»
V 
 
DIAGKAMS
OF THE
NERVES
OF THE HUMAN BODY;
EXHIBITING  THEIR ORIGIN, DIVISIONS AND CONNECTIONS, WITH  THEIR DISTRIBUTION
              TO THE VARIOUS REGIONS OF THE CUTANEOUS SURFACE
                           AND TO ALL THE MUSCLES.
                        BY


      WILLIAM HENRY  FLOWER,

FELLOW OF THE ROYAL COLLEGE OF SUROEONS; ASSISTANT SURGEON TO, AND
      DEMONSTRATOR OF ANATOMY AT THE MIDDLESEX HOSPITAL.
                   EDITED, "WITH ADDITIONS, BY


                WILLIAM W.  KEEN, M.D.,

LECTURER ON ANATOMY AND OPERATIVE SURGERY IN THE PHILADELPHIA SCHOOL OF ANATOMY;
      LECTURER ON PATHOLOGICAL ANATOMY IN THE JEFFERSON MEDICAL COLLEGE;
               FELLOW OF THE COLLEGE OF PHYSICIANS, <fcc. Ac.
                PHILADELPHIA:

TURNER HAMILTON, BOOKSELLER AND STATIONER,

              106 S. TENTH STREET.

                    1872. 

Entered according to the Act of Congress, in the year 1872, by
                 TURNER HAMILTON,
in the Ofifice of the Librarian of Congress.  All rights reserved.   ' 
EDITOR'S   PREFACE.
    The signal benefit derived from these diagrams as illustrations in teaching, and their  great con-
venience for ready reference in practice, have led to their republication, reduced to one-fourth the size
of the originals.
    The Editor has made some  additions where greater  detail seemed  desirable, has grouped the
spinal nerves  in  their plexuses, and  has added to  the text  a synopsis of the various  sympathetic
ganglia.  His  alterations  have been very slight, and limited almost  exclusively  to the mechanical
arrangement, e. g. in the mode of  bifurcation of the  brachial plexus.

   1729 Chestnut Street, Philadelphia,
          January 1st, 1872. 
 
PREFACE.
     The anatomy of the nervous system, although of the highest importance both to the physiologist
and  to  the  medical practitioner,  has, owing to the difficulties which are  supposed to surround its
study, generally met with less attention  than might usefully have been bestowed upon it.  To remove
some of these difficulties  is the author's object  in the publication of this work, which  has  no preten-
sions to enlarge the boundaries of the  knowledge  already existing upon  the subject, but aims at
placing that knowledge in a form easily accessible, as well  to students, as to those whose  avocations
no longer afford time or opportunity for elaborate anatomical investigations.
     The distribution of all the nerves of the body, so far as the branches  have received distinctive
appellations, is shown, and their divisions are traced  to the muscles and to the various regions of the
cutaneous surface.  To afford  greater facility for reference, the names of the muscles  are printed in
red letters ;  those of  the nerves being black.
     It  must be clearly understood that  the plates are only diagrams or plans, and that in reducing to
a plane surface objects which are in reality superimposed at various distances, and which  sometimes
cross one another, their mutual relations and proportions must often be disarranged.
     In  the plexuses and other parts which vary somewhat in different subjects, the  average distribu-
tion in  its most simple form has been selected for illustration; and in difficult or disputed points, such
as the connecting branches of the cranial nerves, only  those which  are established on good  authority
are introduced.
     As few things tend to embarrass  the student  so much as a diversity of nomenclature, that used
in the last  (sixth) edition of Quain's Elements of Anatomy by Dr. Sharpey and Mr. Ellis, has  been
adopted throughout.
     The principal materials for the composition of these diagrams have been obtained by repeated
dissections;  but the author desires to acknowledge the  assistance derived  from the above-named work,
from that of Swan, and from  the beautiful plates of Hirschfeld and  Leveille.

   32 Queen Axne Street, Cavendish Square,
            December 22d, 1860. 
 
                PLATES I.  and  II.—THE  CRANIAL  NERVES.

    Under this name are included the twelve pairs of nerves  arising from the cerebro-spinal centre,
which are transmitted to their destination through apertures in the base of the skull.
    The numerical nomenclature of the  cranial  nerves, introduced  by Willis, had become so com-
pletely incorporated into our medical, anatomical, and physiological  literature before  its errors were
discovered, that it would be impossible now to discard it altogether.  The arrangement of Sommerring,
in which each of the five pairs of nerves forming the seventh and eighth of Willis is  recognized as
distinct, is more correct, and is already very generally used upon the  Continent.  In the diagrams the
two systems are placed for comparison in contiguous columns.
    In the first explanatory column the  superficial  or apparent origins of the nerves only are  given.
Although the deep or real origins  are unquestionably of greater physiological importance, they  are at
present in almost every instance so imperfectly understood, that they could not have been accurately
stated in that concise form required in a tabular exposition.
    Most of the cranial nerves are connected by  fine filaments with branches  of the sympathetic
system.  The  physiological import of these communications being  still  imperfectly understood, the
words to and/Vom applied to them must be taken in an anatomical sense only, and not necessarily as
implying the presumed direction of the current of nerve force.
    The first plate illustrates the distribution of the first six pairs of cranial nerves.
    I. The  Olfactory Nerve  is specially  appropriated  to the sense of smell.  Although  commonly
described as a nerve, this with its  expanded extremity should more properly be considered as a portion
of the encephalon, as it contains much of gray matter, has no sheath or neurilemma, and is homologous
to the more fully developed olfactory lobes of the lower  animals.
    From the under surface of the bulb about twenty delicate nerves  are given off; these pass through
the foramina in the cribriform plate of the ethmoid bone, and are distributed to the mucous membrane
lining the upper two-thirds of the nasal fossa?.
    II. The Optic Nerve is the special nerve of the  sense of sight, and terminates  in the retina.  The
nerves of opposite sides are connected together at the commissure.  From their origin up to this point,
being in  the form of flattened bands, they are called optic tracts.
    III. The Third Nerve  {Motor Oculi) is entirely motor  in  its  function.  It supplies branches to
five of the  seven muscles of the orbit, and one (the short root) to the  ophthalmic ganglion, thereby
giving motor power to the iris.
    IV.  The Fourth Nerve (Pathetic or Trochlear) is the smallest of the cranial nerves, and terminates
in the superior  oblique muscle of the eyeball.  It communicates with the  sympathetic, and often with
the ophthalmic division of the fifth, and according to Bidder,  whose observation  has been confirmed
by Hirschfeld, gives a recurrent filament to the dura mater. 
     V.  The Fifth Nerve (Trifacial or Trigeminal) resembles the spinal nerves in having two roots, one

endowed with  sensory, the other with motor power;  but  the similarity is only partially carried  out,

inasmuch as the motor root is of very small size and of comparatively limited distribution.

     It is the principal nerve of common and muscular sensibility to  the face, confers  motor power on
the  muscles  of mastication,  and one of its branches contains filaments  appropriated  to  the  special

sense of  taste.    As in the  spinal nerves, the sensory root  has a gangliform  enlargement upon it  (the
Gasserian ganglion).   From  this proceed the three main branches or divisions of the nerve.   The two

upper divisions  are purely nerves of  common  sensation, while  the lower, into which alone  the motor

root passes, is of very complex character, having among its branches—

     1. Simple nerves of  sensation (inferior dental;  auriculo-temporal;  buccal).

     2. Nerves  which convey motor power  to  certain muscles, and  probably, like the spinal nerves,

           contain sensory fibres also.

     3. A nerve of ordinary sensation and special sense combined (gustatory), and which  by the addi-
           tion of the  chorda tympani  from the seventh nerve contains motor filaments.

     The branches of the fifth nerve towards their  termination communicate freely with  those of the
seventh, and confer sensibility upon the muscles of the face which receive their motor power from the

latter.

     In connection With this nerve  are four small ganglionic masses, containing gray matter;  each of

these  appears to be in communication (by roots) with a motor, a sensory, and a  sympathetic nerve, and
to  give  branches of  distribution to  contiguous structures.    A fifth ganglion  (sublingual) has  been

described by M. Blandin, and occasionally met with by Hirschfeld, but  as it has not  been  recognized

by other anatomists, it is not introduced into the plate.*


    * [Each ganglion connected with the sympathetic system, whether the Cerebral (in connection with the fifth nerve) or Spinal, has
three roots, Sensory, Motor, and Sympathetic,  and also branches of  distribution.  The following table groups them together for conve-
nient reference.
Name.	Situation.
/Ophthalmic j or Ciliary.	Between Optic Nerve and Ext. Rectus
3 \ Meckel's, or | \ Spbeno-Pa-< latine.	Sphenopala-tine Fossa.
* \ a /Otic. ° 1	Below Fora-men Ovale.
\ Submaxillary.	Above Submaxillary Gland.
Spinal Ganglia.
Sensory Root.
Fifth Nerve— First
 Division—Nasal
 branch.
Fifth Nerve— Second
  Division—
  Spheno-Palatine
  branches.
Fifth Nerve—Third
 Division—Auri-
 culo-temporal
 branch.
Fifth Nerve—Third
 Division —Lingual
 branch.
From Spinal Nerves
Third Nerve.
Cavernous Plexus.
Seventh Nerve through Vidian and
  large Superficial Petrosal.
Seventh Nerve through small Su-
  perficial Petrosal (probably);
  also from Int. Pterygoid branch
  of third division of fifth nerve
Seventh Nerve through Chorda
  Tympani.
From Spinal Nerves,
Sympathetic Root.
Short Ciliary Nerves to Ciliary Muscle and
  Iris.
Carotid Plexus
  through Vidian.
Orbital, Nasal, Naso-ralatine.
Ant. or large Palatine,
Middle or Ext. Palatine, f Levator Palati."]
Post, or Small Palatine to \ Azygos Uvulse. I
                         Glossus j
Plexus on Middle
  Meningeal Arte
  ry.
Plexus on Facial
  Artery.
From Ganglia
  above aud below
Branches of Distribution.
J Azygos
• ^Palato-
To Tensor Palati and Tensor Tympani.
To Submaxillary Gland and Mucous Mem-
  brane of the Mouth.
To the internal viscera through various great
  Plexuses and the vessels.  To the upper
  and lower extremities by the vessels —
  K.] 
9
     VI. The Sixth Nerve (Abducens Oculi) is  the  motor nerve of the external rectus muscle of the
eyeball.
     The second plate shows the distribution of the remaining six pairs of cranial nerves.
     VII. The Facial Nerve, or Portio  dura of the seventh pair (Willis), is purely a nerve of motion,
and is distributed  to the muscles of the face.  Besides those named in the diagram in direct connection
with it, the seventh appears also to supply through  the large superficial petrosal  (which after  being
joined by a branch from the sympathetic, receives the name of  Vidian, and enters Meckel's ganglion),
some of the muscles of the soft palate, and through  the chorda tympani  the  intrinsic  muscular fibres
of the tongue.  Before their termination  in the muscles, its branches communicate  freely  with the
sensory fibres of the fifth nerve.
     VIII. The Auditory Nerve, or Portio mollis of the seventh pair (Willis), is the special nerve of
the sense of hearing, and is distributed to the internal ear.
     IX. The Glosso-Pharyngeal Nerve gives filaments through its  tympanic branch to  some parts of
the middle ear, but is chiefly distributed to the mucous membrane lining  the upper part of the pha-
rynx, the Eustachian tube, the  arches of  the palate, the tonsils, and to the sides and posterior part of
the upper surface  of the tongue.  It is a nerve  of the special sense of taste, and of  ordinary  sensation
to the parts which it  supplies, and is the  chief centripetal nerve engaged in the action of deglutition.
     It is doubtful whether it contains any  motor filaments which are not derived from its communica-
tion with other nerves.
     X. The  Pneumogastric or Vagus Nerve, Par vagum of the eighth pair (Willis), has a most exten-
sive distribution,  giving  branches  to the pharynx, larynx,  trachea,  lungs, heart,  oesophagus,  and
stomach.   Its main trunk being of great  length, it has been  necessary in the  diagram to  give  it a
curve  so as to adapt it to the size of the paper.   It has numerous communications  with other nerves,
both cranial, spinal, and  sympathetic, and  its functions appear to be of very mixed character, partly
motor, partly  sensitive, and partly of a nature allied to those of the nerves of the sympathetic system.
     XI. The Spinal Accessory Nerve is apparently entirely motor in its function.  It arises  from the
upper part of the  spinal cord, a considerable portion of it  joins the  pneumogastric (whence its name,
"nervus spinalis ad par vagum accessorius"), the  remainder is distributed to the sterno-cleido-mastoideus
and trapezius muscles.
     XII. The Hypoglossal Nerve.  The ninth pair  in the system of Wrillis, supplies  all the extrinsic
muscles of the tongue, as well  as certain others  in connection with the hyoid bone.  Its proper func-
tion appears to be exclusively motor, such  sensibility as  it possesses being probably derived through
its free communication with the spinal nerves. 
10
                PLATES  III. and IV.—THE SPINAL  NERVES.

     The nerves which  arise from the  spinal cord have each two  roots.   Of these the  posterior is
 somewhat larger  than the other, has a ganglion situated upon it, and is composed solely of filaments
 which convey sensory impressions towards the cerebro-spinal centre.  The anterior root, which has no
 ganglion, consists on the other hand of fibres which transmit  motor power from  the  centre to the
 muscles.   After the union of these  roots, the  resultant nerve is of mixed function, containing both
 motor and sensory fibres.
     Directly the nerves issue from the intervertebral foramina, they divide into two branches; one of
 which, comparatively small, is  directed posteriorly,  and supplies the skin and muscles of the  back.
 The anterior branches form the large nerves which are distributed to the neck, the lateral, and anterior
 parts of the trunk, and the extremities.
     The spinal, like the  cranial nerves,  are symmetrically disposed on the two sides of the body.
 There are thirty-one  pairs, divided  for the convenience of description,  as  follows:  cervical, eight;
 dorsal, twelve;  lumbar,  five ; sacral, five;  coccygeal, one.
     In Plate III. the distribution of the cervical and dorsal nerves  is shown.
     The anterior branches of the four upper constitute the cervical plexus; those of the four lower
 cervical, together with a large branch from the first dorsal, form  the  brachial plexus.*  The anterior
 branches of the  dorsal nerves are called intercostal.   Those below the third have not been represented
 in the diagram, as they all resemble each other, running forwards between the ribs, supplying the
 intercostal muscles, and  giving off  lateral and anterior cutaneous nerves to  the surface of the chest.
     Small filaments which pass from the anterior branches of all  the  spinal nerves near their  com-
mencement  to the  ganglia of the sympathetic system have been omitted here, to  avoid  the  risk of
 obscuring any portions of the special objects of the diagram, but they will be seen in Plate V.
     Plate IV. illustrates the distribution of the  remaining spinal nerves.   The anterior branches of
the first three lumbar nerves and the greater part of that of  the fourth constitute the lumbar plexus.
The large nervous cord formed by part of the fourth,  and  the whole  of the fifth lumbar, together
with the first three and part of the fourth sacral nerves (anterior branches), is called the sacral plexus.

   * [The formation of the brachial plexus can be readily remembered by observing the double bifurcation of the cords  as indicated in
the plate.  The fifth,  sixth, and seventh cervical unite to form one cord; the eighth cervical and first dorsal a second.  Both of these
bifurcate, the middle branches uniting, and thus three cords are formed.  These three cords again bifurcate,  and two median branches
uniting form five principal cords. The internal cutaneous nerves are readily added.—K.] 
11
         PLATE  V.—THE  SYMPATHETIC SYSTEM OF  NERVES.


     The nerves of this system, also called tri-splanchnic, ganglionic, or nervous system of organic
life, are chiefly destined to supply the viscera.  They have abundant communications with the cerebro-
spinal nerves, in which  the fibres of the two systems appear mutually to interchange.
     The small ganglia, connected with the fifth cranial nerve, are generally considered as belonging
to the sympathetic system.  They have been figured in Plate I., and are not repeated here.   The gan-
glia on  the glosso-pharyngeal and pneumogastric nerves, and those on the posterior roots of the spinal
nerves,  are also by some anatomists reckoned part of it.
     The remaining, and by far the largest portion (which is  illustrated in this plate), consists of two
chains of ganglia connected by intervening cords, situated in  the posterior part of the neck, thoracic,
and abdominal cavities,  one on each  side of the  vertebral column, and extending from the upper part
of the cervical region as far as the  coccyx, where  they unite  in  a single small ganglion  (G. impar.).
Each chain  usually consists of twenty-four or  twenty-five ganglia,  having a generally  symmetrical
disposition on the  two  sides of the body.  Each ganglion  is connected above and  below with the
neighboring  ganglion of the chain; externally it has  communication with one or more of  the  spinal
nerves,  and internally it sends off branches which mostly enter into the formation of certain large
plexuses (prevertebral) situated near the median  line in the visceral cavities of the  body. [See note, p.
8.]  These,  after  receiving further  accessions  from  nerves  of  the  cerebro-spinal system, send off
branches for distribution to the various organs  of the neck, thorax,  abdomen, and pelvis.   In these
plexuses are situated many ganglia,  each of which appears  to be a  centre for the development or
modification of nerve force.  This  portion of the system, like the  parts which it  supplies, shows an
absence of bilateral symmetry.  The branches in reaching their destination  almost always accompany
bloodvessels, forming a fine network around them.  [It is by these vascular branches that  the sympa-
thetic nerve is distributed  to the upper and lower extremities.—K.]
    In  the  diagram, to avoid useless repetition and  obscurity,  only one side of such  parts of the
sympathetic system  as  are double and symmetrical is given, therefore only one of the  ganglionated
cords  with the ascending cranial branch from the first ganglion appears. The  cardiac plexus is, like
the organ it supplies, single; the  cardiac nerves  on  both sides  converging into  it.  The  solar and
hypogastric plexuses are also single, and situated in the median line.  On each side of the former,
where the great Splanchnic nerve joins it, a large gauglion (semilunar) is placed.  Of the  secondary
plexuses derived from it, the diaphragmatic, supra-renal, renal, and spermatic are  double, as are the
arteries  they accompany; but the hepatic, coronary, splenic, superior and inferior mesenteric, and aortic
are single and asymmetrical. 
12
    The hypogastric plexus  divides  below into two parts, which are situated on either side of the
pelvic cavity, and give off the inferior hemorrhoidal and vesical plexuses, with prostatic and cavernous,
or ovarian, vaginal, and uterine branches, according  to the sex of the subject.   It will be  observed
that this portion of the system is  abundantly reinforced by branches which enter it directly from  the
sacral nerves, besides those that pass through the ganglionated. cord.
     PLATE VI.—DISTRIBUTION  OF  THE  CUTANEOUS  NERVES.

     This diagram is intended to show the sources from which the sensibility of the different regions
of the cutaneous surface is derived.
     The position of the dotted lines which form the boundaries  must be regarded only as approxi-
mative, as the exact distribution of the cutaneous nerves varies somewhat in different subjects, and as
they interlace and communicate freely where they come in contact.
     In order to trace the surface nerves to their connection with the cerebro-spinal centre with greater
facility, an initial reference is given below the name of the branch  to the main trunk or plexus from
which it proceeds.
     The explanation of these references is as follows: —
                    1.  V.  First (ophthalmic) division of fifth cranial nerve.
                    2.  V.  Second (superior maxillary) division of the  same.
                    3.  V.  Third (inferior maxillary) division of the same.
                    C. P.  Cervical Plexus.
                    B. P.  Brachial Plexus.
                    L. P.  Lumbar Plexus.
                    S. P.  Sacral Plexus. 
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