Cochlea. The whole of this structure is hollow. 
 
 ^he Semicircular Canals attached to the back and 
 upper part of the vestibule, are so situated that one 
 is Superior, another Posterior, and the third Exterior 
 The superior and posterior are united togetlier at their 
 upper extremities, and therefore have a common cana 
 
THE EAR. 
 
 135 
 
 entering iiito the vestibule; their other extremities 
 are v\idely divergent from each other, and enlarged, 
 each forming an ampulla before it enters into the vesti- 
 bule. The exterior canal is shorter than the others, 
 lies nearly horizontal, and has its exterior extremity 
 enlarged also into an ampulla which is placed near 
 the ampulla of the superior canal. These three canals, 
 from two of them uniting, have only five orifices in the 
 vestibule. 
 
 The Vestibule has a cavity about the size of a gTain 
 of barley, and is placed just on the inner part of the 
 bottom of the tympanum. The foramen ovale is the 
 common orifice between them. On the superior and 
 exterior part of the cavity contiguous to the openings 
 of the canals is the semi- elliptical depression, and be- 
 low this and somewhat more internally is the hemi- 
 spherical depression, the recollection of both of which 
 will be useful to us at a subsequent period of the 
 description. At the lower part of the vestibule is a 
 foramen communicating with the cavity of the cochlea. 
 
 The Cochlea, consists of a conical tube wound spirally 
 two and a half times on itself, and is fixed at the 
 anterior part of the vestibule. It has a broad cribri- 
 form base forming the bottom of the meatus auditorius 
 internus, and an apex which occasions the promontory 
 in the tympanum. Passing from its base towards the 
 apex is a pillar of bone called Modiolus, on which the 
 
136 
 
 OF THE HEAD AND NECK. 
 
 conical tube is wound. This pillar tapers almost to a 
 point, and then is spread out into a cavity resembling 
 a funnel, from whence the name of Infundibulum. The 
 apex of the cochlea from its covering over the Infundi- 
 bulum is called the Cupola. 
 
 When the conical tube is cut open freely a partition 
 is seen to divide it into two equal portions from the 
 base to the summit. This partition, called Lamina 
 Spiralis, arises by two delicate lamellge of bone with 
 an intermediate cellular structure from the Modiolus, 
 but does not go completely across the canal, for on 
 minute examination, the lamina spiralis is seen to con- 
 sist besides of cartilage, of a cellular portion contain- 
 ing a fluid, and of a membrane. These portions are 
 called zones, we therefore have .Zona Ossea, Coriacea, 
 Vesicularis, and Membranacea. The lamina spiralis 
 terminates in the infundibulum by a process called 
 Hamulus. 
 
 The divisions in the Cochlea thus made by the 
 lamina spinalis form the seal*. The lowest of these 
 §calse has the foramen rotundum looking into its base, 
 and the upper eommunicates by the foramen at the 
 bottom of the vestibule with the ca\uty of the vestibule. 
 From these communications we have the names Scala 
 Tympani, and Scala Vestibuli. The seal* commu- 
 nicate also with each other just at the hamulus in the 
 infundibulum. 
 
 The whole labyrinth is lined by a highly vascular 
 membrane, exhibited by our preparations in tlie uni- 
 
THE EAR. 
 
 137 
 
 vej:‘sity, which seems to be very diiferent from common 
 periosteum. 
 
 Thus far the description has applied only to the bony 
 labyrinth, but by removing it we shall find besides the 
 vascular membrane just mentioned, the following parts. 
 Three Membranous Semicircular Canals within the 
 bony, conforming to their figure and containing a pellucid 
 fluid; these canals all communicate by their extremi- 
 ties with a sac called Alveus Communis, situated in the 
 semi- elliptical depression of the vestibule. — ^Within 
 the vestibule, and occupying the hemispherical cavity, 
 another smaller sac like a bubble filled with a trans- 
 parent fluid; distinctfrom the former, and called the sac- 
 culus Sphericus. To complete this part of the descrip- 
 tion of the labyrinth, it is to be observed that between 
 the bony and membranous canals, in the vestibulum on 
 the outside of the sacs, and in the scalsc of the cochlea, 
 is to be found a transparent fluid, which can pass from 
 one of these cavities into the other by the foramina 
 already mentioned. 
 
 It is in connexion with this fluid that we find two 
 supposed aqueducts for its removal, called after Cotun- 
 nius, one for the Vestibule, another for the Cochlea. 
 The first arises near the common orifice of the supe- 
 rior and posterior semicircular canals, and discharges 
 itself just behind the meatus auditorius internus. The 
 other comes from the cochlea near the foramen rotun- 
 dum, and runs into the jugular fossa just at the root of 
 
 s 
 
138 
 
 OF THE HEAD AND NECK. 
 
 the spine for separating the eighth pair of nervxs from 
 the internal jugular vein. ^ 
 
 The Nerve of Hearing, or the Portio Mollis, is 
 distributed throughout the labyrinth. The bottom of 
 the meatus internus being divided into two unequal 
 fosssB by a ridge ; the uppermost is the smaller and per- 
 forated with several foramina, all of which, except the 
 anterior large one, are appropriated to the passage of 
 the portio mollis to the vestibule. The larger fossa 
 at the bottom of the meatus is also cribriform, and forms 
 the basis of the cochlea; through it pass fibrillse to 
 the cochlea, vestibule, and semicircular canals. The 
 portio mollis, descending to the bottom of the meatus, 
 passes in several divisions, to the soft structure with 
 in the hony labyrinth. One division, entering the 
 vestibule, is spent on the alveus communis and membra- 
 nous canals; another division goes to the sacculus sphe- 
 ricus. A third division, penetrating from the base of 
 the modiolus, runs through it and comes out upon 
 the lining membrane of the cochlea, between the plates 
 of the lamina spiralis and through the infundibulum 
 and other parts. The fibrillse of the portio mollis, 
 during this distribution, continue exceedingly delicate, 
 and are finally found in a pulpy state resembling the 
 retina upon the internal surface of the ca%ities and sacs 
 just mentioned. 
 
 ^M.Ribes has ascertained that they only conduct blood-vessels 
 
THE EAR 
 
 139 
 
 The PoRTio Dura, though not concerned in the 
 function of hearing, passes through the petrous bone 
 in a curious manner. Entering into the large foramen 
 in the upper fossa of the meatus internus, it goes out- 
 wards almost as far as the vidian foramen and there 
 makes a very abrupt turn backwards, forming an acute 
 angle called its elbow. It then runs just above the 
 foramen ovale, making a ridge in the tympanum; con- 
 tinues its course so as to surround the back part of 
 the tympanum, and emerges at the foramen stylo-mas- 
 toideum. It is afterwards distributed to the face. 
 Its canal in the bone is called the aqueduct of Fallo- 
 pius. 
 
 The Chorda Tympani, a branch of the pterygoid 
 nerve, passes into the vidian foramen and joins the 
 portio dura, running closely conneeted with it almost 
 to the stylo-mastoid hole. It then leaves the portio 
 dura at an acute angle and enters into the back part of 
 the tympanum, crosses this cavity completely, by going 
 between the long leg of the incus and the handle of the 
 malleus. It gets from the tympanum through a fora- 
 men in the fissure of the glenoid cavity, and joins ulti- 
 mately the lingual branch of the fifth pair of nerves. 
 It sends fibres to the membrana tympani and to the 
 muscles of the malleus. 
 
 The labyrinth is principally supplied with blood 
 from a branch of the vertebral artery which gets to it 
 through the meatus internus. The tympanum and ex- 
 
140 
 
 OF THE HEAD AND NECK. 
 
 ternal ear are supplied from the stylo-mastoid and tern 
 poral arteries. 
 
 Section V. 
 
 Of the A^'ose, 
 
 In order to understand this part of our structure it 
 is necessary to be well acquainted with th e bones con- 
 stituting its cavity, both individually and collectively. 
 Being thus prepared, we shall see that the nostrils 
 which are incompletely separated from each other in 
 the skeleton have a perfect septum in the recent sub- 
 ject, which renders them two distinct cavities. This 
 is effected by a cartilage placed at the anterior parts 
 of the vomer and of the nasal lamella of the sethmoid 
 bone. At the junction of this cartilage with the nasal 
 suture it spreads out on each side into a wing, and is at- 
 tached to the lower edge of the nasal bones, extend- 
 ing by such means, the bridge of the nose. 
 
 Proceeding from the lower edge of the wing of this 
 cartilage, and from the external bony margin of the 
 anterior naris, is an elastic ligamentous membrane form- 
 ing the side of the nostril. At the anterior part of 
 this membrane is an oval cartilage which forms two- 
 
THE NOSE. 
 
 141 
 
 thirds of a ring, the exterior portion of it is the broad- 
 est ; the internal portion, placed in contact with the 
 corresponding part of the oval cartilage of the other 
 side, runs backwards, and the two form by their union, 
 the tip of the nose and the Columna Nasi. In the back 
 of the ligamentous membrane there are several detach- 
 ed pieces of cartilage which give firmness to the struc- 
 ture and produce the prominence of the ala nasi. It 
 is by means of these several cartilages that the orifice 
 of the nostril is kept open. 
 
 The posterior nares, being separated by the vomer; 
 are oval, and do not present an outline differing much 
 from that produced by the naked bone. At the poste- 
 rior extremities of the inferior turbinated bones are the 
 orifices of the Eustachian tubes placed obliquely, and 
 large enough to admit the end of the little finger. It 
 is not difficult to reach them with an instrument gently 
 curved, introduced through the inferior meatus of the 
 nose. They are here partly membranous and partly 
 cartilaginous, running upwards and outwards to the 
 bony canal leading to the cavity of the tympanum. 
 
 The Schneiderian membrane is spread over all the 
 bones composing the nostril, and by its thickness dimi- 
 nishes the foramina leading into the sinuses. Under the 
 anterior part of the middle spongy bone is an orifice 
 which leads through the scthmoidal cells into the fron- 
 tal sinus. At the middle part of the middle meatus, 
 or that between the lower and middle spongy bones, is 
 
142 
 
 OF THE HEAD AND NECK. 
 
 the opening into the Antrum Highmorianum capable 
 of giving entranee to a common quill. In the meatUb 
 formed posteriorly in the mthmoid bone, under the cor- 
 net of Morgagni, are the orifices of the posterior aeth- 
 inoidal cells; at the back part of this cornet, and a little 
 above it, is the orifice of the Sphenoidal Sinus. Imme- 
 diately under the fore part of the inferior spongy bone 
 is the orifice of the Ductus ad Nasum. This membrane 
 is laid smoothly on the septum of the nose. 
 
 The Schneiderian or mucous membrane, when well 
 injected, shows great vascularity; its reflections into 
 the sinuses are not, however, so thick or vascular as 
 the other parts of it. The surface which looks towards 
 the cavity of the nose is villous like velvet, and is stud- 
 ded with many mucous follicles which pass obliquely 
 into it, some of them being arranged in rows. It ad- 
 heres closely to the bones, and that surface in the close- 
 ness of its texture resembles periosteum. 
 
 Its nerves are derived from three sources. 
 
 1. The Olfactory, or Nerves of Smelling. They 
 pass on each side of the crista galli in two rows perfora- 
 ting the cribriform plate, and taking a coat of dura 
 mater which renders them strong and fibrous. One row 
 is spread on the membrane covering the upper part of 
 the sethmoid bone, not descending below the inferior 
 edge of the middle spongy bone; the other is distribu- 
 ted to the membrane of the nasal septum, and its fibi*e‘^ 
 
THE NOSE. 
 
 143 
 
 descend somewhat lower. The fibrillse of these nerves 
 terminate on the mucous surface of the membrane. 
 
 2. The Lateral Nasal Nerve comes from the 
 Spheno Palatine Ganglion through the spheno palatine 
 hole, and gives fibres to the septum and lateral parts 
 of the nose. One of the former dips into the anterior 
 palatine hole, joins with its fellow from the other side, 
 and forms a ganglion near the roof of the mouth. 
 
 3. The Nasal Nerve of the First Branch of the 
 Fifth Pair, passing through the anterior sethmoidal 
 foramen into the cranium, dips down at the side of the 
 crista galli into the nose, and may be traced along the 
 nasal bone to the tip of the nosel 
 
 The nose is supplied principally with Blood fi’om 
 the internal maxillary artery and from the sethmoidal 
 branches of the ophthalmic. Its veins accompany the 
 arteries. 
 
144 
 
 OF THE HEAD AND NECK. 
 
 Section VI. 
 
 Mouth. 
 
 The cavity of the mouth is chiefly formed by the 
 palatine processes of the upper maxillary and palate 
 bones, above; by the tongue and the muscles connect- 
 ed with it, below ; by the cheeks laterally ; by the lips 
 before, and by tlie soft palate behind. 
 
 The Tongue has its root at the os hyoides; it is 
 there thin, but broad; its tip and sides, owing to the 
 lining membrane passing a considerable way under them 
 before it is reflected to the organ, are left free. Four 
 pairs of muscles compose its bulk. The Stylo-glossus, 
 which arises from the anterior part of the styloid pro- 
 cess, and is inserted into the side of the tongue near its 
 root, the fibres going to the tip. The Hyo-glossus, 
 which arises broad and thin from the cornu, appendix, 
 and body of the os hyoides, and forms a considerable 
 part of the bulk of the tongue on its side. The Lin- 
 gualis, arising indistinctly from the root of the tongue, 
 on the inner side of the former muscle, and its fibres are 
 to be traced as far as the tip. And lastly, tlie Genio- 
 Hyo-glossus muscle, the most internal of tlie four, hung 
 in contact with its fellow of the opposite side. It arises 
 
THE MOUTH. 
 
 145 
 
 trom the tubercle on the posterior face of the symphy- 
 sis of the lower jaw; its fibres radiate so as to be in- 
 serted from the body of the os hyoides to the tip of 
 the tongue. Besides these regular and well defined 
 rnusclesj there are many fibres which cross the or- 
 gan in various directions and facilitate much its mo- 
 tion. 
 
 The superior silrface of tlie tongue is rough from the 
 presence of a number of eminences on it, called Pa- 
 pillae. At the posterior part are about nine of them, 
 arranged like the letter V, with the point backwards, 
 much larger than the others. They are fixed in pits, 
 and surrounded by a fold of the integuments ; from their 
 particular form, they have been called Papillae Capi- 
 tatae, or Maximae. Distributed over the tongue, and 
 scattered at irregular distances from each other, are the 
 Papillae Mediae, more numerous than the others, and 
 smaller. A third class of them occupies, by far, the 
 greater part of the surface of the tongue, and are call- 
 ed Papillae Villosae. And a fourth set of them, filling 
 up the intervals left between the others, and being the 
 smallest of any, are called Papillae Filiformes. It is 
 probable that these papillae, except the fii’st, are essen- 
 tially connected with the function of taste, as they are 
 abundantly supplied with nerves and blood-vessels, hav- 
 ing a peculiar arrangement. 
 
 At the posterior part of the tongue is a fold of the 
 membrane covering it, which rises up to join the Epi- 
 glottis cartilage; and within this duplicature is a liga- 
 
 T 
 
146 
 
 OF THE HEAD AND NECK. 
 
 mentous bridle serving to keep the Epiglottis cartilage 
 erect ; muscular fibres from the base of the tongue form 
 its commencement. On each side of it is a small pouch 
 which occasionally produces some trouble from articles 
 of food lodging in it. A little anterior to this fold is a 
 small blind hole, receiving the central papilla maxima 
 and into which some mucous glands discharge their con- 
 tents, it is called the Foramen Caecum of Morgagni;, 
 and sometimes behind it is another foramen caecum but 
 without a papilla. Scattered about the root of the 
 tongue we find many mucous glands. 
 
 The lining membrane of the mouth, when the cuti- 
 cle is separated from it by maceration, exhibits a sur- 
 face covered with fine vilii. On the lips and cheeks, 
 under it, are situated many small glandular bodies, call- 
 ed Glandulae Labiales, and Buccales. It forms a frac- 
 num where it is reflected from the upper and lower 
 lips to the centre of the Jaw Bones. On the alveolar 
 processes, its texture is more dense, constituting the 
 gums, which closely surround the necks of the teeth. 
 This membrane is also united to the lower side of the 
 tongue by a fi’senum, on each side of which we see the 
 orifices of the ducts of the sub-maxillary glands. Under 
 the tongue, at its side, and projecting into the cavitv" 
 of the mouth, but covered by the lining membrane, is 
 the Sublingual Gland, opening by fifteen or twenty dis- 
 tinct orifices. On the cheeks, opposite the intei-stice 
 t»f the second and third molar tooth of the upper jav • 
 is found the orifice of the duct of the Parotid Gland. 
 
thet mouth. 
 
 147 
 
 The lining membrane of the roof of the mouth, is 
 of a dense structure, having a ridge in it just under the 
 middle palate suture, and on each side of that transverse 
 ridges, extending towards the alveolar processes. It 
 adheres very closely to the bone, and beneath are to be 
 found many mucous glands of various sizes, having 
 their' excretory ducts terminating on the surface of the 
 palate. 
 
 Of the Fauces. 
 
 At the posterior part of the mouth may be seen, very 
 distinctly, by depressing the lower jaw, an incomplete 
 partition which divides it from the pharynx. It is the 
 Velum Pendulum Palati, formed by the lining mem- 
 brane of the mouth reflected over several muscles. In 
 the centre is a projection termed Uvula. On each side 
 of the uvula the soft palate has its inferior margin ter- 
 minating in two crescentic edges called its lateral half 
 arches. The anterior half arch is rather more distinct 
 than the posterior, and arising from the side of the uvula, 
 runs around to be inserted into the side of the basis of 
 the tongue. The posterior half arch, arising from the 
 side of the uvula near the anterior, runs backwards and 
 outwards, and is lost insensibly about the middle of the 
 pharynx. Between the half arches, on each side, is 
 placed the Tonsil Gland, the surface of which is com- 
 monly so reticulated, that it might readily be mistaken 
 for ulceration. The space between the lateral half 
 
148 
 
 OF THE HEAD ATsD NECK. 
 
 arches is the Fauces, and the anterior opening into it, 
 is the Isthmus of the Fauces. 
 
 By dissecting off the membrane of the soft palatc- 
 which is continued from the mouth, several mucous 
 glands are brought into view lying immediately under 
 it, and also the muscular structure, which is as fol- 
 lows. 
 
 1. In the anterior half arch is the Constrictor 
 IsTHMi Faucium, which arises from the side of the 
 tongue near its root, and is inserted into the middle of 
 the velum near the root of the uvula. It tends to close 
 the opening from the mouth into the pharynx. 
 
 2. In the posterior half arch is the Palato Pha- 
 RYNGEUS. It arises from the middle of the soft palate 
 behind, near the root of the uvula, and is inserted in 
 the pharynx between the middle and lower constric- 
 tors and into the superior posterior margin of the 
 Thyroid Cartilage. It di-aws the velum palati down- 
 wards. 
 
 3. CiRCUMFLEXUS or Tensor Palati; arises from 
 the spinous process of the sphenoid bone behind the 
 foramen ovale, and from the contiguous part of the Eus- 
 tachian tube, it passes in contact with the pterygoideus 
 internus muscle, and terminates in a broad tendon be- 
 low, which winds around the hook of the internal ptery- 
 goid process, and is inserted into the soft palate near 
 
PHARYNX AND CESOPHAGlJS. 
 
 149 
 
 Its middle, and into the posterior lunated edge of the 
 palate bone. It spreads the palate. 
 
 4. Levator Palati, arises from the point of the 
 petrous bone and contiguous part of the Eustachian 
 tube ; it is on the inner side of the former muscle, and 
 passes downwards to be inserted into the soft palate. It 
 draws the soft palate upwards. 
 
 5. The Azygos UvuLiE arises from the posterior ter- 
 mination of the palate suture, runs through the centre 
 of the soft palate, and ends in the point of the uvula. 
 It draws the uvula upwards and diminishes the verti- 
 cal breadth of the soft palate. 
 
 Section VII. 
 
 Of the Pharynx and CEsophagus. 
 
 The Pharynx is a large membranous cavity placed 
 at the posterior part of the nose and of the mouth for 
 opening an external communication with the cavities of 
 the thorax and abdomen. It lies before the cervical 
 vertebrae, being connected to them by cellular mem- 
 brane, is closely attached to the basis of the skull be- 
 
150 
 
 OF THE HEAD AND NECK. 
 
 fore the foramen magnum, to the posterior mai*gin of 
 the upper and under jaws, to the hack parts of the oe 
 hyoides and of the thyroid cartilage, and below it con- 
 tracts so as to be continuous with the oesophagus. In 
 consequence of these several attachments it constantly 
 remains a patulous unoccupied cavity, having a free 
 communication with the nostrils and Eustachian tubes 
 above, with the mouth just below them, with the 
 larynx still lower down, and with the oesophagus at its 
 bottom. The lining membrane which is expanded 
 over it, is continuous with tlie lining membranes of 
 these several cavities. 
 
 To get a good view of the pharynx, the head 
 ought to be cut off at the root of the neck and all the 
 cervical vertebrae be removed ; the cavity being then 
 stuffed with baked hair, we proceed to the dissection 
 of the muscles which form it, of which there are three 
 pairs, 
 
 1. Constrictor Pharyngis Inferior, arises from 
 the side of the cricoid and of the thyroid cartilage ; it 
 unites with its fellow in a white line in the centre of the 
 posterior part of the pharynx. Its superior fibres are 
 very oblique, covering the lower edge of the next mus- 
 cle, and its inferior fibres are more transverse, being 
 connected with the oesophagus. 
 
 2. Constrictor Pharyngis Medius, arises from 
 the appendix and cornu of the os hyoides, and from 
 
PHARYNX AND (ESOPHAGUS. 151 
 
 the round ligament, connecting the latter with the cornu 
 of the thyroid cartilage. It is inserted, in the same 
 Way as the foregoing, into its fellow and into the cunei- 
 form process of the os occipitis just before the foramen 
 magnum. 
 
 3. Constrictor Pharyngis Superior, arises from 
 the cuneiform process of the os occipitis, from the 
 pterygoid process of the sphenoid bone, and from the 
 upper and under jaw bones behind the last molar teeth 
 being connected with the buccinator muscle. Inserted 
 into its fellow by a white line in the middle, and hav- 
 ing its lower edge concealed by the preceding. 
 
 These muscles all' assist in conveying the food from 
 the mouth into the oesophagus. 
 
 The pharynx, after the dissection of these muscles, 
 may be cut open vertically at its back part, when a 
 very satisfactory view of all the cavities connected 
 with it will be obtained. ; 
 
 The (Esophagus. 
 
 This is a tube leading from the pharynx to the sto- 
 mach, it is placed between the trachea and cervical 
 vertebrsB above, passes into the thorax between the 
 laminae of the mediastinum and in contact with the 
 dorsal vertebrae., penetrates through the left foramen of 
 
152 
 
 OF THE HEAD AND NECK. 
 
 the diaphragm and terminates in the cardiac orifice of 
 the stomach. (See posterior mediastinum). 
 
 The CEsophagus is formed of-three coats, the muscu- 
 lar, the nervous and the mucous. When distended it 
 is cylindrical, but larger below than above. The 
 muscular coat is very strong, consisting of two planes 
 of fibres, the external being longitudinal and the in- 
 ternal circular. The nervous coat connects together 
 the other two; it is formed of loose cellular membrane 
 which allows them to move very freely upon each 
 other, and conducts the blood-vessels through their 
 structure. The mucous coat is a continuation of that 
 of the pharynx, it is covered by a very delicate cuti- 
 cle, which is continued into the stomach, and forms in 
 some animals an abrupt and well marked termination 
 just at the cardiac orifice. The internal coat of the 
 oesophagus is most frequently found in longitudinal folds, 
 which are removed by its distention ; it abounds with 
 mucous follicles, and is well furnished with blood- 
 vessels. 
 
THE LARYNX, 
 
 153 
 
 Section VIII. 
 
 Of the Larynx. 
 
 By the term Larynx is understood the irregular 
 cartilaginous tube which forms the upper termination of 
 the windpipe. The basis of the structure is five dis- 
 tinct cartilages; and a crooked bone the os hyoides, 
 which is intermediate to the larynx and the tongue, ser- 
 ving the purposes of both. 
 
 The Os Hyoides resembles much the letter U, di- 
 visible into its basis or curved part and its cornua, or 
 lateral projections. It is parallel with the lower jaw 
 and about half an inch below it. It acts as a root to 
 the tongue; as two arms in holding out the bag-like 
 orifice of the Pharynx; and from it, is suspended the 
 Larynx. The base of the os hyoides is broad and 
 convex anteriorly, above it is flattened on each side by 
 the insertion of muscles from the lower jaw, and at its 
 posterior part it is excavated sujBiciently to receive the 
 tip of the little finger. At the ends of the base the 
 two cornua arise, separated from it by cartilage and 
 therefore moveable; they are about an inch long, are 
 somewhat flattened, and have a tuberculated termina- 
 tion behind. On the cartilaginous interval of each 
 side, is placed a bony body about the size of a grain of 
 
 u 
 
154 
 
 OF THE HEAD AND NECK. 
 
 wheat, the Appendicula, which stands up obliquely 
 towards the styloid process and is connected to its tip 
 by a round ligament resembling a nerve; this ligament 
 in some cases has been found ossified in the greater 
 part of its length. The five cartilages of the Larynx 
 are the Thyroid,' Cricoid, two Arytenoid, and the 
 Epiglottis. 
 
 The Thyroid Cartilage, (Cartilage Thyroidea,) is 
 about an inch below the os hyoides, and forms a very 
 striking prominence in the male neck. It consists of two 
 flat sides w^hich are symmetrical, and united to each other 
 by an angle slightly acute at its anterior part; the upper 
 place of union forms the projection, called Pomum 
 Adami. The sides of this body lean over somewhat, 
 by which its transverse diameter above is somewhat 
 larger than that below. The upper edge .is notched 
 in front, and terminates behind by a long process on 
 each side; the Cornua Majora, which look towards 
 the ends of the cornua of the os hyoides and are con- 
 nected to them by round ligaments. The inferior edge 
 is somewiiat incurvated, and terminates behind by 
 a short process on both sides, the inferior cornua, or 
 Cornua Minora, by which it is fastened to the sides of 
 the cricoid cartilage and establishes a centre of motion 
 betw'een the two. 
 
 The Cricoid Cartilage, (Cart. Cricoidcs,) is an 
 oval ring of unequal breadth and thickness placed im 
 
THE LARYNX. 
 
 155 
 
 mediately below the thyroid cartilage. Its lower mar- 
 gin is horizontal and ajfixed to the first ring of the 
 trachea; the upper margin is very oblique, rising from 
 before backwards, till the breadth behind is three 
 times as great as that before. In front the ci’icoid 
 cartilage is thin, behind it is thick. On the upper edge 
 behind, on each side, a little head or convexity is 
 formed for establishing a sort of ball and socket joint 
 with the arytenoid cartilages. The interior surface is 
 flat, the exterior is marked by the muscles which lie 
 on it. 
 
 The Arytenoid Cartilages, (Cart. Arytsenoi- 
 deae, Triquetrae.) two in number, one on each side of 
 the upper back part of the cricoid, resemble each a 
 triangular pyramid curved backwards and having an 
 excavated base. The internal sides of the two, face 
 each other, and by the action of their muscles may be 
 brought together ; when thus joined they resemble the 
 spout of a pitcher. On the top of each is a little car- 
 tilaginous tubercle about the size of a grain of wheat, 
 ( Comic ulum Laryngis,) which is included in the soft 
 parts and is extremely moveable. There is a regular 
 articular cavity between the cricoid and arytenoid car- 
 tilages. 
 
 The Epiglottis Cartilage, (Epiglottis,) is an 
 oval disk' with an elongated pedicle below, its up- 
 per edge being thin and rounded. It is fixed behind 
 
156 
 
 OF THE HEAD AND NECK. 
 
 the base of the os hyoides and has its pedicle connected 
 to the entering angle on the posterior face of the 
 ^ thyroid cartilage. The flat surfaces of this cartilage 
 present forwards and backwards, and are above the 
 level of the arytenoids; from this position of the epi- 
 glottis it is said to be placed as a valve over the open- 
 ing of the larynx ; its valvular office, however, I have 
 great cause to disbelieve, for subsequent reasons. It is 
 very elastic, having a fibro-cartilaginous structure, and 
 is perforated with many foramina giving it a cribri- 
 form appearance. 
 
 The upper edge of the Thyroid Cartilage is connect- 
 ed to the internal edge of the Os Hyoides, by a thin and 
 somewhat elastic membrane which fills up the whole of 
 this interval, and completes the front and lateral parietes 
 of the Larynx. Between this membrane and the ca- 
 vity in the base of the Os Hyoides, is a small sac, very 
 rarely mentioned by anatomists, and considered by such 
 as speak of it, as a Bursa Mucosa. It has no connex- 
 ion with any other cavity, and is occasionally the seat 
 of disease. When its natural secretion is converted in- 
 to a meliceris, it is disposed to ulcerate, and form a fis- 
 tulous sore in the neck, not to be cured except by ex- 
 tirpation. This remark, on its disease, I have got from 
 Dr. Physick, in whose practice it is not uncommon; 
 latterly, I have seen him operate successfully for it in the 
 encysted state. 
 
 Between the Epiglottis and the Thyi’oid Cartilage. 
 
THE LARYNX. 
 
 157 
 
 and on the posterior face of the Thyreo-hyoid mem- 
 brane, is a quantity of loose fatty matter intermixed 
 with small mucous glands ; the perforations in the Epi- 
 glottis are supposed to conduct the excretory tubes of 
 the latter into the Larynx. 
 
 Between the Thyroid and Cricoid cartilages, in front, 
 there is a ligamentous membrane which fills up this in- 
 terval 5 it is the Crico-thyroid membrane, and in Laryn- 
 gotomy, is indicated as the proper place for the opera- 
 tion. 
 
 From the antei’ior part of the base of eaich Aryte- 
 noid cartilage, a ligament passes horizontally to the en- 
 tering angle of the Thyroid. These ligaments are not 
 parallel, but converge from the Arytenoid cartilages, 
 and are very near each other in front. At the dis- 
 tance of three lines above these, are two other ligaments 
 passing also horizontally from the Arytenoids to the thy- 
 roid cartilage; they are more parallel, but have not 
 their ligamentous character so well defined. 
 
 There are several pairs of muscles belonging to the 
 Larynx. 
 
 1. The Crico-Thyroideus^ arises tendinous and 
 fleshy from the anterior lateral surface of the cri- 
 coid cartilage, and passes upwards and backwards, 
 to be inserted into the inferior cornu of the thy- 
 roid cartilage, and the adjacent part of its inferior 
 edge. Use, to draw these cartilages obliquely to- 
 gether. 
 
158 
 
 OF THE HEAD AND NECK. 
 
 2. TheTHYREO-HvoiDEUs, which is described in the 
 account of the neck, page 16. 
 
 3. The Cktco-Arytenoideus Posticus, arises 
 from the back of the cricoid cartilage, occupying its 
 excavation, and is inserted into the posterior part of 
 the base of the arytenoid cartilage. To draw the 
 arytenoid backwards, and make the ligaments tense. 
 
 4. The Crico-Arytenoideus Lateralis, arises 
 from the side of the cricoid cartilage, and is inserted 
 into the side of the base of the arytenoid. Use, to 
 draw this cartilage outwards, and open the eliink of the 
 glottis. 
 
 5. The Thyreo-Arytenoideus, arises from the 
 posterior face of the thyi’oid cartilage, and the ligament 
 connecting it with the ericoid, and is inserted into the 
 anterior edge of the arytenoid cartilage. Use, to re- 
 lax the ligaments of the glottis. 
 
 6. The Arytenoideus Obliquus, arises from the 
 base of one arytenoid cartilage, and is inserted into the 
 tip of the other. It is a very §mall fasciculus, and 
 sometimes only one muscle exists. Use, to close the 
 chink of the glottis. 
 
 7. The Arytenoideus Trans versus, arises pos- 
 teriorly from the whole length of one arytenoid carti- 
 
THE LARYNX. 
 
 159 
 
 lage, excepting a little part of the tip, and is inserted 
 in a corresponding manner, into the other. Use, to 
 close the chink of the glottis. 
 
 8. The Thyreo-Epiglottideus, arises by a few 
 fibres, from the posterior face of the thyroid cartilage 
 near its entering angle, and is inserted into the side 
 of the Epiglottis. Use, to draw the Epiglottis down- 
 wards. 
 
 9. The Aryteno-Epiglottideus, arises by a few 
 indistinct fibres, from the superior lateral parts of the 
 arytenoid cartilage, and is inserted into the side of 
 the Epiglottis. Use, to. draw the Epiglottis down- 
 wards. 
 
 These two last muscles are generally so small and un- 
 defined, that they cannot be satisfactorily distinguish- 
 ed from the adjacent soft parts. 
 
 The cavity of the Larynx is lined by a continuation 
 of the mucous membrane of the Pharynx. This mem- 
 brane, where it establishes the upper boundary of the 
 Laryngeal cavity, forms a fold on each side, extending 
 from the Epiglottis to the Arytenoid Cartilage ; it then 
 sinks into the cavity beneath. In extending from the 
 upper to the lower ligament of the glottis, on each 
 side, it forms a pouch between them, called the ven- 
 tricle of Galen or Morgagni. From the lower ligament 
 
160 
 
 OF THE HEAD AND NECK. 
 
 this membrane passes to line the Cricoid Cartilage, 
 aiid thence into the Trachea. 
 
 The fissure between the two lower ligaments, is the 
 Rima Glottidis; and the cavity above the upper liga- 
 ments is the Glottis. 
 
 For an account of the Trachea, see the article 
 Thorax. 
 
 Notwithstanding the Epiglottis is considered as a 
 valve which shuts over the larynx in swallowing and 
 prevents articles of food from descending into it, I am 
 much inclined to doubt the entire correctness of the 
 opinion; for there is no muscular apparatus in the 
 structure capable of producing tliis position, and, there- 
 fore, when it does occur, it must depend essentially 
 on the mechanical pressure of the moi’sel which we 
 swallow. But this explanation does not account for our 
 ability to swallow fluids, or to swallow a very small 
 body, as a crumb of bread ; neither does it account for 
 the manner in which the larynx is protected in vomit- 
 ing. It is more than probable that in all these acts, 
 the motion of the larynx is the same. 
 
 Always impressed with the insufficiency of these 
 doctrines, and knowing also that they had been render- 
 ed still more questionable by cases in which the uppei 
 part of the epiglottis had been lost by wounds or ulce- 
 ration,^' I remained unsatisfied till very lately. In the 
 
 * I have now a case of this kind in the A. H. Infirmary. 
 
I LARYNX. 161 
 
 spring of 1822, in dissecting a muscular subject, I had 
 occasion to observe a position of these parts whic h will 
 account for all. The upper part of the glottis was 
 closed, but in a manner precisely the reverse of the 
 received opinion ; the epiglottis, instead of being 
 drawn down over this opening, had the opening drawn 
 up to it. The natural position of the epiglottis, is not 
 vertical, but somewhat obliquely backwards. Consider- 
 ing the upper opening of the larynx as constituted by 
 a plane passing from the tip of the arytenoid cartilages 
 along the superior line of the cricoid cartilage, we shall 
 then have a surface which by being brought some what 
 obliquely forwards, will come in contact with or nearly 
 so, and be parallel to the posterior face, of the epi- 
 glottis, while the latter is in its natural position. It is, 
 I believe, in this manner that the upper opening of 
 the windpipe is closed, nor are we deficient in pointing 
 out the agent. 
 
 By examining the position and strength of the thyreo 
 hyoid muscle it will be obvious that the shortening of the 
 larynx, which this muscle is said to produce, ^s, in a 
 strict analysis of it, no other motion than what I have 
 just described. It is probable that the inferior con- 
 strictor of the pharynx concurs in the same motion, 
 particularly its upper fibres. The stylo-pharyngeus 
 does the same, and is. very favourably inserted into the 
 posterior margin of the thyroid cartilage. If the 
 glottis be protected in this way during deglutition it 
 shows satisfactorily why the soldier, mentioned by 
 
 X 
 
162 
 
 OF THE HEAD AND NECK. 
 
 Larrey, whose epiglottis was cut off by a musket ball, 
 when the wound cicatrized, could swallow as well as 
 usual, and why such as have the upper part of the 
 epiglottis cartilage removed by venereal ulceration suf- 
 fer no inconvenience of consequence from it. 
 
PART II. 
 
 OF THE TRUNK. 
 
 CHAPTER L 
 Of the Thorax. 
 
 The dissection of the cavity of the Thorax should be 
 preceded by that of the muscles which lie upon its 
 front part and sides. 
 
 Section I. 
 
 Of the Muscles. 
 
 1. The Pectoralis Major is the most superficial, 
 and forms the large swelling cushion of flesh under 
 the skin of the breast. It arises tendinous from the an- 
 terior face of the two upper bones of the sternum their 
 
164 
 
 OP THE TRUNK. 
 
 whole length, fleshy from the cartilages of the fifth and 
 sixth ribs, and by a fleshy slip from the upper part of 
 the tendon of the external oblique muscle. It arises 
 also fleshy from the interior two -thirds of the clavicle. 
 The clavicular and sternal portions of the origin are 
 separated by an interval, giving the appearance of two 
 muscles. 
 
 The fibres converge and terminate by a broad, thin 
 tendon, which is inserted into a roughness on the ex- 
 terior edge of the fossa of the os humeri for the biceps 
 tendon. The under edge of the muscle, near its inser- 
 tion, is folded inwards, which gives the rounded thick 
 margin to the fore part of the axilla. That part of the 
 broad tendon belonging to the cla\dcular portion of the 
 muscle is inserted lower down than the sternal, which 
 produces a decussation of the fibres of the tendon. 
 
 The Petoralis Major moves the arm upwards and in- 
 wards. 
 
 2. The Pectop.alis Minor is brought into \dew by 
 raising the last muscle. -,It is comparatively small and 
 somewhat triangular, arising by thin tendinous digita- 
 tions from the upper edges of the third, fourth, and 
 fifth ribs. It soon becomes fleshy, and is inserted, by 
 a short flat tendon, into the inner facette of the coracoid 
 process of the scapula. Its use is to draw the scapula 
 inwards and downward^. 
 
 3. TheSuBCLAVius is a small muscle placed imme 
 
MUSCLES OF THE THORAX. 
 
 165 
 
 diately under the clavicle, arising from the cartilage of 
 the first rib, and inserted into the inferior face of the 
 clavicle from near the sternum to the conoid ligament, 
 which connects the coracoid process and the clavicle 
 together. It draws the clavicle downwards. 
 
 4. The Serratus Major Axticu^s is a broad mus- 
 cle lying on the sides of the ribs, between tliem and 
 the scapula, and arising fi’Oin a line anterior to their 
 middle. In well defined bones the precise points of 
 origin are readily seen. It arises from the nine upper 
 ribs by fleshy digitations, the superior one of which 
 seems almost like a distinct muscle, the five lower are 
 connected to the obliquus externus abdominis, the digi- 
 tations of the two muscles interlocking with each other. 
 The fibres converge, and are inserted into the base of 
 the scapula its whole length. Its action is to draw the 
 scapula forwards. 
 
 5 . The Intercostales fill up the spaces between 
 the ribs. There are two in each space. The Exter- 
 nal arises from the spine and from the inferior acute 
 edge of each rib almost to its cartilage, and is inserted 
 into the superior rounded edge of the rib below for the 
 same distance, its fibres passing obliquely forwards. 
 The Internal Intercostal, arises from the inferior edge 
 of the rib, beginning at the sternum, and going back- 
 wards to the angle of the rib, it is inserted into the 
 superior rounded edge of the rib below on its inner 
 
166 
 
 OF THE TRUNK. 
 
 side, its fibres passing obliquely backwards. They 
 draw the ribs together. 
 
 With a view to examine the cavity of the thorax, the 
 sternum along with the cartilages of the ribs, is to be 
 taken out. We then see, on their posterior faces, a 
 muscle called 
 
 6, Triangularis Sterni, which arises from the 
 whole length of the cartilage ensiformis at its edge, 
 and from the inferior half of the edge of the second 
 bone of the sternum. The fibres go obliquely upwards 
 and outwards to be inserted into the cartilages of the 
 third, fourth, fifth and sixth ribs by fleshy and tendi- 
 nous digitations. Its use is to depress the ribs, and con- 
 sequently to diminish the cavity of the thorax. 
 
 Section II. 
 
 Vistet'u of the Thorax. 
 
 The most usual manner of getting into the ca\dty of 
 the Thorax is that just mentioned ; but there is a much 
 better one introduced here, by the late Professor Wis- 
 TAR, iu which the five middle true ribs on each side 
 are removed, all the rest with the sternum being left. 
 
VISCERA OF THE THORAX. 
 
 167 
 
 This plan gives an excellent view of the several viscera, 
 and also of their relative situation and extent; and it is 
 such as I would recommend the student to adopt, in at 
 least one dissection. The principal objection to it is, 
 that it renders the upper parts of the trunk unfit for 
 farther investigation, inasmuch as the superior extremi- 
 ties must be removed in the first place. If the muscles 
 connecting the upper extremities to the trunk, on its 
 fore and back parts, should have been previously dis- 
 sected, this objection is no longer valid. 
 
 Approaching the cavity of the thorax, by either of 
 the methods mentioned, we see at once its most striking 
 contents, viz. the Heart and Lungs, each covered by 
 an appropriate membrane. The heart is between the 
 sternum and the dorsal vertebrae ; the lungs are on each 
 side of it and when in a healthy state, always collapse 
 upon the thorax being opened. 
 
 The Pleurse. 
 
 Each of the two lungs has an appropriate membrane 
 called Pleura; which covers its external surface; and 
 giving it a glistening smooth appearance, is reflected 
 from the internal face of the lung over the proper 
 membrane of the heart to the sternum before, and to 
 the spine behind. The membrane also lines the ribs, 
 intercostal muscles and diaphragm, of that side of the 
 thorax to which it belongs. Above, it passes up as 
 high as the head of the first rib, and below, it goes as 
 
168 
 
 OF THE TRUNK. 
 
 low down, as the last rib. That part of the plem-a 
 which covers the lung, is the Pleura Pulinonalis, and 
 that Vi^hich lines the ribs, the Pleura Costalis. 
 
 As the pleurae are bags, one on each side of the 
 thorax, it is very demonstrable that the contiguous faces 
 of them form a septum, which extends from the stei'* 
 niim in front to the spine behind, and from the upper 
 part of the thorax to the diaphragm. This septum is 
 the Mediastinum ; and the heart is placed in its middle. 
 The portion of the septum between the heart and ster- 
 num is the Anterior Mediastinum ; between the heart 
 and spine is the Posterior Mediastinum ; and between 
 the heart and the upper part of the thorax, is the 
 Superior Mediastinum ; each of which merits strict at- 
 tention. 
 
 It is obvious then, that the septum consists of two 
 laminae, one from each pleura. These two laminae 
 are somewhat separated, . where they are called Ante- 
 rior Mediastinum, by tlie remains of the thymus gland 
 above, and by adipose and cellular membrane below. 
 The anterior mediastinum is attached to the middle of 
 the sternum, except at its lower part, where it inclines 
 somewhat to the left, side. . To get a good view of its 
 contents, the stfernum must be s^ved through longitu- 
 dinally, and the two halves separated an inch by a 
 small block of wood. The contents of the posterior me- 
 diastinum and of the superior, are best seen and under- 
 stood at a subsequent stage of the dissection. 
 
 The Pleura is a thin and transparent membrane coji 
 
VISCERA OF THE THORAX, 
 
 169 
 
 nected to the parts on which it lies by a short cellular 
 substance. No red vessels, in its healthy state, are to 
 be observed. In the young subject, it is free from 
 adeps; but in advanced life, attended with corpulency, 
 considerable masses of fat are found in the anterior me- 
 diastinum, and between it and the pericardium. The 
 exhalent vessels of the pleura are derived from the in- 
 tercostal, internal mammary, phrenic, and some other 
 arteries, and secrete a fluid which lubricates its surface. 
 
 The Pericardium. 
 
 Between the pleurae, and under the sternum, is the 
 Pericardium, containing the heart. It is a white, semi- 
 transparent membrane, of a condensed fibrous structure, 
 possessed of little or no elasticity, which renders it 
 highly appropriate for sustaining the action of the 
 heart in its dilatation. 
 
 It is a complete sac, consisting of two laminae; and 
 is reflected over the surface of the heart, so as to give 
 it an investing membrane. This investment commen- 
 ces at the back part or base of the heart, and is conti- 
 nued over the whole of it, being extended on the aorta 
 to the branches which arise from the top of its curva- 
 ture; on the pulmonary artery to its bifurcation; on the 
 pulmonary veins to their first branches; on the ascend- 
 ing cava to the diaphragm; and on the descending cava 
 to the middle of the space between the entrance of the 
 Vena Azygos and the Transverse Vein. The exterior 
 
 Y 
 
170 
 
 OF THE TRUNK. 
 
 lamina has not these reflections, it is only united to the 
 several parts where the reflections commence. 
 
 An analogy is observable in this arrangement with 
 the membranes of the joints; the exterior lamina of the 
 pericardium corresponds with the capsular ligament, 
 and the internal lamina with the synovial membrane. 
 It is the exterior membrane which supports the heart, 
 and the interior which furnishes the lubricating fluid, 
 found in general in the pericardium, to the amount of a 
 drachm. The anterior part of the pericardium lies 
 loosely on the heart. The pericardium is attached 
 strongly, by all its inferior surface, to the tendon of 
 the diaphragm. 
 
 The Heart. 
 
 The Heart is a hollow muscle consisting of four cavi 
 ties, two auricles, and two ventricles. Its shape is some- 
 what conical, but flattened on the under surface. The 
 base of the cone is formed by the auricles, the body by 
 the ventricles, and the apex by the point of the left 
 ventricle projecting beyond that of the other. The 
 heart being fixed as mentioned between the sternum 
 and the dorsal vertebrae, has its base turned obliquely 
 towards the right side, while its apex is about the junc- 
 tion of the fifth rib with its cartilage, on the left. Its 
 flat part reposes on the flat tendon in the centre of the 
 diaphragm, also is on a horizontal line, or nearly so, 
 with the inferior end of the second bone of the sternum, 
 
VISCERA OF THE THORAX. 
 
 171 
 
 'fhe heart, in consequence of being tied down to the 
 diaphragm by the pericardium, is, excepting its pulsa- 
 tions, exposed to but little motion, and is therefore 
 almost uniformly in the same position. It has, between 
 the internal membrane of the pericardium and its own 
 substance, more particularly along the course of the co- 
 ronary vessels, adipose matter in great abundance in 
 old subjects, and this adipose matter sometimes pene- 
 trates so deeply between the fasciculi of its fibres as to 
 give them a very loose texture, and apparently to dis- 
 qualify them in some measure from performing their 
 functions. 
 
 The parietes of the heart are formed principally of 
 muscular fibres, which are variously arranged ; some 
 pass spirally around it, others in an irregular and 
 indeterminate manner, but all in such a direction 
 as to concur, by contracting, in effacing its cavities. 
 The cavities are lined by a smooth elastic membrane 
 which is a continuation of, and resembles the internal 
 coat of the arteries and veins. Between the auricles 
 and ventricles, and at the orifices of the great arteries, 
 this membrane is raised up and reflected so as to con- 
 stitute valves. 
 
 The heart is divided into Right and Left sides, each 
 consisting of an auricle and of a ventricle. The Right 
 Auricle receives the two great trunks of the Venous 
 System, to wit, the ascending and the descending Vena 
 Cava. The Left Auricle receives the pulmonary veins. 
 
172 
 
 OF THE TRUNK. 
 
 The Right Ventricle sends off the Pulmonary Artery, 
 and the Left Ventricle the Aorta. 
 
 The Right Auricle, situated at the right posterior- 
 part of the heart, is an oblong cavity about a line in 
 thickness. To view its internal arrangement it should 
 be slit open in front from cava to cava, we shall then see 
 that its posterior surface is smooth and is formed by a 
 continuation of the structure of the great veins which 
 meet each other at an obtuse angle, and form a projec- 
 tion into the auricles. This last circumstance, connect- 
 ed with a slight thickening of the part, has given oc- 
 casion to the name Tuberculum Loweri. Anteriorly 
 the auricle is swelled into a pouch, (Sinus Venosus) 
 in which the muscular fibres, instead of being uni- 
 formly spread into a coat, are collected into fasciculi 
 lying parallel to and near each other ; they are called 
 Musculi Pectinati. At the upper part of the pouch or 
 sinus is the proper auricular portion of the caAnty, 
 whence it got its name ; it is not marked by any pecu- 
 liarity except that the musculi pectinati prevail in it. 
 Theaui’icles have a common septum, and on it, just below 
 the tuberculum loweri, is situated the F ossa Ovalis, which 
 in the foetal state was an opening between the auricles, 
 and indeed at the upper part of this depression we 
 often find a foramen large enough to admit a probe 
 into the left auricle, even in subjects advanced into 
 old age. The edges of the fossa ovalis, are elevated 
 
VISCERA OF THE THORAX. 
 
 173 
 
 and thickened, being the Columnse or Annulus Fossse 
 Ovalis. 
 
 Beneath the fossa ovalis is the Eustachian valve. It 
 is formed by a duplicature of the lining membrane of 
 the auricle and of the ascending cava, being spread 
 somewhat obliquely across the orifice of the latter. It 
 is of a crescentic shape, about half an inch wide, but 
 occasionally reticulated, and commences at the left 
 pillar of the annulus ovalis; it terminates anteriorly 
 about the junction of the auricle and the vein. It is 
 connected by its convex edge to the parietes of the au- 
 ricle, and its concave or floating edge looks somewhat 
 upwards. Just before and below the Eustachian valve 
 is another much smaller, but also semilunated, which 
 covers the orifice of the coronary vein. 
 
 At the left side of the right auricle is an opening of 
 more than an inch in diameter, the Ostium Venosum, 
 through which it communicates with the right ven- 
 tricle. 
 
 In the right auricle are many small orifices of coro- 
 nary veins called Foramina Thebesii; they also exist 
 in all the other cavities, but are not so numerous 
 there. They are said to be particularly conspicuous in 
 cases of diseased lungs. 
 
 The next ca^uty to be examined is the Right Ventri- 
 cle ; to expose it satisfactorily it should be divided ex- 
 tensively along the septum ventriculorum superiorly 
 and inferiorly. It is of a triangular form, and its sides 
 
174 
 
 OF THE TRUNK. 
 
 are much thicker than the sides of the auricle, as they 
 measure, most commonly, about three lines. Its inter- 
 nal surface is very irregular and rough, the muscular 
 structure of it being thrown into projecting columns of 
 very indeterminate figures, arrangement and dimen- 
 sions. Some of them jut out, and are connected to the 
 valves at the ostium venosum by intermediate tendons ; 
 others pass from one side of the ventricle to the other 
 and a third series presents a reticulated appearance, 
 lying on the face of the ventricle and connected with it. 
 Their general object is to strengthen the ventricle, to 
 enable it to expel its contents and to agitate well and 
 mix the blood. 
 
 The Ostium Venosum has a tendinous margin, fi’om 
 which is reflected the lining membrane of the ventri- 
 cle, so as to form a broad fold surrounding it. This fold 
 being eight or ten lines wide, is irregularly divided at 
 its floating edge, into three parts, whence the name of 
 Tricuspid Valve has been given to it. The tricuspid 
 valve, is situated in the ventricle^ has its loose margin 
 attached to the round tendinous chords just mentioned, 
 called the Chordae Tendineae, which again arise from 
 the Columnae Carneae. These tendinous attachments of 
 the tricuspid valves prevent them from being thrown 
 into the auricle when the ventricle contracts. 
 
 At the upper part of the ventricle is the orifice of 
 the pulmonary artery, which conveys the blood to the 
 lungs ; provision for it is made by the upper part of 
 
VISCERA OF THE THORAX. 
 
 175 
 
 the ventricle becoming smooth. The orifice of the 
 artery is round, and about twelve lines in diameter. 
 From the internal surface of the artery, a little beyond 
 its orifice, three valves arise called Semilunar, which 
 may be compared, each to a semicircular plane, con- 
 nected by its circumference, to a cylindrical cavity. 
 The diameter of the plane is loose ; in the centre of it, 
 is a small cartilaginous body, the Corpusculum Aurantii; 
 and on each side of the corpusculum, the diameter of 
 the valve, instead of being a straight line, is slightly fes- 
 tooned. The valve is almost diaphanous, and seems to 
 be produced by a reflection of the lining membrane of 
 the artery. Between the coats of this reflection is how- 
 ever, to be found another substance very much like that 
 of the artery, which also forms a festooned edge a little 
 below the one just described. As the three valves are 
 placed in a row surrounding the artery, in its action 
 they are thrown down, forming thereby a complete 
 septum against the return of the blood into the ven- 
 tricle ; and the Corpuscula Aurantii being in the mid- 
 dle of each form a point d’appui or abutment at which 
 the edges of the valves support each other. Between 
 the outer face of the valve and the internal face of the 
 artery, a pocket attended with a dilatation of the artery 
 is formed, called the Sinus of Valsalva. 
 
 The Pulmonary Artery is a large white fibrous 
 tube given off* in the manner mentioned ; under the 
 arch of the aorta, it divides into two branches of nearlv 
 
176 
 
 OF THE TRUNK. 
 
 equal magnitude, right and left, which go to the lungs 
 of their respective sides. The right branch passes un- 
 der the arch, and is then minutely distributed to the 
 lung. The left is in front of the descending aorta, 
 and is distributed to the left lung with equal minute- 
 ness. 
 
 The blood is brought from the lungs by the pulmo- 
 nary veins, which are four in number, two on each 
 side. The branches constituting the trunk of each of 
 these veins, are generally united before the trunk pene- 
 trates the pericardium. This trunk afterwards unites 
 to the auricle at one of its corners. 
 
 The Left Auricle has about the same cubic capacity 
 with the right, but differs from it somewhat in its 
 figure, by being more square. Its broad internal sur- 
 face looks towards the spine. It is fixed to the pos- 
 terior part of tlie left ventricle, and is divided like the 
 right auricle, into the Sinus Venosus, sometimes called 
 Sinus Pulmonalis, and into Proper Auricle. The lat- 
 ter is situated at the left side of the pulmonary artery, 
 and is somewhat longer, narrower, more crooked, and 
 more notched at its margins than the other proper 
 auricle. When the left auricle is cut open, whicli 
 should be done by a slit down its middle, it will be per- 
 ceived that its parietes are thicker than those of the 
 right, and that both externally and internally, its sur- 
 faces are perfectly smooth, except in the proper auri- 
 cular part, where the Musculi Pectiiiati prevail. 
 
TISCERA OF THE THORAX 
 
 17 ? 
 
 The Septum between the auricles, viewed on this 
 side, is smooth, not presenting any remarkable appear- 
 ance ; when held up to the light, it is seen to be thinner 
 and more transparent at the place corresponding with 
 the fossa ovalis of the other side. At the anterior and 
 inferior side of the auricle is the ostium venosum, com- 
 municating with the left ventricle ; it has a tendinous 
 margin, and is rather more than an inch in diameter. 
 
 The Left Ventricle differs from the right in shape, by 
 being more conical, but it is equally capacious. , Its an- 
 terior part constitutes the apex of the heart, and strikes 
 against the ribs. The best mode of examining its 
 cavity is to make an incision through its parietes near 
 the septum, and to separate it completely on that side 
 from its fellow. Another incision should be made so as 
 to detach it from the auricle, also, near their septum. 
 The latter cut is to be executed with particular care, so 
 as to avoid wounding the interior structure. That 
 done, we see its general arrangement within, corres- 
 ponding with the right ventricle. Its parietes are 
 eight lines through, being about three times as thick as 
 the other. Its columnse carnese are larger and stronger, 
 but arranged on the same principle, some passing from 
 side to side of the cavity, others being reticulated and 
 easily raised up from the part of the ventricle on 
 which they lie, and a third set aiding the valvular ap- 
 paratus at the ostium venosum. 
 
 The Mitral Valve exists at the left ostium venosum, 
 
 z 
 
178 
 
 OF THE TRUNK. 
 
 and is formed by a duplicature of the lining membrane 
 of the ventricle. It is partially divided into two parts, 
 which are pointed at their edges. Its columnas car- 
 nese are numerous and strong, and its chordse tendiueae 
 are of corresponding characters. The mitral valve 
 prevents the regurgitation of blood into the auricle, 
 and is so placed that the upper half of it, when the 
 blood is rushing into the ventricle, conceals the orifice 
 of the aorta. 
 
 Towards the orifice of the aorta, which is at the 
 posterior superior part of the ventricle, the surface of 
 this cavity is smooth to facilitate the passage of blood. 
 The septum between the ventricles is of the same 
 thickness with the left ventricle; it is formed partly by 
 the right ventricle, but principally by the left. 
 
 The Mouth of the Aorta is about an inch in diame- 
 ter, and is furnished with three Semilunar Valves, 
 Corpuscula Aurantii, and Sinuses of Valsalva, after the 
 same manner with the pulmonary artery, so that the 
 description of one will suit the other with the addition 
 that those parts of the aorta are stronger and more 
 developed. The coats of the aorta are nearly three 
 times as thick as those of the pulmonary artery, to 
 qualify it for bearing the increased pressure of the 
 blood. At the upper part of its curvature the aorta 
 is dilated, to form the large Sinus of Valsalva. The 
 aorta lies first at the back of the pulmonary artei’y, 
 it then gets to its right, being between it and the 
 
VISCERA OF THE THORAX. 
 
 179 
 
 superior vena cava; part of it is there to the right of 
 the spine, it then makes its arch which brings it to 
 the left of the spine and in contact with it about the 
 third dorsal vertebra. The superior part of its arch 
 is about eight lines below the upper edge of the ster- 
 num. 
 
 The heart being a mere machine for propelling 
 blood, requires another source for its nourishment be- 
 sides the fluid circulating through its great cavities; 
 this is furnished by the Coronary Arteries, which are 
 two in number. The first, called Right Coronary, be- 
 comes visible between the pulmonary artery and the 
 right auricle, and passing on the septum between the 
 right auricle and ventricle, extends around the heart to 
 its flat side, distributing to the contiguous parts 
 branches which, for the most part, pass oft* at right 
 angles. The second, or Left Coronary Artery appears 
 between the pulmonary artery and the left auricle; 
 before it has become very obvious, it divides into two 
 branches, one passes on the septum ventriculorura to 
 the apex of the heart; the other winds on the septum 
 between the left auricle and the left ventricle, and 
 some of its branches pass on the flat surface of the 
 heart to its apex. 
 
 The Coronary Veins receree the blood of the coro- 
 nary arteries; a common trunk is formed by them, 
 which passes for some distance on the septum, between 
 the left auricle and ventricle, and then opens into tl^e 
 
180 
 
 UF THE TRUNK. 
 
 right auricle just anterior to the Eustachian Valve, at 
 the spot already indicated. 
 
 Of the. Lungs. 
 
 The Lungs occupy, by far, the greater part of the 
 cavity of the thorax, and consist of two distinct bodies 
 placed one at either side of the heart, from which cir- 
 cumstance they are called right and left Lung. Their 
 external shape and dimensions, with an inconsiderable 
 exception, are the same, as they correspond in their 
 periphery with the symmetrical sides of the thorax. 
 The apex of the heart, from bein^ pushed into the lung 
 of the left side, gives its surface towards the mediasti- 
 num, a somewhat different figure from the lung of the 
 right side. 
 
 Each lung is divided by deep fissures into lobes ; the 
 right lung has three lobes, the left two. To appreciate 
 the extent and form of the lung, it must be recollected 
 that the cavity of the thorax is much deeper behind 
 than it is before. The vertical diameter before, 
 amounts only to the length of the two upper bones of 
 the sternum, whereas the same diameter behind, is the 
 whole length of the column formed by the doi’sal verte- 
 brse. The figure of each lung is also modified by the 
 convexity of the Diaphragm ; for this body, extending 
 from the lower point of the dorsal vertebrae obliquely 
 upwards to the end of the second bone of the sternum, 
 would, if it were only a plain surface, influence the con 
 
VISCERA OF THE THORAX. 
 
 181 
 
 tigiious faces of the lungs so as to make them resemble^ 
 when united, the inferior part of an ox’s hoof; but this 
 1‘esemblance is much increased by the diaphragm form- 
 ing a convexity towards the thorax, which rises much 
 above what its plane wmiild. The similitude of the 
 lungs to the ox’s hoof, with the back part foremost, is 
 therefore sufficiently exact for anatomical comparison, 
 and particularly as it regards their inferior surface. 
 
 The lung lies loose every where, except at the sur- 
 face corresponding to the side of the basis of the heart; 
 here it is attached to the heart by the pulmonary veins, 
 pulmonary artery, and by a branch of the trachea. 
 These tubes constitute the Root of the Lung, and over 
 the root is reflected the pleura from the pericardium. 
 The pleura which covers the root of the lung is ex- 
 tended downwards, under the name of Ligamentum 
 Pulmonis, and serves to fix the posterior edge of the 
 lung to the pericardium, as low down as the diaphragm. 
 
 The structure of the lung is of extreme delicacy. 
 It consists of small cells which are the ultimate ter- 
 minations of the bronchium. The Bronchium may be 
 compared to the stalk of a bunch of grapes, and the 
 cells of the lungs to the fruit; each grape, which is 
 the cell, adhering to its pedicle or stem, which is a 
 ramification of the Bronchium. On these cells the 
 pulmonary artery and vein ramify very minutely, for 
 the purpose of airing the blood. These cells are in 
 contact one with the other, and are kept together by 
 
182 
 
 OF THE TRUNK. 
 
 common cellular membrane, such as forms the medium 
 of connexion for other parts of the body. The lung 
 of the bullock exhibits this structure better than that of' 
 the human lung, and in it we also see, by a little tear- 
 ing of the parts asunder, the manner in which each 
 lobe is divided into Lobuli or smaller lobes, which again 
 are constituted by the cells of the lung. These lobuli 
 are well seen in the foetus, and in very young subjects. 
 
 The Trachea, the bifurcation of which forms the 
 Bronchia is a tube almost cylindrical, which passes in 
 front of the oesophagus and of the vertebrae, from the in- 
 ferior part of the larynx to the third dorsal vertebra ; it 
 there divides into the Bronchia, and is placed between 
 pleurae of the two sides of the thorax. The right 
 Bronchium is shorter, larger, and less slanting than 
 the left; it sinks below the pulmonary artery, and 
 penetrates the lung opposite to the fourth doi*sal ver- 
 tebra ; the left being long and nari’ow, enters the lung 
 below the pulmonary artery, opposite to the fifth dor- 
 sal vertebra. The Bronchia then divide and sub- 
 divide through the structure of the lung, till the 
 ultimate extremities of the tube terminate in the aii' 
 cells. 
 
 The trachea preserves its cylindrical shape, and 
 is kept open by a cartilaginous structure, which is com- 
 posed of from sixteen to twenty pieces, more or less 
 distinct from each other: some are separated entirely: 
 some are united to the contiguous ones by their middle. 
 
VISCERxi OF THE THORAX. 
 
 183 
 
 and others by their extremities. Thus arranged, the 
 cartilages form about two thirds of the circumference 
 of a circle, occupying the front of the trachea, and giv- 
 ing it the appearance, anteriorly, of a cartilaginous 
 tube. The remaining third is membranous. The car- 
 tilages of the trachea are deposited in a kind of peri- 
 chondrium, possessed of extreme elasticity, which has 
 continually a tendency to approximate the cartilages, and 
 is resisted only by the attachments of the two extremi- 
 ties of the trachea. The effect of this elasticity is de- 
 monstrated in the living body by attempts at suicide, 
 where the trachea being cut through, so great a gap is 
 made in the throat that it presents the appearance of a 
 part having been removed. The deficiency at the back 
 part of the cartilages, is not filled up by a continuation 
 of this elastic membrane. Transverse muscular fibres 
 are placed, between the extremities of the cartilages, 
 and by their contractions bring them towards each 
 other; according to the opinion of Dr. Physick, by 
 diminishing the size of the trachea they - assist in the 
 expulsion of mucus. The trachea is lined by a continu- 
 ation of the membrane which covers the mouth ; it is 
 perforated with a great number of holes through which 
 the mucus passes. Under the membrane are many 
 glands, from the size of a millet-seed to that of the 
 head of a small pin ; these glands have their excretory 
 tubes terminating in the orifices just mentioned. These 
 glands are also abundant on the posterior face of the 
 transverse muscular fibres. 
 
184 
 
 01' THE TRUNK. 
 
 At the lower end of the trachea, and about the 
 root of the lungs, is found the commencement of a chain 
 of glands which follows, for some distance, the bronchia. 
 In the adult they are black, numerous, and vary from 
 the dimension of a large pin’s head to that of a kidney 
 bean. No excretory ducts are found belonging to them 
 and anatomists generally consider them as lymphatic. 
 The bronchia, in dividing, still preserve, for some 
 length, the cartilaginous structure of the trachea, but 
 as they , approach their terminations the deficiency at 
 their back part ceases and the cartilages form sections of 
 circles which produce, by the apposition of several of 
 them, complete cylinders. This arrangement holds till 
 finally the cartilaginous structure ceases, and only mem- 
 brane is left. It is probable, from the elasticity of the 
 lung and from its collapsing when the thorax is opened. 
 that the elastic membrane, in whieh the cartilages are 
 deposited, forms the essential cellular structure of this 
 organ on which the blood-vessels are ramified. 
 
 The lungs are furnished from the aorta with nutri- 
 tious vessels called Bronchial Arteries ; they follow the 
 course of the bronchia and communicate freely with the 
 pulmonary arteries; notwithstanding the latter they 
 have their proper veins, which empty on the right side 
 into the vena azygos, and on the left into tlie subclavian 
 vein. The bronchial veins also communicate freely with 
 the pulmonary veins. 
 
 While studying the contents of the thorax it is of 
 the first importance to attend to the relative situation of 
 
VISCERA OF THE THORAX. 
 
 185 
 
 the parts included in the description. One of the most 
 useful and interesting points is the space between the 
 two upper ribs, bounded laterally by the pleurae, 
 anteriorly by the sternum, posteriorly by the upper 
 dorsal vertebrae, and having the top of the pericar- 
 dium for its basis. This cavity is too irregular to admit 
 of comparison with any thing else without a hazard of 
 communicating false ideas of its shape. The course of 
 the pleura, on each side, must be well attended to, and 
 in order to understand it, the obliquity of the first rib 
 must be taken into consideration. Considering the 
 spine as a vertical column, the first rib, so far from be- 
 ing horizontal, is, in a majority of subjects, inclined 
 downwards so much, that it makes an angle of about 
 forty-five degrees with the spine; and the pleura, be- 
 ing reflected from the internal edge of the first rib 
 from its head to its front part, will, of course, observe 
 a similar obliquity. It is probably this circumstance 
 which Sabatier, Soemmering, and Colies allude to when 
 they speak of the pleura rising above the level of the 
 first rib. This arrangement should influence the con- 
 siderations arising from a wound in the lower part of 
 the neck^ as a ball or sword passing through horizontally 
 just above the sternal end of the clavicle, would cer- 
 tainly enter the cavity of the pleura in a great number 
 of persons. 
 
 In this upper section of the mediastinum, just at the 
 upper edge of the sternum, are the remains of the 
 Thymus Gland, much shrivelled, having a ligament- 
 
186 
 
 OF THE TRUNK. 
 
 ous feel, and of a light pink colour. In contact with the 
 pleura on the right is the Descending Vena Cava. The 
 common trunk of the left subclavian and internal jugu- 
 lar, (Vena Innominata) after crossing, by an oblique de- 
 scent, the upper portion of the sternum, joins the de- 
 scending cava about an inch above the place where the 
 latter penetrates into the pericardium. Behind this 
 transverse vein are the top of the arch of the Aorta, 
 the origin of the Arteria Innominata, the left Carotid, 
 and the left Subclavian Artery. The oesophagus makes a 
 vertical descent just before the dorsal vertebrae, the tra- 
 chea is placed before it, and we see the arteria innominata 
 erossingthe latter obliquely from left to right. The arte- 
 ria innominata is placed much more superficially than 
 the left subclavian, being removed from the upper end of 
 the sternum only the thickness of the transverse vein, 
 and is very accessible, as proved by Dr. Mott's opera- 
 tion whereas the other, being the last branch given off 
 from the curve of the aorta in its course backwards, is 
 an inch deeper, and inaccessible in the living body. The 
 arteria innominata varies much in length before its di- 
 vision into subclavian and carotid; I have examples 
 of it from half an inch to two inches, but the general 
 length is about sixteen lines. 
 
 In this dissection the phrenic nerve is seen to de- 
 scend in contact with the internal edge of the scalenus 
 anticus muscle, and passing between the subcla\Tan 
 
 * Eclectic Repertor3% Vol. 9, p. 1- 
 
VISCERA OF THE THORAX. 
 
 187 
 
 artery and vein to proceed vertically in contact with 
 the pleura at first? and afterwards between it and the 
 pericardium to the diaphragm. The par vagum is on 
 the inner or mesial side of the internal jugular vein, and 
 gets into the thorax 'between the subclavian artery and 
 vein, near the origin of the subclavian artery. The trunk 
 of it passes along the side of the trachea, and behind 
 the root of the lungs to the oesophagus and terminates 
 at the stomach. On a level with the subclavian artery, 
 the Recurrent or Inferior Laryngeal Nerve is sent olf, 
 which, to get to the larynx, winds around the sub- 
 clavian of the right, and the aorta of the left side. 
 About the root of the lungs, the Pulmonary Plexus is 
 detached from the Par Vagum nerve. The sympa- 
 thetic nerve lies closer to the vertebra, and sends off 
 from its two inferior cervical ganglions principally, 
 the branches which supply the heart, by the cardiac 
 plexus. In the thorax it continues its course by the 
 heads of the ribs, and sending off the greater and less- 
 er Splanchnic nerves, is distributed in a manner to be 
 described hereafter. 
 
 ' In making this dissection it must be observed that, 
 from the lower part of the thyroid gland, the conden- 
 sed membrane called Fascia Profunda Cervicalis, which 
 seems to afford protection to the upper opening in the 
 thorax, and is extended to the upper edge of the 
 sternum, has beneath it, connecting the vessels and 
 other parts together, a loose, vascular, adipose, and 
 cellular matter, which must be removed by dissection, 
 
188 
 
 OF THE TRUNK. 
 
 before the rest of the structure can be rendered dis- 
 tinct. The plan for opening the thorax, by the ster- 
 num being sawed in two longitudinally and kept open 
 to the distance of an inch or so, is by far the most exact 
 and satisfactory manner of studying these parts. 
 
 This stage of the dissection having been accomplish- 
 ed, the sternum must be removed, and by turning 
 up the lungs, we see the parts contained in the poste- 
 rior mediastinum and what is meant by it. To the 
 left is the aorta, which gradually gets to the front 
 of the dorsal vertebrae in the lower part of the thorax, 
 as it penetrates the erura of the diaphragm. The 
 (Esophagus is in the middle above, but in getting 
 to its own opening in the diaphragm it crosses the aorta 
 very obliquely and is then to the left of the lower dor- 
 sal vertebrae. The Vena Azygos, made up of the 
 six lower intercostal veins on the left side and the ten 
 lower of the right, occupies the right side of the me- 
 diastinum and forms an arch at its termination where 
 it joins the descending cava, over the root of the 
 - right lung. The Thoracic duct enters the thorax be- 
 tween the crura of the diaphragm, and passes nearly 
 in the middle line between the aorta and the vena 
 azygos, till it reaches the third dorsal vertebra; it 
 then inclines to the left side, and rising into the root 
 of the neck, forms an arch which terminates in the angle 
 produced by the junction of the left internal jugular 
 and subclavian vein. The Par Vagum is strictly within 
 the limits of the posterior mediastinum, the Sympathe 
 tic is not. 
 
PART II. 
 
 CHAPTER II. 
 
 Of the Mdomen. 
 
 Before the commencement of the dissection of the 
 Abdomen, it is useful to acquire a knowledge of its re- 
 gions, the boundaries of which are thus established by 
 imaginary planes passing through the subject. Draw 
 a line from the superior part of one Ilium as it appears 
 through the skin, to the superior part of the other; 
 strike a perpendicular then from the anterior inferior 
 spinous process of the Ilium on each side through the car- 
 tilages of the ribs above; then draw a fourth line parallel 
 with the first through the points where the latter touch 
 the cartilages of the ribs. These four lines, two verti- 
 cal and two horizontal, which represent as many planes, 
 form with the periphery of the abdomen nine regions. 
 The one, above, on the right, is the right Hypochond- 
 riac, that in the middle the Epigastric, and that to the 
 left, the left Hypochondriac. The region which has 
 the navel in its centre is the Umbilical, and on its sides 
 are the right and the left Lumbar Regions. Below 
 the umbilical is the Hypogastric Region, and on the 
 wings of the latter are the right and the left Iliac 
 Regions. 
 
190 
 
 OF THE TRUNK. 
 
 So^ie anatomists call the pit around the ensiforni 
 cartilage the Scrobiculus Cordis, and a small space just 
 behind, and elevating itself about an inch above the 
 pubis, the Regio Pubis. The boundaries of the latter 
 are rather undefined, but the terms are in use. 
 
 Section I. 
 
 Of the Muscles of the Abdomen. 
 
 To begin the dissection of the muscles of the abdo- 
 men, a straight cut must be made through the skin 
 - from the end of the second bone of the sternum to the 
 symphysis pubis; another is to cross this at its com- 
 mencement above, extending obliquely towards the arm- 
 pit, till it reaches the side of the chest. The second 
 terminates and a third commences there, having a 
 sweep backwards, parallel in its direction with the 
 margin of the cartilages of the ribs and equidistant from 
 it. The third cut by being extended to the spine 
 affords an opportunity of opening the integuments still 
 further by a vertical cut over the spinous processes 
 down to the small end of the sacrum. This manner of 
 opening the integuments of the side of the belly, de- 
 scribes in a great measure the outline of the external 
 
MUSCLES OF THE ABDOMEN. 
 
 191 
 
 oblique muscle, makes it thoroughly accessible in the 
 progress of the dissection, and enables one to see and to 
 display every part of it. One of the greatest obstacles ' 
 (simple as the circumstance may appear,) to understand- 
 ing the broad muscles of the abdomen well, is the im- 
 perfect manner in which the integuments are opened 
 by dissectors, and there is no dissection more often 
 spoiled, than the one in which we are now engaged, 
 owing to the want of a plan (founded on some previous 
 knowledge of the parts,) for commencing operations. 
 Having thus marked olf the section of the subject on 
 which to work, begin by dissecting at the upper part, 
 to turn the flap downwards. But few strokes of the 
 knife will be made, before the upper fibres of the exter- 
 nal oblique muscle will be exposed. The flap is now 
 to be entirely dissected off as far down as the hip and 
 thigh, exposing, by such means, the superior margin of 
 the pelvis from the spine to the symphysis pubis. The 
 beginner must cut very slowly, seeing that he detaches 
 fully the cellular membrane from the muscular fibre, 
 by cutting in the same direction with the latter ; he will 
 by such means leave it clean and brilliant, and the tran- 
 sition from it to the broad tendon connected with it, will 
 be comparatively easy. 
 
 In this dissection, as indeed in all others of the mus- 
 cles I cannot attach too much importance to cutting 
 in the course of the fibres ; it is absolutely essential to 
 the beauty of the display, and indispensable to a per- 
 son desirous of success in practical anatomy. A dissec- 
 
192 
 
 OF THE TRUNK. 
 
 tion done in any other manner is unfit for study from 
 its obscurity, and offensive to inspect from its rough- 
 ness. The sum of directions to make a good dissector 
 of muscles, is to cut in the direction of the fibres, close 
 to them, and to keep the cellular membrane tense. 
 
 There are five pairs of muscles to the abdomen, three 
 broad and two narrow. 
 
 1. Musculus Obliquus Externus, arises from the 
 eight inferior ribs by muscular and tendinous digitations 
 attached near their anterior extremities. The fii’st 
 head is covered by a slip from the pectoralis major, the 
 five upper heads are interlocked with the serratus 
 major anticus, and the three inferior with the latissimus 
 dorsi. The fibres pass obliquely downwards, and ter- 
 minate in a broad thin tendon. This tendon extends 
 over the whole front of the abdomen from the lower 
 end of the second bone of the sternum to the symphy- 
 sis of the pubis. 
 
 It is inserted into the whole length of the linea alba, 
 and into the anterior half or two -thirds of crista of the 
 Ilium, by muscular fibres posteriorly, and tendinous 
 anteriorly. And from the anterior superior spinous 
 process, the tendon extends to the body of the pubes, 
 forming thereby the ligament of Poupart. 
 
 In the middle line of the body, the tendons of the 
 three broad muscles on each side of the abdomen unite 
 to form the Linea Alba, which extends from the ster 
 
MUSCLES OF THE ABDOMEN. 
 
 193 
 
 iium to the pubes. From two to three inches in the 
 adult on each side of the linea alba, but more distant from 
 it above than bdow, is another line formed by the same 
 tendons, which is the Linea Semilunaris. The navel, 
 which originally was a hole for the passage of the um- 
 bilical vessels, and in the adult, is commonly de- 
 pressed into a pit, now appears in the linea alba as a 
 protuberance composed of condensed cellular mem- 
 brane. Just at the navel there appears a line crossing 
 the linea alba, and extending from one linea semiluna- 
 ris to the other. At the lower end of the Cartilage 
 Ensiformis, there is another, and half-way betvyeen this 
 and the navel, a third. About half-way between the 
 navel and the pubes is a fourth, but it is generally 
 imperfect. These are the Linesa Transversse, and 
 they are formed by tendinous matter in the substance 
 of the recti muscles, connecting them to their tendin- 
 ous sheath in front. 
 
 The most interesting insertion of the tendon of the 
 external oblique is, the part constituting PouparCs 
 Ligament. The latter, as it approaches the pubes 
 from the Ilium, splits so as to leave a hole for the pas- 
 sage of the Spermatic Chord in the male, and of the 
 Round Ligament of the Uterus in the female. This 
 opening obtains the name of Abdominal Ring. Thq 
 tendon forming its upper boundary, is inserted into the 
 symphysis pubis, and into the pubes of the opposite 
 side, by fibres which are interwoven with and decus- 
 sate those of its fellow. The tendon forming the lower 
 
 B b 
 
194 
 
 OF THE TRUNK. 
 
 margin of the ring, is inserted into the spine of the 
 pubes, and into its crest for an inch. The portion 
 inserted into the crest of the pubes, is Gimbernat's 
 ligament, which, it will be readily undei'stood, means 
 only a part of Poupart’s. 
 
 The ring in the External Oblique is rather triangu- 
 lar than round; its base is formed by the body of the 
 pubes, and its point is at the place where the tendon 
 separates. The latter is kept from parting still further, 
 by a fasciculus of tendinous fibres which runs across it. 
 The sides of this opening are called its Columns, and 
 from their situation, internal and external, or upper 
 and lower Columns. 
 
 There are several small round holes in the tendon of 
 this muscle, which afford passage to nerves and to veins. 
 When, by the cleanness of the dissection, the tendon 
 •has its characteristic gloss and polish, they are very 
 distinct. 
 
 Use. This muscle compresses the viscera of the ab- 
 domen, and brings the pelvis and thorax towards each 
 other. 
 
 The External Oblique is now to be turned over to 
 the other side, by dissecting up its origin from the ribs, 
 and its insertion into the crista of the Ilium. This pro- 
 cess will enable the student to gain a more satisfactory 
 view of its insertion into the spine and crista of the 
 pubes. 
 
 2. The Obliquus Internus lies beneath the last. 
 
MUSCLES OF THE ABDOMEN. 
 
 195 
 
 and its fibres pass in a contrary direction to the fibres 
 of the other. It arises tendinous^ by the fascia lumbo- 
 rnm, from the three inferior spinous processes of the 
 loins and from all those of the sacrum, tendinous and 
 fleshy, from the whole length of the crista of the Ilium, 
 and fleshy from the upper half of Poupart’s ligament. 
 Though the fibres of this muscle, in general, decussate 
 the fibres of the external oblique, all of them do not,, 
 for the lower are brought gradually to pursue the same 
 direction towards the symphysis of the pubes. 
 
 Near the Linea Semilunaris, the muscular fibres 
 cease, and the tendon begins. 
 
 It is inserted into the cartilaginous margin, formed by 
 the six inferior ribs ; by tendon resembling condens- 
 ed cellular membrane, into the cartilages of the seventh, 
 eighth, and ninth ribs, and by flesh into the tenth, 
 eleventh, and twelfth. It is inserted also into the side 
 of the ensiform cartilage, its whole length, and into the 
 linea alba, from the sternum to the pubes. 
 
 The tendon of this muscle divides into two laminae, 
 in a manner which will be better explained presently, 
 after the rectus and pyramidalis muscles have been dis- 
 sected and turned down. 
 
 Its use is the same as that of the External Oblique. 
 
 The Internal Oblique is now to be dissected up from 
 its attachments to the ribs, vertebrae, ilium, and exter- 
 nal half of Poupart’s ligament; by beginning near the 
 spine of the ilium, where it is separated more distinctly 
 
196 OF THE TRUNK.' 
 
 from the muscle below, by an artery, a vein, and cel- 
 lular substance. 
 
 3. The Transversalis Abdominis, arises by the 
 Fascia Lumborum, from the transverse processes of the 
 last dorsal, of the four upper lumbar vertebrie, and 
 from the back part of the spine of the ilium. It also 
 .arises fleshy from the anterior two-thirds of the spine 
 of the ilium, and from the exterior half of Poupart’s 
 ligament; tendinous and fleshy alternately, from the in- 
 ferior margin of the thorax formed by the cartilages 
 of the six or seven inferior ribs, at their inner sur- 
 faces, where they are concerned in the origin of the 
 diaphragm. 
 
 The fleshy part of this muscle occupies about one- 
 thiini of its extent. It is inserted, into the side of the 
 ensiform cartilage, filling up the vacancy between it 
 and the cartilages of the sixth and seventh ribs, and into 
 the linea alba, from the extremity of the sternum to 
 the pubes. 
 
 Use, to compress the contents of the abdomen. 
 
 4. The Rectus Abdominis muscle is seen beneatli 
 the tendons of the other muscles on each side of the 
 linea alba. A longitudinal cut, its whole length, is to 
 be made on its imier edge through tliese tendons, and 
 they turned over towards the linea semilunaris. Its 
 origin will then be seen as a flat tendon of an inch oi 
 more in breadth from the symphysis pubis and the 
 
MUSCLES OF THE ABDOMEN. 
 
 197 
 
 upper posterior part of the body of the pubes. The 
 muscle increases gradually to the breadth of three 
 or four inches in its ascent. The tendinous intersec- 
 tions, confining it to the tendinous sheath in front, are 
 established at the places mentioned as lineee transversae, 
 but, for the most part, they do not extend through the 
 muscle. 
 
 Inserted fleshy, into the cartilagoj ensiformis and 
 into the cartilages of the fifth, sixth and seventh 
 ribs. 
 
 It draws the thorax towards the abdomen. 
 
 5. The Pyramidalis is at the lower front part of 
 the rectus. It arises somewhat thick, tendinous, and 
 fleshy from the upper part of the pubes, from near its 
 spine to the symphysis, between the rectus behind and 
 the insertion of the external oblique before. It is fix- 
 ed in a sheath formed by the separation of the tendons 
 of the broad muscles. It tapers to a point above, 
 and is 
 
 Inserted into the linea alba and internal edge of 
 the rectus, half-way between the umbilicus and the 
 pubis. 
 
 It strengthens the lower part of the abdomen.* 
 
 The Rectus and the Pyramidalis muscles are now to 
 be detached from their origins and turned aside. By 
 doing so we become sensible of an arrangement of the 
 
 * Tills muscle is often wanting. 
 
4 
 
 198 OF THE TRUNK. 
 
 tendons of the broad muscles always difficult to describe 
 intelligibly, and generally imperfectly understood. It 
 is this: at the linea semilunaris the tendon of the in- 
 ternal oblique and transversalis unite intimately, and 
 just beyond this junction two laminse are formed, which 
 enclose the rectus muscle. The anterior lamina is one- 
 half of the tendon of the internal oblique, which, after 
 passing half an inch or an inch, is joined to the ten- 
 don of the external oblique, goes in front of the rec- 
 tus muscle? and covers it from origin to insertion. The 
 posterior lamina, made' by the posterior half of the ten- 
 don of the internal oblique, is united already at the 
 linea semilunaris to the tendon of transverealis ; in this 
 manner they pass behind the rectus muscle from the 
 cartilago ensiformis to a line half-way between the um- 
 bilicus and the pubes. From this line downwards, all 
 the tendons go in front of the rectus muscle. The ob- 
 liquus externus tendon may, however, be dissected 
 from the common tendon of the others, without much 
 difficulty, almost to the linea alba. 
 
 The term insertion is very inadequate to express the 
 manner in which the tendons of these broad muscles all 
 terminate in the linea alba from the thorax to the pel- 
 vis, but the inspection of the part will qualify the term 
 so as to prevent mistakes. 
 
 The Cremaster muscle is commonly attributed ex 
 clusivelyto the internal oblique, as it is said to beade 
 
MUSCLES OF THE ABDOMEN, 
 
 199 
 
 tachmeiit of fibres from it. The dissection is now in a 
 stage to exhibit what is really the fact in regard to this 
 muscle^ — that it is also formed by fibres from the lower 
 edge of the transversalis muscle. The history of its 
 formation is as follows : in the descent of the testicle, 
 the testicle has to pass beneath that edge of the trans- 
 versalis and of the internal oblique which is extended 
 from the upper part of Poupart’s ligament to the spine 
 of the pubes. As it descends it comes in contact with 
 a fasciculus of these fibres and takes it along. This con- 
 stitutes the Cremaster muscle, which, in adult life and 
 in a strong muscular subject, is seen descending on the 
 outside of the spermatic chord, and spreading over 
 the anterior part of the tunica vaginalis in arches with 
 their convexities downwards, then rising on the in- 
 ner side of the chord and inserted into the spine of the 
 pubes.* 
 
 It draws up the testicle. 
 
 As one becomes acquainted with the dissection of 
 this part by operating on a number of subjects, he will 
 be sensible that there are differences in individuals 
 which render the established descriptions occasionally 
 unsuitable. One of the most usual is the deficiency of 
 
 * Mr. J. Cloquet of Paris, has given this explanation of the 
 formation of the cremaster and it sometimes is manifest in tlie 
 adult ; it is, howevei', not in accord with Mr. Hunter’s account 
 of it, neither does it correspond with what I have witnessed in 
 the male buffalo. Mr. Hunter has seen it running up to the tes- 
 tis, while the latter was still in the loins. 
 
200 
 
 OF THE TRUNK. 
 
 the transverse muscle in that part, the origin of which 
 is usually attributed to the upper half of Poupart's 
 ligament. In this case the internal oblique has in- 
 creased thickness, and, of course, the cremaster will 
 be exclusively derived from it. In other instances the 
 two muscles are so much blended that they cannot be 
 satisfactorily separated from each other. 
 
 The Transversalis,, and the Internal Oblique per- 
 form so important a part in the doctrines of Hernia, 
 that one desirous of understandig them wxll, should at 
 this time, pay attention again to the mode of their in- 
 sertion into the pubes. It will thus be seen that they form 
 below, a common tendon, w hich is inserted, for an inch, 
 into the crista of the pubes behind GimbernaPs liga- 
 ment, into its spine, and into that part of its body 
 which is behind the annulus abdominalis; and that just 
 within and above their insertion the same common ten- 
 don splits into two laminae, one going before, the other 
 behind the pyramidalis muscle, thus forming a sheath 
 for it. 
 
 In examining the origins of the Recti muscles from 
 behind, the peritoneum being stripped off, it will be 
 seen that a protusion of intestine between them is pre- 
 vented by the internal edge of the one tendon over- 
 lapping the internal edge of the other, and by a trian- 
 gular ligament called, by Mr. Breschet its discoverer, 
 the Superior Pubic Ligament. 
 
INGUINAL HERNIA. 
 
 201 
 
 Section II. 
 
 On the parts concerned in Inguinal Hernia, 
 
 It is better for the student to postpone the subject 
 of Hernia until he has become acquainted with the ab- 
 dominal muscles and the contents of the abdomen. 
 When he has paid due attention to what is remarked 
 concerning them, the rest of the investigation will be 
 comparatively easy. 
 
 Make an incision through the skin and fat, from the 
 Umbilicus to the dorsum of the Penis, and for three 
 or four inches along the inner margin of the thigh ; 
 commence another at right angles with the beginning 
 of this, and continue it from the umbilicus in a straight 
 line towards either flank ; make a third incision parallel 
 with the first, beginning an inch behind the anterior 
 superior spinous process of the ilium, and terminating 
 in the second incision. The flap of skin thus marked 
 out, must be turned down over the thigh by a care- 
 ful dissection, which will bring into view the fascia 
 superficialis abdominis. 
 
 The Fascia Superficialis consists of condensed 
 cellular membrane, which may be considered as taking 
 its origin on the front of the thigh, and extending in 
 
202 
 
 OF THE TRUNK. 
 
 front of the abdominal muscles, as higli up as the thorax ; 
 indeed, if we are disposed to trace it to its whole ex- 
 tent, there is no difficulty in following it over the front 
 of the thorax, also to the neck, and even to the face. 
 In ordinary cases its aponeurotic character is very 
 equivocal, but where the parts about the groin have been 
 pressed upon and tliickened by the irritation of hernial 
 protusion it is better developed. On the thigli it i^ 
 blended with fat, and encloses between its laininsB the 
 lymphatic glands of the groin, and the small vessels 
 given off from the femoral artery immediately below 
 Poupart's ligament. On the tendon of the external ob- 
 lique it is more condensed; branches of the femoral ar- 
 tery are also seen in it there ; one longer and larger than 
 the others, the arteria ad cutem abdominis of Haller 
 winds over Poupart’s ligament and runs upwards some- 
 what in the line of the epigastric artery, being distri- 
 buted to the skin of the abdomen ; the division of it 
 will produce sufficient hemorrhage to require attention. 
 On the symphysis pubis and about the external ring 
 the laminsB of the fascia superficialis are multiplied, and 
 it has more of the character of common adipose matter, 
 as in all cases the adeps there, is abundant. This fascia 
 is more loosely connected to the parts beneath it, along 
 the anterior margin of Poupart’s ligament than else- 
 where, which disposes the femoral hernia to observe 
 that course in its increase. From the pubes it may be 
 traced as a condensed cellular membrane along the 
 penis to its extremity, and, according to Mr. Colies of 
 
INGUINAL HERNIA. 
 
 203 
 
 Dublin, wlieii matter is formed beneath it, it is apt to 
 create fistulous sores on this organ. A thin edge of 
 this membrane may be traced for some distance reflect- 
 ed along the spermatic cord. 
 
 The Fascia Superficialis, under the name of 
 Tunica Abdominalis, is well developed in animals with 
 a large and projecting belly, particularly in the large 
 ruiniuantia and the solipedia. It has a yellowish tinge, 
 is very elastic and strong, and well calculated to sup- 
 port the viscera in them. 
 
 In dissecting at the Abdominal Ring, do not work 
 too closely between the spermatic cord and the margin 
 of the ring ; by which precaution we avoid cutting a 
 process of the fascia superficialis that unites the two. 
 This process arises from the margin of the ring all 
 around; it passes immediately to the spermatic cord, and 
 is lost insensibly on the exterior surface of the cremaster 
 muscle. A quantity of loose cellular substance, inter- 
 mixed with fat, is placed between "the constituent parts 
 of the cord and the cremaster muscle. This eellular 
 substance, the cremaster muscle, and the fascia, form, in 
 scrotal ruptures, a thick lamina over the hernial sac, 
 called Tunica Vaginalis Communis. 
 
 Next make an incision through the tendon of the ex- 
 ternal oblique, commencing at the Linea Semilunaris, 
 a quarter of an inch above the upper margin of the 
 
204 
 
 OF THE TRUNK. 
 
 ring, and ending a quarter of an inch above the anterior 
 superior spinous process of the Ilium. This incision 
 should be regularly curved, its convexity being down- 
 wards, and almost touching the middle of Poupart’s 
 ligament. The tendon of the external oblique, border- 
 ing on the incision, should be then turned upwards 
 and downwards, by which a good view is given of the 
 inferior part of the internal oblique muscle where it 
 arises from the iliac or upper half of Poupart’s liga- 
 ment, and is inserted into the crista of the pubes just 
 behind the external abdominal ring. The origin of 
 the cremaster muscle is well seen, and the constituent 
 parts of the cord, as they are about to enter into the' 
 external ring. 
 
 Separate the inferior margin of the internal oblique 
 from Poupart’s ligament, and turn it upwards, begin- 
 ning near the anterior spine of the ilium, where the 
 distinction between the internal oblique and the trans- 
 versalis is better marked. The lower part of the 
 transversalis is thus exhibited placed behind the inter- 
 nal oblique, and having the same origin from Poupart’s 
 ligament and insertion into the Crista of the Pubes. 
 The raising of the internal oblique brings into view 
 more of the spermatic cord near the external ring. 
 
 The Transversalis Muscle is then to be detached 
 from Poupart’s ligament, and raised up. This gives a 
 complete view of the spermatic cord, consisting here, 
 
INGUINAL HERNIA. 
 
 205 
 
 of its vessels, nerves, and excretory duct, united by 
 cellular membrane. The upper part of the visible 
 portion of the cord is about half-way between the 
 anterior spine of the ilium and the symphysis of the 
 pubes, and penetrates the fascia transversalis. The 
 fascia transversalis is placed immediately behind the- 
 transversus muscle, between it and the peritoneum. 
 The opening of the fascia transversalis, which permits 
 the cord to pass, is called the Internal Abdominal 
 Ring, in order to distinguish it from the opening in 
 the tendon of the external oblique, called now the Ex- 
 ternal Ring. The internal ring is rather nearer to the 
 symphysis pubis than to the spine of the ilium. It will 
 now be understood that the space between the internal 
 ring and the external ring, is about eighteen lines in 
 the adult, and that it is very properly called the Abdo- 
 minal Canal, as giving passage to the spermatic cord. 
 The anterior side of the canal is formed by the tendon 
 of the external oblique; the inferior part in the erect 
 posture, is formed by Gimbernat’s ligament; the pos- 
 terior parietes are formed by the fascia transversalis, 
 and above, this canal is overhung by the internal oblique 
 and transversalis muscles. It should be observed that 
 the spermatic cord, after penetrating the fascia trans- 
 versalis, does not cross, directly, the inferior edge of 
 the internal oblique and transversalis at right angles ; 
 but it crosses them very obliquely, its inclination 
 being towards the pubes, so that the spermatic cord 
 can only be considered as disengaged from the inferior 
 
206 
 
 OF THE TRUNK. 
 
 edge of these muscles, about the middle of the abdo • 
 minal canal. 
 
 The opening in the Fascia Transverealis is not abrupt 
 and well defined; but the fascia, where it transmits the 
 spermatic cord, is reflected by a thin process to the 
 cord, and insensibly terminates on its cellular substance. 
 At the posterior or ventral face of the External Ring, 
 the fascia transvei’salis is not in contact with the cord, 
 but that part of the tendon of the internal oblique and 
 transversalis which is inserted into the crista of the 
 pubes, and forms a sheath for the pyramidalis muscle, 
 is placed between them, and secures this opening. 
 
 The incisions which were originally made only 
 through the skin of the abdomen are now to be carri- 
 ■ ed through the parietes of the same into its cavity, 
 and the flap thus constituted, to be turned down in order 
 to get a view of its posterior or ventral face. This 
 surface covered by peritoneum is divided in the iliac re- 
 gion near the middle of Poupart’s ligament into two 
 superficial fossse by a narrow falciform process of the 
 peritoneum. The pi’ocess arises froiii the side of the 
 bladder and extends upwards and inwards towards the 
 umbilicus, stopping about two inches short of the um- 
 bilicus. It is broader below than it is above, and 
 its loose edge is turned towards the abdomen. By 
 stripping down the peritoneum we shall see that this 
 falciform process is^ simply a duplicature of it, occasion- 
 
INGUINAL HERNIA. 
 
 207 
 
 ed by a fibrous cord, the umbilical ligament of the blad- 
 der, which once was the umbilical artery of the foetus. 
 The cord passes near the pubic margin of the internal 
 abdominal ring. Replacing the peritoneum we be- 
 come convinced that the bottom of the superficial fossa 
 on the outer or iliac side of the falciform process, cor- 
 responds with the, internal abdominal ring, and fre- 
 quently a little pouch of peritoneum enters the lat- 
 ter. The fossa on the inner or pubic side of the falci- 
 form process is just behind the external ring, but sepa- 
 rated from it by the fascia transversalis, and the ten- 
 dons of the lower parts of the internal oblique, and the 
 transversalis muscles where they are inserted into the 
 pubes, and form the sheath of the pyramidalis. The 
 two fossae indicate the points where inguinal herniac 
 commence, the proper inguinal protusion beginning in 
 the external fossa, and the ventro-inguinal in the inter- 
 nal fossa. We should here notice the looseness of the 
 attachment of the peritoneum by cellular substance to 
 the parietes of the abdomen, and consequently the little 
 resistance which it, unsupported, can afford against in- 
 testinal protusion. 
 
 The view of the Fascia Transversalis from behind 
 is extremely satisfactory. For a proper knowledge of 
 this membrane, the profession is indebted to the labours 
 of Sir Astley Cooper, and much of the zeal with which 
 the anatomy of hernia has been investigated, in latter 
 years is attributable to him. Tlie fascia transversalis 
 
208 
 
 OP THE TRUNK. 
 
 is a thin tendinous membrane most generally, occasion- 
 ally it resembles more, condensed cellular membrane. 
 It arises from the internal or abdominal edge of Pou- 
 part’s ligament, and from the crista of the pubes just 
 behind the insertion of the tendon of the internal ob- 
 lique and transversalis muscles, and is extended up- 
 wards on the posterior face of the transversalis muscle to 
 the thorax. At its origin it is attached to the inferior 
 edge of the transversalis and internal oblique, particu- 
 larly the part of the edge between the internal ring and 
 the pubes. It is also attached to the exterior margin 
 of the rectus abdominis. The internal ring or opening 
 in this fascia marks it out in some measure as consisting 
 of two portions, that on the iliae side of the ring is not so 
 thick as the other, or the one on its pubic side, and 
 both portions are much more tendinous near the crural 
 arch than they are higher up.^ 
 
 Removing the peritoneum from the iliacus internus 
 muscle, we see the spermatic vessels descending from 
 the loins to the internal ring, where they are joined 
 by the vas deferens coming from the pelvis. As they 
 
 * Were it not for the important influence of the fascia super- 
 ficlalis and the fascia transversalis upon hernia, and the con- 
 sequent necessity of a minute knowledge of them, the descrip- 
 tion might be much curtailed in considering them in their proper 
 light, to wit: as the sheaths of muscles; for it is now sufiiciently 
 apparent that the first is contiguous to the external oblique and 
 the second to the transverse muscle. 
 
INGUINAL HERNIA. 
 
 209 
 
 engage under the edge of the internal oblique muscle, 
 after penetrating the ring, the cremaster muscle is 
 detached to spread itself over them. The spermatic 
 cord, thus constructed, passes through the abdominal 
 canal in the manner mentioned, obliquely downwards 
 and inwards; emerging from the external ring it des- 
 cends vertically, lying rather upon the outer column 
 of the ring than upon its base. 
 
 On the posterior face of' the fascia transversalis, be- 
 tween it and the peritoneum, is the Epigastric Artery. 
 The epigastric arises from the external iliac as the 
 latter is about to go under the crural arch; it ascends 
 inwardly along the internal margin of the internal 
 abdominal ring to the exterior margin of the rectus 
 abdominis muscle, which it reaches after a course of 
 two and a half or three inches. The spermatic cord, 
 in getting from the abdomen to the abdominal canal, 
 therefore, winds, in part, around the epigastric artery, 
 in the first of its course being at the iliac edge of the 
 artery and then in front of it. Two epigastric vein§ 
 attend the artery, one on each side, which end by a 
 common trunk in the external iliac vein. 
 
 From what has been said it will now be more fully 
 understood that this structure admits of two places of 
 protusion. In the first, the intestine protudes the peri- 
 toneum through the internal ring and along the abdo- 
 minal canal into the groin, the constituent parts of the 
 cord being below the sac and separated by it from the 
 
 D d 
 
210 
 
 OF THE TRUNK. 
 
 cremaster muscle, which, in this case, forms one of the 
 envelopes of the sac. In the second, from weakness of 
 the fascia transversalis and the pubic insertion of the 
 internal oblique and transversalis muscles, a protusion 
 immediately from behind the external ring may occur, 
 in which the whole cord, including the cremaster, is 
 at the outer margin of the sac. In the first species, or 
 the Inguinal Hernia, the epigastric artery is at the 
 pubic side of the neck of the sac ; but in the second, 
 or the Ventro-Inguinal, it is at the iliac side. 
 
 The anatomical arrangement of the parts concerned 
 in inguinal hernia in the female is the same as in the 
 male, except that the round ligament of the uterus 
 supplies the place of spermatic cord, and there is no 
 cremaster muscle. 
 
 Section III. 
 
 Of the parts concerned in Femoral Hernia, 
 
 The study of Femoral Hernia should be commen- 
 ced with precise ideas ; of the concave edge of the os 
 innominatum, which terminates externally by the an- 
 terior superior spinous process of the ilium, and inter- 
 nally by the symphysis pubisj— also of the muscles of 
 
FEMORAL HERNIA. 211 
 
 the lower extremity which are connected with this 
 edge; — and of the insertion of the tendon of the exter- 
 nal oblique. 
 
 / 
 
 A muscular subject without much fat answers suf- 
 ficiently w’ell for this dissection; the male black is, 
 therefore, most frequently resorted to in our school. If 
 the subject have suffered somewhat from a previous 
 infiltration or dropsy of the cellular membrane, the 
 facility of separating the different layers of fascia from 
 each other is much increased. Make an incision 
 through the skin from the umbilicus to the root of the 
 penis, and extend the lower end of the incision around 
 the penis along the internal margin of the thigh for six 
 inches. Commence a second incision at the umbilicus, 
 and carry it out to the flank of the side on which you 
 operate. Begin a third incision through the skin at 
 the termination of the first and carry it to the outer side 
 of the thigh. A flap, consisting simply of skin, being 
 thus described, is to be carefully raised and turned out 
 of the way. In raising this flap of skin guard against 
 cutting up with it the fascia superficialis abdominis, 
 which lies immediately^beneath. 
 
 The Fascia Femoris is beneath the fascia superfi^ 
 cialis; its general character and arrangement is intro- 
 duced into the account of the lower extremity, but 
 there are other and minute circumstances in its dispo- 
 sition at the groin, indispensable ^ a knowledge of 
 
212 
 
 OF THE TRUNK. 
 
 femoral hernia. When the fascia superficialis is clear- 
 ed away, the fascia femoris is seen to arise at the 
 groin along the anterior edge of Poupart’s ligament, 
 from the spine of the ilium to within a short distance 
 of the spine of the pubes. This portion of it is thin, 
 and through it the sartorius muscle may be seen. The 
 fascia arises also from the crest of the pubes, and along 
 its ilio pectineal ridge which is a continuatioTi of the 
 same ; this latter portion covers the pectineus muscle. 
 The one is called the sartorial, and the other, the pec- 
 tineal fascia. The pectineal fascia is behind the fe- 
 moral artery and vein, and the sartorial fascia is be- 
 fore them. 
 
 The Saphena Vein, placed between the fascia fe- 
 moris and the fascia superficialis, runs up along the 
 Inner side of the thigh, and joins the femoral vein an 
 inch and a half below Poupart’s ligament. Raise the 
 saphena where it joins the femoral vein, and beneath 
 this junction a rounded semicircular edge of the fascia 
 femoris is seen, where the sartorial fascia becomes con- 
 tinuous with the pectineal. Apply the end of a finger 
 to this edge and draw it downwards. Immediately on 
 its being made tense, the sartorial fascia will show itself 
 to terminate by a thin edge in front of the femoral vein. 
 This edge is concave or crescentic, and extends from 
 the junction of the sartorial and pectineal fascia to near 
 the crista of the pubes. At the upper end of this 
 crescent; the sartqfial fascia terminates in a point or 
 
FEMORAL HERNIA. 
 
 213 
 
 angle which is turned inwards towards the pubes. The 
 upper margin of the angle is closely connected with 
 Gimbernat’s ligament near its edge, and the point is 
 inserted into the pectineal fascia over the crista of the 
 pubes and for a line or two below it, just at the internal 
 margin of the femoral vein, or rather about half-way 
 between it and the spine of the pubes. This angular 
 production or elongation of the sartorial fascia is called 
 Key’s or the Femoral Ligaipent. 
 
 By introducing a finger under Key’s ligament into 
 the abdomen, we find that the crural arch or Poupart’s 
 ligament, and the sartorial fascia exercise a mutual 
 tension on each other like the falx major and the ten- 
 torium; by abducting the limb very much and turning 
 the toe outwards, the greatest rigidity is given to both, 
 but by making the limb cross the other and turning the 
 toe inwards, both are relaxed. 
 
 A posterior view must now be taken by opening 
 the abdomen. The peritoneum must be separated 
 from the abdominal muscles, from the iliacus internus 
 and psoas magnus, which brings into view the fascia 
 iliaca. 
 
 The Fascia Iliaca is a tendinous membrane which 
 lies on the iliacus internus and psoas magnus muscles, 
 and is continued into the tendon of the Psoas Parvus. 
 Externally it is connected to the margin of the crista 
 of the ilium ; at the internal -edge of the psoas magnus 
 
214 
 
 OF THE TRUNK. 
 
 it is connected with the brim of the pelvis and sinks 
 into the cavity of the pelvis, being continuous with the 
 Aponeurosis Pelvica ; and below, it is inserted into the 
 edge of the crural arch from the anterior superior 
 spinous process of the ilium almost to the pubes. The 
 external iliac vessels are upon this fascia between it and 
 the peritoneum; by raising them with a knife-handle it 
 will be seen that the fascia iliaca goes over that part of 
 the pubes which gives origin to the pectineus muscle, 
 and that it is continuous with the pectineal fascia. If the 
 student should have a preparation in which every thing 
 is removed from the os innominatum except the insertion 
 of the tendon of the external oblique, it will be of essen- 
 tial service to him here : for by it will be seen the arch- 
 ed form of the edge of the tendon next to the bone, 
 from whence the name Crural Arch ; the vacancy 
 which exists between the bone and the arch ; and the 
 insertion of Gimbernat’s ligament from the spine of 
 the pubes, an inch or more along its crista. He will 
 then understand how this space is only partly filled 
 by the iliacus internus and psoas magnus, and that if 
 the fascia iliaca had not an attachment to the crural 
 arch so as to keep it down towards these muscles, her- 
 nial protusions would be constantly occurring. 
 
 The iliac vessels pass beneath the crural arch on the 
 inner margin of the psoas magnus muscle, the vein be- 
 ing nearest the pubes and the artery at the outer side 
 of the vein. Close inspection will satisfy us that the 
 
femoral hernia. 
 
 215 
 
 fascia iliaca is inserted into the crural arch as far as 
 the vein, and may indeed be traced to the crista of 
 the pubes, and that it is so connected with the vessels 
 that no opening for hernia exists between them, or 
 indeed in all the space from the internal margin of 
 the vein to the spine of the ilium. But at the inner 
 side of the vein between it and Gimbernat’s ligament 
 an opening appears called the Crural Ring, and is 
 the place where femoral hernia commences. This 
 opening is generally occupied by a lymphatic gland 
 and a lamina of condensed but loosely attached cel- 
 lular substance continuous with the Aponeurosis Pel- 
 vica. 
 
 Make a cross cut of an inch in length, through the 
 Fascia Iliaca; then, by introducing the finger, ora 
 knife-handle through this cut, downwards, our concep- 
 tions of the attachment of the fascia iliaca with the cru- 
 ral arch, and its continuity with the fascia pectinea, will 
 be much improved. 
 
 The femoral vessels are enveloped by a sheath. In 
 order to see this distinctly, separate the fascia trans- 
 versalis from the transverse muscle; cut vertically 
 through the falciform process of the fascia lata, over 
 the artery, and continue the cut also through Poupart's 
 Ligament, taking care to injure the fascia transversalis 
 as little as possible. In order to render this part of 
 the examination convenient, only a narrow flap of the 
 
216 
 
 OF THE TRUNK. 
 
 abdominal muscles should be left at the groin. By 
 turning towards the symphysis pubis the falciform pro- 
 cess, with that part of Poupart’s ligament to which it 
 adheres, we shall see that the fascia transversalis is not 
 only attached to the edge of the crural arch, but that 
 it continues to the thigh in front of the femoral vessels. 
 The fascia iliaca, besides its connexion with the pecti- 
 neal fascia, gives a layer to the posterior face of the 
 femoral vessels. The crural sheath is then formed from 
 the fascia transversalis' in front, and the fascia iliaca be- 
 hind. Mr. Colies has adopted a very satisfactory mode 
 of describing the formation of the crural sheath, which 
 I think more expressive than such as are most in use. 
 The fascia transversalis and iliaca, he considei’s as a con- 
 tinuous membrane, which maybe compared to a funnel, 
 from the manner in which it lines the lower part of the 
 abdomen. The inner side of the funnel is deficient. 
 From its lower part proceeds the membranous neck 
 which surrounds the femoral vessels, and constitutes 
 their sheath. This sheath is very separable from the 
 fascia lata in front, and the pectineal fascia behind, 
 and may be traced, easily, to the entrance of the sa- 
 phena vein into the femoral. On the thigh, just below 
 Poupart’s ligament, it has a number of foramina in it 
 occasioned by the passage of the lymphatic vessels from 
 the surface of the thigh. 
 
 At the place where the fascia iliaca is united to the 
 crural arch, a white line appears, formed by their union: 
 
FEMORAL HERNIA. 
 
 21T 
 
 in this is fixed tlie Arteria Circuniflexa Ilii, coming 
 from the external iliac. The epigastric artery is about 
 half an inch distant from the Femoral or Crural Ring, 
 at its outer side. Occasionally, the Obturator Artery 
 comes from the Epigastric, and winds around the in- 
 ternal margin of the ring. As the iliac vessels enter 
 the sheath beneath PouparCs ligament, a close fibrous 
 connexion is formed from them to the sheath, both 
 anteriorly and posteriorly, which sends a partition be- 
 tween the artery and the vein, and a partition also on 
 the inner side of the vein. By such arrangement, her- 
 nial protusions, are prevented at this spot; the only 
 opening for them, being at the inner side of the vein 
 between it and GimbernaPs ligament or at the Crural 
 Ring, as stated. 
 
 When an intestine descends, it passes into the femo- 
 ral sheath on the inner side of the iliac vein, it follows 
 the course of this vein down the sheath, till it comes 
 to an aperture made by one of the lymphatic vessels; 
 it then protrudes through this aperture, and gets under 
 the fascia superficialis. Afterwards, if the hernia in- 
 crease, instead of continuing to descend, it turns up- 
 wards and outwards, towards the anterior spine of the 
 ilium. From this, it is obvious, that the places of stric- 
 ture may be; First, the opening in the femoral sheath 
 for the lymphatic; Secondly, Hey’s Ligament; and 
 Thirdly, the edge of Gimbernat’s Ligament which 
 looks towards the iliac vein. Mr. Colles, whose opinions 
 
 E e 
 
218 
 
 OF THE TRUNK. 
 
 are entitled to the utmost respect, thinks that surgeons 
 err in regard to the third place, and that the stricture 
 is formed there, by the internal margin of the commence- 
 ment of the _ femoral sheath instead of by Gimbernat’s 
 ligament. He says that this orifice remains with a sharp 
 and distinct edge, even when Gimbernat’s ligament is 
 taken completely out of the way, and that the edge of 
 Gimbernat’s ligament, supposed to constitute this stric- 
 ture, stops several lines short of the Crural Ring. A 
 dissection performed in the manner that he recom- 
 mends, is unquestionably in favour of his position. 
 
 The Anterior Crural Nerve has but little to do with 
 this dissection, as it is placed beneath the fascia iliaca, 
 and is on the outside of the artery. 
 
 Section IV. 
 
 Of the Contents of the Abdomen. 
 
 For common examination, a crucial incision through 
 the parietes of the Abdomen, from the sternum to the 
 pubes, on the left of the navel, and from one side to 
 the other, on a line with the umbilicus, but a little be- 
 low it, answers very well. The flaps, thus made, be- 
 
CONTENTS OF THE ABDOMEN. 219 
 
 ing turned aside;, and kept down, the viscera of the ab- 
 domen can be easily seen. 
 
 1. The Livee is in the Right Hypochondriac region; 
 it occupies nearly the whole of it, the upper part of 
 the Epigastric, and the right superior part of the left 
 Hypochondriac. The fundus of the gall-bladder pro- 
 jects from its right inferior surface beyond its anterior 
 edge. 
 
 2. The Stomach, when not distended much, is 
 confined to the lower half of the Epigastric region 
 and to the right inferior part of the left Hypochon- 
 driac. 
 
 3. The Spleen, if not large, recedes into the back 
 part of the left Hypochondriac so much, that to be seen 
 it must be drawn out. 
 
 4. The small Intestines lie in the Umbilical, Hypo- 
 
 gastric, part of the Iliac regions, and also in the 
 Pelvis, when the viscera of the latter are not dis- 
 tended. -1 
 
 5. The Colon begins in the right Iliac region, 
 passes up into the right Lumbar and Hypochondriac, 
 and through the upper part of the Umbilical, or the 
 lower of the Epigasti’ic, according to the distention of 
 the stomach; it then gets to the left Hypochondriac, 
 
220 
 
 OF THE TRUNK. 
 
 being commonly higher up in it than in the right Hy- 
 pochondriac; thence it passes into the left Lumbar and 
 Iliac, forms its sigmoid flexure, and dips into the pelvis, 
 where it is continuous with the rectum. 
 
 6. The Omentum, is in front of the small intestines, 
 and most frequently found gathei-ed up in the Umbilical 
 region. If it be not diseased, it may he drawn down- 
 wards to the pelvis, and spread out so as to conceal all 
 the front of the intestines. 
 
 7. The Pan-creas, is at the back of the Epigas- 
 tric Region, behind the stomach; it lies horizontally, 
 and extends from the right of the spine into the left 
 Hypochondriac region. It cannot be seen without cut- 
 ting through the omentum, and turning the stomach up- 
 wards. 
 
 8. The Kidneys and Capsulai Renales are in the 
 Lumbar Regions, at their back parts. They should 
 not be sought for at this stage of the dissection. 
 
 It is useful to know that the position of the viscera 
 of the abdomen is influenced much by the position of 
 the body, and that in what is said of the occupancy of 
 the regions, it is undei'stood that the subject is on his 
 back. When one stands upright, the lumbar ver- 
 tebrae are more convex in front, and the abdomen moi t- 
 protuberant below. The pehis is so adjusted that the 
 
CONTENTS OF THE ABDOMEN. 
 
 221 
 
 acetabula are nearly in a vertical line with the spine, 
 which gives great obliquity to the superior strait, 
 mounts the sacrum up on high, and brings the bodies 
 and rami of the pubes not many degrees from the hori- 
 zontal line. Most of the viscera descend, but more 
 particularly the liver, which being no longer sustained 
 by the false ribs, and being influenced by its heavy 
 inert mass, may, in many cases, be felt externally along 
 the right inferior margin of the thorax. This descent 
 of the liver will be according to the degree of vacuity 
 of the stomach, intestines, and bladder. 
 
 It is said by Winslow, that the uneasiness, pain, and 
 faintness we feel in a vacuity of the stomach, &c. from 
 the want of food, arise from the liver drawing the 
 diaphragm downwards. Portal informs us, that in 
 order to ascertain the descent of the liver in the erect 
 posture, he has often thrust poignards below the false 
 ribs of dead bodies, and that he has invariably found 
 the wounds much higher up, than when they were 
 inflicted in the horizontal posture. 
 
 It should be well recollected that the abdominal 
 cavity is always full, there being no unoccupied space 
 in it ; hence, whenever any viscus has an inordinate 
 growth, or a tumour forms on it, or an effusion occurs 
 in the peritoneal cavity, the other viscera are en- 
 croached upon. In a treatment for sickness, when the 
 stomach and bowels have been evacuated by low diet 
 and purging, air supplies the place of more solid matter, 
 and keeps them distended. It is indeed exceedingly 
 
222 
 
 OF THE TRUNK. 
 
 rare to find the small intestines contracted; in the large, 
 it is more common. 
 
 Having become generally informed on the viscera of 
 the abdomen, by repeated handling, we should, in the 
 next place, proceed to an examination of their forms 
 and structure. 
 
 The Peritoneum is a thin, delicate, semitranspa- 
 rent membrane, very extensible, and spread out so as 
 to line the cavity of the abdomen, and to give an exter- 
 nal covering to the greater number of its viscera. In 
 man, it is a complete sac, having no hole in it; but in 
 woman, its cavity communicates externally through tlie 
 fallopian tubes. It has a double use; in consequence of 
 covering the viscera, it is so reflected from them to the 
 sides of the abdomen, that its processes keep the viscera 
 in their proper places, and therefore answer as liga- 
 ments. Again, its internal surface being smooth, 
 highly polished, and continually lubricated by a thin 
 albuminous fluid corresponding with the synovial mem- 
 brane of the joints, the motions which the viscera have 
 upon each other in exercise, and in the peristaltic 
 movements of the bowels, are much facilitated. 
 
 The manner in which a double night- cap is applied 
 to the head, will afford the easiest conception of the 
 reflections of the peritoneum. If there were only one 
 viscus in the belly, and that of a somewhat regular out- 
 line, as the spleen, the comparison would be rigid, and 
 perfectly appreciable. One part of the cap is close to 
 
CONTENTS OF THE ABDOMEN. 
 
 223 
 
 the head, and compares with the peritoneal coat of the 
 spleen ; the other is loose, and is equivalent to the peri- 
 toneum, where it is in contact with the parietes of the 
 belly. It is also evident from this, that none of the 
 viscera can be said to be within the cavity of the peri- 
 toneum; that they are all on its outside; and that a 
 viscus, in getting a coat from the peritoneum, merely 
 makes a protusion into its cavity. Starting with this 
 most simple proposition, it is easy to conceive of a 
 second, a third body, and so on, deriving an external 
 coat from a protusion into the. same sac. Admitting 
 these bodies to be spheres, the proposition is immedi- 
 ately intelligible ; and as a last step from it, the idea is 
 not rendered much more complex by substituting any 
 bodies, even the most irregular in form, for these 
 spheres. Such, then, is the fact, in regard to the 
 stomach, intestines, &c. ; they all, with exceptions to 
 be stated, derive an external coat from the peritoneum. 
 
 The reflections of peritoneum forming the ligaments 
 of the liver will be best described in connexion with 
 that viscus. Its reflections over the viscera of the 
 pelvis will be described with them ; we will merely say 
 for the present that it covers the upper and back part 
 of the urinary bladder, and is reflected from it to the 
 rectum. 
 
 The reflections for immediate study are the Omen- 
 tums. Fatty Appendages of the Colon, the Mesentery 
 and the Mesocolon, 
 
224 
 
 OF THE TRUNK. 
 
 1. There are four Omentums. Omentum Minus or 
 Hepatico Gastricum, Omentum Majus or Gastro-Coli- 
 cum; Omentum Gastro-Splenicum, Omentum Colicum. 
 
 a. The Omentum Minus extends in a transverse 
 direction from the transverse fissure of the liver where 
 the capsule of Glisson is connected to the latter ; from 
 the right of the lobulus spigelii at the posterior half of 
 the umbilical fissure ; and from the inferior face of the 
 diaphragm, to the lesser curvature of the stomach from 
 the end of the oesophagus to the pylorus and duodenum. 
 It is composed of two laminae which, near the stomach, 
 are separated by the coronary vessels. It has always 
 but an inconsiderable quantity of fat in it. 
 
 h. The Omentum Majus, or Gastro-Colicum, is 
 an irregular quadrilateral membrane having its base 
 upwards. The latter is fixed anteriorly to the gi’eater 
 curvature of the stomach, and posteriorly to the trans- 
 verse arch of the colon. It hangs loose in its infei’ior 
 part, and is sometimes found spread over the intestines 
 as low as tlie pelvis ; it is, therefore, not improperly 
 compared to an apron. On its right side it is continued 
 into the omentum colicum, and on the left into the gas- 
 tro-splenicum. It consists of two lamin®, the anterior 
 is fixed to the stomach, the posterior to the colon. 
 Each of these laminae again is composed of two, so that 
 it may be compared to two bags, one within the otlier, 
 connected at their upper or open end to the stomach 
 
CONTENTS OF THE ABDOMEN. 
 
 225 
 
 and colon. The internal and external bags are very- 
 separable above, but below they are closely united. In 
 corpulent subjects a great deal of fat is found in this 
 membrane. 
 
 By searching for the neck of the gall-bladder, we shall 
 firid near it under the capsule of Glisson, the Foramen of 
 Winslow, an opening which conducts into the bag of 
 the omentum majus. It is large enough to admit easily 
 two fingers. By detaching the omentum majus from 
 the stomach, and turning it down, we shall see the na- 
 ture of its cavity, its extent, and all the parts constitu- 
 ting its parietes. This cavity is bounded above, by the 
 omentum minus and stomach, in front by the two laminm 
 sent from the stomach; behind and below, by these 
 laminse being reflected upwards and joining the colon, 
 and posteriorly and above, by the upper lamina of the 
 mesocolon which is extended to the lobulus spigelii. 
 By a little reflection it will be understood that I 
 have described an uninterrupted cavity, beginning at 
 the lobulus spigelii by the omentum minus, and termina- 
 ting with the lobulus spigelii by the upper lamina of the 
 mesocolon. It is acknowledged on all sides to be one 
 of the most obscure propositions in descriptive anatomy, 
 even when the subject is before a young student. If 
 is a point well worth mastering, as, when this is ac.- 
 complished all other difliculties, in studying the reflec- 
 tions of the peritoneum, are much diminished. 
 
 F f 
 
226 
 
 OF THE TRUNK. 
 
 c. The OMENtuM CoEicuM is a prolongation of the 
 omentum majus, from the internal side of the right 
 ascending colon, and from the adjacent part of the trans- 
 verse. It is filled with fat from the same causes as the 
 preceding, but consists of only two single laminse. 
 
 d. The Omentum Gastro-Splenicum is that pro- 
 cess of peritoneum which extends from the large ex- 
 tremity of the stomach to the spleen ; it may be consi- 
 dered a prolongation of the omentum majus, and en- 
 closes in its duplicature the arteries and veins called 
 Vasa Brevia. 
 
 e. The Appendiculje Epiploicje are little pro- 
 cesses of peritoneum, filled with fat, appended at irre- 
 gular intervals to the anterior sides of the cjEcum, co- 
 lon, and the upper part of the rectum. 
 
 The Mesenterium is extended obliquely across the 
 spine from a line parallel with the second lumbar ver- 
 tebra to the right iliac fossa. This part, called its root 
 in the adult, is about six inches in length and flat, but 
 the inferior edge, which is loose and pendulous having 
 the intestines connected with it, has its circumference 
 increased to many feet, which causes it to lie in folds. 
 The mesentery attaches the left extremity of the duo- 
 denum, the jejunum, and ileum to the spine. It con- 
 sists of two laminae of peritoneum separated by the 
 mesenteric arteries and veins, the lacteal glands and 
 
CONTENTS OF THE ABDOMEN. 
 
 227 
 
 vessels, and the nerves derived from the solar plexus. 
 There is also some fat between them. 
 
 The Mesocolok fixes the large intestine to the 
 back of the abdomen. The posterior part of the cae- 
 cum b,eing devoid of peritoneal coat, is of course in 
 contact with the internal iliac muscle and is tied down 
 to it. The eolon in the right and left lumbar regions 
 is also for the most part immoveably fixed, the mesoco- 
 lon being there of very little length; but the transverse 
 mesocolon is long, and forms a complete and moveable 
 partition between the upper and the lower parts of the 
 abdomen, which permits the colon to ascend and de- 
 scend according to the distention of the small bowels and 
 stomach. In the left iliac region the mesocolon is elon- 
 gated so much as to allow very free motion to the sig- 
 moid flexure of the gut, and continues into the meso- 
 rectum. 
 
 Of the Ventriciilus, or Stomach. 
 
 The stomach is a sac curved considerably. As was 
 stated, it is in the epigastric region, in contact above 
 with the diaphragm, with the left lobe of the liver and 
 the lobulus spigelii; on the left with the spleen ; behind 
 with the pancreas ; and below with the colon and meso- 
 colon. The stomach has a very great obliquity in its 
 situation, the right extremity being much lower down 
 than the left. 
 
228 
 
 OF THE TRUNK. 
 
 The exterior of the stomach presents two facesj two 
 orifices, two curvatures, and two extremities. 
 
 When the stomach is nearly empty it becomes some- 
 what flattened, and then exhibits an anterior and a pos- 
 terior face ; in a state of distention, the first looks ob- 
 liquely upwards, and the latter obliquely downwards. 
 The angle, formed with the oesophagus, is increased 
 according to the degree of distention. 
 
 The orifices are the Pyloric and the Cardiac. Tlie 
 pyloric viewed externally presents nothing remarkable 
 but seems to be a continuation of the right extremity 
 of the stomach into the duodenum. The cardiac, form- 
 ed by the junction of the oesophagus with it, is at the 
 upper edge of the stomach, some distance from the ex- 
 ti’eme left. 
 
 The curvatures are the Great and Small. The fii-st 
 includes the great extremity and the inferior edge of the 
 stomach to the pylorus ; the smafi is the upper margin 
 between the orifices. 
 
 The Tuber or great extremity of the stomach is tlie 
 part to the left of a vertical plane passing through the 
 cardia ; it is smaller in proportion in children than in 
 adults. 
 
 The stomach consists of four laminae. The external 
 is peritoneal, and derived from the separation of the 
 two leaves of the omentum minus. The second is mus- 
 cular, its thickness is inconsiderable, and the fibres 
 which compose it are remarkably pale ; they are best 
 seen near the cardia and at the pylorus. At the latter 
 
CONTENTS OF THE ABDOMEN. 
 
 229 
 
 they are collected into a ring of considerable thickness, 
 which making a marked prominence internally, helps to 
 constitute the valve of the pylorus. The muscular fibres 
 go in three directions. The first being longitudinal, are 
 continued from similar ones of the oesophagus, and ex- 
 tend to the pyloric orifice. The principal part of them 
 is collected into two bands, the thicker of which passes 
 along the lesser curvature, and the thinner along the 
 greater. The second set of muscular fibres surrounds 
 the stomach by segments of circles, none of them going 
 completely around. It is this set, in an especial manner 
 which assists in the pyloric valve. The third and most 
 profound set of muscular fibres is oblique, and forms 
 two large bands. One is extended from the left side of 
 the cardia over the anterior and posterior faces of the 
 stomach, and the other is prolonged from the right side 
 of the same orifice over the great extremity also before 
 and behind, where it supplies the want of transverse or 
 circular fibres. 
 
 The third coat of the stomach consists of a very 
 dense compact short cellular membrane, which unites 
 the muscular and internal coat, and conducts the vessels 
 and nerves to the latter. 
 
 The fourth or Internal Coat of the stomach, called, 
 also the Mucous or Villous, is of a light red. It is form- 
 ed of villosities like velvet, which terminate at the 
 cardiac orifice; it is thrown into very irregular folds, 
 according to the degree of contraction of the stomach, 
 and by its reflection over the circular plane of fibres at 
 the pylorus increases the projection of the valve. 
 
OF THE TRUNK, 
 
 :^30 
 
 Of the Intestinal Canal. 
 
 This Canal is from thirty to thirty -five feet long, 
 in the human subject, and extends from the Pylorus to 
 the Anus. It consists of two portions, the longer forming 
 four-fifths of the whole, extends from the stomach to 
 the ileo-cascal valve, the other from this latter to the 
 anus. The first is Intestinum Tenue, the second Intes- 
 tinum Crassum. This canal like the stomach consists of 
 four coats, peritoneal, muscular, nervous, and \fillous. 
 
 The small Intestine, or Iktestinum Texue, is divid- 
 ed, somewhat artificially, by anatomists, into three parts. 
 Duodenum, Jejunum, and Ileum. The first, from 
 peculiar civcumstances, is perhaps named properly 
 enough; but several distinguished men, as Chaussief, 
 Soemmering, &c. think that the two last may be treat- 
 ed of more advantageously, under the name of Mesen- 
 teric Portion of Small Intestine. 
 
 The Duodenum deduces its name from its length, 
 which has been fixed at twelve fingers breadth. It is 
 also called Ventriculus Succenturiatus. Beginning at 
 the pylorus, it passes to the right, and upwards, to- 
 wards the neck of the gall-bladder; it then forms a right 
 angle, and passes downwards before the right kidney, 
 to the third lumbar vertebra between the two laminae of 
 the Mesocolon on the right side. Here it forms a 
 
CONTENTS OF THE ABDOMEN. 
 
 231 
 
 round elbow, and crosses the spine obliquely upwards, 
 making it§ appearance to the left of the second lumbar 
 vertebra, where it is continued into the mesenteric por- 
 tion of intestine. 
 
 The head of the Pancreas lies in the bend of the 
 duodenum, and fixes it firmly just there. The first 
 part, where it emanates from the pylorus, is moveable, 
 and covered with peritoneum j the second and third 
 portions are between the laminae of the mesocolon, but 
 have no peritoneal coat j and the termination is both 
 moveable, and has a peritoneal coat. The partial 
 deficiency of peritoneal coat, is said to be the cause why 
 the duodenum is susceptible of an enlargement, in some 
 cases, but little inferior to the stomach. 
 
 The muscular coat of this intestine consists of two 
 planes of fibres, the external one longitudinal, the other 
 circular and much the most numerous. Beneath is the 
 coat of cellular membrane connecting it with the mu- 
 cous or villous coat. The internal coat is reddish, 
 tinged with bile, and occupied by a great number of 
 rugSB or folds. They are transverse and oblique, very 
 near each other, about three lines broad, and as promi- 
 nent in the distended as the undistended gut ; these 
 constitute the Valvulse Conniventes. Many mucous 
 follicles exist in this intestine, and mucous glands, call- 
 ed Glandulse Brunneri; the latter are particularly ac- 
 cumulated about the pyloric orifice. It is, in its pos- 
 terior part, about four inches from the stomach, that 
 
232 
 
 OF THE TRUNK. 
 
 the orifices of the pancreatic and hepatic ducts are 
 found. 
 
 The Inferior, or Mesenteric portion of the Intesti- 
 num Tenue, has the same coats with the preceding. 
 In the upper two-fifths, called Jejunum, the valvulse 
 conniventes are numerous, and arranged transversely; 
 but in the lower three-fifths, called Ileum, they gra- 
 dually diminish, and near its terminatidn, cease en- 
 tirely. There is a gradual diminution of the diameter 
 of this intestine from above downwards. From the 
 length of the mesentery, great latitude of motion is 
 allowed to it. It presents a very irregular and con- 
 fusing appearance at first, but one soon becomes accus- 
 tomed to its course and convolutions : and then its com- 
 mencement and termination are as readily found as 
 those of any other organ. It is probable that in the 
 distentions of this bowel, the peritoneal coat does not 
 stretch much, as the laminae of mesentery are loosely 
 applied against each other where they join the intes- 
 tine, and are separated in its distentions, as far as tlie 
 first row of the mesenteric arches of blood-vessels. 
 Cases are reported, in which it has had appendiculae 
 epiploicEe and cul-de-sacs projecting from its sides. I 
 have never seen the former, but of the latter, a spe- 
 cimen was presented to me a few years ago, taken from 
 a child by the late Dr. Edward Barton ; and another 
 specimen now belongs to the Wistar Museum, obtained 
 in the dissecting rooms. 
 
 The mucous or internal coat of the Intestinum To- 
 
CONTENTS OF THE ABDOMEN. 
 
 233 
 
 nue, differs from that of the stomach, in resembling 
 more, the downy cuticle of an unripe peach. The little 
 pT’ojections from it, are called Villi; on the surfaces of 
 which, open the orifices of the lacteals. ft abounds 
 with mucous follicles and glands; the latter, called 
 GlandulsB Peyeri, are particularly conspicuous near its 
 junction with the mesentery. 
 
 The large Intestine, or the Intestinum Crassum, has 
 already been explained in regard to its course. It is 
 more obviously a conical tube than the small intestine, 
 being very large at its commencement when inflated, 
 and diminishing much to the lower end of the sigmoid 
 flexure. Anatomists call its commencement, or that 
 part below the ileo-colic valve. Caecum or Caput Coli ; 
 and the remaining portion, which is by far the longest, 
 the Colon, until it reaches th,e pelvis, when it becomes 
 Rectum. 
 
 The Caput Coli is about two inches in length, and is 
 fixed to the iliac fossa by peritoneum and loose cellular 
 membrane. At its inferior extremity, towards the left 
 is the Appendix Vermiformis, a blind cavity of four 
 coats, about four inches long, and of the size of a tur- 
 key quill, enclosed in a duplicature of peritoneum. It 
 floats loose, and occasionally becomes a cause of mis- 
 chief, by getting around the ileum, and inflaming, 
 by which it adheres and produces, in some measure, 
 strangulation. The Colon makes a large sweep around 
 the abdomen, and in passing under the gall-bladder, 
 touches it, and thus becomes tinged with bile after 
 
 G g 
 
234 
 
 OF THE TRUNK. 
 
 death. In its transverse course, we frequently find it 
 passing through the umbilical region. 
 
 The coats of the Intestinura Crassum, correspond in 
 number with those of the small intestine ; but there are 
 some differences in structure. The longitudinal mus- 
 cular fibres are much more conspicuous ; they are col- 
 lected into three bands, which commence at the head 
 of the colon, and extend to the upper part of the rec- 
 tum ; one is superior, another inferior, and a third an- 
 terior. They are equidistant from each other. These 
 longitudinal bands produce the cells of the colon, by 
 drawing its extremities nearer together. The cells 
 are separated laterally, by partitions or butresses form- 
 ed of a doubling of all the coats of the intestine; where- 
 as in the small intestine, the valve or doubling belongs 
 exclusively to the mucous membrane. These cells are 
 not so numerous or well formed in the sigmoid flexure 
 and thereabouts ; the channel is therefore more open 
 and unobstructed. By dividing the longitudinal bands, 
 the cells are removed, and the intestine elongates con- 
 siderably. 
 
 The Ileo Colic Valve, or valve of Bauhen, or Tulpius, 
 is a great curiosity in the anatomical structure of this 
 gut. The ileum runs into the left side of the colon, 
 and continues its cellular and mucous coat into the cor- 
 responding coats of the colon, the muscular coat of the 
 latter being simply parted. To prevent the furtlier 
 separation of the muscular fibres, a little ligamentous 
 arrangement, called Retinacula Morgagni, prevails at 
 
CONTENTS OF THE ABDOMEN. 
 
 235 
 
 each end. When viewed from within the colon, the 
 opening appears as a transverse, or very narrow ellip- 
 tical slit, established by two lips, the superior broader 
 than the inferior. They meet like the gates of the 
 common ship-dock or hydraulic lock; and from being 
 placed transversely, in regard to the cavity of the 
 intestine, every distention which the latter may suffer 
 from the accumulation of faeces, has a tendency to force 
 this valve, and will, by stretching its extremities, make 
 the lips tighter and more resisting. 
 
 The internal coat of the large intestine differs very 
 materially from that of the small. It has few or no villi. 
 Near its commencement, it preserves the fungous ap- 
 pearance of the stomach, but about the sigmoid flexure, 
 it is a plain smooth, surface. A great many mucous folli- 
 cles and mucous glands are in it. It has lacteals, but 
 they are not so numerous. 
 
 The Rectum will be described with the Pelvis. 
 
 Of the Liver ^ {Hepar Sive Jecur.) 
 
 Its position in the abdomen and the space it occupies 
 have been mentioned. It is placed in the following 
 relations; above, it is in contact with the concavity 
 of the diaphragm; below, are the Omentum Minus, 
 the Stomach, and the Transverse Arch of the Colon; 
 behind, are the Vertebral Column and the Ascending 
 Cava. When we lie on the right side it is sustained 
 by the ribs in the easiest posture; when on the left it 
 
236 
 
 OF THE TRUNK.' 
 
 sometimes occasions uneasiness by pressing on the 
 stomach; and when on the back it compresses the 
 ascending cava. 
 
 Its form is happily compared, by Professor Chaussier,. 
 to the section of an ovoid made in the direction of its 
 greatest diameter, the thick end being to the right side. 
 It is fastened in its situation by the following reflections 
 of the peritoneum. From the centre of the diaphragm, 
 and extending from the umbilicus backwards to near the 
 ascending cava, is the Falciform or Suspensory Liga- 
 ment, consisting of two laminae ; it is thickened at its 
 anterior edge by what was once umbilical vein in the 
 foetus, but is now converted into a fibrous substance 
 called Round Ligament. This falciform ligament di- 
 vides the upper surface of the liver unequally into two, 
 the left being the smaller; it also penetrates a notch in 
 the anterior edge of the liver. On the right of the fal- 
 ciform process, and extending from the diaphragm to 
 the posterior edge of the liver, is the Right Lateral 
 Ligament; to the left of the same process, and also ex 
 tending from the diaphragm to the back edge of the 
 liver, is the Left Lateral Ligament; and that portion 
 of peritoneum concerned in the union of these three 
 ligaments forms the Coronary Ligament. Within the 
 circumference of the coronary ligament the sui’face of 
 the liver is not covered by peritoneum, and it is attach- 
 ed to the diaphragm by loose cellular substance. 
 
 The precise shape of the liver is best seen in one rc 
 moved from the body. Its colour is a reddish brown 
 
CONTENTS OF THB ABDOMEN. 237 
 
 The following parts are noticed by anatomists : its upper 
 surface, its lower surface, its right extremity, its left 
 extremity, its anterior edge, and its posterior edge. 
 
 The upper surface is uniformly convex, and pre- 
 sents nothing remarkable but its unequal division by 
 the suspensory ligament. 
 
 The lower surface is very irregularly concave, and 
 on it are the following appearances: From the front to 
 the back edge is a deep fissure corresponding, in situ- 
 ation, with the suspensory ligament above, and, with 
 it, giving occasion to divide the liver into right and 
 left lobes. This is the Sulcus Umbilicalis, occupied 
 in front by what was umbilical vein, and in the rear 
 by what was ductus venosus, both vessels in the adult 
 being in a ligamentous state. Crossing this fissure at 
 right angles, passing from the left lobe, for some dis- 
 tance into the right, and occupying about the middle 
 third or fourth of the long diameter of the liver, is the 
 Sulcus Transversalis. In it are the Vena Portarum, He- 
 patic Artery, and Ducts. TheLobulus Spigelii or pos- 
 terior lobe is at the back of the liver just to the right 
 of the posterior part of the sulcus umbilicalis. It is 
 like a ridge and terminates forwards in a papillae which 
 is one of the portae of the liver; to the right, the 
 lobulus spigelii sends off a small process which unites it 
 with the greater lobe of the liver, and is called the Lo- 
 bulus Caudatus. On the front of the inferior surface 
 between the fore part of the umbilical fissure and the 
 gall-bladder is a flat rising, the Lobulus Anonymus or 
 
238 
 
 OF THE TRUNK. 
 
 Quartus; its posterior extremity, opposite to the an- 
 terior of the lobulus spigelii, is the second pula or porta 
 of the liver. 
 
 The right extremity of the liver is very thick and 
 almost fills the right hypochondriac region, but the left 
 tapers to a very thin edge. The posterior border or 
 edge is thick, but the anterior is thin. The former is 
 marked by a short large sulcus for the ascending vena 
 cava, sometimes converted into a complete canal ; the 
 latter only has the notch for the suspensory ligament 
 already mentioned. 
 
 Besides the peritoneal coat, the liver has a second, 
 which covers its whole exterior surface, adhering very 
 closely to the peritoneum on one side, and to the liver 
 on the other ; it penetrates into the substance of the 
 liver, and holds together its gi’anulated structure.^ 
 This tunic is easily seen by stripping off the peritoneum , 
 and in parts which naturally are left uncovered by the 
 latter. 
 
 The Blood-vessels are of three kinds. The two 
 first bring the blood to the liver, the third takes it 
 away. The hepatic artery, a branch of the cceliac, 
 after having detached some smaller ramifications, gets 
 to the transverse fissure of the liver and divides into 
 three branches ; one to the right lobe, one to the left 
 lobe, and another to the Lobulus Spigelii ; they, how 
 
 * See ScEimnering'S Anatomy, Laennec^s .Tonrnal de Med-’- 
 
 cine. 
 
CONTENTS OF THE ABDOMEN. 
 
 239 
 
 ever, subdivide before they reach the substance of the 
 liver. These branches are between the sinus porta- 
 rum and the biliary ducts. The vena portarum is 
 formed from the union of all the veins of the intes- 
 tines, stomach, pancreas, and spleen, forming a single 
 trunk about three inches long. It gets to the trans- 
 verse fissure of the liver, over the duodenum and 
 under the pancreas, and immediately sends off, at right 
 angles, two branches which, collectively, are called the 
 sinus of the vena portarum. -The right branch, being 
 the shortest and largest, is distributed to the great right 
 lobe ; the left sends its branches to the lobulus spigelii, 
 anonymus, and left lobe. 
 
 At the bottom of the transverse fissure is a lamellat- 
 ed fibrous cellular tissue, closely adhering to the liver, 
 which accompanies the vena portarum, the hepatic 
 artery, and hepatic duct in their ramifications, form- 
 ing sheaths for them as they go off successively. As 
 the branches of these tubes keep togetlier they are 
 united by the cellular sheaths. Glisson believed these 
 sheaths to be muscular and they have obtained the 
 name of his capsule ; and, indeed, the capsule, is ge- 
 nerally spoken of as lying on the aforementioned ves- 
 sels, even before they reach the liver. The hepatic 
 veins arise from the capillary extremities of the hepa- 
 tic artery and vena portarum ; there are three princi- 
 pal trunks of them coming, two from the right and one 
 from the left lobe of the liver, and emptying into the 
 ascending cava, just below the diaphragm ; there are 
 also, five or six little trunks, coming from the the pos- 
 
240 
 
 OF THE TRUNK. 
 
 terior surface of the liver, and the lobulus spigelii, which 
 empty into the ascending cava below the other. The 
 hepatic veins have no valves, and may, in a section of 
 the liver, be readily distinguished from other vessels 
 by their lonely course, by their crossing the others at 
 right angles, and by their thinness. All of thes'e vessels 
 of the liver are remarkable for the number of their anas- 
 tomoses and the facility of their communication with 
 each other. A minute injection of either pervades all 
 parts of the liver, and the injection if persevered in will 
 fill all the other vessels. By tearing the substance of 
 the liver a good view of its organization may be ob- 
 tained ; it will then be seen to be composed of an im- 
 mense number of spherical or polyedrical grains united 
 to each other by the cellular tissue of the internal coat. 
 These grains contain the essential and ultimate points 
 of the glandular arrangement, the anastomoses of the 
 vessels are formed in them, and also the capillaries of 
 the hepatic duct ; but what the final organization is 
 by which bile is formed is yet doubtful. 
 
 The nerves of the Liver will be mentioned ^at an- 
 other place, along with the general account of such as 
 belong to the Abdomen. 
 
 The Gall-bladder, (Vesicula sive Cistis Fellea,) is 
 fixed on the inferior surface of the great lobe, it\ a 
 broad shallow fossa for the purpose. It is not placed 
 in the line of the short diameter of the liver, but some- 
 what obliquely, its anterior end, which reaches to t!ie 
 edge of the liver, being turned to the right, and its 
 
CONTENTS OF THE ABDOMEN. 
 
 241 
 
 posterior, which goes to the transverse fissure, being 
 turned towards the left. Its shape is conical, the base 
 being rounded off* and the apex curved ; the body di- 
 minishes gradually to the apex. The gall-bladder has 
 three coats; the peritoneal is only partial, from the 
 upper face of the gall-bladder being in contact with 
 the liver. The second coat is cellular membrane, in 
 which ramifies a great number of blood-vessels and 
 lymphatics. The third may be considered a continuation 
 of the mucous coat of the intestines, but has some pecu- 
 liarities. On its internal face, it is thrown into irre- 
 gular tortuous folds or wrinkles of extreme delicacy, in 
 the intervals of which are many round or polyedrous 
 cells ; some small, others a line and a half deep, 
 particularly about the middle of the body. In the 
 neck or apex of the gall-bladder, from three to seven 
 elevated semilunar folds are formed, of the internal 
 membrane. 
 
 The gall-bladder and the contiguous parts, after 
 death, are always tinged with bile, which does not oc- 
 cur in tlie living body. I have, however, in one case 
 in our dissecting rooms, seen a gall-bladder in an old 
 African woman, filled by a pint of very fluid watery 
 greenish bile, and the tissue of which had been so lax, 
 that a quart or more of the same secretion had perco- 
 luted into the abdomen probably before death. 
 
 The Hepatic Duct arises, by very delicate 
 branches, from the granuli of the Liver. These 
 
 Hh 
 
242 
 
 OF THE TRUNK. 
 
 branches are united into three or four tmnks, in the 
 transverse fissure, which trunks again unite into one 
 about the size of a writing^quil], and eighteen or 
 twenty lines long. The Hepatic Duct joins, at a very 
 acute angle, with the Cystic Duct, which is somewhat 
 smaller and shorter, and the two form the Ductus Com- 
 munis Choledochus. The biliary canals thus formed, 
 are situated in the right side of the Hepato gastric, or 
 lesser Omentum, in what is commonly called the Cap- 
 sule of Glisson. The Ductus Communis being three 
 inehes, or three and a half long, is to the right of the 
 Vena Portarum and the Hepatic artery; descends be- 
 hind the pancreas and the upper part of the duodenum; 
 and passes obliquely between the coats of this intes- 
 tine, for the distance of an inch, its orifice being, as 
 mentioned, at the back of the second turn of the intes- 
 tine. 
 
 The Biliary ducts have two coats. The external is 
 a lamellated fibrous membrane, highly extensible, and 
 having many blood-vessels. The internal is of the 
 same character with that of the gall-bladder. In the 
 cystic canal, and towards the lower part of the Ductus 
 Communis, are several longitudinal folds. 
 
 Of the Spleen, ( Lien. Splen.J 
 
 This organ, as mentioned, is situated deeply in the 
 left hypochondriac region, in the concamty of the 
 Diaphragm, at the left extremity of the stomach, and 
 
CONTENTS OF THE ABDOMEN. 
 
 243 
 
 above the Colon. Its form approaches to the longitu- 
 dinal section of an oval, being commonly four and a half 
 inches long, and two and a half wide. But there is no 
 viscus in which more frequent varieties of magnitude 
 occur. I have seen it extending almost to the Ilium, 
 and but little smaller than the liver; and again, not by 
 any means the length just mentioned as a mediuni size. 
 Its transitions of magnitude are frequent and rapid in 
 the same individual, depending on the stage of diges- 
 tion, upon sickness, and probably on mental sensations. 
 Several spleens sometimes exist in the same person. 
 In such cases the supernumerary ones are, for the most 
 part, very small. 
 
 The Spleen has a partial division lengthwise, by a 
 fossa, where the blood-vessels are connected with it. 
 Its circumference is sometimes notched. Its colour 
 varies from a deep blue, which it is in early life, to a 
 very dark brown. It is fixed by three processes .of 
 peritoneum, the names of which indicate their attach- 
 ments; the Gastro-splenic, the Splenico-phrenic, and 
 the Splenico-colic ligaments. 
 
 The external coat of the spleen is obtained from the 
 peritoneum, being a continuation of the ligaments just 
 mentioned. The internal coat is a greyish, compact, 
 extensible, elastic membrane, in close adherence with 
 the external; it sends in processes to accompany the 
 blood-vessels; and moreover from its internal face there 
 proceeds a multitude of lamellae and of fibres, dividing 
 its cavity into cells. ( Wistar Museum. ) It seems to 
 
244 OF THE TRUNK. 
 
 be intended to sustain the natural shape of the spleen^ 
 and to support its peculiar structure. 
 
 The spleen is remarkably well furnished with blood- 
 vessels. It derives a large artery from the coeliac, 
 distinguished by its tortuous course, and by the 
 branches which it furnishes to the stomach and pancreas. 
 It divides into several trunks just before it enters the 
 spleen. The veins come out by an equal number of 
 trunks, unite into one trunk, and attend the artery 
 along the upper edge of the pancreas; it joins the Vena 
 Portarum. 
 
 In the body of the spleen are found many gi’eyish, 
 soft, semi-transparent gelatinous corpuscles, from an 
 almost imperceptible magnitude to a line or more in 
 diameter. By Malpighi, they were considered glan- 
 dular; and by Ruysch, as convoluted vessels. The mass 
 of the spleen, upon a superficial examination, seems to 
 consist in a bloody dark brown pulp, contained in the 
 numerous cells of the internal coat. On this cellular struc- 
 ture, the vessels pass. M. Assolont considers that blood, 
 besides existing in the arteries and veins, is placed in a 
 state of particular combination, and of intimate union 
 with the other organic elements of the viscus, and with 
 a large quantity of albumen ; that this peculiar combi - 
 nation of the blood forms the dark grumous fluid just 
 mentioned, which may be easily seen by scraping the 
 spleen with the handle of a scalpel. Of the latter, 
 there can be no doubt; but a question arises whether it 
 is contained in the cells I have just spoken of, or in the 
 
CONTENTS OF THE ABDOMEN. 245 
 
 extremities of the vessels. Slight examination is in 
 favour of the former, but M. Marjolin denies it, on the 
 following gi’ounds: That injections, cautiously made, 
 pass immediately from the arteries into the veins j and 
 that when the spleen, successfully injected, is frozen, 
 qne can see no ice in the interstices of the vessels, 
 while the capillary ramifications of the vessels disten- 
 ded hy the injected fluid, are distinctly seen. The 
 probability then is, that the peculiar structure of the 
 spleen is formed essentially, of arterial and venous 
 capillary vessels, with very delicate and extensible 
 coats, and that they communicate with each other, 
 without the intermedium of any cell; and that the ex- 
 treme tenuity of these vessels, and their extensibility 
 in every direction, are sufficient to explain the aug- 
 mentation of volume which the spleen affords, under 
 certain circumstances, and the promptitude with which 
 it diminishes under others. 
 
 Of the Pancreas, {Pancreas.) 
 
 This is an oblong conglomerate gland, extending 
 across the spine, and fixed in the back and lower part 
 of the epigastric region. It is connected to the spleen 
 on the left, to the duodenum on the right, is behind 
 the stomach and between the laminae of the transverse 
 mesocolon. 
 
 The Pancreas is of a light grey colour. It is about 
 seven inches long and two wide; and would represent 
 
OF THE TRraK. 
 
 r24b 
 
 tolerably a parallellogram, if at its right extremity, it 
 were not swollen out into a head, to which Winslow 
 gave the name of Small Pancreas. It has two faces, 
 two edges, and two extremities. The anterior face 
 is turned obliquely upwards and corresponds with the 
 superior lamina of the mesocolon. The posterior face 
 is obliquely downwards, has a long fossa in its upper 
 part for the splenic vessels, and is in contact witli the 
 aorta, vena cava ascendens, the superior mesenteric 
 vessels, and several nerves. 
 
 The pancreas has no peritoneal coat, excepting the 
 mesocolon, neither has it a proper tunic, unless one 
 should consider as such the lamina of condensed cellu- 
 lar membrane which envelopes it, and which sends 
 in processes between its lobules. 
 
 The structure of the pancreas strongly resembles that 
 of the salivary glands and consists of granuli, united 
 into lobules, which form lobes whose intei*stices arc 
 occupied with numerous vessels. The excretory duct 
 of the gland arises from these granulations, by ver)' 
 fine radicles which, uniting, form larger cylindei’s in- 
 clining from left to right. These latter empty succes- 
 sively into a long tube, the Ductus Wirsungii, going 
 the whole length of the gland and situated near tlie 
 very centre of its substance ; it is small at the splenic 
 extremity, but gradually increases till it becomes as 
 large as a crow’s quill at the other end. It is there 
 joined by the duct of the lesser pancreas, and in a short 
 course afterwards empties into the ductus communi" 
 
CONTENTS OF THE ABDOMEN. 247 
 
 choledochus, or runs at its side and makes a distinct 
 opening into the duodenum at the posterior part of its 
 second curvature. 
 
 The arteries of the pancreas are principally de- 
 rived from tlie splenic. The veins empty into the 
 splenic. 
 
 Of the Kidneys, {Renes,) 
 
 To get a good view of the kidneys, the other abdomi- 
 nal viscera should be removed, or at least the intes- 
 tines. 
 
 The Kidneys are two glandular bodies for the secre- 
 tion of urine, fixed one on each side of the spine. They 
 are in the back part of the lumbar regions in a space 
 extending from the upper part of the eleventh dorsal 
 vertebra to the lower part of the second lumbar, 
 though the right, in consequence of the pressure of 
 the liver from above, is lower down than the left. 
 They are deposited in a large parcel of fat on the up- 
 per part _of the great psose, the quadrat! lumborum 
 muscles, and on the lower part of the great dia- 
 phragm. 
 
 The shape of the kidney is a compressed ovoid ex^ 
 cavated on one side like a bean. The broad end of the 
 ovoid is above, and the excavation presents obliqudy 
 forwards and inwards. The latter has a deep fissure 
 in it for the passage of the blood-vessels and excretory 
 duct. The kidney is hard and solid ; its colour is brown . 
 
248 
 
 OF THE TRUNK. 
 
 The kidney has not a peritoneal coat^ but it has a 
 proper capsule, which completely envelopes it and 
 penetrates into its fissure. The capsule is there per- 
 forated with many foramina for transmitting the blood- 
 vessels. This membrane is fibrous, semi-transparent, and 
 somewhat elastic ; it is easily peeled from the surface 
 of the kidney, and in doing so we see that it adiieres 
 by a very delicate cellular and fibrous tissue and by 
 some small vessels. The kidney being originally form- 
 ed in lobes which subsequently unite, the vestige of 
 this union is frequently preserved. 
 
 The kidney being laid open longitudinally, we shall 
 obtain an idea of its internal arrangement. It is seen 
 obviously to consist of two parts of different appear- 
 ance; the external; which, from its. position, is called 
 Cortical; and the Internal or Tubular. 
 
 In regard to the structure of the kidney, it receives 
 from the aorta, at right angles, a large artery, the 
 Emulgent, which divides into several branches as it ap- 
 proaches the fissure ; these terminate by penetrating to 
 all parts of the gland in a crowd of arterioles, so that 
 when they are injected with wax and corroded, the 
 figure of the gland is preserved. Some of these mi- 
 nute arterial branches terminate in corresponding veins, 
 others in the parenchymatous structure of the organ, 
 and others in the excretory branches. 
 
 The Cortical part is the most vascular ; it is, at an 
 average, about two lines in depth, and forms the peri- 
 phery of the gland, but different portions of it project 
 
CONTENTS OF THE ABDOMEN. 
 
 249 
 
 and form partial partitions between the tubular sections. 
 It tears with facility, with a granulated edge or surface^ 
 and its colour is a dark or reddish brown. When view- 
 ed with a microscope the granulations are distinctly 
 seen of extreme minuteness, and formed by the capil- 
 lary extremities of arteries and veins. I have more 
 than once injected these granulations from the arteries, 
 and observed the fluid coming through the ureter and 
 the emulgent vein. 
 
 The second or Tubular portion of the kidneys, to the 
 naked eye, consists of conoidal fasciculi of fibres pre- 
 senting their bases to the periphery of the organ, and 
 their apices towards its centre. These cones are from 
 twelve to eighteen in number, and as mentioned, are 
 partially separated from each other by processes from 
 the cortical part ; they are dense, of a lighter brown, 
 and tear with facility in the course of the fibres. Each 
 cone is formed by a great number of very fine canals 
 converging close to each other near the apex, and 
 continuous at the other end with the vessels of 
 the cortical part. They appear only to give passage 
 to the urine, as cases have occurred, in which they were 
 entirely removed by suppuration and ulceration. (See 
 Wistar Museum.) The technical name for these canals 
 is Tubuli Uriniferi. The terminations of the cones 
 are called Papillse, and an attempt has been made to 
 establish for them some peculiarity of organization | 
 but tliat idea is now abandoned, and they are generally 
 admitted to be the same with the other portions of the 
 
OF THE TRUNK. 
 
 yoO 
 
 tubular part. They have many orifices in them wiiick 
 are the terminations of the tubes, and from which urine 
 in most subjects can be readily squeezed. 
 
 Of the Excretory Ducts of the Kidnies. 
 
 The excretory duct of the kidney begins in its een 
 tre by a dilatation called Pelvis, branching into several 
 funnel shaped tubes named Infundibula. Generally 
 three or four of the latter discharge by their little ends 
 into a common tube, and the union of three or four of 
 the latter, as the case may be, constitutes the pelvis 
 of the kidney. Each papilla has its appropriate infun- 
 dibulum ; but sometimes there are two of the former, 
 to but one of the latter; there are besides many other 
 modifications in the collateral arrangement of the gland, 
 which could not be introduced into an abbreviation like 
 the present. 
 
 The excretory duct of the kidney has two coats, the 
 external of which is fibrous and the internal mucous. 
 The latter is said to be continued over the papillae, and 
 may probably enter into the tubuli uriniferi. It enjoys 
 a great degree of extensibility and contractility of tis- 
 sue, and its sensibility not perceptible in health, is ex- 
 quisite in disease. 
 
 The Pelvis of the kidney is continued into the ureter, a 
 canal about the size of a writing-quill, and which is in 
 contact behind with the psoas magnus muscle, and the 
 iliac and hypogastric vessels, crosses the vas deferens 
 
CONTENTS OF THE ABDOMEN. 25] 
 
 at the back part of the bladder, and passes obliquely 
 through the coats of the latter, to end in an orifice a 
 little behind that of the Urethra. 
 
 The emula:ent veins are uarallel with the arteries, and 
 terminate in the vena cava ascendens. 
 
 Of the Renal Capsules, {Capsulse Renales.) 
 
 They are two little triangular pyramidal bodies, 
 one for each kidney and placed at its superior part : they 
 are of a yellowish brown colour somewhat tinged with 
 red, and being connected with some process of foetal 
 existence, are much larger then than in the adult; 
 their structure also seems to be much clianged in the lat- 
 ter. From being placed precisely on the upper extre- 
 mity of the kidney they have the lower surface which 
 touches it of a corresponding concavity. 
 
 On the exterior of this body is a proper coat formed 
 of lamellated and condensed cellular tissue, which fur- 
 nishes from its internal surface many prolongations di- 
 viding the gland into lobes. These lobes are di\dsible 
 into lobules, which again consist of a granulated struc- 
 ture that seems susceptible of other divisions. These 
 granulations are not firm and resisting. 
 
 In the centre of the Capsula Renalis, sometimes 
 there is a triangular cavity which may be demonstrated 
 by thrusting a tube into it, and inflating, or by an in- 
 cision. In the foetus this cavity contains a reddish 
 Auscid fluid coagulable bv alcohol ; in children it be- 
 
252 
 
 OF THE TRUNK. 
 
 comes yellow : in adults it is dark brown, and in old 
 people it is either wanting or in a remarkably small 
 quantity. 
 
 The arteries of these bodies come from the emul- 
 gents, the phrenics and the aorta. The veins termi- 
 nate on the right side in the cava, and on the left in the 
 emulgent. 
 
 Section V. 
 
 The Diaphragm, {Diaphragma,') 
 
 Is a complete, though moveable septum, placed be- 
 tween the thoracic and abdominal cavities; it is ex- 
 tremely concave below and convex above, the concavity 
 being occupied by several of the abdominal viscera. 
 To view it properly, all the abdominal viscera should 
 be removed, a large billet of wood placed under the loins 
 of the subject, and the peritoneum carefully dissected 
 olf. It is particularly necessary to attend to the latter 
 direction in order to get a good view of the varied 
 structure of this important organ, and the dissector, 
 while performing it, is continually liable to the accident 
 of a puncture being made through it into the thorax ; 
 in which case the diaphragm loses its concavity, and 
 
DIAPHRAGM. 
 
 253 
 
 becoming flabby and displaced, the value and beauty 
 of the display are much impaired,- 
 
 The dissection being properly achieved, exhibits a 
 broad concave muscle connected with the inferior 
 margin of the thorax on all sides, and having for its 
 centre a silvery tendon resembling in its outline the 
 heart of a playing card. This cordiform tendon oc- 
 cupies a considerable part of the extent of the dia- 
 phragm, having its apex next to the sternum and its 
 notch towards the spine ; the muscular part of the dia- 
 phragm is inserted all around its circumference. The 
 cordiform tendon is nearly horizontal in the erect pos- 
 ture, its elevation being on a line with the lowest end 
 of the second bone of the sternum. On each side of 
 this tendon the muscular fibres rise so high upwards 
 before they join it, that they are on a horizontal level 
 with the anterior end of the fourth rib. The fasciculi 
 of muscular fibres are, for the most part, convergent 
 from the circumference of the thorax, and are easily 
 separated from each other. 
 
 In the diaphragm are three remarkable foramina. 
 The first is in the back of the muscle between the spine 
 and the notch of the cordiform tendon, a little to the 
 left. It gives passage to the oesophagus and the par 
 vagum as connected with it, and is rather a fissure or a 
 long elliptical foramen made by the separation and 
 reunion of the muscular fibres; for above and below at 
 each end of the ellipsis these fibres decussate each other 
 in columns. To the right of this foramen aiid a little 
 
254 
 
 OF THE TRUNK. 
 
 above its horizontal level in the back part of the cordi' 
 form tendon, is a very large and patulous foramen for 
 the ascending vena cava. It is between an irregular 
 quadrilateral figure and a circle; its edges are composed 
 of fasciculi of tendon rounded off, and are not suscep- 
 tible of displacement, or of alteration in their relative 
 position to each other, by which means is obviated any 
 impediment which might arise from a different arrange 
 ment, to the course of the blood in the ascending cava. 
 Almost in a vertical line below, but about three inches 
 from the foramen for the oesophagus, is the third hole 
 in the diaphragm, which affords passage to the aorta. 
 It is just in front of the bodies of the three upper lum- 
 bar vertebrae, and is a much longer elliptical hole than 
 the oesophageal; its lowest extremity or pole is consti- 
 tuted by the tendinous crura of the diaphragm, and its 
 upper by a decussation of muscular fasciculi arising 
 from them. Through it, besides the aorta, pass the 
 Thoracic Duct, and the Great Splanchnic Nerve from 
 each side. 
 
 In the horizontal position of either the dead or tlie 
 living body, the right side of the diaphragm ascends 
 higher in the thorax than the left, but the weight of 
 the liver makes it, in the vertical posture, descend 
 lower than the other. 
 
 Thus circumstanced, the Diaphragm arises fleshy, 
 from the internal face of the upper edge of the Xi- 
 phoid Cartilage, from the internal face of the cartilages 
 of the seventh true, and of the succeeding false ribs. 
 
DIAPHRAGM. 
 
 255 
 
 on each side. That is, from tlie cartilages of the eightli 
 and ninth, from the osseous extremities of the tenth and 
 eleventh, and from both the osseous and cartilaginous 
 termination of the twelfth rib. As the line described 
 includes almost the whole of a circle, and the fibres all 
 converge to the cordiform tendon, they, of course, will 
 pass in different radiated directions, and be of different 
 lengths, which it is unnecessary to specify. Between 
 the sternal and costal portions, on each side, there is a 
 triangular fissure filled with fatty cellular tissue, which 
 sometimes leaves an opening for Hernia. I have seen 
 a case of this kind, in which the transverse part of the 
 Colon was the subject of protrusion into the Thorax; 
 It is probable that the great displacement of the abdo- 
 minal viscera, into the thorax of adults or children, may 
 have had a congenital origin in this very fissure, and 
 is subsequently, when the parts are modified to this 
 unnatural situation, set down as a Lusus Naturae. The 
 part described, is called the greater muscle of the Dia- 
 phragm. 
 
 Besides these origins, the , Diaphragm has several 
 from the vertebras of the loins, called its crura, there 
 being four, on each side of the foramen for the aorta. 
 The first pair, entirely tendinous, comes from the front 
 of the body of the third vertebra of the loins, and is 
 prevented from being very distinct in its origin, in 
 consequence of running into the ligament in front of 
 the bodies of all the vertebrae. The second pair of 
 heads is on the outside of the first, and arises tendinous 
 
236 
 
 OF THE TRUNK. 
 
 from the Intervertebral ligament, between the second 
 and third vertebrae. The third pair of heads arises 
 tendinous from the upper part of the lateral margins 
 of the second lumbar vertebra. And the fourth pair of 
 heads comes also tendinous from the fore part of the 
 roots of the transverse processes of the second lumbar 
 vertebra. These tendinous heads terminate in what is 
 called the Lesser muscle of the Diaphragm, which is 
 inserted into the notch of the cordiform tendon. It 
 will now be understood that the aorta passes between 
 the heads of the lesser muscle, and that the oesophagus 
 has a hole in the upper part of its belly. * 
 
 The origin of the Diaphragm is completed between 
 its greater and lesser muscles, by a tense ligament, 
 called Ligamentum Arcuatum, which passes from the 
 root of the transverse process of the first lumbar ver- 
 tebra to the inferior part of the middle of the twelfth 
 rib; with the upper edge of this ligament the Dia- 
 phragm is connected; and with the lower, the psoas 
 magnus muscle. At the margin of the other ribs, the 
 diaphragm is connected with the transversalis abdo- 
 minis. 
 
 The action of this muscle, in assisting respiration, 
 is very obvious ; its fibres passing in a curved line with 
 
 This origin of the lesser muscle of the Diapliragm is given 
 by Albiniis, but it is difficult to make out fairly, and for the 
 most part it would be much better to say that it arises tendinous, 
 from the first, second, and third vertebrae. The heads arc 
 occasionally much sumher on one side than the otlier. 
 
PSOAS MAGNUS. 
 
 257 
 
 their convexity, towards the thorax, from the bony 
 margin of the thorax to the cordiform tendon, and hav- 
 ing a tendency to become straight by contracting, 
 will descend, and thereby enlarge the thorax. It is 
 not certain that the cordiform tendon descends, its con- 
 nexions being too strong and numerous to admit of 
 much motion. In expiration, the relaxation of the 
 Diaphragm, with the contraction of the abdominal 
 muscles, restore the former to its first state. In vomit- 
 ing, the Diaphragm and abdominal muscles concur to 
 expel the contents of the stomach. 
 
 The Psoas Magnus muscle arises, fleshy, from the 
 side of the bodies of the last dorsal and of the four up- 
 per lumbar vertebrae, and from the transverse pro- 
 cesses of all the lumbar vertebrae. It forms an oblong 
 fleshy cushion on the side of the lumbar vertebrae, and, 
 constituting the lateral boundary of the inlet to the pel- 
 vis, it passes out of the pelvis, under Poupart’s ligament 
 about its middle. 
 
 It is inserted, tendinous, into the trochanter minor 
 df the os femoris, and fleshy for an inch below it. 
 
 It bends the body forwards, or draws the thigh up- 
 wards. 
 
 The Psoas Parvus, arises, fleshy, from the conti- 
 guous edges of the last dorsal andof the first lumbar verte- 
 bra at their sides, and from the intervertebral ligament. 
 It is at the anterior and internal edge of the psoas mag- 
 
 K k 
 
258 
 
 OF THE TRUNK. 
 
 nus ; has a short belly, and a long tendon by which it 
 is inserted into the linea innominata, about half-way be- 
 tween the spine of the pubes and the junction of this 
 bone with the ilium. The tendon, besides, is expand- 
 ed into the fascia iliaca. 
 
 Its use seems to be, to draw upwards the sheath of 
 the femoral vessels which is derived from the fascia 
 iliaca, and consequently to draw upwards the vessels 
 themselves, which probably diminishes the liability to 
 injury from their too great or sudden flexion. This 
 muscle is sometimes wanting. 
 
 The Iliacus Internus occupies the concavity of 
 the ilium, being on the outside of the psoas magnus. 
 It arises, fleshy, from the transverse process of the last 
 lumbar vertebra, from the inner margin of the crista 
 of the ilium, and from its whole concavity ; also from 
 the anterior edge of the concavity of the ilium at and 
 above the anterior inferior spinous process, and from 
 that part of the capsule of the hip joint near this process. 
 
 This muscle terminates in the tendon of the psoas 
 magnus just above the insertion into the trochanter 
 minor. 
 
 It has the same action with the psoas magnus. 
 
 The Quadrates Lumborum is an oblong muscle 
 passing from the back part of the spine of the ilium, by 
 a tendinous and fleshy origin of two inches in length. 
 It lies at the side of the lumbar vertebrae, into all the 
 
QUADRATUS LUMBORUM. 
 
 259 
 
 transverse processes of which it is inserted by short 
 tendinous slips. It is also inserted into the lower edge 
 of the last rib just by its head, and into the transverse 
 process of the last vertebra of the back. 
 
 It bends the loins to one side, and will draw down 
 the last rib. This muscle is covered posteriorly, by the 
 tendinous origin of the transversalis abdominis muscle, 
 which separates it from the sacro lumbalis and longis- 
 simus dorsi. 
 
PART II. 
 
 CHAPTER III. 
 
 Of the Male Pelvis. 
 
 I HAVE chosen to give this a distinct chapter not 
 only on account of its importance, but because the dis- 
 sections which are performed on it have but little con- 
 nexion with the parts just described, are performed in 
 very different postures of the subject from the preceed- 
 ing, and have in them an intrinsic difficulty requiring 
 them to be made in several ways in order to exhibit 
 well the relative position and anatomy of the parts. 
 
 I conceive that the first step of the student, after a 
 short examination in situ of the contents of the pelvis, 
 should be to detach the penis from its bony connexions 
 and to remove it, with the bladder and rectum, from 
 the pelvis. Then to make a fair and clean dissection 
 of these organs by detaching the surrounding fat, cel- 
 lular membrane, and muscles. This dissection is best 
 made with the scissors, and its utility is in proportion 
 to its cleanness ; the latter is much assisted by inflating 
 the bladder and by stuffing the rectum. The scrotum 
 may be separated and laid aside for future examina- 
 tion. 
 
MALE PELVIS. 
 
 261 
 
 Section I. 
 
 Of the Viscei'a of the Male Pelvis. 
 
 The Peetum, being the termination of the colon, be- 
 gins at the left sacro-iliac symphysis; from thence 
 it passes down obliquely towards the middle of the sa- 
 crum about one -half of its length ; its course afterwards, 
 is directly downwards before the sacrum and os coc- 
 cygis till it terminates in the anus; its orifice there points 
 backwards and dowmwards. It is cylindrical till just 
 before its termination, it then dilates into a pouch which 
 is spread on each side of the prostate, and is apt to be 
 cut in lithotomy. 
 
 The inferior third of the rectum is destitute of pe- 
 ritoneum, its anterior face is in contact with the lower 
 fundus of the bladder, the vesiculag serainales, and the 
 prostate gland. Posteriorly and above, it is confin- 
 ed to the sacrum by the mesorectum, which conducts 
 its nerves and blood-vessels. The dip of the peri- 
 toneum, between the vesiculae seminales so as almost 
 to touch the base of the prostate gland should be re- 
 marked. 
 
 The muscular structure of this gut is remarkably 
 strong, consisting, externally, of vertical and parallel 
 fasciculi of fibres close together, and internally of cir- 
 
262 
 
 OF THE TRUNK. 
 
 cular fibres which form a thick and continued plane, 
 particularly on a level with the lower fundus of the 
 bladder. Just below the pouch of the reetum these 
 circular fibres form the Internal Sphincter Muscle. 
 The mucous membrane of the gut is smooth above, but 
 at the lower part it is thrown into several longitudinal 
 folds, called the Columns of the Rectum. The villosi- 
 ties of this surface are distinguishable, as well as its 
 mucous lacunae which are numerous. The anus is 
 . thrown into radiated folds from the influence of the 
 sphincter ani. 
 
 The Bladder^ (Vesica Urinaria,) is fixed just behind 
 the symphysis of the pubes and when pressed upon by 
 the neighbouring viscera, is somewhat flattened before 
 and behind; but removed from the body and distended, 
 it resembles an elongated sphere, of which the greatest 
 diameter is vertical in regard to the linea ilio pectinea. 
 The technical name for each end of the sphere is F un- 
 dus, distinguished by the terms upper and lower, the 
 lower being somewhat the more obtuse. From the 
 upper end proceeds to the navel a long conical liga- 
 ment, the Urachus. By putting the anterior parietes of 
 the abdomen on the stretch we shall see starting out 
 and protruding the peritoneum into a semilunar dupli- 
 cature on each side of the urachus, the remains of the 
 umbilical arteries of the foetus which now are called the 
 Round Ligaments of the bladder, though they have but 
 little or no influence on it. At the anterior part of the 
 
MAI.E PET.VIS. 
 
 263 
 
 lower fundus, the bladder is somewhat elongated into a 
 process called its Neck, resembling a truncated cone, 
 and being the commencement of the urethra. 
 
 The bladder consists of four tunics; the Peritoneal, 
 Muscular, Cellular, and Mucous. 
 
 The Peritoneal is a very incomplete coat placed 
 upon the upper and posterior parts of the bladder, and 
 passing from it to the muscles of the abdomen before, 
 and to the rectum behind. It is connected to the 
 muscular coat by very loose cellular membrane, which 
 prevents it from participating in any considerable dis- 
 tentions of the organ, and permits it to leave the ante- 
 rior face of the bladder, so that its reflection to the 
 recti muscles in these cases, is placed much above the 
 pubes. Tapping is performed here, as well as the high 
 operation for the stone. 
 
 The Muscular coat consists of flattened fasciculi 
 of white fibres passing in very varied directions, and 
 separated to some distance from each other. Many of 
 them arise from the neck of the bladder and pass before 
 and behind upwards towards the urachus, where they 
 end; others, arising laterally from the same place, pass 
 up in a corresponding course and also terminate at the 
 urachus. There are many transverse and oblique 
 fibres uniting these together, but still leaving interstices 
 through which the internal coat occasionally protrudes, 
 and thus forms cells in the cavity of the bladder. 
 
264 OF .THE TRUNK. 
 
 There is an accumulation of fibres about the neck of 
 the bladder and the urachus, which gives an increased 
 thickness at these points. 
 
 The Cellular coat consists of a close, dense, lamel- 
 lated, and fibrous tissue, highly extensible and difficult 
 to tear. It is impervious to water, closely adherent to 
 the muscular and mucous membranes, and pervaded by 
 many vessels. 
 
 The Mucous, or internal coat of the bladder, though 
 called villous, has less of this appearance than tliat of 
 the stomach. It is white with a slight tinge of red; 
 abounds with mucous follicles which, in a state of health, 
 are difficult to be discerned; possesses great extensi- 
 bility and but little contractility, from whence, when 
 the bladder is not very full, it is thrown into folds pass 
 ing in various directions. It offers several points for 
 observation. 1. A triangular space between the orifice 
 of the urethra and those of the ureters, (the Trigone 
 Vesicale of die French,) which is elevated into a plain 
 smooth surface. Mr. Charles Bell thinks the lateral 
 margins have muscular fibres beneath intended to regu- 
 late the orifices of the ureters.* 2. The Uvula 
 Vesicse, a small pointed production terminating the 
 triangle in front, and formed by a projection of the 
 
 * My personal Investigations on this point have not verified 
 the assertion. 
 
MALE PELVIS. 
 
 265 
 
 third lobe of the prostate gland into the cavity of the 
 bladder. 3. The orifices of the ureters, about an inch 
 behind the orifice of the urethra. 4. The Inferior 
 Fundus, (bas-fond of the French,) a depression of the 
 general concavity of the bladder making it lower than 
 any other part, placed between the base of the trigone 
 and the posterior side of the bladder. 5. The Inter- 
 nal Orifice of the neck of the bladder, resembling some- 
 what a crescent, extending its horn around the uvula 
 vesicse. 
 
 The Neck of the Bladder is thicker than any other 
 part 5 it is surrounded by cellular tissue in which a 
 great number of veins is found, and it penetrates, in 
 front, the prostate gland, which has a continual tendency 
 to close it. The muscular fibres concurring in its forma- 
 tion have not been considered, by the greater number 
 of anatomists, as sufficiently regular to form a distinct 
 sphincter muscle, but Mr. Charles Bell differs from 
 them and gives the following account of it: Begin 
 
 the dissection by taking off the inner membrane of the 
 bladder from around the orifice of the urethra. A set 
 of fibres will be discovered on the lower half of the 
 orifice which, being carefully dissected, will be found 
 to run in a semicircular form round the urethra. These 
 fibres make a band of about half an inch in breadth, 
 particularly strong on the lower part of the opening, 
 and, having mounted a little above the orifice on each 
 side, they disperse a portion of their fibres in the sub- 
 stance of the bladder. A smaller and somewhat weaker 
 
 L 1 
 
266 
 
 OF THE TRUNK. 
 
 set of fibres will be seen to complete their course, sur- 
 rounding the orifice on the upper part; to these sphinc- 
 ter fibres a bridle is joined, which comes from the union 
 of the muscles of the ureters.” 
 
 ProUate Gland, {Glandida Parastata.) 
 
 This is a body about the size and form of a hoi’se 
 chestnut, fixed on the neck of the bladder, and pene- 
 trated by tbe urethra, which traverses it much nearer 
 its superior than its inferior surface. The base of it is 
 turned backwards, and the point forwards; its inferior 
 surface rests upon the rectum, and its sides, in the dis- 
 tentions of this organ by fasces, are overlapped by it. 
 The Prostate has, posteriorly, a notch in its centre, 
 which divides it into two lateral lobes, and by raising 
 the Vesiculas Seminales, we shall see where their ex- 
 cretory ducts penetrate the gland, and separate from 
 the body of it the little tubercle, to which Sir Everard 
 Home, has particularly called the attention of the pro- 
 fession, and considered as a Third Lobe, it being cer- 
 tain that it is frequently the seat of disease and tume- 
 faction. (See Wistar Museum.) 
 
 The organization of this body seems to consist in a 
 condensed, white, extensible, though easily lacerated 
 cellular tissue, and within it are placed a great numbei’ 
 of mucous follicles, which form from eight to twelve 
 ducts, passing obliquely forwards, and terminating in 
 the urethra on each side of the urethral crest or Caput 
 
MALE PELVIS. 
 
 26 ? 
 
 Gallinaginis. The fluid secreted is thick, ropy, white, 
 and semitransparent in a healthy state. The Prostate 
 is surrounded by a fibrous capsule, of which more 
 hereafter.* 
 
 The Seminal Vesicles, (Vesiculm Seminales,) are 
 two convoluted bodies of two inches in length, one on 
 each side of the lower fundus of the bladder, approach- 
 ing each other very nearly at the base of the Prostate, 
 but diverging much as they recede. They are sepa- 
 rated before, by the interposition of the vasa deferential 
 and being fixed between the rectum and the bladder, 
 they are matted to the latter by a close cellular mem- 
 brane, having many large veins pervading it. 
 
 When inflated and dried, they present the semblance 
 of cells, but are in fact long tubes, which, by being 
 convoluted, are reduced to the apparent dimensions 
 mentioned : there are also several pouches on each side 
 of this long tube which increase the number of cells. 
 The convolutions are preserved by the intermediate 
 cellular tissue. These bodies consist of two coats, an 
 external, which is, fibrous and cellular ; and an internal, 
 which is mucous, being a continuation of the lining 
 membrane of the bladder. They are commonly filled 
 by a drab-coloured thick fluid, supposed to be a 
 
 * An opinion prevails among the anatomists of Philadelphia, 
 that the prostate is larger in the African than in whites. Indeed 
 this much may be said of all the organs of generation in both 
 
 sexes. 
 
268 
 
 OF THE TRUNK. 
 
 mixture of the semen, and of their own proper sec re 
 tion, though, of this, Mr. Hunter doubted.* The ex- 
 cretory duct of each vesicle is about a line and a half 
 long, when it joins in the substance of the prostate 
 with the vas deferens of the same side; a common 
 canal, (Ductus Ejaculatorius) is thus formed, which 
 runs parallel with its fellow, below the urethra. 
 
 The Ductus Ejaculatorius, is about eight or ten 
 lines long, and opens by an oblong orifice, at the late- 
 ral anterior face of the Caput Gallinaginis ; it is larger 
 behind than before, which gives it a conical shape, and 
 allows fluids injected to pass freely from the vas defe- 
 rens to the vesicula, or the reverse. . 
 
 Of the Penis, {^Memhrum Virile, Meniula.) 
 
 It is a membranous and cellular body afiixed to the 
 margin of the pelvis, at and below the symphysis pubis, 
 and appropriated to the passing of urine and semen. 
 It is formed by the common integuments, by cellular 
 tissue, by the corpus cavernosum, and by the corpus 
 spongiosum. 
 
 The skin covering the penis is more thin and deli- 
 cate than in most other parts of the body, and is fur- 
 nished with a considerable number of sebaceous follicles, 
 more particularly about the root of the organ. It is 
 
 See Observations on the Animal (Economy. 
 
Mx\LE PELVIS. 
 
 269 
 
 very loosely connected by cellular membrane to the 
 parts beneath, so that -it is easily made to correspond 
 with all states of the penis. At the anterior extremity 
 it is arranged into a duplicature or fold, the Prepu- 
 tium, which is inserted just behind the glans; the 
 iiiferior part of the prepuce is connected with the ex- 
 tremity of the glans by a process called Frsenum. 
 
 The penis, besides arising from the bones of the 
 pelvis in a manner which will be presently explained, 
 is fixed to the symphysis pubis by a ligament, (Liga- 
 mentum Suspensorium,) which is a triangular fibrous 
 body, flattened triansversely and lost insensibly on the 
 fascia of the thigh covering the adductor muscles. The 
 portion of it which goes to the penis arises in front of the 
 symphysis pubis and is inserted into the dorsum of the 
 penis near its root ; from this insertion it is extended 
 laterally over the penis, and according to Mr. Colles con- 
 stitutes one of its coverings, by going as far as the glans. 
 Professor Marjolin says that he has seen on several 
 occasions muscular fibres entering into its composi- 
 tion, and in that case it draws the organ with more 
 force towards the anterior parietes of the abdomen.* 
 
 The Corpus Cavernosum of the penis, forms by 
 inuch the most considerable portion of the whole organ. 
 Externally it is a white fibrous membrane of a dense 
 structure, enjoying extensibility and an extreme de- 
 gree of contractility ; its fibres pass for the most part 
 
 * I have seen it in one case, Febniary 1 1th 1825, 
 
270 
 
 OF THE TRUNK. 
 
 longitudinally, except about the root, where they arc 
 blended with the periosteum of the bone, and with the 
 tendons of the muscles. This coat of the penis is occa- 
 sionally called its elastic ligament. It arises by tw'o 
 conical crura, one from the internal face of the crus of 
 each pubes and ischium, to wdthin a little distance of 
 the anterior part of the tuber ischii. At the lower 
 part of the symphysis pubis these crura join and form 
 a body, which, when stripped of its connexions, resem- 
 bles two cylinders lying along side of each other and 
 united ; anteriorly they terminate in common by a trun- 
 cated cone covered obliquely by the glans. At the pos- 
 terior part of the corpus cavernosura, in its centre, 
 there is a tolerably complete septum of the same kind 
 of substance, separating its tw o halves from each other, 
 but anteriorly this septum is imperfect, having an 
 arrangement like the teeth of a comb, whence the 
 term Septum Pectiniforme. 
 
 In the middle of the corpus cavernosum above, is a 
 longitudinal sulcus for lodging the veins of the penis, 
 and in tlie same manner below, another for the corpus 
 spongiosum urethrse. The cavity of this membrane 
 is filled by a spongy tissue, w'hich arises from its inter- 
 nal face, and is formed of filaments and little lamime ; 
 they, by crossing each other, form a multitude of cells 
 which have a perfectly free communication with 
 each other, and generally are somewhat occupied by 
 blood. 
 
 The Corpus Spongiosum Uretlirm extends from tei; 
 
MALE PELVIS. 
 
 271 
 
 or twelve lines behind the junction of the crura of the 
 corpus cavernosum, to the anterior extremity of the 
 penis. . Externally it is covered by a coat resembling 
 that of the corpus cavernosum, except that it is thinner. 
 In its centre is the canal for the urine. Between this 
 canal and the coat is a spongy structure, much finer 
 than that of the corpus cavernosum, and though the cells 
 communicate freely, still they have the appearance of 
 'convoluted veins. The corpus spongiosum is not of the 
 same thickness in its whole course ; its commencement 
 in the perineum where it is pendulous, is enlarged into 
 what is termed its Bulb, from this it diminishes gi’adu- 
 ally to the end of the corpus cavernosum, where it is 
 again enlarged into the Gians Penis. The transverse 
 diameter of the glans being larger than that of the body 
 of the penis, it forms all around a projecting shoulder, 
 the Corona Glandis. The surface of the glans is covered 
 by a very delicate epithelium, and has a gi’eat number of 
 papillae for the distribution of nerves. Numerous folli- 
 cles also exist about the corona glandis, to secrete the 
 sebaceous fluid which collects there in persons who are 
 not cleanly. 
 
 The Urethra is a canal whose length varies accord- 
 ing to the degree of erection in the penis, and extends 
 from the neck of the bladder to the extremity of the 
 glans. It has several curvatures and receives in its 
 course the ductus ejaculatorii, the excretory ducts of 
 Couper’s glands, and the mucous lacunae of its internal 
 membrane. The first part of this canal which traver- 
 
272 
 
 OF THE TRUNK. 
 
 ses the prostate gland is about fifteen or eighteen lines 
 in length; it is the Prostatic Portion, and is well sup- 
 ported by this body, although its own sides are very 
 thin. On its inferior surface is the Verumontanum or 
 Caput Gallinaginis, an oblong projection of the lining 
 membrane an inch in length, broad behind where it 
 commences a little in advance of the Uvula Vesicse, and 
 coming to a point very gradually before. In the pos- 
 terior ridge of the caput is a long cleft, which is the 
 orifice of a large lacuna observed first by Morgagni ; and 
 on the front surface on each side, is the orifice of the ductus 
 ejaculatorius. On the sides of the caput gallinaginis the 
 canal of the urethra is depressed into something like a 
 cul-de-sac, where are to be found from four to six very 
 small orifices, or according to Loder from sixteen to 
 twenty-two, belonging to the lacunae of the prostate 
 gland. 
 
 Between the Prostate and the Bulb is the Membra- 
 nous Part of the urethra, about eight or ten lines long; 
 it is unprotected except by a soft covering which seems 
 in some measure to be a mixture of gelatinous matter 
 and muscular fibre. The former was considered by 
 Littre as a glandular body which secreted a viscid 
 humour into the interior of the canal ; the latter pro- 
 bably is the part described by Winslow as the infe- 
 rior prostatic muscle, which arising on each side of 
 the membranous canal goes to be inserted into the cor- 
 responding branch of the pubes near the symphysis. 
 The membranous part of the urethra does not get 
 
MALE PELVIS. 
 
 273 
 
 iato the end of the bulb, but penetrates it from above, 
 half an inch or more occasionally, from its extremity, 
 just below the junction of the crura of the Corpus 
 Cavernosum. 
 
 The canal varies in its dimensions; at its commence- 
 ment at the bladder it is large; it then contracts at the 
 back of the caput gallinaginis, and hnmediately enlarges 
 in the fore part of the prostate. The membranous part 
 is small; the canal then enlarges in the bulb. In the 
 body of the penis the canal is successively diminished, 
 till it comes almost to the glans, when it is so remark- 
 ably enlarged as to get the name of Fossa Navicularis; 
 it terminates finally by a short vertical slit at the 
 extremity of the glans. 
 
 In the whole length of the canal there are two 
 whitish middle lines, one above and the other below, 
 •and in the membranous and spongy portions, excep- 
 ting the fossa navicularis, longitudinal folds of the 
 lining membrane exist, which are effaced by distention. 
 In the upper part of the canal there are a great many 
 mucous lacunae; Loder, in his plates, has marked about 
 sixty-five; there is one particularly large in the upper 
 surface of the fossa navicularis, which, it is said, has 
 stopped the point of a bougie and been mistaken for 
 stricture.* 
 
 * Sir Everard Home has lately communicated to the Royal 
 Society a highly interesting paper on the structure of the lining 
 membrane of the urethra. From his microscopical observa- 
 tions, he is induced to tbink, that there can be no doubt of its 
 Aiuscularity. 
 
 M m 
 
274 
 
 OF THE TRUNK. 
 
 At the posterior part of the hulb are Couper*s 
 Glands, two small bodies about the size of a garden 
 pea. Their excretory ducts are about an inch long, 
 and, passing very obliquely under the internal mem- 
 brane of the urethra, they terminate at the anterior 
 part of the bulb, in the lower side of the canal. Other 
 glands, but smaller, of the same kind are said to exist 
 occasionally; I have never seen them except in a pre- 
 paration in the museum of Mr. Bell in London. Mor- 
 gagni and Couper describe them. Marjolin says their 
 existence is not constant, though they have been des- 
 cribed by many anatomists. 
 
 Mr. Shaw of London has described a set of vessels 
 immediately on the outside of the internal membrane 
 of the urethra, which, when empty, are very similar, 
 in appearance, to muscular fibres. He says he lias 
 discovered that these vessels form an internal spongy 
 body which passes down to the membranous part of the 
 urethra, and forms even a small bulb there. See Med. 
 Chir. Trans, vol. x. His preparation, being a quick- 
 silver injection of the part, is certainly a very satisfac- 
 tory demonstration of their existence: yet in my own 
 observations, I have not been able to distinguish them 
 from the cellular membrane connecting the canal of the 
 urethra to the corpus spongiosum. 
 
MALE PELVIS. 
 
 27 5 
 
 Of the Testicles, ( Tester . ) 
 
 These bodies, two in number, are surrounded by 
 several coats, the most external of which, is common 
 to both the testicles and is called Scrotum; the 
 others are proper. The scrotum is a sac formed by a 
 continuation of skin from the internal sides of the 
 thighs, from the inferior part of the penis, and from 
 the anterior part of the perineum. It is very thin, 
 darker than the rest of the skin, sparingly covered 
 with hairs, has many sebaceous follicles in it, and is 
 closely united to the cellular membrane beneath. It 
 is very extensible, and has a great power of contraction, 
 its surface being covered with w^rinkles which are 
 more apparent when it is contracted. It consists of 
 two symmetrical halves marked off from each other by 
 an elevation of skin, the Raphe, w^hich extends from 
 the perineum over the scrotum along the inferior sur- 
 face of the penis to the end of the latter. 
 
 Beneath the scrotum is the Dartos, a fibrous mem- 
 brane, which is vascular, reddish, and deprived of fat ; 
 it arises from the inferior margins of the crura of the 
 ischia and pubes, and passing downwards, it joins 
 the raphe ; it is then reflected upwards, forms a sep- 
 tum between the two sides of the scrotum, and goes 
 up to the inferior part of the urethra. This mem- 
 brane has been confounded with cellular substance, but 
 it appears frpjn the reports of Messieui’s Chaussier, 
 
276 
 
 OF THE TRUNK, 
 
 Lobsteiii, and Breschet^ that it does not exist in the 
 scrotum till the descent of the testicle, and that it is 
 an expansion of the gubernacuhmi testis. 
 
 Notwithstanding its great contractility, the ques- 
 tion of its muscular structure is not settled, and cer- 
 tainly, ill the greater part of its extent, there is not 
 the appearance of muscular fibre, but at its poste- 
 rior end, just at the anterior point of the sphincter 
 ani, I have often seen a broad muscular expanse, the 
 character of which could scarcely be misconceived. 
 The contractility of the scrotum has been attributed 
 to the cremaster muscle instead of to this membrane, 
 but common observation will convince most pei'sons 
 that the elevation of the testicles in the scrotum by 
 the contraction of the cremastei’s is very distinguish- 
 able from that contraction of the scrotum by which 
 the testicle&are squeezed against the sides of the pubes 
 and the scrotum brought into a hard corrugated mass. 
 
 The Cremaster muscle is rjither an imperfect coat ; 
 its course has been explained in the account of the 
 abdominal muscles. Its fibres are much separated on 
 the tunica vaginalis; they lay on its front part, and oh the 
 internal and external sides of the spermatic cord- With- 
 in the last is a coat of cellular substance the Tunica 
 Vaginalis Communis. 
 
 The Tunica Vaginalis Testis was originally a pro 
 cess of peritoneum, though it appears in the adult as a 
 complete sac. The testicle being protruded into ii 
 from behind, one half of the sac applies itself closely to 
 
MALE PELVIS. 
 
 277 
 
 the epididymis and testicle, while the other half is 
 "loose; the whole arrangement being precisely after the 
 manner of the double night-cap when drawn over the 
 head. It passes up some distance on the cord; its cavity 
 is smooth, polished, and moistened by a. synovial haliius 
 which allows the surfaces to move freely upon each 
 other. 
 
 The Tunica Albuginea is the proper coat of the 
 testicle which preserves its form, and is in immediate 
 contact with the glandular structure. It is a dense, 
 strong, white, and fibrous membrane, corresponding 
 very much in its general characters with the tunica 
 sclerotica of the eye. From the internal surface of 
 the albuginea, several membranous processes forming 
 partial partitions pass off, and terminate at the pos- 
 terior part of the cavity in the Corpus Highmorianiim. 
 These septulse conduct the blood-vessels through the 
 substance of the gland, and form little apartments filled 
 up by the seminiferous tubes. The Corpus Highmo- 
 rianum is a longitudinal projection of the tunica albu- 
 ginea, somewhat broader above than below ; its upper 
 part is perforated by the vasa efferentia. 
 
 The form of the Testicles as communicated by the 
 tunica albuginea, is very much that of an oval, some- 
 what compressed laterally, the edges presenting for- 
 wards and backwards; they do not hang with the long 
 diameter vertical, but the upper end is advanced a 
 little forwards, and the lower points somewhat back- 
 wards. They are both of the same size generally, but 
 
278 
 
 OF THE TRUNK. 
 
 in case of a difference the right is larger; it is also 
 higher up than the left, a circumstance which has been 
 marked by sculptors in all ages. 
 
 The glandular structure of the testicle consists of a 
 congeries of convoluted tubes, stated by Monro to 
 amount to three hundred, whose diameters do not 
 exceed individually the one two-hundredth part of an 
 inch, and when extended to their full length, would 
 form in the aggregate, a tube 5208 feet long. These 
 tubes, almost inconceivably line as they are, can be 
 injected in a retrograde course through the vas deferens 
 with mercury, but the task is one of exceeding diffi- 
 culty, and scarcely ever succeeds. Such preparations 
 are consequently very rare in anatomical cabinets. 
 Those which I have noticed particularly, were made by 
 Mr. Shaw of London for the Museum of Mr. Bell, 
 and by the present Professor Sandifort, for the col- 
 lection at Leyden. Haller has introduced the plate 
 of one in his Opusculum Minus, which was highly dis- 
 tinguished in its time, but in this the mercury does 
 not seem to have pervaded fully the tubuli seminiferi, 
 notwithstanding which, it went far to establish the struc- 
 ture of the testis, and to settle the dispute in regard to 
 the organization of the corpus higbmorianum. 
 
 The Tubuli Seminiferi, it has been stated, fill up 
 nearly the whole of the cavity of the albuginea, being 
 kept from each other by the processes termed Septulse. 
 These tubes send out a great number of trunks, which, 
 from their observing a straight coui'se, obtain the name 
 
MALE PELVIS. 
 
 279 
 
 of Vasa Recta. These vasa reeta unite and form a net- 
 work, the Rete Testis. From the rete testis there 
 proceed from twelve to eighteen tubes, whieh pass 
 through the upper part of the eorpus highmorianum, 
 and get to the outside of the tuniea albuginea; these 
 are the Vasa Elferentia. Each of these vasa is rolled 
 iip - externally at this plaee, so as to give the outline 
 pf a cone, therefore, it gets the name of Conus Vascu- 
 losus. Each cone successively empties into a single 
 tube on the back of the testis, which is prodigiously 
 convoluted and forms a large body, the Epididymis. 
 
 The Epididymis is a prismatic arch enlarged at both 
 extremities, and resting vertically on the back of the 
 testicle, being connected with it by the tunica vagi- 
 nalis. The enlargement above is the Globus Major, 
 and is formed of the coni vasculosi, but what remains 
 of this body below, consists of one tube excessively con- 
 voluted. The enlargement below is the Globus Minor; 
 after this is formed, the tube becomes less convoluted 
 and turns upwards on the inside of the epididymis, and 
 a little further on it becomes nearly straight, and is 
 called Vas Deferens. There is a blind duct which, 
 commences at the top of the epididymis and terminates 
 below, the intention of which is not known. 
 
 The Vas Deferens is a white tube about a half line 
 in diameter, having a cartilaginous feel; its cavity is 
 large enough to admit a bristle.. It passes on the back 
 
 * It is sometimes called the Vasculum Aberrans Halleri, and 
 is said, by Mr. Cruikshank, to be an anomaly. 
 
280 
 
 OF THE TRUNK. 
 
 of the spermatic cord, and continues with it through 
 the abdominal canal; at the internal ring it leaves the 
 residue of the cord, and dipping into the pelvis by the 
 side of the bladder, goes between it and the ureter to 
 the lower fundus, approaching its fellow on the inside 
 of the vesiculse seminales, and ending in the urethra. 
 About two and a half inches from its termination it be- 
 comes somewhat tortuous and enlarges. 
 
 The Spermatic Cord is formed of the Vas Deferens, 
 the Spermatic Artery and Veins, Lymphatics, Nerves, 
 and Cellular Membrane, all covered by the Cremaster 
 muscle. The artery arises from the aorta and retains 
 its first size till it arrives at the testis, it then divides, 
 some of its branches being spent on the epididymis, 
 and the remainder going into the testis, and termina- 
 ting on the tubes. The veins in ascending form a 
 remarkable plexus, the Corpus Pampiniforme, at the 
 internal ring they unite into one trunk, which on the 
 right joins the ascending cava, and on the left the 
 emulgent vein. 
 
 Having thus become acquainted with the, structure 
 of the viscera of the male pelvis, I advdse tlie student 
 in the next place to put a subject in the posture recom- 
 mended for Lithotomy, in order that he may work on 
 the Perineum, 
 
MALE PELVIS. 
 
 281 
 
 Section II. 
 
 Of the Perineum and the Fascise of the Male Pelvis. 
 
 The subject being fixed in the posture indicated, 
 make a horizontal cut through the skin, at the junction 
 of the raphe of the perineum with tlie scrotum, ex- 
 tending it on each side three inches; drop perpendicu- 
 lar cuts equally profound with the first from both of its 
 extremities, to a line which would pass horizontally 
 through the point of the os coccygis. The skin con- 
 stituting this flap being raised up carefully, so as not to 
 injure subjacent parts, the structure of the perineum is 
 sufliciently opened for the time. 
 
 The Perineal Fascia is first exposed; it occupies 
 nearly all the space between the anus and the posterior 
 margin of the scrotum, (insensibly blending with the 
 latter,) and between the rami of the pubes and of the 
 ischia, being very firmly fixed to these bones. This 
 fascia, in case of rupture in the posterior part of the 
 urethra, prevents the urine from showing itself in 
 the perineum, and drives it into the cellular struc- 
 ture of the scrotum. In abscesses of the perineum, 
 it also prevents the fluctuation from being very evident. 
 Having studied well its connexions, structure and in- 
 fluence, it is to be cleared away in order to bring into 
 view the Perineal Muscles. 
 
 N n 
 
282 
 
 OF THE TRUNK. 
 
 The Erector Penis is so situated as to cover the whole 
 of the crus of the penis which is not in contact with the 
 bony margin of the pelvis. It arises, therefore, from 
 the anterior part of the tuber ischii tendinous and 
 fleshy, its fleshy fibres, adhering to the internal and 
 external margins of the rami of the pubes and ischium, 
 proceed upwards, and, just before the union of the 
 crura of the penis, end in a flat tendon which is lost 
 on the side of the elastic membrane of the penis. ^ 
 
 Its use is not well understood. 
 
 The Accelerator Urinac lies on the bulb and back 
 part of the corpus spongiosum urethrae; it is a thin 
 muscle consisting of oblique fibres. 
 
 It arises by a pointed production from the side of the 
 body of the penis; its origin is continued obliquely 
 across the inferior surface of the crus where the 
 latter begins to form the body of the penis. It arises 
 also from the inner side of the ramus of the pubes be- 
 tween the crus penis and the triangular ligament of the 
 urethra. The muscles of the opposite sides are insert- 
 ed into each other by a white line which marks the 
 middle of the bulb of tlie urethra, and by a point into 
 the anterior extremity of the sphincter ani, where they 
 are joined by the transversal es perinei. 
 
 In order to see the origin of these muscles very dis- 
 
 * The late Dr. Lawrance informed me that he has fi-equently 
 found muscular fibres between the bone and the crus penis. 
 
MALE PELVIS, 
 
 283 
 
 tinctiy, separate them from each other in the middle 
 line and dissect them from the corpus spongiosum. Cut 
 transversely through the corpus spongiosum about three 
 inches before the triangular ligament and dissect it 
 clearly from the corpus cavernosum, turning it down- 
 wards so that it may hang by the membranous part of 
 the urethra. By putting the two acceleratores on the 
 stretch it will be seen that, besides the origins men- 
 tioned, they arise also from each other by a tendinous 
 membrane that is interposed between the corpus spon- 
 giosum and cavernosum, so that they literally surround 
 the bulb of the urethra constituting a complete sphinc- 
 ter muscle for it. 
 
 These two muscles are considered by M. Chaussier 
 as forming but one; in that case its origin will be re- 
 versed, and commence in the middle line of the peri- 
 neum instead of terminating there.. The relation of 
 this muscle and the erector penis should be observed, 
 in order to appreciate the difficulty of getting into the 
 membranous part of the urethra in lithotomy, without 
 cutting through the muscular fibres of one or the other. 
 
 It propels the urine and semen forward. 
 
 The Transversus Perinei, as its name implies, passes 
 directly across the perineum ; it arises from the inner 
 side of the tuber ischii just at the origin of the erector 
 penis, and is inserted where the sphincter ani and 
 the acceleratores join. 
 
 I have observed that when the lower part of the 
 
284 
 
 OF THE TRUNK. 
 
 accelerator was extended much below its usual line and 
 strongly developed, that the transversus was very irre- 
 gular in its origin and course, consisting frequently of 
 a few fibres which did not deserve the name of a dis 
 tinct muscle, and were almost unappropriated in the 
 adipose matter of the part. 
 
 Occasionally a fasciculus of muscular fibres exists, 
 called, by Albinus, Transversus Periuei Alter, which 
 arises in front of the former muscle, and is inserted into 
 the perineal junction just behind it. 
 
 The use of these muscles seems to be, to contribute 
 to fix the bulb of the urethra. 
 
 The Sphincter Ani muscle consists in a plane of 
 fibres which surrounds the anus in order to keep it 
 closed. It has two fixed points, the last bone of the 
 os coccygis behind and the perineal union of the other 
 muscles in front; its lateral diameter occupies about one- 
 half of the space between the tuberosities of the ischia, 
 as it is in the middle of this space. 
 
 Besides closing the orifice of the rectum it will draw 
 the bulb of the urethra backwards, or the point of the 
 os coccygis forwards. 
 
 The Coccygeus muscle rather belongs to the interior 
 of the pelvis, but is seen well enough here. It arises 
 by a small, tendinous, and fleshy beginning from the 
 spine of the ischium, and, lying on the anterior face of 
 the anterior sacro sciatic ligament, it is inserted into 
 
MALE PELVIS. 
 
 285 
 
 the sides of the last bone of the sacrum and into all 
 those of the os coccygis. 
 
 It draws the os coccygis forwards. 
 
 The Erectores Penis, Acceleratores Urinse, and 
 Transversi Perinei are now to be removed. A large 
 quantity of adipose and cellular matter will be found on 
 the side of the reetum between it and the parietes of 
 the pelvis, concealing the levatores ani muscles. This 
 fat is better left in situ for the present. 
 
 The muscles being removed, the bulb of the urethra 
 is seen to great advantage, extending in the middle of 
 the perineum almost to the anus. It is not loose and 
 pendulous as described, but is eonnected by its superior 
 face to the Triangular Ligament of the urethra, a mem- 
 brane which fills up the space below the sym.physis of 
 the pubes. This ligament is a septum between the 
 perineum and pelvis, and, when closely examined, is 
 seen to connect itself to the internal edges of the rami 
 of the pubes and ischia on the inner posterior sides of 
 the crura penis as far down as the origins of the latter. 
 At its lower edge its ligamentous character is not so 
 well defined. It extends from the top of the pubic 
 arch downwards to the line mentioned, filling up all the 
 intermediate space between the bones. On its anterior 
 surface is the bulb of the urethra, and just at the extre- 
 mity of the latter, enclosed by the ligament and adher- 
 ing to it, are Couper’s Glands. A perforation exists in 
 it through which passes the membranous part of the 
 
286 
 
 OF THE TRUNK. 
 
 urethra; to get a view of which the corpus spougiosuni 
 if not already detached, must be cut through an inch 
 anterior to the symphysis pubis; dissected carefully 
 from the corpus cavernosum;. and turned down on the 
 perineum. The opening at first is not very apparent 
 m consequence of its edges being continued a little dis- 
 tance on the canal, but by detaching them the hole 
 becomes well defined. 
 
 Here it becomes necessary to attend to the relative 
 situation of the bulb, and of the membranous part of the 
 urethra. The former has just been described going 
 towards the anus, the latter passes upwards towards the 
 neck of the bladder, they consequently form a consi- 
 derable angle with each other, and the membranous 
 part of the urethra is much the deeper; the recollec- 
 tion of which is all important in lithotomy, as it teaches 
 us to avoid the one, and to cut into the other. It will 
 also be observed that the hole in the triangular liga- 
 ment is an inch below the symphysis pubis. 
 
 By dissecting off the upper corner of the triangular 
 ligament, we are made acquainted with another just 
 behind it which is totally distinct. This ligament is 
 half an inch broad, thick and strong particularly at its 
 lower edge, and is very firmly attached laterally to 
 each pubes just below the symphysis. Mr. Colles calls 
 it pubic ligament, with great propriety; I would sug 
 gest, as somewhat more expressive, the term Inter-Pu- 
 bic ligament, as it serves to distinguish it from another 
 
MALE PELVIS. 
 
 287 
 
 called pubic, which is above the pubes.* The breadth 
 of this having been stated at half an inch, it is obvious 
 that the hole in the triangular ligament is half an inch 
 below the lower edge of the interpubic. 
 
 We have now seen as much as can be viewed advan- 
 tageously from the perineum at this stage of the dissec- 
 tion, and I recommend an inspection of the parts from 
 above on the side of their abdominal surfaces. The 
 pelvis is therefore to be separated from the trunk at the 
 last lumbar vertebra and the posterior part of the pel- 
 vis to be removed, sawing through the os ilium from its 
 erista to the upper margin of the sciatic notch on each 
 side; the os coccygis however must remain in situ, as it 
 is very material to the description of the Levatores Ani 
 muscles. Care must be taken not to iiyure the rectum 
 in these sections. 
 
 Begin by raising the peritoneum from the anterior 
 surface of the rectum, after which by letting the rec- 
 tum fall backwards and putting the raised peritoneum 
 on the stretch, an excellent view is obtained of the line 
 of attachment of the latter to the lower part of the 
 bladder. It is seen that the peritoneum is reflected 
 from the bladder at the posterior end of the vesiculse 
 seminales, but that a pouch or process of it is sent 
 down between them which reaches to a short distance 
 from the prostate gland, and that below this process of the 
 
 * See Abdominal Muscles. 
 
288 
 
 OF THE TRUNK. 
 
 peritoneum, a very small space of the bladder lies naked 
 which can he punctured from the rectum, without in- 
 juring either the cavity of the peritoneum or the 
 vesiculsB seminales. 
 
 By distending the bladder moderately, the different 
 reflections of the peritoneum from it to the abdominal 
 parietes and to those of the pelvis will be better under- 
 stood, and the possibility of puncturing the former 
 above the pubes without getting into the cavity of the 
 abdomen will be demonstrated fully, as well as the 
 freedom with which its neck may be divided in the 
 lateral operation for the stone. 
 
 Next strip the peritoneum from the sides of the 
 pelvis, which brings into view the Aponeurosis Pelvica 
 connecting the bladder to the sides of the pehds. 
 
 This fascia descends from the ilio-pectineal line to 
 about midway in the depth of the pelvis; here it is 
 reflected from the surface of the muscles (the Levatores 
 Ani) and applies itself to the prostate gland and blad- 
 der, on the body of which it is ultimately lost. At 
 the angle of its reflection this fascia appears particularly 
 strong and white, but becomes more weak and thin as 
 it lines the muscles and covers the bladder. In tra- 
 cing this membrane it will be seen, that from the pubes 
 just below the symphysis, a pointed production of it 
 constituting its anterior margin is fixed into the side of 
 the neck of the bladder. This pointed production on 
 each side is called by most anatomists the Anterior 
 
MALE PELVIS. 
 
 289 
 
 Ligaments of the bladder. Between them just beneath 
 the symphysis of the pubes a pouch large enough to 
 receive the end of the finger is formed by the union of 
 the fascige of the two sides; this pouch connects the 
 middle anterior part of the neck of the bladder to the 
 lower margin of the symphysis pubis.^' 
 
 A good account of this fascia is published by M. 
 Breschet, in his Thesis on Hernia, p. 130, presented 
 to the Faculty of Medicine in Paris for the place, of 
 Chef des Travaux Anatomiques in the year 1819. 
 He says, “ that when the aponeurosis which covers 
 the iliac fossa arrives at the internal margin of the 
 iliacus internus and psoas magnus muscles, near the 
 superior strait of the pelvis, it plunges into this cavity 
 in order to line its sides, and to cover the muscles 
 which are applied on its several openings. Having 
 got very low down it embraces the rectum, is reflected 
 upon the bas-fond of the bladder, the prostate gland, 
 and in woman upon the vagina. From which cause 
 these viscera may be said to be in part in the cavity of 
 the pelvis, and partly out of it, if we consider this 
 cavity as the space on the outside of the aponeurosis. 
 Some practitioners have observed, that the consequen- 
 ces of the operation of lithotomy are different when, 
 the instrument penetrates more or less deeply behind 
 or on the side. Inflammations, suppurations, abscesses 
 in the cavity of the pelvis occur when the instrument 
 is thrust in too much, while no such accidents follow an 
 instrument introduced moderately deep. Some dis- 
 
290 
 
 OF THE TRUNK. 
 
 tinguished practitioners^ have asked the reason of 
 these differences; and I believe that I have found them 
 in the arrangement of the aponeurosis pelvica. If the 
 instrument does not penetrate beyond this fascia, there 
 is no abscess in the pelvis, or if a small quantity of pus 
 be formed, it readily finds an issue externally. On 
 the contrary, if the pelvic aponeurosis be injured, 
 inflammation developes itself, suppuration takes place 
 beyond this aponeurotic barrier, the liquid cannot get 
 out, and it makes ravages which sometimes cause the 
 death of the patient.” 
 
 This description of the aponeurosis pelvica is true, 
 but rather too general; the most common condition 
 of it is found to be as follows. It adheres closely to 
 the peinosteum of the pubes between the upper mar- 
 gin of the thyroid foramen and the crista of the pubes: 
 about the middle third of the linea innominata it is 
 obviously a continuous membrane with the iliac fascia, 
 but behind this again it arises from the remaining third 
 of the linea innominata. 
 
 The portion of this fascia which Mr. Colles speaks 
 of as particularly strong and white, forms a bow, the 
 concavity of which looks upwards, one end of the bow 
 being fastened to the pubes above the foramen thyroi- 
 deum, and the other end to the ischium above its spine. 
 The perineal surface of this bow is an important point 
 of the origin of the levator ani. Above the bow this 
 
 \ 
 
 Scarpa's IMemoir on Hawkins' Gorget- 
 
MALE PELVIS. 
 
 291 
 
 lasck is very thinj for the fibres of the obturator inter- 
 ims can be readily seen through it. 
 
 At the bow this fascia divides into two laminae, one 
 having the course to the bladder and rectum indicated, 
 the other covers the lower part of the obturator iuternus 
 muscle and constitutes the obturator fascia. The levator 
 ani is interposed between the laminae. The aponeurosis 
 pelvica also forms a bow or semilunar edge in front of 
 the sacral nerves. 
 
 The Levator Ani muscle is essentially connected with 
 the aponeurosis pelvica. In order then to get a view 
 of it, make a cut through the fascia, from the symphy- 
 sis pubis backwards to the sciatic notch about half an 
 inch above the middle of the fascia. As the muscle 
 is placed nearer to the perineum, the fascia must be 
 turned down towards the bladder as low as possible, 
 the upper surface of the muscle is thus exposed, and 
 also the manner in which it may be said to arise, par- 
 ticularly at its posterior part from the under or peri- 
 neal surface of the fascia. '' 
 
 The Levator Ani muscle arises fleshy from the back 
 of the pubes near its symphysis, and from near the su- 
 perior margin of the foramen thyroideum above the 
 obturator internus muscle. It also arises from the 
 aponeurosis pelvica, where this membrane is extended 
 as a thickened semilunar cord from the superior margin 
 of the thyroid foramen to the margin of the sciatic 
 notch. This second part of the origin of the levator 
 
292 
 
 OF THE TRUNK. 
 
 ani is defectively described in most books on anatomy. 
 It is then seen to cross obliquely, as far as the spine of 
 the ischium, that portion of the obturator internus 
 which arises from the plane of the ischium. 
 
 From this extensive origin the fibres converge, 
 descend backwards, afid have three distinct places of 
 insertion; the posterior fibres are inserted into the two 
 last bones of the os coccygis; the middle, and by far the 
 greater number are inserted into the semi-circumference 
 of the rectum between its longitudinal fibres and the 
 circular fibres of the sphincter ani; and finally, the most 
 anterior fibres pass obliquely downwards and backwards 
 on the side of the vesical end of the membranous part 
 of the urethra, and on the side of the prostate gland, 
 and are inserted into the common point of the perineal 
 muscles. These insertions of the levatores ani, to be 
 well understood, must be studied both from the peri- 
 neal and abdominal surfaces. 
 
 It yet remains to speak more definitively of theTri 
 angular Ligament; it has been seen from the perineum, 
 and is now to be viewed from the pelvis. Remove the 
 anterior part of the levatores ani; the ligament is then 
 seen occupying the interval under the symphysis and 
 between the rami of the pubes and ischia, extending 
 dowmvards an inch and a half. Its base or inferior edge 
 is crescentic, and half an inch above the base is the 
 hole for the membranous part of the urethra. This hole 
 is, in fact, not very distinct, for the triangular ligament 
 
MALE PELVIS. 
 
 293 
 
 IS reflected backwards from its edges along the mem- 
 branous part of the urethra, which obscures the hole. 
 The prostate gland also gets a ligamentous capsule from 
 a continuation of this same reflection, and is thereby 
 very firmly fixed in its place. 
 
 The edges of the triangular ligament, fastened to the 
 side of the pubic arch, are continuous with the fascia 
 covering the obturator internus muscle. The triangular 
 ligament is a membrane consisting Of two laminae; the 
 bulb of the urethra is fastened to the anterior lamina, 
 and the prostate gland is fixed to tlie posterior lamina; 
 between these laminae above is the interpubic ligament, 
 and several blood-vessels derived from the vena ipsius 
 penis. 
 
 Mr. Colles says: If we attempt, in conformity to 
 
 the custom of anatomical writers, to describe all these 
 continuous fasciae which connect the bladder and ure- 
 thra to the pubes, as . productions of one and the same 
 fascia, we might say that the triangular ligament, by its 
 outer edges, is fixed into the rami of the pubes and is 
 there continuous with the ligament lining the obturator 
 muscles, that the edge of the opening for receiving the 
 membranous portion of the urethra is produced back- 
 ward along the prostate, and having ascended as high 
 as the arch of the pubes, it there splits into two lami- 
 nae, one continuing its course over the upper surface of 
 the gland and bladder, the other lining the upper por- 
 tion of the levator ani.” 
 
294 
 
 OF THE TRUNK. 
 
 The description of the fasciae of the pelvis is one of 
 the most difficult and perplexing in the whole range of 
 anatomy, and the proof of it is, that almost every wri- 
 ter on the subject considers the labours of his prede- 
 cessors imperfect, and, with a very laudable spirit, 
 hoping to supply the defect, invites the attention of the 
 profession to his improved views. Not joining in this 
 conviction, of the insufficiency of preceding descrip- 
 tions, and the consequent value of such as ai'e offered 
 as substitutes, I feel satisfied in drawing materials from 
 Mr. Colles’s excellent work on Surgical Anatomy. 
 Here I may express a regret that a gentleman whose 
 views are so luminous on a most intricate subject, 
 should have confined his descriptive talents within 
 such small boundaries as those of his Surgical Anatomy 
 
PART II. 
 
 CHAPTER IV. 
 
 Of the Organs in the Female fm' the Generation and 
 JVourishment of the Infant. 
 
 Section I. 
 
 Of the Female Pelvis. 
 
 The viscera of the female pelvis should be first 
 studied in their natural situations; they should then be 
 removed and dissected neatly for more satisfactory ex- 
 amination. The whole study may afterwards be con- 
 cluded with a side view, as in the male subject. 
 
 The Female Pelvis contains the Urinary Bladder and 
 Rectum, besides the Organs of Generation. The two 
 first do not demand particular description here, as 
 enough has been said concerning them in the account 
 of the male pelvis. The Organs of Generation are si- 
 tuated between them, and consist of the Vulva exter- 
 nally, of the Vagina in the middle, and of the Uterus 
 with its appendages internally. 
 
296 
 
 OF THE TRUNK. 
 
 Under the term Vulva we consider the Mens Vene- 
 ris, the Labia Majora or Externa, the Labia Minora or 
 Interna, the Clitoris, the Vestibulum, the Orifice of the 
 Urethra, the Foiirchette, and the Fossa Navicularis. 
 
 Of the Vulva. 
 
 The'MoNS Vexeris is an eminence on the fore part 
 of the pubes which is produced by the deposit of a 
 great quantity of fat under the skin. In very corpu- 
 lent women its size is occasionally enormous. The 
 skin covering it, at the age of puberty, is studded with 
 hair, , and under it, is a considerable number of seba- 
 ceous glands. 
 
 The Labia Externa are oblong eminences, continued 
 downwards and backwards, one on each side, from 
 the mons veneris, and unite with each other by the 
 fourchette at the anterior part of the perineum. 
 They are produced in the same way mth the mons 
 veneris by a deposit of adipose matter beneath the 
 skin or integuments; they are broader and more 
 prominent above than below^ On the side which looks 
 to the thighs they are formed by the common skin, fur- 
 nished sparingly with hairs; but on the internal face the 
 integument is a mucous membrane, being a continua- 
 tion of, that of the vagina. These bodies have many 
 sebaceous glands externally, and mucous orifices inter- 
 nally on them. In their interior structure much cellu- 
 
FEMALE PELVIS. 
 
 297 
 
 iar membrane, like that of the scrotum, is found pos- 
 sessed of great extensibility in order to favour the 
 dilatation of the parts in parturition. Between them 
 is a longitudinal rima about twice the length of the ori- 
 fice of the vagina for favouring still more the expulsion 
 of the foetus. It is the Fissura Vulvae of authors. 
 
 The Clitoris is a small body situated between the 
 upper extremities of the labia externa on the lower 
 part of the symphysis pubis, and corresponding with 
 the male penis. It is furnished with a suspen- 
 sory ligament, and curved tow^ards the urethra. It 
 consists of a body and of two crura; the body is 
 about an inch long, and the crura being of the same 
 length, arise from the internal faces of the crura 
 of the pubes. It is covered by an elastic ligamentous 
 membrane; has an internal spongy body capable of 
 erection like the penis, divided by a-septum pectini- 
 forme, and having a similar supply of blood-vessels and 
 of nerves. It has also an erector clitoridis muscle 
 lying upon each crus and extended to the side of its 
 body in the same way with the erector penis. 
 
 The extremity of the body of the clitoris projects into 
 the upper part of the bottom of the rima, and is called 
 its Gians, but does not resemble, in structure, the 
 glans penis. A kind of hood is thrown over it by a 
 duplicature of the integuments of the part, which giving 
 some resemblance to the penis, it is therefore called 
 the Prepuce, (Preputium.) This prepuce is occasion- 
 
 pp 
 
298 
 
 OF THE TRUNK. 
 
 ally much elongated and its orifice constricted, so that 
 the secretion from its cryptae is imperfectly discharged 
 and produces much itching and irritation. Mr. Mar- 
 jolin relates the case of a Spanish girl of four yeai-s, in 
 whom he performed circumcision successfully, in order 
 to free her of a very had habit to which she was ad- 
 dicted in consequence of this disease. 
 
 The Labia Interna, or Nymph;e, are two mem- 
 branous productions passing downwards, one from each 
 side of the prepuce. They arise from the internal 
 sides of the labia majora, are seldom so broad naturally 
 as to project beyond them, and, are wider in the 
 middle than elsewhere; they terminate insensibly about 
 half-way down the orifice of the vagina. They consist 
 of a duplicature of the mucous membrane of the part, 
 between the laminse of which is placed a vascular cel- 
 lular membrane giving to them, when excited, a some- 
 what erected condition. In young subjects their vas- 
 cularity communicates a vermilion tint, which is lost 
 in the progress of life. They are supposed to direct, 
 in some measure, the stream of urine; but it is more 
 probable that, as they are efiaced during parturition, 
 they are intended to facilitate the enlargement of the 
 vulva. 
 
 The Vestibulum is the depression at the upper 
 part of the rima, bounded by the clitoris above and 
 the nymphae laterally; in it are many mucous follicles. 
 
FEMALE PELVIS. 
 
 299 
 
 At the inferior part of the vestibuhim, about an 
 inch below the glans clitoridis, is the Orifice of the 
 Urethra, (Orificium Urethrae.) It is generally marked 
 by a slight rising or tubercle which, is easily distin- 
 guished by the sensation of touch alone; its margin 
 is often bounded by a little caruncle on each side. The 
 urethra itself is an inch long, larger and much more 
 dilatable than that of the male; its course is obliquely 
 downwards and forwards from the neck of the blad- 
 der; passing under the symphysis of the pubis, and be- 
 ing slightly curved from that cause. It consists of 
 two membranes, a lining and an external one. The 
 lining membrane is a continuation of that of the blad- 
 der; is thrown into several longitudinal folds, and has 
 many mucous follicles in it. The external coat of the 
 urethra consists of condensed laminated cellular mem- 
 brane, forming a cylindrical body of half an inch in its 
 transverse diameter, which has given the idea of the 
 existence of a prostate gland in the female. The 
 lower and lateral surfaces of this cylinder are in con- 
 tact with the vagina, forming a protuberance into its 
 cavity, and the upper surface is firmly connected to 
 the triangular ligament of the pubes. 
 
 The Fourchette, or Frenulum Vulvje, is situa- 
 ted at the inferior junction of the labia externa; it is a 
 narrow duplicature of skin extending across the vulva 
 from one side to the other, and is, most frequently, 
 ruptured at the first parturition and disappears. That 
 
300 
 
 OF THE TRUNK. 
 
 portion of the rima, betwixt it and the orifice of the 
 urethra, is called, by many anatomists, the Fossa 
 Navicularis. 
 
 Of the Vagina. 
 
 The Vagina, is the intermediate part of the sexual 
 organs, extends from the Vulva to the Uterus, being 
 placed between the Bladder and Rectum, and com- 
 pressed anteriorly and posteriorly by them. In vir- 
 gins its external extremity is contracted into a smaller 
 canal than the internal, and besides this, is closed by a 
 membrane called the Hymen. 
 
 The Hymen, situated just within the orifice of the 
 vagina, is a partial septum formed by a reflection or 
 duplicature of its lining membrane: it varies very much 
 in shape, breadth, and thickness. Most commonly it 
 is crescentic and fixed to the inferior part of the 
 vaginal orifice by its convex edge, the horns being 
 upwards; in other cases it is to the side. Sometimes 
 it is a circular membrane having a hole in the centre. 
 It is generally so weak that it is ruptured at the first 
 act of copulation, but occasionally so resisting that it 
 has required artificial division to make it yield even to 
 the expulsive efforts of the uterus in parturition. Its 
 presence then is not invariably a proof of virginity, 
 nor is its absence a proof of improper indulgence. 
 
FEMALE PELVIS. 
 
 301 
 
 The vagina is a membranous canal of from four to 
 six inches ' in length, dilfering according to age and 
 pregnancy, being much shorter in women who have 
 borne children than in virgins. Its shape varies some- 
 what, near the vulva its greatest diameter is vertical, 
 but behind near the uterus the greatest diameter is 
 transverse. Its anterior and posterior surfaces are in 
 contact from the circumstances just mentioned of pres- 
 sure between the bladder and the rectum. It is shorter 
 before than behind, corresponding in this respect with 
 the pelvis by which it is influenced, and also in conse- 
 quence of being attached to the uterus higher up on 
 the sacral than on the pubic side. 
 
 The peritoneum, in descending from the uterus an- 
 teriorly, touches the top of the vagina for a little dis- 
 tance, and is then reflected to the bladder, but poste- 
 riorly, nearly the upper half of the vagina has a 
 peritoneal coat, before this membrane is reflected to 
 the rectum. The attachment of the vagina to the 
 bladder is strong and close just about the urethra, but 
 its connexion to the rectum is by rather loose cellular 
 membrane. 
 
 It consists of two coats, a fibrous and elastic one 
 externally, and a mucous one internally. The first is 
 of a reddish colour, and seems to be formed of con- 
 densed cellular membrane, its fibres not passing in any 
 determinate direction. Many blood-vessels are found 
 in its structure, and it has an abundance of large 
 venous sinuses surrounding it. 
 
302 
 
 OF THE ITIUNK. 
 
 On the anterior part of this coat externally, there is 
 a flat spongy body, (Corpus Spongiosum Vaginae,) 
 about one inch broad and a line or two thick, which is 
 placed on its superior and lateral surfaces, covering 
 about one-half, or two-thirds of the whole circumfe- 
 rence of the vagina. The structure of the body 
 closely resembles that of the corpus spongiosum ure- 
 thrae, and from being very vascular, is subject to dis- 
 tention in its cells during sexual excitement. This 
 body is covered by the sphincter vaginae muscle. 
 
 The Sphincter Vaginse arises from the body of the 
 clitoris, forms an expanse of an inch and a quarter 
 around the anterior end of the vaginae, and is inserted 
 into a dense whitish substance in the centre of the 
 perineum, common to it, the sphincter ani aiid the 
 transversi perinei muscles. 
 
 The transverse perineal muscles exist in the female, 
 and have the same circumstances of origin and insertion, 
 but are not so strong as in the male. 
 
 Anterior to the corpus spongiosum on each side of 
 the vagina, near its middle, is a mucous gland, about 
 the size of a garden pea, which is the Couper’s gland 
 of the female. 
 
 To bring into view satisfactorily the internal mem- 
 brane of the vagina, the canal should be slit up laterally 
 from its external orifice to the uterus; this membrane 
 being mucous will then be observed as continuous with 
 the mucous membranes of the vulva and uterus. 
 Near the vulva it is of a vermilion tinge, but near the 
 
FEMALK PELVIS. 
 
 303 
 
 uterus it is greyish with several dark spots giving it a 
 marbled appearance; its thickness diminishes as it 
 recedes from the external orifice. 
 
 In females in whom the hymen is ruptured, its 
 remains consist in from two to six small tubercles, the 
 Carunculas Myrtiformes. On its anterior or pubic wall 
 the internal surface of the vagina is divided longitu- 
 dinally by a ridge, commencing in a sort of tubercle at 
 the anterior orifice of the vagina just under the meatus 
 urinarius; this ridge proceeds backwards, but becomes 
 indistinct in approaching the uterus; from it on each 
 side proceed transverse ridges or folds of the mucous 
 membrane, which are particularly numerous and pro- 
 minent before, but become indistinct and irregular near 
 the uterus. The inferior side of the vagina has the 
 same sort of arrangement as the superior, only not so 
 well marked. 
 
 By cleaning the vagina and suspending it in water, 
 an abundance of mucous cryptae may be observed oh its 
 whole internal surface, which by an increased discharge 
 produce leucorrhoea. 
 
 The Uterus and its Appendages, the Fallopian Tubes 
 and Ovaria. 
 
 The Uterus is a compressed pyriform body with a 
 cavity in its centre, is placed between the blad- 
 der and rectum, has the small intestines above it, 
 and the vagina below. Unimpregnated it is two inches 
 
304 
 
 OF THE TRUNE. 
 
 and a half long, and an inch and a half wide at its broad- 
 est part; its anterior surface is much flatter than the 
 posterior. It is divided into fundus, body, and neck. 
 The fundus is the superior convex edge, the neck the 
 narrow part below about an inch long, and the body the 
 portion between these two. 
 
 The uterus is maintained in its situation in the 
 centre of the pelvis by the reflections of the perito- 
 neum, which are called ligaments. The peritoneum, 
 after covering the uterus completely is reflected ante- 
 riorly upon the vagina, and at each side of this reflec- 
 tion is a fugitive duplicature of the membrane denomi- 
 nated the Anterior Ligament, which goes to the blad- 
 der. The peritoneum in passing from the back part 
 of the uterus to the vagina and subsequently to the 
 rectum, has on each side of this reflection also a dupli- 
 cature, which constitutes the Posterior Ligament. 
 The peritoneum is also reflected from the whole length 
 of each side of the uterus to the corresponding part of 
 the cavity of the pelvis; these reflections are termed 
 the Lateral or the Broad Ligaments. The peritoneum 
 covers much more of the vagina posteriorly, than it 
 does anteriorly. 
 
 These Broad Ligaments, with the uterus, form a 
 transverse septum in the middle of the pelvis. At 
 the superior edge of this septum, on each side, is the 
 Fallopian Tube, and on the posterior face of the sep- 
 tum, below the edge, and about an inch or a little more 
 fi’om the uterus, on each side, is an Ovarium. The 
 
FEMALE PELVIS. 
 
 305 
 
 peritoneum adheres to the uterus by a cellular tissue, 
 which is somewhat loose and can be easily dissected 
 from it. 
 
 Besides the ligaments mentioned, the uterus has two 
 more, one on each side, called the Round Ligaments. 
 They arise from the side of its body, between the du- 
 plicatures of the broad ligaments, ^nd pass under the 
 peritoneum to the abdominal ring, through which they 
 penetrate, and are lost upon the fat of the mons veneris 
 and of the labia majpra. They are of a fibrous struc- 
 ture, and have many blood-vessels in them. 
 
 The neck of the uterus is enclosed by the cavity of 
 the vagina, in such a way that it projects into the latter. 
 In the centre of this projection is the Orifice of the 
 Uterus, (Os Tincse,) which is not perfectly cylindrical 
 but somewhat flattened or oval; this orifice is bounded 
 before and behind by the lips or projections of the 
 neck, which are transverse. The posterior lip is some- 
 what thinner than the anterior, but, in consequence of 
 the insertion of the, vagina on that side being higher 
 up, it projects more into the vagina, and is easily dis- 
 tinguished by the finger. 
 
 Behind the os tincse is the Cavity of the Neck, which 
 is a paraboloid cylinder, larger in the middle than at 
 either end; its termination forwards is about the size of 
 a small writing quill, the posterior extremity is some- 
 what larger. In the middle of this cavity, before and 
 behind, longitudinally, is a line formed by an elevation 
 of the lining membrane, and on each side of this line, 
 
 Q q 
 
306 
 
 OF THE TRUNK. 
 
 transversely, there are others presenting an arborescen: 
 arrangement. Tliis is the Arbor Vitse. In the inter- 
 stices of the transverse lines there are small mucou.'; 
 glands called Ovula Nabothi, in consequence of thi^ 
 anatomist mistaking them for eggs. 
 
 The cavity of the body of the uterus is triangular, 
 the sides of the triangle being curved inwards so as to 
 present their convexities to its cavity. The cavity is 
 nearly equilateral, and has its anterior and posterior 
 surfaces in contact; the angle below is continued into 
 the cavity of the neck, and the angles above are con- 
 tinuous with the fallopian tubes, being extended very 
 kir through the parietes of the uterus in order to meet 
 them. This cavity is .sometimes divided into two sym- 
 metrical halves by an elevated line on its antenor and 
 posterior surface, running from above downwards. It 
 is said, that in some cases, they have formed a complete 
 partition. 
 
 The internal membrane of the uterus is a continua- 
 tion of that of the vagina, and adheres so closely that 
 its existence has been doubted. It has very little thick- 
 ness, is extremely smooth, and presents villosities so 
 fine, that they are seen with difficulty by the naked eye. 
 It is of a light pink colour, which changes into a deeper 
 vermilion a few days before and during menstruation. 
 It abounds with mucous cryptse and exhalent orifices. 
 
 The texture of the uterus is essentially fibrous aiul 
 of a white colour tinged with red, from having a great 
 number of blood-vessels in its composition. The fibres 
 
FEMALE PELVIS. 
 
 307 
 
 have no determinate course, but are blended and inter- 
 woven in every direction. Its muscularity is not ap- 
 parent in the unimpregnated state. 
 
 The Fallopian Tubes, (Tubae Uterinse,) are two 
 membranous canals fixed, as mentioned, in the upper 
 edges of the broad ligaments. They are about four 
 inches long, somewhat serpentine, and extend from the 
 upper angles of the uterine cavity to the sides of the 
 pelvis. At their uterine extremities these tubes 
 scarcely admit a hog’s bristle, but as they proceed ex- 
 ternally, about half-way of their length, they begin to 
 increase, and continue to do so very rapidly almost to 
 their termination, where they become somewhat con- 
 tracted, and immediately afterwards enlarge to end by 
 an oblique trumpet shape mouth, singularly fringed, 
 called Morsus Diaboli, or Corpus Fimbriatum. This 
 latter part of the tube is loose and pendulous, over- 
 hanging the ovarium on the back part of the broad 
 ligament. 
 
 The Fallopian Tube seems to be a continuation of 
 the structure of the uterus, having a fibrous membrane 
 externally, and an internal mucous one; the latter is 
 principally concerned in forming its large extremity, 
 and is rendered erectile in sexual excitement, probably 
 by its great vascularity. 
 
 The Ovaries, (Ovaria, Testes Muliebres,) are si- 
 tuated one on each side of the uterus, and on the pos- 
 
308 
 
 OF THE TRUNK. 
 
 terior face of the broad ligament enclosed in a dupli- 
 cature of it. They are compressed ovoids about half 
 the size of the testicle, of a very light pink colour; 
 are connected to the uterus by a small, vascular, and 
 fibrous cord, called Ligament of the Ovary, which is 
 inserted into the uterus just below the fallopian tube. 
 The external end of the ovary has one of the processes 
 of the corpus fimbriatum or morsus diaboli adhering to 
 it. 
 
 The surface of the ovary is generally found some- 
 what uneven, from a number of marks resembling cica- 
 trices. It has a complete peritoneal coat, and within 
 this is another of a strong, compact, fibrous character, 
 sending many processes internally, which corresponds 
 with the tunica albuginea. 
 
 The structure of this body is imperfectly known; a 
 good deal of vascular fibrous matter enters into its com- 
 position, containing from fifteen to twenty vesicles of 
 various sizes, from the head of a small pin to a French 
 pea. The parietes of these vesicles are very thin, 
 transparent, and vascular, and contain an albuminous 
 light coloured fluid. 
 
 The Bladder and Rectum, with unimportant excep- 
 tions, are the same in both sexes. The arteries of the 
 viscera of the pelvis, in both cases, are derived from 
 the internal iliacs. 
 
 The Levator Ani, Coccygeus, and Sphincter Ain 
 muscles have the same arrangement as in males. 
 
FEMALE MAMM^. 
 
 309 
 
 The Fasciae connecting the bladder to the sides of 
 the pelvis, and the triangular ligament of the urethra 
 also exist. 
 
 Section II. 
 
 Of the Female Mammx. 
 
 The Mammae are two glandular bodies, situated over 
 the thorax, upon the great pectoral muscles between 
 the arm-pits and the sternum, and intended, in the 
 female, for the secretion of milk. They are hemis- 
 pherical, and vary very much in size, according to the 
 age of the person and the state of the uterine system. 
 
 The skin which covers the mamma is very fine and 
 thin, and through it may be seen readily the veins 
 which creep beneath it. It is very extensible, but 
 does not possess much power of contraction. Beneath 
 the skin, between it and the surface of the gland, there 
 is an abundance of cellular substance intermixed with 
 lobules of fat, which together make a greater volume of 
 matter than the gland itself. The exterior surface of 
 the gland is rendered very unequal, by being penetrat- 
 ed at different depths by this cellular and adipose mat- 
 ter, and its lobules are divided by irregular fossse from 
 each other. The substance of the gland is united to 
 
310 
 
 OF THE TRUNK. 
 
 the pectoralis major muscle, by a loose cellular tissue, 
 which contains very little fat. 
 
 The mamma is composed of lobes of different sizes, 
 united together in such a way by cellular texture, that 
 they cannot be separated without injury to them. 
 These lobes are composed of Lobuli, which again are 
 formed by granuli of a white colour tinged with red. 
 These granuli are the size of a millet-seed, and, ac- 
 cording to some anatomists, consist of vesicles which 
 are very apparent by the aid of a microscope, in a gland 
 iilled with milk.* 
 
 The roots of the excretory vessels, or the lactiferous 
 ducts, arise from these grains; they are extremely fine, 
 and unite, after a short course, to contiguous ones, by 
 successive accumulations resembling the branches of a 
 tree; large trunks are finally formed which terminate 
 in a sinus, placed in the centre of the gland near the 
 base of the nipple. The lactiferous ducts converge 
 from the circumference of the gland to its centre; their 
 course, however, is very tortuous, and their coats are 
 thin, semitransparent, and very capable of extension 
 and contraction. They are mimerous, from two to four 
 of them unite into a common root, called sinus, which 
 is only a few lines long, and placed near the base of the 
 nipple. These sinuses are about fifteen in number, and 
 are of different diameters, the largest about three lines 
 wide, but others scarcely exceed the diameter of tin 
 
 * See Marjolin, vol. ii. p. C95- 
 
FEMALE MAMMiE. 
 
 311 
 
 factiferous tubes. From the external extremity pf each 
 sinus arises a small excretory duct, which conducts the 
 milk to the surface of the nipple. This duct is of a 
 conical shape, sometimes dilated in its middle, and is 
 curved and folded upon itself w^hen the nipple is not 
 ill a state of erection, by which means the milk is 
 prevented from flowing through it. The. sinuses, 
 
 and the excretory ducts, are united to each other by 
 condensed cellular membrane; they have no valves, 
 neither have the lactiferous tubes in any part of their 
 course. 
 
 An opinion was entertained by Haller, and by many 
 other anatomists after him, that some of the lactiferous 
 ducts originated in the surrounding cellular texture; 
 this has been refuted by the researches of Cuboli. The 
 excretory ducts of the different lobes are, for the most 
 part, kept distinct from each other, there being no 
 anastomoses between them; hence it happens that in 
 the injection of the gland with mercury, it is necessary 
 to inject each lactiferous sinus separately. Some ana- 
 tomists have thought that there is a direct communica- 
 tion between the roots of the lactiferous tubes, and the 
 arteries, veins and lymphatics. Mascagni, after a very 
 successful injection of the gland, in which he filled its 
 vesicles with quicksilver, not meeting with such an 
 occurrence, was induced to think that when such com- 
 munication did happen it was by rupture. 
 
 The Areola in virgins, is a rose-coloured circle. 
 
312 
 
 OF THE TRUNK. 
 
 which surrounds the base of the papilla or nipple. In 
 women who have borne children, or in those whose 
 age is advanced, it becomes of a dark browm. The skin 
 of the areola is extremely delicate, and on its surface, 
 particularly in pregnant or nursing females, there are 
 from four to ten tubercles, which sometimes form a 
 regular circle near its circumference, and in other 
 subjects are irregularly distributed. Each of these 
 tubercles has, near its summit, three or four foramina, 
 which are the orifices of the excretory ducts of a little 
 gland forming the tubercle. From this gland is secreted, 
 according to some, an unctuous fluid for protecting the 
 surface of the areola, while others consider them only 
 as lactescent. The areola consists of a spongy tissue, 
 beneath which there is no fat; it is susceptible of dis- 
 tention during lactation, or from sexual excite- 
 ment. 
 
 The Papilla is a truncated cone in the centre of 
 the mamma, of the same colour with the areola, and 
 surrounded by it. The lactiferous ducts terminate 
 on its extremity. It is collapsed and in a very pliable 
 state for the most part, but when excited it swells, 
 becomes more prominent, and of a deeper colour. 
 Its skin is rough, and provided with numerous and 
 very small papillse. Its internal structure consists of 
 the lactiferous ducts, united by condensed cellular 
 membrane. 
 
FEMALE MAMM^. 
 
 313 
 
 The mamma is supplied with blood from the exter- 
 nal thoracic, intercostal, and internal mammary arteries. 
 Its veins attend their respective arteries. The nerves 
 come from the brachial plexus and the intercostals. 
 Its lymphatics run into the internal mammary and 
 axillary trunks. 
 
 H r 
 
PART II. 
 
 CHAPTER V. 
 
 Of the J\'erves and Vessels of the Trunk. 
 
 I HAVE thought it better to give a separate consi- 
 deration to the nerves and vessels of the trunk, by not 
 involving them with the viscera; because it is the 
 easiest manner of studying them, and such as the stu- 
 dent most frequently adopts when left to his own dis- 
 cretion; which alone, is in some measure, a proof of its 
 being the most natural and agreeable method. The 
 / arteries should be filled with either of the coarse in- 
 
 jections; it is less important for the veins, and may be 
 dispensed with. 
 
 Section I. 
 
 Of the JVei'ves. 
 
 The Phrenic Nerve passes into the thorax from the 
 neck, by the side of the descending cava on the right, 
 between it and the pleura; it then continues on the 
 
NERVES. 
 
 315 
 
 side of the pericardium in a direction almost straight, to 
 the diaphragm, going before the root of the lungs. On 
 the left side, with the exception of the descending 
 cava, and of its being turned somewhat out of its way by 
 the projection of the point of the heart, its course is 
 the same.^ 
 
 The nerve getting to the diaphragm is spread out in 
 a radiated direction on its muscular wing, both on its 
 upper and lower surface. Anatomists of sufficient res- 
 pectability report branches from the sympathetic 
 mounting up to the diaphragm, and having their ter- 
 minating ramifications united with those of the phrenic. 
 Portions of the renal plexus of nerves, are also said to 
 be bestowed on the diaphragm. 
 
 The Par Vagum, before it gives off the recurrent 
 nerve, sends off one or more twigs to join the cardiac 
 plexus, it also contributes to the same when the recur- 
 rent nerve is separating from it’. From a little below 
 this place, the par vagum sends off the Anterior Pulmo- 
 nary Plexus, derived principally from two branches, a 
 large and a small one, which subdivide and go in front 
 of the trachea and >of the root of the lungs. The rami- 
 fications of this plexus follow generally the bronchium 
 and blood-vessels, into the substance of the lungs, but 
 some of them are turned into the cardiac plexus. 
 
 The trunk of the par vagum proceeds then on the out- 
 
 •* For a fui'ther account of this nerve see the Neck- 
 
OF THE TRUNK. 
 
 316 ^* 
 
 side of thebronchium, and a little lower down behind it, 
 then passes in contact with the posterior surface of the 
 root of the lungs. Here it gives off successively live 
 or six branches of different magnitudes, which leave 
 the main trunk almost at right angles, divide and subdi- 
 vide, and following the bronchium, are spent upon its 
 ultimate ramifications in the lungs. These branches 
 constitute the Posterior Pulmonary Plexus. 
 
 After the posterior pulmonary plexus is given oil’, 
 the par vagum remaining still considerable, betakes it- 
 self to the oesophagus, being split into three or four fas- 
 ciculi which spread out and unite again. From the 
 crossing of the bronchium to the joining with the oeso- 
 phagus, a great many small ramifications are sent to the 
 oesophagus, forming a plexus on it; some are sent also to 
 the aorta. 
 
 The Left Par Vagum is situated on the anterior 
 lateral sui’face of the oesophagus, and the Right Par 
 Vagum on the posterior lateral surface, each however 
 adhering to its own side, and forming a plexus which 
 partially surrounds the oesophagus. They pass through 
 the foramen of the diaphragm, along with the oesopha- 
 gus, and their fibres are reassembled into more consi- 
 derable trunks. The left par vagum is distributed 
 along the lesser curvature of the stomach, between the 
 cardia and the pylorus, to the anterior side of the sto- 
 mach, to the lesser omentum, and some of its branches 
 extend to the left hepatic and solar plexus. The right 
 par vagum surrounds with its branches the cardiac ori 
 
NERVES. 
 
 317 
 
 fice of tlie stomach, supplies the under side and great 
 curvature, sends branches along the coronary artery to 
 unite to the hepatic and splenic plexuses, and one trunk 
 to the solar plexus. 
 
 The Sympathetic, or Intercostal Nerve, is 
 principally employed in the thorax in supplying the 
 heart. With this view it sends to it three nerves on 
 the right side, and two on the left, called Cardiac. 
 
 The Right Superior Cardiac is derived by several 
 filaments from tlie upper cervical ganglion, joined by 
 some from the superior laryngeal nerve. They unite 
 into one trunk, which accompanies the common carotid 
 on its external surface as far as the middle cervical gan- 
 glion; here the trunk divides, one part of it and the 
 smaller, running along the carotid and arteria innom- 
 inata to the aorta, the other joining a plexus just below 
 the middle cervical ganglion. 
 
 The Middle or Great Cardiac Nerve arises from the 
 inferior part of the middle cervical ganglion, passes 
 along the external surface of the carotid artery, and 
 crosses the subclavian in front just at its root, it then 
 goes along with the arteria innominata for a little dis- 
 tance, and te.rminates in the upper part of the cardiac 
 plexus. 
 
 The Third or Small Cardiac Nerve comes from the 
 lower cervical ganglion, by several filaments which 
 unite into a smaller number to form a plexus, which de- 
 scei>ds behind the subclavian artery, and between the 
 
318 
 
 OF THE TRUNK. 
 
 innominata and trachea, to the posterior part of the 
 arch of the aorta. 
 
 On the left side the Upper Cardiac nerve originates 
 in the same way as on the right, from the first cervi- 
 cal ganglion and upper laryngeal; attending the com- 
 mon carotid, it is increased by fibrillsB from the sym- 
 pathetic, between the first and second ganglions. In 
 the upper part of the thorax this nerve is between the 
 carotid and subclavian arteries, and at their roots some 
 of its branches go in front of the aorta and others be- 
 hind it. The second cardiac nerve of the left side, is 
 derived from the middle and lower cervical ganglions 
 of the sympathetic. Several branches being despatch- 
 ed by the two ganglions, they form a plexus which sur- 
 rounds the subclavian at the origin of the inferior thy- 
 roid and transversalis colli arteries. From this plexus 
 several cords proceed longitudinally behind and before 
 the subclavian artery to the aorta, and here being join- 
 ed to branches from the upper cardiac nerve, they 
 form a plexus on the anterior and posterior faces of the 
 aorta. 
 
 The Cardiac Plexus consists of a very considerable 
 number of nervous filaments, formed by the combina- 
 tion of the cardiac nerves on both sides, with branches 
 sent off from the recurrent nerves- and the par vagum. 
 It is placed between the aorta and the trachea and 
 bronchia, and extends from the lower cervical ganglion 
 to the top of the base of the heart where the aorta and 
 pulmonary artery come out. It is fixed in loose cel 
 
NERVES. 
 
 819 
 
 lular and adipose membrane at its upper part; below, its 
 meshes are much involved with the glands about the 
 bifurcation of the trachea, and on the aorta its branches 
 lie very close to this vessel, being bound to it by the 
 internal lamina of the pericardium. 
 
 Several branches of the plexus wind over to the front 
 of the aorta and pulmonary artery, where they are also 
 conlined closely to these vessels by the internal lamina 
 of the pericardium, and seen to enter into their struc- 
 ture. The cardiac plexus, penetrating from the base 
 of the heart to the root of the aorta, is diffused through 
 the muscular structure of the former, its trunks follow- 
 ing the courses of the coronary arteries. 
 
 The Sympathetic Nerve, from the last cervical 
 ganglion, proceeds over the head of the first rib, and 
 descends through the thorax in contact with the heads 
 of all the ribs, and exterior to the pleura. At the up- 
 per edge, of the head of each rib it forms ar ganglion, 
 which unites with the intercostal nerve behind it by 
 two branches. At the lower part of the thorax it pe- 
 netrates into the abdomen beneath the crus of the 
 diaphragm; it then proceeds forwards and downwards 
 on the spine between the tendinous crus of the dia- 
 phragm and the psoas magnus muscle, and lies on the 
 side of the bodies of the lumbar vertebrae, being near 
 the vena cava on the right sidp and the aorta bn the 
 left. About the middle of the body of each lumbar 
 vertebra, it forms a ganglion which dismisses one or two 
 
320 
 
 OF THE TRUNK. 
 
 nervous filaments to the corresponding lumbar nervcj 
 which filaments pass between the bone and the psoas 
 muscle. From the loins, the sympathetic descends in- 
 to the pelvis on the inner side of the foramina of the 
 sacrum; here also it forms a ganglion corresponding 
 with each sacral nerve, and detaches a filament to join 
 it. Finally the sympathetic terminates on the os coc- 
 cygis where the ultimate branches of the opposite sides 
 unite. 
 
 From several of the upper ganglions of the sympa- 
 thetic in the thorax, fibrillae depart which join the 
 posterior pulmonary plexus, and also are distributed 
 in the form of a plexus on the aorta. F rom the sixth, 
 seventh, eighth, ninth, and tenth thoracic ganglions, 
 branches are sent off, which, descending obliquely on 
 the sides of the vertebrae, unite successively so as to 
 form a considerable trunk, the Great Splanchnic Nerve, 
 which gets into the abdomen through the foramen in 
 the diaphragm for the aorta, or by penetrating the 
 crus. From the tenth, eleventh, and twelfth dorsal 
 ganglions, filaments are, in like manner, successively sent 
 off, which form one or two trunks that penetrate into the 
 abdomen through the crus of the diaphragm; this con- 
 stitutes the Lesser Splanchnic Nerve, which, in part, 
 unites to the great splanchnic nerve, and the remainder 
 goes to the renal plexus. 
 
 The Great Splanchnic Nerve, having entered the 
 
NERVES. 
 
 321 
 
 abdomen, is associated with the semilunar ganglion. 
 This ganglion is situated on the crus of the diaphragm, 
 and on the sides of the coeliac and superior mesen- 
 teric arteries. It is frequently formed rather by a 
 congeries of small ganglions arranged in a lunated form, 
 than by a single one. These small ganglions are united 
 by a reticular work of nerves, and from them proceeds 
 a very intricate and combined net-work of nervous 
 fibres, called the Solar Plexus. 
 
 The Solar Plexus is behind the stomach and above 
 the pancreas, and surrounds with its branches, the 
 coeliac, superior mesenteric, and renal arteries. It is 
 formed from the semilunar ganglions of both sides, and 
 to their ramifications are added some from the par va- 
 gum and phrenic nerves. That portion of the solar 
 plexus on the coeliac artery, assumes the name of coeliac, 
 and dismisses ramifications in the coui'se of the gastric, 
 hepatic, and splenic arteries to the viscera supplied 
 by them, as the stomach, liver, pancreas, and spleen. 
 
 The Superior Mesenteric Artery has around it the 
 Superior Mesenteric Plexus, which accompanies the 
 arterial branches to the right side of the colon, to its 
 transverse portion, and to all the small intestines. 
 From the inferior part of this plexus, proceeds a de- 
 tachment in front of the aorta, to the inferior mesente- 
 ric artery which supplies the left side of the colon and 
 the rectum. 
 
322 
 
 OF THE TRUNK. 
 
 From the lower part of the solar plexus, arises the 
 Renal Plexus, which surrounds the emulgent arteiy, 
 and is distributed to the kidney and to the capsula 
 renalis. The renal plexus detaches near the kidney a 
 few fibres, which, being joined by others from the first 
 or second lumbar nerves, accompany the spermatic 
 artery, and are therefore called the Spermatic Plexus. 
 In the male they are distributed on the cord arid testis, 
 and in the female on the ovarium and fallopian tube. 
 
 From the lower part of the renal and solar plexus, 
 there proceeds a reticulated structure of nerves in 
 front of the aorta, as low down as its bifurcation. This 
 is joined by 'fibres on each side from the sympathetic 
 of the loins. It divides, and following the course of 
 the hypogastric artery on each side, is distributed to 
 the bladder, rectum, and vesiculae seminales of the 
 male, and to the uterus, vagina, bladder, and rectum 
 of females. This is the Hypogastric Plexus, which is 
 further increased by filaments from the sacral parts of 
 the sympathetic. 
 
 The other nerves of the trunk consist of the Dorsal, 
 the Lumbar, and the Sacral. Each arises as a solitary 
 trunk from its appropriate spinal ganglion, and very 
 soon divides into anterior and posterior fasciculi. The 
 posterior is distributed to the muscles of the back, but 
 the anterior has a destination not so uniform. ‘ 
 
 The anterior branches of the Dorsal nerves are all 
 connected to the ganglions of the sympathetic, and. 
 
ARTERIES. 
 
 323 
 
 running between the internal and external intercostal 
 muscles, are distributed to the parietes of the thorax 
 and abdomen. 'The first dorsal nerve joins the axil- 
 lary plexus. The second sends a branch through 
 the external intercostal muscle to the axilla, which joins 
 with a branch of the internal cutaneous nerve of the 
 arm, and is supposed, as it also sends a filament to the 
 lower cervical ganglion of the sympathetic, to estab- 
 lish the sympathy between the arm and the heart in 
 angina pectoris. The third dorsal also sends a branch 
 to the axilla. 
 
 The upper lumbar nerves are employed upon the 
 integuments of the abdomen, and in the formation of 
 the lumbar plexus which supplies the front of the thigh 
 and leg. The lower lumbar nerves and the sacral, 
 form the sciatic plexus, which supplies the posterior 
 parts of the lower extremity. 
 
 The further consideration, of the spinal nerves is 
 referred to the Anatomy of the Limbs. 
 
 Section II. 
 
 Of the Blood-vessels of the Trunk. 
 
 The course of the aorta, from its origin to its passage 
 through the diaphragm, has already been mentioned, 
 (see Thorax;) as well as that a line to subtend the base 
 
324 
 
 OF THE TRUNK. 
 
 of its curvature, must be drawn from the sternal extre- 
 mity of the third rib on the right, to the dorsal extre- 
 mity of the third rib on the left side. The first 
 branches given off after the coronary arteries, are the 
 Arteria Innominata, the Left Carotid, and the Left 
 Subclavian. The Arteria Innominata is in advance 
 of the others, and divides, after an inch and a quarter 
 of length, into right carotid and subclavian. For an 
 exposition of the course of the Carotids, see the article 
 Neck. 
 
 The Subclavian Artery, before it passes between 
 the scaleni muscles, sends off five branches: the Inferior 
 Thyroid, the Vertebral, and the Transverse Artery of 
 the neck have been mentioned in the article Neck; 
 the other two belong to the trunk. The first is the 
 Arteria Mammaria Interna, which comes from the 
 subclavian commonly before any of the others: and the 
 second is the Superior Intercostal Artery, about the 
 last of the cluster. 
 
 The Internal Mammary Artery, after its origin, 
 descends immediately, and fixes itself between the 
 pleura and the cartilages of the true ribs, about tliree- 
 fourths of an inch from the outer edge of the sternum; 
 it gets into the abdomen and is distributed finally to 
 the rectus muscle, anastomosing in it with the epigas- 
 tric artery. It sends a branch which attends the 
 phrenic nerve on the side of the pericardium; it sup- 
 plies the intercostal muscles, anastomoses with the 
 intercostal arteries, and sends some branches to the 
 
 mamma. 
 
ARTERIES. 
 
 325 . 
 
 The Superior Intercostal Artery runs across the 
 heads of the first and second ribs, and supplies the in- 
 tercostal spaces corresponding to them; it also, some- 
 times, supplies the third intercostal space. 
 
 Below its curvature, in the thorax, the aorta gives 
 off the CEsophageal, the Bronchial, the Posterior Me- 
 diastinal and the Intercostal Arteries. 
 
 The Bronchial Arteries are vessels intended for 
 the nourishment of the lungs; the right comes from the 
 superior intercostal artery, and the left from the aorta; 
 this arrangement is not uniform, forsometimes both come 
 from the aorta. 
 
 The CEsophageal Arteries are five or six in number, 
 and are spent upon the cesophagus, as their name im- 
 plies; the lowermost descends to the stomach. 
 
 The Posterior Mediastinal, as their name indicates, 
 supplies the posterior mediastinum and its contents. 
 
 The Aortic Intercostals supply, commonly, the ten 
 inferior intercostal spaces. The upper ones have to 
 rise somewhat obliquely to get to their destination, 
 whereas the lower ones pass nearly horizontally. The 
 right are longer than the left, and the oesophagus is in 
 front of them. Each one joins the rib near its tuber- 
 cle, and keeps at its lower edge, between the internal 
 and external intercostal muscles in the groove of the 
 bone. The first branch is the dorsal, given off near 
 the spine, which passes to the muscles of the back, and 
 
326 
 
 OF THE TRUNK. 
 
 despatches an arteriole through the intervertebral 
 foramen to the medulla spinalis. When the intercostal 
 arrives near the middle of the rib, it sends off a branch, 
 which passes near the upper edge of the lower rib. 
 When it has got two-thirds of the length of the rib, it 
 leaves the lower edge to be distributed to the inter- 
 costal space and contiguous parts. 
 
 The Abdominal Aorta passes almost in front of the 
 vertebrae, being pushed but very little to the left of 
 the median line. It gives off several large branches 
 to the viscera, and at the intervertebral space of the 
 fourth and fifth vertebrae of the loins it divides into the 
 two Primitive Iliacs. 
 
 The Phrenic Arteries come from the aorta imme- 
 diately on the latter emerging between the crura of 
 the diaphragm. They are two in number, and named 
 from their situations. Right and Left; they ramify on 
 the concave surface of the diaphragm. Their origin 
 is subject to variations. 
 
 The Cceliac Artery, (Arteria Cceliaca)is immediate- 
 ly below the phrenic; it is a large vessel about half an 
 inch long, standing from the aorta at right angles, and 
 divides into the Hepatic, Gastric or Coronary, and 
 Splenic Arteries. 
 
 The Hepatic Artery goes to the liver through the 
 
ARTERIES. 
 
 327 
 
 capsule of Glissoiij and is distributed through this vis- 
 cus. Near the liver it sends off the Arteria Gastrica 
 Dextra, which is distributed to the great curvature of 
 the stomach and the contiguous parts. 
 
 The Gastric Artery is between the other two; it 
 joins the stomach near the cardia, and proceeds along 
 the lessure curvature to the pylorus, supplying conti- 
 guous parts. 
 
 The Splenic Artery, is the largest of the three. 
 It goes tortuously along the upper edge of the pancreas 
 to the spleen; in its course it sends to the stomach the 
 Gastrica Inferior Sinistra, which is spent on its greater 
 extremity and the left side of the greater curvature. 
 From this vessel also are derived the Vasa Brevia of 
 the stomach, and the Arteries of the Pancreas. 
 
 The Superior Mesenteric, (Arteria Mesenterica 
 Superior) is about half an inch below the coeliac, and is 
 nearly of the same size; it passes downwards under the 
 pancreas and above the duodenum, supplying all the 
 small intestines, the right side of the colon, and its 
 transverse arch. It has a great many anastomoses in 
 it, constituted by a series of arcades, one upon the 
 other, diminishing in size as they approach the intes- 
 tine. That portion of the artery which supplies the 
 junction of the ileum with the colon, is called Arteria 
 Ileo-Colica; that which supplies the right side of the 
 great intestine, is the Arteria Colica Dextra; and that 
 
328 
 
 OF THE TRUNK. 
 
 which supplies the arch of the colon, is the Coliea 
 Media. • 
 
 The Emulgent Arteries, (Arterise Emulgentes) are 
 two in number, one from each side of the aorta, coming 
 off at right angles from it, and not much inferior in 
 size to the mesenteric. The right is the longest, and 
 passes behind the ascending vena cava. They go to 
 the kidneys and to the capsulse renales. The arterial 
 distribution from the aorta here is subject to varia- 
 tions, the arteries of the capsulge renales coming some- 
 times from the aorta, and on other occasions from the 
 emulgents. There are also several arteries going to 
 the adipose matter in which the kidneys are placed, 
 equally unsettled in their origin. 
 
 The Spermatic Arteries, (Arteriae Spermaticae) 
 arise immediately below the emulgents, one on each 
 side; they are about the size of a crow-quill, and are 
 remarkable for their length; sometimes the left arises 
 from the emulgent of that side. They pass downwards 
 to the testicles, behind the peritoneum, and before the 
 psosB muscles, not far from the ureters, spermatic plex- 
 us of nerves, and spermatic veins. At the internal 
 abdominal ring they meet with the vasa deferentia, 
 and constituting a part of the spermatic cords, are dis- 
 tributed on the testicles, in the manner described in 
 the account of these organs. In the female, these 
 arteries go to the ovaria, fallopian tubes, and uterus. 
 
ARTERIES. 
 
 329 
 
 The Inferior Mesenteric, (Arteria Mesenterica In- 
 ferior) arises below the spermatics; it is much smaller 
 than the superior. Three branches proceed from it, 
 called the Left Colic Arteries, from their distribution 
 to the left side of the colon, and are distinguished from 
 each other by the terms Superior, Middle, and Infe- 
 rior. The superior anastomoses with the colica media^ 
 forming with it the great Mesocolic Arch. The 
 others supply the sigmoid flexure of the colon, and the 
 part just above it. A branch is continued from the 
 inferior mesenteric to the rectum, constituting the 
 superior hemorrhoidal artery. 
 
 From the centre of the fork formed by the bifur- 
 cation of the aorta, there proceeds a small arterial 
 tube, about the size of a crow-quill, called the Arteria 
 Sacra Media, from its running down to the os coc- 
 cygis, just over the middle line of the sacrum. It 
 sends branches on either side towards the foramina in 
 the sacrum. 
 
 The Lumbar Arteries, (Arterise Lumbares) are from 
 three to five in number on either side; they pass off at 
 right angles from the aorta over the sides of the lumbar 
 vertebrae, some of their branches penetrate the interver- 
 tebral foramina to get to the medulla spinalis, others pass 
 to the muscles of the back. Besides which, the lower 
 parts of the parietes of the abdomen are supplied by 
 
 T t 
 
330 
 
 OF THE TRUNK. 
 
 them. They inosculate with the circiimflexa ilii, with 
 the epigastric and with the gluteal arteries. 
 
 The Primitive Iliacs, (Art. Iliacae Communes,) one 
 on each side, are formed by the termination of the 
 abdominal aorta ; they extend from the fourth lumbar 
 vertebra to the sacro-iliac junction, opposite to which 
 they divide into two trunks, the External Iliac Artery 
 and the Hypogastric. In this course they give off no 
 collateral branch of any consequence, and are crossed 
 by the ureters. 
 
 The Hypogastric or Internal Iliac, (Arteria Iliaca 
 Interna, or Ramus Hypogastricus, ) gives off several 
 branches, the origins of which differ considerably. The 
 main trunk itself is of various lengths, and is distributed 
 to the viscera of the pelvis and to the muscles on ite 
 external surface. Sometimes it is previously divided 
 into two principal trunks, an anterior and a posterior. 
 From it the following branches proceed. 
 
 1. The Ilio-Lumbar Artery, (Arteria Ilio Lumbalis,) 
 is commonly the first branch of the hypogastric or of its 
 posterior trunk. Arising from its posterior external 
 part, it passes outwardly between the psoas magnus and 
 iliacus internus muscles, and divides into two branches, 
 one of which is distributed to the loins, and the other 
 upon the iliacus internus muscle. 
 
 2. The Lateral Sacral Arteries, (Arteriac Sacrse 
 Laterales,) come next, arising by one or more tninks 
 
ARTERIES. 
 
 331 
 
 from the hypogastric or one of its large branches; they 
 commonly equal in number the foramina of the sacrum, 
 and passing into them are distributed upon the inferior 
 part of the cauda equina ; they also anastomose with 
 the middle sacral artery. 
 
 3. The Obturator Artery, (Arteria Obturatoria, ) 
 comes from the hypogastric, or one of its trunks, and 
 passes along parallel with the brim of the pelvis; going 
 through the obturator foramen it is distributed to the 
 hip joint, and to the muscles on the upper internal part 
 of the thigh. Its origin is occasionally from the epi- 
 gastric. 
 
 4. The Middle Hemorrhoidal Artery, (Arteria 
 Hemorrhoidea Media,) comes sometimes from tjae 
 gluteal, &c. It is thus named from its relative position 
 to the upper and lower hemorrhoidal, on the rectum. 
 Besides going to this organ, it supplies the prostate 
 gland and the vesiculse seminales of the male, and the 
 vagina and bladder in females. 
 
 5. The Uterine Artery, (Arteria Uterina,) is pecu- 
 liar to females, and gets to the uterus between the 
 laminae of the broad ligaments. 
 
 6. The Vesical Arteries, (Arteriae Vesicales,) are 
 derived from what was the umbilical artery of the foetus, 
 and are distributed to the bladder. 
 
 What remains of the hypogastric consists in two large 
 branches, the Gluteal and the Ischiatic. 
 
 7. The Gluteal Artery, (Arteria Glutaea,) passes out 
 of the pelvis at the upper part of the ischiatic foramen 
 
332 
 
 OF THE TRUNK. 
 
 above the pyriformis muscle, it is situated in contact 
 with the edge of the bone, and its trunk is accessible 
 from the external parts of the pelvis. Having got to 
 its outside, the trunk of the gluteal divides immedi- 
 ately into two branches, which pass forwards towards 
 the anterior margin of the pelvis, one of them ramify- 
 ing between the gluteus minimus and medius, and the 
 other between the medius and maxhnus. 
 
 8. The Ischiatic Artery, (Arteria Ischiadica,) com- 
 ing from the inferior part of the hypogastric, is situated 
 before the belly of the pyriformis muscle, and issues 
 from the pelvis below its inferior edge and in front of 
 the sciatic nerve. It pursues its course downwards on 
 the back part of the thigh, between the trochanter 
 major and the tuberosity of the ischium, being then at 
 the internal edge of the sciatic nerve. In the pelvis 
 it sends off the Internal Pudic, and on the outside 
 of it, is distributed to the inferior edge of the gluteus 
 maximus, and to the muscular structure near the sa- 
 crum and coccyx ; also to the muscles, on the back and 
 upper parts of the thigh. 
 
 The Internal Pudic Artery, (Arteria Pudica In- 
 terna,) emerges from the pelvis with the ischiatic, and 
 then returns between the two sacro-sciatic ligaments tc 
 the inner side of the tuberosity of the ischium, and con- 
 tinues on the inner side of the rami of the ischium and 
 pubes towards the symphysis. In this coui*se it gives off 
 
ARTERIES. 
 
 333 
 
 several branches in the following order. The Lower 
 Hemorrhoidal Artery to the pyriformis muscle at its 
 lower edge, to the lower part of the rectum, and to the 
 sphincter ani muscle. To the back part of the scrotum, be- 
 tween the transversusperinei muscle and tlie skin it gives 
 the Perineal Artery, originating near this muscle and 
 passing in its direction. Upon the arrival of the inter- 
 nal pubic near the penis, it detaches to this body a 
 branch which penetrates and ramifies minutely through 
 the structure of the corpus spongiosum urethrae. At the 
 symphysis of the pubes it sends off a branch which gets 
 to the dorsum of the penis, and extends longitudinally 
 as far as the glans, being distributed to the elastic liga- 
 ment, to the integuments, and to the prepuce; this is the 
 Superficialis Dorsi Penis. Finally, the terminating 
 branch of the internal pudic penetrates into the corpus 
 cavernosura, passes straight forwards on the septum, and 
 is distributed to the, cells, by very minute branches, 
 some of which go to the other side. 
 
 The External Iliac Artery, (Arteria Iliaca Externa, ) 
 seems to be the continuation of the common iliac ; it 
 passes along the brim of the pelvis on the inner side of 
 the psoas magnus muscle to Poupart’s Ligament. Here 
 it is about half way between the symphysis of the pubes 
 and the anterior superior spinous process of the ilium, 
 having the anterior crural nerve on its outside and the 
 internal iliac vein on its inside. It gives off no bran- 
 
I 
 
 334 OF THE TRUNK. 
 
 ches till it reaches Poupart’s ligament, when the Epi- 
 gastric arises from it. 
 
 The Epigastric Artery, (Arteria Epigastrica, ) at 
 first passes inwards ; it then rises upwards obliquely 
 till it reaches the exterior edge of the rectus muscle. 
 Continuing afterwards to ascend, it is spent upon the 
 anterior parietes of the abdomen by many branches, 
 some of which inosculate with the internal mammary. 
 
 The Circumflex Artery, (Arteria Circumflexa Ilii,) 
 arises from the external iliac opposite to the epigastric. 
 It runs along the posterior edge of Poupart’s ligament 
 to the spinous process of the ilium ; thence it continues 
 its course near the internal margin of the crista, being 
 distributed to the iliacus internus muscle. A branch 
 of it, near the spinous process, rises upwards and is 
 spent upon the abdominal muscles. It anastomoses with 
 the arteria ilio lumbalis. 
 
 Veins of the Trunk. 
 
 The Superior Cava, (Cava Descendens,) is suffici- 
 ently alluded to in the description of the thorax, to 
 render a minute notice of it here unnecessary. It re- 
 ceives the blood from the left arm and side of the head 
 by a trunk (the vena innomiuata,) common to the two, 
 which crosses the sternum obliquely a little below its su- 
 perior edge. This venous trunk, and the one belong- 
 ing to the right arm and the right side of the head, 
 constitute the Descending Cava, properly speaking. 
 
VEINS, 
 
 335 
 
 On a horizontal line with the upper edge of the root 
 of the right lung is the point where the descending 
 cava is joined by the vena azygos. The latter is form- 
 ed hy the union, into one trunk successively, of the ten 
 inferior intercostal veins of the right side. About the 
 sixth dorsal vertebra this trunk is joined by one form- 
 ed by the successive union of the six inferior intercostal 
 veins of the left side. The trunk of the vena azygos, 
 as stated, is on the right side of the posterior medi- 
 astinum, and forms a regular and beautiful arch over 
 the root of the right lung. 
 
 The Superior Intercostal Veins of the left, discharge 
 into the subclavian vein by a common trunk ; the two 
 superior of the right side into the descending cava. 
 
 The Internal Mammary Vein has nothing very pe- 
 culiar; it observes the course of its artery, and empties 
 into the subclavian vein near its origin. 
 
 The Cava Ascendens is formed in the lower part of 
 the trunk, by the union of the external and internal 
 iliac veins, into the common iliacs and the subsequent 
 junction of the latter at the fourth dorsal vertebra. 
 This vein ascends on the right of the aorta, receives 
 many accessions in its course, penetrates the right open- 
 ing of the diaphragm, and terminates in the right 
 auricle. 
 
 Each artery of the pelvis has its corresponding vein; 
 it is therefore unnecessary to describe the latter, ex- 
 
336 
 
 OF THE TRUNK. 
 
 cept in regard to peculiarities. About the neck of the 
 bladder, vesiculse seminales, and the base of ther pro- 
 state there is a considerable accumulation of veins form- 
 ing a very vascular plexus of them; they come origi- 
 nally from the vena ipsius penis and from the proper 
 vesical veins. 
 
 The several veins of the pelvis derived from the 
 ischiatic, gluteal, and internal pudic arteries, &c. ac- 
 cumulate at the sacro-iliac junction into one trunk, 
 which ascends by the side of the hypogastric artery 
 and joins the external iliac vein. 
 
 The ascending cava is joined, at its fork, by the 
 middle sacral vein, and above it, by the lumbar veins 
 on each side. The right spermatic vein discharges 
 into the ascending cava, but the left into the emulgent 
 of that side. The emulgent and capsular veins corres- 
 pond with the arteries, the right being shorter than 
 the left, from the position of the vena cava. The left 
 emulgent vein is in front of the aorta. 
 
 The ascending cava is next joined by the hepatic 
 veins which have been mentioned, and lastly, by the 
 phrenic. 
 
 The Venous Trunks, derived from the superioi’ and 
 inferior mesenteric arteries and from those of the 
 coeliac which do not go to the liver, as the splenic and 
 gastric, form the large trunk of the vena portarum. the 
 history of which is given in tlie account of the liver. 
 
THORACIC DUCT. 
 
 337 
 
 Section III, 
 
 The Thoracic Duet, {Vas Chy lifer us.) 
 
 The common trunk of the absorbent system com- 
 mences most commonly at the second or third lumbar 
 vertebra, in front of its body, by the union of the 
 absorbent vessels of the lower extremities, pelvis, and 
 intestines. This vessel, immediately after its forma- 
 tion, is sometimes subjected to a dilatation of various 
 shapes and lengths, called the Receptaculum Chyli; after 
 which it proceeds regularly upwards in front of the ver- 
 tebrae, between the vena azygos and the aorta, to the 
 upper part of the thorax. It passes between the crura of 
 the diaphragm, and, for some part of its course, is 
 immediately behind the oesophagus. At the fourth 
 dorsal vertebra it begins to incline to the left, and, 
 preserving that direction, it gets into the neck as high 
 as the upper edge of the seventh cervical vertebra 
 and just to its left side. Here it forms an arch, which 
 descends forwards and outwards in front of the sub- 
 clavian artery, and between the internal jugular vein 
 and the scalenus anticus muscle, and there terminates 
 by an orifice protected by two valves, in the fork form- 
 ed by the junction of the left internal jugular and sub- 
 clavian veins. 
 
 Several interesting varieties occur in the vas chy- 
 liferus; sometimes two trunks are formed originally 
 
 u u 
 
338 
 
 OF THE TRUNK 
 
 on the lumbar vertebrae, which run parallel with each 
 other, and then unite at the lower dorsal vertebra. 
 The thoracic portion of the duct varies in size and con- 
 tinuity, being divided once or oftener, into two trunks, 
 which unite again, and being also contracted at parti- 
 cular points. The cervical, or terminating portion of 
 the duct is occasionally divided into two tubes, which 
 have separate orifices. 
 
 There is a very good plate in Caldani, representing 
 the terminations of the several . lymphatic trunks in 
 the region of the neck; in this plate the thoracic duct 
 empties, after a considerable dilatation, into the inter- 
 nal jugular vein, about an inch above its junction with 
 the subclavian; and the lymphatics of the left side of 
 the head and neck, form two trunks, which discharge 
 separately, into the convex side of the Thoracic duct. 
 The lymphatics of the left upper extremity form a 
 trunk, whose orifice is in the subclavian vein, about an 
 inch below its junction with the internal jugular. 
 The lymphatics of the right arm, lung, right side of 
 the neck and head, converge towards the junction of 
 the right subclavian and internal jugular by four trunjcs, 
 and then unite into one, which discharges itself at 
 the posterior face of this junction. The venous orifice 
 of each of these lymphatic vessels, is secured from a 
 regurgitation of blood by one or more valves. 
 
PART II. 
 
 CHAPTER VI. 
 
 Of the Muscles of the Back. 
 
 Make an incision through the integuments from the 
 lower part of the occiput to the os coccygis, directly 
 over the spinous processes of the vertebrae. Make a 
 second incision from the lobe of the ear to the acromion 
 process. Unite the upper ends of these incisions. 
 Make a third cut through the integuments from the 
 acromion process to the posterior fold of the arm-pitj 
 extend the latter downwards to the middle of the crista 
 of the ilium, in a direction somewhat curved, the con- 
 vexity of the line being backwards. Lastly, make a 
 cut horizontally from the acromion process to the spine. 
 
 Begin the dissection at the last cut, and raise the 
 upper, and then the lower flap, in the direction of the 
 muscular fibres, as they make their appearance. In 
 this manner is exposed the two superficial broad mus- 
 cles of the back, the Trapezius and the Latissimus 
 Dorsi. 
 
 The Trapezius is a beautiful broad muscle, imme- 
 diately under the skin, covering the back parts of the 
 
340 
 
 OF THE TRUNK. 
 
 neck and thorax, extending from the bottom of the 
 latter to the top of the former. Its anterior edge 
 above, is parallel with the posterior edge of the sterno 
 cleido mastoideus. Its posterior edge is joined with 
 that of its fellow, and below, it overlaps the latissimus 
 dorsi in part. 
 
 It arises from the occipital protuberance, and from 
 eight or ten lines, sometimes more, of the upper trans- 
 verse ridge of the occiput, by a tendinous membrane. 
 It arises also from the live superior spinous processes 
 of the neck, through the intervention of the Ligamen- 
 tum Nuchse, and tendinous from the two lower spinous 
 processes of the neck, and from all of the back. 
 
 It is inserted fleshy into the external third of the 
 clavicle, tendinous and fleshy into the acromion pro- 
 cess, and into all the spine of the scapula. Its fibres 
 having a very extended origin must of course con- 
 verge in getting to these insertions; the upper fibres 
 descend, the lower ascend, and the middle are hori- 
 zontal. 
 
 It draws the scapula towards the spine. In the cer- 
 vical portion of these muscles, formed by the origins 
 of both muscles united, is an elliptical expanse of ten- 
 don, lying over the ligamentum nuchaB, and extended 
 on each side. The ligamentum nuchse itself, is a ver- 
 tical septum of ligamentous matter, extending from the 
 central line of the occipital bone, to the spinous pro- 
 cesses of all the vertebrae of the neck. At its upper 
 
MUSCLES OF THE BACK. 
 
 341 
 
 part, where the spinous processes of the neck are short, 
 this membrane is very broad, and divides completely 
 the muscles of the two sides of the neck from each 
 other. 
 
 The Latissimus Dorsi is situated under the skin 
 at the lower part of the back, so as to cover its whole 
 posterior portion. It arises by a thin, tendinous ex- 
 panse, from the seven inferior spinous processes of the 
 back, and by a thick tendinous membrane from all the 
 spines of the loins and sacrum. This membrane is the 
 fascia lumborum, is common to several of the muscles 
 which have their origin in this region, and extends 
 along the iliac margin of the sacrum, so as to arise also 
 from the posterior third of the spine of the ilium.^ 
 Besides these origins, the latissimus dorsi has four fleshy 
 heads from the sides of the four inferior false ribs, 
 which are interlocked with the inferior heads of the 
 obliquus externus abdominis. 
 
 From this extended origin the fibres converge, so 
 as to form the posterior fold of the axilla, and to termi- 
 nate in a flat, thick tendon, of two inches in breadth, 
 which is inserted into the posterior ridge of the groove 
 of the os humeri. The upper part of this muscle 
 passes over the inferior angle of the scapula, and de- 
 rives a fasciculus of fibres from it. 
 
 * This origin frequently is tendinous at the back part of the 
 ilium, and fleshy in front. * 
 
342 
 
 OF THE TRUNK. 
 
 It draws the os humeri downwards and backwards. 
 
 Detacii now the. trapezius from its origin and turn 
 it over the shoulder. Begin also to detach the latissi- 
 mus dorsi from its origin above, turning downwards the 
 upper edge of the muscle as the separation goes on. By- 
 doing so, in a little time is brought into view the upper 
 edge of the 
 
 Serratus Inferior Posticus. The origin of this 
 muscle is inseparably united to that of the latissimus 
 dorsi, therefore to view it properly, let the fleshy part 
 of the latissimus be detached from the fascia lumborum. 
 We shall then see that the serratus arises by a tendi- 
 nous membrane from the two inferior spines of the 
 back, and the three superior of the loins. 
 
 It is inserted by fleshy digitations into the under 
 edge of the four inferior ribs. 
 
 It draws the ribs downwards, and is an antagonist to 
 the diaphragm in some respects, but more particularly 
 to the serratus superior posticus. 
 
 The removal of the trapezius above, brings into view 
 several muscles, the most superficial of which are the 
 rhomboid, there being two together looking very much 
 like one. 
 
 The Rhomboideus Minor is above. It is a nar- 
 row muscle which ai’ises by a thin tendon from the 
 three inferior spines of the neck, and passing obliquely 
 
MUSCLES OF THE BACK- 
 
 343 
 
 downwards, is inserted into the base of the scapula op- 
 posite the origin of its spine. 
 
 The Rhomboideus Major arises also by a thin ten- 
 don from the last spine of the neck, and from the four 
 superior of the back, and is inserted into all the base 
 of the scapula below its spine. 
 
 These muscles draw the scapula upwards and back- 
 wards. Detach them from their origins, which shows 
 next. 
 
 The Serratus Superior Posticus, arising by a 
 thin tendon from the three inferior spines of the neck 
 and the two superior of the back, and inserted into the 
 second, third, fourth and fifth ribs by tendinous and 
 fleshy slips, a little beyond their angles. 
 
 This muscle draws the ribs upwards. A good view 
 of the serratus major anticus where it is inserted into 
 the base of the scapula, and of its situation between 
 the thorax and scapula, is obtained at this stage of the 
 dissection. The muscle itself, in consequence of aris- 
 ing on the anterior lateral parts of the thorax, has been 
 considered in the remarks preliminary to the study of 
 that cavity. 
 
 The Levator Scapula is placed between the pos- 
 terior edge of the sterno-cleido-mastoideus and the an- 
 terior of the trapezius: its lower end is just above the 
 
344 
 
 OF THE TRUNK. 
 
 J 
 
 Rhomboideus Minor.. It arises by rounded tendons 
 from the three or five superior transverse processes of 
 the neck, between the scaleni muscles and the splenius 
 colli. 
 
 It is inserted fleshy into that part of the base of the 
 scapula above the origin of its spine. As its name ex- 
 presses, it draws the scapula upwards. A good view 
 of this muscle may be obtained in the front dissection 
 of the neck. 
 
 The Splenius muscle comes next; its inferior ex- 
 tremity is under the serratus superior, but the prin- 
 cipal part of it is covered by the trapezius. It arises 
 from the spinous processes of the five inferior cervical, 
 and of the four superior dorsal vertebrae. 
 
 It is inserted into the back of the mastoid process 
 and a small part of the adjacent portion of the os oc- 
 cipitis, and also into the transverse processes of the two 
 superior cervical vertebrae. It is customary to consider 
 the part which goes to the head as Splenius Capitis, 
 and the part below as Splenius Colli; the latter, in that 
 case, is said to arise from the third and fourth dorsal 
 vertebrae. It draws the head and neck backwards. 
 
 Between the spinous processes of the vertebrae and 
 the angles of the ribs, on either side, there is a deep fossa 
 filled up by muscles, some of them large and powerful; 
 the most striking are the Sacro Lumbalis and the Lon- 
 gissimus Dorsi. 
 
MUSCLE'S OF THE BACK. 
 
 345 
 
 The Sacro Lumbalis and Longissimus Dorsi 
 have a common origin from the back of the pelvis and 
 of the lumbar vertebrae, and extend to the top of the 
 thorax. They arise, tendinous externally, and fleshy 
 internally, from the posterior surface of the sacrum by 
 its external margin and spinous processes ; they arise 
 also, tendinous, from the spinous processes, and fleshy, 
 from the ends of the transverse processes of all the 
 vertebrae of the loins and from the posterior part of the 
 spine of the ilium. From the under surface of this 
 common belly, two tendinous and fleshy heads are in- 
 serted into the inferior edge of the transvei*se process 
 of each lumbar vertebra, the smaller near its root and 
 the larger near its extremity. On a level with the 
 lowest rib, and, indeed, somewhat below it, a fissure 
 occurs in the muscle which divides it into the two 
 parts. 
 
 The Longissimus Dorsi is nearest the spine ; it is in- 
 serted, by small double tendons proceeding from its 
 internal surface, into the ends of the transverse pro- 
 cesses of all the vertebrae of the back except the first. 
 It also, from its outer edge, sends long slender tendons, 
 by which it is inserted into the under edges of all the 
 I’ibs near their angles, except the two inferior. 
 
 The Sacro Lumbalis is inserted from its outer edge 
 into all the ribs at their angles, by long and thin ten- 
 dons, which are longer, the higher they are inserted. 
 
 By turning over this muscle from the other, towards 
 the ribs, one may see coming from the eight lower 
 
 X X 
 
346 . 
 
 OF THE TRUNK. 
 
 ribs, as many slips, which run into the under surface of 
 the sacro lumbalis; they are the Musculi Accessorii ad 
 Sacro Lumbalem. 
 
 These two muscles keep the spine erect, and draw 
 down the ribs. 
 
 Between the ends of the spinous processes and the 
 edge of the longissimus dorsi, is a muscle almost 
 entirely tendinous, and scarcely to be distinguished 
 from the latter, both in consequence of its close con- 
 nexion with it and of its insignificant size. At its 
 lower part, it is absolutely a portion of the Longissimus, 
 and can be separated from it only by an unnatural 
 division. It is a mere string lying along the sides of 
 the spinous processes, and is called from its origin and 
 insertion, the Spinalis Dorsi. 
 
 The Spinalis Dorsi arises tendinous from the 'spi- 
 nous processes of the two superior lumbar, and of the 
 three inferior dorsal vertebrae, and is inserted tendi- 
 nous into the spinous processes of the nine superior 
 dorsal vertebrae, except the first. 
 
 It tends to keep the spine erect. Tui'n now the 
 splenius from its insertions, which exhibits several 
 muscles under it. 
 
 The Cervicalis Descendens is a small muscle 
 placed at the upper portion of the thorax, between the 
 insertions of the sacro lumbalis, and of the longissimus 
 
 / 
 
MUSCLES OF THE BACK. 347 
 
 doi-si into the upper ribs; it looks, at first, very much 
 like a continuation or appendix of the first, running to 
 the cervical vertebrae. 
 
 This muscle arises from the upper edges of the 
 four superior ribs by long tendons; it forms a small 
 belly, which is inserted into the transverse processes 
 of the fourth, fifth, and sixth vertebrae of the neck, 
 between the levator scapulae and splenius colli, by three 
 distinct tendons. 
 
 It draws the neck backwards. 
 
 The Traxsversalis Cervicis is on the inner side 
 of the last and in contact with it, being about the same 
 size, and having very much the same course and ap- 
 pearance. It is considered as an appendage to the 
 longissimus dorsi. 
 
 It arises from the transverse processes of the five 
 superior dorsal vertebrae by distinct tendons, and forms 
 a narrow fleshy belly, which is Inserted by distinct 
 tendons also, into the transverse processes of the five 
 middle cervical vertebrae. It draws the head back- 
 wards. 
 
 The Trachelo Mastoideus is at the imier side of 
 the last muscle, in contact with it. 
 
 It arises, by distinct tendinous heads, from the trans- 
 verse processes of the three superior vertebrae of the 
 back, and of the five inferior of the neck, and is insert- 
 
348 
 
 OF THE TRUNK. 
 
 ed, by a thin tendon, into the posterior edge of the 
 mastoid process. 
 
 The dorsal origins are frequently deficient or irre- 
 gular. It draws the head baekwards. 
 
 The CoMPLEXus, a fine large muscle, is situated at 
 the inner face of the trachelo mastoideus, and is readily 
 recognized by showing itself between the bellies of the 
 two splenii capitis, just below the occiput. A quantity 
 of tendinous matter exists in its middle, which gives it 
 the complicated appearance from whence its name is 
 derived. 
 
 It arises, by tendinous heads, from the seven supe- 
 rior dorsal, and the four inferior cervical vertebrae by 
 their transverse processes; aiso by a fleshy slip from 
 the spinous process of the first dorsal. It is inserted 
 into the inferior part of the os occipitis by the surface 
 between the upper and lower transverse ridges, and 
 on the outside of the vertical ridge which exists in the 
 middle of the bone. 
 
 It draws the head backwards. 
 
 The Semispinalis Colli is a muscle which passes 
 obliquely from transverse to spinous processes, and is 
 situated between the complexus and the multifidus 
 spinae; the course of its fibres renders it difficult to be 
 distinguished from the latter. 
 
 It arises from the transverse processes of the six 
 upper vertebrae of the back, by tendons which are in- 
 
MUSCLES OF THE BACK. 
 
 349 
 
 volved with those of the adjacent muscles, and passes 
 up to the neck, to be inserted into the sides of the spi- 
 nous processes of the five middle cervical vertebrae. 
 
 It extends the neck obliquely backwards. 
 
 The Semispinalis Dorsi is lower down on the 
 spine, and with difficulty distinguished from the mul- 
 tifidus, like the other, passing from transverse to spi- 
 nous processes. It lies under the longissimus dorsi, 
 between it and the multifidus. 
 
 This muscle arises by tendons connected with those 
 of the other muscles, from the transverse processes of 
 the seventh, eighth, ninth, and tenth dorsal vertebrae, 
 and passes upwards obliquely, to be inserted, tendi- 
 nous, into the sides of the spinous processes of the two 
 lower cervical, and five upper dorsal vertebrae. 
 
 It draws the spine obliquely backwards. 
 
 The MULTIFIDUS Spin.® lies under the muscles as yet 
 mentioned, close to the bones of the spine; in order to 
 see it well, they, therefore, should all be cut away. 
 
 It has its commencement, tendinous and fleshy, on 
 the back of the sacrum, being connected to its spinous 
 processes and posterior surface, also to the back part 
 of the spine of the ilium. It there forms a belly of 
 sufficient magnitude to fill up much of the cavity be- 
 tween the spines of the sacrum and the posterior part 
 of the ilium. It arises also from the roots of the ob- 
 lique and transverse processes of all the vertebrse of the 
 
350 
 
 OF THE TRUNK. 
 
 loins, of the back, and of the four inferior of the neck. 
 
 The multifidus is inserted, tendinous and fleshy, into 
 the roots and sides of the spinous processes of all the 
 vertebrae of the loins, of the back, and of the five in- 
 ferior of the neck. 
 
 This muscle consists of a great number of small 
 bellies, which are parallel^o each other, arising from a 
 transverse process, and going to the spinous process 
 either of the first or second vertebra above it. 
 
 It twists the spine backwards and keeps it erect. 
 
 Between the head, and the first and second verte- 
 brae, and between the two latter, there are, on eacli 
 side, four small muscles, intended for the motion of 
 these parts upon each other. They are brought into 
 view by the removal of the complexus. 
 
 The Rectus Capitis Posticus Ma.ior arises ten- 
 dinous and fleshy, from the extremity of the spinous 
 process of the dentata, and is inserted into the inferior 
 transverse ridge of the os occipitis, and part of the sur- 
 face below it. 
 
 Its shape is pyramidal, the apex being below. It 
 turns the head, and also draws it backwards. 
 
 The Rectus Capitis Posticus Mixor is at the 
 internal edge of the first. It arises tendinous from the 
 tubercle on the back part of the first vertebra, and is 
 inserted into the internal end of the inferior ti’ansversf 
 
MUSCLES OF THE BACK. 
 
 351 
 
 ridge of the os occipitis, and into part of the surface 
 between it and the foramen magnum. 
 
 It is also pyramidal^ with the apex downwards. It 
 draws the head backwards. 
 
 The Obliquus Capitis Superior arises from the 
 transverse process of the first cervical vertebra, and 
 is inserted into the inferior transverse ridge of the os 
 occipitis, behind the posterior part.of the mastoid pro- 
 cess, and beneath the complexus muscle. 
 
 It draws the head backwards. 
 
 The Obliquus Capitis Inferior arises from the 
 side of the spinous process of the dentata, and is in- 
 serted into the back part of the transverse process of 
 the first vertebra of the neck. 
 
 It rotates the first vertebra on the second. 
 
 The Interspinales are small short muscles, placed 
 between the spinous processes of contiguous vertebrae. 
 In the neck they are double, in consequence of its 
 spinous processes being bifurcated; in the back they are 
 almost entirely tendinous ; in the loins they are single 
 and well marked. 
 
 They draw the spinous processes together, and keep 
 the spine erect. 
 
 The Intertransversarii are also short muscles 
 placed in a similar manner, between the transverse pro- 
 
352 
 
 OF THE TRUNK. 
 
 cesses of the vertebrae. In the neck they are double, in 
 the back they are small, tendinous, and not well express- 
 ed, and in the loins they are single and well seen. 
 
 They draw the transverse processes together, and 
 will, of course, bend the spine to one side. 
 
 The Levatores Costarum are small muscles con- 
 cealed by the sacro lumbalis and longissimus dorsi, 
 and pass from the transverse processes of the last 
 cervical and the eleven superior doi'sal vertebrae, to the 
 upper edges of all the ribs. They are twelve on either 
 side of the spine, are tendinous in their origins and in- 
 sertions, with intermediate muscular bellies. 
 
 The upper ones are small and thin, and they increase 
 in magnitude as they descend. From the inferior edge 
 of nearly all these muscles a fleshy slip is detached, 
 which passes over the rib next below its origin, to the 
 second rib below, and occasionally to the third. These 
 slips are called Levatores Costarum Longiores. The 
 others which descend from the transverse process to 
 the rib next below, are called Levatores Costarum 
 Breviores. 
 
 These muscles are parallel in their obliquity, with 
 the external intercostals, and are not very obviously 
 separated from them. They perform the same ser- 
 vice, that of elevating the ribs. 
 
PART III. 
 
 O F T-H E EXTREMITIES. 
 
 CHAPTER I. 
 
 Of the Upper Extremities. 
 
 Section I. 
 
 Of the Fascia. 
 
 * The Upper Extremity, consisting of shoulder, arm, 
 fore-arm, and hand, has not so regular, or so strong 
 an investment of fascia as the thigh. In the shoulder, 
 excepting its back part, and in the arm, this envelope 
 has but few ligamentous fibres in it, and is principally 
 condensed cellular membrane, which ought to be re- 
 moved with the skin; but in the fore-arm its character 
 is better developed, and is there decidedly aponeurotic. 
 The aponeurosis of the fore-arm forms a complete 
 
 y y 
 
354 
 
 OF THE UPPER EXTREMITIES. 
 
 sheath for its muscles. It is connected with the bony 
 prominences at the elbow joint, more particularly the 
 external and internal condyle, with the ulnar side of the 
 tendon of the biceps muscle, and the olecranon process 
 of the ulna; and passes down to the carpus, where it 
 terminates both anteriorly and posteriorly in the an- 
 nular ligament of the wrist. It is attached to the 
 ulna along its internal margin, from the elbow joint to 
 the wrist, and several muscles arise from its interior 
 surface. 
 
 It is unnecessary to undertake, from the first, a 
 regular dissection of this fascia, inasmuch as it will be 
 gradually exposed in proceeding with the muscles. 
 This extremity is most conveniently studied by detach- 
 ing it from the trunk, taking care to have the clavicle 
 with it. 
 
 Section II. 
 
 Of the Muscles of the Upper Extre?nities. 
 
 The Muscles situated on the shoulder are six in 
 number; they extend, for the most part, from the 
 scapula to the head and neck of tlie os humeri. 
 
MUSCLES. 
 
 355 
 
 1. The Deltoides arises from the inferior edge of 
 the whole spine of the scapula, from the outer margin 
 of the acromion process, and from the exterior third 
 of the clavicle. Its origin, for the most part, is tendi- 
 nous and fleshy mixed; but at its posterior part, it is 
 entirely tendinous. 
 
 It is inserted by a tendinous point, into the triangu- 
 lar rough surface, on the outer side of the os humeri, 
 near its middle. It raises the os humeri to a horizon- 
 tal line with the acromion. 
 
 The deltoid is situated just beneath the skin, and 
 forms the cushion, which protects and gives rotundity 
 to the shoulder joint. Its general configuration is tri- 
 angular, and, when spread out, its upper margin is 
 much more extensive than one would suppose, from be- 
 ing opposed to the insertion of the trapezius. Its fibres 
 do not converge regularly to its insertion like the 
 radii of a circle, but the whole muscle is divided into 
 several parts; the interposition of intermuscular ten- 
 dons into which, affecting the course of the fibres, 
 makes several portions of the deltoid look penniform, 
 and others like smaller deltoids introduced into the 
 larger. 
 
 The deltoid covers the insertion of the peetoralis 
 major, latissimus dorsi, and teres major, besides that 
 of the other muscles of the shoulder. It also conceals 
 the origin of the biceps flexor cubiti and of the coraco 
 brachialis. Its insertion is between the triceps exten- 
 
356 
 
 OF THE UPPER EXTREMITIES. 
 
 sor and the biceps flexor, and above the origin of the 
 brachialis internus. 
 
 The deltoid should be detached from its origin and 
 thrown down, which gives a good view of the other 
 muscles. 
 
 2. The Supra Spinatus arises fleshy from the 
 whole fossa supra spinata which it fills up, and from 
 its margins. Forwards it terminates in a thick robust 
 tendon, closely connected with the capsular ligament 
 of the joint, which passes under the jugum formed by 
 the articulation of the acromion with the clavicle. 
 
 It is inserted tendinous into the inner face of the 
 great tubercle of the os humeri, and will assist in 
 raising it. 
 
 3. The Infra Spinatus arises fleshy from all that 
 portion of the dorsum scapulas below its spine, from 
 the spine as far as the cervix, and from the several 
 margins of the fossa infraspinata. Its fibres pass ob- 
 liquely to a middle tendon, which adheres closely to 
 the capsular ligament, and goes under the projection of 
 the acromion. 
 
 This tendon is inserted into the middle face of the 
 greater tubercle of the os humeri. 
 
 The infra spinatus rolls the os humeri outwards and 
 backwards. 
 
 4. The Teres Minor is situated at the inferior 
 
MUSCLES. 
 
 357 
 
 margin of the infraspinatus, in the fossa of the inferior 
 costa scapulae, and looks very much like a part of the 
 infra spinatus, to which it occasionally adheres so close- 
 ly, as to be separated with difl5,culty. It arises fleshy 
 from the whole of the fossa, from the margins of the in- 
 ferior costa, and from the cervix of the bone, to within 
 an inch or so of its angle. 
 
 It is inserted, tendinous and fleshy, into the outer 
 face of the great tuberosity of the os humeri, just be- 
 low the infra spinatus. 
 
 It draws the humerus downwards and backwards, 
 and rotates it outwards. 
 
 5. The Teres Major is situated at the inferior 
 edge of the teres minor. It arises fleshy from the pos- 
 terior surface of the angle of the scapula, and from a 
 small part of its inferior costa; the interstice between 
 it and the teres minor is considerable. 
 
 It is inserted, by a broad tendon, into the internal 
 ridge of the groove of the os humeri, along with the 
 tendon of the latissimus dorsi. Their tendons, at first, 
 are closely united, but afterwards there is an interme- 
 diate cavity lubricated with synovia. The tendon 
 of the latissimus dorsi is anterior, and the lower edge 
 of the teres extends further down the arm than that 
 of the other. 
 
 It rolls the humerus inwards, and draws it down- 
 wards and backwards. 
 
358 
 
 OF THE UPPER EXTREMITIES. 
 
 6. The SuBSCAPULARis occupies all the thoracic 
 surface of the scapula, being between it and the ser- 
 ratus major anticus. It arises fleshy from the whole 
 base, superior and inferior costa, and venter of the 
 scapula; it is divided into several columns which look 
 somewhat like distinct muscles, but which all termi- 
 nate, in a thick, robust tendon that adheres to the in- 
 ferior surface of the capsular ligament. 
 
 This tendon is inserted into the lesser tubercle of 
 the os humeri. The subscapularis rolls the bone in- 
 wards and draws it downwards. 
 
 The Muscles of the arm are five in number, three 
 anterior, and two posterior. 
 
 1. The Biceps Flexor Cubiti is situated imme- 
 diately beneath the integuments, and forms the swell 
 so obvious in the middle front part of most arms. It 
 arises by two heads; the first called the long, is a round 
 tendon, which comes from the superior exti’emity of 
 the glenoid cavity of the scapula, passes through the 
 shoulder joint, and through the groove of the os hu- 
 meri. The second head arises, tendinous, from the 
 extremity of the coracoid process of the scapula, in 
 company with the coraco-brachialis muscle. The 
 fleshy bellies in which these tendons terminate, unite 
 with each other, a few inches below the shoulder joint, 
 to form a common muscle. At first, they are only con- 
 
MUSCLES. 
 
 359 
 
 iiected by loose cellular substance, but about half way 
 down the arm they are inseparably united. 
 
 The biceps terminates below in a flattened oval ten- 
 don, and passes in front of the elbow joint to be insert- 
 ed into the posterior rough part of the tubercle of the 
 radius. A bursa mucosa is placed between the tendon 
 and the front of the tubercle, the surface of the latter 
 being covered with cartilage. From the ulnar side of 
 this tendon proceeds a fascia running into that of the 
 fore- arm. 
 
 The relative position of the biceps is as follows: Its 
 long head is first within the cavity of the capsular 
 ligament, and then between the tendons of the latissi- 
 mus dorsi and pectoralis major, where it is bound 
 down by strong ligamentous fibres. The tendon below 
 is superficial, and may be easily felt by flexing the 
 extremity; but its insertion dips down between the 
 pronator teres and supinator radii longus. 
 
 This muscle flexes the fore-arm. 
 
 2. The CoRACo Brachialis is situated at the up- 
 per internal side of the arm, at the inner edge of the 
 short head of the biceps muscle, with which it is con- 
 nected for three or four inches. It arises tendinous 
 and fleshy, from the middle face of the point of the 
 coracoid process of the scapula, in common with the 
 short head of the biceps muscle. 
 
 It is inserted, tendinous and fleshy, into the inter- 
 nal side of the middle of the os humeri, by a rough 
 
360 
 
 OF THE UPPER EXTREMITIES. 
 
 ridge, just below the tendons of the latissimus del’s! 
 and teres major, and in front of the brachialis exter- 
 niis. From the lower end of this muscle proceeds an 
 intermuscular ligament to the internal condyle of the 
 humerus, which separates the brachialis interims from 
 the third head o^the triceps. 
 
 Tliis muscle draws the arm upwards and forwards. 
 
 3. The Brachialis Internus is situated immedi- 
 ately beneath the biceps, and is concealed by it, ex- 
 cepting the outer edge. It has a bifurcated fleshy ori- 
 gin, from the middle front face of the os humeri, on 
 each side of the insertion of the deltoid, and its origin 
 is continued fleshy from this point downwards, from 
 the whole front of the bone to within a very small dis- 
 tance of its articular surface. 
 
 It is inserted, by a strong short tendon, into tin 
 rough surface at the root of the coronoid process of the 
 ulna. 
 
 The brachialis flexes the fore-arm, and, by passing 
 in front of the elbow joint, strengthens the latter very 
 much. Its lower part lies under the tendon of the 
 biceps, and between the pronator teres and the supi- 
 nator longus. 
 
 4. The Triceps Extensor Gubiti forms the 
 whole of the fleshy mass on the back of the arm: it 
 therefore occupies the space between the integuments 
 and the bone. It arises by three heads. The first. 
 
MUSCLES. 
 
 361 
 
 called Longus, comes, by a flattened tendon, from a 
 rough ridge on the inferior edge of the cervix scapulae. 
 The second, called the Brevis, arises, by a sharp, ten- 
 dinous, and fleshy beginning, from a slight ridge on 
 the outer back part of the os humeri just below its 
 head. The third head, called Brachialis Externus, 
 arises, by an acute fleshy beginning, from the inner 
 side of the os humeri, near the insertion of the teres 
 major. This muscle, both at its external and internal 
 edge, is separated from the muscles in front of the arm, 
 by a ligamentous septum, which arises near the middle 
 of the os humeri, and runs to its condyles. The whole 
 back of the os humeri, as well as the posterior surface 
 of these intermuscular septa, are occupied by the origin 
 of the triceps. The muscular fibres run in various 
 directions according to their respective heads and 
 places of origin. 
 
 At the inferior end of the muscle is found a broad 
 tendon which covers its posterior face. This tendon 
 is inserted into the base or back part of the olecranon, 
 and into the ridge leading down the ulna on its radial 
 side. 
 
 The triceps extends the fore- arm. Its bellies unite 
 above the middle of the os humeri, but the interstices 
 between them may be observed much lower down. 
 
 Connected with the last is a muscle which should be 
 dissected at the same time, as it has corresponding 
 
 z z 
 
362 
 
 OF THE UPPER EXTREMITIES. 
 
 functions, and looks very much like an appendage of 
 the triceps; it is the 
 
 5. Anconeus. This is a small triangular muscle 
 just beneath the skin, at the outer posterior part of the 
 elbow joint. It arises tendinous from the posterior 
 lower part of the external condyle of the os humeri, 
 adheres to the capsular ligament of the joint, and is 
 partly covered by the tendon of the triceps. 
 
 It is inserted, fleshy and thin, into the ridge on the 
 outer part of the head of the ulna leading from the 
 oleeranon, and fills up the triangular depression found 
 there. 
 
 It extends the fore-arm. 
 
 Section III. 
 
 Of the Muscles in front of the Ferre- Arm. 
 
 The most of these muscles arise from the inner con- 
 dyle of the os humeri, and from the ridge leading to 
 it, and are, either directly or indirectly, flexors of the 
 fore-arm upon the arm. This fact should be impress- 
 ed on the mind of the student, as it simplifies much 
 the act of committing them to memory. The syste- 
 matic treatises of anatomy describe the origin of each 
 
MUSCLES. 
 
 363 
 
 muscle as if it were totally distinct from the rest; the 
 student will soon correct the error arising from this^ 
 and learn that the heads of all these muscles are con- 
 nected to contiguous heads, by adhesion and by inter- 
 muscular ligaments, and that there would be almost as 
 much propriety in describing them as having a common 
 origin, as there is in considering them so insulated. 
 
 There are eight muscles situated on the front of the 
 fore-arm, some of which are superficial and others 
 deep-seated. 
 
 1. The Pronatoe Radii Teres is just beneath the 
 fascia of the fore-arm, and forms the radial side of the 
 muscles of the internal condyle. It arises fleshy from 
 the anterior face of the internal condyle of the hume- 
 rus, and tendinous from the eoronoid process of the ulna. 
 It passes veiy obliquely across the fore-arm at the in- 
 ternal edge of the brachialis internus muscle, and is 
 
 Inserted, tendinous and fleshy, into the external 
 back part of the radius just below the insertion of the 
 supinator radii brevis, occupying thereby about two 
 inches of the middle of the bone. 
 
 It rolls the hand inwards. 
 
 2. The Flexor Manus vel Carpi Radialis is 
 placed at the ulnar side of the last muscle, and is also 
 superficial. It arises, by a narrow tendon, from the 
 lower front part of the internal condyle of the hume- 
 
364 
 
 OF THE UPPER EXTREMITIES. 
 
 rus; fleshy from the intermuscular ligaments, fascia, 
 and from the upper part of the ulna. It forms a 
 thick, fleshy belly, terminating below in a tendon, 
 which passes under the anterior annular ligament of the 
 wrist, and runs through a groove in the os trapezium. 
 
 It is inserted, tendinous, into the base of the meta- 
 carpal bone of the fore-finger, in front. 
 
 It bends the hand. 
 
 3. The Palmaris Loxgus is at the ulnar side of 
 the flexor carpi radialis, and is superficial. Sometimes 
 it does not exist. It is a small short muscle terminating 
 in a long slender tendon, and arises by a small tendon 
 from the internal condyle, and fleshy from the inter- 
 muscular ligaments on each of its sides'. 
 
 It is inserted, tendinous, into the humeral margin 
 of the ligamentum annulare anterius near the root of 
 the thumb, and a division of its tendon passes on to the 
 aponeurosis palmaris. 
 
 It bends the hand, and makes tense the palmar apo- 
 neurosis. 
 
 4. The Flexor Manus vel Carpi Ulnaris occu- 
 pies, among the superficial muscles, the ulnar side of 
 the fore-arm. It arises, tendinous, from the internal 
 condyle of the humerus, fleshy, from the upper inter- 
 nal side of the olecranon, and, by a tendinous expan- 
 sion much connected with the fascia of the fore-arm. 
 
MUSCLES. 
 
 365 
 
 from the ridge at the internal side of the ulna to within 
 three or four inches of the wrist. 
 
 It is inserted into the humeral side of the os pisi- 
 
 r 
 
 forme by a round tendon, which arises high up at the 
 radial margin of the muscle, and into which the mus- 
 cular fibres run. Sometimes the tendon is continued 
 over the os pisiforme, so as to be likewise inserted into 
 the base of the metacarpal bone of the little finger. 
 
 It bends the hand. 
 
 r 
 
 5. TheFLEXOR Digitorum Sublimis Perforatus 
 is concealed very much by the muscles just enumera- 
 ted, in consequence of being placed between them. To 
 get a good view of its origin they all should be cut 
 away from the os humeri. It arises,, tendinous and 
 fleshy, from the internal condyle of the os humeri; 
 tendinous, from the coronoid process of the ulna, and 
 fleshy, from the tubercle of the radius; the latter part 
 of its origin is extended tendinous obliquely, for 
 three or four inches along that line of the radius which 
 is at the lower margin of the pronator teres. With 
 these origins the muscle spreads over the front of the 
 fore-arm at its upper part, from the radial to the ulnar 
 margin. 
 
 From the lower end of the muscle, four distinct ten- 
 dons pass which commence much above the wrist, go 
 beneath its anterior ligament, and, having got to the 
 palm of the hand, diverge to the several fingers. To 
 each finger, a tendon is appropriated which passes in 
 
J66 
 
 OF THE UPPER EXTREMITIES. 
 
 front of the metacarpal bone to the phalanges; and is 
 inserted, after having split into two, into the angles 
 formed by the junction of the cylindrical and flat sur- 
 faces near the upper part of the second phalanx. 
 
 It bends the second phalanges on the first ; its action 
 may also be continued so as to clench the hand and to 
 bend it on the arm. 
 
 6. The Flexor Digitorum Profuxdus Perfo- 
 RANS is beneath the flexor sublimis and the flexor ulna- 
 ris. It arises fleshy from the oblong concavity of the 
 ulna between the coronoid and the olecranon processes; 
 fleshy from the carpal margin of the base of the coronoid 
 process; from the ulnar portion of the interosseous liga- 
 ment; and from the front of the upper two-thirds of 
 the ulna. 
 
 The tendons of this muscle are different from those 
 of the other; they commence in front of it, like a ten- 
 dinous membrane, which is gradually divided into seve- 
 ral fasciculi, adhering to each other by cellular mem- 
 brane. The fasciculated character of the tendons is 
 still preserved when they go under the anterior carpal 
 ligament, and until they begin to dispei’se as distinct 
 tendons to the four fingers. 
 
 Each tendon, going in front of its metacarpal bone 
 and of the corresponding phalanges, gets through the 
 slit in the flexor sublimis, and is inserted into the front 
 part of the root of the third phalanx of the finger. 
 
 It bends the last joint of tlie fingers, and by 
 
MUSCLES. 
 
 367 
 
 increased action, may flex tlie hand like the preceding 
 muscle. 
 
 7, The Flexor Longus Pollicis lies in front of 
 the radius, but beneath the flexor sublimis. It arises, 
 by an acute fleshy beginning, from the radius just be- 
 low its tubercle; also, fleshy, from the middle two- 
 thirds of the front of the bone, and from the radial 
 portion of the interosseous ligament. The body of the 
 muscle is joined by a small fleshy slip, of a tendinous 
 origia from the internal condyle of the humerus. 
 
 On the ulnar margin of this muscle a tendon is form- 
 ed early, to which the fibres pass obliquely. This 
 tendon goes under the annular ligament of the wrist, 
 through the fossa formed in the short flexor muscle 
 of the thumb, and between the sesamoid bones, to 
 be inserted into the base of the second phalanx of the 
 thumb. 
 
 It bends the last joint of the thumb. 
 
 While performing this dissection there are several 
 minutiae which deserve attention. The Annular Liga- 
 ment of the wrist in front, is a very strong membrane 
 passing across the carpus, from the projection of the 
 scaphoides and trapezium on the radial side of the 
 wrist, to the unciform process on the ulnar side. Be- 
 tween it and the concavity of the carpus, an oval fora- 
 men is formed for transmitting the tendons of the seve- 
 ral flexors. These tendons, though they slide with 
 
368 
 
 OF THE UPPER EXTREMITIES. 
 
 perfect freedom upon each other, are connected by a 
 dense and elastic cellular membrane, forming a bui’sa, 
 which has the power of keeping them lubricated by a 
 synovial secretion. 
 
 The Vaginal Ligaments of the Angel’s extend from 
 the roots of the fingers to the bases of the third pha- 
 langes. They are of a ligamento- cartilaginous struc- 
 ture, are attached on either side to the anterior edge 
 of the phalanges, and are much thinner as they pass 
 over the fronts of the finger joints than elsewhere. 
 They are inelastic, their internal surface is extremely 
 smooth, and kept continually lubricated by synovial 
 fluid. 
 
 Within the vaginal ligaments small tendinous fraena 
 are found to arise from the first and second phalanges, 
 they run obliquely forwards, and terminate in the ten- 
 dons of the two flexor muscles. We may also observe 
 that in front of each joint, independently of the swelling 
 of the articular extremities of the bones, the capsular 
 ligament is thickened by an addition of cartilaginous 
 matter, by which a trochlea is formed. This trochlea 
 facilitates the sliding of the tendons by its smoothness, 
 and the flexions of the phalanges by removing the ten- 
 dons further from the axis of motion, after the same 
 manner with the patella. 
 
 8. The Pronator Quadratus is just above tlic 
 carpal surfaces of the radius and ulna, and between 
 the other muscles and the bone. In the adult it is 
 
MUSCLES. 
 
 369 
 
 about two inches wide, and its fibres run across the 
 fore-arm. It arises, fleshy and tendinous, from the 
 ridge at the inner surface of the plna near its lower ex- 
 tremity, and from the front of the bone. 
 
 It is inserted into the eorresponding front surface of 
 the radius. It rotates the radius inwards. 
 
 Of the Muscles on the Back of the Fore- Arm. 
 
 These muscles are ten in number. They arise for 
 the most part from the external condyle and the ridge 
 leading to it, and are extensors either of the fore- arm, 
 or of the fingers and hand. Their origins are less 
 blended with each other than those of the flexor mus- 
 cles, nevertheless between several of them there are 
 intermuscular ligaments which connect them closely. 
 They are superficial and deep seated. 
 
 1. The SupixATOR Radii Longus is situated along 
 the radial edge of the fore-arm, immediately beneath 
 the integuments. It arises, fleshy and tendinous, from 
 the higher part of the ridge leading to the external 
 condyle, commencing just below the insertion of the 
 deltoid muscle, and being here placed between the 
 brachialis internus and the short head of the triceps. 
 It forms a thick, deshy belly, constituting the external 
 margin of the arm about the elbow joint, and termi- 
 nates about the middle of the radius in a flat tendon. 
 
 It is inserted, by the tendon, into a small rough 
 3 A 
 
370 
 
 OF THE UPPER EXTREMITIES. 
 
 ridge on the outer side of the radius, just above its 
 styloid process. 
 
 It rolls the radius outwards. 
 
 2. The Extensor Carpi Radialis Longior is si- 
 tuated beneath the former muscle. It arises, tendinous 
 and fleshy, from the space of the external ridge of the os 
 humeri between the supinator longus and the external 
 condyle. It forms a short, fleshy belly, which termi- 
 nates in a flat tendon above the middle of the radius. 
 
 It is inserted, by this tendon, into the posterior part 
 of the root of the metacarpal bone of the fore-finger 
 near the thumb. 
 
 It extends the hand. 
 
 3. The Eietensor Carpi Radialis Brevior is 
 beneath the last, but projects somewhat beyond it. 
 It arises, tendinous, from the posterior and lower part 
 of the external condyle, and from the external lateral 
 ligament of the elbow joint. It forms a thick, fleshy 
 belly, placed along the radius, which terminates in a 
 flat tendon about the middle of that bone. 
 
 Its tendon, becoming rounded, is inserted into the 
 posterior part of the base of the metacarpal bone of the 
 second finger. 
 
 It extends the hand. 
 
 4. The Extensor Carpi Ulnaris is superficial, 
 and placed principally parallel with the ulna. It 
 arises, tendinous, from the external condyle, fleshy. 
 
MUSCLES. 
 
 371 
 
 from the intermuscular ligament and inside of the fas- 
 cia. Crossing very obliquely the upper part of the 
 radius and the ulna, it also arises fleshy from the back 
 part of the latter bone. Its fibres terminate obliquely 
 ill a tendon which goes through the groove of the 
 ulna. 
 
 It is inserted, by its tendon, into the ulnar side of 
 the base of the metacarpal bone of the little finger. 
 
 It extends the hand. 
 
 5. The Extensor Digitorum Communis is super- 
 ficial, being placed between the extensor ulnaris and 
 the extensor radialis brevior. It arises, tendinous, 
 from the external condyle, and fleshy, from the inter- 
 muscular ligament of the contiguous muscles. As it 
 approaches the wrist it sends off four tendons, which 
 pass together through a common groove on the back of 
 the radius. On the back of the hand these tendons 
 diverge, and near the roots of the fingers send cross 
 slips to each other. 
 
 Each tendon goes to its respective finger and covers 
 the whole posterior part of it, being spread out into a 
 membrane, which adheres to the phalanges from the 
 root of the first to the root of the last. 
 
 The section of this muscle appropriated to the little 
 finger has a distinct appearance, and sometimes its 
 tendon goes through a distinct fossa in the radius, 
 from which causes it has obtained the name of Auri- 
 cularis. 
 
372 
 
 OF THE UPPER EXTREMITIES. 
 
 This muscle extends all the joints of the fi.ngei's, 
 being the antagonist of the flexors. 
 
 6. The Supinator Radii Brevis can only be well 
 seen by detaching the origins of the aforesaid muscles; 
 it will then be found in contact with the radius, making 
 a close investment of its head and upper third. It 
 arises, tendinous, from the external condyle of the 
 humerus, tendinous and fleshy, from the ridge on the 
 posterior radial edge of the ulna which descends from 
 its coronoid process. 
 
 Its fibres surround, obliquely, the upper external 
 part of the radius, and are inserted into its tubercle, 
 and into the oblique rough ridge corresponding with 
 the upper margin of the pronator teres. At the inter- 
 stice between the radius and ulna, near the anterior 
 edge of this muscle, a fleshy slip is occasionally seen, 
 which passes from the radial side of the coronoid 
 process to the ulnar edge of the radius. 
 
 This muscle rotates the radius outwards. 
 
 7. The Extensor Ossis Metacarpi Pollicis 
 Manus arises, fleshy, from the posterior part of the 
 ulna immediately below the anconeus, from the inter- 
 osseous ligament, and from the back part of the radius 
 just below the insertion of the supinator brevis. It 
 terminates in a rounded tendon, which passes over the 
 tendons of the radial extensors, and through a groove 
 on the styloid side of the head of the radius. 
 
MUSCLES. 
 
 373 
 
 It is inserted, by its tendon, into the base of the 
 metacarpal bone of the thumb, and into the external 
 side of the trapezium. 
 
 It extends the metacarpal bone of the thumb. 
 
 8. The Extensor Minor Pollicis Manus is at 
 the ulnar side of the last muscle. It arises, tendinous, 
 from the back of the ulna below its middle, and fleshy, 
 from the interosseous ligament. It adheres to the ra- 
 dius, and terminates in a tendon which passes through 
 a groove in the styloid side of the radius along with the 
 last named muscle. 
 
 It is inserted into the first phalanx of the thumb by 
 its tendon, which is extended to the root of the second 
 phalanx. 
 
 It extends the first phalanx. 
 
 9. The Extensor Major Pollicis Manus arises, 
 by a small tendinous, and extensive fleshy origin, from 
 the back of the ulna above its middle, and from the 
 interosseous ligament ; it terminates near the wrist in a 
 tendon, which passes through a groove on the back of 
 the radius near the ulna. The belly of this muscle 
 conceals, very much, the other extensors of the thumb. 
 
 It is inserted, by its tendon, into the oblong trans- 
 verse tubercle on the back of the base of the second 
 phalanx of the thumb. 
 
 It extends the second phalanx. 
 
 The tendons of the two last muscles are much con- 
 
374 
 
 OF THE UPPER EXTREMITIES. 
 
 nected with each other, and are spread in the form of a 
 membrane on the back of the thumb, after the manner 
 of the extensor tendons of the fingers. 
 
 10. The Indicator is a small muscle on the back 
 of the ulna, concealed by the extensor communis and 
 extensor ulnaris. It arises, tendinous and fleshy, from 
 the back of the ulna, commencing near its middle, and 
 from the contiguous part of the interosseous ligament. 
 It terminates in a tendon which goes through the same 
 fossa with the extensor communis; it afterwards is 
 joined, about the head of the first phalanx, to the ten- 
 don of the common extensor belonging to the fore- 
 finger. 
 
 With the tendon of the extensor communis it is in- 
 serted along the back of the fore-finger to the base of 
 the third phalanx. 
 
 It extends the fore-finger. 
 
 At this stage of the dissection it is proper to notice 
 the Posterior Carpal Ligament, which passes from the 
 side of the radius to the side of the ulna. It is two in- 
 ches in breadth, and seems much like a continuation of 
 the fascia of the fore-arm. It will be found strongly 
 attached to the different ridges of the radius and ulna, 
 and from its want of elasticity, perfectly adapted to 
 prevent the tendons from springing out of their respec- 
 tive grooves. It forms one jugum for the two first ex- 
 tensors of the thumb, another for the radial extensors 
 
MUSCLES. 
 
 375 
 
 of the hand, a third for the tendon of the third exten- 
 sor of the thumb, a fourth for the indicator and exten- 
 sor communis, and a fifth for the extensor ulnaris. 
 
 Of the Small Muscles of the Hand. 
 
 The skin and fat being carefully removed from the 
 palm of the hand, we bring into view the Aponeuro- 
 sis Palmaris. This is a triangular tendinous mem- 
 brane which covers all the hollow of the hand, and is 
 spread over its muscles. It arises from the anterior 
 carpal ligament somewhat narrow; it then spreads out, 
 and dividing into four sections, is fixed to the heads 
 of the metacarpal bones. Each section bifurcates, to 
 allow the flexor tendons to pass to the fingers, and is 
 I united to the contiguous sections by transverse bands 
 i or frsena. 
 i 
 
 j The Palmaris Brevis is apt to be cut away un- 
 I consciously; it is just below the skin at the inner side 
 
 I of the hand. It consists of separate fasciculi unequally 
 
 I I divided, and arises from the ligament of the wrist, and 
 j from the ulnar side of the palmar aponeurosis. 
 
 I It is inserted into the skin and fat at the inner mar- 
 ’ gin of the hand, and covers the muscles of the little 
 finger. 
 
 It contracts the skin of the hand. 
 
 The Aponeurosis being removed, a good view is 
 
376 
 
 OF THE UPPER EXTREMITIES. 
 
 obtained of the flexor tendons and many of the small 
 muscles of the hand. 
 
 The Lumbricales are conspicuous; they are four 
 in number, of the size and shape of earth worms. 
 They arise, tendinous and fleshy, from the radial sides 
 of the tendons of the flexor profundus, beneath the li- 
 gamentum carpi annulare, and a little beyond its ante- 
 rior edge. 
 
 They terminate in little flat tendons which run along 
 the outer or radial edges of the fingers, and are inser- 
 ted into the tendinous expansion on the back of the 
 first phalanx of each finger about its middle. 
 
 They bend the first phalanges. 
 
 Four muscles constitute the ball of the thumb. 
 
 1. The Abductor Pollicis Manus arises, tendi- 
 nous and fleshy, from the anterior surface of the liga- 
 mentum carpi annulare and from the projecting ends 
 of the trapezium and scaphoides. 
 
 It is inserted, tendinous, into the outer side of the 
 base of the first phalanx of the thumb, and into the 
 tendinous membrane derived from the extensors on its 
 back part. 
 
 It draws the thumb from the fiugei’S. This muscle 
 is next to the skin. 
 
 2 . The Opponens Pollicis is beneath the abduc- 
 
MUSCLES. 
 
 377 
 
 tor, and without its removal can scarcely be seen. It 
 arises, tendinous and fleshy, from the projecting point 
 of the os trapezium and from the adjacent part of the 
 annular ligament. 
 
 It is inserted, tendinous and fleshy, into the radial 
 edge of the metacarpal bone of the thumb from its base 
 to its head. 
 
 It draws the metacarpal bone inwards. 
 
 3. The Flexor Brevis Pollicis Manus is be- 
 neath the abductor pollicis and at the ulnar side of the 
 opponens pollicis. A groove is formed in' it by the 
 tendon of the flexor longus pollicis, which divides it 
 into two heads. 
 
 The first head arises, fleshy, from the points of the 
 trapezoides, trapezium, and from the eontiguous part 
 of the internal surface of the annular ligament, and is 
 inserted into the outer sesamoid bone ; the sesamoid 
 bone, like a patella, being connected to the first pha- 
 lanx of the thumb by tendon. 
 
 The second or internal head arises, fleshy, from near 
 the metacarpal surfaces of the magnum and unciforme, 
 and from the base of the metacarpal bone of the middle 
 finger. It is inserted into the inner sesamoid bone, 
 which, like the external, is connected, by ligament, to 
 the first phalanx. 
 
 The short flexor, as its name implies, bends the first 
 joint of the thumb. 
 
 3 B 
 
378 
 
 OF THE UPPER EXTREMITIES. 
 
 4. The Adductor Pollicis Maxus lies in the 
 palm of the hand beneath the lumbricales and the ten- 
 dons of the flexor sublimis and profundus. It arises, 
 fleshy, from the ulnar edge of the metacarpal bone of 
 the second finger between its base and head. 
 
 It is inserted, tendinous, into the inner part of the 
 base of the first phalanx of the thumb near the internal 
 sesamoid bone. 
 
 It pulls the thumb towards the fingers. 
 
 The Abductor Indicis Manus is on the radial 
 edge of the hand between the metacarpal bones of the 
 fore-finger and thumb, and is just beneath the skin. 
 It arises, tendinous, from the trapezium, fleshy from 
 the ulnar edge of the metacarpal bone of the thumb be- 
 tween its base and head. 
 
 Being placed along the side of the metacarpal bone 
 of the fore-finger, it is inserted, by a short tendon, into 
 the radial side of the first phalanx. 
 
 It draws the fore-finger from the others. 
 
 There are three muscles constituting the fleshy part 
 of the ulnar side of the hand, or the ball of the little 
 finger. 
 
 1. The Abductor Minimi Dtgiti Manus is tlie 
 most superficial. It arises, fleshy, from the protuber- 
 ance on the internal side of the os pisiforme and from 
 the contiguous parts of the annular ligament. 
 
 It is inserted, tendinous, into the ulnar side of the 
 
MUSCLES. 
 
 379 
 
 iii’st phalanx of the little finger and into the tendinous 
 membrane which covers its back part. 
 
 It draws the little finger from the rest. 
 
 i 
 
 2. The Flexor Parvus Minimi Digiti Manus is 
 beneath the abductor. It arises, fleshy, from the 
 unciform process of the os unciforme, and from the 
 contiguous parts of the annular ligament. 
 
 It is inserted, tendinous, into the ulnar side of the 
 base of the first phalanx of the little finger, being 
 united with the tendon of the abductor, and with the 
 tendinous membrane expanded over the back of the 
 finger. 
 
 It bends the little finger. 
 
 The Adductor Metacarpi Minimi Digiti is 
 placed beneath the Abductor and Flexor, next to the 
 metacarpal bone. It arises, fleshy, from the unciform 
 process of the os unciforme, and from the contiguous 
 part of the annular ligament of the wrist. 
 
 It is inserted, tendinous and fleshy, into the fore 
 part of the metacarpal bone of the little finger, from its 
 base to its head. 
 
 It brings the metacarpal bone of the little finger to- 
 wards the wrist, and thereby deepens the hollow of 
 the hand. 
 
 The Interosseous Muscles fill up the interstices of 
 the metacarpal bones; they are seven in number, four 
 
380 
 
 OF THE UPPER EXTREMITIES. 
 
 on the palm, and three on the back of the hand. The 
 latter ones arise by double heads from the contiguous 
 sides of two metacarpal bones; the inner ones have each 
 a single head only, which comes from the metacarpal 
 bone of the finger, which such interosseous muscle is 
 intended to serve. As a general description they all 
 may be said to arise, fleshy and tendinous, from the 
 base and sides of the metacarpal bones, and to be inser- 
 ted tendinous, into the sides of the first phalanges, and 
 into the tendinous membranes on the back of the fin- 
 gers, derived from the tendons of the extensor com- 
 munis. The four first are very deeply seated, but the 
 three others rather superficially. 
 
 1. The Prior Indicis is along the radial side of the 
 first metacarpal bone, and arises from the base and side 
 of the same. 
 
 It is inserted, tendinous, into the radial side of the 
 first phalanx. 
 
 It draws the fore-finger towards the thumb. 
 
 2. The Posterior Indicis is at the ulnar side of 
 the first metacarpal bone. It arises from the base and 
 ulnar side of the same bone, and is inserted, tendinous, 
 into the ulnar side of the first phalanx of the fore- 
 finger. 
 
 It draws the fore-finger towards the others. 
 
 3. The Prior Annularis is at the radial side of 
 
MUSCLES. 
 
 381 
 
 the metacarpal bone of the third or ring finger. It 
 arises from the base and radial side of the said bone. 
 
 It is inserted, tendinous, into the radial side of the 
 first phalanx of the ring finger. 
 
 It draws that finger towards the thumb. 
 
 4. The Interosseous Digiti Auricularis is at the 
 radial side of the metacarpal bone of the little finger. 
 It arises from the radial side and base of said bone. 
 
 It is inserted, tendinous, into the radial side of the 
 first phalanx of the same finger. 
 
 It draws the little finger towards the others. 
 
 By removing the tendons of the extensor communis 
 from the back T)f the hand, we see the three posterior 
 or Rouble-headed interosseous muscles. 
 
 5. The Prior Medii is between the metacarpal 
 bones of the fore and middle fingers. It arises from 
 the opposite roots and sides of these bones. 
 
 It is inserted tendinous, into the radial side of the 
 first phalanx of the middle finger. 
 
 It draws the middle finger towards the thumb. 
 
 6. The Posterior Medii is between the metacar- 
 pal bones of the middle and ring fingers. It arises, 
 from the opposite sides and roots of these bones. 
 
 It is inserted, tendinous, into the ulnar side of the 
 first phalanx of the middle finger. 
 
382 
 
 OF THE UPPER EXTREMITIES. 
 
 It draws the middle finger towards the little. 
 
 7. The Posterior Annularis is between the me- 
 tacarpal bones of the ring and little finger. It arises 
 from the opposed sides and roots of these metacarpal 
 bones. 
 
 It is inserted, tendinous, into the ulnar side of the 
 first phalanx of the ring finger. 
 
 It draws the middle towards the little finger. 
 
 Section IV. 
 
 Of the Blood- Vessds of the Upper Extremities, 
 
 The Arteries of the Upper Extremity are derived 
 from the Subclavian, the course of which, to the sca- 
 leni muscles, is described in the account of the neck. 
 The subclavian passes over the middle of the first rib 
 between the scalenus anticus and inedius muscles, and 
 afterwards goes between the first rib and the subclavius 
 muscle to the arm-pit. Here it is called Axillary Ar- 
 tery, (Arteria Axillaris,) and its position is under the 
 tendinous insertion of the pectoralis minor, and almost 
 touching it; it then passes, at the internal inferior part 
 of the head of tlie humerus, parallel with, and border- 
 
BLOOD VESSELS. 
 
 383 
 
 ing on, the internal edge of the coraco brachialis mus- 
 cle. At the posterior fold of the arm-pit it is placed 
 very near the tendon of the latissimus dorsi, between 
 it and the coraco brachialis. Emerging from the axilla 
 at this place, its name is changed into that of Arteria 
 Brachialis. 
 
 The Arteria Brachialis descends the arm at the 
 internal margin of the lower part of the coraco brachi- 
 alis, and afterwards at the internal margin of the 
 biceps flexor cubiti. At the bend of the arm it is at 
 the inner edge of the tendon of the biceps, and passes 
 under its aponeurosis, and a little below the joint it 
 splits into two branches of nearly equal magnitude, the 
 Radial and the Ulnar Arteries. 
 
 The relative situation of the great artery with the 
 nerves and veins of the part, should be closely observ- 
 ed; between the scaleni muscles, the majority of the 
 nerves, forming afterwards the axillary plexus, is 
 above and somewhat posterior to the subclavian artery j 
 but when this artery becomes axillary, the nerves unite 
 in various combinations, and surround it like so many 
 cords of a platted whip thong. The axillary vein is 
 below and somewhat in front of the artery, and very 
 near it. These several parts are united by a loose, 
 vascular, adipose, and cellular membrane containing 
 many lymphatic glands. 
 
 1. The Arteria Dorsalis Superior Scapula 
 varies much in its origin; it comes sometimes from the 
 subclavian, and on other occasions from the upper part 
 
384 
 
 OF THE UPPER EXTREMITIES. 
 
 of the axillary. Not unfrequently it is a branch of the 
 inferior thyroid. In either the first or the last case, 
 its course is very important to the surgeon, for it runs 
 along the posterior margin of the clavicle towards its 
 acromial extremity, and in an operation, by being 
 opened, might be mistaken for the subclavian artery 
 itself. When it comes from the axillary artery it is 
 tortuous, and has to ascend to its destination, being 
 completely out of the way of an operation from above, 
 upon the subclavian artery. Its final distribution is 
 always the same, for it passes through the notch in the 
 upper costa of the scapida, and there divides into 
 branches supplying the supra-spinatus muscle and the 
 shoulder joint. 
 
 2. The Arterije Mammari^ Externa arise from 
 the axillary just above the pectoralis minor. They 
 consist in four principal branches, going uniformly to 
 certain parts; but the origin of these branches varies, 
 for sometimes they are originally distinct trunks from 
 the axillary artery, and on other occasions blended into 
 one or more. They are 
 
 a. Thoracica Superior, distributed to the parts of 
 the pectoralis major muscle just below the clavicle, 
 some branches going to the pectoralis minor. 
 
 h. Thoracica Longa, supplying the inferior parts of 
 the great pectoral muscle, the mamma, and integu- 
 ments. 
 
 c. Thoracica Acromialis, making for the fissure be- 
 
BLOOD VESSELS. 
 
 385 
 
 tween tlie deltoid and great pectoral muscle, and dis- 
 tributed to them along the margins of this fissure 
 upwards and do^vnwa^il. 
 
 d. Thoracica Axillaris, very irregular in origin and 
 size; when small it is distributed generally to the fat 
 and glands of the axilla; when large it is a trunk, the 
 size of a goose-quill, running on the scapular surface 
 of the serratus major anticus, and distributed to it by 
 branches coming off at right angles. 
 
 3. The ScAPULARis arises from the axillary artery 
 about the anterior margin of the subscapularis muscle. 
 It passes downwards towards the ^ngle of the scapula 
 in contact with this muscle, and is distributed to the 
 teres major aiid minor, subscapularis and latissimus 
 dorsi muscles. 
 
 A little, below the neck of the scapula a large trunk, 
 the Dorsalis Inferior Scapulas, arises from the scapula- 
 ris, which winds around the bone to be distributed to 
 the infraspinatus and the contiguous muscles, an anas- 
 tomosis being formed under the neck of acromion pro- 
 cess, between the dorsalis inferior and superior. 
 
 4. The CiEcuiiFLEXA Anterior is a small artery 
 about the size of a crow’- quill. It arises from the ax- 
 illary just above the superior or posterior margin of 
 the tendon of the teres major and latissimus dorsi. It 
 surrounds half the os humeri just below its head, go- 
 ing between the bone and the coraco brachialis and 
 
 3 c 
 
386 
 
 OF THE UPPER EXTREMITIES. 
 
 biceps muscle, to be distributed to the articulation and 
 to the contiguous muscles. ^ 
 
 5. The CiRcuMFLEXA Posterior is much larger, 
 and arises from the axillary about the same place with 
 the last, but commonly a little below; sometimes they 
 have a- common trunk. It surrounds the back part of 
 the os humeyi, going between the long head of the 
 triceps and the bone by passing between the teres 
 minor and major muscles in the first instance. It is 
 distributed to the shoulder joint and the contiguous 
 muscles, especially the deltoid. 
 
 6. Tlie Profunda Humeri or Spiralis arises from 
 the great artery of the upper extremity just below the 
 tendon of the teres major, where the artery is called 
 Brachial or Humeral. It passes downwards a little dis- 
 tance, and there enters the interstice between the first 
 and the third head of the triceps muscle. It winds 
 between this muscle and the bone very obliquely 
 downwards, and appears, at last, on the outer side of 
 the arm, between the brachialis internus and the supi- 
 nator longus; it reaches to the external condyle. In 
 this course the profunda sends many branches to the 
 triceps and to the contiguous muscles. Its origin is 
 sometimes from the scapular or from the posterior cir- 
 cumflex artery. 
 
 7. The Profunda Minor is uncertain in its origin, 
 
BLOOD VESSELS. 
 
 387 
 
 4 
 
 but comes commonly from the humeral two inches be- 
 low the last; sometimes it is a branch of the last. It 
 is distributed on the internal surface of the triceps ex- 
 tensor, and extends to the internal condyle. 
 
 8. The Nutritia is a very small branch from the 
 humeral, arising near the medullary foramen of the os 
 humeri, which it penetrates, and is distributed to the 
 lining membrane. 
 
 9. The Anastomotic A is a small branch from the 
 humeral, arising about the place where the os humeri 
 begins to expand in order to form the elbow joint. It 
 passes on the internal face of the brachialis internus 
 muscle, and then over the ridge of the internal con- 
 dyle to the groove between the condyle and the ole- 
 cranon process, where it anastomoses with a recurrent 
 branch of the ulnar artery. 
 
 Several arterioles are also sent from the humeral 
 artery to the biceps, brachialis, triceps; and coraco 
 brachialis, which are too irregular and too small to der 
 serve description. 
 
 $ 
 
 The Humeral Artery, it has been stated, is divid- 
 ed a little below the elbow joint into two principal 
 trunks. Radial and Ulnar. Sometimes this division is 
 on a line with the joint; at other times it occurs nearer 
 the insertion of the brachialis muscle. The division^ 
 
388 
 
 OF THE UPPER EXTREMITIES. 
 
 however, does occasionally occur in all the space be- 
 tween the axilla and the elbow joint, in w'hich case 
 the -radial artery sometimes is just beneath the skin at 
 the elbow, and continues uncommonly superficial to the 
 wrist. 
 
 The Radial Artery (Radialis Arteria) in the 
 early part of its course, is at the bottom of the fissure 
 between the pronator teres and the supinator radii lon- 
 gus; afterwards it crosses the insertion of the former, 
 runs parallel with, and in front of the radius to the 
 wrist, between the tendons of the supinator longus and 
 of the flexor radialis. At the styloid process it gets 
 between the carpus and the extensors of the thumb, 
 runs a little distance on the radial side of the back 
 of the hand, and then penetrates to the palm between 
 the bases of the metacarpal bones of the thumb and of 
 the fore-finger. It furnishes the following branches, 
 collateral and terminating. 
 
 1. The Recurrens Radialis arises about the neck . 
 of the radius. It winds around the joint externally, 
 between the external condyle and the muscles coming 
 from it, and anastomoses with the spiralis or profunda 
 of the humeral artery, being distributed, in many col- 
 lateral branches, to the joint and contiguous muscles, v 
 
 2. Several small- and irregular muscular branches 
 
BLOOD VESSELS. 
 
 389 
 
 arise from the radial artery in its progress to the wrist; 
 they have no appropriated names. 
 
 3. The SuPERFiciALis VoLaE arises from the radial 
 about the inferior margin of the pronator cpiadratus 
 muscle. It passes superficially over the process of the 
 trapezium to the muscles of the ball of the' thumb, and 
 one of its terminating branches joins the arcus subli- 
 mis. Sometimes the superficialis volse is the principal 
 branch of the radial. 
 
 4. The Dorsalis Carpi arises from the radialis at 
 the carpus, runs transversely across the back of the 
 latter, and detaches the posterior interosseous arteries 
 of the back of the hand. They anastomose with bran- 
 ches from the ulnar and interosseous arteries of the 
 fore-arm. 
 
 5 . The Magna Pollicis, a terminating branch of 
 the radial, comes from it in the palm of the hand just 
 
 ■ at the root of the metacarpal bone of the thumb. It 
 runs beneath the abductor indicis, and at the head of 
 the metacarpal bone divides into two branches, which 
 run along the sides of the thumb to its extremity, where 
 they anastomose and terminate. 
 
 6. The Radialis Indicis, arising at the same place 
 ; with the latter, runs along the metacarpal bone of the 
 
390 
 
 OF THE UPPER EXTREMITIES. 
 
 fore-finger, and along the radial side of the same finger 
 to its extremity. 
 
 7. The Palmaris Profunda is the third terminat- 
 ing branch of the radial artery. It arises near the 
 same place with the two last; crosses the hand between 
 the metacarpal bones and the flexor tendons, thus form- 
 ing the Arcus Profundus, from which, branches pro- 
 ceed to the interossei muscles, and which ends on the 
 ulnar side of the palm of the hand by a branch to tlie 
 Arcus Superficialis. 
 
 The Ulnar Artery, (Arteria Ulnaris,) one of the 
 forks of the brachial at the elbow, passes more in a 
 line with it than the radial artery does. Being deeply 
 seated, it goes, immediately after its origin, urtder 
 several of the muscles of the internal condyle, and be- 
 tween the flexor sublimis and profundus; getting from 
 beneath the flexor sublimis, it afterwards runs paral- 
 lel with the ulna or nearly so, lying on the flexor pro- 
 fundus between the flexor ulnaris' and the ulnar mar- 
 gin of the flexor sublimis, and concealed two-thij’ds of 
 the way down the fore-arm by the overlapping of these 
 muscles. At the thin part of the fore-arm, commonly 
 called the wrist, it is superficial, and may be felt pul- 
 sating in the living body at the radial margin of the 
 tendon of the flexor ulnaris. 
 
 The ulnar artery, at the carpus, takes a very diffei' 
 ent course from the radial, for it passes over the ante 
 
BLOOD VESSELS. 
 
 391 
 
 rior annular ligament of tlie carpus just at the radial 
 side of the os pisiforrae, to which it is held by a small 
 ligamentous noose, and then proceeds to the palm of 
 the hand. Between the aponeurosis palmaris and the 
 flexor tendons it forms that curve from the ulnar to the 
 radial side of the hand called the Arcus Sublimis. 
 This curve commonly begins a little beyond the ante- 
 rior margin of the annular ligament, and presenting its 
 convexity forwards, terminates about the middle of 
 the ball of the thumb at its inner margin. 
 
 The branches sent from the ulnar artery are as fol- 
 low: 
 
 1. The Recuerens Ulnaris arises from the ulnar 
 about the lower part of the tubercle of the radius, and 
 winding upwards is distributed in small branches to 
 the muscles of the internal condyle. One of its ra- 
 muscules goes between the internal condyle and the 
 olecranon process, to anastomose with the arteria 
 anastomotica of the humeral. 
 
 2. The Interossea arises from the ulna just be- 
 low the other. It is a large trunk, and proceeds but 
 a little distance when it divides into two principal 
 branches called anterior and posterior interosseal ar- 
 teries. 
 
 a. The Interossea Anterior is much the larger; it 
 runs in contact with the interosseous ligament to the 
 upper margin of the pronator quadratus, giving off' 
 
392 
 
 OF THE UPPER EXTREMITIES. 4 
 
 branches to the deep-seated muscles of the fore-arm 
 in its course. Under the pronator it perforates the in- 
 terosseous ligament, and' distributes to the back of the 
 carpus and of the hand, branches, which anastomose 
 with branches of the radial and posterior interosseal. 
 
 b. The Interossea Posterior is sometimes a sepa- • ^ 
 rate trunk, arising from the ulnar just above the for- 
 mer. In either case it soon perforates the interosseous • . 
 ligament to get to the back of the fore-arm. Here it ?! 
 sends backwards a Recurrent Branch to the back of ^ 
 the elbow, which anastomoses with the recurrens ul- ’ . 
 naris and radialis. It then proceeds downwards, being J 
 dgeply seated tind distributed to the different muscles 
 on the back of the fore-arm. Some of its branches, \ 
 as was mentioned, reach the wrist, and anastomose with J 
 the carpal arteries. 3 
 
 i 
 
 3. The ulnar artery, in its descent on the fore-arm. ^ 
 
 sends off many small and irregular muscular branches m 
 called by Professor Chaussier, Cubito-musculaires; mi 
 they do not require description. • % 
 
 4. The Dorsalis Manus leaves the ulnar at the 
 lower end of the fore-arm, and passes under the ten- j 
 don of the flexor ulnaris to the back of the hand. It 
 there meets ramuscules of the radial and interosseous, ^ 
 and conjointly they supply, with very small branches, 
 the back of the wrist, of the metacarpus and of the 
 fingers. 
 
BLOOD VESSELS. 
 
 393 
 
 5. As the Arcus Superficialis is about beginning, 
 the ulnar artery sends superficial but small branches 
 to the integuments of the palm. And a little further 
 on, a considerable branch, which dives into the bottom 
 of the palm, through the muscles of the little ^ finger, 
 and joins the ulnar extremity of the arcus profundus ; 
 this is the Cubitalis Manus Profunda of Haller. 
 
 6. The Arcus Superficialis then sends a branch 
 to the ulnar side of the little finger. Afterwards in suc- 
 cession three digital branches are sent off, which, arriv- 
 ing at the interstices between the heads of the metacar- 
 pal bones, each divides into two branches to supply the 
 sides of the fingers which are opposite to each other ; one 
 branch is called Digito radial, the other Digito ulnar, 
 according to the side of the finger on which the artery 
 may be placed. 
 
 The Digital Arteries, before they divide, receive 
 each a small branch from the arcus profundus. The 
 digito radial and ulnar arteries, pass along the front 
 sides of the fingers to their extremities; at the joints 
 and extremities, anastomoses between the arteries of 
 the two sides of the same finger frequently occur. 
 
 The Arcus Superficialis terminates on the radial 
 side of the palm by a branch which joins the artery 
 of the thumb coming from the radial. 
 
 3 D 
 
394 
 
 OF THE UPPER EXTREMITIES. 
 
 The most frequent arrangement of the arteries of- 
 the hand is what has been just described; anatomists 
 are, however, not all agreed on this point. It would 
 probably be more just to say, judging ft om our eollec- 
 tion in the University, that this oceurs more often tlian 
 any other single arrangement. The variety, in fact, 
 is so great, that before a hand is opened it is not possi- 
 ble to know in what manner its arteries are dis- 
 tributed. Sometimes the radial artery furnishes one- 
 half of the arcus sublimis, and the ulnar the other. 
 On other occasions the interosseous artei^y is continued 
 as a large trunk over the ligament of the wrist, and 
 across the root of the thumb to join the arcus sublimis. 
 
 Of the Veins of the Upper Extreinitics. 
 
 These Veins are abundantly supplied with Aalvcs, 
 and are superficial and deep-seated; the former lying 
 beneath the skin have original names ; the latter atten- 
 ding the arteries, on all occasions, are called after 
 them. Anastomoses are numerous in both sets, but are 
 particularly so in the superficial, where plexuses arc 
 formed which surround the arm. 
 
 Three principal superficial trunks are formed on the 
 lower part of the fore-arm, one on its radial side, an- 
 other on its ulnar, and the third between the two. 
 
 1. The Cephalic A first arises about the root of the 
 tliumb and fore-finger on the back of the hand; a dis- 
 
BLOOD VESSELS. 
 
 395 
 
 tiuct trunk is formed which winds obliquely over the 
 radius, and then runs along the external edge of the 
 fore-arm to the elbow joint. The cephalic ascends 
 afterwards along the external edge of the biceps flexor 
 muscle, lies over the interstice between the pectoralis 
 major and deltoid muscles, and ascends to within eight 
 of ten lines of the clavicle, when it dips into the axilla 
 to join the axillary vein. In the whole of this coiu’se 
 it may be seen easily beneath the skin. 
 
 2. The Vexa Basilica arises, by several branches, 
 from tlie back of the hand, principally on the ulnar 
 side, one of which, placed between the metacarpal bone 
 of the little finger and the ring finger, is called Salvi- 
 tella. From this origin the basilic vein gets to the 
 ulnar side of the fore-arm and continues so to the elbow 
 joint, receiving on either side, anterior and posterior 
 ulnar branches ; at the elbow or a little above, it is on 
 the inner edge of the biceps muscle, and the pulsation 
 of the brachial artery may be felt beneath it. It as- 
 cends regularly at the inner edge of the biceps, and 
 about the middle of the arm becomes, by a junction 
 with other veins, the Brachial Vein. 
 
 This vein on the fore-arm frequently consists in two 
 trunks, of which the posterior is the largest. 
 
 3. The Vena Mediana arises, by branches, from 
 the wrist and from the palm of the hand; it forms a 
 trunk in the front of the fore-arm, which, three or four 
 
396 
 
 OF THE UPPER EXTREMITIES. 
 
 inches below the bend of the arm, bifurcates. One 
 branch, the Mediana Cephalica, joins the cephalic 
 vein; the second, the Mediana Basilica, joins the 
 basilic vein. 
 
 The deep-seated Veins, called Vense Satellites or 
 Comites, are found in company with every artery of 
 the upper extremity, there being, for the most part, 
 one vein to each side of the artery. They anastomose 
 frequently by branches which cross the artery. At 
 the elbow, the radial, ulnar, and interosseous satellites 
 unite, and form a plexus over the bifurcation of the 
 brachial artery; from which plexus a short large 
 branch goes outwards to join one of the superficial 
 veins. 
 
 The trunk, formed by the union of the satellites of 
 the fore-arm, passes upwards on the inner side of the 
 brachial artery and receives the small veins from the 
 different muscles. Sometimes it joins the basilic 
 about the middle of the humerus; on other occasions 
 it joins it near or in the axilla, from which union re- 
 sults the axillary vein. 
 
 The Vena Axillaris receives the veins corres- 
 ponding with the circumflex, scapular, and thoracic 
 arteries, in their proper succession. It is fixed be- 
 neath the artery and very near it in the same sheatli 
 of cellular substance. Under the clavicle it becomes 
 
NERVES. 
 
 397 
 
 Vena Subclavia; and as sueh it passes between the cla- 
 vicle and the first rib at the inner side of the subcla- 
 vian artery. It then leaves the artery to go in front 
 of the scalenus anticus, whereas the artery goes be- 
 tween this muscle and the medius. After crossing the 
 first rib it receives the superior dorsal vein of th-s sca- 
 pula, the external jugular, and afterwards the internal 
 jugular, besides several small veins from the skin and 
 muscles of the neck. 
 
 Section V. 
 
 Of the JVerves of the Upper Extremities. 
 
 The four inferior cervical and the first dorsal nerves 
 supply the upper extremity by an appropriation of 
 nearly the whole of their anterior branches, which 
 are of considerable magnitude, especially the three 
 intermediate ones. They come out between the an- 
 terior and the middle scalenus muscle, being situated 
 above and posterior to the subclavian artery, at vari- 
 ous heights according to the origin of the nerve indi- 
 vidually. Almost immediately after disengaging them- 
 selves from the scaleni muscles, they commence the 
 formation of a plexujs which surrounds the artery and 
 
398 
 
 OF THE UPPER EXTREMITIES. 
 
 continues with it to the lower part of the axilla. The 
 fourth and fifth cervical nerves unite into a common 
 trunk which splits into two; the seventh cervical and 
 the first dorsal do the same ; the sixth cervical also bi- 
 furcates. It is under various combinations of these 
 different primary divisions that the axillary plexus is 
 formed, from which proceeds the different nerves of 
 the upper extremity. This plexus, from its close con- 
 nexion with the great artery, must, of course, go be- 
 tween the subclavius muscle and the first rib; and, in 
 the upper part of the axilla, separate the axillary vein 
 from the artery in some measure. The following bran- 
 ches are given off by the brachial plexus, besides the 
 filaments fwm its roots to the sympathetic and phrenic 
 in front, already mentioned in the account of the Neck. 
 
 1. The Nervus Scapularis is a small branch com- 
 ing from the upper part of the plexus, commonly the 
 fourth cervical nerve. It accompanies the arteria dor- 
 salis scapulee superior to the foramen in the upper costa 
 of the scapula, and is distributed to the muscles on the 
 back of the scapula. 
 
 2. The Nervi Thoracici are priin,arily two or 
 three in number. They arise from the middle of the 
 plexus, and are divided into anterior and posterior 
 branches, the former being distributed upon the pec- 
 toralis major and minor, the latter upon the serratus 
 major anticus. 
 
NERVES. 399 
 
 3. The Nervi Subscapulares of Bichat are about 
 three in number ; they com« also from the central parts 
 of the plexus to be distributed upon the teres major; 
 latissimus dorsi; and subscapularis. 
 
 ■ 4. The Nervus Axillaris, or Circumflexus, 
 comes from the lower part of the brachial plexus. It 
 follows the course of the posterior circumflex artery, 
 winding around the upper part of the os humeri be- 
 tween the teres minor and major in order to get to the 
 internal surface of the deltoid muscle, where it termi- 
 nates. In its passage it also furnishes branches to the 
 subscapularis, the teres major and minor, the infra- 
 spinatus, and to the integuments on the back of the 
 shoulder and arm.* 
 
 5. The Nervus Cutaxeus Ixterxus proceeds 
 from the lower part of the brachial plexus, and follows 
 the course of the basilic vein to the elbow or near it. 
 In its descent it detaches small cutaneous filaments an- 
 teriorly to the integuments of the biceps, and poste- 
 riorly to those of the triceps. A little above the bend 
 of the elbow, commonly where the median basilic joins 
 the basilic vein, it divides into two terminating bran- 
 ches of nearly equal magnitude. The one next the 
 internal condyle lies in front of the basilic vein just at 
 its junction with the median basilic, and continues in 
 front and parallel with it for some inches. It is dis- 
 tributed, by many ramifications, to the skin of the 
 
400 
 
 OF THE UPPER EXTREMITIES. 
 
 ulnar side of th? fore-arm and back of the hand, some 
 of the branches winding around to the back part of 
 the fore-arm. The other branch of the internal, cutane- 
 ous passes beneath the median basilic vein about six 
 lines from its junction with the basilic, and is distri- 
 buted to the integuments on the middle front of the 
 fore-arm. Before this latter branch reaches the me- 
 dian basilic vein it sends off a cutaneous filament which 
 Crosses the median basilic in front, about half-way in 
 the course of this vein. 
 
 6. The Nervus Musculo Cutaxeus comes from 
 the middle of the brachial plexus. It perforates ob- 
 liquely the upper part of the coraco- brachial is muscle, 
 to which it dispenses filaments, it then passes between 
 the biceps and brachialis internus muscles, giving also 
 filaments to both of them. Its course being remark- 
 ably oblique under the biceps muscle, it makes its ap- 
 pearance superficially, only a little above the elbow 
 joint near the external condyle. It then passes super- 
 ficially between the skin and the supinator radii lon- 
 gus muscle, distributing filaments in its course, and 
 near the lower part of the radius djndes into two or- 
 ders of fibres, one of which is distributed on the pal- 
 mar side of the hand, and the other on the dorsal, but 
 both go to the integuments. 
 
 7. The Nervus Radialis, or Musculo Spiralis, 
 arises from the upper portion of the brachial plexus. 
 
NERVES. 
 
 401 
 
 It is a large trunk which winds spirally around the 
 os humeri between the triceps muscle and the bone, 
 entering the fissure between the third and the first 
 head of the triceps. It appears on the outside of the 
 os humeri between the brachialis internus and the tri- 
 ceps muscles, running for some inches in contact with 
 their intermuscular ligament. While beneath the tri- 
 ceps it sends several branches to its heads. There are 
 three principal trunks afterwards to this nerve. 
 
 a. The Ramus Superficialis Dorsalis is sent from it 
 on a line with the point of the deltoid muscle. This 
 branch, then, goes just below the skin, parallel with 
 and over the external ridge of the os humeri; it of 
 course crosses the origin of the muscles of the exter- 
 nal condyle. It continues superficial on the posterior 
 external edge of the supinator radii longus muscle, 
 and terminates in the integuments on the back of the 
 hand. 
 
 The continued trunk of the muscular spiral goes in 
 the interstice between the extensor muscles and the 
 brachialis internus, and at the external condyle divides 
 into the other two branches, from which filaments pro- 
 ceed to the contiguous heads of the muscles. 
 
 b. The Ramus Profundus Dorsalis, perforates the 
 supinator brevis muscle, and gets beneath the radial 
 extensors to the back of the fore-arm; it is then dis- 
 tributed in numerous filaments to the muscles on the 
 back of the fore-arm, some of its branches reaching to 
 the wrist. 
 
 3 E 
 
402 
 
 OF THE UPPER EXTREMITIES. 
 
 c. The Ramus Superficialis Anterior seems to be a 
 continuation of the main trunk of the nerve, and de- 
 scending at the anterior margin of the supinator radii 
 longus muscle, it joins with the radial artery and con- 
 tinues in its company to a short distance below the 
 middle of the radius. Here it crosses the bone ob- 
 liquely beneath the tendon of the supinator longus, 
 and then divides into a palmar and a dorsal ramuscule; 
 the first being distributed to the muscles and integu- 
 ments of the thumb, the second terminating so as to 
 supply the back of the hand, of the thumb, fore, 
 middle, and ring fingers to their extremities. 
 
 8. The Nervus Medianus arises from the brachial 
 plexus, like the other nerves. It descends the arm at 
 the inner edge of the biceps muscle along the anterior 
 surface of the humeral artery, adhering firmly to it 
 and to the deep-seated veins by cellular substance. As 
 far as the elbow it sends off* no branch of importance. 
 There, it lies at the side of the biceps tendon, crosses 
 the lower part of the brachialis internus, and being be- 
 neath the aponeurosis of the biceps. It then perforates 
 the pronator teres and gets between the flexor subli- 
 mis digitorum, and the flexor longus pollicis, and 
 enters the palm of the hand under the ligamentum 
 carpi at the radial edge of the tendons of the flexor 
 sublimis. In the palm it is situated beneath the apo- 
 neurosis and the arcus sublimis. 
 
 The median nerve dispenses the following branches- 
 
NERVES. 
 
 403 
 
 At the bend of the arm it furnishes filaments to the 
 heads of the first layer of muscles of the fore-arm; 
 and a little below, it detaches the nervus interosseus 
 which supplies filaments to the flexor longus pollicis 
 and flexor profundus. The interosseous nerve then 
 descends with the interosseous artery in front of the 
 interosseous ligament, and terminates in the pronator 
 quadratus. Before the median nerve reaches the 
 wrist it sends a branch which supplies with filaments 
 the muscles and integuments of the ball of the thumb. 
 In the palm of the hand it divides and subdivides, so 
 as to furnish the two sides of the thumb, of the fore, of 
 the middle, and one side of the ring finger with 
 branches, which reach their extremities along with the 
 digital arteries. 
 
 9. The Nervus Ulnaris comes from the lowest 
 section of the brachial plexus. It descends along the 
 internal anterior part of the triceps muscle in a groove 
 formed between it and the intermuscular ligament, 
 diverging in this course gradually from the median 
 nerve till it reaches the elbow, when it is at its greatest 
 point of separation. At the elbow it is behind the 
 internal condyle, in the groove between it and the 
 olecranon, and separates the two heads of the flexor 
 ulnaris muscle. It then gets to the fore-arm between 
 this muscle and the flexor profundus digitorum, and 
 continues between them to within two inches of the 
 wrist joint, when it detaches the Ramus Dorsalis. 
 
404 
 
 OF THE UPPER EXTREMITIES. 
 
 The Ramus Dorsalis slips between the ulna and the 
 tendon of the flexor ulnaris, runs along the internal 
 margin of the ulna to the carpus, when it divides into 
 ramuscules which supply the ulnar side of the integu- 
 ments on the back of the hand and the backs of the 
 two last fingers. At the interval between the heads 
 of the metacarpal bones of the middle and ring fingers, 
 a considerable ramuscule joins one from the ramus su- 
 perficialis anterior of the nervus radialis or musculo 
 spiralis. 
 
 The Ulnar Nerve, having given off this dorsal 
 branch, descends along the radial margin of the ten- 
 don of the flexor ulnaris and of the os pisiforme above 
 the annular ligament to the palm of the hand. Get- 
 ting beneath the aponeurosis, it there detaches first a 
 deep-seated branch, which penetrates the muscles of 
 the little finger to supply them, the interossei, and the 
 short flexor of the thumb. The ulnar nerve then 
 furnishes a superficial branch, and afterwards divides 
 into three ; one for the ulnar side of the little finger, 
 another for the opposing sides of the little and ring 
 finger, and a third which joins the most internal digi- 
 tal branch of the median nerve. 
 
 To conclude; the dissector should also attend to 
 what are called the Intercosto-Humeral Nerves. 
 They consist of a branch from the second, and anotlier 
 from the third intercostal, which pass out at the fore 
 and lateral parts of the thorax; the first from beneath 
 
NERVES. 
 
 405 
 
 the second rib, and the other from beneath the third 
 rib. 
 
 The first intercosto-humeral, being connected with 
 a filament from the internal cutaneous, is distributed 
 upon the axillary glands, and the integuments of the 
 axilla and inner side of the arm. The second, being 
 joined by filaments from the first, is chiefly distributed 
 to the integuments on the back of the arm, some of its 
 branches reaching the elbow. The numbness of the 
 inner side of the arm, in angina pectoris, is supposed 
 to be owing to the sympathy of these nerves with the 
 cardiac. 
 
PART III. 
 
 CHAPTER II. 
 
 Of the Lower Extremitien. 
 
 Section I. 
 
 • Of the Fascia. 
 
 The lower Extremity, from the pelvis to the foot, 
 is enveloped by a strong Fascia or Tendinous Mem- 
 brane, lying between the skin and the muscles. This 
 fascia consists, for the most part, of ligamentous fibres, 
 passing in the direction of the length of the limb, 
 secured together by transverse filaments of the same 
 matter, but by no means so abundant. Its structure 
 undergoes some variations; its greater part is decidedly 
 of the character just mentioned; but at the groin it is 
 between ligament and cellular membrane; the latter 
 occasionally predominates so much, that the appearance 
 of the first is lost, particularly in corpulent subjects. 
 
FASCIA. 
 
 407 
 
 On the contrary, in the lean and such as have suffered 
 from pressure and irritation of the part by hernial pro- 
 trusion, the ligamentous structure is welP expressed. 
 On the Gluteus Maximus also, this fascia exists as a 
 condensed cellular membrane, sending in its processes 
 between the fasciculi of the muscle. 
 
 The thickness of the Fascia Femoris is not uniform. 
 On the outer side of the thigh, knee, and hip, it is 
 very thick and strong; on the inner side it is thin, and, 
 compared with the other, weak. It is thick on the 
 anterior part of the leg, and somewhat thinner on the 
 posterior, but in neither is it so thick as at the outer 
 part of the thigh. At the ancle it is connected with 
 the bony prominences around .it, and increasing in 
 thickness, it constitutes the annular ligament of the 
 joint for confining the tendons on its anterior part. 
 It is also extended over the foot, and is connected at 
 different points to its periphery so as to keep itself 
 tense. 
 
 This membrane is very closely attached to the cel- 
 lular membrane at every point of its external surface, 
 and is kept tense all over by its bony connexions. 
 Above, it arises from the exterior margin of the pelvis, 
 as constituted by the pubes, Poupart’s ligament, the 
 crista of the ilium, the side of the sacrum and the 
 ischium. At the knee it is fastened to the condyles 
 of the os femoris, and to the heads of the tibia and 
 fibula. On the posterior part of the thigh it sends in 
 a long process, by which it adheres to the linea aspera. 
 
408 
 
 OF THE LOWER EXTREMITIES. 
 
 Its connexion with the knee and ancle, below, fixes it 
 on the leg; besides which it adheres to the spine of the 
 tibia. 
 
 Its connexion with the muscles of the lower extre- 
 mity is very interesting ; to some of them it adheres by 
 its internal face, and to others it does not. To the 
 muscles of the hip it adheres closely, and gives origin 
 to some of the fibres of the gluteus medius. To the 
 muscles of the exterior face of the thigh its adherence 
 is generally loose, and indeed in some parts scarcely 
 deserves to be considered as such, as where the inter- 
 nal surface of the fascia is opposed to the tendinous 
 facing of the vastus externus muscle. On the internal 
 semicircumference of the thigh, it adheres somewhat 
 closely to the muscles by cellular membrane. On the 
 leg it is in close connexion with the muscles of its an- 
 terior and fibular side, many of their fibres arising from 
 it; but on the posterior face of the leg it is rather 
 loosely fixed to them. From the internal face of the 
 fascia, prolongations of cellular membrane of various 
 densities, sometimes ligamentous, are sent in between 
 most of the muscles. These prolongations separate 
 the muscles from each other, form sheaths in which 
 they repose, and preserve them in their position in 
 some instances. As an envelope to the muscles of the 
 leg the fascia is highly useful in supporting and sus- 
 taining their action. The knowledge of its peculiar 
 connexion at different parts of the lower exti’emity. 
 
MUSCLES. 
 
 409 
 
 is all important in the management of abscesses of that 
 region. 
 
 Though useful, it is not indispensable to make a 
 complete investigation of the fascia at once, but the cir- 
 cumstances mentioned should be very carefully ob- 
 served in extending downwards the muscular dissec- 
 tion. 
 
 Section II. 
 
 Of the Muscles of the Lower Extremities. 
 
 1 
 
 The Psoas Magnus, Psoas Parvus and Iliacus 
 Internus are described at pages 257, 258. 
 
 The Sartorius arises, by a short tendon, from the 
 anterior superior spinous process of the ilium ; a body 
 of various breadths in different subjects is then 
 formed, whose fibres are in the direction of its length. 
 It passes in a spiral course to the inner side of the 
 thigh and the internal condyle, and, winding under 
 the head of the tibia, advances forwards so as to be 
 inserted into the side of the lower part of its tubercle 
 by a broad tendon. The lower part of the tendon is 
 
 3 F 
 
410 
 
 - OF THE LOWER EXTREMITIES. 
 
 continued into the fascia of the leg, by which this 
 muscle is preserved in its spiral direction. 
 
 The sartorius muscle is superficial, lying its whole 
 course immediately beneath the fascia femoris; it cros- 
 ses the rectus femoris, vastus internus, and triceps 
 abductor; at the lower part of the thigh, just above 
 the knee, it is between the tendon of the latter and 
 that of the gracilis. 
 
 It bends the leg and draws it obliquely inwards. 
 
 The Tensor Vaginje Femoris is a short muscle 
 just on the outer side of the origin of the sartorius ; it 
 arises, tendinous, from the anterior superior spinous 
 process of the ilium, and passes downwards and some- 
 what backwards between two laminge of the fascia 
 femoris. 
 
 It is inserted, a little below the level of the trochan- 
 ter major, into the inner face of the fascia femoris. 
 It rotates the foot inwards, and makes. the fascia tense. 
 
 The Rectus Femoris is in front of the thigh bone 
 and just beneath the fascia femoris. It is a complete 
 penniform muscle, fleshy in front for the most part, 
 but faced behind with tendon. It arises, by. a round 
 tendon, from the anterior inferior spinous process, 
 which is joined by another tendon coming from the 
 superior margin of the acetabulum. 
 
 It is inserted into the superior surface of the patella 
 
MUSCLES. 
 
 411 
 
 by a strong tendon, and intermediately by the liga- 
 mentiim patellae into the tubercle of the tibia. 
 
 It extends the leg. 
 
 Under the rectus femoris, the anterior and lateral 
 parts of the thigh bone are enveloped by a large mus- 
 cular mass, considered, by most anatomists, as three 
 distinct muscles, called Vastus Externus, Vastus Inter- 
 nus, and Crurseus or Cruralis. Their heads are very 
 distinguishable from each other, but below they are 
 inseparably united and join with the patella. 
 
 The Vastus Externus, a very large muscle on 
 the outside of the thigh, arises, tendinous and fleshy, 
 from the upper part of the os femoris immediately b*e- 
 low the trochanter major. Its origin commences in 
 front, and passes obliquely around the bone to the 
 linea aspera. It continues, afterwards, to arise the 
 whole length of the linea aspera, and from the upper 
 half of the line running from it to the external condyle. 
 
 It fibres pass inwards and downwards, and are inser- 
 ted, by a flat tendon, into the external edge of the 
 tendon of the rectus, and also into the external upper 
 part of the patella. This muscle has a broad tendi- 
 nous surface exteriorly and above ; at its lower part it 
 has a tendinous facing on the side next to the bone. 
 
 It also extends the leg. 
 
 The Vastus Internus covers the whole inside of 
 
412 
 
 OF THE LOWER EXTREMITIES. 
 
 the os femoris. It arises, by a fleshy and pointed ori- 
 gin, in front of the os femoris just on a level with the 
 trochanter minor, tendinous and fleshy, from the whole 
 length of the internal edge of the linea aspera, and from 
 the line leading from it to the internal condyle. 
 
 It fibres descend obliquely, and are inserted by a flat 
 tendon into the internal edge of the tendon of the rec- 
 tus, and into the upper internal edge of the patella. 
 
 It also extends the leg. 
 
 The Crurx^us Muscle is almost completely over- 
 lapped and concealed by the two vasti, and is imme- 
 diately behind the rectus femoris. The edge of the 
 vastus externus above is very distinguishable from it, 
 as it overlaps it, and is rounded ofi*, besides being 
 somewhat separated by vessels. But the origin of the 
 eruraeus on the side of the vastus internus is not so 
 distinct, as the fibres of the two muscles run to- 
 gether; it is therefore necessary most frequently 
 to cut through some of the fibres on the internal face 
 of the os femoris on a level with the trochanter minor. 
 The crurseus will then be seen to arise, fleshy, from 
 all the fore part of the bone, and from all its outside 
 as far as the linea aspera. Between the internal edge 
 of this muscle and the linea aspera, the interior face 
 of the os femoris is naked, for an inch, along the whole 
 shaft of the bone, which is very readily seen by turn- 
 ing off the vastus internus. 
 
 The Cruraaus is inserted into the posterior face of 
 
MUSCLES. 
 
 413 
 
 the tendon of thfe rectus below, and into the upper sur- 
 face of the patella. It also extends the leg. 
 
 The Ligaraentum Patellae is the common cord by 
 which the action of the four last named muscles is 
 communicated to the tibia. It is a flattened thick 
 tendon an inch and a half wide, arising from the in- 
 
 I 
 
 ferior edge of the patella, and inserted into the tuber- 
 cle of the tibia. Besides this, a fascia or tendinous 
 expansion comes from the inferior ends of these mus- 
 cles, and extends itself over the whole of the an- 
 terior and lateral parts of the knee joint, and is insert- 
 ed into the head of the tibia and of the fibula. Through 
 this it happens that even when the patella or its tendon 
 is fractured, some motion or extension may be com- 
 municated to the leg from the thigh. ^ 
 
 The Gracilis is a beautiful muscle at the inner 
 margin of the thigh, which lies immediately under the 
 fascia, and extends from the pelvis to the leg. 
 
 It arises, by a broad thin tendon, from the front of 
 the os pubis just at the lower part of its symphysis, 
 and from its descending ramus ; the muscle tapers to a 
 point below, and a little above the knee terminates in 
 a round tendon which passes behind the internal con- 
 dyle of the os femoris and the head of the tibia. It 
 then makes a curve forwards and downwards at the in- 
 
 A case of this kind was lately in tlie Philadelphia Alms- 
 house. 
 
414 
 
 OF THE LOWER EXTREMITIES. 
 
 ternal side of the latter, and is inserted at the lateral 
 and inferior part of its tubercle. 
 
 The tendon at the knee is beneath the tendon of 
 the sartorius. This muscle is a flexor of the leg. 
 
 The Pectinalis is a short fleshy muscle at the 
 inner edge of the psoas raagnus. It arises, fleshy, 
 from the concavity on the upper face of the pubes 
 between its erista and the ridge above the obturator 
 foramen, and is inserted, tendinous, into the linea aspera 
 immediately below the trochanter minor. 
 
 It draws the thigh inwards and forwards. 
 
 The Triceps Adductor Femoris is a large mus- 
 cular mass consisting of three distinct portions, which 
 are placed at the inner side of the thigh, and contii- 
 bute much to fill up the vacuity between the thigh 
 bones above. These portions are 
 
 1. The Adductor Longus which comes, by a round- 
 ed short tendon, from the upper front part of the pubes 
 near its symphysis; it forms a triangular belly which 
 increases in breadth in its descent, and is inserted 
 into the middle third of the linea aspera at its inner 
 edge*. 
 
 This muscle, as the subject lies on its back, is up- 
 permost of the three ; its origin is between that of the 
 pectinalis and of the gracilis; its upper edge is in con- 
 tart with the lower edge of the pectinalis. 
 
MUSCLES. 
 
 415 
 
 2. The Adductor Brevis is the smallest of the 
 three ; it is situated beneath the adductor longus and 
 pectinalis, and on the outside of the gracilis. It 
 arises by a rounded tendon from the middle front part 
 of the pubes between its symphysis and the foramen 
 thyroideunij just below the origin of the first adductor. 
 
 It is inserted into the upper third of the inner edge 
 of the linea aspera, between the trochanter minor and 
 the upper edge of the adductor longus, by a flat thin 
 tendon. 
 
 3. The Adductor Magnus is below the other two, 
 and is by far the largest. It arises, fleshy, from the 
 lower part of the body of the pubes and from its de- 
 scending ramus^ also from the ascending ramus of the 
 ischium as far as its tuberosity, occupying the whole 
 bony surface between the foramen thyroideum below, 
 and the margin of the pelvis. 
 
 It is inserted, fleshy, the whole length of the linea. 
 aspera, and on its internal margin a tendon is gradually 
 generated, which passes downwards to be inserted into 
 the upper part of the internal condyle of the os femo- 
 ris, and by a thin edge or expansion into the line 
 leading from the linea aspera to the internal condyle. 
 
 The adductor magnus separates the muscles on the 
 anterior from such as are on the posterior part of the 
 thigh, and its insertion is closely connected with the 
 origin of the vastus internus, the two surfaces adhering 
 by a short and compact cellular membrane. 
 
41G 
 
 OF THE LOWER EXTREMITIES. 
 
 The three adductors contribute to the same end, 
 that of drawing the thigh inwards. 
 
 The subject should now be turned over in order to 
 enable us to study the muscles on the back of the 
 limb. 
 
 The Gluteus Magnus arises fleshy, from the pos- 
 terior third of the spine of the ilium, from the side of 
 the sacrum below it, from the side of the os coccygis, 
 and from the posterior surface of the large sacro- 
 sciatic ligament. The fibres of this muscle are collect- 
 ed into large fasciculi with deep interstices between 
 them, and the lower edge of it is folded over the 
 posterior sacro-sciatic ligament. 
 
 Its fibres pass obliquely forwards and downwards, 
 and terminate in a thick broad tendon, the upper part 
 of which goes on the outside of the trochanter major, 
 and is very strongly inserted into the fascia femoris, 
 and the lower part is inserted into the upper third of 
 the linea aspera, going down as far as the origin of the 
 short head of the biceps flexor cruris. 
 
 This muscle is placed immediately under the skin, 
 the fasciculi being separated to some depth by pro- 
 cesses from the fascia femoris. It covers nearly all 
 the other muscles on the back part of the pelvis, laps 
 over its inferior margin laterally, and conceals the 
 origins of the hamstring muscles. It draws the thigh 
 backwards. 
 
MUSCLES. 
 
 417 
 
 The Gluteus Medius arises from the whole length 
 of the spine of the ilium, except its posterior part, and 
 from that part of the dorsum of the bone which is be' 
 tween its spine and a semicircular ridge extending * 
 from the anterior superior spinous process to the sciatic 
 notch ; also from the lunated edge of the os ilium be- 
 tween the anterior superior and anterior inferior spi- 
 nous process, and from that part of the inner face of 
 the fascia femoris which covere it. 
 
 The anterior superior part of this muscle is not co- 
 vered by the gluteus magnus, but lies before it. Its 
 fibres converge, and are inserted, by a broad thick 
 tendon, into the upper surface of the trochanter ma- 
 jor, and into the upper anterior part of the shaft of the 
 bone just in front of the same trochanter. 
 
 It draws the thigh backwards and outwards. 
 
 The Gluteus Minimus arises from that part of the 
 dorsum of the ilium between the semicircular ridge, 
 just spoken of, and the margin of the capsular ligament 
 of the hip joint. It is entirely concealed by the 
 gluteus medius. 
 
 Its fibres converge and terminate in a round tendon, 
 which is inserted into the anterior and superior part of 
 the trochanter major, just within the anterior insertion 
 of the gluteus medius. 
 
 It abducts the thigh, and can also rotate the limb 
 inwards. 
 
 3 G 
 
418 
 
 OF THE LOWER EXTREMITIES. 
 
 There are several small muscles about the hip joints 
 the most of which can be seen by the removal of the 
 gluteus magnus. 
 
 The Pyriformis arises, fleshy and tendinous, with- 
 in the pelvis, from the anterior face of the second, 
 third, and fourth bones of the sacrum. It forms a 
 conical belly which passes out of the pelvis at the up- 
 per part of the sacro-sciatic foramen, receiving a slip 
 of fibres from the posterior inferior spinous process of 
 the ilium. 
 
 It is inserted, by a round tendon, into the upper 
 middle part of the trochanter major within the inser- 
 tion of the gluteus medius. 
 
 It rotates the limb outwards. 
 
 The Gemini are two small muscles closely connected 
 with each other, which are situated lower down on the 
 limb than the pyriformis. The upper one arises from 
 the posterior part of the root of the spinous process 
 of the ischium ; the lower from the upper back part 
 of the tuberosity of the ischium. 
 
 Being parallel to each otlier, and connected by their 
 contiguous edges, they are inserted together into the 
 posterior part of the thigh bone at the root of the 
 trochanter major, where the rough pit is. 
 
 They also rotate the limb outwards. 
 
 The Obturator Internus muscle is principally 
 
MUSCLES. 
 
 419 
 
 Situated within the cavity of the pelvis. It arises^ 
 fleshy, from all the pelvic margin of the foramen thy- 
 roideum, except where the obturator vessels go out, 
 and from the internal face of the ligamentous mem- 
 brane stretched across it; also from the upper part of 
 the plane of the ischium and just below the linea in- 
 nominata; its fibres converge, and, forming a tendon, 
 pass out of the pelvis over the trochlea of the ischium 
 between the sacro-sciatic ligaments. 
 
 The tendon is placed between the gemini muscles, 
 which form a sheath for it; and it is inserted into the 
 pit on the back of the os femoris at the root df the 
 trochanter major. 
 
 It rotates the limb outwards. 
 
 The Quadratus Femoris is below the other mus- 
 cles. It arises, tendinous and fleshy, from the ridge 
 on the outer side of the ischium which constitutes the 
 exterior boundary of the tuberosity. 
 
 Its fibres are transverse, and are inserted, fleshy, 
 into the rough ridge of the os femoris on its back part 
 which goes from one trochanter to the other. 
 
 It rotates the limb outw’ards. 
 
 The Obturator Externus is concealed, in front, 
 by the pectineus and triceps adductor, and behind by 
 the quadratus femoris ; to get a satisfactory view of it, 
 therefore, these muscles should be detached from the 
 bone. It arises from the whole exterior circurafer" 
 
420 
 
 OF THE LOWER EXTREMITIES. 
 
 ence of the foramen thyroideum, excepting the place 
 where the obturator vessels come out, and from the 
 exterior face of the ligamentous membrane stretched 
 across it. 
 
 The fibres of this muscle converge, pass beneath the 
 capsular ligament of the hip joint adhering to it, and 
 terminate successively in a round tendon which is in- 
 serted into the inferior part of the cavity on the pos- 
 terior surface of the os femoris, at the root of the 
 trochanter major. The course of the tendon of this 
 muscle is marked on the neck of the thigh bone by a 
 superficial fossa. 
 
 It rotates the thigh outwards. 
 
 The Biceps Flexor Cruris constitutes the outer 
 hamstring, and is situated on the posterior outer part 
 of the thigh ; it arises by two heads. The fii’st, called 
 the long head, has an origin, in common with the se- 
 mitendinosus, from the upper back part of the tube- 
 rosity of the ischium by a short tendinous head, which, 
 in its descent, is changed into a thick fleshy belly. 
 The other, called the short head, arises, by an acute 
 fleshy beginning, from the linea aspera just below the 
 insertion of the gluteus magnus, and is continued along 
 the lower part of the linea aspera from the ridge lead- 
 ing to the external condyle. 
 
 A thick tendon is gradually formed on the outside of 
 the muscle and is inserted into the upper part of the 
 head of the fibula. 
 
MUSCLES. 
 
 421 
 
 This muscle flexes the leg on the thigh.* 
 
 The Semitendinosus is on the inside of the thigh, 
 between the biceps and gracilis ; it is superficial, be- 
 ing immediately under the fascia, and arises, in com- 
 mon with the biceps, from the back part of the tubero- 
 sity of the ischium ; it also adheres, for three or four 
 inches, to the inner edge of the tendon of the long 
 head of the biceps. 
 
 About four inches above the knee it terminates in 
 a long round tendon, which passes behind the internal 
 condyle and the head of the tibia, and is reflected for- 
 wards to be inserted into the side of the tibia, just be- 
 low its tubercle and very near it, being lower down 
 than the insertion of the tendon of the gracilis. 
 
 It flexes the leg on the thigh. 
 
 The Semimembkanosus is at the inner side of the 
 thigh; its upper part is concealed by the semitendi- 
 nosus and the origin of the long head of the biceps, 
 and below, it projects between these two muscles. It 
 is in contact with the posterior surface of the triceps 
 magnus. 
 
 It arises, by a thick round tendon, from the exterior 
 upper part of the tuberosity of the ischium, which 
 tendon soon becomes flattened and sends off the mus- 
 cular fibres obliquely from its exterior edge, to a cor- 
 responding tendon below. The latter passing behind 
 the internal condyle and the head of the tibia, de- 
 
422 
 
 OF THE LOWER EXTREMITIES. 
 
 taches a thift aponeurotic membrane under the inner 
 head of the gastrocnemius, to cover the posterior part 
 of the capsule of the joint, and to be fastened to the 
 externa] condyle. 
 
 It is inserted, by a round tendon, into the inner and 
 back part of the head of the tibia just below the joint. 
 The unfavourable insertion of this muscle is compen- 
 sated by the course of its fibres, which gives it gi’eat 
 increase of strength. 
 
 It flexes the leg on the thigh. 
 
 Muscles of the Leg. 
 
 These muscles are situated anteriorly, posteriorly, 
 and externally. 
 
 The Tibialis Axticus muscle is situated superfi- 
 cially under the fascia of the leg, at the outside of the 
 spine of the tibia, and in front of the interosseous liga- 
 ment. It arises, fleshy, from the head, outer surface, 
 and spine of the tibia, and from the interosseous liga- 
 ment, to within three or four inches of the ancle. It 
 also arises by its front surface from the internal face of 
 the fascia of the leg. 
 
 A rounded long tendon is formed below, which, 
 passing through a distinct noose of the annular liga- 
 ment in front of the malleolus internus, crosses the 
 astragalus and os naviculare, and is inserted into the 
 anterior part of the base of the cuneiforme internum, 
 
MUSCLES. 
 
 423 
 
 and into the adjacent part of the metatarsal bone of the 
 great toe. 
 
 It bends the foot, and presents the sole obliquely 
 inwards. 
 
 The Extensor Longus Digitorum Pedis, is also 
 superficially. placed just under the fascia of the leg 
 and in front of the fibula, being in contact above with 
 the tibialis anticus, and below with the extensor pro- 
 prius pollicis. It arises, tendinous and fleshy, from 
 the outer part of the head of the tibia, from the head 
 of the fibula, and almost the whole length of its anterior 
 spine; also from the upper part of the interosseous 
 ligament and the internal face of the fascia of the 
 leg. 
 
 About the middle of the leg this muscle splits into 
 four tendons, which are confined by the annular liga- 
 ment of the ancle, and then diverging, are inserted 
 into the base of each small toe, and expanded over its 
 back part as far as the last phalanx. 
 
 It extends all the joints of the small toes and flexes 
 the foot. 
 
 The Peroneus Tertius is rather an appendage of 
 the extensor longus, is found at its lower outer part, 
 and cannot be naturally separated from it. It arises 
 from the anterior angle of the fibula, between its mid- 
 dle and lower end. 
 
 It is inserted, by a flattened tendon, into the base 
 
424 
 
 OF THE LOWER EXTREMITIES. 
 
 of the metatarsal bone of the little toe, and assists in 
 bending the foot. 
 
 The Extensor Proprius Pollicis Pedis is be- 
 tween the lower part of the tibialis anticus, and the 
 extensor longus. It arises from the fibula between 
 its anterior and internal angles, by a tendinous and 
 fleshy origin, which commences about four inches be- 
 low the head of the fibula, and continues almost to 
 its inferior extremity. A few fibres also come from 
 the interosseous ligament, and from the lower part of 
 the tibia. 
 
 The muscle being half penniforra, the fibres run 
 at its fore part obliquely to a tendon, which passes un- 
 der the annular ligament, and over the astragalus and 
 scaphoides and upper internal parts of the foot, to be 
 inserted into the base of the first and second phalanges 
 of the great toe. 
 
 On the outside of the leg, between the fibula and 
 fascia, are the two Peronei muscles. 
 
 The Peroneus Longus arises, tendinous and fleshy, 
 from the fore and outside of the head of the fibula, 
 from the space on its outer side above, between the 
 external and anterior angles, also from its external 
 angle to within a short distance of the ancle. 
 
 A flattened thick tendon constitutes the outer face 
 of the muscle, to which the fibres pass obliquely. This 
 
MUSCLES. 
 
 425 
 
 tendon is lodged in the groove at the posterior part of 
 the malleolus externus, being confined to it by a thick 
 ligamentous noose, and traverses the outer side of the 
 os calcis, where its passage is marked by a superficial 
 sulcus. It then runs through the groove of the os 
 cuboides, and lying deep in the sole of the foot next 
 to the tarsal bones, is inserted into the base of the in- 
 ternal cuneiform bone, and into the adjacent part of 
 the metatarsal bone of the gi’eat toe. 
 
 It extends the foot and inclines the sole obliquely 
 outwards. 
 
 The Peroneus Brevis is concealed in a great de- 
 gree by the peroneus longus, being situated between 
 the latter and the extensor longus digitorum. It arises, 
 tendinous and fleshy, from the outer surface of the 
 fibula, commencing about one third of the length of 
 the bone from its head, and continuing almost to the 
 ancle. 
 
 A tendinous facing exists externally also in this 
 muscle, to which its fibres proceed obliquely. This 
 tendon is continued through the fossa at the back part 
 of the malleolus externus, being covered by the tendon 
 of the peroneus longus, and confined by the same liga- 
 mentous noose, and passing through the superficial 
 fossa at the outer side of the os calcis, is inserted into 
 the external part of the base of the metatarsal bone of 
 the little toe. It extends the foot and presents the sole 
 obliquely downwards, 
 
 3 H 
 
426 
 
 OF THE LOWER EXTREMITIES. 
 
 The Triceps Siirse is placed on the back of the leg, 
 and consists of Gastrocnemius and Soleus which in fact 
 form but one muscle. 
 
 The Gastrocnemius is the most superficial and 
 conceals the other in consequence of its breadth. It 
 arises from the condyles of the femur by two heads. 
 One head arises, tendinous, from the upper back part 
 of the internal condyle, and fleshy, from the ridge lead- 
 ing to the linea aspera; the", other head arises, by a 
 broad tendon in the same way, from the external con- 
 dyle and the line above it. A triangular vacancy is 
 left between the heads of the muscle for tlie passage of 
 the popliteal vessels; they then join together, but in 
 such a way that the appearance of two bellies is dis- 
 tinctly preserved, of which the internal is the largest. 
 The muscular fibres pass from a broad tendinous facing 
 on the back to a corresponding one on the front sur- 
 face of the muscle, from the latter of which comes the 
 Tendo Achillis. 
 
 The heads of the gastrocnemius being detached 
 from their origin, we then see the Soleus or Gastroc- 
 nemius Interniis. 
 
 The Soleus arises, fleshy, from the posterior part 
 of the head of the fibula and from the external angle 
 of that bone for two-thirds of its length down, behind 
 the peroneus longus. It also arises, fleshy, from the 
 oblique ridge on the posterior surface of the tibia. 
 
MUSCLES. 
 
 427 
 
 just at the lower edge of the popliteus muscle, and 
 from the internal angle of the tibia for four or five 
 inches. The two heads are separated for the passage 
 of the posterior tibial vessels. 
 
 The body of this muscle has a great intermixture 
 of tendinous matter in it, and from its lower extremity 
 proceeds the other origin of the tendo achillis; about 
 three or four inches above the heel, this tendon joins 
 the anterior face of the tendon of the gastrocnemius, 
 and by the union ofithe two is formed the Tendo 
 Achillis, which is inserted into the posterior inferior 
 surface of the os calcis at its tubercles. 
 
 These two muscles extend the foot, and are all-im- 
 portant in walking. 
 
 The Plantaris is a singular little muscle conceal- 
 ed by the gastrocnemius, and has a short fleshy belly 
 and a long tendon. It arises, fleshy, from the ridge 
 of the os femoris just above the external condyle; pas- 
 ses across the capsular ligament of the joint, adhering 
 to it in its course; the belly terminates somewhat be- 
 low the head of the tibia in a long delicate tendon 
 which descends between the inner head of the soleus 
 and the gastrocnemius. 
 
 At the place where these tendons unite, the tendon 
 of the plantaris emerges from between them, and, run- 
 ning at the inner edge of the tendo achillis, is insert- 
 ed into the inside of the os calcis just before the in- 
 sertion of the tendo achillis. 
 
 It extends the foot. 
 
428 
 
 OF THE LOWER EXTREMITIES. 
 
 The PoPLiTEUs is a triangular muscle on the back 
 of the knee joint. It arises from a deep depression on 
 the exterior face of the external condyle, by a thick 
 round tendon, which passes through the capsular liga- 
 ment, being connected with the external semilunar car- 
 tilage, and then forms a fleshy belly that passes ob- 
 liquely inwards and downwards. 
 
 It is inserted, fleshy, into the oblique ridge on the 
 back of the tibia just below its head, and into the tri- 
 angular depression above it. 
 
 It bends the leg, and when bent, rotates it inwards. 
 
 By removing the soleus we expose three other mus- 
 cles on the back of the leg, the Tibialis Posticus, the 
 Flexor Longus Digitorum Pedis, and the Flexor Lon- 
 gus Pollicis Pedis. These muscles are covered by a 
 thick strong fascia, from which some of their fibres 
 originate, and which should be removed. 
 
 The Flexor Longus Digitorum Pedis Perfo- 
 RANS is behind the tibia, and at the inner edge of the 
 tibialis posticus. It arises, by an acute, tendinous, and 
 fleshy beginning, from the back of the tibia a little 
 below the popliteus muscle, its origin being continued 
 from the internal angle of the tibia almost to the ancle 
 joint. It arises also, by tendinous and fleshy fibres, 
 from the outer edge of the tibia, just above its connexion 
 with the fibula at the ancle; and between this double 
 order of fibi’es the tibialis posticus lies. 
 
MUSCLES. 
 
 429 
 
 The fibres pass obliquely into a tendon at the pos- 
 terior edge of the muscle, which runs in the groove of 
 the internal malleolus, and is confined there by a strong 
 ligamentous sheath. The tendon then gets to the sole 
 of the foot along the sinuosity of the os calcis, and, 
 being joined by a considerable tendon detached from 
 the flexor longus pollicis, it divides into four branches 
 which are appropriated to the four small toes. 
 
 These tendons are inserted into the bases of the last 
 phalanges of the lesser toes, are very near the tarsal 
 bones, and, from perforating the tendons of the flexor 
 brevis, correspond with the flexor perforans of the 
 hand. 
 
 This muscle flexes the small toes and extends the 
 foot. 
 
 The Flexor Longus Pollicis Pedis is a stout 
 muscle formed of oblique fibres, situated on the back 
 part of the fibula, and at the outer side of the tibialis 
 posticus. It arises by an acute, tendinous, and fleshy 
 beginning from the posterior flat surface of the fibula, 
 commencing about three inches from its head, and 
 continuing almost to the ancle. 
 
 The tendon of this muscle is large and round; i£ 
 forms gradually, and constitutes a facing to the poste^ 
 rior edge of the muscle. It passes through a superfi- 
 cial fossa of the tibia at the back of the ancle, near its 
 middle, and from thence through a notch in the back 
 edgc^ of the astragalus to the sole of the foot, where it 
 
430 
 
 OF THE LOWER EXTREMITIES. 
 
 crosses the tendon of the flexor longus digitorunij 
 giving off the branch just mentioned to join it. This 
 tendon is deeper seated in the foot than the other. 
 
 The tendon of the flexor longus pollicis is inserted 
 into the last joint of the great toe. It bends the great 
 toe, and from its connexion with the others will bend 
 them also. 
 
 The Tibialis Posticus is placed between, and 
 concealed by the two last muscles. It arises, by a nar- 
 row fleshy beginning, from the fi-ont of the tibia, at 
 the under surface of the process which joins it to the 
 fibula, and then gets to the back of the leg, through a 
 hole in the interosseous ligament. It eontinues its 
 origin from the whole of the interosseous ligament, 
 and from the surfaces of the tibia and fibula, bordering 
 on the ligament, excepting one-third of the lower part 
 of the fibula, and rather more of the lower part of the 
 tibia. 
 
 The fleshy fibres run obliquely to a middle tendon, 
 which passes in the groove at the back of the malleo- 
 lus internus, and is inserted into the upper internal 
 part of the os naviculare. This tendon also divides 
 in such a way as to be inserted into the internal and 
 external cuneiform bones, into the os cuboides, and os 
 calcis. 
 
 It extends the foot, and presents the sole obliquely 
 inwards. 
 
MUSCLES. 
 
 431 
 
 Of the Muscles of the Foot. 
 
 The Ext&nsor Brevis Digitorum Pedis is the 
 only muscle on the superior surface of the foot, It is 
 placed beneath the tendons of the extensor longus, and 
 arises, tendinous and fleshy, from the fore upper part 
 of the os calcis. It forms a short fleshy belly, which 
 is partially divided into four parts ; from these bellies 
 proceed as many tendons, which crossing very oblique- 
 ly the tendons of the extensor longus, are inserted into 
 the great toe and the three next toes, by joining with 
 the tendons of the extensor longus, which are spread 
 over their backs. It extends the toes. 
 
 The Sole of the Foot is protected, in the first place, 
 by an unusual thickness of its euticle, which is increas- 
 ed in such parts as are most pressed upon, as the heel, 
 and the ball of the great toe. 
 
 Beneath it, is a thick layer of adipose matter, found, 
 in the most emaciated as well as the most corpulent 
 subjects, which seems to be less under the influence 
 of the eauses producing a diminution or increase of 
 fat, than the adipose matter in any other part of the 
 body. It is collected into granulations separated from 
 each other by processes of condensed cellular mem- 
 brane resembling ligament, that pass from the inte- 
 rior surface of the skin to the aponeurosis plantaris. 
 It fills up completely all the fissures in this aponeu- 
 
432 
 
 OF THE LOWER EXTREMITIES. 
 
 rosis, and adheres very closely to it, so that it requires 
 much trouble to get out a fair dissection of the apo- 
 neurosis. 
 
 The Aponeurosis, or Fascia Plaxtaris, is a 
 ligamentous membrane, extending from the tubercles of 
 the os calcis, to the anterior ends of the metatarsal 
 bones. It is triangular, and corresponds with the out- 
 line of the foot, by being narrow^ behind, and broad 
 before. It is divided into three parts, according to the 
 division of the muscles of the foot, one part lying on 
 the muscles at the outside of the sole, another on the 
 muscles at the inside of the sole, and the third being 
 between the other two. The internal and external 
 portions are thin, and reticulated ; they extend from 
 the tubercles of the os calcis to the roots of the inter- 
 nal and external metatarsal bones, and are scarcely 
 seen beyond them. But the central portion is remark- 
 ably strong near the heel, and diminishes in thickness 
 as it spreads out. Anteriarly, it is divided into five 
 portions, one for each metatarsal bone; each of these 
 portions is bifurcated, and dips down to be inserted on 
 either side of the metatarsal bone near its head. Be- 
 tween the prongs of each bifurcation pass the tendons, 
 nerves, &c. to the toes. The interior face of this 
 membrane affords origin to many of the muscular fibres, 
 and from it proceed vertical partitions, separating the 
 muscles of the middle of the foot from such as are on 
 each side of it. 
 
MUSCLES. 
 
 433 
 
 When the Aponeurosis Plantaris is removed, we see 
 three muscles ; the middle one under the large central 
 portion of the aponeurosis, is the Flexor Brevis Digi- 
 torum Pedis, the outer is the Abductor Minimi Digiti, 
 and the inner the Abductor Pollicis Pedis. 
 
 The Flexor Brevis Digitorum Pedis arises, 
 fleshy, from the tubercle of the os calcis by a narrow 
 beginning, also from the interior surface of the apo- 
 neurosis, and the tendinous septa between it and the 
 contiguous muscles. 
 
 It forms a fleshy belly going nearly as far forwards 
 as the middle of the metatarsal bones ; there it divides 
 into four tendons, which go to the smaller toes. These 
 are perforated by the tendons of the flexor longus, and 
 are inserted into the sides of the second phalanges. 
 The tendon for the little toe is often deficient. 
 
 It bends the second joint of the toes. 
 
 By detaching this muscle from its origin and turn- 
 ing it down, we bring into view the tendon of the 
 Flexor Longus Digitorum Pedis, and its attachments 
 behind, to the tendinous slip from the Flexor Longus 
 Pollicis, and to the Massa Carnea Jacobi Sylvii, or 
 Flexor Accessorius, and before, to the Lumbricales 
 muscles. 
 
 The Flexor Accessorius is at the outside of the 
 tendon of the flexor longus. It arises, fleshy, from 
 
 3 I 
 
434 
 
 OF THE LOWER EXTREMITIES. 
 
 the inside of the sinuosity of the os calcis, and, by a 
 thin tendon, from the outside of the bone before its 
 tubercle. 
 
 It is inserted, fleshy, into the outside of the tendon 
 of the flexor longus, just at its division into four ten- 
 dons. Like a second hand at a rope, it assists in flex- 
 ing the toes. 
 
 The Lumbricales Pedis are four small tapering 
 muscles which arise from the tendon of the flexor lon- 
 gus just after its division, or while it is in the act of 
 dividing. One of them is appropriated to each lesser 
 toe, and is inserted into the inside of its first phalanx, 
 and into the tendinous expansion that is sent off from 
 the extensor muscle to cover its dorsum. 
 
 They increase the flexion of the toes and draw them 
 inwards. 
 
 The Abductor Pollicis Pedis arises, tendinous 
 and fleshy, from the internal anterior part of the tu- 
 berosity of the os calcis, from a ligament extended 
 from the tuberosity to the sheath of the tendon of the 
 tibialis posticus, from the internal side of the navicu- 
 lare, and from the cuneiforme internum. 
 
 It forms the internal margin of the sole of the foot, 
 and is inserted, tendinous, into the internal sesamoid 
 bone and into the base of the first phalanx of the great 
 toe. 
 
 It draws the great toe from the rest. 
 
MUSCLES. 435 
 
 The Flexor Brevis Pollicis Pedis is situated im- 
 mediately at the exterior edge of the abductor pollicis. 
 It consists of two bellies, parallel with each other, but 
 separated by the tendon of the flexor longus pollicis; 
 one is inseparably connected with the tendon of the 
 abductor pollicis, and the other with the adductor 
 pollicis. 
 
 It arises, tendinous, from the under part of the os 
 calcis, just behind its connexion with the os cuboides, 
 and from the under part of the external cuneiform 
 bone. 
 
 The internal belly is inserted, tendinous, into the 
 internal sesamoid bone along with the tendon of the 
 abductor pollicis; and the external belly is inserted, 
 tendinous, into the external sesamoid bone along with 
 the ■ tendon of the adductor pollicis. Each insertion 
 is continued on to the base of the first phalanx of the 
 great toe. 
 
 It flexes the great toe. 
 
 The Adductor Pollicis Pedis is situated at the 
 outside of the flexor brevis, and iS extended obliquely 
 across the metatarsal bones. It arises, tendinous, at 
 the external part of the foot, from a strong ligament 
 which is stretched from the os calcis to the os cuboides, 
 and from the roots of the second, third, and fourth 
 metatarsal bones. ‘ 
 
 It is inserted, tendinous, into the external sesamoid 
 bone, which insertion is continued to the first phalanx 
 
436 
 
 OF THE LOWER EXTREMITIES. 
 
 of the great toe, and is closely united to the tendon of 
 the external head of the flexor brevis pollicis. 
 
 It draws the great toe towards the others. 
 
 The Abductor Minimi Digiti Pedis forms the 
 external margin of the sole of the foot, and is imme- 
 diately beneath the aponeurosis plantaris. It arises, 
 tendinous and fleshy, from the outer side of the tuber 
 of the os calcis, and also from the exterior part of the 
 base of the metatarsal bone of tbe little toe. 
 
 It is inserted, by a round tendon, into the exterior 
 part of the base of the first phalanx of the little toe. 
 
 It draws the little toe from the other toes. 
 
 The Flexor Brevis Minimi Digiti Pedis is just 
 within the tendon of the abductor minimi digiti. It 
 arises from the ligament which is extended from the 
 tuberosity of the cuboid bone to the heads of all the 
 metatarsal bones; also from the root of the fifth meta- 
 tarsal bone. 
 
 It is inserted, by a tendon, into the lower part of 
 the first phalanx of -the little toe at its base, and into 
 the head of the metatarsal bone of the same toe. It 
 bends the little toe. 
 
 The Transversalis Pedis is placed beneath the 
 tendons of the flexor muscles. It is small, and lies 
 across the anterior extremities of the metatarsal bones. 
 It arises, tendinous, from the capsular ligament of the 
 
MUSCLES. 
 
 437 
 
 first joint of the little toe; it also arises from the cap- 
 sule of the first joint of the next toe. 
 
 It is inserted into the exterior face of the common 
 tendon of the adductor and flexor brevis pollicis at the 
 external sesamoid bone. 
 
 It approximates the heads of the metatarsal bones. 
 
 The Interosseous Muscles are seven in number, four 
 of which may be seen on the upper surface of the foot. 
 There are two to the first small toe, two to the second, 
 two to the third, and one to the fourth or little toe. 
 The muscles seen on the upper side of the foot are for 
 the most part double headed, that is, they arise from 
 the contiguous surfaces of the metatarsal bones. 
 
 The Interosseus Primus Digiti Primi Pedis, or 
 the Abductor Indicis Pedis, is seen superiorly. It 
 is placed between the metatarsal bone of the great toe 
 and the first small toe, and arises, fleshy, by a double 
 head, from the opposed surfaces of their roots. 
 
 It is inserted, tendinous, into the inside of the root 
 of the first joint of the first small toe, and pulls it in- 
 wards. 
 
 The Interosseus Secundus Primi Digiti, or the 
 Adductor Indicis Pedis, is also external or above. 
 It is situated between the metatarsal bones of the first 
 and second small toes, arises from the opposed surfaces 
 of their roots by a double fleshy and tendinous head. 
 
438 
 
 OF THE LOWER EXTREMITIES. 
 
 It is inserted into the outside of the first phalanx of 
 the same toe by a tendon. It draws this toe outwards. 
 
 The Interosseus Primus Secundi Digiti Pedis, 
 or the Abductor Medii Digiti, is at the bottom of 
 the foot, and arises from the inside of the metatarsal 
 bone of the second small toe. 
 
 It is inserted into the inside of the first phalanx of 
 the second toe. 
 
 It draws this toe inwards. 
 
 The Interosseus Secundus Digiti Secundi, or 
 the Adductor Medii Digiti, is seen at the upper 
 part of the foot, between the second and third meta- 
 tarsal bones of the lesser toes, arising from the oppo- 
 sed surfaces of their roots. 
 
 It is inserted, tendinous, into the outside of the base 
 of the first phalanx of the second small toe. It draws 
 this toe outwards. 
 
 The Interosseus Primus Digiti Tertii, or the 
 Abductor Tertii Digiti, is in the sole of the foot. 
 It arises from the inside of the metatarsal bone of the 
 third toe near its root, and is 
 
 Inserted, tendinous, into the inside of the base of 
 the first phalanx of the third toe. 
 
 It draws this toe inwards. 
 
 The Interosseus Secundus Digiti Tertii or 
 
MUSCLES. 
 
 439 
 
 the Adductor Tertii Digiti, is seen on the upper 
 surface of the foot, occupying the interval of the meta- 
 tarsal bones of the third and fourth small toes, and 
 arises, by a double head, from the opposite surfaces of 
 their roots. 
 
 It is inserted, tendinous, into the outside of the root 
 of the first phalanx of the third small toe. 
 
 It draws this toe outwards. 
 
 The Interosseus Digiti Minimi is on the under 
 surface of the foot. It arises from the inside of the 
 base of the metatarsal bone of the fourth small, or the 
 little toe, and is 
 
 Inserted, tendinous, into the inside of the first 
 phalanx of the little toe. It draws this toe inwards. 
 It is also called. Abductor Minimi Digiti Pedis; but 
 this name has rather a tendency to confuse, as one of 
 the muscles, as stated, on the outer side of the sole of 
 the foot, has the same name. 
 
440 
 
 OF THE LOWER EXTREMITIES. 
 
 Section III. 
 
 Of the Blood Vessels of the Lower Extremities. 
 
 The Femoral Artery, (Arteria Femoralis,) is a 
 continuation of the external iliac. It appears first on 
 the thigh, half-way, or nearly so, between the sym- 
 physis pubis and the anterior superior spinous process 
 of the ilium ; emerging from beneath Poupart’s liga- 
 ment, it is there covered only by the skin and fascia of 
 the part, having the femoral vein at its inside, and the 
 trunk of the anterior crural nerve, about half an inch 
 from it on the outside. It lies upon the psoas magnus 
 muscle, crosses the pectinalis, and the whole of the in- 
 sertion of the adductor longus muscle. About one- 
 third of the length of the thigh bone from below, it 
 penetrates the insertion of the adductor magnus and 
 gets to the ham, being then behind the leg. For the 
 upper third of its course the femoral artery is at the 
 inner edge of the rectus femoris, and but a little dis- 
 tance from it ; it then inclines inwards and occupies the 
 angle formed by the contact of the vastus internus, 
 and the adductor longus. Above, the sartorius is at 
 its outside; but as this muscle inclines very rapidly in- 
 wards, immediately after its origin, it in a little time 
 begins to pass along the external margin of the artery, 
 and shortly afterwards covers the artery completely to 
 
BLOOD VESSELS. 
 
 441 
 
 the place where it penetrates the adductor. Where 
 the artery lies in the angle formed by the adductor 
 longus, and the vastus internus, it is covered by a 
 strong interlacing of tendinous fibres from the 
 muscles^ and is also enveloped by its own cellular 
 coat. 
 
 To cut upon the femoral artery in any part of its 
 course, lay the subject horizontally, and turn the leg 
 outwards, so that the external margin of the sole of the 
 foot will be in contact or nearly so with the table. A 
 line drawn then from midway between the anterior 
 superior spine of the ilium, and the symphysis pubis, 
 to the centre of the internal condyle of the os femoris, 
 will be precisely over it.* 
 
 The following branches come from the Femoral 
 Artery : 
 
 1. The first is called by Haller, Arteria Ad Cutem 
 Abdominis. From this a branch is sent upwards to- 
 wards the umbilicus under the skin, and one more to 
 supply the inguinal glands. 
 
 2. The External Pumc (Arteri® Pudendse Ex- 
 ternse,) two or three in number; they are sent to the 
 integuments and lymphatic glands of the groin, also to 
 the skin of the penis and scrotum, or to the labia ex- 
 terna. One of these trunks arises from the upper 
 
 * Marjolin. 
 
 3 K 
 
442 
 
 OF THE LOWER EXTREMITIES. 
 
 internal part of the femoral artery, and the other some- 
 times from the profunda. 
 
 The arteries as yet mentioned, anastomose freely 
 with each other; are irregular in their number, size, 
 and origin, but for the most part do not exceed the 
 size of a common knitting-needle. 
 
 3. The Profound Artery, (Arteria Profunda Fe- 
 moris,) is very happily called, by Professor Chaussier, 
 La Grande Musculaire De La Cuisse, in consequence 
 of its distribution. It is almost equal in size to the femo- 
 Tal itself, and arises from its posterior part on a level 
 with the trochanter minor, but sometimes only five or 
 six lines below PouparPs Ligament. It immediately 
 begins to give olf branches externally and internally, 
 but the main trunk of the artery continues for several 
 inches in contact with the femoral artery or nearly 
 so, and beneath it. It then terminates gradually by 
 branches which penetrate to the back of the thigh. 
 
 The profunda femoris is distributed as follows : 
 
 a. The External Circumflex, (Arteria Circum- 
 flexa Externa,) arises from its external superior part, 
 sometimes, however, from the femoral itself; it passes 
 outwards under the sartorius and the rectus femoris, 
 and divides into two secondary branches. The superior 
 and shorter of these is distributed to the parts about 
 the trochanter major, as the anterior edges of the 
 gluteus medius and minimus, the capsule of the hip 
 
BLOOD VESSELS. 
 
 443 
 
 joints and the heads of the extensor muscles. The 
 second goes along the outside of the thigh to the pa- 
 tella, and is about the size of a crow-quill. It first 
 passes obliquely between the rectus and the crureus, 
 and then vertically under the anterior margin of the 
 vastus externus, between it and the crureus till it ter- 
 minates about the knee, by anastomosing with the arti- 
 cular arteries. It is principally distributed to the 
 erurseus and vastus externus. 
 
 b. The Internal Circumflex, (Art. Circumflexa 
 Interna,) arises from the inner side of the profunda, 
 just below the external circumflex, but sometimes it 
 also comes from the femoral. It is somewhat under 
 the size of the other, and penetrates between the psoas 
 magnus and pectinalis ; it winds under the neck of the 
 os femoris, and divides into two branches which supply 
 the contiguous' parts, as the heads of the muscles and 
 the joint. 
 
 c. Several ramifications are also sent from the pro- 
 funda to supply the anterior faces of the adductor 
 muscles ; they are irregular in number, size, and place 
 of origin, and have no appropriated names. 
 
 d. The Perforating Arteries, (Rami Profundi 
 Perforantes, ) three or four in number, are given off 
 successively, are numerically named, and all penetrate 
 
444 
 
 OF THE LOWER EXTREMITIES. 
 
 the adductor muscles near the thigh bone to get to the 
 back of the thigh. 
 
 The first arises immediately below the little tro- 
 chanter, and, gets through the adductor magnus just 
 below the quadratus femoris, to be distributed about 
 the heads of the hamstring muscles. 
 
 The second penetrates the adductor magnus at the 
 lower part of the insertion of the gluteus maximus into 
 the linea aspera, to be distributed about there and to 
 the corresponding section of the long head of the 
 biceps flexor cruris. 
 
 The third penetrates the adductor magnus a little 
 below the commencement of the origin of the short 
 head of the biceps, and is distributed thereabout. 
 
 The fourth penetrates the adductor magnus about au 
 inch and a half above the hole for the femoral artery, 
 and is distributed to the neighbouring part of the 
 adductor and to the hamstring muscles. 
 
 After the origin of the profunda, the femoral artery 
 gives off three or four twigs the size of a large knit- 
 ting-needle, which are disposed of, upon the sartorius, 
 adductors, vastus internus, and integuments, but they 
 are too irregular in number, origin, and course for 
 systematic description. 
 
 The Anastomosing Artery, (Arteria Anastomo- 
 tica,) the last branch of the femoral, is sent from it just 
 before it enters the aperture in the adductor magnus. 
 This artery descends, in the course of the tendon of 
 
BLOOD VESSELS. 
 
 445 
 
 this adductor, to the knee, in front of the tendon, be- 
 tween it and the vastus internus muscle. It is distri- 
 buted to the parts lying along its course. 
 
 The Popliteal Artery, (Arteria Poplitsea) is the 
 continuation of the femoral after the latter has passed 
 through the adductor tendon, and extends from this 
 point to the opening in the interosseous ligament of 
 the leg, just below the heads of the bones. Its first 
 act is to cross obliquely the os femoris as far as its 
 middle ; it then passes in a vertical line downwards, 
 very nearly over the centre of the os femoris, knee 
 joint, and head of the tibia, being only separated from 
 these parts in consequence of a thick envelope of fat, 
 which fills up the hollow of the ham, and protects the 
 artery from the effects of sudden flexions of the part 
 and of bruises. The popliteal artery sends off the 
 following branches : 
 
 1. The Superior Internal Articular Artery, (Arti- 
 cularis Superior Interna) sometimes exists as two 
 trunks; it arises just above the internal condyle, per- 
 forates the adductor tendon, and, going horizontally, 
 is spent oh the inner side of the joint above. 
 
 2. The Superior External Articulating Artery, 
 (Articularis Superior Externa) arises just above the 
 external condyle, passes horizontally between the 
 femur and the biceps flexor, and is distributed to the 
 upper external parts of the joint. 
 
 3. The Middle Articular, (i\rticularis Media) 
 
446 
 
 OF THE LOWER EXTREMITIES. 
 
 sometimes comes from one of the others; it is distri- 
 buted to the posterior middle parts of the knee joint. 
 
 4. The Inferior Internal Articular Artery, ( Articu- 
 laris Inferior Interna) arises on a level with the infe- 
 rior part of the internal condyle. It descends ob- 
 liquely, passes between the lateral ligament and the 
 head of the tibia, and then mounts towards the patella, 
 to be distributed in numerous branches. 
 
 5. The Inferior External Articular Artery, (Arti- 
 cularis Inferior Externa,) arises near the last, and some- 
 times they are derived from a common trunk. It pas- 
 ses between the external lateral ligament and the head 
 of the tibia, mounts afterwards towards the patella, and 
 is then minutely ramified on the lower external parts 
 of the knee joint. 
 
 The upper articular arteries anastomose with the 
 lower, and also with the anastomotic and the long 
 branch of the external circumflex. 
 
 Below the knee, the popliteal artery is over the po- 
 pliteus muscle and between the heads of the gastroc- 
 nemius. Here it sends olf a large branch to each head 
 of the gastrocnemius muscle, and small irregular bran- 
 ches to the other muscles, and sometimes the nutritious 
 artery of the tibia. 
 
 On a level with the aperture of the interosseous liga- 
 ment, the popliteal artery may be considered as ter- 
 minating by a division into two large branches, tlie An- 
 terior Tibial, and the Posterior Tibial. 
 
BLOOD VESSELS. 
 
 447 
 
 The Anterior Tibial Artery, (Arteria Tibialis 
 Anterior^) after getting through the interosseous fora- 
 men, passes down the leg in front of the interosseous 
 ligament and in contact with it; it passes also over the 
 middle of the ancle joint to the dorsum of the foot, 
 and is continued in a straight line to the interval be- 
 tween the metatarsal bone of the great toe, and of the 
 one next to it. This artery is situated under a line 
 drawn from the middle anterior part of the head of 
 the fibula, to the middle of the ancle joint in front, 
 and is continued in the course of a line drawn from 
 this latter point to the junction of the two first me- 
 tatarsal bones. Above, it is placed between the tibialis 
 anticus and the extensor longus digitorum ; below, on 
 the leg between the extensor pollicis and the tibialis 
 anticus; and while engaged with the tendons of the 
 muscles under the annular ligament of the joint, it 
 gets to the fibular side of the tendon of the extensor 
 pollicis. 
 
 The anterior tibial artery gives off several branches, 
 
 1, The Recurrent Tibial, (Tibialis Recurrens) 
 penetrates the head of the tibialis anticus muscle, and 
 is distributed about the exterior and anterior part of 
 the head of the tibia, and the patella. 
 
 2. Several small arterial twigs are then sent to the 
 muscles and periosteum on the fore part of the leg, but 
 they have no name. 
 
448 
 
 OF THE LOWER EXTREMITIES. 
 
 3. The Internal Malleolar, (Malleolaris Inter- 
 na) arises from the anterior tibial somewhat above the 
 joint, it passes under the tendon of the tibialis anticus, 
 and is distributed to the internal ancle, and the con- 
 tiguous part of the foot. 
 
 4. The External Malleolar, (Malleolaris Ex- 
 terna) exists most commonly as two small branches, one 
 arising on a level with the joint, and the other an inch 
 or two above. They pass beneath the tendons of the 
 extensor longus and the peroneus tertius, to the lower 
 part of the fibula, and inosculate with the peroneal 
 artery. 
 
 5. The Tarsal Artery, (Arteria Tarsea) arises 
 from the anterior tibial just below the ancle joint; it 
 runs outwardly under the tendons and the belly of the 
 extensor brevis, to be distributed to the upper outer 
 part of the tarsus. 
 
 6. The Metatarsal Artery, (Arteria Metatar- 
 sea) arises just below the last, and is distributed by 
 many branches on the upper part of the metatai-sus. 
 A successful injection demonstrates a branch in each 
 of the three outer interosseous intervals of the metatar- 
 sal bones above. 
 
 7. The Dorsal Artery of the Great Toe, (Dor- 
 salis Hallucis) arises from the anterior tibial at the root 
 
BLOOD VESSELS. 
 
 449 
 
 of the first metatarsal bone^ it runs in the superior part 
 of the first metatarsal interval, and terminates in two 
 branches which go to the opposed faces of the great 
 toe, and the second toe. 
 
 After this the anterior tibial artery sinks down and 
 joins the external plantar in the sole of the foot. 
 
 The Posterior Tibiae Artery, (Arteria Tibialis 
 Postica) extends from the head of the tibia to the hollow 
 of the os calcis ; it is on the tibial side of the leg, and 
 is placed between the soleus posteriorly, and the flexor 
 digitorum anteriorly, and beneath the fascia of the 
 part. It is distributed in the following manner : 
 
 1. The Peroneal Artery, (Arteria Peronea) 
 arises a little below the commencement of the posterior 
 tibial, and is extended from the inferior edge of the 
 popliteus muscle to the external ancle. It is placed 
 at the tibial edge of the fibula, between the flexor 
 longus pollicis muscle, and the external edge of the 
 tibialis posticus. Its situation is therefore deep and 
 of difficult access in the living body. After des- 
 cending along two-thirds of the fibula, it divides into 
 anterior and posterior branch. The first traverses the 
 interosseous ligament, and descending in front of it, is 
 ramified on the upper external part of the foot. The 
 second descends posteriorly along the fibula, and is dis- 
 tributed about the peroneo-tibial articulation and the 
 adjacent 'parts. 
 
 3 L 
 
450 
 
 OF THE LOWER EXTREMITIES. 
 
 2. Several small irregular muscular and cutaneous 
 branches afterwards arise from the posterior tibia), 
 and at its upper part most commonly, the Arteria Nutri- 
 tia Tibiae. 
 
 At the ancle the posterior tibial is at tlie internal 
 edge of the tendo achillis, and still confined by the 
 fascia of the part. It passes to the sole of the’ foot in 
 the hollow of the os calcis, between the bone and the 
 abductor muscle of the great toe. At the ancle it is on 
 aline with the internal margin of the joint behind, and 
 in {contact with the posterior malleolus, between the 
 tendon of the flexor longus pollicis, and that of the 
 flexor longus digitorum. Having got to the sole of the 
 foot it terminates by dividing into two branches, the 
 Internal and External Plantar Arteries. 
 
 The Internal Plantar, (Arteria Plantaris Inter- 
 na,) is the smaller of the two; it is covered by the 
 abductor pollicis, and passing between it and the in- 
 ternal inferior margin of the foot, it terminates at the 
 anterior end of the first metatarsal bone in the internal 
 digital artery of the great toe. In this course it sends 
 several branches to the contiguous parts, which give 
 them a high degree of vascularity. One of the most 
 remarkable is given off about the os scaphoides and 
 cruizes along the internal margin of the abductor pol- 
 licis to its anterior end. Another makes its appearance 
 superficially in the sole of the foot, in the fissure be- 
 
BLOOD VESSELS. 
 
 451 
 
 tween the abductor pollicis and the flexor brevis digi- 
 toruin, and goes as far forward as the other. 
 
 The External Plantar, (Arteria Plantaris Ex- 
 terna, ) inclines towards the outer margin of the foot, 
 between the flexor brevis digitorum and the flexor 
 accessorius; it then advances at the internal edge of the 
 abductor minimi digiti to the root of the metatarsal 
 bone of the fourth toe, and makes a curvature forwards 
 and inwards between the tendons of the flexor longus 
 and the metatarsal bones, to the first metatarsal interval, 
 where it is joined by the anterior tibial artery from 
 above. This sweep forms the plantar arch (arcus 
 plantaris. ) The distribution of the external plantar is 
 as follows: 
 
 a. Half an inch from its origin it detaches back- 
 wards and outwards to the inferior and to the external 
 parts of the heel a multifidous branch, which also sends 
 an arteriole along the external edge of the abductor 
 minimi digiti. 
 
 i. At the root of the fourth metatarsal bone a branch 
 arises, called the External Plantar Artery of the Little 
 Toe, which goes first along the internal margin of the 
 muscles of this organ, and afterwards at the. head of its 
 metatarsal bone, gets between them and the bone, and 
 is distributed along the external margin of the little 
 toe. 
 
 c. The Digital Arteries come next, which arise suc- 
 cessively at the fourth, third, second, and first meta- 
 
452 
 
 OF THE LOWER EXTREMITIES. 
 
 tarsal iritervals, or near them, from the convex side of 
 the plantar arch. They get forward between the 
 transversalis pedis and the interosseous muscles, and, 
 arriving at the roots of the toes, each artery bifurcates 
 and goes to the opposed sides of the adjacent toes, like 
 the corresponding arteries of the hand. 
 
 The digital artery that supplies the great toe and 
 the opposite side of the toe next to it, is derived from 
 the united trunks of the anterior tibial and the external 
 plantar. At the head of the metatarsal bone it de- 
 taches a branch which runs along the inner edge of the 
 great toe, and is united, by anastomoses, with the in- 
 ternal plantar artery. 
 
 Of the Veins of the Lower Extremities. 
 
 These veins are superficial and deep-seated. The 
 more important of the first are the Saphena Magna and 
 the Minor. 
 
 1. The Saphena Magna arises from the inside of 
 the foot, about the great toe, and from its sole ; it passes 
 in front of the internal ancle, along the inside of the 
 leg, over the internal condyle of the femur, along the 
 inner front part of the thigh, and terminates in the fe- 
 moral vein just below Poupart’s ligament. As it as- 
 cends it collects branches from the anterior and pos- 
 terior parts of the lower extremity. It may be seen 
 very readily in the living subject beneath the skin. 
 
BLOOD VESSELS. 
 
 453 
 
 2. The Saphena Minor is also readily seen through 
 the skin. It arises from the external superior parts of 
 the foot, passes behind the external ancle, and ascends 
 on the outside of the leg to the ham, receiving contri- 
 butions in its course; here it crosses the external head 
 of the gastrocnemius muscle, and, dipping into the 
 ham, empties into the popliteal vein. 
 
 Frequent anastomoses occur between the saphena 
 magna and minor. 
 
 The origin and course of the femoral veins are so 
 similar to the distribution and course of the femoral 
 Artery, that a description is needless. A venous tube 
 always attends an arterial one, being in contact with 
 it, enclosed in the same sheath, and called by the same 
 name. The smaller arterial branches in the leg and 
 thigh have each two veins called Venae Comites. 
 
 The relative situation of the large venous trunks is 
 important. At Poupart’s ligament the femoral vein 
 is at the inside of the artery; at the passing of the 
 adductor tendon, the vein is nearest the thigh bone ; 
 and in the ham, the popliteal vein is behind the artery 
 and consequently more superficial. 
 
454 
 
 OF THE LOWER EXTREMITIES. 
 
 Section IV. 
 
 Of the JVerves of the Lower Extremities. 
 
 The Nerves of the Lower Extremity are derived 
 from that part of the medulla spinalis which is situated 
 in the lumbar vertebrae and in the sacrum. The 
 lumbar nerves form a plexus behind the psoas magnus 
 muscle, from which proceeds a cluster of nerves to 
 supply the front part of the lower extremity, including 
 both its skin and muscles. The sacral nerves form a 
 plexus in the pelvis at the side of the rectum, from 
 which proceeds the largest nerve in the body, the 
 Sciatic, appropriated to the supply of the skin and 
 muscles on the back part of the lower extremity. The 
 lower part of the lumbar plexus is continued into the 
 upper of the sciatic or sacral, so that, under a more 
 general classification than what is adopted, both of 
 these plexuses may be considered as forming but one. 
 
 The Plexus Lumbalis is seen by dissecting the 
 psoas magnus muscle from its origin and turning it 
 aside; the primitive nerves, constituting this plexus, 
 sometimes pass through the substance of the muscle 
 instead of going behind it. The plexus is formed by 
 the four upper lumbar nerves with a filament from the 
 last dorsal. The anterior branches only of these nerves 
 
NERVES. 
 
 455 
 
 are concerned in forming it, as the posterior bran- 
 ches all go to the muscles of the back. 
 
 In the distribution of this plexus to the lower ex- 
 tremity, it will be seen, shortly after the commence- 
 ment of the dissection, that its branches may be con- 
 sidered under two divisions ; first, such as go to the 
 skin, and secondly, such as go to the muscles. 
 
 From the upper part of the plexus, fibrillce pass out- 
 wards and downwards over the quadratus muscle; some 
 of their ramuscules are spent on the sides of the ab- 
 dominal muscles ; others wind over the crista of the 
 ilium about its middle part and are distributed to the 
 integuments of the hip. 
 
 The Spermaticus Externus arises also from the 
 upper part of this plexus ; it crosses the iliacus inter- 
 nus muscle, shaping its course towards the anterior 
 superior spinous process of the ilium. Here it involves 
 itself in the edge of the abdominal muscles, and, go- 
 ing on the posterior face of Poupart’s ligament, at the 
 internal abdominal ring it joins the spermatic cord of 
 the male, or the round ligament of the uterus of the 
 female. In the first case it is distributed to the sper- 
 matic cord and scrotum; in the second to the labia ex- 
 terna and mons veneris. 
 
 The CuTANEUS Externus arises from the lumbar 
 plexus below the external spermatic. It passes across 
 
456 
 
 OF THE LOWER EXTREMITIES. 
 
 the illacus internus towards the anterior superior spi- 
 nous process about an inch below the spermaticus 
 externus, and crosses the latter nerve just at that pro- 
 cess. Emerging from the abdomen, by penetrating 
 the commencement of Poupart’s ligament, it is distri- 
 buted, in several branches, to the integuments of the 
 vastus externus muscle and along the edge of the 
 rectus femoris ; one of the latter extends to the pa- 
 tella. 
 
 The CuTANEUS Medius is given from the anterior 
 crural, an inch or so above Poupart’s ligament, com- 
 ing from it, among the cluster of branches which arise 
 there to be distributed to the iliacus internus muscle 
 and to the muscles of the thigh. It appears superfi- 
 cially on the thigh, for the first time, by penetrating 
 the sartorius muscle, about the internal edge of the 
 rectus femoris ; it descends then along the same edge 
 of the latter muscle, and is distributed to its integu- 
 ments. It does not descend so low as the other nerve. 
 
 The CuTANEUs Anterior arises also from the cru- 
 ral nerve ; it is on the inner side of the cutaneous me- 
 dius, emerges from the fascia of the thigh, and crosses 
 the sartorius muscle two or three inches below the 
 cutaneus medius. It is distributed on the integuments 
 of the vastus internus muscle, and some of its branches 
 extend to the internal edge of the patella. 
 
NERVES. 
 
 457 
 
 The CuTANEUs Internus arises from the anterior 
 crural nerve among the same cluster above Poupart’s 
 ligament. It divides into four or five branches of 
 different lengths, and is distributed to the integu- 
 ments of the adductor muscles and along the inner 
 front side of the thigh. One branch observes, very 
 much, the course of the tendon of the adductor 
 magnus, and reaches as far down as the inner side of 
 the knee. 
 
 The Cruralis Anterior arises from the middle 
 nerves of the lumbar plexus; at first it is beneath the 
 psoas magnus muscle ; it then gets to its outside and 
 passes from the abdomen, under Poupart’s ligament, 
 about half an inch from the exterior margin of the femo- 
 ral artery. Before it reaches Poupart’s ligament it gives 
 off a cluster of nerves, several of which go to' the iliacus 
 internus muscle, others form superficial or cutane- 
 ous nerves of the thigh„ and others deep-seated or 
 muscular branches. The distribution of the cutaneous 
 nerves has just been mentioned; the muscular ones 
 supply the adductor muscles, the four extensors, the 
 pectineus, the sartorius, and the gracilis. 
 
 One of the branches of the anterior crural nerve is 
 seen to accompany the femoral artery, till the artery 
 penetrates the adductor magnus ; it then runs along the 
 front margin of the tendon of the adductor magnus, in a 
 channel formed by this tendon and the origin of the 
 vastus internus. The nerve alluded tQ is the Saphe- 
 
458 
 
 OF THE LOWER EXTREMITIES. 
 
 nusj it passes afterwards between the internal condyle 
 of the femur and the sartorius muscle, attaches itself to 
 the saphena vein, and is distributed to the integuments 
 of the inner side of the leg and of the upper internal 
 parts of the foot. 
 
 The Nervus Obturatorius is derived from the 
 middle of the lumbar plexus, also, and has very much 
 the same position in regard to the psoas magnus as the 
 anterior crural nerve. It descends from beneath the 
 psoas magnus into the pelvis, near the sacro-iliac suture, 
 and passes forwards and downwards to the obturator 
 foramen, having got through which, it divides into an 
 anterior and a posterior branch. The first is distri- 
 buted to the heads of the adductor longus and brevis, 
 and to the gracilis and integuments. The second ter- 
 minates in the obturator externus, and the adductor 
 magnus. 
 
 The Sciatic Plexus, (Plexus Ischiadicus) is formed 
 by the union of the last lumbar with the four upper 
 sacral nerves; the last lumbar, before it joins the 
 plexus, receives the branch of the fourth lumbar nerve, 
 which is left after the lumbar plexus is formed. This 
 plexus is situated at the side of the rectum before the 
 pyriformis muscle. 
 
 The sacral nerves amount to six in number, some- 
 times only to five. They arise from the lower part of 
 the cauda equina, and pass in a very oblique direction 
 
NERVES. 
 
 459 
 
 in order to arrive at the sacral foramina. Like the other 
 nerves of the spine they form ganglions by the union 
 of their anterior and posterior fasciculi, and then pass 
 outwards from the spinal canal, each one by an an- 
 terior branch which goes through the foramen in front 
 of the sacrum, and a posterior branch much smaller, 
 which gets through the foramen on the back of the 
 sacrum. The volume of the posterior branches in- 
 creases till the fourth, but the fifth and the sixth are 
 much smaller, in fact only fibrillse. These posterior 
 branches all communicate with each other, being dis- 
 tributed to the head of the sacro-lumbalis and lon- 
 gissimus dorsi, to the posterior edge of the gluteus 
 magnus, to the integuments of the buttock, margin of 
 the anus, and to the internal parts of the thigh. 
 
 The anterior branches of the sacral nerves are much 
 larger than the posterior. The four first communi- 
 cate with the sacral ganglions of the great sympathetic, 
 besides forming the ischiatic plexus. The third and 
 the fourth, assisted by the sympathetic, form the hypo- 
 gastric plexus. The fifth, and the sixth when it ex- 
 ists, are distributed to the coccygeus, sphincter, and 
 levator ani.'^ 
 
 * This is only given as the most frequent arrangement of the 
 sciatic plexus, and of the, branches of nerves which proceed from 
 it; other arrangements will often be met with in the cavity of 
 the pelvis, in which not so many sacral nerves are sent to the 
 plexus, and the several branches proceeding from it, depart in 
 a different manner. 
 
460 
 
 OF THE LOWER EXTREMITIES. 
 
 The following small branches are sent from the 
 Sciatic Plexus:^" 
 
 a. Nervi Glutsei, one passing through the upper part 
 of the sciatic notch along with the artery to the glutseus 
 medius and minimus, the other below the pyriformis 
 muscle to the glutaeus magnus. 
 
 h. Nervus Pudendalis Longus Inferior, which passes 
 under the tuber of the ischium to the glutseus magnus, 
 perineal muscles, urethra and integuments of the penis, 
 and scrotum in men, and to the inferior parts of the 
 labia externa in women. 
 
 c. Ramus Feraoralis Cutaneus Posterior. This 
 nerve is placed between the integuments of the thigh, 
 and the muscles which arise from the tuberosity of 
 the ischium. It sends many branches successively to 
 the skin on the back of the thigh; one of its branches 
 longer than the others goes down to the ham, and there 
 divides into several filaments which are distributed to 
 the integuments on the back of the leg. 
 
 TheNERvus Pudexdalis Superior comes from the 
 third and fourth sacral, occasionally receiving a contri- 
 bution from the small sciatic when it exists. It goes in 
 company with the internal pudic artery between the sa- 
 cro-sciatic ligaments, and then divides into two bran- 
 ches; the inferior of which is distributed to the in- 
 
 * They sometimes come from a common trunk called the 
 small sciatic. 
 
NERVES. 
 
 461 
 
 teguments and muscles of the perineum, to the urethra 
 and scrotum ; the superior passing along the ramus of 
 the ischium and pubes with the trunk of the internal 
 pudic artery, is distributed to the obturator internus, 
 accelerator urinas, urethra, and afterwards getting 
 between the symphysis of the pubes and the penis, 
 terminates on its integuments and the glans penis. 
 
 The Nervus Ischiadicus, or the Great Sciatic, is 
 the common trunk formed from the sciatic plexus ; it 
 is much the largest nerve in the body, and passes from 
 the pelvis between the pyriformis and the geminus 
 superior. It crosses vertically behind the small rotator 
 muscles of the thigh, being concealed by the inferior 
 edge of the glutseus magnus ; it is there about half-way 
 between the tuberosity of the ischium and the trochanter 
 major. Thence it descends on the back of the adduc- 
 tor magnus at the outer edge of the long head of the 
 biceps flexor cruris. About half-way down the thigh, 
 sometimes a little lower, the Sciatic nerve divides into 
 the Popliteal or Posterior Tibial, and Peroneal nerves. 
 Occasionally this division takes place as high as the exit 
 of the nerve from the pelvis, but in this case the fasci- 
 culi are parallel with each other as far as the middle 
 of the thigh. From the trochanter minor to its usual 
 place of division, this nerve is parallel with, and on the 
 back of the thigh bone, but there the two branches 
 begin to diverge. The popliteal nerve continues 
 straight downwards to the back and middle of the knee 
 
462 
 
 OF THE LOWER EXTREMITIES, 
 
 joint, and to the interstice between the heads of tlie 
 gastrocnemii muscles, whereas the fibular nerve goes 
 along the inner posterior edge of the biceps flexor 
 cruris, and passes between its tendinous insertion and 
 the external head of the gastrocnemius muscle. 
 
 In this course the following branches are sent fronj 
 the sciatic : Twigs to the little rotator muscles of the 
 thigh. The Cutaneus Internus Superior, which arises 
 near the upper part of the thigh, and is distributed to 
 the skin of the corresponding part. The Cutaneus 
 Internus Inferior, which arises just below the last, and 
 descending upon the inner head of the gastrocnemius 
 externus, is distributed to the integuments of the calf 
 of the leg. A large trunk, and sometimes instead of 
 it, distinct branches which go to the Adductor Magnus, 
 Semimembranosus, Biceps and Semitendinosus. 
 
 The Peroneal Nerve, (Nervus Peroneus) at the 
 head of the fibula divides into two branches, the Pe- 
 roneus Externus and the Tibialis Anterior: but before 
 this division it sends a small branch to the external 
 parts of the knee joint, and two cutaneous branches 
 called Peroneo-Cutaneus. The internal of the two 
 latter descends behind the external head of. the 
 gastrocnemius, and at the bottom of the leg is 
 united to a division of the posterior tibial called the 
 External Saphenus or Coramunicans Tibiae. The ex- 
 
. NERVES. 
 
 463 
 
 ternal branch of the peroneo-cutaneous is distributed 
 to the skin along the fibula. 
 
 The External Peroneal Nerve, (Peroneus Exter- 
 nus) gets between the head of the peroneus longus 
 and the fibula, then between the peroneus longus and 
 the extensor longus digitorum ; it descends at the outer 
 edge of the last muscle to the inferior third of the leg, 
 giving out, in the mean time, many muscular branches. 
 Here it penetrates the aponeurosis and divides into 
 subcutaneous branches, which supply the lower part 
 of the leg and the upper surface of the foot and toes. 
 This nerve is called, by the French, the Musculo Cu- 
 taneous of the leg. 
 
 The Anterior Tibial Nerve, (Tibialis Anterior) gets 
 obliquely between the fibula, the peroneus longus, 
 and the extensor longus digitorum to the front of the 
 interosseous ligament, where it accompanies the ante- 
 rior tibial artery. It passes with the artery under the 
 annular ligament of the ancle, and has its terminating 
 filaments going to the muscles and integuments of the 
 upper surface of the foot as far as the end of the two 
 first toes. One of its branches sinks down with the 
 anterior tibial artery to the sole of the foot. High up 
 in the leg it gives filaments to the knee joint, and, in 
 its course downwards, it furnishes the muscles on the 
 front pf the leg. 
 
 The Popliteal Nerve, (Nervus Popliteus) having 
 the direction mentioned, is placed between the skin 
 
464 
 
 OF THE LOWER EXTREMITIES. 
 
 and the popliteal vein. It gets between the heads of 
 gastrocnemii muscles and perforates the origin of the 
 soleus, going with the posterior tibial artery between 
 this muscle and the flexor longus digitorum to the 
 bottom of the leg. It gives off 
 
 a. The External Saphenus, (Saphenus Externus or 
 Coramunicans Tibiae) which arises above the knee 
 joint, and, descending between the skin and the gas- 
 trocnemius, turns ^outwardly and anastomoses with 
 the cutaneous branch alluded to of the peroneal nerve. 
 The common trunk passes behind the external ancle, 
 along the external margin of the foot, and terminates 
 on the two last toes, having given off a great number 
 of cutaneous branches. 
 
 h. Branches to the heads of the gastrocnemius, 
 - soleus, plantaris, and popliteus. 
 
 c. Branches to the flexor longus digitorum, tibialis 
 posticus, and to the flexor longus pollicis pedis. 
 
 d. A branch through the interosseous ligament above 
 to the tibialis anticus. 
 
 e. At the inferior part of the leg many cutaneous 
 .filaments, one of which gets to the sole of the foot. 
 
 The Posterior Tibial Nerve, having given off these 
 branches, divides in the hollow of the os calcis into 
 Internal and External Plantar Nerves. 
 
 The Internal Plantar, (Plantaris Internus) pro- 
 ceeds along side the tendon of the flgxor muscle of the 
 
NERVES. 
 
 465 
 
 great toe and the flexor longus, and gives filaments to 
 the contiguous muscles. It then divides in such a way 
 as to furnish the two sides of the three first toes and, 
 the internal side of the fourth. 
 
 The External Plantar, (Plantaris Externus) 
 proceeds with the artery of the same name to the 
 outer edge of the foot between the flexor brevis digi- 
 torum and the flexor accessorius. It is distributed to 
 the two sides of the little toe and to the external side 
 of the fourth toe. One branch penetrates to the in- 
 terosseous muscles and to the transversalis pedis. A 
 branch of considerable size is detached near the heel 
 to the muscles and integuments connected with the 
 os calcis. 
 
PART IV. 
 
 CHAPTER I. 
 
 Of the Ligaments. 
 
 Section I. 
 
 Of the Ligaments of the Head and Spine. 
 
 Articulation of the Lower Jaw. The condyle 
 of the lower jaw is invested by a capsular ligament 
 which arises from the margin of the glenoid cavity of 
 the temporal bone, and the front edge of its tubercle, 
 and is inserted into the place where the condyle and 
 neck of the lower jaw unite. This ligament has 
 an accumulation of fibres internally and externally, 
 which gives the joint the appearance of lateral liga- 
 ments. 
 
 By cutting open the capsular ligament, we shall see 
 that a moveable cartilage is interposed between the 
 glenoid cavity and the condyle, having its upper and 
 under surfaces accommodated to the opposite articu- 
 lar surfaces of these parts. There are also two dis- 
 
HEAD AND SPINE. 
 
 467 
 
 tinct synovial membranes, one passing from the move- 
 able cartilage to the glenoid cavity, and the other from 
 the lower surface of the cartilage to the Condyle. The 
 moveable eartilage is also attached by its circumference 
 to the internal face of the capsular ligament. 
 
 The Stylo Maxillary Ligament is seen here, 
 which runs from the styloid process, to the angle of the 
 lower jaw, where it is inserted between the masseter 
 and the internal pterygoid muscles. Also a small 
 round ligament which goes from the styloid process to 
 the appendix of the os hyoides. 
 
 The Ligaments of the Spine. 
 
 There is a capsular ligament with its synovial mem- 
 brane, which surrounds on either side the superior ob- 
 lique process of the first vertebra, and is inserted into 
 the root of the corresponding condyle of the os occipitis. 
 
 A circular ligament arises from the whole superior 
 margin of the first vertebra, and is inserted into the 
 margin of the great occipital foramen. 
 
 The Occipito-Dentatum Ligament passes from the 
 point of the processus dentatus, and is inserted into 
 the anterior part of the margin of the occipital 
 foramen. 
 
468 
 
 OF THE LIGAMENTS. 
 
 The two Moderator or Lateral Ligaments, one on 
 each side, arise from the lateral margin of the proces- 
 sus dentatus; and are inserted into the corresponding 
 surfaces of the first vertebra, and into the inner margin 
 of the foramen magnum. 
 
 The Transverse Ligament subtends the cavity in 
 the first vertebra for the reception of the processus 
 dentatus. The upper edge of this ligament is fi_\ed 
 to the foramen magnum and the lower edge into the 
 root of the processus dentatus. It keeps this process 
 in its place. 
 
 On each side there is a loose capsular ligament 
 with its synovial membrane passing between the con- 
 tiguous oblique processes of the first and second ver- 
 tebrsB. 
 
 Between the bodies of all the vertebrae except the 
 first and second, a ligamento-cartilaginous matter is 
 placed, which is fixed to their bodies, and is a very 
 potent means of union. This substance is more 
 fibrous and hard externally, but near its centre it is 
 of a pulpy consistence. A horizontal cut seems to 
 demonstrate it as formed of concentric fibres, but there 
 are also many others whose course is oblique, and 
 irregular. The central pulpy part is confined by 
 the other, and also in a state of compression, it makes 
 
HEAD AND SPINE. 
 
 469 
 
 an articulation in some degree equivalent to the ball 
 and socket joint. 
 
 The Anterior Vertebral Ligament extends from the 
 second vertebra to the sacrum. It consists of longi- 
 tudinal white fibres, and is placed on the convex fore 
 part of the spine. It adheres very closely to the 
 intervertebral substance, and sends olf processes on 
 each side to fix it more securely to the bodies of the 
 vertebrae. Where much motion is admitted, as in the 
 neck and the loins, it is thinner than on the dorsal 
 vertebrae. 
 
 The Posterior Vertebral Ligament is in the spinal 
 cavity. It arises from the edge of the foramen mag- 
 num, and passes down to the sacrum on the posterior 
 surface of the bodies of all the vertebrae, adhering to 
 them and to the intervertebral substance. It is nar- 
 rower on the bodies of the vertebrae than on the inter- 
 vertebral substance. 
 
 The Yellow Ligaments; there are twenty-three 
 pairs of them. They pass between the adjoining ver- 
 tebrae; one on each side, between the spinous and ob- 
 lique process; and are best seen from the inside of the 
 vertebral cavity. The first pair passes from the bony 
 bridge of the second vertebra to that of the third, 
 and so on successively to the sacrum. They are very 
 elastic. 
 
470 
 
 OF THE LIGAMENTS. 
 
 Ligamentous fibres pass also between the spinous 
 processes, and there are others between the transverse 
 processes. 
 
 The Ligamentum Nuchse is a tendinous septum be- 
 ginning at the spinous process of the seventh cervical 
 vertebra, and running up to the occiput, where it is 
 fixed into its vertical ridge. It is connected intermedi- 
 ately to the spinous processes of all the vertebras above 
 the seventh, so that it forms a partition between the 
 muscles of the two sides of the neck. 
 
 All the Oblique Processes have their capsular and 
 synovial membranes. 
 
 Section II. 
 
 Ligaments of the Thorax. 
 
 The heads of the ribs and their tubercles are fiu’- 
 nished with capsular and synovial membranes uniting 
 them with the corresponding articular surfaces of tlie 
 vertebrae, and admitting of motion. 
 
 The Ligamenta Transversaria Interna arise from 
 
THORAX. 
 
 471 
 
 the inferior surface of each transverse process under 
 its articular face for the tubercle of the rib, and are 
 inserted into the upper margin of the neck of the rib 
 below j its fibres run obliquely inwards. The Liga- 
 menta Transversaria Externa are behind the others and 
 pass horizontally between the points of the transverse 
 processes and the upper margin of the back of the ribs; 
 beyond their tubercles, their fibres go obliquely out- 
 wards. 
 
 The Ligamenta Cervicum Costarum are concealed 
 by, and pass between the back of the neck of the rib, 
 and the front of the corresponding transverse process. 
 To be seen the rib must be sawed through in its length. 
 
 At its anterior extremity there is a cavity in the rib 
 into which the sternal cartilage fits and is there united. 
 This junction is strengthened by short ligamentous 
 fibres surrounding the part and going from the rib to 
 the cartilage. 
 
 The cartilages of the seven true ribs run into pits 
 in the sternum, and are there secured by the radiated 
 ligaments which lie in front of the joint. 
 
 The Sternum is covered, both in front and behind, 
 by a strong ligamentous expansion adhering very 
 closely to it. From the second bone of the sternum 
 and from the inferior margin of the seventh true rib, 
 
472 
 
 OF THE LIGAMENTS. 
 
 near it, ligamentous fasciculi are sent to the cartilage 
 ensiformis. 
 
 Section III. 
 
 Of the Ligaments of the Pelvis. 
 
 At the posterior part of the junction of the ilium 
 with the sacrum, several distinct ligaments are found. 
 
 The Ilio Lumbar Ligament is stretched from the 
 transverse process of the last vertebra of the loins to 
 the posterior superior spinous process of the ilium and 
 the adjoining part of the crista. It is much mixed 
 with fat. Just below this is the Ligamentum Sacro- 
 Spinosum, which is extended between the posterior 
 superior spinous process and the two or three upper- 
 most transverse processes of the sacrum. 
 
 The Sacro Iliac Ligament is an assemblage of very 
 short, strong, compact fibres, which lie on tlie back of 
 this articulation. It is connected to the sacrum by 
 its transverse processes and by the rough surface just 
 on the iliac side of them, and to the ilium by the rough 
 edge just behind its articular surface with the sacrum. 
 
PELVIS. 
 
 473 
 
 In front also tliis articulation is covered by short, strong 
 fibres. 
 
 The Os Coccygis is united to the sacrum by inter- 
 vertebral substance and also by longitudinal ligaments 
 on its front and back. The anterior ligament is not 
 very distinct, but the posterior is, as it arises from the 
 inferior margin of the spinal canal of the sacrum, and, 
 contributing to finish the canal or to close it up, is 
 then distributed on the back of the os coccygis to its 
 extremity. 
 
 The foramina, on the posterior part of the sacrum, 
 are much diminished by ligamentous fibres which pass 
 in every direction. 
 
 The Posterior Sacro Sciatic Ligament arises from 
 the inferior posterior spinous process of the ilium, 
 from the side of the sacrum which is below it, and 
 from the side of the os coccygis. Its fibres converg- 
 ing, it becomes thicker in the middle, and is inserted 
 into the ridge at the inner margin of the tuberosity of 
 the ischium, and is prolonged towards the pubes by a 
 continued attachment along the inner margin of the 
 ramus of the ischium. 
 
 The Anterior Sacro Sciatic Ligament has its origin 
 somewhat confounded with that of the posterior. It 
 arises from the side of the sacrum, below its junction 
 with the ilium, and from the upper part of the side of 
 
 3 o 
 
474 
 
 OF THE LIGAMENTS. 
 
 the os coccygis. Its course is more horizontal than 
 that of the posterior, and it is inserted into the spinous 
 process of the ischium. 
 
 The articular surfaces of the sacrum and ilium are 
 covered, each with its appropriate cartilage ; that on 
 the sacrum is somewhat thicker than the one on the 
 ilium. The contiguous surfaces of these cartilages are 
 rough, and are separated by a yellow half-fluid tena- 
 cious substance. 
 
 The Obturator Ligament closes the obturator fora- 
 men, and arises from its margin; it is defective .at the 
 superior part where the obturator vessels go out. It is 
 also frequently defective, or extremely thin below. 
 The obturator muscles arise from it. 
 
 The Ossa Pubis are joined together by a ligamento- 
 cartilaginous matter which fills up the space between 
 them. It is more fibrous externally, and is there form- 
 ed of concentric lamellse which surround the articu- 
 lation. In men there is more of this fibrous matter 
 than in women ; in the latter, one frequently finds in 
 the posterior part of the symphysis, a little flat oblong 
 cavity occasioned by a distinct plate of cartilage on 
 each bone. This cavity is moistened by a white or 
 yellowish fluid. 
 
 The Sub-Pubic Ligament is a strong tendinous 
 
UPPER EXTREMITIES. 
 
 475 
 
 membrane of half an inch in breadth, occupying the 
 very top of the arch of the pubes, and passing from one 
 bone to the other; it is spoken of in the account of the 
 fascise of the pelvis. 
 
 In front of this joint there are several other fasci- 
 culi of fibres, which get collectively the name of the 
 Anterior Pubic Ligament. 
 
 CHAPTER II. 
 
 Section I. 
 
 0/ the Ligaments of the Upper Extremities. 
 
 The Clavicle and the Sternum are very firmly united 
 from the breadth of their articulating surfaces, and by 
 the thickness of their ligaments. The Radiated Liga- 
 ment arises from the front of the internal end of the 
 clavicle, and is inserted around the margin of the cor- 
 responding part of the articular surface of the sternum. 
 The Interclavicular Ligament lies on the posterior sur- 
 face of the upper end of the sternum, and passes from 
 one clavicle to the other. 
 
476 
 
 OF THE LIGAMENTS. . 
 
 The Capsular Ligament proceeds from around fhe 
 internal end of the clavicle, and is inserted into the 
 margin of the articular surface of the sternum. By 
 cutting it open we find that there is a moveable carti- 
 lage interposed between the two bones, connected by 
 its margin with the internal surface of the capsular 
 ligament, and that on each side of this cartilage there 
 is a distinct synovial membrane. 
 
 The Costo-Clavicular, or Rhomboid Ligament, arises 
 from the cartilage of the first rib, and is inserted into 
 the tubercle on the under surface of the clavicle, near 
 the sternum. 
 
 The Scapulo-Clavicular Ligaments are two in num- 
 ber. The first is a capsular ligament with its synovial 
 membrane, which unites the acromial end of the clavi- 
 cle to the acromion process. This ligament being 
 thickened above and below, these parts are called the 
 Superior and the Inferior ligaments; occasionally a 
 moveable cartilage is found also in this joint. The 
 second ligament is the Conoidal ; its apex arises from 
 the tubercle at the root of the coracoid process, and its 
 base is inserted into the tubercle near the acromial end 
 of the clavicle. From the outer margin of the conoid, 
 a ligamentous membrane, called the Trapezoid Liga- 
 ment,. is extended to the acromial end of the clavicle. 
 
 In front of the subclavius muscle, arising from the 
 
UPPER EXTREMITIES. 
 
 477 
 
 root of the coracoid process and going to the clavickj is 
 the Ligamentum Bicorne. 
 
 The Triangular Ligament of the Scapula is extend- 
 ed over the shoulder joint. Its basis arises from the 
 upper margin of the coracoid process, and its apex 
 is fixed to the sternal margin of the acromion beneath 
 the clavicle. It is thinner in the middle than at either 
 edge. 
 
 The Coracoid Ligament of the Scapula is stretched 
 across the semilunar notch, and converts it into a 
 foramen for the vessels. 
 
 Of the Shoulder Joint. 
 
 The Scapulo-Humeral Articulation is formed by 
 the glenoid cavity of the scapula, and the head of the 
 os humeri. A capsular ligament arises from the neck 
 of the former, and is inserted into the neck of the lat- 
 ter. A fold or thickening of it called the Accessary 
 Ligament, passes from the coracoid process towards 
 the great tuberosity of the os humeri. 
 
 By cutting open the joint we see the synovial mem- 
 brane lining its cavity, and sending a process into the 
 groove of the os humeri, which is afterwards reflected 
 along the tendon of the biceps in such a way as to keep 
 its cavity entire. This tendon is connected with the 
 upper margin of the glenoid cavity, and sends on each 
 
478 
 
 OF THE LIGAMENTS. 
 
 side a fibrous part which surrounds the margin of the 
 cavity, and deepens it. 
 
 Of the Elbow Joint. 
 
 The Elbow Joint has a eapsular ligament arisiug 
 from the margin of the articular surface of the os hu- 
 meri, and inserted into the margin of the articular 
 surface of the ulna, and into the coronary ligament of 
 the radius. This capsule has additional fibres inter- 
 nally, and externally, called Lateral Ligaments, or 
 Brachio-Ulnar, and Brachio- Radial. The first arises 
 from the internal condyle, and spreads in a radiated 
 manner to be inserted into the inner side of the coro- 
 noid and olecranon process. Tlie second arises from 
 the external condyle, and is inserted into the coronary 
 ligament of the radius. 
 
 The Coronary Ligament of the Radius arises from 
 one side of the sigmoid cavity of the coronoid pro- 
 cess of the ulna, and surrounding the neck of the 
 radius it is inserted into the other side of tlie same 
 cavity. Its upper margin is blended with the capsu- 
 lar ligament, and its lower is loosely attached to the 
 root of the neck of the radius. 
 
 On the anterior and posterior surfaces of the cap- 
 sule of the elbow joint, there are small and irregular 
 fibres, termed accessary ligaments, but the capsule is 
 
UPPER EXTREMITIES. 
 
 479 
 
 particularly thin under them, in order to accommodate 
 the flexions of the joint. 
 
 By cutting open the eapsule we see the extent of 
 the synovial membrane, and the eartilaginous surfaces 
 of the bones. At the bottom of the greater sigmoid 
 cavity of the ulna, a small quantity of vascular adi- 
 pose matter is found. 
 
 The Interosseous Ligament fills up the space be- 
 tween the radius and the ulna, being fixed on each 
 side to their sharp edges. It is composed principally 
 of oblique fibres interwoven with each other, and in 
 it are several perforations for blood-vessels. One par- 
 ticularly large is just at the tubercle of the radius. 
 
 There is a small ligamentous band called the round 
 ligament, at the upper part of the opening for the in- 
 terosseous vessels, going from the base of the coronoid 
 process to the lower part of the tubercle of the radius 
 and called the round ligament. 
 
 Of the- Wrist Joint. 
 
 The Wrist Joint is formed between the lower ends 
 of the radius and ulna, and the three first bones of the 
 upper row of the carpus. A capsular ligament passes 
 from the margin of the cartilaginous surface of the 
 radius, and from the part of the same cartilage which 
 
480 
 
 OF THE LIGAMENTS. 
 
 is continued between the ulna and the cuneiform 
 bone, and is inserted into the margin of the articular 
 head formed by the scaphoid, lunar, and cuneiform 
 bones. 
 
 The External Lateral Ligament arises from the sty- 
 loid process of the radius, and is inserted into the 
 scaphoid bone. The Internal Lateral Ligament arises 
 from the styloid process of the ulna, and is inserted 
 into the inner side of the cuneiform bone, and the cor- 
 responding part of the anterior ligament, which con- 
 fines the flexor tendons. 
 
 By cutting open this articulation we see the syno- 
 vial membrane of the part, and a fold of it called the 
 Mucous Ligament, which passes from between the 
 scaphoides and lunare to the end of the radius. We 
 also see the cartilage of the radius projecting between 
 the cuneiform bone and the head of the ulna, and 
 forming with the head of the ulna, a distinct joint, sur- 
 rounded by a capsule called the Sacciform Ligament. 
 
 The Articulation between the first and the second 
 row of carpal bones is performed by a capsular liga- 
 ment which goes from the first to the second row, be- 
 ing strengthened laterally by a multiplication of its 
 fibres, constituting lateral ligaments internally and ex- 
 ternally. There are also several fasciculi of fibres 
 which run in varied directions, some oblique and some 
 
UPPER EXTREMITIES. 
 
 481 
 
 ti’ansverse, fastening the two rows together as well as 
 the individual bones of the same row. When this 
 joint is opened we find but one synovial membrane 
 for the two rows of bones where they are in contact, 
 and this membrane sends in digital processes between 
 the lateral surfaces of the several bones which are op- 
 posite to each other. 
 
 There are strong ligaments which go from the car- 
 pal to the bases of the metacarpal bones, but owing 
 to the irregular surfaces of these bones but little mo- 
 tion is allowed, although the apparatus of articulation 
 is complete with its capsular ligaments and synovial 
 membranes. The meta -arpal bone of the little finger 
 has more motion than those of the other fingers; the 
 ring-finger is next^ the middle and fore-fingers are 
 almost stationary. 
 
 The Metacarpal Bones of the fingers are connected 
 to each other at their bases by transverse ligamentous 
 fasciculi ; they are also connected at their heads in the 
 same manner. 
 
 A strong capsular ligament, with its synovial mem- 
 brane, is applied to the articulation between the tra- 
 pezium and the thumb. This capsule is of nearly an 
 uniform thickness, being very similar, in that respect, 
 to the capsule of the shoulder joint, arid, therefore, 
 admits of every variety of motion. 
 
 3 p 
 
482 
 
 OF THE LIGAMENTS. 
 
 Between the heads of the metacarpal bones and 
 the first phalanges there is a capsule and a synovial 
 membrane. The eapsule is thickened at its sides by 
 which lateral ligaments are formed. In front it has 
 a eartilaginous thickening which forms a trochlea for 
 the flexor tendon. Behind, it is thin, its principal 
 strength being derived from the tendon of the exten- 
 sor muscle. 
 
 The Phalanges are articulated in the same way with 
 each other that they are articulated with the me- 
 tacarpal bones. 
 
 CHAPTER IIL 
 Sectiox I. 
 
 Ligaments of the Inferior Extremities. 
 
 The Hip Joint is formed by the acetabulum and the 
 head and neck of the os femoris, which parts are enclos- 
 ed in a strong capsular ligament arising on the outer 
 circumference of the margin of the acetabulum, and 
 inserted into the root of the neck of the os femoris. 
 The capsular ligament varies in its thickness at different 
 
INFERIOR EXTREMITIES. 
 
 483 
 
 places; in front it is a fourth of an inch thick, inter- 
 nally it is somewhat thinner, and posteriorly where it 
 is covered by the quadratus muscle it is thinnest. The 
 surface of the ligament which looks towards the cavity 
 of the joint, is reflected somewhat at its junction with 
 the neck towards the head of the os femoris, and forms 
 regions or retinacula. From the anterior inferior 
 spinous process, accessory fibres arise, which give to 
 the capsule an increased thickness above. 
 
 By cutting open the capsule, we see that its internal 
 face, as well as the surfaces of the bones, are covered 
 by a delicate synovial membrane; that a strong liga- 
 mentous cord passes from one side of the notch in the 
 lower part of the acetabulum to the other, leaving an 
 opening below for the introduction of vessels into the 
 cavity of the articulation. 
 
 The Ligamentum Teres arises from the pit in the 
 head of the os femoris, and seems to be inserted into 
 the bottom of the acetabulum, but by dissecting the 
 synovial membrane from it, its insertion into the ex- 
 tremities of the notch of the acetabulum by a bifurcated 
 termination, and into the inferior margin of the cord, 
 subtending the noteh, will be seen. 
 
 The depth of the acetabulum is increased by the 
 cotyloid ligament, which surrounds its margin, and is 
 within the origin of the capsular ligament. A quantity 
 
484 
 
 OF THE LIGAMENTS. 
 
 of loose, vascular, adipose matter, fills up the pit in the 
 bottom of the acetabulum, and is covered by the syno- 
 vial membrane. By some anatomists it is called the 
 Gland of the Hip Joint. 
 
 Of the Knee Johit. 
 
 The Knee Joint is formed by the femur, tibia, and 
 patella. It is surrounded by an imperfect capsular 
 ligament which is very thin and loose on each side of 
 the tendon of the patella, and which is placed in con- 
 tact with the fascia of the lower extremity, where the 
 latter is continued over the knee. 
 
 The External Lateral Ligament arises from the 
 tubercle of the external condyle, and is inserted into 
 the head of the fibula. The internal lateral ligament 
 arises from the tubercle of the internal condyle, and is 
 inserted into the inner side of the head of the tibia, 
 being continued for some distance down the internal 
 side of the bone. The front of the joint is much strength- 
 ened by the ligament which passes from the point of 
 the patella to the tubercle of the tibia. On the poste- 
 rior face of the capsular ligament is found an irregular 
 collection of fibres passing obliquely from the upper 
 back part of the external condyle, to be inserted into 
 the back of the head of the tibia; these constitute the 
 Ligament of Winslow. 
 
INFERIOR EXTREMITIES. 
 
 485 
 
 By opening the joint in front, so as to let the pa- 
 tella fall upon the tibia, a good view of its internal, 
 arrangement may be obtained. The synovial mem- 
 brane will be seen arising from the cartilaginous mar- 
 gin of the head of the tibia, and around that of the 
 patella ; but it is reflected on the front and sides of the 
 condyles of the os femoris half an inch or more above 
 the margin of its cartilaginous surface. On both sides 
 of the ligament of the patella, and between it and the 
 synovial membrane, a large mass of fat is found filling 
 up the vacuity between the condyles and the head of 
 the tibia. This fat projects into the cavity of the 
 articulation, and forms on each side of the patella an 
 oblong ridge covered by the synovial membrane. It 
 is called, on the outside of the patella, the Ligamentum 
 Alare Minus, and on its inside, the Ligamentum Alare 
 Majus. These ligaments terminate each in a point be- 
 low the patella where they are in contact with each 
 other; and from this place a duplicature of synovial 
 membrane, ending on the crucial ligaments, and on the 
 os femoris between its condyles, is extended to the 
 posterior part of the articulation. 
 
 At the posterior part of the joint, are fixed the 
 Crucial ligaments, two in number, the Anterior and the 
 Posterior. The first arises from the internal face of 
 the external condyle, and is inserted in front of the 
 ridge on the top of the tibia, its fibres being partially 
 blended with those of the semilunar cartilages. The 
 
486 
 
 OF THE LIGAMENTS. 
 
 Posterior arises from the external face of the internal 
 condyle of the os femoris, and is inserted into the head 
 of the tibia behind the ridge on its top, some of its 
 fibres being blended with the external semilunar car- 
 tilage. These ligaments are exterior to the synovial 
 membrane. 
 
 The Semilunar Cartilages, two in number, are 
 placed between the tibia and the os femoris; to see 
 them well the last bone must be removed, lea\ing them 
 on the tibia. They are thick at their exterior cir- 
 cumference and are brought to a thin edge internally ; 
 are fastened to the capsular ligament by their outer 
 margin, but the internal is loose ; their upper and 
 under surfaces are covered by the synovial mem- 
 brane. The internal is longer from before backwards 
 than transversely, it is therefore nearly semi-circular; 
 the external is almost circular, in each of which cases 
 they exactly conform to the corresponding articular 
 surface of the tibia. The posterior end of both of 
 these cartilages is fixed to the tibia between the spine 
 on its top, and the posterior crucial ligament; their 
 anterior ends are inserted into the tibia before the 
 same spine. Occasionally a transverse ligamentous 
 band is seen to unite their anterior extremities. 
 
 The height to which the synovial membrane ascends 
 above the patella, should be noticed by the student, as 
 well as a large bursa just behind the tendon of the ex- 
 
INFERIOR EXTREMITIES. 
 
 487 
 
 tensor muscles, which, most commonly communicates 
 with the joint. 
 
 Of the Peroneo-Tihial Articulation. 
 
 The head of the fibula, where it is united to the 
 tibia, has all the apparatus of a moveable joint. The 
 capsular ligament is thickened in front and behind, 
 which occasions the names of Anterior and Posterior 
 Ligaments. But this joint is particularly sti'ength- 
 ened by the insertion of the external lateral ligament 
 of the knee and by the tendon of the biceps muscle. 
 
 The Interosseous Ligament fills the interstice be- 
 tween the two bones. It is attached to the interosseous 
 ridges which lie on their opposing surfaces and runs 
 the greater part of their length. It consists of oblique 
 fibres going from one bone to the other, and forming a 
 thin strong membrane. Just below the head of the 
 tibia it is perforated by a large foramen which trans- 
 mits the tibialis posticus muscle and the anterior tibial 
 artery and vein; near the ancle joint it is perforated 
 also by the fibular artery. 
 
 The Tibia and Fibula are united at the ancle joint 
 by triangular surfaces, concave on the part of the tibia, 
 and convex on the part of the fibula. These surfaces 
 are held together by intermediate ligamentous matter, 
 
488 
 
 OF THE LIGAMENTS. 
 
 as well as a ligament expanded on the front and 
 back of the junction called the Anterior and the Pos- 
 terior Ligaments. The cartilaginous crust, on the 
 ends of the tibia and the fibula, belonging to the ancle 
 joint, are continued for a line or two, on the opposed 
 surfaces of the tibia and the fibula. 
 
 Of the Ancle Joint. 
 
 The Ancle Joint is formed by the tibia, fibula, and 
 astragalus. The capsular ligament is extremely thin, 
 and, indeed, has no very evident existence before and 
 behind; the fatty matter which surrounds the joint, is 
 in immediate contact with the synovial membrane, and 
 protrudes it in some places, inwards, towards the ca- 
 vity of the articulation. 
 
 There are very strong lateral ligaments on both 
 sides. The Deltoid arises from the inferior extremity 
 of the malleolar process of the tibia, and by radiating 
 considerably, is inserted into the internal side of the 
 os calcis, and astragalus. The ligaments on the exter- 
 nal side of the ancle are divisible into three fasciculi. 
 The Anterior arises from the anterior part of the end 
 of the malleolus externus, and passes obliquely for- 
 wards to be inserted into the upper and outer part of 
 the astragalus. The Middle Ligament, or Fasciculus, 
 arises from the extremity of the fibula, and descends 
 perpendicularly to be inserted into the outside of the 
 
INFERIOR EXTREMITIES. 
 
 489 
 
 os calcis. The Posterior Ligament comes from the 
 back of the extremity of the malleolus externus, and 
 passes very obliquely to be inserted into the outer back 
 part of the astragalus. 
 
 On cutting open this joint, it will be seen that the 
 synovial membrane is connected to the several bones at 
 the margins of the cartilaginous articular surfaces. 
 
 Ligaments of the Foot. 
 
 The os calcis and the astragalus are united by liga- 
 ments investing their articulating surfaces; the syno- 
 vial capsule belonging to their posterior surface is in- 
 sulated, but the anterior is extended into that which 
 unites the os astragalus and the naviculare. Between 
 the two bones there is a very strong ligament arising 
 from the fossa of one to be inserted into the fossa of the 
 other ; it is their strongest means of union. 
 
 The Naviculare and the Astragalus are united by 
 a capsular ligament with its synovial membrane. This 
 capsule is thickened by additional slips above and in- 
 ternally ; the whole arrangement of the joint is such as 
 to admit of much motion. 
 
 The Os Calcis and Cuboides, besides their capsular 
 ligament and synovial membrane, have an acces- 
 
 3 Q 
 
490 
 
 OF THE LIGAMENTS. 
 
 sion of fibres called Superior, Lateral, and Inferior 
 Ligaments. 
 
 A very strong ligament passes from the anterior in- 
 ternal part of the os calcis, and is fixed into the tuber- 
 cle on the under surface of the scaphoides. This li- 
 gament supports the astragalus. 
 
 There are many other strong ligaments connecting 
 the bones of the tarsus together; their course is varied 
 and complicated. Besides which there are capsular 
 and synovial membranes to the several opposed articu- 
 lar surfaces of hones. 
 
 The Ligaments of the Metatarsus and of the Pha- 
 langes correspond so nearly with those of the meta- 
 carpus and the phalanges of the fingers, that the 
 reader is referred to the account of the Ligaments of 
 the Hand. 
 
PART V. 
 
 Of the Skin, Hair, JStails, and Sebaceous Organs. 
 
 CHAPTER I. 
 
 Of the Skin. 
 
 The Skia consists of Cuticle, Corpus Mucosum, and 
 the Cutis Vera. These parts are easily separated from 
 each other by maceratioii ; and by boiling or immersion 
 into hot water for a few minutes, and immediately 
 afterwards throwing the part, thus heated, into cold 
 water. Vesicatories also, applied to the living body, 
 cause the cuticle to detach itself from the parts below. 
 
 The Cuticle is a very thin semitransparent mem- 
 brane, distributed over almost the whole surface 
 of the body. In some parts it is from birth much 
 thicker than in others, as in the palms of the hands and 
 the soles of the feet, and from friction and pressure in 
 after life, it increases further in its proportionate thick- 
 
492 
 
 OF THE SKIN. 
 
 ness. The cuticle presents every where, but more 
 obviously in the hands and feet, a multitude of fur- 
 rows caused by the surface of the cutis vera, and which 
 are arranged in straight, curved, or spiral lines. It 
 adheres by filaments to the cutis vera, and is perforat- 
 ed by the exhalent or perspiring pores, by the ex- 
 cretory ducts of the sebaceous glands, by the hairs, 
 and according to some anatomists by the origin of ab- 
 sorbent vessels. These perforations are best seen on 
 the nose, ears, external parts of generation, the palms 
 of the hands, and the soles of the feet. From the in- 
 ternal surface of the cuticle processes are sent in, 
 which line the difierent foramina of the cutis vera. 
 When the cuticle is raised by a blister these processes 
 become collapsed, by which their sides are approxi- 
 mated, and the fluid effused beneath is prevented from 
 escaping. 
 
 The cuticle has but little elasticity, no vascularity, 
 and no sensibility. Its use seems to be to diminish 
 evaporation from the surface of the body, and to shield 
 the pulpy terminations of the nerves of the cutis vera. 
 
 The Corpus, or Rete Mucosum, is the second layer 
 of the skin, and on it depends the great variety of 
 colours observed in the human species. It covers 
 every part of the cutis vera except under the nails. ^ 
 
 * It is probable, however, that it exists even there, but it is not 
 so obvious as elsewhere. 
 
OF THE SEIN. 
 
 493 
 
 Its consistence is mucilaginous, from which its name is 
 derived. 
 
 Mr. Gaultier states that on^ the soles of the feet in 
 negroes, the corpus mucosum is seen to he disposed in 
 the following manner : 1st. On the inequalities of the 
 cutis vera, next to its papillae, there is a layer, which 
 he calls bloody pimples, (bourgeons sanguins) but 
 which, in the opinion of other anatomists, are only the 
 papillae of the cutis vera. 2d. Next to them is a 
 layer, called Albida Profunda, on account of its con- 
 stant colour and situation. 3d. Then small points, 
 constituting a layer, placed over the last, of a very 
 dark brown, in negroes, which he calls Gemmula. And 
 4th, a layer adjacent to the cuticle, spread over the 
 last, and called Albida Superficialis, also, from its 
 colour and position. 
 
 In cutting through the skin, from the heel to the 
 toes, at right angles to its furrows, in negroes, this 
 arrangement may be readily recognized. And in cases 
 where it has been rendered indistinct from sickness 
 it may be improved by immersing the skin for three 
 or four days in lime water, a solution of potash or 
 barytes, and afterwards keeping it the same length of 
 time in a solution of corrosive sublimate. 
 
 Mai’jolin Man. d’Anat. vol. ii. p. 587. Bichat Anat. Gen. 
 Paris, 1818, vol. ii.p. 703. 
 
494 
 
 OF THE SKIN. 
 
 The existence of this arrangement of the corpus 
 mucosum may be established in other parts of the body 
 by the elfects of blisters. The fluids being thus 
 locally attracted, infiltrate the corpus mucosum and 
 separate its layers, in part, in order to form a vesicle, 
 frequently very thick, particularly in fat persons. 
 
 The Cutis Vera gives a covering to the whole body. 
 It consists of fibres variously blended and running in 
 every direction. Its blood-vessels and nerves are so 
 numerous that the prick of the finest needle in any 
 part will occasion pain and produce blood. Its inte- 
 rior surface is in close connexion with the subjacent 
 cellular and adipose membrane, from which it may be 
 imperfectly separated by dissection.* The cutis vera 
 is extremely elastic. Its thickness varies; on the back, 
 on the soles of the feet, and on the palms of the hands 
 it is thicker than elsewhere. On the lips and on the 
 margin of the anus it is very thin. 
 
 The cutis vera, on its external face, is divided by 
 numerous lines running in different directions. When 
 the cuticle is removed, this surface is seen to be stud- 
 ded with papillm which are extremely sensitive and 
 vascular, and which as mentioned, are, by some, consid- 
 ered as the same with the projections termed Bour- 
 geons Sanguins, by Mr. Gaultier, though he views the 
 
 * Maceration is a mnch more complete way of effecting this 
 separation. 
 
OF THE HAIR. 
 
 495 
 
 latter as the first layer of the rete raucosuin and the 
 papillae as entirely distinct. They are very obvious 
 on the palms of the hands and on the soles of the feet, 
 where they are arranged in double rows on the ridges 
 of the cutis vera. 
 
 CHAPTER II. 
 
 Of the Hair. 
 
 The Hair grows in the cellular membrane beneath 
 the skin. It is best studied on the mustachios of the lar- 
 ger animals, as the horse, ox, and so on. Around the 
 root of each hair there are two capsules, one within 
 the other. The internal is very vascular, and the 
 blood reaches it, not from the bottom, but near the sur- 
 face of the cutis. In the root of the hair there is a 
 hollow canal filled with a pulpy substance. 
 
496 OF THE SEBACEOUS ORGANS. 
 
 CHAPTER III. 
 
 Of the jVails. 
 
 The Nails are fibrous, a continuation of the cuticle, 
 but are indebted for their growth to their adhering by 
 their roots and under surface, to the cutis vera. If 
 they are torn off by pincei’s or separated, by macera- 
 tion, their form and origin may be readily seen. 
 
 CHAPTER 1\. 
 
 Of the Sebaceous Organs. 
 
 They consist of follicles and glands. The follicles 
 are placed around the roots of the hair in the interior 
 of the capsules. They secrete an unctuous fluid 
 which, by inspissation, becomes of the consistence of 
 suet. Being seated under the skin they are more 
 abundant in some parts than in others, as, for exam- 
 ple, in the nose, ears, groins, and external parts of 
 generation. 
 
 The Sebaceous Glands are about the size of millet 
 seeds, and are placed also under the cutis vera. They 
 are particularly numerous under the skin of the mons 
 
 veneris. 
 
INDEX 
 
 Abbomejt, 
 
 Page 
 
 189 
 
 muscles of. 
 
 190 
 
 contents of, 
 
 218 
 
 Accessory Nerve, 
 
 109 
 
 Adductors of Thigh, 
 
 414 
 
 Adductor Oculi, 
 
 113 
 
 Ankle Joint, 
 
 448 
 
 Aorta, 
 
 178 
 
 Aponeurosis Pelvica, 
 
 288 
 
 Aqueduct of Ear, 
 
 137 
 
 Articular Arteries, 
 
 446 
 
 Arm, Muscles of. 
 
 359 
 
 Arteries of. 
 
 387 
 
 Arteries of Neck and Head 
 
 29 
 
 Arbor Vitae, 
 
 62 
 
 Auditory Nerve, 
 
 105 
 
 Auricular Artery, 
 
 32 
 
 Back, Muscles of. 
 
 339 
 
 Biceps Flexor Cubiti, 
 
 -358 
 
 Bladder, 
 
 262 
 
 Brain, 
 
 50 
 
 Blood vessels ofv 
 
 74 
 
 Brachial Artery, 
 
 383 
 
 Bronchia, 
 
 • 182 
 
 Bronchial Glands, 
 
 184 
 
 Bronchial Arteries, 
 
 325 
 
 Buccinator, 
 
 8 
 
 Carotid Arteries, . 29, 30, 35 
 
 Cava Ascendens, 
 
 335 
 
 Carunculae Myrtiformes, 
 
 303 
 
 Cardiac Nerves, 
 
 317 
 
 Cervical Artery, 
 
 36 
 
 Cervical Nerves, 
 
 48 
 
 Cervicalis Descendens, 
 
 340 
 
 Cerebrum, 
 
 54 
 
 Cerebellum, 
 
 61, 80 
 
 Choroides, 
 
 119 
 
 Chorda Tympani, 
 
 139 
 
 Ciliary Ligament, . 
 
 121 
 
 Ciliaris, 
 
 4 
 
 Circumflex Iliac Arteries, 
 
 336 
 
 Circumflex Art. of Arm, 
 
 385 
 
 Clavicle, Articulation of. 
 
 476 
 
 Clitoris, 
 
 297 
 
 Coeliac Artery, 
 
 Page 
 . 326 
 
 Commissures of Brain, 
 
 83, 59, 88 
 
 Compressor Naris, 
 
 89, 90, 91 
 
 <r> 
 
 • 
 
 Complexus, 
 
 
 348 
 
 Convolutions of Brain, 
 
 
 94 
 
 Coronary Arteries, 
 
 
 179 
 
 Veins, 
 
 
 179 
 
 Cornea, 
 
 
 118 
 
 Corpus Callosum, . 
 
 
 56 
 
 Corpus Cavernosum, 
 
 
 269 
 
 Corpus Spongiosum, 
 
 
 270 
 
 Corpusculum Arantii, 
 
 
 175 
 
 Corrugator Supercilii, 
 
 
 5 
 
 Cremaster, 
 
 
 198 
 
 Crural Nerves, 
 
 
 457 
 
 Crural Arch, 
 
 
 215 
 
 Crural Ring, 
 
 
 215 
 
 Cutaneus Internus, 
 
 
 399 
 
 Cutaneous Nerves of Thigh, 
 
 ■455 
 
 Dartos, 
 
 
 275 
 
 Deltoides, 
 
 
 355 
 
 Depressor Lab. Sup.Alseque 
 Nasi, . . ... 
 
 6 
 
 Depressor Anguli Oris, 
 
 
 7 
 
 Depressor Labii Infer, 
 
 
 7 
 
 Digastricus, 
 
 
 16 
 
 Diaphragm, 
 
 
 253 
 
 Dura Mater, , 
 
 • 
 
 51 
 
 Ear, 
 
 
 127 
 
 Elbow Joint, 
 
 
 478 
 
 Emulgent Arteries, 
 
 
 328 
 
 Epididymis, 
 
 * 
 
 279 
 
 Epigastric Artery, . 
 
 209, 
 
 334 
 
 Epiglottis, 
 
 , 
 
 160 
 
 Extremities Upper, 
 
 
 353 
 
 Extremity Upper, Arteries of. 
 
 382 
 
 Extensor Muscles of Fore Arm, 
 
 369 
 
 Eye, 
 
 Thumb, 
 
 373 
 
 no 
 
 Muscles of. 
 
 no, 
 
 112 
 
 Eyelids, 
 
 
 111 
 
 Eye Ball, 
 
 
 117 
 
498 INDEX. 
 
 
 
 Page 
 
 Fascia Superf. Cervicis, 
 
 
 10 
 
 Profunda, 
 
 
 12 
 
 Sujjerf. Abdom. 
 
 
 201 
 
 Traiisversalis, 
 
 
 206 
 
 Femoris, 
 
 
 211 
 
 Iliaca 
 
 
 212 
 
 of Upper Extr. 
 
 
 353 
 
 of Lower Extr. 
 
 
 406 
 
 Plantaris, 
 
 
 432 
 
 Facial Artery, 
 
 
 31 
 
 Fallopian Tubes, 
 
 
 307 
 
 Fauces, 
 
 
 147 
 
 Femoral Sheath, 
 
 
 216 
 
 Arteries, . 
 
 
 440 
 
 Hernia, 
 
 
 . 210 
 
 Flexors of Fore Arm, 
 
 
 >363 
 
 Foramen of Winslow, 
 
 
 225 
 
 Fourchette, 
 
 
 299 
 
 Foot, Arteries of, . 
 
 
 451 
 
 Muscles of. 
 
 
 451 
 
 Ligaments of, 
 
 
 489 
 
 Hair, 
 
 
 495 
 
 Hand, Arteries of, . 
 
 
 393 
 
 Muscles of, . 
 
 
 375 
 
 Articulations of. 
 
 
 481 
 
 Hamstring Muscles, 
 
 
 420 
 
 Heart, 
 
 
 170 
 
 Head and Neck, 
 
 
 1 
 
 Hepatic Duct, 
 
 
 241 
 
 Hip Joint, 
 
 
 482 
 
 Hyo-Glossus, 
 
 
 19 
 
 Hypoglossal Nerve, 
 
 
 43, 70 
 
 Hyoides, 
 
 
 153 
 
 Hymen, 
 
 
 300 
 
 Humours of Eye, 
 
 122, 124 
 
 lliacus Internus, 
 
 
 258 
 
 Iliac Arteries, 
 
 
 330, 33 
 
 Intestinal Canal, 
 
 
 23 
 
 Internal Maxillary Artery, 
 
 
 33 
 
 Infundibulum, 
 
 
 65 
 
 Intercostal Muscles, 
 
 
 165 
 
 Arteries, 
 
 
 325 
 
 Inguinal Hernia, 
 
 
 201 
 
 Interspinules, 
 
 
 351 
 
 Intertransversarii, . 
 
 
 351 
 
 Intercosto Hunier.al Nerves 
 
 > 
 
 404 
 
 Inferior I'hyroid Artery, 
 
 
 35 
 
 Interpubic Ligament, 
 
 
 287 
 
 Intercostal Artery, Superior 
 
 325 
 
 Interosseal Artery, 
 
 
 391 
 
 Irfs, 
 
 
 120 
 
 Jugular Veins, 
 
 
 36 
 
 Page 
 
 Kidmes, 
 
 247 
 
 Knee Joint, 
 
 484 
 
 Labia Externa, 
 
 296 
 
 Labyrinth, . 
 
 134 
 
 Lachrymal Gland, . 
 
 112 
 
 Lachrymal Ducts, . 
 
 111 
 
 Sac, 
 
 112 
 
 Larynx, 
 
 153 
 
 Cartilages of, . • 
 
 154 
 
 Muscles of. 
 
 158 
 
 Laryngeal Nerve, . 
 
 45 
 
 Lateral Ventricles, 
 
 57 
 
 Latissimus Dorsi, 
 
 341 
 
 Lungs, , 
 
 180 
 
 Leg, Muscles of. 
 
 422 
 
 Nerves of. 
 
 463 
 
 Lenticular Ganglion, 
 Levator Labii Slip. Alsque 
 
 127 
 
 Nasi, 
 
 5 
 
 Levator Anguli Oris, 
 
 5 
 
 Levator Scapula:, 
 
 343 
 
 Ani, 
 
 291 
 
 Levatores Costarum, 
 
 352 
 
 Lingualis Musculus, 
 
 19 
 
 Lingual Artery, 
 
 30 
 
 Ligaments, 
 
 456 
 
 of Jaw, 
 
 466 • 
 
 Spine, 
 
 467 
 
 Thorax, 
 
 470 
 
 Pelvis, 
 
 472 
 
 Upper Extremity, 
 
 475 
 
 Lower Extremity, 
 
 482 
 
 Liver, 
 
 Blood vessels of. 
 
 235 
 
 238 
 
 Longus Colli, 
 
 19 
 
 Longissinius Dorsi, 
 
 345 
 
 Lower Extremity, Muscles of. 
 
 409 
 
 Arteries of. 
 
 440 
 
 Lower Extremity, Nerves of. 
 
 454 
 
 Veins of. 
 
 452 
 
 Lumbar Arteries, 
 Lymphatics of Neck, 
 
 329 
 
 28 
 
 Mammary Artery, . 384, 
 
 324 
 
 Masseter, 
 
 9 
 
 Mammie, 
 
 309 
 
 Medulla Oblongata, 6f 
 
 , 79 
 
 Mediaslina, . 168, 
 
 ISO 
 
 Mesentery, 
 
 226: 
 
 Mesocolon, 
 
 227 
 
 Mesenteric Arteries, 327, 
 
 329 
 
 Median Nerve, 
 
 401 
 
 Slotores Extern!, . 
 
 68 
 

 * 
 
 , -x; ' • 
 
 
 
 INDEX. 
 
 4998 
 
 
 Page 
 
 
 Page '7^ 
 
 Mouth 
 
 144 
 
 Platysma Myoides 
 
 11 
 
 Multifidus Spihae ■ . . 
 
 349 
 
 Pleura 
 
 167 
 
 Musculo Cutaneus N. 
 
 400 
 
 Plexus Axillary 
 
 49 
 
 Mylo Hyoideus 
 
 18 
 
 Solar 
 
 ■ 321 ,-m 
 
 
 
 Lumbalis 
 
 454 . 
 
 Nails 
 
 ■ 496 
 
 Ischiadicus 
 
 458 ' 
 
 Nose 
 
 140 
 
 Pons Varolii 
 
 63 
 
 Nerves of. 
 
 143 
 
 Popliteal Artery 
 
 ‘445 V 
 
 Nymph^e . . 
 
 298 
 
 Portio Dura N. 
 
 . 38, 69 ;■ 
 
 
 
 Mollis N. 
 
 138, 139 
 
 Obturator Muscles 
 
 419 
 
 frostate Gland 
 
 266 
 
 Occipito Frontalis i 
 
 2 
 
 Psoas Parvus 
 
 257 ■ 
 
 Obliquus Esternus 
 
 192 
 
 Magnus 
 
 . 257 
 
 Internus 
 
 194 
 
 Pterygoideus Externus 
 
 . 22 
 
 Capitis 
 
 351 
 
 Internus 
 
 22 
 
 Occipital Artery 
 
 31 
 
 Pulmonary Artery 
 
 175 > 
 
 (Esophagus 
 
 151 
 
 Pubic Ligament 
 
 200 
 
 (Esophageal Artery 
 
 325 
 
 Pyramidalis 
 
 197 
 
 Olfactory Nerve 
 
 66, 142 
 
 
 
 Omenta . . 224, 226 
 
 Quadratus Lumborum 
 
 259 •• 
 
 Orho Hyoideus 
 
 16 
 
 
 
 Orbicularis Oris 
 
 8 
 
 Radial Artery 
 
 388 •. 
 
 Orbicularis Palpebrarum 
 
 4 
 
 Nerve 
 
 400 
 
 Orbit, Vessels and Nerves of, 125 
 
 Rectus Femoris 
 
 410 
 
 Optic Nerve 
 
 66 
 
 Rectus Abdominis 
 
 196 
 
 Os Tines 
 
 305 
 
 Rectvis Capitis 
 
 20, 350 
 
 Ovaries . . ■ ■ 
 
 307 
 
 Rectum 
 
 261 
 
 
 
 Renal Capsules 
 
 251 
 
 Pancreas 
 
 245 
 
 Retina 
 
 121 
 
 Palate, Soft 
 
 147 
 
 Rhomboideus 
 
 343 
 
 Muscles of . ■ 
 
 148 
 
 
 
 Papills of Tongue 
 
 145 
 
 Sacro Lumbalis 
 
 345 
 
 Parotid Gland 
 
 24 
 
 Sartorius 
 
 409 
 
 Par Vagum Nerve 
 
 315 
 
 Saphena Vein 
 
 . - 452 
 
 Par Vagum . ,, 
 
 45 
 
 Scaleni Muscles 
 
 2 
 
 Pectoralis Major 
 
 163 
 
 Scapula, Muscles of 
 
 356 
 
 Minor 
 
 164 
 
 Scapular Artei-ies . 
 
 385 
 
 Pelvis Male 
 
 260 
 
 Sciatic Nerve 
 
 461 
 
 Female 
 
 295 
 
 Sclerotica 
 
 118 
 
 Pelvis Arteries of . 
 
 331 
 
 Scrotum 
 
 275 
 
 Penis 
 
 268 
 
 Sebaceous Glands 
 
 496. 
 
 Pericardium 
 
 169 
 
 Semi-spinalis Colli 
 
 348 
 
 Peritoneum 
 
 222 
 
 Dorsi 
 
 349 
 
 Perineum . 281, 285, 292 
 
 Seminal Vesicles 
 
 267 
 
 Muscles of 
 
 282 
 
 Serratus Major 
 
 165 
 
 Peroneal Artery , . 
 
 449 
 
 Serrati Postici 
 
 342, 343 
 
 Peroneo-Tibial Articulation 
 
 487 
 
 Shoulder, Articulations of 
 
 475 
 
 Pharynx 
 
 149 
 
 Skin 
 
 491 
 
 Pharyngeal Artery 
 
 31 
 
 Spermatic Cord 
 
 280 
 
 Phrenic Nerve 
 
 48, 314 
 
 Spermatic Artery 
 
 328 
 
 Artery 
 
 326 
 
 Spleen 
 
 . ■ 242 
 
 Pia Mater 
 
 54 
 
 Sphincter Ani 
 
 284 1 
 
 Pineal Gland 
 
 60, 93 
 
 Vagins 
 
 302 . 
 
 1’ituitary Gland 
 
 65, 93 
 
 Spinal Marrotv 
 
 71, 77 
 
500 
 
 INDEX. 
 
 Spinalis Dorsi 
 Splanchnic Nerve 
 Splenius 
 
 Sterno-Cleido Mastoideus 
 Sterno Hyoideus 
 
 Thyroideus 
 
 Stomach 
 
 Stylo-Glossus 
 
 Hyoideus 
 Pharyngeus 
 Subclavius 
 Subclavian Artery 
 Submaxillary Gland 
 Sublingual Gland 
 Sympathetic Nerve 46, 
 
 Temporal Artery 
 Temporal Muscle 
 Tensor Tarsi 
 Tensor Femoris 
 Testicles 
 
 Coats of 
 Third Nerves 
 Thigh, Muscles of . 
 
 Arteries of . 
 Thorax 
 
 Muscles of 
 Thorax, Viscera of 
 Thoracic Duct 
 Thymus Gland 
 Thyreo Hyoideus 
 Thyroid Gland 
 Artery 
 Veins 
 Tibial Artery 
 Tongue 
 Trachea 
 
 Trachelo Mastoideus 
 
 Page 
 
 
 Page 
 
 346 
 
 Transversalis Cervicis 
 
 347 
 
 321 
 
 Abdominis 
 
 196 
 
 344 
 
 Perinei 
 
 283 
 
 12 
 
 Trapezius 
 
 339 
 
 15 
 
 I'riangular Ligament 
 
 285, 292 
 
 15 
 
 Triangularis Sterni 
 
 165 
 
 227 
 
 Trigeminus Nerve 
 
 . 39,68 
 
 17 
 
 Trochleares 
 
 67 
 
 17 
 
 Trunk, Nerves and Vessels of 314 
 
 17 
 
 Veins of 
 
 335 
 
 163 
 
 Tunica Arachnoidea 
 
 . 53 
 
 324 
 
 Tympanum . 
 
 130 
 
 26 
 
 Bones of 
 
 132 
 
 27 
 
 Muscles of 
 
 133 
 
 317 , 323 
 
 • 
 
 
 
 Ulnar Artery 
 
 390 
 
 . 33 
 
 Nerve 
 
 403 
 
 9 
 
 Upper Extremity 
 
 353 
 
 114 
 
 Arteries of ’ 
 
 382 
 
 4ip 
 
 Veins of 
 
 394 
 
 275 
 
 Nerves of 
 
 397 
 
 277 
 
 Ureters 
 
 250 
 
 67 
 
 Urethra of Male 
 
 271 
 
 409 
 
 of Female 
 
 299 
 
 440 
 
 163 
 
 Uterus 
 
 303 
 
 163 
 
 Vagina 
 
 300 
 
 165 
 
 Valve of Brain 
 
 61 
 
 , 337 
 
 of Bauhin 
 
 234 
 
 185 
 
 Vasti 
 
 411 
 
 16 
 
 Vas Deferens 
 
 278 
 
 23 
 
 Vertebral Arteries 
 
 35 
 
 30 
 
 Vestibulum 
 
 298 
 
 37 
 
 Vulva 
 
 296 
 
 447^444 
 
 144 
 
 Wrist Joint 
 
 479 
 
 182 
 
 Zygomaticus Major 
 
 6 
 
 347 
 
 Minor 
 
 6 
 
/i 
 
 L, 
 
 1 V 
 
 
 ■■ - 
 
 0 
 
 *jSf* : 1 
 
 
 ml 
 
 ■'jjHorner ■ 
 
 : 1827