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LESSONS
M*
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THE USE OF DISSECTORS.
Br W. E. HORNER, M. D.
ADJUNCT PROFESSOR OF ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA, ONE
      OF THE SURGEONS OF THE PHILADEIPHIA AXMS-HOUSE, &C.
SECOND EDITION.
           PHILADELPHIA:
H. C. CAREY & I.  LEA—CHESNUT STREET.
1837-
f 

Eastern District of Pennsylvania, to wit:
***«*#*** BE IT REMEMBERED, That on the twenty-sixth day of June, in
J seal, t the forty-seventh year of the Independence of the United States of
********* America, A. D. 1823, William E. Horner, M. D. of the said District,
hath deposited in this Office the title of a Book, the fight whereof he claims
as author in the words following, to wit:
" Lessons in Practical Anatomy, for the Use of Dissectors.   By TV. 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 entitied ' An act for the encouragement of  learning, by
securing the copies of maps, charts, 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 historical and
other prints."
                        (Signed)                D. CALDWELL,
                            Clerk of the Eastern District of Pennsylvania. 
TO
          PHILIP S. PHYSICK, M. D.
S ROFESSOR 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. 
 
CONTENTS.
                                                         Page
Preface,      .--.„-      -     vij
Introduction—On Dissecting, and on the method of making Ana-
  tomical Preparations,        -            -     -     -    xv

                          PART I.
Of the Head and Neck,                                     1
Chap. I. External Parts ofthe Head and Neck,       -      -    1
      Sect. I. Ofthe Muscles and Fasciseofthe Head and Neck,     2
           II. Ofthe Glands ofthe Head and Neck,     -    -    23
           III.  Ofthe Blood vessels ofthe Neck and Head, -    29
           IV.  Of the Nerves ofthe Head and Neck,    -    -    38
Chap. II. Ofthe Internal Parts ofthe Head and Neck,           50
      Sect. I. Of the Brain and Spinal Marrow,                 50
           II. Of the Brain and  Spinal Marrow according to
                  Gall and Spurzheim,    _    -     -    -    70
           III.  Ofthe Eye,.......110
           IV.  Ofthe Ear,.......127
           V. Ofthe Nose,.......140
           VI.  Ofthe Mouth,......144
           VII.  Ofthe Pharynx and Oesophagus,  -     -    -    149
           VIII.  Of the Larynx,  ---_---    153

                          PART II.
Of the Trunk,        -     -      -      -     -   ,   -    163
Chap. I. Of the Thorax,.....163
      Sect. I. Of the Muscles in front, and on the side6 of the
                  Thorax,       -     -      -      -      163
           II. Ofthe Viscera ofthe Thorax,      -      -      166
Chap. II. Ofthe Abdomen,        -      -      -      -      189
      Sect. I. Ofthe Muscles ofthe Abdomen,    -      -      190
           II. Of the Parts concerned in Inguinal Hernia,       201
           III. Ofthe Parts concerned in Femoral Hernia,       209
           IV.  Ofthe Contents ofthe Abdomen,  -      -      218
           V. Ofthe Diaphragm, &c.           -      -      255 
 vi                     CONTENTS.
                                                           Page
 Chap. III.  Ofthe Male Pelvis,      ...      -       260
      Sect. I. Ofthe Viscera ofthe Male Pelvis,   -      -      261
           II.  Of the  Perineum and the Fascise  of the Male
                  Pelvis,  -      -      -      -      -      281
 Chap. IV.  Ofthe Organs in the Female, for the Generation and
              Nourishment ofthe Infant,         -      -      295
      Sect. I. Ofthe Female Pelvis,      ...      295
           II. Ofthe Female Mammae,                        300
 Chap. V. Ofthe Nerves and Vessels ofthe Trunk,  -       -      314
      Sect. I.  Ofthe Nerves,      ....      314
           II. Ofthe Blood vessels,      -      -      -      323
           III. Ofthe Thoracic Duct,                         336
 Chap. VI.  Of the Muscles of the Back,                         338
                          PART III.
 Of the Extremities,
 Chap. I. Ofthe Upper Extremities,
      Sect. I.  Ofthe Fascia,
          II. III. Of the Muscles,
             IV.  Ofthe Blood vessels,
             V. Ofthe Nerves,
 Chap. II. Of the Lower Extremities,
      Sect. I.  Ofthe Fascia,
           II. Of the Muscles,
           III. Ofthe Blood vessels,
           IV. Ofthe Nerves,
                          PART IV.
 Of the  Ligaments,
 Chap. I. Ligaments of Trunk,
Sect. I.  Ligaments of Head and  Spine,
      II. Ligaments of Thorax,
      III.  Ligaments of Pelvis,
 Chap. II. Ligaments ofthe Upper Extremities,
      HI.  Ligaments ofthe Inferior Extremities,
                           PART V.
Of the  Integuments,
 Chap. I. Skin,
      II. Hair,
      III.  Nails,
      IV.  Sebaceous Organs,
Index,      ....
353
353
353
354
382
397
406
406
409
440
454
466
466
466
470
472
475
482
491
491
495
496
496 
PREFACE.
The following sheets were put together with a hope
of their contributing, in some measure,  to  facilitate
the most  difficult  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 
 viii                 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
r^oty 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 dissections; 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 Spurzheim, &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 where 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:

     Yellow Bees-wax, pure, sixteen ounces,
     Bleached Rosin, eight ounces,
     Turpentine Vanish, by measure, six ounces.*

                       Or, No. II.

     Yellow Resin, two pounds,
     Yellow Wax, one  do.
     Turpentine Varnish, a sufficient  quantity to make the
   mixture 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 fire, 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.     t Munro.
                           c 
xviii
INTRODUCTION.
      do.          do.    pale blue; S BestFlake White> !»&'
                                   £ Fine Blue Smalt, "§iijss.
      do.          do.    dark blue; Blue Verditer, |xss.
      do-          do.    black;     Lamp-Black, §i.
                                 C Powdered Verdigris, iivss.
      do-          do.    green;   5 Best Flake White, giss.
                                 ( Gamboge, powdered, ^i.

                          No. IV.

    For Fine injection take the following:

             Brown Spirit Varnish, §iv.      \
             White Spirit Varnish, |iv.
             Turpentine Varnish,  |i. .

                                 Mix and h?at.

  To make this mixture red;   add Vermilion, Si.  \
     do.      do.    yellow;    King's Yellow, ^.
     do.    #do.    white;     Best Flake White, |ij.

     do,      do.    light blue;  £ Fine Blue Smalt' liss-
                                (_ Best Flake White, §i£.
     do.      do.    dark blue;  Blue Verditer, §iv.
     do.      do.    black;      Lamp-Black, gss,

                        Or, No.  V.

  According to Dr. Munro, a fine injection may be obtained; by
pourmg oil of turpentine on any finely powdered  colouring
matter,  till it reaches a proper consistence. 
INTRODUCTION.
xix
                        No. VI.

   For Minute injection take the following:

 Most Transparent Glue, broken to pieces, or Isinglass,* 5viij.
 Water,                                          ffciss.
                                              Mix.
   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, ^v.
                            King's Yellow, 5iv.
                            Best Flake White, §v.
                            Fine Blue Smalt, ^viij.
                            C Powdered Verdigris, 5iij.
                            } Best Flake White, 3ij.
                            ( Gamboge powdered, Jij.
                            Lamp-Black, ?i.

   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
do.	do.	yellow
do.	do.	white;
do.	do.	blue;
do.	do.	green;
do.	do.	black;
' The Isinglass is much more expensive, but more minute. 
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 5iv.
   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 with 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  varnish 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. VIII.
  Red Lead.
  Linseed Oil sufficient to bring it to the 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 by 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,   tbij-
              Turpentine Varnish, -^x.
             Red Lead,        ^viij.
                                    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. 
XX11
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. VII. VIII.
and IX. it is indispensable to warm the subject thoroughly
by previous immersion in water hot  enough to excite
the sensation of scalding in the finger.   If the water
be warmer it will cause the parts  to contract  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.  VI. is adopted in wet preparations and such as are
intended to demonstrate minute vascularity.   Nos.  VII.
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 sufficient,  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 3i-
              Muriate of Ammonia, $\s$.
              Water,            foi.

   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 disfigured.
                         d 
 xxvi            INTRODUCTION.
   After injecting it, the preparation is to be laid in a
 mixture of three parts of muriatic  acid, faith 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 corrdded 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.            Xxvii
  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 lor thin membranous parts,
as an intestine, &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 INJECTIONS.

  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; they  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 Vesiculae Seminales  and the  Testicles of the
adult, are also excellent subjects for this kind of prepa-
ration.  The lactiferous ducts of the  mammae 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.

   F 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 secured with a ljgature. 
Xxx              INTRODUCTION.
   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  this
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 with 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; soak it in pure water
 again for a day, then dry it, and finally immerse  it in
 spirits of turpentine to make it transparent. 
xxxii            INTRODUCTION.
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, *|i.
     Common Salt,           ^ij.
     Sulphuric Acid,           %\i.
     Water,                iiss.
  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 
t  •
             LESSONS
                  IN

PRACTICAL ANATOMY.
        PART  I.
OF THE HEAD AND NECK.
                  CHAPTER I.
   Of the External Parts of the Head and Neck.
The integuments of the head are remarkably  thick
and hard, but give the sensation, when felt externally,
of being a very thin layer spread over the bones.   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 
2           OF THE  HEAD AND NECK.
few days  by the changes, which  their diminution of
volume, infiltration, and confusion of colour vvith 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 Fascise.

  The  Occipito-frontalis  muscle consists of two
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 two  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 pericranium be- 
MUSCLES AND FASCIAE.
3
low, and  to  the integuments of the head above.   It
is best, therefore, to commence by making one incision,
through the integuments only, from 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 frontis; 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 frontis.  The in-
ternal edges of these latter are in conjunction below.
   It is inserted fleshy,  on each side,  into  the superior
margin of the orbicularis oculi  and corrugator super-
cilii, and by its nasal slip into the internal angular pro-
cess of the os frontis and into the root of the os nasi.
   It pulls the skin of the  head backwards 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 -nf 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
horizontal 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 the nasal pro-
cess just beneath it.
   The Ciliaris muscle  is the internal margin  of  the
orbicularis planted on the edges of the tarsi cartilages.
   As the  Orbicularis muscle  is  fixed at its  nasal and
temporal sections more than  elsewhere, it  is obvious 
MUSCLES AND FASCIA.
3
that the contraction of its circular or curved fibres by
making them straight, will close the eyelids and wrinkle
the skin on them.   This muscle frequently  has a slip
from its lower border to the upper lip, anterior to the
zygomaticus 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 Axguli  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-orbitariumand 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
 malae; it descends obliquely aud 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, arises 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 draw the corner of the mouth
 towards the cheek bone, or obliquely upwards and out-
 wards as in smiling.

   The Depressor Labii Superioris Akeque Nasi
is concealed by the orbicularis oris  and by the levator
 labii  superioris alaeque 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 fraenum 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 FASCIAE.
/
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 the leva-
tor anguli oris.

  The Depressor Labii Inferioris  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,s
  These two last muscles are much obscured by being
mixed with a quantity of 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 fraenum; it will
then be seen to arise in front of the alveolar process of 
8
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 Buccinator 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 FASCIiE.
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 ofthe 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
frontis 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 Neck.  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 the lowTer
jaw in advance of the  masseter  muscle.   It is  spread
over the parotid gland, is fixed to the mastoid process,
to the meatus auditorius, and to the zygoma; in the lat- 
MUSCLES AND FASCIiE.            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
down.

   The Platysma Myoides muscle, or the Musculus
Cut an els, 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
 base of 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 clavicle, 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  fistulae 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
this fascia 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 great 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 well
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 FASCIJE.           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 of 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 ribj 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 downwards.

   The Digastricus  is a double-bellied muscle at the
upper side of the neck, passing  from the back part 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 FACILE.
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 maxillav
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 StyloHyoideus, 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 the 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 part
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 FASCIJE.
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 muscles 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 I
front of the bodies of all the cervical vertebrae.
   It bends the neck forwards and to one side. -

   2.  The Rectus  Capitis Ixternus Major  arises
tendinous and fleshy from the  fronts of the transverse
processes of the third, fourth,  fifth and sixth cervical
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 Capitts Ixternus  Minor arises
fleshy from the front of the body of the  first  cervical
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 vertebrae to the upper parts 
MUSCLES  AND FASCIA!.
2J
of the thorax, are the Scaleni muscles, three in num-
ber, and named from their situation.

   1. The Scalenus Anticusarises by three distinct
tendinous heads  from the transverse processes of the
fourth, fifth and sixth cervical vertebrae, 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
vertebrae, 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 vertebrae,
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 thrown  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  in
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.  If passes outwards and backwards hori-
zontally,  and is inserted into the inner side of the neck
of the inferior maxilla and into the capsular ligament of
the articulation.

  The Pterygoideus Internus 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
tion; they close the jaws, throw the lower one forward,
and produce the grinding motion by acting alternately.
                   Section II.

       Of the Glands of the Head and Neck.

  The Thyroid Gland, (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 Musculus  Glandulae
Thyroideae.  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 Gland (Glandula Parotis) is the most
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 the 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 
26          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  Gland  (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 artery.  It almost touches the paro-
tid gland behind, being separated  from it only  by the
septum sent in from the fascia superficialis, 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 Whartonianus,) arising  in
the same  way by ramuscles,  but  much thinner and
more extensible than the parotid  duct; it penetrates
between the back edge of the mylo hyoid and the hyo-
glossus muscles, and continues between the  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-hyo-
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 occasions  several of these short ducts are col-
lected into  one or two  principal trunks which open
either directly 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 Gla?ids.   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  sterno-
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,
there are half adozen.   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 cervical 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
2V»
                   Section  III.

    Of the Blood-vessels of the Neck 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 nearh
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
platvsma 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  off
branches as follow:

   1.  The Arteria Thyroidea Superior passes in a
meandering direction to its principal destination the
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 laryngeal
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 Linuualis arises just above the
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 further
forwards it divides into  two branches, one going to the
Sublingual Gland (the  Ramus Sublingualis), the  other
distributed through the tongue (the Ranina). 
                 BLOOD VESSELS.              31
  3. The Arteria Facialis 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 mouth, 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 Artert a Occipitalis is large, and arises op-
posite to the facial and sometimes higher up.  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 Arteria Stylo Mas-
 toid e a, 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 ofthe zygo- 
                 BLOOD VESSELS.              33
ma.   When on a line  with the neck of the jaw bone
it sends off a very large branch, the internal maxillary,
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; 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 internal and exter-
nal  pterygoid muscles immediately after  leaving 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 greater 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  mental 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 infra 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 commencement,' 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 the
great vessels of the neck and the  vertebrae; in its dis- 
36
OF THE HEAD  AND NECK.
 tribution  it anastomoses  very freely  with the  other
 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 very 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 subclavian 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 of 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 Nerves  of the  Head and Neck.

   A minute 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 divides 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 the  cheek which join  those
of the infra-orbitar nerve, branches to the  chin which
join those of the inferior maxillary nerve, and branches
to the upper part of the neck, which join those of the
superior cervical nerves. 
NERVES.
39
  The 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."              N

  The Second,  or Superior Maxillary  branch of
the Fifth, comes out of  the cranium through the  fora-
men rotundum,  and is first 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-
lar, 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 ofthe outside ofthe 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 the tongue is
divided very minutely among the papillae.   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-cleido-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-Pharyngeal
and Ninth pair; and passing obliquely behind the in-
ternal jugular vein downwards and backwards, in order
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 cervical 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 ofthe internal carotid artery. Follow-
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 papillae
maximae.  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
OF THE HEAD  AND NECK.
next large nerve below the glosso-pharyngeal, the order
of descent being first the lingual branch of the fifth 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 jugular 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  the  sternum  and  os hyoides: and unites  with
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 lower
parts of these muscles. 
NERVES.
45
  The Par Vagum, 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 off, 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 Sympathetica^ 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 not one
of its contents; but, on  the contrary,  that .it. is fasten- 
                      NERVES.                  4/
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  vertebrae, 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
rairdiac nerves. 
*8
OF THE HE-aD 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 descends into 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 trunk 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, the  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.
r 
PART  I.
CHAPTER II.
                    Section I.

  Of the Encephalon or Brain, and Spinal Marrow.

   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 cavity 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.

   1. The  membranes are three:  The Dura Mater,
Tunica Arachnoidea, and Pia Mater.

   The Dura 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  mem-
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 aethmoid, 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 broadei
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-
te rior  edge ofthe  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
see 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 effects of valves.  In this sinus, also under the dura
mater near the top  of the 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 Pi a Mater is a tender and highly vascular mem-
 brane, lying in close contact 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 Cerebru m  fills by  far the greater  part of
<he cavity of the cranium, and extends from the 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 properly 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 cavities consisting each of three pro- 
         BRAIN AND SPINAL MARROW.        57

messes or cornua, and extending from the anterior to the
posterior portions of the hemispheres.  In the anterior
lobe is the Anterior Cornu separated only by 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, along 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 HEAD 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.   This  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 the 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 ofthe 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 matter, 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 ofthe third ventricle, just below
the crura fornicis, and seen between  their  curvature
where they  diverge, is the Commissura 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 ofthe 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 fossae of the basis of the cranium.  It is divi 
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 Vita, which is
 merely expressive of this arrangement without designa-
 ting any particular part of it.  But if horizontal cuts
 be made the arbor vita resemblance is not manifested,
 and the proportion of medullary matter appears more
 ■xmsiderable. 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 stria 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 Pyramidale, 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 ventricle 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 men- 
BRAIN AND SPINAL MARROW.         65
sure with 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
Eminentia 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.

  TheGLANDULA Pituitaria 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 stria
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 oethmoid 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 ofthe 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 sewing 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, apd  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 lacerum, 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
ofthe 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-
gum 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 Glos-
so-Pharyngeal is before the other, and consists of one
cord.   The Par Vagum  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 Medidla 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 conical 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  much 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 vertebra, 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. 
72
OF THE HEAD AND NECK.
   The Tunica Arachnoidea lies 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 arachnoidea,  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 divided each into
anterior and posterior portions by a long lateral fissure
which is not so deep or long as the other.   These seve-
ral  divisions of the spinal  marrow being  connected by 
BRAIN  AND SPINAL MARROW.       73
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.
                         K 
74
OF THE HEAD AND NECK.
   Of the Blood  Vessels of the Brain  and Spinal
                      Marrow.

   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 clinoicl 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 Arteries come up through the foramen
magnum  and  unite with  each  other at the posterior
part of the pons varolii, to form the basilar artery.

  The Basilar artery divides  anteriorly  into  two
branches which run to the posterior lobes of the  brain;
they constitute the Arteria 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-
ria 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 Anatomy of the Brain and Spinal Marrow,
         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 their'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 extremely 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 consists 
BRAIN AND SPINAL MARROW.         77
entirely of them.  The fact is that it is fibrous, which
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 cateroillars,
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, will  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 condition 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 with the origins of the nerves,  the 
78         OF THE HEAD AND NECK.
largest swellings being where the nerves of the cxtre
mities go off, 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 cineritious 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, from 
         BRAIN AND SPINAL MARROW.       ?9
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 composed of  fas-
ciculi which may be traced into the brain above, and
into the spinal marrow  below.    Messrs.  Gall and
Spurzheim consider the cerebral  mass  to  arise from
these fasciculi  instead of the latter coming from  the
cerebral mass, as is most commonly 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 oblongata.   This pecu-
liarity consists  in the fibres of the  right corpus pyra-
midale arising from the left side of the medulla oblon-
gata, and the fibres of the left corpus pyramidale aris- 
80          OF THE  HEAD AND NECK.
ing 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 which 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 Corpus 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 
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 sends off other branches
which go upwards, downwards, and outwards,  towards
the periphery of the hemisphere; 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 cut 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 Vita.

  u 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-
bellum 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 ofthe pons varolii.  The pons varolii is 
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 ofthe 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 Valvula 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  the
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 of  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.  Af 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, tfhd
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 others.
 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 fibrilla 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 appears 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 ofthe part folded below the pos-
terior lobe, this converging  mass may be followed in
an uninterrupted bed till it forms distinct filaments.
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 collected very much in
consequence of their converging, the anterior 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 flat 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 transverse 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 considered
as commissures by G. and  S., or consisting of converg-
ing fibres, as the Taenia 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 lamina 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
stria  accompanied  with blood-vessels.   Possibly  the
vertical lamina; on each side of the middle line, may
form a seam by juxtaposition;  but it is  more proba-
ble that the  converging fibres  arc continued  across
these.
  Besides the commissures, there are Transverse Bands
Complicationes  Transversa,) 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 the
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  Eminentije  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.
ones or the nates, are evidently ganglions for the ori-
gins of the  optic nerves,  (see the account of these
nerves.)   They are flattened and somewhat cineritious
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
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 orders 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-
tious 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 uncertain whence  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  whe- 
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 different  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 HEAD 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 the 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 duphcature of  cloth having iti
 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
mulate 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-
na.   Yet it does consist of two lamina 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 force, 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
                         N 
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 lamina 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
 tania 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  destroying  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 effected without much difficulty.   All
the  interior of the cerebral expansion, thus produced,
resembles a case of hydrocephalus; the  fibrous struc-
 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 lamina 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 the convo-
  lutions asunder,  a very slight additional effort will be suf-
  ficient to separate them and to show that their lamina 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-vessels. 
100
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 lamina 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 off 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
authors of the  system  very justly complain, that in-
stead of considering the convolutions both of the Cere-
brum and Cerebellum as consisting of two  lamina 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 Nerves 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  the  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 three
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,  comoosed 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 very
 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 stria
exist, supposed to be the origin of this nerve.   These
stria 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 striae 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  stria;
 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 mai* 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 their beginning are -Upara- 
BRAIN  AND SPINAL MARROW.
107
 ted from the common  mass.   In mammiferous 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
three 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 eminentia 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 eminentia 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 this,
the nerve becomes rounder  and adheres to a firm  bed
of cineritious substance, (tuber cinereum,) 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. 
110         OF THE HEAD AND NECK.
                   Section III.

                   Of the  Eye.

  The  hairs on the superior edge  of the  orbit are
called Supercilia, 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 groove is formed posteriorly where
they are in contact,  by which the tears are conducted
to the inner  corner ofthe eye.  Near the internal ex-
tremity of each, but not in the 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 Meibomius,
and secrete an unctuous substance.  In  the  upper lid
are about thirty, 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-
malis.   There is a sort of flap of the 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  duphcature 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 qf 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 Palpebrje 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  draw the lid upwards.

   2. Levator Oculi, or Rectus Superior, arises from
the superior margin ofthe 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-
wards.

   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 ball 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 tarns
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-ball 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 ofthe os
unguis near its  junction  with the os aethmoides,  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 punotum 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 underneath it. The mus-
cle is now seen, and by passing  bristles through the
lachrymal ducts its connexion with 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 anatomists 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 thistendon 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.
 efficient 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 palpebra, the
 tendency of the margin of the lid is to leave the ball;
 the upper part of the little  muscle obviates  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 puncta 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.f   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-
  f Chapman's Journal for 1824.
  "t My attention was first called to it by Dr. Harlan. 
 118        OF THE  HEAD AND NECK.
 ed sufficiently 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 time.  The eye
 is to be removed from the orbit and cleared 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 perfectly  transparent  membrane,
 consisting of many lamina 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
ofthe  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 black, and is covered on the
 outside with a flocculeut 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 having a
large quantity of pigmentum nigrum on  its posterior
surface, the vessels are not evident  in a living 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 short fibres, 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 off 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 Stria ofthe 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 active,
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 much 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  lamella,
which, wijli 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 ft 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 lamina, one  going before and
the other behind it.  But if this  be really the  case, 
124        OF THE HEAD  AND NECK.
the structure 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 injected is 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.
  Of the Vessels and Nerves met with 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, detaches 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
branches which go  to the  Lachrymal  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 athmoi-
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 Palpebra 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 athmoidal 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 prin-
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 the up-
per part of  the  concha, and dividing  it into  two un-
equal fossa, 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 the
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 Innominata,
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 course copflfcspond-
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   Incisura.
 The whole 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 incisura.   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 glandula  cerumi-
 nosa which secrete the wax.
  On the external ear are five muscles, which can sel-
dom be seen distinctly enough to merit the name. On
the superior and anterior part of the helix is the He-
licis 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-
cula which arises from the  temporal fascia just above
the posterior part of the zygoma,  and is  inserted into
the anterior  part of the helix.  And the Retrahen?
Auricula, 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
membrana 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 inward- 
THE EAR.
131
by the handle of the malleus. It consists of four layers,
the cuticle, the true skin,  the proper membrane, and
the lining membrane oi* 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
the 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 tympani and the
Labyrinth;  they afe 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 neck 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 Longus; and  from the back part
looking into the orifice of the mastoid cells is the Pro-
cessus  Brevis.

   The Os Orbiculare  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 mal-
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 Tym-
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, two 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 the
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 Labyrinth.   To  obtain a good view of
 this  structure, a fcetal 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 readily
 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.

  The 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 together at their
 ipper extremities, and therefore have a common canal 
                    THE EAR.                 135
entering into  the  vestibule;  their other extremities
are widely 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 grain
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
interims, 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 lamella 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 scala.  The lowest  of  these
 scala has the foramen rotundum looking into its base,
 and  the  upper communicates hy the foramen  at the
bottom of the vestibule with the cavity of the vestibule.
From these communications we have the names  Scala
Tympani, and Scala  Vestibuli.   The scala 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  the  uni- 
THE EAR.                 137
versity, which seems to be very different 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; distinct from 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 scala 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 nerves from
 the internal jugular vein.**

   The Nerve of Hearing, or the Portio Mollis,  is
 distributed throughout the labyrinth.  The bottom of
 the meatus interims being  divided into two  unequal
 fossae 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 fibrilla 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 bony 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 fibrilla 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 cavities 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 connected  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 aud tern -
poral arteries.
                    Section  V.

                   Of the Nose.

   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 athmoid
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, artd
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 athmoidal 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 entrance to a common quill.   In the meatus
 formed posteriorly in the athmoid bone, under the cor-
 net of Morgagni, are the orifices of  the posterior ath-
 moidal 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 aethmoid  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 fibres 
THE NOSE.
143
descend somewhat lower.  The fibrilla 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 athmoidal
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 nose.

  The nose  is  supplied principally with Blood  from
the internal  maxillary artery and from the athmoidal
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 the 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, the Genio-
Hyo-glossus muscle, the most internal of the four, lying
in contact with  its fellow of the  opposite side. It arises 
THE MOUTH.
145
from 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
muscles, there are  many fibres which  cross  the or-
gan in  various directions and  facilitate  much  its mo-
tion.
  The superior surface of the tongue is rough from the
presence of a number of eminences on it, called Pa-
pilla.   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  Papilla Capi-
tata, or  Maxima.   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 first, 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 duphcature is a Uga
                         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 Cacum 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 Glandula Labiales, and  Buccales.  It forms a fra-
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 franum, on each side of which we see the
orifices of the ducts ofthe sub-maxillary glands. Under
the tongue, at its side, and projecting into the cavity
 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 interstice
 of the  second and third molar tooth of the upper jaw,
 is found the orifice of the duct of the Parotid Gland. 
                   THE 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 AND 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 palate
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 draws 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 ofthe internal ptery-
goid process, and is inserted into  the soft palate near 
PHARYNX AND (ESOPHAGUS.       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 ofthe former muscle, and
passes downwards to be inserted into the soft palate.  It
draws the soft palate  upwards.

  5. The Azygos Uvulje 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  (Esophagus.

  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
vertebra, 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 margin  of
 the upper and under jaws, to the back parts of the  os
 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 the 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 vertebra 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
vertebra above, passes  into the  thorax  between the
lamina of the  mediastinum and in contact with the
dorsal vertebra, 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 CEJsOphagus 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 sufficiently 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, (Cartilago Thyroidea,) is
about an inch below the os hyoides, and forms a very
striking prominence in the male neck.  It consists of two
flatsides which 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 somewhat  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
between the two.

   The  Cricoid Cartilage, (Cart. Cricoides,) 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 affixed 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 cricoid
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.  Arytasnoi-
deae, Triquetral.) 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,
(Corniculum 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 thjn 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 Thyroid 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 ; it is the Crico-thyroid membrane, and in Laryn-
 gotomy, is indicated as the proper place for the opera-
 tion.
   From the  anterior part of the base of each 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.
             i
   2. TheTHYREO-HYOiDEUs, which is described in the
 account of  the neck, page 16.

   3.  The  Crico-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 chink of the
 glottis.

   5.  The  Thyreo-Arvtenoideus, arises from  the
 posterior face of the thyroid cartilage, and the ligament
 connecting  it with the cricoid, 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 small  fasciculus, and
 sometimes only one muscle exists.   Use, to close the
 chink of the glottis.

   7. The Arytenoideus Transversus,  arises pos-
 teriorly from the whole length of one arytenoid carti- 
                  THE LARYNX.               159
                                                 j
lage, excepting a little part of the tip, and is inserted
in a corresponding manner, into the  other.  I se, 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,
 and 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 this position, and, there-
 fore, when  it does occur, it  must depend essentially
 on the mechanical pressure of the morsel 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 upper
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. 
LARYNX.                 161
 spring of 1822, in dissecting a muscular subject, I had
 occasion to observe a position of these parts which 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 somewhat
 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,  is, 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  I.

                 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
OF 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 clavicular portion ofthe
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 Pectoralis Minor is brought into view by
raising the last muscle.  It is comparatively  small and
son,ewhat triangular, arising by thin tendinous digita-
tions  from the  upper edges of the  third, fourth,  and
fifih 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 downwards.

   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 Anticus is a broad mus-
cle  lying on" the sides  of the ribs, between them and
the scapula, and  arising  from 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  cartilago 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.

              Viscera of the  Thorax.

  The most usual manner of getting into the cavity of
the Thorax is that just mentioned; but there is a much
better one introduced here, by the late Professor Wis-
tar, in 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 vertebra; the lungs are on each
side of it and when in a healthy state, always collapse
upon the thorax being opened.

                    The  Pleurae.

   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 pleura
 which covers the lung, is the Pleura Pulmonalis,  and
 that which lines the ribs, the Pleura Costalis.
   As the pleura 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 ster-
 num 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
 lamina, one from  each pleura.   These  two  lamina
 are somewhat separated, where they are called Ante-
 rior Mediastinum, by the 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 sternum must be sawed 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 con 
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 pleura, 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 lamina; 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  vertebra, 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
The 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 cavity,
 whence it got its name;  it is not marked by any pecu-
 liarity except that the musculi pectinati prevail in  it.
 The auricles have a common septum, and on it, just below
 the tuberculum loweri, is situated the Fossa 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 Columna or Annulus Fossa
Ovalis.
   Beneath the fossa ovalis is the Eustachian valve.  It
is formed by a duphcature 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 tkan 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
eases of  diseased lungs.

  The next cavity 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, from
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  Tendinea, which again arise from
the Columna Carnea.  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 nearly 
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 the 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, which
should be done by a slit down its middle, it will be per-
ceived that its  parietcs 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 Pectinati prevail. 
VISCERA  OF THE THORAX
1.77
  The Septum between the auricles, viewed on this
■4de, 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 columna  carnea 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 duphcature of the lining membrane
 ofthe ventricle.  It is partially divided into two parts,
 which are pointed at their edges.   Its columnae car-
 nea3 are numerous and strong, and its chorda? tendineae
 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 artery,
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 off 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 ventriculorum 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 receive 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 the 
180
OF THE TRUNK.
 right auricle just anterior to the Eustachian Valve, al
 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 being 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 dorsal verte-
 brae.  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 vertebra 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
liguous faces of the lungs so as to make them resemble,
when united, the inferior part of an ox's hoof; but'this
resemblance is much increased by the diaphragm form-
ing a convexity  towards the thorax, which  rises much
above what its  plane would.  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 vertebra, from the in-
 ferior part of the larynx to the third dorsal vertebra; it
 there divides into the Bronchia, and is placed between
 the pleura 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 dorsal ver-
tebra ; the left being long and narrow, 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 air
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. 
VISCERA 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. 
itvl
OF  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 adujt 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 which 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 the 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 Colles 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-
                        a a 
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 vertebra, the tra-
chea is placed before it, and we see the arteria innominata
crossing thp latter nhliqnply 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, beingthe 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 subclavian
* EcLectic Repertory, 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 off,
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  crura  of  the diaphragm.   The
 QEsophagus 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  vertebra.   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 Abdomen.

  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.
  Some  anatomists call the pit around the ensiform
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.
V  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 off 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 first
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

num 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 below, 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  Cartilago
Ensiformis, there is another, and half-way between 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 Linea Transversa,  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  Poupart's
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.  The
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
                        ub 
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 understood, 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-
      rum,  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 lamina,
      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, vertebra, 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 vertebra, 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-
 third 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 beneath
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 inner edge  through these tendons, and
they turned over  towards  the  linea  semilunaris.   Its
origin will then be seen as a flat tendon of an inch or
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 lineae transversae,
hut, for the  most part, they do not extend through the
muscle.
   Inserted fleshy, into the cartilago 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
               This muscle is often wanting. 
 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 lamina 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 transversalis; 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-
 clusively to the internal oblique, as it is said to be a de 
MUSCLES OF THE ABDOMEN.       199
tachment 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 aoquainted 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 the
adult; it is, however, 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 tfcat 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 well, 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, which is inserted, for an inch,
 into the  crista of  the pubes behind Gimbernat's 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 lamina, 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
                        C c 
202              0F THE TRUNK.
front ofthe abdominal muscles, as high 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 thickened by the irritation of hernial
protusion it  is better developed.  On the thigh it is
blended with fat, and encloses between its lamina 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 lamina 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. Colles of 
INGUINAL HERNIA.
203
Dublin, when 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
ruminantia 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 cellular
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 Transversalis 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 transversalis is not  in contact wTith 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 fossas by a  narrow falciform process  of the
 peritoneum.  The process arises from 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 duphcature 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 fossa indicate the  points where inguinal hernise
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 FasciaTransversalis 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.  The fascia transversalis 
208
OF  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 iliac 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 coining from the pelvis.  As they

   Were it not for the important influence of the fascia super-
ficialis 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 sufficiently
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 veins
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
                       Dd 
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 pubis;—-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 well 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 to 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 continuation  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 sartorial 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
Giinbernat'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
Hey's or the Femoral Ligament.
  By introducing a finger under Hey'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.
21.5
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,  or a
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 afrch, 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. Colles 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 considers as a con-
 tinuous membrane, which may be 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.            217
   in this is fixed  the Arteria Circumflexa 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 Poupart's 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 Gimbernat's 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 Liver 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.

   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 Epigastric, 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 gathered up in the Umbilical
region.  If it be not diseased, it may be drawn down-
wards to the pelvis, and spread out so as to conceal all
the front of the intestines.

  7. The Pancreas, 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 Capsula  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 understood that the subject is on his
back.  When one stands upright, the lumbar  ver-
tebra are more convex in front, and the abdomen more
protuberant below.  The pelvis 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 the
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-
turns, 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 lamina which, near the stomach,
 are separated by the coronary vessels.   It has always
 but an inconsiderable quantity of fat in it.

   b. The Omentum Majus, or Gastro-Colk:um, is
 an irregular quadrilateral membrane  having its base
 upwards.   The latter is fixed anteriorly to the greater
 curvature of the stomach, and posteriorly to the trans-
 verse  arch of the colon.   It hangs loose in its  inferior
 part, and is sometimes found spread over the intestines
 as low as the 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-splenicura.  It consists of two lamina, the anterior
 is fixed to the stomach,  the posterior to  the colon.
 Each of these lamina again is composed of two, so that
 it may be compared to two bags, one within the other,
 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 ofthe gall-bladder, we shall
find 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 lamina
sent  from the stomach; behind and  below, by  these
laminae 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.  It
is a point well worth mastering, as,  when this  is ac-
complished all other difficulties, in studying the reflec-
tions of the peritoneum, are  much diminished.
                       f f 
226
OF THE TRUNK.
  c. The Omentum Colicum 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  laminae.

  d. The Omentum Gastro-Splentcum 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  duphcature the arteries and veins  called
Vasa Brevia.

  c. The Appendiculje EpiPLOiCiE  are little pro-
cesses of peritoneum, filled with fat, appended at irre-
gular intervals to the anterior sides of the cacum, 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 Mesocolon fixes the large intestine to the
back of the abdomen.  The posterior part of the cae-
cum being devoid of peritoneal coat,  is of course in
contact with the internal iliac muscle and is tied down
to it.   The colon 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 mesp-
rectum.

          Of the Ventriculus, 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. 
22g             OF THE TRUNK.
  The exterior of the stomach presents two faces, two
orifices, two curvatures, and two extremities.
  When the stomach is nearly empty it becomes some-
what flattened, and then exhibits an anterioP 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.   The
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-
treme left.
  The curvatures are the Great and Small.   The first
includes the great extremity and the inferior edge of the
stomach to the pylorus;  the small is the upper margin
between the orifices.
  The Tuber or great extremity of the stomach is the
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 lamina.  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 assets 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. 
230             OF THE TRUNK.

             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-caecal 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 villous.

   The small Intestine, or Intestinum Tenue, is divid
ed, somewhat artificially, by anatomists, into three parts,
Duodenum,  Jejunum,  and  Ileum.   The first, from
peculiar  circumstances, is  perhaps  named properly
enough;  but several  distinguished men, as  Chaussier,
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 lamina 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 its appearance to the left of the second lumbar
vertebra, where it is continued into the mesenteric por-
tion of intestine.
  Tire 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; the second and third
portions are between the lamina of the mesocolon, but
have no peritoneal  coat; 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
ruga 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  Valvula  Conniventes.   Many mucous
follicles exist in this intestine, and mucous glands, call-
ed Glandula Brunneri; the latter are particularly ac-
cumulated about  the pyloric orifice.  It is, in its pos-
teri-or 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 vajvula
 conniventes are  numerous, and arranged transversely;
 but in the lower three-fifths, called Ileum, they gra-
 dually  diminish, and near its  termination, 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 lamina of mesentery  are loosely
 applied against each other where they join the  intes-
tine, and are separated in its distentions, as far as the
first  row  of the mesenteric arches of blood-vessels.
Cases are  reported, in which it has had appendicula
epiploicae 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 Te- 
          CONTENTS OF THE  ABDOMEN.      233

nue, differs from that of the stomach, in resembling
more, the downy cuticle of an unripe peach.  The little
projections from it, are called Villi; on the surfaces of
which,  open the orifices of the lacteals.   It abounds
with mucous  follicles  and glands;  the latter,  called
Glandula 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, Cacum or Caput Coli;
and the remaining portion, which is by far the longest,
the Colon, until it reaches the 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 duphcature 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 Intestinum 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 further
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 faces, 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 lamina; 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  surface 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 re-
moved from the body.   Its colour is a reddish brown. 
          CONTENTS OF THE 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, end
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.  The Lobulus Spigelii or pos-
terior lobe is at the back of the liver just to the riajht
of the posterior part of the sulcus umbilicalis.   It is
like a ridge and terminates forwards in a papilla which
is one  of the porta 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
cata,  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  granulated 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 coeliac,
after having detached some  smaller ramifications, gets
to ihe transverse fissure of the liver  and divides into
three branches; one to the right  lobe, one to the left
lote, and another to the Lobulus Spigelii;  they, how-

  * See Scemmering's Anatomy.  Laennec's Journal de Mede-
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 together  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 these 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, in 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 the
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 the 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 percp-
luted into the abdomen probably before death.

  The   Hepatic  Duct  arises,  by very  delicate
branches,  from the  granuli  of the  Liver.  These
                        Hh 
^42              OF THE TRUNK. <
branches are united into three or four trunks, in the
transverse fissure, which trunks again  unite into one
about the  size of  a writing-quill,  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
inches, 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 concavity  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 medium 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 lamella 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 greyish,
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  grounds:  That  injections, cautiously made,
pass immediately from the arteries into the veins; and
that when the  spleen, successfully injected, is frozen,
one can see no  ice in the interstices of the vessels,
while the  capillary ramifications of the vessels  disten-
ded by 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 lamina of the transverse
mesocolon.
   The Pancreas is of a light grey colour.  It is about
seven inches long and two wide; and would represent 
 246              OF THE TRUNK.
 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 with 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  interstices are
 occupied with numerous vessels.  The excretory duct
 of the gland arises from these granulations, by very
 fine radicles which, uniting, form larger cylinders 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 the
 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 communis 
          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 the splenic.  The  veins empty into the
splenic.

             Of the Kidneys,  (Benes.)

  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  psoa,  the quadrati 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  obliquely
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 adheres
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 Papilla, and an attempt has been made  to
establish for them  some peculiarity of organization;
but that idea is now abandoned, and they are generally
admitted to be  the same with the other portions of the
                        i i 
250
OF  THE TRUNK.
 tubular part.  They have many orifices in them which
 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 ceu
 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 papilla, 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.      251

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 emulgent veins are parallel with the arteries, and
terminate in the vena cava ascendens.

    Of the Benal  Capsules,  (Capsulae  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 changed 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 divisible
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
viscid fluid coagulable by alcohel:  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
off.   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
lortg 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 and 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 ofthe bodies of the three upper lum-
bar vertebra, 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 the
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 the cartilages of the eighth
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 Natura.   The
part described, is called the greater muscle of the Dia-
phragm.
   Besides these origins, the  Diaphragm has several
from the vertebrae 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, aad arises tendinous 
 256              OF THE TRUNK.
 from the Intervertebral ligament, between the  second
 and third vertebras.   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 Diaphragm is  given
by Albinus, but it is  difficult to make out fairly, and for the
most part it would be much better to say thatit arises tendinous,
from the first, second, and third  vertebrae.  The heads are
occawpjially much smaller on one side than the other. 
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 vertebra, and  from the transverse pro-
cesses of all the lumbar vertebra.   It forms an oblong
fleshy cushion on the side of the lumbar vertebra, and,
constituting the lateral boundary of the inlet to the pel-
vis, it passes out ofthe pelvis, under Poupart's ligament
about its middle.
  It is inserted, tendinous, into the trochanter minor
of 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 and of 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
()¥ THE TRUJNK.
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 ofthe capsule ofthe 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 Quadratus 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 vertebra, 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 preced-
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 Viscera of the  Male  Pelvis.

  The Rectum, 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 downwards.  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 vesiculae seminales, 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
K>F 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  rectum 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 Fun-
 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 duph-
 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 
MALE PELVIS.
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              0F 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 that 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 the 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
Vesica,  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
vesicae.
   The Neck of the Bladder is thicker than any other
part;  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:   (i 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.7'

      Prostate Gland,  {Glandula Parastata.)

   This is a body about the size and form  of a horse
chestnut, fixed on the neck of the bladder, and  pene-
trated by the 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 faeces, are overlapped by it.
The Prostate  has,  posteriorly,  a  notch  in  its centre,
which divides it into two lateral lobes, and  by raising
the Vesiculae 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 4he 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 number
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.              267
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, (Vesicula 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 deferentia;
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 secre-
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? (Membrum Virile, Mentula.)

  It is a membranous  and cellular body affixed 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  h

       ' See Observations on the Animal (Economy. 
MALE 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 duphcature or fold, the Prepu-
tium, which is inserted  just behind  the glans;  the
inferior part of the prepuce is connected with the ex-
tremity of the glans by a  process called Franura.
   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 transversely 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
 much 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, February Uth 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 two
conical crura, one from the internal face of the crus of
each pubes and ischium, to within 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  cavernosum,  in its  centre,
there is a tolerably complete septum of  the same kind
of substance, separating its two 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 the same manner below, another for the corpus
spongiosum  urethra.  The  cavity  of this membrane
is filled by a spongy tissue, which arises from its inter-
nal face, and is formed of filaments and little lamina;
they, by crossing each other, form a multitude of cells
which have a perfectly  free  communication  with
each other,  and generally are somewhat occupied  hy
blood.
   The Corpus Spongiosum Urethra extends from ten 
                  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 gradu-
ally to the end of the corpus cavernosum, where it is
again  enlarged into the Glans 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 great number of
papilla 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 lacuna 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 Vesicae, 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 lacuna of the prostate
 gland.
  Between the Prostate and the Bulb is the Membra-
 nous Part of the urethrar 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 mufcele, 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
into 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 immediately 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 lacuna; 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.*
  rf Sir Everard Home has lately communicated to the Royal
Society a highly interesting paper on the structure ofthe lining
membrane of the urethra.  From his microscopical  observa-
tions, he is induced to think, that there can be no doubt of its
^muscularity.
                         m m 
274             OF THE TRUNK.
   At the posterior part of the  bulb  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 has
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.
275
             Of the  Testicles, {Testes.)

   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  thiny
 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  wrinkles 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, which  extends from
 the perineum over the scrotum along the inferior sur-
 face ofthe penis to the end ofthe 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 from  the  reports of Messieurs  Chaussier, 
276              OF THE TRUNK.
Lobstein, and Breschet, that it does not exist in the
scrotum till the descent of the testicle,  and that  it is
an expansion of the gubernaculum testis.
  Notwithstanding its great  contractility, the  ques-
tion of its  muscular structure is  not  settled,  and cer-
tainly, in 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 coirfmon observation  will convince  most persons
that the elevation of the testicles in the  scrotum by
the contraction of the cremasters is very distinguish-
able from that contraction of the scrotum  by which
the testicles are squeezed against the sides of the pubes
and the scrotum brought into a hard corrugated mass.
  The Cremaster  muscle is rather 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 on the
internal and external sides ofthe 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 appeal's in the adult as a
complete sac.  The  testicle being protruded into  it
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 halitus
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 Highmorianum.
These septula 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 eud  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 fine  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 highmorianum.
  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 Septula.
These tubes send out a great number of trunks, which,
from their observing a straight course, obtain the name 
                  MALE PELVIS.              279
of Vasa Recta.   These vasa recta unite and form a net-
work,  the Rete Testis.   From  the  rete testis' there
proceed from twelve to  eighteen tubes, which pass
through the upper part of the corpus highmorianum,
and get to the outside of the tunica  albuginea; these
are the Vasa Efferentia.   Each of these vasa is rolled
up externally at this place, 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
i* said, by Mr. Cmikshank, 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 vesicula 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 retain*
 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 advise the 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 Fasciae 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 the 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
sufficiently 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 Urina lies on  the bulb and back
 part  of  the corpus spongiosum urethra; 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 erus 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 the urethra,  and by a point into
 the anterior extremity of the sphincter ani, where they
 are joined by the transversales perinei.
   In order to see the origin of these muscles very dis-

  •* The late Dr. Lawrance informed me  that he has frequently
found muscular fibres between the bone and the crus penis. 
MALE PELVIS.
283
linctly, 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 Perinei 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 Urina, and
Transversi Perinei are now to be  removed.  A large
quantity of adipose and cellular matter will be found on
the side of the rectum 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 connected by its superior
face to the Triangular Ligament of  the urethra, a mem-
brane which fills up  the space below the symphysis 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
Ob  THE TRUNK
urethra; to get a view of which the corpus spongiosum
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
in 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
crista 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 injure 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 vesicula
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 Muscle* 
288
OF THE TRUNK.
peritoneum, a very small space of the bladder lies naked
which can be punctured from the rectum, without in-
juring  either the cavity, of the  peritoneum or the
vesicula 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 pelvis.
" 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 fasciae 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-
                        o o 
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 periosteum 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 Memoir on Hawkins' Gorget. 
MALE PELVIC.
291
fasck is very thin, for the fibres of the obturator inter-
nus can be readily seen through it.
  At the bow this fascia divides into two lamina, one
having the course to the bladder and rectum indicated,
the other covers the lower part of the obturator internus
muscle and constitutes the obturator fascia.  The levator
ani is interposed between the lamina.  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, and 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 serai-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
downwards 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 lamina;  the
bulb of  the urethra is fastened to the anterior lamina,
and the prostate gland is fixed to the posterior lamina;
between these lamina 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 fascia 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-
na, 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 fascise 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 are 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 for the Generation and
            Nourishment 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 Mons Vene-
ris, the Labia Majora or Externa, the Labia Minora or
Interna, the Clitoris, the Vestibulum, the Orifice of the
Urethra, the Fourchette, and the Fossa Navicularis.

                  Of the  Vulva.

  The Mons Veneris  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 with 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
lar 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  towards  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 ofthe body of the clitoris projects into
the upper part of the bottom of the rima, and is called
its  Glans, but does not resemble, in structure, the
glans  penis.   A kind of hood  is thrown  over it by a
duphcature of the integuments ofthe 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 years, in
 whom he performed circumcision successfully, in order
 to free her of a very bad habit to which she was  ad-
 dicted in consequence of this disease.

   The Labia Interna, or Nympeue, 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 duphcature of the mucous membrane of the part,
 between the lamina 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 effaced 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 nymphag laterally; in it are many mucous follicles. 
FEMALE PELVIS.
299
   At the inferior  part of the vestibulum, about an
inch  below the glans  clitoridis, is the  Orifice of  the
Urethra, (Orificium Urethra.)  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 Vulvae, is situa-
ted at the inferior junction of the labia externa; it is a
narrow duphcature 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
duphcature 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, differing 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. 
V
302              OF THE TRUNK.
  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-
thrse, 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 Vaginae 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 and 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 
FEMALE 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
Carunculae 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 hi  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 on 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 TRUNK.
 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 duphcature 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 duph-
 cature,  which  constitutes the Posterior  Ligament.
 The peritoneum is also reflected from the whole length
 of each side ofthe 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
 from 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, and 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 majora.  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 Tinea,) 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 tinea 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,
                        Qq 
306
OF THE TRUNK.
 transversely, there are others presenting an arborescent
 arrangement.   This is the Arbor Vita.   In the inter-
 stices  of  the  transverse lines there are small  mucous
 glands called Ovula Nabothi, in  consequence of this
 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
 far 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 anterior 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 cryptee and exhalent orifices.
   The texture of the  uterus  is  essentially fibrous and
 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, (Tubse Uterina,) 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 duph-
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 Ani
muscles have  the same arrangement as in males. 
                FEMALE MAMMiE.            309
  The Fascia connecting the bladder to  the sides of
the pelvis, and the triangular ligament of  the urethra
also exist.
                   Section II.

              Of the Female Marmme.

  The Mamma 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  fossa 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
filled 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 numerous, 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 the
* See Marjolin, vol. ii. p. 295. 
FEMALE MAMM^.
311
lactiferous tubes. From the external extremity of 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 when the nipple is not
in 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 brown. 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  papilla.  Its internal  structure consists of
the lactiferous  ducts,  united by  condensed  cellular
membrane. 
FEMALE MAMMiE.
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.
R r 
PART  II.
                 CHAPTER  V.

       Of the Nerves 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 Nerves.

  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 further account of this n^rve see the Nfck. 
316
OF THE TRUNK.
side of the bronchium, 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 five
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 off,
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 surface 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
free of the 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
heftrt.   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 the upper  cervical gangl.or, 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 terminates 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-
scends 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 fibrilla 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 eel- 
NERVES.
319
lular and adipose membrane at its upper part; below, its
jneshes 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
confined 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  a 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 vertebra, being near.
the vena cava on the right  side and the aorta on the
left.   About the middle of the body of each lumbar
vertebra, it forms a ganglion which dismisses one or two 
320
OF THE TRTTNK.
nervous filaments to the corresponding lumbar nerve,
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, fibrilla depart  which  join the
posterior pulmonary plexus, and also  are distributed
in the form of a plexus on the aorta.  From 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
abdpmen 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 c-oeliac artery, assumes the name of coeliac,  ,
and  dismisses ramifications in the course of the gastrica
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.
                         ss 
322              OF THE TRUNK.
   From the lower part of the solar plexus,  arises the
Renal  Plexus, which  surrounds the emulgent artery,
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 and 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 vesicula 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
funning 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 three-
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 (Esophageal, 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, for sometimes both come
from the aorta.
   The (Esophageal Arteries are five or six in number,
and are spent  upon the oesophagus, 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
 vertebra, 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 vertebra  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 Coeliac Artery, (Arteria Coeliaca) 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 Glisson, 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 Colica
Media.

   The Emulgent Arteries, (Arteria 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 capsular renales.  The arterial
distribution from the aorta here  is subject  to varia-
tions, the arteries of the capsulae 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
psoa 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
  Th<? 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 tl^e
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, (Arteria 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
                       Tt 
330             OF THE TRUNK.
them.   They inosculate with the circumflexa fl% 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 abrta; 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  Hypogastrics,) 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 its
external surface.  Sometimes it is previously divided
into two principal trunks, an anterior and a posterior.
From it the following branches proceed.
  1. TheIlio-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, (Arteria  Sacra
Laterales,) come next, arising by one or more  trunks 
                    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 the
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 vesicula 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
lamina of the broad ligaments.
  6. The  Vesical Arteries, (Arteria 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 Glutaa,) 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 maximus.

  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 to
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 course 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 transversus perinei muscle and the 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 urethra. 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
cavernosum, 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- 
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 innominata,)  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 by 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, vesicula seminales, and the base of the 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 superior 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 the account of the liver. 
THORACIC  DUCT.
337
                   Section III.

       The Thoracic Duct, (Vas Chyliferus.)

  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, ofthe ver-
tebra, 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 vertebra, 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, ahout 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 trunks,
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 vertebra.   Make a
second incision from the lobe of the ear to the acromion
processl  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-pit,
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 five superior spinous processes
of the neck, through the intervention of the Ligamen-
tum Nucha, 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 nuchae, and extended
on  each side.   The ligamentum nuchae 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 vertebra 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.
  Detach 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 arises 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 Scapulae 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.
 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 vertebra.  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 vertebras and
the angles of the ribs, on either side, there is a deep fossa
filled up by muscles, some of them lapge and powerful;
the most striking are the Sacro Lumbalis  and the Lon-
gissimus Dorsi. 
MUSCLES OF THE BACK.
345
  The  Sacro Lumbalis and Longissimus  Dorsi
have a common origin from the back of the pelvis and
of the lumbar vertebra, 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
vertebra 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 transverse 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 vertebra  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
ribs 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 vertebra, and  is inserted  tendi-
nous into  the spinous processes of the  nine  superior
dorsal  vertebra, except the first.
   It tends to keep the  spine  erect.  Turn 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
dorsi into the upper ribs; it looks, at first, very much
like a continuation or appendix of the first, running to
the cervical vertebra.
   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 vertebra of the neck,
between the levator scapulae and splenius colli, by three
distinct tendons.                  '
   It draws the neck backwards.

   The Transversalis 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 vertebra 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  vertebra.   It draws the  head back-
wards.

   The Trachelo Mastoideus is at the inner 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 backwards.

   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 vertebra 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 Semispinals 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 vertebra 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  Semispinals  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 vertebra,
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-e 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 vertebrae 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 to 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  each
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 Major 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 Minor 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 transverse 
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 vertebra.
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 vertebra.   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 dorsal vertebra, 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.
OF  THE  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 forei-arm  forms  a complete
                       yy 
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 Extremities.

  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  the 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 pectoralis
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
brachial is.   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  scapulae 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 scapula, and looks very much like a part of the
infra spinatus, to which it occasionally adheres so close-
ly, as to be separated with difficulty.   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 extremity 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
nected 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  dorsi
and teres major, and in front of the brachialis exter-
nus.  From the lower end of this muscle proceeds an
intermuscular ligament to the internal  condyle of the
humerus, which separates the brachialis  internus from
the third head of the triceps.
   This 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 the
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 Cubiti  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 scapula.
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
olecranon, and fills up the triangular depression found
there.
  It extends the fore-arm.
                   Section III.

     Of the Muscles in front of the Fore-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 Pronator 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 coronoid process of the ulna.
It passes very 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  Longus 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-
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.

  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 
366
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 Profundus  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 disperse 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  the fingers,  and  by 
MUSCLES.
367
increased action, may flex the 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
origin 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
minutia 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 bursa,
which  has the power of keeping them lubricated by a
synovial secretion.
   The Vaginal Ligaments of the fingers 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 frasna
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  the
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 ulna near its lower ex-
tremity, and from the front of the bone.
  It is inserted into the corresponding 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 Supinator 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, fleshy 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 ofthe external ridge ofthe 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 Extensor 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
in 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-
• uilaris. 
372      OF THE UPPER EXTREMITIES.
   This muscle extends  all the joints of the fingers,
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
united to the contiguous sections  by  transverse bands
or frana.

  The Palmaris Brevis is apt  to be cut away  un-
consciously; it is just below the skin at the  inner side
of the hand.  It consists of separate fasciculi unequally
divided,  and arises from the ligament of the wrist, and
from the ulnar side of the palmar aponeurosis.
  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 fingers.  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 contiguous 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.
                       3b 
378      OF THE UPPER EXTREMITIES.
   4.  The  Adductor Pollicis Manus 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 Digiti Manus is the
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 v
first phalanx of the little finger and into the tendinous *
membrane which covers its back part.
  It draws the little finger from  the rest.

  2. The Flexor  Parvus Minimi Digiti Manus i9
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 ofthe
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 of the hand, we see the three posterior
or double-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. 
385       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- Vessels 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 medius 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 the 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;
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 Scapulae
varies much in  its  origin; it comes sometimes from the
subclavian, and on  other occasions from the upper part 
384       OF THE  UPPER EXTREMITIES.
  ofthe 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 scapula,  and  there  divides  into
  branches supplying the supra-spinatus muscle and the
  shoulder joint.

    2. The Arterije Mammarije Externje 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.
    b. 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 the deltoid and great pectoral muscle, and dis-
tributed to them along the  margins of this  fissure
upwards and downwards.
   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 angle  of the scapula
in contact with this muscle, and is  distributed  to  the
teres major  and minor, subscapularis  and latissimus
dorsi muscles.
   A little below  the neck of the scapula a large trunk,
the Dorsalis Inferior Scapulae, 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 Circumflexa 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
                       3c 
 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 commcnly a little below; sometimes they
 have a  common trunk.  It surrounds the back  part of
 the os  humeri, 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. The 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
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 coracp
brachialis, which are too irregular and too small to de-
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  which 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 paraljel  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.

   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 Volje arises from the radial
about the inferior margin of the  pronator quadratus
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 vola 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 the
 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,  under
 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-thirds 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 differ-
ent course from the radial, for it passes over the ante- 
BLOOD VESSELS.
391
rior annular ligament of the carpus just at the radial
side of the os pisiforme,  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 k 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 Recurrens 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.
 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
 deeply seated and  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
 the carpal arteries.       f '

  3.  The ulnar artery, in its  descent on the fore-arm,
sends off many small  and irregular muscular branches
called  by  Professor  Chaussier,  Cubito-musculaires:
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-
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 ofthe 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.
                        3d 
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 from our collec-
tion in the University, that this occurs more often than
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 artery 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 Extremities.

   These Veins are abundantly supplied with valves,
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 are
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
thumb and fore-finger on the back of the hand; a dis- 
BLOOD VESSELS.
395
  linct 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
  or ten lines of the clavicle, when it dips into the axilla
  to join the axillary  vein.  In the whole of this course
  it may be seen easily beneath the skin.

    2. The Vena Basilica arises, by several branches,
  from the  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 ofthe 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  Vena 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 sheath
of cellular  substance.  Under the  clavicle it becomes 
NERVES.
397
Vena Subclavia; and as such 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 the 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 Nerves 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 plexus 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 from 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 scapulae 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 primarily 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 come 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  Cutaneus Internus  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 the 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 Cutaneus comes from
the middle of the brachial plexus.  It perforates ob-
liquely the upper part ofthe coraco-brachialis 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 lowTer part of the radius  divides 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 another
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 Extremities.
                    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 well  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  extremity. 
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.

  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
                       3f 
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  backward^  between two laminae  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-
mentum patella 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  Cruraus 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  be-
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 Crurjeus 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 off,  besides being
somewhat separated by vessels.  But the origin of the
cruraeus  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 cruraus 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 Cruraeus is inserted into the posterior face of 
MUSCLES.
413
the tendon of the rectus below, and into the upper sur-
face of the patella.  It also extends the leg.
   The Ligamentum  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-
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 the 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  magnus.  It arises, fleshy,
from the  concavity on the upper face of the pubes
between its  crista 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  contri-
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-
tact 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
thyroideum, 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. 
416      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.                41T
   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 covers it.
   The anterior superior part of this muscfe 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 joint,
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
ofthe tuberosity of the ischium.
   Being parallel to  each other, 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 of 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 outwards.

  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  circumfer- 
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-
■gerted 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 first, called
the long head, has an origin,  in  common with  the  se-
snitendinosus, 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 belowT  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 Semimembranosus 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 thin 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
 external 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 great
 increase of strength.
   It flexes the leg on the thigh.

                 Muscles of the Leg.

   These muscles are  situated anteriorly,  posteriorly,
 and externally.

   The Tibialis Anticus 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
ofthe 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 penniform, 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 great 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.
                        3h 
426      OF THE LOWER EXTREMITIES.
   The Triceps Sura 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 the 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 Internus.

   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 of the  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 fibres 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; it
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
edge of the astragalus  to the sole of the foot, where it 
430      OF THE LOWER EXTREMITIES.

crosses  the  tendon of the  flexor  longus  digitorum,
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 front 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  continues 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 Extensor 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 cuticle, 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  causes  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 Plantaris, 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.   Anteriorly, 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
                        3i 
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.
135
   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  the 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 ef 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. 
140      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 Pudic (Arteria Pudenda Ex-
terna,) 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.
                       3k 
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-
ral  itself,  and  arises  from its posterior part on  a level
with the trochanter minor,  but sometimes only five or
six  lines below Poupart's  Ligament.   It immediately
begins to give off 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
joint, 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
cruraus 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 an
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 ofthe 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 Poplitaa) 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 on 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,  (Articularis  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 off 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, the 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 metatarsus.
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 Tibial 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.
                        3l 
450     OF THE LOWER EXTREMITIES.
  2.  Several small  irregular muscular and cutaneous
branches afterwards arise from  the posterior  tibial,
and at its upper part most commonly, the Arteria Nutri-
tia Tibia.

  At the ancle the posterior tibial  is at the 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
a line 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 scaphoidfes 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-
torum, 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.
  b. 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 intervals, 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.
45o
   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 Vena 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 Nerves 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 vertebra 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, fibrillae 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 iliacus 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  to is the Saphe-
                        3 M 
458      OF THE LOWER EXTREMITIES.
nus; 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 fibrilla.  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.*

  e 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 Glutai, one passing through the upper part
of the sciatic notch along with the artery to the glutaus
medius and minimus, the  other  below the pyriformis
muscle to the glutaeus magnus.
   b. Nervus Pudendalis Longus Inferior, which passes
under the tuber of the ischium to the glutaeus 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  Femoralis  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.

   The Nervus Pudendalis 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 urinae, 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 glutaus magnus; it is thereabout 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 the
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 from
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 Communicans Tibia.   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 of 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
Communicans Tibia)  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 ofthe 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.
   b. 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 flexor 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.
3x 
  PART  IV.

CHAPTER  I.

Of the Ligaments.
                   Section I.

     Of the Ligaments of the Head a?id 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 cartilage 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 ofthe corresponding condyle ofthe 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 fixed
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-
tebra.

  Between the bodies of all the vertebra 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 off processes on
each side to fix it more securely to the bodies of the
vertebra.   Where much motion is admitted, as in the
neck and  the loins, it is thinner  than  on  the dorsal
vertebra.

   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 vertebra, adhering to
them and to the intervertebral substance.   It is nar-
rower on the bodies of the vertebra 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
clastic. 
470           OF THE LIGAMENTS.
  Ligamentous fibres pass also  between the  spinous
processes, and there are others between the transverse
processes.

  The Ligamentum Nucha 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 vertebrae 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 fur-
nished with  capsular and synovial membranes uniting
them with the corresponding articular  surfaces of the
vertebra, and admitting of motion.

  The  Ligamenta Transvcrsaria 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; 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 cartilago
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 the back of
this articulation.  It is connected  to  the  sacrum by
its transverse prucesses 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 this 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 arc
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 lamella  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.

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
fascia 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.

    Of 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 ofthe 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.
475 
476
OF THE LIGAMENTS.
   The Capsular Ligament proceeds from around the
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 clavicle, 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 capsular ligament arising
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.   The  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 the 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 capsule we see the extent of
the synovial  membrane, and the cartilaginous 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
transverse, 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 metacarpal 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, and, therefore,
admits of every variety  of motion.
                        3p 
482           OF THE LIGAMENTS.
  Between the  heads of the metacarpal bones and
the first phalanges  there is a capsule and a synovial
membrane.  The capsule is thickened at its sides by
which  lateral  ligaments are  formed.   In front  it has
a cartilaginous 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 III.

                   Section  I.

      Ligaments  of the  Inferior Extremities.

  The rjip 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 eavity
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 Joint.

  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.         4S5
   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  duphcature 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,  leaving 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-Tibial 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 strength-
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 veryDbliquely 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-
                       3q 
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 bones.

  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, Nails, and Sebaceous Organs.
                 CHAPTER I.

                    Ofthe Skin.

  The Skin consists of Cuticle, Corpus Mucosum, and
the Cutis Vera.  These parts are easily separated from
each other by maceration; 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  different  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
 bo obvious as elsewhere. 
                   OF THE SKIN.               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 be disposed in
the following manner:  1st. On the inequalities of  the
cutis vera, next to its papilla, there is a layer, which
he calls  bloody  pimples,  (bourgeons sanguins)  but
which, in the opinion of other anatomists, are only the
papilla 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.

  *■■ Marjolin 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 effects 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 papilla 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  much more complete way of effecting this
separation. 
                  OF THE HAIR.              495

latter as the first layer of the rete mucosum  and the
papilla 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. 
196       OF THE SEBACEOUS ORGANS.

                 CHAPTER III.

                   Of the Nails.

  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 pincers or separated by macera-
tion, their form and origin may be readily seen.
                 CHAPTER IV.

             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
arc particularly numerous under the skin of the mons
veneris. 
INDEX.
	Page 189
Abdomen,	
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 Vitje,	62
Auditory Nerve,	105
Auricular Artery,	32
Back, Muscles of,	339
Biceps Flexor Cubiti,	358
Bladder,	262
Brain,	50
Blood vessels of,	74
Brachial Artery,	383
Bronchia,	182
Bronchial Glands,	184
Bronchial Arteries,	325
Buccinator,	8
Carotid Arteries, . 2	9, 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,
Commissures of Brain,
83,
89,
 Compressor Naris,
 Complexus,
 Convolutions of Brain,
 Coronary Arteries,
         Veins,
 Cornea,
 Corpus Callosum,  .
 Corpus Cavernosum,
 Corpus Spongiosum,
 Corpusculum Arantii,
 Corrugator Supercilii,
 Cremaster,
 Crural Nerves,
 Crural Arch,
 Crural Ring,
 Cutaneus Internus,
 Cutaneous Nerves of Thigh,


 Dartos,
 Deltoides,
 Depressor Lab. Sup.AIaequ
    Nasi,
 Depressor Anguli Oris,
Depressor Labii Infer,
Digastricus,
Diaphragm,
Dura  Mater,      ,
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
                     Thumb, 373
Eye,       .      .      .110
    Muscles of,     .       110, 112
Eyelids,    .      .      .    m
Eye Ball,                .117 
498
INDEX.
	Page		Page
Fascia Superf. Cervicis,	10	Kidnies,	247
Profunda,	12	Knee Joint,	484
Superf. Abdom.	201		
Transversalis,	206	Labia Externa,	296
Femoris,	211	Labyrinth, .	134
Iliaca	212	Lachrymal Gland, .	112
of Upper Extr.	353	Lachrymal Ducts, .	111
of Lower Extr.	406	Sac,	112
Plantaris,	432	Larynx,	153
Facial Artery,	31	Cartilages of,	154
Fallopian Tubes,	307	Muscles of,	158
Fauces,	147	Laryngeal Nerve, .	45
Femoral Sheath,	216	Lateral Ventricles,	57
Arteries, .	440	Latissimus Dorsi,	341
Hernia,	210	Lungs, ,	180
Flexors of Fore Arm, .	363	Leg, Muscles of,	422
Foramen of Winslow,	225	Nerves of,	463
Fourchette,	299	Lenticular Ganglion,	127
Foot, Arteries of, .	451	Levator Labii Sup. Alxque	
Muscles of,	431	Nasi,	5
Ligaments of,	489	Levator Anguli Oris,	5
		Levator Scapulae,	343
Hair,	495	Ani,	291
Hand, Arteries of, .	393	Levatores Costarum,	352
Muscles of, .	375	Lingualis Musculus,	19
Articulations of,	481	Lingual Artery,	30
Hamstring Muscles,	420	Ligaments,	466
Heart,	170	of Jaw,	466
Head and Neck,	1	Spine,	467
Hepatic Duct,	241	Thorax,	470
Hip Joint,	482	Pelvis,	472
Hyo-Glossus,	19	Upper Extremitj	r, 475
Hypoglossal Nerve,	43,70	Lower Extremit	y, 482
Hyoides,	153	Liver,	235
Hymen,	300	Blood vessels of,	238
Humours of Eye,	122, 124	Longus Colli,	19
		Longissimus Dorsi,	345
Iliacus Internus,	258	Lower Extremity, Muscles	of, 409
Iliac Arteries,	330, 33	Arteries o	f, 440
Intestinal Canal,	23	Lower Extremity, Nerves of	454
Internal Maxillary Artery,	33	Veins of,	452
Infundibulum,	65	Lumbar Arteries,	329
Intercostal Muscles,	165	Lymphatics of Neck,	28
Arteries,	325		
Inguinal Hernia,	201	Mammary Artery, .	384, 324
Interspinales,	351	Masseter,	9
Intertransversarii, .	351	Mammae,	309
Intercosto Humeral Nerves,	404	Medulla Oblongata,	63,79
Inferior Thyroid Artery,	35	Mediastina,	168, 180
Interpubic Ligament,	287	Mesentery,	226
Intercostal Artery, Superioi	325	Mesocolon,	227
Interosseal Artery,	391	Mesenteric Arteries,	327, 329
Iris,	120	Median Nerve,	401
Jugular Veins,	36	Motores Externi,	68
 
INDEX.
499
	Page
Mouth	144
Multifidus Spina;	349
Musculo Cutaneus N.	400
Mylo Hyoideus	18
Nails	496
Nose . .	140
Nerves of,	143
Nymphae	298
Obturator Muscles	419
Occipito Frontalis	2
Obliquus Externus	. 192
Internus	194
Capitis	351
Occipital Artery	31
Oesophagus	151
Oesophageal Artery	325
Olfactory Nerve	•66, 142
Omenta	224, 226
Omo Hyoideus	16
Orbicularis Oris	8
Orbicularis Palpebrarum	4
Orbit, Vessels and Nerves c	f, 125
Optic Nerve	66
Os Tincae	305
Ovaries	307
Pancreas	245
Palate, Soft	147
Muscles of	148
Papillae of Tongue	145
Parotid Gland	24
Par Vagum Nerve	315
Par Vagum	45
Pectoralis Major	163
Minor	164
Pelvis Male	260
Female	295
Pelvis Arteries of .	331
Penis	268
Pericardium	169
Peritoneum	222
Perineum . 281,	285, 292
Muscles of	282
Peroneal Artery	449
Peroneo-Tibial Articulation	487
Pharynx	149
Pharyngeal Artery	31
Phrenic Nerve	48, 314
Artery	326
Pia Mater	54
Pineal Gland	60,93
Pituitary Gland	65,93
	Page
Platysma Myoides	11
Pleura	167
Plexus Axillary	49
Solar	321
Lumbalis	454
Ischiadicus	458
Pons Varolii	63
Popliteal Artery	445
Portio Dura N.	. 38,69
Mollis N.	138, 139
Prostate Gland	266
Psoas Parvus	257
Magnus	257
Pterygoideus Externus	22
Internus	22
Pulmonary Artery	175
Pubic Ligament	200
Pyramidalis	197
Quadratus Lumborum	259
Radial Artery	388
Nerve	400
Rectus Femoris	410
Rectus Abdominis	196
Rectus Capitis	20, 350
Rectum	261
Renal Capsules	251
Retina	121
Rhomboideus	343
Sacro Lumbalis	345
Sartorius	409
Saphena Vein	452
Scaleni Mliscles	2
Scapula, "Muscles of	356
Scapular Arteries .	385
Sciatic Nerve	461
Sclerotica	118
Scrotum	275
Sebaceous Glands	496
Semi-spinalis Colli	348
Dorsi	349
Seminal Vesicles	267
Serratus Major	165
Serrati Postici . 1	542, 343
Shoulder, Articulations of	475
Skin . .	491
Spermatic Cord	280
Spermatic Artery	328
Spleen	242
Sphincter Ani	284
Vagina:	302
Spinal Marrow	71, 77
 
500
INDEX.
	Page
Spinalis Dorsi	346
Splanchnic Nerve	321
Splenius	344
Sterno-Cleido Mastoideus	12
Sterno Hyoideus	15
Thyroideus	15
Stomach	227
Stylo-Glossus	17
Hyoideus	17
Pharyngeus	17
Subclavius	163
Subclavian Artery	324
Submaxillary Gland	26
Sublingual Gland	27
Sympathetic Nerve 46,	317, 323
Temporal Artery .	33
Temporal Muscle	9
Tensor Tarsi	114
Tensor Femoris	410
Testicles	275
Coats of	277
Third Nerves	67
Thigh, Muscles of .	409
Arteries of .	440
Thorax	163
Muscles of	163
Thorax, Viscera of	165
Thoracic Duct	337
Thymus Gland	185
Thyreo Hyoideus	16
Thyroid Gland	23
Artery	30
Veins	37
Tibial Artery	447,444
Tongue	144
Trachea	182
Trachelo Mastoideus	347
	Page
Transversalis Cervicis	347
Abdominis	196
Perinei	283
Trapezius	339
Triangular Ligament	285, 292
Triangularis Sterni	165
Trigeminus Nerve	. 39,68
Trochleares	67
Trunk, Nerves and Vessels	of 314
Veins of	335
Tunica Arachnoidea	55
Tympanum .	130
Bones of	132
Muscles of	133
Ulnar Artery	390
Nerve	403
Upper Extremity	353
Arteries of	382
Veins of	394
Nerves of	397
Ureters	250
Urethra of Male	271
of Female	299
Uterus	303
Vagina	. • 300
Valve of Brain	61
of Bauhin	234
Vasti	411
Vas Deferens	278
Vertebral Arteries	35
Vestibulum	298
Vulva	296
Wrist Joint	479
Zygomaticus Major	6
Minor           6 
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