CIHM Microfiche Series (Monographs) ICMH Collection de microfiches (monographles) Canadian Instituta for Historical MIcroraproductiont / Institut Canadian da nriicroraproductiont historiquas Technical and Bibliographic Notes / Notes techniques et bibliographiques The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual msthod of filming, are checked below. Coloured covers/ Couverture d« couleur Covers damaged/ ^ I Couverture endommagte □ Covers restored and/or laminated/ Couverture resUuree et/ou pellicula* n Cover title missing/ Le titre de couverture manque □ Colour**! maps/ Caites giographiques en couleur □ Coloured ink (i e. other than blue or black)/ Encre de couleur (i.e. autre que bleue ou noirel Coloured plates and/or illustrations/ Planches et/ou illustrations en couleur Bound with other material/ Relie avec d'autres documents D , I Tight binding may cause shadows or distortion ^ ' along interior margin/ La reliure serr*e peut causer de I'ombre ou de la distorsion le long de la marge interieure □ Blan with Blank leaves added during restoration may appear iin the tent Whenever possible, these have been omitted from filming/ II sa peut que certainei pages blanches a|outies lurs d'une restauration apparaissent dans le texte, mais, lorsque cela etait possible, ces pages n'ont pas ete film^s. L'Institut a microfilm^ le meillcur exemplaire qu'il lui a eti possible de se procurer. Les details de cet exemplaire qui sont peut-itre uniques du point de vue bibliographique, qui peuvent modifier une image reproduite. ou qui peuvent exiger une modification dans la methode normale de filmage sont indiques ci-dessous. □ Coloi Pages Coloured pages/ da couleur Pages damaged/ Pages endommagees n Pages restored and/or laminated/ Pages restaurees et/ou pellicul^s Q Pages discoloured, stained or foxed/ Pages decolorees, tachetees ou piquees n HSh Tr Pages detached/ Pages detachees Showthrough/ ansparence □ Quality of print varies/ Qualite inegale de I'lmpression n I 71 Inclu lid Com, Continuous pagination/ Pagination continue ides index(es)/ Comprend un (des) index Title on header taken from: / Le titre de TentCte provient' n Title page o* issue/ Page de titre de la li □ Caption of issue/ Titre de depart de la li n ivraison vraiton Masthead/ Generique (piriodiques) de la livraison S Additional comments / Pagination is as follows: p. 11-258, [1]-16. Commentaires supplementaires: Copy has manuscript annotat lon.s . This Item IS filmed at the reduction ratio checked below/ Ce document est filme au taux de reduction mdique ci dessous lUx 14X 22 X ."bX ]0x ! 1 1 — \ — L, I .,_u_j — /' 1 1 ! MX itx 20X 2«x l%\ 3:« The copy filmed h«r« has b««n r«produc*d thanks to ths ganarosity of: Academy of Medicine Collection The Toronto Hospital Tha imagaa appaaring hara ara tha bast quality possibia conaidaring tha condition and lagibility of tha original copy and in kaaping with tha filming contract spacifications. L'axamplaira fUmi fut reproduit grice i la gAnArositA da: Academy of Medicine Collection The Toronto Hospital Las imagas suivantas ont iti raproduites avec la plus grand soin. compte tenu da la condition at da la nattat* da l'axamplaira filmA. at en conformity avac las conditions du contrat da filmaga. Original eopias in printed papar covars ara fllmad beginning with tha front covar and ending on tha last page with a printed or illustrated imprea- sion, or the back cover when appropriate. All other original copies are filmed beginning on the first page with a printed or illustrated impree- sion, and ending on the last page with a printed or illustrated impression. Les exemplairas originaux dont la couvartura an papier est imprimte sont filmAs an commandant par la premier plat at an tarminant soit par la darniire page qui comporte una empreinte d'imprassion ou d'illustration, soit par la second piak, salon la cas. Tous las autres exemplairas originaux sont filmis an commandant par la premiere page qui comporte une empreinte d'impreasion ou d'illustration at an tarminant par la darniAre pege qui comporte une telle empreinte. The laat recorded frame on eech microfiche shall contain the symbol ~^ (meaning "CON- TINUED"), or the symbol y (meaning "END "). whichever applies. Un des symboles suivsnts apparaitra sur la darniire image de cheque microfiche, seion le cas: le symbols — »> signifie "A SUiVRE". le symbols ▼ signifie "FIN". Maps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one exposure are filmed beginning in the upper left hand corner, left to right and top to bottom, as many frames as required. The following diegrams illuatrata the method: Les cartas, planchea, tableaux, etc.. peuvent itre filmte A des taux de reduction diffirents. Lorsque le document est trop grand pour ttra reproduit an un seul clichi, il est film* A partir oa Tangle supArieur gauche, de gauche k droita. at da haut an bas. en prenant la nombre d'imeges nicessaira. Las diagrammas suivants illustrant la m^thoda. 1 2 3 1 2 3 4 5 6 4 '1*^7 felt'ij "P^HWfMMHMH !#iS I M > H rr - J fit .- as and Text? of Human Anatomy i;i -f ,!*- i; #t# Sobotta=Me Murrich mmmmmmttimmtmmm -«J* ,41 ^1 '41 ,!. J I l:i?xl^ I t.:~:«^. ATLAS AND TEXT-BOOK HUMAN ANATOMY BV DR. JOHANNES SOBOTTA PKUFESSIIR OK ANATOMY IN THK IMVfcRSITV OK wi'K/BrKi, KDrrKi). \vi 111 AnniTioNs. bv J. PLAYFAIR McMURRICH, A.M., Ph.D. PROKKSSOR Ol- ANATO:\1V IN THK INULKSIIV oj Ml. Hit. AN VOLUME I BONES, LIGAMENTS, JOINTS, AND MUSCLES IVith 320 Illustrations, Mostly in Colors I'll! I Mil I nil \ \N-|i 1 .i\p. iv W. B. SAUNDERS COMPANY 1906 gp,^ Co[>yright, i()o6. by W. B. Saunders Company M. m SAUNOCMS CO ^M I L AO e L P>H l< m^m/mR^ EDITOR'S PREFACE. There can be no question as to the value of a gwxl Atlas of Anatomy as an aid to the acquisition and retention of correct ideas regarding the structure of the human hodv and the relations of its various parts. Anatomy, at i.-ast the descrii)tive ])art of i;, is k-arned onl- when one can call up a mental picture of the part in ([uestion, and volumes of description wih do less to furnish a correct picture than will a single dissection or the inspection of an accurate illustration. This is especially ;rue as regards relational anatomy, and without an accurate know'ofjgc of the relations of parts the student or practitioner will find hims.lf sadlv at sea in his a^ plication of Anatomy to diagnosis and treatment. To both the student and the i)ractitioncr, therefore, a good Atlas must prove a great boo- to the one in enabling him to imjjress upon his mind wliat he has seen in the laboratorv, without recourse to the pernicious "qui/.compend," which is but a Tantalus , up, to the other in recalling the mental image more or less blurred bytim( , The !)resent Atlas, with its wealth of accurate illustrations and its thorough though concise desc, :ptive text, is presented to Knglish- speaking students and practitioners in the full confidence that it vvill prove of the greatest value to them. The work of the Editor in adaj)tin.., the Atlas for English readers has largely been conlined to changes in t'-e omendature and :n the airangement of the text. In the (.riginal (Jerman edition the text and Atlas were separate \.)lumes, the Atlas pro; er being i)rovide(l with a descriptive epitome of the > irts re.i, both to the publisher and to the ixlitor of the pr-sent edition, to unite the text and Atlas in a com- mon volume, much repetition being thereby avoided and the usult being still a volume of con- venient size. The translation of the German text ha< been done l;y Dr. \V. Hersev Thomas. As to the nomenclature emi)loyed, it is es.sent.ally that projxjsed by the Hasel Committee on Ana'omical Nomenclature, the tenns being, h()we\er, for the most jiart .Xnglici/.ed. In the section on Myology thi' Latin terms have been retained throughout, since usage has already made many of them familiar in their da.ssical form and it seemed i)referable, for uniformity's sake, to use that form for all. A fe>v terms may be found sor ewl.at unfamiliar \n luiglish speaking students of anatomy, and when these are used the more familiar term lias "been added in parentheses. The adoption of a uniform code of nomenclature is of such great im- portance that the slight inconvenience which the i)resent generation may exjjerience in the temporary use of a double set of names for a few structures will be more tlian counterbalanced by the advantages which a universal terminology will eventually olTer. TiiE Editor. University of Michigan, April tn, iyo6. m ^£M t-K* TXT if'] .J^Wty-it AUTHOR'S PRbFACE. When I was invited by the publishers to prejiare an atlas of descriptive anatomy at a time when f^'ood atlases were in abundance and the wants of the jjrecedinj; di>ennium had been largely su|)plied, I did not accej)! without due retlection as to the demand for such a work. I believed that this Jemand could be 1 t tested by hu -g -^fudents use the existing atlases in their dissections. This test demonstrate!, not only t ossible ])oi)u'-irity of an approi)riate work, but in many respects em[)hasi/.ed the i.icessity prei)aring an atlas which would be handy, practical, not too comjirehensiv. nnn-'i-d with illustrations true to nature, and specially adapted for the use of medical stude-.'s in the dissecting room. My first thought, conse(|uen ^ vas to pn •.• e an atlas which would sui)i)iy the ])ractiial wants of b<>th the student and the . , sician. Jt .s not an atlas fur the finished anatomist. The admirable a..as of Toldt contains a vast number of well-chosen illustrations, but it is so com prehensive that it is difikult for the student to pick out what he actually needs, and, owing to its high price and the fact that many of its illustrations are not true to nature, it has not met with great favor from the student body. In the present atlas ilie aiir. lias been to limit tiie material to what is absolutely necessary. The first volume has been comjjiled as an atlas esi)ecially adapted for use during dissection, and the illustrations have consequently been arranged to conform to the usual miliiods of instruction in anatomy. The fundamental princii)le of the work lias i)een to avoid any unusual presentation of the subject which would make the recognition of well known relations more dilVicult for the beginner. To die best of my knr.wledge this is the first anatomical atlas in wide h muhicolor lithograiihy has been employed. .Mmost the entire myology has been illustrated in this manner; of the thirty-four plates in this volume, thirty were made by this method and the remaining four by the so-called three (four) color process. The other illustrations wee made by the so-called half-tone method, the complete adajitability of which is alumdantly demonstrated by the ])!( - tures. .\dditional explanatory figures and diagrams ha\e been rei)roduced by simi)le line- etching. \() woodcuts have been emjiloyed, since the failure of the latter method to produce illustrations true to life has been distinctly sh )\vn by several of the newer anatomical atlases. It leaves entirely too much to the discretion of the wood-engraver, whereas the photomechanical method of reproduction depends entirely upoi_ the impression made upon the photograjihic plate by the original drawing.* * It has bee - ■ '■■-" --'^; * In a few eases in win, 1, |,er.,,eetive .listnnion was feared even when len,es of the lonR-st f,„ al l.nRths were en- £:;!:,;"■■ ''"'■' • "^" '•^"-'-^^■>'^'" -half .he si.e of ,he ..esirH ilh.s.ra.i ,n.l ,he ,„!„., ,, . ^^.^J^LZy in h, J.;;;:z::,;t ::;::;::' "- '""- """•■ ■■- -'-- -^ "-■"•" ••^' •"•■ »-"■■ - ^ < ^a,,,,,,, . - he ,„ ,.„e t AtxiUt ten uf Ihl- i||n»lrat!..>r!-. •••. !!;;■ •!!::; ■^,:,- sulMijuenlly eomplet'd liv Mr. Ilajek rit-ti r;y \\ . Fn ytag, .ii,iv»iNn iiia.stei in the I niversily, and CONTENTS Ifitroduction 17 Osteology I,, Gexkrai. ( )sTi:()i.or,v uj Special Ostkoi.ocv 22 The Skeleton of the Tkink 22 The Xcrtcbrul Column 22 The Trui' \'crtt'lir;c 22 Till' C\rvi\ al \iTti'l)r:i' j ^ The Thiiraiit Nertehnr 26 The Lumhar \erteljra- 27 The False \'ertel)r:e 2S The Sacrum 2S Ihe ('onyx ^q The X'erteliral ("oluniii as a \\ iKile ;o The Develoiimeiit of the Verlehral Col umn . I The kihs [\\[ ,2 The Steriuim -^ The Thora \ . ^ Tile Develo|iment of tin- Rilis ami of tne Sternum .^ Variations in the Skeleton of the Trunk '^5 The Skeleton t>F' THE Hi; \i) ^f, The Anterior Aspect of the Si- nil \h The Lateral As|)ect of the Skull ,7 'I'he i:\teri\al Surface of tin Uase of the Skull ,,, The Internal Surface of the iia^e of the Skull ^, The Superior Aspei t of the Skull 44 The Inner Aspect of the Cranial Vault or Calvaria 44 The Hones of the Skull 44 The Craniiil Hones 4r The ( )n ipital Hone 4^ The Sphenoiii Hone 4- The Temporal Hone ^i The I'ariet.il Hone i;,, The Frontal Hone ^ The Fthnioirj Horif t. . | The Inferior Turiiinateil Hone f)4 The Lachrymal Hone 64 The Skeleton 01 the Head (Cnnliiiiinl) p,,,. The Nasal Hone (15 The \"onier 6:; 'The Maxilla 60 The Talate Hone (xj The Zxuoniatic lione 70 The \iantal Radio I'Inar Joint .md the In- terosseous Membrane 1 23 The Joints and Ligaments of thi. Hand... 124 The Joint> of the Carjius 124 The Carpal Lipaments 1 2(1 The Unper joints 127 TirK Joints ani> Ligaments of the I'kiak (liHKLF 128 The I'ehic Lipamei.tv. Synarthroses and Diarthroses 128 The liidepencles of the I ;ii)er .Arm 188 The Muscles of the 1 urearm i<)i j The Muscles of the Hai.d ig8 I The Muscles of the Thenar l.minence iqi) ' The Muscles of the Hy|>othenar Fminence 200 The Inlerossei and Lumbricales 200 The Relalinnsof the Fxtensor Tendonsand their Sheaths beneath the Dorsal Car- pal Lipamenls 203 The i;\teM>cir Tendons of the Finpers 204 The TeiKJoiis and Synovial Shcatlis of the Flexor Teiiilons in the Palm 205 The ['as(ia' of the Cppcr Fxtremity 207 The Most Important Bursa' of llir rp]HT JAlremitv 20H The Mcsi I fs of the I.owtR Fxtremity — 2og The Musi les >'( the Hip 210 The Muscles of the 'Fhiph 214 The Muscles of the Lep 2l() The Mus. l.s i.f ihc Fortant Bursa of the I^)wcr F--:ir!mity =3,1 Index 2^7 rAOE -•137 -■137 --I39 ..142 ..142 ..144 --I44 ..144 •-■55 ..156 • -I57 ..163 . .164 ..166 ..170 ..171 ...76 ..177 . . . 2CK) . . .210 ...214 ...210 ...224 . . .22Q . . . 2? I WIT • ■ ' -.1.1 ...H7 ATLAS AND TEXT-BOOK HUMAN ANATOMY. INTRODUCTION. Human anatomy treats of the structure of the human bo .,f the different parts of the IkkIn to ,ach other or to the lK,dy in general, certani technical . vpro.ions are employe.!. In des. ril.inu' ihe position of a structure a i> always to be asM.me.l that ilu' lK.!y is in the ere, t p,.>t,.re. Tl,.. m,.,lian plane .lixi-les tlie b..ly into two alnu,st similar habes* sin.e man, like th,. nuijorilN of animals, i> bilaterally .symmelruv.l. .\ny plane of th,' lunly u hi, I, is parallel t,. th,- mclian plane is t.-rnu,! w;^.,//,,/ (from tlu' sagmal sutur,., see page 7,,,; di,.se whi, h ,>ass thn.u.J, the Uxly hon/.onialh are terme,! Iwrn.n,,.,/ or Iransr.rs., while v.rnV.d planes at right angles to th.. m,dian plan,- are kn..wn as /.„«/osition of the body, and this direction may be frequently better indicated by the terms cranial and caudal. In front and behind refer to the anterior and posterior surface of the body, but this relation may be more accurately expressed by ventral anrl aorsal. Special additional designations arc to a certain extent necessary for the extremities. In this connection, proximal means nearer to the trunk and distal more remote. In the forearm it is preferable to use the words radial and ulnar instead of outer and inner, since during prona- tion (see page 123) the inner side is directed outward and vice versa; and since the pahn cf the hand and the sole ni the foot are designated respectively as the volar and plantar surfaces, the words volar and plantar are used to indicate the position of parts situated upon the corre- sponding surfaces. OSTEOLOGY. GENERAL OSTEOLOGY. The greater portion of the skeleton of the human body is composed of bones, the remainder consisting of cartilages, and since the lx)nes consist largely of lime siilts they are miirh lirmer than tl- • cartilages, which, though harfl, arc nevertheless flexible. The i)arts of the skeleton are either j .aired or single, the latter being in the minority. The bones of the human body van,- greatly in their form, shape, and size. The largest bone is the thigh bo,>c or femur; the smallesi are the sesiunoid bones of the harJ and the auditon,- ossicles. According to form, we usually disiinguish between Inn or tiibii/ar hon«<■(/- tnatk l.ims. The long brrics have in general a cylindrical shajjc and are found only in the extremities. With few exceptions, they consist df a middle iK)rtion or shajl dliapliysis) and of two ends or cxtranitics {cpip/iyscs*). The shaft contains a cavity, the nudullary cavily, w is filled wilh bone-marrow, and it is on this account th.U these ijones are also termed //(/' ix)nes. The bony sub.-taneeof their shaft surrounds this medullary cavity and, on account of \\. firm slnirture, is know 1 as the compact substance, in contradistinction to a less .knse sjKingy substance, which consists of a fine network and forms llie greater portion of tlie extremities of the lx)nes with the exception of a ver>' thin outer conipat i layer of c )rliial substance. Tile long i)ones of the human txxly are found only in the skeKton of the extremilies. They are as follows, the ckivicle, the humerus, the radius, the ulna, the five nietaeaq)al JHrnes, the l>ones of the fingers and toes, the femur, the tibia, the !".bu!a, and Uie metatars;il lx)nes. Tiic ribs are classified with tlir Hat Ixmes. The broad nr flat bones are markedly llattened one direction rind have the sliajje of llat or curvid pkiics. Their central portion ((insists ot spo-gy l>one, the cortex In ing fonued. ho\ever, l)y a more or less thick kiyer of comjiact corlieal substance. In manv iii^tauds tl cy are i.r-vi.ied with well markeJ iinnesses. In the tlat Ixnies of the skull the spongios;i i> kno\ n a> the (///)/,)(•, while the la>ers .if compact subs! ukc are designated as the outer i'nd inner vitreou.- laMvN The llat Ixiius of the human IhkIv are: the sternun-, the scapula, tlu innoiiiiiiale l«.nes, the rii)s, and many of the ( raniai Ixmes. The ■ lort bones have an irregular fomi and ; ■ one ot liuir diameters giialh e\((((ls the others. ..ley consist almost entirely of spongy ti--ue, their e()mpa( t ((irti(al laver be iiii,' fre f!licn!!v VI- thi-- Tht\ are freijUeiit!\ ii: : ♦ Tlic 'crnis I |ii|iluMs am! rxin mil'i« .in rii.l. as a rulf, I'xtrcmiiit-, usually mnlain |Mirtiim^ uf ilu- ilia|>liv>JH a- we '9 in 1,'i't'!! '.:', groiijjs, as in liii carpus aini i.nMi.-.. 1 in- nuii^nidus, siiHi- llir |Mir;ii.i,, ,if \\h- Ikiiics iI, -ii-ii.iif il a^sLj.. ._^JkijJ 20 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. most important short bones of 'he human body arc: the true vertebra?, the carpal bones, the tarsal bones, the patella, and the sesamoid bones. In addition to the long, flat, and short bones there arc a number whic.i cannot be ciassiCcd in any of the three cate<;ories. These are designated as irregular bones ; as a rule, thev repre- sent transition forms between the broad and flat bones, as in the cases of the sacrum and of many of the cn-.nial bones. Among the latter there are also some— for e.\ami)lc, the temporal bone and the occijjital bone— which in a portion of their extent are typical flat hones, while in their remaining jjortions they would be regarded as belonging to the group of the short or irreg- ular bones. .AH the varieties of bones may possess prominences which take the form of projections, ridges, and ])roce.«ses of the most viritd shapes. .-According to their size and form, they are designated as tubercles, tuberosities (rough, more or less jironounced projections), spines, crests (rough lines or projecting ridges), processes, condyles (also termed condyloid or articular processes), epieondylcs (/. c, j)rojecli()ns situated alxivc the condyles), and outgrowths {apophyses). In a similar manner many bones possess excavations {jovece or josser), impressions, grooves, furrows {sulci), notches (incisurir), perforations {joramina), slits {hiatus), and canals. The enlarged rounded ends, particularly of the long bones, are frequently called heads, while the constriction situated beneath tliem is known as the neck. All bones poss ss larger or smaller foramina for the entrance of the nourishing l)lood-\ sscls; these are known as the nutrient joramina, and are particularly large in the shafts of the larger long bones, where ?hey lead into a nutrient canal, which extends into the medullarv cavity. Thi hones of the human body are usually studied in the n.acerated condition, /. e., after their soft j.art.-, iia\e been removed by putrefaction. The bones of the living bo- l«,m-ash, ,'. r., tlic ;lii|. I he actual bony ti? -le apptaiN in two ni(>(!ilications, which jiass into each other, how ever, wi'huut ileniaixat he conijiac t Mih>b(ine and the >p.ingy sul^laiuc. The former lui> a dense and ap|iarenli\ |Uiti' iinil'orni stmiliire, while the spongy suifsiance conM.sls of a line network of Iwrny trabet uhe, whit h al lirsl sight seem to be without delinile arrangement. In reaJilx, howe\-er. the :in liiioi tnro of tli(. cTu>n.r, ^iilj^i. ,«,.,. jo i„. .,,, .,,, : r--!ir . / i'""r .: '••'•■■'•■ 11 ! t - n ;..;,, 1:1a . . Its parts are arranged in siuli a manner a> to pnxiiiie a tirm and resistent structure with the greatest po^bihle sa\ing in weight, and a careful examination of its trabecular and plates will GENERAL OSTEOLOOY. 21 show that they arc placed so as tc lie in the direction of the greatest pressure or muscular trac- tion exerte:i upon the bone, and cvcr>- bone or part of a lK)ne formed of sp. -v substance con- tains, consequently, several intersecting systems of trabecule which cross each other mostly at right angles (Figs. 167 to 171). Almost nowhere in the Ixxly do we fmd Ixiny tissue uncovered, as it is enveloped either by articular cartilage or by periosteum. Articular cartilage covers the ends of two lx>nes form- inn a joint, a.s in the extremities of most of the long bones; the remainder of the lx)ne is envit-)ped by f)eriosteum, a fibrous connective-tissue structure van,-ing thickness, whiih is of great im- IX)rlance for the nou-ishment, growth, and regemiation of the bone. Articular cartilage i.; hard but elastic, and consists of the so called hyaline cartilage. Its thickness varies gnriK in difTerent bones, Ix^ing sometimes only the fraction of a millimeter or in other cases amounting to several millimeters. (I )r ihe mo:v minute structure of tone, jieriosteum, articular cartilage, and lx)ne-mar-ow, see Solxuta's "Histology," Saunders' "Medical Hand Alhues.") The bone-marrow appears in two varieties, the red and the yellow, TIu- ycll„w marrow is really fat tissue, and is found in the medullar)- cavity of the long Ijones of the adult, while in young individual- these spaces are Idled by red marrow, a soft vascuiar structure, whiih is also situated in the liner medullar,- spaces of the adult Ix.ne Ixtwetn tin sp.,ngv trahecuke. The vessels nourishing the lx)ne are found cliiell\ in the medullar- cavit\ and ].eri()sirum, but they also occur in the bony tissue itself. The nerves, on the contrary^ are found princinallv in the periosteum, the bony tissue having no ner\es, and the articular cartilage luither nerves nor vessels. In certain regions of the hur.an Ixxly, ewn in the a.lult condition, jxirdons of the skeleton arc formed by cartilage, as at -he anterior extremitiis oi' ilij ribs, and sin.e lartilage is clastic and flexible, it jjlays quite a (V rent functional role from dial of lx)ne. These canilages are enveloped by a connective tiss,'. covering, the p,ricli>mdriu»; Willi rcfrnncc to tti.^ .i,v,-lopm.-nl .,f h„n,., |nv„ v^rioiirsuf l«,n,. furi.^mion an- r.TORnizal.I,.. ThrKr.-al tnaj<,rity of thr Lotus ar.. lai.l down l„ .artilap. ai a - . f f.tal .iinloimi. nt, an.l llu-s.- l«,nrs, whi, h arc tint, pr.for.tt.-.l in .artilagr, stan.l in contrast with those «hi,ls slowly an.l la.sts very long, usuallv nol l.einn completed unlil the lw,niv lifih vcar, ^-.called .emers .,f ,„si,„ „ion apiH.ar in the cartilaginous portion^ of ihc skel.ion Tlu-c , enter, nuv U- si„g|,. ,.h,.rt l«,ne , or, as is uM.allv the ta.se, multiple, and .sometimes they .u,ir in relativch large nmnlHr. an,l are s,,me«hal irn-gulariv arranged (a- in the sternum). I sually, however, particul.irly in the long !».»,■. of the estremi'u , the , enter for the fulur.' shaft of the U.ne the diaphvsial center, appears firs,, while the en.ls or epiphyses s,i|| r.ma.n artilaginou., an,l each epiphvsis laler ,le. veU.ps at least one ami f^.,,uentl^ several s.'parate centers of ossil,, ,,iion (the evcepiion- .,re giv, n npon pag,' y ■> whi, h not only apiK-ar at a much later peri,Kl than the .liaphysial enter. Inn long after hirlh an Mill -, parated fn.n, !h. ,,n ler for the .haphy-is hy a layer of > artilag,-. This is term,,! ihe epiph^.ial line (syn, lumdr.u. .,>,/ I,ys.;.s), and ,1 linally disapfiears and the Ixjiie Injcomes obsilitd lliroughuut. ..^Ai- r»,«ipvv;f>i: '^*^. 32 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. SPECIAL OSTEOLOGY. The human skeleton may be Ecpara'ed into three chief divisions: (.\) The skeleton of the trunk; (H) the skeleton of the head; (C) the skeleton of the extremities. I-'rom the stan(ifM)int of embryology and t-voiution the skeleton should lie divided into: (i) The axial skeleton, »'. c, the vertebral eolunin with its adnexa and the greater part of the base- of the skull; {2) the appendicular skeleton, /. r., the skeleton of the extremities; and ( ^^) the membrane and viseeral bones, /'. f., the Hat bones of the rranial vault and the facial Ixmes, and those portions of the skeleton which re|)resent the visceral or branchial skeleton of the lower vertebrates. The skeleton of the trunk is formed by the \ertebral column and its appendages (the ribs and the sternum), the skeleton of the head is re])resented by the skull, and the skeleton of the extremities is further sulxlivided into the skeleton )f the uj)per and that of the lower extremity. The Skeleton of the Trunk. The principal portion of the skeleton of the trunk is the vertebral column, which is com- posed of a series of ])arts, the verlebrcr. A ty])ical vertebra consists of a body and of arches, these latter being sulxlivided into a posterior or dorsal and an anterior or ventral arch. The posterior or dorsal arches surround the spinal cord, while the anterior or ventral arches, in the form of the ribs, are well de\eloped only in the thoracic portion of the vertebral column and are rudimentan,- in the remaining vertebras they surround the vegetative cylinder of the body, the intestine. While the dorsaJ arches are firmly united with the bodies of the vertebra-, the ribs are jjaircd bony arches articulating with the thoracic vertebne behind and anteriorly with a sj)ecial bone, the brcast-lx)ne or sternum. The entire series of the vertebra; form the s])ine or vertebral column, and the thoracic ver- tebra- with the ribs and the sternum form the thorax. The skeleton of the trunk consequently consists of the vertebral column together with the thorax. THE VERTEBRAL COLUMN. The TRUE VERTEBRiE. In the vertebral column two main subdivisions may be recogni/.ed. One subdivision is formed by the true vertebrcr, the other bv the jalse vertebra-, the former being separate bones connected by ligaments and joints, while the latter are united by bon\ tissue to form larger hones. The entire human spinal column consists of thirty-two to thirty-five vertebra-; of these, twenty-four are true vertebra- and eight to eleven are false vertebra.-. The true vertebra; may be separated into three sulxlivisions: (i) The cervical verttbra-; (2) the thoracic or dorsal vertebra-; and (^ the lumbar vertebra-. There are seven cervical, twelve thoracic, and five lumbar veri. Ijra-. .■\ typi(al vertebra is comijosed of: (i) The bod; ; (3) the vertebral arch; and f_^) a num- ber of ])rocesses. THE VERTEBRAL COLUMN. 23 The body (Figs, i and 2) is composed of spong\- substance enclosed by a thin layer of cor- tical compact bone. It presents a superior and an inferior plane or curved surface, an anterior surface markedly convex from side to side and slif,'htly concave from above downward, and a posterior surface which is concave in Ixjth directions. The posterior surface usuallv presents one or more larn;e nutrient foramina and, with the vertebral arch, completes the enclosure of the spinal foramen (joramen vertebralr). The arch consists of somewhat I'lrmer tissue than the body and forms from a half to three-(|uartcrs of a circle. The ]>ortion continuous with the body on each side is known as the pedicle or root (radix arcus irrltbrtr) (Vv^. i), antl presci '~ a notch upon both its ujjper and its lower surface {the superior and '.njcrior irrtcbral iwlclns) (Fig. 2), the notches of contiguous vcrtebne (the inferior notch of the upper vertebra and the superior one of the lower vertebra) together forming an intervertebral foramen whi( h commiini- transverse process. /, proceai. spinous process ,. . suptnon/ertebral notch superior arlicular r\: rv process SUpenordimi facet forhcadofnp\ < matiersc jjroeas facet for luhercleof rib h 'Or demi facet Inferior Inferu. ^ fo, .eadofrib mlebral articular ' ' notch firoeess A vcrtcljra seen from above. Flo. 3. — .A vcrtilr >oen from the siili- cates with the spinal canal. The superior intervertebral notch is usually the shallower; the inferior one the dce[)er. The processes of the vertebra- consist of the articular jirocesscs (Fig. 2), for the ])urpose of articulation with neighboring vertebra-, and the spinous (Pig. 2) and transverse processes (Fig. i), which serve as ])oints of attachment for the mu.scles. Even,- t\ ^ ''-al vertebra j)ossesses four articular processes, two superior and two inferior, and these bear articular surfaces which are correspondingly named. Of the remaining jjrocesses, the sjjinous process is single, while the transverse j)rocesses are paired. THE CERVICAL VERTEBRE. Of the seven cervical vertebra-, the two uppermost ones, the first or atla^, and the second or axis (epistropheus), show marked deviations from tlu- type. They are also known as "rota- tor\'" vertebra;, in contradistinction to the remaining vertebra- (tle.xion vertebra-l. The general characters of the cervical vertebra- (Figs. 4, 5, and 6) arc \.s follows; The 24 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fig. 4.— The cervical vertebra; seen from behin(i and partly from the side (f ). Fir,. 5.— The fifth cervical vertebra seen from above ( } ). Fig. 6. — The seventh cervical vertebra seen from above (|). Fig. 7. — The atlas seen from above (|). Fig. 8. — The axis seen from above (J). bodies arc relatively small, low, oblong for quadrilateral with rounded corners), and thev in- crea.se in size from above downward. The Ixxlies arc smaller than in any other region of the spine, and their u]5pcr surfaces are concave from side to side and slightly con\e.\ from before backward, while the lower surfaces an.- concave from before backward and slightly convex from side to side. As a consequence of this, the upper surface of every vcrte})ra projects laterally beyond the body of the \ertebra ne.xt abo\e (Figs. 3 and 4). The arches of the cervical vertcbne (Fig. 5) are of medium height and ari.se by a pedicle which is directed outward and backward. Together with the body, the arch surrounds a s])inal foramen which is ver\- wide, especially in its transverse diameter. The articular proces.ses (with the e.\- cc[)tion of tho.sc of the upper two vertebra') are ])laced obliquely, so that the plane of the articu- lation pa.sscs from above downward and from before backward, and the articular surfaces are consequently in a midrlle position between a hori- zontal and a frontal jilane, tho.sc nearer the skull approaching the horizontal position, and those ncarci the thoracic vertebra; the frontal plane. The transverse processes (P'igs. 5 and 6) of all the cervical vertebrae arc perforated by a large round foramen {joramcn Iransvcrsariiim), a peculiarity which distinguishes the cervical from all other \ertebra'. Furthermore, the ends of the transverse proces.ses are ])rolongcd into two Uibercles separated by a groove (sulcus itrni spinalis) (Fig. 5), situated u])on the surface of the transverse ])rocess. The anterior nwt (if the tr.insverse iiriiiev-;, whii h passes cliret lly oulwaril from the ImkIv of the vertelira and is .separated from the |K)slerior root by the foramen transversarium, the sulcus ncn'i spiiuilis, and the eonslrietion between the two tutjercl s, is known as the eostal proeess {processus coslarius), and represents a rudimentary rib adherent to the true transverse process whieh is represented by the posterior root. This eostal process is ok asionallv independent, especially in the seventh rervieal vertebra, and forms then a cer\i(al riti. The s])inous processes (Figs. 4 and 5) arc for the most part small, somewhat downwardly inclined, and distinctly bilid at their apices. From the third to the sixth the cervical \ertebra; arc typical. The seventh (Fig. 6) is dis- tinguished by jjossessing a long spinous process which is rot bifid and is directed downward. Fig. jj. — Cervical %ortebra' seen from in front. (idoiUo, i process I ransvcrst pivoss vr lor 'III iirtiiv S/)iiii>iis prori'ss Arch Siipniiir iirliruliir fiicil IpiiHrssi I I'riinicii iiisvirsiirhiin Body \'!h I :.'!■ iiihririi- •'/ /'.'-;. )/>;■ iiihriilr .'I Hi!. iviiith iirvirul VI itilirii Spiihni^ pr.nrss Odoiiioiil proii.^<. (iiiilirinr iirliniliir fllCCti Superior drlinilur Pant Siiprn'or iirliniliir fiiirt tpr(>ii\\) f lo. 0. I'o^ttrior tiiluirlr Infrrior Body iirliaihir facet Hne a..^o ])os';"sses. The spinous process is also wanting, its place btinK taken by a jirominence known as the ])osterior tulxTcle, correspondini,' to which there is an anterior tubercle upon the anterior arch. Finally, instead of articular processes, it possesses two upper and two lower articulaiuif; su' faces, and lx)th the superior and the infc rior vertebral notches are absent. In the atlas there are distinj^uishable therefore : anterior arch, a jjosterior arch, and the connecting lateral masses, which are thi- stron ;est portions of the Ijone. The anterior arch is shorter and weaker but hi<,dier than the posterior one; anteriorly (ventrally) it presents a slight projection, the anterior tubercle; i>osteriorly (dorsallv, /. c, toward the spinal v,;mal) a round hallow articular surface (joi'ea articidaris dentis), for articulation with the txlontoid jirocess or dens of the axis (the second (^irvical vertebra). The posterior arch of the atlas bears ujion its posterior surface a short i)roji(iion, the pos- terior .uberclc, a rudiment of the spinous process, and is the lowest of all the arches of the cer.'ical vertebra- (and in fp.ct of all the vertebra?). It is Hat and broad, howewr, and presents U])on its upper surface near the pedicle a furrow wliieii is sometimes shallow and sonnlinies broad and deej), and which is (K:cu])ied by the vertebral artery. This i,'r(H)\c is ndt infrec]uenlly bridged over and converted into a foramen or short canal with a rough inner margin. The inner portion of each latend mass of the atlas (tuberositas atlautisi projects markcdlv into the anterior juirt of the sjjinal canal, so that the latter is converted into a smaller anterior comi)artmcnt, for the reception of the odontoid jirocess of the axis, and a larger posterior com- partment. This j)Osterior compartment is really the spinal foramen and lonlains the spinal cord. U])on the upper surfaces of the lateral masses are the u])i)er articular surfaces for the reception of the occijjital condyles. These surfaci's are Ix'an-shaped and, corresponri(i"V' " .•^ '"5^^ r-rt'- 1 ATLAS AXD TEXT-HOOK OF HirMAX AXATOMY. 9.— The tenth to the twelfth thoracic and the first and second lumbar vertebra^ seen from the side and sliijhtly from Ijehind (J). Fig. 10. — The tenth thoracic vertebra from above (',). Flc. II. — The sixth thoracic vcrtelira from the side (|). Fic. 12. — The third lumbar vertebra seen from above ({). epistrophei) and projects into the anterior compartment of the spinal foramen of the atlas. This odontoid j)roce.ss is conc-shapec! with a rounded apex, and presents an anterior facet for articu- lation with the anterior arch of the atlas and a posterior articular facet which is not alwavs dis- tinct. Instead of articular ])rocesses the ujiper part of the body presents corres])onding articular surfaces for connection with the atlas; tliese surfaces are slii^htly con\ex and bu; 1 trille inclined from the horizontal. The spinous process {Y\'^. 4) is fairly well developed and always distinctly bifid; the trans vet'se i)roces.se-. on the contrary, are smaller than those of the atlas and their lulxTcles and sulci nervi spinalis are likewise absent, although there is usually a shallow groove for the second spinal nerve on each side Ix'hind the superior articidar facet. The inferior articular |)roces.ses are more inclined than the superior ones, and already show the characteristics of those of the flexion vertebra'. The fciramina transversaria of ihc- artinilatnl er thoraiic certebr.T their surfaces are elliplital, like those of the cerxical region, but as we jiass downward they betome rounder, then cordifomi, and fmally reniform in the lower nn nilxrs of the series, which approximate the form of the lumbar \erlebra'. And not only do tile iKxlies iK'conie largir. but their lateral diameter especially is increa.sed as they gradu- ally approach the form of the lundjar \ertelira'. Their (dniigiious surfaces are almost per fectly tlat. The spinal foramen (Fig. 10) is not only absolutely, but even relatively smaller tlum that of th tervital vertebra', and in the upper memlnrs of thi' scries it is roimded, wiiiK in th( lower <'. it is rather triangular. The upix-rand lower margins of the Ixxiieseach present, imtnedialel} in front of the petlicles, a demifatct for the head of a rib (Fig. 11 ). The first ami the two (or three) lowest vertei)ra', however, thuw de\iations from this arrangement, the former having an entire facet u|M)n the upper margin, anil each of the latter (Fig. ()) ]iresenliiig an entire faiel toward the niiddle of ihi 1mm1\ of (he Mrlebra. The arti' ul.ir surfat e^ for the he.ni^ ol the rit^^ are plaied on two ailjad-nt thorat it vertelira' in ^iii h a manni-r Ihiit eaih \erteliral niarnin i|ihs not rei eive exaitly ..I'l half of the arlii illation, hui lowani Ihe lower eml of th( seriis if ii^-ith-r iw--'!:i,-!---f i!-.-rmir- ^m'WM i'nci-t f(V haul <>/' rih Superior (irtinilur proass Spino:!^ /Vi'iv /(•///// r/ionnu vrrtchni iwclfih t/iiviii/r vrrtrhrti I irsf linnlnu vi rliinu I rmiwi' -.r priii<-^ ^ I iiiil h'r tii/irnii- ill rih Siip,rior uriirtihir prOd ■.^ i't rJi I /". 10. Siiiih>:i^ pr.'ii liiliiiiir (inidiliir iiiiHf.\ Spiiu'ii-^ pu'ii Sn/hru'iui'iiii/'ir pr,h / /iff/'V, r\t' pitUi '•'* /■'A- '-' M^Sl^llM..^^ ■'i%/:i^.:::i.i^.j»^^^-k THE VERTEBR^VL CvJi-UMN. 27 ally the tenth also, possesses an entire rostal facet 'Fig. 25). These vertebra; which [x)ssess an entire facet have typically n;h and thick. The articular })rocesses, with the excejjtion of tliose of the twelfth \ertil)ra, he almost in the frontal jilanc and are placed so that tile almost round and slij^htly concave inferior surfaces l(x>k forward, while the >lightl\ convex -aperior ones look backward, the surfaces forminj; part of a thick cvlimler the axis of which lies in front of the vertebral body. The superior processes are ver\ ]in>miniiit, while the inferior ones project but slij^htlv. Th( long transverse processes (Fiji;. 10) are strongly develojicd. They are directed back- ward as well as outward, and have thickened club-shaped extremities. The anterior surfatr of this thickenin.!^ usually ])resenls an a])i)roximately circular, slij,'htlv conia\e arliiiilar face!, for the accommodation of the tubercle of a ril); this facet is wantinj;, however, in the eleviiilh and twelfth vertebra' (Fij^. q), and the transxcrse i)roce.ss of the latter often shows a \ariable develo])ment, freipiently consistinf^ of *■ 'veral irrej^ular tubercles. The spinous processes (Fif^s. (), 10, and 2?) a^ ' nj; and three-sided, and are directed ob li()uely downward, one border looking U])ward and one surface downward. Those of liie midiile vertebra" of the series overlap each other like the shingles of a roof ( Fig. j ? ). That of the twell ih vertebra (Fig. (j) resembles those of the lumbar vertebra'. 'I he twelfth thnraiic vertebra (ami scimetinies ihi- eh venlh aUo) i-. the only one that 1 an Im' ses) ,ir( the surc-t points of ideniilication for the thorai i. vertebra' in general THE LUMBAR VERTEBRA. The lumbar vertebra- (Figs, o, 12, :i, and 2;,) are the largest of the true wriebra'. The bodies in partiiular are large, very high and broad, and have plane reiiiform siirtaces, /. c, they are convex anteriorly and concave j)0.steriorlv. The anterior surface is distinctly cuniavc from above downward and convex from side to side, so ih.il the up|)( r and lower siirfatts of the bodies are con.' directed forward and outward. The surlaiis represent seitioiis of a lar^'e hollow < vlinder. whose axis is situated, not in fnmt of the vertel.-ral bodies, as in the thoracit region, but iH-hin.l ihi in lU hind the spinous process), and the inferior pro( e>ses of each vertebra are n)nsei|uentlv oMrlappeij laterallv In the superior processes of the next su(ceeding one. The infi rior pnM'esses of the iiilii Miiibr.i are united wiiii the U|iper arlii ul.ir proic.s.ses o| Ihr sai ru"> 1 see jiage jcj). » ,-.fey 5 28 ATLAS AM) TEXT-BOOK OF HUMAN ANATOMY. Fig. 13.— The sacrum seen from behind (dorsal surface) (j). Fig. 14. — The sacrum seen from in front (i)elvic surface) (|). Fig. 15. — The sacrum seen from al)ovc (ba.'^e) (J). Fig. 16.— Horizontal section of the sacrum at the level of the second sacral foramina (J). Fig. 17.— Median lonjrituchnal section through a sacrum, showing the synchondroses between the n- vidual vertcbnu (j). Fig. 18. — The .sacrum and coccy.x seen from the side (*). Fig. ig. — The coccy.x seen from in front (j). Fig. 20. — The coccvx seen from behind ( {}. The transverse ])r()ccsses of the lumbar vertebra? (Fig. arc lonR, (lirccted almost at a right angle from the sjjinal column, and nes, the .sacrum and the l(HC\ x. THE SACRUM. Tite sacrum is that ])ortion of the \crubral u)lunin which is connected with the jieKic girdle and completes the latter posteriorly; it cons-i|" ntly forms a i)ortion of the |)elvi> itself. It i> a broad, uir\cil, nuMlcrat-'ly flat, shovel shaped bnin- 1 Figs. 1;, and 14), which is broad and tiiick above, and narrow and thin below (Fig. iSi. I it there may 1k' distinguished an anterior relatively smooth surface, concave in both the sagittal and tr:ins\er>e dircdion--, ami known as pehic surfaii, bciausc it looks toward the pehic cavity, and .1 posterior exlreinely rough dor>al surface. The broad iijiper surface of tlu' s.icrum is c:dle(l the base and the lower angle the ajiex. The pchii surface presents a number of traiisverM' ridges, usuallv lour, which connect fur pairs of irregtilar rminiltd foramin.-. known as the anterior sairal foramina. The ridges corresixmd to the jumlion-, ol the ii\e originalb ^ejiarate sacral \trtebra' of which the bone i> composed, while the >.u r;d I'oraniina indicate tlu juiutioiis of \hv Ixxlies with tlu- lateral jiro- ces.ses (costal and transverse proce.^se.-i. The anterior sacral foramina communicate pos- • Tticsi- priKC" tic ( ,i-.ii>n:illv f.rrm Miiallcl iil.iliiniiii.il ur lunilur rili> EmfM^amm ^!n " .* v^^:-. '^-vi?'?^ y^- BV- '^'■A^^-S^i ^mmsm^^mm 0^- •5 3 l^^f 'N.. 'X.i S;T%5^ Miilidil sdcnil Posterior sdcrol rnst forninai .^ lnlmrrl,i\i;riil vi rlihrui '^. liA'^^i'^mit!:- liL-rt^Nfii THE VERTEHRAL COLUMN. 2() tcriorly with the spinal canal and extend laterally as gnxives which gradually become shallower and are finally lost upon the lateral masses of the Ijone. The portions of bone situated external to the sacral foramina and which are jjarticularly well developed in the up[)er ])art of the sacrum, where they articulate with the pelvic girdle, are designated as the lateral masses (partes hiUralcs) (Fig. 15). Their lateral surfaces exhibit large ear-shaped articular surfaces, known as the auritular surjaccs, which articulate with the pelvic tones, anro- cesses on each side retaining a certain degree of independence, the su])erior ])nKe.s.ses of the first vertebra and the inferior ones of the fifth. Tb.e former lie at tlie ba>e of the s;icrum and are called the superior articular processes of the sacrum ; they articulate with the inferior articular ])r(Kes-i s of the last lumbar verlel)ra and are ei|ually well fomied. Their articular surfaces arc ])laceft midway between the sagittal and the frontal plane. The articular crest is ((inlinucd downward on i-ach side o\er the apex of the sacrum and usually jirojects beyond it as a horn like process called tlie sacral cornit. This process is the modified lowennosl articular )inicess, and is unitt'd b\ ligaments to a similar process on the coccyx. Tlu- lateral sacral crest is lo be regardi-d as fornu-d by the fusion of tlu- tran>\irse proces'-es and forms a nnigli riilge which i^ occasionally interrupted. Tlu- sacrum is traxersed throiiglunit its lengtli b\' a canal 1 1'"ig. 17) whiih !■ tlu- dii-ed con linuaiion of the s|iinal canal and is known as tlu- sacral canal. It is toK-raiily widt- in the ujiiicr part of the sacrum, but ra])idly diminishes in Ixuh its .s.ij,.aal and transx-er.se diaiiuters as it descends. It terminates externally Ixtween the sacral cornua as the saa-al hiatus ( l-'ig. 1^1, and is connected wiiii the anterior and ])oslerior sacral foramina by four short ii-a ,,\'erse canals, ilu- iittm-rrtihrii' jorantlnu (Fig. 1(1). The jjosterior wall of the sacral canal is formed cs.sentially by the completely fused arches i^^^XjIUA^ 3° ATLAS AND TEXT-BOOK OF HUMAr; ANATOMY. Flc. 2 1 . — The vcrtel)ral column seen from in front (§). Fig. 22. — The vertebral column seen from behind (§). Fig. 23. — The vertebral column seen from the left side (J). of the sacral vertebrx. The inter\-crtcbral foramina corrcsiwnd to the similar structures in the true vertebra' ; but in the latter there arc no openings comparable to the sacral foramina, at least not in the bony spinal column. This is due to the fact that the spinal nerves divide into an anterior and a posterior branch within the sacral canal instead of outside of the spinal canal as in the true vertebra-, or, to go back a stej) Turther, it is due to the fact that whereas throughout the scries of true vertebra' the ribs or costal processes remain distinct from one another, in the sacrum the costal ])rocesses, which are rci)rcsented in the lateral masses, fuse together and a'.^o unite with the transverse processes, so that the intervertebral canals are closed at their outer ends. The a])cx of the sacrum presents an elliptical surface for articulation with the coccyx, and at its sides there is a shallow notch which is converted into a foramen by the transverse process of the first coccygeal vertebra and the connecting hgaments (sec page n.^). THE COCCYX. The coccyx (Figs. 18, iq, and 20) is a small bone of variable length formed by the fusion of four or tive (rarely three or six) (juite rudimentary vertebne (vcrlchnr caudalcs). The first vertebra alone shows some vertebral characteristics, since there can be recogni/.ed in it indica- tions of transverse processes as will as of the up]ier articular ])rocesses which are transformed into the ciuryi^ial coruiia. The transverse processes also freiiuently a])])ear in the second ver- tebra in the shajic of feeble indistinct i)rojections, but the remaining coccygeal vertebne are irregular, rounded jiiece , (,f l)<)ne. None of the coccygeal vertebr;e ])ossesses a trace of \ertebral arches or of a spinous process, and the individual vertebne are united either by syi nondroses or (more rarely) by Ijony tissue. Thi' sacrum sHdws ivpicjl st\u:il dilTirciu is, since it is Ijrcwdir. shortiT, ami less curviil in tlic ft ni.ilc than in the male. Nut infrc(iui-nllv the lir-l sai ral vertebra remains jiartlv c.r cm n eiuirely inilejiendent (Ihc lnntl'iises, whili' in the thoracic and lumbar regions thev are in front of them (Fig. 23). THE DEVELOPMENT OF THE VERTEBRAL COLUMN. As far as tin- (l>-v.Io|iliU'm of tlic Lony virlil^ral ...Uinm i-, .Miu.rr.M!. la.h Mrulira ari~is from ihric .mlir-. ..f os>il»ati..n, i.iu' fur tin' .icily ami oiu- fnr . ai h lialf ..f ilu- \,ruliral ar,h. Ossili. ali.Mi . ..iiiiiirni .s at llir i ii.l ,4" ihc sriiinil mc.nih c.f iinhrvi.iiic lif-, llu- . ,-nti rs fur thr ari Ins a|.|.cariiiK scim-^hal rarli. r tliaii tlv-c f.ir iln l.ml} i?ul al-o giving risr t,i llu- ilitTiTint v, rtcliral ].nKiss,>. In adiHliun tu tins,- ihiif ( ,nli rs, a. . i — iry (. nl. r^ .l.i. Iu|. , i,n-.i.!. r.l.ly laliT, at the age of puli' rly or even sulisfi|ui-nlly, an|'in..ii, ami ira"-v r-r |iri>'i-sscs, on llio niami illary )ironssfS of the lumliar v.rtrl.ra-, ami on ih.- u|'i.,r and lo",r ■ irfa.rs of tli.- \. :l.!.ral ho.liis, Th.'s,- iiiiphysc do not uniti- witli the- nniaind.r of tin- v.rlt'.ra until thr groMti oi -In- l.ody ha^ 1.,, nconi- ,,lrlr,l. In the first yr.n ..f lifi' till- two centers for thr vcrtel.ral .in hi-s unilr. i:i tli.' tiiivd year the ar. In^ 1,. . onu- jouird to the l.odies, uiiile the ipii'hyses remain distimt until the twenty-tifth year. In the atlas thi iinlir for the l..idy is wanting. The anterior an li ren- lin- . ..riilaeiiiou-. f. ■ ., l.nLMinie, ii. I ..--ify- in« unti' the first v.ar, and not uniting with the posterior an h until the fifth or sixth >ear. The two , . nters fur ihi pos- terior arih remain .separated until thi- thinl year. In the axis there is a eenter for tile Lodyand a similar om- (..riginaliy doubl. i foi the odoiUoj ;,roeesv. n.,th Muile :„ ,u,. !hird vear. The s.iiral virK-bra- ossifv in a similar mann.r to the true virlelira-, in (a. h tin n i- .i single . ■. lit. r f^r the liod>, two for ea. h ar. h. epiphyseal plate , and spei ial ventral eenters eornsp,,mling to the sa, ral -il -. 'i he l.odv and an he. e.f the filth sa. ral vertehr.i unite first (se.ond yearl and then f.ill.iws the union of [hr !i...lv aii.l ar. he- ..I ih. Iii m r- 1,-hra (fifth and sixth yiMrl, while I.,my uni.m l-nv,en the l.o.lu's ii.,es n..l ... . ui until th,' tw. nty-hflh y. .r,„ lat.-r. In the r.Ki ex the frst verlehra is ossified at hirth, the last one not until the Iweiuieih \e.ir 32 ATLAS AND TFATHOOK OF HIMAX ANATOMY. Fig. 24. — The first rih of the ri^ht siilc .seen from above and from the siJt (J). Flo. 25. — The scconil rih of the riijht side seen from above and from the side (I). Flc. 26. — The |iosterior extremitvof tiie .seventh rib of the rii^ht side seen from behind and partlvfrom below (§). Fk;. 27. — The seventh ril) of the left side seen from behind (ij). Fli;. 28. — The seventh rib of the left side seen from within (^). THE RIBS. The ril)s nosta) helonji; to tlial iimilcd ^roii]) of skeletal sefjmcnts which remain partly lartilaj^inous throu.ijhout life, .\ttenlion may first be (lireded to tiie tM)ny ribs, of whieh then; are twelve pairs (Fii,'s. 2.\ and :;o), < orres])on(lin,i; to the nurnbir of llu' ihoraiie \ertebra-. The ribs are not tubular Ixmes, but llat \n)n\- slri])S of considerable lenj.;th. Tliose in tlie middle of the series arc (juitc uniform in shaiK', only the up[)er and lower ones show in^ certain deviations. In a ty])ical rib the foiicnvini; parts may he rccoirnized: I. The haul, the posterior (vertebral) slijjhtly thickincd end. It presents an arlituhtr surjiUi' (Fit;. 27), which is opposed to the Ixxiies of the vertel)ra', and is marked b\- a median ridfie, the rrr.sl, wiiich at first tlirected outward, Iwckward, and downward, but at the costal angle it turns tijion il-elf and pa.s.ses for- ward. On the inner siirfaie of the lower margin of the iMHly theri is a gn>o\c. the rosldl f;rame [lecuiiar torsion of the Ixxiv, so that one surface looks outward and u])war(l while the other is diretted downward and inward. The position of its anterior extremity is txpical, an,i it posses>( s a capitidar crest, although the tubercle and angle still coincide. A roughness, tin- tulKidsitv, scr\is for liie origin of one, or sometimes two digitations of the serratus magnus muscle. The eleventh I I'ig. 21)) and esjiecially the twelfth ribs (Fig. ,;o) an -liort and but slightly curved. The crests of the heai to tlu' se\enth and tiun decreaM' downward to the twelfth. The riljs present a cur\ature which mrrc^poniK to that of the thoracic wall and is known as lue surface cur\ature. It is only in the la-cs of the first and the posterior portion of the second ribs that the outer doweri border (orres])onds to thi' thora(i( wall. liy torsidii runalurr is imam llu' tor-imi of tin- rilis ii|'iiii thrir a\i -. ^ h li a lur^ioti i- {■■iiTiil in llu iirM and sr. fitul ritK, sinie lluv pax froni a liuii/oiilai inln an uliliiiuc plane. Inn .1 ( irl.iiii aminini uf inr-hm ,il-n m(.iii^ in thi inidillr (ly|>iial) ril)s .is ilu-ir anurinr >\lroiniliis pass fnini a vrrtiral In ,in oliliinic plani-, -■> thai ilic ii|ipper Iwinler direeted liackward ili^;. j;'. The costal cartilages conned the bony ribs with the sternum, but it is only in the upi)er se\-en ribs that the sternal connection is a diri-(t one iFig. ,vt). '['he eighth, ninth, and tenth ribs ha\e a common cartilage whitli is (imtinuous with that of tin- sr\(nth, anil the ele\cnth and twelfth ribs ha\e free ends with short lartilaginous apices. C'onsei)uenily true ami jiihe rihs ma\ be recognized, the true ribs being the tir^t to le sevinth and the false ones the eighth to the twelfth. The eleventh and twelfth ribs are also ti ined /loiiling r//iv. The ( osial cartilages are Hat, are placed Nirtically like 'he ribs, and tin ir margins are rounded, posses>ing neither grooves nor ridges. Their length rapii i,- ini reaMs from the I'lrst to tlu' se\enlh and then decreases marked];,', the eleventh and especial the twelfth ribs having merely car tilaginous apices; the first (ostal cartilage i^ also \(n- ^l^orl but broad. The laitilages, par ti( ularlv of the middle ribs, """dme di>limt'' wider as tin v pass toward the sii imim. The tirsi and second cari.lage-' are iiu lined slighll\ downward toward the sternum (from aNixi downward .md from without inward), the thini isc iitl\ hori/ontal, and from llu' fourth downward tlu re is an inireasing iiK linalion from IkIow u|iward anil from witiioiit invvard (Fig. H !. The cartilagts of the si\lh to the tenth ribs are often ipiite bioad and artii ulate with e.u li other b\ variously formed jiroccNses jias.^ing upwarl and downward; they form s\ in hoiidroses or, as is usuall\ the tse, diarihroMs, and by their union there i> formed an arch like lowir Ijonier for the thorax, the (oslal an It. mt" ig^ 34 ATLAS AND TEXT-BOOK OF HIMAX ANATOMY. Fii;. 2g.^Tlie eleventh ril) of the ri^ht side seen from liehind (j|). Fii-.. ;,o.— The twelfth rib of the rijjht side seen from behind (j). Fir.. 51.— The sternum seen from in front (J). r ic. ^2. — The xternum seen from the left side (\). THE STERNUM. Tlie breast bon., or sternum, is a single, Hat, oblong Ixwe. It lies a])proximatelv in the frontal jilan',- and fonns the middle ].()rtion of the anterior wall of the thorax, and bv its articu^ lation with the clavicles, it ccmi .letes the shoulder girdle anteriorly. It is compostxl (Fig. 31) ot Ihrei. distinctly separated portions placed one aUne the other, an upper broad handle, the nunnibrium, a middle piece, the body or gladiolus, anrl a lower jjiece, the xiphoid process. The three portions are either separated b\ cartilage or are united by tone; the former condition prevails between the nianubriimi and |l.e Ixxiy {syncliomlrosis stcrnalir), while the latter ol)tains between the body and the .\iplioid process. .\t the synchondrosis k^tween the manubrium and the l^xiy there is usually cjuite an obtu.se angle, o\Kn [wsteriorly, the nni^ulus slrnii {aii^i^ir oj Louis). TW .sternum is not exactly in the frontal plane, but is i)lace(l somewhat obli.|i 'ly, so that the upiier end is considerably nearer to the vertebral column than the lower one, a rela- tion whi. h is also partly due to the curvature of the vertebral column isee jjage 14). The manubrium is considerably broader than the ixxly of the lH)ne, and is broadest alH)ve and narrowest below; its anterior surface is sli^,;itly convex, an.l the postirior surfa.e slightlv concave. The upj-er margin i^rcsenls ihree rounded notches, a median shallow inUnlaviaihir or juf^ulur notdi, and two lateral deeper clavicuhir iioldirs. which are covereent.s a demilacet, for articulation with the cartilage of the second rib. The body is usually narrowest alnnv, gradually widening as it dc^sccnds, until it attains its greatest breadth in its lower third, and tiien ra])idly narrowing again as ii ai.i>roaciic's the xiphoid ]iroccss; it is occasion.illy, however, of iiiiilorm width throughoul. Its nearly tlat anterior ivenlrali surface- i> called the pbiiium stmuilr, and sometimes presents transvei- ■ lines (Fig. :,.\\ which indicate the original fusion of several parts situated one alx)ve the other. .\1 the margins of the lx)dy i Fig. ',j\ are found not. lies for the cartilages of the six h)wer true ribs, liiat for the second rib Uing sitiiaied at tlu junc lion of the manubrium and the Ixxly, that for the sixth nb .m the lower mai gin of the Ixxly, and that for the .seventh in the angle Ulween llie Innly and the xiphnid protess. The notches for the fifth, sixth, and seventh libs lie c lose logc the r, an.l the fourth note h is situated Ixlow the middle of the entire Ixme. Tl.e xi/dioid pronss varies greatly in shape and ^i/.v. It is always markedly narrower lltroi ill.. lwwl\- i.t"r..»* •...t.d.. .... r_ ...I,. .11. .-^.-•1 • I • . . - * . .,., •"• i-"^t- o, v-.n •■,!i-,-ii-. caniiagino-.i:;, ann it is sonuiin.i s julloialed. 1 he female sternum is usually shorter and broader than that of the male. i Hv;. 20. f-'ij^. 30. Iiii;iiliir iitilih ( Idviiiiliir llOfi/l Xiit(/i fi'i- first r,h .\ol(h lor ■'iTi'nd rih \olili lor lliirj nil XoU'/l for foiirth rih \ usuallv form,-,| fn,„, a sinnl.. „u. 1.,.., uhil, ,1„ U.h i, .1, ^, I,,,,. ,1 (ron, a „u,„- ,..r ,„ m„ 1,., ,f„ur L, IhirU.n., uhu 1, an (n,|u. „.l^ arra„K,-,l in ,«■„ mor,- „r l.-.s ,l,M,n, , l„n«itu.linal r„«,. A. a rul. .lu.r..,sl,u,on..,..n.,.r(„r,h, xi,h„i,| ,,r.„,..s. . .s.ifi, a.i.m „f ,1,.. sU-rnun, .l„.. n„, i„ ,in un,il ,lu- f.,ur.h,„ .iMli n,„nlh „f ,.ml,ry.,ni, l,f.., an,l in llu- .vi,,h„i,| ,,r„..>s n.,1 until fn,m thr mmH ,., |I„. tu, nli,lh y,,,r. VARIATIONS IN THE SKELETON OF THE TRUNK. Su,HTn,un,rar,^UTUl,ra. a„- ,„„„.„n„ . |,r.>.n,. |,ar,„ u!arl> ,„ th. l„„vr ,„„u , ,1„. v.-n.-hral u,lumn Ka, run, urn ,ar v.ru ,r..,, N,., ,nfro|U..n,ly ril„ ar,- f„rnu..l fr„m .h.. ,,.s.al ,,r„,...s,.s ,.( ,h, ... n,l, , ,.r^ i, al an,| ,.f ,]„. ! ,.,' lumbar v.Tlrbra-, an,| ar,. .1, .iKnab.l a. .,rvi,al an,! knnbar ribs r.s,,.. ,iu Iv. -11,,. las, hunbar u,,,!,,., s,„„,,„„„ 36 ATLAS AND TEXT-HOOK OF HUMAN ANATOMY. p,(, ,, _Thc thorax toijethcr with the left shoulder sirdle, seen from behind (I). p,,.; :' _'rhc thorax together with the left shouUler (girdle, seen from in front (>)• r,.",t-The skeleton of the trunk, divi.led by a medium lon.itu.lin.l seefon, together w.th the shoulderandpelvicgirdles, seen from the left side (J. Fk-, ,6 -The skeleton of the trunk, divided by a median longitudinal section, together w,th the shoulder and jadvic girdles, seen from tlie median line ^ J. a..,,,, a „n,., n,a. .,u, „ .,.uu. .ii„ iho ..run, .,„. i. ,„ ,. r.^ira., . ;; -:;;;;;;^:::;r::;:;,;::r;i;: ,,,t!,- ,0) ;.n.l t!u- iK.sUTior arch of ,!«• atlas and the i-m-ns rq,rrs.-nUnK tW arch, . ol tlu fail l/. ..,.ifv, s.. that the spinal >anal nmains ol-n postiTicrly (rhach,.sones of the head is designated as the skull or crannm antl this por- tion of tl.. skeleton differs front the others in that all of its constituents, with the cxccpt.on of the lower jaw, are llrmlv united evt n in the macerated con.lition (the exact nature of the union is described untler "S; ndesmology,'^ page 107), so that special means are re<,u.renes and of their chief corn,K.nent parts The skull will therefore be siudie.l first front in front, then front the si.le, from below (without the inferior maxilla,, ami from above, looking dt.wnward upon the great crania cavitywhich .nclo>es the brain, and hnally the outer and inner aspects of the cranial vault will be consulere.l. THE ANTERIOR *-3PECT OF THE SKULL. If the anterior as-eet of the skull (l-'igs. .^7 an.l ,^S. be examine.l, it will be seen that the. ,.onv forehead (/n... is formed by ihe vertical portion of the jnnUal /,.,„• art. 1 that tow.trd he vcrt'ev a slightiv sernite.l suture, the .>ronal sulurr. separates the vertical plate o. the Ironta from the two panual ho,us. The fron.nl l».ne also forms the upper margin of the ..rl,it, an.l .,/„r /., r !):!}!: h\ !,>■ at the outer margin of the orbit it is separate,! from ihe Contiguous -v^-<;»;m./;<- V.ccs.s. o either s,de of the fronlal lx,ne will Ix^ observe\ ik- snli,r., parietal siilurr. A \»,vvw of the Innporal hoii, i> alx. \i,-.il)K- on 0-. .murior asi.c( i of tin kull. Be-low the \( n:, • ilatc of the frontal l«)ne are ihe lar-e o,!,iial (aviii,-. ih, ,t,Mvate- jH-rtion of whose roofs are toi nied bv the orbital plate.> of the frontal l)on. . wlii, h arlieulaU Aith ili. orbital surface of the ;;reater win,i,'s of the sphenoids, ilie intervi iiin.4 .,imire Ik mu llu spli-'w jroiilal siilun: thev are sejiaraied ironi the le>ser u iiii,' of the spheiiuid- bv ih, sii /,, rior orf.ial /i.ssiirr hhnwidal jissiin). 'IIk' s>>hniozyoomati< sitHirr \> situated in di, outer wall of ih. .rbi! between the .i;reater whv^ of llx' sphenoid and the /y.i^omane bone, llu kitler formin- a part oi the outer wall of the orbit, a,- well as the outer r.nd a portion of die lower ni.irtrin of di. orbit. I"he iMMiy brid>;e of ihe no-. i> plaeed belwetii the twoorbiial ea\ih. «, and in lhi> -iiualini. the frontal lx)ne artiiulates on either side widi ihrei bones which. Irum within oulward, are the nasal bonv, the na^al or -noUal prouss of ine maxilla, and llie l.ulirymal hour. Vhv inter venin,^ sutures are called tlu nasojronlat. the ■ixillary. and the jroulohu hrvnial -utures, 'I'hi' two na^al Ixmes, which form the mai . ,„, of the lH)nv brid,m oi the iiom-. are .ep arated from each other bv the nilrni,i-..i! Miliir: , and from the nasal proc c-,- o| llie m.ixill.i 1)\ the iias,niu!.\i/lary suliirr. V\\v\ form ih.' ui)i)er Ix.undarv of the anterior nar,- la />, rliira piri /Dniiisi. which are l)ounded ihrou.i,'liout the rest of their c ircumferc iicv b\ the two maxill,, . These two l)one> are .separated in the median line by the iiil, niutxillaiy Mitiin\ and die frontal or na^al j)rocess of each is separated from the' cc)rres|K)ndin,i,' nasal Ixmc' by the nasomaxillary siitun; and Ijorders externally ujx.n the lachrymal bom (for a detailed description -cv die orbital ca\ily, |,a,i,'c 731. The maxilla also forms the inner half of the llcH)r of tlu' ..ibit and .-i the interior orbital mar<;i!i, the in';, rior orbital i.^plirnonuixillarytjissnn. in llu lloor of llu' nrbil sejjaratin.i,' the maxilla from the ,i;reater winj; of the- sphenoid. Below the inferior orbital mar.Liin, in the body of the maxilla, is i!,,' injranrhital joramni. and in the anterior nares can be seen the lx)n\- nasal septum* and also ih,- „„>„/ naidia Uurbin aled hones), particularly the inferior ones, which jiroject from the outer wall of ih,- nas.il fe,ss.,. .\t die junction of the intermaxillary suture with the lower m.-ii^'ins of the anterior narcs ,h,iv is a bony siiine. the anterior nasal ■^piiie. The :yi^oniaiieoinaxiii,!ry suture separate s tin- maxilla trom the /yijomalie Ixine, who.se malar irface is xisibl, i-f the- anteri.ir \iew o| the skull. Tin I'lwer portion of the maxilla forms the loolh luaiint,' aiveotar proei ss. Finallv there- is the maii.lihle ,,r lowe r jaw. lis middle p,>rti..n or 1xhI\ pn.sents a loranien. the- mental joramen, an.l the- in,,th bc-arin- alv,olar f>oriion: lot-ithei- si,lc (and s^meuh.il fore- shortened in the- liijurci ihe ramus. THE LATERAL ASPECT OF THE SKLTLL. The kiteral aspect of the skull : id.^s. ;;(, and .\o< ccniains a number of bones uhi, h ha\e- been idrcady ecinsidered in ihe- description of the anterior cranial ic-ion. .\bo\. uid anierioriv we observe that the frontal bone- is separalc^d from the p.iri l d bone- bv tin- eoro,;.i! uilure. and from tnc jjreater wmir of i-> sphenoid b\ llu- sphenoironlal :,!ure. The :\\:;om.:!ieojrontal iulure separates the /},<,'onia!ic jirocc-ss of the frontal boiu from du jronlosph, noidal proeess * Ml e .iiilcrii.i |"irtiii;i ,,f tin- n.is.il M |iiuni artiln).'iiiou.T. 38 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. m •i of the zygomatic bone, and the temporal ridge commences at the zygomatic process of the frontal bone and passes backward in a curved manner over the frontal and parietal bones. Behind the frontal bone is seen almost the entire parietal lx)ne. It is limited anteriorly by the coronal suture and is separated from the occipital bone ])osteri()rly by the lambdoid suture. Its lower border articulates with the greater wing of the sphenoid by the s plieno parietal suture, wuh ii.e squamous portion of the temjwral Inme by the squamosal suture, and with the mastoid jwrtion of the temjwral lx)ne by the parietomastoid suture. The only inirlion of the oecipital bone visible in the lateral view of the skull is its squamous portion, which is se!>arated from the mastoid prtxess of the temjxjral lx)ne by the occipitomastoid suture. Below the frontal and parietal lx)nes, the temporal surface of the greater wing of the sphenoid is visible. It is separated from the zygomatic lx)ne anteriorly by the sphenozygomatic suture, and from the s(iuamous jxjrtion of the temporal Ixme [wsteriorly by the splienosquaiiuisal suture. The first jwrtion of the temporal bone to attract attention in the lateral a.spect of the skull is the s, the nasomaxillary suture by which it articulates with the nasiil lK>nes, and the alveolar jirwess, whiih is vi'reele, the upper portion of which is divided by a derp notch, the sigmoid notch, intn two imxessi'S, the coronoid and the condyloid pres. The articular surface of the (ondvloid prmess rests in a lo.->sa of the temjxiral Ixme situated Ixlow the riK)t of the /ygoma, ihc nuvniibuiar or glenoid jcc.sa. S^Sli :-JH I ,!<» //X'. t7. nasal process of maxilla lachrymomaxillarv suliirr sphenofror.tal suture supriiorhilal margin internasJ ^'"■<""'' suture •"'""•'' nasofrontal suture ^^\ '^^^ S*, Jrontomuxillary suture ', /^ 5v orbital surface \ 'j ^\. of orbital plate \frontal bone (vertical plate) / '^W of frontal bone ^ ^ \ \ / . ;/ / \ lachrymal bone \ \ \ /'* /■'-' 4\ ■ sphenofrontal \ ' \ ■■/; /■ -^'-i f/M suture \ \ ■J \Mk sphenoparietal / Ip+'Jl suture parietal bone < ^pheniyidal tingU > Sirfatfr u'int; fl/ fphennii/ ,., /tt'm/wral surface > zygomatic process I" orbital plate of ^- frontal bone \ sphenoidal fissure h •eater wlf ^ sphettoid \ jfyeontafi i'. bone sphenomaxillary \ fissure infraorbital marsrin nasal bone nasal septum alveolar process of superior maxilla anterior nasal spine if nuxrlla I -Vf^ r rr i I >; V, mandible (body) Fig. 3S. ,'/'. temporal bone zyiromatico-frontiil Z' "•••/. \ i suture sphcnozyiioniatic suture nasomaxillary suture zyi^omatico- maxillury suture infniorbifiil foramen ramus of mandible inferior tiirhinalcd hone >.j mental foramen iutcrmn miliary suture Ki^s. .<7 aiul .Vs. The -kul' sofii trtim in trmU ('-). In tl^. .*^ the tVontiil liono i-* vi^ilct. tlic rTi;i\ill.'i \i'lln\\. the splirtmicl ^rci'n. tin- p.uirtJiK lirnwii. Ihf laclii' nials .uul \iinui pink, tlu' ctliniDiil (Mannc thi' /xgoniatii' pin' stri'nkid. tin- nwindilili' i/liii' !il(i-ttki-ti ami ilie tia>di*i una Itiiipoi .ii<« while. i r c _ "^ it = is ^ h. "m^ 1 iMHI THK F.XTERXAL SURFACE OF THE BASE OF THE SKIM.. 39 THE EXTERNAL SURFACE OF THE BASE OF THE SKULL. The inferior asjjcct of the human skull, exposed by the removal of tlie lower jaw, jiresents an extremely irregular surface (Fi>,'s. 41 and 42), and is termed the external surface of the ba.se of the skull, basi:> cranii externa, to distinguish it from the internal surface which forms the floor of the cranial cavity. Passing from before backward, there may be noticed first the bony [ilate of the hard palate, \.hich is Iwundcd externally by the alveolar process of the maxilla and the upper row of teeth. It forms the bonv ] ' lition separating the oral and nasal cavities, is lomposcd of two bones upon either side, the pnlaliiie process of the maxilla, forming' its anterior two thirds to three quarters, while the j)OSterior third or fourth is furnished by the horizontal portion of the ])alate Ijone. It is trawrsed in the median line by the median palatine suture, the anterior extremity of which contains the incisive joramen, a pit like depression, which leads to a canal of the same name. The palate lx)nes are sejjarated from the y)alatine processes of the maxilla by the trans verse palatine suture, and at the posterior extremity of the median jjalaline suture, the two lK)nes terminate in a sjjine, tlie posterior nasal spine. The posterior free margins of the horizontal plates of the palate bones form the lowc r lx)undar\- of the jjosterior nares or riioanir. the i)OS- terior outlets of the Ixiny nasal foss;e. To the outer side of the hard palate is seen the short, broad zyi^oniatic process of the maxilla, which articulates with the malar Umv by means of the zyi^omaticomaxillary suture. There is also to be seen tlie anterior extremity of the injerior orbital or si)henoniaxillary lissure between the upi)er jaw and the greater wing of the s])henoid l;one. The zygomatic arch, fornud b\ the junction of the zvf^omalic process • f the temjioral l.x)ne with the temporal process oi the zygo matic Ijone, is distinctly visible. A large portion of tlie external surface of the ba.se of the sk'.dl is formed by the splienoiil bone. The greater wings are almost entirely visible and are limited posteriorly and externally by the sphenosquamosal suture, their foreshortened temporal surfaces, already noticed in the lateral view of the skull, being seen to unite with the infratemporal surfaces,which are actually situated in the base of the skull, at a distinct angle marked by a rough ridge, the injratemporal crest. The posterior margin of this infratemi.oral surface is separated from the contiguous i)etroiis l)ortion of the temporal l)one by the sphenopetrosal fissure, whi( h is lontiniious internally with an irregular foramen, the joramen lacerum. The extreme postiro external angle of the greater wing of the sphenoid, the spine, is (lireel>'d toward the temporal Ixme, and preseiUs a round opening, the joramen spiiiosum, whicii leads into the cranial cavity and transmits the middle nieningeMJ arlerv. In front of this is a larger oval aperture, llie joramen muile, tinough whieii the mandibular division of thi' trigeminal nerve emerges from the cranial cavity. In the middle of the base of the skull a -lait of tin Ixxly of the sphenoid U>ne is visible between the two greater wing>, but itsanteri lortion is jiartly concealed. It will I h- observed that the |)o,sterior margin of the bony r d ..ejitum, which in this jirejiaration repres Us the septum choanoruiii, is formene, its tuberosity : processus pvramidalis), which is dirccterl backward and outward and fills the gap Ix'tween the external and internal pterygoid plates, consequently aiding in the formation of the pterygoid jossa, which occui)ies the inte'rval between the two plates. In the j)alate lx)ne, at its junction with the pterygoid |)r(.cess of the sphenoid, there is a larger anterior foramen, the (-realer palatine joramen, and usually se\eral smaller posterior oi)enings, the lesser palatine foramina. The iK)sterior half of the external sur.ace of the base of the skull is formed by the two tem- poral bones and by the occipital lx)ne. .Ml the four portions of which the temiK)rai Iwne is comjiosed are \isiljle, naniel\-, the inferior surfaces of the petrous portion, of the mastoid portion, and of the tympanic portion, and a |)art of the squamous portion. The apex of the petrous portion lies in an irregularly shajied opening, the ioramen laeerum: it is se[)arated from the sphenoid bone anteriorly by the sphenopetrosal fissure and from the ...cipital Iwne posteriorly by the pctro-occipilal fissure. The mai,toid jx.rtiim articulates with the occiiiital Ijfjne b\ mean's oi the occipitomastoid suture. Of the >(|uamous portion, one sees mainly the zygomatic process (forming a jjortion of the zygomatic arch) and the mandibular jossa, which accommwiatcs the condyloid i)rocess of the mandible and presents anteriorly the articular eminence. Of the mastoid' portion, there is to lie sen the mastoid process {processus ma.Uoideus), which has a deep gr(«)\-e, the digastric fos.sa (inci.sura mastoidea), upon its inner surface, and. at the side of the oci ipitomasloid suture, an op.'ning, the mastoid joramen. The tNinpanic portion, with the meatus audilorius exiernus, is placed Ix'tween the m;Lstoid procTss an;i, and in front of it there is a' fissure, the (ilaserian fissure (fissura petrotympanica). Th.Te are many foiunn'na and fossa- uix)n the ven,- rough and irregular lower surface of the petrous portion of the temp(,nii Ixme. Slightly to tiie inner si.le and in front of the mastoid process is 111,' pointed styloid process, between the mastoid and styloid processes there is ;;n oi)ening. tii< stylonuistoid Inramcn; to t],e inner si.le of the styloid process there is a radier iWxu dei.ression, the jugular jossa, leading into th,' iraniai cavilv through an irregular opining, the juf^ular joramen; and to the inner side and in front of ilie jugular fossji there is a round opening, the external orilire of the uirniid canal. Thr occipital hone forms the large remaining i«.rtion of the external surface vi the i)asc of the skull. In the adult s,nre prohe in hypoglossal ennui petrooeeipitui fi^sitre styloid /iroeess jllgllhll fossil '; mastoid j^roove mastoid foramen ■' occipital cond'Je londyloid fossa foivmen imiamiiii portion t^non r TF-e mastoid /iivccss ■tornU't,':c>'n tron 1, .isr. 4: Ihr vari..u. I.."irs are r,,!,,,-...! as in tif;. i'' .'xrHit li.at tl,.^ ■ ■ npitai .-> uilli lid ami the luilaliiif- are bliiL-. 1 lu'liiw. tlu' uulor -url.iw uf ihr huso 1 ' , ). m cribriform ethmoidal spine //taie fr ■^■iten caecum jiigiim ethmoidale optic groove ^• ^i-ita gain . fronto-ethmoidal suture sulci arterios! olivary eminence optic foramen anterior clinoid process fonimen rotiindum sulcus arteriosus t foramen ovale fonimen spinosiim trigeminal impression inrmiiil Mulitory meatus jugular foramen Orilerwr com/mrlmeiit) lambdoid suture jugular tuhercle ..,,.„ ,„,„■: nunwi hvpOglOSSa! Ult'l! remains of the spheno-nrnpital su:.ire ^^,.,,,„„; ,„•„/«/"/ synchondrosis ,r. i nrouihe ranee Fi:. 43. l-ias. U^ und 41 Th. inner -urhu - •' l„ li". 4'. the •.ari..us 1^ ^>es an ihe bav otl a> in I sphenofrontal suture dorsum -ellae coronal suture carotid groove siiiunoparktal suture ^/•henosquamosa/ ^utuir foramen lacerum squamosal suture mlirior I'l •■■fill iinwrf pttro-OfCipitii' ''*' hiatus lulhpii jugular joi . " sigmoid -oove rondyloii: cunat mastoid •i-iimen transvtKe g ■>■'<' 4 !'f ! »: THK INTERNAL SURFACE OF THE BASE OF THE SKII-I.. 41 There is further to Ix." ()l)served the entire nuchal surface {planum niuhale) of the squamous l)ortion and r. foreshortened portion of tlie planum oiripilalc, the lx)undary Ixtween 'le two portions Ixing formed by a rough line, the suprrior nuchal, which extends laterally from the central rxlirnal orcipital protuberance. Below the upi)cr line, the nuchal surface is crossed by the injcrior nuchal line. THE INTERNAL SURFACE OF THE BASE OF THE SKULL. By the interna! urface of the base of the skull (Figs. 43 and 44) is understood the lloor of the cranial cavit\- which is expose! by sawing horizontally througli tlie !x)nv cranium and removing llie ealvariuni. It is (<)nca\( , and contains the so tailed cranial fossa-, of which llii n- are recogni/.ed ar. anicrior, a ntidillc, and a poslcriiir jossa (Fig. 4.;i. All tliree fos>a' n-,eil in a saddle like elevation, the sella lureiai, which is a portion of the Ixxly of the sphenoid Ixme and is situated somewhat anteriorly to the middle of the cranial cavity. The anterior cranial fossa is relaiively tlat. The greater portion of ii> tloor is formed by the orbital jjlates of the frontal bone (Figs. 4;, and 44), whose Upper surfaces are dirccled toward the cranial ca\ity and are known as the cerebral surjaa's. They ])risent peculiar eleva tions and corresixmding dtpressions, called n>pei lively cenbral lUi^a an for IjIikmI vessels. The two halves of the fnml.il bone an- .~e])a rate of tlie s]ihenoid b\ the sphenojrontal sulure. Lving Ixtween the two orbital plates of the frontal l)one and txtmding from the foramen ca'cuni to the sjihenoid Ume there is a thin Ixmy plate, ( liaraiteri/.ed by Uini; ])erf()rated by numerous forandna. It i^ the cribrijorm plate of the ellimoid bone, and it ])resenl> in its nudian line a (ond) like t livation, the rrisl nf the jronto ethmoidal suture. In the niedi.in line behinil tlu 1 ribriform plate ni the ethmoid is ^een the iu;.;uiii ^phenoidali of the sphenoid iione witii tile ethmoidal ^pine, ami to (ilher side arr ob^erved tin- lesser :ci)ii;\ of the lx>ne. tin se laltt r ari-ing from eitlur side of the Ixxly of the sphenoid bv two nxtis whidi ei.dosc an o])eniiig, tlie opiii joraiiiiii. Xe.ii- the mII.i turdca, the Iomt win-; of either side proic( t> nilo the middle uribr. I I'd^si a,> a -hurl, ^lighlly curved, hixik like pnKe», thi anterior tlinoid proiiw. Tile middle cranial fossa i> mui h deeper , and larger th.m \h< anterior om, and i- divided into two halvi> by a marked meilian elevation, the sella tuntm. In ihi- tliere may 1k' re(og ni/.ed tin lii'.;li back of the saddle, tlie dorsum ulhr. with tin hypophyseal jossa in front of it, and, -till fiirtlur anleiiorlv , the olivary imineme \iuher< uliim srllo ). In iron! >n ihi lallti i> a grixive, the optie ^romr 1 \ulius i hia\matis 1, and a M(ond gnxivc , the larotid i^roi!natecl on each side of the sella tunica. .\ >hort distance tx hind the dorMim sella- \\i find the spin no- • ;/>.'* i' xf '1 •<-■••■ Kir'ii! "I'-t! '•••• ..1.^1. :...i. .1,.^. ii.. !„.,... .Ill', i,..i,.... I, ill., luwiv of the Sphenoid anil the otiipilal Ixme and i> the remain^ of the -viu hoii originalh s( jiaral ing the two lx)ne-. (>ee page 4; 1. r i 42 ATLAS AND TEXT BOOK OF HUMAN ANATOMY. To the outer side of the sella turcica we sec the cerebral surface of the greater wing of the sphenoid bone, which is sejjarated from the overhing lesser wing of the s])henoid by the superior orbital or sphenoidal fissure. The remaining boundaries of this surface are the same as those seen on the external surface of the base of th.' skull, namely, the sphenoparietal and spheno- squamosal sutures, the foramen lacerum or sphenopetrosal fissure. \ear its origin from thi' Ixxly, the greater wing of the sphenoid bone contains three orifices; the joramen rotundum, Kl.i. 45 -Tl..- iiiii. I «»rfa.a pink. directed obli(|iuK antirjo.lvand leading int.. a short canal, the /oram/« mw/c, and the joranun spinosum. In addition to the greater wing of the sphenoid bone, the n(H)r of the middle cranial fossa •>. .nrmc!. .!y !.•:• ral »l THE INTERNAL SURFACE OF THE BASE OF THE SKUI.I.. 43 bone in the middle fossa are also similar to those observed upon the external surface of the base of the skull, namely, the s plicnosquamcsal and squamosal sutures and the joramcn larrrum. U[Xin the cerebral surface of the squamous portion of the temj)oral, commencing; at the foramen spinosum. there is a groove, the suku.-< arlcriosus, which is continued by manifold rami- I'lcations uj)on the inner surface of the cranial vauli. UjOTn the apex of the ))etrous portion, which is in contact with the body of the sphenoid, there is a shallow depression, the Irii^nniiiiil impnssion for the Gasserian ganglion, and at atjout the middle of its anterior >urfaie there is a slil-like opening, the hiatus canalis jacialis (hiatus Fallopii), while u])on it> su|)erior margin there runs a shallow groo\e, the superior petrosal j^roove. The posterior cranial fossa is the largest of all. Its n(V)r is formed by only the (Kcpital and temi)oral lx)nes, the lioundaries between which in the jxisterior fossa are the pelro-occipital fissure, the juf^ular joramen, and the occipitomastoid suture. Upon the [KJSterior surface of the i)etrous ])ortion of the temporal bone there is a large, round, irregular opening, the internal auditory meatus {porus uustieus internus). The jugular joramen, situated between the temjmral and occipital lx)nes, is formed in tiic following manner. Each of the two l)ones possesse.-> a corresponding notch which is so sub divided that the jugular foramen consists of a smaller anterior and of a larger posterior com partment, the former giving passage to the glosso-i)haryngeal, pneumogastric, and spinal accessor)- nerves; the latter to the internal jugular vein. In tile iM)sterior foss;i the mastoid (mrtion of the temporal l>one exhibits a curN-.tl groove, the sit^moid j^roo^'e, which begins at the posterior com()artment of tht jugular foramen and is at first situated on the lateral portion of the occipital bone, passing in a curve around the jujiular process, which is directed toward the temporal Ixine. In the mastoid portion of tlu tem|)oral lione is thv inner (cerebral) orifice of tlie mastoid joramen, and at the junosterii(r foss;!. Its basiinr portion forms a jiortion of the su called ciii'ny .1 steeii lx)ny incline p,i>sing from the back of the sella turcica to ihc lK)rder of the foran-n, ..lagnuni; the anterior |M)rlion of ihe clivus is formed by that part of the Ijodv of the sph- ,ioul which is situated anterior to the original spheno o( cipilai synchondrosis. Al the outer side of tlie eli\us there In the shallow, injcrior petrosal f^romr, which is formed In tin juiii lion of tin (xcipilal and . 11 jHiral lx)nes in the |)etro ixcipital fissure. The hileral portions of the cKcipital !xus!y nH'nlionn! hyjnigins:^ii or anicrior condyloid cnnai, and Uiiiiid the jugular iinxess (usually in the Ixginning of the sigmoid gnM)ve) is situated the internal extremitv of the condvloiil canal. 44 |i t ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fig. 46. — The skull seen from aix)ve (i). X = foramen parii'tali-. Fig. 47.— The inner surface of the roof of the skull (calvarium) (1). The posterior margin of the round jnramcn maf^num, situated in the mifkllc of the posterior fossa, is formefi by the s.-juamous jsortion of the ociii)ital, which exhibits, Ix'low the transverse groove, two concave depressions, the inferior occipital joss(C, which are separated by a median riilge, the inUrnal occipital crest. THE SUPERIOR ASPECT OF THE SKULL. The super'"-)r aspect of the skull (Fif;. 4O) is much less comitlicated. It shows only four Ixmes, the vertical [KDrlion of the frontal, the large surla^.s of the two parietals, and the apex of the squamous |M)rtion of the occipital. The visible sutures are the coronal suture, thi' s;igittal .suture, si'parating the parietal Ijones throughout their entire length, and the lamlyl-)id suture, which forms an obtuse angle with the sagittal suture. In the parietal Ijone, on eilher side of the sigittal suture and at alxnit the junction of the third and fourth (|uartei>, there is an orifice, the parietal jonimeii. and the foreshorlenc Ik' seen. THE INNER ASPECT OF THE CRANIAL VAULT OR CALVARLA. The inner surface of the cranial vault (Fig. 47 1 corn-jionds to the outer surface ^viili sliglu differenies. It presents the .s;ime Ixines, frontal, parietal, and (k< ipital, and the siime ^uture~. the coronal, s;igittal, and lamlxloid. Upon the inner surface of thi sjigiita! suture wi find a shallow groove, the saf^iltal i^roove, which comnKnces at the crest of the frontal Ijone and pa.s.si> Iwickward over the jjarietal to the iKcipital lK)ne. The it rebral surfaces of all the lx)nes of the cranial vault show \ascular gr(K)ves, the sulci arteriosi: they are found in griatest numlxrs upon the parietal Ixtne and. next in fre(|uency, u|)on the frontal Ixme. Small inconstant de|)res sions, often of inion^id'.ra))le depth and situated i)articularly along the sigittal suture, are desig- nated as the jovcolic f^raiiulares or pacchionian depressions. THE BONES OF THE SKULL. After this consideration of the skull a-- a whole we tu"-. 1" llu desiriplion of '.hi iridi\idual Ixmes of the skull. These nia\ be divided inln two groujis: ( 1 ! the Ixmes of tile cranium (. raniiini nrehritli 1. and 1 -" llu Ixmes of ilie fau [cranium visclunoiit Ixtne, the two lim fioral Ixmts, the two paridiil Ixtnes, tin jrontal Ixiiie, and tilt illimoiil Ixtm. The latial Ixtnes are the na^al Ixmts, tin totlirymat Ixmts, thi vomer, the injerior turbinolnl hones {concha nasates in'jcriores], the 'iiaxillo, tin pitl.iU boms, the zyjtioniittii Ixme-.. tilt iiiiiwlihli , and llu liyoiil Ixme. I'lr liiituMif llif ^kiill iiiuviIm. (n I la^^ilii-.l aniinlitiK In Ihr mHli>Kl ni ilitir (livilti|imfm fsif |iiim- jt I, ami (runt tlii^ Hi a nil jM lint thiv .in' (ptitr hfttr; -^umi- of thfiti. .(h li a-- ttms*' nf tin- lia'.r nf ittc s^ull, arr »', vcl- ii[«il 111 I hi' |iriiiiupli ' atlilaKiniiii- ■ i iiiiiint. «iitii arr iialiuii'. .i( llir \i-< i i.il -kiU lull, .iiitl muui an -.n > .illril n ah lug I s M lu i¥y I THE BOiJES OF THE SKULL. 45 or dormul iM.n.s which serve to close in the cranium, the upper ,x.rtion of which is unrepresented m the .arflapnuus primordial skeleton. Only a part ..f the cranial l»nes are preformed in cartilage, the nu.jonty be.nK formed by d.re.t ossification of connective tissue. Those- which are preformed in cartilaRe are al.so known as pnmord.al In.nes, and they are the occipital, with the exception of the upper part .,f the s<|uamous ,K>rtion, the phenoid, w,th the exception of .he internal plate of the pterygoid process, the entire ethmoid and the inferior turbinal, and the petrous and mastoid ,K,r- tions of the temporal. . ■ •. , .1 ■ , 1 The cranial In.nes formed in membrane are the upper part of the squamous porti.m of the .,,,,, ,.tal, the ,K,net..ls, the frontal, the s,|uamous and tvmpanic porti.ms of the temporals, the vomer, the na.sais, and the lachrymals. The onlv portions of the visceral cephalic skelet.m which are preformed in cartilage and are to Ix- regarded as primordial bones are the hvoid and the small auditory ossicles situated >vithin tlf t.n,poial lK,ne. The follo«w.g bones of the face are f.,rmcd in membrane; the maxilhe, the palate bones, the internal plates of the pterygoid processes of the sphenoid Inine, the zygomatic bones, and the mandible. ) THE Cranial Bones. THE OCCIPITAL BONE. The occipital lionc (Figs. 48 to 51) is comi)osc(l of tiirec jKirtions which arc not shari)ly separated, and of these portions one is i)aired and two are single. They are termed the basilar portion, the laUral portions, and the squamous portion, and are groupctl alK)ut the joraimn ;«(/,(;- num in such a way that the basilar jwrtion is in front, the lateral jwrtions are to cither side, and the stiuamous portion is Ix'hind the foramen. The basilar portion of the adult skull and the body of the sphenoid Ijonc arc united by osseous tissue (Fig. 51), but up to the time of puberty they are articulated by the splinw-oaipital synchondrosis or fissure (see page 47)- The lower .surface of the basilar portion, which lomis a [)art of the external surface of the base of the cranium, lies almost horizontally, but the cerebral surface i)asscs oblitiuely from alx)ve downward and from iK'fore backward and forms the clivus (Hlumcnbachii). The inferior surface (Fig. 50) presents a median projection, the pliaryufical lubinl,', for the attachment of the pharyngeal ajmneurosis, and to cither side are roughened surfaces for the in.sertions of the rectus capitis anticus minor and major muscles. The surface of the clivus (Figs. 4,^, 44- and 51) is slighth concave and its lateral margins exhibit a gnnive, fre(|uently c|uite shallow, the injerior petrosal f-romr, which forms with a similar gr.Kive of the temi)onil iK.'ne (see page 55), over the pctro-occipital fissure, a tl,..nncl for the inferior ))etros;d sinus of the dura mater. The lateral portions, also termed the condyloid portions, extend posteriorly, and gradually become broader and thinner as they i)ass into the .sciuamous portion of the Ixmc. The ir most important structures are the condyles (Figs. 41, 4-', 4^, and 50), which are situated upon their inferior surface and articulate willi the first cervical vertebra. The articular surfatrs of the tondyles are reniform in shape and are markedly conve\, particularlv from Inforc backward; they Cxtend from the anterior margin to alxiut ojiposite the middle of the foramen magmmi, hut only their posterior halves iHirdir directly uixm this opening. Uehind the tondyles ihcre i^ a depression, the c(.'«t/v/(>a/ /.•••sij J rg. 4r'-, w. in HT ii.-.i c.uuii c.i ..i.e. fin a so tailed emissary forainen, and the base of the condxle is traversed from side to side by the hypofilosuil canal (Figs. 4c; and 50), through which the twelfth cranial nerve, the hyiH)glo.ssal, leaves tlic skull. 46 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fu;. 48. — The occipital bone seen from behind (i). Fig. 49. — The oc(i|)itaI bone seen f-om in front (i). Fic;. 50. — The occipital bone seen from below (J). Fig. 51. — The occipital and sphenoid bones seen from above (i) fused with the middle one. The right anterior clinoid process is Upon the outer margins of the lateral portions of the Ijonc, projecting toward the temporal bone, there is a prominence, the jugular process (P'igs. 48, 49, 50, and 51), in front of which is situated a notch, the jugiiler notch, which is sulxlividcd by a small iitlrajugiilar process (Figs. 50 and 51). into a small anterior and a larger ]x)sterior compartment. By apposition of the notches to corresiwnding notches of the temporal lx)nc there is formed the jugular joramen ^F'K'^- 43 snd 44), which is divided into two comj)artments by a ligament extending between the corresjwnding intrajugular processes (a^e page 55). The inner or cerebral surface of the lateral jwrtion of the occinital exhibits a blunt pro- tuberance, the jugular tubercle (Fig. 51), above and to the outer side of the internal orifice of the h\ix)glossal canal, which consequently passes through the lateral portion of the bone, below the jugular tubercle and alx)ve the condyle. Heside the jugular process and beginning in the jugular notch is seen the commencement of the sigro'd grooir (see ]jage 43), which cur\es over the cerebral surface of the jugular process. The largest jwrtion of the occipital tx)ne is formed by the squamous portion, which is flat and moderately curved, and in which an internal and an external surface be recognized. It is lx)unded by the (xrcipitomastoid suture, forming the mastoid I- r, ar,.i )V the lambdoid suture, forming the lambdoid border, and its apex is situated at the posterioi vtrcmitv of the sagittal suture. The most striking formation uperic)r one is the posterior extremity of the sagittal gnnrce (see page 441. The external surface of the scjuamous portion (Fig. 48) is markedly convex in lx)lh the sagittal and transverse directions, and is divided into two surfaces, an inferior nuchal surf:'ce [planum ««(7/(j/(), roughened for the insertion of numerous nniscles, and a superior smtxither triangular occipital surface (planum occipitale). These two surfaces are .separateitiile I xlenuil cccipittil itivtiihrranct / "'."'^^1^^^ l.itiiii niichdc ■miui I'laniiin niicliaU' Superior niichnl line Squama occipitalis Jf 'nferior niiclnil line Comlvloid ecinnl I'hiinini iiiichdle Lateral portion ('('ndyloid tossa Hvim^lflssal eaniil f'onimeii ninnni liisiiiliir /imeexs Oiiipitiil eondvli' lixlerntil iHcipiliil cresl S(i!iitt(tl i;roove hlr, VS. '/'n/wsiv/v <'V(>('iv Inlirnul occipitiil fimtn/ieniine Inlertiiit cccipilnl cresl JiiiTiihir /I'lUi IjinilultUil border Sii/ierior tiecipilal fossa liilerior oeeipiliil lOs'.ll Mi/sfi'id lionler Condyloid riini/l /ii!;nlar Inherrle Hvpoi^lossid canal ( tccipilnl condyli P M Basilar portion I'iir. 10. r- »i '.ifm^'^'^y^i. Basilar portion Hv/iof^lossa! ainal /iitm/iii^ii/iir />ro(iss -^ I'ltarvngi'iil tiihervlr I ortiinni nuif^tniii! ihii/'iral ioiuIyIi' Jdi^nliir notill Itiiriilar process ^ . i0 Lateral portion Fif;. 50. Si/iKiiih'iis /),'rnoii I lontiit honlcr liififii'r iiiiclliil liilf I'hiiuim iiiitiiii/r I'lllictlll iiiwlr .\itleiirr Elhnio- ri^^iti; clinorit Optic itirl t)livnry Oftric /^/I'lV -^ 'groove s/)i'!i proft^^ lommftt Siiiitiiihnis lunJer I'l'^ltTior cUnoid prongs lillriiiti!;iil(ir /iroas s liii;iilur iH'Icli I- in. il. Pttiiiidl tiiivje Si;j;nhnd y/'iKH'i / tVtiiiirii rolinuliim I 'Vltllhll (M'l//r / iviiiiicii f./iiiicisiiin I ill nil I II Splhiu'-oicipiliil syiirlioiiiln'-'i-^ lui^iiliir liil'i'i'iii lii!;ii!iir pri'irss .WisiDiil ItonSiT I aiiihilohl I'urJir : H: : i I //•|7//M<7 -( I'liU'VI ^n, ^j r ■ .1 If! f m '^*«ahi THE BONES OF THE SKUI.I.. 47 f qucntly two particularly wdl-markcl n^ught-ntd ri.iges, the crrsi jor Ihr rectus aipith poslnus mahr muscle and that for the rcclus minor. The rdalions of the occipital hone t(; the nuiKhljoring bkiill liave been pre- viously dcscribcfl on pages 3S and to. Onlv the basilar ,,nrtion, the lat.ral ,...,. i.,.,s, aiM .h. 1, .,r ,.,-.. of Ih.- squamous ,K,r.ion ar. ,,n-f..nn..h lateral norL.an.l one ...r tw„) in the lower par. of .l,e s,,uam..u. portion. The upper part of the s.,uaM,ous port.nn ,. 'eparately formed, and i.s partly isola.e.l from the nmain.ler of the l.one un.il after birth by a suture, the .H/«r„ „,n,.!os.,. -.Imetimes the part of the s,,uamous p.,rtion vvhi. h is r„.t pref-rnu-.l in -arula.e renjains tndepen.lent Irum the per- -,..en. . of the sutura memlosa, and forms the triangular .. i„„rf,arir,..l,- ( . i,,..). Inr a lon^ tmte after b.rth (ur,.,l the end of the f..urth year) the h.ter.al portions are se,.arated fmm the body and fnm. the lower part of the s.,uamou,s I)onion by thi- .interior and posterior intrronipit.:! synchonJros,^. THE SPHENOID BONE. In its form the sphenoid bone (Figs. 51 to 54) some\vhat resembles .. v. .iged in>ect. It consists of the following parts: (i) The body; (2. the two gm// and 53) is formed by two thin, appro.ximately triangular bony ])latelets, the sphenoidal lurbitiatcd bams (concltm sphcnoidalcs), which, although usually unite siluatecl a ratiier deep, slightly cllipti. al de|>»Ts.sioii, the hypophyseal jossa, which Uxlges the pituitary Ixxly or hypophysis. On cai li Mdi of this foNs;i dure is u|iiin tin nxit of Mie grcilc r wing of the sphenoid a >-ha!l.)vv but rather broad gnxvvi, situated at llu ju;i(lion of llu upper •md lateral surf,u(s of the Ixxly of the sphenoid Ixme and limited externally low.ird the greater wing of the -phenoid by ;i fi.U' Ixmy piiitdtt, tlie lin)iula (Fig. ^\). Tills gnx-ve i-- calleil ihi larolid .i;n ntv ( ' ig. i;4i, since it Uxlges tlu inlrrnal lanilid arliry. The dorsum sell.e Ixarv u|M>n 1 ithir sidi slightly [xjinted shar]> (orners, the posterior liinoid proiessi - hi hind llu dorsum s, ll.i ,1 |.()rtioii of tlu 1 livii ^o Ix long- to tin Ixxly of ihe sphenoid frontal border Orhitiil ^11 r Hue ronimen rotiimiiim ol prahr wing: Lesser wing^ Arrrriin of /' i^rriilir wiiii;' lii/riilrm/'onil ruli;r '*^-' J "'I'll mini /itnygoiil pliilr J //if. 57. S/IIIIOIIS /l/(l('C>.'> Purviiniialdtiiir groove / \/eni(il plerygoiil plute I'tiivgoi.l //■•■-lire H imiilar proee^^^- flllhlltl 'tllt'h .'I ^irnii'i l)or--iiiii /'.isf. elinoiil proe. "'■''''" .\iit. elinoiil proe I csvcr Willi; ■i ■ If I'.ineto! iiiiale S"/;A//? iirlerio^iK $\ nam 011% I'onler ( iiroliil gi'ioie I'tfrvgoiil eiiiiiil hihrifii pleryi:oiil pintr Spnioii\ proee^^ (iiOf I lor I 11^1,1, III, I'l lul'e seiiplioiil 'civv( ^/ 'inio-oi, //iihil y -v'lthoiiilri'^i^i > / \leiiHil pferxyoiil plile lloninlii' /"iii/o IS i '■ til' il. I \i THE BO.\'ES OF THE SKULL 49 bone (see also page 43). -hich thus aids in forming a part of the flo<,r of the ,K,sterior cranial '""l^!?",SLior surface of the body of the sphenoid .>one (Fig- 54) is adhen.nt ,0 .he I^pil^ U.ne. In young indivi.iuals. if a synchonu.yn,eal aural :ng ;;r:.x hr:rr^:::x:e whic.; is t... ..,..,/ pro.. ..f ,he ptery... pn.ess ,Ki.r -11 i< the *//. The tora.nen n.lu.Klum lead. -1 l.qu.lv :,.' ' Ir .h du- l...:^' into ,h: sphenotnaMllary fo.a „o.so pUr.,o,„., .and tran>- ; I , nlvilh^v nerv.. Mhe second division of the trigendn,.. Th. .uram.n ,na ■ trav... C 1 . in a ver.i.al .lir.-t..,, an.l tnak.. its ..i, upon the ext.rnal sur.ace ., th.^ Ik^c o. h. ull l.e page V,. an.l Fig>. 4. and ,..; h .ran.nits tlu- man.libular n.rv.. ,.he th.rd .l.vM, :!;7h.!^ri^.n'nus,. The f-ramen spinosum pursu.-s ,h.. .un.. .lirot.on and g.v.. passage ,0 the miildle mining, al artery* liiimilv The gre,.,.r wu.g, lik. th.- less., on., i^ pra. ti. allv hori.o, tal. it , .-^. , u.v .l.-..n, tl .e,nr.. 1 surfaces, ti; .en/.,,/, th- orl.U,!, and the ,n„por„L and tlu -v n.-, aUo U n. ...n.,..l TPiJlZ^Irr ,Fig. .n. th.. verv rough margin .lin.t.d to.anl tl,- front d , a -.,o,na,., , ,, u n.l,Mr,lH,l >Ul...ual. ,ml.'...rrr.tly,.„..,i,.n»! l-">'i" '"-l^ ■•' "" ■I'''" mill ,1, ,.1. a Ulwr.li llif for.imrn rnliiMilmii .ui'l ,A. Ill- 111 ."I'O"' '■■"""" ' n.,i,l 1.1 ihr.M r.«.tv .1 mi.l.lli- lir 1 n-.l, Mli...t..l lHl»...iin. i„i,i,,i, llu f..riiiiT n\ac ...,«..„ .h.. f.irani,- m.un.tun, ;in.l ,1,.. ,,,h. n..*.l..l O^Mir. , ami „ v. r, -.a,ri,« ,Ki.l.ru., ...u, Ik.mi.i.Uh ,, an.! .|.,n.m.m. TW laU.r, h.,«.i.i. > an «ar,.lv I,. r.R.ir.lr.l a, a r.K,!. 1 m so ATI.AS AND TEXT-BOOK OF HUMAN AXATOMV. I border, in contart with the zygomatic bone, and a squamosal border* direrted toward the tem- poral lK)ne. The most external jjortion of the greater wing, which is in contact with the parietal lx)ne in the spheno]'arietal suture, is known as the parietal angle, and its most jjosterior, jjointed portion, which is directed toward the pet- :'s portion of the temjwral Ijone, is called the spine (Fi«s. 53 and 54). The cerebral surface is distinctly concave and exhibits the interna] orifices of the joramen rotundum, m-ale, and spino.-,nm (Fig. 51), the last receiving its name on account of its location in the spine. t It also cKcasionally shows digitate impressions and cerebral juga (see i)agcs 41 and 61), and a suteiis arteriosus which is continued from the temjKiral bone. The ahnost plane, slightly concave, (luadrangular orbital surjace (I'igs. 38 and 53) is thi smallest of the three surfaces. It forms a jjortion of the outer wall of the orbit, and in this situ ation its zygomatic border articulates with the zygomatic lK)ne by nu:in> of the sphrnozygomatie suture. The sijhenomaxillary or inferior orbital fissure sei)arates the greater wing from the maxilla, and at the margin of this fissure, the orbital surface jkjsscssc's a sharp edge, the orbital crest, which sejiarates it from the sphenomaxillary surjace (Fig. 53), a lower iK)rtic>n of the tem- ]K)ral surface. In the vicinity of the superior orbital fissure the orbital surface exhibits a lx>ny spine of variable development which is called the spina recti lateralis and is the j-oint of origin for the muscle of the same name. The temporal .surjace (Figs. 3c), 40, and SS'I '^ ^y ^'•^'^ l'^'^' liirj.'"--^' o^ t'lc three surfaces ..f the greater wing of the sjihenoid and is distinctly angulated at the level of liic injratemporat crest (see page 3c)). Tlie almost vertical portion of the tem]K)ral surface, situcted above this crest, forms a iK)rtion of the planum temporale (see ])age 38), while the portion >ituated IkIow the crest is divided into the more horizontal injratemporal surjace and the triangular splunv maxillarv surjace b\ a ratlu r low ridge wliich is called the splienomaxillary ridg<. The spheno maxillarv surface 1 Fig. 53) lcx)ks rather anteriorly and overlaps the rcK)t of the |ilcrygoid prcness, while the infratemporal surface is directed more to the side, and jiresents the external orifices of the foramen ovale and the foramen spinosum. Jt forms tile jiostcrior wall of thi pleryiio^ palatine (sphenomaxillary) jossa (see jjage 781, and contains the anterior or external orifice nl the foramen rotundum. It is sharjly separated from the orbital surface by th. orbital crest I Fig. 53). While the greater and U-ser wings of the sphenoid are practically horizontal, the third pair of ])nKes>es, tlu pterygoid processes iFigs. 53 and ;4i, pass abvio-t Miticallv down.vani and are aiijiosed 1 Fius. 41 and 4.>i to the posu rior surface of thc> maxill.i (>ee page 071 and to the iiard |)alate (-ee page 79), forming the lateral l)oiindarie>- eif tin- posterior iiares, F.ac h pteryi^'oid pnHcs> arises from the lower surface of tin \»«\\ of the sphenoid by two rcMJts, Ix'twceii whiili is the plirygoiil '\'idian\ lanat (Fig. ^},), uhjeh runs almost liori/.ontalh , il- anterieir extremitv being in the ptervgeipal.itiiie fossii, and its |iosterior one in llie loramc n laecrum. Heleiw the |)ter\ge)id canal the pteivgoid process di\ielc-s into two lamella, tlu intirmit and the t\l,riiiil pterygoid plate, '{"he internal jilate i> narrower and .ilniost vertically placcel, while * s <.e!ie»i Iht ftiltttS'll ftt'rtirr, i C)( eaMi>ii.illv ill! fiirunuii spinosum i^ imly ii.iniall> Imiilnl In Ihe- ^|i!ieniiiil U.iii-, i f., il i> »ini|il>. k mn. Ii in !h. spine. THE RONKS OF THE SKUI.I,. 51 the external plate is broader and directed more externally. Between the two is situated the pterygoid jossa, which is nanow above, wide below, and open iKisteriorly, and whose anterior inferior lx)undary is formwl by the tuberosity o; , ;ramidal protess of the palate Ix.ne, which closes the space, the ptcrvgnkl notch, between the two plates. At the base of the internal plate there 1. a small elliptical fos.sa, the scupboul jossa (Pig. 54), to the outer side of which, toward the spine, there is a shallow -hk.m', in whi( h is situ.ited the'cartilaginous iK)rtion ..f the Eustachian tube which connects the mid.ile ear with the naso pharynx. M its lower end the internal plate terminates in the slender h(X)k like hamular i)ro(ess (humulus ptcrygoidms) (Fif;s. 5;, anfl 54), the gnx.ve at the ba.se of this Ixin^- called tiie iMmulor i^rooz'c and forming a puUev for the tendon of the tensor vi li jjalatini. Beside the scai)hoid fos.sii is situated a small, flat, rather trian^^ular pnKes.-, calk-.. forms a portion of \\u- .interior, middle, and ix- -.'rior cranial fos.s;e. of the orl)it, oi the r,as;il l.'v„c, of the tem].orai foss.', of (he intf,*t |ir.l..rmr(i in < .irlil:iKr "iili ill'- s :i:i.| il\. -I'll- '"'il il tiirhinalnl U.iii-., 'a hii li ari' ilrvi lopcil A- rcijanl^ ■=»- 'li ■' I'^nnirnt .if tin- ^plir-iui.l, ll r.\, ,.«ctiti<>n .d ihr iiiumal plali-; '■! lt»- pliryK^i.l [ircH , i„ „„.ml,r:in- .K,rt....i.m l«-«iM, i.mar.i ill. . „.! of ,l,r „■,„„.! f.t.,1 nwnih U..l..t.-.l . .nl.r. a|M"ar ,n -h,- ..nl.n in.l |«.-trri..r ,«.rl.>.n, ..f ih. l««lv of Ihr Nmu-. m, ihat l..r a time itu r.- ;,:. i«,, ^l,ll, noi.l l..n.-. ,i- il u.r. , .,,i.i.,lr,l 1„M„.I llu mhiT. Ihr l.-r vunK. uHm- from .|h..,,I . , ntrr,. .,. .L, ..l-. ih,' iin al.r «m«^. ih, . , nl> r- f.., ,!»■ lath r ,K,. i„rmin._' th. ,.v„rr |.l,.t,-, ..f th.- ,.trrvn..i.l ,.r.«.-w,. I h.- 1,-,, r « inK^ unit- v,,i), ih, ant. r...r . ml. r ..I ih. lu..K ,,f ih. . h..i..i.i l«-lvvrcn till- sixth an.l m v,-nlh 1. 1..I month-, ih.- iir. :,i, r «ini.'-, .L. n..i ui.iU "Uh in. |....|,ii..r , , m, t „„„| all.-t bif.h, an.l th.- !«.. hah., of the t.«ly of Ihr .,.h. m.i.l .1-. .v .1 unit.- nnlil .ifh ■ l.irlh, an.l th.n I..U -|..N.h. ... Ill ll m intrrsf-'nrniuiltil ivm-lnmilro^ir i-vi^t-* (or a lonn linn-. 1 h. .... rnal plate of th, |.|.-rvK..i- (..rm.-.l .. ptriv.Oifinoin />r. .,...( />f-,w.'5vi(f Ciiinin:) THE TEMPORAL BONE. 111. h-mporal Imhu- (Figs, c;^ to (>V i- siluah.l in Ih, ial. nil p.:ri of ih. Iia-. oi tli, -kiiil, :,ml loim> portions of til. middle and i«)>te,i()r iranial fos-a-. Ipon eillu r -i.le ..lu- ..f ili. I. m iw.t ll lione- ("'IN li. (he largi gap in tlie (»v hasiuirr (sir pages 40 .inil 1; I. - 51 I if 52 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. p,c 55.-The right temiwral bone seen from the outer (lateral) surface (\). p,P,' 56.— The right temporal Ixme seen from the cerebral surface (j). Each temporal iK.nc consists of four portions: (1) A squamous portion, (2) a petrous por- tion; (3) a mastoid portion; (4) a tympanic portion. The petrous portion ts also tcrme.1 the ^'"m^ squamous and mastoi.l portions arc placed almost vertically, while the pyramid is practicallv 1 .,ri«.ntal. At the external auditory meatus, the in.lividual portions of the tern,x,ra rxne rc'..ouped in such a manner that the smallest portion, the tympanic portion, is sUuated !n from of anil below the auditory canal, .he mastoid ,K,rtion is bc-hind. the squamous portion above, and the petrous portion inteinally and anteriorly. THE SQUAMOUS POKTION. The squamous portion of the temporal tx>ne (I-igs. 5,^, .0. and 57) consists of an approxi- nt.telv semicircular ' criical bmv plate which is concave internally and convex externally An^ " r V Trticulates - Ki,. ,., and 40) with the temporal surface of the greater wing of the sphenoid bv the sphenos,uamo., suture ^spUenoiM border), and superiorly with the l^-tal .x.ne by means of the suamosal suture i parietal harder, sc-e page ,8). A deep notch, the parretai noUl., "".mmphenoid.l angle of the parietal Ix.ne an.l separates the squamous portion from the mastoid iM.rtion, which is situated inferiorly and iK.steriorlv, l-he ..,onJ proeess ,Fig. ,0 springs from the external surface o the ..uamous portion „f the .em,K.ral In.ne and aids in .he formation of the zygomatic arch, by ar,u uhmng w„h the temporal pnxess of .lie /.vgoma.ic U,ne by means of the zy,omali.otemp<.al su,ure. 1. .s alt^o. 2.onta a, it> origin, but later i, ro.a.es through alK.ut .p degrees, ., that it assumes a vertical position and forms a l..nv pnxess tlmened .mm side to side. Its ,x,s.er.or prolongation alxnv the external au.litorv meatus form, a s,. p.am.stoid rid.e. which ,K,stenorly U'cme^ conl.n.ou- Nvi.h the terminal iH.rtion ol th( inicri.r temi«.rMl line (xe I-ig. 3.)). Th. part of the ..uamous .H.r.ion whi. h lies Ix.low .he zygoma forms par o-h.- ..U,n surface of the Ix... of th, .kull and i^ umscqucntK almoM lioruontally place! (Mg ,H) and ,„,rdcr. upon tlu infrate,n,«.ra! surface o, ,he greater wing ol the ^plum.ul 1-me, It is th.TC _ for., advatnageoa. .0 .ulKliv.de the s.,uamou- ,K,r.ion o( tin- ,em,K,rai Ik.uc into a larger .eriteal portion and a smaller hori-.ntal portion. In tl,.. v.r,i.al portion ,1,. r, mav W re.ogni/ed an cx.ernal t.mp,nal surjare and an uu ,,.al cerehral un,,,,. Mh. l.m.r ,. al,M.nt in d,e horizontal ,H.r.ion.. The .em,...ral .ur ace h.rms , par. of the planum Innporale an.l of the jossa /,m/..n;/rv .see Fig. V)., a>,.l .. usuallv .mm, h, „ ,.,gh it. lo'r po„ion mav sometimes U- roughened by .he origin of the ,.m,..ral mus. le. I, present- a .hallo. ,r,«.v. for the middle ,em,K.ral artery, k-ginning ,,l..ve ,he external audi- lor nieatu. and running up\\aid. 1 •;, „ • \, ,u. i. .n. -f .he h. •i^ontal and vertKal parts i- -itnated .he roof of the external au. n„r> meatu. ,.,e nma.nn,. . .1- >. ,he aud.torv canal Uing fonne.1 by .lu- tsmpanu ,x.r„.m, and j„,, .ilH.v, ,h.. ev.emal audi.o,^ meUM.. „ tin -ransi.ion into the mastoid ,K,r..on, .here is fre.iuen.ly foun.i ., -nn'l b..!n .p-n,. ti'v ^uprammlal ^pme ilm. ^^\. f'(in'iii)' honfir (iivnvf for iiuild/t Uini'onil iirtriy I'vinponil line ."iin'dii/ iiott'li Siipniiiii'iilnl s/^iiii Mut /(irdiiiru Ori'ipildl boiilir (mastoid portion^ Mii^'loid i^nun-r Mii''li'itf porlion Mii-!(inl piiur^' Squamous portion (Iniiponi! ••iir/'dcc) Snhi'ni'iiuil honlir Artiriiiiir lUiiiuiiir 1,;.,,, / /'f nvrw'n/tiiiiir //>-.»/(• Tympanic portion ' >''''"''' niiilifiny uniitii^ I I'liiiildl /'I'lilir t'i'fihiii/ ^infill' \iriiiiti riiiiiii:ir- SpfltHOiJiU hof .<■/ Petrnii^ portion Siilmri'iiilli' /I'^vJ lilhnitit iiiltlilor'' iihiitii'i lnfi'iiiH /iiri(>\ii/ t;"':>\'i flif'H/ilf il.^U If I iiS. '■>(>. ^™ THE BONES OF THE SKULL. 53 portion, the articular eminence, vv-h.ch .s .1.. parUaU, '-- ,^ / ^^^^ ^,^.„, .Here the zy,on.atic process surround the --chbu a fos- fr^.n^^ ^^^.^^ ^_ _^^^^^^^,^ ^^^^ tremely ^ou^h and sharp, and, in t^e ^^l)'^™-,;;' ;;:r;;tl - of t^^ sph.nos„uan,osal ..uan^osal suture, and it is separat.l '--'-!;:;;;:;^;:Ll/ ,.,.-■. l.s cerebral usually even in the adult, by a n..re or less ..s.^.ed -^u , h P ^^ .^^ . ^. ^_. ^^^. ,^^^^^^,,^,^ surface consists of only a vertual I""^'""; -^';^;^ i^^ " I iu,. and digiuUe impressions. of the middle meningeal arter>-, .Kcasu.nally exhibits cereb.al juf,., THE MASTOID PORTION. The mastoid portion of the temporal ,.ne ..^s. ., to .S. ji^ves U. na.,e H^m t . -. • ^^^ toid process, the mos, important structure of t^ ,.^u oH - > ;^^^^^^_^ .^^ ^,^^,,^„,_ |„,, ,,, notch it articulates with the masto.d angle ot "^ I-- '^ 7; J^, .oaifHo'uasWid su,.^. ~ee ..ccipital.x,rcleraraculates.jthd.es,u„,..ru^^^ ..n Fi,,. 42). In the lem,H.ral Ix.ne U.elt the mastoui iK „.,,nious p..rtion; it is se,a ,;;„;...../ ;...0, upon d.pej..us,...,.^ ;,, ^^,^„ ^^^, ,,, rated from the latter dunng ^'.ath h^ M sgu ^^^^^^.^^ ^^^^^^^^ ^.^,^,,.,^^^, Incomes more or less oblit. rated .n later hU. J^ ^ ^^^^ ;,,,,,,,, ,„,,,. surface, which .n-ars the mastoui process, an 1 an -^ ' ^ ^ ^^ ,.,„sid.rable part nf The ,u.:.loid pr..uss is a broad, conual. l.n, ^^^^^ '^^ ^ ;„^. „„„,,, „„ , ,Ki«. U. mastoid ,.rtion, an.i presents --!;-;;-;: ^l,: ^1 ;:!;;,.. .hue ,- a .>a....ver ^8). Internal tu thi. notch, l^tween it a»d tlu Kcipn jjn„.ve for tlv occipital artrrv. „,;,.loid |,<.rlinn, i- the ma.st.uil ::;"::;',r;,^r riJs'i:.:;^..- ■ •• "••■ -- »- •^uture. . , nMii- ■' broad Kr.H.\v, the v/,i;»fMW .1,'r'W The cerebral .urface of tlu masUud pnK.--^ '"; ; .^J'^ „urn..stoid enu^^arium ,ri,. (see ,.'.> F... 4,.). ^^•hich usualK o.mam^ tlu ;-;;;:;_,, „,. ,„..,„;,„ surfa, e „f S^n In ihis sni.ati.m the m-.-toi ! i ••• -u o,r. .tlv the inraniid. L.wn i.tlv duisIohI oi: iTis^-. ')i The mastoid i.HKCss .umains nmup.us a.. spa>. ■ L Avn Ik. .1 ^^ AT1.AS AND TEXT 1500K OF HUMAN ANMOMV- ,,, „._Thc ri.h. ten^poral Lone seen fro. the -cerebral surface and fro. the apex of .he i^trous portion (\). p,£. c;8.— The right tem;.oral bone seen from below (1). jrj,. -g -The right temi)oral bone of a new born elilM (;])• Vui 6o.-The left temporal bone of ^:yZ:'l::!t'rluL^ ..a.oi.l ,.,.nion. vdlow, a™, th- ..M-i. In 1-igs. VI ami fra the s(|uamous iwrtion i» i;^ . n, tnt p. ir )u jH)rtion ivhiti' the Ixmy tissue and even expand it. lhc\ arc connciu thf tympi-'itc antrum. < .^ h;..f „ ,inu for muscular at-a.hnunt which tho skull ,,...sesscs, ami it r. is one of the - hu ,. .,n.. for mu longisMmus capitis n.usdcs. „„ i„..r,ion^ ..f .he .ern,Klei.lon,as,oi.. and o, p..,,...^ .>^ ^^^'^^ Several ,.„enin«s may 1. presen, in ,he The mas.,.iu n,„>l, «ive. ..riRin to the posterior l,en^ o " < ''^ ^^ J^^, ^^,j ^„„,, „,, „a,u,i,l i-roce,. .> also vi,i„i,v ..f the mastoid foramen. The depression Ixs.de the supram.al.l sp.ne called the masloiil /"S.vi - £ PETROUS PORTtON. The petrous ,>ortion or pvramidt.f tlu ten.poral hone (Fi,s. ,6 to 58) forms a port.n. o. .ranial cavity and ^^^ ;^^'';^^^^ ' ^^^'^^^^r ^^r^^^ - di^inKuiJhe.l internally an forwanl and from w.thout tn.ard. ^ ';-;;;;;, ."'^,,^i;,, ,,,,,,, ,;., there is a superior, rrr:;;: :=:-"- — >- - --- -^-- an anterior, an 11 p-.r^bral ortio>i in the adult is directly cont.u.ous external, a .ih the ^>'^I'^""^^ '' an,l ii^a. Interior surfat. l.rders u,K,n the squamous pt.t.n >^- -- - / - I- niL.e -) tntl uiKjn the snhenoid. bone ^sphvopHrosal l,ssur,\ Tht .>■ an. a,.. " u which is emlK'-Lled in the petrous portion of the hont . Lpnn th. ant also a small slit like orilKt, tiic luuu, / ,,,,-,mid and to tbc foramen the Kreat superficial petrosal nerve pasM s toward the apex of tlu psramid lacenim in a groove (Fig. 57)- • i; ,i, .,-,. is i senmd smaller opening, ihe Eternal and anterior to the h.atus --"^ '^ ' . :f:. ^he les.er superhcial petrosal nerve, u hit ii alst, passes forwani to ihe region o. tne ltd... - Squamous port/on (n-relmil siir/'iint Z\'goinatic process Tegmeii fornmen I'llivsqiiiimosal fissure Aperture of super, tvm/innie carmluulus ( ■ groove far itunll ^uperj. prtro^ol nerve} MiisciilotiilKir Cdiiiil Inlermil orifiee of eiiri'tiil eiliiill lmi're>^i:> trii^emini Pyramid (irome for i:mi: superl. petn'rnii fi^^ure 1 'iii;iniil firocc^s I \l. (iiiilfterv nieiitii^ •S/r/i'/i/ /i«i(V .lf(/^^l/l/ /"I'll". M(C-l(ii(f ".''(iiii'i -.; / \t ,1/xiriiie ot inpntedintti^ eoetlleih Inlrniilgnlnr /vv., s- \l,l~to:il riimilhiiliis flll^llllU fO-'^il l\lomii~toi,l loniiiii II ( )ccipit(il horilcr (mastoid 's^ portion) I ii^. 'i!A. I !• ■i\m I ii'. 00 THK nONF.S OF TIIF. SKUI.I.. The rather thin Ixmy plate of the petrous i)ortion whieh form- 'he anterior surface of llie pyramid between the hiatus eanahs facialis and the arciiate eminence, and which extends to the ])etros(|uamosal fissure, is the roof of the nii )«/)«(/ impression [V'v^. 571 and l(xlj;es the semilunar ((iasserian) f;anf,dion of the trif^eniinal nerve. The sui)erior Ijorder of tin ramid, which separates the two (irebral surfaces from each other, shows upon its surface a shallow furrow, occasionally emi)hasized by pronounced elevated marf^ins, the superior petrosal i^nxnr, which empties into the siijctnoid ^roo\i'. Like the latter, it contains a sinus of the dura mater. The i)ostcrior cerebral surface of the jietrosal ]K)rtion is almost vertically ]ilaced and torir> a portion of the posterior cerebral fossa. .\t al)out the middle of the ])yramid, nearer the superior than the jiosterior Ijorder, it exhibits an api)roximately round openin},', the inleriial nudilory jortimeu (Fi^'. 56), which leads into a short canal, the iuleriuil uiulilory menliis, which lodges the facial and auditory per\is. .\l)ove and somewhat external to tlii- ojieninK -"t' immediately Ixlow the lK)rder of the ])etrous portion, there is a dejiression, the suluimmle jcssn il'ii;. 501, the conca\ily of which is (iirected toward the ai)ex of liie pyramid. Sometimes it is bul sliuhlly marked, thouf,'h it is distinctly dcyeloped and very larjie in the infantile skull; it contains a pnKcss of the dura mati'r. Helow and external to it, and al :ibout tiie level of the orilicc of the internal meatus, there is a slit like oril'ice, the external aperture oj the aqiKrihultts vestihuli {V'v^. =;()), which is open exter nally and below, and accommo;!aies a process (tiie d\ictus endolym|ihaii< u-; of tlie membranous ear.* In the vicinity of the anterior ) )riion of the posterior lH)nlcr there i- a cjuite shallow j,'rooye, the injerior petrosal i^roov, il'i^. 5(11. which, ii>i,'ethcr with a simii.irly named j^roovc of the (KTii)ital Ixme, forms a channel in tiie petro-occipital fissure for the inferior petrosal -inu- of the dura mater isee also I'ii,'. |;i. The |M)sterior Ixirder of the |i\ ramid is separated from tiie ociipital Inuie {the ba-ilar .ind lateral [Kirtions) bv the jielro occipital tissiire and the jufiular foramen. It iireseiil- the iiii;iitar notch (Fij;. ti(>), (iirres]!ondin),; to the similarlv named notch of tlie cKcijiital l)one, and also ii>u ally an intrajiif^ular process isee jiage 4(1^. The anterior Ixirder is sejiarated from the ba-e of the ,i,'reater wini; of the s|.lunoid hone bv the sphenopetrosal fissure and by the joramen lacerum: the apex oj the pyramid i- in ((Mii.ut with the lateral surface of the Ixnly of the sphenoid lionc-. At the foramen l.uc rum, 1 lose to the actual a]H'X of the jiyramid, there Is an irregular opening;;, the intirnal lamiiil joramen >■,'. 57), which leads into the carotid canal, a short canal which Iraveisis tin- iii.u r h.ilf of du pc!rou> portion of the temporal Iwine and IcKlj^es the internal carotid arfcrx . Kxternal to the inleriial carotid foramen i> situatetaclii.in tulu- i-ee also page si I. 5 i < I •A unmvi- nin^ (nun llu rMirii.il .ijmiiuh' "I llu .ii|U.iilui ici^ m-iIKuIi !•■ iIh juciul.ir rwilili. 56 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fig 6i —The left temporal bone dividerl through the axis of the petrous portion (J). Fig 62.-The right temiwral bone divided in a plane passing through the external auditory meatus and nearly parallel to the axis of the i)etr()us jwrtion (i). Fig 6, -The right temporal bone divided in the upp-r half through the axis of the jKtrous ,»rt.on and iK-low horizontally, the wall o." tne canalis musculo-tubarius beuig partly chiseled away to show the septum (]). In this situation the spine of the sphenoid insinuates itself into the angle Ix'twccn H'o anterior border of the pvramid and the cerebral surface of the scjuamosal portion, so that the groove for the Eustachian lube (see page 51), running ui>cn the inferior surface of the sphenoul bone, leads into the orifice of the musculotubar canal. The external surface of the petrous portion forms part of the external surface of the base of the skull. It presents quite a numlxT of noteworthy structures and is the roughest ami nu,st uneven surface of the bone. At its junction with the mastoid portion there is a rounded opening, the slylomasloi,l joraw.n (Fig. 58), the external orifice ..f the jacial canul, which traverses the temiHjral bone in a curve and Uxlges principally the facial nerve. In front of the stvlomastoid foramen is situate^.! the slyloid proa-ss (Figs. 55 and 58), the remains of one of the' bran( liial arches. Sometimes it is short ami thick ami sometimes it is ven- long* and it is usuallv place.! in a sort of lx)ny sheath, the vuaiml process (Fig. 55). which is mainlv in contact with the prrl> marke.l depression, the p.ln>sal jo^s.1 (Fig. 581, which (..mains the inferior aperture of the tympanic canaliculus, which trans- mils the tvmi)anic nerve, internal and anleri.ir lo the external caroti«.n. is fn .|mn.l.v .|Uiu- short, 1ml it may U- < .mt.nm.l as a In.ny s|m> uI. in .i..- .ijio- hyoid ligament («»• pag<- iii)i. Ext. srmiciir. rniuti Sii/tii: sriiiinirii/(ir i niuil ['/■■itil'ii/i liitfnnil iiiulilorv tit i'acial caiiiil m.^ ^•L ('tiiotid aiitiil rvtiiptiitt'i- (intnitii Stylo/It Mif-li>i(f (v//.s n<,r. 01. i-l Ml txtiriKii aitiltttvy IttC.tttts .\liiiitii(' (tttlniJii CitlVtiil I'dlllll I V'lipnittc attHiiiit ni' III .l/(/,s7ii/i/ iii/'i ' ,' .\trtiitfr nititii till I niiiiinii' I'ltr fnciii! rattnl I'lWtionloiy <\i:olt, iiittill I \r>iiiii/ iitiilitiK V ntriittf- I XllTlllt/ I'll/iff III i;tr ' iiitiiil \\ii-itilii,i iiiitiil y i THK BOXES OF THE SKULL. s: The anterior portion of the external surface of the [)yrami(l, the fjreater |)art of wliiili is concealed by the tympanic i)ortion, forms the inner wall of the cavitv of the middle ear. THE TYMPANIC PORTION. The tympanic portion (Fij^. sO i^^ a small, slightly curved portion of the 'emporal lx)ne which Ijecomes secondarily adherent to the remaininjj jx)rtions and is represented in the new Ijorn by a simple ring open aljove (Fij^. 5()i. Outf^rowths from this ring fomi liie anterior, posterior, and inferior walls of the external auditory meatus, l\- orilii 'f thi , and the outer wall of the tympanic cavity.* A process of the tegmen tympani, the itijirior process, is ])ushe(l in Uiueen the s(iuamous and tympanic jwrtions internally. It is lx)unded upon ■■ -.e side by the pre\iously mentioned petrosf]uamos;d fissure, and u])on the other by a second grof.ve, the pdrolymponh or Gltisi/ian fissurf,i Ixith of which unite to form the lympaiiostjuamosal fissure. The tympanic ])orlion is separated from the mastoid |)ortion iiy the lympanumastoid fiysiire, which contains the outlet of the mr.'toid canaliculus. The tymuanic jxirtion also forms the Tiiginal process (see page 5()). .•\t the inner I'xtrrmily of thi' cMcnial ■„ .ililnry nualus, lowaril ihc l>ni|aniin;, iliiri- i- a lirdilar iinnvi. ilu- lyni- panic i;ro(Ke, iinly tln' uppiT c,ua(lrant niii\c nut fciriniii li\ ihi- lun|iariii I'cirlion). This prf the jrroovf. and (f»nsf(|ucntly of the tynipanir \n\: rioii, ihtrc arc I\vo sniall lion\- spii ulrs. known as the qrriittr and lesser spines, and, furtherniore, in this situation t'nTe i> a noti h iK-twfen the tympani) portion and the upper wall of the meatus whi( h is furnisher! !)y tlie s<]uanious p« rtion ; iltiv i^ i ath d tbi txwptniu unhh THE MOST IMPORTANT CANALS OF THE TEMPORAL BONE. In the temporal Ijone there is a scries of tanals wliirli transmit \essels oi nerves, or usuall\- vessels and ner\es together. The most important of t!' s are the following: The jacidl canal (Fig. fii) contains, in addition to !)lon ;im»uni nt ihcir rcialiiMi In iht' scn-^t- of hcarirm ihc remaining -irudurc'^ {lavitif thf ptirnus portion \\\\\ N- (on^iilcnd in <|i tail in \hv scitii'ii upnn nrj^an^ «>f spn i,| ^t-HM', rate foramina. J Tht U'nd of the (anal in ihis situation i> lalhd llu i^fuUulum c/ thr /,ni,jl iutial. ( anal-, * ti i s'tuali'i in 58 ATLAS AND TEXTBOOK OF HUMAN ANATOMY. Fk;. 64.— The outer surface of the riijht parietal Ijone (i). Fig. 65.— The inner surface of the rij^ht parietal hone (4). While the facial canal is the longest of the canals of the petrous portion, the carotid canal (Fics. 6t to 63) is the widest. It is al.so Ix'nt at a right angle. It commences at the external carotid foramen u|)()n the external surface of the petrous jiortion of the temporal and passes at first almost \erticalh- upward, in ct^ntact with the anterior wall of the tympanum; in the immediate vicinity of the c chlea it bend.s at a right angle and then runs almost horizontally in the axis of the ])yramid to reach its irregular and frequently incomplete superior orifice at the aj)ex of the j)ctrous portion. Fine canals, the carotkolym panic canaliculi, lead from the carotid canal into the tymjjanic cavity. The mtisculoliibar canal (Fig. 6;,) runs jiarallel to the carotid canal and in such immediate proximity to it that jiortions of lx)th canals have a common wall. It begins at the inner side of the apex of the i)etrous portion of the temporal bone upon the anterior border of the jiyramid, between the jjctrous portion and the horizontal jjart of the squamous portion, and runs aj)- I)roximately in the axis of the pyramid. .\n incomjilete horizontal septum which proceeds from the inner and j^osterior wall (Iwrdering ujjon the carotid canal) separates an upper smaller compartment, the semicanal for the tensor tymjjani, from a larger inferior one, the semicanal lor ti. ■ Eu.stachian tulx'; lx)th compartments have their exits in the anterior wall of the tym- panum. Tlie canal contains the tensor t_\Tnpaiii muscle and the Eustachian tube. The tympanic canaliculus, for the nerve of the same name, proceeds from the ])etrosal fossa, and at first passes vertically upward into the inferior wall of the tvmpanum to be con- tinued as a groove, the ,?mnr oj the promontory, upon the inner wall of the tympanic cavity. It then leaves the tymjianum as a canal jjassing from its upjier wall to the sujxTior aperture of the tympanic canaliculus on the anterior surface of the petrous ])ortion, where it rommunicates with the cranial cavitv. The mastoid canaliculus Ixgin^ in the jugular fossa as a groove, crosses the lower jjortion of the facial canal at a right angle, ,ind terminates in the tymiianomastod fissure. It transmits the auricular branch of the pneumogastric nervc'. In adcliiif.n l,j ti, .lir-rrlls of the rna.stui.l pro., s, i|u' tomixiral txino also loiuaiiis a larger eavily, the lyvipanic .iiitnim (Kig. (),). (For a d.laileil desrription see the ^peiial sense organs.) 'this is in conneelion with the mastoid cells behind and with the niuseulotubar >anal in front. It is not separated from the evKrnal auditory meatus 1)V osseous tissue liul only l)y nienihrane. In the devel.ipment of the temporal Ixme, the jH'trous portion antl the mastoid prcKess are developed in (cmimon from the cartilapn.ms auditory vesicle, and the squamous and tympanic (xirtions are added later as supplenuntarv l).mes. The styloid process has no eonnertion whatever with the remaining portions of 'he temporal Ixme and arises from a jxirtion of the branchial skeleton. CommcniinR at the Ihinl fetal month, ses.ral .enters appear in ,hc cartilaginous auditory vesi. le anrli..n ossifi.'S at about the same time as the nvramid In tbv temporal Ixme of the new-born (Fig. 501 the tympanic portion has the shape of a ring ..pen alx.v,-, and is known as th.- „iru>r 'ifi/'t'iiii I roil III! Ihiidcr I nr. 04. "^plhlioidill (lll''lc i r Mii^toid (iiioic Si/iiiiiiiosid liortlcr Sni'ittut border I'iiriclii! foninicii I'roiiliil (iii<;lc f roil til/ ^ border \ Spill iioidill iii.ob Siii^iitiil i^roovc < Iccipildl iiiii;!e Sulci (irteinf-i Si/tuiiiioyiil lioider ►, , Ociipiliil hordir I ill. fmni the mastoici jHir- tions. The hone also varies considerably from that of thi ailull in other respects, ahhoURh all the portions an' already united by osseous tissue. I-.spec iaily large in the new-born is the subareuale fr>ssa During the first years of life the tympanic porlion develops by the growth of the annulus tympanic us lo a trough- Uke structure, and it is as the result of this growth that the bony meatus is formed. There nevertheless remains a .on- stant unos.sined portion o? the inferior wall of the meatus (Fig. Oo), which usually doses in during the fifth vcar. The mastoid proces;, iH-comes distinct at this time, but does not ccntain air-cells until the time of puberty. The- styloid process, ari.sing from the second cartilaginous branchial arch, l.^sil"les l.ile and sul>ser|Uently beo.mes connected with the temporal bone. THE PARIETAL BONE. The parictrl bone (Figs. 64 and 65) i> a topical Hat Ixinc which arises from the membranous cranial cap.sule ant! is not jjreformed in fiiniiage. It is one of the simplest of the cranial Intnes, is distinctly (]uadrangular in shape, and is markedly curved lx)th in the sagittal and in the frontal direction. It presents for e.xam.ination U\n surfaces, an external convex paricia! siirjarr, anil an internal concave cerebral surjace. The four borders of the Ixine are named rcspecti\ely the jnmlal, the sdi^illnl, the oeeipilal, and the squamosal Jxjrdcr, and by them the Iwne articulates (Figs. ,:;8 and 40) .11 the coronal suture with the frontal bone by its frontal border, at the s[)henoparietal, .sf|uamosiil, and jjarieto- mastoid sutures with the greater wings of the si)henoid and with the temporal l)one by the stjua- mosal border, and at the lambdoid suture with the (Kcipital Ixtne by the (xcipital torder. In the sagittal suture, the s;igittal lx3rders of Ixith parietal Ixjnes articulate with each other (Fig. 46). The anterior, superior, and posterior margins are markedly serrated, ( orresponding in character to the sutures isiiturcp serraltr); the inferior margin, however, is lK\elec! and its external surface is overki' ,ii the squamosal suture by the mari,'iii of the temjjoral lx)ne. The four angles of the bone arc the jronlal aiii^le, the anterior superior angle, formed by the coronal and saguial sutures; the splieiwh I aui^h; the anterior inferior angle at the s])henoi)arietal suture; the occipital angle, the posterior superior angle, formed by the sjigittal and lambdoid sutures; and the mastoid angle, the jiosterior inferior angle, at the ])arietc)mastoiil suture, lilling out the parietal notch of the temporal lx>ne. The most acute angle is the sphenoidal. The external or parietal surface (Fig. 64) presents at its point of greatest curvature the parietal eminence. Relow this nn the superior and iiijerior temporal lines (see also Figs. t,i) and 40), the latter Ix'ing much more distinct than the former. Relow these lines the external surface of the iiarictal tone form.T a portion of the planum temporale (see Fig. 31;). In the vicinity of the sagittal suture and near its posterior extremity is situated the pariet ' joramen, a so called emi.s.sar>- foramen. ;ximctimcs the internal and sometimes the external nrilice is wanting; the fonncr leads into the sagittal gnxive. The most striking structures upon the cerebral surface (Fig. 65) are the extensive grooves for the l)l(xxl-ves.sels, sulci artcriosi, of which, as a rule, there is a well-marked anterior and a less pronounced posterior one. They are for the branches of the middle meningeal arler>- and are accurate moulds of these vessels.* The cerebral surface also exhibits two other grooves which acc<>mino.mmcr cernent of the sulcus arteriosus is not infnc|uently converted into a short canal l>y a biidge of os.seous tissue (>cc I-jg. 65). i . \ II 6o ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fig. 66.— The frontal bone seen from in front (4). . (G. 67.— The frontal bone .-cen from behind (i). presents one-hall of the sagitlal gromr, while the mastoid angle contains a small portion of the sif^moid gromr (see also Figs. 4.:! and 44)- Digitate imi)ressions and cerebral jiiga likewise occur and granular jnrokr j^ranularcs {Pacchionian depressions) are still more common. The parietal iK.ne ilevel.ips in meinl)rane in the thinl : \a.\ month fnmi .1 renter of (>ssifir;itiim situated in the pari- etal eninenee. I-.ven in the new-lxjrn the bonv tralxeulie show a distinit radiation from this point. THE FRONTAL BONE. The frontal Ijone (Figs. 66 to 69) consists of a vertical a' hcd portion and of a horizontal portion. The vertical ])ortion Is known as the jrontal porlion and the horizontal portion is composed of two orbital plates, and a small median nasal portion. \v the orbital margins the horizontal and vertical ])ortions become continuous. The frontal portion, the main jxirtion of the entire Ixine, articulates in the coronal suture with both paiietal Ixmes by its parietal border (Figs. 3<) and 40) and in the sphenofrontal suture with the greater wing of the sphenoid Ijone. It forms the entire frontal porlion of the cranial vertex and presents two surfaces for examination, an external 'jrontal surjace and an internal cerebral surjace. The jrontal surjace (Fig. 66) is m..rkedi\- convex in lx)th the sagittal and the transverse direction and i)resents some distance above the orbital cavities two feebly projecting flattened elevations, the jrontal eminences. Immediately alx)ve the orbital margins and parallel to them are two slighllv ])P jecting ridges, the superciliary arches, the develojjment of which varies con- siderably in dilTerent individuals; the Hat area between these two ridges is called the glabella. The remainder of the external surface is sm(K)th, although there may be a slight roughening in the median line which represents the remains of the original jrontal or metopic suture. The supraorbital border is situated at the junction of the vertical with the orbital plate. .\ ]>ortion of it is furnished by the zyi^omatic process of the frontal Ume, which also forms ])arl of the external orbital margin and, in the latter situation, articulates with the frontosplieaoidal process of the zygomatic bone in the zygomalicofrontal suture (Figs. 37 and ,^S). The temporal line commences at the zygomatic process and separates the frontal surface of the frontal portion of the Iwne from the small temjjoral surface, the latter surface, almost in the sagittal i)lane, fomiing a portion of the planum temporale and being that ])art of the frontal tx)ne which bordi ujK.n the temporal surface of the greater wing of the sphenoid bone. Immediately alxne the sUf)raorbital border there are foramina, which may be represented h\ notches of var>ing depth in the border itself. The inner one is designated as the jrontal notch or joramen (Fig. 65), wh'' he outer one is known as the supraorbital notch or joramen* (Figs. 66, 68, and 69). The inner rir cerebral surjace nf the front 1 jxirtion (Fi«r. 67) presents a median rifigc upon * The supraorl)iial noKh is much more fre<|ucntly [.resent as a foramen than the frontal notch; sometimes b<'th of the notches form a single shallow groove. T I he I iviildl ciiiiniiHc I'lin'iliil honirr Frontal portion fiviitdl Gillian Sii/iirr/7i(iry iiir/i Orbital portion 'orhiliil 'iiirfairj Sii/iriior/'ifii/ fcninii r I i<:. ()<). Sii/ii n'l'r ti/ii/'itni/ litir liiiiijonil ■•iirfiiir Nasal portion froi,U,l spin,- Snpr.iorhiuil „ot,h Siii^itliil i;ivi}\;- I'liriildl bordci- ('nrbnil siiifan- I'f In'iitdl portiiiii :. Oi. (Wr/ini/ siiifiiir (of orhmil pnitioii) I ■'•■'■ "!,n rruhittii I iviiiiil rirsi f idiilii/ -.pinr Mil (| i It THE BONES OF THE SKUI.L. 6i its lower portion, the jronlal crest, which extends to the joramen ctrcum (see pa^e 41), and is continued superiorly as a groo\e, the commencement of the sat^iltal tiromr (see page 44). The cerebral juga, digitate impressions, and sitki artcriosi upon the cerebral surface of the orbital portion are sometimes continued ujwn the inner surface of the vertical jjlate, as there is no dis- tinct boundary between the cerebrfil surfaces of the two ])ortions of the bone. The foramen ca;cum is sometimes situated entirely within the frontal bone. The two orbital plates of the frontal lx)ne are separated by a deep notch, the ethmoidal notch (Fig. 68), which articulates with the cribrijorm plate of the ethmoid lx)ne. They jH)s.sess two surfaces, a superior cerebral surjace, which forms a portion of the anterior cerebral fos.sa, and an orbital surjace, which constitutes a portion of the nK)f of the orbit. The cerebral .surface (Fig. 67) is .separated from the ethmoid bone by the frontoethmoidal .suture (Figs. 4.^ and 44), and is in contact with the lesser wing of the s[)henoid lx)ne at the sphenofrontal suture. It is almost flat and exhibits quite di.stinct cerebral juga and digitate impressions, as well as the sulci arteriosi of the anterior and middle meningeal arteries. The orbital surjace (Figs. 68 anti 6()) is distinctly concave, and forms the largest part of the r(x)f of the orbit and also a jwrtion of its internal and external walls. In this situation it articulates (Figs. 37 and 38) with the greater wing of the sphenoid Ijone by the sphenofrontal suture, with the lamina papyracea of the ethmoid Ixjne b\' the fronlcK'thmoidal suture, and with the lachr>i ,d Ijone by the frontokulirymal suture. The apjjcarance of the ethmoidal notch as ^een from the inferior surface of the frontal bone between the orbital surface is (|uite dilTerenl from that which it presents from the cerebral surface. It is not limited by a simple suture, but its U)rders are rather broad and irregular, and are j.roviiled with small depressions, the ethmoidal del>ressioiis, which comjjlete the air c ills of the ethmoid bone. In the septa Ix-twei n the ethmoidal cells there are two gr(K)ves or can;d>, an anterior ami a jjosterior, which run resjx < livelv to the' anterior and posterior ethmoidal joramina, situated beside or in the jrontoethmoidat suture; they give pa.s.siige to the ves.sils and nerves of the same name. The portion of the orbital s\ rface which is in the inner wall i-t the orliil alwavs presents a •small (iei)ression, tlie trochlear depression (Figs. OS and tv)), and sometimes a small ix>ny spicule, the trochlear spine, Inyth of which are m. named on aiiount of the IiI.I'k artilaginous |)ulley of the superior obli<|ue musi le bi ing attached in this situation. In the out. r portion of the orbital surface Uneath the /ygomalic process there is situated a shallow depression, which lodges the lachrymal gland. The nasal portion of the frontal Inme il'igs. <>() and 67) i> the small me.han portion situated between tlie ()rl)ii,il (avities and jirojecting somewhat below the frontal jHulion. It [K)ssesses a very irregular roughened Ixirder, known as tlie nasal border, for artiiulalion with the na.s;d Ixme and the frontal process of the maxilla, and its inferior surfati is marked In a l)on> ridge, the jrontal spine, which, together with ilf roagh nasal l)order, articulates with the Ix.nes which fonn the skeleton of the nose. rile frontal Ixme. like many of the (ranial lK)nes, contains a (avitv, the jrontal sinus (Fig, 102), or, accurately speaking, two cavities, which are sei)arated by a septum usuallv jilad'.! to oiif Mde of the meiiiaii iinr, Liki- the majority ol the liony sinuses lliev communiiate with the nasiil cavity, the communication in this instance Ixing etTected by the two ojienings (Fig. 67) -*n;, ii ! 2 62 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fio. 68. — The frontal bone seen from IjcIow (^). Flo. 69. — The frontal Inme, the f;realer part of the ethmoid, and the nasal hones in place, seen from below (i). The frontal bone is while, the ethmoid yellow, and the nasal pink. Fir.. 70. — The ethmoid bone seen from above ( } ). Flc. 71. — The ethmoid lM)ne seen from the side (}). Fic;. 72. — The ethmoid Ixme to^,'ether with the ronrh:e sphenoidales, which are united with it, .seen from alx)ve and jKirtly from Ijehind (j). situated between the frontal si)inc and the ethmoidal notch. The development of the frontal sinuses is subject to j^reat individual variation; they are generally larger in advanced life than during youth, and they are always situated at the base of the frontal jxirtion, esj)ecially behind the su[)crciliar\- ridges, the prominence of which is actually dcjjendent u|M)n the size of the sinuses. They frequently also extend into the orbital plates for a varying distance, and are sometimes enormously developed and markedly distend the frontal lx)ne in the region of the sujx;rciliar\- ridges. Thi' frontal Ntm* is om the two halves of the frontal l)one are eoinpletely separated hy the frontal suture (FiR. 105), whieh diK's not ilisiip|H'ar until the serond year of life and may sometimes 1h' present in th<' ailult. ami is then .ilso termed the ineli>/>ii- suture. ,\t .il»mt the time it dis^ippiars 'in frontal :,inu.ses Upii m divelop anil tlnA enlarge r]uite gradually until the time of jiutx-rty, when thiy ini rease n; re rapidly. THE ETHMOID BONE. The ethmoid Ixine (Figs. 70 to 7,^) forms the median portion "f the nasi! skeleton; antl its iribrijorin fi/iilr aid.*; in the formation of the lloor of the anterior cereijnil fos.sa. In the artituhiti'd skull ihi largest ]iorti(U! of the ethmoid is (dncealed by othtr Ixmes; it is (|iiite centrally placi-d and anidiialis with several of the cranial Ixines ;inii with the mujorit. of the f.,iial Ikhhs. It has, as a whole, an irngularK- tubiial form, and |irrsints a median and two lateral iK)r- tions. Till fomn r tonsisis nf a siiiali hnri/nMlal plate, the irihrijurni philc, and - nerves from the olfacton,' bulb, which -csts upon the cribriform j)late; the nerves for the most i)arl continue their course downward in small lx)ny gr(M)ves ui)on the nasid septum and the lateral nasal wall. The most anterior foramen, frequently incomplete, ^ives passa>,n to the anterior ethmoidal vessels and nerve. In front of the crista p;alli, the cribriform i)late sends out two small, somewhat (|uadrangular, Ijony platelets, the ahir processes (Fij.^. 70), which pass toward the base of the frontal crest of the frontal bonj and usually complete the foramen ciecum posteriorly (Figs. 43 and 44). The cribrifonn plate is situated in die ethmoidal notch of the frontal bone and articulates posteriorly with the ethmoidal spine of the sphenoid Iwne. The perpendicular plate (Figs. 69 and 73) extends downward in the spacv lx>twcen the two lateral massis and forms the anterior superior portion of the bony nasal septum. It is approximatelv pentagoi. d in shape. Its anterior superior border articulates with the frontal spine by the frontoethmoi'hl suture; its anterior infericr lx)rder is continuous with the cartilaginous nasal septum*; its inferior border ardculates with the superior ix)rdef of the vomer, which forms the remainder of the tony septum; its jwsterior lior ier articulates with the si)henny ])latelets into the ethmoidal cells, which arc onlv j)artially situiited within the ethmoic' Ixme and are frequently cl(xsed in by neig 'ng tones, particularly by the frontal. \Vc may ionsii|iicnllv (li>iinKuisli th.- rthmoidal alls pnijxT. i r., th- nhirh ,iri actually inil..s»'(l within tin- I'lhmoid Ixinc hv the I, inina papyraroa, from thoM- whii li an- ilosiil in liy the Inints adjaunt I.) ilu- cilin-'ii! ( :lii- Innlal, la>hr\-nial, sphomiidil, maxillary, and palatini- ivWs). The external surface of the labyrintli finTns a jmrtion of the inner wall of the or!;it (Figs, o; and qO). It is (juadriLteral in form, and, on aitount of its iMreiiu thir. less, is known as the /. .('«(/ papyraeea (Fig. 70), al'hough it is also known as \\\r 's planum. In the nrbital cavi'v it articulates anteriorly with the lachrymal Ixme, inferioriy witli tlif niaxill.i, ])osteri()rlv with tile palate Ixme (the orbital surface) and superiorly with tile r l>itai plate of the Ironlal l)(me,t the two (thmoidal joramiiui (see jiage ()i ) king siiuated either ch. ,i to (-r ac tually m iht froiito ethmoidal sv.ture (Figs, ijs and 06V The margins of the adjacent iM.nes .lici more or less in ilcsing in thr .llimoidal eel',-. The internal wall of the echmoiik I labvrinth (Figs. 101 awl ioj> forms the ujiper i«)rtiry. H f its posterior extremity is attached to the similarly named crest of the palate bone. Between the sui)erior and middle turbinated bones is situated the superior meatus ot i ic nose, whicK is short and developed only in the j)osterior portion of the nasal fossa-. Between the middle and inferior turbinated bones (the latter structure iK'ing an independent bone) is the middle meatus, in which, covered by the middle turbinated bone, there is a bulging of the ethmoidal wall, the ethmoidal bulla, a rudimentar>- turbinated bone, and another rudimentary turbinal (the osnaso- turbinale of the mammalia) is the sickk-shaped uncinate process (Figs. 8i and 102), which is also covered bv the middle turbinated bone. It articulates with a j)rocess of thi inferior turbinated bone (see below) and helps to close the orillce of the maxillarv' sinus. Between the uncinate process and the etlimo-lal bulla is a wide fissure, the injundibulum, which leads both into the orifice of the frontal sinus and into the ethmoidal cells; its orifice in tne nasal fossa is known as ihc hiatus semilunaris (Fig. loi). The ethmoidal cells communicate partly with one another, partly with the air-cells of the adjacent bones, and in all cases, either directly or indirectly, with the nasal fossae. The ethmi)i(l txme is cnmplrti-ly |>rrfn\-mc(i in cartilagi-. Ossification commi-nccs late (in the fifth month of cm- Ijrvonic life) and prts of a bnial Inme by the lachrymocont hal suture, and forms a jiortion of the wall of the nasal duct (nasolachrymal canal) (Fig. ;()). Thv ethmoidal process (Figs. 81,82, and 102) is directed ujiw,!- nd backward and artictilates with the uncinate jirocess of the ethmoid Ixme in the regio the orifice of the maxillary sinus. The inferior liirliitialed 1. .n. ussjfi.s in immediate connection with the ethmoid Ixmi- in tin- fifth month of em- bryonic lifi . THE LACHRYMAL BONE. The lachrymal hone (Fig. 781 is an approximateh' rectangtilar bony plate, ven- thin and frequently even perforated, situated in the inner wall of the orbit between the frontal jirocess of THE BONES OF THE SKULL. f>> the maxilla and the lamina papyracea of the ethmoid bone (Fips. 95 and 96). It articulates with the nasal portion of the frontal bone above, with the inferior turbinated l)one bel v, and extends inward as far as the nasal fossa (the sutures are considered ujjon papie 79). It presents an external or orbital surjace, and an internal or rtlvnoidal surjaic, which is in contact with the ethi-'ioid bone. The ethmoidal surface closes in the laihrymal tells, and a sniall {x>rtion of it aids in the formation of the outer nas;d wall in the middle meatus, as it articulates w'th the lachrvjnal process of the inferior turbinated lx)ne by the lachnimoconchal suture (Fig. loi). The anterior ]K)rtion of the orbital surface exhii)its a widi groove which, together with a similar groove on the frontal ])roc 'ss of the maxilla, forms a dejjression for the lachr}mal siic (see Fig. 77). The jx>sterior bouni.an,' of this ile])ression is the poslrrior lachrymal crest which extends downward into a hooic like irocess (bent up anteriorly), the hamulus lacrimalis (Fig. 78). This is situated in Jie lachrymai notch IxHween the frontal process of the maxilla and the orbital surface of the Ixxly of the same Ijone (see page 67). The posterior jwrtion of the orbitai surface, situated Ix'hind the lachninal crest, is smooth. [The laihrymal liono is formni I'v ossifiiation iif mcmlirano and usually develops from a single cirUir whii h a|i|Hars during tli' liird or fourth month of fetal lifr. ( )i i asion.'lly tworcnIiTs apj.rar, from onr of \vhi( h the harv.ulus ili'vrlo(is, and moR- rarely a number of centers cki ur, in whii li ease the Ixme is represented hy a numlxr of se|ii Mle parts — Ku] THE NASAL EONE. The nasal bones (Figs. 86 and 87) are two Hat, elongated, tr:ij)ezoidal Ixines, which meet in the median line to form the bridge of the nose (Figs. ^7 and ,v*^'- The interna al suture separates the short internal margins of the i -o Ixmes, while the external margin of each, consit'er- ably longer, articulates with the front;.' oeess of the maxilla b\ vhe nasi)ma\illar\- suture. The shorter and thicker sujjerior margin is in contact v'th the nasal |.orti )n of the frontal ]x)ne by the nasofrontal suture; the longer and thinner inferior margin forms ihe upper ljounf ox-.ili. alion whic h appears in r.enibrane at atxml the third month of fetal life. At birth the length of the Umes hardly excwds their breadth. — Si) ] i IH' THE VOMER. The vomer (Figs. 73 to 75) of the adult skull is a tlat single Ixine, approximately trapezoid in shape, which fonns the inferior and (Xjsterlor )K)rtion of the lx)nv nasal seittum (Fig. 7^1. its upper end is thickened and spread out into two plat's, the ahr (Fig. 741, which articulate with the inferior surface of the Ixxly of the s])henoid Ixjnc in such a manner that the sphenoi(kil rostrum is received between them, while the vaginal i)rotes.ses of the pterygoid prcness and 5 66 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fig. yj.—The osseous nasal septum seen from the left side. The frontal, sphenoid, maxilla, and palate bones, and al^o the lamina cribro! a of the ethmoid and the ala vomeris, have been sawed throuf^h close to the median line. The ethmoid is yellow, the vomer (e.xcept the cut sur- face of the ala) pink. Fig. 74.— The vomer seen from behind (\). Fig. 75.— The vomer seen from the side (}). Fig. 76.— -The right maxilla seen from the inner surface (\). Fig. 77.— The right ma.xilla seen from the outer surface (}). the sphenoidal process of the jialate bone (see page 70) arc applied to their margins. The pxjstcrior border of the vomer forms the septum choanarum; the narrow anterior border articulates with the cartilaginous septum of the nose and the anterior portion of the nasal crest of the maxilla; the superior lx)rder is attached to the peq)endicular plate of the ethmoid; and the inferior one is firmly fixed to the nasal crests of the maxilla and palate bone (Fig. 73). The vomer arises during the third month of fetal life as two plates situated one on either side of the upper part of the cartilaginous septum of the nose, which subsequently disappears, so that the two plates become adherent after birth, with the exception of the ala-, which remain separated throughout life. THE MAXILLA. The maxilla (Figs. 76, 77, a.id 79) is a paired lx)ne which forms the center of the facial skeleton, all portions of which arc more or less intimately connected with it. It assists in the formation of the orbit and forms a considerable portion of the nasal fossx and of the roof of the mouth. It consists of a bmly and of four processes, the jrontal or nasal process, the zy_qomatic process, the palatine process, and the alveolar process. Of these, the aheolar process is directed downward and the frontal process upward, while the zygomatic and palate ])nKesses extend in the hori- zontal plane, the former externally, the latter internally. The body of the maxilla is irregularly cubical, and contains a large cavity, tht. maxillary sinus (Figs. 70, 79, 97, and ()&}, also known as the antrum oj Highmore. In the body there may be recognized four surfaces: the anterior, the nasal, the orbital, and the injratemporal. The actual facial surface of the bone, the anterior surjace (Fig. 77), is convex, and i'- sui)erior loonier forms a ])ortion of the infraorbital margin. Helow this margin is an irregula. rounded opening, the injraorhital joramen (Figs. ,^7, .^jS, and 77), which gi\es exit to the vessels and nerves of the siime name and is the termination of the infraorbital canal. Below the infra- orbital foramen there is a (lei)ression, the canin( jo'isa, which gives origin to the musculus caninus (levator anguli oris). The anterior Ixirder of the facial surface forms a portion of the lateral l)<)undarv of the apertura pirijnrmis (anterior naresi.and at the infraorbital margin the surface becomes continuous with the triangular orbital surjace, which articulates with the lachrymal, zvL^omatic, and ethmoid Ixmes. but is se[)aratett/l /'ni, fill Mil fat luherosity „,.,,„,,/ ^ lnfn„;l„t„l m,,,^,, of maxilla Infraorbital t;i\ •0V( Frontal process (anterior al Ineisivi canal f^jcr, 7(j. Infratemporal . . <| fe' surface \>^\ .\lveolar foi amino Zygomatic process j 'j*'. ' ^ "^^■^m THE BONES OF THE "KUI.L. 67 The infraorbital groove pratlually leads into a canal, the injraorhilal canal, whirh runs to the infraorbital joramen. The inner margin of the ortiital surface presents a notch, the lachrymal notch (Fig. 77), which accommodates the hamulus of the lachrjmal Ixme. The infratemporal surface (Fig. 77) is situated Ix'hind the zygomatic process, toward the infratemporal and sphenomaxillar>' fossie, and represents the j)Osterior surface of the Ixxlv of the ma.xilla. It bulges somewhat posteriorly, forming the tuberosity, and jiresents a pteryf^ofx- tine grome (see page 79), and also from two to four small foramina, know, us the alveolar i,..a- mina,* which transmit the nerves and vessels of the sami name. The superior internal angle articulates with the orbital process of the palate bone. The nasal surface (Fig. 76) forms the lower portion of the outer wall of the na.sid fossa; it exhibits a large irregular opening, the ori/ice of the maxillary sinus, .^bove this orifice there are usually fossa and depressions which close in the incomplete maxillary cells of the ethmoid bone. Only a small part of the anterior jjortion of the na-al surface is ex])osed in the lateral nasal wall, the entire roughened posterior jwrtion of this surface tx^ing concealed by other Ixjnes, namely the palate bone, the inferior turbinated bone, and the Mncinate process of the ethmoid (Fig. 81), which considerably diminish the size of the orifice of the maxillan,- sinus (see also page 69). Refeen the orifice of the sinus and the frontal process there is a deep gr(X)ve, the lachr lal grooin iFig. i)o), which is converted into the nasolachrymal canal by the lachrvmal bone and the lachrymal i)rocess of the inferior turiMnated Ixine (see page 64). The transition of the nasal surface to the frontal pnKcss is indicated by a rough ridge, the comlial crest (Fi". 76), for the attachment of the anterior portion of the inferior turbinated lx)ne {concha msalis inferior) (see also page 64). The upper extremity of the frontal process articulates with the nas;il jiortion of the frontal bone by the frontomaxillar)- .suture; its inner margin is in contact witli the na.s;d txme bv the nasomaxillary suture, and its outer or lachrymal border is oj)ix)sed to the lachrj'mal Ixjne along the lachrymomaxillan.- suture (Figs. ,^7 and 38). It narrows as it passes upward and presents an external surface, forming the lateral portion of the lx)ny nose, and an internal surface, directed toward the na.sal cavity. This internal surface is seppr'ted from the nas;d surface of the Ixxly of the lx)ne by the conchal crest, and parallel to t' are is a less ])rominent ridge, the ethmoidal crest, for articulation with the anterior pi . the middle concha of tlie ethmoid bone. The external surface of the frontal process presents the lachrymal f^rooir, which, together with the .similarly named gnxjve of the adjacent lachrymal bone, forms a : iressinn for the accommodation of the lachrymal sac. The sharj) anterior Ixirder of this tossa is called the anterior lachrymal crest (Figs. 77 and qs). The frontal ])rocess also forms tlie largest i)art of the lateral lx)unflar>- of the apertura piriformis. The zygomatic process (Fig. 77) is broad, short, and three-sided, and terminates in a rough articular surface for the Ixxly of the zygomatic lx)ne (zygomaticomaxillary suture). The maxil- lar)- sinus extends into the ba.se of the jjrocess. * These lca'■'. '■ { //>. 82. l-i<'. SI. m- m : THE BONES OF THE SKULL. 69 In the skull of the new-born and of the child the hard palate always shows an incisive suture, which is also frequently observed even in adult life (Fig. 100). In thi- fetus \iolh {hv im isor lei-lh and thiir alvioli arc situatiil in a special Ininc, thi' inlrrmaxillary hove or iw inci- sk'tim, whiih also forms ihc anlcrior jMirtion of the hard palate. Although the portion of the incisive suture inditating the Uiundary iH-twcen ihi' intermaxillary Ixine and the alveolar piotess usua..y ilisappears liefore hirtli, the iiKisi\e suture upon the hard palate is maintained for a eonsiderably longer time. The upper jaw is formed in membrane towanl the end of the sei ond fetal month, from four or five ( enters of ossi- fication, two of which form the intermaxillary l)one and remain independent longer than the others, whiv h usuallv unite as early as the fourth month of fetal life. The infraorbital suture is another indication of the ortinn of the maxilla and also articulates with tile splienoid (body and pterygoid processes) and with the inferior turi)inated Ijones. It consists of two rectaiioular txiny l)lates placed at right angles ti> each other, one, the Itnrizonlal pUile, being in the hori/onlai, and the other, the perpendicular plate, in tile sagittal plane. The palate ixme also posses.ses three ])r')cesses. The Iwrizuntal plates of the two p.ilate Ixmes form the ]iosterior portion of the liard pala'e (Figs. 41, 42, and 100). They articulate willi each r>tlier in the posterior jiortion of the midille jialatine suture, and with the palatine processes of the nia.xiila in ihe transverse palatine suture. .\t the ])osterior extremity of tlie median suture tlie two palate ixmcs logetlier fonu the posterior nasal spine (Figs. S? and 100), as well as the ]io-.HTior iiorlioii of the nasal cresi upon the nastl surface of the hard palate (Fig. 7S1, and their ixistcrior margins form the lower boundarv of the choana' (Figs. 41 and 42). The rough ])alatiiie surfaci' of the hori/oiiial \<\mk- (Fig. too,', like the similar surface of the palatine pn«(s,> of the ma\illa. exhiUil- jialaiine spines and grtMives, and also presents, near the posiero external aiigK, the x'''""'"' palatine joramm. one of the oriliies of the pteryi^opalatim laiial. The nasil surfac,- (JMg. -,,1^ lioweM-r, i- snxMilh anil distinctly concave, like the corresponding surface of the palatine prods- of ihe maxilla. 'ilie perpendicular plate of the jialate Ix.nt' i- narrower and thinner, but loni.'cr ili.in the hori/.onlal one. Its maxillary surjace (Fig. 84^1 is a].plied to ihr lough siirfatf of llir poslcrior portion id" the na-al surface of the maxilla and abo partl\ lit- i;i from of and parlb closes iln orifice ot tlu ma\illar\ sinu-. Its internal or i;./,v.;/ surjace d-'ig. 85) forms the posterior portion of til. Literal n.isd wall 1 Figs. 101 and 102), and pn-enis two hori/oiilal parallel iiimilarlv nanuil grooves of the maxilla (see • 'K ,••; -'"'I ■■: 1:1: |-f. ._i^--!i! j)nn.vr-. td ;iie rijiiie;;ia:! iione ; see riU'. ^ ^ :, iorjo- !iu p!,T\-:^,:p.;;.l tine canal, wlio-e inferior exiremity is the |ire\ioii-lv mentioned i:rcaler palatine Jorannn. Iti ils vitinily are also the orifices of .several smaller lateral tamilication-, the palatini niiials. mosi 70 ATLAS AXD TEXT-BOOK OF HUMAN ANATOMY. Fig. 83.— The r.uiu i)alatc bone seen from behind (j). Fig. 84.— The rijjht palate bone seen from the outer surface (\). Fig. cSs. -The riijht palate bone seen from the inner .surface (}). * = surface whicli lompktis the pliryKoid fossa. Fig. 86.— The left nasal hone seen from the outer surface ({). Fig. 87. — The left nasal hone .seen from its inner surface (}). Fig. 88. —The right malar hone seen from the outer surface (}). Fig. 8q.— The right malar bone seen from the temi)oral surface (\). of which perforate the pyramidal process and end on the hard jjalate as the lesser palatine j Oram ilia. Of the three j)rocesscs of the ])alate Ixine, the pyrniiiidnl process or tuberosity passes back- ward from the junction of the two ])lates of the Ixine, fillinK in the jjtervgoid notch of the ptcri'- goid processes of the sphenoid bone and coinplelin},' the pterj-god fossa. The other two prcKes.scs, the nrhiial and the sphenoidal processes, are given of! from the upper portion of the perpendicular ])late alxive the ethmoidal crest, and arc separated from one another by a deep notch, the sphenopalatine notch (Fi^'s. 84 and 85). The inferior surface of the body of the sphenoid bone con\erls this notch into the sphenopalatine jorainen (Fig. 102), an imi)ortant communication Ixtween the ptcrxgopalatine (sphenomaxillary) foss;i and the nasal cavity, which gives passage to ves.sels and nerves (see page 78). The orbital process (Figs. 8;, 8^, and (>0) is the anterior and larger of the two processes, and is directed outward. Its upper surface forms the most [wsterior [Kjrtion of the floor of the orbit, articulating with the lamina papyracea by the j)alat(K'thmoidal suture and with the orbital jwrtion of the maxillu by the palatomaxillary suture. Its anterior surface is closely ajiplied to the maxilla, while the internal one has an irregular Ixjundan.- and articulates with the ethmoid lab\rinth, where it assists in closing in -^ome of the ethmoidal cells, the palatine cells. The orbital jjrfxess is also in contact with the external surface of the Ixnly of the sphenoid bone by the s])hen(X)rbital suture, and forms I'.ie posterior |)orti()n of the inner margin of the inferior orbital ispheiiomaxillarv ) ri>.sure. The thin i)osteri<)r splienoidal process iFigs. 8;„ 85, and 101 1, directed internally, is a])plied to the ala vomeris. to the inferior surfice of the b..rn '111. ..rliil.il -iirfa..- ..f ihi- ..rhiial pr'Kcss is s.ini. linns iimisd.illy larKi-. an.l ili.- width ,,f th>' |nr|u ii.li. uiar plate is sulijril I.) Rrcat indiviilual \.iriatii.n. THE ZYGOMATIC BONE. The zyKomalic cr malar Ix.nes (Figs. 88 and 8<)) are three sided, flat, strong bones which form the prominence of the cheek. They artic\datc with the fnmtal, .sphenoid, and ma\illar)- l><)ni'>i ^Fi"* '" a"'l •>*** Tn.l ..l.j.> >• ills lis., •j.^s. ...... .1 I...,.,. U.. _. ft'- 1- !-• ' I •! over the temporal fossa (Figs. T,q and \o) (the suiures are dest ribed upon pages ^7 and 80). The small orbital plate. ], laced at right angles to tht malar surfaie, a.ssists in the formation of Orbital pnurss Sphenoiildi pmrss Siihciiopalatine notch Orhiliil piVff^s Horizontal plate I'oslirior IHISIll spi'/ii- Maxilliiiy siir/'df f-'i'r. 84. I 'tiiygopaliiliiir !>roovc if^rcatir /nihitiiit' fontnien) Xiisii/ lofiinuii Hfr. SO. I roiitii- s/i/iiiiiin/ii/ <>r/>itii/ siirftin \ I 'tnys^opiiliiliiw !,'yvi()i'/' Perpendicular plate Orhiliil piiH t thmoi- iliil .V V'ss >/'//f fii*/iu/i/' ' nut,!' -V I'yniiniiltil fig. Si f-'i''. S5. I ( s^(^ /I :,'iin:li I I'm 'III n lhiiiiitiil l',>niiiniiii /-a V''"'"'"'/i"' . MM iii'.i. . . . ihhiliil \iiiitirr /ilOii^-. /v:;,;i.,i,n,''"f"'i' '■"•'' ""■''•"" hiltil /{ ■,iii>in ^ 1 1 tniiiiriil ntjt. ^Ill/ill yllliilll 1 1 ill/l,'l,l,' -.III lilil ^ 1 1: it^. '. SO. -"..- ( ^?^ % 1 3&Ji' -*fe- -^^^i I THE BONES OF THE SKULL. 71 the orbit. Tho malar l)Gnc i^rcscnts three surfaces, the \add or malar surlacc, the poslcnor or temporal surjace, and the orbital siirjace formed by the upper surface of the orbital ,)late. The or6//a/ .w(r/arr is slightlv concave and its anterior border forms part of the infraorbiial margin (Fig. 95). It articulates with the orbital surface of the greater wing ol the sphenoid bone is usually separated from the orbital surface of the maxilla hv the injcrwr orbital (spheno- maxillary) fisurn; and forms a portion of the fl(K,r and of the outer wall of the orbu Upon this surface is the zvgomaticoorbilal joramnt (Fig. 88), lea.ling into a branching canah whose cNtcmai orifices are the zvi^omaticolcwporal an.l zviiomatirojaaal joramnu,, although frequently these two canals are entirely independent of each other, in which case there are two zygomaticoorbital foramina (l"ig. 88). The quadrilateral malar plate possesses a convex malar surface and a s. ghtly concave temporal surface. It articulates bv me.-ms of its anterior rough margin with the zygomatic process of the maxilla, an.l in common with the orbital plate it gives off the jroutosphnuwtal procns (Fi"s. 88 and 89), which j.asses ui)wanl. forming the outer margin ot the orbit, and articulates with the zygomatic process of the frontal U>ne an.l the zygomatic Ix.rder of the greater wing of the sphenoid tone. The temporal process ,,asses posteriorly to form th.' zygoma bv articulating \vith the .'.vgomatic j^rocess of the temporal Iwnc (Figs. 39 and 40'. I he sutures between the zygomatic and the adjacent lH)nes hinv been previously r.ote.l (page ^7\ ''md will be reviewed in another place (page 80). The malar surface a,ovs the zy,>;omaticojae,al joramev (Fig. 89); the temporal surface, the =\\qomalicolempor|) from two scimrati' (I'ntiTs of os.silKaliim. In r^ri insUinri'S the tw purUn : : lumr. whi, h n, ,v iK. socn a, aU.u, U. ..1- of ih.- , sine .ho bon,-!,.. anally push.-, ou,..n. . nnn. i,. .l.:v.lopn».n, an.l .luring ih. Rnnv.h „f th. in-,livi.lual, i. bapp.ns .ha, in on.-half of .h. -ponnu-n. .h,- .rh,.al .urla. no lonpr forms ono of ihr l>.mn.larirs of thr nf.rior oil.ital ( -uhcnomavillarvl hssurr. THE MAT'DIBLE. The I le (Figs. 90 to 9U is a singk In.ne, an.l i^ the only t)one of the skull whi.h is connecle.1 remainin^ b • bv a joint instea.l of by sutures. It consists ot two main ,K>rtions, a u„ly an.l two rami. Fhe upper en.l of eacli ramus is composed of two |.r(K-esses. an anterior pointed corom,iroress an.l a i.osleri..r roun.le.l eowlyhul proee^^ (I'lg. .),V. tl. two being separatc.l bv the ,wl< I, oj the ma,„tible isi^moi,! ,wt,ln. The body of the nian.lible is an apprt.ximately paral..loi.l Ix-nv i>late fn.iu the ,,osteri..r extremities of wliu h ihe ram. pass vertically upward. Its inferior margin is terme.i the base of the mau c ^J ^^^^^^^ ^^^^^^^^^^^ ^^.^^ a^vay, and finally entirely disappears somewhat to the 90 and 90- . , , I f ,h,. i^mdible (Fi"s. 02 and c),V) exhibits, to either side "^ The internal surface of the bcxly of ^^e ™hbl ^. ,,^_ .^ ^^,^.^,^,^,,, of the median line, a shallow deprc.su,n -'- ^^^^ ^ 2, a J. this there i. a ,hort, rough, Uu. mser-ion of the anterior IxUy of the '»'f- " ^^^X' a paired structure an.l son.etimes also irregular prominence, the ,.«/././>;-, ^^^^^^ ^'^^ ,,,,,,hvoid and geniohvoglossus shows a further transverse sul.ln.s.on; .t «'^^ ""^^, ^^^^^^'.hallow depression which lodges niuscles. To the outer side of the mental spme ^^ ;;';,,, „L is the termination Uu. sublingual s^divary gland, and between tesb ^^^^^ ,„., from alx.ve downwanl „f U.e rough ,„yloM Inn: which i;--;/:2le3 gives nri.in to the mvlohvoid nmscle. ,„.,„ uu. inner surface of the l.dv of he - -d Ic^.m ■ . ^^^,^^^ ^^^^^^^^^^^^ ^^ ,^^ ■ A certain distance below the mvloh>oKl hue th r. *^ „„, ,,,,u- -:, i::,;::;;:":, .;::::--:r::i:;:;.: - ^. « - --" •"- Mon for the .ubmaxiUary glan.l. ^ ^^^ .^„,l ;, ,^,jh broader and K.ch ramus forms almost a r„bt -fl'-^^^^^' ,,;,,, ,,,. ,,.0 ,,nKesses. an anteri..r „„„,, ,Han the IhkIv. It passe, upward, '^ -' " ;;'^ J;^^, ,, „,■ notch of the mandible anonoul and a ,,o.tenur .n,uHo„! I^rou • , whuh arc scparat . ahe Mi-moid notch). ,.vi..rnal surface and an inl.rnal surface. The ramus, like, tl.c lx>dv of the bone, poss.^se. an U mal . ^^^^^^^ ^^^^^^^^^ ^^^,^_ ^^,^^ , ,.nion of the latter being directed toward ^ ^^^^ ^ ,,^ ,,^, i„^,,,,„ of the masseter for :hr insertion of llie internal pterygoid muscle. ^^ ^ _^^^ „,„„.r,hnlar iiuirrior dcnlar) Al .dHHU .he middle of the rann.s uie. -^-^-;;--:;^ ,;,„„i , ,„„./* which passes /«nimnMFig..,,V.thesupenoron.-'-.ngofth. m.,m// , , , v„n,l Ih. numal fwr..nur. aln.oM tu tlu nud.an hnv ..n.l ,i... ,„T .,,,..11 l.,u r,,l r..mitK:,nM„. «h. h L-l ." "'^' '^l'"" "' '^'^ "''"""• ^■f^K?a^ ■„ tv. .f<;::',-(TS ■ nir iin-TTi-mimiTrriia—Mi ()l)liiliii' liiii Miiiltil l\ri/t Of i\'ii,lv!oid //-'. Oi. Malta/ spinr Sn/fft/n.\fi/iiry ilrpnssioti it :^. ^>s'f:^sm^^mm^ss^si£^^mm THi: BOXES OF THK SKIILL. 73 obliquely through .nc mandible to the mental foramen and transmits the inferior dental vessels and nerve. A thin tongue-shaped bony plate, the lingula, overhangs the anterior margin of the foramen. The coronoid process is llattenefl from side to side and terminates in a more or less sharp apex which gives attachment to the temporal muscle. In the ])r()longation of its anterior mar- gin runs the previously described oblique line, and passing from its base to the region of the last molar tooth is a ridge, the buccinator crest (Fig. 93), for the origin of the buccinator muscle. The condyloid process terminates above in a condyle, whose head (Fig. 91) is sei)arated from the base of the ])roccss by a constriction known as the neck (Fig. 92 ). The articular surface itself is ellipsoidal and its longitudinal axis is i)laced almost transversely, although directed somewhat ])osteriorly, so that the condyloid jjrocess, in contrast to the coronoid, is c()m])ressed from before backward. U])on the anterior surface of the neck of the condyle there is a shallow pterygoid depression, which receives jiart of the ins-rtion of the external ptengoid muscle. The lower j.i\v is formed in memhrane about Mt< kel's c arlilane, u larlilagc c.f the visceral skelitcm wliic h niark^ the position of the adult mandible. The first center of ossifuation ., ipears in the M'lond fetal month u|H)n Uith si(Us externa! to Meckel's cartilaKe; a second center appears above the first, and the tv.o unite in su( h a manner that ihey form a groove which is open alxne for the reception of the teeth. Kven a', birth the tvso halves of the mandible are usually separated by a synchondro.sis, and they do not unite until the first year. Tlic mndyloid proi ess is preformed in c artilage and is developed by the let; the ethmoid orange; the lachrymal pink, the sohenoid creen; the nasal, parietal, and zygomatic Iwnes white; and the palate bone blue . b . foramen. Its base is a quadranj.'lc with rounded comers, and foiros the entrance to the cavity (ad litis orbita). The four walls of the orbit are designated the superior, the internal, the cxtem.ii, and the inferior. Since thcic is no sharp dividing-line between the superior and internal and between the internal and inferior walls, and also since such a dividing-line is partly absent between the external and superior wall, the pyramidal orbital space [jossesses for the most part no sharj) angles; inrleed, posteriorly the pyramid has ])ractically but three sides. Each orbit is formed by seven bones: the frontal, the sphenoid, the ethmoid, the lachrymal, the maxilla, the zygomatic, and the luilatine. The sutures Ijetween these bones arc descrilied on pages 79 and 80. The upper wa'; 'ir the nxif of the orbit (Fig. 95) is formed bv the orbital portion of the frontal Iwne, and in '.he jjosterior portion also by the lesser wing of the sjjhenoid bone. It is horizontal, smooth, and slightly concave. The inner wall ^Fig. 97) is formed anterioiiy by the lachrvTn: 1 bone and posteriorly by the lamina papyracca of the ethmoid lx)nc and by a sn.iU portion of the ala parva of the sphenoid (near the junction of the inner wall with the roof). Below the lamina jiapyracea, the orbital surface of the maxilla extends upward from the tloor upon the inner wall, and its frontal process also forms a narrow jrortion of the inner wall, internal to the lachrymal Ixine and immediately adjacent to the internal orbital margin. The inner wall of the orbit is approximately vertical and its anterior jtortion exhibits the fossa for the lachrymal sac. The floor of the orbit (Fig. 99) passes quite gradually into the inner wall, and its posterior I)ortion is separated from the largest (jxisterior^ portion of the outer wall by the inferior orbital (si)henomaxiliary) fissure. Its greatest [lortion is formed by the o^-bital surface of the maxilla, only a small posterior jxirtion being formed by the orbital j)rocess of the i)alate bone. In the anterior portion of the orbit the zygomatic bone also forms a narrow strijj of the lloor, but the extent to which it takes part u subject to considerable variation (see page 71). The inferior orbital wall is quite smiilal ■" 'tt'h Jhniminu / lontottiaxillary ,i/iii/nrt'i'- t.i-y,/ Ih'Uiil ii[v,,
  • -) and contains one shallow notch or two - mit the frontal and sujjraorbilal vessels and nerves. The frontal hone exiends lower down internally than it jIocs externally. The infraorbital margin (Fig. t/j) is formed internally ijy the maxilla, and externally by the zygomatic ixjne, these Ijoncs extending intirnaily and cxtemallv as far as the frontal lx)ne. \ i)orlion of the internal margin (Fig. ();) is furnished by the anterior lachrvmal crest of the frontal prmess of the maxilla, and its smcxHhest jvortion is .situated alK)ve this crest. The external margin (Fig. 97) is formed by tlie zygomatic l)one, particularly by its frontosphenoidal process. The following foramina and fissures lead either into or from the orbit: 1. The opllc joramcii (Fig. 9O), situated in the nnit of the lesser wing of the sjilunoid lx)ne, leads from the cranial cavity to the apix of the orbit ami tr.msmits tlie optic nerve and th( ophthalmic artery. 2. The supirior orbital (sijhenoidal) jissurc (Fig. 95), between the greater and lesser wing of the si)hcnoid, also leads from the cranial into the orbital cavity and ininsmits the ojiiithalmic, oculomotor, trochlear, and alxlucens nerves ;md the .sujierior ophllialmii vein. This fissure se])arates the outer from the U])i)er wall of the ori)it. Its inlern;il portion i-. wide; its external j)ortion i.s narrow and closcne on one side and the gre;iter wing of tile sjiheiioid Ixme or the greater wing and the zygomatic lx)ni' on the other, le;ids from tlie pterygopalatine (spiunoni.ix illary) fos-sa into the orbital cavity and transmits the infraorbit;il vessels ;ind nerve. It .separates the outer wall from the tlix)r of the orbit and is larger antem exti rnally tli;in it is ])ost('ro internally. The external boundary of the fissure is furnished l)y tiie crista orbiiali^ nl ilie greater wing of tlie sphenoid txme. 4. The sujfcrior oi)ening of the uasolai hrymal iitasal) canal (I'"ig. 1)9), in tiie fos.si fur liu' lachrvmal sac; tliis canal leads from tiie orbit, d into liie n;isiil i .. il_\ .iiid traiisniit> the na>o lachrymal (nas;d) duct. 5. The anterior itlimoiilal joramcii (Figs. <); and ()(>), jiiissing from tlie orl)it;d to the cranial cavity and transmitting the iinterior ethmoida' essels and nasal luTNe. 6. The posterior ethmoidal joramen (Figs. <)^ and 96), le:iding into tht- nasd cavity and transmitting the posterior ethmoidal vessels. Hoth this and the preieding foramen are siluateniit the ner\es ,in i Is of the same name or tluir brarulus. 8. '{"he entrance of the injraorbital laiial (for the vessels and nerve uf the same name), ti 76 ATLAS AND TKXT-BOOK OF III MAN ANATOMY. Fig. 98. — .\ frontal section tliroujili the anterior part of the skull, showing the orbits, the nasal fo.ssx, and the ma.xillary sinuses (i). Fli;. t)(). — The lloor of the left orbit seen from above, the roof havint; been removed (}). Fli;. 100. —The maxilla, palate bone, and lower ends of the jiterygoid i>roeess of the sphenoid, seen from the oral surface (the hard yialate) ( [). leading, to the infraorbital foramen, is situated in the lloor of the orbit, ll commences al the inner end of the inferior oruital fissure as the infraorbil il .groove {Fi<,'. ()q). Q, The jronlal and supraorbital joramina, situated ' the supraorbital marf^in. The orbit contains the following depressions or fossa-: 1. The jossa jor- the ladirymal gland (Fig. 69), on ihe frontal lx)ne beneath the outer ])ortion of the sujiraorbital margin. 2. The trochlear (lcpr(!:sioii (Fig, 68), also on the frontal Ixjne, where it passes into the inner wall of th'- orbit, for the attachment of the iiuUey of the superior obli(|ue nuiscle. _S. The jossa jar the lachrymal sac (Fig. ()<;), situated in the inner wall of the orbit Ix'twcen the anterior lachrymal crest of the frontal process of the maxilla and the posterior lachrymal I rest of the lachrvmal Ixme. The onlv groove in the orbil i^ liie liijraorhilal i^ronvc (Fig. {)H), u|)on the orbital surface of the l)0(lv of the maxilla. There are several ]irojections into the orbital cavity. These are the anterior and posterior lachrvmal (rests which fomi the fossa for the lachrymal sac, and a Ixinv spine u])on the greater wing of the sphenoid lx)ne near the outer margin of the superior orbital lissure, the spiiir jor the cxirnial rrcliis muscle ( I'"ig. ()()\. 'Fhe frontal bone occasionally presents a trochlear spine alongside of tile lim iilear depression. Till iirMl.il u.ilU v;u\ KN .Illy in lluir lliii liiii ^■,. Tin' ihiiun ^1 w.ill i> ihi' iiiiur ■me, Imlh in ihc riKinti ni tln' lamina |>.i|'yr,i,i .1 "1 llic (llinioiil %iiu' .mil iiNo in ih.it of ihr lai lirynial Ixmi'. llir latl'T lumr even Ihiiik .nmitiniis (l(fiiliM Tlu r"A "f llir '■rhil nut infn<|uiiilly inntainN .i |iiirliiin of \\n- fnmtal sinus, in whiih lax- it h, holloa. Till null r w.ill is u^u.ilK ilu' ihii ki I. THE NASAL CAVITY. The l)on\ nas;il cavity (J-'igs. ()o, loi , anil to.' i issubcHvided into two symmetriial na.sal fossiu b\ ilu iiavil se|)tum, which is fii<|uently obliinu and not exactl;, in thi median siigittal plane. I'he i.uitv i-- liighi'st jiisi beiiind tile aiiUrior nares and gradu.diy Ihioiiu's lowi r toward the |ios|i rior nans, ;ind nine of liu- Imuhs of thi- skidl the nasal, frontal, etiinioid, sphenoid, maxilla, palate, infiiinr turbinated, lailiniiial, and \oiiur take part in its formation. In cat h nasal fossa the re may tie ri < "ni/ed a riMif, a HcHir, an internal w.dl, .ind an evternal wall. The anti rior opening of ilu two iMin nasal fossa' is knnwn .is ilie apertura pirijormis (anterior naresi, wliile the posterior upeniiig of eai li i> the choaiia. I'he former i I'igs. ;; and ?8| i^ Ixmndeil l)y the niisal Imni's ;uid b> tilt frontal pninsses and iKwiies of tin maxilla, wiiile eai h t lioana (posterior iiari-i (Figs. 41 and 4J) !'« imunded by tlie palate iMiiie. the internal plate of thi' plen'g'>id pHMess, and tin IhxIv iif ilie sphmoid Ixini'. Tin nnif of the nasiil cavity is formeortions also form, so to spea!;, an anterior and a posterior wall. The lloor of the nas;il f .ssii (Fis- 79) i^ formed by the upi)er surface of tlie iiard palale. composed of the palatine prinesses of the maxilla' and the hori/onial ])lates of ilie pala'i' Ixmes. The internal or median wall is smooth and of sim])le composition, the anterior ])orlion being incom])lete in the Ixmv skeliton. The external wall is extremely comi)li( ated. Tin median wall (FI.l;. 72) is the ;/one, the courlui nasi injirior. It is the largest and longest of the turl)inated Ixmes, while the superior is the smallest anti shortest. The superior ard middle turbinated ixmes are pnuesses of the ethmoid lx)ne. The outer portion of each na.s;d fossa is div id'-d into three (anals by the three urbinated Ixincs: the suprrior meatus, Ixtween the suinrior and middle turbinated lx)nes; the middle meatus, txtween the middle and inferior turbinated Ixmes: and the injerior meatus. Ix'twcen the inferior turbinated Ixme and the tloor of the nasal fossa. .\lx>ve the su])erior turbinated Ixme in the su])erior meatus is situated a deft like recess known as thi' sphenoethmoidal reeess. The iK)rti(m of the nasid foss;i situated Ixtween the imier margins of tiie turbinated lx)nes and the na.sal se])tum is termed the common meatus oj the nose.- tile posterior portion situated Ix'hind the ])osterior extremities of the turbinated Ixxlies i> known as the »f tin anterior palatine xessejs and nerve. (f ) The inferior orilicc of the nasolachrynial lan.d in iht inferior meatus, which contain-. thi nasolachrvmal duel. iv??:^:;'^^;::.^ 78 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fir,. loi.— \'ic\v of the lateral wall of the rij,'ht nasal fos.^^a, the nasal scjnum havinp; liccn removed (IV Fic. 102. — View of the lateral v.all of the right nasal fossa, the middle turbinated bono having been removed (i). In Ihcsc limins tin- frontal lione is vioht, the 1:i( hrynuil pink, the rthm< i ..r;iTij;i-, thr maxilla villiiw, the palatini' blur, thi- sphinoid Rnin. anil thr iithir lionis whiti-. Fic. lo.v- -The left pterygopalatine fossa seen from the side, after the n nioval of the zygomatic bone (i). Tlu' ma.xilla is yiliciw, ihr pal iti- l«'ni- blue, the sphcni)i(l pn in, and thi- 7.yf;omatir and tLm|K>ral lionis white. !(/) The lihilus scwiliiiuiris (Fig. loi), in the middle meatus in the region of the infundib- ulum, which leads to the orifice of the frontal sinus ( Fig. 102 ) and to the openings of the anterior ethmoidal cells; the middle meatus also contains the orifice of the maxillary sinus. (<) The ojienings of the midd'e and jMisttrior ethmoidal cells in the superior meatus. (/) The upper and posterior portion of the nasal cavity contains the sphenoethmoidal recess, the orifice of the sphenoidal sinus (Fig. 102), the small posterior etiimoidal foramen (leading into the orbital cavity and transmitting the vessels of the same name), and the spheno- fxiUiliiic jonnihii (Fig. 102), whiili accommodates the ganglion and vessels of the same name anil communicates with the plerygojjalatine (sphenoma.xillary) fofsa. fc^ -i THE ROOF OF THE ORAL CAVITY, THE HARD PALATE. The nxif of the oral lavity ( Fig. too) is f )rme(l by the hani ])alate. It is a markedly concave elliptiial bonv jil.ite, composed of the jialatine ])r(H esses of the maxill.T and of the horizontal jwrtions and 01 part of tiu' ])yramidal processes or tuberosities of the palate lK)nes. It jiresents in the median line the median i)alatine suture, upon which a bon\- swilling, the torus pdlaliiius, is occasionallv observed; it also contains the transverse palatine suture and sometimes the remains of the incisive si'tuir. .\l the anterior extremity of tlie median suture is situated the single incisive foramen, by whiih the bony oral cavity cimimunicates with both bony na. .il fossie; ]M)ste'-'orlv in llie iiori/onial plate of each jiahite Ixuie is the greater jjalatine foramen, and the pvramidal proci'Ss contains the lesser ])alatine foramina (inconstant 1. .Ml these foramina are the orificis of the pler\gopalatine canal. THE PTERYGOPALATINE FOSSA. The plir\!^opalatine or sphciiciihixilhiry jossit d'ig. 10^ ) lies between the anterior surface of the jiterygoid process of the sphenoid bone, the ]Hri)indii iilar portion of the palate bone, and the posterior exlreniiiy of liie maxilla. It i> funnel shaped and is continued direttly downward into the iitervgojialaline canal, whicii is bounded by the same three bones. It opens oMt supe riorly into the interior orbital (si)henomaxillary i lissure which •inumicales with the orbit and e.Mernallv the ]iterygomaxillary fissure connects the ])terygopalatine with the infratem fKiral fossa. Ojjvning into the pterygrjjKilatinc t<>--n an- !!"• j^'r^imrn rnitirJum. by which it communicates with the cranial cavity, the pirryKi'i'l canal, which passe-> horizontally backward in the root of the i)terygoi(l process, and the spin no palatine joramm, hading into the nasal (a\ity. 'i'he fossa contains the sphenopalatine ganglion of the niaxillary nerve as will as arteries and veins. I'rontiil sinus Crista iralli -^'feSS Nasal hones ^ ■ Sii/iir/or Inihinated hone Parietal bone I einporal hone Sphenoidal sinus liasihir portion of orripital bone /yi^onuitie areh rlulr /-VtliillhilroUiluil! tm-::ri!rti ll'nfii^ ^iiinliotnri\ I ninsverse palatine sntiire f-'itr. 101. I rontal s. Ori/iee of frontal ■ni MiMIr tio- liiiatrtt /)(>//( Orifiir IllUlt. ^Itlll> ( 'fttii.:1fi /imr mtixata/ AtttiriiU' Infratemporal fossa Foramen ovale Spine of sphenoid I'teryij^opalatine fos->a Pyramidal proee^^ of palate bone ' Hamnlar proee--s Alveolar foramina 'orm plate < Sn/irrior turbinated hone 'ifiee of ■^phen-^idal sinifi Sphenoidal \inns rior. 11)2. iliilnw foramen nntidai eri\l (if /lalate hone inferior tiirhinaled bone Hg. W'i. I ':''. Incisive eanal e^ Kl^ THE BONES OF THE SKTTI.I.. 7Q The ptcn-gopalatinc canal, proceeding from the pterygopalatine fossa, is formed by the union of the pterygopalatine grooves of the pterygoid process and of the palate bone and maxillary lx)ne; it gives otT tine canaliculi which pass to the nasal cavity, and finally subdivides into a number of canals which terminate in the palatine foramina. THE INFRATEMPORAL FOSSA. The injratemporal (zyjiomalic) j:'ssa (Fig. lo,:!) has only a partial bony boundary, and is directly continuous alwve with the temi)oral fossa at the infratemi)oral crct of the greater wing of the sphenoid bone. It is situated between the infratemjxiral surface of the greater wing of the sphenoid bone, the infratem])oral surface and tuberosity of the maxilla, and the externa! i)late of the pterygoid process. It has no external or posterior boundary. The Sutures of the Skull. The sutures of the skull are subdivided into the long sutures of tlie cranial vertex and the short sutures between the remaining cranial bones. The long sutures are named according to their shape, the shorter ones according to the bones which they sei)arate. Several separate sutures are freiiucntly grouped together and named as a single suture; for exam]>le, tiie fronto ethmoidal suture. The coronal siilinr (Figs. 37 to 40) is situated between the ])arietal margins of the frontal and tlie frontal margins of the parietal bones. The siitiilliil 'Uturv (Figs. 45 and 46) is situated between the sagittal margins of the two parietal Ixmes. The lambdoid sitttiri' (Figs. ,v). 4°, 45, :iri) i^ situated between the occipital margins of tile ])arietal Ixmes and the lambdoid margin of the (xcipital. The siiiKimostu siiturr (Figs. 39 and 40) is situated l)etween the sfiuamous margin of the parietal Ixme and the parietal margin of the squamous ])ortion of tii( temporal. The oca pilomasloiil sulitir (Figs, y) and 40) is situated between tl'.e (Kcijiital margin of the mastoid portion of the temi)oral bone and the mastoid margin of the s(|uamous portion of tlie occijiital. It fre(iuently contains the mastoid foramen. riie Ixiricloimisloid siitiin (Figs. V) and 40) is situated between the mastoid angle of the parietal bone and the ])arictal notcli and a part of tlie mastoi situated i)etween the siilicncidal angle of the ])arietal bone and the parietal angle of the sphenoid inine. The spluitojrontal suture (Figs. v> ^'n'l 4°) '^ situated between the frontal margins ol tiie greater and lesser wings of tiie sphenoid bone and the orbital portion of the frontal \xmv. The spiioi.'oihiiai ^u!Uiy io siuiatcd between the anterior m.irgin of the external ^nrfao' of the l)()dy of the sphenoid bone and the orbital pr(K ess of the palate bone. The sphnirllimoidJ suture is situated lietween the crest of the sphenoid bone and the l)OStcrit)r margin of the perpendi( ular jjlaU' of the ethmoid. i y-: i H So ATIAS AND TKXT-BOOK OF HUMAN ANATOMY. I> ' The .\/)liciwsquamosiil suture (Fi)»s. .^g and 40) is situated between the squamous margin of the greater winj' of the sphenoid Ixine and the s])iienoidal margin of the temporal bone. The jrouUnlhmoidal suture (Figs, j?;, },f>, 4,^, and 44) is situated between the inner margin of the orbital portion of the frontal lx)ne (the outer margin of the ethmoidal noteh) and the outer margin of the cribriform plate of the ethmoid, Ix'tween the posterior margin of the nasal portion of the frontal Ijone and the anterir • margin of the cribriform plate (joramoi rrrnim), and also iKtween the upi)er margin of th ■ lai . ])ap\Tacea of the ethmoid and the inner margin of the orbital [wrtion of the frontal Itone. 1 tie latter portion of the suture i.s in the inner wall of the orbit and frequently contains the etlimoidal foramina (Fig. (/)). The nasDJroiital suture (Figs. ,57 and 38) is situated between the nasid jxirtiim of the frontal bone and the upper margin of the nasal Ixine. The intcrnasol suture (Figs. 37 and 38) is situated between the inner margins of the two nasal Ixincs. The jroiitoiiHixillary suture (Figs. 37, 38, and 95) is situated Ix'tween the nasal portion of the frontal ix)ne and the frontal process of the maxilla. The jrontdaelirymal suture (I-'igs. 37 and 38) is siti'ated Ix'tween the orbital ])ortion of the frontal 1-H)ne and the u])per margin of the lachr>mal bme. The zvgomatieojronlal suture (P'igs. 37 to 40) is situated between the frontos])henoidal process of liie zygomatic bone and the zygomatic (external angulrr) process of the frontal. The splunwzyi^^omatk suture (Figs. 39 and 40) is situated between the zygomatic margin of the greater wing of the sphenoid and the zygomatic lx)ne. The zygonmtieolem poral suture (Figs. 39 to 42) is situated between the tem]>oral process of the zygomatic bone and the zygomatic process of the temporal Ixme. The zy fiomatkomaxilUiry suture (Figs. 37 and 38) is situatetl Ixtween the zygomatic bone and th. zygomatic pnxxss of the maxilla. The nasomaxillary suture (Figs. 37 and 38) is situated between the frontal process of the maxilla and the outer margin of the nasal bone. The etiimoideomaxillary suture is situated at the junction of the inner wall with the floor of the orbit and separates the lower margins of the lamina papyracea of the etlinioitl lx)ne from the orbital surface of the body of the maxilla. The laclirymoconclml suture is situated Ix-tween the lachrymal process of the inferior tur- binated lx)ne (concha nasalis inferior) and the lachrymal Ix) le. The laehrymomaxillary suture (Figs. 31) and 40) is situated in the inner wall of the orbit between the lachrymal margin of the maxilla and the r.nterior (and inferior) margin of the lachrymal lx)ne. The huhrymoethmoidal suture is situate*! in the inner wall of the orbit Ixtween the lachr\mal lx)nc and the lamina papyracea of the ethmoid. The intermaxillary suture (Figs. 37 and 38) is situated Ix-tween the alveolar i)rocesscs of the two maxilUe. The palatomaxillary suture, in the floor of the orbit, is situated Ix'tween the posterior margin of the orbital surface of the maxilla and the orbital process of the palate twne. The palatuelhmoidat suture is situated immediately alongside of the preceding suture n THE ROXF.S OK TIIK SKUM.. 8t betwc.,,1 th. iMsttrior extremity of the lamina papyraca ot thr .thmoid an.l thr orl.i.al pro- cess of the ]>alati- lK)ne. ' The media,, palati„e suture (Figs. 4,, 4,, and ,00) traverse., the hard palate in the median hne. Th^lrcisversr pahthie s,U„re (Figs. 41, ,2, and 100) is sitnate,! Ix'tween the palatine pnx • c.s.ses of the maxilhe and the horizontal j)ortions of the palate IxMies. The following sutures an- inconstant: the wjraorbilal ,„l„re (see pag.' r/,), the „ie,sive suture (see page 6()), the t>elrosq,ta,„osal suture (see j.age 51), the sq,ia,ru,so„uisto,d s,Uure ,see page 5,) the sphe„o„,axillary ,v«/«r,. (between the pterygoid process ami the IxkIv of the max- illa), the jro„lal or ,„etopic suture (see ])age 60), ami the sutura me,idos„ (see page^/) I he petrooecipital and sphe„op,'trosal jissures are filled uith librotarlilage (jetrooccipilal and sphenopetrosal sy,u:lu>ndroses *). The Skull of the New-born. The skull of the new-born (Figs. .0410 ,of.) differs in manv respects from that of adult hfe (sc^ he development of the indivi.lual l)ones of the skull). Th^ verti. al plate of the occipital bone s^fll exh.btts the sutura ,„e„dosa (l.^igs. ,05 anrm large spaces partuular" n or lo,Uuul,, and s..x of them may 1h> recogni.e.l, tw.. of whic h are single an.l t^a, .loubk- .. Ih. lro„ta/ or anterior fo„u,„elle ,Fig. ,05) is the largest of all an.) is .,ua,lrangular in shape, the short .l.agonal being situate.1 in the transverse ami the k.ng .liagonal in th.. ..n t 1 \.^^o halves of the frontal Ix.ne and the two [.arietal lx)nes. 2.Th.- oeripitnl or posterior j„„ta„eii, (Fig. ,05. i> small and triangular, an.l is situat.xl at he junct..,n ..f the sagittal ami iantUloid sutures, between the two pa...tal l>,nes an vertical portion of the occipital Ix.ne. II lill 5-i| * Trui syn. li,„„lroses ,xiM in ilio skuil only iluring rhildliood. 82 ATLAS AND TKX T-BOOK OF HUMAN ANATOMY. Fig. 104. "Skull of a new-born child from the side (]). Fio. 105— Skull of a new-l.orn rhild from above (']). p,(.„ ,06. -Skull of a new born child from behind and .w(]). , The f.vo sphenoidal ]o,itancllrs (Fig. 104) are of medium size, irregular m lorm, jKK.rl) defme.!, and situate.l between the parietal angles ..f the greater xvings (.f the s,.heno.d l..nes and the sphenoi.lal angles of the parietal Ix.nes. in tlu' location of the later-.levelo,.e.l sphmo- parictal suluns and the contiguous bonv margins. , ,- v, 4 The two mastoid jontancllcs (Fig. 1061 are situated between the mastoul angles ot the parietal bones and the parietal notches of the tcm,)oral bones, extending outward to the neigh- boring U,ny margins. They resemble the antero-lateral fontanelles in respect to their si/.e, shai)c, and boundaries. . Bv thr progressive ossification of the flat bones of the cranial vault, the- lontanelles bec.,nie closed 'in the t.rsl vear of life, rarelv later, the frontal fontanelle closing last (at the end of the first or the beginning of the second vcar). .\t the same time the coronal, sagittal, an.l lambdoid sutures develop, whereby small lx)ny areas frequently remain as independent structures within ihe sutures, and are known as supernumerary hones, Wormian hones, or ossa sulurarum. They are particularly common in the sagittal and lamlxloi.l sutures, where they are sometimes j.rcscnt in large numbers and are occasionally of considerable size. The Skeleton of the extremities. The skeletons of the upper and lower extremities are more or less similar. They are com- posed of: (I) The girdle of the extremity, and (2) the free extremity. The shoulder gin le is com,x>sed of the scapula and the clavicle; the pelvic girdle of the two pelvic Ix.nes The skeleton of each free extremitv consists of a proximal, a middle, and a d.sta segnunt, these being represented in the upper extremity bv the bone of the ann, the In.nes of tlie toream., and ,he Ixmes of the han.l, an.l in the lower extremity l)y the thigh-U.ne, th.. rx.nes of the leg, and ,he U)nes of the fcK.t. The skeleton of the pn.ximal segment of each extremity ^;oris,sts ..f a single tenc: in the up,K-r extremity, the Innnerus; in the lower one, ^h. /enu.r. The muUlle segment is fonne.1 bv two bones: the radius ant, contain a number of Ix.nes, those o the h-in.l bc-ini' sulxlivided into the carpal bones, the meUuarpol b.n.s, and the. phalanges of the fingers, and those of the foot into the tarsal bones, the melatarsal l...nes, and the phalanges ol jY^ ^,,,i.;... .\.o ...ntain a number of sesamoid bones; tiiey occur in the u])iier ex- tremity only in ti-' hand; in the lower extremity they are to be foun iM.nil l\n:- .\\u-.:,>,.l !hMti<"l I'fhl fi^inn'IfUt' I'/ i'(<7- I'llth futuj ^TOh/ I'll) :i till I'llliilillt I )tripital ti'itlanrHi Siitiirn ruiiilo--ii {II Oi'ii/iiliil jouliiiiiiif llVlllill ^Ill/Ill Si/iiiiiinnis porlioii i^f luripitiil I'lirieliil tiniiuiiir . Siimrn •nrnilosd Mastoid foiUiindh- t itlciiil /'>'rr!'"/ I'/ /( IHI>0!lll ot li'itl!h'nll Miinhriiiiii lYIUpillll liiti-nuil p'l 'vvvitl pliili I'll/nil' Ih'tli I 1,'llllli foillilllllli I till J piildtt ()'■ iitri-'iMitti Sii'^illiil \iiliiir ^■.piiinii'ii- p,! OitipiUil I'iiT. mo. Ihlipitlll ':l>ltllllli/l- ^mm^m. 1 ri t ? 'ik THE SKELETON OF THE UPPER EXTREMITY. g, THE SKELETON OF THE UPPER EXTREMITY. The Shoulder Girdle. Unlike the pelvic girdle, the shoulder girdle is n„t completelv closed, but remains open posteriorly, ,ts posterior constituent, the scapttla, having no direct or indirect .onneciion with the c<,rresponding lx>ne of the opposite side, while the anterior skeletal portion., the clavicle. close the shoukler girdle anteriorly by their connection with the manubrium sierni. IJoth con- stituents of the shoulder girdle articulate with each other, and the free upper extremity articu- lates with the scajjula. THE SCAPULA. The shoulder-blade or scapula (Figs. 107 to no) is a dcridcdlv flat bone which is verv thm m places and exhibits several marke.l processes. It articulates onlv with the clavicle and the humerus; otherwise it is completely free and the sur- face resting against the ribs i-, sei.arated from them bv the intervening muscles. It is triangular in form, and there may c()n.sef]uently be recognized in it three sides, three angles, and two surfaces. According lo the i)osition ,)f the scapula when the arm lies close to the side of the body, the three angles are designati'd as the inkrnal (superior) mi^lv, the iujcrior mti^l,; anosterior one the dorsal surjace. The costal siirjace (Fig. io(,i is rel.uivily smcM.th and somewhat concave, the shallow deprosion King termed the suhua pillar jossa, from the subscai)ular mus< I,- which arises from i,s surfa.v. Several rough lines, the line.r n.useulares, .on,me,ue al the vertebral margin and pass outward almost transversely across the surface. The .lorsal surja.e ,Fig. 1081 is rough; and is suUlivide.l'into two portions bv a marked roughenc.l ndge. the spine, which commences at the upp.T half of ,1,,. v.rtebral margin as a 'iMlten,.! pn.j.etion and g.a.lually Incomes mor.. elevated as it passes out.ar.l. The small upper area „ known as the supraspinatons jns.n (Fig. ,071. ami the larger lower one as the injraspnuuous jossa; Ix.th of these names Uing .lerive.l from the muscles .0 which the fossx- givi- origin. 'rill- Vi-flihr.tl /i^iw//..* .,( »U.. ......I. ,-,1 , _^ I i_ » t .. ...r n..r...r ..) ,.,. -,,,j,,j., ,.,],„ ,(.„„„, ,}-^ ^,_.^, , ^^ ^^^^, ^^.^^.^j^. straight, but pre- sents .. slight angle at the origin of the spine. The upper ami lower portions of the U.rder are thickened; the middle portion is thin. Flo. 107.— Thr tlcrMl Mjrf.iir .if iln I, ft Si a|)ti!,i. I «.^s«i^Lm-. 84 ATLAS AND TEXT HOOK OF HUMAN ANATOMY. Fig. 108.— The dorsal surface of the left scapula (J). Fig. 109.— The costal surface of the left scapula (J). Fig. no.— The left scapula seen from the outer angle and axillary border (J). Fic. III.— The left clavicle seen from below (§). Fig. 112.— The left clavicle seen from above (§). L 1- This iH.rdcr receives the ins..rtion of ihf sorralus .iw.Rnu . : is.le. whid, also .-xten.ls outwar.l uposlal surface presents two shallow tr.angular arras for the attachment of muscles, in ailditioii to the subscapular fossa The supfrior border presents a notch, the scapu!ar nolcli iFios. 108 and 109), which may be either deep or shallow, and to the outer side of this there projects from the superior margin a .strong, curved, hook like i)rocess, the coracoid prorrss (Fig. io()). This arises by a broad base between the scapular notch and the outer angle, and is at first di.ectcd ui)ward and .omc- what forward; it then becomes narrower, makes a distinct turn, and passes forward and out- ward to end in a roughened a])e.x. Tile uxillary border (Fig. no), so called Ix-cause it is directed toward the axilla, is slightly thickened ami roughened, particularly toward the external angle. .\ furrow separates this elevated Ijorder from the anterior surface of the lK)nc. The inUrnal anisic is eit'-.r a right or an obtuse angle; the injirior one is acute with a mark- edly rounded apex. .Vt the external anj^k is situated the so called head of the scapula, whi. h l)resen'^ the articular surface for the head of the humerus, the t^lenoid envily (Fig. no), which •■ m(M)th, slightly concave, and shaped like a pear v Jih the apex upward. .\lx)ve the glenoid lavity is a small surface, llie supraj^lenoidnl tuberosity (Fig. no), which gives origin to the narrow ctird-likc tendon of the long heatl of the hi.eps, and tx'low the cavity there is a larger, markedly rougiuned surface, the iujroi^leiwid.il tiiberosily, which giv -s origin to the broad strong tendon of the tri(Ti)s. The hea.l of ihe scapula is sejiarate.l from the remainder of the \xmr l)y a slight ( onstriclion calleil the "<(/■. The .-'pine of the scapula (Fig. 108) arises by a iiroad base from the dorsal surface In-tween the sui)raspinalous and infraspiiuitous fossa', and gradually becomes higher as it passes from the vertebral iH)r(ler to liie net k of the Inme. It i)as.sts over the neck, overhangs the glenoid cavity from aiM)ve and beiiinti. and terminates in a strong, broa.l, llattened process, the aeromion. Internal to its apex, the airomion presents an elongated, Hat, articular surface for the attach- ment of tile airomial end of the ilaviile. The s...pula is pretorn,.-,! ,„ , artiU*- .luring I, lal iif.-. 'l-hc hr.l . ci.l, i of ossifi.ation apiK-ars it. the ihir.l month of embrvoni. life m the reKion of the ne, k. but os^lIm .ilioi. pr.«e.sl, ,o ,lowlv that iarff- areas are stiil . artihiKinous in the „e«-l».rn 1 >urinK the lirst ve.ir of hfe an in.lei-n.l. nt center api^ars in the .oracoi.l pr.H ess,* from whi. h i- forme.i the Knater |«.riion ..f this pr..j.-.tion .\l the aRe of pulK-riv s|k-, iai .piphysi-al centers make th.-ir apin-aran.e, in the a|.. , aT..| th.- base ..f the .oraM.i.1 priness, in ih. .i.r..mi..r. lusuallv several .enlen.), in Ihe base ..f the siapula. in the inlirior anRle, in Ihe Rlenoui lossa lusuaiiy s.iti..'»iiai iaietj. ^ .ii h. tii' iinrgin t;f ihr -,p;nr '-f ilir ^. Aj.iik, ^mi (even earlier, in Ih. I. mh yearl in th.' .Mernal anRle ..f th.- »■ .ipula in th.' r.-Rion ..f the ori«in of Ih.- bi.eps lemltin. • In reptili ., l.ir.K. ..nil ili. lomst mammalia th.- lor.i.oiil pro, es.s is an iinlepen.lcn! bom-. Inltrmi! tiiii;lr Scapular iiatrh Sii/iriicr ('oraroid /j/vcc^.s honl,r f/!/. lOS. S/i/fir 1 iTlrhnil I'oritir Infiiii'r iiiii;!i Siih^ia/iiiltir /('sm; hiliriiid aiw/t /'.>ri/t»- Siufnilaf \,rlil'nii Iwnlri \ .V / htfiii' i:iil<il Ai titular s."»/i/ir lU luranihiii (A'nnv/il (il(7iiiiil (i/i-.'/c 1 Ki'ltirv lu'iilrr />■-•. 10>K lalii-'in aiii;,' rn mm^ "TM: #.^:i 'Mr. A ■s ■si* I ^ it i 1 J t ■ ■i |! I III r ' ^n. THE SKKI.F.TON OF THE IPPER EXTREMITY. 85 '"' '^:scapu.ar n....h is son^U.nes .„.v..ea int„ a foramen l,y a bri-ige of osseous >issue. THE CLAVICLE. The ..,.,v/, ,Fi„,. o. a.,, o,ns .n s-»i.»H -'.^1" '7-;^-^';;;r:::j:r:;;:^^^^ ™:^r:- t^j:;:^:.;^::;* r;r =::: c::::u: - .^^». > a„,n,ial cn,l i, da..™™! a„,l ""»'- ;'" ™*:,i,t V, ,L .h. ...r lavi.nlar a„i™. ;^:r:;r::::™:;:;"":»"™s»i«:"" ...v.™»r.. .- .»- an.l also a small smooth articular fact for conncct.on ..ih the acromu.n ^^^^ ^^^^^^^^^ ^^ ^^ TH.. .lavU. is ,...for„,.l in . anila.-. T>,.- ,.un ;;;';:-;;;-:'^:;:r, :';!:!;, o,.v .H. sU.n.U ,.,. „os- :;r :r:;,:trr :^;::t\;:;i;':::;;:;:;i-;^^ ..„. .... . ... ..... .... THE SKELETON OF THE FREE UPPER EXTREMITY. THE HUMERUS. .r- , , MO , ,6) is ■. tvnical Ion., hone, h is composcvl of a Inn;. mi.l.lK- Tho luimmis (Imrs. n;, to nO) is a up ;,„Vr/<'r cMa-mitii>. -r;:,;!r:::r:::;;:^r;::r:';:::i:;':!::. ^ - "•""■■' ''''"""'■ , , , .luu.ll.rf.., lh^in..•r^,..„s,,(..■Mll.r.I-|'i"^>l"- „.i« ,,, ,,,infras,,in.>tu. iH,, - . ,. -M. an.l „r,-..nno - ■ ;;;^;; ;-;;; ;;;;;::::, ,i,,uc, «hi.h sul.s..,,u.n,ly «ra.l«all.v a.su, .-s ., .haraCr of ,.u, . .TUlaK 86 ATLAS AND TEXT-BOOK OF HITMAN ANATOMY. Fig. IIS-— The left humerus seen from behind (J). Fir,. 1 14.— The left humerus seen from in front (i). Fig. 115.— The head of the left humerus leen from above (4). Fig. 116.— The lower end of the left humerus seen from below (i). diminution in the thickness of the lx)ne. forming what is called the surgical neck, because the humerus is easily broken in this situation. The upper jwrtion of the shaft of the humerus is almost cylindrical, while the lower |)ortion is ijrismatic and flattened. Passing downward from either tulxTosity uj)on the ui>pcr portion of the shaft there is a rough ridge; one is the gmilcr luberciilar (bicipital) ridge, which gives insertion to the ])ectoralis major muscle, and the other the lesser tubercular (bicipital) ridge, into which the latissimus dorsi and teres major muscles arc inserted. The intertubercular (bicipital) groove is continued down- ward between these ridges for a short distance and they form its lips (Fig. 114)- Below the greater tubercular ridge uyKin the outer and posterior jmrtion of the shaft there is a large, Hat, roughened surface, the deltoid tuberosity (Fig. 114), for the insertion of the deltoid muscle, and at atxnit the middle of the shaft and upon its inner aspect there is a roughening, which is rarelv distinct, for the insertion of the coracobrachialis muscle. Near this rough surface there is a large nutrient foramen (Fig. 114) which leads downward into the lx.ne as the nutrient canal. In the lower half of the .shaft three surfaces, an antero-interual, an aiitero-external, and a posterior, can Ix' recognized. The two anterior surfaces are separated from each other by a Hat elevation and from the posterior one by the shaq) ex'.erml and internal borders of the Iwne (Fig. 114). The external border commences Ixlow the deUoid tulxrosiiy and is sejjarated from it by a shaUow groove jor the radial (musculospiral) nenr (Fig. 114). It is sometimes termed the musculospiral groove, anortion of the shaft becomes llatter and broader, and its lateral Ixirders nm downward to terminate in two rough projections whitli are known as epieondyles (Fig. 116), the sharj) outer iH)rder passing to the small exttrnal epieondyle an which articulates with the Ixtnes of the forearm. Tln> articular surface ])resents a separate area for each lx)ne, a large trochlea with a median gnxne being situated inlernallv for the idna and a smaller hemispherical mpituliiin externallv for the radius. .•\lx)ve the trochlea and upon liie anlero-interna! surface ;i the level of the ejiicondyle there is a moderately deep dejiression. which is known as ihc coronoid /dwc/ (Fig. 114) becau>e it accommodates the coronoid process 01 the ulna when the arm i^ lle.xed, and alx)ve the capilulum, upon the lower portion of the aniero- $i^ hJ^^^ (jmitir tii/ifirlr "4^ Upper extremitv m n Haid Hmd f ^-i Aniitoiiiiiii/ III! I; Siinrmil inrh / csscr liibarlc IftTrtllll'iiriiiiir i,v.'.'lf (jmilii tiihcirh' w \ l.csstr liihrmi/iir //(/i.'V x-% (iinitrr tiilnrathir rids^c Shaft (innn'i' for nidial iicnw Niilriiiit fonimm f n 'I n Ddloid liilitnic m tiiT. Ill f%r. 114. 1 Lower extre- mity t \ii null t'lvivndylf I nirhiiti Intd'tiilhiriiliii ai'OOVf 1 ^ AiKitiiiiiinil ' turl; (iri'iilif lii/'cic/r l't>stfii<>r siirhiir liitrnnil hordir Aiiliiv-iiili'niiil ••iiifiuc C.onuioid I'ossii O/ccniih'ii I'ossd , , Inti'niiil Intiiiiiil cpiiviidylc rpi(Viidy/i' (iiV''vr for ii/iiiii iiirvc I (\^(r tii/iiii/i I ivihiiii I yirnid/ \/ ininiiidvlc 1 jc.. 3 //../,/ ('ns, r„ d tnto riulH-rosity an.l the coronoid process also gives crigin to por-ions of several of the n,us, le- ^ - the forcarn,. The ^ha'it of th- lK,ne IxTomes much ihinner ami more rounded towar.l iN lower extremity so that while the tn.ne resembles a three-sided prism in its upper i-ortiun, ,t becomes cylindnra in its lower fourth. In the shaft mav Ik- reognized an anterior volar, a posterior or dorsal ami an internal or ulnar surjace. The inlernal surjace is separated from the posterior t.tie by the dorsal border, antl from the anterior on, bv the volar border. The third l.nnhr ,s ^-^^V ^^'^^ is directed tt)war.i the ra.lius; it seiuiraies liie anteiiui liuiu th> j.-'-stcrKn Mtif-:-.-.- .:nd •'-<•••'"' the interosseou rid^r (Fig. 1.9). The volar surjaee contains th- nutrient joramen, trom which a nutrient eanal passes towanl the ell^.w within the tx.ne, b> otherwise the surface cdiibits no peculiarities. 88 ATLA A.M. Tior-I^OOK .p hUMAX ,'U\AT0M\ . Fig. 117. -The Fig. iiS. -The I'IG. 119. -The Fir.. 121. ~ The Fic. 122. -The Fic. '2.V- -The Fk;. I -M.- -The Fi(,. I2v- -The '§). left ulna seen inr.^ uic > i(( ;• ..urf;i(( left ulna seen fr,,m Jjchi.M J) left ulna seen fr' m in front if). left radius seen from in front (jjj. ii'ft radius seen from the inner side f^). left radius seen rom liehind (J). upper extremines of the radius and ulna seen from .hove and somewhat in ,r„nt r- lower extremities of the radius .nd ulna seen from below (| ,. ' . I - f n ■i».ai »,rf,„ ,., ,h, „„i,„,„„, ,,,„„ ,H, „„„„ ,;„„„,;„„„ ^„, ,^,, ,;;„■', v;';;;;;';,,,; " THE RADIUS. The r«rf/«. (Fij,s. ,_ . to 135) is the outer of ih. two bones of the for.ami to the ulna, U ,s narrow and thin above ami broad and thick below h.snp.norcM/y Fi. ,241 i^ forn .,1 bv the di. -like /;,-„/ of ,1„ constriction bel-.v the head bein. designated as the .,r^, whi, h potion of ,he' ,.. ■ in ' on;: xmi . ,! distin' < s e\ iindrii dortal bonit dortrl hordtr. I-"IC^ \20. volar border ^° ulna -Iransv.-D-L >cilii.ii i '-rough I 'f the t-'n-arri!, t.i ■■' till- mi io//t~ Itordtr • I'-dr; The upper surface of the hea.l exhibits a de. -essed irt^ humerus, and the upper . ;:rumfere,ue ui nv .nannn 01 ciimjirniti- (Fi^. uj,. Below the neek the upj.. r p„r;,un of ti:. x,l,r surfa projection, the /»/)-rw//v (Kiir:-. .. ■ • -■ ■.,^.,1 t -. . f„ -. The shaft of the radius, lik ihat of ,, ,- ulna,'is'l!liap..d like three surface, are arran,e,l in a ,in.ilar mann,- ., that volar ,/, volar .xna dor., hordrr. .M :m inur. sana rid,, . .av b. re ^niVed sur; he resi-n!- i|)ltl (/;■//( . (he ouirh, marked i»s nniscle. prism, and the . r IlltVl in front (]). Its ladial iif)). anrl a 119). The artilugi'. i'hysc.-, ;„ar I.-. iMci jit.rs Thin ,. .,i in ■ (jnii .i distini I -■v iindrii ihv £H />- , niaikcxl IStlf. , and the litres. and tnjsscoiis Siiiii/iiiii, 110: h Rinli.:: ili'fih Cii/'ilii/iini '^iipiiui' '/• / sill •^iirtinr l)or\iil !iOfii liift mill -^iiiti, Dorsal -.iildi'i Si'iiildthtr 'trii Sfy.'iHi! pnnr-. iiv:i'!:t ;■.•:■ 1 • r III'. 117. /7'r. IIS. II!'. Il'l. : ■ejtrS tinid S,Vl! I ii/ifiosily Xiitnciit /i'.iimnt Aiiiailiir Hmd . cinuiiil'i-irinr I iihnosilv Shaft 1 'oliir iiirfinr l.ntt-ivs^i\,ir^ti! siirliU( 1 hhir ihUi', Ciiya' iiifiiiiliir s irhiif siylo ■tl /i/,iirs ,s7i7ii/(/ liibnvsiiv Ulna ,1/ i,iiliii\ /V'l/'V Doisiil Imrdir DiV-^iil ^irltiir fit: 12 i //A'. fJi ( Ill/Ill! iiintii/tir •■III hill j 1 UlnM Radius aiF: I if r II u It^t h i 1 THE BONES OF THE HAND. 89 ridge is situated opposite to the similarly nametl ridge of the ulna, and is only the shaq) margin possessed by the radius, the two remaining margins having markedly rounded edges. The three surfaces of the radius exhibit no structure of particular note, except that the volar surface contains the nutrient foramen, the nutrient canal, like that of the ulna, passing in a ])roximal direction through the compact substance into the medullary cavity. The broad inferior extremity (Fig. 125) is flattened, so that a volar and a dorsal surface are distinctly differentiated. The interosseous ridge terminates below in a slightly excavated surface, the ulnar or sigmoid notch (Fig. 122), which articulates with the capitulum of the ulna. Opposite to this surface^ upon ihe radial side, the styloid process (Figs. 121, 12,;?, and 125) j.rojects Ixyond the Ijone; it li broader and less pointed than the corresjwnding pn)cess of the ulna. The volar surface of the inferior extremity (Fig. 121) is smooth and slightly concave; the dorsal urface is traversed by ridges (Fig. 12.^*) which separate distinct grooves for the ten.lons of the extensor muscles of the hand and of the fingers, a particularly deep one accommcxlating the tendon of the extensor pollicis longus muscle. The distal or carpal articular surface is directed toward the carpal bones; it is concave and usually distinctly suljdivided into two facets (Fig. 124), by means of which the radius artic ulates with the scaphoid and semilunar Inmes. The ra.liu> is simnwhnl shorlir than lh>- uhia and the two iK.ms an- s,> nlattil that 'he ulna pnijn ts ..msiikral.ly bcyon.l the pnixinial cn.l of thf railius anil the ra.liu> -vKn.ls Ih'V.ihiI the iliMal cvtrcmiiy ..( the uln.i. Hoth 1.,ti.. , ..■ (ur.c.l, 1.UI in an upix)sili- ilimtinn, s" tliai th.- ..in.anli.s of the tw.i l».ni-< arc .lir.-.tiil tmv.inl va. h hiIht Thr uln.i also cxhilrils a siiuhl |iir-.ion. In supinalion Ix'lh 'ooni-s of thr foriann arc- par.ill.i an riilK's an- op|K>sitr on.' another ( fiR 1 JO); in pronation the Ix.nrs are . rost.cl, -inie the inferior , xtremity of the ra.liiiMlo«elher with the han.l) rotates aU.ul the ulna. «hile ih.- h. a.l of th, ra.-ar still later in the tuUnle an.l in the styloi.l pnKOss. s ..f the ra.lius. Ossi- fi. ati.in is n.it ..»mpl>-l. until th.- twenti.th yen^. The Bones of the Hand, the carpal bones. The eight Ixmes of the carpus (Figv ijO to i.^i) arc arrange.! in a pnivinial .iii.l a i!islal row. I'a.-s.sing fn>m the radial lo the ulnar side llie pro.vimal row (i>ntaiii^ the iiavi'u!,.. or scaphoid lM)ne, the lunate or sentihnu.r \nmv, the triquetral or (Utuijorm Ik)iu , ami in i>isijorm )K)ne. Passing in the siime dirt-cli.>n, the distal row i.-, .()ni|W)sc.il of the 'greater mullaiifiular lione or Iraptzium, lesser ntnllanfiuLir Ume or the trapezoid, the os laptlatutn or os magnum, and the hamate or uncijorm lione. The l)<)nes of the pn>\imal row (reall> the lirst three only) are not siliiated in a straight line, but are curved .so as to form an arch niili it i- ^ligiiiU tonse'. jiritKiniaiiy an.i markedly concave distally (Figs. 128 and 121/). In the distal row the capitalum projects markedly lowanl the jiniximal row and is accommcxlatt d In its (opcavity. ti ^•^^ Z,i^t 90 ATLAS AND TKXT-BOOK OF HUMAN ANATOMY. Fig. 126.— The lower ends of the bones of the forearm, and the carpal and metacarpal hones in their natural positions, seen from the dorsal surface (i). The- preparalion was masition i-.' tlu l)onis loulil !»• pirKi lly (iiliTmined. Fig. 127. — The same prc|)aration seen from the volar surface (i). Fig. 128. — The hones of the left hand seen from the dorsal surface (l). Fig. :2g. — The same preparation seen from t'e volar surface (i). Fig. 1^0. -Frozen j)reparation of the hones of the left hand, together with the lower ends of the radius and ulna, seen from the dorsal surface {■). Fig. i_y. — The same preparation seen from the volar surfaie (I). All the bones are irregularly sha])ed and arc difTicultof description. The navicular (scaph- oid) bone is cllijisoidal; its distal surface is excavated, and the radial Ijorder of its palmar surface is j)rovi(led with a rough tubercle (Fig. 127). The lunate (se...ilunar) lx)ne is shaped like a half-moon, the triquetrum fcuneiform) resembles a short three-sided pyramid, and the ])i:;if()rm b<>n U)tli the radial and the ulnar sides of the j)abiiar surface of the carpus and fomi the carpul i^romr. The radial (aq)ai eminence (Figs. 127 and 1,^11 is formed !)y the lul)eriles of the navicular and greater multangular Ixmes; the ulnar eminence, by the jtisiform bone and the hamulus of the hamatum. The small, almost splier'cal j)isiform Ixme is situated only in the palmar surface of the car])us; all of the remaining caqial lx)nes possess a roughened dorvil and palmar surface. Hoth surface: of the four Ijories situated at the radial and ulnar margins of the caqjus, the navicular (scaphoid)— greater multangidar (trai)cv,ium ), tri(|uetnim (cuneiform), and hamatum (unciform)— are con nccted by lateral, radial and ulnar surfaces but the numerous remaining surfaces (numernus on account of the irregular shapes of the iMmes) are smcxxh articidar facets covered w iili cartilage for articulaticm with c.uh other, with the radius, or with the nielaiarpal b. nc s. Th( piriform Ixini' has but a simple articular facet for c onnec tion with the triijuetrum (ciun i fomi ), but all of the remaining carpal Ixmes have several .arlicvdar surfaces. The most imitoriatit of these are the following: the navicular isca])hoicl) and lunate (semilunar) lK)nes each ]M)ssess a i(in\c\ articular surface which arlicidates with the distal end of the radius; the lri(|uetrum i- mil connected with the ulna, however, but with an intervening disc of c-arlila«e. Of the ioints U'tween the proxim.il and the distal row of the carpal Ixnes, the most important is that Iwiween the convex surface of tlu head of the capitatum and the concave surfaces of the lunate and navicular Ixincs. Bjkte (lius lar the K; •>< - ri r ' -r u Ill 3 5 5 S ■53 r 'isHbmiJm' ■■■ ^- '- THK nONF.S OF THE HAND. 01 The greater multangular articulates with th. Urst metacarpal lx,ne by a , l.sl.nctly sa.l.lle- shapll sur^c^; the lesL multangular ,trape.,id) articulau-s with the see..n,l the cap.tatum (OS magnum) with the thinl, and the hamatum ,u,uif.,m,) with the two remammg metacarpal btmes (Figs. 126 and 127). ,hc luna.um .se-milunar) 1k.,u, for the n^'^' " •' • J ^ ,.,„„ilunar) a,„l hamamm (undforM,); on ih,- Kr.-afr ,nuUan«u,ar ,.ra,„.iun,) [''-^^^^X;: mJ ^ r S-^i-i i^- the a.i.u.ar face. indu,... ..,.■ ^n-a.c. ,.,r- r r rrir:;a;:tr :rr;:=r:r^^ ^^ ^-^ •> --- >-- truni, anil lunalf lionc. :,-... f„ ,„, smuli- nnliT In llu- i aiiitatum ami ..„ll,f::,ri:;= ::.;:tr:i:rr™::,;;::;:::.:'::;::i. „ < ... »- > in the- pisiform not unlM ihc twelfth y.-ar ..r . ^, . ,.t> r. . . ,,.„,,„, ,„„„ .^ ,„,r,i„n of llu- skeleton situated .tJr— ■:r::;;=:.r:;:>.J:;:;ri^^^ 5;' bl is dearly re,,resentc;i. In the a.lult it is t.sualh fused with the nav.eular, form.ng Us tulxrd, . THE METACARPAL BONES. The five mclacarpal bones (Fig. ,.-6 to .;,i) an typical long bones in which may be recog- nizcci a proximal extremity or base, a slu.jl, and a distal extremity or lna,L Fhe bases art.cuate with the distal row of carpal bones, the hea.ls with the proxmial row o the phalanges. I he metacarpal lx,ne of the thumb is the shorlest. .hat of the index-f.nger the longest, an.l they grad- iiillv decrease in leni'th toward the little linger. , , r i -Tt^Ws of th: metacarpal l.>nes are irregularlv cubical and thicker than the shaft; that of the metacarpal Ix.ne of the thumb beavs a sa.Ulle shaped surface for arf.culat.on w.th the ^. tium, an. the remaining ones present, in addition to the ar.uular a.e.s .r the carpal Zes, lateral surfaces for articulation with each other. Th. base o. the dnrd metacarpal bone presents a styloid process (Fig. 128) which is directetl tt.ward the rathal side. The base of the Hrst nut.uarpal t».ne h,. :. single anu ui,. surf,.e. that of the .e,,,nd h,„ ihn , ^ a snuU r.i,l, d Zt. a radial one for the third, and an ulnar one for the fdlh ntetaearyal bone; and ,he '' ;;'>'''':' 7, ' forearm. , . . . -. -. , ..•.•,.!...,..,,. .,t;.->n <-.f tlvi! Mf the thumb, is appro.xi- The shaft ol cam metatarpai IaHk. .-un .... i ..i.L|it..i.. .. matelv three-si.led, and possesses a pnl,n.,r and a .lorsal bonUr The palmar ^^^^^^^^^ flat as it passes towani the base, while the dorsal In.rder w.dens out .nto a surface as U approaches the head. ill .//i •JvT *l,-\ .■ f ^ -i^^ if 92 ATLAS AND TKXT-BOOK f)F HC.MA.V ANATOMY. The heads of ihe bones are provided w ii'i sphen\al articular surfaces, and their sides present depressions which >erve for the attachment of li;^anunt>. Their hases (will; the exception of that of the freely movable bone of the thumb) are closely ai)i)ro.\imated, bu: both the shafts and the hi ads are separated by large ini. rspaccs which are known as the htterosscous spaces (Figs. 12b n<\ 1271. Hetween the heads these spaces are tilled by ligamentous masses, between the shafts b\ ^lu^cles. Xiii.rdinK 1. .lie t.i'.i'mcnts (if most authors, the niitar.irpal Ixmcs (\i\. lup from a diapliysi'al (enter in the midcDe of the Ixme and from an ejiiphyseal renter in the head; only thi' metacarpal Ixine of the thunil) liilTering in that its epi- physeal O'nler is in the tiast' Oeeasionally the third metacarpal has a separate renter for its stvloid pnKiss. The epiphyseal centers do not apix'ar until after birth, while the diapiiv-Mal center appears very early (in the ninth week) before the centers in tin radiu, .ind in the ulna. THE BONES OF THE FINGERS. Each finger bus three l>jnes or phalanges, but the thumb has but two (Figs. 128 to 131). These are designateti as the j)roximal or first j)halan.\, the middle or second phalanx, anfi the distal, terminal, ungual or third phalanx. The thumb has no middle phalanx. The phalanges diminish in length a> we pass towani the finger-tips, so that the terminal jihalanges are the shortest, and the longest ])halanx is the proximal one of the middle finger. The phalanges are long txmes com[K)sed of a proximal extremity or base, of a sliajt, and of a di.stal extremity or Iroelilra. The bases of the j)roximal phalanges have concave hemi- sjjherical s(Kkcts for the heads of the metacaqial Ixmes; the articular surfaces or bases of the remaining jihalanges |)resent a double concavity sejjarated by a metlian elevation. The shalls of the phalanges have >har]) lateral Ijorders, and their dorsal surfaces are con- vex, their |)alniar ones ])lane or slightly concave. The short Ixxlies of the ungual jihalangcs terminate in a rouL'li horseshoe ^ilaped expansion, the uniiiial tuberosity (Fig. 1,^0). The distal extremities of the jin.ximal and middle phalanges exhibit small fos.sa', similar to those u])on the heads of the melacariial 1joik>. for the altachtmnt of ligaments, and tlii' nutrient canals run towani the finger-ti])s, in an opposite direction to those of the other bones of the extremity. The jihalangc'' are (leveloj.. d like the nuta. ari>al bone of the ihundi, each phalanx luing ossified from a (enter in the shaft and from an t-piphyseal (enter in the proximal extremity; there are no centers for the viistal ends. The proximal phalanx ossifies lirsl (third month) and then follow the middle and the terminal phalanges. THE SESAMOID BONES. In addition to the lH)nes jirevioush' described, the hand also contains a \ar)'ing number of sesamoiil bones. Two of these are constantly found at the metacarpo]>halangeal joint of the thimib, and occasionally others occur at the simihir joints of the index and little fingers, but in the latter situation they may Ix' replaced by fibro-cartilage. In the thumb they are usually covered with cartilage ujion one side and are connected with the articulation. There is also usually a sesamoid Ixjne at the interj)halangeal joint of the thumb. THE SKELETON OF THE HAND AS A WHOLE. The metacarpal and ])halangeal Ixjnes do not lie in one ])lane, hiil form a curved surface, convex uj>on the dorsum and concave in the palm; in the metacarpal region this curve may .mmmnsim^mm^^m' THi: SKKI-KTON OF THK I.OWKR KXTRF.mTY. ')3 be. consi,lc-rably increas«l or diminished by th. muscles of the hand. I he convex, y of ,ho ne of the .ndex-lm^er and r<,m th.s pom deelin.. graduallv toward the metacaqml Ix.ne of the little lm«er and abruptly towar.l that of the thumb. The so-called dor«U surfaces of the metacarpal U,ne and ot the two phalanges of the thumb are .llrected externally and th.ir lH>rders, instead ol d.eir surfaces, are conse.,uentlv din te,i toward the dorsum of the hand. The -lorsal .urface of -he metacarpal Ix.ne of the little tin XT is also directed somewhat toward the ulii.ir side. Wl- le the inelacan)al lx,ne of the inde.x-tmger i. -In longest, the- phalanges of the middle nnge .re longer than those of the index-fmger, so thai the middle linger is the longest hnger. The I .h: es of the ring-fmger are also longer than those of the mdcx-lmger. in corr, ^pondence with the functions of the- hand as a prehensile organ the hngers are well u -loped aae most .l.st.nct .n ,he m.ddle of th .1 ac crest where it is thickest an.l reache., its greatest height, and are terme.l the cMer„J, the intenwl. ami the »»;.v of the crest (Figs. .,^^ and .,U'- . . ,_. Xna.riorlv the crest of the ilium end> in a spine, .he aulrri.r su!>,nor sp.nc (F.gs. ,,. U. ,U)' and at the ..osterior extremity of the crest there is another less pronounced sp.ne, x\u- ^os- X superior sli,. ,Fig. .,... helow the posterior superior spine, and separate,! from ., by a shallow notch is the pos.rior u,,r,or spnu, an.l l.tow ,h.s tin; l---;;.--^- <; ^ innominate Ix.ne presents a deep paralx.loid noUh, .he ,reat saaUc notch ,l-,g. ..,2,, .ho Tpper lx,un,lary is' formed by .he posterior margin ..f the ala, and .ts antero .n.er.or one b> ihe Uxlies of the ilium and isdiium. ,,,■,• ■ •■ . 1 Below the an.erior superior spin. a. the anterior Ix.rder of the Ixxly of .he .hum >s s,.uated Uu. Irior inlrrior .pin.- \v^^. ... .0 „4>. ^ i> pla-i a, a greater <..s.ance ..m t e an er.-r .u,,eri,.r spine than .s .he po.teri..r inferior from .he p.,>ter,or super,„r one. and .s s„ua,c,l >m- media.elv alx.ve the uj.per and anterior margin ol .he ace.alndum. T ;e^.ernal ..riue of .he .,/. of .he ilium , Fig. .,.. is rough and convex and presen.s ,hree .ouuh line^ which indica... .iu- area, of origin of .h. gkKeal mt.de. 1 hese h.ies are 'cM«nat.d as the posterior or sup-rior, the ani.nor or nuMr. an.l .he ,„/,n,>r ulu.eal l.nes. Th ...... ,iur giu..'d line i. alm..s. v..r.i,al an,! run^a.n.s ,he p..s,..rior por..on .. th.. ala 'f h ilium .0',,.. upper l.un.lary .,f .he gr.-a, .,a.i. no,.h. and .he .nal. an. - u- ,u , • . .• 1' .1 .....ii-iw nil V eius mu- . !.• ani tun ns ikmii ^^hi.h i. l-ninds giv.- nng:n to a por.ion nt .l,r glulau^ niaMiuis mu """•;•;;::;;::.,..„ .i,. pa.... ...kwam ,n an ar.,.., n,am..r f ,he an,..ri„r s..per,or ..i... i, i. a. .,rM almoM h„ri.o„,al, .hen mark ver.ieal. a,i.l .r..ls near ,h. ..oen.-r hn. a ,-!,;. upper n.arg,n of .iu gr.a, ..ia.u f-ram.n. The ..rfa.e of .he ala .n.h,de.l U.ween .. an.! the superior line gi\... ..rigin ... the glut., u- m.diu. mus. 1... , . ,., The inferior lin.. ,- . • Toi-lerabU s.,.,r.er .han .he an.eri..r -me. 1. ...nmum..- lH..we..p. .h. .„U.ri.,r su,K.n.,r and a: ..ri-.r inferior ,.ines an.l pa.-s..s ba.kwar.l ah..., hor....,,.a v ab.,u^ ,h.. a.e.abulum to the middle of th. great .ciatU foramen. It .s but ^hgh.ly curv,,! and .> ap, ^ ill flip ill ^Jili Il I ! ■ |l| THE SKELETON OF THE I.OWES EXTKKMITY. O'i to Ix' ihc least distinrt of the thri-c lines. The surface included Ixtween it and the anterior gluteal line )rresi)onds with the >iniilarly name;Krum. At the Ixirder of the auricular surface there is a distinct gr(K)ve known as the fiaraf^Unoiilal !iro(Ki i Fig. i.^,',i. The iliac jossa, th( middle of whiih i> fre'|uently as thin as paper,* i> sei)arated from the remaining iKirtions of tlie innominate Inme (the IkkK of tiie ilium, the juihis, ami the is( hium I l>y a line which is continued ui>on the jiubi- and is known a-, the .iniuili- liiir ( Fii;. i;;i. I hi> line forms a jiortion of the divi.ling line ix'tween the true an.l tiie false pel\i^ the Irrmiiui! ulio^ prrtininl) liiif, and is con>e(|uently also known a> the ili.r.- jiortion of the terminal line. The body oj III,- ilium forms the upi-er portion of tlie adtalnilum (see jiai^e o'n and a por ti(m of the ooundary of the great siialic notdi. It i> dinttly (ontinuou^, jiariit uiarly upon its inner surface, with the ala of the ilium alH)vc, and in the adult with the lx)dies of the pubis and isf hiimi Ik'Iow. The pubic bone is intimately connecte a portion of tlie acetabulum (see ])age ()6!. .\t the juiK lion of tiie Inxlie- of ilu- pubis and ilium then- i> a low rounde. "'i>''i '^ praitiially hori/oiiial, ano gi\c> origin to the inferior ramus, iiresenls an oblong surface, tii.' \vm/>/;y,N/.v (Fig. i.^;i,for arli. idation willi the Um* of the op|K»ile side, and tht anterior surface is directed forward and oiiluard, ih. iiilc nor one inward and I'orw.ird, and the iiostcrior one tow, ird ilu inti rior of the \»'.\\-. I he upper l)order presents a sharp edge, the (Figs. l.;-'an.l i,U ■ At the- juneiion of the superi.ir ramus with llu' IhmIv of ilu p. ibis ilie p.ist. rior or |«l\ie surface of the I Mine presents :i broa.l sl,,ill,,u gr.H.vc, tin ohiiir.ilor aroov, ^ I'ii;. 1 ;ji, wIihIi ^ra.lii .illy fades away .is it jiasMs inwar.l upon lii. interior surfa.i- l.iwar.l the ,,|ilur,it.a loranien. 1 he sharp ridge which forms the inner iHHindary of the' grr riilf;r (Fig. i.^n. The obturator gnwiv. is usuallv Iwiiin.le.l in front ami IhI.iw by a jinMis, diricied |..wai.l thecibtiirai.ir foramen, the anlmor obiur,ili>r liilurn, il'ii;. 1 ; ronnerted with ihe inferior ramus of the ischium at the site of a slight eonstri.tiun. The ischium is shaped \er) nnich hke the pubis, and in the adult its fxxlv is intiiiialelv connected with those of the ilium and pubis. It f,,rms the antero inferi.,r Ixnindai^- of the ^rcat saatir noUh. and in this situation j.resc'nts a shaq) triangular projection, the spiw iPi- 132). Hilow the si)ine i> ;,ituated the hssvr snatic nolch, whi. h is not .so deep as th,- ^rreatiT one anundar\- of the oi.tunor foramen The acetabulum (Fig. ,.,2) is formal by the Ixxlies of th.. ilium, pubis, and ischium but dividing lines Ixtween its component portions are visible in vouthful individuals onlv It is a hemis,,hencal cavity with elevatt.l margins l.K.king directlv outward, an.l onlv theanterior inferior |H.rlion of the margin toward the obturator foramen is incomplete; this gap is known as the tiiilahuliir or cotyloid iiotrli. The ll(«.r of th,. acetabulum is cominrsed of two dilTerentlv shainnl i>orlion>. 'Ilie larger portion, the srmil,n„ir surjace (Fig. ,32). is sm.K.ih and covere.1 with cartilage; it forms the upper and lateral portions of the cavity and eMen.ls downwar.l to the U>rders of the cotyloid notch. Ihe remaining .|uallVS!S .15. 1 ' tn h 1 i ! 1 THE SKELETON OF THE LOWER EXTREMITY. r:;t .,:::; ;t':::,:;:::: "'r :;;;;;*:rr-, .,* ,... ... ,..„. ,., -n -■ - -• - to the twenty -ftllh year. The pc-lvis as a whole is considered upon page 130. THE SKELETON OF THE FREE LOWER EXTREMITY. THE FEMUR. The Innur (Fi.s. :,- to uO is the lar.es. l,n, bone of the human 1h.1v, and consists of a sut»ru'r cx,rn„i!y, a ./,«//, and an inirri,.r ..Irr^.y __^ . ^^^^^^ ^ ^^_^^,^ Ix'low and to the inner side of ine niuKlit 11 i„. 1,1 • .,„ „l,li,,u..lv ,n,n,-a..,l cylin.Ur, .1,. sui^Ti,,, l..r,l,r l.ms »!-"• " ' ' ' " ; ^ , „,„„., „„,, Th, „«.r «m-milv „( 111.' I«.n,, M il,o marpn ,.l .1... n,.,k. | a. •..■..« i»" lar... u. n, uni. 1 ni ii^nr t.Miwiii, -iiiii hill, ni ol nanuroii.^ mux U>. The LT-,.'- /r,.. //<;»/. r is amsi.leral.lv larger than ihe K.s>er one and ,. M.uaud cxU n.tllv , n m rV^ : .. .r ponion of the superior ex.reniily of ihe fenu.r. 1-^ h.hli. curvt-tl ='I-, ' ^ ;,:„„,„,;..,, .hi.h ;.. ...nip..sed uf uw di.in.l l>p. .n .H„r :,nd an ,.M . ";;;,,;;, ,„U,:middU „f,h.. >..,„.„ ,:„,.,.. U appn.MmaUd,ln,nl,ven.., nd i>..n, . in 111. (.m;,le the :.nRle .MM'^' ''■ ' •• "K>" """'■ , , ,, ,, ,., ,,„ „„„ , The intent- l„ n -- ..-^ ■.■ u-i ,.■ ... ,e--..t ,„.,.,, t,.,u, „. - .-..:.,. the im, a asjura i,!...f 98 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fig. 137. — The riRht femur seen from behind (f). Fig. 138. — The right femur seen from the inner .>;urface (%). 139. — The right femur seen from in front (J). 140. — The ujjper end of the right femur seen from behind (J). 141. — The lower end of the right femur seen from below (J). Fig. 142. — The patella seen from in front (}). Fig. 143. — The patella seen from behind (|). Fig. Fig. Fig. the upper and the lower extremity of the bone, passing toward the trochanters above and to the epicondylcs below. The outer li{) of the linea aspera passes upward to a long broad elevation, the f^luteal luhcr- nsity* (Fig. 140), which is usually tlat but markedly roughened, and receives the greater fwrtion of the insertion of the gluta-us ma.ximus muscle. The intem.al lip becomes less distinct as it jiasscs u])ward and is continuous with the intertrochanteric line. Parallel to the ui)per part of the inner lij) and somewhat to the outer side of it is situated a second rough line, the pectineal line (Fig. 140), for the insertion of the pectineus mu.scle. Toward the lower extremity of the femur the two lips of the linea aspera gradually diverge and fomi the lx)un(laries of an almost plane triangular area'ui)on the [xjsterior surface of tho l)one, the fx^pliteal surjtue (Fig. 157). Upon the line, above its middle, there are usually one or more nutriint foramina which lead into canals jjursuing a dis'inct upward (proximal) directi(m. The sliajt ol the femur exhibits a distinct curvature, which is convex anteriorl\ (Fig. lyy), and ujKJn its anterior broad pt)rtii)n there may be distinguished an antero-inti'rnal, .in antero- extemal, and a ]K)Sterior surface. The linea aspera furnishes either the origin or the insertiun for a large number of muscles. The iiijcriot rxircmily of the femur is ver}' broad, and jiresinls two convex ciikMcs I Fig. T37I, a larger inlmuil londyli- and a smaller txlrrnal condyle, which are directeii |h)s1i ri('rlv and are separated from each other by the iulcrcomlyluid jossii, an inlrrcondyloid line se|..ira'ing this fos.sii from the popliital surfaci. Anteriorly 1 1'ig. i") the cartilaginous surfaces of both (ondyles are shapiurfaiis i>f the lower end ot the bone are -ituated two rough and slightly ijrcniinen; processes, the epiciiiid} les 1 Fig>. 1^7, !,^8, and 141 I, whicli are lemieii tile Inlirniil ij>iiondyle and the ixlcrihil ( picoudyh . The lowir portions of the lips ol the line:' asjH ra run downward to the cijicond\le>. wiii. h gi\i origin to the ga>l^u^llemiu^ muscle. I.ikt- liii'^i "I ll" I'lii^; Ikiiii-. ilif I1 iiiur i^ iI>mIi'|i,,| (rojn .1 ni.iplnM .il .mil l»i> [iriiii.ir'. i|n|ilnsiM| c riilrrs. Tli'- ciia]ili\-i .il • ' iiu ; iiiipi .ir» .1- r.i'l;. .1- tin- -ivrnihunk of .tnlirvciiii lifi . .inil \\U\U ilir Ii>wir riiiplnsi'al ici.lir I- u»u.4Uv vi^ilili- .tl litrlli, l!u < riiii r lt>i tlu- hen) ut ilti- ti-titur ilm . tint ,i|>| r.it until .itirr tli, 1)1 i.tt tlu- rtut (if (lu- nrsi vi'.irK \i a ;att r {m ri'Ml *[Miia! rpiphy-it al • cnUTN a|ijMar iti ilii ^*r( alt r fr-.hanlti ifourtti vciri .iiu! in tiir loMT triH haiitrr ■ tlintii-iiih 'n fnurtrrntn vrar*. Mlliiiu^l! Ilii 1 tfUr! fur tlu I«^>', r inulianliT aji,ic.ir^ !alt r iti.in .vw nf iIii- oiIut «pijilu>«al « i iittT-.. it i-. ii;r ::■, rjrv.-r-;- :r:t-' a :. -^r jT'T!--u::ir.! ;-r--j:-i !:■■", ihi Ilind (jmit tmiiiiiii/ir Dninssici: on hcnit Nirlt (iniil tiiulumlir (imt! imhiintir (111 lliilil Inltifhil Inliitrodinn- Irrir liiif I csser Innluinlti liitiiiitil rpiit'iitlylf / V Irnii I.' , V/l/|/( In cnwl liilrn i n,!v l'i(f /ilSM. Inliiivi'dv 'lUll I'illl Ins- Ii7 Piitilliir ^niiiiii f'hs Jin. /:- ns. •Jfjrr. i ! i , Head I'littUar siirfiii-e ,W,rk (heat troilnintir / fiximiii! :/ f/)iivi!((vlr •§ J»>- 1 Inlmuil i\rtineiil liiii '■/"'"'"''■''■ hiinr lip oi liiiiti iispfni Li / XlillKll ^H Intmviiihiiml Ji'ssn hi>r. 141. InliTinil nmdyli' liiiirtivilKiiilmc tnnlutntir liear until the fourth year. Ossification is not comfilete until after pulxTty. THE TIBIA. The tibia (Fig.s. 144 to 147 and 150 to 152) is the inner and by far the larger of tlu two bones of the leg. It is composed of a superior extremity, a sliajt, .mil an initrior extremity. if '\ ■ \i\ I I internal bonJer external erest. / f . \ ,' antrnur erftt [<}' inteh.-i5cous errs/ tihin Flc. 147— .A .section of ihe Nines of ihr cms taken at alnrnt the middle- of iluir IcriRlh isc h. mali/ed). The superior extremity is tlic thitkcsi portion of the lM)nc. It jiresents two condvits (Fig. 1511, whiih artiddale wiih tile lower end of the fmuir, and are knov ,■> the internal and external eondyhs. They exliihit ui)on their upjier siirfatis two roim .i> the anterior and posterior inlcrcondvloid /ovv- (Ki.,,r. i:;,). The artitular r.uffacer, arc iKnindcd by the aln ^.,t Veriicai ijuii> niaigii. ••■ liK- upper i mi 1 1 I lOO ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Flc. I44.'-The ris^ht tibia seen from in front (5). Fi(.. 145. -The rii;lit tibia seen from behind ( = )■ Vii. I46.-Tiie riyht tibia sen from the outer surface (s). p„. ,48.— The right nl)uia >een from the inner surface (s). Fio^ 149.— The right tibuhi seen trom the outer surface ( = )■ Fig i<;o-The til)ia and fibula seen from behind (p. F,r." , .' -The upper end> of the tibia and f.bula seen from above (\) F,,' ,^ -The lower ends of the tibia and fibula seen Irom below (i). osily (FiR. .44). The entire upper end of .he t.l.ia is bent sl.ghth backvNarcl of the Ijone (Fig. i4''l- , . ..^ Tt ;< iViirU it its iunction The shajl of the tibia is of a distinctly triangular pnsmat.c form. t . thick "^^^ J^^ .. .e ..,>^;;-^;^->. - -; -;;r:: r—:^ "tde: ::d z:j. T Tr'";an nU., o ^.i Fi.'. 4. --e.hat S-shape.l and beginning at the lower Mb in^ c '1 .1.0 i^rrual and ,.lrrnal surjacc, while the e,uall>- shaq- n.arg,n of ^'^^. ^^T^';:^^^'\^ ,;,,,,,, ,,,,„, „u. nbula (Fig. 147). is si.ua.e.l between ;;::=:;:? ^.Z:::^:' W third bord.. . .he ti... is .unded; . separate, .he S£SSS3iE ===== *'»*■ "■^' '" "• "■ ;"•■ "'T' 't'l", :::;'" »:^ ;;;r;::;;r :;.".;; i':,i-» licit bcini^ covered with cartilage f'xtcnuil Infrtif^liiioid miirii'i" Iiitirnal IntmomWIoid nninaiiY Xninihr s„rf,„r lor Jilnitd Superior „ extremity ^^ liilinm! (■■ukIvIi liiUrmd siirfdCf I'oplihvl lini I ibiihir y^. .» notill Inlirior iirliiiihir sinlihY lio. 144. hiltrihil niii/livlii' (hvovi- ,<>i iiilri/ui/ iiiiillivhi'- n>'. rn. i'.xtinml sinldcr Shaft Xrliailiir sinUiiT ,1/ mnllivhi'^ InlVrior (iilmiliir ■^lllldii //.'. 140. Inferior extremity lii'iii," iiili.llliir -.ll hiic I I i.l i -. \ A iitciii'i- crest Articular s.irface Apex (f- of head Imid Superior extremity rosterior crest I xteri al ; creii I Siitrient foniincii Intcnuil siirfiice Shaft I .^tennil siirfncc Hani AiHerioi- Cif-'i Arliiiiliir surface ot iiHillecliis Aiiiitii:!- iitrriro f'osterit.r •iiirfiice fig. l-fS. . Inferior exti-emity I'croiicdl sulcus r.r. 140. I \icnnil UlllllCl'lu- :■!.} iJ /I'VMi Tilhinnlly ol lll'iti f-ig. IW. hihiiinl ..■iiilr'liii /'croucdl sulcii'^ [iliiiiliii ..iiiuu; 01 I \rirniil ivnilvlf 11,11.1 of III'"'" Ailiiiilii' ■•"I- l,i,r 01 i'llrr- „.il HUlll'OllI' .]/:r\ 01 Ik'I'I Inrrrrtiil inlfiroii tlvlortl tiil'iiilt I'o.l. nor mtfn-on.Moul /.'-"" ^ ^^_^ ^^, u,U-r,on,hloid Ulhnl. l„„no, olloolor -'»/.„.■ 01 llho i-<'. h2. if I 1! iiil Mill i 11 ;i 1 J ■ 1 r 1 ^ ^fttsa Jd^'... :;^;r^ F'?^^^ THE SKELETON OF THE LOWER EXTREMITY. lOI The diaphyseal center of Ihe tibia appear^ in the seventh week cr in the twenty-.seeond year. THE FIBULA. The fibula (Fiffs. 148, 140, 151, and 152) i.s a .slender bone, and although its upi)cr extremity is situated lower than that of the tibia, it is but a trille shorter than that lK)ne, since it ])rojects below it (Fij^. 150). It is situated ujmn the outer side of the leg, and is composed of an upper extremity, a shajt, and a hr'vr extremity. The sujjerior e.\trem-'v is formed by the head (Fig. 148), the inferior by the external malleolus. The head is dist..K v thickened as comi)ared with the slender shaft of the txiiie, and its upjiermost j)ortioii, whidi is t ,e( ted outward and somewhat backward, is known as the apex. It jjresents a small llat articular facet (Fjo. 148) for articulation with the tibia. The sJiajt of the fibula is of a distinctly triangular ])rismatic form, and its three surfaces are ir'i rnal, external, and posterior (¥\g. 147). The three Iwrders are very sharj; and do not ])ursue straight course on account of a distinct torsion of the lower end of the bone alxiut its longi- tudinal axis; they are known as the anterior, external, and internal erests, the anterior crest separating the internal and external surfaces, the posterior crest tiie i)osteri<-r and internal surfaces, and the external crest the ])osterior and external surfaces. The inn surface also presents a feebly developed border, the interosseous ridge (Fig. 148), so that the libida may \k' said to |x)ssess four Ixiniers. The nutrient foramen is situated slightly alxjve the middle of the posterior surface and at a lower level than that of the tibia; il leads into a canal wiii(h is directed downward The tibia and the nbula have, therefore, different relatiressi(>n for the attachment of ligaments (Fig. 148,-.;:). 'I he dia[iliyseal i enter of the fibul.i appears somewhat later i that of ihe tibia (eighth wi'ek of fetal life), and thi- epi[)hvseal centeis develop at a cimsiones. (i) The talus or astragalus: (2) thc- calcaneus- (x) the navicular or scaphoid bone; (4) the cuboid tone; an.l (5 l<> 7) Uwcxfrnat middle and inlerml cuneijorm bones. Only in the distal portion of the tarsus, where the cuboid articulate, with the three cuneiform bones, is there an indication of an arranger, 'in nws as m the caq.us, and in further contrast to the hand, a single tarsal bone articulates wi,h both bones of the leg, while the can)us articulates with the radius only. THE TALUS. The talus or astra<^alHS (Figs. 156, 157) is ^ short hone, irregularly cuboid in shape and is composed of a bodv and of a head, the constriction between the two being termed the neck. The bodv IS the thickest an.l most posterior portion of the bone. Its upper surface presents a cartila-^inous trochlear surface, the trochlea (Fig. 157), -ith which the tibia and fibula articulate, ami it possesses three .surfaces, a largo superior one and two smaller lateral or s. The superior surface i. convex in the longitudinal (sagittal) axis of the bone and concave from side to side; it is broad anteriorlv and narrow posteriorly. The lateral surfaces are ahiiost hat and approxi- mateU triangular, the external one being much larger than the internal. The externa surface is known as the external malleolar surjaee; it forms the outer side of the astragalus an.i is a,n- tinucd upon a strong process of the bone, the external process (F.gs 154 and 156), which is directed outward. The internal surface forms a part of the inner side of the astragalus, he remainder of which is rough, and is terme.l the .Uernal malleolar surface Behin.l the trochlea and directed backward is the posterior process (Fig. 157^ which is notched l^- a broad groove for the tendon ot the flexor hallucis lonRUS.* The lo'^rr surface of the bone (I-.g. 156) presents a :ali i.resents an oblong, ^lightlv • -ex, artictdar facet, i.arallel to the posterior one, and known as the middle articular facet Un i.e calcaneus, and l.>rdering upon this, and forming a portion of the head of the talus, is a small, slightly convex elliptical anterior articular facet ,or the calcaneus (Fi;.;. 156'!. * Tlicrc mav „nsrqvK.ntly Ik- ,li.tin«uishe/ iHii't II nhiihin V / !>/ i/ZyvV // \\ llivil el' liilii-' livchliii of lulus I'xliriiii! fiiviTS'i Ol llllll'i ( iilniiirii'i I xicniul itioiis-' oj tiilurosily of ailro'iiu'^ fi.ir. li'' liihirosily of ailaiiti (iiitcniii! pnri's^J lis/. n4. J" ■ •■ !i ,: . . I . ' -'■»' if- i-'r Wvrk'i 1 - 1 I I i •13 J" t/5 if 1 it I - a i'^r!. =1 .li'^'^ THE SKELETON OF THE LOWER EXTREMITY. lO': The neck is f the bone. The I,ea.l of the talus (astragalus), the rounded anterior extremity of the bone, presents an ellipsoidal articular surface for articulation with the navicular bone. Th.. pos„.ri,. ,,r„...ss i, sHm.-unn. an in,l.,,cn,Km U..u; a,„l is Uun ,l..i«n.u,..l as .lu- ,. >.„„..,„. U r,.pr,.s..n,s uhal is usually an in(l.']KnilaH Urn- in thr lo'vcr viTli-l)raU'.s. THE CALCANEUS. The a,lca,„us ,Fi,s. . s8 to ,60) is the largest of the tarsal bones, an.l fornis the postero- inferior portion of the tarsus. It articulates with the talus iaslr..^.!,.) by nu.ui. o, ' --•■ '™ - facets an.1 with the cuboid bone, an.l has its longitudinal ax.s .hrected from behmd loruanl and hli'ditlv from within outward. . , . , , ■, ; The nudn portion of the Ix.ne is terme.l the bor t luckened extremUy . known as the >ub,n.i,y an.l projects posteriorly far beyon.l the remain.n, bones of -h'' f-'t; > > plantar surface presents two pro esses or tubercles, the h.UnuU an.l n:lrnu,l proass (1 „. .,V, a„,l in front of the lulxrositv is tlat and cvere.l by the l.,n« plantar hKanunl ,see pa^e uO- Up..n the upper aspect' ..f the calcaneus (Fi,'. .60^ n.n be ..bserve.l the three acets f.., ,,„„,;ui.,„ wi,,; Ihe ,alu> .astragalus); they are known as the posUrior, „ud^, an. a,.r,,,r ,rnn,l.,r ja.rls. The posteri..r is the largest an.l is marke.liv convex, the mul.lle an.l an enor are ^l.htlv oncav.. an.l the anteri..r is the smallest. Th.. mi.l.lle facet hes upon the susten a .ui.,m tali'. an.l la^tween the nn.l.lle an.l posteri.>r i> a ;.r.>ove, the sulru.s n,lnn,n. winch » wuler evternallv than internallv an.l. together with the suU us tali. f..rms the si,u,s o, ihr l.nsus The' mark...llv conca^.. internal surface .,f the cal. aneu> (Fi,. . 58) presents a broac process ,,,^. ,„,,,„„,„!„,„, „li, which projects towar.l the talus ,astr.,alus, an.l bears th.. muldle face, f.,r arti. ulation . i.h that lx>ne. Below i, is a bn.a.l «r.«.ve. the .lirect contmuati.m ..f > ,t upon ,h.. ,K>M.ri..r pnKess .,f the talus (astragalus), kn.nvn as th,. ,r,.,.r,. /or llu //..v.r h.Uuas /,.»,». \ similar but shall.nver ,r.Hne is situate.l u,,..n the otiurwise Hat vert.cal external ^urfa.e of ,he lH>ne (Fi..^. . ..... the peroneal s^roov,; ami al.ne this there is usuallv a sn,all blunt pn.jec- ti,.n km)wn as th. Innlihar iperonml) process. Th, anterior surface of the calcaneus pa-sents a sa.l.lleshape.l tacet, f..r ar,uula„..n ^^>lh the culx)i(l bone. THE NAVian.AR BONE. The ,u,vieular ..r sraplwi.l In.ne (Figs. .(., an.l .6.) is situat.'.l at the inmr m.Ic ..f the tarsus be.w...n the talus (astragalus) khiml an.l the three .uneif..rm b-n.s m lr.,nt .1m«s. 15s .,„d . ; It^ l"ng aNis is place.l transversely to the axis of the f....t, ami i. i^ cmux anter,..rly. markcllv cn.ax, i.os,eri..rly, ami .listinctly cnv.'X uiK.n its .lorsal surface. Near th.. mner lx,r.l..r.)f tliei^antar >urfa.e it presents a strong rouml.d/«/«mv//y. Th.. ...ncave p..steri..r >,.rfa... .>f th.. l.me (Fig. .(.,,) f..rms th.' mm ket for th.. lua.l ..t the talus (astragalus.; the slightlv ...nv.x anteri.,r surface (Fig. .(-.> exhibits thne facets f.>r ,h.. three cuneiform lx,nes; an.l the external surface presents a small nat inconstant facet for the cuboid bone. I i I I i 104 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. riRht calcaneus seen from the inner surface (5). right calcaneus seen from the outer surface (;). right calcaneus seen from above (i). right navicular hone seen from behind (J). Fig. 158— The Fig. 159 — The Fig. 160. — The Fig. 161.— The Fig. 162.— The right navicular bone seen from in front ( Fig. 163. — The Fig. 164.— The Fig. 165.— The Fig. 166.— The right cuboid bone from the inner surface ( j). right internal cuneiform bone si( n from in front (j). right middle cuneiform bone sccii from behind (|). right e.xternal cuneiform bone seen from behind (j). THE CUBOID BONE. The cuboid bone (Fig. 163) is situated on the outer side of the fool, 111 front of the anterior extremity of the calcaneus and behind the bases of the fourth and fifth metatarsal bones (FIrs. 133 and 154). It is irregularly cul)oid in form and its inner border is longer than the outer one. Its dorsal surface is convex, its anterior surface jjresents two articular facets for the bases of the fourth and fifth metatarsal bones, and its posterior surface is .siiddle-shajied and articulates with the caliancus. The internal surface (Fig. 16;,) presents a flat articular facet for connection with the external cuneiform Ijone. and a small inconstant one for the na\icular, and the external surface is narrow and forms a part of the outer U.rder of the foot. The i)lanlar surface presents a llatlened tuberosity (Fig. 15,^), in front of whi. h is situated a bro; groove, the peroneal groove, which is lined with cartilage and accomnuxlates the tendon of the p^ loneus longus muscle. THE CUNEIFORM BONES. The three cuneiform Ixines (Figs. Mn to i()()) are situated between the navicular and the bases of the first three metatarsal U)nes, and, as their name indicates, are more or less wedge- shaped. The internal or first cuneiform bone (Fig. \<^) is by far the largest and also the longest of Ihi three, and it has tiie narrow edge of its wedge directed dorsally, so that its plantar surface is much broader than the d<.rsal surface. Its internal surface is directly continuous with the narrow dorsjd one; the anteri.ir s.miUinar surface articulates with the base of the metatarsal l)one of the great toe; the i)Ostcrior triangular surface articulates with the naxi. nlar Inme; and the external surface is in conliut \vidi the middle cuniiforin and with the base of the second metatarsal Itone, and exhibits articular facet', for both. The middle or second cuneifoim bone Fig. i(>5i is the smallest and the shortest of the three. The thin edge of its wedge is direUed downward and is almost concc led between the external and the internal cuneiform Inmes; ii> base forms part of the dorsal surface of the foot, and its posterior surface presents a triangular articular fai . t for the navi. ular In.ne. The middle ( unciform also articulates with the second metatarsal, and with the external and intirnal cuiu ifomi Inmes. „ • , i Thf external or third cuneiform bone (Fig. if/)) is some what larger (especially in length) than the middle one. Its thin edge is likewise directed downward and its broadest surface looks Po/, iU'tfirorni iuinr) Annul'" I""' . ii'iiliii l'i"iri ^\ Aili'Ul'ii hurt I'lll't'lil th"tll I if,'. 100 I :. 1 'i ! t-l u m 11 i*»-i* THE SKELETON OF THE LOWER EXTREMITY. 105 ..a.! .'^ .0... of the foot. T, .niculate. .i.h .he navicular, cul..!. and .iddle cuncUo... and v> . the second, third, am! urth metatarsa. bones. THE FIVE METATARSAL BONES. r:zt.:-i::i^:'^t:t:.'f::p^^^ -. »...■ »-< '^^ „, ,h. nr,, ,-»«,., a broad plamarpr,,..™,.,, ,1, '"^^''^^^^ „^, ,„^,„„,, „, „„ „■„„ . , f , hi- hisc .il ihr first pr.stnts ;i sint;!' f:i' <■' inl.rnal un.ifor.n, an.l tw,. lal.nd , u ,H for ,h. .h>r 1 "' ' ■ ■ '^^^' ", „;,„;.! ■ m- for Ih. .M- rn,.l , un.if .rm. ami an ..U.rnal.,n..for.h..f..unhm..,a.ar.aUK,m.; '';'' '"^ Y^ ' ^ ^ , ,,„,1,„„, .-.f.h m.-.a.ar.al ...m-; un.l .h..- -a.- of ;;:.^;;;t;r:;c,::;:"';i- -:f:::r a„„ .,„ ^ ..-^•^ .-^ - --- --- -- Ti. .,.. or .he n..aa.a, ,.n.. panic.a.v .hose "f t.u. s^l .. d. I;^^;^;-— — ,,.,er .oward .heir heads and e.hii,,, a — 'j-;^- ^^'^^ .^rian.ular pr.sn.a.ie the dors..m of the .".k,.. In eon.ras. to the.r quadrangular ba.cs, ^"-:rhe ... of .he second . .he .d.h .e.a.arsa, -;;^;;;;; -;;::-'::;:: \:r:iz compressed f-om >ide to side. Thev presen. -';'"- V"^'^!^^; ,,., f„, ,,ieula,i..n w„h •iir-ion, .hich e..end far ..p. he , anUr s.r .ee ; ;^,^;;;'; ^ J^,^^,, „„„..„., ,„. „.• •he l,ases of .he ,,rox,mal phalanges On .he la.c U _ .^^_ nH.....ar>al hone a..achn.en. of hga.en.s. an-i t^ 'f"-.-' j :,:';; l,,. ,.o eo,..ant sesan.oi.l hones presents .wi. concave articular faiel>, sei)ar.u..l in of .he grea. toe. THE BONES OF THE TOES. PHALANGES. Ler ,o.t ar- . o.sideraMv ..orU-r an.l .nore ^i>"''>- ;- -;; ^. ^ „ „„. , ,,„., .i,H In other respec.s ,he phalange. ,.t .he .,k. are ahn.M , - >' ^ ,,,,,,„^,, U.e exception of irregularities ..f devel.,pnten, . nch :m. . u .i^^ .^.^^^ J^^^^,^ ,^^ of the .wo outer toes an-l are lar,..h ,., W ..urflmt.-l ... . u .-> >■ ^ ^^^^^^^^^^^^,^. ,.n,.. .,f these two toes are -"l^i'^^'- .>r.. U..dlv e en .h - 1 ^^^^^ ^^^^^^^ 1^^^^ and in all the toes it is onlv the pr„untal pha ,n«e- da . a ^ ^^^^^ ^^^ _^^^ ^,_.^^, A. in the hand, each ,>halans Kes..n.> a /.„sr and a Inn hl.„. an,. phalanges termina.e in an »/Hi,w«J/ lul« rosily. io6 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. THE SESAMOID BOf ; , OF THE FOOT. Two sesamoid bones, remarkable on account of their sixe, are constantly found at the metatarsophalangeal joint of the great toe (Fig. 153). Inconstant sesamoids are also found in the tehdon of tlic peroneus longus muscle, at the interphalange;i '. joint of the great toe, and less frequently in tlie tendon of the tibialis posterior muscle. It \ u THE SKELETON OF THE FOOT AS A WHOLE. The skeleton of the fcxH (Figs. 153 and 155) difTers from that of the hand not only in the numlxT and form of the component elements of the tarsus, but also in certain peculiarities, chiefly due to the functional adai)talion of the foot as a sup])ort for the erect body. While the axis of the hand is situated in the direct continuation of that of the arm and forearm, the axis of the f(K)t is placed at almost a right angle to that of the lower extremity, and while in the hand the phalanges take up alx)ut one-half of the length of the skeleton, in the foot the tarsus alone occu])ies the proxi- mal naif and tin- metatarsus and f)halanges together form the anterior half. The phalanges make up only a fifth of the entire length of the f(K)t. The foot shows a much more ])' mounced curvature than do the relatively llat and closel' approximated i ones of the hand, and this curvature is ])ractically a constant one. The convexity is directed toward the dorsal, the concavity toward the plantar surface, and the dee])est jioint of the concavity is situated at the apex of the middle cuneiform l)one, tlie dorsal surface of the same l)one likewise forming the highest point of the middle portion of the arcii. The arch of the f{K)t is supported posteriorh bv the luberosit} of the calcaneus and anteriorly by the heads of the metatarsal Ijones. The tarsal arch is formed exchisi\ely b\ tlie tarsus and metatan us and is o])en internally, since the inner lx)rder of the fiKit is much higher than the outer one, which is in contact with tlie ground throughout its entire length. The sinus of the tarsus 'see page 102) is a striking formation which gradually becomes narrower as it ])asses inward and l)ackward from the outer side of the dorsal surface. The tarsus is much narrower posteriorly than anteriorly. The i)halanges of the second lo the fifth toe do not lie in one plane even during extension, but are strongl_\- cur\e(l with the ccmvexity upward and seem to Ix- Ix'nt ujion the heads of the metatarsal Ixmes like claws, so that only their ti])s touch the ground. The second toe is the longest and marks the longituflinal axis of the fcxit. fsuall) till' imly tarsil lumc-. ikksc^miik I'l^nti-rs at liirlh an Ihi- i alrant-us (t iif thrcr luniiform Uitiis to ossify (lirsl yi-arl, thf inliTtial is tile nixt (ihiril yearl, and the miildle one is the last, its nation and that of the navii ular Ixine (KiurrinR respeetively in the fourth and the fourth to the fifth year. The lal- aiieus alone has a < iilel Ulllll ,lll< 1 puUliV. The ossitHation of the phal inRcs of the foot als' third fetal nionlh, the epiphvs.-.d .enters in the third lo the fourth year, and the union of the epiphysis with the di.iplivses. .is in the iiiitatars,il Umes. oeeurs after pulM-rty. .•'•;.■;■■• ■'■•■ ,■ '^•■'^'■'^•^.^•..Nl'il- til...,".. ;.'.:<-r;v^ ■.■•)- j; 5^, I iiiiiilmliiiiil i/iviiliil' salioii i'l till- iipiur txtirmily i>l llif Iriiiiir I oiiiiiliiiliiiitl i^i:Kitli'l '•irfic'i I'l' till i;i/'\iiiiii^ I /.'. los. Sift' -QsiiS r 1' - ' ! -; i ;' Fig- '69- lontah section of the '.""^;"i/r;;/(v oA """"•'■ I'iS- 171. f/cr. 170. '''''«'';;;!;::r'r^''S'''''''^'"'' .•V^f^v,!-'; Si/jrif" ; sic""" • ,;■ /,/»l/'(f '■'■'■ Ichiii i, £ .; Is ' -T iL ■ IS \ It '< I! 3jtJ W^ i ?fij^ I ita ,^J i SYNDESMOLOGY. GENF.RAL SYNDESMOLOGY. The bones of the bodv are connected . i,h each other in one of two ways. '^^^^^^^ Tie of cLnection, allowing of a nntch nu.re extensive ran«e of mot.on between the bones. SYNARTHROSES. The svnirthroses are classiUed, according to the character of the tissue connecting: the ends Svmhoiid roses are diaphyses of the long lx)nes (see pa-e 2 1). An example !> lurni. rib to the manubrium of the sternum. The syndesmoses .r, sub-'^'ided into two .roups, true sy,ules,noses and s,,uns ,.c pages , , in The true svnd c ^lose in which interosseous hgaments, which n,ay be e a>tu and 80). The tn e s>nd ^^^^, frequently str..ngthene, wnieii aie . ... i„,ny margms by means nect the bones, layer of |>eiio^toum (see jiai; e- (yS). In the mixed synarthroses or symfhyses the tissue conne^ cartilage. Typical' examples arc furnished by the connection cting the e;-.', . of the bones is libro- s of the bodies of the vertebr;u :h,. ! I i !i ] I io8 ATLAS AND TEXTBOOK OF Hl'MAN ANATOMY. by the inlerverlcbrdl fibrocarlilagcs, and b\' the connection of the two j)ubic Ixincs by the inter- pubic /ibrocarliliii^f. We occasionally find a combination of a synarthrosis (particularly the syndesmosis) with a joint, as in the connection of the sacrum with the innominate bone, or .a lit alar spaces may appear within the symphyses, and such arrangements are termed half-joints [ampliiar/lirosfs). DI ARTHROSES. The diarthroscs or true joints are characteri/id by congruent cartilaginous surfaces which a separated from each other by a cppilhm- s])ace, and are provided with a number of struc- tures, the majority of which ai ibsent in the synarthroses. These are the arlieular capsules, the ;it ces,sor}- ligaments, and the articular cartilages. They may also be ])rovided with s])ecial structures, such as the interarticular cartiuiws or menisci, diverticula of the synovial membrane forming synoi'ial burscr, glenoiilal lips, joint cushions fdcsignr.tcd by fliffcrcnt names in he dilTerent joints), and lx)ny locking mechanisms. The articular capsule usually surrounds the cartilaginous articular surfaces of the con- tiguous Ix)nes so as to form a completely closed articular ca\ ity. It consists of an external firm fibrous layer, the fibrous layer, and of an internal softer vascular layer, the sy vial layer or membrane. The latter gives off microscopic thread-like \ascular ])roces.-ies of irreg .ir sha])e, the synovial villi, and occasionally it forms large structures; visible to the naked eye, the synovial jolds. The articular cavity, usually a capillar}- space, is filled with a \ iscid fluid, the synovia. The articular cajjsule varies in thickness; it is sometimes strengthened by accessory liga- ments and sometimes interrupted, .so that diverticula of the synovial membrane jjrotrude through its ojjenings and form syno\ial burs;e (see also juige 143), whose ca\ities are conse(iuently vlirectly continuous with that of the articulation (communicating synovial burs;e). Accessory ligaments form important com])onents of the articulations, and according lo function the ligaments of the Ixxlv can be sulxlivided into the following classes: (i) Ligaments oj fi.valion; i. e., those ligaments which firmly unite iwo bones, as in the syndesmoses. (2) Ke- injorcing ligaments of the joint capsule; tiiese are more or less adherent lo the capsule itself, but sometimes apijca"- as independent structures. (,V) Check ligaments, i. c, ligaments which are ca])able of limiting certain movements of the joint. (4) Ligaments oj conduction, i. e., liga ments whose function is to conduct vessels and nerves to a part of a bone. (5) Ligaments which take the i)lace of b; .., polvax.al faces. These sulxlivisions are as loUows. (i) LmaNiaij joints. , „f ,^^.^ varieties those with a tran>ver>e aNi^ an.l tli"-«- The uniaxial joims ^^ J^^^^^ :i :::,::t:.: .r. variety is at ri.ht angles to the a., uith a l.mgiluainal axis '• - ' . ,^^. ,,,„ .j,,., are coincident, of the moving bone and in the second Nanct> tin 1. UNIAXIAL JOINTS. A -c Tl„. I,i,v'r hnn< or 'iiu'^lvmrn belongs in this (lass. 1 hese ,a, With a Transverse Axis.-llu/n. . . -_. ^ ^^^^^.^^^ ,,^^, ^,,,^^.^.^ ,„,,,,, joints are broad an.l the articular ^^^^^^^^^^ , .L.esi.nding elevaii.n. Thi^ c.n- Lhibi.ing a median excavation and ^^J^^ _^^,^^ ,,, ,,,.,a ai^placenun, of the hone, formation together with -'-^ ^'^ ^ ^ .1 ,, ..Android and i. con.,uent.v hori.onud- so that the axis ot motion comedo wUh h ^^^ -„^^,^^„, ^,^ Hexion and cxtensi..n. and m The mo.ion> permitted by a gmglymoid 3 '"^' .'^ ' ;,;^,^,^ ., „f „u. ginglynu,> .,r hmgc complete extension the bones fornj an ang e o o^ ^ ^. .^ , _^^ Join! are furnished by the iiiterpbalangeal ^ ^^ ^ ^^ ^ ,-,,, ..,,avaUon m the =i:r:,tH:;:=^ j;-™--^^^^^^ , ,. examples of this t""" of joint. Ill ill m:m H l! ; S I; i H no ATLAS AND TEXT-BOOK OF HUMAN ANATOMW 2. BIAXIAL JOINTS. This class of joints includes the ellipsoidal or condyloid joint and the saddle joint. In the ellipsoidal joint the convex surface of an ellipsoid of rotation articulates with a cor- responding concavitv, and the two axes of motion, the lesser and the greater axis, arc placed at right angles to one another, but both jiass through the same bone. An example is found in the atlanto-occii}ital articulation. The saddle joint is formed by the ajjproximation of two saddle-sha])ed surfaces, /. c, sur- faces which are concave in one direction and convex in the other. Each surface alternately forms a head and a socket, and the two axes are at right angles to one another but are situated in different Ijones. The most typical saddle joint of the human body is the carpometacarjial articulation of the thumb. In reality the motions in the ellipsoidal and saddle joints are not strictly biaxial, but may occur in any intervening axis between the two, and one of the two motions is fre(piently so lim- ited tha; the joint practically becomes a ginglymus. t ! 3. POLY AXIAL JOINTS. The only polyaxial joints are those with spherical surfaces, the spheroid joints. These are sul)di\i(ie(l into two varieties, the ,(,'//'//",(,' /()/'«/s- or arthrodia and the ball-nndsockel joint or eitiirllirosis. In the at.iirodia a spiierical head moves in a spherical socket, but the articulating surfaces are segments of very large si)heres, and may seem in some cases to be almost planes. Com- paratively little motion can take jilate between the surfaces, and what does occur is more or less of a glidiuL; ( harai ler. (iood examples of arthrodia are to be seen Ix'tween the articulating processes of the vertebra'. Ill the iiiiirlliroMS the arliiulaling surfaces are more extensive segments of smaller si>lieres and the capsular ligameiMs are rtM.niyand relaxed, so tlial a considerable range of molion is po^^ible belwciii the two Ixines. I'Npical ixamplt s of these ball and socket joints are to be found in the sho\ilder-joiiit and hip-joint. SPECIAL SYNDESMOLOGY. JOINTS AND LIGAMENTS OF THE VERTEBRAL COLUMN. THE CONNECTIONS OF THE VERTEBRAL BODIES. Thi li(Mli(s of thi' true \irtebra' are ( onneiled by intenrrlehral /ilmhiirl!hn;es ( Kigs. fj; to 1 7S i, eai h ol whi( h i Kig, i 71 ) cunsisis of an exiiTnal linn /iliroii^ /-/)/!,' ( oniposi'd of loni inlrii and interw'MM bun relaxed in the cervual -' ^ '^^, ,^^. ,^,„,,,„u. ..nnection. of the :z:;;rCei:^rx-^- '■ THE LIGAMENTS OF THE VERTEBRAL COLUMN. 1 „f .«■„.. roui.-- thosi- whi.h run through- The liganu.nts ..f the vertebral column are con,p...l o^^^^^K^^^^^^^^^ on, the en,irc leng.h of the vcrte,,ml "-;-;;' ^.^ J ^^ );;„„,. ,., ., .hi,h -here is an U.uou> v.rtebra.. Ti. ,n>t «":;;;;;;!;,,,;,,; ,,„„,.„ i, :,nache,. ,„ d,e ant.ior :r::;n:,:v!:;r;;Xa:^t;:.erver;ebran^ "-- invests their posterior surface-. .,„i ,S^) commence, al the phar^ ivjeal U.,..Me up<.n the ba. of the ^Uull a. a ;-■•;;-;;;' '^XZ^U uni.cd t„ .he inter- and il terminate, upon the anterm,- surface ot ,lu sa.n ■ ^^^^^ ^^^^^.^^_^^ ^^^. _^^^ ,,,,,,,,, ubn.car,ilages, bu, i. -nly l'"- >' -"nc U. . - -I J__^^.^^^_,,^_^ ^^,„ ,he periosleimi of the bodies ul the vtitii.ia. an i .hort deep ones which ,...> from one veM, bra to ^^^']^'- ,„ „„. „.,,,i„r surface i;!:,,^::!::;'I:;^trr;;:;;;::•''5:v^^^ rri::"::i::;^!''V;:.i;:::;::::::-":;'^"--- - ■ ■"■ 1, is |ikewis.Momposed of a superhual and ot a Oeep la>e,. I I S J I I j il lj Ij |i i »'i. 112 Fig. Fic. Fir,. Fir.. ATLAS AND TlCXT-nOOK OF HIMAN ANATOMY. '7.V '74- i7.=;- 170. Fi... >77- Fi... ■ 78. Fic. i7g. Fk;. 180. -The anterior longitudinal ligament in the lower thorad< p.^ ion of the vertebral eolun^n, I tret her with the ■ osto vertehral ligaments seen from in front (,). The n r t udinal h.ament in the lower tl.-raeie and upr^r h.mhar portions of the ver.el.ral column. The vertebral arehes have been remove"-s plexuses. ul. iti 11 .0 llH. l..ngi.u.linal ligaments, this group also eontains a portion of he .«pn^ s,iJ:stL.I. I. will be deseril.d subse.,uentb , however, together w„h ihe interspinous li.rmu-nis wiih whi( h il i> intimately ronneeted. . , ,. ,,1. ^ The short ligaments of the vertebral <..lumn. eonne.ting e-,n„guous verlebra-, an .ib- arehe- and th"-e lonneeting the processes. ' 17(11, are divided into tho-^e connecting ihi '""t c iVm. .lu. venebral arches, the U.unnU,, //.n-MFigs. 17. and lyb., arc stron n U e cmposed almo. entirely of elastic ti.sue, ,0 whi. h .he. o.. ihcn- pron-iuncc Iw .1 Ik'hc ihcir name. Thev e.tend anleiiorly as far a. du- po., "'-'-J- ; ar„.ul.u- capsule, of the in.ervenebral ani.ulaiion. and -n.^u-ly < .;se ', u I With the exception of a dislim I 1 surface is absolutcK -ni.H.lh aii.l i- dire.ll\ .onlinn.ui> lU their ela-licity ihex keep .lu posterior wall llir artu ul.i , . rinil . \cept a. th> siiuaiion of the in.crvcr.ebr.il loramina. ^,n„„, in .he me,lian line, '.beir in.ernal ^urfacv is absoluieK :;';;:'":;:;:;•:";,;:::::;, r;,:;!,:.:::. ."m'-- - --r T '::'::,■:„;;,,:;:; ;;;>;.„, „.,..., - ■«-"■" "■■■ '"- > ■" ' ' -"■ "■ III ••. l.i-i -mil •ire slroivc-l below and Wcakis. abo\c. '"':;t;: ::;::«;«.- '^i- ■= > *.»-,„;,.„.,„ „., .„..,,,,. ..».....■ ,r,„,s,... Ill ,lu- Mrt.l,.-a-. .!u ) are par.uularly dcv.l.ip.-d ,., Uu (ni.uding the lr,in>ver-e pr |i.,,raii< and hunbar region^. .. ._ ..._, .i.,..,.i, .,,■,,..•■•.! in \h.v liiiubar region. ,!„■ y,i[>Msl=iiwlis //>/»".»/ I Fig. 1701 whuli con ,.|„,.ssc, (if 1 iinligncni-- verteiir.i' Ihev are (onlimioii-. anit riorlv and aliaiii on n uiih .lu- ligamenl.i d.ua and ] lilt l. ihe a| Misit riorh with ;:L. „, ilu spinous processes and form, an independent ligamen,. 1 lu ni.erspinous ■toMrik Anterior eonio- :rim.^vrrsr <• iiliami'tti^ Aiitirior l()nf;itiiiliitiil lii:M«i^ l.ifrtl- ments of costal neck Ril's W'llchntl boilv Artiaiiiirjaii ■Is for (vstiil tnl'irdcs meiiU: flin-d Posterior Iniiiiiliidimil liiianirnt ertfbral iirrhrs X Fio. 170. liUmirliniliir luHiiniiit Intnrtilfhnfl lor.inun I li^dtiieiit oj io^tiii nirl< Sdcnini I'dslrrior ivsto- rniiisvrrsr lii^uiiwnl Inr. 177. Inlinrrl.hnil li/in'i lilt: lit;'' I iiluirti- I'l "'' 11 yR/^la^'JJS^ ^ .Si^S r m i |i ■ i' " 6 I 1 i !: S iH JOINTS AND LIGAMENTS OF THE VERTEBRAL COLUMN. '.S and supraspinous U..n,cnts a. found t^-^^^^^^^ -!;-;;;- ^Llli:!.:"';^ '^X cervical vertebra- they forn. the n,.»u;^u,n «m/.MP g- ^9;;;"^^,^„ ,,„,,,,,,,, process although relatively poorly developed m the human sujeU — n .^ J^^^^ ^ of the seventh cervical vertebra (vertebra l--'^ ^^ f a "Iterior vertical band .hich is :::rb^rr;=;i'r:^--n^^^^ I t^ps of the spinous processes of the remaining cerv.cal vertebnc. THE ARTICULATION OF THE SACRUM AND COCCYX. The ape. of ti™.. and the Hr. ^^^^j^^ ;-;^t:z:rr;:l r i: " H^s" ,v,„/,/n.,W,s- and by a number of relatively --^'-^''" /.5;; ,^ ".j.^" ,.,), to either side are .;f .Je'two Ixmes is situate.l the anUnor -"•--;'^- j ^' ' i^^^, j , process of t..e the /--' 7-7-"' ^ZZ fl'min^T^f n-1 Lin, an.l posuiiorK there are first ccK-cygeal vertebra and thcrcb f"'-"]'"J^ ' ^^ superficial and a deep one. The ../>../,>•/„/ posterior sarrocoay,.,! n,a,un; ^'^f^^°^^^:^^°^. ,,,, ,i,,p i,„s,rior s.rro coccygeal cornua, an.l closes m the ^'"^Jtcr port ^^^^ ^^^^^^.^^ ^^^ ^,^^, ^^^^^ tudinal ligament. T. e... . .„e ...... ...u.n .e .'-^■-■;' ^r '"kC:!:: ^i-^::^:": :::;::;.::! ,:; ■• :: rtn:i^::'r; ■ ::rr ::r ::x.x;:; •.,.,„..... ... . .,..,.. ..< ... „, of its indiviilual mi,'"ii'i'^. The A«a„,o-oc=ipUa. and .he A..a„.o-«ia. Articulation. -J... ..^>vn,™,._^^ ,»„!, a,lan,„-.«ipi.al am,„la.i,„» an.l .1h; » l!'"';.'' .■';,,,„„,„,,„ a,, .«Ti,ii.al ;::;i:^ :;:::;;::- ;>--'':.;;;::.: i. ^ a,,,. an art 11 u! sur n.temblinii; ^i cone. The axis of rolalinn respont Is to the long axis of the otlon itoitl p Thi artit u lition between tlie oi Ion toid 1' Lss and the anterior ih of the atliis i^ a im\oI I giJ '^^^S^-^l^ .ML. M \ ( 11 IT4 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fig. i8i.— a frontal longitudinal section of the sternum and costal cTtilapes (J). Fig. 182.— a portion of the occipital l)onc together with the atlas and axis (e|)istropheus) and their lifjamenls seen from behind. On the left side the capsule of the atlantoaxial articula- tion has been removed (,'',,). Fig. iS;.~.\ i)ortion of the occij)ital bone touether with the upper three cervical vertebra' seen from in front. The ca|)sular li-^aments have been removed on the rijjht sii'e (,''„). (■trochoid) ioint with incomplete articular surfaces, since the oftontoitl ])rocess is frc(|uently covered with cartilajje upon its anterior surface only, its posterior surface arliculatinj,' with the transverse li<;ament of the atlas by a .separate joint. Both joints have se])arate ca])sules; the ])osteri()r one is also regarded as a synovial bursa. The paircci lateral articulations are ])ecu!iar in that both of the aiticidatinj,' surfaces are slightlv convex, so that during rest there is only a line of contact. The rotation ettectcd by the combined joints is consequently not in one plane, but assumes a spiral character. occipiuii hituf Dut'i mitrr Antiriiir ■inl: n; ,:!! Aniiruir ■irlini: ir snr/'i'C 11/ ixloiil i:J prorrss Odtiiuiiid friirrs. Biiily iij iixis Iio,l\ <•/ f.rrii-.il vcruhri III M>itihr!ri 1; n'j allaihed lu ihc inner margins uf ihc lateral masses of the atla-; it i)asses across the spinal foramen of the atlas in a curved direction, the convexity being jjos- terior, and invests the odontoid jirocess of the a\i> tdcns rpistrnphti) behind. It divides the s])inal foramen into two compartments, a small anterior one for the reception of the o. ■** • — &■• & & ^ ^ t: '"• '^ 2 ■^ "^ ■f ■-C ' w «j '>j ■iiiii JOINTS AND IJGAIIF.NTS OF Till. VFRTI.HRAI. COI.IMX. r r: process anrl a larger posterior one for thi' spinal cord. The i ortioii of tl.e liuanunt whirh i^ in conlaet with the [Kisterioi- .surfaee of the odontoid process is I'oven'd with eartilaf;e and there is (usually) an articulation in this situation. From the middle of the transverse li!,'amenl of the atlas are given off two vertical fa>cicuh', one of which jjasses upward toward the occipital hone and tiie alianto occipital t:'end)rani\ wliile the other pa,-ses downward and is inserted into the jiosterior surface of the body of tlir axis ('epistropheus). The combination of these fasciculi with the traiis\er>e ligament forms what is known as tlie crwiiitc lit^nmciil '. Fig. tS;). The joint jw^sesvo tliree other ligaments which arise from the odontoid process of the a\i~. a small weak rjiiddle ligament and two strong lateral ligamenls. The middle ligann-ni i- known as the apical odonloid Ht^iimdil (Fig. i8S) and runs from the li|) of :he (nlontoid pnniss to the nuirgin of the oicipil:'.! Iv ne. I' is a ouite thin and insignificant structure and has scarcelv an\ mechanical function. It contains remains of the chorda dorsalis (see page i lo). The strong ligaments extending laterally from the (xlontoid jirocss are the alur lii^anini/s (Fig. i88), and they i)ass oljli(|uel\- upward toward the inner margins of the londvles of the (K-cipital hone. They attach the (xlonloid process to the skull and act as check ligamenls for the atlanto axial joint. The cruciate ligament jiartly covers them when \ieweil from behind. The ligaments arising from the odontoid jirocess and tile transwrse liga-iieiii of the atlas are separated from the wrtebral CMial by a tirm broad ligamentous ma>--. the Irdoria! membrane (Fig. 185), which forms a smooth surface exhibiting in relief the umlerhing odontoid process and alar ligaments. In the skull it i- loiuinuous with, the dura mater, and below it i> continued into the deeper layers of the po-tercir longituiiinal lig;cment. It i> separate I iVoni the atlas by a ])le\us of veins. .\ further jieculiarity of the articulation of the lir-,t two cer\iral vertebra' wilh the occinul is furnished by the allanlo-ocrifiital iobluraior) invmhraiiis, which >rr\e to close the broad spate-. which exist between the atlas and llu- occiput. Tiie anhrinr alianto ocd pilal labliiralor) num hranc (Fig. i8_;;) fulfils this function upon the anterior surface of the iwo \-ertebr,e; it is stretched bi'tween the >ccipital bone and the anterior arch of the atlas and i> adherent to tlu' uppiT extremity of tlv anterior longitudinal liganu'nt. The paslcrior allanlii-OK ipilal {obttiralor) mrmhranr (iMg. iS^i i- to be reuanlid as reiire- scnting the uppermost jKirtion of the ligamenta llava, although il ha> not the ela-:ir slructun- ot the latter li ^anient, and is much thinner. It closes in the sjiace liei"ven the occiput and the posterior anh if the atlas, le;i\ing apertures for the jiassage of ves>rl> , nd nerve>, and is con tinned in thi' interspace between the atlas and axis, taking the plate of the first ligamentum tlavvuu. In tli<- atlant(i-oriipii;il :\rtiiul.->tion tliiTc i-; |irMilii;illy no nicninirnl |HTmiai-rl .\\vm\. ili. -liurt N.i^iii.ii .i\i,, liiii till' I liicf riiiivrmiTit o( rurs about tlic liiiri.^ont.il and tr.in^vcrsi- axis am! i ■moists of tln' nml.ii iiinvrnirnl- ..I llu !u nl In the atlanlii-axi.ii arli. uiali.in ihc ac lual mtatinn nf the lu;ul ..nurs .il>.mt a Mili a\U |ia~-in>; il".nii;!i llu- r«!i.lii,.i,i |.i.Ki>.^ oi liii- aM>. 'I'mi' main juitii ail-, a^ a jiuiii-juinl, inn liic- nualion i- i hi. i hy tne alar liganHau^ and aniuuiils to .diout 40 dcKm, uidy in lai h dim licm; the' laturai jrnnts allow nf a ^jiiral niotiun. ■.i. ■ tt6 ATLAS AND TKXTIiOOK OK HtMAN ANATOMY. Fk;. 1.S5,— The lertoriul membrane seen from behiiKi. The |K)^terior portion of llie oetipital bone and the arches of the three ujijier cervical verleljra' iia\ebeen rennned, as well as the cap- sular ligaments of the rii;ht side ({'„). Flc. iSf).— The atianlo-iHlonloiil articulation. The odontoid process (iAhv cpistrophi-i) and the ankrior arch of the alias have been cut (,",,1. Flc. 1.S7.— The cruciate li|,Mment after removal of llie icitoriai membrane. Tlie articular lapsuli-- have also been removed on the ritiht >ide (-,'',5). Fk;. iSS. 'Flu- alar liu'amenl- after removal of the cruciate liirament. 'Fhe articular cap^ule^ as in the lirecedini; l'i,i;ure ( y',, I. THE ARTICULATIONS OF THE RIBS WITH THE VERTEBRAL COLLTMN AND WITH THE STERNUM. The posterior extrePiilies of the rilis an- connected with the thoracic vertchne by arthrodial joint- iFigs. 172. 1 ;(), and 17.S to 180); their anterior extremities (Ki.i,'. 181) articulate with the sternum or with each other by means of either arthrcMJial joints or synchondroses. The anterior extremities of the Iwo lowermost ribs are not attached to any portion of the skeleton. The ribs are (oniiecled to the vertebrtL' t)\ a (loid)le arlii ula'M:). The head of each rib articulates with the iKwiies of two adjacent vertebra- (the e.xccptions are {;i\en U])()n pa>;e '(>) and the tubercles of the ribs, with the exception of the last two (-.ee paj;e J71, articulate with the transverse ])rocesses. 'File arlictdaliuns of ihe luads of the riljs, with the excei)tion of the uppermost and the two lowermost, ail ^ haracteri/.ed by the fact that the intervertebral librocartilage between the two vertebne forminj,' the articular cavities is continued, as the iiilirartidiliir lii^nmiiil (Fij;. 17S), as far a- the (rest upon the heail of the rib, and divides the arlic idalion into two ( omiiartments. The weak articular capsules are reinforced by ihe niitlalr (stilluli ] lif^,iitiiiils (Fiiis. 172 and iHo), which arise from the head of the rib and radiate to the lateral surfaci's of t!ie IxKlies of the V( rtebra' forniinn the aniculation. 'Flu i()\lo Iriiii^Virsi iirliailiilioiis havi- lajiacious (ajisules and are cliarac teri/.ed by ikis.hss ini; i|iule a luimlKT of reinfon inf.; or c lui k ligaments. 'Fhe posli lior surface of the ca))sule is ninforccci bv a -hort tense lig.sment, the lii;am(iil aj llu (oslnl luhinlr ipuslrtior a-slo Innis-irrsc lii^iimiiil] (Fig. 17c)), which is app|-oxiiiiately (|iiadratigular and composed of ])ara!lel t'jbcr-, and c xteiicls outward and slitrhtlv upward from tin lip of the iraiibVerse |)roiesN to the posterior sur face of the neck of llie arlic ulaliiig lib. 'Fhe lii;iim(iil oj llir iinl.' imiddh ' i('ipil [y^ ivT: "1 9 — -^ [ll_KL ^m ()il(iilloiil /iron ■• Itihlv Ol II MS i^i^ I Tin: ARTIcn.ATIONS AM) IICAMINTS OK TUV. IIKAH. 117 and frequently also from llie lower bonier of tlu' a.ijacent rib to the neek of the next lower rib. The jiosterior li,i,'ament (Fiir. ,7,,) is niueh weaker than the anteriir one; it i> trian-ular in shape an to the pos- terior surface of the nrek of the next lower rii,. The two li,iran,ents form the l.oun.lari. . of an opemnu, the coslo-tniii.sirr.u- jor.imcn, whieh -ives -'assa-e to the intercostal branch of the spinal ner\e. The m-.voment. of (li,. ril,s upon th.- v,Tt,-l,m- arr .onsi.l.T.il.lv lin,i..-.l l,v ih.- -urroun.li.u. , !„■, k lii-anunt-. Thr iwo jo,„,s, that of .1,.- h..a,l a„,l ,ha. of ,1„. lulnn I.-, a,, ,o«,,l„.. a. a , nn,l., .,1 ar.i, „lal,o„ u I,,, 1, ,„,nak,.. „f ,1„.„ „ur,. of a Pivot joinl, uhos.. axis corrrspomis to ,h,. ,„■, k oi tlu- ni, an,l i. ih.-rrfon- ahno-. iransv,,,,.. Tlu- nmumnn ,l,out tills axis .s sue h that thr anKTior .■«niniii.-s r,f the ril.s an- ,kvatr,l, and the ,h.lan. <■ I,, t^^r,„ their anlrn. and tl'.e vrrtiliral column is in, reascil. nor rxtnniitics Tl. ' cartilai;es are connecterj with the sternum partly In svni liondro^c , and partl\ by mov Is, the sIrnw-rosUi! arlini/.Hions (Kifr. ,81). The first costal lartila-c is always united to ,R sternum by a sent hondrosis, biU l«l«een the anterior cMninili.s ,,rilu- second to the sevei.dl costal cartilages and the sternum, however, there are usuallv true join.s. The second sternocostal articulati.,n (and fr(<|ucnllv the remaining ones) alwavs contains an inirr arluuhir li^amnit (Fit;. ,S,) whi.l, passes from die synchondro.sis betwtrn'the manubrium and tlu iMHly of the sternum, ,.r from thr outer mar-in of the bodv, to the anterior extremilv of the costal eartila-e an.l divides the joint into two compartments. This li-ument is inonstant in the articulati.ms of the thinl to the s, vt„ih tuMal cartila-es with the .sternal b.,rder, and wh.n It IS present it is fre(|uently so siiualed that the articulation is une<|uall\ suMiv i.led. The anterior surfatvs .,f the articidar capsul.s of the sternocostal articulations are rein forced by the rmlhUr lif;,„nnils (Fi^-. u)2) which arise from the ends of the costal cartilai^es and spread out like fans up<.n ihe anterior surface of the sternum. The interlai ini; fibers of the radiate lif,'aments of the lower tartilages form a m.-mbrane, the sUrual nnmhnni,; up,,,, ,l,e anterior surfa.v of the lower pinion of He sternum, and are blended uiih the peri,.steum in this silualion. Joints, whi. h are known a.s the inhnlu „ lr.,1 i„i„ls, maN also be present between the tosid carlila-es of the fifth to the tenth rib^ (see p ;e ,5,^1, an.l in the >1. rimm ilself there is a sl,r„„l syiirliniidrosis fsee pa^e vD between the mam: )rium and IkkIv which frc,|uenll\ ha> a cavity, and s,»„„/. ai. rtallv mtxlil. j fastia' whieh uill i,e uMi^dered in the d.-t rip tion of the mus( les (see ]iHf^v Kii;). an artitular 'Tlu- a. Iiiai rannf oi inoimn ..| \\\r , osial ..iriilaK. > I" ih.- Hirlrrahlv iiii ri'.isrd liv Ihi- rla~liiilv of ihi- . .iriil.ii;. , ihinis vi- ail simullamously ami in ihi- Mnii- manm r. ■-Iirno,o,|al aril, ul ,1101,, ,, ,|, III, innii, ,1, hui ii jsmn- Ihe cosi,„,rli l.r.d .md lli,- , osi,,.i,rnal aril, nl.iiion. THE ARTICUlAnONS AND LIGAMENTS OF THE HEAD. Tl .• onlv movable joint bt Iween the b.,n.s uf the h , I is th, 1, nip,M,. masillarv articulation. The remiiininK Ix'nes are unile,l by sutures, the termiii(,|,)ny of \vhi,h l...s alrea-h been discuss,,! m lif ii8 ATl.AS AM) TEXT-BOOK OF HUMAN ANATOMY. Fic. 189. — The right tompnro manclihukir articulation seen from the outer side (]) Fk;. igo. — The rijiht tempuro-mandiljular articulation seen from the inner side (', ). Fii;. in. The rii^ht temporo mandibular articulation opened hv a sagittal section, arWi iias been removed (\). The zygomatic n in the sect. on ujKJn osteoloj^y. Considerable quantities of connectixe tissue are found onlv in the s])henopetn)sal fissure, in the foramen huerum, and in the ])elr() occipital fissure {sphcno- petrosal and pciro occ ipilnl synchondroses). THE TEMPOROMANDIBULAR ARTICULAnON. The temporomandibular articulation iFigs. i8(; to iqi ) is the joint Ix'twcen the condyloid tircKcss of (he mandible and the nnuulihular jossa of the- tem](oral bone. It is completely sulxliyidcd into an U])])er and a lower portion by an oblong, biconcaye urlkuUir disc (Fig. i()i), which is adherent to the capsular ligament by its circum*'erence. The two joints which are thus formed, namely, that belwei'n the mandible and the disc and that between the disc and the mandibular fossa, act separately. 'Fhe articular capsule of the joint iF'ig. \q\) is rather thin and relaxed. It embraces the mandibular fossa as far as its posterior non cartilaginous surface, the articular eminence, and the head of the condyloid process, and i> insertecl into tlie neck of the mandible. Its external surface is reinforced by a ligamc nt jiassing from the zvgoma to the neck of the condyloid process, the Umporomtuidihular l<:\t,riiiil h.Urah lif^amrnl (F"ig. iSiji, ;ind it-- Jilxrs ]ia^> from abo\c- downward and from before backward. In tli( 11 ni]i"r"ni.inililn;I.ir anil ul.iiion llu' -"iki 1 i^ fdTiiK.l [Mrllv l.> ill. ;ii.ini!il>iil.ir fn.„.i and |>arll\ l.\ \\\v anil iilar rinimn. 1 , and n\i r llir lalli r an a|i|iri>\inialrly cinirruinl surfai r im !'•> luad of tin ,ond\ ii i- I'nrnud l.\ llic artii ular di-i . Tin two ii in|)or>>ni.ind)luil.ci- ar!i( ul iliun^ a. I sinwillaninu-li Will- ilu- inc.ulli iv i>|.,iird ill. Iliad nl llu imidvlc nilh llic inirrarlii u'ar di>i Kliilr-. fnrwanl Uimn iliv irtiiular I mini 111 1 . and wlnn ilh- nmulli i, . IumiI it -liii^ hai k into 1 n ni.imlilmlar lus-.i. llu- np, ninj? and 1 jn^inn of llic- nioiilli arc (iinMiiucnllv aiii nr|i-d by a vjidint; uf ihr niaiidililc (.1 niidinK j"inii. In aildiliiin t.. lhi> rntidilud fnrni of liinnf inimnu ill. llu .irlii iilalinn |.iivMv-.r^ a -i 1 mid kii d ■■!" mntinn. ilv laliral i|i-|i|.iirnii nt lit I 111 niandilili in n fi rrnn- li. the- >ku'il. In ihi^ 1111 i\i nn 111 niu inndvluid In ad h main-, in llu- maiidiliulai 'iK-,! uliiii- ilir ulli. T aiKani 1 - uimn llu ariii ular 1 mini m 1 , 1 innviriunl uliii hi- ■' iii,s,i!,|i- \( h, n th,- mnulli i- ii| mud tit Its ^naU--t (Ntcnl, linlh tlii' liin^r and llu- laur.il miivi nu ni> arr iniiiliiiud in ir .u I nt nia-lii alum INDEPENDENT LIGAMENTS IN THE HEAD. In the vicinity of the lemporoma\illary articulation, but without .in\ direct cimneclion with tile joint, are situated two liganii ills, the spheaomanclibular ligament (i''ig. ii»oi and the -tvlomandibular ligament (!''igs. ie;i and ic)2). Tin ^pluiwimiiulilnihir linaiiuiU arises I'roni the under surface- of the greater wing of tlie splic-noicl Ixine near il« spine and is inserted into thi lingula of llie mandilile. The styloiiuitulihiihir Hi^nmoil takes origin from the styloid jirocess, which i- freciuentl} embedded in the ligament for some distance, nrui ji.Ts^is til trii inner suriaic cd liu- .iugK- uf iJu- jaw. Rulh iig,iiiieiil> ,iic \m-:iIs and resemble fasc i.i', and thi^ i^ partic iilarlv true of the stylomandibular ligament, wliiil. radiates (lircelh into the fu.seia of the internal pterygoid muscle (bimtipharyngcal fascia, see page 184J. i iimiioivm iintilnihir Ui^nninil /\Xt"ihitic inch I /a t'T/Ull iiiuliti'iy meatus Miisloiil /innrss Sivloiiiciiiili'/iiiliir lii^amfiit (OllilvltVtl ItroiTss t-ii'. ISO. Arliniliir iiiiiiiiihi- h'lii/itirii/ lii'iii' I'lliyLilUll /l^ll(■|'^^ SpllOIOK/ llOlli' liiiipoidl hoiii' SpUiiu'iiiiiiiili- hiihir lii^iiiiiciil /\i^i)miili(' hiiiif .\itliiiliir (ii/i''il/r Artitiiliir ilisf ( iHlHWill /)/l>i( >s fin. l»l. I IV. I'H). !h H .:'^..-:|,;5S7^':i^;,5^^;1 •T * <^y7..^^4^ 'mm-.^^^- THK JOINTS AND I.U.AMF.NTS OF THE UPPER EXTRKMITY. liq In addition to these structures, the head possesses another indq)endent hf;ament, the {>trry- aospimus ligament, which passes fr.,m the spine of the sphenoid Ix.ne to the upper extremUy of the outer plate ol the pter>f.oid process. Sometimes this ligament l)ecomes oss.hed, and it then forms tlie ptery^ospinous process (Civinini). THE LIGAMENTS OF THE HYOID BONE. The Rreatcr comua of the hvoi.l are connected with the Ixxly of the h.nc either bv movable joints or bv svnchon.lroses, or they arc united by synostoses. The lesser cornua are fre(|uently cartilaginous and are connectc.l to the Ixxly by movable joints or bv syndesmoses. Kach lesser cornu is connected to the styloid process of the tem|.oral Ix.ne by the slylohyonl liganunt. \ iKirtion t'\ lln' li'sscr cornu. ,r 1 r..a of . irtilni;.- noi .onncdc.l th thi- tn-ni,l lKim. somolini. , .•NtotiHs im.. ibi- .,vl„hv„i,l li,:>,.cnt, an.l in a similar n,anncr .lu- stvlo„i pn„«s .,r ., ., mM t».ny spuuU- may .vu,.! '^^^^^^^J^^ mon.; Al, U,u.- ,«,r>i,ms, the k-sscr ...rnu, the s,yl,.hy.,ul liKam.nl, au. .h. stylo,.l ,,r.K,.s.,. hav. a ,..„„„on or,«,n ,„ thf sier mar-in nl tlu^ sternum and en ne(t> the sternal ends of Ixith clavicles, tlnis reinforcing' the upper pcrtinns c,f die ca|.sule> ol bciili ■.tenvHlavicular articulations. llu' a>sloiix ol die . l.nicie . and almcsl completelv fills the s,,a6) is the joint between the acromial articuhir surface ol . lavicle and the acromial articular surface of the sca])ula, and it conse- (juciitlv forms th.' connection between ihi two com])()nenls of the shoulder girdle. The articu- lation ma\ contain an articular (li>c, but it is small anrl \aries greatly in the degree of its develo])- menl; it is frerjuently incomijjete and often entirely absent. The up]ier iwilion of the articular ca])sule is the strongest, and i.- still further reinforced by the acnimUiclaviitilar lii^aiiunl (Figs. 1CJ4 and J0), which connects the bones forming the articulation. .\ >trong ligan-.entous connection between the acromial end of the clavicle and the scai)ula is elTecteil 1)\ the loractulavkuhir Hi^tinunl (Figs. 11)3 and h)(i), which passes from the upi)er surface of the base of the coracoid process to the coracoid tuberosity of the clavicle. The liga- ment is comi)ose(l of two jjarts, an anterior tlat cpiadrangiilar portion, known as the trapezoid lif^amntt, and a ]H)sterior triangular one, broad above and narrow below, the (())((;;'(/ linamrnt. Between the two the siibclavius muscle is inserted. '\'\v ;iinmiic>ilavicul;ir urtiiul.iiioTi ha^ hul 3. slight T:\n\ic of motion. Thi' roracoclavicular lig.imont acts as a chcik ligamiTil, jii^l a< \hv . ii!,ioi lavii iil.ir IJKaniinl dcK-s in llii- sli-rniKlavicular articulation. Thf relative- position of tin- two Ixmc-s, i.in -, .irtcly Ik i handed voluntarily, Imt pa^sivi- tnovrTin-nts, prmlui in^ a < liange in llif angle lic-twrtn the two Ume^, ell ., oc i ur. The -niall, imlistim tly Imumleil, and usually ll.il articular surfaces allow of a liisplannienl of the two hones, hut llse direction of the movenitnt is not determined hy the- slwpe of llu- articular facets. THE LIGAMENTS OF THE SCAPULA. There are three ligaments attached to the scajuda i Figs. \i)\, rc)^, and i()6) which do not luiong to any of the neighlKiring joints. These are the loracoacromiai lif^amrnl, the superior transverse lif^aweul. and the injerior transverse lii^ament. The KiraniiK romial lii^ament (F'igs. u)^, it)4, and it)6l is a llal, tense, strong ligament whit h connects the anterior margin of the acromion with the posterior surface ot the anterior e.Mremity of the coracoid pnx ess. It is situated immediately alxive the shoulder joint. The superior Innisi'erse /ii;ameut ( Figs. 193 and \>)^) is a shor', tense ligament which bridges j»«t Articnhir i\i/)siili (AKiitl nirtilii!;!' I (A^stiiiliiviitiliir limiiiifiil Miiiiiiliriiiiii Si f mil/ sYiichoiiilrosi-i C.ldvicli ConiU'Cliiv iiiliir lii^iimeiit il'onoiit /lorticii) Siipiiior tninsnrsc ligiiniait SliTiioiliiviiiihir lii^iiiiicnt Riiiliiilc sliiiiiKv^/ii/ //;'• /•Vi,'-. 102. C.ostiil iiirti/(i!Si' II C.onuoiliiviciildi- /ifTii/iti'iit ( fni/iiZ(>itl /iciiiiiiii) Connviil /inurss (AViiiV-(irn)iiii(i/ lif^diiieiit Acromion liitiiliibciriiliir miuoiis ••liidl/i Snl'^i'o/iii/iins I t'tii; hiiiil 01 biii/i^ . Ji / /<^ 103. *^ /fj-; AiroiniocUiviiiiiiir ligament ('oriiiv-nnvniinl lii;(imi'iit Siipnispiiintii> Infriispiiititiis Amimioi! Ti'irs minor H II nil I IIS Spinr ('/ scd/'iiiii F-'i'' 104. V. ' ;i Mi Sii/iriis/iiiiiitiis liifnispiiHitii^ Siipcrwr trctiy'Virsc lii^iinunt Spine of ^iiipiild Cormoid prociss y"^ Connvhiimrral !ii:iiii!nit /ins iiiiiior l.onfT hi-iid /loaw.nt ^v ' of triiips \ ti^. 105. I » Clttviilf 1 1 •ape'. ■ ii !U" twnt Anvmh<,l(ivinili}r lii'diiu nt \/r,viiJO/l ('ortiivi/,:. iiiilar /ii^iiiiii/it (C.oiwitl /nirlio/ij C.ordcviil /'ivnss Coniio-atiomiul /igami in I union of lorii^ liriiil of hiirp (i/iih'idiil lip //''. lOh I out; liCdil of trinps ('oiiK ConuohiiiiiiTiil li''iiiii( hittidihriailiir iiiikoiis slirnth -/■...J... ,/■ / I. ...I ,*■ /,.* — r r .'.•[IC:.' ',' ft".':,* •••r.-'f fj; r-."r/-~ ii\ ItV ■ i |l f I |i ' I ; t I i i^' "Svi Tin: JOINTS AND I.KIAMFNTS OF THK TI'PKK lATKI.MITV. I2t over the scapular notch and converts it into a foramen. It is occasionally nphKcd by hone (sec page 84). The su])rascai)ular nerve jjasses lieneath this li,t,'anient. while ihe transverse artery of the scapula (suprascapular artery) passes over it. The inji-rior transverse lii^amcnl (Fiif. n)-,) is much weaker than tlu' superior one. It (on sists of delicate connective-tissue fasciculi which form a l)ridge iieneath the base of llii' acromion where the sujjraspinous and infrasjjinous fossa' communicate wilh each other, and (oNcrs (crlain small branches of the blowi-vesscls. The lif,'aments of the scapula belong lo that class of liga ments which take the place of bony strui'ures. THE SHOULDER- JOINT. The shoulder-joint (Figs. 19,^ to 197) is the articulation between the glenoid cavity of the scai)ula and the head of the humerus. The f^lfiioii! cavity is relatively small and very slightly concave, but it is considerably enlarged and (leejjened by a markedly fibrous articular lip, the glenoidal lip {glenoid lif,ament) (Fig. nK)), which surrounds the margin of the lH)ny socket. In spite of this, however, the socket of the shoulder-joint is still considerably smaller than ihe head of the humerus, and conseciuently doi 'lot interfere wilh the free movemeni of the latter bone. The articular capsule (Figs. 194 and 11)5) is roomy and relaxed, as must necessarily be the case in a freely movable enarthr)sis. It arises from the margin of the glenoidal li|) and is inserted into the anatomical neck of the hunums, and aUhougli il is in itself thin, it ac<|uires considerable strength from its adherence to the tendons of the surrounding m iscles (supra- spinatus, infraspinatus, teres minor, subscapularis) and to a reinforcing ligament, the loraio- humeral ligament (Figs. 195 and k);). This ligatiunt arises from the outer Inmler of the ba:.> of the coracoid process and passes, independently at ("irst and then inseparably connecti'd with the UP1K.T and iK)sterior i)ortion of the capsular ligammt, to the insertion of the latter structure in the neightx)rhoo portion of the inter tulxrcular groove is lined with cartilage. .\l the termination of the mucous sheath the svnovial membrane is closely adherent to the tendon, .and il also extends Ix'neath the tendon of the uli sca]ndaris muscle in the shape of a bursa which communicates with the- articular ca\ii\ (Fig. icj<). This suhseaputar bursa has a very thin wall and is siluali'd iHtuath the concave anterior surface of the coracoid i)rocess, Ixlween the coracohumeral ligament and the reinforcing libers of the internal portion of the capsule. Till' sti.mlilrr jiiint is ihr ninvt (rnly mm.ililr .irlii ul.tliuii in tin nuin luini.m UhIv, .md |Hrmils ut mi'viniinl^ in .ill iliriiti"n> 'I'lir i hiif imnfrntiil^ iiriv |Hniluluni munniinl- in I hi -.ikiImI pl.im . wliii h an- nmri r.xli-nsui mii 4 ; Hi ■^ l' 122 ATLAS AND TKXT-BOOK OF HUMAN ANATOMY. Fig. 198.— The left elbow-joint seen from in front (§). Fir.. 199.— Ttie left elbow -joint seen from l)chin(l and from the radial side (?). Fio. 200. —The bones v)f the left forearm with the interosseous membrane; the annular ligament has l)een divided (J). I Iff I ' '!l rinrly ih.m postcriorlv; r.iisinK .ind lowering iif llu' arm in a 1 oronal |iiani' (alMlurtion anil aildui ti HHimv and relaxed, particularly in front and behind. It encloses the threi th. lower end of the humerus (the olecranal, coronoid, anil radial foss;ei. is attached to 'i a just below the tip of the olecranon, al the mar.nin of the semilunar (urealer si>,'nioidi not. .i, and at the tip of the mronoid process, and the entire head and the fjreater portion of the neck of ihe radius are situated wir'iin it. The only portions of it which are firm and tensi' are the lateral ligaments and the annular lii'amrnt which surrounds the upjur end of ilte radius. There mav be re»()i;ni/e:l a radial or external lateral lii^ament and an ulnar or internal lateral lii;am(nt. The radial lateral lii^anienl { Im^'s. 1()8 and i.)()) ari-es from le estevnal ei>icon dyle and jia^ses a> two fasciculi to the annular liKamenl, whh whiih a jiorlioii of ils tilnrs are nmtinuous. The ulnar lateral ligament (Fi>;. luXl ari>e^ from lln internal ejiicondyle of the humerus and passes in a radiatini: manner to ihe idnar iiiar^iii i>f the semilunar notch. The annular lii^amenl (Fii;. ii)i)> i> a lirm teu'^e liuament wiiit h surrounds the liead of ilie radiu-- like a slini; and fornix three fourths of ihe i ircumference of the so( ket for the pivot joint of ihr j)ro\imal radioulnar arlii ulalion. ihe riMiaininj' fourth beinn; formed by the radial (!e>ser -i^'inoid) tiiiiih of tiu- ulna. Tlie liijament .irises from ihe anterior margin of the semilunar ijireatir simnoid) tioldi and is iiisirted inlo llie i><)siirinr margin of tin' nidial noUli. Hclow it the lapsule is tliin, and at ilie ne( k of the radius forms a small proirusion wliidi is known as the saeeuliir reiew. The braihialis aniiiiis musLle passes ,.ver ihe anterior surface of the capsular li^jament of the ellwnv jojnl 1 !■ iti. .!0i 1 and Mime of lis liUrs are inserted direttlv into this siructure. The tritcps musde, jiartii iilarly lis middle head, holds a similar relalion lo the |K)sterior surface of the cai>sule. from which liie lendon of ihe musde is separated by fattv ti.s.sue. Intrniiil i/iin'/iilv/i I 'I liar IdtiTiil iijitniuiit /xtiniii/ i/iKvndvIr Rii<1in of hi I I'll •< Sriiii/iiiKir iidtch MW ik4 Aiiiniliir riii'^iili' of ili^tut iiiilii'-iilmir iirtiinliitioii fh'. 200. Aiiiiiiliir liiiamiiil Arliiiilar dtriirtitetrntr ('/ riutiw. Iiiidoii of liici/i-i <)/i/i,/iii' /ii-iiiiii III llll'lll/inilli' • i ■■ Hi .—■ . — THE JOINTS AM) I.IGAMF.NTS OF TlIK IPPKR KXTRFMITY. 1^,5 From a nhvsioloRical standiK.int the cl'oow is a combination of two jomts only, smcc the humcro-ra.lial articulation does not ftmction as an independent joint. These two jomts are the hinge j<,int of the humero-ulnar articulation and the pivot joint of the proxmial radu. ulnar articulation. Th,- n>..i..n „f the f.marm upon the arm i. not a pure hin^e motion, but rather that of a spiral joint, .ime the f f h , .KhU , . n.l tlu. median ri.lge of the semilunar not. h reseml.le that of the worm of a >, rew. bron, a r,.i.,.rfiv.- hones ire scareelv in eonlait ilurinR flexion. ■ ,r \ '''^^^■S:;::;.:!-:';:!::! -'u;;:.l"i"-.v passlveU. invoU.. in ,he p.... ment of .he pro.,,.. ra.,io.>nar ,oint sinee t^'r!;:;;: :;;:.': in .he ...We. a,«,u,'ts ion. a.is, an,l the a-tua, pivot n,oven,ent takes p tee .n the prov ana distal ra.lio-ulnar articulations. Both movements of the elhow-ioin. are , o.npie.elv „„l,.pen,lent, THE DISTAL RADiaULNAR JOINT AND THE INTEROSSEOUS MEMBRANE. The radius and ulna are connecte.l l.y a thin inlrrossrous mvmlmmc i Fig. :oo) which alny.sl comple.elv nils Ihe spate intervening between the two b..nes of the forearn,. . .- at'aehe.l to ,he interosseous ridges of the two bon. s ami consists for tite greater part ot hbers wh.cit pass obliquelv .lownwanl from the radiu. to the tdna. It does no,, however. eMen.l -o ,l,e t„.per- moM part of the interosseous space and ,.osse>ses an opening in i,s lower ,.ort,on tor lite ,.assage „f bl.KHl vessels. 11 represents a memi.ranous supplement m il,e bo.us ol the lotvarm. and. lii.r..,and.oo^ winch passe>nl,l,MUelvfn,,nllu;..,nMt,,,. pro.es> of the ulna L-lhe lower margin of th. tulxTosity of ,he radius, .nd „ dtreclly ,n .onl.ul Willi die tipper iiorlion of liie interosseous meml)rane. The .li^hil r.dwiilmr hint (Figs. -o. to .0,1 i- 'lie joint betw.-en ih.^ ..rit. uiar , iirum R.n.nce of the ca|,itt,lun, of' the uhta and th,. uin., isigtroi.l. n„.,h of ,h.- ra.lm. an., a K,, ,,.,ween ihe , apilulum of ihe ulna ami llic ar.i.uiar .Um whi, h st.pMr.tlc .h, h.:.,! ol liu- uin,, f,„m Ihe iriqueiral -cuneiform, bon, . .Xnalmni.ali. il i> an indepen.Un, ,o„.,. bat 1, tun.l.on^ in assotialion with the, ovi,iial,-,i,iio ulnar arliculali.m. Tl,e s.Hkel f,.r du .apiluhim .-f ih.- uh.a ■ Kig. -'O.-. i^ fonv.e,! b; ,„■ .Inar no,.!, ,. ,h. rulius as well as bv the ,„-ncuiar dis. ; ihe portion of ,l,e s„. ket formd Us iW r,„bus ,- ah,,,,-, verlital and that ft-rme.l bv the .lis.- is praCi.allv itori/or: .1, and . p..rlion ol ihe lai, ,;d s„rla., „ uvll i> the inferior surfatr of th.' .ap.udtim of ti,e ulna c,,„s..<|uenlly res,, ,n ih.^ s.„ ,.., 1 ol ;,,, i,.i,„, Tite a,licular cai-suie is so.mwlial r,H,mv and relave.l, and .. prol,,nga,,„n ol .1 k,iown as ihe s,.,.ul.,r nass, exten.is upwanl betwe. t, the Ihmu, ot ,h.- forearm ,.lH,ve iht K.,1 '" ''\\l'Zi,uLr ,li^r is allach.^l upon <.ne si.je to line tilnar margin of Hie .nnl.li,- r'"-"> >''' the radius, where it ins-'psibiv merges in.o the covering of this porl.onof tin bon. ; i ; i i ill m% I. ! I r ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. lumd (i). „,„„ ,h. ,«1» ,i.l.. it i. ..uclK,, ,« ...c ..yloid ,.-«» ot ,ho „,na, I™ rare in.anc, i. i. jicrforalL'tl. r il mt till' ulni which i~ simuUaniously The movenK-n. in .h- .li..al ra.li.vulnar join, is a -••^''■;" '' ''"^^^nown as pronaiio,,. ,he radius is apphcd earn., ou, in ,ho „n.xin,a, .aa.,-uh,a. ani.u,..,.n ^^ ^^^^^^^ )Lr. ,„ L ,.a.aUc. p„si,i„n of U. ,.o „,,|i,,..lv to Ih. ulna, so ,ha. Uu- .wo bom-s . ros.s. f^^ l'^"^' , '^,.^,„^^ arlicula.ions ..asses .hrouRh .he hea-ls of Ixnh aljout .he ulna amounts to about i8o degreeb. THE JOINTS AND LIGAMENTS OF THE HAND. Those of the carpus are: (.) The radn.arpal -;-'^ " "^ / .^^ - h nu/... m<7„i.r/>./ """rle j:t:of .he angers indu.le the ...... ^.^/<./.'«.-/ -^/-''-'"- -^-' "^^'"" ^ '""^ blitilaitiiciil arliiiihilioiis. THE JOINTS OF THE CARPUS. ra.Uus an.l the triangular ar.ieular d.e ..nerpose. bet. n ^ " ^^ , ,^„„,,.. ,.,., ,x,ne upon one side, and -he pn.Mmal -' -; !' ^^^Z J^ j .^ , ,„„, ,;;. ..her. the navicular (seaphoi 1,. lunatum ,semdunar . and ''''I '.\^™;;\ •;.''. ^.J^^^ .cuneiform) lx,ne navicular and lunate l.nes -!'->-';;j ^^^ ^^^i : r^^ "'- -^^''^^ ^"^"^ ,vi,h the triangular ar.Kular d.se m su h a "^' "';,.^. ,^,^^, ,,„,„ f.,m a condyle. ;;;;=rrrrt::;-::::r--^^^^^^^ -'^ .*«-—«"■": -•■v'';''';x";;:::'';:":'"r';:!;"::"n.ai ani,- ,«.„ «,».!», i-n.ni liK Mi.ip. cii I. .•.M.y... ••„ in d livin in the coronal iliameler. ,,i,„. The curvature of the surfaces ,s ^'reat.r ,n the .ag.t.al ">■" " j„^,.,„„, Iriir/is fliiinaiis Ohrranon fossa Tendon of triceps Snbaihineons olecranat bursa Synovial cavity Coronoiil fossa / ' */ I roctiica of hiiincrus •aian vein lirachiul ai icrv ( Ina his. 201. I Ina Railiw. Di^ta/ radioulnar articulation Articular disc I rii/iiclnitn ^ , Intercarpal articulation I':'- I la lua I II III /.fi (arponietaccrpiil articulation f. . , ' .Metai arpal hones (Uipilaliiin I iiiiatc hone Radiocarpal articulation \iivi(nl,ir hone Radial lull ml ligament \ (ireatcr niiiltan^iilar hone >\ \ i.iini"ii,ttu-'/■ iiiiiltiin^ii'ar hone \\\ w m fin. 202. i .1* f I \ ' i im^ ^, THE JOINTS AND LIGAMENTS OF THE HAND. 125 the one side, and by the proximal facets of the greater and lesser multangular (trapezium anc trapezoi.l). capitate (os magnum), ami hamate (unciform) bones upon the other. I he hrs row of the carpal bones practicallv forms a socket for the head of the cap.tatum |os magnum) and the proximal portion of the hamatum (unciform), and toward the radial, and to a certam extent also the ulnar, side of the j<.int, the proximal row exhibits a convex and the .l.sta row a concave surface, since the navicular bone presents a convexity toward the greater and lesser multangular (trapezium and trapezoid) Ixmes. As a result, the line of the jomt .s not a simple curve, but has an irregular CO shape (Fig. 202). , , , , ,• ,,1,,. The articular cavitv of the joint is ver> complicated, since it extends from the actual articular line both proximallv and distallv between the in.lividual carpal Ix.nes of Unh rows. It is sep- arated from the rad'iocarpal joint by the previously mentioned ligaments, and sinular ligaments connect the tones of the second row and separate the in.ercaq.al from the caq.o-melacarpal articulation. The latter separation is incomplete, however, and these two articulations usually communicate totween the capitatum (os magnum) an, which pa.sses to the base of the fifth metacaq.al Ix.ne and sends prolonga- tions to the neighlH)iing metacan)al Ix.nes. Th. carpometacarpal hint iFig. 202) is the joint between the- bases of the secon.l to the Ufth metacarpal In.nes and' the distal articular facets of the lesser muhangular (trapezoid), of a small portion of the greater multangular (trapezium) (see page 01), capitate (os magnum i, und hamate, unciform .'bones. The articular cavity, which is usually single, communicates, as a rule, with tiie intercarpal juinl in the manner previously .lescribed. It is sometimes com ,„.sfd <.f tw(. separate articulations, eacli of whicii connects two metacarpal Ix.nes. Th. b<.nes forming tlie carpometacarpal articulation are capable of <.nly sliglit m,.vemei,ts and the articular ca].su1e is c..nvsp,.n.!ingly tense and llrm. In a an arlhnKlium. Tin. carpo metacarpal inint oj the thumb is the joint between the sad.lle shaped articular facet at the distal ex.remitv ..f the greater muhangular Ix.ne (trapezium) anecn from the sule (i). ^ ^ .hicf movomcnts of ,l,o hand .u- ncx.on, ..f --;^^'^^:^:J" 'jLi,,;,. ,, .,1.-, .n almost complete cinumduc- Ix-ttcr. ulnar alxiuCion). Ify a cmb.naU.m .nc.c mo^cmcnt. ! tion of the haml. .,„,i ovtrn^ion The aN.-s of rotation of the tw.. liinp- joints are not The , hicf nxnements of the jomts are "">"" •"' "^^^ ^ interseCinR ea.l, other.* During fe- . ,n of the- ra.lio placed at ri^ht angles to the axis of the forearm, '- "^^^'^-^ ^^^ilar movement in th. int., ..n.u articulation larpal articulation, the han.i .leviates to the rad.al ^'^'J^^^X^^^n.^ f.e other exten.ied, the movements in the the han.l .leviate., to the ulnar side an< f..r -.rr^.'- '.„,.„, (ra.lia' ulnar abduction, as the ,ase may be) a..is of the extremity neutralise each o.her, whtle the '^ '-■ ' ^ '^ "^ ; ,^, ,„„,,„,ms neutralise each other and are more pronounced. If toth joints are iL^Ned or extend, d top th. , tl ,hc movements in the axis ,.f the extremity (nexiot, or ""■'-"";"; J' "^, ,„„,,,,,,, ,„, i, particularly true of the The carpo-metacarpal articulauons are artlu.Kha ^J^^^^^ ^^,,.„ .,„ ,.,„„,;,, .,f Ute hand is increased carpo-metacarpal joims of the secoml and thtr.l hnRcrs. T1k> mm U „„i,i„„ „f ,he little finger. „r diminished, that is to say, during hollow.ng or natten.ng ■■' ' ^^^is ih m.'e extensive. Like all saddle joints The range of motion of the carpo-nte.acarpal ynu of '^ hun. s mu ^^^ ^^^ ^^^^^^^^^ ^^ ,^^ ^^^^^^^^ it is biaxial, but owing to the incongruitv of the -"-'-"« ^^'^ '™ mav be so combined that actual circum- more pronounced than those of the other. ''';■ -"rl; ^l m awav from the index-fmger,. addu. tion (toward TZ:.^^:^J::^'^'^^^ r^;:r o;;1. to .. ...^... ...n. the .tter motion the con. cavitv of the palm is markedly mcreaseil. THE CARPAL LIGAMENTS. :!;:v;r;:. «;u» a,:;; ,.; ,1. .„,,„ n.,™™. .-„„-„ ,.„,-„„,. .., »», „.,.,. .„. 1 iiL ui/».M.. r i,„„„,. .,,,,1 i< itt-ichi't Dartii'iilarlv in llic trit uetrai U, the dorsal surface of the Urs. -^ -^;>;;;;;^ J ^ ^ ^ 2 r.uUocar,a, U,a„u:,> ,Fi«. (cuneiforr^t) ..>ne. I he ---^'" ■^. ' ' ^^ ^^^^^ ., ,He articular surface of the caq-us 3041. is lonuer than the dorsal one, it ariM.. tiom inc ma _ ,„;„,,_, ,nc .na-mtim^. and is inscrtetl not only intt, the tones of the lu>l nv., but a...- :utu th. ■ .p.... - ,. ,f ,1„. hmd his bein materiallv m.Klitied by the more n^cent studies .,f these ,This description of the -'"■"";:'; ;'„:':,, ,,,,,.1 l..nes cannot move upon each other; during ra.lial •iniculalion-. It must not be suppose.l that th. two r »^ . i Z^Z the navicular Ixine is markedly moved toward the adjacent l.nes. CM 1-3 I'U > < ! t UlMh mm^mtamimmF^-m Tin JOINTS AND I.IOAMKNTS ('V li.i HANK. 127 The trait verse car ' (andrinr niiiuhi li^iur )il which servo rcf. r.ter . of th, k.n- 1 unaa-sson-l.-amcni ;hc ca . It conm■ct^ wo car,.;.! to th(. idius, and convciis the . 1 groove into a anal. V\. n the 'or of the caq)a, mal are found . ic l.-ini, ' ran-al I" -lies (!-,'. 204): thcy rad ,ae toward thr h« d ni the tlu W(//a/c carpal lif^amfiil. The remainin<; carpal hgamch!> which urn, ihe . d h,„,.. of the meta.aqial bones are d(sila(e i>er i)a<^e 205) !ha but is ab' ilta(hed hich . onnecl th( OS mai'nu' iixidua.i forniinu - or I onnect ihem ''ion as the u.l'ir ,' * and the vol ' 20) . Tlu '.'/' melan'-pal h> vr rvv 'lis 'iictacarp T) ■/(j/flH,!, "/ arliciilai .nes am' ihc ba-r- ,_ ir , ..rly sph( al, th- irfaces of the hea f ti .. t of the bones, so Hat IS. T ..f tb^ >urfaces articular almar a> uurin'/ Mon they are and .. rtxlial ty])es (.C'C/v an e-cei. :;ion; ii rescml The articular car -einf' '■'•'I in several headh ^ " th' metacarj - >rr..ill deurt a. (...nuicl durhifz extension are IS ,,rc ionse(|uently a mixture of rile nutacarpo-])halan,ueal joint vi-'f;^ ;nt. )Ut ihev are th F1.NGEP -05) ar. the joints 1^ n the heads iialansies. AUhou.^i arliculatin.i; nts are restricted b> linenl.-. The ■come M.mewhal cvlinurical ui)on the herical, while ;j';i^lvmoid '11 umib i> ■ ian-eal articulations and is a true giniilym. ■md 205) are thin and somewhat relaxe. lalrral //,!,'() hic»/.^ are excenirically in,->erted into the V. become ten>e during llexion of the phalan.nes; thev es of the heads of the metacarpal bones c^ee page i)2 reinforced by the accessory volar lii^aiiiniLs (Fig. J04 he llexor tendons (see page 205), and hv the Iraiisvcrs. M ilat strong ligaments connecting the hea.ls of the sen.nd dorsal surfaces of the capsules are proteded by the d..r .euro,es 01 m. .^e.. >... .^s^ 205), which are intimately connecte,! with them. The nu-lacarpo phala,r>ical ioint oj the thumb always contam. two sesamoid l..nes (a radia and an ulnar) (Fi.. 204), which are embedded in the articular capsule; th ^ 's .hivcc. toward the articula .n are covered by cartilage. Sesamoul bones occa>...ia.,, ■ < ur n, tlu melacarpo-phalang. ioint^ of the other lingers (see also page <)2 :. which pLs from .he hamulus of ,hc han,.,. : .. iforn,. l,.,.-,- ,„ ,hc has. of ih.- „Uh nu-c, arpal ,k„„.. „ >.- ,h, meUic.irptil ligamcnl. arise tP The a which capilulii to tl'.c ti a|X)neuro ir surfaces of ' connec led wid ■(F(7)»CH/\ I Fig. n ni< ;.. ^al lx)n i of in. ngers (see ; ,.• il' i M 128 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fig 206 -The female pelvis with its ligaments, seen from behin.i (§). Fig 207 -The female jK-lvis with its ligaments, seen from l)elovv (s). Fig 208 -The male pelvis vith its ligaments, seen from m front (j). Fig 209 -The female pelvis with its ligaments, seen from in front (s). Fig 210 -The male pelvis with its ligaments, seen from above (j). Fig 211 -The female pelvis with its ligaments, seen from above (s). .,ne extensive n-.auon is in,..,ssih.c. the phalanges an.. e.,nse„uentK- the fingers can be atx.ucte.. and a.Muc.ed. The mc'taearpo-i.halangeal articulation of the thu,nl> is a pure hinge joint. The dMal or inter phalangca! articulations (Fig. 205) arc the joints between the individual Phalanges of the Imgers, the bases forming the articular sockets and the trochlear -rfa.^s co.- stJturng the articular heads. The articulations are pure hinge joints. Lateral hgamcnts (I-.g. 20 T^the sial-s of the capsules prevent any lateral motion, an.l tlu^ articular capsules are roomy. Volar flexion is the only movement of which these joints are capable. It I l> i THE JOINTS AND LIGAMENTS OF THE PELVIC GIRDLE. THE PELVIC LIGAMENTS. SYNARTHROSES AND DIARTHROSES. The pelvic gir.Ue and its ligaments form the prMs (Figs. 2o(. to 2. . ami 2,5). which, unlike ,he II girdle, is complete l.ith anteriorlv an.l posteriorly, the pu I.k bone, being conneaed antedorh 1^^. svmphvsiJ antl the p.hic ginllc complete,! posteriorly by the sacrum, whuh •iriiculates with the two iHuclx.nes either by joints or half joints. It s^ pin is p„l>is (Figs. 208 an.l 20.,. is a mixed synarthrosis connecting the symphysial surfa ' o the -two pubic boius. These surfaces are coveretl with cartilage ""-> <'^^-l-; ^ them is niletllv a mass, consisting largely of dense connective . issue and par, v cif . bn^^ . t C. -hich i> ,erme.l the int.pulu, „l,roa,r,i,a„: This interpubi. tissue is ^-f^^^ ;,;: ; lihind .,,.1 its ,H,s,erior portion frequently contains a space resembling an articular cav.t> , s„ thit the svmi.hvsis is ..mverte.l into a half joint (amph.:ulhn.sisi. n Uuivsis is reinforce.1 by libers which pass across its upper margin fr.,m te pub.c spine .^ one ide to that of the other; dus. (ibers an intimately connected w„h dte i,,U.,^b. r ncirlilP'e ind form the superior pulu. li,,nu,,U , !■ ig. 2.0). 'I he lower margin of the s>m r- 'rXf;::lf bv a more Llep^'den, structure. ,he arn.a. iinl.ior p.^in l,..^cnt (F.gs. 20^,'and 20«1, Which is approximately triangular and rounds oft the ,H.bic angle. T cT-s Uricr con,Jc;ion of the peluc girdle is a paire.1 arbcula.ion which ;---;; .„,roil.a, artnulation. It .Kctirs l.tween the auricular Hirfa. e of the sacrum -- --1;-^ n med surface of the ilitmt. and is an almost intntovable j-in,, a trtie am,,hiarthros.s h :::;;; irregular surfaces of the two Ix.nes are scarcely adapted for reciprocal movements, and , . i;.,__,.„. rr,..,o,i:n.r ihr articulation further insure ,ts immobihty. '" TZ^^ ;;rbeing"comH;.«l bv .he auncular surfaces. ,h. innominate. In.n,. and tite sac nl: f als^ h-id toother bv a strong ligament passing iK.ween the tul.ros.t.es of the two ■r^fSPHF W m Short ,,ost. sacro-iliac. lig. f;^™;, li^timi'fit Iliolumbar ligament Short posterior sacro-iliar lig. (jreat tro- chanter I is-.er M/cw-V""''"'' ligaiiiiiit I esser sciatir fornmen iiij^iiimi! iifi'i 'liilli Artii iilar viijiyiile Xmiati Itgamenl I ■ i ii ,1/ hii> ioint i i \ 1 1 :il !t l.iimhar vertebra l\ Anterior \iiterior loiiiritiidimil lifiiimeiit llioliimhiir //y Anterior sujurinr spine of ilium Greiil Iroihantrr inal li^. itlar cii/isiile hi/i joint lliofimoral it ■ i i! i > ill ! 1 r t ^.r "-•> ■.' '•*>\i t*:.' f r i ■ » ! i • 1 i I 't 1 1 lil ih Anterior longitudinal tig. Lninhar vertebra IV Iliolumbar lig- Anterior saero- iliac lig. r 1 Great \ ■ seiiitir loiiiiuen JH im 1 esser .*. ^-^^ ^K'^ ••lititic M---i^^m foramen Suiwrior piibie //■,'. f-liT. 210. : lllj II JM It,:. 211. fh [ ■ !l^ i ih ^ THE JOINTS AND LIGAMENTS OF THE PELVIC OIKPI.E. 129 space between the tuberosities of the .burn ami ^^^^^^^^^ ^ svndesmosis. but from les are connecte.! anteriorly by an ^l'^'-^*-';-- , ' :^Li\:,,, ., ,h. ar.i.ui.tion, the physiological stamlpoint, the syndesmos.s -J*^^; ^^ ,, ' ' , '"^.i^,,, ..^he entnv trunk, since it firmly unites the pelvic bone to the ^^ -; J ' ^j ^ ,,,,t,,,: Ute ani.rior sarrn- The sacrum and ilium are als., ---"^ ^ ^ ^^t Cands, con,,osed ..f transverse, mac li.amnus (Figs. 20S, ^^°' .^"^ .,^'--^\;'"''^. ff,, Hor surfac of the sacrum in front of oblique, and fre<,uenlly interlacmg hbers, from !!^ '^^ ™' .' j^. ^„ ^,,^, ,;„,, ....ninalis; .he liosacral joint to the anterior surface oi the .hum, -< -^^ ^ J^. ,., „^, ,,,„^,,,,., , the ^.s/.T/<>r sacroiliac lif^amcUs (Pigs. 206 and 2,,^ "/.;;'"; \ j^^^ „f ^^ „,,„,,„, .,f long and a short Ugament. The ./,<>. 7'-;,:;;';;;^:,^: hi "res, in the region fibers which pass obliquely ^-"^^^ ;-;^; ^ ^,;:Z^,.,„ i. composed of superficial of the posterior mferior spme. The loni, posUrwr s j,^^^^,^, 'TX^t^ :r T,;:ii,':r ii™!:;:-:';- .;.: ->.-- ,-." -; iK)rtion of the dorsal suriatc rorresuond ng short ligament the sacrotulnrons ii^rcat sacroscialic) Usamenl. It cosers in the corrcspon g :::;;;r=e.;^:=- ■ r;::.;:";^ ^: >■ -.. - --. but also w ith the sacrum. THE INDEPENDENT LIGAMENTS OF THE PELVIS. m n >«».«- -^'-»'' ;';-•'>■ :;7;',;';::;';^:r;;r:;:l'u.;t'; E"":i of the obturator gn...ve, the opening, tlie obturator an,a. .1 ig. -H". .1 .^ ■ .v.rnm.r is it passes downward, but again broaden- out n.ar 1 ll becomes narnmir as 11 pa..i ....-nwuinoiis li-ament I'OsUrimK , and the inu, the tuberosity of the ischium. I. covers "-..r"' ?' ~;- '^„J.. ,^. ,„, ,07. is .. :.... lijraments are a.lherent at their m.crsection. 1 he /.,/ne. Its cavity is considerably larger than that of the true pelvis, from 'vhich it is separated by the terminal (ilio])ectineal) line (Fig. 210). It is boumled by the al;e of the ilium, by the fifth lumbar vertebra together with the jiromontory, and by ' two iliolumbar liga- ments. The true or lesser t>'''vis is a short canal, the greater ])ortion ot whose i. undarit'S are bony. TIk' anterior wall is short while the ])osterior one is considerably longer, and it is open aljove and Ixlow. The up))er opening is termed the superior aperture oj the pelvis or 'he pelvic inlet (Figs. 210 and 211), whose lx)undani- is formed by the terminal line, by the jjromontory, and by the upper margin of tile inter|)ubic fibrocartilage. The terminal line is composed of a sacral, an iliac (the arcuate line), and a ])ubic (crest of the ])ubis) jjortion. The actual cavity oj the pelvis is lM)unded posteriori}- bv the concave ])elvic surface of the .sacnmi and by the anterior surface of tln' coccyx; laterally by the jielvic surfaces of the IxKJies of tile iMum, jiubis, and ischium (the lloor of the acetabulum), by the sacrotulxTous and sacro- spinous ligami'uts, by the rami of the pubis and ischium, and by the obturator membranes; and anteriorly by the symplivsis ])ubis with its lit;aments an LIGAMENTS OF THE PELVIC fURni.E. 13' The inierior aperture oj the pelvis or pelvic outlet (Fig. 207) is bounded by the louxr margin of tlu- symphysis (arcuate ligamenU, by the tuben.sitiesof the ischium, by the inferior ram. of the ischium an.i i)ubis, by the sacrotuberous ligaments, and by the tip anut 60 degrees. The plane of the peKic inlet conse.|uently passes obliquely from aboyc downward and from liehind. The pehis exhibits, as does no other portion of the skeleton, tyjiical sexual characteristics. T his i. particularly noticeable in the true pehis. In the female the false peh i> i> lower, broader, and flatter, and the ale of the ilium usually show a less marked curyature. Tiie true pehis exhibits similar characteristics, an.l its cavity in particular is more caj ac.ous. In the ma e the pehic inlet is heart-shaped (from the marke.l projection of the promont.m), while in the female it is elliptical, and the pehic outlet ■ the male is also much narrower than in the female on account of the conyergence of the tuberosities of the ischia. The pubii angle in the male peh is forms an acute angle of alx>ut 75 degrees, while in the female it forms a right or obtuse angle «,o to 100 '^''^'^I^r'a more detailed account of the pehic diameters and of the pehis in its relations to obstetrics tlu- reader is referred to the text-lx.oks ami atlases of topographic anatomy. The inguinal or PouparCs ligament (Figs. 207 and 200) is not one of the actual ligaments of the pehis but is a portion of the a,.oneurosis of the external oblique muscle ol the aUlomen. It arises from the anterior superior spine of the ilium and is inserte.l into the spine of the ,.ubis. An almost horizontal continuation of the ligament passes from its insertion to the upper margin of the' h.)ri/.ontal ramus of the pubis, forming the lacunar ((Hmbernat's) ligament ( !• ig. • ). THE HIP-JOINT. The hip-joint or coxal hint is the articulation between the acetabulum of the innominate bone and the'head of the lemur. The acetabular cavity is considerably deepened by a strong circular iibroeartilaginous ligament, the glenoidal Up (cotyloi.l ligament) (l-ig. 2i(,), so that the socket embraces more than half of the spherical head of the femur, and the joint conscpiently iK-longs to that group of the spheroi.lal articulations which is known as an enarthrosis. _ The glenoidal lip - the .interior suri ;- c of the articular cajisule, broadening as it goes, and is inserted into the entire length of the intertrochanteric line. The puhocapsular liga- iiiitil (Figs. 2i2and 21O) arises from the horizontal ranuis of liie pubis and passes ac ross the inner and posterior portion of thearticular capsule towanl the lesser trochanter. The iseliioca psular liga- mcnl (Figs. 215 and 2181 ari>es from the Ixxly of the i-,i hiiini and runs in the jiosterior jiortion of the capsular ligament; the majority of its libers pas.- into the /.ona orbicularis, but some of them converge upward to the great trochanter. The thinnest places in the caii:.;:;e of the hip joint are r-ilUalcd in it-^ lower j-ortiiin b.-'^veen till jiubocapsular and the ischio. apsular ligaments, and above the zona orbicularis between the istliiocajisular and iliofemoral ligaments. There is also a thin place in the aniero-internal wall of the capsule between the iliofemoral and puljocapsular ligaments, and a communication occasion- \'^ Tendon o/'^^^^y :j! ' rtiis fcmoris >^^ , '^-1 'i 1 lliofcmonil jU/ i ligament Wi-^r—- tiniir troclmnli-r J^'JiIm j^^ /9«-^ ' -111 /'li/'oeapsnliir ligament lendi'n of net 11^ Jeinoris liinald Artiiit/iir (ilii/e'il liihiiv^ilv /i\'. 21 i. Iriiii'iyrrse lii^nnuut of lutlahiiliiin III m rn^f 1 Mf! 1 s T^ '''1-'/..';'^.^' ^_JX^^^_^_^^ :im[m^. fc v n Sarivs/iiiii'ii^ lioiiiiii/il Sdcivtiil'iivii'^ lit;'. Ohiiinilor imwhniiir Arai.iU li,i;. of /uilih l„t,r/,„/m- libwauHlufic '^'"""' ''■'-'■ /il'. 2/5. Xrtiailiir ni/>'>ii/r Ohiiiiiitor nunihniiii' lit:. 211). r f {•:■■ m = i i I . i i i I r '■> 1 1 \\\ I • THT; joints AXD MGAMKNTS of TIIK PKI.VIC CIRDI.I,. 133 ally exists at this -oint hctnc-cn the synovial cavity of the hip and the ilwpcctincal bursa which is situated beneath the ilio{)soas muscle (see page 211). The hip-joinl i, a l)all-an.l-s„l allhouRh thr smkrt cml.ra.rs murv than „nc-half „f ihr .nh.rical head of th.. U-mur an,l limits th- rang., of motion to a sliRht extent, movements in all dire, lions ar.- possil.le Si„, ,. ,he hea, of the femur fomts a mark.-,! angle with the avis of the hone, the as^s of mov.ment of the j,.int .Lh^s n tss through but forms an a. ute angle with, that of the femur. The , hief n.ove.nents of the hi|.-joint are aNIu.tion ami a.Mu, tio,', (siM-aration an.l approximation of the lower extremii . , llexi.m (anteriorlv) an.l .xtension (,iors.,l |l..,i„n is inn,o.,il,l,. on acTount of the tension .,f ,h.. iliof.-,,. ,r.,l ligament), rotation, an.l , in um.lu.tion. Wh.., the joint is half M.-x.-.l (the middle posi.L.n) all ..f the ligamenN .ire relaxed. In the upright position the iliof.-moMl ligaments are fnse a,,,! steady the |h1vis upon the femora. The roun.l ligament has n,> m.-.hani.al fun.tion whalev.r, hut a, ts .imply a. ., ligam.nt of ron.lu.li,.,, ,s.... page .08). It IS ,H.asi,.nally wanting in man an.l regularly al.s..nl in many aninuls, „n,l is to U- reganl.-,| as an oriKinallv extra-anieular stru.ture pn.bahlv .. po.tion of the ju'etineus mu^. 1.-, « hi, h has lH.en .lispla...,! into th.. joint The head ,.1 the femur is hel.l in its so.ket m>t only l,v the strong . apsular ligaments hut also by atmosph.ri. pressure. THE KNEE-JOINT. The kncciohit (Figs. 2,7 to 222) is the articulation hetween the condvles (and the arlicul.r surface for tlie patella) of the f. ,.„r an.l the .ondyles of the tibia, and the posterior surfa.e of ihc patella is al.so passively involved in the formation of the articulation. DisregardinK' the p-,i. I|-, ji will be noticed that, in contrast to the elbow, ody two lM,nes are inchulcd in the articulation as ,he fibula IS completely excluded from ii. From the form of its articular surfaces as well as on at couni of the manifold t hara. icr of its .structures, the knee joint is one of the most complicate.' ,irti. ulaii.ms of the human l>.«ly Tiu. arliculatinK surfaces arc incnuruenl, sin.e the n.n.avities of the cm.Mes of th.. til.ia'ari less than the ...nvcMties of the con.lyles .,f the femur. Th.. j.mornl unul.lrs ai.. M.parat...! bv the deep mter.-.n.iylar f.issa, an.l their posteri.ir p..rtions are spherit.d «hile their ant. riur stirf.L.s ar.> cylin.in.,.1 ^id unif in fr.,nt ..f the inter.-.,n.lyl.,i.| fo»a to form th.. arii.ular surfa.e f..r the pate la ( Kig. .201. Or.iinarily the .-on-lyKs .,f ,he femur pr...,,, tluir ex lin,|ri.,.l s„rfa...s to the nbia ami th.. articulati.,M is .„nse.,uently a hinge j<.int. th.- inl. r. ,.n,M„id .mimn... ,>f the t.b.a iH.ng re.. ,ve.l int.. the inter..,n.lyl.,i,| noi.h of the lemur an.l preNcnling lateral .lisi.la., ment of the art,, t.lating surfa.vs. The m..sl posterior portion. „f th,. f..n,.„a| ..m.Mcs, houexcr ar.. .ph.rical, ami wh.n they rest u,H,n the comix les ui th. tibia, .luring llexin,-, ,., ,h, kn.. j.-int' they form a .l.nible arlhr.Hlial j„inl. JMom the sh,.,,,, ,„• ,-,. „.,i,„|ating s„rfa...s ,h.. kn.e join,' IS .-.insciuently a ginglym.i .irthr.KJial arti. ulalion. I'lxm th.. comiyle .if ihe tibia are situal...l lu,. ,un,is,i, „l,i,h from ti„ ir „.,sitio„ .„,■ i.rm.-.l the n.t.nu, ami the ,x,,r,u,l mnn.u.s , |.,g. ,,, ,. Th.v ar.. !„;, |,..,s..K . „,„ „.,1 u hi, ih.. .on . TIk- , v/,W ,„n,i. „. . ,l„ , v/, n,„l v nnha.ar ,„r,il.,„ , is .dnioM compleulv cutilar an.l is ..p.n .,nb at its p. inl .,f ,,tt,uhm.nt h. the inlercomh l.,i.l emineme iiifl 134 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fio. 217. — The right kiiec-joinl in vxlcn>ion >een from in front (§). Fn;. J18. -The right knee-joint in exlensi.m ^ecn from behind (§). Fic-. 21Q.- The right knee joint in extension opened In two lateral incisions. The quadriceps nuis( le, together with the jiatella, has ]>een reflected downwani (j). Fir,. 220 The right knee-joint in llcxion after removal of the articular lapsuie and the lateral ligaments (ij). i '-.h. h is broader than the internal meniscus, and, as its radius is smaller, it covers the condyle of the tibia except in the situation of its relatively small median hiatus. It arises in the anterior intcrcon dvloid fossa of the tibia and runs to the ixternalinlercondyloid tui)eiTle, whili^ the internal meniscus ])asses from the anterior margin of the articular surfaic of the internal i inidyle to the posterior intercondyloid fossa. The anterior lK)rtioll■^ of both menis( i are connei ted by fasciculi which vary greatly in their development and are known as the lraiisirr.sc iii^amfit, and lluir thick external margins are adheient to the articular capsule, the external meidscus being le^^ inlimatel\- adherent, and hence more mn\able than the internal one. In addition lo liu' niii>isci, the articular ca\it\ also contain- two iinportatit aciessor\ liga ments. the < rm iiil lii^iimcnls 1 Figs. 220 and 2211, of w hich there ari' two, an aiilirior and a poslcrior. Their anterior surfaces arc provide^ and iiiierc ond\ loid fossu' oi the libia. 'I'he anterior ligannnt has a broad origin on the i ,ner surfac e of the external condvle of thi femur, and, iKcoming narrowi r, it passi^ lu the aiiti tioi inlet, ond) loid fo.sa and to \\w atUcrioi- inicrcundyloid tulxTcle of the tibia. The posterior liga- ment |iasM > from the outer surf.ii tof the internal conilyleof the femur to the ]«)stt rior intcrioti- d\loi I fossa and to tin (orrcsponding tulxrcle of the tibia; it i^ flat ai its origin but rounded at it^ illM rtion, and is Usi'.dh stronger than the .iiitcrii.r ligament. l)i.ringri>l iM'milh \ion ), die two ligament^ cross i.i such a wav that the anterior ('tie is in front ot liu posterior. 'lite lan.i r 1 usu alh connei te 1 v ith the (sternnl nieiiisi us. \\ ith the c\i ijilion of ( t rtain ili\crli( ul.i of ihe s\ no\ ial membrane, w lii< h w ill -ubsci|uetitl\ be doi li'icd, till' artitulan .(p'-ulc is .tllai lied to ihe m,irgin-of the ( arlilaginou^artii iilar surfaces. ii» line of .iti.H hment upon the jio^tcrior ■•uifaie of itii' l\ mur i- indicated !i\ the inteicotulv loid line, -o til, it the 1 iitirr ii; ell ond> loii] fos^a is sit 'la ted within the .utii ular iaMt\. Ihe kiu e joint ]Hisses-.»s a number o! |ieculiarilii^: it- -\no\ial folds are mori' pronouiued that! tlio-e of an\ other joint in tile bmh ; it- s^ no\ ial menibrane gives ol'f di\irti< ula, :.oi"i of w liii h .ire of l.irgc si/( and pa-- beiii .ith tin 111 ighlrtuing nni^i li s; it is mui ii -tn nglhi ncd If. ihe majotiix of -.hi overlving luidons; and the paii ll.i i>- imbedded in the aiilitior portion i.f tlie arlii ular i ap'-vile .md fornv. the ininndi.ite anterior boundary of the artii iilar 1 a\ it\ . rill ma jorit\ of tlu re m Ion ing lig.imi nt- of the km 1 loinl an adhen ril to the 1 ap-ulc tlu'ough out ;he grciler portion of their e\'i ■, There an- luii lateral iiganienl--, the jihuhir .\\m\ the lil'ial I, 111 rill lii;itit,, III. The /;/)/'.// tinhrihil , lii/i ml /i:;/ piiirllii I ihtthn liilenil li>i- Dn'fi III- friipn- Irlliir hiir-.li Hem) 0/ Jihiii'ii Intcniiil iiitermnsailar septum (Tendon of adductor inaf^nus) Tendon of f^astrocncmius ,■' (int. Head) X- (Juadrireps finilini of ^rmi iilfnihratnt-'ti'i liliial lateral lil^ament Tihifi Int leitntuiiliti'i •ii/f /'i'fii/iir \inlii( lit:. 210 AiiliTiiir I mil, li I'll "II III Antiiior iii/iili'/iir I ill I iihiiii^ilv t'l lihiii ]\ i I r !. i i i- i I ■' St s 1 11 ihfi THE JOINTS AND LIGAMENTS OF THE PELVIC r.tRDLE. '35 inner margin of the condyle of the tibia, while the shorter dee]) libers pursue a somewhat oblique course and i)ass posteriorly to be inserted into the internal meniscus and into the infraglenoidal margin of the internal condyle. The main portion of the fibular (external^ lateral lif;aiiinil (Figs. 217, 218, and 2i()) is separated from the capsular ligament by fatly tissue, and < ()nse(|Uently a])iiears as a lirm, inde])en- dcnt, flattened cord which passes from the external condyle of the femur to the head of the fibula. A deci)er and shorter portion of the ligament ( the short external lateral ligament ) is adherent to the ca])sule. The ])osterior wall of the capsule is reinforced b\ two ligaments wliich arc intimately con- nected with the muscles which h.:ve .heir insertion in the vicinity of the kmc jninl. The iHiqiic popliteal Uf^ament (Fig. 218) is a '-ontinuation of the tendon of the semimembraiidsu^ muscle ami runs obli(|uelv from below upward and from within outward upon the iiositriur surfate of the capsular ligament, in which structure it finally , j 1 7 aii'l 222) which ])asses from thi' ti!)of the patella to the tuberosity oi' the liliia. Tlu' patellar ligament, liowever, is indijiendi-nl of the knee joint and is not adiie.ciit to liie ( .ip ular lig:iment ; i; is one of tht thickest ligaments of th.' IkhIv, anurs,t \V\'Z. jj.'S wiiieh (joes not comni'inic aii' with ti;e syno\i.il i.uil}. Molli ihe p, lelia and "'e ariual tendon of tlie ipiadriceps, howiver, directly form a portion of ilii' anterior loiundarv oi ihe \i'\\\\, aiMl the ,i!!T, rior |iortion of dt ( ap^iil,;r liganu ni i- ai^o r,inton el !>\ l.i'.er.d iihrou^ 1 onlmu.dion-. (if the i(u.ii!t.i I ]y-, wliieh are known as the inierne.t and <\liriial palillar ri iitaiula 1 1- ig. .'171. The\ ariM trom tiie lali-ral margin^ of '.he patella, receive libi r- I'roni ilie va^ii upon either -ide i>i'e |ia;;e 2 i ^), ;ind pas> .lownward to ihe lateral ni.itgin'- ol ilu 1 • >n • li - oi ihe liliia Till s\no\ial l'old> of die knee joint are the alar jclih ! I'igs. jhj an i -'_'.' 1 and the palillar synmial jolil V \ -ji!. 'ihe greaur portion of die al.ir lolN ! on-i^i oi liie f.iiu li-^sue uliiih i^ situa!eil< liar hur^a Fig. 222\ "hiJi eshnd^ U] ward beneath tin U-ndon of the i|ua(iri(ep^ lVni"K- l"or iliiin-i a hand'-- brradih It .dwavs tommunii ali ■- \mi1i llu •~\rio\ial i.ivin. u^Kalh In i|uile ,1 Lu'lt aiterture. and rei i ue- (he in>ertion of thoM libers of llu i|u.idric 1 p-. w hie h .ire tinned llu .irlii ular r '« li 136 ATLAS AND TEXT-BOOK OF HVMAN ANATOMY. t i Fic;. 221. — The c of the tihia with the two menisci .ind the oiijrins of the crucial ligaments (j). Fi(.. 222. — Sagittal section of the right knee-joint in extcrsiim. The section passes through the external cond\ Ic of the til)ia ( j). Flc. 22;,. — The right tiijia and fibula with thii) ligaments {{). muscle of the knee (subcrureus) (sec page 215). The suprapatellar bursa docs r.ot lie directly u]K)n the anterior surface of the femur, but is separated from it Ijy a cushion of fat. There are two or three other considerably smaller diverticula of the synovia) membrane at the i)Osterior portion of the articulation. These are the popliteal bursa, Ix'neath the tendon of the i)oplileus, the semimembranous bursa, beneath the iendon of the semimembranosus, and the internal i^aslroenemial bursa (Fig. ,■^04), beneath the tendon of the inner head of the gastrocnemius. The last two bursa' may communicate. Thin' :iri' other bursa' in the ncightxirhtioil of ihc knee-joint whiih have no ilirert relation to the articulation. In adilition to the previously mentioned deep infrapatellar bursa, the>e are: the siihculnneous pre putelliir bursa (I'ig. 222), a suIm utaneous bursa which is constantly found in front of the patella; the suhjuuial prepalcllar bursa, U'tween the fasi ia and the tendon of tlu' i|Uadriit ps; the sublciuiinous prepatellar bursa, iKtween the ijuadriteps tendon and the i>eriosteum of the patella; .ind the subcutaneous iiijra patellar bursa, which is situated in front of the pntellar ligament (se'_' also IKiKi'234)- As mi^ht Ik' supposed from the shape of the artii ulatinR surfaies, there are two kind.. >l nioti"i' possible in the knee- joint, a hin(;e motion 1 Itexion of the lei^ and the return to the extended posit'on) and a Tiio\emf ai of rotation which is [Kissible only when the kriee is flexeil. Rotation is imiMissible when the knee is extendeii, not only from the shape of the articulating surfaces (sec page i v;l, but es|>eually on aciount of the tension of the lateral liKamenls, which are relaxed only during llixion of die joint. The latenil ligaments e.lso prevent a lateral displacement of the iHines during flexion of the artii ulation. The i .-ucial liRaments serve mainly to hold the fei ,ur and tibia together; they an' so situated that ime of them is always tense in any position of the joint, the posterior lig.imi ill liiing tense durim; part of the move- ment of llexion and part of the mo\ement of extension, and the anterior one during ilu wl.iile of 'lexi'in. The cruiial ligaments also < ho k the movement of nitation. The palell.i glides ui«in the surfan' of the femur, anil has no influence upim ihe nu-i liani.s-i of the ar.iculation. During exten..ion of the joint it Is pulled upward by musiular action anil daring flexion it desc<'nds towar'I the ti* 1. The funition of the menisci is rather to form an arlii ular 1 ushion than to sup|)li'n'ent aiifl dii'lH'ii the artirul.ir sot ket. In sonie positions of the joint they ai t Imth as i usiiions and .is {Mtrtions o! tht artii ular sik kct. in other nosili*»ns thcv at t onlv as cushions, .mil in still others 'licv exert no influenie wh never U|«>n the methaiii>i.i of ihe joint. Durine soni',' of the movements of the arlitulaiion 1 v arc m.irkttllv ili^plated or strongly n.mprcM'il ! I -> THE ARTICULATIONS Of THE TIBIA AND FIBULA. The til)ia anl libuhi art tdiinriud '.\iih cnii other in ilirn \va\s: their u]iper extreniiiii's iirticiilate liv means of ;i snidl joint, the tibio/ihular dilii uhilion; the Ixulics of the lx)iies are (oniUiled 'jv tile inter(issei)ii!< mimbrane: ami llie lower extremities are united by tense ligaitients, forming the tihio/ihuliir ^y.ultsmosis. The libiiijihiiiiir ,irl'u ulalinn (l'"igs. 217, Ji8, 220, and 22},) is the joint between tiic liluilar ani( ular surface of the tibia and tiie c;'i)itular articul;i, siirlace ol tlie libuhi. It is an arlhrodiuna with altnost iilane arliiular surfai vs and ])ossesses strong aicessory ligaments, which reiL^Jree the capsule anteriorly and ])osterit)rly and are known ;is the anterior and posterior ..v'tulcr lit^a mrnls (Figs, ji.''', 220, ;ind 22,^). 'I'he tense ea])Stiliir I'gamenl snagi\ embraces the . tilagirious surfaces. Tiiis artit illation may occisimi.illy commiinicat..' with the knee joint (through the popliteal bursa 1. ' Tmnsxrrsc lia;iimeiil AiUirior iTuciul Ihvp infrupatellar bursa lis- ^^^Bi^^to- I'litMir lis Internal meniscus \ntirior ni/iilu/iir lisiinienl / \iiit>,i! nuinlininr i il I ? .:■ fill L-4M- «» V > .t« iTld^. THE JOINTS AND LIGAMENTS OF THK FOOT. 137 The interosseous membrane (P'ig. 22,^) resembles the iiucrosseous membrane of the forearm very closel; and extends between the interosseous ridf^es of the two tones. It eonsists ehietly of obhque fibers, the majority of which run downward from the tibia to the l'ilnil:i, aUhoUf^h some l)ursue a course at right angles to this direction. Its upptr portion contains a large foramen for the passage of blood -vessels. The lihio/ihithir syndesmosis (Figs. 223. 224, and 220) is situated between the fibular notch of the tibia, which is not covered by (artilage, and the internal surface of thi' external malleolus. It is formed by two ligaments, rii ii in elastic fibers, the anterior and posterior lii^a- ments oj the external malleolus (tibiofibular ligaments) (Figs. 225 and 22f>l, which are situ. .led ujwn the anterior and ])osterior surfaces of the lower end of the two Ijones. They pass obli(|uely downward from the tibia to the libula and are made tense when the broader jxirtion of the sujKTior articular surface of the talus (astragalus) enters into the articular socket of the ankle-joint. The lower ends of the tibia and libula may conse(|uently be passi\ely se|)arated for a certain distance; this is, however, practically the only movement between the tibia and libula. THE JOINTS AND LIGAMENTS OF THE FOOT. The joints and ligaments of the foot will be considered separately, since many of the ligaments of the foot l)elong to several joints. THE JOINTS OF THE FOOT. The joints Ix^tween the talus (astragalus) and the bones of the leg and those between the indi vidual bones of the foot may be divided into the following gr(.ui)s: I. The Artieulations oj the Talus {Astraf;alus), which include the taloerural artieulation (the ankle joint), tiie taloealeaneal artieulation, the taloialeaneo navieular artieulation, and liie calcaneoeuboid artieulation. 2. The tarsal Arlhrodia. (a ) The intertarsal artieulations 1 the euneonavieular artieulation). (/)) The tarsometalarsal joints illie tarsometatarsal and inlermetatarsal artieulations). (■),) '\'\n- Joints oj till 'rorstiUrmitalarsoplialaufieal am] i is the joint Inlween the astraga- lus an, tli.' i.ilm rur.ii .irii. ul,iti"ii i- :\ liinn.- j..int, Ihr siKki-l i«f wlii. h. li.nMM-r. i^ f..rnu-.l In !«.. In.nis. A^ tin- syml. -.ni..>.i^ (.mni'itini? tli. lil.i.i .in.l llif (ilml.i il.K's n.il at)S<)lutc-lv |iri.lii.l.- ni.>li..ii. \\w l>r.>.i.l aniiri..r p.irli.in ..( Ih. Ir.Hlilr.i ..( tin- lalus ..in li. a.. i.nini.j.ialc(l by a f: i \ } 1 ' !'n 138 ATLAS AND TEXT-BOOK OF HITMAN ANATOMY. j.-j(- 224 _The anklc-juim seen from liehind (}). F,,-.' 2^, .-Horizontal frozen section through the tarsal articulatmns (J) Vu!'. a^l-Frontal frozen section through the ankle and ,.o.ter,or talocalcaneal jomts (i). .,Ht sepa.u>„n .. .H.- ... .. .. u.; .n., .v.n .He n-. ^,;;:^^';:r;:::z^::r:: ciZu. 'T;:i: dorsal flexion. The talocalcaneal articulation (Figs. 225 and 226) is the joint between the convex posterior r h r^ tee of the calcaneus and the concave posterior calcaneal art.cular .urface of he arucular surface of ^^^ -^'; ^^^^ ^i„„, „{ ^he surface of a cone, the axis of wh.ch "'t^Z "d ..u^- ^^^vhat obliMueK upward and forward. The articular capsule Tnd .^hx This articulation occasi<,nally communicate^ with the ankl.-jomt ■^ 'H i: r : J!:^/.. ^^rticulation ,Figs. .., and .30) is U.e Joint ..rmed h, the head f .t . s s,r-.g-.lus the anterior and n,iddle articular facets of the calcanetis, the po. er or . ", r t t' n w ".dn^ar, and the navicular hhn,cartilage of the plantar calcaneon.tvuular ; e , . I j'.in> i^ ^' pronouncedly compound articulation, and includes an l:^::ZXl,.^. ';ro...her wi,h .he talonavicular joint, it forn,s the transverse artuulat.n o] the tarsus (C'hopaM's joint). i- ,1... rln, .«.,.,,.„ ,h.. .-,.«aluM a,.,l ,1.; nav,, u.ar ...,,,«,. - ;« ^^ " , ' ,„ .„,. ,,,. ,,,.,,„, „„, \, „ ,„ .,|,,.„„lal i..in.. »hil.- .1.,. ,al.,n.n„ular ar,„ula , . a ■ • ^ «^^^^^_^^_ i_ _^^^^ ^^ ^^^_^^_^ ^__^ „„„ ,,„..W ,,„!, ,.-iur n..i,,r.„ailv, >„ .1 lur,„« n,u, ;',;;„ ], ,„, ,,„,„.,,„, ,...„„, j .., „ -.."- -"' ""■ '■■'■»:": -'/■""■ :, :a:r:l; i u :: in aU., a,, ..>..!.. ..... in,,.. ,nar« f i! ,„ „.„ ,., ., a,i >;:::;,::i:.::r::.h.,..,„...a, a..ia,i,.,.„ ,. ,... *.,.-.... au....... ..i,T...n,, a- 1, a,.. Th.. ..rthrodi. of .in. ,ar.u> coumM of a variaLI. number of .ingle or combine.l articulations. ....::;;:;;;;n::r,i.u,ar.avi.iesfre.,t.en,bint.co,™ f,.ets i. relativelv large, the numlHT of joints .s con.p.natnih smail biuivi.e ,rti. id ,r facets ,.o not all form in.lependent artindalions. ';:. .-'» j-:'-?::.;; ;:r,i;:;i,;r ;:'::;„:;:::" r:;:»t::;: Tibia Infnvs^nvis Mrfn- Intero^^ AUtararsai III M.taUinal nineo-meUi- tuntil It ^rous hon,- of """'^ ^'^- bii^iUli}:. liiii't roe larsottu-iiitatsaf arliaiUuion It-Ill Mefii- tan>at IV Ttirsometatnrsn! jiunt of ^ivtit rot' Int. inniif'onti hone Po^forior /a-. of rxtfrnal malleohis Inft rossfoim tntvirunei- form lig. Po^mior tulo-fihiiliir ( iint'o- tjitviailnr art. P(f>tinor fti/o- ailitifirn! litf. Stiviiuliir hone ( nfainro- fihular ii^. Inlonnvinthr iirtnuUnnni Ciitiartio- nif'Ofti arfic- Fig. 224. ('oliuneal icni'on ttilO'inlntnOtl V f \lirmil nuilU'o'tits f'lhulii In/'iiior tirfitnlor I thus \urf(H-f of tihui Tolo-oilitinrn arfiiuliition Aitiniliir ^nrfiii 01 mtillfOlii Ih/roiti li^timcnf ruliU'intl umion f'<'f""""'i /tlr, 225. /\'^tfnoi fiilo-oilnvi- :! ailhiittition I io. J'JO. tft\or diiiitoiwn hnvf^ t'tilnt'im^ I otm fi/u/rlin li^ttnttuf ■ i:!l Tlir JOINTS AM) I.ir.AMKNTS OK THE FOOT. 139 surface of the cuboid and the corresponding surfaces of the navicular and ex(ernal cuneiform bones. The joint also usually communicates between the internal and middle cuneiform bones with the second tarsometatarsal joint, and is c()nse(|uenily a very complicated articulation. The Uirso-mdalarsal arlkulation (Lisfranc's j(iinl) (Fig. 225), logethi'r with the hilcr mctalarsal articulations t l'"ig. 225), form three sei)arate joints: one connecting the metatarsal lx)ne of the great toe with the internal cuneiform bone; one connecting the ba.ses of the second and third metatarsal bones with each other and v ith the middle and external cuneiform l)<)nes; and the third connecting the fourth and fifth metatarsal lK)ncs with the culx)i(l Ixme. Thi line of Lis frani 's joint has its most ])roximal point at the inner margin of the sole of the fool and its most distal point at the base of the second metatarsal bone, so that a dee|) indentation is jjresent in this situation. From this point the joint line jnirsues a markedly distal direction and then makes a distinct curve toward the proximal portion of the foot. The miivcmcnts in thi' tars,il .•>'lhroiiia .ire ixtrcmcly sliglu, sinar ticularly those of the second to the fifth metatn a! Ixmes, which permit of a hy])erextrn-ion (dors;d fk'xiim) )f the toes. These articulations also resemble hinge joints more than arthnKJia iginglymo- arthrodial. Ossification is freipiently observed between the indi\idual phalango, particularly in the little toe. The accessory ligaments of thesi- joints are similar to tho>e of the han Tht liga- ments lit the ankli' joint, < 2I the ligaments betweiii ilie astragalus and t'.e ealcane is, ;; j the dorsal tarsal ligaments, 14) the plantar tarsal ii^aments, and i;; the inlernsseous larsil ligaments. The ligaments of the ankle-joint (Figs. jj4 ^md 22(1 to 22S1 canned tlie Imnes nf du leg with tin- laliis (asiragalusi and the calcaneus, and ptn-ue a more or less \ eiiiial ilireitiim. I'.aih of the iwo malleoli is connoted with the neighboring tarsal bones. The lidloiit liiianun' 1 1'ig. 2271 arisi's from the intirnal malleolus aiul radiates to the lalu: lastrai^alusi, the cah.ine'iN and die naviitdar Inine. It is narrower at its nrigin, hroad at it - inserdoti, and is mmpo-e'i .it tour separate ligaments: the anterior talo tiliial, the posterior lalo tibial, the cahaneo til ial, .,n^ ihi tibionavicular lifianienls. The anterior talo tibial 1 1 .^anient 1 Fig. 227) ]iasses to tlv antc.or extreivily of the neck n| the talus i.istragalus) and is .ilmost lomiiletely covered by the cal'aneo tibial lii^amenl 1 Fiu. .'271 wiiieii runs to tjie margin of tlie susleniac uluiii laii. 1 he poslirmr l-tic libiai iii^anh in I ]•:•.. 24 ■ 140 ATLAS AND TKXT-BOOK OF HTMAN ANATOMY. tr*^ Fi<;. 227.— The ligaments of the tarsus seen from the inner side (j). Flii. 228.— Tiic ii.naments of the foot seen from alxne and from the outer side (J). 22Q— The nj,Mm"nts of the foot seen from the plantar surface (J). ^30— 'I'lii' ligaments of the foot seen from the dorsal surface. The talus has been remo\ed so as to show the |)artiii|)ation of the navicular li,i,'ament in formini; llie socket of the talocalcaneo-na\ icular joint {'{). Vu Fit and 227) fjocs to the j)()sicri(>r process of the talus, and 'he liliio-iuivicii/.ir (Fig. 227) has its insertion upon the dorsiil surface of ihi' navicular hone. Lij^aments pass in a similar nianii. r from the external malleolus to the talus (astragalus) and to the calcaneus. These are known as the aiilerior tiilo-fibuUir, the posterior talo- jihiihir. and the Cukanco fibular lii;amcnls. The anterior lalo-fibidar ligamcut (Fig. 228) I)asses almost liori/.ontally from the anterior surface of the external malleolus to the an- terior margin of the trochlea of the talus; the posterior talofibular (Fig. 224) pursues a corresi)onding course and connects the jiosterior border of the external malleolus with the outer tubercle of the ])osierior ])rocess of the talus; and the caleatteojibular lii^amenl (Figs. 226 and 2;;o) ]iasses somewhat ()bli(]uely downward and backward from the tip of the external malleolus to th.' outer surface of the calcaneus. Upon this ligament run the tendons of the two peroneal muscles isee i)age 222). The ligamentous connections between the astragalus and the calcaneus consist of the rein- forcing ligaments of the talocalcaneal articulation and of the ligamentous mass which occujjies the sinus of the tarsus, the interosseous lalo-caleaneal lii^ament. The latter (Figs. 22-i and 2^0) consists of a number of firm fibrous layers and forms a s])ecies of syntlesmosis between the two Ijones. The reinforcing ligaments of the posterior articulation of the two lK)nes are known as the internal, external, posterior, and anterior talo eahamal lii^aments. The external and particularlv the anterior ligaments, which bridge o\er the sinus of the tarsus, are connected with the inter- osseous lig,.ment. The external ligament (Fig. 228) pas.ses from the outer and lower su'-face of the neck i>f the '■ lus (astragalus) to the upjter surface of the calcaneus; the anterior ligament connects the lower surfaie of the talus (astragalus) with the ujjper surl'aie of the calcaneus; the IK)sterior lig-.ment connei is ti:e outer tubercle of the jjosterior process of the talus with the u])per surface (tl the cahaneus; and the very narrow intirnal liganiint i)asses from he inner tuber- cle of the i)osterior pnn-ess of the talus to the sustentaculum tali. The dorsal and plantar ligaments of the foot are practically hori ontal, and are composed partly of transverse and partly of longitudinal fasiiculi which lonnect niiiihtxiring bones and i(>nse(|uenlly reinforce the arlicidar (apsules. The plantar ligaments are considerably the strong! r, and some of them conned ibstant portions of the tarsus, passing over one or even more lx)nes. The dorsal tarsal ligaments are tho>e which connect the talus (astragalus) and thecal (aneuswiih ihe t.avii ular and ihetuU.id l)<)nes. They are the f/cr.w/ /(//o-mnvrHA/r //(,',;>«(■«/. the ilorsal I aleaneo naiieular lit^a.nent, and the bijureate lii^ament. The bi'jureate ligament ( Fig. 228) connects tiie antero internal angle ul the calcaneus with the dorsal surfaces of the navicular and ■r.- Tfl |ii I Of- i ■ ■7 ^-n 1 i ■ ^1 i ' i :i I ;1: 1 i i i ■ 1 I Mi : J ■ ii 1 i h- m I I I N ! 1 Tninsverse capitular Mct,itarso-/>liiilaai:eal ligaments aiiiailiitioits I I'll g /ilaiiliir Hi leiidon of /moiiaeiis loiiiiiis ] /'Iciiiliir tdrsaiiii'idt.irsai //, • rimttnr niiiit'iiliin- nine'ltfrrii It^jtni'nts Dorsal tarso-iintalarsal r /iu'llllll'lltS Oor^itl ntivitn/iin ainrihn-iil lix''' fir. 220. Aruniliiy UitTt .'( luivinil.ir l\'ne Navicular Jihrocartilag;i' Miihlh- articular facet of calcaneus lircrasscous talo-calc.iiical li^aunut Anterior articuUir facet of calcaneus I'aslerior articular facet of calcaneus Dorsal iineocul'oid Dorsal c.ilaneo- cuhoiil Hi;: icudon of /leroiiaciis hri\'is /7^,^ 230. Uli n ^ I THK JOINTS AND LIGAMENTS OF THE FOOT. 141 cuboid bones; it necessarily divides into two portions, one for each bone, known as the cakaKco- naviciilar and the calcaneocuboid portions. The navicular is connected with the cuneiform bones by the three ,iorsal mnicuhirnmn jorm ligamaits i Fi-. 228). The first of these is the broadest. The cuboid an.l navicular Ih.ihs are connected bv the dorsal cuhoideo-navicularlijiamcnt (Fig. 228); the cuneiform bones are connected with each other by the dorsal intcrcumijorm ligaments (Fig. 230); an.l the dorsal euneoeiihoid ligament (Fig. 2 -,o) runs between the external cuneiform and culjoid Ijones. The connection between the bases of the metatarsal lK)nes and the tarsal bones is elTected bv the dorsal tarsometatarsal ligaments (Figs. 228 and 2,^0); the bases of the metal; rsals are connected with each other by the four dorsal basal ligaments (Fig. 228). The plantar tarsal ligaments maintain the normal arch of the foot. By far the largeM and strongest of them is the long plantar ligament (Vi'A^. 22A, 227, and 229), which is, in.l.ed. one of the strongest ligament> of the Ixxly. It arises from the entire lower '.urface of the eali an- 11 m front of the tubercles of the tuberosity, its width almost entirely covering the In.ne, and ii . i nng longitudinal fasciculi are inserted into the tuberosity of the culx.id. From the main n^ ot the licrament there are given otT superficial fasciculi which jiass over the tendon sheatli m the pen. ncus longus situated in the culx^id groove, and extend to the base, of the outer metatarsal Ix.ncs (secpage227, Fig. 312). . , ,. , ,- The second strongest ligament of the tarsus is tiie plantar calcaneonavicular ligament ( !• igs. -7 and 229), whose strong fibers i)ass obliiiuely between the sustentaculum tali and the na\ic elar Iw.ie. The dorsal surface ot the ligament is covered with cartilage and contains the nam u iarfihroc Milage (Fig. 2,^0), which forms a jxirtion of the socket for the head of the talus (astrag- alus) (see ,)age i:,8). Upon the dorsal surfa. . of the loot tliis ligament is connected with the tibio-navicular ligi-ment. The plantar ilcaneocuhoid ligament is adherent to the dorsal surface ol \hv long j.lantar h-ramenl and reinforces the i)lantar surface of the artirular caj.sule of the calcaneocuboid joint. The navicular ami the cuneiform bone^ are connected by tlie plantar navinilarieaneijorm liga- ments (Figs. 227 and 2;o); the culx.id am' the navicula.' bones by the plantar euhoideo navicu- lar ligiment ('-ig. 2^o); the cuboid and th.; eMernal cuneiform bones by the plantar cuueo cuboid ligament: and tl" ■ three .■vmeif..rm bones with each ..ther by the plantar intercuneijorm ligaments. ■[■here are a!>o plantar larso metatarsal ligaments and three plantar basal ligaments. -Aliieii pursue a similar course to the corresj.om'ing dorsal ligaments. The interosseous ligaments are those ligaments o. the foot wliiili are Mtnated neither up<.n the dorsal nor the j.lanta, surface, but which connect contiguous surfaces (.f tfe tarsal (.r -netalar- sal bones in those situations where no articular connection exists. Thex' really represent syn.ks imses, and are found onlv between those bones which move ujion eac h (.ther but slightly, if at all. In additi..n to the previ<.usly mentioned interosseous tal-.calcaneal ligament (Figs. 22(, and 2,^01, these ligaments are tlu' interosseous cuneo cuboid ligament, i\k- interosseous intercuneijorm liga ments, the interosseous ciineo metatarsal ligaments , particularly between the internal cumif<.rm and the base (.f the seconr ctatarsal bone, where an interosseous basal metatarsal is wanting 1, and the inieross.ou. i>u.ui nutaiarsa! ligamrnts. The uj>i.er and lower surfaces of some of these ligaments are in direct ..ontacl with the cor .sponding dorsal and plantar ligaments. li'.ili l-'i I t Hi i I i W i MYOLOGY. GtNERAL MYOLOGY. .Myoloiderablv tliinner than the muscle Muscles are distinguished according t.. their sha].es. A great many, jiarticularh" those forming the mass of the extremities, are fusiform or si)indle-shaped, while others are broad, thm, and llat; muscles whose length but slightly exceeds their breadth are designated short muscles. Some musdes surround orifices of the Ixxly or canals, and their fibers are circularly a, ranged: they are known as orbicular musclrs. or, if they serve to close orifices, such as the mouth, for exam])ie, as sphincter;-. Those' muscles in which the fasciculi pass to a tendon develojied at the side of the muscle are known as jiinnale or jjcnniform muscles, and if the tendon 1k' situated in the middle and receives muscular fasciculi from either side, the muscle is said to be bijjinnate or iji])enniform. The majority of the muscles have a single head, but occasionally two, three. ■'- four heads unite to form a muscular belly, producing a biceps, triceps, or (|uadriceps muscle. A muscle com- posed of two bellies with an intervening tendon is termed a biventer or digastric muscle. If mu.scles pass only over one joint of the body (particularly in the extremities), they are known as monartir ''-.r muscles; if they extend over two main joints in their course, they are called biarticula Tendons occur in connectioi, with nearly all the muscles, and are comi)letely aljsent in the sphincters onlv, though partly wanting in the orbicular muscles. Every muscle, however, has not a tendon at both ends, it freiiuently hapjx'ning that onh tiie tendon of insertion is develoiied, while the origin is purely muscular. The fibers of the tendcms of origin or insertion are \ery Mi t'ral r. slenioi'liiiloiiuislciiil I (I I, nil irrvicdl /'• ii/)rmi(iriailiir /'. cliivinilcir r. iicioiiiiiil r. iilnici.iviiii!iir r. nil u! rr. external rninti r. internal rrnral r. internal retromallevlar r. internal mu'leotar r. caleaneal r. digital rr. of loot - lingual rr. - (1 FifT. 231. Regions of the human body. yJLJSSi auricular r. fovea imchac acromial r. external cnliitnl r. posterior eahilal r. external brachial r. - internal brachial r. external cubital r. olecranal r. posterior cabital r. volar digital rr. external femoral r. txttrnni crural r. extrrnul retromalleolar r. \lor\ol of fool cali-ii'cal r. fifr. 212 Regions of the human body h, i ! I i « ■ ■ 1 f j m superior palpebral r. in/trior palpebral r. superior labial r. inferior labial r. auriiitlar r. V pnal r / / /i's\/7 ■iiiprnibu'inibir lowU /ui;iilar Iowa /lir.Jii. Regions of the head and neck. ! f i li perineal regions. ruf /vff. 234. Male perinviin, . f-'iiv '2.'\^ f't'nUlli' !}i*!'!!ii'!i!!! If r- GENERAL M\'OLOGY. 143 frequently mixed with mu^cuiar fibers, so that neither a purely muscular n<,r a purely tendinous origin or insertion exists. The spindle-shaped muscles have cylindrical and frequently very long tendors, hut the tlat muscles usually arise by means ■ ' f.attened tendons which are known as ti/xnicdosi's, and, mi the cases of the tlat muscles, may serve as fasci;e for other muscles. The round tendons also occasioiiallv form aponeuroses in the vic'nity of their insertions. Broad tendino>>.s i)lates are sometimes found u])on one of the surfaces of a muscle in the middle of its course, and a musde may ]>ossess ;[ lumber of tendinous interruptions, arranged at more or iess regular distances from each other; these are termed Inidiiwits iiiscriplions. The jascict are connective-tissue coverings which surround indix idual muscles oi groui)S of muscles. They are fre<|uenlly adhere.it to their muscles and form their aponeuroses, an(i are especialb- well develo;)efl in the extremities, where they form a common sui)erticid >hcalh for all of the muscles. Some muscles do not possess fascia-, as, for example, the muscles sudated in the skin, such as the i)]atysma and the majority of tlie facial muscli'< The inlcrmisciihtr s.'pla are intimately connected with the fascia-, biing sheet like prolonga- tions of those of the extremities, extending to \\\c i)eriosieum so as to fer layers of the muscles of the back and nei k. The muscles of the alidomen and of the extremities arise seccmdarily from the myotomes. In man the musculature of the extremities is very strongly develipped an Id -med l)y the trapezius and the latissimus dorsi, the seccmd by the rhomboidei and the levator scapulx, and the third tjy the serratus |)osterior superior and inferior and the sjjlenius capitis and cervicis. The muscles of the first and second layers are inserted into the skeleton of the extremities; those of the third layer find their insertions in the skeleton of the trunk. The First Layer. The trapezius or cucullaris (Figs. 2,;f) and 256) takes its name from the trapezium formed by the muscles of the two sides. Each muscle by itself is triangular, its longest lH)r(ler i)eing situatc-d at the vertebral column. It is flat and sm(X)th; below, ami i)articularly alx)ve, it is very thin, and it is situated in the nuchal, median dorsid, sujirascapular, scapular, and inlrascapular regions. It takes origin from the following situations: from the inner half of the superior nut lial line (extending to the linea supn na as a short thin tendon), from the external (M-cijiital protuber- ance, from the nuchal ligament (by a muscular origin, sometimes by a short tendon i.i the upper jKirtion), and from the s])inous i)rocesses and su])raspinous ligaments of all of the thonuic vertebne (more or less tendinous^. It is inserted into the i.,.p- '>f the acnmiial third of the clavicle, into the iniur margin of the acromion, an almost horizontally outwani; while the inferior fibers r, from within outward and from b.-|ow al'ruptiv upward. Tendinous areas are constantly found at the origin of tiie trapezius from the occiput, in the region of the seventh ciTvieal vertebra ami of the spines of the upper thoraeu vertebra', and at its insertion into the inner end of the spine of the seainila ; the fil)ers coming from the S])ines of the lower thoracic vertebra' arc alM) tendinous for a certain dis* .nci , and in the region of the spines of lite upjier thoracic vertebne tiie museles of the two sides form a broad, well-developed, trapezoid aponi'urosis. .\t the occiput the trapezius joins the tendinous insertion of the -ternoc ' '. lomastoid. He tween the two muscles, the s])lenius capitis and the levator scapula- are always iiarllv \ isijjle, and if tile ui)per part of the tra])ezius is narrow, a jiortion of tiie seinispinalis capitis al-o ajijiears li I 1 i ' 145 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. between it and the splcnius capitis. The deltoid has its origin immediately adjacent to the insertion 01 the trapezius, and a small transverse muscle occasionally passes between the insertions of the trapezius and the sternocleidomastoid; it is known as the transirrsus nucha- {Vig. 244), and usually has a tendinous origin from the tendon of one muscle and passes to ihc vcndon of the other. The trapezius is supplieil hy the .icccssory none anula is also drawn backward by the ,iciion of the entire muscle, since the upper and lower fasciculi neutralize each other to a certain extent and aid the middle portion of the muscle. If the shoulder-blade is fixed, the muscle turns the head; when both scapulx are fixed anil the two muscles act together, the head is extended. The muscle may also fix the scapula. It usually acts together with the levator scapuli, the rhomboidei, the splenii, and the other muscles of the l)ack. !■ = !•■» The latissimus dorsi (Figs. 236, 238, 269, and 272) is a broad, thin, triangular muscle which becomes somewhat thicker toward its insertion. The upjur y)ortion of its oriirin is 1 rtlv con- cealed by the tra])e/.ius, and it is situated in the median dorsal, the sacral, the lumbal he infra scapular, and the scapular regions. Its origin is tendinous throughout, with the exception of three or four accessory digilalions which arise from the three or four lower ribs. The tendon of origin is furnished by the jrasterior surface of the posterior layer of the lumbodorsal fascia (see jiage 156), by means of which the muscle arises from the s])inous jjrocesses of the lower li\e or six thoracic vertelira', from the s])inous jirocesses of the lumbar \iTtel)ra', and from the median ridge of the sacrum and the neighboring jjortion of the outer lip of the crest of the ilium. The superior fil)ers nm almost horizontally; the inferior fibers ascend abruptly from within outward and from Ijelow upward, and toward the insertion the fibers converge, and terminate in a tiat tendon which is adherent to that of the teres major and is inserted with it into the lesser tubercular ridge (the posterior lip of the bicipital groove) of the humerus. .\n almost constant bursa, the lalissimus bursa, separate- the non adherent ])ortions of the tendons of the latissimus dorsi anri teres major. The tendinous surface of the ])osterior layer of the lumbodorsal jascia (Figs. 2,v'* and 240) is widest in the region of the middle and lower lumbar vertebra", and it becomes markedly nar- rower as it extends upward, and to a lesser degree as it ])asses downward. Between the U])j)er border of the latissimus, the lower br rder of the tra])ezius, and the vertebral border of the sca])ula, there is a triangular space, which is larger or smaller according to the ])osition of the scapula and in which are visible a ])ortion of the rhomboideus major, small ])ortions of one or more of the middle ribs with their intercostal muscles, and a segment oi the iliocoslalis dorsi. Upon the neighlxiring dorsal surface of the scaj)ula, the dense infraspinatus fascia covers the infraspinatus muscle, and a portion of the deltoid muscle, covered by its fascia, is also \isibU' in this situation. The costal serrations of the lalissimus dorsi interdigitate with the inferior serrations of the oblif|UUS abdominis externus (Fig. 247). Retween the outer Ixirder of the latissimus, the pos- terio" border of the external oblique, and the crest cf the ilium there is usually a sm^'U triangle. TITF. \rUSCLF.S OF THE BACK. Is. the lumbar triangle or triangle oj Petit (Fig. 236), in which a portion of the orij^in of ilic abdominis intemus from the anterior layer of the luml)ar fascia (see i)am' i()o) is exju-'sed The posterior border of the latissimus dorsi forms a part of the posterior bounchiry of the axillary jossa, and the muscle not infrequently receives accessor)- fibers from the interior anj^le of the scapula (the scapular digitation). Since the latissimus is rially one <>f he muscirs iif the e\trvn,ily, it is sup|ilieil from the plexus liraihialis, its nerve Ix'ir.R the thur.ieodnrsal (middle or lonR suhMapular) nerve. The latissimus dorsi adducts the arm, carrying it backward and rotating it inward. ::;! The St:concI Layer. The second layer of the flat must ks of the ' -ick ( Fig. 2i,S) is coveretl by the trai)e/,ius, with the exception of a j)ortion of the rhomix>idea. major, which is exj>osed Ix'tween the latissimus and the trapezius, and of that pan of the levator scapuhe which is situated immediately beneath the cervical fascia at the outer lx)rder of ;lie trajie/.ius. This la\er is not '•(.■i)resente(i beneath the latissimus which directly overlies the third layer. The rhomboideus major (Fig 2.:;8) is a flat and rather thin (|ua(lrangular iiui.scle which arises from the spinous pcoces.ses and supras])inous ligaments of the upper four llioracic \ertebra'. Its fibers are distinctly ])arallel and pass downwird to be inserteii 'nto the \ertebral Ixirder of the scapula Ix'low the r(K)t of the sjjine. The muscle is freipiently rather intimately coniu-cled wiili the rhomlioideus minor, and, according to the jjosition of tlie sca]iula, may Ije eitlier (|iia(hanguiar or rhomlx)i(lal in sliape. The rhomboideus minor (Fig. 2,vS) resembles the majnr in e\-er\' n^jied, l)iii i> nnu h narrower. It takes origin from tlie spinous ]ir()cesses of tiie two lowirmost cer\i.r nirs, „. fnunln inu-.,.tal nerve. U draw. ,he upper ribs upwanl an,l ba, kwar.l an,l aii> ..^ a niusile iif inspiraliun In enlarniiiK ihe \h .rax. The serra.us posterior inferior .Fig. 238) resembles the serratus posterior superior in nruix respects, but it i. llatler an,l its libers run from within outwar.l and from below upward 1,'arise. from the anterior surface of Hk- posterior layer of the lumlx.lorsal fascia ,n common wuh the im^.imus do.M, at lite level of the two lowermoM thonu ic and tile two uppermost lumbar vertebra ■ it is at first a thin and in.Kpendent aponeuroM., but subse,|uenlly be. omes entirely musctda,", ..n.l is inserte.1 into the lower b..nlers ..f the lower f..ur ribs by .ligitations whuh fre- .|U.'ni!v \;;rv in ih.ir .Uv.lopmcnt or may be wanting. .nu. nu,. 1. ,- ^applie,! bv ,he 1 r ,nln,h ,., nvelfh, in,er„.>al nerve. I. Mraw. .be inwer rib. ba. kwar-l and ,,„„,.!,;:, \Jher !,„„b in,.K„n.n .„ expirau,. ,., un>.r,ain, in eiU.er ease i,s .nlluen, e u,.,„ .be r.l.> ,s .er> vli^ht H may in. rease lb, iei.-.i..n ..| ih, lun.bar l.i- i i ■lb.- splenius capitis - F,u. .3S ami 230^ i^ a strong, elongat..!, stra,. sh:.pe,l mus, !.■. uliich ,riM.. Us nu an. .,f the nu. h.,1 iiganun, lr..m th.. spinous ,.,... sses of tit.. low.T four or t.v.. cervual „„|„.„nnl,.upp.r.w.,onh,v..,hora,iev.rt,b,.e. I, pa.^ses from within oulwani ami from below ,,„,,„, - ,nlv ...vere.l In th. trap, /ni., du' rh,..nbnidei, ami ttu- ^. rrattt. posLTtor sup.ru.r, ami ll i,,:, , , i.' intn tiie .,ute, halt ol ,l,e upp.nm.st nuchal line n| tin- occipital b-wu^ .M.'mbng a> (..,• ,. lb. nu-tuid pro. e... Tlu' ins.-rlion i. .ov.tvd bv the stermH le.,ln,m.sl.nd. The splenius cervicis (Fig. 2m>^ i~ MU.ai.d unmcliatelv to th. nut..- sul. ..I tin- spleniu> ...,„i,,. It ,ui-..inimmediat.M,c...M,.n m ilu^ i.ittrr nuis. le fn-m th.- spimn,. pn.cess..s ot tlu^ ,;J,.,, .;,. f„„„|, ,„ ,„.■ Itfth or sivth thora, i. v.„. b.a-, ami ,.asses ..bli.pi. Iv outward ami upwanl .,.3 11,.! but rath..- sl.n,ler mu>.l., .0 b.- in.n.d into the poM.rior tub.n K . ol th.- transverse ,„-,He-M-> ..f du upper tuo or ihr.-c ..-ni.al v. rt.bra-. It^ in.-rtlo,, i. intimal.ly conne. t.d w„h tl-,(- ,,riuin of lib- 1. \ator Mapuhe. -,b, ,un .pl.nu .,r, -upph..l f .he p„-b-r,„, ,l.u-i..n, ,.f ,h. ^..-,..m,I .,..1.. .i«l.ll'_^ uiv.li-. •,( l'..lll -i,l, 1,1 in ,,.nnii,in. It"-v pni' li" '"-"i '" ■ " ■ '^ • ''■^■'^~ ■■■■'■ ■'■■ „, ,|„„.., ,b.: lun, .lu b.,„ 1 k' - ir'l "" ■"'• "f "" ""-"■"•"'« '""-" • i, .il M,-rv,.- Wlu n 111, 1 ...,,v. |. 5 ..f .ini- >iil|. ii^iS?-*'*^-. Oiri/iitalis Simis/iirialis capitis Sternorleidomastoidfus (Supraspinatusj Teres major I ntissimiis Serratiis anterior - I iiitssimm * Obliquiis aMominis internus ^ / Hi /li'. JiS. ^ «j' THK MIISCLKS OF THE BACK. 149 THE LONG .MUSCLES OF THE BACK. The long muscles of the back (Figs. 23Q and 242) arc sulxlividc.l int.. two layers accordinK 'o the direction of ihcir fasciculi. In the superficial layer, the spinolransvcrsalis, the hl.ers j.ass from the spinous processes to liie transverse processes or to the ril.s; in the dee]) layer, th.- Innis- irrsospiiialis, the\- jKtss from the transverse to the spinous proces.es. The sftnuilis. heloni^- ing to the upi)er hiyer, is the only muscle j.assing from spinous ,u-ocess m spinous pnuAss. The First Layer. The Spinotransversalis and Spinalis. The muscles of this laver (Fig. 2,?<)l fill the vertebral groove between the spinous processes of the verlebrx and the angles of the ribs, and extend over a large area of the vertebral column, usuallv the entire length (,f the back. With the exccpti.m of a Miiall i.ortion xvliiili may heduectly beneath the >kin, between tiie trapezius an-t the latissimus dor-i (see page 145'. 'h^T •''•c- com- pletelv covered either by the Hat muscles (,: .■ Ic.a. The spim.transverse fibers form a .ingle, large, (..mpli.ated nui-cle. llie s,t, ros piiuili^. The sacrospinalis or nr,l„r spimr iFigs. 2,V) and 241 1 i- a l'>ng and Mrong muMiilar ma-s wliich extends from the .lorsal -urfa.e of the sacrum and the en -t of the ilium t., the ^kuii. il forms a .ingle mas. ontv in it^ louvr portion. dividLg a. it i.a.sis up\\,ird into t«o -Maratr nvasdes, thi" external and weaker i!ion>sl>ilis and the internal and .trongir lon-i.ssiwu. inp..-..l ..f three sub.liv i-i.m- the //ww/...;^ liimborum. .lor^i, an I .inids. Tlu' ilionnlatis Inmhanim (Figs. j,;o and 241 ' ari.. - in t.>mm..n uiih llu- l.Migi-nnu- an.l in-erl. inn. th. an^d.- .-I llu- lilth L, llu- 1 .■Iflh ril^. ■Hi,- Mip. rior inMiliun- an I.', m.an- ..f 1,,,,,^ irnd..n-, xvhil.' lb.' l-'.ur in-erti-n. aiv in th. .hape ..f ll. ^Iin m rraliu,,-, llu |..-A.rnu.-l ..! whi. h i- the .ir.mmM .iml pa.'c- to tlu- l.iwer bonier ..f llu tw.lfili rib. The greater p..niun ..f ihr "vigin ..I ihe ilio, nshil,-, ,!■'•■. i .Fig-. j,^.) an.l .mi i- .nv.iv.l by ,lu ili......lali-lumb..n.m. !la,i-.--lA m. an. ..I .p.. iai , ..-^.-in m naii.m. Imm iIu inn. r -i.l.- „f the angles ..i the tv-illih t.. llu- ..x. nlh lib^ and i- in->. (L- b- thin. I.n.ion- xvhi. Ii pa.s t.. llu- an-l.s ..fllu- siMh 1.. llu- fii-M ribs and I., llu iraiiM. r-.- pn... ss ..1 llu- la.i .. rv i. al \. ru bra. " The iliiHO-'ali''- "Wins (Fig.. 2,;o. ^ \o, and .' 1 1 ;. ab., 1. rm. d llu nrii.ali^ .r. , n.A i;>, h a .K-n.ler mu..i.- llu- ..riuiu ..f ^^Wwh i- imimaU-K ...niucU-.l uiih ilu ili.M.Mali-. .I.'!-!, ll ...nu-- In.m the upper .nul mid.lle rib. in a variabi.- mann. r ,,n-i b i.-. lU-d b> n.irn.u I. u.lnn. inin ihe n-an-v.-r.e pn..e-^.c- ol" llu- niid.il.- . . r\ i. al \, rubra imm. .'..H.-K aL.ng.i.le ..| llu .. al. nu. po. U-rior i.ee pau'e 17V, \\illi ll" "Hi-in "I «hi.h il ma;, b. .i.iiunnl. , 1 1 It 1 i \ 150 ATI.AS AND TEXT-BOOK OF in'MAN' ANATOMY. Flc. 2^9.— Tlie superficial '-vcr of the lonj; musclo of the back. All Ihi' flat mus<:k-s, thi- spli-nii and the iliiKOstalis of ihf Irft >i.li- liavf Win removed. The longissimus, tlic inner ])()rti()n of ihc sai.rosi)inali.s is comi)OhC(l of three subdivisions -the loiii^issiniK.'i dorsi, icn'icis, .-.nd capilis. K,il,ll,iris liillgi littUtiin > .'•ii L'(5 Miiilifniiii • Tr'i>'S7'rrst' ftrinrsses Srni,\fn''!>lhs Kl... j(o,-I)iairr,im ..f ihe arrariRrment .if ilir varum-, portion-, of Ih. iranr-VTr-o-piimlis UeMU,..|nnali>. nmll(liilu«. roialorr.*). The l ;(> and 241 1, in addilion to its common origin with the ilio- cosi.iii^ iuini)oruni. riTei\e> an ■^^oi\ un^^iii- li lin ll".ili.s\ ( rsc ]iroccsscs 01 nis- tw. ,; ,;it'i.:'. n vcrjf r;i-. Its insertions are arranged in an inlirnal and in an eMernal series, and are partly Splenius capitis x Longissimus capitis — Splenius cervicis x Longissimus cervicis Nuchal Ug. Splenius capitis Sternocleidomastoid Splenius cervicis Levator scapulae lliocostalis cervicis Semispinalis dorsi Obliquus abdominis ext. Serratus poster. super ■ Spinalis Latissimiis ilorsi Serratus iiiitifiot "^•Srmilus poster, infer I Nff. 230. CcS? !#[ -,?: ■ if.-- THE MUSCLES OF T " BACK. 151 fleshy, partly tendinous, and their digitations arc frequently yariable. Those of the internal series are inserted into the accessory processc-s of the ui.l)er luml.ar yertebra- and into the trans- ycrse processes of the thoracic yertebrie; those of the external series insert into tlie apices of the transyerse i^rocesses (cistal ,.rocesses) <'f the upper lumlxir xerlebra- and int.. the ribs bet^veen the angles an inserted by tendinous slii.s into the iransvei-e processes of the uj.p.r and n.id.lle crvical vertebra'. ■ The lo,r^issimus a.pHis* (Im^s. 2,,o, 241. and 2^2) i^ the only portion ot the sa.rospmahs Nvhich extends uj) to the head. It is >itualed internal to the lon-issimus cervicis. with the on-in of which it is fre(iuentlv unite.l, and arises by separate short ten.linous slip> ol variable .xlen. from the transverse and articular processes of the middle and lower cervi. al Ncrtebra- ., ,d trom the transverse processes of the up|,er thoracic vertebra-. Thi> muscle often presc-nt> a i.udin.nis inscription, i. inscTted bv a short tetidon into the posterior margin of the mastoid pr.H.^s. and is comi.lelely conceale.l bx' the splenius capitis. The iliocostalis and lon.L^issimus cervun :>nd the lon^isvimus cai.ili> are situated beneath (in front of) the two splenii. ■ The spinalis (Fius. 2^., an.l 241 ) i- .omposed of the splm.lis .hrsi. nrvias. and r„ />//;.. ol which the spinalis a part of ihr semispinalis caj.ilis. The spinalis dorsi (Figs. 2V, and 241. is intimat.lv eonne.l.d will, the t.nduuuis .,n;.;m> „f the l.uv'i-inius .loi>i whi.h ...m.- tn-m the spin.uis processes ..f the lumbar vrt. 1.. an.l tak.'> its ..ri.dn' partly fn.m these b.mv p..inls. It is situate.l al.-n-i.le ..f th.- spine, ot du ihora.u vertebra- and c.aUain> i.am.n.us ten.lin.ais fas. i.uli. It take, it^ ..ri,.dn trom tl,.' ^pm.n.s ,,n.. i.sses ..f the ui.per lumbar an.l "f the lower th.-racic vertebra- an.l passo I., the sian.s ..| t h. mi.l.lle an.l upper tii.M-acie vertebra-, bri.lging over one or two ..f the spin.uis ,,rocesse^ (Usually tin- ninth .)r the .lintli an.l tenth). The spinalis nrviris (Fig. 2 + 1) i> incnstant ami, when i.rcsenl, is fre.|Uenlly .|Uit.- ru.li m.ntarv It is a verv sUn.ler muscl. which aris.-s fn.m the spinous i.ruoses of tin- Mxth an.l ..venth cervi.al vertei.ra- an.l inserts int.. the spim.us processes .,f th.' .-pistn.pheus (axisi an.l ol the thir.l cervical vertebra-. Xn m.on...n. nn..,ul,,r f.. i, uUh uln.h arises fr.,m ,h,- spi.vm, ,,n...-ss.-s of ,1„. Inn.r . .ni, a! l'"'' "IM-""--^, (,..■ llUgl- i%2). m The Second Layer. The Transversospinalis. The fibers ..f this laver (Figs. 2,,() t.. 242). i)assing from the transv.-rse t.. the spin..us p.rocesses. rei-rcsent in their arrangement a portion of the original trunk musculatur.- whidi has .Tlu> mu,>l.- lias alsu 1h-,-„ U-rm.-.i ih. rr„„..,Tw/» .apilis. •>,.- „.»,;,/. v.,, .„nor. a,M ,1,.- ,r.„ l.r!..,„.nl«iJ 3 W^"* ^ } i J ) : ^ 1 1 ;-t ! » ■it if/ ^i'^^ 15-^ ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Tic. 241. — The deeper layers of the loni^ mus'-les of the back. On llie left Side the sacrospinalis has iK'i-n partly removed and the semispinaiis has been cut and reflected. Flc. 242.— The cervical portion of the deeper lu.vers of the muscles of the hack, .seen from the side. Tlic trapezius and splenii have been rrt;(ine but sli<,'ht changes. They are arranged in three layers, each of which is described as a special muscle, although they are not separated by fascia-, but are distinguishable from each other chieflv b\ the length of their fasciculi. The semispinaiis, the most superficial layer, has the longest and conseiiuentlv the most slanting fibers, which bridge over from four to si.\ s])inous ]»roces.ses; the mullifulus, tiie middle layer, has fa.sciculi which pass over two or three vertel)ral s])ines; and the rolatorcs, forming the dec])csl la\er, either extend o\er only one spinous process (ro/dlon-s loiii^i) or j)ass to the next succeeding \ertel)ra {rotalnrcs hrrvi). With the exception of ihe semispinaiis capitis, ail of tlie fil)ers of the transversospinalis end at the spinous process of the axis. The semispinaiis is absent in the lumbar region, and the rotatores are situated chielly in the thoracic region. The semispinaiis (Figs. ^Vd ^41- and 242) consists of the snnispiiuilis dorsi, semispinaiis irn-iemi>pinalis capitis. The .••' mispiiialis iiipilis i Figs. 2,;(), 241 , and 2421 is a llat but rather thick muscle and is tlie slnumest must le ni the neck. .\- a rule, it consists of two |iorlions which are se]iarated below but adherent abo\e ai iheir in-t rn'on a slnmger external or .'•emis;)inal i)ortion and a weaker internal or spinal ]iorli"ii. The -emi^pinal segment, sometimes termed the fcm/J/cv;*.?, arises by numerous short tendinous --lips from the transverse jirocessesof the third cervical to the fifth or sixth thoracic \trtebra', whilt the s])inal segment arises from the spinous ])ro( esses of the lower cerxical and of the ui>per iliorai ic vertebra- (lite spinalis capitis -. This latter portion is characterized by a tendin- i)us inscriptimi. ami hence is >umetimes termed the Idvcntir tcrvitis, aiitl sometii..es, when the spinalis lapilis ;- ab-.eni, its origin extends to the transverse processes of the second to the sixth ier\ical \'enebv,i . The external portion of th" muscle also usually jiossesses a broad tendinous in^iriptini wIikIi i- situated ab(i\e tile middle trndim of ;he liiventer. Both portions ol the musile unite and pass to the nucha! surfai c of the oci ipital bone, where they insert between the siiperioi .iinl inferior nuch.il liius. The multifidus ■ Fig>. J41 and 242! consists of the miillijidiis lnml>onim, dorsi, and (cniiis, but tlicM- ^egmenl> (.iniiot be clearly (lemartated from each other. It commences below at the :io-.!t'rior -iurface of tb.e .-aerutn and. ii/rniitiiiles .;dio\r .'it the siiinous iirocess ot the eiiistrophelis laxisi. It i- >trongt>t in the lumliar region, where it lies direitl\ beneath the longissimu-^; it is weakest in llif thoracic region, where it i< cuxcred by the semi>pinali-. dorsi; and in the cervical Ttansversus itnrhac Spknitis aipi'is Splenias capitis x Splenius rervicL -cngisiimus capitis L'ngir.'imus cervicis lUocostalis cen'ids Semispinalis dorsi et rervicis Sicr-iocU-ido- maitoid SiHrmiif cirvicis ^ ilioro;. talis cenicis [■if:. 2tl. 'i^xt i ' I THE MUSCLKS OF TH . BACK. 153 region i. is partly concealed bv the semispinalis cervicis, to the outer si.le of which it i^ cu\ ere,l hy lue semispinalis'capitis. In the lumbar region the greater portion of its libers arise from the a. ces- sorv and mammillarv processes, in the thoracic region from the transverse processes, and m the cervical region from the articular ],rocesses of the four lower cervical vertebne. The fasciculi are interm'ixe.l with tendinous libers anitii! bone (misi!i:r firrlian) Alias Epistropbeui Jn!crtrnvsv di-'.ingui throu-hout^ the entire -,!,!!vd rolumn. h'.'.t :ire ehiellv dewloiied in the thoraiic feL'ion. The rohUons hnvfs (Fig. ? |oi are almost horizontal and j.ass from the transverse i^rocess of one vertebra to tlie root of the -pinou- procos of tlie vertebra next above; tiie roluUms loiti^i (Fig. 240) extend over one or ^(.metimes ;!^; ^xM'^^'MW'^W ■^'' 1 54 ATLAS AND TKXTBOOK OF HIMAX ANATOMY. M1ii' «M two vcrtcbrie before inserting into the roots of the s])inous processes, iheir fibers having a course parallel to that of the multifidus. All of tin- lonf" muiiU'S of tho l>,uk :irc supplii'il l>y the posU-rior illvisions of iln- -ipin:!! lUTvis (nTvical, Ihorack, lumbar, and sairal'. ""he niajorily of tin- lonp muscics of ihi- h... k have ilic sami.' funrtioiT^, If the nnis(li< of llu- twr) si'K-s ai 1 fojrithir. till V liolil ihi' trunk utirif»ht. extend the vertiliral i olumn and ihe head, and liend Ihr head and vcrti-bral column bai k- ward. During nnilaieral aili i.ipiii-; «lirn ihey act loKether, they |iull the head backward, but whin thiy act sinf-iy they rot„'r the head so that the fan- i- |,'in:di s and inti-rtransversaril. atlas. The first f;rouj) is rom])0.=ed of two further subdivisions: the inhrspiiuilcs, bt.-tween the spinous proees,ses of the vertebras and the inlirlrausvirsarii, between the trans\er>e ])roces.ses. The second oroui) is also desifjnated as the short muscles of the neck. The interspinales ! Ki.ys. 241, 24,^ and 2441 are -mall mu.sdes which are well developed only in the cervical refj;ion and may be entirely wantint; throui^hout the thoracic \(Ttel)rMl column. They are connected with the interspinous lif^aments and jiass from the spinous jjrocess of one TITK MT'SCI.I.S OK Till: HACK. I^; vertebra to that of the next lower one, and in the bifid s])inous proeesses of the eerviral vertebne they form paired j-truetuns. Like the majority of liie museles of ihc Ijaek, liuy do not im^,-.' beyond the s])inous process of the epistropheus (axis). The intertransversarii (Im,i;s. 24,^ and 244) are small, short, |)aired muscii's whieh eomurl the transverse processes of nei.uhborin.H vertelira'. Thiy arr doubk- uiion bolh sidrs and are well developed both in the eervical and in the lumbar verlrliral eoliimn. Tluy may \ic entirely abst'nt from die thorai i( column. In the cer\ical reijion inlrrtriinsvrrsiirii niilirinris and pn^lcrioris 1 l''ii_r. 2|,;i, \\lii(h run l>e!-.veen ihe anlcior and po.-tiTior tubercles of du- trans, crsc proc c ssi -, arc dillcrenlialed. Both muscles are .d)o,it L.|uallv developed: the anterior ones are situated in the anterior cervical rather than in the luichal reijion. The intertransversarii of the lumbar rcL'ion are (onijioscd of the wider and stronger inhr trniisvirsiirii lalcrulis. runnini; between tin- transverse pronsses, ,ind the narrower and weaker intertransversarii medialcs, whieh extend between the accessory and mammillary processes (Fii;. 244I. A- rl■l;,lrcl^ llirir fumti'.n ami innrrvali'in, tin- imrr^i'i!..il.^ and tlu intrrlran,\irsarii re-inililr the I"";' niu>cle of ihf li.il k. THE SHORT MUSCLES OF THE NECK. The short muscles of the neck T''i,^-. J 41 and 2y)\ arc' the reeliis eafiilis pif^Urior majur. the rcetiis capitis poslirior minor, \\\v rcc/n ■ mpitis iaiiralis. \W uhliiptiis lapiiis \ii p< rior. mm\ tlie obliqiius capitis injeriar. The rectus capitis posterior major Fii;. 2 in arises l,y a short tin. Inn fmni iln -pinous proeessof the axis, runs ujiward and outward, becinninu' muc h i)idader. and inserts iiu" the middle ]>c)rtion of the inferior nuchal line of the occijiital bone. '"'he rectus capitis posterior minor I'i;.^'. 2111 is i<)nsideral)ly weaker than ilu' major. It is a small trian.^ular muscle wliiih arise- liy a shoit Icaidon from tin- iiosU-rior tubercle of the atlas to the inncT side of and partlv bc-neatli the lectus major. It runs to liu inner third of the interior nuchal line- of the occipital bone. 'I ne rectus capitis lateralis ^ I-'ii,'. 251)1 arises from the fansv.rse proce>- of the atke- and inserts into the jui;ular process o! the' occipital bone. It rep. -calls the' uppermosi intertrans \ersarius. The obliqUUS capitis superior ii''i,Lr. -l'' ^'bo arises from ihc' ir.illsverse process of the atlas, and runs to the outer third of the inl'erior nuciial line- of the oiciiiiial bone , where its |, ndin- ous insenion jiarllv covers the rectus capitis posterior major. The obliquus capitis inferior 1 Mi;. 241 1 is a rather >,tronL; ,d lleshy niusi k which runs from the spinous process of the epistropheus (axisi to the Iran- -e process ol the atlas. It is thick in the n'iddle and becomes narrower toward its ori.Ljin and insertion. Till- -hurl iiui-i ii-s of tiir ni'i k an- Mi|i|iiini ii> liu |"i-.|, n..i ihvi-i..r. ..T ir.. lir-i .i rvi, ,<: nt rvr : .■.;;■.•: • :; ;:a: nrrvr;. The funiti. ■-. of the -linn inu-. Ir- of the no I, pr.u li. allv .nTi-i-,is of ,i rotation or ,-\i,iisi.,n .., ihr hi ail. .lipi ii.l.nt upon whetlliT thrv ail u|«in ..nr or l„iil\ Mil,-,, ■fhe rr. lei- neiiior . an onK ,AI.-ral ih. li. .i.l aM.linv^ iiiov. nu nl i , the rc-rliis latiTali- ini line- the h, ,i.! lo one -i.lr. ih. olileiiiu- iiif.-rior and tlu- nuu- major roia;, tin- lioail in \\-' -amr (lireition and are- iippused l)> the oliluiuu- -upiri or. W\ I 156 ATLAS AND TF.XTHOOK OF HIMAX ANATOMY. Fig -'4S --Suiicrfu-ial and second lavcrs of the abdominal and i)cctoral muscles seen from in front. C^ii thi' rii;hl tide thu pctonilis major ami ihc ..l.li.nuis alKli.iiiinis i-xUrnus have been rcnic.v.-d. IVlw.-.n llir rr,tiKr maj-r an.l llu- ol,li,|.m. .apiiis suiKTlnr an.l inferior is Miualt-.l a >mall Irianglc (the ,„b,„,ipilul iri.nii^lc) in whi, h i. >a|...^.-.1 i1h- |,..,l.n..r an li uf ihe alia-, . tosm.I by the vtru-brul artery. THE FASa^E OF THE BACK. In the dorsal r.-.irion there are liul two fa.siix worthy ol note, the- lumbodorsal j,!sri,i and l!ie nuchal i .-u|ienii ially situated in the hack and form- the ai.oneiirosis of the latissinnis and tlu'serratiisiioslerior inferior, and 1 lie anterior or dee;> layer, which i- (l\elo]ied only in the lumbar region, w lure the lon.n muscles of the hack are included between the two laver,-. •I'lu' posUrior l.ivr 1 Fi.u's. j^() and .\vS) co\er> the sacro.spinalis from behind and < Mends alM)\e thi' U]iiierm<>sl ]iorlion of the lali-imus to the inferior marj;in ><\ ilic aponeuro-i- ol the -erratus jio-tiTior sujierior. .\|iliou,i.;h the fa-i ia becomes .on^iderably lliiiini r alliv n cia-c - to be the apoiuupwi- .,f the lalissimus, il u -ually ,-till contains distintl tendinous slip.s. In the thorac ic re::i"u ihe po-lerior layer i> atla< hed laterally to the an!;les of the ribs, and i- covered by the tra]ie/ius and by till rhomUiidii. •Idle aiU.r'wr layr VvA- -'.ij' run- from the inn.T lip of the .rest of !h( ilium !o ihe twelfth rib, .m 1 i- altache.l internally lo ih, iran-\erse i-r.Mr-se- of the lamb.ir \irtel)ra-. li- upper niar;.'i.i form- ,1 lu-mer lendinuus band v.iii.h pa--e- front the tran-ver-e pn»,— of the hr-t lumbar \erlehra to the twelfth rib and i- known a- the hinih,>a>:i.il uxl.nuil <,nii,il,> //,t,w;»c)i/ I Kiu. -'51 1. 'Hie anterior layer i- -ilualed betwt tn the -ac rosi)inali- md the (|uadr,uu- lutnborum, an-l at the outer niaroin i<\ the sai rosjiinali- ilu' two l.ivers unite .md ;;ive ori^'in lo several of the aUlominal mu-i K-, 'I'he ihln nuchal fascia i- -iluaU'd bene.nh ih.' impe/ius and .d-o pa.rlly b.nealh the rliom lK)i,|,i. It i- ible ini.i nv. |...rti..n..: , , 1 ih. .l.>i.al irunlv nm^Huialur, , ,1, tixe.l In.n, ilu- ,|.M-..i i...ru..n- ■■f ihe inyMtn. . .....I -u|.plie.l b;. the .lor-al ■ p -u ii,.n bran, he- ..f tlie -puial tierxe , .in.l i .• i lb. v.niral Iruiik nui- iii.eu.. , .lei. I..pi "ill b. ...ii-ei- i.'l Lit.-- in ...n lli.!i..n iMIh Ihi ..Itl. r Mill- l.» "t lili ir ur..!!].- .-,, (,,r .1- ih.- ini.- .I..1 -..1 imi-. ul.iiure i- . -.ni .rne.l. . - .n!parativ.-anal..Mn ha- -h..vi n thai il i-. ..inp..-i-.l ..f i • .. p.ir.ill. 1 ljr.„ip« ..i nm-.l,-, ., I.u. i.il ..n.. «hi.h ...n-i-N of nui-, I.- priniarilv pa^^ing fr...ii Ih. lei.wv.rM pr...e-e.< i.. Ihi- rib-, .111.1 h, n. . i- l.rn.i.l Ih. /r.,u.rrr.... ..-/.,/ ,vr,.,./.. an.l a ni..r. Mi..li.iii ..ne, uh..-. niu,. 1. . j.a-- fr..ni the Iraii^-v. rM !•. ih.- Crfmasifr..^ Reflectfd inguinal lig. Intrrcrural fihm ' Subcutantoiib inguinal ring. ^permstif CCd ) 11 Huperior pillar, tundiform lig- of prm's Fig. 245. Infnior piltur. i-^L ,j if _.-.\-J;_ XriK ABDOMINAL MUSCI.KS. ^57 as IKCM UTmo.1 Uu- lr.nn:rrso..f,iw,l Er.mp. Tlu- .onsliluiion ..i ilw two gr.mp-, i. ■>> spinous processes, and wliiih li follows: 1 ..I ■ Transvers..-.oslal;-^^^m»p/.^///,^■, /V/W«M/n. /."^w>.,m.^<, an.l 5/./<-",».<- and obliqmis cupitis iiijfri,n of ..ostcrioralxlominal wall, an.l cxt.n.l from .hc low.r mar,,in of ih. thorax ,.. llu. u,,pc.r ma-^m ■ ,dvis Thc.v aro sul..livi.U.o, include the ohlu^uu^ r.Urnus. ,he .W^"'- aMomwis i„lrnn,s, an.l th.. Inwsv.rsn. Mominis; thev are arran,.d m thne avers an. IL the lateral an.l a porti..n of the anterior alnL-nunal .all. Acconhn, ,0 .h.. ,re. ,.on . f the.r hber., the two ol.li.|ue muscles may Ix' r.uar.le.l as th.. .lirect .-ontnnKU.on. ol the inhr cstales, the obli.iuus interna, in particular, heiuK .lirectly .onuntun,. .ith the lou.r mter..Mal """' The obliquus abdominis extemus < Ki^s. . ^.i" ^ to) is a broa.l Hat nmsck which i. a,,..neu roti. anteriorlv an.l n.arke.lly .> in its anterior inferior p.,r,ion. I, )^ situa.e.l u, the la.end IKr.oral. the hyp-K h.,n.lriac, ih ■pii^a.stri., the meM.p.Mric .lateral .dKlonunal an.l umh.h.aL, an.l the hviK)ua>tri. I inguinal an.' pubic) re.ui.)n-. U arises l.v ei.ht llcshv serr 1 .ns from ,h. . i.h, .f.fth „. lu.lf.h) low. r rd. Uu- upp.r hu- .,n-a,ions inlenli.ilalin^ uhh tlu .w. r on. s „f the M.rra;us ant.rior, .he l..u.r three wth th..se ,„■ ,lK. latissintus .l.nsi. The mai..ri,y ..f .he lib. -. of .he musd. , like those ol .In umMvostales ..Mcrni. .-un from above .l.nvnwar.' Mi.l fn.n, uid,..u, inwar.l; ih.- sup.iMM- 1,1k rs, ho^.x.r, ,,as> M.m.A...al h.H-i/,nntahv, uhile the ,. feri.M- ...us app.-..a. h a veru. al .Inv. ...m. Tlu. hb.r, ...nin.. In>m the ower ribs Iunc an .vt.n.ne ll.shy .nMnnn, ,n,.. .lu .uU. r ,;„ „r ,h,^ ,n~l of th.. ilium, eMen.li.tK an.eri..rh ... .!>.■ ar,., ri..r su,..ri..r ^.n,. and p..s.ei-,n,U Jnt..s. ... .lu -..r nK>r,in of the bussinu.s .lor^i. Tlu ...main.l. r .,f .h. nw r.,on ,s ap..n..,r..ti. ,n,l ,,,.... ,„ ,he ,nuui,tal ,|-..upan's, liKam.nl, .he U-valer p.,.-.ion ..I wh,. h ,~ lorm.. bs th. ^,,,,in..us fasu.uh of ,lu. n,us.le .sc.. pa,e ,(.,.. an.l .0 .h.. :o,„ , mr laxer „. m, sh.a.h oMh. rectus, bv m. an, of . hu h ,, is . ..nnnu..! m .h. Inu ,. ..Iba. \lmo-. .lu ■ n.n-. an-eruu- ab. .m.nal surface is . ..n...,uen,ly ap..neur.,.i. . esp.. iallv in .lu lou> r ab,i..nunal r..,i..n .h.. mus. le hlH.s i.mimeiue .luit.' at ih.. sidi.. , , ■ , s .... ,.. , 1 ,..;,.: ......_ ;. , . ,-..l,i;,», Mii.rri.irh v.i.h .lu ilKlomiiud p.H-li.>n ol ,lH. ,.ec...r,dis mai,.r, .Memallv wi.h the s. rralus anteru.r, p..s.en. eM.rnally u„h .h. la.,ssM„us ,i„r'i. vsi.h uhi.h' i. f.mns the hnubar >I'elil's) triangle (see page i^V- ami mteru.rly u.lh -c X58 ATLAS AND TEXT-BOOK OF HU.MAN ANATOMY. Flc. 247. — The su[)crficial lavtr of the aluJomiiuil musilcs and llic serrutus anlcior >ci.'n from the left Till' pirtorali.^ iiKijrri,ir i-illar Sttht itl'iiii-owi int^uiiiiil lil]iriiir piliir [iitl^uithl I .XiUrrior stt furrier sffitic vj ilium hi^uhml /ii^'int' nf .Icil'thulum V Symphysis pubis I ti;. : t" -Iii.iKr.iiii .f ihi- >ul« ul.mii'ii^ inguinal riiip. On tlte rinlil only ,1 |Kirllun m' ihi- .i|Hini-urci-is nf ihr olilirjuurt .ilMliiMiinis is riprrsented. ihrrc is t'orni((l a iriangK', the outer angle of \\liich i-; direcled upward and outward, ami which ((>n>tiluiis tile siihi uliiiuotis iiif^uituil {iwlirnal abdominal] rim^ (l''ig>. 245 and ?4'>). 'I'he margins of tiic ring arc formed by the ajioneurosis of the obli(|uiis abdoiuinis externus, and are known a-, llu sii f'triar (riis or pillar and the nijtrwr trus or pillar ol ihc ring. The upper and outer angle of lhi> ..iangular >lit in the apoiuunois of the external obli(|ue muscle is rounded off by lilxrs which arise from the region of the inguinal ligament and arc ^^v^V', .w-f-i^-^^^J' Clavicle .< Omohyoid Scnleniis medius Sternohyoid + Sternothyreoid Scalenus anterior - Pectoralis minor Pedoralis major/ Fig. 247. ill : it .V^:\.^;-,^!„^:v,Vv^' ^-V ..: :r>:P^ jYM^m Hi -L ^f^lgj^g^.. ... .., :W-^^m^ . :^;-C'',.;y;:i!f«r.i.w> »/ Afioiiniriisis I'J ((inlcrior layer) ohliquus ,ihdomiin\ rxirrinis ohliquus .ilxtomim^ inleriius 1 (IHiquiia \ rxlrnius I } nilcrni'S I r |ili.it;r.un- niatii !. Sliciiili «j rriiuf .ihliiminh [anterior layi-r) A/MinruriiuK nj dliliijiiu^ .iMomiiih iiiirriui^ Apont'uriisii; oj obliijuus aMi'iriiins fxlrrntfi '. I >lHi(jlllt.S ti!fir:nts / r,nn- I'll;. 24'). 'I'raii-vc r-r M dion of ilu' aiitiiicir Ml"l'>min.il w.ill miilw.iy 1h Iw.-i n tin- iimhilii lis ami llu- -Mti|ili\ -i^ pulii-. iliape. It is tile antirior extremity of a laiiat, the inguinal (anal, whidi passes obli(|uely thnnigli the abdominal walls, and transmits the spermatie eord in the niaii , and the round ligament ol the uterus in the female. ' i| il-nr a mnrr ilii.iili'H .-iiTount of ihi' inguiniil < anal tin rcadir i.. nfirnil to ti\i lioneurotie muscle which is completely covered hv \hv obli ■ T'ig. 2^01, in su< h a manner that the uppermost libers coming from the ribs alnio-t apprtnuh rath other in the median line, the middle ones become aponiurotii at ((uite a dislantc from thi- loialioii. and the inferior fasiitiili rtmain muscular for a somewhat greater distance. The upper uvo thirds of iht aponeuro-is of the trans\ersus, tog.ther witli that of ilu inlernus, form the ])ostirior layt r heath of \hv rulu- (Fig. 2,48); the lower third together with the aixineuroses of the obliiiuus internus and externus, forms the anterior l:;vcr of the ^heatb (Fig, ?]■■}''■. i External intercostal ligts. Obliquui abdominis intfrnus :■: Cremaster Interrostale- iiiterni Sirratus anterior Internstales externi Oblitfiiiis abdo- minis externus x Cremaster m FifT. 250. Is \ ^ THK AIJDOMINAI, MISCI.KS. I6l THE STRAIGHT ABDOMINAL MUSCLE. RECTUS ABDOMINIS. The rectus abdominis (Fi^s. 248 to 250) is a tlat, broad, and rather thick mu?clc. It arises (Fij,'. 250) l):-oadlv by Hat imis< uiar serrations from the cartila.tres of the tlflli l.i the seventh ribs and from the xiphoid imx-ess, and its libers ]iass almost vertieally downward iu>t to eidier side of the median Sine. The muscle becomes somewhat narrower as it descends .md is inserted by a much narrower tendon into the ujjper border of the i>ubis between the pubic luliercle and the symphysis, a portion of the tendinous fasciculi of the muscles of the two >ides inlerlacinu m front of the ptibic syn-'physis. The rectus is '-haiacteri/.ed by possessing several narrow, transverse, sli.i;htly curve inler>e( lions the muscle i- a llurenl to the anterior laver of its .-.heath. Instead of beinj^ surrounded be fascia, the re( tus is inclosed by the aponeurotic layers of its sheath (Fi-^s. 245, 247 to 2;oi, which loiisists of an anterior and a poslcTior la\cr. Only the anterior layer covers the mu.scle throu.-jhout: the posterior layer forms a sheath for only the ui)i)er two-thirds of the muscle (Fifis. 24S and 24(1). .\t the juncti the posterior layer of the rectus sheath abru])tly ceas' in the shape of a slightly curved line', the semieireular line {line oj Ihiii^las) ( Vvj,. 250), and below this line, the muscle is in immediate relaticm jiosleriorly with the transversidis fascia (see page i(),^). The layers of the sheath are formed from the Hat abdominal muscli's (Figs. 24S and 240 1 in such a way that the ajKmeurosis of the obliquus internus splits into two layers in the upi)er two- thirds of :he sheath, one of which forms the anterior layer and the other the jio^icrior; in the- lower third of the rectus, h;iwever, the aponeurosis of the ol)lic|uus internus forniN only the anterior layer. The ai)oneurosis of the oblicpius externus ji.-i.ssc^s into the anterior layer; the upjier two thirds of that of the transversus goes to the posterior layer, and the lower third to the anterior layer. M the inner margin of the rectus the two layers of the sheath unite with eac h other and with the corresiicmding lavers of the opjjosilc side u> form a thick tendinous strip, the ///;'(( supjihcd by the cNternal spermatic nerve (the genital branch of the genitoi rural nerve). When all the aiUi rior abdominal muscles ad together their function is to diminish the si/e of the alRlominal cavity and to compress the abdominal < .niienis, the inc reased intra-abdominal tension aidins; in the ev.,. uaticm of the contents of the intestine -, of the- uleru>, and p.is>ibly aUo of the urinary bladdc-r. W ith the exception of the transversus abdominis, lhe>e muscles also draw the thorax downward, the rectus directly downward, and the ol.li.|ui, when .acting scjearately, toward the side of the c ontrac tinj; mu^le. Whc-n the thorax is l.sc-d, the anterior abdominal mus, l,s and particularly the rectus, raise' the pi Ivis. THE POSTERIOR ABDOMINAL MUSCLE. The' quadratus lumborum (Fi^s. 251 and -'54) i^ '^ llaik-ned, rather tliirk, and apjiroxi- niatilv (luadrilak'ral muscle which forms a jiortion of the ])<)sterior abduniiiial wall. It extends Thordck vrriihrd .\ 1 1 Lumbar verttbra I ;i;timcnt T: -tilh rib Lumbar vertebra V Iliitlumbar il^-iiiu'U Fig. 251. — The ipi.iclratus lumborum seen from the sicle anci somewhat from behind idi.iRran:matir). between the (rest of the ilium and the iwelflii rib, and consists of two incompleK-ly sepanited layers, a posterior and an anterior. The [x'slrrior portion 1 Fig. 251 ) arises by ajKjneiirotic libers from THE ABDOMTNAI. MrSCI.I S. thi' jiustv-rior ]);irt of llu- intu r lip of tlu' crc-t of ihi' ilium and from tlu' .liolumhai ' i;amfnl anil ;; . lo ihu inner half of thi' lower bonier oi ihc tui'lfth rib and lo Ik trans-ersc procoM-- of the iij)]ier four lumbar \i'rtebra'. The diUcrior portion of the muMli arise-- from tlu' transverse proeesses of the loWiT and middle lumbar wrtebra', tlie fibiT^ iiilimali l_\' iii' ilacint; with ihnse of the ])()sterior portion, and inserts into ihe lrans\erse proeess nl ilu' fir-t lumbar \ ' rtebra and into the inner lialf of the last rib. The inner half of the <|uadratus kmiboriim is pLiced beneath (po^iirior '.■ ■ ihe p~oas major, and it is situated in front of tin anterior layer of the lumbodorsal fas( ia. « hi. h sejiarales i' from the sacrospinalis. The lateral limiboeostal anh leMi rnal annate liu'ameni of the diaphragm bridges over the insertion of I'le musele into the twilfili rib. To the outer sidi of ihe mu^i le then is visible ; he aponeurotie origin of the transvi-rsus abdominis from the i'.inibodorsal fa^iia, and at the crest of the ilium it bo ' : on the iliaeus. n Tlir >!U.i(lratus lu?iil«iruni is sup]ilic'il liv musi ul:ir liranc tic< from tin' lumbar plrNu^. It ilraw-. '1:. la-i ril- Inwn- ward ant! iK-nii.s llio vrlihral mlunui Imvaril tin- ^iilc. THE ABDOMINAL FASCIA. The superlk'ial layer of the llat abdominal museles is rovi-red only by iht- i^ciurdl siipfr:u i,il ja.scid (Fips. 248 and 240), which i>, however, well de\elo])i(l iii the lower portion .4' the abdomen in the refjion of the subcutaneous inguinal rinf^, where it forms what is known as Srarpii's jasrio. From this situation it extends downward upon the thigh and also envelops tin- spermatii cord as the cnmaslerk jascid. The sheath of the rectus musele serves as its I'asc ia. The inner surface of the alxlominal musculature, i.e., tlie inner ^urfaie of the transxersus alxlominis and the posterior surface of the jiosterior layer of the sheath of the rectus, i- lined by the Ininsvirsalis lusciu, which also covers the anterior surface of the ([uadratus limi)M)nini :in broader alnne than below the umbilicus and, at the umbilicus iuelf, ii i- adhh. ahao.ina. v,s..ra have bec-n removed; the thorax has been bent back.ani so that the lumbar vertebne are stronnly convex forward. I|! ligament, the lanuu.r li,a,nn,t (Gimbernars ligament) (Figs. 212 and 21,,) which is also con- n ccd w'ith radiating f.hcrs of the fascia of the thigh ,sec page 2,.). The n//.. <t only to the Hat alxlominal muscles, but U also lurnishl attachment to the fascix of the alxlomen and thigh (see page 231), and the deeper layers of the integument are also adherent to it. rrh> ventral ,,or.io,. of ,he trunk mvotonu. during their development undergo a eo-^uWrable -'"""' "f'";'- 1 '"> \wiii.ii I ..i. „,,,,,,,ni.. 1 i>..rtiiin < 1 ut off whieh eomes to lif ventral to ,,,n-iitute uhal i> known as ih.' oblique group of nuisdi's. •n„. alHlominal mvw. le< aie r, 1. rable to thoe group-^ as follows: UyiKiskelelal; /N.'./< '«.',/'"• and pso.is mi. ObUMue ,,o„u,ns. and ,u„^r.U.s ^ ';:;: ,,.. ,.„,,.„U. ,ha, ,he ..,W.„nv.M„n, /.,..„/,•. „, ,he luml. .ion are pro,.rlv referable to th.- obli,,ue t;roiip -V.i>,| THE DIAPHRAGM. •Ihe ,naphra„n .Fig. 2,2^ is :. singl. independent muscle, whit^ from a ,opognt,Oncal .tandpt.int. is IkM ...nsi.lered with the abdnnnn.tl muscles. l,s shape .l.lTers from ,ha. o a 1 he . Ir skele al ntusdes. in iha. i, is a ,hin and n,arkedly donw sitaped musde, u u h ,s stretched , OS. the infeiior ape,U,n of the thor^.x in sut h a wav tha, i. is convex t.nvanl he horax an. ;;;,,,.. ,„.,,d Ihe Ul-men. I, tonsi-.s of a .tniral tendintnis portion, the ,nUr.l inulou, and of a I ierii)herial muscular portion. . • • . .1., •Itc mustular fas.i.tdi of ,lu. diaphragm are s,i!.,!ivi.le.l according .0 the.r or.gm m.o thret^ ,,.r.. .l.i.h are .lesi.nate.l the s„nuH portu.u .he a.,ol porUo,,. and the lu,nhar parUon and o. llHM the lumbar ,K,rtion is the strong. M an.l tlte st. rnal p..r.ion by far the weakest. I he IdnTs „f ail three iH,rli..ns are inserted into the margins. d- Ihe Mtttral tendon. T,,, Lu,l poruon .Figs. 252 an.l 2.3) arises fn-n the ,K,s,en..r surfa... .,. the Mph.„.l -.rocess an.l ...nsisis .d' but a few slender fasticuli. . . , ■ ■n,. „..M/ por,i Figs. 2,^ an.l 2,,,) arise, by br.,a.l tUshv serrat,..ns fr.-m the mner s r. ace ' ' , .. .• ! ,-•. 1 if.V. rllvu lu inn :iUi. atta.hed to liie ,,f Ihi >i\ low(r..>staiiariiiagesarid iromtneeie-.viiin.jTiM - ■ ,umlK.c..stal liganunt in this situati.m. interdigita.ing wi.it the tran.sversus alKl..nun.s and w.th ansvt r.,s th.,nu i. f..il.nving the curvature ..f tlu .iome of the tiiaphragm and passing ...the U 1 ,en.lon. Tlu hbers of this .K.rl.on. alth.-ugh weaker than those of .he lumbar portion. L^S^:<^\: Opening for the vena ca ^^ Otsonhageal opening Oesophagus ^ Internal liimbo- costal arch External lumho- roslal arch Fig. 25J 1 1^ ■,!f: , « - 1 I i u ■■■ 1 s 1 J t ■■ i I i t ! f THK AHDOMINAI. MI'SCIKS. I^S cover a much larf^cr area and form the main iiortion of the dome of the (Hajihrasim. rutween the individual serrations of origin there are sometimes Unear intervals whieh eoiilaiii no museular tissue. "T^he greater part of llie liimlnir porlioii i Fig. 252) comes from tlie l)o ol th.- himhar vertebrx. " Ujion either side tiiere ay l)e distinguished three crura, or pillars, the rocarlilage to form a i.ointed ar. h with tendinous margins, w ..k h is converted into a short canal l.y the anterior surfaces of the last thoracic and the lirst lumbar vertebra. The opening so formed gives pa>sige to the aorta and i-^ c.m->e«|uently at lir>l almost verticallv ^ wanl in front of the lumbar column, but juM l.efon' their insertion into the central tendon iliev follow tlie curvaluiv of the diai.hragm, and in thi> situation they inclose a sc.nd opening in the diaphragm, which is elliptical, the long axis luing vertically i>lace(l. The margins of the foramen are purely mu-cular and, as it gives passage to the es,,phagus, it is known as the esophageal opening. In its formation there usually occurs a decussation of the libers of the two inner crura. The iiii.lill,' appri>\imated to the miisi ular tissue of tin m. The otiuririiy^i practicalh arise from the luo tendinous hanibocosial an lies, the inlirwil ,.ih1 vxurual lumbon,./,,! „r.lus „/'/•-/;, ^ ,ii li-iu. .'s-M i- a librous lay.r vvlii.h inav be .illi. r n nif..rm .'r sh.ip.d lik.- a ,|o\,r l,al*an.lit-faMi,uli uml.rg.. manifol.l .1.-. iissati.ms, Tlu . ..nv. \ siirfa. .-of llu- ..ntial .,.n,|,,n i- -itu,!!.-.! ani.-riorlv; th. molt- nuirk.il ..m.avitv i- ■ • . .•(! posteri.irlv . In it llu n- mav Ik- i,...gni/.e.l a mi.l.'le almost plane or but sii..hil\ jiri-Miil wh. 11 the ti-nlriil t.-n.l.m i-.\l. nL-. li.w.ir.l lli. M. 01, il (...lUuii 1 If't iti' w m^ l55 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. ivvo domes of the diaphragm, and two Icatlcts which are directed posteriorly. The left leaflet is the smaller and forms the left dome of the diai)hragm; the right is larger and forms the right dome. \\. the base of the right leallet near its iK)sterior margin is situated a large irregular rounded opening, completely within the central tendon, which gius passage to the inferior vena ca-c. and is designated the opniiiii; jor the vcm cava (qiiadrilaleral joramcii). The curvature of the (liai)hragm is not uniform, but there is a middle lower portion and two lateral domes which project mar!;edly toward the thoracic cavity. The right dome is more capa- cious and exten.ls to a hi-her level than the left; its highest point corresponds to the fourth, that of the left to the fifth intercostal si.ace. I'osleriorly the dia].hragm ( the lumbar portion) extends much lower than it iloes anteriorly. Its transverse is considerably larger than its .sagittal diameter. ... r The diai)hragm po.sses.ses a series of foramina and spaces which give passage to vessels or nerves These are: ( : ) The aortic Ppcnhif;, which is only partly formed by the diaphragm: (2) the csophasealopciH,^, purelv muscular and formed entirely by th.^ (liaj.hragm: ^^) the opening jor the vena cava, situated entirely within the ten.iinous j.ortion of the muscle; and (4) the slit like .paces Ix'tween the inner and mi.ldle crura and between the mi.l.Ue and external crura. 1 he later spaces give passage to the vena a/vgos, to the vena hemiazygos, and to the sympa- thetic antl the splanchnic nerves, whic>- an' arrangei.;i'iin'llhial«lMmiiial lavilyisdiminisliid. "(Tlu- .liai.hrasn,. from ll„- .Irv. l„;mH.nlal s.an.l,».inl, LdonRS to tho ..rvi, ,,1 n>UM ulatur.-. th,- m..^, lUar t.ssuf whuh i. .on.ain. l..inK .hriv,-.! from th. fot.rth (an.l to a ..rtain . xt.nt from tlu- third an.l CfthU .-ni, al nnotonus, th,- .-nfr.- :,ru.,un- Ivin^ at „„.■ ,..ri.«l of ,1 ,.v..l,.pn,..nt in th.. .r.vi.al r.-gi.m an-l lat.T nd^ratin^ .l..wnwar.l ,.. ..s final ,«...- ,Ln U ,w,-, „ th. thora. an.! „b.l..m.n. Il.n. ,- it is th,„ it is suppli.-i U th.- phr.-ni. nom-, wht.h ar,s.s from th.. fourth ilhir.l to fif.hl . . rv i. .,1 n.rv... an.l .lon^at- m |,roi»,r.,on a, th.' .li,.|.hr..Km r.ced.s t.,war.l its final ,K.s,t,. n. --Kl. ] THE THORAQC MUSCLES. The muM 1. > of the thorax i Figs. , ^-^, 247. 25,,, an.l 2Mt '>r'' cmposed of two main groups: , , ) Those whi. h arise Ifoin ihc th.-ra. i. skeleton and insert ^ m. llie skeleton of the up].er extrem itv; tlu M- are, ,unse.|Uently. -eally muscles of the extremity . and ..^1 the a.tual muscles of the thoracic wall, whiih are known a- llie intercostales. Th,- first group i> arran-ed in lime layers vhi. h are not exa.tiv superimp.oe.l. The lirst hiyer is formetl by the pr.tnrali^ major, the second bv the pdoralis minor and the suhclavius, and the thinl by the scrraliis aiUrrior. THE THORAaC MUSCLES OF THE UPPER EXTREMITY. The Firit Layer. The Pectorahs Major. The pectoralis major . Fig. 24s' '> a large. Hat, thi. k must le whi. h is situated in th. sternal, inlrulaviMiln. m.immary. axillarv. and inframammarv' regions, its out r iH.nler forming the THK THORACIC MUSCLES. ■ 67 anterior boundary of the axilla. The muscle is ai)i)roximately triangular in shai)e, since its orisin is very extensive and its insertion ([uile limited. It arises by three more or less separated portions, which are designated as ihe tlnvkular, the sternocostal, and the abdomiml portions. The clavicular portion comes from the sternal half of the clavicle, the sternocostal portion from the anterior surface of the manubrium and tlie IxkIv of the sternum, with accessory digitations from the cartilages of the second to the >i\lh or seventh rib, while the alxlominal portion, which is by far the smallest i)orticin of the origin of the muscle, is a tlat bundle which is attached to the lower margin of the sternoiostal portion and arises by an aponeurosis from the anterior layer of the sluath of the rectus alxlominis. Toward its insertion, the ])ectoralis major becomes consideral)ly narrower but corresjiond- inglv thicker. Only the filxTS of the chivicular piortion and the upper libers of the -termuo-ial portion jtursue their original course, the greater number of the lil)ers of the >terno(()stal and alxtominal ])orlions ;)assing from the anterior surface of the muscle toward the posterior surface of the tendon of insertion, m) that an extensive twisting of 'he muscular fasciculi occurs in the outer ;)()rtion of ilie muscle. The .endon is inserted (Fig. 2()()l into the entire lengtli of the greater tubepular (anterior bicipital) ridge of the humerus. It (onsists of a weaker jMisterior a])oneurolic layer and of a stronger anterior layer which becomes tendinous inmiedialely Ix'fore its actual insertion, iiolh layers are adherent Ix'low; the anterior is formed by the davicular and by the ujjper part of the sternocostal jjortion, the lower by tlu bulk of the sternocostal and alxlominal portions. Tendinous fasciculi from the insertion of the pectorali> major not infn'(|Uently bridge over the intertubercular (bicipital) gr(K)\f and jiass to the latis^imu-. Thoe tiber> s'lmetinus contain muscle fibers the miisdr oj iMiii^cr). The two i)eclorales arise from llie anterior >urface of the sternum in -ui h a way that an area is left in the middle of the Umv, narrow above and somewhat broader below, wiiicli tontaiiis no muscular tissue and in which is exposed tile sternal meml)rane. In thi> situation the sternal headof thesleriKHleidoniastoid ( Kig. :?55) (seepage 171) 1 Herders inimeiliateiy upon the pectoraiiv. and at the daviile the origin of the pectoralis is situate. i exailly opposiii- to the davicular head of the sternocleidomastoid. The anterior margin o'" iheddidid usually l)()nlirs immediatdv upon the U])i)er convex margin of the ])ecliirali-- maje, , ;i cDiisiderabie s|ia(f lietween ihi two nnis< its, known at llie ddtoidiOpalonil Iriaiit^li , usually existing only inunidi^ili i\ l)i low the < la\ i( le, and the npliali( vein 1 Fiir. ii)i> usually runs in the groo\c between the two miisi Ks. At its lower margin the pettoralis major is (onlinuous with the aponeurosis oi the .il.iominal muscles dlu' sheath of the redusi, ;rid itsouter margin bordiTs anteriorly iijion tla oblii|ims MlMJoniinis e\ter nus and ])osleriorly upon dli' serratus anterior. Tlutendolio' 'Msertiou is situated between the deltoid U|)on one side and the short hi id of the binjis ,md tlu , nrai obrat hinlis ujion the other, in this situation it is si])arated from the l.itissiiuus by the inierluben ular 'biupii.di groove. An I mhiUiikU iiu ml imisi li . ihi W/um/m, i, i|iiiii' r.m Is luiinil u|iim ihi |in Inr.iii- iii,ii"> ll ni.iy l« I'M-rnl ii|Kiii niir iir Imtli .si(U>. i- i lonKulrd, tiiulinuus ,ii ii~ i \lrrmitii ~. ,inc| is u-.u.illy i ■mim Uc| \miIi Ihr 1. inlmi n( ih. -irrii.i I |i'|ilMni:|.^'..{i| :im! (Iir «lli;lth nt I 111; n rlll« :li well .,» uilll I hi In i Ir.r.lli^ ni.liiir .Uul ll->ll.lllv niili srlMs .1 |||-I|>I .llcll jKirtllin lit llir laUir miisilc. 'Ihr |H( tiiralis iPiijiir is supiilinl liv llir aiiti rior iIkt.k It ihtm - 'I'lim ihrr «iih lln- l.ilissiiiiu», il .uliiii. N llu- .inn, nnil "hen it ails .ili.pr. ll ilra"s ihc arm anii ticirlv iiinl tun.ml I Iir i lirsi ami. al llir sanir liiiu . r..|.iti - il inlriii,i!l\ m I : -!■■ i Is !• i It i68 ATLAS AND TEXT-BOOK OF HUMAX ANATOMY. The Second Layer. The Pectoralis Minor and the Subclavios. Tlu' pectoralis minor (FIk- 24O is a flat trianjiular muscle which is comi.lclcly concealed bv the i-ectoraHs major and, at its insertion, also by tlu- o ai.l in tixiiiK tlu- siajmla. The subclavius (Fi-s. 24; and 26.,) i> a small, elongated, somewhat flattened muscle whi, li ■irises bv a ten.lon from the first costal (artila-e alongside of the costoclavicular ligament, and is 'insene.1 into ih.- umier surfa.e of the' acromial end of the .lavicie iK'tween the two portions ol Ihe c.racociaxicular ligament (see page .20.. In this situation there is usually a shallow groove in the iMine. Tlu nerve ^ui.i.lviMKlh.nu ■ i. ilir Mil., lavian from llu- l.ra, hial i-l.-xus. . „ ■ ,- , Th,. L.. ].■. l.y ii. , ontra, uon, tiw, th.- , lavi. l. in ihc M.-rno. iavi, uiar join,, an,l when .h,- .howM.r «,r.ll.. ,- U..i the iTUi-ili- il. vatf^ till lir-i ril.. •-''• The Third Layer. The Serratus Anterior. The serratus anterior isrmiius „ur^ni,s, (Fig^. 247. -\soi is covere lower portion i, >iuiate.l in the lateral pectoral region an.l. immedi- aielv 1k4ow the i.ectorali- major, i^ covere.l only by the inlegumint and tax .a, the m.,M mfenor poitiop .,f llu' muM K-. howevn-. being pla.ed beneath the anterior margin ol the lan»imus. Tlu' nuiMle i^ Hat thnmghout. irregularly .|ua, the lower live ol which are di-liiu-iv M-aratid and inlerdiuitale with the serrations of the origin of the obliMUUs exter- num alHloniiiiis. In tin- bp>,,,l mu>. le sluet formed h^ ihe uninn t.f the >errations, three pt.r- tions disiin.tiv din.t-en'.iated bv thr .linvlioi. of their libers, may be recognized. 'Ihe libers ,,f the upiKT and Inv.rr pnrliuns eonverg.- mward tln^ inMTlion of the nuiMle. while those ol the middle seumuin i.a^s in tlu s:,n,r .liivcli.-n bal in a diveiging manmr. Thr noper ■ onvergmg ,,,,riion ,Fig. 2-,S, ariM-s as a rather strung inuseular mas, trum the lirst ancapula: the mul.lle .!ix,T..ingi.<,rti,.n is bv far the thinm-st and Nv,-akesi part of ilu' mus.K- an.l it aris,> fr.^m the ,,-, on.l * .1,1,1 Ihinl :il)s and .liv.rg, s marke.liy to b,- inserl.d in-., ih-' .ntire l.-ngth ol the vertebral iH.nl.r of thes.ai,ula; an.l the lov.er cnvenging porti.,,,. which is du- slron.gest part ..ftlie enllfe muMle. arises from tin- fifth t.-lh,' ninth ribs ami i,ass,s 1,, tlie inh-n.,r au'^de .,1 tin m apnia. 1 !,.• fibers „f tin L.wer p.>rti.,n aiv il„- h.ngest an.l those ol tile upjier porli.,n ,,iv ihe short, si. 1 he * I'),,' s, ,..nt passes belund the sub- scapularis as far as the vertebral border of the bone and is separated front th.s muscle by a xery l(H,se onneclive tissue. Throughout its course it fornix the mner Nvall of tlie axtUa. ihoMTrat,Ham.-riurHsiii,,,lhcll,vthrlonKtli"r:,,i, mrvofromth.-l,r.,hi.,l|.U'vu, ::t=i::i;';;;:r;:;:;i::;r";;r;;.;r«=t;r::;,: :f t: - .;...„ levat„r s.apuk-V tlu- serratus .an al., .Uval,- tlu- rih. an,l a, t a. an accessory nni>, Ic ,.[ rc~,„ra.>..n. THE MUSCLES OF THE THORAaC WALLS. The muscles of the thoracic walls are the iutmoslalcs, tlte IruUons cosUnun,. the suhroslah's, and the Iraiisvirsus Ihormis. The intercostales (Figs. 247, 250, 25;,. anetween the bonlersof adjacent ribs; they are ^hort Hat nmscles winch fre- nuentlv contain numerous tcndin.ms tiberx They commence posteri- iv in the region ot the costal tulx'rcles and ex end ant.riorlv as far a^ the ci.sto. hondral articulations, leavmg the spacrs Ix.tween the co>tal cartilages free. In these spaces a,v found tendincn^s slips «h.ch run m ttf same clinrtion as tlte liber> of tlu' intercostales c xterni and extend to the' margnt ol thc^ Mc rmmt; Ihev are called the r.\l,riuil inknn'-lcl li-oimnls di^nmnUa n>rus, ,iiUi,i). ■ The inlrnosl„lrs ;»/,r»/ ( Fi->. 2^0, 25;,, 254I run from alxnv downward and from wuhin out xvard between the l..rder. of adjacent rib>, and they ari.e fron, ihc^ lower l..rd> r ol llu. upper r,b c.f each intercostal ^pacr in -uch a manner that the co-tai groove, i. .i.ualed belwe.'n the two muscular lavers. Thev cross ,he intercostales extern! at right angles an-l arc c-ov.T.-d by ih.^m cxeept in the spaces b,iw.en the' costal cartilages. They . xtc^nd ante riorlv lo \\n- sic rmmi or to ,!,, anterior exlrendli. s of the crlilages of the f.dse- ribs and end posh riorlv a. .I,e costal angles. |„ ,1,, n.'ion of the costal cartilages thev lie behi.ul the. external intercc.slal hgananls and those ncrtions of then occ urring in these situations atv also terntecl the in>,rn,rlihK<'»n. He Iw.c ., the- posterior ex.rcntities of the ribs t!tey arc replaced by tendi.x.us structures win. h are. called the. iiilirihil iiihirv^hil lii'jiiih »/..■. •i'h,. inlrnosl.il.^ rxl.nr are covered almosl throughout their entire. exU'iil by the- ihorac ir . •dnlonunal an.l -lorsal mu^ .pectoralis maje.r an-l minor, serratus anterior, obliquus alHlonunis externus, I'alissimus, s, 'i ,,.,slc.riorcs, rhomUmieii. uilh the excepti. - e.t a sn,all area U.lue..n the irape/.iiis and tlie l.ii.ssimus i|.'ig. 2^S). ^ ^ The levatores COStarum iFig. :\:.>. in>ni cite coiose e,f iheir ii'ncr., ':ele;ng U- t.ie (•-!! ;-';a, inte-rc u .tal nuisclcs. Thev ar,. siluatc-.l :n th.' dorsal thorac ic region imme.liai.iy beside the deeper h.vers of the long muscles of the back, a.e covered by the sucrospinalis (particularly by the V:tl !' ff i II J i t V 170 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fig. 253.— The sternum, sternal ends of the clavicles and the rihs, with the intercostales, and the transversus thoracis, seen from behind. Fig. 254.— The fifth to the twelfth thoracic vertebnu and the vertebral extremities of the corres|)onding ribs, with the intercostales and subcostales, seen from in front. On the left silk- the intercostal ligaments have tx-en remuved. iliocostali.s), and are skeletal gri aps ckc ur in this region. The ilassititalion is 1 onsi'C|Uently as fuhows: M'm in i t ' in. I I M^mmmmsmii^: THE MUSCLES OF THE NECK. 171 Hyposkrlctal : wantir.f;; Rectus: wanting; Oblique- Inlrnoshilesexlerni, intccoslaks bilcrni, uiWosUile^. /r,ji.urrji,< Ihoracis, and lcv,Wm-. ,ml,trii»,. In a.l.liti.,.,, two muscles descrilH-l as t,el«nKinK to the muscles of the hack are prohahlv numl.ers of the thorauc ol)lii|ue Kroup, namely, the sirralus fmslerior supcrwr ami the serralus posterior injcrtor — I'.D.] THE MUSCLES OF THE NECK. The muscles of the neck (Figs. 256 to 259 an.l 2(.7i incKulc the i.latysnip, the sternocleido- mastoi.i, the hvoid muscles, and the deep cervical muscles. The hyoi.l muscles are sulKJivided into the suprahyoid and the infrahyoid ^roap; the dee]) cervical muse U > are comi)osed of an outer group, the scaleni, and of an inner grou]), the ]>revertehral muscles. The platysma im. suhniUimus colli) (Figs. 260 and 20; ) is a thin, tlat, (luadrilaleral muscle which is situated in the sulxutaneous connective tissue in the neck, the upper portion of the chest and the lower j.ortif.n of the face. It arises (Fig. 207) from the fascia over the pectoralis major and the deltoid at the level of the first or second rib, by sej)arate fast iculi which are fres extensively the lateral cervical, the sternocleidomastoid, the carotid, and submaxillary regions, and toward the chin the margins of the two muscles convi r-e and m. > 1 cacli other in the mental region, freciuently interlacing. Some of the fibers of the platysma are attached to the lower i)order of the mandiltle. while the rest pass over the mandible ami ai)i)ear u-pon the face, graflually disai)pearing i)aitly upon the par )tideo- masseteric fascia, and parllv by intermingling with the risorius and triangularis by wnich they reach the angle of the mouth. The [ilatvsma is .ufphe-l I'v the c ^^rinkl.s the skin i.^ ih,- cervi, a! and upper thoracic regions and ... Is upon the angle of the mouth with the facial nmsi k s. H . an also i,» re.ise th. u nsion of ih.- fasi ia iir the fai ial, cervi. .il, an.l th.ira.i. ri'gi.ms. The sternocleidomastoideus (Figs. 2;,S, 25;, 256, 260, and 2(121 is a strong, broad, and thick muscle which is situated in the sternocleidnmastoid region. It arixs Ir. two heads, a strong, thick, tendinou.s, sternal head from tlie anterior surfaie of the manubrium, and a -hort, tendinous, clavicular head fr.im the sternal end of liu- tlavicle. The sternal head |)asses over the sternoclavicular arliculalion and forms a muscular inter- space of varving si/e, the Ir.ssrr sii pnuhivkular jnssd, by uniting with the clavicular licid. It becomes much wider as it iiasses ujiwanl to a»i-t in fnrming the tiiick belly ol the nniscle and ]iartly conceals l!ie (la\icular portion. The sternoclei.i.. mastoid is inserted into the outer surlaie of the mastoid process of the tern ]>oral bone and into the outer half of the superior nuchal line , the anterior [Kirtion of the insertion being c tlected by a sh.irt, the jiosierior iioriie:, by a long leiuion. The musck passes obli(|uely throug me neck from below upward and from within outward. At its insertion it borders upon the trapezius (see page 145)> with the anterior margin of which V t 172 ATI A'; ANr> T1..XT-1 .OK OF HUMAN ANATOMY. Fig. 255.— Sufc rficial i . < r < f the musde> of the neck, seen from in front. On Ihi- riKht si.ii- ihe stc-r-.uhyoid- n-i • .i . 1 x <)/ tH. iliKiiMri. , and llir -submaxillary glan.l hav. ln'cn nmovid. Fig. 25().— Superficial layer m ihe muscles of the nc( k, seen from the left side. * =■ Kxtcrnal carotid artiry. it forms a irianijle in which arc siluaud die splenitis capitis, the levator scapiiLc, the scaleni, and the inferior belly of the uniohyoi.i. The anterior man.,'in of the mu.sclc Ijorder- ujio: the infrahyoid muscles, Inninds the carotid fossa (a deep muscui ir inters _.ace c :itainin:. the '.K' 'her Ai'.h Iho trapezius i.^ supplii-il liy t!'- ain-ssory n. rv,. When lK>tli slirn(Kk'i.lnmasti)ids ait tonith.r, Ih. y inglr mu^- lar lik> the rectus, have The group till ludes the slirnoliv'iitltus, the ^Irr}^ •ihyr-o'uhii':., the ihyn; The stemohyoideus Uig^- - - 1. \v^> -.'"• •" which i- -imaled in th. suprasternal, lliyroid, la- (I*'ig. 2;4l from the iiil'.rnal surfan of the lirsl co the manubrium ,.nd llie cai. stile of the slernoclavi- bv the .sternal end of t' ■ i( le anil the stem ujiwanl at a sliglr distai ■;! Jl'c median lii into tile body of the IumkI bone. It not in" inscription. The sternothyreoideu Fiu-. ;,, 25-;, -'^o. origin is similar iiit n.ure duply : l,i d iImi.'. 2- second costal cartilage. T' e lov., r ■rlioii of \; and die sleriKH kidomastoi i, but -- ■ '')' tile sti ])roje(l biyond the Litter muscle, an. its nii.ldlf ai w':- benea''! the ui'per Ik ' . of the < .nioh;, "idelis. ll ir lil\reoiii gi.imi, | las.si - .iniillV U,..'. aiM, s,-. \r,\\\ r.w.y :: betAcen tin two must k s ,,f opposite ■ 'des, ami is inset" canilage. .i''>r additioii .1 details - "Si. he hnologx must ll - is situated a tiorli' of the lar\ n\, ti tiyreoidgla oidciis, and the miioii '^.Si i- a tlat, long, an. eal, subiiyoid, am; eartil; ;e and froni ;r artii n' iiion, ' of lie stern - ii ,;!g somcwhn nar e.xh)i)i a fi- ' "■■ r n.! niuscle ■Su in ""{.ses III- ol .ritiin .is.ses tied tendinous -onii .1U.S( i ■lVometimes luing alx. attache.l to tlv transvers. ligmient It i^ ai first cov.red bv the tiape/iu^ an.l tlu' davi. le an.l ihen IxTomes suimtIu lal m the greater supra, lavi.ular fossa a> it passes t.. the po>tenor margin of llu- M.rnocl. ito..l. us Henealh the latter it f..rms a flat interm..liate tend..n which i^ a.ilierent lo the cerM.al fas. la an.l ,„ the sheath of the great vessels of the neck. The sHf>rrior brily ...innun, . s at ih.' .nterme.liate ten.lon, appears at the anteri..r margin of the slerno. lei.i.Mnast..i.l, partly ...n..ai.d bv ill. M.rno lhyre..i.l an.l il,yre..hyoia 1.v,h,r thvr.-..lnoi,1 r.-,.iv.-. a .(.r. ...1 t.ra.v I. Ir-m (h. -...»■ n.rvs, «hi. 1. a. . ..n,|.anH s ihr l,>l..«l."Hal. Ihr I' i 11 174 ATLAS AND TEXTBOOK OF HUMAN ANATOMY. Fig. 258.— Deep layer of the muscles of the rck, seen from the left side. The anterior Ix'lly of the iliRastric [ the niylohyoirl, thi> stcrnoclcidomastoiil, ami ilit- sternal end of the clavicle have been removed. Fig. 259. — The deep mu'Jes of the neck, seen from in front. On the ri^ht side the longus capitis has U-en drawn outward. The infrahyoid muscles depress the hyoiil Inmi , the stemothvreoiil draws down the larynx, and the thyreohyoid approximates the hvoid Ume to -he larynx. They also act a.s ai cessory musi l<-s of ilcKlutilion, ani(i muscles (Fij>s. 255 to 258) lie between the hyoid bone at-'i 'he mandible. Thev are the ili)^tislricus, the slyloliyoidfus, the myhhyouicus, and the gciiialiyoiihus. The digastricus {bivcntcr mandibula) (Figs. 255, 25b, and 258) is a ty])i(al two-lxllied muscle wit'i a distinct cylindrical intermediate tendon which is attached to the hyoid Ixtne. The two bellies form an obtuse angle, oi)cn above, in which is situated the sui)maxillary s;ilivary };land. The anterior Ix-lly is a fairly thici. muscle which pas.ses from the intermediate tendon, frwiuently rec 'iv inji a fi w tendinous IiIkts directly from the hyoid !)one, to the diga.stric fo.ssa of the mandible, wheic it is inserted by a short tendon. The ^fterior htlly is longer but somewhat weaker than the ai terior one. It arises from the mastoid notch of the tcmi)<)ral Ijone and passers with the stylohyoidiiis to the hyoid region, where it iKfomes continuous with the intermediate tendon. The anterior Ixlly of the digastric lies in the submental and mental regions, Ix'twwn the skin and the mvlohvoid; the posterior iK-lly is omjiletely concealed at its origin by the stemcK leido- mastoid, and further anteriorly it seiuirates the submaxillary region from the carotid fossa. When iIk' hvoid iH.nc i.. fixed, the anti nor 1.1 .'epn-s.M-» the l.iwcT jaw and opens the mcvulh, ih. posterior iM'lly draws the hvoid l»ine bai kw.ird anri upward and. u. net her with the stylohyoiil and the infrahyoiil mus< les. fixes the hyoid Umr The |Histi .-ior In llv is • upplied by the fa< iai nerve, the anterior Ully by tin niyjoliyoii! nerve twin the third division ipf thi' trigeminus. The stylohyoideus iFigs. 2;^, 2;^, atui 2;8) arises by a tendon Irom the styloid process of the temporal Ixine and run^ ;i> the hyoicl txiiie as a tlai rounded muse Ic- aU)\f and almost parallel to the posterior Ik'IIv of the digastric before its insertion into tin lioi-r it almost always divides into two slips, iK-tween which ll;.' intermediate tendon of the diga'^^lric jiasses. These slips have muscular attachments to the base of the greater cornu and ic the posterior extremity of the IhhIv of the hyoid lK)ne. 'lh<' ailion ..f iheniusileis similar to that of the |(osicrior Ully of ihe illgasln. and ii e. aKi. supplied by the fa( iai nerve Hetweeti llie infrahvoid musdc^ .ind ilu- anterior Uirder of the sterniM leiiloinastoid there n mains a liil /m<.i.<, und il i ontains the ((real vessels and nerve of the neck (llie i oitimon i amlid arlerv, the interna! jugular v. in. and the \agus mrvel The lateral wall Ihe mylobyoideus (Figs. 2^6 to 258 and 2f)?) is a (ifculiar broad, llat muscle which is situateii in the submental and submaxillary regions .mil is partly covi red oy the anterior ImIIv of i HI i'i n ■ i It ' 'll . *. H f THE MUSCLES OF THE NECK. 175 the digastric. The two muscles of opposite sides unite in the median line in a slightly tendinous mvlohyoid raphe, and form a muscular layer which extends across the mandibular arch and constitutes the floor of the mouth. Each muscle arises (Fig. 257) hy a short tendon from the mylohyoid line of the mandible, and the majority of the fibers nm ot)iiquely to tlie median raphe, some of them, however, passing to the upper border of the IkkIv of the hyoid bone. Tho musrU' i< supplird hv tin' mvloludid m-rvt' fnmi the thinl division iif thi' trincminus. DuriiiK drglutilion it oli-vatcs itif t-nlirr llixir i-f thi- mouth, togothi-r with tlir tonKUi ; itu- hyoid lionr i^ al^o drawn upward Iiy the filiirs in^rrti> of llie transverse proiisses of the fourlli to the sixth cervical vertebra-, and jtasses downward and forwarii to the lirst rib, becoming narrow ami tendin- ous at its insertion into the scalene tiilunlf. The anttrior surfaie of the must le just alxi\-e the » insertion is provided with an aiioneiirosis. The scalenus medius d'igs, 258 and 251)) is longer and usually strong! r than the anterior, with which it is closely relateii by it- short iiridons of origin. It arises fmm the anterior tuberiles of all of the cervical vertebra' and is situated to the outer side of and ]iartly iKiiealh the scali mis anterior. It is insertid bv a broad short tendon into the outer surface of the first rib alK)Ut a fmgerbreaillh to the outer side of tlu si alenus anterior. Hetweei> the insertions of the scalenus .interior and medius into tin first rib there is a space which gives pass;ige to tl.e sulnlav ian arti ry and to tlie gnater part of tin brat hial plexus. The scalenus posterior (l*ig>. vu aiii -sifi i^ tlie smallesl oi tin- siuKiu, and is ininunily adherent to the medius, from which i| i- di--tingui hable onlv by its separate insertion. It arises fmm the transverse prtrvical vertebra', is situated Ixtween the [ill- H i|! iiN' ' iii % ■ i s 176 ATLAS AND TEXT-BCOK OF HtJMAN ANATOilY. scalenus mcdius and the levator scapula-, and is inserted by a short tendon into the upper border of the second rib. Its insertion is covered by the upper digitations of the serratus anterior. There is occasionallv present a small independent muscular fasciculus situated Ix-tween the scalenus anterior and mwlius. It is known as the scahnus minimus, and is inserted into the f^rst rib and also into the di-me of the pleura. The s.al.ni r.> .iv ,l,oir ncrv..u,,,,ly ,,ar,ly fn,m the ..-rvi...! plexus a„.l partly Che scalenus posteHor, fr.,m small spe. ial t.ran> hes of the brachial plexus. They elevate the tw„ up|.,T r.bs. ii! I ii THE PREVERTEBRAL CERVICAL MUSaES. The muscles of the prevertebral group (Figs. 258 and 250) are situated to the inner side tnd ah.ve the scaleni, from which they are separated by the transverse pnxesses of the cervical vertebra- Thev are the /<;h?«.v colli, the hmi^us capitis, l, ul the rectus capitis uutcrwr. The longus colli ( Fig. 2^.,) is a rather thin Hat muscle which is situate.1 between the cervica viscera and tlv bo a's,,ate, the width t.f the little fmger, in which may be seen the anterior l„ngilu^r an,i o.tcr portion arises by Hat tendinous tligitati.ms fr.m the anterior ,t,l,ercles of the transverse processes ..f the upper tervical vertebra antl is inserte.l into the antenor tubercle of the atlas, this ,.ortion being sometimes termetl the lou^us allantis, and also mlo the l.Klies of the im.lerlvi.ig . . rvit al ^t■rtebra■ in common with the inner segment ot the muscle I he /.v,r"and outer portion ..ises from the lateral surfaces t,f the Uxlies of the-^ upi>er thoracic vertebra- an-i is inserte.l by tiie tt n.iinous slips into the transverse prt.cessc-s of the lower cervical ''' '-riH' longus capitis (rectus capitis anterior major) (Figs. 258 an.l 25.)! is a rather broail Hat muscle the upper p.,nion .,f ^^hi. h is somewhat timkene.i. It lies t.. the outer si.le of the It.ngus colli an.l ...vers its upper ami outer segment, an.l arises by .listinctly separatetl ten.hnous tlig.tations in.m the anterior lulxrcl. s ..f the transverse proces- s .,f the th.nl t.. the sixth eervital urlebrav Fn.m these origins it passes upwanl ami slightly inwar.l, ami is inserted i„l„ the lowtr surfa.e ..f the basilar iK.rtion of the occipital iH.ne. There .s a .l.stnul aponeu- ...,.;. .,....., .1 ,tt.r;,,r tnrf.ur i.f the muscle somewhat al>ove its mifl.lle. The lonuu. ,..lli an.l .he longus , api.., are ,uppli.-l bv N"< i^'l '-""'h- ■•' assin^ hcUvei-n the atlas and the occipiuil bone and is almost entirely concealed by the longus capitis. It arises from the base of the atlas and passes upward and inward behind tb.e insertion of the lon-us ea„.>is. to l)e inserted into the under surface of the basilar process of the occipital l)one. B,>th .he funriion ami ih. inn.-rvalion ..f ihis musclo an- intimat.ly .onn.TU-.l with thoso of th. ,,ro>.-,lmK onrs, THE FASaiE OF THE NECK. In the neck two fasclic mav be distinguished: the rrn'iai! jasria anKio" ^'«."n th. ,u|M,Kra,,hi. al r.-la,i.m> of .1,.. mus. U-s arr far fn,m a«nrinK will, ,h.-ir .l.-v.lnpm.mal rclaliuns, n,anv ..f llu- mu.s, l.s ,lrs.rilH.l al».v.-, su, h a, Uk' plaly.ma, ll,.- ...-rn.K Ui,|o,r ■ ...a.l, a„. all ih. supralnnwl mus, l,s will, tlic fNcoptinn ..f thr Kcninhyoi-I, iKlonRinR U tl.r ■ ranial mus, uialur.- 11., tru.- . ,rv.. al nuis, ks, ,. , , .!>,.„■ (U rived friMii tile eervi, al my,Homes. may l)e i lassifieil as fi>ll,ms: Hyi>,isk,l,lal: lmii;iis inlli. Iiin!;iis ■.J/>///<. and rrr/id ni/>i/n ,inwrwr- Re external auditory meatus. The auricularis superior (attollcns auricuhr) (Fig. 2f)o) is u>ually the strongest portion of the auricularis. It arises broadly from the galea aponeurotica abow the tem])oral region and becomes markedlv narrower as it descends to be inserted by a tendon into the upper margin of the root of the auricle. The auricularis posterior inlraliciis auricula-) (Fig. 264) consists of one or more flat slender fa.M iciili which arise over the' tendon of the sternocleidoma.stoid and are atlac bed to the posterior e.xtiemity of the root of the auricle. The Irnusvirsus nurJio belongs to the auricularis |)osterior. Till' film li- 'IIS of ihf imlividual |Hirti>ns "f tin- Miirii iilaris an' tii movr llif aurii It- in l)n' (liriilioii of ih,- nius. ular MIkts. Thi inri' . ation i< frowi tlu- fai ial lUTvc. THE PROPER MUSCLES OF THE FACE. The remaining muscles of the face pro])er are composed of three groups: the pulpthral musch'S, those surrounding the orbital orifice; the oral musdi.s, those situated about the mouth: and the itasai nnisclcs, those >i!uated upon the nose. THE PALPEBRAJ. MUSCLES. The palpebral musculature forms the orbicularis oculi {palpebrarum) (Figs. 260 and 261 1. This is a flat muscie, situated < hielly in the ori)ital region, which forms a broad ring about the entrance to the orbit, and is comjjosed of three ]iortions, the orhilal, the palpi hral, and the ladiry- mal portion. Onlv the last ]K)rtion possesses a certain degree of independence; tiie orbital and paljvjbral portions ar- directly i cintinuou> with each other. The orbital portion forms the broader external circumference of the mu^cidar ring, and lies U]X)n the margin of the orbit inmiediaii iy beneath the >kin. Its broad fasciculi arisi' from the frcmtal process of the maxilla and the adjacent ]iortion of the frontal l«in. . and pass in a wide curve alK)Ut the ' ntrance of ihr orbit to return almost to their -tarling jioini at the inner canthus. The muscle is connected witii many of its neighbors, i)articularly with the frontalis, and til)ers which radiate into the skin of th< eyebrow constitute what is ti-rmed ilic (orrut^al'tr siipcrrUii (Figs. 262 and 2(>4), while others w hich pass to the cheeks are known as the walar portion ol the muscle. The palpebral portion is the more posterior portion of the muscular ring, and is that jiart of the muscle wiiich is situated within t'ne eyelids. The fibers ol the muscles of Ixnh the ujiper and the lower lid ari-e at the inner canthus from a short hori/onial tendinous band, the inlirual palpebral lifiniiient, and pass as line fasciculi in an arched manner to the outer canthus, where they are partiaiiv inlerlan d and foim die ,\lerndi pdip,hral rapiic. [Vv.r a further dcss nplion ol the relations of the I'iIkts in the eyelid itself, see "Atlas and I'.pitome of Histology," Sobotta Huber.) The laelirymal portion, also known as Horner's musili (Fig. 2(11 ), is a deeply situated portion of the muscle, which is connected with the ]ialiiel>ral portion. It arises from the jiosterior k'c hry- m^ ,^:^- I Hr ilk':' S J ( ' i :M! ^g 1 80 ATI.AS ANI> TKXT-BOOK OF HI MAN ANATOMY. Yu. ^0^.— Tho (Icencr laver the farial mustics , ■ , , The „.a,...u . lalni supcriori:, ;,,„„K,,i. u. ,nL«u,ans, „ Ira.us lahii i.Uri.n. tlu- „an,„.U.o-n,assc.on, fa. M. tho parotid i;l.inii. t a iHirtion of .h.- -^uiHTrii iai layi-r of the li-ni ,|Miral fa~( ia have been renlovcl. Fi( 2()( —The oral musculalurc seen from bchiiul. The mus, le. ,.,KeU,er w„h .h: ime,u.nent, have bee. separaU-l fn,„, .he hones a,vl .h.. mu.nus nu-.^hrane e„ver,n^ the mu^iles ha^ been n muveil. n.al ri.l.'c of Uu- lachrvmal Ix.n. and the fibers i>ass hori.t.ntally acn.s the lachrymal sat to tl. I^ar "nCof the litis, whert : -^ v clecus.ate antl tlisappear ia the fibers t,f the palpebral port.on. < \ more tlelailetl tlest riplion uii! !« f'>uml in the seetitm upon - Fhe K>e. ) The ,.,.u,ans „et„. h.e au ,. the ^^f----;^;:^-;-;:, ^ ::::';:::" z^^i':: r:ntrat,„ .. .he ^.j::::::::::i::^X;::::u^^^^^ -^ the [..rehead -.vrinkle the -km in th. m- legion^. THE ORAL MUSCLES. The nntsdes of the oral regit.n consist of the buahuUor, of the circttlar m.trs situau..! ab.mt the mouth which form the orbicularis oris, t,f the mu.cles t.f the upper hp, o, the njuscles of le : lip, of muscles which are situate.l upon the sUin. and of muscles wh.ch -hate ,m., e anis tlf the mt.uth. The ^reat majority of these muscles are .nfm.tely connectetl ..th each ""''"•rhe quadratus labii superioris me^d.tt intonsiant cyt:.mt,//c /.c,./ ,.v,,.m.//n. ./..n tlK. U At the insertion of the .,ua.lratus labii superioris into the upper hp Us muscular fibers interlate with those of the orbicularis oris. The zygomaticus i,.,om,tirus maior^ (Fig. .<.o) is an elongatetl, rather strong, antl eas.l ist,la,cd mu^le which is shuatetl in the malar, buccal, an.l t.ral regions. t has an in.lepentlent r g in from the malar surface of the malar bt.ne, close besitle the zygomatic hea, of the t.uadrat^ Z^\ superior., an.l rtins to the angle of the mouth, where it fuses with the orbicularis oris and the neiirhl>oring mustles. . , • 1 The risorius or "smiling" muscle (ligs. 360 and .6;) is a thin, approximately triangular mustle of variable tlevelopment which is situate.l chielly in the par.iti.leo-massctenc anc buccal "gimetimes exten.l.ng Cormgator supt'riilii Quadratus \ Angular head labii \ Zygomatic head " superioris \j„fraorbital head Zygomaticus x Quadratus lahii infer. Trapezius 'Spleniiis capitis ill Depressor sepli Inciwus labii superioris Hi ■f* Buccinator Triangularis fig. 203. ill lll !f THE MUSCLES OF THE FACE AM) OF THH SCAM'. l8l upward as far as the zv^oma and covcrinK the radiating: fitxTs of the j)hitysnia in this situation. The lower portion of the mu.seie is eonnetted with the platysma and fre(|uenlly apjiears to he a direet eontinuation of some of the individual fas.ieuli of the latter muscle ( Fij,'. -'(.7 i. It is inserle.l into the laijial musculature at the ang'e of the mouth immediately l.elow the /y-o- maticus major. The triangularis >ntiii;ul,iris hibii injcriorh or ^uperfn ial fasciculi j.assing to the opjxisite side in an arche.1 manner [n f(,rm a single subcutaneous nuisde which i- known as the :r,iiisv,rsus lUiiili (Fig. 2(k)). . . The (|uadratiis labii superiori>, the /.ygomaticu>, the ri^oriu>, and llie lriangulari> lorm the superficial layer of llie oral mus. les and con(eal tiie greatir nunil)er of tluoe wiiidi are now to be des( ril)ed. The caninus ari,nii;iil,iris l.ihii suprrioris or Irr.ilor ,iit,^iili oris] iFigs. j(.o, j()j, and -'(141 arises from the canine fossa of the n axilla and passes into tile mus.ulature of ill. lip above the /.ygomaticii-. It is a ilaltened elongatid mus. le and i- iilmost entirely (..ncealed by ih, over Iving i|uadratus hibii siqierioris and /ygomaliius. The quadratus labii inferioris k/, />r. xv.-r hihii ii:j,rioris 1 1 Figs. j(.o. .■(•-•. and .-o 1 > i- a ilai (|uadrangular nuivlr. the posterior portion of which i> lov.ivd by tiie triangulaiis. it arises from the :inlerior cMremiiy .'f tin- lower iM.rder of the jaw and passe, to the orbi.ularis oris in Ihe lo\u r lip. rii( incisivi ii siipcrioris ,1 injrrioris] .Fig. .■'vv ^ire small slimier nuisdes which arise from the alveolar juga of the superior and inferi.>r l.il.ral incisois and jiass dire.tly into the musculature of ihe orbit iilaris oris. The orbicularis oris ../-///m/.r ,t/m (Figs, joj ai;.l .'Oy is the mus. le which surroun.,,sinu' in ill. sanu- ,|ir.'cli."^.n a- ill.' fas, Villi .>f th.'orbi. ularis.,ris. In a.l.lili.m lo ilu lil ris ^^Wu h . n. in I.- ih.' inonih. ,|„, ,,,|,i, Iilaris ,,ri- al-o |,osm->ms ..^.in.il an.l x.rli.;-! I,is, i. uli' llu lall.r loiiu a siu.ill ~l. lul. r mus, le, situal..! al..n-si,U. of llu- nu-.lian liiu' ..lilie npp. r lip, uin, '> ' ■ iiis.n.'.l inio llu- . an il.iL'iii ..Us nasal s,-|,ium and is knoA- as die ,1, pnysiir w /-// w/./wi 1 i'ig. .•(.,;'■ 'I'll, mentaliiS /.;.//."■ -■,»;// ..r h :ol,>r l.ihii injiriori^ 1 l-igs. ..(..■ lo .(.| i 1 s|„,ri mus. I. silual.-d in llu- in.iilal r. gion, vnIiuIi aiiMs (n-m llu- l.m. 1 jau n.-,ir \\u .ib.-l..i iat'uni ..| llu me.liaii in, is,>r. S.nu- ..f llu .ir, liini; IiIh rs uniu- wilh tlu.s, ,,| ilu nii.s. |. ,.| ih, opp.. ii. -Id.. but th; gnaU-i iiiinil'.r an iii~.il,-.l mio ilu ml. -uni. nl o| ili, . Iiiii. Ih. .origin .•! b.'lh menlali-s is ,,.\i nd b\ llu <|ti,i.li.ilus kibii inf. riori-. The buccinator d-i-s. ..(,,., -i). an.l .'OM i- a llal nn;s,l.. .M. luiin- Ul«..n ill. upi . 1 an.l III. lower j..u. an.l siiual.,1 inim. .li.il. I\ Iniualh ill. bii. .al niii..Mis nu iiibran. . « liilv llu l83 ATLAS- AXD TKAT HOOK OF HUMAN ANATOMY. Flc. 264. —The (ici|H">l layer of the fiu ial mus( les and liu' temporalis. Till' ianinu>, tin />x.iiiialir an li, .i |iMrtinn of ihi- zyKomatic lioiir wiih the urigin .if iln- mkissi-Iit .in'l ihc tcmpur.il Flc. 265. — The tui) |)tervK"iilei --een from the inner surface. The- anti-rior |Kinnin .if ihr ^kul! h.i^ hen .iiviilnl 111 lli.' ^axiiLiI plaiu, .uul llii- tn){ue anil siifl pal. 11. • h.ivr U'lri iiiiiov.il. i I i antcrini tx)nl(r of ilie must le 1 shixtIk i.il, ]);i>-iiii,' into ihe orljii ularis oris and the other muscles of the nioiitli. It is the slronnest imiscle in the oral region. It arises from the buccinator ridge of the niandihle, from the ]«)sterior extremity of the alveo- lar process of the maxilla, and from liie i)teryg<)niandil)ular raphe. The pterygomandibular raphe (pterygomaxillary ligament : is emlx-dded in tlu' iHiccojiharyngeal fascia (see ])age 184) and e\iriion of the mandible. It separate- the inu inator from the constrictor ])haryngis .suixrior (see••S])lan^hnolog\ '). .\t the angles of the mouth the lil)ers()f the Inu cinalor muscles are directly <()nt:niious wiih tho.se of the orbicularis oris, whili the jiost* rior surfaces Ijorder immediately uiion the oral muious membrane. The .interior portion of eat h muMle is covered ])y the risorius, the triangularis, the zygonialicus, and the canihus, while the |K>stt rior ])ortion is situated Ixneath the massc-ter (see jjage i8. j.erforai. • by the parotid dud, and the small bunal gl.md- rest directly ijjon the mu.sile. THE NASAL r^USCLES. I'iie musilc of the n.-. are muih less imjH)rtant than those of the inouih. The feebly develo|«fl nasalis < l-'igs. 2<>j. -•'.(. and j()()i i^ ( oniiK)sed of a transirrs, portion and an ali:r par tioii. The Iraitsvirsi portion i- .1 llat .ind \ery thin nuisile i\liich uri-ns from tin up]>er jaw .ind i- adherent to the angular head of tin i|uadratu- l.diii Mi|HrioriN u]Kin lh( bridgi of the nn^v, it is united with its ft How i,f;hi r.A.wl,!r jngiim of the iippir tanine tiMHh and goe^ to lilt ..iriilagi 111 llu al,i of llu in >m: ii^ gii .Her |Mir!ion i- i mered by tlu i|iiailr,itiis labii superi ori-. .dthoiigh ,1 --mall portion is .lUo 1 ont t .ded b\ tin mbuul.iriN ori-. {"hi .ila of the nose ij-o reteives tor, I nily tin inM-rtion.if a [Hirtion of the .ingular lu.iil of the ijuadralus labii NUperiori-. ,\!l III 111. tr.ii.. 1. . i.f ;(ii fan i.r.i|irr.in -upiili. .1 In ili. I.i, .al ii.rvr. Thiir fun. ti-m i< i.i pr.nlu, .- ilic mutenii iilx ..f ix[.t.>-i..ii. 1 1....U1. ..I 111. III. mill, nil iM nil in- . .| ili. Ii|... .in.j . .niiprt ,M.in .i| llir miiunl-. ..( the nmulh i ,is, in IiIuhihk, till liih . m.il.in. THE MI.ISCLES OF MASTICATION. I hi nuiMlts of inasijia;' ;i are tom|M>-td of four -inmg Mparale muscles which an dnidtil inio iwi. iiroiip^ iht iir^t K^'i^l' i-~' foriiud In llu niasulir ami tlu timpoiali^. the sen.nii by the ivMi jll, t ,1'oitil I. Ihi masseter Fig. :(>}) U a ihiik, >lrong, .uul apjiroximately i|u,idrilalt ral mustle whit h (-Orrugator , Procrrus QuadmtttS labii sup. X Zygomatiais - Trianguiaris frapmiis :^plenius capitis l'tcrvfioir\s ^nloftiiiiiilihu/iir lif^. .Am. I'flii" fig. 2t)'i i THF. MrSCLF.S OF THE FACF, AMI OF TlfK. SCAI.P. 183 is situaU'd chicllv in the paroikko-massc-ric and partly also in the zygomat.c region. Its super- ficial iH,rtion arises bv a broad aponeurosis from the lo.er border of the an.enor and n.uldle thirds of the zygoma', while the d.ep ,)ortion take> a short muscular or.gm Irom the lower border and the' inner surface of the ,,osterior part of the zygomatic arch. I.> < hut mserfon ,s into the angle of the jaw and into the adjacent portion^ of the l..dy .nd ot the ramus, the deep portion being inserted into the ramus alH.vr the superUcial portion, wli.ch conceals n The aponeurosis cover> more than half of the length of the muscle an.l usually ,,enetrales its interior in the >hape of individual serrations. The masscter is covere.l I.ehin.l hv the i.arotid gland, whose orius. which i. still more superhcal than the naroli,lc..-masseteric fascia, with the /.ygomaticus, and ,>artly with the zygomatic licul of the I.uadratus labii superiorly. Onlvth. lower portion of the muscle is situated immediately beneath the fascia, the aponeurosis being usually covered l.y a layer of fatty tissue. It covers the inserti.-n of the temporalis an.l i^ .eparate.l from the buccinator by the ft;/r,-.// /.;/ »u,ss (s.r page liS.'i. Th.. massrl.T is suppli.-l l.v th.- „K,s«-„Ti, l.ran. h ,.f tl,.. .hint .livi.ion ..f ,1,,. Iri^wninu. 1. . los.-, tlu- ,nnu,i, by bririKinK thi- Lw.t jaw 1,1 ..mlact willi tli>- ui>|mt. The temporalis i rig. 204) i> a i.n.ad -f nig mu>cl.', rather 'lal in ii> '.tpper porli,.n, whi.h covers the plamim t.mpurale an.l th.. t.inp..,.! f.>ssa. In the temporal regi.>n it is almost sub- cutamous, and lakes a muscular origin fr.-m the entire M.rfa.e ..f the planum temiH.rale Ixlow the inferior temporal line, partiv fn.m the anterior i.orti..n of th. temporal to>sa. an.l als.> fr.>.r .i« -.verlving .k-M' I^'V.t ..I th,. tem|.or:il fascia. Th.' wi.l.. la.cicuh ol th.. nius.l.. .-on- vcr,«r ym-ar.l the ...r..n..i.l pr..c.>s of the niau.libU. ..n.l in .l-'ing >- beu.m.^ marke.lly lendi nous upon th. out.r surfa.e. Th. y .nibrace the entire ape.v of the process and upon its inner surfan' extend dowinvar.l as far a> llie base. ■I ,„. „„,., 1. ■■ -u,.,.li. •! I'V >'"• ■!■ -I' '■ "'l-ral l.ran, l>,s (r.„„ ,1„. n,o,„r ,.,r.i.,n ,.f ,1,.- .l>iM 'l.v -i-n of ,1„. ,ri«,n,im„. 1,- „„„ 1I..M U ... . I.-.' .!..■ moulh, ■.„..;;,«. UW llu- ,„.>.>. Ur, llu- |..u, , muar.l tlw u|.|K.r jau Th. pterygoideus externus .Figs. ,.,- an.l -'(-'.i i- a triangular, fairly stn.ng muscle vUiich is siuat. lin til. i„frat.nip..ral tnssa U^tween ih.' i.mp.-ralis an.l the pl.Tv^ouleiis mt.T nu- It arises bv iwo more ..r l.ss .listin.ilv M-parau.l h.a.ls: th.. larg. r an.l int.ii...- tn.m ili. „ul.r snrf.i.e .-I'lhe .mt.r |.lat.- ..f the pt.-yg..i.l pr..ce~s, from ill.' pvranu.l.d l.nuvss ..I the ,,,1,,, |„„u. an.l troMi the tuber.Mtv .,f the maxilla; th.' sniaii,-, .u,.l sup.ri..r ..„.■ fn.m th.' infral,mp..ral crest an.l s„vfa.,' ..I llu givai.r uin« ..t th. sph.n.-i.i 1....... I h. tw.. h.a.ls unii.' ih.' pu.scle l»...m.^ n.ark.'.llv nar...wci, an.l is in^.rh.l bv a sh,,r, t.n.l.-n nito t ,,■ ptcryg....i lo-a ..f tlu h.a.L.f ilu^ man.libl.. som.' td..Ts passing a!s,,i..tlu articular .lis, ..f the li-miioroni-i\illar\ arli. tllalion. I'hr pterygoideus internus i Kius. .^(,-, a.nl ."." is ^n.ng.r than th. .M.nr.-s, ^^lll,h ...n ,v.ls its ...iu'In, an.l its fasciculi cn.ss those ^.l du latter nn.s.l... It lak. s a t.ir.K t.n.hn.-us origin fn. n the i-lervgoi.! fossa of the spiv. n..i.l iK.ne an.l passes h. the iiuur surta..' .•! ih. angle m If ^ 1 !' 184 ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. Fk; 266.— The ilccp hivcrs uf the faci;il muscles, the buccinator, and the ptervRouls, seen from the side. ' Till- lowir puriiun of I'hr nm|».ralis loKflhtr with the (onmoid pnxrss of the mandible has U'l-n rcmovod; the whole of the masseier i^ also removed and the parotid duet has Ix-en severed near its entrance into the buccinator. Fig. 267. -The left platysma, seen from the side. ' 1 1 :, 1 ": i II of the jaw, where it is inserted exactly opposite to the masscter. The outer surface of the muscle is usually ajioneurotic. (The ptervRoideus inlernus is an elevator <.t the mandible, assisting the temporalis and m.issotcr. The ptcrygoidcus cxtcrnus ilraws the eondvie of the man.lil.le and the artiiular disc forward uiM.n the articular eminence; when th. muscle of on.' sUle acts alone, it s.sa. and the result Ining an api-arintly la!< ,.d m.ivement of the mandible.— Eo ] The musdes are supplied by the external and i.iternal i.lerygoid nerves from the third division of the trigcmuius. THE FASaiE OF THE HEAD. The p,irotUlfo-maortion of ihi- hu^'Opliaryiiiirii/ jum in lies upon il.e buo inab.r and is conn, rted with the parotide., ni.i-el.ric fascia; tlic ifMcri-.r portion is stronger, more i.ndinofo. .iml (overs the inner >urfa ini.rnn.. In ilii^ !,oM,i-i.,r p<.rli..n are . mU-tMui ih. pt.ryf^onwiiilihul.ir raplu , pt.rxi^nm.ixilhiry lii^uninil- an.t the slyl,wu„ulihul,ir sty'oiiuixillarvi lifi.niKitl (se. ' ag. I iHi. In this Hiuali..n the fax ia form- the poster., lateral «all of the oral cavit'' anii ih> lateral wait of the pharynx. jTh. .r..n...i m,... uUlure, .onsi.l.nd f,-..., il., d. u i..pm. m.il .t.mdi.o.nl . in. hide, Mveral m .- le- in a.j.lili.m lo thos,. «l.„l. ..r, ...MKI1.-.I toth.' h.ad ii, th. ..I.,v.' d.-. option -i... .■ it .- proj.rly to U- r,Kar.l..l as , on.i^tinK of all the ,„.i.. 1. -.ippl.. d l.v ih. , runial fi. n. ■. \moni; ll.ev ... rvr- ih.t,- , vi,i m..tor hln-r^ ..( H.. .bit. r.1,1 .,.Mhties 1 1 1 lateral „„„„r r...tv v>l„.M-n,..l.i.f ...iain ,na , I-' re«.,.d,-d a- .« . u,.^ in« .. ,-.-.ti.... ...I. r..i.-.|ial.- b.tw.,.. th. im-.lian moP.r r...t^. and { ;l ih.- /.r.<"./i. .m,rr:, n,u~lt- -iippi,..! l-v lal.-ral ..■..'••r r.-.l- The mii'« I. •• l..l..n«i.tK !.. ill. form, r ijn.up a- >v.ll a. .eri„ris. rntu, u.fcrior, rectus mnl,„lis. rn lus n,,,rior. .,,,,1 ohliquu. inleriitr. (b) The troililciris musi lis; ohliquus sut^rriur, (() The alKhiirn.-. muscles: rrciiia liilcr.ila (d) The hy|Kigli)ssus musiles. frHWc'"""'- hy^l-"^"^, slyhqlossiis. and liiixu.di':. 2. likANCMIOV.KKIC M I'SCl.IiS. {,•) The trigeminus museles: m„.wfrr, lcmpor,:li>, phryaoidn,^ ,x„r„us. !,lrryx„i.l,;..<: Uuenv,^. myhl „■ ' . >. .' ■ Iricus (anterior Ik'IIvI, Innnr p.ihi'.i, anidf,i^. dig.islnnis (i»,sUTi..r lu llv\ >.l„pnl,i,-<, t.l.ilysni.i, ,pi,ra:u. < ,„. ;.•■ auricular, i.alpeliral, iiral, and nasal nnisclis as classilud alii.c. (c) The vagc-accessorius muscles: „yl.'pl,.,rv„nn.^. /--v/mr v,li p.ilalm.e. mus.: ,r.:,l,<: p.,l.„.n:l„.su-. ;w/„/,./,/,„rv»- geus, constriclori-s pharynsn, the larNriReul nius( les. trapezius, an.l sl,rm,deid„m„slo,dni^.-\:D\ THE MUSCLES OF THE UPPER EXTREMITY. The muscles of the ujiiar ixlrtiiiily arc comixistd of four cliiif ,i;rouiis; I. The muscles of the shoulder, /. -., nuisdcs which ari^' from the .shoultkr-^irdk', pass throui,'h the refjion of the slioulder. anr,i- spinalHS, the injrnspiiuitus, the tma minor, ilie siiku.i pulnris, and llir i.ns worn. II. The muscles of the upper arm, ;. <■., nni-iU- tlie ,i,'reater j-ortion of wiii. h ;ire Miuaii-d in the upijer arm. 'I'his .'.^roup is subdivided into: i i ' Tlu' miisvl.'s of the llexor ~urt:e,e: u) the muscles of the extensor surhK e. ('.rou]) II, I, is ■■onij.Msrd of liie hi<--h: br,i,l:it. tile lonimhr.n In.ilis. and ih. hra,hiy die Iri,, ps hrmliii coul 'lie •iiKdiini^':. III. The muscles of the firearm, ;. <■., liio-e of wliiih the .i^reater iioriion- -re -iiu.iud in the forearm. .\c cord in;; !(■ their arranu'ennnl .md jiosilion iluy irc' cuiii-OMci oi tliro suh divisions: (i) tlie miisele^ of :he Ik \or surlac'; I -'• the niustic- of ih.' radi.d H'ir; (?; ihi' museks of die (Aiiiisor suu.m. The nii;.-.k- .d' llu ik \or Mirfaee are arranged in t"o l.iyers. Tlu- sninrluial iner i foriiitd iiy tlie pronator /.t. v, ih, p.ilmoris loii,Ktis, llu /. vor .nrpi niili, and llir y/'.vo;- ,,irpi uhutris. The dee]. la\cr I- .omiioscd of th'- jU\or ,li:'Horiiin pro jitni/-'i, tlu ;l(.\i'r poll.ii-. loiii^ii^. and the pronalor ,ji<.,idriUu^. The 'adial '.rroir. (on-i>ts of llir br,u liiora'li.ili^, tlu i xU nu-r lorl'i raili.il:^ l,nr^i<\ and ihe I vtiii^oi- iiirpi roiliiil:^ hri'!'^. In tlie iniisi le> nf llu ext.ii- r ;,roui) tin ■.iipinotor luiM- a soec i.d posiliiM.. The remaii> ill!,' nr:sii.-saiv ,n,ni>osed, of ihr... -uLdiv i^.m-. on A -.uperli. i.d lavrr, form, d 1,\ ilu rMnisor ,lii^ilon < I tlu- thenar m^i^ *^*J«Bfel^ii*i*«$ ' iZLJf' jj,6 ATLAS AND TEXTBOOK OF HUMAN .\NATOMY. F:r .68 ^Thc n^usdcs „f the p...orior surfac of ,he left sc.pula an.l .he neighboring portion of the TZ^^^:'::^:T::t':::;::^i^^:oi the .ft ..^.a a„.l tl. ne.h,.oring ^.tion of .he vt 1 11:1; 2 ■ 11 M .ho muscles of th. hviK.ihcnar eminence; and (3) the lumbricales (four) (four) and the inhrossci volarcs (ihrerV THE MUSCLES OF THE SHOULDER. Th . deltoideus Jmrs. -(,8 and .70) is a thick, triangular, markedly c.rvcd muscle .hich wmmmmmm tascia (sLc iM^i -"/I. > muscle rau d v diniuushis in si/.e as uiiiuT siirfice "t lit inseiiion is mn-cular, inc m^h '^ ' ui)l)tr sur!ai.(. ui siibd. I„, bursa (Im-. 26h;. th.. fascia of which partlv cvers ,.. under surface, and ,hc in ,r ,„. .r Uk. ,rape.iu>. It. .nser,io„ i. emhrace-l by the orig.n of the brach.ali>. Th. supraspinatus .Kig. .oS, is a triangular, moderately -7^;-;;';;;;: \f tr'!: ;:;r;:-:zr!zr::;r;;;r:rn^^^^^ Acromio-clavi rulur tig. DeltoUU'its > Subdeltoid hiir.^ii I cvinor sritniiltic h'/ii'.">l:iniic:is minor < fh'li'-ii'!- ■ l(/i,^in-ii>idi-i:, I'Kijor Pectcriilii, major l the infr.ispin.nus .in' suppliiil hy llu- .~ii|ir,i-.i apiil.ir iutm. 'I'h. v r.it.iir llir arm ..itw.ird (baikuaril). The teres minor is an elongated (|uadrangu]ar nniscK-, situated immediately below the infraspinatus, to which it is more or less adherent. It is covered by the inlras]iinatus fascia, from which it takes a ])artial origin, and in its outer third ii is also covered by the ileltoideus. It arises from the lower ])art of" the infrasiiinatus fossa and from tin' middle portion of the a.xillary lx)rder of the scajmla. The tendon of the muscle is but slightly narrowed and is insertey iIk- axillary (i irmnillc* ) nirvi- an. I i, an ■•Mirnal Mlatnr liki- ill.' '.ui.ra?|.iTialii-i and ihc infraspinaui^. The teres major (Figs. 268 and ^(k)) is stronger and longer than the teres minor. Its origin is covereil by the latissimus, luing situated between this musde and the teres minor, and it lies along the axillary Ixirder of the scapula somewhat nearer tr the dorsal surface. It arises from the dorsal surface of the lower third of the axillary border of the sca]>ida, ixtending iloun ward as far as the inferior angle, and, (Tossing the long Inad of the triceps, it terniinatis in a broad thick tendon which is situated in front of that of the latissinuis and i^ inserted with it into the entire length of the lesser tubercular ridge (sec jiage 1.401. Iktween the teres major and minor then' is a Iriangidar a])erlure whiih is sulxlivided by the long head of the triceps into an inner triangular and an outer (|uadrangular space. The triangular sjiace gives jiassage to the lircimillix scapular artery, while the (|uadrangidar space transmits the axillary nerve and the i)osterior lirmmllex arter\ of the humerus. Tin- Iin^ Tiiajnr i- ^upplird liy lllf .--uIim aprllar ihtv.".. ll i^ an inlirnd rntalMr of ilu arm, a^-i^liiiK tin- lali-.-imiis. 'l"he subscapularis iFig. 2(h)) is a broad, llat, triangular nniMle whi. h completely lilb the subscap'dar fossa. The nnisilc with its fast ia i^ in (ontatt with the serralus anterior b\ its entire w.Mih, with the origin of the ^hort head of the biceps an ihiri'on. Its f;(sriiuli converge to a numlHT of intermuscular sepia, and the stri>ng broad t ■Md"n o( ins( riion pa--Ms over the anterior surface of the artiiiilar (a])sule of the shoulder joiiii, lo uhi(li ii is lirndy adheren', and is attached to the lesser tulKrile of the hunttrus and lo the mighltoring portion of the Icssi r tubtreular ridge. < ncus has lifin rfmovt-ii and thi- ouUr h.ad of Uu- Iriiciw has lirin stviri-d and turned aside in either direilinn. Flc. 272.— The muscles of the flexor surface of the up[)er arm, superficial layer. The deltoid has Uen removed. Fu;. 273.— The muscles of the tle.xor surface of the upper arm, deep layer. The deltoid and hiieps have l)een removed. Immediately below the coracoid jiroccss, and on the under surface of the suhscapularis near its insertion, ihere is a constant bursa which is a diverticuhim of the synovial membrane of the shoulder- joii- and is known as the suhscapiilnr bursa (see page 121). e suhseapularis i- sui-plied l.y the subscaimlar nerves from the brachial plexus. It is an internal rotatornf The sul)scai the arm. THE MUSCLES OF THE UPPER ARM. THE MUSCLES OF THE FLEXOR SURFACE. Ujion either side of the lower \wn\on oi the arm there is a distinct intermuscular srplurt (Figs. 270 to 27,^) Vtween the mus( ' s of the llexor and tho.se of the extensor surface. The internal intvrmusnitar st jilum is the stronoer of the two and ends ; • the internal ei)icondyle, the external intermuscular septum is weaker antl extends downward as far as the external epicon- dvle. These -ejna give oiit^in to muscles of boiii groujis, the external seiitum fumisiiing attach- ment also foi lie radial tiruup. '\'hv biceps iFigs. 272 and 27;,! is a lonij, larj,'e, si)indle shaped muscle which is situated immedialelv l)eneath tiie brachial fast ia in (he anterior braihial and cubital re:.iioiis, and ari.ses hy two distinct heads, the loni; head and the siiorl head. The long head arises from liie sujiragle- noi.lal tulRTosiiv of llie s, ajmla by means <>l a loiiir «ylindri.al tendon, whi. li jiasses through the cavitv of the siioidd.r joint isec page 121 1 and thrniigii the inttTtubercular groow, Ining enviloi)ed in llie latter siui.-njon by the inlerliil" niilar muioiis sludtli 1 F ig. 27.O. 'I"he irndon of liie short head is -horl. ilai, and adherent !<> that rti,.ii l.niiun tis lUi' liKirliis iiliriiMis iFiu-. a >'i.-ep, il.:i . -t:--:-^ n:;M--Ti ^i-jm,. •■■.•• -■;« ; 2-2, 2"^ 27,}, a .d 2()i ). I'lie latttr i> (i)m)K).sed of superiiiial nidiating lil)t rs from the lendfii Trapezius .'i Hxlernal epiconriyle (ilfrran?n Outer head ■ t.xtfrniti intrr- Braehioraiiiiilis ixten^or carpi radtalis loriffus I xtermil e/iirondyle t.xtinscr turpi rudialis hrei'is t. Fig. 270. nf>. 271. Oniohyoideus x Coracoid process. Internal intermuscular septum % Lmfrtiis V*' /ihrostts Antibrachiat fascia Deltoideus Supra- spinatus Coracobrachialis Tendon of long head of bleeps ifiursa of Idtisslmus Tendon of latissimus Tendon of xioralls major Coraco- brachialls htleriiid inif-niiseular septum Internal epieondyle lendon if bleeps braehii Coracoctavi- 'r-"^ ndarltg. Coraco-acro- mleil llg- Intertnhereutar miieons sheath lenUin of hice:)S (lonii lieod) Tendon of ■torahs major oni; head of biceps ■ I aeerlns llieipilii-radlal tnirsti I eiidon bleeps fig. 272. H^. 271. F II i. I:= i^ THE miSCI.KS OF THT-. TU'PKR ARM. iS() i i of the biceps, which pass obliquely across the antecubital fossa toward the ulnar suU uvl fade away n \hv antibrachial fascia covering the supertkial llexors ol the lorearm. mi tendon of the biceps .uscle passes deep down bc^een the .lexo^and U,e r. uU croups of muscles an,at>.>or,ui.al bursa ,!•,«. ,vith .h.- su,.inu,or bn-vis). an.l iP..r.as,.s ihc- .cn.,,., o, .lu- :uu,l,r., h , 1 f.,- A h,„l i. ,,rc.s.nt in ran- instanus; i. aris.-s from .ho hun.-n,. u, , ..n,m.,n w,.H .„ hr,„ h.,.,,. The coracobrachialis (Fis. 273) is a Ion, and rather Hat muscle, which i. placed alon.si.l.. of th short head of the biceps and is almost entirely conceale.l by th,s structure. 1 > >lor tencU n f origin, arisin, from the tip of the coracoid process, is adherent to jh. short head o TZ.,s an^ overs ^e insertion of the subscapularis and the ten on> o, the la„sMmus an. te re n ajor shortlv before their insertion. It is inserted into th. antenor and m ernal uHaces ,f the humerus at about its mi.Uile, below the lesser tubercu ar rul.e, and m he internal intermuscular septum. The muscle possesses a Ion, slit wh.ch g.ves passage to the musculocutanious nerve. Tin- . ora. ol,ra< hi.ilisi> Miiiplio'l ''X tlu- musi ul.KUlam-.ms n.TW, II cl^'vati's tin- upiKT arm. as>islinK the ck-llimlius. The brachialis (Fi,s. 273 to 27?) is a stron,, broad, rather Hat, elongated muscle, almost cntirelv concealed bv .he biceps, whi, h is situate.l in the lower two th.rds o, the tlexor surlace of the' arm. It arises from the antero-internal surface ot .e humerus, somewhat abo... the middle of the b<,ne and, embracing the insertion of the -leltoid, take. on,u, al., Irom the an ero- internal and antero-ex.ernal surfaces of the lower portion . f the .halt o, the hun,eru. and f n he internal and external intermuscular septa, the origin from .he .nternahn.ernu>scular scp urn extending .lownward aln.ost to the internal condyle. The amerior surfac. o the nu.cle . distinctlv hollowed to accommodate the overlyin, bice,,s, and m .Ije lower ,.ornon of .he .rn app..ars ,0 either .ide of .ha. muscle. ( )n .he ou.er side i. is in rela.-on wuh .he ou.er head of he triceps and with .he brachiora.iialis; on .he intter side, it isespecially d.s.u.ct and ,s „, relat.on with the inner head of .he triceps. 1. is inserted into the tulxTosity o, .he- ulna by mean, of a strong .en. and usually also by tbc ra.lial. It i, a pure flow of .Ik- forearm. THE MUSCLES OF THE EXTENSOR St^FACE. The triceps (Figs. 268 and 270 .0 27.^) is a larg.. elonu I muscl, wl hich ]iossesses .liree hcad^ T^^h,>:-hr-u! 'anamrus h'K^us) (Figs. 268 and 27. .0 27.^) is a somewhat roun.lal muscle which arises bv a short tendon from .he infraglenoi.lal tuberosi.v of he ^_';M'ula. It passes iK'lween the teres major and minor, that is to .say, in fron. of .he lere. mn.or an-l beh.nd the IQO ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. ■'I teres major (sec page 187), and becomes aponeurotic u])on its inner surface. It is frequently connected with the latissimus dorsi by a tendinous slip. The oulcr head (anconeus lateralis) (Figs. 270 and 271) arises from the iMistero-external surfac I 01" the humerus, commencing immediately below the greater tubercle, and from the upper half c ■ the upper two-th-'nls of the external intermuscular sejitum. The origin of this outer head is librou^ above but fleshy below; its libers run downward and inward to the common tendon of the tricejjs. The inner head (anconeus medial is) (Figs. 271 to 2;;,) arises more deeply than the outer one, and its fibers are shorter and extend further downward; a:, a rule, however, it is not as strong as the outer head. It arises fro.ii the entire length of the internal intermuscular s'jptum, opposite to the brachialis and i)artly covered by the biceps, from the posterior surface of the humerus below the groove fo • radial nerve, and from th. i-xternal intermuscular septum as low down as the external epicondy le. The j)ortion of it which jomes from the internal intermuscular septum and which is not concealed by the biceps, lies immediately beneath the brachial fascia, as does also that portion arising from the external intermuscular septum, which is not covered by the outer head. A large i«rt of the inner liead is concealed by the outer one, and between the origins of the inner and outer heads the radial nerve runs in its groove. The fibers of the inner and outer heads unite with those of the long head and pass into the common extensor tendon, which commences upon the j)osterior surface of the muscle at about the middle of the arm and is inserted chicly into the olecranon pr. ,ess of the ulna. The insertion not only completely surrounds the olecranon, but also radiates to the ulna and the a..tibrachial fascia. The triceps occu])ies the entire extensor surface of 'he arm l)etueen the intermuscular >epta, and is conse(|uently situated in the po.stenxAternal and [)ostero-internal irachia' regions. The relations of the long head have already been described (-ee page 1871. The inner head is in relation with the brachialis at the internal intermuscular septum, and at the internal epicondyle its fil)ers are C(mtinued directly into the anconeus; the outer head, at the external intermuscular septum, is in relation successixely with the brachialis, the brachioradialis, and sometimes also with the extensor carpi radiali^ longus. Till- triccp- i^ v(i|i|,li,.,l l.y the ni -hort tendon from the external epicondyle, passes over the articular capsule of the ellK)w joint, to uhii h il is adherent, and is inserted into the upper portion of the posterior surface of the ulna immediately below the olecranon. The ujjjjcr libers of the muscle are usually directly continuous with the lower ])onion of the inner head of the trice Tlu' ancum-iis has a funiticm ami innervation Mniilar to that of the Iric'ii^, an. I in ad.lilion it m. rcasi-s the tension ■it the artirular eapsnle .if the ell),)w-ioint. Th.n- is f,r,|„enlly a small rnnsrular fas, i, iilus passing between the internal epicondyle and the olecranon over the iiln.ir nerve; il i- known as the epilroihlco-aiiconcus. THK MUSCLES OH TlIK FOREARM. 191 !i THE MUSCLES OF THE FOREARM. THE MUSCLES OF THE FLEXOR SURFACE THE SUPERFICIAL LAYER. The superficial layer of the flexor firoup (FiK- 274) consists of a muscle complex which arises by a common tendon from the internal e])iconflyle. All of the muscles of this grouj) with the exception of the jjronator teres pas.; beyond the wrist joint and become tendinous at a varying distance alxne this articulation, and they occupy the ulnar side of the volar surface of the forearm. In the u per portion of the forearm they are all adherent to the antibrachial fascia, with the excejition of the Ikxor digitorum sublimis, and conceal the insertii)n of the brachialis. They are sepii- itid from the radial grou]) of muscles by a deep groove through which the tendon of tht .lu ^ passes to its insertion (see page 188), and in contrail to the muscles of the dei 'n.r tlu y ;n :>e cli 'ly in the upper arm and, with the e.xce-plion of the ilations. he (' termost of the grou]), is an elongated quad- rhe hmmral head is the stronger and comes from u nor head x-. more deei)ly ])laced, coming from the Ihen he tendon of the brachialis. The 'lan lUTM. ions of the bice])s and su])in:' ■ and ])asses ariace of the radius, \>here - attached to ! \'<) pronator teres, consequ tly |)ass 1 The pronator teics (Figs. 2; , and rai gular muscle which arises by tw.- b.i ad the common tendon of origii^; the ni-.. ct)ronoid pnKess of the ulna, and is la-tp s])ace between the two hea is gU'es passa;. The Ix'Uy of the i)r')nator tea- covei below the latter musile to the middle of i. the bone by a short tendon (Fig. 2S0). This musi If. liki' tlu- majority of \\u- -luuii, i- -uinii: the foaarni, and it lan also assi-t ih.- brai hiahs in ll.-' ■ H" Usually gives a |Mrii;,l origin lo the tmisiU'. The flexor carpi radialis irmlialis im mi, the distal half of which is ienuiiraiundyloi(l proeess W present, it Spindle-shaped muscle, group pas.^ing from the ' lend'm an'! from the . vhich pa.s-i - through the gi'^ve n! the iird nulai ,;r])al bone. '-oduiis vol \ion ; \\hen ,il muscl. of 'he enlire f il- t o! rsc. Its he aniil)r:n hial 10 rearm (I is :;;,riienl, to uhich lan al>o assist in pleolii li. ■■■r {hv le trai - erse i . urosis (se ]iagi flexing the forearm. It is -upi'lied liy the median nerve. 192 ATI.AS AND TEXT HOOK OF IIIMAN .\NATOMY. Fi(.. 274. —The superficial layer of the museles of the llexor -urface o the ' Airm together with the liraehioradialis, seen from in fnirit. Flc. 275.— The superficial liver of the tnu-cies of the llexiightly from the radial side. Thi- hrachiurailiulis is drawn oulwuril to show the su|iinalur ami llif insertion of tin- len.,.m of the tjicrps. lUl m-- The flexor digitorum sublimis 1 Im^s. 274 to 276) is tonceakd at its oriirin by the ],alm;tris longusand the tk'xor cari.i radialis, and ihc greater portion of its ulnar lx)i(kT is c'()'erj(i by the flexor caq)i ulnaris. The main origin of the muscle, the humeral head, forms the deei)est ])ortion of the common tendon arising from the internal e])icon(lyle, while the second heat, he radial head, arises by a llat ti idon from the volar surface ann: 1 iiii;'lii .sujii>lii'(l In iln- ulnar niTvi-, the radial li.ilf )iy iho median nrrvc. It ttvxvs llu- li-rminal plialaiiK^s .if tlii four Iuikits. The flexor pollicis longus (Figs. 275 to 277) is a spindli shajied muscle placed imme- diatelv alongside of the ilcxor digilorum profundis; it is penniform above and semipenniform Ixlo" . It ariMs from ihc volar surface of the radius between tl'.e ins.rlion of the supinator and the upper border of the pronator (luadratus. It also usually receives a >lender fasciculus, fre(|uentlv a]>onein'otii , from the coronoid process and from the internal condyle; this origin, howev( ', whi( h. is known a> tin- Itlinuriil luail. does not come direcllx Horn the boiv but from the muscul mass of the superlnial tiexors. Tlu nuiscle bi'comi's tendinous almo,~l imnudialely Ix'low i;- origin, the upjier portion receixing the muscular libers from either ^idi'. the lower portion from ilie radial ^ide only, and the tendon run> in il-- own tendon - to the ungual ])halanx of the thumb. Ihr '1 In- ihr nu-dian rn'r\r. h tlrxt^ tin' trr!iiinal |'liaian\ of thi ihurut' The pronator quadratus .(■'igs. 277 aid 2S11 i> :i ll.-it (juadrilateral niu-rle wliidi i- con- cealed b\ all ill, t. iidon^ id' the lliAor mu>i Ks and lie^ r.pon llie volar surfair^ id' bolh bone> o| the forearm inward llu ir di-lal exlrrmitii^. It arises from llu volar border of llie ulna and is inserted into llir volar sindai e ami Imrdt; of the radium, ImiIi ii> (uigiii and insertion being Usual!;. b\ short ,i] • neuroses. Till' niusi il i- -ii]i|iliid ii\ ih.' 11;. dijn lurvi id pronali - ilii' foriarm. i THE RADIAL GROUP OF THE MUSCLES OF THE FOREARM. 'I"he ihrir musi II s of the radial group are jilaied at the radial -ide of the forearm and of llir loner |Mirlion id llu' .11111 in llu' so (ailed r.nli.il teuinii. belvvetii liii (li Vuis ,uiil llu evteiisors. The brai hioradialis belongs more to the llexor surfaic, but the other ivvo must les are upon the extensor side of ihe fort arm, and vvhilt the supenk iai la\t rs of bolh tlexor and extenx r must les are ii: ! lii-riiU li! ll'.i- fjisti.i of lilt' forearm, ihe extensor ■. art.! radialis lirevis is the oidv p.lusi le i>f the radial group in vvhiih a similar nlalion obtains. The brachioradialis iuipniiilor li'ii^^its) . 270, 271, and 27 j to :->)) is a very long tlat Palmaris longus Pronator teres (humeral head) + Flexor carpi radialis Ulnar head' of pronator teres Tendon of biceps ' Humeral head of -' flexor longus polticis Brachioradialis Bicipito-radial bursa Fendon of fit carpi ii/nans Tendons of flex. dig. suhlimn'^ I'ronatoi teres liraihioradialis Interosseous membrane I'enu'on of bnicbii'tadinlis u \hducl0: lendonofeu.-nsor pMcis lonpis ' earpi mdial. i"nnus FMcn.wr pnllicis hrevis fendon I endon onlexor "/■ '>^trns. ,. .. , . r.irni nidi il>y f"'r' '"«<'• '<^"g:- t>ars„f / rnrpom mamh 1 Fxternal epirondyle g • Olecranon I \tensor dig. V propr. 1,1 l.ndi'U of extens. r teniioit I h/i:. 27H. \len\ ;iidieis prorr s VZi THK MT'SCI.KS OF THE FORF,AR^r. K): muscle which is in immediate relation in the forearm with the sui'orticial layer of the tlexor surface (see jjai^e iQi)- T arises fro:n the es.ernal intermuscular sei)tum of the uj.per arm, where it is in mimediate relation with the outer portion of the brachialis on the one >ide an.iratus to be attached to the uii!>er end of the styloi.l proce-s of the radiu.,. The radial nerve passes between the outer portion of llu brachialis and the braci.ioradiali-. The musilris ^upi'lii'l I'v lli.' ra.li.il m-rvr. ll i> prarlically ., Iloxor ..f th,- fnr.arni, an.l tl.r n.inir, Mi|.inal..r lonnus, foriiicrlv '- niic' i it, iW< net iDrrrilly state its fi'mti.>n. T'.ie txtensor carpi radialis longus (riuli,i/is i:\iiriius loutiiis] (Fi>;-. 270, 271, and 278> is a long llat muM le resemblin.i,' the brachinradialis. Ii arisen as a direct t dntinuation c die origin of the latter muscle, from the lowr end of the exlern.il ml. rmuscular septum of llie upin r arm and from the e\trrnal epicondyle opposite to tlie lowermost (lorlion of the inner head of lite triceiis (Fig>. 270 and 271) (see page i<)0(, and terminates above llie middle of tin- fonarm in a somewhat llatlened tendon. It lie-, immediately adjaicni m the brae nioradial,-. (iiiion its ulnar md somewhat jjosteriorly 1, covers ihe vi.lar and iatirai Mirfaccs of tht- rathiis, pa-ses heneai dor>al carjuil ligaiuent, ai; 1 insert- into the dorsal >urfaie of the base of the xtond metacar]al i)oni- (see also ]iage 20\\. The extensor carpi radialis brevis (nnliiilis rxirnins hnils) iFig-. 270. 271, and 278! lies immediately bcMde the Immuu--. It ari^s jus: lulow the lall.r must Ir from the exit rnal epicnndvie, the aiitibrachial laxia, and the articular tap ule of tin- .Ibnw joii,,; i( cMwr- .hr lateial -iirlaie of tlie nidiiis and lieiomes tmiliinui- sonu v, ;al IuI.av ilir middle of llic lonant'. The tlatteneil liiitlon is longer th n that of thf loiigil-, wiih whii h it passes beneath tin- dorsal carpal ligament, and i- inserted into tlu- ba-c of llic third mdaiarp.d buni'. Both I'Xtensdir- tarpi '-adiali- are stio]'lir(l b\ llu- r.idial tier\> . TdL'rd'.i r with the rxler-.>r cari>i idnari> thev produtv dorsd llexion; and wilh ihr lit \or tarpi radi.ili- ihr> cited radial (lexion (radial abduction). Their temlon- are ii-(i"td in ihr Inr.arm l.\ ih.- e\lin-or polli. 1- bv(,\i.., and the abdu'lor pollit i- longu-. and tlu ir iiiserlion- are iio-ed by llu- I. ii ,ir. .-iuialtd to ihe ulnar >idc ot llu- radi.d gKiup. Tlu- supinator suipiuaUn- hi;-,-ist 1 Fi;:-. 275 lo 27- and 2S0! i- a llal iiuim K wlii. li (i:r\(- 1 , .1 _ ... ,_ :... . ; ll... »..,i;,,^ ..,,,1 ;. ;., i-..l.ii L.m « ii!i 1:1 mhv nf llu- niu-i Ics r-, anil its anterior ivojari portion by ihe radial group and the pronator teres. The insertion ot the 196 ATLAS AND TEXT-BOOK "F HUM, X ANATOMY. Fk;. 279. — Tlic suitcrlkial layer of muscles of the ..-xtensor surface of the forearm. Fig. 2S0. — The (leej) laver of muscles of the e.\tensor surface of the forearm. The superficial lavir i)f thi- the back of the hand (Fig. 2«()l, where those for the ulnar tuigers are connected by slender transverse or olilitpie tendinous fascitiili. the iniirliira loidiiiiim. In the fingers, these tendons form the main portion i>f the dorsal a])oneurosis. The extensor digiti V proprius iFigs. 270 and 28()) is a thin slender musde which is so closely connected with the extensor digitorum communis that it seems to Ix' a part of it. Its slender tendon passes through a se!)arate compartment in the dorsal carjtal ligament to the dorsal aponeurosis of the little finger (Fig. 281) and is sometimes double, taking the place oi the tendon of the extensor communis to the little finger, whith may be poorly developed or even absent 1 Fig. 28(>i. Ute Brachialis- W Radial lateral ligament- Annular tigan- it I m Pronator teres x / K Flexor carpi ulnaris Abductor iiollicis long.— Extensor potlicis brtvis Temions of exten- . sores carpi radial- Extensor pollim'-^j^rr^r,! carpal iigcmr. long. Fig. 27Q > Extensor dig. V proprius Extensor indicts pr Win ^y Dorsal carpal ligament x ,' Tendon ofextensoris carpi radial, brtvis Tendon ofextensoris carpi radial- longi Fig. 280. npm vm-m TUl. MUSt:i.I.S OF THK FORKARM. 197 Roth muscles an- supplied from tin- r.,lial mrvr. Tlu-y .NUnd llu- luur ulnar linp-r. .sp,-, iaily ll'air ,,ruxi,ua- phalanges The extensor carpi ulnaris (iihuiris exlmius) (Fi.us. 270 and 28()) arisis t()<;ctlur with the two other muscles of this Kroup from the external epieondyle of the hunieni>, and also from the articular ca])sule of the elbow-joinl and (luite extensively from the antil.rarhial fascia, vvitli xvhu ii the muscle is adherent for almost half of its emire lenRth. It is in relation above wuh the anco neus and lower down ' separated from the llexor caq.i ulnaris l,y the dorsal bortler of the ulna. It pas.ses over the dorsal .surface of the ulna, becomes tendinous in the lower third uf the forearm, runs beneath the dor>al caq.al li-ament, and inserts into the base of the fifth nuta. ar,,al l)one. Tlu- exu-usor , arpi ulnaris i. M,ppli,.l from th,- radial n, rv, . Win n a.li.,..,' vilh th- ,vu n^orr, , arpi ra.liaU- it procUuc- dorsal llexion, anil loi-etluT witl, the ll. xor ,arpi ulnari- it , If. . K ulnar ll.xion (ulnar ahdmllonl. THE DEEP OBLIQUE GROUP OF EXTENSORS This layer is differentiated from the deep strai-ht i^roup by the fact that only the ori-in> of the muscles comprising it are conceale.l by the superfuial extensors. The muscle^ b.rome superficial below and cross the tendons of botli extensores can)i radiales in the lower third o\ tlie forearm, l-ike the muscks of the deei) Hexor tirou]), they pass over only the wrist joint. The abductor pollicis longus (ixlntsi>r o.ssis miUuarpi polluis) (Im^s. nyt), ->So. and 2K()i, the outermost of the group, is a tlal strong muscle, the origin of which is comiiletely concealed liy the .superficial group of extensors. It has a long pointe.l origin from the dorsal surface ol the ulna and also arises from the interosseous membrane and from the tiorsal surtace ot the radiu^ below the insertion of the supinator. In the lower third of the forearm il t rosses, together with the extensor pollicis brevis, the tendons of the extensores carpi nidiales at an acute angle a ,d terminates in a tendon (or two tendons) which passes beneath I'.e dorsal carpal ligament lo be inserted chietlv into the l)ase .d' the metacarpal bone of the thumi). Tendinous fibers usually .idiate also to the greater multangular bone and to the abductor pollicis brevis (see i)age iqt)). •n,.. „u,s, k i. .u,.pli>d iron, tl- radial .rerv. . Il a!,du,l. ll„- thun.l. and al- a-.i,., in th- , stcuMon ..f tlu. .I,«il The extensor pollicis brevis (Figs. 270, 280, and 28QI is situated more t.. ihe ulnar side and is bv far the weakest muscle of the group. It is a slender muscle, situated immediately alongside!' of the abductor, and arises from the interosseous membrane and from the dorsal surface .,; the radius. It crosses the ten.lons of the extensores carjii radiales and its slender tendon passes through the same compartment as the abductor (Fig. 28()l and is in.serted into the dorsal aponeurosis of the first phalanx of the thuml). It i, ,u!)plicd Ir.un i!« radial mrvv. It .-M.nd. and ahdu.t. th.' tir.t phalanx ..f tlu ihinnh. THE DEEP STRAIGHT GROUP OF F.XTENSORS. The muscles of this group lie immediately to the ulnar side of the preceding, but they are deeply placed in the forearm and are completely concealed l)v the sui)erlitial extensors. Th. extensor pollicis longus (Figs. 27c), 280, and 28t,) is stronger than the brevi-. It aris. ■ from the dorsal surface of ,he ulna and from the interosseous membrane and lorm- a 198 ATLAS AXn TEXT-BOOK OF HVMAN ANATOMY. Fir.. 2S1.— Tcn(ions and musrlcs (intcrossei dorsales) of the (K)rsum f)f the hand. The iliir^al wn eovored !«• the fasiia. long, slcndiT, muscular belly which ]iasscs (lo\vn\\ar(l to the wrisl-jtiint beside the extensor (ligiiorum communis. Just before reachinjj; the wrist it terminates in a tendon which passes throuj^h a S]>ecial com]>artnHnt in the dorsal carpal ligament (Fig. 2Si)i, crosses* the In Ions of the e.xlensores carpi radiales imim-diately before their insertion, and is attached to the ungual jihalanx of the thumb, being partly adherent to the tendon of the extensor ])ollicis brevis. 'Ihi^nui^i K' IsaKosupi'lie.] from the radial nervi . I, extend- the ungual ph.il -sx of the lluuiih and assists the action of ihe alidui lor. The extensor indicis proprius (the iiulicalor) (Figs. 2-q, 280, and 281)1 is a long blender muscle situated to the ulnar side of the extensor poliicis longus. It arises chiclly from the dorsal surface of the ulna, receiving adfliiional libers from the interosseous nietnhrane, is com])letely concealed l)v the extensor digitorum commu'^'s, and passes ihrough the dorsal cari)al liga- ment in the same compartment wit' the latter n.uscle i Fig. j8i)i. Just above the wrist-joint it terminates in a tendon which runs on the dorsuf'' of the hand alongside of the tendon ol the communis for the index-finger and forms with this tindon the dorsal a])oneurosis of that finger. Il is ^up|llied from ihe railial nerve. Il aid~ in ihe e\len-.ion of liie iiidex-fmger. THE MUSCLES OF THE HAND. Tile tlienar and hyjiotlienar eir.itKiices o(xupy r>-spectively the radial and ulnar bor- ders of the hand, l)ut the 'lexor tendons and lunihricales, running in tile middle of the ]ialm. are cowivd hv a strong aponeurosis which is u>ually a direct radiation of the tendon of the palmaris longus i-ee page !(Ki and is isnown as the palmar aponciirvxh 1 Fig. 284; (the palmar fascial. This aponeurosis is alw:iys ronneded with the lran-\erse (arjial liganu'Ut and g.-' (les awav u])on eitlur side into the fascia of the thenar and hyiiotlicnar eminenco. i. iw at tile tran-verse cari)al ligament and becomes broader a- il pa>M's downward lowani . ..• lingers, anil il> longitudinal faM-iculi. which gradually disappear in i!k' integument over the Ijases of the proximal |ilialangcs of the -cmnd to tlie fifth lingers, arc united in the distal i)ortion (-f the ])altTi i)v transverse fasciculi, wliiih i lose in the interspaces lying helwcen the longitudinal fasciculi ])assing to the individual finger-. Tlu-e spaces gi\e pa>>agc to the vessels and nerves for the marL'ins of the finders, and henealh them are >iiuated the lumliricales. The ulnar margin of the denser central ]'onion of tiie palmar aponeuro-i- and the transvirse cari)al ligament give origin to a muhde which passes over the muscles of ihi' hyiiothenar emi- nence ,ind llu- ulnar ve->el- to the integument at the ulnar border of llie hand. This muscle is situated cntirelv within the suiiorhcial lascia ol the palm, vaiies in it- development in dilTerent individuals, and is termed the palmaris brevis 1 1-'ig. 282). * This iro^-ing oei in- « it bin llu dor-.il . arpal Imainenl, -o il.at the tmdon -heaths al>o ■ ro>s eai h other (-ei' the deseri|ition oi the tendon -hiaih~of tin- hand, )Mg<- joj!. -! ' ^.-z .- ■IH— P-~~»" m ilUi ^ 199 "•""""^^"'"T-^....-^ "-' u „f 'oil" t.irv,- ana i^ ,...uppUe..y.he.upeH..a>vo.aH.aneH.. of the hand. ,„H »SC.^ or THE THENAR ^^ , „. „ ., o, phalanx of thclhumb. U >^ " longus (sec vaj^c iQ?)- „,1 -ibdM. t^ lb.- tln'ml'- . ^,^^ n.ou-on, nmsdc «^ '8_i ana-^<)0)i>;i'^'il'i^'^^ ,' from tho lulHTosiiy The opponenspolUcis.^..- -^v -J^; ,^ ^„,,,,„ ,..vi. U --^.^^ ,\.^,,,,„ .,ul -r:::r;:ri;-7? :rr::-^^^^^^ ^ - tens bv oblique, partly U.nbcr carpal bone oHbe thumb. ;:;-T•-':S■':;:n;;^^:-'^^-^;?'"' ■■•■''■ ™ ... ,, ,s, ami 2,r^^ is situau-a ui 'l^^.'':'"' , ,„ ,he lum- The adductor pou-s ^^;^;--;;;^;, :,,,.,. .. u. «-"-'';::::-;:;■ z;:!, .hieh have ma^J^^ 200 ATLAS AND TEXT-ROOK OF HUMAN' .V^ATO^^V■. Fir.. 28-,.— Tlic palmar mu>clcs after removal of the palmar ai>oneurosir;. The tcnilon-li.alli .if thr nii.l.l!.- lMij;,r h;i.-. iRcn split l,■n^•lll^vl^<■. Fic. ^8a -The deep laver of the jjalmar musilcs. . , , it,.! have bfcn iiartly removed ami |>arlly drawn aside. the bott<.m <,f the carpal canal from the i^almar surfaces of llie lesser nn,hanf,'ular .trapezouli and capitate (os niasnum) Ixmes, hut the greater numlnr ari^e from liu- ,,al>nar surface ol the sh.ft of the I'.ird tnetacaqial bone, and pass almost hori/.ontally toward the narrow tendon ot insertion which i> attached to the basal phalanx of the thumb by means ol the ulnar .se.samoir rurve^ It adduets the .huntl., i. r., approvmale. the thumb and imlev-l-m;,.-,. THE MUSCLES OF THE HYPOTHENAR EMINENCE. The abductor digiti quinti ( Fi'Js. 285 and 200) i-^ the .tron-est and innermo-t muscle of the unnip. Il ari-e. from the j, inform bone, sometimes also from the transverse carpal li-ameni, and is inserte.l into the idnar l)onkr of the dorsal aponeiiroM- of the little fin.ger. U i, -upplied 1. the uii.ar „erve, ;,„d abdu. .- the little l„e;er, /. ... separate, the liitl,. in.n, the rin^; nns.T. The flexor digiti quinti brevis ( Mj^s. j8^ antl j86i arises from ilu- transverse (arpal li-a- menl anti fn-m the hamulus of the hamate (unciform 1 iHtne. it i^ a small slen.ler muscle situated t.tthcra.lial M.le of ihe alHlticIor and mav be entirely absent, or ftiM.I «ilh ihe opponent. In short te.ul.mof insertion isaltaehe-l besi.le that of the alHl.i. fr inf. the ba.s.l phalanx of the little lin.i^er. Il i, -uiM'lied bv the ulnar nerxe It l1e\e- th.- fir>i phalanx ..f ihr llttl,- Ihiixer. The opponens digiti quinti (Fi-s. .;8;v 28.,, am! j.»oi ari-es lo^ndher with the precedin- muscle aii.l runs to the ulnar border .d the nieta. arpal U-iie . Ihe ftuir interossei dorsales I Figs. j8i. jS;. anil jS.)i are l.uaied in the dorsal jMirtions (,f ih. four interovM'oii- sp.i. es, the largist being tile interossevis .iorsali:- primti-, which is situated Ixtween the metacarpal Ix.nes of tht thumb antl index finger. They arise by two heads from the oppo-ile surfaces of the conliguou- inela. arpal lH>nes and art the only muscles which are partly vi-JMe h:rva !■■.• f.i-cia ufjn tlf l>ai k of th.' hand. Near the heails of the metacarpal Iwnes 1 1 1 ^ I ^ --•§ i 1 l2 * ^■5 1 s- ^ i: ^^2 >J 11 i g •a 5r ^ 5 ^ -tS i ;* Mi f:-ff THE MTISn.KS OF THE HAND. 20 1 they terminate in short tendons which ra.liale into the dorsal aponeuroses of the l)asal j-halan^-es (see paide of the rini;-fin,L'i'r. The interossei volares (,Fi-s. .'8i ami jS-ji are three in number and arc deej.ly [.laced ni yii//T./.(irii.? ij/if «,.'.'/( /.' /i(i*'T,i*.s( H^ (Jor^ liJS I tal'im Ti'iiii'xfs '<; lumliriialfS ln!rro\';nis i/.e by a sj„.u. l„,,d, the lir>i one comin-,' from the ulnar l«>rd.r of the metacarpal l^-ne of the index fin ire r and the . < <.nd and ihinl fnmi the radial sides of the fourth and lifth metacarT)al Ixmes. Kach mas( h i> iiiM rted into thr extensor lendon of the fingiT from the metacarpal Ijone of whi. h it taU,- it^ origin. Ih. ir.dex fincer (onsenucntiv receives the tendon of an interosseus dorsalb uj-on il. radial sidi- and k 202 ATLAS AND TK.XT-BOOK OF HI ■^^A^• ANATOMY. Trttilim of txtnisi>r tliy/ifonim ciiniiu. Tnidnii oj inlcrnssciis Tciidmi ni Inmliriiiilis Tcnil.nl ,•■ ;h-x,:r .li.JU'rum fillil,"! oj ;hxi:r Jl^iturum silblimis pro/:iiliitis Ik. vM,.-I)iai;r.Lm -li.."iiim'i..-nl.ilinii.>f ihc uml..iu ..f ihr iiil.r.i.-., i ami lunil.ri, :il<;^ to tlir :. .'H; — I)Mi;ram ..f ttii- inl. nw^i i vo!.iris. l-'lii. jS-v. l)i.ii;tam "I tli' kmilirii .ilcs. i^a^' '^^^m^^im^^mimmi Till-; AIVSCMS OK TTIK HANP. 20; the tendon of an intcrosscus volaris uj.on it> ulnar >\i\v; the middle Im^'er has iw.. ml iovmi dorsales; the ring-lmj^'er has a volar tendon uiK.n its radial, and a dorsal tend.ni upon its ulnar side; and the link' linger received a sin!,de tendon, that of the third inlerosseus volaris, upon its radial side. The interossei dorsali s re posterior an, xvhieh conswiuently sej^aiaie the tuo .^nnips of interossei in the region of their insertions. [ V, .f.u-.l al.uvr, i, i~ . u>t..marv .0 r,-, n^;ni/.■ but ihr.v int. f.^M^i vnl;,rr., A l..nnli i-, h..^^^^.■r prrM„t in tl.r i,.>->ii of ,,n ,-N.v,.,linKlv hmWr nn,- 1.- wlii.i, .i,-i>.'> frun, th, InM ,n,..„,,i,ul ..n.l i~ in-, rtr.l n,... .!..■ nln.n -..!,■ .4 th.- I..,..' „f th. l-.r.-t ,,h.lanv „f In. ihuniL ;,IonK witl, th.- ulnar lua.l ,,f tlv -Lx,,,- hn^i. ,,.,lli. i-. ui-h ^^hi, 1, nu,-, I. n ,. (,.■.,», nlly nion- .ir li-^s I'McnsiviIy fused.- i:ri.] ., , Ml ,,: llu- i>U,T,.->.-i ar.- wsiullv sui.|.ii..l l.v ih.- nln.,,- u.■r^,. Th. v . ilb.T al»|... 1 ..r ...l.lu, t th.- In.«. . -, , h, nn,,,!!.- nnmr mnv b.- P,..v,-<1 unvanl eith.-r tin- in,l.A.hnt;,T .,r rint; hnt;. r by th.- ... li.in .,f i;- int. n,.-. . .|..,-.,l. th.- n. n n,i, r- .,-s™. .l..i^^.ais ,,ulls th.- it,.l.-x-lin^;,r l,m-.,ni tit.- thutttb; th,- la,t .,n.- .Iraw. th,- rinu hntt.r t.a.var.l th.- bill. hn^;. .. I h.^ ,n-,t v.,iari. ,mll. th.- i.i.l.-x f.war.l th.- mi.l-li.- hnt;,-r; th.- -,.-,...1.1 .Ir.tw- tb.- rinu t....ar.l th. nn.l.ll.- tin,-, r; ,,n,l tlu thii.l adducts th- httU- t,.war.l th,- rint;fmn,r. Th.- int.-r.,.ssi-i aK., ;- - IM th,- a,ti,.n .-f th. bnnbii, ai,~ .- . 1 . l,.« 1. The fciur himhriailis , Fi-^. 2.^,^ 2,S(., 2.S.S, and ->()0i are lon.t;, narrow, wtirni like niustles whieh ariM- .leep in the palm frt.m the f.mr tendons of the llexor .li..iib-rum profunilus. Th, two radial lauseli-s arisi- hv a single lu-atl from thi- radial borders of the two ranini,.n \sith ihe interossei. Th.- t-.v,, ra.i;..l lumliricali-s ar,- u.ualK- ,,-i.|.li.-.l by th. ni.-han n.-iv.-, th.- tw<. ulnar by tb.- ubia: ->, rv.-. 'l b, y ll.-x th, ba>:ii l.halani.', < ..f th.- litli!,-rs all.l , \t,n.l tb,- ■■ • -.ml -in.l tibr.l lilialani;, -. THE RELATIONS OF THE EXTENSOR TENDONS AND THEIR SHEATHS BENEATH THE DORSAL CARPAL LIGAMENTS. A- the teiidnns of the- .-Mens.n- .d du- hand an.l ..f the lingers jiass M\er ilu- wiiM joint (Mgs 280. 283, a.i.l 2.S,,) lluv are . n, I ,-d in th,- ■.vno^ial sh.alhs an.l h, Id in tit- l'vo.im- uj.on lib- .l.trsal slirfa..s of ih,- ra,h,. miuI uln.i liy a tlii, k, n.d p.irtion of tlu- air 'na, hial la- ia. ih, ^lon„l ,arf>al > posUno, ,i,nn,!.ir, liL'.im.-nl. ■I'lu- iii.livi.lual -ymnial -lualb n -ilual,,! in .lili.i.nl .omiiartnu ,,1 iln ligam, la, -in..- thi- -trmtuiv i-aiia, h..l m the l.ingilu.hnal lidg,- upon ih.- boiie-- .ind ,-peiially 1" ; 11— ,- .if th,- ladm-. ■I'l,.-M-,,.inpartni, 111 ..ill b.- .1,-^, 1 ibe.l in ill.- .ml.T in v.hi. h ih. \ ,in- , m ot: it, ml in i,i--ing iHim th,- radial to th.- ulnar .-i.le pa-lhrotu;ha,oinun .ompartin, nt an,l lo a ,.rlain .■M.tii are in\.Me.l bv a ..Mnmoti -\ ;io\ iaUh.ath. T!u-s.-.on.l , ..m^.a-ini. iii fiN.- pa-;i-.'.- to th, I.lid.in- .if th, .-M.tiMir ..tri ,,|i,ili- loni^u- .tnd brev i-, wlii, b u-ualb, po-, - ■ -' niu.il svno\ial -1uaih-. The thi;-'l . .nniiarimenl i- -niu fiii iallv pla...l in.l i- noi lon;^ib,...ii.il but ..bli.|ue; il .fo-e-llu- tendons an.l -ynovi.il di, ath- ,.f ih, iti.ir. .l.-,p!v -itualt.l -,.on,l .omoar! m.nt at an a. tite angk and lont.iin- tlu- len.l.m an.l -ynoxial -h.-alh of th. , M. n-or imiIIi, 1- l.MiL'us. NeM follows the larg.-t of all the < .mipar- uent-; il .ontain- 111 .. (.imnion di.aih ilu 204 ATLAS AND TF.XT-HOOK OF HUMAN ANATOMY. four tendons of the extensor digitoru i communis and that of the extensor indicis proi)rius. The fifth eomiKirtment contains the slencK." tendon of the extensor digiti X" j-roprius and is superficially situated. The Mxlh and last compartment gives passage to the tendon of the extensor carpi ' The syno\'al sheaths are considirahlv longer than the width of tlv dorsal carpal ligament; those of the extensores communis, indicis, and digiti X' may extend to the middle of the meta- carpus. Tendons nj f.v/cin.ir Jii^il.'nim Jtiihliir r tniilinuin '-' / . ,1,1, III -\h ■ nil •', rxtntsor - ' l\ii,i.ni-sli,-i:l! .■/ i-MeiiSiir' ( irpi it'll ir;^ I, i:\,,r (//i;.; 'mm ,liui :.\t(i:- .si'r iihli, i\ IiUir,is^,iis il'irs.ilis ! 1 riuliiU'^h'-ilh i>i 'Xtin'or n.illici'i f,rr:'is '\ I n:,l -l\lie,llh oj ,lh.l li, t.ir piilliiis l or dor.al apuneuroM. nl the fingers i ligs. 2,Si , 'SO, and -'8(), are < iiiefiy romoosed ..f the ten.ion. of llu' extensoirs digilorum, hut al-c. receive fibers from the tendons of the inlero>>ei and lumldnales. THi: MLSCLKS OF THl". 1IAM>. .^O! The tendon of the extensor or those of .h> t^vo extensors* which pass to a fmger, beconu- flattened in the region of the metacarpo-phalanseal joint anses are "rmly attache.l t.. the onvex surfaces of th.- phalanges an.l are intimately connected w^'H the articular caj-sules of the interphalangeal j..mts. THE TENDONS AND SYNOVIAL SHEATHS OF THE FLEXOR TENDONS IN THE PALM. ]„st as the exteuM.r ten.l.ms run in synovial sheaths upon the back ..f the han.l, s., wc- find the tendons of the llexores digit<,rum, and those of the llexor pollicis L.ngus an.l tlexor c.rp. ra,h- alis .urroun.le,l bv svn.nial sheath^ an.l passing beneath the Irausv.rsr carpal U,, mm ,n the carpal canal (Figs. .8,, 285, an.l 2 p). The llexo;- carpi ulnari. has n.. synovial sheath. I he outermost synovial shea.h in the ca.pal canal ,Fig. 282) is that of the tl.xor carp, ra.hahs, whuh extends t.. near th. inserti..n ..f the ten.l.,n an.l is alm.,st enli.vly .-onceale.l by tin. ..r.gnis ..1 the thenar mus.les. \, xt this sheath is the l.-ng narr..w ..ne f.,r the tlex..r p..ll.. >s l.mgus, wh.ch extemls fn.rn ,h.^ .p'-" '"^"-Si" "^ "^^' ^^'"--■^^^' ''''^'''^ "«=^"^^"^ '" "^'' "'?'T I/'^^''^'"". '" ' ^' thumb. Next in .n-der. passing towar.l the ulnar si.le. is th.. large sh.alh wh,ch eontams the eight len.ions .,f the llexor .ligit..rum sublimit an.l pr.>fun.lus; it cmmences al)..v.. the transvet-se carpal ligament and exten.ls t.. about -he mi.l.Ue ..f the palm. Only tiu^ svn.-vrd slnath t.>r th.. tendons .)f the little finmr i- . ontinued dire.tly int.. the tmger itsell. The fingers p..ssess >.parate svn.nial sheaths (Fig. 2.p>, ...mm.n.hig at th.. m.ta. (,rp.>^ ,,halan.-eal pints an.l exten.ling to the !....■> of tl^e t.rminal phalang... wlti.h a,v .um.un.le.l bv fibrni. structures kn.nvn a. the vaginal ligaments , Fig. 28.. In tlte -li-tai port,.,,, ot tlu- lingers th..^.. sheaths became thinner a.i.l (ct frcpiently int..rn!pte.l, an.l a. .■..-.hng as t.. wh..th..r thc'r fas.iculi cross ea.h .uher ..r are arra,ige,l circularly i,t this Mtuati..n. n-unal a,„l annular lii'am..nts mav be .listingui ,tM i,nm,.,ha,. ly up.,n^thnM. „f ,lH. pn.fundus within the teml..n-slu-alhs. but at th.' mi.M', ..i tl,e firM phaiang.. ihev „.ule, forminl: >lits whi.h give passage to the t.n.Ums .f the pn.lOn.lus. In lhi> Mfuaf.m the ,t..r ,,n.l.u.s bec.me s..mewhat broa.l.r, exhibit an i.vlistin.t nu-.lian l^ngitu.itnai n.snr... a,,. a,v eveniualiv attached t.. the bases of the ungual phalang.'s. Th.e tu.. shps ,.| .a. h snbhnu. ^Th. i:^.:: uliins. k^j^: 206 ATLAS AND TEXT-BOOK OK HU.M/VN .VNATOM\. 'I riuioii-slltdl}i I'j :l(.\ •!■ ■ Ahiwii'r pi'lli'i-. ''rr:i O/it""!! "■' ,''■■/''■' " I. •'"'■"' inij. 'II ,•, rxuiis. urp: r,itii-u l^nir TflM'H-sh.f-ill' !'■ :l''y'f thiili'l-. I,nii;lis l)ii;il'i! \li,;illis of tfitdoiis ■ C'lnmu'ii ttiid'"!- slir.llll 11; jh-.wrcs dK,:. Opp'iifiis di-^iii V Trin'i-rrsr r.irii'il lii^itmnil ■J'liid.iii «: iliwr i.irfn iilinris T r.ia.m ^::ri:i: ■■; ;:: ;, ._ JJ;iiM\ ,111,1 n't :hx,:r ,/,■„■. firnjimdln ri,., j,,o.— Tlu'.irr.mn.ni.nt ..( th, trn.l..ii-sli> .uh-, ■ 't 1 h, l.mi; llr\.,r~.i il"! ih.- |K'\. .r ...rpi r.i.ii.ili- 1 M,in.« h.ii .1 THE FASCIA OF THK UPPER EXTREMITY. -°7 tendon pass beneath that of the profundus and are attaehed to th. f ^-^' --"--^;;;;;-;';^ 1 . .,, flv.t th,. tendons of the Ikxor sul)limis are tonsc.iuently pcrloratc-d In tho.c .-1 the :;:::::" irl »,:'.■«*.>,. ■>... ...n,. m, i„s„„.„ ;,„„ ,i, -n.. ...... .1.. ...... proiunuusiuL , , ' , ry, ,, tindons are im rcetlv eonneelc-d with thr IkimI t'l rlll't^:^- t^ <.f ::w;."l. ^"n.e of .h.h ar. thr.ad-li.e .n.ifonn,. £:X '^ ,:^ uh;^Xse in the noddle phalanx, are triangular. Tiu, n-U onl^- c.,nneet :;!: tenil^"ol the sublhnis and profundus to the hasal phalan..s, but al.o those of the pr..- fundus to the middle iihalanf^es. •l-HE FASCLE OF THE UPPER EXTREMITY. The muscular masses of ,hc upper extremity are enveloped by a o.mmon faseia (H^s. ..,, and ' ) -hieh is particularlv w.ll dcvdope.l in the arm and .otvarm at.l whteh ha> ,....1 d^.;cm names in iilTetvnt re.,ions. M the shoulder the.,v are r.o.nt.ed at, -:.y/ ..v, a «/^ , an n,jr„s,>ina,us. and a .suksn,pular /„,./„.• in the arm. the l.raJn.l ,,snu, ,n the o "a m' t^ Jlil'rM /— and in the hand, the .loru.l l„sn,. and the ^1.,,,. ,, t>...,.ros,s X v///„n. /„./„ , Ki,. ., . i> a thin lau. wl,iei> elo.es in the ax.Ua,. eav.ty. I. ts dt.-eti continls below^with the mueh s.rott.er brachi.d faseia, i. perf,.ntUj by a ---;;• vessels, ami contains .several strong, fasciculi .sometimes mu.cular) v,hu h p.i>.. lion, tli. ia„. " ^"^n;!;;/.-.. ;-'■/.' -vers the supraspinatus an.l is partly u.dinoi. in '_'-;;-; ; The n,n,s hu,l„s /„./„ ,Fi,. .,8- i> a very elense. ten.hnou. .ase ,a wh . 1, . o.eis th n.t spinll:. the teL mi.or, aiul the te-res majo,., .ivin. partial ori,i„ ,o the Ur. two mu.le.^ and also to the eleltoideus, beneath which muse le it ' uluaily .l.>ap,.ear>. The.v,r^vn//>, ■.capulans nu.>cle- Hn„ f , , i.. The l,nukial jJia , Vl^. .... an.l :o. > is .he immeeliate e,.„„nua,u,n „, th.. preevehn, f, >< , .„., ^ .i.^. thin i.ve the insertion of the deltotde-u. 1, cot.i.^ . lu-ly o, n---; -' ' ' and u,l it^ ante-rior H.rfaev ,1,.. ivlie 1 ,.f .he. hie.ps may be .iiMmctly ,ve.„n..e d. to . . u , Md " V e uateel the . v.r,,,,/ .uul inl.n,.,l lun pUal ,ro.nrs. In tii,. lo..r par, o. the- an,, lt:':i nese.U the t.o i..n,u..„!„r . ,„ .Inch pa. to tlu- bo,, be-tweeii le ,.o nm. u .. ^,-oup> of thi. region, the inlrnul inUnnu.ul.r . punn exten.hu,. .L-nuaiel „> ,1,. nncn.d cicon.lvK' a,i.l the cxUnud on.- to the extei-nal epie .'ti.lyle. ' The a,;uri.,r surta. .■ of .he fa. ,a e-xhibit. orilieo ,..r th.. pa.a.e .„ nUan.... n. ...^ an.l veins, do,- further . an.hl,.- /./-•, , ,^ . . f ,h,- l-icep. t.-ud.,n .e-e pa,.- iSS^ i. ,-e-aliv form.-,l bv this fa.ia. 1, ,. . i.nne. ,n L cubital f..>.. an.i ove,- the l.a. hiora.liali. an.l exten.-r ea.pi ra.liah. i.,n,u. unh ulu.l, „ '^Td:-';:::::-,po,-,,..noftl,ef..r.-a,-mthea,n,b,.a.h,a,fa.ia.. T .lee-per lav.,^ .h,. li ..nelos.. the in.liu.lnal mu.el.s an.l ten.l..,,.. ■lo.a.d tlie .,i.~.Ju,nt the ^olar and eiot.ai y^ if^^ M.^!m 208 ATLAS AND TEXT-BOOK OF HUiLVN .VNATOMY. Fig 2gi -The fascia of the left arm seen from the volar surface. Fig. 292.-The fascia of the left arm seen fn.m the dorsal surface. surftce. arc reinforced bv strong circular fibers, forming the volar carpal ';^--""j!«; J^J^j S!ch is situated above the .rist-joinl and over the flexor tendons and is continuous bv its distal ..^hichpasse^J.^ t^ :r Ih ti^^ uti>-l a4,artn.ents for the extensor tendon, .see page .03). T^ie W / 1 : ./ ,k. Mnd commences at the distal margin of the dorsal carpal hgament .s it^ V ervthii, .he line of demarcation is much more noticeable than is ^^e one bcu - ^ Hgament and the an.ibrachial fascia. The palmar aponcnros. (see page 198) .s .ell dc^eloped and is by far the strongest of the fascia; of the upper extremity. THE MOST IMPORTANT BURS^ OF THE UPPER EXTREMITY. ,. The sulnuro,nial hursa is situated beneath the acromion and above the insertion of the tendon of the supraspinatus. of the humerus. I. s: ;r:;'::r ,:x:^ .: '.^^ir" n„„„ ,„ ,„.. ».,. .« .. greater tubercular ridge. - The hiirsa oj tlir latissiimis dors, (see pat ■ '4^))- S' The sul.J„ro,.s oUcranal hursa .Fig. = -> between the olecranon an.l the .k n. I The 'suluuiancous rpianuiylar burs. unUrnal an/»ll i/-_,.^^j ,.y^^'Wr THK MT-Sn.KS OF THK I.OWKR KXT U'.MITV. 209 >8. The inl.rmrlacarpophah,i>Kcal bursa; s.tuatc.l at tlu m uu.iqx [ posterior to tlu- lapitular li^..;-'"ts. ■ , . vinmitv ,,„ .-arli.-st ililT.T,miatinnnl,M'n;it.UM "I llu- u,,,.>-i- ; ^^^ ^^^ ^.^^^^^ ^^^^^^ ^,^^^j ^^,,i,,, |„,^ „|„„, ,h,- ,,..l.-n..r the musrU- sh.-,-t xvhi. !, U.- vip-n tlu- |.oM>T,ur or ,M.n>,, - . ,„„un„r ,.r, a- tlu v „., |,r. UrM.lv l,n,u-.l. p„s,-u.u,l mu.,l.s. a.ul a s, end ,r.,t,i. -t ,n.^a.,..l ->- '' ' ^^ ^ ;^"^,„.^ „„. ,^,,,,i.,„„,,„ „f tlu- cnls ,.f ,1,. '.ra, l.ial that tlK- fornu-r, in so far as ,lu-y ar. su.M- u-. '--^^^'^^ ,,.,, „;, ,„,^„ ,,.. ,,,,,H..,1 l,v .Urivam.- of tlu- . .-i-r plexus, mcixr tlu-ir ittnm-atum through t.-. po^Uru.r .oni, (;•. c, the imiiT anil out.-rW'ords. , ,- , ,„„,nt~ ,- uivcii al»A., mavllu r, fore !..■ -.'I'liK tiu ■ tr.| The elassilVation of the limb muscles aeconhnK ""!>'■ ''"''• - *^"" "'- ''^ ^'" l,v dlvi.li,tR each set imo a ,.ost-axial an,l a l'^'^-^';':'' »^;";';; "l"^;,,, ,,,1 „,, ,,,„„, ,„u., les a.ul the -u,.er.u i.,! -nu-, les ■ 1. Thk MfS.-i.KS OF Tin: S11(H1.I>1,K (to whuh ^ho.il.i I.. a,l I of the l.ac k with the eN.epti...! of the tra|.e/.iu>l. ^,^^^^,,,^. ,„„,,„„, ,/,/,„„/,-»,s. w,,-..;- ,„) ,..,s.-axial muscles: ln:.U>r so,^-, rl'o'ohouUu. «u.,.r. / . ' '"' ,/,> I-re-axial museles: /.,-,/»r„/» -»„;«r, /-er/»^./^< - .w,M,„ <»., an II. Tin: Misci.Ks or iiiK vpi-kk aum- („^ I'ost-asial nuisiles; (r/.r/n. .l>ini/H-H.v. (M l're-axialniu>^le^: I'i.rp^. hr.uhuUis. III. Tilt: Mtsci.is or thi, ioki ahm. _,^ ., ■ ,.,„,„„;, ,„,;.,-,, ,,v/,-„s„. (.n I^.s.-a^ial nu.s.les: / ■''"-"■"-'-"■";;.;;':/'„:';, r.,,,,,.,,,,,-, „/„/„.... ,-//- /-.<-■ '— ^ ,:„„, „r..is, r.,..s,:r ^f-;^'";-;;;^ :";,-;:: ::;-:Z.. ,r i'.'^. ,.(.\'' ■ / suh/inus. lt,'Xor ,Ii,qilori,m pr,. ,„) r,st-axi.ll museles: wanting; „..,„„-», /,-,///,;../;«- hr,vi^ pollUh. alnhu :.>r (M m-axial muscles: A""'"-. -X;..!: ' ; i.t/, /.-..^Wo,,^ ,.-/,/«./- ^.//'-. '"— ^-^--- ' "' dorsales. — !'•"] THE MUSCLES OF THE LOWER EXTREMITY. t::'^T:::rz^:r:z.f2:L ,.„. , -»".-- ;- - -^ M.l. tl; ;,;;:;,:'::?;,::'„;:;;i:n:;::-":;:,»:-';; -4-;:;:;:;:;:", ;;:,;:;:,:: ini,nus. an.! tlu- ,./.,'»r„/,.- ,.v/,r;,».s.- .v.A ihos. nl iiu- i)o niiundb ,.1 il... V, iiw'i)). mln-iiniisu< i:;,: w .IU-.V > , i„.n.i..i .:..■ ---; < ";- '7::':::'!;;"";:":;:;;: ?m-?^. ■' I Li; 210 ATI.AS AND TT.XT BOOK OF IIIMAN ANATOMY. f .,r . .,rrin.'.■ ..>■ '"t,;:! :,:.;:.;. -.-«.' '■'■••■" "» ami the /«/.r,»..r/ are al.o situated in the sole of the foot. THE MUSCLES O^ THE HIP. THE INTERNAL MUSCLES OF THE HIP, THE ILIOPSOAS. .,n,l ^noi i> (omix.-i'l of 111" A^.i.v mnior and the The iliopsoas ,Fi,^. .;., .0, ^07. .... and -^ '^ ^^,^ J ,,^,^ ,,,,,.1 .^ „,,!, ,//.,. ».,wl,i.h are eompletely se,arated ,n the ui^per poUmn o, i,,.„,.n. This n.u.le fre,,uen,lv al.o ineh.de. ';;-;;;';-;.. ^,^ ^, ^^,,,,, , „„,,, „, .He •nu. psoas major ,- a ion,. >.ron, mus.le, tin ^ •'^'''^f ^,,^,, „„,.,.,. .f,!,, twelfth posterior aUlonnnai .all. 1. arises from the upper and ''; ^ ^ p'^' ^ ,^,^^.,. ,„, f,„„ „te i'->'- -'■ - ":■ ^-;-!'; ' -;,;.\'r ::,: :;;;;,; ,;; : ;i:;: :;'.: ^lii^^ ..n.u. mmhar ver,e^ ''::;: e':n:;:::-;^^^.'i;'•"n:.a;ed ,. „„ ...rs proeeedm. f,..n the vertebral l.d.es. :,;;,;:;.::: ^..-nin, .. ...u. p... pa. ,., ;•-;;';;--:;;::;;::;;;,, ,., ,„, ,„„.,,,K ;„„1 |,.l,,u uiih the inner nKU-.n ol ihe iluuu^ I h. inn.r mar^ ■'"■ 'n"~ "';.'.m'.;,.! iii....... !■:.".- 1™™"' '•""i"'-> !«»"■■" """"«" "■" "',":"'" '■"""■' THK MUSCLICS OF THK HIP. 211 j,,,t th.a. is a bur., whi.h not infrequently n,n,nu.nica,.s.i,h tlu- ania,hu- >avi,v, ,1,. i!iof.r. tiiual hiirsii (Fig. 2i)S). , i i,- ; .,n , ^ li 1., ■! llat V psoas minor (Fig. 2,8) is present in sonu.vhat more than hall ol all .a>c . It is a at thin'mtle. Ivin, upon the psoas ntajor an.l aris,n, Hon, the l.o.lv o, the la. , ..nuae o the tZ Zl a vJne Jand from the in,ervertel>ral .lise between the two. 1 he nu,. le soon passes !;:; !; ;;!: Ldon whieh Ix^onK. continuous wuh the iliac fas. ia eoverin. the thopsoas ,sec pa.e 2;, I) and i> inserted with thi^ fas. ia in the re-L.n of the iliopectineal .■minence. 'Ilu- ilin|,s,,.,~ is supiilira fnmi lb. lu.'ilur iiles...^. H A'""'^ ,h,- llnKh an.l al>., rnlal, . il slinhuy inuar.l. -fh,- [.s-as .mn„r is a unsor of ihc ili.u fast ia. ■0 THE GLUTEAL MUSCLES. The glutaeus maximus di.u's. 2.),^ and 204^ '^ a large slron- muscle, particularly thi. k* in its lower porti.m, and is situate.l in the ghit.al re-i.m im mediatelv Ik neath the skin. It is covere.l hy a thni layer of fascia and by lite layer of sub. utan.-.ui^ lat which is very well f ihe sa. rum and ...i.w i.md fiom the posteri.>r sa.r.nlia. liganunt in thi> Mlua tion), and from die >a.ro lubenno ligament. Its hlnrs iia^s fmni aUive dowiiwanl and from widiin outward. The faM i. uli ar.' vuuisually thi. k an.l -lis tin.tly >eparate. gU.,a.us nta.mus is m re,a.ion with ,h.. p..s„.,ior la.. .,f ,H Untd..,.. .rsal fa'lia. .her.^ this s.ru.ture gives origin ,., the lat, tt. the -'- n. evt. d ,lni..n is in ivladon with the glutaus me.lu.s a„,l the glut.al 1... ,,, uhi, h .in.lops 1 ut r , t, „ run -th.. tub..n.sity .,f the i. hium an.l the ..rigius o, tlu ,lev..r group o. . . -^ ; MS, tluse latt. r making tlu ir app. arance beneath tl... fas. ia below ,h. mneran.l 1 1 i^\ '/: .,....-70 wtf ^■.fAAJ' W.y .,ll;:lll- "1 111. Ill" ' l^l"''' ' "1"'" ''" ,|,.l iiin .il 111. ihan. Ih. rl.lH.il III..-. 11. ..fti. nt..lliV 111. .I..U..I lill'-- I 1.; ♦ 1 111 i;lill.lll- m.lXiiil.l- i.m "1 Ui. liiii Ml III 212 ATIAS AN1> TEXT-BOOK OF HUMAN ANATOMY. Tl>. Rluui-us maxi.nu. has'lH-cn .li^ic/...cn./,»«. a.,,^ ,.K xncaU..^ ^^^^^^ ^^^ ^^^. ^^^_^^^^^ ^^^^.^^^ uonal burs^e. the ,/«/../""-''' '"'-" ^ ^ '! ^'-,; .,, f,n.oris. and the adductor mint- the nirif..rmis, the obturator mternus and semelh, the mus are c..vere -u,,,>lKa l,y th.- inf.ricr gUUcal n.rv. "'"''^""~ .. , ■ on- , is lis,, 1 strong, flat, thick muscle, part of Nvhich is Th. glutaeus mediUS ,1 .«s. . - <> ^- .»- ' ward and inuaid. 1 lu slioit ano 1 f.,. ns ihe tin of this pnK-ess. ,,urv, the />.'>" ^/<'^ /'"rva »/ ///. f^luKrus malms . !• .g. ^o. K , , , „, ha,., t,,h..lhiKh; thclawr anterior ,K,m.,n ,,!-.. uls as ,,„, „„,.U ,. .u,,,,li.a 1.V >;u. ->„.,n.,r gU.,,.! - ; , ^J ' " ,^ .., i,:'.,f i„„„,.aiat. t..na.,n ana l.y a .l.mKm ,„,„...-n,ar..ta,or,th, ,«.>t.rior,K,rt (n .,>., n,lv . h,>r,., t, n/, . 1 ;,„,,,j„„„f„,r,lurO.,Koasan.-M.TnalroC,l.. ,- ,o ,oi and '0^1 i- a Hal, broa.l. fan-like muscle whi.nhcs The gluteus mm.mus il.tr^. -m, .,o., an i ■ °- „f „,^. .^lieula. tap ""- r, "T'^ •"• r" H :;s;^^;r::;h"::;s:n!.; :-:• ^"^ .- >" '--- ";■ ---' :-• ::;::;;:^n;::'i;;;t::;v:,::r--^^^ -"^•■— ^ ,,„g,u,a.-,„in,nn,-,hU.h, ,u,., .-..,,..„ a ,o , .' •' " "' ( iliamtioni , , . 1 • 1 • t .!!.. ..>-.;■' t!'.'.:-: !; >.vn!'-!l IS ..■ u ..il ,r«-\ Ui jn 1 ) i^ a uivitie*''** ;w::u.u ■ " •* £ 2 B <3 •■r, O ■A- " ■'^^' ' *^^.'^'''''' THF. MX-SCLKS OF TTIK IllP. 21,^ covered by the gluteus melius and minimus, the midcile .,r main ,...rt.nn of ,he muscle .s d.rec- ly beneath the sh.ta'us maximus, an.l the origin i> situated wi.hin the pelvic c avUv. 1. ar,-. s In.m he pelvic surface of the sacrum a. the maruin. of the anUrior sacral foranv.na II lo 1\ - tre.|ucn.lv also from between the foramina or concealin,- ihem ., and !,om ,he mar.nn ..f .iu- ,n-, ,,.cr . u„u no,, h. \fter leavinfi its Hat and broad ..ri.i-in, the muscle l,ecomes M.nuwiu,, narrower, pa-M-. ihrou^^h 'the middle of the greater sciatic foramen, beneath ,he uluta u> maxima. becon,c. lendmou. rather abrupllv. and is inserted bv a slen i- u.ullv M„,,liul !n .lir.-. , ...uW^ fmn, -lu- -, i.,... ,t. vu- 1. i- an , v., rn.l ..,ca.„. „ , .■ lim, - |Krf..niUil l.y ,. |,.,rUi.n ..f tin m iali. n. i \. . The Obturator internus (Fig^. 20-. and ;,oo to :,02), like the pirifomti^. aii.o in the true pelvi., but U ,,as.es to the gluteal region through the lo.er m iatic foratnen. 1 he tm.sclc ar,-.. Irom the obturator membrane atid the a.lja.ent surface, of tlu pul.i. and ,Mh,u,., and, ,0 a .cr ,,in exten. from the obturator fa. ia. 1- i> very broad at it, origin, bu, become, n.arkc.lly nar rower as its tlbers converge toward the lesser .iatic foramen, in passing through winch the muscle bends at aimo., a right angle anmn.l the tnargin of the lesser sa. ro.. iatic notch, the Mirlacc duvcted ,.,,,,1 UK- bone being ten.linou., and reaches th,- gh.teal region, .here ,, .o„n t.-tnunates u, a slighllv naltencl tendon which passe, directly to the trochanteri. lo.s., where ,t ,. ntM-rtcl. Vfter pasMug through the lesser viatic foramen a,>d rea.lung the poMetaor M,r a.e ol he pelvis the inu.le receive- two accc^orv head, in the for,, of the .lender ,.null, he ,n„rllus luprrior ari.es from the spine of the ischium, the .n.llns ,n,nor front the- tMlnai ubcros, y. Tlev are inserted into the ten.lon of the obturator internus ahno., tltroughon, ,h, ,r en.ue K ng h, so that thev together with the t.ndon form a kittd of pennitonn nn..,l.. XMutv th. obtura or iniernt.s l.nd: about the margin of the leer .ciati. notch th.re ,. c^nMantlv .ttuated a bursa, the 6»rs., ./ the oblunilor iul, attd upott the tnu- I lu . the tin, k .c.tta nerve. ,,„. .,,„„,„, ;„„„„„. ,„^„„„. .„,. ,!„■ ..n,.ni. i- u.ull. .u,,,l,.,l t. .!,.„ ..„„.,„.. „ ,1,. -n --i fi-u- l.ikr ill. pirif..Mni,. it i . .in . xl. rn.il ...i.c.or ol llu- ilii^li. Th,- quadratus femoris d- ig>. ..,. and ,o. li. a Hat, thi, k. r.itangular mu.. k- .ituat.d in (,..„, f „u. glu.a-u,. tnaxinn... I- an.c frotn the out.-r b,„d. r of the tub. ,o.,.y o, the wihunn ^,d in.crt. L a .ho,-, tendon into the inte-t,-o. hanteric tidg. . The upp.r tnargtu ,. the nu.. - i, in nntncdiate relation wi,h ,h,- .. tnellu. mt.-rio,-. and the k.w r n,a,-.,n u„h tin- „ddu. ,,. n n nu,.. r.ually betuath the .,uad,,atu., or in the grouv,- betuien tt and th,- mntellu. ,nl,-M,„ . ,u,,. die obturator extcrnu., upor, whi, h li,. th,- s> iati, mvw. ■llu .|,l.nll --I- I' ,,1,. ,ll„ i!„. Mi.iii, n. r>> ll i- an.M'-rn,,! i..i. i lii.-ihu'li The tensor fasci« lat« -I-'ig.. .., ami ...o, i. a tl.it ,lo-u:at,,l nm.,1. , nart-,iw ab,.,- atul ,, . .1 I... ..,■ ,l„. r,,. ;., Inlil i.,-,' D.IL',- J ; 'I in tiu U],p, I broad iieiow. "in, h I- .Mu,.i, ! ll,;-*, - • ■■'.'.■ , ,i , , ,, i,,„ i-,.,,m ,,„„,,, „..,.han„-ri,, an-l .-M.rnal femoral r.-.ion. I, aii.,. bv .. ^hort an.l .kit nndon bo,n ^ . 214 ATI.AS AND TKXT «OOK OF Ul MAN ANATOMY. rC .;.,1 1 ,v..r of mu-^clvs „f Ihc anterior surface of the li.ish. I- IG. 207-- ril- m"^^ '^^ :;.,,,, i„^,,i„,, |iK.,„..,U h... als.. be.-,. r>move K.iM' tlu- I. iisi.m uf the fascia lata. ).() Till.- mu «l^^^u,.,.l..al>^•th,■^u,.,■ri.,r^luu,am■rv,■ami THE MUSCLES OF THE THIGH. THE SARTORIUS. .„H.ri..r surface of fhe thi^h. ttt.i is U. -n.. ;— ^ ^ t' ^ ^-^ "^ ^'^^^ '''''' "^"^^'^' superior ^,,ine of tlu. iliu.11 m co.iimon ^^ tth he U ">"■ '^^ ' j,^^^ ^^^,, ^.,,1 ...vnwar.l U^omes eonsiclerahlv i.roader for a short thst.UK. ; ^ ^^^ ^J ^,,^.^^^ ,,, „,,,,, ,..,.,.. U-low the iliopsoas ami u,>ou th. upper portton ' ' _„.,, ,„, ,,,hes U.. va.us tn.,ia,ts ami the ad.lu. --- ^^ '^'t ^ ^.a.iou \. gradually U.eo..es ,H. lower ,.rtiou of the -'-V ^ 't^^ras anterior in the upper portion of the thi«h narrower and ts ,w ts ed . ^ ' ^^^ \,.,^i„„ ,,„,u. the outer (anterior, niar.ni o, the ,ra- n,nv iKeonus nnernal. It tlu ti laKCs up a ^^^^.^ ^^^^^^ ^^^ ^^^^,^, ,,, „,^. ^^^^,,.. "",. ■ ":,'■- "■" "■■•" ""°'""'"' THE MUSCLES OF THE ANTERIOR SURFACE. THE HUSCLna ur ir... ~ •.1„. quadriceps femoris iKis* =*>.' --'A .l"' •'"■^^^^^^ T,,, rectus fcmorls ,1..^>. •* ■" -'*' '";."':;.;„,,,, ,„,, ■i„„„„li,mly I,. .,,,,.1, .1..- t':,;;;;:;;;. .is::;;;::::,,,; 1.™ a,,,, «.» ...^ --^ "™ »- "- ^^ ■""- *riii' ,,irliiriii> a .lv,|«.-,s,'- ,lh.-l.>iW-t MUl iM iilar (a^iUuli in lli'- I""')' Anterior super, spine of iliu;n Tensor _ „. fasciae latae llicitibial ' baud of fascia lata -^ Prontontory Unrtorius Tensor fasciae Piriformier,>on iron, a .end,nou> s,r,,, in ;lu. mi.ldk'of ,he nn»ele. The Hat ten.ion <,l in>eni..n .onu.Hnees up'-n the anterior a.peel of the museular belly a few eentimeters above the i>a,ella and uniu.> wuh tl^e rc.nanung head. ,o pass to the ujiiier margin of this l)one. , ■, , i The vastus medians unUmus. .Fig^. ...(. to ..S. i^ a large, llat. dn. k mu.. le Mtua.ed the anterior and internal femoral r.gion>. h. origin is from the inner lip o, du- hnea a., . ra o the fenu,r where i, i> adherent to V . insertions of the addue.or. hs , k,. run downuani and fonvanh .ome of them being inserle.l into the upper n^argin of the patella v.d, the eonuu<.n ,en ,l„n and some of them passing in.lepen.lendy to the inner margin of .h,s bone. I he greater por- tion of the musele is situated in the lower thi-d of the femur; its outer uu.rgn, r. tuse.i wuh .he vastus intermedius. . n . i The vastus lateralis irxlcmu. . , F'g^. .<;<- --' ^-.S. ^oi , and ,,o. ) » an unusually strong, large. ,lat mu.sele, whieh forms the ehief bulk of the museula.ure of the external lemoral o.non. 1. ,. stn>nger than the medialis and do., no, exten.l as far .lownward as ,h,s nu.sele, ...ng h uated chielW in the upper and nud.lle thirds of d,e llugn. I. arises from the outer hp o. d,e hnea as,.,a as far' upward '.s the great trochanter and ,o a eer.ain extent Iron, the ou-r pon.on o d,e ia„e prominenee, and its libers run <,ui.e obliquely from behind forward and Iron, aUne downward. the direction of the upper fasciculi apjiroaciiing the vertical. The entire -xternal surface of the m.r.cle is covered by a broa.l aponeuro.,.; ,N inner mar gin conceals the greater portion of the vastus intermedius. wid, win. h i, w inseparably connec,.., an.s imm.-.lia,. v ab.,ve the pa,ella bv ,he union of du' ten.lon ..f ,he rectus wi,h ,ll..se of ,lie vas,i. I, embra. .•. ,!,.• entire upper an.l ,lie la,..ral margins .,f ,lie pa,ella. ,he la„er s,ru. ,u,v simply serv ing a- a ..■samo.,1 bone f.'r the ten.lon which i. c,.ii,inu...l ,o ,he ,ulHn.si,v of ,li.. ,ibia a. die i-au^llar hganu-n, (..r pag.^ ,,,5). The actual point of insertion ..f the .lua.lricep. i. c.,nse.,uen,ly d>i. rough.n.-l pro..... ot the tibia. •I-l„. ,,„,„lri,,.,.s i^ >u,,pli..l 1./ tl-- l."-.'l — '" -'-■"'l"-« "" l''^ *' '■''""- ""■ I''"'"' I: ATLAS AND TEXT-ROOK OF HT'MAN ANATOMY. Fig -oS.-Tlie .icq. lavtr of musdcs of iho ^interior surface of the thigh. Th. iii,,,Las, sartoriu. r.aus f.moris ,,.-.n.KU.. ad.lu.l.r lon«us, an<; graul.s have been rcmov.-,!. Fir -GO -The insertion of the iliopsoas and the origin of the ol.turator externus. Th. a-Ulll^U.;'";... t.!^ "ivi,Ud an., r..,,,.,.,, ' ,.,. f.nu.r ha. W,n .a.v„ ,hr„u.n ... ,w th. tr.nha.U.rs, and ,. sHchtlv Ik'Xiil anil rcitateii outwanl. Fig. 300.— The origin> of the piriformis and th. ohuirator internus. Thi- pelvis h.i.s livvn diviik-il in llu- mc' ar 1 ischium in such a way tha, ,hev forn. a series of rin<^s ahou, the ol„uraU.r foramen. The outermost ring is forme, exnrnus, the'middle l.y the. M,aor /-nr/.v an.l mhw.us. and the inner by the !>,rlnuvs, the Mu- tor hn^m, the ,i,'n" ///.v, and the nddiuWr mapius. , • . 1 , ,„.,., „ tL pectineus .Figs. .oO and ..;, is a llat, -trong. .t^drangular muscle suuated between the iliopsoas and the a.lductor L.ngus in the subinguinal and anlerior femoral reg.ons. and form- in., to.'ether with the iliopsoas, , he iliopeCineal h.sa. h arises from the ., est o. the pubis a. Ki." fc;.vard as the pul,ic tubercle, passes ..bliquely fron, above dovvnwanl and t,-om within outw.ird, .,nd i. in.erte.l bv a short len.lon int., ihe pectineal line of the femur. 1 he i.tser lion ,s parH, conceale.1 bv the iliopsoas, covei's the obturator externus and the upper pan of the ad.iuctor bn Cs, and passes over the inner siirface of the articular capsule ot the hip-Joint TlK. ,„., ,in, u. addua. .he ,hi«h and als„ a.i-t- iL xi-.n. 1. i^ -upi'li. ■! '- '1- ..'--t,,,- and fen,oral nerves. T-he adductor longUS ^Mgs. ,^u and .07. i> a thick. Hat, almost triangular truscle, situate.! ,..,ween .he pectineus ait,! the gracilis, it ar,.-. bv a rather naiTow In. .hor. ami strong te,.do. 1, ,he sup rior puwic ramu. between the origin, of the pectinetis and gracilis b^conjes decidedb " uler as t passes downward, an.l i^ i,i. rU..i by a ^hor, icn.L.n in-o the mi.l.Ue ihinl . .he inner he lin a a.p..ra. The hb.is ,d .he mu.le pursue a direc,i..n siiiular ,0 .h.^sc- o. the pe. „ s though th V run m.„-e ,lii-e. .ly .l-wnwai-.l. If ,he muscle i> w.ll de. op.-d ii. upper mar^ ;; i; imm..dia,..i; ..,n.i,ti,otis w„h ,he lower margin of .he p,c,i,t.u. a,t,l wl, e i, .s .,uaU.d b...we..n .he p. e.ineu^ a.t.l .h.. g-'a. ills ab.ne. i.~ L .wer p,.i-ti..n I.es up..n .he a.l.lu. .- magm,>. 1 ic is exp.le.l between .h.. a.l.iu.„.r longi,. aivl ihe gra. ili. Tl,e upper p.,r,,.,n o the i, due - „„. longtis lovers the a.l.lu.tor bn vi. .he lower .he addu..,..- n.agnu. u- .en, on .- in--e : J^ ,„nceale.l bv the sir...riiis an.l i^ a.ih.T.n. .0 ,lu- ...gins .d .!,.■ Nas.u> mciah^ (se. ,.ig. -is>, ;:;X ut 'h- -.^.1,0 sar...riii. an.l ,h.. iiiguinal ligam..,., .he ntuscle forms a .rtangle, the le.oral tr'miii^^k (triangle .'f Scari.ai. The a.ldu, .0,^ luni:u. i^ sunphed l.v ih,- ul,u,r.„.,r nvrv. , ii addua- the .h,uh. The mcili. .Fi.'. ..,71 i^ a long, thin, slemler mu.de, .i.ua,.-.l i.pon .he inner aspe.l of .he 1 lie gracilis. I.,. - ;, ^ - ^^ ^ ^_ ^_ ;.,,•,.,.;.„. r.,nu ,,i ihe nubi- near .he svm- |hi"h. It ari-e- i)\ a ilai . .11, i"n ironi .iie :U|Tt.. :■.!■,:, •,, ,, i „ ;,„•„, Hv^i, be.„m,.. -m.vhii. bn.a,l.r a. .k>., but s.,.,n narrow- a.i.l. ,u>t ab„v.. the k,ue ,o u .. : ■s.-Jinio a long, r.,und. .l..n.U.r .en.l.nt which runs t., the inn.r bonier ,d ,h,. .ubercl.. o. .he liljia and radiates inf.. the />, v anscrinn. as .he secon.l .eii.ion .d .ha. Mru.ture. Sartoriiis I lio pectineal bursa Iliopsoas < ^-^ Siicrotuhrrous ligament * Adductor tpn^iis Obturator externiis Addiictiir brevis Adductor opening. Tendon of adductor magnus - Semimembranosus Obturator canal. Internal intermuscular septum Tendon of sartorms_ _ / endon ofgradlis ■ Tendon of semitendinosus Pes anserinus Sartorial bursa .-\nserine bursa Fiff-. 299. Adductor longus ■ A^ymphyseat lift surface I I ; 1 (>/' pubis Piriformis Coccvgeiii Sacrotuberous ligament Promontory Si'cral canal. Sacrotuberous ligament fifr. 300. rig. 20S. ■■^'■1 T^ i i 1 1 ; \ s! 11 THE MUSCLES OF THE THIflTI. 21' TK musck- is Mn.plicd hythc obturator m-rv,-. \Vh,n ih. kn. i- rsl.n.l, ,1. il a,l,lu.t- hv tliiL'h ,,.,.1 ..-i--.- fli'xcil, tkv.iU- iIu '-t; lUA.iril The adductor brevis (Fig. pqS) is a long, broad, rathrr tbic k muscK' which i> uiuur.l m the midd-- lavir of the adchictors (t,chind the i» rtineu-. ami addiulnr lon-n-, Imi in In.m -; ilu- adductor inauniis). Ii i^ longer than the pctineu.-. >horter than ih, addiutor longvi-. .'.vA i~ usualK .omi'.letulv .oncealod by these two ntu^ele.. It ari-.e> from 'u >ti,.enor ramus .A thr I)ubi>,' nean . ihc'obturai- - foramen thnr the ad.ltutor l(.ngu>. an.' ,t- libera imr^iie a c...,u>. similar to those of the lai r mti~- k; but nni m. nbli(|ue, t.. the ui-ik r third ..| the inner lip ^ i the line;! aspera of the femur. •[•|„. ,„ rvi— up|.lv .incl the fund:, i. an- i.^.-. iliusr . \hr .ul.l . l<.r liini."i- The adductor magnu? .Figs. 2<)(^ to 2()S, ,^oi, and ;,02) is ■;'- stnnv. est of the addtuK.rs. It forms the deei.e.-t layei .nd i- Mluate.i most ;.o>terior!v, arisi-i- from tli,- inf. r ,r ,.ubic amu^ and from the km. r bo'rd. r of ' 'e luSenoiiy .,1 the i- am. In np|-. r liber^ ;.a» bi,' dighliy downward, the middle ,ire more oblique, and the lower an.i anermnq liber- pursu. m alm..^ vertical direction: the upper and middle libers i.as.-, behin.! the a l,. a muscular or short t.ndinou- insertion int.. .e upper t\\M tl.ir.l-^of ■ • iiuur hp of ti;. linra a-pera . the lower. alm...t xerli.al liber^. l,owe\, :, pas> mlo a round ^1^ .ler ten.l.m whu h run^ lo th. lowest portion ..t the linea aspe. and t.. 'he int. nal ej.i. ..n.lyle nl the lemur. .\l aN.ut the lower third ui the Ihigii this insertion eoni,.in> an el..n..;ated orilae. kno'.vn a> \hr l,n,Inwii^ ten liiirou- va,-. idar sheath. . While the gre:.-.T porti.m of the anterior -urfa,, f the ...l.luct..: magn-- is .(.\. r.il 1,\ ihe adductorl.mgusandbrevis. it-i-o-ierior-arla.. liesup. nth. ll.A.,r .nusc 1. -, a) i it is . ..n-e.|Uently -iluated between these tw,, -, ts of mils, i, s. Hie m i.itic nerve li.> upon it- p..-teri..r -urta.e. The adductor minimus il'igs. 2.>;. .^oi, .^02) 1- a small, llal, approximat, K quadrangular muscle, which fre.iu. :niy appear- to be -imi)ly '.la up; • . p..nion ni ■he .. huL.. nagn :>, with which il i-alwavsdir.-.tiy ...nlinuous. It ari-<- from iii.- inf. a.r pe-a r,mus.,i in.m ili. juiu tion of the infer!.. r rami of ;h.- pnbi- an.! i-. itium, il- upjicr liber- 1.. in' Im.. hori/...Mial, ,inil running below ,di-tali ami i>arail.l ■ . ihe .|uar!ratu- Umori- ...v. aigin : u'u; ..rm.iM ^il..!;. .,f the adductor magnus from behin.l . to be insert.d int.. ihe upper . a.l .)f i f.aii r bel..u 'i'. -real trochanter ami be-i.le the glui.a! liib.r..-ilv. It- k.,ver liber- nn; oblLiuely .|..wnwant .1 are in.serte.1, t.igether with th..-.> ■•i the a.lductor maL'nu-. ii.io the pper Mremi' ..f the raier lip of the linea aspera. The sciali. nerve lie- also upon th. ,.lduct..r miiuinu- (-it .M-e 21;. I'll.' a.l.lu.ti.r ni.innv;- ili.i Thtir .itUi)n is -imil.ir t.. lli.it >>i i!iiu> ai' . .Ill in -..pe iitllcr ail.l.-Hl.il'--. :,;ur;K r nvr\v .lit-: Th.' obturator externus . igs. 2^,S ami 2 ,■ belongs to the ad.huM- -;roup .mly ..n acmni £-iM^-'' i i^\:. m 2j8 atlas and tkxt-book of human anatomy. F,o. 30.. -The d.ep^layer^_of the posterior hi,. n,u.dcs and the su,.cr«c1al layer of the Oexor. of the •nu. «luu.us .SSr^llnH-lius an,l ,1... „...ura,„r ''^^^■'';''' '^;;r ]CaZuL of the rtexors of the thigh F,G. 302. -The .lee,, layer of the posterior h.p muscle, and the .kt,. l.ucr region. , ■ ,1, i„ni, !„■ 1,1 ..f thi' hiirus, ami thu srmiti-mlinosus haw Th>- Rluta-us maVimus an,l nH-.li.>, ih. .,ua.lrau,s f.muns, ,lu- lon^ h. a.l 1 • b«n rinioviil. .„,, ischium »,1 is .,™,,k,dy ■,.vm-.l l.y , .■ 1" ;""'- 'j' ' ^ ""\i . ,„„„ ,h, i,,„i„„,, , ,„,„, ,„ .--;;»;*»;„„ : — r^rn.:^:;:":;;! -„. ,„ ... .... chanter, and i.asse> n\cr and i.c n.nd ur ,.„v(.red hv the latter muscle, to the ^xr^:rr*:;:t;i::s.t:;:Jr^ -" dinous a short distance before its insertion. The „„U..U.,r >..U.n,u- i, sup.li,-.. i,v -h,- ,„„ura,.,r n.rv,.. I. a- ,. as an eternal ...a... THE POSTERIOR GROUP. THE FLEXORS. ,, , 1 th,. />;,, fts ;Vm(>r/v the .'"■m//()i(//»<>';i/v, and the srm/- -i:s;i:;;::r;rpri:';;t:;:«^^ hulf'.f the outer lij. of the iineaas]Kra. ,.,,.:, ,h,. ,K,sterior surface of the lon« „ ,^:^;:r;:i,;i;';;:::^^^^^^^^^^^^ - '- „„. ,:■ ;:;;;::;;;';«;;.r'n;:i: ,;':,l;:i,; „; -.,.. < - -■ lH.]ilileal fossa (see page 2.-0.. „„,„n,hea„.,t.he ,.„.,, i .,..,....,. ,h,0.„.„ , .he .„.Oh,a,M. ,.„.,.,. a,,„ne. S,icroti:herous lig. Sacrospinous lig- Obturator internus x / fiiirsa of obturator int. Tendon of ■ifmitfiidinoiiU'^ Trndon of si-mimemhranosiis I rndv'i '''' i^iiljra- tor iiitirnns MiilJIr '^iutM'i hui v( >' jlntaeii s incdiiis Hiiv/i'i fi'iioris (short heiiit) Irrtdon of Iticrps Itndon 0) ^ simimtm- branosus Oemellus superior Gemellus inferior aiutaeus medius - Qiuidratas fimoris ■ llinii:i femons Inni' head) n, m lie WJ. .T> ^iH mijj-:L^r^;,khs. S.:^i£. . .n,o a c yhndrual ten^ don which is insenci into the inner surface of the tubercle of the ..l.a and .orm^ tl,. .o..nK,st tendon of the pes anserinus (^iS- 2q8)- ,,n.i,en.lino.u> form!,,, the The three tendinous i-xi.ansions ot the sartonus, i^iaciii.. i ,•,,.,, uesans rinus(Fi,. ..,8. are peculiar in that they form fan hke ra.hat.ons Intween whul are Su2rt^nu.mbranes. The broa.l ten.iinous surface of the pes anseru.. ,> separated .rom ttlX:Z^^ns.rn,c l...rsa ,Ki«. ., attachment to the t.b.a, the pe> anserinus is also intimately connected ^vith the crural fascia. Th.. .■,.....n.l.n..us i, >u,,,,iu.a l.v .h.- til,i„, n.rv.. 1, IVm< -i.- W, and r.,,.,,. „ ,n.anl The semimembranosus (Fi,. ^on i> a v.ry pe.uli.r mu.le. Its up,.r ^^^jf^'uiZ- sistsof a Hat membranous tendon, then follow, a tla. but wry .huk muscular belly whu h Ima aim nates at its insertion in a llalt.ned round tendon. The ma.k- ar,... Irom the ube-oM' , "r hi m in front of the Ion, hea.l of the biceps an.l the s.mi,end>noM.-, by a .b, tendon : '; ^Z.:..n the posterior surface of the adductor ma,nu. and .i'-^".-!;;;-;" o tl. s.n. lcn the nuddle ol ,lu tin^h. uh.k sZwh t i.rter upon hs inn.r aspect. Fron, .his undon ar. ,uen .... muscular tascuuh l^ri^ from alH.u. downward and from witltou, inward, and Ikcohu. ..nnmun. .„ a ^ rlded t..ndon .tuated t.pon ,h. inner ..l. of the •"-^'--V''';;:";;;!; ".':.:: 1 r „f „,, thi.h. Thi-^ tendon of in.r.ion passes to the n,ternal tuber, le of the tib.a ,. >nudl p. , .' a i^aes into the obli„ue popliteal li.amen, ..e ,.a,. ,,.,, an,l .; ..be. ^''^ '- •-- orh to the inner n,ar.in of the tibia. Heneath the ten.l.M. .., the s..mu.u ,nb,an..sU. tin,. .. Z!ue!l a bursa which communiea,e> with tlu knee-j..int. the l.rs. o, ,l,r s. ,un,u,„l.r.u.s,.s .see '"'Viule the upper portion of the >emimembrano>t,. i. M-uat..! in fnu,, .,f -h. -->-'''--;; „., L lon« head of 'h.^ bicep>. in the lower ,hir 1 -f the ,h„h. , .- nu., 1. h.-. m,..rnal t.. the biceps. t..«ether with winch it f.-rms the u,,per Ix.un.lary ..f liie !„>ph..al .o-s, ,mv IkIo.v .. ,-,„. n,.rv. .„.,U ..,,.. ,h, fun, „ I -l. -. nun,, ,nl,MM,„u. an ..n„l„ ■•, .1..- .m n,| ■„ an,l i, a... .„u as a t,ais.,r ,.f lllr tai.-ular li«anu nl ..I llv t-n. . I„.m THE MUSCLES OF THE LEG. THE MUSCLES OF THE POSTERIOR SURFACE. THE CALF MUSCLES. The muscles of the po>teri..r asp.c, of the le« , Fi,. ^o^ .o ,o;, a-"""i"; '''";;;;; '^^ ^;; a superl-uial laver forme...m« .. in /../■/""- •' ,„,lo( tin- libiali. po.Urinr:,hx,.r l,.,l.,ui. hw„<^, and //rv.r .//,■'""•"'" /"".^'"^ ^u^. . THE SUPERFICIAL LAYER. THE TRICL 'S SURAR. .- :.i i: ._.;. ..I.,- ,M,I l.liiiiilal iKirtion. till' i,"'*''"'" The triceps sure »"ii-i--,- "• a ii.rni.n -r..-.:- mm/«v, and .'f a d.TiHT m.mariiMilar p.)rtion, liu' M'/c/(^. ... . The gastrocnemius , Fi«. ,o.V i> a .lat, . I..n..ate.l. .lis.inctly bi, ipUal an-l verv Mron, nuH. le. "s^^mmtm^^ms:. vts^^. i \ t ! 2 20 ATLAS AND TEXT-BOOK OF HUMAN .\NATOMY. Yic 30^.— The superricial muscles of ■.'tc calf of the- leg. Fic 504 -The second laver of the calf muscles. The gastrocnemius has been removed. P,(, ' _xhe deep musculature of the calf, seen from behind and from the inner side. Thi.' iriups sur:i- has luin rcmi.vi-cl. which is situate! upon the ].(.stcri<.r aspect of the knee and leg; its muscular belly ,s s.tuated chietlv in the sural region, ^^hile its tendinous portion is located in the po.stenor crural region. The two heads the inner hnul .^aslroawnuus miJu.lls) and the oulcr head (aastrocnamus laler- alh) arise bv tendons from the upper extremities of the epicon.lyles of the femur and exhibit aponeuroses ujK.n their internal and external surfaces, extending ituate(l a bursa which communi- cates with the interior of the knee-joint, the inmr ^i^.islrocncmial bursa (Fig. 304) (see also page n6) Both heads of the muscle pass immediately over the ].osterior surface of the knee-joint furmin-r the inferior Ix.undarv of the popliteal fossa, and below the articulation they become broader ami are united in such a manner that their line of union is indicated by a median groove which extends almost to their insertion into the common tendon. Somewhat below the middle of the leg, the muscular tissue terminates rather suddenly in a broad tendon which becomes nar- rower and fuses with that of the sulcus. The soleus J'ig. ^04) is a Hat, verv broad, ami rather thick muscle, the upper portion of which is covered bv Uu- gastrocnemius, the lower porticm be ing situated immediatelv beneath the deep fascia to either .ide of the gastrocnemius tendon. The- nu.scl.. arisen Irom the- capitulum, ,K.sterior surface, ami outer Ix-nler of the fibula fr.mi the poi-Hleal line .id the surface immedi- atelv belcjw it upcm the posterior surface- of the tibia, and from a tendinous arch pasMng over the popliteal vessels between the tibia and fibula. Hie tendinous ar,h 0] the sohus. Shortly after Us I,ri.nn the muM Ic- become-, broader, and e dlibit^ upon il> ] osterior aspect an aponeurosis which ismMinuousNvilhatcidon ^^hich fu>c-. with that of the ga>tro. nemius and also receives the inse.rtions ,• lower Iving lateral mUM ular fa>ciculi. Thi> Ic-.tdon of the triceps .ura-, broad at hrsl and becoming narr.mc r and thic ker a. it pa»c-s downward, is km.wn as the uiUaneal Inuhn itnuh ArhiUh . it i. tin- strongest tendon in the entire Ix.dyand is in>erte.I into the ui.per margin of the tube rosiiv of the calcanc-us. , . . 11. The triceps Mine also in, hides ih, plantaris (iMg. ;,04i,;i small muscle wit a very short but rather strong b. liv and a verv long -lender tendon. It aris, s fn,m the- external enicondyle- ol tlie femur to the inner -ide of and s.,mewhat alH.ve the- outer h, ad of the gastro. m-mn,s, « hie h partlv covers' i! :,nd the- short muMuler b.lK i- dim tc-d ol.li,|Uc-U .mtw.rd and downward betwc-en the uastrcKnemiu. and sole c,s. Tlu slen.le r tendon lies up.m the- inn. r si,le of the soleus, runs d.mn ward along ihe i.m, r margin -f the tendo Achillis, and fadc-> auas partly into .his structure ami j)artlv into the dceji fasi ia of the leg. Tl„ ,n,,ps -ur- I. s„p|.l.-l '.y .K- „. . ,1 n, ,., , I. ,.r. 1... • ,.!.en,.,r ll, vi ( ilv- f..,.,. Th,..,.l,emaris a. .s as a (cllsnl- i.f llle- letl'l" \' I'llll'. THE POPLITEVIS. The- popliieus I-igs. ^0 1 ,ind ^o-.) i> a Hat triangular musde which is in a class by iisc-lf. It i. .iu.atce! in til, s.,nu- lav.-r as the soleus. with vvhieh it is dire. Iv related by its U.nmt ami outer IniiiT head of Gaslrocn InH'^i- hriid :}fpv^l-orneiin, Tendon of ! semiten- I diiwsus Crura'.fascia (deep layer) /'.'iintarii ■ lute.- hi'd Ciisfroni A ■citatr Pmmaeus I peronacus I (iilranea * I tfmiim ^ii/i ptron nlittflCllI rir irt'> Fig. 3U3. fig i(i4. p THE MUSCLKS OF THK IKC. 221 margin, and is covered by the gastrocnemius; it runs immediately over the iK.Men..r .urta.e of The knee-joint. It arises (inserts) by a tendon from the external epieondyle of the fenu.r and ron, the arcuate popliteal ligament and inserts (arises) in the trian.uhr area alx.ve the poph.eal hne upon the posterior surface of the tibia. The lower portion of tlu. muscle .s covere.l by a la>aa, aponeurotic in character, which a'so gi^c. .H,in to muscular tibers. lU.neath the tendon of or„„. (insertion) is situated the poplil.ai hnrsa <.ee pajje ,3"'. ^vhich communicates wUh the knee- joint. The ..opHtous U .upplu-d by .hc .it>i.. n^rvc. I, a.-.s as a ..nsor „f .lu- ar.i.ular , ap...,- of .h. W.H.-ioi,,. an,l hdps to rotate the tibia inward (when the knee i> rleNedl THE DEEP LAYER. The muscles of this laver (Fifi. .^o?) .the ,.osition of which has been previot.sly described) have experienced a peculiar' displacement with reference to those of the antenor ^roup smce the S^ 1" o erior is pushed awa uc.n the :ibia and situated in the middle, w .le the .^.or . ., c!rum lies a.a.nst the tibia; the llexor halhu i> conse.,uently lies upon the hbula a,K there.ore to the outer and not to the inner side of the llexor di.itorum. as nn^ht Ik expected. The correct relation is restored bv a crossing of the nn,>clcs. that of the tib.ahs posterior .k curr.n, .n the Ic, ,vhile the tendons of 'the .lexer hailucis and of the flexor di.itorum do not cro.. unul .h.y reach '"' te ^Llau/^^^terior (Fi«s. ,0. and ,. . i. a Ion., , ather Hat, di... tlv , c-nniform mu. Ic (llu. lower ,.,r,ion is onlv semipenniform ., which arise, l.a short -cndon from ,hc. upp^T 1""'- >f Ute postlrior surface of the tibia, from the interosseous ntcn.b.ane. and .rom the -- scjr.acv of the ibula beside the .lexer diKiton.m, which frec.uentty , ar.ly cover. U. Imincc ha el b.low this origin a verv stron, tendon appears in the mi.hlle of the mu.cic vc-r^n, «radua ly .0 U. nmc. rder, and parses l.hind the internal nudleolus to the sole of .he foot I he .e.don ,s >n.e,te. dtie.lv nto tl tulKrosity of the navi.u.ir bone (Fi.. ,..). son,e fascuuh be.n, ouvctly prol...^d to thJ internal cuneiform and others radia.in, al>o .0 the remannn, cuned ,rm l,ones and extend inc as far as the (ul)oid. , . M.ove the malleolus, ,hc. tibiali> posterior cros... be.ea.h tlic Hexor .l„Uoa.m, .0 , ha, U. tendcm assumes a position internal U. that of the latter ,.ascle. Heltind the malleolus U . ..ua-ed within a tendon-.healh in the huini,llr /(..,/mr;,/ l:ee i)a-e -\^il. Il prochi' , pl.un.n 11, AioM'of I'l.- fool .m\ ,iUn , I he inn.r iiiarj-ir, oi ihe .v.le i .u|.M.,,iiMU- The flexor digitorum longus (Ki^s. ,,0.; a-^d ,;m r.sembk- .he tibialis pn-t,.!,,,- in i.s external appearance . 1. i^ p. uniform above , scntipenniform belou , and he. a, l,rM „pon ,he nl,.a an 1 1 wer .ourd, of the U., be, ween ,1k tii,ialis poMeri-v and d.c .lexor hallu. ,>. .he .ormer n^ Kin, crossed bv i, a. a sh.h.ly higher level. The mu. ic- ari.. .rom .h, pe.Menc.r M,rfae .^ rimerosions crest of the tibia, and i.. .endon.like ,ha, ,-. ,],.■ .ib.al. p..„;nor. . deveiope^ , . ., , >.^.,.,... „f ,1, ..h. Thi. tendon is sitnal.el .0 ,lu outer sulc- o. .ha, ol ,he Eir^Ilr'and ntns lH.nea,h ,he lacinia.e ii.a.nen. ,o.he s,.i,..,f ,h „., ,l,.. ..n, when. , ,,ivid s in.o four .ettdon. for ,he outer four ten.. These perfot.Ce ,h.. tendo.s o. .!.■ ll. xo. ^m'- :^m'^j^^:^ ^ in si i J i 222 ATLAS AND TEXTBOOK OF HUMAN ANATOMY. Fig. 306.-The muscles of the anterior surface of tl„ lower leg and of the dorsum of the foot. The transverse crural ligament has been removed. Pic 307. -The muscles of the lower leg and of the dorsum of the falanges). The flexor hallucis longus (Figs. 30^ and 311) resembles the other two muscles in -his group, but it is somewhat shorter and stronger and, at the same time, distinctly penniform. It is the most external muscle of the group and preserves this relatitm throughout the leg. It arises by a short tendon from the posterior surface and outer border of the fibula, Ix^low the origin of the soleus / e from the lower two-thirds of the Ijone, extending downward to just above the malle- olus ' \ thick tendon which is situated in the center of the broad muscle, commences m the middle of the leg and passes through the outer compartment of the laciniate ligament to the sole of the foot (Fig. ,v 1 ), where it crosses the tendon of the Hexor digitorum and runs to the ungual i)halanx of the great toe and indirectly also to the other toes. The mu« le is supplied from the tibial nerve. It flexes ,he great toe and indirectly also the four lesser to,.s. THE MUSCLES OF THE OUTER SIDE OF THE LEG. THE PERONJEL The posterior iH.rd.rs of Ix.th of these muscles are in relation with the soleus and with the deep flexor group, while their anterior margins are in relation with the muscles of the extensor group, from which thev are separale.l in the lower third of the leg by the lower portion of the shaft of the fibula and the external malleolus. Tiny are situated in the external crtiral region. The peroneeus longus (Figs. ;,ot. an-i 307) is a very long, distinctly semipenmform muscle, which ariMs l,v indistinctiv separated anterior and posterior heads. The anteri.-r head is a short tendon from the head of the fibula, the contiguous portion of the external e.mdyle of the tibia and the .rural fascia; the p.slerior springs from the upper two-thirds of the outer surface and outer border of the fibula. .\t the junction of the middle and upper thirds of the leg, In.th heads pass into a slightlv llaltene.l tendon upon ihe anterior surface of the muscle, which broadens as it descends and passes beneath the nthianil.i prromorum (Fig. ;,07) (see page 230) in the gr.H.ve behind the external malleolus, to the outer sid.^ of the sole of the fool. Deep down in the sole the 'end.m lie~ in the groove of the culxml (Figs. ,^1 and ,;i2),is provided with a thick sesamoid cartilage or sesamoid bone, and passes L- the UiIh rosity of the metatarsal bone .^f the great Icks s,,m.. filKTs being prc.l.mgc.ll.. the internal .•ut>eif..rm and to the base of Ihe second metatarsal bone. The peronanis longus almost entirely conceals lite origin of the perona'us brevis; in the lower (. ,, . .1, I.,... r -eiv he --e" i>oib i" fn..ii of and behind the maruinsof the perona'US I. .'in 01 ine le^ iile LiiuT mt\\ oi ..t.. .,< . . longus or iis tendon. The i-ronau. longus i. M.ppli'-I f-n, ,he peroneal nerve. I. abdu, .s the f,«„, assi.,. in produ. ing plantar flexion, and ilevates the outer margin of the sole (pronation). Tendon of biceps Tibia (Inner surfnce) Pes anserinus Tuberosity of tibia Plantaris Soieus F.xtensor digitorum longtis Extensor Crural fascia hailuds longus (Deep layer) Extensor digitorum- brevis Cruciate lig. I xtensor Httllucis brex'i-i Calcaneal tendon Tendon of peronaeus HI \l\\^ \\1 \\\ Tendon of ext. hiiU. long. ^Patellar lig. Capiiulitm of fibuin Tuberosity of libui Tendon of peronaeus lent; \--^ Peronaeus brevis Super pfronaeal rrtinacttlum Inf. peronaeal retinandum Tendon of peronaeus long. Fig. 306. Tendon of peronaeus brev. jendon of peronaeus III Fig. 307. ^'~;^ ^-^i^^m^r '^4^S^ ^ 4--.;"l=S: 1 I ' i:^ ■■*»*r if t: W'^^^'^' W^^^^'^WM^: ... p.; THE MUSCLES OF THE l.EC. 223 1 .^■.■ ch„vi..r ihin the lontnis, which il markedly The peron^us brevis (Fi^s. ,oO, ,08, ^p\^^^Zn..^^uri... an.l anterior resembles, and by whieh U >s largely eoneeak^^ ,'\;";.,r margin of the external malleolus. ,^.1.. of the lower half of t e 1; ^ J ^ ;:^:;;^ ^^^'the muscle and then passes to the The tendon commences m the middle of the upper pc .^^ ^^^^^^^ ^^^ ^1^^. :::=;v:r=rr^^;"----^^^^^^ --'> 1„„K,,I inlJ tht .k.rsa ui«.r,™r.»is of llu' l.uW l-c. ,-,. , „ ,. »„.».,. ." - — ■' ■"■'" '"' ' ■ '" dorsal iVxinn anil pron.m.m. THE ANTERIOR GROUP. THE EXTENSORS. The outer margin of this grcup is in relation with the„er...e^ ^:''-:Z:::::;t isolated, since its inner margin is boun.led by the .nner sur.aee of the t>b,a. group are situate.l i,, tl.e -^J-'- --;; "-^f;;;^; ^^ ,„„„ „„,,,, ,,hi,h is broa.l alx.ve and narrow The tibiahs anterior il-gs. ^^ -^ ; .;^ f^,„, „^, .„,,, ,,Hace of th. libia as far below. It is the strongest muscle ot tlu gnap anl „,,.„,,,r,n. The upper ihinl of the ,p.vard as the external condyle an. from the "-;- ^ ^ '^ ; ;^, ,,,,,,, \l „,,.„.. of ihe nUle is marl.n!i"iatiun>. .- 1 .,,,1 U 1 riiluT weak -einipennilorni muscle The extensor hallucis longus (l-gs. ,06 and _;;';';, ^.^,^,,^^„^ j.^,,.,,,, tIu.. K,.g to the outer .de of the libiah, ^-^^-^^^^^^^Z ^^^^ -1,. origin of the ext.nsor two muscles, partaulariy the latter, .-ncea ^ ; ' ^ ^ ^ ^^.,.,,^ ,„ ,,^. ,■,,,„ ,,, f,.,,. th. hallucis, which is from th, n,ner surhu^o, ,h. ^ ^ ^,,^„. ,^ .,H„i,, . undon „,j,,,,„ portion of tltc. in,.ro.>eous men,brane. ^ ^ -^ ' ^ , ,.^..,,,,, „,,,,,,, is |ornu. ' .....out inward and passes r,b,rs which are .lirected obliquely Irom ahov. dov^nwa d .m-l r ., itLh the an- 7'-- »-,;r;:r,:::;;.;;:i:»: -.h:^'-": ,"•;;;., .,.. IM AII.AS .Xn TEXT HOOl OF HVMAN AN ^^M^ Fig. ^o8.— The mu.-d. uf o (lorsum of the l T'herompanim-msoftluirmiuti-liK'amcm liHv U-vn .ru-a ami th.' undon ,ih.|,,: i^'iisors . tjcfiirc tlifir in^tTtiuns, Fk.. 309. — Th ]vlant;>^ .'.(x! :rosis. Fig. 310. -T!' uperti< ial 1 r nf tli. pL. Uarrri-, les. The plantar (as(i., has Iwri largely " '."ifnmi th( - r ucoflh. ll.-\ r (iigiu.ru i brevi,. .iT shortly brane. The u,.i.er imnion <.. :!;<■ musck i- adh. rcn! -) tnc origin of the til)ialis anu-nur and to'the'duci) fascia of the leg. 1;k- tenrlon i- situated 1 the anterior margin of the muse! and re. lives the mi.ldie and inferior liln: vhich pursi. ., rour,. similar to those of the extci.sor hallueis. During ii> I'^'-'^'i?^''-' '*"'"'t,'h ■■ -niriai ligament <^ just a -n-c it, the U ' >n sub- divides into four ilat, rather ^^.■ak lendons, uliuh n t., Uiv lorsal a oncuroscs of 1; sec i to thi' lll'lll toes, ■nu perotiaeus -rtius Mgs. 306 and ,31, sLvms to h. , part 01 'n' extensor digiiori It irises Ip 'hose xv ne lati' ' muscle wni. h come p the In-. portion ..f the hue hs !lat tend. runs tjcneath ih. crucial 'iganuT- uth thus. tl; nsor dig-orum . d inserted hv cans of it tefiinous ■ •.• ansion to lite dors 1 suiiai. of the I met bone. TI1. :he fiHlt. _;iti)ruM! len' - are s^^vilje. Mtrr UK , ijrae ^lus assist, in jiroii -:-mt; .ft!-. Ur 'ik. \tensi Tl ex ■ lich . -•• isi in .,[ 1:, :-sal !,■ 1,. eat! THE MUSCLE' F IHE FOOT. THE MUSCLE- OF THE DO^' M- hand, the di'" -^.. lecl of Kit i.s providei . brevis (Figs. - ;(>, ; s, and ^15 a ■ uic .iorsal surface ol the >nes, joints, nid II the exien.s<)r digitonim brexi-. with whii h it is au lat. 1 ascle ;s of s. It rent, from ilie dorsal .», passes forward and inwa'd, and in tile region of the base 01 the lirst ines continuous with a tlat narrow tendon which nn ~ over the metatarsal ulon of the extensor longus, the two tendons togeth forming tiii' d.irsal ..'Xtensoi digitorum brevis ( Figs. ,;;o6, ,;;o,^ ! ,:;i .s) ari.ses togetl' • He preceding ,0111 the dorsal surfac e and the adjacent p.^ 1 of the lateral surta.e oi ilie calcaneus, livides into three 1 rarely four) muscular bell.^ which terminate in very slender tendons . . .u 1 Ov-'i -"'I fonrih Iocs apd fusinc with the tendons of the extensor digi- •.-; tie, -T^'-ifi, .,fi)... . -- . -.1- . longus to form dorsal ajioneuroses. Both mt.s.le, u,K,n the .lnr„t are futiplie-l 1.) tlte ,1.-1. peroneal nerve. They .xtoml llie toes, .\ teni|..n for the Intl.' 1ih' is r.irelv pr.'sent. 1^. :rv ^ IC I'.: { ^'U THE MUSCLES OF THE FOOT. 225 THE MUSCLES OF THE SOLE OF THE FOOT. The muscles of the sole dilTer materially from those of the palm, since in addition to the frroups for the ^nat and little toes there is also a central muscular mass. This central group is formed by the flexor digitorum hrevis and the fiuadratus planta-, an accessory hea.l of the flexor digitorum lonRUS which arises in the f.x.t. The superficial muscles of the sole are cvere.l by the plantar aiK)neurosis (plantar fascia) (Fi.i?. :,o<)) (see page 233), wuh vvhuh they are partly adherent. THE MUSCLES OF THE MIDDLE OF THE SOLE OF THE FOOT. The flexor digitorum brevis (Fig. ;,io) is a thick elongated muscle entirely covered by the plantar fascia, and forms the middk pUwtar cmimm,' (see page a;,;,! (••"'K- :^°<')- '^ ""'^^■■^ by a short tendon from the inner tulxnle of the calcaneus an.l from the j.lanlar fascia, with which the entire pro.ximal half of the muscle is adherent. Just in front of the mui.lle of the sole it sulxlivides into four bellies, terminating in four flat l.ndons, whuh beluive m exactly the s;ime manner as do those- of the flexor digiton.m >ublimis in the hand, /. . ., ihey are per- forated by the tend.ms of the flexor longus in the region of the i.roximal phalange^ an.l are inserted chieflv into the second i)halanges. Tlie posterior jK.rlion of the flexor digitorum brevis is in immediate relation with the two alxluctors (hallucisaml digili V) which form the middle an,' .xternal plantar eminen.es (I'lg. .o.,^ and the origin ..f the muscle is especially adherent t.. the aUiu. tor halUicis. Us anterior portion covers the tendons of the flexor .ligitonim l.mgus .,nd the lunibri, ales an.l is in r.lation on either side with the short musdes ..f the great anrl little toes. Thf musili- i> >upplir'l I'v llv inti rn.il |.l.inl.ir turvr. The quadratus plantse, aUo termed the jhxor mssorius an.l th.' <'iro quadrala Sylrii (Fig. Vi). niav be regar.le.l as a plantar hea.l of the flex..r .ligitorutn l.Higus. It is situated upon the ilorsal surfa.e of the flex..r brevis an.l is entir.ly (.nere.l by tlu' latter muscle. It takes origin bv mean- of two hea.ls, ..f wlii.h th. inner is usually ill.' stronger, fr.im the plant.u surface of the calcaneus an.l fr.im the l.mg plantar ligament, an.l the flat ami approximately nuadran-'ular muscle inserts int.. the outer margin ..f th.. t.n.L.n ..f tiu' flexor longus .ligitorum •IS it passes obli.|uelv across the s,.le of • f.n.t fn.m within .mtvvai.l an.l In.m Inhiml forvv.n.l. Th.' insertion .Kcurs l.fore the iVxor ;us ten.L.n h.is sulnlivi.!..! int.. its f..u, .ligilal shps ■ind after it has . rosse.i th,- ten.lon ..f llu fleN..r halhuis. .\l the .rossing ..f these t.n.L.ns they assume their proper positions (see page 22^) an-l are always ...nne.te.l bv anasionu.ti. IiIkts. While the ten.i..n of the flexor hallu.is runs in the long axis of the t..e, an.l . ..ns, .pu ntly in th. axis „f tra.tion, those of th.' flexor digitorum pursue an oblLpie (ourse as alnne .lescnln.! an.l deviate from the axis of tra( tion by about to degrees. Till- .|U.i(lr.itu- pl.inl..- i- Mi|.|.li. .1 l.v tlir iM..n..l [.l.im.ir mnr |,.Milun> 111 111. Itixi.r iiJKil..riiiii !■ itfu- ihi.. .1 -ii.iijjhi ,.r.i .imi in; ir.i-'- 1 .; 1... i.....l..n. «s 226 ATLAS AND TEXT-BOOK OF HUMAN ANATOifV. Fir. III.— The miiicUe la ver of plantar musdcs. Th.- flexor .ligitorum brcvis. ,ho ib.iuc.or hallucis. an.i .'he ab,lu.,.,r digi.i .,uinli hav. In-.-n r.-,m.v.„; the ..-n.lon- shfath.^ of the- .limits and of the pi-ronxus lon^us have Ihto opetu-cl. Vu: ji2.—T^e(leq)lav(Tcif plantar musrles. The tendon, of the flexor .iiKm<.run, lon«us. the llevor hallu. is lon^us, and the ..uadratu. p)anta. have Ix-en renu.ved. i iici I I THE MUSCLES OF THE BALL OF THE GREAT TOE. The muscles of the hall of the groat tcK' (lilT.r from those of the thenar eminence not only in their numlxT but also in the fact that one of them arises from the posterx.r extrem.t) ol the calcaneus an.l the other two from the anterior portion of the tarsus. The ball of the great toe eonse.,uentlv contains one long an.l Uu, .h.,rt muscles, ^vhile all four muscles of the thenar eminence ai^c practically of the same length, on account of the shortness of the carpus. The abductor hallucis (Kig. :,.o) is a long, triangular, ,Hnniform muscle which occupies the entire inner margin of the f.n.t and whose origin is situate.l imme.hately alongside of that of the flexor digitorum. It forms th.. internal ,.lantar eminence (Fig. ,;o„) and arises from the inner tutx-rcle ..f the calcaneus from the a.lja.ent ,K,rti..n ..f the inner surfa.e of that l..ne, from the laciniate ligament, an.l also from the plantar a,Hmeur..sis. which ...vers the mus.le completelv bv the ra.liations ..f its mi.l.lle p.rtion. S.,on after its ..rigin, a flat strong ten.lon .levelops in the mi.ldle of the muscle, which is inserte.l by m.a.ts .,f the int..mal sesam.,..! l.>ne into the first phalanx ..f the great to., an.l into its .lors.l ap..neur.,M,. The .lex..r hallucis brev.s is siiuate.1 Ntween th.. ten.lon ■ of the alKluclor hallu. i< and tl.xor hallu. i^ longus. The , I,, i, .„|,,.l.ed l,v ihe ,„.. rn.a |.l,,n.,,r n. rx ■ . It^ ■ !>., 1 fum lion i- .he ..l.du. li,.,, .,f the «rea. toe.* The flexor hallucis brevis ,Figs. ,;,, an.' .;>-m is mu.h ~lto,„r titan th.. ab,luc:or. t arisc-s turttv fn.m the plantar surfa..-^ of the mi.i.lle an.l external . i.n..if..rm iK-ne. an.l ,.art y from th.. ten.lin..us pr..l..ngati..ns of the l.,ng ,.lantar ligament whi. L f..rm .he ~h ath ot the .Krona.us longus. Like the lU.x..r polii.i^ brevis, llie inser.i.m of the -nus.le .im, es into lw., 'lips. lH.tween which PUS.SC-S the tend..n ..f the flexor hallu. is longus. The inner shp, t.-g-tur with the addu.tor hallucis, passes int.. the t. tuL.n of the internal sesanu.i.l b..n..: th.. ..uter shp, ,„f;ether with the a.l.lucf.r hallucis, passes t.. the evt.mal sesanu.i.l l^.n.'. I h. ,.ut. r margin of the muscle is in relation with ih.. alKlu.tor. the inner with th. ...l.iu.lor hallu. iv The „n.. le .1. xes , l,e ,u M U, and , .,1-' l'.-'^ ''^ >'" ^ '"■' I''""" """ ■""' '"'"'^ '" ''" '"'"'•'' '''"" ■" ntrvr. The adductor hallucis (Fig. vj) is a .lislinctK bi.ii-ital muscle an.l the tu.. hea.ls .lo no. unit, until th.v alm..M rea. h th.. ins..r.ion. Th.. .-W/./m li,.ul is a n.un.i, strong, elongate, mus.le ariMng fn.m th,- plantar ^urfa.. ..f the . xt. mal . .m.iform l..ne, in ...mmon wuh an.i partly a.lh. ren" to .he t!. x..r hallu. i.. fron, th. bas... ..f the ■.r...n.l an.l thir.l m...a;ars.-,i iK.nes. .The m.rked .levelo,,M,e.,. of mo., -,( the ,m.M 1. - ..1 the «na, and i.,ne .,.v o, ,,.,!. -i ih. iimmd r..„«e o notio o. ,h... di«i,- wiO he .,M.,d .overtnu. ol the f,.. alt .he .on. tu.on tha, ,h,.,e mu«l.., n.. .T,:.. . ...s. ,„„ tha, thev ,dav an in.,..r,an. o.te in ,u,.,H,r,in« .... ar, h o, ,h.. f,... ...,.., .allvMn.e the a .,^„ V ,i,.., no. . ,..M th. t.H a. all, 'm, .. .n-ert, d in, ■ pra.ti.allv nnmovahle l.fth n,..,a,ar.al !.«,.. fcii ' I THE MUSCLES OF THE FOOT. 227 and especially from the anterior extremity of the long plantar liganiint (see ])agc 141). The broad muscular belly is at first situated in the middle of the sole, covering the i)lantar interossei, and it then passes inward toward the external sesamoid bone of the great toe, and in this situation unites with the weaker Iraitsvcrsc licail. This arises by a puriiy niuM ular origin from the jilantar aspect of the tarsometatarsal joints of the second to the liflh toes; it remain> muscular until its insertion, while the obti(iue head usually exhibits an aponeurosis before reaching this point. Both heads are inserted together into the first ])halanx of the great toe, tile tendon of insertion containing the external sesamoid t)one. Thi' aililiHlcir li.illuc i^ i- svi|)pliiil liv ilu' cxtiTn.il ulanlar nerve. lis . hi, f funnioii i-. ad.hu ii..ii uf ilu- fiUM tin-. THE MUSCLES OF THE BALL OF THE LITTLE TOE. The muscles of tin's group lorrespond to thoM- of tlie hyiiollunar eminence botli in numb(r and in function, but the alKluctor is mucii longer than the otlier two muscles. The abductor digiti quinti (Kig. .^10) nsembles the abductor haiUuis not only in its posi tion but in many other respects. It forms tiic external jilantar eminence, and is tiiic k and broad t)ehind and narrow tid tendinous in front. It ari-es by a >horl tendon from the outer tulnTcle of the calcaneus be -nle the tlexor digitorum brexis, and also (piite extensively from llie plantar ajH-neurosis, which covers the greater jiorlion of the muscle. The insertion is jiartly into the tui)erosilv of the fifth metatarsal bone and partly into the outer liorder of tlu' lirsl phalanx of the little toe. The inner margin of the al)du( tor digiti \' is in relation with the Hexor digitorum bre\is behind and with the llexor digiti \' b!c\i> in front. It is su|i]ilii'il l>v till- cxtrmal plMnl.ir jutm-. lis ^jiei i.il fum li.Mi i> .il)ilmiioti >,i iW iillli- (oc. The flexor digiti quinti brevis (Figs. ,^10 and ,:;iii is a --mall elongated iiiumK which arises chiellv from the anlerior portion of the long jitanlar ligament (see page i(i) and is inserted bv a short tendon into the first phalanx of tile little toe. Il is in relation eMernally with tile third jilantar interosseous musci ■. The opponens digiti quinti (Fig. u 1 > is smaller but somewhat b-- ider lii.in tlu tlexor bre\is, the two muscles lia\ing a tonnnon origin. It inserts into tlu' oult r liorder of the anterior portion of the fifth metatarsal bone, extending forward almost a.s far as the lu.id. Ilie musi le is almost entirely comtimI by the abdm lor digiti \'. THc flivT .iii'l .i|i|»ininsainiti \' aiv "iipi'lii'l In 'ln' ' Mirn.il pl.inl.ir n.rve. Tlu ir . Iiii f lunuiuns ,iii- iiiili. .ilrH I'V th, ir n.inii-si. THE INTEROSSEI PEDIS. There are, as in the hand, fov.r dorsal and three plantar interossei (Fi^s. ;i.> ib i three havf a bicipital origin. In the vicinity of the metatarsophalangeal joints, they pass from 11;; inner side inio the dorsal a,K,neun>ses of the toes. At their insert.ons are usually s.tuate.l small bursa-, the //("i/ir/n;/ /ii/rw. , , , ,„ 1 These must ks are supplied in a variable manner partly by the external plantar nerve ami partly by the irt.ernal ,.laniar nerve. Their functions .re similar to the corresiKmdmg muscles in the hatid (see page 203). THE MUSCLES OF THE FOOT. 229 THE SYNOVIAL SHEATHS OF THE FOOT. Like the tendons of tb'; muscles of the forearm, the muscles of the leg nm in synovial sheaths as they pass into the foot. The rctinacula of these synovial sheaths are formed parth by rein- forcements of the deep fascia and jjartly by processes of the ligaments of the fool. Upon the dorsum of the foot (Fig. 315) arc situated three synovial sheaths: one for the tibialis anterior, one for the extensor hallucis longus, and a common one for the tendons of the Extrnsor dii^itorttm lonaiis + I'cronaus III lixlcnsor hallucis loiif^us Fibula m. jirroturus brevis Tendon-shealh 0/ cxiriisor dicilnrum li'iif;us and l>rri>'i,rus III Tninon anil Inidoii-shralh ()j fxlfiisiir halliii'i^ Inni^us / \ iti. rxlnmnr hallucis brevis Superior prrinirat retinaculum Injcrior fiiruncal rctiiuu iiluin I'rmlan sheath lendan ,i> fcro- ":■ exi.iiynr ,ii,i. Tciidani aj cxieniar oj In-ronaus Tendon and n,i us I'l 1 Irrum l.n.is' dieitorum lari^us lonKus ■rndim'Shealh oj 'tfon.rus hrevis Vic. 315. 'rtir tinilnp. -Iiiatli^ ami riliiiaiula '^f liiii.^uai ami cxliTiial virfau- ni ilu' Imii (•;uini "I: 1 diaKiammatiiJ. extensor digitorum longus and jieronanis tirlius. They commence in the U:' ird cn c .id for ii variable 'isliMKc uiion the dorsum of llie fool. Their retiii.uulum i> ihiellx idriuiii by a rein forcement of liie dorsal fascia nf the fool, llie iritiiitlc {untcriiir aitmdiir) lii^'iiiitiil, wliii h arises from the outer surface of ihi' cdcaneus, whcri it i. adherent to the intirosseous talot alcaneal ligament, and di\ides into a (ii>tal and a proximal band wiiich form almost a right angle with each other (Fig. ^of)). The proximal band runs lo the internal malleolus, the distal to 1 u dorsal surfaces of the navicular and internal (unciform l)ones, and when tiic lallir band is prolonged 23° ATLAS AND TEXT-BOOK OF HUMAN ANATOMY. to the external malleolus, as sometimes occurs, the ligament jjresents a cruciform appearance. The outer undivided half of the ligament is connected at its origin with the inferior peroneal retinaculum and the ligament contains three compartments separated by fibrous partitions, for the three synovial sheatlis. At the outer side of the ankle-joint the two jjcroneal muscles (longus and brevis) have a common synovial sheath (Fig. 31 0, the upper and Umer j.ortions of which are usually sub- divided for a short distance. This sheath is held in place by two retinacula which are frequently indistinctly separated. The superior peroneal retinaculum (Figs. 307 and 315) passes from Tendnti shii}lh ni lihiiiUs niitrriiv- I eiiddii-shriilli ii/ rxlensur hnlluin hiiixiis -Temhni-shralh oj tibialis ftoilrrior 'Tcndnn-shalh n/ flfxor ilii^ilontm Tt'iiilon-slw'itli ' ' cxlfiisnr hill, .s loili^US 'C'tlranC'il tendon - I.iii iiiiiilr lif;. 'I'liui"!! o; ;lf.\"r h.illtii i lull:. I ' >td<, an.! i> alx) conneiud ■■•iih the ueej) fascia of the leg. The iiijmor prroiuv! rclnuifU- lum iFig>. 307 ami 31.:;) tMen from tiie outer exinmity of the i ruciale ligamenl to the outer Mirfaie of the < aitaneu^ anil its iroi iiltar process. \. .1, ; _ ;,i,. ..r iK, I 1. ;,,;.,! 1 J'i.r ;iA> ilu'fe an- three synovial heaths for the tiliialis posterior, liie llexor digilorum longUN and liie Uxor h.illucis longli>. The sheath for the tibialis po>leriui- i- liie shortest and exteniU <'u\^ i- tile inner border of the fool. The two remaining Nhealii- are K.nliiiued into tile M,le of the fool and extend as far as the deeussatioii of the ten.ions. Wk THE FASCLE OF THE LOW ER EXTREMITV . 231 These sheaths are held in place by the laciniak linlrrnal annular) li^amnil (Figs. 305 and t,i6), a wide, ])o<)rly defined band which commences at the internal malleolus and jjasses partly to the inner and upper Iwrder of the calcaneus and partly to the plantar surface of the f(H)t as far for- ward as the navicular lx)ne. It contains three distinctly sei)arated comi)artments for the three synovial sheaths. In the sole of the fiK)t, in addition to the continuations of the synovial sheallis of the llexor hallucis longus and digitorum longus, there i> situated the sjjccial synovial sliealli oj llw pinmiriis lonf^us, which surrounds the tendon of this muscle in its i)assage ac ross the sole within the groove of the cuktid (Figs. ;,ii, 312, and 316) and almost to the point of its insertion.* This >heath is at first shuated aljove (dorsal to) the tlexor digitorum brevis and the tendon of the longus, and its retinaculum is furnished by a prolongation of some of the fibers of the long iilanlar liga- ment which i)ass Ix^yond the cutx)id to the base of the metatarsal tH)nes (see page 141)- The tlexor tendons of the toes ;dso jiossess syno\ial sheaths which reseinble those in tile lingers, although they are corresi)on(ling!y >iiorler and smaller. The longest sheath is usually that for the tendon of the tlexor pollii is longus. The retinacula for these sheaths are the Vdt^iiuil lifiamrnls, which are analogous to the similar structures in the lingers (see i)age jo;). Within the >vnovial sheaths of the second to the tilth toes exactly the s;inie relation^ obtain which we have previously observed in the lingirs. since tin wiak t( ndons of the llixor digitorum brevis are jierforated by the much stronger tendons of the tlexor digitorum longus (>ee page J07I. THE FASCIiE OF THE LOWER EXTREMITY, The lower I'Xtremily is envelojjed in a very strong fasi ia ( Fig>. 317 to 3-'0' Nvliith i> iuni>- ualiy thick in certain situations. In the different region- ..f ihe extremitv tiii> la-i ia rc(en(s corresiionding names, and wi- conse(|uently sjieak of the iliac fascia the fa^ia lata, the crural fascia, the doi>al fax ia of the tool, and the plantar aponeurosis. THE ILIAC FASCIA. The iliiK j,is(i,i cov( he anterior surface of the ilioii.Mias al)Ovi' the inguinal ligament. .\l the inner margin of th ,.,.oa> major this fax ia i- ituitinuous wiili the ju'lvic I'aM-ia; at the outer margin it iia>se- into the thigh with the iliojisoas and joins the jieitineal ta-iia to torm the iliopirthual j,isn,i, a ])ortic)n of the fascia lata (see pagi' -'3-'i. In doing tlii> llu lax la i> attached to the anterior sujierior sjiine of the ilium, to the inguinal ligament, and to the iliopei tineal eminence (tin- iliopcilhual H;^iitfiis il.v.jnp, .1 m -aiiiui.l I".m.' (.t ,,umI,ii!i 1. '' if"' 1 vy 232 ATLAS AND TEXT-BOOK OF HITMAN ANATOMY. Fig. 317.— The fascia of the thigh seen from in front. Fig. 318.— The fa^iia of the thigh seen from behind. Fig, 3ig. — The fa>iia of the lower leg seen from liehind. Fig. ^20. — The fascia of the lower leg. seen from in fr. '. and the dorsal fascia of the foot. and transverse fasciculi which are so arranj^efl that sometimes one set and sometimes the other i)reponderates, or both mayoccur together. In a general way the [losterior jjortion of the fa.scia lat.i is stronger than the anterior and the external pl the fa.scia lata covers ui the jiofjliteal spare and its con- tents, the dee]) layer envelo])ing iis muscular ntargins. The strongest portion of the fa.scia lata is situated u].on the outer -ide of the thigh and is known as the iliotibial lor Maissiat's) htiud (Figs. jcjO and ,?iS). This Land is composed cliielly of strong tendinous longitudinal fasciculi and receives the insertion of the tcn-or fascia' lata'* and of a portion of the glula'us maximus (see page 2ri). lis lower extremity i> attached to the external lubero.sity of the tibia, and l)eneath it is situated the va.stus iaii ;ali> with its large ajioneurosis. In the lower portion of the thiu'li the fascia lata givo olT a .sejilum u|K)n lillier side, and these ])ass l)etween the fi'moral muscles to the lips of the linea aspera, forming the internal and cxlcrnal inlcrmusculiir .sepia. Just below the inguinal ligament the fascia lata i> com])osed of two layers. The supert'ic ial layer ])a.s.ses over the anterior surface of the sar- lorius and the great femoral xcssels: llie posterior goes behind the sartoriii> and covers in the ilio])ectineal fossii (sec ])age 2101 and the groove between the vasiu- nu-dialis and the adductors. Over the adductor muscle the fascia i> \iry thin and transparent. The 'ortion of it mxering the ]ieilineus is also called the pcctimal jastia: it tuiites wiih the lower extremity of ilic iliac jasi'ia to form the iliopci lineal jaseia coxcring ihi l1(X)r of the ilioi)ectineal fossa. Immediately l)elo\\ the inguinal ligament the .su|)erricial layer of the f.iscia lata exhibit> a free internal margin, the jahijorm marii^in (Fig. S'TK which, together with the pectineal fa.scia. bounds a round or o\al depression in the fascia lata, \hr mal jossa (saphenous opening). Tin inferior portion of tile fall iforni margin, which i)asses almost imperceptibly into the pectineal fa.scia. is called the injerior eornii, while the su])erior portion, extending ujiward <■•< the lacunar ligament, is termed the superior eornn. The opening of the o\al foss;i is coxered \<\ a portion of the sutierticial laver. the erihri ior^f! ^astiii. whicii contaiti^ a '.onsideral)le (luan'.itx' of lat and <|uile a number of foramina, the largest of whicii gives jjas.sage to the ,i;na ' " I ^/ihaitanfoii. rtitf/i'iir t'lU'iii Cirrat siifihcinniS Gluunl sii/ais i,iyy^u Fig. 317. f-i<'. lis. ■f- ! Iw ■ wll ~ ^ ^.>:-:'^£-- m^^mm TmM^m f'ofUirrnl fossa i'ti/iiinmf tnuion m ^ intrafftiu'llar hnr-ii I rtOf'Vi I ■>»■ mi ml /it;. ( riitiiiti- li<iT the anli-rior iiihrmuscuhir septum, which i)asses Intween the extensors and tlic ])eron;ei to tlie anterior l)()rder of the libula, and the posit rior inlrr»iiis< nlar sipliim, which passes in'tween the perona'i and the flexors to the jiosterior l)<>rdir of the fibula, and itsui)|Kr and inner portion is adiierent to the»pes anserinus (see page 210)- Upon the posterior aspect vi the leg it divides into a superficial and a u>. THE FASa^ OF THE FOOT. While tile d0rs.1l fuM ia I if the foot ( I''ig. ^jo I is an exceedingly thin iayer, iIk nl.iniar apoiu iiro-i- (Fig. ;»)) is the thicke-i iiortion ol the entire fasi ia of llu' leg. In the middle of tile ^oj, ii (on-i^ts of a Ncry thick a|KMieurolii iaver, (iimpo-id cliiell\ n< lungiludinal I'a-cii uli with -nnie IiImt-- ■\hi( h passobli(|Uelv toward the Literal margins of the loot. Tlu proxiinai portion of 1 he, i|.nneuro--i>.i :, •« from tile inner and outer lubenles of tlu- calca.neiis an aijlun nl lo tin Ioi.l; mu-ilis of the fiKit which lake their origin- from the same Imnv |oint^; ii i- toi-ideraliK iliiik^ r ill. in the broader d'stal port,, n. iiie aponeun»i- together willi llu long niu It ^ lorni^ die inni' pUinl lo .-j;!. It> lap r:d p-i~ di > ule^ iiilo four ~lip~. • orre>-piinil ing to tile four outer to< -, wliiili art Ixniml logethe'- by traiisvcrM liUr-, llu /r./i/w.rw j^i^iii.ili. I'lMin thv ttM~ the .i|«iiieurovi- gratluallv ilisijipears in tin ionmtii\e tis>ue la\ir^ of llie ^kin. llolli lilt f.i-t i,i I.Ua .mil lilt laM i.i 1 niri-, like llu l,i-t i,i o| iht upper i xirt iniiv , imm p.i--ai;e |o \ivmK ,inil nt r\(^. THE MOST IMPORTANT BURS^ OF THE LOWER EXTREMITY. I. Tlu ui'ii iili^iiiniiy Inn lidiitirii hiir^ii. iht t hit t Imrsi upon tlu gii.il Irot li.inli r. :. The Irm hiiiilirt, I'ur^'i oj llu t^lui.iif m,i\iiuii^ iset page jt-'. Fig. .'n^K i,. Tlu i;luli(>, miir,it hiirui (set |>.ig( .• 1 J. Fig. .'>)><. inioii-tant. II r 234 .\TLAS .VXD TF.XT HOOK OF III MAX ANATOMY 4- The sciatic bursa oj the j^lulcrus mnvinius, Ixtwicn the- tulxTositv of the isehium and the Uluta-us maximus. tendo IS of the glulieus 5- The (!«/' rior ( /roflnnilirii ! hiirsd oj Ilu- i^iuin us imdius. ljc'l\Men tht nudiu.s incl na.\inni>. (). The ■ pos/trior {Irochautrrii ] bur ii n; Ilu i;/iiltiits nudiiis, bttwun Uu leiuluns of ihe i;lulncus nuii us and ihc jiiriformis i.si'i' |iagf .^1.". -. The trociiant'rii bursa oj llic f^liila lis niininim. a! Uu- inM-rliani - iiatn( - iiilo Uu- <;r(-at Irochant (T. U- riu- i'ursa oj ihr obturalorius iiiUritus (see ])agi- Ji.;, l-'i^. ioi -. 10. Tllr /);(;•'./ ('/ the rictus j, moris. al Uu origin of the nui-i 1( of Uu same iianu- from Uu- margin uf ilu aei lahuiiini. 1 1. ■Vhi- i/iopci liiii .it bursa oei- pafzi- 2ii,l-'i^. jijM onasioiially lonnnunii aUs wiili Uu- | Iiipj'oint I.'. Tin- siibli iiiUhoiis iliac bursa, al Uu in.-erlion of ihr iiiop.Mias iiilo Uu li -s.-i r Iroi liaiili V. '.V The pectineal bursa, al Uu inst nion of the iiiii^t Ic of Uu- same n. me. 14. Ilu ^upirior bicipital bursa, al Uu- oriL-in of ilu loiii; lu-ad of Uu )i(l-[).s. 'v The injcrior bicipital bursa, iK-iunn Uu u inlon of ins(-rtioii of 1 u- liin [IS aiu! ihi- ioni; ( Mirnal lalcral lijianuiii dl'hi- ktui' joint. If). The suhcutaiunus prcpalillar biir^a i-vv pa^i 1 \i>. 1m,!.;>. ,u 7 aiul ,, JO). 17- Ilu- subjasiial prcpalillar bur\ii isd- |>af;i i,;')i. iS. Ihe subtcmliiuaiy pnpalillar bur^a t-n- pa^i- 1 ;'o. • II). 'I'lu su prapatitlar bursa ii< pagi- i;;) (omnumiiaii- alnui^i alw.iv^ wiili liii kiin joint. .•o. Ilu subiutatunwi iiijrapatillar bur^^a. in front of Uu- upiur '-Mrrmiiy t.f Uu- li^anu iiiiiin piilella -^ri |iaU( 1 i'l, \\j~ :i, and ;.-c . .?!. 'I III iticp iii.rii pa/iil.ii lair^ii 1 --i i |>am- 1;; . ->->. Till •■iibi Hl.i'i- I'us l>nr a Of Ihi liilh rosity oj tin ///)/.;, a -^lllH^il.ln( oii> biir^.i omt llii tvdicnK- of liu- liliia. 2;. I hi sartorial bur^a (■-(-( |iaui- .m |, l-i::. Jo8i. .'|. Ilu aii^irnii bursa i>n' pat;r :u). \'\m. ji).'^'. -■;. Tlu poplii, at bursa i^.i paui ^ i;'iand j.'ii i onimunii air^ wiUi Uu kiui- ioini. j'). Tlu- iitlcnhil i;a\lri>i lit iiiia! buci ' -> 1 pa^i-^ 1 ;(i and j.?o, l-'ii;. ;o ; 1 al-o < onnnunii ,iii s uiih till kni-i joint. _•;. Tlu ^iiiiiiiinnlir.iiioiis hur-a 1 -. 1 pau;< - i.;f) and : {<) ) nia\ lomniiiiikati- \wih tlu kiui joint. .'S. I'hi ^iib< Ulan- oil. ,\t,riial iihilhoiar lf ihc lalocalcani'ona\i( ular articulation. ,^i. The siihlcnitiiioiis hiirsa oj llir lihiali antirior, at ilu- insertion of llic liiidoii nt \\\v tihiaiis antorior. 7,2. The suhtcndinoiis hursu oj Ilu lihliill^ fxi.slinor, at the insertion uf tlie tenilon nt liie tibialis |)osterior. _^?. The sulk Ilia nrous lahnniiil hiirsii. a -iihi utaneoiis bursa l)inealh the lulxr ( aieanei. .^4. Tile hitrsd (ij the (lilt ii mill lituloii. at the insi-rtion of tile tendo Aeliiilis. ^^5. Tile inlrniii liiliir.sof)luiliiii;;. Tile liniihrii al hnr\ir (see Jiai^i' jjSi. I \~ in 1I1,' 1 ,i-',- of ill,- ii|>|H r cvm-niily, -o em in ilu- jow.r a 1 l.i^^iii. ,iii..n cil ilu nui^i li'^ of 1 ,1. Ii nf llir ^;IllU|l^ i. . cm ni/f(l alMivc into />.»^^url;t, i -, a^ - "Hiitar, (I with lllo>r i.f ihr ii|tiHr limit. ■» < ur>, so lli.il ihr |>nrl'a. .■ ,iiiil tlu- |in- a\i,il niii>, h , mi llir |io hiici surfatt. turthcriiior. , ilu it i^ not, in tlu lit r\t |jIi \il^i - l axial lilnr-. ilu iioi 1 oiii|ili ir ilu 11 v,|i.ir.iiion. a riiU , iinlil ilu \ li.m- n .u linl ilic low. r thin I of thr thi|.;h. ilu iliiivioii of thr ^riMI s( i.iiii iutm' into tlu liiii.il an'l |m r.,iu-.il ncr\r- 'H i urrini; ,it a I mill thai li-ii-l, Uf.irin^ tlu M- f.it u in nainl. .' moriiliolniiii .it . Liy^itu .ition of tlu- !nii..( K-s of tlu low. r linili liia\ !..■ m.i.l.- a . follow ^ I I 111 Misn I s 01 1 HI Ilii'. f'M I'.i-t axi.il lulls, h-s; rfittifif^ ni'txiniit^. -/»/..f(^ mriijtt^. i^/tit-'ifi miiii'itity, an. I /. 'm-t ;.i\n,i I'l,'.! (/'I Vu- .ivi.it iiui.i lis; ilt'itit\, l*iri;^irmi\ ''liirtilor twtiriuty, tt'>,iir^ ;, iiuin^, an. I ''/- 'f> ;< nuiri\ 1 -li. .rl. r la I'i i.* \h) I'n i\ial liiiK, l,-^' fut ttiii'li\. i;riliii!\, ilildluh'r lni:.'li\. ihljtnfiir lirf,'i\, iiii. Ill I ill Ml s, 1 I , 1,1,.. f.Jl t'.i^t i\i..l mils. 1. s f\!ti!\tti lin^iltflini /*ilt,"/n. fnr^nhi rhm. t\;itt\nr ihilhiii\ lli:'iriitr^ pfroih' Wi ti'fltiii^. alul fhr'>n,tn\ hni /. I'm I*rr a\i.li iini^.r.s, (;,n/r..f ».»i;/o, f'iiiitifi^, yn/,iix. I'ttflH-t ii\, ;h\i*r iln^ittitttni /a.n;/(\. Ithu>!i\ tit\iir:.ir^ jfrvitr Ihiltiiii- /iiiii,'»\, an.l ./H.i./i.i/;(> f'l iiih, t 1\ till Ml .. I I . .ii I 111 I'. 1111. (.O I'iKt axi.il iihuiIi-n; rv/fHTfir iliiiilnrum hmiy an.l tilininr h>l'itt>i\ /irr/« CI I'r, -.ivi.il imiM li ■>: //i vr ilii^iinrum hn , /•. ,i> !.•>• hr,: i\ li,iltu, (.. ./W.i. !.ir ih^ih i/iiinli .i^r>.> », iM ttt\:itt tfti:>tri, tuniUrifiit^. iitUiui ti'r It tit lit /., ;U v.t htt-i;^ lii^iti >juitlti . .in. I i>itiri''^i 1. I 1> ) * Tlu l.i. . p-. f. !n..Ms I. .lilv I. ). lis. Ill 1 Ao iniiM h ^ Willi iniiiou iiivt rl 1. .n . it ■ lontj lu .i.| i a |'l» ;. vi.il n ih. It an.l it" -h.trt li. i.| It. Im^s |iriiii,i,il\ l.t ih. KJutt .il ^.1 ..I inii^ 1. - t "I lu .|ii.i.li.iiu |.l iiil.i . .illlutiiuh ^ilii.ilt.l in Ihr f....t. i. lita. rtluli.a iii.ir).h..|..m. .ilh ..n. ..fllu mu-. 1. - ..I Ilu I, tf, Itiiiin .1 .!• lii.ilivi ..f Ilu ■,imi nui-( 1. in i-s w In. li «im ■, n , i., ih, il. x.tr I.hiuik li.illu. i. ..n.l ili. iiln ih. |t. tO. n. ,r J ■1 ,v*; ^1 ^H. I J" V IHil^* INDEX Abdomina:, fascix, i6^ musclfs, 157 anuriiir, 157 ilcvflopnicm. 164 dcvi'liipnicnl, 1^)4 flat, 157 (ii-\('loi)mtnt, 164 jH»sttTi(tr, i6j (U'vclopmont, 104 straight, idi ilfvrli)|mn'nt, 164 |M)rtiiin of |iritoralis major musdi', 167 ril)s, 128 rinn. fxtfrnal, ijS AUluctor iligiti iiuinli musric, 220, 227 function 'if, 200, 227 nt-rvo supply of, 200, 227 lirivis must If, 18(1. 210 hallutis mustle, 2 to, 226 fum lien iif, 22^1 ncrvi' siipplv uf, 22fi |K)iiicis hrcvis niu-itli-, iSfi, ig<> function of :,ji) iicrvr iiipt^' . of, oii| longus nniwii', 185, 11)7 funition of. 107 inTvc sup!»ly of, 1^7 At I (■s,w>rv I'Kaiinnl-,, io>i of foot. I (0 plantar liganiml. 1 v; pr'Mfss. 28 sril.tr liiiann-nt''. 1 27 At ti.iiiul.ir fo>-.i. t>6 noli li, o'l At ctahuhini, oi. •*'» ticvclojinn lit , o't Aironii.il I'viniiiiiy of ilaviilc, 81; AcroniiiK la\ii ular ,irti< ul.ilion, 1 .mi liRanifnt. 120 .\i roiiiioii prtHc— .. 8 I ,\iMuctor liri-vi^ imi-^i It*, ?o^^ 2iti, 217 funition of. 217 niT'.f ■■•upply of. 217 canal, 217 halluuppU- ol, 2il> niaijTv.i'i niu^t Ir. 20<), ji'». 217 funition of. 217 ncrM- >upplv of, "1 7 tnininiU' nuisi It- .hmj. .'.<>. 217 Ad'luctor minimu.s must Ic, tunctitm of, 217 nt'rv<* t\ipply t)f. 21 7 muscles of tliivifi. 2iti tipeiiing, tentlinous. 2 1 7 jKiIlit is must le. iSfi. it>t) function of. 200 nerve suppl)' of^ 200 .Vlitus orliila'. 7 ( .VIminiculum line.e alli.e, 165 .\l.i' of ethmtiiil. fij of ilium, t)^, 1)4 Nurfat t's t)f, ()4, tj5 vomer:'., ;\(t, 65 .Mar ftiKIs of knee, i^j liKaiuerts, 1 15 IKiriion tif na^^ilis must le, 182 processes. 6; AUt'oIar Ijonler of mandible, 71 (anais. '17 foramina. (17 )"«•'. 7> ptirtit.n of iiKinilililf, 7 , pron-ss, ^7 of suj>erior maxilhir\-. 6fi. fiS .Mveoli ft)r teetli, 68, 71 Amphiartlirtisis, 108 Anatoniit al net 1: o( humerus. .S5 .Vnaitiiiu . tieliiiition. r 7 tlesi riptide, tit rmition, i 7 Kcneriil, ili liniiioii, 17 sjM't i.it, tlt-tinitittn, 17 system. (lit , tlermition. t 7 If>lK>i;rapliit . tletinition. 17 Ant. mills l.iitr.ili, mus, le. i,)o It, nulls must le. I St, nietlitilis must If, ii|0 niu-(le. i'^>. hio fum lion of, ii)o ner\e sujiply of, mo qUiirtus musile, it)o funition 'if. I 10 iiervf ^uppK tif, ii>o AnKioloyy. tl'-linition. 17 Vimle. I Mcrnal. of si.tpul.i. 84 inferior, of st .ipul.i, 8) infrasternal. <; intern. il. of s, .ipui.i. H4 m.isioi, I. n of l.ollis. t } of parietal iHine. fionl.il. S') masioiil, ^i| i«iipit.il, So sphenoidal. ?i( of rilis. i.- of St apulii, e\lirii.d. 8 t ipi.itlralus l.diii su- i.So .Angle nf sra[i'.ila, inferior, 85 internal, 8( su|)erior, 85, 84 of sternuni, ^4 parietal, 50 puhic, lit sphenoidal, 36 suh.ostal, ?5 \ngul,ir heail tif perioris n^ust le, .Xn^ulus iierni, ^4 .\nkle-ioiiit, 1^7 ligaments o' 1 V) .\nnular li^imenl, 122 toiierior, 127. 2.11) internal, 2?i of palm, 205 Imsierior, 20V 208 Aiinulus tvnipanit us, ^8 \nserine liursa, 2 nj \niagoni-l mustles. 1 j \ \nterior alKloniinal must les, 157 tie\elt)pniem, 1(14 annular ligament, 127, 221) arih of atlas, 25 of verlelir.i, 22 articular f.it ei of talia-ieus, 10 <- t;ilH'>. 10 atlanto'ii t ipii.il tne' U'lly of tligaslrit , iti|iitular lii^.imenl, ilinoid priHt'ss, 41, itintlyloiil t anal, 40, . ^ (oronoiti protest of ni.nalilile. 7.' (osioirans\,rse ligamcm, iH) 1 rani.il ftfs.i. (i crest of liliitl.i. i.-si irui i.il tig.imi ni. i ^ t irtis of stilit ui.inttiii^ inguin.il ring, 1 so elhmoitl.il f.ir.iniin, Oi. 7> f'lnlaneitf. Si gluteal line, f|| inferior spine of ilium, ij) intt rt oniKloitl fo».i, tut inliTniust ultir septum. 2 t i intt'riH I ipittit ,-\ ni hontlrosis, 47 inlertr.iiisvt rs.iriii-^ mii^t le. 15s inlraot 1 ipilal svnt liomlrti^is, ,>(i t.H hr\'mal 1 re>t. '17 l.iver of lumUnl.iiv.il f,i-,t ia. 150 ligament of eMerii.il m.tlleoliis, I 57 lonifitiitlin.il liiijiaint of \ertel)t.il 1 ttUinm, 1 1 1 musi les t>( leg. •.' t nares, 66, 76 .hrane ■'Uisi le , ,(i 10 238 INDEX. Anterior nasal spini-, j;, 68 obturator nu'iribrant', 115 tulnri li', 05 pi'lvif surface, t)U pillar of . subcutaneous int^uinal rin^, '5') portion of ■luiilraliis Uiniboruni niusi le, I (15 :.aeral foramina. :!.S .sai HM oei ypeal ligament, 11 i saeroiliae ligament, i jj) superior spine of ilium, 04 surface of su|)eri()r maxillary, <)(> of thi^h, muscles of, ^[4 of ulna, S7 taloialcaneal articulation, i ^.S li^ami-nt, 140 talot'ibular lii^anu-nt, 1 ;o talotibial lin.jnienl, i ;'i troihanterie bursa of ^'utjcus me- (lius, ^54 AnlenKxteriial surface of humerus, S(, Anteroipternal .surface of humerus, Sft Anlibrailii.ll fasc ia, ;oy ■Anlrum of ir.;hniore, (iD tympanic. 5.,. 5H Aortit optiiifm of tli.ijihrai^m. i(f>. itil. .\|KTtura piriformi-, ;;. (>^. (<(<. -(> .-\}M.'rturt of at|ua'(iuuas vestiliuli, e\- lern.il. 51; of peKi>, inferior. 1 ;i -upcrior. I (.~ ofi\nipanic i.m.iiii ulu-. -upcrior, \pe\ of tiblil.l, 101 'if p.itella. 'Ill if pvr.tmiil "f timjH)r.ii b..nt. -: ; \|iii.il inlonliiirl lin.imenl. 1 1 ; \i«meurosis, 14^ palmar, I'j.S. J07, ioS \|niph\ses. :!o \pjieiulie 111;!! >kileliin. -•-» \t|u:iiluciu^ iiMhiea/. iiriliie .if. ^f> vestibuli. api rturi of. cxp rn.ii. ^ ; \rih. losi.il. j) lunili«>ii»^l.il. i\ti Mi.il, 1(1^ intern'!. ,0; of llallir, lbs of v.li u , .'."O of \ertebra'. -'.', .' ; ligaru nls betueen, 1 1 ,' pubi< . I ti >u|R'fi ilian . (lij lemllnoiis, I i < /\(.jomatif . t."^, io. 40 .\ri 11. lie eminent e 5 1 Mltan.ent. 1 -•>* iMirnal, 1 io iii^ ini'rn.'i. I'l^ line. 1)1; | Vrthrixlia, 1 10 Articular capsules, lo.S of hip-joint, i%2 of phalanges of foot, 137 of hanil, 127 cartilages, ji, 108 circumference of radius, .S8 of ulna, 88 crest of .sacrum, 21) discs, 108, 1 i.S of elbows, I 1 ^ emineiue, of (»ci ipital Ume, 40 c*f tenitioral Uiiie, 5^ j margins. 108, ich) i proit-sses, 20 of sacrum, superior Jo ().' vertebra-, : \ surfaces of calcaneus. 103 of patella. t>ij of rac|iu.>, carpal. .So 1 of tibia, inferior, 100 su|>erior, c)t) \rticulari- genu muscle, .'15 subc rureus niuscle. J15 Vnii Illations, 107. loS .11 ••onie M 1.1 vii ut.ir. 1 2C iinkle. 1 >7 ■111. into, iviil. 1 1 ! i I ^ .iti.into. pi^iropliii , 1 1 i allantoo, 1 ipiial, 1 1 ;. 1 :', ball-.ind -01 ket, 1 \o biaxi.il. I 10 iiiioc ul.ir, loS ■ .lit .ineoi nboicl. I .^7 I ;.*< c .irpometac .irp.i' ■ ■ : 1 .'s of lluiiiib, l.'4. 1 .s ( hoparts, 1 (8 t 01 hit . I (I) iiicta..iriieipn.d.ingeal. \ jy of t'lumb. I J7 n\ii.'ia> i,.li.ilangi ,1! 1 57. i to III .I'liaK.tliis, 1 (7 of at lav, ir ( of axi-., 1 1 ( I I'l I ;7. 1 C* 1 i<> Articulations of carpu.s, 124 of costal cartilages, 117 of elbow, I2J of fibula, 136 of fingers, 127 of first and seconl cervical verte- bra', 1 13 of fcHit, I.!7 of hand, I2\ of hea'l, 117 of knee, T 51 of pelvic girdle, 128 of jihalanges of fcKit, 137 of h.ind, 1^7 of pi>iftirm JHine, 124, 1 -s of ribs with sternum, iiO. 117 with vertebral colunen, 2>7 of uri>t. 1-' i pelvic, Ij8 pivot, IOC) |>olya\ial. i to radioi arpal, i 2 t Milioulnar. .li,-M!, 12 i proxiin.il. 1.2 v.ie roili ic, 1 .'.S s.idc!le, 1 10 simple, ici; -.plieroid, 1 10 iiir.il. IOC) -tfPviclinii ular. 1 ic) -.le nioc cista!, 1 1 7 t.el " .ileuneal, 1 57 1 (S t.ilot atcaneonavic ular, ,17. ' •i'< lalcjrrural. 157 t.Uim.i'. icular, i,(S lar^l, 1 .■;, 1 58 t.irwMni". .i.irv.d 1 57 1 thiirt, 1^4 • ie\(lopment. i'.i> It.tll of ^jrcal I«K', mu-mIi-^ i i, .-.'O of liiile lot-, nin^< le> of. .-^7 li.ill-an'l-'^fH kci joint. ' 10 hasal li^aminl-s. dor-al, i.'7. i|i itit' ro>*rou ;. I -'7 n-,1 tatat-ai, 141 planta- 141 vohii. I, '7 Ha-^i of maniiililf, 71 of nietaiarpai Umh •-. fi! of .net iitrsal 't )n( -, ic> of p.itil!.'. 00 of ph.il.inirr- . of lirit:( r-. 'j.' of i-H ^. 10^ of Mapul... S^ Ha^ilar portion of o»iipii.il l-o'n-. \> Ila-ripliarvngi.it . .ui.d, 4;» Ha•^l•^ I r.inii i Mirn.i, i,i) H.-llv ol -MiMlr. .1: lii.irtii ui.ir nuiM Ic. r jj Itiaxial if'int^. 1 10 lU. < p-. Kra-hii mn-. !r, iS^. jSS funi (i.tn of. iK) Mt r\e ■ nppiv of, iNf Ii-ntlon of lonK 111 .m! ot, i . r frmoris Ui\\>t le. 20*). 21S full) tioti of 2 |S rurxc siippU of, .' iS Hit li.il''* fitt nia^^. \Xj. iSt |iu ipilai It'irsa, infitiof _■ < j -utHrior. .•;! f;roovr, rvTrrnal. 'S"^ .'-17 Bicipital groove, internal, iS.S, 207 of humerus, 85 ridges, 86 Kiciimoradial bursa, iSg Hifuri Is of Ikhu-, 21 Hone-cartilage, 20 Hone-marrow, 21 Hones, m l»l^lod\t>•^^ K i»f, 2 r Kruid, K) calt inetl. 20 f oni(«isiiitm ot, 20 dtvclopmnu of, .-r flat. U) hl-iuls of, JO iiioruam'i npn^iiiiK-n'-- of. 20 irrij;ular, 20 ionp, K). >^ce aU() Lorn^ I'onts-. macerated, 20 nu-ni!)ranous, 21 , 22 Till k of. 20 IUT% C-. Ill, 2 1 lunririi! t arials of. 20 orjf.init t on^titiitnt> of, _>o jrieaniatii, 10 ii.---tii- of, 20 tulMil.tr. i»> xi^rral, 22 Hony loikini; mi 4 h.tnisni-, icS, io<) |>|-1VK, Hi, ti--i]e. ."o Itra. Iii.d TiMi,!. 2-7 Hrai hi.di> miumIc. 1S5, iSij funi tion of. I s., nerve -uppiv of. i.Si, Brai hioradiali- nui-( If, iS;;, k,) tutu tion of, Kj; nerv«' injOy 'il, m^ Hrant hioriHTK nui~t h •-. i>(. 1^; Hrra>t iM.ne. 2-', ^.\. Sy\ also .V/ci-- rft tt 11 road Uoni -. ]<) liuii al f.tl nia^N. 1S2. iJ<\ Hill 1 ifiatiir i revj, 7 ^ Hm- t ophar\nneal I\i~. i.i. i.S | Muitiii^ \i-iia- iuv'ulati> vuprrior ;m lUir'-.r. ari^rrinr, .■ 10. 2 i i I'i. ipit.d. infi rior. 2; j Mi|.rrior. .'u lii ipitor.-idiit, t^i) '.il',int\d. -u'h ulaneou^. 2^1; -■■i.uohi.i.hial. 208 ■ tiliila! mli, 208 diitital. ilor-al ->ul'« ut.meou-. 20S e.i-lriu ru ndal.inh-rnal. 1 ^0, :jxi, 2\ | ututf*iftteor[d, 2r 2. .* ; { liiopi-i tiiical. I n. 2U infrap.M- ll.ir, dn-p i ;■; >ul" uliricou . I ;'i 2 ! i Burs;c, infraspinatus, 308 inlerniv.i irpoj luilanReal, 200 intermet ilarsophalangeal. 2^5 intralendinous olecranal, 208 latis>irmis. 140 !und)rical, 22!^ malleolar. >u1k utane<)us external, internal, 2 ^4 nietacarpo|)lialani;eal, dtirs.il -,.{,- I utaneou-'. 20S mm ous, 14^ of » alcane.d tendon, 2_;5 iif iMiriMir t arj.i radialis bnvi-;, 20S of llexoriarpi radialis. 2c<) uin.iris 20S major. 20S of tibialis ant»-rior >ilil |tr( tltn.d y;i piriform. 2\ i Itoplilcal. I ;;<. 2^0, 22] . _ ; • prepatellar, -.ijb iit.rirou-, 1 ,0, 2U -ul.faMJ.d. 1^0 iditiiidinoiis. I ;f» sartorial. :i \. 2^\ St iatit . of i;iula'u> ;ii.i\inuis, .' ^i si-niinu inliranou-'. 1 .;''. 210. •,» '-uUh romi.d. 20S suIk utaneta'-^ ( pit orith !,ir, 208 otrn..n.d. 2^-8 NlllKlflto'rl, iSO, T S -uhs* apular. 121, iSS ■^iditmdinous iiiai . ;4 olfit.in.d, 20S ' I'pnipatellar. 1 ;; .• ^4 -yn >\ial. i.)S ( otJUJiunii it aiy 108 tP» li.intrrit , 2 \ : anterior, of glulau-- midiu->, 2U of |^U:',tMi ndnii-iii - ; ( maxiirui'. .' r • 2 , , |>»tsfirior, uf liluiani- niei.'ti-.. 212. 'U ^ul1l utaneous. 2 \ { (' vi» \\( \i Imr^a. -uIm ulanrou-, trndon-. 22.' Inir-a of, .> j^ 240 Caliancocuboi'". articulation, i,?7, i^S ligament, -it l-lantar, I4r Ca:' -m-ofi' ular ligament, 140 Caicunconaviiular liganu-nl, 141 dorsal, 140 plantar, 141 C'akani-otibial ligament, i3<) Calcaneus, 103, 10^ articular surfaces of, 10 j Ixxly of, 10; rv, imirn.il. S!; basi|)har>nReal, 40 lurotitl, 5>. 5'^ extern, il oriliu- of, 40 conilyloi'l. 4°- 4s anterior. 40. 45 IMislerior. 40 ilenlal, inferior, 7J faiial, 50, 57 m'ni< nluni of. ^7 for verteliral artery, j'> \ein. 2(1 Hunter's, :;[7 hy|ionlos-al. to. 45 infraorhit.il, ''7 en'r.iiu I 'f. 7^ inKuin.il, ISO tn;.nulai . 7-' muMuloluliar. ;;. ^H nas..l. 7s nasi, 1. 11 lirym.ii. 04, (■-. ;, nutrient, of .1; :\ .s; Mf l»)ne-.. .-.. of radiu-. .s>.> i,f temiKiral 1 -'ne. ;7 |i,il.itnu-, ^(> I'h irvpiie.i!, to. t; i ii.er\ i^oid. 50, ;>^ ]iier> ^upalatint . si. ''-.} sairal. -M) >|)inii. ;i verteltral. '. 1 vidian. - < ,.ii ilii uli, ' .iriitiiiilcmiMnii. ; ■- C.oi.iliiulu- ihnrda- tMii|'..ni. 57 ,.., hle.e. ..rliM i.f. s'> mastoid. s>t tympani" , ?>! Cinidis vertelirali-, )i ('.mine foss.i 'lO v'anir.us nuisi It . i'"*! Capitular li^i.iineni. .ititerior, i ;'' (iiMeiior. ! i<' tiansverse. ot f'mt. I \i ol li.oi.l. i-'7 Capituluin "' liiii"' ni^, So i.f ulna. ,VS ('.apsides, .irtit lll.ir. ! os of hip ioini, 1 1;; INDEX. Capsules, articular, of ph,ilanges of foot, 137 of hand, 127 Caro i|uadrata Sylvii muscle, 325 Caroticotympanic canaliculi, 5''. 5** Carotid canal, 55. 58 external oritice of, 40 foramen, external, $h internal, 55 fossa. 172, 174 groove, 41, 48 tulHTcle, 3(> ("arpal articular surface of radius, 81) hones. 8:. .^v) anil ulations of, i J4 central, iji development, o> supernumerary, ij surf.ices of, 00, 01 eminenc e, radi.il, go ulnar, go <^r(K)Ve. ()0 ligaments, I3fi dorsal, 303, 20H extensor tendon slieaths Ih'- neath. 20\ radiati', 137 tr.insverse, 127. J05 volar. 20.S CariMmiet iiarpal artii ulation, tom- mon. i>|, Us of ilumdi. 1J4. i-'S litjament. dorsal. i.'7 viil.ir I. '7 of, ,.M 108 Carpus. 80 a.liculalion liganunls nf Cartila«(s. .'i artii ular. ji Imne, 20 ,o-tal. ,.? I'rnlations -if, iiilei.iriii ular. 108 ^t 111 oiiia"-, i,?t I, im lions nf. 1 ;' Cavities, gl.noid. ."it. na.al 7;. iiral, •.11.' of. 7^ oriiital. ; i pt Imi . I t:? (Ml;., eti-.tni.iil.il. i'\. frontal, ''! lachryni.d. '■ in:istoid. s i iii.,\ill.i! . '1 palatini ' ;, sphenoid. i Ceni, rs •■! 'M 'S (I- Cent, li .-,i|,. lal li. 01 .1 ilia|"iragm, I'l). 10^ tendon Cerebral Ljga. i of -iihenoid imnr. '0 siirfati . of f-tjii.ai li-'iu of orhiia' iw.i!es, (■ .if p.iriet:; fume, sn of s|,heni.id ti'ine. 4.' of ti mpiii d Uille. ^.' (.'er\ii ,il f.i .1 i.i, I 77 Cervical muscles, prevertebral, i -() ribs, 35 vAlehra', 2.V See also ]'erlel>rcr, cervical. Ccrvicalis asccmlcns muscle, 141) t?hassaignac's tubercle, 2I1 Check ligaments. loS Chiasma of tendons, 207 Choana-, 30 "(> Chopart's joint, I,v8 Chorda dorsalis, 1 10, 1 15 tvmpani, S7 Clavicle, 83, 85 iMxly of, 85 development. 85 e.xtremities of, 8^ Clavicular notches, ;^^ jionion of pectoralis major mu.scle, i(>7 Clinold pro. ess, anterior, 41, 40 middle, 48 jKisterior, 48 Clivus, 4,'v 4S. |8 Coccygeal (ornua, ,10 Cmcyx, 30 development of, ,^1 joints of, 1 1,; movements of, 1 1? (■(Hhlear ioint. io<) Colla'- bone. 85. See also Clavicle. Cilles' ligament, 150 Common i arpometacarpal joint, 12|, '-S UM-atvis i)f nosi', 77 Ciimnuiniiaiing synovia' bursa-, 108 Complexus minor muscle. 151 nuisi le, I s2 Compound joinf^. loi) Compressor n.iriuni. 182 Coniha nasalis inferior, (14. f)7, 77 Com ha' nasales, 77 nii'dia. '>! superior. <^\ sphenoidale ., (8 Conihal crest. (17, 61) Conduction I'gaments, 108 Condyle^. 20 femoral. 1(8. 1 ;i of (M I ipil.d Imtie. 4s if tibia fvtern.d. oo inn rnai ij*i I Conilyioi I • .inal. to. ,5 [ .interim, f-i. t< I p..-ln Coral 0.11 romi.il lii'amen'. 1 Cor.iiiibrai lii.il burs.i, ne, 93 development. <)6 ioint, 131 Cranial iMtne^, 44. 45 fossa*, 41-43 anterior, p middle, t > |>osta--ter niu-.. It , \()o ^^uiutions of, i6j n'TVi suppU 'if, )/».' Crem;'Steri< fasiia. I'l^ Cre-.t. JO Inn < in.H'n, 7^ cont Iial, *')7, 'kj > th?nnidid, f>7, (»; foi rectus (apiii- |Kistiiu- mai<: inuM If, 47 frf^nt.d, 41. (m infratem|M(ral. 30. ; ■ lai hrynial. .intiii'ii. (17 posterior, 0:; na-^al, ftK, fuj o( t ipiiiil. ' \{iTn,iI. 4'' inn tpal, 41. jf> of ni.ul... 101 of lu.id of ril)'.. 32 of ilium. 04 lips of, <; \ nf n<-< Iv of rill ^j of puliis, 0; '. Crest of sacrum, 29 of tibia, 100 orbital, of sphenoidal Ixme, 50 sphenoidal, 48 j Cribriform fossa, 232 plate of ethmoid Ixme, 41, 61, 62 j r,,-' . ■ 41,62 i »-"r: ' ,, . >.w ■... .■, 43, 46 \ itw'.i r- r , ,4 j rf p;; -' . -. I ;"'-^i' '■ ■' > ■ , j '' .' . ■'■ ■ ■'.•'< r' I [ ^, 22() .' : ■'.iieni i'-^iisverse, 2;^j^ i ( n. -. a.. '. <■, "f iiaphragm, 165 inurmediu!,! of diaphragm, 165 lateralo of dia|)hr;igm, if>s mediale of diaphragin, 1^15 of subcutaneous inguinal ring, an- terior, I ^0 I inferior. 1 5S jKistcrior 1 5() superior. 1 5S Cubiial interosseous bursa, 20S t'ulxiid [nine of foot, K 2. iO| (ieveldpnu-nt. lof> Culxiideonavicul ir ligament, dorsal, [ '"*' plantar. 141 j Cuc\illaris mu-.c le. i 15 functions of, 146 I nerve sujiply of. ! |0 I Cuneifori:; liones. evternal. 104 first, 104 j internal. 104 middle, loj j *>f fiKit. 102, ic; i d ■vr|(,pment, lo^ j w' Ictnd. >(;. (JO. ()i I sei iind, Tot I fliird. 10 i j ligaments, na\ii 1:' M '■ Txal. \ \] I Ci:n(-o< uboid Iig;.'ii' 11 , r>iil, ip inieio^Mous, 1 [ 1 j piant.ir, 141 Cuntttmetafitrs.il ligimt vu, ir.ter- I *('. 'COUS, i X t Cuneon.'p-ii >!.■.! .irlii LiLnu-f, : i- ■ -s In IP Ih.m' ,.; n,-\or i-.iii. is bn\., ime-i It . I 'J') infrajialell.i; b'ir-,i. ! 'v=^ l.iycr of I ,df nius( les, J2i of I er\ii ai f.isi i.i. i ;; of e\tensi»ts of fnrcarni. obliiju< , 107 'Straight. ot7 of flt'xi.r inusi ' Uiarthioses, 107. loS. See als<» Ir/n . ulalionx. Digastjit foss.i, 40, ~: mus( le, I 4.', 174 Tunctions of, i 7 ) nerve supplv of, 1 7 j Digital artii ulations, i 'S. 1^7, m.j bursa-, doisal suIh ulaneou-. Jo^ fossa. 07 Digitate iir.pressir.n>. 4- of sphenoiil U>ne, 50 Diploi", 11) Disarticulated skuii. \h Disis, arlM nlar, 108, 1 iS of elbow. I :3 Distal radioulnar articul.uion. tj; Dorsal an h of virtibra. 22 basal hg.irnenl'-. i .>7, 1 1 1 Ihirder of meiaoS surfate of r.idius. HS of s. .ipula, S^ of uln.i. Sj t.ilonax i* ular lig.tment. 1 ( > l.tisai lig.tmenis, 1 \ ^ Iar-.oMiet.il,ir--al linann nt-. 1 (i I "irsum. tnust 'n ~ of. 2 .; \ ^ell.r. p. iS Douglas' line, im Dui (Us entloluuph.ui- w-. ^s \^M' .MMl 242 1 i.HOw, arlicular disc of, u^ articulatii'Ti of, 122 Klljow -joint, 122 movciiR'nts of, 1 23 Kllipsoidal joint, no Kmbryology, (Icfinition, 17 Kmint'nt v, art uatr, 54 artirular, of tfnijM)ral })i)Uc, 40, ^^ carpal, radial, (;o ulnar, go ' r'lii iai, 4^, ^6 frotual, (io '■;|>() I"-narthro^i^. 1 lo, i;^r Epitoiul>lcs. JO of fr.-nur. L-xlcrnal, (j-^ inti-rrial, o>i of hiinirrus, SO Kpiiraniu-s musile. i 7S Kpi|)ltyscs, II) l^liijihysial rintirs r,| ossifu ation, .m line, 21 f-'-pisternal hones, ^0 i;pi>triipheii>, .'!, .>5 I'-pilrut liletKinconetH must le. lo-'^ !%rer;or spinie nnist le, 14') I'.-ophap'al openin;; uf i!!aplirat;m, K),, 166 I'.tlli :..i'l iKine, 6.' ala' of, fi; (riV)riforni jilale of, 41. (o, '.j deVelopnietU of, (i) " ,ewl«]rn, (14, ,Si ' tcral masses ef. t)2, hj^ p( rpendii ul:'. , ' 11 of, (>.», u^ I'.!limi>ii!:il 1p"'1 ., ') ivIK, (M. erest, 67. " depression . ci foranun. 0^ anP licir, Oi. 7^ [H.,.1. rj.ir. (.,, 7- i;nHJi<', ()> l,il»\rinlhs, t'j, fi; n..l,|i, Oi pros of infiri.. ■ uilti.i.tU'i l-me. spine, t ' . t'^ 'iirfae" o' l.;i hrynta! bone, t>5 I'".t!imiiideuma\ill.tij sutun, .So ru.sl.K hi.m tube, I artila^itions iHirli.in of, St semi function of, 107 nerve supply of, ic)7 dij{ilorum brevis miisi !,■, 210, 224 communis niusde, i.S^. n^o fuTK tion of, i()7 nerve supply of, 107 longus nuNcle, 210, 22^^ funition of, 224 nervt- >upply ()f, 224 halkuis brevis mustle, 210, 224 function of, 221 nerve supply of, 224 longus must le, 210, 22^ funttitin t)f, 22 ^ nerve supply of, 22 ^ indii is |iropriu.s must le, 1.S5, jij.S funi lion of, it)S ner\e supply 'if, iij.S of leg, 22? ossis nietat.-irpi pollit is nuistle, H17 ptillit is brevis must le, 1.S5, !()7 functif>n t>f. r(j7 nerve supply of, 107 Itingus must le, iSq. [97 fcnction of, njS nerve supply of, |.;.S I surfatc of forearn,. nuist les of. ms I tif upper arm, nui-t le of, i.Stj I tentions of Imgers, 20 i ttf hand, 20J, ■heaths ,,f, 20^ Il\tern,d alKl.iminal ring, 1 s.S tirif^'e of s, apula, s^. S| angular proi ess of fnHii,il Ihiuc, \u .iperture of ai|uaibii Ills vcsiibuli, ;; art u,ite liganu-nl, i ;0, if)^ ,iuililory nii,[ius, ^s, 40 bicipital grotAf, i,**s. 107 iHirtler .>i imiiii us, Sd i,iro;!ii I'l ranu 11, ^o I onil\ !•■ of lemur, i>S of libi.i. If) t rest tif libul.i. I ni • jneiioini 111. He- ..f fcK.i 102, lo) i epitondylcs 1 ' f,Mi:ur, i.s tif humerus. St) 'm i.ondyloiil luiien le c f li!,;,,, ,,,, iti'ert osl.d li'Mnients i^xj il '• riosl;ile, musi le,. '.<•■, inierniust ul.ir sei-i.t of .irni. 207 of ii.i«h. ,,;. l.itrml Iii;;im(iii nl ;in'!. i • : of h.-.i.l, \iS of kr.t'f. 1 ;; lunl!^lK.t^Ial ;irt h, td.; i;i.»llf«(i.ir lnir^.u ^-uln utJtit'oU'. .• ; | '-urf.u f of lalu'^. IC-' in;iilrolu-., 101 ■ Iit;anicnis i.f, anlirinr, i i; )Misurif)r. (5[7 in;in;in of -.(aimi.i. S^ nuni-(us n{ knr<- I tint, i \i, in I ipii.i! I riM. (f) [tmt iilirraTK f, \\. \(\ External palpebral raphe, 170 liatellar ptinacukim 135 plantar enii ■tntc, j^j pHKL'Ss of talcantus, 10,5 of talus, 102 ptery^ioid plate, 40, 50 rcctu> mustle, 'ipine for, 76 semilunar rarlilaftc, 133 sulHutanei)US t-pimndvlar l)ur>a, su|)erior articular surface of tibia. «,() surfate of shaft of tibia, 100 talo( all am-al li^anu-nt, 140 IuIkTi Ir of talus, lOJ Kxtremities, lower, Inirsa' of, 2_^^ fasci;e of. 2.:ji free, skeleton of, 07 tnust"k-s of, 2o<) elu^situation. 2_j,^ skeleton of, S», cj^ of lon^ IkmU's, ii> skclelctn of, 2J, Sj, S^ upper, artieulation?- of, i n) bursa' of. 20S fascia' of, 207 frte, skeleton of, S:; ligaments of, 1 i<) museles of. 185 flevi lopment, 201) -skeleton of. S_>. K^ thora* ir riiu-« le^ of, 166 V\(V, bon^■•^ of, ( I must les of, I 7S funttioti^ of. iS_' nerve ■^uppl\■ of, iSj proper. i;.j i .!(ial eanal, 5'>, >7 f^enieuluni of. 57 surface of malar hone. 71 1 all itorm marj;in of fasi i,i lata, 2^2 process, i2t) I'al^e j)elvis, i ^o rib>, I J, vertebra-, 22, 2X Ka-.. ia-. r j^ ai"!oniinaI. i^; aiiiibrai hia!, J07 axillary, 207 braeliial. J07 buetojtharyni'e.il, iS.; terviial. 1 77 » orat ot i.ivit ular, i 70 I rema>t( rii . i '• ( (ruri>. 2 {-^ ^iul.Ml. 21,2 iliai . 2 \\ . : \2 iliope) tineal, 2 \i. j^* infra^pinatu-^, -'07 lata, 2i,\ himlMxIorsal. i i of i)ai k. I ;f) of f.«.i, ..(^ of hand, dorsal, 20";, .-•oS of lirad, 1S4 of leg, 2,.? INDEX. 243 Fascia; of lower txtrcmity, 231 of nt'ik. 177 of tliij^h, 2^1 of iipiKT rxtrmiity. J07 [Kiroti'ironiasst'Urii , 1S4 JH'ttilU .ll. 2_J,2 piTtor.il. t ;o jiri-viTiihnil, 177 Scarpa's, ih^ suhsv apular. J07 ^upt•r^nial. ^t-iura!, i6^ supras|)in.itus, .'07 ltin(M)ral. 1S4 iransviT^aiis. U»t Kaxituli, transvtTsi', jri? l-at tnas^, Iliihat\, iSj, i8^ hut cal. iSj?, iS; Finiali' iH-Ivis. 1 :;i i'Viiioral lotnUI -, 155 Irianiilr, .'ifi I'Vinur. Sj, 07 tcnniyk's of, gS ; vrulii< . loS, ijS intcrvirti hral. loS, 1 ro na\iiiilar, 141 Kihrous l.iytr of ariii ular (apsiiU-, loS rin^ of iMttr\c!:; I-'irst (iiiiriforni l>onr of fiM,). 10 i Kis.sura iMiroiympanit a. 10. > ?. 5 I■i^^^lrt■, (it.iM-rian, \o. 5 ^ ;7 infitior orliital. 17. VK '•''. 7'. 7 infundilM'hr. t*\ ,Miroo, » ij)ii;il. 40. n. 51, ,Si ■ |»( lros<(iiam(»^al. ; ^, 54 M. i.V'. ".*; '.M. i.vS Fissure, petrotymiiai'i. 40. 51. 57 s])ht'noiht'nojK'lrosai, ^k 1'='. 4-- > *• ^s- .Si superior orhital, 37, 4*. 40. 71, 7i tyupanomastni;!. 51. 57 tynipanos(|uainosaI. ^j Fixation lii^anuni^. loS Flat .lUloniinal nui"! Irs, [:;7 (ie\ flopiiictit. i*)^ iMme--. J must I. > of h,i( k, 145 (levclopnu-nl, 15O l-'lexiori vrt" lira-. 2 ^ Flexor ae(essi.rius niU'i le, 2.'-'5 hrevis iji^ili \' niusi )e. 21 .• larpi ratliati-. imum le. iN^. imi funi tion 'if. itji nerve siipjily of. !-)[ u.nari^ musi le, iS;, i()> funetion of, i<)j neive --upply of. \u2 dit^ili quiiili hrevis nm-- le. iSo, :oo, - - 1 fuin 'ion of. .^ -.o. 2.^7 ner\e ^t;p|'t\ , .'oo, j.'7 ilit;iloruni hre\ i - niu-t le. _■ tc. 2.'^ nerve sajiply of, 22^ lon^u-' inusile. Jio, 2i(), 22\ funi lion of. .'.• > nerve supptv of. 222 profundus nui-t le. iS-;. oji fnm lion of. loi ner\.- --uppl) ol. m j ■-uhlinii'^ niu^* le, |.S>, I f).' lurn lion of. ro-' ner\ \ --upph of. m j liallui i-- hre\ i^ inu-t le j 10, jjO funi lion of. 220 ner\e -upply of. 22U l<»n^us nui--i le. 2\o. 210. 222 fuiM tion of, 222 )rCiMi\v for, to^ nerv*' -upplv "f. :?--• nf liiiph. 21S |Hillii is hre\i^ nui->t le. 1 S^, \m) funi tion of. ii}^;. lo^ fnm lion of, i., j nerve -u|'ply of. nj 1 surfaie nt (oreann. must les uf. iiji ol upp' r arm, 1 lu-i les of, iSS tendons of p. dm, 205 llo.iiiuLi rih- . ^ l-'onlantiU'. s ! mlerior. Si fr.intal. Si m,a-toii|. S» o( ( ipiial. Si jHMerior. Si sphenoidal, S2 I'ontii nli. Si l\nii. .iriii ul.ition-^ of. 1^7 U.ni's of. 101 eaUaneus of, loj, 10^ Foot, lulxud Umt* of, 102, 104 euneiform iMines ol, IC2, 104 fast i;e of, 2i,_\ ligaments of, 1^7* auessorv. \ \f} inlerossenus, 141 hmdirit lies must les of. 22S niiiatars.it fmii'-^ of. 10^ nuisi le*- of. 224 t la->irii .ition, 2 iS navii ular Uine of, 102. o\ phaiam^es 4»f, S2, ic; se-an.oi»! hones of, S2, lofi skeleton of, 101, io(' sole nf, l-;iJ.|^( Irs of, 2 J ; syaovi.ii -heath- of, 22t) talus of. 1.^2 tarsal hones of, 102 xaj^inal ii;.^anient~ of, 2;i I'oramina, 20 alvmlar. U- anterior -.h ral, .:- auililnry. internal. 55 ( ai um. 41. ^M . So ( aroiid. exiernal. ;/» intirn.d. ;; I n-ioir.in-\er^t .117 dental, inferior. 72 ethiimirlal. 6; anterior, (>i . 75 I«i-lerior. 'm . -:; front. d. f)'". 7-;, ;'» ini i--i\ e, ;o, ''S infraori'ital, ^7, ('H. (17 interverlehial. 2 \. \\ iuj^ular, 11. 1 ^ \(i Lif eruin, ;(). j-i. (.-. n, 5^ ma^nuhi, 40. ( \. 1^ itLUidiindar. 72 in.iMo'.!, ,0 ;;. Si. 51 mental. ^7. , 2 na-ai, ''5 miirien', 20 of hn„r. -n of lilii.t. 100 .►f ulna. S7 ohiur.ilor, o;. o'l of di.iplu:igm. U'') i -ji rum, iiiK t verl( hial, 20 of -i< mum. \f' ol xii-hoid pro< I -s. ;() o|.tii . (f. )S. :^ ovale. ;.;, 4:. 10. so p.liatine, L'leatel , 40. (n) I'-'-'vel , j.i, 70 )uri< t,d, \\. 50 <|u.idri'aiera!. i(tO mtmidum, \2. to. 50, 7S sairal. 2S. 20 interxerli hr.d. 2n ^Ai ro>i i.idc . I \''- -I iatii . ^ncil. I \o le--ser. I ^o -pheno|>aIatine. 7c, 7H sliinal, 2 ^ spino-um. \ii. \2. 10. 50 stvloma-loiil, \v. ;fi -,*,-T- ii T-''<* 244 Foramina, su;>raorbiial, 60, 75. 7ft transvtTsarium, 24 vertehrak', 2^ zyKiimatii-ofarial. yt zyg()inatinM)rl>ital, y •. . 75 /yg<>m.iiitotfmjK>ral, 71 Forearm, extensor surfare of, mus< Ir^ of, ii)S flexiir surface of, niiiseles of, igi muscles of, 1S5, i(>i classification, 20() radial musilcs of. i()i Foreheail. Uiny, ^l> Fossx, 20 acetabular. ()6 anterior « ranial, 41 axillary, 147 canine, dd carotid. 172. 174 condyhiid, 45 coronoid. .S6 cranial, 41-4? anterior. 41 niddlc, 41 IK)sterior. 11. 4.5 cribriform. .',^.' di^ia.stric, 40. 72 .IJKiial. (17 for lailirvnial nl-""'> 7* ■-ai , 7''i Ulenoiil. ,?S, yt liypo(;lo-.s.il, 4S hy|«o|il>y^c,il, 41 iliai , 115 iliopei lineal. 210 infras]iinalou-i, of siapula, H) infratemporal. 7() intercondyloid, ()8 anterior. ()<) postirinr. i|i) juKular, in. |(i. 50 niandibul.ir. ^.S, |o. 55. iiS niastoiil. ;i tniddle t r.oii.il. p • mipilal, inferior. 4 (. 40 superior. 4'i olecranon, S7 oval, -vt-' pelrusil, 5'> |io^n rior cranial, 41, 41 pler\4ioit!. 40, 5 1 ptervxo|i.ilalin. . 40. ^o. 7,S radiiil. S7 .s( aplioul. 51 !«|ilteiiom.i\ill.ir\ . 4'i. 50. 7.S nulKiri uali . s; sulisiapul.ir. .■<( .siiprai l.ivii uf.ir. lesser, 171 Hupraspinalou^. "»f s(apul.i, Ht temiioral. i-'^i ^J triK hant* m . 07 /.VKomatii . 71) FoMM. ..n arti< nl.iri^ dentin, :^ I-o\iH(I.e yr.imilires. ^^, i)o Free lo«el < MreniilV. --kel'Mon of. 07 Ujiper e\trelillt\. skeielon of. is., F'rons, 4(1 INDEX. Frontal angle of parietal Iwne, 51) bon. , ^<), 60 Ixirders of. ()o cerebral surfaces of, 41 development of, 62 frontal [jortion of, 60 ill ne\ ')orn, 62, 81 nasal portion of, Ao, 61 orbital plates of, 61 surfaces of, 61 suit i arteriosi of, 61 surfaces of, 60 zygomatic jirocess of, 60 iHinler of parietal bone, 5() of sphenoid bone, 41) cells, (\\ crest, 41, ft I eminences, fto fontanelle. Si foramen, fio. 75, 76 notch. 60, 75 plane, 17 |«)rtion 01* frontal iMine, 60 process of maxilla. ,^7 of sujierior maxillary, 6^, 67 sinu'., 61 development, f)2 sjiine, ft I surface of frontal l«ine, (to suture, (to, .Hi Fronlali* mus. li'. 17.H functions of, 1 7.S nerve supply of, 1 7S FrontiKthnviidal suture. 41, (it, .So Frontol.idirymal suture, (7, .So Frontoin.ixiilary suture, ,?7, i'o Frontosphinoiiial process, 57, 71 Fusiform mu-cle, 142 G.M.K.x a|«>neurotiia, 17.S (rasirocnemial burs.t. inner, 220 nilernal, 1 ^ft. 220. 2(4 (lasirocnemius lateralis niusile, 220 nieilialis muscle. 220 niu--! le. 211) (lenielli mii^i les, 201). .' 1 i (iemellus inferior nuisi !e, 214 su|HTior nnisili'. 21 \ (leneral .m.ilomy, delinilion. 17 su|K'rfii i.d fa-iia. ift) Cieniculum of f.n i.d caii.d. ^7 (ienioliV'iidcus niu^i le. 171, 17; fum lion^ of. 17s nerve su|.|ilv 111, 17:; Ciimlx'rnat's li(tameiil. iti. I'n, lOj, -Ml llinnlvmoaiiliri»lia. 127. i to CilnKlvinus. 100 later. il. io<) Cfinlle. pelvic. ()( anil ulalioii, of. 12H lipianieni- of, i 2S shoulder, .s^ C.lalM'lla. fv.i I'lladiohi^ of -lemuiii, \4 to.ind, i.HfMvnt.ti, [o„,.,i I«tr, 7n (ikseriun lissurr, 40. 5,A, 57 Glenoid cavity, 84, 121 fossa, 38, 55 ligament, 121 Glenoidal lip, 108, io<), 121 of hip, 131 Gliding joints, 1 10 Glut.Tus masimus muscle, 200, 211 function of, 21 2 nerve supply of, 212 medius musile. 20<), 212 function of, 21 2 nerve sujtply of, 212 minimus muscle, 20<), 212 fun( tion of, 212 nerve suppiv' of, 212 Gluteal fascia. 2_^2 line, anterior, ()4 inferior, 1)4 middle, ((4 jiosterior, ()4 superior, ()4 muscles, 21 1 sulcus, 2,^2 tulKTOsity, q8 Gluteofemoral burs,T, 212, 2,5? domphosis, 107 Gracilis muscle, 2tx), 2i() funition of, 217 nerve supply of, 2 1 7 Great sacrosciatic ligament, I 2(( saphi'nous vein, ;,u sci.itic foramen. 1,^0 nop h. 1)4. ()(> UK-, ball of. muscles of, 226 Greater icirnua of hyoiil iKjnc, 7.5 multangular Imne, .S<), r)o palatine foramen, 40, (»> pelvis, 1^0 sigmoid notch of ulna, S7 troihanter, (17 tulierile )f humerus, 85 tubircular ridge, 8ft wings of s|.henoift, 7ft imerlulH-n ular, of humerus, 85 lai hryni.il. S ciassiluation, 201J palm of, tendons cif. 205 phalanges of, 82. ()2. See also /'/;,/ iiiflt^rs 11} hiiful. sesamoid hones of, 82, i|2. .Sec .iNo Sesamoid hours oj Intmi. skeU'ton of, ()2 Il.inl palate, 3.). trn, 'hj tulHTOsily of. 40 [farmoni( suture, 107 Head. arti( ulalions of, 1 17 fas(ia' of, 1H4 ligar'U'nls of, 1 17 independent, i iS mus{ les ()f, 177 of I Mines. 20 of femur, 07 of hliula, 101 of humcru'-, Xs of melam.pal Ixmes, 01, 02 of nn-tatarsal iKines, 10s of must le, 142 of radius, 88 of rilis, ^1 of scapula, 8) of lalus, 102. T03 skeleton of, i:. 3() Ili.ilu-, 20 lan.ili^ faiialis, 4;, s» Kallopii. 43. 54 seniilunari-, (14, 7S Hinge joint, icxi Hip. must les of. 210 , lassilu atitin. J i,\ internal. 210 Hip joint, 131 anil ul.ir ia|)sule of, 132 glenoid.d lip of. I s.sa, QS ' Hiatus mustle. 210 Ilioi -tstalis ccrvicis muscle, 14C1 ilorsi muse It . 1 |cj lumlK>runi muse Ic-, 1 10 must le, 1 41) functions of. i;t nerve suppiv of, 1 SI lliofi iiior.il lig.imcnl. 1 ii IlioluMili.ir lig.imeni. 121) Iliopct lineal Imrsa. 133, 211, 2(4 eminent e, t); fascia, 331, ii,! fossa. 210 ligament, 231 line, OS Illiipso.is ntustle, 200. 210 funttion of, 21 1 nerve supply of, 21 1 llioiiliial hand. .•}-• Ilium, CJ3, o) ala of, 1)3, 01 surfaies of, 04, c)S IkxIv of, lis crest of. 1)4 lips ..f. ..4 ileMlo)iment. c)6 Iliun), spines of. 04 tulierosiiy tif, c)S Incisive f,)ramen, 31), 68 must les, 181 r iih. <>8 s 'urc. t>i). 8t Int isor teeth in fclus. (x) Incisura. 20 mastoidea. 40 Independent ligaments of he.itl, 118 Incliiator muse le, li)8 Inferior .ingle of st.ipul.i, 83, 8( aperture if pelvis, 131 artitular surfat cs of tihia, 100 helly of omohyoideus must le, 171 liitipilal hursa. 234 tornu of fasc i.i I.Ua. 232 t rus of siilic uianeous inguin.il ring, 158 tienlal tanal. 72 foramen. 72 extremity of femur, 07, cjS surfac-es of, t).S of lilnila. 101 of humerus, 85 of radius, 81) • if lihia, 00 of ulna, 87, 88 glute,ll line, lit inlerverteliral notch, 2; maxillary, 71. See aKo meatus of nose, 77 nut hal line, 41, 40 01c ipiial foss,i, 4 1, |0 orliiial lissure. 37. 30, 'Ki. 7 perime.il retin.ii ulum. 230 petrosal groove. 43, 45. ss, pill.n of sulii uianeous inguinal ring, 158 prcH c-ss of icnipiiral hone, 57 puhii* ligameiU, I 28 ramus of ist hium. cjj of puhis. 03, c)(i temporal line. S') thoratic aperliire. tS transverse ligament, 121 turhinateil Inine. 64. 67, 77 ilevelopincni, (14 \ertehral nolc hc-s. 2 { infr.iglenoiil.il margin of tihia, mo lul«rosiiv, 8| Infrahvoiil mii^c li s. 172 fum lions C.I. 1 7 I nerve supply of. 173 Infr.iiirliil.il i.inal. 1 nirance of. 7v for.imcn. 37, '»6, 67 grcKixe. ''/). 76 ni.irgin. 7s siilure. '18, 81 Infr ip. o ll.ir hursa. dc-ep. 1 ;s siilii iii.iniiiiH, 136, 231 Infraspinatus hursa. 20H f.isi la. 207 fossa of siapul.i. H; must le, 1 8s. ISO fun' lion "1. 17 nerve --uppl' "I, i>7 M.imlMr. 71. 7s 246 InfrasUTnal angle, 35 Infratrniporal crest, ,{(), 50 fossa, "(> surface of sphenoid iMjne, 50 of superior niaxillary, 66 Infundibular fissure, 64 Inguinal canal, r5(> ligament, 131. it\^ reficcted, I5(). 164 ring, sul)cu'.';neous, 1 58 Inner 1 rura of diaphragm, 165 ga^lnHnemial bursa, 220 head of gastrocnemius muscle, 220 of triceps muscle, iijo lip of tinea aspera, ()7 portion of longus colli muscle, 17O vitreous table of flat bones, 19 Innominate bone, (13 development, 06 Inscriptions, tendinous, 143 of rectus abdominis, 161 Insertion of muscle, 142 Interalveolar septa, 68 Interarticular cartilages, los ligament, ir6, 117 Intercarpal articulations, 124 ligament, dorsal, 127 volar, 127 Intercartilaginei ligaments, i6q Interchondral joints, 117 Inten lavif tibia, ijc) fossa. oH ant*'rior, (j<> lK>sterior, gt; line, i)H tuln-rt le, external, tut internal, i)() Intercostal ligaments, 117 external, ifx/ internal, i(«) spa-e^, ;; Inli-r(o-,i.ilc> extern! niu^iles, 161) interni nuistles, i(x) muscles, !<>(), I'm functions of, I 70 nerve >uppl.v of. 170 Intercrur.-d tit>ers of ^ubi ul.ineous in- guinal ring. 150 Interi unciform ligament, dor-.il. 141 iaten»sseous, 141 plantar, 141 Intcrnuixiilar)' Iwtnc. fxj suture. 17, ,So Intermetlial crus of di.tphragm. 105 In: -met.-H arpoplial.mge.il bur^a', 200 Inlermclatar'i.il anil 111. iiions, 1(7, 1 ^i) Inlermel.itar^oph.dangc.d burs.i. 2^5 I.ilerttui--< ular sept.i. 1 ^ \ anterior, of leu. .•(( external, of arm. 207 of thigh 2^1 internal, of arm. iSH. 207 of thigh, 2\2 of .If Ml-,. 18S. 20; INDEX. Intermuscular septa, posterior, of leg. Internal angle of scapula, 83, 84 annular ligament, 231 arcuate ligament, 165 auditory cani>l 53 foramen. 55 meatus, 43 bicipital grcMive, 188, 207 border of humerus, 86 of tibia, 100 rarotiil foramen, 55 cerebral surface of frontal lx>ne, 60 condyle of femur, g8 (ii tibia, (>() crest of libula, 10: cuneiform bones ot fo'. 102 of uln.i, H7 talynihonilrose-., 47 Interossei itor'^ales muscles, 1H6, 200 fum lions of. 20 ( nerve supply of, 2C\ ntusi les of f«Mt|, 210, 227 of hand. iHli, 200 [M'dis mu-.! les. 227 dorsid. 227 fniH lions iif, 22S nerve -apply of. 228 plant. ir. 227, 228 volares muscle-, 186, 200, 201 function of, 303 nerve sup|»iv of, 203 Interosseous basal ligahunts, 127 metatarsal ligaments, 141 bursa, cubital, 208 cuneoculxiid ligament, 141 cuneometatarsal ligaments, 141 intercuneiform ligament, 141 ligaments of f(M)t, 141 of neck, 1 16 membran'' of ra, . ji, 188 Intervertebral discs, 30 fibrocartilages, 108, no foramen, 23, 31 c)f sacrum, 20 joints, 1 1 1 Intrajugular pfxess, 46, 55 IntraiKt ii'ital svni hondrosis, anterior, 81 posterior, 81 Inlratendinous olei ran.il bursa, 208 Irregular l>ones, 20 Isthiocapsular ligament, 132 Isihiuin, 03, ()6 de\'elopment, 96 Jaws. Sei' Mamlihle and M.ixilUr. Joint. See ArtUutiiliimi. lu-hions. 108, itx) Juga alveolaria, 68 Jugular foramen, 40, 41, 4( fossa, 40, 46. s6 nod li of manubrium, 34 of ti-mporal Innie, 55 prixess. 43, 46 tul«'ri le-., 43, 46 Jugum sphenoidale, 41, 48 Juucluro; lenduiuin, 196 INDEX. 24/ Knee-cap, gg. Sec also Patella. Knee-joint, 1,53 menisci of, 133 funrtions of, 13'' movements, 136 semilunar cartilages of, 133, 136 transverse ligament of, 134 Lacertus fibrosus, iXH, 207 Lachrymal bone, 37, 64 development. 65 surfaces of, 65 cells, 63, 65 crest, anterior, 67 posterior, 65 gland, fossa for, 76 grtxjve, 67 notch, 67 portion of orbicularis txuli muscle. pnx'ess ftf inferior turbinated, /)4 sac, fossa for, 7(1 Lachrymoconchal suture. 80 Lachrymoethmoidal suture, .So Lachrymoma.xillarv suture, 80 Laciniate liganu-nt, 231, 231 Lacuna musculorum. 231 vasorum, 231 Lacunar ligament, 131, if>3, 164, 231 Lambdoid border of occipital bone, 46 suture, 38, 7q Lamina papyracea, 6? Langer's muscle, 1(17 Lateral crest of s.t rum, 2(, crus of diaphragm, 1(15 ginglymus, loq i..tertransversarius muscle, 155 ligament, external, of arm, 122 of head, 1 18 of knee. 13S fibular, 134, 135 internal, of arm, 122 of knee, 134 of lingers, 127 of f(M)t, I3() radial. 12O tibial, 134 ulnar. 12') masses of atlas. 25 of ethmoid, ')2, (13 of sacrum, 21) jtortions c)f (Hcipit,!! fionr, 40. 4., sacr(hi>c( yge.il liganii-nts, 11 \ surfaii' LcT.-tT c:irn-da of hytjiri Inint-. 73 multangular (xine, 8<), i>o Lesser palatine foramen, 40, 70 pelvis, 130 sacrosciatic ligament. I2(;, 130 sciatic foramen, 130 notch. 1)6 sigmt>itl ntitth tif ulna, 87 sui)raclavicular ft)ssa, 171 trochanter. t)7 tubercle of humerus, 85 tubercular ridge, 86 wings of sphi-nt)i(! Ixme, 47, 40 Levator ala' nasi mustle, 180 anguli oris muscle, 181 glandul.1' thyreoitlea' muscle, 173 labii ir.ferioris muscle. 181 superioris ala'quc nasi muscle. i.So mustle. iSo menti mustle. 181 scapuKx* mustle. 147 functit)ns t)f. 147 nerve supply of, 147 Levatores costarum breves muscles, 170 Itmgi mustles, 170 muscles, li-n) Ligamenta mruscantia, 169 Hava, 112 Ligaments, 108 accessory. 108 acromitH lavicular, 120 alar, 1 15 annular, 122 anterior, 127, 221) internal, 231 of palm, 205 [HKterior, 203. 208 a|iical iKlontoiil, 115 arcuate, 128 external, 156, 165 internal, 165 1H>pliteal, 135 basal dorsal, 127. 141 intertis.seous, 127 metatarsal, interosseous, 141 plantar, 141 volar. 127 bifuriate, 140 caltaneiHulxiiil, 141 plantar, 141 ialcanet)libul.ir. 140 lalcaneonaviiular, 141 dorsil, 140 plantar. 141 I .iltaneiiiibi.il. 131) 1 ipilular. ,in , , lor. "36 |)Oslirii r (() transvcr>. , tf ftKH, 1 3tj larpal, 126 titjrsal, 203. 20S extci.s.ir leniltm sheaths In- neath. 203 railialf. 127 transverse, i 27. 20^ --lar. 208 carpmielai iirpal. ttorsal, 127 vtilar, 127 check. i=H Colles', 151) Ligaments, conoiil, 120 ctirattiacrtimial, 120 coracoclavicular, 1 20 ct)ract)humeral, 121 costocIa\icular, i it) costotransverse, anterior, 116 miilille. 1 16 posterittr. 1 16 superitir, 116 iDtyloitI, 131 trucial, 134 anterior, 134 of palm, 205 posterior, 134 cruciate, 1 15, 220 crural, transverse, 23^ cuboidet)navicular. tltjrsal, 141 plantar, 141 cunetKuboiil, tlt)rsal, 141 intert>sseous, 141 plantar, 141 cuneometatarsal, interosseous, 1 41 deltoiti, I 30 dtjrsal, t)f ftK... 140 Gimlx'rnat's. 131. 163, 1(14, 231 glentiiil, 121 hamatomelacarpal, 127 iliofemoral, 132 iliolumbar, i2t> iliopettineal, 231 inguinal, 131, 163 rtfletHil, 151), 164 interanitular, 110, 117 intertarpal iltirsal, 127 vt>lar, 127 inlercartilaginei. i6<) inten lavit uiar, 111) interttjsial, 1 17 external, 161) internal, ifx) intert uneiftirm, dorsal, 141 intertjsset)us, 141 plantar, 141 intert>sseous, 1 16 basal, 127 metalars;il. i \y cunetM"ulM)itl, ■ • 1 I unettni,'talars.il. 141 intercvmeiftirni, 141 t)f ft>ttt. 141 sacroiliac. 12() taltnaltancal. 140 intersi ntuis. 1 1 • inltrtransvt rsc, •>{ vcrlebral loluinr 1 12 isi hiiH.ip-.ular, 132 lat\ii,ite, 2.1, 231 lat un.ir, 131, 163. 164, 231 lateral, exit rnal, tif arm, I2J tif head, 122 of knee. 13s '1, i.iS lit ar, 134, I3S internal, of head, 122 tif knee, 134 of fingers, 127 of f'Jot, I ;:j radial, 122, I2fi 248 INDEX. if Ligaments, lateral, tibial, 134 ulnar, 122. 126 lumlxKostal, 156 navicular tnneiform, tlorsal, 141 plantar, 141 oblique, 123 JHipliteal, 135 «lontoi(l apiral, 115 of ankle-joint. 130 of confluction, loH of costal tubenle. 116 of external malleolus, anterior, i,: posterior, 137 of fixation. toS of fiH)t, 137 accessor)', 13Q of hanil, 124 of head, 1 17 inflependeni, i iS of hyoiil l«)ne, 1 jij of lower extrcmilies, 12S of neck . 116 of pelvii ginlle. 12S of scapula, i 20 of upper eMreniities, 1 U) of vertebral column, 1 1 1 orbicular, 1^2 pal|iebral, internal, I7g patellar, 135 pelvic, 128 inilepenileni, I2() pisohamale, 125 pisometacarpal, 12; plantar accessory, i,^c) lonj;, 141 of fiHil. 140 tarsal, 141 ]K)pliteal, arcu.ite, 135 oblique, I IS Poupart's, lii. if)? ptervRomaxillary, 184 pteryg<)spinous, i if) pubi( . inffrior, 12H s^pcior, I 28 pulxxap-ular. 132 radial lateral, 122, 126 radiate, 11 0, 117 raditwarpal, dorsal, 126 volar. I .''t reinforiinv;. 108 rliomlKiid. I U) round, i.;2. 13^ satrodKcy^eal. ant*'rior, 113 lateral. 1 1 ? posierioi, I n s.u roiiiai , anterior, I2<^ iniero>^n.us, 1 2t) |«i^Ierior. 121) sacrosi iaiii , ^reat, 121) lesser I 2(), 130 sacrospi us, 120. 130 sacroiul- 'Us, 121) sjilienon ilibular, i iH stellate, ; ^•.117 ■-tcrntK iii\ 11 ular, 1 ic) slvlohyoid, I II) -IviolM.liidlbui.il, I I.N, i.';4 stylonuixillary, 184 140 •Vi Ligaments, supraspinous, 112 talocalcanea!, anterior, 140 external, 140 internal, 140 interosseous, 140 ]tosterior, 140 talofibular, anterio |M)steristerior, 130 tarsal, 13Q d()rsal, 140 tarsometatarsal, dorsal, 14T plantar, 141 lemiH)n')mandibuIar, ;iS tibitmavicular, I3(), 140 *ransverse, tapit'ilar, 127 inferior, 121 of a:'.is, 1 14 of hip, 13T of knee. 134 .superior, 1 20 tra|)ezoid, 120 triangular, 150, 1O4 ulnar, lateral, 122, 126 vaginal, 143 of foot, 23: \' Jar, accessory, i 27 Ligamentum nuch.r, 113 teres. 132 Limbus alveolaris, ')8 Linea alba, 161, 1O3 aspera, 1)7, q8 musi ularis. S3 suprema, 40 termin.dis, 2() Lingula. 48, 73 Li(is, glenoidal, loS, icx) I2r of hip, 131 of crest of ili'im, 1)4 Lisfranc's joint, 1 31) tutxTcle, -^2 Little toe, ball of, niusdes of, 227 l^iocking mechanisms, l)ony, 108, Long lM>nes, ig diaphyses of, n) epiphyses of, II) extremities of, K) neck of, 20 shaft of. 1,, head of triceps mus< Ir-, 180 must les of bat k. 14*) tlevclopmenl, 1 s'> plantar ligament, 141 |K>slerior sat roiliac ligament, 1. Ltingissimus tapitis niustle, 150, terviiis musile, 150. 151 ilorsi must If, 1 10, 150 musile, 141), 150 funttions of. 154 nerve supplv of, m LongilutHnal ligaments tif verti t oiumn, 1 1 1 Ltingus .itlanlis niustle, 176 ( .ipiti> ; lusi le, 176 funttions of, 17(1 nerve suppi> of. 1 jf, ttilli niustle, 176 l.ral Longus colli muscle, functions of, 176 nerve supply t)f, 1 76 L,>uis' angle, 34 Lower extremity, bursa- of, 233 fascia? of, 231 free, skelettin of, t)7 muscles t)f, 2og classification, 235 skeleton tif, 82, ()3 jaw, 37. Sec also Mandible. portion t>f longus colli muscle, 176 Lumbar jxirtion of diaphragm, 164, 165 rite, 28, 35 triangle, 147 vertebrae, 27 LumlKKtistal arch, external, 165 internal, 165 'igament, 13b Lumlnxltirsal fastia, 146, 156 Lumbtjsacral vertebra, 30, 36 Lumbricales bursx, 228 muscles t>f ftHit, 210, 228 of hami, 200, 203 functions of, 203 nerve su|i|ily of, 203 Lunate Ijtme, 8t), tjo Maissiat's baml, 232 Malar \nmv, 3b, 70. Sec also Zygn- matic hour. jHirlion t)f orbicularis ,« \ili muscle, 170 surface t)f malar ln)ne, 71 Male [k'vis, 131 Malleolar bursa, subt utanetjus exter- nal, 234 intern.d, 234 surfates c,f lalus. 102 Malleolus, external, 101 ligaments of, anterior, 137 fMisterior, 137 internal, 100 Mammillar\' pi functions ol, i8^ nerve sufifily of, 183 M.is-.eterii iuliero>i'y, 72 M.istoid angle, 4,, 50 Utnler t>f oi(i[)ital lM>ne, 4ft tanaliiulus, 56, 5S tells, S3 fonlanelles, 8j INDEX. 249 Mastoid foramen, 40, 43, 53, 54 fossa, 54 jKirtion of temporal bone, ,^8, 40, 52, 53 process, 38, 40, 5.?, 54 Maxilla*, 37, 66 Ixxly of, 66 developmem, 6q frontal j)r(H-esses of, 37 in ni'\vlK)rn, 6<), 81 nasal prcKi-sses of, 37 processes of, 37, 66 surfaces of, 66 Maxillary cells, 63, 67 process of inferior turbinatexJ, 64 sinus, 66 orifice of, 67 surfa'e o." ])alate Ixine, tx) Meatus acusticus externus. 38 auditorius externus, 40 nasopharyngeal, 77 of nose, 77 common, 77 inferior. 77 middle, 64. 77 suiwrior, 64, 77 Medial crus of diai)hraRm. 165 inlertransversariuM niustle, 15s Mi-dian palatine suture, ^tj, 81 plane, 1 7 Meitai, 115 (posterior, 1 15 cosl(Koracoi(i, 170 interosseous, of ra^lius and ulna, ij , of tibia and fibi:la, 136, 137 ol)tuiittor, 1 11;, i2t) anterior, 1 15 |K)Sterior, 1 15 sternal, 117 •-ynoviiit, 108 tectorial, 111, 115 Membrane. us Ixjnes, 21, 22 MtTiiscu^, 108 of knee idint, 133 funtti'-n of. 136 Mental fi development, 92 llCild 111, If., t)2 shaft of. gi su»"faces of, gi MetacariM)pha!:inKial artit ulalitm^, 127 men!, 106 head of, 10^ Metatarsi] liones, shaft of, 105 ligaments, basal intenwseous, 141 Metatarsophalangeal aliculation.s, 137. i.W Metatarsus. 105 Nietopic suture. 60. 62, 81 Middle articular facet of calcaneus, of talus, 103 clinoid pnnesses, 48 costotransverse ligament, it6 cranial fossa, 41 •Tura of diaphragm, 163 cuneif( rm Inmes of f3 ' Monaniculiir mu.si U"^, 142 Mucous bursa', 1 43 { Nheath, intertuben ular, 121, 188 I Multangulai •Mine, greater, .iij. (jo I lesser, ik), i;:> Mult'*ulus cervicis niustU, 152 dorsi must le, [52 lundKirum mii>t le, i ^2 must le. 152 function^ of, ■ 5 1 nerve supply of. :54 Mu-'cles, 142 alxlominal, 157 antagonistii , 14^ belly of, 142 li'articular. 42 biceps. 142 bipenniform, i \2 bipinniile, 142 bivrnter, 142 cervical, prevertebr.d, 176 development, 1 ,s digastric, 142 fusif of face, 178 of fle.vor surf.ice tti f»>re;irm, l<)l of upper ;irni, i ^S of fiMU. 224 of forearm, 185. iiji of hiind. 1^5, U)S of hfiid, 177 of hip, 210 of hyiM>then:ir eminent e, 200 of 'eg, 310 o. it7-,vrr r-'itremiti . 2Ci} of niiistiiaiion. 182 I Muscles of ne(k, 171 (tf scalp, 178 ()f shoulder, 185, \Ah of thenar eminenpindle-shaped, 142 supraiiyoid, 174 synergistic. 143 thoracic, 166 ! triceps, 142 lypital, 142 Mus( ulospiral gro4»ve. 86 nerve, groove for. 86 Mux ulotubar < anal. 5^, 5S Mylohyi-id groove, 72 line, 72 r; 'he. i 75 Mylohyoideu-^ muscle, 174 futK lions nf, 17:; ner\e -ui>l)Iv of, 175 M, ■;,,«>, ,4. • detinitio.i, I 7 general, 142 spei iai, 14.' Myonierlc niu-dcN, 1S4, 185 N.ARF.s. anterior, 66, 76 ]>o-,terior, 3(> \a"«al Uine-i, 37, 65 development , 65 in nt \v-1mtii. 65 iMinh r ot' front*.. !?'«ne, 61 I an;ii, 75 ravi.y, 7'. f tramina of, 77 I ttncha'. 37 crest, 68, (x) foramina, 65, 77 must les. I 70, 1S2 nott h, 68 IM)rti<»n of frontal Uine, 60. 61 proiess of maxilla, 37, 6ft. 67 >eptim, 3; 76, 77 •^pin« , anterior, 37, 68 posterior, v). ^x) surface tif palatt l«ine. 6«) of s\iperior i.iaxill,ir\ . 66. fi7 Nasalis nui-;* le, r S2 Nasofrontal suture. 37. d^. 80 NaMilai hrvtnal i an;d, 64. 67, 7^ N iM>fnaxiltarv suture, 37, 6:^. 80 N Tsojihnryngcai meatus. 77 Nusoph 'r\ii\, 77 250 INDEX. Navicular Ixmc of foot, 102, 103 dcvdopmenl, 106 of hand, 8<), 90 fibrocartilagf, 141 Naviculari-cunciform ligaments, dor- sal, 141 plantar, 141 N'crk, fascia- of, 177 ligaments of, 116 muscles of, 171 deep, 175 short, 155 development, 156 of femur, 97 of humerus, anatomical, 85 surgical, H(i of long bones, 20 of radius, 88 of ribs, ,^2 of scapula, 84 of talus, 102, 10^ Nerves of b, definition, 17 Nose, meatus of, 77 common, 77 inferior, 77 laiddle, 64, 77 superittr 64. 77 "jchal fascia, 15<> 1, e, inferior, 41, 4f) superior, 41, 4(1 surface of occipital bone, 4ft Nutrient canal of arm, 87, 81) of tM>nes, 20 of radius, 87, 89 foramen, 20 of tibia, 100 of ulna, 87 Oblique head of adductor halluci^ muscle, 226 ligament, 12,^ line of mandible, 72 of tibia, too muscles, 164 IHipliteal ligaments, I,VS Obliquus aUlominis exlemus mus- cle, 157 functions of. 162 nerve supi)ly of. 1A2 internus muscle. IS", 't>o functions of, I'lj nerve supply of, 162 capitis inferior muscle. 155 functions of. 155 nerve supply of. 155 superior muscle. 155 functions of. 1 55 nerve supply of. ilj Obturator i-xternus muscle. 2011, .'•ift, -'" functions of. .-iS nerve sujiply of. 21.H for.\nien, 0?. o'l pr:..v.. o: intemus musile. 20<), 21.5 functions of. 21,; Obturator internus muscle, nerve sup- ply of, 2 1 3 membrane, 115, 129 anterior, 1 1 5 posterior, 115 ridge, 95 tubercle, anterior, 05 posterior, 95 Occipital angle of parietal bone, 59 bone, 38, 40, 45 b:tsilar jKirtion of, 40, 45 Ixirders of, 4ft condyles of, 45 condyloid portions of, 45 development of, 47 in ne\v-lx)rn, 47, 81 lamtxI'Mil iKirder of, 46 lateral [Hmioiis of, 40, 45 mastoid border of, 46 nuchal surface of, 4 1 , 46 relations of, 38, 40 squamous ixjrtion of, 38, 45, 46 border of parietal bone, 59 condyles, 40 cest, external, 46 internal, 44, 46 fontanelle, 81 fossa, inferior, 44, 46 superior, 26 protuberance, external, 41. 46 internal, 43, 46 Occipitalis muscle, 1 78 functions of, 178 nerve sufiply of, 1 78 Occipitomastoid suture, 38, 40, 43, 53, TO Occiput, articulation of first and sec- ond vertebra- with, 113 Odontoid ligament, apical, 1 15 process, 25, 26 Olecranal bursa-, 208 Olecranon, 87 fossa, 87 Olivary eminence. 4t, 48 Omohyoideus muscle, 172, 173 Opponens digili (|uinti musele, 200, 227 funciii.n of. 200. 227 i\tT\e supjtly of. 200. 227 V muscle of fi»)t, 186, 210 [M)llicis muscle, 18A. 109 functi(^n of. 199 nerve supply of, 199 Optic foramen. 41, 48, 75 gro<)ve, 41. 48 Oral cavity, riMif of. 78 muscles. 179, 180 Orbicular ligament. 132 muscles, 142 Orbicularis oculi muscle, 179 functions of, i.So tierve supj)ly of. 180 oris muscle. 180, 181 Orbit, margins of. 7^ walls of, 73. 74 de^'i'loprncnl . ':fl Orbital lavil'.es. 37. 73 cri-sl of -phenoidal Ixinc, 50 Orbital fissure, inferior, 37, 39, 66, 7'. 74, 7,i superior, 37, 42, 49, 74. 7.'i pLites, 61 surfaces of, 61 portion of orbicularis muli muscle, I7Q process of palate bone, 70 surface of lachrymal l>one, 65 of malar bone. 71 of orbital plates, 6 1 of sphenoid lione, 49, go of superior maxillary, W) wings of sphenoid bone. 47. 49 Orifice of aquaductus cochlea', 56 of canaliculus cochlea-. 56 of maxillary sinus, 67 Origin of muscle, 142 Os basilare, 47, 51 capitatum, 8g, 90 inca;, 47 incisivum, 69 interparietale, 47 magnum, 8g, 90 nasoturbinale, 64 planum. 63 trigonum. 103 Ossa Bcrtini, 48 suturarum, 83 Ossification, 21 centers, 21 Osteology, 19 definition, 17 general, 19 special, 22 Outer crura of diaphragm, 165 head of gastrocnemius muscle, 220 of triceps muscle, 190 leg muscles, 222 lip of '.inea aspt-ra, 97, 98 |Kirtion of longus colli muscle, 176 vitreous table of flat Imnes, 19 Outgrowths, 20 Oval fossa, 232 P.\CCHIONIAN depressions, 44, 60 Palate bone. 611 development, 70 horizontal plates of. (tq in newborn, 70 perpendicul.tr [)late of. 6<) processes of. 70 surfaces of. U) hanl, 39, 68, 78 in newlKirn. 68 tuberosit\' of. 40 Palatine ( anals, fn) cells, 63, 70 foramen, greater, 40, (x) lesser, 40, 70 gr(K>ves, 68 prftcess, 31), 66, 68 sjiines, 68 suture, metlian, 39, 81 transverse. 39. 81 PalatiK'thmotdal suture, 80 Palatomaxillary suture, 80 INDEX. 251 Palm, tendons of, 205 flexor, 205 Palmar a[)oneurosis, ii)8, 207, 208 Palmaris brcvis muscle, 186, ig8 function of, i(^ nerve supply of, I'W longus muscle, 185, i()i function of, igi nerve supply *)f, IQI Palpebral ligament, internal, 171; muscles, I7g jjortion of orbicularis oculi muscle, rqphc, external, 171) Par-glenoidal groove, ()5 Parietal angle, 50 bo.ic, ^(1, 5() angles of, 5g borders of, 5q development of, 50, 60 in new-Uirn, 60 sulci of, 5(> surfaces of, 59 bor^ r of frontal bone, 60 emporal bone, 52 cn.i ence, 59 foramen, 44, 50 notch, 52 surface of parietal fxine, 50 Parietomastoid suture, 38, j.v 7<) Parotidcomasseteric fasda, 184 Patella, 09 aiH'X of, Ql) base of, gg development, gg surfaces of, gg Patellar ligament, 1,15 retinaculum, external, 135 internal, 135 surface of femur, g8 synovial fold, 135 Pectineal bursa, 234 fascia, 232 line, g8 Pectineus muscle, 20<), 216 function of, 2if> nerve supply of, 216 I'ectoral fascia, 170 Pectoralis major muscle, 166 functions of, 1(17 nerve supply of, 167 minor muscle, if)(), if)8 functions of, 168 nerve supply of, i68 Pellicles of vertel)ra', 2\ Pelvic contraction, plane of, 130 diarthroses, 1 2S expar ion, plane of, 130 ginlK ,)3 articulations of, 128 ligaments of, 1 28 inlet, 130 ligaments, 12S independent, i 2g oulli'l, 131 svnarthrosLcs, 128 Pelvis, 128, 130 a|)erture of, inferior. 131 Pelvis, a[)erlure oi, superior, 130 bony, g3 cavity of, 1 30 diameters of, 131 false, 130 female, 131 greater, 130 lesser, 130 ligaments i). 60 Matysma muse le, 1 71 functions c:f. 1 71 nerve supply of, 171 Pneumatic Umes, k) Polyaxial joints, 1 10 Po[ili.,al bursa. 136, 221, 234 ligament, arc uate, 135 obliciue, 135 line, 100 space. c)8 Popliteus muscle, 210, 21c), 220 funclion of, 221 nerve supply of, 221 Porus ac usticus inlernus. 43 Positions, designations of, 17, 18 Postaxial muse Ic-s of lower extremity 2., 212 capimlar ligame-nt, 1 1'' e iinoid processes, 4-8 conclvloiei e ,in;ii. 40 process of manelible. 72 lostotransverse ligameni, 11') cranial fewsa, 41, 43 crucial ligament. 134 crus ol sui)cutaneous inguinal ring, l.SO ■^A^-;**!ifc\filr\" n 252 Posterior ethmoidal foramen, 'ii, 75 fontanellc, 81 ' ("luteal line, Q4 inferior spine of ilium, q4 inlerconilyloid fossa, qq intermuscular septum, 2.?,? intenxeipital synehonilrosis, 47 intertransversarius muscle, 15s inlraocrijiilal synchondrosis, ,Si huhrymal i rest, (15 layer of lumlxKlorsal fascia, i.s() ligament of external mallei>lus, 1,^7 lonRituilinal lipiment of verteliTn (olumn, II I muscles of thigh, 218 nares, 30 | nasal spine, .w, 60 I obturator memlirane, 115 j tubercle, 05 ■ pelvic surface, <|(> pillar of subcutane of legs, muscles of, 211) of tiVna, 100 of ulna, 87 of zvprniatir Ixme. ;i taloiaicaneal ligament, 140 talolibular ligament, 140 talotibial ligament, i.V) trochant.Tic bursa of gluta-us me- diu-,. .'I 2. 2,u Pouparl'- ligament, 1,^1, if'.i Preaxial muscles of lower extremity, of upper extremity, 20<) Prepatellar bursa, subcutaneous, 136, subfascial, i^h subtenilinous. 136 Prevertebral c ervical muscles, i 76 fascia, 177 —S rriHcnis nasi muse le, Proces'-c's, 20 accessory, 28 at romion, 84 nlar, (1? alveolar, 37. ''''• '^^ articular, 20 of vertebra-, 23 c'.inoid, anterior, 41, 4<) middle, 48 posterior, 48 rondyloid. 20, 38, 71, 72, 7? coracoid, 84 Kironoid, of m.indibli', ,?8, 71, 73 anterior, 72 ..i uina. '-7 costal, 24 , . , ethmoidal, of inferior lurbmaled, 64 IN HEX. Processes, external angular, 3O ! of calca us, 103 of talus, 102 falciform, 12() frontal, of maxilla, 37, fi6, <'7 frontosjjhenoidal, 37, 71 hamular, 4°, S'' '1° inferior, of temporal bone, ^J internal, of calcaneus, 103 intrajugular, 46, 55 iugular, 43, 4b , . , lachrvmal, of inferior turbinated, mammillary, 28 mastoid, 38, 40, 53, 54 . maxillarv, of inferior turbinated, f)4 n.asal, of maxilla, ,7, W), f)7 cKlontoid, 25, 2() of sacrum, sui>erior articular, 2C) of vertebra-, 23 orbital, 70 jialatine, 30, 6(>, 68 peroneal, 103 posterior, of talus, !C2 ]ilerygoici, 3(1, 47- 5° |iterygospinous, 51 ]iyramidal, 40 of palate bone, 70 sphenoi'l,il. of palate bone, 70 s]iinous, of tibia, i)c) of vt-telira', 23 styloid, c)f metacariial lion,', 0' 'of radius, 8(i of tem|ioral bone, 40, ,S') of ulna, 88 supracond vliiid, 87 tcTOporal, of ulnar Ume, 71 transverse, of vertebre, 23 troi hlcar, of calcaneus, 103 un< iform, tyo uncinate, (14 vaginal, of jiterygoid processes. 4<), 51 of temporal Ixme. 5'', 57 xiphoid. 34 foramen of, 3'> zygomatic, of frontal li ' of maxilla. M. 67 of temjioral bime, 3ft, 3S, 30, S2 Processus civinini, 51 costarius, 24 mastoideus, 40 pvramidalis. 40 Promontory, groove of, 58 of vcrti bral ccilumn, ,]o Prcmation, 12 ( Pronator ciuadratus nuisde, 185, Iocapsular ligament, 132 Pulleys, 143 I'ulmcmarv groove, 35 Pulpy nut leus tif intervertebral fibro cartilage-, 1 10 PvramicI of temporal bone, 52, 54 apex of. 5S i Pvramitlal emiiunce. 57 'prticess t)f ptilate iKine, 40, 70 Pvramiilalis muscle, 1(11 i ' funclicms of. ih2 nerve sujiply of, 162 n.a.si muscle, 178 QCAUKATUS femoris muscle, 20c), 213 function of, 213 nerve supply of, 213 labii inferioris muscle, 181 superioris muscle, 180 lumborum muscle, 162 functions of, ih? nerve supply of, i'>3 ]>lanta' muscle, 210, 225 functitm of, 225 nerve sui)ply of, 225 Qutidritep^ femoris muscle, 20c), 214 function of, 21:; nerve suppiv of, 215 muscle, 142 Qjaclrilateral foramen, r6f> R,\DI.\L carpal eminc-nc", i)o fossa, 87 he.ad of flextir digitorum -.ttuscle, ic)2 lateral ligament, 122, I2(> mu^t Ic-s of forearm, ic)4 lit 1 ^c-, gloo\c fi.: , .-'O notch of ulna, 87 Radiate carpal ligament. 127 lublimis i6i Radiate liganirnts, Ii6, n" Railiorarpal artiiulaliims, 124 ligament, dorsal, 12I' volar, I2h Radioulnar artii ulalion, distal, w^ proximal, i.'2 Radius, H2, SS and ulna, relations. Si) articular rinumferenie of, 88 borilcrs of, 88 development, S() extremities of. 88 hea.l of, 88 inteross'-ous ri(ls<' "'. "" ner i of, 88 nutrient canal of, 81) shaft c', 88 si-rfac-'S of, 88 tuberosity of 88 Ra.-iX arcus vertebra-. 23 R; nus of isdiium, ()4 of mandible, .^7, 71.7^ of pubis, 1).?, ')$■ ')'! Rectus aljns of, i'>2 nerve supply of, 162 capitis anterior major muscle, 17 minor muscle, 177 functions of, 177 nerve supi)ly of, 177 lateralis muscle, 155 functions .'f. I55 nerve supply of. '55 posterior major r-.uscle, 155 ere ; ' 47 fun( ti s .if, 155 nerve supply of, 155 minor muscle, 155 functions of, 155 nerve sujiply of, .5.S femoris muscle, 214 muscles, if)4 external, spine for, 76 Red boiu'-marrow, 21 Rellected iiiKuinal ligament, I5r), ReirforcinK liK.imeiils, 108 Retinacula perona'orum, :'22, 230 Reti.iaculum of arc uatc' lij;ament, patellar, external, ;.^5 internal, i ?5 peroneal, inferior, 2,?o superior, 230 tendon, 142, 14 i Ri'lralien* auricula- muscle, 171) Rliachischi'-is, j(i RnomlMiid li|;anunl, 1 i<) Rhomboideus major muscle. 147 func tions of. 1 17 nerve supply "f. ' 17 minor nuisiles. 1 17 functions of, 1 17 nerve supply ol, 147 Ribs, 22. ,v alxlominal, 28 .:^nc;!e of. 12 artlculatic'ms oi, with sternum, H7 I'M INDEX. Ribs, articulations of, with vertebral column, 2b, 116, 117 IhxIv of, ,v bony, 32, .^,5 cervical, 35 curvature of, v? development of, ,^5 eleventh, 3.5 false, 33 fenestration of, 3'> first, 32 lloating, 33 head of, 32 lenKth cjf, ,^,^ lumbar, 28, 35 movements of, 117 neck of, 32 sacral, 3'> second, ^^ surface c urvature of, 33 torsion c urvature of, ^^J, true, 33 twelfth, 33 tvpical. 32. 33 Ririn, alxlominal, external, 15S inguinal, subc -ataneous, 158 Ridge. bici|>ilal, 8() interosseous, of fibula, 101 I of radius, 88 I of tibia, 100 1 of ulna, 87 \ intertrochanteric, c)7 ' obturator, ci; sphe.iomaxillary. 50 ■ supinator, 87 temporal, ^8 I tubercular, greater, 86 les-cr So Risorius nuisc'e, 180 Rcof of oral cavity, 7S RcK)t of MTUbra-. 23 Rostrum, sphenoidal, 4^. 4') Rotary vertebra-. 23 Rc.tatoresbrevc-smu-.cle>, 152, 153 longi iiUiscU-!, 152, 153 iuuscli,-s, r;2, 153 functions of. 154 nerve sujiply c>f, 1 >t Round ligaiiunt, 132. i3.( i.VS ' S.^crl'l AR recess, 122, 123 Sacral can.il, 2c> cornu. 2ij foramina. 28. 21) inti-rvcrtcl>ral, 2c) J hiatus, j(|, 31 rib. 3'> tuberosiiv. 21) Sacroc.iicygeal ligament, anterior, lateral, 1 13 posterior, 1 13 svmphvsi-, 1 13 Sacroiliac arlic ilation. 128 ligament, ai lerior. 121) interos..cous, 1 --i) ,i(-,, p.ci.ri.ir, 12:; Sacrosciatic foran ,, 130 -'53 Sacrosciatic liganvnl. greater, 1 21) leaser, 1 2cj, 130 Sacrospinalis muscle, i4c| 'line tions of, 15 J nerve supply of, I54 Sacrospinous ligament, I2ci, 130 Sacroluberous ligament, 12c) Sac rum, 28 a[)ex of, 2A, 50 ba.se of, 28 canal of, 21) crests of, 2c) development of, 31 dorsal surface of, 2c; female, 30 foramina of, 28, 2C) intervertebral, 2e) joints of, 1 1 i male, 30 movements of, 1 1 3 pelvic- surface of, 28 prcM-esse-^ of, Nupcrior articular, 2 lulM-rosity cif, 21J upper surface of, 21) Saddle joint 1 10 Sagitt:il Imrdi-r of |iaric-tal iMinc, ,Vi gro.,v . 4), 4''. '». '" plane-, 17 suture, 71) Saphenous opening of f.iscia lata, 23 j vein, great, 2},2 Sartorial bursa, 214 Sarlorius muscle. 201), 21 1 function of, 214 nerve supply of. 214 Scalene tubercle, 32 Scaleni muse les. i 75 functions lel, 1 "') nerve supplv ol, 1 7'> Si alenus anterior mu-' le, 175 mc-dius muse le, 175 minimus muse le, i 70 posterior muse le-, 1 75 Scahi, muscles of. 178 Scaiihoiil bone- of foot, 102, 103 dc'vc-lopmc-nt, io() of hand, .So, c)o fossa, 51 Scapula. 83 angles of. .S3. 84 base- .if. 83 border- of, 83, S4 de^elopme-nl, 84 head of, 84 ligaments of, 120 margin-^ of, 83 neck of. S, -pine of. Si, 84 surf.iees of, 83 Scapuleir iioti h. 84 Siarua's fa-cia, 1I13 Sciali. bursa of gUila-iis maximus, 2\\ foranic-n, great. 1 \o le-sser, 130 notch, gre-at, Ol. 0" li-sse-r. 1)0 Si.re.nil . ime-iform bone-, 104 Sella tunica, ti- 17- 4-'^ 254 -8 i\ •■'■ ; -- ». t... ■■-, ■■>. Semiranal for Eustachian tub for tensor tympani, 58 Sc-miririular lini-, if)i Seniilun^ir bono, Sy, yo cartilaps, I.V3 funition of, 136 lini', i(K) note h of ulnar, 87 surfaii- of aictabulum, qd Seminu-mbranous bursa, 136, 210, 2^4 musili'. 2CK), 2 1 8, 2iy funi'ion of, 2i<) niTVf su|>]ily of, 211) Scmispinalis capitis musrlo, 151, 152 rcrvicis musilc, 152 (lorsi musi li-, 152 muscles, 152 functions ol. 154 nerve supply of. 154 Scmitenilinosus musde, 20Q, 218 (unction of. 21c) nerve supply of, 210 Septum ■hoanaruni. 39, bb inlermusiular, 143 anterior, of lej;, 233 external, of arm, 207 of tlii»;l>. 232 internal, of arm, iSS, 207 of thigh. 21,2 of arm. iSS, 207 of IcK, 233 of thi«h, 232 posterior, of Icr, 233 nasal, 37' 7^'* "7 Serrate suture. ro7 Serratus anterior muscle. ''lO, if)8 function- of, i(k) nerve sui'ply "f. ''"> magnus mu-t Ic. i()8 functions o(, itx) nerve supply of, ifx) [Kisterior inferior musiK. 148, 171 fund ions of, 14^ nerve -upply of, 14S superior mu-i le, 148, 171 functions of, 14** nerve supply of, 148 Sesamoi 4'). 7') Sphenoid bone, 37, y), 47 body of. 47 iMirdcrs of, 4c). '50 ciTcbral juga of, 50 surface o', 42 development of. s;! digitate imprc'ssions of, 50 greater wing of. 42 in newborn. 51. 81 lesser wings f, 41 orbital c rest of, 50 v.iii.cllon- in, 31 wings of. greater, 47, 49 surfaces of. 4c) lesser, 47, 4<» Sphenoid bone, wings of, orbital, 47, 4') tem]K)ral, 47, 41) spine of, 3c) Sphenoidal angle, 36, 59 cells, 63 crest, 48 fissure, 37, 42. 49. 74. 75 fontanelles, 82 process of palat^ bone, 70 rostrum, 48, 41/ sinus, 47 spine, 56 turbinated Imnes. 48 Sphenomandibular ligament, I Sphenomaxillary ' .sure, 37, 74. 75 I fossa, 41), 50, 78 1 ridge, 50 I surface of sphenoidal bone, 50 j suture. Si 1 Sphenooccipital fissure, 45 svnchondrosis, 41, 45, 47, 81 Sphenoorbilal sutu'c, ■;<) Sphenofialatine foramen, notch. 118 ,39, ,78 nolcn, 70 Sphenoiiarietal suture, 37, 38, 4', 7c), 82 Sphenopetrosal fissure, 3g, 4°. 4^- 54. synchondrosis, 81, it8 Splicnosciuamosal suture, 38, 39, 4-'. 4^, 52, .80 Spheno/.ygomatic suturc\ 77, 38, 50, 80 Sph;'rciici joints, no Sphincter muscles, 142 oris muse le. 181 Spigelius' line. 160 Spina ree ti lateralis, 50 Spinal canal, 31 , , , column. 22. See also Vrrlchral mi- ll 111 11. Spinalis eapilis muscle, 151, 15- cervicis muse te, 151 de.rsi muscle, 151 muscles. 14C1, 151 functions '>f. 154 nerve supply of. 154 Spindle-shaped muscles, 142 S]iine, 20 anterior nasal. 37 ethmoiihd. 41- 4^ for external rectus muscle, 76 frontal, 61 mental, 72 nasal anterior, 68 1 po-icrior, 6<) j of ilium, anterior inferior, 94 superior. ei4 IMisterior inferior, 94 of ischium. ■/6 ' of jiubis. ey5 of scapula. 83, 84 palatine. 68 sjihenoidal, 56 v.ipramealal, 5' trochlear, 61 tympanic, greater, 57 lesser, 57 INDEX. Spill"! ransvcrsali^ muMle, v Spincius jiriKi-ss oi tibia, i)i) 14!^ lerviiis muMle. 14** funitions (if. I l^^ nerve ^upplv nf. 14?* Squum.isal Inmler .if parietal Imne, 50 uf sjibenciiii limie, 50 suture, ^S, ),?. s-'. T'l Simaniii-.imastoi.l suture, 5.t, 5.1M S.iuam.iu^ purli.ins uf .i.ripual bune, .V**. -t.v 4'' of temporal txine. .?■"*. 4°, 4.i, .s- >ulure. 107 Slellate liijaments, 1 1(>, 117 Sternal eMri'iiiity of el.ivii le, >**5 menilirane. 1 17 jiortion of iliapliraKni, I'M synchonilrosi'-. 1 17 Sternalis muM le, I'V Sternoi l.ivieular artieulation, no ligament, "') Slern.K leiil. '.oideus inusele, 1 : i funitions of. 17-' nerve supply of. 17-' Stcrnoeostal artieulations, 117 portion of peetoialis major imiM le ■'17 Sternobyoi.leus mu-i le. 17:1 Sternolbyreoiileus nm-i le. 17-' Sternum. 2j. .; I ansle of. ^4 • , - artiiulalionsof rib- "itb. ii'i, ", YuhW of. U (levelopnieiit of. ,^5 foramen of. 3<> srlailiolu^ of, ,^4 manubrium of, 34 not 's of, .u Niphoill proiess of, ,u Straight alKloiiiinal muscle, I'n il.velopnieiii. i'i4 Sivlohyoid lit;anient. 1 n) Stvlobyoideus mu-,! le, 171 funetions of. 174 nerve supply of, 174 Styloid liro. ess of metaearpal Imiie, ■ of railiu-. .'s(i of temporal bone. 40. =.>' of ulna. .-^.S Stvlonian.libular ligament, n."*. I'^t Si'vlonia-loid fora-iien. 40. |;ii Styloinaxillary licameiit, i.'<4 Suliai romial bursa, 20S Subareuale fossa, 55 Subelavian groove, v^ Subelavius musele, iW), i6,S funetions of, I'lS nerve supily of, I'lS Subeostal angle. ^; Subeostales mus. les. 1(10. 170 Subcutaneous bursa ..1 ;anercisiiy tibia, J,U Subcutanwus rakaneal bursa, 2,^ eolli musele, 171 digital bursa' dorsal, -'0>S epieondvlar bursa-, 20S external' malleol.ir bursa, -■ ; 1 infr.ipatellar burs.i, i,?<'. -',' : I inguinal rini.'. 15,** I internal malleolar bursa, -VU , metaiarjioph.il.iiigeal bursa-, dorsal, oleeranal bursa, .'fS prepaiell.ir burs,i. i,('>, J.?4 1 troibanteric bursa. 2,^.^ > ! SulKielloid bursa. iH(i, ;o,S 1 1 Sulifas.ial prepatellar bursa, I s<> I SulHieeipit.d triangle. 15(1 ^ I I Subseapul.ir bursa, i-m, iS.S | I fasei -07 fossa, f ., Subsiapularis mus( le. iS;. I funetions of. 1-^* nerve suppb ■'. i--*"^ . Subtendin--.. '- ' "'"•'''- •'""■■ I rior, -•,,;, i i |„,-tt-rior. ■ .^ ,1, .- bur-a. o^,- ' -anal bursa, -"^ ! I i A|.alellar bursa, i.^n . ! I Sulius, 20 arteriosus, 4!. 44 of frontal bone, (u of parietal iKine, 50 i 1 ,,t spbelloiil bone, 50 j I ,,f Knip ir.il bone. 5,5 ' ealeaneus, l-D- ihiasmalis. 41, .|.S gluteal. -',i-'^ , nervi spinalis, :i i tali, 102 ' venosiis. of pariet.d bone. 50 \ Superiiliarv arilu-s. (10 i Superli. iai fas. ia, general, id^ I head of tl,-xori.olliiisbrev.smus,le, ' too laver of . ,01 niuseles. .-lo 'of cervii.d fascia. 177 of ,-\leiisors of forc-.uni. icjd ,,f |l,-\or muscles of fon-.irni. 101 l„,M,-ri"r sa.ro. oe.ygeal ligantent. tc-niporal f.is, la. e^t Suiieri.-r angle of s, upula. .S;. S4 aperture of p.-Kis. 1 ,!0 ,,f tvm]iani. . analii uliis. ;; articular proci-ssc-s of sacrum. -•., ^i,rf,i.c-s of tibia, cjc) bill-.- of onii hvoideus musi le, 17.? biei'pll..l bursa, .\u bordc-r of -, apul.i. .•-< I ,,,rnu of fas., lata. .',?-• (■os(otransvc-rs.- ligament, i m ,rus .if sub. utani-ous inguinal ring is.S extremity ..f femu.- i)7 of I'diula. ici ,,f humerus, .'^i „f ra-lK:-,-^'^ of tibia, .|.| Miixili,r iuperior extremity of ulna, gluteal line-. .11 inti-rvcrlebt.il notch. .'.< n-..irgin of scipula, ."<.< niaxill.iry. ('('. Sn- .lis mt-atus of nosi oj. 77 nuchal line-. 41. 4'i cKcipital fossa-. 4(1 orbital lissurc-, .^7, 4-', 40- 74- 7.? pi-r..m-al reiinacidum, -\!o |,(trosal griH.ve. 4,^. S.s . pill.ir.if sub. utani-ous inguinal ring, pubic ligani. ' '. i-'S ramus .if is.i .uni. .14 of pubis, c);. 1)5 surface- of t.ilus, lOJ tcmp.ir.il line. 5,; thora.i. apc-rture. ,Vs transvc-rsc- ligam(-nt. i-'o lurbinali-d bone, b? vi-rlc-bral notch. s, 2? Supernum.-rary b..ncs, ,~. 70 si)hen7, 80 /vHomalieo!eniporal, i,!^, 52, 80 Symphvsis, 107 pubis, 91;, Ii8 saeruicHiy^jeal. 1 13 Synarlhri'sis, 107 mixed, 107 pelvic, i.'.8 Synihnnilro-is, 107 epiphyseo~, ji interiii lipilal, anterior. 47 |)osleriur. 17 inu-r-plunoidal, 51.81 inlr.ioKipilal. .interior. Si posterior. 81 petrtHH < .pita!. St , 1 iS splieniHui ipilal, |r. 4v 47' St sphenopiiro~al. 81, 1 :S sternal, 31. ' I7 Synde^niotogy. 107 ddniiiion. 17 jji-ner.d. 107 '-pel i.il. 1 10 Synde-mo-is. 107 libiolilailar. 1 t'l, 13" I rue, 107 Syneri!i~l>, t 1 < .^\no\i.t. i^S Swiovial hur-a-. inS lominiini'.ilMiu. 108 fold-. 108 patellar, i t; laver of .irti. iilar 1 ap~ule, inenibraiie. ioS .-li.alli-ofd.ir-.di.irp.ilIiKaMienl..'^ I'f linfi* rs. 205 of lleyor lelidon. of palm, .'05 of fiuil, INDEX. Talocalcaneal articulation, 137, 138 .nterior, 138 ligament, anterior, 140 external, 140 internal. 140 interosseous, 140 posterior, 140 Talocalcaneonavicular arliculation. 1,^7. ',^S Talocrural articulation, 137 Talofibular ligament, anterior, 140 posterior, 140 Talonavii ular articulation, 13S ligani' nt. ilorsal. 140 Talotibial lieament, anterior, 139 [)Osler: r, 139 Talus, lOi articular facets of. \o! articulations of, 137 binly of, loi (bvelopment, 106 gr(H)Ve of, 102 head of, 102, 103 neck of. 102, 103 surfaces of, 102 Tarsal iMines. i^2, 102 articulations of, 137, 138 development, 106 ligaments, 139 dorsal. 14° plantar. 141 Tarsometatarsal artic ul.itions, ligamenls, dorsal, 141 plantar, 141 Tarsus, 102 I articulations of. 137. 13S ligaments of, 131) sinus of, 102, 103 transverse artic illation of. 138 Tectorial mendirane. 111. 115 Teeth, alvc-oli tor. 08, 71 incisor, in fetus. («) SOI kets of. fi8. 71 Tegmen tvnipani. 5;. 57 TciniMmd lionc-. 57. 38. !;i artic ular eminence of, 53 canal- of 57 development of 58 in newborn, 58, 51). 81 108 i,?7 iriferictr procc-^ ..f. 57 of iMTona ii-' longu- ill! i/^K -31 Systematic an.itoniy. cletinilion. 17 mantoid portion of. vH, |o. 5.'. s! pctroii- piirlion cif. 40. 52, 51 ape \ of. -^ pyrai lid of, 5.'. 5 1 a|H'\ ol. ^^ scpianiou- potiioM of. (8. 40, It. iMiipaiiii |iortioii ol, 38, 40, 5.', ' '!7 fascia. 18 1 fo^a. iS line' 1 1. 'CO inferior, 5c) superior, ^'}0 priMi>- of /\goniaiic bone. 71 ridge. 38 surface of /ygoin.ilic i~.cic , Ji Temiwral surface of sphcnoici bone, 49. 50 . , , of squamous [xirtion of temporal bone, 52 wings of sphcnoici lione, 47. 41) Tem[K)ralis muscle-, 182, 183 functions of, 1S3 nerve supplv of. 183 Temporomandibular articiilation. 118 ligament, 1 18 TemiKiromaxiilary articulalion, 1 1 , Tendinous adductor opening, 217 arches, 143 inscriptions, 143 of rectus alKlominis, I'li Tendc) .\chillis, 220 Tenclons, 142 central, of .liaphragm, 1(14, 163 chiasma of, 207 flexor, of palm. 205 of fingers, i-xlensor, 204 of hand, I'xtensor, 203 of long head of biceps, 121 of palm, 205 retinae Ilia, 142, 143 vincula, 207 Tendon-sheaths, 143 Tensor fascia- lata- muscle, 200, 213 function of. 214 nerve supply of. 214 tvmpani, semicanal for, 58 Teres major muscle, 185, 187 function of. 187 nerve -upply of. 1S7 minor muscle-. 185. 187 func lion eif, 187 nerve sup] Iv of. 187 Terminal line- of ilium. 1)5 Thenar eminence--, ojS muscles of. ie)9 Thigh, addiiifor musiles of, 2 if) anteiior -.urfaee- of, muscles of, 214 fascia- of. 2U flexors of, 218 intt-rnal muscles of. Jift niusc Ic-s of. 21 4 ( lassilie ,ition. 235 iwisterior muse le- of, 218 Third cuneiform bone-, 104 trcKhantcr, i)8 Thoracic mu-ile- I'l'i velle-bl.'e. J'l elevc-nlli, 2(), 27 lir,I. 26 walK, musilc-s of, I'n) Thorax, 22, 35 ii]«Tture'- of, (5 iiuiMles of, ififi w.ilU ol. mu-iles ..f, 1(1 1 Thumb, bone- of, 92 i.irpomilae.irpal joint of. 1 -' t i.-; nnlacarpophal.ingicil.iriiiul.itionof. I -'7 Thvreolivoiiliu- mu-c Ic-. 17.-. i:t ■ril.i.l, 82, <)e( anil libul.l. rel.nioiis, ini .irtieul.ir -iirfaces of, inferior, too INDEX. -.•)/ Tibia, articulations nf, i,?6 borders of, loo 1 condyles of, 99 crest of, 100 developmiiu, ici extremities nf, go ' interosseous membrane of, 1.^6, 137 [ shaft of, W. 100 , surfaces of inferior extremity of, <)i) j of shaft of, 100 ; of >u|ieric)r extremity nf, i)0 | lulxTosily of, subcutaneous bursa of, 234 ' Tibial lateral liRamenl, i,u Tibialis anti-rior nui>( le, !\o, 221, 1 function of, 221, j nerve supi>ly of, :;:>^ ' ]H>^terior niusi le. 210, 2ni, 221 , function of, 2^1 1 nerve supply of, 221 Tibiofil)ular articulation, 1 ^6 ' >ynclesmosi'i, i.^O, 1 57 Tibionavicular liKanurn, i,V). 14° Tissue, bony, 20 TiK's, articulations (jf, 1 ^7 lH)nes of, 105 great, ball of. muscles of, 220 lif'r, ball of. muscles of, 2.'7 To] -graphic anatomy, (litinilmn, 17 Toru^ palatinus. 7S Tracheloina^toid muscle, 151 Tran^ver^alis caiiitis muscle, 151 cervicis muscle, '.'i fascia, 16,5 Transverse articulation of tar-u^, 1 ^S capitular ligament of foot, i.t') of h.inil, 127 c.up.il lipimcnt. 127. 205 1 rur.il ligament, 2 V4 fasciculi, 2.<.! j;rcK)vc-, n, .((i head of ,cdcluctor llallucl^ muscle. 227 ligament, inferior. 121 of .11 la^, 1 14 of hip. i,?i cif knee, i ?4 superior, 120 lines cif re(lu-> aUlcimini-, idi palatine sutuie. v(. f^i plane, I 7 (Hirlion of nasalis mu-de, iXi prcK esses of vertc bra . .' i TransverscHostal mu>c lc->. is''- 1^," Tran-.versospinalis mu-c le, 1 ici, i^i, ">" Transversu-> aUloimiti^ muscle, 157. ifK) (line lions of. |02 nerve -uppK cif. idj nicnti muscle, iSi luic lia'. 14(1. i/ci Ihor.ic i^. I'"). 1 70 Trape/ium, .H«j. cjo Trapc /ill niu'-c Ic, 14s (unctions cif. 14I1 nerve supply ci(. 14(1 Trapc.-oiii, .-:j. t;c »7 Trapezoid liRamcnt, 120 Triangle, deltoidcH)pectoral, ifi? femoral, 216 lumbar, 147 of Petit, 147 suboccipital. I5t> Triangular ligament, i.sc), 1114 Triangularis labii inferioris muscle, i.Si superioris muscle. iSi muscle. iSi sterni muscle. 170 Tricejcs brae hii muscle, 142, 1S5, iS, 102 rnxhiear area of humeru-, S'l clepre-i-ion, 01. 70 prcKess of ealc anc u--, lo.i spine, 61 Tr.ic hoid joint, loej True joints, loS jH'Ivis, I (O rib>. .?.< ■ svndc-smosis. 107 vertebra', 22 Trunk, mu^c les of, 1 4) ske Icton of. 22 \ari.iliiins in. ,(> Tubcrc le. 'O c .ircitid, jO c cisi.d, ligament of, 1 1'l intcrconclvli.id, extern, d c)c) internal, cii) jugul.ir, 4), 4'' nu-ntal, 72 .ilituralcir, anieiior, 115 IMisterior, nS c'f ("hassaign.ic , 2(1 ii( hunienis, greater. «? IC-SCT, S5 Cif Lisfranc . \! eif neik cif rii)-, ^2 of pubis, 1,; of talus, e\te rnil, 102 internal, u" eif tni|K'fiuin, i)0 Tubercle, sc cilene, ,<2 Tubercular ridge, gre-ater. Sfi lesser, Htt TuUrculum c, erotic um, 20 sella', 41. 4'"^ TulR'rositas atlanti'^, 25 Tuberosities, 20 coracciicl, 85 e-ostal, Sc; deltoid. SO gluteal. e)S infraglenciidal. S( mas'^eteric, 72 of calcaneus, !o; of fifth metatarsal bone. 101; cif lirst mciatar-al bone, \r:% of hard palate. 40 of ilium, c.s cif isehiuni c)0 of maxilla. (17 of n.ivic ular Ixme, lo? of palate bnne, 70 of r,idius, .SS cif sc.ipliciicl Inine. io( cif tilii.i. 100 subc ut.ilieeius bursa of. -\u of uln.i. ><- pterygoid, 72 sacral, 2c) supraglenciiclal, S4 ungual. C12, 10^ Tubular bemcs. ic| I Turbin.ilc'd Uines. ^7. 77 I inferior. inu-i Ic, 215 laler.ilis nin~c le. 215 niedialis niu.i li-, 215 Vein, s.iplunou-. Kre.ii, 252 vertelir.il. lan.il for. 2(1 Vena lav.il opininKof cliapliragm, ifX) Ventral an h of vertebra. 22 Verlebr.T. 22 arc he- of. 2:. 2,^ artii ul.ir pnne^^se-; of, 23 iHKlie- of, 22. 2.i .onneiiioii-- ol. 1 10 laudale-. ',^ icrviial, 2 i iharailer-. of, 24 hr-t. 2(. -S anil M.on.l. .iriic ul.Ulon^, of, I I i (levelopnii nl. \l set on< 1 . 2 t . 2 s ilivelo]Mnenl, \i INDEX. Vcrtebraf, cervical, seventh, 24 third to sixth, 24 development, 31 false, 22, 28 fle.xion, 2,^ lumbar, 27 lumbosacral, .^0, 36 l)edicles of, 2,^ ])rocesses of, 2,^ j)rominens, 25 root of, 23 rotatory, 23 spinous prcKC'iscs of, 2,i supernumerary, 35 thoracic, 2b hrsl. 2(> twelfth. 26, 27 transverse prcscesses of, 23 true, 22 Vertebral arches, liRaments Inlwcen, 112 artery, 25 canal for, :(> bonier of sc apuhl. 83 canal, 31 column. 22, ^o articulation cif ribs with, 116, 117. -■<>i I ur\,iiure of, 30 development, 31 intertransverse ligaments of. 1 12 joint- if, 1 10 liK.imc nls of. 1 1 1 movements of, 1 13 promontory of. 30 margin of scapula, 83 nouhes. 23 M-in, can.il for. 2b Vertical i»irtioii of squanmu- porlim of temporal Iwine, 52 Vidian c.inal. so X'illi. synini:d, 108 X'incula. I t! of lem'on. 207 Visceral iBines. 22 Vitreous t.dlles of 111! Umes, I,) Volar ba-.ii liii.iin.iils. 127 JKirder of radiu-. .88 of uln.i. 87 Volar carpal ligament, 208 cariK)metac arpal ligament, 127 Intercarpal ligament, 17 ligaments, accessory, 127 radicK-arpal ligament, 126 surface, 18 of radius, 88 nf ulna, 87 Vomer, y). (15 ala- of. (15 develo|>ment, 66 W.Ml.s of thorax, muscles of, ific) Wings of sphenoid iKine, 47, 4c| Wormian lionc-, 82 Wrist -joint, 121 XiPHOili proces-, 34 foramen of, 3!) Vl.I.l.O'.v bonc--marro\v, 21 Zona orbicularis. 132 Zygom.' 70 Zygoni anil. 38, 30, 40 ' [Mine o. 70 dc \ .ipment. 7t serial c-s of, 71 iKirder of sphenoid Ixine, 50 fossa, 711 head of i|uadratus labn su|HTioris muscle, I. So process of frontal iKine. 60 of maxilla. 66. 67 of teni|ioral iMine. 36, 38. 31). 52 /ygoniaticof.ici.il foramen, 71 Zvgomatiiofronlal sutun . 36. 37. 80 i Zygomatic oni.ixillary suture-. 37, .3ci. '67,80 I Zygomaticoorbii.d for.imcn, 71, 7"; I Zvgomatiioiem|Hiral foramen, 71 ' suture. 38. S2. '^o Zvgomatii us maior muscle, ISO ntinor muscle, 180 I muscles, i.So I»^ ^ r-i*.' :.'■ :^ i--'! SAUNDERS' BOOKS -on- SURGERY and ANATOMY v; r>. B SAUNDERS COMPANY 925 WALNUT STREET PHILADEf^HIA 9, HENRIETTA STREET COVENT GARDEN. U ON SAUNDERS' REMARKABLE SUCCESS ^ATIC arc often asked t(i accDUiit (or iiHss methods, caiviully pir- fLCtcd tiiisiiK'ss iiiai liiiu'iy, and uiiiivalli'd laiilitics ior (li--tril)utMin nf books. I-Acry dc|)aitiiK'iU is sn uiLj.i'ii xd that ilic j;rcalist possible amount of work is i)rodiiccd with tii' lca->t waste of encrf^y. The n prcscntativts of tlic ftiin .iic tiicM \ i lifc-loni; i\pi;it lu c in the s.do iif tiicdical hooks. ThLH, too, wc iiiu- imt nVL-rionk tliat in.ijor force in the modern business world — advertising. Wc have a special department ile.oied entirely tn tlu- pl.innin;.;, w lilini;, and i)!aiinj; of advertising inatlcr; .\\m\ 've rni;_;ht mention tliat the nmnt y .mniially spent in advertisini; nnw t.ir evcecds the entire .nnni.d tciii])!-- of tlu' linuse during its e.iilier years. '1 li. •~e cNtiaoiilin.uy f.H ilitli ■ fur di-^- pusin;.^' i>f l,irL;e e KeenV Surgery AN tNABRIDOED TREATISE FOR THE SLROEON AND THE UENERAL PRACTITIONER W^ Surgery: Its Pkincii'I.ks anh I'kactick. Written by 66 eminent siKcialists. Kditc.l by W. \V. K!;ks, M.l)., LL.D., H..N. F.R.C.S., Kng. AM. Hi. IN., I'rofessor of the Principles of Sur^'ery and of Clinical Sur^'ery at tlK Jefferson Medical Colle<;e, I'liiladelphia. Five large octavo vol- iinio ct" about 950 \m\'^c-^ eacii, containing 1 500 tf'xt-illiistrations and 50 colored plates. Per volume : Cloth, S7.00 net ; Half Morocco, ;iil8.00 net. IN FIVE VOLUMES- ISOO TEXT-CUTS AND SO COLORED PLATES VOLUME I -JUST READY THE EMINENT CONTRIBUTORS Rnbtrt Ahlio, M.I). I. ci. .\,l.imi, M.l I. 1:. WUl)- .\'i.lr.-«-. M.lt <;. K. .\rin>lriini;, M I >. rhijiii.li I.. llcniiLil, M.l> A h. lie. MM, M.l). W.irnn S. H.tkliaiii, M I ) lolin !• liimiiis M D I'lforjjf K. lirevvcr. M.l>. J. lilami Sutton, K.R"' S. A r. CaUdt, M.n. Il.irni'tnn !.. ("arson, Kv| K A. I'c.lman, M I ). \Vm li. r..!o-, \1.I). M, I.. i..| lui, M.n. I,,..,,;, \V. fill.-. M I) ll,.rvi-v I'l'^iiiit;, M l> I. Ch.ilmi.ri 1 ):;(■.,, I;:, Ml) l<,lii> I'. ll.iC.la, ji . M 1 1 K. 1; Drnrli, M.I). i . \ I M\uni, M.ii- (i 1- ili-Sih«tinii/, M I). Davi.l I.. KdNill, MI). I). N Ki-cmlratli. Ml). Win. I . K-t.s, Ml). I. M r. l-iiimy, Ml) l.ilii. A. lonlycc, Ml). Clia-. II, lia/i.r. MI) l,,,.iianl Irc.-nian. M.l). 1 u-.l,n>k II. Ccrr.ili, M.D l..|in II. t".!!.!...!!, MI). (K-orm- I iou^tiin. Ml). I ulvic ll.klDcn, M.I). drxiU,- Il<.r»iiz, M.I). All,.'ii K-ilit-r, M.n. K.iil I lu-i.iv I iiiiiaii'k'i. Ml) llian>fiii(l l.ewi-. Ml). K. W. I.ovitt, MI) \V I.. MaiDonal.l. Ml). i:.lv(,iil Martin, \l . I ). Ku.l..li,li Matas, Ml). Cli.is A Mayo, M.D. Will, i. May.-, M I'. Mai \Vallir 1 1 M>< aw 11. (1. A Mi>>nihan. l-.K.C.S. I. (1 Munifor.l, Ml). I„liu C. Munio, Ml). John H. Murphy, M.D. E. II. Nichols, M.l). A. I. DdiMier, M U. William Dskr, M D. K.limincl Owen, K.K < .S Jm„. Kansohott. M 1 ). l;tii;. C.cn. K. M. ' )RiilIy .\.lniiral I' M. Ki\cy, John U. KohiTt-, M.n. A.W . Mayo Kotison, K.K.l'.S \V. 1. Koilnian, Ml) r.uRcne A Smith, MI). ll.irmon Smith, M D. Wm i;. Spillct, M.I). Wellcr Van IltMik, MI). J. I'. Warlasse, M.D. K. ( . Wood, M.n {;...r;T.. W.«i!".ry. M.l). Hugh II NiniiK, MI). SlAo/t/iy AXn AXAIOMV. Fowler's Treatise on Surgery IN TWO VOLUMES A Treatise on Surgery. Hy Gk()i<(;k R. I'owlkk. M.D., Professor of Surgery (Emeritus), New York I'olyrlinic . Sur^cim to the Metho- dist Episcopal (Seney) Hospital, Brooklyn ; Surgeon-in- Chief to the Brooklyn Hospital. Two imperial octavo volunus of 725 ]>a!:;es each, containing S88 original text-illustration-^ and 4 colored plates. IV. set : Cloth, ;gl 5.00 net ; 1 lalf Morocco. $17.00 net. JUST READY WITW 888 ORIGINAL ILLUSTRATIONS This entifly r,. w w.irk preNCnts iho sc icnc ;inil art of Miri;tTy as it is prac- tised to-day. i • irst part of the worlt ilc.ils wuh ^cner.il siirj^ery. aril eiiitirares what is usually irn lulled under the head of print iplcs of surgery. Special .ilten- tiiin is Kivpn tn the suhject of intl\iiini.ition from the surueon's point of vie.v. due (- 1 nd part of the work is really the clinical portion, devond to re-ional smtjcry. Ilercin the author cspci ially endeaiois to rmph.isi/e those ,n| iries and siirj^ii al diseases that arc of the greatest import, in , but .ilso because of the dilVn ully of dia^;nosis and the spei iai (are demanded in then treat- ment. The text is elabiuately illusliated with enti-ely new and on>;inal ilhistra- Rudolph MalM, M. D.. rtvfu,ltndid v..|umfi (ully jtntify the re(mH' of ilinir aiitli"r Imi iriii»im-^s. lli..|.ii,!hii.«», aii.l Icarninu " SAUA'DERS- BOOKS ON Howard A. Kelly and C. HURDON on the Vermiform Appendix RECENTLY ISSUED-AN AUTHORITATIVE WORK The Vermiform Appendix and Its Diseases. By Howard A. Kki.i.y, M. I)., Professor of (}ynecology in the Johns Hopkins Univer- sity, Halliniorc ; and K. HuKUON, M. D.. Assistant in Gynecology in the Johns Hopkins University, Baltimore. Haiulsome octavo volume of 827 pages, containing 399 superb original illustrations and 3 litho- graphic plates. Cloth, .^lio.oo net ; Half Morocco, $1 i.oo net. WITH 399 SUPERB ORIGINAL ILLUSTRATIONS This work is one of the most niaRnifirent medical books ever published, con- t...nmK some four hundred beautiful illustr.itions. in the preparat-on of which the artists"of the Johns Hopkins Hospital have spent many years. IlarN beautifully and .ir.uratelv portrays the condition represented, and together they form a magnifi- cent collection unequaled by those in any other work on the subject ever placed upon the market. \ large amount of original work has been done for the ana- tomic chapter, f(,r which over one hundred original illustrati.ms have been le. Afp.mlutlh naturally receives the fullest consideration. The pathology is not only amply ind clearly dcscnbe.l. but it is beautifully illuminated with an abun- dance of Illustrations depi. ting the pathologic conditions with rare fidelity. Diag- nosis and treatment, by far the most important sections to the practitioner and surgeon, are elaborately discussed and pr,.fusely illustrated. Special chapters are devoted to the peculiarities of appcnduiti- in children, and to the characteristics of the vermiform appendix in typhoid fever. A valuable chapter is that on the mediiologal status i>f appendicitis. Briliih Medicsl Journal • h i.i..h.'5 till- liiKh.w.iIrr m.irk ..f n..'.|ir,,l m.mnKr.l|*. hmh in rrR.ir.l l.. in.- ,<-aoiMiB, rrsMrrl,, .,„.» clinu-.il r,a.„„inK of ihc toxi. and in the .,u.,liiy of its illuMrUion.. IIr-so are really maKnificont." \ i SURGEK y AND ASA TOM 1 Kelly and Noble's Gynecology and Abdominal Surgery aynecology and Abdominal Surgery, lulited liy Hhwaki. A. Kia.LY, M. 1)., I'rofcssor of Gynecology in Johns Hopkins UnivcrMty ; and Chaklks P. Noble, M. D., Clinical Proft-ssor of Gynecology in the Woman's Medical College, Philadelphia. Two imperial octavo volumes of ipo pages each, containing 650 original illustrations, some in colors. IN TWO VOLUMES- VOLUME I JUST READY WITH 6S0 ILLUSTRATIONS BY *X BRODEL AND HERMANN BECKER In view of the intimate as-sotiation of , neclojry with alnlominal surgery the eait.)rs have combined these two important subjects in one work, for this reason the work will be doubly vaUialile, fur not only the j;ynecolot;i.st and j^cncral prac- titioner will tind it an exhaustive treatise, but the surgeon also «ill tind litre the latest te hnic of the various al)do-iiinal operations. It poss. . s a nuudicr of valuable features not to be f mnd in any othe; publication < ovenn- the s.iuk- li.lds. It contains a chapter upon the bacterio^.^'y and one upon the |iatholo-y of >;>ne- coloCT. dealin;; fully with the s. ieatific basis of f,'yne((ilot;v. In no other uork can this information. pre|ared by specialists, be found as scpaial.- . hapters. There is a large chapter devoted entuely to m,,/h;i/ .i,MV/rV,'/.!:r. written e>pe, i.dly for the physician en-agcl in general pr.i. tice. lieremfore o,. gencr.d |ua(ti- tioner was compelled to search through an entire work in order to obtain the in- formation desired. . J/',/.w;;;.i/ w^/.v/t proper, a. distin. t from t;\ nei clogy. is fully treated, embracing operations upcm the stoma, h, ujion the iniestmcs. uiion the liver and bile-ducts, upon the pam reas and spleen, upon the kidn.vs, ureter. bladder, and the peritoneum. Special atten* .n has b.-.-n guen to wo./.m l.rhni, and illustrations of the very highest order h.ive been used to make clear the various steps of the operations. Indeed the illustrations are Irulv mag- nificent, being Ihe «..,k of Mr. Max liriiL: and >!■-. ,'/-'-«••.••••-■■■ /•• ' - ' ! the Johns Hopkins Hospital. SAi'XDEKS' UDOKS OX Moynihan's Abdominal Operations b fi Abdominal Operations. By B. G A. Moyniuan. M.S. (Lond.), F.R.C.S., Senior Assi.stant Surgeon, Lewis General Infirmary, England. Octavo, beautifully illustrated. Cloth, Sj-Oonet ; 1 lalf Morocco, .S8.00 net. JUST ISSUED- NEW (2nd) EDITION TWO LARGE EDITIONS IN ONE YEAR It has Vjeen said nf Mr. Moynihan that in describin;,' det.iils of operations he is at his best. I'he appearance of this, his latest work, therefore, will be widely welcomed by the medical profession, ^'iv in<,', as it does, in most clear and exact lan^'uane, not only the actual miu/iis op.iamii of the various abdon '.lal operations, but also the preliminary technic of preparation and sterilization. Complications and scquel.i; and after-treatment are presented in the same clear, ( lean-cut manner as the operations themselves. The beautiful illustrations have been especially drawn. Edward Martin, M. D. I'r.'ftswr of Clinh.it Siit\',-ry. Vnr.frutv of I'fnn an be most safely adopted. Kvery phrase of >;all stone disease is dealt with, and is illustrated by a larRC number of clinical records. The account of the operative treatment of all the forms and < (implications of gall stone disease is full and accurate. A number of the illustrations are in lolor. Britiih Medical Journal ■ He expresses Ins views with admirable ele.irne55, ,ind he supp.irts llieni l.v a l.iri;e num- ber ,.f ilinicd <.«Hn.ples. vvhieh will b- nuleh prue.l by iho.e wlm kllo^^ tl,e difficult problem. and tasks which g.ill-sione surRerv not infreipienlly presents." i:.J' ..H srA'(;/:/n- a\o axatomv Sc\idder*s Treatment of Fractures WITH NOTES ON DISLOCATIONS The Treatment of Fractures: with N-.to^ on a few Comnmn Dislocations. Hy Cmaklks L. Scui.ukk. M. D., Sup^ch to the Massa- chusetts General Hospitil, Boston. Octavo volume of 562 pa-es with 736 original illustrations. I'olished Huckrani. S500 net; Half Morocco, !56.00 net. RECENTLY ISSUED NEW (5th) EDITiON. ENLARGED riVE LARGE EDITIONS IN LESS THAN FIVE YEARS Five lar^e editions of this remarkable work have been < alic.l for in less than nve years. Kor this new fifth e.lition Dr. Srudder ha. n.ado nun.evm.s .uM>t,un. throuehont the text, and has ad.led s..n,e fifty new ilhist.a.ions, KnatK rnhanrmR the value of the work. The articles on D.slo.at.ms, >ll.>str,,te.l in that pra.lu.-,! manner which has made Dr. Scuddcrs work so useful, will l.e foun.l eMrenuly valuable. JoKVh D. B-yMit. M.D.. rro/..u„- of !'„■ r.mctl.s -m,/ /V,„y^,■ of Su,;,ry, Vnu.r.,, and HfU,:u,- llo /■it.ll .U.,il,.l/ ('.'//^V''. •■.\s .> praclK-.il ,U-nu)nstrat...,. ol ll,.- mpic a .s t-xclU-nl, an.l ... an >-xrin.|.l.- uf Iwuknuika.g a Is higlily commemlable." BickhamN Operative Surgjery A Text-Book of Op •.. Surgery. Hy W akki n St.im; Uk kii.vm, M.D. I'liAK. M., Visitino ^^urs,-e, M. D., oi Boston. Large octavo, witli 19c original illustrations, sonic in colors. Cloth, S5.00 net ; Half Morocco, sO.oo n^^^t. JUST ISSUED Dr. (loulds new work is the result nf exhaustive experiincntatiiin, the technic of the operations descriheti beinj; simplilieJ as far as possible by experiments on animals, thus leading; to the development of many new features. The te.vt is pur- posely concise, the te( hnic bein;,' presented very clearly by the numerous practical illustrations, all made from actual operations done either upon the animal or the human bein^'. As the success of i;astro-intestinal surjjery depends upon an accur- ate knowlidf,'e of the elementary stejis, a thorou;.,'h accoimt of repair is included, followed by a full description of all the important stitches, knots, and instruments used in intestinal suri^ery. DaCosta's Modern Surgery Modern Surgery — Gk.nkkai. and ( )i'i;KATivr.. By John C'jiai.mkks UaCd.sia, M. 1). ^'rofcs.sor of the I'rinciplcs of Surgery and of Clinical Surger> in the Jefferson Medic, il College, I'liiladelphia. ()ctavo of 1 283 pages, with 872 illustrations. Cloth, Si. 5') net; Half Morocco, Sf>.?o net. JUST ISSUED— THE NEW 15th) EDITION Kor this new fifth edition the work has been entirely rewritten and reset. One hundred new practic .il lUuntiations have been addcil ; .intl the work has been en- larged by the addition of two hundicd p.ijjes. lo keep the book of a si/e to handle conveniently, a thinner but hi^jh grade paper has been used. DaCost.i's Surjfery in this edition will moie than maintain the reputation already won. The M«dical Record, New York ■ 1 !:-.■ '.\^Mk t!:!''Ui:h"'it U n.tt;»hlf f.ir its rnnris.'nr-;';, P*..lnn(Innc'' of t.mijuaut' and n:id- din)j h.ivt* titen scrupuluuslv .ivoulrd, wliilf ;it Ihc ^www tinir it cont.iins .1 sufficit-nl am.nint oi inforriuiiion to fulfil thf oli|iit aimiil :ii by its aullii>r— naim-.y, \ li-xt liook for tl '; use of the student and the Ijusi pr.ici.uoner." .S7 A't/AA'f ,L\7> AXATOMS Schultze and Stewart's Topographic Anatomy Atlas and Text-Book o' Topojcraphic and Applied Anatomy. \\y l*k()i'. l)u. C). Sciiui.i/i;, of Wiirzburi;. lAlitcil, with additions, hy GKoK(iK 1). SiEWAKT, M.U., I'lofcssor of Anatomy and Clinical Sur- gery, University and Ikllcvue Hospital Medic il Coile<:;e, N. Y, I^r^e quarto of 189 passes, with 25 colored fi^Mr-s on 23 colored litho<.rraphic plates, and Su text-cuts, Oo in colors. C -Ji, ^SS-jo net. RECENTLY ISSUED It was IVofessdr Schultze' s special aim, in preparing' this work, to produce a Text-liook and .\tlas. not for the n.itomist aWme, but more partindarly for the general practitioner. The value of the knowledge of toponraphii anatuniy in bed- side diajjnosis is eniphasi/ed throujdiout the book. 1 he many colored lithoyiaphic plates are exceptionally excellent. Arthur Dean Bevan. M. D., /''.'A<""- >■/ Smxery in Ki,s>: M,,/i.,i! CMx'\ Chic^: ■■ I i.q.iiil Silr,ili/r iin.l Sliw.irl'< Tcipc.sjr.ipliic- ;iinl Appli< il .Xiuiloiiu .is a vMcat advanta},'e of this over other similar works lies in the larK'e number of maKnilic ent lithoKraphic plates which it contains, without ipie^tion the best that have ever l)een produced in this lield. They are accurate .ind be.iutiful r.,, reduc- tions of the \ariou5 anat'-mic part= reprrsrnted, Edward Martin. M.D., /'r./.^vr .■/ Ohiiai/ S,i>x,iv, Imv/ydtv,! r,mivi.n,ij I hi-, i-, .1 pi.c of ho.ikin.lUinK «liKh i^ IniU ..tlnui.ililc. willi |.i il. - in I t.M -o Ufll chose" .itiil so il. ,r tint til.' \».Mk I- m..-! u- fiil lo lliu |,r.Kti^in^ surE:i-"n." '■<'- SArXD/:KS' h'OOA'S (^V Eisendrath's Surgical Diagnosis A rext-B(K)k of Sureicai Diagnosis. Hy Damil N. Kisknorath, Ml). Ailjmict rrofcssiir .)f Surgery and Clinical Sur^'try. Ci)liet^e of riiysicians ;iiul Suri;eoiis, Chicago. Octavo of 600 pages, with 400 < 11- iiniy new aiui orii^inai tcxt-iilu.strations ami sonic colored plates. Cloth, SU.^o net ; Hair Morocco, ^S.oo net. JUST READY WITH 400 ORIGINAL ILLUSTRATIONS ()( first importance in every sur^'ic:il condition is .1 correct Jiaijnosis, for upon this ileppnUs the treatment tl only ex. client Irom an artistic stan.lpoinl. luit also from a pt.u ti. d point of view, for eai h one indicates precisely how to diagnose the v.irious i onditions. Eisendrath's Clinical Anatomy A Text-Book of Clinical Anatomy. Hy 1),\mki. N F.isKNDRATri, A H. M. I) , A'iiinut I'rofessur .if Snrgci^'and Clinu.il SiirRoiy, C.'ll; ..f surla. c ;in.il drawings an.l photographs. MmUoI Record, New York ,\ s,,,., ,1 ,,im.'n.tiu..n lur Ui.- tigurM is lh«i ilirv «rr m..-.llv .jr.>[.iial .ii..l wirr 1.1.1.1. I..r il..- i.iiri in vi.w 1 lif srclions of joiliK .in.l Ininkj «r» Ih.iw .»f f.>mi»Jllin«a i:uij>'r« «nil .ir« unimiw.u ImIiL m .i.r.irmy ' ;,?r^^ SUftGER Y AND AXA TOMY International Text-Book of Surgery SECOND EDITION. THOHOVGHLY HEVISED A.!!* ENLARGED The International Text-Hook of Surgery, In two \nluiius. By American and Hritisli authors, lulitcd l)y J. Coi.i.iNS Wakkhn, M.l)., LL.D., F.R.C.S. (Hon.). I'rofcssor of Surijcry. Harvard Mtilical School ; anil A. I'e.xklk ("ioild, M.S., l'".R.C.S., of LcmkIoii, Kni^land. — Vol. I. Gemral and Opinitivi- S/oxirv. Royal ort.ivo, 973 pai^'os, 461 illustrations, 9 full-pat^c colored plates. — Vol. 11. Sf<,;!,il or Regional Siin^vry. Royal octavo, 1 122 p.ivjes, 499 iliii.strations, and 8 full-pa^e colorcil plates. I'er volunK': Cloth, jSj.OO net; Half Morocco, ;S''>.oo net ADOPTED BY THE V. S. AR.MY In thii new cilitinii I he entire ImidU \\.\> 1»-cn < .-ircfiill\ icMscd. and s|ii' i.iIcIIimi has boon niaiU- In liiinn tin' u..rl< il.nvn tii llic pirstnt ilav . I lu' .utiiU's , l|o\ l.k.t'.S., \^.\^.. wii I hiN , and | WiiiiWi Winih, .\1 I". I'm I> (tila\<), 1 ;f>,? pa^es, ^5 1 li'M ( iits and v» ' ^ili"< . ( lodi. J7.00 net ; llah Mokm 1 o. i,>^ 00 lu-l. rOURTH EDITION. KKCENTUY ISSUtO OVER 42.000 COPIES In lliis pii-srhl i-diti..n cwiA I liaplii li.i-. I.i'cn . xlrnsnclv nLulilu'd. ,ini1 iii.inv (it llii in li.iw I Kin p.iin.dK . ind ■...nic < ntniK . ic'«iillrn '^i'" i-r\tii>U n< « . Ii.ip Icis .ipp''-'i Ui,'i/,i)\ s/„,,,|, .\\i:;i/ ■-II',:, n\ /),/(..// .V/^',;.- ' r. / i .'».'"•(/'•"" ,1/ M. /i'/.i.'./, Imiiiiiiiih. .ind Siiii^.iv ,>l l/i, /'iit,>,,i\ Edmund Owen. r.R.C.S.. .tA^/*-. fl.,,.r> /■ ^-n,, ,.. /■,.,.,/(-...7,v,./-'. ■ » . / ". ■ r. , ,.,, ,iK 1 I, nl.l n..| ni.n.l .1 I.. ii,v ■ 'il' 'I Th« !■ >l M-k i inst.v..| ..I A 1 rM It.^Lkl t,,r t know .1 11.. iMi'l. \..liim. «liii li . i nliiiir ■- r. i.lilil. an.l . ,.inpl..|.- in n.. 1.11111 ul 'In ■-i irn. > ma irl .if siiti'.T\ :is t'li ilorv \^f ■^■•*'. vy".^ '• ''> sAr^'D/■:J!'^''^ hooks on American Illustrated Dictionary New74th'Edition The American Illustrated Medical Dictionary. With tables of Arteries, Miis< les, Nerves, Veins, ett. ; of liai illi, Hai teria, et( . ; Kiioiniuic Tables of Diseases, Operations. Stains, Tests, etc. By W. A. NnvMAN DoKiANL", M.l). I jrgc o< tavo, 840 pages. Hexilile leather, 54.50 net ; with thnn;l) inilev, #5-oo net. Howard A. Kelly. M.D., /'/■,/..,..<- ,/(,>«f<.V,,4-,'. /'A"' H.'piins I nivnsih: l<..lhm,Hf. • III. l>..H.,ri.l-. .h. ii.inarv is aJmir.ilile. II is s,i well ^owv-a up iiiul of siuh con- .1111111 ^\K. No trnirs have Ihtti I. .1111. 1 in iii> us of It. Golebiewski and Bailey's Accident Diseases Atlas and Epitome of Diseases Caused by Accidents, liv 1»R. Ku. (Ini 1 iiiKWhKi, of Merlin. Kdiled, with additions, by I'k.xkii- Uaiikv, M.l). Consulting Neurologist to St. I.nke's Hospital, New Soik (ity. With 71 (olored figures on 40 plates, 14.? text-cuts, and 549 l"t;e^ '^^ text Clolli, j;402 1"^'' ''" StiiDK/tri' J/,tn,/ A/An X/iis. Helferich and Blood((ood on Fractures Atlas and Epitome of Traumatic Fractures and Dislocations liv I'Kiii. Hk. 11. Hi I 1 IKK H, of (ireifswuld, Prussia. I'.dUed, « itli ad- ditions, by l.isKiH C. I'.i M- I>-, Assot iate in Surgery, l.)lins Hopkins L'niversity, Itahiinore. .iifi .olored figures on 64 lithogniphu: jilates, Kjot.xt . uts, and J5.} pages of text, (.'loth, #3 00 net. /'t -S.iioi- d,-. . tlUt!. Siiii-s Sultan and Coley on Abdominal Hernias Atlas and Epitome of Abdominal Hernias. I'.v I'k. Dr. (; Si 1,- i\N, of ('..itlmgen r'.ditrd, with adtlitions, l.\ \V\i. I!. Cni.iA. M. D., (Iini illustialions, \\ in lolois Cloth, J(i;,oo 111 I ; llill MoroiKi. f,i>.oo iiel Zuckjrkandl and DaCosta's Surgery Ed^^on Atlas and lipitome of OiH-Tative Suritery. Il\ Dk <» /i.kkk KVNi.i. ..I Vienna r.dile.l, with a.lditn.ns. bv | Ciiaimkks DaCo>ia, M D. I'lof.-.sor of the I'nnnpl.s ..f S.iigerv air.l Clini- al Siirgerv, jeffer- son Medi.al lolbt;.. I'hil.i 40 . olored plates. .7S text . uts. and 410 Kiu.s of t.'vl Cliiih, . .S,'/,>. SrRCERY A\n ANATOMY 13 Lewis' Anatomy and Physiology for Nurses Just i»ued Anatomy and Physiology for Nurses. V, 317 pages, with 146 illusirationb. t loih, •;i.75 net. A dfm;ind for sued a work as this, IreatiHi^' thf iuhjeits from thf nurw' ^ r'"if ■ /" -■tC'''. '..la lony i-xisted. Dr. Lewis h.is ti.iM-d tin* plan aiul sropi' t»f Itin Wi-rk "ii iti.- ni- thinh - ni ■ pU.yi'il by liim in liMcliinj; llirsi' lir.iiulif., making the It-xt unu^nallv sini|ilo .iml 1 liar. Nunei Journal of the Pacific Co&it '■ ll IS H(U in iiny srtiv nulimtntary , Inn i iiiiprthrnsive in its frcrttnn-nt i.f tin- sul-j" ts ni han'i," McClellan's Art Anatomy Recently Iiiued Anatomy in Its Relation to Art. Uy Ci -^k McCi.f.i.i.av. NLD.. Professor of .Anatomy, Pennsylvania .■\;raphs, and jf>o pa;;(s of text. Dark bhie velUim, #10.00 net ; Half Russia, ■f.iz.cm net. Howard Pyle, '" ''''■' I'hihi././p/iiti Mi.iu.il /,>iiin,il " i hf I'MMk is nil.' Ml itn- lifst an.l l.H' ..msl ll iiyh tivt I ks >>f aiti- .iiiatnmv win- li it li.is \f \y the wiitt-r •* Icrlune t.i lalt upun, and, as a trxl-bo.ik, » ..ukIu to make itt, way iiitu Iht lit-lil l-i wlmh it in intrndeil." Senn on Tumors Second Reviled Edition Patholofcy and Suriclcal Treatment of Tumors. L> Nn lifi \^ ^i n^ M.I)., I'li.l).. LL.I>,. I'nifessiir of Siir.nciy, Kush Medii .il ' flic;;"', < Ima-o. Handsome tntavo, 71.S pi-cs. with 47H en-iaMn-s. int liidnv.; 1 -• lull pa-e colored plates. Cloth, *5.(x) net ; Sheep or ll.ilf Moroxd, *6.<«i net. Journal of the American Medical Auociation ■■111. IIMSI 1 vIl.lll.tiM- -r .IIIV 1 "I I k I" K|i„ll~tl I. II till (li.nlill.ss i.niain as llic |iriii. ip.il iih.Mi.traiili ..n 111. sill j. ■ t (.« Senn Practical Surgery II illiiMiaU'l .Mi'l 1 Bated on Dr. Senn'i 2J Yean' Experience l>ractical Surgery. A Work foi the 1 .tnetal T'r.n iitiim 1 liy Ni 1 \- SlN-s, M. 1)., I'M. I)., LL. I)., I'tofessor if Siir}.;er\ in Kusli Medu .\I I illei;e. ( hii ano. (Vtavo of 1113 pajjes. with '150 illiisiiatinns. many m lolnis. Cloth. *6, 00 ; Sheep or Half Moroi ro, 57.00 net. SM hy Siih'i, fif>li,>n. ■ It fi i)f value not onlv .is pn-vnlinj:' "niprfln'nsivrlv I'n- 1110 1 • ;> .in. ,d !• c 1 ini;- ■■( iii.Mlirn sunjiTV in the siibjrcts wliiili il t.ikfs itp. hiit ;ils.i a n re. m •( tin- in itnml ..pm ions .ind pratiicf "( .in an ninplisli.'il ami t-\p.ri. nifil siii^ion .1 • i/i / .s»<.4-».i- Macdonald's Dia|(nosis and Treatment A Clinical Text-Book of .Surgical UlngnosU and Treatment. I'v I W MA( |H.\ VI 11, Mil. I dm , I.K.( .S. ^ l-din ). I'l.iffssii, I menliis t,t ilu- I'lai tire of Siiri:>ty ami nf ' liniial Siir',^ery in llamlinc I niveisiis Minne.ipolis. (Ktavo, 7((« paues, illtis. (loth, 55 ihi net ; Sheep or Hall M.t , *■<< 0,1 n.l sjygaK^ M s.tr.\7i/:A's' /.vu)A'.s- ox Haynes' Anatomy A Manual of Anatomy, liy Ikv-fnc; S. Havnes, M.D., Professor of Prac- tical Anatomy, Cornell University Medical College. Octavo, 6So pages, with 42 diagrams and 134 full page lialf tones. Cloth, Jti.so net. " This txMik is the work uf a pt;n tiral instructor — one who knows bv expt'riftue tlif require- ments of tlie averaKi- studeli- .iv! is ai)le to meet these requirements in a very satisfactory way.'- 7A<- Medical Ketoul, .^Va■ Votk. American Pocket Dictionary rourth S^vUeMtion The American Pocket Medical Dictionary. I.>iit. il by \V. A. Newman DoKl..\Ni), ,\.M., .M.D., Assist, lilt Obslrlriciaii, Hospital of the University of Pennsylvania, etc. 566 pages. Kiill leather, limp, with gold edges, $1.00 net ; with patent tlmnil) index, J1.25 net. " I am struck .it once with admiration at the compact size ami attractive exterior. I can reiom- meml it to our students witlioiit reserve."- Jamks W H*ti iank. M.I)., t^ofeliot of Medtfal C/iemnliy "rit J\rl irolm'v. Ml l/ir J.;^; ■ wn .1/. .IJ..1/ tcK.ic, /■lii:.iji/^''ii,i. Beck's Fractures Fractures, liy Cakl Ukck, Ml)., Professor of Surgery, New York Post- giadnate Medic.il .School and Hospital. With an Appentlix on the Practical Use of the Rijntgeii Rays. 3^5 pages, 170 ilhislralioiis. Clotli, $3.50 net. ■' The use of the ravs with itstechtiic is iully cxpl.iiiied, and I he practical [hiints are brought out with a thoToURhiiess that ineiits hi«li praise. " T/if Mntuai AVcc*./, AVw Yofk. Barton and Wells' Medical Thesaurus Recently inued A Thesaurus of Medical Words and Phrases, lis Wii n;<'tii» n 1 nivcrsltv. \\'asliin.L;tim, I >. C. ; and W M i IK .\. Will.s. M.l>.. I iciiiiinstratir of Uir\ n.u;M|ii.4y, Cicid-elnwn Cnisersity. W.tshln-ton. 11 C. 1 :iiiii uf 534 pa^e;,. Ilexihle le.ither. >2 50 net ; with thiniili iiulcx, * vi""" net. ra*i: _ , t c> ^< • «i« t. • Recently liiued Stoneys Surgical Tecnnic New (2d) Edition BacterioloKy and Surgical I'echnic (or Nurses. Hv I mm \ M. A. Stum v, Siipcnnloiidem at the t ainrv llusj.ii.d. Smith lioston. Mass. Revised hy Vhi 111 Kic K. (.1(1111111. M. 1>.. Surgeon, of .New Voik. unio, 20(\ pa^cs. iUustiatcd. »l-50 "»^' " These subji-i ts ate lieali,i most ,t. t lirati U ■ which 1- %.■ "lien cinpl.o.d Nuisc 7't,Uft'-.l \lti S' and //■"/ If^lf A*. ;*..' id in. lo d.itr. uith-iul lb. slipeltlu,ms leadinR will liiid Ihis lK,ok ol ihe ,;leutest value." Grant on Face, Mouth, and Jaws A Text- Book ti( the Surgical Principles and Surgical Diseases of the Face, Mouth, and Jaws. I ..i Denial .Stiidi iits. jiv II, Huu.v. 1 (.kant, A.M., M.r>.. Professor oi Surgery and of Cliiinal Stirger\, Hospital College of Medicine. Ocl.ivo of 2,v p.igi-, with (.,S illustrations, Clotli, |i so net. " The latlKuace of the l»iok is oimplc and . Icai whom II IS intended 1'hil.iJttfkia Mrdnjl Jtmintl. We recommend the woik to thow; (or Khm.' SUKGF.R V AND ANATOMY >5 Preiswerk and Warren's Dentistry just i»ued Atlas and Bpitome of Dentistry. I!y I'kium;. I'ki iswi hk. ,,f i;,isil. I <| itcd. with additions, by (;i;(>i«.K W. \V auri n.D.D.S.. I'n.fi-sor nf Opoialuf Dentistry, Pennsylvania Collej^e iif 1 )cntal Siirj^cry, I'liil.iili i|)lii:i. With 44 hthosraphii: phites, 152 text < iits, aiul 343 pa-, > of text. Lh.lh, #3 50 net. /« Siiutitiirs' Alias \ii,s. " Nowheri" in ilental lilprallirc linvf \n- ivi r scrn illustralior. wliic l\ r m l"gin I.. ( nmiMrf Willi thecMiuisite colored plati's proiluteil in Ihii volume." — Pcntul h'ezitw Beck's Surgical Asepsis A Manual of 5urKical AsepRis. !'■> l \ki Diik. M, |i. ' 1 p-'^:''^ > ''^ text-ilhistratiuns and 12 full-page plares. (, loiji, >i .-j Tin "The tuM.k is well wiiui-n. The data are tli.uK ;uhI rnticisfly Rivi-ri. The facts ai,- well arraiiKid. Il is well worth readinK to Ihe s.ud. 1,1. ihe phvsieian in general practiee, and the surge* »n."—/>'c'j/fjif Aff-ttica/ ami Suiv:it:al JumnaL Griffith's Hand-Book of Surgery Recently Iiiued A Manual of Surgery. Hy I- itian un K. ('.mil rrii, M. I> , Siirj,'eon to the Hcllcviie Dispensary, New ^■()rk City. i,;ino of 57^ pa:.;es. with 4i7ilhis- trations. Ilcxililc leather. »;;.oo net. '* Well a'lapled to the needs ..t itii' stii'l'-ni .iii.i in the tie^y [ins miuiicf for a hasty review of iniiH-rtanl points ill surjfery." — Aniii ;. UH ,1/r.//, iHi . Senn's Syllabus of Surgery A Syllabus of Lectures on the Practice 01 Surger-' Arranged in con- formity with "American Text-llook of Surgery." I'.y Ni(;mol.\s Sicnn, M.D., Ph.D., 1.I..D., Professor of -Siirijery, Rush Medii.il Collc>;e. Chicat;o. Cloth, $1.50 net. "The author Ii.is e\ ,(i, nil y v| 1.(1 td no pains in in.ikint; his S\tl.iliii-. Ihoion^hlv i ompiehenstve, and has ailileii new inatloi and .ilhided to the most recent anlhui^ .lod oiu-iatmns. l-iiU leter- ences an- also >iiveii to all lequistii itetailsof surgical anatomy and pathology." — Hulish Mrdv cat Journal. Keen's Addresses and Other Papers Recently Ittued Addressc-- and Other Papers. Drliwrnl '.\ Uiiiiwi \\ , Kmn, M. D , IIP. ■<. t. S. (llonV I'lnfessni it Ihe I'nni iplis of Ntn ir\ ,iiiil id'i Im ical Surgery. Uilersun Medii.il t i'lle:,;c, I'hilaiklphi.i. iht.i-' M.lnnie of 441 |iaj;es, illtistiated. Chilh, Keen on the Surgery of TypKoid The Surgical Complications and Set^uels of I'yphoid lever. Ily \\ m. \V. Kkkn. M.D., IT.D,, K.R.C.S. (Hon.), Professor o<'lhe Principles. d■^lll^;cly and of Clinical Smoery, Jefferson Meilical Collej.:e, I'hiladelphia, etc. Octavo vohime of 386 pa^es, illiislralctl. Cloth, S3 net. " Kvei V siiii:i< .d ln< dent \^ htch can m 1 nr dnimg 01 hilly illnsliiied hy inses . , . Tile IkkiW will In 1 The I'laclitumt't , Lom4en. Ill r l\phoitl lever is .iinptv disc nssed alld eliit iKrth to Ihe suige»iu/s 0/ .VioiT^'O'- Fowler's Operating Room Juit Iiiued The Operating Room and the Patient. Ky Ki ssi t.i. S. Iowiik, M. 1). Surgeon to the (".erman Hospital. Brooklyn, New York. Octavo of 172 pages, illustrated. •- >"th, *2.oo net. Dr. Fowler li.is wrilti-n his 1)1... k f.ir siirs;i-..iis. muse- .is^i-lin!; .it ,111 ..peralinn. interne>. ,111.1 ill ..ih. r- wli..-.e iliilies tjrini; them inl.i tl.i cpenitlTit i....iii It eontams explicit ilir.-. lion- f..r tlie pi. p.iration cif in.iten.il. in~tniin.nl- n.i.leil, p..~iticm iif patieni.it. all heautiftilly iliu.^tr.ite.l. Recently lijued Nancrede's Principles of Surgery Ne* (2d) Edition Lectures on the Principles of Surgery. I!y Cii as. H. Nanckf.dr, M.U., I.1..I)., I'rofcssor of Surgery and of Clinical Surgery, University of Michigan, Ann Arbor, fktr.vo, 407 pages, illustrated. Cloth, S2.50 net. •■VVecan stn.iiKK rec.miiKiid this hii,,k to all Murlciiti; anil lh.se wh. m.uIiI see si.m.lhinB of the scienlilic foundati1.11 .i|K)n which the art of smuerv is lunll."— (.'kui ' ly M.-ilniilJ^nn tuil, ShiffiFld. l-.Mglaiid. Nancrede's Essentials of Anatomy. ^""th'Edition Essentials of Anatomy, including the .Anatomy of the X'iscera. ByCiiAS. H, NaNihkhi;. M.U., Professor of Surgery and of Clinical Surgery, University of Michigan, Ann Arbor. Crown octavo, 3K8 pages; 180 cuts. With an Appendix containing over 60 illustrations of the osteology of the body. Based on 0>«n'. Cloth, Ji.iMnet. /ii S,ii()i,/,rs (Jii,sf/,>n Ci'mpi-n./s. :\ concisely (;i\cn."-- " The nuestions ha\e lieeil « i.elv selected, anil the answers accuratel t'niTrt sily Mi-diial Ma^itiztttc. Martin's Essentials of Surgery. Seventh Fldition Revised Essentials of Surgery. Containing also \ ciieieal Diseases, Surgical Land- marks, Minor and 1 i()crati\e Surgery, and a complete description, with illus- trations, of the ll.iudkcrchief and Koller liandages. Uy Kdwaki) M vktin, A.M.. M.D., I'rnfessor of Clinical Surgery, University of Tcnnsylvania, etc. Crown octavo. 338 pages, illustrated. With an Appendix im Antiscjiiic Sur- gery, etc. Cloth, 51.00 net. /« S,iii;u/,rs' (Jiieslhn (i>inf« .1, I'hilaitflpkm, of will, h it Heals >rt pl,lceil helorethe pT..lessio» ' MM ^