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About 3000 pages m double DUNGLÍSON'S MEDICAL DICTIONARY; 6th edition, containing over 40,000 wordsandsynonymes. Large 8voof over 800 pages, double columns HOBLYN'S MEDICAL DICTIONARY; edited by Hays. 1 vol. royal 12mo. 4(M MEDICAL NEWS AND LIBRARY. Published Monthly atOne Dollar a Year. SELECT MEBíCAL ESSAYS; by Drs. Dungüson, Chapman and others. 2 vols. 8vo. 1150 pages. A NEW MEDICAL DICTIONARY. In one volume, large 12mo., now ready, at a low pnce. a dictTonary OF TERMS USED IN MEDICINE AND THE COLLATERAL SCIENCES; BY RICHAED D. HOBLTN, A.M., OXON. FIRST AMERICAN, FROM THE SECOND LONDON EDITION REVISED, WITH NUMEROUS ADDITIONS, BY ISAAC HAYS, M.D., EDITOR OF THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES. OPINIONS OF THE PRESS. " We hardly remember to have aeen so much valuable matter condenaed into auch a small compass aa thia little volume preeenls. The firat edition waa published in 1835, and the present •naj be aaid to be almoat rewritten, introducing the most recent terma on each eubject. The Btymology, Greek, Latín, &c, ia carefully attended to, and the ezplanationa are clear and preciso: " We cannot too atrongly recommend thia small and cbeap volume to the library of every siu- dent and every practitioner."—Medico-Chirurgical Revietc. " We gave a veiy favourable account of thia little book on ita firat appearance, and we havs only to repeat the praise with increased emphasia. It ia, for ita aize, decidedly the beBt book of the kind, and ought to be in the possesaion of every atudent. Ita plan ia aufficiently comprehenaive, and it contains an immenso maaa of necessary information in a very small compasa.''—British and Forcign Medical Rtvicw. "A work much wanied, and very ably executed."— London Medical Journal. "Thia compendioua volume ia well adapted for the uae ofatudenta. It containa a complete Sloseary of the terma used in medicine,—not only those in common use, but alao the more recent nnd lesa familiar namea introduced by modera writera. The introduction of tabular newsof different eubjeets is at once comprehensivo and satisfactory."—Medical Gaietle. " Conciae and ingenioua."—Johnson.'* Medico-Chirvr. Journal. " It is a very learncd, paina-taking, complete, and useful work,—a Dictionary abaolutely necea- ■ary in a medical library."—Spectator. "Thia ia a work that we can cheerfully recommend to all medical studenta and tn .,„. „i,„¡ eian who occaaional y atumbles across words. with the meaning of which h'p i.n2» ZZ7 S"5?1" m.liar. Itindeed fully comes up to what a dictionary of terina Sugít to bt-ítf «n'ñ-flí. *£ express the en^e significaron of a word in all ita bearings. andI yet conciL ^n.Lh ? gí ,0 that defimtion remembered. Some dictionaries, that aspire to the charaX ñf ™mS 8 • ° have are mcrely vocabulario of synonyma, in which you may seek in vaií fo?2 .«íuf?'1,"1" ,n pfrvo- tion of the meaning of terma ; while others are essays on every*Robiect VrS rí^°ry %p,anB* widedomamofthe medical and phyaical sciencea. Mr. Hoblyn fias hit unon^hl£e W,tbln tho and produced a work that must be highly esteemed by the medical profe^oS H«a„P„P,y m,ed,um- a very aecurate and full account of the mean ng of every term émnlnv«l ?m'~ a "ot °1iy «,VM ita etymology. which, i, very important in fixing the meaning"™ íhTmmd tEÜSu*1 £Ut a,g0 formed no aliarniwprk in bnngmg it out; but has done bona firli» whi?» lí." i,/ e 3dl,or. has Per' alwaya doea. He has. not only in ñame, but in truth " revIaeS kíi .^. .h28-underíak8n' a" ne tha American practitioner."-having added our na iv'e rnediclna? nl.„1?Ptffi " l? the wants °f &c. and made the work conform to the Pharmacoweia ofihñ rlnSlfa! ?ffic,nal Preparationa, numeroua, and display a knowledge of medicinal1 tS hiihfuYíL'í? ?itat.eBVH,s ,ad«iitiona are duatry."-rA« JVeio York Journal of Medicine ' S y credlta°le to bis tálenla and in- ed to the wnn a of medical atudents during ther attendance „n„n iL... 8 " to be. specially adapt- fprm and small coet will be strong recommendaliona fV? H»»? Jectur?8, to wh°m ita portable tions, haa adapted it to the American reader."- The Wel't^'r^ add¡].¡°ns aní a era- Suretrv. J ae weitern Journal of Medicine and UNITED STATES DISSECTOR. THE UNITED STATES DISSECTOR, OR LESSONS IN PEACTICAL ANATOMY. BY t - WM. E. HOJBJÍ..ER, M. D., PROFESSOR OF ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA. FOURTH EDITION, WITH NUMEROUS ILLUSTRATIONS. EDITED .f BY HENRY H. SMITH, M. D., FELLOW OF THE COLLEGE OF TIIYSICIANS, OF PHILAD., &C, PHILADELPHIA: LEA & BLANCHARD. 1846. Entered, according to the Act of Congress, ¡n the year one thousand eight hundred and íbrty-six, by WM. E. HORNER, M. D., in the Clerk's Office of the District Court, of the Eastern District of Penrí- ¡ sylvania. GRIGGS & CO., PRINTERS. o* oo •Se Sí ^3 ■** k —I *** Es» ^ — o tí-*0 *S t* L. - . ,3 . — . o> ó a. 3, C, ■SC *,!= . . á) o> . 3 B i. 3 = a22s2-g3 2 3 ^ 3 a) «? a — —. W3 n: ce < »ja,2iS 3 »í O OJ 13 3 3 3 3 33^5c9-Oc53re3 c; o -■- a> c e-. o -x> oj -' oj i> 3 J"0 0.25a2=í5eaacuca^:eas.íi5 '3, etí 3. # — c?w--3-~ ■ ©Mv. —' —3<£ — © • .ra ¡a <—, ~ "> fe es CM O *■.©** Ci íO (-■ r» !■■.©»< í£3 *■. OS .O © *5t d Wi »rt 4009¡vl'*r.OOO<9INOOO»8>»'*»<- <©»*©_«» 4-4- I +++++ I I +*■ I I I 4- I ++4- ©CN5O30r«-l |©S00l« SI**»)© «•«»!*-<»*«*»*»*»• ©I wí wipj osessasa ooüi>*aooo0ine>nso)3;an oteólo» t^i-»i-r»i«.»<«t-.t-«*-«r-»-.t-.r".r-.t-.i.-. r« f*< i» t<< 9 f •as. ■ 9'* £°" o • ¿o» si ® o s .«o !S lf §* s*. a-2 = 1 T3 £3 -1 i II i i fj 58 "années d'expériences el dé succtís,~c0n&^u,s par les plus célebres médecins, ne laissent aucun doute sur son efficacité contre les ehüme, catarühe, snrodekenv, ORIFPE, ASTHDUB et IRRETATXON OS POITR-IWE. 0n en prend un morceau cliaque fois qué l'on éprouve le besoin do tousser ou d'expectorer. 1 .-a Trix: 1 ir. 50 cent, la Bolle. — 75 cent, la 1/2 Vétiquette porte la signatura de finventeur, /k$ftlit¿{$£? dont le modele est ci-contre. The two divisions of the instrument, acting each upon its side respec- tively of the sternum, the latter, parts open four or five inches. The pericardium is then slit up, and a large pipe introduced into the root of the aorta. A syringe will do for throwing in the mixture; but the best way is by a column, of twelve or eighteen feet in height, to which for convenience is attached a flexible tube of leather of four feet in length, to conduct the injection to the aorta pipe; and furnished with a stop cock at the lower end. By this apparatus, the pressure can be so exactly regulated, as to keep the vessels full without rupturing them, and the injection be pushed uniformly on. In all cases where it succeeds well, it returns by the veins, and keeps them beautifully distended as in exercise. It should be thrown in warm. Injection through one of the collateral arterial trunks is not so effectual as from the aorta itself. I have, for the purpose of saving the sternum, tried the brachial, the femo- ral, the carotid and some other arteries, but always with some measüre of disappointment. If the subject is to be used immediately, the above quan- tity will hold it in good preservation for two months in winter; if it is to be kept during the summer and for an indefinite length of time, twice the quantity should be in- jected; or even more if the subject be very large. The objection to using the latter quantity where a subject is to be dissected at once, is, that it inundates rather too much, but where time is left for evaporation, the latter process cor- reéis the over-humidity. If a subject is to be kept during the whole summer, it * Vol. iii. p. 212, Am. Journ. Med. Se, Nov. 1828. INTRODUCTION. 29 should be preserved besides in a mixture of one part of common salt to four of mahogany or pine sawdust; and, to prevent its becoming too dry, it should be sealed up in lead, or surrounded by a cloth which is impenetrable to moisture, or by some other of the numerous means of insulation from the atmosphere, as a box covered well with pitch, or an oíd oil barrel or hogshead. A subject may be kept in this way, fit for most anatomical purposes, for an indefinite length of time. If the investment used fail in preventing evaporation and the limbs get hard, they may be soaked out to a proper suppleness. Insects have no disposition to molest such pieces in their dried state. The above injection impairs the great nervous centres, as the brain and spinal marrow ; also the mucous membranes and the rete mucosum, by softening them and making them pulpy; a proof by the way of the quantity of neurine and nervous fatty matter entering into the composition of the rete mucosum. This influence is derived from the free alkaline matter in the injection, coalescing with the neurine, and making a half difnuent soap. Henee the cuticle always parts in ten or twelve days. Leaving the alkali out will correct this, but with another disadvantage in its place, to wit, the too great hardening of the tissues. The accident is, at best, but unimportant, as a roller imbued with tallow or wax, laid down in place of the cuticle, will resist the drying of the skin at the part. The muscles are beautified to a remarkable degree by the above injection, and are also preserved in a fine state of strength and tonicity. I resort to it invariably in my de- monstrations of the muscles, and have done so since its first adoption, and should consider my arrangements incom- plete without it. Whether my partiality is justified, must however, depend more upon the evidence of some thou- sands of young men, who have been trained in their anatomy by me. Anatomical pieces preserved this way, do not make good spirits of wine preparations for suspensión; the salts and the molasses are constantly tinging that fluid. If the pieces are to be shown by direct handling, the turbidness of the fluid is inconsequential, and the muscular fibre, though its colour is changed by the spirits of wine into a dark olive, yet has its character very strongly developed in parts where it may 30 INTRODUCTION. previously have been equivocal. The fibre is also rendered somewhat more brittle, and the cellular substance more dis- tinct by it. A muscle thus treated, becomes a fine subject for unravelling and for study. The arteries distended in this wTay, are for a short time rendered very soft and exten- sible, and receive then a much fuller amount of the common coarse injections. Some delay should be had before the latter, so as to allow the antiseptic injection to pass on, and the aorta should at any rate be emptied of it. This injection has a fine effect in developing the tissue of an artery, espe- cially if the latter be steeped afterwards in alcohol. The skeleton, the ligaments and the cartilages, are made extremely firm by the injection above, so that in boiling, the gelatin is not formed so readily; and maceration in water seems to produce, even in very hot weather, scarcely any effect in accelerating the putrefaction of these parts. Skele- tons thus injected, though much more durable and heavy, when prepared by boiling, than others; yet never can be well bleached, but always retain a brown tinge. Upon a dissected surface a soapy glairy formation will occur after a few hours exposure to the air: this may be partially corrected by an envelop saturated with tallow, or with molasses and water. As to the vaunted preparations of arsenic, they are cer- tainly, antiseptic, but poison the dissector's fingers, add nothingto the qualities ofthe parts for dissection, and indeed rather impair them. The Sulphate of Alumina recommended by Mr. Gannal of Paris, is also antiseptic, like all the other forms of this earth, but spoils completely the colour of the muscles, and also hardens them and other parts too much. It has in this respect a similar effect to corrosive sublimate which of all articles is the most potent, both for preventing and for arresting putrefaction; but like arsenic exposes the health of the operator, and also, by its ready action upon the albuminous constituent of our tissues, confounds them all into a hard, drab-coloured undistinguishable texture. I will make a few remarks on alcohol, or spirits of wine, from my own observation. There is no other fluid which I think equal to it for wet preparations; and those who claim for the dilute acids, and the solutions of neutral salts an equal valué, have overlooked too much the constant pre- cipitating of their solid constituents, so as to obscure the INTRODUCTION. 31 preparation and make the fluid finally turbid; at least I have tried none against which this objection did not hold. When alcohol is used, the blood should be removed from the specimen by soaking it for a time in fresh clear water, frequently changed; then at least three times its weight of alcohol should be taken and the specimen so arranged that the alcohol shall be in contact with its whole surface: mas- sive pieces should be cut into, to give to the alcohol a pro- per access. When the preservation of the white tissues is concerned, the alcohol is very exactly suited to them. My most usual strength of it is about 26° of the glass float oí Cartier, or 60° of the centesimal float of Gay Lussac. A bulky anatomical specimen, from the quantity of water it discharges, will dilute the spirits of wine probably six or eight degrees, but at least several, and a great state of di- lution always incites to softening and maceration, so as to spoil the piece. A good spirits of wine preparation, properly made and suspended, is constantly improving in the perfection of its appearance; and is decidedly better at the end of twenty years, than at the beginning of them, so far as the condition and aspect of the tissues are concerned. Alcohol can o-enerally be got of the strength named, at seventy cents a gallón; it is therefore not very expensive in this country, to keep up anatomical cabinets of wet preparations. In Europe, the excise duties impose a much higher price, and the anatomists are, therefore, constantly attempting to adopt a cheaper substitute. Wet preparations should be exposed freely to the light of the sun, otherwise their texture is injured by its absence, and they acquire a dark ugly drab colour; this is especially the case with ligamentous tissues, and with the great nervous centres. It is difhcult to get glass or stone vessels of sufficient size for large anatomical pieces, to be kept in spirits of wine. Vats of lead are used to some extent, but a carbonate of lead is formed in great quantity, which, being precipitated on the specimen, spoils its surface, and makes it ragged and opaque. I have tried zinc partially and find it to answer better, but timé is wanted to mature the observation.* * American Journal of Medical Sciences, No. xvii. Jan. 1845. p. 245. 32 INTRODUCTION. DRIED PREPARATIONS. Whenever a section of the body, as the head, the arm, leg, or any other part, is to be injected, the arterial 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 frequentsource of disappoint- ment 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 greater part of the arterial system. After thirty, few subjects answer well in consequence of a profusión of adeps blending itself with the muscles, and not unfrequently of a diseased state of the arterial system. In dried preparations the arteries should be fairly traced in all their ramifications, and the muscles separated from each other. Every thing not essential to the object of the preparation must be cut away. When the part is fully dis- sected, care should be taken to put every portion of it in a proper posture, and to fix it so till it becomes stiff by ex- posure to the air. The muscles are to be kept asunder by strips of wood. When the preparation is thoroughly dried, and not be- fo re, it should be varnished. But previously to the latter pro- cess, it should be washed twice with a solutioñ 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 prepara- tions suffer much from insects, and the best security for them is obtained by immersion in a solutioñ 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 are dried, INTRODUCTION. 33 they may be washed four times advantageously with this solutioñ: Corrosive Sublímate, %i. Muriate of Ammonia, 3iss. Water, fti. At the last two washings add to the foregoing, Common Glue, dissolved, ^i. The glue makes the solutioñ adhere to the preparation, and also furnishes for the varnish a basis or ground, which causes it to stick and dry well. Two thin coats of copal varnish must afterwards be laid on with a soft brush. Copal varnish will take up a small quantity of corrosive sublímate, henee, I find itin many instances sufhcientto re- sort to that coating, from the aversión the inseets have to it. To make a preparation which will show perfectly the shape and communication of the air cells of the lungs, the lung should be previously filled through the bronchus with melted tallow. When the latter cools, the lung should be cut into thin slices and dried. The pieces are then to be digested for some days in spirits of turpentine at the tempe- rature of about 110° so as to dissolve out the tallow. Should the blood-vessels of the lung have been minutely injected with size previously, a most brilliant set of prepa- rations can be made, which may be mounted either in the dry state, or suspended in spirits of turpentine. CORRODED PREPARATIONS. The heart, lungs, liver, spleen, páncreas, kidneys, and penis, are most commonly chosen in making corroded pre- parations. Their vessels, excretory duets, and cavities, as the case may be, should be distended moderately with No. I. observing to give to each system in the structure of the viscus, a colour different from the rest. The successful in- jection of these requires good management, because, if too much forcé be used, extravasation will oceur, and the pre- paration will be materially disfigured. After injecting it, the preparation is to be laid in a mix- 3 34 INTRODUCTION. ture of three parts of muriatic acid, with one of water, wThich corrodes the fleshy part and leaves the injection ex- posed. The process of corrosión 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 wreek, add enough of the fresh, to bring the mixture to its original strength. When the animal part is converted into 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 prepa- ration, remain floating in water for twenty-four hours, in or- der to remove any acid wThich may adhere to it; then dry it by suspensión in the air, or by laying it on a heap of soft carded cotton covered with a thin cambric cloth, to pre- vent the cotton from sticking to its vessels. The preparation should be fixed on a pedestal of plaster of Paris, and coated by dipping it into copal varnish, di- luted with one half of its quantity of spirits of turpentine. It should, after drying, be varnished in the same way once more. Such preparations, when kept under glass btlls or cases, are among the most beautiful that can be made. As corroded preparations break from the slightest vio- lence, I have 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 injured by slight jars. WET PREPARATIONS. Minute injections, generally, and all morbid derange- ments, are proper subjects for wet preparations. The na- tural structure of many parts is also very advantageously displayed in this way. The specimen previously to being put up, should be steeped in water changed daily, till all the blood is out. INTRODUCTION. 35 Spirits of wine, spirits of turpentine, and a solutioñ of corrosive sublimate, are each suitable for suspending such preparations in. The latter answers particularly well for eyes and for thin membranous parts, as an intestine, &c. Two grains of corrosive sublimate, with an equal quantity of muriate of ammonia, to an ounce of water, make a so- lutioñ sufficiently antiputrescent for an eye, and which con- traéis the preparation much less than spirits of wine. When larger bodies are preserved, the quantity of corrosive subli- mate must be increased proportionably. Corrosive sublimate with in fact all saline solutions, has however, the disadvantage of precipitating after a while. 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 bladder; over this must be placed sheet lead, about the thickness of a quarter of a dol- lar, 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 pro- perly trimmed, should be varnished twice with copal var- nish coloured with lamp-black. In later years a plan which I have found to answer better than any other for closing bottles, so as to prevent evapora- do^ is to have the upper end, i. e., mouth and neck of the bottle, in the shape of two short truncated cones joined at their summits. This shape accommodates well a cross bar of white metal as pewter, to which the preparation should be suspended through holes. If spirits of wine be used, a waxed muslin should be attached by heat to the under sur- face of the leaden cover, and while still warm be fixed in its place, and then covered by two layers of bladder. _ If the menstruum be spirits of turpentine, the best cover is a moist bladder coated with dissolved glue, containing a small quantity of honey, or of some saccharine substance to make it less brittle. Upon its drying, a lead may be se- cured over it by another laycr of bladder, coated in the same way. Generally, in wet preparations it is better to secure two or three turns of fine strong twine around the neck of the bottle over the bladders, as the latter are apt to crack and loosen themselves. 36 INTRODUCTION. QUICKSILVER INJECTIONS. These constitute a beautiful and interesting department in the occupations of the practical anatomist. The parts most frequently subjected to this process are the lymphatics and lacteals. In the extremities we introduce the pipe 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 inject- ing for the lacteals we must introduce the pipe into a lacteal trunk in the mesentery and inject baekwards; as the lac- teals on the intestine itself are, for the most part, too small to admit of its introduction into them. The liver has a great many lymphatics in its peritoneal coat; they may be injected from one of the trunks on the broad ligament. It is unnecessary to preserve the whole liver; a section of it half an ineh thick, dried and hung in spirits of turpentine, answers very well. The parotid gland injected with quieksilver 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 Vesiculse Seminales and the Testicles of the adult, are also suitable subjects for this kind of preparation. The lactiferous ducts of theMammse are very favourably displayed in the same manner ; they are injected separately from the nipple. Bristles should be previously introduced into each duct, and withdrawn suecessively as the injection advances, otherwise we may commit the mistake of injecting a duct twice. As each duct is injected, it should be secured with a ligature. A woman who has died during lactation is the best subject for it. The hand of a thin, aged female may be readily injected, both arteries and veins, by a pipe fixed into the radial artery. After it is filled it should be macerated in water frequently INTRODUCTION. 37 changed till all the blood is removed and the cuticle comes off; it should then be dried and varnished. The Veins of the kidney of a cat, afford a beautiful prepa- ration 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 dissolved 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 now to be dried and is fit for use. If the maceration be properly conducted no bleaching is necessary; if otherwise, the pro- cess adopted in whitening linen and cotton cloths, answers well, that is, exposure to the sun, and frequently wetting with clean water or with weak chlorine water. A cranium from four to ten years oíd 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 wTarm water. The beans in a short time begin to swell and 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 pint. 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. The acid is to be renewed from time to time. On such a preparation one may demónstrate the pliability and the lamellated and fibrous texture of the hardest bone. 38 INTRODUCTION. A bone, by being thrown into a strong fire, wTill have all its animal parts destroyed and nothing but the calcareous left. This preparation is the reverse of the last. To demónstrate the vascularity of bone, cut off the limb of a fcetus, or of a young child, and fix a pipe into the prin- cipal artery. By filling the part with the size injection, the vessels of the bone will also be injected. Remove theflesh when it becomes cold, and macérate in wrater till the blood is washed out. Place the bone in the acid mixture just mentioned till the calcareous part is removed; soak it in puré water again for a day; then dry it, and finally immerse it in spirits of turpentine to make it transparent.* ON FUMIGATION. The air of rooms, where dead bodies are kept, as well as the walls and furniture, become exceedingly offensive; to correct wThich we resort to the following mixture with great advantage. It is called the Guytonian from its inventor. Take Oxide of Manganese 1 part by weight. Common salt 7 parts Water 4 parts Sulphuric acid at 66°, 4 do The water and the acid should be previously mixed and allowed to cool. Then stir all the ingredients well together in a itone vessel. When the room is abandoned for the night, cióse its doors and windows and commence this fumigation. The next morning it will be found much sweetened, and on ven- tilating freely, its atmosphere will lose still more of its of- fensiveness and be in a great measure renovated. * For a very valuable and instructive exposition in detail, the student is referred to a work entitled Directions for making Anatomi- cal Preparations; by Usher Parsons, M. D. Professor, &c. Phila. 1831. Also Anatomical Manipulation, &c, by Tulk and Henfrev- London, 1844. J INTRODUCTION. 39 The fumes of this mixture are very penetrating ; they give their peculiar smell to clothing for several days, and rust metallic surfaces intensely. All articles therefore, which are not intended for such depuration, should be removed. A milder fumigation which may be used beneficially in sick chambers, is obtained by pouring in successive portions, five parts of hydrochloric acid upon one of peroxide of manganese. PRECAUTIONARY MEASURES AGAINST DISSECTING WOUNDS. The propriety of using certain precautions in performing PostMortem examinations, especially if the patients have died of disease of the Serous Membranes, or, of an Erysipela- tous character, is now well established. Under the cir- cumstances protection will ensue from smearing the hands with oil or lard; and if sores, scratc.hes, or abrasions exist on the fingers, even in the slightest degree, they should be covered with adhesive plaster or touched with Nitrate of Silver, so as to form an eschar. If the operator should wound himself, or the matter or fluids of the corpse come in contact with an abrasión, he should immediately wash his hands, and suck the part thoroughly, in order to draw blood if possible; or it may be necessary to apply a cup- ping glass, when practicable. Students of Anatomy frequently have their fears much excited on the score of the constitutional symptoms, arising from small wounds inflicted during their ordinary dissections; under an erroneous impression, that a specific virus is, there- by introduced into the system, as in cases of the post mortem examinations just referred to. Inconveniences of this kind, though they occasionally do occur, are by no means frequent; and are just as apt to be produced from the pnck of a needle, of a brier, or of an oyster-shell. The first intimation oí such mischief, is the part becoming painful, red, and swollen, and the arm getting somewhat stiff; if in the early stage ot these symptoms, a blisterbe applied according to the recom- mendation of Dr. Physick; the person live lightly, and take a 40 INTRODUCTION. saline cathartic, the treatment is almost invariably sufficient for the cure. Such accidents are much more liable to oc- cur from the prick of a spicula of bone, than from any other cause to which the Anatomist is exposed, furnishing thereby, a useful hint for him, never to break a bone, but always to saw it off smoothly. PART I. OF THE HEAD AND NECK. CHAPTER I. OF THE EXTERNAL PARTS OF THE HEAD AND NECK. The integuments of the cranium 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 con- sist of skin, and below it of small, compact, granulated masses of fat enclosed in the cells of a cellular substance; which has very much of a ligamentous character, and ad- heres closely to the muscle and tendinous matter beneath. Beneath the cranium we find the brain, which being liable to rapid decomposition should generally be the first part ex- amined, before softening has changed materially its structure; after which, the muscles of the face should be dissected, as under the most favourable circumstances they are difficult for the student to make out, and are rendered unintelligible to him in a few days by the changes which their diminution of volume, infiltration, and confusión of colour with contiguous parts, produce. I would also advise that one side of the face and neck be appropriated exclusively to the dissection of the fascise, 42 OF THE ENCEPHALON OR BRAIN. muscles, and glands; every thing, therefore, should be re- moved which interferes with a thorough examination of them. The student having accomplished 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 coarse injection; it is of less impor- tance to inject the veins. SECTION I. OF THE ENCEPHALON OR BRAIN. 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 and tendón of the occipito frontalis muscle over the face, and be- hind the back of the neck. The skull-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 superciliary ridges. With the aid of an iron chisel, and a mallet, the bone is afterwards easily broken through and separated from the dura mater. Should the adhesión of the latter be great a common spatula is very well adapted to destroy it. Bichat broke the skull-cap to pieces with a hammer and then re- moved it, which is a much inferior mode to the other, and objectionable from the spiculse of bone made by it. The vault of the cranium being removed as directed, an inspection of its internal table, shows us the grooved chan- nels made by the Arteria Meníngea Media over nearly its whole surface—the groove for the Superior Longitudinal Sinus, on its middle line, and a number of ulcerated look- ing fossae made by the Glands of Pacchioni. The medullary mass placed within the cavity of the era-. nium is termed in common language Brain. It affords the " following parts for sepárate examination. 1. The Mem- branes. 2. The Cerebrum. 3. The Cerebellum. 4. The Pons Varolii and the Medulla Oblongata. THE DURA MATER. 43 1. The Membranes are three: The Dura Mater, Túnica 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 at every point by filaments of fibres, and by very numerous small blood-vessels, which are shown by the dots of blood upon it, when the bones are removed as in this manner of opening the head. It is a white, shining, fibrous, semitransparent membrane consisting of two layers closely adherent to each other, the internal of which forms several processes. The most conspicuous is the Falx Major, or Cerebri, which arises from the middle of the body of the sphenoid bone, from the crista galli of the ethmoid, 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 trie junction of the limbs of its cross at the internal occi- pital protuberance. It is narrow before and broader behind, where it joins with the tentorium. Being strongly fastened in front and behind, it is kept in a state of strict tensión, which prevenís any lateral deviation. Its inferior edge is concave, and reaches nearly to the Cor- pus Callosum. The next process is the Tentorium, which forms an arch slightly convex above, and crescentic in its general figure. It is connected to the Falx Major, 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. On each side of the sella turcica, is a process of dura mater forming its lateral boundaries. At the anterior edge of the tentorium is the Foramen Ovale, which is occupied by the Pons Varolii and Crura Cerebri, and immediately under the centre of the tentorium and running towards the occipital foramen, is the Falx Minor or Cerebelli. SINUSES OF THE DURA MATER. The Sinuses are large cavities placed between the two laminse of the Dura Mater, and receive the blood from the veins of the Pia Mater. They are formed by the separation of these laminas, and are lined by a membrane, correspond- áis: with the internal coat of the veins. 44 OF THE ENCEPHALON OR BRAIN. The first is the Superior Longitudinal Sinus, and is trian- gula!*; it commences by a small beginning near the crista galli, having according to some, a small vein from the nose joining it through the foramen caecum. It enlarges by a continual accession of veins from the pia mater and termi- nates 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 strings called the Chordae Willisii or Trabeculae;—and the veins of the pia mater run- ning into it obliquely forwards, and furnished with valves. In this sinus, and also under the dura mater near the top of the brain, are many small bodies of various sizes, the Glán- dulas Pacchioni, from a line or less to three or four lines in diameter. One of the largest of these bodies on each side, near the parietal foramen, actually protrudes from the sur- face of the brain through the dura mater, and makes a deep pit into the parietal bone, near the sagittal suture. They have no excretory ducts that have been discovered, and it is uncertain whether any specific fluid is secreted by tiiem. A View of the Dura Mater of the Cranium and part of the Spinal Canal; with their Sinuses. 1.2.3. A Section of the Bones FlG. 1. composing the Vault of the Cranium, showing the arched attachment of the Falx Major. 4. Anterior portion of the Superior Longitudinal Si- nus. 5. Its Middle Portion. 6. Its Inferior Portion; the outer table of the Cranium is removed. 7. Commencement of the In- ferior Longitudinal Sinus. 8. Its Termination in the Straight Sinus. 9. The Sinus Quartus or Rectus. 10. The Vence Galeni. 11. One of the Lateral Sinuses. 12. The Torcular Herophili. 13. The Sinus of the Falx Ce- rebelli. 14. The Internal Jugular Vein. 15. The Dura Mater of the Spinal Marrow. 16. The Tentorium Cerebelli 17. 17. The Falx Cerebri. OF THE ENCEPHALON OR BRAIN. 45 From the posterior extremity of the longitudinal sinus proceeds on each side in the posterior margin of the tento- rium, the Lateral Sinus, to terminate in the foramen lacerum posterius. The lateral and inferior veins of the cerebrum and the inferior veins of the cerebellum, run into the Lateral Sinus. At the inferior edge of the falx major just above its con- cave edge and between its duplication, isthe Inferior Longi- tudinal Sinus. And at the junction of the falx major and tentorium, is the Sinus Quartus or Rectus, formed by the Inferior Longitudinal Sinus and a vessel from the interior of the brain called the Vena Galeni. The sinus quartus joins the superior longitudinal sinus at the internal occipital pro- tuberance where the general meeting of the vessels is called Torcular Herophili. The sinuses of the base of the skull. Fig. 2. 1. The Ophthalmie Veins. 2. The Cavernous Sinus of one side. 3. The Circuliir Sinus; the figure oceupies the position of the Piluitary gland in the Sella Turcica. 4. The Inferior Petrous Sinus. 5. The Transverse or anterior occipital sinus. 6. The Superior Petrous Sinus. 7. The Infernal Jugular Vein. 8. The Foramen Magnum. 9. The posterior Occipital Si- nuses. 10. The Torcular Herophili. 11, 11. The Lateral Sinuses. 46 OF THE ENCEPHALON OR BRAIN. Around the pituitary gland, in the sella turcica, is the Circular Sinus of Ridiey; and on each 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 sympa- thetic 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 de- rived from the internal carotids and vertebráis. Some of the veins accompany the arteries, and discharge into the sinuses about the base of the cranium. Within the dura mater and covering the whole exterior surface of the pia mater, is the Túnica Arachnoidea, a deli- cate transparent membrane with no red vessels in its com- position. It forms an uniform coat, not dipping into the convolutions of the encephalon, and may be seen dis- tinctly 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 base of the brain, it is continuous with the túnica arachnoidea of the medidla spinalis. It lines the internal surface of the dura mater in an analogous man- ner to that of the synovial membranes of the joints with the capsular ligaments, and secretes alubricating fluid which facilitates the motions of the brain. The Pía Mater is a tender and highly vascular mem- brane, lying in cióse contact with the brain, dipping into its convolutions and spread over the surface of its ventricles in a manner difficult to be understood without 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 membrane. By its course between the fornix and thalami it constitutes the Velum Interpositum or Tela Choroidea. It is highly useful in conducting vessels into the substance of the brain by being so extensivelv spread over its surface, and by dividing them minutely before they penétrate it. Its blood-vessels are exceedingly numerous, beino- re- OF THE CEREBRUM. 47 ceived from the vertebral and internal carotid arteries at the basis of the cranium in the manner which will be explained at the end of the chapter. Its veins are all introduced into the sinuses of the dura mater, and therefore do not accompany the arteries. THE CEREBRUM. 2. The Cerebrum weighs about three pounds, and is se- ven times as heavy as the cerebellum. It filis by far the great- er part of the cavity of the cranium, and extends from the tentorium and anterior basis of the cranium, to the vault of the latter. Above, it is partially divided by the falx major, into two equal parts called Hemispheres, and below, we see that each of these hemispheres is subdivided into three lobes. The Anterior Lobe is placed upon the orbitar process of the frontal bone; the Middle Lobe is in the middle fossa of the base of the cranium ; and the Posterior Lobe upon the ten- torium. Between the anterior and middle lobes there is a deep indentation, the Sulcus, or Fissura Magna Sylvii, cor- responding in position with the posterior edge of the little wing of the sphenoid bone, which prescribes their bounda- ries. The middle and posterior lobes are not so well sepa- rated from each other. The external surface of the cerebrum, is arranged into many convolutions (Gyri) which at a little distance, give it the appearance of the intestines of a child. The pia mater, dipping down to the bottom of the Sulci between 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, varies from a line to three or four in depth; is called the Cineritious or Cortical; is of a yellowish red colour; somewhat less consistent than the other; and covers all the convolutions. Within the cortical is the Medullary or Fibrous Matter, which is of a white colour, with small spots or dots of red owing to the blood-vessels. By separating the hemispheres, we see that just below the edo-e of the falx major they adhere together by the pia ma- ter°of the opposite sides. Dissect this adhesión through, and a broad expansión of medullary matter, the Corpus Cal- losum, is seen extending from the anterior to the posterior edge of the falx, and marked in its centre by two white lines 48 OF THE CEREBRUM. running longitudinally and slightly curved, wTith their con- vexities towTards 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 separated from it by a fissure running the whole length of the latter. The Encephalon being looked upon by the best authori- ties of the present day as a development of the spinal mar- row, may now be taken out of the head and studied from below upwards, instead of from above downwards. This method has the advantage of fixing on the mind the order of growth, but as it is difficult to demónstrate the parts in the recent state according to this plan, the following outiine will perhaps sufficiently explain the order of appearances, whilst the continuance of the brain in the cranium will faci- lítate its dissection. In proceeding with the anatomy of the brain from its base upwards, the following is the order of succession of parts in its structure. The Medulla Oblongata, the continuation of the Medulla Spinalis—the Pons Varolii on the top of the me- dulla oblongata; the Crura Cerebelli running off on each side to form the Cerebellum,,and the two diverging trunks Crura Cerebri, in advance of the Pons, which run forwards and are lost in the medullary substance of the Cerebrum. On the upper surface of these are two protuberances; the posterior is the Thalamus Nervi Optici, and the anterior the Corpus Striatum. Each crus cerebri having penetrated into the substance of its respective hemisphere, expands by a multiplication of the filaments composing it, so as to con- stitute the principal bulk of the hemisphere. The filaments may be satisfactorily traced in almost every direction to- wards the periphery of the cerebrum, where they terminate in the convolutions, their extremities being covered by the cineritious matter there. The arrangement is bést seen by scraping with a knife along the base of the brain, especially when the latter has been hardened in spirits of wine, and ít is constituted by what are called the diverging fibres of the brain by Gall and Spurzheim. The point is not indeed en- tirely settled that the diverging fibres end in the convolutions, or rather do not afterwards inflect or double themselves, and pass onwards again to the middle line of the brain, forming by their convergence the Corpus Callosum. At all events OF THE CEREBRUM. 49 the fact is quite demonstrable that as the lateral and under portions of the hemispheres consist in diverging fibres arising in and from the crus cerebri, so the upper portion and the corpus callosum consists in filaments which arise in the adjoining convolutions and collect towards the middle line of the corpus callosum, where they adhere to their congeners of the opposite side. The simplest illustration of this arrangement is given by folding a towel or strip of cloth double, on itself so as to convert it into a loop; the under part of the loop would be the diverging fibres of the cerebrum, and the upper part the converging fibres of the corpus callosum, it being recollected that the continuation of the two orders of fibres into one another in the brain is not so fully ascertained as is represented in this model. Between the two orders of fibres there is a horizontal cleft or interval. This interval is the lateral ventricle, which may be got into, under the posterior margin of the corpus callosum, from its being open there, or rather only closed by an adhesión of the membranes, which is easily lacerated. A DIAGRAM, REPRESENTING A TRANSVERSE SECTION OF THE BRAIN. Fig. 3. ]. 1. The Corpus Callosum, or great commissure of the hemispheres, extending transversely into each hemisphere. 2. The Raphé a linear de- pression between two slightly elevated ridges. 3. 3. The Lateral Ventri- cles. 4. The space between the two layers of the septum lucidum called the Fiah Ventricle. 5. 5. The Fornix. 6. 6. The thinedges of the fornix, called CorporaFimbriata. 7. The Velum Interpositum. 8. 8. The plexi- form borders of the velum interpositum, called Plexus Choroides. 9. 9. The Thalami Optici. 10. The space between the two thalami, called Third Ventricle. 11. The gray commissure of the thalami optici, called middle commissure, or commissura inollis of the third ventricle. 12. The line of the base of the brain. The details of the brain may now be learned by removing the hemispheres above the corpus callosum, with a sharp 4 50 OF THE CEREBRUM. knife, whereby a view is got of the Centrum Ovale of Vieus- sens, and also of the connexion formed between the hemi- spheres by the corpus callosum. The Centrum Ovale is, properly speaking, 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 commissure between its two sides, and also the roof of the lateral ventricles. By removing the corpus callosum, the Lateral Ventricles, one on each side are brought into view. They are horizontal cavities or fissures of an extremely irregular shape, in the very centre of the hemispheres; being the interval between the diverging and converging filaments of the cerebrum, and consist each of a central portion orbody, and three processes or cornua, which extend from the anterior to the posterior portions of the hemispheres. In the anterior lobe is the Anterior Cornu separated only by the Septum Lucidum from its fellow. In the middle lobe is the Inferior or Mid- dle Cornu passing in a winding direction downwards and forwards, and in the posterior lobe is the Posterior Cornu, also called Digital Cavity. Thk Lateral Ventricles of the Cerf.bhüm. Jb IG. 4. 1.1. The two Hemispheres cut down to a level with the Corpus Callosum, so as to show the Centrum Ovale Majus. The surface is stud- ded with the small Puncta Vasculosa. 2. A small portion of the An- terior Extremity of the Cor- pus Callosum. 3. Its Posterior Boundary; the intermedíate portion, form- ing the Roof of the Lateral Ventricles, has been removed so as to completely expose these cavities. 4. A- part of the Septum Lucí- dum, showing a space be- tween its layers which is the 5th Ventricle. 5. The Anterior Cornu of one side. 6. The comwicncemcnt of the Middle Cornu. OF THE CEREBRUM. 51 7. The Posterior Cornu. 8. The Corpus Striatum of one Ventricle. 9. The Tamia Striata. 10. A small part of the Thalamus Opticus. ] 1. The Plexus Choroides. 12. The Fornix. 13. The commencement of the Hippocampus Major in the Middle Cor- nu. The Rounded Oblong Body in the Posterior Cornu of the Lateral Ven- tricle, directly behind the Figure 13, is the Hippocampus Minor. A bristle is seen in the Foramen of Alonro. In the anterior part of the lateral ventricle is the Corpus Striatum, a long convex body, broad befóre 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 corpus striatum is the Thalamus Nervi Optici, a large convex body, the surface of which is medullary, and the interior cortical; ithas anode or tubercle (Tuberculum Anterius,) on its upper anterior face, and three on its posterior side; they are of different sizes in different subjects, and called Tuberculum Posterius Superius, Corpus Geniculatum Internum, and Corpus Geniculatum Externum. Between the thalamus and the corpus striatum in the angle formed between the internal margin of the corpus striatum, and the external one of the thalamus opticus is a streak of medullary matter called Tsenia Striata. In the posterior cornu of the lateral ventricle is a rising, called Hippocampus Minor, or Ergot from its resemblance to a cock's spur; and in the inferior cornu is a larger rising the Hippocampus Major or Cornu Ammonis, passing to its bottom and increasing in breadth as it descends. Its lower end terminates by two or three tubercles which give it the appearance of a claw, being called, from that cause, Pes Hippocampi. A considerable part of the Thalami Nervorum Opticorum is concealed by the Fornix. This is a triangular arched body of medullary matter, narrow before and broad be- hind, and extending from the anterior to the posterior ex- tremity of the thalami. It commences forwards by two crura (Crura Fornicis Anteriora,) very mucheurved, with their con- cavity backwards, and which arise deeply from the sides of the tíialami, near their unión with the corpora striata. These crura come afterwards into contact, increase much in breadth, conceal the thalami, and form the fornix, which posteriorly 52 OF THE CEREBRUM. is lost in the back of the corpus callosum and the hippo- campi 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 of the Lateral Ventricle, or Taenia Hippocampi. The under surface of the fornix is ge- nerally called Lyra on account of the striated under surface, though this is erroneous. The Septum Lucidum is a partition, fixed between the lateral ventricles at their fore part, and extends from the cor- pus callosum above, to the fornix below. It is of an irre- gular triangular shape, formed of two laminas, placed side by side with a cavity between them at their front, called 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 effusion into the ventricles, the septum looks like a continuation of the middle of the fornix, a lamina of it being contributed by the internal margin of each crus. Under the fornix and liningthe cavities of the lateral ven- tricles, as well as the other ventricles, is placed a delicate reflection of pia mater with many vessels in it, but so very thin that it can scarcely be raised up as a perfect membrane. This membrane gets into the lateral ventricles from the fossa of Sylvius and under the back of the corpus callosum. Along the hippocampus major and the exterior margin of the fornix, on each side, is placed a fold of it quite loóse and floating, which consists of a great congeries of small veins and arteries. This fold is the Plexus Choroides, which be- coming 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, being a more complete membrane, is called the Velum Interpositum or Tela Choroidea. The fornix should now be raised with the velum inter- positum, by cutting through its anterior crura and turnino- it backwards, which gives a more perfect view of the thalami. From these bodies on the opposite sides being in contact á kind of junction, the Commissura Mollis, is formed by their convexities. Anterior to this junction, is a triangular space OF THE CEREBRUM. 53 called Vulva. It is here that the lateral ventricles commu- nicate, under the anterior crura of the fornix, with the third ventricle. This communication is the Foramen of Monro. Behind the commissura mollis is a similar triangular space, the Anus. The Third Ventricle is now brought fully into view by separating the thalami, and we shall find that it is a narrow oblong cavity bounded below by the pons tarini A View of the Ventricles of the Brain, as given by a Transverse Silction of the Cerebrum just above the top of the Lateral Ventri- cles and a Perpendicular Section of the Cerebellum. 1. Section of the Os Frontis. FlG. 5. 2. Its Orbitar Píate. 3. Anterior Lobes of the Ce- rebrum. 4. Its Posterior Lobes. 5. The Medullary or White Matter of the Cerebrum. 6. The Cineritious or Gray Matter. 7. Anterior portion of the Middle Fissure of the Ce- rebrum. 8. Section of the Anterior portion of the Corpus Cal- losum. 9. The curved portion of the anterior part of the Cor- pus Callosum placed be- tween the Corpora Striata. 10. Anterior portion of the Corpora Striata. 11. Their Posterior Extremi- ty. 12. The Thalami Nervi Op- tici. 13. The Tamia Striata. 14. Section of the Anterior Crura of the Fornix. 15. Anterior Extremity ofthe3d Ventricle. 16. Its Posterior Extremity. 17. The Commissura Mollis. 18. The Peduncles of the Pineal Gland. 19. The Pineal Gland. 20. The Tubercula Quadrigemina. 21. The Valve ofVieussens divided and turned on each side. 22. Section of the Cerebellum and Arbor Vita;. 23. The 4th Ventricle.—The dark middle Fissure which leads from the ' Fourth to the Third Ventricle under the Valve of Vieusseus is the Aqueduct of Sylvius. 24. Lower portion of the Calamus Scriptorius. 25. Extremity of the Medulla Spinalis. 54 OF THE CEREBRUM. crura cerebri and emminentia mammillares, and above by the velum interpositum and fornix. At its lower front part be- low the anterior commissure is an open way, the Iter ad Infundibulum, leading to the basis of the brain, and at its posterior part just below the posterior commissure, is the aqueduct of Sylvius, or the Iter e Tertio ad Quartum Ven- triculum. The Tubercula Quadrigemina, or Nates and Testes, are situated on the superior face of the Crura Cerebri just behind the thalami, the nates being above. They are each about three or four lines in diameter; consist of medullary matter externally and cineritious within; and constitute a means of communication between the cerebrum and cerebellum by being united to the valve of the cerebellum, also called the Valve of Vieussens, which is inserted into the lower part of the Testes. The Pineal Gland is a small conoidal cineritious body, of a reddish colour found on the top of the nates. It is com- monly four lines in its longest diameter, and contains a small quantity of calcareous matter, feeling and looking like fine sand, which, however, is occasionally collected into one or more irregular masses of a line in diameter. This sandy matter is the Acervulus Cerebri, that appears about the sixth year of ufe and continúes for ever afterwards. The pineal gland is situated between the nates and the back of the fornix, being closely connected writh the under surface of, and sur- rounded 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 internal face of the thalami, on each side, above the com- missura mollis, a medullary streak the Peduncle of the pineal gland, which goes from the latter to the anterior crus of the fornix. At the anterior part of the third ventricle, just below the crura fornicis, and seen between their curvature where they diverge, is the Commissura Anterior, a medullary band like a nerve, near the corpus striatum and 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 also from one thalamus' to the other, and being a semicylindrical fold of medullary matter. OF THE CEREBELLUM. 55 The Valve of Vieussens, is seen by cutting off the poste- rior lobes of the cerebrum, removing the tentorium, 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 portion of the testes. By intro- ducing a probé 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 farther examination of the Encephalon should be prosecuted by detaching it from the basis of the cranium and turning it out, the nerves being left as long as possible, and the spinal marrow also. When inverted, it has the following parts uppermost. The anterior and the middle lobes of the Cerebrum; the two hemispheres or lobes of the Cerebel- lum; the pons Varolii or Tuber Annulare; and the Me- dulla Oblongata. THE CEREBELLUM. 3. The Cerebellum is remarkable for the difference be- tween its size and that of the Cerebrum, as it occupies only the space between the tentorium and the posterior fossse of the basis of the cranium. It is divided 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 convolutions being straight and thin, anjl resembling horizontal laminas. The latter are separated by fissures penetrating, from four to twelve lines, and thereby increasing the surface for the entrance and exit of the ves- sels. The upper surface of the cerebellum is slightly con- vex, corresponding with the concavity of the tentorium. The under surface has a double convexity corresponding with the double concavity in the inferior part of the occipital bone. The upper central part of it, just above the fourth ventricle is caljed Vermis Superior; the anterior extremity of which is called the Monticulus Cerebelli from its elevation; ' and when the two hemispheres are separated below, a promi- nence like a third lobe is seen between them, which is the Vermis Inferior. This central part of the cerebellum is the fundamental portion of Gal!. 56 OF THE CEREBELLUM. A View of the Superior Face of the Cerebellum. 1.1. The Circumference of the Cerebellum. 2. The Space between its Hemispheres behind. 3. One of the Hemispheres of the Cerebellum, show- ing the Laminas which compose it. 4. The Vermis Superior. 5. The Tubercula Quadri- gemina. 6. Section of the Crura Cerebri. When the cerebellum is cut into, 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 arborescent outiine upon all vertical sections made into the cerebellum, and has obtained the ñame of Arbor Vitas, which is merely expressive of this arrangement without designating any particular part of it. If horizontal cuts be made, the arbor vitas resemblance is not manifested, and the proportion of medullary matter appears more considerable. The two Crura of the Cerebellum one on a side pass from the medullary portion, being in fact a mere continuation of the latter. They are separated from each other by the fourth ventricle and are lost in the poste- rior upper part of the Pons Varolii. In their centre is a denticulated oval ring of cineritious matter called Corpus Dentatum or Rhomboideum. The Medulla Oblongata also called Bulbus Rachidicus is that portion of encephalic substance, which extends from the middle of the basilar process of the os occipitis to the superior margin of the first cervical vertebra. Being a con- tinuation of the medulla spinalis, it becomes gradually larger as it ascends and is about one inch long. On its under surface it is divided longitudinally by the middle fissure,' which is continuous with that on the front of the medulla spinalis. On each side of this fissure, is an oblong eminence called Corpus Pyramidale, coming to a point below, and BRAIN AND SPINAL MARROW. 57 disappearing 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 Eminentia Olivaris. 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 has some cineritious internally. By lifting it up from the cere- bellum and dissecting away the túnica arachnoidea and pia mater, a good view may be got of the Fourth Ventricle of the brain, which is closed below and separated from the spinal canal by these membranes. 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 posteriorly; by the pons Varolii anteriorly; by the medulla Oblongata below; and by the Crura Cerebelli laterally. The superior face of the medulla is excavated between the Corpora Restiformia and marked by an arrangement of its surface corresponding in some measure with the slit and nib of a writing pen, from which it has the ñame of Calamus Scriptorius. The Pons Varolii is the large projecting body placed at the top of the medulla oblongata, upon the junction of the body of the sphenoid bone with the basilar process of the os occipitis, between the anterior part of the cerebellum and the posterior part of the middle lobes of the cerebrum. It is hemispherical on its inferior surface—about an inch in diameter and divided into two halves by a superficial mid- dle longitudinal fossa, with transverse medullary fibres passing from it on each side, which come from the Crura Cerebelli. In its substance is much cineritious matter blended with medullary, the latter being arranged in strise which run in different directions and may be traced to the Crura Cerebri. In advance of the Pons Varolii and springing from it are two diverging medullary trunks, one on each side which run forward and are lost in the medullary matter of the Cerebrum. These trunks are the Crura Cerebri. They are rounded below, about eight lines long and ten in their vertical diameter, diverge mutually from their roots and are separated by a deep fissure which is considered as a repeti- tion of that on the front of the Medulla Oblongata. Each 58 BRAIN AND SPINAL MARROW. crus presents on its surface a medullary layer to which suc- ceeds a parcel of cineritious matter which on being removed is followed by a mixture of both cineritious and medullary matter more abundant than either of the preceding. A View of the Base of the Cerebrum and Cerebellum, together with their Nervks. Fig7. 1. Anterior Extremity of the Fis- sure of the Nemispheres of the Brain. 2. Posterior Extremity of the same Fissure. 3. The Anterior Lobes of the Cerebrum. 4. Its Middle Lobe. 5. The Fissure of Sylvius. 6. The Posterior Lobe of the Cere- brum. 7. The Point of the Infundibulum. 8. Its Body. 9. The Corpora Albicantia. 10. Cineritious Matter. 11. The Crura Cerebri. 12. The Pons Varolii. 13. The top of the Medulla Oblon- gata. 14. Posterior Prolongation of the Pons Varolii. 15. Middle of the Cerebellum. 16. Anterior part of the Cerebel- lum. BRAIN AND SPINAL MARROW. 59 17. Its Posteiior part and the Fis- 29. The Optic Nerve before the sure of its Hemis(jheres. Chiasm. 18. Superior part of the Medulla 30. The Motor Oculi, or Third Pair Spinalis. ofNerves. 19. Middle Fissure of the Medulla 31. The Fourth Pair, or Pathetic Oblongata. Nerves. 20. The Corpus Pyramidale. 32. The Fifth Pair, or Trigeminus 21. The Corpus Restiformc. Nerves. 22. The Corpus Olivare. 33. The Sixth Pair, or Motor Ex- 23. The Olfactory Nerve. ternus. 24. Its Bulb. 34. The Facial Nerve. 25. Its External Root. 35. The Auditory—the two making 26. Its Middle Root. the Seventh Pair. 27. Its Internal Root. 36. 37. 38. The Eightli Pair of 28. The Optic Nerve beyond the. Nerves. (The Ninth Pair are Chiasm. not here seen.) Between the Crura Cerebri at their anterior part are two small round bodies, three lines thick, in contact with each other and about the size of a French pea; they are the Cor- pora Albicantia or Eminentiae Mamillares and are formed of medullary matter without and cortical within. The Pons Tarini, or Tuber Cinereum, is a portion of the under surface of the crura cerebri, at the floor of the third ventricle. It is continuous in front with the anterior margin of the Corpus Callosum. 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 im- pervious at its apex. It is cineritious externally, which gives it a red cast, and medullary intérnally. The Glándula Pituitaria oceupies the sella turcica, and is somewhat spherical, being about six or seven lines in diameter. Its structure is firm and resisting, formed of a tough cineritious matter externally, and of a kind of me- dullary intérnally. It is almost concealed by a cióse reflec- tion of dura mater over it. NERVES OF THE BRAIN. There are Nine pairs of nerves going from the basis of the brain, and named numerically by beginning in front. 60 NERVES OF THE BRAIN. The lst Pair, the Olfactory (Nervi Olfactorii,) ap- propriated to the nose, arise by three medullary strise from the base of the brain at the corpora striata, in the fissure of Sylvius and make their appearance on the back and inferior part of the anterior lobes. Their structure is soft and pulpy, and they are protected 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 crista galli, and perfórate the cribriform píate of the cethmoid 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. A View of the Second Pair or Optic Nerves, with the origin of Seven other Pairs of Nerves. 1.1. Globe of the Eye; the one on the Left Hand is perfect, but that on the Right has the Sclerotic and Choroid Coats re- moved in order to show the Retina. 2. The Chiasm of the Op- tic Nerves. 3. The Corpora Albicantia. 4. The Infundibulum. 5. The Pons Varolii. 6. The Medulla Oblongata. 7. The Third Pair, Motores Oculi. 8. Fourth Pair, Pathetici. 9. Fiílh Pair, Trigemini. 10. Sixth Pair, Motor Ex- ternus. 11. Seventh Pair, Auditory and Facial. 12. Eighth Pair, Pneumo- gastric, Spinal Accessory and Glosso-Pharyngeal. 13. Ninth Pair, Hypoglossal. The 2á 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 surrounds their particular fasciculi; and also from having more medullary matter in Fig. 8. NERVES OF THE BRAIN. 61 them. They arise from the posterior end of the thalami and from the testes, and make their appearance between the middle lobes and the crura cerebri. There is a very cióse intertéxture of the nerves of the opposite sides just before the infundibulum, so that it is a question whether they decussate each other, or simply unite. This junction pre- sents the shape of the letter X, and is called the Chiasm or Crossing of the Optic Nerves. Being the nerves of visión, they pass to the ball of the eye, through the foramina óptica and are expande d into the retina. The 3d Pair, (Motores Oculorum,) arise from the inner margins of the crura cerebri near the pons varolii by several filaments. They pass outwards and penétrate the dura mater near the posterior clinoid process, and traversing the upper part of the cavernous sinus they get into the orbits through the foramen sphenoidale. They are distributed to the muscles of the eye, except the obliquus superior and rectus externus, and contribute to the ophthalmic ganglion. The 4th Pair, (Trochleares.) each arise by two fila- ments which quickly unite, from the valve of Vieussens just below the testes. It is the smallest cranial nerve and is not larger than a common sewing thread; it makes its appear- ance at the anterior lateral margin of the pons varolii. It penetrates the edge of the tentorium not far from the entrance of the third nerve, and running in an investment of dura mater through the cavernous sinus at the outer side of this nerve, it afterwards crosses it above, and getting into the orbit through the foramen sphenoidale, is appropriated to the trochlearis or superior oblique muscle. The 5th Pair, (Trigemini,) are the largest of all. Each arises by three portions, the middle being largest, from the side of the tuber annulare just where it is blended with the crus cerebelli. Their fibres may be traced through the pons into the posterior column of the medulla oblongata and 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 ex- panded like a fan, into seventy or eighty filaments. At the lower end of the latter is a brownish substance, called the 62 NERVES OF THE BRAIN. ganglion of Gasser, formed principally upon the middle root of the Trigeminus. The nerve then passes off in three great divisions, named from their appropriations; lst, the Oph- thalmic nerve which goes out of the cranium at the foramen sphenoidale of the orbit; 2d, the superior Maxillary, at the foramen rotundum; and 3d, the Inferior Maxillary, at the foramen ovale. Its general distribution is to the orbit, the face and the tongue. The 6th Pair, (Motores Externe) Each nerve arises from the commencement of the medulla oblongata in the base of the corpus pyramidale, its root being frequently overlapped by the pons. It passes forward through the dura mater, in a canal, of the cavernous sinus, on the inside of the fifth nerve, and lying betwreen this nerve and the carotid artery, it detaches one or more filaments to form the commencement of the sympathetic nerve, and which accom- panies the carotid artery through the carotid canal to the neck. The trunk of the motor externus then gets into the orbit through the foramen sphenoidale.and is appropriated to the rectus externus muscle of the eye. 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, at the calamus scriptorius and corpus restiforme, being separated from its fellow of the opposite side by the slit of the calamus scripto- rius. The second, or portio dura, arises from the superior part of the corpus restiforme behind, near the pons. A third nerve, which at a little distance joins the portio dura and is a mere fibril of it called portio Media, arises near the lat- ter. The seveníh 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 different destinations: The Glosso-Pharyngeal; The Par Vagum or Peumo-gastric ; and the Spinal Accessory nerve of "Willis. The first two arise near each other behind the Corpora Oli- varla from the side of the Medulla Oblongata. The Glosso- brain and spinal marrow. 63 Pharyngeal is before the other, and consists of one cord. The Par Vagum is composed of several fasciculi having a flattened appearance, which afterwards unite together. The Spinal Accessory has a remarkable origin from the posterior fasciculus of the Medulla spinalis, occasionally as low down as the seventh cervical nerve. Its fibres successively 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 Oblon- gata. The eighth pair passes out of the cranium at the pos- terior foramenlacerum, 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 Spinal Accessory for the muscles and integuments of the neck. The 9th Pair, (Hypoglossi.) Each nerve arises from the side of the medulla oblongata in the groove, between the corpus pyramidal and olivare, by three or four fasciculi. These fasciculi unite into a trunk, which gets from the cra- nium through the anterior condyloid foramen, and is dis- tributedto the tongue. 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 anteripr clinoid pro- cesses. They thére send off, each anteriorly, the ophthalmic artery through the optic foramen, and, in a short space after- wards, the Arteria Communicans Posterior, a branch which goes backwards to join the posterior artery of the cerebrum; the main trunk is continued into the fissure of Sylvius, and forms the Arteria Media Cerebri, and from this is sent off the Arteria Anterior which supplies the anterior lobe of the 64 OF THE HEAD AND NECK. brain and the corpus callosum. The arteria anterior com- municates by a short transverse branch, the Communicans Anterior, with its fellow. A View of the Circle of Willis. Fig. 9. 1. The Vertebral Arteries. 7. The 2. The two Anterior Spinal 8. The Branches. 9. The 3. One of the Posterior Spinal ar- 10. The teria. 11. The 4. The Posterior Meningeal Ar. 12. The tery. 13. The 5. The Inferior Cerebelli Artery. 14. The 6. The Basilar Artery. Superior Cerebelli Artery. Posterior Cerebelli. Posterior Communicans. Internal Carotid. Ophthalmic Artery. Middle Cerebral Artery. Anterior Cerebri. Anterior Communicans. 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 basilary artery. BRAIN AND SPINAL MARROW. 65 The Basilar artery divides anteriorly into two branches, Which run to the_posterior lobes of the brain; they consti- tute the Arterise Posteriores Cerebri. From the basilar near the vertebráis, on each side, arises a trunk, the Arte- teria Inferior Cerebelli; and from its anterior part the Arte- ria Superior Cerebelli. This arterial link is called the Ch- ele of Willis, and is formed as we have seen, by the anterior bifurcation of the basilar, with the internal carotids and the arteriae communicantes. It endoses the chiasm of the op- tic nerves, and the emminentia mammillares. The veins of the brain have been mentioned, as all emp- tying into the sinuses of the dura mater. OF THE MEDULLA SPINALIS. The Spinal Marrow is placed in the vertebral canal, and starting from the first vertebra of the neck, passes down as far as the first Or second vertebra of the loins; and there terminates in a conical point. It has the same number of membranes with the Brain; to wit, the Dura Mater, Túnica Arachnoidea and Pia Mater. The Dura Mater resembles very much the same membrane of the brain, except that it has more elasticity. It does not adhere closely to the spinal canal, but lies loosely envelop- ing the spinal marrow and nerves, until it touches the fora- mina through which the latter pass out*. Between the spi- nal canal and the dura mater, is interposed a soft, watery and vascular fat, which forms a sort of bed for the dura mater, and filis up many of the inequalities of the canal. At the egress of the dura mater from the cranium, just around the foramen magnum, it adheres very closely to it and also to the first cervical vertebra. The Pia Mater is in cióse unión with the Medulla Spi- nalis, and is commonly found with its veins injected after the same way, with the pia mater of the brain; it is, how- ever, not so vascular, and ends by a conical cord below, which goes to the lower end of the sacrum, with the dura mater. The Túnica Arachnoidea, lies loosely between the dura 5 66 OF THE HEAD AND NECK. and the pia mater, preserving a character of extreme tenuity and transparency; it may be elevated any where with a pair of fórceps; continúes 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 Denticulatum, Fig. 10. An Anterior View of the Spinal Mar- row, seen in its whole length after removal from the spinal canal. 1. Lines indicating the Corpora Pyrami- dalia. 2. Eminentia Olivaría. 3. Anterior Face of the Spinal Marrow: 4. Anterior Roots of the Cervical Spinal Nerves. 5. Anterior Roots of the Dorsal Nerves. 6. Anterior Roots of the Lumbar Nerves. 7. Anterior Roots of the'Sacral Nerves. 8.9.10.11. The Anterior and Posterior Roots of the Spinal Nerves, united to pass out of the Dura Mater. 12. Dura Mater of the Medulla Spinalis. 13. Ganglia on the Cervical Nerves. 14. Ganglia on the Dorsal Nerves. 15. Ganglia on the Lumbar Nerves. 16. Ganglia on the Sacral Nerves. 17.. Cauda Equince. 18. Sub-Occipital Nerve. 19. Ligamentum Denticulatum. BRAIN AND SPINAL MARROW. 67 fixed beneath the túnica ar- achnoidea, and connected to the pia mater by its internal margin. It is first observed arising at the occipital fora- men ; it then descends, and as it passes between the ante- rior and posterior fasciculi of nerves, it detaches many lit- tle round tooth-like processes, fixed to the inner surface of the dura mater, and carrying the túnica arachnoidea along with them. From these pro- cesses it derives its ñame. The Medulla Spinalis like the brain consists of two kinds of matter, cineritious and me- dullary. But, the latter is here placed externally. The medulla spinalis has anteriorly and posteriorly, a fissure penetrating almost to its centre, and extended its whole length, which divides itinto two equal parts. These halves are again divided each into an anterior and posterior column, by a lateral fissure, which is not so deep or long as the other, butterminates in the thoracic portion of the canal, and is nearer the poste- rior than the anterior fissure. Fig. 11. An Anterior View of the Spinal Marrow, Medulla Oblongata, &c, of a new-born Infant. 1. The Pituitary Gland. 2. The Infundibulum. 3. The Optic Nerves. 4. The Corpora Albicantia. 5. Crura Cerebri. 6. The triangular space between the Crura. 7. Corpus Geniculatum Internum, 8. Corpus Geniculatum Externum. 9. Posterior portion of the Thalami Nervi Optici. 10. Pons Varolii. 11. Its prolongation into the Crus Cerebelli. 68 OF THE HEAD AND NECK. 15. Anterior Middle Fissure of the Spinal Marrow. 16. Enlargeinent for the Origin of the Lumbar nerves. The posterior column is again divided into two. These several divisions of the spinal marrow being connected by the internal cineritious matter, when a horizontal cut is made, the latter puts on the appearance of a line with a crescent at each end. At the upper end of the medulla spinalis near the oblongata, a considerable part of the anterior portions or columns, crosses from the side to which they belong to the opposite one, and in doing so they are interwoven. This de- cussation or crossing is known as that of Petit or Mitischelli. An Anterior View of the Me- dulla Oblongata and of the Termination of the Decus- sation of Mitischelli. 1. The Pons Varolii. 2. The Eminentia Olivaria. 3. The Corpus Pyramidale. 4. The Corpus Restiforme. 5. The Decussation of Mitischelli. 6. The Anterior Columns of the Spinal Marrow. 7. The Lateral Columns. In the bottom of the anterior fissure there is a commissure of transverse fibres, said to be like the teeth of a saw; and at the bottom of the posterior fissure, there is a commissure of longitudinal fibres, these are called anterior and poste- rior Commissures. From the anterior and posterior portions of the spinal marrow, fíat fasciculi of nerves proceed by double roots which penétrate the dura mater separately, and derive a coat from it. This coat exists for some distance as a sheath, united to the nerve by loóse cellular substance, but is closely fixed to it near the intervertebral foramen. The posterior fasci- culus, 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 com- 12. Eminentia Olivaria. 13. Corpora Pyramidalia. 14. Corpus Restiforme. FlG. 12. BRAIN AND SPINAL MARROW. 69 mencement 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 ac- cording to* the part of the body to be supplied. Fig. 13. A View of a small portion of the Spinal Marrow, showing the Origins of some of the Spinal Nerves. 1. The Anterior or Motor Root of a Spinal Nerve. 2. The Posterior or Sensory Root of a Spinal Nerve. 3. The Ganglion connected with the latter. 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 foramina, are short and nearly horizontal; those of the back pass obliquely downwards, in- creasing in obliquity as they descend. The lumbar and sacral nerves are extremely oblique, the lowest being almost vertical; they arise very much in a cluster, cióse to each other, and form, while still within the dura mater, the Cauda Equina. The Arteries of the Spinal Marrow are derived from the vertebráis, intercostals, lumbar and sacral arteries. The veins accompany the arteries and form sinuses on the outside of the dura mater, one on each side, which empty into the occipital and lateral sinuses, anastomosing however very freely, with a plexus of veins which surrounds the spi- nal column. 70 OF THE HEAD AND NECK. SECTION II. Of the Muscles and Fascia. The Occipito-frontalis, a single muscle, consists of two symmetrical parts, and coming from the back of the head, is inserted into the front of it. It is superficial, being placed immediately below the skin of the scalp; and has four bellies of muscular fibres, two behind and two before, connected by a thin tendón which covers all the top of the head. The dissection of this muscle is difficult, from the cióse adhesión of its tendón to the pericranium below, and to the common integuments above. It is best therefore, to replace the scalp, and commence by making one incisión 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 each eyebrow, to the external angular process of the os frontis; by raising up this flap and enlarging it in an appropriate manner on each side, it leads to the dissection of the whole muscle. It arises from the superior semicircular ridge of the os occipitis, by tendinous and fleshy fibres which form two dis- tinctbellies, (Musculus Occipitalis,) about an inchandahalf long, one on each side of the bone. Its tendón, when care- fully traced, will be found terminating a little in front of the coronal suture, in the two anterior fleshy bellies, (Musculus Frontalis,) which cover the whole front part of the os frontis. The internal edges of these latter are in conjunction below. It is inserted fleshy on each side, into the superior margin of the orbicularis oculi and of the corrugator su- percilii, and by its nasal slip, into the internal angular pro- cess of the os frontis and into the root of the os nasi. It pulís the skin of the head backwards and forwards, and throws that of the forehead into horizontal wrinkles. It also elevates the supercilia. Its fleshy portion is said to have covered, in some in- stances the whole skull cap. The Compressor Naris arises by a pointed begi: MUSCLES AND FASCIiE. 71 from the root of the ala nasi; it spreads like a fan over the lateral parts of the nose below, is inserted into its fellow of the opposite side on the dorsum of the nose, and into the lower part of the os nasi, where it is connected with the nasal slipof the occipito-frontalis. This muscle consists of thin and palé fibres placed imme- diately under the skin. If it act from both extremities by its curved fibres being made straight, it will compress the nostril; but if it act from its dorsal margin assisted by the nasal slip of the occipito-frontalis, it will dilate the ala nasi, and has, therefore, been called Dilatans Nasum by Co- lumbus. The Orbicularis Palpebrarum is a broad circular mus- cle, 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. The fixed part of the muscle, is principally the ligamentum palpebrale internum and the internal canthus of the orbit, beingr elsewhere connected to subjacent 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, from the upper end of the nasal process of the os maxillare superius and the os unguis, and from the su- perior edge of the round horizontal tendón, called internal palpebralligament, 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 inserted into the orbital margin of the nasal process, and into orbitar process of the upper maxilla, and into the lower edge of the same ho- rizontal tendón from which it aróse. The Ciliaris muscle of Albinus, 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 tem- poral portions more than elsewhere, it is obvious that the contraction of its circular or curved fibres by making them straight, will cióse the eyelids and wrinlde the skin on them. This muscle frequently has a slip from its lower border to the upper lip, anterior to the zygomaticus minor. 72 OF THE HEAD AND NECK. A Front View of the Superficial Layer of Muscles on the Face and Neck, Fig. 14. 1.1. Anterior Bellies of the Occipito-Frontalis. 2. Orbicularis or Sphincter Palpebrarum. 3. Nasal Slip of Occipito-Frontalis. 4. Anterior Aurículas. 5. Compressor Naris. G. Levator Labii Superioris Alajque Nasi. 7. Levator Anguli Oris. 8. Zygomaticus Minor. 9. Zygomaticus Major. 10. Masseter. 11. Depressor Labii Superioris Alaeque Nasi. 12. Buccinator. 13. Orbicularis Oris. 14. The denuded surface of the Inferior Maxillary Bone, 15. Depressor Anguli Oris. 16. Depressor Labii Inferioris. 17. The portion of the Platysma-Myodes that passes on to the Mouth, or the Musculus Risorius. 18. Stemo-Hyoideus. 19. Platysraa Myodes. It is wanting on the other side of the Figure. MUSCLES AND FASCIiE. 73 20. Superior belly of the Omo-Hyoideus near its insertion. 21. Stcrno-Cleido-Mastoideus. 22. Scalenus Medius. 23. Inferior belly of Omo-Hyoideus. 24. Cervical edge of the Trapezius. The Corrugator Supercilii, is placed beneath the up- per margin of the orbicularis, at the internal end of the su- perciliary ridge. It arises from the internal angular process of the os frontis, and passing obliquely upwards and out- wards, 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 eyebrow and skin of the forehead into ver- tical wrinkles, and also draws them over the eye so as to overshadow it. The Levator Labii Superioris Aloque Nasi is fixed just at the side of the nose. It arises by a pointed pro- duction, from the nasal process of the os maxillare superius at the internal 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 upper lip, being narrower below than above. The part of this muscle which comes from the orbitar process is so distinct, that Albinus and others give it the exclusive ñame of Levator Labii Superioris. It draws the upper lip and the ala nasi upwards. Just beneath this muscle there is sometimes a fasciculus, called the Anomalus Faciei of Albinus, wThich is attached by one end to the upper jaw near the canine fossa, and by the other to the upper lip. The Levator Anguli Oris, is a small muscle concealed very much by the last; it arises from the anterior part of the superior maxillary bone, between the foramen infra-or- bitarium and the first small grinder, and is inserted into the comer of the mouth. It raises the angle of the mouth. The Zigomaticus Minor, is a small muscle sometimes deficient and sometimes double, arising from the fore part of the os malas; it descends obliquely and is inserted into the upper lip just above the córner of the mouth. 74 OF THE HEAD AND NECK. The Zigomaticus Major, being on the outside 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 pass- ing obliquely downwards, is inserted into the córner of the mouth, and runs into the depressor anguli oris. These last two muscles draw the córner of the mouth to- wards the cheek bone, or obliquely upwards and outwards, as in smiling. The Depressor Labii Superioris Alíeque Nasi, is con- cealed by the orbicularis oris and by the levator labii supe- rioris alseque nasi. To get a view of it, the upper lip must be inverted and the lining membrane of the mouth removed on the side of the frsenum of the lip. This muscle arises from the inferior part of the upper maxilla, in front of the alveolar processes for the dens caninus and the incisores, and is inserted into the side of the ala nasi and into the con- tiguous 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 cór- ner of the mouth. This muscle draws the córner of the mouth downwards. It lies immediately under the skin, and blends above with the zygomaticus major and with the levator anguli oris. The Depressor Labii Inferioris, is in part, beneath the last muscle, and like it, arises broad and fleshy from the basis of the lower jaw on the side of the chin; its fibres pass obliquely upwards and inwards, and are inserted into the whole side of the lower lip. It draws the lip downwards. These last two 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 pe- nétrate between the intervals of their fibres. Its exterior border is often formed by the Platysma- Myodes. MUSCLES AND FASCIiE. 75 A Front View of the Deep-seated Layer of Muscles on the Face and Neck. Fig. 15. 1.1. Temporalis. 2. The Eye-Ball in the Orbit with its oblique muscles in situ. 3. Corrugator Supercilii. 4. Points of insertion of the Orbicularis Palpebrarum. 5. Anterior Aurícula. 6. Orbitar portion of the Levator Labii Superioris Alaeque Nasi, 7. Compressor Naris. ti. Levator Labii Superioris in its lower third, showing its intermix- ture with the Orbicularis Oris. 9. Levator Anguli Oris. 10.11. Depressor Labii Superioris Alaeque Nasi, seen on both sides of the Face. 12. Buccinator. 13. Masseter. 14. Orbicularis Oris at the angle of the mouth. 15. Orbicularis Oris as shown in the edge of the lower lip. 16. Depressor Anguli Oris. 17. Levator Mcnti vel Labii Inferioris. 18. Depressor Labii Inferioris. 19. Adipose Tissue on the chip. 76 OF THE HEAD AND NECK. 20. Scalenus Mcdius. 21. Sterno-Hyoideus. 22. Omo-Hyoideus. 23. Sterno-Cleido-Mastoideus. 24. Trapezius as seen on the Neck. ' 25. Attachment of the Fascia Profunda Colli to the Clavicle. The Levator Mentí Vel Labii Inferioris, being placed beneath the depressor labii inferioris, is demon- strated by turning down the lower lip and dissecting away its lining membrane on the side of the frsenum. It will then be seen to arise in front of the alveolar processes of the external incisor and the canine tooth of the lower jaw, and passing obliquely downwards, to be inserted into the lower lip. It elevates the lower lip. The Buccinator, arises from the root of the coronoid process of the lower maxilla, from the back part of the upper maxilla near the pterygoid process of the sphenoid bone, and from the roots of the alveolar processes of both the upper and lower maxillary bones, as far forwards as the dentes bicuspides. It is inserted into the córner of the mouth, and into the contiguous parts of the upper and lower lip. It draws the corners of the mouth directly backwards. 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 surrounds the mouth entirely. It has no bony origin, but arises from the fibres of the several muscles which join each other at the córner 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 of 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 Supe- rioris. The Masseter is placed immediately between the skin and ramus of the lower jaw. It arises tendinous and MUSCLES AND FASCIJE. 77 fleshy from the malar process of the upper maxilla, and from the inferior edge of the malar bone between the max- illary and zygomatic sutures; and from the zygomatic pro- cess' of the temporal bone. 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 insert- ed 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 external, without the latter being raised up. When both portions act together, they cióse the jaws; the external alone also draws the lower jaw forwards; and the internal alone, will draw it backwards. The Temporalis muscle lies on the side of the head, oc- cupying its middle inferior región; it is covered externally by a thick dense tendinous membrane, the fascia temporalis, which arises from the semicircular ridge on the side of the cranium, and is inserted into the upper margin of the zy- goma. By removing this fascia, the temporal muscle is seen to arise fleshy from its inner surface, from the whole length of the semicircular ridge on the side of the os frontis and parietale, also from the surface of the cranium between this ridge and the zygoma, including the part contributed bythe frontal bone, the lower part of the parietal, the squa- mous portion of the temporal and the sphenoid. It also receives a small accession of fleshy fibres, from the internal face of the zygoma. From this extensive origin the fibres converge towards 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. It pulís the lower jaw directly upwards. 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 dis- section on a vertical section of the head, or on a head de- tached from the cervical vertebree, which can be done very 78 OF THE HEAD AND NECK. conveniently when we are engaged in the study of the nose, or of the pharynx. The Pterygoideus Externus, so called from its posi- tion, arises fleshy from the outer side of the external ptery- goid process of the sphenoid bone, from the under surface of the temporal and spinous process of the same bone, and from the tuber of the upper maxilla. It passes outwards and backwards horizontally, and is inserted into the inner side of the neck of the inferior maxilla and into the capsu- lar ligament of the articulation. When the muscles of the opposite sides act together, they draw the lower jaw forwards, but if alternately, they give it a grinding motion. The Pterygoideus Internus, arises by tendinous and fleshy fibres from the internal pterygoid process of the sphenoid bone, along the outer side of the Eustachian tube, and from the greater . part of the pterygoid fossa. Passing downwards and backwards, it is inserted tendinous and fleshy into the interior face of the angle of the lower jaw. When the muscles of the opposite sides act they cióse the jaw. A View ofthe Pterygoid Mus- cles, as shown by the remo- val of the Zygomatic Arch and the greater part of the Ramus of the Jaw. 1. Sphcnoidal portion of the Ex- ternal Pterygoid. 2. Pterygoid portion of the Ex- ternal Pterygoid. 3; Internal Pterygoid. OF THE MUSCLES OF THE NECK. The dissection of this part can now be advantageously pursued; with which view, make one incisión through the Fig. 16. MUSCLES AND FASCIiE. 79 skin, along the clavicle and upper edge of the sternum, another from the chin, over the thyroid cartilage to the ster- num, and a third from the chin to the upper part of the ear. The flap thus marked out is to be raised carefully, without cutting up a superficial membrane that lies below the skin called Fascia Superficialis Colli. The Fascia Superficialis Cervicis or Colli, is a conti- nuation of the one spread in front of the abdominal muscles, and which is there called Fascia Superficialis Abdominis; it 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 over the neck to the face, being slightly fastened to the base of the lower jaw in advance of the masseter muscle. It is spread over the submaxillary and parotid glands, is fixed to the mastoid process, to the meatus auditorius, and to the zygoma; in the latter place it is continuous in some measure with the fascia temporalis. The existence of this membrane, is thought by Mr. Colles of Dublin, to obscure the afTections of the neck and of the parotid gland, by checking the development of tumours, rendering their fluctuation and particular feel very equivo- cal, and giving a wrong course to the pus when they suppu- rate. The fascia superficialis is better marked over the parotid gland, and about the base of the jaw, than lower down. The Platysma-Myodes or the Musculus Cutaneus, is immediately beneath the fascia superficialis, or rather is between two laminas of it, the thicker one being the inner- most. It 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^iearly the whole length of this bone. * Its fibres are much more palé than those of other voluntary muscles, are collected into longitudinal fasciculi constituting a plañe of scarcely a line in. thickness, and ter- mínate in the integuments of the lower jaw and cheek. It is slightly attached to the lower jaw, and not unfreqúently runs into the muscles of the lower part of the face. 80 OF THE HEAD AND NKCK. A Side View of the Superficial Layer of Muscles on the Face and Neck. Fig. 17. 1. Tendón of the Occipito-Fron- talis. 2. Its Frontal Belly. 3. Anterior Auriculte. 4. Attollens Auriculae. 5. Occipital Belly of the Occipito- Frontalis. 6. Retrahens Aurícula;. 7. Orbicularis Palpebrarum. 3.8. Levator Labii Superioris Alce. que Nasi. 9. Compressor Naris. 10. Levator Anguli Oris. 11. Buccinator. 12. Zygomaticus Minor. 13. Orbicularis Oris and Zygoma- ticus Major. 14. Platysma-Myodes. 15. Splenius. 16. Masscter. 17. Stcrno-Cleido-Mastoid. 18. Levator Scapurae 19. Sculenus Medius. 20. Trupezius. When the whole muscle is in action, it elevates the skin of the neck. The external jugular vein is seen nearly in the centre of it, in the same direction with the fibres of the muscle, between it and the sterno-mastoid. Upon the up- MUSCLES AND FASCIiE. 81 per part of this muscle there is occasionally a thin distinct plañe of fibres crossing it and running into the depressor anguli oris. This is the Musculus Risorius of Santorini. The Sterno-Cleido-Mastoideus is beneath and decus- sates the last muscle. It forms always a prominent feature in the outiine of the neck, by passing obliquely 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 sternal end of the clavicle. These origins are separated by a considerable fissure ; they soon unite and are inserted tendinous into the mastoid process, and into the part of the superior transverse ridge of the cranium next to it. It draws the chin towards the sternum. This muscle 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, riband-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 ano- ther fascia of the neck; the Fascia Profunda Colli, or Cervicis. When the origin of the sterno-cleido-mastoideus is turned to one side, the Fas- cia Profunda of the neck is brought into view. This mem- brane arises from the larynx, forms a thin capsule to the thyroid gland, and being closely attached toits inferior mar- gin, it descends by investing the sterno-hyoid and thyroid muscles, being well marked on their anterior surfaces. It is firmly fastened to the upper edge of the sternum, the sternal end of the clavicles, and to the cartilages of the first ribs, forming an elastic and resisting membrane from the larynx to the thorax. By turning oíf 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 margin of the thyroid gland to the upper bone of the sternum ; this lamina of it is in- serted into the sternum twelve or fifteen lines below its up- per edge. It endoses, or surrounds, the transverse vein and the arteria innominata. 6 82 OF THE HEAD AND NECK. A Transverse Section of the Neck, showing the Fascia Pro- funda, and its Prolongations as Sheaths for the Muscles. Fig. 18. 14. Blood-vessels and Pneumogas- tric Nerve in. their Sheath. 15. Longus Colli. 16. Rectus Anticus Major. 17. Scalenus Anticus. 18. Scalenus Medius and Postieus. 19. Splenius Capitis. 20. Splenius Colli. 1. Platysma Myodes. 2. Trapezius. 3. Ligamentum Nuchre. 4. Sheath of Sterno-Cleido- Mastoid. 5. Muscle itself. 6. Point of Union of its Fas- cia. 7. Point of Union of the Fas- eia Profunda Colli of each side of the Neck. 8. Section of the Sterno-Hy- oid Muscle. 9. Section of the Omo-Hyoid Muscle. 10. Section of the Sterno-Thy- roid Muscle. 11. Lateral Lobe of the Thy- roid Gland. 12. Trachea. 13. Gísophagus. 21. Levator Scapula. 22. Complexus. 23. Trachelo-Mastoid. 24. Transversalis Cervicis. 25. Cervicalis Descendens. 26. Semi-spinalis Cervicis. 27. Multifidus Spinae. 28. A Cervical Vertebra. 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 loóse cellular and adi- pose matter placed at the lower part of the neck beneath this fascia, between it and the trachea, and through which the thyroid veins with their ramifications pass. This last circumstance, must always render suppurations and opera- tions in the part highly dangerous, as the pus may form fís- tula under the sternum; moreover, the continual motion of the part in respiration, prevenís adhesión from forming, 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 suggested by the late Allan Burns. He conceived that theywere a defence to MUSCLES AND FASCIJE. 83 the upper part of the thorax, and sustained in an operation, the atmospheric pressure, which without them, would fall upon the trachea, and produce difhculty of breathing, from the air not passing through the larynx with sufficient rapidity to keep pace with the dilatation of the thorax. He illustrates this opinión 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 pres- sure upon the trachea at this place.* Mr. Velpeau, on the contraryasserts,that cutting through it in opening abscesses and in operations, has no such consequences. The external borders of the fascia profunda are continued into the sheaths of the great vessels of the neck. It and the fascia superficialis, are also continuous with each other along the anterior edge of the sterno-cleido-mastoideus. Within the inferior maxilla, at its angle, is a ligamentous expansión connected with the pterygoideus externus mus- cle, which is spread out between the styloid process and the ramus of the lower jaw. This membrane, called the stylo- maxillary ligament, is joined by the fascia superficialis at its inferior edge, just before the upper part of the sterno-mas- toideus, whereby its breadth is increased downwards in the neck, giving it somewhat the condition of a vertical septum of that región; at its lower edge it runs into the sheath of the great vessels of the neck. Through its lower part, penétrate the stylo-hyoideus and digastricus muscles, and the upper part separates the parotid from the submaxillary gland. It is felt like a cord, extending 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 * The late Dr. Jason O. B. Lawrence, who, to the great regret of all who knew him, died prematurely, in 1823, in the midst of his la- bours and usefulness in anatbmy, informed me that this fascia pro- funda is well developed in the neck of a cat; and that having occa- sion to remove 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. • 84 OF THE HEAD AND NECK. of the os hyoides. Like the fascia superficialis, it is only the sheath for muscles which it surrounds, and is called fascia, from having some development of fibrous matter in its sub- stance. A View of the Superficial and Deep-seated Muscles on the Front of the Neck. Fig. 19. V6* 1. Posterior Belly of the Digas- tricus. 2. Its Anterior Belly. 3. Ligamentous Loop on the Os Hyoides through which its Ten- don plays. 4. Stylo-Hyoideus. 5. Mylo-Hyoideus, 6. Genio-Hyoideus. 7. The Tongue. 8. Hyo-Glossus. 9. Stylo-Glossus. 10. Stylo-Pharyngeus. ]1. Sterno-Cleido-Mastoideus. 12. Its Sternal Origin. 13. Its Clavicular Origin. 14. Sterno-Hvoideus. 15. Sterno-Thyroid of the Right Side. 16. Thyro-Hyoideus. 17. Hyoid Belly of the Omo.Hyoid. 18. Scapular Portion of the Omo- Hyoid. 19. Anterior Edge of the Trape- zius. 20. Scalenus Anticus of the Right Side. 21. Scalenus Posticus. 22. Scalenus Medius. The Sterno-Hyoideus arises thin and fleshy on the inte- rior of the thorax, from the approximated surfaces of the cartilage of the first rib, the clavicle, and the first bone of the sternum; it passes upwards, somewhat obliquely, and MUSCLES AND FASCIJE 85 is inserted into the inferior edge of the base of the os hy- oides. It draws the os hyoides towards the sternum. The Sterno-Thyroideus is beneath the last, and con- cealed 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 thé first rib; di- minishing in breadth somewhat as it ascends, it is inserted obliquely into the side of the thyroid cartilage. It draws this cartilage towards the sternum. The Thyro-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 approximate the os hyoides and the thyroid car- tilage. 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 intermedíate tendón; its inferior part is con- cealed by the trapezius muscle, its middle, where the tendón exists, crosses the great vessels of the neck and is covered by the sterno-cleido-mastoid muscle, and its upper extre- mity is over-lapped by the platysma-myodes. It arises from the scapula just behind the notch in its su- perior 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 placed at the upper side of the neck, and passing from the back part of the base of the head to the chin. It arises, principally fleshy, from the fossa of the temporal bone at the inside of the mastoid process; as the muscle descends towards the os hyoides, its middle part is converted into a round tendón 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 86 OF THE HEAD AND NECK. into the inside of the base of the maxilla inferior at the side of the symphysis. It receives an accession from the base of the os hyoides. It draws the os hyoides upwards when its extremities are fixed, and throws the head backwards and thereby opens the mouth, when the lower jaw is fixed upon a level of the same height, as pointed out by Mr. Hunter. By raising the posterior belly of this muscle we get a better view of the styloid muscles, which are three in number, and placed within it. The Stylo-Hyoideus, is the more superficial of the three, and arises tendinous from the middle and inferior part of the styloid process of the temporal bone, and being perfo- rated as mentioned, by the tendón of the digastricus, is in- serted 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-Pharyngeüs is more deeply situated than either of the other two muscles. It arises from the inner side of the styloid process near its root, and runs into the inside of the pharynx, between the middle and upper con- strictors, opposite the tonsil gland. It afterwards descends between the lining membrane of the pharynx, and the mid- dle and lower constrictors, and is inserted into 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 process of the lower jaw, extending from the last dens molaris to the chin. Its fibres converge inwards, and are inserted into the corresponding fibres of the opposite side, by a white tendinous line placed between it, and its fellow, and extending from the base of the os hyoides to the muscles and fascia. 87 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. A Vertical Section of the Tongue and lower Jaw, showing the Muscles attached thereto. Fig. 20. 1. A Section of the Lower Jaw. 2. Styloid Process of the Tem- poral Bone. 3. Stylo-Glossus Muscles. 4. Lower portion of Genio- Hyo-Glossus. 5. Upper portion of Genio-Hyo- Glossus. 6. Tip or Point of the Tongue, showing the Vertical Lin- gual Muscle. 7. Surface of the Tongue. 8. Transversales Lingua?. 9. Superficialis Linguae. 10. Superior Extremity of the Constrictor Pharyngis Me- dius. 11. Stylo-Pharyngeus. 12. Its Insertion. 13. Constrictor Pharyngis Inferior. 14. Os Hyoides. 15. Thyro-Hyoid Ligament. 16. Thyroid Cartilage. 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 re- moving this muscle we bring into view The Genio-Hyo-Glossus, which arises also tendinous from the tubercle on the inside of the maxilla inferior, near the symphysis, and immediately after its origin, spreads itself after the manner of a fan. Its inferior fibres are inserted into the base of the os hyoides, and the remainder by their di- verging, are inserted into the tongue its whole length, con- stituting a part of its substance. The muscles of the oppo- 88 OF THE HEAD AND NECK. site 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 side of the base and part of the cornu of the os hyoides, and from its appendix, 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 dissection. It is one of the intrinsic muscles of the tongue, and lies on the inner side of the last. For a farther account of the muscles of the tongue, see the article Mouth. There are four pairs of muscles situated on the front and sides of the cervical vertebra, behind the pharynx and cesophagus, which can only be seen imperfectly in this dis- section. 1. The Longus Colli, is next to the middle line of the vertebras, and arises from the sides of the bodies of the three superior vertebrse of the back, and from the anterior edges of the transverse processes of the five lower cervical vertebra?. Its fibres pass somewhat obliquely upwards and inwards, to be inserted into the front of the bodies of all the cervical vertebree. It bends the neck forwards, and to one side. 2. The Rectus Capitis Anticus Major, is placed out- side the last muscle, and arises tendinous and fleshy from the fronts of the transverse processes of the third, fourth, fifth, and sixth cervical vertebree, forms a considerable fleshy belly, and is inserted into the cuneiform process of the os occipitis just before the condyle. It bends the head forwards. 3. The Rectus Capitis Anticus Minor, is a very small muscle, which arises fleshy from the front of the first cer- vical vertebree, near its transverse process, and is inserted MUSCLES AND FASCIiE. 89 under the rectus major before the root of the condyloid pro- cess of the occipital bone. It bends the head forwards. 4. The Rectus Capitis Lateralis is also small, and arises fleshy from the front of the transverse process of the atlas. It 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 pulís the head a little to one side. On the outside of these muscles, passing from the exte- rior edges of the cervical vertebree to the upper parts of the thorax, are the Scaleni muscles, three in number, and named from their situation. 1. The Scalenus Anticus, arises by three distinct tendi- nous heads from the transverse processes of the fourth, fifth, and sixth cervical vertebree, and is inserted tendinous and fleshy into the upper surface of the first rib, just anteriorly to its middle. 2. The Scalenus Medius, arises by distinct tendons from the transverse processes of all the cervical vertebree, and is inserted tendinous and fleshy into the upper face of the first rib, in all the space from its middle to its tubercle. 3. The Scalenus Posticus, arises from the transverse processes of the fifth and sixth cervical vertebras, and is in- serted into the upper face of the second rib, just beyond its tubercle. The last three muscles are concealed by the sterno-cleido- mastoideus, and the anterior edge of the trapezius; to be well seen, the clavicle should beloosened from the sternum, and thrown oíf 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 ñame of Levatores Costarum. All the Scaleni elévate 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 extremity, which will be more particularly alluded to in the dissection of the axilla. 90 OF the head and neck.. SECTION III. Of the Glands of the Head and Neck. The Thyroid Gland, (Gland. Thyroidea,) consisting of two lobes united by an isthmus, is placed on the first and se- cond rings of the trachea on the sides of the larynx, extend- ing upwards laterally by the cricoid cartilage, to the thy- roid. It resembles a pair of saddle-bags in its general out- iine ; the upper edge however, being very much excavated or crescentic, wTith the horns pointing upwrards. The isth- mus passes over the second ring of the trachea, and is firmly fixed to it by a short cellular substance. Duverney and Soemmering, 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 ñame of Levator Glándulas Thyroideee. Its occurrence, in this country, is I presume, exceedingly rare, as out of several hundred subjects which I have superintended the dissection of, but few examples of it have been noticed. It may be observed however, that a process of the isth- mus looking like a muscular slip, is frequently formed on the left side, and-goes up to the base of the os hyoides, and that sometimes a few filaments are detached to the gland from the thyreo-hyoid, or crico-thyroid muscle. This gland is covered in front, by the sterno-hyoid and thyroid, and laterally, by the omo-hyoid and sterno-mastoid muscles. It is of a dark brown colour, has a capsule from the contiguous cellular membrane, or fascia, besides its own proper coat. The structure of it is very imperfectly under- stood ; the most that we know is, that it is extremely vascu- lar; when cut into, or inflated, it exhibits a great number of cells communicating with each other, of different sizes, and containing an unctuous and somewhat transparent fluid, and that it has no excretory duct. The probability is, that it is a diverticulum of blood from the salivary glands, during the intermittence of their action, and from the sympathy between it and the brain in goitre, it may exercise a corresponding function on this organ during its intervals of repose. On each side of the neck are MUSCLES AND FASCIA. 91 three large salivary glands, the Parotid, the Submaxillary, and the Sublingual. A View of the Salivary Glands in situ. Fig. 21. 1. The Parotid Gland in situ, and extending from the Zygona above, to the Angle of the Jaw below. 2. The Duct of Steno. 3 The Sub-Maxillary Gland. 4. Its Duct. 5. The Sub-Lingual Gland. The Parotid Gland [Glándula Parotis) is the largest of the three, and of a very irregular figure, as this depends 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 raeatus auditorius, to the ramus of the jaw, and extending from the skin externally to the styloid process, styloid muscles, and the tendón of the digastricus intérnally; it is there only separated from the internal carotid artery by these parts intérnally; its con- nexions are numerous and exceedingly intricate. It is re- moved in the dead subject from the contiguous parts with 92 OF THE HEAD AND NECK. great difficulty, and in the living subject, its complete and safe extirpation, is nearly impracticable. The portio dura nerve, and the external carotid artery, have to penétrate directly through its substance in order to arrive at their destinations. It has been observed, that this gland has no capsule, but is covered externally, by an extensión of the fascia superficialis of the neck; from the interior face of this fascia, many prolon- gations are sent off, which penétrate the gland in every direc- tion, separating its lobules from each other, and conducting the blood-vessels and nerves through its substance. The sub- stance 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 margin into a point, lying on the posterior part of the masseter muscle. From the upper part of this point, proceeds the parotid duct across the masseter muscle, about eight lines below the zy- goma ; and according to the observations of the late Dr. Phy- sick, 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 and formed by the coalition of branches from ramuscles, which unite successively. 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 cióse to the masseter muscle, and may easily be overlooked by the young anatomist; forwards, it dips over the edge of this muscle, 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. Sometimes 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. The Submaxillary Gland, (Gland. Sub-Maxillaris) is irregularly ovoid. It is situated below the Platysma-myo- desin the space bounded bythe digastric muscle below, the mylo-hyoid towards the mouth, and the body of the lower jaw externally, and is in contact with the facial artery. It MUSCLES AND FASCIJE. 93 almost touches the parotid gland behind, being separated from it only by the septum sent in from the fascia superfi- cialis, and at the posterior edge of the mylo-hyoideus it touches the sublingual gland. Its colour and structure is the same with that of the parotid gland, except in the capsule of cellular membrane with its internal prolongations, being much looser. It has an ex- cretory 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 muscle, and conti- núes between the genio-hyoglossus and the sublingual gland; from the latter, it receives occasionally several branches; it terminates by an orifice on the side of the frsenum linguee near its anterior edge. The Sublingual Gland (Glándula Sublingualis) is placed under the lining membrane of the mouth, between the side of the tongue, and the mylo-hyoid muscle, and being ob- long, is paralíel with the genio-hyoglossus, where the lat- ter is about to join the tongue. This gland is not uniform in the arrangement of its ex- cretory ducts. Sometimes it has fifteen or twenty excre- tory orifices in the lining membrane of the mouth; on other occasions, several of these short ducts are collected into one or two principal trunks, (Ductus Riviniani) which open either directly into the mouth, or into the duct of Wharton. By turning up the tip of the tongue, the projection of this gland is readily seen, as well as several salivary granula- lations, or little glands, which border on it. Lymphatic Glands. Medical men are often consulted on the subject of indurated and not very painful 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 ováis; some are not more than two lines in their long diameters, others are nine or ten lines long. They are both superficial and deep-seated. 94 OF THE HEAD AND NECK. Between the skin and the insertion of the sterno-mastoid muscle, there are from four to six; in the interstice just above the clavicle, between the posterior edge of the sterno- mastoid muscle and the anterior edge of the trapezius, bor- dering on the external jugular vein, there are half a dozen. Between the skin and the parotid gland there are two, one above, and the other below. On the submaxillary gland, and at its anterior and posterior extremities, there are eight or nine. It is supposed, by respectable surgeons, that several asserted cases of extirpation of the parotid and of the sub- maxillary gland, have amounted actually only to the re- moval of some of these lymphatic glands in a state of en- largement, though these glands themselves have occasionally been removed. The deep-seated lymphatic glands, are also very abun- dant; along the course of the great cervical vessels, but principally between them and the anterior edge of the tra- pezius 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 to- wards the heart, by the existence of several on the side of the cesophagus, trachea, and great blood-vessels. SECTION IV. Of the Blood- Vessels of the Neck and Head. The Right Primitive Carotid Artery, is a branch of the arteria innominata, and the left, a branch of the aorta ; their course diflers somewhat at first, the right being more oblique; afterwards the course and distribution are uniform in both.' A regular ascent is performed in front of the cervical ver- tebree, at the side of the cesophagus and pharynx, no branch being sent off till the carotid is near the os hyoides and just below its cornu. Here it divides into two branches, of nearly equal size, the Internal and the External Carotid ; the first is intended for the brain, and the last for the ex- ternal parts of the neck and head. In the lower part of MUSCLES and FASCIiE. 95 the neck, just above the sternum and clavicle, the primitive carotid is covered by the sterno-hyoideus and thyroideus, and by the sternal portion of the sterno-cleido-mastoideus, and on a line with the lower part of the thyroid cartilage, it is crossed obliquely by the omo-hvoideus muscle. This point may be ascertained before the skin is opened, by a horizon- tal line drawn across the neck over the first ring of the trachea, and consequently below the larynx. In its whole course, it is joined with the par vagum, sympathetic and descendens noni nerves. Parallel with the larynx, the carotid may be felt pulsating very distinctly, being there covered only by the platysma myodes and integuments. It is contained in a sheath of condensed 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 internal carotid, and it immediately begins to send off branches in the fol- lowing order: 1. The Arteria Thyroidea Superior, passes in a me- andering direction to its principal destination, the thyroid gland, through which it is minutely distributed, 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 between the os hyoides and thyroid cartilage, and also some twigs to the same betwreen the thyroid and cricoid cartilages. It sends off some smaller branches to contiguous parts. 2. The Arteria Lingualis arises just above the last; it goes very near the cornu of the os hyoides, by penetrating the hyo-glossus muscle. At the root of the tongue it sends off a transverse branch (the Dorsalis Linguee,) and a little farther forwards it divides into two branches, one going to the Sublingual Gland (the Ramus Sublinguahs,) the other distributed through the tongue (the Arteria Ranina.) OF THE HEAD AND NECK. A View of the Arteries of the Neck and Shoulder. Fig. 22. 1. Primitive Carotid Artery. 2. Internal Carotid Artery. 3. External Carotid Artery. 4. The Superior Thyroid Artery. 5. Branches to the Muscles. 6. Main Branch to the Gland. 7. Inferior Pbaryngeal Artery. 8. Lingual Artery. 9. Facial Artery. 10. Its Branches to the Sub-Maxillary Gland. 11. Sub-Mental Branch. 12. Principal Branch of the Facial as it goes over the jaw. 13. Occipital Artery. 14. H ranches to the Muscles on the back of the Neck. 15. Main Trunk to the Occiput. 16. Posterior Auricular Artery. MUSCLES AND FASCIA. 97 17. A Branch cut off, which goes to the Parotid Gland. 18. Origin of the Internal Maxillary Artery. 19. Origin of the Temporal Artery. 20. Origin of the Anterior Auricular. 21. The Sub-Clavian. 22. Origin of the Internal Mammary. 23. Trunk of the Inferior Thyroid, from which arise in this subject the Anterior and Posterior Cervical Aiteries. 24. Branch of the Inferior Thyroid going to the Thyroid Gland. 25. Anterior Cervical going up the Neck. 26. Posterior or Transverse Cervical. 27. Branches to the Scaleni and Levator Scapuke Muscles. 28. The Superior Scapular Artery. 29. The Thoracica Superior of the Axillary Artery. 30. A Branch to the Deltoid. 31. Recurrent Branches of the Intercostals. 3. The Arteria Facialis arises near and above the other^ it is tortuous, passing under the stylo-hyoid, and the tendón of the digastric muscle. It is much involved with the sub- maxillary gland, to which it sends branches. The submen- tal branch, arises from it here and passes forwards to the symphysis of the jaw, near the exterior margin of the mylo- hyoid muscle. The Arteria Facialis móunts over the lower jaw just be- fore the masseter muscle; to the latter, it sends a branch ; forwards, it sends another towards the front of the chin, called Inferior Labial. On a line with the córner of the mouth, it sends to the lips the Inferior and the Superior Coronary Arteries, which are very tortuous 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 infra orbitar artery ; at the internal canthus it anastomoses with branches from the ophthalmic, and then terminales. 4. The Arteria Pharyngea Inferior, is one of the smallest of the original branches, and arises from the carotid opposite to the lingual; it is small, being distributed on the pharynx, and sending a branch, the Posterior Meningeal Ar- tery, upwards through the foramen lacerum, to the dura mater. 5. The Artería Occipitalis is large, and arises oppo- 7 98 OF THE HEAD AND NECK. site to the facial and sometimes higher up. It crosses over the internal jugular vein and the eighth pair of nerves, passes the base of the cranium under the insertion 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 temporal artery. Its collateral branches, are one to the dura mater, through the posterior foramen lacerum, or the mastoid foramen, another to the interior parts of the ear, and a considerable one to the complexus and adjacent muscles of the neck. 6. The Arteria Posterior Auricularis, arises from the carotid at the lower edge of the parotid gland, and passes backwards and upwards between the meatus externus and the mastoid process, to terminate behind the ear. It is distributed principally to the contiguous superficial parts, but one branch, goesup thestylo-mastoid foramen (whence the ñame of stylo-mastoidea,) to the tympanum, and to the labyrinth. The External Carotid, while detaching these branches, becomes very deeply situated, under the digastric and stylo- hyoid muscles and the inferior end of the parotid gland, af- terwards it penetrates the substance of the gland, becoming much involved in it, and sending off several small twigs. It ascends through the gland and exhibits itself superficiaíly just before the meatus externus, in mounting over the root of the zygoma. When on a line with the neck'of the jaw- bone it sends off a very large branch, the Internal Maxillary, to the parts beneath the ramus of the bone. The origin of this branch, is to be considered as the termination of the ñame 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 distributed to the conti- guous parts. The temporal artery then rises over the zygo- ma, where a branch leaves it which penetrates the tempo- ral fascia, and is distributed to the muscles beneath ;.thisis the Middle Temporal artery. muscles and fascije. 99 A View of the Internal Maxillary Artery, as given by Sec- tions of the Bones of the Head and Face. Fig. 23. 1. Primitive Carotid Artery. 2. External Carotid. 3. Internal Carotid. 4. Section of the Superior Thyroid Artery. 5. Point where the Facial Artery crosses the Lower Jaw. 6. Inferior Goronary Artery. 7. Superior Coronary Artery. 8. Point of anastomosis of Facial with the Nasal Branch of Oph- thalmic. 9. The Occipital Artery. 10. Posterior Auricular. 11. Temporal Artery. 1». Origin ofthe Internal Maxillary Artery. 13. Meníngea Magna ofthe Dura Mater ramifying over its Surface. 14. Inferior Dental Artery in the Alveolar Processes ofthe Lower Jaw. 15. The Pterygoid Arteries. 16. The Masseter Arteries. 17. Deep-seated Posterior Temporal Artery. 18. Deep-seated Anterior Temporal Artery. 19, Buccal Arteries. 20. Infra-Orbital. 21. Posterior Palatine. 22. Origin ofthe Pterygoid Artery. 23. Origin of the Spherio-Palatinc. 100 OF THE HEAD AND NECK. 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 ihe 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 región, also anastomosing with its fellow ofthe 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 tor- tuous manner to the bottom of the zygomatic fossa, touch- ing in its course, the inferior surface of the temporal bone. It passes between the internal and external pterygoid mus- cles immediately after leaving the carotid artery ; and sends off several branches, generally in the following order: 1. Arteria Tympanica, to the cavity of the tympanum through the glenoid fissure. 2. The Arteria Meningea Parva, to the dura mater through the foramen ovale. 3. The Arteria Meningea Magna, to the dura mater through the foramen spinale. From this trunk, sometimes proceeds the lesser raeningeal to the dura mater, through the foramen ovale. 4. The Arteria Maxillaris, or Dentalis Inferior, to the teeth of the lower jaw,. through the posterior mental fora- men. 5. The Temporales Profunda?, two branches to the tem- poral muscle; the first is the posterior deep, the second the anterior deep temporal artery.. 6. The Arteria Pterygoidea, branches to the pterygoid muscles, and to the masseter. 7. The Arteria Buccalis, a branch to the buccinator and zygomaticus major. 8. The Alveolaris or Maxillaris- Superior to the great and small molar teeth of the upper jaw. 9. The Infra-Orbitalis, through the infra-orbitar canal, to the canine and incison-teeth, and,to the cheek. 10. The Palatina Superior, through the posterior pala- tine canal to the soft palate. MUSCLES AND FASCLE. 101 11. The Pharyngea Superior, to the upper part of the pharynx. 12. The Spheno-Palatina, which is the terminating branch of the internal maxillary artery, and is very mi- nutely 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 incipient aneu- rism; it curves much in getting to the foramen caroticum ofthe temporal bone, and is in contact with the par vagum and sympathetic nerves; it sends off no intermedíate branches. In the canal, it gives a branch to the tympanum, and as it lies on the side of the sella turcica, it gives the anterior and posterior arteries of the cavernous sinus. Its subsequent history is merged in that ofthe ophthalmic and cerebral arteries. The following arteries belong to the neck, and are derived from the Subclavian, as it is aboüt to get between the sca- leni muscles. A View of the Vertebral Artery, Carotid and Arch of the Aorta, as given by a Vertical Section of the Neck. I. Commencement ofthe Tho- racic Aorta. 2. The Innominata at its Ori. gin. 3. The Left Sub-Clavian. 4. The Internal Mammary Artery. 5. The Artery ¿f the Right Side. 6. The Inferior Thyroid. 7. The Vertebral in the trans- verse processes of the Cervical Vertebra?. 8. Superior Inter-Costal Ar- tery. 9. Left Primitive Carotid. 10. External Carotid Artery. 11. Superior Thyroid. 12. The Lingual, which has here a common trunk wi'h the Facial. 13. Internal Carotid. 14. Origin ofthe Aorta. Fig. 24. 102 OF THE HEAD AND NECK. 1. The Arteria Vertebralis, which goes into the canal of the transverse processes of the vertebras of the neck at the sixth, and following its course, enters the foramen mag- num occipitis to be distributed to the brain. It is very tor- tuous at the first and second vertebra. 2. The Arteria Thyroidea Inferior, which passes up obliquely to the thyroid gland, between the great vessels of the neck and the vertebras; in its distribution it anastomoses very freely with the other thyroid arteries. This artery ge- nerally sends off The Cervicalis Anterior, a small artery, which is distributed along the course of the scaleni muscles, and which comes frequently from some other branch of the sub- clavian. 3. The Cervicalis Posterior is very tortuous, and runs horizontally across the root of the neck, to the tra- pezius muscle and the subjacent ones. It arises most frequently, either from the subclavian or the inferior thy- roid. The veins of the face and external parts of the head, cor- respond so much with the distribution of the arteries, that they may be considered as having nearly the same course ; to undertake the description of them, therefore, 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 Externa,) which crosses obliquely the sterno-cleido-mastoid muscle under the platysma-myodes, 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 immedi- ately after its formation, joins the internal jugular. On other occasions the facial vein 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-myodes and outside of the sterno-cleido-mas- toideus, to join the subclavian vein in front of the scaleni NERVES. 103 muscles. 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 sinus. It lies on the outside of the internal and of the common carotid artery, enclosed in the same sheath, descends into the up- per mediastinum in contact wTith the pleura, and is joined at the internal edge of the scalenus anticus muscle, by the subclavian vein. This jugular vein ;s occasionally much di- lated, and, in the contractions 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 ; sometimes 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. SECTION V. Of the Nerves of the Head and Neck. A minute dissection of these will scarcelybe undertaken by the young student; to perform it successfully requires much time, patience, and address; when by advanced study, the latter two-are obtained, the labour will be fully compen- sated, 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 this dissec- tion may be performed on the subject appropriated to the arteries. 104 OF THE HEAD AND NECK. A View of the Facial Nerve, together with the Branches of the Cervical Plexus, &c. Fig. 25. I. The Portio Dura or Facial Nerve escaping from the Stylo-Mastoid Foramen. The Parotid Gland has been removed, in order to show the Nerve more clearly. 2. Its Posterior Auricular Branch. 3. The Stylo-Hyoid Branch. 4. The Pes Anserinus. 5. Temporal Branches ofthe Facial Nerve. 6. Malar Branches. 7. Ccrvico-Facial Branches. 8. Supra-Orbital Nerve. 9. SubCutaneus-Mala?, a Branch ofthe Superior Maxillary Nerve. 10. The Infra-Orbital Nerve. 11. Terminal Branches ofthe Inferior Dental Nerve. 12. Nervus Auricularis ofthe Cervical Plexus. 13. The Superficialis Colli Nerve. 14. The Plexos formed between the Superficialis Colli and the branche» ofthe Facial. 15 The Occipalis Minor Branch, ofthe Cervical Plexus. 16. Descending branches ofthe Cervical Plexus. 17. Tne Phrenic Nerve. 18. The Nervus Accessorius ofthe Eijrhth Pair. 19. The Great or Posterior Occipital Nerve. NERVES. 14)5 The Portio Dura, comes out at the stylo-mastoid fora- men, is almost immediately afterwards deeply involved in the parotid gland, and divides into fasciculi in its substance. Emerging at different points, it is distributed 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 ofthe inferior maxillary nerve, and branches to the lipper part of the neck, which join those of the superior cervical nerves. 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 called Pes Anserinus. The dissection of it should be commenced at the stylo-mas- toid 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 cióse 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 distribution of the first or oph- thalmic trunk, see the " Auxiliary Parts ofthe Eye." The Second, or Superior Maxillary branch ofthe Fifth pair, comes out of the^ cranium through the foramen rotun- dum, and is first seen in the upper part of the pterygoid fossa. It immediately sends forwards a branch into the in- fra-orbitar canal of the upper jaw bone, which passes through it, comes out at the infra-orbitar foramen, and ter- minates by branches on the face. This is the infra-orbitar nerve, which just before entering the canal, sends off the Posterior Dental Nerve to supply the last three molares, and afterwards sends off the Anterior Dental Nerve to sup- ply the canine, and incisor teeth. The Bicuspid teeth are supplied by a unión of filaments from the anterior and pos- terior dental nerves. 106 OF THE HEAD AND NECK. A View of the Distribution of the Trigeminus or Fifth Pair. FlG. 26. 1. Orbit of eye. 2. Antrum Highmorianum. 3. Tongue. 4. Lower Jaw-Bone. 5. Root of the Fifth Pair, forming the Ganglion of Gasser. 6. First Branch of the Fifth Pair, or Ophthalmic. 7. Second Branch of the Fifth Pair, or Superior Maxillary. 8. Third Branch ofthe Fifth Pair, or Inferior Max- illary. 9. Frontal Branch, dividing into External and In. ternal Frontal Nerves. 10. Lachrymal Branch ofthe Fifth Pair. 11. Nasal Branch. Just un- der the Figure is the long Root of the Len- ticular or Ciliary Gan- glion and a few ofthe Ciliary Nerves. 12. Internal Nasal Nerve, disappearing through the Anterior Éthmoidal Foramen. 13. External Nasal Nerve. 14. External and Interna! Frontal Nerve. 15. Infra-Orbitary Nerve. 16. Posterior Dental Branches. 17. Middle Dental Branch. 18. Anterior Dental Nerve. 19. Terminating Branches ofthe Infra-Orbital Nerve, called the Labial and Palpebral Nerves. 20. Subcutaneous-Maloe, or Orbitar Branch. 21. Pterygoid or Recurrent Nerve, from Meckers Ganglion. 22. Five Anterior Branches of the Third Branch of the Fifth Pair. 23. Lingual Branch ofthe Fifth, joined by the Chorda Tympani. 24. Inferior Dental Nerve. 25. Its Mental Branches. 26. Superficial Temporal Nerve. 27. Auricular Branches. 28. Mylo-Hyoid Branch. Afterwards, the Superior Maxillary Nerve «passes down- wards in two divisions, sometimes to a level with the sphe- NERVES. 107 no-palatine foramen, and forms the spheno-palatine ganglion, or ganglion of Meckel, from which proceed the Pterygoid, the Lateral Nasal, and the Palatine Nerves. The Pterygoid Nerve, retrograding through the foramen ofthe same ñame, gets into the cavity of the cranium through the anterior foramen lacerum at the point of the petrous por- tion 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 from the spheno-palatine ganglion; getting into the nose, they are distributed to the pituitary membrane of the outer- side of the nose, and also to the same membrane where it covers the septum. One of the branches of the latter makes a long sweep, dips into the foramen incisivum, and, ac- cording to Mr. J. Cloquet, forms a ganglion with its fellow near the bottom of the canal. With this ganglion commu- nicate branches of the palatine nerve. The Palatine Nerve, passes through the posterior pala- tine canal to the roof of the mouth; it there divides into fila- ments supplying 4the lining membrane, the soft palate, the uvula, and the tonsils. In its way downwards, it sends several small twigs to that portion of the pituitary mem- brane which covers the inferior turbinated 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 minute ramifications to the muscles of mastication, as the pterygoid, masseter, and tem- poral ; it also sends a branch (the Superficial Temporal,) of the size of aknitting-needle, which joins the portio dura, and in order to get to it, adheres closely to the neck of the infe- rior maxilla. This last branch from being blended with the portio dura, must of course, as long as it remains undi- vided, render nugatory the section of the portio dura for tic doloureux. The Second Branch of the Inferior Maxillary Nerve, 108 OF THE HEAD AND NECK. passes between the pterygoid muscles, and divides into two trunks; one of which proceeding to the tongue, is the Lin- gual 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 then passes above the mylo-hyoid muscle near the duct of Wharton, and advancing to near the end of the tongue, is divided very minutely among the papillas. The inferior maxillary nerve enters the posterior maxillary foramen ; but while doing so despatches a branch, the Mylo-hyoid, to the submaxillary gland and the muscles under the jaw; it then goes in a canal in the spongy part of the bone. Very frequently it divides into two branches, the upper of which is literally the dental nerve, and is spent by dismissing ramifications to all the teeth successively. The nerve below, however, remains to come out at the anterior maxillary foramen, and is spent on the chin. In order to proceed properly in the 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 mus- cle, and after having given a few branches to it, passing backwards, to be distributed on the anterior edge of the trapezius. By detaching next, 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 tothe Par Vagum, Glosso-Pharyngeal, and Ninth Nerve; and passing obliquely behind the internal jugular vein, downwards and backwards, in order to reach the ster- no-mastoid muscle. At this stage ofthe dissection, a multitude of nervous fila- ments is seen upon the neck, going. to its muscles, integu- ments and other parts, and interwoven with its blood-ves- sels. They form an intricate plexus, derived from various combinations of the eighth and ninth pairs, the sympathetic and the proper cervical nerves, the detailed description of which is too elabórate for a dissector's manual. It is best, therefore, for the attention to be confined to leading trunks. NERVES. 109 The Course and Distribution of the Hypo-Glossal, or Ninth Pair of Nerves. The deep-seate» Nerves of the Neck are also seen. Fig. 27. 1. The Hypo Glossus-Nerve. 2.. Branches communicating with the Gustatory Nérvea 3. A Branch to the origin of the Hyoid Muscles. 4. The Descendens Noni Nerve. 5. The Loop formed with the Branch from the Cervical Nerves. 6. Muscular branches to the Depressor Muscles of the Larynx. 7. A Filament from the Second Cervical-Nerve, and 8. A Filament from the Third Cervical, uniting to form the com- municating branch with the Loop from the Descendens Noni. 9. The Auricular Nerve 10. The Inferior Dental Nerve. 11. Its Mylo-Hyoidean Branch. 12. The Gustatory Nerve. 13. The Chorda-Tympani passing to the Gustatory Nerve. 14. The Chorda-Tympani leaving the Gustatory Nerve to join the Sub-Maxillary Ganglion. 15. The Sub-Maxillary Ganglion. 16. Filaments of communication with the Lingual Nerve. 17. The Glosso-Pharyngeal Nerve. IS. The Pneumo-Gastric or Par Vagum Nerve. 19. The three Upper Cervical Nerves. 20. The four Inferior Cervical Nerves.. 110 OF THE HEAD AND NECK. 21. The First Dorsal Nerve. 22.23. The Brachial Plexus. 24.25. The Phrenic Nerve. 26. The Carotid Artery. 27. The Internal Jugular Vein. The Glosso-Pharyngeus, is a small nerve coming from under the internal jugular vein, adhering to it and to the other branfches of the eighth pair, by condensed cellular membrane;. it passes to the tongue, between the stylo- glossus and stylo-pharyngeus muscle, and on the outside of the internal carotid artery. Following the course of the stylo-glossus muscle at its internal edge, it gets to the root of the tongue, where it is distributed on its side and mid- dle, and to the papillse máxima?. In its course, it sends se- veral branches to the muscles of the pharynx, and to its in- ternal membrane. The Ninth Pair, or the Nervus Hypoglossus, is also very deeply seáted, wThere it emerges from the cranium, at the anterior condyloid foramen. Adhering for some distance to the par vagum, by condensed cellular membrane, it abandons the par vagum, by getting between the inter- nal carotid artery, and internal jugular vein, and crossing them obliquely, about half an inch below the glosso-pha- ryngeus muscle. It descends much lowTer in the neck than the glosso-pharyngeal, forming a large curve with the con- vexity downwards. It is the nearest large nerve below the glosso-pharyngeal, the order of descent being, first, the lingual branch of the fifth pair, the glosso-pharyngeal se- cond, and the ninth nerve third. In its descent, the Ninth nerve winds externally around the external carotid artery, just below the origin of the occipital artery. Here it is below the posterior belly of the digastricus, and the stylo-hyoideus. It then passes for- wards 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 tendón of the digastricus. It now ascends on the inside of the mylo-hyoideus, and divides abruptly into many ramifications which are distributed to all the muscles of the tongue, from the space between the genio-hyo-glossus and the lingualis muscle. nerves. 111 Where the Ninth nerve winds externally around the ex- ternal carotid, it dismisses the Descendens Noni. The lat- ter descends externally along the common carotid, con- nected with its theca, as far as midway between 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-hy- oid and thyroid muscles, and from the bow, branches pro- ceed to the lowrer parts of these muscles. The Par Vagum, an important nerve, is immediately seen on separating the common carotid, and the internal jugular, from each other. It lies in the sheath of these ves- sels, at their back part and between them. Emerging from the cranium at the posterior foramen lacerum, it is some- what swollen, adheres to the ninth nerve, and to the supe- rior cervical ganglion of the sympathetic. It then 'leaves them after a short distance, assumes the position just ex- pressed, 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 Pharyngeus. Just below the pharyngeal nerve, the Laryngeus Superior is sent oíf, which descends obliquely under the Internal Ca- rotid, and divides at the posterior edge of the thyreo-hyoid membrane, into an internal and external branch. The for- mer being the largest, and above, proceeds between the os hyoides and the thyroid cartilage under the thyreo-hyoideus muscle, to the internal parts of the larynx, where it is dis- tributed by minute ramifications to the arytenoid muscles, epiglottis, 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 carotid, and passes before the subclavian artery on the right side, and before the aorta on the left. Immediately after passing these vessels, it divides into an anterior and a posterior trunk; the first is the continued par vagum, the second the recur- rent, or the Inferior Laryngeal. The Laryngeus Inferior, has the same distribution onboth 112 OF THE HEAD AND NECK. sides, but it is to be observed, that on the right, ít 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 cesophagus, and the thyroid gland. It is minutely distributed by termi- nating ramifications to the small muscles of the larynx, and to its lining membrane. One of its branches at the infe- rior part of the larynx, communicates with filaments from the laryngeus superior. The Laryngeus Inferior, has branches connecting it with the inferior cervical ganglion of the sympathetic, the car- diac plexus, and the pulmonary plexus of nerves. The Nervus Sympatheticus, is also on the back part of the great vessels of the neck, dose to the vertebra; it is commonly said to be in their sheath; this however is a loóse, if not an inaccurate style of speech, as by passing a knife handle below the sheath, and raising it up, it will be seen that the sympathetic is not one of its contents; but, on the contrary, that it is fastened somewhat tightly to the longus colli and the contiguous muscles, by cellular mem- brane. The sympathetic nerve arises by filaments of the ptery- goid, and the sixth nerve, which form a net-work in the carotid 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 chord is cióse to the eighth and ninth nerves, and opposite to the second cervical ver- tebra ; it swells out into the Superior Cervical Ganglion, which for the purposes of description, is sometimes con- sidered as the first ofthe series; it then descends, and op- posite to the space between the fifth and the sixth cervical vertebrse, it forms the Middle Cervical Ganglion, which is much smaller and more irregular than the first. The sym- pathetic is traced with some difficulty from this, in conse- quence of numerous branches coming from it; a trunk, however, may be found, as the continuation 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 Thoracie Ganglion.. NERVES. 113 The first Ganglion is increased by filaments from the sub- occipital, the first, second, and third cervical nerves. The second Ganglion receives filaments from the fourth, fifth, and sixth cervical nerves. The third Ganglion receives fila- ments from the sixth and seventh cervical, and the first dor- sal nerves. From these ganglions proceed the cardiac nerves. The Nervus Phrenicus is a small, straight, insulated 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 scalenus 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-occipital, after its ganglion is formed by the posterior fasciculus ofthe spinal marrow, exists as a trunk, which is joined by the an- terior fasciculus of the same. This common trunk gets out between tbe transverse processes of the cervical vertebra?, and is immediately divided into an anterior and a posterior branch. The posterior branches are distributed to the mus- cles and to the integuments, which lie on the posterior part of the cervical vertebra?, but the anterior branches are va- riously disposed of. The sub-occipital, and the first three cervical nerves, have their anterior branches going princi- pally to the muscles which arise from the transverse pro- cesses of the vertebra?, and to the skin of the neck. Each of these anterior branches, is united by filaments to the nerve above and below it, and a sort of plexus is formed, which lies over the levator scapula? muscle. Filaments are also sent from the anterior branches of the cervical nerves, which join with the spinal accessory nerve, the hypo-glos- sal, the portio dura, the sympathetic, and the phrenic, in various ways, which are too numerous to be mentioned here. The Axillary Plexus, from which the nerves of the upper extremity are principally derived, arises from the an- terior branches of the four inferior cervical nerves, and of the first dorsal. These branches are much larger than the pos- 8 114 OF THE HEAD AND NECK. terior, and emerge between the anterior and the middle scaleni muscles. They send some very small filaments to the lower and middle cervical ganglions of the sympa- thetic. SECTION VI. Ofthe Eye. The hairs on the superior edge of the orbit are called Supercilia, and those on the edges of the eyelids, the Cilla. The Orbicularis Palpebrarum muscle being removed, im- mediately beneath it are the two Tarsi Cartilages, which ibrm the margin, and a considerable part of the breadth of the upper and of the lower eyelid. 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 exter- nal extremities are united with each other and kept in their places by a ligamentous expansión, (Ligamentum palpebrale externum) connecting them with the orbitar margin of the malar bone, and intérnally they are fixed to the nasal pro- cess of the superior maxillary borle, by the tendón (Liga- mentum palpebrale internum,) which afíords origin, in part, to the orbicularis palpebrarum. The edge of these bodies is slanting, so that a groove is formed posteriorly where they are in contact, by which the tears are conducted to the inner córner of the eye. Near the internal extremity of each, but not in the cartilage itself, is to be found in the centre of a small eminence, a foramen, the Punctura La- chrymale, capable of receiving a bristle, and being the ori- fice of a canal, the Ductus or Canaliculus Lachrymalis, which conveys the tears into the Sacculus Lachrymalis. On the posterior surface of the tarsi cartilages, are placed several white tortuous cañáis 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 there are about thirty, and in the lower about twenty. the eye. 115 At the internal junction of the eyelids is placed the Car- úncula Lachrymalis, a small granúlated body, inferior in size to a grain of wheat, and of a glandular structure for secreting an unctuous fluid. The lids are connected to the ball of the eye, by a delicate, vascular, and highly sensible membrane, the Túnica Con- junctiva, which is spread over the anterior third of the eye, not excepting the cornea, but there it becomes perfectly transparent. At the inner surface of the eye, the conjunc- tiva is thrown into a fold, the Plica Semilunaris, corres- ponding with the membrana nictitans of some animáis. The Lachrymal Ducts, (Canaliculi Lachrymales) are under the skin of the internal canthus, are from five to six lines long, and terminate by sepárate foramina in the sac- culus lachrymalis. There is a sort of flap of the internal membrane of the sac which falls over these orifices. The Lachrymal Sac occupies all the concavity in the os unguis, and extends from a short distance above the tendón 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 extremity, and there has the ñame of Ductus ad Nasum. A duplicature of the membrane of the nose resembling a valve, is fre- quently found at the orifice below. Fig. 28. A View of the Shape and Position of the Lachrymal Canals. 1. The Puncta Lachrymalia or openings of the Lachrymal Canals in the Lids. 2. The Cul-de-Sac at the Orbital end of the Canal. 3. The course of each Canal to the Saccus Lachrymalis. 4.5. The Saccus Lachrymalis. 6. The Lower part of the Ductus ad Nasum. 116 OF THE HEAD AND NECK.. The Lachrymal Gland for the secretion of tears, is placed in the superior and external part of the orbit, near its mar- gin ; it is about ten-twelfths of an inch long, and half an inch wide, being flattened so as to suit the parts with which it is in contact. It is placed on the outer side of the túnica conjunctiva, and sends six or seven small ducts through it, whose orífices are in the túnica conjunctiva of the upper eyelid, near the external junction of the tarsi cartilages. It is divided into an anterior and posterior lobe by a small ligamentous band, attaching it to the depression of the os frontis. The muscles in the orbit are as follow: 1. Levator Palpebrje Superioris, arises near the su- perior margin of the optic foramen, and is inserted 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 of the optic foramen, and is inserted into the upper part of the ball of the eye near the cornea, by a fíat tendón. It turns the cornea upwards. 3. Depressor Oculi, or Rectus Inferior, arises from the inferior margin of the optic foramen, and is inserted 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 inserted 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 inserted into the external part of the ball of the eye. It turns the cornea outwards. THE EYE. 117 A View of the Muscles of the Eye-Ball, taken from the Outer Side of the Right Orbit. Fig. 29. 1. A small Fragment of the Sphenoid Bone around the entrance of the Optic Nerve into the Orbit. 2. The Optic Nerve. 3. The Globe of the Eye. 4. The Levator Palpebrse Muscle. 5. The Superior Oblique Muscle. 6. Its Cartilaginous Pulley. 7. Its Reflected Tendón. 8. The Inferior Oblique Muscle; a picce of its Bony Origin is broken off. 9. The Superior Rectus Muscle. 10. The Internal Rectus almost concealed by the Optic Nerve. 11. Part of the External Rectus showing its two heads. 12. The Extremity of the External Rectus at its Insertion: the interme- díate portion of the Muscle having been removed. 13. The Inferior Rectus Muscle. 14. The Sclerotic Coat The Tensor Tarsi, or Muscle of Horner, cannot be here shown, but should be sought for on the eyelids. 6. Obliquus Superior, arises from the internal margin of the optic foramen, runs along in contact with the orbitar píate of the os frontis, passes through the trochlea, near its internal angular process, and being enclosed ín a sheath sent ofT from the trochlea, its round tendón is inserted about half-way between the cornea and optic nerve in the superior part of the eyeball. It turns the eye on its axis. 7. Obliquus Inferior, arises from the orbitar píate of the superior maxillary bone near the os unguis, and is in- serted into the outer part of the eyeball, half way between tlje cornea and optic nerve. It turns the eye on its axis. 8. Tensor Tarsi. At the internal canthus of the orbit is a small muscle belonging to the internal commissure of the eyelids. This muscle is about three lines broad and six lines long; it arises from the posterior superior surface of the os unguis near its junction with the os planum, and passes forwards 118 OF THE HEAD AND NECK. 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 appro- priated to a duct, and inserted along its course almost to the punctum lachrymale. m To get a distinct view of it, the eyelids must be sepa- rated from the eye and turned over the nose, leaving the tendinous attachment of the orbicularis and ciliaris muscle. The válvula semilunaris being brought into sight by this process, must be dissected away, and also the fat and cellu- lar membrane underneath it. The muscle is now seen, and by passing bristles through the lachrymal ducts, its con- nexion with them is rendered evident, at the same time that we get a good idea of its size, origin, and insertion. While making this inspection, by turning the muscle some- what aside, we shall be rendered sensible of another fact, of some importance, that the attachment of the inner com- missure of the eyelids to the internal canthus of the orbit, is imperfectly described, even by anatomists of much mi- nuteness in their accounts. It is attributed exclusively to the tendón of the orbicularis muscle, so much so, that in the operation for fístula lachrymalis, we are strictly enjoined not to cut through the tendón, lest a puckering of the eye- lids be produced, by their line of extensión being de- stroyed. The fact on the contrary is, that a ligamentous matter behind this tendón, passes between the internal ends of the eyelids and the posterior fíat surface of the os un- guis, so that admitting the tendón of the orbicularis to be cut through, this ligament, assisted by the little muscle de- scribed, would prevent the dreaded deformity. The inter- nal extremity of this posterior ligament, is at least half an inch from the insertion of the orbicularis tendón into the nasal process, and it brings the eyelids into the curve com- monly seen at their junction. The lachrymal ducts are in- volved in this posterior ligament, passing along it into the sac, instead of going along the edges of the commissure just under the skin, as commonly described. The muscle described, must influence considerably the position ofthe puncta lachrymalia, by drawing them towards the ball of the eye, and keeping them in cióse contact with THE EYE. 119 it; it is, therefore, a very efficient means for regulating so far, the lachrymal passages and for securing the course of the tears. I am indebted to the late Dr. Physick, for a farther suggestion in regard to its use, which appears highly proba- ble. 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 this muscle is to draw the lids backwards and to keep them applied on the ball. Again, in the elevation of the upper lid, or rather the drawing of it within the orbit by the levator palpebra?, the tendency ofthe margin of the lid is to leave the ball; the upper part of the little muscle obvi- ates this tendency. As such appears to be the actions of the part, I must therefore, coincide with him in calling it Tensor Tarsi, a ñame expressive of its functions. The puncta lachrymalia have a power noticed by Richter, of projecting themselves beyond the plañe of the eye-lid in which they lie, and have an equally obvious power of re- tracting themselves, so as.to do away all appearance of pro- minence. I do not understand the cause of the first motion, but the second depends upon the muscle just described. The Ball of the Eye (Bulbus Oculi) is composed of several coats and humours. As the human subject can seldom be obtained sufficiently fresh for a proper display of the structure, it is recommended to use the eyes of sheep, bullocks, 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; for my own part, I have found a common saucer with water enough in it to float the organ, suíficient. 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 ex- amination. 120 OF THE HEAD AND NECK. A Longitudinal Section of the Globe of the Eye. Fig. 30. 1. The Sclerotic Coat. 2. The Cornea. 3. The Choroid Coat. 4. The Ciliary Ligament. 5. The Ciliary Processes. 6. The Iris. 7. The Pupil. 8. The Retina. 9. The Canal of Petit, which encircles the Leus, 10. The Anterior Chamber of the Eye, containing the Aqueous Hu- mour. 11. The Posterior Chamber. 12. The Lens enclosed in its proper Capsule. 13. The Vitreous Humour enclosed in the Hyaloid Membrane. 14. A Tabular Sheath ofthe Hyaloid Membrane. 15. The Neurilema ofthe Optic Nerve. 16. The Arteria Centralis Retinse. The Túnica Sclerotica the first coat ofthe 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 consider- able thickness, being of a compact fibrous texture, possessed of little elasticity, and therefore well calculated 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 be- fore to the Cornea. THE EYE. 121 The Cornea is a perfectly transparent membrane, con- sisting of many lamina?, united by a delicate cellular sub- stance. It is much more convex than the sclerotica, and is united to it by a broad sloping edge, where the two mem- branes adhere very firmly to each other by the sclerotica overlapping the cornea. They may be separated by putre- faction. The cornea in a healthy state, has no red blood circulating through it. It is covered before by the túnica conjunctiva, which there becomes assimilated 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-pointed scal- pel, 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 injure the coat below. By making radiated sections to the optic nerve from this circular one, we shall be able to peel off with but little difficulty, all the posterior part of the sclerotica, observing however, to leave the optic nerve. What remains of the anterior part of the sclerotica, may be easily drawn away along with the cornea. This stage of the dissection gives a good view of the Túnica Choroidea; of a white circle called the Ciliary Ligament, seeming to termínate 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 Túnica Choroidea lines all the interior of the scle- rotica and is a much thinner and more delicate membrane than it; it appears black, and is covered on the outside with a flocculent cellular substance connecting it with the sclerotica. Its black colour depends upon a large quantity of colouring matter deposited principally on its inner surface, and called Pigmentum Nigrum. The túnica choroidea abounds with blood-vessels, which make it look perfectly red in living animáis devoid of the black pigment. It has a singular ar- rangement of veins, which can be made distinct only by in- jection. They are called Vasa-Vorticosa. It is well fur- nished with nerves, which appear like flattened pieces of white thread lying on its outside. If the Iris be torn away, 122 OF THE HEAD AND NECK. the anterior edge of the membrane is seen terminating in a fringe, called Corpus Ciliare, and this fringe if closely ob- served, will be seen to consist of a great number of short and distinct processes, arising from small folds, called the Ciliary Stria?, and covered with pigmentum 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 deter- mines the colour of the eye. In its centre is a round hole called the Pupil, for admitting light, and which is increased or diminished, by the action of circular and radiated fila- ments composing the body of the membrane. They are con- sidered by many as muscular. In the Fcetus the pupil is i closed by the Membrana Pupillaris till the seventh month. The Ciliary Ligament as stated, is a circle of whitish substance which is placed around the anterior part of the eye, and serves to connect strongly the Iris with the Túnica Chorodea, and these again with the anterior edge ofthe 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 fórceps strip off the whole of the Túnica Cho- roidea. This is one of the nicest manipulations in the whole dissection, and must therefore be done with great care. If it be well executed, the most delicate membrane in the hu- man frame, will be found lining the choroid coat; it was dis- covered in Dublin, by Mr. Jacobs, and may be satisfactorily demonstrated, 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 ofthe eye. It extends from the optic nerve to the anterior edge of the retina. Beneath the Túnica Jacobi, is placed the Retina, a deli- cate, transparent, and pulpy membrane, extending from the optic nerve, distinctly to the commencement of the Ciliary Stria? of the Choroid Coat; and some anatomists maintain, that it goes on as far as the circumference of the Crystalline Humour, which is by no means so obvious. The optic THE EYE. 123 nerve, after penetrating the cribriform part of the Túnica Sclerotica, forms a bulb on its inside; from this bulb the membrane called Retina, is expanded over the interior sur- face of the eye. The Retina consists of two layers; the internal is a very delicate and a vascular net-work, consist- ing of fine meshes; the external is the proper nervous matter, having a consistence 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 arte- rial ramifications, and we commonly see them distended with blood, in our dissections of animáis killed by a blów on the head. In the centre of the Retina, is the Foramen of Scemmering, 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 visión, and of the contractions and dilatations of the pu- pil. The late Dr. Physick believed, in regard to the latter, that the Iris was immediately stimulated by the light, as he had seen cases where its motions were active and well marked, in paralysis of the Retina. The Humours of the Eye are three, the Vitreous, Crys- talline, 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 ñame. When minutely examined, it is found to consist of a fluid like water, contained in a very delicate membrane or capsule, which is cellular; the peculiar consistence of it is therefore derived from the latter. This capsule, called Túnica Hya- loidea, is fixed at the bottom of the eye by a branch of the central artery of the Retina, and before, by a cióse adhesión to the Ciliary Stria? and Body. The Retina lies loóse 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 diameter, the pos- terior convexity of which is much the greatest. Its con- sistence is that of half dissolved glue, but it becomes more 124 OF THE HEAD AND NECK. solid towards the centre. By putting 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 may be separated with a needle, into very fine fibres. It is enclosed in a capsule oí the same shape, and between it and the capsule is found a small quantity of transparent fluid, called Liquor Morgagni. Anatomists do not agree in regard to the origin of the capsule, some thinking that it is entirely derived from the túnica hyaloidea, others that it is totally distinct from it, an opinión which I am disposed to consider the correct one. Admitting the opposite to be correct, the structure of the túnica 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. In the túnica hyaloidea, surrounding the circumference 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 incomplete partitions. The Aqueous Humour is placed between the lens and the cornea, and is nearly as thin as water. The Iris floating in it, has occasioned the división of the space occupied by the aqueous humour, into Anterior and Posterior Chambers ofthe Eye; all the space ofthe aqueous humour behind the Iris, is called the Posterior Chamber, and all the space before the Iris, is called the Anterior Chamber. Both of these chambers are said by Mr. J. Cloquet, to be lined by the capsule ofthe aqueous humour ; this membrane, however, is not very evi- dent 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 profusión of which, in health, gives prominence to the or- gan, and the absorption of which in disease, produces the sunken 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 THE EYE. 125 near the anterior clinoid process of the sphenoid bone, de- taches 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 in- side of the nerve. Near the posterior part of the eye, it sends off a branch which penetrates to the centre of the optic nerve, and is distributed to the retina. It also divides into several branches which go to the Lachrymal gland; to the muscles of the eye-ball; to the Túnica Choroidea, consti- tuting the Ciliary Arteries; and finally branches which pass through the anterior and posterior a?thmoidal 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 Maxil- lary 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 exter- nal jugular; others, sending a trunk through the fora- men opticum, wrhich runs into the cavernous sinus, and con- sequently into the lateral sinuses. Five trunks of Nerves are to be found in the Orbit. 1. The Optic, which is expanded into the Retina. 2. The Third Pair, or Motor Oculi, which, passing through the foramen sphenoidale into the orbit, divides into two branches. One goes to the upper part of the orbit, and is distributed to the Levator Oculi, and the Levator Palpe- bra? Superioris; the other goes to the Adductor, the Depres- sor, and the Obliquus Inferior. From it is sent a filament which runs to the Lenticular or Ophthalmic ganglion; the latter is situated on the outside of the optic nerve near its entrance into the orbit. 3. The Trochlearis or Patheticus, the Fourth pair of nerves, is exclusively appropriated to the Obliquus Superior muscle, and also gets into the orbit, through the foramen sphenoidale. 4. The Motor Externus or Sixth pair of nerves, passes 126 OF the head and neck. through the foramen sphenoidal of the orbit, and is spent on the Musculus Abductor. 5. The First Branch of the Fifth nerve, or the Ophthal- mic, passing also through the same foramen, divides into the Frontal, Nasal, and Lachrymal. The first has but lit- tle to do with the orbit, as it simply passes along its supe- rior part, to get out upon the forehead through the supra-or- bitar foramen, and at the trochlea of the os frontis. The second passes along the inner side ofthe orbit, sends a fil- ament to the lenticular ganglion, another through the an- terior asthmoidal foramen which goes ultimately to the nose, and what remains is distributed to the lachrymal sac and the contiguous parts. The third branch goes to the lachrymal gland, whence its ñame. SECTION VIL Ofthe 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. The External Ear, consists ofthe structure exterior to the head ; and of the passage called Meatus Auditorius Ex- ternus, leading to the interior of the petrous portion ofthe temporal bone. The part in common language called Ear, is principally cartilaginous, but to the lower edge of the cartilage is ap- pended a softer structure, consisting of delicate granulated adeps, with a kind of tendinous cellular membrane. The cartilaginous portion is called Pinna, the other Lobus. The pinna presents a very unequal surface both on the out- side and on the inside. The former, being the part era- ployed in collecting rays of sound and converging them through the meatus externus, merits our principal attention. THE ear. 127 The deep concavity in the middle of it, is called Concha. In the upper part of the concha, and dividing it into two unequal fossa?, we find a ridge of cartilage commencing, which is traced in the form of a scroll, along the circumfe- rence of the pinna, till it terminates insensibly in the poste- rior 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 Anti-Tragus. Under the fold of the helix is the Cavitas Innominata, and between the bifurcation of the antihelix is the Scapha. Fig. 31. An Anterior View of the Ester- nal Ear, as well as of the Mea- tus Auditorius, Labrynth, &c. 1. The Opening into the Ear at the bottom of the Concha. 2. The Meatus Auditorius Externus or Cartilaginous Canal. 3. The Membrana Tympani stretched1 upon its ring. 4. The Malleus. 5. The Stapes. 6. The Labyrinth. The Meatus Auditorius Externus, is in the adult about one inch in depth, calculating from the bottom of the con- cha, to the membrane of the tympanum; it proceeds ob- liquely forwards, in a course corresponding to the situation of the petrous bone, and besides that, has a curve with the convexity upwards, so that when we wish to see the mem- brana tympani, or look to the bottom of the canal, the ex- ternal ear must be pulled upwards and backwards. The internal half is bony, but the outer half is composed of car- tilage and of ligamentous matter. If the skin be removed from the ear, it will be seen that the concha is formed not 128 OF THE HEAD AND NECK. entirely by cartilage ; but at the bottom of it, and connect- ing it and the commencement of the helix with the tragus, is a ligamentous expansión, which contributes also to the meatus externus. In the tragus cartilage, near the bone, are found two fissures filled up with elastic ligamentous substance ; they are the Incisura?. The whole of this ar- rangement 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 matter is joined by ligaments to the bony meatus, the exterior edge of the pe- trous bone being rough and irregular for this purpose ; there are also three ligaments, one sent to a point above the mas- toid process, one to the zygomatic process, and a third to the temporal aponeurosis. The External Ear is covered by a delicate skin, having a great number of sebaceous follicles in it; as the skin de- scends into the meatus, it becomes still more#delicate and sensible, is beset with hairs, and under it are found, in con- siderable numbers,the Glándula? Ceruminosa?, which secrete the wax. On the external ear are five muscles, which can seldom be seen distinctly enough to merit the ñame. On the supe- rior and anterior part of the helix, is the Helicis Major: on its inferior part is the Helicis Minor; on the anterior side of the tragus is the Tragicus; on the anterior part of the anti- tragus is the Antitragicus ; and on the cranial side of the ear is the Transversus Auris. In most persons, there are also three muscles appropriated to the movement of the external ear upon the head, and which, though sufficiently well developed, are scarcely ever employed. The Attolens Auricula?, which arises by a broad membrane from the tendón of the occipito-frontalis and the fascia of the temporal muscle, and is inserted into the pro- minence made by the Scapha, or Fossa Navicularis. The Anterior Auricula?, 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 Retrahens Au- ricula?, consisting of two or three parallel slips, the inferior of which arises from near the root of the mastoid process, THE EAR. 129 and is inserted into the prominence madeby the concha be- low ; 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 ñames of these muscles express their action. 2. THE TYMPANUM. This is the middle portion of the organ of hearing, and is situated in the outer part of the Petrous Bone, being separated from the Meatus Externus 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 outermost. It is not fíat, but has its centre drawn inwards by the handle of the malleus. It consists of four layers, the cuticle, the true skin, the proper membrane, and the lining membrane of the tympanum. When successfully injected, it shows a high degree of vas- cularity. The two outer layers are easily separated from the others, and do not partake much of their vascularity. The tympanum contains a great deal of curious and in- teresting structure; its depth is about three lines; its antero- posterior diameter six lines; and its vertical diameter ratfier 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 ante- rior side is seen the canal of Eustachius, going to the pos- terior naris. In the bottom and central part of the tym- panum, 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 Rotundum. On the posterior surface of the tympanum, in a line with the foramen ovale, is a very small bony process, the Pyra- mid, 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 are the Malleus, Incus, Os Orbiculare, and Stapes. The Malleus is placed before the others, and consists of a sphericaí head, a neck just below the head, uniting it with 9 130 OF THE HEAD AND NECK. a tapering handle; a long and crooked projection of the an- terior part of the neck, called Processus Gracilis, and a short one on the outside below the other, called Processus Brevis, which sends out a round ligament to the edge oí the tympanum. This ligament is described by some as the Laxator Tym- pani Minor Muscle. The Incus is behind the malleus, and resembles some- what a molar tooth, with two fangs widely separated, one being much longer than the other. The superior and ante- rior part of the body of the bone is excavated for articu- lating with the head of the Malleus. From the lower part of the body proceeds the Processus Longus; and from the back part looking into the orifice of the mastoid cells is the Processus Brevis. The Os Orbiculare, is a flattened sphere, about the size of a mustard-seed, placed between the extremity 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 malleus. It has a small head, articulating with the os orbiculare, from which proceed an anterior and a posterior crus. On the inner side of each crus, is a fossa, running 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 ofthe tympanum; their bo- dies 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 throufrh "the Eustachian 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 movcment of these bones, two to the Malleus, and the other to the Stapes. THE EAR. idl A View of the Labyrinth and Tympanum of the Ear, with the Bones in Situ; highly magnified. Fig. 32. 1. Processus Longus of the Malleus. 2. Its Processus Brevis. 3. Its Manubrium. 4. Its Neck. 5. Its Head. 6. Body of the Incus. 7. Its Processus Brevis. ... • r 8.8. Its Processus Longus, with the little head for articulating with the Stapes. 9. The Head of the Stapes. 10. Its Anterior Crus. II. Its Posterior Crus. 12. Its Base. 13.14.15. The first turn of the Cochlea. 16.17.18. Its second turn. 19. Its half turn. 20. The Cupola. 21. The Fenestra Rotunda. 22.23. The Vestibule. 24.25.26. Anterior Semicircular Canal. 27. Its junction with the Posterior Canal. 28.29.30.31. The Posterior Semicircular Canal. 32.33.34.35. The External Semicircular Canal. The Enlargements on these Canals are called AmpuÜíe. 132 OF THE HEAD AND NECK. The Laxator Tympani, placed in the glenoid fissure of the temporal, and arising from the spinous process of the sphenoid bone, is inserted into the processus gracilis of the Malleus. It draws the Malleus forward and out- wards, so as to relax the membrane of the tympanum. The Tensor Tympani, arises from the cartilage of the Eustachian tube, lies in its upper bony part and is inserted by a tendón into the neck of the malleus, a little below the processus gracilis. It draws the handle of the malleus inwards, and makes tense the membra tympani. The Stapedius, arises from the bottom ofthe cavity of the pyramidal process, and is inserted by a delicate round tendón 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 acces- sible in it, and nearly as fully developed as in the adult. The petrous bone here has a condensed but thin struc- ture on its surface, which being removed, brings into view a soft cellular bone, easily managed with a pen- knife. By paring it away, we come in contact with the labyrinth, which is readily recognised by its hardness and brittleness, and may be got out with but little trouble. Having proceeded thus far, the labyrinth is seen to consist of three parts; above and posteriorly are the Semicircu- lar 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 up- per part of the vestibule, are so situated that one is Supe- rior, another Posterior, and the third Exterior. The su- perior and posterior are united together at their upper extremities, and therefore have a common canal entering into the vestibule; their other extremities are widely di- vergent from each other, and enlarged, each forming an ampulla before it enters into the vestibule. The exterior canal is shorter than the others, lies nearly horizontal, and THE EAR. 133 has its external 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 orífices 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 orífice between them. On the superior and exterior part of the cavity, contiguous to the openings of the canals, is the semi-ellíptical depression, and below this and some- what more intérnally, is the hemispherical depression, the rccollection 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 ca- vity 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 cribriform base, forming the bottom of the meatus auditorius internus, and an apex which occasions the promontory in the tympa- num. Passing from its base towards the apex, is a pillar of bone called Modiolus, on which the 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 ñame Infundibulum. The apex of the cochlea, from its covering over the Infundibulum, 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 lamelkeof 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 consist besides cartilage, of a cellular portion containing a fluid, and of a membrane. These portions are called Zones, we therefore have Zona Ossea, Coriácea, Vesicularis, and Membranácea. The lamina spiralis terminates in the infundibulum by a process called Hamulus. The divisions in the Cochlea, thus made by the lamina spiralis form the scalse. The lowest of these scalse, has the 134 OF THE HEAD AND NECK. foramen rotundum from the tympanum, looking into its base, and the upper, communicates by the foramen at the bottom of the vestibule, with the cavity of the vestibule. From these Communications we have the ñames Scala Tympani, and Scala Vestibuli. The scalae communicate also with each other, just at the hamulus, in the infundibulum. The whole labyrinth is lined by a highly vascular mem- brane, exhibited by our preparations in the Üniversity, 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 vas- cular membrane just mentioned, the following parts. Three Membranous Semicircular Canals within the bony, conform- ing to their figure and containing a pellucid fluid; these canals all communicate by their extremities with a sac called Sacculus Ellipticus, and by Scarpa from its function, Alveus Communis, situated in the semi-elliptical depression of the vestibule. In it are found some small crystalline pulverulent masses of a calcareous composition, which are thought to contribute to the auditive function of the Labyrinth, and are called Otoconie by Mr. Breschet. Within the vestibule, and occupying the hemispherical cavity, is another and smaller sac like a bubble, filled with a transparent fluid, distinct from the former, and called the Sacculus Sphericus. To complete this part of the description 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 scalae 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 the two sup- posed aqueducts for its removal, called after Cotunnius, one for the Vestibule, another for the Cochlea. The first arises near the common orífice of the superior and posterior semi- circular canals, and discharges itself just behind the meatus auditorius internus. The other comes from the cochlea near the foramen rotundum, and runs into the jugular fossa just at the root of the spine for separating the eighth pair of nerves from the internal jugular vein. In investigating these canals, Mr. Ribes has since ascertained that they only con- THE EAR. 135 duct blood-vessels, and that Cotunnius and others were in error in regard to their functions. The Nerve of Hearing, or the Portio Mollis, is dis- tributed throughout the labyrinth. The bottom of the meatus internus being divided into two unequal fossse by a ridge, the uppermost is the smaller and perforated 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 fibrillas 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 within the bony labyrinth. One división entering the vesti- bule, is spent on the alveus communis and membranous canals; another división goes to the sacculus sphericus. A third división, penetrating from the base of the modiolus, runs through it and comes out upon the lining membrane of the cochlea, between the plates of the lamina spiralis, and through the infundibulum and other parts. The fibrillse of the portio mollis during this distribution, continué exceed- ingly delicate, and are finally found in a pulpy state re- sembling the retina, upon the internal surface of the cavities and sacs just mentioned. 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 outwards almost as far as the vidian foramen and there makes a very abrupt turn back- wards, forming an acute angle called its elbow. It then runs just above the foramen ovale, making a ridge in the tympanum; continúes its course so as to surround the back part of the tympanum, and emerges at the foramen stylo- mastoideum. It is afterwards distributed to the face. Its canal in the bone is called the Aqueduct of Fallopius. Near the vidian foramen, it sends a filament to the tensor tympani and at the base of the pyramid, one to the stapedius. The Chorda Tympani, a branch of the pterygoid nerve, passes into the vidian foramen and joins the portio dura, 136 OF THE HEAD AND NECK. running closely connected with it almost to the stylo-mastoid foramen. It then leaves the portio dura at an acute angle, en- ters into the back part ofthe tympanum and 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 the glenoid foramen and joins ultimately the lingual branch of the fifth pair of nerves. The labyrinth is principally supplied with blood from a branch ofthe vertebral artery, which gets to it through the meatus internus. The tympanum and external ear are sup- plied from the stylo-mastoid and temporal arteries. SECTION VIII. Ofthe Nose. In order to understand this part of our structure, itis ne- cessary to be well acquainted with the bones constituting its cavity, both individually and collectively. Being thus prepared, we shall see that the nostrils which are incom- pletely separated from each other in the skeleton, have a perfect septum in the recent subject, which renders them two distinct cavities. This is effected by a cartilage placed at the anterior part of the vomer and of the nasal lamellae of the asthmoid bone. At the junction of this cartilage with the nasal suture, it spreads out on each side into a wing, which is attached to the lower edge of the nasal bones and the adjoining margin ofthe nasal process ofthe upper maxillary, and extends by such means, the bridge of the nose. Proceeding from the lower edge ofthe wing of this car- tilage, and from the external bony margin of the anterior naris, is an elastic ligamentous membrane forming the side of the nostril. At the anterior part of this membrane is an oval cartilage, which forms two-thirds of a ring, the exte- rior portion of it is the broadest; the internal portion, placed in contact with the corresponding part of the oval THE NOSE. 137 cartilage of the other side, runs backwards, and forms by the unión, the Columna Nasi. In the back of the ligamen- tous membrane there are several detached pieces of carti- lage, which give firmness to the structure, and produce the prominence of the ala nasi. It is by means of these several cartilages that the orífice of the nostril is kept open. The posterior nares being separated by the vomer, are oval, and do not present an outiine differing much from that produced by the naked bone. At the posterior extremi- ties of the inferior turbinated bones are the orífices of the Eustachian Tubes, placed obliquely, and large enough to admit the end of the little finger. It is not difficult to reach them with an instrument gently curved, introduced through the inferior meatus of the nose, an operation fre- quently required in cases of deafness. They are here partly membranous, and partly cartilaginous, running up- wards 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 thiekness diminishes the foramen leading into the sinuses. Under the anterior part of the middle spongy bone, is an orifice which leads through the ethmoidal cells into the frontal sinus. At the middle part of the middle meatus, or that between the lower and middle spongy bones, is the opening into the Antrum Highmorianum, capable of giving entrance to a common quiil. In the meatus.formed posteriorly in the ethmoid bone, under the cornet of Morgagni, are the orifices of the posterior ethmoidaj cells; at the back part of this cornet, and a little above it, is the orifice ofthe sphenoidal sinus. Immediately 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 ofthe nose. The Schneiderian or mucous membrane when well in- jected, shows great vascularity; its reflections into the si- nuses 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 studded with many mucous follicles which pass obliquely into it, some of them being arranged in rows. It'aüheres closely to the bones, and that surface in the compactness of its texture resembles periosteum. 138 OF THE HEAD AND NECK. 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, perforating the cribriform píate, and taking a coat of dura mater which ren- ders them strong and fibrous. One row is spread on the membrane, covering the upper part of the eethmoid bone, and descends as low as the inferior edge of the middle spongy bone; the other is distributed to the membrane of the nasal septum and its fibres descend somewhat lower. The fibrilla? of these nerves terminate on the nasal surface of the membrane. A View of the First Pair or Olfactory Nerves, with the Nasal Branches of the Fiith Pair. Fig. 33. 1. Frontal Sinus. 2. Sphenoidal Sinus. 3. Hard Palate. 4. Bulb of the Olfactory Nerve. 5. Branches of the Olfactory Nerve on the Superior and Middle Turbi- nated Bones. 6. SphenoPalatine Nerves from the Second Branch of the Fifth Pair. 7. Internal Nasal Nerve from the first Branch of the Fifih. 8. Branches of 7 to the Schneiderian Membrane. 9. Ganglion of Cloquet in the Foramen Incisivum. 10. Anastomosis of the branches of the Fifth Pair on the Inferior Tur- binated Bone. THE MOUTH. 139 2. The Spheno-Palatine Nerve, comes from the Spheno- Palatine Ganglion through the spheno-palatine foramen, and gives fibres to the septum and lateral parts ofthe nose. One of the former dips into the anterior palatine foramen, joins with its fellow from the other side, and forms a ganglion near the roof of the mouth. 3. The Nasal Nerve of the First Branch of the Fifth Pair, passing through the anterior sethmoidal foramen into the cranium, dips down at the side of the crista galli into the nose, and may be traced along the nasal bone to the tip of the nose. The nose is supplied principally with Blood from the in- ternal maxillary artery, and from the sethmoidal branches of the ophthalmic. Its veins accompany the arteries. SECTION IX. The Mouth. The cavity of the mouth, is chiefly formed by the palatine process of the upper maxillary and palate bones, above ; by the tongue, and the muscles connected 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, and 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 mus- cles compose its bulk. The Stylo-Glossus, which arises from the anterior part of the styloid process, 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 thm 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 Lingualis, which arises indistinctly from the root of the 140 OF THE HEAD AND NECK. 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 con- tact with its fellow of the opposite side. It arises from the tubercle on the posterior face of the symphysis of the lower jaw; its fibres radiate so as to be inserted from the body of the os hyoides to the tip of the tongue. Besides these regu- lar and well defined muscles, there are many fibres which cross the organ in various directions, and facilítate much its motion. They are the Superficialis Linguse forming a thin layer on the upper surface ofthe tongue; the Transversales Linguse being scattered fasciculi going horizontally, and the Verticales Linguse which are also scattered and go ver- tically. The superior surface of the tongue on its anterior two- thirds is rough from the presence of a number of eminences on it, called Papillse. At the posterior part are about nine of them, arranged like the letter V, wTith the point backwards, much larger than the others. They are fixed in pits, and surrounded by a fold of the integuments; from their parti- cular form, they have been called Papillse Capitatse or Máx- imas. Distributed over the tongue, and scattered at irregu- lar distances from each other, are the Papillse Medise, 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 called Papillse Villosse. And a fourth set of them, filling up the intervals left between the others and being the smallest of any, are called Papillse Filiformes. It is probable that these Papillse, except the first, are essenti- ally connected with the function of taste, as they are, abun- dantly supplied with nerves and blood-vessels, having a pe- culiar arrangement. At the posterior part of the tongue is a fold of the mem- brane covering it, which rises up to join the Epiglottis car- tilage ; and within this duplicature is a ligamentous 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 pro- duces some trouble from articles of food lodging in it. A little anterior to this fold is a small blind hole, receiving the central papilla máxima and into which some mucous glands discharge their contents, it is called the Foramen Csecum of THE MOUTH. 141 Morgagni; and sometimes behind it is another foramen cse- cum, but without a papilla. Scattered about the root of the tongue we find many mucous glands. The lining membrane of the mouth, when the cuticle is separated from it by maceration, exhibits a surface covered with fine vilii. On the lips and cheeks, under it, are situ- ated many small glandular bodies, called Glandulse Labi- ales, and Buccales. It forms a frsenum where it is reflected from the upper and lower lips to the centre of the jaw bones. On thealveolar processes, its texture is more dense, constituting the gums, which closely surround the necks of the teeth. The membrane is also united to the lower side of the tongue by a frsenum, on each side of which we see the orifices of the ducts of the sub-maxillary glands. Un- der the tongue, at its side, and projecting into the cavity of the mouth, but covered by the lining membrane, is the Sub- lingual Gland, opening by fifteen or twenty distinct orifices. On the cheeks, opposite the interstice of the second and third molar teeth of the upper jaw, is found the orifice of the duct of the Parotid Gland. 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 mu- cous 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 dis- tinctly, by depressing the lower jaw, an incompíete parti- tion, which divides it from the pharynx. It is the Velum Pendulum Palati, formed by the lining membrane 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 terminating in two cre- scentic rido-es, 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 in- serted into the side of the basis of the tongue. The pos- 142 OF THE HEAD AND NECK. terior half arch, arising from the side of the uvula near the anterior, runs backwards and outwards, and is lost ihsensi- bly about the middle of the pharynx. Between the half arches, on each side, is placed the Tonsil Gland, the surface of which is commonly so reticulated, that it might readily be mistaken for ulceration. The space between the lateral half 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 follows: 1. In the anterior half arch is the Constrictor Isthmi Faucium, which arises from the middle of the soft palate near the root of the uvula, and is inserted into the side of the tongue near its root, in a line with the papillse maximae. It tends to cióse the opening between the mouth and the pharynx. 2. In the posterior half arch is the Palato-Pharyngeus. It arises from the middle of the soft palate behind, near the root of the uvula, and is inserted in the pharynx be- tween the middle and lower constrictors and into the supe- rior posterior margin of the Thyroid Cartilage. It draws the velum palati downwards. t 3. The Circumflexus or Tensor Palati, arises from the spinous process of the sphenoid bone behind the foramen ovale, and from the contiguous part ofthe Eustachian tube, it passes in contact with the pterygoideus internus muscle, and terminates in a broad tendón below, which winds around the hook of the internal pterygoid process, and is inserted into the soft palate near its middle, and into the posterior lunated edge of the palate bone. It spreads out, or extends the palate. 4. The Levator Palati, arises from the point of the pe- trous bone and contiguous part of the Eustachian tube; it is on the inner side of the former muscle, and passes down- wards to be inserted into the soft palate. It draws the soft palate upwards. PHARYNX AND CESOPHAGUS. 143 5. The Azygos Uvulíe arises from the posterior termi- nation 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 vertical breadth of the soft palate. SECTION X. Of the Pharynx and QZsophagus. 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 substance, is closely attached to the basis of the skull before 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 and cricoid car- tilage, and below, it contracts so as to be continuous with the cesophagus. In consequence of these several attach- ments, it constantly remains a patulous unoccupied cavity, having a free communication with the nostrils and Eusta- chian tubes above, with the mouth just below them, with the larynx still lower down, and with the cesophagus at its bottom. The lining membrane which is expanded over it, is continuous with the lining membrane 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 ver- tebra 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. The 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, 144 OF the head and neck. covering the lower edge of the next muscle, and its inferior fibres are more transverse, being connected with the ceso- phagus. 2. The Constrictor Pharyngis Medius, arises from the appendix and cornu of the os hyoides, and from 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 cuneiform process of the os oc- cipitis just before the recti majores muscles. 3. The Constrictor Pharyngis Superior, arises from the pterygoid process of the sphenoid bone, and from the upper and lower jaw bones, behind the last molar teeth, being con- nected with the buccinator muscle. It is inserted into its fellow, by a white line in the middle of the pharynx, the upper end of wmich adheres to the cuneiform process of the os occipitis; it has its lower edge concealed by the pre- ceding. These muscles all assist in conveying the food from the mouth into the cesophagus. The pharynx, after the dissection of these muscles, may be cut open vertically at its back part, when a very satis- factory view of all the cavities connected with it will be obtained. THE 03SOPHAGUS. This is a tube leading from the pharynx to the stomach, it is placed between the trachea and cervical vertebra? above, passes into the thorax between the laminse of the posterior mediastinum, in contact with the dorsal vertebra, pene- trates through the left foramen of the diaphragm and ter- minates in the cardiac orifice of the stomach. (See Poste- rior Mediastinum.) The GSsophagus is formed of three coats, the muscular, the cellular, or 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 internal circular. The nervous THE LARYNX. 145 coat connects together the other two ; it is formed of cellu- lar substance, which allows them to move very freely upon each other, and conducís the blood-vessels through their structure. The mucous coat, is a continuation of that of the pharynx; it is covered by a very delicate cuticle, which is continued into the stomach, and forms in some animáis an abrupt and well marked termination just at the cardiac orifice. The internal coat of the cesophagus, is most fre- ' quently found in longitudinal folds, which are removed by its distensión; it abounds with mucous follicles, and is well furnished with blood-vessels. SECTION XI. Of the Larynx. By the term Larynx, is understood the irregular cartila- ginous tube which forms the upper termination of the wind- pipe. The basis of the structure, is made by five distinct cartilages, and a crooked bone, the os hyoides, which is intermediate to the larynx and the tongue, servmg Üie pur- poses of both. The Os Hyoides resembles much the letter U, and is di- vided into its base or curved part and its cornua, or lateral projections. It is pa/allel 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 some- what flattened, and have a tuberculated termination behind. On the cartilaginous interval of each side, is placed a bony body about the size of a grain of wheat, the Appendix, 10 146 OF THE HEAD AND NECK. which stands up obliquely towards the styloid process, and is connected to its tip by a round ligament reserabling 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 fíat sides, which are symmetrical, and united to each other by an angle slightly acute at its anterior part; the upper place of unión forms the projection called Pomum Adami. The sides of this body lean over somewhat, by which its trans- verse 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 Cornu Majus, which looks towards the end of the cornu of the os hyoides, and is connected to it by a round cord, the posterior thyro- hyoid ligament. The inferior edge is somewhat incurvated, and terminates behind by a short process on each side, the inferior cornu, or Cornu Minus, by which it is fastened by the posterior crico-thyroid ligament, to the side of the cri- coid 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 immediately below the thyroid cartilage. Its lower margin is horizon- tal, 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 coü- vexity is formed, for establishing a sort of ball and socket joint with the arytenoid cartilage. The interior surface is fíat; the exterior is marked by the muscles which lie on it. The Arytenoid Cartilages, (Cart. Arytsenoidese, Tri- quetra,) two in number, one on each side of the upper back part of the cricoid, resemble each, a triangular pyra- mid, curved backwards, and having an excavated base. THE LARYNX. 147 The internal sides of the two are flat, face each other, and by the action of their muscles may be brought together; when thus joined they resemble the spout of a pitcher. In front they are excavated somewhat irregularly. On the top of each, is a little cartilaginous tubercle, about the size of a grain of wheat, (Corniculum Laryngis,) which is in- cluded in the soft parts, and is extremely moveable. There is a regular articular cavity between the cricoid and aryte- noid cartilages. The Epiglottis Cartilage, (Epiglottis,) is an oval disk with an elongated pedicle below, its upper edge being thin and rounded. It is fixed behind the base of the os hyoides, and has its pedicle connected to the entering angle on the posterior face of the thyroid cartilage. The broad surfaces of this cartilage, present forwards and backwards, and are above the level of the arytenoids; from this position of the epiglottis, it is enabled to cióse the opening of the larynx, in consequence of the larynx and it, being approximated by the thyro-hyoid muscle. It is very elastic, having a fibro- cartilaginous structure, and is perforated with many fora- mina, giving it a cribriform appearance. The upper edge of the Thyroid Cartilage, is connected to the internal edge of the Os Hyoides, by a thin and some- what elastic membrane, the Middle Thyro-Hyoid Ligament, which filis up the whole of this interval, and completes the front and lateral parietes of the Larynx. Between this membrane and the cavity in the base of the os hyoides, is a small sac, and considered by some persons as a bursa mucosa. It has no connexion with any other cavity, and is occasionally the seat of disease. When its secretion be- comes excessive, it extends down as far as the isthmus of the thyroid gland. Between the Epiglottis and the Thyroid Cartilage, and on the posterior face of the Thyro-Hyoid ligament, is a quantity of loóse fatty matter, intermixed with small mucous glands; the perforations in the epiglottis 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 filis up this interval; it is 14S OF THE HEAD AND NECK. the middle Crico-Thyroid ligament, and in Laryngotomy, is indicated as the proper place for the operation. From the anterior part of the base of each arytenoid cartilage, a ligament, Thyro-Arytenoid, passes horizontally to the entering 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 distance of three lines above these, are two other ligaments passing also horizontally from the arytenoids to the thyroid carti- lage ; they are more parallel, but have not their ligamentous character so wrell define d. 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 cricoid cartilage, and passes upwTards and backwards, to be inserted into the infe- rior cornu of the thyroid cartilage, and the adjacent part of its inferior edge. Use, to draw these cartilages obliquely together. Fig. 34. A Front View of the Crico-Thy roid Muscles. I. Thyroid Cartilage. 2. Crico-Thyroid Ligament. 3. Right Crico-Thyroid Muscle. 4. Its Origin. 5. Its Insertion. G. First Ring of the Trachea. 2. The Thyreo-Hyoideus, which is described in the account of the neck. 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 aryte- noid cartilage. Use, to draw the Arytenoid backwards, and make the ligaments tense. THE LARYNX. 149 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 out- wards, and open the chink of the glottis. 5. The Thyreo-Arytenoideus, 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 relax 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 cióse the chink of the glottis. 7. The Arytenoideus Transversus, arises posteriorly from the whole length of one arytenoid cartilage, excepting a little part of the tip, and is inserted in a corresponding manner, into the other. Use, to cióse the chink of the glottis. Fig. 35. A Vertical Section of the Larynx to show some of its Muscles. 1. Cornu Majus ofthe Thyroid Cartilage. 2. Its Superior Border. 3. Section of its Body. 4. Its Internal Surface. 5. Arytenoid Cartilage. 6. Posterior Surface of the Thyroid Carti- lage. 7.8.9. Arytenoid Muscles. 10.11.12. Thyreo-Arytenoid Muscle. 13. Crico-Arytenoideus Lateralis Muscle. 14. Cricoid Cartilage. 15.16.17. Crico-Arytenoideus Posticus. 18.19. First Rings of the Trachea united by Ligament. 8. The Thyreo-Epiglottideus, arises by a few fibres, from the posterior face of the thyroid cartilage near its en- tering angle, and is inserted into the side of the Epiglottis. Use, to draw the epiglottis downwards. 150 OF THE HEAD AND NECK. 9. The Aryteno-Epiglottideus, arises by a few indis- tinct fibres, from the superior lateral parts of the arytenoid cartilage, and is inserted into the side of the Epiglottis. Use, to draw the epiglottis downwards. These last two muscles are frequently so small and un- defined, that they cannot be satisfactorily distinguished from the adjacent soft parts. The cavity of the Larynx, is lined by a continuation of the mucous membrane of the Pharynx. This membrane, where it establishes the upper boundary of the laryngeal cavity, forms a fold on each side, extending from the Epi- glottis 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 be- tween them, called the ventricle of Galen or Morgagni. From the lowTer ligament, 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 ligaments is the Glottis. For an account of the Trachea, see the article Thorax, PART II. OF THE TRUNK. CHAPTER I. OF THE THORAX. The dissection of the cavity of the Thorax, should be pre- ceded by that of the muscles, which lie upon its front part and sides. SECTION I. Ofthe 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 anterior face of the two upper bones of the sternum their whole length, fleshy from the cartilages ofthe fifth and sixth ribs, and by a fleshy slip from the upper part of the tendón of the external oblique muscle. It arises also fleshy from the interior two-thirds of the clavicle. The clavicular and sternal portions of the 152 OF THE TRUNK. origin are separated by an interval, giving the appearance of two muscles. The fibres converge, and termínate by a broad, thin ten- don, which is inserted into a roughness on the exterior edge of the bicipital fossa of the os humeri, and into the brachial fascia, just at the internal edge of the deltoid muscle. The under edge of the muscle, near its insertion, is folded in- wards, which gives the rounded thick margin to the fore part of the axilla. That part of the broad tendón belonging to the clavicular portion of the muscle, is inserted lower down than the sternal, which produces a decussation of the fibres ofthe tendón. The Pectoralis Major, drawTs the arm inwards and for- wards, and also depresses it when raised. 2. The Pectoralis Minor, is brought into view by raising the last muscle. It is comparatively small and some- what triangular, arising by thin tendinous digitations from the upper edges of the third, fourth, and fifth ribs. It soon becomes fleshy, and is inserted, by a short flat tendón, into the inner face of the coracoid process of the scapula. Its use is to draw the scapula inwards and downwards. 3. The Subclavius, is a small muscle placed immediately under the clavicle. It arises from the cartilage of the first rib, and is inserted into the inferior face of the clavicle, from near the sternum to the conoid ligament, which conneets the coracoid process and the clavicle together. It draws the clavicle downwards. 4. The Serratus Major Anticus, is a broad muscle lying on the sides of the ribs, between them and the scapula, and beginning at 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 ab- dominis, the digitations of the two muscles interlocking with each other. The fibres converge, and are inserted into the base ofthe Scapula its whole length. Its action is to draw the scapula forwards. MUSCLES OF THE THORAX. 153 A View of the Superficial Muscles of the Upper Front part of the Trunk. Fig. 36. 1. Sterno-Hyoid. 2. Sterno-Cleido Mastoid. 3. Sterno-Thyroid. 4. Clavicular portion ofthe Sterno-Cleido-Mastoid. 5. Anterior Edge of the Trapezius. 6. Clavicle. 7. Clavicular Origin ofthe Pectoralis Major. o. iseuuiu. 9. Fold of Fibres of the Pectoralis Major on the Anterior Edge of the Axilla. 10. Middle of the Pectoralis Major. 11. The crossing and interlocking of the Fibres of the External Ob- lique of one side ef the Ahornen with those ofthe other. 12. Biceps Flexor Cubiti. 13. Teres Major. 14. Scrratus Major Anticus. 15. Superior Hcads of the External Oblique interlocking with the Ser- ratus Major. 154 OF THE TRUNK. 5. The Intercostales fill up the spaces between the ribs. There are two in each space, of which the External arises from the transverse process of the vertebra, and from the inferior acute edge of each rib, from its head almost to its cartilage, and is inserted into the superior rounded edge of the rib below, for the same distance, its fibres passing ob- liquely forwards. The Internal intercostal, arises from the inferior edge of the rib and costal cartilage, beginning at the sternum, and extends backwards to the angle of the rib; it is inserted into the superior rounded edge of the rib and cos- tal cartilage below, on its inner side, its fibres passing ob- liquely backwards and downwards. They draw the ribs to- gether. With a view to examine the cavity of the thorax, the sternum along with the cartilages of the ribs, is to be taken out by cutting through the cartilages. We then see, on their posterior faces, a muscle called 6. The Triangularas Sterni, which arises from the whole length of the cartílago 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 in- serted into the cartilages, ofthe third, fourth, fifth and sixth ribs, by fleshy and tendinous digitations. Its use is to de- press the ribs, and consequently 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 in Philadelphia, by the late Professor Wis- tar, in which the five middle true ribs on each side, are re- moved, all the rest with the sternum being left. This plan gives an excellent view of the several viscera, and also of their relative situation and extent; and 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 VISCERA OF THE THORAX. 155 parts of the trunk unfit for farther investigation, inasmuch as the superior extremities 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 pre- viously dissected, 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 con- tents, viz. the Heart and Lungs, each covered by an appro- priate membrane. The heart is between the sternum and the dorsal vertebree; the lungs are on each side of it, and, when in a healthy state, always collapse upon the thorax being opened. THE PLEURA. Each of the two lungs, has a perfect serous membrane called Pleura, which covers its external surface; and giving it a glistening smooth appearance, is reflected from the in- ternal face of the lung, over the side ofthe pericardium, to the sternum before, and to the spine behind. This mem- brane 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 low down as the last rib. That part of the pleura which covers the lung, is the Pleura Pulmonalis; that which lines the ribs, the Pleura Costalis; and that covering the Diaphragm, the Pleura Diaphragmaticus. As the pleurae are bags, like other serous membranes, and each one is a perfect sac, and as there is one on each side of the thorax, it is very demonstrable, that their opposing faces form a septum, which, extends from the sternum 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 be- tween the heart and sternum is the Anterior Mediastinum; that between the heart and spine is the Posterior Mediasti- num; and that between the heart and the upper part of the thorax, is the Superior Mediastinum; each of which merits strict attention. 156 OF THE TRUNK. AnOutline of a Transverse Section of the Chest, showing the RELATIVE POSITION OF THE PlEURjE TO THE ThORAX AND ITS CoN- TENTS. Fig. 37. 1. The Skin on the Front of the Chest drawn up by a Hook. 2. The Skin on the Sides of the Chest. 3. That on the Back. 4. The Sub-Cutaneous Fat and Muscles on the outside ofthe Thorax. 5. Section of the Muscles in the Vertebral Gutter. 6. Section of the 5th Dorsal Vertebra. 7. The Spinal Canal. 8. Spinous Process. 9.9. > 10*10, ( Sections of the Ribs and Intercostal Muscles. 11. Their Cartilages. 12. The Sternum. 13. The División of the Pulmonary Artery. 14. The Exterior Surface of the Lungs. 15. Posterior Face of the Lungs. 16. Anterior Face of the Lungs. 17. Inner Face of the Lungs. 18. Anterior Face of the Heart covered by the Pericardium. 19. Pulmonary Artery. 2l' i Its División into Right and Left Branches. 22. Portion of the Right Auricle. 23. Descending Cava cut off at the Right Auricle. 24. Section of the Left Bronchus. 25. Section of the Right Bronchus. VISCERA OF THE THORAX. 157 26. Section of the CEsophagus. 27. Section of the Thoracic Aorta. The space between Figures 12 and 18 and the two 16's is the Anterior Mediastinum, and the space which contains 26 and 27 is the Posterior Mediastinum. These spaces are formed by the Reflections ofthe Pleura;. It is obvious then, that the septum consists of two lami- nse, one from each pleura. These two laminse are some- what separated, where they are called Anterior Mediasti- num, by the remains of the thymus gland above, and by adipose and cellular membrane below. The anterior me- diastinum 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 longitudinal!}^ and the two halves separated an inch, by a small blockof wood. The contents of the posterior mediastinum and of the superior, are best seen and understood at a subsequent stage of the dis- section. The Pleura is a thin and transparent membrane, connected to the parts on which it lies, by a short cellular substance. No red vessels, in its healthy state, are to be observed in it. 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 mediastinum, and between it and the pericardium. The exhalent vessels of the pleura, are derived from the intercostal, internal mammary, phrenic, and some other arteries, and secrete a fluid which lubricates its surface. THE PERICARDIUM. Between the pleura?, under the sternum, and reposing on the tendinous centre of the Diaphragm, to which it adheres by cióse cellular substance, is the Pericardium, containing the heart. It is a white, semi-transparent, double mem- brane, of a condensed fibrous structure, externally, and possessed of little or no elasticity, which renders it highly appropriate for sustaining the action of the heart in its dila- tations. Intérnally, it is lined by a serous lamina, which forms a complete bag, in being reflected over the surface of the heart, so as to give it an investing membrane. This invest- 158 OF THE TRUNK. ment commences at the back part or base of the heart, and is continued 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 ascendíng cava to the diaphragm ; and on the deseending cava to the middle of the space between the entrance of the vena azygos and the transverse vein. The exterior 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 peri- cardium corresponds wTith the capsular ligament, and the internal lamina with the synovial membrane. It is the ex- terior 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 fore part ofthe pericardium, lies loosely on the heart. The peri- cardium is attached strongly, by all its inferior surface, to the tendón of the diaphragm. THE HEART. The Heart is a hollow muscular organ, consisting of four cavities, two Auricles and two Ventricles. Its shape is some- what conoidal, but flattened on the under surface, which lies upon the diaphragm. The base of the cone is formed by the auricles, the body by the ventricles, and the apexby the anterior end of the left ventricle projecting beyond that of the right. The heart being fixed as mentioned, between the sternum and the dorsal vertebra?, has its base turned ob- liquely towards the right side, while its apéx is about the junction of the fifth left rib with its cartilage. Its flat part reposing on the flat tendón in the centre of the diaphragm, is on a horizontal line, or nearly so, with the inferior end of the second bone of the sternum. The heart, in conse- quence of being tied down to the diaphragm by the peri- cardium, is, excepting its pulsations, exposed to but little motion, and is therefore almost uniformly in the same posi- tion. It has, between the internal membrane of the peri- cardium and its own substance, more particularly along the VISCERA OF THE THORAX. 159 course of the coronary vessels, adipose matter in great abundance in oíd subjects, and this adipose matter some- times penetrates so deeply between the fasciculi of its fibres, as to give them a very loóse texture, and apparently to dis- qualify them in some measure, from performing their func- tions. The parietes of the heart are formed principally of mus- cular 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 con- tracting, in effacing its cavities. The cavities are lined by a serous membrane, which is a continuation of, and resem- bles 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 constitute val ves. The heart is divided into Right and Left sides, each con- sisting 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. The Right Ventricle sends off the Pulmonary Artery, and the Left Ventricle the Aorta. The Right Auricle, situated atthe right posterior part of the heart, is an oblong cuboidal 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 continua- tion of the structure of the great veins, which meet each other at an obtuse angle, and form a projection into the auricles. This last circumstance, connected with a slight thickening of the part, has given it the ñame of Tubercu- lum Loweri. Anteriorly, the auricle is swelled into a pouch, • (Sinus Venosus,) in which the muscular fibres, instead of beino- uniformly spread into a coat, are collected into trans- verse fasciculi, lying parallel to and near each other; they are called Musculi Pectinati from their resemblance to the teeth of a comb. At the upper part of the pouch, or sinus, is the proper auricular portion of the cavity, resembling the ear of an animal, whence it got its ñame; it is not marked by any striking peculiarity, except that the musculi pectmaü 160 OF THE TRUNK. 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 fcetal 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 probé into the left auricle, even in subjects advanced into oíd age. The edges of the fossa ovalis are elevated and thickened, constituting the Annulus Ovalis, or Isthmus of Vieussens. Just below the fossa ovalis, is the Eustachian Valve. It is formed by a duplicature of the lining membrane of the auricle and of the ascending cava, being spread somewhat obliquely across the orifice of the latter. It is of a crescentic shape, about half an inch wide, but occasionally reticulated, and commencing at the left side of the annulus ovalis, ter- minates anteriorly, about the junction of the auricle and the vein. It is connected by its convex -edge to the parietes of the auricle, and its concave or floating edge looks some- what upwards. Just before and below the Eustachian valve, is another much smaller, but also semilunated, the Valve of Thebesius, which covers the orifice of the great coronary vein. Between the right auricle and right ventricle, is an opening of more than an inch in diameter, the Ostium Venosum, through which the auricle communicates with the ventricle. In the right auricle, are many small orifices of coronary veins called Foramina Thebesii; they also exist in all the other cavities, but are not so numerous there. They are said to be particularly conspicuous in cases of diseased lungs. The next cavity to be examined is the Right Ventricle; to expose it satisfactorily, it should be divided extensivelv along the septum ventriculorum, superiorly and inferiorly. It is of a triangular form, and its sides are much thicker than the sides of the auricle, as they measure, most commonly, about three lines. Its internal surface is very irregular and rough, the muscular structure of it being thrown into pro- jecting columns, the Columna? Carnea?, of very indeterminate figures, arrangement and dimensions. Some of them jut out, and are connected to the valve at the ostium venosum, by four or eight Chorda? Tendinea?; others pass from one side of the ventricle to the other, and a third series presents VISCERA OF THE THORAX. 161 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 agí- tate well and mix the blood. The Ostium Venosum has a tendinous margin, from which is reflected the lining membrane of the ventricle, 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 ñame of Tricuspid Valve has been given to it. The tricuspid valve, is situated in the right ventricle, has its loóse margin attached to the round tendinous chords just mentioned, called the Chorda? Ten- dinea?, which again arise, from the Columna? Carnea?. These tendinous attachments of the tricuspid valve, prevent it from being thrown into the auricle, when the ventricle con- traéis. At the upper part of the ventricle is the orifice of the pul- monary artery, which conveys the blood to the lungs; pro- visión for it is made by the upper part of the ventricle be- coming 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 semi- circular plañe, connected by its circumference to a cylin- drical cavity. The diameter of the plañe is loóse ; in the centre of it, is a small cartilaginous body, the Corpusculum Aurantii; and on each side of the corpusculum, the diame- ter of the valve, instead of being a straight line, is slightly festooned. 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 however, to be found another substance very much like that of the ar- tery, which also forms a festooned edge a little belowr 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 ventricle ; and the Corpuscula Aurantii being in the middle of each, form a point of support or abutment, at which the edges of the valves sustain each other. Between the outer face of the valve and the in- ternal face of the artery, a pocket attended with a dila- 11 162 OF THE TRUNK. tation of the artery is formed, called the Sinus of Val- salva. 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, right and left, which go to the limgs of their respective sides. The right branch is the larger of the two, and passing under the arch, is then minutely distributed to its lung. The left, is in front of the descending aorta, and is distributed to the left lung with equal minuteness. These trunks sepárate widely, and from the middle of their fork, proceeds a ligamentous substance, the remainsof the Ductus Arteriósus of the fcetus, to the aorta, posteriorly to the origin of the left subclavian artery. The blood is brought from the lungs, by the pulmonary 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 penetrates the pericardium. This trunk, afterwards unites with the auricle at one of its corners. The Left Auricle, has about the same cubic capacity with the right, but difters from it somewhat in its figure, in being more square. Its broad internal surface looks towards the spine. It is fixed to the posterior part of the left ventricle, and is divided like the right auricle, into the Sinus Venosus, sometimes called Sinus Pulmonalis, and into the Proper Auricle. The latter is situated at the left side of the pul- monary 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 parietes are thicker than those of the right, and that both externally and intérnally, its surfaces are perfectly smooth, except in the proper auricular part, where the Musculi Pectinati prevail. The Septum between the auricles, viewed on this side, is smooth, not presenting any remarkable appearance; when held up to the light, it is seen to be thinner and more trans- VISCERA OF THE THORAX. 163 parent at the place corresponding with the fossa ovalis of the other side. At the anterior and inferior side of the au- ricle, is the ostium venosum, communicating with the left ventricle; it has a tendinous margin, and is rather more than an inch in diameter. The Left Ventricle difters from the right in shape, in being more conical, but it is equally capacious. Its anterior part constitutes the apex of the heart, and strikes against the ribs. The best mode of examining its cavity, is to make an incisión through its parietes near the septum, and to se- párate it completely on that side from its fellow. Another incisión should be made so as to detach it from the auricle^ also near its septum. The latter cut is to be executed with particular care, so as to avoid wounding the interior struc- ture. That done, we see its general arrangement within, corresponding 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 principie, 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 apparatus at the ostium ve- nosum. The Mitral Valve exists at the left ostium venosum, and is formed by a duplicature of the lining membrane of this ventricle. It is partially divided into two parts, which are pointed at their edges. Its columna? carnea? are numerous and strong, and its chorda? tendina? are of corresponding characters. The mitral valve prevents the regurgítation of blood into the left auricle, and is so placed, that the upper half of it, when the blood is rushing into the ventricle, con- ceals 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 be- tween 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 diameter, and is furnished with three Semilunar Valves, Corpuscula 164 OF THE TRUNK. 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 ofthe aorta are stronger and more developed. The coats of the aorta are nearly three times as thick as those of the pulmo- nary artery, to qualify it for bearing the increased pressure of the blood. The aorta is dilated shortly after its com- mencement, so as 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 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 su- perior part of its arch, is about eight lines below the upper edge of the sternum. The heart being a mere machine for propelling blood, requires another. source for its nourishment besides the fluid circulating through its great cavities; this is furnished by the Coronary Arteries, which are two in number. The first, called Right Coronary, becomes 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 conti- guous 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 auri- cle 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 coronary 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 right auricle just anterior to the Eustachian Valve, at the spot already indi- cated. VISCERA OF THE THORAX. 561 OF THE LUNGS. The Lungs are of a bluish colour, and occupy by far the greater part of the cavity of the thorax; they are two dis- tinct bodies, placed one at either side of the heart, from which circumstance, they are divided into right and left lung. Their external shape and dimensions, with an in- considerable 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 mediastinum, a somewhat different figure from the lung of the right side ; the left lung is also the smaller. 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 vertebra?. 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 contiguous 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 forming' a convexity towards the thorax, which, rises much above what its plañe 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 loóse every where, except at the surface 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 con- stitute 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 extended downwards, under the ñame of Ligamentum Pulmonis, and serves to fix the posterior edge of the lung to the pericardium, as low down as the diaphragm. 166 OF THE TRUNK. The Right Lung, is divided by an oblique and a horizontal fissure passing from it, into three lobes—the Left Lung, has a single oblique fissure dividingit into two lobes. Each lobe consists of a multitude of lobules adhering laterally by cel- lular substance: and each lobule is formed of a congeries of air vesicles, which communicate freely through their sides from the imperfection of the latter, though the cells of diffe- rent lobules do not communicate. The parietes of the air vesicles are of extreme tenuity, and have the pulmonary artery and vein ramifying with ex- ceeding minuteness on them for the purpose of respiration. The lung of the bullock, exhibits the structure better than that of the human lung, by a little tearing of the parts asunder. The lobuH are also well seen in the fcetus, and in very young subjects. The Trachea, the bifurcation of which forms the Bron- chia?, is an almost cylindrical tube, which passes in front of the cesophagus and of the vertebra?, from the inferior part of the larynx, to the third dorsal vertebra?; it there divides into the Bronchia?, and is placed betwreen the pleura? of the two sides of the thorax. The right Bronchia is shorter, larger, and less slanting than the left; it sinks below the pulmonary artery, and penetrates the lung opposite to the fourth dorsal vertebra; the left being long and narrow, en- ters the lung below the pulmonary artery, opposite to the fifth dorsal vertebra. The bronchia? then divide and sub- divide through the structure of the lung, till the ultímate extremities termínate in the air vesicles. The Trachea preserves its cylindrical shape, and is kept open, by a cartilaginous structure, which is composed of from sixteen to twenty pieces, more or less distinct from each other. Thus arranged, the cartilages form about two- thirds of the circumference of a cfrcle, occupying the front, of the trachea, and giving it the appearance, anteriorly, of a cartilaginous tube. The remaining third is membranous. The cartilages of the trachea are deposited in a kind of perichondrium, possessed of extreme elasticity, which has continually a tendency to approximate the cartilages, and is resisted only by the attachments of the two extremities of the trachea. The effect of this elasticity, is demonstrated in the living body by attempts at suicide, where the trachea VISCERA OF THE THORAX. 167 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 filled up by a condensed cellular substance in continuation with 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 opinión of the late Dr. Physick, by diminishing the size of the trachea, they assist in the expulsión of mucus. A con- tinuation of the mucous membrane of the Pharynx and Larynx, lines the trachea; it is studded with a great number of follicles which secrete mucus. Under the membrane are many glands, from the size of a millet-seed to that of the head of a small pin, and which have their excreíory tubes terminating in the trachea. These glands are also abundant on the posterior face of the transverse muscular fibres. The Bronchije, 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 cartila- ginous structure ceases, and only membrane is left. It is probable, from the elasticity of the lung, and from its col- lapsing when the thorax is opened, that the elastic mem- brane, in which the cartilages are deposited, forms the essential cellular structure of this organ on which the blood vessels are ramified. At the lower end of the trachea, and about the root of the lungs, is found the commencement of a chain of lym- phatic glands, which follow for some distance, the bronchia?. In the adult they are black, numerous, and vary from the dimensión of a large pin's head to that of a kidney bean. The lungs are furnished from the aorta with nutritious vessels, called Bronchial Arteries. They follow the course ofthe bronchia? and communicate freely with the pulmonary arteries; notwithstanding, 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. 168 OF THE TRUNK. The Larynx, Trachea and Bronchia, deprived of their Fibrous Covering ; with the outline of the Lungs. Fig. 38. 1.1. Outiine of the Upper Lobe of the Lungs. 2. Outiine of the Middle Lobe of the Right- Lung. 3.3. Outiine of the Inferior Lobe of both Lungs. 4. Outiine of the 9th Dorsal Vertebra, showing its relation to the Lungs and the Vertebral Column. 5. Thyroid Cartilage. 6. Cricoid Cartilage. 7. Trachea. 8. Right Bronchus. }>. Left Bronchus. 10. Crico-Thyroid Lijrament. 11.12. Rings of the Trachea. 13. First Ring of the Trachea. 14. Last Ring of the Trachea, which is Corset-shaped. VISCERA OF THE THORAX. 169 15.16. A complete Bronchial Cartilaginous Ring. 17. One which is Bifurcated. 18. Double Bifurcated Bronchial Rings. 19.19. Smaller lironchial Rings. 20. Depressions for the course of the large Blood-Vessels. While studying the contents of the thorax, it is of the first importante to attend to the relative situation of the parts included in the description. One of the most use- ful and interesting points, is the space between the two upper ribs, bounded laterally by the pleura?, anteriorly by the sternum, posteriorly by the upper dorsal vertebra?, and having the top of the pericardium 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 being horizontal, is in a majority of subjects, inclined down- wards so much, that it makes an angle of about forty-five degrees with the spine; and the pleura being 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, Scemmermg and Colles allude to, when they speak of the pleura rising above the level of the first rib. This arrangement should influence the considerations arising from a wound in the lower part of the neck, as a ball or sword passing through horizontally just above the sternal end ofthe clavicle, would certainly enter the cavity of the pleura in a great number of persons. In the upper section of the mediastinum, just at the upper edge of the sternum, are the remains of the Thymus Gland, much shrivelled, having a ligamentous 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 jugular veins, (Vena Innomi- nata,) after crossing, by an oblique descent, the upper por- tion of the sternum, joins the descending vena 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 170 OF THE TRUNK. Left Carotid, and the Left Subclavian Artery. The cesopha- gus makes a vertical descent just before the dorsal verte- bra?; the trachea is placed before it, and we see the arteria innominata, crossing the latter obliquely from left to right. The arteria innominata is placed much more superficially than the left subclavian, being removed from the upper end of the sternum, only by the thickness of the transverse vein, and is very accessible, whereas the other, being the last branch given off from the curve of the aorta in its course backwards, is an inch deeper, and extremely difficult of access in the living body. The arteria innominata varies much in length, before its división into subclavian and caro- tid. I have examples of it from half an inch to two inches, but the general length is about sixteen íines. In this dissection, the phrenic nerve is seen to descend in contact with the internal edge of the scalenus anticus mus- cle, and passing between the subclavian artery and vein, to procéed vertically in contact with the pleura at first, and af- terwards between it and the pericardium, to the diaphragm. The par vagum is on the inner side of the internal jugular vein, and gets into the thorax, between the subclavian ar- tery 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 cesophagus, and termi- nates at the stomach. On a level with the subclavian ar- tery, the Recurrent or Inferior Laryngeal Nerve is sent off, which to get to the larynx, winds around the subclavian of the right, and the aorta on the left side. About the root of the lungs, the Pulmonary Plexus is detached from the Par Vagum nerve. The Sympathetic Nerve lies closer to the vertebra?, and sends off from its two inferior cervical gan- glions principally, the branches which supply the heart, by the cardiac plexus. In the thorax it continúes its course by the heads of the ribs, and sending off the greater and lesser 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 condensed mem- brane called Fascia Profunda Cervicis, which seems to afíbrd protection to the upper opening of the thorax and is extended to the upper edge of the sternum, has be- beneath it, connecting the vessels and other parts together, VISCERA OF THE THORAX. 171 a loóse, vascular, adipose, and cellular matter, which must be removed by dissection, before the rest of the struc- ture can be rendered distinct. The plan for opening the thorax, by the sternum 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 accomplished, the sternum must be removed, and by turning up the lungs, we see the parts contained in the posterior mediastinum and what is meant by it. To the left is the Aorta, which gradually gets to the front of the dorsal vertebra? in the lower part of the thorax, as it penetrates the crura of the diaphragm. The GEsophagus 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 ofthe lower dorsal 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 mediastinum, and forms an arch at its termination where it joins the de- scending cava, over the root of the right lung. The Tho- racic Duct enters the thorax between the crura of the dia- phragm, 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 conjunction ofthe left internal jugu- lar and subclavian vein. The Par Vagum is strictly within the limits of the posterior mediastinum, the Sympathetic is not. PART II. CHAPTER II. OF THE ABDOMEN. Before the commencement of the dissection ofthe Ab- domen, it is useful to acquire a knowledge of its regions, the boundaries of which are thus established by imaginary planes passing through the subject. Draw a line from the superior part of the Crista of one Ilium, as it appears through the skin, to the superior part ofthe other; strike a perpen- dicular then, from the anterior inferior spinous process of the ilium on each side, through the cartilages ofthe 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 vertical and two horizon- tal, which represent as many planes intersecting the abdo- men, form with the periphery of the abdomen, nine regions. The one above, on the right, is the Right Hypochondriac, that in the middle, the Epigastric, and that to the left, the Left Hypochondriac. The región which has the navel in its centre is the Umbilical, and on its sides are the Right and the Left Lumbar Región. Below the umbilical is the Hypogastric Región, and on the wings ofthe latter are the Right and the Left Iliac Región. Some anatomists cali the pit around the ensiform carti- lage, the Scrobiculus Cordis, and a small space just behind and elevating itself about an inch.above the pubis, the Re- gio Pubis. The boundaries of the latter are rather unde- fined, but the terms are in use. 174 OF THE TRUNK. A View of the External Parietes of the Abdomen, with the POSITION OF THE LINES DRAWN TO MARK OFF ITS REGIONS. Fig. 39. 1.1. A line drawn from the highest point of one Ilium to the same point ofthe opposite one. 2.2. A line drawn from the Anterior Superior Spinous process to the Cartilages of the Ribs. 3.3. A similar one foi the opposite side. 4.4. A line drawn perpendicularly to these, and touching the most pro- minent part of the Costal Cartilages, thus forming nine regions. 5.5. The Right and Lelt Hypochondriac Regions. 6. The Epigastrio Región. 7. The Umbilical Región. 8.8. The Right and Lelt Lumbar Regions. 9. The Hypogastric Región.* 10.10. The Right and left Iliac Regions. 11. The lower part ofthe Hypogastric, sometimes called Pubic. MUSCLES OF THE ABDOMEN. 175 SECTION I. Of the Muscles of the Abdomen. To begin the dissection ofthe muscles of the abdomen, 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 commencement above, ex- tending obliquely towards the armpit, till it reaches the side of the chest. The second terminates and a third com- mences there, having a sweep backwards, parallel in its direction with the margin of the cartilages ofthe ribs, and equidistant from it. The third cut by being extended to the spine, affords an opportunity of opening the integuments still farther, by a vertical cut over the spinous processes down to the small end of the sacrum. This manner of opening the integuments ofthe side ofthe belly, describes in a great measure the outiine ofthe external oblique mus- cle, 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 to understanding the broad muscles of the abdomen well, simple as the cir- cumstance may appear, is the imperfect manner in which the integuments are opened by dissectors: and there is no dissection more apt to be 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 ofíhe sub- ject on which to work, begin by dissecting at the upper part to turn the fiap of common integuments downwards. But few strokes of the knife will be made, before the up- per fibres of the external oblique muscle will be exposed. The flap is now to be entirely dissected off as far down as 176 OF THE TRUNK. the hip and thigh, exposing, by such means, the superior margin of the pelvis, from the spine to the symphysis pu- bis. The beginner must cut very slowly, seeing. that he detaches fully the cellular membrane from the muscular fibres; by cutting in the same direction with the latter, he will leave them clean and brilliant, and the transition to the broad tendón connected with them, will be comparative- ly easy. In this dissection, as indeed in all others of the muscles, I cannot attach too much importance to cutting parallel with the fibres; it is absolutely essential to the beauty ofthe dis- play, and indispensable to a person desirous of success in practical anatomy. A dissection done in any other man- ner, is unfit for study from its obscurity, and off'ensive to inspect, from its roughness. The sum of directions to make a good dissector of muscles, is, to cut in the line of the fibres, cióse to them, and to keep the cellular membrane tense. There are five pairs of muscles to the abdomen, three broad and two narrow, to wit, the Obliquus Externus, the Obliquus Internus, the Transversalis, the Rectus, and the Pyramidalis. In the middle line of the body, the tendons of the three broad muscles on each side of the abdomen unite to forra the Linea Alba, which extends from the sternum 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 be- low, 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 umbilical vessels, and in the adult is commonly depressed into a pit, now appears in the linea alba as a protuberance composed of condensed cellular membrane. Just at the navel, there is a line crossing the linea alba, and extending from one linea semilunaris to the other. At the lower end ofthe Cartílago 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? MUSCLES OF THE ABDOMEN. 177 Transversa?, and they are formed by tendinous matter in the substance of the Recti muscles, connecting them to their tendinous sheath in front. 1. The 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 origins of the serratus major anticus, and the three inferior, with the latissimus dorsi. The fibres pass obliquely downwards, and termi- nate in a broad thin tendón. This tendón extends over the whole front ofthe abdomen, from the lower end ofthe second bone of the sternum, to the symphysis of the pubes. It is inserted by its tendón into the whole length of the linea alba, and into the anterior half or two-thirds of the crista of the ilium, by muscular fibres posteriorly, and tendinous anteriorly. It is also to be observed, that from the anterior superior spinous process, the tendón stretches to the body and symphysis ofthe pubes, forming thereby the Ligament of Poupart, or the Crural Arch. As this ligament approaches the pubes from the ilium, it splits so as to leave a hole for the passage of the Spermatic Cord in the male, and of the Round Ligament ofthe Uterus in the female. This open- ing is named the External Abdominal Ring. The tendón 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 decussate those of its fel- low. The tendón forming the-lower margin ofthe ring, is inserted into the spine of the pubes, and into its crista, for an inch. The portion inserted into the crista of the pubes, is Gimbernat's Ligament, which it will be readily understood, means only a part ofthe crural arch. The ring in the external oblique is rather triangular than round ; its base is formed by the body ofthe pubes, and its point is at the place where the tendón splits. The latter is kept from parting still farther, by a fasciculous of tendi- nous fibres, which runs across it. The tendinous sides of this opening are called its Columns, and from their situation, internal and external, or upper and lower columns. In the female it is oval, and scarcely half an inch long. 12 178 OF THE TRUNK. A View of the Superficial Muscles of the Left Side and of the Deep Muscles of the Rig.it Side, on the Front of the Trunk. Fig. 40. 1. Pectoralis Major. 2. Deltoid. •i. Anterior Edge of Lntissimus Dorsi, 4. Serrated Edge of Serratus Major Anticus. 5. Subclavius Muscle. 6. Pectoralis Minor. 7. Coraco-Braclriulis. 8. Bíceps Flexor Cubiti. 9. Coracoid Process ofthe Scapula. 10. Serratus Major Anticus after the removal o" the Oblicuas Externus Abdominis. MUSCLES OF THE ABDOMEN. 179 11. External Intercostal Muscle ofthe Fifth Intercostal Space. 12. External Oblique ofthe Abdomen. 13. Its Tendón. The Median Line is the Linea Alba.—The line to the Right of the number is llie Linea Semilunaris. 14. The portion ofthe Tendón ofthe External Oblique, known as Pou- part's Ligament. 15. External Abdominal Ring. 1 (i. Rectus Abdominis. The White Spaces are the Linea Transversae. 17. Pyramidalis. 18. Internal Oblique ofthe Abdomen. 19. Common Tendón ofthe Internal Oblique and Transversalis. 20. Crural Arch. 21. Fascia Lata Femoris. 22. Saphcnous Opening. The Cresentic Edge of the Sartorial Fascia is seen just above fig. 22, and the Interior or Pubic Point of the Crescent is known as Hey's Ligament. There are several small round holes in the tendón of this muscle, which affbrd passage to nerves and to veins. When, by the cleanness of the dissection, the tendón has its characteristic gloss and polish, they are very distinct. Use. This muscle compresses the viscera of the abdo- men, and brings the pelvis and thorax towards each other. Latterly, the attention of anatomists has been directed to a flat band of cellulo-fibrous matter, called the Ventrier, or Belly Band, which arises from the tendón of the external oblique from the linea alba to the linea semilunaris, just above the internal abdominal ring, and passes downwards, to be inserted into the fascia femoris over the origin of the gracilis. Its outer margin reposes in front of the spermatic cord, and leads it outwards as the band goes downwards. 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 process 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, and its fibres pass in a transverse direction to the fibres of the other. It arises tendinously, and by the fascia lumborum, from the three inferior spinous processes of the loins, and from all those ofthe sacrum; tendinous and fleshy, from the whole leno-th of the crista of the ilium, and fleshy from the upper haíi of Poupart's ligament. Though the fibres of this muscle, in general decussate the fibres of the external 180 OF THE TRUNK. oblique, all of them do not, for the lower are brought gra- dually to pursue the same direction towards the symphysis of the pubes. Near the Linea Semilunaris, the muscular fibres cease, and the tendón begins. It is inserted into the cartilaginous margin, formed by the six inferior ribs; that is, by fibrous, condensed, 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 ofthe ensiform cartilage, its whole length; and into the linea alba, from the sternum to the pubes. The tendón of this muscle divides into two laminse, in a manner which will-be better explained presently, after the rectus and pyramidalis muscles have been dissected 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, vertebras, ilium, and external half of Poupart's ligament; by beginning near the spine of the ilium, where it is separated more distinctly from the muscle below, by the circumflex ilii artery, vein, and cellular sub- stance. 3. The TransversaLis Abdominis, arises by the Fascia Lumborum, from the transverse processes of the last dorsal, and of the four upper lumbar vertebras, and also by it from the posterior third of the spine of the ilium. t likewise arises fleshy from the anterior two-thirds of the spine of the ilium, and from the upper'half of Poupart's ligament; ten- dinous and fleshy alternately, from the inferior margin of the thorax, formed by the cartilages of the six or scven in- ferior ribs, at their inner surfaces, where they are concerned in the origin of the diaphragm. The fleshy part of the 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 carti- lages 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. MUSCLES OF THE ABDOMEN. 181 A Lateral View of the Mus- cles of the Trunk, espe- cially on the abdomen. 1. Latissimus Dorsi. 2. Serratus Major Anticus. 3. Upper portion of the External Oblique. 4. Two of the Externa! Inter- costal Máseles. 5. Two of the Internal Inter- costal Muscles, 6. Transvcrsalis Abdominis. 7. Fascia Lumborum. 8. Posterior part of the Sheath of the Rectus or Anterior Aponeurosis of the Trans- vcrsalis Muscle. 9. The Rectus Abdominis cut off in its Sheath. 10. Rectus Abdominis of the Right Side. 11. Crural Arch. 12. Glnteus Magnus—Medius and Tensor Vaginse Femoris, co- vered by the Fascia Lata. 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 tendón of an inch or more in breadth, coming from the symphysis pubis and the 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 ten- dinous interseetions, confining it to the tendinous sheath in front, are established at the places mentioned as lina? trans- versas, but for the most part, they do not extend through the muscle. Inserted fleshy, into the base of the cartilago ensiformis and into the cartilages of the fifth, sixth, and seventh ribs. 182 OF THE TRUNK. It draws the thorax towTards the abdomen. 5. The Pyramidalis, is at the lower front part of the rectus, and is about three inches long. 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 be- fore, and is fixed in a sheath formed by the separation of the common tendón ofthe transversalis and internal oblique muscles. It tapers to a point above, and is Inserted, into the linea alba and internal edge of the rec- tus, two-thirds of its own length, by beginning about an inch above the pubes. It strengthens the lower part ofthe abdomen, but is often wanting. The Rectus and the Pyramidalis muscles, are now to be, detached from their origins, and turned áside. By doing so, we become sensible of an arrangement of the tendons of the broad muscles, always difficult to describe intelligi- bly, and generally imperfectly understood. It is this ; at the linea semilunaris, the tendón ofthe internal oblique and that of the transversalis unite intimately, and just beyond this junction two laminas are formed, which endose the rec- tus muscle. The anterior lamina, is one-half of the tendón of the internal oblique, which, after passing half an inch or an inch, is joined to the tendón of the external oblique, and the two thus go in front of the rectus muscle, and cover it from origin to insertion. The posterior lamina, is made by the posterior half of the tendón of the internal oblique, united atthe linea semilunaris to the tendón ofthe transver- salis; they in this manner pass behind the rectus muscle, from the cartilago ensiformis, to a line half-way between the umbili- cus and the pubes. From this line downwards, all the ten- dons go in front of the rectus muscle. The obliquus ex- ternus tendón, may however, be dissected from the common tendón 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 termínate in the linea alba, from the thorax to the pelvis; but MUSCLES OF THE ABDOMEN. 183 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- tachment of fibres from it. The dissection is now in a state, to exhibit what is really the fact in regard to this muscle, viz., that it is also formed, by fibres from the lower edge ofthe transversalis muscle. The history of its formation is as follows: in the descent ofthe testicle, the latter has to pass beneath that edge of the transversalis, and of the in- ternal oblique, which is extended from the upper part of Poupart's ligament, to the spine and crista of the pubes, but as it descends, it comes in contact with a fasciculus of these fibres and takes it along. This fasciculus constitutes the Cremaster muscle, which in adult life and in a strong muscular subject, is seen descending on the outside of the spermatic cord, and spreading over the anterior part of the túnica vaginalis in arches, with their convexities down- wards, then rising on the inner side of the cord and in- serted into the spine ofthe pubes.* It draws up the testicle. As one becomes acquainted with the dissection of this part by operating on a number of subjects, he will be sen- sible that there are diñerences in individuáis, which render the established descriptions, occasionally unsuitable. One ofthe most usual, is the deficiency ofthe transversalis muscle in that part, the origin of which is usually attributed to the upper half of Poupart's ligament. In this case the internal oblique has increased thickness, and of course, the cremas- ter 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, perform so important a part in the doctrines of Hernia, that one desirous of understanding them well, should at this time, again pay * Mr. J. Cloquet, of Paris, has given this explanation of the for- mation 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, in a specimen given to me by Dr. Harían. Mr. Hunter has seen the muscle running up the testis, while the latter was still in the loins. 184 OF THE TRUNK. attention to the mode of their insertion into the pubes. It will thus be seen that they form below, a common ten- don, which is inserted for an inch, into the crista of the pubes behind Gimbernat's ligament, into its spine, and into that part of its body which is behind the external ab- dominal ring ; and that just within and above their inser- tion, the same common tendón splits into two lamina1, one going before, the other behind the pyramidalis muscle, thus forming a sheath for it as just stated. In examining the origins of the Recti muscles from be- hind, the peritoneum being stripped off, it will be seen that a protrusion of intestine between them, is prevented by the internal edge ofthe one tendón overlappingthe internal edge of the other; and by a triangular ligament called, by Mr. Breschet its discoverer, the Superior Pubic Ligament. SECTION II. Ofthe parts concerned in Inguinal Hernia. It is better for the student to postpone the subject of Her- nia, until he has become acquainted with the abdominal 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 incisión through the skin and fat, from the Um- bilicus to the dorsum of the Penis, and extend it for three or four inches along the inner margin of the thigh; com- mence another at right angles with the beginning of this, and continué it from the umbilicus, in a straight line to- wards either flank; make a third incisión parallel with the first, beginning an inch behind the anterior superior spinous process of the ilium, and terminating in the second incisión. The flap of skin thus marked out, must be turned down over the thigh by a careful dissection, which will bring into view the fascia superficialis abdominis. INGUINAL HERNIA. 185 The Fascia Superficialis, consists of condensed cellular substance, with but very little fibrous matter in it, and may be considered as taking its origin on the front ofthe thigh, and extending in front of the abdominal muscles, as high up as the thorax; indeed, if we are disposed to trace it to its whole extent, 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 desmoid or aponeurotic charac- ter is very equivocal, but where the parts about the groin have been pressed upon and thickened by the irritation of hernial protrusion, it is better developed. On the thigh it is blended with fat, and endoses between its laminas, the lym- phatic glands of the groin and the external pudic vessels, given off from the femoral artery immediately below Pou- part's ligament. On the tendón of the external oblique it is more condensed ; branches ofthe femoral artery are also seen in it there; one longer and larger than the others, the Arteria ad Cutem Abdominis of Haller, winds over Pou- part's ligament and runs upwards somewhat in the line of the epigastrio artery, being distributed to the skin of the abdomen; the división of it will produce sufficient hemor- rhage to require attention. On the symphysis pubis and about the external ring, the laminas of the fascia superficia- lis are multiplied, and it has more ofthe character of com- mon adipose matter, as in most cases the adeps there, is abundant, and forms in both sexes the protuberance called Mons Veneris or Penil. From the pubes, it may be traced as a condensed cellular membrane, along the penis to its extremity, and according to Mr. Colles of Dublin, when matter is formed beneath it, is apt to créate fistulous sores in this organ. This fascia is more loosely connected to the parts beneath it, along the anterior margin of Poupart's ligament than elsewhere, which disposes the femoral her- nia to observe that course in its increase. A thin lamina of this membrane, may also be traced for some distance along the spermatic cord, and identified with the túnica vaginalis communis. 186 OF THE TRUNK. A View of tiie External parts concerned in Inguinal and Femoral Hernia. Fig. 42. 1.1. The common Integuments and Adipose Tissue of the Abdomen turned back. 2. The Penis with its Suspensory Ligament, deprived of the Integu- ments. 3. Integuments ofthe Scrotum drawn down. 4. Fascia Superficialis ofthe Abdomen. 5. The same on the Thigh. 6. The Left Spermatic Cord covered by the Fascia Superficialis. 7. The Inguinal Glands which are placed on the Fascia Superfi- cialis. ti. Branch of the External Pudic Artery. 9. Fascia Superficialis turned oífthe Thigh. 10. Tendón ofthe External Oblique, 11. Linea Alba. 12. External Oblique Muscle. 13. External Abdominal Ring. 14. Its Superior Column. 15. Its Inferior column. INGUINAL HERNIA. 187 1 fi; Testicle covered by the Oremustcr Muscle. 17. Anterior Superior Spinous Process. 18. Cióse Attachment of the Fascia Superficialis on the outside of the Thigh. 19. Cribriform Openings in the Fascia Lata Femoris. 20. Saphenous Opening. 21. Branch of the Saphena Vein. 2i2. Siphena Vein. 23. External Femoral Ring. 24. Testicle. The Fascia Superficialis, under the ñame of Túnica Abdominalis, is well developed in animáis 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 support 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 the 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 insensi- bly on the exterior surface of the cremaster muscle. A quantity of loóse cellular substance, intermixed with fat, is placed between the constituent parts of the cord and the cremaster muscle. This cellular substance, the cremas- ter muscle, and the fascia superficialis, form in scrotal ruptures, a thick lamina over the hernial sac, called Túnica Vaginalis Communis. Next make an incisión through the fascia superficialis and the tendón of the external oblique, commencing at the Linea Semilunaris, a quarter of an inch above the upper margin of the external ring, and ending a quarter of an inch above the anterior superior spinous process of the ilium. This incisión should be regularly curved, its convexity being downwards, and almost touching the middle of Pou- part's ligament. The tendón of the external oblique, bor- deringon the incisión, 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 ligament, and is inserted into the body and crista of the pubes, just behind the ex- 188 OF THE TRUNK. ternal abdominal ring. The origin of the cremaster mus- cle is well seen, and the constitutent parts of the cord, as they are about to enter into the external ring. Sepárate the inferior margin of the internal oblique from Poupart's ligament, and turn it upwards, beginning near the anterior superior spinous process of the ilium, where the dis- tinction between the internal oblique and the transversalis is better marked. The lower. part of the transversalis is thus exhibited, placed behind the internal oblique, and having the same origin from Poupart's ligament and the same insertion into 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 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 superior spinous process of the ilium and the symphysis of the pubes, and penetrates the fascia transversalis. The fascia transversalis is placed immediately behind the transversalis muscle, between it and the peritoneum. An opening of the fascia transversalis, which permits the cord to pass, is called the Internal Ab- dominal Ring, in order to distinguish it from the opening in the tendón of the external oblique, called the External Ring. The internal ring is rather nearer to the symphysis pubis, than to the spinous process 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 Abdominal, Inguinal, or Spermatic Canal, as giving passage to the spermatic cord. The anterior side of the canal, is formed by the tendón of the external oblique; the inferior part in the erect posture is formed by Gimbernat's ligament; the posterior parietes are formed by the fascia transversalis, and above, the canal is overhung by the internal oblique and transversalis muscles. It should be observed, that the spermatic cord, after penetrating the fascia transversalis, does not cross directly the inferior edge of the internal oblique and trans- INGUINAL HERNIA. 189 versalis at right angles, but crosses them very obliquely, its inclination being towards the pubes, so that the spermatic cord can only be considered as disengaged from the infe- rior edge of these muscles, about the middle of the abdo- minal canal. The opening in the Fascia Transversalis, or the Internal Ring, is not abrupt and wéll defined; but the fascia, where it transmits the spermatic cord, is reflected by a thin pro- cess, or sheath, to the cord, and insensibly terminates in its cellular substance. At the posterior or ventral face of the External Ring, the fascia transversalis is not in contact with the cord, but that part of ,4he tendón of the internal oblique and transversalis which is inserted into the crista and body of the pubes, and forms a sheath for the pyrami- dalis 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 carried through the parietes of the same into its cavity, and the flap thus con- stituted, to be turned down in order to get a'view of its posterior or ventral face. This surface covered by perito- neum, is divided in the iliac región near the middle of Pou- part's ligament, into two superficial fossse, by a narrow, falci- form 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 umbilicus. It is broader below than it is above, and its loóse edge is turned towards the abdomen. By stripping down the peritoneum, we shall see that this falciform process is simply a duplicature of it, occasioned by the fibrous cord, the umbilical ligament of the bladder, which once was the umbilical artery of the fcetus. This cord passes near the pubic margin of the internal abdominal ring. Re- placino- the peritoneum, we become convinced that the bot- tom of the superficial fossa on the outer or iliac side of the falciform process, corresponds with the internal abdominal ring, and frequently a little pouch of peritoneum enters the latter. The fossa on the inner or pubic side of the falciform process, is just behind the external ring, but separated from it by the fascia transversalis, and by the tendón ofthe lower 190 OF THE TRUNK. 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 fossse indícate the points where inguinal herniae commence, the proper inguinal pro- trusion beginning generally in the external fossa, and the ventro-inguinal in the internal fossa. Such, at least, is the opinión of some writers, though it is not held by others, as they believe, (of which I have had evidence,) that all cases of hernia at the groin, both inguinal and ventro-inguinal, begin in the external fossa. The Germán anatomists are decidedly of this opinión. 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 intestinal protrusion. The view of the Fascia Transversalis from behind, is extremely satisfactory. For a proper knowledge of this membrane, the profession is indebted to the labours of Sir Astley Cooper, and much of the zeal wúth which the ana- tomy of hernia has been investigated in latter years, is at- tributable to him. The fascia transversalis is most gene- rally, a thin tendinous membrane; occasionally it more closely resembles, condensed cellular membrane. It arises from the internal or abdominal edge of Poupart's ligament, and from the crista of the pubes just behind the insertion of the tendón of the internal oblique and transversalis muscles, and is ex- tended upwards on the posterior face of the transversalis muscle to the thorax. At its origin, it is attached to the in- ferior edge of the transversalis and internal oblique, par- ticularly that part of their. edge, between the internal ring and the pubes. It is also attached to the exterior margin of the rectus abdominis, where the muscle is destitute of its sheath behind, and it is then continued on to the linea alba. The internal abdominal 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. Were it not for the important influence of the fascia super- ficialis and the fascia transversalis, upon hernia, and the consequent necessity of a minute knowledge of them, the INGUINAL HERNIA. 191 description might be much curtailed, in considering them in their proper light, to wit, as the sheaths of muscles; for it is now sufficiently apparentthat the first is contiguous tothe external oblique, and the second to the transversalis muscle. Removing the peritoneum from the iliacus internus mus- cle, we see the spermatic vessels, descending from the loins to the internal ring, where they are joined by the vas defe- rens coming from the pelvis. As they 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, ob- liquely downwards and inwards; emerging from the external ring, it descends vertically, lying rather upon the outer column of the ring, than upon its base. On the posterior face of the fascia transversalis, between it and the peritoneum, is the Epigastrio Artery. _ The epi- gastrio, arises from the external iliac as the latter is about to go under Poupart's ligament; it ascends mwardly 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 epi- o-astric 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 un- derstood that this structure admits of two places of pro- trusion. In the first, theintestine protrudes thé peritoneum through the internal ring and along the abdominal canal, into the groin, the constituent parís of the cord are behind the sac and separated by it, from the cremaster muscle, which, in this case, forms one of the envelopes ofthe sac. In the second, from weakness of the fascia transversalis and the pubic insertion of the internal oblique and transversalis muscles, a protrusion 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 192 OF THE TRUNK. species, or the Inguinal Hernia, the epigastrio 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 the spermatic cord, and there is no cremaster mus- cle. SECTION III. Of Uve parts concerned in Femoral Hernia. The study of Femoral Hernia, should be commenced, with precise ideas of the concave edge of the os innomi- natum, which terminates externally, by the anterior superior spinous process of the ilium, and intérnally by the symphy- sis pubis;—also of the muscles of the lower extremity, which are connected with this edge;—and of the insertion oí the tendón of the external oblique. A muscular subject without much fat answers sufficiently 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 sej^arating the díffe- rent layers of fascia from each other, is much íncreased. Make an incisión through the skin, from the umbilicus to the root of the penis, and extend the lower end of the incisión around the penis along the internal margin of the thigh for six inches. Commence a second incisión at the umbiíicus, and carry it out to the flank of the side on which you opé- rate. Begin a third incisión through the skin at the termi- nation ofthe first, and carry it to the outer side ofthe 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 FEMORAL HERNIA. 193 superficialis abdominis, which lies immediately beneath, and which is next to be dissected up. A View of the deep-seated parts concerned in Inguinal and Femoral Hernia. Fig. 43. 1.1. Integuments and Adipose Tissue. 2 luteeuinents of the Scrolum. 3 3 Fascia Superficialis Abdominis and Fascia Lata Femoris turned off. 4. External Oblique Muscle. 5. Its Tendón. li. Linea Alba. . , , 7. Lower part of the External Oblique Tendón, divided and turned e Ri"ht Testicle in the Túnica Vaginalis Testis. !)' Internal Oblique and Transversalis Muscles. lü' Epigastrio Artery and vein, as placed between the Fascia Irans- versalis and the Peritoneum. 13 194 OF THE TRUNK. 11. Points to the Surface ofthe Peritoneum, through the Internal Ab- dominal Ring. 12. Cord covered by the Cremaster Muscle laying in the Abdominal Canal. 13. External Abdominal Ring, laid open. 14.15. Fascia Propria of the Vessels laid open so as to expose them. 16. Pectineus Muscle. 17. The Vessels in their Sheath. 18. Penis and Ligamentum Suspensorium. 19. Testicle and Cord, in its entire length. The Fascia Femoris, is beneath the fascia superficialis abdominis; its general character and arrangement are in- troduced into the account of the lower extremity, but there are other and minute circumstances in its disposition at the groin, indispensable to a knowledge of femoral hernia. When the fascia superficialis is cleared away, the fascia femoris is seen to arise at the groin along the anterior edge of Poupart's ligament, from the anterior superior spinous process 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; it is therefore called the Sartorial Fascia. The fascia femoris, arises also from the spine and crest of the pubes, and along its ilio-pectineal ridge, which isa continuation of the same; this latter por- tion covers the pectineus muscle, and is called the Pectineal Fascia. The pectineal fascia is behind the femoral artery and vein, and the sartorial fascia is beíbre them. The Saphena Vein, placed between the fascia femoris and the fascia superficialis, runs up along the inner side of the thigh, and joins the femoral vein an inch and a half be- low Poupart's ligament. Raise the saphena where it joins the femoral vein, and beneath this junction, a rounded semi- circular edge of the fascia femoris is seen, where the sarto- rial fascia becomes continuous 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 ex- tends from the junction of the sartorial and pectineal fascia, to the crista of the pubes; it is frequently reticulated. At the upper end of this crescent, the sartorial fascia termi- nates in a point or angle, which is directed deeply towards. FEMORAL HERNIA. 195 the upper branch of the pubes. The upper margin of this angle is closely connected with the edge of Gimbernat's lig- ament, and the point is inserted into the crista of the pubes in the same line with Gimbernat's ligament, but exterior to it, just at the internal margin of the femoral vein. This angular production or elongation of the sartorial fascia is called Hey's or the Femoral Ligament. The free edge of it is turned towards the femoral blood-vessels, by a sort of half twist. The preceding arrangement of the fascia femoris for the transmission of the saphena vein and the superficial lym- phatics, gives the. appearance of an oval aperture, called the Saphenous opening. By introducing a finger under Hey's ligament into the abdomen, we find, that the crural arch or Poupart's lig- ament, and the sartorial fascia, exercise a mutual tensión on each other, like the falx major and the tentorium ; by abduct- ing the limb very much, and turning the toe outwards, the greatest rigidiíy 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 ab- domen. The peritoneum must be separated from the ab- dominal muscles, and 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 tendón of the psoas parvus. Externally, it is connected to the margin of the crista ofthe ilium; at the internal edge of the psoas magnus, it is connected with the brim of the pelvis, and sinks into the cavity of the pelvis, being continuous with the Aponeurosis Pélvica; and below, it is inserted into the edge of the crural arch, from the an- terior superior spinous process, of the ilium, almost to the body of 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 196 OF THE TRUNK. thing is removed from the os innominatum except the in- sertion of the tendón of the external oblique, it will be of essential service to him here: for by it will be seen the arched form of the edge of the tendón next to the bone, from whence the ñame of 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 at- tachment to the crural arch, so as to keep it down towards these muscles, hernial protrusions would be constantly oc- curring. The Iliac vessels pass beneath the crural arch on the in- ner margin of the psoas magnus muscle, the vein being nearest the pubes, and the artery at the outer side of the vein. Cióse inspection will satisfy us that the fascia iliaca is inserted inio 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 anterior superior spinous process of the ilium. But at the inner side of the vein be- tween it and Gimbernat's ligament, an opening appears called the Crural or Femoral Ring, and is the place where femoral hernia commences. This opening is generally oc- cupied by a lymphatic gland, and a lamina of condensed but loosely attached cellular substance, called sometimes the Cribriform Fascia, continuous with the Aponeurosis Pélvica. 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 conceptions of the at- tachment of the fascia iliaca with the crural arch, and its continuity with the fascia pectinea, will be much ¡m- proved. The femoral vessels are enveloped by a sheath. To see this distinctly, sepárate the fascia transversalis from the transversalis muscle; cut vertically through the falciform FEMORAL HERNIA. 197 process of the fascia lata femoris, over the artery, and con- tinué the cut also through Poupart's ligament, taking care to injure as little as possible the fascia transversalis. To render this part of the examination convenient, only a narrow flap of the abdominal muscles should be left at the groin. By turning towards the symphysis pubis the falciform process, with that part of Poupart's ligament to which it adheres, weshall see that the fascia transversalis is not only attached to the edge of the crural arch, but that it continúes to the thigh in front of the femoral vessels. The fascia iliaca, besides its connexion with the pectineal fascia, gives a layer to the posterior face ofthe femoral Ves- sels. The sheath of the femoral vessels is by this method of examination, proved to be formed from the fascia transver- salis in front, and the fascia iliaca behind. Mr. Colles has adopted a very satisfactory mode of describing the forma- tion 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 continuous membrane, which may be compared to a funnel, from the manner in which it lines the lower part of the abdomen. The inner half of the funnel is deficient. From its lower part, proceeds the membranous pipe which surrounds the femoral vessels, and constitutes their sheath. This sheath, is very separable from the sartorial fascia in front and the pectineal fascia behind, and may be easily traced, to the entrance of the saphena vein into the femoral. On the thigh, just below Poupart's ligament, it has a number of foramina in it oc- casioned by the passage of the lymphatic and other ves- sels from the surface of the thigh. The texture of this sheath is evidently filamentous and fibrous, and there are many of these fibres passing from it to the sartorial fascia, and its lunated edge. At the place where the fascia iliaca is united to the cru- ral arch, a white line appears, formed by their unión; in this is fixed the Arteria Circumflexa Ilii, coming from the external iliac. The epigastrio artery is about half an inch distant from the Femoral or Crural Ring, at its outer side. Occasionally, the Obturator Artery comes from the Epigastrio, and winds around the internal mar- 198 OF THE TRUNK. gin of this ring. As the iliac vessels enter the sheath be- neath Poupart's ligament, a cióse fibrous connexion is formed from them to the sheath both anteriorly and poste- riorly, which sends a partition between the artery and the vein, and a partition also on the inner side of the vein. By such arrangement hernial protrusions 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 femoral 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, or veins; it then protrudes through this aperture, and gets under the fascia superficialis. The route thus indicated, constitutes the Femoral Canal of Cloquet. Afterwards, if the hernia increase, instead of continuing to descend, it turns up- wards and outwards, towards the anterior superior spi- nous process of the ilium. From this, it is obvious, that the places of stricture may be: First, the opening in the femoral sheath for a lymphatic, or small vein; Secondly, Hey's Ligament; and Thirdly, the edge of Gimbernat's Ligament, which looks towards the iliac vein. Mr. Col- Íes, whose opinions 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 ofthe commencement ofthe sheath ofthe femoral vessels 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 stricture, stops several lines short of the Crural Ring. A dissection performed in the manner that he recommends, 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. CONTENTS OF THE ABDOMEN. 199 SECTION IV. Ofthe Contents ofthe Abdomen. For common examination, a crucial incisión 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 below it, answers very well. The flaps thus made, being turned aside and kept down, the viscera of the abdomen can be casily seen. 1. The Liver, is in the Right Hypochondriac región: it occupies nearly the whole of it, the upper part ofthe Epi- gastrio, and the right superior part of the left Hypochon- driac. The fundus of the gall bladder projects from its right inferior surface, beyond its anterior edge. 2. The Stomach, when not much distended, is confined to the lower half ofthe Epigastrio región, and to the right inferior part of the left Hypochondriac. 3. The Spleen, if not large, recedes so much into the back part of the left Hypochondriac, that lo be seen it must be drawn out. 4. The small Intestines lie in the Umbilical, Hypogastric, part of the Iliac regions, and also in the Pelvis, when the viscera of the latter are not distended. 5. The Colon begins in the right Iliac región, passes up into the right Lumbar and Hypochondriac and through the upper part of the Umbilical, or the lower of the Epigas- trio, according to the distention ofthe stomach; it then gets to the left Hypochondriac, being commonly higher up in it than in the right Hypochondriac; thence it passes into the left Lumbar and Iliac, forms its sigmoid 200 OF THE TRUNK. flexure, and dips into the pelvis, where it is continuous with the rectum. 6. The Omextum Majus is in front of the small intes- tines, and most frequently found gathered up in the Umbi- lical región. 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 Páncreas, is at the back of the Epigastric Re- gión, behind the stomach ; it lies horizontally, and extends from the right of the spine into the left Hypochondriac región. It cannot be seen without cutting through the omentum majus, and turning the stomach upwards. 8. The Kidneys and Capsulse 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 vertebra? are more convex in front, and the abdomen more protuberant below. The pelvis is so adjusted that the acetabula are nearly in a ver- tical 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 horizontal line. Most ofthe 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 infe- rior margin of the thorax. This descent of the liver, will be according to the degree of vacuity of the stomach, in- testines, ancí 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 dia- phragm. 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, contents of the abdomen. 201 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; henee, whenever any viscus has an inordinate growth, or a tumour forms on it, or an effusion oceurs in the peritoneal cavity, the other viscera are encroached 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 ex- ceedingly 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, wTe should, in the next place, proceed to an examination of their forms and structure. The Peritoneum is a thin, delicate, semi-transparent membrane, very extensible, and spread out so as to line the cavity of the abdomen, and give an external covering to the greater number of its viscera. In man, it is1 a complete sac, having no hole in it; but in woman, its cavity commu- nicates externally through the Fallopiah 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 there- fore answer as ligaments. Again, its internal surface being smooth, highly polished, and continually lubricated by a thin albuminous fluid, corresponding with the synovial fluid 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 afTord the easiest conception of the reflections of the peritoneum. If there wrere only one viscus in the belly, and that of a somewhat regular outiine, as the spleen, the comparison would be rigid, and perfectly appreciable. One part of the cap is cióse to the head, and compares with the peritoneal coat of the spleen; the other is loóse, and is equivalent to the peritoneum, where it is in contact wTith 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 202 OF THE TRUNK. peritoneum; that they are all on its outside; and that a viscus in getting a coat from the peritoneum, merely makes a protrusion into its cavity. Starting with this most simple proposition, it is easy to conccive of a second, a third body, and so on, deriving an external coat from a protrusion into the same sac. Admitting these bodies to be spheres, the proposition is immediately 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 sto- mach, intestines, &c; they all, with exceptionsto 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 blad- der, and is reflected from it to the rectum. The reflections for immediate study, are the Omenta, Fatty Appendages of the Colon, the Mesentery and the Mesocolon^ There are four Omenta. Omentum Minus or Hepatico- Gastricum, Omentum Majus or Gastro-Colicum, Omentum Gastro-Splenicum, and Omentum Colicum. 1. The Omentum Minus, or Hepático Gastricum, ex- tends as its ñame imports between the liver and the stomach. Beginning at the transverse fissure of the liver; it passes from the lobulus Spigelii, at the posterior half of the umbili- cal fissure and from the tendinous centre of the diaphragm, to the lesser curvature of the stomach, in all the space from the cardiac to the pyloric orifice and the diiodenum. It is composed of two laminas, which, near the stomach, are separated by the coronary vessels. It has always but an in- considerable quantity of fat in it. Its right margin is com- monly called the Capsule of Glisson, and contains the he- patic vessels. 2. The Omentum Majus, or Gastro-Colicum, is an irregu- lar quadrilateral membrane, having its base upwards. The lat- ter is fixed anteriorly to the greater curvature ofthe stomach, CONTENTS OF THE ABDOMEN. 203 and posteriorly to the transverse arch of the colon. It hangs loóse 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 gastro-splenicum. It consists of two lamina?, the an- terior is fixed to the stomach, the posterior to the colon. Each of these laminas again is composed of two, so that it may be compared to two bags, one within the other, con- nected at their upper or open end to the stomach and colon. The internal and external bags are very separable above, but below they are closely united. In corpulent subjects a great deal of fat is found in this membrane. By searching for the neck of the gall-bladder, we shall find near it, under the capsule of Glisson, the Foramen of Winslow, an opening which conducís into the sac or cavity 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 nature of its cavity, its extent, and all the parts constituting its parietes. This cavity is bounded above by the omentum minus and stomach ; in front by the two laminas sent from the stomach; behind and belowr, by these laminas 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. A little reflection will show that I have described an uninterrupted cavity, beginning at the lobulus spigelii by the omentum minus, and terminating 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 wrell worth master- ing, as when this is accomplished, all other difnculties, in studying the reflections of the peritoneum, are much di- minished. 204 OF THE TRUNK. A View of the Reflections of the Peritoneum, as given bv a Vertical Section of the Bodv of a Man. FlG. 44. 1. A section of the Spinal Column and Canal. 2. A section of the Sacrum. 3. A section of the Sternum, &e. 4. The Umbilicus. 5. A section of the Linea Alba and Abdominal Muscles. 6. The Mons Veneris. 7. Section of the Pubes. 8. The Penis divided at the Corpora Cavernosa. 9. A section of the Scrotum. 10. The Superior Right Half of the Diaphragm. 11. A section of the Liver. 12. A section of the Stomach, showing its cavity. 13. A section'of the Transverse Colon. CONTENTS OF THE ABDOMEN. 205 14. A section of the Páncreas. 15. A section of the Bladder, deprived of the Peritoneum. 16. The Rectum, cut off, tied and turned back on the promontory of the Sacrum. 17. The Peritoneum covering the anterior Parietes of the Abdomen. 18. The Peritoneum on the inferior under side of the Diaphragm. 19. The Peritoneum on the Convex side of the Diaphragm. 20. Reflection of Peritoneum from Diaphragm to Liver. 21. The Peritoneum on Front of Liver. 22. The same, on its under surface. 23. The Hepato-Gastric Omentum. 24. A large pin passed through the Foramen of Winslow into the Cavity behind the Omentum. 25. The anterior Face of the Hepato-Gastric Omentum, passing in front of the Stomach. 26. The same Membrane leaving the Stomach to make the anterior of the four layers of the Great Omentum. 27.28. The junction of the Peritoneum from the front and back part of the Stomach, as they turn to go up to the Colon. 29. Tiie Gastro-Colic, or Greater Omentum. 3.). The separation of its Layers, so as to cover the Colon. 31. The posterior Layer passing over the Jejunum. 32. The Peritoneum in front of the right Kidney. 33. The Jejunum cut off and tied? 34.34. The Mesentery cut off from the small Intestines. 35. The Peritoneum reflected from the posterior Parietes of the Blad- der to the anterior of the Rectum. 36. The Culde-Sac between the Bladder and Rectum. 3. The Omentum Colcicum, is a prolongation of the omentum majus, from the internal side of the right ascend- ing colon, and from the adjacent part ofthe transverse. It is ñlled with fat from the same causes as the preceding, but consists of only two single laminas. 4. The Omentum Gastro-Splenicum, is that process of peritoneum, which extends from the large extremity of the stomach to the spleen ; it may be considered as the left ílank or prolongation of the omentum majus, and endoses in its duplicature the arteries and veins called Vasa Brevia. 5. The Appt:ndiculj2 Epiploice, are little processes of peritoneum, filled with fat, appended at irregular intervals to the anterior sides of the cascum, colon, and the upper part ofthe rectum. The Mesentery, is a process of peritoneum which is extended obliquely across the spine, from a line parallel with the second lumbar vertebra, to the right iliac fossa. This part, called its root in the adult, is about six inches in 206 OF THE TRUNK. length and flat, but the inferior edge which is loóse and pendulous, having the intestines connected with it, has its circumference increased to many feet, being the whole length ofthe small intestines, with the exception ofthe duodenum. The mesentery attaches the left extremity of the small intes- tines to the spine. It consists of two laminas of peritoneum separated by the mesenteric arteries and veins, the lacteal glands and 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 cascum is in con- tact with the iliac fascia, and is tied down to it. The colon in the right and left lumbar regions, is also for the most part immoveably fixed, the mesocolon 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 ofthe abdomen, which permits the colon to ascend and descend according to the distention of the small bowels and stomach. In the left iliac región the mesocolon is elongated so much, as to allow very free motion to the sigmoid flexure ofthe gut, and is continued into the meso- rectum. OF THE VENTRICULUS, OR STOMACH. The Stomach is a conoidal sac, curved considerably up- wards. As was stated, it is in the epigastrio región, in con- tact above with the diaphragm, with the left lobe of the liver and the lobulus spigelii; on the left with the spleen; behind wTith the páncreas; and below with the colon and mesocolon. The stomach has a very great obliquity in its situation, the right extremity being much lower down than the left. The exterior of the stomach presents two faces, two or> fices, two curvatures, and two extremities. When the stomach is nearly empty, it becomes somewhat flattened, and then exhibits the Anterior and the Posterior face; in a state of distention, the first looks obliquely up- wards, and the latter obliquely downwards. The angle, CONTENTS OF THE ABDOMEN. 207 formed with the cesophagus, is increased according to the degree of distention. The orifices are named Pyloric and Cardiac. The Py- loric, viewed externally, presents nothing remarkable, but seems to be a continuation of the right extremity of the stomach into the duodenum. The Cardiac, formed by the junction of the cesophagus with it, is at the upper edge of the stomach, and some distance from the extreme left. The curvatures are the Great and Small. The first in- cludes the great extremity and the inferior edge of the sto- mach to the pylorus; the small is the upper margin be- tween the orifices. The Tuber or great extremity of the stomach, is the part to the left of the vertical plañe, passing through the cardiac orifice; it is smaller in proportion in children than in adults. The stomach is formed by four coats or laminas, the Pe- ritoneal, Muscular, Cellular, and Mucous. The external is Peritoneal, and derived from the separation of the two la- minas of the omentum minus. The second is Muscular, its thickness is inconsiderable, and the fibres which compose it are remarkably palé; they are best seen near the cardia and at the pylorus. At the latter, they are collected into a ring of considerable thickness, which, making a marked prominence intérnally, 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 cesophagus and extend 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 espe- cial manner, which assists in forming the pyloric orifice. The third and most profound set of muscular fibres, some- times spoken of as the muscle of Gavard, 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 scarcity of transverse or cir- cular fibres. 208 OF THE TRUNK. The third coat of the stomach, consists of a very dense compact short cellular membrane, which unites the muscu- lar 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 colour, about a line in thickness, and can be easily raised up by dissection. It is like velvet, and thrown into very irregular folds, accord- ing to the degree of contraction of the stomach. At the pyloric orifice^it forms a circular fold constituting the pyloric valve, and having a round hole in the centre. At the base of this valve, the muscular fibres make a distinct ring. The stomach is supplied with blood, by the Gastric, Right and Left Gastro-Epiploic Arteries, and by the Vasa Brevia. The veins follow the course of the arteries, and terminate di- rectly or indirectly, in the Vena Portarum. OF TUE 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, which, owing to a welt marked difference in magnitude, is divided by anatomists into the Small and Large intestines, the former forming four-fifths of the whole, extends from the stomach to the ileo-colic valve, the latter from this valve to the anus. This canal, like the stomach, consists of four coats, peritoneal, muscular, cellular, and mucous. The Small Intestine, or Intestinum Tenue, although an uninterrupted tube, is divided somewhat artificially, for the sake of description, into three parts, Duodenum, Jejunum, and Ileum. The Duodenum, named from its length, which has been fixed at twelve fingers breadth, is nearest the stomach, and the commencement of the canal. It is also called Ventri- culus Succenturiatus. Beginning at the pylorus, it passes upwards, and to the right side, till it reaches the neck of the gall-bladder; it then forms a right angle, and passes down- CONTENTS OF THE ABDOMEN. 209 wards before the right kidney, to the third lumbar vertebra, being there placed behind the superior lamina ofthe transverse Mesocolon. Here it forms a round elbow, and crosses the spine obliquely upwards, under the junction of the mesen- tery and mesocolon, and makes its appearance to the left of the second lumbar vertebra, where it is continued into the mesenteric portion of intestine. The head of the Páncreas lies in the bend of the duode- num, 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 laminas of the mesocolon, but have no peritoneal coat; and the termination is both moveable, and has a peritoneal coat from being at the commencement of the mesentery. 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 cellular coat, connecting it with the mucous or villous coat. This internal coat is reddish, tinged with bile, and occupied by a great number of rugas or folds. They are transverse and oblique, very near each other, about three lines broad, and as pro- minent in the distended as the undistended gut; these con- stitute the Válvulas Conniventes. Many mucous follicles exists in this intestine, and mucous glands, called Glands of Brunner; the latter are particularly accumulated about the pyloric orifice. It is in the posterior part, about four inches from the stomach, that the orifices of the pancreatic and hepatic ducts are found. The Inferior, or Mesenteric portion of the Intestinum Tenue, has the same coats with the preceding. In the upper two-fifths, called Jejunum, by Galen, from a supposi- tion that it was most frequently found empty, the válvulas con- niventes are numerous, and arranged transversely; but in the lower three-fifths, called Ileum, they gradually diminish, and near its termination, cease entirely. There is a gradual diminution of the diameter of this intestine from above downwards. From the length of the mesentery, great lati- tude of motion is allowed to it. It presents a very irregular and confusing appearance at first, but one soon becomes 14 210 OF THE TRUNK. accustomed to its course and convolutions; and then its commencement and termination, are as readily found as those of any other organ. It is probable that in the distentions of this bow el, Üie peritoneal coat does not stretch much, as the laminas of mesentery are .loosely applied against each other where they join the intestine, 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 appendiculas epiploicas and cul-de-sacs projecting from its sides. I have never seen the former, but of the latter, a specimen was presented to me some years ago, taken from a child, by the late Dr. Edward Barton ; and another speci- men now belongs to the W istar Museum, obtained in the dissecting rooms. The mucous or internal coat of the Intestinum Tenue, differs from that of the stomach, in resembling more the downy cuticle of an unripe peach. The little projections from it, are called Villi. It abounds with mucous follicles and glands; the latter consist in those of Brunner, which are insulated from each other and may be seen at intervals along the whole intestine:. and in those of Peyer, which make about thirty patches of an elliptical shape and of va- rious sizes, towards the lower end of the Ileum. The small intestine is supplied with blood from the superior mesenteric artery. Its nerves come from the Sympathetic. The course of the large Intestine or the Intestinum Cras- sum, has already been explained. It is more obviously a conical tube than the small intestine, being very large at its commencement when inflated, and diminishing much to the lowrer end of the sigmoid flexure. Anatomists cali its commencement, or that part below the ileo-colic valve, Cíe- cum 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 CascuM, or Caput Coli, is about two inches in length, and is fixed to the iliac fascia by peritoneum and loóse cel- lular membrane. At its inferior extremity, towards the left, is the Appendicula Vermiformis, a blind cavity of four coats, about four inches long, and of the size of a turkey quill, enclosed in a duplicature of peritoneum. It floats loóse, and occasionally becomes a cause of rnisehief, by getting around the ibum, and inflaming, by which it adheres CONTENTS OF THE ABDOMEN. 211 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 death. In its transverse course, we fre- quently find it passing through the umbilical región. The coats of the Intestinum Crassum, correspond in num- ber with those of the small intestine; but there are some differences in structure. The longitudinal muscular fibres are much more conspicuous; they are collected into three bands, which commence at the head of the colon, and ex- tend to the upper part of the rectum; one is superior, an- other inferior, and a third anterior. They are equidistant from each other. These longitudinal bands produce the cells of the colon, in consequence of being shorter than the other coats of the gut, and puckering them up by drawing its extremities nearer together. The cells are separated laterally, by partitions or buttresses, formed of a doubling of all the coats of the intestine; whereas inthe small intestine, the válvulas conniventes or doublings belong 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 di- viding these longitudinal bands, the cells are removed, and the intestine elongated considerably. The Ileo-Colic Valve, or vahe of Bauhin, or Tulpius, is a great curiosity in the anatomical structure of this gut. The ileum runs into the left side of the colon, and continúes its cellular and mucous coat into the corresponding coats of the colon, the muscular coat of the latter being simply parted. To prevent the farther separation of the muscular fibres, a little ligamentous arrangement, called the Retina- culum of Bauhin orMorgagni, prevails at each end. When viewed from within the colon, the opening appears as a transverse, or very narrow elliptical slit, established by two lips, the superior being broader than the inferior. They meet like the gates of the common ship-doek 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 fasces, has a tendency to forcé this valve, and will, by stretching its extremities, make the lips tighter and more resisting. The internal coat of the large intestine differs very mate- rially from that of the small. It has no doublings or folds 212 OF THE TRUNK. exclusively in it, like the válvulas conniventes of the small intestines, and few or no villi. Near its commencement, it preserves the fungous appearance ofthe stomach, but about the sigmoid flexure, it is a plain smooth surface. A great many mucous follicles and mucous glands are in it. It has lacteals, but they are not so numerous as in the small in- testines. The Rectum will be described with the Pelvis. OF THE LIVER, (HEPAR, SIVE JÉCUR.) The Liver secretes the bile, and is the largest glandular body in the human frame. Its position in the abdomen and the space it occupies, have been mentioned. It is placed in the following relations, with neighbouring parts. Above, it is in contact with the concavity of the diaphragm ; below, it has the Omentum Minus, the Stomach, and the Trans- verse Arch of the Colon; and behind, is the Vertebral Column, intercepted, however, by the lesser muscle of the diaphragm, 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 sometimes occasions uneasiness by press- ing on the stomach; and when on the back, it compresses the ascending cava. The liver, from being completely enveloped in perito- neum, has a smooth, glossy appearance, and is of a red- dish-brown colour. Its form is happily compared, by Pro- fessor Chaussier, to the section of an ovoid, made in the di- rection 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 dia- phragm, and extending from the umbilicus backwards to near the ascending cava, is the Falciform or Suspensory Ligament, consisting of two laminas; it is thickened at its an- terior edge by what was once the umbilical vein in the fcetus, but is now converted into a fibrous substance called the Round Ligament. This falciform ligament, divides the upper sur- face 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 falciform process, and ex- tending from the diaphragm to the posterior edge of the liver, is the Right Lateral Ligament; to the left of the same process, and also extending from the diaphragm to the back CONTENTS OF THE ABDOMEN. 213 edge of the liver, is the Left Lateral Ligament; and that portion of peritoneum concerned in describing the periphery of this space, constitutes the Coronary Ligament. Within the circumference of the coronary ligament, the surface of the liver is not covered by peritoneum, but is attached to the diaphragm by loóse cellular substance. The precise shape of the liver, is best seen in one re- moved from the body. The following parts are noticed by anatomists: its upper surface, its lower surface, its right ex- tremity, its left extremity, its anterior edge and its posterior edge. The upper surface is uniformly convex, adapts itself readily to the concavity of the under surface of the Dia- phragm, and presents nothing remarkable, but its equal di- visión by the suspensory ligament. The lower surface is very irregularly concave, and on it are the following appearances: From the front to the back edge, it is traversed by a deep fissure, corresponding in situa- tion with the attachment of the suspensory ligament above, and with it, giving occasion to divide the liver into Right and Left lobes. This is the Sulcus Umbilicalis, or umbilical fissure, occupied in front by what was the umbilical vein, and in the rear by what was the ductus venosus, both ves- sels in the adult being in a ligamentous state. Crossing this fissure at right angles, passing from the left lobe, for some distance into the right, and occupying about the middle third or fourth of the long diameter of the liver, is the Sul- cus Transversalis, or Transverse Fissure. In it, are the vena portarum, hepatic artery, and ducts, lymphatics and nerves, all of which are bound to each other by a cióse cellular substance. The Lobulus Spigelii or posterior lobe, is placed at the back of the liver, just to the right of the posterior part of the sulcus umbilicalis. It is like a ridge, and termi- nates forwards in a papilla which is one of the portas 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 Lobulus 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 Quartus ; its posterior extremity, opposite to the anterior of the lobulus spigelii, is the second gate-way or porta of the liver. 214 OF THE TRUNK. The right extremity of the liver is very thick and almost filis the right hypochondriac región, but the left tapers to a very thin edge. The posterior border or edge, is thick and indented by the spine, but the anterior edge is thin. The former is sometimes converted into a complete canal, marked by a short large sulcus for the ascending vena cava; 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 to- gether its granulated structure.* This tunic is easily seen by strippingoffthe peritoneum, orin parts which naturally are left uncovered by the latter, as within the circle of the coro- nary ligament. The blood-vessels are of three kinds. The first two bring the blood to the liver; the third takes it away, by empty- ing into the ascending cava. The Hepatic Artery, a branch of the cceliac, after having detached some smaller ramifica- tions, gets to the transverse fissure of the liver and divides into three branches; one to the right lobe, one to the left lobe, and another to the lobulus Spigelii; they, however, subdivide before they reach the substance of the liver. These branches are between the sinus portarum and the biliary ducts. The Vena Portarum being formed from the unión of all the veins of the intestines, stomach, páncreas, and spleen, forms a single trunk about three inches long. It gets to the transverse fissure of the liver, over the duodenum and under the páncreas, and immediately sends off, at right an- gles, 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 left lobe, lobulus spigelii, and ano- nymus. * See Scemmering's Anatomy. Laennec's Journal de Medecine, CONTENTS OF THE ABDOMEN. 215 A Horizontal Section of THREE SUPERFICIAL Lo- BULES OF THE LlVER, SHOWING THE TWO PRIN- CIPAL SYSTEMS OF BLOOD- VESSELS. 1.1. Intra-Lobular Veins pro- ceeding from the He- patic Veins. 2.2. Intra-Lobular Plexus formed by branches of the Portal Veins, At the bottom of the transverse fissure is a lamellated fibrous cellular tissue, closely adhering to the liver, which accompanies the vena portarum, the hepatic artery, and he- patic duct in their ramifications, forming sheaths for them as they go offsuccessively. As the branches of these tubes keep together, they are united by the cellular sheaths, which may be considered as continuous with the processes sent in from the cellular coat. Glisson believed these sheaths to be mus- cular, and they have obtained the ñame of his capsule, al- though subsequent examination, has proved him to have been in error. This capsule is frequently spoken of as lying on the aforementioned vessels, even before they reach the liver. The Hepatic Veins arise in the acini, from the capillary extremities of the hepatic artery, and vena por- tarum. There are three principal 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 dia- phragm; there are also, five or six little trunks, coming from the posterior surface ofthe liver, and the lobulus spi- gelii, 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 anastomoses, Fig. 45. 216 OF THE TRUNK. and the facility of their communication writh each other. A minute injection of either, pervades all parts of the liver, and the injection if persevered in, will fill all the other ves- sels. By tearing the substance of the liver, a good view of its organization may be obtained; it will then be seen to be composed of an immense number of spherical, or polyhe- drous grains, called acini from their resemblance to berries. These are united to each other by the cellular tissue of the internal coat, and traversed by blood vessels. Each of these grains is a representative ofthe gland, as its structure is complete in itself, being formed by the terminations ofthe blood vessels, and by the origin of a branch of the hepatic artery, called the porus biliarius. When examined with a microscope, these acini are observed to be composed of a yellow and brownish substance, the yellow being the corti- cal portion. The commencing radicles or ramifications of the Hepatic Duct, take their origin in the acini, and as is said, upon the boundary between the two kinds of matter, avoiding the brown, and passing through the yellow or cortical. The larger branches, converge into their respective trunks suc- cessively, or in pairs, while several of the primordial or most minute ones converge to the same point, giving a pen- icillous appearance. These several tubes, constitute the Pori Billiarii, and are always in the same group with the branches of the Vena Portarum, and Hepatic Artery. It is unsettled, whether these brush like or penicillous ends of the pori billiarii, are enlarged at their free extremities, so as to be there like a pin at its head, in the manner so common in glandular structures. Krause asserts the fact, and states that the enlargement measures from ¿V to 5V of an English line, and there are said to be preparations of the kind at Utrecht. It is asserted, that a fine injection passes more readily from them into the lymphatics, than into any other order of vessels: which may account for the promptitude of jaundice, upon any obstruction ofthe hepatic duct. According to the observations of Mr. Kiernan, the acini of anatomists generally, should be called lobules, inasmuch as they consist in a collection of smaller granulated bodies, to which he restricts the ñame of acini. The principal ob- jection to this is, the introduction of a new definition on a COXTENTS OF THE ABDOMEN. 217 point heretofore considered as settled in the universal phra- seology of anatomists, but as his descriptions are founded on this assumption, it may for the time be admitted. His statement is, that the finer branches of the vena portarum, which he calis Interlobular Veins, form a perfect and minute plexus, surrounding the lobules, or small granular masses of the liver: they there form convergent lines of vessels directed towards the centre of each lobule, and communicating by transverse branches with one another. These latter con- nexions, or the sets of veins making them, constitute the lobular venous plexus, and in their intervals are placed what he calis the acini or subordínate granules. He farther states, that the Hepatic Duct forms a plexus upon the lobules like that of the vena portarum; the plexuses of the contiguous lobules being indisposed to anastomose, though he thinks there is ground to believe in such anastomosis. The inter- lobular biliary ducts, there penétrate the lobule, and ramify by anastomotic connexion through it. The Hepatic Artery also makes a plexus upon the surface of the lobule, and penetrates interiorly, from its periphery, towards the cen- tre. Its ultimate branches supply the meshes of the vena portarum, of the vena hepáticas, and of the biliary ducts, but their final termination is unsettled. Kiernan believes that it is in the vena portarum, and Meckel, that they end in the incipient branches of the venas hepáticas. The Hepatic Veins, according to Mr. Kiernan, are seen as a small trunk, in the centre of a lobule: this trunk arises from the convergence of from four to eight venules, from the periphery to the centre of the lobule. The trunks having escaped each from its respective lobule, there unite with contiguous trunks similarly circumstanced, and as the arrangement is progressive, by the successive junction of larger and larger trunks, we have finally the large Hepatic Veins formed, which discharge into the ascending vena cava. 218 OF THE TRUNK. A Horizontal Section of two Superficial Lobules, showing the Intra-Lobular Plexus of Biliary Ducts. Fig. 46. 1.1. Intra-Lobular Veins. 2.2. Trunks of Biliary Ducts, procceding from the Plexus which tra- versos the Lobules. 3. ínter-Lobular Tissue. 4. Parenchyma of the Lobules. The nerves of the Liver will be mentioned at another place, along with the general account of such as belong to the Abdomen. The Gall-Bladder, (Vesicula, sive Cistis Fellea,) is a re- servón- for the bile, and is fixed on the inferior surface of the great lobe, to the right of the umbilical fissure, (from which it is removed by the lobulus quarters,) in a broad shallow fossa. It is not placed in the line of the short diameter of the liver, but somewhat obliquely, its anterior end, which reaches to the edge of the liver, being turned to the right, and its posterior, which goes to the transverse fissure, being turned towards the left. Its shape is that of an oblong pyriform sac, the base being rounded off and the apex curved; the body diminishes gradually to the apex. The gall-bladder has three coats, a peritoneal, cellular and mucous. The peritoneal coat is only a partial one, in con- sequence ofthe upper face ofthe gall-bladder being in con- tact with the liver. The second" coat is cellular membrane, in which ramifies a great number of blood-vessels and lym- CONTENTS OF THE ABDOMEN. 219 phatics. The third is always tinged of a deep green, or yellow colour by the bile after death, though during life it is palé. On its internal face, it is thrown into irregular tor- tuous folds or wrinkles of extreme delicacy, in the intervals of which are many round or polyhedrous 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 and in the beginning of the cystic duct, from three to seven or more elevated semilunar folds, are formed of the internal membrane: which sometimes adopt a spiral arrangement, like a valve. The contiguous parts to the gall-bladder, like its inner coat, are always tinged with bile after death, which does not occur in the living body. I have, however, in one case in our dissecting rooms, seen a gall-bladder in an oíd African woman, filled by a pint of very fluid, watery, green- ish bile, and the tissue of* which had been so lax, that a quart or more of the same secretion had percolated into the abdomen, probably before death. The Hepatic Duct arises as stated, by very delicate branches, from the Acini of the Liver. These branches are united into three or four trunks, in the transverse fis- sure, which trunks, again unite into a single one, the He- patic Duct, 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 Commu- nis Choledochus. The biliary canals thus formed, are si- tuated in the right side of the Hepatico-Gastric, or lesser Omentum, in what is commonly called the Capsule of Glis- son. 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 behind the páncreas and the upper part ofthe duodenum, and passes obliquely between the coats of this intestine, for the distance of an inch, its orifice being as mentioned, at the back ofthe second turn of the intestine. The Ductus Communis, sometimes re- ceives the Pancreatic duct. The Biliary ducts have two coats. The external is a lamellated fibrous membrane, highly extensible, and having 220 OF THE TRUNK. many blood-vessels. The internal is of the same character with that of the gall-bladder. OF THE SPLEEN (LIEN, SPLEN.) This organ, as mentioned, is situated deeply in the left hypochondriac región, in the concavity of the Diaphragm at the left extremity ofthe stomach, and above the Colon. Its form approaches to the longitudinal section of an oval, being commonly four and a-half inches long, and two and a-half or three wide. But there is no viscus in which more frequent varieties of magnitude occur. 1 have seen it ex- tending almost to the Ilium, and but little smaller than the liver; and again, not by any means the length just men- tioned as a médium size. Its transitions of magnitude are frequent and rapid in the same individual, depending on the stage of digestión, 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 división lengthwise, by a fossa, where the blood-vessels are connected with it. Its cir- cumference 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 ñames of which indicate their attachments; the Gastro-Splenic liga- ment or Omentum, the Splenico-Phrenic, and the Splenico- Colic Ligaments. The external coat of the spleen is obtained from the pe- ritoneum, being a continuation of the processes just men- tioned. The internal coat is a grayish, compact, extensible, elastic membrane, in cióse adherence with the external; it sends in processes to accompany the blood-vessels ; and moreover from its internal face, there proceeds a multitude of lamellas and of fibres, dividing its cavity into cells. It seems to be intended to sustain the natural shape of the spleen, and to support its peculiar structure. The spleen is remarkably well furnished with blood-ves- sels. The largest branch from the cceliac artery, runs to it along the superior margin of the páncreas and is distin- guished by its tortuous course, and by the branches which CONTENTS OF THE ABDOMEN. 221 it furnishes to the stomach and páncreas. 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 páncreas; it joins the Vena Portarum. The splenic vein is destitute of valves. In the body of the spleen, are found many grayish, soft, semi-transparent, gelatinous corpuscles, from an almost im- perceptible magnitude to a line or more in diameter. By Malpighi, they are considered glandular; 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 ofthe internal coat. On this cellular structure, the vessels pass. M. As- solont considers that blood, besides existing in the arteries and veins, is placed in a state of particular combination, and of intimate unión with the other organic elements of the viscus, and with a large quantity of albumen; that this peculiar combination of the blood forms the dark grumous fluid just mentioned, which may be easily seen by scraping the spleen with the handle of a sc'alpel. Of the latter, there can be no doubt; but a question arises whether it is con- tained in the cells I have just spoken of, orin the extremi- ties of the vessels. Slight examination is in favóur 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, suc- cessively injected, is frozen, one can see no ice in the in- terstices of the vessels, while the capillary ramifications of the vessels distended by the injected fluid, are dis- tinctly seen. Theprobability then is, that the peculiar structure ofthe spleen, is formed essentially of arterial and venous capillary vessels, with very delicate and extensi- ble coats, that they communicate with each other, with- out the intermedium of any cell, and that the extreme tenuity of these vessels, and their extensibility in every di- rection, are sufhcient to explain the augtnentation of volume which the spleen affords, under certain circumstances, and the promptitude with which it diminishes under others. It has no duct, and is not known to secrete any thing. Its probable function is, to act as a diverticulum of blood from the liver. 222 OF THE TRUNK. OF THE PÁNCREAS, (PÁNCREAS.) The Páncreas secretes saliva, and is the largest of the salivary glands. It is an oblong conglomérate gland, ex- tending across the spine, and fixed in the back and lower part of the epigastrio región. It is connected to the spleen on the left, to the duodenum on the right, is behind the stomach, and between the laminas of the transverse meso- colon. The Páncreas is of a light gray colour. It is about six or seven inches long and two wide ; and would represent tolerably a parallellogram, if at its right extremity, it were not swollen out into a head, to which Winslow gave the ñame of Lesser Páncreas. It has two faces, two edges, and two extremities. The anterior face is turned obliquely up- wards, and corresponds with the superior lamina of the me- socolon. The posterior face is obliquely downwards, has a long fossa in its upper part for the splenic vessels, andis in contact with the aorta, vena cava ascendens, the supe- rior mesenteric vessels, and several nerves. The páncreas has no peritoneal coat, excepting the me- socolon, neither has it a proper tunic, unless we should consider as such, the lamina of condensed cellular mem- brane which envelopes it, and which sends in processes between its lobules. The structure ofthe páncreas, strongly resembles thatof the salivary glands and consists of granuli, united into lobules, which form lobes, whose interstices are occupied with numerous vessels. The excretory duct ofthe gland, arises from these granulations by very fine radíeles, which, uniting, form larger cylinders inclining from left to right. These latter empty successively 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 othet end. It is there joined by the duct of the lesser páncreas, and in a short course afterwards, empties into the ductus communis cho- ledochus, or runs at its side and makes a distinct opening into the duodenum, at the posterior part of its second curva- ture. CONTENTS OF THE ABDOMEN. 223 The arteries of the páncreas, are principally derived from the splenic. The veins, empty into the splenic vein. OF THE KIDNEYS, (RENES.) To get a good view of the kidneys, the other abdominal viscera should be removed, or at least the intestines. » The Kidneys are two glandular bodies for the secretion of uriñe, 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 con- sequence 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 upper part of the great psoas, and quadrati luraborum muscles, as well as on the lower part of the great diaphragm. The shape of the kidney, is a compressed ovoid, exca- vated on one side like a kidney 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. 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 perforated with many foramina for transmitting the blood-vessels. This mem- brane 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 formed in lobes which subsequently unite, the vestio-e of this unión is frequently preserved. The kidney being laid open longitudinally, we shall ob- tain an idea of its internal arrangement. It is seen obvi- ously to consist of two parts of different appearance; the íxternal which, from its position, is called Cortical; and the internal Tubular. In regard to the structure ofthe kidney, it receives from 224 OF THE TRUNK. the aorta, at right angles, a large artery, the Emulgent, which divides into several branches as it approaches the fissure; these terminate by penetrating to all parts of the gland in a crowd of arterioles, so that when they are in- jected with wax and corroded, the figure of the gland is preserved. Some of these minute arterial branches ter- minate in corresponding veins, and others in the glandular structure of the organ. The Cortical part is the most vascular; it is on an ave- rage, about two lines in depth, is made of granules called acini, and forms the periphery of the gland; but different portions of it project and form partial partitions between the tubular sections. It tears with facility, with a granu- lated edge or surface, and its colour is a dark or reddish brown. When viewed with a microscope, the granulations are distinctly seen of extreme minuteness, and receiving the capillary extremities of the arteries. I have more than once injected these granulations from the arteries, and ob- served the fluid coming through the uréter and the emul- gent vein. The second or Tubular portion of the kidneys, to the naked eye, consists of conoidal fasciculi of fibres, present- ing their bases to the periphery of the organ, and their ápices towards its centre. These cones are from twelveto eighteen in number, (PyramidesMalpighianas,) and as men- tioned, 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, con- verging cióse to each other near the apex, and joining. They appear only to give passage to the uriñe, as cases have occurred, in which they were entirely removed by suppuration and ulceration. The technical ñame for these canals, is Tubuli Uriniferi; they begin in the cortical part of the kidney from the acini and pass through it in a ser- pentine course. The terminations of the cones are called Papillas, 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 tubular part. They have many orifices in them, which are the terminations of the CONTENTS OF THE ABDOMEN. 225 tubes, and from which uriñe, in most subjects. can be rea- dily squeezed. A Vertical Section of the Left Kidney. 1. Cortical or Vascular Structure. 2. Pyramids of Malpighi or Tubular Structure. 3. Papillas or Ápices of Pyramids. 4. Terminations of other Papilla? in In- fundibula. 5. Cálices. 6. The three Infundibula. 7. Pelvis of the Uréter. 8. The Uréter. Fig. 47. OF THE EXCRETORY DUCT OF THE KIDNEY, OR THE URÉTER. The Uréter is a canal which conveys the uriñe from the kidney to the bladder. It begins in its centre by a dilata- tion called Pelvis, and branches into several divisions called Cálices, each of which ends in three or more funnel-shaped tubes, named Infundibula. Each of these embraces by its expanded orifice, the base of the papilla, so as to permit the latter to project into it and distil its uriñe there; but sometimes, there are two papillas to one infundibulum. The Pelvis of the kidney is continued into the Uréter, a canal about the size of a writing quill, and which is in con- tact behind, with the psoas magnus muscle and the iliac and hypogastric vessels, crosses the vas deferens 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 excretory duct of the kidney has two coats, the ex- ternal of which is fibrous and the internal mucous. The latter is said to be continued over the papillas, and also, by some anatomists, to enter into the tubuli uriniferi. Its 15 226 OF THE TRUNK. lowrer end is continuous with the internal coat of the blad- der. The Uréter enjoys a great degree of extensibility and contractility of tissue, as shown in the transmission of large calculi, and its sensibility not perceptible in health, is ex- quisite in disease. The emulgent veins are parallel with the arteries, and ter- minate in the vena cava ascendens. OF THE RENAL CAPSULES, (CAPSULA RENALES.) These are two little triangular pyramidal bodies, one for each kidney, and rest by a concave base on its superior part; they are of a yellowish brown colour, somewhat tinged with red, have no excretory duct, and being connected with some process of fastal existence, are much larger then, than in the adult; their structure also seems to be much changed in the latter. They are about fifteen lines high, and as many wide. On the exterior of their body is a proper coat formed of lamellated and condensed cellular tissue, which furnishes from its internal surface many prolongations, dividing the gland into lobes. These lobes are divisible into lobules, which again consist of a granulated structure that seems susceptible of other divisions. These granulations are not firm and resisting. In the centre of the Capsula Renalis, there is occasionally a triangular cavity, which may be demonstrated bythrusting a tube into it, and inflating, or by an incisión. In the fcetus this cavity contains a reddish viscid fluid coagulable by al- cohol : in children it becomes yellow: in adults it is dark- brown, and in oíd people it is either wanting, or in a remark- ably small quantity. The arteries of these bodies come from the emulgents, the phrenics and the aorta. The veins termínate on the right side in the cava, and on the left, in the emulgent vein. DIAPHRAGM. 227 SECTION V. The Diaphragm, (Diaphragma,) Is a complete, though moveable septum, placed between the thoracic and the abdominal cavity; it is extremely con- cave below, and convex above, the concavity being occu- pied by several of the abdominal viscera. To view it pro- perly, 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 ne- cessary 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 becoming flabby and displaced, the valué 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 ten- don resembling in its outiine the heart of a playing card. This cordiform tendón, occupies a considerable part of the extent of the diaphragm, has its apex next to the sternum, and its notch towards the spine ; the muscular part of the diaphragm is inserted all around into its circumference. The cordiform tendón 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 tendón, some of the muscular fibres rise so high upwards before they join it, that they are on a horizontal level with the an- terior end of the fourth rib. The fasciculi of muscular fibres, are for the most part, convergent from the circum- ference of the thorax, and are easily separated from each other. In the diaphragm are three remarkable foramina. The first, (Foramen QZsophageum) is in the back of the muscle between the spine and the notch of the cordiform tendón, a little to the left of the middle line. It gives passage to 228 OF THE TRUNK. the OEsophagus and the Par Vagum nerves along with it, and is rather a fissure or a long elliptical foramen made by the separation and reunión ofthe muscular fibres; for above and below at each end ofthe ellipsis these fibres decussate each other in columns. To the right of this foramen and a little above its horizontal level, in the back part of the cordiform tendón, is a very large and patulous foramen, (Foramen Quadratum) for the Ascending Vena Cava. Its form is between an irregular quadrilateral figure and a cir- cle; its edges are composed of fasciculi of tendón rounded off, and are not susceptible of displacement, or of alteration in their relative posilion to each other, by which means any impediment which might arise from a different arrangement, to the course of the blood in the ascending cava, is obviated. Almost in a vertical line below, and about three inches from the foramen for the cesophagus, is the third hole in the diaphragm (Hiatus Aorticus) which affords passage to the Aorta. It is just in front of the bodies of the three up- per lumbar vertebras, and is a much longer elliptical hole than the cesophageal; its lowest extremity or pole is con- stituted 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 of both sides. 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 detailed origin ofthe Diaphragm is as follows. It arises fleshy, from the internal face ofthe upper edge ofthe Xiphoid Cartilage, from the internal face ofthe cartilages ofthe seventh, eighth, and ninth ribs, from the os- seous extremities ofthe tenth and eleventh, and from both the osseous and cartilaginous termination ofthe twelfth rib. Asthe line described, includesalmostthe whole ofthe círcle, and the fibres all converge to the cordiform tendón, they, of course will pass in different radiated direction?, and be of different lengths. which it is unnecessary to specify. Be- tween 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 DIAPHRAGM. 229 was the subject of protrusion into the Thorax. It is pro- bable that greater displacements of the abdominal viscera, into the thorax of adults or children, may have had a con- genital origin in this very fissure, and are subsequently, when the parts are modified to this unnatural situation, set down as a Lusus Naturas. The portion just described, is called the Greater Muscle of the Diaphragm. Besides these origins, the Diaphragm has several from the vertebras of the loins, called its crura, there being four, on each side of the foramen for the aorta. The first pair, entirely tendinous, comes from the front of the body of the third vertebra of the loins, and is prevented from being very distinct in its origin, in consequence of running into the ligament in front ofthe bodies of all the vertebras. The second pair of heads is on the outside ofthe first, and % arises tendinous, from the intervertebral ligament, between the second and third vertebras. The third pair of heads arises tendinous, from the upper part ofthe lateral margins of the second lumbar vertebra. And the fourth pair of heads, comes also tendinous from the fore part ofthe roots ofthe transverse processes of the second lumbar vertebra. These tendinous heads termínate in what is called the Lesser Muscle of the Diaphragm, which is inserted into the notch of the cordiform tendón. It will now be un- derstood that the aorta passes between the heads of the lesser muscle, and that the cesophagus 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 the Ligamentum Arcuatum, which passes from the root of the transverse process of the first lumbar vertebra, to the infe- rior part of the middle of the twelfth rib; with the upper edge of this ligament the Diaphragm is connected ; and with the lower, the psoas magnus muscle. At the margin of the other ribs, the diaphragm is connected with the transversalis abdominis. The action of this muscle, in assisting respiration, is * 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 do much better to say, that it arises tendinous, from the first, second, and third vertebra?. The heads are occasionally much. smaller on one side than the other. 230 OF THE TRUNK. very obvious ; its fibres passing in a curved line with their convexity towards the thorax, from the bony margin of the thorax to the cordiform tendón, and having a tendency to become straight by contracting, will descend, and thereby enlarge the thorax. It is not certain that the cordiform tendón descends, its connexions being too strong and nu- merous to admit of much motion. In expiration, the re- laxation ofthe Diaphragm, with the contraction of the ab- dominal muscles, restores the former to its first state. In vomiting, the Diaphragm and abdominal muscles concurto expel the contents ofthe stomach. The Psoas Magnus muscle, arises fleshy, from the side ofthe bodies of the last dorsal, and ofthe four upper lum- bar vertebras, and from the transverse processes of all the lumbar vertebras. It forms an oblong fleshy cushion on the side of the lumbar vertebras, and constituting the lateral boundary of the inlet to the pelvis, it passes out of the pel- vis, under Poupart's ligament about its middle. It is inserted, tendinously, 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 contiguous edges ofthe last dorsal, and of the first lumbar vertebra at their sides, and from the intervertebral ligament. It is at the anterior and internal edge of the psoas magnus; has a short belly, and a long tendón, by which it is inserted into the linea innominata, about half-way between the spine of the pubes, and the junction of this bone with the ilium. The tendón, besides, is expanded 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 flexión. This muscle is some- times 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 ver- QUADRATUS LUMB0RUM. 231 tebra, from the inner margin of the crista of the ilium, and from its whole concavity; also from the anterior edge of the concavity of the ilium at and above the anterior inferior spinous process, and from that part of the capsule of the hip joint near this process. This muscle terminates in the tendón of the psoas mag- nus, just above the insertion into the trochanter minor. It has the same action with the psoas magnus, and from their also having a common tendón, they might with pro- priety be considered as only one muscle. The Quadratus Lumborum, is an oblong muscle arising from the crista of the ilium, by a tendinous and fleshy origin of two or three inches in length. It lies at the side of the lumbar vertebras, and is inserted into all their transverse processes by short tendinous slips. It is also inserted into the lower edge of the last rib near 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 tendi- nous origin of the transversalis abdominis muscle, which separates it from the sacro-lumbalis and longissimus-dorsi. It may also be very well seen from behind, in the dissection of the back. PART II. CHAPTER III. OF THE MALE PELVIS. 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, cellular 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 stufhng the rectum. The scro- tum may be separated and laid aside for future examination. SECTION I. Of the Viscera of the Male Pelvis. The Rectum, being the termination of the colon, begins at the left sacro-iliac symphysis; from thence it passes down obliquely towards the middle of the sacrum about one half MALE PELVIS. 233 of its length; its course afterwards is directly downwards before the sacrum and os coccygis, till it terminates in the anus; its orifice there points backwards and downwards. It is round 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 perito- neum, its anterior face is in contact with the lower fundus of the bladder, the vesículas seminales, and the prostate gland. Posteriorly and above, it is confined to the sacrum by the mesorectum, which conducts its nerves and blood- vessels. The dip of the peritoneum between the vesículas seminales so as almost to touch the base of the prostate gland, should be remarked. The muscular structure of this gut is remarkably strong, consisting externally, of longitudinal and parallel fasciculi of fibres, cióse together; and intérnally, of circular fibres which form a thick and continued plañe, particularly on a level with the lower fundus of the bladder. Just below the pouch of the rectum these circular fibres are multiplied so as to form a perfect Internal Sphincter Muscle. Many of the longitudinal fibres on getting to its inferior margin, pass beneath it, and are then turned upwards for an inch or so, so as to be inserted into the mucous coat, or rather its cellular substance. The mucous membrane of the gut is smooth above, but at the lower part, it is thrown into several longitudinal folds called the Columns ofthe rectum, at the lower end of which are some small blind pouches the orifices of wiiich look upwards; they are occasionally the seat of disease, and produce when enlarged a painful itching. An original observation of Dr. Physick, on the nature of this afféction, and the remedy for which, consists in slitting them open or removing them, induced me to look for the ordinary natural structure, which I have found to be as just described. The Anus is thrown into radiated folds from the influence of the external sphincter ani. In some sub- jects large cells are formed in the cavity of the rectum, by transverse doublings of the mucous coat only, resembling the válvulas conniventes of the small intestine, and there is also, frequently a sort of valve formed, which presents a barrier to the involuntary evacuation of the fasces. 234 OF THE TRUNK. A Vertical Section of the Parietes of the Anus, with the Rectum, so as to show the relation of the Rectal Pouches to the surrounding Parts, their Orífices being marked by Bristles. Fig. 48. 1.1. Columns of the Rectum. 2.2. Rudiments of Columns. 3. Section of Internal Sphincter. 4. Section of External Sphincter. 5.5. Radiated Folds of the Skin on the Surface of the Nates. 6. Imperfect Pouches. 7. Bristles in the Rectal Pouches. MALE PELVIS. 235. The Bladder (Vesica Urinaria,) is the reservoir for the uriñe, and 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 ñame for each end ofthe sphere is Fundus, distinguished by the terms superior and inferior, the lower being somewhat the more obtuse. From the upper end proceeds to the navel a long conical ligament, the Urachus, which is placed between the linea alba and the peritoneum, and produces a slight doubling or elevation of the latter. In mankind the urachus is solid, but some very rare cases are reported in which it was so hollow as to. permit the uriñe to flow through it from the bladder. By putting the anterior parietes of the abdomen on the stretch we shall see starting out and protruding the peritoneum into a semilunar duplicature on each side of the urachus, the remains of the umbilical arteries of the fcetus, 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 lower fundus, the bladder is somewhat elon- gated into a process called its Neck, resembling a truncated cone, and being the commencement of the urethra. The bladder consists of four coats ; the Peritoneal, Mus- cular, 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 loóse cellular membrane, which prevents it from par- ticipating in any considerable distentions of the organ, and permits it to leave the anterior face of the bladder, so that its reflection to the recti muscles in these cases, is placed much above the pubes. Tapping the bladder is performed at this point, 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 236 OF THE TRUNK. 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 corre- sponding course and also terminate at the urachus. There are many transverse and oblique fibres uniting these to- gether, but still leaving interstices through which the in- ternal coat occasionally protrudes, and thus forms cells in the cavity of the bladder. 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 cióse, dense, lamel- lated, and filamentous 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 and nerves which it conveys to the mucous coat. 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 diffi- cult to be discerned; possesses great extensibility and but little contractility, from whence, when the bladder is not very full, it is thrown into folds passing in various direc- tions. It offers several points for observation. 1. A tri- angular space between the orifice of the urethra and those of the ureters, (the Vesical Triangle,) which is elevated into a plain smooth surface. 2. The Uvula Vesicas, a small pointed production, terminating the triangle in front, and formed by a projection of the 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, and forming the lateral angles of the vesical triangle. 4. The Inferior Fundus, (Bas-Fond ofthe French,) a depression of the general concavity of the bladder, making it lower than any other part, placed between the base of the triangle and the posterior side of the bladder. 5. The Internal Orifice of the neck of the bladder, resembling somewhat the neck of a Florence flask. The Neck of the Bladder is thicker than any other part; it is surrounded by cellular tissue, in which a great number MALE PELVIS. 237 of veins is found, and it penetrates in front, the prostate gland, which has a continual tendency to cióse it. It has a sphincter muscle formed in the following way, which may be seen by removing the lining membrane. A transverse fasciculus crosses its inferior semi-circumference from one lateral lobe of the prostate gland to the other; this fascicu- lus is half an inch wide and from one to two lines thick, and is placed over the third lobe of the prostate. The su- perior semi-circumference is also crossed by a thin layer of muscular fibres, which spreads itself out at the ends where it is lost in the ordinary muscular structure which it resem- bles exactly. Under the mucous membrane corresponding with the vesical triangle, there is a muscle of the same shape and di- mensions, the posterior corners being inserted around the orifices of the ureters, and the anterior attached to the caput gallinaginis. PROSTATE GLAND, (GLÁNDULA PARASTATA.) This is a body about the size and form of a horse chest- nut, fixed as stated 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 distentions of this organ by fasces, are overlapped by it. The Prostate has, posteriorly, a notch in its centre, which divides it into two lateral lobes, and by raising the vesículas seminales, we shall see where their excretory ducts penétrate the gland, and sepárate from the body of it the little tubercle, called the Third Lobe, and which is often the seat of disease. The organization of this body, seems to consist in a con- densed, white, extensible, though easily lacerated fibro-cel- lular 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 at the sides of the urethral crest or Caput nallinaginis. The fluid secreted is thick, ropy, white, and semitransparent * Loder says there are from thirty-two to forty-four. 238 OF THE TRUNK. in a healthy state. The Prostate is surrounded by a fibrous capsule, of which more hereafter.* Cowper's Glands are two in number, and are situated in advance of the prostate, between the laminas of the tri- angular ligament, at the point where the bulb of the urethra adheres to it. These glands are also intended for the secre- tion of mucous, or a fluid very much like it, into the canal of the urethra. Commonly they are about the size of a garden-pea, but not unfrequently much smaller, and in some instances cannot be found at all. They are yellowish and hard bodies, consisting of several lobules united together, and each one has an excretory duct, that readily receives a bristle, which passes obliquely forwards between the corpus spongiosum and the canal of the urethra, to terminate in an oblique orifice in the latter, about an inch distant from the gland. One or more glands of the same description and discovered by Littre, are occasionally found just in front of Cowper's. They also discharge their secretion into the ad- jacent part of the urethra. The Seminal Vesicles, (Vesiculas Seminales,) are two convoluted bodies of two inches in length, one on each side of the lower fundus of the bladder, approaching each other very nearly at the base of the Prostate, but diverging much as they recede. They are separated before, by the interposition of the vasa deferentia; and being fixed be- tween the rectum and the bladder, they are matted to the latter by a cióse cellular texture, 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 convo- luted, 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 convolu- tions are preserved by the intermediate cellular tissue. * An opinión 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. MALE PELVIS. 239 A Side View of the Viscera of the Pelvis, showing the Blad- der and its surrounding Parts. Fig. 49. 1. Symphysis Pubis. 2. The bladder. 3. The Recto-Vesical Fold of the Peritoneum. 4. The Uréter. 5. The Vas Deferens. 6. Vesícula Seminalis of the Right Side. 7. Section of the Prostate Gland. 8. Section of the Neck of the Bladder. 9. Prostatic Portion of Urethra. 10. Membranous Portion. 11. Corpus Spongiosum. 12. Anterior Ligament of the Bladder. 13. Rectal End of the Pelvic Fascia. 14. Space between the Deep and Pelvic Fascia. 15. Triangular Ligament. 16. One of Cowper's Glands. ] 7. Continuation of Superficial Perineal Fascia. 18. Scrotum. 19. Deep Fascia prolonged to the Rectum. 20. Portion of the Levator Ani. 21.22. Course of Deep Fascia. 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 blad- der. The excretory 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, 240 OF THE TRUNK. (Ductus Ejaculatorius) is thus formed, which runs parallel with its fellow, below the urethra. They are commonly filled by a drab-coloured thick fluid, supposed to be g mix- ture of the semen and of their own proper secretion, though, of this, Mr. Hunter doubted.* The Ductus Ejaculatorius, is about eight or ten lines long, and opens by an oblong orifice, at the lateral anterior face of the Caput Gallinaginis; it is larger behind than be- fore, which gives it a conical shape, and allows fluids in- jected, to pass freely from the vas deferens to the vesícula, or the reverse. OF THE PENIS, (MEMBRUM VIRILE, MÉNTULA.) The Penis 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 uriñe 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 delicate than in most other parts of the body, and is furnished with a considerable number of sebaceous follicles, more particu- larly about the root of the organ. It is very loosely con- nected by cellular membrane to the parts beneath, so that it is easily made to correspond with all states of the penis. At the anterior extremity it is arranged into a duplicature or fold, the Preputium, 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 Frasnum. 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, (Ligamentum Suspenso- rium,) which is a triangular fibrous body, flattened laterally 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 ofthe symphysis pubis, and is inserted into the dorsum of the penis near its root; from this in- * See Observations on the Animal Economy. MALE PELVIS. 241 sertion it is extended over the penis, and according to Mr. Colles, constitutes 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 forcé towards the anterior parietes of the abdomen, and one strongly marked instance has also been presented to me in my own dissections. The Corpus Cavernosum of the penis, forms by much the most considerable portion ofthe whole organ. Exter- nally, it is a white fibrous membrane of a dense structure, enjoying extensibility, and an extreme degree of contractility; its fibres pass for the most part longitudinally, except about the root, where they are blended with the periosteum of the bone and with the tendons of the muscles. This coat of the penis is occasionally 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 dis- tance 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, resembles two cylinders lying along side of each other and united ; anteriorly they termínate in common by a truncated cone, covered obliquely by the glans. At the posterior part of the corpus cavernosum, in its centre, there is a tolerably complete septum ofthe same kind of substance, separating its two halves from each other, but anteriorly this septum is imperfect, having an arrangement like the teeth df a comb, whence the term, Septum Pectiniforme. In the middle of the corpus cavernosum above, is a longitudinal depression for lodging the veins of the penis, and in the same manner below, another for the corpus spongiosum urethras. The cavity of this membrane is filled by a spongy tissue, which arises from its internal face and is formed of filaments and little laminas; they, by cross- ing each other, form a multitude of cells which have a perfectly free communication, and generally are somewhat occupied by blood. The Corpus Spongiosum Urethrje, extends from ten or 16 242 OF THE TRUNK. twelve lines behind the junction of the crura of the corpus cavernosum, to the anterior extremity of the penis. Ex- ternally, it is covered by a coat resembling that of the cor- pus cavernosum, except that it is thinner. In its centre, is the canal for the uriñe. Between this canal and the coat is a spongy structure, much finer than that of the corpus caver- nosum, 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 di- minishes gradually 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 ofthe penis, it forms all around a projecting shoulder, the Corona Glandis. The surface of the glans is covered by thin skin, making a very delicate epithélium, and a great number of papillas for the termination of nerves. Numerous follicles also exist about the corona glandis, to secrete the sebaceous fluid which collects there, inpersons who are not cleanly. They constitute the glándulas odiriferas Tysoni. The Urethra, is a mucous canal whose length varies ac- cording 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 ducti ejaculatorii, the excretory ducts of Cowper's glands, and the mucous lacunas of its internal membrane. The first part of this canal which traverses the prostate gland, is about fifteen or eighteen lines in length ; it is the Prostatic portion, and is well supported by this body, although its own sides are very thin. On its inferior surface, is the Ve- rumontanum 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 Vesicas, and coming to a point very gradually before. In the posterior ridge of the caput is a long cleft, which is the orifice of a 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 MALE PELVIS. 243 found the orifices belonging to the lacunas of the prostate gland, as stated. Between the Prostate and the Bulb, is the Membranous Part of the urethra, about eight or ten lines long; it is un- protected 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 probably, is the part described by Winslow as the inferior prostatic muscle, which arising on each side of the membranous canal, goes to be inserted into the cor- responding branch of the pubes, near the symphysis. The membranous part ofthe urethra. does not get 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 commencement in the bladder it is large; itthen contracts at the back of the caput gallinaginis, and immediately enlarges in the fore part of the prostate, at the sides of the urethral crest. The mem- branous 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 remarkably enlarged as to get the ñame of Fossa Navicularis; it termi- nates, 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, excepting the fossa na- vicularis, longitudinal folds of the lining membrane exist, which are effaced by distention. In the upper part ofthe canal, there are a great many mucous lacunas; Loder, in his plates has marked about sixty-five; there is one parti- cularly large in the upper surface ofthe fossa navicularis, which, itis said, has stopped the point of a bougie, and been mistaken for stricture. Sir Everard Home formerly communicated to the Royal Society, a highly interesting paper, on the structure of the lining membrane of the urethra. From his micro- 244 OF THE TRUNK. scopical observations, he was induced to think, that it was muscular. Mr. Shaw, of London, has described a set of vessels im- mediately on the outside of the internal membrane of the urethra, which when emply, are very similar in appear- ance 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.* His preparation, being a quicksilver injection of the part, is certainly a very satis- factory demonstration of their existence: yet in my own observations, I have not been able to distinguish them from the cellular membrane,. connecting the canal ofthe urethra, to the corpus spongiosum. The arteries of the penis come from the internal pudic; some of the veins follow the course of the arteries, and others collect into the two venas dorsalis penis: the nerves come from the Superior and Inferior Pudendal. OF THE TESTICLES, (TESTES.) These bodies, two in number, are surrounded by seve- ral coats, the most external of which, is common \o both the testicles, and is called Scrotum ; the others are called the Darlos, Túnica Vaginalis, and Túnica Albugínea. The Scrotum is a sac formed by a continuation of skin from the internal sides of the thighs, from the inferior part of the penis, and from the anterior part of the perineum. It is very thin, darker than the rest of the skin, sparinglv 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 oontraction, its surface being covered with wrinkles which are more ap- parent when it is contracted. It consists of two symme- trical halve?, marked off from each other by an elevation of skin, the Raphe, which extends from the' perineum over the scrotum, along the inferior surface ofthe penis, to the end of the latter. Beneath the scrotum is the Dartos, a fibrous membrane * See Med. Chir. Tiaas, VoL x. MALE PELVIS. 245 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 septum between the two sides of the scrotum, and goes up to the inferior part of the urethra. This membrane has been confounded with cel- lular substance; but it appears from the reports of Mes- sieurs Chaussier, Lobstein, and Breschet, that it does not exist in the scrotum till the descent of the testicle, and that it is an expansión of the gubernaculum testis. Notwithstanding its great contractility, the question of its muscular structure is not settled, and certainly in the greater part of its extent, there is not the appearance of muscular fibre; but at its posterior end, just at the anterior point ofthe sphincter ani, I have often seen a broad mus- cular expanse, the character of which could scarcely be misconceived.* The contractility of the scrotum has been attributed to the cremaster muscle, instead of this membrane, but common 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 an imperfect coat, and belongs rather to the spermatic cord; its course has been explained in the account of the abdominal muscles. Its fibres are much separated on the túnica vaginalis; they lay on its front part, and on the internal and external sides ofthe spermatic cord. Within the last, is a coat of cellular substance, the Túnica Vaginalis Communis, which connects the dartos and the cremaster muscle, with the túnica vaginalis. The Túnica Vaginalis Testis, was originally a process of peritoneum, though it appears in the adult as a com- plete sac. The testicle being protruded into it from behind, one half of the sac applies itself closely to the epididy mis and testicle, while the other half is loóse; the whole arrangement * I have dissected one subject since this, (Jan. 1839,) where the fibres were evidently muscular, though interwoven. 246 OF THE TRUNK. being precisely aftér the manner of a 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. This cavity may be injected with but little forcé, so as to hold an ounce or more of fluid. It is the seat of Hydrocele. The Túnica Albugínea, is the proper coat ofthe testicle, preserves its form, and is in immediate contact with the glandular structure. It is a dense, strong, white fibrous membrane, corresponding very much in its gene- ral characters with the túnica sclerotica of the eye. From the internal surface of the albugínea, several membranous processes, forming partial partitions, (Septulae Testes) pass offj and termínate at the posterior part of the cavity in the Corpus Highmorianum. These'septulas, conduct the blood- vessels through the substance ofthe gland, and form little apartments, which support, confine, protect, and nourish the tubular structure of the testes. The Corpus Highmo- rianum is a longitudinal projection of the túnica albugínea, somewhat broader above than below; its upper part is perforated by the vasa eflerentia. The form of the Testicles as communicated by the tú- nica albugínea, is very much that of an oval, somewhat compressed laterally, the edges presenting forwards and backwards; they do not hang with the long diameter ver- tical, but the upper end is advanced a little forwards, and the lower points somewhat backwards. They are both of the same size generally, but in case of a diflerence the right is larger; it is also higher up than the left, a circum- stance which has been marked by sculptors in all ages. The glandular structure of the testicle, consists of a congeries of zig zag tubes, (Tubuli Seminiferi) stated by Monro to amount to three hundred, whose diameters do not exceed individually the one two-hundreth part of an inch, and when extended to their full length, would form in the aggregate, a tube 5208 feet long. These tubes, al- most inconceivably fine as they are, can be injected in a retrograde course through the vas deferens, with mercury, MALE PELVIS. 247 but the task is one of exceeding difficulty, and scarcely ever succeeds fully. The Tubuli Seminiferi, it has been stated, fill up nearly the whole of the cavity of the Albugínea, being kept from each other by the processes termed Septulas. These tubes send out a great number of trunks, which, from their ob- serving a straight course, obtain the ñame of Vasa Recta. These vasa recta unite near the centre ofthe testicle, 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 túnica albugínea; these are the Vasa Efterentia. Each of these vasa is rolled up exter- nally at this place, so as to give the outiine of a cone, therefore, it gets the ñame of Conus Vasculosus. 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 ex- tremities, and resting vertically on the back of the testicle, being connected with it, by the túnica vaginalis. 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 convoluted. The enlarge- ment below, is the Globus Minor; after this is formed, the tube becomes less convoluted and turns upwards on the in- side of the epididymis, and a little farther 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. It is called the Vasculum Aberrans Halleri, and varies in length from one and a half to fourteen inches. Its use is ünknown. The Vas Deferens, is a white tube about a half line in diameter, having a cartilaginous feel j its cavity is large enough to admit a bristle. It passes on the back of the spermatic cord, and continúes with it through the abdomi- nal canal; at the internal ring it leaves the residue of the cord, and dipping into the pelvis by the side of the bladder, 248 OF THE TRUNK. goes between it and the uréter to the lower fundus, ap- proaching its fellow, on the inside of the vesículas seminales, and ending in the urethra, by the Ductus Ejaculatorius. About two and a half inches from its termination it becomes somewhat tortuous and enlarges. Fig. 50. A View of the Minute Structure of the Testis. Túnica Albugínea. Corpus Highmorianum. Tubuli Seminiferi, convoluted into Lobules. Vasa Recta. Rete Testis. Vasa EfFerentia. Coni Vasculosi, constituting the Globus Ma- jor ofthe Epididymis. Body ofthe Epididymis. Its Globus Minor. Vas Deferens. Vasculum Aberrans or Blind Duct. The Spermatic Cord is formed ofthe Vas Deferens, the Spermatic Artery and Veins, Lymphatics, Nerves, and Cel- lular membrane, all covered by the Cremaster muscle. The artery arises from the aorta and retains its first size till it arrives at the testis, it then divides, some of its branches being spent on the epididymis, and the remainder going into the testis, and terminating on the tubes. The veins in ascending, form a remarkable plexus, the Corpus Pampini- forme; 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 the subject in the posture recommended for Li- thotomy, in order that he may work on the Perineum. MALE PELVIS. 249 SECTION II. Of the Perineum and the Fascice 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, extending it on each side three inches; make another transverse cut of the same length over the end of the os coccygis; drop a perpen- dicular cut, equally profound with the first, from its middle to the point of the os coccygis. The skin constituting the flap on each side being raised up carefully, so as not to in- jure subjacent parts, when the two flaps are pinned aside, 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 be- tween the rami of the pubes and of the ischia, being very firmly fixed to these bones. This fascia, in case of rup- ture in the posterior part of the urethra, prevents the uriñe from showing itself in the perineum, and drives it into the cellular structure ofthe scrotum. In abscesses of the pe- rineum, it also prevents the fluctuation from being very evi- dent. Having studied well its connexions, structure, and influence, it is to be raised up, and turned to each side by a cut down its middle, in order to bring into view the Pe- rineal muscles. The Musculus 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 exter- nal margins of the rami of the pubes and ischium, proceed upwards, and just before the unión of the crura ofthe pe- nis end in a flat tendón which is lost on the side of the corpus cavernosum ofthe penis.* * The late Dr. Lawrence informed me that he has frequently found muscular fibres between the bone and the crus penis. 250 OF THE TRUNK. Its use is not well understood. The Accelerator Urin.5: Muscle, lies on the bulb and back part of the corpus spongiosum urethras; 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 penis, where the latter begins to form the body of the penis. It arises also from the in- ner side of the ramus of the pubes, between the crus penis and the triangular ligament of the urethra. The muscles of the opposite sides, are inserted into each other, by a white line which marks the middle ofthe bulb ofthe urethra, and by a point, into the anterior extremity of the sphincter ani, where they are joined by the transversi perinei. In order to see the origin of these muscles very distinctly, sepárate 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 trian- gular ligament, and dissect it clearly from the corpus caver- nosum, turning it downwards so that it may hang by the membranous part of the urethra. By putting the two ac- celeratores on the stretch, it will be seen, that besides the origins mentioned, they arise. also from each other by a ten- dinous membrane that is interposed between the corpus spongiosum and cavernosum, so that they literally surround the posterior part of the urethra, constituting a complete sphincter muscle for it. This account of the accelerator urinas, being peculiar to myself, is adopted from a strong analogy between it and the sphincter vagina. These two muscles are considered by M. Chaussier, as forming but one; in that case its origin will be reversed, and commence in the middle line of the perineum, 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 ofthe urethra in lithotomy, without cutting through the muscular fibres of one or the other. It propels the uriñe and semen forward. The Transversus Perinei Muscle, as its ñame implies, passes directly across the perineum ; it arises from the in- MALE PELVIS. 251 ner side of the ischium just at the origin of the erector penis, and is inserted where the sphincter ani and the acceleratores urinas join. I have observed, that when the lower part of the accele- rator was extended much below its usual line, and strongly developed, that the transversus was very irregular in its origin and course, consisting frequently of a few fibres which did not deserve the ñame of a distinct 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 first, and is inserted into the perineal junction, just be- hind it. It seems generally to be a loóse fasciculus of the accelerator urinas muscle. The use of these muscles seems to be, to contribute to fix the bulb of the urethra. The Sphincter Ani muscle, consists in a plañe of fibres which surrounds the anus, in order tokeep it closed. The long diameter of the elipsis is extended from the coccyx to- wards the symphysis pubis, and has its angles very much elongated; the anterior, may be traced terminating insensi- bly in the posterior face of the scrotum. It has two fixed points, the last bone of the os coccygis behind, and the pe- rineal unión 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. The point of it in front, is continued into the dartos. Besides closing the orifice of the rectum, it will draw the bulb of the urethra backwards, or the point of the os coc- cygis 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, is inserted into the side of the last bone of the sacrum, and into all those of the os coc- cygis. It draws the os coccygis forwards. 252 OF TIIE TRUNK. It frequently happens that there is on each side, a small fasciculus of muscle, arising from the inferior bone of the Sacrum in front, and inserted inlo the bones of the coccyx. It is called the Sacro-Coccygeus. A View of the Muscles of the Perineum of the Male. The parts on one side only are referred to. Fig. 51. 1. Ascending Ramus ofthe Ischium. 2. Tuber Ischii. 3. Posterior Face of the Coccyx. 4. Portion of the Great Sacro-Sciatic Ligament. 5. Musculus Accelerator Urirue. 6. Erector Penis Muscle. 7. Transversus Perinei. 8. Sphincter Ani. 9. Levator Ani. 10. Musculus Coccygeus. 11. Section ofthe Gluteus Magnus. 12. Adductor Longus. 13. Adductor Brevis. 14. Adductor Magnus. 15. Extremity of the Gluteus Magnus. 16. The Urethra. 17. Corpora Cavernosa turned up. 18. Spermatic Cord turned up. 19. Free Extremity of the Penis with its Integuments. MALE PELVIS. 253 The Erectores Penis, Acceleratores Urinas, and Trans- versi Perinei, are now to be removed. A large quantity of adipose and cellular matter will then be found on each side ofthe rectum, between it and the parietes of the pel- vis, concealing the levatores ani muscles. This fat is bet- ter 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 pe- rineum almost to the anus. It is not loóse and pendulous as described, but is connected by its superior face to the Triangular Ligament of the urethra, a membrane which filis up the space below the symphysis ofthe pubes. This liga- ment is a septum between the perineum and pelvis, and, when closely examined, is seen to connect itself to the in- ternal edges ofthe rami ofthe pubes and ischia, at the in- ner posterior sides of the crura penis, as far down as the beginning ofthe latter. At its lower edge, its ligamentous character is not so well defined. It extends from the top ofthe pubic arch, downwards an inch and a half, filling up all the intermediate space between the bones. On its an- terior surface is the bulb ofthe urethra, and just at the ex- tremity of the latter, enclosed by the ligament and adhering to it, are Cowper's Glands. A perforation exists in it through which passes the membranous part of the urethra. To get a view of this opening, 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 distance on the canal, but by detaching them the hole becomes well defined. Here it becomes necessary to attend to the relative situa- tion of the bulb, and ofthe 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 considerable angle with each other, and the membranous part of the urethra is much the deeper; the recollection of this is all important in litho- tomy, as it teaches us to avoid the one^ and to cut into the 254 OF THE TRUNK. other. It will also be observed, that the hole in the trian- gular ligament is an inch below the symphysis pubis. By dissecting off the upper córner of the triangular liga- ment, we are made acquainted wrirh 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 calis it pubic ligament, with great propriety. I would suggest, as somewhat more ex- pressive, the term Inter-Pubic ligament, as it serves to dis- tinguish it from another 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 inter-pubic. We have now seen, as much as can be viewed advan- tageously from the perineum, at this stage of the dissection, and I recommend an inspection of the parts from above, on the side of their abdominal surfaces. The pelvis is there- fore to be separated from the trunk at the last lumbar verte- bra, and the posterior part of the pelvis removed, by saw- ing 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 ofthe Levator Ani muscle. Care must be taken not to in- jure the rectum in these sections. Begin by raising the peritoneum from the anterior surface of the rectum, after which by letting the rectum fall back- wards 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 ofthe bladder. It is seen, that the peritoneum is reflected from the bladder at the posterior end of the vesiculas 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 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 vesiculas seminales. The upper margin of this pouch next to the * See Abdominal Muscles. MALE PELVIS. 255 bladder forms a strong horizontal doubling, stretching across the pelvis, when the rectum is empty. By distending the bladder moderately, the different re- flections of the peritoneum from it to the abdominal parietes, and to those of the pelvis, will be better understood, and the possibility of puncturing the former above the pubes, without getting into the cavity of the abdomen, will be de- monstrated 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 Pélvica connectingthe bladder to the sides ofthe innominata. " 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 mus- cles (the Levator Ani) and applies itself to the prostate gland and bladder, on the body of which it is ultimately lost. At the angle of its reflection, this fascia appears par- ticularly strong and white, but becomes more weak and thin as it lines the muscles and covers the bladder. In tracing this membrane, it will be seen that from the pubes just below the symphysis, a pointed production of it con- stituting its anterior margin is fixed into the side of the neck of the bladder. This pointed production on each side is called by most anatomistst, the Anterior Ligament of the bladder. Betwreen the two, just beneath the symphysis of the pubes, a pouch large enough to receive the end of the finger, is formed by the unión of the fascias 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 was published by M. Bres- chet.* 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 * Thesi9 on Hernia, p. 310, presented to theFaculty of Medicine in Paris for the place of Chef des Travaux Anatomiques, in the year 1819. 256 OF THE TRUNK. 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 consequences of the operation of lithotomy are different when the instrument penetrates more or less deeply behind or on the side. In- flammations, 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 distinguished practitioners* have asked the reason of these difTerences, and I believe that I have found them in the arrangement of the aponeurosis pélvica. If the instrument does not penétrate beyond this fascia, there is no abscess in the pelvis, or if a small quan- tity of pus be formed, it readily finds an issue externally. On the contrary, if the pelvic aponeurosis be injured, in- flammation developes itself, suppuration takes place beyond this aponeurotie barrier, the liquid cannot get out, and it makes ravages which sometimes cause the death of the patient." This description of the aponeurosis pélvica is true, but rather too general; the most common condition of it is found to be as follows. It adheres closely to the perios- teum of the pubes, between the upper margin of the thyroid foramen and the crista of the pubes ; about the middle third of the linea innominata, it is obviously a continuous mem- brane 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 thyroideum, 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 leva- tor ani. Above the bow this fascia is very thin, for the fibres of the obturator internus can be readily seen through it. At the bow this fascia divides into two laminas, one having * Scarpa's Memoir on Hawkin's Gorget. MALE PELVIS. 257 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 inter- posed between the laminas. The aponeurosis pélvica, also forms a bow or semilunar edge in front of the sacral nerves. The triangular ligament and this fascia are so identified in forming the capsule of the prostate gland, that the latter in description, may be referred either to the one or the other, or to both, according to the fancy of the describer. The Levator Ani muscle, is essentially connected with the aponeurosis pélvica. In order then to get a view of it, make a cut through the fascia, from the symphysis pubis backwrards to the sciatic notch, about half an inch above the middle of the fascia. As the muscle is placed nearerto the perineum, the fascia must be turned down towards the blad- der 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, particularly at its posterior part, from the under, or perineal surface of the fascia. The Levator Ani muscle, arises fleshy from the back of the pubes near its symphysis, and from near the superior margin of the foramen thyroideum, above the obturator in- ternus muscle. It also arises from the aponeurosis pélvica, where this membrane is extended as a thickened semilunar cord, from the superior margin of the thyroid foramen to the spinous process of the ischium. This second part of the origin of the levator 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 plañe 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 last two bones of the os coccygis; the middle, and by far the greater number, are inserted into the semi-circumference of the rectum, be- tween its longitudinal fibres and the circular fibres of the sphincter ani; and finally, the most anterior fibres, pass ob- liquely 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 17 258 OF THE TRUNK. levator ani, to be well understood, must be studied both from the perineal and abdominal surfaces. The fore-part of this muscle is by some of the English anatomists, called the Compressor Urethras.* It yet remains to speak more definitely of the Triangular Ligament; it has been seen from the perineum, and is now to be viewed from the pelvis. Remove the anterior part of the levator ani; the ligament is then seen occupying the in- terval under the symphysis, and between the rami of the pubes and ischia. Its base or inferior edge is crescentic; and half an inch above the base, is the hole for the mem- branous part of the urethra. This hole, is in fact, not very distinct, for the triangular ligament is reflected backwards from its edges, along the membranous part of the urethra, which obscures the hole. The prostate gland also gets a ligamentous capsule from a continuation of this same reflec- tion, 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 cover- ing the obturator internus muscle. The triangular ligament • is a membrane consisting of two laminas; the bulb of the urethra is fastened to the anterior lamina, and the prostate is fixed to the posterior lamina; between these laminas 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 continu- ous fascias which connect the bladder and urethra 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 ofthe urethra, is produced backward along the prostate, and having ascended as high as the arch of the pubes, it there splits into two laminas, one continuing its course over the upper surface of the gland and bladder, the other lining the upper portion of the levator ani." The description of the fascias of the pelvis is one of the * Wilson's Anatomy, p. 198. MALE PELVIS. 259 most difficult and perplexing inthe whole range of anatomy, and the proof of it is, that almost every writer on the sub- ject considers the labours of his predecessors imperfect, and with a very laudable spirit, hoping to supply the de- fect, invites the attention of the profession to his improved views. Not joining in this conviction, ofthe insufficiency of preceding descriptions, and the consequent valué of such as are offisred as substitutes, I feel satisfied in drawing ma- terials from Mr. Colles's excellent work, on Surgical Ana- tomy. PART II. CHAPTER IV. OF THE ORGANS IN THE FEMALE FOR THE GENE- RATION 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 examination. The whole study may afterwards be concluded with a side view, as in the male subject. The Female Pelvis contains the Urinary Bladder and Rectum, besides the Organs of Generation. The first two do not demand particular description here, as enough has been said concerning them in the account ofthe male pel- vis. The Organs of Generation are situated between them, and consist of the Vulva externally, of the Vagina in the middle, and of the Uterus with its appendages intérnally. Under the term Vulva we consider the most superficial of the copulative organs, as the Mons Veneris^the Labia Ma- FEMALE pelvis. 261 jora 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 corpulent 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 sebaceous glands, about the size and shape of millet seed. The Labia Externa are oblong eminences, continued downwards and backwards, one on each side, from the mons veneris, and united with each other by the fouichette at the anterior part of the perineum. Their elevation is produced in the same way with the mons veneris, by a de- posit of adipose matter beneath the skin or integuments; they are somewhat broader and more prominent above than below. On the side which is next to the thighs, they are formed by the common skin, furnished sparingly withhairs; but on the internal face, the integument is a mucous mem- brane, being a continuation of that of the Vagina. The skin here as well as at the commencement of every mu- cous membrane, is insensibly changed into the latter. These bodies have many sebaceous glands externally, and mucous orifices intérnally on them. In their interior structure is found much cellular membrane, like that of the scrotum, possessed of great extensibility in order to favour the dilatation ofthe parts in parturition. Between them is a longitudinal rima, about twice the length of the orifice of the vagina, for favouring still more the expulsión of the fcetus. It is the Fissura Vulvas of authors. The Fourchette, or Frenulum Vulv^, is situated at the posterior commissure of the labia externa; it is a nar- row transverse duplicature of skin; extending across the vulva from one side to the other, and is most frequently, 262 OF THE TRUNK. ruptured at the first parturition, and disappears. That por- tion of the rima, betwixt it and the orifice of the urethra, is called by many anatomists, the Fossa Navicularis. The Clitoris, is a small body situated between the up- per extremities of the labia externa, on the lower part of the symphysis pubis, and corresponding in some respects, with the penis of the male. It is furnished with a suspensory 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 in- ternal 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 pectiniforme, and having a similar supply of blood-vessels and of nerves. It has also an erector clitoridis muscle lying upon each crus, and extended to the side of its body, in the same way with the erector penis. The extremity of the body of the clitoris, projects into the upper part of the bottom of the rima vulvas, and is called its Glans, but does not resemble in structure, the glans penis. A kind of hood is thrown over it by a du- plicature of the integuments of the part, which giving some resemblance to the penis, it is therefore called the Prepuce, (Preputium.) This prepuce is occasionally much elongated and its orifice constrieted, so that the secretion from its cryptas is imperfectly discharged and produces much itching and irritation. Mr. Marjolin, relates the case of a Spanish girl of four years, in whom he performed cir- cumcision successfully, in order to free her of a very bad habit to wmich she was addicted in consequence of this disease. The Labia Interna, or Nymph^e, are two duplicatures of the mucous membrane of the vulva passing downwards, one from each side from the clitoris. The prepuce of the latter terminates on either side in the labia; while the latter are continued upwards by a narrow process, to the under surface of the glans clitoridis. They arise all along their base from the internal sides of the labia majora, are seldom so broad naturally as to project beyond them, and are wider female pelvis. 263 in the middle than elsewhere; they terminate insensibly about half-way down the orifice of the vagina. They con- sist of a duplicature of the mucous membrane of the part, between the laminas of which, is placed a vascular cellular membrane giving, to them when excited, a somewhat erected condition. In young subjects their vascularity com- municates a vermilion tint, which is lost in the progress of life. They are supposed to direct in some measure, the stream of uriñe; but it is more probable, that as they are eftaced during parturition, they are intended to facilitate the enlargement of the vulvas. The Vestibulum, is a depression of twelve or fifteen lines in length, at the upper part of the rima, bounded by the clitoris above, and the nymphas laterally; in it are many mucous follicles. At the inferior part of the vestibulum, about an inch be- low the glans clitoridis, is the Orifice of the Urethra, (Ori- ficium Urethras.) It is generally marked by a slight rising or tubercle, wdiich is easily distinguished 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 bladder; passing under the symphysis of the pubis, and being 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 bladder; is thrown into several longitudinal folds, and has many mucous folli- cles in it. The external coat of the urethra consists of con- densed laminated cellular membrane, forming a cylindrical, body of half an inch in its transverse diameter, wdiich has given the idea of the existence of a prostate gland in the female. The knver and lateral surfaces of this cylinder are in contact with the vagina, forming a protuberance into its cavity, and the upper surface is firmly.connected to the tri- angular ligament of the pubes. OF THE VAGINA. The Vagina, is the intermediate part of the sexual organs, and extends from the vulva to the Uterus, being placed be- 264 OF THE TRUNK. tween the Bladder and Rectum, and compressed anteriorly and posteriorly by them. In virgins, its external extremity is contracted into a smaller canal than the internal, and be- sides this, is closed by a membrane called the Hymen. The Hymen, situated just within the orifice of the vagina, is a partial septum formed by a reflection or duplicature of its lining membrane; it varies very much in shape, breadth and thickness. Most commonly it is crescentic and fixed to the inferior part of the vaginal orifice by its convex edge, the horns being upwards; in other cases it is to the side. Sometimes it is a circular membrane, having a hole in the centre for the passing of mucus and menstrual blood. Be- ing simply a duplicature of the mucous membrane, it is generally so weak that it is ruptured at the first act of copu- lation, or by slight causes during infancy, but occasionally it is so resisting, that it has required artificial división to make it yield even to the expulsive eflbrts of the uterus in parturition. Its presence then, is not invariably a proof of virginity, ñor is its absence a proof of improper indulgence. The Vagina, is a membranous canal of from four to six inches in length, diftering according to age and pregnancy, being much shorter in women who have borne children, than in virgins. Its shape varies somewhat; near the vulva, its greatest diameter is vertical, but behind near the uterus, the greatest diameter is transverse. Its anterior and poste- rior surfaces are in contact from the circumstances just men- tioned, of pressure 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 béing attached to the uterus, higher up on the sacral, than on the pubic side. It consists of two coats, a fibrous and elastic one ex- ternally, and a mucous one intérnally. The first is of a reddish colour, and seems to be formed of condensed cel- lular membrane, its fibres not passing in any determínate direction. Many blood-vessels are found in its structure, and it has an abundance of large venous sinuses surround- ing it. On the anterior part of this coat externally, there is an erectile tissue, (Corpus Spongiosum Vaginas,) about one FEMALE PELVIS. 265 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 circumference of the vagina. The structure of this body closely resembles that of the corpus spongiosum urethras, and from being very vascular, is sub- ject to distention in its cells during sexual excitement. It is frequently called the Plexus Retiformis, and is covered by the sphincter vaginas muscle. The Sphincter Vagina, arises from the body ofthe clitoris and the crus pubis; forms an expanse of an inch and a quarter, around the anterior end of the vagina; and is in- serted into a dense whitish substance in the centre of the perineum, common to it, the sphincter ani and the transversi perinei muscles. The transverse perinei 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 frequently a mucous gland about the size of a garden pea, which corresponds with Cowper's gland in the male. To bring into view satisfactorily the internal membrane 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 mem- branes of the vulva and uterus. Near the vulva it is of a vermilion tinge, but near the uterus it is grayish, 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 Carúnculas Myrtiformes. On its anterior or pubic wall, the internal sur- face of the vagina is divided longitudinally by a ridge, commencing in a sort of tubercle, at the anterior orifice of the vagina, just under the meatus urinarius; this ridge pro- ceeds backwards, but becomes indistinct in approaching the uterus; from it on each side proceed transverse ridges or folds of the mucous membrane, which are particularly nu- merous and prominent 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. 266 OF THE TRUNK. By cleaning the vagina, and suspending it in water, an abundance of mucous cryptas may be observed on its whole internal surface, which by an increased discharge, produce leucorrhcea. The peritoneum, in descending from the uterus ante- riorly, touches the top of the vagina for a little distance, and is then reflected to the bladder, but posteriorly, 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 cióse just about the urethra, but its connexion to the rectum, is by rather loóse cellular membrane. THE UTERUS AND ITS APPENDAGES, THE FALLO- PIAN TUBES AND OVARÍA. The Uterus is a compressed pyriform body with a cavity in its centre, placed between the bladder and rectum, has the small intestines above it, and the vagina below. Unim- pregnated, it is two inches and a half long, and an inch and a half wide at its broadest part, about one inch thick and much flatter on its anterior than on the posterior surface. It is divided by anatomists into Fundus, Body and Neck. The fundus is the superior convex edge, between the orifices of the Fallopian Tubes; the neck, the narrow cylindrical part about an inch long below, 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 peritoneum, which are called ligaments. The peritoneum, after covering the uterus completely, is reflected anteriorly upon the vagina, and at each side of this reflection is a fugitive duplicature of the membrane, denominated the Anterior Ligament, which goes to the bladder. 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 duplica- ture, which constitutes the Posterior Ligament. The peri- toneum is also reflected from the whole length of each side of the uterus, to the corresponding part of the cavity of the pelvis; these reflections are termed the Lateral or the Broad Ligaments. The peritoneum covers much more of the vagina posteriorly, than it does anteriorly. FEMALE PELVIS. 267 The Uterus, Fallopian Tubes, Ovaries and a Part of theVagina of a Female of Sixteen Years. On one Side the Tubk and Ovary is divided Vertically; the other Side is untouched. The Anterior Portion of the Uterus and Vagina have also been removed. Fig. 52. 1. Fundus of the Uterus. 2. Thickness of its Parieties Anteriorly. 3. External Surface of the Uterus. 4. Section of the Neck of the Uterus. 5. Section of the Anterior Lip. 6. Its Posterior Lip, untouched. 7. Cavity of the Uterus. 8. Cavity of its Neck. 9. Thickness of the Walls of the Vagina. 10. Its Cavity and Posterior Parietes. 11. Openings of Fallopian Tubes into the Uterus. 12. Cavity of the Left Tube. 13. Its Pavilion. 14. Corpus Fimbriatum. 15. Its Union with the Ovary. 16. Left Ovary vertically divided. 17. The Vesicles in its Tissue. 18. Ligament of the Ovary. 19. Right Fallopian Tube, untouched. 20. Its Corpus Fimbriatum. 21. Right Ovary. 22. The Broad Ligament. These Broad Ligaments, with the uterus, form a trans- verse 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 septum, below the edge, and about an inch or a little more from the uterus, on each 268 OF THE TRUNK. side, is an Ovarium. The peritoneum adheres to the uterus by a cellular tissue, which is somewhat loóse 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 duplica- tures of the broad ligaments, and pass under the perito- neum to the abdominal ring, through which they penétrate, and are lost upon the fat of the mons veneris and of the labia majora. They are of a condensed cellular or fibrous structure, 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 Tincas,) 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 somewhat 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 distinguished by the finger. Behind the os tincas 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 somewhat larger. In the middle of this cavity, before and behind, longitudi- nally, is a line formed by an elevation of the lining mem- brane, and on each side of this line, transversely or obliquely, there are others presenting an arborescent ar- rangement.' This is the Arbor Vitas. In the interstices of the transverse lines, there are small mucous glands called Ovula Nabothi, in consequence of this, anatomists 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 equi- lateral, and has its anterior and posterior surfaces in con- tact; the angle below is continued into the cavity of the neck, and the angles above are continuous with the fallo- pian tubes, being extended very far through the parietes of the uterus, in order to meet them. This cavity is some- FEMALE PELVIS. 269 times divided into two symmetrical halves, by an elevated line on its anterior and posterior surface, running from above downwards. It is said, that in some cases, they have had a complete partition. The internal membrane ofthe uterus is a continuation of that of the vagina, and adheres so closely that its existence has been doubted. It has very little thickness, 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 cryptas 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 have no determinate course, but are blended and interwoven in every direction. Its muscularity is not apparent in the unimpregnated state. The Fallopian Tubes, (Tubas Fallopianas,) 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 ofthe pelvis. At their ute- rine extremities these tubes scarcely admit a hog's bristle, but as they proceed externally, about half-way of their length, they begin to increase, and continué to do so very rapidly almost to their termination, where they become somewhat contracted, and immediately afterwards enlarge, to end by an oblique trumpet-shaped mouth, singularly fringed, called Morsus Diaboli, or Corpus Fimbriatum. This latter part of the tube is loóse and pendulous, over- hanging the ovarium on the back part of the broad liga- ment. The Fallopian Tube seems to be a continuation of the structure of the uterus, having a fibrous membrane ex- ternally, and an internal mucous one; the latter is princi- pally concerned in forming its large extremity, and is rendered erectile in sexual excitement, probably by its great vascularity. The Ovaries, (Ovaría, Testes Muliebres,) are situated 270 OF THE TRUNK. one on each side of the uterus, and on the posterior face of the broad ligament enclosed in a duplicature 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 fal- lopian tube. The external end ofthe ovary, has one ofthe processes of the corpus fimbriatum or morsus diaboli ad- hering to it. The surface of the ovary is generally found somewhat uneven, from a number of marks resembling cicatrices. It has a complete peritoneal coat, and within this is another of a strong, compact, fibrous character, sending many pro- cesses intérnally, and which is the Túnica Albugínea. The structure of this body is as follows: When the ovary of a healthy female (diíTerent from those usually found in our dissecting-rooms, who from disease or excessive sexual indulgence do not present the organ in its normal condition) is examined by cutting through the Túnica Al- bugínea, the organ is found to consist of a spongy fibrous tissue, abundantly furnished with blood-vessels from the spermatic artery and vein. In this spongy tissue, called Stroma, are from fifteen to twenty or more spherical vesicles, (Ovula Graafiana,) according to the commonly received opinión. They vary in size from half a line to three lines in diameter; the larger ones are nearer the surface, and from having caused the absorption of the túnica albugínea. may sometimes be seen through the peritoneal coat and give to the surface of the ovarium an embossed condition. These vesicles contain a transparent fluid, having within it the rudiments ofthe embryo. As the vesicles are evolved, they advance from the centre to the circumference. Their parietes are thin, transparent, and have, creeping through them, minute arterial and venous ramifications. The bed of the ovarium, in which a vesicle reposes, is called the Calyx. To Von Baer belongs the merit of discerning first the Ovulum of man and mammalia, in the Graafian Vesicle. This ovulum occupies but a very small part of the cavity of the graafian vesicle, the remainder being filled with an albuminous fluid, in which microscopic granules float. By FEMALE MAMMiE. 271 discharging the fluid from a graafian vesicle, the ovulum can, with a simple lens, be detected in a globular form and floating in this fluid. A very remarkable point mentioned by Carus, is, that all the essential parts of the ovulum can be detected in the ovary of the mature human embryo, or in that of mammiferous animáis; henee the preparation for new generation seems to begin at a very early period of life. Upon the escape of the contents of a graafian vesicle, the latter is first filled with coagulating lymph or blood, which being after a time, absorbed, the vesicle collapses and shrivels, and the stigma, then remains permanently as a stellated cicatrix (Corpus Luteum.) Sometimes the entire surface of the ovarium is marked with them. The Bladder and Rectum, with unimportant exceptions, 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. The Fascias connecting the bladder to the sides of the pelvis, and the triangular ligament of the urethra, also exist. SECTION II. Of the Female Mammce. The Mammíe 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 hemispherical, and vary 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 ofthe gland, there is an abundance of cel- 272 OF THE TRUNK. lular 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 penetrated at different depths by this cellular and adipose matter, and its lobules are divided by irregular fossas from each other. The substance of the gland is united to the pectoralis major muscle, by a loóse cellular tissue, which contains very little fat. The mamma is composed of Lobes of difTerent 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 according 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 eourse, to contiguous ones, by successive accumulations resembling the branches of a tree; large trunks are finally formed, which termínate in still larger placed in the centre of the gland near the base of the nip- ple. All the lactiferous ducts converge from the circum- ference ofthe gland, to its centre; their course however, is very tortuous; their coaís are thin, semi-transparent, and very capable of extensión and contraction. They are numerous, and from two to four of them unite into a common trunk, called Lactiferous Sinus, which is only a few lines long, and placed near the base of the nipple. These sinuses are about fifteen in number, are of different diameters, the largest about three lines wide, but others scarcely exceed the diameter of the lactiferous tubes. From the extremity of each sinus arises a small excretory duct, which conducts the milk to the summit 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 these ducts, ate united together by condensed cellular membrane; they * See Marjolin, vol. ii. p. 295. FEMALE MAMMiE. 273 have no valves, neither have the lactiferous tubes in any part of their course. An opinión 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 betwTeen them; henee it happens that in the injection of the gland with mercury, it is necessary to inject each milk duct of the nipple separately. Some anatomists have thought that there is a direct communication 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 oceurrence, was induced to think that when such communication did happen, it was by rupture. The Areola in virgins, is a rose coloured circle, 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 ofthe areola is ex- tremely 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 circum- ference, and in other subjects are irregularly distributed. Each of these tubercles, has near its summit, three or four foramina, which are the orifices ofthe excretory ducts of a little gland forming the tubercle. From this gland is secreted, according to some, an unctuous fluid for protect- ing the surface of the areola, while others consider it only as lactescent. The areola consists of a spongy tissue, beneath which there is no fat; it is susceptible of distention during lactation, or from sexual excitement. The Papilla or Nipple, is the truncated cone in the centre of the mamma, of the same colour with the areola, and surrounded by it. The milk ducts all termínate on its upper end. 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 papillas. Its in- 18 274 OF THE TRUNK. ternal structure consists merely of the milk ducts, united by condensed cellular membrane. Fig. 53 A Preparation of the Lacti- ferous Tubes, during Lacta- tion. 1.2. Top and Base ofthe Nipple. 3. Lactiferous Tubes in the Natural State. 4. Two in the Nipple which are in- jected. 5. These Tubes dilated and forming a kind of Sinus at the Base of the Nipple. 6. The Roots of the Lactiferous Ducts. 7. Lobules ofthe Gland. 8. The Orifices of the prepared Tubes. The mamma is supplied with blood from the exterral thoracic, intercostal, and internal mammary arteries. Its veins attend their respective arteries. The nerves come from the brachial plexus and the intercostals. Its lym- phatics run into the internal mammary and axillary trunks. PART II. CHAPTER V. OF THE NERVES AND VESSELS OF THE TRUNK. I have thought it better to give a sepárate considera- tion 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 student most frequently adopts when left to his own discretion; which alone, is in some measure a proof, of its being the most natural and agreeable method. The arteries should be filled wTith either of the coarse injections ; this is less important for the veins, and may be dispensed with. SECTION I. Ofthe Nerves. The Phrenic Nerve arises from the anterior fasciculus of the second and third cervical, and is assisted generally, by two or three filaments from the upper part of the brachial plexus. It descends vertically on the humeral side of the 276 OF THE TRUNK. internal jugular vein, but removed a considerable distance from it, and is attached by cellular substance, to the fpent of the scalenus anticus muscle. Getting in its descent to the internal margin of the latter, it passes into the thorax from the neck, by the side of the descending cava on the right, between it and the pleura; it then goes along the superior mediastinum to the pericardium, to the side of which it adheres in front of the root of the lungs, being between the pericardium, and the corresponding portion of the pleura; it finally reaches the diaphragm to which it is distributed. On the left side, with the ex- ception 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 by branches which interchange filaments. Some of the branches are distributed in its thickness, and upon its concave surface. On the right side, some of these branches pass through the opening for the Ascending Vena Cava, and thus getting into the abdomen, anastomose with the solar plexus and with the pneumogastric nerve. The phrenic nerve of the left side, is nearer to the root of the lung, than thatof the right, in consequence ofthe projection of the apex of the heart on that side. Its distribution, in other respects, does not present any remarkable difference from the other. It sends some filaments to the lower part of the cesophagus. 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 recurrent nerve is separating from it. From a little below this place, the par vagum sends off the Anterior Pulmonary 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 ramifications of this plexus, follow generally the' bronchia and blood-vessels, into the sub- stance of the lungs, but some of them are turned into the cardiac plexus. The trunk of the par vagum proceeds then, on the out- side of the bronchia, and a little lower down, behind it, passes in contact with the posterior surface of the root of * For a farther account of this nerve see the Neck. NERVES. 277 the lungs. Here it gives off successively five or six branches of difíerent magnitudes, which leave the main trunk almost at right angles, divide and subdivide, and following the bronchia, are spent upon its ultímate ramifi- cations in the lungs. These branches constitute the Pos- terior Pulmonary Plexus. After the posterior pulmonary plexus is given off, the par vagum remaining still considerable, attaches itself to the cesophagus, being split into three or four fasciculi which spread out and unite again. From the crossing of the bronchia to the joining with the cesophagus, a great many small ramifications are sent to the cesophagus, 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 cesophagus, 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 cesophagus. They pass through the Foramen CEsopha- geum of the diaphragm, along with the cesophagus, and their fibres are re-assembled into more considerable 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 stomach, to the lesser omentum, and some of its branches extend to the left hepatic and the solar plexus. The right par vagum surrounds with its branches, the cardiac orifice of the stomach, supplies the under side and great curvature, sends branches along the gastric artery to unite with the hepatic and splenic plexuses, and one trunk to the solar plexus. — n, _ „, ^,,-^-w*». *> The Sympathetic, or Intercostal Nerve, is principally i employed in the thorax in supplying the heart. With this I 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 fila- ments from the upper cervical ganglion, joined by some from the superior laryngeal nerve. They unite into one trunk, which accompanies the common carotid on its ex- ternal surface, as far as the middle cervical ganglion: here the trunk divides, one part of it, and the smaller, running along the carotid and arteria innominata to the aorta, the other joining a plexus just below the middle cervical ganglion. 278 OF THE TRUNK. A View ofthe distribution of the Glosso-Pharyngeal, Pneumo- Gastric and Spinal Accessory Nerves, or the Eighth Pair. Fig. 54. 1. The Inferior Maxillary Nerve. 2. The Gustatory Nerve. 3. The Choroda-Tympani. 4. The Auricular Nerve. 5. Its communication with the Portio-Dura. 6. The Facial Nerve coming out of the Stylo-Mastoid Foramen. NERVES. 279 7. The Glosso-Pharyngeal Nerve. 8. Branches to the Stylo-Pharyngeus Muscle. 9. The Pharyngeal Branch ofthe Pneumo-Gastric Nerve descending to form the Pharyngeal Plexus. 10. Branches ofthe Glosso-Pharyngeal to the Pharyngeal Plexus. 11. The Pneumo-Gastric Nerve. 12. The Pharyngeal Plexus. 13. The Superior Laryngeal Branch. 14. Branches to the Pharyngeal Plexus. 15.15. Communication ofthe Superior and Inferior Laryngeal Nerves. 16. Cardiac Branches. 17. Cardiac Branches from the Right Pneumo-Gastric Nerve. 18. The Left Cardiac Ganglion and Plexus. 19. The Recurrent or Inferior Laryngeal Nerve. 20. Branches sent from the curve ofthe Recurrent Nerve to the Pulmo- nary Plexus. 21. The Anterior Pulmonary Plexus. 22.22. The CEsophageal Plexus. The Middle or Great Cardiac Nerve, arises from the inferior part ofthe middle cervical ganglion, passes along the external surface of the carotid artery, and crosses the sub- clavian in front, just at its root, it then goes along with the arteria innominata for a little distance, and terminates in the upper part of the cardiac plexus. The Third or Inferior Cardiac Nerve comes from the lower cervical ganglion, by several filaments, which unite into a smaller number to form a plexus, and which de- scends behind the subclavian artery, between the innomi- nata and trachea, to the posterior part ofthe arch ofthe aorta. On the left side, the Upper Cardiac nerve originates in the same way as on the right, from the first cervical ganglion and upper laryngeal; attending the common carotid, it is increased by fibrillas from the sympathetic, be- tween the first and second ganglia. 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 behind it. The second cardiac nerve of the left side, is derived from the middle and lower cervical ganglia of the sympathetic. Several branches being despatched by the two ganglia, they form a plexus which surrounds the subclavian, at the origin ofthe inferior- thyroid and transversalis colli arteries. From this plexus, several cords proceed longitudinally behind and before the 280 OF THE TRUNK. subclavian artery, to the aorta, and here being joined to branches from the upper cardiac nerve, they form a plexus on the anterior and posterior faces ofthe aorta. The Cardiac Plexus, consists of a very considerable number of nervous filaments, formed by the combination of the cardiac nerves on both sides, with branches sent off from the recurrent nerves, and the par vagum. It is placed between the arch of the aorta and the lower part of the trachea and bronchias, and is fixed in loóse cellular and adipose membrane at its upper part. Below, its meshes are much involved with the glands about the bifurcation of the trachea, and on the aorta its branches lie very cióse 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 con- fined closely to these vessels by the internal lamina of the pericardium, and are seen to enter into their structure. The cardiac plexus, penetrating from the base of the heart to the root of the aorta, is diffused through the mus- cular structure ofthe former, its trunks following 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 upper edge of the head of each rib, it forms a ganglion, which unites with the in- tercostal nerve behind it by one or two branches. At the lower part ofthe thorax, it penetrates into the abdomen be- neath the crus of the diaphragm; it then proceeds forwards and downwards on the spine, between the tendinous crus of the diaphragm 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 verte- bra, it forms a ganglion, which joins by one or two nervous filaments, with the corresponding lumbar nerve, which fila- ments pass between the bone and the psoas muscle. From NERVES. 281 the loins, the sympathetic descends into the pelvis on the inner side of the foramina of the sacrum ; here also it forms a ganglion corresponding with each sacral nerve, and de- taches a filament to join it. Finally, the sympathetic termi- nates on the os coccygis, where the ultimate branches of the opposite sides unite. From several of the upper ganglia of the sympathetic in the thorax, fibrillas depart which join the posterior pul- monary plexus, and also are distributed in the form of a plexus on the aorta. From the sixth, seventh, eighth, ninth and tenth thoracic ganglia, branches are sent off, which, descending obliquely on the sides of the vertebras, 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 and eleventh dorsal ganglia, filaments are, in like manner, successively sent off, which form one trunk that penetrates into the abdomen, through the crus of the diaphragm; this constitutes the Lesser Splanchnic Nerve, wmich, in part, unites to the great splanchnic nerve, and the remainder goes to the renal plexus. The Great Splanchnic Nerve, having enteredthe abdomen terminates in the Semilunar Ganglion. This ganglion is situated on the crus of the diaphragm, and on the sides of the cceliac and superior mesenteric arteries. It is frequently formed rather by a congeries of small ganglia arranged in a lunated form, than by a single one. These small ganglia 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, above the pan- creas, and surrounds with its branches, the cceliac, superior mesenteric, and renal arteries. It is formed from the semi- lunar ganglia of both sides, and to their ramifications are added some from the par vagum and phrenic nerves. That portion of the solar plexus on the cceliac artery, assumes the ñame of ccdiac, and dismisses ramifications in the course 282 OF THE TRUNK. of the gastric, hepatic, and splenic arteries to the viscera supplied by them, as the stomach, liver, páncreas, and spleen. The Superior Mesenteric Artery has around it the Supe- rior 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 detachment in front of the aorta, to the inferior mesenteric artery, which supplies the left side of the colon and the rectum. From the lower part of the solar plexus, arises the Renal Plexus, which surrounds the emulgent artery, and is dis- tributed 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 there- fore 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 ofthe 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 ar- tery on each side, is distributed to the bladder, rectum, and vesiculas seminales of the male, and to the uterus, vagina, bladder, and rectum of females. This is the Hy- pogastric Plexus, which is farther increased by filaments from the sacral parts of the sympathetic. A View of the Great Sympathetic Nerve. 1. The Plexus on the Carotid Ar- tery in the Carotid Fora- men. 2. Sixth Nerve (Motor Externus. 3. First Branch of the Fifth or Ophthalmic Nerve. 4. A branch on the Septum Na- rium going to the Incisive Foramen. 5. The Recurrent Branch or Vi- dian Nerve dividing into the Carotid and Petrosal Branches. NERVES. 283 Fig. 55. 6. Posterior Palatine Branches. 7. The Lingual Nerve, joined by the Chor- da Tympani. 8. The Portio Dura of the Seventh Pair,or the Facial Nerve. 9. The Superior Cervi- cal Ganglion. 10. The Middle Cervi- cal Ganglion. 11. The Inferior Cervi- cal Ganglion. 12. The Roots of the Great Splanchnic Nerve arising(from the Dorsal Gan- glia. 13. The Lesser Splanch- nic Nerve. 14. The Renal Plexus. 15. The Solar Plexus. 16. TheMesentericPlcx. us. 17. The Lumbar Gan- glia. 18. The Sacral Ganglia. 19. The Vesical Plexus. 20. The Rectal Plexus. 21. The Lumbar Plexus (Cerebro-Spinal.) 23. The Rectum. 23. The Bladder. 24. The Pubis. 25. The Crest ofthe Ili- um. 26. The Kidney. 27. The Aorta. 28. The Diaphragm. 29. The Heart. 30. The Larynx. 31. The Sub-Maxillary Gland. 32. The Incisor Teeth. 33. Nasal Septum. 34. Globe of the Eye. 35.36. Cavity ofthe Cra- 284 OF THE TRUNK. The other nerves ofthe trunk consist ofthe 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 dis- tributed to the muscles of the back, but the anterior has a destination not so uniform. The anterior branches of the dorsal nerves, are all con- nected to the ganglia of the sympathetic, and running between the internal and external intercostal muscles, are distributed to the parietes of the thorax and abdomen. The first dorsal nerve joins the axillary plexus. The second sends a branch through the external intercostal muscle, to the axilla, which joins with a branch of the internal cuta- neous nerve ofthe arm, and is supposed, as it also sends a filament to the lower cervical ganglion of the sympathetic, to establish 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 integu- ments ofthe 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 farther consideration of the spinal nerves, is referred to the anatomy of the limbs. NERVES. 285 SECTION II. Ofthe Blood-Vessels ofthe Trunk. The course of the aorta, from its origin to its passage through the diaphragm, has already been mentioned, (see Thorax;) as well as the fact that a line to subtend the base of its curvature, must be drawn from the sternal extremity of the third rib on the right, to the dorsal extremity of the third rib on the left side. The first branches given off af- ter the coronary arteries, are the Arteria Innominata, the Left Carotid, and the Left Subclavian. The Arteria In- nominata is in advance of the others, and divides after an inch or an inch and a half of length, into Right Carotid and Right Subclavian. For an exposition of the course ofthe Carotids, see the article Neck. The Subclavian Artery, before it passes between the scaleni muscles, sends off five branches : of which the Infe- rior Thyroid, the Vertebral, and the Transverse Artery of the neck are mentioned in the article Neck. The remain- ing two, to wit, the Internal Mammary and the Superior In- tercostal belong to the trunk. The Internal Mammary Artery, after its origin, de- scends immediately along the internal margin of the scale- nus anticus, and places 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 epigastrio artery. It sends a branch (Phrenica Superior) which attends the phrenic nerve on the side of the pericardium ; it then supplies the intercostal muscles, anas- tomoses with the intercostal arteries, and sends some branches to the mamma. 286 OF THE TRUNK. The Superior Intercostal Artery, arising from the under surface of the subclavian, opposite the inferior thy- roid, runs across the neck of the first rib, and supplies the two upper intercostal spaces; it also, sometimes, supplies the third intercostal space. . Below its curvature, in the thorax, the aorta gives off the CEsophageal, the Bronchial, the Posterior Mediastinal, and the Intercostal Arteries. The Bronchial Arteries, are vessels intended for the nourishment of the lungs; the right comes from the superior aortic intercostal artery, and the left from the aorta ; this ar- rangement is not uniform, for sometimes both come from the aorta. The CEsophageal Arteries, are five or six in number, and are spent upon the cesophagus, as their ñame implies; the lowermost descends to the stomach. The Posterior Mediastinal, as their ñame indicates, supply 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 cesophagus is in front of them. Each one joins the rib near its tubercle, 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 despatches an arteriole through the inter- vertebral foramen to^the medulla spinalis. When the inter- tercostalarrives near the middle ofthe rib, it sends off a branch which passes near the upper edge ofthe lower rib. When it has got two-thirds of the length of the rib, it leaves the lower edge to be distributed to the intercostal space and contiguous parts. The Abdominal Aorta, passes almost in front of the ver- tebras, being pushed but very little to the left of the median nerves. 287 line. It gives off several large branches to the viscera, and at the intervertebral space ofthe fourth and fifth vertebras of the loins, it divides into the two Primitive Iliacs. The Phrenic Arteries, come from the aorta, immedi- ately on the latter emerging between the crura of the dia- phragm. They are two in number, and named from their situations, Right and Left; they ramify on the concave sur- face of the diaphragm. Their origin is subject to varia- tions. The Cceliac Artery, (Arteria Cceliaca) is immediately 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 Arte- ries. This división is the Tripus Halleri. The Hepatic Artery, goes to the liver through the cap- sule of Glisson, and is distributed through this viscus. Near the liver it sends off the Right Gastro-Epiploic, 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 lesser curvature to the pylorus, supplying contiguous parts of the stomach. The Splenic Artery, is the largest of the three. It goes tortuously along the upper edge of the páncreas to the spleen; in its course it sends to the stomach the Left Gastro- Epiploic, 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 Páncreas. 288 OF THE TRUNK. A View of the Aorta in its whole length, and of its Branches, AS GIVEN BY A SECTION OF THE ANTERIOR PaRIETES OF THE Trunk. Fig. 56. 1 23. Superior Mesenteric, cut off. 24. Emulgent Arteries. 25. Inferior Mesenteric. 26. División ofthe Aorta into Iliacs. 27. Middle Sacral—last Branch of the Aorta. 28. Primitive Iliacs. 29. External Iliacs. Commencement and Arch ofthe Aorta. Thoracic Aorta. Abdominal Aorta. Arteria Innominata. Right Primitive Ca- rotid. Superior Thyroid. Right Sub-ClaviaH. Vertebral. Inferior Thyroid. Anterior Cervical. Transverse Cervical. Superior Scapular. Superior Intercostal. Section of internal Mammary. Left Primitive Ca. rotid. Left Sub-Clavian. A small Artery to the Superior Me- diastinum. Some of the Upper Intercostal Arte- ries. CEsophageal Arte- ries. Phrenic Arteries, here coming off from the Cceliac. Remains ofthe Dia- phragm,and com- mencement ofthe C'Eliac Artery. Tripod of Haller. or División of the Coiliac, into He- patic, Gastric and Splenic Arteries. ARTERIES OF ABDOMEN. 289 30. Epigastrio Artery. 35. Gluteal. 31. Circumflexa Ilii. 36. Vesical Arteries. 32. Internal Iliac Artery. 37. Obturator. 33. íleo-Lumbar. 38. Ischiatic. 34. Lateral Sacral. 39. Internal Pudic. The Superior Mesenteric, (Arteria Mesenterica Supe- rior) is about half an inch below the cceliac, and is nearly of the same size ; it passes downwards under the páncreas 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 intestine. That branch 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 Cólica Dextra; and that which supplies the arch of the colon, is the Cólica Media. The Emulgent Arteries, (Arterias 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 capsulas renales. The arterial distribution from the aorta here, is subject to variations, the arteries of the cap- sulas renales coming, sometimes 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, (Arterias Spermaticas) arise im- mediately below the emulgents, one on each side ; they are about the size of a crow-quill, and are remarkable for their length. They pass downwards to the testicles, behind the peritoneum, and before the psoas muscles, not far from the ureters, spermatic plexus of nerves, and spermatic veins. At the internal abdominal ring, the spermatic artery meets with the vas deferens, and constituting a part of the sper- matic cord, is distributed on the testicle in the manner de- scribed in the account of that organ. In the female, these arteries go to the ovaria, fallopian tubes, and uterus. 19 290 OF THE TRUNK. The Inferior Mesenteric, (Arteria Mesenterica Inferior) arises below the spermatics ; it is much smaller than the su- perior. 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 Inferior. The superior, anastomoses with the cólica media, forming with it the great JVIesocolic Arch. The others supply the sigmoid flexure ofthe colon, and the part just above it. A branch is continued from the inferior mesenteric, to the rectum, constituting the Superior Hemorrhoidal Artery. From the centre of the fork formed by the bifurcation of the aorta, there proceeds a small arterial tube, about the size of a crow-quill, called the Middle Sacral, from its running down to the os coccygis, just over the middle line of the sacrum. It sends branches on either side, towards the fora- mina in the sacrum. The Lumbar Arteries, (Arterias 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 vertebras, some of their branches penétrate the intervertebral foramina to get to the medulla spinalis: others pass to the muscles of the back. Besides which, the lower parts ofthe parietes of the abdomen are supplied by them. They inosculate with the circumflexa ilii, with the epigastric, and with the gluteal arteries. The Primitive Iliacs, (Art. Iliacas Communes) one on each side, are formed by the termination of the abdominal aorta; they extend from the fourth lumbar vertebra to the sacro-iliac junction, opposite to which they divide into two trunks, the External Iliac Artery, and the Hypogastric. In this course they give off no collateral branch of any conse- quence, and are crossed by the ureters. The Hypogastric or Internal Iliac, (Arteria Iliaca In- terna, or Ramus Hypogastricus,) gives off several branches, the origins of which differ considerably. The main trunk itself is of various lengths, and is distributed to the viscera of the pelvis, and to the muscles on its external surface. Sometimes it is previously divided into two principal trunks, ARTERIES OF ABDOMEN. 291 an anterior and a posterior. From it the following branches proceed. 1. The Ilio-Lumbar Artery, (Arteria Ilio-Lumbalis,) is commonly the first branch of the hypogastric, or of its poste- rior 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 dis- tributed to the loins, and the other, upon the iliacus internus muscle. 2. The Lateral Sacral Arteries, (Arterias Sacras La- terales,) come next, arising by one or more trunks 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 ihrough the ob- turator 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 epigastric. 4. The Middle Hemorrhoidal Artery, (Arteria He- morrhoidea Media,) comes sometimes from the gluteal. It is thus named from its relative position to the upper and lower hemorrhoidal, on the rectum. Besides going to this or^an, it supplies the prostate gland, and the vesiculas (seminales of the male, and the vagina and bladder in fe- males. 5. The Uterine Artery, (Arteria Uterina,) is peculiar to females, and gets to the uterus, between the laminas of the broad ligaments. 6. The Vesical Arteries, (Arterias Vesicales,) are de- rived from what was the umbilical artery of the fcetus, and are distributed to the bladder. 292 OF THE TRUNK. The Arteries of the Pelvis and Thigh, as seen from the Inner Side, by a Vertical Section. Fig. 57. 2a. Superior Internal Articular Artery. 30. Inferior Internal Articular Artery. 31. Anastomosis of these with Anastomotica. 1. Inferior Extremity ofthe Ab- dominal Aorta, just where it divides into the Iliac Ar- teries. 2. Right Primitive Iliac. 3. Right Externa] Iliac. 4. Origin of Epigastrio Artery. 5. Circumflexa llii. 6. Hypogastric or Internal Iliac Artery. 7. Íleo-Lumbar. 8. Gluteal. 9. Obturator. 10. Lateral Sacral. 11. Vesical Arteries, cut ofF. 12. Middle Hemorrhoidal. 13. Internal Pudic. 14. Ischiatic. 15. Origin ofthe Femoral Artery at the Crural Arch. 16. Point where it passes through the Adductor Muscle. 17. Profunda Major. 18. Internal Circumflex. 19. First Perforating Artery. 20. Second Perforating Artery. 21. Third Perforating Artery. 22. Another Perforating Artery. 23. Femoral seen in the Adduc- tors. 24. The Anastomotica of the Fe- moral. 25. A Branch to the Sartorius Muscle. 26. Popliteal Artery. 27. The same Artery behind the Knee-joint under the Soleus Muscle. 28. A Supernumerary Articular Artery. What remains of the hypogastric, consists in two large branches, the Gluteal and the Ischiatic ARTERIES OF ABDOMEN. 293 7. The Gluteal Artery, (Arteria Glutasa,) passes out of the pelvis at the upper part of the ischiatic foramen 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 immediately into branches which are dis- tributed upon the gluteal muscles. 8. The Ischiatic Artery, (Arteria Ischiadica,) coming from the inferior part of the hypogastric, is situated before the belly of the pyriformis muscle, and issues from the pel- vis below its inferior edge, and in front ofthe 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. It is distributed to the inferior edge of the gluteus maximus, and to the muscular structure near the sacrum and coccyx ; also, to the muscles on • the back and upper parts ofthe thigh. The Internal Pudic Artery, (Arteria Púdica Interna,) arises from the Ischiatic within the pelvis, 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 continúes on the inner side of the ramus of the ischium and of the pubis, towards the symphysis. In this course, it gives off several branches in the following order. A small branch to lower edge of pyriformis muscle. The Lower Hemorrhoidal Artery to the lower part of the rectum, and to the sphincter ani muscle. To the back part of the scrotum, the perineal muscles and the skin, it gives the Pe- rineal Artery, originating near the transversus perinei muscle and passing in its direction. Upon the arrival of the in- ternal pudic near the penis, it detaches to this body, a branch which penetrates and ramifies minutely through the struc- ture of the corpus spongiosum urethras. At the symphysis ofthe 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 ligament, to the integuments, and to the prepuce ; this is the Superficialis Dorsi Penis. Finally, the terminating branch of the internal pudic pene- trates into the corpus cavernosum, passes straight forwards 294 OF THE TRUNK. on the septum, and is distributed to the cells, by very mi- nute 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 ante- rior superior spinous process of the ilium, having the ante- rior crural nerve on its outside, and the external iliac vein on its inside. It gives off no branches, till it reaches Pou- part's ligament, when the Epigastric arises from it. The Epigastrio Artery, (Arteria Epigástrica,) at first passes inwards; it then rises upwards obliquely, till it reaches the exterior edge of the rectus muscle. Continuing after- wards 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 near the epigastric. It runs along the posterior edge of Poupart's ligament, to the spi- nous process of the ilium, thence it continúes 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 TIIE TRUNK. The Superior Cava, (Cava Descendens,) is sufficiently alluded to, in the description of the thorax, to render a far- ther notice of it here unnecessary. It receives the blood from the left arm and side ofthe head, by a trunk (the Vena Innominata) formed by the unión of the left subclavian and internal jugular vein, which crosses the sternum obliquely a little below its superior edge. This venous trunk, and the corresponding one belonging to the right arm, and the right side of the head, which descends vertically, constitute in fact by uniting, the Descending Cava. veins of trunk. 295 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 formed by the unión, into one trunk successively, of the ten inferior inter- costal veins of the right side. About the sixth dorsal verte- bra, this trunk is joined by one formed by the successive unión of the six inferior intercostal veins on the left side. The trunk of the vena azygos as stated, is on the right side of the posterior mediastinum, and forms a regular and beautiful arch, over the root of the right lung. The six superior Intercostal Veins of the left side, dis- charge into the left subclavian vein by a common trunk ; the two superior of the right side, into the descending cava. The Internal Mammary Vein has nothing very peculiar; it observes the course of its artery, and empties into the subclavian vein near its origin. The Vena Cava Ascendens is formed in the lower part of the abdomen, by the unión of the external and internal iliac veins into the common iliacs, and the subsequent junc- tion of the latter, at the fourth lumbar vertebra. This vein ascends on the right of the aorta, receives the Lumbar, the Spermatic, the Emulgent, the Capsular, the Hepatic and the Phrenic Veins, and in its course, penetrates the right opening 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, except in regard to peculiarities. About the neck of the bladder, vesiculas seminales, and the base of the prostate, there is a considerable accumulation of veins, forming a very vascu- lar plexus; they come originally from the Vena Ipsius Penis, and from the proper vesical veins. The several veins of the pelvis derived from the ischi- atic, gluteal, and internal pudic arteries, &c, accumulate atthe sacro-iliac junction into one trunk, the Internal Iliac Vein, 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 296 OF THE TRUNK. side. The Right Spermatic Vein discharges into the Ascend- inc Cava, but the left into the Emulgent of that side. The emulgent and capsular veins, correspond 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 in- ferior mesenteric arteries, and from those of the cceliac which do not go to the liver, as the splenic and gastric, form that large trunk, the Vena Portarum, the history of which is given in the account of the liver. SECTION III. The Thoracic Duct, (Vas Chyliferus.) The common trunk ofthe absorbent system, commences most commonly at the second or third lumbar vertebra, in front of its body, by the unión of the absorbent vessels of the lower extremities, pelvis, and intestines. This vessel immediately after its formation, is sometimes subjected to a dilatation of various shapes and lengths, called the Re- ceptaculum Chyli ; after which, it proceeds regularly up- wards in front of the vertebra, between the vena azygos and the aorta, to the upper part of the thorax. It passes between the crura ofthe diaphragm, and for some part of its course, is immediately behind the cesophagus. 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 subclavian artery, between the internal jugular vein, and the scalenus anticus muscle ; and then terminates by an orifice protected by two valves, in the fork formed by the junction of the left inter- nal jugular and subclavian veins. THORACIC DUCT. 297 A View of the Course and Termi- nation of the Thoracic Duct. 1. Arch ofthe Aorta. 2. Thoracic Aorta. 3. Abdominal Aorta. 4. Arteria Innominata. 5. Left Carotid. 6. Left Sub-Clavian. ,7. Superior Cava. 8. The two Vena? Innominatae. 9. The Internal Jugular and Sub-Cla- vian Vein at each side. 10. The Vena Azygos. 11. The Termination ofthe Vena Hemi- Azygos in the Vena Azygos. 12. The Receptaculum (hyli: several Lymphatic Trunks are seen opening into it. 13. The Thoracic Duct, dividing op- posite the Middle Dorsal Verte- bra, into two branches, which soon reunite; the course of the Duct behind the Arch of the Aorta and Left Sub-Clavian Ar- tery is shown by a Dotted Line. 14. The Duct making its turn at the Root of theNeck, and receiving several Lymphatic Trunks pre- vious to terminating in the Pos- terior Angle of the Junction of the Internal Jugular and Sob- Clavian Veins. 15. The Termination of the Trunk of the Lymphatics ofthe Upper Ex- tremity. Several iníeresting varieties oceur in the Vas Chyliferus; sometimes two trunks are formed originally on the lumbar vertebras, which run parallel with each other, and then unite at the lower dorsal vertebra. The thoracic portion of the duct varies in size and continuity, being divided once or oftener into two trunks, which unite again, and beino* also contracted at particular points. The cervical, or terminating portion ofthe duct, is occasionally divided into two tubes which have sepárate orifices. There is a very good píate in Caldani, representing the occasional terminations of the lymphatic trunks, in íhe región of the Fig. 58. 298 OF THE TRUNK. neck; in this píate the thoracic duct empties after a consi- derable dilatation, into the internal jugular vein, about an inch above its junction with the subclavian; and the lym- phatics 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 extre- mity form a trunk, whose orifice is in the subclavian vein, about an inch below its junction with the internal juo-ular. The lymphatics ofthe right arm, lung, right side ofthe 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 this trunk, like that of the Thoracic Duct, is secured from a regurgí- tation of blood, by one or more valves. PART II. CHAPTER VI. OF THE MUSCLES OP THE BACK. Make an incisión through the integuments from the lower part of the occiput to the os coccygis, directly over the spinous processes of the vertebras. Make a second incisión from the upper end of the first, to the lobe of the ear. Make a third cut through the integuments from the acromion process to the posterior fold of the arm-pit. 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 most superficial muscles ofthe back, the Trapezius and the Latissimus Dorsi. The Trapezius is a beautiful broad muscle, immediately under the skin, covering the back parts of the neck and thorax, and extending from the bottom of the latter to the top ofthe 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 be- iow, it overlaps in part the latissimus dorsi. 300 OF THE TRUNK. A View of the Muscles of the Back as shown after the re- moval of the Integuments. Fig. 59. 1. Occipital Origin of the Trapezius. 2. Stcrno-Cleido-Mastoideus. 3. Middle ofthe Trapezius. 4. Insertion ofthe Trapezius into the Spine ofthe Scapula 5. Deltoid. 6. Second Head of the Tríceps Extensor Cubiti. MUSCLES OF THE BACK. 301 7. Its Superior Portion. 8. Scapular portion ofthe Latissimus Dorsi. 9. Axillary Border of the Pectoralis Major. 10. Axillary Border of the Pectoralis Minor. 11. Serratus Major Anticus. ]2. Infra-Spinatus. 13. Teres Minor. 14. Teres Major. 15. Middle ofthe Latissimus Dorsi. 16. External oblique ofthe Abdomen- 17. Gluteus Medius. 18. Gluteus Minimus. 19. Gluteus Magnus. 20. Fascia Lumborum. It arises from the occipital protuberance, and from eight or ten lines, sometimes more, of the upper semicircular ridge of the occiput, by a tendinous membrane. It arises also tendinously from the five superior spinous processes of the neck, through the intervention of the Ligamentum Nuchas, and tendinously from the two lower spinous pro- cesses 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 process, and into all the spine of the scapula. Its fibres having a very ex- tended origin, must of course converge in getting to these insertions; the upper fibres descend, the lower ascend, and the middle are horizontal. It draws the scapula towards the spine. In the cervical portion of these muscles, formed by the ori- gins of both muscles united, is an ellipticalexpan.se of tendón, lying over the ligamentum nuchas, and extended on each side. The ligamentum nuchas itself, is a vertical septum of ligamentous matter, extending from the central line of the occipital bone, to the spinous processes of all the vertebras of the neck. At its upper part, where the spinous pro- cesses of the neck are short, this membrane is very broad, and divides completely the muscle 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 membrane, from the seven inferior spinous processes of the back, and by a thick 302 OF THE TRUNK. tendinous expansión from all those ofthe loins and sacrum. » Its origin also extends in this condition, along the iliac mar- gin of the sacrum, and from the posterior third of the spine of the ilium.* Besides which the latissimus dorsi has three or four fleshy heads, from the sides of the three or four in- ferior false ribs, which are interlocked with the inferior heads ofthe obliquus externus abdominis. From this extended origin the fibres converge, so as to form the posterior fold ofthe axilla, and to terminate in a flat, thick tendón, of two inches in breadth, which is inserted into the lower part of the posterior ridge of the bicipital groove of the os humeri. The upper part of this muscle passes over the inferior angle of the scapula, and derives a fasciculus of fibres from it. Afterwards the tendons of the two adhere closely, but have a bursa between them, at their termination. That por- tion of the tendón of the latissimus, which is continuous with the lower edge of its fleshy belly, becomes uppermost by a half spiral turn in the latter; while the upper portion is by the same arrangement, made lowest. At the place of its insertion, it is commonly connected to the Pectoralis Maior. The inferior margin oí its tendón, detaches a slip to the brachial fascia, and the superior margin; another to the smaller tuberosity of the os humeri. It draws the os humeri downwards and backwards. That portion of its origin, which is the tendinous mem- brane, arising from the spinous processes of the loins, is the Fascia Lumborum, and is common to the latissimus, the in- ternal oblique and transversalis of the abdomen, and seve- ral other muscles to be mentioned. The origin of the two latissimi muscles conjointly, makes a beautiful lozenge-shaped expansión, occupying its entire spinal región ; the longest diameter is vertical, and just over the spinous processes, the lateral diameter extends from one Crista of the ilium to the other. Detach now, the trapezius from its origin and turn it over the shoulder. Begin also to detach the latissimus dorsi from its origin above, turning downwards the upper edge of the * This origin frequently is tendinous at the back part of the ilium, and fleshy in front. MUSCLES OF THE BACK. 303 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 mus- cle is inseparably united to that of the latissimus dorsi by the fascia lumborum, in order therefore to view it properly, let the fleshy part of the latissimus be detached from the fascia, and we shall then see that the serratus arises by this tendinous membrane, from the two inferior spinous pro- cesses ofthe back, and the three superior ofthe loins. It is inserted by fleshy digitations into the under edges of the four inferior ribs. It draws the ribs downwards, and is an antagoníst 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 Rhom- boid, which being two together, look very much like one. The Rhomboideus Minor is above the other. It is a narrow muscle which arises by a thin tendón, from the three inferior spinous processes of the neck, and passing obliquely downwards, is inserted into the base ofthe scapula opposite the origin of its spine. The Rhomboideus Major, arises also by a thin tendón from the spinous processes 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 backwards. Detach them from their origins, and we see next, The Serratus Superior Posticus, arising by a thin ten- don from the three inferior spinous processes of the neck, and the two superior of the back, and inserted into the se- cond, 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 dissec- 304 OF THE TRUNK. tion. The muscle itself, in consequence of arising on the anterior lateral parts of the thorax, has been considered in the remarks preliminary to the study of that cavity. Between the two Serrati, is an aponeurotic expansión described by Rosenmuller, which connects them with each other, and has induced some anatomists to consider them as but one muscle. It is thin and diaphanous; but has the fibrous structure very apparent, and running in a transverse direction, from the spinous processes to the angles of the ribs. The superior margin of the latissimus dorsi, also runs into this fascia, so as to render its own bounds somewhat undefined. This fascia, along with the ribs and vertebras, forms that canal in which are contained, the deep seated muscles of the back. The Levator Scapula, is placed between the posterior edge ofthe sterno-cleido-mastoideus and the anterior ofthe trapezius; its lower end is just above the Rhomboideus Minor. It arises by rounded tendons from the three, four 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 sca- pula, which is above the margin of its spine. As its ñame expresses, 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 extremity is under the serratus superior posticus, but the principal 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 vertebras. It is inserted into the back of the mastoid process and a small part of the adjacent portion of the os occipitis, and also into the transverse processes of the two superior cervi- cal vertebras. 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 vertebras. It draws the head and neck backwards. * Albimus, lox. cit. MUSCLES OF THE BACK. 305 A View of the Second Layer of the Muscles of the Back. Fig. 00. 1. Trapezius. 2. A portion of the tendinous ellipse formed by the Trapezius on both sidts. 3. Spine ofthe Scapula. 4. Latissimus Dorsi. 5. Deltoid. 6. Infra-Spinatus and Teres Minor. 7. External Oblique ofthe Abdomen. 8. Gluteus MediuSi 9. Gluteus Magnus of each side. 10. Levator Scapulce. 11. Rhomboideus Minor. 12. Rhomboideus Major. 20 306 OF THE TRUNK. 13. Splenius Capitis. 14. Splenius Colli. 15. A portion ofthe Origin of the Latissimus Dorsi. 16. Serratus Inferior Posticus. 17. Supra-Spinatus. 18. Infra-Spinatus. 19. Teres Minor. 20. Teres Major. 21. Long Head ofthe Tríceps Extensor Cubiti. 22. Serratus Major Anticus 23. Internal Oblique pf the Abdomen. Between the spinous processes of the vertebras and the angles ofthe ribs, on either side, there is a deep fossa filled up entirely by muscles, some of them large and powerful. The most striking are the Sacro-Lumbalis and the Longissi- mus Dorsi. The Sacro-Lumbalis and Longissimus Dorsi, have a common origin from the back of the pelvis and of the lum- bar vertebras, and extend to the top of the thorax. They arise, tendinous posteriorly, and fleshy anteriorly, from the posterior surface of the sacrum, by its external margin and spinous processes; they arise, also tendinously from the spinous processes, and fleshy, from the ends of the trans- verse processes of all the vertebras of the loins, and chiefly tendinously, from the posterior part of the spine of the ilium. From the under surface of this common belly, two tendinous and fleshy heads are inserted into ihe inferior edge of the transverse process of each lumbar vertebra, the smaller near its roqt, 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 its two parts. The Longissimus Dorsi is nearest the spine; it is inserted by small double tendons, proceeding from its internal sur- face, into the ends ofthe transverse processes of all the verte- bras 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 beyond their tubercles, except the two inferior. The Sacro-Lumbalis is inserted from its outer edge, into MUSCLES of the back. 307 all the ribs at their angles, by long and thin tendons, which are successively 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 ribs, as many slips, which run into the under surface of the sacro-lumba- lis; 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 tendi- nous, and scarcely to be distinguished from the latter, both in consequence of its cióse connexion with it and of its in- significant size. At its lower part, it is absolutely a portion of the longissimus, and can be separated from it only by a forced división. 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 tendinously from the spinous processes of the two superior lumbar, and of the three in- inferior dorsal vertebras, and is inserted tendinously into the spinous processes of the nine superior dorsal vertebras, ex- cept the first. It tends to keep the spine erect. Turn now the splenius from its insertions, and we shall see 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 dorsi, into the up- per ribs; it looks, at first, very much like a continuation or appendix of the first, running to the cervical vertebras. This muscle arises from the upper edges of the four su- perior ribs by long tendons; it forms a small belly, which is inserted into the transverse processes of the fourth, fifth, and sixth vertebras of the neck, between the levator scapulas 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 308 OF THE TRUNK. having very much the same course and appearance. It is considered as an appendage to the longissimus dorsi. It arises from the transverse processes of the five supe- rior dorsal vertebras, by distinct tendons, and forms a nar- row fleshy belly, which is inserted by distinct tendons also, into the transverse processes of the five middle cervical vertebras. It draws the head backwards. The Trachelo-Mastoideus, is at the inner side of the last muscle, in contact with it. It arises by distinct tendinous heads, from the transverse processes of the three superior vertebras of the back, and of the five inferior of the neck, and is inserted by a thin ten- don, into the posterior edge of the mastoid process. The dorsal origins are frequently deficient or irregular. It draws the head backwards. The Complexus, a fine, large muscle, is situated at the inner face of the trachelo-mastoideus, and is readily recog- nised by showing itself between the bellies of the two splenii capitis, just below the occiput. A quantity of ten- dinous matter exists in its middle, which gives it the com- plicated appearance from whence its ñame is derived. It arises by tendinous heads, from the seven superior dorsal, and the four inferior cervical vertebras by their trans- verse processes ; also by a fleshy slip from the spinous pro- cess of the first dorsal. It is inserted into the inferior part of the os occipitis, by the surface between the upper and lower semicircular ridges, and on the outside ofthe vertical ridge, which exists in the middle ofthe bone. It draws the head backwards. The Semi-Spinalis Colli, is a muscle which passes ob- liquely from transverse to spinous processes, and is situated between the complexus and the multifidus spinas; the course of its fibres renders it difficult to be distinguished from the latter. It arises from the transverse processes of the six upper vertebras of the back, by tendons which are involved with those of the adjacent muscles, and passes up the neck, to be inserted into the sides of the spinous processes of the five middle cervical vertebras. It extends the neck obliquely backwards. muscles of the back. 309 The Semi-Spinalis Dorsi is lower down on the spine, and with difficulty distinguished from the multifidus spinas. Like the last, it passes from transverse to spinous pro- cesses, and 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 vertebras, and passes obliquely upwards to be inserted, tendinously, into the sides ofthe spinous processes ofthe two lower cervical, and five upper dorsal vertebras. It draws the spine obliquely backwards. The Multifidus Spinje lies under the muscles as yet mentioned, cióse to the bones ofthe spine; in order to see it well, they therefore, should all bé 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 between the spines of the sacrum and the posterior part of the ilium. It arises also from the roots of the oblique and transverse processes of all the vertebras of the 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 vertebras of the loins, of the back, and of the five inferior of the neck. This muscle consists of a great number of small bellies, which are parallel to each other, each arising from a transverse or oblique 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 vertebras, and between the latter two, 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 tendinous 310 OF THE TRUNK. and fleshy, from the extremity of the spinous process ofthe vertebra dentata, and is inserted into the inferior transverse, or semicircular ridge of the os occipitis, and into a part of the surface of bone 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 semicircular ridge of the os oc- cipitis, and into part of the surface between it and the fora- men magnum. It is also pyramidal, writh the apex downwards. It draws the head backwards. The Obliquus Capitis Superior, arises from the trans- verse process of the first cervical vertebra, and is inserted into the outer end of the inferior semicircular ridge of the os occipitis, behind the posterior part of the mastoid pro- cess arid beneath the splenius muscle. It draws the head backwards. The Obliquus Capitis Inferior, arises from the side of the spinous process of the vertebra dentata, and is inserted into the back part ofthe transverse process ofthe first verte- bra of the neck. It rotates the first vertebra on the second. The Inter-Spinales are small short muscles, placed be- tween the spinous processes of contiguous vertebras. In the neck they are double, in consequence of its spinous processes being bifurcated; in the back they are almost en- tirely tendinous; in the loins they are single and well marked. They draw the spinous processes together, and keep the spine erect. The Inter-Transversarii, are also short muscles, placed in a similar manner between the transverse processes of the vertebras. In the neck they are double, in the back they MUSCLES OF THE BACK. 311 are small, tendinous, and not well marked; and in the loins they are single and readily seen. They draw the transverse processes together, and will of course, bend the spine to one side. A View of the Muscles of the Back, which fill up the Fossa on either side of the Spinous Processes of the Vertebra. 1. Tendinous Origin of the Longissi- mus Dorsi. 2. Upper portion ofthe Sacro-Lumbalis. 3. Upper portion of the Longissimus Dorsi. 4. Spinalis Dorsi. 5. Cervicalis Descendens. 6. Transversalis Cervicis. 7. Trachelo-Mastoideus. 8. Complexus. 9. Insertion of the Transversalis Cer- vicis. 10. Semi-Spinalis Dorsi. 11. Semi-Spinalis Cervicis. 12. Rectus Capitis Posticus Minor. 13. Rectus Capitis Posticus Major. 14. Obliquus Capitis Superior. 15. Obliquus Capitis Inferior. 16. Multifidus Spina3 at its Lower part. The rest is concealed by other Muscles. 17.17. Levatores Costarum. 18. Inter-Transversarii. 19. Quadratus Lumborum. The Levatores Costarum, are small muscles concealed by the sacro-lumbalis, and longissimus dorsi, and pass from the transverse processes of the last cervical, and the eleven superior dorsal vertebras, to the upper edges of the next ribs. They are twelve on either side ofthe spine, and are tendinous in their origins and insertions, with intermediate muscular bellies. Fig. Gl. 312 OF THE TRUNK. 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 service, that of ele- vating the ribs. The Rotatores Dorsi, of Professor Theile of Bern, pass from the transverse process of a vertebra below, to the under margin of the arch of the vertebra above. They are eleven in number on each side, beginning at the second dorsal vertebra, and ending at the twelfth. It may be con- sidered as questionable, whether any advantage will arise to descriptive anatomy, by thus separating from the Multi- fidus Spinas, fasciculi heretofore considered a part of it, but which Professor Theile says, are marked off by a layer of cellular tissue. As much may be said at least, of all the numerous strips making up the multifidus spinas. PART III. OF THE EXTREMITIES. CHAPTER I. OF THE UPPER EXTREMITIES. SECTION I. Of the Fascia. The muscles of each upper extremity, are invested by an aponeurotic membrane, called the Fascia Brachialis, which extends from the shoulder to the hand. It begins at the base and spine of the scapula, the margin of the acro- mion process, the acromial extremity of the clavicle, and from the cellular membrane in the arm-pit, and extends itself over all the muscles of the dorsum of the scapula, and over the deltoid muscle. The tendons of the latissimus dorsi, and pectoralis major, each send off from their mar- gins an expansión which is lost in it. Below the spine of the scapula, it is strong and well marked; but on the del- toid muscle, as well as on the muscles of the arm, its des- moid character is by no means so well developed. Above the condyles of the humeras, the Fascia Brachialis sends down to the bone, a strong tendinous partition to each ridge, and which runs the length of the latter, from its upper end to the condyle. These processes sepárate the muscles on the back of the arm, from such as are on the front of it, and are sometimes called the Ligamentum ínter- 314 OF TIIE UPPER EXTREMITIES. Musculare Internum, and Externum. They aftbrd origin to many muscular fibres. At the bend ofthe elbow, the fascia brachialis is joined by a fasciculus of tendinous matter, from the ulnar margin of the tendón of the biceps flexor cubiti, and which, in the contraction of the muscle, will keep the fascia tense. At the lower extremity of the fore-arm, the transverse fibres, after diminishing sensibly, become more numerous, and by their attachments to the several ridges on the back of the radius and of the ulna, form the Liga- mentum Carpi Dorsale. This ligament is extended from the styloid or outer margin of the radius, transversely to the styloid or inner margin of the ulna, to the pisiform bone, and to the fifth metacarpa!. The Fascia Brachialis aífords origin in part, to the mus- cles on the dorsum of the scapula below its spine; on the arm it is not so intimately connected with the muscles, but on the fore-arm they again begin to arise in part from it. In its whole course, partitions constituting the sheaths of the muscles, and which consist, for the most part, of common cellular and adipose membrane, go from it down to the periosteum and interosseous ligament. It adheres very tightly to the ulna, from the olecranon to the styloid process, and on its cutaneous surface, are found all the superficial veins, nerves, and lymphatics ofthe arm. 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. The Upper Extremity is most conveniently studied by de- taching it from the trunk, taking care to leave the clavicle with the former. SECTION II. Oftlie Muscles qftlie Shoulder. 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. 1. The Deltoides is situated just beneath the skin, and MUSCLES. 315 forms the cushion, which protects and gives rotundity to the shoulder joint. It arises from the inferior edge of the whole spine of the scapula, from the circumference of the acromion process, and from the exterior third of the cla- vicle. Its origin, for the most part, is tendinous and fleshy mixed ; but at its posterior part it is entirely tendinous. It is inserted by a tendinous point, into the triangular rough surface on the outer side of the os humeri, near its middle. Its general coníiguration is triangular, and, when spread out, its upper margin being opposed to the inser- tion of the trapezius, is much more extensive than one would suppose. Its fibres do not converge regularly to its insertion like the radii of a circle; but the whole muscle is divided into several parts, between which, the interposi- tion of intermuscular tendons affects 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-brachialis. Its in- sertion is between the triceps extensor and the biceps flexor, ancf above the origin of the brachialis internus. It raises the os humeri to a horizontal line with the acromion. Between the superior edge of the deltoid, the acromion process, and the subjacent tendons on the top ofthe articu- lation, there is a large Bursa Mucosa, which is sometimes partitioned off into two. The deltoid should now be detached from its origin and thrown down, in which a good view of the other muscles will be obtained. 2. The Supra-Spinatus Scapulíe, arises fleshy from the whole fossa supra-spinata, wfíich it filis up, and from its margins. Forwards it terminates in a thick robust tendón, closely connected with the capsular ligament of the joint, and which passes under the jugum formed by the articula- don of the acromion with the clavicle. It is inserted, tendinously, into the inner face ofthe great tuberosity of the os humeri. It raises the arm, and turns it outwards. 316 OF the upper extremities. 3. The Infra-Spinatus Scapula, arises fleshy, from all that portion of the dorsum scapulas below its spine, from the spine as far as the cervix, and from the several margins of the fossa infra-spinata. Its fibres pass obliquely to a mid- dle tendón, which adheres closely to the capsular ligament, and goes under the projection of the acromion. This tendón is inserted into the middle facet of the greater tuberosity ofthe os humeri. The infra-spinatus rolls the os humeri outwards and back- wards. There is a bursa between its tendón and the scapula. 4. The Teres Minor, is situated at the inferior margin of the infra-spinatus, in the fossa of the inferior costa scapu- las, and looks very much like a part of the infra-spinatus, to which it occasionally adheres so closely, as to be sepa- rated with difficulty. It arises fleshy, from the whole of the fossa, and from the margins of the inferior costa, in the space from the cervix of the.bone, to within an inch or so of its inferor angle. It is inserted, tendinous and fleshy, into the outer facet of the great tuberosity of the os humeri, just below the in- fra-spinatus. ' • It draws the os humeri 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 posterior surface of the angle of the scapula, and from a small part of its in- ferior costa; the interstice between it and the teres minor is considerable. It is inserted by a broad tendón, into the internal ridge ofthe groove ofthe os humeri, along with the tendón ofthe latissimus dorsi. Their tendons at first, are closely united, but afterwards there is an intermediate cavity lubricated with synovia. The tendón of the latissimus dorsi is ante- rior, and the lower edge of the teres extends further down the arm, than that of the other. It rolls the os humeri inwards, and draws it downwards and backwards. 6. The Subscapularis, occupies all the thoracic surface MUSCLES. 317 ofthe scapula, being between it and the serratus major an* ticus. It arises fleshy from the whole base, superior and inferior costa, and costal surface of the scapula; it is di- vided into several columns which look somewhat like dis- tinct muscles, but which all terminate, in a thick robust ten- don, that adheres to the inferior surface of the capsular liga- ment. This tendón is inserted into the lesser tuberosity ofthe os humeri. The subscapularis rolls the bone inwards and draws it downwards. Between it and the neck of the sca- pula, there is a bursa, which, as mentioned, communicates with the articulation. SECTION III. Of the Muscles of the Arm. The Muscles of the Arm are five in number, three ante- rior, and two posterior. 1. The Bíceps Flexor Cubiti, is situated immediately beneath the fascia and integuments, and forms the swell so obvious in the middle front part of the arm. It arises by two heads. The first called the long, is a round tendón, which comes from the superior extremity of the glenoid cavity ofthe scapula, passes through the shoulde^; joint, and through the groove of the os humeri; the secbíjíf or short head arises, tendinously, from the extremity of thj»? coracoid process ofthe scapula, in company with the coraco-brachia- lis 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 connected by loóse cellular substance, but about half-way down the arm, they are inseparably united. The biceps terminates below in a flattened oval tendón, and passes in front of the elbow joint, to be inserted into the posterior rough part of the tubercle of the radius. A bursa mucosa is placed between the tendón and the front of the tubercle, the surface of the latter being covered with carti- 318 OF THE UPPER EXTREMITIES. lage. From the ulnar side of this tendón, 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 latissimus dorsi and pecto- ralis major, where it is bound down by strong ligamentous fibres. The tendón 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 on the upper inter- nal side of the arm, at the inner edge of the short head of the biceps muscle, with which it is connected for three or four inches. It arises tendinously and fleshy, from the middle facet 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 internal side of the middle of the os humeri, by a rough ridge, just be- low the tendons of the latissimus dorsi, and teres major, and in front of the brachialis externus, or third head of the triceps. From the lower end of this muscle there proceeds to the internal condyle of the os humeri, an intermuscular ligament, which separates the brachialis internus, from the third head ofthe triceps. This muscle draws the arm upwards and forwards. 3. The Brachialis Internus, is situated immediately be- neath the biceps, and is concealed'by it, excepting the outer edge. It has a bifurcated fleshy origin from the mid- dle front face of the os humeri, on each side of the inser- tion 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 distance of its articular surface. It is inserted by a strong short tendón, into the rough surface at the root of the coronoid process of the ulna. A bursa sometimes exists between the tendón ofthe brachialis internus, that of the biceps, supinator brevis, and the elbow joint. The brachialis flexes the fore-arm, and by pass'ng in front of the elbow joint, strengthens the latter very much. MUSCLES. 319 Its lower part lies under the tendón of the biceps, and be- tween the pronator teres and the supinator longus. 4. The Tríceps Extensor Cubiti, forms the whole of the fleshy mass on the back of the arm; it therefore oc- .cupies the space between the integuments and the bone. It arises by three heads. The first, called Longus, comes, by a flattened tendón, from a rough ridge on the inferior edge of the cervix scapulas. The second, called the Brevis, arises, by a sharp, tendinous 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 Exter- nus, arises, by an acute fleshy beginning, from the inner side ofthe os humeri, near the insertion of the teres major. This muscle, both at its external and internal edge, is sepa- rated from the muscles in the front of the arm, by the inter- muscular 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, is occupied by the origin of the triceps. The muscular fibres run in various directions ac- cording to their respective heads and places of origin. At the inferior end of the muscle is found a broad tendón, which covers its posterior face. This tendón 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 ofthe os humeri, buttheinterstices between them, may be observed much lower down. There is a bursa between the tendón, and the olecranon process; besides which, there is sometimes another on each side of the first. Connected with the last, is a muscle which should be dis- sected at the same time, as it has corresponding functions, and looks very much like an appendage of the triceps; it is the 5. Anconeus. This is a small triangular muscle just be- neath the skin, at the outer posterior part of the elbow joint. It arises tendinous from the posterior lower part of the exter- nal condyle of the os humeri, adheres to the capsular liga- 320 OF THE UPPER EXTREMITIES. ment of the joint, and is partly covered by the tendón 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 filis up the triangular depression found there. It extends the fore-arm.> SECTION IV. Ofthe Muscles ofthe Fore-Arm. There are eight muscles on the front of the Fore-Arm, which arise from the inner condyle ofthe os humeri, and from the ridge leading to it, and are, either directly or indirectly, Flexors of the fore-arm and hand. This fact should be im- pressed on the mind of the student, as it simplifies much the act of committing them to memory. The systematic treatises of anatomy describe the origin of each 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 connected to contiguous heads, by adhe- sión 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 insu- Of the eight muscles situated on the front of the fore-arm, some are superficial and others deep-seated. 1. The Pronator Radii Teres, is just beneath the fascia ofthe 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 os humeri, and tendinous from the coronoid process of the ulna. It passes very obliquely across the fore-arm at the internal edge of the brachialis internus muscle and is Inserted, tendinous and fleshy, into the external back part ofthe radius just below the insertion of the supinator MUSCLES. 321 radii brevis, occupying thereby about two inches oí the middle of the bone. It rolls the hand inwards. 2. The Flexor Manus vel Carpí Radialis, is placed at the ulnar side of the last muscle, and is also superficial. It arises by a narrow tendón, from the lower front part of the internal condyle of the os humeri; fleshy from the in- termuscular ligaments, the brachial fascia, and the upper part of the ulna. It forms a thick, fleshy belly, terminating below in a tendón, 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 metacarpal bone of the fore-finger, in front, and there is a bursa between the lower extremity of its tendón and the trapezium. The tendón is there held down by ligamentous fibres. It bends the hand and draws it towards the radius. 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 tendón, and arises by a small tendón from the in- ternal condyle, and fleshy from the intermuscular ligament on each of its sides. It is inserted, tendinous, into the upper margin of the ligamentum carpi annulare anterius, near the root of the thumb, and a división of its tendón passes on to the aponeurosis palmaris. It bends the hand, and makes tense the palmar aponeu- rosis. 4. The Flexor Manus vel Carpí Ulnaris, occupies among the superficial muscles, the ulnar side of the fore- arm. It arises tendinous, from the internal condyle of the os humeri; fleshy, from the upper internal side of the ole- cranon, and by a tendinous expansión which is part of the fascia ofthe fore-arm, from the ridge at the internal sideof the ulna, to within three or four inches of the wrist. It is inserted into the upper side of the os pisiforme by a round tendón, which begins high upatthe radial margin of the muscle, and into which the muscular fibres run. Some- 21 322 OF THE UPPER EXTREMITIES. times the tendón is continued over the os pisiforme, so as to be likewise inserted into the base ofthe metacarpal bone of the little finger. There is a loóse bursa at the junction ofthe tendón with the pisiforme bone. It bends the hand and draws it towards the ulna. Fio. 62. 3 A View of the Outer Layer of the Mus. cles on the Front of the Fore-Arm (Flexors.) 1. Lower portion ofthe Biceps Flexor Cubiti. 2. Brachialis Internus. 3. Lower Internal portion of the Triceps. 4. Pronator Radii Teres. 5. Flexor Carpi Radialis. 6. Palmaris Longus. 7. Part of the Flexor Sublimis Digitorura. 8. Flexor Carpi Ulnaris. 9. Palmar Fascia. 10. Palmaris Brevis Muscle. 11. Abductor Pollicis Manus. 12. Portion ofthe Flexor Brevis Pollicis Manus. The Line crosses the Adductor Pollicis. 13. Supinator Longus. 14. Extensor Ossis Metacarpi Pollicis. 5. The Flexor Digitorum Sublimis PerforatUs, is Concealed very much by the muscles just enumerated 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 ofthe os humeri; tendinous from the coro- noid process of the ulna, and fleshy, from the tubercle of the radius; the latter partof its origin being extended obliquely MUSCLES. 323 tendinous, for three or four inches along that line of the radius which is at the insertion of the pronator teres. With these origins, the muscle spreads over the front of the fore- arm at its upper part, from the racñal to the ulnar margin. From the lower end of the muscle, arise four distinct tendons, which commence much above the wrist, go beneath its anterior ligament, and having reached the palm of the hand, diverge to the several fingers. To each finger, a tendón is appropriated, which passes in front of the meta- carpal bone to the phalanges, and after having split into two, is inserted into the angle formed by the junction of the cylindrical and flat surfaces of the second phalanx, near the middle. 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 Perforans, is beneath the flexor sublimis and the flexor ulnaris. It arises fleshy from the oblong concavity ofthe ulna between the coronoid and the olecranon processes ; fleshy from the lower margin of the base of the coronoid process; from the ulnar portion of the .interosseous ligament; and from the front ofthe upper two-thirds ofthe ulna. The tendons of this muscle are difTerent from those of the other; they commence in front of it, like a tendinous mem- brane, which is gradually divided into several fasciculi, ad- hering to each other by cellular membrane. 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 each ofthe fingers. Each tendón, going in front of its metacarpal bone and ofthe corresponding phalanges, gets through the slit in the flexor sublimis, and is inserted into the front part of the base of the third phalanx of the finger. It bends the last joint of the fingers, and by increased action, may flex the hand like the preceding muscle. 7. The Flexor Loivgus Pollicis lies in front of the radius, but beneath the flexor sublimis. It arises, by an acute fleshy beginning, from the radius just below its tuber- cle ; also, fleshy, from the middle two-thirds of the front of 324 OF THE UPPER EXTREMITY. the bone, and from the radial portion of the interosseous ligament. The body of the muscle is joined by a small fleshy slip, having a tendinous origin from the internal condyle of the os humeri. On the ulnar margin of this muscle a tendón is formed early, to which the fibres pass obliquely. This tendón goes under the annular ligament of the wrist, through the fossa formed in the short flexor muscle of the thumb, and be- tween the sesamoid bones, to be inserted into the base of the second phalanx of the thumb. From the inferior end of the fore-arm, to the middle of the first phalanx, the ten- don is invested by its appropriate bursa. It bends the last joint ofthe thumb. Fig. 63. A View of the Under Layer of Mus- cles on the Front of the Fore-Arm (Flexors.) 1. Internal Lateral Ligament of the Elbow- Joint. 2. Capsular Ligament of the Elbow-Joint. 3. Coronary Ligament of the Head of the Radius. 4. Flexor Profundns DigitorumPerforans. 5. Flexor Longus Pollicis. 6. Pronator Quadratus. 7. Adductor Pollicis Manus. 8. Lumbricales. 9. Interossei. MUSCLES. 325 While performing this dissection, there are several minu- tias which deserve attention. The Annular Ligament of the wrrist in front, is a very strong membrane passing across the carpus, from the projection of the scaphoides and tra- pezium on the radial side of the wrist, to the unciform pro- cess on the ulnar side, and to the cuneiform and pisiform bones. Between it and the concavity of the carpus, an oval foramen is formed for transmitting the tendons of the several flexors. These tendons as they pass under the anterior annular li- gament of the wrist are surrounded by the superior Bursa Mucosa. It begins about an inch and a half above the ra- dio-carpal articulation, and extends to the lower margin of the annular ligament. It adheres to its circumference to this ligament, and to the capsule of the joint; within, it sends in a considerable number of processes, whereby each tendón is surrounded and connected to the adjoining tendons; while, at the same time, no restraint is put upon the natural motions of the part. In its texture this bursa resembles a dense elastic cellular membrane. In addition to this, the flexor tendons as they pass from the root, to the extremity of each finger, are surrounded by a synovial bursa, which by its secretion continually lubricates them, and permits them to play freely backwards and forwards, according to the flexions and extensions of the fingers. These mucous or synovial sheaths, begin a little distance above the first joint of the finger, adhere there to both flexor tendons, and extend to about the middle of the last phalanx. They give to the tendons a very polished lubricated surface; are re- flected over the anterior flat faces of the phalanges, being separated from them by a small quantity of adipose matter; are also reflected over the anterior faces of the capsular ligaments, and line the vaginal ligaments. The Vaginal Ligaments ofthe fingers (Ligamenta Vagi- nalia) bind down the flexor tendons, and keep them applied to the fronts of the phalanges. They are of the same ex- tent from above downwards, with the mucous sheaths just mentioned, and are stretched between the ulnar, and the radial margins of the phalanges. The fibres of which they consist, pass for the most part transversely, and are of a fibro-cartilaginous character. These fibres diminish in 326 OF the upper extremities. number towards the end of each finger, and are stronger on the fore finger than on any of the others. In front of the first joints, or metacarpo-phalangial articulations, and the pha- langial articulations, the vaginal ligaments are much thinner than elsewhere, in order to permit the free flexión of the fingers. The structure indeed, at these points is decidedly marked off by its diminished thickness; and though the course of the fibres is the same from side to side, yet some anatomists have thought it worth while to designate it par- ticularly under the ñame of Annuli Juncturarum Ligamen- tosi. Within the Vaginal Ligaments, small tendinous frasna arise from the first and second phalanges; they vary in number in different individuáis, and run obliquely for- wards, some to terminate in the flexor profundus ten- dons, and others in those of the flexor sublimis: they are called Vincula Accessoria, and are covered by a reflection of the synovial sheath. Indeed, they seem to be formed almost entirely from the latter. We may also observe that in front of each joint, in- dependentíy of the swelling of the articular extremities of the bones, the capsular ligament is thickened by an addi- tion 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 tendons farther 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 mus- cles and the bone. In the adult it is 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 extremity, and from the front of the bone. It is inserted into the corresponding front surface of the radius. It rotates the radius inwards. MUSCLES. 327 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 thumb. Their origins are less blended with each other than those of the flexor muscles, nevertheless between se- veral of them, there are intermuscular ligaments which con- nect 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 integu- ments. 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 outer head of the triceps. It forms a thick, fleshy belly, consti- tuting the external margin ofthe arm about the elbow joint, and terminates near the middle of the radius, in «a flat tendón. It is inserted by the latter, into a small rough ridge on the outer side of the radius, just above its styloid process. It rolls the radius outwards. 2. The Extensor Carpí Radialis Longior, is situated beneath the former muscle. It arises, tendinous and fleshy, from the space of the external ridge of the os humeri be- tween the supinator longus and the external condyle. It forms a short, fleshy belly, which terminates in a flat tendón above the middle of the radius. It is inserted, by this tendón into the posterior part ofthe root of the metacarpal bone of the fore-finger near the thumb. The tendón of this muscle is surrounded by a synovial sheath, at the place where it passes the lower end of the ra- dius, under the posterior carpal ligament. Another bursa also exists at the insertion; which, on one occasion, I found so much enlarged in a young woman, as to require its extir- pation. The operation was fully successful. It extends the hand. 328 OF THE UPPER EXTREMITIES. 3. The Extensor Carpí 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, and which terminates in a flat tendón about the middle of that bone. Its tendón, becoming rounded, is inserted into the poste- rior part of the base of the metacarpal bone of the second finger. It extends the hand. 4. TheExTENSOR Carpí Ulnarisís superficial, and placed principally parallel with the ulna. It arises, tendinous, from the external condyle, and fleshy, from the intermuscular ligament and inside of the fascia. 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 ter- minate obliquely in a tendón which goes through the groove of the ulna, and is there furnished with a bursa. It is inserted, by its tendón, 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 superficial, being placed between the extensor ulnaris and the extensor radialis brevior. It arises, tendinous, from the external con- dyle, and fleshy, from the intermuscular 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 ofthe radius. On the back ofthe hand these tendons diverge, and near the roots of the fingers send cross slips to each other. Each tendón 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 precise mode of the insertion of these tendons, is as follows: on the back of the first phalanx, the latera] margins of these tendons, are joined by the ten- dons of the lumbricales and interossei, and the tendinous membrane thus formed, simply adheres by condensed cellular membrane, to the whole back: of the first phalanx; the mid- MUSCLES. 329 dle part of this tendón then passes on, to be inserted near the articular margin of the base of the second phalanx, and the two lateral parts of the tendinous membrane, after keep- ing sepárate for some distance, unite and are jointly inserted into the back of the base of the third phalanx. Fig. 64. A View of the Outer Layer of Mus- cles on the Back of the Fore-Arm (Extensors.) 1. Lower portion of the Biceps Flexor. 2. Part ofthe Brachialis Internus. 3. Lower part of the Triceps Extensor. 4. Supinator Radii Longus. 5. Extensor Carpi Radialis Longior. 6. Extensor CarpiRidialis Brevior. 7. Tendinous Insertions of these two Mus. cíes. 8. Extensor Communis Digitorum. 9. Portion ofthe Extensor Communis Digi- torum called Auricularis. 10. Extensor Carpi Ulnaris. 11. Anconeus. 12. Portion ofthe Flexor Carpi Ulnaris. 13. Extensor Minor PoliicÍ3. The Muscle nearest the Figure is the Extensor Ossis Metacarpi Pollicis. 14. Extensor Major Pollicis. 15. Posterior Annular Ligament. The dis- tribution of the Tendons of the Ex- tensor Communis, is seen on the backs ofthe fingers. The section of this muscle appropriated to the little finger has a distinct appearance, and frequently its tendón goes through a distict fossa in the radius, from which causes it has obtained the ñame of Auricularis. A bursa invests these tendons at the wrist, as they pass through their groove, and is single above; but in following the course ofthe tendons, like them it divides, and follows each tendón respectively to the base of the first phalanx. 330 OF THE UPPER EXTREMITIES. This muscle extends all the joints of the fingers, being the antagonist of the flexors. 6. The Supinator Radií Brevis, can only be well seen by detaching the origins ofthe aforesaid muscles; it will then be found in contact with the radius, making a cióse in- vestment of its head and upper third. It arises, tendinous, from the external condyle of the os humeri, and tendinous and fleshy, from the ridge which descends from the coro- noid process, on the posterior radial edge of the ulna. 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 ofthe pronator teres. At the interstice between the radius and ulna, near the anterior edge of this muscle, a fleshy slip is occasionally seen, which passes from the radial side ofthe coronoid process to the ulnar edge ofthe 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 interosseous ligament, and from the back part of the radius just below the insertion of the supinator brevis. It terminates in a round tendón, which passes over the tendons of the radial extensors, and through a groove on the styloid side of the lowTer end of the radius, and is there invested by a bursa. It is inserted, by its tendón, inlo the base of the meta- carpal bone ofthe thumb, and into the external side ofthe trapezium. It extends the metacarpal bone ofthe thumb. 8. The Extensor Minor Pollicis Manus, is at the ulnar side of the last muscle. It arises, tendinous, from the back ofthe ulna below its middle, and fleshy from the interosse- ous ligament. It adheres to the radius, and terminates in a tendón which passes through a groove in the styloid side ofthe radius along with the last named muscle. It is inserted into the first phalanx of the thumb by its MUSCLES. 331 tendón, which is extended to the root of the second pha- lanx. 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; also from the back of the radius; it terminates near the wrist in a tendón, which passes through a groove on the back ofthe radius near the ulna. The belly of this muscle conceals, very much, the other extensors of the thumb. It is inserted, by its tendón, into the oblong transverse tubercle on the back of the base of the second phalanx of the thumb. Its tendón is furnished with one synovial sheath at the inferior extremity of the radius, which extends to the carpus; and another, which is smaller and placed upon the carpus and upon the base of the first metacarpal bone. It extends the second phalanx. The tendons ofthe last two muscles are much connected with each other, and are spread in the form of a membrane on the back ofthe thumb, after the manner ofthe 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 con- tiguous part of the interosseous ligament. It terminates in a tendón, which goes through the same fossa with the ex- tensor communis; it afterwards is joined, about the head of the first phalanx, to the tendón of the common extensor belonging to the fore-finger. With the tendón ofthe extensor communis, it is inserted along the back of the fore-finger to the base of the third phalanx. Ii 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 inches in 332 OF THE UPPER EXTREMITIES. breadth, and seems to be a continuation ofthe fascia ofthe 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 springino- out of their respective grooves. It forms one jugum for the first two extensors of the thumb, another for the radial extensors of the hand, a third for the tendón of the third extensor of the thumb, a fourth for the indicator and ex- tensor 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 Aponeurosis Palmaris. This is a triangular tendinous membrane which covers all the hollow ofthe 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 bifur- cates, to allow the flexor tendons to pass to the fingers, and is united to the contiguous sections by transverse bands or frasna. The muscles of the 1ball of the thumb and of the little finger, are covered by a thin membrane extended from the lateral margins of this aponeurosis. The Palmaris Brevis, is apt to be cut away unconscious- ly; it is just below the skin at the inner side of the hand. It consists of sepárate 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 margin of the hand, and covers the muscles ofthe little finger. It contraéis the skin ofthe hand. The Aponeurosis Palmaris being removed, a good view is obtained of the long flexor tendons and many of the small muscles ofthe 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 MUSCLES. 333 of the flexor profundus, beneath the ligamentum carpi annulare, and a little beyond its anterior edge. They terminate in little flat tendons which run along the outer or radial edges of the fingers, and are inserted into the tendinous expansión on the back ofthe first phalanx of each finger, about its middle. They bend the first phalanges. Four muscles constitute the ball ofthe thumb. 1. The Abductor Pollicis Manus, arises tendinous and fleshy, from the anterior surface of the ligamentum 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 abductor, 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 liga- ment. 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 beneath the abductor pollicis and at the ulnar side ofthe opponens pol- licis. A groove is formed in it by the tendón ofthe flexor longus pollicis, which divides it into two heads. The first head arises, fleshy, from the points of the tra- pezium, trapezoides, and from the contiguous part ofthe internal surface of the annular ligament, and is inserted into the outer sesamoid bone; the sesamoid bone, like apatella, being connected to the first phalanx of the thumb by tendón. The second or internal head, arises fleshy, from the magnum and unciforme, near their metacarpal surfaces, and from the base of the metacarpal bone of the middle 334 OF the upper extremities. 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 ñame implies, bends the first joint ofthe thumb. 4. The Abductor Pollicis Manus, lies in the palm of the hand beneath the lumbricales and the tendons of the flexor sublimis and profundus. It arises, fleshy, from the ulnar edge of the metacarpal bone of the middle 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 pulís 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 ten- dinous from the trapezium, and fleshy from the ulnar edge ofthe metacarpal bone ofthe thumb, between its base and head. Being placed along the side of the metacarpal bone of the fore-finger, it is inserted, by a short tendón, 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 protuberance on the internal side of the os pisitbrme, and from the contiguous parts ofthe annular ligament. It is inserted, tendinous, into the ulnar side of the first phalanx of the little finger, and into the tendinous mem- brane which covers its back part. It draws the little finger from the rest. 2. The Flexor Parvus Minimi Digiti Manus, is beneath the abductor. It arises fleshy, from the unciform process muscles. 335 of the os unciforme, and from the contiguous part 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 tendón of the abductor, and with the tendinous mem- brane expanded over the back ofthe finger. It bends the little finger. A View of the Muscles on the Palm of the Hand. Fig. 65. l. 2.2. 3. 4.5. 6. 7.7. Annular Ligament. Origin and Insertion of the Abductor Pollicis. Opponens Pollicis. Two B llies ofthe Flexor Brevis Pollicis. Adductor Pollicis. Lumbricales arising from Tendons of tKe Flexor Profundus Digitorum. Shows how the Tendón of the Flexor Profun- dus pass thmugh the Flexor Sublimis. Tendón of i he Flexor Lon- gus Pollicis. Abduc'or Minimi Di»i*i. Flexor Parvus Minimi Di- gni. 12. Pisiíorm Bone. 13. First Dorsal Interos eous Muscle. 3. 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 ofthe annular ligament ofthe 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- 336 OF THE UPPER EXTREMITIES. wards the others, 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 on the palm, and three on the back of the hand. The back ones arise by double heads from the contiguous sides of two metacarpal bones; the palmar ones have each a single head only, which comes from the metacarpal bone of the finger, which each 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 ofthe meta- carpal bones, and to be inserted tendinous, into the sides of the first phalanges, and into the tendinous membrane on the backs of the fingers, derived from the tendons of the extensor communis. The first four are very deeply seated, on the palm of the hand, but the three others are on the back. 1. The Prior Indicis, is along the radial side of the first metacarpal bone, or that of the first finger, and arises from the base and side of the same. It is inserted, tendinous, into the radial side of the first phalanx of the fore-finger. It draws the fore-finger towards the thumb. 2. The Posterior Indicis, is at the ulnar side of the first digital 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-finorer. It draws the fore-finger towards the others. 3. The Prior Annularis, is at the radial side of the me- tacarpal bone of the third or ring finger, and arises from the base and radial side of the said bone. It is inserted, tendinous, into the radial side of the first phalanx ofthe ring finger. It draws that finger towards the thumb. 4. The Interosseous Digiti Auricularis, is at the ra- dial side of the metacarpal bone of the little finger, and arises from the radial side and base of said bone. MUSCLES. 337 It is inserted, tendinous, into the radial side of the first phalanx of the same finger. It draws the little finger towards the others. Byremoving the tendons ofthe 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 finger, and 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 metacarpal bones of the middle and ring fingers, and 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. It draws the middle finger towards the little one. 7. The Posterior Annularis, is between the metacarpal bones of the ring and little finger, and arises from the op- posed 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. 22 338 OF the upper extremities. SECTION V. 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 scaleni 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 Artery, (Arteria Axillaris,) and its position is under the tendinous insertion of the pec- toralis minor, and almost touching it; it then passes, at the internal inferior part of the head of the humerus, parallel with, and bordering on, the internal edge of the coraco- brachialis muscle. At the posterior fold of the arm-pit, it is placed very near the tendón of the latissimus dorsi, be- tween it and the coraco-brachialis. Emerging from the axilla at this place, its ñame is changed into that of Bra- chial Artery, (Arteria Brachialis.) The Arteria Brachialis descends the arm, at the inter- nal margin of the lower part of the coraco-brachialis, 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 tendón of the biceps, and passes under its aponeurosis ; and a little below the joint it generally splits into two branches of nearly equal magnitude, the Radial and the Ulnar Artery, although occasionally this división occurs much higher up the arm, as hereafter stated. The relative situation of this great artery with the nerves and veins of the part, should be closely observed. Between the scaleni muscles, the majority of the nerves forming af- terwards the axillary plexus, is above and somewhat poste- rior to the subclavian artery ; but when this artery becomes blood-vessels. 339 axillary, the nerves unite in various combinations, and sur- round it like so many cords of a platted whip-thong. The axillary vein is below and somewhat in front ofthe artery, and very near it. These several parts are united by a loóse vascular, adipose and cellular membrane, containing many lymphatic glands. 1. The Arteria Dorsalis Superior Scapula, varies much in its origin; it comes sometimes from the subclavian, and on other occasions from the upper part of the axillary. Not unfrequently it is a branch ofthe 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 opera- tion, 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 com- pletely 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, near the coracoid process, and there divides into branches supplying the supra-spinatus muscle, the infra- spinatus, and the parts contiguous to the shoulder-joint. 2. The Arteria Mammari^ Externje, arise from the axillary between the subclavius and the pectoralis minor muscles. 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 ofthe pec- toralis 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 of the female, and integu- ments. c. Thoracica Acromialis, making for the fissure between 340 OF THE UPPER EXTREMITIES. the deltoid and great pectoral muscle, and distributed to them along the margins of this fissure, upwards and down- wards. 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 ofthe serratus major anticus, and distributed to it and adjacent muscles by branches coming off at right angles. 3. The Scapularis (Sub-Scapularis) arises from the axillary artery about the anterior margin of the sub-scapu- laris muscle. It passes downwards towards the angle of the scapula, in contact with this muscle, and is distributed to the teres major and minor, sub-scapularis and latissimus dorsi muscles. A little below the neck of the scapula, a large trunk, the Dorsalis Inferior Scapula?, arises from the scapularis, and winds around the bone to be distributed to the infra-spinatus and the contiguous muscles, an anastomosis being formed under the neck of the acromion process, between the dorsalis inferior and superior scapulae. 4. The Circumflexa Anterior, is a small artery about the size of a crow-quill. It arises from the axillary, just above the superior or posterior margin ofthe tendón ofthe teres major and latissimus dorsi. It adheres elosely to and surrounds half the os humeri, just below its head, going between the bone and the coraco-brachialis and biceps muscles, to be distributed to the articulation and to the con- tiguous muscles. 5. The Circumflexa Posterior is much larger, and arises from the axillary about the same place with the last, but commonly a little below; sometimes they have a com- mon 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 musclesj especially the deltoid. blood-vessels. 341 6. The Profunda Major Humeri or Spiralis, arises from the great artery ofthe upper extremity, justbelow the tendón of the teres major, where the artery is called Brachial or Humeral. It passes downwards a little distance, 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 supinator longus; it reaches to the external con- dyle. 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 circum- flex artery. 7. The Profunda Minor is uncertain in its origin, but comes commonly from the Brachial, two inches below the last; sometimes it is a branch of the last. It is distributed on the internal surface of the triceps extensor, and extends to the internal condyle. 8. The Nutritia, is a very'small branch from the hume- ral, arising near the medullary foramen of the os humeri, which it penetrates, and is distributed to the lining mem- brane of the bone. It is not larger than a knitting needle. ■ 9. The Anastomotica is a small branch from the hume- ral, 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 ofthe internal condyle, to the groove between the condyle and the olecranon process, where it anasto- moses with a recurrent branch of the ulnar artery. Several arterioles are also sent from the brachial artery, to the biceps, brachialis, triceps, and coraco-brachialis, which are too irregular and too small to deserve description. The Brachial Artery it has been stated, is divided a little below the elbow joint into two principal trunks, Radial and Ulnar. Sometimes this división is on a line with the joint; at other times it occurs nearer the insertion of the brachialis muscle. The división, however, does 342 OF THE UPPER EXTREMITIES. occasionally occur, in all the space between the axilla and the elbow joint, in which case the radial artery sometimes is just beneath the skin at the elbow, and continúes un- commonly superficial to the wrist. The Radial Artery (Arteria Radialis,) is smaller than the ulnar and extends from the elbow to the hand. In the early part of its course, it is at the bottom of the fissure, be- tween the pronator teres and the supinator radii longus; afterwards it crosses the insertion of the former, runs parallel with, and in front of the radius to the wrist, betwreen the tendons of the supinator longus and of the flexor carpi radi- alis. Belowr the styloid process it gets between the carpus and the extensors ofthe thumb, runs a little distance on the radial side of the back of the hand, and then penetrates to the palm between the base of the metacarpal bone 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 collateral branches, to the joint and contiguous muscles. 2. Several small and irregular muscular branches, arise from the Radial artery in its progress to the wrist; they have no appropriated ñames. 3. The Superficialis Volíe, 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 ofthe ball ofthe thumb, and one of its terminating branches joins the arcus sublimis. Sometimes the super- ficialis volse, is the principal branch of the radial. 4. The Dorsalis Carpí arises from the radial, 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 branches from the ulnar, and interosseous arteries of the fore-arm. blood-vessels. 343 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 go along the sides of the thumb, to its extremity; where they anastomose and termi- nate. 6. The Radialis Indicis, arising at the same place with the latter, runs along the metacarpal bone of the fore-finger, and along the radial side of the same finger to its extremity. 7. The Palmaris Profunda, is the third terminating branch of the radial artery. It arises near the same place with the last two; crosses the hand between the metacarpal bones and the flexor tendons, thus forming the Arcus Pro- fundus, from which branches proceed to the interossei mus- cles, 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 between the flexor sublimis and profundus; getting from beneath the flexor sublimis, it after- wards runs parallel with the ulna or nearly so, lying on the flexor profundus, between the flexor ulnaris and the ulnar margin of the flexor sublimis, and concealed two-thirds of the way down the fore-arm, by the overlapping of these mus- cles. At the thin part of the fore-arm, commonly called the wrist, it is superficial, and may be felt pulsating in the living body at the radial margin of the tendón of the flexor ulnaris. The ulnar artery, at the carpus, takes a very different course from the radial, for it passes over the anterior annular ligament of the carpus, just at the radial side of the os pisi- forme, to which it is heldby a small ligamentous noose, and . then proceeds to the palm of the hand. Between the apo- neurosis palmaris and the flexor tendons, it forms that curve from the ulnar to the radial side ofthe hand, called the Arcus Sublimis. This curve commonly begins a little beyond the anterior margin of the annular ligament, and presenting its 344 OF THE UPPER EXTREMITIES. convexity forwards, terminates about the middle of the ball ofthe thumb, at its inner margin. The branches sent from the Ulnar artery, are as follow: 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 ramuscules goes between the internal condyle and the olecranon process, to anasto- mose with the arteria anastomotica of the humeral. » 2. The Interossea, arises from the ulna just belowT the other. It is a large trunk, and proceeds but a little dis- tance, when it divides into two principal branches called Anterior and Posterior Interosseal arteries. 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 branches to the deep- seated muscles of the fore-arm in its course. Under the pronator it perforates the interosseous ligament, and dis- tributes 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 sepárate trunk, arising from the ulnar just above the former. 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, (Recurrens Interossea) to the back of the elbow, which anastomoses with the recurrens ulnaris 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, reach the wrist, and anastomose with the carpal arteries. 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 re- quire description. 4. The Dorsalis Manus, leaves the ulnar at the lower blood-vessels. 345 end of the fore-arm, and passes under the tendón of the flexor ulnaris to the back of the hand. It there meets ra- muscles of the radial and interosseous, and conjointly they supply, with very small branches, the back of the wrist, of the metcarpus, and of the fingers. 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 farther on, a consi- derable branch, which divides 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 Ma- nus Profunda of Haller. 6. The Arcus Sublimis then sends a branch to the ulnar side of the little finger. Afterwards in succession, three di- gital branches are sent off, which arriving at the interstices between the heads of the metacarpal bones, each divides into two branches, to supply the sides of the fingers which are opposite to each other; one branch is called Digito-radial, the other Digito-ulnar, according to the side of the finger on which the artery may be placed. The Digital Arteries before they divide, receive each a small branch from the arcus profundus. The digito-radial and ulnar arteries, pass along the front sides of the fingers to their extremities; and at the joints and extremities, anas- tomoses between the arteries of the two sides of the same finger, occur. The Arcus Sublimis terminates on the radial side of the palm by a branch which joins the artery of the thumb, coming from the radial. The most frequent distribution of the arteries of the hand is what has been just described; anatomists are, however, not at all agreed on this point. It would probably be more just to say, that this occurs oftener than any other single ar- rangement. The variety, in fact, is so great, that before a hand is opened it is not possible to know in what manner its arteries are distributed. Sometimes the Radial Artery furnishes one-half of the arcus sublimis, and the Ulnar the other half. On other occasions the interosseous artery, or the superficialis vola?, is continued as a large trunk over 346 of the upper extremities. the ligament of the wrist, and across the root of the thumb to join the arcus sublimis. OF THE VEIXS OF TIIE UPPER EXTREMITIES. These Veins are abundantly supplied with valves, and are superficial and deep-seated; the former lying beneath the skin, have original ñames ; the latter attending the arteries on all occasions, are called after them. Anastomoses are numerous in both sets, but are particularly so in the su- perficial, 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, another on its ulnar, and the third between the two. 1. The Vena Cephalica, first arises about the root of the thumb and fore-finger on the back of the hand; a dis- tinct 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 margin 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 2. The Vena Basílica is larger than the Cephalic, and arises by several branches, from the back ofthe hand, prin- cipally on the ulnar side, one of which, placed between the metacarpal bone of the little finger and the ring finger, is called Vena Salvatella. From this origin, the basilic vein gets to the ulnar side of the fore-arm and continúes so, to the elbow joint, receiving on either side, anterior and poste- rior ulnar branches; itis then on the inner edge of the biceps muscle, and the pulsation of the brachial artery may be felt beneath it. It ascends 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. BLOOD-VESSELS. 347 This vein onthe 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 on the front of the fore-arm, which bifurcates three or four inches below the bend of the arm. One branch, the Me- diana Cephalica, joins the cephalic vein; the second, the Mediana Basilica, joins the basilic vein. The deep-seated Veins, called Venae Satellites or Comités, are found in company with every artery of the upper ex- tremity, there being for the most part, one vein to each side of the artery. They anastomose frequently by branches which cross the arteries. 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 ofthe superfi- cial veins. The trunk, formed by the unión 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 mus- cles. Sometimes it joins the basilic about the middle ofthe arm; on other occasions it joins it near, or in the axilla, from which unión results the axillary vein. The Vena Axillaris, receives the veins corresponding with the circumflex, scapular, and thoracic arteries, in their proper succession. It is fixed beneath the artery and very near it, in the same sheath of cellular substance. Under the clavicle it becomes Vena Subclavia; and as such, it passes between the clavicle and the first rib, at the inner side of the subclavian artery. It then leaves the artery to go in front of the scalenus anticus, whereas the artery goes be- tween this muscle and the scalenus medius. After crossing the first rib, it receives the superior dorsal vein of the scapula, the external jugular, and afterwards the internal jugular, be- sides several small veins from the skin and muscles of the neck. It terminates at the internal margin of the scalenus anticus in the Vena Innominata. 348 OF THE upper extremities. SECTION V. Of the Nerves of the Upper Extremities. The Brachial or Axillary Plexus, is formed by the junction ofthe four inferior cervical and the first dorsal nerve, and supplies the upper extremity by an appropriation of nearly the whole of their anterior branches, which are of consider- able magnitude, especially the three intermediate ones. These nerves come out between the anterior and the middle scalenus muscle, being situated above and posterior to the subclavian artery, at various heights, according to the origin of each nerve respectively. Almost immediately after dis- engaging themselves from the scaleni muscles, they com- mence the formation of the plexus, which surrounds the artery and continúes 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 bifurcates. It is under the various combinations of these different pri- mary divisions, that the axillary plexus is formed, from which the different nerves of the upper extremity proceed. This plexus, from its cióse connexion with the great artery, must, of course, go between the subclavius muscle and the first rib; and, in the upper part of the axilla, sepárate the axillary vein from the artery in some measure. The follow- ing branches 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 (or Supra Scapularis) is a small branch coming from the upper part of the plexus, commonly the fourth cervical nerve. It accompanies the arteria dorsalis scapulse superior, to the notch in the upper costa of the scapula, and is distributed to the muscles on the back of the scapula. 2. The Nervi Subscapulares of Bichat, are about three in number; they come also from the central parts of the nerves. 349 plexus, to be distributed upon the teres major, latissimus dorsi, and subscapularis. A View of the Brachial Plexus of Nerves and its Branches to the Arm. Fig. 66. 1.1. The Scalenus Anticus Muscle. 2.2. The Median Nerve. 3. The Ulnar Nerve. 4. The Branch to the Biceps Muscle. 5. The Thoracic Nerves. 6. The Phrenic Nerve, from the Third and Fourth Cervical. 3. 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 350 OF THE UPPER EXTREMITIES. being distributed upon the pectoralis major and minor, the latter upon the serratus major anticus. 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, between the teres minor and major, in order to get to the internal surface of the deltoid muscle, where it terminates. 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 ofthe shoulder and arm. 5. The Nervus Cutaneus Internus, proceeds from the lower part of the brachial plexus between the median and ulnar nerves, and follows the course of the basilic vein to the elbow or near it. In its descent, it detaches small cuta- neous filaments anteriorly to the integuments of the biceps, and posteriorly to those of the triceps. A little above the bend of the elbow, commonly where the median basilic joins the basilic vein, or occasionally some inches higher up, it divides into two terminating branches of nearly equal magnitude. The one next the internal condyle lies in front ofthe basilic vein, just atits junction with the median basilic, and continúes in front and parallel with it for some inches. It is distributed, by many ramifications, to the skin of the 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 cutaneous, passes beneath the median basilic vein about six lines from its junction with the basilic, and is distributed to the integu- ments on the middle front ofthe fore-arrn. Before this lat- ter branch reaches the median 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, is somewhat larger than the preceding and comes from the middle of the bra- chial plexus. It perforates obliquely the upper part of the coraco-brachialis muscle, to which it dispenses filaments, it then passes between the biceps and brachialis internus mus- cles, giving also filaments to both of them. Its course being NERVES. 351 remarkably oblique under the biceps muscle, it makes its appearance superficially, only a little above the elbow joint, near the external condyle. It then passes superficially be- tween the skin and the supinator radii longus muscle, dis- tributing filaments in its course, and near the lower part of the radius, divides into two orders of fibres, one of which is distributed on the palmar 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. 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 triceps muscle, running for some inches in contact with their intermuscular ligament. While beneath the triceps 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 external condyle. It continúes 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 proceed to the con- tiguous heads of the muscles. b. The Ramus Profundus Dorsalis, perforates the supina- tor brevis muscle, and gets beneath the radial extensors to the back of the fore-arm ; it is then distributed in numerous filaments to the muscles on the back of the fore-arm, some of its branches reaching to the wrist. c. The Ramus Superficialis Anterior, seems to be a con- tinuation of the main trunk of the nerve, and descending at 352 OF THE UPPER EXTREMITIES. the anterior margin of the supinator radii longus muscle, it joins with the radial artery and continúes in its company to a short distance below the middle of the radius. This position gives the whole nerve the ñame of radial. Here it crosses the bone obliquely, beneath the tendón of the supi- nator longus, and then divides into a palmar and a dorsal ramuscle; the first being distributed to the muscles and in- teguments 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. i 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 the cellular substance. As far as the elbow, it sends off no branch of importance. There, it lies at the side of the biceps tendón, crosses the lowrer part of the brachialis internus, and being beneath the aponeurosis of the biceps, it then perforates the pronator teres, and gets between the flexor sublimis digitorum, and the flexor longus pollicis, and enters the palm ofthe hand under the ligamentum carpi, at the radial edge of the tendons of the flexor sublimis. In the palm it is situated beneath the aponeurosis and the arcus sublimis. The Median Nerve dispenses the following branches: 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 be- low, it detaches the Nervus Interosseous, which supplies fila- ments 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, wmich reach their extremities along with the digital arteries. 9. The Nervus Ulnaris, comes from the lowest section NERVES. 353 of the brachial plexus. It descends along the internal an- terior 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 be- tween it and the olecranon, and separates the two heads of the flexor ulnaris muscle. It then gets to the fore-arm, be- tween this muscle and the flexor profundus digitorum, and continúes between them to within two inches of the wrist- joint, when it detaches the Ramus Dorsalis. The Ramus Dorsalis, slips between the ulna and the ten- don of the flexor ulnaris, runs along the internal margin of the ulna to the carpus, when it divides into ramuscles which supply the ulnar side of the integuments on the back of the hand, and the backs of the last two fingers. At the interval between the heads of the metacarpal bones of the middle and ring fingers, a considerable ramuscle, joins one from the ramus superficialis anterior of the nervus ra- dialis or musculo-spiralis. The Ulnar Nerve, having given off this dorsal branch, descends along the radial margin ofthe tendón ofthe flexor ulnaris and ofthe os pisiforme, above the annular-ligament, to the palm of the hand. Getting 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 digital 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 tho- racic, which pass out at the fore and lateral parts of the thorax ; the first from beneath the second rib, andlhe other from beneath the third rib. 23 354 OF THE UPPER EXTREMITIES. The first intercosto-humeral, being connected with a fila- ment from the internal cutaneous, is distributed upon the axillary glands, and the integuments ofthe 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 el- bow. The numbness of the inner side of the arm, in an- gina 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. Ofthe Fascia. The Muscles of the lower Extremity, from the pelvis to the foot inclusively, is enveloped by a strong Fascia or Aponeurotic Membrane, lying between the skin and the mus- cles. This fascia consists for the most part, of ligamentous fibres, passing in the direction ofthe length ofthe limb, se- cured 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 charac- ter just mentioned; but at the groin it is between the liga- ment and cellular membrane; the latter occasionally pre- dominates so much, that the appearance of the first is lost, particularly in corpulent subjects. On the contrary, in the lean, and such as have suffered from the pressure and irri- tation of the part by hernial protrusion, the ligamentous structure is well developed. On the Gluteus Magnus also, this fascia exists as a condensed cellular membrane, send- ing in its processes between the fasciculi ofthe muscle. 356 OF THE UPPER extremities. 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 weak compared with the other. 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 ankle it is connected with the bony prominences around it, and in- creasing 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 margin, so as to keep itself tense. This membrane is very closely attached to the cellular 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 consti- tuted 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 head of the tibia and fíbula. On the posterior part of the thigh it sends in a long process, by which it adheres lo the linea áspera. Its connexion wilh the knee and ankle below, fixes it on the leg; besides which, it adheres to the spine of the tibia. Its connexion with the muscles of the lower extremity is very interesting; to some of them it adheres by its inter- nal face, and to others it does not. To the muscles ofthe hip it adheres closely, and gives origin to some of the fibres ofthe gluteus medios. To the muscles ofthe exte- rior face of the thigh, its adherence is generally loóse, and indeed, in some parts scarcely deservcs to be considered as such, as where the internal surface of the fascia is op- posed to the tendinous facing of the vastus externus mus- cle. On the internal semi-circumference of the thigh, it adheres somewhat closely to the muscles, by cellular mem- brane. On the leg, it is in cióse connexion with the mus- cles of its anterior 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 sepárate the mus- cles from each other, form sheaths in which they repose, MUSCLES. 357 and preserve them in their position. As an envelope to the muscles of the leg, the fascia is highly useful in sup- porting and sustaining their action. The knFwledga of its peculiar connexion at different parts of the lower extre- mity, is all important in the management of abscesses of that región. Though useful, it is not indispensable to make a complete investigation of the fascia at once, but the circumstances mentioned should be very carefully observed, in extending downwards the muscular dissection. SECTION II. Ofthe Muscles ofthe Lowzr Extremities. The Psoas Magnus, Psoas Parvus and Iliacus Internus are described at page 230. The Sartorius is placed superficially on the internal side of the thigh, and arises by a short tendón, fj«m 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 to the back of 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 tendón. The lower edge of the tendón is continued into the fascia cruralis, by which this muscle is preserved in its spiral direction. The sartorius muscle is placed in its whole course imme- diately beneath the fascia femoris; it crosses the rectus femoris, vastus internus, and triceps adductor; at the lower part of the thigh, just above the knee, it is between the tendón of the latter and that of the gracilis. It bends the leg and draws it obliquely inwards. The Tensor Vagina Femoris, is a short muscle just on 358 OF THE LOWER EXTREMITIES. the outer side of the origin of the sartorius; it arises, ten- dinous, from the anterior superior spinous process of the ilium, and passes downwards and somewhat backwards, between two laminas of the fascia femoris. It is inserted, a little below the level of the trochanter 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, with the exception of its origin which is covered by the sartorius. It is a complete penniform muscle, fleshy in front for the most part, but faced behind with tendón. It arises from the anterior inferior spinous process, by a round tendón, which is joined by another tendón coming from the superior margin of the acetabulum. It is inserted into the superior surface of the patella by a strong tendón, and intermediately by the ligamentum patellse 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 muscular mass, con- sidered, by most anatomists, as three distinct muscles, called Vastus Externus, Vastus Internus, and Crurseusor 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 out- side of the thigh, arises, tendinous and fleshy, from the upper part of the os femoris immediately below the trochan- ter major. Its origin commences in front, and passes ob- liquely around the bone to the linea áspera. It continúes afterwards, to arise the whole length of the linea áspera, and from the upper half of the line running from it to the external condyle. Its fibres pass inwards and downwards, and are inserted by a flat tendón, into the external edge of the tendón of the rectus, and also into the external upper part of the patella. This muscle has a broad tendinous 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. muscles. 359 The Vastus Internus covers the whole inside of the os femoris. It arises by a fleshy and pointed origin, 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 áspera, and from the line leading from it to the internal condyle. Its fibres descend obliquely, and are inserted by a flat tendón into the internal edge of the tendón of the rectus. and into the upper internal edge of the patella. It also extends the leg. The Crur^us Muscle, is almost completely overlapped and concealed by the two vasti, and is immediately behind the rectus femoris. The edge ofthe 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 together; 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 cruraeus 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 áspera. Between the in- ternal edge of this muscle and the linea áspera, the interior face of the os femoris is unoccupied, for an inch, along the whole shaft of the bone, which is very readily seen by turn- ing off the vastus internus. The Crurseus is inserted into the posterior face of the tendón of the rectus below, and into the upper surface ofthe patella. It also extends the leg. A small fasciculus at the lower part of this muscle which is inserted into the synovial membrane of the knee joint is called by some, the Sub-Crurseus. The Ligamentum Patellse is the common cord, by which the action of the last four named muscles is communicated to the tibia. It is a flattened thick tendón, an inch and a half wide, arising from the inferior edge of the patella, and inserted into the tubercle of the tibia. Besides this, a fascia or tendinous expansión, a continuation of the fascia of the thigh and called Involucrum, comes from the inferior ends 360 OF THE LOWER EXTREMITIES. of these muscles, and extends itself over the whole of the anterior and lateral parts of the knee joint, and is inserted into the head of the tibia and of the fíbula. Through this it happens that even when the patella or its tendón is fractured, some motion or extensión may be communicated to the leg from the thigh.* In consequence of the common insertion of these four muscles, some anatomists describe them as but one, under the ñame of Quadriceps Femoris. A bursa exists between the lower part of their tendón and the fascia femoris, higher up than the patella; occasionally one is found still lower down on the patella. The Gracilis, is a beautiful muscle at the inner margin of the thigh, which lies immediately under the fascia, and ex- tends from the pelvis to the leg. It arises, by a broad thin tendón, from the front ofthe 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 tendón, which passes behind the internal condyle of the os femoris and the head of the tibia. It then makes a curve forwards and downwards at the interna! side of the latter, and is inserted at the lateral and inferior part of its tubercle. The tendón at the knee is beneath the tendón of the sartorius. This muscle is a flexor of the leg. The Pectinalis or Pectineus, 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 the linea innominata and the ridge above the obturator foramen; and is inserted tendinous into the linea áspera, immediately below the trochanter minor. It draws the thigh inwards and forwards. The Tríceps Adductor Femoris is a large muscular mass, consisting of three distinct portions, which are placed at the inner side of the thigh, and contribute much to fill up the vacuity between the thigh bones above. These portions are * A case of this kind was formerly in the Philadelphia Almshoi.se. MUSCLES. 361 1. The Adductor Longus, which comes by a short round- ed tendón, 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 ofthe linea áspera, at its inner edge. This muscle, as the subject lies on its back, is the upper- most of the three; its origin is between that of the pectinalis and of the gracilis; its upper edge is in contact with the lower edge of the pectinalis. 2. The Adductor Brevis is the smallest ofthe three; and is situated beneath the adductor longus and pectinalis, and on the outside of the gracilis. It arises by a rounded tendón from the middle front part ofthe pubis, 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 áspera; between the trochanter minor and the upper edge ofthe adductor longus, by a flat thin tendón. 3. The Adductor Mag?>tus is below the other two, and is by far the largest. It arises, fleshy;, from the lower part ofthe body ofthe pubes, and from its descending ra- mus, also from the ascending ramus of the ischium, as far as its tuberosity, ocoupying the whole bony surface be- tween the foramen thyroideum below, and the margin of the bone. It is inserted, fleshy, into the whole length of the linea áspera, and on its internal margin a tendón is gradually generated, which passes downwards, to be inserted into the upper part of the internal condyle of the os femoris, and bv a thin edge or expansión, into the line leading from the linea áspera to the internal condyle. The Adductor Magnus separates the muscles on the an- terior from such as are on the posterior part of the thigh, and its insertion is closely connected with the origin ofthe vastus internus, the two surfaces adhering by a short and compact cellular membrane. The three adductors contribute to the same end, that of drawing the thigh inwards. 362 OF THE LOWER EXTREMITIES. 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 posterior third or fourth ofthe spine ofthe ilium, and the adjoining flat surface of the bone, from the side of the sacrum below it, from the side of the os coccygis, and from the poste- rior surface of the large sacro-sciatic ligament. The fibres of this muscle are collected 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 tendón, the upper part of which goes on the outside of the trochanter major, and is very strongly inserted into the fascia femoris, while the lower part is inserted into the upper third of the linea áspera, 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 processes from the fascia femoris. It covers nearly all the other muscles on the back part of the pelvis, laps over its inferior margin la- terally, and conceals the origins of the hamstring muscles. There is a very large bursa placed between the tendón of this muscle, and the external face ofthe trochanter major; another of almost equal magnitude between it, the superior extremity of the vastus externus, and the inferior end of the tensor vaginse femoris, and there are two smaller ones be- tween the same tendón and the os femoris, which are placed lower and more posteriorly. It draws the thigh back- wards and assists in keeping the spine erect. The Gluteus Medius arises irom the whole length of the crista of the ilium, except its posterior third, and from that part of the dorsum of the bone, which is between its crista, and the semicircular ridge, extending from the anterior su- perior spinous process, to the sciatic notch ; also from the lunated edge of the os ilium between the anterior superior, and anterior inferior spinous processes, and largely, from that MUSCLES. 363 part of the inner face of the fascia femoris which covers this muscle. The anterior superior part of this muscle is not covered by the gluteus magnus, but lies before it. Its fibres con- verge, and are inserted, by a broad thick tendón, into the upper surface of the trochanter major, 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. A bursa is interposed between the extremity of its tendón, and the tendinous insertion of the small rotator muscles. The Gluteus Minimus, arises from that part of the dor- sum 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 tendón, which is inserted into the anterior and superior part of the trochanter major, just within the anterior insertion of the gluteus medius. It adducts the thigh, and can also rotate the limb in- wards. A bursa of small size, exists between its tendón and the trochanter major. 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, within 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 upper part of the sacro-sciatic fora- men, receiving a slip of fibres from the posterior inferior spinous process of the ilium. It is inserted by a round tendón, into the upper middle part of the trochanter major within the insertion ofthe glu- teus medius. It rotates the limb outwards. Between its tendón and the superior geminus, a small bursa exists. 364 OF THE LOWER EXTREMITIES. A View of the Deep-seated Muscles on the Posterior Part of the Hip-Joint. Fig. 67. 1. Fifth Lumbar Verte- bra. 2. Ilio-LumharLiframcnt. 3. Crest ofthe Ilium. 4. Anterior Superior Spi- nous Hrocess. 5. Origin of the Fascia Femoris. 6. Gluteus Medius. 7. Its Lower andAnterior portion. 8. Pyriformis. 9. Gcmini. 10 Trochanter Major. 11. Insertion of the Glu- teus Med us. 12. Quarlratus Femoris 13. Part of the Adductor Magnus. 14. Insertion of the Glu- teus Magnus. 15. Vastus Exiernus. 16. Long Head of the Bi- ceps. 17. Semi-Membranosus. 18. Semi-Tendinosus. 19. Tuber Ischii. 20. Obturator Internos. 21. Point ofthe Coccyx. 22. Posterior Coccygeal Ligament. 23. ) Greater Sacro-Sciatic 24. ^ Ligament. 25. Posterior Superior Spi- nous Process of Ili- um. 26. Posterior Sacro-iliac Ligaments. 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 pos- terior part of the root of the spinous process of the ischium ; the lower from the upper back part of the tuberosity of the ischium. Being parallel to each other, and connected by their con- MUSCLES. 365 tiguous 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 roíate the limb outwards. The Obturator Internus muele, is principally situated within the cavity of the pelvis. It arises, fleshy, from all the margin of the foramen thyroideum except where the ob- turator vessels go out, and from the posterior face of the ligamentous membrane stretched across it; also from the upper part of the plañe of the ischium just below the linea innominata; its fibres converge, and forming a tendón, pass out of the pelvis over the trochlea of the ischium, between the sacro-sciatic ligaments. The tendón 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. Between the tendón of this muscle and the gemini, is a long bursa; a second is found where the muscle plays over the ischium. It rotates the limb outwards. The Quadratus Femoris, is lower down than the other muscles. It arises, tendinous and fleshy, from the ridge on the outer side of the ischium, which constitutes the exterior boundary ofthe 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. A bursa exists between it and the trochanter minor. The Obturator Externus, is concealed in front by the pectineus and triceps adductor, and behind by the quadra- tus femoris ; to get a satisfactory view of it, therefore, these muscles should be detached from the bone. It arises from the whole anterior circumference of the foramen thyroideum, excepting the place where the obturator vessels come out, and from the anterior face of the ligamentous membrane stretched across it. The fibres of this muscle converge, pass beneath the cap- 366 OF THE LOWER EXTREMITIES. sular ligament of the hip joint adhering to it, and termi- nate successively in a round tendón, which is inserted into the inferior part of the cavity on the posterior surface ofthe os femoris, at the root ofthe trochanter major. The course of the tendón of this muscle, is marked on the neck of the thigh bone, by a superficial fossa. It rotates the thigh outwards. The Bíceps Flexor Cruris, constitutes the outer ham- string, 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 semitendinosus, from the upper back part of the tuberosity of the ischium by a short tendón, 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 áspera just be- low the insertion of the gluteus magnus, and is continued along the lower part of the linea áspera, from the ridge leading to the external condyle. A thick tendón is gradually formed on the outside of the muscle, which descending along the external face of the external condyle, is inserted into the upper part of the head of the fíbula. A bursa is found between this tendón, and the external lateral ligament ofthe knee. This muscle flexes the leg on the thigh. The Semitendinosus, is on the inside ofthe thigh, between the biceps and gracilis; it is superficial, being immediately under the fascia, and arises, in common with the biceps, from the back part of the tuberosity of the ischium ; it also adheres, for three or four inches, to the inner edge of the tendón of this the long head of the biceps. About four inches above the knee it terminates in a long round tendón, which passes behind the internal condyle and the head of the tibia, and is reflected forwards, to be inserted into the side of the tibia, just below its tubercle and very near it, being lower down than the insertion of the tendón of the gracilis. Between its origin, that of the long head of the biceps and the semimembranosus, there is a bursa; one or more are likewise found between its tendón, below that MUSCLES. 367 of the sartorius, of the gracilis and the internal ligament of the knee. It flexes the leg on the thigh. The Semimembranosus is at the inner side of the thigh; its upper part is concealed by the semitendinosus and the origin ofthe long head ofthe biceps, and below, it projects between these two muscles. It is in contact with the poste- rior surface of the adductor magnus. It arises, by a thick round tendón, from the exterior upper part of the tuberosity of the ischium, which tendón soon be- comes flattened and sends off the muscular fibres obliquely from its exterior edge, to a corresponding tendón below. The latter passing behind the internal condyle and the head of the tibia, detaches a thin aponeurotic membrane under the inner head of the gastrocnemius, to cover the posterior part of the capsule of the knee joint, and to be fastened to the external condyle. It is inserted, by a round tendón, into the inner and back part of the head of the tibia just below the joint. The un- favourable insertion of this muscle is compensated by the course of its fibres, which gives it great increase of strength. A bursa exists between its tendón above and the quadratus; another exists between its tendinous termination, the internal head of the gastrocnemius and the capsule of the knee. 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 superficially under the fascia ofthe leg, at the outside ofthe spine ofthe tibia, and in front of the interosseous ligament. It arises, fleshy, from the head, outer surface, and spine of the tibia, and from the interosseous ligament, to within three or four inches of the ankle. It also arises by its front surface from the internal face of the fascia of the leg. A rounded long tendón is formed below, into which the fleshy fibres run obliquely and which, passing through a dis- 368 OF THE LOWER EXTREMITIES. tinct noose of the annular ligament in front of the malleolus internus, crosses the astragalus and os naviculare; and is inserted on the inner side of the solé of the foot, into the anterior part of the base of the cuneiforme internum, and into the adjacent part of the metatarsal bone of the great toe. A bursa surrounds the tendón where it passes beneath the annular ligament; another exists at its lower part. This muscle corresponds with the radial extensors of the arm. It bends the foot, and presents the solé obliquely inwards. The Extensor Longus Digitorum Pedís, is also super- ficially placed just under the fascia ofthe leg and in front of the fíbula, being in contact above with the tibialis anticus, and below with the extensor proprius pollicis. It arises, tendinous and fleshy, from the outer part ofthe head ofthe tibia, from the head of the fíbula, and almost the whole length of its anterior angle; also from the upper part of the interosseous ligament and the internal face of the fascia of the leg. Its fibres go obliquely downwards and forwards to the tendón, which begins not far from its upper end and descends along its anterior margin. About the middle of the leg the tendón splits into four, which are confined by the annular ligament of the ankle, and then diverging, are inserted respectively into the base of each toe, except the big one, and expanded over its back part as far as the last phalanx. A long bursa is found enveloping the tendons, where they pass beneath the annular ligament ofthe ankle. It extends all the joints of the small toes and flexes the foot. The Peroneus Tertius, is rather a portion of the extensor longus; is found at its lower outer part, and cannot be naturally separated from it. It arises from the anterior angle ofthe fíbula, between its "middle and lower end, It is inserted, by a flattened tendón, into the base of the metatarsal bone of the little toe, and assists in bending the foot. The Extensor Proprius Pollicis Pedís, is between the MUSCLES. 369 lower part of the tibialis anticus, and the extensor longus. It arises from the fíbula between its anterior and internal angles, by a tendinous and fleshy origin, which commences about four inches below the head of the fíbula, and con- tinúes almost to its inferior extremity. A few fibres also come from the interosseous ligament, and from the lower part of the tibia. Fig. 68. A View of the Muscles on the Front of the Leg. 1. Tendón ofthe Quadriceps Femoris. 2. Spine of the Tibia. 3. Tibialis Anticus. 4. Extensor Communis Digitorum. 5. Extensor Proprius Pollicis. 6. Peroneus Tertius. 7. Peroneus Longus. 8. Peroneus Brevis. 9.9. Borders of the Soleus. 10. Portion ofthe Gastrocnemius. 11. Extensor Brevis Digitorum. The muscle being half penniform, the fibres run at its fore part, obliquely to a tendón which passes through a par- ticular gutter of the annular ligament, and over the astraga- lus, scaphoides and upper internal parts of the foot, to be 24 370 OF THE LOWER EXTREMITIES. inserted into the base of the first and second phalanx of the great toe. A bursa invests this tendón where it passes beneath the annular ligament. It extends, as its ñame implies, the great toe. On the outside of the leg, between the fibula and fascia, are the two Peronei muscles. The Peroneus Longus seu Primus, 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 ankle. A flattened thick tendón to which the fibres pass oblique- ly, constitutes the outer face of the muscle. This tendón is lodged in the groove at the posterior part of the malleolus externus, being confined to it by a thick ligamentous noose, and furnished there with a bursa. It then traverses the outer side of the os calcis, where its passage is marked by a superficial sulcus, runs through the groove of the os cuboides where there is another bursa, and lying deep in the solé of the foot covered by the calcaneo-cuboid liga- ment and next to the tarsal bones, it is inserted into the base of the internal cuneiform bone, and into the adjacent part ofthe metatarsal bone ofthe great toe. It extends the foot and inclines the solé obliquely out- wards, corresponding with the flexor carpi ulnaris of the fore-arm. Small sesamoid bones are occasionally found where the tendón winds round the os cuboides. The Peroneus Brevis seu Secundus, is concealed in a great degree by the peroneus longus, being situated be- tween 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 ankle. A tendinous facing exists externally also in this muscle, to which its fibres proceed obliquely. This tendón is con- tinued through the fossa at the back part of the malleolus externus, being covered by the tendón of the peroneus muscles. 371 longus, and confined by the same ligmentous noose, and passing through the superficial fossa at the outer side ofthe 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 solé obliquely downwards. It corresponds with the flexor carpi ulnaris. The Tríceps Sur^:, is placed on the back ofthe leg and constitutes its calf. It consists of the 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 os femoris by two heads. One head arises, tendinous, from the upper back part ofthe internal condyle, and fleshy, from the adjacent part of the ridge leading to the linea áspera; the other head arises, by a broad tendón in the same way, from the external condyle and the ridge above it. A triangular vacancy is left between the heads ofthe muscle, for the passage ofthe popliteal vessels; they then join together, but in such a way that the appearance of two bellies is distinctly preserved, of which the internal is the largest. The muscular fibres pass from a broad ten- dinous facing on the back to a corresponding one on the front surface ofthe 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. 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, 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 ofthe posterior tibial vessels. The body of this muscle has a great intermixture of ten- dinous 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 tendón joins the anterior face of the tendón of the gastrocnemius, and by the unión of the 372 OF the lower extremities. two is formed the Tendo Achillis, which is inserted into the posterior inferior surface of the os calcis near its tube- rosities. These two muscles extend the foot, and are all-important in walking. A bursa is between these tendons and the os calcis. The Plantaris, is a singular little muscle concealed by the gastrocnemius, and has a short fleshy belly, and a long tendón. It arises, fleshy, from the ridge of the os femoris just above the external condyle; passes across the capsular ligament of the joint, adhering to it in its course, and the belly terminates somewhat below the head of the tibia in a long delicate tendón, which descends between the inner head of the soleus, and the gastrocnemius. At the place where these tendons unite, the tendón of the plantaris emerges from between them, and running at the inner edge of the tendo Achillis, is inserted into the inside of the os calcis just before the insertion of the tendo Achillis. It extends the foot, but contributes so little to its motions, and in other respects is of such doubtful use, that its pro- per destination is uncertain. The Popliteus, is a triangular muscle on the back of the knee joint. It arises from a deep depression on the exte- rior face of the external condyle, by a thick round tendón, which passes through the capsular ligament, being connected with the external semilunar cartilage, and then forms a fleshy belly that passes obliquely inwards and downwards. It is inserted, fleshy, into the oblique ridge on the back of the tibia just below its head, and into the triangular de- pression above it. A bursa exists between its origin, and the capsular liga- ment; and its tendón is in contact with the synovial membrane of the joint. It bends the leg,«and when bent, rotates it inwards. By removing the Soleus we expose three other muscles on the back of the leg, the Tibialis Posticus, the Flexor Longus Digitorum Pedis, and the Flexor Longus Pollicis Pedis. These muscles are covered by a thick strong fascia, MUSCLES. 373 from which some of their fibres originate, and which should be removed. Fig. 69. A View of the Muscles on the Back of the Leg. 1. Tendón of the Biceps. 2. Inner Hamstring Tendons. 3. Popliteal Space. 4. Gastrocnemius. 5. Soleus. G. Tendo-Achillis. 7. Its Insertion on the Os Calcis. 8. Tendons óf the Peroneus Longus and Brevis. 9. Tendons of the Tibialis Posticus and Flexor Longus Digitorum, behind the Internal Mal- leolus. The Flexor Longus Digitorum Pedís Perforans, is be- hind the tibia, and at the inner edge of the tibialis posticus. It arises, by an acute, tendinous, and fleshy beginning, from the back ofthe tibia, a little below the popliteus muscle, its origin being continued from the internal angle of the tibia, almost to the ankle joint. It arises, also by tendinous and fleshy fibres, from the outer edge ofthe tibia, just above its connexion with the fibula at the ankle, the latter origin is, however, frequently deficient; and between this double or- der of fibres, the tibialis posticus lies. 374 OF THE LOWER EXTREMITIES. The fibres pass obliquely into a tendón at the posterior edge ofthe muscle, which runs in the groove behind the in- ternal malleolus, and is confined there by a strong ligamen- tous sheath, being placed behind, and within the tendón of the tibialis posticus. The tendón then gets to the solé of the foot along the sinuosity of the os calcis, and being joined by a considerable tendón, detached from the flexor longus pollicis, it divides into four branches which are ap- propriated to the four small toes. These tendons are inserted into the bases of the third phalanges of the lesser toes, aré very near the tarsal bones, and from perforating the tendons of the flexor brevis, cor- respond with the flexor perforans of the hand. A bursa exists, where the tendón passes along the tibia and the os calcis; and another is found in the solé of the foot, enveloping this tendón and that of the flexor longus pollicis. A fifth tendón, is sometimes observed, which splits and goes to the second bone of the small toe; this occurs when the latter is not supplied from the flexor brevis. This muscle flexes the small toes and extends the foot. The Flexor Longus Pollicis Pedís, 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 ankle. The tendón of this muscle is large and round, forms gradually, and constitutes a facing to the posterior edge of the muscle. It passes through a superficial fossa of the tibia at the back of the ankle, near its middle, and from thence through a notch in the back edge of the astragalus to the solé of the foot, where it crosses the tendón of the flexor longus digitorum, and gives off the branch just mentioned to join it, which goes principally to the second toe. This tendón is deeper seated in the foot than the other. The tendón of the flexor longus pollicis is inserted into MUSCLES. 375 the second phalanx of the great toe. It bends the great toe, and from its connexion with the others, will bend them also. A bursa invests its tendón in the canal of the astragalus, and along the os calcis; another, as stated, is common to it and the flexor perforans muscle, and a third invests the ten- don along the metatarsal bone, and the first phalanx of the great toe. The Tibialis Posticus is placed between, and concealed by the last two muscles. It arises, by a narrow fleshy be- ginning, 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 continúes its origin from the whole ofthe interosseous li- gament, and from the surfaces of the tibia and fibula, bor- dering 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 tendón, which passes in the groove at the back of the malleolus internus, and is confined there by a fibro-cartilaginous noose, and in- vested by a bursa. It is inserted into the upper internal part of the os naviculare, or scaphoides, at its tuberosity, and 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 solé obliquely in- wards, corresponding with the flexor radialis of the hand. OF THE MUSCLES OF THE FOOT. The Extensor Brevis Digitorum Pedís, is the only muscle on the superior surface of the foot. It is placed be- neath the tendons of the extensor longus, and arises, tendi- nous and fleshy, from the upper fore part of the greater apo- physis of the os calcis, being connected with the origin ofthe annular ligament of the ankle. It forms a short fleshy belly, 376 OF THE LOWER EXTREMITIES. which is partially divided into four parts; from these bel- lies proceed as many tendons, which crossing very obliquely the tendons of the extensor longus, are inserted into the great toe and the three next toes, by joining with the ten- dons of the extensor longus, which are spread over their backs. The tendón going to the great toe, has its principal inser- tion into the first phalanx. It extends the toes. The Solé of the Foot is protected, in the first place, by an unusual thickness of its cuticle, which is increased 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 con- densed cellular membrane resembling ligament, that pass from the interior surface of the skin to the aponeurosis plan- taris. It filis up completely all the fissures in this aponeu- rosis, and adheres very closely to it, so that it requires much trouble to get out a fair dissection of the aponeu- rosis. The Aponeurosis, or Fascia Plantaris, is a ligamen- tous membrane extending from the tuberosities of the os calcis, to the anterior ends of the metatarsal bones. It is triangular, and corresponds with the outiine of the foot, by being narrow behind, and broad before. It is divided into three parts, according to the división of the muscles of the foot, one part lying on the muscles at the outside of the solé, another on the muscles at the inside of the solé, and the third being between the other two. The internal and external portions are thin and reticulated; they extend from the tuberosities of the os calcis to the roots of the internal and external metatarsal bones, and are scarcely seen be- yond them. But the central portion is remarkably strong near the heel, and dimishes in thickness as it spreads out. Anteriorly, it is divided into five portions, one for each MUSCLES. 377 metatarsal bone; each of these portions is bifurcated, and dips down to be inserted on either side of the metatarsal bone near its head and into the bases of the first phalanges of the toes. Between 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 mus- cles of the middle of the foot from such as are on each side ofit. 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 Digitorum Pedis, the outer is the Abductor Minimi Digiti, and the inner the Abductor Pollicis Pedis. The Flexor Brevis Digitorum Pedís, arises fleshy, from the large tuberosity of the os calcis by a narrow be- ginning, also from the interior surface of the aponeurosis 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 per- forated by the tendons ofthe flexor longus, and are inserted into the sides of the second phalanges. The tendón for the little toe is often deficient. It bends the second joint of the toes. By detaching this muscle from its origin and turning it down, we bring into view the tendón ofthe Flexor Longus Digitorum Pedis, and its attachments behind, to the ten- dinous 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 tendón of the flexor longus digitorum pedis. It arises, fleshy, from the inside of the sinuosity of the os calcis, and by a thin tendón, from the outside of the bone before its posterior tuberosities. It is inserted, fleshy, into the outside of the tendón of the 378 OF THE LOWER EXTREMITIES. flexor longus, just at its división into four tendons. Like a second hand at a rope, it assists in flexing the toes. Fig. 70. A View of the Muscles of the Solé of the Foot immediately under the Plan- tar Fascia. 1. Os Calcis. 2. Section ofthe Fascia Plantaris, 3. Abductor Pollicis. 4. Abductor Minimi Digiti. 5. Flexor Brevis Digitorum. 6. Tendón of the Flexor Longus Pollicis. 7.7. Lumbricales. The Lumbricales Pedís, are four small tapering muscles which arise from the tendón of the flexor longus digitorum pedis, just after its división, 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 expansión that is sent off from the extensor muscle to cover its back. They increase the flexión of the toes and draw them inwards. The AbductorPollicis Pedís, arises tendinous and fleshy, from the internal anterior part of the large tuberosity of the os calcis, from a ligament extended from this tuberosity to the sheath of the tendón of the tibialis posticus, from the in- ternal side of the naviculare, and from the cuneiforme in- ternum, being a part ofthe aponeurosis ofthe solé ofthe foot. It forms the internal margin of the solé of the foot, and MUSCLES. 379 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. The Flexor Brevis Pollicis Pedís, is situated imme- diately at the exterior edge of the abductor pollicis. It consists of two bellies, parallel with each other, but sepa- rated by the tendón of the flexor longus pollicis: one is inseparably connected with the tendón ofthe abductor pol- licis, and the other with the adductor pollicis. It arises, tendinous, in common with the calcaneo-cuboid ligament, from the under part of the os calcis just behind its connexion with the os cuboides, and from the under part ofthe external cuneiform bone. The internal belly is inserted, tendinous, into the internal sesamoid bone along with the tendón ofthe abductor polli- cis; and the external belly is inserted, tendinous, into the external sesamoid bone along with the tendón of the ad- ductor pollicis. Each insertion is continued on tothe base of the first phalanx of the great toe. It flexes the great toe. The Adductor Pollicis Pedís, is situated at the outside of the flexor brevis, and is extended obliquely across the metatarsal bones. It arises, tendinous at the external part ofthe foot, from the calcaneo-cuboid ligament, and from the roots ofthe second, third, and fourth metatarsal bones. It is inserted, tendinous, into the external sesamoid bone, which insertion is continued to the first phalanx ofthe great toe, and is closely united to the tendón of the external head ofthe flexor brevis pollicis. Tt draws the great toe towards the others. The Abductor Minimi Digiti Pedís, forms the external margin of the solé of the foot, and is immediately beneath the aponeurosis plantaris. It arises, tendinous and fleshy, from the outer tuberosity 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 tendón, into the exterior part ofthe base ofthe first phalanx ofthe little toe. It draws the little toe from the other toes. 380 OF THE LOWER EXTREMITIES. The Flexor Brevis Minimi Digiti Pedís is just within the tendón of the abductor minimi digiti. It arises from the calcaneo-cuboid ligament, as extended frorn the tube- rosity of the cuboid bone to the heads of the metatarsal bones; also from the base of the outer or fifth metatarsal bone. It is inserted, by a tendón, into the lower part of the first phalanx of the little toe at its base, and into the head ofthe metatarsal bone of the same toe. It bends the little toe. The Transversalis Pedís, is placed beneath the tendons of the flexor muscles, the solé of the foot being upwards. It is small, and lies across the anterior extremities of the metatarsal bones. It arises, tendinous, from the capsular ligament ofthe first joint ofthe little toe; it also arises from the capsule ofthe first joint ofthe next toe. It is inserted into the exterior face of the common tendón 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 mus- cles seen on the upper side ofthe foot, are for the most part double headed, that is, they arise from the contiguous sur- faces ofthe metatarsal boñes. The Interosseous Primus Digiti Primi Pedís, or the Abductor Indicis Pedís, 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 and bodies. It is inserted, tendinous, into the inside of the root of the first joint ofthe first small toe, and pulís it inwards. The Interosseous Secundus Digiti Primi, or the Ad- ductor Indicis Pedís, is also external or above. It is situated between the metatarsal bones of the first and MUSCLES. 381 second small toes, arising from the opposed surfaces of their roots and bodies by a double fleshy and tendinous head. It is inserted into the outside of the first phalanx of the same toe by a tendón. It draws this toe outwards. The Interosseous Secundus Digiti Secundi, or the Ad- ductor Medii Digiti, is seen at the upper part of the foot, between the second and third metatarsal bones of the lesser toes, arising from the opposed surfaces of their roots and bodies. 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 Interosseous Secundus Digiti Tertii, or the Ad- ductor Tertii Digiti, is seen on the upper surface of the foot, occupying the interval of the metatarsal bones of the third and fourth small toes, and arises, by a double head, from the opposite surfaces of their roots and bodies. It is inserted, tendinous, into the outside of the root of the first phalanx ofthe third small toe. It draws this toe outwards. The Interosseous Primus Digiti Secundi Pedís, 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 Interosseous Primus Digiti Tertii, or the Abduc- tor Tertii Digiti, is in the solé 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 ofthe same toe. It draws this toe inwards. The Interosseus seu Adductor, Digiti Minimi, is on the under surface of the foot. It arises from the inside of 382 OF THE LOWER EXTREMITIES. 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. SECTION III. Of the Blood- Vessels of the Lower Extremities. The Femoral Artery, (Arteria Femoralis,) is a conti- nuation of the external iliac. It appears first on the thigh, half-way, or nearly so, between the symphysis pubis and the anterior superior spinous process of the ilium; emerging from beneath Poupart's ligament, 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 ofthe insertion ofthe adductor longus muscle. About one- third of the length of the thigh bone from below, it pene- trates the insertion ofthe 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 ofthe rec- tus femoris, and but a little distance from it; it then inclines inwards and occupies the angle formed by the contact of the vastus internus, and the adductor longus. Above, the sartorious is at its outside ; but as this muscle inclines very rapidly inwards, immediately after its origin, it in a little time begins to pass along the external margin of the ar- tery; and shortly afterwards covers the artery completely to 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 inter- lacing of tendinous fibres from the muscles, and is also en- veloped by its own cellular coat. To cut upon the femoral artery in any part of its course, blood-vessels. 38c lay the subject horizontally, and turn the leg outwards, so that the external margin of the solé 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 inter- nal condyle of the os femoris, will be precisely over it.* The following branches come from the Femoral Artery: 1. The Superficial Artery of the Abdomen, called by Haller, Arteria ad Cutem Abdominis, is small and arises at the lower margin of Poupart's ligament. It goes up- wards towards the umbilicus, under the skin, and sends a branch to supply the inguinal glands. 2. The External Pudic Arteries, (Arterias Pudendas Externae,) come from the Femoral at the same point, and are two or three in number; they are sent to the integu- ments and lymphatic glands of the groin, also to the skin of the penis and scrotum of the male, or to the labia ex- terna of the female. One of these trunks arises from the upper internal part of the femoral artery, and the other sometimes 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 Femoris,) is very happilv called, by Professor Chaussier, the great muscular artery ofthe thigh, in consequence of its distri- bution. It is slightly inferior in size to the femoral itself, and arises from its posterior part on a level with the tro- chanter minor, but sometimes only five or six lines below Poupart's Ligament. It immediately begins to give off branches externally and intérnally, but the main trunk of the artery, continúes for several inches in contact with the femoral artery or nearly so, and beneath it. It then ter- minates gradually by branches which penétrate to the back ofthe thigh. The Profunda Femoris is distributed as follows: * Marjolin. 384 OF THE LOWER EXTREMITIES. a. The External Circumflex, (Arteria Circumflexa Externa,) arises from its external superior part, sometimes, howrever, from the femoral itself; it passes outwards under lhe 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 joint, and the heads of the extensor muscles. The second goes along the outside of the thigh to the patella, and is about the size of a crow-quill. It first passes obliquely between the rectus and the crurasus, and then vertically, under the anterior margin of the vas- tus externus, between it and the crurasus, till it terminates about the knee, by anastomosing with the articular arte- ries. It is principally distributed to the cruraeus and vas- tus externus. 6. The Internal Circumflex, (Art. Circumflexa In- terna) arises from the inner side of the profunda, just be- low 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 pec- tineus; it winds under the neck of the os femoris, and di- vides 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 profunda to supply the anterior faces of the adductor muscles; they are irregular in number, size, and place of origin, and have no appropriate ñames. d. The Perforating Arteries, (Rami Profundi Perfo- rantes,) three or four in number, are given off successively, are numerically named, and all penétrate the adductor mus- cles near the thigh bone, to get to the back of the thigh. The First, arises immediately below the little trochanter, and gets through the adductor magnus just below the quad- ratus femoris, to be distributed about the heads of the ham- string muscles. The Second penetrates the adductor magnus, at the lower blood- vessels. 385 part of the insertion of the gluteus maximus into the linea áspera, to be distributed about there, and to the correspond- ing 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 bi- ceps, 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 ofthe profunda, the femoral artery gives off three or four twigs the size of a large knitting-needle, wdiich are disposed of, upon the sartorious, adductors, vastus in- ternus, and integuments, but they are too irregular in num- ber, origin, and course, for systematic description. The Anastomosing Artery, (Arteria Anastomotica,) the last branch of the femoral, is sent from it just before it en- ters the aperture in the adductor magnus. This artery de- scends, in the course of the tendón of this adductor, to the knee, in front of the tendón, between it and the vastus in- ternus muscle. It is distributed to the parts lying along its course. The Popliteal Artery, (Arteria Poplitaea) is the con- tinuation of the femoral after the latter has passed through the adductor tendón, and got to the back of the lower ex- tremity, and extends from this point, to the opening in the interosseous ligament ofthe leg, just below the heads ofthe bones. Its first act is to cross obliquely the os femoris as far its middle; it then passes in a vertical line downwards, very nearly over the centre of the os femoris, knee joint, and headof the tibia, being only separated from these parts in consequence of a thick envelope of fat, which filis up the hollow of the ham, and protects the artery from the effects of sudden flexions of the part, and of bruises. The Popli- teal Artery sends off the following branches. 1. The Superior Internal Articular Artery, (Articu- 25 386 OF THE LOWER EXTREMITIES. Jaris Superior Interna) sometimes exists as two trunks; it arises just above the internal condyle, perforates the ad- ductor tendón, and, going horizontally, is spent on the inner side of the joint above. 2. The Superior External Articular Artery, (Articu- laris Superior Externa) arises just above the external con- dyle, passes horizontally between the fémur and the biceps flexor, and is distributed to the upper external parts of the joint. 3. The Middle Articular, (Articularis Media) some- times comes from one ofthe others; it is distributed 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 inferior part of the internal condyle. It descends obliquely, 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, (Articu- laris Inferior Externa,) arises near the last, and sometimes they are derived from a common trunk. It passes 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 popliteus muscle and between the heads ofthe gastrocnemius. * Here it sends off a large branch to each head of the gastroc- nemius muscle, (Arterias Gemellse) and small irregular branches to the other muscles, and sometimes the nutritious artery of the tibia. Generally on a level with the aperture of the interosseous ligament, the popliteal artery terminates by a división into blood-vessels. 387 two large branches, the Anterior Tibial, and the Posterior Tibial. The Anterior Tibial Artery, (Arteria Tibialis Ante- rior,) after getting through the interosseous foramen, passes down the leg in front of the interosseous ligament and in contact with it; it passes also over the middle of the ankle- joint to the dorsum of the foot, and is continued in a straight line to the interval between 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 ankle joint in front, and is continued in the course of a line drawn from this latter point to the junction of the first two metatarsal 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 en- gaged with the tendons of the muscles under the annular ligament of the joint, it gets to the fibular side of the tendón of the extensor pollicis. The anterior tibial nerve adheres to it its whole length. The Anterior Tibial Artery gives off several branches. 1. The Recurrent Tibial, (Tibialis Recurrens) pene- trates the head of the tibialis anticus muscle, and is dis- tributed 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 ñame. 3. The Internal Malleolar, (Malleolaris Interna) arises from the anterior tibial near the joint, it passes under the tendón of the tibialis anticus, and is distributed to the internal ankle, and the contiguous part of the foot. 4. The External Malleolar, (Malleolaris Externa) 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 388 OF THE LOWER EXTREMITIES. 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 ankle 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 Metatarsea) arises just below the last, and is distributed by many branches on the upper part of the raetatarsus. A successful injection demonstrates a branch of it, in each of the three outer in- terosseous intervals of the metatarsal bones above. 7. The Dorsal Artery ofthe Great Toe, (Dorsalis Hal- lucis) arises from the anterior tibial at the root 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 solé 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 be- tween the soleus posteriorly, and the flexor digitorum anteriorly, and beneath the fascia of the part. It is dis- tributed in the following manner: 1. The Peroneal Artery, (Arteria Peronea) arises a little below the commencement ofthe posterior tibial, and is extended from the inferior edge of the popliteus muscle to the external ankle. It is placed at the tibial edge ofthe fibula, between the flexor longus pollicis muscle and the external edge of the tibialis posticus. Its situation is there- fore deep and of difficult access in the living body. After descending along two-thirds ofthe fibula, it divides into an anterior and posterior branch. The first traverses the in- terosseous ligament, and descending in front of it, is rami- fied on the upper external part of the foot. The second BLOOD-VESSELS. 389 descends posteriorly along the fibula, and is distributed about the peroneo-tibial articulation and the adjacent parts. 2. Several small, irregular, muscular and cutaneous branches, afterwards arise from the posterior tibial and at its upper part, most commonly, the Arteria Nutritia Tibiae. At the ankle the posterior tibial is at the internal edge ofthe tendo Achillis, and still confined by the fascia ofthe part. It passes to the solé of the foot in the hollow of the os calcis, between the bone and the abductor muscle ofthe great toe. At the ankle it is on a line with the internal margin of the joint behind, and in contact with the posterior malleolus, between the tendón of the flexor longus pollicis, and that of the flexor longus digitorum. Having got to the solé of the foot, it terminates by dividing into two branches, the Internal and External Plantar Arteries. The Internal Plantar, (Arteria Plantaris Interna,) is the smaller of the two; it is covered by the abductor pol- licis, and passing between it and the internal 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 con- tiguous parts which give them a high degree of vascularity. One of the most remarkable, is given off about the os scaphoides, and cruizes along the internal margin of the ab- ductor pollicis to its anterior end. Another makes its appearance superficially in the solé ofthe foot, in the fissure between the abductor pollicis and the flexor brevis digi- torum, and goes as far forward as the other. The External Plantar, (Arteria Plantaris Externa,) inclines towards the outer margin of the foot, between the flexor brevis digitorum and the flexor accessorius; it then advances at the internal edge ofthe abductor minimi digiti to the root of the metatarsal bone of the fourth toe, and makes a curvature forwards and inwards, between the ten- dons 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 390 OF THE LOWER EXTREMITIES. Arch (arcus plantaris.) The distribution of the External Plantar is as follows: a. Half an inch from its origin, it detaches backwards and outwards to the inferior and to the external parts of the heel, a multifideous 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 Digital 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 Four Digital Arteries come next, which arise suc- cessively at the fourth, third, second, and first metatarsal intervals, or near them, from the convex side ofthe 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 detaches a branch which runs along the inner edge ofthe great toe, and is united, by anastomoses, with the internal plantar artery. OF THE VEINS OF THE LOWER EXTREMITIES. These veins like those ofthe upper extremity, are super- ficial and deep-seated. The more important ofthe first are the Saphena Magna, and the Saphena Minor. 1. The Saphena Magna arises from the inside of the foot, about the great toe, and from its solé; it passes in front of the internal ankle, along the inside of the leg, over the internal condyle of the os femoris, along the inner front part BLOOD-VESSELS. 391 of the thigh, and terminates in the femoral vein just below Poupart's ligament. As it ascends, it collects branches from the anterior and posterior parts of the lower extremity. It may be seen very readily in the living subject, beneath the skin. 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 ankle, and ascends on the outside of the leg to the ham, receiving contributions in its course ; here it crosses the external head of the gastrocne- mius 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 deep veins of the lower ex- tremity, are so similar to the distribution and course of the arteries, that a description is needless. A venous tube al- ways attends an arterial one, being in contact with it, en- closed in the same sheath, and called by the same ñame. The smaller arterial branches in the leg and thigh, have each two veins, called Venae Comités. The relative situation of the large venous trunks is im- portant. At Poupart's ligament the femoral vein is at the inside of the artery ; at the passing of the adductor tendón, the vein is nearest the thigh bone ; and in the ham, the popliteal vein is behind the artery, and consequently more superficial. 392 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 lower dorsal and the upper lumbar vertebra?. The lumbar nerves form a plexus behind the psoas magnus muscle, from which proceeds a cluster of nerves to supply the front part ofthe lower extremity, includingboth 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 ofthe lumbar plexus is continued into the upper of the sciatic or sacral, so that, under a more general classi- fication 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 be- hind 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 are conCerned in forming it, as the posterior branches, all go to the muscles of the back. In the distribution of this plexus to the lower extremity, it will be seen, shortly after the commencement of the dis- section, that its branches may be considered under two di- visions; first, such as go to the skin, and secondly, such as go to the muscles. BLOOD-VESSELS. A View of the Lumbar and Ischiatic Plexuses and the B 0F THE FORMER. Fig. 71. 1. The Lumbar Plexus. 2. The Ischiatic Plexus. 3.3. Abdomino-Crural Nerves. 4. The External Cutaneous Nerve (Inguino-Cutaneous.) 5.6.7. Cutaneous Branches from 8. The Anterior Crural Nerve. 9. The Genito-Crural Nerve, or Spermaticus Externus. 10.10. The lower termination of the Great Sympathetic. 11. The Iliacus Internus Muscle. 12. The three broad Muscles ofthe Abdomen. 13. The Psoas-Magnus Muscle. 14. Bodies of the Lumbar Vertebree. 15. The Quadratus Lumborum Muscle. 16. The Diaphragm. 17. The Sartorius. 394 OF THE LOWER EXTREMITIES. From the upper part of the plexus, fibrilla? pass outwards and downwards over the quadratus muscle; some of their ramuscules are spent on the sides of the abdominal 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 internus 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, going 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 spermatic cord and scrotum; in the second, to the labium externum and mons veneris. The Cutaneus Externus, arises from the lumbar plexus below the external spermatic. It passes across the iliacus internus towards the anterior superior spinous process, about an inch below the spermaticus externus, and crosses the latter nerve, just at that process. Emerging from the ab- domen, by penetrating the commencement of Poupart's ligament, it is distributed, in several branches, to the in- teguments of the vastus externus muscle, and along the edge of the rectus femoris; one of the latter extends to the patella. The Cutaneus Medius, is given from the anterior crural, an inch or so above Poupart's ligament, coming from it, among the cluster of branches which arise there to be dis- tributed to the iliacus internus muscle, and to the muscles of the thigh. It appears superficially on the thigh, for the first time, by penetrating the sartorius muscle, about the in- ternal edge of the rectus femoris; it descends then along the same edge of the latter muscle, and is distributed to its integuments. It does not descend so low as the other nerve. The Cutaneus Anterior, arises also from the crural nerve; it is on the inner side of the cutaneus medius, emerges from the fascia of the thigh, and crosses the sartorius muscle two or three inches below the cutaneus NERVES. 395 medius. It is distributed on the integuments of the vas- tus internus muscle, and some of its branches extend to the internal edge of the patella. The Cutaneus Internus, arises from the anterior crural nerve, among the same cluster, above Poupart's ligament. Itdivides into four or five branches of different lengths, and is distributed to the integuments of the adductor muscles and along the inner front side of the thigh. One branch ob- serves, very much, the course of the tendón of the adduc- tor magnus, and reaches as far down as the inner side of the knee. The Cruralis Anterior, arises from the middle of the lumbar plexus; at first it is beneath the psoas magnus mus- cle ; it then gets to its outside and passes from the abdo- men, under Poupart's ligament, about half an inch from the exterior margin of the femoral 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 the superficial or cutaneous nerves of the thigh, and others the 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 ofthe tendón of the adductor magnus, in a channel formed by this tendón and the origin of the vastus internus. The nerve alluded to is the Saphenus ; it passes afterwards be- tween the internal condyle of the os femoris 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 joint and passes forwards and downwards to the obturator foramen, having got through which, it divides into an anterior and a posterior branch. 396 OF THE LOWER EXTREMITIES. The first is distributed to the heads of the adductor longus and brevis, and to the gracilis and integuments. The second terminates in the obturator externus, and the adduc- tor magnus. The Sciatic Plexus, (Plexus Ischiadicus) is formed by the unión of the last lumbar with the four upper sacral nerves; the last lumbar before it joins the plexus, receives the branch ofthe fourth lumbar nerve^vhich is left after the lumbar plexus is formed. This plexus is situated at the side ofthe rectum, before the pyriformis muscle. The sacral nerves amount to six in number, sometimes only to five. They arise from the lower part of the cauda equina, and pass in a very oblique direction in order to arrive atthe sacral foramina. Like the other nerves ofthe spine, they form ganglions by the unión of their anterior and posterior fasciculi, and then pass outwards from the spinal canal, each one by an anterior 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 ofthe posterior branches increases till the fourth, but the fifth and the sixth are much smaller, in fact only fibrillas. These posterior branches all communicate with each other, being distributed to the head of the sacro-lum- balis and longissimus dorsi, to the posterior edge of the glutaeus magnus, to the integuments of the buttock, margin ofthe anus, and to the internal parts ofthe thigh. The anterior branches of the sacral nerves are much larger than the posterior. The first four communicate with the sacral ganglions of the great sympathetic, besides forming the Ischiatic plexus. The third and the fourth, assisted by the sympathetic, form the Hypogastric plexus. The fifth, and the sixth, when it exists, are distributed to the coccy- geus, sphincter and levator ani.* The following small branches are sent from the Sciatic plexus. f * 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 inthe cavity ofthe 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. f They sometimes come from a common trunk called the small sciatic. NERVES. 397 a. Nervi Glutaei, one passing through the upper part of the sciatic notch along with the artery, to the glutaeus 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 mus- cles 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 contribution from the small sciatic, when it exists. It goes in company with the internal pudic artery between the sacro-sciatic ligaments, and then divides into two branches; the inferior of which is distributed to the integuments 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 in- ternus, accelerator urinse, 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 com- mon 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 muscles. It crosses vertically behind the small rotator muscles of the thigh; being concealed by the inferior edge of the glutaeus magnus; it is there about half-way between the tuberosity of the ischium and trochanter major. Thence it descends on the back of the adductor magnus at the outer edge of the long 398 OF THE LOWER EXTREMITIES. 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 división takes place as high as the exit of the nerve from the pelvis, but in this case, the fasciculi are parallel with each other as far as the middle of the thigh. From the trochanter minor to its usual place of división, this nerve is parallel with, and on the back of the thigh bone, but there the two branches begin to diverge. The popliteal nerve continúes straight downwards to the back and middle of the knee joint, and to the interstice* between the heads of the gastrocnemius muscle, 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. A View of the Branches of the Ischiatic Plexus to the Hip and back of the Thigh. 1.1. Posterior Sacral Nerves. 2. Nervi Glutei. 3 The Internal Pudic Nerve. . 4. The Lesser Ischiatic Nerve, giving off the Perineal Cutaneus, and 5. The Ramus Femoralis Cutaneus Pos- terior. 6. Great Ischiatic Nerve. 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 Fig. 72. NERVES. 399 part of the thigh, and is distributed to the skin of the cor- responding part. The Cutaneus Internus Inferior, which arises just below the last, and descending upon the inner head of the gastrocnemius muscle, is distributed to the in- teguments of the calf of the leg. A large trunk and some- times instead of it, distinct branches which go to the Ad- ductor Magnus, Semimembranosus, Biceps and Semitendi- nosus. The Peroneal Nerve, (Nervus Peroneus) at the head of the fibula divides into two branches, the Peroneus Externus and the Tibialis Anterior ; but before this división it sends a small branch to the external parts of the knee-joint, and two cutaneous branches called Peroneo-Cutaneus. The in- ternal of the two latter descends behind the external head of the gastrocnemius, and at the bottom of the leg is united to a división of the posterior tibial, called the Externa! Saphenus or Communicans Tibiae. The external branch of the peroneo-cutaneous is distributed to the skin along the fibula. The External Peroneal Nerve, (Peroneus Externus) gets between the head ofthe peroneus longus and the fíbula, 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 aponeu- rosis 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- Cutaneous of the leg. The Anterior Tibial Nerve, (Tibialis Anterior) gets ob- liquely between the fibula, the peroneous longus, and the extens,or longus digitorum, to the front of the interosseous ligament, where it accompanies the anterior tibial artery. It passes with the artery under the annular ligament of the ankle, and has its terminating filaments going to the musce and integuments of the upper surface of the foot, as far as the end of the first two toes. One of its branches sinks down with the anterior tibial artery to the solé of the foot. High up in the leg it gives filaments to the knee-joint, and, 400 OF THE LOWER EXTREMITIES. in its course downwards, it furnishes the muscles on the front of the leg. The Posterior Tibial, or Popliteal Nerve, (Nervus Popliteus) having the direction mentioned, is placed be- tween the skin and the popliteal vein. It gets between the heads of the gastrocnemius muscle, and perforates the ori- gin of the soleus, going with the posterior tibial artery, be- tween 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 gastrocnemius, turns outwardly and anastomoses with the cutaneous branch alluded to, of the peroneal nerve. The common trunk thus formed passes behind the external ankle, along the external margin of the foot, and terminates on the last two 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 pos- ticus, 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 fila- ments, one of which gets to the solé 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) proceeds along with the tendón of the flexor muscle of the 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 first three toes, and the internal side of the fourth. The External Plantar, (Plantaris Externus) proceeds with the artery of the same ñame, to the outer edge of the foot, between the flexor brevis digitorum and the flexor ac- NERVES. 401 cessorius. It is distributed to the two sides of the little toe, and to the external side ofthe fourth toe. One branch pe- netrates to the interosseous 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. 26 PART IV. LIGAMENTS. CHAPTER I. OF THE LIGAMENTS OF THE JOINTS. SECTION I. Oftlie Ligaments ofthe Head and Spine. The Ligaments, (Ligamenta) properly speaking, are those organs which tie the bones together, and in the moveable joints are either Capsular, or Funicular. The Capsular are like a bag, open at both ends, at either of which the arti- cular extremity of a bone is included, and are much more complete in some joints, than in others. The shoulder and the hip joint afford the most perfect examples of this; in other joints, they are divided into irregular fasciculi of fibres, permitting the synovial membrane to appear in their inter- stices, and sometimes they are still more widely sepa- rated. The Funicular Ligaments are mere cords, extending from one bone to another: some of them are flattened, some rounded, and others oval, or cylindroid. Their ñames are derived either from their position or shape, and are gene- rally sufficiently appropriate. 404 OF THE LIGAMENTS. OF THE SYNOVIAL ARTICULAR CAPSULES. Each moveable articulation is lined by a membrane, re- flected over the internal face of the capsular ligament, and the articular cartilages. This membrane is a perfect sac, and unlike the capsular ligament, has no opening in it. It is remarkably distinct where it is not attached to the articu- lar cartilages, and by being inflated, is caused to protrude in small vesicles or pouches, between the fasciculi ofthe li- gamentous structure. Its connexion with the cartilages, and its continuation over them, is not quite so obvious, and re- quires more management to demónstrate; it is, indeed, so thin and transparent at this part, and adheres so closely, that its existence has been questioned, but may be proved in a variety of ways, as by maceration, &c. The Synovial Sacs have on their outer surface, but pro- jecting into the cavity ofthe joint, adipose cushions of dif- ferent sizes, called the Synovial Glands of Havers, from which, till lately, it was supposed that the lubricating liquor qf the joints was exclusively secreted. These cushions have their projecting margins fringed, are unusually vas- cular, and occupy the small spaces left between the articu- lar faces ofthe bones. As they are covered by the synovial membrane, they no doubt assist in the secretion of the sy- novia. The moveable articulations are all furnished with the fluid called Synovia. This ñame was given to it by Paracelsus, from its resem- blance to the albuminous portion of an egg, to the consist- ence and colour of which it has a cióse afhnity, and like it is thick, ropy, and somewhat yellowish. It is secreted from the whole internal surface of the synovial membrane, and, perhaps, in greater quantities, from the fringed fatty cushions in the joints, in consequence of their increased vascularity. Mr. Beclard believes that it is neither a follicular, ñor a glandular secretion, ñor a transudation; but a perspi- ration, in which a perfect equilibrium is kept up between its exhalation, and its absorption. Its use is to diminish fric- tion, and consequently, to facilitate the sliding of the bones upon each other. HEAD AND SPINE. 405 ARTICULATION OF THE LOWER JAW. This articulation is formed by that portion of the glenoid cavity anterior to the fissure, and by the condyle of the lower jaw. Each surface is covered by a thin cartilage, besides which, there is an inter-articular cartilage, and two synovial membranes, in addition to the ligaments. The whole joint is invested by a capsular ligament, which arises from the margin of the glenoid cavity of the tempo- ral bone, and is inserted into the place where the condyle and neck of the lower jaw unite. This ligament has also an accumulation of fibres intérnally and externally, which are called the Internal and External Ligaments, and restrict somewhat the motions ofthe jaw forwards, and regúlate the position of the vessels and nerves, so that they cannot rea- dily be displaced and injured, by the various motions of the part. By cutting open the capsular ligament, we shall see the Ínter-Articular Cartilage, interposed between the gle- noid cavity and the condyle, having its upper and under sur- faces accommodated to the opposite articular surface of these parts. The two distinct synovial membranes, may also be seen, one passing from the moveable cartilage to the gle- noid cavity, and the other from the lower surface of the car- tilage to the condyle. The cartilage is attached by its cir- cumference to the internal face of the capsular ligament. The Stylo-Maxillary Ligament, arises from the ex- ternal side of the styloid process, and is inserted into the posterior margin of the jaw near its angle, between the masseter and the internal pterygoid muscles. The stylo-glossus muscle is much connected with it, and is thereby assisted in elevating the base of the tongue; the fascia profunda colli is also in continuation with it. OF THE LIGAMENTS OF THE SPINE. Intervertebral Substance.—Between the bodies of all the vertebra except the first and second, a fibro-cartilaginous 406 OF THE LIGAMENTS. matter is placed, which is fixed to their bodies, and is a very potent means of unión. This substance is more fibrous and hard externally, but near its centre it is of apulpy consistence. A horizontal cut seems to demónstrate it as formed of concen- tric fibres, but there are also many others whose course is oblique, and irregular. The central pulpy part is confined by the other, and being also in a state of compression, it makes an articulation in some degree equivalent to the ball and socket joint. The Anterior Vertebral Ligament, is placed on the front part of the spine, and extends from the second verte- bra of the neck to the first bone of the sacrum inclusively. It consists of longitudinal white fibres, and increases gra- dually in breadth, from its commencement to its termina- tion. It adheres very closely to the intervertebral substance, and to the edges of the vertebrae. Where much motion is admitted, as in the neck and loins, it is thinner than on the dorsal vertebree. The Posterior Vertebral Ligament, is placed on the posterior part of the bodies of the vertebrae within the spinal canal. It arises from the edge of the foramen magnum, and passes down to the sacrum and os coccygis, adhering to the bodies of the vertebrae and to the intervertebral substance. It is narrower on the bodies ofthe vertebrae than on the in- tervertebral substance. Articulation of Oblique Processes.—All the Oblique Processes have their capsular and synovial membranes, and are faced with cartilage and a synovial capsule. Articulation of the Spinous Processes.—Ligamentous fibres pass also between all the spinous processes, except those of the neck, where owing to the shortness of the pro- cesses, an arrangement exists called Ligamentum Nüch^, and there are others between the transverse processes. This Ligamentum Nuchíe though continuous with the one just described, may be considered for the sake of perspi- cuity as distinct. It is a tendinous septum, beginning at the spinous process of the seventh cervical vertebra, and HEAD AND SPINE. 407 running up to the occiput, where it is fixed into its vertical ridge and the posterior occipital protuberance. It is con- nected intermediately 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. In quadrupeds it is remarkably strong; but in man, who from his erect position keeps the head nearly balanced, it is com- paratively feeble. Articulation ofthe Bony Bridges ofthe Vertebra.— The intervals between the vertebrae and the posterior part of the spinal canal are filled up by the Yellow Ligaments, so called from their peculiar colour. There are twenty-three pairs of them. They pass be- tween the adjoining vertebrae, one on each side, between the spinous and oblique process, and are best seen from the inside of the vertebral cavity. The first pair passes from the bony bridge of the second vertebra to that of the third, and so on successively to the sacrum. They are very elastic, and assists greatly in elevating the spine, when it has been curved out ofthe proper line. PARTICULAR ARTICULATIONS OF THE SPINE. Articulation of Occiput with Atlas.—There is a cap- sular ligament with its synovial membrane, which surrounds on either side the superior oblique process of the first verte- bra, and is inserted around the root of the corresponding condyle of the os occipitis. The condyles and processes are faced with cartilage. A circular ligament, (Ligamentum Occipito-Atloidien,) arises from the whole superior margin of the first vertebra, and is inserted into the margin ofthe great occipital foramen. Articulation of the Second Vertebra wtith the Occi- put and with the First.—The Second Vertebra, has no articular surface joining the occiput, but some strong liga- ments are passecí between them. The Middle Straight Ligament, or the Occipito-Dentate, passes from the point of the processus dentatus, andis inserted into the anterior part ofthe margin ofthe occipital foramen. 408 OF THE LIGAMENTS. The Moderator or Oblique Ligaments, are two in num- ber, one on each side of the tooth-like process, and arising from the lateral margin of the processus dentatus; they are inserted into the inner margin of the occipital condyle. 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 by an appendix to the forame^ magnum, and the lower edge into the root of the procesÜls dentatus. It keeps the processus dentatus in its place. SECTION II. Ofthe Ligaments ofthe Pelvis. The mode of junction between the sacrum and the last lumbar vertebra, is, in every respect the same as that de- scribed for the bones of the spine generally, with the addi- tion of a ligament on each side, sometimes met with, called Sacro-Vertebral, which arises from the transverse process ofthe last lumbar vertebra, and going obliquely downwards is inserted into the superior part of the sacrum by blending itself with the anterior fibres ofthe sacro-iliac junction. The Sacrum is united to the Coccyx, by a fibro-cartilagi- nous substance resembling that between the bodies of the true vertebrae, with the exception of their being less pulpy matter in its centre, and of its fibrous lamellae being more uniform. The bones of the coccyx are also united to one another in the same way; in consequence of which they are ver}- flexible till the approach of oíd age. The Anterior Coccygeal Ligament, is placed on the fore part of the coccyx, runs its whole length and arises from the inferior extremity of the sacrum. Its fibres are rather indistinct from being blended with fat; on the lateral margins of the coccyx they are better marked. PELVIS. 409 The Posterior Coccygeal Ligament arises from the in- ferior margin of the spinal canal of the sacrum, and, con- tributing to finish the canal or to cióse it up, is then dis- tributed 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 Ilio-Lumbar Ligament arises from the transverse and inferior oblique process of the last lumbar vertebra, and going outwards towards the posterior superior spinous pro- cess of the ilium, is inserted into the adjoining part of the crista. It is much mixed with fat. Just below this the Sacro-Spinous Ligament is extended between the poste- rior superior spinous process and the third and fourth trans- verse processes of the sacrum. The Sacro-Iliac Ligament is an assemblage of very short, strong, compact fibres, which surround this articulation. It is connected to the sacrum by its transverse processes and by the rough surface just on the iliac side of it, and to the ilium by the rough edge just behind its articular surface with the sacrum. In front, the articulation is covered by short, strong fibres. This ligament is so strong that in forcing the joint it does notrupture, but parts from the surface ofthe ilium and some- times brings with it a lamella of bone. The bones of the pelvis are also fastened by two other very strong ligaments, the Sacro-Sciatic. The Posterior Sacro-Sciatic Ligament is the larger of the two, and arises from the posterior inferior spinous process ofthe ilium, from the margin of the sacrum which is below it, from its posterior surface, and from the first bone of the coccyx. Its fibres converging, 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 crus of the ischium. The Anterior Sacro-Sciatic Ligament is much smaller than the other, and has its origin somewhat confounded with 410 OF THE LIGAMENTS. that of the posterior. It arises from the margin of the sacrum, and somewhat from its posterior surface, below its junction with the ilium, and from the side of all the bones of the coc- cyx. Its course is more horizontal than that of the poste- rior, and its fibres converge and are inserted into the spinous process ofthe ischium. The two sacro-sciatic ligaments supply in some degree the place of bone and form a part of the inferior lateral parietes of the pelvis. They convert the sciatic notch into a foramen or rather form with it, two foraraina; the upper and larger of which transmits the pyriformis muscle, the sciatic nerve and the gluteal blood-vessels; while the lower placed between the insertion of the two ligaments, transmits the obturator internus muscle and brings the internal pudic artery into the pelvis. The Articular Surfaces ofthe Sacrum and Ilium are covered each with its appropriate cartilage; that on the sacrum is somewhat thicker than the one on the ilium. The con- tiguous surfaces of these cartilages are rough, and are sepa- rated by a yellow, half-nuid, tenacious substance. The Obturator Ligament is extended across the foramen thyroideum, which it closes, except at the superior part where the obturator vessels and nerves go out. It is also frequently defective, or extremely thin below. The obturator muscles arise from it. The Articulation of the Pubes is formed between the bodies of the Ossa Pubis, and consists of a fibro-cartilaginous matter which filis up the space between them. It is more fibrous externally, and is there formed of concentric lamellae which surround the articulation. In men there is more of this fibrous matter than in women ; in the latter, we frequently find in the posterior part of the symphysis, a little flat oblong cavity occasioned by a distinct píate of cartilage on each bone. This cavity is moistened by a white or yellowish fluid. From frequent observations made in our dissecting-rooms, I have no doubt that this articulation is always very much relaxed in the parturient and pregnant female, which is THORAX. 411 manifested not by the bones separating, but by their sliding upwards and downwards with great readiness. The sacro- iliac junction also becomes relaxed. It was upon the ob- servation of these facts, that the celebrated but nowexploded Sigaultian operation was founded. The Sub-Pubic or Inter-Pubic Ligament, is a strong tendinous 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 fasciculi of fibres, which get collectivelythe ñame ofthe Anterior Pubic Ligament. SECTION III. Articulations of the Thorax. Posterior Articulations of Ribs. The articulations of the bones composing these joints being double, are formed between the heads of the ribs and the bodies of the vertebrae, with the inter-vertebral matter at one point, and between the tubercles of the ribs and trans- verse processes at the other. In either case the respective surfaces are covered by articular cartilage and have a syno- vial membrane. The first joint is the Costo-Vertebral, and the second the Costo-Transverse. The Costo-Vertebral Articulation presents an anterior ligament, an inter-articular ligament, and two synovial mem- branes. The Anterior or Radiating Ligament is fixed as its ñame expresses, in front of the joint. It arises from the margin of the head of the rib by the whole breadth of the latter and diverging towards the spine, is fixed by its supe- rior fibres into the vertebra above; by its inferior fibres, into the vertebra below, and by its middle fibres, into the inter- 412 OF THE LIGAMENTS. vertebral substance. The inter-articular ligament passes from the ridge on the head ofthe rib, to a corresponding line of the inter-vertebral substance. It divides the articulation of the head of the rib into two cavities which have no commu- nication, and it is in consequence ofthe latter, that there are two synovial membranes. The Costo-Transverse Articulation, has in addition to the joint formed between the tubercle ofthe rib and the end of the transverse process, several ligamentous fasciculi which pass in varied directions. Its synovial membrane is much more distinct than in the preceding articulation and contains more synovia. There are a few fibres around the joint having the appearance of a capsule. The Ligamenta Transversaria Interna, arise from the inferior margin of each transverse process between its root and external extremity, and proceeding downwards and inwards are inserted into the upper margin of the neck of the rib below ; its fibres run obliquely inwards. The Ligamenta Transversaria Externa arise from between the points ofthe transverse processes and the back of the ribs just beyond their tubercles, their fibres go outwardly. 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. These poste- rior articulations all require a patient dissection, as they are surrounded by small pareéis of adipose matter, have the in- tercostal nerves and blood-vessels in contact before, and the muscles of the spine behind. ANTERIOR ARTICULATION OF THE RIBS. At its anterior extremity there is a cavity in each rib into which the sternal cartilage fits and is there united. This junction is strengthened by short ligamentous fibres sur- rounding the part and going from the rib to the cartilage, thus presenting an Anterior and Posterior ligament. The cartilages of the seven true tribs run into pits in the THORAX. 413 sternum, and are there secured by the radiated ligaments which lie in front of the joints. The Sternum is covered, both in front and behind, by a strong ligamentous expansión adhering very closely to it. From the second bone of the sternum and from the inferior margin of the seventh true rib, near it, a ligamentous fasci- culus is sent to the cartilago ensiformis, and is called the Costo-Xiphoid Ligament. CHAPTER II. OF THE ARTICULATIONS OF THE UPPER EXTREMITIES. SECTION I. Of the Sterno-Clavicular Articulation. The Clavicle and the Sternum are very firmly united by the breadth of their articulating surfaces, and by the thick- ness of their ligaments. The joint is invested by a thick fibrous capsule, the anterior portion of which presents a strong fasciculus of fibres somewhat separated by small in- terstices. This portion called by some the Radiated Liga- ment, arises from the front of the internal end of the clavicle, and is inserted around the margin of the corresponding part of the articular surface of the sternum. The capsular liga- ment is also strengthenedon its posterior surface, byadditional fibres sometimes called the Posterior Ligament. The Ínter-Clavicular Ligament is closely connected with the capsule of the preceding joint, and lies on the superior end of the sternum, and passes from one clavicle to the other. The Capsular Ligament, is now seen to proceed from around the internal end of the clavicle, and is inserted into the margin ofthe articular surface ofthe sternum. By cut- ting it open we find that there is a moveable cartilage inter- posed between the two bones, connected below with the sternum, above with the clavicle, and 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, UPPER EXTREMITIES. 415 from the upper surface of the cartilage of the first rib, ascends obliquely and is inserted into the tubercle, on the inferior face ofthe clavicle, near the sternum. Of the Scapulo-Clavicular Articulation. These exist at three places; the first by a junction be- tween the acromion scapulae, and the external end of the clavicle, and the last two, by ligaments sent from the cora- coid process to the under surface of the clavicle. The Acromio-Clavicular Articulation is invested by a capsular ligament with its synovial membrane, which unites the acromial end ofthe clavicle 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 also found in this joint. The Coraco-Clavicular Ligament is double, one part being called Conoid, and the other the Trapezoid. It arises from the roughness at the root of the coracoid process, and is inserted into the tubercle near the acromial end of the cla- vicle. The conoid having its base upwards is inserted into the tubercle, near the external end of the clavicle. The conoid and the trapezoid ligaments join each other behind, at an angle which is near a right angle; they are both very strong and fibrous. In front of the subclavius muscle, arising from the root of the coracoid process, and going to the clavicle, and an- terior end ofthe first rib, is the Ligamentum Bicorne. Of the Scapular Ligaments. The Triangular Ligament of the Scapula or Coraco- Acromialis, is extended over the shoulder joint. Its base arises from the whole outer margin ofthe coracoid process, and its apex is fixed to the point ofthe acromion beneath the clavicle. It is thinner in the middle than at either edge. 416 OF THE LIGAMENTS. The Coracoid Ligament ofthe Scapula is stretched across its coracoid notch, and converts it into a foramen for the ves- sels and nerves. Of the Scapulo-Humeral Articulation. The Scapulo-Humeral Articulation is formed by the glenoid cavity ofthe scapula, and the head ofthe os humeri. As usual, each articular surface is covered with cartilage. A capsular ligament arises from the neck of the former, and is inserted into the neck of the latter. A fold or thickening of it, called the Accessory Ligament, (Ligamentum Adsciti- tium) passes from the coracoid process towards the great tu- berosity of the os humeri. By cutting open the joint we see the synovial membrane lining its cavity, and sending a process into the bicipital groove ofthe os humeri, which is afterwards reflected along the tendón of the biceps in such a way as to keep its cavity entire. This tendón is connected with the upper margin of the glenoid cavity, and also with the fibrous ring, called the Glenoid Ligament, which surrounds the glenoid cavity, and by being attached to its edge deepens it. OF THE ELBOW JOINT. The Elbow Joint has a capsular ligament arising from the upper margin of the articular surface of the os humeri in- cluding its sigmoid cavities, and inserted into the margin of the articular surface of the ulna, and into the coronary li- gament of the radius. This capsule has additional fibres intérnally, and externally, called Lateral Ligaments, or Brachio-Ulnar or Internal, and Brachio-Radial or Exter- nal. The Internal arises from the internal condyle, and spreads in a radiated manner to be inserted into the inner edge of the coronoid, and olecranon process. The Exter- na! arises from the external condyle, and is inserted into the coronary ligament ofthe radius. The Coronary Ligament of the Radius arises from one upper extremities. 417 » side of the sigmoid cavity of the coronoid process 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 capsular ligament, and the lower is loosely attached to the root of the neck of the radius. On the anterior and posterior surfaces of the capsule of the elbow joint, there are small and irregular fibres, termed accessory ligaments, but the capsule is particularly thin under them, in order to accommodate the flexions of the joint. By cutting open the capsule, we see the extent ofthe sy- novial membrane, and the cartilaginous surfaces ofthe bones. At the bottom of the greater sigmoid cavity of the ulna, a small quantity of vascular adipose matter is found traversing the articular cartilage, and interrupting it. The Interosseous Ligament, filis up the space between the radius and the ulna, being fixed on ea'ch side to their sharp edges. It is composed principally of oblique fibres, which pass from the radius to the ulna. In it are several perforations for blood-vessels, one particularly large is just at the tubercle of the radius. There is a small ligamentous band, called the Round Li- gament, at the upper part of the opening for the vessels, and which goes from the base of the coronoid process of the ulna to the radius, just below its tubercle. OF THE ARTICULATIONS AT THE WRIST. Several articular cavities present themselves at this point. One is between the lower part of the ulna, and the radius, another between the carpal bones, and those of the fore-arm, and a third between the two rows of carpal bones. One ge- neral capsule invests all these parts. The I ower Radio-Ulnar Articulation is formed into a distinct joint, by the lateral projection ofthe articular carti- 27 418 OF THE LIGAMENTS. lage of the radius, between the ulna and the cuneiform bone. The capsule which unites this joint is very loóse, and is henee sometimes called the Sacciform Ligament. The Radio-Carpal Articulations is formed between the lower end of the radius and the first three bones of the up- per row ofthe carpus. A capsular ligament passes from the margin of the cartilaginous surface of the radius, and from the part of the same cartilage which is continued between the ulna and the cuneiform bone, and is inserted into the margin of the articular head, formed by the scaphoides, lu- nare, and cuneiforme bones. The External Lateral Ligament arises from the styloid process of the radius, and is inserted into the scaphoid bone, the trapezium, and anterior annular ligament. The Internal Lateral Ligament arises from the styloid process of the ulna, and is inserted into the inner side of the cuneiform bone, and partly into the pisiform and the corresponding part oí the anterior ligament, which confines the flexor tendons.. By cutting open this articulation we see the synovial membrane ofthe part, and a fold of it called by some writers the Mucous Ligament, which passes from between the sca- phoides and limare, to the radius. We also see the carti- lage of the radius projecting between the cuneiform bone and the head ofthe ulna, and forming with the head ofthe ulna, a distinct joint, as stated. The Articulation between the First and the Second row of carpal bones is formed by a capsular ligament, which goes from the first to the second row, being strengthened laterally by a multiplication of its fibres, constituting lateral liga- ments intérnally and externally; the fibres of the capsular ligament, and of the radio-carpal joint, are continued into this. There are also several fasciculi of fibres which run in varied directions, some oblique, and some transverse, fastening the two rows together, as well as the individual bones ofthe same row. When this joint is opened we find but one synovial membrane for the two rows of bones, where upper extremities. 419 they are in contact, and this membrane sends in digital pro- cesses, between the lateral surfaces of the several bones, which are opposite to each other. There are strong ligaments which go from the carpal to the bases of the metacarpal bones, but owing to the irregu- lar surfaces of these bones, but little motion is allowed, al- though the apparatus of articulation is complete, with its capsular ligaments, and synovial membranes. The meta- carpal bone of the little finger has more motion than those ofthe 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 basis by transverse ligamentous fasciculi; they are also connected at their heads in the same manner by the inferior palmar ligaments. - A strong capsular ligament, with its synovial membrane, is applied to the articulation between the trapezium and the thumb. This capsule is of nearly an uniform thickness, being very similar, in that respect, to the capsule of the shoulder jointj and therefore, admits of every variety of motion. Between the heads of the metacarpal bones and the first phalanges, there is a capsule and a synovial membrane. The capsule being thickened at its sides, thus forms lateral ligaments. In front it has a cartilaginous thickening which forms a trochlea for the flexor tendón. Behind, it is im- perfect, the principal strength being derived from the tendón of the extensor muscle. The Phalanges are articulated in the same way with each other, that they are articulated with the metacarpal bones; thus they have an Anterior Ligament, an Internal and Ex- ternal Lateral Ligament and a Synovial Membrane. CHAPTER III. OF THE ARTICULATION OF THE LOWER EXTREMITY. SECTION I. Of the Hip Joint. The Hip Joint is formed by the acetabulum and the head and neck of the os femoris, which parts are enclosed in a strong capsular ligament, arising on the outer circumference of the margin of the acetabulum, and inserted into the root ofthe neck of the os femoris. The capsular ligament varies in its thickness at different places ; in front it is a fourth of an inch thick, intérnally it is somewhat thinner, and poste- riorly where it is covered by the quadratus muscle, it is thinnest. From the anterior inferior spinous process, acces- sory fibres arise, which give to the capsule an increased thickness above, but its strength depends principally on the muscles which surround it. By cutting open the capsule, we see that its internal face, as well as the surfaces of the bones, are covered by a deli- cate synovial membrane which is thrown into longitudinal folds on the neck of the os femoris; and that a strong liga- mentous cord, passes from one side of the notch in the lower part ofthe acetabulum, to the other, leaving an opening be- low 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 INFERIOR EXTREMITIES. 421 from it, its insertion into the extremities of the notch of the acetabulum by a bifurcated termination, and into the inferior margin of the cord sub-tending the notch, 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 of loóse vascu- lar, adipose matter, filis up the pit in the bottom of the acetabulum, and is covered by the synovial membrane. By some anatomists it is called the Gland of the Hip Joint. OF THE KNEE JOINT. The Knee Joint is formed by the os femoris, tibia, and patella. The fascia of the lower extremity in passing from the thigh to the leg, covers this joint in front, as far back as the lateral ligaments, and takes the place of a regular cap- sular ligament. It is there called Involucrum. The External Lateral Ligament arises from the tube- rosity of the external condyle, and is inserted into the head of the fibula. The Internal Lateral Ligament arisesfrom the tuberosity of the internal condyle, and is inserted into the inner side of the head of the tibia, being continued for some distance down the edge of the bone. The front of the joint is much strengthened by the ligament of the patella which passes from the point of the patella to the tubercle of the tibia. On the posterior 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. By opening the joint in front so as to let the patella fall upon the tibia, a good view of its internal arrangement may be obtained. The synovial membrane will be seen arising from the cartilaginous margin ofthe head of the tibia, and around that of the patella; but it is reflected on the front and sides ofthe condyles ofthe os femoris, half an inch or more above the margin of its cartilaginous surface. On 122 OF THE LIGAMENTS. 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 ofthe tibia. This fat projects into the cavity ofthe articu- lation, and forms on each side of the patella an oblong ridge covered by the synovial membrane. It is called, on the external side of the patella, the Ligamentum Alare Minus, and on its internal portion, the Ligamentum Alare Majus. These ligaments terminate each in a point below the patella, where they are in contact with each other; and from this place a duplicature of synovial membrane, ending on the crucial ligaments, and on the os femoris between its condyles, is extended to the posterior part of the articula- tion and is called the Ligamentum Mucosum. 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 con- dyle, 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 Posterior arises from the ex- ternal face of the internal condyle ofthe 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 cartilage. 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 circumference and are brought to a thin edge intérnally; are fastened to the cap- sular and the lateral ligament by their outer margin, but the internal is loóse; their upper and under surfaces are covered by the synovial membrane. The internal is longer from before backwards than transversely, and is semicircu- lar; 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 these cartilages is fixed to the tibia, between the spine on its top, and the posterior crucial ligament: their anterior ends are inserted INFERIOR EXTREMITIES. 423 into the tibia before the same spine. Occasionally a trans- verse 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 tendón ofthe extensor 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 ñames of Anterior and Posterior JL-igament. But this joint is particularly strengthened by the insertion of the external lateral ligament of the knee and by the tendón of the biceps muscle. The Interosseous Ligament filis the interstice between 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 descend- ing from the tibia to the fibula, and forming a thin strong membrane. Just below the head of the tibia, it is perforated by a large foramen, which transmits the tibialis posticus muscle and the anterior tibial artery and vein; lower down it has several small foramina for blood-vessels, and near the ankle joint it is perforated also by the fibular artery. The tibia and fibula are united at the ankle joint by tri- angular surfaces, concave on the part of the tibia, and con- vex on the part of the fibula. These surfaces are held to- gether by intermediate ligamentous matter, as well as a li- gament expanded on the front and back of the junction called the Anterior and the Posterior Ligaments. The car- tilaginous crust, on the ends of the tibia and the fibula, be- longing to the ankle joint, are continued for a line or two, on the opposed surfaces of the tibia and the fibula. 424 OF THE LIGAMENTS. OF THE ANKLE JOINT. The Ankle Joint is formed by the tibia, fibula, and astra- galus. The capsular ligament is extremely thin, and, in- deed, has no very evident existence before and behind, excepting a few scattered fibres. The fatty matter which sur- rounds the joint, is in immediate contact with the synovial membrane, and protrudes it in some places, inwards, to- wards the cavity of the articulation. There are very strong lateral ligaments on both sides. The Internal Lateral Ligament, also called Deltoid, arises from the inferior extremity of the malleolar process of the tibia, and by radiating considerably, is inserted into the les- ser apophysis of the os calcis, and into the internal base of the astragalus. The External Lateral Ligament is divided into three fasciculi. The Anterior arises from the anterior part ofthe end ofthe malleolus externus, and passes obliquely forwards, to be inserted into the upper and outer part of the astragalus. The Middle fasciculus, arises from the pointed extremity of the fibula, and descends perpendicu- larly to be inserted into the outside of the os calcis. The Posterior, comes from the depression in the extremity of the malleolus externus, and passes very obliquely to be insert- ed into the outer back part of the astragalus. On cutting open this joint, it will be seen that the syno- vial membrane is connected to the several bones at the mar- gins ofthe cartilaginous articular surfaces. OF THE ARTICULATIONS OF THE FOOT. The Os Calcis and the Astragalus are united by ligaments investing their articulating surfaces; the synovial cap- sule belonging to their posterior surface is insulated, but the anterior is extended into that which unites the os astragalus and the naviculare. Between the two bones there is a very INFERIOR EXTREMITIES. 525 strong ligament, the Interosseous, which arises from the fossa of one, to be inserted into the fossa of the other ; it is their best means of unión. A small ligament called the Posterior is found at the back of this joint. The Synovial Membrane forms a distinct cavity on the posterior, and large articular surface of the two bones, and is in contact with the fatty matter, in advance of the tendo- achillo. The Scaphoides and the Astragalus are united by a capsular ligament with its synovial membrane. This cap- sule is thickened by additional slips above and intérnally; the whole arrangement of the joint is such as to admit of much motion. The Os Calcis and Cuboides, besides their articular car- tilage and synovial membrane, form a moveable joint with a very strong ligamentous fastening, called the Calcaneo- Cuboid Ligaments. The Superior arising from the upper surface of the os calcis, is inserted into the adjoining part of the cuboides. The Inferior one is much the strongest, and consists of two laminae, of which the superficial is the longest; some of its fibres may be traced to the basis of the outer metatarsal bone. A very strong ligament, the Inner Calcaneo-Scaphoid, passes from the interior internal part of the os calcis by its lesser apophysis and is fixed into the inner and un- der surface of the scaphoides. This ligament supports the astragalus. The External Calcaneo-Scaphoid Ligament passes from the greater apophysis of the Os Calcis below, and is fixed to the outer end of the scaphoides. There are -many other strong ligaments on the dor- sal and plantar surfaces of the foot, connecting the bones 426 OF THE LIGAMENTS. of the tarsus together; their course is varied and com- plicated. The Ligaments ofthe Metatarsus and Phalanges corres- pond nearly with those of the metacarpus, and the pha- langes of the fingers. PART V. OF THE DERMOID COVERING. The Dermoid Covering or tissue of the body, consists in the Skin, its Sebaceous Organs, the Nails and the Hair. CHAPTER I. SECTION I. Ofthe S/cin. The Skin (Pellis, Cutis, ho^a) consists of the Cuticle, Rete Mucosum, and Cutis Vera. These parts are easily separated by maceration; also by boiling or immersion in hot water for a few minutes, and immediately after- wards throwing the section, thus heated, into cold water. Vesicatories, applied to the living body, also cause the cuticle to detach itself from the Cutis Vera. The Cuticle is a very thin semitransparent membrane, distributed over almost the whole surface of the body. In some parts, as on the palms ofthe hands, and tbe soles of the feet, it is from birth much thicker than in others ; and from friction and pressure in after life, increases farther in its proportionate thickness. The cuticle presents every 428 OF THE INTEGUMENTS. where, but more obviously in the hands and feet, a multi- tude of furrows caused by the surface of the cutis vera, and which are arranged in straight, curved, or spiral lines. It adheres to the cutis vera, and is perforated by the ex- cretory orifices of the sebaceous organs and by the hairs, and according to some anatomists by the origin of ab- sorbent and exhalent vessels. The perforations are best seen on the nose, ears, and external parts of generation. From the internal 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 approximated 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 evapora- ron 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, but is not so obvious beneath the nails, and at the orifices of mucous membranes. Its consistence is mucilaginous, from which its ñame is derived. Mr. Gaultier states, that on the soles of the feet in ne- groes, the rete mucosum is seen to be disposed in the fol- lowing manner: lst. On the inequalities ofthe cutis vera, next to its papilla?, there is a layer, which he calis bloody pimples, (bourgeons sanguins) but which in the opinión of other anatomists, are only the papillse of the cutis vera. 2d. Next to them is a layer called Albida Profunda, on account of its constant colour and situation. 3d. Then small points, constituting a layer, placed over the last, of a very dark brown, in negroes, which he calis Gemmula. And 4th, a layer adjacent to thé cuticle, spread over tho 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 OF THE SKIN. 429 may be readily recognised. 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 solutioñ of potash or baryta, and afterwards keeping it the same length of time in a solutioñ of corrosive sublimate. The existence of this arrangement ofthe rete mucosum, may be established in other parts ofthe body by the effects of blisters. The fluids being thus locally attracted, infíltrate the rete mucosum and sepárate its layers, in part, so as 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 interior surface is in cióse connexion with the subjacent cellular and adipose mem- brane, from which it may be imperfectly separated by dis- section.* The cutis vera is extremely elastic. Its thick- ness 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 and vulva it is very thin. The cutis vera, on its external face, is divided by nu- merous lines running in different directions. When the cuticle is removed, this surface is seen to be studded with small filamentous processes, the papillse tactus, which are extremely sensitive and vascular. 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. * But maceration is a much mora complete way of eíFecting this separation. 430 OF THE INTEGUMENTS. SECTION II. Ofthe Hair. The Hair grows in the cellular membrane beneath the skin. It is best studied on the mustachios of the larger animáis, as the horse, ox, &c. Around the root of each hair there are two capsules, one within the other. The internal is very vascular. In the root of the hair there is a hollow canal filled with a pulpy substance. SECTION III. Ofthe Nails. The Nails are a continuation of the cuticle, but are in- debted 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 maceration, their form and origin may be readily seen. SECTION IV. Ofthe Sebaceous Organs. These consist of follicles and glands. The Follicles- secrete an unctuous fluid which, by inspissation, becomes of the consistence of suet. They are seated in the skin, and are more abundant in some parts, as for example, on the nose, ears, groins and external parts of generation, than OF THE SEBACEOUS ORGANS. 431 in others. The follicles are placed also around the roots ofthe hair in the interior ofthe capsules. The Sebaceous Glands are about the size of millet seeds, and are placed under the cutis vera. They are particularly numerous under the skin ofthe Mons Veneris. The recent investigations of the Dermoid tissues have enlarged our knowledge of their structure so much that the present account can only be regarded as an outiine. To enter more fully into their structure would be incompatible with the arrangements ofthe present work, and those, there- fore, who may desire more detailed information are referred to the volume on Special Anatomy and Histology. INDEX. Page Abdomen, 173 Abdominal Aorta, 286 Abdominal Canal, 188 Abductor Indicis Manus, 334 Abductor Indicis Pedis, 380 Abductor Medii Digiti, 381 Abductor Minimi Digiti Pedis, 379 Abductor Minimi Digiti Manus, 334 Abductor Pollicis Pedis, 378 Abductor Pollicis Manus, 334 Abductor Tertii Digiti, 381 Accelerator Urinae muscle, 250 Accessory Ligament, 416 Acini of Liver, 216 Adductor Brevis muscle, 361 Adductor Digiti Minimi, 381 Adductor Indicis Pedis, 380 Adductor Longus muscle, 361 Adductor Magnus muscle, 361 Adductor Medii Digiti, 381 Adductor Metacarpi Mini- mi Digiti, 335 Adductor Pollicis Pedis, 373 Adductor Pollicis Manus, 331 Adductor Tertii Digiti, 381 Albida Profunda, 423 Albida Superficialis, 423 Alveus Communis, 131 Anastomosing artery of fe- moral, 385 28 PAGB Anconeus muscle, 319 Annular Ligaments, 325 Annulus Fossee Ovalis, 160 Ankle Joint, 424 Antitragus, 127 Anterior Auricular muscle, 128 Anterior Chamber of Eye, 124 Anterior Ligament of Ute- rus, 266 Anterior Ligament of Blad- der, 255 Anterior Mediastinum, 235 Anterior Pubic Ligament, 155 Anterior Sacro-Sciatic Li- gament, 411 Anterior Tibial Nerve, 399 Anterior Tibial artery, 337 Anterior Vertebral Liga- ment, 406 Antitragicus muscle, 128 Antithelix, 127 Aponeurosis or Fascia Plan- taris, 376 Aponeurosis Palmaris, 332 Aponeurosis Pélvica, 255 Appendicula of Hyoides, 145 Appendiculse Epiploicae, 205 Appendicula Vermiformis, 210 Aqueduct of Cotunnius, 134 Aqueduct of Fallopius, 135 Aqueduct of Fontana, 122 Aqueous Humour, 121 434 INDEX. PAGE PAGE Arbor Vitae, 56 Brachio-Radial Ligament, 416 Arcus Superficialis, 345 Brachio Ulnar Ligament, 416 Areola, 273 Bronchiae, 167 Arteries of Dura Mater, 46 Bronchial arteries, 167 ,286 Arteria Anastomotica, 341 Buccinator, 74 Arteria Centralis, 123 Arteria ad Cutem Abdomi- Canal of Eustachius, 129 nis, 185 Canal of Petit, 124 Arteria Dorsalis Superior Capsule of Glisson, 215 Scapulse, 339 Caput Gallinaginis, 237 Arteria Facialis, 97 Cardiac Orifice, 207 Arteria Innominata, 285 Carotid Artery, 94 Arteria Lingualis, 95 Carunculae Myrtiformes, 115,265 Arteriae Mammariae Exter- Cavitas Innominata, 127 nee, 339 Cauda Equina, 69 Arteria Maxillaris, 99 Centrum Ovale, 50 Arteria Occipitalis 97 Cerebrum, 47 Arteria Pharyngea Inferior, 97 Cerebellum, 55 Arteria Temporalis, 98 Cervicalis Anterior, 102 Arteria Thyroidea Inferior, 102 Cervicalis Descendens mus- Arteria Vertebralis, 64 , 102 cle, 307 Articulation of Lower Jaw, 405 Cervical Ganglions, 112 Aryteno-Epiglottideusmus- Cervical Nerves, 113 cle, 150 Cervicalis Posterior, 102 Arytenoid Cartilages, 146 Chordae Tendineae, 160 Arytenoideus obliquus mus- Chorda Tympani, 135 cle, 149 Chordae YVillisii, 44 Arytenoideus transversus Ciliaris, 75 muscle, 149 Ciliary arteries, 125 Attollens Auriculae muscle, 128 Ciliary Ligament, 122 Axillary artery, 33-i Ciliary ¡Striae, 122 Axillary plexus, 113 Circumflexa Anterior artery, 310 Azygos Uvulaj, 113 Circumflexa Ilii artery, 291 Circumflexa Posteriorartery 340 Ball of Eye, 119 Coccygeus muscle, 251 Biceps Flexor Cubiti mus- Cochlea, 13:1 cle, 317 Coecum, 210 Biceps Flexor Cruris, 366 Cceliac Artery, 287 Bladder, 235 Colon, 199 Blood-vessels of Brain, 63 Columna Nasi, 137 Blood-vessels of Lower Columnas Carnea?, 160 Extremities, :382 Col umnsof AbdominalRing 177 Blood-vessels of Head ai.d Columns of Rectum, 233 Neck, 91 Commissures of Cerebrum, 51 Blood-vessels of Trunk, 2^5 Complexus muscle, 308 Blood-vessels of Upper Ex- Corrípressor Naris, 70 tremities, 338 Concha, 127 Brachial artery, 338 Conoid Ligament, 415 Brachialis Externus, 319 Constrictor Jstlimi Faucium Brachialis Internus, 318 muscle, 112 INDEX. 435 Constrictor Pharyngis infe rior muscle, " " medius, " " superior, Contents of Abdomen, Coraco-Brachialis muscle, Coracoid Ligament, Cornea, Corona Glandis, Corroded Preparations, Corpus Callosum, Corpus Cavernosum Penis, Corpus Ciliare, Corpus Fimbriatum, Corpus Highmorianum, Corpus Pampiniforme, Corpus Spongiosum Ure- thra?, Corpus Spongiosum Vagi- nae, Corpus Striatum, Coronary arteries, Coronary Ligament, Coronary Ligament of Ra- dius, Corpusculum Aurantii, Corrugator Supericilii, Costo-Clavicular Ligament, Costo-Xiphoid Ligament, Cotyloid Ligament, Cowper's Glands, Cuticle, Clitoris, Cranium, Integuments of Cremaster muscle, 18: Cribriform fascia, Crico-Arytenoideus Posti- cus, Crico-Arytenoideus Latera- lis, Cricoid Cartilage, Crico-Thyroideus muscle, Crural Arch, Crura of Diaphragm, Crural Ring, Cruralis Anterior nerve, Crura?us muscle, Crucial Ligaments, Cr.stalline Humour, PAGE 143 111 144 199 318 416 121 242 33 48 241 122 269 246 248 241 264 51 164 213 416 161 73 414 413 421 238 427 262 41 ,245 196 Cupok, Cutaneus Anterior nerve, Cutaneus Externus nerve, Cutaneus Internus nerve, Cutaneus Medius nerve, Cutis Vera, Cystic Duct, 148 149 146 148 177 2Í9 1 6 395 359 422 12 i Dartos, Dorsalis Carpi artery, Dorsalis Manus artery, Dorsalis Hallucis artery, Deltoid ligament, Deltoid muscle, Depressor Anguli oris, Depressor Labii Inferioris, Depressor Labii Superioris Alaeque nasi, Decendens Noni, Diaphragm, Digastricus, Ductus Communis Chole- docus, 219 Ductus Ejaculatorius, 240, 248 Ductus ad Nasum, 137 Ductus Stenonianus, 92 Ductus Whartonianus, 93 Ductus Wirsungii, 222 Duodenum, 208 Dura Mater, 43 PAGE 133 394 394 395 394 429 219 244 342 344 388 424 314 74 74 74 111 227 85 Ear, Elbow Join, Eminentiae Mamillares, Emulgent arteries, 224, Eneephalon, Epididymis, Epigastric artery, Epigastrio región, Epiglottis Cartilage, Erector Penis muscle, Eustachian Valve, Excretory Duct of Kidney, Extensor Brevis Digito- um Pedis, Extensor Carpi Radialis Brevior, I Extensor Carpi Radialis Longior, 126 416 59 289 42 247 294 173 147 249 160 225 375 328 327 436 INDEX. PAGE PAGE Extensor Carpi Ulnaris, 328 Female Pelvis, 260 Extensor Digitorum Com- Femoral Canal, 198 munis, 328 Fissura Vulvae, 261 Extensor Longus Digito- Flexor Accessorius muscle, 377 rum Pedis, 368 Flexor Brevis Digitorum Extensor Major Pollicis Pedis, 377 Manus, 330 Flexor Brevis Minimi Di- Extensor Minor Pollicis giti Pedis, 380 Manus, 330 Flexor Brevis Pollicis Ma- Extensor Ossis Metacarpi nus, 333 Pollicis, 330 Ffffxor Brevis Pollicis Pe- Extensor Proprius Pollicis dis, 379 Pedis, 368 Flexor Digitorum Profun- External Abdominal Ring, 177 dus, 323 External Ear, 128 Flexor Digitorum Subli- Exter. Calcaneo-Scaphoid mis, 322 Ligament, 425 Flexor Longus Pollicis, 323 External Carotid, 95 Flexor Longus Digitorum External Circumflex, 384 Pedis, 373 External parts of Head and Flexor Manus vel Carpi Neck, 41 Ulnaris, 321 External Iliac artery, 294 Flexor Longus Pollicis Pe- External Jugular, 102 dis, 374 External Lateral Ligament Flexor Manus vel Carpi of Wrist, 418 Radialis, 321 External Lateral Ligament Flexor Parvus Minimi Di- of Knee, 421 giti Manus, 334 External Malleolar artery, 387 Foramen Caecum of Mor- External Plantar artery, 389 gagni, 141 External Plantar nerve, 400 Foramen Rotundum of Ear, 129 External Pudic artery, 383 Foramen GEsophageum, 227 Eye, 114 " Quadratum, 228 Foramen of Monro, 53 Falciform T igament, 212 Foramen Ovale of ear, 129 Fallopian Tubes, 259 Foramen of Scemmering, 123 Falx Major, 43 Foramina Thebesii, 160 Fascia Femoris, 194 Foramen of Winslow, 203 Fascia Iliaca, 195 Fornix, 51 Fascia of Lower Extremi- Fossa Navicularis, 243 ties. 355 Fossa Ovalis, 160 Fascia Profunda Cervicalis, 81 Fourchette, 261 Fascia Profundi Colli, 81 Fascia Superficialis, 187 Gall-Bladder, 218 Fascia Superficialis Colli, 79 Gastric artery, 287 Fascia of Upper extremities, 313 Gastrocnemius muscle, 371 Fauces, 141 Gemmula, 428 Female Mammae, 271 Gemini muscles, 364 Female Organs of Genera- Genio-Hyo-Glossus, 87 tion, 260 Genio-Hyoideus, 87 INDEX. 437 PAGE PAGE Gimbernat's Ligament, 177 Itercostals, 154 Glands of Brunner, 209 Intercostal arteries, 286 Glans Penis, 242 Intercosto-humeral nerves, 353 Glándula? Labiales et Buc- Internal Abdominal Ring, 183 cales, 141 Internal Calcaneo-Scaphoid Glands of Meibomius, 114 Ligament, 425 Glands of Tyson, 242 Internal Carotid, 100 Glenoid Ligament, 416 Internal Circumflexa artery, 381 Glosso-Pharyngeal, 110 Internal Iliac vein, 295 Glottis, 150 Internal Jugular, 103 Gluteal artery, 293 Internal Lateral Ligament Gluteus Magnus, 362 of Wrist, 413 Gluteus Medius, 362 Internal Lateral Ligament Gluteus Minimus, 363 of Knee, 421 Gracilis, 360 Internal Malleolar artery, 387 Internal Mammary vein, 295 Hair, 430 Internal Mammary artery, 285 Hamulus, L3 Internal Plantar nerve, 400 Head and Neck, 41 Internal Plantar artery, 389 Heart, 153 Internal Pudic artery, 293 Helix, 127 Interossea Artery, 341 Helicis Major muscle, 123 Inter-Pubic Ligament, 254 Helicis Minor muscle, 123 Interosseous Ligament of Hepatic Artery, 217,287 fore-arm, 417 Hepatic Duct, 216 Interosseous Ligament of Hernia, 193 Leg, 423 Hey's Ligament, 198 Interossea anterior artery, 344 Hiatus Aorticus, 228 Interossea posterior artery, 344 Hippocampus, 51 Interosseus Digiti Auricu- Humours of the Eye, 123 laris, 336 Hyo-Glossus, 88 Inter-Spinales muscles, 310 Hypoglossal nerve, 63 Injections, 19 Hypogastric artery, 290 Inter-Transversarii muscles, 310 Hypogastric región, 173 Intestinal Canal, 208 Hymen. 264 Involucrum, 359 ,421 Iris, 122 Ileo-Colic Valve, 211 Isthmus of Fauces, 142 Ileo-Colic artery, 289 Ischiatic artery, 293 Ileum, 209 Iliacus Internus muscle, 238 Jejunum, 209 Ilio-Lumhar artery, 291 Joints at Wrist, 417 Ilio-Lumbar Ligament, 409 Incus, 130 Kidneys, 223 Indicator muscle, 331 Knee Joint, 421 Infundibulum, 5Í 1, 225 Inferior Maxiliary nerve, 107 Labia Externa, 261 Inferior. Mesenteric artery, 290 Labia Interna, 262 Infra-Spinatus muscle, 316 Labyrinth, 133 ínter-Clavicular Ligament, 414 Lachrymal Gland, 116 29 438 INDEX. PAGE PAGE Lachrymal Sac and Ducts, 115 Ligamentum Suspensorium Penis, Lamina Spiralis, 133 240 Large Intestino, 210 Ligamentum Teres, 420 Laryngeal Nerves, 111 Ligaments of Thorax, 411 Larynx, 145 Ligamenta Transversaria Lateral Half Arches of Interna, 412 fauces, 141 Ligaments of Upper Extre- Lateral Ligaments of Ute- mities, 414 rus, 266 Ligament of Winslow, 421 Lateral Nasal Nerve, 107 Linea Alba, 176 Lateral Sacral arteries, 291 Linea Semilunaris, 176 Lateral Ventricles, 50 Linea? Transversa?, 176 Latissimus Dorsi, 301 Lingualis, 88 Laxator Tympani muscle, 132 Lingual Nerve, 108 Left Gastro-Epiploic artery, 217 Liver, 199,212 Left Auricle, 162 Lobus, 126 Left Lumbar región, 173 Lobulus Anonymus, 213 Left Ventricle, 163 Lobulus Caudatus, 213 Left Lateral Ligament, 213 Lobulus Spigelii, 213 Left Hypochondriac región, 173 Longissimus Dorsi Muscle, 306 Left Iliac región, 173 Longus Colli, 88 Levator Ani muscle, 251 ,257 Lower Extremities, 355 Levator Anguli Oris, 73 Lower Hemorrhoidal Ar- Levator Labii Inferioris, 76 tery, 293 Levator Labii Superioris Lumbar Arteries, 290 Alaeque Nasi, 73 Lumbricales muscles, 332 Levator Palati, 142 Lumbricales Pedis mus- Levator Scapulae muscle, 304 cles, 378 Levatores Costarum mus- Lungs, 165 cles, 311 Lymphatic Glands of Neck, 93 Ligamentum Alare Majus, 422 Ligamentum Alare Minus, 422 Magna Pollicis artery, 343 Ligamentum Arcuatum, 229 Malleus, 129 Ligamentum Bicorne, 415 Male Pelvis, 232 Ligamenta Cervicum Cos- Masseter, 76 tarum, 412 Meatus Auditorius Exter- Ligaments of Foot, 424 nus, 126 Ligaments of Head and Medulla Oblongata, 56 Spine, 407 Mediastinum, 155 Ligaments of Head and Median Basilic vein, 346 Trunk, 405 Median Cephalic vein, 346 Ligamentum Nucha?, 406 Membrane of Jacobs or Tú- Ligaments *>f Inferior Ex- nica Jacobi, 122 tremities, 420 Membrana Pupillaris, 122 Ligamentum Patella?, 359 Membranous portion of Ure- Ligaments of Pelvis, 408 thra, 243 Ligament of Poupart, 177 Membrana Tympani, 129 Ligamentum Pulmonis, 165 Mesentery, 205 Ligaments of Spine, 405 Mesocolon, 206 INDEX. 439 PAGE 1 PAGE Metatarsal artery, 388 Nerves of Orbit, 125 Middle Hemorrhoidal, 291 Nervus Pudendalis Supe- Middle Thyro-Hyoid Liga- rior, 397 ment, 117 Nervus Radialis or Múscu- Middle Sacral artery, 290 lo Spiralis, 351 Mitral Valve, 163 Nervus Scapularis, 348 Moderator Ligaments, 408 Nervi Subscapulares 31- Modiolus, 133 Nervi Thoracici, 349 Mons Veneris, 261 Nervus Trigeminus, 105 Motores Externi, 62 Nervus Trochlearis, 61 Motor Externus, 61 Nervus Ulnaris, 352 Mouth, 139 Nerves of Upper Extremi- Mucous Ligament of Wrist, 418 ties, 348 Muscles of Abdomen, 175 Nerves and Vessels of Muscles of Back, 299 Trunk, 275 Muscles of Eye, 116 Nipple, o^jj Muscles of Face, 70 Nose, 136 Muscles of Foot, 375 Nutritia Arteria, 341 Muscles on Back of Fore- Nympha?, 262 Arm, 327 Muscles in Front of Fore- Obliquus Capitis Su perior Arm, 320 muscle, 310 Muscles of Leg, 367 Obliquus Capitis Inferior Muscles of Lower Extremi- muscle, 310 ties, 357 Obliquus Externus mus- Muscles of the Neck, 78 ele, 177 Muscles of Thorax, 151 Obliquus Internus mus- Muscles of Upper Extre- ele, 179 mities, 315 Obturator artery, 291 Musculi Pectinati, 159 Obturator Externus mus- Multifidus Spina? muscle, 309 ele, 365 Mylo-Hyoideus, 86 Obturator Internus mus- Nasal Nerve, 139 cíe, Obturator Ligament, 410 Nails, 430 Occipito Dentale Liga- Nervus Axillaris orCircum- ment, 407 flexus, 350 Occipito Frontalis, 70 Nerves cf basis of Brain, 59 CEsophagus, 114 Nervus Cutaneus Internus, 350 (Esophageal arteries 286 Nervus Musculo-Cutaneus, 350 Olfactory nerves, 138,60 Nerves of Head and Neck, 103 Omenta, 202 Nervus Ischiadicus, 397 Omentum Colioum, 205 Nerves of Lower Extre- Omentum majus, 200,202 mities, 392 Omentum minus, 202 Nervus Medianus, 352 Omentum Gastro-Spleni- Nervus Motor Oculi, 61 cum, 205 Nervus Obturatorius, 395 Omo-Hyoideus, 85 Nerve Olfactory, 60 Ophthalmic artery, 125 Nerve Optic, 60 Opponens Pollicis, 333 440 INDEX. PAGE PAGE Optic nerve, 1 35,60 Phrenic arteries, 287 Orbicularis Oris, 76 Phrenic Nerve, 113,275 Orbicularis Palpebrarum, 71 Pia Mater, 46 Orifice of Parotid Gland, 92 Pigmentum Nigrum, 121 Os Hyoides, 145 Pineal Gland, 54 Os Orbiculare, 130 Pinna, 126 Os Tinca?, * 269 Pituitary Gland, 59 Ostium Venosum, 160 Plantaris muscle, 372 Ovaries, 269 Platysma Myodes, 79 Ovula Nabothi, 269 Pleura, Pleura Costalis, 155 155 Palatine Nerve, 107 Pleura Pulmonalis, 155 Palmaris Brevis muscle, 332 Plexus Choroides, 52 Palmaris Longus, 321 Plexus Lumbalis, 392 Palmaris Profunda artery, 343 Pneumogastric nerve, 111 Palato-Pharyngeus mus- Pomum Adami, 146 ele, 142 Pons Varolii, 57 Palpebral Ligaments » 114 Posterior Annularis, 337 Páncreas, 200,222 Posterior Auris, 93 Pancreatic arteries, 2*3 Posterior Carpal Ligament, 331 Papilla?, 140 Posterior Chamber of Eye, 121 " Capitata? or Maxi- Portio Dura, 105 ma?, 140 Posterior Indicis, 336 " Media?, 140 Posterior Ligaments of Ute- " Villosae, 110 rus, 266 " Filiformes, 110 Posterior Mediastinum, 155 Papilla? of Kidney, 224 Posterior Medii, 337 Par Vagum, 276,111,62 Posterior Tibial artery, 388 Parotid Gland, 91 Posterior Sacro-Sciatic Li- Parts concerned in F e moral gament, 409 Hernia, 192 Posterior Vertebral Liga- Pectineus muscle, 360 ment, 406 Pectineal Fascia, 194 Popliteal artery, 385 Pectoralis Major mu sele, 151 Popliteus muscle, 372 Pectoralis Minor muscle, 152 Popliteal nerve, 400 Penis, 240 Portio Dura, 135.62 Pericardium, 157 Portio Mollis, 135,62 Perforating arteries, 334 Preputium, 210 Perineum, 219 Primitive Iliacs, 290 Perineal artery, 293 Prior Annularis, 336 Peritoneum, 201 Prior Tndicis, 336 Peroneus Brevis, 370 Prior Modii, 337 Peroneus Longus, 370 Processus Brevis of Incus, 130 Peroneus Tertius, 368 Processus Brevis of Mal- Peroneal Artery, 338 leus, 130 Peroneal Nerve, 399 Processus Gracilis of Mal- Peroneo-Tibial Articula- leus, 130 tion, 4C3 Processus Longus of In- riiaryngeal Nerve, 110 cus, no Pharynx, 143 Profunda artery, 333 INDEX. PAGE PAGE Profunda Humeri artery, 341 Rhomboid Ligament, 414 Profunda Minor artery, 341 Rhomboideus major mus- Promontory of Ear, 129 cle, 303 Pronator Quadratus mus- Rhomboideus minor mus- cle, 326 cle, 303 Pronator Radii Teres mus- Right Auricle, 159 cle, 320 Right Gastro-Epiploic ar- Prostate Gland, 237 tery, 287 Psoas Magnus muscle, 230 Right Hypochondriac re- Ps)as Parvus muscle, 230 gión, 173 Pterygoideus Externus, 78 Right Iliac región, 173 Pterygoideus Internus, 78 Right Lumbar región, 173 Pterygoid Nerve, 107 Right Ventricle, 160 Pulmonary Artery, 162 Rima Glottidis, 150 Punctum Lachrymale, 114 Root of Lung, 165 Pyloric Orifice of Stomach, 207 Round Ligaments of Blad- Pupil, 122 der, 235 Pyramid, 129 Round Ligaments of Liver, 212 Pyramidalis, 182 Pyriformis muscle, 363 Sacculus Sphericus, 134 Sacro-Lumbalis muscle, 306 Quadratus Femoris, 360 Sacro-iliac Ligament, 409 Quadratus Lumborum, 231 Saphena Magna, 390 Saphena Minor, 390 Radial artery, 342 Saphena Vein, 194 Radialis Indicis artery, 343 Sartorial Fascia, 194 Radiated Ligaments, 411 Sartorius muscle, 357 Receptaculum Chyli, 296 Scala Tympani, 134 Rectum, 232 Scala Vestibuli, 134 Recurrens Radialis artery, 342 Scaleni Muscles, 89 Recurrent Tibial artery, 387/ Scapha, 127 Rectus Abdominis muscle, 181 Scapularis, 340 Rectus Capitis Anticus- Scapulo-Clavicular Liga- Major, 88 ments, 415 Rectus Capitis Anticus Mi- Schneiderian Membrane, 137 nor, 88 Sciatic Plexus, 396 Rectus Capitis Lateralis, 89 Scrobiculus Cordis, 173 Rectus Capitis Posticus Scrotum, 244 major muscle, 309 Sebaceous Glands, 431 Rectus Capitis Posticus Sebace >us Organs, 430 minor muscle, 310 Semicircular Canals, 132 Rectus Femoris muscle, 858 Semilunar Valves, 161 Recurrens Ulnaris artery, 344 Semilunar Cartilages, 422 Regio Pubis, 173 Semimembranosus, 367 Renal Capsules, 226 Semispinalis Dorsi mus- Renal Plexus, 282 cle, 309 Rete Mucosum, 428 Semispinalis Colli mus- Retina, 122 cle, 308 Retrahens Auriculae mus- Semitendinons muscle, 366 cle, 128 Septum Lucidum, 52 442 INDEX. PAGE Septum Pectiniforme, 241 Serratus major anticus mus- cle, 152 Serratus Superior Posticus, 303 Serratus Inferior Posticus muscle, 303 Shoulder Joint, 416 Skin, 427 Sinuses of Dura Mater, 43 Sinuses Pulmonalis, 162 Sinus of Ridley, 46 Sinus of Valsalva, 162 Sinus Venosus, 159 Small Muscles of Hand, 332 Small Intestines, 208 Solar Plexus, 281 Soleus muscle, 371 Spermatic arteries, 289,243 Spermaticus externus nerve, 394 Spheno-Palatine ganglion, 139 Spheno-Palatine nerve, 139 Sphincter Ani musele, 233,251 Sphincter Vagina? muscle, 265 Spinal Accessory Nerve, 62 Spinal Marrow, 65 Spinalis Dorsi muscle, 307 Splanchnic nerves, 281 Spleen, 220,199 Splenic artery, 287 Splenius Capitis musele, 304 Splenius Colli muscle, 304 Splenius muscle, 304 Stapedius, 132 Stapes, 130 Stomach, 206,199 Sterno-Cleido Mastoidieus, 81 Sterno-Hyoideus, 84 Sterno-Thyroideus, 85 Stylo-Glossus muscle, 86 Stylo-Hyoideus, 86 Stylo-Maxillary ligament, 83 Stylo-Pharyngeus, 86 Subclavius muscle, 152 Subclavian artery, *b5 Submaxillary Gland, 92 Sublingual Gland, 141,93 Subscapulpris muscle, 316 Sub Pubic Ligament, 411 Sulcus Transversalis, 213 PAGE Sulcus Umbilicalis, 213 Superficialis Dorsi Penis, 293 Superficialis Vola? artery, 312 Supra Spinatus muscle, 315 Superior Maxillary nerve, 105 Superior Mediastinum, 155 Superior Mesenteric artery, 287 Superior Üemorrhoidal ar- tery, 290 Superior Intercostal artery, 286 Superior Pubic Ligament, 184 Supinator Radii Brevis, 327,330 Supinator Radii Longus, 327 Sympathetic, 277,112,280 Tarsal artery, 383 Tarsi Cartilages, 114 Temporalis, 77 Tendo-Achillis, 372 Tensor Palati muscle, 142 Tensor Tarsi, 117 Tensor Tympani muscle, 132 Tensor Vagina? Femoris, 357 Tentorium, 43 Testes, 244 Teres Major muscle, 316 Teres Minor muscle, 316 Thigh, Artery of 382 Tibialis Anticus, 367 Tibialis Posticus, 375 Tongue, 139 Torcular-HerophilL, 45 Trachea, 166 Trachelo-Mastoideus mus- cle, 308 Tragicus muscle, 128 Tragus, 127 Transversalis Abdominis, 180 Transversalis Cervicis mus- cle, 307 Transversus Aura? muscle, 128 Transversalis l.inguae, 140 Transversalis Pedis mus- cle, 380 Trapezoid Ligament, 415 Trapezius muscle, 299 Triangular Ligament, 415 Triangular Ligament of Urethra, 253 INDEX. 443 PAGE PAGE Triangularis Sterni mus- Umbilical región, 173 cle, 154 Upper Extremities, 313 Triceps Abductor Femo- Urachus, 235 ris, 360 Ureters, 225 Triceps Extensor Cubiti, 319 Uterine Arteries, 291 Triceps Surae, 371 Uterus and Appendages, 266 Thalamus Nervi Optici, 51 Uvula, 141 Third pair or Motor Oculi, 61 Third Ventricle, 53 Vagina, 264 Thoracic Duct, 296 Vaginal Ligaments of fin- Thoracica Acromialis, 339 gers, 225 Thoracica Axillaris, 340 Valve of Brain, 55 Thoracica Longa, 339 Valve of Thebesius, 160 Thoracica Superior, 339 Valve of Vieussens, 55 Thorax, 151 Válvula? Conniventes, 209 Thyreo-Arytenoideus, 149 Vasa Brevia, 208 Thyreo-Epiglottideus mus- Vasa Efferentia, 247 cle, 149 Vasa Vorticosa, 121 Thyreo-Hyoideus, 148,85 Vas Deferens, 247 Thyroid Cartilages, 146 Vastus Externus muscle, 358 Thyroid Gland, 90 Vastus Internus muscle, 359 Thyroidea Superior, 95 Vena Cava Descendens, 291 Thyroidal Veins, 103 Veins of Lower Extremi- Thymus Gland, 169 ties, 390 Tonsil Gland, 142 Veins of Trunk, 294 Transverse Ligament, 412 Veins of Upper Extremi- Transversus Perinei mus- ties, 346 cle, 250 Vena Axillaris, 347 Tricuspid Valve, 161 Vena Azygos, 295 Trigeminus, 61 Vena Basilica, 346 Trochlearis nerve, 61 Vena Cava Ascendens, 295 Trunk, 151 Vena Cephalica, 346 Tuberculum Loweri, 159 Vena Galeni, 45 Tubercula Quadrigemina, 54 Vena Mediana, 345,347 Tubuli Seminiferi, 247 Vena Portarum, 214 Tubuli Uriniferi, 224 Vena? Satellites or Co- Túnica Albugínea, 246 mités, 347 Túnica Arachnoidea, 46 Velum Pendulum Palati, 141 Túnica Choroidea, 121 Ventricles and Convolu- Túnica Conjunctiva, 115 tions, 50 Túnica Hyaloidea, 123 Ventricle of Galen or Mor- Túnica Sclerotica, 120 gagni, 150 Túnica Vaginalis Commu- Verticales Linguse, 140 nis, 187 Vessels of Orbit, 124 Túnica Vaginalis Testis, 245 Vesicula? Seminales, 238 Tympanum, 129 Vesical arteries, 291 Vestibule, 133 l'lnar Artery, 343 Vestibulum, 263 444 INDEX. PAGE PAGR Villi, 210 Zona Coriácea, 133 Viscera of Thorax, 154 Zona Membranácea, i:<3 ^ itreous Humour, 123 Zona Ossea, 133 Vulva, 261 Zona Vesicularis, i:-3 Zygomaticus major, 71 Yellow Ligaments, 407 Zygomaticus minor, 73 BOOKS PUBLISHED BY LEA AND BLANGHARD, PHILAD ELPHIA. THE LIBRARYJIrJLfliNDARp LITERATURE. Under this title L. Se B. are publishing a number of valuable worka, which should find, a place in every library. 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In the complexión of his mind the author is so modérate and just that his International statementi are worthy of perfect credit; while the position he occupied gave him such opportunities of mix- ing with the best informed portions of society, that his descriptions and anecdotes of them are of a most agreeable kind.—London Literary Oazette. MACKINTOSH'S PHILOSOPHY. Dissertation on the Progresa of Ethical Philosophy, by Sir James Mackintosh ; with a Preface, by the Rev. William Whewell, M.A. From the second Edinburgh edition; in one neat octavo volume. HUMAN HE AIíTH : or the Influence of Atmosphere and Locality, Change of Ail and Climate, Seasons, Food, Clothiug, Bathing, Mineral Springg, Exercise, Sleep, Cor- pórea! and Mental Pursuits, &c. &c, on Healthy Men, constituting Elementa of Hi- giene. By Robley Dunglison, M. D., áfcc. &c. In one octavo volume. 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HISTORICAL SKETCH OF THE SECOND WAR BFTWEEN THE UNITED STATES OF AMERICA AND GREAT BRI- TA1N, DECLARED BY ACT OF CONGRESS, JUNE 18, 1812, AND CONCLUDED BY PEACE, FEB. 15, 1815. BY CHARLES J. INGERSOLL. One volume octavo of 516 pages, embracing the Events of 1812—1813. Beautifully printed, and done up in neat extra cloth. "The History of Mr. lngersoll, we cannot doubt, will créate no little excitement ihroughout the country. The universally interesting nature of the Bubject, the vigour and ability with which it is evldently written, and the manner in which distingnished men, living and dead, were connected with the great events it nárrales, will combine to give it a very wide circula- tion It will be in many respecta the most marked publication ofthe day. We can see marks of a vi"our of mind, a fulness of investigation and a striking originality of manner, which can- not h\\ to make the book exceedingly auractive to a very wide circle of readers. -N. Y. Courier and Enquirer. ... . . „„„j¡„„ » We do not remember ever to have read a more striking sketch than the one just preceding. It is of a character with the whole book, and imparts to the siyle of the writer a degree of un- usual spirit, making it more like some well-lold and ingenious story, than the detall of mere matters of fact. We have no doubt that Mr. Ingersoll's book will be rapidly purchased and ea»erly read. Men of all parties will admire its frankness, and the numerous rich and lung- buried stores of information with which it abounds. Even those who would assail, will pause before views so ably, so boldly, and so inteüigently expressed, and portraits so cntical and just."—Daily Union. FRENCH~COOKERY. In One Large Octavo Volume, -with many Cuts. THE MODERN COOK; A PRACTICAL GUIDE TO THE CULINARY ART IN ALL ITS BRANCHES, ADAPTED AS WELL FOR THE LARGEST ESTABLISHMENTS AS FOR PRÍVATE FAMILIES. BY CHARLES ELMÉ FRANCATELLI, Pupil ofthe celebrated Careme; late Maitre D'Hótel, and Chief Cook to her Majesty the Queen, &c. IN ONE VERY NEAT OCTAVO VOLUME, WITH UPWARDS OF SIXTY ILLUSTRATIONS. This volume will take the place formerly occupied by the elabórate work of Ude. It con- tains ampie instructions for making all the choicest French dishes, from the simplest to tne most complex. CHEMISTRY OF THE FOUR SEA.S0NS, BY GRIFFITH. IN ONE VERY NEAT DUODÉCIMO VOLUME. WlTH NUMEROUS WOOD-CUTS. The object of this little book is to show in a popular and agreeable manner the chemical agencyexerted in the various phenomena of nature. It forms a neat volume for the Centre Table. A TREATISE ON . „ „ » tvtt^ CORNS, BUNIONS, THE DISEASES OF THE NAILS AND THE GENERAL MANAGEMENT OF THE FEET. BY LEWIS DURLACHER, Sukgeon Chibofodist to the Queen. In one duodécimo volume, cloth. ! L I V E S i ¡QTJEENS OFENGLAND, FROM THE NOEMAN CONQUEST; WITH ANECDOTES OF THEIR COURTS, NOW FIRST PUBLISHED FROM OFFICIAL RECORDS AND OTHER AUTHENTIC DOCUMENTS, PRÍVATE AS WELL AS PUBLIC. NEW EDITION, WITH CORRECTIONS AND ADDITIONS. BY AGNES STRICKLAND. " The treasures of antiquity, laid up In oíd historie rolls, I opened." Beaumont. EIGHT VOLUMES ARE NOW READY. VOL. I.—Contains Matilda of Flanders, Matilda of Scotland, Adelicia of Louvaine, Matilda of Boulogne, and Eleanor of Aquitaine. Price 50 Cents, in faney paper. VOL. II. — Berengaria of Navarre. Isabella of Angouleme, Eleanor of Provence, Eleanor of Castile, Marguerite of France, Isabella of France, Philippa of Hainault, and Ann of Bohemia. Price 50 Cents. VOL. III. —Isabella of Valois, Joanna of Navarre, Katharine of Valois, Margaret of Anjou, Elizabeth Woodville, and Ann of Warwick. Price 50 Cents. VOL. IV. — Elizabeth of York, Katharine of Arragon, Ann Boleyn, Jane Seymour, Ann of Cleves, and Katharine Howard. Price 65 Cents. VOL. V.— Katharine Parr, and Queen Mary. Price 65 Cents. VOL VI. — Queen Elizabeth. Price 65 Cents. VOL. VII. — Queen Elizabeth (continued), and Ann of Denmark. Price 65 Contf. VOL. VIH.— Henrietta Maria. and Catherine of Braganza. Price 65 Cents. Any Volume sold separately, or the whole to match in extra green cloth. &■ PUBLISHED BY LEA AND BLANCHARD. PHILADELPHIA: PUBLISHED BY L.EJÍ JC BIiJUVCUJinD. KIRBY & SPENCE'S ENTOMOLOGY, FOR POPULAR USE. AN INTRODUCTION TO ENTOMOLOGY; OR, ELEMENTS OF THE NATURAL HISTORY OF INSECTS: COMPRISING AN ACCOUNT OF NOXIOUS AND USEFUL INSECTS, OF THEIR METAMORPHOSES, FOOD, STRATAGEMS, HABITA- TIONS, SOCIETIES, MOTIONS, NOISES, HYBER- NATION, INSTINCT, &c, &c. With Plates, Plain or Colored. By William Kirby, M. A., F. R. S. And William Spence, Esq., F.R.S. From the Sixth London edition, WHICH WAS CORRECTED AND CONSIDERABLY ENLARGED. In one large octavo volume, extra cloth. This work, as it at present stands, is acknowledged to be the best extant as a popular intro- duction to the science, containing an irnmense aniount of singular and interesting information, conveyed in an agreeable manner. In preparing the last edition, from which this is printed, the authors have omitted ihe two last volumes, as being too scientifíc for popular use, and arranged ¡tas it now is, forming a cumplete exposition ofthe principies ofthe study, unincumbered with anatomical or scientifíc details. "This publication is one of the highest character of its class; and while the information it contains is, generally speaking, valuable and instructive, muchof it is remarkably curious and inieresCing. The work is comprised in a volume of six hundred pages, and should have a place in every well-chosen library."—Inquirir. THE LANGUAGE OF FLOWERS, WITH ILLUSTRATIVE POETRY; TO WHICH ARE NOW ADDED THE CALENDAR OF FLOWERS, AND THE DIAL OF FLOWERS. SEVENTH AMERICAN, FROM THE NINTH LONDON EDITION. Revised by the Editor ofthe " Forget-Me-Not." In one very neat ISmo. volume, extra crimson cloth, gilt. WITH SIX COLORED PLATES. M A R S T O N, OR THE MEMOIRS OF A STATESMAN AND SOLDIER. By the REV. GEORGE CROLY. Author of "Salathiel," "Ángel ofthe World," &c. IN ONE OCTAVO VOLUME, PAPER, PRICE FIFTY CENTS. " A work of high character and absorbing interest."—N. O. Bee. THOUGHTS ON ANIMALCULES, OR A GLIMPSE OF THE INVISIBLE WORLD. REVEALED BY THE MlüROSCOPE. By G. A. MANTKLL, LL.D., F.R.S., &c. In one beautiful volume, square \2mo. extra cloth. WITH WOOD-CUTS AND COLORED PLATES. PUBLISHED B\* LEA K BLAJVCBABn. GRAHAME'S UNITED STATES. THE HISTORY OF THE UNITED STATES OF NORTH AMERICA. FROM THE PLANTATION OF THE BRITISH COLONIES TILL THEIR ASSUMPTION OF NATIONAL INDEPENDENCE. BY JAMES GRAHAME, LL.D. Second edition, enlarged anuamended. With a forthait of the authob, and A Memoih by PRESIDENT QUINCY. In four volumes, beautifully printed. This edition of Grahame's standard work is far preferable to the English edition, as contain- ing the author's latest amemlments and corrections. From its first appearance in 1836 to his death in 1342, he was occupied in revising it. All these MSS. were given by his son to Har- vard College, and it is from them that this has been printed, under the supervisión of ihe Hon. Josiah Quincy. That this work may have a circulation commensurate with its merits, the publishers are preparing a new ediiion to form two large octavo volumes. Though reduced in size and price, this will contain the whole work, without abridgment, printed on fine while paper, and wiih the same type, though arranged to form a larger page. A few copies of the four volume edition, on extra fine thick paper, still remain, and can be had by gentlemen desirous of procuríng a beautiful work for their libraries. ROSCOE'S KINGS OF ENGLAND. LIVES OF THE KINGS OF ENGLAND FROM THE NORMAN CONQUEST. WITH ANECDOTES OF THEIR COURTS. NOW FIRST PUBLISHED FKOM OFFICIAL RECORDS AND OTHER DOCUMENTS. BY THOMAS ROSCOE. Forming a neat duodécimo series, to match Miss Strickland's " Queens of England." Volume I. contains the Life of" William the Conqueror." "The 'Livesof theKings of England,' must therefore prove a valuable auxiliary tolhose readers, who, fond of tracing effects up to their true causes, are desirous of ascertaining the real share contriboted by each ofthe British Sovereigns to those resulta which have conferred on our country and nation their present proud pre-eminence in power, prosperity,freedom, and glory. To such as seek amusement only, they cannot fail to be equally acceptable, as a connected record of the sayings and doings of personages, many of them ranking foremost as modela of chivalry, and most enjoying the highest renown among the politicians and the warriors of their own time." 0 MOORE'S IRELAND. THE HISTORY OF IRELAND, FROM THE EARLIEST KINGS OF THAT REALM DOWN TO ITS LATEST CHIEFS. In two octavo volumes, extra cloth. Mr. Moore hag at length completed his History of Ireland during the most troubled and inte- resting periods through which it has passed. Those who have possessed themselves ofthe work M far as the Great Expedilhn against Scotland in 1545. can procure the second volume sepárale. PUBLISHED BY LEA AND BLANCHARD. MISS ACTON'S COOKERY. MODERN COOÍCERY IN AtL ITS BRANCHES, reduced to a System of Easy Practice, for the use of Prívate Families. In a Seriea of Practical Receipts, all of which are given with the most minute exactness. By Eliza Acton. With numerous Wood-cut Illustrations. To which is added, a Table of Weights and Measures. The whole revised and prepared for American Housekeepers, by Mrs. Sarah J. Hale, from the second London edition. In one large 12mo. volume. The publishers beg to present a few ofthe testimoniáis ofthe English press in favour of this work. " Mías Eliza Acton may congratúlate herself on having composed a work of great utility, and one that ia speedily finding ita way to every 'dresser' in the kingdom. Her Cookery-book i» unquestionably the most valuable compendium of the art that has yet been published. It atrongly inculcatea economical principies, and points out how good things may be concoctod without that recklea8 extravagance which good cooka have been wont to imagine the best evi- dence they can give of akill in their profession."—London Morning Post, " The arrangement adopted by Mías Acton ia excellent. She has trusted nothing to others. She haa proved all she has written by personal inspection and experimont. The novel feature of her book, which will greatly facilítate the labours ofthe kitchen, is the summary appended to each recipe of the materials which it containa, with the exact proportion of every ingredient, and the precise time required to dress the whole."—London Atlas. " Awaro of our own incompetency to pronounce upon the claims of this volume to the confi dence of thoae most intereated in ita contenta, we submitted it to more than one professor of the art of cookery. The report made to us ia more than favourable. We are assurcd that Misa Acton'a inatructiona may be aafely followed; her receipts are distinguished for excellence. The disnea prepared according to Misa Acton'a directions—all of which, she tella us, have been tested and approved—will give aatiafaciion by their delicacy, and will be found economical in price aa well aa delieious in fiavour. With auch attestations to its superior worth, there ia no doubt that (he volume will be purchaaed and consulted by the domestic authoritiea of every family in which good cookery, combined with rigid economy, is an object of interest."—Olobe. " We have aubjected thia book to the severo test of practice, and we readily concede to it the ment of being a most useful auxiliary to the presiding geniua of the cuisine. The instructiona lt givea in all that relatea to culinary affairs are comprehensive, judicioua, and completely divested of old-faahioned twaddle. It contains, besides, some novel featurea, calculated to facilí- tate the labours of cookery; the principal of these ia the summary appended to each receipt of Ihe exact quantitiea of the ingredients it contains, and the preciso time required to dresa the dish. To the practical woman who aeeka to combine comfort with economy in the direction of ber houaehold concerna, thia book will prove an invaluable treasure."—Sunday Times. " We cannot, therefore, too warmly recommend to the notice of our júnior brethren this com- pilation of Eliza Acton'a, which will prove as useful to young Mra. and her cook in the kitchen, aa Thomson's Dispensatory or Conepectua to the young doctor in the library."—Medico-Chirur- eical Rcview. " Mistress Acton writea well, to the point, and like a woman of aterling aenae; her preface ought to be printed on a broadaide, and taught to all the young ladies at all the boarding-schools, and all the day-schools, whetber boarding or not, in England. "The whole of Miss Acton'a receipts, with a few trifling exceptions, which are acrupu- lously specified, 'are confined to auch aa may be perfectly depended on from having been proved beneath our own roof, and under our personal inspection.' We add, moreover, that the receipts are all reaaonable, and never in any instance extravagant. They do not bid ua sacri- fioe ten pounds of excellent meat that we may get a couple of quarts of gravy from it; ñor do they deal with buttcr and eggs as if they cost nothing. Misa Acton's book ia a good book in every way; there ia right-mindedness in every page of it, as well aa thorough knowledge of the sub- ject abe handles."—London Medical Qaiette. (14) w ü Pí CU O fe NOW PUBLISHING, «««sCSlaí ENCYCLOPiEDIA AMERICANA. A NEW EDITION. A POPULAR DICTIONARY OF ARTS, SCIENCES, LITERATURE, HISTORY, POLITICS AND BIOGRAPHY, INCLÜDINQ A COPIOUS COLLECTION OF ORIGINAL ARTICLES IN AMERICAN BIOGRAPHY. ON THE BASIS OP THE SEVENTH EDITION OP THE GEEMAN CONVERSATIONS-LEXICON. EDITED BY FRANCIS LIEBER, ASSISTED BT E. WIGGLESWORTH AND T. G. BRADFORD. PHILADELPHIA: LEA AND BLANCHARD. 1843. íiüt** IN THIRTEEN VOLUMES. "»>£3£3!Üj PUBLISHED BY LEA & BLANCHAKD; Murraifs Encyclopcedia of Geography, BROUGHT UP TO 1842. PUBLISHED BY SUBS CRI PTION. THE ENCYCLOPCEDIA OF GEOGEAPHY: COMPRISING A COMPLETE DESCRIPTION OF THE EARTH, PHYSICAL, STATISTICAL, COMMERCIAL, AND POLITICAL J EXHIBITING ITS RELATION TO THE HEAVENLY BODIES-ITS PHYSICAL STRUCTURE —THE NATURAL HISTORY OP EACH COUNTRY: AND TIIE INDUSTRY, COMMERCE, POLITICAL INSTITUTIONS, AND CIVIL AND SOCIAL STATE OF ALL NATIONS; BY HUGH MUR.RAY F.R.S.E. ASSISTED IN ASTRONOMY &c. BY PROF. WALLACE, I BOTANY, &c. BY PROF. HOOKER. GEOLOGY. &c. BY PROF. JAMESON. I ZOOLOGY, &c. BY W. SWA1NSON ILLUSTRATED BY EIGHTY-TOTO MAPS, Srrt about EUfaen ©utrtrrelr otjjer SBnfjtaMnas on W00T1 Repreaentioe the moat remarkable objecta of Nature and Art in every región of the Globo; TOOETHER WITH A MAP OF THE UNITED STATES, Drawn by Drayton, from Tanner'a Map. and Engraved on Copper, in which ia embodiodthe lateat information relating to tho Internal Improvemonta of thia country. REVISED, CORRECTED, AND BROUGHT DOWN TO THE PRESENT PERIOD, AND THK POKTION RELATING TO THE UNITED STATES WRITTEN ANEW, BY T. G. BRADFORD, In Three handsome Royal Octavo Volumes, various bindings. Persona can be supplied by sending their ñames to the Publishers, or the general Agent, 8 G. W. GORTON PHILADELPHIA. A NEW WORK FOR SCHOOLS. WHITÉ'S UNIVERSAL HISTORY. LEA AND BLANCHARD HAVE LATELY PUBLISHED, ON A NEW AND SYSTEMATIC PLAN; FROM THE EARXIEST TIBIES TO THE TREATY OF VIENNA; TO WHICH IS ADDED, A SUMMARY OF THE LEADING EVENTS SINCE THAT PERIOD, FOR THE USE OF SCHOOLS AND PRÍVATE STUDENTS. BY H. WHITE, B.A., TRINITY COLLEGE, CAMBRIDGE; WITH ADDITIONS AND QUESTIONS, BY JOHN S. HABT, A.M., PRINCIPAL OF THE PHILADELPHIA HIGH SCHOOL, AND PROFESSOR OF MORAL AND MENTAL SCIENCE, ETC., ETC. In one Volume, large Duodécimo, neatly bound in Maroon. The Publishers, in presenting " IVhite's Universal History" to the public, believe that it is calculated to fill a deficiency, long existing in school-books, of a good and an accurate condensed manual of the History of the World, fitted as an essentially appropriate work for schools. Some of those now in use have been long before the public, and since their appearance, many interesting investigationa have been made, and important facts developed; some are meagre in their details, and the narrations given are proved by later researches to be incorrect; while none embrace a broad and philosophical view of the gatherings of late historians. It is believed that the present volume is capable of fulfilling these indications. The Author, who has had great experience as a teacher of history, has spent several years in the composition of the work ; and every efibrt has been made to insure its accuracy during its passage through the press. In his Preface, he re- marks that " he has consulted the best works in the English language, and acknowledges his great obligations to several of the more recent French and Ger- mán writers. The references introduced in the body of the work, serve to indícate the main sources from which his information has been derived ; and it is hoped they will also be 6erviceable to the student, by directing the course of his further researches, as well as inducing him to continué them in a more extended field." 6517 . WHITE'S UNIVERSAL HISTORY. The work is divided into three parts, corresponding with Ancient, Middle, and Modern History; which parts are again subdivided into centuries, so that the various events are presented in the order of time, while it is so arranged that the annals of each country can be read consecutively, thus combining the advantages of both the plans hitherto pursued in works of this kind. To guide the researches of the student, there will be found numerous synoptical tables, with remarks and sketches of literature, antiquities, and manners, at the great chronological epochs. As tothe method to be adopted in using this manual, " the compiler deems it unnecessary to offer any lengthened directions ; the experienced teacher will readily adopt that best suited to those under his charge. The work may be used simply as a reading-book; but a certain portion should be given :>ut for the attentive study of the pupil, after which he should be closely questioned, not only as to the more general facts, but also the most trivial circumstances recorded." To facilítate this exercise on the part of the teacher, the American Editor, Mr. J. S. Hart, has added a series of Questions, which will be found very useful to those who prefer this mode of instruction. In preparing this edition, the American Editor has paid particular attention to those portions of the work which treat of American History, making them more full, and correcting those mistakes which are inevitable in one residing at such a distance from the source of information. His extended and well-earned reputation as a teacher, is a sufficient guarantee that whatever has passed under his revisión will be free from all errors of importance. In conclusión, the publishers have to observe, that during the short time in which this work has been before the public, it has received the most flattering testimoniáis of approbation. Already it has been introdueed into many of the highest class of institutions for instruction, and three editions have been called for in less than a year. A few recommendations and notices are subjoined. Messrs. Lea 4- Blanchard: Gentlemen—I return the volume of "Elements of Universal History" you left with me a few days since. On a cursory examination, it appears to m¿ to be much the best of the elementary works on the subject which I have met with. The author has executed his method with a great deal of skill, and by this means has avoided much of the confusión which is apt to occur in manual of Universal History. The book is a very comprehensive one, and must have cost Mr. White great labor in collating, and still more in arranging his materials. He shows, more- over, a direct acquaintance with many of the best historical authorities, among them, those of late years. I have turned to several periods of history which I thought would be most likely to show its character, and find them treated wuh considerable fairness and accuracy ; indeed, it is unusually free from the prejudices that often disfigure books of this sort—I mean on questions of history. The book is one that might, I am inclined to think, be introduced with advan- tage as an historical text-book for the younger classes in our colleges. It will be found, too, I believe, a convenient manual for prívate students, which isone ofthe uses conte'mplated by the author. Let me add that, judging from the passages I have looked at, the book is written in good, unaffeeted English. Truly and respectfully, HENRY REED, Professor of Belles Leltres in the University of Femisylvania. A NEW WORK FOR SCHOOLS. Clinton St., Phila. Sept. 15, 1844. Messrs. Lea ó/ Blanchard : Gentlemen,—I thank you for the copy of "White's Elements of Universal Hii- tory," which youwere so kind as to send me. After a somewhat careful examination of it, I was so much pleased with its arrangement, with the judgment evinced in it in the selection of facts, and in the high moral tone which pervades it through- out, that I determined to introduce it into my school. My first class have been studying it since the commencement of the term, and I am increasingly pleased with it. Respectfully yours, C. D. CLEAVELAND, A.M. Author of "GrecianAntiquüies, ' <$<. Messrs. Lea ($• Blanchard: I am indebted to your politeness for an opportunity of examining White's Ele- ments of Universal History, lately published by you. It gives me pleasure to add my suffrage to the respectable testimoniáis of teachers and others, with which the work has been favoured. In my opinión, it affords to teachers and students a facility for imparting and ac- quiring a knowledge of history, superior to any single volume I have ever met with, while it proves an invaluable addition, as a book of reference, to every prí- vate gentleman's library. JOSEPH P. ENGLES, r Classicál Institute. Philadelphia, August 20th, 1844. Messrs. Lea ó/ Blanchard: Gentlemen—I offer you my sincere thanks for the copy of " White's Universal History," which you were so kind as to send me a few days ago. The work pleases me so much, that I have determined to use it in my academy. I am, very respectfully, Your obedient servant, CHA'S PICOT. NOTICES OF THE PKESS. The Wcstminster Review, in noticing the work, t things, and separates, by typogrnphical changos, remarks—" Without branching out into unneces- ! the narrativo of events from the commentary on sary or minute details, it contains a succinct nar- i them."—Spectator. rative of the principal events in our world's his- > tory, from the earliest ages to the present time, " Thia work nas been cornpiled with ikill."- drawn up in a simple and luminous style. Jithenaxim. The author makes no pre.ensions to ..ng.nal.ty; .. Th¡8 work app(?ars tQ u¡) tQ gupp,y % wam "If he shall be pronounced fortúnale ,n the whjcn has |()ng heen fe„ jn Americnn Schoo|, choice and condensation of his materials, he and Colleges. The History of the World, frora will," he says. "have attained the object of his the Creation down to the present time, ha» been wishes." This modest claim we, for our part. arranged by Mr. White in such a way as to ren- unheaitatinglyaccordto his labours. The present dor the gtudy of hig e)egant 8ynops¡, ett8jr and summary will not only prove a valuable class- > agreeable. From its character, we believe that book. but may be advantageously consulted by th¡9 book is ul,imate!ydestined to supersede eve- those who have not in youth bceo syatemalically ry otner ¡n thesame department that has hilherto trained in historical knowledge." S appeared. The style in which.it is 'gotop' < does credit to the enterprising publishers."—JVV» " The Elements of Universal History" is en- í World. titled to great praise -, the writer has taken firm i ------- graspof his subject: he oxhibits a just estímate of < " We were induced, by several noticct of this WHITE'S UNIVERSAL HISTORY. bouk, lo look with more care into it than we have usually timo to bestow on works of this class. It íi a British production, but the author is quite as free from prejudice as one could possibly expect. The plan ia very judicious. It compresses into one volume a survey of universal history,—a complete blank form whicb the student can com- prehend at a glance, and fill up at his leisure. For schools ii is particularly well adapted, as the questions upon the text, appended by Mr. Hart, facilítale the use of it for the teacher and increase its valué for Ihe learner."—JVoríA American. "A work which gives, in a succinct narration, the principal events in the history ofthe world. if faithlully executed, cannot fail to be of vast iir.- portance to prívate students as well as for tho use of schools. The volume here given to the pub- lic, ha9 evidently been prepared with much care. It is arranged with great convenience, and the nnrratives of events are given in a style that will doubtlcss prove interesting to every reader. Welhink it oneof the best manualsof Universal History that has ever been published."—Satur- iay Courier. " On the wliole, this must be regarded as one of the most compendious and well arranged works that have appeared ; and if used for no other purpose than as a chronological guide, will prove most valuable."— Saturday Post. " The great ment is in the arrangement of the matter. which is admirable, and will be found to assist, in an eminent degree, the teacher and the reader. " Mr. Hart has well executed his share of the work, and given thereto an important ingredient in its usefulness."—U. S. Oazettc. " It is on a new and excellent systematic plan, containing a brief narrative of the principa) events in the history of the world, from the ear- liest ages to tho present time. An important feature in the work, is its arrangement into' pe- riods of centuries. This is decidedly of very- great advantage to the student, and cannot fail to coinmend the work."—Boston Atlas. "The work is a brief narrative of tho principal and most interesting events in the history of the world, but these events are placed in such a shape as to enable the mind of the student oí reader to grasp them with more certainty and less difficulty of retention than by the old-fashion ed method.—This must suiely opérate as a pow erful recommendation in favour of its usefulness to the casual reader, as well as to the student— we allude particularly to its chronological ar- rangement, and general memoranda of events, comprised within the limits of the last century— the genealógica! tables with which it abounds, and the conciseness, yet clearness of its notes. The author is indebted to the most scientifíc of modern travellers, (in whom only he seems to place confidence) for the valuable information he gives in his notes, which, in addition to the faets they nárrate and explain, display an admirable perspicuity of language that must gratify the reader, and tend to increase his interest as he progresses."—JV. Orleans Age. '' Under whatever circumstances persona are led to seek an acquaintance with general history, the work by Mr. While will serve to gratify their longings in this particular, and lo aid them in treasuring up a vast amount of well arranged and clearly told historical incidents, of the dif- ferent people who have flourished, in successive ages, from the earliest date down to the present time.—Colonizatian Herald. STATE OF NEW YORK: Secretary's Office, ? Department of Common Schools, 5 Albany, October 14, 1845. Messrs. Lea and Blanchard .• „ Gentlemen,—I have examined the copy of « White's Universal History, which you were so obliging as to forward me, and cheerfully and fully concur in the commendations of its valué, as a comprehensive and enlightened survey of the ancient and modern world, which many of the most competent judges have as I perceive, already bestowed upon it. It appears to me to be admirably adapted to the purposes of our public schools ; and I unhes.tatingly approve of its intro- duction into these seminaries of elementary instruction. Very respectfully, your obedient servant, y V 3 SAMUEL S. RANDALL, Deputy Superintendent of Common Schools. a .k;= «ort i* Brenared with reference to general reading, as well as for b*ÜX-£- wK- rrri "¡T '"*,i0"' n't[ne"' "* ble Wumc fot DLlriet School .nd othet Libnme»._______________________, PUBLISHED BY LEA & BLANCHARD; WORKS FOR SCSOOIS, COLLEGES, &C. A NEW EDITION OF ARNOTT'S ELEMENTS OF PHYSICS, OR NATURAL Pili- LOSOPHY, GENERAL AND MEDICAL. 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A SELECTION OF ONE HUNDRED PERRIN'S FABLES, accompanied by a Key, containing the text, a literal and free transla- tion, arranged in such a manner as to point out the difTerence between the French ard English idiom, &c, m 1 vol., 12mo. A COLLÉCTION OF COLLOQUIAL PHRASES, on every topic necessary to maintain conversation, arranged under different heads with numerous remarks on the peculiar pronunciaron and uses of various words ; the whole so disposed as considerably to facilítate the acquisi- tion of a correct pronunciatíon ofthe French, 1 vol., 18mo. LES AVENTURES DE TELEMAQUE PAR FENELON, in 1 vol., 12mo., accompanied by a Key to the first eight books, in 1 vol., 12mo., containing like the Fables, the text, a literal and free translation, intended as a sequel to the Fables. Either volume sold separately. ALL THE FRENCH VERBS, both regular and irregular, in a small j volume. SOLD BY ALL B O olíS E L L E R~s7 PUBLISHED BY LEA AND BLANCHARD. CHEMISTRY FOR STUDENTS: ELEMENTARY CHEMISTRY, THEORETICAL AND PRACTICAL; BY GEORGE FOWNES, PH.D. CHEMICAL LECTURER TO THE MIDDLESEX HOSPITAL MEDICAL SCHOOL, ETC. ETC. EDITED, WITH ADDITIONS, BY ROBERT BRIDGES, M. D., PROFESSOR OF GENERAL AND PHARMACEDTICAL CHEMISTRY IN THE PHILA- DELPHIA COLLEGE OF PHARMACY, ETC. In one large 13mo. -volunte, with. nearly two hundred wood-cuts. The character of this work is such as to recommend it to all colleges and academies in want of a text-book. It is fully brought up to the day, containing all the late views and discoveries that have so entirely changed the face of the science, and it is completely illustrated with very numerous wood engravings. explanatory of all the different processes and forms of apparatus. Though strictly scientifíc, it is written with great clearness and simplicity of style, rendering it easy to be comprehended by those who are commencing the study. It may be had well bound in leather, or neatly done up in strong cloth. Ita low price places it within the reach of all. Extract of a letter from Professor Millington, of William and Mary College, Va. " I have perused the book with much pleasure, and find it a most admirable work ; and, to my mind, euch a one as is just now much needed in schools and colleges. * * * All the books I have met with on chemistry are eilher too puerile or too erudite, and I confess Dr. Fownes oook seems to be the happiest médium I have seen, and admirably suited to fill up the hiatus." " He has succeeded in comprising the matter of his work in 460 duodécimo pages, which, as- turedly, is a recommendation of the volume as a text-book for students. In this respect it has advanlages over any treatise which has yet been offered to American students. The difficulty in a text-book of chemistry is to treat the subject with sufficient fulness, without going too much into detail. For students comparatively ignorant of chemical science, the larger systems are unprofitable companions in their attendance upon lectures. They need a work of a more ele- mentary character, by which théy may be inducted into the first principies of the science, and prepared for mastering its more abstruse subjects. Such a treatise is the one which we have now the pleasure of introducing to our readers; no manual of chemistry with which we have met comes so near meeting the wants of the beginner. All the prominent truths of the science, up to the present time, will be found given in it with the utmost practicable brevity. The style is admirable for its conciseness and clearness. Many wood-cuts are supplied, by which pro- cesses are made intelligible. The author expresses regret that he could not enter more largely into organic chemistry, but his details will be found to embrace tho most important faets in that interesling branch of the science. We shall recommend his manual to our class next winter."— The Western Journal of Medicine and Surgery. Though this work has been so recently published, it has already been adopted as a text-book by a large number of the higher schools and colleges throughout the country, as well as by Professor Silliman, and many of the Medical Institutions. As a work for the upper classes in academies and the júnior students of colleges, there has been but one opinión expressed concerning it, and it toay now be considered as the Text-book for the Chemical Student. PUBLISHED BY LEA AND BLANCHARD, ____________________________________________________,___________________________________------------------------—-----------------------------------------------------------------------■ - Now ready, in One Volume 8vo. with Illustrations. THE HORSE, BY WILLIAM YOUATT. A NEW EDITION, WITH NUMEROUS ILLUSTRATIONS; CONTAINING A FULL ACCOUNT OF THE DISEASES OF THE HORSE, WITH THEIR MODE OF TREATMENT; HIS ANATOMY, AND THE USUAL OPERATIONS PERFORMED ON HIM; HIS BREEDING, BREAKING, AND MANAGEMENT¡ AND HINTS ON HIS SOUNDNESS, AND THE PURCHASE AND SALE. TOGETHER WITH A GENERAL HISTOM OE THE HORSE; A DISSERTATION ON THE AMEKICAN TROTTING HORSE, HOW TRAINED AND JOCKEYED, AN ACCOUNT OF HIS REMARKABLE PERFORMANCES; AND AN ESSAY ON THE ASS AND THE MULÉ, BY J. S. SKINNER, Assistant Post Mastex General, and Editor of the Turf Register. PHILADELPHIA: LEA AND BLANCHARD. 1844. REPUBLISHED FROM THE NEW EDITION JUST ISSUED IN LONDON, BY THE SOCIETY FOR DIFFUSING USEFUL KNOWLEDGE. PHILADELPHIA. WORKS FOR SPORTSMEN. PUBLISHED BY LEA AND BLANCHARD. SKINNER'S DOG AND SPORTSMAN. THE DOG AND THE SPORTSMAN. embracing the uses, breeding, training, diseases, etc., of dogs, and an ac- count OF THE DIFFERENT KINDS OF GAME, WITH THEIR HABITS. ALSO, HINTS TO SHOOTERS, WITH VARIOUS USEFUL RECIPES, &c, &c. By J. S. SKINNER. With Plates. In one very neat 12mo. volume, extra cloth. "This is an excellent book. It shows how serviceable the dog may be made, and how to make him serviceable. The excellent advice upon the treatment of the half-reasoning animal, (some dogs do reason,) should be read by every one who aspires to own a dog, that is serviceable in the field."—U. S. Gazette. YOÜATT OÑ^THE DOG. THE DOG. BY WILLIAM YOUATT. CONTAINING THE HISTORY OF THE DOG, HIS VARIETIES, QUALITIES, ANATOMY, DISEASES, TREATMENT, BREEDING, &c, &c. In one beautiful volume, with all the fine illustrations beautifully executed. Preparing. CLATER'S FARRIER. EVERY MAN HIS OWN FARRIER; CONTAINING THE CAUSES, SYMPTOMS, AND MOST APPROVED METHODS OF CURE OF THE DISEASES OF HORSES. BY FRANCIS CLATER, Author of "Every Man his own Cattle Doctor." And his Son JOHN CLATER. FIRST AMERICAN FROM THE TWENTY-EIGHTH LONDON EDITION, WITH NOTES AND ADDITIONS, BY J. S. SKINNER. In one l2mo. volume, cloth. "Lea & Blanchard have just published Clater's capital treatise on the Diseases of Horses, containing ' the causes, symptoms, and most approved methods of cure,' with valuable notes and additions by J. S. Skinner, Eso.. This is the first American from the twenty-eighth English edition of this standard work, which should find its way into the hands of every lover ofthe Horse."—N. Y. Spirit ofthe Times. CLATER'S CATTLE DOCTOR. EVERY MAN HIS OWN CATTLE DOCTOR. Containing the Causes, Symptoms and Treatment of all Diseases incident to Oxen Sheep and Swine; and a Sketch of the Anatomy and Physi- ology of Neat Cattle. By FRANCIS CLATER. Edited, Revised, and almost Rewritten,by William Youatt. With Numerous Addi- tions, embracing an Essay on the Use of Oxen, and the Improvement m the Breed of Sheep, by J. S. Skinner, Asst. P. M. General. In one duodécimo volume, cloth, with numerous illustrations. WORKS FOH SPORTSMEN. PUBLISHED BY LEA & BLANCHARD. HAWKER ON SHOOTING. Preparing: INSTRUCTIONS TO YOUNG SPORTSMEN IN ALL THAT RELATES TO GUNS AND SHOOTING. By Lieut. Col. P. HAWKER. From. the Enlarged and Improved Ninth London Edition. edited with many alterations and additions, By W. T. PORTER, Esq., Editor of the N. Y. Spirit of the Times. In one large octavo volume, with numerous Illustrations. This has long been considered as the standard work on shooting, and of the highest authority on all that appertains to guns and their use. An American edition has been much wanted, that sportsmen in this country might have such a work at a reasonable price. The editor, who ás well known to the sporting world on this side of the water, has made very extenstve alterations, so as to adapt it to our game and sporting customs. Many new and beautiful woodcuts have been introduced, in place of comparatively unimportant ones omitted; and the whole is confidently presented to the sportsmen ofthe United States as a work in every respect calculated to meet their wants. STABLE TALK AND TABLE TALK. STABLE TALK AND TABLE TALK, OR SPECTACLES FOR YOUNG SPORTSMEN. BY HARRY HIEOVER. In one very neat duodécimo volume, extra cloth. These lively sketches answer to their title very well. Wherever Nimrod is welcome, there should be cordial greeting for Harry Hieover. His book is a very clever one, and contains many instructive hints, as well as much light- hearled reading.—Examiner. SPORTSMAN'S LIBRARY. THE -SPORTSMANS LIBRARY, OR HINTS ON HUNTERS, HUNTING, HOUNDS, SHOOTING, GAME, DOGS, GUNS, FISHING, COURSING, &c. &c. In one well printed volume, duodécimo, extra cloth. " It has been my object to render this work one oí instruction and of referen* as to every subject connected with our national sports. In the belief that the task has been completed in accordance with the design, I submit the work in all hi- mility, to the favourable consideration of those whom I am proud to callmyfel- lo w-sports me n."—Preface. AT TWElíTY-riVB CENTS PER VOLUME. LEA & BLANCHARD Have commenced the ré-issue, in a periódica!, form, of OF J. FENIMORE COOPER EMBRACING WING-AND-WING, THE SPY, THE PIONEERS, THE PILOT, THE RED ROVER, THE WATER-WITCH, THE TWO ADMIRALS, LIONEL LINCOLN, THE PRAIRIE, HEIDENMAUER, THE HEADSMAN, THE PATHFINDER, THE DEERSLAYER, PRECAUTION, THE BRAVO, THE WISH-TON-WISH, THE LAST of the MOHICANS, HOMEWARD BOUND, HOME AS FOUND, MERCEDES OF CASTILE, THE MONIKINS, AND THE TRAVELLING BACHELOR, In all twenty-two different Works, or forty-four volumes. This edition will be well printed, on good paper and with legible lype, and in a form suitable for convenient reading, and done up in a coloured wrapper. As they will all correspond in size, the set can be bound to match, and will form a beautiful series after it is complete. A work in two volumes, will be issued every week until the series is complete. As it will be issued periodically, copies can be sent by mail, at a postare of lé cent per sheet for 100 miles or less, and at 2é cents for over 100 miles. Persons remitting Five dollars free of postage, in money currpnt ¡n this citv, can have eleven Novéis in the order they may be issued. Other works, in a cheap form for extensive circulation, such as Boz, Fielding, Smollett, &c. will follow. Philadelphia, December, 1842. CHEAP EDITION OF SMOLLETT.—$1 50. 02 < Ph >* WITH A MEMOIR OF HIS LIFE AND WRITINGS, BY SIR WALTER SCOTT, CONTAINING THE ADVENTURES OF RODERICK RANDOM; Price 25 cents. THE ADVENTURES OF PEREGRINE PICKLE; Double Number — Price 50 cents. THE EXPEDITION OF HUMPHRY CLINKER; TMce 25 cents. THE ADVENTURES OF FERDINAND COUNT FATHOM ; Price 25 cents. 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PHILADELPHIA: LEA & BLANCHARD, FOR AM, BOOKSELLERS AND NEWS AGENTS IN THE UNITED STATES 1843. CHEAP EDITION OF FIELDING.—fi 25. NOW PUBLISHING, THE COMPLETE WORKS OF CHARLES DICKENS, ao (BOZ.) H CONTAINING * OLIVER TWIST; Price 25 cents. nicholas nickleby; >* Double Number — Price 50 cents. THE CURIOSITY SHOP WITH WOOD CUTS; Double Number — Price 50 cents. THE PICKWICK PAPERS; Double Number — Price 50 cents. SKETCHES OF EVERY-DAY LIFE; Price 37£ cents. AND Q BARNABY RUDGE, W WITH WOOD CUTS; 55 Double Number — Price 50 cents. THIS EDITION WILL BE WELL PRINTED IN A UNIFORM STYLE TO MATCH, AND SOLD AT THE VERY LOW PRICE OF TWO DOIIAUS AND FIFTTT CENTS, WHEN THE WHOLE IS TAKEN AT ONE TIME. PHILADELPHIA: LEA & BLANCHARD, FOR ALL BOOKSEIAERS AND NB.WS AGENTO IN THE UNITED STATES. 1843. Price Twenty-fice Cents. \ THE COMPLETE COOK. 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BY HENRY WHEATON, LL.D., MINISTER OF THE UNITED 8TATE9 AT THE COURT OF PBUSSIA, ETC. Third Edition, Revised and Corrected. In one large and beautiful octavo volume of six hundred andfifty pages. Extra cloth, or fine law sheep. " In preparing for the press the present edition of the Elements of International Law, the work has been subjected to a careful revisión, and has been considerably augmented. The author has endeavoured to avail himself of the most recent questions which have occurred in the inter- course of States, and has especially sought for those sources of information in the diplomatic correspondence and judicial decisions of his own country, which form a rich collection of in- structivo example. The author has also endeavoured to justify the confidence with whicli he has been so long honoured by his country in the different diplomatic missions confided to him, by availing himself of the peculiar opportunities, and the means of information thus afforded, for a closer examination of the different questions of public law, which have occurred in thH international intercourse of Europe and America, since the publication of the first edition of the present work. He indulges the hope that these additions may be found to render it more use- ful to the reader, and to make it more worthy of the favour with which the previous edition» havo been received."—Preface. "We are not surprised that a third edition ef this profound and invaluable work has been called for. Its appearance at this juncture, when the exigencies ofthe country have directeü every intelligent and inquiring mind to the study of the mutual rights and duties of nations, ia opprotune."—North American. TAYLOR'S JURISPRUDENCE. MEDICAL JURISPRUDENCE. BY ALFRED S. TAYLOR, Lecturer on Medical Jurisprudence and Chemistry at Guy's Hospital. With numerous Notes and Additions, and References to American Law. BY R. E. GRIFFITH, M. D. In one volume, octavo, neat law sheep. CHITTY'S MEDICAL JURISPRUDENCE. In one octavo volume, sheep, with numerous woodcuts. TRAILL'S MEDICAL JURISPRUDENCE. In one small octavo volume, cloth. Preparing for Press. A TREATISE ON THE LAW OF CONTRACTS AND ON PARTIES TO ACTIONS, EX CONTRÁCTIL BY C. G. ADDISON, ESQ., OF THE INNER TEMPLE, BARRISTER AT LAW. With Notes and Additions, adapted to American Practice. LAW BOOKS, PUBLISHED BY LEA & BLANCHARD. EAST'S KING'S BENCH REPORTS. REPORTS OF CASES ADJUDGED AND DETERMINED IN THE COURT OF KING'S BENCH. WITH TABLES OF THE ÑAMES QF THE CASES, AND PRINCIPAL MATTERS. BY EDWARD HYDE EAST, Esq., Ofthe Inner Temple, Barrister at Law. EDITED, WITH NOTES AND REFERENCES, BY G. M. WHARTON, Esq., Of the Philadelphia Bar. In 8 large royal octavo volumes, bound in best law sheep, raised bands and double titles. Price to Subscribers, only Twenty^five Dollars. In this edition of East, the sixteen volumes of the former edition have been compressed into eight—two volumes in one throughout—but nothing has been omitted; the entire work will be found with the Notes of Mr. Wharton added to those of Mr. Day. The great reduction of price (from (¡72, the price of the last edition, to #25, the subscription price of this) together with the Improvement in appearance, will, it is tmsted, procure for it a ready sale. HILL ON~TRUSTEES. A PRACTICAL TREATISE ON LAW RELATING TO TRUSTEES; THEIR POWERS, DU- TIES, PRrvTLEGES AND LIABILITIES. By JAMES HILL, Esq., Of the Inner Temple, Barrister at Law. Edited by FRANCIS J. TROUBAT, Esq., of the Philadelphia Bar. In one large octavo volume. « As to the merits oí the author's worls^the editor can confiáentiy say that, in his opinión, it far surpasses any other on the same subject. Every lawyerwho peruses or consults it will most certainly discover that Mr. Hill writes like aman who has a repu- tation to lose and not to build up. Such writers are few and precious. The editor bees leave to itérate the important observation made by the author, that his work is principally intended for the instruction and guidance of trastees. That single teature very much enhancps its priwtical'valus.'»—.Avumc!¡».P*efaxie, PRKP&BIJVG POR PITBJjICJITIOJV. A TREATISE ON THE RíSE AND ESTABLISHMENT OF THE, JURISDICTION OF THE COÜRT OF CHANCERY, AND THE PRINCIPLES OF ITS EQUITABLE JURISDICTION. By G. SPENCE, Esq., Q. C. If Mr.Spence's profesional engagements should admito/ his "^^JaS^S a work of this elabórate and comprehensivo character, he will have cari»«¡^¡^>*%*™ on his nrofession This gentleman's qualifications for the task are undoubtedly great. io say ^íSS^S^ experience he is the author of the, valuable «bou* into the Origin of the Laws ofModern Emope, &i»-Warren's.Latc Studtee. To befollowed by a work on The Praetice oftht.CPMrtofCMnceryby^a^Autí^. LAW BOOKS, PUBLISHED BY LEA & BLANCHARD. HILLIARD ON REAL ESTÁTE. THE AMERICAN LAW OF REAL ESTÁTE, A NEW, GREATLY ENLARGED AND IMPROVED EDITION. BY FRANCIS HILLIARD, Counsellor at Law. In two large octavo volumes, beautifully printed, and bound in best law sheep. What renders these volumes of especial use to the American Lawyer, is the con- stant reference which is had to the various statutes of all the states. It is, therefore, as valuable in Maine as in Mississippi, and in Georgia as in Massachusetts. The addi- tions which this edition has received in its passage through the press, are almost suf- ficient to render it a new work. Judge Story says:—" I think the work a very valuable addition to our present stock of juridical literature. It embraces all that part of Mr. Cruise's Digest, which is most useful tu American lawyers. But its higher valué is, that it presents in a concise, but clearand exact form, the substance of American Law on the same subject. I know no work that we postea», whose practical utility is likely to be so extensively felt." " The wonder is, that the author has been able to bring so great a mass into so condensed a text, at once comprehensivo and lucid.» Chancellor Kent says of the work (Commentaries, Vol. II., p. 635, note, 5th edition):—" It la a work of great labor and intrinsic valué." Hon. 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Thirteen years have now elapsed since the publication of the last additions to the Encyclopsedia Americana, and the numerous important events which have transpired since then, the advance made in all the sciences and arts, and the number of distin- guished men who have become legitímate subjects for biography, render a supplement necessary for the numerous readers of this widely difiused and popular work. Inthe hands of Professor Yethake, this difficult task has been faithfully executed, and in a short time, those who possess the Encyclopsedia, will be able to complete their sets. MISCELLANEOUS WORKS IN VARIOUS DEPARTMENTS OF LITERATURE. PUBLISHED BY LEA AND BLANCHARD. ACTON'S Modern Cookery, with cuts, 12mo, cloth. AMERICAN Ornithology, by Prince Charles Bonaparte. In 4 vols. folio, half bound. colored plates. AMERICAN Military Law, by Lieut, O'Brien, U. S. A. 1 vol. 8vo, cloth or law sheep. ADDISON on Contracts, at press. ARNOTT'S Elements of Physics. 1 vol. 8vo, sheep. 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