PRACTICAL ANATOMY. 
 
PRACTICAL   ANATOMY.
A  NEW ARRANGEMENT
LONDON  DISSECTOR,
    NUMEROUS MODIFICATIONS AND ADDITIONS,




                 CONTAINING




A CONCISE DESCRIPTION OF THE MUSCLES, BLOODVESSELS, NERVES,


     VISCERA, AND LIGAMENTS OF THE HUMAN BODY AS


           THEY APPEAR ON DISSECTION.






         WITH ILLUSTRATIONS.
             BY



D. HAYES AGNEJBT., M. D.,
                spe*^r . ' .'■' 77-
               g^to'JtSfLPfeiA floern'AL'
LECTURER ON ANATOMY, AND SlIRCJEOX TO T gj^^^ELPfe IA SoCTITAL^BI-OCKLEY).
           PHILADELPHIA:

J. B.  LIPPINCOTT  AND  CO,

                1856. 
A
                        as







    Entered according to the Act of Congress, in the year 1856, by

             J.  B. LIPPINCOTT AND  CO.,

in the Clerk's Office of the District Court of the United States, for the
                Eastern District of Pennsylvania. 
PREFACE
                BY

THE  AMERICAN EDITOR.
                                      h
   The  Editor of the following pages, believing that a
dissector suited to the wants  of the American Student
should be much  more condensed  than those in general
use, has made the following arrangement of the London
Dissector.  In its preparation  the arrangement has  been
entirely altered,  and the nomenclature in many  cases
changed.  The Ligamentous  system:  illustrations and
numerous other  additions in various  parts of  the work
have  been made; everything considered unnecessary
erased, and the whole presented as near as possible  in
topographical order.  The minute anatomy of parts and
the smaller ramifications of the nervous and vascular sys-
tems have been omitted, belonging as  they do more pro-
perly to systematic treatises  on Special Anatomy.
  The work has been  prepared with a single eye to the
faithful economy  of the Student's time.
                           D. HAYES AGNEW.
  August, 1856. 
 
CONTENTS.
                                                         PAGE
                       CHAPTER  I.
General Observations in Reference to Dissecting   ...    13
                       CHAPTER II.
Dissection of the Head........14

                      CHAPTER  III.
Dissection of the Face........18

                      CHAPTER  IV.
Of the Contents of the Cranium, or the Brain and its Membranes   36

                       CHAPTER V.
Dissection of the Anterior Part of the Neck  ....   58

                      CHAPTER  VI.
Dissection of the Throat........82

                     CHAPTER VII.
Dissection of the Orbit of the Eye   .    .    •     •    •     .91

                     CHAPTER  VIII.
Dissection of the Thorax........"'

                      CHAPTER  IX.
Dissection of the Superior Extremity.....103 
Vlll
CONTENTS.
                       CHAPTER  X.
Dissection of the Abdomen     .......  143

                     CHAPTER  XII.
Dissection of the Anterior Part of Thigh     .    .     .     .177

                     CHAPTER  XIII.
Dissection of the Perineum  and of the Male Organs of Gene-
    ration     .".......••  223

                     CHAPTER  XIV.
Dissection of the Organs of Generation in the Female    .     .  239

                      CHAPTER  XV.
Of Parts within the Thorax.......247

                     CHAPTER  XVI.
Dissection of the Muscles on the Posterior  Part of the  Trunk
    and Neck..........2G4

                    CHAPTER  XVII.
Dissection of the Muscles situated between the Ribs, and on the
    Inner Surface of the Sternum   ......  27S

                    CHAPTER XVIII.
Dissection of the Eye    ........  2S0
Ligaments
CHAPTER  XIX.
2S3 
PRACTICAL  ANATOMY.
                 CHAPTER I.

     GENERAL OBSERVATIONS IN REFERENCE TO
                    DISSECTING.

  The student about commencing the duties of the dis-
secting room, should be  supplied with a good apron to
protect his clothes  from being soiled, and a dissecting
case of a good quality.   The knife should be held like a
pen  and moved by the fingers and thumb, not by the
wrist and elbow, and sometimes, as I have seen, by the
shoulder.  The student should practice its use also with
the left hand; such an education will be of great advan-
tage, especially in surgical operations.  In the dissection
of a part, it is a good rule not to turn off more of the skin
than is necessary for the exposure of the part, and always
to replace it  again during  the  interval" of dissection.
Generally I think  it  better to turn off the structures in
the order of superposition;  as the skin, superficial fascia,
deep fascia, &c.  In dissecting a muscle the parts should
be made tense, which is done by blocks properly placed
under the subject.   The cellular membrane which imme-
diately invests the muscle, must be kept extended by the
hand or forceps, and the edge of the knife carried steadily
in the direction of its fibres.  This rule admits of no ex-
ceptions, and should never be lost sight of by the student.
   There are many operations which may be clone on the
     9 
14              PRACTICAL ANATOMY.

subject without injuring the  parts for dissection; such
as the ligation of arteries ; passage of. instruments through
the nasal fossce and their introduction into the Eustachian
tube; introduction of catheter, both in the male and female,
&c.; and these should be practised with care.  The grand
object of the student in the examination of the human
body, should be not only to recognize its constituents:
but above all the relation which they sustain to each other
this is the only knowledge worth obtaining, and the want
of it  accounts for the blunders,  confusion and ignorance
which are so frequently seen in the profession.  Another
point of much importance is order and cleanliness.   Hence
all drippings  from the subject should be wiped up with
the sponge, and no scraps allowed to accumulate about the
table.   Much apprehension is sometimes expressed  by
students of being poisoned.  It  is well if there  be any
abrasions  of the  skin to cover  it with collodion before
engaging in dissecting;  but since the  introduction of the
chloride of zinc as an antiseptic all danger from this source
is removed.   Where an accidental cut  is inflicted,  the
part should be washed, and well drawn by  the mouth.
The common practice  of  cauterizing with the nitras
argenti, I think is in many cases positively injurious.
                 CHAPTER  II.

             DISSECTION OF THE HEAD.

        OF THE EXTERNAL PARTS OF THE HEAD.

  The integuments  of the head are thick, and covered
with hair; under the cutis there is a cellular substance,
which is much condensed, and closely connected with the
epicranium, or expanded tendon of the occipito-frontalis.
This connection  renders the  dissection  of that  muscle
difficult. 
NERVES.
15
  An incision should be made from the  root of the nose
over the median line of the head, terminating  behind at
the occipital protuberance.  A  second  from  the  com-
mencement of the first, over the eyebrows to the external
angular process of the frontal bone; a third  from the
occipital protuberance to the mastoid process of the tem-
poral bone; by dissecting very carefully the flap outwards,
the entire muscle and intervening tendon or aponeurosis
will be exposed.
   The  Occipito-frontalis is the only muscle which
properly belongs to the hairy scalp; it is a single broad
digastric muscle,
   Arising, on each side of the head, fleshy and tendinous,
from  the transverse ridge  of  the  occipital bone, as far
forwards as the mastoid process; it forms  a broad  thin
tendon, which covers the whole upper  part of the cra-
nium.
   Inserted, fleshy, on each  side, into the orbicularis pal-
pebrarum, skin of the eyebrows, and the internal angular
process of the os frontis and os nasi.  The  last insertion
answers to the Pyramidalis Nasi of some books.
   Situation.—The tendon adheres firmly  by cellular mem-
brane to the  skin, but very loosely to the pericranium,
or periosteum of the cranium, by  a loose cellular layer,
which might be called the  subaponeurotic fascia.  At its
insertion it intermixes with the muscles of the upper part
of the face.
    Use: To  pull  the skin  of the head backwards, raise
the eyebrows, and corrugate the skin of  the forehead.
   Bloodvessels seen in the  dissection of the scalp are
the Frontal, emerging from the  internal angle of the
orbit and passing up the middle of the head; supraorbital
out of the Supraorbital foramen; both branches of the
Ophthalmic.  On the side of the head the Temporal,
from the external carotid, behind the Posterior Occipi-
tal, and Posterior Auricular from the external caro-
tid.  All anastomose in the scalp.
   Nerves coming out of the supraorbital foramen: The
Frontal Nerve, a branch  of the ophthalmic, which last is
the first branch of the fifth pair; on the  side, branches of 
16
PRACTICAL ANATOMY.
the Portio Dura and Inferior Maxillary Nerves ;
and behind, the Occipitalis Minor and Major—the for-
mer from the superficial plexus of the neck, and the lat-
ter the main stalk of the second cervical spinal nerve.
  The muscles of the ear are of three classes.
  1.  The common muscles move  the external ear; they
are not always so distinct as to admit of a clear demon-
stration.
  (1.) Attollens Aurem—Arises from the tendon of the
occipito-frontalis,  and  from the aponeurosis of the tem-
poral muscle.
  Inserted into the upper part of the root of the cartilage
of the  ear, opposite to  the antihelix.
   Use: To draw the ear upwards.
  (2.)  Anterior Auris—Arises, thin and membranous,    ;
from the posterior part of the  zygomatic process of the
temporal bone.
  Inserted into a small eminence on the back of the helix,
opposite to the concha.
   Use: To draw the eminence  a  little forwards  and up-
wards.
  (3.)  The Eetrahentes Auris—Arise, by two or three
distinct slips, from the external and posterior part of the
mastoid process, immediately above the insertion of the    \
sterno-cleido mastoideus.
  Inserted into that back part of the ear which is opposite
to the septum, dividing the scapha and concha.
   Use: To draw the ear back and stretch the concha.
  Before describing the proper muscles of the ear,  notice   ■
the following: The part usually called ear is for the most
part  cartilaginous;  appended to it below is a pendulous
portion, the Lobus, composed of granulated fat and dense
cellular membrane:  with the exception  of this, all above    ;
is the Pixxa.   The deep  cavity in the middle is the
Concha.  Dividing the  upper part of the concha  into
two  unequal fossae  is  a ridge which runs along the cir-
cumference of the pinna and ends in the lobus;  this is
the Helix—within  it another, the Antihelix.  On the
anterior part of the concha is a projection, the Tragus,
and opposite  another, the Antitragus.  tinder the rim 
transversus auris.
17
of the helix is the Fossa Innominata, and between the
bifurcation of the helix is  the  Scapha.  The  external
Auditory Meatus is about one inch  in depth, its direc-
tion moderately forward; under the skin which lines the
meatus are the  Ceruminous Glands.
  2. The proper muscles of the ear  must be here de-
scribed ;  but the student must  not  expect to meet with
them  distinctly marked  in every subject: in general, they
are very confused and indistinct.
  (1.) Helicis Major—Arises from the upper and acute
part of the helix, anteriorly.
  Inserted into its cartilage,  a little above the tragus.
   Use: To depress the part from which it arises.
  (2.) Helicis Minor—Arises from the inferior  and an-
terior part of the helix.
  Inserted into the crus  of the helix, near the  fissure x>u
the cartilage opposite to the concha.
   Use: To contract the  fissure.
  (3.) Tragicus—Arises from the middle and outer part
of the concha,  at the root of the tragus, along which  it
runs.
  Inserted into the point of the tragus.
   Use: To pull the point of the tragus a little  forwards.
  (4.) Antitragicus—Arises from the internal  part of
the cartilage that supports the antitragus; and,  running
upwards, is
  Inserted into the tip of the antitragus as far as the infe^
rior part of  the antihelix.
   Use: To turn the tip of the antitragus a little outwards,
and depress the extremity of the antihelix towards it.
  (5.) Transversus Auris—Arises  from the  prominent
part of the concha on the dorsum of the ear.
  Inserted opposite to the outer side of the antihelix.
   Use: It draws  the parts to which it is  connected to-
wards each other, and stretches the scapha and concha.
2* 
18
PRACTICAL ANATOMY.
                CHAPTER  III.

             DISSECTION OF THE FACE.

                  OF THE MUSCLES.

  To expose these muscles an incision should be carried
from the root of the nose  to its tip, around  the  margin
of the nostril to the centre of the upper lip, down to its
margin, around its border to an opposite  point  on the
lower lip, and then to the symphysis of the chin.  From
the termination of the last a second may be carried along
the base of the jaw to the mastoid process of the temporal
bone.  Reflect the integuments outwards.
  Under the integuments of the face, there is always a
considerable quantity of adipose membrane; many of the
muscles are very slender, and lying embedded in this fat,
require  careful dissection.  The whole side of the face is
also supplied with numerous ramifications of the facial
nerve, or portio dura of the seventh pair.   These nervous
twigs are generally removed with the integuments.  If it
is desired to save  them, the skin only should be removed
first.
  Twelve pairs of muscles, and one  single muscle, are
described in this dissection.
  1. The Orbicularis Palpebrarum—Arises from the
internal angular process of the frontal bone, and  from a
tendon  at the inner  angle of  the eye, by a number  of
fleshy fibres which pass round the orbit, covering  first
the superior and then  the inferior eyelid, and also the
bony edges of the orbit.
  Inserted, by a short round tendon, the  Tendo Ocult
into the nasal process  of the  superior maxillary bone.
The above tendon lies across the lachrymal sac. 
       LEVATOR LABII SUPERIORIS ALjEQUE jnASI.     19

  Situation: This muscle is intermixed, at its upper part,
with the occipito frontalis.
   Use: To shut the eye, by bringing down the upper lid,
and pulling up the  lower;  the fibres contracting towards
the inner angle, as  to a fixed point, compress the eyeball
and lachrymal gland, and  convey the tears towards the
puncta lachrymalia.
  The ciliaris is only a part of the muscle covering the
cartilages of  the eyelids,  which are called the Cilia or
Tarsi; Maxillo-palpebral.
  2. The Corrugator Supercilii—Arises, fleshy, from
the internal angular process of the os frontis; it runs out-
wards and a little upwards, to be
  Inserted  into the inferior  fleshy part of the  occipito-
frontalis muscle, extending outwards as far as the middle
of the superciliary  ridge.
   Situation: This  muscle  is  concealed  by the  occipito-
frontalis.  It  lies close to the upper and inner part of the
orbicularis palpebrarum, with which it is connected.
   Use:  To smooth the skin of the forehead, by pulling
it down after  the action of the occipito-frontalis.  When
it acts more forcibly, it pulls down the eyebrow and skin
of the forehead, and'produces vertical wrinkles.
   3.  The Compressor Naris—Arises, narrow, from the
outer part of the ala nasi, and neighboring part  of the os
maxillare  guperius.  From this origin a number of thin
separate fibres run  up obliquely along the cartilage of the
nose towards  the dorsum nasi, where the muscle joins its
fellow, and is
   Inserted, slightly, into the lower part of the os nasi and
nasal process  of the superior maxillary bone.
   Situation: It is superficial; its origin is connected with
the levator labii superioris aloeque nasi.
   Use:  To compress the  ala towards the septum nasi;
but, if the fibres of the occipito-frontalis, which  adhere to
it, act, the upper part of this muscle assists in pulling the
ala outwards: It also corrugates the  skin of the nose.
   4.  Levator Labii Superioris Al^que Nasi—Arises
by two distinct origins: the first from the nasal process of
the superior maxillary bone, where it joins the os frontis at 
20
practical anatomy.
 the inner canthus of the eye; it descends along the nasal
 process, and is inserted into the outer part of the ala nasi,
 and into  the  upper lip.  The  second arises, broad and
 fleshy, from the margin of the orbitar process of the supe-
 rior maxillary bone, immediately above the foramen in-
 fra-orbitarium; it runs down, becoming narrower, and is
 inserted into the upper lip and orbicularis oris.
   Situation: The first portion is sometimes called Levator
 Labii Superioris Alaeque  Nasi, and the second Levator
 Labii  Superioris Proprius.  Their  origins  are  partly
 covered by  the orbicularis  palpebrarum.  They descend
 more outwardly than the ala nasi.
   Use: To raise the upper lip towards the orbit, and a
 little  outwards;  the first portion will also draw the  ala
 nasi upwards and outwards.
   Bloodvessels and Nerves.—Below the orbital ori-
 gin of this muscle will be seen the Infraorbital Blood-
 vessels and Nerve coming out of the infraorbital fora-
 men.   The  artery  is from the  internal maxillary, the
 nerve from  the superior maxillary branch of the fifth
 pair.
   5. Zygomaticus Minor—.iraesfrom the upper promi-
 nent part of the os make, and, descending obliquely down
 wards and forwards, is
   Inserted into the  upper lip  near the corner of the
 mouth.
   Situation: Its origin is covered by the orbicularis pal-
 pebrarum.
   Use: To draw the corner of the mouth and upper lip
 obliquely  upwards and outwards.
   6. Zygomaticus  Major—Arises, fleshy, from the os
 mate, near the zygomatic suture.
   Inserted into the angle of the  mouth, appearing to  be
lost in the depressor anguli  oris, and orbicularis oris.
   Situation: Its origin is partially covered by the orbicu-
laris palpebrarum;  it lies more outwardly than the zygo-
maticus minor.
   Use: To draw the corner of the mouth and under lip
 upwards and outwards.
   7. The Levator  Axgult Oris—.-Imc*. thin and fleshy 
buccinator.
21
from a depression of the superior maxillary bone betwixt
the root of the socket of the first dens molaris, and the
foramen infraorbitarium.
  Inserted, narrow, into the angle ©f the mouth.
  Situation: It lies more  outwardly than the levator labii
superioris alaeque  nasi; it  is in part concealed by that
muscle, by the zygomaticus minor, and part of the zygo-
maticus major.  At its insertion it is connected with the
depressor anguli oris.
   Use: to draw the corner of the mouth upwards.
  8. The Depressor Anguli Oris—Arises, broad and
fleshy, from  the  lower edge  of the  inferior  maxillary
bone, at the side of the chin, and gradually becoming
narrower, is
   Inserted into the angle  of the mouth.
   Situation:  This muscle is firmly connected  with the
platysma myoides; at its insertion  it is blended with the
zygomaticus major and levator anguli oris.
   Use: To pull down the corner of the mouth.
   9.  The Depressor  Labii Inferioris—Arises,  fleshy
and broad, from the side of the lower jaw, -a little above
its lower edge; it runs  obliquely upwards and inwards,
and is
   Inserted into the edge of the under lip.
   Situation: This muscle, at its insertion, decussates with
its fellow.   It is in part  covered by the depressor anguli
oris.  It forms the  thick part of the chin, and has its
fibres interwoven with fat.
   Use: To pull the under lip downwards.
   10. The  Buccinator—Arises, tendinous  and  fleshy,
from the lower jaw as far back as the root of the coronoid
process; from the upper  jaw, as far back as the pterygoid
process of the sphenoid  bone;  it then continues to arise
from the alveolar processes of both jaws, as far forwards
as the dentes cuspidati.  The  fibres run forward, and
are
   Inserted into the angle of the mouth.
   Situation: This muscle lies deep, adheres to the mem-
brane that lines the  mouth;  and a quantity of fat is
 always found between  its fibres and the other muscles 
22
P RACTICAL AXATOMY.

         Fig. 1.
Muscles of  the Face.
 1.  Frontal portion of the Occipito-
      Frontalis,
 2.  Its Posterior or Occipital  por-
      tion.
 3.  Its Aponeurosis.
 4.  Orbicularis Palpebne,  which
      conceals the Corrugator Su-
      percilii, and Tensor Tarsi of
      Horner.
 5.  Pyramidalis Nasi.
 6.  Compressor Naris.
 7.  Orbicularis Oris.
 8.  Levator Labii  Superioris Alse-
      que Nasi.
 9.  Levator Labii Superioris.
10.  Zygomaticus Minor.
11.  Zygomaticus Major.
12.  Depressor Labii Inferioris.
13.  Depressor Anguli Oris.
14.  Levator Labii Inferioris.
15.

16.
IS.
19.
20.
21.
23.
24.
25.
2li.
Superficial Portion of the Mas-
  seter.
Its Deep Portion.
Buccinator.
Attollens Auriculae Muscle.
Temporal Aponeurosis which
  conceals the Temporal Mus-
  cle.
Retrahens Auriculae  Muscle.
Anterior Belly of the Digas-
  tric—the  Tendon is  seen
  passing  through  the Loop
  formed by the Cervical Fas-
  cia.
Stylo-hyoid Muscle.
Mylo-hyoid Muscle.'
Sterno-mastoid Muscle.
Upper part of the Trapezius—
  the Muscle between 25 and
  26 is the Splenitis.
and integuments.   It is partly concealed by the masseter,
and by the muscles which pass to the angle of the mouth,
as the levator and depressor anguli oris, and zygomaticus
major.  It is inserted behind these muscles.   In'the cheek
it is connected with the platysma  myoides. 
      DEPRESSOR LABII SUPERIORIS ALJSQUE NASI.    23

   Use: To draw the angle of the  mouth backwards and
outwards, and to  contract its cavity, by  pressing the
cheek inwards.
  The single muscle is the
  Orbicularis Oris.—It consists of two planes of semi-
circular fibres, which decussate at the angles of the mouth.
These fibres are formed chiefly by the muscles which are
inserted into the  lips; they  surround the mouth.' The
superior  portion runs along the upper lip, the inferior
portion along the under lip.
  Situation: It  is connected and intermixed with the in-
sertions of all the preceding muscles of the face.  Some of
the fibres are connected to the  septum nasi, and are by
Albinus termed Nasalis Labii Superioris.
   Use: To shut the mouth by contracting and drawing
both lips together.
   At  this stage  of the examination the Facial Ar-
tery will be brought  into view, a branch of the external
carotid mounting over the lower jaw in front of the mas-
seter muscle, passing under the depressor anguli oris and
ascending  as high as the angle  of the eye, where it is
called Angular Artery. Its branches, enumerated from
below upwards, are as follows. Masseter branches to the
masseter and buccinator muscles.  Inferior Labial to
muscles of the lower lip, Inferior Coronary to edge of
loAver lip.  Superior Coronary along the  edge  of the
upper lip.  Lateralis Nasi to the ala and septum of the
nose. Nerves.—Anterior Dental, some distance back
from the symphysis of the lower jaw, comes out  of the
anterior dental foramen, and is the termination of the infe-
rior maxillary or 3d branch  of the  5th  pair.   Any
filaments coming  forward from the outer portion of the
face are  from the portio dura of the 7th pair.
   11. Depressor Labii Superioris Al^que Nasi—
Arises, thin and fleshy,  from the os  maxillare superius,
where it forms the alveoli of the dentes incisiva and dens
caninus; thence it runs up under part of the levator labii
superioris alaeque  nasi.                        •
   Inserted into the upper lip and root of the ala nasi.
   Situation: It is concealed  by the orbicularis oris and 
24
PRACTICAL ANATOMY.
levator labii superioris alaeque nasi.  It may be discovered
by inverting the upper  lip, and dissecting on the side of
the frasnum, which connects the lip to the gums.
   Use: To draw the upper lip and ala  nasi downwards
and backwards.
   12. The Levator Labii Inferioris—Arises from the
lower jaw at the root of the alveolus of the lateral incisor.
   Inserted into the under lip and the skin of the chin.
   Situation: Those  two small muscles are found  by the
side of the frasnum of the lower lip.  They lie under the
depressor labii inferioris.
   On the side of the face we observe two strong muscles,
and two other muscles are concealed by the angle of the
inferior maxilla.
   Behind the masseter and overlaying a portion of it is
the Parotid Gland (a salivary gland).  It is wedged in
between the angle and ramus of the jaw and the cartilage
of the ear, extending up  as high as the zygoma, and down
into  the neck.   Its deep surface  rests  upon the styloid
process of the temporal  bone and is insinuated into all
the irregularities about this point: its color is pinkish, and
consists of lobules held together by cellular tissue.  It
has no proper capsule, but is covered by the extension of
the fascia of the neck.   The external carotid artery runs
through  its  substance, giving it many  branches, called   \
Parotidean ; and the Portio Dura, or facial nerve, after
it escapes from the stylo-mastoid foramen, passes through
it  also on its way to  the  face, and its  several brandies
form a looped connection over the masseter called the   I
Pes Anserinus. From the anterior and  upper  part, a
white canal (sometimes  two for a little wavs^) passes for-
ward  over the masseter muscle to its anterior edge, be-
neath which it dips, and, perforating the  buccinator emp-
ties into the mouth opposite 2d molar of the upper jaw
This is the Parotid Duct (duct of Steno).  It is accompa-
nied by branches of the portio dura nerve, and the Trans-
verse Facial Artery from the external carotid.           j
   1.  T^he Masseter is divided into two portions, which
decussate one another.
   The Anterior  Portion arises, tendinous and fleshy, from 
temporalis.                   25
the superior maxillary bone, where it joins the os malse;
from the lower edge of the os malae, and from its zygomatic
process.  The strong fibres run obliquely downwards and
backwards, and are inserted into the outer surface of the
side of the lower jaw, extending as far back as its angle.
  The Posterior  Portion  arises, principally fleshy, from
the inferior surface of the os  malae, and of the whole of
the zygomatic process, as  far back as the tubercle before
the socket  for the condyle of the lower jaw.  The fibres
slant  forwards, and are inserted, tendinous, into the outer
surface of the coronoid process of the lower jaw.
  'Situation: The anterior portion  conceals  almost  the
whole of the posterior portion.  The greater part of this
muscle  is superficial.  Below it is covered by the pla-
tysma myoides; and above, a small portion of it  is con-
cealed by the origin of the zygomaticus major.
   Use:  To pull the lower to the upper jaw, and to move
it forwards and backwards.
  2.  Temporalis—Arises, fleshy,  from a  semicircular
ridge in the lower and  lateral part of  the parietal bone,
from  all the squamous portion of the  temporal  bone,
from  the external angular process of the os frontis, from
the temporal process of the sphenoid bone, and from an
aponeurosis which covers  the muscle.  From these dif-
ferent origins the fibres converge, descend under the bony
jugum formed by the zygomatic processes of the temporal
and cheek  bones.
  Inserted,  by a strong tendon, into the upper part of the
coronoid process of the lower jaw, to which it adheres on
every side, but more particularly its forepart, where the
insertion is continued down to near the last dens molaris.
If the zygoma is removed a better view will be had.
  Situation: This muscle is of a semicircular shape.  It
is covered by  a  fascia  or aponeurosis.  This fascia ad-
heres to the bones which give origin to the upper part of
the muscle, and, descending over it, is inserted into the
jugum and adjoining part of the os malae and os frontis.
This  insertion is by two leaves, leaving a space between
containing some  fat.  The temporalis, at its origin, lies
under the expanded  tendon of the  occipito-frontalis, and
     3 
26               PRACTICAL ANATOMY.
under the small  tendons which move the external ear.
Its insertion is concealed by the jugum and by the mas-
seter; so that,  to expose it, the masseter  must be  cut
away.
  Use:  To  pull  the lower jaw upwards and  press it
against the upper.

                        Fig. 2.
The  two Pterygoid Muscles.  The Zygomatic Aech and the greater
  part of the ramus of the lower jaw have been removed, in order
  to bring these muscles into view.
1. The Sphenoid Origin of the Exter-
   nal Pterygoid Muscle.
2. Its Pterygoid Origin.
3. The Internal Pterygoid Muscle.
  In order to expose the following muscles, we must re-
move the muscles of the cheek and jaw, the masseter and
insertion of the temporalis must be taken away, and  the
coronoid process  of the  inferior  maxilla removed by  a
saw.
  3.  The  Pterygoideus Externus—Arises from  the
outer side of the external plate of the pterygoid  process
of the sphenoid bone, from part of the  tuberosity of the
os maxillare adjoining to it, and from the root of the
temporal process of the sphenoid bone.   It passes back-
wards and outwards, to be
  Inserted into a depression in the neck of  the cond3'loid
process of the lower jaw, and into the anterior and inner
part of the ligament of the articulation of  that bone.
  Situation: This muscle passes almost transversely from
the skull to its insertion.  It is concealed by the muscles
of the face and neck,  and by the ascending processes of
the lower jaw.
 
                INTERNAL MAXILLARY.             27

   Use:  When  this pair of muscles  act together, they
bring the jaw horizontally forwards.  When  they  act
singly, the jaw is  moved  forwards, and to the  opposite
side.
  4. The Pterygoideus Internus—Arises, tendinous
and fleshy, from the inner and upper part of the internal
plate of the pterygoid process of the sphenoid bone, filling
all the space between the two plates; and from the ptery-
goid process of the os palati between these plates.
  Inserted, by tendinous and fleshy fibres, into the inside
of the angle of the lower jaw.
  Situation: To expose this muscle, the jaw must be re-
moved from its articulating cavity, and then  pulled for-
wards, and toward the opposite side;  or it may be sawn
across at its symphysis, and the other half removed. It is
larger than the pterygoideus externus; and between  the
two muscles there  is a considerable quantity of cellular
membrane, and the trunk of the Inferior Maxillary
and Gustatory Nerves.  Like  that  muscle, it is con-
cealed by the lower jaw and facial muscles.  Along its
posterior  edge,  we observe  the Ligamentum  Laterale
Maxillae Inferioris, a ligamentous band, which extends
from the back part of the styloid process to the angle of
the lower jaw.
   Use: To draw the jaw upwards, and obliquely towards
the opposite side.

                      ARTERIES.
  The External Carotid is found ascending  behind  the
parotid gland.  It perforates the  gland at its  upper part,
ascends over the zygomatic  process  immediately before
the ear, and divides into the  anterior, middle, and poste-
rior temporal arteries, which  ramify over the side of the
head, giving also branches to the  forehead and occiput.
  The Internal Maxillary passes  behind the condy-
loid process of the lower jaw; it directs its course towards
the bottom of the orbit of the eye; and it is at this point
that it sends off its numerous branches.  (1.)  Arteria
Media  Durjs Matris, passes through the  spinal hole of
the sphenoid bone into the cranium, and is distributed to 
                                                          1
28               PRACTICAL ANATOMY.

the dura mater.   (2.) A. Maxillaris Inferior, vel Den-
talis Inferior, runs downwards, enters the foramen at the   -j
root of the ascending processes  of the  lower jaw, then   }
passes through the canal of the lower jaw; supplying the    v
teeth and  sockets, and emerges by the foramen mentale,
to be distributed to  the  chin.   It is  accompanied by a   J
nerve and one or two veins.  (3.) A. Pterygoide^e and   *|
A. Temporales  Profunda,  are small  branches of the    1
internal maxillary which pass to the pterygoid muscles,
and to the inner part of the temporal  muscle.  (4.) A.    *
Pharynge^e, branches to the pharynx,  palate, and  base   'A
of the skull.   (5.) A.  Alveolaris, which gives branches
to the teeth of the upper jaw, and to the jaw bone itself.
(6.) A Branch through the  foramen spheno-palatinum to   J
the nose;  and, (7.) An Artery through the  palato-maxil-   J
lary canal to the  palate.                                   1

                         Fig. 3.                            1
       The Internal Maxillary Artery and its Branches.

                              A. External Carotid Artery.
                              a. Internal Maxillary Artery.
                              b. Arteria Tympanica.           .]
                              c. Arteria Pterygoidea.
                              d. Dentalis Inferior.
                              e. Arteria Meningea Parva.     '~\
                              f. Arteria Buccalis.            i
                              g. Arteria Alveolaris, or Maxil-
                                  laris Superior.
                              h. Arteria Meningea Magna.
                              o. Infra-Orbitalis.
                              d. Anterior Mental Artery.       j
  The continued trunk of the internal maxillary enters the
orbit by the spheno-maxillary slit.   It sends off a branch   •
which runs along the inner side of the orbit, and passes out   j
at the inner canthus of the eye on the forehead. The artery   >.
itself  runs along  the bottom  of the orbit in a canal on
the upper part of the great tuberosity of the os maxillare
superius, and emerges by  the foramen  infra-orbitarium   \
 
SUPERIOR CERVICAL NERVES.
29
on the face; hence it is termed A. Infra-Orbitaria, and is
distributed to the cheek and side of the nose.
  The Frontal Artery is also seen in the dissection of
the face, passing from the orbit  through the foramen
supra-orbitarium to be distributed to the forehead.   This
artery is sent off from the ophthalmic  artery, which is a
branch of the internal carotid.
  If the face be  injected,  a remarkable anastomosis  of
arteries will be observed at the inner angle of the eye. ■

                        Veins.
  The veins of the face are numerous,  and pass into the
external and internal jugular veins.

                       Nerves.
  1. The Portia Dura  of the  seventh  pair, Nervus
Communicans Faciei,  or Facial nerve, after its  course
through the temporal bone in the aqueduct of Fallopius,
comes out by the foramen stylo-mastoideum.  It imme-
diately gives off  branches  to the  neighboring  parts,  as
behind the ear.  It then passes through the substance  of
the parotid gland, and emerges on the face in three great
branches, which have frequent  mutual  communications :
this division of the nerve is called Pes  Anserinus.
  (1.)  The ascending  branch ramifies on the temple and
forehead.
  (2.)  The middle branch sends its ramifications over the
side of the face, the proper Faciar Nerves.
  (3.)  The  descending branch sends  its  twigs along
the chin, down  upon the neck, and backwards upon the
occiput.
  2. The Superior Cervical Nerves send off several
branches, which ramify on the side of the face and head,
and communicate freely with the branches  of the portio
dura.
  As, in the course of this dissection, we meet with many
twigs of the. second and third branches  of the fifth pair  of
nerves, it will  be  advisable  here to describe this pair  of
nerves.
                         3* 
30
PRACTICAL ANATOMY.
                               Fig. 4.
The Distribution of the Facial Nerve and the Branches of
                          vical Plexus.
 1. The Facial Nerve (Portio Dura) escaping from the Stylo-mastoid
     Foramen, and crossing the Ramus of the Lower Jaw ; the Paro-
     tid Gland has been removed, in order to  show the Nerve more
     distinctly.
 2. The posterior Auricular Branch ; the Digastric and Stylo-mastoid
     Filaments are seen near the origin of this branch.
 3. Temporal Branches communicating with (4) the Branches  of the
     Frontal Nerve.
 5. Facial Branches communicating with (6) the Infra-orbital Nerve.
 7. Facial Branches communicating with (8) the Mental  Nerve.
 9. Cervico-facial Branches communicating with (10) the  Superficial
     Cervical Nerve, and forming a Plexus (11) over the Submaxillary
     Gland.  The distribution of the branches of the facial in a radi-
     ated direction over the side of the face, and their  looped com-
     munications, constitute the Pes Anserinus.
12. The large Auricular Nerve, one of  the Ascending Branches of the
     Cervical Plexus.
13. The Small Occipital ascending along the Posterior Border of the
     Sterno-mastoid Muscle.
14. The Superficial  and Deep-descending  Branches of  the Cervical
     Plexus.
15.  The Spinal Accessory Nerve, giving  off  a Branch to  the External
     Surface of the^Trapezius Muscle.
16.  The Large Occipital Nerve, the Posterior Branch of the second Cer-
     vical Nerve. 
NERVUS MAXILLARIS SUPERIOR,
31
  1st.  The Ophthalmic Nerve. The first branch of the
fifth pair enters the orbit through the  sphenoidal fissure.
Its branches are the Frontal, which, passing above the
levator palpebral muscles,  escapes upon the  forehead
through the  supra-orbital foramen.   The  Lachrymal
passes along the upper edge  of the external rectus muscle
with the Lachrymal Artery to the Lachrymal Gland.
Here it divides into two branches, one escaping through
the malar bone upon the cheek and temple, the other to
the under part of the gland, and conjunctiva of the upper
lid.
  The Nasal passes between the origins of the external
rectus  muscle, accompanies  the ophthalmic artery and
enters the anterior ethmoidal  foramen, then  up through
the ethmoid bone to the cribriform plate, and then through
the nasal slit in that plate into the nose, which supplies
the mucous membrane and integuments of the  nose.  Its
principal branches while in the orbit, are the Ganglionic,
Ciliary, and infra-trochlear.
   3. Nervus Maxillaris Superior, or second branch
of the fifth pair.   The superior  maxillary nerve, having
left  the cranium by the foramen rotundum of the sphe-
noid bone, emerges  behind the antrum maxillare, at  the
lower back part of the orbit, and at the root of the ptery-
goid process of the sphenoid bone.  It immediately sends
 out branches: 1. A small branch which passes through
 the  spheno-maxillary slit to  the periosteum and fat of the
 orbit.  2.  The largest  branch is  the Infra-Orbitary
 Nerve.  It enters the channel in the top of the antrum
 maxillare, accompanying the infra-orbitary artery, comes
 out at the foramen infra-orbitarium, and is widely  dis-
 tributed to the cheek, under lip, and  outside of the nose,
 communicating with  ramifications of the portia dura.
, 3. Branches to the temporal muscle, os malas, &c.  4.
 Communicating  branches with Meckel's ganglion.   5.
 Posterior  dental branches through the foramina in  the
 superior maxillary bone.   6. Twigs which  supply  the
 gums and alveoli of the upper jaw.
 ° 4. Nervus Maxillaris  Inferior, or third branch of
 the fifth pair.  The inferior maxillary nerve  leaves  the 
32
PRACTICAL anatomy.
 cranium by the foramen ovale of the sphenoid bone.  It
 has its course  downwards  and outwards;  and, having
 given twigs to the parts near which it passes, as the mas-
 seter, pterygoid, and temporal  muscles, it divides  at the
 angle  of the jaw into two branches.
   1. Inferior Dental Nerve—Enters the foramen at the
 angle of the lower jaw, accompanies the Inferior Dental
 Artery along the canal in that bone, giving nerves to
 the  teeth, emerges at the anterior mental foramen, and is
 distributed to the chin.
   2. The Gustatory or Lingual Nerve passes to the
 tongue.  It lies close along the inner surface of the  lower
 jaw, below the inferior edge of the pterygoideus-internus,
 and above the mylo-hyoid will be seen when the neck is
 dissected.  This nerve receives the chorda tympani.
   3. The Frontal Nerve,  which comes from  the first
 branch of the fifth pair through the supra-orbital foramen:
 it is distributed to  the forehead.
   A general view of the distribution of the spinal nerves
 may be usefully subjoined in this place, to complete the
 description of the nerves.
   1. The Cervical Nerves consist of eight pairs; they
 spread their branches over the side and back of the neck
 and  head,  and  to the muscles moving  the head  and
 shoulders.  The superior nerves send  branches to the
 sides of the head, and the inferior to the upper  part of
 the chest and back. They also communicate freely with
 each other, and  with all the neighboring nerves;—hi<di
 in the  neck, and under the jaw, with the portio dura°of
 the seventh  pair, with the fifth, eighth, and ninth pairs,
 and with the great sympathetic;—towards the middle of
 the neck, with the  descendens noni,  the sympathetic and
 eighth pair, and  in the lower part of the neck with the
 sympathetic.
  The  Phrenic Nerve is formed  by branches of the *
 third, fourth, and fifth cervical nerves,  passes obliquely
down the neck through the thorax, then on each side of
the pericardium, and is distributed to the diaphragm.
  The Axilla hv Plexus is formed by the principal parts 
NERVES.
33
of the trunks of the fourth, fifth, sixth, and  seventh cer-
vical, and first dorsal nerves.
  2. The Dorsal Nerves are twelve pairs.—They arise
from the spinal marrow in the same manner as the cervical.
Each nerve emerges betwixt the heads of the ribs, gives
twigs to  the  great sympathetic nerve, and  twigs which
pierce backwards to the muscles of the back; then enter-
ing the groove in the lower edge of each rib, it  accompa-
nies the intercostal artery, and runs towards the anterior
part of the thorax, supplying the great muscles of the
chest, giving  twigs to the diaphragm, and muscles of the
abdomen.
   3. The Lumbar Nerves are five pairs.  They arise in
the same manner;  their trunks are covered by the psoas
magnus muscle.  Each nerve gives  twigs to the muscles
of the loins and back, and to the sympathetic nerves, and
runs obliquely downwards to supply the abdominal mus-
cles and  integuments of the groin and scrotum ; but the
trunks of these nerves assist in forming the  nerves of the
thigh.
   4. The Sacral  Nerves are five on each side, arising
from the cauda equina.  They come out through the an-
terior foramina, and send small branches to the  neighbor-
ing parts; but the great trunks of these  nerves are united
with the lumbar nerves, to form the nerves of the lower
extremity, viz:
   (1.)  The Anterior Crural Nerve,  passing out under
Poupart's ligament to the extensor muscles  of the  leg, is
formed by branches  of the  first, second, third, and fourth
lumbar nerves.
   (2.)  The Obturator Nerve, leaving the pelvis by the
thyroid  holes, and being distributed to the deep-seated
muscles  on the inside of the thigh, arises from branches
of the second, third, and fourth lumbar nerves.
   (3.)  The  Ischiatic  or  Sciatic  Nerve, the greatest
nerve  of the body, passes out  from the back part of the
pelvis, through the sacro-sciatic notch, and takes its course
along 'the back of the thigh, to supply the thigh, leg, and
foot • it  is formed from the two last nerves of the loins
 and three first of the sacrum. 
34
1   PRACTICAL ANATOMY.
  All these  nerves of the spine communicate freely by
numerous twigs, and by the intervention of
  The Great Sympathetic Nerve, or Intercostal.—
This nerve,  consisting of ganglia connected by cords,
passes  out of the cranium with the carotid artery.   It
then descends through  the neck, and forms three gangli-
ons in  its course, which give twigs to the neighboring
parts, and are joined by filaments from the cervical nerves,
and the eighth and ninth pairs. The intercostal then enters
the thorax, and descends by the side of the vertebra, be-
hind the pleura, giving filaments, which, joining with twigs
of the  eighth pair, form several plexuses to supply  the
heart, lungs, &c.   In the abdomen it descends on  the
lumbar vertebras, and at last terminates in the pelvis on
the extremity of the coccyx.
  "While in the thorax, it gives  off a branch, which unit-
ing with branches of the dorsal  nerves, forms
  The Anterior Intercostal, or Splanchnic Nerve.
—This nerve, passing betwixt the crura of the diaphragm,
enters  the abdomen, forms the  semilunar ganglion, and
is distributed by numerous plexuses to all the abdominal
viscera.
  The eighth pair, or par vagum, has  also a very long
course; it arises in the head, passes through the neck, to
which it gives  several branches.  It enters the thorax
anterior to the subclavian artery; here it gives off a re-
markable branch, called the  Eecurrent, because  it is re-
flected round the arch  of  the aorta on the left side, and
round the subclavian artery  on the right, and  ascends to
be  distributed  on the trachea, oesophagus, and  larynx.
The nerve then passes through  the thorax, and, entering
the abdomen, terminates in the stomach; in this course it
has frequent communications with the  great sympathetic,
which  it assists in forming the different plexuses  that
supply  the  thoracic  and  abdominal viscera.  It is  dis-
tributed to  the heart, lungs, liver, spleen, stomach,  and
duodenum. 
THE nose.
35
                       The Nose.

  The two  openings in front are the Nostrils guarded
by  stiff  hairs  (vibrissje).  The  septum  between  the
nostrils, the Columna ; the tip of the nose, the Lobulus;
sides (al^e).  It is covered with great numbers of seba-
ceous follicles : its form secured by five fibro-cartilages.
  1. Fibro-Cartilage of the  Septum divides partly
the nasal fossae into two.
  2. Lateral Fibro-Cartilage  (2)  connected above
to the  nasal  bones and nasal process of superior max-
illary,  and below to the alar fibro-cartilage.
  3. Alar  Fibro-Cartilages (two);  each is curved to
correspond  to  the nostril.  The inner portion of each

                         Fio. 5.
  The Nasal Cartilages, showing their Connection with each othek
                  and with the ossi nasi.
  1. Cartilage of the Septum.
2, 2. Lateral Cartilages.
  3. Ala Cartilage.
  4. Cornua,  or Appendices of the Ala Car-
     tilage.
  5. Nostril.
coming together form the columna.  The alas  are  ex-
tended by three or four fibro-cartilaginous appendages. 
36
practical anatomy.
                CHAPTEB  IV.

OF THE CONTENTS OF THE CRANIUM, OR THE BRAIN
                AND ITS MEMBRANES.

   A  transverse incision, extending from  ear  to ear
over  the  crown of the head, being made through the
tendon of the.occipito-frontalis, the  two flaps may, with
facility, be inverted on the face and neck.  Remove the
superior part of the cranium by a  saw directed anteriorly
through the frontal bone above the orbitar process, and
posteriorly as low as the transverse ridge of the occipital
bone.  Thus the subsequent demonstration of the  brain
will be conducted with greater facility.
   When the superior part of the cranium,  commonly
called the Calvarium, or skull  cap, is torn off, which re-
quires considerable force, you expose the Dura Mater,
a firm, compact, and whitish membrane, somewhat shining,
rough on its  outer surface, from the rupture of vessels
which connected it to the cranium, and covered  with
bloody spots in consequence of the blood effused from
these  ruptured  orifices.  It is described as being separa-
ble into many laminaa (into two with facility); and  it is
said that these two laminae, by separating and reuniting
form the triangular cavities named Sinuses, which are in
fact large veins.   This division of  layers can hardly be
admitted as correct in the recent state of the membrane.     I
   The Superior Longitudinal Sinus lies in a groove
formed by the two parietal bones;  it extends along the
sagittal suture from the crista galli of the ethmoid bone
to the middle of the os occipitis, where it bifurcates into
the two lateral sinuses; in its passage backwards, its size
is increased.  When slit open (which it should be), its
triangular form is evident;  it is lined by a smooth mem- 
ARTERIA MENINGEA MEDIA.              37
brane, and  in it may be remarked  the numerous  open-
ings of the  veins of  the pia mater opening forwards, the
frena, or slips of fibres  crossing  from side to side,  called
chordae willisii, glandulse Pacchioni internee, et externa?,
little bodies like millet-seed seen  on the outer and  inner
surface of the sinus.
Sinuses of the Dura Mater.
  1. Superior Longitudinal Sinus.
  2. Inferior Longitudinal Sinus.
  3. The two Venae Galeni.
  4. Sinus Quartus.
  5. Torcular Herophili.
6, 6. The Lateral Sinuses.
  7. Inferior Petrous Sinus.
 8. Superior Petrous Sinus.
 9. Circular Sinus of Ridley.
10. The two occipital Sinuses.
11. Cavernous Sinus.
12. Internal Jugular Veins.
13. Veins of the Pia Mater.
  The  arteries of  the dura  mater  are divided into the
anterior, middle, and posterior.
  1. Arteria  Meningea Media  (called also the Spi-
nalis or Spheno-spinalis), the  great middle  artery, is a
branch of the internal maxillary; it passes through the
     4 
38              PRACTICAL AN ATOM Y.
spinous hole of the sphenoid bone, and  is seen arising
from the anterior inferior angle  of the parietal bone (in
a groove on which it lies), and  spreading its  numerous
branches over the dura mater.
  The anterior and posterior arteries are small.
  2. A. Meningea Anterior is sent off from the external
carotid, and enters the cranium by the foramen lacerum
orbitale superius.
  3. A. Meningea Posterior is given off by the verte-
bral artery; the dura mater also receives small twigs from
the occipital, pharyngeal arteries, &c.

  OF THE SEPTA OF THE BRAIN, OR PROCESSES OF THE
                    DURA MATER.
  1. The Falx (cerebri or major) is  a long and broad
fold, or duplicature of the inner lamina of the dura mater,
dividing the cerebrum into two  hemispheres,  extending
from the crista galli of the ethmoid bone, along the middle
of the os frontis and point of junction  of the two parietal
bones, to the crucial ridge of the occipital bone, where it
terminates  in the middle of the next septum.
  2. The Tentorium Cerebelli, or transverse septum.
This separates the cerebrum from the  cerebellum, and is
formed by  the inner lamina of the dura  mater, reflected
off  from the os occipitis along the groove of the lateral
sinuses, and the edge or angle of the temporal bones.  Its
position is  horizontal.
  There are some other folds of the dura mater not visi-
ble in this stage of the dissection.
  3. The falx  of  the cerebellum, or small occipital sep-
tum, will be seen when the cerebrum is removed.  It ex-
tends from the middle of the tentorium along the middle
spine of the os occipitis to the foramen magnum, dividing
the cerebellum into two parts.
  4. The sphenoidal  folds, two  small folds of the dura
mater, one on each side of the  sella turcica, stretching
from the posterior to the anterior clinoid  processes.
  The dura mater, also, in many parts of the brain, sepa-
rates its laminae to form  sinuses; the  principal of these 
the dura mater.                 39
Fig. 7.
Oblique View of the Interior of the Cranium as lined by the Dura
                        Mater.
  1. Falciform Process.
  2. Its Superior or Attached Border containing the Longitudinal Sinus.
  3. Its Free Border.
  4. Continuation of the Falciform Process with (6) the Tentorium.
7, 8. Free Concave Edge of the Tentorium.
  9. Termination of this edge at the Anterior Clinoid Process.
 10. Attached  Border of  the Tentorium continued along the Upper
     Angle of the Petrous Bone to the Posterior Clinoid Process.

will be  noticed in the  course  of  the dissection.  This
membrane should  now be divided in the line of the divi-
sion of the cranium; its internal surface is smooth, glisten-
in o-, and free from adhesion, except in the course of  the
longitudinal sinus; into which veins pass from  the  pia

  Detach the falx from the crista galli, and turn  it back-
wards, observe in  its lower edge the Inferior Longitu-
dinal  Sinus,  which enters a  sinus in the  tentorium,
termed the Straight Sinus.  This will fully expose the 
10              practical anatomy.
convolutions of the  brain, which are  closely invested
by the pia mater.
   1. The Tunica Arachnoides is  a fine membrane,
covering uniformly the surface of the pia mater, without
passing into the interstices  of its duplicatures.  It is  at-
tached to it, is  extremely thin, transparent, without ves-
sels, demonstrated with difficulty on the upper surface of
the  brain by the  blowpipe (which  raises it into cells),
but on the base of the brain it can be distinctly seen.
   2. The proper Pia Mater, or tunica vasculosa, is a very
vascular membrane, transparent  in the  interstices of  its
vessels, investing the substance  of the brain, descending
betwixt all its convolutions, and  lining its different  cavi-
ties ; but, where it  lines the ventricles, it is  fine, delicate,
and less vascular, than on the surface, and  betwixt the
convolutions of the brain:  It is connected to the  dura
mater by its veins  passing into the longitudinal sinus.
   The brain is divided into three parts : 1. The cerebrum;
2. The cerebellum; 3. The medulla oblongata.
   The Cerebrum consists of two distinct substances:—
   1. The cortical or vesicular substance forming the outer
part.
   2. The white medullary or tubular  substance forming
the inner part.
   The brain is divided by the falx into two hemispheres,
and by the pia mater into numerous convolutions.
   Each hemisphere is divided into three lobes.
   1. The Anterior Lobes rest  on that  part  of the cra-
nium which forms  the two orbits, and is called the ante-
rior fossas of the basis of the cranium.
   2.  The Middle Lobes are  situated before and above
the medulla oblongata, and rest on the middle fossae of
the basis cranii, which are formed by the sphenoid and
temporal bones.
   3.  The Posterior Lobes are  supported by the tento-
rium.
   The anterior and  middle lobes are parted by a deep
narrow sulcus, which ascends obliquely  backwards  from
the temporal ala of the os sphenoides to  near  the  middle 
                     the cerebrum.                   41

of the os parietale; it is termed Fissura Cerebri, or Fis-
sura Magna Sylvii.
   By gently separating with the fingers the  two  hemi-
spheres  of the  brain,1 we  see  passing betwixt them a

                           Fig. 8.
 Horizontal Section of the Cerebrum upon a Level with the Corpus
                         Callosum.

1. Outer edge of the Corpus Callosum, formed by pressing aside the
      Medullary Substance of the Hemisphere.
2. Medullary or Fibrous Substance.
3 Upper Surface of the Commissure.
4. Raphe.                                    ,         ,  ,  .
  [The fibres of  the Corpus Callosum  are erroneously represented  m
the cut—they should be shown as transverse instead of longitudinal.]


longitudinal white  convex body, the Corpus  Callosum :
it li°es under the falx.  On the surface of the corpus cal-

  ' Between the  hemispheres and on the surface of the corpus callo-
sum, we observe the arteria callosse, which are the continuation of the
trunks of the anterior cerebri. 
42
PRACTICAL ANATOMY.
losum is seen the  Raphe,  between  two  longitudinal
medullary lines, Linea Longitudinalis Lancisii, united
by transverse fibres, the Linea Transversa.
   When one hemisphere of the brain is cut horizontally
on the  level of the corpus  callosum, an appearance is
produced, termed the Centrum  Ovale Minus.  When
both are sliced off to the same level, the Centrum Ovale
Majus.
   Under this surface are the  two lateral ventricles.1  If
one of these be cautiously perforated on the side of the
corpus  callosum, and  gently inflated by a blowpipe, its
extent may be seen;  but, if much force be used, the air
will pass into the other ventricle.
   The two ventricles are separated by a medullary parti-
tion, which descends from the inferior surface of the corpus
callosum to the fornix, the  Septum Lucidum ; it consists
of two laminae, with a narrow cavity between the Fifth
Ventricle.  To see this septum, one of the ventricles
must  be laid open, and the septum pulled  gently to the
other side.
   The Lateral Ventricles  are two, right  and left,
lined  with a fine membrane, narrow, consisting of a bodv,
and three prolongations or cornua.
   1. The body is formed betwixt the corpus callosum,
the medulla of the brain,  the convexity of  the corpus
striatum, and the thalamus  nervi optici.
   2. The Anterior  Cornu or horn is formed betwixt
the more acute convexity of the corpus striatum, and the
anterior part of the corpus callosum.
   3. The Posterior Cornu (called also the digital cavity)
may be traced stretching backwards and downwards into
the posterior lobe of  the brain.
   4. The inferior or descending cornu  cannot be traced
iti this stage of the dissection; it seems like the continued
cavity of the ventricle, takes a curve  backwards and out-

  1 To show the lateral ventricles, the corpus callosum should be cut
away close to the septum lucidum, and then the ventricle of that bodv,
and the thickness and breadth of the septum itself, will be more elearlv
seen. 
THE FORNIX.
43
wards,  and  then,  turning forwards, descends  into the
middle lobe of the brain.
  The  lateral  ventricles  communicate' with each other,
and with the  third ventricle, by  an opening under the
forepart of the arch of the fornix.1
  In the lateral ventricles we meet with,
  The Fornix, a medullary body, flat and of a  triangu-
lar shape, broadest behind, which divides the two lateral
and the third ventricles.  It is exposed  on tearing  away
the septum lucidum; its lower surface is  towards the third
ventricle; its lateral margins are in the lateral ventricles;
on  its  upper surface it supports the septum lucidum, and
under its most anterior part is the foramen Monroianum:
—One of  the angles of  this body is forward,  and the
other  two  towards the  back part: it rests chiefly on
the thalami  nervorum opticorutn, but is separated from
them  by a vascular  membrane called the velum  inter-
positum.
   The extremities of the body  of the fornix are named
its Crura.
   1. The crus anterius is double, bends downwards be-
fore the anterior commissure of the brain, with  which it
is connected, and may be traced into the corpora albican-
tia, and tuber  cinereum on the base of brain.
   2. The two  crura posteriora,  coalescing with the back
part of the corpus callosum, pass, on each side, into the
inferior cornu of the lateral ventricle, and terminate on
the hippocampus major.
   Divide the body of the fornix, invert it, by turning the
anterior crus  forwards, and the  posterior crura  back-
wards ;  on the under surface  of the latter is an appearance

  1 It has been doubted whether or not this be an opening ; the choroid
plexus  passes through it, and seems to unite the surfaces ; it is ab-
surdly  named the Foramen Monroianum, from a mistaken  notion that
Dr. Munro discovered it, and may be seen by gently turning the ante-
rior cruis of the fornix to one side ; it is a space betwixt the most ante-
rior part of the convexity of the thalami nervorum opticorum, and the
anterior crus of the fornix.             ......
  This foramen may always be easily found by following the course of
the plexus choroides, as it passes forwards in the ventricle.  It is a
slit, rather than a round hole, in the natural state. 
44
PRACTICAL anatomy.
of transverse lines, named Corpus  Psalloides, psalterium,
or lyra.
A Transverse Section of the Brain, showing the Corpora Striata,
        Lateral Ventricles, and the Associated Parts.
1,1. Medullary  portion  of  the
      Hemispheres.
  2. Vesicular Neurine or Cortical
      Portion.
  3. Corpus Striatum.
  4. Septum Lucidum.
  5. Ventriculus  Septi  or  Fifth
      Ventricle.
6, 6. The Fornix.
  7. Posterior Crura of the Fornix.
  8. Base of the Fornix.
9,9. Plexus  Choroides,  at  the
      Margin of the Velum Inter-
      positum.
 10. Anterior Cornu of the Lateral
      Ventricle.
 11. Middle or Descending Cornu.
 12. Posterior Cornu.
 13. Hippocampus Major.
 14. Taenia  Hippocampi.
 15. Hippocampus minor.
 16. Longitudinal  Fissure*of  the
      Brain.
The inversion of the fornix exposes
The Plexus  Choroides.—This  is a continuation of 
VULVA.
45
the pia mater, a spongy mass, consisting of folds of tor-
tuous  vessels partly covering the  thalami  nervorum
opticorum, and  continued into the inferior cornu of the
lateral ventricles.   The plexus of each side is connected
to its fellow by the  Velum Interpositum, a membrane
which passes under the fornix, and lies on the third ven-
tricle and corpora quadrigemma.
   From this plexus the blood is received  by the Vena
Oaleni situated in  the middle of the velum interpositum
which consists of two parallel branches; these run back-
wards, unite, and enter the Torcular Herophili through
the Sinus Rectus.
   This plexus ■'should now be detached at its forepart,
and turned back; it will remain as a  guide to the knife
in tracing the inferior cornu of the lateral ventricle.
   We now see,
   The Corpora Striata, two smooth convexities, in the
forepart  of the lateral ventricle, broad, and rounded an-
teriorly,  becoming  narrow, and diverging as they  pass
backwards, consisting of tubular and vesicular substance
disposed in striae.
   The Thalami Nervorum Opticorum, two  large  oval
whitish eminences, placed by the side of each other be-
tween the diverging extremities or crura of the corpora
striata; towards their forepart is a peculiar eminence or
convexity, called the  Anterior  Tubercle.  On the  outer
and  posterior  face two enlargements, the Corpus Ge-
niculatum  Externum and Internum.  The former
connected by a ridge to the testes.   The latter  to the
nates.
   Taenia Semicircularis, a white medullary line, run-
ning in the angle between the corpus striatum and thala-
mus nervi optici of each side.
   Commissura anterior  Cerebri, a short  cylindrical
medullary cord, stretched transversely between  the fore
and lower part of the corpora striata, immediately under
the anterior crura of the fornix.
   Just above the  commissura anterior, and before the
thalami  is the Vulva, or foramen commune anterius,  a
small slit or indentation, formed by the anterior crus of 
46
practical anatomy.
the fornix, bifurcating, and inserting itself, on each side,
between the corpus striatum  and thalamus nervi optici.
This slit is the space by which the three ventricles com-
municate.
  Commissura Mollis  is an  exceedingly soft, broad,
cineritious junction between the convex surfaces of the
thalami nervorum opticorum.
  On separating the optic thalami, we discover the Third
Ventricle.  This is a longitudinal sulcus, or slit, situ-
ated between  the  thalami nervorum opticorum, and  be-
tween  the crura cerebri.  Above, it is covered by  the
fornix and velum interpositum; at  its upper and fore-
part, it communicates with the two lateral ventricles; be-
low the commissura anterior,  it opens into the infundibu-
lum.  This opening is termed  Iter ad Infundibulum.
Backwards, it is continued by a canal which passes under
the tubercula quadrigemina into  the fourth  ventricle.
This passage is named Iter ad Quartum Ventriculum
(aquaeductus Sylvii).
  The Pineal Gland, a small, soft, grayish, and conical
body, of the size of a pea, is  seated above the tubercula
quadrigemina, and behind the thalami, to which it is con-
nected by two white pedunculi, or footstalks; its base is
turned forwards, and the apex  backwards; it is covered
by the plexus choroides and posterior crura of the fornix.
It contains an earthy matter, either in its own substance
or that of the  pedunculi, resembling sand.  It was named
by Soemmering, who first discovered that it belongs to
the healthy structure of the brain, the Acervulus Glan-
dule Pinealis.
  Commissura Posterior, a transverse cord at the back
part of the  third ventricle, before  the tubercula quadri-
gemina, and above the iter ad quartum ventriculum.
  Tubercula Quadrigemina, four  small white bodies,
adhering together, lying  under  the pineal gland, behind
the third ventricle, and above  the fourth.  The upper-
most two are  named Nates, and the other two Testes.
  From the under part of the testes, there project back-
wards  two  ridges or cords, connecting themselves with
the crura cerebelli, Processus a Cerebello ad Testes, 
THE CEREBELLUM.

      Fig. 10.
47

A Section of the Cerebrum, showing the Upper Surfaces of the Cor-
  pora Striata and Optic Thalami, the Cavity of the Third Ventricle,
  and the Upper Surfaces of the Cerebellum.
 a, e. Tubercula Quadrigemina.
   a. Nates.
   e. Testes.
   b. Commissura Mollis.
   e. Anterior  Extremity  of  the
       Corpus Callosum cut.
   f. Crura of the Fornix.
   g. Anterior  Horn  of  Lateral
       Ventricle.
 k, k. Corpora Striata.
 /, I. Thalami Optici.
ztos. Third Ventricle.
      In Front of z is the Anterior
        Commissure.
   s.  Posterior Commissure.
   p.  Pineal  Gland  with its Pe-
        duncles.
 n, n.  Processus   e  Cerebello  ad
        Testes.
m, m.  Hemispheres  of the Cere-
        helium.
   h.  Superior Vermiform Process.
   i.  Notch between the Hemi-
        spheres of the Cerebellum
        behind.
and  a thin medullary  lamina  between  the  Valve  of
VlEUSSENS.
9991 
48
PRACTICAL ANATOMY.
  The inferior  cornu of the lateral ventricle, which  de-
scends into  the middle lobe of the brain, may now be
traced, by following the tract of the choroid plexus.1  In
it is seen
  The Hippocampus Major, or Cornu Ammonis.  At
its commencement it is narrow, but it becomes a broad
medullary projection of the floor of the ventricle; and
its extremity, which is called Pes Hippocampi, is curved
inwards.  The thin edge on its inside, which follows the
whole of its circuit, is named the  Corpus Fimbriatum,
or Taenia Hippocampi.  Within this body is another,
resembling the  teeth of a comb, the Corpus Dentatum.
The posterior crus of the fornix runs along its inner and
anterior part, in the form of  a thin floating edge.
  In  the  posterior cornu of the lateral ventricle, which
passes into the posterior lobe of the brain, there is a
similar medullary projection, but smaller, the Hippocam-
pus Minor.
  Below the iter ad infundibulum, are seen the Corpora
Albicantia Willisii (corpora mammillaria), two medul-
lary eminences  of the size of peas.   The remainder of
these  bodies is  seen on the outer surface of the base of
the brain.
  This  completes  the  demonstration of the cerebrum.
The whole of the posterior lobes, and the lateral part of
the middle lobes, may be removed.  This exposes to your
view
  The Tentorium and the  Falx Cerebelli.  At this
point you should trace the bifurcation of the longitudinal
sinus into the two lateral sinuses.  The lateral sinuses are
formed by the splitting of the laminae of the tentorium;
hence they  follow  the  course of  that  membrane, run
along their grooves in  the occipital bone, and dip down-
wards and forwards through  the foramen lacerum in basi
cranii, to terminate in the internal jugular veins.
  The Torcular Herophili, or fourth sinus, runs along
the middle of the tentorium, and joins the  extremity of
the longitudinal sinus at the  point where it bifurcates.

  1 Or it may he exhibited by cutting away successive slices of the
side of the brain until the ventricle is exposed. 
FOURTH VENTRICLE.
49
  The great notch of the tentorium is a circular opening
left on the anterior part of the tentorium, allowing a junc-
tion between the cerebrum and cerebellum.
  The brain should now be removed by elevating the
front lobes, and dividing the nerves, arteries, &c, as they
appear, cutting through the tentorium as it stretches along
the Petrous bone, and, pushing the knife  through the
great  occipital foramen,  divide the spinal  marrow  and
vertebral arteries, when it may be turned out and inverted.
Clean it off well, leaving the nerves.  Its under  surface
exhibits the Anterior and Middle  lobes of the  cere-
brum, the two hemispheres of the cerebellum, the Pons
Varolii, or Tuber Annulare, and Medulla Oblon-
gata.
  Cerebellum.—This part of the brain, divided into two
lobes by the falx cerebelli, or septum  occipitale, is covered
by  a vascular membrane; consists of medullary and cine-
ritious substance; but,  instead of convolutions, has nu-
merous deep sulci, into  which the  pia mater dips, and
forms thin flat strata.
  Remark the following processes :—
  1. Appendix,  or Processus Vermiformis  Superior,
situated under the pia mater, on the  anterior and superior
part of the  cerebellum, the anterior part the Monticu-
lus.
  2. Appendix,  or Processus Vermiformis Inferior,
will be found situated between the two lobes on the under
surface of the cerebellum,  and immediately behind the
medulla oblongata.
  On separating the  two lobes behind, and  making  a
deep incision, we discover,
  The Fourth Ventricle.—The sides of this ventricle
are formed  by the  cerebellum, the  anterior part by the
medulla oblongata, the upper and back part by the val-
vula  cerebri;  it is lined by a thin  vascular membrane,
and has on its forepart a groove or fissure, which, termi-
nating in  a sharp point, is named Calamus^Scriptorius.
On each side of  this groove are seen  several medullary
lines, which are  the origin  of the  portio mollis of the
seventh pair of  nerves.  The  iter  a tertio ad quartum
     5 
50               practical anatomy.
A Posterior View of the Cerebellum, and the several Lobules of
           which it is composed.  (After Solly.)
1. Spinal Cord.
2. Posterior Spinal Nerves.
3. Amygdaloid Lobule.
4. Lobulus Pneumogastrici.
5. Lobulus Gracilis.
6. Inferior Semilunar Lobe.
 7. Superior Semilunar Lobule.
 8. Lobulus Quadratus.
 9. Superior Vermiform Process.
10. Vermis Inferior.
11. Monticulus.
ventriculum enters the, upper part of the fourth ventricle.
The valve of Vieussens hangs over it.
  On  cutting the  cerebellum perpendicularly, there is
formed, from the intermixture of cineritious and medul-
lary matter, a tree-like appearance, named Arbor Vit^;,
of which the trunk is termed the peduncle of the cere-
bellum, and is continued to the back part of the medulla
oblongata.
  On the under surface is  a gutter  into which projects
the Inferior Vermiform  Process—the  Vallecula.
This leads to the fourth ventricle, on each side of which
and in the centre are lobes.   The lateral ones called the
Amygdalae, the intermediate one the Uvula.   Another
on the restiform body, the Flocculus.
  Fissures  of Sylvius—Separate the Anterior from
the middle lobe of the cerebrum. 
the medulla oblongata.
51
              Fig. 12.
Anterior Aspect of the Medulla Oblongata.
                             JO*
 1. Corpora Pyramidalia.
 2. The point of their Decussa-
     tion.
 3. Corpora Olivaria.
 4. Fibres that run from the An-
     terior Column of  the Me-
     dulla Spinalis to the Cere-
     bellum.
 5. Corpora Restiformia.
 6. Arciform Fibres.
 7. Anterior Columns.
 8. Lateral Columns.
9,10. Pons Varolii.
 11.  Roots  of  the Trigeminus
     Nerve.
  Medulla  Oblongata—Upper  end of the Medulla
Spinalis.  On it a median fissure; three  bodies on  each
side.  One next  to the fissure  Corpus  Pyramidale;
next the Olivaris, next the Restiforme.
  Pons Varolii—The body at the top of the Medulla
Oblongata.  Basilar Artery rests upon its middle.
  Crura  Cerebelli—Thick cords from the Pons to the
cerebellum.
  Crura  Cerebri—Round cords passing in a divergent
manner, from the Pons to the cerebrum.
  Corpora  Mammillaria or  Albicantia—Two  little
round bodies between the crura, front of the Pons.
  Locus  Perforatus—Perforated space between the
last named bodies and the Pons.         _
  Tuber  Cinereum or Pons Tarini—Triangular  space
in front of the corpora albicantia:  a little process in its
centre,  the Infundibulum.  In front the commissure of
the optic  nerves.
  Substantia Perforata—Perforated  space  at  com-
mencement of the fissure of Sylvius.
  Next examine the nerves. 
52                practical anatomy.
Fig. 13.
Base of the Brain.  A, Anterior, B, Middle, and  C, Posterior Lobes
                     of the Cerebrum.
a.	Forepart of the Longitudi-	q-	Horizontal Fissure of the
	nal or Inter-Hemispheric		Cerebellum.
	Fissure.	r.	Gray Tuber.
b.	Notch between the Hemi-	s, s.	Fissure of Sylvius.
	spheres of the Cerebellum.	t.	Left Crus of the Cerebrum.
c.	Optic Commissure.	u, u.	Optic Tracts.
d.	Left Crus Cerebri.	v.	Medulla Oblongata.
e.	Lobus Perforatus Lateralis.	X.	Marginal Convolution of the
o i.	Inter-crural Lamina.		Longitudinal Fissure.
ff-	Convolution of the Fissure	1.	Olfactory Nerve.
	of Sylvius.	li.	Optic.
i.	Infundibulum.	3.	Motor Oculi.
1.	Right Crus Cerebelli.	4.	Trochlearis or Patheticus.
m.	Hemispheres of the Cerebel-	5.	Trigeminal or Trifacial.
	lum.	6.	Motor Externus.
n.	Eminentia Mammillaria.	7.	Facial.
0.	Pons Varolii, forming by its	7.	Auditory.
	continuation on each side	8.	Glosso-Pharyngeal.
	the Crus Cerebellum.	8.	Pneumogastric.
P-	Pons Tarini.	8.	Spinal Accessory.
		9.	Hypoglossal.
 
NERVES.
53
  1. The First Pair of Nerves, the Olfactory, arise
from the outside of the corpora striata, between the ante-
rior and middle lobe  of the brain; run under the anterior
lobes, being lodged in two superficial grooves, and lying
between the pia and dura mater; expand  into a small
oval ganglion, from which several small  filaments descend
through the cribriform  plate of the ethmoid bone, to
ramify on the membrane lining the nose.
  2. The Second Pair, the  Optic, arise from the poste-
rior part of the optic thalami, and also from the tubercula
quadrigemina; they make a circle round the crura cerebri
called the  Tractus Opticus.  The two nerves approach
gradually, and unite, just before the pituitary gland, on
the forepart of the  sella turcica.   They then diverge,
and each nerve passes out at the foramen  opticum  of the
sphenoid bone, to form the retina of the eye.
  On each side of these nerves  are seen the Carotid
Arteries.  Each artery emerges from  the  cavernous
sinus by the side of the anterior clinoid process:  sends a
branch forwards, which, uniting with a  similar branch of
the other carotid, forms the  anterior part of the Circu-
lus Arteriosus Willisii; while other branches, passing
backwards, and uniting with branches of the basilar artery,
complete the posterior part of the arterial circle.
  A fold  of dura  mater passes from the  anterior to the
posterior  clinoid process of  each  side.  This  fold  is
double, and forms by its duplicature  the  Cavernous
SINUS.
  On dividing the optic  nerves, and inverting them, we
see  the infundibulum, a funnel of cineritious substance,
leading from the inferior and  anterior  extremity of the
third ventricle to the pituitary gland; it is generally im-
perforate before it reaches the gland.
  The  Pituitary Gland,  a reddish body somewhat
globular, consisting of two lobes, is situated in the  sella
Turcica of the sphenoid bone, partly covered by a fold
of dura mater, and attached  to the  infundibulum.   The
circular sinus is situated at this point.
  3  The Third Pair of Nerves, Motores Oculorum,
                         5* 
54              PRACTICAL ANATOMY.
arise from the crura cerebri,1 pass outwards and forwards
on the outer side of the posterior clinoid process into the
cavernous sinus, and running through the foramen lace-
rum orbitale superius of sphenoid bone to the muscles of
the eye.
  Between these two nerves are seen the two vertebral
arteries, ascending and uniting, to form the basilary artery.
  4. The Fourth Pair, Trochleares or Pathetici,
are very  slender,  and  situated immediately under the
edge of the tentorium.   This nerve arises from the valve
of Vieussens, comes out from betwixt the cerebrum and
cerebellum, passes by the side of the pons  Varolii, and
passing through the cavernous sinus, continues its course
through the foramen lacerum orbitale superius, to supply
the obliquus superior muscle of the  eye.
  5. The Fifth Pair, Trigemini, are much larger than
the fourth, and are situated more outwards and back-
wards.  Each of these nerves arises by a number of fila-
ments, from the anterior and lowest part of the crus cere-
belli, where the  crus unites with the  pons Varolii; it
passes forwards, enters the cavernous sinus,  where it un-
twists itself, and  forms a flat  irregular  ganglion,  the
Ganglion Gasserianum,  and then divides into three
great branches.
  (1.) Ramus Ocularis, or the Ophthalmic Nerve of
Willis, passes through the foramen lacerum orbitale supe-
rius to the appendages of the eye.
  (2.) Ramus Maxillaris Superior passes through the
foramen rotundum to the upper jaw and face.
  (3.) Ramus Maxillaris Inferior passes through the
foramen ovale to the lower jaw and tongue.
  6. The Sixth Pair, Motorks Oculorum Externi, or
abductores.—This nerve is small, but not so small as the
fourth pair; it  is seen arising  betwixt  the  pons Varolii
and corpora pyramidalia.  It enters the cavernous sinus;

  1  The two crura pass obliquely backwards and inwards, so as to
converge and meet in front of the tuber annulare; it is from the hol-
low formed by their convergence, and named by Vicq d'Azyr. fosse des
nt r/s ocuto-miisrulaires, that the third pair arise. 
NERVES.
55
it there runs by the side of the carotid artery, and passes
through the. foramen lacerum orbitale  superius  to  the
rectus externus oculi.
  7. The  Seventh Pair, Nervi Auditorii, consists of
two portions.
  (1.)  The Portio Dura, or the facial nerve, arises from
the crus cerebelli, and comes out from the fossa or groove
betwixt the pons Varolii, corpora olivaria, and crura cere-
belli.
  (2.)  The Portio Mollis, or more properly the auditory
nerve, arises from the inner surface of the fourth ventri-
cle.  It has a groove on  its surface for receiving  the
portio dura; accompanied by an artery, they enter the
meatus auditorius internus, where the  portio  mollis is
distributed to  the parts of the  internal ear, while the
portio dura runs through the aqueduct of Fallopius,  and
comes out at the stylo-mastoid foramen  below the ear, to
form the principal nerve of the face.
   8.  The Eighth Pair consists of three, the ParVagum,
Spinal Accessory, and Glosso-Pharyngeal.   The  Par
Vagum arises by numerous filaments from the sides of the
corpora olivaria and medulla oblongata. They unite, run
towards the  foramen lacerum in basi  cranii, pierce the
dura mater, and pass out through the anterior part of the
hole, having been first joined by the
   Nervus Accessorius, which runs up from the medulla
spinalis through the great occipital foramen, and then
separate to their different destinations.
   The great Lateral Sinus passes out by the back part
of the same foramen, to form the internal jugular vein;
 it is separated from the nerve by a slip  of cartilage.
   9.  The Ninth Pair, Linguales  or  Hypoglossal.—
 This nerve arises from the furrow betwixt  the corpora
olivaria and  pyramidalia, by several  filaments, which
 often pierce the dura mater separately.  It passes through
the anterior condyloid hole of the occipital bone to  sup-
 ply the muscles of the tongue.
   Immediately after leaving the cranium, the eighth and
 ninth pair, and the ganglion of the sympathetic are con-
 nected together. 
56
practical anatomy.
               vessels  of the brain.

   Internal carotid enters the skull  through the carotid
 foramen in  the  temporal bone;  passing  through the
 cavernous sinus it divides into the following branches:—
   1. Anterior Cerebri, passing between  the anterior
 cerebral lobes.
   2. Media Cerebri, in the fissure  of Sylvius.
   3. Arteria Communicans, passing back  to unite with
 the Basilar.
   Vertebral Atery — From the subclavian ascends
 through the foramina of the cervical transverse processes,
 enters the foramen magnum, and gives branches to the
 dura mater and medulla spinalis, then
   1. Inferior Cerebellar to under part of cerebellum.
 The union of the two vertebral form the
   2. Basilar, which rests on the pons Varolii.
   3. Superior Cerebellar to upper part of cerebellum.
   4. Posterior Cerebral to the posterior lobes of the
 cerebrum.  With this usually the communicating branch
 from the carotid unites to form the circle of  "Willis.
   The veins open into the sinuses, and they into the in-
 ternal jugular vein.
   Medulla Spinalis, or the Spinal Marrow.  This part
 of the nervous or sensorial  system must  be here de-
 scribed, although its dissection cannot be performed till
 all the muscles of  the back are removed, so that the  pos-
 terior part of the spinal canal may be sawed off.
   The spinal  canal  is lined  by  a strong  ligamentous
 sheath, and the dura mater is continued down  upon this
 sheath  in the form of a funnel.
   The  spinal marrow consists externally of  medullary
 substance, internally of vesicular.  It runs down to the
 first lumbar vertebra, where it terminates by  numerous
 filaments, which form the Cauda Equina.   It is closely
 embraced by the pia mater, while the tunica  arachnoides
 adheres to that membrane very loosely.   Durino-  the
whole of its passage, there is on each side a membranous
connection between the pia and dura mater, bv distinct 
SPINAL NERVES.
57
slips, irregular and pointed, which connection is  named
Ligamentum Denticulatum.   This ligament separates
the two roots of the spinal nerves.   The arteries of the
medulla may be seen running  down on its anterior and
posterior  surfaces; they are branches  of the vertebral

                          Fig. 14.
            Fissures or Sulci of the Spinal Marrow.
1. Anterior  Longitudinal  Fis-
    sure.
2. Posterior Longitudinal  Fis-
    sure.
3. Antero-Lateral  Fissure,  for
    the Corresponding Roots of
    the Spinal Nerves.
4. Postero-Lateral Fissure, for
    the Posterior  Roots of the
    Spinal Nerves.
5. Lateral Fissure.
artery; and on these surfaces the Anterior and Poste-
rior Median or Longitudinal Fissure, dividing it into
         Fig. 15.

Origin of the Spinal Nerves.

              I    2  1
1,1. Lateral Columns, mark-
     ed off in front at (2)
     the Anterior Fissure.
  3. Anterior Roots.
  4. Posterior Roots.
  5. Ganglion formed by the
     Posterior Roots.
  6. Spinal  Nerve, formed
     by the junction of the
     Anterior and Posterior
     Roots.
  7. Anterior Branch of the
     Spinal Nerve.
  8. Posterior Branch.
1 
58               PRACTICAL ANATOMY.
                                                       A
                                                       ;>,
lateral columns.   Each column is again divided into three   ;
others by two lateral lines, the points where the roots of
the spinal nerves come out.  The cord has two enlarge- M
ments upon it, the upper  corresponding to the origin of   ,
the brachial plexus, the lower  to the lumbar nerves.
  The spinal accessory nerve is seen arising by small
twigs from the posterior bundles of the fourth, fifth, sixth,   1
and seventh  cervical nerves;  it then ascends along the   f
spinal canal, enters the foramen, and passes forwards, to
accompany the par vagum.
  The spinal marrow sends off thirty pair of spinal nerves,
which pass  through  the  foramina  formed between the
bodies of the vertebras.   They consist of eight cervical,
twelve dorsal, five lumbar, and five  or six sacral  pairs of
nerves.  Each of these nerves arises  in two fasciculi or
roots, one from the forepart, the other from the back part
of the spinal cord.   These fasciculi penetrate the dura
mater separately.  On the posterior bundle or root is a   ,'*
ganglion.
                 CHAPTER V.

 DISSECTION OF THE ANTERIOR PART OF THE NECK.

                   OF THE MUSCLES.

  The utility of this  dissection must be  evident, when
you consider how many important parts are contained in
the forepart of  the  neck.  The tube which conveys air
to the lungs, the vessels which are sent from the heart to
the brain, and  the  nerves which  are destined to supply
the thoracic and abdominal viscera, are  situated in the
neck; and  all these parts  lie embedded in cellular sub-
stance ;  hence the dissection is intricate, and requires the
utmost care in its performance.
  The muscles  of the anterior part of the neck are six- 
SUPERFICIALIS COLLI.
59
teen in number on each side.   They may be divided into
muscles situated superficially, muscles at the upper part
of the neck, and those situated at the lower  part.  To
dissect the neck, make one incision from the top of the
sternum to the symphysis of the chin, a second along the
base of the jaw to the mastoid portion of the temporal
bone, and a third from the sternum along the clavicle to
the acromion process of the scapula.  Reflect the integu-
ments.
  The superficial muscles are two.
  Immediately under  the  integments, and adhering to
them.
  1. The Musculus Cutaneus, vulgo, Platysma myoides
—Will be found to be between two layers  of the super-
ficial fascia of the  neck;  the fascia extends over face and
parotid gland.  It arises, by slender separate fleshy fibres,
from the cellular  substance, covering the upper part of
the  deltoid and pectoral muscles.  These fibres form a
thin broad muscle, which runs obliquely upwards, and is
  Inserted into the skin and muscles covering  the  lower
jaw and cheek.  This muscle should be dissected in the
course of its fibres ; the skin, therefore, must be dissected
off in an oblique direction from the clavicle to the chin.
   Use: To draw the skin of the cheek downwards, and,
when the mouth is shut, to draw the skin under the lower
jaw upwards.
  Remove the platysma  myoides from  its origin, and in-
vert it over the face.  Immediately beneath it is seen the
external  jugular vein,  which is formed of branches from
the  temple, side of the face, and throat.  It crosses ob-
liquely over  the  sterno-mastoideus, passes behind the
outer edge of that  muscle, and plunges beneath the clavi-
cle, to enter the subclavian vein.
  If the platysma  has been carefully lifted several nerves
may be exhibited in its deep surface.  One towards the
angle of the jaw.
  Superficialis Colli.—One to the ear just behind the
jugular vein, the Auricularis Magnus ;  one  along the
posterior border of the  S. cleido-mastoid muscle to the
back of the head, the Occipitalis Minor ; other branches 
60
PRACTICAL ANATOMY.
descend;  some of which are deep for the supply of mus-
cles.  All these  are from the Superficial  Cervical
Plexus, which comes out just behind the middle of the
sterno-cleido-mastoid muscle, and is formed by the  ante-
rior branches of the three  or four upper spinal nerves.
  The strong fascia seen covering the  muscles of the
heck after the removal of the Platysma.   It forms sheaths
for  the muscles of the neck by detaching from its deep sur-
face septa which pass in between them.  It is attached be-
hind to the spinous processes of the cervical vertebrae under
the trapezius muscle; above to the base of the jaw as it

                         Fig. 16.
1. Platysma Myodes Muscle.
2. Scattered Fibres of the same, forming the Musculus Risorius of
    Santorini.
3. Sterno-Cleido-Mastoid Muscle.
4. Trapezius.
5. Splenius.
(j. Posterior Large Triangle of the Neck, bounded in front by the
    Sterno-Cleido-Mastoid, behind by the Trapezius, and below by
    the Clavicle. 
MUSCLES.
61
passes to the face, and at its angle dips down to the styloid
process, forming the Stylo-Maxillary Ligament, and
forming as will be seen again a complete separation be-
tween the Parotid and Submaxillary Glands.  Along
the middle line of the neck it meets the fascia of the oppo-
site side, encasing muscles and thyroid gland; below it is
attached both to the top and inner surface of the sternum,
to the sternal end of the  clavicle, to the cartilage of the
first rib, and is connected to the sheaths of the bloodvessels
and nerves as they pass into the axilla.
   2.  The  Sterno-Cleido-Mastoideus—Arises by two
distinct origins;  the anterior, tendinous and fleshy, and
somewhat  round, from the top of the sternum, near  its
junction with the clavicle; the posterior or outer, fleshy
and flat, from the upper and anterior  part of the clavicle.
These two origins soon unite, and form a strong  muscle,
which ascends obliquely upwards and outwards, to be
   Inserted, tendinous, into the outside of the mastoid pro-
cess,  and into the transverse ridge behind that process.
   Use: When one acts singly, it turns the head to one
side.   When both  act together, they bend the head for-
wards.
   The muscle should be detached from the  sternum and
clavicle, and left suspended by its insertion.   It is pierced
by several branches of the cervical nerves, and, about its
 middle, it is perforated by the Nervus Accessorius.  These
 nerves ramify on the neighboring muscles of the neck
 and shoulder.  Between the posterior edge of the sterno-
 cleido-mastoideus and the forepart of the trapezius mus-
 cles,  above the  clavicle, is seen a quantity of loose fatty
 substance,  intermixed  with branches  of  nerves.  This
 fatty substance is watery and granulated; it must not be
 removed roughly, lest important nerves and  vessels be
 injured;  it is continued around the vessels  under  the
 clavicle.
   In the middle of the throat you see,
   (1.) The Os Hyoides, or  bone of the tongue,  forming
 the uppermost of the projections beneath the chin.
   (2.) The Larynx, or  upper part of the trachea, con-
 sisting of five  cartilages, of which  two are evident  ex-
      6 
62
practical anatomy.
ternally, viz: 1. The uppermost and largest is the thy-
roid cartilage;  2. The inferior is the  cricoid  cartilage.
The two arytenoid cartilages, and the epiglottis, lie behind
this.
  (3.)  The Trachea, consisting of cartilaginous rings, and
extending into the thorax.
  (4.)  Behind the larynx is  situated the pharynx.  At
the part where the  larynx  terminates in the trachea, the
pharynx contracts  itself, and forms the oesophagus, or
muscular tube, conveying the food to the stomach, which
descends behind the trachea, situated rather to the left
side of the cervical  vertebras.
  These parts are covered by muscles;  and on each side
of the trachea lie the great vessels and nerves.
  Muscles at the lower part of the neck are  five.
  3. The Sterno-Hyoideus—Arises,  thin  and  fleshy,
from the upper and inner part of the sternum, clavicle,
and first rib; it forms a flat and narrow muscle.
  Inserted into the base of the os  hyoides.
  Situation: This pair of muscles is seen on removing
the platysma myoides, between  the sterno-cleido  mas-
toidei.
   Use: To pull the os hyoides downwards.
  4. The Omo-Hyoideus, inclosed in lamina of the deep
fascia—Arises, broad,  thin, and fleshy,  from the root of
the coracoid process, and  semilunar notch of the scapula,
ascends across the neck, and forms a middle tendon, where
it passes below the  sterno-cleido-mastoideus.  Becoming
fleshy again, it runs up, and is
  Inserted into  the  base  of the os hyoides, between its
cornu and the insertion of the sterno-hyoideus.
  Situation: The lower part of this muscle is covered by
th© trapezius; its middle by the sterno-cleido-mastoideus;
its  anterior part is  seen  on removing the platysma my-
oides ; it crosses over the carotid artery and internal jugu-
lar  vein.
   Use: To pull the os hyoides obliquely downwards.
  5. The  Sterno-Tiiyroideus. — This muscle   arises,
fleshy,  from the inside of  the  sternum, and of the ex-
tremity of the first rib; forms a flat muscle,  and is 
DIGASTRICUS.
63
  Inserted into the inferior edge of the oblique ridge on
the ala or side of the thyroid cartilage.
  Situation: Beneath the sterno-hyoideus.
   Use:  To draw the thyroid  cartilage, and  consequently
the larynx, downwards.
  Under the sterno-thyroideus we find situated the
  Thyroid Gland, a large reddish mass, situated on the
superior rings of the trachea, below the cricoid cartilage;
in form somewhat like a crescent, with the cornua turned
upwards.
   6.  The  Thyro-Hyoideus—Arises, fleshy, from the
upper surface  of the oblique ridge in the ala of the thy-
roid cartilage, and passes upwards, to be
   Inserted into part of  the base, and almost all the cornu
of the os hyoides.
   Use: To pull the os  hyoides downwards, or the thyroid
cartilage upwards.
   Situation: Concealed by the sterno-hyoideus.
   7.  The  Crico-Thyroideus—Arises,  tendinous and
fleshy, from the side and forepart of the cricoid cartilage,
and runs obliquely  upwards.
   Inserted, by  two fleshy portions, the first into the lower
part of the thyroid cartilage, and the second into its infe-
rior cornu.
   Situation: On the side of the larynx, and  under the
sterno-thyroideus.
   Use: To pull forwards and depress the  thyroid, or to
elevate and draw backwards the cricoid cartilage.
   The  muscles at the  upper part of the neck consist of
nine pairs.
   8.  The Digastricus—Arises, principally fleshy, from
the fossa at the root of the mastoid process of the tem-
poral bone; its fleshy  belly terminates in a strong round
tendon,  which  runs  downwards and forwards,  passes
through the fleshy belly of the  stylo-hyoideus, is fixed
by strong ligamentous and tendinous fibres  to the  os
hyoideus, from which  it receives an addition of fibres; it
then becomes again fleshy, and runs  obliquely upwards,
to be 
64
PRACTICAL ANATOMY.
Lateral View of the Neck, with the Skin, Platysma, and Cervical
                        Fascia removed.
a, a.  Sternal ends of the Clavicles.
  b.  Upper part of the Sternum.
  c.  Third portion of the Subcla-
      vian Artery.
  d.  Primitive Carotid Artery di-
      viding into the internal and
      external Carotids.
  e.  Posterior Scapular Artery.
  /.  Transverse Cervical or Supra-
      scapular Artery. •
  g.  Brachial Plexus of Nerves.
  h.  Trapezius Muscle.
  i.  Tendon  of the  Omo-hyoid
      Muscle.
Anterior belly of the  Omo-
  hyoid.
Sterno-Cleido-Mastoid  Mus-
  cle.
Sterno-hyoid Muscles.
Larynx.
Parotid Gland.
Submaxillary Gland.
Posterior Belly of the Digas-
  tric Muscle.
Anterior Belly of the same.
Stylo-hyoid Muscle.
Hyoid Bone.
  Inserted into a rough sinuosity on the anterior inferior
edge of that part of  the lower jaw called the Chin.
  Situation: Its posterior  belly is covered by the sterno- 
STYLO-PHARYNGEUS.
65
cleido-mastoideus;  its anterior  belly  lies immediately
under the skin and platysma myoides.
   Use: To open  the  mouth, by pulling the lower jaw
downwards and backwards; and, when the jaws are shut,
to raise the larynx, and consequently  the pharynx up-
wards, as in deglutition.
  In  the  triangular space formed by the two bellies of
this muscle, and the base of the lower jaw, lies the Sub-
maxillary Gland. It lies upon a flat muscle, the mylo-
hyoideus, which is  seen between the two bellies of the
digastricus; the gland is surrounded by little absorbent
glands, and is encased in a pocket of deep fascia.
   9. The Stylo-Hyoideus—Arises, tendinous, from the
middle and inferior part of the styloid process of the tem-
poral bone; its  fleshy belly  is generally perforated by
the digastricus.
   Inserted, tendinous, into the os hyoideus at the juncture
of its base and cornu.
   Situation: The origin of this muscle is situated more
inwards than the last;  it is the most superficial of three
muscles which arise from the styloid process; sometimes
it is accompanied by another small muscle, having the
same origin and insertion, the stylo-hyoides alter.
   Use: To pull the os hyoides to one side, and a  little
upwards.
   10.  The Stylo-Glossus—Arises, tendinous and fleshy,
from the styloid process, and from a ligament that con-
nects that process to the angle of the lower jaw.  It de-
scends, and becomes broader, but less thick.
   Inserted into the root of the tongue, runs along its side,
and is insensibly lost near its tip.
   Situation: This muscle lies within  and rather above
the stylo-hyoideus; underneath it is a ligament, extend-
in o- from the styloid process to the angle of the os hy-
oides.  Ligamentous  fibres  are  also seen passing  from
that process to the  inside of the angle  of the lower jaw,
Stylo-Maxillary Ligament.
   Use: To move the tongue  laterally and backwards.
   11.  The Stylo-Pharyngeus—Ames, fleshy, from the
root and inner part of the styloid process. 
66
• practical anatomy.
  Inserted into the side of the pharynx and back part of
the thyroid cartilage.
  Situation: It is situated deeper, and  behind the stylo-
glossus.
   Use: To dilate and raise the pharynx and thyroid car-
tilage upwards.
  On removing the submaxillary glands, and detaching
the digastric muscle from the os hyoides and chin, we ex-
pose the  next muscle; but should  notice in its  removal
the facial artery which runs through it on its way to the
face, giving to it the Submaxillary Branches, and one
which runs along the jaw towards the chin, the Sub-
mental.
  12. The Mylo-Hyoideus—Arises, fleshy, from all the
inside of the lower jaw, between the last dens molaris
and the middle of the chin; the fibres form a flat muscle,
converge, and are
  Inserted into the lower edge of the  base of the os hy-
oides.
  Situation: This muscle unites with its fellow in a mid-
dle tendinous line which extends from the os hyoides to
the chin; its posterior part is lined by the internal mem-
brane of the mouth; it lies under the  digastricus, but is
seen betwixt its bellies.
   Use: To pull the os hyoides forwards, upwards, and to
either side.
  The submaxillary gland sends off a  duct, which passes
behind the posterior edge of the mylo-hyoideus, and runs
along the inner surface of this muscle  forwards  and up-
wards, on the inside of the sublingual gland, to open into
the  mouth  on  the side of  the  frenum  of  the tongue.
Above it will be seen the Lingual Branch of  the infe-
rior  maxillary nerve.
   The Sublingual Gland lies immediately above the
mylo-hyoideus, betwixt  it and the  internal membrane of
the mouth, where it lines the side and inferior surface of
the tongue.  It sends  off several ducts, which open into
the mouth between the root of the tongue and side of the
lower jaw. 
                 genio-hyo-glossus.               67

  The removal of the  mylo-hyoideus exposes a pair of
muscles, which are closely attached to one another.
  13. The Genio-Hyoideus—Arises, tendinous, from a
projection on the inside of that part of the  lower jaw
which is called the Chin; it descends, becoming broader,
and is
  Inserted into the basis of the os hyoides.
   Use:  To draw the os hyoides forwards and upwards to
the chin.

                         Fig. 18.
Muscles op the Tongue.
  1. Stylo-glossus.
  2. Stylo-hyoideus.
  3. Lingualis.
  4. Dorsum of the Tongue.
5, 6. Hyo-glossus.

  By removing this muscle, or turning it back  from its
origin from the jaw, we discover the next muscle.
  14.  The Genio-Hyo-Glossus—Arises, tendinous, from
a rough protuberance on the inside of the lower jaw,
hi«-her°up than the origin of the genio-hyoideus;  its fibres
 7. Genio-hyo-glossus.
 8. Stylo-pharyngeus.
 9. Genio-hyoideus.
10. Raphe of the Mylo-hyoideus.
11. Digastricus. 
68
PRACTICAL anatomy.
 run forwards,  upwards, and backwards, in  a  very wide
 and radiated manner, to be
   Inserted, some into the posterior part of the base of the
 os hyoides, near its cornu, others into the tip, middle, and
 root of the tongue.
   Situation:  This muscle lies under the genio-hyoideus
 before, and more outwardly under the mylo-hyoideus.
   Use: According to the direction  of its fibres, to draw
 the tip of the tongue backwards into the mouth, the mid-
 dle  downwards, and  to render its  dorsum  concave;  to
 draw its root and the os  hyoides  forwards, and to thrust
 the tongue out of the mouth.
   15.  The Hyo-Glossus—Arises, broad and fleshy, from
 half of the base, and part of the cornu of the os hyoides;
 the fibres run upwards, to be
   Inserted into the inside of the tongue.  Be careful here
 of the Hypoglossal Nerve, and  Lingual  Artery, to be
 presently described.
   Situation: It is situated more outwardly than the genio-
 hyo-glossus, and, at its insertion into  the  tongue,  mixes
 with the stylo-glossus.
   Use: To move the tongue inwards and downwards.
   16.  The Lingualis—Arises, from the root of the tongue
 laterally, and runs forwards between the hyo-glossus and
 genio-hyo-glossus, to be
   Inserted into  the tip of the tongue, along with part of
 the stylo-glossus.
   Use: To contract the substance  of the  tongue, and
 bring it backwards.


 OF the vessels and  nerves seen in  the dissection
                    OF THE NECK.

                       Arteries.

   The Carotid Artery  ascends from the thorax by the
 side of the trachea; on its outer side it has  the internal
jugular vein and the par vagum, and behind the sympa-
 thetic nerves.  All these parts are connected and inclosed
 by condensed cellular membrane, which forms a kind  of 
FASCIALIS.
69
sheath for containing them.  At the bottom, and  in  the
middle of the neck, the carotid is covered by the  sterno-
cleido-mastoideus ; at the upper part, by adipose mem-
brane, absorbent  glands, and by the platysma  myoides.
It lies deep on the muscles of  the spine, and gives off no
branches, until it reaches the space between the  larynx
and  angle  of the jaw, just below  the  cornu of the os
hyoides, where it divides into the external and internal
carotids.
  Of the two, the internal carotid  is situated most out-
wardly ; it passes deep to the base of the cranium, where
it enters the foramen caroticum, to supply the brain.
  The external carotid immediately begins to send off
branches.
  Anteriorly it sends off,
  1.  The A. Thyroidea Superior.—This artery passes
downwards and forwards, to ramify on the thyroid gland,
where it inosculates with the  artery of the other  side,
and with the inferior thyroid arteries.  In this  course, it
sends ramifications to the integuments, the outside of the
larynx, the muscles, &c, and one remarkable branch, the
A. Laryngea, which sometimes arises from the trunk of
the external carotid; it  is a  small artery which divides
betwixt the os hyoides and thyroides cartilages, to supply
the internal parts of the larynx.
   2.  A. Lingualis.—This artery passes over the cornu
of the os hyoides, then parallel with  it, covered by the
stylo-glossus, hyo-glossus, and genio-hyo-glossus, to which
it gives branches, and terminates in running along the
inferior part of the tongue from its base to its  apex.  It
gives branches  to the muscles about  the chin, and to
the substance and back part of the tongue.
  3.  A.  Fascialis.— The  external  maxillary artery
passes under  the stylo-hyoideus and  posterior belly of
the digastricus,  then buries itself under the submaxillary
gland.°  It runs over the lower jaw before  the anterior
edge of the masseter muscle, to supply the face.
  In its passage, it gives off numerous branches.  One is
worthy of notice, which runs along under the line of the
lower jaw, 
70
practical anatomy.
   The Submental, and passing over the jaw near the
symphysis, supplies the chin.   Other twigs supply the
submaxillary gland, &c.
   Posteriorly the carotid sends off
   4. A. Occipitalis.—The occipital artery crosses back-
wards and  upwards, over the internal jugular vein and
internal carotid  artery, under the belly of the digastric
muscle ; it passes through a slight groove in  the mastoid
process, below its great fossa, and ramifies on the back
part of the head.   A remarkable branch of the occipital
passes  towards the base of the  skull, to  inosculate near
the foramen magnum occipitis,  with branches from the
vertebral and posterior cervical  arteries.
   5. A. Pharyngea is a small branch of the carotid,
which  passes inwards to the pharynx and  base  of the
skull.
   6. Posterior Auris, which passes backwards and up-
wards in the fold, between the  ear and scalp, and is dis-
tributed on the integuments of the head.
   The  external carotid ascends  behind the angle of the
jaw, and enters the parotid gland, where it divides into,
   7. A. Maxillaris Interna.
   8. A. Temporalis.
   9. A. Transversalis Faciei.
   These arteries  are described in the dissection of the
face.

                        Veins.
   The  Internal Jugular Vein  is a  continuation of
the lateral sinus which passes through the foramen lace-
rum in the base of the cranium.   It comes out deep from
under the  angle of the jaw, and in  its course down the
neck, it runs on the outer side of the carotid  artery, be-
fore it reaches the thorax; it passes rather more forwards
than the artery, to join the subclavian vein.
   Its branches accompany the  ramifications  of the ex-
ternal carotid.  At first the vein which accompanies each
artery is a single branch, but it soon subdivides, so that
two veins accompany one artery. 
NERVUS laryngeus superior.
71
                       Nerves.
  1. The Eighth Pair, or Par Vagum.—On separating
the internal jugular vein, and trunk of the carotid artery,
the par vagum is seen lying in the same sheath of cellu-
lar substance with those vessels.   It lies in the triangular
space formed betwixt the back  part of the  artery and
vein, and the subjacent muscles.   This nerve comes out
of the foramen  lacerum with the  jugular vein; hence it
adheres to  that vein more  closely than to the artery or
muscles; it runs down the  neck behind these  vessels.
   In this course it gives off several nerves.
   (1.) At the base of the cranium  it sends  off several
filaments, which  are  connected  with the other nerves
coming out of the base of the skull, such as the ninth
pair, the superior cervical  ganglion of the  sympathetic,
&c.
   (2.)  Nervus  Glosso-Pharyngeus  leaves  the other
branches of the eighth pair, deep  under the angle of the
jaw.  It passes behind the carotids towards the muscles
arising from the styloid process;  one principal branch of
it passes between the stylo-pharyngeus  and  stylo-glossus
to the tongue,  while  other twigs run behind  the stylo-
pharyngeus, to supply the pharynx.
   (3.) Nervus Laryngeus Superior.—The superior or
internal laryngeal nerve passes behind the internal carotid
artery, obliquely, downwards and forwards; then, under
the hyo-thyroideus muscle, it  plunges betwixt the os
hyoides and thyroid cartilage, accompanying the  laryn-
geal artery,  and supplying  the  internal parts of the
larynx.
   (4.) In the neck, also,  the par vagum gives off fila-
ments to the cervical ganglions of the sympathetic nerve,
and communicates  with the other nerves of the neck
Filaments also unite with  twigs of the sympathetic, and
run down over the  carotid artery to the great vessels of
the heart, where they form the superior cardiac plexus.
   The par vagum enters the thorax by passing betwixt
the subclavian artery  and vein. 
72
PRACTICAL ANATOMY.
                          Fig. 19.
               Nerves of the Neck and Tongue.
                                  1. Part of the Temporal Bone.
                                  2. Stylo-hyoid Muscle.
                                  3. Stylo-glossus Muscle.
                                  4. Stylo-pharyngeus Muscle.
                                  5. Tongue.
                                  6. Hyoglossus Muscle.
                                  7. Genio-hyoglossus Muscle.
                                  9. Sterno-hyoid Muscle.
                                 10. Sterno-thyroid Muscle.
                                 11. Thyro-hyoid Muscle, upon
                                      which is seen a branch of
                                      the Hypoglossal Nerve.
                                 12. Omo-hyoid Muscle straight-
                                      ened by the removal of
                                      the Loop of Cervical Fas-
                                      cia  through  which its
                                      tendon plays.
                                    Common Carotid Artery.
                                    Internal Jugular Vein.
                                    External Carotid Artery.
                                    Internal Carotid.
                                    Gustatory Branch of the
                                      Fifth  Nerve,  giving  a
                                      Branch to (18) the sub-
                                      maxillary Ganglion.
19. Duct of Submaxillary Gland.
20. Glosso-pharyngeal Nerve.
21. Hypoglossal Nerve.
22. Descending Branch from the Cervical Plexus.
23. Communicating Branch from the Cervical Plexus.
24. Pneumogastric Nerve emerging from between the Internal  Jugular
      Vein and Common Carotid Artery to enter the Chest.
25. Facial Nerve, emerging from the Stylo-mastoid Foramen, and cross-
      ing the External Carotid Artery.
  2. The Intercostal, or Great Sympathetic Nerve.
—This nerve lies behind the carotid, in the cellular mem-
brane, betwixt that vessel  and  the muscles covering the
vertebraj of the neck.   It is distinguished from the par
vagum by being smaller, lying nearer  the trachea, and
adhering to the muscles of the spine; also by its forming
several ganglions.  It comes out  by the same foramen as
the carotid artery.
  Immediately after  its exit from the skull, it forms the
Superior Cervical Ganglion,  which is very long, and 
BRANCHES.
73
of  a  reddish color.   The  nerve  afterwards becomes
smaller, and descends; and opposite the fifth or sixth cer-
vical vertebra, it forms another swelling, the Inferior
Cervical Ganglion.   Sometimes  it has another gan-
glion  about the fourth or fifth vertebra  of the neck, the
Middle Cervical Ganglion : but this is not a constant
appearance.   The nerve  then  passes behind the subcla-
vian artery into the thorax.
  The branches of the intercostal nerve are numerous,
and they generally pass off from the ganglions.  Imme-
diately below the base of the cranium,  twigs go to the
eighth and ninth pairs, and to  the upper cervical  nerves.
In  the  middle of the neck, some twigs pass over the
carotid; others go to the parts covering the trachea, uniting
with filaments of the par vagum; others unite with the
descendens noni, or descending branch of the ninth pair,
and some filaments assist the twigs of the par vagum to
form the superior cardiac nerve.  In the lower part of
the neck, twigs are sent to communicate with the cervical
nerves,  &c.
  3. The Ninth Pair, Nervus Hypoglossus, or Lingual
Nerve, having left  the skull  by the  anterior condyloid
foramen, is  connected  with  the eighth pair and sympa-
thetic nerve.  Like them, it lies deep, and comes out from
under the angle of the jaw.  It is seen passing from be-
hind the internal jugular vein, and then over the carotid
artery, running betwixt these two vessels.  It next passes
under the mylo-hyoideus, running over the stylo-glossus,
hyo-glossus, and geniohyo-glossus, which last muscle its
numerous branches perforate.
   4. Branches.—While the nerve is passing betwixt the
jugular  vein and  the carotid  artery,  it sends off  the
Descendens Noni.—This  small and delicate nerve de-
scends  on the forepart of  the vein  and artery, and is
distributed  to the  muscles  on the  anterior part of  the
trachea.  It is joined by a  filament formed by the first,
second,  and  third cervical nerves,  the Communicans
Noni.
   The Lingual Branch sent off by the third branch of
the fifth pair of nerves, is also seen in  the  dissection of
     7 
74                 practical anatomy.
Fig. 20.
Cervical and Brachial Plexuses of Nerves of the Right Side.

    1. Facial Nerve.
    2. Pneumogastric Nerve.
    3. Internal Carotid Artery.
    4. Spinal Accessory Nerve.
    5. Anastomoses of the Spinal Accessory Nerve with the Cer-
        vical  Plexus.
    6. Hypoglossal Nerve, giving off its Descending Branch. 
PHRENIC NERVE.
75
       7. Anterior Branch of the first Cervical Nerve, Anastomosing
           with the Hypoglossal Nerve and with the Pneumogastric.
       8. Descending Cervical Branch of the Cervical Plexus, Anas-
           tomosing with the corresponding Branch of the Hypo-
           glossal.
       9. Phrenic Nerve.
   10, 10. Deep Cervical Branches of the Cervical Plexus.
      11. Brachial Plexus.
      12. Branch to the Subclavian Muscle, sending a Filament to
           the Phrenic Nerve.
      13. Anterior Thoracic Branches.
      14. Lateral Thoracic Branch, or the Branch to the Great Serrate
           Muscle.
15, 16, 17. Subscapular Branches going to the Subscapular, Latissi-
           mus, and Greater Teres Muscles.
      18. Axillary Artery, surrounded by a sort of Sheath, formed
           by Branches going to the Arm.
      19. Brachial Branches.

the neck.  It is found  under the mylo-hyoideus; it lies
close upon the lower edge of the jaw-bone, betwixt the
inferior edge of the pterygoideus internus and the upper
part of the mylo-hyoideus.   It  gives numerous twigs to
the sublingual  gland and  submaxillary duct,  which are
situated near it, and is lost in the substance of the tongue.
  5. Nervus Accessorius  ad par  Vagum, one  of the
eighth pair.—The accessory nerve, having passed out of
the cranium  with the  par  vagum,  separates from  it,
passes behind the internal jugular vein obliquely down-
wards  and backward;  it perforates  the mastoid muscle,
and is distributed to the trapezius and muscles about the
shoulder; it is much connected with the third and fourth
cervical nerves.
  6. The Seven Cervical  Nerves  come out  from the
foramina betwixt  the vertebrae of the neck.  They send
numerous branches to the muscles, &c, on the side of the
neck, and  communicate by  filaments with all the  other
nerves in the neck.
  In this stage  of the dissection we may also see,
  7. The  Phrenic Nerve,  formed  by branches of the
third and fourth cervical nerves.  This small  nerve lies
upon  the  belly of the  Scalenus Anticus  Muscle, and
passes into the thorax, betwixt  the subclavian  artery
and vein. 
76
PRACTICAL ANATOMY.
  8. Eecurrent Nerve.—From the par vagum in the
thorax, lying close alongside the trachea as it ascends.
  9. Brachial  Plexus.— Seen  between  the Scaleni
Muscles, formed by four lower cervical, and first dorsal
spinal nerves, passes into the axilla to become the axillary
plexus.
                     ARTERIES.
  Subclavian Artery on the right side is a branch of
the Innominata, on the left it is derived from the Aorta;
on the right side it passes by a gentle curve to the  sca-
lenus anticus  muscle, and rests upon the pleura.   This
first part on the left side rises almost perpendicularly up
out of the chest, and has the pleura in front. Both after
this pass beneath  the scalenus anticus, having the bra-
chial plexus of nerves and the scalenus posticus to the
outer and posterior  side, thence  over the first rib, after
which they become Axillary Arteries.
  Thyroid Axis—A stem which generally furnishes
  1. Inferior Thyroid  Artery,  which passes under
the carotid bloodvessels to the thyroid gland.
  2. Superficialis Cervicis—distributed to  the  deep
layer of muscles front of spine.
  3. Supra Scapular—following the course of the cla-
vicle, it supplies the muscles on  the dorsum of the sca-
pula.
  4. Posterior Scapular—across the neck, along the
posterior border of the scapula—supplies the muscles on
that portion of the scapula.
   Profunda  Cervicis—passes back between the trans-
verse processes of  last cervical and first dorsal vertebrae;
it sends  a  branch up to  inosculate with the Princeps
Cervicis from the Occipital Artery.
   Backwards, the subclavian sends off
   The Vertebral  Artery.—This artery arises  from
the back part of  the subclavian, passes outwards, and
enters the foramen in the transverse process of the last
cervical  vertebra,  and ascends through  the transverse
process of the vertebras, to enter  the foramen magnum of
the occipital bone. 
arteries.
77
Fig. 21.
Arteries of the Neck.
1.  Heart.
2.  Left Coronary Artery.
3.  Right Coronary Artery.
4.  Pulmonary Artery cut through.
5.  Arch of the Aorta.
6.  Innominata Artery.
7.  Right Primitive Carotid.
8.  Left Subclavian.
9.
10.
11.
12.
Division  of the  Innominata
 into the Right Primitive Ca-
 rotid and Right Subclavian.
Division of the Primitive Ca-
 rotid into External and In-
 ternal Carotid.
Superior Thyroid  Artery.
Lingual Artery. 
78
PRACTICAL ANATOMY.
13.  Facial or External Maxillary      Artery enters the opening in
     Artery.                        the Transverse Process of the
14.  Inferior Palatine Artery.           Sixth Cervical Vertebra.
15.  Submental Artery.          28. Left Superior Intercostal Ar-
16.  Inferior Labial Artery.            tery.
17.  Superior Labial Artery.       29. Transverse Cervical Artery.
18.  Lateral Nasal Branch.        30. Posterior Scapular Artery.
19.  Occipital Artery.            31. Internal Mammary Artery.
20.  Posterior Auricular Artery.    32. Mediastinal Branch.
21.  Ascending Pharyngeal Artery. 33. Superior Phrenic Artery.
22.  Division of the External Ca- 34, 35. Anterior Temporal Artery.
     rotid into Temporal and In- 36. Posterior Temporal.
     ternal Maxillary Artery.     87. Trachea.
23.  Transverse Facial Artery.     38. Middle  Thyroid  Artery, an
24.  Temporal Artery.                 anomalous  branch of  the
25.  Middle or Deep Temporal Ar-      aorta sometimes met with.
     tery.                     39. Thyroid Body.
25'. Inferior Thyroid Artery.      40. Ascending Cervical Artery, a
26.  Vertebral Artery.                 branch of'the Inferior  Thy-
27.  Point at which  the Vertebral      roid.


  Anteriorly, the  subclavian artery gives off,
 . 5. A. Mammaria Interna.—The internal mammary
arises  from  the  forepart of the subclavian  opposite the
cartilage of the  first rib; it runs down  on  the inside of
the cartilages of the ribs, and terminates  in the abdominal
muscles, where it inosculates with the epigastric.  It is a
large artery, and its branches are very numerous.  They
pass to the external muscles of the chest, to the intercos-
tal  muscles, pleura, &c.  It also sends off the Arteria
Phrenica  Superior, vel comes nervi  phrenici,  which,
with two veins, accompanies  the  phrenic nerve to the
diaphragm.
  6. The subclavian artery gives twigs to the root of the
neck, and to the muscles about the scapula.
  7. A. Intercostalis Superior.—Frequently a trunk
comes off from  the subclavian, especially on the right
side, which passes  downwards  and backwards, and lodges
itself by the  spine, to supply  the two or three superior
intercostal spaces.


              Course of the Subclavian Vein.

  The Subclavian Vein is situated anteriorly to the  sub-
clavian artery;  it  passes inwards behind and under the 
NERVES.
79
subclavius muscle, and before and over the belly of the
anterior scalenus (so that this last muscle lies betwixt the
vein and artery).  It runs over the first rib, where it  is
found in  contact with the  axillary artery, and is called
the Axillary Vein.
  The branches of this vein accompany and correspond
to the ramifications of the  subclavian  artery,  returning
the blood from the thyroid gland,  neck, chest, intercostal
spaces, &c.  The subclavian vein also receives the inter-
nal jugular, which passes down behind the clavicle.

       The  Course of the Brachial Plexus of Nerves

  May  also be examined.   This plexus is formed by
branches of the four lower cervical and first dorsal nerves,
which pass between the  anterior and  middle scaleni
muscles into the axilla.   In this passage they are situated
higher up than the artery.
  A considerable part of the scaleni muscles may now be
seen, covered by a strong  fascia,  the  Prevertebral
Fascia ; the upper insertion of these muscles must  be
dissected with the muscles of the back part of the neck.
  1. The Scalenus Anticus—Arises,  by three tendons,
from the transverse processes  of the fourth,  fifth, and
sixth vertebrae of the neck.
  Inserted, tendinous and fleshy,  into the upper edge of
the first rib, near its cartilage.
  2. The Scalenus Medius—Arises, tendinous, from the
transverse processes of all the vertebrae of the neck.
  Inserted into the upper and outer part of the first rib,
from its root to within the distance of half an  inch from
the scalenus anticus.
  3. The Scalenus Posticus—Arises, tendinous, from
the transverse processes  of the first and sixth vertebras of
the neck.
   Inserted into the upper edge  of the first rib, near the

   Situation: These muscles are  covered before  by the
sterno-mastoideus and trapezius, behind by the trapezius
and levator scapuhe; but  the  scaleni  are so  connected 
80
PRACTICAL ANATOMY.
with the  muscles of the  spine  that the  whole of them
cannot be demonstrated till the  muscles of the back and
neck are dissected.
   Uses of these three muscles :  to bend the neck  to one
side, and, when the  muscles of  both sides act to bend it
forwards; or, when the neck is  fixed, to elevate the ribs,
and dilate the chest.

                          Fig. 22.
Cervical Muscles.
1.  Basilar  Process of the Occi-
    pital Bone.
2.  Mastoid Process.
3.  Rectus Capitis  Anticus Ma-
    jor.
4.  Rectus Capitis Anticus Minor.
5.  Rectus Capitis Lateralis.
6.  Longus Colli, right side.
7.  Same, left side.
8.  Scalenus Posticus.
9.  Scalenus Anticus.
10.  First Rib.
11.  Passage  of  the  Subclavian
      Artery.
12.  Second Rib.
13.  Third Dorsal Vertebra.
14.  Transverse  Process  of  the
      Atlas.
15.  First Inter-transversalis Mus-
      cle.
16.  Sixth Inter-transversalis Mus-
      cle. 
CERVICAL VERTEBRA.
81
Dissection of the Muscles on the front of the Cervical Vertebrae.

   These muscles may be exposed by raising off the muscles
already dissected, together with the  trachea, larynx, and
oesophagus.  There are four pairs.
   1. Longus Colli—Arises, tendinous and fleshy, from
the sides of the bodies of the three cervical vertebrae, and
from the anterior surface of the  transverse processes of
the four or five lower cervical vertebrae.
   Inserted, tendinous and fleshy, into the forepart of the
bodies of all the vertebrae of the neck.
   Situation: This muscle lies behind the oesophagus and
great vessels and nerves of the neck.
   Use: to bend the neck forwards and to one side.
   2. Eectus Capitis Anticus Major—Arises, tendinous
and fleshy,  from the  anterior points of the transverse
processes of the third,  fourth, fifth, and sixth cervical
vertebras.
   Inserted into  the cuneiform process of the os occipitis
in front of the condyloid process.
 .  Situation: Further out than the longus colli.
   Use: To  bend the head forward.
   3. Eectus  Capitis Anticus  Minor—Arises,  fleshy,
from the forepart of the body of the first vertebra of the
neck, close  to the transverse process,  and ascending ob-
liquely, is
   Inserted near  the root of the condyloid process of the
occipital bone, under the last muscle :  acts as the last.
   4. Pectus Capitis  Lateralis—Arises,  fleshy, from
the upper part of the transverse process of the atlas.
   Inserted, tendinous and fleshy, into the transverse ridge
of the os occipitis.
   Situation: it is immediately behind  the internal jugu-
lar vein, where it comes  out from the cranium.
   tjse: draws the head somewhat to one side. 
82              practical anatomy.
                 CHAPTER VI.

            DISSECTION OF THE THROAT.

  On looking into the mouth, we  observe the tongue,
and a soft curtain hanging from the palate  bones, named
the Velum Pendulum  Palati, or  soft  Palate.   The
apex  of  the  velum  forms a  small  projecting  body,
termed the Uvula, or pap of the  throat.   From each
side of the uvula, two muscular half-arches or columns
are sent down, the anterior to the root of the tongue, the
posterior to the side of the pharynx.  Between these half-
arches on each side are situated the glands termed Amyg-
dalae, or Tonsils.  The common opening behind the ante-
rior arch is named the Fauces, or top of the Throat, from
which there are six passages, two upwards, being one to
each nostril,  called the  Posterior Nostrils;  two at the
sides, called Eustachian Tubes, passing on each side to
the ear;1 two  downwards,  of which the anterior  is the
passage through the glottis and larynx into the trachea;
the posterior, which is the largest, is the pharynx,  or top
of the oesophagus, and leads to the stomach.

 MUSCLES SITUATED ABOUT THE ENTRY OF  THE FAUCES.

  These consist of four pairs, and a single  muscle  in the
middle.
  1. Constrictor Isthmi Faucium—Arises, by a slen-
der beginning, from the side of the tongue, near its root;
thence running upwards within the  anterior arch,  before
the amygdala, it is
  Inserted into the middle of the velum pendulum  palati,

  1 A probe may be introduced through the anterior  nostrils into the
Eustachian tube; the tube opens into the pharynx in a direction op-
posite to the space between the roots of the middle  and inferior tur-
binated bones. 
MUSCLES.
83
                         Fig. 23.

         The Pharynx laid open and viewed prom behind.

  1. A   Section   carried  transversely
     through the Base of the Skull.
2, 2. The Walls of the Pharynx drawn to
      each side.
3, 3. The  Posterior Nares, separated by
      the Vomer.
  4. The  Extremity of the Eustachian
      Tube of one side.
  5. The Soft Palate.
  6. The Posterior Pillar of the Soft Pa-
      late.
  7. Its  Anterior  Pillar;  the Tonsil  is
      seen  in the niche  between the
      two Pillars.
  8. The Root of the Tongue, partly con-
      cealed by the Uvula.
  9. The Epiglottis, overhanging (10) the
      Superior opening of the Larynx.
 11. The Posterior Part of the Larynx.
 12. The Opening into the Oesophagus.
 13. The External Surface of the Oeso-
      phagus.
 14. The Trachea.

as far as the root of the uvula.  It is here connected .with
its fellow, and  with the beginning of the palato-pharyn-
geus.
  Situation: It forms the anterior half-arch.
   Use: To draw the velum towards the root of the tongue,
Which at the same time it raises, and, with its fellow, to
contract the opening into the fauces.
  2. The Palato-Pharyngeus—Arises, by a broad  be-
ginning, from the root of the uvula in the middle of  the
velum pendulum palati, and from the tendinous expan-
sion of the circumflexus palati.  The fibres  pass along
the posterior arch behind  the amygdalae, and run back-
wards to the superior  and  lateral  part of the pharynx,
where they are scattered, and  mixed with those of  the
stylo-pharyngeus.
  Inserted into  the edge of the upper and  back part of
the thyroid cartilage, and into the back part of the pha-

rynx.
  Situation: It forms the posterior  half-arch or column.
 
81
practical anatomy.
   Use: To draw the uvula and  velum downwards  and
backwards, and pull the thyroid cartilage and pharynx
upwards;  to shut the passage into  the nostrils, and, in
swallowing, to thrust the food from the fauces  into the
pharynx.
  3. The Circumflexus, or Tensor Palati—Arises from
the spinous process of  the sphenoid  bone,  behind the
foramen ovale, and from the  Eustachian  tube  near its
osseous part; runs down along the pterygoideus internus,
and forms a round tendon, which passes over the hook of
the internal plate of the pterygoid process of the sphenoid
bone, and soon spreads into a broad tendinous expansion.
  Inserted into the velum pendulum palati, and semilunar
edge of the os palati.
  Situation: Its insertion extends as  far as the suture
which  joins the two ossa palati.   Some of its  posterior
fibres generally join with the constrictor pharyngis supe-
rior and palato-pharyngeus.
   Use:  To stretch the velum, to draw it downwards,  and
to one  side.
  4. The Levator Palati—Arises, tendinous and fleshy,
from the extremity of the petrous portion of the temporal
bone, and from the Eustachian tube.
  Inserted into the whole length of the velum pendulum
palati, as far as the root of the uvula, uniting  with its
fellow.
   Use:  To draw the velum upwards and backwards, so
as to shut the passage from the fauces into the mouth and
nose.
  Azygos  Uvula—There are  two which arise, fleshy,
from the extremity of the suture which unites  the ossa
palati;  runs down the whole length of the velum, like a
small earth-worm, adhering to the tendons of the circum-
flexi palati.
  Inserted into the tip of the uvula.
   Use: To raise the uvula upwards and forwards,  and
shorten it. 
muscles.
85
                     The Tongue.
  The tongue is connected by its root to the os hyoides,
is  principally formed  by muscular  structure.   On  its
surface  note  its roughness, formed by papillae, eight  or
nine at  its posterior part, arranged  in  a V-shaped figure
(Papillje Maxima).   Smaller and more numerous are
others scattered over the tongue (the  Papillae Mediae).
A third class, very numerous (the Papillae Minima, or
Filiformes).   Three folds of  mucous membrane  pass
from the back part of the tongue to the sides  and centre
of the  Epiglottis (Glosso-Epiglottidean Folds), the
middle  ones  sometimes called the  Frjenum of the Epi-
glottis.  The  Foramen Caecum of Morgagni is in front
of this.

                       Muscles.
   Several of the muscles of the tongue have been de-
scribed  in the dissection of the neck.   Those which enter
into its  structure proper are  the
   Lingualis, which arises from its root, and runs as far
as the tip.
   Use:  To shorten the tongue.
   Superficialis Linguae, Transversales Lingua, and
Verticales  Linguae.—Their names indicate their  di-
rection.

 muscles situated on  the posterior part of  the
                      PHARYNX.
   Of these there are three pair, and are better dissected
after the muscles on the back of the neck are disposed of,
in order to remove the head from its articulation with
the atlas, taking with it the Pharynx, Larynx, and (Eso-
phagus.
   1.  The Constrictor Pharyngis Inferior. —This
muscle  arises from the outside of the ala of the  thyroid
cartilage, near  the attachment  of the  thyreo-hyoideus
muscle  and from the  side of the cricoid cartilage, near
the crico-thyroideus.
     8 
 86              practical anatomy.

   Inserted into the white line  on the back part of the
 pharynx, where it is united to its fellow.
   Situation: This muscle covers  the  under part of the
 middle constrictor;  the superior fibres run obliquely up-
 wards, while the inferior fibres have a transverse direction.
   Use:  To compress  that part of the pharynx which it
 covers, and to raise it with the larynx a little upwards.
   2. The Constrictor Pharyngis Medius—Arises from
 the superior edge of the cornu of the os hyoides, extending
 as far forwards  as the  appendix; and from the ligament
 which connects  it  to the thyroid cartilage.  The superior
 fibres ascend obliquely, the others run more transversely.
   Inserted into  the cuneiform process of the os occipitis,
 before the foramen magnum, and into a white line in the
 middle of the p'osterior surface of the  pharynx, where it
 is joined to its  fellow.
   Situation: The  lower part of this muscle is covered by
 the muscle last described, while the upper part covers the
 inferior fibres of the constrictor superior.
   Use: To compress that part of the  pharynx which it
 invests, and to draw it and the os hyoides upwards.
   3. Constrictor Pharyngis Superior—Arises, above,
 from the cuneiform process of the os occipitis, before the
 foramen magnum; lower down,  from the pterygoid  pro-
 cess of the sphenoid bone; from  the upper and under jaw,
 near the alveolar processes  of the last dentes molares;
 and from the back part of the buccinator muscle.  Some
 fibres also come from the root  of the  tongue, and from
 the palate.
   Inserted into a white line in the middle of the posterior
surface of  the pharynx.
   Situation: The  larger part of this muscle is covered
by the constrictor medius.
   Use: To compress the upper part  of the pharynx,  and
draw it forwards and upwards.

             MUSCLES OF THE LARYNX.

   The Larynx  is  composed  of five cartilages:  1.  The
Thyroid Cartilage, situated immediately below the os 
MUSCLES OF THE LARYNX.
87
                         Fig. 24.

          A Side View of the Muscles of the Pharynx.

 1. The Trachea.
 2. The Cricoid Cartilage.
 3. The Crico-thyroid Ligament.
 4. The Thyroid Cartilage.
 5. The Thyro-hyoid Ligament.
 6. The Hyoid Bone.
 7. The Stylo-hyoid Ligament.
 8. The Oesophagus.
 9. The Inferior Constrictor Muscle.
10. The Middle Constrictor Muscle.
11. The Superior Constrictor Muscle.
12. The  Stylo-pharyngeus Muscle
    passing down between the Su-
    perior and Middle Constrictors.
13. The Upper Concave  Border of
    the Superior Constrictor.  At
    this point the muscular fibres
    of the Pharynx are deficient.
14. The  Pterygo-Maxillary  Liga-
    ment.
15. The Buccinator Muscle.
16. The Orbicularis Oris Muscle.
17. The Mylo-hyoid Muscle.

hyoides  in the middle of  the throat.   2. The Cricoid
Cartilage,  situated  immediately below the thyroid car-
tilage, betwixt it and the superior rings of the trachea.
3. The Epiglottis,  a broad triangular cartilage, very
elastic, situated behind the root of the tongue, and co-
vering  the  entrance into the upper part of the larynx.
4 and 5. The arytenoid cartilages, two small bodies, like
peas,  situated behind the thyroid  cartilage, on the upper
edge  of the back part of the cricoid cartilage, and be-
tween the  two  alse  or  wings  of the thyroid cartilage.
These two small cartilages form betwixt themselves and
the thyroid a longitudinal fissure,  extending from  before
backwards, which is called the Glottis, or Kima Glottidis,
and leads to the trachea.
  The muscles situated  about the glottis consist of four
pair of small muscles, and a single one.
  1. The Crico-Arytjenoideus Posticus—Arises, fleshy,
from  the posterior part of the cricoid cartilage, and is
 
PRACTICAL ANATOMY.
                   Fig. 25.
Cartilages of the Larynx separated and seen in Front.
1 to 4. Thyroid Cartilage.
   1. Vertical Ridge, commonly  called
       Adam's Apple, formed by  the
       union of  the  two Plates  or
       Halves.
   2. Right Half.
   3. Superior, and
   4. Inferior Horn of the Right Side.
  5, 6. Cricoid Cartilage.
   7. Right Arytenoid Cartilage.
   Inserted, narrow, into the back part of the  arytenoid
cartilage of the same side.
   Use:  To open the nma glottidis a little, and, by pulling
back the  arytenoid cartilage, to render the ligament of
the glottis tense.
   2. The  Crico-Aryt^inoideus   Lateralis — Arises,
fleshy, from  the side of the cricoid cartilage, where it is
covered  by the ala of the thyroid cartilage.
   Inserted  into the outer side of the arytenoid cartilage.
   Situation: It lies more  forward than the last described
muscle.
   Use: To open the rima glottidis,  by pulling the liga-
ments from each other.
   3. The Thyreo-Aryt,enoideus—Arises from the mid-
dle and inferior part of the posterior  surface of the thy-
roid cartilage; runs backwards, and a little upwards, and is
   Inserted  into the forepart of the arytenoid cartilage.
   Situation:  It is situated more forwards than the muscle
last described.
   Use: To pull the  arytenoid  cartilage  forwards, and
thus shorten  the ligament  of the larynx or glottis. 
LARYNGEAL muscles.
89
     Fig. 26.
Laryngeal Muscles.
1. Epiglottis.
2. Thyroid Cartilage.
3. Cricoid Cartilage.
4. Crico-arytenoideus Posticus.
5. Arytenoideus Transversus.
6. Arytenoideus Obliquus.
  ArytJEnoideus Obliquus—Arises from the base of
one arytenoid cartilage ;  and, crossing its fellow, is
  Inserted into the tip of the other arytenoid cartilage.

                          Fig. 27.
             Muscles and Cartilages of the Larynx.
1. Epiglottis.
2. Cricoid Cartilage.
3. Thyroid Cartilage.
4. Crico-arytenoideus Lateralis.
5. Thyro-arytenoideus.
   Use: When both act, they pull the arytenoid cartilages
towards each other.
   The single muscle is the
   Arytenoideus Transversus, which arises irom the
         '                   8*
 
90
PRACTICAL ANATOMY.
whole length of one arytenoid cartilage, and passes across,
to be
  Inserted into the whole length of the  other arytenoid
cartilage.
  Situation: It  is situated  anterior to  the  arytaenoidei
obliqui.
  Use: To shut the rima glottidis, by bringing the aryte-
noid cartilages together.
 . On  each side of the larynx, there are also a few mus-
cular fibres, which are named as follows:—
  1. Thyreo-Epiglottideus—Arising, by  a few  pale
separated fibres, from the thyroid cartilage, and
  Inserted into the epiglottis laterally.
  Use: To draw  the epiglottis obliquely downwards, or,
when both muscles act, directly downwards;  and  at  the
same time to expand it.
  2. The  Aryt^ino-Epiglottideus—Arises,  by  a few
slender  fibres,  from the lateral and  upper part of the
arytenoid cartilage, and is
  Inserted into the  epiglottis,  along with  the  former
muscle.
  Use: When  both  muscles act, to pull the epiglottis
close upon the glottis.
  The Thyreo-Hyoideus  and the Crico-Thyroideus were
described with the muscles of the neck.   The inside of
the  larynx is lined with a  mucous membrane, and two
folds will be seen running from the arytenoid cartilages
to the angle of the thyroid ;  on either side these  are the
Vocal Cords.  Between the cords of each side a cavity
(the Ventricle), which communicates with another cavity
at the upper and front part (the Sac of Hilton, or Sac-
culus Laryngis).   The cavity above the upper cords
(the glottis); space between the lower cords, the Rima
Glottidis. 
muscles situated within the orbit.      91
                CHAPTER VII.

       DISSECTION OF THE ORBIT OF THE EYE.

  The globe or ball of the eye is situated about the
middle of the orbit.  It is  connected  to the bone by its
muscles, and by the optic nerve; and all these parts are
embedded  posteriorly  in a soft, fatty substance,  which
fills  up the bottom of the orbit.  The tunica, or mem-
brana conjunctiva, is seen lining the inner surface of the
eyelids, and reflected from them over the anterior part of
the globe of the eye, so that the back part of the eyeball,
and  all the muscles and nerves, are  situated behind it.
This membrane must  therefore be dissected away, the
upper part of the orbit, which is formed by the os fron-
tis, removed with a saw,  and the fat surrounding the
muscles,  vessels, and nerves, cautiously  dissected away
with the scissors.

         MUSCLES SITUATED WITHIN THE ORBIT.

   Seven muscles are contained within the orbit, of which
one belongs to the upper eyelid, and six to the globe of
the eye.
   1. The Levator Palpebr.e Superioris—Arises, by
a small tendon, from the upper part of the foramen opti-
cum of the sphenoid bone; the tendon  forms a broad
flat belly.
   Inserted,  by a broad thin  tendon, into the upper  eyelid,
adhering to the tarsal cartilage, which  gives form to the
eyelid.
   Use: To open the eye, by drawing the  superior eyelid
upwards.
   There are four straight muscles, or  recti, belonging to
the o-lobe of the eye.   These four muscles resemble each 
92
PRACTICAL ANATOMY.
other, all arising by narrow tendons from  the  margin of
the foramen  opticum,  where  they surround  the optic
nerve; all forming strong fleshy bellies, and inserted, by
broad, thin tendons,  at the forepart of the_ globe of the
eye, into the tunica sclerotica, or outer tunic of the eye,
and under the tunica conjunctiva.
  2.  The Levator Oculi, or Rectus  Superior—Arises,
by a narrow tendon, from the upper part of the foramen
opticum of the sphenoid bone; it forms a fleshy belly,
and is
  Inserted into the superior and  anterior part of  the
tunica sclerotica, by a broad thin tendon.
  Situation:  It lies below the levator palpebrae  supe-
rioris.
   Use:  To raise the globe of the eye.
  3.  The Depressor Oculi, or Rectus Inferior—Arises
from the inferior margin of the foramen opticum, and is
  Inserted into the  inferior and anterior part of the tunica
sclerotica.
   Use: To move the globe of the eye downwards.
  4.  The Adductor Oculi, or Rectus Internus—Arises
from the inner part of the foramen opticum, and is
  Inserted into the inner and anterior part of the tunica
sclerotica.
  It is the shortest of the four recti muscles.
   Use:  To draw the eye towards the nose.
  5.  The Abductor Oculi, or Rectus Externus—Arises
from the outer part of the foramen opticum.
  Inserted into the  outer part of the tunica sclerotica.
  It is the longest  of the recti.
   Use: To move the globe outwards.
  The two next are oblique muscles.
  6.  The Obliquus Superior, or Trochlearis—Arises,
by a small tendon, from the  margin of the foramen opti-
cum, between the levator  and abductor oculi.  Its long
slender belly runs  along the inner side of the orbit to the
internal  angular process of the os frontis, where a  car-
tilaginous pulley is fixed.   The muscle then forms a ten-
don,   which passes through the pulley,  runs  obliquely 
MUSCLES OF THE EYEBALL.
93
downwards  and  outwards, inclosed  in a  membranous
sheath; and, becoming broader and thinner, is
  Inserted into the  tunica sclerotica, about  half way be-

                         Fig. 28.
A Side View of the Muscles of the Eyeball.
A. Ball of the Eye.               7.
1. Levator Palpebrae Superioris.    8.
2. Obliquus Superior, or Trochlea-
    ris Muscle.                 9.
3. Trochlea of the last-named Mus-  10.
    cle.                      H.
4. Rectus Superior Muscle.       12.
5. Rectus Inferior Muscle.        13.
6. Rectus Externus Muscle.
Ligament of Zinn.
Origin of the Superior Oblique
  Muscle.
Origin of the Rectus Externus.
Obliquus Inferior Muscle.
Optic Nerve.
Malar Bone, divided.
Upper Maxillary Bone.
tween the insertion of the levator oculi and the entrance
of the optic nerve.
   Use: To roll the globe of the eye, and  turn the pupil
downwards and outwards.
   7. The Obliquus Inferior—Arises, narrow, and prin-
cipally tendinous, from the outer edge of the orbitar pro-
cess of the  superior maxillary  bone, near  its junction
with  the  os  unguis.   It  runs obliquely  outwards  and
backwards, under the depressor oculi, and is 
94
PRACTICAL ANATOMY.
  Inserted, by a broad  thin tendon, into the  sclerotica,
between the entrance of the optic nerve and the insertion
of the abductor oculi.
   Use: To draw the globe of the eye forwards, inwards,
and downwards, and to turn the pupil upwards.
  In the orbit we  also meet with the Lachrymal Gland.
This gland is of a yellowish color;  it is situated in a de-
pression of the  os frontis  near  the temple.  It adheres
closely to the fat which surrounds the  muscles and pos-
terior convexity of the eye.  It  sends off several small
ducts, which pierce  the  tunica  conjunctiva lining  the
upper eyelid; these ducts cannot be seen, unless the part
be macerated in  water, when  they are  filled with  the
liquid.
  The Palpebr^e, or Eyelids, are  two cartilaginous
plates, semilunar in form,  the upper the largest, connect-
ed to the  internal and external angle of the orbit by
fibrous tissue called the external and internal palpebral
ligament (the internal one sometimes called the Tendo
Oculi), above and below to the  periosteal margin of the
orbit, by a fibrous membrane.
  The Puncta  Lachrymalia are two small holes near
the internal angle of the palpebrae, situated one in each
eyelid. They lead into the Lachrymal Ducts, the ducts
into the lachrymal sac.
  The Lachrymal Sac is an oblong  membranous bag,
situated at  the  inner angle of the  eye, in a depression
formed by the os  unguis, and nasal process of the supe-
rior maxillary bone.  It receives the tears by the  puncta
lachrymalia, and from the sac they are conveyed into the
nose by a Duct, named the Lachrymal, or Nasal.  The
lower extremity of this duct opens into  the nose on  one
side of the  antrum maxillare, and under  the os spongio-
sum  inferius.  A  probe, with its extremity bent, may be
introduced from the nose through this duct into the lach-
rymal sac.
  The Caruncula Lachrymalis is a small reddish granu-
lated body, situated at the internal angle of the palpebral.
  Tensor  Tarsi  of  Horner—Arises from the posterior
superior surface of the os unguis, passes forwards  and 
             ARTERIES.—VEINS.—NERVES.          95

outwards, lying on the posterior face of the  lachrymal
ducts,  upon  which it is inserted nearly as far as  the
puncta lachrymalia.
   Use: Draws the ducts towards the eye.

OF THE VESSELS AND NERVES MET WITH IN THE ORBIT OF
                       THE EYE.

                       Arteries.
   The Ophthalmic, or Ocular Artery, is a branch of
the internal carotid.   It enters the orbit from the basis of
the cranium by the foramen opticum.  It gives branches
to the  lachrymal gland, fat, muscle, and globe of the eye.
One twig, named the A. Centralis Retina,  enters the
substance of the optic nerve, and is continued on to the re-
tina ; twigs also pass  to the eyelids, and to the inner angle
of the eye.  The Arteria Frontalis is a branch of this
artery; it is  seen running towards  the  supra-orbitary
notch or foramen, and is distributed to the forehead.
   The Infra-Orbitary Artery is found in the  lower
part of the orbit; it is the continued trunk of the internal
maxillary, entering the orbit by the spheno-maxillary slit.
It is seen  passing along the canal in the upper part  of the
great tuberosity of the os maxillare superius, and emerges
on the face by the infra-orbitary hole.

                        Veins.
  These  correspond  with  the  arteries;  they discharge
their blood partly into the branches of the external jugu-
lar vein near the forehead  and temples, and partly into
the internal juguhm

                       Nerves.
  1. The  Optic Nerve is seen  coming through the fora-
men opticum, and entering the back part of the globe of
the eye, to form the retina.
  2. The  Nerve of the Third Pair, Motor Oculi, having
entered the orbit through the superior orbitary fissure, or
foramen lacerum, is divided into four branches. 
96              PRACTICAL ANATOMY.
  (1.) The first runs upwards, and subdivides into two
nerves, of which one supplies the superior rectus, and the
other the levator palpebrae superioris.
  (2.) The second branch goes to the superior rectus, and
is short.
  (3.) The third branch supplies the obliquus inferior,
and  also gives off a  twig, which assists in forming the
lenticular ganglion.
  (4.) The fourth branch supplies the internal rectus.
  3. The  nerve of the Fourth Pair, N. Patheticus, or
Trochlearis, enters the orbit by the superior orbitary fis-
sure, and runs to the obliquus superior.
  4. The  first branch of the Nerve of the Fifth  Pair,
named Ophthalmic, or Orbitary, enters the orbit by the
superior orbitary fissure, and divides into three branches.
  (1.)  The Frontal,  Supra-orbitary, or  Superciliary
Nerve, accompanies  the frontal  artery along the upper
part of the orbit, close to the bone ; and having passed
through the  supra-orbitary notch, is distributed to the
forehead.
  (2.) The Nasal Nerve, or inner branch, runs towards
the nose, and is distributed to the inner side of the orbit,
and to the nose.
  (3.)  The Temporal  or Lachrymal  Branch, supplies
the lachrymal gland, and  the parts at the  outer side of
the orbit.
  The Lenticular Ganglion is a small ganglion,  situ-
ated within the orbit, formed by short branches of the
ophthalmic nerve, and by a twig of the third pair. It
sends off delicate  nerves, which  run  along the sides of
the optic nerve, and pierce the coats of the eye.
  5. The second branch of the FifthtjPair, called the Su-
perior Maxillary  Nerve, sends off a branch through
the bony canal in the bottom of the orbit.   This  is the
Infra-orbitary Nerve.   It accompanies an artery of
the same name, and emerges  on  the face by the  Infra-
orbitary Foramen.
  6. The trunk of the Sixth Pair  of nerves passes through
the sphenoidal fissure to the external rectus muscle.
  These delicate nerves are surrounded with fat, and de-
mand great care in their dissection. 
female mammae.
97
               CHAPTER VIII.

            DISSECTION OF THE THORAX.

OF THE MUSCLES WHICH LIE UPON THE OUTSIDE OF THE
               THORAX.  THE AXILLAE.

  To expose these muscles, carry an incision from the top
of the sternum along  the median line to  the ensiform
cartilage, from thence obliquely upwards  through the
axillae, and a few inches down the inner side of the arm.
From the commencement of the first  another along the
clavicle to the acromion process.
  Notice the axillae, a conical cavity, having a muscular
fold  in  front  and behind.  The former  made by the
Pectoralis Major muscle, the latter by the Latissimus
Dorsi muscle.
  In removing the integuments from the forepart of the
thorax, the pectoralis major and interior edge of the del-
toid muscle  should be  dissected in  the course of  their
fibres; and  to do this,  it will be necessary to remember
that  the fibres run obliquely from the sternum and cla-
vicle to the upper part  of the os humeri.
  Of the Female Mammae.—Two glandular bodies placed
upon the great pectoral  muscles, having only the fascia
interposed, upon which  they readily move.  In the centre
is placed the  Nipple,  about which are  many sebaceous
follicles.  Ten or fifteen ducts (Tubuli Lactiferi), com-
mence at its extremity, and passing inwards divide and
subdivide, which  ultimately end in enlargements,  from
which pass off many others, to end finally in the ultimate
lobules or vesicles of the  organ.  The lobules are sup-
ported by prolongations from the cellular capsule of the
gland, which pass through its substance.  Much adipose
structure is  usually intermixed with the lobules.
     9 
98
practical anatomy.
  Its bloodvessels  from the axillary, intercostal, and in-
ternal mammary trunks.
  Three pair of muscles are described in the dissection
of the thorax.
  1. The  Pectoralis Major—Arises,  tendinous, from
the anterior surface of the sternum, its whole length;
fleshy, from the cartilages  of the fifth, sixth, and some-
times the seventh ribs, and from two anterior thirds of
the clavicle.  The fleshy fibres run  obliquely across the
breast, and, converging, form a strong, flat tendon, which
is
  Inserted into the ridge of the os humeri  on the outside
of the bicipital groove.
  Situation: The belly of this muscle is superficial.  It
is separated from  the deltoid muscle by  cellular mem-
brane and fat, by the Cephalic Yein, and a small artery,
named Humeral  Thoracic.  Its tendinous fibres,  aris-
ing from the  sternum, are interlaced with those of the
opposite, so as to form a kind of fascia covering the bone;
and the origins from the ribs  are intermixed  with the
obliquus externus abdominis. The clavicular and thoracic
portions of the muscle are separated by a line of cellular
membrane which leads to the axillary vessels.
  The tendon is covered by the anterior edge of the del-
toid ; it forms  the  anterior fold of the armpit, and ap-
pears twisted, for the fibres which proceed from the tho-
racic portion of the muscle, seem to pass behind those
proceeding from the clavicle, and to be inserted into the
os humeri somewhat higher up.
   Use:  To  move  the arm forwards,  and obliquely up-
wards, towards the sternum.
  The pectoralis major should be lifted up from its origin.
This will expose the next two muscles.
  2. The Pectoralis Minor—Arises, by three tendinous
and fleshy digitations from  the  upper edges  of the third,
fourth,  and fifth ribs, near their cartilages; it forms a
fleshy triangular belly, which becomes thicker and nar-
rower as it ascends, and is
  Inserted, by a short flat tendon, into the anterior part of
the coracoid process of the scapula. 
FEMALE MAMMJE.
99
  Situation: The belly of this muscle  is covered by the
pectoralis major:  the tendon passes under  the  anterior
edge of the deltoid, and is connected at its insertion with
the origins of the coraco-brachialis, and of the short head

                        Fig. 29.
Front View of the Pectoralis Major Muscle.
of the  biceps  flexor cubiti, and also with the coraco-
acromial ligament.
   Use: To  draw  the scapula forwards and downwards,
and, when that bone is fixed, to elevate the ribs.  Above
its insertion notice some arteries presently to be described.
  3. The Subclavius—Arises,  by a flat  tendon,  from
the cartilage of the first rib, and  forms a broad fleshy
belly, which is
  Inserted into  the inferior surface of the clavicle, begin-
ning about one inch from the sternum, and continuing as
the lio-amentous connection of the clavicle to the coracoid
process.
  Situation: This muscle is situated between the clavicle 
100              practical anatomy.

and sternum, concealed by the pectoralis major, and ante-
rior part of the deltoides.

                        Fig. 30.
  A Front View of the Subclavius and Pectoralis Minor Muscles.
        1. Subclavius.            2. Pectoralis Minor.

  Use: To draw the clavicle downwards  and forwards,
and perhaps to elevate the first rib.
  Having lifted up the  pectoralis  minor from its origin,
the  situation of the subclavian vessels which pass  under
the  clavicle, and over the first rib, may be seen.

                Dissection of the Axilla.

  The axilla is formed by  two muscular folds, which
bound a middle cavity.   The anterior fold is formed by
the  pectoralis major passing  from the thorax to the arm,
the  posterior  by the latissimus dorsi coming from the
back.
  In the intermediate cavity there is a quantity of cellu-
lar  membrane and absorbent glands and fat, covering and
connecting the great vessels and nerves; and this  is not 
DISSECTION OF THE AXILLA.
101
exactly similar to the fat in other parts of the body; it is
more granulated, watery, and of a reddish color;  it sur-
rounds the great vessels and nerves, rendering the dissec-
tion both tedious and difficult  The lymphatic glands here
are continuous under the clavicle with those of the neck.
  The Axillary Vein will be found lying anterior to
the artery, that is, nearer the integuments.  The axillary
vein receives branches corresponding to the ramifications
of the artery.  Passing under the clavicle, it becomes the
subclavian vein,  and runs over the first rib, and  before
the anterior scalenus muscle into the thorax.
  Deeper seated, and immediately behind the  axillary
vein, lies the Axillary Artery.  It is seen coming
from under the clavicle; from under the arch formed by
the pectoralis minor, it comes over the middle of the first
rib, and between the anterior and middle scaleni muscles.
In the axilla it is surrounded by the meshes of the axil-
lary nerves, and  runs under the tendon of pectoralis mi-
nor along the inferior edge of the coraco-brachialis muscle;
when it has passed  to the tendon  of the latissimus dorsi
muscle, it assumes the name of the Brachial Artery.
  The branches  of the axillary artery are,
  1. A.  Mammaria Externa, called also A. Thoracicae
Externae.—The external mammary artery consists of four
or five branches  which run downwards and forwards  ob-
liquely over the  chest.   These  branches  sometimes come
off separately from  the  axillary artery, at other times by
one  or two  common  trunks, which subdivide.  They
supply the pectoral  muscles and mamma.  Some of their
branches  pass to the muscles of the shoulder, to the side
of the chest, and to the muscles on the inside of the sca-
pula.  They are as follows:—
  a. Thoracico Acromialis—going towards the  fissure
between the deltoid and pectoralis major.
  b. Thoracico Superior—to the pectoralis major.
  c.  Thoracico Longa—along the border of the  pecto-
ralis minor and side of  the chest.
  d. Thoracico Axillaris—to the glands and cellular
tissue of the armpit.
  2  A  Subscapulars arises  from the under and back
                          9* 
102
PRACTICAL ANATOMY.
part of the axillary artery, attaches itself to the inferior
costa  of the scapula,  where  it splits  into  two great
branches: 1. The Dorsalis Scapula, a large branch, which
passes to the outer  surface of the scapula below the spine,
and has its principal ramifications close upon the bone.
2.  The other branch (which is larger) passes to the inner
surface of  the scapula,  supplies the  subscapularis,  and
sends branches downwards to the muscles of the back
and loins.  (See Fig. 30.)
  3. Arteria Circumflexa Humeri  Posterior arises
from  the lower  and forepart of the axillary  artery, and
runs  backwards close to the bone, surrounds its neck,
and is lost  on the  inner surface of the deltoid; it gives
also twigs  to the  joint and neighboring muscles.  It is
accompanied by the Circumflex Nerve.
  4.  A. Circumflexa  Anterior is  a much  smaller
artery, often a  branch  of the circumflexa posterior; it
encircles the neck  of the bone on  its forepart, and is lost
on the inner surface of the deltoides, where it inosculates
with the posterior  circumflex artery.
  The Great Brachial Nerves accompany the subcla-
vian  artery over the first rib.  In the axilla they  are
united by numerous cross branches, forming the Axillary
or Brachial Plexus, which is continued from  the clavicle
as low as the edge  of the tendon of the  latissimus dorsi,
and which surrounds the axillary artery with its  meshes.
   From the axillary plexus seven nerves pass off.
   1. Nervus Supra-scapularis.—This nerve comes off
from the upper edge of the plexus; it crosses the axilla
at the highest part, runs towards the superior  costa of the
scapula, accompanies the external scapular artery through
the semilunar notch, and supplies the muscles on the pos-
terior surface of the scapula.
   2.  N. Circumflexus lies deep; it passes from the back
part of the plexus, goes backwards round the neck of the
bone, accompanying the posterior circumflex artery,  and
is distributed to the deltoid  and the muscles on the out-
side of the arm.  Small nerves also pass from  the axillary
plexus to the subscapular muscle (subscapular), the teres
major, latissimus dorsi,  and pectoral muscles. 
OF THE SHOULDER AND ARM.         103
  3. The External Cutaneous Nerve, or Nervus-Musculo-
cutaneus.
  4. The Median Nerve.
  5. The Ulnar Nerve.
  6. The Musculo-Spiral Nerve.
  7. The Internal Cutaneous Nerve.
  8. The Lesser Internal Cutaneous, or Nerve of Wris-
berg, formed by  a  filament from the second intercosto
humeral, and another from the axillary plexus.
  At this  exposure of parts a nerve may be observed
descending close along the thorax upon the serratus mag-
nus muscle.  This is the Long Thoracic or External
Respiratory of  Bell,  and comes from the fourth and
fifth cervical nerves.  Two others come through the in-
tercostal spaces, the Intercosto Humeral.  They come
from the intercostal nerves, and mingle with the axillary
nerves.
  Six of these nerves will be described in the dissection
of the arm and forearm.
                CHAPTER IX.

     DISSECTION OF THE SUPERIOR EXTREMITY.

             OF THE SHOULDER AND ARM.

  An incision carried  down the middle of the arm and
integuments  reflected,  will  expose the parts properly
for  dissection.  The arm  is invested with  a  superficial
fascia, mingled with fat, in and beneath which are situated
important veins.   Beneath the superficial  fascia  is the
Deep Fascia, consisting of fibres running circularly and
longitudinally.   This fascia is very thin over the deltoid.
Strono- at the internal  condyle, and on  the  back  of the
forearm  sending processes in  between  the  muscles and
furnishing to them a surface of origin. 
104               PRACTICAL ANATOMY.
   In removing the  integuments, we meet with  several
cutaneous veins and nerves.
   The  cutaneous  veins1 of the  upper  extremity  are the
following:—
   1. The Basilic Vein is seen arising from a small vein
on the  outside of  the little  finger, named  Salvatella.  It
then runs along the inside of the forearm near the ulna,

                         Fig. 31.
          Superficial Veins of the Superior Extremity.
 a. Commencement of the Cephalic Vein.
 b. Main Trunk of Cephalic Vein.
 c. Anterior Branch of Basilic Vein.
 d. Posterior Branch of Basilic Vein.
 e. Basilic Vein.
/. Median Vein.
 g. Median Basilic Vein;
 h. Median Cephalic Vein.
 i. Biceps Muscle.
""<*
  1 The veins are described from their origii
sake of perspicuity.
in  the forearm for the 
OF THE SHOULDER AND ARM.
105
receiving the internal and external ulnar veins from  the
anterior and posterior surface of the  fascia.  It passes
over the fold of the arm near the inner condyle of the
humerus.    It ascends  along the arm, becoming more
deeply seated, and included in the sheath which  invests
the brachial artery.   As it approaches the neck of the
humerus, it sinks deep betwixt  the folds of the armpit,
and  terminates in the axillary vein, which may be con-
sidered as a continuation of the basilic vein.  It commu-
nicates with the deeper-seated veins, and receives numerous
branches from the muscles.
  2. The  Cephalic  Yein  begins on  the back  of  the
hand, between the thumb and metacarpal bone of the fore-
finger, by a small vein, named Cephalica  Pollicis.  It
runs along  the radius between  the muscles and  integu-
ments, receiving  the  internal and  external radial veins.
It passes  over the bend of the arm  near the external
condyle, and ascends  along the  outside of the arm near
the outer edge of the biceps flexor cubiti.  It then runs
betwixt the edge  of the deltoid and pectoral muscles, dips
down under the clavicle, and enters the subclavian vein.
In all this  course the cephalic vein receives branches.
  3. The Median Vein.—Several veins are seen running
along the middle of the anterior  part of the forearm.  The
trunk formed by these veins is called the Mediana Major. It
ascends on the flat part of the forearm, betwixt the basilic
and cephalic veins, and bifurcates at the fold of the arm
into two branches : 1. The Mediana Basilica, passing off
obliquely  to  join the basilic  vein;  2.  The Mediana
Cephalica,  which joins the cephalic.
   The cutaneous nerves of the arm are seen ramifying
above the muscles; they consist of,
   1. The  Internal  Cutaneous Nerve,  a branch of the
axillary plexus.   It is seen accompanying the basilic vein,
and twisting its fibres over it.  It descends along the in-
side of the arm,  crosses over the  forepart of the elbow-
joint, and,  in the  dissection of the forearm, will  be seen
dividing  itself into  twigs,  which ramify between the
fascia and  integuments, and  are distributed to the inside
of the forearm and wrist. 
106
practical anatomy.
  2. The upper part of the arm receives cutaneous nerves
from the branches of the dorsal nerves, which come out
of the thorax between the ribs.
  3. The shoulder and back part of the scapula receive
twigs from the cervical nerves.
  4. The  external  cutaneous, ulnar,  and spiral nerves,
also send twigs to the integuments of  the arm and  fore-
arm.

    muscles situated on the shoulder and arm.

  These are ten in number.
  1. The Deltoides—Arises, tendinous and fleshy, from
the posterior third of the clavicle, from the whole edge
of the acromion, and from the lower margin of the whole
spine of the scapula.   From these several origins the
fibres run in different directions, and converge to be
  Inserted, tendinous, into a triangular rough surface on
the outer side of the os humeri, near its middle.
  Situation: This  muscle is entirely superficial, except
where the thin fibres of the platysma myoides arise from
its  anterior surface.  It arises from the same extent of
bone  as the trapezius is inserted into.  It is a coarse mus-
cle, consisting of large fasciculi of fibres. It conceals the
insertion of the  pectoralis major, and the origins of the
biceps flexor cubiti and coraco-brachialis, and covers the
whole of the forepart  and outside of the shoulder-joint.
Its external surface is quite fleshy; but,  on cutting it
across, its internal surface is found tendinous; and where
it slides over the great tuberosity of the humerus there
is a large bursa.
   From the insertion of the deltoid to the  outer cond)de
of the os humeri is extended an Intermuscular Ligament,
which separates the muscles on  the. anterior part of the
arm from those  on the posterior part, and  gives attach-
ment to the fibres of  both.  It is  named  the External
Intermuscular Ligament. It is only the deep fascia.
   Use:  To draw the arm directly upwards, and to  move
it a little forwards and backwards, according to the dif-
ferent directions of its fibres. Reflect it from the scapula 
MUSCLES ON THE SHOULDER AND ARM.     107
and clavicle, that you may expose more completely the
muscles on the dorsum of the former bone.

                        Fig. 32.
               A View of the Deltoid Muscle.
1. Body of the Muscle.
2. Its Insertion into the Clavicle.
3. Its Insertion into the Spine of the
    Scapula.
4. Its Insertion into the Humerus.
   The following two muscles, which fill up the posterior
surface of the scapula, are covered by a fascia, which ad-
heres to the spine and edges of that bone.  On dissecting
off this fascia, the  fleshy fibres of the muscles will be
found arising from its inner surface.
   2. The Supra Spinatus—Arises, fleshy, from all  that
part of the base of the scapula that is  above its  spine,
from the superior costa as far forwards as the semilunar
nitch, from the spine itself, and  from the concave surface
betwixt it and the superior costa.   The  fleshy fibres ter-
minate  in a tendon which  passes under the acromion,
slides over the  neck of the  scapula (to which it is  con-
nected by loose cellular  membrane), adheres to the  cap-
sular ligament of  the shoulder-joint, and is
   Inserted into the anterior and superior part of the great
tuberosity near the head of the os humeri.
   Situation: This  muscle  fills up the fossa or cavity above 
108              PRACTICAL ANATOMY.
the spine of the scapula, and is entirely concealed by the
fibres of the trapezius.
   Use: To raise the arm.
   The supra-scapular artery and nerve pass through this
fossa.
   3.  The Infra-Spinatus—Arises, principally  fleshy,
from  the lower part  of the spine  of the  scapula as far
back as the triangular flat surface;  from the  base of the
bone below the spine to near the inferior angle; from the
posterior ridge of the  inferior costa; and from all the
dorsum of the bone below the spine.  The fibres  ascend
and descend towards a  middle tendon, which runs for-
wards over the neck of the  bone, and adheres to the cap-
sular ligament.
   Inserted, by a strong short tendon, into the middle part
of the great tuberosity of the os humeri.
   Situation: This muscle is  in part concealed  by the del-
toid, and the trapezius  passes over  its upper  and  back
part;  but a considerable portion of the belly of this  mus-

                        Fig. 33.
Muscles of the Scapula.
       1. Supra-spinatus.              3. Teres Minor.
       2. Infra-spinatus.               4. Teres Major.

cle  is seen betwixt these two  muscles.   It  is  inserted
below the tendon of the supra-spinatus. 
THE SUBSCAPULARS.
109
   Use: To roll the humerus outwards, to assist in raising
the arm, and in moving it outwards when raised.
  4. The Teres Minor—Arises, fleshy, from the narrow
depression between the two ridges in the inferior costa of
the scapula, extending from the neck of the bone to within
an inch or two of the inferior angle.  It passes forwards
along the inferior edge of  the infraspinatus, adheres to
the capsular ligament of the shoulder-joint, and is
  Inserted, tendinous and fleshy, into the lower and back
part of the great tuberosity of the os humeri.
  Situation: It is inserted below the tendon of the infra-
spinatus.  Its origin lies between the infra-spinatus  and
teres major, and partly concealed by them.   Its insertion
is concealed by the deltoid. The fascia which covers the
infra-spinatus envelops also the teres minor; and the two
muscles are in some  subjects so closely united as to be
with difficulty separated.
   Use: To draw the humerus downwards and backwards,
and to roll it outwards.
   5. The Teres Major—Arises from an oblong, rough,
flattened surface, at the inferior angle of the scapula.  It
forms a thick belly, which passes forwards and upwards
towards the inside of the arm.
   Inserted, by a broad thin tendon, into the ridge of the
os humeri, at the inner  side of the bicipital groove.
   Situation: Its belly passes before the long head of the
triceps extensor cubiti.   Its tendon is inserted along with
the tendon of the latissimus dorsi.   Observe the relative
situation  of these tendons; they  both pass  under the
coraco-brachialis and short head of the biceps flexor, to
■reach the place of their insertion.   They appear at  first
inseparably united, but on dividing them with some care
we find an intermediate cavity lubricated with synovia.
    Use: To roll  the  humerus inwards, and  to draw it
backwards  and downwards.
   6  The Subscapulars—Arises,  fleshy,  from all the
 base of the scapula internally, from the superior and in-
 ferior costas, and from the  whole internal  surface of the
 bone. It consists of tendinous and fleshy bundles, which
 converge, slide over the inner surface of the neck of the
     10 
110
PRACTICAL ANATOMY.
scapula, pass in the hollow under the root of the coracoid
process, and adhere to the inner part of the capsular liga-
ment of the shoulder-joint.
  Inserted, by a strong tendon, into the lesser tuberosity
near the head of the os humeri.

                        Fig. 34.
Muscles of the Scapula.
       1. Subscapularis.            3. Part of Triceps.
       2. Teres Major.              4. Deltoid Muscle.

  Situation: The whole  of this muscle is concealed by
the scapula and muscles of the shoulder.  It lies betwixt
that bone and the serratus  magnus.
   Use: To roll the os humeri inwards, and to draw it to
the side of the body.
  7. The Biceps Flexor  Cubiti—Arises by two heads.
The first and outermost, called the Long Head,  arises, by
a strong tendon, from a smooth surface in  the upper edge
of the glenoid cavity of the scapula.   It  passes over  the
head of the os humeri, within the capsular ligament of
the shoulder-joint, and enters  the  bicipital groove.   It
forms a strong fleshy belly.  The second  and innermost,
called the Short Head, arises, tendinous, from the lower
part of the coracoid process of the scapula, in common
with the  coraco-brachialis,  and sends off a fleshy belly.
   These two fleshy bellies  form a thick mass, and, below
the middle  of the arm,  become inseparably united.  They 
biceps flexor cubiti.
Ill
send off a strong tendon, which passes into the forepart
of the elbow-joint.
  Inserted into  the posterior  rough part of the  tubercle
of the radius.  A bursa  mucosa is  placed between the
tendon and front of the tubercle.
  Situation: The tendon of the long head cannot be seen
till the capsular ligament of the shoulder is opened.  The
two origins are concealed by the deltoides  and pectoralis
major; and, at the bend of the elbow, its tendon sends off
from its inside an  aponeurosis (Bicipital), which assists
in  forming the fascia of the forearm,  and  covers the
brachial artery, and median nerve.
                         Fig. 35.
Muscles of the Anterior Brachial Region, the Anterior Half of the
                   Deltoid being cut away.
  1.
  2.
3, 6.
4,4.
  5.
  7.
10.
11.
12.
13.
Subscapularis Muscle.
Biceps.
Teres Major.
Brachialis Anticus.
Tendon of the Pectoralis Major.
Internal Head of the Triceps.
Tendinous Expansion of the Bi-
  ceps.
Extremity  of   the  Pectoralis
  Minor.
Coraco-Brachialis.
Long Head of the Biceps.
Short Head of the Biceps.
Coracoid Process of the  Scapula.
   Use: To turn the hand supine, to bend the forearm on
the arm, and the arm on the shoulder. 
112
PRACTICAL ANATOMY.
  8. The Coraco-Brachialts—Arises,  tendinous and
fleshy, from the middle part of the apex of the coracoid
process of the scapula.  Its fibres, as it  descends, also
arise from the edge of the short  tendon of the biceps
flexor cubiti.  It forms a flat fleshy belly which is always
perforated  by the  nerve, named Musculo-Cutaneus Ex-
ternus ;
  Inserted, tendinous and fleshy, about the middle of the
internal part of the os humeri, into a rough ridge.
  Situation: This  muscle is much connected with  the
short head of the biceps flexor cubiti.   In the arm it lies
behind, and on the inside of the biceps, and  is concealed
partly by the pectoralis major and deltoides.  It is insert-
ed immediately below the tendons of the latissimus dorsi
and teres major, and before the brachialis externus.  The
Axillary Artery is on its inner  edge and  the median
nerve.
  The internal intermuscular ligament (Deep Fascia of
the Arm) is seen extending from the lower part of this
muscle along a ridge to the internal condyle, and separat-
ing the brachialis internus from the brachialis externus,
or third head of the triceps extensor cubiti.
   Use: To move the arm upwards and forwards.
  9. The Brachialis Internus—Arises from the middle
of the os humeri, by  two  fleshy  slips, which pass on
each side of the insertion of the deltoid  muscle; fleshy
from all  the forepart of the  bone below, nearly as  far as
the condyles.  The fibres converge, pass over the elbow-
joint, and adhere to the capsular ligameut.
  Inserted, by a strong short tendon, into the rough sur-
face immediately below the coronoid process of the  ulna.
  Situation: The belly is almost entirely concealed by
the biceps flexor cubiti, excepting a small portion which
projects  beyond the outer  edge of  that  muscle.  The
tendon dips down betwixt the supinator radii longus and
pronator teres, crosses  under the tendon  of the biceps
flexor, and is inserted on the inside of that tendon.
   Use:  To bend the forearm.
  10. The Triceps Extensor Cubiti  is the great muscle 
TRICEPS EXTENSOR CUBITI.
113
which covers all the back part of the arm.  It arises by
three heads.  The first, or long head, arises, by a broad
tendon,  from the inferior costa of the scapula near its
cervix, and forms a large belly, which covers the back
part of the os humeri.  The second, or short head, arises,
on the outer and back part of the os humeri, by an acute
tendinous and fleshy beginning, from a ridge which runs
from the back part of the great tuberosity towards the
outer condyle.  They also arise from the surface of bone
behind  the ridge, and from the intermuscular ligament
which separates them from the muscles on the forepart of
the arm.  The third head, called Brachialis Externus,
arises, by an acute beginning, from  the inside of the os
humeri  above its middle, and from a ridge extending to
the inner condyle, from the surface behind this ridge, and
from the internal intermuscular ligament.
  The three heads unite above  the middle  of the os
humeri,  and invest the  whole back part of  the bone.
They form a thick strong tendon, which is
  Inserted into the rough back part of the process of the
ulna, called Olecranon, and  partly into  the  condyles of
the os humeri, adhering firmly to the capsular ligament.
  Between the first and third  head passes the musculo-
spiral nerve.  The  Ulnar Nerve  rests  upon the front
part of  the triceps muscle, accompanied by the Inferior
Profunda artery from the brachial.  The Superior Pro-
funda Artery accompanies the musculo-spiral nerve.
  Situation:  The long head,  where it k arises  from the
scapula, is concealed by the deltoid; it arises betwixt the
teres minor and teres major.  The  short head  arises im-
mediately below the insertion of the teres minor.   The
tendon of the triceps sends off a thin fascia, which covers
the triangular surface of the ulna, on which we commonly
lean.  Numerous fibres are also sent off, to assist in form-
ing the fascia of  the forearm.
   Use:  To extend the forearm.  The long head will also
assist in drawing the arm backwards.
10* 
114
PRACTICAL ANATOMY.
DISSECTION OF THE FASCIA AND MUSCLES SITUATED ON
               THE CUBIT OR FOREARM.

  On removing the integuments of the forearm, we find
a strong fascia investing all the muscles.  It  is attached
to the condyles, and it adheres firmly to the olecranon of
the  ulna.  It receives, on the posterior part, a great addi-
tion of fibres from  the  tendon of the triceps extensor;
and on the forepart of the arm, it appears to be a continua-
tion of the aponeurosis which is sent off from the biceps
flexor cubiti.
  Above the fascia  we meet with several cutaneous veins
and nerves.   The veins have been already described; the
nerves are twigs of  the branches of the brachial plexus,
principally internal and external cutaneous.
  The relative situation of the  vessels at the bend of the
arm should be well attended to.   The cutaneous  veins
situated here vary  much in size.    The vena basilica is
seen running  over the forepart of the bend of the arm
near the inner  condyle, the vena cephalica situated near
the outer condyle; and each  of these veins  receives a
branch passing obliquely from  the vena mediana.   These
vessels  lie above the fascia, while the brachial artery lies
just beneath the fascia, in a hollow resembling that of
the axilla. It descends over the joint near the inner con-
dyle, on the inside of the tendon of the biceps flexor cu-
biti, and under the aponeurosis sent off from that muscle
to the common fascia  of the forearm.  It lies  embedded
in cellular substance, betwixt the pronator teres and flexor
muscles of the wrist and  fingers on one side, and the su-
pinator longus and extensor muscles on  the  other.  In
this hollow it divides  into the radial ulnar and interosseal
arteries.   The  artery is  accompanied  by two veins, and
on  its inner side runs the radial nerve.

MUSCLES SITUATED ON THE FOREPART OF THE CUBIT, AND
 ARISING  FROM THE INNER CONDYLE OF THE OS HUMERI.

  These are eight  in number, and  may be divided into
two classes, the superficial and the deep-seated. 
FLKXOR CARPI  RAD1ALTS.
115
   First, the superficial.
   All the muscles passing from the inner condyle may
be said to arise by one common tendinous head from the
condyle, and  this head may be said to divide into the
different  muscles;  but they will be  here described as
arising distinct from the condyle.  It must, however, be
recollected that their origins are intimately connected by
intermuscular fascia, and that they cannot be separated
without dividing some of their fibres.
   1. The  Pronator Radii Teres—Arises, tendinous and
fleshy, from the anterior surface of  the inner condyle of
the os humeri, and from the coronoid process of the ulna.
It also arises from the fascia of the forearm.  The fibres
pass outwards, run by the side of the  tubercle of the ra-
dius,  and  pass over the outer edge of that bone, to be
   Inserted, tendinous and fleshy, into a rough  surface  on
the back  part of the radius about its middle.
   Situation: Of the muscles which pass from the internal
condyle, the pronator  teres is  situated nearest the outer
edge  of the arm.    Its tendon,  to arrive  at its  place of
insertion, passes under the belly of the supinator longus.
   Use: To  roll the radius, together with  the hand,  in-
wards.
   2.  The Flexor Carpi Radialis—Arises, by a narrow
tendinous beginning, from the lower and forepart of the
internal condyle of the  os humeri; fleshy from the fascia
and  intermuscular ligaments, and from the upper  end of
the ulna.   It forms a  thick belly, which runs  down the
forearm, and terminates in  a flat tendon.  This tendon
passes under the annular ligament1 of the wrist, runs
through a groove in the os trapezium,  and is

  1 The annular ligament of the wrist consists of two parts: 1. The
ligamentum carpi transversale externum passes from the styloid pro-
cess of the  ulna and  os pisiforme, transversely, over the back of the
wrist, and spreads out broad, to be affixed to the styloid process of the
radius. Under it pass the tendons of the extensor muscles.  2. The
ligamentum carpi transversale internum is  a strong ligament, which
passes across the forepart of the wrist.  It arises from the os pisiforme
and os unciforme on the inner edge of the  wrist, and is attached to
the os scaphoides and os trapezius on the outer edge.  Under it pass
the tendons of the flexor muscles. 
116
PRACTICAL ANATOMY.
  Inserted into the forepart of the base of the metacarpal
bone of the fore-finger.
  Situation: This muscle  is  situated immediately under
the fascia, excepting its upper extremity, over which the
pronator  teres crosses.   Its insertion cannot  be seen till
the palm  of the hand is dissected, where it will be found
concealed by the  muscles of the ball of the thumb.
   Use: To bend the hand  and to assist in its  pronation.
               Fig. 36.

The Muscles of the Front of the Forearm.



       3
 1. Lower part of the Biceps.
 2. Part of the Brachialis Internus.
 3. Edge of the Triceps.
 4. Pronator Radii Teres.
 5. Flexor Carpi Radialis.
 6. Palmaris Longus.
 7. One of the Divisions of the Flexor Sublimis
     Digitorum.
 8. Flexor Carpi Ulnaris.
 9. Palmar Fascia.
10. Palmar Brevis Muscle.
11. Abductor Pollicis Manus.
12. Portion of the Flexor Brevis Pollicis Manus.
13. Supinator Radii Longus.
14. Extensor  Ossis Metacarpi Pollicis curving
     around the lower Border of the Forearm.
  3. The Palmaris Longus—Arises, by a slender  ten-
don, from the  forepart of the inner condyle of the os
humeri, and fleshy from  the intermuscular ligament;  it 
FLEXOR sublimis perforatus.         117
forms a short fleshy belly, which soon sends off a long-
slender tendon.  This tendon descends along the forearm,
and is
  Inserted^ near the root of the thumb, into the ligamen-
tum carpi  transversale internum, and into a tendinous
membrane that covers the palm of the hand  named Pal-
mar Fascia, or Aponeurosis Palmaris.
  Situation: It arises  betwixt the  flexor carpi radialis
and flexor ulnaris.  This muscle  is sometimes wanting.
   Use:  To bend the hand, and stretch the palmar apo-
neurosis.
  4. The Flexor Carpi  Ulnaris—Arises,  tendinous,
from the inferior part  of the internal condyle of the os
humeri; tendinous and fleshy, from  the inner side of the
olecranon, and by  a tendinous expansion from the poste-
rior ridge of the ulna, to near the lower end of the bone.
It also arises from the  intermuscular fascia and fascia of
the forearm.  The fibres pass obliquely forwards into a
tendon which runs over the forepart of the ulna, and is
  Inserted into the os pisiforme, and  sometimes sends its
fibres over a small ligament which goes to the base of the
metacarpal bone of the little finger.
  Situation: This  muscle  runs along the inner edge of
the forearm, between the flexor sublimis on the forepart,
and the extensor-carpi-ulnaris on the back  part of the
ulna.
   Use:  to bend the hand.
  5. The Flexor Sublimis Perforatus—Arises, tendi-
nous and fleshy, from the under part of the internal con-
dyle of  the os humeri; tendinous, from the lower part of
the coronoid process of the ulna; fleshy, from the tuber-
cle of the radius, from  the middle of the forepart of that
bone,  and  from  the   middle  third of  its outer  edge.
These origins form a strong fleshy mass, which sends off
four tendons.   These tendons are connected by cellular
membrane, and pass together under  the annular ligament
of the wrist;  after which they separate,  become thinner
and flatter, pass along the metacarpal bone and first pha-
lanx of  each of the fingers, and are
  Inserted into the anterior and upper part of  the second 
118
PRACTICAL ANATOMY.
 phalanx, each tendon being, near  the  extremity  of the
 first phalanx, divided for the passage of a tendon of the
 flexor profundus.
   Situation: To expose  the origin  of this muscle, the
 bellies of the pronator  teres, flexor carpi radialis,  and
 palmaris longus, must be detached from the condyle.  It
 descends along the forearm  under these  muscles, but a
 part of it is seen projecting towards the inner edge of the
 arm,  betwixt  the  tendons of the  palmaris longus and
 flexor carpi ulnaris.  It arises from the radius below the
 insertion of the biceps flexor cubiti.  Its tendons will be
 seen in the dissection of the  palm of  the hand.
   Use: To bend the second joint  or phalanx  of  the
 fingers.
   Notice  the  following bloodvessels and  nerves, which
 will be discussed in detail, when the dissection of the arm
 has been finished.
   Brachial  Artery at the bend of the  arm, the median
 nerve on its inner side.  The artery divides into Radial
 and Ulnar.
   The Radial crosses to the  radial side of the arm, at the
 root of the thumb passes under its extensor tendons.  Its
 branches are
   Recurrens Radialis, toward external condyle.
   Muscular, to the muscles.
   Superficialis Vol^:, to the ball of the thumb.
   Carpal.  Anterior and  Posterior.  These are all
 that can be seen at the present stage of the dissection.
   Radial Nerve, to the outside of the artery.
   A. Ulnaris.—Its first part deep under several muscles
 which  arise from the internal condyle, and not visible,
 emerges on the ulnar side of arm, and passes down  the
 arm between the Flexor Carpi Ulnaris  and Flexor
 Sublimis Digitorum, over the annular ligament into the
 hand, to form the arcus sublimis.   The ulnar nerve is  to
 its ulnar or inner border.   Its branches are
  Recurrens Ulnaris—Passes back toward the inter-
nal condyle.
  Interossea—Too deep to  be seen yet. 
            FLEXOR PROFUNDUS PERFORANS.          119


  Dorsalis  Manus—Leaves the ulnar at the lower part
of the arm, and passes to the back of the wrist.

                          Fig. 37.

            A View of the Arteries of the Forearm.

 1. The Lower Part of the Biceps Muscle.
 2. The Inner Condyle of the Humerus,
     with tlH  Humeral Origin  of the
     Pronator Radii Teres and  Flexor
     Carpi Radialis Muscles cut across.
 3. The  deep  portion of  the Pronator
     Teres Muscle.
 4. The Supinator Longus Muscle.
 5. The Flexor Longus Pollicis.
 6. The Pronator Quadratus.
 7- The Flexor Digitorum Profundus.
 8. The Flexor Carpi Ulnaris.
 9. The Anterior Annular Ligament. The
     figure  is placed on the Tendon of
     the  Palmaris  Longus  Muscle, di-
     vided close to its insertion.
10. The Brachial Artery.
11. The Great Anastomotic Artery.
12. The Radial Artery.
13. The Radial Recurrent Artery.
14. The Superficial] s Volae Artery.
15. The Ulnar Artery.
16. Its Superficial Palmar Arch giving
     Digital Branches  to three  fingers
     and a half.
17. The   Great Artery of the Thumb
     (Magna Pollicis).
18. The Posterior Ulnar Recurrent.
19. The Anterior Interosseous Artery.
20. The  Posterior  Interosseous, as it is
     passing through the Interosseous
     ligament.


  By removing  the belly of the flexor sublimis, we ex-
pose the deep-seated muscles.
  6. The Flexor Profundus Perforans—J.m<?s, fleshy,
from the smooth concavity on the  inside of the ulna, be-
twixt the coronoid process and  the  olecranon ; from the
smooth  flat surface of the ulna, betwixt its posterior and
internal angles ; from the under part of the coronoid  pro-
cess, and from  the forepart of the ulna below that process.
 
120
PRACTICAL ANATOMY.
It also arises from the inner half of the interosseous liga-
ment.  This muscle  forms a thick mass, which descends
along the forepart of the ulna, adhering to  that  bone as
low as one-third of its length from its inferior extremity,
and terminates  in sending off four tendons.  These ten-
dons  pass together  under the  annular ligament of the
wrist, run through the slits in the tendons of the flexor
sublimis, and are                          •*
  Inserted into the fore and  upper part of the third or
last phalanx of all the fingers.
  Situation: This muscle  is concealed by the flexor sub-
limis and flexor carpi ulnaris.  Its tendons will be seen
in dissecting the hand.
   Use: To bend the last joint of  the fingers.
  7.  Flexor Longus Pollicis  Manus—Arises, by an
acute fleshy beginning, from the upper and  forepart of
the radius,  immediately below its tubercle, fleshy from
the outer edge and anterior surface of that bone as low as
two inches  above its inferior  extremity, and  from the
outer part of the interosseous ligament.  It  has  also
generally a tendinous origin from the internal condyle of
the os humeri.  This origin forms a distinct  fleshy slip,
which is joined to the inner and upper part of the portion
of the muscle arising from the radius.  The  fibres pass
obliquely into  a tendon  on the  anterior surface of the
muscle.  The tendon passes under the annular ligament
of the wrist, runs between the two  heads of the short
flexor of the thumb, and between  the two sesamoid bones,
and is
   Inserted into the base  of the extreme phalanx of the
thumb.
   Situation: This  muscle lies  by the  side of the  flexor
profundus;  the portion which arises from the inner con-
dyle passes over the belly of the flexor profundus, and
under the flexor sublimis. Its  tendon will be seen in dis-
secting the short muscles  of the thumb.
   Use: To bend the last  joint of the thumb.
   On separating the lower part of the two last described
muscles, we expose a small square muscle, passing trans-
versely just above the wrist. 
PRONATOR QUADRATUS.
121
  8. The Pronator Quadratus—Arises, broad, tendi-
nous, and fleshy, from the inner edge of the ulna, extend-
ing from the lower extremity of the bone two inches  up
its edge.  The fibres run transversely, adhere to the inter-
osseous ligament, and are

                         Fig. 38.
      A Front View of some of the Muscles of the Forearm.
1. Pronator Radii Teres.
2. Pronator Quadratus.
3. Supinator Radii Brevis.
  Inserted into the lower and anterior part of the radius.1
  Situation: This muscle lies close to the bones, covered
by the flexor longus  pollicis and flexor digitorum sub-
limis.
   Use: To turn the  radius, together with  the hand, in-
wards.

  1 This muscle, if carefully examined, will be seen to consist of two
sets of  fibres, having different directions—first pointed out, I believe,
by Dr. J. Rhea Barton, of  this city.
11 
122
PRACTICAL ANATOMY.
MUSCLES SITUATED  ON THE OUTER AND BACK  PART OF
  THE FOREARM, AND ARISING  FROM THE OUTER CON-
  DYLE OF THE OS HUMERI.

  These muscles are eleven in number, and may be di-
vided into two classes: 1. The Superficial; and 2.  The
deep-seated.

                   The Superficial.

  The muscles which  arise from the  outer condyle are
much more distinct  in their origins than those which arise
from  the  inner condyle.   Several of  them arise a con-
siderable way  up the os humeri;  but there is here also a
common tendinous origin, from which the extensor carpi
radialis brevior, extensor digitorum communis, and ex-
tensor carpi radialis longior proceed, so that these muscles
are intimately connected.
  1. Supinator Radii Longus—Arises, tendinous  and
fleshy, from the external ridge of the os humeri which
leads  to the outer condyle.  It begins to arise nearly as
far  up as the middle of  the bone, and  ceases to adhere
about two inches above the condyle.   It forms a thick
fleshy  belly,  which passes over  the side of the elbow-
joint, becomes smaller, and terminates above the middle
of the forearm in  a  flat tendon.  The  tendon becomes
gradually rounder, and is
  Inserted into a rough surface on the outer side of the
inferior extremity of the radius.
  Situation: This muscle is situated immediately under
the integuments along the outer edge of the arm and fore-
arm.  Its origin lies betwixt the  brachialis internus  and
short  head of  the triceps extensor cubiti.  Its  insertion
is crossed by the extensors  of the thumb.
   Use: To roll the radius outwards, and  turn the palm of
the hand upwards;  also to  bend the forearm on the hu-
merus.
  2. The Extensor Carpi Radialis Longior—Arises,
tendinous and fleshy, from the external ridge of the os 
            EXTENSOR DIGITORUM COMMUNIS.       123

humeri, beginning immediately below the origin of the
supinator longus, and continuing to arise  as far as the
upper part of the outer condyle.  It forms a thick short
belly, which passes over the side of the elbow-joint, and
terminates above the middle of the radius in a flat tendon.
The tendon runs along the radius, and, becoming rounder,
passes through a groove in the back part of the inferior
extremity of that bone, to be
   Inserted into the posterior and upper part of the meta-
carpal bone of the fore-finger.
   Situation: The belly lies under the  supinator longus,
but part of it projects behind that muscle.   The tendon
descends behind that of the supinator,  and  passes under
the extensors of the thumb and annular  ligament of the
wrist, to arrive at the place of its insertion.
   Use:  To extend the  wrist and move  the hand back-
wards, and to assist in bending the forearm.
   3. The Extensor Carpi Radialis  Brevior—Arises,
tendinous,  from the under and back part of the external
lateral ligament of the elbow-joint.   Its thick belly  runs
along the outside of the radius, and terminates in a ten-
don, which passes through the same groove in the radius
as the extensor radialis longior, and under the annular
ligament.
   Inserted, by a round tendon, into the upper and back
part of the metacarpal bone  that supports the middle
finger.
   Situation: This muscle lies partly under the  extensor
radialis  longior;  but it also projects behind  it.  It passes
under the extensors of the thumb and the indicator.
   Use:  To extend the hand.
  4. The Extensor Digitorum Communis—Arises, ten-
dinous, from the under part  of the  external condyle of
the os humeri; fleshy, from the intermuscular fascia, and
from the inner surface of the fascia.   It  descends along
the back  part of the forearm, and  adheres to the  ulna
where it passes over  it.  The fleshy belly terminates  in
four flat tendons, which pass under the annular ligament
in a depression on  the back part of the radius, and are 
124
PRACTICAL ANATOMY.
  Inserted into the posterior part of all  the bones of the
fingers by a tendinous expansion.
  Situation: It arises and descends betwixt the extensor
radialis brevior  and  the extensor carpi ulnaris, and  is
situated immediately under the integuments.  The tendons
are connected  on  the back of  the metacarpal  bone by
cross slips.  The inner  part of this muscle is sometimes
described  as a  separate muscle, and is called Extensor

                          Fig. 39.
    The Superficial Layer of Muscles on the Back and Forearm.
The Lower Part of the Biceps,
Part of the Brachialis Internus.
The Insertion of the Triceps into the Ole-
 cranon.
The Supinator Radii Longus.
The Extensor Carpi Radialis Longior.
The Extensor Carpi Radialis Brevior.
The Tendinous  Insertion  of  these two
 Muscles.
The Extensor Communis Digitorum.
The Extensor Minimi Digiti.
The Extensor Carpi Ulnaris.
The Anconeus.
Part of the Flexor Carpi Ulnaris.
The Extensor Minor Pollicis and the Ossis
 Metacarpi Pollicis lying together.
The Extensor Major Pollicis ; its tendon
 is seen crossing the tendons of the two
 radio-carpal extensors.
The Posterior Annular Ligament.  The
 tendons  of the  extensor  communis  are
 seen upon the  back of the  hand, and
 also  their mode of distribution on the
 backs of the fingers.
Proprius Minimi Digiti, vel Auricularis.   It passes
through a separate depression of the radius and a particu-
lar ring of the annular lip-ament.
 
EXTENSOR CARPI ULNARIS.
125
   Use: To extend all the joints of the fingers.
   The posterior surface of each finger is covered with  a
tendinous expansion, which is formed by the tendons of
the common extensor, of the lumbricales, and interossei.
This tendinous expansion terminates in the third or ex-
treme phalanx.
   5. The Extensor Carpi Ulnaris—Arises, tendinous,
from the upper part of the external condyle: fleshy, from
the intermuscular fascia and inside of the fascia.  It
crosses towards the ulna, and arises, fleshy, from the back
part of that bone.   It  terminates  in a strong tendon,
which passes through a groove in the back part of the
lower end of the ulna, under the annular ligament, and
is
   Inserted into the posterior and  upper part of the meta-
carpal bone of the little finger.
   Situation: This muscle is entirely superficial.  It arises
from the condyle betwixt the extensor digitorum commu-
nis and anconeus.
   Use:  To extend the wrist, and bring the hand back-
wards ;  but chiefly to bend  the  hand laterally towards
the ulna, as it will appear by pulling its tendon in the
dissected subject.
   6. The Anconeus is a small triangular muscle, situated
at the outer side of the olecranon-, immediately under the
integuments.
   It arises, tendinous, from  the  posterior and lower part
of the external condyle  of the os humeri; forms a thick
triangular fleshy mass, adhering  to the capsular ligament
of the elbow-joint, and is
   Inserted into the concave surface on the outside of the
olecranon, and into the posterior edge of the ulna.
   Situation: This muscle lies betwixt the upper  part of
the extensor carpi ulnaris and the olecranon. It is partly
covered by the tendon of the triceps extensor cubiti, and
is enveloped in a fascia sent off from that tendon.
   Use:  To assist  in extending the forearm.
   By removing the superficial muscles, we expose
11* 
126
PRACTICAL ANATOMY.
                   The Deep-Seated.

   7. The Supinator Radii Brevis—Arises, tendinous,
 from  the lower part  of the  external  condyle of the os
 humeri ;  tendinous and fleshy,  from the ridge running
 down from the coronoid process along the outer surface
 of the ulna.  The fibres adhere firmly to  the ligament
 that joins these two bones, pass outwards round the upper
 part of the radius, and are
   Inserted into the upper and outer edge of the tubercle
 of the radius, and into  an oblique  ridge extending from
 the tubercle downwards and outwards  to the insertion of
 the pronator  teres.
   Situation:  This muscle nearly surrounds the upper and
 outer part of the  radius.   It is concealed at  the outer
 edge of the arm by the supinator longus and extensores
 carpi  radiales ; behind,  by the extensor digitorum com-
 munis, extensor carpi ulnaris, and anconeus; before, by
 the brachialis internus,  and by the tendon of the biceps
 flexor  cubiti,  close to which tendon this muscle is in-
 serted.
   Use: To roll the radius  outwards, and bring the hand
 supine.
  On the back part of the forearm we  meet with three
 muscles going to the thumb, and one to the fore-finger.
  8. The  Extensor Ossis Metacarpi Pollicis—Arises,
 fleshy, from the middle and posterior  part of the ulna,
 immediately below the termination  of the anconeus, from
 the interosseous ligament, and from the posterior surface
 of the  radius below the  insertion of the  supinator radii
 brevis.  The  fleshy fibres  terminate in  a  tendon which
 passes  through  a groove in the outer edge of the lower
 extremity of  the radius.                         #
  Inserted, generally by two tendons,  into the  os trape-
zium, and into the upper and back part of the metacarpal
bone of the thumb.
   Use: To extend the  metacarpal bone of the thumb
outwardly.
  9. The Extensor Primi Internodii Pollicis Manus
—An.es,  fleshy, from the back part  of the ulna below its 
INDICATOR.
127
middle,  from the interosseous ligament and radius.  It
runs along the lower edge of the extensor ossis meta-
carpi, and forms a tendon, which passes through the same
groove as the tendon of that muscle, and is
  Inserted into the posterior part of the first bone of the
thumb.   Part of the tendon is also  continued into the
base of  the second or extreme phalanx.
   Use:  To extend the first phalanx  of the thumb ob-
liquely  outwards.
  10. The Extensor  Secundi  Internodii  Pollicis
Manus—Arises, tendinous and fleshy, from the posterior
surface  of the ulna above its middle, and from the inter-
osseous ligament.  Its  belly partly covers the  origins of
the two other extensors of the thumb, and terminates in
a tendon, which runs through a  distinct  groove in  the
back part of the radius, and is
   Inserted into the posterior and upper part of the second
or extreme phalanx of the thumb.
   Use: to extend the last joint of the thumb obliquely
backwards.
   Situation of the extensors of the thumb.—The origins
of these muscles  are  concealed by the extensor digito-
rum communis and extensor carpi ulnaris.  The tendon
of the  extensor secundi internodii is at  a considerable
distance from  the tendons  of the two other extensors;
so that, in the intermediate space,  we see the terminations
of the  tendons of the extensores carpi radiales.  They
invest the back part of the thumb with a fascia.
   11. The Indicator—Arises, by an acute fleshy begin-
ning, from the middle of the back part of the ulna,  and
from the interosseous ligament. Its tendon, passes through
the  same sheath of the annular ligament with the exten-
sor  digitorum communis, and is
   Inserted into the posterior part of the fore-finger with
the  tendon of the common extensor.
   Situation: It arises nearer to the inner edge of the arm
 than the extensor secundi internodii pollicis.  It is con-
 cealed  by the extensor digitorum communis and extensor
 carpi ulnaris.   The tendon passes under that of the com-
 mon extensor. 
128
practical anatomy.
  Use: To assist in extending the fore-finger.
  Posterior Interossea Artery, resting on the poste-
rior part of the interosseous ligament, supplying muscles
and anastomosing  with  carpal arteries on the back of
the wrist.

        dissection of the palm of the hand.

  The tendons which  pass over the bones of the carpus
into the palm of the hand are firmly bound down by the
annular ligament of the wrist.  They are invested  and
connected by cellular membrane, which forms sheaths,
and secretes synovia to facilitate their motions.
  On removing the integuments from the palm of the
hand we meet with a  strong fascia.  It  arises from the
tendon of the palmaris longus and from the annular liga-
ment of the wrist, expands over all the palm of the hand,
and is fixed to the roots  of the fingers, splitting to trans-
mit their  tendons.  These forks  or splits are connected
by transverse fibres.  This is the Fascia or Aponeurosis
Palmaris.  It  is triangular.  Where it arises from the
wrist  it is narrow, and does not cover the bases of the
metacarpal bones of the  little and fore-finger.  As it runs
over the hand it becomes broader, and is fixed by a bifur-
cated extremity in the lower end of each of the metacar-
pal bones of the four fingers.  The palmar fascia is strong
and thick, and  conceals and supports the muscles of the
hand.  Its deep surface  is connected to the interosseous
fascia by two membranous prolongations. It exerts great
influence  on deep-seated abscesses of this part.
   There is a small  thin  cutaneous muscle situated be-
tween the wrist and the little finger.
   The Palmaris Brevis—Arises from the annular  liga-
ment of the wrist, and from the inner edge of the fascia
palmaris.
   Inserted, by small scattered fibres, into the skin and fat
 which cover the short  muscles of the  little finger and
 inner edge of the hand.
   Use: To assist in contracting the palm of the hand.
   The Fascia  Palmaris may now be removed.   Under 
ABDUCTOR POLLICIS MANUS.          129
it will  be seen the arcus sublimis and the digital nerves
from the ulnar and median presently to be described, and
the four tendons of the flexor sublimis perforatus.  They
are seen coming from beneath the annular ligament of the
wrist, and diverging as they pass towards their respective
fingers.  Each  tendon splits at the extremity of the first
phalanx for the passage of the tendon of the flexor pro-
fundus perforatus, and inserted into the base of the second
phalanx.
   Under the flexor sublimis are the four tendons of the
flexor  profundus perforans, which  pass through the slits
in the  tendons of the former, and  are inserted  into the
bases of the third phalanges of the fingers.
   The Lumbricales are four small muscles, which arise,
tendinous and fleshy, from the  outer side of the tendons
of the flexor profundus perforans, soon after those ten-
dons have passed the ligamentum  carpi annulare.   Each
of these muscles has a small belly, which terminates in a
tendon.   The tendon runs  along  the outer edge of the
finger, and is
   Inserted into the tendinous expansion which covers the
back part of the phalanges of the fingers about the mid-
 dle of the first joint.
    Use: To bend the first phalanges of the  fingers, the
 flexor profundus being previously in  action,  to afford
 them  a fixed point.
    The short muscles of the thumb and fore-finger are five
 in number.
    1. The Abductor Pollicis Manus—Arises, by a broad
 tendinous and fleshv origin, from  the anterior  surface of
 the annular ligament of the wrist, and from the os navi-
 cular and os trapezium.
    Inserted, tendinous, into  the outer side of the root o±
 the first phalanx of the thumb, and into the  tendinous
 membrane which covers the  back part of all the pha-

    Situation: This muscle is situated immediately under
 the integuments, and is the outermost portion of the mus-
 cular mass forming the ball of the thumb.
    Use: To draw the thumb from the fingers. 
130               PRACTICAL ANATOMY.
   2.  The Flexor Ossis  Metacarpi  Pollicis, or Oppo-
nens  Pollicis—Arises, broad and fleshy, from the annular

                           Fig. 40.
A Front View of the deep-seated Palmar Muscles.
1.  Pronator Quadratus.             7.
2.  Opponens Pollicis.               8,
3.  Its attachment to the Annular
    Ligament.                    8.
4.  Adductor Pollicis arising from   9.
    the whole front of the second  10.
    Metacarpal  bone (Os Trape-  11.
    zium and Os Magnum).        12.
5.   Adductor Metacarpi  Minimi  13.
    Digiti.                       14.
6.  Its Origin  from  the  Os Unci-
    forme.
Os Pisiforme.
9,10, 11, 12,13,14. Interossei
 Muscles.
Prior Indicis.
Posterior Indicis.
Prior Medii.
Posterior Medii.
Prior Annularis.
Posterior Annularis.
Interosseus   Digiti Auricu-
  laris. 
ADDUCTOR POLLICIS MANUS.          131
ligament of the wrist, and from the os naviculare and os
trapezium.
  Inserted tendinous and fleshy, into the anterior  and
lower part of the metacarpal bone of the thumb.
  Situation: It lies under the abductor pollicis, and is
almost entirely concealed; but a few of its fibres are seen
projecting beyond the edge of that muscle.
   Use: To bring the first bone of the thumb inwards.
  3. The Flexor Brevis Pollicis Manus arises by two
distinct heads.
  (1.)  The outer head arises from the inside of the annu-
lar ligament;  from the anterior surface of the os trape-
zium and os trapezoides, and from the root of the meta-
carpal bone of the fore-finger.
   Insertedinto the outer sesamoid bone, which is connected
by a  ligament to the root of the first phalanx of the
thumb.
   (2.) The inner head arises from the upper part of the
os  magnum and  os unciforme, and from the root of the
metacarpal bone of the middle finger.
   Inserted into the inner sesamoid bone, which is connect-
 ed by a ligament to the root of the first phalanx of the
 thumb.     «■'■
   Situation: This muscle is  in great part concealed by
 the abductor pollicis.  Its inner origin is under the first
 lumbricalis ; its upper part is seen projecting, and between
 its two portions we find the  tendon of the  flexor longus
 pollicis.
    Use: to bend the first joint of the thumb.
   4. The Adductor Pollicis  Manus—Arises, fleshy,
 from  almost  the whole length of the metacarpal bone
 sustaining the middle finger.  The fibres converge, and
 pass over the metacarpal bone of the fore-finger, to be
    Inserted, tendinous, into the inner part of the root of
 the first phalanx of the thumb.
    Situation:  The belly of this muscle is concealed, as it
 lies close to the bone under the tendons of the flexor pro-
 fundus and lumbricales.  The tendon is seen where it is
 inserted into  the thumb.
    Use:  To pull the thumb towards the fingers. 
132
PRACTICAL ANATOMY.
  5. The Adductor Indicis Manus—Arises, tendinous
and  fleshy, from the os trapezium, and from the inner
side of the metacarpal  bone of the  thumb.  It  forms a
fleshy belly, runs over the side of the  first joint of the
fore-finger, and is
  Inserted, by a short tendon, into the  outer  side of the
root of the phalanx of the fore-finger.
  Situation: This muscle is seen most distinctly on the
back of the hand.   It is there superficial, and is crossed
by the tendon of the extensor secundi internodii pollicis.
In the palm of the  hand it is concealed by the muscles of
the ball of the thumb.
   Use: To move the fore-finger towards the thumb,  or
the thumb towards the fore-finger.
  The insertion of  the flexor carpi radialis is exposed by
removing the muscles of the thumb.
  The short muscles of the little finger are  three  in
number.
  1. The  Abductor Minimi Digiti  Manus—Arises,
fleshy, from the os pisiforme, and adjacent  part of the
annular ligament of the wrist.  Its  fibres extend along
the metacarpal bone of the little  finger.
  Inserted, tendinous, into the inner  side of*the first  pha-
lanx, and into the tendinous expansion which covers the
back part  of the little finger.
  Situation: The belly of this muscle is  superficial.  It
is only covered by the  straggling fibres of the  palmaris
brevis.
   Use:  To draw the little finger from the rest.
  2. The Flexor Parvus Minimi Digiti—Arises, fleshy,
from  the outer side of the  os unciforme, and from the
annular ligament of the wrist, where it is affixed to that
bone.
  Inserted, by a roundish tendon, into the base of the first
phalanx of the little finger.
  Situation: This muscle is also  covered by the fibres of
the palmaris brevis.  It lies on the inner side of the ab-
ductor minimi digiti, and its tendon is  connected to the
tendon of that muscle. 
INTEROSSEI INTERNE
133
   Use: To bend the little  finger, and bring it towards
the other fingers.
  3. Adductor Metacarpi  Minimi Digiti Manus—
Arises, fleshy, from the os unciforme, and adjacent part of
the annular ligament of the wrist.  It forms a thick mass,
which is
   Inserted, tendinous, into the  forepart of the metacarpal
bone of the little finger, nearly its whole length.
   Situation: It is concealed by the bellies of the  abductor
and flexor brevis minimi digiti.
   Use: To bend and bring the metacarpal bone of the
little finger towards the rest.
   The Interossei are small muscles situated between the
metacarpal bones, and extending from the bones of the
carpus to the fingers.   They are exposed by removing
the other muscles of the thumb and fingers.
   The Interossei Interni are seen in the  palm of the
hand, and are  four  in number.  They arise, tendinous
and  fleshy, from the base  and sides of  the metacarpal
bones, and are inserted into the side of the first phalanx
of the fingers, and into the  tendinous expansion which
covers the posterior surface  of all the phalanges.  The
Arcus profundus runs  across the metacarpal bones  and
these muscles.
   1. The First, named Prior Indicis, arises from the outer
part of the  metacarpal bone of the fore-finger, and  is
Inserted into  the outer side of the first phalanx of that
finger.  Use: To draw the fore-finger towards the thumb.
   2. The  Second, named  Posterior Indicis, arises  from
 the root and inner side of the metacarpal  bone of the
 fore-fino-er • and is inserted into the inner side of the first
 phalanS  of the fore-finger.    Use: To draw that finger
 outwards.
   3 The Third, named Prior Annularis,  arises from the
 root and outer side of the metacarpal bone of the  ring-
 finger •  and  is inserted into the outer side of the first pha-
 lanx of the  same finger.  Use:  To pull  the ring-finger
 towards the  thumb.                     .     .
    4 The Fourth, named  Interosseus Auricularis,  arises
 from the root  and  outer side of the  metacarpal  bone of
      12 
134
PRACTICAL ANATOMY.
 the little finger ;  and is inserted into the outer side of the
 first phalanx of the little finger.  Use: To draw the little
 finger outwards.
   The internal  interossei also assist in extending the
 fingers obliquely.
   The Interossei Externi, seu Bicipites, are three in num-
 ber.   They are larger than the internal, and are situated
 betwixt the metacarpal bones on the back of the hand.
 Each of these muscles arise, by a double head, from two
 metacarpal bones, and is inserted into the side of  one of
 the fingers, and into the tendinous expansion which covers
 the posterior part of the phalanges.
   1. The First, named Prior  Medii, arises from the roots
 of the metacarpal bones of the fore  and middle fingers;
 and is  inserted into the outer side of the middle  fino-er!
 Use: To draw the middle finger towards the thumb.  °
   2. The Second, named Posterior Medii, arises from the
 roots of the  metacarpal bones of the middle and ring-
 fingers, and is inserted into the inner side of the middle
 finger.  Use: To draw the middle finger towards the ring-
 finger.
   3. The Third, named Posterior Annularis, arises from
 the roots  of the  metacarpal  bones of the ring and little
 fingers; and is inserted into the inner side of  the ring-
 finger.  Use:  To draw the ring-finger inwards.  The ex-
 ternal interossei also extend the fingers.


   OF  the vessels  and  nerves of the superior
                     extremity.

                       Arteries.
   The subclavian and axillary  arteries have  been  de-
 scribed.
   The Brachial Artery may be said to have its course
along the inside of the arm.  Having  left the axilla it
runs along the inferior edge of  the coraco-brachialis.
Rather  higher  up than the middle of the os humeri it
crosses over the tendinous insertion of that muscle,  bei'no-
here situated between the belly of the biceps flexor cubit? 
ARTERIES.
135
and  the  superior fibres of the brachialis externus.  The
artery then passes  behind the inner edge of the biceps
flexor cubiti,  descending betwixt that  muscle and  the
fibres of the brachialis internus.  In dissecting this ves-
sel, we find it invested by a  fascia or sheath, formed by
cellular membrane and some tendinous fibres.  On dis-
secting  this fascia, we find,  close to the  margin of the
coraco-brachialis and biceps flexor cubiti, the great median
nerve; under  it the brachial artery, and, more superfi-
cially seated, the venae comites and the vena basilica. As
the artery approaches the lower extremity of the os hu-
meri, it inclines forwards  toward the fold of  the arm, and
dives beneath the aponeurosis  which arises  from the in-
side of the tendon of the biceps flexor  cubiti.  Its situa-
tion at the fold of the arm has been described.
                Fig. 41.
A View of the Axillary and Brachial Arteries.
 
136
PRACTICAL ANATOMY.
            Branches of the Brachial Artery.
   1. A. Profunda Humeri Superior, or Muscularis Su-
 perior,  is sent off from  the  inner side of the brachial
 artery, immediately where it has left the fold of the arm-
 pit.   It passes downwards and backwards round  the  os
 humeri, and is accompanied by the musculo-spiral nerve.
 It passes betwixt the brachialis externus and short head
 of the triceps extensor cubiti.  Here it lies deep among
 the muscles, and divides into two branches.  One accom-
 panying the nerve spreads its ramification  over the outer
 condyle, and anastomoses with  the arteries  below the
 elbow.  The other branch is distributed along  the inside
 of the arm, and about the inner condyle.
   2.  A. Profunda  Humeri Inferior, is smaller than
 the last, and is sent off from the  brachial artery about
 two inches lower down.  It descends among  the muscles
 on  the inside of the arm, and  is lost about  the  inner
 condyle.
  3.  The  anastomosing or  collateral  arteries  are  as
 follows:—
  (1.) The Ramus Anastomoticus Major passes from the
 inside of the brachial artery, about two or three  inches
 above the inner  condyle.   It  is  distributed  about the
 condyle, and its principal branch accompanies  the  ulnar
 nerve in the groove betwixt the olecranon and inner con-
 dyle,  to  anastomose  with the recurrent branches of the
 arteries of the forearm.
  (2.) Muscular Branches.
  The Brachial Artery, where it lies deep under the apo-
 neurosis of the biceps, divides into three  branches.   1.
 The radial. 2. The ulnar; and 3. The interosseous artery.
 The two last generally come off by one trunk, which sub-
 divides.
  1.  Arteria Radialis.  The radial artery is smaller
 than  the ulnar, and  in its  course  more superficial.   It
 leaves the ulnar  artery, and inclines towards the radial
 and outer edge of the forearm.   At first it lies betwixt
 the pronator teres and supinator longus. It then descends
close along the inner edge of the supinator longus, be-
twixt  the supinator longus and flexor carpi radialis, and 
ARTERIES OF THE FOREARM AND HAND.     137
is accompanied by the radial nerve.  Reaching the lower
extremity of that bone, it divides into two branches.
  (1.)  A. Superficialis YoLiE is by  much the smallest
of the  two  branches.  It passes into  the muscular mass
which forms the ball of the thumb, anastomosing with
the superficial palmar arch.
   (2.) The  trunk of the radial  artery crosses over  the
lower extremity of the  radius to the  back of the hand.
It passes under the extensors of the thumb, and, arriving
at the space betwixt the bases of  the metacarpal bones of
the thumb and fore-finger,  plunges  into the palm of the
hand.

                          Fig. 42.
               Arteries of the Forearm and Hand.
    1.
    2.
    3.

    4.
    5.
    6.
    7.
    8.
    9.
   10.
   11.
   12.
   13.
   14.
   15.
   16.

   17.
   18.
19, 19.
Brachial Artery.
Profunda Minor.
Bifurcation of the  Brachial into  the
  Radial and Ulnar.
Radial.
Recurrens Radialis.
Anterior Carpal.
Dorsalis Carpi.
Superficialis Volse.
Arcus Profundus.
Magnus Pollicis.
Artery of the Thumb.
Radialis Indicis.
Ulnar Artery.
Recurrens Ulnaris.
Anterior Interosseal.
Cubitalis-manus Profunda, or  Anasto-
  mosing Artery.
Arcus Sublimis.
Digital Arteries.
Digito-ulnar Arteries.
  The branches of the radial  artery, in its course along
the forearm, are the following:—
  (1.) The recurrent  artery  is sent  oft  from  the radial
                           12* 
138
PRACTICAL ANATOMY.
   immediately after it leaves the ulnar artery, and is dis-
   tributed over the anterior part of the outer condyle,
   where  it anastomoses  with branches  of" the brachial
   artery.
     2. Muscular, to the muscles of the forearm.
     (3.)  A branch leaves the artery immediately after  it
   has turned over the edge of the radius, and, ramifying on
   the back of the hand, is named Dorsalis Carpi.
     (4.)  Small vessels are sent off to  the back  part of the
   thumb, named A. Dorsales Pollicis.
     Having reached the palm of the hand, the radial artery
   divides into two branches.
     (1.)  A. Pollicis, which sends two or three arteries along
   the anterior part of the thumb, and also often gives off a
   twig, the A. Radialis Indicis, which passes along the outer
   edge of the fore-finger, and inosculates with  a branch of
   the ulnar artery.
     (2.)  The trunk of the radial artery forms  the  Deep-
   seated Palmar Arch.  From the root of the thumb, it
   passes across the metacarpal bones near their bases, and
   terminates at the metacarpal bone of the little finger, in-
   osculating with  a branch of the ulnar artery.   This arch
   lies deep, close to the bones.  It supplies the interosseous
   muscles and deep-seated parts of the palm, and some of
   its branches pass betwixt the  metacarpal bones to the
   back of the hand.
'*%* 2- Arteria Ulnaris.   The ulnar artery is the largest
   branch of the brachial,  and generally gives off the inter-
   osseous  artery.   It takes its  course deep  among the
   muscles on the inside of the forearm.  It is seen passing
   under the pronator teres/flexor carpi radialis, palmaris
   longus, and flexor sublimis perforatus, but over the flexor
   profundus perforans.  It descends in the connecting cellu-
   lar membrane, between the flexor sublimis and profundus;
   but above the  middle  of  the  forearm, it emerges from
   these muscles, and appears at the ulnar  edge  of the arm,
   betwixt the  flexor sublimis and flexor carpi ulnaris.   It
   passes over the annular ligament  of the wrist,  but  is
   covered by the fascia  which ties down the tendon  of the
   flexor carpi  ulnaris.   It passes under the palmar aponeu- 
        ARTERIES of the forearm and hand.     139

rosis, on the inside of the os pisiforme, reaches the base
of the metacarpal bone of the little finger, and begins to
form the  Superficial Palmar Arch.  This arch lies
above the tendons of the flexor sublimis perforatus, imme-
diately beneath the Palmar Aponeurosis.  It crosses
the metacarpal bones  betwixt their bases and the middle
of their bodies.  It begins at the root of the little finger,
and terminates at the  root of the thumb, in inosculations
with the branches of the radial artery.   The convex side
of the arch is turned  towards the fingers, and  sends off
five branches.
  (1.) A branch to the  muscles and inner edge of the
little finger.
  (2.) Ramus digitalis primus, or the first digital artery,
which runs along  the space betwixt the two last meta-
carpal bones, and bifurcates into  two  branches, one to the
outside of the little finger, and the other to the inner side
of the ring-finger.
  (3.) The second digital artery, which bifurcates  in a
similar manner, and supplies the outer edge of the ring-
finger, and the inner side of the  middle finger.
  (4.) The third digital artery, which is distributed to the
outer edge of the middle finger,  and  to  the inner side of
the fore-finger.
  (5.) The  ramus  Pollicis  ulnaris  is  the last branch
of the  ulnar artery,  and is sent to the muscles of the
thumb.
  From the concavity of the arch are sent off the inter-
osseous  arteries of the palm, small twigs which supply the
deep-seated  parts,  and perforate betwixt the metacarpal
bones to the back of the hand.
  The  branches of the ulnar artery, in its course along
the forearm and wrist, are the following:—
  (1.) The Recurrent Arteries  are sent off  from the
ulnar artery immediately below the elbow;  These arte-
ries inosculate with branches of  the brachial.
  (2.) Twigs to the muscles of the forearm.
  (3.) A.  Dorsalis  Carpi is sent off from the ulnar artery
a little above the wrist to the back of the hand.
  (4.) A.  Palmaris Profunda  is sent off from  the ulnar 
140
PRACTICAL ANATOMY.
 artery, on the inside of the os pisiforme.   It passes into
 the flesh at the root of the little finger, and inosculates
 with  the termination of the deep-seated  palmar arch of
 the radial artery.
   3.  Arteria  Interossea (or Interossea  Communis).
 This  artery  is  generally sent off from  the ulnar.   It
 immediately  divides into two branches.
   (1.) The external or posterior interosseous artery is the
 smallest  branch.  It passes through the upper  part of
 the interosseous ligament, to supply the muscles on  the
 posterior part of the forearm.   It sends off the A. Recur-
 rens Interossea,  which ramifies on the middle of the back
 part of the elbow-joint.
   (2.) The internal or anterior interosseous artery descends
 close upon the middle of the interosseous ligament, giving
 twigs to the adjacent muscles.  At the upper edge of the
 pronator quadratus, it perforates  the membrane  to  the
 back  part of  the arm, and spreads its extreme  branches on
 the wrist and back of the hand.

                        Veins.
   The cutaneous veins have been already described.
   The brachial artery is accompanied by two veins, named
 Venaa Comites,  or  Satellites.  These  receive  branches
 corresponding to the ramifications of the artery.

                       Nerves.
   In  the dissection of the  axilla, we demonstrated  the
 great axillary plexus, and traced its two first  branches,
 the external scapular and circumflex nerves. See Fig. 20.
 The distribution of the five remaining branches of  the
 plexus must now be described.
   (3.) The External Cutaneous  Nerve (Musculo-
cutaneus, or  Perforans Casserii) is the  third  branch  of
the axillary plexus.  It passes through the belly of  the
coraco-brachialis muscle.  It continues its course betwixt
the Biceps flexor cubiti and  the  Brachialis internus.   It
gives  twigs to these muscles, and appears  as a superficial
nerve on the  edge of the supinator longus. It runs over 
ULNAR NERVE.
141
the outer condyle, and is distributed to the integuments
on the outside of the forearm, and back of the hand.
  (4.) The Median Nerve accompanies the brachial artery
to the bend of the elbow.   In its passage down the arm,
it lies before  that vessel, but at the elbow is situated on
its  inside.  It gives off no branches  until it  has sunk
under the aponeurotic expansion of the biceps  flexor.
Here it distributes many nerves to  the  muscles  of the
forearm, to the  pronator  teres, flexor carpi radialis, the
flexors of the thumb and fingers, and the pronator quad-
ratus   The trunk  of the nerve  perforates  the pronator
teres, passes  betwixt the  flexor  digitorum sublimis and
flexor profundus, and continues  its course betwixt these
muscles down to the wrist.  Near the wrist it becomes
more superficial, lying amongst the tendons of the flexors,
and before it descends under the annular ligament, sends
a superficial  branch to the integuments and short muscles
of the thumb.  The nerve itself passes with the flexor
tendons of the fingers under the annular ligament of.  the
 wrist, and appears on their outside, near the  root of  the
 thumb   It ramifies superficially in the hand,  sending oil
 four branches, which supply the thumb and all the fingers
 except the  little finger and  the ulnar  side  of the ring-

    (5) The Ulnar Nerve descends  along the inside  of
  the arm   It is at  first situated  immediately under the
  inteo-uments, but below the middle  of  the arm is  tied
  down by the intermuscular fascia.  The nerve then runs
  between the inner condyle and the olecranon. _ After
  passing  the condyle,  it continues its course betwixt the
  two heads  of the flexor  carpi  ulnaris,  till it reaches the
  ulnar artery.  It then accompanies the ulnar artery, lying
  on its inside, and running along the fo^m.bet^x* ^
  flexor ulnaris and flexor digitorum sublimis.  It sends
  twigs to the neighboring muscles, and, whenamv^w
  the wrist, divides  into two branches.  1. The  bmailer
  Branch, called Ramus posticus, passes under the tendon of
  the flexor carpi ulnaris, and over the lower end of the ulna,
  to be distributed to the back of the  hand, and of the  little
  and ring-fingers.  2.  The continued trunk  of the nerve 
142             PRACTICAL ANATOMY.
passes, on the inside of the ulnar artery, over the annular
ligament of the wrist.  It  passes under  the palmar apo-
neurosis, and divides into three principal branches.  The
first supplies the integuments and  muscles on the ulnar
edge of  the hand, and the inner side of the little finger.
The second is distributed to the outer side of the  little
finger, and  inner  side  of the ring-finger.   The third
branch  accompanies the deep seated palmar arch,  and
terminates in the short muscles of  the thumb and fore-
finger, communicating with the median nerve.
  (6.) The  Musculo-Spiral  Nerve (Radial of some
anatomists) passes from the axilla behind the  os humeri,
making  a spiral turn round the bone to reach  the outside
of the arm.  It first descends between the brachialis ex-
ternus and short head of the Triceps extensor cubiti, ac-
companying the arteria profunda humeri superior,  and
passing  deep into the flesh of the arm.   Before it makes
this turn, it  gives branches to the  muscles, also  a  cuta-
neous branch, which descends on  the inside of the arm.
From the back part of the arm the great trunk of the
nerve is reflected spirally forwards.   It is seen emerging
betwixt  the supinator  longus and brachialis internus,
seated deep and close to the bone.   It  descends betwixt
these  muscles, keeping close to the edge  of the supinator
longus.   Immediately after passing the  fold of the arm,
it sends  off a nerve, which descends, superficial, upon the
radial edge  of the forearm, as far  as the wrist;  and,  at
this point, the trunk of the muscular nerve divides  itself
into two branches.   The first, a large branch, perforates
the supinator brevis, and supplies  the extensor muscles
of the hand and fingers.   The second branch accompanies
the supinator longus down the forearm, and near the
wrist  turns  under the tendon of that muscle, over the
edge of the radius.   It then divides into several branches
which ramify on the back  of the wrist,  thumb, and fore-
finger.
   (7.) The Internal Cutaneous Nerve descends, super-
ficial, along the inside of the arm  and  forearm.  It was
described among the cutaneous nerves of the arm. 
dissection of the abdomen.         143
                 CHAPTER X.


           DISSECTION OF THE ABDOMEN.


 MUSCLES OF THE ABDOMEN, AND THE PARTS CONNECTED
              WITH THEM IN DISSECTION.

  Before commencing its dissection, study  what  are
called  its  regions.  To mark them out, drop  a perpen-
dicular from  the  anterior inferior  spinous  processes
through the cartilages of the ribs.  Then cross these two

                         Fig. 43.
The Abdominal Regions.
  1 1. Hypochondriac Regions.      4. Umbilical Region.
  ' 2. Epigastric Region.        5, 5. Iliac Regions.  _
  3, 3. Lumbar Regions.           6. Hypogastric Region.


lines  by two others drawn the upper  one through  the
points where the first two  touched the cartilages of the
ribs  and the second from  one anterior superior  spinous 
144
PRACTICAL ANATOMY.
process of the ileum to the other.  These lines will define
nine regions.   Three in the centre, which, enumerated
from above downwards,  are the Epigastric, Umbilical,
and Hypogastric.   Three on either side, which from
above downwards are the Hypochondriac, Lumbar, and
Iliac Regions.
  The muscles are ten in number, five on each side.
  An incision should  be made through the integuments,
from the sternum to the os pubis;  and  this should be
crossed  by another passing from the lower end of the
sternum  obliquely upwards towards the axilla; dissect
off the layers in order and this will expose—
  In the superficial  fascia of the abdomen an artery, ac-
companied by its veins, the Superficial Epigastric, or
Arteria  ad cutem abdominis.
  1. The Obliquus Descendens Externus.—Origin: By
eight triangular  fleshy slips from the lower edges and
external  surfaces of the eight inferior ribs, at a little dis-
tance from their cartilages; the five superior slips meet
on the ribs an equal  number of the digitations of the
serratus  major  anticus,  and the three inferior  are con-
nected with the attachments which  the  latissimus dorsi
has to the rib.  To  gain a complete view of this muscle,
the neighboring portions of the pectoralis major, serratus
anticus, and latissimus dorsi should be dissected with it.
  The muscular fibres proceed obliquely downwards
and forwards, and  about  the  middle of the side of the
belly terminate abruptly in a  thin broad tendon, which
is continued in the  same direction over all the  forepart
of the belly.  Here  it covers the anterior surface of the
rectus abdominis; it is very thin at the upper part, where
the rectus lies on the cartilages of the ribs, and  is often
removed by the beginner, unless he is very cautious.
  Insertion: Tendinous  aud  fleshy, into two  anterior
thirds of the outer edge of the crista  of the os ileum, from
the anterior superior spine of which, for  it extends to the
os pubis, forming Poupart's ligament, into the ensiform
cartilage, and into the whole length  of the linea alba.
   Use:  To draw down the ribs in expiration, to bend the
trunk forwards  when both muscles act, or  to  bend it 
ANNULUS ABDOMINALIS.
145
obliquely to one side when one of them  acts singly;  to
raise the pelvis obliquely when the ribs are fixed;  to
compress the abdominal viscera, to thrust the diaphragm
upwards, to assist in the expulsion of the urine and feces,
and of the foetus.
  In the course of the dissection of this single muscle, the
following points must be attended to.
  The Linea  Alba,  a white line running along  the
middle of the abdomen, from the cartilago  ensiformis to
the os pubis ; formed by the tendinous fibres of the two
obliqui and the transversalis  muscles,  interlaced with
those of the same muscles on the opposite side; it is half
an inch broad at the navel;  and decreases gradually both
above and below that part;  but particularly in the latter
situation, where it is reduced at las* to a  mere line.
   Linea Semilunaris, a semicircular white line, running
from the os pubis obliquely upwards over the side of the
abdomen, at the distance of about  four inches from  the
linea alba; formed by the  tendons of the two  oblique
and transverse muscles uniting at the edge of the rectus,
before they separate to form the sheath for that muscle.
   Linea Transversa, three  or four white lines, cross-
 ing from the linea semilunaris to the linea alba ; formed
 by the tendinous intersections of the recti shining through
 the strong sheath which covers  them.   These_ are  not
 evident in all subjects in this stage of the dissection.
   Umbilicus, or Navel. This which, before the  integu-
 ments were removed,  was  a depression, appears now a
 prominence ; it consists of  condensed cellular membrane.
   Annulus Abdominalis, or Ring, an oblique slit or
 opening just above the angle of the pubis ; formed by the
 tendon of the external oblique, divided into  two portions
 called the pillars  or columns of the ring, of which one (the
 superior or internal) is attached to the symphysis, and the
 other (the  inferior or  external) to the tuberosity of the
 pubis;  and allowing a passage to the spermatic cord in
 the male, and the ligamentum teres of the  uterus in the
 female   This slit is triangular;  the pubis is the base, the
 two columns are the two sides of the triangle.  From the
 margins of the  pillars  a  thin fascia is  derived which
      13 
146               PRACTICAL ANATOMY.
Fig. 44.
Dissection of some of the Parts concerned in Femoral and Inguinal
                          Hernia.

 1.  Tendon of the External Oblique Muscle.
 2.  Tendon of  the Internal Oblique, the first-named muscle being
     dissected off.
 3.  Cribriform  Fascia.
 4.  Vena Saphena.
 5.  External Abdominal Ring and Spermatic Cord.
 6.  Poupart's Ligament. 
           OBLIQUUS ASCENDENS INTERNUS.        147

passes down upon the cord (the Intercolumnar or
Spermatic Fascia).  It forms a coating for an inguinal
hernia.  The apex has  a rounded figure in consequence
of some transverse fibres, which connect the two, columns
where they first separate; and it  points  obliquely up-
wards and outwards.  It belongs to the external oblique
alone, there being no such opening, either in the internal
oblique, or the  transversalis; it is much smaller in the
female than in the male.
  Ligamentum Poupartii, a strong ligament, stretching
from  the anterior superior spinous process of the os ilium,
to be fixed to the spine of the os pubis.  This in truth is
merely the lower edge of  the tendon  of the obliquus
externus abdominis, extended from the anterior superior
spinous process of the ileum to the angle  of the  pubis.
It covers the  femoral vessels  and nerves, and  certain
muscles, and has  lately been often described under the
name of the Crural Arch.
  Dissect off the serrated origin of the external oblique
from the ribs and from the spine of the os ilium, and de-
tach it from the obliquus internus, which lies below it, and
which is connected to it by loose cellular substance, and
by small vessels.   Continue to  separate the two muscles
till you find their tendons firmly attached, i. e., a little
way  beyond the linea semilunaris.   Separate the tendon
from Poupart's ligament to within half an inch of the
abdominal ring.
   2.  Obliquus Ascendens Internus—Arises by short
tendinous fibres,  which soon  become  fleshy, from the
whole length of the spine of the os ilium, and from the
fascia lumborum; also fleshy from the upper part of Pou-
part's ligament at the part next to the os ilium.
   The fibres run in a radiated direction; those which
 originate from the  back part of the  os ilium run ob-
liquely upwards; those from  the forepart of the ilium
 pass more transversely; and from  Poupart's ligament the
 fibres descend.  The fleshy belly is continued rather more
 forward than  that of the external oblique before it ter-
 minates in a flat tendon.
   Inserted  into the cartilages of the  six or seven lower 
148
PRACTICAL ANATOMY.
Fig. 45.
The Muscles of the Anterior Aspect of the Trunk ;  on the Left Side
 the Superficial Layer is seen, and on the Right the Deeper Layer.

 1. The Great Pectoral Muscle.
 2. The Deltoid Muscle.
 3. The Anterior Border of the Latissimus Muscle.
 4. The Indigitations of the Great Serratus Muscle.
 5. The Right Subclavian Muscle.
 6. The Small Pectoral Muscle.
 7. The Coraco-Brachialis Muscle.
 8. The Upper Part of  the Biceps Muscle, showing its two heads.
 9. The Coracoid Process of the Scapula.
10. The Great Serratus Muscle of the Right Side.
11. The External Intercostal Muscle of the Fifth Intercostal Space.
12. The External Oblique Muscle.
13. Its Tendon or Aponeurosis ; on the left of this number is the  semi-
     lunar line,  and on the right the middle white line (linea alba).
14. Poupart's Ligament or the Crural Arch. 
MUSCLES OF THE TRUNK.
149
15. The External Inguinal or Abdominal Ring ; the crescentic opening
     to the right of 15 is the saphenous opening in the Femoral Apo-
     neurosis.
16. The Rectus Abdominis Muscle of the Right Side brought into view
     by the removal of the anterior segment of the sheath formed by
     the tendons of the Broad Muscles of the Abdomen.
17. The Pyramidal Muscle.
18. The Internal Oblique Muscle.
19. The Conjoined Tendon of the Internal Oblique and Transversalis
     Muscle.
20. The Arch formed by the Lower Border of the Internal Oblique and
     Transversalis Muscles, from beneath which the Spermatic Cord
     has been removed.
21. Fascia Lata Femoris.
22. Saphenous Opening.
The Crescentic 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.

ribs; fleshy into the three inferior,  and, by a  tendinous
expansion,  which is  extremely thin, resembling cellular
membrane, into the four superior, and also into the ensi-
form cartilage.   The sheet of tendon in which the  fleshy
belly ends  is continued, single and  undivided, into the
linea semilunaris, where,  adhering pretty firmly to the
tendons of  the obliquus  externus and transversalis,  it
divides into two layers.  The anterior and more consider-
able layer joins the tendon  of the external oblique, and
runs over the rectus to be inserted into the whole length
of the linea alba.  The posterior and thinner layer, ad-
hering to the anterior surface of the transversalis,  passes
into the linea alba behind the rectus as low as half way
between the umbilicus and os pubis;  but below this place
the  whole  tendon  of the  internal oblique passes along
with that of the external oblique before the rectus, and
is inserted into the  lower part of the linea alba.  The
inferior  edge of the muscle extends in a nearly straight
direction over the spermatic  cord to be fixedby a tendi-
nous attachment to the tuberosity of the pubis.
   Situation: It is covered by the obliquus descendens ex-
ternus and latissimus dorsi.
   Use:  To assist the obliquus externus; but it bends the
trunk in the reverse direction, so that the muscle on each
                           13* 
150
PRACTICAL ANATOMY.
side  co-operates with the obliquus externus of the oppo-
site side.
  About the middle  of Poupart's  ligament, a  delicate
fasciculus of fibres is sent off from this muscle over  the
spermatic cord, where it passes  under its edge in its way
to the ring.  This is named the
  Cremaster, and is continued down to the cord till it
is insensibly lost on the tunica vaginalis testis.   It will
be seen  in the  dissection of  the  scrotum.   It  forms  a
covering for oblique  inguinal hernia, as from what will
be presently seen it overlies the inguinal canal.   Its  use
is to suspend, draw up, and compress the testicle.
  We must now dissect  the attachments of the  internal
oblique from the  cartilages of the ribs, from the fascia
lumborum, and from  the spine of the os  ilium, and, by
continuing our dissection from behind forwards,  separate
it from  the transversalis abdominis, which lies under it.
This separation may be continued as far  as where  the
tendons of the  two muscles are inseparable, i. e., rather
more forward than the linea semilunaris. As this muscle
lies very close upon the transversalis, caution is required
to avoid detaching both muscles together.   Let  the  stu-
dent begin his separation at the crista of the ilium, where
the course of the Circumflexa Ilh Artery and Vein
will show him when he has arrived at the surface of the
transversalis.
  3.  Transversalis  Abdominis — Arises,  tendinous,
from the fascia  lumborum and back part of the  spine of
the  os ilium;  fleshy from all the remaining part of the
spine of the ilium and from the inner surface of Poupart's
ligament; and fleshy from the inner or back part of the
cartilages of the seven lower ribs, where its fibres meet
those of the diaphragm.
  The fleshy fibres proceed  transversely,  and end  in a
flat sheet of tendon, which, after being  connected to the
other tendons at the linea  semilunaris, passes with the
posterior layer of the internal oblique behind the rectus,
and is  inserted into the ensiform cartilage,  and  into the
whole length of the linea alba, excepting  its lowermost
part; for, at the middle  distance  between the umbilicus 
VENTRO-INGUINAL OR DIRECT HERNIA.     151
and os pubis,  a slit  or  fissure is formed in this tendon,
through which the rectus abdominis passes; and the  re-
mainder  of the tendon  passes before  the  rectus, to  be
inserted  into the lower part of the linea alba.  Its infe-
rior  edge is connected with that of the internal oblique
muscle, and the two form  a common tendon (the con-
joined tendon), which is inserted into the Linea Inno-
minata, which would place it behind the external abdo-
minal ring, and thus strengthen it.
   Use: To support and compress the viscera of the  ab-
domen.
   When the transversalis  is detached from its origins,
and turned back towards the linea semilunaris, it will be
seen to be lined by a fascia, strongest near to Poupart's
ligament, to which it is attached.   This is named by Sir
Astley Cooper, its  discoverer, the Fascia Transver-
salis, and prevents the bowels from being protruded
under the  inferior  margins of  the  obliquus   internus
and transversalis muscles.   It  is perforated about  the
middle between the  ilium and pubes, by an opening (In-
ternal Abdominal Eing) for the passage of  the sper-
matic cord, which then goes obliquely downwards, in-
 wards and  forwards to the ring of the external oblique.
 The space between this internal ring in the fascia trans-
 versalis and the external ring in the tendon of the external
 oblique is called the Inguinal Canal, and is  traversed
 by  an oblique inguinal hernia.   If the cord be drawn
 out, the fascia transversalis follows, being prolonged  into
 a funnel-shaped  figure.  This prolongation forms the In-
 fundibular Fascia  of some, and is enumerated often
 as a covering of inguinal hernia.
   In Yentro-Inguinal  or Direct  Hernia,  the intes-
 tine comes out only through the external ring  instead  of
 entering the  canal at the internal ring; and, as the Con-
 joined Tendon is inserted behind the external ring, it
 must carry this tendon before it, and will.not receive a
 covering from the cremaster, as the cord which  it overlies
 will be to the outer side of the tumor.
    The sheath of the rectus is now to be attended to;  it
 is formed bv the tendons of the three other muscles,  viz: 
152      *       PRACTICAL ANATOMY.
the two obliqui and the transversalis.  These, when they
reach the edge of the rectus, form the appearance named
Linea Semilunaris;  they then split and inclose the rectus
in their duplicature; the whole  tendon of the  external
oblique, with  the anterior layer of the internal  oblique,
passes before  the rectus; and the whole posterior layer
of the internal oblique, together with the whole tendon
of the transversalis  muscles, pass behind the rectus, ex-
cepting at the lower part; but, for two or three inches
above the pubis, all the tendons go in front of the muscle,
and the posterior part of  the sheath is  consequently de-
ficient, the rectus lying  naked  on the peritoneum,  or
having a very thin expansion of the transversalis fascia.
  The two oblique muscles are now to be replaced; then,
making an incision by the side of the linea  alba, and thus
opening the sheath of the rectus through its whole length,
you  dissect it back towards the linea semilunaris, and
thus lay bare the fibres  of the muscle next to be de-
scribed.
  4. Rectus Abdominis—Arises, by a flat tendon, from
the forepart of the os pubis; as it ascends, its fleshy belly
becomes broader and thinner.
  Inserted, by  a thin  fleshy expansion, into  the ensiform
cartilage, and into the cartilages of the three inferior true
ribs.
  Situation: This pair of muscles is situated on each side
of the linea alba,  under the tendons of the  oblique mus-
cles.  The muscle is generally divided by three tendinous
intersections;  the first  is at the umbilicus, the second
where it runs  over  the  cartilage  of the seventh rib, and
the third in the middle between these;  and there is com-
monly a half intersection below the umbilicus.  By these
intersections, the  muscle is connected firmly to the inte-
rior part of its sheath, forming the Line^e Transversa,
while it adheres very slightly by loose cellular substance
to the posterior layer.
   Use: To compress the forepart of the abdomen, to bend
the trunk forwards,  or to raise the pelvis.
  On each side of  the linea alba, and inclosed in  the 
     dissection of the cavity of the abdomen.  153

lower part of the sheath of the rectus, is sometimes found
a small muscle, named
  5. Pyramidalis.—Origin: Tendinous and  fleshy, of
the breadth of an inch from the os pubis, anterior to the
origin of the rectus.
  Insertion: By an acute termination, near half-way be-
tween the os pubis and umbilicus, into the linea alba and
inner edge of the rectus muscle.
   Use:  To assist the lower part of the rectus.


      dissection of the cavity of the abdomen.
   Make a longitudinal incision from the scrobiculus cor-
dis to the umbilicus, and from that point an oblique inci-
sion on each side towards the anterior spinous process of
the  os  ilium, forming thus  three triangular flaps.  In
doing this,  avoid  cutting the  intestines, by  raising the
muscles from them after the first puncture.
   Before  you disturb the viscera, observe  the general
situation of those parts which appear on the first opening
of the abdomen.
   1.  The internal  surface  of the  Peritoneum, smooth,
shining, and colourless, covering the parietes of the abdo-
men, and the surface  of all the viscera.
   2. In the triangular portion of integument folded down
over the pubes, three ligamentous cords project through
the peritoneum, two  running laterally, and the other in
the middle, towards the navel.  These are the remains of
the two umbilical arteries and  the urachus.
   3. The epigastric artery, accompanied by  two veins,
may be seen through the peritoneum, ascending obliquely
upwards  and  inwards  from under Poupart's  ligament.
From the external iliac artery,  and its relation to the
 internal abdominal ring  should  be noted, being on its
 posterior wall; and,  therefore, when a hernial stricture
 occurs  here, the  incision  should be made upwards, to
 avoid it.   Close along Poupart's  ligament will be seen
 the Circumflex  Ilii artery, running towards the crest
 of the ileum.  It  comes from the external iliac artery.
   4  The upper edge of the lijer is seen extending from 
154
PRACTICAL anatomy.
the right hypochondriac region, across the epigastric, into
the left hypochondriac region;  in it a fissure is seen, into
which enters, inclosed in a duplicature of peritoneum, the
ligamentum teres, which was, in the foetus, the umbilical
vein.  The fundus of the gall-bladder, if distended, is
sometimes seen projecting from under  the edge of  the
liver.
  5. The Stomach will be found lying in the left hypo-
chondriac region, and  upper part of the epigastric;  but,
if distended, it protrudes into the umbilical region.
  6. The Great  Omentum proceeds  from  the great
curvature of the stomach, and stretches down like a flap
over the intestines.
  7. The Great Transverse Arch of the Colon will
be seen projecting through the omentum; it mounts up
from the os ileum of the right side, crosses the belly
under the edge of the liver, and under the greater curva-
ture of the stomach, and  descending again upon the left
side, sinks under the small intestines, and rests upon the
wing of the left os ilium.
  8. The Small Intestines lie convoluted in the lower
part of the belly, surrounded by the arch of the colon.
  Such is the  general appearance  on first opening  the
abdomen; but  this will vary somewhat, as one intestine
may happen to be more inflated than another, or as  the
position of the body may  have  been after death.
  It will now be proper to consider the parts more  mi-
nutely.
  1. The Peritoneum.—Observe how it is reflected from
the parietes of the abdomen  over all the viscera, so that
they may be said to be situated behind it; trace its reflec-
tions from side to side, and from above downwards; you
will see that the external  coat of every viscus, and all the
connecting  ligaments,  are reflections  or continuations of
this membrane.
  (1.) The four Ligaments  of the Liver are formed by
the peritoneum, continued from the diaphragm  and  pa-
rietes of the abdomen.
  a, The Middle or Suspensory Ligament, inclosing
in its duplicate the Ligamentum Teres. 
reflections of the peritoneum.
155
                            Fig. 46.

                 Reflections of the Peritoneum.

 1. Liver.
 2. Stomach.
 3. Small Intestine.
 4. Arch of the Colon.
 5. Duodenum.
 6. Pancreas.
 7. Rectum.
 8. Uterus.
 9. Vagina.
10. Bladder.
11. Peritoneum reflected a little
     farther back, from the Dia-
     phragm to the Liver, which
     last it covers above in front
     and below,  and forms the
     Anterior  Lamina  of  the
     Lesser Omentum.
12.  It  then  covers  the  anterior
     face of the stomach,  and
     forms at 13 and 14 the an-
     terior layer of the omentum
     majus : at
15.  It  is reflected  upwards to
     form  at 16 the  posterior
     layer of that omentum ; at
17.  It  embraces the colon on its
     posterior surface and forms
     the posterior lamina of the
     mesocolon at  18;  it then
     passes  in front  of the duo-
     denum, 5, and descends to
embrace the small intestine, 3,  whence it is reflected upwards so as to
give the posterior lamina to the mesentery, 19 ;  it next passes down
the posterior parietes of the abdomen, covers the rectum, 7, in front,
the uterus, 8, the bladder, 10,  and thence ascends to constitute the
abdominal peritoneum, 20 and 21, lines the diaphragm, and terminates
above  in the coronary ligament of the liver at 22.  If we now trace
the peritoneum from the posterior margin of that ligament, 22, we find
 it coating the posterior face of the stomach, 1, and then separating from
that organ to form the posterior lamina of the  lesser omentum  at 23 ;
 it next covers the  posterior face of the stomach, 24, and is  thence
 reflected downwards  to  constitute the posterior  layer of the anterior
 fold of the greater omentum, 25, 26 ; after which it turns upwards and
 forms  at 27  the  anterior layer of  the posterior  fold of  the  greater
 omentum; it then invests the front  surface of the colon, 4, and forms
 at 28 the anterior face of the mesocolon; it thence passes upwards in
 front of  the pancreas, 6, and terminates where  we began, at the poste-
 rior margin of the coronary ligament of the liver.
 
156
PRACTICAL anatomy.
  b, The Coronary Ligament, connecting  the  upper
surface of the Liver to the diaphragm.
  c, The Broad Ligament of the right side.
  d, The Broad Ligament of the left side.
  (2.) The  Lesser  Omentum,  or  Hepatico-Gastric
Omentum, is formed by two laminae of peritoneum, pass-
ing from the under surface of the liver to the lesser curva-
ture  of  the stomach, and containing in its duplicate the
vessels of the liver.
  (3.) The Great Epiploon, Gastro-Colic or Omentum
Majus.—Observe, that the peritoneum, coming from both
surfaces of the stomach, and from  the spleen, proceeds
downwards into the abdomen, and is then reflected back
upon itself, till it reaches the  transverse arch of the colon,
where its lamina? separate to invest that intestine.  This
reflection is named the Great Omentum ;  it is a pouch or
bag,  composed of four laminae of  peritoneum, and  the
opening into it is by the Foramen of Wlnslow. Observe
the situation of this  semilunar opening; it is on the right
side  of  the abdomen, at  the root of the  lesser lobe, or
lobulus spigelii of the liver;  it leads under the lesser
omentum, under the posterior surface of the stomach, but
above the pancreas and colon, into the sac of the omen-
tum ;—the omentum sometimes reaches to the lower part
of the hypogastric  region, sometimes not beyond  the
navel; it contains  in its duplicature more  or less of adi-
pose substance.
   (4.) The Mesentery.—Observe, that the peritoneum,
reflected from each side of the vertebras, proceeds for-
ward, to connect the intestines loosely to the spine; that
it begins opposite  to the first lumbar vertebra, crosses
obliquely from left  to right, and ends half-way between
the last lumbar vertebra and the groin. At its  com-
mencement, it binds down the extremity of the duode-
num, and  it terminates  where  the  head of the colon
begins.  The great  circumference  which  is  in  contact
with the intestines, is very much plaited or folded, and  is
several yards in length.  Between the  laminae  of  me-
sentery, observe the Mesenteric Glands, the branches
of the superior mesenteric artery ramifying and  forming 
            MESOCOLON—HEPAR, THE LIVER.        157

arches;  the  mesenteric veins  accompanying the arteries;
the trunk of the lacteals, situated contiguous to the me-
senteric artery on its left side.   It may sometimes be in-
flated by the blowpipe.  Nerves also  run in the mesen-
tery, but are not easily demonstrated.
   (5.) The  Mesocolon is  similar to the mesentery, and
connects, in like manner, the colon to the spine.
   2. Hepar, the  Liver.—Situation: Partly in the  right
hypochondrium, which it fills up, reaching  as low as the
kidney  of that side, partly in the epigastrium, and  run-
ning also some way into the left hypochondrium.
   Connected by its four ligaments to the inferior surface
of the diaphragm, and by the lesser epiploon to the small
curvature of the stomach:—The little epiploon should
now be removed, to  discover the different parts of the
liver.
   Observe the superior or convex surface adapted to the
arch of the diaphragm; the inferior or  concave surface
resting  on  the stomach;—the  posterior or thick  edge
lying against the vertebrae, and the anterior thin margin
corresponding to the lower edge of  the chest;—Observe
the three lobes of the liver;—the great or right lobe;1—
the small or left  lobe;—the lobulus spigelii;—the great
fissure,  separating the right  and left lobe, and receiving
the suspensory ligament, and the ligamentum teres;—the
cavity  of the portae between the  great lobe and lobulus
spigelii;—the fissure on the  right side of the lobulus for
the vena cava inferior, which fissure is almost a complete
foramen;—the notch in the  back-part for the vertebrae;
—the depression in the right lobe  for the gall-bladder.
Observe the vessels in the cavity of the portae, the hepatic
artery on the left side, the ductus communis choledochus
on the  right side, and  betwixt, but  at the  same  time
behind them, the vena portae;  they are all surrounded
by a plexus of nerves.  From  the  sympathetic  and par
vagum these vessels and nerves pass along the edge of
 the little omentum, surrounded and connected by adipose

   1 Two others are enumerated, the lobulus caudatus and quadratus.
 See Special Anatomy.
     14 
158
PRACTICAL ANATOMY.
and cellular substance;  the part is called Capsula Glis-
soni.  Observe that the ligamentum teres was the umbi-
lical vein of the foetus, entering the vena portae, and that
the ductus venosus in the foetus  (obliterated in the adult),
leaving the vena portae, passed into one of the venae
cavae hepaticae.
  3. Vesicula Fellis, the Gall-Bladder.—Situation:
In the  right hypochondrium, in a superficial depression
on the under surface of the  right lobe  of the liver:  it
sends off the  Ductus Cysticus, which, uniting with the
Ductus Hepaticus, forms the Ductus Communis Cho-
ledochus; this perforates the first  curvature  of the
duodenum.
  4. Yentriculus, the Stomach.—Situation: In the left
hypochondriac  and  epigastric regions: Connected  to part
of the  interior surface of the  diaphragm, to the concave
surface of the liver  by the little omentum, to the spleen
by a reflection of peritoneum, and to the arch of the colon
by the great  omentum.  Observe its  greater curvature
looking downwards, its lesser curvature looking upwards;
and  its two  lateral surfaces.  In the living  body, the
greater curvature is turned forward, and  a little  down-
ward, the lesser arch backward, i. e. towards the spine,
while one of the lateral convex sides is turned upwards,
and  the  other  downwards.  Observe the bulging ex-
tremity on the left side, the cardia or upper orifice, where
the oesophagus enters  half-way between this  great ex-
tremity and the lesser arch:  the pylorus, or lower orifice,
at the  end of the small  extremity,  situated  under the
liver, and rather to the right side of the spine, feeling
hard when touched.  A constriction may be seen where
the stomach ends in the duodenum, it marks the position
of the  pyloric valve on the inside.
  5. The Intestines.—These form one continuous tube,
but are divided into two portions, differing  in their figure,
structure, and functions, and distinguished by the names
of small and  large.
  The small intestine is divided into duodenum, jejunum,
and ileum; the large into caecum, colon, and rectum. 
UNDER OR CONCAVE SURFACE OF THE LIVER.    159
    1.
    2.
    3.
    4.
    5.
    6.
    7.
    8.
    9.
   10.

   11.
   12.
13, 14.

   15.
   16.
   17.
   18.
   19.
   20.
   21.
   22.
   23.
   24.
   25.
   26.
   27.
       Under or Concave Surface of the Liver.

Right Lobe.
Left Lobe.
Its Anterior or Inferior Edge.
Its Posterior or Diaphragmatic Portion.
Right Extremity.
Left Extremity.
Notch in the Anterior Margin.
Umbilical or Longitudinal Fissure.
Round Ligament or remains of the Umbilical Vein.
Portion of the Suspensory Ligament in connection with the
  Round Ligament.
Pons Hepatis, or  Band of Liver across the Umbilical Fissure.
Posterior End of  Longitudinal Fissure.
Attachment of the obliterated Ductus Venosus to the Ascending
  Vena Cava.
Transverse Fissure.
Section of the Hepatic Duct.
Hepatic Artery.
Its Branches.
Vena Portarum.
Its Sinus, or Division into Right and Left Branches^,
Fibrous Remains of the Ductus Venosus.', l „,  '
Gall-bladder.                  >T?^*  — -"
Its Neck.
Lobulus Quartus.
Lobulus Spigelii.
Lobulus Caudatus.
Inferior Vena Cava.

v
56214 
160
PRACTICAL ANATOMY.
   28. Curvature of Liver to fit the Ascending Colon.
   29. Depression to fit the Right Kidney.
   30. Upper Portion  of its Right Concave Surface over the Renal
       Capsule.
   31. Portion of the Liver uncovered by the Peritoneum.
   32. Inferior Edge of the Coronary Ligament in the Liver.
   33. Depression made by the Vertebral Column.

  (1.) Small Intestine,;^-about four times the length of
the body.
  a, The Duodenum is broader than  any other part of
the small intestine, but is  short; it takes a turn from the
pylorus upwards, and to the right side, passing under the
liver and gall-bladder;  then, turning upon itself, it de-
scends, passing as low as  the right kidney; it is in this
space that it receives the pancreatic and gall ducts; thence
it crosses before the renal vessels, before  the  aorta, and
upon the last dorsal vertebra, firmly bound down by the
peritoneum, which covers only  its  anterior  surface; it
then  ascends from right  to left, till it is lost  under the
root of the mesocolon.
  Turning back the colon and omentum, fixing  them
over the brim of the thorax, and pushing down the small
intestines towards the  pelvis, you  find  the  duodenum
coming out from under  the mesocolon, but still tied close
to the spine; it terminates in the jejunum, exactly where
the mesentery begins.   The intestine in this course forms
nearly a circle, the root of the mesocolon being the only
part lying between its two extremities.
  You have now to trace  the rest of the small intestine,
which lies convoluted in  the umbilical and hypogastric
regions.
  b, Jejunum constitutes the first or  upper half of the
remaining  small intestine, and  is situated more  in the
upper part of the abdomen; it is redder, and its coats
feel thicker to the  touch, from the greater number of the
valvuhe  conniventes on  its inner surface; its diameter
exceeds that of the ilium.
  c, The lower half is named Ileum ; it  is situated more
in the lower part of the abdomen, and terminates in the
great intestine, by entering  the  caput  coli, or  beginning
of the colon. 
digestive tube.
Fig. 48.
       The Digestive Tube, from the OSsophagus to the Anus.

     1. (Esophagus, which  is laid open at 2, to show its  termination
         in the cardiac orifice of the stomach.
     3. Interior of the Stomach with its rugae.
     4. Duodenum,  commencing at the Pylorus.
     5. Gall-bladder with the Cystic  Duct, which last passes down-
         wards to open into the duodenum.
6,  6, 6. Small Intestine, terminating in 7, the Caecum.
     8. Appendicula Vermiformis.
     9, Right ascending Colon,
    10. Transverse Arch of the Colon.
    11. Left descending Colon.          13. Rectum.
    12. Sigmoid Flexure.               14. Anus.
                              14- 
162
PRACTICAL ANATOMY.
  As a general observation it may be said that the con-
volutions of the small intestine occupy the middle of the
umbilical  and rrypogastric  regions; but  their situation
varies much, particularly according to the state of the
bladder and rectum.  The course of the tube, independ-
ently of its convolutions, is from the left lumbar  region,
where the duodenum emerges from under the mesocolon
to the right inguinal region, where the ileum terminates
in the caput coli.    Here a duplicature  of the internal
membrane into two folds, forms the ilio-colic valve.
  (2.) Great intestine.
  d, The Cjscum, or blind gut, is tied  down by the peri-
toneum to the loins on the right side, lying in the space
under the right kidney, hid by the convolutions of the
ileum.  On its posterior part there is a little appendage,
of the shape of an earth-worm, named Appendix Coed
 Vermiformis.
  e, The Colon.— Its commencement at the Caecum  is
termed Caput Coli, or head of the colon ; it mounts up-
wards from the cascum over the anterior surface of the
right kidney, passes under the  gall-bladder,  which, after
death, tinges  it  with bile;  and then, going across the
upper part of the  belly, forms  its Great Transverse
Arch.  In its whole course it is contracted into cells by
its  muscular fibres, which  are  united together, forming
longitudinal bands ; and it has some fatty  projections
attached  to its  surface,  named Appendices  Epiploica?.
Both these circumstances distinguish the large from the
small intestine;  which  the difference  of size does not
always.   The colon then goes  backwards under the sto-
mach and spleen into the left hypochondrium; and then,
descending over the left  kidney, it is  again  tied down;
it afterwards turns over  the brim of the pelvis, being at
this part unconfined, and forming a loose  and remarkable
curvature, which is named  the  Sigmoid or  Iliac Flex-
ure.  After this convolution, the intestine assumes the
name of
  The Rectum.—Drawing aside the intestines, you find
the gut continued over the anterior surface of the sacrum
and os coccygis to  the anus. 
pancreatic duct.
163
Fig. 49.
Ileo-C^cal Valve.
a. The Terminal Part of the Ileum, d. The Appendicula Vermiformis.
   I e "e°-C3ecal Val^e.         e. The  Commencement  of the
c. 1 he Caecum.                    Colon.

  On pulling the stomach towards the  right side, you will
perceive
   6.  The Lien, or Spleen.—Situation: In the left hypo-
chondriac  region, between the great  extremity  of the
stomach, and the  neighboring  false ribs, under the edge
of the diaphragm, to all of which it is connected by the
peritoneum.   It is of an oval figure;  its external surface
is gently convex ; its  internal surface irregularly concave,
and divided by  a longitudinal fissure, into  which its
vessels enter.
   7. The Pancreas.—Situation: This  gland was in part
seen on removing the little epiploon ; it is more fully ex-
posed by tearing through the great epiploon, between the
great curvature of the stomach and  the transverse  arch
of the colon.  It lies in the cavity into which the foramen
of Winslow leads;  it extends from  the fissure  of the
spleen across the spine, under the posterior surface of the
stomach, and terminates within the circle  formed by the
duodenum ; it is only covered on its anterior surface by
the peritoneum. 
164
PRACTICAL ANATOMY.
   The Pancreatic Duct pierces the coat of the duode-
num, and enters the cavity of that intestine by an orifice
common to it, and to the ductus communis choledochus.
The duct runs along the very centre of the gland, where
the whiteness of its coats will readily enable the student
to distinguish it.
   All the abdominal viscera may now be removed, ex-
cept the rectum, where it descends into the pelvis, which,
being tied, should be allowed to remain, for it belongs to
the demonstration of those parts; or the liver and its ves-
sels, with the pancreas, may be left, and the vessels enter-
ing the portae of the liver traced.
   The student should open different portions of the intes-
tine, and mark the folds of the mucous membrane, Val-
vular Conniventes; also,  the small  eminences over
those folds;  Villi.   He should also examine the Pylo-
ric Valve ; the Ileo-Cecal Valve, at  the termination
of the ileum.  Little bodies are frequently seen under
the mucous  membrane of the  duodenum, the  Glands of
Brunner, and  other patches of ductless glands in  the
ileum, the Glands of Peyer.
   The peritoneum should now be carefully dissected from
the diaphragm, and from the sides and back part of the
abdomen ; thus the parts which lie more immediately be-
hind that membrane may be examined.
   8.  Eenes, the  Kidneys.-—Two  glandular  bodies,
situated in the posterior  part of the cavity of  the abdo-
men, on each side of the lumbar vertebras, between  the
last false rib and the spine of the ileum, and imbedded in
a quantity of adipose membrane.
   Observe the renal or emulgent artery entering the vein
and ureter passing out of its fissure.  Observe the course
of the ureter; it passes behind  the peritoneum over the
psoas muscle into the pelvis, and runs between  the rec-
tum and bladder, which last it enters.
   If the kidney be laid open from its convex  to its con-
cave  margins, the following  points may be  observed:
An exterior  or  Cortical Portion ; an  internal, which
being arranged  in cones, formed of uriniferous tubes,
the Tubular or  Conical part.  These cones look into 
diafiiragma or midriff.
165
three cavities, Infundibula, and  these again  into the
Pelvis, and this into the ureter.

                       Fig. 50.
Longitudinal Section of the Kidney, with its Renal Capsule.
  9. The  Capsule  Eenales.—Two glandular  bodies,
situated on  the  upper extremity of each kidney, of an
irregular figure,  crescent-like, or somewhat triangular.
  By the removal of the peritoneum, several muscles are
exposed, situated at the superior and posterior parts of
the abdomen.
  One single muscle is situated in the superior  part of
the abdomen.
  Diaphragma, the Diaphragm, or Midriff.—This is
a broad, thin, muscular septum  between the thorax and
abdomen,  situated obliquely; it is concave below, and
convex above, the middle of it on each side  reaching as
high within the thorax as the fourth rib.  It is divided
into two portions.
  1. The  superior or greater muscle of the diaphragm, 
166             PRACTICAL ANATOMY.
forms the transverse partition between the chest and ab-
domen,
   Arising, by distinct fleshy fibres, 1. From the posterior
surface of the ensiform cartilage;  2. From the cartilages
of the seventh, and all the false ribs;  3.  From the liga-
mentum arcuatum, which is a ligament extended, some-
what indistinctly, from  the top of  the twelfth  rib to  the
lumbar vertebrae, forming  an arch over the psoas and
quadratus lumborum muscles.  From  these origins  the
fibres run, in different directions, like radii from the cir-
cumference to the centre of a circle,  and are
   Inserted into a broad tendon {tendinous centre, or cordi-
form tendon), which is situated in  the  middle of  the dia-
phragm, and  in  which, therefore,  the fibres from  the
opposite sides are interlaced.
   2.  The inferior  or lesser muscle, or appendix of the
diaphragm, lies on the bodies of the vertebrae, and
   Arises, by four small  tendinous feet,  on each side, from
the  second, third, and fourth lumbar vertebrae;  these
tendons soon join, to form a  strong pillar on each side,
named  the Crus  of the  Diaphragm.  The  crura run
obliquely upwards and forwards, form two fleshy bellies,
a fasciculus of each of which crossing  over to  the  other,
decussates with the opposite one, and thus  forms  the
interval of the two crura  into a superior and inferior
opening.
   Inserted into the posterior part of the middle cordiform
tendon.
   Situation: The  diaphragm  is covered  on its superior
surface by the pleura, and on its inferior by the perito-
neum ;  it separates the thoracic from  the abdominal
viscera:  It is perforated in its fleshy and tendinous parts
by several bloodvessels, and other important organs.
   (1.) The aorta passes between the  tendinous part of the
crura, lying close upon the spine;  and  the thoracic duct
passes betwixt the aorta and the right  crus.
   (2.) A  little above,  and to the left side of the aorta,
the oesophagus, with the eight pair of nerves attached to
it, passes through an  oval fissure formed in  the  fleshy
columns of the inferior muscle. 
THE DIAPHRAGM.                 167
  (3.)  The vena cava perforates the tendon towards the
right side.

                         Fig. 51.
The Diaphragm.
1,2,3

  5,6
    7,
   Tendinous Centre  of the
     Greater Diaphragm.
   Ligamentum Arcuatum.
   Foramen  of the  Lesser
     Splanchnic Nerve.
 8. Right Crura of Diaphragm.
 9. Fourth Lumbar Vertebra.
10. Left Crura of Diaphragm.
11. Hiatus Aorticus.
12. Foramen CBsophagenum.
13. Foramen Quadratum, for the
     Passage of the Vena Cava.
14. Psoas Muscle.
15. Quadratus Lumborum.
16. Transverse Processes  of the
     Lumbar Vertebra?.
  (4)  The  great  splanchnic nerve, and branches of the
vena azygos vein, perforate some of the posterior  fibres
.of the crura.   The lesser splanchnic nerve also passes
through an opening in the substance of the crura
  (5 )  On each side of the sternum there  is a small fissure,
where the peritoneum and pleura are only separated by
adipose membrane.
   Use- The diaphragm is one of the chief  agents in
respiration; it also acts in coughing, laughing and speak-
ing  and in the expulsion of the urine and feces, &c. 
168               PRACTICAL ANATOMY.
   Four pair of muscles are situated within the posterior
part of the cavity of the abdomen.
   I. The Psoas Parvus, often wanting.—It arises, fleshy,
from the sides of the last  dorsal, and first  lumbar verte-
brae; it sends off a small long tendon, which, running on
the inside of the psoas magnus, is
   Inserted, thin and flat, into the brim of the pelvis, at the
junction of the os ilium and pubis.
   Use: To assist the psoas magnus  in bending the loins
forward.
   2. The  Psoas Magnus.—It  arises, fleshy, from the

                         Fig. 52.
  1. Small Psoas Muscle.
  V. Insertion of the Tendon of the same into the Iliac Fascia cut.
  2. Great Psoas Muscle.
  3. Quadratus Lumborum Muscle, partly concealed by the two Psoas
      Muscles.
  3'. Same of the Right Side entirely exposed.
4, 4. Foramina formed by the Grooves upon the Bodies of the Lumbar
      Vertebrae, and the Origins of the Great Psoas Muscle, for the
      passage of the Lumbar Arteries and Veins.
5, 5. Inter-Transverse Muscles.
  6. Iliac Muscle entirely exposed by the removal of '2, Great Psoas
      Muscle cut. 
ILIACUS INTERNCS.
169
side of the body, and transverse process of the last verte-
bra of the back, and in the same manner from  all those
of the loins, by  as many distinct slips.  It runs down
over the brim of the pelvis, and is
  Inserted, tendinous, into the trochanter minor of the os
femoris, and fleshy, into that bone immediately below the
trochanter.
  Situation: It is situated betwixt the psoas parvus and
iliacus internus.
   Use:  To bend the thigh forwards,  roll it outwards; or,
to assist in bending the body.
  3. The Iliacus Internus.—It arises, fleshy, from the
transverse process of the last vertebra of the loins, from
all  the  inner  margin of the spine of the os ileum, from
the  edge of  that  bone  between its anterior  superior
spinous process  and the acetabulum, and  from  all its
hollow part between the spine and the linea innominata.
Its fibres descend  under the outer half  of  Poupart's
ligament, and join the tendon of the psoas magnus.
  Inserted with the psoas magnus.
  Situation: It fills up the internal concave surface of the
os ileum.   It is covered by a pretty strong fascia, which
is inserted into the crista of the ileum, and into the crural
arch: Fascia lliaca: at which point it joins the Fascia
Transversalis.  This Iliac Fascia passes under the  iliac
bloodvessels into the pelvis.   The  latter insertion pre-
vents the bowels from descending under Poupart's  liga- ^
ment, except at the inner edge of the iliac vein, which is
accordingly the situation of a crural hernia, and which
the student should examine most carefully.  A part of
this fascia  is also continued behind the femoral vessels
over  the pubis, to form a  part of the  sheath which
incloses those vessels.  A  short distance  to the pubic
side of  the iliac vein, a strong semilunar tendinous  edge
is seen; this is one of the attachments of Poupart's liga-
ment to the linea innominata, and is called Gimbernais '
ligament.   Between this and  the femoral vein, is a space
filled by a lymphatic gland, and cellular tissue.  The last
called the Septum Crurale.  This space is the Femoral or
Crural  ring, and is the place where an intestine sometimes
     15 
170
practical anatomy.
passes through, forming Femoral Hernia:   The  septum
crurale  would  form one of  its coverings. _ Bemember
these points,  and apply them when conducting the dis-
section of the thigh.
   Use:  To assist in bending the thigh, and in bringing
it directly forwards.
  N. B. The insertion of the two last described muscles
cannot be seen till the thigh is dissected.
  4. The  Quadratus  Lumborum.—'This  muscle arises,
tendinous and fleshy, from rather more than the posterior
third part of the spine of the os ileum.
  Inserted into  the transverse processes of all the verte-
brae of the loins, into the posterior half of the last rib,
and, by a  small tendon, into  the side  of the last vertebra
of the back.
  Situation: It is situated laterally at the lower part of
the spine, more outwardly than the psoas magnus.
   Use:  To move the loins to one side, pull down  the last
rib.  If both act, to bend the loins forwards.

 of the vessels and nerves  situated  behind  the
                    peritoneum.

1.  The Arteries, viz: The Aorta Abdominalis, and its branches.
  The Aorta passes from the thorax into the abdomen,
between the crura of the diaphragm, close upon the spine.
It then descends on the forepart of the vertebras, inclined
to  the left side.   On the fourth lumbar vertebra, it bifur-
cates into the two primitive or common iliac arteries.
  Branches of the Abdominal Aorta.—1. The two
Phrenic  Arteries arise from the Aorta, before it has
fairly entered into the abdomen,  and ramify over the
diaphragm.
  2. The  Cceliac Artery or Axis comes off at the point
where  the aorta has fairly extricated itself from  the dia-
phragm, surrounded by the meshes of the semilunar
ganglion.   It divides into three branches.
  (1.) A. Gastrica, smallest of the three. It passes along
the lesser curvature from left to right, to inosculate with
the pylorica or  coronaria dextra. 
aorta and its branches.

            Fig. 53.
171
Abdominal Portion op the Aorta and its Branches.
                         8, 8. Renal Arteries.
                         9, 9. Spermatic Arteries.
                           10. Lumbar Arteries.
                           11. External Iliac Artery.
                           12. Internal Iliac Artery.
                       13,  13. Epigastric Artery.
                           14. Circumflex Iliac Artery.
  1. Aorta.
2, 2. Primitive Iliac Arteries.
  3. Coeliac Artery cut across.
  4. Superior Mesenteric cut.
  5. Inferior Mesenteric cut.
  6. Middle Sacral.
7, 7. Diaphragmatic  or Phrenic
Arteries.
15, 16. Musculo-cutaneous Nerves. 
172
PRACTICAL anatomy.
  (2.) Arteria Splenica passes under the stomach, and
along the upper border  of the pancreas;  it enters the
spleen, and gives off the following branches:—
  a, Pancreatine Parvus to the pancreas, where it runs
along the border of that viscus.
  b, Vasa Brevia to the  bulging extremity  of  the
stomach.
  c, A.  Gastro-Epiploica Sinistra,  along the  greater
curvature of the stomach, inosculating with the  gastro-
epiploica dextra.
  (3.) Arteria Hepatica runs to the liver. It sends off
the following branches:—
  a, Pylori ca.—It sends its ramifications along the lesser
curvature, to inosculate with  the proper coronary artery.
  b, Gastro-epiploica Dextra, or Gastro-duodenalis,
passes under the pylorus, and along the great curvature
of  the  stomach, inosculating with the  gastro-epiploica
sinistra  (from the splenic), and sends off a  branch to the
pancreas.
  The hepatic artery then divides into the right and left
hepatic.  The Bight  is  distributed to the right lobe of
the liver, and to the gall-bladder.  The Left supplies the
whole of the left lobe, the lobulus Spigelii, and  part of
the right lobe of the liver.
  3. The Superior Mesenteric Artery.—It leaves the
aorta about half an inch lower than the cceliac artery ; it
enters the fold of peritoneum forming the mesentery, and
runs down in this, incurvating from the left to the right
side.
  From the right  side or concavity of this arch, three
branches are given to the  colon.
  (1.) A. Ileo-Colica to the caput coli and last of the
ileum.
  (2.) A. Colica Dextra to  the right side of the colon.
  (3.) A. Colica Media to the arch of the colon.
  The convexity of the arch of the  superior mesenteric
sends off from sixteen  to twenty branches, which, forming
frequent anastomoses  and arches, proceed to the small
intestines.
  4. The  Kenal or Emulgent Arteries are  two in 
THE SEVERAL PARTS OF THE LARGE INTESTINE.  173

                      Fig. 54.
          The Several Parts of the Large Intestine.
  a.  The Caecum.
  b.  Right or Ascending Colon.
  c.  Transverse Colon, or Arch of the Colon.
  d.  Left or Descending Colon.
e, e.  Sigmoid Flexure of the Colon.
 f.  Rectum.
  g.  Mesocolon.
  h.  The end of the  Ileum, or its termination  at  the  Ileo-csecal
      Valve.
  i.  Appendicula Vermiformis.
  k.  Pouch of the Rectum.
  I.  Anus.
 m.  Appendices Epiploicas.
                           15* 
174
PRACTICAL ANATOMY.
number.   Below  the superior mesenteric,  pass  to  the
kidney. The right artery longer than the left, and passes     j
behind the vena cava ascendens.                            '
  5. The Spermatic Arteries are also two ; they come
off an inch below  the emulgent from the forepart of the
aorta.  Each artery descends  in its course, accompanied
by the spermatic vein and nerves.  It passes through the
abdominal rings, and enters the upper part of the testicle.
In the female it supplies the ovaria and fundus uteri.
  6. The  Inferior Mesenteric is  a  single  trunk.
Comes off rather from the left side of the aorta, below the
spermatic  arteries; it passes in the mesentery to  the left
side of the abdomen, where it  divides as follows:—
  (1.) The Colica  Sinistra.  To the left  side of the
colon.  Inosculates with the A. Colica Media.
  (2.) Branches which pass to the  sigmoid flexure.
  (3.) The great  trunk  of the artery runs down to the
rectum, on which it ramifies.  Is termed Art. Hemor-
rhoidalis Superius.
  7. The Lumbar Arteries are five or six small arteries
on each side, which  arise from the back part of the aorta,
and are distributed  to the spinal canal, muscles  of the
spine, and of the sides of the abdomen and pelvis.
  8. A. Sacra Media is a single  artery, arises from the
back part of the  aorta  at its bifurcation, and  descends
along the anterior surface of the sacrum, giving twigs to
all the neighboring parts.
  At the  fourth  lumbar vertebra, the aorta bifurcates
into the two primitive or common iliacs.
  The Iliaca Communis runs along the edge  of  the
psoas muscle, and at an  inch  or two  from its origin di-
vides into—
  (1.) The Internal  Iliac which  passes down  into the
pelvis.
  (2.) The External Iliac, which following the direction
of the psoas muscle, passes under Poupart's ligament, and
becomes the Femoral artery. 
VEINS.
175
                      2.  Veins.
  The Vena Cava Abdominalis, vel Inferior, is formed
by the junction of the two common iliac veins; it passes
up through the abdomen on the right side of the aorta.
  In  this course it receives the following veins, which
resemble their corresponding arteries :—
  1. The Lumbar Veins.
  2. The Emulgent or Kenal  Veins:—the  left is  the
longest, as it crosses over the forepart of the aorta.
  3. The Eight Spermatic Vein ;—the left enters the left
renal vein.
  The vena cava  then passes through the fissure of the
liver, being nearly  surrounded by that viscus, and  re-
ceiving three branches from it, called the  Ven^; He-
PATiCAi.  It then  perforates  the diaphragm,  and enters
the thorax.
  The common iliac vein  of each side  is formed by the
union of two  branches, the  External and Internal
Iliac Veins, which accompany the arteries of the same
name:—The common  iliac vein of each side lies on the
inside of its artery; hence both veins  cross behind the
right iliac artery, to unite and form the vena cava, on the
forepart of the lumbar vertebrae.
                              do not join the cava, but
                              are  united   behind  the
                              pancreas, to  form   the
                              Vena Portae.  This vein
The   Superior  Mesen-
teric Vein, the Inferior .  ramifies  anew  through
Mesenteric Vein, and the   the liver>) and its blood is
Splenic Vein,               returned into the vena
                             cava by the venae cavae
                             hepaticae.
  Although  the trunks just enumerated  are the chief
veins that contribute to form the vena portae, yet  the
returning veins of  all the  viscera inclosed in  the peri-
toneum, except the liver, are included in the same system,
and joiA one or other of the large trunks.  This is  the
case with the stomach, pancreas, gall-bladder and omen- 
176
practical anatomy.
 turn.  The blood which goes to the spleen, large and
 small intestines, is all returned by the three great trunks.

                      3. Nerves.
   1. The eighth pair, or Par Vagum, descending on each
 side of the oesophagus through the diaphragm, forms the
 two Stomachic Plexuses on the anterior and posterior
 surfaces  of the stomach.   These  plexuses  send some
 branches to the cceliac, to the hepatic, and to the splenic
 plexus.
   2. The Splanchnic Nerve, or Anterior Intercostal, a
 branch  sent off by the intercostal nerve in the  thorax,
 enters the abdomen betwixt the crura of the diaphragm;
 here each nerve forms a Semilunar  Ganglion by the
 side of the cceliac artery.
   From  the ganglion  on each  side branches are sent
 across, which communicate intimately together, and form
 round  the root of the cceliac artery,  a very intimate
 plexus, containing several  ganglia of various sizes, for-
 merly called the Solar or Cceliac Plexus.  Nerves
 pass from this plexus, with  the branches of the aorta, to
 the various viscera of  the abdomen; they form the He-
 patic, Splenic, Superior  and Inferior Mesenteric,
 Renal, and Spermatic Plexuses.
   3. The trunk of the  sympathetic  nerve (the posterior)
 perforates the diaphragm close to the spine, and runs along
 the upper edge of the psoas magnus.  It terminates on
 the extremity of the os  coccygis by union with the nerve
 of the  opposite side, in a ganglion  (Ganglion Impar).
 In this course, it communicates with the lumbar  nerves
 and the various abdominal plexuses.
  The Thoracic Duct may be seen passing from the ab-
 domen into the thorax,  between the aorta and the right
crus of the diaphragm.   It is larger here than in its sub-
sequent course.  It empties  into the junction of the left
subclavian and internal jugular veins. 
fascia lata.
177
                CHAPTER XII.

   DISSECTION OF THE ANTERIOR PART OF THIGH.

  Carry an incision from the middle of Poupart's liga-
ment obliquely across the thigh, and around the internal
condyle of the femur to the tubercle of the tibia.  Reflect
the integuments.  The  superficial fascia, especially at the
groin, is lamellated;  and situated in  it about Poupart's
ligament a cluster of lymphatic glands.  In and beneath
this fascia notice,
  1. The Vena Saphena Major, seen running up in
the inside of the knee  and thigh.  At first it  lies very
superficial, betwixt the skin and fascia lata.  As it ascends
it is gradually enveloped by the fibres of the fascia, and
then sinks beneath it to join the femoral vein  about  an
inch below Poupart's ligament.  The space through which
it sinks to join the femoral vein is the Saphenous Open-
ing, and the loose cellular tissue which envelops the vein
and occupies the opening is called the Cribriform Fas-
cia.  In its course it is joined by  several  cutaneous
veins.
  2. Immediately under the true skin you may occasion-
ally perceive the Lymphatic Vessels running, like lines
of a whitish color, to enter the inguinal glands.
  3. Several  Cutaneous Nerves are  seen  ramifying
above the fascia.  They all come from the lumbar nerves
or anterior crural nerve.
  The deep fascia, or Fascia Lata, may now be exposed
distinctly by carefully clearing away the superficial fas-
cia ; preserving, however, the saphena vein, a  short dis-
tance down.   Observe how extensively it arises from the
bones, tendons, and ligaments.  On the anterior and su-
perior part of the thigh, it arises from Poupart's  ligament, 
178
PRACTICAL ANATOMY.
Dissection op some of the Parts concerned in Femoral and Inguinal
                          Hernia.

 1.  Tendon of the External Oblique Muscle.
 2.  Tendon of the Internal Oblique, the first-named muscle being
     dissected off.
 3.  Cribriform Fascia.
 4.  Vena Saphena.
 5.  External Abdominal Ring and Spermatic Cord.
 6.  Poupart's Ligament. 
       DISSECTION OF ANTERIOR PART OF THIGH.    179

from the os pubis, from the descending ramus of that
bone, and from the ascending ramus and tuberosity of the
ischium; behind,  and on the outside, from the whole
spine of the ileum, and from the sacro-sciatic ligaments.
It receives a number of fibres from a muscle belonging
to it, viz., the tensor vaginae femoris, and from the tendon
of the  gluteus-maximus; it passes down over the whole
thigh, is firmly fixed to the linea  aspera, to the  condyles
of the femur, and to  the patella, and is continued  over
the knee,  to be attached to the heads of the tibia and
fibula,  after which it forms the fascia of the leg.
   On the  upper and anterior part of the  thigh, below
Poupart's  ligament, there is  a slight  hollow, where the
great vessels descend under the crural arch. The fascia
lata forms, just on the outside and upper part of this, a
crescent-shaped  fold,  called its semilunar edge,  which is
strongly connected to the crural  arch  and linea innomi-
nata.  The commencement of this semilunar edge, some-
times called the Superior  Cornu, is  Hey's Ligament.
The fascia on the outside of the  saphenous opening is
called the Sartorial, that on the inside the Pectineal.
If the  cribriform  fascia  be  removed  from  between the
two, we will see the femoral bloodvessels lying beneath
inclosed in their sheath.  Press the finger down from the
inside of the abdomen on the pubic side of the iliac vein,
and it will be found to project in the thigh  on  the  inner
side of the  femoral vein, but within its sheath.   This
space is the crural ring, and gives you the course of a
femoral hernia,  which projects  forwards,  after passing
under Poupart's ligament through the saphenous opening,
covered, as you  may perceive, by the peritoneum, septum
crurale, fascia propria, or sheath of the vessels, cribriform
fascia,  superficial fascia, and skin.
   The fascia should now be  dissected back; and, in lift-
ing up the thicker part of it, which covers  the outside of
the thigh,  observe that it is composed of two  laminae of
fibres.   The fibres of the outer  lamina  run  in circles
round  the thigh, while  those on the inside, which are
stronger and more firmly connected, run longitudinally. 
PRACTICAL ANATOMY.
Fig. 56.
The Femoral or Crural Arch, and the  Structures situated between
  it and the Anterior Part op the Superior Margin of the Pelvis.

 1. The Crural Arch, or Poupart's Ligament.
 2. Pubic Bone.
 3. Superior Anterior Spine of the Ilium.
 4. Spine of the Pubis.
 5. Pectineal Line, and the Insertion of  Gimbernat's Ligament.
 7. Iliac Muscle cut.
 8. Crural Nerve cut.
 9. Great Psoas Muscle cut.
10. Point at which the  Crural Branch of the Genito-Crural Nerve
     reaches the Thigh.
11. Femoral Artery.
12. Femoral Vein, receiving the Saphena Vein.
13. External Portion of the Sheath of the Femoral Vessels lying in
     contact with the Femoral Artery.
14. The large funnel-shaped Cavity of the Sheath on the Inner Side
     of the Femoral Vein.
15. Internal Femoral Ring, bounded above by the Crural Arch, behind
     by the Pubis, externally  by the Vein, and internally by the free
     edge of (16) Gimbernat's Ligament.


MUSCLES  SITUATED ON  THE FOREPART  AND  INSIDE  OF
                        THE THIGH.

  These are  nine in number.

  1. The Tensor Vagina Femoris—Arises, by a narrow,
tendinous, and fleshy origin, from the external part of the
anterior superior spinous process  of the os ileum; it forms
a considerable fleshy belly. 
RECTUS FEMORIS.
181
  Inserted into the inner side of  the great fascia, where it
covers the outside of the thigh, and a little below the tro-
chanter major.
   Use: To stretch the great fascia of the thigh, and assist
in its abduction.
  2. The Sartorius—Arises, by short tendinous  fibres,
from the anterior superior  spinous  process of  the os
ileum, soon becomes fleshy, extends obliquely across the
thigh, and passes behind the inner condyle.
  Inserted, by a broad and thin tendon, into the inner side
of the tibia, immediately below its anterior tubercle.
  Situation:  It lies before the muscles of the thigh, cross-
ing them like a strap  about two inches in breadth.   At
the lower part of the thigh, it runs between the tendon of
the triceps adductor magnus, and that of the gracilis.  It
is inserted  above  tendons  of the gracilis and semitendi-
nosus, over which it sends  an aponeurotic expansion.
   Use: To bend  the leg obliquely inwards on the thigh,
and to bend the thigh forwards.
  It crosses over the femoral artery.
  3. The Rectus Femoris—Arises, by a strong tendon,
from the inferior anterior spinous process of the os  ileum;
and, by another strong tendon, from the dorsum of that
bone a little above the acetabulum, and from the capsular
ligament of the  hip-joint.  The  two  tendons  soon unite,
and send off a  large belly, which runs down  over the
anterior part of  the thigh,  and terminates in a flat  strong
tendon, which is
  Inserted into the upper extremity of the patella.
   Situation: To expose the  tendinous origins of  this
muscle, the  origins of the sartorius and tensor vaginae
femoris must be raised.   Its insertion lies  betwixt the
two vasti.
   Use: To  extend the leg on the thigh, and to bend the
thigh on the pelvis; to  bring the pelvis and thigh for-
wards to the leg.
  Under the rectus, and partly covered by it, there is a
large mass of flesh, which,  at first sight, appears to form
but one muscle.   It may, however, be divided into three;
the separation on the external  surface is  not generally
     16 
182
PRACTICAL ANATOMY.
very  evident, but, by following the  course of the vessels
which enter this mass, and by cutting through perhaps a
few fibres externally, you will  discover the line of sepa-
ration ; and this separation, as  you proceed deeper with
your  dissection, will  become very distinct.   The  three
                 Fig. 57.
A View op the Muscles on the Front of the Thigh.
1. Tensor Vaginae Femoris.
2. Pectineus.
3. Rectus Femoris.
4. Vastus Externus.
5. Vastus Internus.
6. Sartorius.
7. Adductor Longus.
muscles are named vastus externus, vastus internus, and
cruraeus: at the upper and middle parts of the thigh,
they  may be  separated very distinctly;  but  for two  or 
CRURiEUS, OR CRURALIS.            183
three inches above the condyles they are connected in-
separably.
  •1. The Vastus Externus—Arises, tendinous and fleshy,
from the anterior surface of the  root of the trochanter
major, from the outer edge of the linea  aspera, its whole
length, from the oblique line  running to the external
condyle, and from the whole external flat surface of the
thigh bone.  The fleshy fibres run obliquely forwards.
  Inserted into the external  surface of the tendon of the
rectus cruris, and into the side of the patella.
  Situation: This muscle  forms the large  mass of flesh
on  the outside of the thigh.
   Use: To extend the leg, or to bring the thigh forwards
upon the leg.
  5. The Vastus Internus—Arises, tendinous and fleshy,
from the  forepart of the root  of the trochanter minor,
from all the upper edge of the linea aspera, from the ob-
lique line  running to  the inner  condyle, and from the
whole internal surface of the thigh bone.  Its fibres de-
scend  obliquely downwards and forwards.
   Inserted  into  the  lateral  surface of the  tendon of the
rectus cruris, and into the  side of  the patella.
   Situation: This muscle  embraces  the inside  of the
femur in the same manner as the last described muscle
does the  outside, but it is much smaller;—it is also in
part covered by the rectus.  At its upper part the sarto-
rius passes over it obliquely.
    Use: Same as the last.
   6. The  Cruraeus, or Cruralis—Arises, fleshy, from
between the two trochanters of the os  femoris, from all
the forepart of  the bone, and from the outside as far
back as the linea aspera; but from the inside of the bone
it does not arise, for between the forepart of the femur
and the inner edge of  the linea aspera, there is a smooth
plain surface, of the breadth of an inch, extending nearly
the whole  length of the bone, from which no muscular
fibres arise.
   Inserted into the posterior surface of the tendon of the
rectus, and upper edge of the patella. 
184
PRACTICAL ANATOMY.
  Situation: The principal part of this muscle is lapped
over, and concealed, by the bellies of the two vasti.
   Use:  Same as the last.
  7. The Gracilis arises, by a broad thin  tendon, from
the lower half of that part of the os pubis which forms
the symphysis, and from the inner edge of the descending
ramus:—It soons  grow fleshy, and forms a belly, which,
becoming narrower as it descends, terminates in a tendon,
which passes behind the inner condyle of the thigh-bone,
and is reflected forwards,  to be
  Inserted in the inside of the tibia.
  Situation: From the pubis to the knee it runs immedi-
ately under the integuments on the inside of the thigh; it
is  inserted below the tendon  of the sartorius, and  above
that of the semitendinosus.
   Use:  To bring the thigh inwards and forwards, and to
assist in bending the leg.
  8. The Pectinalis—Arises, fleshy, from  that ridge of
the os pubis which  forms the brim  of the pelvis, and
from the concave  surface below the  ridge: It forms a
thick fat belly,
  Inserted, by a flat tendon into the linea aspera, immedi-
ately below the lesser trochanter.
  Situation: Its origin lies on the inside of the belly of
the psoas magnus, where that  muscle slides over the brim
of the pelvis, and on the  outside of the origin of the ad-
ductor longus.
   Use:  To bend the  thigh forwards, to move it inwards,
and to perform rotation, by turning  the toes outwards.
  9. The Triceps Adductor Femoris consists of three
distinct muscles, which, passing from the  pelvis  to the
thigh, lie in different layers  upon one another, and have
nearly the same action.
  (1.) The Adductor Longus—Arises, by a short strong  "
tendon,  from the  upper  and  inner  part of the os pubis,
near its symphysis;—forms  a  large  triangular belly,
which, as it descends, becomes broader, but less thick.
  Inserted, tendinous, into the middle part of the linea
aspera:  from its tendon and  that of the vastus internus,
a membranous canal is  formed for  the  femoral artery. 
ADDUCTOR BREVIS.
185
The Anastomotica Magna  Artery is given off here
also.

                         Fig 58.
    Another View of the Adductor Muscles with thr Pectineus.
  1. Upper Part of Adductor Magnus.
  2. Pectineus.
  3. Adductor Longus.
  4. Adductor Magnus.
5,6. Foramina  for the first and Second Per-
      forating Arteries.
7, 8. Foramina  for the Femoro-Popliteal ves-
      sels.
  Situation: It arises betwixt the pectinalis and  gracilis,
and above the adductor brevis.
  (2.)  The Adductor  Brevis—Arises, fleshy and tendi-
nous, from the os pubis, between the  lower part of the
symphysis pubis, and the foramen thyroideum:—it forms
a fleshy belly.
  Inserted, tendinous, into the  upper  third of the linea
aspera.
  Situation: Its origin  lies under the origins of the pecti-
nalis  and adductor  longus, and on the  outside of the
tendon of  the gracilis:—It is  inserted  behind those
muscles, but before the  adductor magnus.   The obturator
                          16* 
18b'
PRACTICAL anatomy.
nerve  lies upon  it after  coming  through the  obturator
foramen, with an artery of the same name.

                        Fig. 59.
        Adductor Muscles, with the Obturator Externus.
  1.  Femur.
  2.  Ilium.
  3.  Pubis.
  4.  Obturator Externus.
  5.  Superior Fasciculus  of the Ad-
      ductor Magnus.
 6, 7.  Adductor Brevis.
  8.  Adductor Longus.
9,10.  Adductor Magnus.
  11.  Foramen for the Passage of the
      Perforating Arteries.
  12.  Same for  Femoro-Popliteal Ves-
      sels.
   (3.)   The  Adductor Magnus—Arises,  principally
fleshy, from  the  lower part of the body, and from  the
descending ramus of the os  pubis, and  from the ascend-
ing ramus of the ischium, as far as the tuberosity of that
bone.  The fibres run outwards and downwards, having
various degrees of obliquity.
   Inserted, fleshy, into the  whole  length  of  the linea
aspera, into the oblique ridge above the internal condyle 
ARTERIES.
187
of the os femoris, and, by a roundish long tendon, into
the upper part of that condyle.
  Situation: This large muscle arises behind and below
the two other adductors; it forms a flat partition betwixt
the muscles on the fore and back parts of the thigh.
   Use: To approximate the thighs to  each  other;—to
roll them outwards.

ARTERIES,  VEINS, AND NERVES ON  THE FOREPART AND
                INSIDE OF THE THIGH.

                      1. Arteries.
  The Femoral Artery may be said to pass along  the
inside of the thigh, where it emerges from under Poupart's
ligament;  it lies cushioned on  the fibres  of  the  psoas
magnus, is called the  inguinal artery, and  is very nearly
in the mid space between the angle of the pubis, and the
anterior superior spine of the  ileum, nearer however by
a finger's breadth to the former;  having left the groin, it
assumes the name of Femoral, and in its course down the
thigh, runs over the following muscles:—The  pectinalis,
part of the adductor brevis; the whole of the adductor
longus, and about  an inch  of the adductor magnus: it
then slips betwixt the tendon of the adductor magnus and
the bone, and, entering the  ham, becomes  the Popliteal
artery.  There is a strong interlacing of the tendinous
fibres, forming a deep groove for the artery between the
adductor longus and vastus  internus.   The artery is ac-
companied by  the  Femoral vein, first inside, and  then
gradually getting behind it.   The long saphenous nerves
and short  saphenous  nerves accompany the  vessels, as
will presently  be seen.  It is also invested  by a firm
sheath, which consists of condensed cellular membrane,
intermixed with some tendinous fibres:—For some inches
below Poupart's ligament, this artery is on its forepart
only covered by cellular substance, absorbent glands, and
the general fascia of the thigh;  but, meeting with the
inclined line of the sartorius, it is, during the rest of its
course, covered by that muscle.  It perforates the tendon 
188              practical anatomy.
of the adductor magnus, at the distance  of rather  more
than one-third of the length of the bone from  its lower
extremity.
  Branches  of the  Femoral Artery.—The  A. Pro-
funda comes off from the femoral  artery at the distance
of two  or three inches from Poupart's ligament;  it is
nearly as large as the femoral itself, runs down for some
little way behind it,  and  terminates in  three or four

                         Fig. 60.
           Arteries seen on the Front of the Thigh.
1, 2. Femoral Artery.
  3. Superficial Epigastric, cut off.
4,4. External Pudics, cut off.
5, 5. Profunda Femoris.
  6. Internal Circumflex.
  7. External Circumflex.
8, 8. Perforating Arteries.
  9. Epigastric.
 10. Circumflexa Ilii.
 11. Muscular branch.
 12. Superior Internal Articular artery.
 13. One  of its Branches.  The Pop-
      liteal artery begins where  the
      femoral terminates, at 2.
branches, which,  perforating  the triceps adductor,  are
named Arteries Perforantes.  These supply the great
mass of muscles on the back part of the thigh, and inos-
culate  largely with  the sciatic, gluteal, and obturator 
VEINS.—NERVES.               189
arteries.  The profunda also sends off two considerable
branches (the first ones), which, encircling the upper part
of the thigh,  are  named  Circumflexa Interna, and
Circumflexa Externa.
  The small branches of the femoral artery before the
profunda may be enumerated as follows: 1. Some twigs
to the inguinal glands {inguinal); 2. Some to the external
parts of generation, named Pudicae Externae;  3. One or
two  going  towards the anterior superior spinous process
of the ileum  (Superficial Circumflex Ilii); 4. One
upwards over the  fascia of the  abdomen,  Superficial
Epigastric, or arteria ad cutem abdominis.
  The Obturator Artery, arteria obturatrix, which is
a branch of the  internal  iliac artery, passes through the
notch at the upper part of the foramen thyroideum, and
ramifies on the  deep-seated muscles  at the upper and
inner part of the thigh.

                      2. Veins.
  The  Femoral Vein adheres closely to the femoral
artery in its passage out of the  abdomen, and accompa-
nies it in its course down the thigh, where it passes under
Poupart's ligament;  it lies on the inside of the artery,
but, as it descends, it turns more  and  more posteriorly, so
that where they perforate the tendon of the adductor
magnus, the vein is situated fairly behind the artery.
  Its branches correspond to those of the femoral artery;
but  about  an inch below Poupart's ligament, it receives
the vena saphena major, to which there is no correspond-
ing artery.
  The  Obturator  Vein accompanies  the  obturator
artery, and has the same distribution.

                      3.  Nerves.
  Femoral  nerve,  Nervus Cruralis Anterior, or  the
Anterior Crural nerve, where  it passes from under Pou-
part's ligament, lies about half an inch on the outside of the
femoral artery;  it immediately divides into a number of
branches, which supply the muscles and integuments on 
190             practical anatomy.
the forepart and  outside of the thigh:  a considerable
branch, however, accompanies the femoral artery, leaves
that vessel  where it is about to perforate the adductor
magnus, and appears as a cutaneous nerve on the inside
of the knee; proceeding downwards on the inside of the
leg, it accompanies the saphena vein, and terminates on
the inner ankle, and upper part of the foot. This branch
is named Nervus Saphenus Longus.
  Another  branch, which, running close to  the femoral
vessels, pierces the  fascia, and is distributed below  the
knee.   The Short Saphenous.
  Nervus  Obturator, or the obturator nerve, is found
accompanying the obturator artery and vein ; it has  the
same distribution, and some branches extend as far as the
internal  condyle  of  the  thigh-bone,  and communicate
with the nervus saphenus.

  DISSECTION OF THE FOREPART OF THE LEG AND FOOT.

  Carry an incision from the tubercle of  the tibia along
its spine, over the dorsum of the foot to the toes, where
it may be crossed by a second from the inside to the out-
side of  the foot.  Reflect the  integuments.   The skin
must  be dissected off the toes separately.  The fascia
covering the muscles on the front of the leg is very strong
It is fixed to the heads of the tibia and fibula,is strength-
ened by a contribution from the Fascia Lata Femoris, and
by its deep  surface gives origin, in part, to the muscles.
At the ankle it becomes very strong, and adhering to the
outer and inner malleolus, forms the Annular Ligament
which binds down the tendons.   Before removing this
fascia, notice the Saphena  Interna Vein and Nerve,
running along the inside of the leg, and  over the ankle
to the foot, and around the external malleolus.  The  Sa-
phena externa vein and nerve to the outer part of the
foot, and over the outer ankle filaments  of the peroneal
cutaneous nerve (from the Peroneal).
  The fascia should  then be dissected off, and, in doing
this, remark that it sends down processes between  the
muscles;  these are named intermuscular ligaments; they 
         EXTENSOR LONGUS DIGITORUM PEDIS.      191

give origin to the fibres of all the muscles betwixt which
they pass, connecting  them together inseparably, so that
the dissection has a rough appearance.

  MUSCLES SITUATED ON THE FOREPART AND OUTSIDE OF
                       THE LEG.

  These are six in number.
  1. The Tibialis Anticus—Arises, principally fleshy,
from the exterior surface of the tibia, from its  anterior
angle or spine,  and from nearly half of the interosseous
ligament, and two-thirds of the length of the bone; also
from the inner surface of the fascia of the leg, and from
the intermuscular ligaments.  The  fleshy fibres  descend
obliquely, and terminate in a strong tendon, which crosses
from the outside to the forepart of the tibia, passes through
a distinct ring of the annular  ligament  near the inner
ankle, runs over the astragalus and  os naviculare, and is
  Inserted into  the upper and inner part of the os cunei-
forme internum,  and  the base  of  the  metatarsal bone
supporting the  great toe.
  Situation: The belly is quite superficial, lying  under
the fascia of the leg on the outside of the spine of the tibia.
   Use: To draw the  foot upwards  and inwards; or,  in
other words, to bend the ankle-joint.
  2. Extensor Longus Digitorum Pedis—Arises, ten-
dinous and fleshy, from the outer part of the head of the
tibia;  from the  head of the fibula; from  the  anterior
angle of the fibula almost its whole  length, and from part
of the smooth surface  between  the  anterior and internal
angles;  from a small  part of the interosseous ligament;
from the fascia  and intermuscular ligaments.
  Below the middle of the leg, it splits into four round
tendons, which pass   under the annular ligament, be-
come flattened,  and are
  Inserted into the root of  the  first phalanx of each of
the four small toes, and expanded over the upper side of
the toes as far as  the root of the last phalanx.
  Situation: This muscle also runs entirely superficial;
it lies between  the tibialis anticus and peroneus longus, 
192
PRACTICAL ANATOMY.
but at the lower part of the leg it is separated from  the
tibialis anticus by the extensor pollicis longus.
   Use: To extend all the joints  of the four small toes:
to bend the ankle-joint.
   3. Peroneus Tertius—Arises, fleshy, from the anterior
angle of the fibula, and from part of the smooth surface
between the anterior and internal angles, extending from
below the middle of the bone downwards  to near its
inferior extremity; sends its fleshy fibres  forwards  to  a
tendon, which passes under the annular ligament, in the
same sheath as the extensor digitorum longus, and is
   Inserted into the base of the metatarsal bone  of the
little toe.
   Situated: The belly is inseparably connected with the
extensor longus digitorum, and is properly the outer part
of it.
   Use: To assist in bending the foot.
   4. Extensor Proprius Pollicis Pedis—Arises, tendin-
ous and fleshy,  from part of the smooth surface between
the anterior and internal angles of the fibula, and from
the neighboring part of the interosseous ligament, ex-
tending from some distance below the head  of the bone
to near its inferior extremity; the fibres pass obliquely
downwards and forwards into  a tendon, which, inclining
inwards, passes over the forepart of the astragalus and os
naviculare, to be
   Inserted into  the  base  of the first  and  of the  second
phalanges of the great toe.
   Situation: The belly is concealed between  the tibialis
anticus and extensor digitorum longus, and  cannot be
seen till those muscles are separated from one another.
   Use: To extend the great toe;  and to bend the ankle.
   The anterior tibial artery and nerve will be seen at the
upper third of the limb between the extensor communis
of the toes and  the tibialis anticus, at the middle between
the last  and  the extensor pollicis,  and at  the  ankle
between the last and the extensor communis digitorum.
Branches will be described  presently.
   5.  The  Peroneus Longus—Arises,  tendinous  and
fleshy, from the forepart  and outside of the head of the 
muscles of the leg and foot.
193
                 Fig. 61.

A Side View of the Muscles of the Leg an© Foot.
 9.
10.
11.
12,
13.
14.
Biceps Flexor Cruris.
Vastus Externus.
Gastrocnemius.
Soleus.
Tendo Achillis.
Tibialis Anticus.
Extensor Longus Digitorum
 Pedis.
Extensor Proprius Pollicis.
Peroneus Tertius.
Peroneus Longus.
Peroneus Brevis.
12. Abductor Minimi Digiti.
Extensor Brevis Digitorum.
Interosseus Dorsalis.
-jifJ2lOI3 II12141212
fibula, and from the adjacent part of the tibia, from the
external angle of the fibula, and from the smooth surface
between the anterior and external angles as far  down as
one-third of the length of the  bone  from its lower ex-
tremity; also from the fascia of the leg and intermuscular
ligaments.  The fibres  run  obliquely  outwards  into  a
tendon, which passes behind the outer  ankle, through a
groove in the  lower extremity of  the fibula;  is  then
reflected forwards  through a superficial* fossa in the out-
side of the  os calcis, passes over a projection, runs in a
groove in the os cuboides, passes over the muscles in the
sole of the  foot, and is
   Inserted, tendinous, into the outside of the base of the
     17 
191
PRACTICAL ANATOMY.
metatarsal bone of the great toe, and into the os cunei-
forme internum.
  Situation: The belly is quite superficial; it lies between
the outer edge of the extensor longus digitorum and  the
anterior edge  of  the soleus.  The tendon is superficial
where it crosses the outside of the os calcis, but, in  the
sole of the  foot,  is concealed by the  muscles situated
there, and will be seen in the  dissection of that part.
   Use: To extend the ankle-joint,  turning  the  sole of
the foot outwards.
  6. The Peroneus Brevis—Arises, fleshy, from  the
outer edge of the anterior angle  of the fibula, and from
part of the smooth surface behind that angle; beginning
about one third down the bone, and continuing  its  ad-
hesion to near the ankle;  from the fascia of the leg, and
from the intermuscular ligaments.   The fibres run  ob-
liquely towards a tendon, which passes through a groove
of the fibula behind the outer ankle, being there inclosed
in the  same ligament with the tendon  of the peroneus
longus, then through a separate groove on  the outside
of the os calcis, and is
  Inserted into the external part of the base of the meta-
tarsal bone that sustains the little toe.
  Situation: This muscle arises between the extensor
longus digitorum and  peroneus longus;  its belly is over-
lapped, and concealed by the belly of the peroneus longus.
  Below, it is separated from the peroneus tertius by that
projection of the fibula which forms the outer ankle, and
which is only covered by the  common integuments.
   Use: Same as that of the peroneus longus.

      MUSCLES ON THE UPPER PART OF THE FOOT.

  Only one muscle is found in this situation.
  Extensor Brevis  Digitorum  Pedis—Arises, fleshy
and tendinous, from the anterior and upper part of the
os calcis,  from the os cuboides, and from the  astragalus;
forms a fleshy belly, divisible into  four portions; these
send off four slender tendons, which are
  Inserted, the first tendon, into the first phalanx of the 
ARTERIES.
195
great toe, and the other three into all the small toes ex-
cept the little one, uniting with the tendons of the exten-
sor digitorum longus, and being  attached to the upper
convex surface of all the phalanges.
   Situation:  The belly of this muscle lies under the ten-
dons of the extensor digitorum  longus and  peroneus
brevis.
   Use: To extend the toes.

OF THE VESSELS AND NERVES IN  THE FOREPART OF THE
                    LEG AND FOOT.

                      1. Arteries.
   Arteria Tibialis Antica.—The anterior tibial artery
passes from the ham betwixt the inferior edge of the pop-
liteus  and the  superior fibres of the  soleus,  and then
through a large perforation in the interosseous  ligament,
to reach the forepart of the leg;  this perforation is much
larger than the size of the  artery,  and is filled up  by the
fibres of the musculus  tibialis posticus, which  may thus
be said to arise from the forepart of the tibia. The artery
then runs down close upon the middle of the interosseous
ligament,  between the tibialis anticus and extensor pro-
prius pollicis; below the middle of the  leg it leaves the
interosseous  ligament,  and passes gradually more for-
wards ;  it crosses under the tendon of the  extensor pro-
prius pollicis, and is  then  situated between  that tendon
and the first tendon of the extensor longus digitorum.
At the ankle it runs over the forepart of the tibia, being
now situated more superficially; then over the astragalus
and os naviculare, and over the junction of the os cunei-
forme internum and medium, crossing under that tendon
of the extensor brevis digitorum which goes to the great
toe.   Arriving at the space between the bases of the two
first metatarsal bones, it plunges into the sole of the foot,
and immediately joins the plantar  arch.
   Branches.—1. A. Recurrens, which  ramifies over the
forepart of the knee,  inosculating  with the articular ar-
teries. 
196
PRACTICAL ANATOMY.
  2. Numerous twigs to the tibialis anticus, extensor pol-
licis, and other muscles on the forepart of the leg.
  3. A. Malleolaris Interna ramifies over the inner
ankle, and inosculates with the perineal  and posterior
tibial arteries.
  4. The External Malleolar ramifies over the outer
ankle.
                         Fig. 62.
            A View of the Anterior Tibial Artery.
 9.
10.
11.
12.
13.
14.
15.
16.
17.
Tendon of the Rectus Muscle.
Ligament of the Patella.
Tibia.
Extensor Proprius Pollicis Pedis.
Extensor Communis Digitorum Pedis.
Peroneus Longus and Brevis Muscles.
Inner Border of the Gastrocnemius and So-
 leus Muscles.
Anterior Annular Ligament.
Anterior Tibial Artery.
Recurrent Articular Branch.
Internal Malleolar Branch.
Anterior Peroneal Artery.
Dorsal Artery of the Great Toe.
Tarsal and Metatarsal Branches.
Branch to the Great Toe.
Terminal Branch to join the Plantar Arch.
External Malleolar Artery.
  5. The Tarsal and Metatarsal Arteries  are two
small  branches  which cross the  tarsal  and metatarsal
bones, and pass obliquely to the outer edge of the foot. 
POSTERIOR part of THE THIGH.        197
  From the tarsal or metatarsal  artery come off the In-
terosseal Arteries,  which  supply  the interosseal
spaces and the back part of the toes.
  6. A  large branch  comes off from the anterior tibial,
where it is about to plunge into the sole of the foot;  it
runs  along the  space  betwixt the two first  metatarsal
bones and at the anterior extremity of those bones bi-
furcates into—
  (1.) A. Dorsalis Hallucis,  a considerable branch.
which runs on the back part of the great toe.
  (2.) A branch which runs on the inner edge of the toe
next to the great one.

                       2. Veins.
  The Anterior Tibial Vein consists of two branches,
which accompany the artery and its ramifications.

                      3. Nerves.
  The Anterior Tibial Nerve is a branch of  the pe-
roneal nerve; it is seen in the ham arising from the pero-
neal and crossing under the muscles on the outside of the
fibula; it emerges from under the extensor longus digit-
orum, comes  in  contact with the anterior  tibial artery,
and accompanies it down the leg; it is distributed on the
back part of the foot and toes.

           POSTERIOR PART OF THE THIGH.
  Above that part  of the fascia which invests the thigh
behind  there  are  several  cutaneous  nerves.   They
originate either from the lumbar  nerves  and  come over
the spine  of the ileum, or from  the great  sciatic nerve
emerging under the edge of the gluteus maximus.   Other
twigs come from the sacral nerves or the sciatic as it passes
down the thigh.

          Muscles on the bach part of the thigh.
  There  are eleven.  Carry an incision along the crest
of the ileum to the  spine, thence over the sacrum to the
point of the os coccygis. Reflect the integuments.
                        17* 
198
PRACTICAL ANATOMY.
  Gluteus  Maximus—Is usually covered by a large
amount of adipose substance.  It arises, fleshy, from the
posterior third of the crest of the ileum, from the whole
lateral surface of the sacrum below the posterior spinous
process, from the  back part of the inferior sacro-sciatic
ligament, over which the  muscle projects, and from the
side of the os coccygis.  The fibres converge to form a
strong flat tendon, which glides over the trochanter major,
is connected to the fascia lata, and is
  Inserted into the rough surface on the outer part of the
linea aspera immeditaely below the trochanter.
  Situation: It is quite superficial, covering all the other
muscles which are situated on the  back part of the hip,
covering also the tuber ischii,  and the tendons of the
muscles which arise from that  projection.  Its insertion
lies between the vastus externus and the adductor" magnus
femoris.
   Use: To  restore the thigh, after it has been bent; to
rotate it outwards; to extend the pelvis on the thigh, and
maintain it in that  position in the erect posture of the
body.
   The muscle  is now to be lifted from its origin, and left
hanging by its tendon;  remark the large  bursa mucosa
formed between the tendon and the trochanter major.
   2.  The Gluteus  Medius—Arises, fleshy, from all  the
outer  edge of the spine of the os ileum, as  far as  the
posterior tuberosity;  from the  dorsum  of  the  bone,
between the spine, and semicircular ridge; also from  the
rough surface which extends from the anterior superior
to  the anterior inferior  spinous  process,  and from  the
inside  of a fascia which covers its anterior part.  The
fibres converge into a strong and broad tendon, which  is
   Inserted into the upper  and outer part  of the great
trochanter.
   Situation: The posterior part  of the belly and  the
tendon  are concealed by the gluteus maximus, but the
 anterior and largest part of this muscle is superficial,
 being covered by a strong fascia.
    Use: To draw the thigh bone outwards, or  away from
 the opposite limb; to maintain  the  pelvis in a state  of 
PYRIFORMIS.
199
equilibrium on the thigh in progression, while  the other
foot is raised from the ground; by its posterior fibres to
rotate the limb outwards; and by its anterior inwards.
  Having lifted up this muscle from its origin, you will
discover
Fig. 63.
•           A View of the Gluteus Minimus Muscle.

  3. The Gluteus Minimus.—It arises, fleshy, from the
semicircular ridge of the ileum, and from the dorsum of
the bone below  the  ridge  within half an inch of  the
acetabulum.  Its fibres run in a radial direction towards
a strong tendon, which is
  Inserted into the anterior and superior part of the great
trochanter.
  Situation: It is entirely concealed by the gluteus medius.
   Use: Same as that of the preceding.
  4. The Pyriformis—Arises, within the pelvis, by three
tendinous and fleshy origins, from the second, third,  and
fourth false vertebra? or divisions of the sacrum.  It forms
a thick belly, which passes out of the pelvis through  the
great sacro-ischiatic foramen above  the superior sacro-
sciatic ligament. 
200
PRACTICAL ANATOMY.
  Inserted, by a roundish tendon, into the uppermost part
of the cavity of the root of the trochanter major.
  Situation: Like the  other small muscles of the hip, it
is entirely concealed by the gluteus maximus; its  belly
lies behind and below the gluteus medius.
   Use:  To move  the  thigh a little upwards, and roll it
outwards.  The  great sciatic nerve,  the  ischiatic and
internal pudic  bloodvessels and  nerves, pass out of the
pelvis below this muscle, and the gluteal bloodvessels and
nerve above it.
  5. The Gemini consist of two heads, which are distinct
muscles.
  (1.) The superior arises from the back part  of the
spinous  process of the ischium.
  (2.) The inferior from the upper part of the tuberosity
of the os ischium, and the anterior surface of the posterior
sacro-sciatic ligament.
  Inserted, tendinous  and  fleshy, into the  cavity at the
root of the  trochanter  major,  immediately below the
insertion of the pyriformis,  and above the insertion of the
obturator externus.
  Situation: Like the other muscles, they are covered  by
the gluteus maximus; they lie below the pyriformis, and
above the quadratus femoris.                          9
   Use:  To roll the  thigh  outwards, and to bind down
the tendon of the obturator internus.
  Lying between the bellies of the  gemini,  you will
perceive,
  6. The Obturator Internus.—It arises, tendinous and
fleshy, from more than one half of the  internal circum-
ference of the foramen thyroideum, and from the inner
surface of the ligament which fills up that hole;  it forms
a flattened  tendon, which  passes out of the pelvis in a
sinuosity betwixt the spinous process and tuberosity of
the ischium, and, becoming rounder, is
  Inserted, into  the  pit  at the  root of the trochanter
major.
  Situation: Its origin lies within the pelvis, and cannot
be exposed till the contents of that cavity  are removed;
the tendon,  where it passes  through the  notch in the 
quadratus femoris.
201
ischium, is seen projecting between the two origins  of
the gemelli.  There is a bursa mucosa betwixt the tendon

                        Fig. 64
         A View of the Muscles on the Back op the Hip.
   1, 2. Gluteus Medius.
    3. Cut  Origin of Gluteus
        Maximus.
    4. Pyriformis.
5, 8,10. Gemelli.
   6, 7. Obturator Internus.
    2. Quadratus Femoris.
of this muscle and the surface of the ischium over which
it glides.
   Use:  To roll the os femoris obliquely outwards.
  7. The Quadratus Femoris—Arises,  tendinous and
fleshy, from an  oblique  ridge, which descends from the
inferior edge of the acetabulum along the body of the
ischium, between its tuberosity and the foramen thyroid-
eum ; its fibres run transversely, to be
  Inserted, fleshy, into a rough ridge on the back part of
the  femur, extending  from the root of the  greater tro-
chanter to the root of  the lesser.
   Situation: It is concealed by the gluteus maximus;  its
origin is in contact with  the origin  of the hamstring
muscles.
   Use: To roll the thigh outwards. 
202
PRACTICAL ANATOMY.
  On lifting up  the  quadratus  femoris from its origin,
and  leaving it suspended by its  insertion, you discover,
running in the same direction, the strong tendon of,
  8. The  Obturator Externus.—This  muscle arises,
fleshy, from almost the whole circumference of the fora-
men thyroideum, and from  the  external surface of the
obturator  ligament; its fibres pass outwards through the
notch placed between the inferior margin of the aceta-
bulum and the tuberosity of the ischium, wind  around
the cervix of the os  femoris, adhering to the capsular
ligament, and terminate in a strong tendon, which is
  Inserted into  the lowermost part of  the  cavity, at the
root of the trochanter major, immediately below the  in-
sertion of  the inferior  head of the gemini.
  Situation: This muscle cannot be distinctly seen, until
all  the muscles which run from the pelvis to the upper
part of the thigh are removed, both on  the fore and back
part.
   Use: To roll the thigh-bone obliquely outwards.
  9. The Biceps Flexor Cruris—Arises by two distinct
heads; the first, called the  Long Head, arises in  com-
mon with the  semitendinosus, by a  short tendon, from
the outer  part of  the  tuberosity of the  ischium, and, de-
scending, forms a  thick fleshy belly.—The second, termed
the Short Head, arises, tendinous and fleshy, from the
linea aspera, immediately  below the  insertion  of the
gluteus maximus; aad from the oblique ridge  running
to the outer condyle, where it is connected with the fibres
of the vastus externus.  The two heads unite at an acute
angle, a little above the external condyle,  and terminate
in a  strong tendon, which is
  Inserted into a rough surface on the  outside of the head
of the fibula.
  Situation: The long head of this muscle is concealed at
its upper part by the  inferior fibres of  the gluteus maxi-
mus ; below this,  it is  situated quite superficial,—it forms
the outer hamstring.
  Use: To bend  the  leg, and particularly by  means  of
its shorter head to twist the leg outwards in the bent state
of the knee. 
SEMITENDINOSUS.
203
  10. The Semitendinosus—Arises,  tendinous, in com-
mon with the long head of the biceps, from the tuberosity
of the ischium; it has also some fleshy fibres arising from
that projection more outwardly:—as it descends, it arises,
for two  or three  inches, fleshy, from the  inside  of the
tendon of the biceps; forms a thick belly, and terminates

                        Fig.  65.
A View of the Principal Muscles of the Back of the Thigh.
at the distance of three or four inches from the knee in
a long round tendon, which, becoming flat, passes behind
the head of the tibia, and is reflected forwards, to be 
204
PRACTICAL ANATOMY.
  Inserted into the anterior angle of that bone, some little
way below its tubercle.
  Situation: This muscle, as well as the biceps, is covered
above  by the gluteus maximus; its belly  lies between
the biceps flexor and gracilis, and  is situated entirely
superficial.
   Use: To bend the leg backwards, and a little inwards.
  11. The Semimembranosus—Arises, by a  strong round
tendon, from the upper and outer part of the tuberosity
of the ischium;  the  tendon, soon  becoming  broader,
sends off obliquely a  fleshy  belly; this muscle is con-
tinued, fleshy, much lower down than that last described.
—The fleshy fibres terminate obliquely in another flat
tendon, which passes behind the inner condyle, sends off
a thin aponeurotic expansion under the inner head of
the gastrocnemius, to cover the posterior part  of the
capsule of the knee-joint, and to be affixed to the external
condyle: the tendon then becoming rounder, is
  Inserted into the inner and back part of the  head of the
tibia.
  Situation: This is a semi-penniform muscle; its origin
lies anterior  to  the tendinous origin of  the  two  last
muscles,  and more outwardly, being situated  between
them and the origin of the  quadratus femoris.
   Use: To bend the leg backwards.
  The two last described muscles properly form the inner
hamstring; but some  enumerate among the  tendons of
the inner hamstring, the sartorius and gracilis.


VESSELS AND NERVES  ON  THE  POSTERIOR  PART OF THE
                       THIGH.

                      Arteries.
  1. Arteria Glutea, or Iliaca Posterior.—This is
the largest branch of the  internal iliac artery; it passes
out of the pelvis at the  upper part of the  sciatic notch.
On raising the gluteus maximus, and  medius, this artery
is seen coming over the pyriformis, betwixt the superior
edge of that muscle and the inferior edge of the os ileum. 
NERVES,
205
The principal trunk passes under the gluteus medius, and
ramifies on  the dorsum  of the os ileum;  other large
branches are also continued to the gluteus maximus, and
the muscles  situated on the back part of the pelvis.
  2. Arteria Sciatica, vel Ischiatica, is another large
branch of the internal iliac, which comes out from under
the pyriformis, betwixt the lower edge of that muscle and
the superior sacro-sciatic ligament; its principal branches
descend between the  trochanter major and tuberosity of
the ischium; it sends other twigs round towards the anus
and perineum.
  Both these arteries inosculate with  the other branches
of the internal and external iliac.
  The Internal Pudic, a branch of the ischiatic, within
the pelvis, comes out below the pyriformis, and re-enters
the pelvis through the lesser ischiatic opening, and con-
tinuing up along the ramus of the ischium and pubes, is
ultimately distributed to the penis.
  The Veins  correspond  exactly to the arteries.  They
terminate in the internal iliac vein.

                       Nerves.
  Nervus  Sciaticus, vel Ischiaticus, or the Great Sci-
atic Nerve,  from the sacral plexus, is seen coming  out
of the pelvis, below  the pyriformis.   It descends oyer
the gemiui  and quadratus femoris in the hollow betwixt
the great trochanter and the tuberosity of the ischium—
runs  down  the back part of the thigh, anterior to, i. e.
nearer the bone than the hamstring muscles; being situ-
ated between the anterior surface of the semi-membrano-
sus and  the posterior surface of the triceps adductor
longus.  After sending off the peroneal nerve, it arrives
in the ham,  and becomes the Popliteal nerve.  In this
course it gives off several branches to the muscles and
integuments.  It sometimes perforates the belly of  the
pyriformis by distinct trunks, which afterwards unite.
   Gluteal Nerve,  derived from the fifth  lumbar nerve,
and accompanying the Gluteal Artery.
   Internal  Pudic  Nerve, derived from  the  sacral
     18 
206
practical anatomy.
plexus, and follows the course of Internal Pudic Artery
and its branches.
  Lesser Ischiatic—from the sacral plexus:  passes out
below the pyriformis, and passes down the thigh to the
ham,  where it becomes  connected  with  the  external
saphenous nerve.  Its branches are muscular, and  cuta-
neous ; to the gluteus maximus integuments  of the hip,
&c.  One branch, the Inferior Pudendal, curves around the
tuber ischii, and is distributed to the scrotum.

dissection of the ham and fascia on the  back part
                   of the thigh.
  On removing the integuments from the back part of
the knee-joint and leg, we observe a Fascia, which covers
the great vessels and muscles.  It is evidently continued
from the great fascia of the  thigh, is strengthened by ad-
hesions to the condyles of the femur, and to the head of
the fibula, and is prolonged upon the muscles on the back
of the leg.
  Upon dissecting back that part of the fascia which
covers the ham, the Great Sciatic Nerve appears lying
between the outer and inner hamstring muscles.  This
nerve, having  given  off branches about the ham, and to
the integuments on the back of the leg, divides at some
distance above the condyles of the femur into two large
branches.
  1. The Greater Nerve continues its  course betwixt the
heads  of the  gastrocnemii  muscles.  In  the ham it  is
named the Popliteal Nerve, and where it descends in
the leg, Posterior Tibial.
  2. The lesser Nerve, which is the  external branch, is
named the Peroneal or Fibular Nerve ; it passes out-
wards and obliquely downwards, runs between the  exter-
nal head of the gastrocnemius, and  the  tendon of the
biceps flexor cruris;  and sinks among the muscles which
surround the head of the fibula.

            Branches of the Peroneal Nerve.
   (1.) Cutaneous branches are sent off from the peroneal
nerve at its uppermost part over the gastrocnemius to the 
                Fig. 66.
A View of  the Greater and Lesser Sci-
  atic Nerves in their entire  Course
  down the Limb.
207
    1.  Superior Gluteal Nerve.
    2.  Pudic Nerves.
    3.  Lesser Sciatic Nerve.
    5.  Inferior Pudendal Branch.
    6.  Continuation of the Small Sciatic.
    7.  Greater Sciatic Nerve.
  8,9.  Popliteal  and  posterior  Tibial
        Nerve.
10,12.  Short Saphenous Nerve.
   11.  Peroneal Communicating Branch.
   13.  Peroneal Nerve. 
208
PRACTICAL ANATOMY.
integuments in the back part of the leg, and outer side of
the foot.  Branches also are distributed about the joint.
  (2.) A  large branch, the Anterior  Tibial  Nerve,
passes under the flesh of the peroneus longus and extensor
longus digitorum, where those muscles arise from  the
heads of the fibula and tibia; and comes in contact with
the anterior tibial artery, which it accompanies down the
leg.
  (3.) Another branch  passes into the  upper extremity
of the peroneus longus, and is continued in the substance
of that muscle for some space.  It  then emerges from
beneath it, and continues its course under the  muscles on
the forepart and  outside of the leg;  it pierces the fascia,
and, becoming cutaneous, is lost  on the ankle and upper
surface of the foot.  (The Peroneal Cutaneous.)
  Below the great sciatic  nerve, there is much cellular
membrane  and  fat,  which being removed, the Great
Popliteal Vein is exposed.  It adheres to the Popli-
teal Artery, which lies under it close upon the bone.
  Arteria Poplitea is the trunk of the Femoral, which
assumes that name, after it has perforated the tendon of
the triceps.  It lies between  the condyles of the femur,
close upon the bone, and descends between the heads of
the gastrocnemius.  At the lower edge  of the popliteus,
the popliteal artery divides into the Anterior  and Pos-
terior Tibial Arteries.
  Branches.—1. Articular Arteries are  four or five
small twigs, ramifying over  the knee-joint  and neigh-
boring muscles,  inosculating with one another, and with
the arteries below the knee.
  2.  Two branches are sent to the two heads of the gas-
trocnemii muscles;  the sural twigs are  also given to the
soleus, plantaris, &c.
  The Popliteal Vein receives branches corresponding
to those of the artery; it  lies behind the artery in the
erect posture.
  About two inches above  the condyle, it receives the
Vena Saphena  Minor, which returns the blood from the
outer side of the foot;  the trunk of this vein lies  under
the fascia on the back of the leg. 
SOLEUS, OR GASTROCNEMIUS INTERNUS.     209
    DISSECTION OF THE POSTERIOR PART OF THE LEG.

  The fascia investing the posterior part of the leg is
much thinner than on the front part.  Eemove it and the
muscles on this aspect of the limb may be exposed.
  They are seven in number.
  1. Gastrocnemius—Arises, by two  heads, from  the
upper and back part of the condyles of the os  femoris.
Each head forms  a fleshy belly, the fibres of which  are
oblique, passing from a tendinous expansion which covers
the posterior  surface of the muscle to  another which
covers the anterior  surface.  The internal  belly is the
largest, and they are separated  by a triangular interval,
in which the popliteal bloodvessels and  nerves pass to the
leg.   These heads unite a little below the knee, in a mid-
dle tendinous line, and below the middle of the tibia ends
in a strong flat  tendon which joins that of the soleus.  In
the groove on its surface lies the saphena externa nerve
and vein.
  Eeflect the two  heads of the  gastrocnemius from  the
femoral condyles, and you will then expose
  2. The Soleus, or Gastrocnemius Internus—which
arises by two origins or heads.  The  first,  or External
Origin, which is by much the largest,  arises, principally
fleshy, from the posterior surface of the  head of the fibula,
and from the external angle of  that bone, for two-thirds
of its  length, immediately behind the  peroneus longus.
The second, or internal head, arises, fleshy,  from an ob-
lique ridge on the posterior surface of the tibia, just below
the popliteus, and from the inner  angle of that bone,
during the middle third of its length.   The two heads
which are separated at  first by the posterior tibial artery
and nerve, unite immediately, form a large belly, which,
covered by the  tendon of the gastrocnemius, is continued,
fleshy, to within  a short  distance of the ankle-joint; a
little above which  the tendons of the gastrocnemius and
soleus unite, and form a strong  round tendon, named the
Tendon  Achillis,  which  slides over  the  upper  and
posterior part of the os calcis, where it is furnished with
a small bursa mucosa, to be
                         18* 
210
practical anatomy.
  Inserted into a rough surface on the back part of that
bone.
  Situation: The gastrocnemius arises between the ham-
string tendons: Its belly is superficial, and  forms  the
upper or greater calf of the leg.
  The soleus has its largest part concealed by  the gastro-
cnemius, but part of it appears on each side of the belly
of that muscle.  There is a bursa mucosa  betwixt  the
upper part of the os calcis and the tendo Achillis.

                          Fig. 67.
     The Superficial Muscles of the Posterior Face of the Leo.
1. The Biceps  Muscle forming the Outer Ham-
    string.
2. The Tendons forming the Inner Hamstring.
3. The Popliteal Space.
4. The Gastrocnemius Muscle.
5. The Soleus.
6. Tendo Achillis.
7. The Posterior Tuberosity of  the Os Calcis.
8. The Tendons  of the  Peroneus  Longus and
    Brevis Muscles passing  behind  the outer
    ankle.
!). The Tendons  of the Tibialis Posticus and
    Flexor Longus Digitorum  Pedis passing
    into the foot behind the inner ankle.
   Use: To elevate  the os calcis, and thereby, to lift up
the whole  body as a preparatory measure to its being car-
ried forward in progression;  to carry the leg backwards 
POPLITEUS.
211
on the foot when that is fixed; the gastrocnemius, from its
origin in the thigh, also bends the leg on the thigh.
  The heads of the gastrocnemius should now be lifted
up, which will expose
  3. The Plantaris.—This muscle  arises,  fleshy, from
the upper part of the external condyle, and from  the ob-
lique ridge above  that condyle, forms a pyramidal belly
about three  inches in length, which adheres  to  the cap-
sule of the knee-joint, runs  over the  popliteus, and  ter-
minates  in  a long, slender, thin tendon.  This  tendon
passes obliquely inwards over the inner head of the soleus,
and under  the  gastrocnemius;  emerges from between
those two muscles, where their tendons unite, and then
runs down by the inside of the tendo Achillis, to be
  Inserted into the posterior part of the os calcis, on the
inside of the insertion of the tendo Achillis, and some-
what before it.
   Situation: The origin and belly  of  this  muscle  are
concealed by the external head of the gastrocnemius.
   Use:  To  extend the foot and  roll it inwards, and to
assist in bending the leg.
  4. The Popliteus—Arises, within the capsular liga-
ment of  the knee, by a round tendon, from a deep pit or
hollow on the outer side of the external  condyle; adheres
to the posterior and  outer surface  of the external semi-
lunar cartilage;  passes, within  the cavity of the joint,
over the side of the condyle to its back part; perforates
the  capsular ligament, and  forms a  fleshy  belly, which
runs obliquely inwards, being covered by a thin tendinous
fascia, to be
  Inserted, broad, thin, and fleshy, into an oblique ridge
on  the  posterior surface of the tibia, a little below its
head, and into the triangular space above that ridge.
  Situation: This muscle  is  concealed  entirely by the
gastrocnemius.
   Use:  To bend the leg, and, when bent, to roll it, so as
to turn  the toes inwards.
  The belly of the soleus should now be lifted, in order
to  expose the  deeply seated  muscles.  A strong mem-
branous fascia {Intermuscular) is seen  connecting  and
investing them, which is to be removed.   This fascia also 
212
PRACTICAL ANATOMY.
covers the posterior  tibial  vessels and  nerve, but  the
description of the course of  these vessels, though seen in
this stage of the dissection, must be deferred.
  The deep-seated muscles are,
  The Flexor Longus Digitorum Pedis; situated behind
the tibia.
  The Flexor Longus Pollicis Pedis, situated behind  the
fibula.
  The Tibialis Posticus, which  is  almost concealed by
the two other muscles, and by the fascia,  which connects
them, and binds them down.
  5.  The Flexor Longus Digitorum Pedis Perforans
—Arises, fleshy, from  the posterior flattened surface of
the tibia, between its internal and external angles, below
the attachment  of the soleus, and continues to arise from
the bone to within two or three inches of the ankle;  the
fibres pass obliquely into a  tendon.  This tendon runs
behind the inner ankle in  a groove of  the tibia, passes
under a strong ligament which goes from  the inner ankle
to the os calcis, and having  received a strong  tendinous
slip  from the  flexor  pollicis longus, divides about  the
middle of the sole  of the foot into four tendons, which
pass  through  the slits in the tendon of the flexor digit-
orum brevis,  and are
  Inserted into the extremity of the last joint of the four
lesser toes.
  The situation of the tendon  is  described with  the
muscles of the foot.
   Use: To bend the last joint of the toes, and to assist
in extending the foot.
  6.   Flexor Longus  Pollicis Pedis—Arises, fleshy,
from the posterior  flat surface  of the fibula, continuing
its origin from  some distance below the head of the bone
to within an inch of the ankle.   The fleshy fibres  termi-
nate  in a tendon, which passes  behind the inner ankle
through a groove in the tibia; next through a groove in
the astragalus, crosses in the sole of the foot the tendon
of the flexor longus digitorum, to which it gives a  slip of
tendon; passes between the  two sesamoid bones, and  is
  Inserted into  the last joint  of the great toe.
  Situation: It lies on the  outside of the flexor longus 
TIBIALIS POSTICUS.
213
digitorum, between that muscle and the peroneus longus;
the tendon will be seen in the foot.
   Use: To bend the last joint of the great toe, and, being
connected by a  cross slip to  the  flexor digitorum  com-
munis, to assist in bending the other toes.

                          Fig. 68.
             Deep Muscles on the Back of the Leg.
 1. The Lower Extremity of the Femur.
 2. Ligament of Winslow.
 3. Tendon of the Semimembranous Muscle.
 4. Internal Lateral Ligament of the Knee-Joint.
 5. External Lateral Ligament.
 6. Popliteus Muscle.
 7. Flexor Longus Digitorum Pedis.
 8. Tibialis Posticus Muscle.
 9. Flexor Longus Proprius Pollicis Pedis.
10. Peroneus Longus Muscle.
11. Peroneus Brevis.
12. Tendo Achillis divided near its Insertion.
13. Tendons of the Tibialis Posticus and Flexor
     Longus Digitorum Pedis, just as they are
     about to pass beneath the Internal Annu-
     lar Ligament.   The interval between the
     latter Tendon  and the Tendon of the
     Flexor Longus Pollicis is occupied by the
     Posterior Tibial Vessels and Nerve.
   7.  The Tibialis  Posticus—Arises,  fleshy, from the
posterior surface of both the tibia and fibula, immediately
below the upper  articulation of these  bones  with each
other; from the whole of the interosseus ligament;  from
the angles of the bones to which that ligament is attached;
and from the flat surface of the fibula behind its internal
angle for more than two-thirds of its length.  The fibre 
214
PRACTICAL ANATOMY.
run obliquely towards a middle tendon, which, becoming
round, passes behind the inner ankle through a groove in
the tibia.
  Inserted into the upper and inner part of the os navicu-
lare, being further continued through a groove in that
bone to the internal and external cuneiforme bones.
  Situation: The belly is concealed at its lower part by
the flexor longus digitorum and flexor pollicis, and can-
not be seen till those muscles are separated.  The tendon
crosses under that of the flexor longus digitorum above
the ankle, and, where it passes through the groove in the
tibia, is situated more  forward than the tendon of that
muscle.
   Use: To extend the foot, and turn it inwards.


VESSELS AND NERVES OF THE POSTERIOR PART OF THE
                        LEG.

                      1. Arteries.
  Arteria   Tibialis  Postica.—The  posterior  tibial
artery, which is the continued trunk  of the popliteal,
sinks under the origins of the soleus, and runs down the
leg between  that muscle and the more  deeply scattered
flexors of the toes:  It  does not lie in immediate contact
with the fibres of the flexors, but, like the femoral artery,
is  invested  by a strong sheath of  condensed  cellular
membrane.  It is, together  with  its veins  and accom-
panying nerve, also supported by the fascia which  binds
down the deep-seated muscles.  As it descends, it gradu-
ally advances more forwards, following the course  of the
flexor  tendons:  it passes behind  the  inner ankle, lying
posterior to the tendon of  the flexor longus digitorum,
and  anterior to  that of the flexor  longus pollicis.  It
sinks  under  the abductor  pollicis, arising from the os
calcis, and immediately divides into two branches:
  (1.) The Internal Plantar  Artery is the smallest, and
ramifies among the mass of muscles situated on the inner
edge of the sole of the foot.
  (2.) The External Plantar Artery directs its  course 
ARTERIES.
215
outwards, and having reached the metatarsal bone of the
little toe, forms the  Plantar Arch, which crosses the
three  middle  metatarsal  bones obliquely,  about their
                   Fig. 69.
Arteries on the Back of the Thigh, Leg, and Foot.
1, 2.  Popliteal Artery.
  3.  Anastomotic Artery, the Last Branch
      of the Femoral.
  4.  Superior Internal Articular Artery.
  5.  Superior External Articular Artery.
  6.  Inferior Internal Articular.
  7.  Azygos Artery.
  8.  Sural or Gastrocnemial Arteries.
  2.  Point at which the Popliteal divides
      into the Anterior and Posterior Ti-
      bial Arteries.
  9.  Point at which the Posterior Tibial
      gives off the Peroneal Artery; being
      called thus far the Tibio-Peroneal
      Artery.
 10.  Nutritious Artery of the Tibia.
 11.  Continued Trunk of the Posterior Ti-
      bial Artery.
 12.  Peroneal Artery.
 13.  External Malleolar Artery.
 14.  External Plantar Artery.
 15.  Internal Malleolar Artery.
 16.  Inferior External Articular Artery.
middle, and terminates at the space betwixt the^ two first
metatarsal bones, where the  trunk of the anterior  tibial
artery  joins  the  arch.  The convexity of this arch is
towards the toes, and sends off the following branches.
   a, A small  branch to the outside of the little toe. 
216
PRACTICAL ANATOMY.
  b, Ramus  digitalis primus, or the first  digital artery,
which runs along the space between the two last  metatar-
sal bones, and bifurcates into two  branches, one to the
inner side of the little toe, and the other to the outer side
of the next toe.
  c, The second digital artery, which runs  along  the next
interosseous space, and bifurcates in a similar manner.
  d,  The third digital artery.
  e, The fourth, or Great Digital Artery, which sup-
plies the great toe, and the inner  side of the  toe next
to it.
  The concavity of the arch sends off the Interosseal
arteries, three or four small twigs, which go to the deep-
seated parts in the sole of the foot, and, Perforating be-
tween the metatarsal bones, inosculate with the  superior
interosseal arteries on the  upper side of the foot.
  The branches  of the Posterior Tibial  Artery in the
leg are,
  1. The Peroneal Artery, which  comes off  from the
tibial a little after it has sent off the anterior tibial; it is
generally of a considerable size;  it runs upon the inside
of the fibula, giving numerous branches to the  peroneal
muscles and flexor of the great toe; its course is irregular.
At the lower part of the leg, it splits into,
  a, A. Peronea Anterior, which  passes betwixt the
lower heads of the tibia and fibula, to the  forepart of the
ankle, where it is lost.
  b,  A. Peronea Posterior is properly the termination
of the artery; it descends along the sinuosity of the  os
calcis, inosculating  with the  branches  of  the tibialis
postica, and terminates in the posterior part of the sole
of the foot.
   2. Muscular branches arise from the  artery  as  it de-
scends; twigs also are sent over the heel and ankle.

                       2. Veins.
   Ven^e Tibiales Postica.—The posterior tibial veins
are generally two in number; they accompany the artery,
and  terminate in the popliteal vein;  they are formed of
branches, which correspond to those of the artery. 
         DISSECTION OF THE SOLE OF THE FOOT.     217


                      3. Nerves.
  The Posterior Tibial Nerve, which is the continua-
tion of the  great sciatic  nerve, sinks  below the  soleus,
and accompanies the posterior tibial artery;  it gives  off
numerous filaments to the muscles in its neighborhood.
At  first  it is  immediately behind the artery, gradually
getting on the outside of it as it descends:  so that where
they pass along the  sinuosity of the os calcis, the nerve
is situated close in  contact with the side of the  artery,
but nearer to  the projection of the  heel than  that vessel
is.  With the artery, it divides into,
  1. The internal plantar nerve, and,
  2. The external plantar nerve.—These nerves  supply
the muscles and integuments in the sole of the foot.


         DISSECTION OF THE SOLE OF THE FOOT.

  The cuticle is very much thickened  on  the sole of the
foot from constant  pressure;  betwixt the integuments
and plantar aponeurosis, we find a tough  granulated fat,
which adheres firmly to the aponeurosis, and is dissected
off with difficulty.
  Aponeurosis, seu Fascia Plantaris, is a  very strong
tendinous expansion, which arises from  the projecting
extremity of the os calcis, and passes to the root of the
toes, covering and supporting the muscles of the sole of
the foot.  Where it arises from the heel,  it is thick, but
narrow; as it runs over the foot, it becomes broader and
thinner; and  it is fixed to the  head of each of the meta-
tarsal  bones  by a  bifurcated extremity, which, by its
splitting, leaves room for the tendons, &c, to pass.   It
seems divided into three portions, which are connected by
strong fasciculi of  tendinous fibres; and  fibres are sent
down,forming perpendicular partitions among the muscles,
and separating them into three classes:—
   1. The middle portion, which is the largest, and under
which are contained the flexor brevis digitorum,  and the
tendons of the flexor longus and lumbricales.
     19 
218
PRACTICAL anatomy.
  2.  The  external lateral  portion,  which  covers the
muscles of the little toe.
  3. The internal lateral portion, concealing the muscles
of the great toe.
  On  removing  the plantar aponeurosis, the first order
of muscles in the sole of the foot is exposed: it consists
of three  muscles:
  1. Abductor  Pollicis Pedis—Arises, tendinous and
fleshy, from  the  lower and  inner part of the os calcis;
from a ligament which extends from the os calcis to the
os naviculare; from the inside of the os naviculare and
cuneiforme internum;  and from the fascia plantaris.
  Inserted, tendinous, into the internal sesamoid bone and
base of the first phalanx of  the great toe.
   Use: To move the great toe from the rest.
          Fig. 70.
Muscles of the Side of the Foot.
  1. Abductor Pollicis.
2, 2. Its Tendon.
3, 3. Flexor Brevis Pollicis.
  4. Tendon of Flexor Longus Pollicis.
  5. Aponeurosis Plantaris, divided.
6, 7. Flexor Brevis Digitorum Pedis.
  7. Lumbricales.
  8. Abductor Minimi Digiti.
  9. Flexor Brevis Minimi Digiti.
 10. Interossei.
  2. Abductor Minimi Digiti Pedis—Arises, tendinous
and fleshy, from the outer side of the os calcis, and from 
muscles of the foot.
219
a strong ligament which  passes from  the os calcis to the
metatarsal  bone of the little toe;  also from the fascia
plantaris.
  Inserted, tendinous, into the base of the metatarsal bone
of the little toe, and into the outside of the base of the
first phalanx.
  This muscle can frequently be divided distinctly into
two portions.
   Use: To move the little toes from the other toes.
  3. Flexor Brevis Digitorum  Pedis Perforatus—
Arises, fleshy, from the anterior and inferior part of the
protuberance of the os calcis, and from the inner surface
of the fascia plantaris; also from the tendinous partitions
betwixt it  and the  abductors of the great and little toe.
It forms a  thick fleshy belly, and sends off four  tendons,
which split for  the passage of the tendons of the flexor
longus digitorum, and are
   Inserted  into the second phalanx of the four lesser toes.
   The tendon of the little toe is often wanting.
    Use: To bend the second  joint of the toes.
   The first order of muscles  being  removed,  or being
lifted from their origins and left hanging by their tendons,
the second order is exposed.
   1. The tendon of the flexor longus digitorum pedis is
 seen coming from the inside of the os calcis, and, having
 reached the middle of the foot, dividing into its four ten-
 dons,  which pass through the  slits of the tendons of the
 flexor digitorum brevis, and are inserted into the base of
 the last phalanx of the four  lesser toes.
   2. The  tendon of the Flexor  longus pollicis is  seen
 crossing under the tendon of the flexor longus digitorum,
 and, having given to it a short slip of tendon, proceeding
 between the two sesamoid bones to  the base of the  last
 phalanx of  the great toe.           .
    3. Flexor Digitorum Accessories, or Massa Oarnea
 Jacobii Sylvii—Arises, fleshy, from the sinuosity at the
 inside of  the  os  calcis, and, tendinous, from that bone
 more outwardly.   It forms a belly of a square forrn.
    Inserted into the outside of the tendon of the flexor
 digitorum longus, just at its division. 
220
practical anatomy.
   Use: To assist the flexor longus.
  4. Lumbricales Pedis—Arises, by four tendinous and
fleshy beginnings, from the tendons of the flexor longus
digitorum, immediately after their division.
  Inserted, by four slender tendons, into the inside of the
first phalanx of the  four lesser toes, and into the tendi-
nous expansion that is sent from the  extensors to cover
the upper part of the toes.
   Use: To promote the flexion of the toes, and to draw
them inwards.
  The second order of muscles being removed, we expose
the third order:—
  1. Flexor Brevis Pollicis Pedis.—It arises, tendi-
nous, from the under and forepart of the os calcis, where
it joins with the os cuboides; also from the  os  cunei-
forme externum.   It forms a fleshy belly, which is con-
nected inseparably to the abductor and adductor pollicis.
  Inserted, by two tendons, into the external and internal
sesamoid bones; and it is  continued  on into the base of
the first phalanx of the great toe.
   Use: To bend the first joint of the great toe.
  2. Adductor Pollicis Pedis—Arises, tendinous  and
fleshy, from a strong ligament which extends from the
os calcis to the os  cuboides, and from the roots of the
second, third, and fourth metatarsal bones.  It forms a
fleshy belly, which seems  at  its beginning divided into
two portions.
  Inserted, tendinous, into the external sesamoid bone and
root of the metatarsal bone of the great toe.
   Use: To bring this toe nearer the rest.
  3. Flexor Brevis Minimi Digiti Pedis—Arises, ten-
dinous and  fleshy, from the os cuboides, and from  the
root of the metatarsal bone of the little toe.
  Inserted, tendinous, into the base of the  first phalanx
of the  little toe and into the anterior extremity of  the
metatarsal bone.
   Use: To bend this toe.
  4. Transversalis Pedis—Arises, tendinous, from  the
anterior extremity of the metatarsal bone supporting  the' 
MUSCLES OF THE FOOT.
221
                        Fig. 71.

Dissection of a SecoND Layer of the Plantar Muscles of the Foot.
                                            ,.....'.............\
 9.
10.
11.
12.
13.
Tendon of Tibialis Posticus.
Tendon of Flexor Longus Pollicis.
Tendon of Flexor Longus Digitorum.
Point where it separates into four Ten-
 dons.
Points of Insertion.
Flexor Accessorius.
Calcaneo-cuboid Ligament.
Lumbricales Pedis.
Adductor Pollicis.
Flexor Brevis Pollicis.
Tendon of Peroneus Longus.
Flexor Brevis Minimi Digiti.
Interossei Muscles.
little toe; becoming fleshy,  it crosses over the anterior
extremities of the other metatarsal bones.
  Inserted, tendinous, into the anterior extremity of the
metatarsal  bone of the  great toe, and into the internal
sesamoid bone adhering to the adductor pollicis.
   Use: To  contract  the foot, by bringing the toes nearer
each other.
  Banging  with  this  order of muscles, we  may also
observe—
  A broad  strong ligament, passing from  the anterior
sinuosity of the os calcis over the surface of the os cu-
boides.
  The tendon of the tibialis  posticus, dividing into nume-
rous tendinous slips, to be inserted into the bones of the
tarsus.
  Having removed the muscles last described, we expose
the fourth and last order.
  The tendon  of the peroneus longus is seen  passing
                           19* 
222
PRACTICAL ANATOMY.
along a groove in the os cuboides, and crossing the tarsal
bones, to be inserted into the base of the metatarsal bone
of the great toe, and into the internal  cuneiforme and
second metatarsal bones.

                          Fig. 72.
                      Plantar Interossei.
    1. Metatarsal Bone of the Great Toe.
2, 2, 2. Interosseous Muscles.
3, 3, 3. Their Insertion into the First Phalanx.
  Interossei Pedis Interni are  three in number, situ-
ated  in  the sole of the foot.  They arise,  tendinous and

                          Fig. 73.
                  Dorsal Interossei Muscles.
      1. First Metatarsal Bone.
    2, 2. Interossei Muscles.
3, 3, 3, 3. Their tendinous inser-
          tion into the first Pha-
          langes of the Toes. 
MALE ORGANS OF GENERATION.         223
fleshy, from between the metatarsal bones  of the  four
lesser toes, and are
  Inserted, tendinous, into the inside of the  base of the
first phalanx of each of the three lesser toes.
   Use: To move the three lesser toes inwards  towards
the great toe.
  Interossei Pedis Externi are four in number, larger
than the internal interossei, and situated on the back of
the foot; they are bicipites, or arise by two slips.
  Arise,  tendinous  and  fleshy, between  the metatarsal
bones of all the toes.
  Inserted, the first,  abductor indicis pedis, into the inside
of the base of the first phalanx of the fore-toe;—the second,
adductor indicis pedis, into the outside of the same toe;
—the  third, adductor medii digiti pedis, into the outside
of the middle toe; the fourth, adductor tertii digiti pedis,
into the outside of the third toe.
   Use: To separate the toes.
               CHAPTEK  XIII.

  DISSECTION OF THE  PERINEUM AND OF THE  MALE
              ORGANS OF GENERATION.

  The subject should  be secured as in the operation for
Stone. A staff passed into the bladder, and some hair into
the. rectum.  Carry two  incisions, one upon either side,
from  the root of the scrotum  to the tuberosities of the
ischii; from thence to the point of the coccyx, and dissect
the flap upwards.
  The muscles of the perineum  consist of five pair, and
a single muscle:
  Erector Penis,        1
  Accelerator Urinas,   I Qn each  , SpHINCTER AxT
  Transversus Perinei,  \   gide>   j  gi  le musde>
  Levator Ani,
  Coccygeus, 
224             practical anatomy.
  The Raphe or line running along the skin of the peri-
neum, marks the place where the opposite muscles meet.
The appearance of these muscles will vary in different
subjects.  In those who have died weak and emaciated,
the fibres will be  pale, and not very evident,  while  in
strong muscular men, who have expired suddenly, they
will be very distinct.  When the fat and superficial fascia
have  been carefully cleared away, the first muscle com-
ing into view will  be the  superficial sphincter ani;  and
in front of the anus, a shining fascia will be seen stretch-
ing across from the ramus of the pubes and ischium of one
side to the same points on the other.  This is the Super-
ficial Perineal  Fascia of some.  The Middle Peri-
neal fascia of others.  All  in front of the anus is called
the anterior or urethral perineum.  This fascia covers the
muscles of this part of the perineum,  and, instead of con-
tinuing back over the superficial sphincter ani, dips down
in front of  the anus, and  becomes connected with the
anterior layer of the triangular ligament, or Deep Peri-
neal fascia.  On either side of the rectum, and the tuber-
osities of the ischii, are  two large deep fossae, filled with
granulated fat, and having bloodvessels and nerves from
the Internal Pudic Artery, vein, and nerves.  These are
the Ischio-Rectal Fossae.  The outer boundary of these
cavities is formed by the obturator internus  muscles,
covered by the obturator fascia; the inner boundary by
the levator ani muscles, covered by the fascia of the same
name.  Clean off the fascia, and you will expose the fol-
lowing muscles:—
  1. The Erector Penis—Arises, tendinous and  fleshy,
from the tuberosity of the os ischium; its fleshy fibres
proceed upwards over the crus of the penis, adhering  to
the outer and  inner edges of the ascending ramus of the
os ischium, and of  the descending ramus of the os pubis;
—but before the two crura meet to form the body of the
penis, it ends in a  flat tendon, which is lost in the strong
tendinous  membrane that covers the corpus cavernosum.
  Situation: This  muscle  covers  all the surface  of the
crus penis that is not in contact with  bone.
   Use: It was formerly supposed to compress  the crus 
ACCELERATORES URIN.E.
225
penis, and thereby to propel  the blood into the forepart
of the corpus cavernosum; and to press the penis upwards

                         Fig. 74.

              View of the Deep Perineal Fascia.

                          1_____
      Symphysis Pubis.
      Sub-pubic Ligament.
      Triangular Ligament, or Deep Perineal Fascia.
      Perforation for the Urethra.
      Two prominences of anterior layer of the Fascia, marking the
       Position of the included Cowper's Glands.
      Pudic arteries.
      Arteries of the Bulb.
      The Superficial Perineal Fascia dissected off in three angular
       Flaps.


against the pubis.   But its obvious effect must be that of
drawing the  crus downwards. to the tuber ischii; which
cannot have  any influence  in  contributing to the erect

state of the organ.
  2. Acceleratores  Urinje—Arise  from a tendinous
point in the centre of the perineum, and a tendinous line
in the middle of the bulb.  The  fibres diverge.   The in-

ferior  ones 
226
PRACTICAL ANATOMY.
  Inserted into the ramus of the ischium and pubis. The
middle surround the corpus spongiosum, and the ante-
rior ones extend upon the corpus cavernosum.
   Use: To drive the urine and semen  forwards, by com-
pressing  the  lower part of the urethra,  and to  propel
the blood towards the corpus spongiosum and the glans
penis.

                       Fig. 75.
Perineal Muscles of the Male.
1.	Accelerator Urinae.	7. Gluteus Maximus.
2.	Erector Penis.	8. Adductor Magnus.
3.	Transversus Perinaei.	9. Gracilis.
4.	Sphincter Ani.	10. Adductor Longus.
5.	Levator Ani.	11,13. Corpora Cavernosa
6.	Coccygeus.	12. Urethra.
	14,14.	Spermatic Cords.
  3. The Transversus Perinaei—Arises from the tuber
ischii, immediately behind the  attachment of the erector
penis;  thence its fibres run transversely inwards.
   Inserted into the central  point  of  union  where  the
spinchter ani touches  the accelerator urinae, and where a
kind of tendinous  projection is formed, common  to  the
five muscles.
   Use:  To dilate the bulb of the urethra, to prevent the 
levator ani.
227
anus from being too  much  protruded, and to retract it
when protruded.
  The  middle perineal fascia passes behind these muscles
to join the deep or triangular ligament.  Accompanying
these muscles, is the Transversales Perinei arteries (from
the superficial perineal arteries), which, coming from the
internal pudic, pass up in the groove between the erectores
peni and accelerators urinae.
  There is sometimes another slip of fibres, the Trans-
versus Perinei Alter, which has the same course, and
is inserted into the  posterior part of the  bulb  of  the
urethra.
  4. The Sphincter Ani  Externus  consists of  two
semicircular  planes, which run round the extremity of
the rectum, passing nearly as far out  as the tuber ischii;
the fibres of each side decussate where they meet, and
are
  Inserted into the extremity of the os coccygis behind;
and before, into a tendinous point common to this muscle
and to the  acceleratores urinae and  transversi  perinei.
This tendinous point is  worthy of remark; it seems to
consist in part of an elastic ligamentous substance.
   Use: To close the anus,  or extremity of the  rectum,
and to pull down the  bulb of the urethra.  It is in a state
of constant contraction, independently of the will.
   5. Sphincter Ani Internus—a band of fibres under
the  superficial  sphincter, surrounding the lower end of   •
the rectum.
   More deeply seated than the muscles now described, we
see some of the fibres of
   The Levator Ani.—This muscle arises from the in-
side of the os  pubis,  at the upper edge of  the foramen
thyroideum,  from the inside of the os ischium, from  the
tendinous membrane covering the obturator internus  and
coccygeus muscles; from the semicircular origin its fibres
run down like  radii towards a centre, and are
   Inserted in the two last bones of  the os coccygis,  and
into the extremity of the rectum, passing within the fibres
of  the sphincter ani, but on the  outside of the longitudi-
nal fibres of the gut itself. 
228             practical anatomy.
       Situation: This muscle, with its fellow, very much re-
     sembles a funnel, surrounding the extremity of the rec-
     tum, the neck of the bladder (which passes through  a
     slit in his fibres), the prostate gland, and part of the vesi-
     culae seminales.
        Use: To draw the rectum upwards after the evacuation
     of the faeces, to assist in shutting it, and to compress the
     vesiculae seminales and other viscera of the pelvis.
       6. The Coccygeus arises, tendinous and fleshy, from
     the spinous process of the os ischium, and covers the in-
     side of the posterior sacro-sciatic ligament;  it forms  a
     thin fleshy belly.
       Inserted, into the extremity of the os  sacrum, and into
     the lateral surface of the coccygis, immediately before the
     gluteus maximus.
       Situation: It is  placed betwixt the levator ani  and
     edge of  the gluteus maximus.
        Use:  To support and move the os coccygis forwards,
     and connect it more firmly with the sacrum.
       If the muscles be cleared away the corpus spongiosum
     will be found to rest upon a  dense membrane, which  is
     placed beneath the arch of the pubes, and between the
     rami of the pubes and ischii.  It is the  Triangular
     Ligament. This ligament consists of two layers, between
     which is placed the  membranous portion of the urethra,
     the glands of Cowper, and some muscular fasciculi termed
•    the muscles of Wilson and Guthrie.   The internal pudic
     artery, with nerve, is likewise between its lamellae, and gives
     off a large branch, the Arteria Bulbosi, and another,
     the Arteria Cavernosi.  The main  trunk finally be-
     comes the Arteria Dorsalis Penis.
       The rectum must now be separated from the bladder,
     and pulled downwards.  This dissection will expose a
     great part of  the levator  ani; the neck and body of the
     bladder; the  prostate gland;  the vesiculae seminales;
     part of  the vasa deferentia; part of  the ureters; the
     urethra, its bulb, and corpus spongiosum; the  crura penis,
     and their origin from the ischium; observe,
       1. The connection of the bladder and rectum, and the
     cellular  substance interposed between them. 
VASA DEFERENTIA.
229
  2. The prostate gland, situated between the bladder and
rectum, surrounding the beginning of the urethra in such
a manner that one-third of its thickness is situated above
the urethra, and two-thirds below it; its shape  is some-
what pyriform.
  3. The  Urethra.—The  curve should  be  carefully
observed.   The  urethra begins at the neck of the blad-
der ; it is a continuation of that part of the bladder which
in the erect posture is lowest.  (1.) Its beginning is em-
bedded in the prostate gland.  (2.) Its membranous part
is quite narrow; situated between the prostate gland and
bulb of the urethra, and between the layers of the trian-
gular ligament.  (3.) The urethra then enters the corpus
spongiosum.
  4. The  Corpus Spongiosum Urethras  consists  of a
plexus of  minute veins covered externally by a thin but
uniform fibrous sheet; it surrounds the urethra from a
short distance from the bladder to its extremity.  At its
beginning  it forms a  considerable body of a  pyriform
shape,  termed the Bulb  of the Urethra; that part of the
bulb which is below the urethra is named the pendulous
part of the bulb.  The corpus spongiosum has on its an-
terior the glans penis.
   5.  The Glandulje  Ante prostata,   or   Cowper's
Glands, are two small glands of the size of  peas between
the layers of the triangular ligament.
   6. The  Vesiculae  Seminales are two  soft,  whitish,
knotted bodies, about three or four fingers' breadth in
length and one in breadth, and about three times as broad
as thick; situated between  the rectum and lower part of
the bladder obliquely, so that their inferior extremities
are contiguous, and are affixed to the base of the prostate
gland,  while  their superior extremities are at a distance
from each other, extending outwards and  upwards, and
terminating just on the inside of the insertion of the ure-
ters in  the bladder.  They consist of coiled tubes.
   7. The two Vasa  Deferentia are seen running be
twixt the vesicuke seminales, and united to them and to
the base of the  prostate.  Their union forms the Ducti
Ejaculatorii.   Observe  that part of the bladder left
     20 
230
practical anatomy.
between these tubes, and connected by cellular substance
to the rectum, which is pierced when the bladder is punc-
tured from the latter part,  no peritoneum intervening.

                        Fig. 76.
  Base of the Bladder with the Vesicul^; Seminales, Ureters, and
                     Prostate Gland.


                            Muscular Structure of the Bladder.
                            Ureters.
                            Vasa Deferentia.
                            Vesicula Seminalis.
                            Same of the opposite side, dissected
                             out to show its tubular character.
                            Efferent Duct of the Vesicula Semi-
                             nalis, which joins the Duct of the
                             Vas Deferens to form at 7 the Duc-
                             tus Ejaculatorius.
                            Prostate Gland.
                            Urethra.
  8. The Corpora Cavernosa Penis arise, on each side,
by a process named the Crus, from the ramus  and from
the tuber ischii, ascend along the ischium and pubis, and
are united immediately before the cartilaginous arch of
the pubis.  They consist  of erectile  tissue, covered  by a
strong, white,  fibrous substance,  which  is very  elastic.
Internally  they are cavernous,  and are  separated from
each other by a septum, which, from being perforated, is
named Septum pectiniforme.
  By the union of the two corpora cavernosa, two grooves
are formed: (1.) A smaller one above,  in which two ar-
teries pass,1 a large vein or two betwixt them, and some
large twigs of nerves. (2.)  A larger groove below, which
receives the urethra.
  9. The prepuce  is a fold of skin forming a sheath or
covering for the  glans  penis.  It makes a duplicature
extending along the flat part of the  glans from its  basis
to the orifice of the urethra, termed Frjenum Pr.eputii.

  1 Arteria Dorsalis Penis. It is  the termination of the internal pudic
artery.
 
MALE TELVIS.
231
Fig. 77.
A Side View of the Viscera of the Male Pelvis, in situ.  The Right
  L/ide of the Pelvis has  been removed by a Vertical Section made
  through the Pubis near the Symphysis, and another through  the
  middle of the Sacrum.

  1.  Th^* Divided Surface of the Pubis.
  2.  The Divided Surface of the Sacrum.
  3.  The Body of the Bladder.
  4.  Its Superior Fundus  ; from the Apex is seen passing upwards the
      Urachus.
  5.  The Inferior Fundus  of the Bladder.
  6.  The Ureter.
  7.  The Neck of the Bladder.
8, 8.  The Pelvic Fascia; the Fibres immediately above 7 are given off
      from the Pelvic Fascia, and represent the Anterior Ligaments of
      the Bladder.
  9.  The Prostate Gland.
 10.  The Membranous Portion of the Urethra, between the two Layers
      of the Deep Perineal Fascia, or the Triangular Ligament.
 11.  The Triangular Ligament, or Deep Perineal Fascia formed of two
      Layers.
 12.  One of Cowper's Glands between the two Layers of the Triangular
      Ligament, and beneath  the Membranous Portion of the Urethra.
 13.  The Bulb of  the Corpus Spongiosum.
 14.  The Body of the Corpus Spongiosum.
 15.  The Right Crus Penis.
 16.  The Upper Part of the Rectum.
 17.  The Recto-vesical Fold of Peritoneum.
 IS.  The Middle Portion of the Rectum.
 19.  The Right Vesicula Seminalis.
 20.  The Vas Deferens. 
232
PRACTICAL ANATOMY.
 21. The Rectum covered by the Descending Layer of the Pelvic Fas-
     cia, just as it is making its bend backwards to terminate in the
     Anus.

  10. The Vesica Urinaria, or Urinary Bladder, is
situated within the pelvis, immediately behind the  ossa
pubis and before the rectum.  It is covered on its upper
and back part by  a reflection of peritoneum; in front and
below  (where it is contiguous to the  rectum) it is  con-
nected by cellular membrane  to the surrounding parts.
Shape, oval, but flattened before and  behind, and, while
in the pelvis, somewhat triangular.   Divided  into the
Fundus or bottom, Corpus  or  body, and -Cervix or
neck.  At  the top of the  bladder, above the symphysis
pubis,  may be observed the  superior ligament of the
bladder, consisting of the  Urachus, a  ligamentous  cord,
which  runs up between the peritoneum and linea alba as
far as the navel and two of the ligamentous cords, which
are the remains of the umbilical arteries, and run up from
the sides of the bladder.  The bladder is also connected
in front by two ligaments formed by the pelvic fascia,
and  passing  to the viscus  from either side of the  sym-
physis, and on its sides also by the pelvic fascia.
  Observe the parts of the  bladder not covered by peri-
toneum, as  they are the situations of surgical operations.
These  are  the whole anterior surface, lying against the
pubis,  and rising above it, when the bladder is distended,
so that it may be  punctured above the pubis; the  sides,
at the very lowest part of which the cut is made in the
lateral operation of lithotomy, and where the viscus  may
be punctured from the perineum:  and the inferior sur-
face, resting on the rectum, and allowing us to puncture
from it.  Observe also the direction  of the axis of the
bladder, in  conformity with which all instruments should
be introduced; this is in a line drawn from the navel to
the os  coccygis.
  11. The entrance of the ureters into the bladder on the
outside of the vesiculae seminales.
  12. The rectum, following the curve of the os sacrum
and os coccygis.
  To have a more connected view of  the  relative situa- 
ARTERIES.
233
tion of these important parts, one side of the pelvis should
now be removed  by dividing  the  symphysis pubis, and
by sawing through  the os  ileum, or separating it at its
junction with the sacrum.   By carefully removing all
the cellular membrane, the student will be enabled more
accurately to  examine  the  situation of the parts  above
described.
OF THE VESSELS AND  NERVES CONTAINED WITHIN THE
                       PELVIS.

                      1. Arteries.
  The A. Iliac A Interna, having left the trunk of the
iliaca communis, passes immediately into the pelvis, where
it gives off several large arteries.
  1. A. Ileo-Lumbalis supplies  the  psoas and iliacus
internus muscles.
  2. A. Sacr,e Laterales, two  or  three small vessels
which supply the sacrum, cauda equina, and neighboring
parts.
  3. A. Glutea (or iliaca posterior), a very large branch,
passes out of the pelvis through  the  upper part of the
sciatic notch to supply the haunch; but, in its passage, it
gives some branches to the  os sacrum, os coccygis, the
rectum, and the muscles situated within the pelvis.
  1. A. Sciatica passes out of the pelvis by the sciatic
notch  and below the  pyriformis  muscle  to supply the
hip; in its passage it gives branches to the  neighboring
parts.
  5. A. Pudica (pudenda  communis  or interna) is the
branch of the  internal iliac or ischiatic, which  is more
immediately destined  to supply the  parts of generation,
perineum, and lower part of the rectum.  It goes out of
the pelvis above the superior sacro-sciatic ligament, twists
round  it, and re-enters  the pelvis above and before the
inferior sacro-sciatic ligament; it  then descends on the
inside  of the tuber  ischii, ascends on the inner surface of
the rami of the ischium and pubis, and, reaching the root of
the penis, divides into two branches.  Superficial and deep.
                         20* 
234
practical anatomy.
Fig. 78.
Arteries of the Pelvis.
1. Termination of the Aorta.        9. Obturator Artery.
2. Middle Sacral Artery.          10. Vesical Artery.
3. A Lumbar Artery.             11. Ilio-lumbar Artery.
4. Primitive Iliac Artery.         12 and 13. Lateral Sacral Arteries.
5. External Iliac Artery.          14. Gluteal Artery.
6. Circumflex Iliac Artery.        15. Middle Hemorrhoidal Artery.
7. Epigastric Artery.             16. Internal Pudic Artery.
8. Remains of the Umbilical Ar-  17. Ischiatic  Artery.
    tery of the Foetus converted
    into a Ligament.


  (1.)  A. Superficial Perineal, a branch, which gives
twigs to the bulb of the urethra and neighboring muscles
and skin.  Noticed in the dissection of the perineum.
  (2.)  Arteria  Bulbosi, to the bulbous  part of  the
urethra.
  (3.)  A. Cavernosi, to the  cavernous bodies.
  (4.)  A. Dorsalis Penis passes under the arch of the
pubis, runs along the dorsum penis, and is distributed to
the integuments.
  While in the pelvis, the pudic gives twigs to the blad-
der, prostate and rectum. 
VEINS.—NERVES.
235
                      2. Veins.
  The veins attend the arteries and their ramifications ;
they unite to form the internal iliac vein, except the veins,
from  the rectum, named hcemorrhoidales,  which ascend
along its back part to join the inferior mesenteric vein.

                      3. Nerves.
  The nerves  met with in this dissection consist of nu-
merous twigs sent off from the lumbar and sacral nerves
to supply the parts about the pelvis.
  But, in this dissection, we meet with three pair of large
nerves, which  have their course through the pelvis, and
pass to the thigh.
  1. Course of the  Anterior Crural Nerve while in
the pelvis.  The anterior crural nerve  is formed  by
branches of the first, second, third, and fourth lumbar
nerves; at its origin, it lies under the psoas magnus, and,
as it descends,  passes betwixt the  psoas magnus and
iliacus internus, till, having passed under Poupart's liga-
ment, it emerges from betwixt those muscles, and appears
on the outer side of the femoral artery.
  2. Course of the Obturator Nerve within the pelvis.
This nerve  is formed by branches  of the  second,  third,
and  fourth  lumbar  nerves: it lies  under the internal
border of the psoas magnus, descends into the pelvis, and
goes obliquely downwards, to accompany the obturator
artery through the thyroid hole.
  3. Course of the Great  Sciatic Nerve  within  the
pelvis.  This nerve arises by branches from the fourth
and  fifth lumbar, and three first sacral nerves, which
unite together to form the largest nervous trunk in  the
body.   The  nerve passes betwixt  the  pyriformis and
gemini, and thus escapes from the back part of the pelvis
by the  sciatic  notch.  Sometimes one  of the  branches
goes through the pyriformis, and joins the sciatic trunk
at the back of the pelvis. 
236
practical anatomy.
                   of the scrotum.

  The scrotum consists  externally of  a loose, rugose
skin, and internally of the Dartos, consisting of unstriped
muscular tissue.
  On dividing the anterior part of the scrotum, on either
side of the raphe, we expose a grayish coat, which is the
Tunica Vaginalis  Testes.1   Kemoving this, another
very dense coat, the  Tunica Albuginea, within which
may be seen the proper glandular structure of the testes,
having on its upper edge an appendage termed Epididy-
mis, a little enlarged  above  and  below the Globus Ma-
jor and Minor, all of which are convoluted tubes.
  2. The Spermatic Cord, connecting  the testicle  to the
abdominal ring.  It consists of,
  a. The spermatic artery, a branch  of the aorta; this
divides into several branches, which enter the upper  edge
of the testicle.
  b.  The spermatic veins, which form a plexus that ter-
minates in the abdomen in a single  vein.
  c.  The spermatic nerves, which come from the  sympa-
thetic and lumbar nerves.
  d. The vas deferens, or excretory duct of the testicle.
This is situated in the back part of the cord, and  is dis-
tinguished by its firm cartilaginous feel.
  e.  These parts are all connected by cellular membrane,
and by the tunica vaginalis, which  is covered  by a  thin
muscle.
  /.  The cremaster.  This arises from the obliquus de-
scendens internus, and is lost on the tunica vagiualis.
  It is well now to take out the bladder and  penis, and,
laying them open by an  incision which  shall pass through
the upper wall of the urethra and bladder, notice the in-
ternal appearance.   The bladder consists of four coats,
the peritoneal one, as has been stated, incomplete; the
others are muscular, cellular, and mucous.  The muscular

  1 Tunica vaginalis is derived from the peritoneum, carried down in
the descent of the testicle: it consists, therefore, like all serous mem-
branes, of two layers, with a cavity within.  The outer layer  is the
tunica vaginalis ivtlcxa ; the internal one, the tunica vaginalis propria. 
                MUSCLES OF THE URETERS.            237

coat  consists  of fibres running  in different  directions.
The mucous coat is generally found thrown into folds in
the undistended state of the  organ.   Some  distance be-4
hind its neck  is a smooth triangular surface, the Vesical
       Fig. 79.
1         2i
A View op a Portion op the Inside of the Bladder, with the Prostate
  Gland appended to it by the Attachment op the Common Tendon of
  the Muscles of the Ureters.

1,1.  Inside of the Bladders
  2.  Lower Fundus.
3, 3.  Mouths of the Ureters.
4,4.  Muscles of the Ureters, from which the Mucous Membrane has
      been dissected.
  5.  Junction of the Muscles at the apex of the Vesical Triangle.
  6.  Tendon of the United Muscles.
  7.  Middle Lobe of the Prostate and Point of Insertion, according to
      Sir Charles Bell.
  8.  Caput  Gallinaginis, the  Point  of Insertion according  to  Dr.
      Horner. 
238
PRACTICAL ANATOMY.
Triangle.   The entrance of the ureters corresponds to
the posterior angles, and the mouth of the urethra to the
apex or anterior angle.   The  sides of this triangle are
sometimes ridged up;  and,  if the mucous membrane  be
removed, a few muscular fibres are sometimes seen, which
have been described  as  the muscles of the ureters.  A
pointed  projection in  the orifice of the  urethra is the
uvula vesicas.
  Urethra.—The first part of the urethra passes through
the  prostate gland, which, having in its structure much
unstriped muscular tissue, can compress it.  This portion
is called the prostatic  portion.  In  this part we have a
prolonged elevation of its mucous membrane, the Caput
                         Fig. 80.
The Prostatic, Membranous, axd Part of the Spongy Portion of the
              Urethra with Part of the Bladder.
                          Internal Surface of the Bladder.
                          Vesical Trigone.
                          Openings of the Ureters.
                          Uvulae Vesicas.
                          Urethral or Gallinaginous Crest.
                          Opening of the Sinus Pocularis.
                          Openings of the Ejaculatory Ducts.
                          Openings of the Prostatic Ducts.  The
                           numbers 7, 7, and 8, 8, are placed
                           on the cut surface of the Supra-ure-
                           thral portion of the Prostate Gland.
                          Lateral Lobes of the Prostate Gland.
                          Membranous Portion of the Urethra.
                          Cowper's Glands.
                          Mouths of the Ducts of the same.
                          Commencement of the Spongy Portion
                           of the Urethra.
                          Upper Surface of the Bulb.
                          Roots of the Cavernous Bodies.
                          Corpora Cavernosa.
                          Spongy Portion of the Urethra.
Gallinaginis;  on  its sides are  the  openings of  the
Ducti Ejaculatorii.  On  each side of the  caput is a
considerable depression, the Prostatic Sinuses.   The
numerous  openings  upon  their  floors  are  those of the
Prostatic Ducts.  Sinus Pocularis: an opening in front
of the Caput Gallinaginis.
 
LABIA externa.
239
  Membranous Portion—in  advance of the prostatic,
and is eight to twelve lines in length.
  Bulbous  Portion—so much  of the  urethra as tra-
verses the bulb.
  Spongy Portion—the remaining part of the canal.
Just behind its termination is a fossa, the Fossa Navicu-
lars.   Mucous lacunae are scattered over the surface of
the canal.
  The  Glands of Cowper—two little bodies placed be-
tween the layers of the triangular ligament, and opening
by two ducts into the anterior part of the bulbous ure-
thra.
               CHAPTEK  XIV.

dissection of the organs of generation in the
                     FEMALE.

  Previous to the dissection, it will be proper  to exa-^
mine the external parts.
  The Mons Veneris is a rounded prominence, covered
with hairs after puberty.  It consists of the common  in-
teguments, with an additional quantity of cellular and
adipose  substance, and lies upon the forepart of the ossa
pubis.  From the inferior part of the mons veneris arise
  The Labia Externa, called also the labia majora; they
are continued downwards and forwards in the direction
of the symphysis pubis and terminate in the perineum
anterius: they consist of integuments, cellular substance,
and fat, are thicker above than below, and are red and
vascular on their inner side.  The places where the labia
are joined to each  other  above  and below,  are termed
Commissures, the lower commissure the Fourchette.
  The longitudinal cavity, or fissure, situated betwixt the
labia, and extending from the mons veneris to the perineum
anterius, is sometimes called the  Sinus Pudoris; it is
broader above  than  below,  and  contains several  other
parts.                           .     Tiii    i
  On separating the labia, we see, immediately below the
superior commissure, 
240              practical anatomy.
  Fig. 81.
The Vulva.


     1. Mons Veneris.
     2. Right Labium.
     3. Right Nympha.
     4. Clitoris, of which only the Ante-
         rior extremity is seen.
     5. Vestibule.
     6. Orifice of the Urethra.  "
     7. Commencement of the Vagina.
     8. Fourchette.
     9. Navicularis Fossa.
    10. The Anus.
    11. Perineum.
   The Clitoris, a red projecting  body, situated below
the arch of the pubis, and partly covered by its Prepuce.
The prepuce is a fold of skin, continued from the inner
surface of the labia, so as to cover the superior and lateral
part of the clitoris.  The clitoris resembles the penis of
the male, and  consists  of two cavernous  bodies;  these,
however, cannot be traced in this stage of the dissection.
That part of the body which forms an obtuse projection
externally, is called the Glans.
   The Perineum Anterius  is  that portion of the  soft
parts which extend from the inferior commissure of the
labia to the anus.
   The  Perineum  Posterius is the space betwixt  the
anus and point of the os coccygis.
   Labia Interna, or JNymphas, are two prominent dou-
blings of the integuments, extending from the glans of the
clitoris to the sidos of the vagina.  Their external side is
continued from the inner surface of the labia, and from
the prepuce of the clitoris.
   Vestibulum—A space bounded above by the clitoridis,
and laterally by the nymphai.  At its lower  part we
see the  orifice of the  urethra,  above the orifice of the
vagina;  it consists of a small rising prominence like a  pea,
in the centre of which is  a small opening or hole.
   The  Hymen, or Circulus Membranosus, is a thin  and
 
erector clitoridis.             241
extensile membrane, formed by a doubling of the lining
membrane of the vagina, much contracted in virgins.  It
generally has an opening in its upper part.
  After the destruction of the hymen, in married women,
we see some irregular projections marking the orifice of
the vagina, and termed Caruncul^e Myrtiformes.
  Behind these is the Vagina, or canal leading to the
uterus; at the  extremity of which may be felt projecting
the Os Internum Uteri, or Os Tinc.e. but it cannot be
seen without dissection.
  The skin  should be now divided on the side of the
right labium, and the dissection should  be carried  from
the groin to the side of the anus; the cellular membrane
must be carefully removed, in order to expose the follow-
ing parts.
  We find the Clitoris consisting of two spongy bodies
termed Crura,  which unite  and form the body. The crus
of each side is a cavernous body, arising from the ramus
and  upper part of the  tuberosity of the ischium, con-
tinued along the ramus of  the os pubis,  and uniting with
its fellow opposite to the  symphysis pubis.  The body
formed by the crura does not extend upwards, but forms
a curve downwards towards the urethra; it is  divided
internally by the Septum Pectiniforme, and is attached
to the symphysis pubis  by a suspensory ligament; it is
invested by a  ligamentous  membrane.
   The  muscles which are met with in this dissection
consist of four pair, and two single muscles.
   The Erector Ciatoridis,    »
       Transversus  Perinei, /       h gida
       Levator Ani,          (
       Coccygeus,             '
   The Sphincter Ani,     j     si  le muscles<
       Sphincter Vagina, j       °
   1. The Erector Clitoridis arises, fleshy and tendin-
ous, from the  tuber ischii,  from the inside  of the ramus
of the os ischium, and from the ramus of the os pubis;
It passes over the crus of  the clitoris, and, becoming ten-
dinous, is lost upon it.
     21 
242
practical anatomy.
   Use:  To draw the clitoris downwards  and forwards,
and, by compressing it, to propel the blood.

                        Fig. 82.
Muscles of the Female Perineum.
1, 2, 6. Sphincter Vaginae Muscle.
  3, 4. Erector Clitoridis
 5, 11. Transversus Perinaei
    7. Levator Ani
    8. Gluteus Maximus
    9. Sphincter Ani
10. Junction of the Sphincter
    Ani and Sphincter Va-
    ginas Muscles.
12. Adductor Magnus.
13. Gracilis.
  Arising from the same point, and surrounded by much
cellular membrane, we find,
  2. The Transversus Perinei.—Its origin is the same
as in the male.
  It is  inserted into a ligamentous  substance in  the
perineum anterius, at the  point where the sphincter ani
and sphincter vaginae meet.
  This ligamentous  or tendinous  substance  deserves
attention.  Here, as in the male, it is  the point of union
into which muscles are  inserted.
  Use: To sustain the perineum.
  3. Surrounding  the  extremity of  the vagina, and a
small  part of the vestibulum,  we  find the Sphincter
Vaginae ; it  arises, anteriorly, from the crura of the cli- 
uterus, or womb.
243
toris and pubis on each side; it surrounds  the  orifice of
the vagina, and is
  Inserted into the ligamentous point of the perineum.
   Use: To contract the mouth of the vagina,  and com-
press the plexus retiformis.
  4. The Sphincter Ani exactly resembles  the  same
muscle in the male.
  5. The Levator Ani resembles the same  muscle of
the male; it surrounds the sides of the vagina in part,
and consequently assists in constricting and supporting
it.
  6. The Coccygeus is longer than in the male.
  Under the fibres of the sphincter vaginae you will find
the Plexus Ketiformis, or Corpus Spongiosum Va-
ginae, a  spongy body, consisting of cellular substance,
interwoven  with  a number of convoluted bloodvessels.
It arises  from the sides of the clitoris, passes on each side
of the extremity of the vagina.
  The Vagina is the canal leading from the vestibulum
to the uterus.  It lies betwixt the rectum and inferior
surface of the urethra and bladder, and  is connected to
them by cellular membrane.  It is  composed of fibro-
elastic substance, very vascular; its inner  surface is ru-
gose, and occupied by mucous glands.  On slitting it up,
we see, at its posterior extremity, the Os Uteri, a rounded
projection, with a transverse fissure.
  The Uterus, or Womb.—This organ is best  seen from
the cavity of the  abdomen.   It is situated betwixt the
bladder and rectum, to both of which it is connected by
reflections of peritoneum; it is of the shape of  a  pear,
and of a firm consistence.  The broad upper part of the
womb is called the  Fundus Uteri, the narrower part is
named the neck, or  Cervix Uteri, and the intermediate
part its Body.
  If the uterus be slit open, its cavity will exhibit the
following appearances: Its entrance, the Os Externum,
moderately large.  Then a constricted  portion, Cervix,
which expands into a triangular  cavity,  at the  upper
angles of which open the Fallopian Tubes. 
244             PRACTICAL ANATOMY.
                    Fig. 83.
Transverse Section of the Uterus,and Part of the Vagina.
1. Cavity of the Body.
2. Cavity of the Neck, its  walls
   marked by fine oblique ridges.
3. Cervico-vaginal Orifice (Os Ute-
   ri).
4. Cervico-uterine Orifice.  The two
   bristles are introduced through
   the Orifices of  the Fallopian
   Tubes.
  The uterus has four ligaments, two on each side:—
  1. The  Ligamentum Teres, or Bound Ligament.  It
is a round long cord, extending from the side of the fundus
uteri, and  passing through the abdominal ring, to be lost
in the groin.
  The Ligamentum  Latum, or Broad  Ligament,  is a
broad fold of peritoneum, reflected from  the body of the
uterus, and connecting it on the sides of the pelvis.   The
duplicature of the broad ligament  incloses  the Fallopian
tube, ovary, and round ligament.
  The Fallopian Tubes are two.  Each tube is  con-
tained in  the upper part of the doubling of the broad
ligament; it goes out from the fundus of the womb, and
is a slender hollow tube.  Its outer end  is curved down-
wards and backwards,  and terminates by a  broad fringed
extremity, termed Morsus Diaboli, or  the Fimbria;.— 
OVARIA.—BLADDER.                245
This broad extremity is connected  to  the next pair of
organs.

                          Fig. 84.
Anterior View of the Uterus and its Appendages.
    1. Body of the Uterus.
    2. Its Superior Border or Fundus.
    3. Its Neck (Cervix).
    4. Its Mouth (Os Uteri).
    5. The Vagina.
  6, 6. Broad  Ligament formed by the Peritoneum, which has been
        removed from the Opposite Side.
    7. Prominence formed by the Subjacent Ovary.
  8, 8. The Round Ligaments, cut where  they enter the Internal In-
        guinal Ring.
  9,9. Fallopian Tubes.
10, 10. Their Fimbriated Extremities—on the Left side the Extremity
        of the Tube is turned forward, to show its Mouth or Abdomi-
        nal Orifice.
   11. The Ovary.
   12. The Utero-Ovarian or Broad Ligament.
   13. One of the Processes of the Fimbriated Extremity of the Tube
        connected to the Ovary.
   14. Cut Edge of the  Peritoneum on the Anterior  Surface of the
        Uterus—this Membrane is represented here  as descending
        rather lower upon the organ than is really the  case.


  The Ovaria are two  small oval  bodies, white and flat,
situated by the sides of the uterus, and inclosed  in the
posterior fold of the broad ligament behind the Fallopian
tube; each ovarium  is  connected  to the fundus uteri by
a short round ligament, Ligamentum Ovarii.
  The Bladder is   situated before the  uterus, and  is
described in the preceding chapter.
                           21* 
246               PRACTICAL ANATOMY.
  The Urethra is short in females (one inch to one and
a half long), and  near  the bladder is  surrounded by a
spongy substance.
  The Ureter descends from the kidneys over the psoas
muscle ;  it runs for some space  betwixt the bladder and
vagina, and at last perforates the bladder  near the neck.

                         Fig. 85.
Left Half of a Vertical Section of the Female Pelvis, with the
  Rectum, Vagina, and Bladder laid open, and the Uterus turned
  to the Left Side.

1. Bladder.                     7. Left Fallopian Tube.
2. Urachus.                    8. Left Ovary.
3. Anterior Ligament of the Blad-  9. Uterus.
    der.                      10. Vagina.
4. Urethra.                  11, 12. Anterior  and Posterior Verti-
5. Rectum.                          cal Bands or Pillars of the
G. Transverse Folds or Pouches          Vagina.
    of the Rectum.             13. Clitoris.

  The Rectum  lies behind the uterus. (See the preceding
chapter.) 
PLEURA.
247
  To obtain a more satisfactory knowledge of the relative
situation of the parts, the left side of the pelvis should be
removed as in the male, and the parts  examined in that
situation.
                 CHAPTER  XV.

           OF PARTS WITHIN THE THORAX.

  The cavity may be exposed  by dividing the cartilage
from the ribs, and taking these  out with the sternum.
  On looking under the sternum, while it is lifted up, we
see the Mediastinum, separating, as  it is gradually torn
from the posterior surface of the sternum, into two layers,
and thus forming  a triangular  cavity.   This cavity is
artificially produced, and is entirely owing to the method
of raising the sternum.
  When  the sternum is laid back or removed, the follow-
ing parts are to be observed :—
  The Mediastinum, now collapsed, dividing the thorax
into two distinct cavities, of which the right is the largest.
   The lungs of each side lying distinct in these cavities.
   The pericardium, containing  the heart, situated in the
middle of the thorax,  between the two  laminae of the
mediastinum, and protruding into the left side.
   The  internal surface of the  pleura, smooth, colorless,
and glistening, lining  the ribs,  and reflected over  the
lungs.
   1. The  Pleura.—Each side  of the thorax has its par-
ticular  pleura,  The pleurae are like two bladders, situ-
ated laterally with respect to each other, by adhering to-
gether in the middle of the thorax, and passing obliquely1

  1 They run obliquely, not being in general attached to the  middle
of the sternum, but towards its left side, especially at the lower part
of the  bone, near the diaphragm.  Besides the pericardium, the
mediastinum contains betwixt its laminre some adipose membrane
and absorbent glands. 
248
practical anatomy.
from  the posterior surface of the sternum to the dorsal
vertebrae, they form the mediastinum.  The pleura lines
the ribs and the upper surface of the diaphragm, and is
reflected over the  lung, which is in  fact behind it.   It
forms the Ligamentum Latum Pulmonis, a reflection of
membrane, which connects the inferior edge of the lungs
to the spine and diaphragm.
  2. The Lungs.—Color, reddish in children, grayish in
adults, and bluish  in  old  age.  Shape, corresponding to
that of the thorax, somewhat pyramidal, convex towards
the ribs, concave towards the diaphragm,  and irregularly
flatted next the mediastinum.
  Division (1.) The Bight Lung is the largest, and  is  di-
vided into three  lobes, two  greater ones, and an inter-
mediate lesser lobe.
-  (2.) The Left Lung has two lobes, and also a square
notch opposite the apex of the heart.   Into  the  sulci or
grooves which form the divisions of the lungs into lobes,
the pleura enters;  that part of the lung which is affixed
to the spine is called its root; it is the part by which  the
great  vessels, nerves and bronchise enter.
  3. The  Pericardium is a strong, white, and compact
membrane, smooth, and lubricated upon the inside,  form-
ing a  bag for containing the  heart, and having its inner
lamma reflected over the substance of the heart itself.
  4. When you slit open the forepart of the pericardium,
you expose the Heart.  The right ventricle protrudes;
the right  auricle, also, is towards  you;  while  the  left
auricle is retired, and  its  tip is seen lapping round upon
the left ventricle.   From under the tip of the left auricle
a branch of the coronary vein, and  one of the coronary
arteries ramify  towards the apex of the  heart, marking
the situation of the Septum Cordis.  The left ventricle
will be found firm, fleshy, and resisting, whilst the right
ventricle is more loose, and seems partly wrapt round  the
other.
  The heart is situated obliquely in  the middle of  the
breast; its posterior surface is flat, and lies upon the dia-
phragm; its apex  is  turned  forwards,  and towards  the
left side, so that, in the living body, it is felt striking  be- 
LARYNX, TRACHEA, AND LUNGS.         249
Fig. 86.
A Front View of the Larynx, Trachea, and Lungs, with the Heart
                 INCLOSED IN THE PERICARDIUM.
    1. Thyroid Cartilage.
    2. Crico-thyroid Muscle.
    3. Trachea.
4, 5, 6. Upper, Middle, and Lower
        Lobes of the Right Lung.
  7, 8. Upper and Lower Lobes of
        the Left Lung.
  9. 9. Pericardium investing the
        Heart.
   10. Mediastinum.
   11. Left Subclavian Artery.
12. Left Primitive Carotid.
13. Right Primitive Carotid.
14. Left Subclavian Artery.
15. Left Vena Innominata.
16. Right Vena Innominata.
17. Right Subclavian Vein.
18. Right Internal Jugular.
19. Left Internal Jugular.
20. Left Subclavian Vein.
21. Root of the Lungs.
22. Ligamentum Pulmonis.
tween the  fifth and sixth  ribs, at the point  where  the
cartilages and bony extremities  are united.  The Vena
Cava°Superior  is seen coming  down from  the upper
angle  of  the  pericardium.   The  Inferior  Cava is
seen  coming  up  through  the  diaphragm; but only  a 
250
PRACTICAL ANATOMY.
very small part of  this vein is covered by the peri-
cardium;  the  two veins enter the right auricle.   The
Right  Auricle  is  turned  forwards, and might be
called the anterior;  it generally appears black, by the
blood shining through its thin coats.   The Right Ven-
tricle is  situated  almost directly opposite.   The Pul-
monary Artery  arises from the right ventricle; its
root is concealed by the right auricle;  it ascends on the
left side of the aorta;  it divides into, 1, the right pulmo-
nary artery, which passes  under the arch of the aorta,
crosses behind it and the vena cava superior  to the right
lung,  and is  the longest;  and,  2,  the left pulmonary
artery, which passes to the left lung, crossing the descend-
ing aorta anteriorly.   The Pulmonary Veins enter the
left auricle; two veins come from  each lung; the right
veins are longest, as they pass behind the vena cava supe-
rior.  The left auricle is situated on the left side of the
right auricle,  and somewhat behind it; its tip is seen lap-
ping round upon the Left Ventricle.  This is situated
behind,  and on the left side of  the right ventricle; its
substance is stronger  and more firm to the touch.   The
Aorta arises from the back  part and  right side of the
left ventricle;  its root  is  covered by the pulmonary
artery.  It then ascends betwixt that artery and the veua
cava superior.  Immediately from  the  root of the aorta,
within the pericardium, the two coronary  arteries are
sent off to supply the heart itself.

   dissection of the great vessels  of the heart.
  The Vena Cava  Superior will be seen descending
before the root of the lungs, and on the right side of the
aorta.  Immediately before  perforating the  pericardium,
it is joined upon its  posterior part  by the vena  azygos,
which comes forwards from the spine, returning the blood
from the intercostal spaces.
  Behind the sternum, and just above the arch of the
aorta, the superior  cava is  seen  receiving two  great
branches.
  1. A  branch coming from the right side, formed by
the right subclavian vein, and the right internal jugular. 
dissection of the great vessels of the heart.   251
Fig. 87.
  a. Right Ventricle of the Heart.
a, a, and b, b.  Pericardium.
  6. Pulmonary Artery.
c, c. Arch of Aorta.
  d. Right Auricle.
Fibrous Remains of the Ductus
  Arteriosus through  which
  the Pulmonary Artery of the
  Foetus communicated with
  the Aorta. 
252
practical anatomy.
 /. Superior cava.             q. Right Common Carotid Artery.
  g. Left Brachio-cephalic Vein.   r. Trachea.
  h. Left Common Carotid Artery,  s. Thyroid Gland.
  k. Lower End of the Left Internal t. Brachial Plexus of Nerves.
     Jugular Vein.            u. Upper  End of  left  Internal
  I. Right Jugular Vein.             Jugular Vein.
 m. Right Subclavian Vein.    v, v. Clavicles cut across and dis-
  n. Innominata or Brachio-cepha-     placed downward.
     lie Artery.             x, x. Fifth Ribs cut across.
  o. Left Subclavian Artery.    y, y. Right and Left Breasts.
 p. Right Subclavian Artery cross- z. Lower End of Sternum.
     ed by  the  Pneumogastric
     Nerve.

  2. A larger  branch coming from the left side (Vena
Transversa or Innominata).  It  is formed  by the left
subclavian and left internal jugular, which unite to  form
a trunk.  This trunk crosses before the arteries arising
from the arch of the aorta, and then enters the superior
vena cava.  Into the posterior part of the angle formed
by the union of the left subclavian  and the left jugular,
the thoracic duct empties itself.
  On each side the internal jugular vein  descends along
the neck by the side of the carotid,  while the subclavian
vein comes from the arm.
  The Vena Cava Inferior, immediately after passing
through the diaphragm from  the   abdomen, enters the
pericardium.
  The Aorta leaves the heart opposite the fourth dorsal
vertebra; it crosses over the pulmonary artery, ascends
obliquely upwards, backwards, and to the  right side, as
high as the second dorsal vertebra.  Here it  forms an
Arch or incurvation, which  passes from the right to the
left side, and at the  same time obliquely from before
backwards.   It then comes in contact with the upper part
of the third dorsal vertebra, and descends along the spine
in the posterior mediastinum.  This arch of the aorta is
situated behind the first bone of the sternum,  behind and
somewhat below the left branch of the vena cava superior.
  From the upper part of the  arch come off  three  large
arteries.
  1. The Arteria Innominata,  or  common  trunk of 
POSTERIOR MEDIASTINUM.
253
the right carotid and subclavian, ascends above an inch,
and bifurcates into,
  a. The Right Carotid, which ascends in the neck by
the side of the trachea.
  b. The Right Subclavian, which passes outwards to
the arm.
  2.  The Left Carotid.
  3.  The Left Subclavian comes off from the extremity
of the arch.
  The arch of the aorta also gives off some small twigs
which pass to the pleura, the  mediastinum, and thymus
gland.
  The Thymus Gland is a soft glandular body, lying
before the lower part of the trachea and great vessels of
the heart, a little higher than the tops of the two pleurae.
It is very large  in the foetus, smaller in  adults, and nearly
disappears in the aged.
  Where the aorta begins to  descend, it is connected to
the pulmonary artery by a ligament, which, in the foetus,
was a large canal, the Ductus Arteriosus.

dissection of  the posterior  mediastinum,1 and of
  the nerves and vessels which have their course
  through  the thorax.

  Course of the Phrenic Nerve through the thorax.—
On each side  this nerve is seen  entering the thorax be-
twixt the subclavian artery and subclavian vein. It then
proceeds downwards and forwards before the root of the
lungs, and on the outside of the pericardium, betwixt
that bag and the pleura.  It is  lost on the diaphragm.
This nerve is accompanied by one artery and two veins.
Some twigs pass from the phrenic nerve into the abdomen,
to the liver, &c.
  Behind the arch of the aorta and great vessels passing
from  the heart, is seen the  Trachea.  It enters  the
thorax between the two pleurae, and, opposite  the third

  1 By Posterior Mediastinum is designed that part of the mediastinum
situated behind the root of the lungs.
    22 
254
PRACTICAL ANATOMY.
or fourth dorsal vertebra,  bifurcates  into two parts,
bronchia, one  of which passes toward  the right, the
other toward the left, to enter the lung of each side.
  These bronchiae divide and subdivide, finally ending in
the Air Cells.  The trachea and larger bronchiae consist
of cartilaginous  rings,  defective on the  posterior third,
which is filled up by muscular tissue.
Fig. 88.
Terminal Vesicles of the Lung, hanging to a Branch of the Bronchia
              as Berries hang to their Stalk.

  By folding back the lungs towards the left side of the
chest, we expose the pleura reflected from the under sur-
face of the root of the  lungs to the spine and ribs.  A
triangular space is formed  betwixt the  two pleurae and
the bodies of the dorsal vertebrae.  This space or cavity
is  named  the cavity of the posterior mediastinum.  It
contains many important  parts, and must, therefore, be
carefully dissected.
  But first let us attend to the course of the Great Sym-
pathetic Nerve.
  Cardiac Plexus.—From the three sympathetic ganglia
of the neck come off three  nerves, called the Superior
Middle, and Inferior Cardiac Nerve*. The superior
cardiac  receives filaments  from the  superior  laryngeal
branch of  the par vagum.   These nerves, with branches
also from the recurrent laryngeal of the par vagum, send
filaments about the great bloodvessels at the root of the
neck, and  afterwards form, between the arch of the aorta
and the lower part of the trachea, the Cardiac  Plexus.
  The Sympathetic Nerve, where it enters the thorax, 
255
A. A Front View of the Larynx,
  Trachea, and Bronchial Tubes.
  1. Hyoid Bone.
  2. Thyro-hyoid Membrane.
  3. Thyroid Cartilage.
  4. Crico-thyroid Membrane.
  5. Cricoid Cartilage.
  6. Trachea.
7, 8. Two Cartilaginous rings.
  9. Membrane which separates
      them.
 10. Right Bronchus and its di-
      visions.
 11. Left Bronchus.
 B.  The Larynx, Trachea, and com-
   mencement  of the Bronchial
   Tubes, viewed from behind.
  1. Upper opening of the Larynx.
!, 3. Lateral grooves of the Larynx.
  4. Fibrous  Membrane   of  the
      Trachea,  interspersed with
      small Glands, beneath which
      is seen
  5. The Muscular Fibi'es ; beneath
      this last are seen
    Small Fibrous Bands.
    The  Mucous  Membrane seen
      between them.
6,7
is  situated  behind  the great  vessels,  close  upon the
articulation  of the  first rib  with  the body  of the  first
dorsal vertebra as it descends along  the thorax.  It lies 
256             PRACTICAL ANATOMY.
upon  the heads of the  ribs, where they  are  articulated
with the vertebrae.   It receives additional branches from
all the dorsal  intercostal nerves, and in  each intercostal
space  it forms  a  ganglion.  This nerve may be dissected
with greater facility when the lungs are removed, and the
ribs sawed off  near  the spine, which will enable the dis-
sector to trace its branches more fully.  It lies behind
the pleura, but is seen through it.  It passes into the ab-
domen by  the side of the spine, running through the
fibres of the small muscle of the diaphragm.

   BRANCHES OF THE SYMPATHETIC IN THE THORAX.

  The Great Splanchnic  Nerve  should be attended
to.  It is formed by twigs, which come off from the sixth,
seventh,eighth, ninth, and tenth thoracic ganglia, and pene-
trates, with the aorta, the diaphragm.  Lesser Splanch-
nic Nerve, formed by filaments  from  the  tenth and
eleventh dorsal ganglia, it passes through the crus of the
diaphragm, and partly uniting with the great splanchnic,
they together  terminate in the  Semilunar  Ganglion,
which is formed  by a number of smaller  ones connected
by many filaments, constituting  the Solar Plexus, and
placed at the root of the Cceliac Axis.
  The Solar Plexus also receives twigs from  the  par
vagum and  the phrenic nerves.  The Phrenic, LTepatic,
Splenic, Mesenteric, Spermatic, and Renal Plexuses
all emanate from the Solar, and are formed by filaments
winding about the bloodvessels of these parts.
  Lumbar Ganglia—four in number,  and  connecting
with the lumbar  spinal nerves.
  Hypogastric Plexus is formed by branches from the
lumbar and aortic  plexuses,  and is  distributed to the
pelvic viscera.  It is situated at the bifurcation of the aorta
into the iliac  arteries, and communicates with branches
from the fourth and fifth sacral nerves.
  The sacral ganglia are five in  number.   The nerves of
the two sides  communicate over the coccyx, forming  a
ganglion, the  Ganglion Impar.  The cranial  ganglia,
six in number, are  not described, as  the student rarely 
THORACIC DUCT.
257
           Fig. 90.
Vena Azygos and Thoracic Duct.
       1.  External Iliac Vein.
       2.  Internal Iliac Vein.
       3.  Ascending Cava.
       4.  Middle Sacral Vein.
     5, 5.  Lateral Sacral Veins.
       6.  Origin of the Greater Vena
           Azygos in the Lumbar Re-
           gion and from the Lumbar
           Veins.
       7.  Its Trunk.
       8.  Its Termination in the De-
           scending Cava.
       9.  Lumbar Veins of the Left
           Side, forming at
      10.  The  Lesser Vena Azygos,
           which terminates at
      11.  In the Greater Azygos.
12,12,12.  Eight or nine Inferior Inter-
           costal Veins of the Right
           Side,  opening   into  the
           Greater  Azygos.
13,13,13.  Superior  Intercostal Veins,
           opening  by  a   common
           Trunk  into the  Greater
           Vena Azygos.
14,14,14.  Five  Inferior  Intercostal
           Veins  of the Left  Side,
           joining the Lesser Azygos.
      15.  Receptaculum Chyli.
16,16,16.  Thoracic Duct.
      17.  Its Termination in the An-
           gle   formed between  the
           Left Internal Jugular and-
           Left Subclavian Veins.
      18.  Right Thoracic Duct.
      19.  Subclavian Vein.
      20.  Internal Jugular Vein.
pursues  such a dissection in  the limited time which he
has for his dissecting-room duties.
                             22*
 
258
PRACTICAL ANATOMY.
  Toward the middle of the spine you  see the  Vena
Azygos.  In dissecting, it is found  situated betwixt the
right sympathetic nerve and the aorta; it begins below
from ramifications of the lumbar veins, which pierce the
small muscle of the diaphragm.   This vein ascends along
the spine, receiving  veins  from each of the intercostal
spaces  of the right  side; and, about the middle of the
back, it receives a considerable trunk, which comes from
under the aorta,  Vena Azygos Minor, and returns the
blood from  the  left  side of the  thorax.  At the fourth
dorsal  vertebra, the  vena  azygos leaves  the  spine;  it
makes a curve  forward, and empties its blood into the
back part of the vena cava superior, immediately before
that vein enters  the pericardium.  The superior intercos-
tal veins on  the left side empty into the vena azygos also.
  Descending through the posterior mediastinum will be
also found the Aorta.   This great artery, having formed
its arch, comes in contact with the third dorsal vertebra,
and is now called the  Descending Aorta, or Thoracic
Aorta.  It descends along the bodies of the dorsal verte-
brae, rather on their  left side; it lies behind the oesopha-
gus, and passes betwixt the crura of the diaphragm into
the abdomen.

       BRANCHES OF THE AORTA IN THE THORAX.

  1. The A. Intercostalis Superior, on the right side,
is mostly sent off by the subclavian, on the left  side by
the aorta.
  The Inferior Intercostals are  eight or nine in number
on each side of the thorax: they come off separately from
the side or  back part of the aorta, and seem to tie that
great artery to the spine.   Each intercostal artery passes
immediately into the interval betwixt two ribs, and there
subdivides into
  (1.)  A branch which perforates between the heads of
the ribs to  the muscles of the back; this branch also
gives twigs which enter the spinal canal.
  (2.)  The continued trunk of the artery runs forwards,
in the  interval of the two  ribs, giving many branches to 
ESOPHAGUS.
259
the intercostal muscles.  When it reaches the  anterior
part of the thorax it is lost in the muscles.
  Each intercostal  artery is accompanied by one or two
veins, branches of the vena azygos, and by an intercostal
or dorsal nerve.
  2. A. Bronchiales, are two, sometimes  three, small
twigs of the  aorta,  one of which passes to the  lungs on
each side.
  3. Small arteries pass forwards  from the aorta on the
oesophagus, named A. CEsophageae; others run to the
pericardium and  pleura.
  The  dissector  also finds in the  posterior mediastinum
the Thoracic Duct.  He must look for it behind the oeso-
phagus, betwixt the vena azygos and aorta. It is collapsed,
and appears  like cellular membrane condensed, and can
only be distinguished when inflated or injected; it was
seen in the abdomen  close to the aorta, and  passing  into
the thorax between  the crura of  the diaphragm.   It
ascends along the posterior mediastinum, and, about the
fourth  dorsal vertebra, passes obliquely to the left side,
behind the aorta  descendens, and  behind  the great arch
of  the  aorta, until it reaches the left carotid artery.   It
runs behind this  artery and behind the left internal jugu-
lar vein; and, after forming  a  circular  turn  or arch, it
descends and enters the left subclavian vein at the point
where  that vein is joined by the left internal jugular.
The absorbents of the right  superior extremity, and of
the right side of the head and thorax,  usually form a
trunk,  which enters the right subclavian vein.
   The  (Esophagus is also situated  betwixt the layers of
the posterior mediastinum.   It lies immediately before
the aorta, but rather  towards  its left side; it is seen de-
scending from the neck behind  the  trachea;  it passes
through an opening in the lesser muscle of the diaphragm,
and immediately expands into the stomach.
   Behind the trachea and vessels  going to the lungs, and
on the forepart  of the oesophagus, we meet with a  con-
geries of lymphatic glands.   Its  muscular  fibres are ar-
ranged longitudinally and circular. 
260
practical anatomy.
Course of the Par Vagum, or Eighth Pair of Nerves, in
                     the Thorax.

  From the neck, the par vagum passes betwixt the sub-
clavian vein  and artery into the thorax;  it immediately
sends off a  large branch, the Becurrent Nerve, back
into  the neck.   On the right  side, this branch twists
round  under the arteria innominata; on the left side,
under the arch of the aorta, it ascends behind the carotid,
and lodges itself betwixt the trachea and oesophagus, to
both of which it gives branches, and to the muscles of the
larynx.
  The par  vagum, having  given  off the recurrent, de-
scends by the side of the trachea and behind the root of
the lungs.   It here sends off numerous filaments to the
lungs, which, uniting with twigs* from the great sympa-
thetic, form the Anterior and Bosterior Pulmonary
Plexuses.   These plexuses lie on  the anterior and pos-
terior surfaces of the root of the lungs.  Other twigs of
the par vagum pass to form the  inferior Cardiac Plexus
about the pericardium.
  The trunk of the eighth pair  soon reaches the oesopha-
gus ; the left par vagum runs on the forepart of the oeso-
phagus, the  right nerve on its back part.  Here they
split into several branches, which unite again and form a
Plexus. This plexus is called the (Esophageal.  The
two nerves continue  their course  along the oesophagus,
and pass with  it through the  diaphragm, to ramify on
the stomach  and form the stomachic plexus.
  The twelve dorsal or intercostal nerves are also seen
in this dissection emerging from the spinal canal, between
the bodies of the vertebrae, and supplying the intercostal
muscles, &c.

 dissection of the heart when  removed from the
                       BODY.

  The heart consists of three tunics or coats. 1. An ex-
ternal smooth one, Exocardium, which is a  reflection of 
RIGHT VENTRICLE.               261
the internal lamina of the pericardium.  2. A middle
muscular coat.   3. A smooth internal  coat, Endocar-
dium, which is a continuation of the internal coat of the
great veins and arteries. In the right side of the heart we
always meet with a considerable quantity of coagulated
blood.   In the left side there is much less.
   Slit open, with the scissors, the two venae cavae on their
forepart, the inner surface of these veins and of the  right
auricle wrill be seen lined by a smooth membrane; and in
the auricle the musculi pectinati, or bundles of muscular
fibres, will  be seen projecting in the  auricular appendage.
At the point of union between the two  cavae, there is a
projection formed by the thickening of the muscular coat,
the Tuberculum Loweri. The Septum Auricularum
is seen separating the right from the left auricle.   Ob-
serve that it is thin, that in it there is an oval depression,
named Fossa Ovalis.  Bound this fossa the fibres  are
thicker, forming the annulus ovalis; this is the remains
of the Foramen Ovale of the foetus.   The Eustachian
Valve is a membrane-like duplicature of the inner coat
of the auricle, observed where the vena cava inferior is
continued into the auricle, and stretching from that vein
towards  the  opening into the  right ventricle.  Behind
this valve is the orifice of  the Coronary Vein, with its
small valve.
   The Foramina  Thebesii are minute  orifices, some of
which are  veins, which open into all the cavities of the
heart; they are most  numerous, however, in the  right
auricle.
   The Ostium Venosum, or opening of the right auricle
into the right ventricle, is somewhat oval; it has a  valve
which projects into the right ventricle.
   The Bight Ventricle may now be opened by an in-
cision, carried  from  the root of the pulmonary artery
down to the apex  of the heart.   This incision should be
made with care, lest the parts on the inside of the ven-
tricle be destroyed by it.  It should pass along the right
side of the septum ventriculorum, the situation of which
is marked  out by large branches of the coronary artery
and vein.  A small opening should first be made, into 
262              practical anatomy.

which one blade of the scissors can be introduced.   The
incision may be continued through the apex of the heart,
or a flap may be made by another cut, passing from the
beginning of the first along the margin of the right au-
ricle.   In this  ventricle, observe  the  projecting bundles
of muscular  fibres, the Tricuspid Valves arising from
the margin of the ostium  venosum, and projecting into
the right ventricle.  This valve forms a complete  circle
at its base,  but has  its edge divided  into three parts,
which  are  attached  by  tendinous  filaments,  named
Chordae Tendinejs,  to the Carne^e Columnje, or mus-
cular  bundles of the ventricle.

                        Fig. 91.
 A View of the Interior of the Right Auricle and Right Ventricle.
 1. The Right Ventricle.
 2. Tricuspid Valve.
 3. Chordae Tendineae.
 4. Pulmonary Artery.
 5. The Aorta.
 6. Descending Vena
    Cava.
 7. The Right Auricle.
 8. Orifice of the ascend-
    ing Vena Cava.
 9. Vena Cava  Ascend-
    ens.
10. Valvula Eustachii.
11. Orifice of  the  De-
    scending Vena Ca-
    va.
12. Position of the Tu-
    berculum Loweri.
13. Valvula    Thebesii
    overhanging   the
    orifice of the Coro-
    nary Vein.
  The Septum Ventriculorum, or partition of the two
ventricles,  is marked  out externally  by two veins run-
ning from the apex to the basis of the heart.
 
LEFT VENTRICLE.
263
  Slit up the pulmonary artery.   Observe how it arises
from  the back  part of the right ventricle, how smooth
the inside of the ventricle  becomes as it approaches the
entrance of the artery, or  ostium arteriosum.  Observe
the three Semilunar or Sigmoid Valves. Between the
valves and  wall of the artery are little sinuses, the Si-
nuses of Valsalva.  The bases of the valves arise from
the artery, their loose  edges project  into its  cavity, and
in the middle of the loose  edge  of each valve is seen a
small white body, termed Corpus Sesamoideum Arantii.
The artery is seen bifurcating into the right and left pul-
monary arteries, and, just before its  bifurcation, sending
off to the aorta the ductus arteriosus, which in the  adult
is a ligament.
   The Left Auricle has four pulmonary veins opening
into its cavity, which may be exposed by slitting up two
of those veins.   Observe that its coats are thicker than
             Fig. 92.
A View of the Left Ventricle laid open.
 1. Parietes of the Ventricle.
 2. Its Cavity.
 3. Mitral Valve.
 4. Chorda? Tendineae.
 5. Columnae Carneae.
 6. Right Auricle.
 7. Left Auricle.
S, 8. The Four Pulmonary Veins.
 9. Aorta.
 10. Pulmonary Artery.
those of the right auricle.   The septum auricularum,
with the fossa ovalis, is here seen less distinctly than  on
the ri^ht side.  Observe also the ostium venosum, open- 
264
PRACTICAL ANATOMY.
ing into the left ventricle, and giving attachment to the
Valvula Mitralis.
  The Left Ventricle may be  opened in the same
manner as the right by an incision  carefully made in the
left side of the septum or partition  of the ventricles, and
continued round the upper part of the ventricle under the
auricle.  Observe  the  great  thickness of the muscular
coat;  the Valvula Mitralis, forming two  projections,
which are attached by the chordae tendineos to the fleshy
columns of this ventricle.
  Slit up the aorta. It has three semilunar valves, which
resemble those of the pulmonary artery.  Behind these
valves the  artery bulges out,  as in  the pulmonary, form-
ing the Sinuses of the aorta.  Above two of the valves
lie the orifices of the two coronary arteries, of which the
left is the largest.
               CHAPTER  XVI.

  DISSECTION OF THE MUSCLES OX THE  POSTERIOR
          PART OF THE TRUNK AND NECK.

  An incision must be made from the occipital protube-
rance of the occipital along the spine to the top of the
sacrum, and the integuments turned off.
  In this  dissection we  meet with twenty-two distinct
pairs of muscles, besides a number of small muscles situ-
ated between the processes of contiguous vertebrae.
  1. The  Trapezius—It arises, by a thick round  ten-
don, from  the lower part of the protuberance in the mid-
dle  of the os occipitis  behind, and, by a thin tendinous
expansion, from  the  superior transverse  ridge of  that
bone;  from the five superior cervico-spinous processes
by the ligamentum nuchas; tendinous, from the two infe-
rior cervical spinous processes, and from the spinous
processes  of all  the vertebne of the back.   The fleshy 
LATISSIMUS DORSI.
265
fibres coming from  the neck descend obliquely, while
those from the back,  ascend.
  Inserted, fleshy, into the posterior third part of the cla-
vicle ;  tendinous and fleshy, into the acromion, and into
the upper edge of all the spine of the scapula.  The fibres
slide over a triangular surface  at the extremity of the
spine of that bone.
  Situation: This muscle is  quite  superficial, and  con-
ceals all the muscles situated in the posterior part of the
neck and  upper part of the  back.  The Ligamentum
Nuch^e vel Colli is  a ligament which arises from the
middle of the occipital bone, runs down on the back part
of the  neck, adhering to  the spinous processes of the
cervical vertebrae, and giving origin to the fibres of the
trapezius and of other muscles.
   Use: To move the scapula in different directions.  The
superior fibres draw it  obliquely  upwards, the middle
transverse ones draw it directly  backwards, and the infe-
rior fibres move it obliquely downwards and backwards.
  It should be reflected from the spine and head.
  2. The  Latissimus Dorsi—Arises, by a broad thin ten-
don, from all the spinous processes of the os sacrum and
of the.lumbar vertebrae; from the spinous processes of
the  seven  inferior dorsal  vertebrae;  from the posterior
part of the spine of  the os ilium;  also from the extremi-
ties of  the four inferior  ribs,  by four distinct fleshy digi-
tations, which intermix  with those of the obliquus exter-
nus abdominis. The inferior fleshy fibres ascend obliquely;
the superior run transversely.   They pass over the infe-
rior angle of the scapula (from  which the muscle often
receives a thin  fasciculus of fibres) to reach  the  axilla,
where they are all collected and twisted.
  Inserted, by a strong flat tendon, into the inner edge of
the groove in the os  humeri, which receives the long ten-
don of the biceps flexor cubiti.
  Situation: Where  this muscle arises from  the  dorsal
vertebrae  it is concealed by  the origin of the trapezius.
The remainder  of it is placed  immediately  under the
skin, and  covers the deeper seated muscles of the loins
and  back.  The tendon of this muscle, with the subjacent
     23 
266               practical anatomy.
The First and Second and Part of the Third Layer of Muscles of the
  Back, the First Layer being shown upon the Right and the Second
  on the Left Side.
1.  Trapezius Muscle.
2.  Tendinous portion of the same,
     which, with the correspond-
     ing  portion of the opposite
     Muscle, forms a  Tendinous
     Ellipse  on the lower part  of
     the  Back  of the Neck.
3.  Acromion Process and Spine of
     the  Scapula.
4.  Latissimus Muscle.
5.  Deltoid.
6.  Infra spinatus and Teres Minor
     Muscles.
    7. External  Oblique of the
        Abdomen.
    8. Gluteus Medius Muscle.
    9. Gluteus Magnus.
   10. Levator of the Scapula.
11,12. Rhomboid Muscles (Small
        and Large).
13,14. Splenius Muscle.
   15. Aponeurosis  covering the
        Spinal Erector Muscles.
   1G. Serratus Inferior  Posticus
        Muscle.
   17. Supra-spinous Muscle. 
LEVATOR SCAPULAE.
267
tendon of the serratus posticus inferior, assists in forming
the fascia lumborum.
   Use:  To pull the arm backwards and downwards, and
to roll the os humeri.
   It should be reflected from the spine, pelvis, and ribs.
   Bemove the trapezius and latissimus dorsi, and  two
muscles will  be  seen  passing  from the neck to the sca-
pula.
   8. The Bhomboideus.  This muscle is  divided  into
two portions.
   (1.) Bhomboideus Major (the inferior portion) arises,
tendinous,  from the spinous processes of the four or five
superior dorsal vertebrae.
   Inserted into all the base of the scapula below its spine,
extending  as far as its inferior angle.
   (2.) Bhomboideus Minor (the superior portion) arises,
tendinous, from the  spinous  processes of the  three infe-
rior vertebras of the neck, and from  the ligamentum
nuchas.
   Inserted  into the base of the scapula, opposite to the
triangular plain surface at the root of the spine.
   Situation: This muscle lies beneath the  trapezius and
latissimus  dorsi.
    Use: To draw the scapula obliquely upwards and di-
rectly backwards.
   The  rhomboidei should be reflected from the spine.
   4. The  Levator Scapula—Arises  from the trans-
verse processes of the five superior vertebrae of the neck
by five distinct tendinous and fleshy slips, which unite
and form a considerable muscle.
   Inserted, tendinous and fleshy, into the base of the sca-
pula, above the root of the spine and under the superior
angle.
   Situation: This muscle is concealed  by the trapezius
and sterno-mastoideus; but a small part of its belly may
be seen 'in the space between the edges of these muscles.
    Use: To draw  the  scapula  upwards  and a little for-
wards.
   Detaching  the  rhomboideus from its  origin in the 
268
PRACTICAL ANATOMY.
spine,  you will see another muscle  passing from  the
whole of the basis of the scapula.
  5. The  Serratus  Magnus—Arises, by nine fleshy
digitations, from the nine superior ribs.  These digita-
tions are seen  on the  anterior part of the thorax; they
pass obliquely backwards,  and  form a  strong fleshy
muscle.
  Inserted, principally fleshy, into the whole of the base
of the  scapula.
  Situation: This  muscle lies between the  scapula and
the ribs.   The lower digitations, which  pass more ante-
riorly than the edge of the latissimus dorsi, are intermixed
with the superior  digitations of the  obliquus externus
abdominis.

                       Fig. 94.
The Serratus Major Anticus Muscle.
   Use:  To move the  scapula  forwards, and, when  the
scapula  is forcibly raised, to draw the ribs upwards.
  The removal of the rhomboideus also exposes,
  6. The Serratus  Superior Bosticus.—This muscle 
SERRATUS POSTICUS INFERIOR.          269
arises, by a thin broad tendon, from the spinous processes
of the three inferior cervical  vertebras, and  of the two
superior dorsal.
  Inserted,  by distinct fleshy slips, into the second, third,
fourth, and sometimes the fifth ribs, a little beyond their
angle.
  Situation:  This muscle is concealed for the most part
by the rhomboideus and scapula.
   Use: To elevate the ribs, and dilate the thorax.
  Beflect it from the spine.
  7. The Splenius is divided  into two portions.
  (1.) The Splenius Capitis—Arises, tendinous, from the
spinous processes of the two superior dorsal, and five in-
ferior cervical vertebras.  It forms a flat broad muscle,
which ascends  obliquely, and  is inserted, tendinous, into
the posterior part of the mastoid process, and into a small
part of the os  occipitis,  immediately below its superior
transverse ridge.
   Situation:  This muscle is covered by the trapezius, and
by the insertion  of the sterno-cleido-mastoideus,  and a
small part of it is seen on the  side of the neck  betwixt
those two muscles.
   Beflect it from the occiput.
   (2.) The Splenius Colli—Arises, tendinous, from the
spinous processes of the third, fourth,  fifth, and sometimes
the sixth dorsal vertebras.  It  forms  a small fleshy belly,
which ascends by the side of the vertebras, and is inserted
into the transverse processes of the four  or five superior
cervical vertebras, by distinct  tendons, which lie behind
similar tendons of the levator scapulas.
   Situation: This muscle is concealed by the serratus su-
perior posticus, and splenius capitis.
   Use: To bring the head of the upper  vertebrae  of the
neck  obliquely  backwards.   When both muscles act,
they pull the head directly backwards.
   Beflect  it from the dorsal vertebras.
   8. The  Serratus Bosticus Inferior—Arises, by  a
broad thin tendon, from the spinous  processes of the two
 or three inferior dorsal vertebrae, and from the three su-
 perior lumbar spines by the fascia lumborum.
                          28* 
270
PRACTICAL anatomy.
  Inserted, by distinct fleshy slips, into the lower edges of
the four inferior  ribs, at a  little distance  from  their
cartilages.

                         Fig. 95.
  Situation: This is a thin muscle, of considerable breadth,
situated at the lower part of the back, under the middle
of the latissimus dorsi.  Its tendon lies under that of the
latissimus dorsi, but, although firmly adhering to it, is
distinct, and may be separated by cautious dissection.
   Use: To pull the ribs downwards and backwards.
  Beflect it from the spine.
  The Fascia Lumborum is now seen.  It is a tendinous
fascia, arising from the  lumbar vertebrae and os sacrum,
giving origin to  the lower part of the serratus posticus 
LONGISSIMUS DORSI.
271
inferior,  and  to the  posterior fibres  of the obliquus
internus  and  transversalis abdominis.   It is also con-
nected with the tendon of the latissimus dorsi.
  On detaching from the spine of this fascia, and the ser-
ratus posticus inferior, we expose a thick muscular mass,
filling up all the space betwixt the spinous processes of
the vertebrae, and the angles of the ribs.   This mass con-
sists of three muscles:—
  (1.) Sacro-Lumbalis on the outside.
  (2.) Longissimus Dorsi in the middle.
  (3.) Spinalis Dorsi close to the spinous processes.
  These  three muscles are closely  connected together; so
that, to effect their  separation, it is  necessary  to  divide
some of  the fibres.
  9  and 10.  The  Sacro-Lumbalis and Longissimus
Dorsi—Arise, by one common origin,  tendinous  exter-
nally, and  fleshy internally, from  the spinous processes
and posterior surface of the os  sacrum; from the posterior
part of the spine of the os ilium, extending nearly as far
forwards as the highest part of that bone when the body is
erect; from the  spinous processes, and from the roots of
the transverse processes of all the lumbar vertebras.
  The thick fleshy belly, formed by this extensive  origin,
ascends,  and, opposite  to the last rib, divides into the two
muscles.
  The sacro-lumbalis is  inserted  into all the ribs near
their angles, by long and thin tendons.  The tendons
which pass to the superior ribs are longer, ascend  nearly
straight,  and are situated  nearer to the  spine than those
tendons which pass to  the lower ribs.  On separating the
inner edge of this muscle (i. e. the edge next to the spine),
from the latissimus dorsi,  and  turning the belly towards
the ribs,  we see six or eight small tendinous and fleshy
bundles,  which pass from the inner side of this muscle,
to be inserted into the upper  edge of the  six or eight
inferior ribs.  These are called the Musculi Accessorii ad
Sacro - L u mbalem.
   Use: To  pull the ribs downwards, to assist in erecting
the trunk of the body, and in turning it to one side.
  The longissimus dorsi is inserted into all the ribs  except 
272
PRACTICAL anatomy.
the two inferior, betwixt their tubercles and  angles, by
slips which are tendinous and fleshy, and into  the trans-
verse processes of all the dorsal vertebrae by small double
tendons.

                         Fig. 96.
            Third Layer of the Muscles of the Back.
1, 2, 6,8. Sacro-lumbalis Muscle,
          turned outwards to
          separate it from the
          Longissimus  Dorsi,
          which lies  between it
          and the spine.
     3. Point at which  these
          two muscles are blen-
          ded in one, the Sacro-
          Spinalis.
     4. Complexus Minor.
     5. Complexus Major.
     7. Transversalis Cervicis.
   Use: To extend  the vertebrae,  and  keep  the  body
erect.
  11. The Spinalis Dorsi is much smaller than the two 
TRACHELO-MASTOIDEUS.
273
last described  muscles;  below, it cannot be  separated
from the longissimus dorsi, without dividing some fibres;
it lies betwixt that muscle and the spine.
  Arises, tendinous, from the spinous processes of the two
superior lumbar vertebras, and of the three inferior dorsal.
  Inserted into the  spinous  processes of the  nine upper
vertebras of the back, except the first, by as many distinct
tendons.
   Use:  To  extend  the vertebrae, and to assist  in raising
the spine.
  12. The  Cervicalis  Descendens—Arises  from the
upper edge of the four or five superior ribs,  by as many
distinct tendons, which lie on the inside of the  tendinous
insertions of the sacro-lumbalis.   It forms a  small belly,
which ascends upwards, and is
  Inserted, by three distinct  tendons, into the fourth, fifth,
and sixth cervical vertebras.
  Situation:  This muscle is small; it  is frequently de-
scribed  as an appendage to the sacro-lumbalis.   It arises
between the sacro-lumbalis and longissimus dorsi, and  is
inserted into the transverse processes between the splenius
colli and levator scapulae.
   Use:  To turn the neck obliquely backwards.
  13. The Transversalis  Colli—Ames from the trans-
verse processes of the five  superior dorsal vertebras, by
five tendinous and fleshy slips, and is
  Inserted, tendinous, into the transverse processes of the
five or six inferior cervical vertebras.
  Situation: The origin  of  this  muscle lies on  the inside
of the longissimus dorsi, and is sometimes considered  as
an  appendage to it.   The  insertion is situated between
the cervicalis descendens and trachelo-mastoideus.
   Use:  To  turn the  neck  obliquely backwards, and a
little to one side.
  14. The Trachelo-Mastoideus lies nearer to the bone
than the last described muscle.
  Arises from the transverse processes of the three upper-
most vertebrae of the back, and of the five inferior of the
neck, by as  many thin tendons, which  unite  and form a
fleshy belly. 
274
PRACTICAL anatomy.
  Inserted, tendinous, into the posterior  surface of  the
mastoid process.
  Situation: This muscle lies on the outside of the com-
plexus, and  on the inside of the transversalis colli; its
insertion is concealed by the splenius capitis.
   Use:  To keep the head and neck erect, and  to draw
the head backwards, and to one side.
  15. The Complexus—Arises, by tendinous  and fleshy
fibres, from the transverse processes of the seven superior
dorsal, and of the four or five inferior cervical vertebras.
It forms a thick, tendinous, and fleshy belly.
  Inserted, tendinous and fleshy, into  the  hollow  betwixt
the two  transverse ridges of the os  occipitis, extending
from the middle protuberance of that bone, nearly as far as
the mastoid process.

                        Fig.  97.
  Situation: This is a large muscle.   Its origin  from the
cervical vertebras is nearer to the spine than the trachelo-
mastoideus; it is covered by the splenius;  but a large 
RECTUS CAPITIS POSTICUS MINOR.         275
portion of it is seen  between the splenitis and spine, im-
mediately on removing the trapezius.
   Use: To draw the head backwards, and to one side.
  On removing the complexus from the occiput, we find,
close to the  spine,
  16. The Semi-Spinalis Colli.—It arises, by distinct
tendons, from the transverse processes of the six superior
dorsal vertebras, ascends obliquely close to the spine, and
is
  Inserted into the spinous processes of all the vertebras
of the neck, except the first and the last.
  Situation: This muscle is situated close to the vertebras
at the posterior part of the neck and back.
   Use: To extend the neck obliquely backwards.
  17. Semi-Spinalis Dorsi—Arises from the transverse
processes  of the seventh, eighth, and ninth vertebras of
the back, by distinct tendons, which soon grow fleshy.
  Inserted,  by distinct tendons, into the spinous processes
of the five superior dorsal vertebras, and of the two lower
cervical.
  Situation:  This  muscle  lies nearer the spine than the
lower part of the semi-spinalis colli; its inferior  origins
lie on the outside of the insertion of the spinalis dorsi.
   Use: To extend the spine obliquely backwards.
  The removal of the complexus brings  also  in  view
several small muscles situated at the superior part of the
neck, immediately below the occiput.
  18. The Bectus  Capitis  Bosticus  Major—Arises,
fleshy, from  the side of the spinous process of the dentata,
or second cervical vertebrae.  It ascends obliquely out-
wards, becoming broader,  and is
  Inserted, tendinous and  fleshy, into the inferior trans-
verse ridge  of the os occipitis, and into part of the con-
cavity above that ridge.
  Situation: This  muscle  is  situated obliquely between
the occiput and the second vertebrae of the  neck.
   Use: To extend and pull  the head backwards, and to
assist in its rotation.
  19.  The  Bectus Capitis  Bosticus  Minor—Arises,
tendinous  and narrow, from an eminence in the middle of 
276
PRACTICAL ANATOMY.
the back part of the atlas, or first cervical vertebra.   It
becomes broader, and is
  Inserted, fleshy, into the inferior transverse ridge of the
os occipitis, and into the surface betwixt that ridge and
the foramen magnum.
  Situation: It  is  partly covered  by the  rectus capitis
posticus major.
   Use: To draw the head backwards.

                        Fig. 98.
1. Rectus  Capitis  Posticus
     Minor.
2. Rectus  Capitis  Posticus
     Major.
3. Obliquus Capitis Inferior.
4. Obliquus Capitis Superior.
5. Interspinales.
  20. Obliquus  Capitis  Superior—Arises,  tendinous,
from the upper and posterior part of the transverse pro-
cess of the first cervical vertebra.
  Inserted, tendinous and  fleshy, into the inferior trans-
verse ridge of the os occipitis behind the mastoid process,
and into a small part of the surface above and below that
ridge.
  Situation:  This muscle is situated laterally between the
occiput and atlas.
   Use: To draw  the  head backwards,  and to assist in
rolling it.
  21.  Obliquus  Capitis  Inferior—Arises,  tendinous
and fleshy, from  the  side of the spinous process of the
dentata  or second cervical  vertebra.   It forms a thick
belly, and is
 
INTERSPINALES.
277
  Inserted into the under and back part of the transverse
process of the atlas.                          *
  Situation: This  muscle is  obliquely situated between
the first two vertebras of the neck.
   Use: To rotate the head, by turning the first vertebra
upon the second.
  22. The Multifidus Spin^e.
  On removing the muscles of the spine which have been
described, we  find  situated beneath  them the Multifidus
Spinas.  It is that mass of muscular flesh which lies close
to the  spinous and  transverse processes of the vertebras,
extending from  the  dentata to the  os sacrum.   The
bundles of which  it is  composed seem to pass from the
transverse, to be inserted into the spinous processes.
  Arises, tendinous and fleshy, from the spinous processes
and back  part of the os sacrum, and from the posterior
adjoining part of the os ileum; from the  oblique and
transverse processes  of all the lumbar vertebrae; from
the transverse processes of all the dorsal vertebrae; and
from those of the cervical vertebras, excepting the three
first.   The fibres arising from  this extensive origin  pass
obliquely to be
  Inserted, by distinct tendons, into the spinous processes
of all the vertebras of the loins and  back, and into those
of the six inferior vertebras  of the neck.  The fibres
arising from each vertebra are inserted into the second
one above it, and sometimes more.
   Use: To extend the back obliquely,  or move it to one
side.   When both muscles act, they extend the vertebras
backwards.
  The small muscles situated  between the processes  of
the vertebrae are,
  1. Interspinales  colli, dorsi, et lumborum.—These
are small bundles of fibres, which fill  up the spaces be-
tween  the spinous processes of the vertebras.   Each  of
these little muscles arises from the surface of one spinous
process, and is inserted  into the next spinous process.
  In the neck they are large, and appear double, as the
spinous processes of the cervical vertebras are bifurcated.
     24 
278
PRACTICAL anatomy.
In the back and loins they are indistinct, and  are rather
small tendons than muscles.
   Use: To draw the spinous  processes nearer  to  each
other.
  2. The Intertransversales colli, dorsi, et lumborum,
are small muscles which fill up, in a similar manner, the
space between the transverse  processes of the vertebrae.
In the neck they are bifurcated and distinct, in the back,
they are small and  slender, and  in the loins they are
strong and fleshy.
   Use: To draw the transverse processes  towards  each
other.
               CHABTEB  XVII.

DISSECTION OF THE MUSCLES SITUATED BETWEEN THE
 RIBS, AND ON THE INNER SURFACE OF THE STERNUM.

  The muscles which fill up the space between the ribs
are named  Intercostals;  they are  disposed on each side
of the thorax in  two layers, and  each layer consists of
eleven muscles.
  1.  The Intercostales Externi—Arise from the in-
ferior acute edge of each superior rib, extending from the
spine to near the junction of the ribs with their cartilages.
The  fibres  run obliquely forwards and downwards, and
are
  Inserted into the upper obtuse  edge of each  inferior
rib, from the spine to near the cartilage of the rib.
  Situation: These muscles are seen,  on removing the
muscles which cover the thorax.
  The Levatores Costarum are twelve small muscles,
situated on each side of the  dorsal vertebrae.  They are
portions of the external intercostals.  Each of these small
muscles arises from the transverse process of one of the
dorsal vertebras, and passes  downwards, to be  inserted 
TRIANGULARIS STERNI.
279
into the upper side of the rib next below the vertebras,
near its tuberosity.
  The first of these muscles passes from the last cervical
vertebra,  the  eleven others from the eleven superior
dorsal vertebrae.   The three or four inferior Levatores
are longer,  and run  down  to  the second rib below the
transverse process from which they arise.
  2. The Intercostales Interni—Arise from the infe-
rior acute edge of each superior rib, beginning  at the
sternum, and  extending as  far  as the angle of the rib.
The fibres run obliquely downwards and backwards, and
are                                           .    .
   Inserted into the superior  obtuse edge of each inferior
rib from the sternum to the angle.  Portions of  the in-
ternal intercostals pass over one rib, and are inserted into
the next below it.
   Thus the intercostal muscles decussate,  and are  double
on the sides of the  thorax; but, from the spine to the
angles of the ribs, there are  only the external intercostals,
and, from the cartilages to the sternum, only the internal
and some cellular membrane covering them.   The whole
of the internal intercostals,  and the back part of  the ex-
ternal, are lined by the pleura.
    Use: To elevate the  ribs  so as to enlarge the cavity of
 the thorax.
   One pair of muscles  is situated on the inner surface of
 the sternum.
   The Triangularis Sterni. or Sterno-Costalis—Arises,
 tendinous and fleshy, from the edge of the whole cartilago-
 ensiformis, and from the upper edge of the lower half of
 the middle bone of  the sternum.  The fibres ascend ob-
 liquely upwards and outwards, and form a  flat   muscle,
 which is                                        .
   Inserted, by three or four triangular fleshy and tendinous
 terminations, into the cartilages of the third, fourth, fifth,
 and sixth ribs.                  ,   .  .,    „,-,   •■,    -,
   Situation:  This muscle lies on the inside of the  ribs and
 sternum, and is lined by the pleura.
    Use: To depress the cartilages and the bony extremi-
 ties of the ribs,  and consequently to assist  in lessening
 the cavity of the thorax. 
280             PRACTICAL ANATOMY.
             CHAPTEB  XVIII.

              DISSECTION OF THE EYE.

  The eyes of inferior animals, as the bullock's, sheep s,
or pig's, are generally used for purposes of dissection.1
  The Ball of the Eye—composed of tunics and hu-
mors.  The anterior part is covered by a mucous mem-
brane, the Conjunctiva, which  is reflected  upon the
eyelids.   Clear away all loose structure, and you expose
  The Sclerotic Coat—an exceedingly strong fibrous
coat.  It is perforated behind by several small openings
for the filaments of the optic nerve, and in front has con-
nected with it the cornea.
  The Cornea—a  transparent membrane, made up of
numerous laminae.  The conjunctiva covers it, though
altered  very much  in character.   Make  an incision
through  the sclerotica,  and,  introducing  a  blowpipe,
force in sufficient air to separate it from the coat beneath;
then carefully, with a pair of scissors, divide around its
entire circumference.  This accomplished, make a  num-
ber of antero-posterior incisions, and turn back the cut
portions, under which the ciliary nerves will be seen run-
ning forward.
  Tunica  Choroidea—a  dark coat, depending for its
color upon a layer of  pigment  cells. This  coat is very
vascular.  Where it seems to terminate in front, a white
line is seen, the Ciliary Ligament.  In front of it  is
placed the Iris, and, if this be now torn away, a number
of vascular  fringes  will  be seen  on its  front  border.
These are the ciliary processes.
  The Ciliary Ligament is a line of union between the
iris with the choroidea, and these again with the sclero-
tica and cornea.
  Iris—a muscular and  vascular  body,  consisting of
fibres longitudinal and circular.   It is colored with pig-
mentum nigrum, and the opening  in it is the pupil.

  1 They should be floated in a saucer of water when being examined. 
RETINA.
Fig. 99.
Dissection op the Eye, in which the Scleeotica has been dissected off
  and turned down in okdek to expose the Nerves and some of the
  Bloodvessels.

1,1. Ciliary Nerves entering the Ciliary Ligament and passing forward
      to the Iris.  The Ligament is dissected away in two places to
      show their course.
  2. Smaller Ciliary Nerve.
  3. Vasa Vorticosa, or Veins of the Exterior Layer of the Choroid.
  4. Ciliary Ligament and Muscle.
  5. Converging Fibres of the Greater Circle of the Iris.
  6. Looped and knotted form of these  Fibres near  the  Pupil, the
      knots  or enlargements  being regarded  as Ganglia  by Meckel.
      Within them is seen the lesser circle, Sphincter Iridis, with its
      Converging Fibres.
  6. The Optic Nerve.

   Bettna.—If the choroid be  dexterously removed, the
retina is exposed, an exceedingly delicate nervous mem-
brane.1  It is connected in front to the lens by  its vascu-
lar layer,  the Zonula Ciliaris.
   There are three humors or lenses  in the  interior of the
eye.

  1 For its structure and  that of the other coats, see works on special
anatomy.
                             24* 
282
practical anatomy.
                         Fig. 100.
Internal View of the Choroid Coat and Ciliary Processes, as seen in
              A Vertical Section of the Eyeball.


                  a, b. Corona Ciliaris, or Ciliary Body, the rays of
                        which  are adherent to the Choroid at b,
                        and free at a.
                    s. Sclerotic Coat.
                    c. Choroid Coat.
  Vitreous Humor—makes the great bulk of the eye,
and is situated posteriorly.
  It is inclosed in a delicate capsule, the Hyaloid Mem-
brane.
  Crystalline Humor is a double convex lens, situated
on the front part of the  vitreous humor, and inclosed in
a membrane called its capsule.
Fig. 101.
A Horizontal Section of the Eye.
1,1. The Cornea, fitted into the Sclerotica.
  2. Its Posterior Lamina, or Cornea Elastica, forming the Anterior
      Parietes of the Chamber for the Aqueous Humor.
 
LIGAMENTS.
283
  3,3. Sclerotic Coat.
  4, 4. Choroid Coat.
  5, 5. Ciliary Ring or Ligament.
   6. Its Internal Surface, corresponding to the Ciliary Processes.
   7. Ciliary Body, or Corona Ciliaris of the Choroid Coat.
   8. The Iris.
   9. Posterior Chamber of the Aqueous Humor.
   10. Anterior Chamber of the Aqueous Humor.
   11. The Retina.
12,12. Termination of the Retina (according to Cruveilhier and others,
       mar go dentatus),  at the Posterior Extremities of the Ciliary
       Processes of the Vitreous Body.
   12. The Vitreous Humor.
   13. The Hyaloid Tunic, one layer of which passes behind.
   14. The other in front of the Crystalline Lens.
   15. The Lens.
   16. Canal of Petit.
   17. Optic Nerve, invested by a Sheath from the Dura Mater.
   18. Vitreous Humor, or Corpus Vitreum.


   Aqueous Humor—it has  the  least consistence of the
three, and occupies all the space between the crystalline
lens behind and the  cornea  in front, filling up the ante-
rior and posterior chambers  of the eye.  The communi-
cation between the two chambers of  the eye is the pupil.
                 CHABTEB XIX.

                      LIGAMENTS.

  If the student designs examining the articulations, they
should be kept moist after the  dissection of the muscles.
  The Ligaments are found either in the form of cords,
bands, or sacs.   The most perfect capsular ligaments are
those of the shoulder and hip-joints.
  Within  the  ligaments of  movable articulations  is  a
lining of serous membrane.   The synovial sac which se-
cretes a tenacious viscid fluid, the Synovia; designed
for  lubrication of the joints.  The student should examine 
284             PRACTICAL ANATOMY.

the most important articulations, of which the following
may be described:—

            Articulation of the Lower Jaw.
  It is formed between the glenoid cavity of the temporal
bone, and the head of the inferior maxillary bone.

                       Fig. 102.
Articulations of the Lower Jaw.
  A Capsular Ligament invests  the joint,  arising
around the glenoid cavity, and inserted about the neck of
the  inferior maxillary bone.  A few additional fibres on
the  inner and outer side of the capsular ligament  have
been named the Internal and External Lateral Liga-
ments.
  Stylo-maxillary Ligament—arises from the  styloid
process, and is inserted on the posterior  face of the jaw,
close to the angle.
  Interarticular Cartilage divides the capsular liga-
ment, and it is seen placed  between the condyle and the
glenoid cavity.   Usually there  are  two distinct synovial
sacs, one above and one below this  cartilage. 
articulations of the spine.         285
                Ligaments of the Spine.
  Anterior Vertebral Ligament extends along the
front of the spine from the second vertebra to the sacrum.
  Bosterior Vertebral Ligament extends from the
foramen  magnum  to the  sacrum and coccygis,  on the
posterior part of the bodies of the vertebrae, within the
spinal canal.
   Intervertebral  Substance.—Fibro-cartilaginous
disks placed between all the vertebrae except the first two.
They consist of an exterior part, the fibres of which are
arranged concentrically, and also oblique, and an interior,
consisting of a soft pulpy substance.  This material is,
in the connected spine, in a  state of compression, as it is
seen to rise up when the contiguous pieces are removed.
The Oblique Brocesses are connected by capsular liga-
ments, lined by synovial membranes.  The spinous pro-
cesses have  ligaments passing between them.  Between
the bony bridges of the vertebrae are placed the ligamenta
subflava, or yellow elastic ligaments.

            Special Articulations of the Spine.
   Of the Occiput with  the Atlas.—The  articulating
processes of each are faced with cartilage, and surrounded
by a capsular ligament.

                       Fig. 103.
 
286
practical anatomy.
  Occipito-Atloidean Ligament—Arises from the mar-
gin of the great occipital foramen, and is inserted into the
upper margin of the Atlas.

        Articulation of the Axis with the  Occiput.
  Occipito-Dentate Ligament—From the  processus
dentatus to the front of the great occipital foramen.

                      Fig. 104.
The Posterior Arch of the Occiput and two Upper Vertebrae.
  Transverse Ligament stretches across from one side
to the other of the  first vertebra, just behind the  pro-
cessus dentatus.
  Moderator Ligaments—Two in number, and extend
from the processus dentatus to the inner part of the occi-
pital condyles.
           Principal Ligaments of the Pelvis.
  Those connecting the sacrum to the vertebrae are called
Sacro-Vertebral.
  The Coccygeal Ligaments, Anterior and Bosterior,
are placed in front and behind the coccyx.
  Ilio-Lumbar Ligament—From the transverse and ob-
lique  processes of the last lumbar vertebra, to the pos-
terior part of the crest of the ileum. 
LIGAMENTS.
  Sacro-iliac Ligaments.—Bands of fibres which sur
round the sacro-iliac junction.

                           Fig. 105.
X
ur-^^
Articulations of the Pelvis and Hip.
1. Posterior  Sacro-sciatic  Liga-    8
    ment (Vertical Ligament of    9
    Bichat), arising from the Sa-
    cro-iliac Junction.
2. Also from the Sacrum and Coc-10, 11
    cyx.
3. Free portion of the  Ligament,
    inserted into the Tuber Ischii
    at 4 and 5.
6. Lesser or Anterior Sacro-sciatic
    Ligament.
7. Obturator Ligament.
Os Coccygis.
Sacral  Fasciculus of the
 Posterior Sacro-Sciatic Lig-
 ament.
Capsular  Ligament  of the
 Hip-Joint.
Trochanter Minor.
Trochanter Major.
Lesser Sciatic Notch.
Greater Sciatic Notch.
Posterior  Sacro-iliac Liga-
 ment.
  Bosterior Sacro-sciatic Ligament.—From the pos-
terior inferior spinous process of the ileum, from the sacrum
and coccyx, to  the inner part of the tuberosity  of the
ischium, and continued towards the pubis. 
288             practical anatomy.
  Anterior  Sacro-Sciatic Ligament.—From the sa-
crum and coccyx to the spinous process of the ischium.
  Obturator Ligament fills up the foramen thyroideum.

               Articulation of the Pubes.
  Between  the  bodies of the pubes, fibro-cartilage, and
in front, bands of fibres passing across from one bone to
the other.
  Subpubic Ligament placed beneath the arch of  the
pubes.

           Posterior Articulations of the Ribs.
  The ribs  are  connected to the bodies of the vertebrae
and intervertebral  cartilages  by  an interarticular liga-
ment, and an anterior one; and to the transverse processes
by ligaments called Costo-transverse Ligaments.

           Anterior Articulation of the  Ribs.
  The ribs  have small cavities on their anterior extremi-
ties, into which fits the corresponding  cartilage, and
strengthened by fibrous bands in front  and behind.
  The cartilages of the true ribs  are let into cavities in
the sternum, and strengthened by radiated fibres in front.

             Sterno- Clavicular Articulation.
  The end of the clavicle is placed in a cavity on the edge
of the  sternum; a strong cartilage interposed,  and  the
whole articulation encased in  a capsular ligament.  The
clavicle is connected  also to the first rib or its cartilage,
the Costo-clavicular or Bhomboid Ligament.

            Scapuh-Clavicular Articulation.
  The  Acromioclavicular Ligament.—A capsular
ligament investing the acromion process and the acromial
end of the  clavicle.
  Coraco-Clavicular Ligament between the coracoid
process of  the scapula and the first rib. It presents the
appearance of two  which have been named the Conoid
and Trapezoid Ligaments. 
ARTICULATIONS.
289
Fig 106.
Sternoclavicular Articulation.
1. Capsular Ligament.            4, 4. Clavicles.
2. Inter-clavicular Ligament.       5, 6. Costo-sternal or Chondro-
3. Costo-clavicular or Rhomboid          sternal Ligaments.
   Ligament.

  Coraco-ACROMIAL  Ligament  between  the coracoid
and acromion processes.
  Coracoid Ligament across the coracoid notch.

             Scapulo-humeral Articulation.

  Glenoid Ligament around the glenoid cavity of the
scapula in order to deepen it.
  Capsular Ligament between the margin of the glenoid
cavity and the neck of the humerus.
  Accessory Ligament.—A simple thickening of the
capsular ligament between the coracoid  process and the
great tuberosity of the humerus.
  The tendon of the biceps muscle  passes  through the
upper part of the cavity on its way through the bicipital
groove to the arm.
25 
290              practical anatomy.
Fig. 107.

       2
Scapulo-humeral Articulation.
  1. Ligamentum Bicorne.
  2. Acromio-clavicular Ligament.
  3. Coraco-acromial Ligament.
  4. Coraco-clavicular Ligament.
  5. Coracoid or Supra-scapular Ligament.
  6. Capsular Ligament.
  7. Tendons of the Supra-spinatus, Infra-spinatus, and Teres Minor
      Muscles.
  8. Tendon of the Long Head of the Biceps.


                     Elbow-Joint.

  Capsular Ligament arising from the margin of the
articular surface of the os humeri and inserted  into the
ulna and coronary ligament of the radius.  A thickening
of its fibres on the inner and outer side of the articulation
constitutes the External and Internal Lateral Liga-
ments.
  Coronary Ligament of Badius passes from one side
of the lesser  sigmoid  cavity of the ulna to the other.  It
embraces the neck of the radius.
  Interosseous Ligament, a fibrous membrane stretched
between the radius and ulna.
  Bound Ligament, from  the coronoid  process to the
radius below its tubercle. 
articulations.                291
Fig. 108.
The Humero-cubital Articulation.
      1. External Lateral Ligament, blended with the Extensor Ten-
          dons.
2, 3, 4, 5. Capsular Ligament.
      6. Tendon of the Biceps.
      7. Humerus.
      8. Ulna.
      9. Radius.

                Articulation of the Wrist.
  This includes  the connection of  the radius  and ulna
below; the first  row of the carpus with these; and the
two rows of the carpus with each other.

               Radio-ulnar Articulation.
  A triangular cartilage extends from the  side of the
radius, and is fixed by a  pointed process into the root of
the styloid process of the ulna.   This cartilage separates
the lower end of the ulna from the cuneiform bone.   The
capsule of fibrous tissue which connects these bones above
the cartilage is loose-lined with a synovial membrane, and
called the Sacciform Ligament.  The cartilage is often
perforated by an opening, and the  synovial membrane is
continuous above and below. 
292              practical anatomy.
               Radio-carpal Articulations.

  Formed between the radius and the first three bones of
the first carpal row; it is  effected by an Anterior and
Fosterior Badio-carpal Ligament, and the External
and  Internal Lateral Ligament.  The lateral  ones
arising from the styloid processes of the radius and ulna,
and inserted into the scaphoid, trapezium, and cuneiform
bones.


         Articulations of the Bones of  the Carpus.

  These bones are arranged  in two rows,  having a com-
mon synovial membrane, except the pisiforme,  and that
between the trapezium and the metacarpal bone of the

                        Fig. 109.

Articulations of the Bones of the Carpus with each other, and with
             those of the forearm and metacarpus.

                                   1. Scaphoides.
                                   2. Lnnare.
                                   3. Cuneiforme.
                                   4. Pisiforme.
                                   5. Trapezium.
                                   6. Trapezoides.
                                   7. Magnum.
                                   8. Unciforme.
                                   9. Radius.
                                  10. Ulna.
                                  11. Synovial Membrane of
                                       the Inferior Radio-ul-
                                       nar Articulation.
                                  12. Synovial Membrane of
                                       the Radio-carpal Ar-
                                       ticulation.
                                  13. Inter-articular Ligament
                                       between the Ulna and
                                       Radius, and separat-
                                       ing the two preceding
                                       Synovial Membranes.
    14. Synovial Membrane of the Os Pisiforme.
 15, 15. Synovial Apparatus between the First and Second Rows of
         Carpal Bones, and between the Second Row and the Meta-
         carpus.
    16. Synovial Membrane of the Articulation of the Os Trapezium
         with the First Metacarpal Bone.
 
CAPSULAR LIGAMENT.
293
thumb.  The  figure will explain.  Ligamentous  bands
run in different directions from one bone to the other.

              The Phalangeal Articulations
May be considered as Capsular Ligaments thickened
very much on their sides, forming the Lateral  Liga-
ments, and strengthened in front and on the back by the
sheath for the flexor tendons and  the  expansion of the
extensor tendons.

             Articulations of the Hip-Joint.
  It occurs between the acetabulum and the head and
neck of the femur.
  Capsular Ligament—arising from  about the  aceta-

                        Fig. no.
       View of the Capsular Ligament of the Hip-Joint.
1. The Capsular Ligament
    is separated from the
    Acetabulum,  and is
    thrown back to show
    the manner in which
    it  invests and con-
    ceals the neck of the
    Femur.
2. Ligamentum Teres.
bulum, and inserted into the neck of the femur, lower in
front than behind.
 
294
PRACTICAL ANATOMY.
  Ligamentum Teres—a round cord from the pit  on
the head of the femur to the sides of the notch of the
acetabulum.
  Cotyloid Ligament—surrounds the brim of the ace-
tabulum as far as the notch.
  Transverse Ligament—subtends the notch of the
acetabulum.  The student will observe a loose vascular
pad of fat filling up a little space in the bottom of the
acetabulum.   These masses were  once  considered  as
glands.

                   The Knee-Joint.
  An expansion from the tendons of the  muscles of the
thigh incloses  this articulation in a loose  bag of fibrous
tissue.
        Fig. ill.
Front View of the Knee-Joint.
The Invobicrum.
  External Lateral  Ligament—from the external
condyle to the head of the fibula.
  Internal Lateral Ligament—from the internal con- 
knee-joint.                     295

   Fig. 112.
A Longitudinal Section of the Left Knee-Joint, showing the Reflec-
                  tion of its Synovial Membrane.

 1.  The Cancellated Structure of the lower part of the Femur.
 2.  The Tendon of  the Extensor Muscles of the Leg.
 3.  The Patella.
 4.  Ligament of the Patella.
 5.  The Cancellated Structure of the Head of the Tibia.
 6.  A Bursa situated between the Ligament of the Patella and the Head
     of the Tibia.
 7.  The Mass of Fat projecting into the Cavity of the Joint below the
     Patella.   ** The Synovial Membrane.
 8.  The Pouch of the Synovial Membrane, which ascends between the
     Tendon of the Extensor Muscles of the Leg and the Front of the
     Lower Extremity of the Femur.
 9.  One of the Alar Ligaments. The other has been removed with the
     opposite section.
10.  The Ligamentum Mucosum left entire—the Section being made to
     its inner side.
11.  The Anterior or External Crucial Ligament.
12.  The Posterior Ligament.  The scheme of the Synovial Membrane,
     which is here presented to the student, is divested of all unneces-
     sary complications.  It may be traced from the Sacculus (at  8)
     along  the inner  surface  of the patella; then over the adipose
     mass (7), from which it  throws off the Mucous Ligament (10) ;
     then over the  head of the Tibia, forming a sheath to the Crucial
     Ligaments; then  upwards along the Posterior Ligament and
     Condyles of the Femur  to the Sacculus, where its examination
     commenced. 
296             PRACTICAL ANATOMY.
 dyle of the femur, some  distance along the head and
 upper part of the shaft of  the tibia.
   In front of the articulation  is placed the  patella, con-
 nected by the Tendo Batell^; to the tubercle of the
 tibia.
   Ligament of Winslow—a derivation from the tendon
 of the semi-membranosus muscle, passing to the back part
 of the capsular ligament and giving it increased strength.
 If the patella be turned off the front of the joint, a mass
 of fat is seen filling up the space between the condyles
 of the  femur and the head of the tibia.  A  ridge of sy-
 novial  membrane on each side of this forms the Alar
 Ligaments.  From their junction above  starts  another
 duplicature of synovial membrane back  to  the crucial
 ligaments.   This is the Ligamentum Mucosum.
   Crucial  Ligaments, Anterior and Bosterior—the
 first from  the inner face of the external condyle, and
 inserted in front of the spinous process of the tibia; the
 last  from  the inner face of the internal condyle of the
 femur, and inserted behind the same  process of the tibia.
   Semilunar  Cartilages—two  in number,  between
 the femur and tibia.  Their posterior and anterior ends
 are fixed behind and in front of the spinous process of
 the tibia.  Notice the extent of the synovial membrane
 above the  patella.

              Peroneo-tibiaI Articulations.
   The upper end of the fibula  is connected to the tibia
by a capsular ligament, thick in front, and behind form-
ing  the Anterior  and  Bosterior  Beroneo-tibial
Ligaments. At the lower end in the same manner, but
called there the Anterior and Bosterior  Inferior Be-
roneo-tibial Ligaments.
   Transverse  Ligament—extends between  the  two
malleoli on the posterior aspect of the joint.
   Interosseous Ligament—fills up the space  between
the shafts of the two bones.

                   The Ankle-Joint.
   Constituted by  the  tibia, fibula, and astragalus.   On 
LATERAL LIGAMENTS.
297
the front and  behind  the joint  there exists only the ap-
pearance of a  capsular ligament,  but on the sides we
have the Lateral Ligaments.
  The  External Lateral Ligament consists of three
fasciculi, arising from  the external malleolus, and  is in-
serted into the astragalus and the os calcis.
  Internal Lateral  Ligament—Arises from the in-
ternal malleolus, and is inserted into the lesser apophysis

                         Fig. 113.
Internal Ligaments of the Ankle and Foot.
 1. Anterior Fasciculus of the Deltoid Ligament.
 2. Middle Fasciculus.
 3. Posterior Fasciculus.
 4. Groove for the^Flexor Digitorum Communis.
 5. Internal Calcaneo-scaphoid Ligament.
 6. Tendon of the Tibialis Posticus.
 7. Tendon of the Tibialis Anticus.
 8. Ligament connecting the Os Scaphoides with the  first Cuneiform
    Bone.
 9. Ligament connecting the Scaphoides with the Cuneiform Medium.
10. Ligaments connecting the first Metatarsal with the first Cuneiform
    Bone. 
298              PRACTICAL ANATOMY.

of the  os calcis.  It spreads out towards its insertion,
hence sometimes called the Deltoid Ligament.

       Articulations of the Os Calcis and Astragalus.

  A very powerful interosseous ligament forms the prin-
cipal one.

                          Fig. 114.
The External Lateral Ligaments of the Ankle and Foot.
1.  Anterior Ligament of the Lower Tibio-fibular Articulation.
2.  External Lateral Ligament, sometimes called Peroneo-calcaneum.
3.  Anterior Fasciculus of the same, or Peroneo-astragalian Ligament.
4.  External Calcaneo-astragalian Ligament.
5.  Interosseous Ligament.
6.  Lower Calcaneo-cuboid Ligament.
7.  Ligament (Ligamentum  Dorsale  Obliquum), uniting the Fifth Me-
    tatarsal Bone with the Os Cuboides.
8.  Dorsal Ligament of the Fourth Metatarsal Bone.   The dorsal sur-
    face of the foot is covered by smaller ligaments that connect the
    tarsal and metatarsal bones, and these again with each other.


   Scaphoid and Astragalus—united by  a capsular
ligament. 
OS CALCIS AND SCAPHOID.
299
  Os Calcis and Cuboides—united by the superior and
inferior calcaneo-cuboid ligaments  passing between the
two bones.
  The  Os Calcis and Scaphoid are very firmly united
by the  internal and external Calcaneo-Scaphoid Liga-
ments—the former  from the lesser apophysis of the os
calcis to the  inner  surface of the  scaphoid;  the latter
from the greater apophysis of the os  calcis to the outer
end of the scaphoid.  Other ligaments, both on the upper
and lower surface of the foot, connect the different pieces
together. 
 
INDEX.
Abdomen, 141
    superficial fascia of, 144
    arteries of, 144
Abdominal regions, 144
    ring, external, 145
         internal,  151
Acervulus, 46
Air-cells, 254
Alimentary canal, 154
Amygdalas, 82
Antihelix, 17
Antitragus, 17
Anus, 162
Antrum maxillare, 94
Aortic sinuses, 264
Appendix vermiformis, 162
Appendices epiploicae,  58
Aqueous humor, 283
Aqueduct of  Sylvius, 46
Arachnoid membrane, 40
Arbor vitse, 50
Arch, palmar, 129
Arytenoid cartilages, 62, 87
Auricles of heart, 250,  261-263
Axilla, 97-100
Axis, cceliac, 170
Arteries.
    ad cutem abdominis, 144
    alveolar, 28
    anastomotica brachialis, 136
         femoralis, 185
    angular, 23
    aorta, 170—250, 252, 258
    arcus sublimis, 129
         profundus, 133, 138, 139
    articular, 208
    auricular, 15, 70
    axillary, 76,  101.  Ill
    basilar,  51
    brachial, 101, 118, 134
    bronchial, 259
    bulbosi,  228, 234

      26
Arteries—continued.
    buccal, 28
    carotid, common, 253
        external, 27, 68
        internal, 53, 56
    carpal, radial, 118, 138
        ulnar, 139
    cavernosi, 228, 234
    centralis retinae, 95
    cerebellar, 56
        superior, 56
        inferior, 56
        posterior, 56
    cerebral anterior, 56
        media, 56
    cervicis superficialis, 76
        bronceps, 76
        profunda, 76
    circumflex femoral, 189
        humeral, 102
        ilii,  150, 153,  189
    cceliac axis, 170
    colica dextra, 172
        media, 172
        sinistra, 174
    communicans cerebri,  56
    coronaria cordis, 250,  264
        ventriculi, i70
        labial, 23
    dental, 28
    digitalis manus, 119, 139
        pedis, 216
    dorsalis pollicis, 138
        hallucis, 197
        penis, 228, 230, 234
        scapulae, 102
    emulgent or renal,  164, 172
    epigastric, deep, 153, 189
        superficial, 144
    facial, 23, 66, 69
        transverse, 24. 70
    femoral, 187 
302
INDEX.
Arteries—continued.
    frontal, 15, 95
    gastric, 170
    gastro-epiploica sinistra, 172
        dextra, 172
    gluteal, 204, 233
    hemorrhoidal, superior, 174
    hepatic, 157, 172
    hypogastric, 230
    ileo-colic, 172
    iliac,  common, 174
        external, 174
        internal, 174, 233
    ileo-lumbar, 233
    infra-orbital, 28, 95
    innominata, 76, 252
    intercostal,  258
        superior, 78; 258
    interosseous, leg, 216
        arm, 118, 128. 139, 140
  9     pedis,  197, 216
    ischiatic, 205, 233
    labial, 23
    lachrymal, 31
    laryngeal, 69
    lateralis nasi, 23
    lingual, 68, 69
    lumbar, 174
    magna pollicis, 13S
    malleolar, 196
    mammary, internal, 78
        external, 101
    masseteric, 23
    maxillary, internal, 27, 70
        superior, 28
        inferior, 28
    meningea magna, 28
        parva, 28
        media, 37
        anterior, 38
        posterior, 38
    mesenteric, superior, 172
        inferior, 174
    metatarsal, i96
    obturator, 189
    occipital, 15, 70
    oesophageal ,259
    ophthalmic, 95
    pancreaticae, 172
    parotidean, 24
    perforantes, 188
    perineal,  superficial, 231
        transverse, 227
    peroneal, 216
    pharyngeal, 28, 70
    phrenic, 78, 170
    plantar, 214
Arteries—contained.
     popliteal, 208
     princeps cervicis, 76
     palato-maxillary, 28
     profunda cervicis, 76
         femoris, 188
         humeri, superior, 113, 136
             inferior, 113, 136
     pterygoid, 28
     pudic external, 189
         internal, 205, 223, 224
     pulmonary, 250
     pyloric, 172
     radial,  118, 136
         indicis, 138
         recurrent, 118,  137
     renal, 164,  172
     sacrai lateral,
         media, 174
     scapular, supra, 76, 108
         posterior,  76
     spheno-palatine, 28
     splenic, 172
     subclavian, 76, 253
     subscapular,101
     submental, 66,  69
     superficialis volse, 118,  137
     superficial circumflex ilii,  189
     supra-orbital, 15
     sural, 208
     spermatic, 174, 236
     tarsal, 196
     temporal, 15,  70
         deep, 28
     tibial, anterior recurrens,  195
         posterior, 214. 216
     transverse facial, 70
     thoracic acromial, 101
     thoracic, 101
         longa, 101
         axillary, 101
         humeral,  98
     tympanic, 28
     ulnar, 118,  138
         recurrens, 118,  13S
         pollicis, 139
     umbilical, 153
     vasa brevia, 172
     vertebral, 54,  56, 76
     thyroid, superior, 69
         inferior, 76
         axis, 76

Brain, 40
     cortical part of, 40
     hemispheres of, 40
     lobes of, 40 
INDEX.
303
Brain—continued.
    medullary part of, 40
Bladder, 228
Bronchiae, 254
Brunner's glands, 164
Bulb of urethra, 239

Caecum,  162
Calamus scriptorius, 49
Capsule of Glisson,  158
Capsules, supra-renal, 165
Caput gallinaginis, 238
Cardiac  orifice, 158
Cartilage, interarticular clavicle, 288
         ofjaw, 284
         of wrist, 292
     semilunar, 296
 Caruncula lachrymalis, 94
     myrtiformes, 241
 Cauda equina, 56
 Ceruminous glands, 17
 Centrum ovale majus, 42
     minus, 42
 Cerebellum, 49
 Cerebrum,  40
 Chambers of the eye, 280
 Chordae tendinese, 262
     vocales, 90
     Willisii, 37
 Choroid plexus, 44
 Ciliary ligament, 280
 Circle of Willis, 53
 Clitoris, 240, 241
 Colon,  154, 162
 Columna nasi, 35
 Columnae carneae, 262
 Columns of spinal cord, 58
 Concha, 16, 17
 Columns of abdominal ring, 145
 Commissures of brain, 46
  Conjoined tendon, 151
  Conjunctiva, 91, 208
  Cornea, 280
  Cornua of the ventricles of brain, M
       ammonis, 48
  Corpora albicantia, 48
       arantii, 263
       cavernosa, 230
  Corpus spongiosum,  229
  Corpora pyramidalia, 50
       geniculata, 45
      •olivaria, 51
       restiformia, 51
       quadrigemina, 46
       striata, 45
  Corpus callosum, 41
       fimbriatum, 48
Corpus—continued.
    dentatum, 48
    psalloides, 44
Cowper's glands, 228, 229, 239
Cranial nerves, 53
Cricoid cartilage, 62, 87
Crura cerebelli, 51, 56
    cerebri, 51
    penis, 228
Crural arch, 147
    canal or ring,  169
Crystalline lens, 282

Dartos, 236
Ductus ad nasum, 94
     arteriosus, 253
     communis choledochus, 158
     cysticus, 158
     ejaculatorius, 230, 238
     hepaticus, 158
     pancreatieus, 164
     prostatic, 238
     thoracic, 166,  176, 252, 259
     venosus,  158
     parotid, 24
     lachrymalis, 94
 Duodenum, 160
 Dura mater, 36

 Ear, 16
 Endocardium, 261
 Exocardium, 260
 Epididymis, 236
 Epiglottis cartilage, 62, 85, 87
 Eustachian tube, 82
      valve, 261
 Eye, 280
 Eyebrows, 15
 Eyelids, 94

 Falciform process, 174
      or semilunar edge, 174, 179
  Fallopian tubes, 243, 244
  Falx cerebelli, 38, 48
      cerebri, 38
  Fascia—
      cervical, 59
      crural, 169
      cribriform, 177
      iliac, 169
      infundibular, 151
      intercolumnar, 147
       intermuscular, 211
       lata femoris. 177
       lumbar,  270
       palmar, 128
       pelvic, 231 
304
INDEX.
 Fascia—continued.
     pectineal, 179
     perineal, 224
     plantar, 217
     propria, 179
     sartorial, 179
     spermatic,  147
     subaponeurotic, 15
     temporal, 25
 Fauces, 82
 Fissure cerebri, 41
     Sylvii, 41,  50
     of the liver, 157
     of spinal cord, 57
 Flocculus, 50
 Foramen caecum, 85
     commune anterius, 45
     of Monroe, 43
     of Winslow, 156
     Thebesii, 261
 Fornix, 43
 Fossa, ischio-reetal, 224
     ovalis, 261
 Fourchette, 239
 Fraena epiglottidis, 85
 Fraenum linguae, 68

 Gall-bladder, 154
 Ganglia, cervical, 72
     Casserian, 54
     impar, 176, 256
     lenticular,  96
     semilunar,  256
     lumbar, 256
     sacral, 256
 Glands of Brunner, 164
     ceruminous,,i7
     Cowper, 228^229, 239
     inguinal, 177
     lachrymal,  31, 94
     lymphatic,  101
     mammary,  97
     mesenteric, 156
     Pacchionian, 37
     parotid, 61
     Peyer, 164
     pineal, 46
     pituitary, 53
     sublingual, 66
     submaxillary, 61, 65
    thymus, 253
Glans clitoridis, 240
    penis, 229
Globus major, 236
    minor, 236
Glottis, 87
Guthrie's muscle, 228
Heart, 260
Helix, 16
Hernia, 151
    femoral, 178
    inguinal, 151
    ventro-inguinal, 151
Hey's ligament, 178
Hippocampus major, 47
    minor, 48
Horner's muscle, 94
Humors of eye, 282
Hyaloid membrane, 282
Hymen, 240

Ileo-coecal valve, 162, 164
Infundibulum, 51, 53
Intercolumnar fascia, 147
Intervertebral substance, 285
Intestinal canal, 154
Iris, 280
Ischio-reetal fossa, 224
Isthmus of the fauces, 82
Iter ad infundibulum, 46
    quartum ventriculum, 46, 50

Jejunum, 160
Joint, ankle, 296
    elbow, 290
    hip,  293
    lower jaw,  284
    knee, 294
    shoulder, 2S9
    wrist, 291

Kidneys, 164

Labia majora, 239
    minora, 240
Lachrymal canals, 94
    gland, 31,  94
    puncta, 94
    caruncie, 94
    sac, 94
Larynx, 61
Lateral ventricles, 42
Lenticular ganglion, 96
Locus perforatus, 51
Ligaments, 283
    acromio-clavicular, 288
    alar, 296
    annular of ankle, 296
        wrist, 115
    arcuatum,  166
    of bladder, 230
    calcaneo-cuboid superior, 299
        inferior, 299
    oalcaneo-scaphoid, internal,  299 
INDEX.
305
Ligaments—continued.
    calcaneo-scaphoid, external,
    capsular of hip, 293
         of jaw, 284
         of shoulder, 289
         of elbow, 290
    cotyloid, 294
    conoid, 288
    coracoid, 289
    coraco-acromial, 289
         clavicular, 288
    coraco-humerales, 289
         accessory, 289
    coronary, 290
    costo-clavicular, 288
         transverse, 288
    coccigeal,  286
    crucial,  296
    deltoid,  298
    of elbow-joint,  290
    ileo-lumbar, 286
    interosseous, 290, 296
    of the ankle-joint, 296, 298
    of the knee-joint, 294, 296
    of the hip-joint, 293, 294
    of the wrist-joint, 291, 292
     of the phalanges, 293
     of the pelvis, 286
     of shoulder-joint, 289
     occipito axoid,  286
         atloid, 285
     radio-ulnar, 290, 292
     radio-carpal, 292
     sacro-ischiatic, 287, 288
     sacro-vertebral, 286
     tibio-fibular, 296
     tarsal, 292
     temporo-maxillary, 284
     phalangeal, 293
     patella, 296
     palpebrae, 94
 Ligamentum nuchae, 265
 Linea alba,  145
     semilunaris, 145
     transversae, 145, 152
 Liver, 157
 Lobus caudatus, 157
     Spigelii, 157
     quadratus,  157
 Lungs, 247, 248
 Lymphatic glands, 101

 Mammae, 97
 Mediastinum, 247
 Medulla oblongata, 51
 Membranous urethra, 238
 Mesentery,  156
  Mesocolon, 157        ,
i  Mitral valve, 264
  Mons veneris, 239
  Monticulus, 49
  Morsus diaboli, 244
  Muscles—
      abductor indicis, 132
          brevis, 184
          longus, 185
          magnus, 186
          minimi digiti pedis, 218
          minimi digiti,  132
          oculi, 92
          pollicis manus, 129
               pedis, 218
      anconeus, 125
      acceleratores urinae, 225
      accessorius, 219
      anterior auris, 16
      anti-tragicus, 17
      arytenoideus, 89
      aryteno-epiglottideus, 90
      attollens aurem, 16
      auricularis, 124
      azygos uvulae, 84
      biceps flexor cruris, 202
      biceps flexor cubiti, 110
      brachialis anticus, 112
      buccinator, 21
      cervicales ascendens, 273
      circumflexus palati, 84
      eoccygeus, 228
      complexus, 274
      compressor-naris, 19
      constrictor isthmi faucium, 82
           pharyngis,  85, 86
       coraco-brachialis,  111
       corrugator supercilii, 19
       cremaster, 150, 236
       crico-arytenoid lateralis, 88
           posticus, 87
       crico-thyroideus, 63
       crurasus, 183
       deltoid, 106
       depressor labii  superioris alaeque
             nasi, 23
           anguli oris, 21
           labii inferioris, 21
           oculi, 92
       diaphragm, 165
       digastricus, 63
       erector clitoridis,  244
           penis, 224
           spinae, 271, 272
       extensor carpi radialis brevior, 123
                longior, 122
            brevis digitorum pedis,  194

26* 
306                            ini


Muscles—continued.
    extensor digitorum communis,
               123
         longus digitorum pedis,  191
             indicis, 127
         minimi digiti,  124
         ossis metacarpi pollicis, 126
         primi internodii, 126
         proprius pollicis pedis, 191
         secundi internodii, 127
         ulnaris, 125
    flexor brevis pollicis manus,  131
             minimi digiti pedis, 220
             pedis, 220
         carpi radialis, 115
             ulnaris, 117
         digitorum brevis pedis, 219
             longus pedis, 212
         longus pollicis  manus, 120
         ossis metacarpi pollicis,  130
         parvus minimi digiti, 132
         pollicis longus manus, 120
         profundus digitorum, 119
         sublimis digitorum, 117
    gastrocnemius, 208
    gemellus, 200
    genio-hyoglossus, 67
         hyoideus, 67
    gluteus maximus, 198
         medius, 198
         minimus, 199
    gracilis, 184
    helicis major,  17
         minor, 17
    hyo-glossus, 68
    iliacus, 169
    indicator, 127
    infra-spinatus, 107
    intercostales, 278, 279
    interossei manus, 133
         pedis, 220, 223
    inter-spinales, 277
    inter-transversales, 278
    latissimus dorsi, 265
    levator anguli oris,  21
         ani, 227, 243
         costarum, 278
         labii superius,  19
             inferius, 24
         palati, 84
         palpebrae, 91
         scapula;, 267
    lingualis, 85
    linguae superficialis, 85
         transversalis, 85
         verticalis, 85
    longissimus dorsi, 271
Muscles—continued.
    longus colli, 81
    lumbricales, 129, 220
    masseter, 24
    multifidus spinas, 277
    mylo-hyoideus, 66
    obliquus externus abdominis, 144
        internus abdominis, 147
        capitus superior, 276
             inferior, 276
        oculi, 92, 93
    obturator externus, 202
        internus, 200
    oecipito frontalis, 15
    omo-hyoideus, 62
    opponens, 131
    orbicularis oris, 23
        palpebrarum, 18
    palato-glossus, 82
        pharyngeus, S3
    palmaris brevis, 128
        longus, 116
    pectinalis, 184
    pectoralis major, 98
        minor, 98
    peroneus brevis,  194
        longus, 192
        tertius, 194
    plantaris, 210
    platysma myoides, 59
    popliteus, 211
    pronator quadratus, 121
        radii teres, 115
    psoas magnus, 168
        parvus, 168
    pterygoideus externus, 26
        internus, 27
    pyramidalis, 153
    pyriformis, 199
    quadratus femoris,  201
    rectus abdominis, 152
        capitis anticus major,  81
             minor, 81
             lateralis, 81
             posticus minor, 275
                 major, 275
        femoris, 181
        oculi externus,  92
             inferior, 92
             internus, 92
             superior, 92
    retrahens aurem, 16
    rhomboideus major, 266
        minor, 277
    sacro-lumbalis, 271
    sartorius, 181
    scalenus anticus, 79 
INBEX.
307
Muscles—continued.
    scalenus medius, 79
        posticus, 79
    semi-membranosus, 204
    semi-spinalis, 275
    semi-tendinosus, 203
    serratus magnus, 268
        posticus inferior, 269
             superior, 268
    soleus, 209
    sphincter ani internus, 227
             externus, 227, 243
         vaginae, 241
    spinalis dorsi, 272
    splenius, 269
    sterno-hyoideus, 62
         cleido mastoideus, 61
         thyroideus, 62
    stylo-glossus, 65
         hyoideus,  65
         pharyngeus, 65
    subclavius, 99
    subscapularis,  109
    supinator brevis, 126
         longus, 122
    supra-spinatus, 107
    temporal, 25
    tensor-palati, 84
         tarsi of Horner, 94
         vaginae femoris, 180
    teres major, 109
         minor, 109
    thyro-arytenoideus, 88
         epiglottideus, 90
         hyoideus, 63
    tibialis anticus, 191
         posticus,  213
    trachelo-mastoideus, 273
    tragicus, 17
    transversalis colli, 273
         abdominis, 150
    transversus auris, 17
         perinei, 226
             alter, 227
    transversalis pedis,  220
    trapezius, 264
    triangularis sterni, 279
    triceps adductor femoris, 184
         extensor cubiti, 112
    vastus externus, 183
         internus,  183
    zygomaticus major, 20
         minor, 20
    musculi pectinati, 261
    nares, 35
    nasal duct, 34
    nates cerebri,  46
Nerves, abducentes, 54, 96
    accessories, spinal, 51, 61, 75
    auricularis magnus, 59
    cardiac, 254
    cervical, 29, 32
    cervico-spinal,  75
    chorda tympani, 32
    ciliary, 31
    circumflex, 102
    communicans noni, 73
    cranial,  53
    crural, 33, 189, 235
    cutaneous externus  of arm, 103,
             140
         internus, 103, 105, 111, 114,
             142
         of the thigh, 177
    dental anterior, 23
         inferior, 32
         posterior,  31
    descendens noni, 73
    digital, 129, 141, 142
    dorsal, 33
    eighth pair, 34
    facial, 34
    fifth pair, 31, 54
    first pair, 53
    fourth pair, 54, 96
 .   frontal,  15, 31, 96
    glosso-pharyngeal, 55, 71
    gluteal, 205
    gustatory, 27,  32
    hypoglossal, 55, 68,  73
    inferior maxillary, 23
    infra-trochlear, 31
         orbital, 20, 31,  96
    intercosto-humeral,  103
    ischiaticus major, 33, 205, 235
         minor, 205
    lachrymal, 31
    laryngeal inferior, 34, 76, 260
         recurrent, 34, 76, 260
         superior, 71
    lingual, 55, 68, 73
    lumbar, 33
    maxillary inferior, 23
         superior, 31, 96
    median, 103, 118, 140
    motor oculi, 53, 95
    musculo-spiral, 103, 113,  118, 142
    nasal, 31, 96
    ninth pair, 55, 68, 73
    obturator, 33,  185, 190, 235
    occipitalis major, 16
         minor, 59
    oesophageal, 71
    olfactory, 53 
308
IN0EX.
Nerves—continued.
    optic, 53, 95
        tracts, 53
    pathetici, 54, 96
    par vagum, 55, 71, 176, 260
    perforans Casserii, 103, 140
    peroneal, 190, 206
        cutaneous, 208
    phrenic, 32, 75, 253
    plantar, 2l7
    pneumogastric, 55, 71, 176, 260
    popliteal, 205, 206
    portio dura, 16, 23, 29, 55
        mollis, 55
    pudic internal, 205
    pulmonary, 103
    radical, 103, 113, 118, 142
    recurrent laryngeal, 34, 76, 260
    respiratory external of Bell, 103
    sacral, 33
    saphenous, long, 187, 189
        short, 187, 189
    sciatic,  33, 205, 235
    second pair, 53, 95
    seventh pair, 16, 23, 29,  55
    sixth pair, 54, 96
    spinal nerves, 58
        accessory,  51, 61, 75
    splanchnic, great, 34, 67, 176, 2ij£
        less, 167, 256
    supra-scapular, 102, 108
    superficialis colli,  59
    superior maxillary, 31, 96
    supra-orbital, 96
    sympathetic, great, 34, 72, 254
    thoracic humeral,  103
    tibial anterior, 197,  206, 208
        post, 208
    trifacial, 31, 54
    trigeminus, 31, 54
    ulnar, 103, 113, 141
Nipple,  97
Nose, 35
    cartilages of, 35
    lobulus of, 35
    aire, 35
Nymphae,  240

ffisophagus, 62, 166, 259
Omenta, 154, 156
Os tincae, 241
Ovaries, 245

Pancreas, 163
Papillae of tongue, 85
    maxim;?, 85
    mediae, 85
 Papillae—continued.
     minimae, 85
     filiformes, 85
 Parotid gland, 61
 Peduncles of pineal gland, 46
 Penis,  229
 Pericardium, 247, 248
 Perineum, 223
 Peritoneum, 153, 154
 Pes anserinus, 29
     hippocampi, 48
 Peyer's glands, 164
 Pharynx, 62, 82
 Pia mater, 40
 Pineal gland, 46
 Pituitary, 53
 Pleura, 247
 Plexus, axillary, 33
     brachial, 76, 79, 112
     cardiac, 254, 260
     choroid, 44
     gastric,  176
     hepatic, 176
     hypogastric, 206
     lumbar, 277
     mesenteric,  176
     oesophageal, 260
     phrenic,  256
     pulmonary,  260
     renal, 176
     reetiformis,  243
     solar, 176, 256
     sacral, 264
     spermatic, 176
 Prepuce, 232
 Processus vermiformis superior, 49
         inferior, 49, 50
 Pons Varolii, 51
 Processus cerebello ad testes, 46
 Prostate gland, 228
 Prostatic sinus, 238
i Puncta lachrymalia,  94
! Pupil,  280
I Pyloric valve, 158, 164
 Pylorus, 15S

 Raph6 of perineum, 223
 Rectum, 162, 228, 246
 Retina, 281
 Rima glottidis, 87, 90
 Ring, abdominal, exterior, 145
         interior, 151
     crural, 169

 Sacculus larynges, 90
 Saphenous opening, 177
 Sclerotic coat, 280 
INDEX.
309
Scrotum, 236
Semilunar, 296
Septum auricularum, 261
    cordis, 248
    crurale, 169
    lucidum, 43
    pectiniforme, 230, 241
Sigmoid flexure, 162
    valves, 203
Sinus, aortic, 263
    cavernous, 53
    lateral, 36, 55
    longitudinal, superior, 36
        inferior, 39
    of Valsalva, 263
    rectus, 40, 45
    pocularis, 471
    prostatic, 238
Small intestines, 154, 158,  160
Spinal cord, 56
Spermatic cord, 236
Spleen, 163
Sphenoidal folds, 38
Substantia perforata, 51
Supra-renal capsules, 165
Suspensory ligament of liver, 157
Synovia, 283
Synovial membrane, 283
Stylo-maxillary ligament, 61, 65

Taenia semicircularis, 45
Tendinous centre of diaphragm, 166
Tendo-Achillis, 209
Tentorium cerebelli, 38, 48
Testes cerebri, 46
Testicles, 236
Thalami optici, 45
Thoracic duct, 166, 176, 252, 259
Thorax, 247
Thymus gland, 253
Tongue, 82, 85
Tonsils, 82
    cerebelli, 50
Torcular Herophili, 45, 48
Trachea, 62, 253
Tragus, 17
Triangular ligament, 224, 228
Tricuspid valves, 26i
Trigonum vesicle, 237
Tuber cinereum, 51
Tubercula quadrigemina, 46
Tuberculum Lowerii, 261
Tunica albuginea of testicle, 236
    vaginalis, 236

Urachus, 230
Ureter, 164, 246
Urethra, 229, 238, 240, 246
Uterus,  243
Uvula, 82
Urinary bladder,  230

Vagina, 241
Vallecula, 50
Valsalva sinuses,  263
Valves,  Eustachian, 261
    ileo-caecal, 162, 164
    mitral, 264
    pyloric, 158,  164
    tricuspid,  261
    semilunar, 263
    Vieussens, 47, 50
Valvulae conniventes,  160, 164
Vas deferens, 229
Veins, abdominal, 175
    axillary, 79,  101
    azygos major, 167, 258
         minor, 167, 258
    basilic,  105
    cava superior, 157, 167, 173, 249,
      250
    cava inferior, 249, 252
    cephalic, 98, 105
         pollicis,  105
    coronary, 261, 248
    comites, 140
    emulgent, 164, 175
    femora], 189
    Galeni,  45
    gastric, 175
    hepatic, 175
    iliac, 175
    innominata,  252
    intercostal, superior, 257
    jugular, exterior, 59
         interior, 68,  70
    lumbar, 175, 258
    median, 105
         basilic, 105
         cephalic, 105
    mesenteric, 175
    orbital, 95
    popliteal,  208
    pia mater, 40
    portal, 157, 175
    pulmonary, 250
    salvatella, 104
    interna or saphenous major, 177,
          189, 190
         externa, 190, 208
    spermatic, 236
    splenic, 175
    subclavian, 78
    tibial, 197 
310 INDEX.	
Veins—continued.	Vesiculae seminales, 228, 229
transversa, 252	Vestibule, 240
Velum interpositum, 44	Vibrissae, 35
pendulum palati, 82	Villi, 164
Ventricles of the brain, 42	Vitreous humor, 282
third, 46	Vulva, 45, 239
fourth, 49	
fifth, 42	Wharton duct, 61, 65, 66
lateral, 42	Willis circle, 53
Ventricles of the heart, 250, 261	Wilson muscles, 228
larynx, 90	Wrisberg nerve, 103
Vermiform process, 162	
Valvula conniventes, 160, 164	Zonula ciliaris, 281
;  \  THE end.    y 
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589999994