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SUF*M)N  GENERAL'S OFFICE
Section,
No. 11  (o  0 0 7 ,
V9*'*?*
 
t
I 
4
   '•1
  ; 
THE
ANATOMICAL REMEMBRANCER,
                 OR,

     Complete ftocket &nat0mist:

              CONTAINING
        A CONCISE DESCRIPTION
                 OF

THE STRUCTURE OF THE HUMAN BODY.


         A~ 3STew Edition.

                WITH
  COEEECTIONS AND  ADDITIONS

        By C. E. ISAACS^ M.D.,
Demonstrator of Anatoiiy In the University of New York



                       I I(o0o
            NEW YORK:
 WILLIAM WOOD & CO., 61 WALKEE  STEEE
               1865. 
                  as.




  Entered according to Act of Congress, in the year 1855,
             By S. 8. & W. WOOD,
In* the Clerk's Office of the District Court of the United
     States for the Southern District of New York.


         F*/^   No   <rf?7  .  ne-i
   R. CRAIGHEAD, PRINTER,

81, 88, and S5 Centre st^ K T. 
PREFACE TO THE  FIRST EDITION.
  The sole object of this little  Manual is to recall
to the mind of the Student  in Anatomy the  inform-
ation  he  may  have  acquired, either  by  actual
dissection,  or  by  the perusal of  works  which
profess  to treat more  fully on the subject.   The
Author, therefore, presumes it will be found highly
useful to those  who  are preparing  for examination
at the Royal  Colleges of Surgeons  and Societies of
Apothecaries 
PREFACE TO THE FOURTH  EDITION.
  In the attempt to introduce the more important
modern discoveries in  Anatomy,  the  Editor  has
experienced difficulty in keeping  this work to its
proper limits:  he hopes, however, that it  will be
found to contain sufficient to recall to the Student
in Anatomy  that  information which he  has  ac-
quired  in the Dissecting  Rooms.   He has endea-
vored to simplify the description of certain regions,
which   conflicting  inaccuracies  have   rendered
almost  unintelligible.   Foremost  amongst these
stands  "the  perineum," which is justly regarded
by  the Student  as an  incomprehensible  riddle;
next  comes  the  anatomy of the  brain;  thirdly,
the muscles of the back.   The minute structure of
bone and of some  of the more  important  glandu-
lar  structures has  for  the  first  time been intro-
duced,   such  information  being  required  by  the
examining Boards of the Profession.
October, 1850. 
PREFACE TO THE SECOND AMERICAN
                EDITION.
   This work, as its  name indicates, is intended  as
a Pocket Companion, and aid to the memory of the
Student, and especially while engaged in the details
of Practical Anatomy.
   Several errors in the last edition have  been cor-
rected,  and some  additions made to the present,
which seemed to be useful,  and demanded by the
advanced state of  the science.   Hernia is  one of
the subjects which  usually  present  the greatest
difficulty to Medical  Students: such  a description
has therefore been  given of its anatomy and  dissec-
tion, as from long  experience I have found to  be
most easily comprehended, avoiding all unnecessary
complexity  and  detail, or reference  to discordant
statements of different authors.
  It is  hoped that this book, in  its present form,
will be of increased  utility to those for whose use
it was especially designed.
                           C. E. Isaacs, M.D. 
 
INDEX.
OSTEOLOGY.
Minute Structure of Bone
The Spinal Column   ....
  Common characters of a true vertebra
  Characters of the lumbar vertebra?
  Deviations    ....
  Characters of the dorsal vertebrae
  Deviations    ....
  Characters of the cervical vertebra
  Deviations
  False vertebras
  Os sacrum
  Os coccyx
The Thorax
  Common characters of a rib
  Deviations
  The sternum
The Pelvis ....
  Os ilium  ....
  Os pubis  ....
  Os ischium
The Bones of the Superior Extremity
The Bones of the Lower Extremity ,
The Sesamoid Bones
The Skull and Face
  Frontal bone
  Parietal bone  .
  Occipital bone . 
viii
index.
  Temporal bone
  Ethmoid bone ....
  Sphenoid bone ....
  Malar bone    ....
  Superior maxillary bone  .
  Palate bone   ....
  Inferior spongy bone
  Lachrymal bone
  Nasal bones   ....
  Vomer.....
  Inferior maxillary bone
  Os hyoides    ....
The Cranial and Facial Sutures
The Orbits.....
The Temporal Fosses  .
The Zygomatic Fossjs
The Pterygo-Maxillary Fissures
The Articulations
  Tomporo-maxillary articulation .
  Occipito-atlantoid articulation   .
  Occipito-axoid articulation
  Atlanto-axoid articulation •
  Common vertebral articulation  .
  Costo-spinal articulation  .
  Chondro-sternal articulation
  Lumbo-sacral articulation .
  Ilio-sacral articulation
  Sacro-coccygeal articulation
  Pubic articulation
  Sterno-clavicular articulation
  Scapuloclavicular articulation  .
  Coraco-clavicular articulation   .
  Ligaments of the scapula .
  Humero-scapular articulation   . 
INDEX.
  Humero-cubital articulation
  Superior radio-ulnar articulation
  Inferior radio-ulnar articulation.
  Radio-carpal articulation
  Carpal articulations  .
  Carpo-metacarpal articulations  .
  Metacarpo-phalangeal articulations
  Inter-phalangeal articulations  .
  Ilio-femoral articulation
  Femoro-tibial articulation .
  Tibio-fibular articulation  .
  Articulation of the ankle  .
  Articulations of the tarsus.
  Tarso-metatarsal articulations  .
The Muscles    ....
  Muscles of the head  .
  Muacles of the external ear
  Muscles of face
  Muscles of lower jaw
  Muscles on anterior and lateral parts
      neck      ....
  Muscles of the pharynx   .
  Muscles of the palate
  Muscles of the larynx
  Deep muscles on anterior and lateral
      of the neck
  Muscles of the thorax
  Muscles of the back  .
  Muscles of shoulder and arm
  Muscles of fore-arm and hand  .
  Muscles of abdomen  .
  Deep muscles of abdomen.
  Muscles of male perinseum
  Muscles of female perinseum
of the
parts 
  Muscles of inferior extremity
  Muscles of hip  .
  Muscles on back of thigh  .
  Muscles on  anterior and external part of
       leg   .
  Muscles on outer part of leg
  Muscles on back of leg
  Muscles of foot.
  Muscles of orbit
  Muscles of internal ear
The Brain and its Membranes
  Dura mater
  Sinuses
  Tunica arachnoidea
  Pia mater.
  Cerebrum.
  Cerebellum
  Medulla oblongata
  Base of the brain
  Origins of the cerebral nerves
  Distribution  of the cerebral nerves
  Ganglions in  connexion  with  the  fifth
      pair  .
  Spinal nerves  .
  Cervical plexus.
  Brachial plexus.
  Dorsal nerves  .
  Nerves of Wrisberg
  Lumbar plexus
  Sacral plexus  .
  Sympathetic nerves
  Cervical ganglions
  Cardiac nerves .
  Cardiac plexus . 
index.
xi
  Thoracic ganglions  .
  Semi-lunar ganglions
  Solar plexus
  Renal plexus   .
  Inferior mesenteric plexus.
  Lumbar ganglions
  Sacral ganglions
  Ganglion impar
The Thorax and its Contents
  Pleurae   ....
  Anterior mediastinum
  Middle mediastinum .
  Posterior mediastinum
The Lungs ....
  Trachea and its Ramifications
The Heart and Pericardium
The Arteries
The Veins .
The Digestive Apparatus
  Mouth
  Teeth
  Pharynx .
  (Esophagus
  Stomach  .
  Duodenum, jejunum, and ilium
  Ccecum
  Colon
  Rectum   .
  Parotid glands .
  Submaxillary glands.
  Sublingual gland
  Liver
  Pancreas .
  Spleen 
xii
INDEX.
The Urinary Apparatus  .
  Kidneys  .....
  Ureters.....
  Urinary bladder
The Peritoneum ....
The Male Organs of Generation
  Testicles.....
  Spermatic cord .
  Vesiculae serainales and prostate gland
  Cowper's glands
  Penis.....
  Urethra.....
The Female Organs of Generation
  Mammae .....
The Organs of the Senses
  Organ of touch ....
  Organ of smell ....
  Organ of taste ....
   Organ of vision
   Appendages of the eye
   Organ of hearing
   Absorbent system
 Peculiarities of the Foetus
   Cervical fascia ....
   Superficial fascia of the abdomen
   Fascia transversalis and fascia iliaca
   Deep perineal fascia,  or triangular li
        of the urethra  .
   Fascia of upper extremity .
   Fascia lata     ....
 The Larynx     ....
 The Thyroid Body
 Hernia.....
ament 
THE
ANATOMICAL REMEMBRANCER.
          MINUTE STRUCTURE OF BONE.
 Bone is composed of gelatine and phosphate, and
 carbonate of lime.  It is surrounded by a fibrous
 vascular membrane (periosteum): the long bones
 are lined  by an internal membrane called me-
 dullary.   The minute vessels of bone, all of small
 size, run  in canals  called  Haversian; from the
 Haversian canals radiate  minute  tubes,' which
 abstract the phosphate of lime from the blood;
 they are called " calcigerous" tubes, or canaliculi,,
 and terminate in bone cells, or lacunas.  If bone
 be cut transversely, it seems under the micro.*--
 scope composed of  rods, placed side by side, in
 the centre of each  of which is a Haversian ca-
 nal, sending off its  radiating calcigerous tubes,
 and surrounded by concentric rings of bone cells.

                 OSTEOLOGY.
  The  assemblage  of bones, constituting the
framework of the human  body, is termed the
skeleton;  it is divided into head, trunk, superior
and inferior extremities.   The whole number of.
bones is 211.
                     1 
2
  2 he Trunk consists of the spine or vertebral
column, and includes the thorax and the pelvis.
  The Spinal or Vertebral  Column, situated in
the posterior  part  of the trunk, supports  the
head, and is supported by the pelvis.   The bones
which enter into its formation are called verte-
brae, of which there are two classes, the true and
the false.
  The true vertebrce, twenty-four  in number, are
subdivided into three classes, viz., seven cervical,
twelve dorsal, and five lumbar.
  The false vertebrce  are coalesced to form two
pieces, viz., the os sacrum and os coccyx, both of
which bones enter into the formation of the pel-
vis.   The sacrum is composed of five and the
coccyx of four pieces of bone.

   COMMON CHARACTERS OF A TRUE VERTEBRA.

  A ring of bone, the opening of which is called
the spinal or vertebral foramen.
   The body, a mass of bone  placed anterior to
the  ring, thick,  spongy,  and presenting many
small holes for blood-vessels.
  Lamina;, two lateral plates which pass back-
wards from the posterior part of the body, form-
ing the sides of the ring, and terminating poste-
riorly in the spinous process, from the existence
of which • the vertebral column has been called
spine.
   Two transverse processes, which pass outwards
from the sides of the laminee. 
3
m
  Four articular processes, two upon the upper
and two upon the lower surface of each vertebra,
situated at the roots of the transverse processes,
and  articulating with the vertebrae above  and
below.
  All  these processes differ from  the  body in
being formed of more compact bony texture.
  Four notches, two above and two below, which
are  formed  by the laminae  being  grooved out
where they join the body.  Each of these, with
the corresponding notch above and below, forms
a lateral hole, the intervertebral foramen, for the
exit of the spinal nerves and the entrance of
blood-vessels.

    CHARACTERS OF THE  LUMBAR  VERTEBRiE.

  1st.  They are the largest of the three classes.
  2nd. The bodies are very broad  transversely,
of oval form, deepened upon their upper and
lower  surfaces by a  more  compact lamina of
bone,  which,  projecting beyond their bodies,
renders them slightly concave from above down-
wards upon their fore part.
  3rd. The  spinous processes  are  broad, thick,
and short.
  4:th.  The  transverse processes  are long, thin,
and horizontal, and are regarded  by some anato-
mists as abdominal ribs.
  5th.  The  superior  articulating  surfaces are
oval, concave, and look inwards and backwards;
the inferior being oval and convex, directed out- 
                       4
  m
 wards and forwards;  from each of the superior
 articular processes, which are wider apart than
 the  inferior, there projects backwards the " tu-
 bercle."
   6th. The vertebral foramen  is of  triangular
 shape, and larger than in the dorsal vertebrae.
   7th. The notches, particularly the inferior, are
 very large, and form larger foramina than at any
 other part of the spine.

                 DEVIATIONS.
   The last lumbar vertebra has its body cut off
obliquely  upon  its sacral  aspect, so  that it is
much thicker before than behind.   Its transverse
processes also are short and rounded.

     CHARACTERS OF THE DORSAL VERTEBRAE.
   Is*. They are intermediate in size between the
cervical and lumbar vertebrae.
  2nd.  Their bodies are thicker behind than be-
fore, and  more  convex  transversely,  assuming
upon their surfaces a  triangular rather than an
oval form.   On  either side at the  upper and in-
ferior margins each body presents two small de-
pressions, the upper being the larger, which with
the intervertebral cartilage and the contiguous
vertebra, form depressions for lodging the heads
of the ribs.
  3rd. The spinous processes are long, prismatic
tuberculated  at their extremities,  and directed
obliquely downwards. 
5
   4th.  The transverse processes are long, and di-
 rected  backwards;  on the extremity and ante-
 rior aspect of each is  an oval articular surface
 for the tubercle of the rib.
   5th.  The articular processes are nearly verti-
 cal,  the superior looking backwards, the inferior
 forwards.
   6th.  The vertebral foramen is  smaller than in
 the  cervical or lumbar vertebrae, and  is of oval
 shape.
                  DEVIATIONS.
   The first dorsal vertebra has a full depression
 for the head of the first rib, besides the half de-
 pression for the second; its body is longer in the
 transverse direction, its spinous process is strong
 and  horizontal,  and its articular processes are
 oblique.
   The  11th and 12th have each a full depression
 upon the  body  for the corresponding rib,  but
 want the depression on the transverse process-
 es ; the 11th and 12th have very short transverse
 processes, and the 12th resembles a lumbar verte-
 bra in  the shape of its body, and of its inferior
 articular processes.

      Characters of the Cervical  Vertebra;.

   1st They are the smallest of the three classes.
   2nd.  Their bodies, deeper before than behind,
 and long transversely, are concave from side to
side  upon their upper surface, and concave from
before backwards upon their lower.
                      1* 
6
  3rd. The lamince are broad and thin.
  Ath. The spinous processes are short, horizontal,
and bifid.
  5th. The  transverse  processes  are bifid and
short grooved upon their upper surface for the
spinal nerves, and perforated by a round hole at
their  basis for the vertebral artery, the direction
of which is upwards.   Each  transverse process
has two roots;  the  posterior springs from be-
tween the articular processes, at the junction of
the pedicle with the arch, as is the case with the
transverse processes in the  dorsal  and lumbar
regions:  the anterior arises from the side of the
body  of the vertebra.
  6f^. The  articular surfaces are oval in shape,
the superior being  convex,  and  directed ob-
liquely  backwards and upwards;  the inferior
being concave, and directed  obliquely forwards
and downwards.
  7th. The notches, nearly of equal size, are small,
and  anterior to the articular processes,  as in the
other vertebrae ; but are behind the anterior root
of the transverse processes.
  8th. The  vertebral foramen is large and trian-
gular.
                  DEVIATIONS.
  The first, or  atlas, consists of a  large bony
ring  enclosing an irregular hole, which  in the
fresh state is divided into two parts by the trans-
verse ligament;  the anterior being occupied by
the odontoid process of the  axis, the posterior 
7
by  the  spinal chord.  Instead of a " body," it
presents anteriorly a small arch of bone, marked
by a tubercle in front, and a smooth oval surface
behind, which articulates with the odontoid pro-
cess of the axis.   At the extremities of this an-
terior arch the bone acquires great density and
thickness, and presents upon its upper and lower
aspects the articular processes,  the  superior  of
which,  horizontal and  oval from before back-
wards, look upwards and inwards, and articulate
with the condyles of the occipital bone ;  the in-
ferior, circular, slightly oval, and directed down-
wards  and inwards, articulate with  the second
cervical vertebra.   The parts of the vertebra
which support the articular processes are called
the "lateral masses," and are marked  internally
by  rough surfaces,  which afford attachment  to
the  transverse ligament.   The  transverse pro-
cesses  are long,  and terminate in a  tubercle;
they are pierced at  their basis by the foramen
for the vertebral  artery, the direction of which
is upwards and backwards ; behind the superior
articular surface  is  a groove, which marks the
continued course of this  vessel.  The spinous
process is represented by a small tubercle upon
the middle of the posterior segment of the ring,
which  is considerably larger than the anterior.
  The  second, or axis, is distinguished  by its
large tooth-like, or odontoid, process.   This pro-
cess presents anteriorly an oval  surface for arti-
culation with the ring of the atlas, and posteri-
orly a smooth surface, which moves against the 
8
transverse ligament, whilst its apex presents an
acuminated  top, to which the check ligaments
are attached.   The laminae are  very thick  and
strong, and terminate behind in the spinous pro-
cess, which  is  strong and bifid:  the  vertebral
foramen is heart-shaped, the apex being behind.
The superior  articular  surfaces are large,  and
directed  a little outwards,  whilst the inferior
looking downwards and  forwards, are smaller
and flat.
  The transverse processes, not bifid, are short
and directed downwards, the aspect of the fora-
men for the vertebral artery being directed  ob-
liquely upwards  and outwards;  the superior
notches are behind the superior  articular pro-
cesses, whilst the inferior notches  are before the
inferior processes.
  The seventh cervical vertebra is called vertebra
prominens, from the length of the spinous pro-
cess, which  projects backwards  and terminates
in a tubercle;  the foramina,  when they exist in
the transverse processes, give passage to the ver-
tebral veins: the transverse processes  are often
of such length as to resemble rudimentary ribs.
  _ In  examining the  peculiar characters of the
different vertebrae, it is  best to select  one from
near the centre of each class: thus the 3d lum-
bar, the 6th or 7th  dorsal,  and the 4th or 5th
cervical,  offer the best examples of the class to
which each belongs; for as the cervical vertebrae
approach the dorsal, they  begin to assume more
or  less the characters of the latter, and the last 
9
dorsal vertebra, upon its under surface, presents
the characters of a lumbar vertebra.  But there
is no difficulty in determining the  region  from
which any vertebra comes,  however faintly its
characters may be marked.  The transverse pro-
cesses of all the cervical vertebrae are perforated
by a foramen which transmits the vertebral ar-
tery or vein;  the dorsal vertebras present  upon
the bodies  a smooth surface of articulation for
the head of the rib: the lumbar vertebrae are dis-
tinguished  by the absence of these characters.

              FALSE VERTEBRAE,
eight or nine in number:  the  five superior form
the sacrum, the four inferior the coccyx.

                 Os Sacrum.
  Figure, triangular, the base resembling a  lum-
bar vertebra;  the apex presenting a small oval
surface to articulate with the  os coccyx; the
sides presenting two surfaces: the superior,  large
and  irregular for articulation with the ilium;
the inferior thin for the attachment of the sacro-
sciatic ligaments.
  Pelvic surface, anterior,  smooth, concave from
above downwards, traversed by four, transverse
lines, and presenting on either side of the median
lines four holes,  called anterior sacral, for the
transmission of the anterior sacral nerves.   The
projection which the sacrum forms with the last
lumbar vertebra is called " the promontory." 
10
  Dorsal surface, irregularly convex, rough, pre-
senting in the median line irregular processes of
bone  (spinous  processes), and  more  externally
on either side tubercles of bone analogous to the
articular processes of the  true  vertebrae.   On
either side of the median line are the posterior
sacral foramina, for the transmission  of the pos-
terior sacral nerves.
   Vertebral canal, at the base large, and of tri-
angular form, runs at  the  dorsal aspect  of  the
bone, and terminates in a triangular fossa at its
apex, where it is bounded on either side by two
tubercles, which are in general prolonged to join
the base of the os coccyx.  It contains the cauda
equina.
                  Os  Coccyx.
  Figure, triangular, the base articulating with
the sacrum.
  Anterior  surface,  smooth, and supports  the
extremity of the rectum.
  Posterior surface, rough,  for  attachment  of
ligaments and muscles.
   Cornua,  are two,  placed superiorly,  which
unite with the last tubercles of the sacrum.
  The coccyx  is usually composed of three or
four pieces, of which the first, which articulates
with the sacrum, is the largest.

                 THE  THORAX

is formed by the dorsal vertebrae posteriorly, the
libs laterally, and the sternum anteriorly. 
11
                  The  Bibs,
twelve  in  number, are  divided into  seven true
and five false ; the two lowest of the false being
called abdominal, or floating ribs.
   The true ribs are each attached to the sternum
by separate cartilages.
   The three superior false ribs have their carti-
lages attached to each other and to the cartilage
of the seventh rib.
   The false or floating ribs have their cartilages
free.
         Common Characters of a Bib.

   The head, round, and divided by a  ridge into
two articular surfaces, which are  received into
depressions on the sides of the bodies of the dor-
sal vertebrae, the ridge affording attachment to
a ligature which connects the rib  to  the inter-
vertebral fibro-cartilage.
   The neck,  narrow  and round;  at its union
with the shaft is
   The tubercle,  a prominence  of bone,  with a
smooth surface looking backwards to articulate
with the transverse process  of  the vertebra be-
neath,  and a  rough surface  for the attachment
of the  posterior  costo-transverse ligament.
  The angle, is marked  by a rough line, and is
the point where  the rib  makes its  great turn to
circumscribe the thorax.
   The shaft,  that portion of the rib which  ex-
tends from the angle to its sternal  end, presents
an external smooth convex surface, and an inter- 
12
nal concave one;  its upper edge being round and
smooth, its lower edge thin, and grooved for the
intercostal vessels, and its sternal  extremity of-
fering an oval pit for the reception of the costal
cartilage.

                 DEVIATIONS.
                 First  Bib,
  Has no angle, is short and flat, the head arti-
culating with only one  vertebra, has no  ridge,
and one articulating service; its  sternal extre-
mity being thick and  strong;  one  surface  is
directed  upwards, the  other downwards;  the
superior presenting  a ridge for the  attachment
of the anterior scalenus muscle, which separates
two grooves, one for the subclavian artery, the
other for the subclavian vein.

               The Second Bib,
  Longer than the  first, presents  externally an
oblique prominent ridge for  the attachment of
the first digitation of the serratus magnus muscle.

           Eleventh and Twelfth Bibs,
have  neither angle, tubercle, nor groove,  are
very short, and the  head resembles  that of the
first.

                THE STERNUM,
  Consists of three  pieces. 
13
    Figure, flat, elongated, broad above, narrower
  in the centre, and pointed inferiorly.
    Anterior surface, is marked by four transverse
  lines, and is rather convex.
    Posterior surface, smooth and concave.
    Upper piece, quadrilateral and thick, is  con-
  cave from side to side upon its upper edge, and
  presents at each superior angle two semilunar
  depressions for articulation with the clavicles;
  its lower edge  is united to the second piece; its
  lateral edges receive on either side the cartilage
  of the first rib  and half that of the second.
   Middle piece, long  and narrow; receives, by
 five depressions upon its  lateral edges, the  car-
 tilages of the  five inferior true ribs, and by a
 notch at its superior angle half the cartilage of
 the second rib.  Its inferior extremity is°long    f
 and thin, and ends in  a cartilaginous epiphysis
 called the                                   '
   Ensiform  cartilage, which  is generally bifid
 and pierced by a foramen, its direction  bein<*
 variable.
                  THE PELVIS,
   Is formed of  the os sacrum, os  coccyx (both
 of which bones have been already described),
 and the two ossa innominata.

               OS INNOMINATUM,
  Consists in early life of three bones, the ilium,
ischium, and pubes.  We shall describe each of
these bones separately.
                      2 
14
                  OS ILIUM.

  Situation, upwards and outwards in regard to
the pelvis,  forming the upper part  of the  ace-
tabulum, and bounding the lower lateral part of
the abdomen.
  It forms  the upper and outer part of the  ace-
tabulum, joining the  pubes  anteriorly, and  the
ischium posteriorly.
  The dorsum is rough at the posterior fifth for
the gluteus maximus; and presents two semicir-
cular lines, of which  the superior passes from
the anterior superior spine  to  the sacro-sciatic
notch, and  the inferior from  the anterior inferior
spine  towards  the  same notch:  the gluteus
minimus arises from between the curved lines:
the gluteus medius from the space between the
superior curved line  and the rough surface for
the gluteus maximus.  In the centre is a nutri-
tious foramen.  The venter,  which forms  the
iliac fossa,  has also a  nutritious foramen ;  there
is a rough  articular surface for connection with
the  side of  the sacrum, and a small portion
smooth and immediately above the sciatic notch
which  enters into the formation of  the  true
pelvis.

                  Processes.

   The crest, which forms the  upper border of
 the bone.
   The anterior superior spine, which terminates
 the crest anteriorly. 
15
   The anterior inferior spine, immediately above
 the acetabulum.
   Both spines are separated by a notch.
   The posterior superior spine, which terminates
 the crest behind.
   The posterior  inferior  spine,  separated from
 the former by a small notch.
   The llio-pectineal eminence, marks the  union
 of this bone with the following,

                   os  PUBIS.

   Situation,  fore  part of pelvis, and  internal
 part of acetabulum.
   Body,  forms the internal and superior part of
the acetabulum.
   Horizontal ramus, passes inwards to meet the
opposite  ramus.  Descending ramus passes ver-
tically downwards from the inner extremity of
the horizontal  ramus to join the ramus of the
ischium.
   Symphysis pubis, is formed by  the apposition
of both descending rami.
   The angle  is formed by  the junction of the
horizontal  and  descending rami.   From  the
angles, a rough line, the crista, about an inch in
length, runs  horizontally  outwards, and termi-
nates in a tubercle called the spine.
   The obturator groove, for the obturator vessels
and nerve, is situated upon the under surface of
the horizontal ramus.
   The obturator or thyroid foramen is the oval 
16
space bounded by  the  pubes above, and by the
ischium below.
                THE ISCHIUM.
  Situation, lower, outer and back part of the
pelvis.
  Body, forms the outer and  back part of the
acetabulum; immediately beneath this cavity is
a groove for the tendon of the obturator exter-
nus muscle.  The anterior thin edge of the body
assists  to form the obturator foramen, the pos-
terior to form the sciatic notch.
  Spine, projects backwards and inwards,  and
gives attachment to the lesser sacro-sciatic liga-
ment.
  Tuberosity, the thickest part of the bone,  on
which  we rest when sitting: gives  attachment
to the greater sacro-sciatic ligament. Between
this process and the spine is a pulley-like sur-
face, for the tendon of the  obturator internus
muscle.
  Ascending ramus, turns forwards, upwards,
and inwards, and joins the descending ramus of
the pubes;  it bounds the obturator  foramen by
its outer thin edge, and  the lower aperture of
the pelvis by its thick one.

                ACETABULUM.
  Is formed by the union of the ilium, ischium,
and  pubes; the ilium  forming less than  two-
fifths ;  the ischium  more than two-fifths; and the
pubes the smallest part.   It presents an articular 
17
 surface for the head of the femur, and is sur-
 rounded, in the greater part of its circumference,
 by a margin,  which  is prominent at the upper
 and outer part;  but deficient at the lower and
 inner  part,  towards the  obturator  foramen.
 The part where the  margin is wanting is called
 the cotyloid  notch;  to its borders is attached
 the ligamentum teres of the hip joint.

              SUPERIOR EXTREMITY,
   Consists of the shoulder, the arm, the forearm,
 and the hand.

         THE  BONES OF  THE SHOULDER,
   Are the clavicle and the scapula.

                THE  CLAVICLE.

   Situation, from the notch in the upper piece
 of the  sternum, to the acromion process of the
 scapula.
  Figure, curved like the  italic/
  Sternal end, thick, presenting a triangular
 articular surface;  its edge is rough  for liga-
 ments.
  Body, cylindrical towards sternum,  flat and
expanded towards its acromial  end.   Upon its
under surface  are,  1, towards the  sternal ex-
tremity, a rough surface for  the costo-clavicular
ligament; 2, towards  the acromial extremity, a
rough line for the  coraco-clavicular ligaments,
and between  both a groove for the subclavius
                     2* 
18
 muscle, in which groove is fjund the nutritious
 foramen.
   Acromial end, rough  and  flattened,  passes
 oyer the coracoid process to meet the acromion,
 with which it articulates  by a small oval sur-
 face.

                   SCAPULA.

   Situation, upper and back part  of thorax, ex-
 tending from the second to the seventh rib.
   Figure, triangular.
   Costce or  edges.—The superior  or cervical  is
 the  shortest, and is  interrupted by a notch for
 the suprascapular nerve; the inferior or axillary
 is next in size,  and is the thickest; the posterior
 or vertebral is the longest, and is also called the
 base of the scapula.
   Angles.—The superior posterior  angle is acute
 and prominent, the inferior angle  is thicker and
 rounded, and the anterior angle has connected
 to it the neck of the bone.
   Costul surface, or subscapular fossa, is slio-htlv
 concave and divided  by three or  four Tines
 which run from above obliquely downwards and
 inwards.
   Dorsal surface is divided unequally by  the
spine,  which thus gives  rise to  the' spinous
fossae.
   Spine arises by a small triangular surface  at
the vertebral margin, and proceeds forwards
becoming more  elevated,  and terminates in the
acromion, which surmounts the shoulder joint 
19
and  articulates  with the acromial end  of the
clavicle by a small oval surface.
  Supraspinous fossa, situated above the spine,
is deep,  and presents a nutritious foramen; it
lodges the supraspinatus muscle.
  lnfraspinous fossa,  larger, irregularly concave
and convex, affords attachment to the infraspina-
tus muscle, the teres  minor muscle, and  by an
inferior  rough  surface,  to  the  teres  major
muscle.
   Coracoid process  overhangs  the inner  and
upper part of the glenoid cavity.   This process
has a crooked appearance, and gives attachment
to the pectoralis minor, the short head  of the
biceps and coraco-brachialis muscles, also to liga-
ments.
   Glenoid cavity, articulates  with the head of
the humerus, is shallow and oval, being broader
below,  and  giving   attachment by its  upper
narrow part to  the  long  head of the  biceps
muscle.
  Neck is the contracted portion of the  scapula
immediately behind the glenoid  cavity; it gives
attachment to  the  capsular  ligament  of the
joint.

                 |OS  HUMERT.
  Articulates with the scapula above and radius
and ulna below.
  Head  forms a small section of a large  sphere,
is  smooth and  covered with cartilage  in the
recent state.  Its direction is  obliquely back- 
20
wards  and inwards to the glenoid cavity of the
scapula.
  Neck, a slight contracted line, rough for the
attachment  of the  capsular  ligament.   It is
united to the shaft at an obtuse angle.
  Tuberosities exist at the junction of the shaft
with the  neck.   The largest is  posterior,  and
affords attachments by three flat surfaces to the
supra-spinatus, infra-spinatus, and  teres minor
muscles; the  smallest being anterior, is more
prominent, and gives attachment to the subsca-
pular muscle.
  Bicipital groove is between both  tuberosities,
lodges the long biceps tendon, and affords attach-
ment by its  anterior margin to  the  pectoralis
major muscle, and by its posterior margin to the
latissimus dorsi and teres major muscles.
  Shaft is rather twisted, the upper  extremity
cylindrical, the lower flattened; two longitudinal
ridges, arising one from the outer, the other from
the inner  condyle, and affording attachment to
intermuscular septa, divide it into an anterior
and a posterior region.  The external longitudi-
nal ridge is  interrupted by an oblique groove
which indicates the course of the muscular-spiral
nerve and vessels: upon the external and central
aspect  is a  rough portion for insertion  of the
deltoid muscle, and upon the inner side of the
bicipital  groove is a slight rough  line  for  the
insertion of the coraco-brachialis muscle.  The
nutritious foramen  is directed downwards  to-
wards  the elbow joint. 
21
 WT Internal condyle is prominent and sharp, af-
 fording attachment to the  pronator and flexor
 muscles and to the internal lateral ligament.
   External  condyle  is   less  prominent,  but
 descends  nearer  the  elbow  joint, and  gives
 attachment to the supinator and extensor  mus-
 cles, and to the external lateral ligament.
   Articulating surfaces.   First, a  small round
 head, situated externally and nearer the anterior
 than  the  posterior part  of the bone,  for the
 radius.   Second, the trochlea or pulley-like  sur-
 face placed internally for the ulna;  being much
 below the level of the head, so as to give the
 articular surface an oblique direction from above
 downwards and inwards.
   Small sigmoid fossa at the fore part of the
 trochlea to receive the coronoid process in the
 bent position of the forearm.
   Great sigmoid fossa at the back part of the
 trochlea, to receive the olecranon process in the
 extended position of the forearm.

                    ULNA.
  Situation at the inner  side of  the forearm."
   Upper extremity articulates with  the humerus
 and radius.
   Olecranon process, forming the  projection of
the elbow, is the highest point of the bone, and
by its extremity gives attachment to the triceps
muscle; beneath this it  is smooth for  a bursa
mucosa.
   Coronoid process, anterior to the olecranon, is 
22
smaller than it,  and gives attachment to the
brachialis anticus muscle, some  of the flexors
and pronators of the forearm, and to the internal
lateral ligament.
  Lesser sigmoid cavity, oval, receives  the side
of the head of the radius.
   Greater sigmoid cavity has its long axis  from
before backwards, is divided in the centre  by a
transverse line, and by a,vertical ridge, into two
lateral portions, is bounded above by the ole-
cranon process,below by the coronoid process,and
receives the articular extremity of the humerus.
  Shaft presents three surfaces and three edges;
the anterior surface affords attachment to the
flexor digitorum profundus muscle, and  is pierc-
ed by the nutritious foramen, which is  directed
upwards.   The posterior gives attachment to
the anconeus muscle and to the extensor muscles
of the thumb;  the internal is subcutaneous for
its greatest extent.   Of the  edges, that  directed
towards the radius is the best  marked ;  it gives
attachment to the interosseous ligament.
  Carpal  extremity slender  and  rounded,  pre-
sents  the head, which by its side articulates  with
the radius, and by its  carpal aspect with the
fibro-cartilage   of the  wrist-joint;  also   the
styloid process at the inner margin, which by its
apex  gives attachment to the internal lateral
ligament of the carpus, and  by a depression at
its root,  to the  fibro-cartilage;  posteriorly it
presents a groove  for the tendon of the flexor
carpi ulnaris muscle. 
23
                    RADIUS.

   Situation, external to the  ulna;  it  is  also
 shorter than that bone, by the length of the
 olecranon.
   Head, a superficial circular cavity, articulating
 above with the humerus, and latterly with the
 lesser sigmoid cavity of the  ulna.
   Neck, an inch in length, narrow and rounded,
 and terminating in the
   Tubercle, a prominent process into which the
 tendon of the biceps muscle is inserted.
   Shaft,  triangular,  by its  anterior surface  af-
 fording attachment to the flexor longns  pollicis
 and pronator quadratus muscles, by its posterior
 convex surface to the supinator radii brevis and
 extensor  muscles of the thumb;  its external
 surface being round  and convex, and rough near
 its centre for the pronator  radii teres muscle.
 The inner  edge of  the shaft  is sharp for the
 attachment of the interosseous ligament, and the
 nutritious foramen upon the anterior surface of
 the shaft is directed  upwards.
   Carpal extremity expanded, gives attachment
 by its anterior edge to the  anterior carpal liga-
 ment; upon its  posterior  edge to a shallow
 groove at its ulnar side for the extensor com-
 munis digitorum and indicator muscles, a  second
 more externally, narrow and  oblique for  the
tendon of the extensor secundi internodii  pollicis
 muscle, and a third more external than the  last
tor the tendons of the extensores carpi radiahs 
24
longior  and brevior.  Upon the radial edge of
this extremity is the mark of the passage of the
extensor ossis metacarpi and the extensor primi
internodii pollicis muscles.
  Styloid process, prolonged on the outer side of
the bone downwards, giving attachment to the
external lateral ligament of the carpus.
  A cavity on the inner border of the carpal
extremity for articulation with the ulna.
   Carpal aspect presents two articular surfaces,
divided by a slight elevation; the external being
triangular for articulation with the os scaphoides,
the internal square for the os lunare.

                   CARPUS.
  This part consists of two rows of small bones,
four bones in each row, placed between the fore-
arm and metacarpus.   It is convex  and rough
upon its dorsal  aspect, and concave upon its
palmar aspect, where the vessels, nerves,  and
tendons of the flexor muscles are situated;  to-
wards the radius and interarticular cartilage  of
the wrist, it is convex ; towards the metacarpus
it presents articular surfaces for  the  metacarpal
bones.

                  FIRST ROW

                Os Scaphoides.

    Situation, on outer and upper part of  the
 carpus, next the styloid process of the radius.
   Articulations,  with  the  radius above  with 
25
 trapezium and trapezoides below, and with the
 lunare and magnum internally.

                  Os Lunare.
   Situation, between the scaphoides and cunei-
 forme.
   Articulations, with the radius above,  with
 the magnum and  uncifbrme below, with  the
 scaphoid externally,  and with  the  cuneiforme
 internally.

                Os Cuneiforme.
   Situation,  at the  internal and upper part of
 the carpus between the lunare and pisiforme.
   Articulations, with the lunare externally, with
 the carpal fibro-cartilage  above, with the  unci-
 forme below, and upon its palmar aspect with
 the pisiforme.
                Os Pisiforme.
   Situation, upon the inner and palmar aspect
 of the cuneiforme.
  Articulation, by a circular small surface with
 the cuneiforme.

                SECOND ROW.

               Os  Trapezium.
  Situation, between the scaphoides and meta-
carpal bone of the thumb.            /
  Articulations, with the scaphoides above, with
the metacarpal  bone of the thumb below,  and
                     3 
26
internally with the trapezoides  and side  of the
metacarpal bone of the index finger.
   Groove, upon its palmar aspect for lodging the
tendon of the flexor carpi radialis muscle.  The
surface which articulates with the first metacar-
pal bone is concave  in one direction, convex in
the other.

                Os  Trapezoides.
   Situation, between  the trapezium, magnum,
scaphoides, and  metacarpal  bone  of the index
finger.
  Articulations, with the scaphoides above, the
trapezium  externally,  the magnum  internally,
and below with the metacarpal  bone of the in-
dex finger.

                 Os Magnum.
   Processes, head, neck, and body.
   Situation, between the scaphoides and  lunare,
and  the second, third, and  fourth  metacarpal
bones.
   Articulations, by  its  head with the scaphoides
and lunare above, by its base with the second,
third, and  fourth metacarpal bones  below ex-
ternally  with the  trapezoides,  and  internally
with the unciforme.

                Os Unciforme.

   Situation, between the cuneiforme and meta-
carpal bones of the ring and little fingers. 
27
   Articulations, with the lunare above, the mag-
num externally, the cuneiforme internally, and
below with  the fourth and fifth  metacarpal
bones.
   Process, a hook-like process upon its palmar
aspect.
   The carpal bones in their natural state are  so
arranged that the os magnum and  os unciforme
form  a convex head  which  is received  into  a
concavity formed by the ossa scaphoides, lunare,
and cuneiforme.  The trapezium and  trapezoides
form a concavity which receives the convex sur-
face of the os scaphoides.

                 METACARPUS.

  This part consists  of five long bones  placed
between the carpus and the fingers.
  Bases,  irregularly flattened  for articulation
with  the  second  row of  carpal  bones, with
rough surfaces for the attachment of ligaments.
  Heads, convex,  and rounded for articulation
with the first bones of the fingers,  and affording
attachments  for the  capsular, transverse, and
lateral ligaments.
  Bodies.—The first, for the thumb, is the thick-
est and shortest; its carpal articulating surface
corresponds  with  the saddle-like articulating
surface of the  os trapezium; the  second, third,
and fourth present on the dorsal aspect of each
a prominent line, which bifurcates towards the
head; the fifth presents an oblique  line on its 
28
dorsal aspect, which divides it into two surfaces.
The third is the longest.

                  FINGERS.
  The fingers are composed of three phalanges,
except the thumb, which has only two.
  The Metacarpal, or first Phalanges, are five in
number, their bases presenting oval concavities
for the heads of the metacarpal bones; their an-
terior extremities are convex from before back-
wards,  and concave from side to side, to articu-
late with the second phalanges.
  The Middle, or second  Phalanges, are  four in
number, and smaller than the first:  their bases
present pulley-like surfaces, to form  a  gingly-
moid joint with the first phalanges, and at their
anterior extremities resemble the first.
  The  Ungual, or third Phalanges, are five in
number, and the smallest.  By their bases they
form a ginglymoid joint with the  middle pha-
langes ; and their extremities are convex upon
their dorsal aspects for the support of the nail,
whilst their palmar aspects are irregularly tuber-
culated for the extremities of the finders.
  The  Sesamoid  Bones are sometimes  absent.
In general two  are to be found between the
metacarpal bone of the thumb :md its first pha-
lanx, and one or two at the corresponding joint
of the index finger.

              LOWER  EXTREMITY.

  The bones proper to the lower extremity are 
29
 the femur, the tibia, the fibula, the patella, seven
 tarsal bones, five metatarsal bones, and fourteen
 phalanges.

                  THE FEMUR.
   Head,  forms nearly two-thirds  of a sphere,
 and is  received into the  acetabulum, being  di-
 rected  forwards, upwards, and inwards; below
 its centre is a rough pit for the ligamentum teres,
 and its junction with the neck is marked  by a
 rough line.   With the exception of these  parts
 it is covered by cartilage in the recent state.
   Neck, extends obliquely downwards and out-
 wards from the head to the shaft, which it joins
 at an obtuse angle; it is flattened anteriorly and
 posteriorly, and its lower edge is  much longer
 than its upper.
   Great trochanter, is  continued  upwards  from
 the shaft,  but does not extend  as high as the
 head, is situated externally, and gives attach-
 ment to the gluteus medius, gluteus minimus,
 and pyriformis muscles.
  Digital fossa,  is  situated at the  root of the
 great trochanter, and affords insertion to the ex-
 ternal rotator muscles.
  Lesser trochanter, is situated posterior and in-
ternal to the shaft, and has inserted into it the
common tendon of the psoas and iliac muscles.
  Intertrochanteric line,  as the  name  implies,
passes (obliquely) from one trochanter to the
other.
  Shaft, is broad  at  either extremity,  particu- 
30
larly towards the knee, and is narrow and tri-
angular in the centre;  it is arched and smooth
anteriorly,  where  it affords attachment to the
crureus muscle;  at its  posterior part it is con-
cave, and  presents  a  rough line called  linea
aspera, about the upper third of which, and di-
rected upwards, is the foramen for the nutritious
vessels.
  Linea aspera, for the attachment of  muscles,
is best marked for the central  third of the shaft;
towards the upper third it bifurcates, one  ridge
running to each  trochanter; inferiorly it also
divides  into two ridges, which  pass to either con-
dyle, the inner one being interrupted where the
popliteal vessels pass over it.  By these inferior
ridges a flat  triangular surface of the femur  is
bounded laterally, which receives the  name  of
popliteal surface.
  External condyle, is larger and projects  more
upon the anterior surface of the femur than the
internal: its  articulating surface is  broader and
ascends higfier upon the shaft.
  Internal condyle, narrower than the external;
it also descends lower,  in order that bath con-
dyles should rest upon  the tibia  in  the natural
oblique direction of the femur.
  External tuberosity, above the external con-
dyle for the attachment of the external  lateral
ligament of the  knee-joint.
   Internal tuberosity,  above  the internal con-
dyle and more prominent than the external, for 
31
the internal lateral ligament and the insertion of
the great adductor tendon.
   Trochlea,  between the condyles on their ante-
rior aspects, supports the patella when the leg
is extended.
   Intercondyloid fossa, is situated posteriorly
between the condyles.

                   PATELLA.

   Shape, triangular, the base superiorly having.
the extensor muscles inserted  into it, the apex
below,  to  which is attached  the ligamentum
patella?.
   External surface, presents a fibrous appear-
ance, and is convex.
   Internal surface,  presents two articular sur-
faces, divided by a prominent edge: the internal
surface is  the  deepest, whilst the external is
broad and shallow.

                     TIBIA.
   Shaft, is triangular, presenting three surfaces,
separated by corresponding edges.  The inner
surface is subcutaneous, except at its upper part,
where the tendons of the sartorius, gracilis and
semitendinosus muscles pass over  it:  it termi-
nates in the inner malleolus;  the external surface
is  covered  by  the  belly of the tibialis  anticus
muscle for its upper two-thirds, and is here con-
cave ; interiorly the  bone is flattened to support
 the tendons of the extensor muscles of the toes; 
32
the  posterior surface presents an  oblique line
directed upwards  and outwards for the attach-
ment of the soleus, popliteus,  and deep flexor
muscles;  the nutritious foramen, which is the
largest in the body, is a little below this line, and
directed downwards.  Of the edges, the anterior
is most prominent and subcutaneous; the  inner
is less  defined, and the outer is well marked,
affording  attachment to the interosseous liga-
ment.
   Upper or femoral extremity, which articulates
with the femur, is expanded from side to  side ;
anteriorly its circumference is convex ; posterior-
ly it is slightly hollowed. Two concave surfaces,
condyles,  of which the inner is the deeper, re-
ceive the condyles of the femur.  Between the
condyles is  the spine,  a bifid eminence, before
and behind which are depressions for  the inser-
tion of the crucial ligaments and the  semilunar
cartilages.
  Tuberosities, are three in number,  two lateral,
and one anterior; the anterior is most prominent
for the insertion of the ligament of  the patella •
the inner is  less so, and affords attachment to the
internal lateral ligament of the knee-joint, and
the semimembranosus muscle; the outer is the
least developed, and has an  articulating surface
for the fibula.
  Lower or  tarsal extremity,  is much smaller
than the  upper  and quadrilateral, the anterior
edge being convex for the passage of the extensor
tendons: the posterior, marked by a groove for 
33
the passage of the tendon of the flexor longus
pollicis muscle;  the external presenting a rough
triangular surface for the fibula, and the internal
terminating in the internal malleolus.
  Internal malleolus, is convex and subcutane-
ous internally; its articular aspect being smooth,
to articulate with the astragalus; it gives attach-
ment by its inferior border to the internal lateral
ligament of the ankle-joint, and is grooved poste-
riorly for the tendons of the tibialis posticus and
flexor longus digitorum muscles.
  Inferior   articular  surface,  rests  upon the
crown of the astragalus ; it is quadrilateral and
concave  from before  backwards, and joins the
small articular surface of  the internal malleolus
at a right angle.

                   FIBULA.

  Situation, on the outer side of the  tibia.
  Shaft, triangular and twisted, gives attachment
to the peronei muscles by its external surface, to
the soleus and flexor pollicis muscles by its pos-
terior surface, and to the extensor muscles by its
anterior surface.  Its inner edge is well develop-
ed to afford attachment to the interosseous liga-
ment, and the nutritious foramen,  directed down-
wards, is placed upon the posterior  aspects  of
the bone.
   Head, articulates with the  tibia by  a  small
circular surface directed  upwards and inwards,
and affords attachment to the  external lateral 
34
ligament of the knee-joint, and the biceps flexor
muscle by a rough projection situated posteriorly.
  Neck, is the small constricted part by which
the head is united to the shaft.
  Tarsal extremity, presents a large oval process
called the external malleolus, about two inches
and a half above which the shaft is constricted.
  External malleolus,  is larger than the inter-
nal, on a line posterior to which it is situated;
by its edge it affords attachments to the external
lateral ligaments of the  ankle joint.  Its outer
surface is convex and subcutaneous, the inner or
articular being smooth to  articulate with the
outer side of the astragalus; above this surface
is a triangular rough aspect for the inferior con-
nection of the bone with the tibia.

                   TARSUS.

  Forms the posterior part of the foot; the bones
which compose it are seven in number, and ar-
ticulate with each other.   It  is connected above
to the tibia and fibula, below it is hollow, and
anteriorly it unites  by articular surfaces with
the five metatarsal  bones.  The  seven tarsal
bones are the calcaneum,  astragalus,  navicular
or scaphoid, cuboid,  and three cuneiform.

          CALCANEUM, OR  OS  CALCIS.
  Situation, at the posterior and  under part of
the tarsus.
  Posterior aspect, elongated to form the heel 
35
presents a smooth surface above for a bursa mu-
cosa, and a rough surface below for the insertion
of the tendo-achillis.
  Anterior aspect articulates by a smooth surface
with the cuboid bone.
  Superior aspect presents two articular surfaces,
which support the astragalus; they are separat-
ed by a groove, into which a strong interosseous
ligament is inserted.
  Inferior aspect is irregular,  and presents two
small tubercles, and two lines for the attachment
of muscles and ligaments.
  External  aspect presents a small tubercle for
the insertion of  the middle external lateral liga-
ment of the ankle joint; it is also slightly groov-
ed for the passage of the  peronei tendons.
  Internal aspect presents a  projection for  the
internal lateral ligament, and a fossa for the lodg-
ment of posterior tibial vessels and nerve and
tendons of muscles.

                 ASTRAGALUS.
  Situation, at the upper and middle part of the
tarsus, between the malleoli at either side:  the
tibia above, and the os calcis below.
   Crown,  broader anteriorly than posteriorly,
presents three articular surfaces; one, large su-
periorly, to articulate with the tibia; the others,
one on either side, to articulate with the malleoli
  Had, convex and smooth, is directed forwards
and inwards,  and is larger than the concavity of
the navicular  bone with which it articulates. 
36
   Neck,  the contracted portion between  the
 crown and the head is rough for the attachment
 of ligaments.
   Inferior aspect presents two articular surfaces
 for connexion with the os calcis: they are sepa-
 rated by a groove, from which ligaments pass to
 the groove in the os calcis.
   Posterior  aspect is narrow, and presents a
 groove for the tendon of the flexor longus polli-
 cis muscle, and a pointed eminence for the pos-
 terior external lateral ligament of the ankle-joint.

                 NAVICULARE.
   Situation, middle of the tarsus.
   Posterior aspect is smooth and concave, to ar-
 ticulate with the head of the astragalus.
   Anterior aspect presents two vertical  lines
 which divide it into  three smooth surfaces  for
 articulation with the three cuneiform bones and
 in general, a  small articular surface, externallv'
 where it touches the cuboid bone.            "'
   Tubercle, situated internally for  the  insertion
 of the tendon of the tibialis posticus muscle.

                  CUBOIDES.

   Situation, outer and anterior part of the tarsus
   Upper surface, flat and rough for ligaments
   Lower surface, tubercular behind, for the cal-
 caneocuboid ligament, and presenting a groove
anteriorly for the tendon of the peroneus loneus
muscle.                                   8 
37
   Posterior surface, smooth and concave trans-
 versely,  to articulate with the os calcis.
   Anterior surface  presents  two articular sur-
 faces; the external  triangular to articulate writh
 the metatarsal bone of the little toe,  the inner
 square for the fourth metatarsal bone.
   Externa' surface narrow and free.
   Internal surface presents posteriorly a small
 articular s ulaee for the naviculare, and  anteri-
 orly another, which is larger, to articulate with
 the outer side of the external cuneiform bone.

           INTERNAL  CUNEIFORM BONE.
   The largest  of  the  three  articulates behind
 with the navicular;  before, with the first meta-
 tarsal  bum-; externally, with the  middle cunei-
 form and side of the second metatarsal bone.
   Tubercle is situated inferiorly for the insertion
 of the t.-ii'lon of the tibialis anticus muscle, and
 part of (he tendon of the tibialis posticus.

            MIDDLE CUNEIFORM BONE.
  The smallest, articulates behind with the na-
 vicular buiiL"; before, with the second metatar-
sal  bon  ;  externally, with the external  cunei-
form;  and internally, with the internal  cunei-
form.
           EXTERNAL  CUNEIFORM BONE.
  Articulates behind with the navicular  bone;
before, \v:t!' the third metatarsal bone;  inter-
nally, wuh the middle cuneiform and side of the
                      4 
38
second metatarsal bone;  and  externally,  with
the cuboid and fourth metatarsal bone.

    •            METATARSUS
is the middle part of the  foot, and is composed
of five long bones placed between the tarsus and
the toes.
           FIRST METATARSAL BONE,

the shortest and thickest, is  convex above and
concave below.
  Posterior extremity is smooth and oval, to ar-
ticulate with the internal  cuneiform bone.
  Anterior extremity, round, to articulate with
the  first phalanx of the great toe.  The under
surface  of this extremity articulates with two
sesamoid bones, and receives the insertion of the
tendon of the peroneus longus.

           SECOND METATARSAL BONE,
the longest.
   Posterior extremity articulates with the three
cuneiform bones, and also with the third meta-
tarsal bone.
   Anterior extremity presents a round head, for
articulation with the second toe ; it is separated
from the  shaft of the bone by a groove.

            THIRD METATARSAL BONE.
   Posterior extremity articulates with the third
 cuneiform bone. 
39
   Anterior extremity resembles the second, and
 articulates with the third toe.

           FOURTH METATARSAL BONE.
   Posterior extremity articulates with the cuboid
 bone, and by its inner side with the third cunei-
 form.
   Anterior extremity resembles the second, and
 articulates with the fourth toe.

            FIFTH  METATARSAL BONE.
   Posterior extremity articulates with the cuboid
 bone by a surface directed obliquely upwards and
 outwards.
   Anterior extremity resembles the second, and
 articulates with the fifth toe.

              PHALANGES,  OR TOES,

 are composed of fourteen  bones, three to  each
 toe, except the first, which has only two.

               FIRST PHALANGES.

   Shape, convex above, concave below, and the
 longest.
   Anterior  extremities, convex   from   above
 downwards,  and  concave laterally;  form  gin-
 glymoid articulations with the second phalanges.
   Posterior extremities are large,  and present
rounded concavities for the heads of the  meta-
tarsal bones. 
40
              SECOND PHALANGES.

  Anterior extremities resemble those of the first
phalange?.
  Posterior extremities,  concave  from  above
downwards, and convex transversely, articulate
with the first phalanges.

              THIRD PHALANGES.

  Anterior extremities, pyramidal in  form,  sup-
port the nails on  their  upper surface, and are
rough on their under surface.
  Posterior extremities resemble the posterior
extremities of the middle phalanges.

               SESAMOID BONES.

are uncertain  in development;  two are gene-
rally found at the base of the first phalanx of the
great toe, and one at that of the  fifth toe.  They
are also  frequently developed  in  the tendons
which cross the sole of the foot in  those situa-
tions where they are subjected to much pressure.
               THE SKULL,
  Consists of eight bones, four of which are sym-
metrical, viz., the frontal, the ethmoid, the sphe-
noid,  and the occipital; and  four arranged in
pairs, viz. two parietal, and two temporal. 
41
                FRONTAL BONE.

   Situation.—Upper and anterior  part  of  the
skull.
   External,  or frontal aspect, is convex and
arched, and  presents a median vertical depres-
sion, which marks the original division of the
bone into two.
   Nasal spine, at the inferior part of the median
depression or line.
   Frontal eminences, on either side of the median
line, marking the points of ossification  of  the
bone.
   Superciliary  arches,  two convexities which
extend for about an inch on either side of the
median line inferiorly.
   The glabella, or  eminence of frontal sinuses,
between, but a little  above,  the  superciliary
arches.
   Orbital arches, form  the  upper edges  of the
orbits, and present towards  their inner third the
supraorbital  holes or notches, for the passage of
the frontal nerve and artery.
  External  angular processes, at the outer ter-
minations of the orbital arches.
  Internal angular processes, at the inner ter-
minations of the orbital arches.
  Temporal  ridges, extend  backwards and up-
wards from  the external angular processes.
  Internal or cerebral  aspect,  is  concave, and
presents in the median line a groove, which cor-
responds to  the superior longitudinal sinus.
                     4* 
42
   Crest, at the commencement of the  median
groove, gives attachment to the falx.
   Foramen caecum, at the root of the crest, gives
passage to a vein which opens from the nose into
the longitudinal sinus.
   Eminences and  depressions, on  either side of
the median line, commonly stated  to correspond
with the convolutions of the brain.
   Orbito-ethmoidal aspect, is irregular, forming,
on either side, part of the orbits, and in the me-
dian line part of the nose.
   Ethmoidal  notch,  quadrilateral,  articulates
with  the  ethmoid bone by a serrated margin;
its edges being cellular to  unite  with the eth-
moidal cells.
   Anterior and posterior ethmoidal foramina,
along the margins of the ethmoidal notch, giving
passage to the  nasal  twig of the ophthalmic
nerve and the ethmoidal arteries.
   Orbital processes, triangular, and on either side
of the ethmoidal notch, form the roofs of the or-
bits  by their smooth concave  surface, and on
their convex surface are marked by the convolu-
tions of the brain.  Towards the external angu-
lar process of each is the fossa for lodging the
lachrymal gland, and at the nasal margin^is  a
depression for the reflected tendon of the supe-
rior oblique muscle.
  Frontal sinuses, which exist only in the adult
at the antero-inferior  part of the  bone and  be-
tween its two tables, open at either side of the
nasal process. 
43
  It articulates with twelve bones, viz., the sphe-
noid, ethmoid, two parietal, two  nasal  bones,
two ossa unguis, two superior maxillary, and two
malar.
               PARIETAL BONES.
  Situation, upper and lateral parts of cranium ;
ifrey are quadrilateral.
  External surface, convex,  and marked by a
semicircular ridge, which is continued from the
temporal ridge of the  frontal bone.
  Four  edges.   The upper is  the  longest,  and
joins its fellow,—the anterior joins the frontal
bone,—the posterior is very irregular, and joins
the  occipital,—and the inferior is thick where it
joins the mastoid process, but thin  and  semicir-
cular where  it is  overlapped by the squamous
portion of the temporal bone.
  Four angles.  The anterior inferior is long and
curved,  and joins the sphenoid bone ; upon its
cerebral aspect is  a canal or a  groove, for the
trunk of the middle meningeal artery.  The pos-
terior inferior angle is grooved  upon its  cerebral
aspect to lodge part of  the lateral sinus.   The
superior angles are rather rounded.
  Internal surface, concave, and marked by the
convolutions of the brain and the  ramifications
of the middle  meningeal artery, presents along
its upper edge a shallow  groove, which, with its
fellow,  accommodates the superior longitudinal
sinus; external to this  groove are depressions
marking where the glandulae Pacchioni  externae 
44
were situated.  Each  parietal articulates  with
five  bones, viz, the frontal, sphenoid, occipital,
temporal, and with its fellow of the opposite side.


               OCCIPITAL BONE.

  Situation, posterior and inferior part of cranium.
  Tuberosity, near the centre of external surface.
  Superior  transverse  ridge, leads  from either
side  of the spine transversely outwards.
  Inferior transverse ridge, midway  between tu-
berosity and foramen magnum.
  Spine, leads from tuberosity down to the fo-
ramen magnum.
  Foramen magnum, larger internally than ex-
ternally, is of  oval form, and transmits the me-
dulla spinalis,  vertebral arteries, and  spinal ac-
cessory nerves.
  Basilar process,  passes forwards and upwards
to join the sphenoid bone, is rough inferiorly for
the attachment  of the  pharynx; and upon its
cerebral aspect is smooth and concave from side
to side to support the pons Varolii and basilar
artery, and  marked laterally by two  superficial
grooves, which lodge the inferior petrosal sinuses.
  Condyles, smooth and oblong,  look  down-
wards, outwards, and backwards ; each presents
a roughness internally  for the  check ligaments.
  Anterior condyloid foramina,  situated before
the condyles for the passage of the  ninth pair of
nerves.
  Posterior condyloid foramina, behind the con- 
45
dyles, for the passage of small veins.  They are
sometimes absent.
  Jugular eminences, external to either condyle;
they form with  the  temporal bone the foramen
basis cranii posterius.
   Crucial ridges, on the cerebral aspect, formed
by a transverse  and vertical line: they give at-
tachment to the falx major by the upper half of
the vertical  line, in  which  is a groove for the
termination  of the longitudinal sinus, and to the
falx minor or falx cerebelli by its  lower half;
the transverse ridge gives attachment to the ten-
torium, and  also presents a groove on either side
for the lateral sinuses.
  Four fossce,   two  superior for the posterior
lobes of the cerebrum, and two inferior and
deeper for the lateral lobes of the cerebellum.
   Grooves  for  the  termination of  the  lateral
sinuses,  on each side of the foramen magnum
above the jugular eminences.
  It articulates  with six  bones, viz., the two
parietal,  the two temporal,  the sphenoid, and
the atlas.
                TEMPORAL BONE.
   Situation,  at  the  lateral, middle, and inferior
part of  the skull.  It is divided into squamous,
mastoid, and petrous portions.
   Squamous portion, semicircular, flat, and thin,
forming part of  the side of  the  skull and of the
temporal fossa.
   Zygomatic process, arises by two roots, one 
46
anterior bounding the front of the glenoid cavity,
the other posterior,  which  is bifurcated;  the
process then passes  forwards, and presents  a
serrated edge to unite with the malar bone.
  Zygomatic tubercle, is situated at the union
of the zygomatic roots, and gives attachment to
the external lateral ligament  of the lower jaw.
  Glenoid cavity, transversely oval, deep ante-
riorly for the reception of the maxillary condyle,
and shallow behind, where it lodges a portion of
the parotid gland.
  Glasserian fissure,  crosses the glenoid cavity
in a direction obliquely  forwards and inwards.
It transmits the chorda tympani nerve, the laxa-
tor tympani muscle,  and lodges the  processus
gracilis of the malleus.
  Auditory process, commencing by the external
meatus, leads inwards and forwards to the mem-
brana tympani, and presents externally a rugged
edge for the attachment  of the cartilage  of the
ear.
  Internal surface of squamous plate, is marked
by the convolutions of the brain and by blood-
vessels.
  Mas'oid process, at the posterior and  inferior
aspect of the bone.
  Mastoid grooves, internal to the mastoid pro-
cess for po.-terior belly of the digastric muscle.
  Mastoid foramen, posterior to mastoid process
for the tr nsmission of a vein.
  Mas oid fossa, in the cerebral  aspect,  for the
lateral sinus. 
47
  Mastoid  cells,  in  the  interior  of mastoid
process.
  Petrous portion, containing in its interior the
internal  ear,  extends forwards  and  inwards,
and  presents three aspects, being of a prismatic
form.
  Aqueduct of  the cochlea, a  minute foramen
on the under surface, posterior  to  the styloid
process.
  Styloid process, long  and tapering,  descends
obliquely forwards and inwards, gives origin to
the styloid muscles and ligament.
   Vaginal  process, a plate of bone between the
glenoid cavity and the carotid foramen.
  Stylo-mastoid foramen, between  the styloid
and mastoid processes for the exit of the portio
dura nerve : near the stylo-mastoid foramen is a
minute aperture for the auricular branch of the
pneumo-gastric  nerve.
  Carotid  canal, commences  in  front of the
styloid process,  turns forward, upwards and in-
wards, and terminates by the side of the body of
the sphenoid bone.
  Jugular fossa, a  smooth  surface behind and
a little external to the carotid foramen: it forms
with  the occipital  bone  the foramen lacerum
posterius, which transmits  the eighth pair  of
nerves and the jugular  vein.   In  the  bony
septum,  between the  jugular fossa  and the
carotid canal,  is a small foramen,  which trans-
mits the  nerve of Jacobson to the tympanum.
  Processus cochleariformis, a thin plate of bone 
48
 separating two canals, which are situated in the
 angle between the petrous and squamous por-
 tions; the superior of which transmits the tensor
 tympani  muscle;  the inferior forming the bony
 part of the Eustachian tube.
   Superior petrosal ridge, separates the anterior
 from the posterior surface; it gives attachment
 to the tentorium, and is grooved for the superior
 petrosal sinus.
   Depression for Gasserian ganglion, on the an-
 terior extremity of the superior surface.
   Hiatus Fallopii,  a foramen on  the superior
 surface for the passage of the Vidian nerve.
   Meatus auditorius  internus,  on the posterior
 surface, for the transmission of the seventh pair
 of nerves and a small artery.
   Aqueduct  of the  vestibule,  a small slit-like
 open  ng posterior to the meatus internus.
   The  superior  semicircular canal,  forms an
 eminence on the superior petrosal surface.
  The temporal articulates with five bones, viz.
 the parietal, malar,  inferior maxillary,  sphenoid'
 and  occipital.   It  is connected  also to  the os
hyoides by the stylo-hyoid ligament.

                ETHMOID  BONE.
  Situation, in the ethmoidal notch of the frontal
 bone.
   Crista galli, an angular process which divides
the cerebral  aspect into two equal portions to
which is attached the commencement of the falx
cerebri. 
49
   Cribriform plate, on either side of the crista
galli,  concave, to lodge the olfactory bulbs, and
perforated with holes, for the passage of the
filaments  of the  olfactory   nerves, the  nasal
division of  the  ophthalmic  nerves, and  some
small blood-vessels.
   Nasal plate  or lamella, descends from the
under surface  of the  crista galli, j ins the
sphenoid bone posteriorly, the vomar and nasal
cartilage inferiorly, and the os frontis and nasal
bones anteriorly.
   Orbital plate, or Os planum, a smooth square
plate  of bone situated externally, and forming
part  of the orbit; in its upper  edge are two
notches, which,  with those in the frontal  bone,
form  the   anterior   and posterior ethmoidal
foramina.
   Ethmoidal cells,  between the orbital plate and
the nasal  plate, being ten or twelve  in  num-
ber.   They  are  divided into  anterior and pos-
terior.  The former,  the most numerous,  com-
municate  with  the middle meatus; the latter,
few and small in size,  open into the superior
meatus of the nose.
   Superior  spongy bone, descends  in a curved
manner outwards  from  the upper and posterior
part of the bone, forming a short channel, called
the superior meatus of the nose.
   Middle spongy bone, larger and more curved, ,
descends outwards, forming the middle meatus
of the nose.
   Infundibulum, a smooth groove leading from 
50
 the  anterior  ethmoidal  cells to  the  middle
 meatus.
   The  ethmoid articulates with thirteen bones,
 viz.,  sphenoid,  frontal,  vomer, two nasal,  two
 superior maxillary, two ossa unguis, two palatal,
 and two inferior spongy bones.

                SPHENOID  BONE.

   Body, corresponds to the median  line,  and
 presents six aspects.
   Posterior  aspect, is rough for connexion with
 the basilar process of occipital bone.
   Anterior aspect, presents the openings of the
 sphenoidal sinus.
   Inferior aspect,  presents the rostrum or azygos
process, which articulates with the vomer.
   Superior  or cerebral  aspect, presents a fossa,
 called sella turcica.
   Lateral aspects, join the great alae or wings.
   Sella turcica, a deep fossa  on the cerebral
 aspect  of the bone, for lodging  the  pituitary
body.
   Posterior clinoid processes, two rounded  emi-
 nences  posterior to the sella turcica.
   Anterior  clinoid processes, two  rounded  emi-
nences  situated  external and anterior  to the
 sella turcica.
   Olivary process,  an eminence  between the
anterior clinoid processes,  and anterior to the
sella  turcica, on  which  the optic commissure
rests. 
51
   Carotid  grooves,  one  on either  side  of  the
sella turcica for the internal carotid arteries.
  Processes of Ingrassias or lesser wings, two thin
plates of bone extending forwards and outwards
from the anterior clinoid processes, presenting
anteriorly a spine in the median line, to unite
with the ethmoid bone, and a serrated margin on
either side  to unite with the frontal bone.  Their
posterior free edges afford  attachment to the
sphenoidal folds of the dura mater.  The exter-
nal extremity of each terminates in an acute
point, their cerebral aspect being smooth, to sup-
port the anterior lobes of the brain.
   Great wings, extend laterally from the sides of
the body;  each  presents  three aspects, one an-
terior and smooth to assist in forming the outer
part of  the orbit; the second posterior, concave,
and marked by cerebral convolutions, to assist in
forming the middle cranial fossa;  and  the third
external, being divided by a crest; the portion
above, which forms  part of the temporal fossa,
and  the portion below, part of the zygomatic
fossa.
  Spinous processes, extend backwards and out-
wards  from the posterior termination  of each
great wing.
  Pterygoid processes, two on either  sicle,  de-
scend from the angle of junction of each great
ala and  the body.  The external is broad and ir-
regular; the internal is long and narrow,  and
terminates  in a hook called the hamular process. 
                       52

   Pterygoid fossa,  is  the  hollow between the
 pterygoid processes posteriorly.
   Sphenoidal fissures  or foramina  lacera,  on
 either  side of the  sella  turcica, are  placed be-
 tween the greater and lesser wings;  each  gives
 transmission to the third, fourth, first branch of
 the fifth, and the sixth nerves, and to the oph-
 thalmic vein.
   Foramina  optica, at the roots  of  the lesser
 wings,  give  passage  to the optic nerves and
 ophthalmic arteries.
   Foramina  rotunda,  posterior, and a little ex-
 ternal to the  bases of the foramina lacera, give
 passage to the second division of the fifth nerve.
 _ Foramina ovalia, near the posterior termina-
 tions of the  great  wings, give passage to the
 third division of the fifth nerve.
   Foramina spinosa,  in  the spinous  processes,
 give passage to  the middle meningeal artery of
 either side.
   Foramina pterygoidea, at  the  roots  of  the
 pterygoid processes,  for  the  passage  of  the
 Vidian nerves.
   The sphenoid articulates with all the bones of
 the cranium,  and  with several  of those  of the
 face, viz., the vomer, two malar, and two palate
 bones.,
             BONES OF TnE FACE.
                MALAR BONE.
  Situation, at the outer and  under part of the
orbit, forming the cheek. 
53
  Internal surface,  convex,  and of irregular
quadrilateral  form.
  External angular process,  at  the  upper and
outer edge, joins the frontal bone.
  Maxillary process, serrated, and rests at inner
edge on the superior maxillary bone.
  Zygomatic process, passes backwards, and sup-
ports the zygomatic process of the temporal bone
by a serrated edge.
   Upper  edge, forms the outer  and  inferior
margin of the orbit.
   Orbital process, a thin plate  of bone, which
passes from the upper edge backwards  and in-
wards.
  Lower edge, thick and uneven for the attach-
ment of the masseter muscle.
  Temporal aspect, behind the  zygomatic pro-
cess, is smooth for the lodgment of the temporal
muscle.
  Foramina,   two or three  in  number on its
cutaneous aspect,  for vessels and branches of
lachrymal nerves.'  It articulates with the frontal,
superior  maxillary,   temporal,  and sphenoid
bones.

          SUPERIOR MAXILLARY BONE.

  Body,  quadrilateral,  presents anteriorly  the
canine fossa for the levator anguli oris muscle, a
slight depression above the sockets of the incisor
teeth, the myrtiform fossa, for the depressor alee
nasi muscle, and the opening of the infra-orbital
                     5* 
54
canal for the superior maxillary nerve. Inferior-
ly it is bounded by the alveolar border.
   Malar process, external and superior, presents
a rough surface which supports the malar bone.
   Nasal process, internal and superior, is serrated
above to J0;n the frontal bone, and  presents a
groove to support the nasal bone.  Its cutaneous
aspect is perforated by two or three small holes
for blood-vessels,  its  posterior aspect is deeply
grooved to assist in  forming the fossa for the
lodgment of the lachrymal sac and duct, and its
internal  or nasal aspect is divided by a ridge,
which supports the inferior spongy bone.
   Orbital plate, triangular,  assists to form the
floor of the orbit.
   Infra-orbital canal, passes  from behind for-
wards between the plates of the orbital process,
and  terminates  in the  infra-orbital foramen,
which transmits the infra-orbital nerve.  It gives
off a smaller canal, anterior dental, which con-
ducts a small nerve to the incisor teeth.
   Temporal aspect, presents  behind  the malar
process a smooth depression  for  the temporal
muscle, and more posteriorly and inferiorly a
tuberosity which corresponds  to the  dens sapi-
entiae.
   Posterior dental foramina  are  three or four
small holes which give passage to the posterior
dental nerves, and are found near the tuberosity.
   Palatine process is thick internally,  and rough
where it joins its  fellow; its circumference cor-
responds to the alveolar processes, and its pos- 
55
 terior edge is thin and serrated where  it joins
 the palate bone ; its upper surface is smooth and
 concave from side to side, formirg part of the
 floor of the nose, and its under surface is rough,
 forming, with the gum, part of the hard palate.
   Nasal Crest, at the union of the palatine pro-
 cesses,  projects upwards to receive the vomer.
   Nasal spine projects forwards, above and be-
 tween the central incisor teeth.
   Foramen incisivum, is common to both bones,
 and  exists interiorly at the  anterior union  of
 their palatine  plates; superiorly  it  bifurcates
 and opens by two foramina,  one to each nostril.
   Antrum  maxillare  or Antrum  Highmori,  a
 large cavity in  the body of  the bone, bounded
 above by the orbital  plate, below by the  alveoli
 of the molar teeth, anteriorly by the canine fossa,
 and posteriorly  by the temporal aspect:  exter-
 nally it corresponds  to the malar process, and
 internally presents a large irregular opening.
   The  superior  maxilla  articulates  with  its
 fellow of the opposite side, with the frontal, os
 nasi, os unguis,  ethmoid, with the malar, vomer,
 inferior  spongy bone,  palate, and  occasionally
 with the sphenoid.
                 PALATE BONE.
   Horizontal  or palate plate,  quadrilateral,  is
 concave and smooth above,and completes the floor
 of the nose, and rough below, where it  completes
 the hard palate.  Its  anterior edge is serrated to
join the superior maxillary  bone,  its posterior 
56
 edge is concave and gives.attachment to the soft
 palate, its inner edge is  serrated where  it joins
 its fellow, and sends a crest upwards to  support
 the vomer;  its outer edge joins the nasal plate.
   Nasal  spine projects backwards  from the
 union of the palate plates.
   Nasal process, broad and thin ; its inner sur-
 face  is divided into two by a ridge which  sup-
 ports the inferior spongy bone : above and below
 this  ridge  the process  is  slightly concave,  to
 assist in  forming  the  inferior  and   middle
 meatuses: its  external  surface is rough and
 marked  by  the posterior palatine vessels and
 nerves;  its anterior thin  ed<re assists to close the
 antrum, and the posterior edge joins the ptery-
 goid  processes of sphenoid bone.
   Pterygoid process,  the thickest part of the
 bone, of a wredge shape,  inclines  backwards and
 outwards; it presents three  grooves, a  central
 one,  smooth,  which  completes the  pterygoid
 fossa, and a rough  one on either side to articulate
 with the  extremities of the pterygoid processes.
   Palatine foramina, at the junction  of ptery-
 goid and palatine processes, give passage to the
 posterior palatine nerve  and vessels.
   Orbitai plaie surmounting  the nasal process
 is  divided  into two by a notch,  Avhich forms
 with the sphenoid bone  the   spheno-palatine
foramen.
   Orbital process, is large  and  hollow,  and  of
 triangular form; At presents five surfaces, three
 articulated,  two free.  The anterior articulates 
57
with the superior  maxilla;  the  posterior with
the  sphenoid;  the internal  with the ethmoid.
The superior forms part of the floor of the orbit:
the external looks into the zygomatic fossa.
   Sphenoidal process, articulates with the body
of the sphenoid bone, and is also  hollow, form-
ing the pterygo-palatine canal.
   It articulates with six bones, viz., the  corre-
sponding  palate  bone,  the  superior  maxilla,
ethmoid,  sphenoid, vomer, and inferior  spongy
bone.
            INFERIOR SPONGY BONE.
   Rough and convex towards the septum of the
nose, and concave externally;  presents a free
margin inferiorly, and is attached above  to the
os  unguis, and to the  ridge  on the superior
maxillary  and palate bones.  It perfects the
nasal duct inferiorly.

                  OS UNGUIS.
   Situation, inner and anterior part  of orbit.
  Edges, serrated to join the os frontis  above,
the maxillary bone below, the nasal bone  ante-
riorly, and the  ethmoid bone behind.
  External surface,  divided  by a  perpendicular
ridge,  presents a  groove  anteriorly  for the
lachrymal sac, and a smooth surface behind to
assist in forming the orbit.
  Internal surface, covers the  anterior ethmoi-
dal  cells.   It  is sometimes, although  rarely,
wanting. 
58
                 NASAL  BONES.

   Situation, beneath the nasal process of frontal
 bone and between the nasal processes of superior
 maxillary bones.
   External  surface,  convex,  presents  small
 foramina for blood-vessels.
   Internal surface, concave, and grooved by the
 nasal nerves..
   Superior edge, thick and serrated, to join the
 frontal bone.
   Inferior edge, thin  and expanded, joins the
 lateral nasal cartilages.
   External edge is the longest, and is serrated to
join the superior maxillary bone.
   Internal edge is flat, and joins its fellow.
   The nasal bone  articulates with  the frontal
 superior maxilla, opposite bone, ethmoid bone,
and nasal cartilage.

                    VOMER.

   Situation, in the median line of nose.
   Superior edge, grooved to receive  the  azygos
process of the sphenoid bone.
   Anterior edge  or  lamella, slightly  grooved to
 receive the nasal plate and nasal cartilage.
   Posterior  edge,   free,  looks  towards  the
pharynx.
   Inferior edge, the longest, is received into the
nasal crest of  the superior maxillary and palate
 bones. 
59
          INFERIOR MAXILLARY BONE.
  Body, the anterior portion, projects inferiorly
into mental process or  chin, superiorly is  sur-
mounted by alveoli of four incisor teeth,—ante-
riorly has on each side a depression for muscles,
and posteriorly, two depressions for the digastric
muscles,  above which are two pair of spines;
the inferior for the  geniohyoidei,  and the supe-
perior for the genio-hyo-glossi muscles.
  Symphysis, a vertical ridge in the centre of body.
'  Horizontal  rami.  On  the outer surface  of
each  is an oblique ridge  for muscles; on the
inner is the  mylo-hyoidean  ridge, above which
is a depression  for the sublingual gland, and
another below for the sub-maxillary gland.  The
lower edge or base is rounded and  grooved for
the faciaf artery, and upon the upper edge are
alveolar processes.
  Angle,  obtuse and rough for muscles.
  Ascending  rami, are thick and  round  posteri-
orly—externally smooth—internally grooved.
   Coronoid process, passes upwards from anterior
part of ascending ramus.
   Condyle, transversely oblong to articulate with
temporal bone.
   Neck,  constricted part below condyle.
  Sigmoid notch, between condyle and coronoid

  Inferior dental foramen, situated at internal
surface of ascending ramus, and surmounted by
a spine. 
60
  Mental foramen, situated at anterior  surface
of bone external to body.
  Dental canal, traverses bone between the two
foramina, and eommunicates with each alveolus.
This canal contains  the inferior dental nerve
and artery.
                 OS  HYOIDES.
  Situation, in  the anterior part of the neck be-
tween  the chin and larynx.
  Body, square, is rough anteriorly for muscles,
smooth and concave posteriorly.
  Greater  cornua, pass  obliquely backwards
from the sides of the  body, and  end  in  tuber-
cles.
  Lesser cornua, are  very small, and pass ob-
liquely backwards and upwards from the point of
junction of the  great cornua and  body, and con-
nect the bone with the styloid process of tempo-
ral bone by means of the stylo-hyoid ligaments.
  'The  bones of the ear are described in connec-
tion with the organ of hearing.

     SUTURES OF THE CRANIUM AND FACE.
  Coronal suture, commences a little behind the
external angular process of the frontal bone,  at
the upper termination of the  great wing of the
sphenoid bone, and, inclining backwards, extends
across  the cranium to the opposite corresponding
point,  connecting in its course the frontal to the
parietal bones.
  Lambdoid suture, commences at the union  of 
61
the petrous  portion of the temporal bpne with
the parietal  and occipital bones, and extending
across the posterior part of the cranium to the
opposite corresponding point, connects the occipi-
tal to the parietal bones.
   Sagittal suture, extends from the angle of the
occipital bone forwards, connecting in its course
the  parietal bones and corresponding to the
median line; it generally terminates in the coro-
nal suture, but is occasionally prolonged to the
nasal bones, dividing the frontal bone.
   Squamous suture, corresponds to the semi-
circular edge of the  squamous portion of the
temporal bone, and connects it to the great wing
of the sphenoid bone, and to the parietal bone.
   Additamentum suturce  lambdoidalis, extends
from the termination  of the lambdoid suture  to
the foramen lacerum posterius, and unites the
mastoid process  of  the temporal  bone to the
occipital.
   Additamentum  suturce  squamosce,  extends
nearly horizontally backwards from the posterior
termination  of the squamous suture to the lamb-
doid suture,  connecting the upper extremity of
the mastoid  portion of the temporal bone to the
parietal bone.
   Sphenoid suture, extends around the irregular
margins of the  sphenoid bone  connecting  it  to
all the bones of the head, and to the  malar, su-
perior maxillary, and palate bones.
   Ethmoid suture, surrounds the ethmoid  bone,
connecting it to the frontal, nasal, superior max-
                     6 
62
illary, lachrymal, and palatine bones, and to the
vomer.
  Transverse suture, connects the bones  of the
face to those of the head.
  Zygomatic suture, corresponds to the junction
of the temporal with the malar bone.

                   ORBITS.
  The orbits  are two pyramidal cavities, the
bases of which look outwards and forwards, and
their  apices in the  contrary direction; so  that
two lines passing through their axes if prolonged
posteriorly would decussate at the sella turcica.
Each orbit is formed  of seven bones, three  of
which—viz. the frontal, sphenoid, and  ethmoid,
are common to both orbits; the other four—viz.
the lachrymal, superior  maxillary, malar, and
palate bones belonging to  the orbit of their cor-
responding side.   The roof  is  formed by the
lesser wing of the sphenoid bone and the orbital
plate  of the frontal.  At  the outer angle is  a
depression for the lachrymal gland; at the inner a
depression for the pulley of the  trochlearis
muscle.  The  floor is  formed  by the superior
maxilla, the malar and palate  bones, and con-
tains  the infra-orbital canal.  The outer wall is
formed by the malar and sphenoid  bones ; it is
pierced by some small foramina for  nerves; the
inner is formed by the os planum of the ethmoid
the os unguis, superior maxilla, and a bit of the
sphenoid.  It is perforated by the anterior and 
63
 posterior ethmoidal foramina.   The foramina in
 the base of the orbit are, the supra-orbital, the
 infra-orbital, and the upper orifice of the nasal
 duct:  within the orbit are the optic  foramen,
 the superior foramen lacerum, and  the spheno-
 maxillary fissure.  Through the optic foramen
 passes the optic  nerve  and ophthalmic  artery.
 Through  the fissura lacera the third,  fourth,
 ophthalmic division of the fifth nerve, the sixth
 nerve, and the ophthalmic vein.

               TEMPORAL FOSSA,
   Placed on the side of the cranium, is bounded
 by the frontal, sphenoid,  malar, parietal, and
 temporal  bones, and  lodges the temporal muscle.

               ZYGOMATIC FOSSA.
   Extends from the  temporal  fossa downwards,
 and is  bounded by the zygomatic arch, the supe-
 rior maxillary bone, and the portion of the great
 wing  of  the  sphenoid  bone  below its  crest.
 Between the great wing of the sphenoid and the
 border  of the superior maxillary bone is  the
spheno-maxillary fissure, which opens into  the
orbit.
         PTERYGO-MAXILLARY FISSURE,
  Lies deep in the zygomatic  fossa, is  bounded
by the pterygoid processes, the tuberosity of the
superior maxilla,  and the  nasal plate  of  the
palate bone; and communicates with the spheno- 
64
maxillary fissure.  The angle of union of the
spheno-maxillary and pterygo-maxillary fissures
is called the pterygo-maxillary fossa, into which
five  foramina open;  foramen rotundum, for se-
cond branch of fifth cerebral nerve;  foramen
pterygoideum for the vidian nerve;  pterygo-
palatine for a small  artery ; posterior  palatine
for nerves and  arteries; spheno-palatine, which
lodges the spheno-palatine  ganglion.
         .   ARTICULATIONS.

      TEMPORO-MAXILLARY ARTICULATION.
  Bony formation.  Glenoid cavity of temporal
bone and condyle of inferior maxillary bone.
  External  lateral  ligament,—origin, zygoma-
tic  process and external  meatus.   Insertion,
outside of the neck of condyle of lower jaw.
  Internal  lateral  ligament,—origin,   spinous
process   of sphenoid  bone.   Insertion, spinal
orifice of inferior dental canal.
  Stylo-maxillary ligament,—origin, styloid pro-
cess of temporal bone.   Insertion, angle of infe-
rior maxilla.
  Synovial  Membranes; two; one is  reflected
from  the  cartilaginous surface  of zygomatic
eminence and glenoid  cavity over  the  superior
surface of the fibro-cartilage;  the other covers 
65
  the under surface of the fibro-cartilage, and is
  reflected over the condyle.
    Inter-articular,  or  fibro-cartilage,  of  oval
  figure,  thick in its  circumference, thin  in  the
  centre, where  it is sometimes perforated.   Di-
  vides the joint into  two.
    Capsular ligament,—origin, zygomatic emi-
  nence, and glenoid  fissure.   Insertion, neck of
  lower jaw.

        OCCIPITO-ATLANTOID ARTICULATION.
   Bony  formation,  condyles of occipital bone
  and superior articular process of atlas.
    Capsular ligament, imperfect.
   Synovial membranes,  cover the opposed carti-
 laginous surfaces.
   Anterior occipito-atloidean ligament,—origin,
 anterior edge  of foramen magnum.  Insertion,
 upper edge of atlas, anterior to its articular pro-
 cesses.
   Posterior occipito-atloidean ligament,—origin.
 posterior edge of foramen magnum.  Insertion,
 upper edge of atlas behind  its  articular pro-
 cesses.

         OCCIPITO-AXOID  ARTICULATION.

   Check,   or  oblique ligaments,—(syn.) Ligam.
alaria;  odontoid ligaments,—origin, from each
side of  odontoid process.   Insertion,  inner side
of each occipital condyle.
  Apparatus ligamentosus, or occipito-axoidean
                     6* 
66
ligament,—origin,  lower  part  of  basilar pro-
cess, being  posterior to odontoid process.  In-
sertion,  superior part of transverse ligament of
atlas and  bodies of second and third vertebrae,
where  it is  continuous with the posterior com-
mon ligament.

         ATLANTO-AXOID ARTICULATION.
  Bony formation.—The anterior portion of the
spinal hole of the atlas, and the odontoid process
of axis; no intervertebral substance.
  Anterior and posterior ligaments, as in all the
other vertebrae.
  Transverse ligament,  attached on each side to
inner edge of articular process of the atlas, and
by means of apparatus hgamentosus to basilar
process above, and body of axis below.
  Synovial membranes.—One between posterior
surface of odontoid process, and anterior surface
of transverse  ligament.  Another  covers  the
opposed  cartilaginous surfaces of the atlas and
odontoid process.

       COMMON VERTEBRAL ARTICULATION.
  Bony formation.—Opposed  surfaces  of  the
bodies  and articulating  process of the vertebrae.
  Anterior  vertebral ligament,  extends  from
axis to sacrum, adhering to  the bones  and the
inter-vertebral substances.
  Posterior  vertebral ligament, extends along
the posterior part of bodies of vertebrae within 
67
 the spinal canal.  It is separated from the bodies
 of the vertebrae by some large veins.
   Inter-vertebral  ligaments, or  fibro-cartilages
 are placed between the bodies of all the verte-
 brae, except the atlas and dentata, and united to
 their flat surface above and below.  They are
 thicker  in  front  than behind in the neck and
 loins, and  the contrary  in the back: in  the
 dorsal region they are attached to the heads of
 the ribs.
   Synovial membranes  and ligamentous fibres
 connect the articulating processes.
   Ligamenta  sub-fiava,  composed  of yellow
 elastic tissue, are  situated  between  the  laminae
 of the vertebrae from  the second to the sacrum,
 completing the  posterior  part  of the  spinal
 canal.
   Supraspinous  and  inter-spinous ligaments,
 connect  the spinous processes of the vertebrae.
   Inter-transverse ligaments, connect the trans-
 verse  processes.   The  Ligamentum  Nuchae
 extends   from 7th  cervical vertebra to  the
 occiput.


          COSTO-SPINAL ARTICULATIONS.
   Bony  formation.—Heads, and tubercles of
ribs, and bodies and transverse processes of ver-
tebras.
   Anterior ligament,—origin, front of head of
rib.  Insertion, side of the  vertebra above  and
below, and to the inter-vertebral substance  by 
68
radiating fibres, hence sometimes  called "stel-
late ligament."
   Inter-articular ligaments,—origin, projecting
ridge in the articular surface of each rib.  Inser-
tion, cavity in  the inter-vertebral  substance in
which the  head  is  received.  The upper and
lower divisions of this joint have distinct syno-
vial membranes.
   Costo-transverse ligaments, three  in number.
   Internal costo-transverse  ligament, — origin,
neck  of each rib.   Insertion, transverse process
of the vertebra above.
   Posterior  costo-transverse  ligaments, connect
the tubercle  of each  rib to the corresponding
transverse process.
   Middle or  interosseous costo-transverse liga-
ment connects the neck  of the rib  to the con-
tiguous transverse process: to see  it, the bones
must  be forcibly separated.
   Synovial membranes are between the tuber-
cles and transverse processes.


       CHONDRO-STERNAL ARTICULATION.
  The ribs are connected to the sternum through
the intervention of their cartilages, which  firm
a joint lined by synovial membrane and secured
anteriorly and posteriorly by ligamentous fibres.

          LUMBO-SACRAL  ARTICULATION.
  Bony formation.—Last lumbar vertebra and 
69
 sacrum.   These are joined together in the same
 manner as the other vertebrae.
 k» Ilio-lumbar ligament,—origin, transverse pro-
 cesses of fifth  lumbar  vertebra.   Insertion,
 posterior  superior spinous process and crest of
 ilium.
   Sacro-vertebral ligament extends almost ver-
 tically downwards from transverse process of
 last lumbar vertebra to base of sacrum.

           ILIO-SACRAL ARTICULATION.

   The ilium and sacrum are connected  anteri-
 orly and posteriorly  by short ligamentous fibres.
 Great sacro-sciatic ligament,—origin,  posterior
 inferior  spine of ilium and side of sacrum and
 coccyx.   Insertion, lower  edge of tuber ischii.
 Along the ramus of the ischium it sends a falci-
 form process which covers  the obturator inter-
 nus muscle.
   Lesser sacro-sciatic  ligament,—origin, side of
 sacrum and coccyx.   Insertion, spine of ischium.
   These ligaments  convert  the great  lateral
 pelvic  notch  into foramina, called the greater
 and lesser sacro-sciatic foramina.  The former,
 superior, transmits the pyramidalis muscle, the
 great  sciatic  nerve,  the   sciatic  vessels,  and
 the  gluteal  vessels  and   nerve;  the  latter,
 inferior,  and bounded  by  the  two  ligaments,
 transmits  the   tendon of  the  obturator  in-
 ternus muscle  and the internal pudic vessels
and nerve. 
70
        SACRO-COCCYGEAL  ARTICULATION.
  The sacrum and coccyx are united together
by a similar  substance to  the inter-vertebral,
and  by ligamentous bands anteriorly and pos-
teriorly.
             PUBIC ARTICULATION.
  Fibro-cartilage,  which  attaches closely . the
bones of the pubes;  also ligamentous fibres.
  Sub-pubic ligament, passes from the ramus of
one bone to the other, and rounds off the angle
formed by their union.
  Obturator ligament, attached to the circum-
ference of obturator foramen, except superiorly,
where the obturator nerve and vessels pass.

       STERNO-CLAVICULAR ARTICULATION.
  Anterior  ligament,—origin,  anterior  surface
of sternal end of clavicle.  Insertion,  anterior
surface of sternum.
  Posterior  ligament,—origin, posterior surface
of sternal end of clavicle.   Insertion, back part
of sternum.
   Costo-clavicular ligament,—origin,  lower sur-
face  of sternal end of clavicle.   Insertion, carti-
lage of first rib.
  Inter-clavicular  ligament extends   from the
sternal extremity  of one  clavicle to that of the
other,  dipping down in its course to become at-
tached to the upper surface of the sternum.
  Inter-articular cartilage, thin below and  at-
tached to sternum, thick above and attached to 
71
  clavicle;  having  a synovial  membrane  con-
  nected to each surface and its corresponding


        SCAPULO-CLAVICULAR  ARTICULATION.
    Superior acromioclavicular ligament —oriqin
 upper surface  of  acromion.   Insertion,  upper
 part of clavicle.                          1 ^
    Inferior  acromioclavicular  ligament. — At-
 tached to under surface of each bone.
    Synovial  membrane' covers the articulating
 surfaces in the usual manner.                °

        CORACO-CLAVICULAR  ARTICULATION.
    Conoid ligament, triangular;  base connected
 to the tubercle  on inferior surface of clavicle
 apex at the broad part of coracoid process.    '
   Trapezoid ligament, attached above to an ob-
 lique line on the clavicle;  below to upper part
 of the coracoid process.

          LIGAMENTS OF THE SCAPULA.

   Coraco-acromial ligament,—origin, broad from
coracoid process.  Insertion,  narrow into  point
of acromion.
   Posterior or coracoid ligament,—origin,  supe-
rior costa of scapula behind  the notch. Inser-
tion, base  of  coracoid  process.  This ligament
converts the  notch into  a  foramen,  through
which passes the suprascapular nerve. 
72
       HUMERO-SCAPULAR ARTICULATION.
  Bony formation.—Head of humerus and gle-
noid cavity of scapula.
  Capsular ligament,—origin, circumference of
neck of scapula.  Insertion, around the neck of
humerus.   It  is  strengthened by the coraco-
humeral  ligament,  and  by prolongations  from
the tendons of the supra and infra spinatus and
teres minor muscles.
  Coraco-humeral  ligament,— origin, coracoid
process.  Insertion, anterior part of great tube-
rosity.
  Synovial membrane is reflected over the sur-
face of the glenoid cavity around the glenoid
ligament; lines the  capsular ligament, head of
humerus, and  bicipital groove.
  Glenoid  ligament, closely connected with the
tendon of the biceps flexor cubiti, encircles the
glenoid cavity, and by elevating the border, adds
to the depth of the articulating surface.

        HUMERO-CUBITAL ARTICULATION.
  Bony formation, articular processes of hume-
rus, great sigmoid cavity of ulna, head of radius.
  External  lateral ligament,— origin, external
condyle  of humerus.   Insertion,  annular liga-
ment of radius.
  Internal  lateral  ligament,— origin,  internal
condyle.  Insertion, inner edge of olecranon and
coronoid processes. 
73
   Anterior ligament consists of  thin  fibres —
 origin, principally from the above internal con-
 dyle and depression on the forepart of humerus-
 insertion, annular ligament of radius  and syno-
 vial membrane.                           J
   Posterior ligament is composed of fibres which
 extend from one condyle to the other,  and are
 attached to the synovial  membrane.
   Synovial membrane is reflected from behind
 the anterior ligament to  neck of radius  and an-
 nular ligament;  it then lines the sigmoid cavities
 ot the ulna, and is  reflected to the lateral  liga-
 ments and tendon of the triceps muscle, which
 conducts it to the posterior depression' of the
humerus; it is then expanded over its articular
processes.
      SUPERIOR RADIO-ULNAR ARTICULATION.

   Bony formation, lesser sigmoid cavity of ulna
 and inner side of head of radius.
   Coronary ligament—origin, anterior border
 of lesser sigmoid cavity of ulna; insertion, pos-
 terior  border of the same cavity.  It encircles
 the neck of radius.
   Obi que ligament—origin, coronoid process of
ulna.  Insei tion. radius below its tubercle.
  Interosseous ligament connecis the opposed
edges of radius and  ulna, its  fibres  descending
obliquely inwards from the former bone  to* tt.e
latter.
                      7 
74
      INFERIOR  RADIO-ULNAR ARTICULATION.

   Bony formation, round head of ulna, and sig-
moid cavity of radius;  the bones are united by
some fibrous bands, which are so thin as  not to
need description.
   Fibro-cartilage—origin, styloid process of ul-
na.  Insertion, inner  edge of radius below the
ulna.
   The synovial  membrane,  called sometimes
membra'ia sacciformis, extends horizontally be-
tween the extremity  of the ulna and  the tibro-
cartla^e,  and  vertically between the  opposed
articulating surfaces of the radius and ulna.

          RADIO-CARPAL ARTICULATION.

   Bony formation, lower end of radius; sca-
phoid, lunar,  and cuneiform bones.
   The extremity of the ulna  is separated from
the joint by the fibro-cartilage.
   External lateral  ligament—origin,  styloid
process of radius.  Insertion, scaphoid bone, and
by some fibres  into annular ligament and trape-
zium.
   Int'rnal lateral ligament—origin, styloid pro-
cess  of ulna.  Insertion,  cuneiform bone and
pisiform bone.
   Postrior ligament—origin,  posterior part of
radius and fibro-cartilage.  Insertion, back part
of superior row of carpus.
  Anterior ligament—origin,  anterior part  of 
75
 radius and  fibro-cartilage.   Insertion, fore part
 of first row of carpus.
   The synovial membrane lines the hea 1 of the
 radius,  the fibro-cartilage, and is then reflected
 over the three carpal bones.


            CARPAL ARTICULATIONS.

   The  bones of the carpus are  articulated by
 ligamentous bands, both anteriorly and posteri-
 orly.
   The scaphoid, lunar, and cuneiform bones are
 connected by dorsal and palmar  ligaments, ex-
 tending from bone to bone: between the opposed
 surfaces are interosseous fibro-cartilages.
   The pisiform bone possesses a distin-it fibrous
 capsule and  synovial membrane.
   The trapezium, trapezoides, magnum, and un-
 ciforme, are  also connected by dorsal and palmar
 ligaments.
   Interosseous  fibro-cartilages  are found on
 either side of the os magnum.
   Lateral ligaments extend on  the  radial side
 from the scaphoid to the trapezium; on the ul-
 nar side, from the cuneiform to the unciform.
   The  carpal  synovial membrane extends be-
 tween the first and second row of carpal bones,
and is prolonged to the carpal extremities of the
four inner  metacarpal  bones.  The trapezium
articulates with  the metacarpal  bones of the
thumb by a  distinct capsule and synovial  mem-
brane. 
76
  Annular  ligament—origin,  trapezium and
scaphoid bones.  Insertion, cuneiform and unci-
form and pisiform bones.

       CARPO-METACARPAL ARTICULATION.

  The carpus and metacarpus are  secured by
fibrous bands, which pass in different directions,
and cover the synovial membranes.

    METACARPO-PHALANGEAL ARTICULATIONS.

  The heads of the metacarpus and first pha-
langes are secured  by lateral ligaments, and are
lined by synovial membranes; a transverse liga-
ment connects the  digital extremities of the me-
tacarpal bones one  with another.

      INTER-PHALANGEAL ARTICULATIONS.

  The phalanges are connected to each other by
means of two  lateral ligaments, one  anterior
hgament, and between each of their joints is a
synovial membrane.

         ILIO-FEMORAL ARTICULATION.

  Bony formation, acetabulum and head and
part of neck of femur.
  Cotyloid ligament, a fibro-cartilaginous circu-
lar band  adhering  to the margin of the  aceta-
bulum.
  Transverse ligament, attached to the opposite 
77
points of the notch of the acetabulum, and partly
filling it up.
   Capsular ligament—origin, circumference  of
acetabulum and transverse ligament.  Insertion,
below root of trochanter major, and the  two
inter-trochanteric lines.
   Accessory  or  ilio-femoral ligament—origin,
anterior inferior spinous process of ilium.  Inser-
tion, anterior trochanteric line.
   Synovial membrane,  reflected from inside of
capsule upon periosteum of neck, and cartilagi-
nous  surface of head;  is  continued over inter-
articular ligament, and thence is reflected upon
the cartilaginous surface of the acetabulum.
   Inter-articular ligament, or ligamentum teres
—origin, depression on the head of femur.  Inser-
tion, by two bands into the extremities of the
notch, and into the transverse ligament.

         FEMORO-TIBIAL ARTICULATION.

   Bony formation, condyles of femur, head  of
tibia and the patella.
   Ligamentum patella}—origin, lower angle  of
patella.  Insertion, tubercle of tibia.
   Posterior ligament—origin, tendon of semi-
membranosus  muscle at internal  and posterior
part of tibia.    Insertion, external  condyle  of
femur.
   Internal  lateral  ligament—origin,  internal
condyle of femur.  Insertion,  internal condyle
of tibia and semilunar  cartilage. 
78
  External  lateral  ligament—origin,  external
condyle of  femur.   Insertion,  head of  fibula.
This ligament is  often divided into two by the
tendon of the biceps muscle.
  Synovial membrane lines the back part  of the
patella, from which it  is reflected two or three
inches on the fore part of the femur, and on its
condyles; from thence it is conducted by the
crucial ligaments to the  semilunar  cartilages,
and head of tibia.
  Alar ligaments arise from each side of patella,
and unite below that bone.  They are mere folds
of synovial membrane.
  Ligamentum  mucosum—origin,  fatty  sub-
stance behind ligamentum  patellae.  Insertion,
hollow between  the condyles.   It also is a fold
of synovial membrane.
  Transverse ligament, attached to the  anterior
portion of each semilunar cartilage.
  Anterior crucial ligament—origin,  inner side
of external condyle.   Insertion,  near  the fore
part of head of tibia, where it is connected  to the
cornu of the internal semilunar  cartilage.
  Posterior  crucial  ligament—origin,  outer side
of internal condyle.  Insertion, depression  on
back  part of head of tibia,  and external  semi-
lunar cartilage.
  Semilunar cartilages, thick  externally,  thin
internally: concave  above,  flat below.   The
outer convex edge of the internal is attached to
the lateral ligament; the inner edge is free; the
anterior and posterior extremities of each are 
79
attached  to the head of the tibia.  The outer
cartilage is  circular, the inner is semi-circular.

          TIBIO-FIBULAR ARTICULATION.
   The head of the  fibula is  attached to the tibia
by anterior and posterior fibrous bands and sy-
novial membrane.
   Interosseous membrane extends from one bone
to the other, nearly the whole length.
   The lower extremities  of the tibia and fibula
are connected together by anterior and posterior
ligaments;  the synovial membrane is a prolon-
gation of that which lines the ankle joint.

         ARTICULATION  OF THE ANKLE.

   Bony formation,  lower ends of tibia, fibula,
and astragalus.
   Internal  lateral  ligament—origin,  internal
malleolus.   Insertion, astragalus, naviculare, and
os calcis.
   External  lateral  ligament has three parts; all
take their origin from  the external malleolus.
Insertion of anterior, upper and outer part of
astragalus.   Insertion of middle, os  calcis.  In-
sertion of posterior, ridge  on the back of astra-
galus, which bounds the  groove for the  flexor
longus pollicis.
   The synovial membrane  covers  the opposed
surfaces of the bones, and sends upwards  a pro-
longation into the  inferior  tibio-fibular  articu-
lation.' 
80
        ARTICULATIONS OF THE TARSUS.

  The astragalus and os calcis have two articu-
lar surfaces, covered by synovial membranes.
  Interosseous ligament passes nearly perpendi-
cularly from the groove which separates the in-
ferior articular surfaces of the astragalus, to the
corresponding groove in the os calcis.
  Posterior ligament is attached to the posterior
edges of the astragalus and  os calcis.
  External lateral ligament  passes from the as-
tragalus to the outer surface of the os calcis.
  There are two synovial membranes; one pos-
terior to the interosseous ligament, between the
astragalus and os calcis: a second anterior to the
interosseous  ligament,  between the  astragalus
and os calcis, and continued forwards between
the astragalus and os naviculare, over the calca-
neonavicular ligament.
  The bones of the tarsus are connected on their
dorsal and plantar aspects by numerous ligamen-
tous bands.
  Calcaneo-scaphoid  ligament—origin,  inferior
surface of os calcis.  Insertion, inferior surface of
os naviculare.
  It is composed of elastic tissue, and is  sup-
ported inferiorly by the tendon of the  tibialis
posticus muscle: superiorly  it forms with the os
calcis and os naviculare a  cup,  which receives
the head of the astragalus
  Inferior  calcaneocuboid  ligament — origin,
posterior  inferior part  of os calcis.   Insertion, 
81
under part of cuboid bone, and third and fourth
metatarsal bones.
  The superficial fibres, longer than the deeper,
form the " ligamentum longum plantae." There
is a distinct synovial membrane  between  the
calcaneum and cuboid bones.
  The three cuneiform bones are  connected by
dorsal, plantar, and interosseous ligaments:  one
synovial membrane  is reflected over their  op-
posed surfaces with the os naviculare.

       TARSO-METATARSAL ARTICULATIONS.
  These joints are secured by dorsal and plantar
ligaments, and are lined by synovial membranes.
The metatarsal bones are secured to the phalan-
ges, and the phalanges to each other, by lateral
ligame its and synovial membranes.  There  is
one synovial membrane  between the internal
cuneiform bone and the first metatarsal bone: a
second betwen the os cuboides and the fourth
and fifth metatarsal bones. The second and third
metatarsal bones form part of the articulation be-
tween  the cuneiform and  the navicular bones.
                 MUSCLES.

                   HEAD.
  Occipito-frontalis. — Origin,  two  external
thirds of superior semicircular ridge of occipital 
82
 bone, and posterior external part of mastoid pro-
 cess of temporal bone.   Insertion, integuments
 of  eyebrows, when the fibres become blended
 with those of the pyramidalis nasi, the corruga-
 tor supercilii, and the orbicularis palpebrarum.

          MUSCLES OF EXTERNAL EAR.
  Attollens   aurem.— 0.  cranial  aponeurosis
 above external tar.  I. upper and anterior part
 of cartilage of ear.
  Attrahens aurem.— 0. posterior part of zygo-
 matic process and cranial aponeurosis.  I. ante-
 rior part of helix.
  Betrahens  aurem.— 0.  mastoid process.  I.
 back part of c. ncha.

                    FACE.
  Orbicularis palpebrarum.— 0. Internal angu-
 lar process of os frontis and upper edge of tendo
 palpebrarum.  I. nasal process of superior max-
 illary bone and inferior edge of tendo palpebra-
 rum.
  Tensor tarsi.— 0. posterior edge of os unguis.
 I. lachrymal ducts as far  as puncta.
  Corrugator supercilii.— 0.  internal angular
process oi'os  frontis.  I.  middle of eyebrow.
  Pyramidalis nasi.— 0. occipito-frontalis mus-
cle,  descends  along nasal bones.   /. compressor
nasi muscle.
  Compressor nasi.— 0. canine fossa in superior
maxilla.  I. dorsum of nose. 
83
    Levator labii superioris alceque nasi — 0. up-
 per extremity of nasal process of superior max-
 illa, and from edge of orbit  above infra-orbital
 hole.   I. ala nasi, upper lip, and orbicularis  oris
 muscle.
    Zygomaticus minor.—0. upper part of malar
 bone.   I. upper lip, near commissure.  Some-
 times wanting.
    Zygomaticus minor.— 0. lower part of malar
 bone, near zygomatic suture. I. angle of mouth.
    Levat>r angnli ori<.— 0. canine fossa above
 alveola  of the first molar tooth.  /. commissure
 of lips and orbicularis oris.
    Depressor  labii superioris alaique  nasi.— 0.
 myrtiform fossa above canine and  incisor teeth
 of superior maxilla.   /.  integuments  of upper
 lip and fibro-cartilage of septum and ala nasi.
   Depressor  anguli.— 0.  external  oblique  line
 on lower jaw, extending from anterior edge of
 masseter muscle to mental foramen. I. commis-
 sure of lips.
   Depressor labii inferioris.— 0.  side and front
 of lower maxilla,  above  its  base.  I. half of
 lower lip and orbicularis oris.
   Levatir labii inferioris.— 0. alveoli of incisor
 teeth of  lower jaw.  I. integument of chin.
   Orbicularis oris surrounds mouth  by two
 fleshy fasciculi.
   Buc inator.— 0. two last alveoli  of superior
maxilla and external surface of posterior alveoli
of lower  maxilla, and  from  a ligament (pterygo-
maxillary)  which  extends  from the  internal 
84
 pterygoid plate of the sphenoid bone to the ex-
 tremity of the mylo-hyoid ridge of the inferior
 maxilla.   I. commissure of lips.

         MUSCLES  OF  LOWER JAW.
   Masseter consists of  two portions:  Anterior
portion.   0. superior maxilla where it joins ma-
 lar bone,  and inferior edge of latter.  I. outer
 surface of angle  of lower jaw.
   Posterior portion.— 0. edge of malar bone, and
 zygomatic arch, as far as glenoid cavity.  I. ex-
 ternal side of angle and ramus  of lower jaw.
   Temporal.— 0. side of cranium, beneath semi-
 circular ridge  on parietal bone, temporal fossa,
 and aponeurosis.  /. coronoid process of inferior
maxilla to last molar tooth.
   Pterygoideus internus.— O. internal pterygoid
plate  and pterygoid  fossa  of  palate bone.  /
inner side of  angle  of jaw and rough surface
above.
   Pterygoideus externus.— 0. outer side of ex-
ternal pterygoid plate, spinous  process of sphe-
noid bone and tuberosity of superior maxilla. I.
anterior and internal part of neck of lower jaw,
cartilage, and capsular ligament.

MUSCLES OF  ANTERIOR  AND  LATERAL PARTS OF
                   NECK.

   Platysma-myodes.— 0.  cellular   membrane
covering  upper  and outer part of  deltoid and
great  pectoral muscles.  I.  chin;   fascia along 
85
 side  of lower jaw;  and fascia covering parotid
 gland.  Some of the  fibres become blended with
 those of the depressor labii inferioris and anguh
 oris.
   Sterno-cleido mastoideus.— 0.  upper and an-
 terior part of the first  bone of  sternum  and
 sternal third, sometimes half, of clavicle.  I. up-
 per part of mastoid process and external third of
 superior transverse ridge of occipital bone.
   Stemo-liyoideus.— 0. posterior surface of first
 bone of sternum, cartilage of first rib,  sternal
 end of clavicle, and sterno-clavicular articulation.
 I. lower border of body of os hyoides.
   Sterno-thyroideus.— 0.  posterior  surface  of
 first bone of sternum and cartilage of second rib.
 /. oblique line on ala of thyroid cartilage.  It is
 broader than  the preceding.
   Omo hyoideus.— 0. behind semilunar notch in
 scapula, from the ligament which passes over the
 notch, and  from  base  of coracoid  process.  I.
 lower border of os hyoides, at the junction of its
 body and  great  cornu.  It is a double-bellied
 muscle, the  mesial tendon being bound down by
 a pulley of cervical fascia.
  Digastricus.—A double-bellied muscle.  Pos-
 terior belly.   0. groove internal to  mastoid  pro-
 cess.  Anterior belly, 0.  rough depression on
 inner surface of base  of jaw, near  its symphy-
 sis.   The two bellies unite at an angle,  in a
 tendon which passes  through the fibres of the
 stylo-hyoid  muscle, and is inserted into  the os
hyoides.
                      8 
86
   Mylo-hyoideus.   0. mylo-hyoid ridge of infe-
 rior maxilla.  I. base  of os  hyoides,  chin, and
 middle tendinous line common to it and its fellow.
   Genio-hyoideus.   0. inner side of chin, above
 the digastricus.  i". base of os hyoides.
   Hyo-glossus.   0. great cornu and part of body
 of os hyoides.  I. side of tongue.
   Genio-hyo-glossus.   0. eminence inside chin,
 below fraenum linguae.  I. mesial line of tongue
 from apex to base, and body and lesser cornu of
 os hyoides.
   Lingualis consists of fasciculi of fibres, run-
 ning from base to apex of tongue, and lying be-
 tween the genio-hyo-glossus, and the  hyo and
 stylo glossi.
   Stylo-hyoideus.  0. outer side of styloid pro-
 cess, near its middle.   I. cornu  and body of ofl
 hyoides.
   Stylo-glossus.   0. styloid process, near its tip
 and  the  stylo-maxillary  ligament.  /. side of
 tongue, as far as  the tip.
   Stylo-pharyngeus.   0.  inner  part of root of
 styloid process.   I side of pharynx, cornu of os
 hyoides, and thyroid cartilage.

           MUSCLES OF  THE PHARYNX.

   Constrictor pharyngis  inferior.   O. side of
cricoid  cartilage, inferior cornu, and posterior
edge of thyroid  cartilage.  I. with its fellow,
along mesial line  on back of pharynx.
   Constrictor pharyngis medius.  0. great cornu 
87
and also lesser cornu of os hyoides, stylo-hyoid
and thyro-hyoid ligaments.   I. mesial tendinous
fine, and basilar process of occipital bone.
   Constrictor pharyngis superior.   0. petrous
portion of temporal bone, lower part of internal
pterygoid plate, also pterygo-maxillary ligament,
posterior third of mylo-hyoid ridge, and side of
base of tongue.  I. basilar  process of occipital
bone and mesial line of pharynx.

           MUSCLES OF THE PALATE.
   Levator palati.   0. petrous  portion of tem-
poral bone in front of foramen caroticum, and
from  cartilage of Eustachian  tube.  I.  broad,
into the velum.
   Tensor, vel circumfiexus palati.   0. spinous
process of sphenoid, and fore part of Eustachian
tube; tendon turns round hamular process.   I.
into velum, meeting its fellow in the mesial line.
   Levatores uvulae.   0. posterior  extremity  of
spine of palate bones.  I. cellular tissue of uvula.
   Palato-glossus.   0. inferior surface of velum.
I.  side of tongue.  It forms anterr  r half arch.
   Palaio-pharyvgeus.  0. inferior surface of pa-
late.  I.  side and back of pharynx, and superior
cornu of thyroid cartilage.   It  forms- the poste-
rior half arch.
                   LARYNX.
   Thyro-hyoideus.   0. oblique  ridge on  ala  of
thyroid cartilage.  /. lower edge of great cornu
of os hyoides. 
88
   Crico-thyroideus.   0. fore part of cricoid car-
tilage.  /. lower border of thyroid cartilage.
   Thyro-arytenoideus.   0.  posterior  surface of
thyroid  cartilage,  near its angle.  I.  anterior
edge  of arytenoid cartilage.
   Crico-arytenoideus  lateralis.   0.  upper  edge
of side of cricoid cartilage.  /. base of arytenoid
cartilage.
   Crico-arytenoideus posticus.   0. depression on
posterior surface  of cricoid cartilage.   I. outer
side of base of arytenoid cartilage.
   Arytenoideus fills the interval between aryte-
noid cartilages, and consists of two arrangements
of fibres: oblique, run from apex of one cartilage
to base of opposite one ; transverse, are attached
to posterior surface of each cartilage.

DEEP  MUSCLES ON  ANTERIOR  AND LATERAL PARTS
                 OF THE NECK.

  Longus colli.  Divided into two portions, ver-
tical and oblique.   Vertical  portion.   O. bodies
of three upper dorsal and  four  lower  cervical
vertebrae, and the intervertebral fibro-cartilages.
I. bodies of second  and third cervical  vertebrae.
Oblique portion.  0. anterior part of transverse
processes of third, fourth, and fifth cervical ver-
tebrae.  I. body of the atlas.
  Pectus capitis anlicus major.    0. anterior tu-
bercles of  transverse  processes of four  inferior
cervical vertebrae.  I.  basilar process of occipital
bone. 
89
   Beclus capitis anticus minor.    0. transverse
process of atlas.  I. basilar process of occipital
bone.
   Pectus cap it's lateralis.   0. transverse process
of atlas.  I.  jugular process of occipital bone.
   Scalenus  anticus.  0.  anterior tubercles of
transverse processes of third,  fourth,  fifth,  and
sixth cervical vertebrae.   I. upper surface of first
rib, just anteriorly to  its middle.
   Scalenus  medius.  0. posterior tubercles of
transverse processes of  four or five inferior  cer-
vical vertebrae.  I.  upper edge of first rib.
   Scalenus posticus.  0 posterior tubercles of
two or three inferior cervical  vertebrae.   I.  up-
per edge of  second rib between its tubercle  and
angle.
                    THORAX.

   Pectoralis major.    0. sternal half of clavicle,
anterior surface of sternum, cartilages of second,
third,  fourth, fifth,  and  sixth  ribs,  and aponeu-
rosis common to it and external oblique muscle.
I.  by a flat tendon into anterior tdge of bicipital
groove,  and by an aponeurosis  into  fascia of
forearm.
   Pectoralis minor.   0. external surfaces  and
upper edges  of third, fourth, and fifth ribs, some-
times from second.  I.  inner and upper surface
of coracoid process of scapu'a.
   Subclavius.   O. cartilage  of first rib.   I.  ex-
ternal  ha!f of inferior surface of clavicle.
   Strratus magnus.   0. by eight or nine fleshy
                      8* 
90
slips, from eight or nine superior ribs.   I. base
of scapula.
  Intercostales  are  twenty-two  in  number on
each side: eleven internal and eleven external.
The fibres of the external  pass obliquely from
behind, forwards and downwards; those of  the
internal in the  opposite direction.
  External.   0. inferior edge of each rib, com-
mencing at transverse processes of vertebrae.   /.
external lip of  superior edge of rib beneath,  ex-
tending to costal extremities of cartilages.
  Internal.   0. at  sternum  from the inner lip
of lower edge of each cartilage and rib as far as
angle.   I. inner lip  of superior edge of  cartilage
and rib beneath.
  Levatores costarum.   0. extremity  of each
dorsal transverse process.  I. upper edge of rib
below, between tubercle and angle.
  Triangularis sterni.   O. posterior surface and
edge of lower part of sternum and ensiform car-
tilage.   I. cartilages of fourth, fifth, and sixth
ribs.

            MUSCLES OF  THE BACK.

                First Layer.
   Trapezius.    0.  internal  third of  superior
transverse ridge of occipital bone, ligamentum
nuchae, and  spinous process of last cervical  and
all  dorsal vertebrae.  /. posterior  border of ex-
ternal  third of clavicle,  acromion process,  and
superior edge of spine of scapula. 
91
   Lat'ssimus  dorsi.   0.  six inferior  dorsal
 spines,  and  by lumbar  fascia from  all lumbar
 spines,  from back of sacrum, posterior third of
 crest of ilium, and  from three to four inferior
 nbs.   I.  posterior edge  of bicipital groove  of
 humerus.

                 Second Layer.
   Bhombo'deus minor.   O.  lower part of liga-
 mentum nuchae and  last cervical spinous process.
 I. bnse of scapula, opposite to its spine.
   Bhombo deus major.   0.  four or five superior
 dorsal spines.  I. base of scapula  from spine  to
 inferior angle.
   Levator  angnli scapulae.   O.  posterior tuber-
 cles of transverse processes of four or five supe-
 rior cervical  vertebrae.  I. base of scapula, be-
 tween spine and superior angle.
   Sermtus posticus  superior.    O. ligamentum
 nuchas, and two or three dorsal spines.  I. second
 third, and fourth ribs, external to angles.
   Serrat is posticus inferior.   0. two^last dorsal
 and two superior lumbar spines.  / lower edges
 of four inferior ribs anterior to angles.
  Splenius  muscle, flat and oblique, single at its
 origin ;  divides at its insertion into  two portions,
the splenins colli, and splenius capitis ; the former
attached to the cervical vertebrae, the latter to
the cranium.   0. from  spines  of  five superior
dorsal and last cervical  vertebra, and from liga-
mentum nuchae as high  as  the third  cervical
vertebra.   I.  the lower portion, splenius  colli, 
92
the smaller, into posterior tubercles of transverse
process of three or four superior cervical verte-
brae.   Upper portion, splenius capitis, into pos-
terior part of mastoid  process, superior curved
ridge of occipital bone, and the rough surface
below  it.

                 Third Layer.

  The following muscles lie beneath the serrati,
and  a  fascia called the vertebral  aponeurosis.
The  fleshy mass occupying the vertebra grooves
of either  side  is  called erector  spinae, and  it
divides opposite  the last rib into two  portions,
sacro-lumbalis, and longissimus dorsi.
  Erector spinas.   0.  from a  dense fascia con-
necting with the spines of the sacrum, from the
posterior  third of the crista of the ilium,  from
the posterior surface of the sacrum, and  from
the sacro-sciatic ligaments.   The  outer  portion,
called  sacro-lumbalis, is inserted  into the angles
of six or seven lower ribs.   Musculus accessorius
ad sacro-lumbalem, a continuation of sacro-lum-
balis.  0.  angles  of six or seven  lower  ribs,
internal to the tendons of preceding muscle.  I.
angles of  six upper ribs,  and into transverse
process of last cervical vertebra.
  Cervical's asce.ndens, the continuation of sacro-
lumbalis into the  neck.    0. from angles  of
third, fourth, fifth, and sixth ribs,  I. transverse
processes  of third, fourth, fifth, and sixth cervi-
cal vertebrae.
  The inner portion of erector spinae, longissimus 
93
dorsi, is inserted into transverse processes of all
the dorsal and lumbar vertebras and into all the
ribs between their tubercles and angles.  Trans-
versalis colli, a continuation of the longissimus
dorsi.   0. transverse processes of third, fourth,
fifth,  and sixth dorsal  vertebrae.    I.  posterior
tubercle of transverse processes of second, third,
foir h, fifth, and sixth cervical vertebrae.
   Trahelo-mastoid,  the  prolongation  of  the
longissimus dorsi  to the head.   0. transverse
processes of four upper dorsal and four lower cer-
vical  vertebrae.  I. posterior  margin of mastoid
process.
   Complexus.   0. transverse and oblique pro-
cesses of  three or four inferior cervical and five
or six superior dorsal vertebrae.  I. into occipital
bone  between its two transverse ridges.

                Fourth Layer.
   Semispinals colli.  0.  extremities of trans-
verse processes of  five or six superior dorsal
vertebrae.  I. by four heads into spines of second,
third, fourth, and fifth cervical vertebrae.
   Semispinalis dorsi.  0. by  five or six tendons,
from  transverse processes  of dorsal vertebrae,
from fifth to eleventh.  I. extremity of spines of
two inferior cervical and three or four  superior
dorsal vertebrae.
   MuWfidus spince.   0.  first fasciculus arises
from  spine of vertebra dentata, and is  inserted
into transverse process of third, each successively
in  a  similar manner down to the last,  which 
94
 arises from the spine of last lumbar vertebra,
 and is inserted into transverse process of sacrum.
   Interspinales—are situated  between spinous
 processes of vertebrae : they are  in  pairs in the
 cervical region.
   Intertransversales—attached and  situated as
 their name implies.
   Bectus capitis posticus major.    0. spinous
 process of  second vertebra.  /.  inferior  trans-
 verse ridge of os occipitis.
   Bectus capitis posticus  minor.   0.  posterior
 part of atlas.  I. occipital bone, behind foramen
 magnum.
   Obliquus capitis inferior.  0. spinous process
 of second  vertebra.  I. extremity of transverse
 process of atlas.
   Obliquus capitis superior.  0. upper part of
 transverse process of atlas.  I. occipital  bone,
between its transverse ridges,  posterior to mas-
toid process.

              UPPER EXTREMITY.

                Shoulder Arm.

  Deltoideus.   0. lower edge of spine of scapula,
anterior edge of acromion, and external third of
clavicle.   I. rough surface on outer  side of
humerus, near its centre.
  Supra-spinatus.   0. all  scapula  above  the
spine, which forms supra-spinous fossa, and from
fascia covering muscle.  I. upper  and fore part
of great tuberosity of humerus. 
95
   Infraspinatus.  0. inferior surface  of spine
and dorsum of scapula beneath, except near the
neck, as low down as posterior ridge on inferior
costa.   I. middle of great tuberosity of humerus.
   Teres minor.   0. depression between the two
ridges on  inferior 'costa of scapula, from fascia
covering it, and  ligamentous septa.  I. inferior
depression on great tuberosity of humerus.
   Subscapularis.    0. all the surface and circum-
ference of  subscapular fossa.   I lesser tubercle
of humerus, and  a small portion of the neck of
the bone.
   Teres major.   0.  rough surface on  inferior
angle of scapula, below  infra-spinatus.   I. pos-
terior edge of bicipital groove.
   Coraco-brachialis.   0. coracoid process and
tendon  of short head  of biceps.  I. internal side
of humerus about its middle.
  Biceps.   0. short head, from coracoid  process;
long head, from  upper edge  of glenoid cavity.
I.  into  tubercle  of  radius.   It  gives off  an
aponeurosis at the bend of the arm.
  Bra'hialis anticus.   0. centre of humerus by
two slips on either side  of insertion of deltoid,
and fore part of humerus to its condyles.  I. coro-
noid process of ulna and  rough surface beneath.
  Triceps extensor cubiti.   O.  long head, from
lower part  of neck of scapula and inferior costa.
Second  head,  from ridge on  humerus,  below
insertion of teres  minor.   Third head,  from
ridge below insertion  of teres major, leading to
the internal condyle,  and from internal  inter- 
96
muscular  ligament.   I. olecranon  process  of
ulna, and fascia of forearm.

             Forearm and Hand.
  Palmaris brevis, lies between the skin and the
palmar fascia.   0. annular ligament and palmar
fascia.  I. integuments on inner side of palm.
  Pronator radii teres.    0.  anterior  part  of
internal condyle, fascia of forearm, intermuscular
septa, and by a small slip, separated from the
larger head by the median nerve, from coronoid
process of ulna. I. outer and back part of radius,
about its centre.
  Flexor carpi radialis.   0.  inner condyle and
intermuscular  septa.   I. base  of  metacarpal
bone of index finger.
  Palmaris longus.    0.  inner condyle  and
fascia of  forearm.   I. annular  ligament  and
palmar aponeurosis, near root of thumb.
  Flexor  carpi  ulnaris.   0.  inner  condyle,
inner side  of olecranon,  a  tendinous  band
between  these points, under which  passes the
ulnar nerve, inner edge  of  nearly whole length
of ulna, and fascia of forearm.  I. os pisiforme
and base of fifth metacarpal bone.
  Flexor  digitorum   sublimis  perforatus.    0.
inner condyle, internal lateral ligament, coronoid
process, and radius below tubercle.  /. anterior
part of second phalanges of each finger.
  Flexor  digitorum profundus perforans.    O.
upper  three-fourths  of  anterior  surface of ulna
by two heads, which embrace the insertion  of 
97
the brachialis anticus, internal half of interosse-
ous ligament.   I. last phalanx of each finger.
  Flexor pollicis longus.  0. fore part of radius
below the tubercle, from interosseous membrane
to within two  inches of carpus, and from coro-
noid process.   I. last phalanx of thumb.
   Pronator  quadratus.   0. inferior  fifth  of
anterior surface of ulna.   /.  anterior  part  of
inferior fourth  of radius.
   Supinator radii longus.   0.  external ridge of
humerus to within two inches of outer condyle,
and from intermuscular ligament. I. rough surface
on the outside  of radius, near its styloid process.
  Extensor carpi  radialis longior.   0. ridge of
humerus, between supinator longus and external
condyle.  /. back part of the carpal extremity
of metacarpal bone of index finger.
  Extensor  carpi  radialis  brevior.   0.  inferior
and posterior  part of external condyle,  and
external lateral ligament.   I. carpal extremity
of third metacarpal bone.
  Extensor  digitorum  communis.  0.  external
condyle, fascia  of forearm and its intermuscular
septa.   I. posterior aspect of all the phalanges
of four  fingers.
  Extensor carpi ulnaris.   0. external condyle,
fascia, and  septa, and middle  third of ulna.   I.
carpal end of fifth metacarpal bone.
  Anconeus.  0. posterior and  inferior  part  of
external condyle and  lateral ligament.  /.  ex-
ternal surface of olecranon,  and superior fifth  of
posterior surface of ulna.
                      9 
98
  Extensor minimi digiti.  0. in common with
and between extensor digitorum communis and
extensor  carpi  ulnaris.   I. posterior part of
phalanges of little finger.
  Supinator radii brevis.   0. external condyle,
external,  lateral, and  coronary ligaments, and
from a ridge on  outer  side of ulna, which com-
mences below its lesser sigmoid cavity.   I. up-
per third of external and anterior  surface of
radius, from above its tubercle to the insertion
of pronator radii teres.
  Extensor  ossis metacarpi pollicis, lies imme-
diately below the border of the supinator radii
brevis.   O.  middle of  posterior part of  ulna,
interosseous ligament, and  posterior surface of
radius.  I. base  of metacarpal bone of thumb.
  Extensor primi internodii pollicis   0. inter-
osseous ligament, radius, and  occasionally  a
small portion of the ulna.  I. base of first phalanx.
  Extensor secundi internodii pollicis.   0. pos-
terior surface of ulna, above its centre, and from
interosseous ligament.   I. base of last phalanx.
  Extensor indicis.  0. middle of posterior sur-
face of ulna, and interosseous ligament.  /. se-
cond and  third phalanges, uniting with the ten-
don of the common extensor.
  Abductor pollicis.  0.  anterior surface of an-
nular ligament and os scaphoides.   I. outside of
base of first phalanx, and by an expansion into
both phalanges.
   Opponens pollicis.   0. annular ligament and 
99
  os trapezium.   I. anterior extremity of meta-
  carpal bone of thumb.
  _ Flexor pollicis brevis.   0. external head, from
  inside of annular ligament and trapezium and
  sheath of the flexor carpi  radialis.  I. external
  sesamoid bone and  base  of first phalanx  of
  thumb.  Internal head.   0. from os trapezoides,
  os magnum, and base  of metacarpal bone  of
  middle finger.   I. internal sesamoid  bone and
  base of first phalanx.
  # Adductor pollicis.   0. three-fourths of ante-
 rior  surface of  the third metacarpal  bone.   I.
 inner side of base of first phalanx of thumb.
   Abductor indicis.   0. metacarpal bone of fore
 finger and one-half  of  that of the thumb.   I.
 outer side of base of first phalanx.  The radiai
 artery passes between its two heads.
   Lumbricales.   0. outer side of the tendons  of
 flexor profundus, near the carpus,  a  little be-
 yond annular ligament.  I.  middle of  first pha-
 lanx into tendinous expansion covering the back
 of each finger.
  Abductor minimi  digiti.    0. annular liga-
ment and os  pisiforme.   I. ulnar side of first
phalanx.
  Flexor  brevis minimi digiti.  0. annular liga-
ment and unciform bone.   I. base of first pha-
lanx of little finger.
  Abductor minimi digiti.   0. internal to last,
and overlapped  by it.   I.  all the  metacarpal
bone of little finger.
  Interossei palmares,  three in  number.   0. 
100
sides  of metacarpal bones.  I.  first  phalanges
and tendinous  expansion covering the dorsum
of each finger.
  1st, arises from ulnar side of second metacar-
pal bone; 2d, arises from radial side of fourth
metacarpal bone; 3d, arises from  radial side of
fifth  metacarpal bone;  each,  joining with the
tendons  of common extensor, is  inserted into
the base of the first phalanx of the correspond-
ing finger.
  Interossei dorsales, four in  number.   0. op-
posed sides of two metacarpal bones.  I.  base
of first  phalanx of each  finger and posterior
tendinous expansion.
  1st, has been  already described  under the
name of abductor indicis.
  21, arises from second and third metacarpal
bones,  inserted into radial side  of base of first
phalanx of middle finger.
  3d, arises from  third  and  fourth metacarpal
bone^,  inserted into ulnar side of base of first
phalanx of middle  finger.
  4th,  arises from  fourth  and fifth metacarpal
bones, inserted into ulnar side of base of first
phalanx of ring finger.
  All the palmar interossei are adductors, and all
the dorsal interossei are  abductors  to  a line
drawn longitudinally through the middle finger.

                  ABDOMEN.
   Obliquus externus vel descendens.   0. exter-
nal surfaces  of eight or nine inferior ribs at a 
101
  little distance from their cartilages.  I. the fibres
  end in a broad aponeurosis, inserted int"> ensi-
  form cartilage,  linea alba,  os pubis, Poupart's li-
  gament.  It is also  inserted into anterior supe-
  rior spinous process  of  ilium, and outer edge of
  anterior half of crista ilii;  a triangular opening
  formed  by the  separation of  the  aponeurotic
  nores, the inner passing to the symphysis pubis,
  the outer to the spine of pubes, is called the ex-
  ternal abdominal ring.
    Obliquus internus  vel ascendens.    0.  fascia
  lumborum, anterior two-thirds of crista ilii, and
  external half of Poupart's ligament.   I.  carti-
  lages of five  inferior ribs, ensiform  cartilage,
  linea alba, also by conjoined tendons into upper
  edge of pubes, and into linea ileo-pectinea.
    Cremaster.   This muscle, formed by the low-
 er fibres of internal  oblique, is here described
 though Iving a muscle of the testicle.  0. inner
 surface of external third of Poupart's ligament,
 and from lower edge of obliquus internus, and
 also from transversalis; the fibres pass through
 the external abdominal ring, forming loops,  both
 in front, and behind the spermatic cord.  /.  crest
 of the pubes.
   Transversalis.   0.  fascia  lumborum, anterior
 three-fourths of crista  ilii, iliac third of Poupart's
 ligament, and inner side of six or seven infe-
 rior ribs.  I along with  posterior lamina  of
 obliquus internus, into the whole length of linea
 alba, upper edge of pubes,  and the linea ileo-
pectinea.
9* 
102
  Bectus.   0. upper and anterior part of pubes.
I. ensiform  cartilage, costo-xiphoid  ligament,
and cartilages of filth, sixth, and seventh ribs.
  Pyran.iialis.   0.  broad  from  pubes    I.
linea  alba, miciway to  umbilicus;  sometimes
wanting.

        DEEP  MUSCLES OF TnE ABDOMEN.
  Diaphragm, is  a thin muscular and aponeu-
rotic  septum  between the chest and the abdo-
men.   0, posterior surface of xiphoid  cartilage,
internal surfaces  of cartilages of the  last true
and  all the false  ribs, external or false ligamen-
tum arcuatum, and convex edge of true ligamen-
tum arcuatum.  I. cordiform tendon.
  Crura of diaphragm.   0. right  crus  from
fore part of bodies of second, third, and  fourth
lumbar  vertebrae.  Left crus from the sides of
the second and third lumbar vertebrae.  /,  pos-
terior border of  cordiform tendon.  There  is a
foramen  in the  diaphragm, for the passage of
the  vena cava,   one  for  the  oesophagus,  and
another for the  aorta, thoracic  duct and vena
azygos. It also transmits the great sympathetic
and the splanchnic nerves.
  Quadratus lumbo-'um.  0. posterior fifth of
spine of ilium, and from  ilio-lumbar ligament.
I. extremity of transverse processes  of four su-
perior lumbar vertebrae, also  inner  surface of
posterior half of last rib.
  Psoas parvus.   0. side of last dorsal and first
lumbar  vertebrae.  /.  linea ileo-pectinea, fascia 
103
 iliaca, and fascial lata, behind the femoral ves-
 sels ; sometimes wanting.
   Psoas magnus.  0. sides of bodies of last dor-
 sal, and from bodies and transverse processes of
 all the lumbar vertebrae; also from inter-verte-
 bral  ligaments.  I  inferior  part  of lesser tro-
 chanter and ridge below that process.
   llitcus internus.   0.  iliac fossa, with  inner
 margin of the  crista; two anterior  spines of
 ilium, and intervening  notch, base of the  sa-
 crum, ilio-Iumbar ligament, and capsula of hip-
 joint   I. common tendon with psoas magnus;
 the  inferior  fibres  are  inserted  into  anterior
 and inner surface of femur, below trochanter
 minor.  This  muscle, with the  lower part of
 the psoas magnus, is bound  down by the fascia
 iliaca.

          MUSCLES OF MALE FERINJJUM.

   Sphincter ani.   0. ano coccygeal ligament.
 I. into raphe,  superficial  fascia,  and  common
central point of perinaeum.
   Sphincter internus encircles the lower part of
 the rectum.
   Erector penis.   0. inner surface  of  tuber
ischii,  and from  insertion  of great or inferior
sciatic ligament.   I. fibrous membrane of crus
penis.
   Accelerator urinoz.    0. central tendon and
raphe  of perineum.    I.  posterior fibres  into
ramus of pubes;  anterior fibres  into body of 
104
penis;  middle fibres  surround  the bulb  and
neighboring corpus spongiosum urethrae.
   Transversalis perincei.   0.  inside of tuber
ischii, I. central point of perinaeum.
  Levator  ani.   0.  posterior part of body  of
pubes, spine of the ischium,  and between these
points the  angle of division of deep pelvic fascia
into obturator  and vesical.   /.  anterior fibres
into central  point of perineum  and  prostate;
middle fibres  into  side of  rectum,  posterior
fibres into  back part of rectum and os coccygis.
   Compressor  urethrae.   0. From the posterior
surface of  the  pubes, near its lower edge and a
little on each side of the symphysis.  I.  below
membranous portion of urethra, into the narrow
tendinous  line, which becomes lost in central
point of perineum.*
   Coccygeus.    0. inner  surface  of  spine  of
ischium.  I. extremity  of  sacrum and side  of
coccyx.

        MUSCLES OF FEMALE PERINEUM.

  Split uter ani, as in the male.
  Levatjr  ani.   0. as in the  male.  I.  it forms
a ljop  round  the vagina as well as around the
urethra and rectum.
   Coccygeus, as in the maie.
  * This muscle is innre correctly described as arising by a
narrow tendon from the ra ns of the pubes on either s-ide,
and as terminating in fleshy fibres, which decussate in the
mesial line, some passing above, others passing below, the
membranous portion of the urethra. 
105
   Transversalis perinoei, as in the male.
  Ereztor clitoridis.   0. inner surface of tuber
ischii, and insertion of great sciatic ligament.  I.
fibrous^ membrane of crus clitoridis.
  Sphincter vaginas represents the accelerator
unnae in the male, and extends from the clitoris
superiorly, around each side of vagina, to central
point of pennaeum, in front of anus.
       MUSCLES OF THE INFERIOR EXTREMITY.

        Fore Part and Sides of #js Thigh.

    Tensor  vaginas femoris.   0. external part of
 anterior superior  spine of ilium.  /. fascia lata
 about three  or four inches  below the great
 trochanter.
   Sartorius.    O.   anterior superior  spine  of
 ilium  and  notch beneath  it.   /. inner  side  of
 upper end of tibia, below its tubercle.
   Bectus femoris.  0. by two strong tendinous
 heads: the outer from  rim of acetabulum ;  the
 inner  from anterior inferior spine of ilium.   I.
 upper edge of patella.
   Vastus externus.   0. root and anterior part
 of great trochanter, outer edge of linea aspera,
 oblique ridge leading to external condyle, exter-
 nal surface of femur,  and fascia lata.  I. external
 edge of tendon of rectus, side of patella.
   Vastus internus.   0  root of small trochanter
and line leading from it to linea aspera, anterior
part of femur, inner edge  of  hnea aspera, and 
106
ridge leading to inner condyle.  I. inner edge
of tendon of rectus and patella.
  Crureus.  0. anterior and external part of fe-
mur,  commencing at  linea inter-trochanterica,
and extending  along  three-fourths  of the bone,
as far outwards  as linea aspera.  I. upper  and
outer edge of patella.
  The rectus, crureus, and  two vasti, are some-
times described as one muscle, named quadri-
ceps extensor cruris.
  Subcrureus or capsularis.  0. inferior fourth
of anterior surface of femur.  /.  Synovial mem-
brane of knee-joint.
   Gracilis.   0. lower part of body and ramus
of pubes, and part of ascending ramus of ischium,
from a surface two inches and a half in length.
I. superior part of internal surface  of tibia,  just
below its tubercle.
   Pectineus.  0. pectineal line external to spine
of pubes, and  smooth surface of bone in front.
I. rough ridge leading from lesser trochanter to
linea aspera.

            Triceps adductor femoris.

   1st, adductor longus.  0. anterior surface of
 pubes, between spine and symphysis.  /. middle
 third of linea aspera.
   2d. adductor brevis.  0.  anterior inferior sur-
 face of pubes,  between symphysis and  thyroid
 foramen.  I. superior third of  internal  root of 
107
  cha'nte3?6^ t0 *"* 'm°hea bel°W fesser tr0"
    3d, adductor magnus.   0. anterior surface  of
  descending ramus  of pubes, ramus  of ischfum
  and external border of its tuberosity   froS
  ndge leading  from  great  trochanter  to  K

  femur'       aSpera'  aQd internal  condyle of

                MUSCLES  OF HIE.
    Gluteus maximus.   O. posterior fifth of cris-
  ta iln, the rough  surface between it, and sune-

  Zlt!TTUlf ridge' P°sterior m°:sacr^ liga-
  ments, lumbar faseia, spines of sacrum, side of
  coccyx and great  sciatic  ligament.   > ,o eh
  ridge  leading from great trochanter to luS
 aspera, upper third of linea aspera, and fascia

   Gluteus medius.   O.  deep  surface  of fascia
 covering ,t, anterior three-fourths of crista iui
 superior semi-circular ridge, and surface of ilium'
 above and below it.   / upper and outer part of
 great trochanter.                       F
   Gluteus  minimus.   0.  inferior semi-circular
 ridge on dorsum of ilium,  rough surface between
 it and edge of acetabulum.   /. upper and ante-
 rior part of great trochanter.

 thi^TT- >& C°nCaVe  aSPect  of second,
 third, and fourth divisions of sacrum,  upper and
 back part of ilium, and anterior surface of great
sciatic ligament.   /. upper  part of great tro-
chanter, behind the insertion of gluteus minimus 
108
   Gamellus superior.  0. spine of ischium.  /
root of great trochanter.
   Gamellus inferior.   0. upper part of tuber
ischii, and great sciatic ligament.  I. root of great
trochanter.
   Obturator internus.  0. pelvic surface of ob-
turator ligament, circumference of obturator fo-
ramen, and obturator fascia.  I. root  of great
trochanter.
   Quadratus femoris.  0. external  surface of
tuber ischii.  /.  linea quadrata.
   Obturator externus.   0. inferior  surface of
obturator ligament and surrounding surfaces of
pubes and ischium.   I. root of great trochanter.

      MUSCLES ON BACK PART  OF THIGH.

  Biceps flexor  cruris.   Long  head.   0. outer
and back part of tuber ischii, by a tendon com-
mon to it and to the semitendinosus.   Short head.
0. hnea aspera, from below insertion of gluteus
maximus to within two inches of external  con-
dyle. I. head of fibula.
   Semitendinosus.   0.  tuberosity  of  ischium,
and from three inches of the tendon of the long
head of biceps.   /. inner surface of tibia, below
tubercle.
   Semimembranosus.   0. upper and  outer part
of tuber ischii.   I. inserted by three portions:
1st, into head of tibia, the tendon passing under
internal  lateral  ligament;  2d, into the fascia,
covering the popliteus muscle; 3d, into exter- 
109
  nal condyle  of femur, crossing the knee joint,
  and_ forming the  ligamentum  posticum Wins!



  MUSCLES  ON ANTERIOR AND  EXTERNAL  PART  OF
                       LEG.

    Tibialis anticus.   0. outer part of two supe-
  rior  thirds of tibia,  inner  half of  interosseous
  ligament, fascia of leg, and intern^l^S?
  /.inner side of internal cuneiform bone, and base
  of first metatarsal bone.
    Extfs°r£9itorum longus.   0. external part
  of head of tibia, head and three-fourths of fibula
  part of interosseous ligament, fascia of leg  and
  intermuscular septa.   I last phalanges of four
  outer toes.
    Extensor pollicis proprius.   O. inner edge of
 middle  third  of fibula, interosseous ligament
 and lower part of tibia.  I  base of second pha-
 lanx of great toe.                         p
   Peroneus  Urtius.    0. anterior   surface  of

 bone""      °f fibUla"  l baSe °f fifth metatarsal
   Extensor digitorum brevis.   0. upper and an-
 terior part of os calcis, calcaneo-astragaloid, and
 annular ligaments.   /. internal tendon into base
 oi first phalanx of great toe; the three others
join the outer edges of corresponding tendons of
 extensor digitorum longus. 
110
       MUSCLES ON OUTER PART OF LEG.
  Peroneus  longus.    0.  upper  two-thirds of
outer surface of fibula, small portion of tubero-
sity of tibia, fascia of leg, and  inter-muscular
septa.  I. tendon passes in a groove in os cuboi-
des obliquely across the sole of the foot, to be-
come attached to  the  tarsal end of metatarsal
bone of great toe.
  Peroneus  brevis.  0. outer and back  part of
lower half of fibula and intermuscular septa,  /.
base of metatarsal bone of little toe.

          MUSCLES ON  BACK OF LEG.

              Superficial Layer.

  Gastrocnemius.   0.  internal  head, upper and
back part of internal condyle of femur, and ob-
lique ridge above it;  external head, from above
external condyle.  /. lower and back part of os
calcis.
  Plantaris.  0. back part of femur above ex-
ternal condyle, and posterior ligament of knee.
I. posterior  part of os calcis.
  Soleus.   0. external  head, from back part of
head and  superior third of fibula; internal  head,
from middle third  of  tibia, below insertion of
popliteus, and from a tendinous arch extending
between  the bones over  the posterior  tibial
vessels:   unites with  gastrocnemius  to  form
tendo Achillis.  I. lower and  back part  of os
calcis. 
Ill
   Popliteus.   0. depression on outer condyle of
femur.   I. flat triangular surface, occupying the
superior posterior filth of tibia.
   Flexor dgitorum  longus.   0. posterior flat
surface of tibia, from  below popliteus to within
three  inches of ankle,  fascia, and  intermuscu-
lar septa.   I.  last phalanges  of  four  lesser
toes.
   Tibialis posticus.   0. posterior internal part
of fibula, upper part of tibia, and nearly whole
length of interosseous ligament.   I.  inferior and
internal tuberosity on os naviculare, internal cu-
neiform and cuboid bones, and second and third
metatarsal bones.
   Flexor pollicis longus.   0. two inferior thirds
of fibula.  /. last phalanx of great toe.


               MUSCLES OF FOOT.

                 First Layer.

   Abductor pollicis.   0. lower  and inner part
of os culcis,  internal annular ligament, plantar
aponeurosis,  and  internal  intermuscular sep-
tum.   I. internal side of base of first phalanx of
great toe;  there  is  a  sesamoid bone  in the
tendon.
  Flexor digitorum brevis perforatum.  0. infe-
rior and internal part of os calcis, plantar apo-
neurosis, and intermuscular septa.   I.  second
phalanges of four lesser toes.
  Abductor minimi digiti.   0. outer side of os 
112
calcis, ligament extending from os calcis to out-
er side of fifth metatarsal  bone, plantar fascia,
external intermuscular septum, and base of fifth
metatarsal  bone.  I. outer side of base of first
phalanx of little toe.

                Second Layer.
  Musculus accessorius.  0. inferior and internal
part of os calcis.   /.  outer part of tendon  of
flexor digitorum longus.
  Lumbricales.  0. tendons of flexor digitorum
longus.  I.  internal side of first phalanges  of
four lesser  toes.   Between the flexor brevis and
flexor  accessorius  lie the external plantar ves-
sels and nerve.

                Third Layer.

  Flexor pollicis brevis.   0. by a pointed pro-
cess from inner border of os cuboides and from
external  cuneiform bone.  /. by  two divisions
into outer and inner border of base of first pha-
lanx of great toe:  the tendons contain sesamoid
bones.
   Abductor pollicis.   0. os cuboides,  base  of
third and fourth metatarsal bones and sheath of
peroneus  longus.   I.  base of first phalanx  of
great toe.
   Transversalis  pedis.   A  narrow  fasciculus
stretched beneath  the digital extremities of the
metatarsal  bones.
   Flexor brevis minimi digiti.  0. fifth metatar- 
113
sal bones and sheath of tendon of peroneus longus.
I. inner side of base of first phalanx of little toe.

                Fourth Layer.

  Seven interossei muscles.  Three on sole of
foot, and four upon its dorsum.
  Inferiores, vel plantare3.
  1st. 0. inner side of  third metatarsal bone.
/. base of first phalanx of the same toe.
  2nd. 0. inner side of  fourth metatarsal bone.
/. inner side of first phalanx  of the same toe.
  3rd. 0. fifth  metatarsal bone.  I. inner side
of base of first phalanx of little toe.
  Superiore3, vel dorsales;  they arise by  two
heads from  the contiguous surfaces of the meta-
tarsal bones.
  1st. 0.  internal  side  of second  metatarsal
bone  and outer side of first.  /. inner side of
base of first phalanx of second toe.
  2nd. O.   opposite sides of second  and third
metatarsal bones. I. outer side of first phalanx
of second toe.
  3rd. 0. opposite side of third and fourth me-
tatarsal bones.  /. outer  side of first phalanx of
middle toe.
  4th. 0. opposite sides of the  fourth and fifth
metatarsal bones.  I. outer side of the first pha-
lanx of fourth toe.

         THE MUSCLES OF THE ORBIT.

  1.  Levator palpebrce  superioris.    0.  upper
                     10* 
114
 edge of the foramen opticum.   I.  superior bor-
 der of tarsal cartilage.
   2.  Obliquus superior.   0. foramen  opticum.
 I. sclerotic coat between superior and external
 rectus.
   3.  Obliquus inferior.   0.  orbital edge of su-
 perior maxillary bone.  /. sclerotic coat between
 it and external rectus muscle.
   4.  Bectus superior.
   5.  Bectus inferior.
   6.  Bectus internus.
   7.  Bectus externus.
   [All arise  round optic foramen, the external
 rectus being  also attached to margin of sphenoi-
 dal fissure, near the origin of the superior rectus,
 and they are inserted about a quarter of an inch
 behind cornea.  The internal rectus is the mus-
 cle most frequently divided in  the  operation for
 strabismus.]
   The third,  fourth,  nasal division of fifth, sixth
 nerves, and the ophthalmic vein, pass between
 the two  heads of the rectus externus.

           MUSCLES OF INTERNAL EAR.
   Stapedius.    0.  within pyramid.  I. neck  of
 stapes.
   Tensor tympani.   0.  canal in petrous portion
 of  temporal  bone, above  Eustachian  tube.   /.
 short process below neck of malleus.
   Laxator tympani.  0. spinous process of sphe-
 noid  bone and Eustachian tube.   I. processus
gracilis of malleus. 
115
     BRAIN  AND ITS MEMBRANES.

                DURA MATER.

  A firm, dense, fibro-serous membrane, adher-
ing by its outer suiface to the bones of  the cra-
nium,  its inner surface  being intimately con-
nected  with  the  arachnoid  membrane.    It
defends the bra:n, acts as an internal periosteum
to the bones  of  the skull, forms the  sinuses,
and sends envelopes upon the several nerves as
they pass through  the cranial  holes. It sends
off the following processes.
  Falx cerebri commences  narrow at crista galli,
and arches backwards  between the lobes of the
cerebrum, becoming deeper  until it meets  the
tentorium, with which process it is continuous on
either side.  Its convex edge corresponds to the
median groove of  the os  frontis,  the  sagittal
edges of the parietal bones, and the upper half
of the perpendicular ridge of the occipital bone.
The great longitudinal sinus is in its upper edge,
and the lesser longitudinal sinus in its  inferior
free concave edge.
  Tentorium cerebeUi extends  in a horizontal
manner above the cerebellum and below  the
posterior lobes of  the cerebrum.  Its  convex
edges contain the lateral sinuses, and correspond
to the transverse ridges of the occipital bone,
the inferior posterior angles  of the parietal bones,
the superior angles of the petrous  portion of the 
116
temporal bones, and to the clinoid processes of
the sphenoid bone.  It separates the cerebrum
from the cerebellum, and is bony in the carni-
vorous animals.
  Falx cerebelli is attached to the lower half of
the perpendicular ridge of the  occipital bone,
and extends betvvesn the lobes of the cerebellum
towards the foramen magnum.
  Sphenoidal folds are attached to the lesser
wings of the sphenoid bone.

                   SINUSES.

   Great longitudinal sinus, of triangular form,
extends along the convex margin  of the falx
cerebri.  It commences by a small vein in  the
foramen ccecum, and increasing in size as it pro-
ceeds backwards, pours its blood into the torcu-
lar  Herophili.  Its interior is crossed by small
bands culled chordae WiUisii,  and  presents  the
openings of  the  veins  which course upon  the
upper surface of the cerebral hemispheres, and a
number of small whitish granules  called glan-
dular Pacchioni.   They are also found upon the
outer surface of the upper wall of the sinus be-
tween it and the cranium.
  Inferior longitudinal sinus is very small, runs
along the concave edge of the falx  cerebri, and
terminates in the straight sinus.
   Straight sinus  passes from the termination of
the inferior longitudinal sinus downwards and
backwards,  receiving  the  blood of the venae 
117
Galeni, and empties itself into the torcular He-
rophili.
   Lateral sinuses, each corresponds to the trans-
verse groove  in  the  occipital bone, the groove
in the  posterior  inferior angle of the parietal
bone, the mastoid  fossa of  the temporal bone,
and the groove in  the occipital bone on either
side of  the foramen magnum ; it passes through
the foramen lacerum  posterius and becomes the
jugular vein.
   Torcular Herophili corresponds to the centre
of the  crucial spine of the occipital bone; six
sinuses communicate with  it, viz., the two la-
teral, the  great longitudinal,  the  straight,  and
the two occipital.
   Cavernous sinuses,  each extends from the an-
terior clinoid  process to the petrous portion of
the occipital bone; and, upon being  cut  into,
presents a  cellular appearance.  The  internal
carotid artery, the  sixth nerve, and branches of
the sympathetic  nerve, are  found within each,
but separated from the  blood by the  reflected
venous  lining membrane.   In the outer wall of
each run the  third and  fourth  nerves, and the
first branch  of the fifth;  the sinus of either side
presents the openings of the ophthalmic  vein,
of the two petrosal sinuses, and of the circular
sinus.
   Circular sinus  surrounds the pituitary body,
and is formed of an anterior and posterior trans-
verse  vein which extends from one cavernous
sinus to the  other. 
118
  Superior  petrosal sinuses, each  passes  from
the cavernous sinus along the upper angle of the
 fietrous portion of the temporal bone, to the
 ateral sinus.
  Inferior petrosal sinuses, each  passes from the
cavernous  sinus  downwards and  backwards,
along the line of contact of the  petrous  portion
of the temporal bone, and  the  occipital to the
lateral sinus, just where this terminates in the
internal jugular vein.
  Transverse sinus crosses the basilar process of
the occipital bone, and connects the inferior pe-
trosal sinuses.
  Occipital sinuses, two in number, are contained
in the lalx cerebelli, and open into the  torcular
Herophili.
             TUNICA ARACHNOIDEA.

  Belongs  to the class of serous membranes, is
spread over  the surface of the  brain  without
penetrating between its convolutions, and is re-
flected upon the dura mater, in those situations
where the nerves and veins pierce this fibrous
membrane; thus, after the manner of all serous
membranes, it lorms a shut sac, and consists of
a parietal and a visceral layer.   It is stated  to
gain access to the interior of the brain by the
great transverse fissure, and to  line the free sur-
faces of the ventricles. 
119
                 PIA MATER.

  The vascular covering of the brain lines its
entire surface, dipping between its convolutions
and sending numerous blood-vessels into its sub-
stance ;  it is  intimately connected to the arach-
noid membrane by its outer surface, except at
the base and sulci of brain; and entering the
ventricles by the great transverse  fissure, gives
them a lining membrane, and forms the choroid
plexuses.
                THE  BRAIN.

  The brain  is  subdivided into three portions,
viz., the cerebrum, the cerebellum, and the me-
dulla oblongata.

                TnE  CEREBRUM.

  This is the largest of the three divisions, is of
oval form and divided into two equal portions,
called hemispheres, by a fissure (superior longi-
tudinal) which extends  along the  median line
upon its upper  surface,  and  contains the falx
cerebri and the arteries of the  corpus callosum.
At  the  base  of  the  brain the hemispheres are
divided at each extremity by this fissure, but in
the centre they are  united.
  Hemispheres, right and left, are convex supe- 
120
riorly  and externally,  and flat  towards  each
other, where they correspond to the falx.
  Lobes.  Each hemisphere is divided into three
lobes upon its under surface; the anterior, which
is the smallest,  rests upon the roof of the  orbit
and  presents a  groove for the lodgment of the
olfactory nerve; the middle, prominent and con-
vex, lies in the  middle fossa, in the base of the
cranium; and the posterior rests upon the ten-
torium.
  Fissura Sylvii separates the anterior from the
middle lobe, and corresponds to the lesser wing
of the  sphenoid bone and its fold of dura mater.
The  cerebral surface of this fissure is pierced by
small arteries,  branches of the middle cerebral
artery.
  Convolutions, or gyri, are eminences longitu-
dinal and rounded, but directed in various ways
upon the surface of each hemisphere.
  Sulci are the fissures which separate the  con-
volutions from each other, over which the arach-
noid membrane passes, but into which the pia
mater dips.
  Cineritious substance of brain is of a yellow-
ish-grey colour,  from three to four lines in thick-
ness, soft and very vascular, and for the most
part situated upon the outer surface of the brain.
It is however found in striae and masses in the
interior of the  brain,  and  surrounded  by  the
medullary  substance.  In  some  situations its
colour  assumes  a dark hue, as  is seen when  a
section of the crus cerebri is made.  Microsco- 
121
pic examination  shows that it  is composed of
vesicles, containing nuclei and granules: hence
it is sometimes called " vesicular matter."   This
grey vesicular or  nucleated  cell  material, is be-
lieved to have the power of generating or pro-
ducing nervous influence, while the white fibrous
or tubular  substance  merely acts  as a conduc-
tor.
   Medullary substance, white and fibrous, forms
the greater part of the brain.
   Centrum ovale  minus,  a term  applied to the
appearance brought into view by making a sec-
tion of  each  hemisphere within  a few lines of
the corpus  callosum;  an  oval mass of white  mat-
ter is seen  surrounded by the grey cortical sub-
stance.
   Centrum ovale  magnum, a term applied to the
mass of medullary structure, which is rendered
apparent by slicing both hemispheres on a  level
with the corpus callosum.
   Corpus  callosum,  unites the hemispheres to
each other, is about three inches  in length, and
presents upon its  upper surface the raphe, which
corresponds to the anterior cerebral arteries, and
from which, on either side, pass  the connecting
transverse  fibres of the hemispheres, called lineae
transversae. It unites by its posterior extremity
with the fornix and the hippocampus, major and
minor; its anterior extremity being curved upon
itself and continuous with the optic commissure
aud tuber cinereum at the base of the brain.
 ^Septum lucidum descends from the raphe of the
                     11 
122
corpus callosum to the fornix separating the la-
teral ventricles from each other.   It  consists of
two layers, which are composed of white and of
grey matter, and lined by epithelium ; the cavity
between them  is called the fifth ventricle: its
form is triangular, the apex corresponding to the
union of the corpus callosum and the fornix, the
base anterior, corresponding to the curved  por-
tion of the corpus callosum.
  Literal ventricles, each consists of a body and
three cornua, the body corresponding to the cen-
tre of each cerebral hemisphere, the cornua pro-
ceeding one to each lobe.   The bodies  of the
ventricles are separated from each other by the
septum lucidum.
   Corpora striata, two pear-shaped bodies,  their
large bulbous extremities being contained in the
anterior cornua  of the lateral  ventricles,  their
narrow  stalk-like  extremities  being  directed
backwards into the bodies of the ventricles;  they
are cineritious  on their surface, but when cut
into present alternating striae of cineritious and
medullary matter; and hence their name.
    Optic thalami, two large bodies placed behind
and between the corpora  striata; ea h presents
upon  its superior  surface two  tubercles, called
corpora geniculata.   Towards the median line
 the optic thalami  are flat and united  to  each
 other by a soft cineritious structure, called com-
 missura mollis; upon their external surface they
 are white, but their interior is grey.  Tiie cor-
 pora  striata and optic thalami,  like the cineri- 
123
tious surface of the brain, are very vascular, hence
all  these  parts are apt to be the most frequent
seats of apoplectic effusions.
   Taenia  semicircularis,  a narrow  medullary
band, situated in the groove between the optic
thalamus and corpus striatum of either side.
  Fornix, a longitudinal commissure, placed ho-
rizontally beneath the septum lucidum and cor-
pus callosum, and composed of medullary struc-
ture, arches above the  third ventricle, and lies
upon the velum interpositum and choroid  plexus.
It commences by its two posterior crura, which
arise from the hippocampi majores in the infe-
rior cornua of the lateral ventricles; these unite
in the  median line, and form what is called the
body of the fornix, which passes  forwards  and
terminates in the anterior crura:  finally,  the
anterior crura descend to the base of the brain,
and terminate in the corpora mammillaria, or
albicantia.
  The  lyra, is the appearance presented upon
the under surface of the fornix  by some white
fibres which  connect, by  a transverse commis-
sure, the hippocampi and the posterior crura of
the fornix.
  Choroid plexus, the fold of pia mater  which
lies upon the optic thalamus, and  which  enters
the body of the  lateral  ventiicle by the inferior
cornu; the choroid plexus of either side  passes
forwards and  inwards,  and both unite  in  the
foramen commune anteri is.
   Velum interpositum, lying underneath the for- 
124
nix,  unites the choroid plexuses of either side;
it is composed of arachnoid  membrane and  pia
mater, and contains in  its centre the  venae
Galeni.
   Vtnai  Ga7eni, contained in the velum  inter-
positum,  pass  fom before  backwards  and ter-
minate in the straight sinus.   These veins return
the blood from the choroid plexuses and  from
the parts within the ventricles.
  Pineal body, a small conical cineritious  mass
containing  in  general sandy  matter, which  has
been found to consist of phosphate and carbonate
of lime.  It is placed upon the corpora quadri-
gemina, and is connected with the optic thalami
by two peduncles.
  Hippocampus  minor, an oval eminence in the
posterior cornu of  the lateral ventricle; medul-
lary externally, and cineritious in  its interior.
  Hippocampus major, a similar eminence to the
minor, but  larger, and placed in the inferior cor-
nu of the lateral ventricle.
  Pes hippocampi,  the tuberculated appearance
which the extremity of  the hippocampus major
presents.
   Taenia  hippocampi,  or  corpus fimbriatum,
the free margin of  the posterior crus of the for-
nix,  where it  is connected  with the hippocam-
pus major.
   Corpus  denticulatum,  a cineritious  serrated
line in the inferior  cornu of the lateral ventricle,
and which  is exposed upon removing the  taenia
hippocampi, beneath which it lies. 
125
 •  Third ventricle, a deep fissure between the
 optic thalami, exposed by separating these bo-
 dies.  It is bounded anteriorly by the descend-
 ing crura of the fornix  and the anterior commis-
 sure, posteriorly by the  posterior comnvssure and
 the tubercula quadrigemina, laterally by the op-
 tic  thalami: its floor corresponds to the locus
 perforatus, tubercinereum  and infundibulum ; it
 is covered in by the velum interpositum and for-
 nix.
   Foramen commune anterius, a hole by  which
 the  choroid  plexuses unite anteriorly.  It ferms
 a medium of communication for the two  lateral
 and the  third ventricle.
   Infundibulum,  a  hollow funnel-shaped  pro-
 cess of grey matter leading from the anterior and
 inferior  part of the  third  ventricle to the pitui-
 tary body.
   It:r e  tertio  ad  quartum  ventriculum,  an
opening  in the posterior part of the third ven-
tricle,  under the posterior commissure and tu-
bercula  quadrigemina,   and  leading obliquely
backwards and downwards to  the fourth ven-
tricle.
  Anterior commissure, a medullary, round cord,
anterior  to  the crura of the fornix, and pass-
ing transversely from one corpus striatum to the
other.
  Posterior  commissure,  extends  transversely
from  one optic thalamus  to  the  other.  It is
shorter and smaller than  the  anterior commis-
sure.
11* 
126
   Tubercula  quadrigemina,  four   eminences,
called  also nates and  testes, situated under the
posterior  part  of the  v'elum  interpositum; the
two anterior (the nates) are connected to the op-
tic thalami; the posterior  (the  testes)  are  con-
nected to the cerebellum by the following  pro-
cesses.
   Processus e cerebello ad  testes,  two medullary
bands or plates, which pass obliquely  from the
cerebellum upwards and inwards to the testes.
   Valve of Vieussens,  a layer of cineritious and
medullary substance, of triangular form, attached
by its sides to the processus e cerebello  ad testes,
by its base to the cerebellum, and by  its  apex
to the testes.
   Fourth ventricle, is exposed by cutting through
the valve of Vieussens. It is bounded anteri-
orly by the pons  Varolii, laterally by  the  pro-
cesses e cerebello ad  testes, superiorly by  the
valve of Vieussens,  inferiorly by pia mater and
arachnoid  membrane,  and posteriorly by  the
cerebellum.
   Calamus scriptorius, the fissure seen upon the
posterior  surface of the  pons  Varolii, in   the
fourth  ventricle, from  either side of which  four
or five white lines proceed.
   Choroid  plexus  of fourth  ventricle, a small
fold  of pia mater, which enters  the ventricle as
this  membrane is passing from the cerebellum to
the spinal cord. 
127
                  CEREBELLUM,
   Consists  of a  central portion  called superior
 and inferior  vermiform processes, and of" two
 hemispheres, united inferiorly by the pons Varolii.
   Hemispheres,  are flat superiorly, where they
 correspond  to the tentorium, and convex inferi-
 orly, where they lie in the inferior occipital fos-
 sa:  the surface  of each presents semicircular
 narrow lines,  arising from the laminated arrange-
 ment of the cineritious portion of the organ; be-
 tween these laminae the pia mater enters, but the
 arachnoid passes  over them.
   Crura cerebelli,  two medullary  cords which
 pass from either he nisphere and  unite in the
 pons Varolii.
   Superior  vermiform process,  a small conical
 eminence corresponding to the superior and cen-
 tral part of  the cerebellum.
   Inferior vermiform process, larger than the
 superior,  and  corresponding to the inferior and
 central part of the cerebellum.
   Arbor vitce, the  branching of the  medullary
 substance of the cerebellum, exposed  by making
 a vertical section  of it.
   Corpus dtntalum, a. small oval mass of cineri-
tious substance, surrounded by a yellow  zigzag
fine, and exposed upon making a section of the
cerebellum, parallel to, but an inch distant from,
the median line.
             MEDULLA OBLONGATA,
   A large conical  process of medullary structure, 
128
extending from the lower margin of the pon3
Varolii  to the  commencement  of the spinal
cord.   It is rather  more  than  an  inch  in
length, and presents the following bodies, which
are  separated from  each  other  by  distinct
grooves.
   Corpora pyramidalia, or the  anterior pyra-
mids, the two anterior eminences of the medulla
oblongata.
   Corpora olivaria, smaller than the pyramidal
bodies, situated laterally.
   Corpora restiformia, hirge, and situated poste-
riorly ; the posterior pyramids, small  and cord-
like, lie within the restiform bodies upon  the
posterior surface of the cord.

              BASE OF THE BRAIN
Presents on  either side of the median line  the
anterior and middle lobes of the cerebrum, sepa-
rated from each other by the fissure of Sylvius,
and  a lobe of the  cerebellum  resting upon  the
posterior lobe of the cerebrum.   In the median
line, proceeding from before  backwards, is the
anterior  extremity of the median fissure  (on
either side of which run the olfactory  nerves),
the lower extremity of the corpus callosum, the
optic commissure, the tuber cinereum, the cor-
pora albicantia, the pituitary body and infundi-
bulum, the locus perforatus (on either side of this
is  the crus cerebri), the pons  Varolii, the me-
dulla oblongata, and  lastly the posterior extre-
mity of the median fissure. 
129
   The brain consists—
   1. Of certain  masses of grey, or cineritious
 matter, microscopically consisting of nucleated
 cells, and having white or tubular matter  inter-
 mixed or  passing through it.   To these masses
 the name of " ganglia " has  been applied.   Ex-
 amples: the  cortical  surface of  the brain and
 cerebellum, the  corpora striata,  optic thalami,
 locus niger, etc.,  etc.
   2. Of commissures, or bands of union, connect-
 ing these ganglia and other parts.  Thus, the
 corpus callosum  unites the hemispheres, the an-
 terior commissure, the corpora striata,  the mid-
 dle  and posterior unite the optic thalami, the
 pons Varolii unites the two lobes of the cerebel-
 lum, etc., etc.  Many  of  these commissures are
 formed of converging fibres.
   3. Of diverging fibres.   These can be traced
 upwards from the columns of (he spinal cord into
 the medulla oblongata, where they form the cor-
 pora pyramidalia, olivaria, and  restiformia, etc.
 The corpora pyramidalia are continuous  with the
 antero-1 iteral  columns of the spinal cord,  from
 which motor nerve-* arise; they can be traced up
 under  the  pons  Varolii,  expanding  always as
 they pass through grey matter, passing on to help
form the crura cerebri, still expanding they pass
 through the optic thalami and  corpora striata,
until they spread out in the convolutions of the
brain.   Motor  nerves  arise  from  the  corpora
pyramidalia, from its continued  track, as traced
upwards.  The corpora  pyramidalia decussate 
130
below the pons Varolii.   This explains the fact
that when pressure is made upon one hemisphere
of the brain, as by depressed  bone, etc.,  the pa-
ralysis will generally be found to affect the oppo-
site side of the body.

       ORIGIN OF THE  CEREBRAL NERVES.

  First nerve  (olfactory), arises by three roots,
the external, long and white,  from the fissure of
Sylvius; the internal,  also white,  from the  pos-
terior  internal surface of the  under part of the
anterior lobe; and the middle short and cineri-
tious, from a grey tubercle upon the under  sur-
face  of the anterior lobe.
  Second  pair (optic), arise by two roots from
the  corresponding nates and from the corpora
geniculata;  the roots unite and form the tractus
opticus, which passes around and becomes slight-
ly attached  to the crus cerebri; the tracts,  one
from either side, then unite in  the optic commis-
sure, having  previously received  a few fibres
from the tuber cinereum; from the anterior  part
of this co'nmissure proceed the optic nerves.
   Third pair (motores  oculorum), arise from
the  inner side of the crus cerebri,  near the pons
Varolii.
  Fourth pair (trochleares), arise from the valve
of Vieussens, by several delicate filaments,  which
meet, those of the opposite side in the mesial  line.
  Fifth nerve (trigeminal), consists of two  por-
tions,  one for sensation, the other for motion. 
131
 TJie motor division, the smallest, arises from the
 corpus pyrarnidale, in the substance of the pons
 Varolii; and the sensory  division, from the angle
 between the crus cerebelli and the pons Varolii.
   Sixth pair (abducentes), arise from the corpus
 pyrarnidale near its junction with the pons Varolii.
   Seventh nerve consists of the portio dura, or
 facial, and  the  portio mol'is, or auditory.  The
 portio dura arises from the groove between the
 corpus restiforme and olivare, near the pons Va-
 rolii.   The portio  mollis  arises by three or four
 white lines from the  calamus scriptorius in the
 fourth ventricle.
   Eighth nerve  consists of the glosso-pharyngeal,
 pneumo-gastric and spinal accessory.   ITie glosso-
 pharyngeal arises  from   the  groove  between
 corpus olivare and corpus restiforme, by four or
 five filaments.   The  pneumo-gastric arises  in
 the same groove, but  below the glosso-pharyn-
 geal,  by eight or ten filaments, and the spinal
 accessory arises from the side of the spinal cord.
 as low as the sixth cervical vertebra, by several
 fiiaments.
   The ninth pair (linguales)  arise by reven  or
 eight filaments from the groove between the py-
 ramidal and olivary bodies, about half an  inch
 below the origin of the sixth.

       DISTRIBUTION OF CEREBRAL NERVES.

   First pair (or olfactory), sends off three sets
of branches to the upper part of the nose.  In- 
132
ternal branches to septum nasi; middle branches
to mucous membrane of roof of each nostril; and
external branches to spongy bones.
  Second pair (or optic), pierce the sclerotic
coat of the eye, and form the retina.
  Third pair (or motores oculorum).  Superior,
or smaller branch, supplies the superior  rectus,
and  the levator palpebrae.  Inferior, or  larger
branch, supplies the internal rectus, the inferior
rectus, and the inferior oblique ; and also sends
a branch to the lenticular ganglion.
  Fourth  pair (or trochleares), are distributed
to superior oblique muscles of eye.
  Fifth pair (or trigemini),  first form  the Cas-
serian  ganglion,  and  divide  into  three  main
branches—viz., ophthalmic, superior and infe-
rior maxillary.
  Ophthalmic  division.—Divides intrj—1.  La-
chrymal nerve, which, passing along the outer
wall of the orbit, sends a branch  downwards to
the  orbital branch  of the superior maxillary
nerve; then gives filaments to  the  lachrymal
gland and the conjunctiva; and finally, perforat-
ing the fibrous attachment of  the upper eyelid,
terminates in the integument  of the forehead.
2. Frontal nerve, enters the orbit above the le-
vator palpebrae; it divides into supra-orbital and
supra-trochlear:  supra-orbital nerve,  escaping
through  the supra-orbital notch, is  distributed
to the integuments of the forehead; the  supra-
trochlear, passing above the pulley of the  troch-
learis muscle, sends a filament  to the infra-troch- 
133
 lear branch of the nasal nerve, and terminates
 in the  mucous membrane of the inner canthus
 and in the integuments of the forehead.  3. Na-
 sal nerve, enters the orbit between the two heads
 of the rectus externus muscle.  It gives a fila-
 ment to the lenticular ganglion, two or three cili-
 ary  nerves, and the infra-trochlear branch; the
 nerve then enters the skull by the foramen eth-
 moideum anterius, and escaping into the nose by
 a fissure in the cribriform plate of the ethmoid
 bone, terminates  at the tip of the nose: the ter-
 minal filament is  called naso-lobular.
   Superior  maxillary   division.—1.   Orbital
 branch, which sends off a malar twig and a tem-
 poral twig. 2. Two branches to Meckel's gan-
 glion.   3.  Posterior dental, which sends off an
 anterior branch to the  buccinator muscle and
 gums, and a posterior branch to the molar teeth.
 4.  Anterior dental, to the antrum and teeth.  5.
 Infra-orbital, distributed to the face.
  Inferior maxillary division.—1.  The superior
 or external branch, which is joined by the motor
portion of the  fifth nerve, sends off deep tempo-
ral twigs—a masseteric branch to masseter mus-
cle and  temporo-maxillary articulation, a buccal
branch to the buccinator and temporal  muscles,
and  a  pterygoid  branch to the pterygoid and
palatine muscles.   2. Inferior or internal branch,
sends off the inferior dental (which gives off the
mylohyoid nerve), it supplies the teeth, and ter-
minates in the mental nerve; the  gustatory,
which  goes to the glands, mucous membrane,
                     12 
134
and papillae of the tongue, and is joined by the
chorda tympani nerve;  and the auriculo-tempo-
ral, which supplies the external ear, and the in-
teguments  of the side of the head.

GANGLIONS  IN CONNEXION WITH THE  FIFTH  PAIR.

   Casserian ganglion.—A large grey semi-lunar
body, analogous to the ganglion upon the  pos-
terior roots of  the spinal nerves.  It lies  in a
depression  at the end of the petrous portion of
the temporal bone,  and  presents anteriorly a
convex border, from which proceed the  three
main divisions  of the fifth, just described.   The
motor  mot of  the fifth nerve joins the inferior
maxillary division only.
   The  lenticular ganglion is  situated between
the optic nerve and  external  rectus muscle;  it
receives at  its posterior superior angle a long fila-
ment from the nasal branch of the filth, and by its
posterior inferior angle a branch  from the in-
ferior division of the third.  Its anterior angles
furnish the ciliary nerves, about twenty in num-
ber, which run along the optic nerve, pierce the
back part of the sclerotica, run forward between
it and  the  choroid coat, enter the ciliary liga-
ment,  and  are  ultimately distributed to the iris.
   Meekels  ganglion.—A little, red body of tri-
angular shape,  situated deep in the fat and cel-
lular tissue of  the pterygo-maxillary  fossa;  it
communicates  superiorly by two small nervous
twigs  with the second division of the fifth, and 
135
sends off—1. Spheno-palatine nerve to the mu-
cous  membrane of the  superior  and middle
spongy bones; it  gives  off the naso-palatine
branch which runs along the septum nasi, and
terminates in the foramen incisivum. 2. Palatine
nerve, which descends in  the palatine canal, and
divides into anterior branches which supp'y the
teeth,  and posterior and middle branches which
supp'y th; amygdalae, soft palate, and.uvula. 3.
Vidian nerve, which passes  backwards through
the  Vidian  canal,  enters the cranium by the
foramen  lacerum  anterius, and divides into an
inferior and a superior branch, having firs^ sent
filaments  to  the sphenoidal sinus: the inferior
branch enters the carotid canal, and unites with
the branches of. the sympathetic, whilst the su-
perior  branch  runs beneath  the  Casserian gan-
glion on  the  petrous portion of the temporal
bone, enters the hiatus Fallopii, attaches itself to
the portio dura nerve, leaves it,  and  enters the
tympanum a  little below the pyramid, and is
here called chorda tympani.   It  then passes be-
tween  the.long crus of the incus  and the handle
of the malleus, emerges from the tympanum by
the Glasserian fissure, unites with the gustatory
nerve,  and at the submaxillary gland terminates
in a small ganglion named after Boch.
   Otic ganglion, a small body connected with
the inferior maxillary nerve, near  the foramen
ovale;  it  receives  the lesser petrosal nerve of
the glosso-pharyngeal.
   The naso-palatine ganglion lies in the anterior 
136
palatine hole, and is formed by the anterior pala-
tine branches from Meckel's ganglion.
  The submaxillary  ganglion lies at the edge of
the submaxillary gland, and is formed by the
termination of the chorda tympani nerve.
  Sixth pair,  or abducenles, are distributed to
the external rectus muscle of each  side exclu-
sively, but receive two filaments from the sym-
pathetic in the cavernous sinus.
  Seventh pair  consists of two portions, viz.,
Portio dura and portio  mollis; both enter the
meatus auditorius internus.
  Portio dura, or facial nerve, passes into the
aqueduct of Fallopius, and escapes by the  stylo-
mastoid foramen.  It gives  off, 1, a branch to
the stapedius  muscle; 2, the chorda tympani;
3, posterior auricular; 4, digastric; 5, stylo-hvoid
nerves: and then  divides into, 1, cervico-facial
division, which sends off branches to the muscles
of the face and to the plarysma myoides; and 2,
temporo-faeial division, which sends off tempo-
ral, malar, and buccal branches   The interlace-
ment of the branches of the facial nerve, as it
passes through the parotid gland, is  called "pes
ansfrinus."
  Portio mollis, or auditory nerve.—1. Branch
to cochlea.  2. Branch  to vestibule and  semi-
circular canals.
  Eighth nerve  consists  of three portions, viz.,
glossopharyngeal pneumo-gastric,  and  spinal
accessory.   Tuey escape from the skull by the
jugular foramen. 
137
   Glosso-pharyngeal, or  first  branch  of the
eighth, gives off,  1, Jacobson's nerve,  which
enters the tympanum by a small foramen upon
the  under surface  of  the  temporal bone, and
sends a filament (small petrosal) to  the otic gan-
glion, and carotid filaments which ramify  on the
coats of the vessel, and communicate with the
sympathetic and vagus nerves.  2.  Branches to
the pharyngeal plexus.  3.  Branches to theton-
sillitic plexus.   4.  Branches to the stylo-pha-
ryngeus and superior and middle constrictors of
the pharynx, mucous membrane of fauces, &c.
5. Branches to the papillae and mucous  mem-
brane at the root of the tongue.
   Pneumo-gastric,  or  second  branch  of the
eighth, gives off, 1.  Branches to unite with the
spinal accessory, glosso-pharyngeal, lingual, and
sympathetic nerves.  2  Branches  to assist in
forming  the  pharyngeal plexus.   3. Superior
laryngeal nerve,  which is the nerve of sensation
of the  larynx, gives off an  external laryngeal
branch to the exterior of the larynx, the inferior
constrictor and pharynx, and crico-thyroid mus-
cle, and then pierces the thyro-hyoid membrane
in company with the superior laryngeal artery,
and supplies the epiglottis,  mucous membrane,
an I arytenoid  muscles.  4.  Cardiac branches, to
the cardiac nerves  of  the  sympathetic,  is the
nerve  of motion of the  larynx.   5. Inferior
laryngeal or recurrent nerve, which sends off
cardiac  filaments, branches to the  fore part of
the trachea and thyroid gland, and  branches to
                    12* 
138
the  pharynx,  laryngeal  muscles, and mucous
membrane, on which  they communicate with
branches of the superior laryngeal.   6. Pulmo-
nary branches, which send off branches in front
of the bronchial tubes  to  form  the  anterior or
lesser pulmonic  plexus; this plexus sends fila-
ments to the pulmonary vessels, also  to the lungs
and pericardium, and to the posterior pulmonic
plexus.  7. Posterior, or greater pulmonic plexus,
is formed by the pneumo-gastric nerves, which
increase in size  at  the root of each lung, and
subdivide and unite in an areolar manner.  This
plexus is joined by several branches of the sym-
pathetic nerve, and  its branches accompany the
bronchial  tubes through  the substance of the
lung.  8. (Esophageal plexus, or plexus gulae, is
formed by the communications of both  nerves,
encircling the oesophagus  in their course along
this tube.   9. Gastric  plexus is formed by both
nerves dividing, subdividing, and  uniting  upon
the stomach.   The left  pneumo-gastric nerve  is
anterior upon  the  stomach, and sends branches
to the lesser omentum and liver; the right  is
posterior.
  The pneumo-gastric supplies the pharynx, the
larynx, the trachea, the  bronchial  tubes, the
oesophagus, the heart, lungs, and stomach.
  Nervous  accessorius,  or  third branch  of the
eighth.  1. Branches to communicate with the
eighth,  ninth,  and  sympathetic  nerves.   2.
Branches to the sterno-cleido-mastoid muscle, 
139
 which muscle it  then perforates.  3. Terminal
 branches to the trapezius muscle.
   Ninth pair, or lingual.   1. Descendens noni
 unites with the internal descending branches of
 the cervical plexus, forming a small plexus, in
 loops, the branches of which pass  to the omo-
 hyoid, sterno-hyoid, and sterno-thyroid muscles.
 2.  A  branch to  the  thyro-hyoid  muscle.  3.
 Branches  to the hyoglossus and  surrounding
 muscles, and to the gustatory branch of the fifth
 pair.  4.  Terminal branches to  the genio-hyo-
 glossus muscle, and muscular structure of the
 tongue.
                SPINAL NERVES.

   Symmetrical, thirty pairs, viz., eight cervical,
 twelve dorsal,  five  lumbar, and five  sacral.
 Each  spinal nerve has  two roots, an anterior
 and a posterior.  The  anterior is small, and is
 the motor  division.  The posterior large, with a
 ganglion upon it, and is for sensation.  These
 roots are separat.-d by the cord itself, and by
 the ligamentum dentatum.   The  anterior root is
 connected  to the posterior root beyond the gan-
 glion.  On the outer side of the  ganglion both
 nerves unite in a  siig'e cord,  which, after a
 short course, divides into an anterior and pos-
 terior branch.  The posterior branches of this
 division are the smaller  (except  that of the
 second  cervical),  and are  distributed to the
dorsal muscles and integuments.   The anterior
 branches form the several plexuses which supply 
V
                    140

the muscles and integuments anterior to  the
spine, and also the extremities.

DISTRIBUTION OF THE  EIGHT  CERVICAL NERVES
          AND  FIRST DORSAL NERVES.

  Posterior  branches  are   small,  except  the
second cervical, which  perforates the complexus
muscle, and accompanies the occipital artery;
the rest  are lost in the neighbouring muscles
and integuments.
  Antcior branches. The first, or sub-occipital,
twists round the atla«,  to unite with the second,
forming the nervous loop of the atlas: and  the
second, having received the  first,  descends to
unite with the  third.   The  third unites in  like
manner with the fourth, and thus is formed, by
the anterior branches of the four first cervical
nerves, the

               CERVICAL PLEXUS.

  From this plexus proceed :—
  Branches  to the platysma, integuments, paro-
tid gland, ear,  and back of the head.
  1. Great  auricular,  arises  chiefly  from  the
third cervical, and  is distributed to the ear;  it
accompanies the external jugular vein.
  2. Small  occipital  which,  arising from  the
second  cervical, pierces the fascia behind  the
sterno-mastoid, and is  distributed to the integu-
ments of the scalp.
  3. Descending branches from third and fourth 
141
cervical, which are divided into sternal, clavicu-
lar, and acromial, and supply the integuments.
   4.  Branches, generally two in number, which
form loops with the descendens noni in front of
the jugular vein.
   5.  Phrenic,  or internal respiratory,   which
arises from the  third and fourth cervical,  and
has a small filament also from the fifth cervical:
it sends  branches to the liver, pericardium, infe-
rior cava, and terminates in the diaphragm.  The
phrenic is the most important nerve in the hu-
man  body, as upon it depends the action of the
diaphragm.
   6.  Muscular branches, which are given to the
sterno-mastoid and trapezius (these  muscles are
also  supplied by the spinal accessory);  to the
levator anguli scapulas, the  scaleni, and recti
capitis antici.

            THE  BRACHIAL PLEXUS,

Is formed by the union of the anterior branches
of the four  inferior cervical and  first  dorsal
nerves.   From the plexus  proceed:—
   1. A branch to join the phrenic nerve.
  2.  Branches to the longus colli, scaleni,  and
subclavius muscles.
  3.  The  external  respiratory  nerve of Bell,
which, arising from the fifth and sixth cervical,
passes behind the axillary vessels, and is distri-
buted to the serratus magnus.
  4.  Ihoracic nerves, three or four  in number, 
142
 which form loops round the axillary artery  and
 supply the pectoral muscles.
   5. Suprascapular nerve, which passes through
 the notch in the  scapula,  jind supplies  the
 supra-spinatus,  infra spinatus, and teres minor
 muscles.
   6. Subscapular nerves are three  or four in
 number;  they descend behind the vessels to the
 subscapular, latissimus dorsi, and teres major
 muscles.
   7. Internal cutaneous nerve, sends one branch
 which descends over the bend of the elbow as
 low as the wrist, and another  branch  which
 descends   towards  inner condyle, and  sends
 branches  to inner and posterior part of the fore-
 arm.
  8. External cutaneous, musculocutaneous or
 perforans  Casserii, which sends branches to  the
 coraco-brachialis, biceps, and brachialis anticus-
 branches  to the integuments of  the fore arm'
 an anterior branch to the ball of the thumb and
 palm of the hand; and a posterior branch to  the
 dorsum of the hand.
  9. Median nerve, sends branches to the super-
 ficial and deep pronators and flexors of the fore-
 arm, except the  flexor carpi  ulnaris, and half
 the flexor digitorum profundus, which are sup-
 plied by the ulnar nerve;  the anterior interosse-
 ous nerve, which sends a branch to the pronator
quadratus, and another  to  the dorsum of  the
hand; a superficial branch  which  is  given  oft
above the  wrist, and which runs to the palm oi 
143
the hand ; and five digital branches, which sup-
ply the thumb,  index, and middle fingers, and
the radial edge of the ring finger.
  10.  Ulnar nerve, sends muscular branches to
skin of forearm, flexor  profundus, and  flexor
carpi ulnaris muscles;  the  nervus  dorsalis carpi
ulnaris to the integuments on the dorsum of the
hand and the three inner fingers;  the superficial
palmar branch, which  divides into three  digital
branches for the supply of the little finger and
the ulnar edge of the ring finger;  and the deep
palmar branch to form  the deep  palmar arch,
which supplies the interossei muscles, two inner
lumbricales, and the adductor pollicis muscles.
  11. Musculo-spiral,  or  radial  nerve,   sends
branches to  the triceps, through which it winds;
a long cutaneous branch  to the elbow; branches
to the  supinators and extensors; the  anterior or
radial branch, which runs along the inner side of
the supinator radii longus, and sends a branch
to the  integuments <f the  thumb, and another
to the  dorsum of the hand, which supplies the
index and middle fingers, and Ci mmunicates with
the dorsalis  ulnaris; and a deep branch, or pos-
terior interosseous, which supplies by superficial
and deep branches  the  extensor  muscles and
terminates in a  ganglion  on  the  wrist.    The
median and  ulnar nerves  supply the flexors; the
extensors are supplied by the muscular  spiral
nerve.   This may be called the great extensor
nerve.
  12.  Circumflex nerve,  sends branches  to  the 
144
deltoid  and  teres  minor  muscles,  skin,  and
shoulder joint.  Injury of this nerve, in disloca-
tion of the shoulder, is sometimes the cause of
subsequent wasting and paralysis of the limb.
        TWELVE PAIR OF  DORSAL NERVES.

   Posterior branches are small, and pass back-
 wards to the muscles and  integuments of the
 back and loins.
 "Anterior  branches,  or  Intercostals.   First is
 the largest; it contributes  to  the  formation of
 the  brachial plexus.    Second and third  run
 backwards and outwards, and at the angle of the
 ribs  pass between  the  intercostal muscles,  and
 running along the lower edge of each rib supply
 the  surrounding  muscles:  opposite the  axilla
 they send off the intercosto-humeral nerves, of
 which  one,  joining a branch from the  brachial
 plexus,  forms the nerve  of Wrisberg,  for  the
 skin  of the arm, and the terminal branches sup-
 ply the  muscles and skin upon  the lateral and
 fore  part of the  thorax.   Fourth to   twelfth,
 inclusive, are similar to the second and third in
 distribution, supplying the intercostal and adja-
 cent muscles:  the  two last go chiefly to  the
 diaphragm,  and the twelfth sends a branch to
join  the  first luml ar.   [All  the intercostals  are
 connected by two  short branches to the gan-
 glions of the sympathetic] 
145
         FIVE PAIR OF LUMBAR NERVES.

   They are larger than the dorsal, and like them
 divide into posterior and anterior branches.
   Posterior branches are distributed to the lum-
 bar muscles.
   Anterior branches unite in the substance of the
 psoas muscle, to form the lumbar plexus.

                LUMBAR PLEXUS.

   It  is  formed  by the last dorsal and four first
 lumbar nerves.
   Branches.—1.  External  inguino-cutaneous,
 sends branches to the abdominal muscles, a cuta-
 neous branch to the integuments on the outer
 part  of the thigh, and the ilio-scrotal.
   2.  Middle inguino-cutaneous, to the abdominal
 muscles  and  skin, on  the outer  part  of the
 thigh.
   3.  Internal  inguino-cutaneous,  or  genito-
 crural, sends  a  branch  to the spermatic cord,
 which accompanies the spermatic vessels, and a
 branch  to  the integuments and  glands  of the
 groin.
   4. Anterior crural  nerve,  formed  by  the
second,  third, and fourth nerves, passes beneath
Poupart's ligament,, and divides into two fasciculi.
 The superior  fasciculus sends four or five long
branches,  which  pierce the fascia  lata, and
descend to the knee : some of them accompany
the saphena vein;  the  deep  fasciculus sends
                    13 
146
external  muscular  branches  to  the  vastus
externus, rectus,  iliacus  internus  muscles, and
internal  branches to the  sartorius, vastus inter-
nus, and crureus:  branches also accompany the
femoral artery, near to the knee,  the  internal
saphenous nerve, which joins  the saphena vein
at the knee, lying between the tendons of the
gracilis and sartorius, goes  on  to the inner side
of the foot, sending off numerous branches to the
integuments.
  5. Obturator  nerve  sends  branches  to  the
obturator internus, an anterior branch to  the
adductor brevis and pectineus, and a posterior
branch to the gracilis, the adductor magnus and
longus muscles: articular nerves  are  given  to
the hip and knee joints.
  6. Lumbosacral nerve  proceeds  from  the
fourth  and fifth lumbar into  the pelvis, and
divides into the superior gluteal and the commu-
nicating nerve ; the superior gluteal is distribut-
ed to the gluteus medius, minimus, and tensor
vaginae femoris muscles: and the communicating
branch joins the first sacral nerve.

         FIVE  PAIR OF SACRAL  NERVES.

  Posterior branches, very small, to muscles and
integuments.
  Anterior  branches, very large,  particularly
the three superior: these five, with the commu-
nicating  branch of the lumbo-sacral, form the
Bacral plexus. 
147
               SACRAL PLEXUS.

  It is formed by the last lumbar and four first
sacral  nerves.   Sends  off  internal or  pelvic
branches, which are named Haemorrkoidal, Vesi-
cal, Uterine, and Vaginal.   External branches.
  1. Muscular nerves, tothepyriformis, obturator
internus, gemelli, and quadratus femoris muscles.
  2. L< ssrr sciatic nerve, to the gluteus maximus
and integuments of the buttock.
  3. Posterior cutaneous nerve, to the back part
of the thigh and leg.
  4. Pudic nerve,   which  sends  an  inferio
branch to  the muscles of the perineum  and to
the scrotum; and a superior branch which passes
along the dorsum of the penis to its glan-^.
  5. (Irnt Sciatic nerve, sends off s weral bran-
ches to supply the semimembranosus, semitendi-
nosus, biceps and adductor magnus muscles, also
the hip joint;  it divides at the upper and outer
part of the  popliteal space into two branches, viz.
the peroneal and the popliteal nerves. The pero-
neal nerve  first sends off the external cutaneous
nerves of the leg, which communicate with the
external saphenous nerve;  it next gives off the
musculo-cutaneous nerve, which divides into an
internal and an external branch, the former being
distributed  to  the  integuments of the  first and
second toes, and the latter to the integuments of
the third, fourth, and fifth tocB; and lastly, the
anterior tibial,  which winds round the head of
the fibula,  and supplies  the  integuments on the 
148
 anterior part of the leg, the tibialis  anticus, the
 extensor digitorum longus, the extensor pollicis,
 and  the extensor  digitorum brevis  muscles,
 and terminates at the first interosseal space by
 communicating with the plantar  nerves, having
 first supplied the inner interosseous muscle.   The
 popliteal division of the great sciatic first  sends
 off the external saphenous nerve, and branches
 to the gastrocnemius, soleus, plantaris, and pop-
 liteus muscle.   At the lower border of the pop-
 liteus  muscle it  becomes the posterior tibial,
 which supplies the tibialis posticus, flexor longus
 digitorum, and flexor  longus  pollicis; it finally
 divides into the  internal  and external  plantar
 nerves;  the former sending branches  to the
plantar muscles and skin, and four digital branches
to supply the 1st, 2d,  3d toes, and inner side
of the 4th toe, and the latter a superficial branch
to the little toe and outer side of the 4th toe,
and a deep branch of the plantar and interossei
muscles.

SYMPATHETIC OR GANGLIONIC SYSTEM  OF  NERVES.

  The  sympathetic  nerves,  characterised by
their reddish or grey color, and by their  nume-
rous ganglia, form a system,  which communi-
cates with all the cerebral nerves,  except the
three nerves of special sense [viz. the-olfactory,
the optic, and the auditory] and with all the spinal
nerves. In the chest and abdomen large plexuses
ar\3 formed in front of the vertebral column. 
149
           THE CERVICAL  GANGLIONS,

Are three in number,
   Superior cervical ganglion extends from the
first to the third cervical vertebra, and sends off
1, two superior branches, which ascend along
with the carotid  artery in the carotid canal to
the  cavernous sinus, where  they communicate
with the sixth or abducens nerve, and with the
Vidian nerve. 2. Descending or inferior filaments
which join the laryngeal and  pneumo-gastric
nerves, the superior cardiac nerve, and the mid-
dle cervical  ganglion, if it exists; if not, they
join the inferior ganglion.  3. Internal branches,
which unite with the pharyngeal plexus.  4. Ex-
ternal  branches,  to join  the superior cervical
nerves.   5. Anterior branches, which unite with
the pneumo-gastric and facial nerves, and form
a plexus around the carotid  artery, from which
branches proceed along the external carotid and
its divisions.
  Middle cervical ganglion, placed opposite the
fifth or sixth cervical vertebra, is sometimes ab-
sent; when present it sends branches to unite
with the vagus and cervical nerves, and branches
to join the  cardiac nerves.
  Inferior cervical ganglion is situated between
the transverse process of the last cervical verte-
bra and the neck of the first rib; it sends branches
to the phrenic nerve, brachial plexus,  subclavian
artery, and its ramifications, and branches to the
inferior cardiac nerve.
                      13* 
150
   Cardiac Nerves are three in number, and are
 named superior, middle, and inferior.   1. Supe-
 rior Cardiac Nerves arise by two or three fila-
 ments from the superior cervical ganglion, com-
 municate with the vagus and laryngeal nerves,
 and with the  middle and inferior cervical gan-
 glia, pass along the coats of the arteria innomi-
 nata on the right side, and between the left ca-
 rotid and left subclavian on the left side of the
 aorta, and here communicate with the recurrent
 nerves, and the middle and inferior cardiac nerves,
 and the cardiac ganghon or plexus.  2. Middle
 Cardiac Nerves.  That of the right side is gene-
 rally the largest; on the left side it is sometimes
 wanting.  They enter the thorax anterior to the
 subclavian artery, are joined  by branches from
 the pneumo-gastric  and recurrent nerves, and,
 passing along  the arteria innominata, terminate
 in the cardiac ganglion and plexus.  3. Inferior
 Cardiac Branches.  The right descends along the
 arteria innominata to the fore part of the arch of
 the aorta, and  terminates in the anterior cardiac
 plexus; some  branches  pass  between the aorta
 and pulmonary artery to the cardiac ganglion ;
 on the left these nerves accompany the subcla-
 vian artery, and partly join  the  middle cardiac
 nerve,  and partly the cardiac plexus.
   Cardiac Plexus or Cardiac  Ganglion, is situ-
ated behind the ascending aorta, near its origin,
in front of the trachea and right pulmonary ar-
tery; it consists of a plexus of nerves formed by
 the cardiac  nerves of the opposite  sides and 
151
 branches of the eighth pair and recurrent.  In
 the meshos of this plexus several small ganglions
 are enclosed, and  to  these  conjointly the term
 cardiac ganglion is applied.  Branches proceed
 from this plexus to the coronary and pulmonary
 vessels, to the aorta  and vena cava, and to the
 substance of the heart itself.
   Thoracic  Ganglions are twelve on each side,
 sometimes only eleven, the last cervical and first
 dorsal being united.   1. Branches to the medi-
 astinum, which ramify on the aorta and adjacent
 vessels, and  communicate with the pulmonary
 plexus.  2. Great Splanchnic Nerve, is formed
 by distinct roots, from the 6th, 7th, 8th, and 9th
 ganglions; uniting on the  9th dorsal  vertebra
 into one cord, it enters the abdomen along with
 the aorta, or separated from it by a fasciculus of
 the diaphragm, and expands into the semilunar
 ganglion.   3. Lesser Splanchnic Nerve arises by
 two roots from  the 10th and 11th ganglions;
 uniting on the side of the last dorsal vertebra,
 it enters the abdomen through  the crus of the
 diaphragm, and  ends  partly in the renal plexus
 and partly in the semilunar ganglion.
  Semilunar Ganglia  are situated on the dia-
 phragm, partly on the aorta, and on either side
 of the cceliac axis, and above and  behind  the
 supra-renal capsule.  They are the largest gan-
 glia  of the  sympathetic;  several  nervous fila-
 ments, on which  small ganglia are placed, pass
from one to  the other surrounding the cceliac
axis, forming a plexus, called the 
152
   Solar Plexus,  which is situated behind the
 stomach, above the pancreas, and in front of the
 aorta.   It gives off, 1. Branches in various di-
 rections, accompanying the blood-vessels, form-
 ing plexuses around each, and  named accord-
 ingly,  hepatic, splenic, and  gastric, and these
 communicate with the eighth pair. 2. Branches
 descending  in front of  the aorta, which sub-
 divide at the renal  and mesenteric arteries, ac-
 companying them, and forming plexuses, named,
 accordingly, renal, superior,  and inferior mesen-
 teric, and into each of these branches of the
 lumbar ganglions enter.
   Benal Plexus  receives the lesser  splanchnic
 nerves; from  it descends  the spermatic plexus,
 which goes to the testicle in  the male, and to the
 ovarium and uterus in the female.
  Inferior  Mesenteric  Plexus sends  branches
which descend to the brim of the pelvis, unite
with others from the lumbar  ganglions, and form
a plexus around the internal  iliac artery and its
branches, named hypogastric plexus. It is joined
by numerous filaments  from  the  lumbar and sa-
cral ganglions of the sympathetic, and communi-
cates with the pelvic branches  of the sacral
plexus.
  Lumbar Ganglions are five  on each side, some-
times only three or four.   1.  Filaments to  an-
terior branches  of  lumbar spinal nerves.   2.
Filaments to assist  in  forming the several ab-
dominal plexuses.
  Sacral Ganglions are three or four in number. 
153
1. Filaments to sacral nerves.  2.  Filaments to
hypogastric and  pelvic  plexuses.   3.  A  small
branch  from the last ganglion, which passes in
front of the coccyx, there forming with its fel-
low the
   Ganglion Impar, which sends branches to the
coccygeus, levator, and sphincter ani muscles.
  The  sympathetic nerve  twines  around and
enters  the coats of the arteries of the viscera,
contained in the cranium, the neck, thorax, abdo-
men, and pelvis.  Hence it has been called the
Great Visceral nerve.  It is believed to preside
over the functions of secretion, nutrition, and
involuntary motion.
   THE THORAX AND ITS CONTENTS.

   The thorax is bounded anteriorly by the ster-
num and cartilages of the ribs, posteriorly by the
vertebrae and lesser circle of the ribs, and on ei-
ther side by the shafts of the ribs and the  inter-
costal muscles.   Its upper orifice is transversely
oval, and allows the exit and entrance of vessels,
nerves, and muscles, to and from  its cavity; its
inferior orifice, or  circumference, being  much
larger, and closed by the diaphragm.
  The thorax contains the heart and lungs, and
also several vessels, nerves,  glands, &c,  to be
noticed as we proceed. 
154
                THE PLEURiK

Are two serous membranes, one on either side,
which cover the inner surface of the thorax, and
are reflected upon the outer surface of the parts
contained in its cavity.  That portion of the
pleura which lines the thorax is called the pari-
etal layer, and  that which lines the contained
parts  the visceral layer.  Each pleura can be
traced in the following manner:—From the pos-
terior surface of the sternum it passes backwards
until it meets with  the anterior surface of the
pericardium, along the side of which it passes to
the anterior surface of the root of the lung; from
this it passes upon the lung, and is reflected over
the entire surface of the organ, until it arrives
at the posterior surface of its root and of the pe-
ricardium, from whence it passes upon the sides
of the bodies of the vertebrae, reaching as high
as the transverse process of the sixth  cervical
vertebra on the right side, the seventh on the
left, and descending  to the diaphragm, the tho-
racic  aspect of which it covers; it finally lines
the ribs and intercostal  muscles, until it arrives
at the portion which was opened,  and which
corresponds  to the posterior  aspect of  the
sternum.
   Ligamentum latum pulmonis (one  on either
side) is merely a triangular fold of pleura, formed
by the reflection of the membrane from the lower
edge of the  root of the lung upon  the vessels
from the heart. 
155
            ANTERIOR MEDIASTINUM.
  A triangular cavity formed by tearing through
the cellular tissue, which connects the right and
left  pleura  behind the  sternum;  the  base  is
formed by the sternum, the  sides by the sepa-
rated pleurae, and the apex corresponds to the
anterior  surface of the pericardium,  where the
pleurae separate to  enclose  this  bag.   Thus
formed, it contains the origins of the sterno-hyoid
and sterno-thyroid muscles, the remains of the
thymus gland with its vessels, lymphatic glands
and absorbents, the triangularis, sterni  muscles,
and loose cellular tissue.

             MIDDLE MEDIASTINUM
Is of oval shape, and is formed by the reflection
of the pleurae upon the sides of the pericardium;
it consequently contains this bag  and  its  con-
tents,  viz. the heart,  with its  vessels;  also the
phrenic nerves.

            POSTERIOR MEDIASTINUM
Is formed by the  reflection of the pleurae upon
the  sides of the bodies of the vertebrae;  it is of
triangular form, the apex anterior corresponding
to the posterior surface of the pericardium, the
sides formed by the  pleurae, and the base repre-
sented by the anterior surfaces of the  bodies of
the vertebras; it extends from the third to the
 tenth dorsal vertebra, and contains the following
 parts:—the bifurcation of the trachea,  the  ceso- 
156
phagus and pneumogastric nerves, the thoracic
duct, the vena azygos, the thoracic aorta, lym-
phatic glands,  absorbents, bronchial  and  oeso-
phageal arteries, and loose cellular tissue.

                  THE LUNGS

Are two soft, spongy, vascular bodies, one con-
tained on each side of the cavity of  the  chest.
Each lung resembles a cone, with  that side cor-
responding to  the  median line  truncated; the
base, concave,  corresponds to the diaphragm;
the obtuse rounded apex rises in the neck, a little
above the level of the first rib;  the external
convex surface corresponds to the internal con-
cave surface of the thoracic parietes, and the flat
or truncated surface corresponds to the medias-
tina.  The posterior edge of the lung is  tliick
and rounded, whilst the anterior is  thin and irre-
gular.   Each  lung is  distinguished into  lobes,
which are separated from each other by fissures;
a little  above  the  centre  of  each is the root
formed  by the  pulmonary vessels and bronchial
tube, connected to each other  by cellular tissue,
and invested by the pleura.  The bronchial tube
is situated posterior and superior to the pulmo-
nary vessels; the two pulmonary veins are placed
anterior and inferior to the artery and  bronchus,
and the pulmonary artery is placed between the
bronchus and  the  pulmonary veins, but behind
the pulmonary veins  and before the  bronchus.
On the left side, the bronchus, more oblique than 
157
its fellow, descends near the root of the lung so
as to lie between the artery and vein.  The root
of each lung has anterior to it the phrenic nerve
and filaments of the pneumo-gastric nerve, pos-
terior to it the pulmonic plexus.  The root of the
right lung has the vena azygos arching over it.
   The right and left lungs differ from each other
in some important particulars: the right lung is
broader and shorter than the left, and consists
of  three lobes, separated by two fissures; the
right also ascends higher in  the  neck, and the
anterior edge of the left presents a notch where
it corresponds to the apex of the  heart.
  The intimate structure of the lungs consists of
the ultimate ramifications of the bronchial tubes,
which are the continuations of the trachea, and
the branches of the pulmonary artery and veins;
the larger tubes at the root of the lung receive
bronchial  arteries for their nutrition.

       TRACHEA  AND ITS RAMIFICATIONS.
  The  wind-pipe, or  trachea, is a cylindrical
tube, extending from the cricoid cartilage of the
larynx to  the level of the third dorsal vertebra.
It consists of from  seventeen to twenty fibro-
cartilaginous rings,  truncated behind, and con-
nected to  each other by an elastic membrane;
about the posterior fourth  of each ring  is defi-
cient, and its place is supplied by fibrous mem-
brane and unstriped or involuntary muscular fibre.
  Opposite the third dorsal vertebra the trachea
                     14 
153
divides into the right and left bronchial tubes;
the rig!it bronchus, larger than  the  left, runs
transversely into the root of the lung and divides
into three  branches;  the left bronchus passes
under the arch of the aorta,  to the root of the
left lung, and divides into two branches.
  The bronchia consist  of cartilaginous rings,
but as these tubes advance into the substance of
the lung they diminish in size and firmness, until
their  place is supplied  by fibrous tissue, invo-
luntary muscular fibres, which tissue also disap-
pears, and at length nothing remains but the
mucous membrane,  which terminates in the air-
cells,  upon which ramify the ultimate ramifica-
tions  of the pulmonary artery and the commenc-
ing radicles of the pulmonary veins.
  The ramifications  of  the  pulmonary  artery
communicate with those of the pulmonary veins,
beneath the mucous membrane of the air-cells,
and are  enveloped  in fine cellular tissue;  and
except this cellular  tissue the lung has no proper
parenchyma, its structure being entirely vascu-
lar.   The roots  of the lungs are supplied with
blood by the bronchial arteries, derived from the
thoracic  aorta; these vessels run along the bron-
chial  tubes, subdivided as they proceed, and form
a minute network on the attached surface of the
bronchial  mucous membrane; the blood they
convey to the  lungs is returned to the vena
azygos, or superior intercostal.  The nerves dis-
tributed to the lungs are derived from the eighth
pair,  and from the sympathetic. 
159
          HEART AND  PERICARDIUM.

  The pericardium consists  of two layers, an
outer, or proper fibrous layer, and an inner, or
serous layer.  It is of conical form, the base be-
low connected to the central division of the cor-
diform tendon of the diaphragm, the apex above
corresponding to the great vessels at the base of
the heart, along the outer coats of which the
fibrous layer is gradually lost; it is connected
laterally to the pleura and to the pulmonary ves-
sels ;  the phrenic nerves, one on either side, run
in close contact with it to  the diaphragm. Upon
laying open the cavity of the pericardium, the
serous layer is exposed, and, like all serous mem-
branes, it consists of  two portions—a parietal
layer, which lines the inner surface" of the fibrous
pericardium, and  a  visceral  layer,  which  lines
the outer surface of the heart and great vessels.
When the pericardium is fully opened, we bring
into view, covered by  the serous membrane, the
right auricle, the venae cava?, the left auricular
appendix, the right  ventricle, the tip of the left
ventricle (which forms the apex of the heart),
the aorta, the pulmonary  artery, and the ante-
rior branches of the  coronary vessels, with the
ramifications of the cardiac nerves.   Upon turn-
ing up the heart its  posterior surface will  be
brought into  view,  presenting the left auricle
(proceeding to  which, on either  side, are the
pulmonary veins)  and the left ventricle.
  The  serous membrane may be traced in the 
160
 following manner:—After  having Jned the fi-
 brous pericardium it is reflected on the superior
 cava and aorta, and the pulmonary artery, as these
 vessels are passing through the fibrous membrane,
 ascending highest, however, upon the aorta;  in-
 feriorly it is partly reflected around the  inferior
 cava, as this vessel pierces the fibrous pericardium
 to  enter the  right auricle, and laterally it is re-
 flected upon the pulmonary veins as these vessels
 pierce the fibrous pericardium to enter the left
 auricle; from these different points it reaches the
 surface of the heart, which it completely covers.
   The heart, of conical shape, is situated ob-
 liquely between the lungs, its base being supe-
 rior, posterior, and  to  the  right side, its  apex
 pointing towards the cartilage of the sixth rib of
 the left side.   The axis of the heart is obliquely
 from right to  left, and from behind forwards.  It
 is retained in its situation by the great vessels
 and the reflections of the serous membrane.
  The heart consists of four cavities, two  auri-
 cles and two  ventricles; the  auricles  are sepa-
 rated from each other by a partition, called sep-
 tum auricularum, the ventricles by the septum
 ventriculorum. We  shall examine these cavities
 in the order of the circulation.
  The right auricle is placed between the two
 venae cavae, the blood conveyed by which it re-
 ceives and transmits to the right ventricle; the
 small loose portion  is called the auricular ap-
pendix, and the portion between the cavae the
 sinus of the auricle.  Upon laying open this au- 
161
ricle, by a perpendicular cut from the superior
cava to within a few lines of the entrance of the
inferior cava, and by a second cut from the cen-
tre of this at right, angles towards the auricular
appendix,  the  following parts present  them-
selves.
   Tuberculum Loweri, an eminence  upon the
under  surface of the sinus of the auricle, and
placed between  the  orifices of entrance  of the
vena; cavae.
   Septum  auricularum,  a membrano-muscular
partition separating this auricle from the left.
   Fossa ovalis, an oval depression in the septum,
which marks the situation of the foramen ovale,
or  the  oval communication which existed be-
tween both auricles in the foetus.   The edges of
this fossa present a thickened margin.
   Eustachian valve,  a semilunar fold of the lin-
ing membrane, the anterior aspect of the inferior
vena cava.
  Musculi pectinati, the muscular bands situated
in the auricular appendix.
   Openings of the  Venae Cavae.   The superior
cava opens at the upper and back part of the
auricle, its direction being downwards, forwards,
and inwards; the  inferior cava opens beneath,
in a direction upwards, backwards, and inwards.
   Opening of the Coronary Vein is situated be-
tween the  Eustachian valve and the right ven-
tricle, and is guarded by a semilunar valve (the
valve of the coronary vein).
   Opening  of the  Auricular Appendix, is small
                     14* 
162
 and circular, and exists where this portion of the
 auricle joins the sinus.
   Foramina  Thesebii, small orifices on different
 parts of the auricle, supposed to be the openings
 of veins.
   Bight Auriculo-ventricular  opening, the large
 opening by which the auricle communicates with
 the  ventricle, the boundaries of each cavity be-
 ing marked by a white line.
   Right ventricle, of conical form, is joined by
 its basis to  the right auricle, its  apex  being
 above the apex of the heart, in consequence of
 the apex of this organ  being formed by the left
 ventricle.
   Septum  ventriculorwm, a thick  muscular par-
 tition which separates one ventricle  from  the
 other.
   Carnece  columnae, the muscular projections in
 the interior of the ventricle, which give  it its
 irregular appearance.
   Chordae  tendmew, the delicate but strong ten-
 dinous cords which are connected  by one ex-
 tremity to the carneae columnae, and by the other
 to the tricuspid valve.
   Tricuspid Valve, three triangular duplicatures
 of the lining membrane of the heart,  strength-
 ened by the chordae tendineae  which pass  from
 their  apices to  their bases.   These triangular
 valves are  attached  by their bases to the right
auriculo-ventricular opening, and by their apices
to the chordae tendineae, and prevent the regur-
gitation of  the blood from the ventricle into the 
163
auricle, by closing the opening of communica-
tion between both cavities, when the ventricle
contracts.
   Orifice of the  Pulmonary Artery is  situated
at the left extremity of the base of the ventricle,
close to the right auriculo-ventricular opening,
which is situated  inferior,  posterior, and  to  its
right,  and  separated  from the mouth of the ar-
tery by the largest triangular division of the tri-
cuspid valve.
   Pars planum is a name given to that smooth
portion of the ventricle which leads to the mouth
of the pulmonary artery.
  Pulmonic  Semilunar Values extend from the
line of junction  of the pulmonary artery and
right ventricle into the cavity of the former.
These three valves are duplicatures of the lining
membrane,  and  are  attached by their convex
edges to the roots of the pulmonary artery; their
free concave margins  presenting in their centre
a small tubercle,  called corpus  sesamoideum,  or
corpus arantii.  These valves,  when the  blood
passes from this  ventricle  into  the pulmonary
artery, are thrown down, and thus, by closing
the opening, prevent a reflux of the blood back
again into the ventricle.
  Left auricle is placed at the upper and back
 fart of the heart, and is  of quadrilateral form.
 t is smaller than the  right auricle, and receives,
at its four angles, the  openings of the pulmonary
veins; its parietes are much  thicker than  the
right;  its auricular appendix smaller, but  the 
164
 musculi pectinati are the stronger:  with the ex-
 ception of the auricular appendix its inner sur-
 face is smooth, and  it communicates  with  its
 corresponding ventricle by the left auriculo-ven-
 tricular opening, which is situated inferior to the
 opening of the auricular appendix, and is marked
 by a whitish line.   The septum auricularum pre-
 sents towards this auricle a smooth aspect, from
 circumstances already explained.
   Left ventricle^s longer, stronger, and smaller
 than the right; from its greater length it forms
 the apex of the heart; from its greater  strength
 it is of power sufficient to  propel  the arterial
 blood  through  the aorta and  its ramifications.
 We  consequently find the carneae columnae, the
 chordae tendineae,  the bicuspid, or mitral valve,
 the  parietes of the  cavity, the aorta, which
 arises from it, and the semilunar valves with their
 corpora sesamoides, which guard the opening of
 this  vessel,  much stronger than in the right di-
 vision of the heart.
   The  left auriculo-ventricular opening,  and the
 mouth of the  aorta, are situated at the base of
 this cavity, and are close to each other, the aortic
 opening being anterior, and both being  separat-
 ed, as in the right  ventricle, by the  larger  divi-
sion of  the bicuspid valve.  With the exception
 of the  peculiarities just mentioned, the left
auricle  and ventricle  are, in their  anatomical
configuration,   similar to the  right, and the
several  valves,  muscular eminences, tendons,
cords, &c,  serve similar purposes:  the  septum 
                     165

ventriculorum  belongs chiefly to the left ven-
tricle.
                 ARTERIES.

                  THE AORTA,
Is divided into three portions—viz., the arch of
the  aorta, the thoracic  aorta, and the abdomi-
nal aorta.

           THE ARCn OF THE AORTA
Sends off five branches.
  A. Arteria coronaria  dextra, which sends  a
branch to the right  auricle, a branch  to the an-
terior part of the right ventricle, and a branch
to the posterior part  of the right ventricle.
  B. Arteria coronaria  sinistra, which sends  a
branch to  the left auricle, and a branch to the
left ventricle.
  C. Arteria innominata, which divides into the
right carotid and right subclavian arteries.
  D. Left carotid artery.
  E. Left subclavian  artery.

             TnE COMMON CAROTIDS

Divide opposite  the upper corner of the thyroid
cartilage into two branches.
  A. External carotid artery.
  B. Internal carotid artery. 
166
             THE EXTERNAL CAROTID

 Sends off ten branches, viz.:—
   A. Superior  thyroid, which sends off—1st, a
 hyoidean branch; 2d, a superficial  branch;  3d,
 a laryngeal  branch;  and  4th, a  thyroidean
■branch.
   B. Lingual, which sends off—1st, a hyoidean
 branch;  2d,  the dorsalis  linguae artery;  3d,
 the  sublingual   artery;  and  4th,  the  ranine
 artery.
   C. Facial, which  sends off—1st,  the  inferior
 palatine; 2d, the tonsillar; 3d,  the glandular;
 4th, the  submental;  5th, the inferior  labial;
 6th, the inferior coronary; 7th, masseteric; 8th,
 superior coronary;  9th, the lateral nasal; and
 10th, the angular, which anastomoses with the
 ophthalmic.
   D. Muscular.
   E. Occipital,  which  gives off the princeps
 cervicis, the inferior  meningeal, and the terminal
 branches, of which one enters the mastoid fora-
 men ; the others ramify in the scalp.
   F. Posterior auris, which  gives off the mus-
cular, the glandular,  and the stylo-mastoid.
   G. Ascending   pharyngtal, which  gives  off
the  pharyngeal  branches  and  the  meningeal
branches.
   H. Transverse facial.
  I.  Superficial  temporal, which gives off—1st,
the anterior auris;   2d, the capsular branches; 
167
3d, the middle temporal; 4th, the posterior tem-
poral ;  and 5th, the anterior temporal.
  K. Internal maxillary,  which gives off—1st,
the tympanic, which enters the fissura Glasseri;
2d, the meningea media, which enters the fora-
men spinosum; 3d, the inferior maxillary or den-
tal, which enters the dental canal; 4th, the deep
temporal;  5th, the pterygoid ; 6th, the massete-
ric ;  7th, the buccal; 8lh, the alveolar; 9th, the
infra-orbital;  10th,  the  descending  palatine;
11th, the  vidian; 12th, the  pterygo-palatine;
13th, the spheno-palatine.


             THE INTERNAL CAROTID

Supplies no vessels in the neck, but in its pass-
age through the petrous portion of the temporal
bone, gives off—
  A. The tympanic.
  B. The  arteries receptaculi, or vessels to the
cavernous sinus.
  C. The anterior meningeal.
  Opposite the anterior clinoid process it divides
into—
  A. Ophthalmic  artery,  which sends off—-1st,
the lachrymal; 2d, the centralis retinae; 3d, the
supra-orbital; 4th, the ciliary branches; 5th, the
muscular ;  6th, the posterior ethmoidal; 7th, the
anterior ethmoidal; 8th, the palpebral; 9th, the
nasal;  and 10th. the frontal.
  B. Anterior cerebral, which sends off—1st, the 
168
anterior communicans;  2d, the arteria corporis
callosi.
  C. Arteria media cerebri.
  D. Posterior Communicans.
  The anterior cerebral arteries are united by
the anterior communicans, the posterior commu-
nicans passes back to join the posterior cerebral
(a branch of the basilar), and in this manner
is formed an  arterial circle,  called the circle of
Willis.
           THE SUBCLAVIAN  ARTERY

Is divided for surgical purposes into three por-
tions—1st, on the right side  it extends from the
arteria innominata to the inside of the scalenus
anticus.   2d, the second portion lies  under the
scalenus anticus.   3d, the third portion extends
from the  scalenus anticus to the lower  border
of the first rib.   On the left side, the left sub-
clavian  extends from the arch of the aorta to
the inside of the scalenus anticus muscle.   2d,
the second portion of the left  subclavian, like
that of the right  side,  lies  under the scalenus
anticus.   3d, the third portion  of the left sub-
clavian, also like that of  the right, extends from
the scalenus anticus to the lower border of the
first rib.   The third portion of the subclavian
arteries is the one usually ligated.
  A.  Vertebral, which  gives off—1st, the arte-
riae medullae spinalis transwrsae; 2d, the menin-
geal;  3d, the inferior cerebellar; 4th, anterior
and posterior spinal.  The basilar artery, formed 
169
by  the union of  the two vertebrals,  gives  off
transverse  branches to the pons, a small branch
enters the meatus auditorius internus;  and ter-
minates by dividing into four large vessels—the
posterior  cerebral and  superior  cerebellar ot
either side.
  B.  Internal mammary, which gives  off—1st,
the anterior intercostal; 2d, the  mediastinal;
3d, the comes nervi phrenici; 4th; the musculo-
phrenic ; and 5th, the superior epigastric.
  C.  Thyroid axis, which divides into—1st,  in-
ferior thyroid, which gives  off the cervicalis as-
cendens;  2d, supra-scapular, which gives off a
supra-acromial branch, and  then passes into the
Bupra-spinous fossa of  the scapula,  over the
notch;  3d,  posterior scapular, which gives off a
superficial cervical branch,  and  then terminates
in the muscles of  the scapula.
  D.  Cervicalis  profunda,   anastomoses  with
princeps cervicis from the occipital.
  E.  Superior intercostal, supplies the two or
three first intercostal spaces.

            THE  AXILLARY  ARTERY,

Extends from first rib to the lower border of the
tendon of the latissimus dorsi; it sends off seven
branches.
  A.  Acromial thoracic.
  B.  TAoracica suprema.
  C.  Thoracica alaris.
  D.  External mammary, or long thoracic.
                     15 
170
   E. Subscapular, which sends off an anterior
 and a posterior branch.
   F. Posterior circumflex.
   G. Anterior circumflex.

            THE  BRACHIAL ARTERY
 Extends from the lower border of the tendon of
 the  latissimus dorsi  to  a finger's breadth be-
 low the  bend of the  elbow, and sends off four
 branches.
   A. Profunda superior, which sends off—1st,
 an ascending branch;  and  2d,  the musculo-
 spiral  branch.   It accompanies the musculo-
 spiral nerve.
   B. Nutriiia humeri.            (
   C.  Profunda inferior, which accompanies the
 ulnar nerve.
   D. Anastomotica magna.

             THE RADIAL ARTERY

 Sends off ten branches.
   A. Becurrent  radial.  It  anastomoses with
 the profunda superior.
  B. Muscular.
  C. Superficialis voice, anastomoses with  the
ulnar to form the superficial palmar arch.
  D. Anterior carpi radialis.
  E. Dorsalis carpi radialis.
  F. Dorsalis pollicis.
  G. Dorsalis indiris.
  H. Princeps poUicis. 
171
  I.  Badralis indicis.     '
  K.  Palmaris profunda.
              TnE ULNAR ARTERY
sends off eight branches.
  A.  Anterior recurrent.
  B.  Posterior recurrent.
  C.  Interosseous, which sends off—1st, the an-
terior recurrent;  2d, the anterior interosseous;
3d, the posterior  interosseous;  4th, the poste-
rior recurrent; and 5th, the posterior descending
branch.
  D.  Muscular.
  E.  Carpi ulnaris anterior.
  F.  Ulnaris posterior.
  G.  Arteria communicans.
  H.  Palmaris  superficialis, which anastomoses
with the superficialis volae to form the superficial
palmar arch.   A long branch comes off from the
ulnar or interosseous, called  the comes nervi me-
diani; it is of uncertain size.

               PALMAR ARCHES.
  The deep palmar arch is  formed by the pal-
maris profunda  of the radial, uniting with the
arteria communicans from the ulnar; it sends off
five small branches to supply the interossei mus-
cles.
        THE SUPERFICIAL PALMAR ARCn
is  formed by  the  arteria palmaris of the ulnar,
uniting with  the superficialis  volae from the  ra-
dial.   It sends off four branches. 
172
   A. Branches to ulnar edge of little finger.
   B. Branch  to  cleft  between  little and ring
fingers.
   C. Branch to cleft between ring and middle
fingers.
   D. Branch to cleft between middle and index
fingers.
              THE THORACIC  AORTA
sends off five sets of branches.
   A. Pericardiac.
   B. Mediastinal.
   C. Bronchial.
   D. Oesophageal.
   E. Intercostals: each divides into—1st, the pos-
terior branches; and 2d, the anterior branches.

            THE AORTA  ABDOMINALIS
sends off the following branches.
   A. The two phrenic arteries.
   B. The cceliac axis.   From this  axis arise—
1st, the  superior  gastric artery, which divides
into a superior and  an inferior branch;  2d, the
hepatic  artery, which gives  off the  superior py-
loric artery, the gastro-duodenal artery, which
divides  into the arteria pancreatica duodenalis,
and the arteria gastro-epiploica dextra.  The he-
patic artery then divides into the left hepatic and
right hepatic arteries, from the last of which pro-
ceeds a small branch to the gall-bladder, called
arteria  cystica;  3d, the splenic artery, which
sends off the pancreaticae parvae, the pancreatica 
173
magna, the  vasa brevia, splenic branches, and
the gastro-epiploica sinistra.
   0.  T e superior mesenteric artery, which gives
off—1st, the colica dextra,  which divides into a
superior  and an  inferior branch; 2d, the colica
media, which divides into a right and left branch;
3d, the ileo-colica, which divides into a superior
branch, a middle branch, and an inferior branch;
and lastly, the mesenteric branches, from fifteen
to twenty in number.
   D.  Two capsular, to the renal capsules.
   E.  Iwo renal, to the kidneys.
   F.  Two spermatic, to the testicles.
   G.  Inferior  mesenteric, which  sends off—1st,
the colica sinistra, which divides  into an ascend-
ing branch and  a descending branch;  2d, the
sigmoid artery;   and 3d, the  superior  hemor-
rhoidal artery.
  H.  Ureteric arteries.
  I.  Lumbar arteries.
  K.  Sacra media.
          THE COMMON ILIAC ARTERIES
extend  from the bifurcation of the aorta to op-
posite  the sacro-iliac symphysis;  the right  is
usually longer  than the left: they extend into
two branches, viz.
  The internal, and
  External iliac arteries.

         THE INTERNAL ILIAC  ARTERY
sends off eleven branches in the female.
                     15* 
174
  A.  Arteria Uio-lumbalis, which sends off—1st,
ascending branches; 2d, external branches; and
3d, descending branches.
  B.  Lateral sacral.
  C.  Middle hcemorrhoidal.
  D.  Vesical.
  E.  Umbilical.
  F.  Uterine.
  G.  Vaginal.
  H.  Obturator,  which sends  off — 1st,  the
branches within  the pelvis;  and 2d, branches
without the pelvis.
  I.  Gluteal, which sends off—1st, a superficial
branch ; and 2d, a deep branch.
  K.  Ischiatic,  which sends off—1st, the coccy-
gseal  branch;  2d, the arteria comes nervi ischi-
atici;  and 3d,  the muscular branches.
  L.  Pudic, which sends off—1st, the external
haemorrhoidal  arteries;  2d, the  perinseal; 3d,
the transversalis perinaei; 4th, the arteria cor-
poris bulbosi, which gives a branch to Cowper's
gland, and  a branch to the corpus spongiosum ;
5th, the arteria corporis cavernosi  penis; and
6th, arteria dorsalis penis.

             THE EXTERNAL ILIAC

sends off two branches.
  A.  Epigastric, which sends off—1st, a sper-
matic branch,  and 2d, the muscular arteries.
The epigastric  anastomoses with the internal
mammary. 
175
   B.  Circumflexa ilii,  anastomoses  with  the
ilio-lumbar.

             THE FEMORAL ARTERY
extends from Poupart's ligament to an opening
in the tendon of the adductor magnus, where it
becomes "popliteal."  At Poupart's ligament
the femoral vein is on the inside of the  femoral
artery, the anterior crural nerve is on the out-
side of the artery.  In  the  upper third of the
thigh, the femoral artery lies  in a  triangular
(Scarpa's space) space, bounded on the outer side
by the sartorius, inside by the adductor longus
brevis and the pectineus, and superiorly by Pou-
part's ligament   In the middle of  the thigh
the artery is overlapped by  the  sartorius.   In
ligaturing the femoral artery  here, an  incision is
to be made  on the  inside of the sartorius.   It
sends off the following branches:
  A.  Superficial epigastric.
  B. Pudenda superficiales.
  C.  Circumflexa ilii superficialis.
  D. Profunda femoris,  which  sends off—1st,
the circumflexa externa, from which arise  the
ascending  branches,  the  circumflex  branches,
and descending  branches; 2d, the circumflexa
interna,  from  which  arise arterial branches to
the muscles  of the hip-joint, and a branch to
the interior of the hip-joint; 3d, the  arteria
perforans prima;  4th, the perforans secunda;
5th, the perforans tertia.
  E.  Anastomotica magna. 
176
            TnE POPLITEAL ARTERY
lies upon the ligamentum  posticum Winslowii,
and upon the popliteus muscle:  and divides into
anterior  and posterior tibial; it sends off seven
branches.
  A.  Superior Muscular.
  B.  Articularis superior externa, which sends
off a  superficial branch, and a deep branch.
  C.  Articularis superior interna,  which sends
off a  superficial branch, and a deep branch.
  D.  Azygos branch, which perforates the liga-
mentum  posticum Winslowii.
  E.  Articularis inferior externa.
  F. Articularis inferior interna.
  G.  Inferior muscular.
            THE TIBIALIS POSTICA
lies upon the tibialis posticus, and flexor longus
digitorum, and  is bound down by the deep fas-
cia of the leg.  It is accompanied by two veins
(venae comites) and by the posterior tibial nerve
—sends off—
  A. Musculur.
  B. Peroneal, which sends off—1st, the nutritia
fibulae ;  2d, the muscular; 3d, the anterior pero-
neal ;  and 4th, the posterior peroneal.
  C. Nutritia tibiae.
  D. Internal plantar.
  E. External plantar 
177
            THE TIBIALIS  ANTICA
passes through the interosseous space, and sends
off the following branches.
   A Muscular.
   B. Becurrent.
   C. Internal malleolar.
   D. External malleolar.
   E. Tarsal branch.
   F. Metatarsal branches.
   G. Arteria pollicis.
   H. Arteria communicans.

              THE PLANTAR ARCH
is formed by the external plantar artery uniting
with the arteria  communicans of the anterior
tibial; it sends off two sets of branches:—
   A. Arterim perforantes.
   B. Arteria; digitales.

           THE PULMONARY ARTERY

divides into two branches:—
  A. Bight pulmonary.
  B.  Left pulmonary.
                  VEINS.

  The veins are not so uniform in  their distri-
bution as the arteries.  Besides the numerous
superficial veins which ramify on the skin, one 
178
 or two are found to accompany each artery. In
 the extremities there are generally two to each
 artery, and in these situations they receive the
 name of  venae comites.  When, however, an
 artery is of great size, as the femoral or the axil-
 lary, it is  accompanied by but one vein, which
 receives the same name as the artery.

         VEINS OF THE HEAD AND NECK.
   The veins  which  accompany the branches of
 the internal maxillary artery, form the internal
 maxillary vein.
   External jugular vein, formed by the junction
 of the internal maxillary and one temporal vein
 descends obliquely backwards, and joins the sutv
 clavian vein;  after crossing  the sterno-mastoid
 muscle it receives the supra and posterior sca-
 pula veins.
   Internal jugular vein, commences at the  ter-
 mination of the lateral sinus,  descends along the
 outer side  of the common carotid  artery, and
joins  the subclavian  vein at  the  sternal extre-
 mity of the clavicle.  It receives  the superior
 thyroid,  lingual, facial, occipital, and ascending
pharyngeal veins.

      VEINS OF THE  SUPERIOR EXTREMITY.
   The Cephalic vein is formed by the union of
several veins from the back of the hand.  It as-
cends along the radial side of the extremity
and, passing along the interval between the pec- 
179
 toralis major and deltoid muscles, terminates in
 the axillary vein.
   The Basilic vein commences by a small vein
 from the little finger (vena salvatella), ascends
 along the inner side of the extremity, and  ter-
 minates in the axillary vein, or joins one of the
 vence  comites  which  accompany the  brachial
 artery.
   The Median vein commences at the fore part
 of the wrist and hand, ascends along the anterior
 aspect of the forearm, and at the elbow termi-
 nates by dividing  into two branches.   One of
 these joins  the basilic vein, and is  named the
 median  basilic;  the  other  joins the  cephalic
 vein, and is named median cephalic.
   The Axillary vein, formed by the union of the
 veins just described, and by the brachial vence
 comites, ascends in front of the axillary  artery,
 receiving the thoracic veins, and passes beneath
 the clavicle, where  it terminates  in  the  subcla-
 vian vein.
   The Subclavian vein passes inwards over the
 anterior scalenus  muscle,  receives numerous
 veins from the neck  and shoulder, also  the ex-
 ternal jugular and vertebral veins, and joins  the
internal jugular vein behind the  sternal extre-
mity of the clavicle.
   Vena innominata, formed by the union of the
internal  jugular  and subclavian veins,  on  the
right side is very short, and descends  into  the
thorax; the left vena innominata, which is much
longer, enters the thorax in a transverse direc- 
180
 tion  in  front  of the trachea to join the right
 vein, and in its course receives the thyroid veins,
 and veins from the anterior  mediastinum.   By
 the union of the venae innominatae is formed the-
   Vena cava superior, which descends in front
 of the right pulmonary vessels, enters the peri-
 cardium, and opens into the right auricle.

                 VENA AZYGOS,
 commences on the first lumbar vertebra by one
 or two small veins from the renal or from the in-
 ferior vena cava, gains the posterior mediastinum
 by passing through  the  aortic opening of dia-
 phragm,  ascends along the  right  side  of  the
 bodies of the dorsal vertebrae, curves forwards
 over the  root of the right lung, and terminates
 at the posterior aspect of the superior vena cava,
 as this vessel is entering the pericardium. In its
 course it  receives  the lower intercostal veins ot
 each side, oesophageal veins, the  azygos minor,
 right bronchial, and sometimes the right superior
 intercostal veins.  It has no valves.

      VEINS OF THE INFERIOR EXTREMITY.
  Internal saphena vein, commences at  the  in-
ner part of the foot, ascends along the inner side
 of the leg and knee, behind the inner condyle
 becomes  more anterior upon the  thigh, and
reaching to within about two inches of Poupart's
hgament, passes through  the saphenic opening
of the fascia lata, ani joins the femoral vein. 
181
   External saphena vein, commences at the outer
 part of the foot, ascends  along  the back part of
 the leg and ham, and joins the popliteal vein.
   Both these veins are superficial, and in their
 course receive  several veins from  the  integu-
 ments.
   Deep veins of the leg, two veins (venae comites)
 accompany each artery in the leg, and terminate
 in the following:—
   Popliteal vem:  this vessel accompanies the
 artery of the same name, and having received the
 external saphena vein, and the veins of the knee,
 terminates in  the femoral vein.
   Femoral vein accompanies the femoral artery,
 and having received the profunda vein, the in-
 ternal saphena  vein,  and a few muscular veins
 passes beneath the crural arch, and  ends  in the
 external iliac vein.
  External  iliac vein accompanies the external
 iliac artery.  This vein  is below, and to  the in-
 side of the artery.
  Internal iliac vein is formed by the union  of
 the veins  which accompany the branches of the
 internal iliac artery, and joins the external iliac
 vein at the sacro-iliac symphysis.
  Common iliac vein, formed by the union of the
internal and external iliac vein-Joins its fellow
at the right side of the body of the fourth lumbar
vertebra to form the inferior vena cava.
  Inferior vena cava ascends along the right side
of the bodies of the lumbar vertebrae, behind the
liver, and  passes through the quadrilateral open-
                     16 
182
ing in the tendon of the diaphragm, and opens
into the right auricle of the heart at its lower and
back part.   It receives  the  middle sacral, one,
and sometimes both spermatic veins, the emul-
gent and capsular veins, the venae cavee hepaticae,
and the phrenic veins.

                 VENA  P0RT2S

commences on the back of the rectum by one of
the haemorrhoidal veins,  ascends towards the
meso-colon,  and unites with the inferior mesen-
teric vein ; this trunk next unites with the supe-
rior mesenteric vein, and behind the  pancreas it
unites with  the  great splenic vein, and  receives
veins  from the  stomach, duodenum, and  pan-
creas.   The vena portae thus formed ascends to
the right side, inclosed in the capsule of Glisson,
and reaches  the transverse fissure of the liver,
where it divides into two branches: these enter
the liver, ramify through its substance like an
artery, and its blood is returned  to the inferior
vena cava by the venae cavae hepaticae, which are
three  or four in number, and open into the cava
as this vessel is entering its opening in the dia-
phragm.  The vena portae represents a tree, the
roots  of which are  in  the  stomach,  intestines,
pancreas, and spleen; they gradually converge to
form a large trunk, which  passes up to the trans-
verse fissure of the liver, and divides into branches
which subdivide like the branches of a tree, and
terminate in the minute lobules of the liver. 
183
      THE DIGESTIVE APPARATUS.

                 TnE  MOUTH.

   This cavity is bounded superiorly by the hard
 and soft palate, inferiorly by the tongue and the
 reflections of mucous membrane from it to the
 gums, and laterally by the cheeks.  Its anterior
 opening, which forms the commencement of the
 digestive canal, corresponds to the lips; and pos-
 teriorly  it  communicates  with the  pharynx
 through the opening called isthmus faucium, the
 boundaries of which are the soft palate and uvula
 superiorly, the tongue  inferiorly, and the pillars
 of the palate and tonsils laterally.  Within the
 mouth we observe the opening of the three sali-
 vary glands and follicles, and the teeth of either
 side. The parotid gland opens by a single orifice
 opposite the second superior molar tooth; the
 sub-maxillary gland of either side, by a single
 orifice at the anterior part of the tongue, by the
 side of the reflection of mucous membrane, called
 frenum linguae; and the third salivary gland or
sublingual by several small orifices (eight or ten)
 on either side of the frenum linguae.

                 THE  TEETH.

   The number of teeth in the  adult is thirty-
 two, sixteen  in  each jaw;  and to  distinguish
 them from the teeth of the child they are called
permanent.   They  are divided  into eight inci- 
184
sors, four  canine, eight bicuspids, and twelve
molars.  The  last molar does not appear until
late in life, and hence has been called the wis-
dom tooth.   It  is, however, sometimes want-
ing.
  In the child the number of teeth is only twenty,
and  are called milk, deciduous, or temporary
teeth.  They are divided into eight incisors, four
canine, and eight molars.
                 THE  PHARYNX
is a musculo membranous bag of conical shape,
extending by its base from the  posterior part of
the mylo-hyoid ridge and base of the skull, to the
posterior aspect of the cricoid cartilage, where it
terminates in  the  oesophagus.  It is connected
by its  posterior wall  to the  vertebrae by loose
cellular tissue, and interiorly it corresponds to
the mouth  and larynx.
  On laying open the cavity of the pharynx by
a perpendicular incision along its posterior me-
dian fine, the  internal mucous fining of the bag
will be exposed, and the following openings, viz.,
superiorly, one on either side of the mesial line,
the openings  of the posterior  nares; more ex-
ternally, one  on either  side of (he openings of
the  Eustachian tubes;  inferior to these  is the
opening of the mouth into the pharynx, or the
isthmus faucium; posterior and inferior to the
tongue is the superior opening  of the larynx,
and, lastly, the opening of the pharynx into the
oesophagus. 
185
               THE QSSOPHAGUS

extends from the termination of the pharynx to
the  stomach; it  is placed above, between the
vertebrae and the trachea, inclines at the inferior
part of the tube to the  left side, and passes be-
hind its left bifurcation to reach the posterior
mediastinum.   In the mediastinum it descends
forwards,   above  the   thoracic aorta,  passes
through the oval muscular aperture  of the dia-
phragm, to terminate in the stomach.  The mu-
cous membrane of the mouth, pharynx, and oeso-
phagus, is covered by epithelium.

                THE STOMACH.

  A large  pyriform musculo-membranous bag,
situated in the epigastric and left hypochondriac
regions, communicating at one extremity with
the oesophagus, and at  the other with the duo-
denum.
  Connexions.—Its large extremity, or fundus,
to the spleen by the gastro-splenic omentum; its
upper concave,  small edge, to  the hver, by the
gastrohepatic omentum; and its lower, convex
large edge, to the colon by the gastro-colic omen-
tum.  Its oesophageal, or cardiac orifice, situated
between the fundus and lesser curve, connects it
to the diaphragm, and its pyloric orifice to the
duodenum.  The superior-anterior surface of the
stomach looks towards  the diaphragm, ribs, and
left lobe of the  liver; the posterior-inferior sur-
face towards the meso-colon.
                    16* 
186
  The stomach is composed of three tunics, con-
nected by cellular tissue, an external peritoneal
coat, an internal mucous coat, and between both
the muscular coat  The muscular fibres of the
stomach  observe  three  directions; the longitu-
dinal are seen along the edges or curves, the ob-
lique on the fundus, and the circular are well de-
veloped at the centre of the  organ,  and at  its
pyloric orifice.   The mucous coat, smooth, and
of light pink colour, is thrown into folds (plicce),
which intersect  each other, inclosing irregular
quadrilateral spaces.   Numerous mucous glands
are found along  the  curves and at the pylorus:
in the fundus small glands exist, which secrete
the gastric juice.  At the pyloric orifice the mu-
cous membrane  is thrown into  a circular fold,
which  forms an imperfect valve between  the
stomach and duodenum; and at the oesophageal
opening the epithelial lining is observed to ter-
minate in a  fringed edge.


              8MALL INTESTINES
are divided into duodenum, jejunum, and ileum.
  Duodenum, the shortest portion of the small
intestines, forms a  curve  in  the concavity  of
which is  situated the head  of the pancreas; it is
divided into  a superior transverse portion, a mid-
dle  perpendicular portion, and an inferior trans-
verse portion.   The transverse portion mounts
upwards  and to the right  to  the under surface
of the liver and neck of the gall bladder; the 
187
descending extends as low as  the body of the
third lumbar vertebra; the transverse portion
crosses to the left side of the body of the second
lumbar vertebra, and then  opens into the jeju-
num.  The superior part is covered  by perito-
neum on both its surfaces, and on this account is  i
more moveable than the  perpendicular or infe-
rior portions.
   Besides the numerous mucous glands which
open on its interior surface, the pancreatie duct
and the common  biliary  duct  enter  at its per-
pendicular division, either  by  a common aper-
ture, or in close proximity.  These ducts gene-
rally open about from three to four inches below
the pyloric orifice  of the stomach.  This intes-
tine differs not only in these particulars from the
rest of the  small intestines,  but also in being
much larger, more  dilatable, more fixed to  its
position, in having a greater number of valvulae
conniventes (or  circular folds of the mucous
membrane),  and  in its  muscular fibres being
much stronger.  It  also  contains  Brunner's
glands, which  are  small  conglomerate glands
near the pylorus.
  The duodenum has also been called ventriculus
succenturiatus.
  Jejunum and Ileum form the longest part of
the intestinal  tube,  being  in  general from  24
to 30 feet in length; the upper two-fifths are
given to the jejunum, and the remainder to the
ileum, but there is no anatomical foundation for
this arbitrary boundary, as the intestines run 
188
into each other insensibly, and from the duode-
num the remainder of the small intestinal tube
gradually diminishes in thickness, has fewer val-
vulae conniventes, and exhibits less vascularity;
so much so, that the termination of the ileum is
much thinner and paler than the upper part of
the jejunum, and it is in these situations only
that the differences  between both are marked
and striking.  The mucous membrane of the
small intestine is studded with  glands of two
orders, viz. the glanduke solitarice, and the glan-
dulae agminatce.   The solitariae are disseminated
like granules over the mucous  membrane, and
the agminatae are placed  in oval clusters.  These
last sets of glands are termed Peyer's glands.
The fibres of the  muscular coat of the small in-
testines take a circular and  longitudinal  direc-
tion, the latter being placed externally.
  Peyer's plates, or glands, situated in the lower
part of the ileum; they  are  often  ulcerated in
typhus fever, and sometimes in tubercular dis-
ease of the lungs;  they do not always exist.

              LARGE INTESTINE,

divided into the ccecum, colon, and rectum, forms
about one-fifth of the intestinal canal.  It differs
from the small intestine in its great size, in  being
sacculated, in having small processes along its
entire course, called appendices epiploicce, in pre-
senting three well defined longitudinal bands, in
being thinner, and in having no  valvulae conni- 
189
ventes.  It is composed of an external serous
coat, an internal mucous coat, and between both,
a muscular coat.   The fibres of the muscular coat
are longitudinal and circular; the former are col-
lected into three bands, which being shorter than
the intestine throw it into sacculi: the latter re-
semble the circular fibres of the small intestine.
   Caecum or caput coli, placed in the right iliac
fossa  and connected to the iliacus and psoas mus-
cles, is fixed in  its situation by the peritoneum,
which only covers it  anteriorly and somewhat
laterally; it receives at its inner side the ileum,
which  terminates in  its cavity by a slit-like
opening,  which  is guarded by  the ilio-coecal
valve;  this, in health, allows the transit of ali-
mentary and excremental matter from the ileum
to the colon, but not in the  reverse direction.
The appendix vermiformis is a small diverticu-
lum which proceeds from the posterior  part of
the ccecum;  it is the size of a goose-quill in dia-
meter, and from three to five inches in length;
its orifice of entrance into the ccecum is guarded
by a small valve: sometimes foreign bodies, as
bird-shot, cherry stones, &c, get into the cavity
of the appendix and  excite ulceration, perfora-
tion,  and  fatal  peritonitis.   The  appendix is
sometimes 8 or 9 inches  long, and may become
constricted  in  a hernial sac:  the ccecum  has
no valvulae conniventes, but is thrown into irre-
gular sacculi by  the three longitudinal bands.
  The colon extends from the ccecum to the rec-
tum, and is divided into four portions, viz.  the 
190
right or ascending colon, the middle or transverse,
the left or descending, and the sigmoid flexure.
   Tlie  rectum extends from the sigmoid flexure
of the colon  to the anus;  its upper third is
wholly covered by peritoneum, its middle third
is only covered by this membrane upon its ante-
rior  aspect  and sides, and its inferior  third has
no peritoneal covering.   In the male subject the
antero-inferior aspect of the rectum is connected
to the inferior surface of the  bladder, the vesi-
culae serainales,  and the prostate gland, and in
the female to the  uterus and vagina.  The  rec-
tum has the longitudinal fibres scattered over its
whole  surface, and  is  not sacculated like the
other parts of the  large intestine.

              SALIVARY GLANDS

are three in number, viz., the Parotid, the Sub-
maxillary, and the Sublingual.
  Parotid gland,  the  largest of the  three, ifl
bounded superiorly  by the zygoma, posterior-
ly by  the mastoid process and sterno-mastoid
muscle, and  advances on  the side of the  face
partly  resting upon the masseter  muscle.  It
sends off processes which fill the posterior  part
of the glenoid cavity,  the fossa between  the
ear,  ramus  and  angle of  the lower  jaw,  and
the intervals between the pterygoid,  digastric,
and  styloid  muscles;  it often unites  with the
submaxillary gland.    Its duct  (duct of Steno)
passes  across  the  masseter muscle,  pierces the 
191
buccinator muscle, and opens into the mouth op-
posite  the  second  superior molar  tooth.  The
portio dura nerve,  the internal maxillary artery,
and  the external jugular vein, pass through the
substance of the parotid gland. This gland cannot
therefore be extirpated,  without destroying the
above  named  vessels and nerve.   Two or three
lymphatic  glands  are sometimes  found on the
surface of the parotid which may become en-
larged and form tumours, which may be mistaken
for those of the parotid itself. A small gland
(soda parotidis) occasionally is found between
Steno's duct and the zygoma, the  duct of which
unites with that of the parotid gland.
   Submaxillary gland,  placed in the  digastric
space,  and  covered by the skin, platysma-myoi-
des  muscle,  and  superficial  fascia,  is of oval
figure, and much smaller than the parotid.  Its
duct (Whartonian) turns round  the posterior
edge of the mylo-hyoid muscle,  and runs for-
wards and inwards, upon the hyoglossus muscle,
towards the fraenum  linguae, at the side of which
it opens into the mouth.
   Sublingual  gland,  placed  between  the  mu-
cous membrane of the mouth and the mylo-hyoid
muscle, is  the smallest  of the salivary glands,
and  opens by several small ducts (Bivinian),
which perforate the mucous membrane, reflected
from the side of the tongue.
                    LIVER.
Situated in the right hypochondriac, the epigas- 
192
trie, and partly in the left hypochondriac regions,
is the largest gland in the body.  It presents an
upper convex surface, a lower irregularly con-
cave  surface, a posterior thick margin attached
to the diaphragm, and an anterior inferior mar-
gin which is free.   The upper surface  is une-
qually divided by the falciform ligament into a
right and left  lobe.  The  inferior  surface pre-
sents the following fissures and depressions.
  1. Longitudinal fissure extends from a notch
in the anterior thin edge of the liver backwards
and upwards, defining  the boundary between
the right and left lobes of the organ;  it crosses
the transverse fissure at right angles, and is con-
tinued to the superior edge of the posterior sur-
face of the liver, by a canal often concealed in
the substance of the liver.   As far as the trans-
verse fissure it contains the remains  of the obli-
terated umbilical vein:  beyond that point, the
obliterated ductus venosus.
  2.  Transverse fissure extends  from the longi-
tudinal fissure  into the right lobe of the liver;
it contains the trunk of the right and left hepa-
tic arteries, the trunks and branches of the portal
vein, the hepatic extremities of the biliary ducts,
the hepatic plexus of nerves and absorbents.
  3. Fissure of the vena cava,  situated to the
right of the  horizontal fissure and  behind the
transverse fissure, forms the right  boundary of
the lobulus Spigelii.
  4.  Depression for the gall-bladder, situated to
the right of the lobulus quadratus. 
193
   5. A broad notch in the posterior thick edge
 of the liver, which corresponds to the right crus
 of the diaphragm.  Besides these there are su-
 perficial depressions for the colon, right kidney,
 and stomach.
   Lobes of the liver.  1st, right lobe, the largest;
 2nd, left lobe, separated from the right by the
 horizontal fissure; 3rd, lobulus Spigelii, bound-
 ed before by the  transverse fissure, and placed
 between the  ductus  venosus and vena cava;
 4th, lobulus  caudatus, extending from the lobu-
 lus Spigelii  along the right lobe, and lying pos-
 terior to the transverse fissure; 5th, the lobulus
 quadratus,  which  is  bounded behind  by  the
 transverse fissure,  to the left by the horizontal
 fissure, to  the right by the gall-bladder, its an-
 terior edge being free.
   Vessels of the  liver.—1st, the hepatic artery;
 2nd, the vena portae; 3rd, the venae cavae hepa-
 ticae ;  4th, the biliary or hepatic ducts;  and 5th,
 the absorbents.  The hepatic  artery is the nu-
 trient  vessel  of the liver; its  terminal branches
 open into  the subdivisions of the vena portae.
The vena  portae  conveys  like an artery, the
blood  for secretion of the liver.  Its first divi-
 sions, interlobular, pass between the lobules in
company with branches of the  hepatic artery
and biliary ducts, and form the vaginal plexuses,
which apply themselves to the walls of the canals
in which the vessels run: the interlobular veins
open  by the lobular veins  into  a vessel which
commences in the centre of each lobule, the in-
                      17 
194
tralobular vein, the commencement of the he-
patic veins.  The intralobular vein opens into
the sublobular  vein, and  the sublobular veins
form  the venae  cavae  hepaticae.   The biliary
ducts commence amongst the lobular veins.
   Ligaments  of the Liver.—Besides  the  liver
being invested with a proper fibrous capsule, it
is also covered by peritoneum, which forms four
of its ligaments, viz. 1st and 2nd, a right and
left lateral, triangular  in form, and connecting
the right and  left lobes to the diaphragm ;  3rd,
a suspensory or  falciform ligament, which con-
nects its upper convex surface to the right rec-
tus muscle, and to the  diaphragm; and 4th, the
coronary ligament, which  connects the superior
thick border of the diaphragm.   There is also
a fifth ligament  (ligamentum teres), the oblite-
rated umbilical vein, which  extends  obliquely
from  the umbilicus upwards  and backwards to
the anterior portion of the horizontal fissure.
   Gall-bladder, pyriform  in shape, and  com-
posed  of an  internal  mucous coat,  a proper
fibrous  coat, and a partial  serous covering, is
lodged in a depression  on the under surface of
the right lobe of the liver.   Its large extremity,
or fundus, is directed downwards and forwards;
its upper extremity terminates in the cystic duct,
about an inch  and a half in length, which unites
with  the hepatic duct,  formed by the union of
the light and left  ducts from the correspond-
ing lobes  of the  liver.  The common biliary
duct  thus formed  by  the cystic and  hepatic 
195
 ducts is called the ductus communis choledochus,
 which is about three inches in length, and con-
 veys the bile to the duodenum.

                    PANCREAS.
 A flattened oblong gland from five to six inches
 in length, similar in its formation to the salivary
 glands.  It consists  of a left  caudal extremity,
 situated in the lower part of the left hypochon-
 drium, a body which  crosses, anterior to the left
 crus of the diaphragm, the  aorta and the vena
 portae, to the right side; and a right extremity
 (the head) which  is the largest part of the gland,
 and which is surrounded by the duodenum.  Its
 duct, of a whitish colour,  extends along  the
 centre of the gland  from left to right, but "lying
 near  its posterior aspect; receiving the small
 ducts from the granules of the pancreas, it finally
 opens into  the duodenum, close  to the  ductus
 communis  choledochus, which  it  sometimes
joins.

                 THE SPLEEN,
 Connected to the large extremity of the sto-
 mach by blood-vessels and peritoneum, and situ-
 ated between the stomach  and ribs of the left
 side, is of a deep  blue venous colour, and varies
 in weight from six  to  fifteen ounces, its figure
 being oval.   It presents a convex surface, which
 corresponds to the ribs, and a concave surface
 towards the stomach; it is enveloped by a pro^ 
196
per fibrous membrane, and  a peritoneal coat.
Its interior is composed of cells separated by
septa, with white granules intermixed.   It has
no excretory duct.  Its function is not under-
stood ; it is supposed  by some to be concerned
in the formation of the  red  corpuscles of the
blood.
         URINARY APPARATUS.

                THE KIDNEYS.

  Two glandular bodies of oval form, situated
behind the peritoneum,  in each lumbar region,
lying upon the diaphragm, psoas magnus, and
quadratus lumborum muscles, and enveloped in
a thick layer of adipose  tissue.  The right kid-
ney, which is  rather lower than the left, is be-
low the liver, above the ccecum, and behind part
of the duodenum and the ascending colon; the
left being bounded above by the spleen, below
by the sigmoid flexure  of the  colon,  and an-
teriorly by the  descending colon.  The extremi-
ties and outer border of each kidney are convex,
whilst the inner margin  presents a concave as-
pect called the renal fissure, which contains the
trunks of the  blood-vessels and its excretory
duct, observing in general the following order,— 
197
 the veins anterior, the arteries behind these, and
 the ureter obliquely behind both.  Besides the
 adipose capsule which envelopes each kidney, it
 also has a proper fibrous  coat, which  adheres
 closely to its outer surface, and sends prolonga-
 tions into its interior, as far as the calyces.
   The structure of the kidney is essentially tu-
 bular.   On  splitting open  a kidney lengthwise
 we find that it evidently consists of two distinct
 portions, the cortical and the medullary.  The
 cortical substance forms the  whole circumfe-
 rence of the kidney; it  is about two to three
 lines in thickness, of a reddish brown colour,
 very vascular, and from  its inner surface pro-
 cesses  pass  down, separating  the pyramids of
 the medullary portion from each other.  The cor-
 tical portion consists of  myriads of intricately
 convoluted uriniferous tubes, and of minute ar-
 teries, veins, and capillaries.  An immense num-
 ber of small spherical bodies are found  in the
 cortical substances, to which the name of Cor-
 pora Malpighiana has been applied.   They con-
 sist of a ball of convoluted capillaries.   If we
 trace up a convoluted tube  in  the cortical sub-
 stance, we find  that  it gradually expands, and
 forms a capsule,  which embraces and surrounds
 the Malpighian  body.  The medullary portion
 is  arranged  in  masses of a  pyramidal  shape,
 called  the pyramids of Malpighi.  Their bases
 are turned towards the cortical substance, their
pointed extremites  project free into  the cahces
of the  kidney,  and  are  called papillae.  The
                     17* 
198
 number of the pyramids is from 9 to 20.  They
 are composed of straight uriniferous tubes, con-
 verging from the base  of  the  pyramid  to its
 apex.   They are also very vascular.  The tubuli
 uriniferi both in the cortical and medullary por-
 tions are lined by epithelium.  Those of the cor-
 tical  portion  lie in the midst of a plexus of
 capillaries, and of minute veins.   It  is believed
 by Bowman that the uriniferous tubes, by means
 of their epithelial lining, separate the urine from
 the blood of the vessels which are in contact
 with them—the water of the urine being derived
 from the  Malpighian body, the  saline portion
 from the plexus of minute veins.
   The  Calyces  are  small  membranous sacs
which surround one or more papillae.
   The Infundibvla are three funnel-shaped tubes
formed by the union of the calyces.
   The  Pelvis  is  the  membranous  reservoir
formed  by the union of the three infundibula.
  The watery parts of the urine are secreted by
the Malpighian bodies, which lie in small sacs,
the commencement of the  uriniferous  tubules;
the saline parts are  separated from the blood of
the venous capillaries, which convey the  blood
back to  the renal vein.
   The ureters  extend from  the termination  of
the pelvis of either kidney to the bladder.  Each
ureter about eighteen inches long and of the dia-
meter of a moderate sized quill, passes behind
the peritoneum, lying anterior to the psoas mag-
nus muscles and to the iliac vessels, and gaining 
199
the  inferior and posterior part of the bladder,
passes obliquely between its coats and  perfo-
rates its interior at the outer angle of its tri-
gone.*

            THE URINARY  BLADDER.
  This musculo-membranous viscus, when mode-
rately distended, is of ovoid figure and occupies
the  lower region of the pelvis, behind the sym-
physis pubis,  and anterior and superior  to the
rectum in the male, and the uterus and  vagina
in the female.
  Ligaments of the bladder are divided  into true
and false. The true ligaments are four in number,
viz., two anterior and two lateral.   The anterior,
white and  cordlike, extend from  the posterior
surface of the pubes to the front of the prostate
and  neck of the bladder; the lateral, thinner and
wider, pass  from the sides of the  prostate and
bladder to the sides of the pelvis, and thus form
the  pelvic partition, between the  parts  in the
pelvis, and those in the perinaeum.  The lateral
ligaments constitute the vesical fascia. Both are
reflections of pelvic fascia.   The false ligaments
are  five in  number, viz.,  two  posterior,  two
lateral, and one superior, and are formed  by the
reflections of  the peritoneum,  some of  which
partially enclose the obliterated umbilical arte-
ries,  and the urachus.
  * To gain a view of the parts just described, a perpendicu-
lar section of the  gland should be made from  its convex to
Its concave margin. 
200
   The regions of the bladder are divided into
six.   1st. The superior region, to which are at-
tached the  urachus and  obliterated  umbilical
arteries.   2d and 3d.  The  lateral regions,  on
which the vesical  fascia of either side passes.
4th.  The  anterior region,  the  aspect  of  which
looks towards the recti muscles, and the poste-
rior surface of the pubes.   When the bladder is
distended, the anterior region  rises above the
pubes, and presents a surface uncovered by the
peritoneum; through this region an opening may
then be made to relieve retention of urine, or for
the high operation of Lithotomy.  5th. The pos-
terior region, the aspect of which looks towards
the rectum  in  the  male, and the uterus  in the
female.   6 th.  The  inferior  region or fundus,
which rests on the vesiculae seminales, the pro-
state gland, and the rectum in  the male, and on
the uterus and vagina in the female.
   Coats  of the  bladder. — Besides the  partial
peritoneal covering which invests all  the poste-
rior region and the posterior parts of the upper
and lateral regions, there  are also three proper
coats: 1st. The muscular, placed externally, the
fleshy fibres of which  take two directions; the
external  run  longitudinally  (the anterior and
superior fibres, being stronger, have been  distin-
guished by  the name  of detrusor urines), deep
fibres immediately in connexion with the mucous
coat, are circular and best developed around the
neck of the bladder.  2d.  The  cellular coat, and
3d. The mucous, which is exposed on opening 
201
 the bladder.   This coat is in general thrown in-
 to rugae by the projection of the muscular fibres.
    The trigone or vesical triangle is the name
 given to a smooth space enclosed between the
 openings of the ureters into the bladder, and the
 vesical orifice of the urethra.   It is the most
 sensitive portion of the bladder.
    The uvula is a small duplicature  of the  mu-
 cous membrane  on the under surface  of the
 vesical orifice of the urethra, and corresponds to
 the third lobe of the prostate gland.
   The urethra, which terminates  the urinary
 apparatus  in  the male,  being more  connected
 with the reproductive organs, we shall defer its
 consideration for the present.


               THE PERITONEUM.
 The largest serous membrane in the body,  lines
 the parietes of the abdomen, and invests almost
 all the abdominal viscera; like all serous mem-
 branes, it is distinguished  into two  layers,  a
parietal and a visceral.  The abdominal parietes
 being divided  by a transverse  incision  corre-
 sponding to the  umbilicus,  the uninterrupted
 continuity of the peritoneum, and the different
 productions it forms in its course, may be  thus
 demonstrated:—lining the inner surface of the
 upper section of the abdominal parietes, it ascends
 to the margin of the thorax, and lines the inferior
 surface of the diaphragm; from this muscle it is
 reflected on the  spleen on the left side, and on 
202
 the liver on the right side, forming its ligaments
 (vide ligaments of liver).   From the transverse
 fissure of the liver, the two layers which cover
 the convex and concave aspects of this gland
 meet, and are conducted by the hepatic vessels to
 the lesser curvature of the stomach, thus form-
 ing the gastro-hepatic omentum, which  contains
 the hepatic artery, portal vein, and biliary ducts,
 surrounded by a fibrous structure, called Glisson's
 Capsule.   The  artery lies to the left, the ductus
communis choledochus  to the  right, and the
 portal  vein between and behind.  At the lesser
 curve  of the stomach the two laminae of the
 gastro-hepatic  omentum  separate and  enclose
 this organ, passing from its left extremity to the
spleen, thus forming the gastro-splenic omentum;
at the great curve of the  stomach, and lower ex-
tremity of the spleen, the two laminae again meet,
and descend in  front of the colon and the small
intestines to  the lower  part of the abdomen;
they then turn upon themselves backwards, and
ascend, forming the great omentum, to the trans-
verse arch of the colon, where they separate to
enclose this  intestine.   Having enclosed  the
colon, the layers again unite and form the trans-
verse meso-colon, which passes backwards to the
spine;  having arrived at the  spine, the two
laminae separate into a descending and an as-
cending layer; the descending layer passes into
the lumbar regions, where it is reflected upon the
ascending and  descending colon, forming the
right and left lumbar meso-colon; it attaches it- 
203
self to the left sides of the bodies of the lumbar
vertebrae, forming the anterior lamina of the root
of the mesentery; from this fixed point it is con-
tinued around the jejunum and ileum, forming the
peritoneal  coat of  these intestines, and returns
a»ain to the spine, forming the posterior lamina
o? the root of the mesentery.  This layer of the
transverse  meso-colon having thus formed the
mesentery, still pursues its  descending course,
and passes into either iliac region, and into the
pelvis;  on the right it attaches the ccecum to the
right iliac fossa, thus forming the meso-ccecum;
on the left side it attaches the sigmoid flexure of
the colon to the left iliac fossa, forming the sig-
moid meso-colon; and in the middle it connects
the upper portion of the rectum to the upper and
anterior part of the sacrum, forming the  meso-
rectum.  Still pursuing its course downwards.
and covering the upper and anterior aspect of
the middle third of the rectum, it is at length re-
flected on the posterior surface and sides of the
bladder to the superior region of this viscus,
from  which, and  from the iliac fossa, it is  re-
flected on the inner surface of the lower section
of the abdominal parietes to the transverse in-
cision, from the upper edge of which the descrip-
tion was commenced.  Having thus traced the
descending layer of the transverse meso-colon,
the continuity of  the ascending layer remains to
be noticed :—ascending in front of the inferior
and middle portions of the duodenum and of the
pancreas, it is conducted to  the diaphragm by 
204
the vena cava where it becomes continuous with
the peritoneum, which has been reflected from
the posterior aspect of the liver.*
  Foramen of Winslow.—By  this opening the
cavity which is between the layers of the great
omentum communicates with the general perito-
neal cavity of the abdomen.  It is of oval form,
being  bounded anteriorly by the gastro-hepatic
omentum, posteriorly  by  the ascending layer of
the mej o-colon, superiorly by the liver, and infe-
riorly by the duodenum.
  Inguinal Pouches.—As   the  peritoneum is
ascending on the lower  part of the abdominal
parietes, it is thrown  into four pouches,  two on
either side, by the obliterated hypogastric artery.
The external pouch, between the ilium and hypo-
gastric artery, is  the largest and corresponds to
the internal abdominal and the femoral rings;
the internal corresponding  to the external ring.
  In the female the peritoneum  passes from the
rectum on the upper and back part of the vagina,
from which it ascends  on  the uterus, forming on
each  side its  broad ligaments,  and is reflected
from the anterior part of  the uterus to the back
of the bladder.

  *  This, the usual description of the peritoneum, leaves un-
explained  the way in which the hepatic vessels reach the
liver without perforating the membrane.  This point can be
understood only by  referring to the history of the develop-
ment of the foetus, in which the intestinal tube, nearly verti-
cal, is bound to the spinal column by two folds of peritoneum
between which lie  the aorta and its branches.   When the
viscera assume the  position known in  the adult, it is im-
possible to trace all the peritoneal folds. 
205
    MALE ORGANS OF GENERATION.

                THE TESTICLES

 are two in number, of oval form, are contained
 in the scrotum, and are likewise enveloped by
 proper tunics.
   Tubuli seminiferi are numerous  small tubes,
 which form the body of each  testicle.  They
 are very long and tortuous, and are arranged in
 conical lobules, which are separated from each
 other by. fibrous bands, derived  from the tunica
 albuginea.  Lauth states the number of tubes to
 be 840, and the length of each to be 27 inches.
   Vasa recta, from sixteen to twenty in number,
 are formed by  the union of the tubuli seminiferi,
 and are contained between the layers of the cor-
 pus Highmorianum.  The vasa  recta terminate
 in a kind of plexus or network called the rete
 testis.   From the rete  testis proceed from 12 to
 18  ducts, called  vasa  efferentia.  These are so
convoluted as  to form the coni vasculosi.   The
coni vasculosi form the globus major, or  head of
the epididymis, which  is situated at the upper
part of the body of the testicle;  still convoluted,
it is traced downwards, forming the body of the
epididymis, which is narrow, and placed at the
posterior part of the body  of the testicle, and
arriving at the inferior part of the glands it forms
the globus  minor  (or tail of the epididymis).
The vas deferens having thus formed the epidi-
                     18 
206
dymis, escapes from the globus minor, and hav-
ing increased in size and density, ascends along
the inner aspect of this body, until it becomes
connected to the spermatic vessels and cremas-
ter muscle;  it then passes through the external
abdominal ring and the inguinal canal, and hav-
ing passed through the internal abdominal ring,
it  separates from  the spermatic vessels, and is
conducted by the false lateral ligaments of  the
bladder to this viscus, along the side and inferior
part of which it runs, lying internal to its corre-
sponding vesicula seminalis.   It here approaches
its fellow of the opposite side, and both ducts be-
coming flattened arrive at the base of the pro-
state gland,  where they are joined by the ducts
of the vesiculae seminales, their union forming the
common ejaculatory  ducts;  these run through
the prostate gland, and open into the prostatic
portion of the urethra, at the side of the veru-
montanum.   The  canal of the vas deferens is
small.  Surrounding this canal, are organic mus-
cular fibres, by the action  of which the semen
can pass upwards  from the testicle against  the
force of gravity.

       PROPER COATS OF EACH TESTICLE.

   Tunica albuginea.—A strong  fibrous invest-
ment, of opaque white colour, which forms  the
capsule  of the gland.   From  its inner surface it
sends two laminae, which project  into the back
part of the testicle for -about  two fines, fronting 
                     207
          i
the body called corpus Highmorianum:  from
the free edge of this proceed the fibrous bands,
already mentioned as separating the conical bun-
dles of tubuli seminiferi.
   Tunica vaginalis.—A serous  membrane, con-
sisting of two layers, one covering the testicle,
called tunica vaginalis testis, the other lining the
scrotum, called tunica vaginalis scroti.  When
the tunica vaginalis scroti is divided, its continu-
ity with the visceral layer may be demonstrated
by tracing the membrane, when it will be found
to be reflected on  the side and  fore  part of the
epididymis  and testicle, forming  a  pouch be-
tween these bodies, and also for a short distance
on the fore part of the  chord.   Hydrocele is a
collection of serum in the tunica vaginalis.
   Tunica communis, formed by  the fibres of the
cremaster muscle  and cellular  membrane,  sur-
rounds the chord and the fore part and sides of
the testicle.

    COMMON COVERINGS  OF BOTH TESTICLES.
   The scrotum, a prolongation of the common in-
tegument, is of brownish colour, slightly studded
with hairs and sebaceous follicles, presenting in
the median line a hard ridge, called the raphe,
from either side of which it is thrown into rugae.
   The dartos, composed of elastic tissue, mixed
with unstriped  muscular fibres,  is formed by the
subcutaneous cellular tissue and  the ramifications
of numerous bloodvessels, which were formerly 
208
 supposed to give this coat a reddish appearance.
 The vermicular or rolling motion of the testicles
 is caused by the action of the dartos.
   The Superficial fascia lies immediately under
 the dartos, is  derived from the superficial fascia
 of the abdomen, and is continuous with the su-
 perficial fascia of the perineum.
   Septum scroti.—This partition,  which divides
 the scrotum into two, is formed  by the dartos
 and superficial fascia, these membranes being at-
 tached to the raphe, and from thence ascending
 between the testicles to the urethra.
   Each testicle is  supplied with blood by the
 spermatic artery, the blood of which is returned
 by the spermatic veins; it receives nerves from
 the  spermatic  plexus,  which  is  formed  by
 branches from the renal and aortic plexuses of
 the sympathetic.
  The spermatic chord is composed of the vas de-
 ferens, with its small artery, derived from  the
 vesical; the spermatic artery, veins, and nerves;
the genito-crural nerve, the ilio-scrotal nerve, an
 artery to  the cremaster coming off from the epi-
 gastric and absorbents;  all  of which are con-
nected to each other by fine cellular tissue, and
 are enveloped  by fascia and the cremaster mus-
cle.   The chord, thus  formed, extends from  the
epididymis to the internal abdominal ring, where
 its constituents separate from each other.
   Corpus pampiniform*  is the name given to
the venous plexus formed by the spermatic veins
after these vessels have escaped from  the testi- 
209
 cles.  The  spermatic vein on the right side en-
 ters the vena cava at an acute angle; on the left
 side, it joins the renal vein at a right  angle.
 This may be given as one reason why varicocele
 is more common on the left side.
   The  vesicuhe seminales are two oblong  flat-
 tened bodies, situated  at the inferior fundus of
 the bladder, behind the prostate gland, and on
 the outer side of the  vasa  deferentia.   Each
 seminal vesicle is about two  inches  long, and
 consists of a long tortuous  membranous tube
 convoluted on itself, the small excretory duct of
 which joins  its corresponding vas deferens.
   The prostate gland is a flat conoidal body, the
 base being posterior, corresponding to the vesi-
 culae seminales, the apex anterior, corresponding
 to  the vesical  extremity of the urethra.  It is
 divided into three lobes; two lateral, large,  and
 united in the mesial line, their union being mark-
 ed by a slight groove; and a  third or small lobe,
situated in  the angle between  the two lateral
lobes towards the base of the gland.   The pros-
tate gland is  firm and resisting to the touch, and
composed of numerous follicles, with minute
ducts, which unite to form larger tubes, the open-
ings of which, ten or twelve in number, are on
the under surface of the urethra, on either side
of the verumontanum.  Posterior to the base of
the  prostate  is a triangular  space, bounded on
each side  by the  vasa deferentia, anteriorly by
the prostate,  and posteriorly by the reflection of
the peritoneum.  In this space the bladder may
                     18* 
210
be punctured through the rectum in certain cases
of retention of urine.
   Cowper's glands .are two small oblong-round
bodies, placed before the prostate gland, and im-
mediately behind the bulb.  They lie below the
layers of the triangular ligament.  The duct of
each gland having run a course of about an inch,
opens into the urethra a little anterior to its bulb.

                  THE  PENIS.
   This  organ consists  of two long cylindrical
bodies, named  corpora cavernosa,  and a body
named corpus spongiosum, which contains the
urethra, all these parts being connected together
and surrounded  by the superficial fascia and the
common integuments.
   The corpora  cavernosa are  two cylindrical
bodies, united to each  other in the mesial line.
They are composed of erectile tissue, vessels and
nerves, surrounded by a dense fibrous covering.
   Each corpus  cavernosum commences by the
crus penis, which  is the narrowest part, and
which is attached to the rami of the ischium and
pubes, covered by the erector penis muscle.  At
the symphysis pubis both crura unite, forming
the chief part of the body of the penis, and ter-
minate anteriorly in an obtuse point, to which
is  intimately attached the glans penis.
   Septum pectiniforme,  a partition,  imperfect
as its name implies, which corresponds to the
mesial line, and  marks the division of the cor-
pora cavernosa. 
211
  The urethra is a membranous  canal, extend-
ing from the neck of the bladder to the extremi-
ty of the glans penis, its length and width vary-
ing according to the erect or collapsed state of
the organ.  In the latter condition its length is
from  seven to eight inches  long, and its calibre
about  three or four  lines.  It is lined by mu-
cous membrane, and is distinguished into, 1st,
the prostatic portion, which  is an inch  and a
quarter in length;  2d, the membranous portion,
which is  about three quarters of an inch long;
and 3d, the spongy portion, which occupies the
remainder of its length.
   The corpus spongiosum urethras is a cellulo-
vascular tube surrounding the urethra, and oc-
cupying the under mesial line of union  of the
corpora cavernosa;  it commences in the bulb
of the urethra, and extends along the canal to
its  extremity, where it terminates in the glans
penis, the bulb and glans penis being merely ex-
pansions of this structure.
  Upon  exposing  the  mucous surface  of the
urethra by  an  incision, we observe,  1st, a slit-
like contraction at the orifice; 2d, behind this a
dilatation, called fossa navicularis ; 3d, the con-
stant  diameter of the canal until we arrive at
the bulb,  where it becomes gradually and very
slightly dilated;  forming, 4th, the sinus of the
bulb;  5th,  the  narrowest  part of  the  canal,
which corresponds to the membranous portion;
6th, the  dilatation  corresponding to prostate
gland; and 7 th, a contracted orifice  at  its ter- 
212
mination  in  the bladder.  In the prostatic por-
tion of the urethra, a prominent fold of mucous
membrane, called verumontanum, projects from
its  under surface, and presents in its centre a
large lacuna, the sinus pocularis, the orifice of
which is directed forwards.   The verumontanum
is the point to which Lallemand's caustic is to
be  applied, in cases of spermatorrhoea, &c, at-
tended with great irritability of the urethra.   On
either side of the verumontanum the prostatic
sinuses are situated.  Upon the upper surface of
the urethra, from the orifice to the bulb, are the
openings of numerous  mucous follicles, directed
forwards,  the largest of  which is about an inch
from  the  orifice, and is called, from its size, la-
cuna  magna.  This, with the other mucous fol-
licles, is often the seat of obstinate gonorrhoea.
The ducts of the mucous  follicles open on the
surface of the urethra: the orifices of Cowper's
glands open a little anterior to the sinus of the
bulb,  the  common  ejaculatory ducts on either
side of the verumontanum,  and the ducts of the
prostate in the prostatic sinuses.
  The superficial fascia,  which  envelopes  the
penis, is derived from that of the abdomen, and
terminates at the corona glandis.   It is strong
where it passes from the linea alba upon the dor-
sum of the penis, forming the suspensory liga-
ment, but  is exceedingly delicate  and loose upon
the body of the organ.
  The skin of the penis is remarkably thin and
loose, and extending for an indefinite length be- 
213
yond the  organ, is reflected inwards, and inti-
mately attached to the corona glandis; the loose
fold thus formed being called the prepuce.  Frdm
the  corona  glandis it  is continued along the
glans until it becomes identified with the mucous
membrane at the orifice of the urethra, having
first formed the fold which  lies  posterior  and
inferior to this opening, called frcenum preputU.
   Glandulas odoriferas  are a number of  small
sebaceous  glands  which  surround  the  corona
glandis, and which he beneath the skin.
THE FEMALE ORGANS OF GENERATION
   The ovaries are two ovoidal bodies, placed, one
on either side of the womb, in the duplicatures
of the peritoneum, ealled the broad ligaments of
the uterus.  Each ovary, enveloped by a white
fibrous membrane, consists of a pulpy brownish
grey substance, highly vascular, and containing
from fifteen to twenty minute vesicles, each of
which is composed of a thin membrane contain-
ing a viscid yellowish fluid; these are called the
Graafian vesicles.
   The Fallopian tubes  are the excretory duets
of the ovaries; each is about  four inches  in
length, and is contained in the broad ligament,
one extremity being attached to the superior
angle of  the uterus into which  it opens by a 
214
small orifice (orificium uterinum), the other being
free, and surrounded by a fringe (corpus fimbria-
tum), in the  centre  of which is the peritoneal
aperture (orificium superius).   At this point the
mucous membrane of the Fallopian  tube com-
municates with  the serous membrane, the peri-
tonaeum, forming the only exception to the rule,
that the serous  membranes are perfect  bags or
sacs, and have no opening.
  The uterus is a  hollow  organ of pyriform
shape, and is  distinguished into the fundus, the
body, and cervix.  The fundus is  superior and
posterior, and receives at either angle the Fallo-
pian tube: the body is intermediate between
the fundus and the neck, the latter being infe-
rior and anterior, and surrounded by the vagina:
at the extremity of the neck is a small  elliptical
opening, surrounded by a thick margin, which,
from its  resemblance to the  mouth of a tench,
has been called os tincae, as well as os uteri.  The
cavity of the uterus  is small  compared to the
thickness of its walls, and is of triangular shape;
its superior and outer angles presenting the ori-
fices of the Fallopian tubes,  the inferior  angle
presenting  the  os tincae.  The uterus is placed
between the bladder and rectum.
  The vagina is a membrane-vascular tube, ex-
tending from the neck of the uterus to the ex-
ternal outlet, where it is  continuous with the
surface.   It is composed of mucous membrane
surrounded by  cellular tissue, a vascular  net-
work, and the sphincter vaginae muscle ; its length 
215
is about four or five inches, its breadth one; but
being very distensible these measurements vary.
Its lining membrane is thrown into transverse
rugae on its anterior and posterior surface, and
is  studded with the orifices of numerous mucous
follicles.   The colour of the membrane  varies,
at the external orifice being red, and of a grey
and sometimes marbled colour as it approaches
the uterus.
   The mons veneris is a soft adipose  eminence,
situate on  the upper and  anterior part of the
pubes, covered by  common integument, which
in the adult is thickly set with hairs.
   Tlie vulva is the fissure extending from the
mons veneris to the perineum.
   The labia magna are large folds of the integu-
ments which bound the vulva on either side, and
unite below in a crescentic edge (the fourchette).
They  contain  large mucous glands  about the
centre.
   The clitoris, a small  oblong  conical  body,
 !)laced between the  upper extremities of the
 abia.   It  consists  of a structure similar to the
corpus cavernosum in the male, and arises by
two crura from the pubes; these unite to form
its body, at  the extremity of which  is placed a
red protuberance,  called  the glans clitoridis,
over which is thrown a loose fold of integuments
(the prepuce).
   Meatus urinarius is about half an inch below
the clitoris.
   Labia parva, or nymphas, are two red cres- 
216
 centic  folds of  mucous  membrane,  enclosing
 erectile tissue; they descend,  one on each side,
 from the prepuce of the clitoris, and are lost
 about the centre of the vulva.
   The Hymen, when it exists, is a crescentic fold
 of mucous membrane, surrounding the sides and
 inferior orifice of the vagina,
   The  caruncuke myrtiformes are small  reddish
 bodies  surrounding the orifice of the vagina;
 they are sometimes described as the remains of
 the hymen.

                  THE MAMMAE
 are two in number,  situated at the anterior and
 superior part of  the  thorax, and connected to
 the great pectoral muscles by a capsule of con-
 densed  cellular tissue.   Each of these glands, of
 a  hemispherical shape, consists  of vessels  and
 numerous lactiferous tubes,  arising from  dilated
 blind extremities, or cells: the tubes are group-
 ed together to form  lobes and  lobules; as they
 approach the  nipple they become considerably
 dilated,  and form  sinuses, but in the nipple they
 are again reduced in size, and  terminate at the
 apex by open orifices  surrounded by delicate
muscular tissue.   The nipple is a conical process,
 surrounded by a brownish areola, and composed
 externally of the  integuments, which are  very
 thin,  and internally of the lactiferous tubes, to-
gether with  numerous blood-vessels, from which
the nipple derives its property  of occasional
erection. 
217
        ORGANS OF THE SENSES.

            THE ORGAN OF TOUCH.
   The  skin is composed of the cuticle, or epi-
 dermis, the rete mueosum, and  the corion or
 cutis vera.
   The cuticle is composed of epithelium cells, of
 which  the more superficial a:e  flattened and
 dried;  they  are deposited in thickest layers
 upon the  soles and palms.
   The  deepest layer  of  cells of  the cuticle, or
 that which lies immediately upon  the cutis vera,
 is coloured, in the negro and other dark-skinned
 races.   To this coloured  layer the name of Bete
 Mueosum  has been applied  The cuticle with its
 pigment is removed by maceration.
   The corion is a dense strong  membrane, con-
 sisting  of fibres interwoven with each  other,
 which  are more firmly compacted  the nearer
 they are to its outer surface.  Its internal sur-
face  is  cellular, its  external very vascular, and
presenting numerous  small  conical  papillae; at
the extremities of the fingers these papillae are
best  developed, are  furnished with minute ner-
vous filaments and covered with very thin cuticle;
(bus  affording a delicacy  of  organization neces-
sary  for the greater perfection  of the sense of
touch.
   The  arrangement of the  blood-vessels varies
according  to the delicacy of the sense of touch.
   The capillaries of the papillae  end in loops.
                      19 
218
   The skin is  studded with minute hairs, and
with sudoriparous and sebaceous glands.
   The sudoriparous or sweat glands consist of a
convoluted tube, which opening upon the surface
of the cuticle, may be traced downward through
the skin, until  it end in a coil, forming a small
rounded body in one of the meshes of the corium.


            THE ORGAN OF SMELL.

  The nose is bounded superiorly by the nasal,
frontal, ethmoid, and  sphenoid  bones; inferiorly
by the palatine plates of the superior maxillary
and palate bones; externally on  either side by the
superior maxillary, lachrymal,  inferior  spongy,
ethmoid, and palate bones, and by the internal
pterygoid plates  of the sphenoid bone.  It is
divided into the two  nares by  the  septum nasi,
which  is formed by the azygos process of the
sphenoid bone, the nasal plate of the  ethmoid
bone, the  vomer, and  the mesial spines of the
superior  maxillary and palate  bones.  Besides
the bony boundaries, the nose presents, anterior-
ly. (\ve cartilages, which form the anterior nares,
or the nostrils.   The middle vertical cartilage is
of t iangular form, and rests in the  fissure of the
vomer inferiorly, is attached to the vertical plate
of the ethmoid  bone above, and presents anteri-
orly a  subcutaneous, free, thick edge, and  thus
completes the septum nasi.   The  lateral  carti-
lages which form the wings of the nose  are also
triangular, are attached to the superior maxillary 
219
and nasal bones, and in the  median line to the
vertical cartilage., The inferior lateral fibro-car-
tilages are attached to the three cartilages just
described, are thick and semicircular,  forming,
with the vertical cartilage, the anterior-inferior
oval openings of the nostrils.
   The posterior nares  are of oval shape, and
open into the upper part of the pharynx; they
are separated from each other by the posterior
free edge of the vomer, are  bounded superiorly
by the body of  the sphenoid bone, inferiorly by
the palate bones, and externally by the internal
pterygoid plates of the  sphenoid bone.  The ex-
ternal lateral wall of each nostril,  from the ar-
rangement  of the spongy bones, forms  three
fos-ie, called meatuses, with which several orifices
communicate.
   In the  inferior meatus, at  the junction of its
anterior with its middle third, is the opening of
the nasal duct, and posteriorly, on a level with
the inferior spongy bone, is the opening of the
Eustachian tube.  In the middle meatus is the
slit-like opening  of the antrum maxillare, anterior
to which  is  the groove  called  infundibulum,
which leads  from  the  frontal sinus,  and  into
which open the  anterior ethmoidal cells.
   Into the superior meatus, the  posterior eth-
moidal cells and  the sphenoidal sinus open.  The
interior of the nose is  lined  with the Schneide-
rian membrane, which is  highly vascular and
sensitive, and consists of two layers;  a fibrous
layer, which is the periosteum, or perichondrium 
220
of the nasal cavities, and  a mucous membrane.
The nerves which supply  the nasal cavities are
the olfactory (which pass through the cribriform
plate of the ethmoid bone), the  internal nasal of
the ophthalmic,  and  branches  derived from
Meckel's ganglion.

            THE  ORGAN OF TASTE.
  The tongue presents several  papillae covered
by mucous membrane.   It is of triangular form,
is  connected  by its base to the os hyoides, by
folds of mucous membrane to the epiglottis and
palate, and by muscles to  the lower jaw.  It is
highly vascular, and receives six nerves, three  on
either side, viz., the gustatory branch of the fifth
for taste, the ninth, or lingual, for motion, and
the glosso pharyngeal,  the function of which is
doubtful, but most probably is connected  with
the sense of taste.
  The papillae are of three orders,—the filiform,
situated at the tip and sides; the fungiform, scat-
tered over the dorsum;  the circumvallatae  at
the root

            THE  ORGANS  OF VISION
   Consist of the globes of the eyes and their ap-
pendages.  The eye-ball  is composed of mem-
branes and fluids, called humours.
   The sclerotic coat, occupying  about four-fifths
of the  globe, is a strong fibrous  structure, and
thicker behind and anteriorly than in its centre. 
221
Its outer surface is in contact with the  adipose
tissue of the orbit, the tendinous expansions  of
the muscles of the eye, and anteriorly with the
conjunctiva;  its inner surface is lined by the
choroid coat.  It presents posteriorly  a  small
aperture for the transmission of the optic nerves,
and an anterior large one, about six or seven
lines in diameter, for the cornea.
   The cornea, which forms the anterior fifth  of
the globe, is smooth and transparent.  It consists
of three layers, viz. the conjunctival layer exter-
nally, an elastic layer internally, and between
both, the proper cornea, which is composed  of
fibres connected together by fine cellular tissue.
   The choroid coat is a thin vascular membrane,
situated between the sclerotic coat and the reti-
na;  it extends from the  entrance  of the  optic
nerve to the ciliary ligament, to which it is firm-
ly connected;  it is  then  directed inwards, and
forms the folds called ciliary processes.  Its in-
ternal surface is coated  by a dark brownish se-
cretion, called nigrum pijmentum, its outer sur-
face being connected to the sclerotic coat by fine
cellular tissue, and  by the ciliary vessels and
nerves; on  this surface  the  veins observe an
arched arrangement, and  are  called  vasa vor-
ticosa.
  The ciliary ligament is about a line and a half
in breadth, of a greyish white cellular structure,
and corresponds to the circle of junction of the
cornea and sclerotic coat  externally, and of the
choroid and iris internally.
                     19* 
222
   The ciliary processes vary in number from
 sixty to seventy, and are productions or continu-
 ations of the choroid  coat;  each ciliary process
 is of a triangular figure, the anterior edge being
 attached to the ciliary ligament, the posterior to
 the hyaloid membrane, and the internal free pro-
jecting into the posterior chamber of the aqueous
 humour, towards the lens, but not attached  to
 this body.
   The Iris is a circular membrane placed in a
 transverse vertical position, attached by its larger
 circumference to the ciliary ligament, floating in
the aqueous humour, and presenting a circular
 opening in its centre called the pupil.  It divides
the space between  the anterior surface of the
capsule of the lens, and the  posterior surface  of
the cornea, unequally, into what are termed the
chambers of the aqueous  humour,  the  anterior
chamber being much the largest;  both  cham-
bers, however, communicate through the pupil.
The anterior surface of the  iris presents a radi-
ated appearance, and varies in colour in different
individuals;  the posterior surface is covered by
nigrum pigmentum, and has received the name
of uvea.   The iris is supplied by  the ciliary
nerves and vessels.
  The retina, placed between the choroid coat
and vitreous humour, consists of three layers, an
external or serous layer, called from its discover-
er membrana Jacobi* an internal or vascular
  * The membrana Jacobi is not a serous membrane, but
consists of rod-shaped bodies possessing high power  of
refraction. 
223
layer, and between  both  the  nervous  layer.
About two lines on the temporal side of the en-
trance of the optic nerve the  retina presents a
small hole surrounded by a yellow margin called
the foramen of Soemmering, round  which  the
retina is thrown into a fold.
   The aqueous humour is contained  in the  an-
terior and posterior chambers of the  eye, is per-
fectly transparent, and is from four to five grains
in quantity.
   The vitreous humour occupies about  the three
posterior fourths of the eye ; it is contained in
the hyaloid membrane,  which not only envelopes
it, but sends numerous partitions from  its inner
surface  to form cells in which  this  transparent
fluid is  deposited.  The vitreous humour thus
contained  in its capsule is convex  posteriorly
and on  its lateral circumference, but presents an-
teriorly  a concavity for the reception  of  the
crystalline lens;   around  the circumference of
this cavity the vitreous humour presents a striat-
ed appearance, caused  by the marks of the cili-
ary processes, to which the term corona ciliaris
is applied.
  The crystalline  lens,  enclosed in  its capsule
and placed in the anterior depression of the vi-
treous humour, is a transparent body, presenting
an anterior and posterior convex surface, the lat-
ter being the more prominent.  Its external sur-
face  is  soft and pulpy, gradually increasing in
density  towards its centre.
  The capsule of this body, like the  lens itself, 
224
 is transparent, and composed  of homogeneous
 membrane.
   The lens and its capsule derive their nutriment
 from the vessels of the retina.  Opacity of the
 lens constitutes cataract.
   Liquor Morgani is a fluid  found  some  hours
 after death between the lens and its capsule.
   Canal of Petit.—The lens is retained  in its
 situation by the hyaloid membrane,  which, split-
 ting into two laminae at its circumference, pass
 one  anterior the other posterior to  its capsule;
 a triangular canal is thus formed, which is  inter-
 sected  by minute septa;  this  is  the canal of
 Petit, and may be demonstrated by distending
 it  with air, when  it will  present a  vesicular
 appearance.


         THE APPENDAGES OF  THE EYE.

  The lachrymal gland, placed in the upper and
 outer part of the orbit,  behind the external an-
 gular process of the os frontis, and about the
 size  of a small almond, is of greyish color, con-
 sists of numerous granules united by an imperfect
 capsule, and pours forth its secretion  of  tears
by  means of five or six minute ducts, which
 open behind the  upper eyelid,  in the angle
formed by the reflection of  the conjunctiva.
  Tunica  conjunctiva,   a  mucous  membrane
which lines the interior of each eyelid, and is re-
flected on the anterior part  of the globe of the
eye.   At the inner angle of the eye it forms a 
225
small fold called plica semilunaris, covers the
caruncula lachrymalis,  and having  lined the
lachrymal sac and duct becomes continuous with
the mucous membrane of the nose.   The epithe-
lial layer of this membrane is continued over the
cornea.                                   .
   Caruncula  lachrymalis,  a  small  vascular
body composed of mucous glands  and  cellu-
lar tissue situated in  the nasal angle  of  the
eye, and covered by  the membrana  conjunc-
tiva.                          . .         „
   The palpebrae or eyelids, semicircular m torm,
are composed of skin externally, which is very
fine the tunica conjunctiva internally, and be-
tween both the orbicularis palpebrarum muscle,
the tarsal cartilages and  their ligaments, and the
Meibomian  glands, together with blood-vessels,
nerves, and absorbents.
   The superior eyelid, besides being the largest,
has also peculiar to it, the levator palpebrae supe-
rioris muscle.                           .
   The  tarsal  cartilages  are thin  cartilaginous
plates of a semicircular form, the superior being
the largest; to their convex margins are attached
 the palpebral ligaments.
   The Meibomian glands, of a yellow colour, are
 very numerous, particularly in the upper eyelid,
 and are arranged in vertical rows.
   The opposed edges of the  eyelids are thick,
 and are bevelled off obliquely  towards the eye,
 so that when closed they only touch at their an-
 terior edges, thus leaving a triangular canal, the 
226
base of which is formed by the tunica conjunc-
tiva, along which the tears are conducted to the
puncta lachrymalia.
   The din or eye-lashes, attached by their roots
to the opposed  margins of the eyelids, observe
a curved arrangement, their convexities looking
toward each other.
   The puncta lachrymalia are the two minute
orifices of the  lachrymal  canals,  placed within
two or three lines of the  nasal terminations of
the eyelids and upon their opposed edges.
   The lachrymal  canals, the  superior of which
is  longer and curved, the  inferior being nearly
straight, lead from the puncta lachrymalia to the
lachrymal sac.
   The lachrymal sac, placed in the fossa formed
by the lachrymal and superior maxillary bones,
behind the fibrous expansion from the tendon of
the orbicularis palpebrarum, is of  oval form, re-
ceives the lachrymal secretion by  the puncta la-
chrymalia,  and  transmits  it to the nasal  duct,
with which it is connected inferiorly.
   The nasal duct,  enclosed  in   a bony canal
formed  by the lachrymal, superior  maxillary,
an 1 inferior spongy bones, passes obliquely down-
wards, backwards, and outwards, and terminates
in  the inferior meatus of the nose.

           TnE  ORGAN OF  HEARING.

  This organ consists of the external ear, includ-
ing the auricle and meatus auditorius externus; 
227
the middle ear, including the cavity of the tym-
panum and its appendages; and the internal ear
or labyrinth, including the vestibule, semicircular
canals, and cochlea.
  The external eir consists of a fibro-cartilagi-
nous plate covered by skin, and so moulded as to
form different elevations and depressions, which
have been described with more minuteness than
they deserve.
  The helix is the semicircular eminence which
forms the outline of the external ear.
  The antihelix commences  superiorly by two
root<, which enclose a fossa (fossa navicularis),
and is situated inferior to the helix.
  Th>- trajus is an eminence placed anterior and
inferior to llv; meatus externus.
   Tue antiiragus is a smaller eminence posterior
to the meatus externus.
   The lobule is a pendulous body placed under-
neath the antitragus.
   The concha, a deep conoidal cavity which leads
to the meatus externus, and in which the several
depressions formed by the eminences just  de-
scribed terminate.
  The meatus externus is a curved canal which
leads from the concha to the membrana tympani;
it is lined  by skin, beneath  which  are placed
small glands (glandules ceruminosas), which se-
crete the ear-wax (cerumen).   The  inner  half
of this canal is surrounded by bone.
   The membrana tympani, separating the exter-
nal from the mhldle ear, is of oval form, and 
228
 consists of three layers, viz. the external or cuti-
 cular, the internal or mucous, and between both
 a fibrous layer.  To its inner aspect is  attached
 the crus of the malleus, which, by drawing  it
 towards the middle ear, gives it a concave aspect
 externally.
   The middle ear consists of the cavity of the
 tympanum and the small bones  of the ear and
 their muscles.
   The cavity of the tympanum   is an  irregular
 cylindrical space, closed externally by the mem-
 brana  tympani, and  bounded   interiorly by a
 bony partition which separates it from the laby-
 rinth.  It presents the following eminences and
 foramina,  viz. the promontory, a convex emi-
 nence  situated  on its  internal  side, and which
 marks the situation of the  vestibule; the fora-
 men ovah, placed above the promontory, and to
 which  the base  of the stapes is affixed ; the fora-
 men rotundwm,  below the promontory, closed by
 a membrane (lesser tympanum) which separates
 the scala tympani of the cochlea from the  cavity
 of the tympanum; the opening  of the  mastoid
 cells, situated  posteriorly  and superiorly;  the
pyramid, a  bony projection  placed below the
 opening of the  mastoid cells, hollow within and
 containing the  stapedius muscle; a. small fora-
 men below the  pyramid  for the  transmission of
 the chorda tympani nerve;  anteriorly the open-
 ings of the two bony canals, the superior of
 which lodges the tensor tympani  muscle, the in-
 ferior forming the bony part of  the  Eustachian 
229
tube ;  inferiorly is the opening of the Glasserian
fissure, and superiorly are several smaller fora-
mina for blood-vessels.
   The bones of the ear are three in number, very
small,  and contained within the cavity of  the
tympanum.
 " The malleus is divided into the head, which is
smooth and articulates with the incus ; the neck,
which is small, and connects the head to  the
shaft;  the handle or shaft, which descends from
the  neck, and  is attached to  the  membrana
tympani; and the processus gracilis, which passes
from the neck to the Glasserian  fissure.
   The incus is divided into  its body, which pre-
sents a cup-like cavity for the head of the mal-
leus ; a superior crus, which is short and lies in
the mastoid cells ; and a long  crus, to  the extre-
mity of which  is attached a small process of
bone, considered by some as a distinct bone, and
called os orbicuhire.
   The  stapes presents a small  head, which is
attached to the orbicular process ; a short neck;
two  curved crura, which terminate in the base;
and the base itself, which is of oval shape and
connected to the foramen ovale.
   The  internal ear or labyrinth contains—
   1. The vestibule, placed behind the cochlea and
before  the semicircular canals.  It is a small oval
cavity  lined by a membrane  common   to  the
labyrinth, contains a watery fluid, and presents
the" folio wing openings;  viz. the foramen ovale,
the five  orifices of the  semicircular canals,  the
                     20 
230
orifice of  the  scala  vestibuli of  the  cochlea,
and the  orifice of the aqueduct of the vesti-
bule.
  2. The semicircular anna's, placed behind the
vestibule, are three in number, two vertical and
one horizontal; of the former, one is superior,
and the other posterior.   The openings of these
canals are only five in number, in  consequence
of one opening of the vertical canals being com-
mon to  both.
  3. The cochlea,  of  conical form, the base  to-
wards the internal meatus, the apex towards the
carotid canal, is composed of a bony tube which
makes two turns and a half round a central pil-
lar  called the modiolus.  This tube  is  divided
longitudinally  by a  thin plate, half bony  half
membranous, called  lamina spiralis, into  two
independent cavities; the two tubes thus formed
are called the soako  of the cochlea, they both
unite at the  apex in a cavity called  infundibu-
lum, and at the base of the cochlea they sepa-
rate,  one  called  scala  vestibuli, which opens
into the vestibule, the other called  scala tym-
pani, which  opens into  the tympanum by  the
foramen rotundum.   From the scala  tympani
proceeds a narrow bony canal  called the aque-
duct of the cochlea, which  terminates in a slit-
like opening in the inferior border of the petrous
bone.
  4.  The auditory nerve gains the internal ear by
the minute foramina at  the base of the meatus
auditorius internus, and is expanded in the form 
231
of soft pulpy filaments in the cochlea and ves-
tibule.
       THE ABSORBENT  SYSTEM.

  Comprehends—1st, the vessels which convey
the lymph and chyle into the veins, and 2d, the
enlargements which occur in their course called
glands or ganglia.
  The lacteal or chyliferous vessels commence on
the villi of the mucous surface of the intestines,
pass through the mesenteric glands backwards
towards the spine, where they terminate in the
thoracic duct.
  The lymphatic vessels are found in most situa-
tions of the body, and generally observe a deep
and superficial arrangement.
  Lymphatics of  the  lower  extremities.—The
supeificial set accompany the external and inter-
nal saphena  veins: they communicate freely in
their course with the deep  lymphatic trunks
which accompany the deep vessels.  Those which
accompany the external saphena vein enter the
glands in the popliteal space, whilst those accom-
panying the internal saphena vein ascend to the
groin and pass through the inguinal glands, hav-
ing formed numerous connections with the su-
perficial lymphatics of the abdomen, the perine-
um, and the genitals.   The deep lymphatics of
the hip  and  perineum  are conducted  by  the
branches  of the internal iliac vessels  into the 
232
 pelvis, and  pass through the pelvic glands.
 From the inguinal and pelvic glands the lympha-
 tics pass through the iliac vessels to the recepta-
 culum chyli.
   The  Thoracic  Duct.—This canal commences
 by a dilatation called receptarulum chyli, placed
 on the body of the second lumbar vertebra;
 passing between  the crura of the diaphragm it
 gains the posterior mediastinum, where it lies
 between the aorta and the vena azygos; at the
 fourth dorsal vertebra it crosses the spine oblique-
 ly to the left side, passing behind the oesophagus
 and arch of the aorta, and placed behind the left
 pleura and between the left carotid and left sub-
 clavian arteries:  it  is then  conducted by the
 oesophagus to the left side of the neck  as high as
 the sixth cervical vertebra,  where, making a
 slight curve downwards and outwards, it opens
 close to the external angle formed  by the  left
 subclavian and jugular veins.
  Lymphatics of  the  upper  extremities.—The
 superficial set accompany the superficial veins,
 and pass through two or three glands situated at
 the inner condyle; having joined the deep lym-
 phatics which accompany the venae comites, they
 proceed onwards to the axilla, and pass through
 the axillary glands; following the course of the
 axillary vein, they pass beneath the clavicle, join
 the lymphatics of the neck, and terminate in the
 thoracic duct.   The lymphatics of the right up-
per extremity and  right  side of  the   neck
unite   to  form  the  right or lesser  thoracie 
233
duct, which  opens into the right vena innomi-
nata.
  The lymphatics of the trunk consist of a deep
and superficial set;  in the chest the former  are
seated between  the muscles and pleura, in the
abdomen between the muscles and peritoneum,
the superficial being subcutaneous. The viscera
contained in the chest and abdomen also have a
superficial and deep layer of lymphatics,  the
deep  being   distributed  through  the  peculiar
tissue  of  each organ,  the superficial  running
beneath the  membranous envelope.
  Lymphatics have been seen in the membranes,
but not in the proper substance of the brain and
spinal cord.
    PECULIARITIES  OF  THE FCETUS.

   The principal  anatomical peculiarities of the
foetus, by  which it is distinguished  from the
adult, are the following:—
   The thymus gland occupies the anterior medi-
astinum,—the kidneys are lobulated, and each is
covered by a cellulo-vascular body called Benal
capsule, which is larger than the kidney itself,—
the liver is  very large, particularly its  left lobe,
—the lungs are  compact, of a deep  red  colour,
and sink in water, the bronchial tubes and their
ramifications being void of air,—the auricles of
the heart communicate with the foramen ovale,
—at the bifurcation of the pulmonary  artery  an
                    20* 
234
arterial trunk  about nine lines in length, called
ductus arteriosus, proceeds  to the aorta,  into
which vessel it opens—the umbilical  vein  pro-
ceeds to the liver, where having distributed some
branches to its left lobe, it divides into the com-
municating branch, which unites into  the portal
vein, and  the  ductus venosus, which opens into
the vena cava inferior,—the internal iliac arte-
ries, under the name of umbilical or hypogas-
tric, turn upwards and forwards  along the sides
of the bladder, pass through  the umbilicus, and
run a tortuous course along the  umbilical  vein
to the placenta,—and the urinary  bladder  is in
the abdominal part of the pelvis,  from the sum-
mit of which a ligamentous cord, called urachus,
passes to the umbilicus. Until the seventh month
the pupil is closed by a membrane, called mem-
brana  pupillaris,  and in the male the testa are
contained in the abdomen.

              CERVICAL FASCIA.

  The superficial fascia is thin and consists of
two layers, between which are placed the fibres
of the platysma myoides.  The deep fascia binds
down and invests the muscles of the neck.  It is
a strong, dense, pearly white structure, attached
behind to the spines of the cervical vertebrae, in
front  to the mesial line,  and below to  the clavi-
cle and sternum;  above  it is connected with the
jaw and parotid gland;  and it sends  a  process
from  the  styloid process to the angle  of the 
235
jaw known as the stylo-maxillary ligament.  The
sterno-mastoid, the omo-hyoid, and the subcla-
vius muscles, receive complete sheaths from it.
   The carotid artery, pneumogastric nerve, and
the internal jugular vein, with its accompanying
chain of lymphatic glands, are contained  in  a
sheath, which lies underneath the deep cervical
fascia.  These glands sometimes become greatly
enlarged, and form  either benign or malignant
tumours, which are bound down firmly by this
strong, resisting fascia.
              THE FASCLE.
     SUPERFICIAL FASCIA OF THE ABDOMEN

passes downwards from the thorax over the ab-
dominal muscles and Poupart's ligament  to the
thigh.  In the median line it passes off the pubes
upon the penis, forming its suspensory ligament,
and in  the female it descends into the labia.  In
the male it passes on either side round the sper-
matic cord into the scrotum, and becomes  con-
tinuous with the fascia of the perinaeum.  After
having passed over Poupart's ligament it forms
envelopes for the inguinal glands and adheres to
the fascia lata, presenting  a cribriform  appear-
ance (vide Fascia lata);   and continuing its
course  downwards becomes identified with the
subcutaneous cellular tissue  of the lower ex-
tremities. 
236
   FASCIA TRANSVERSALIS AND FASCIA ILIACA.

  The fascia transversalis is placed between the
transversalis muscle and the  peritoneum; it is
very strong inferiorly, and is  connected to the
internal lip of the ilium and to the whole length
of Poupart's ligament, and is continuous, behind
the rectus muscle, with the fascia of the opposite
side.  As the external iliac vessels are passing
beneath Poupart's ligament, a production of this
fascia extends along the anterior aspe; t of their
sheath, and becomes identified with  the cribri-
form fascia in the groin.  The spermatic cord in
the male, and the round ligament in the female,
pass through a foramen in this fascia about half
an inch above Poupart's ligament, and midway
between the spine of the ilium and the symphy-
sis pubis; this opening is  the internal abdomi-
nal  ring; from its margin is prolonged over the
cord a funnel-shaped process, called the infundi-
buliform fascia.  The fascia transversalis  forms
a covering in  all  the varieties of abdominal
hernia.
  The fascia iliaca is much stronger  than the
fascia transversalis; it is connected to the inner
lip of the ilium,  passes over the iliacus internus
muscle,   adheres to Poupart's  ligament,  from
which it passes behind the  sheath of the femoral
vessels into the thigh, and is connected with the
capsule  of the hip-joint and the pubic portion of
the fascia lata.  The processes  of fascia  trans-
versalis and fascia iliaca, passing one in front and 
237
the other behind the femoral vessels, and uniting
at the outer and inner border, form  the sheath
of the vessels.  Femoral  hernia  is covered by
the sheath of the vessels  here described.   The
fascia iliaca continued into the pelvis becomes the
pelvic fascia;  it lines the parietes of  this cavity
as far as  the upper origin of the levator ani
muscle, where it  divides  into two layers;  one
layer (the  outer) called  the obturator fascia,
descends between the obturator internus muscle
and the levator ani, and is inserted into the great
sciatic ligament, the tuberosity of the  ischium,
and pubes.   The internal layer of the pelvic fas-
cia, called also vesical fascia, passes downwards
along the inner surface of the levator ani muscle
to the  inferior margin of the symphysis pubis,
from which it is reflected on the prostate gland
and neck of  the bladder,  forming the anterior
true ligament of the bladder, and laterally  it is
reflected on the sides of this viscus,  forming its
true lateral ligaments.  This vesical fascia pass-
ing from the side of the  prostate and bladder
to the  side  of the pelvis, forms the  " pelvic
partition."

         SUPERFICIAL PERINEAL FASCIA

strongly adheres to the rami of the ischium and
pubes of either side,  and extends  across the
perinaeum, being continuous anteriorly with the
superficial fascia of the scrotum derived from the
superficial fascia of the abdomen.  At the central 
238
tendinous point of the perinaeum, it passes back-
wards to join the anterior layer of the triangular
ligament.   In cases  of rupture of the urethra,
this fascia prevents the urine from passing out-
wards upon the groin and thigh; while it allows
it to mount upwards, in the loose cellular tissue
of the scrotum, which it often  entirely destroys.

    TRIANGULAR LIGAMENT OF  TnE URETHRA.

  The triangular  ligament between the rami of
the pubes  is an interosseous ligament, like the
membrane filling up the obturator foramen ; it is
connected  on either side to  the rami of the
ischium and pubes, its base looking towards the
rectum, its  apex  towards  the sub-pubic  liga-
ment ; it is pierced by the membranous portion of
the urethra, which passes  through the ligament
about three quarters of an inch  below the pubes.
It consists of two layers, between which are situ-
ated the artery of the bulb and  Cowper's glands;
one layer (the anterior) is expanded on the bulb,
keeping that body in its situation; the other
(the posterior) is continued along the membra-
nous portion of the urethra to the prostate gland,
forms its capsule, and becomes continuous on the
bladder with the vesical layer of the fascia iliaca,
The ligament is sometimes called the deep  peri-
neal fascia.   Urine, when it escapes from the
urethra, lies under  the superficial  fascia, and
makes its way into the scrotum. It cannot make
its way into the thigh, on account of the attach- 
239
ment of the superficial fascia to the rami of the
ischia and pubes.   The triangular ligament ex-
tends for a very little distance below the urethra.
In the female it is smaller than in the male.

         FASCIA  OF UPPER EXTREMITY

"consists of tendinous fibres, which are stronger
in some situations than others;  it invests the
entire arm,  and  sends partitions between the
several muscles.   It takes its origin superiorly
from the spine of the  scapula, adheres  to the
condyles  of the  humerus, and  to  the ridges
which lead to them; passes from thence on the
forearm, where it is very strong,  particularly at
its posterior part, and, binding down the several
muscles, reaches the wrist-joint, to the annular
ligaments of which it is connected.
  "The palmar fascia, of triangular form, is very
strong, and takes  its  origin from  the anterior
annular ligament;  from this it expands over the
palm and  near the fingers divides into four fas-
ciculi'  each  of which is forked and inserted into
either side of the sheaths of the flexor tendons,
and  into the ligaments of the first phalanges.
                FASCIA LATA.

  The fascia lata takes its origin from the crest
of the ilium,  the  spines  of  the sacrum, the os
coccygis, Poupart's ligament, the  tuberosity of
the ischium, and the rami of  the ischium and 
240
pubes.  From this  extensive connexion it ex-
tends, down  the  thigh, confining the different
muscles in their situation, and also sending par-
titions between them.   At the posterior part of
the thigh  it  adheres  intimately to the linea
aspera, and at the  knee-joint  to the  condyles
of the femur; it is then continued over the heads
of the tibia and fibula, to which it adheres and
forms the fascia of the leg.
   Upon the anterior and upper part of the thigh,
the fascia lata, from its special arrangement, has
been divided into the iliac and pubic  portions,
and about an inch  and a half below Poupart's
ligament,  and between  the iliac and pubic por-
tions, it  presents the opening for the saphena
vein.   This opening is semilunar, the concavity
being directed towards Poupart's ligament; it
presents an internal and external cornu and its
edge,  turning inwards on itself,  becomes con-
tinuous with the sheath of the femoral vessels.
  The pubic portion of the fascia lata covers the
pectineus  muscle, adheres  to the spine of the
pubes and the lineo  ileo-pectinea, passes behind
the sheath of the femoral vessels, and becomes
continuous with the fascia iliaca.
  The iliac portion of the fascia lata covers the
sartorius, tensor vaginae femoris, rectus and iliac
muscles,  and presents, towards the pubic por-
tion, a crescentic or falciform edge, the aspect  of
which i-s directed  downwards and inwards; the
inferior cornu of this edge is continuous with the
outer  cornu of the saphenic opening, and its su- 
241
perior cornu extends along Poupart's ligaments,
crosses the femoral vessels, and is inserted into
Gimbernat's ligament, and the linea ilio-pecti-
nea;  the upper part of the  falsiform edge is
called Hey's ligament.
  The cribriform fascia.   The superficial fascia,
in passing over Poupart's ligament to the groin,
adheres to the crescentic edge of the fascia lata,
and to the edge of the saphenous opening, and is
attached to that layer of the fascia transversalis
which passes anterior to the sheet of the femoral
vessels;  this portion of the superficial  fascia is
perforated by numerous small bloodvessels, and
by the anterior superficial absorbents of the limb,
which gives it, when dissected, a cribriform ap-
pearance, from which it derives its name.
  The fascia of the leg adheres to the heads of
the tibia and fibula, and  to  the spine of the
tibia,  to the annular ligaments of the  ankle-joint,
and to the malleoli; it binds down the muscles,
sends partitions  between them, which pass from
its posterior surface to the bones  of  the leg and
interosseous membrane, and from  the anterior
annular ligament it is continued  thin upon the
dorsum of the foot.
  The plantar fasda  is very strong, and arises
from the  under aspect of the os calcis, is attached
to the sides of tarsus and metatarsus, and sends
two processes between the muscles of' the sole of
the foot,  dividing them into an internal, a middle,
and an external set.  At the base of tne 4o >s it
divides into five portions, each of which bifur-
                     21 
242
cates, and is inserted by two fasciculi into the
lateral  ligaments of  the joints, and into the
sheaths of the  flexor tendons.   This fascia is
strengthened by transverse fibres.
               THE LARYNX.

    Besides the muscles, vessels, nerves, and mu-
 cous membrane which enter into the formation
 of the larynx, there are four cartilages and one
 fibro-cartilage.
    The thyroid cartilage,  the largest, presents
 anteriorly  a prominent angle called pomum
 Adamiyhieh is formed by the meeting of its ate.
 Each ala is  of quadrilateral form and presents
 posteriorly two cornua; the superior cornu is the
 ongest and is connected to the great cornu of
 theos-hyoides by the thyro-hyoidhgament; the
 esser  or inferior cornu,  being connected to the
 side of the cricoid cartilage by  synovial mem-
 brane  and ligaments.
   The upper margin of each ala is connected to
 the  os hyoides by the thyro-hyoid membrane
 the inferior margin being connected to the cri-
 coid cartilage by the cnco-thyroid  membrane
 which  is of yellow colour and elastic;  the outer
 surface of each is rough, and divided unequally
 by  an  oblique  ridge, the inner surface  beincr
 smooth and covered by mucous membrane   °
L Ihe cricoid cartilage is next in size, and forms 
243
a ring;  it is narrow before and deep behind ; its
inferior edge is connected to the first ring of the
trachea; its superior edge, anteriorly, is connect-
ed by the crico-thyroid ligament to the thyroid
cartilage; posteriorly it supports the arytenoid
cartilages; its inner surface is covered by mucous
membrane, and its outer surface is  rough, and
presents posteriorly  a vertical ridge  for the at-
tachment of muscles.  The operation of Laryn-
gotomy is performed in the space  between the
thyroid and cricoid  cartilages.  The crico-thy-
roid membrane,which is formed of yellow elastic
tissue, must be incised transversely.
  The arytenoid cartilages, two  in number, and
of triangular shape,  are  the smallest: the apex
of  each  is surmounted by a small moveable
cartilaginous appendix; the base, concave, moves
upon the cricoid cartilage; the posterior surface,
concave, lodges the arytenoid muscles, the exter-
nal edge is convex for the attachment of muscles,
and the inner edge is flat.  The  apex of each is
connected to the epiglottis by a fold of mucous
membrane called  the  aryteno-epiglottideanfold,
and the base is connected to the  cricoid cartilage
by synovial membrane and ligament.
  The epiglottis, resembling in form an artichoke
leaf, or rather the lateral half of the kernel of
the'butternut, is connected  by a stalk-like pro-
cess to the angle of the thyroid  cartilage; ante-
riorly it is attached to the body of the os hyoides
by  cellular tissue and mucous membrane, and to
the base of the tongue by three  folds of mucous 
                     244

membrane, the central one of which  is called
frcenum epiglottidis /  posteriorly  extend  the
aryteno-epiglottidean folds of mucous membrane.
The dangerous disease, oedema of the larynx, is
situated in the loose cellular tissue of these folds
and of that of the surrounding parts.  It is here
that scarification may be employed, according to
the plan of Dr. Gurdon Buck of New York.
   The  glottis  is the  superior  opening of the
larynx, and is  of triangular form, its base being
anterior, formed by the epiglottis, its apex pos-
terior and  inferior,  formed by the appendices of
the arytenoid cartilages, and its side formed by
the aryteno-epiglottidean folds.
   The rima glottidis is also of triangular form,
and placed beneath the glottis : the base is pos-
terior, is formed by the bases of the ary tenoid
cartilages; the apex is anterior, corresponding to
the  angle  formed  by  the  alae of  the  thyroid
cartilage;  and the sides are formed by the infe-
rior or  true chordae vocales.
   The chordae vocales, two on either side, arise
from the anterior aspect of  the  arytenoid carti-
lages, and approaching  each other are  inserted
into the angle formed by the alae of the thyroid
cartilage :  the superior is semilunar,  the inferior
horizontal, and between the  vocal  chords  of
either side is a small oval fossa, called*  the ven-
tricle of the larynx; from the ventricle a pouch
extends upwards between the thyroid cartilage
and the superior vocal chord;  it is called the
sacculus laryngis. 
245
          THE THYROID BODY,

of a reddish-brown colour, consists of two lateral
lobes and a connecting middle lobe. The lateral
lobes are placed by the side of the trachea and
larynx, and the middle lobe rests upon the ante-
rior aspect of the two or three first rings of the
trachea.   Each lateral lobe is of pyriform shape,
the base inferior, and the apex ascending to the
thyroid cartilage; both lateral  lobes overlap the
carotid vessels, the  inferior thyroid artery, and
the recurrent  nerve,  and are covered  by the
sterno-hyoid,  sterno-thyroid,   and  omo-hyoid
muscles, the cervical fascia, and the integuments.
This body or gland is supplied with blood by the
superior thyroid arteries from the external caro-
tid, the inferior thyroid arteries from the thyroid
axis, which is  a branch of the subclavian artery,
and  sometimes by an  artery from the arteria
innominata,  or from the aorta itself, called the
middle thyroid artery; its blood is returned by
the thyroid veins, which descending on the ante-
rior aspect of the trachea empty themselves into
the left vena iniominata.   No excretory duct
has been discovered  emerging from this body.
The names of Goitre and Bronchocele, have usu-
ally  been given to  enlargement of the thyroid
gland.
                     21* 
246
                 HERNIA

"  Before commencing the study of Inguinal, and
more, especially  that of Femoral Hernia,  it is
absolutely necessary that the student should be
well acquainted  with the  anatomy  of the os
innominatum, and particularly with that of the
pubic and iliac portions of that bone.   It is also
of  great  advantage  to obtain a  pelvis,  upon
which Poupart's  ligament is well preserved, with
that portion of it to which the name of Gimber-
nat has been applied.   The  distance from the
anterior superior spinous process of the ilium to
the symphysis pubis, in  most subjects, is  about
six inches.   The Spine of the pubes is an inch
and a quarter from  the symphysis.  From this
spine, a sharp ridge or border extends obliquely
backwards and outwards, and is called the linea
ilio-pectinea, and which in the subject is covered
by a ligamentous expansion—an inch and a quar-
ter, on the outside of the spine of the pubes is a
depression on the upper face  of the bone, upon
which we find the femoral absorbents, the femoral
vein,  and outside of the vein, the femoral artery.
  Poupart's ligament extends from the anterior
superior  spinous  process to  the  spine of  the
pubes, where it  is inserted;  a portion of this
ligament extends backwards and inwards, and is
inserted  into the linea  ileo-pectinea.  This is
called Gimbernat's ligament.  It presents exter-
nally a sharp lunated border, which looks towards
the femoral vein. 
247
                   HERNIA.
  Hernia is a protrusion of an organ from the
cavity in which it is naturally placed.   All the
great cavities of the body, as that of the cranium,
thorax, abdomen, and pelvis, are lined by a serous
membrane, which is protruded before the organ,
as it is  escaping from its cavity, and is called
the  hernial  sac.   Hernia may therefore occur
from any of the great cavities; but for several
reasons is most commonly met with in the region
of the abdomen.  To  understand  the nature of
abdominal hernia, it  is necessary to consider the
structure of the walls of the abdomen,  and the
organs contained in that cavity.  In looking on
the  inside of the anterior wall of the abdomen,
we find it smooth and polished, which appearance
is due to the serous  lining, or peritoneum.  On
stripping off this membrane we expose to view a
strong, dense white fascia, the fascia transversa-
lis, so called bee use it lines the posterior surface
of the transversalis muscle.  This fascia is of  very
great extent;  commencing  below, we   find  it
attached  to  the whole extent of Poupart's  liga-
ment, to the internal lip of the crest of the ilium;
it becomes weak and  thinner towards the linea
alba; superiorly it may be traced as high as the
diaphragm.  From the grent extent of surface of
this membrane, lining as it does the whole ante-
rior  and  muscular wall  of  the abdomen,  and
having the peritoneum attached to its posterior
suiface, it is  evident that  any organ or viscus 
248
which tends to push the peritoneum before it,
must  also  protrude the  fascia  transversalis.
This fascia  therefore must necessarily foim a
covering to all kinds of abdominal hernia.  The
next layer, passing from within outwards, is the
muscular wall of the abdomen, consisting of five
pair of muscles with their tendons, their fibres
running in various directions, some downwards,
some  upwards, and others transversely, while
some  again  are  arranged  vertically.  By  the
decussation  of these fibres in so many various
directions, the muscular and tendinous wall of
the abdomen is rendered very strong and resist-
ing; and were it  as much so in all points as has
been  described, it is difficult to conceive how a
hernia could ever take place. Upon the outer sur-
face of the muscles  we find the superficial fascia
and fat, and upon this the skin.   The posterior
wall of the  abdomen is formed by the lumbar
vertebrae, psoas magnus  quadratus lumborum,
and superiorly the abdominal cavity is bounded
by  the  diaphragm,  inferiorly  it communicates
with that of the pelvis.   The viscera  of  the
abdomen, which are most likely to protrude and
form hernial tumors, are  those which are  en-
dowed with the greatest mobility.  Accordingly
we find that the  small and large intestines, and
the omentum, are most frequently found in hernial
protrusions.   In a few rare cases, nearly  all  the
viscera have been seen in a  hernial sac, with  the
exception of the  kidneys, pancreas, and duode-
num.  From the description of the great strength 
249
 of tin muscular, tendinous, and fascial structures,
 entering  into the formation of the abdominal
 wall, it might be asked, how is it ever possible
 for hernia to occur?  We shall find that it does
 so only at certain points, which are congenitally
 defective, or which are  weakened by the transit
 of certain  organs, which in their  progress of
 development  are necessarily  obliged  to  pass
 through the anterior abdominal wall.   It  now
 becomes necessary to examine the situation and
 nature of these  various openings, from which
 the different varieties of hernia protrude.
   If a hernial tumour  presents at the superior
 part of the groin, above Poupart's ligament, pass-
 ing down in the scrotum and towards the testicle,
 it is called Inguinal Hernia.  If the tumour shall
 have followed the course of the spermatic cord,
 it is called oblique; if it has not done so, but
 passed directly out of the cavity of the abdomen,
 passing out of the external ring, it is  then called
 Direct Inguinal Hernia.   The anatomy of Hernia
 can  never be comprehended, without a careful
 dissection  of  the dead  body.   The  mode of
 making the  dissection  will  therefore  here be
 described, and in the simplest manner, for the
 benefit of those who are just entering upon their
 anatomical studies.   A block being placed under
 the loins  of the  subject, and  the thighs widely
 separated, the legs lying over each  side of the
 table, make an incision from the umbilicus to the
symphysis pubis, another from the umbilicus out-
wards towards the lumbar vertebrae.  This inci- 
250
 sion should be made carefully through the skin
 and superficial fascia, down to the tendon of the
 external oblique.  The superficial fascia should
 be  cautiously raised from the tendon, and the
 flap dissected back towards the crest of the
 ilium ; when some of the muscular fibres of the
 external oblique will be displayed. On approach-
 ing Poupart's ligament, the superficial fascia will
 be  found closely  adhering  to  it, and  can  be
 separated or detached with  the  handle  of the
 knife;  the superficial fascia is formed of condens-
 ed  cellular tissue and fat, and has several small
 vessels  ramifying in  its substance.  The tendon
 of the  external oblique is now  fairly  exposed,
 the direction of its fibres is downwards;  at the
 upper  part  of the groin, the tendon  becomes
 thickened, and forms a strong tendinous band,
 called Poupart's ligament, which extends from
 the anterior superior spinous process of the ilium
 to the  spine  of the pubes.   A rounded reddish
 cord is seen emerging from the abdomen through
 an opening in the tendon of the external oblique.
 This cord is  the spermatic cord,  which consists
 of the vas deferens, which is the excretory duct of
 the testicle;  the spermatic artery and vein, the
 cremasteric   artery,  the  artery of   the  vas
 deferens, the nerves of the testicle, the absorb-
ents, and the cremaster muscle, which covers or
is spread out over the other constituents  of the
cord. The opening in the external oblique tendon
through which the cord  passes,  is the external
abdominal ring.  A thin fascia proceeds from the 
251
edges of the ring, downwards upon the cord, and
is called intercolumnar fascia.  When this fascia
is dissected away, the ring and cremaster become
distinctly seen.  The " ring" is now seen not to
be circular, but triangular.
  The portion of tendon which passes above the
cord is called the superior column of the ring; it
passes over the  symphysis pubis, and  interlaces
with its fellow of the opposite side. The portion
of tendon passing below the cord is inserted with
Poupart's ligament into the spine of the pubes,
and is called the inferior column of the ring.   It
is often important, as in  the examination  of
recruits for the army or  navy, &c, to ascertain
whether a tendency to a hernia exists, and there-
fore  to know the  exact place at  which such
tumour will  protrude, or  in  other  words the
situation of the external ring.  This is about one
inch or an iuch and a quarter from  the centre
of the symphysis pubis, and may be easily found,
by  grasping the  cord  with  the  fingers  and
thumb, and  tracing it up to the ring.  It now
becomes necessary to trace the course of the cord,
from the ring upwards, and to ascertain the rela-
tion of the surrounding parts to it.   An incision
is to be made through the external oblique  ten-
don, commencing near the  outer extremity or
attachment of Poupart's ligament, and carried
parallel with the ligament (and about a quarter
of an inch above it) almost to the external ring,
but so as to preserve the  ring, and then turning
suddenly upwards towards the median line. 
252
   The flap is then  to be raised, when the mus-
 cular fibres of the internal  oblique  are brought
 into view, as well as the fibres of the cremaster,
 which originate from it, and also from Poupart's
 ligament.  The muscular fibres of the internal
 oblique and  transversalis arise from  the outer
 half of Poupart's ligament, arch over the cord, and
 their fibres become united, forming the conjoined
 tendon, which  passes inwards and downwards,
 and is inserted into the  linea ileo-pectinea, and
 into Gimbernat's  ligament, hereafter to be de-
 scribed. If the internal oblique and transversalis
 are now carefully detached from Poupart's liga-
 ment, the fascia transversalis is seen as a dense
 whitish membrane,  the muscles  may  be still
 further raised up,  when  the  fascia can be traced
 to the  outer  edge of the cord, and  from  thence
to the edge  of the rectus  muscle,  gradually
 becoming very thin and delicate  towards the
 median line.  On first inspection the cord appears
 to pass through an opening in the fascia trans-
versalis ; this point is called the  internal abdo-
minal ring, and is just  half way between the
anterior superior  spinous  process  of the ilium
and  the  symphysis pubis, and  half  an  inch
above Poupart's ligament.   The ring, however
is not an opening,  but a funnel-shaped process of
 the fascia, sent down upon  the cord; and it is
in this  funnel that  the  hernia  engages  as  it
 descends. 
253
    COVERINGS OF OBLIQUE INGUINAL HERNIA.
   As the intestine  or omentum protrudes from
the abdomen, it pushes before it: 1.  The peri-
toneum.  2.  It enters the funnel-like process of
the fascia transversalis, and is covered by  it.
3. It passes under the fibres of the cremaster, and
is covered by that muscle.  4. It is next invested
by the  intercolumnar fascia.  5. Its last or ex-
ternal covering is from  the  superficial fascia
and skin.

          OF TOE EPIGASTRIC ARTERY.

   This artery is a branch of the external iliac,
and is given off from it close to the upper margin
of Poupart's ligament, and sometimes behind it.
At first it passes slightly downwards, then up-
wards and inwards, towards the edge of the rectus
muscle, to which  it sends many branches.  It
inosculates with the internal mammary.  It lies
on the inner edge of the internal abdominal ring
and behind the fascia transversalis; consequently
when the intestine descends in oblique hernia,
following necessarily  the course of the cord, it
must push the epigastric artery to the inside.

           OF THE  INGUINAL CANAL.
  This is merely the space which  the  cord
occupies  between  the  external and  internal
abdominal rings.  Anteriorly, it is bounded by
the tendon of the  external  oblique, posteriorly
                     22 
254
by the conjoined tendon and fascia transversalis,
and inferiorly by the upper grooved border of
Poupart's ligament.  The obliquity of this canal
is a considerable protection against the occur-
rence of hernia, which would doubtless have been
much more frequent had the cord passed directly
from the cavity of the abdomen.   When  the
abdominal muscles are in  strong  action  they
act as a valve pressing together the sides of the
inguinal  canal,, and thus tend  to  prevent the
descent of the viscera.

           DIRECT INGUINAL HERNIA.
   The conjoined tendon formed by the internal
oblique and transversalis muscles, passes behind
the outer edge of the rectus muscle, to be insert-
ed into the linea ileo-pectinea, and into Gimber-
nat's ligament.   This conjoined tendon is closely
attached to the inner portion of the fascia trans-
versalis,  or  in other words to that part  of it
which extends  from the inner margin of  the
internal ring, inwards towards the rectus muscle
and downwards towards the pubes.  This close
attachment of the conjoined tendon to the inner
portion of the transversalis is of great importance
as preventing the occurrence of direct hernia'
inasmuch as the powerful  contraction of  the
internal oblique and  transversalis upon  the con-
joined tendon  tightens and braces  the fascia
transversalis, to  which  it is attached.  On  ex-
amination it will be found, that  the conjoined 
255
tendon and fascia transversalis close up and pro-
tect a triangular space, between  the epigastric
artery, the outer  edge  of the  rectus,  and the
pubes below.  In most subjects, this combination
of fascia and tendon is  strong  enough  to resist
the  tendency of the  viscera to protrude when
violently compressed  by the abdominal muscles;
but  in some subjects, "these  parts are naturally
imperfect, or so weak as to be incapable of resist-
ance to the passage of a hernial tumour. When
this  protrudes through this deficiency in  the con-
joined tendon and fascia it affords  an example of
direct inguinal hernia.   As we trace the pro-
gress of the hernia, we find that it continues  to
descend to the  external ring, through which it
passes, receiving as it  goes through that  ring, the
intercolumnar fascia, and then the  superficial
fascia and skin.  It will thus be seen, that  this
variety of hernia is well named, inasmuch as its
course is  straight  forwards or direct, from  the
deficiency in the conjoined tendon to the external
ring. It differs from oblique inguinal hernia, as it
leaves the cord to the  outside, and  is not covered
by the cremaster—as it passes down, it pushes  or
leaves the epigastric artery to the outside.  The
form of the direct hernial tumour is generally
rounded, that of the oblique most usually pyriform.

   COVERINGS OF A DIRECT INGUINAL HERNIA.
  1.  The  peritoneum.  2.  The  fascia transver-
salis.  3.  Intercolumnar fascia.   4. Superficial
fascia and skin. 
256
              OF THE STRICTURE.
  1. The stricture maybe caused by the external
abdominal  ring   2.  By the  constricting  edges
of the internal  oblique and  transversalis mus-
cles, where they arch over the cord.   3. By the
edges of the opening in the  conjoined  tendon.
4. More frequently at the  internal ring,  or in
the neck of the sac itself.  In all cases of stran-
gulated hernia, it is safest to divide the stricture
directly upwards.
                    TAXIS.
  The patient should lie upon his back, a pillow
should be placed under the pelvis  and another
under the shoulders, the thighs should be raised
to a right  angle with the body, and  the knees
brought close  together.   In applying the taxis
in oblique  hernia, the pressure  on  the tumour
must be made in the direction of the course of
the cord or towards the anterior superior process
of the ilium.  In direct hernia, the pressure may
be made directly  upwards and backwards  in
accordance  with  the direction  in which  the
hernia came down.   In using the  taxis,  great
gentleness  and caution are to be observed.

              FEMORAL HERNIA.
  Supposing that the  dissection for inguinal
hernia has  been made on the left side, continue
the incision from the  spine of the pubes down-
wards for five inches in a perpendicular direc- 
257
tion,  from the termination of which, a second
incision is to be made across the fore part of the
thigh so as to allow a flap of the superficial fascia
and skin to be reflected outwards.  In raising
up the superficial fascia, the fascia lata, on which
it reposes, will be exposed.  This must be done
with  caution, so as to avoid injuring the saphena
vein,  or  the fascia  lati—frequently  using the
handle of the knife  to separate the  parts.  A
number of lymphatic glands or vessels, and small
arteries and veins, are involved in  the  layers of
the superficial fascia.  Commence the separation
of the superficial fascia from the fascia lata; from
the inner portion of Poupart's ligament and the
pubic part of the fascia  lata;  lower down, find
the saphena vein, separate  the superficial fascia
from  the vein, which is to  be left, reposing upon
the fascia lata.  This vein passes  up  from  the
inner part of the foot and leg, to join the femo-
ral  vein at  the upper  and  inner  part of the
thigh.
  By now gently pushing with the  handle of the
knife  on  the pubic side of the fascia  lata, from
above downwards and inwards, upwards under
the vein, and upwards and to  the outside of  it,
we bring into view a lunated edge of an opening
in the fascia lata.  This edge or border is to  be
carefully traced upwards and  outwards; when,
if we continue cautiously to separate  as before,
it will have the appearance of a falciform mar-
gin or process, passing up to be inserted into the
inner portion of Poupart's ligament. The lunated
                     22* 
258
and falciform edges or borders above  described.
will be found to form the  margin of an opening
in the fascia lata for the passage of  the saphena
vein,  and hence called the saphenous opening.
   The femoral artery and  vein, side by side, lie
in a sheath of areolar or cellular tissue of con-
siderable thickness, which occupies the  saphe-
nous opening.  The femoral vein is  on the inside
of the artery.   This sheath is closely  connected
with  the superficial fascia of the  groin which
covers over  the saphenous opening,  adhering
closely to its margin.   This superficial fascia is
now to be removed from the saphenous opening,
but in such manner as to  leave a large portion
of cellular  and  adipose  tissue, covering  the
vessels, and which in fact constitutes the ante-
rior part of the  sheath of the vessels above men-
tioned.
   The fascia lata is now seen as a dense, strong,
fibrous membrane, covering the muscles on  the
upper portion of the thigh.  Its outer part, or
Uiac portion, is attached to  the crest of the ileum,
and to the whole inferior  border of  Poupart's
Hgament, and is  on a  higher  plane  than  the
pubic portion, which is attached  to the symphy-
sis, spine of the pubes, and linea ileo-pectinea.
By extending the thigh and throwing it strongly
outwards, Poupart's ligament  and the  upper
portion of the fascia lata are put strongly upon
the stretch.   On the other hand, by flexing  the
thighs towards  the abdomen and  turning  the
knee  inwards,  the same  parts become greatly 
259
 relaxed.  This fact is important to be  remem-
 bered in the reduction of hernia.
   The abdomen may now be opened by cutting
 in the line of  the first median  and transverse
 incisions into that cavity.  The peritoneum may
 now  be cautiously separated from the  fascia
 transversalis, beginning on the outside, near the
 middle  of the crest of the ilium,  and passing
 inwards towards the  median line.  The  fascia
 transversalis is attached to the crest of the ilium,
 to the whole extent of Poupart's ligament, and
 can be traced under Poupart's ligament to become
 continuous with  the cellular aud adipose tissue
 which covers the femoral artery and vein, as they
 lie in the saphenous opening.  The peritonaeum
 is now to be detached from the parts in the iliac
 fossa, when a strong pearly white fascia is  ex-
 posed which is called the  fascia iliaca.  The
 fascia iliaca covers over the psoas magnus and
 iliacus internus muscles; it is attached to the
 inner lip of the crest of the ilium where it meets
 the transversalis  fascia in  a  seam;  also in  a
similar manner it is attached  to  the outer half
of Poupart's ligament; it then passes underneath
the external iliac artery and  vein, these vessels
reposing upon  it.   It  can now be traced,  under
Poupart's ligament, becoming continuous with
the pubic portion of the fascia lata of  the  thigh.
The fascia transversalis dips down on the  inside
of Gimbernat's ligament to join the fascia iliaca.
It will thus be seen that by the fascia transver-
salis, passing down from the abdomen  over  the 
260
anterior surface of the  femoral vessels as they
pass under Poupart's ligament, and by the pas-
sage of the fascia iliaca underneath these vessels,
a large funnel-like  sheath  is formed, in  wh;ch
the  vessels are enclosed, and  which is called
the  " sheath  of the vessels,"  or the  "femoral
sheath."  The finger may now be inserted on
the inside of the external iliac vein between the
vein and the sharp lunated border of Gimbernat's
ligament, when it will easily pass into an open-
ing called the femoral ring.  The finger is now
in the funnel-like sheath of the vessels, and by a
little pressure passes easily under Poupart's liga-
ment, still  covered  by the anterior part  of the
sheath which was left on the vessels when the
superficial  fascia  was removed from over the
saphenous opening.  It  is through the femoral
ring that a femoral hernia descends from the
abdomen,  passing down  into the femoral sheath,
pushing the anterior layer of the sheath (which
is  the fascia  transversalis) before it, and then
emerging from the saphenous opening upon the
anterior and upper portion of the thigh, where
it is then covered  by the superficial  fascia and
skin.  While the finger is in the ring, it will  be
found  to  pas3 most readily downwards and
forwards, which is the general course  of a femo-
ral hernia, sometimes  turning upwards  over
Poupart's  ligament; while  the finger of  an
assistant  is passed into the ring and femoral
sheath, this last may be opened, to understand
more readily how the sheath envelops  or encloses 
261
 the hernia.  The fascia iliaca may now be raised
 up from the iliacus internus and psoas magnus
 muscles, and cut away from its attachment  to
 the crest of the  ilium and Poupart's ligament.
 The fossa of the iliac bone will be seen to be
 filled up by the above named muscles; next we
 find passing towards  the median line, the ex-
 ternal iliac  artery, next  the external iliac vein,
 then  the femoral ring;  after  that we come  to
 the lunated border of Gimbernat's ligament. We
 thus  perceive that all the space between the
 anterior superior spinous process of the  ilium
 and the femoral ring, and between the iliac fossa
 and Poupart's ligament, is occupied by muscles
 and by the femoral vessels, and strengthened by
 the meeting together of  the fascia transversalis
 and fascia iliaca (in a seam) from the crest  of
 the ilium to the outer side of the external iliac
 artery.   As the fascia transversalis passes down
 upon  the vessels, and while  under  Poupart's
ligament, it sends down a partition or  septum  of
fascia,  between  the external  iliac artery and
vein,  and another,  which passes down on the
inside of the vein, forming the outer wall of the
femoral  ring.  The  inner wall of this ring or
opening  is formed  by a  septum or partition  of
fascia, passing downwards from the fascia trans-
versalis to the fascia iliaca, and lining the lunate
border of Gimbernat's ligament. It thus becomes
evident that the parts which separate and shut
the abdomen from  the  thigh, are so arranged
that there is  only  one place where femoral 
262
hernia is likely to occur, and that is at the point
already  designated as the femoral ring.   In the
natural  condition of the parts this ring is occu-
pied by a small absorbent gland, lymphatics,
and  a  small  quantity of cellular and  adipose
tissue.

          OF THE EPIGASTRIC ARTERY.

  This artery ordinarily arises from the external
iliac close to  the upper  margin of  or  behind
Poupart's ligament.  Its course is at first slightly
downwards, then upwards and inwards, to the
outer border  of the rectus  muscle.   When  a
femoral hernia descends, the epigastric is pushed
to the outer side of the hernial tumour.   Occa-
sionally the obturator, instead of coming off, as
it usually does, from the internal iliac, arises by
a common trunk with the epigastric from the
external iliac; and  in such cases the hernia is
almost  encircled by the  artery.  This  variety
is said  by Cloquet and others to occur once in
about three or four cases: but in the majority
of instances the tumour, in its descent, would
probably evade  the artery, which  would  be
pushed   to  the  outside and  below the  hernia.
The possibility, however, of the hernia becoming
encircled by  the artery should  always  be kept
in mind, and should suggest great  caution  in
dividing the  stricture, cutting or rather nicking
it only so much as  is just sufficient  to  liberate
the constricted part. 
263
              OF  THE STRICTURE.
  A femoral hernia may be constricted.  1. In
the femoral sheath and by the falciform edge of
the fascia lata, as it passes up to be inserted into
Gimbernat's ligament.  2.  By the posterior edge
of Poupart's ligament.  3. More  frequently in
the neck of the sac itself.  As the hernia passes
through the femoral ring it is greatly constricted,
this ring being bounded on the  inside by the
sharp lunated border of Gimbernat's ligament,
superiorly  by the posterior edge of Poupart's
ligament, inferiorly  by the fibrous  covering of
the os pubis and pubic portion of the fascia lata,
while the  outer boundary is  the femoral vein:
and it is only in this  direction  that the ring
admits  of  much  dilatation.   As  the hernial
tumour is nearly surrounded by dense and fibrous
tissues,  delay in relieving the strangulation is
more dangerous than in inguinal hernia.

      COVERINGS OF A FEMORAL HERNIA.
  As it descends, entering  the femoral ring, it
pushes before it—1. The peritoneum. 2. A small
lymphatic  gland, absorbent vessels, cellular tis-
sue, and fat, which fill up the femoral ring, and
together constitute what has been called the sep-
tum crurale.   3.  The transversalis fascia, or the
anterior wall of the funnel-like or femoral sheath.
4. The superficial fascia and skin.
                    TAXIS.
   In applying the  taxis the  abdominal muscles 
264
 must be relaxed as much as possible, the thighs
 are flexed towards the abdomen, the knees turn-
 ed inwards. The hernia should be pressed gently
 backwards, as it were* into the thigh, and then
 upwards.  If  it has turned up  over Poupart's
 ligament, it must be carefully disengaged from
 it, brought down, and then pressed backwards
 and  upwards  as  before.   Femoral hernia  is
 usually very small,  especially when recent.   It
 is often mistaken  for an  enlarged lymphatic
 gland,  and such errors are not unfrequently fatal.
 If a  patient, and especially a female, is seized
 with nausea and vomiting, pain in the abdomen,
 and obstinate constipation, the possibility of the
 existence of a strangulated hernia should never
 be forgotten, and the necessity of an immediate
 and careful examination of the points where
 hernia  (and particularly femoral) may  occur,
 should be insisted upon.  From false motives  of
 delicacy, but  more  frequently from ignorance,
 an examination has  not been made;  or if so, the
 tumour, which is generally  small, if recent, has
 been mistaken for a  lymphatic gland, and poulti-
 ces have sometimes been applied to what was
 supposed to be a  suppurating  tumour, which
 being f.pened  by an  incision, faeces were dis-
 charged from the wound,  the patient dying soon
afterwards.  Another very dangerous  error  is
that  of  mistaking  crural for inguinal  hernia,
inasmuch as the mode of applying the taxis and
 of operating,  is essentially different in the two
kinds of hernia. 
265
  Diagnosis.—The neck of the hernial tumour
is situated above Poupart's ligament in inguinal
hernia.   In femoral hernia it is below, and if the
tumour is drawn down in femoral hernia, Pou-
part's ligament may be traced above  it.  The
neck of  the tumour in inguinal hernia is above
the spine of the pubes, that of femoral hernia is
below  and to its outside.  Femoral hernia may
also be mistaken for psoas abscess, and for other
diseases, but  the history of the case and a care-
ful  examination of the parts will generally suf-
fice to determine the character of the disease.
  The student may now remove the cellular and
adipose tissue from the femoral artery  and vein,
in such manner as  to get a clearer and more dis-
tinct view of the saphenous opening.  He may
then remove all the cellular  and adipose tissue
from  the vessels,  above and under Poupart's
ligament, when he will obtain a more  perfect
idea of  Gimbernat's ligament, and of  the man-
ner in which  the  fascia iliaca passes under the
great vessels to become continuous with the pu-
bic  portion of the  fascia lata.
  The parts in hernia should be carefully and
repeatedly dissected, and may be compared with
the  description here given.   The knowledge ob-
tained from reading alone is worse than useless,
and it would be much better for the student never
to read  a word upon  hernia until, with scalpel
in hand,  and his book open before him, he com-
mences his dissection upon the subject.
                     23 
 
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                        A


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   MEDICAL   LEXICON;


                      BEING A


Dictionary of  the Words, Terms, and  Symbols

               of Medical  Science,


Collated from the best authorities, with the addition of new
       words not before introduced into a lexicon,


              WITH AN  APPENDIX,


                        BY


      D.  B. ST. JOHX  ROOSA, M. D.,

Aural Surgeon ,to the New York Eye and Ear  Infirmary.

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OP
MICROSCOPIC     OBJECTS;
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THOMAS  DAVIES.
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MATERIA    MEDICA

                       AND

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Fellow of the Royal College of Physicians; Prof, of Materia
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                      23* 
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ON  VENEREAL  DISEASES.

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Traite de Pathologie Externe et de  Medecine Operatoire,
&c, Ac.   Translated and  Edited by GEORGE C. BLACK-
MAN, M.D., Fellow of the  Royal Medical and Chirurgical
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THE STANDARD.
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          ON   DIABETES
                      AND  ITS
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                     ON THE

            ORGANIC   DISEASES


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                       OF THE

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               LECTURES   ON

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                      OF

UTERINE  THERAPEUTICS,

                      BY
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We hail it as a most valuable  addition to the literature
of a class of diseases, tho pathology and the therapeutics
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the great pracUcal  tact they exhibit; and we And this to
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Jour., Feb. 16, 1865. 
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THEIB
DIAGNOSIS  AND TREATMENT.
A TEXT-BOOK OF A.TJJRA1L. SUR-
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           BY

DR. ANTON VON TROLTSCH.
Translated from the German by D. B. St. John Eoosa, M.D.
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 "We have perused the volume with pleasure and pro-
fit  and shall always consult it with confidence." —Boston
Med. and Surg. Jour., July 14, 1864. 
Wm. Wood & Co., Publishers.
                   Third Edition.
                        THE

principles  ano  practice  of  ©bstetrics.
         Br Gunning S. BBnroKD, A.M., M.D.,
Formerly Professor of Obstetrics, the Diseases of Women and
    Children, and Clinical Obstetrics, in the University.
       of New York; Author of Clinical Lectures
         on the Diseases of Women and Children.
Illustrated  by Four Colored  Lithographic Plates and
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ers having passed to a third edition in the  brief period of
thirteen months from the day of publication.  The following
extracts will indicate its  enthusiastic reception by the Medi-
cal Press, both at home and abroad:
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with  so  mucli unalloyed  pleasure and profit   The style is
plain fresh—welling up  from an exuberant fountain—com-
pact' The whole book  exhibits the careful  preparation of
the successful teacher.   The plan and arrangement of  the
work are at once comprehensive, systematic, complete—and
fully posted to the existing state of the science."—Philadel*
phta Medical and Surgical Reporter.
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pared us to regard with unusual  interest  this  systematic
treatise on  the ' Principlen and Practice of Obstetrics.
This  new book is no failure;  our just expectations of the au-
thor are fully met.  He has presented us an originality, which
is quite refreshing in these days of fl inkeyism and imitation.
 We most cordially recommend the bo ik us a complete and
 most attractive Text Book on the science and art of Obste-
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 which the practitioner will find detailed those rules which
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                         the


 DISFASES OF WOMEN AND CHILDREN.

       By Gunning S. Bedford, A.M., M.D.,


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          versity of New York; Author of the
             Principles  and Practice  of
                       Obstetrics.

    EIGHTH EDITION, CAREFULLY REVISED AND ENLARGED,
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■ so remarkably exempt from the superficial views that abound
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NATIONAL LIBRARY OF MEDICINE
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