N412o 1852 ISlllililliMIIBif 712375 3NI3IQ3W JO HVlill 1VNOI1VN 3NI3IQ3W JO A » V * « I 1 1VNOUVN 3 N I 3 I d 3 W JO A1VBII1 1VNOI1VN INI 3NI3IQ3W JO ll«llll 1VNOI1VN 3NI3IQ3W JO A D V» 9 II 1VNOI1VN 3 N I 3 I Q 3 W JO 11*1111 1VNOI1VN 3N NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NA NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE Hi NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE N /ViVN.I L « w c< /» rc * (oi is iw llliriaH MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL I JO tHIIM 1YNOI1VN 3NI3I03W JO U««lll 1VNOUVN 3NI3I03W JO A * V efl IT 1VNOI1YN 3NI3IQ3W JC LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL I OUTLINES THE NERVES; WITH SHORT DESCRIPTIONS. DESIGNED FOR THE USE OF MEDICAL STUDENTS. BY JOHN MILL, A.M., M.D., Surgeon to Wills Hospital. Demonstrator of Anatomy in the University of Pennsylvania. SECOND EDITION. PHILADELPHIA: KD. BARRINGTON AND GEO. D. HASWELL 1852. INDEX. PANE Abdomino-Crurul - - 2.1 Accessorius - - 10 Anterior Crural - - 2.-5 Anterior Cutaneous - - 2G Anterior Dental - - ]."] Anterior Tibial - - 27 Auditorius - 10, Ki Axillary - - 24 Axillary plexus - - 23 brachial plexus . . 23 Buccal - - - 16 Cardiac Plexus . - 21 Casserian Ganglion - - - 12 Cervico-Facial - - 16 Cervical Nerves - - 2,'i Cervical Plexus - - 16 Chorda Tympani - - 14 Ciliary branch - - 12 Ciliary Nerves - - 11 Circumflex - - 21 Cloquet's Ganglion - - - 13 Communicans Tibia- - - 27 Coronary - - 21 Cranial Nerve:---course and c is- tribution - - 10 Cranial Nerves — origin - - U Cutaneous Medicus - - - 26 Deep Petrous - . . 14 Descendens Noni - . 19 Dorsal - - - 25 External Cutaneous (of arm) . 24 External Cutaneous (of •eg) - 25 Externnal Peroneal - . 27 External Peroneo-Cutaneous - 27 External Plantar - . 29 External Saphenus - - - 28 External Spermatic - - - 25 Facial - . - 10 , 15 Frontal - - - 12 Gangliform Plexus PAGE 18 Glosso-Pharyngeal - - 10,17 Gluteal . 26 Great Splanchnic - 21 Gustatory - 14 Hypogastric Plexus . 22 Hypoglossal - - 10, 19 Inferior Cardiac _ 21 Inferior Dental . 15 Inferior Laryngeal - 18 Inferior Long Pudendal 26 Inferior Maxillary - 12 Infra-Orbital . 13 Intercosto-Humeral . 25 Internal Cutaneous < arm) - 21 Internal Cutaneous (leg) - 26 Internal Nasal - 12 Internal Peroneo-Cutaneous 27 Internal Plantar . 28 Ichiatic - 27 i Jacobson's Nerve - 17 Lachrymal . 12 Laumonier's Ganglion 15 Lenticular Ganglion - 11 Lumbar - 25 Meckel's Ganglion . 13 Median . 24 Mental . 15 Middle Cardiac - . 20 Motor Externus . - 10,14 Motor Oculi . - 9, 11 Musculo-Cutaneous . 24 Musculo-Spiral - - 24 Nasal _ 12 Naso-palatine - - 13 Xervi Molles - 20 Obturator _ 20 u INDKX. r * (i k Olfactory - - M, Id Ophthalmic - - 12 Ophthalmic Ganglion - 1 1 Opticus - - - - 0, n Patheticus . . - it. 12 Peroneal - - - 27 Pes Anserina - - - 16 Pharynffeal Plexus - - 16 Phrenic Nerve - - 23 Pneumogastric - - - 10, 17 Popliteal - - 2s Post-Auricular - - Hi Posterior Cutaneous - 27 Posterior Dental - - - 13,II Posterior Tibial - - 28 Portio Dura - - - 10,15 Portio Mollis - - - 10,16 Pterygoid - - 14 Pterygopalatine - - 13 Pulmonary Plexus - IS Radial . . . - 24 Rami Cardiaci - - 18 Ramus Ciliaris - - 11 Recurrent - - 14 Recurrent Larynge nl - 18 Renal Plexus - - 22 Sacral . . 25 Saphenus - - 26 Scapular - - 23 Sciatic - - 27 1* \cv. Sciatic Pl»\\ii> - - - 26 Semilunar Ganglion - - - 21 Small Splanchnic - - - 21 Solar Plexus - - - 2 1 Spheno.palatine - - - 13 Spinal Accessory - - - lit Spinal Nerves - - 22 Splenic I'lexus - - - 22 Subscapular - - - 23 Submaxillary Gangl on - - 1 1 Sub-Occipital - - - »>'j Superficial Cardiac - - - 211 Superficial Petrous - - - 11 Superficial Tempora - - 15 Superior Laryngeal - • - 19 Superior Long Pudendal - - 26 Superior Maxillary - - 13 Superior Mesenteric Plexus - 22 Superior Pharyngeal - - 17 Sympathetic - - - 19 Tempore-Facial . - . 16 Thoracic - - - 21 Tracheal - - - 18 Trigeminus - - - 10 Ulnar - - • 21 Vasns . . . 10, 17 Vidian - - - 14 Wrisberg's Nerves - - - 25 r KE EACE TO THE FIRST EDITION. To obtain a correct general idea of a subject is the best means for subsequently acquiring a more accurate and extensive know- ledge. Hence, in all sciences, Elementary Treaties are placed in the hands of beginners, before the fuller and more comprehen- sive works. It is hoped that these Outlines will afford to Students of Medi- cine a simple and concise view of the Nerves, so that the most important branches may be learned without difficulty: and, in order to avoid the confusion and trouble arising from references made in the usual way, the names have been placed on the several filaments. In a work of this size, it is not to be supposed that all the minutife of the discoveries of the nervous system are to be found ; much less that there should be the shadow of any thing original. If what is already known be made clear to students, and an easy mode of acquiring it be presented to them, the object will be s PREFACE. accomplished. Most of the Rates are altered from others, so as to suit the terms and descriptions of the standard text-books of the day. I am indebted to Dr. Lowber for the Delineations. JOHN NEILL. Philada. Nov. 1st, 1815. . \ frit's P/a/r /" ZdPair. Optic........... 3 d Pour. Jfob/r Ocu/i....... ■f^Pair Patheticus......... 7** Piur Portio Dura <&\ Portia Jfollij J 8 f* Paw Par Fayum.....^ Gbjse Phajyjigtal & J Spuial j4cc*jsory ...J. S~ Pair Trigeminus 6*1 Pair Motor £xt 9 ** Pair Mypoglossal. r• S DuialZM Ph,l° THE NERVES. There are Thirty-nine pairs of Nerves which arise from the Spinal Marrow and Brain ; nine of these pairs emerge thn ugh fora- mina of the Cranium, and are called Cranial, the remaining thirty escape through the intervertebral foramina of the Spinal Canal, and are called Spinal. CRANIAL NERVES AND THEIR ORIGIN. PLATE I. These are d 'signated numerically with reference to the order in which th-y apparently arise from the base of the Biain. They also receive names from their function and mode of distribution. They are as follows : — 1. Olfnr tori IIS. — The Olfactory r'ses by three roots, from the anterior lobe of the brain, which coalesce in the fissure of Sylvius. 2. Opticus. — The Optic nerve arises from the Thalamus nervi optici and the Tubercula quadrigemina. 3. Motor Oculi. — The Motor nerve of the eye-ball arises from the internal face of the Crus Cerebri. {. Patilfticus or Trochlenris. — The Pathetic nerve arises from the Valve of the Brain. 10 OUTLINES OF •5. Trigeminus, — The Trifacial nerve emerges from the side of the Pons Varolii near the Crus Cerebelli. 6. Motor E X t er n 0 s. — The External Motor of the Eye-ball nerve arises from the Corpus Pyramidale. 'Facialis TP1 Portio Dura. — The Facial nerve arises from the junction ef the Corpus Restiforme and Pons Va- y# j rolii. Anditoriusvel Portio Mollis.— The Auditory nerve arises from the Calamus Scriptorius and Corpus Restiforme. The pars intermedia of the 7th arises from the Corpus Restiforme, and may be considered as the posterior or sensitive root to the Fa- cial. 'Gl OS SO-Pll ary n gC OS.— The Glosso-Pharyngeal nerve arises in the fissure between the Corpus Olivare and Corpus Res- tiforme. Pn f nmogflst Hens Tel VagUS. — The Pneumogastric nerve b ') arises from the same fissure as the Glosso-Pharyngeal, but behind that nerve. Acces SOrius.— The Spinal Accessory nerve arises by numer- ous filaments from the Medulla Oblongata and Medulla Spinalis as low down as the Fourth Cervical Vertebra. 9, H V p 0 ? 10 S SU S t — The Hypoglossal nerve arises in the fissure be- tween the Corpus Pyramidale and Corpus Olivare, CRANIAL NERVES. Course and Distribution. I OLFACTOR1US. PLATE II., FIG, 1, It passes forwards from its origin on the under surface of the anterior lobe of the brain, and converges gradually towards its fellow, . I erreuy"/.£itfi Ph, THE NERVES. 11 so as to reach the cribriform plate of the ethmoid bone. The anterior extremity is enlarged into what is called the Bulb* from which proceed filaments which penetrate into the nose through the perforations of the Cribriform plate, and spread themselves on the Schneiderian membrane. It is exceedingly soft and pulpy in its whole length. II. OPTICUS. PLATE If., FIG. It The optic is a large and flattened nerve, which passes forwards and inwards in front of the tuber cinereum, joining its fellow and forming the Chiasm, which resembles the letter X/ It after-1 wards enters the orbit, through the Foramen Opticum of the sphenoid bone, and joins the retina of the eye. III. MOTOR OCULL PLATE II., FIG. 3\ This nerve proceeds from its origin towards the' external margin of the cavernous sinus ; and, entering the orbit, through die Sphenoidal Foramen, it divides into two large branches, Which are distributed to most of the muscles of the eye-ball. It also sends a short branch to the posterior margin of the Lenticular or Ophthalmic ganglion. This ganglion is situated at the outer side of the optic nerve, in the orbit of trie eve, and is about on^ line in diameter, being flattened. Two nerves con- cur to form it—the branch just alluded to from the 3d pair, or Motor Octdi, and the Ramus Ciliaris, Which Conies from the Ophthalmic branch of the 5th, or Trigeminus-. From this- ganglion arise most of the ciliary nerves, which are about 20 in number, and are spent upon the choroid coat of the eye and the iris. 12 OUTLINES OF IV. PATHETICUS. PLATE II., FIG. 3. The Trochlearis or Patheticus is the smallest cranial nerve, being not larger than a sewing thread. It passes through the Cavern- ous Sinus, and then enters the orbit through the Sphenoidal Foramen. It is distributed upon the superior oblique muscle of the eye, entering it near its middle. V. TRIGEMINUS. PLATE III. This is the largest cranial nerve; it has formed upon it, in a canal of dura mater, a large ganglion, called the Ganglion of Casser, and then divides into three large trunks called Ophthalmic, Superior Maxillary, and Inferior Maxillary Nerves. 1. OPHTIIALMIC.—The first branch of the Trigeminus passes through the Cavernous Sinus, and enters the orbit through the sphenoidal foramen. While in this foramen it divides into three branches, called Nasal, Frontal, and Lachrymal. The Nasal branch of the Ophthalmic ascends towards the internal face of the orbit. It gives off a branch called Ramus Ciliaris, which joins the Lenticular Ganglion, which was referred to in the description of the third pair. Afterwards it gives off a branch called Internal Nasal, which enters the cavity of the cranium through the anterior orbitary or ethmoidal fora- men, and then passes into the nose, through the most anterior perforation of the cribriform plate, descending in a groove upon the under surface of the nasal bone to the Schneiderian membrane. The remainder of this nerve is spent upon the muscles, eye-lids, conjunctiva, &c. lA^erves Plat* 3 d, """ftlio) Trigeminus Saptrf. Petrous- Deep Petrous Sliperf. Tunf . ij.>S^^^ OF The Vidian or Pterygoid or Recurrent nerve proceeds backwards from Meckel's ganglion through the Pterygoid foramen of the Sphenoid bone. While in this foramen it divides into two trunks called the Superficial Petrous and the Deep Petrous, which enter the cavity of the cranium through ihe Anlerior Foramen Lacerum. The Superficial Petrous traverses a gutter on the superior surface of the Petrous bone, and disappears through the Vidian Foramen or Hiatus Fallopii. It adheres to the Facial nerve in the aqueduct of Fallopius, after leaving which it traverses the tympanum, and receives the name of Chorda Tympani: it then emerges at the Glaserian rissure or foramen, and, de- scending, joins the Gustatory nerve,- with which it continues until it reaches the Submaxillary ganglion. The Deep Petrous enters the carotid canal, and anastomoses there with the branch of the Motor Externus, or sixth pair, around the internal carotid artery joining the ganglion of Laamonier, which is usually considered as the origin of the sympathetic nerve. 3. INFERIOR MAXILLARY. — Is the third breach of the t. igemi- nus, and is the largest of the three. It escapes from the cranium through the foramen ovale of the sphenoid bone, and divides into anterior and posterior branches. The anterior branches are spent upon the Masseter, Temporal, Buccal, and Pterygoid muscles. The Posterior consists of the Lingual or Gustatory, Inferior dental, and Superficial Temporal nerves. The Lingual, after receiving the chorda tympani at an acute angle, between the pterygoid muscles, enters (he side of the root of the tongue. The Submaxillary Ganglion is joined by filaments" from the lingual *■ nerve and chorda tympani. The branches from this ganglion are distributed to the Submaxillary gland, &c. The Lingual or Gustatory nerve supplies the papilte upon the anterior portion of the tongue. * .. rt'rrfs Plate ¥fi lA h'ari/tl Gus>a \*-'J P SI>LiraJ Lib- THE NERVES. If, Inferior Dental descends between the Pterygoid muscles and en- ters the Posterior Mental Foramen of the Lower Jaw. While traversing the jaw, it sends numerous branches to the teeth and gums ; and a large branch, called Mental, comes out at the Anterior Mental Foramen, which is distributed to the chin and lower lip. Superficial Temporal is formed by a union of fasciculi from the Lingual and Inferior Dental. It passes outwardly, giving branches to the Parotid gland, and afterwards, in company with the Temporal Artery, is distributed to the integuments on the side of the head. The Otic Ganglion, a small, reddish, gray, body, is situated upon the inferior majcillar}' nerve near its emergence from the foramen ovale. VI. MOTOR EXTERNUS. PLATE II., FIG. 3. This nerve, when passing through the cavernous 6inus, sends a branch to join the ganglion of Laumonier and the Deep Petrous nerve in the carotid canal, after which it enters the orbit through the sphenoidal foramen, and is distributed entirely upon the external rectus muscle. VII. FACIALIS ET AUDITORIUS. PLATE IV. The seventh pair consists of two principal trunks — the Facial or Portio Dura, and Auditory or Portio Mollis. THE FACIAL, OR PORTIO DURA leaves the cavity of the cra- nium by entering the Internal Meatus Auditorius of the tem- poral bone, in which it is accompanied for a short distance by 10 OUTLINES OF the depp petrous, which becomes the Chorda Tympani nerve. It escapes from the temporal hone at thp stvlo-masloid fora- men, and assumes a radiated form, 1o which Hie name of Pes Anserina is given, the filaments of which are denominated as follow : Post-Aliricill ar.— This extends from the Stylo-mastoid Foramen to behind the centre, supplying the muscles, integuments, &c. It also sends off anastomotic branches downwards. The Facial then penetrates the Parotid Gland, in which it divides into several branches ; several of which are called Temporo-facial. —These are distributed to the muscles on the upper part of the side of the head. Buccal. — These are three in number, and supply the muscles of the cheek. Cervico-facial. —This branch d°scpnds to join the anastomosis formed by the three superior cervical nerves, frequently called Cer- vical Plexus. The Facial nerve does not supply the skin, but the muscles of the face. AUDITORY OR PORTIO MOLLIS— This nerve enters the Meatus Auditorius Internus with the Portio dura. It is dis- tributed to the Labyrinth, &c, of the Internal Ear. [Refer to Plate IV., Fig. 2.] VIII. GLOSSO-PHARYNGEAL, PNEUMOGASTRIC, AND SPINAL ACCESSORY. PLATE V. The Eighth nerve escapes from the cavity of the cranium through the posterior foramen lacerum, in company with the Internal Jugular vein, from which it is separated hy a small fpine of bone. It consists of three principal trunks, viz : \ erres I'lut, j ,.>.«.. Lick. Pkt:'- THE XKRVKS. 17 GLOSSO-PHARYNGEAL. —This nerve, after leaving the base of the cranium, is separated from the Pneumogastric by the In- ternal Jugular vein. Upon it are two small Ganglions. It is directed downwards and forwards between the Internal Caro- tid Art' ry and the Stylo-Pliaryngeus muscle, afterwards be- tween the latter and the Stylo-Glossus muscle : it accompa- nies the latter to the side of the root of the Tongue. It sup- plies the Papilla? of the base of the Tongue, the Tonsils, and Soft Palate. It also sends branches to the muscles of the Tongue and Pharynx, and to the Pharyngeal Plexus of the Sympathetic and Pneumogastric nerves. A branch called Jacohsori's Nerve enters the Tympanum through a small open- ing between the Jugular and Carotid Foramina, to form a Plexus upon the inner wall of the Tympanic in which the Fifth Pair and Sympathetic communicate. PNEUMOGASTRIC — This nerve is frequently called Par-vagum, and is closely united to the other branches of the eighth pair and also to the ninth, after its exit from the cranium. An enlarge- ment exists at its upper part called the Plexus Gangliformis. It descends the neck between the Internal Carotid Artery and the Internal Jugular vein, and is enveloped in their sheath. At the root of the neck, upon the right side, it passes in front of the Subclavian Artery, but on the left it crosses the root of the Subclavian and the arch of the Aorta, it is then directed backwards and downwards into the cavity of the Thorax, and becomes connected with the root of the Lung, after which it applies itself to the CEsophagus, and follows it through the Diaphragm to the Stomach : the Par-vagum of the left side is on the anterior surface of the (Esophagus and that of the right side on its posterior surface. It giv.'s off three sets of branches, viz.: Cervical, Thoracic, and Abdominal. Cervical Branches. — These are in the Neck, and are three in * number. The Superior Pharyngeal. — It anastomoses with the GlossoPharyn. o-eal and forms the Pharyngeal Plexus on the middle constric- 8 18 OUTLINES OF tor of the Pharynx. A filament called Inferior-Pharyngeal sometimes arises from the Par-vagum, below the Superior, and is spent upon the Pharynx. There is an enlargement and softening of the Par-vagum nerve at the origin of the Pharyn- geal branches, which is called the Gangliform Plexus. Superior Laryngeal. — It arises from the Gangliform Plexus, anas- tomosing the Pharyngeal Plexus, &.C., and divides into two branches, »\ hich supply the Mucous Membrane of the Larynx and Vocal muscles. In its descent, the Par-vagum gives off, at the lower part of the neck, two or three filaments called Rami Cardiaci. These reach the arch of the Aorta and anastomose with the Superficial Cardiac nerve. Inferior Laryngeal.—This is often called Recurrent Laryngeal. On the right side it arises from the Par-vagum after the trunk has passed in front of the Subclavian Artery. It then winds around the Subclavian, forming a loop: upon the left side it forms a loop around the Aorta. Ascending upon the side of the Trachea and Larynx, it is distributed to its muscles. It also gives off branches called Cardiac, Pulmonary, (Esopha- geal, &c. Thoracic Branches. — These branches of the Par-vagum are the Tracheal, which form The interior Pulmonary Plexus — from which branches are sent to the Lung along the course of the Pulmonary Artery. The Posterior Pulmonary Plexus— is formed by several filaments of the Par-vagum and Sympathetic. Its branches pass through the Lung along with the Bronchial tubes, and are distributed to its mucous membrane and glands. Abdominal Branches —The Par-vagum of the right and left sides form a plexus around the cardiac orifice of the stomach. The right nerve is then distributed along the lesser curvature THE NERVES. 19 and posterior face of the stormed, anastomosing with the gas- tric plexus and solar plexus. The left supplies the anterior face of the stomach and its lesser curvature, anastomosing with the nerve of the right side and gastric and solar plexuses. SPINAL ACCESSORY.—The Accessory nerve is directed out- wards and backwards, and divides into two branches. The internal branch gives filaments to the superior pharyngeal nerve. The external descends for about two inches behind the internal jugular vein, and afterwards pierces the sterno- cleidomastoid muscle at the junction of its upper and middle thirds. It is augmented by branches from the second and third cervical nerves, and is distributed by numerous filaments to the trapezius muscle. IX. HYPOGLOSSAL. PLATE V. This nerve adheres for an inch to the pneumogastric nerve. It crosses the external carotid artery, just below the origin of the occipital artery, making a large curve below the digastiic muscle, and ascends to the tongue, being concealed by the mvlo hyoid muscle. As it crosses the carotid artery, it sends off a large branch called Descendens Noni, which descends upon the sheath of the vessels upon the neck, anastomosing with the cervical nerves, and then supplies the sterno mus- cles. The hypoglossal nerve is distributed to the muscles of the tongue. SYMPATHETIC NERVE. PLATE VI. This nerve consists of a chain of ganglions placed upon the sides of the bodies of the vertebra?, extending from the base of the cranium to the end of the sacrum. Thev are united to each 20 0 IT LINES OF other by filaments, and also to the anterior trunks of the spinal nerves. The origin of the sympathetic nerve was formerly described as the ganglion of Laumonier, which is formed in the carotid canal and joined by a branch of the fifth pair, called Deep Petrous, and by a branch of the sixth \ air, or Motor Externus. Now the sympathetic is to be traced from the ganglion of Ribes, which is formed upon the anterior communicating ar- tery in the middle of the base of the brain. This anastomosis is exhibited in Plate VI., Fig. ± The ganglions of the sym- pathetic are placed opposite the intervertebral spaces through- out the spine, with the exception of those of the neck, which are but three in number, viz.: SUPERIOR CERVICAL G A NG LI ON — Varies considerably in its size and extent, commencing opposite the second vertebra, and reaching to the third or fourth. It sends off branches of a reddish color, which are extremely soft, and hence are called Nrvi Mol/es. These are divided into Superior, Middle, and Inferior. The Inferior form by their union a cord called the Superficial Cardiac Nerve, which descends along the neck, and is lost in the middle cardiac nerve and contiguous anasto- moses. MIDDLE CERVIfAL GANGLION —Is placed between the fifth and sixth cervical vertebrae, upon the Longus Colli muscle. It sends off numerous filaments, some of which collect into a cord, which is called the Middle Cardiac Nerve, which anasto- moses with Superficial Cardiac and Pneumogastric, and ex- tends to the Cardiac Plexus. INFERIOR CERVIfAL GANGLION —Is situated near the head of the first rib, and varies in form and size. Its branches are nu- merous, some of which collect into a cord, and form the Infe- rior Cardiac nerve, which is blended with the Cardiac Plexus on the right side, and with the Middle Cardiac nerve on the left. The Cardiacs of the right side are more constant than those of the left. . / t'/'l V'J' Plate 6'$ SynijiaUi.,1,, Suboccipital r t ._, '.. ~) I '^1 '# ^*\^*~ Tf7">V-i.....Slip. Cervical Gari.f ■Middle Ccri'tcat GiUiy. Cardiac Pier us 4 ^ A K'-j -i■ Stnat Plc.rus >*%&*- V -%. A-" t* V * i. w*. Oaia't-oti if Syrr.nattirtlc Ant Commtuicc Artery (sanation, of Kite .'' A'tuat branch, of OpUlolnu a'",;* Moi hrt ' . ■ P C.- -~z - c-\\n r" X." " ■y^ ■ "W- ' ■■'■'■ ■ Ciliary ,_-;''' _ jj Lenticular Oanyliim //■{ "'■ 3 pr Mot Oc uii ~2T- Gang, of LauTTwrner orci^ V,\"i Sup.MaJcrUary 3' V 'I Vteryifo Palatine I . ^,7^ ^" . Splzd7io Palatine ■J <' ■'< "< A „ , . ~ V^ """ Ganglion '^ Palatine ^b. of r'/afiai Alaxillary bang F.XiJuVuJ. i.it\ /'-■- THE NERVES. 21 CARDIAC PLEXUS, Is situated between the arch of the aorta and the bifurcation of the trachea. It is formed by branches from the three cervical ganglions of each side of the neck, but principally from the Middle Cardiac Nerves. It is also joined by filaments from the par-vagum, and inferior laryngeal. The branches of the Car- diac Plexus are divided into Anterior, Posterior, and Inferior. The Anterior and Posterior branches are spent about the roots of the large vessels. The Inferior branches are the largest and most abundant ; and are arranged into two Plexuses, called Anterior and Posterior Coronary, from which filaments are distributed to the auricles and ventricles of the heart. THORACIC GANGLIONS OF THE SYMPATHETIC. These are twelve in number, placed at the intervertebral spaces, near the heads of the ribs. They are united to each other and to the spinal nerves. Great Splanehnic Nerve is formed by filaments from the sixth to the ninth or tenth ganglions inclusively, which is directed down- wards, and enters the abdomen at or near the foramen aorticum of the diaphragm. Whilst in the abdomen it divides into fasci- culi; upon which are formed the small ganglions which are fused in a crescentic manner, and called the Semi-lunar Gang- lion. Small Splanchnic N e r V e is formed by filaments of the tenth and eleventh Thoracic Ganglions. It reaches the abdomen by penetrating the cms of the diaphragm, and then divides in- to two branches, one of which joins the great splanchnic and the other descends to the Renal Plexus. SOLAR PLEXUS. The origin of the Solar Plexus rr.ay be considered to be the Semi- Lunar Ganglion. This ganglion is semicircular or oval, is 22 OUTLINES OF about an inch in length, and is placed on the si!e of (lie aorta, it is composed of smaller ganglions, formed upon fila- ments of the splanchnic nerves. From it proceeds the Solar Plexus, which extends along the aorta to the cceliac and to the emulgent artery, and is common to both sides. From it are derived several smaller plexuses, accompanying the large arterial trunks, from which these several intertextures derive their names ;—for instance, the Hepatic Plexus, supplying the liver, gall-bladder, &c, surrounding the Hepatic Artery. The Splenic Plexus surrounding the Splenic Artery supplies the Spleen. The Superior Mesenteric, Renal, and Inferior .Me- senteric Plexuses surround ihe Superior Mesenteric, Renal, and Inferior Mesenteric Arteries. HYPOGASTRIC PLEXUS, PLATE VI. Is situated in the lower part of the pelvis, and is formed by fila- ments from the Lumbar ganglions, through the Inferior Mesen- teric Plexus, and by means of filaments from the Sacral gan- glions, which are usually three in number. This plexus is dis- tributed upon the rectum and bladder, organs of generation, &c. The last Sacral ganglion, called azygos or impar, is situ- ated in front of the coccyx, and terminates the sympathetic nerve. SPINAL NERVES. These are usually thirty in number, and are divided into 1 sub-occipi- tal, 7 cervical, 12 dorsal, 5 lumbar, and 5 sacral. Each arises by two roots from the spinal marrow, which unite in the inter- vertebral foramen. Before their union, an oval ganglion is formed upon the posterior and larger root. After their union, they divide into posterior and anterior trunks. [Plate VII. Fig. 2.] The sacral ganglions are in the spinal canal. / r/'/tu Plate 7?'. mrTK Digital. , ^-rrZ-Post. Trusi/c '/ '">£ J-nt TrunJ; Section at Spinal marrow P f Duraf,!.-. THE NERVES. 23 SUB-OCCIPITAL NERV E. —This nerve is exceedingly small, and generally arises by a single root from the spinal marrow. It passes out of the vertebral cavity between the occiput and the atlas, and supplies the muscles on the back of the neck and head. [Plate VI.; and Plate IV., Fig. 1.] THREE SUPERIOR CERVICAL NERVES.—After escaping through the intervertebral foramina, they divide into anterior and pos- terior trunks. The posterior trunks are spent upon the muscles upon the back of the spinal column. The anterior trunks form a Plexus, branches from which supply the muscles of the neck ; and cutaneous branches are distributed to the integuments. The Great Auricular branch passes behind the ear. PHRENIC NERVE. — This nerve is formed from the second and third cervical, descends upon the front of the scalenus anticus muscle, and then enters the thorax through the superior medi- astinum ; passing over the pericardium is distributed to the dia- phragm. FOUR INFERIOR CERVICAL N ERVE S. Plate VII. — The pos- terior branches are distributed to the muscles and back. The anterior branches are larger, and descend between the scalenus anticus and scalenus medius muscles, above the subclavian artery, to form the brachial plexus. BRACHIAL OR AXILLARY PLEXUS. —This plexus is formed by the junction of the four inferior cervical nerves and the first dorsal, and extends from the scaleni muscles to the neck of the humerus, surrounding the axillary artery. It gives off the fol- lowing nerves, viz: Scapular. — It passes backwards over the shoulder, through the coro- coid notch of the scapula, and is distributed to the spinati mus- cles. Subscapular. — These are usually three in number. They are distri- buted to the subscapulars and teres muscles. 24 OUTLINES OF Thoracic. — These are two in number, are distributed to the subclavius and pectoralis minor and major muscles and integuments. The posterior or long thoracic is the External Respiratory Nerve of Bell, and is distributed to the Serratus Anticus muscle. Axillary or Circumflex. — It descends and winds around the head of the os humeri, running with the posterior circumflex artery, and is distributed to the deltoid muscle. Internal Cutaneous—Is a small, thin nerve, descending the arm, di- viding into several branches at the elbow, and is distributed to the integuments. Some of the branches reach the hand. Musculo Cutaneous, or External Cutaneous. — It descends and per- forates the coraco brachialis. At the elbow it divides into several branches, supplying the muscles of the arm, and the intesuments of the fore-arm and hand. Radial or Musculo-Spiral. — This is very large, and winds spirally around the humerus, passing between the first and third heads of the triceps muscle, making its appearance near the external condyle. It divides into three principal trunks— Superficial- is, Anterior and Posterior, and Profundus Dorsalis. They are distributed to the muscles of the arm, fore-arm, and hand. Median Nerve. — This is one of the largest branches of the Brachial Plexus. It descends on the inside of the biceps muscle, firm- ly adhering to the brachial arteiy. It then passes between the two heads of the pronator teres muscle, and, descending the fore-arm between the flexor sublimis and flexor longus pol- licis muscle, it passes under the annular ligament of the wrist, terminating in branches which supply each side of the thumb and fingers, with the exception of the little finger and the ulnar side of the ring finger. Ulnar. — It descends the arm upon the anterior part of the triceps muscle, and passes under the internal condyle, where it is quite superficial. It gives off several branches, which supply the muscles of the fore-arm, and passing over the annular ligament of the wrist, it sends branches to each side of the little finger, and to the ulnar side of the ring finger. . 1 h'irs /'A/A •) th #^'wk^ Ma^wr Crural ft/ ^ P.S.DmnU.LUk.PhU? THE NERVES. 25 DORSAL NERVES. — The posterior branches are distributed to the muscles of the back, and the anterior branches generally accompany the intercostal vessels in the groove at the inferior edge of each rib. They are spent upon the abdominal muscles and integuments. The first joins the axillary plexus, the sec- ond and third give off two branches called the Intercosto-Hu- meral, which join a small branch from the nerve of Wrisberg, and are distributed to the integuments of the axilla and arm. The twelfth sends a branch to join the first lumbar. LUMBAR AND SACRAL N ERV E S.— The posterior branches are spent upon the muscles of the loins and back ; the anterior branches form a large plexus called Crural, which is divided into two parts called Lumbar and Ischiatic. LUMBAR PLEXUS, Is formed by four superior lumbar nerves ; is concealed by the psoas magnus muscle, and gives off the following branches, viz: Abdomino Crural. — These are three in number ; they arise from the upper part of the plexus, and descend obliquely over the quad- ratic lumborum muscle towards the crista of the ilium. They send branches to the abdominal muscles and through the rings to the pubes, and also send filaments to the integuments of the hip and thigh. External Spermatic penetrates the psoas magnus muscle, upon which it descends. It sends branches to the groin and cremaster muscle. External Cutaneous passes obliquely outwards over the iliacus inter- nus muscle towards the anterior superior spinous process of the ilium, and, penetrating Poupart's ligament, is distributed to the integuments of the outer portion of the thigh. Anterior Crural is the largest branch arising from the lumbar plexus. It passes beneath the psoas magnus muscle, and em- erges from the abdomen under Poupart's ligament, about half an inch from the outside of the femoral artery. It gives off several branches. 4 26 OUTLINES OF Cutaneous Medius — Arises from the anterior crural, about an inch above Poupart's ligament: descending, it penetrates the Sar- torius Muscle, and is distributed to the integuments. Anterior Cutaneous — Aiises from the Anterior Crural, penetrates the fascia of the thigh, and is distributed to the integuments. Internal Cutaneous — Is another one of the same cluster, arising from the Anterior Crural, above Poupart's ligament, and is distribut- ed to the integuments on the inside of the thigrh. Saphenus — Is a filament of the Anterior Crural which accompanies the femoral artery till it perforates the adductor magnus. It then attaches itself to the saphena major vein, and is distribut- ed to the integuments upon the inner side of the leg and foot. Obturator—Is derived from the lumbar plexus, and descends into the pelvis from beneath the psoas magnus muscle. It then passes forward through the obturator foramen, and dividing into two branches is distributed to the adductor muscles of the thigh. SCIATIC PLEXUS. This plexus is formed by the junction of the last Lumbar and the four Superior Sacral nerves. It is situated in the back portion of the pelvis, and in front of the Pyriformis Muscle. The fifth and sixth, if the latter should exist, are distributed to the mus- cles about the anus. This plexus gives off the following branches: Gluteal.— These are two in number; one passes out of the Sciatic notch, above the Pyiiform Muscle, and the other below it. They are distributed to the Glutsei Muscles. The Pudic or Superior Long Pudendal.— It accompanies the Internal Pudic artery, between the two Sacro-Sciatic ligaments, and is distributed to the Perinaeum and organs of generation. THE NERVES. 27 Thfi Lesser Ischiatic escapes from the pelvis between the Pyri- formis Muscle and the Greater Sacro-sciatic Ligament, and gives off: The Perineal or Inferior Long Pudendal— Passes under the tuber of the Ischium, and is distributed to the Gluteeus xMaximus, and to the external parts of the organs of generation. Posterior Cutaneous—Is given off from the plexus in common with the Inferior Pudendal; descends the back of the thigh, and is distributed to the skin. SCIATIC 0 R I S C n 1 A T IC — Is the largest nerve in the body. It escapes from the Pelvis through the Sacro Sciatic notch, above the ligaments and between the Pyriformis and Geminus Super- ior Muscles. It descends the back of the thigh beneath the Biceps Flexor Cruris Muscle, and below the middle divides in- to two large trunks, called Peroneal and Popliteal; previous to which, however, it gives off several cutaneous and muscular branches of small size. Peroneal — Extends from the bifurcation of the Sciatic, towards the External Condyle, and gives off the two following branches: External Peroneo-Cutaneous — Is spent upon the skin over the fibula. Internal Peroneo-Cutaneous — Descends under the external head of the Gastrocnemius, and between the knee and ankle joins the Externus Saphenus or Communicans Tibiae, which is a branch of the Posterior Tibial. The Peroneal thence is directed to- wards the head of the Fibula, and divides into two large branches, viz: External Peroneal— Descends from the head of the Fibula, giving off filaments to the muscles arising therefrom. At the lower part of the leg it becomes Superficial, and gives off cutaneous branches about the External Malleolus, instep and toes. Anterior Tibial — Commences at the bifurcation of the Peroneal; passing under the heads of the muscles, reaches the Interosse- ous ligament, upon which it descends in company with the An- 28 OUTLINES OF THE NERVES. terior Tibial artery. It is distributed to the muscles and inte- guments upon the upper surface of the foot, one branch de- scending to the sole in company with the Pedal artery. Popliteal — Descends between the heads of the Gastrocnemius, and then perforates the Soleus muscle. Below the knee it re- ceives the name of Posterior Tibial. External Saphenous — Is given off from the Popliteal ; descending an- teriorly it is joined by the Internal Peroneo-Cutaneous. The common trunk thus formed passes behind the External Malle- olus, and gives off cutaneous branches to the foot and toes. Posterior Tibial — Descends upon the back of the leg under the Tri- ceps Surte Muscle, in company with the Posterior Tibial ar- tery: it gives off numerous muscular branches, and passing un- der the sinuosity of the os calcis, it divides into the following: External Plantar — Accompanies the External Plantar artery along the outer edge of the sole of the foot. It sends off branches to the muscles of the sole, to the little toe, and to the outer side of the next toe. Internal Plantar — Is larger than the external, and passing along the inner edge of the foot is distributed to both sides of the three inner toes and the inside of the fourth toe. FINIS. 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